HISTORY
MEDICINE,
ORIGIN TO THE  NINETEENTH  CENTURY,
WITH AN APPENDIX, CONTAINING A PHILOSOPHICAL AND HISTORICAL REVIEW OF

                MEDICINE TO THE PRESENT TIME,
BY P. V. RENOUARD, M. D.
The Sciences are gradually developed. It is only by reviewing past centuries that we can
                 determine their laws of growth.
 TRANSLATED  FROM THE FRENCH  BY

     COKNELIUS G. COMEGYS, M. D.,
PROFEBSOR OP THE INSTITUTES OF MEDICINE, MIAMI MEDICAL COLLEGE.

             ,„on Pent'- n
■^   ■"  $

              CINCINNATI:

MOOEE,  WILSTACH,  KEYS  & CO
   NEW YORK: MILLER.  ORTON & MULLIGAN.
    BOSTON: WIIITTEMORE, NILES & HALL.
      P III L A . : .1 .  B .  LIPPINCOTT t CO.
                  1 8 r, <j. 
tftt-Htsi.


         \6C6>
           Entered according to Act of Congress, in the year 1HD5, by
                MOORE, M'lLSTACH, KEYS & CO.
In the Clerk's office of the District Court of the United States for the Southern District of Chic
  CINCINNATI:
WM. OVEREND & CO.,
   PRINTERS. 
                   £' 0 t b e  |tl t m 0 r g





                           0 F





                     MY  FATHER,




          CORNELIUS P.  COMEGY8,



             LATE GOVERNOR OF DELAWARE,





                          AND




                     MY PRECEPTOR,



          WILLIAM E.  HOEFEE, M. D.,



l.ATI. PROF. OF ANATOMY IN THE UNIVERSITY OF PENNSYLVANIA,





                    THE  LABORS OP





               THB TRANSLATOR



                     ARE  AFFECTIONATELY  AND




                              GRATEFULLY INSCRIBED. 
 
TRANSLATOR'S  PREFACE.
  In producing .the work of Dr. Eenouard in the English  language, I
have been actuated by the conviction that a treatise of its nature is greatly
needed.  Indeed, if I except brief sketches affixed to some of our spe-
cial treatises, we  possess nothing in our literature that is at all cal-
culated to satisfy the wants of the profession in this respect.  The only
work on this subject, of any magnitude, by an English author,  is that
of Dr. Freind, which is a  continuation of Le Clerc, and comes  down
only to the beginning  of  the sixteenth century; besides, it is out of
print.
  Why no history of Medicine commensurate with the dignity and extent
of our profession has yet been written  in our  tongue, I am entirely
unable to explain.  Other languages are prolific  enough in this respect,
particularly the German and the French.  To  obtain any scholarly
attainments on this subject, it has been necessary to  read books in for-
eign languages.   Knowing, therefore, the wants  of the profession, and
having been greatly encouraged by medical gentlemen" in  different por-
tions of the Union,  to  whom I  have communicated  my design, I have
ventured to offer this  translation to fill this vacuum  in  our  medical
literature.  I  have hesitated to  enter  into this very difficult  field of
authorship, from a real distrust of my  abilities for the task; and now
that it is done, many errors are plainly visible.   Some  are  minor ones,
and are such as will creep into publications in  spite of the utmost care.
There are others, more serious, which I would  gladly correct, and hope
to have an opportunity of doing  so at another time.   Few of them, how-
ever,  impair  in any great degree the  original,  and do not, therefore,
materially pervert the author's meaning.   My professional brethren will 
viii                  translator's preface.
be kind in their criticism, when they remember that  the active duties
of our profession are most unpropitious to literary pursuits.
  The work of Dr. Eenouard should  be studied in  several aspects;
first, as a historical narrative, in which the relation of Medicine to civ-
ilization is shown, and its progress compared with that of the sciences and
arts;  secondly,  in  the history of its cultivators, with the theories  and
systems which they have proposed;  thirdly,  the  relation of medical to
philosophical theories; lastly, the great argument of the author: Empi-
ricism or the Empirical method is alone applicable to the cultivation of
Medicine, and therapeutics, not  physio-pathology, the  foundation upon
which the science rests.   *
  In these respects the  author has acquitted himself as fully as  the
limits of an  elementary treatise will allow, and particularly in his  dis-
cussion of philosophic methods and on the general subject of metaphysics
he has presented one of the clearest, most comprehensive, yet condensed
expositions that any single work affords, and it will thoroughly prepare
the reader to appreciate properly his main argument.
  Many eminent minds in our profession are steadily at work endeav-
oring to  build up Medicine, like other branches of natural science, by the
careful study of facts.  We have millions of well attested observations,  and
if our reason is invoked, in the language of Kant, only to guide experience
in the careful study and co-ordination of  these facts, we shall be able
by  induction  to reach  those great general  principles  or axioms that
shall give our science a lofty rank among kindred sciences for complete-
ness and certainty.  I humbly think that the work of Dr. Eenouard will
greatly aid in this conquest, by turning the mass of medical mind from
the vain efforts of  speculation to the tried and  fruitful path  of observa-
tion.   But this is a laborious route,  and  its difficulties  were early
expressed by Hippocrates, in his well known  Aphorism: life is short.
art  is long, experience deceptive, judgment difficult.
  The uncertainty of Medicine, and the different opinions of those who
cultivate it,  are  often referred to as  an  evidence  of its  low rank as a
science ;  yet I believe that, excepting mathematics and pursuits resting
strictly upon it, no pursuit of man surpasses or equals Medicine  in the
certainty of its  opinions, and in its positive and increasing  blessings to
society.  We do not assume that Medicine,  as a science or an  art, is 
translator's  preface.
ix
 now perfect;  on the  contrary, none feel its  defects more keenly than
 medical men;  yet we know that a steady and brilliant improvement is in
 progress.
   When we examine other professions, it is very plainly seen that there
 is as much uncertainty and want of uniformity in opinions as in ours.
   In theology, learned bodies are divided, not in regard to speculations
 about mysteries more than in the meaning of  words and the  interpreta-
 tion of phrases,  access being  had by all parties  to the same sources of
 knowledge,  to enable them to  settle these  questions.  These varieties
 are  seen  in  confessions  of  faith,  administration of  ordinances,  and
 church government.
   The law is said to be the perfection of human reason ;  but if Medi-
 cine is proverbially uncertain, what may not be said of law ? Its doc-
 trines are written, its decisions  are  voluminous,  and moreover,   the
 whole science  may  be narrowed down to  a question of right and wrong,
 in which the whole moral faculties  of  man instinctively lead the judge
 to decide aright.  In nothing have  men  more  intuitive knowledge than
 in law.  It may be said that legal  decisions are uncertain, because  evi-
 dence is defective.  This is granted, but its uncertainty is seen  as  fre-
 quently in interpretations of organic as of common law.  The opinions of
 lawyers are given with great  deliberation, with  ample opportunity for
 research, while doctors are expected to be ready at a moment's warning
 to decide the most momentous questions; and I have  no hesitation in
 saying that the opinions of medical men, thus given on the spur of  the
 moment, are characterized by  as much  certainty as those of lawyers.
  Let us compare Medicine with political economy.  Are our statesmen
 unanimous in  their views on  the  subjects  of  domestic manufacturing,
 tariffs, banks of issue,  internal improvements, educational systems,
 modes of taxation, currency, the general rights of citizens, and on other
 highly important topics ?
  The movements of the mercantile and manufacturing world rest upon
 calculations or estimates, but of all pursuits none are so uncertain.   A
 very small number  of men who embark in commerce and  manufactur-
ing succeed.   These noble  occupations, which are most important ele-
ments in the progress of civilization, offer but little  hope of permanent
 success. 
X
translator's preface.
   Uncertainty marks  also the estimates of engineers and  architects,
 although it would seem that ample data are in their  possession to give
 great precision to their statements.
   Navigation, so far as it relates  to mathematics, is  remarkably accu-
 rate.   The ship is guided from port to port, and throughout  her voyage
 her exact position on the surface of the ocean can be defined.   These
 calculations are founded on the movements of  the heavenly bodies ;  but
 the opinions of the captain in regard  to  the weather, and  the  duration
 of his voyage, are all uncertain.  When he  encounters the commotions
 of nature, the fierce  tempest, and  the surging ocean, he has  no more
certainty of saving his ship and crew, than the physician who struggles
 with the conflicts of nature in the  human organism.
   My brief space will  not allow me to say more on this topic, but these
 examples will contribute somewhat, I trust, to wipe off the stigma of
the greater uncertainty in Medicine than in  other pursuits.
   Our science is also reproached with being  stationary.  Thus it is said
that while society has been flooded with  light on other topics, and civili-
 zation has improved steadily, Medicine has contributed an inferior share
 to this progress.  Nothing can be more unfounded than these statements.
If we examine the great eras in civilization, Medicine will be found to
 have progressed as rapidly as the physical sciences generally.  The dis-
 coveries  of Columbus,  and successive navigators, were not  earlier  nor
 more important in geography, than those of Mondini, Beranger, Vesa-
 lius, and Sylvius, in anatomy.   Copernicus did not  earlier conceive  the
 errors  of the Ptolemaic astronomy, than  Servetus, E. Columbus, and
 Cesalpine the errors of Galenic physiology;  and Galileo, who demon-
 strated the movements of the earth and planets around the  sun, was a
 cotemporary with Harvey, who demonstrated the circulation of the blood.
 The universal law of Xewton for the solar  system, was not greatly in
advance of that of Haller of the laws and special forces of life.  If the
 great philosopher established that the force manifested in the fall of  an
apple to earth,  is the same as that which keeps the planets in their orbits,
 so the pathologist has shown that the laws of inflammation in the deep-
 seated and vital organs are  identical with those  that are seen  in  the
smallest  inflammatory  point  on the skin.  And how much might  be
added on the application of physical laws in diagnosis, the  prevention 
translator's  preface.
XI
of small pox, the easy cure of autumnal fever, etc., to show that in point
of progress Medicine marches hand in hand with kindred sciences.
  Literature and  the fine  arts offer no comparison in this respect to
Medicine.   Our oratory does not  surpass that of Greece and  Eome.
Where have we profounder reflective philosophers than Pythagoras and
Plato of the ancients, and Locke  and Descartes  of moderns ?  What
astronomers are adding anything to the laws developed by Newton, Kep-
ler, and La Place ?   In sculpture we only equal  ancient Greece.  Our
paintings are not esteemed like those of the old masters.  Our jurists
do not surpass the Erskines and Blackstones.   " Except the writings of
Lord Mansfield on commercial law," says a late writer, " nothing impor-
tant  has  been added for many  years, and  no great errors have been
expunged."  In statesmanship, the present generation will scarcely rival
the past.   Who shall fill  the senatorial chairs of Clay, Calhoun, Wright,
and Webster ?  The present commentators on the Bible are not superior
to those who have passed  away ; our writers on moral science  are largely
copyists of  old authors; our poets  and prose writers do not surpass our
classics.  There is no progress in mathematics;  the most eminent intel-
lects are  only able to  master  the inventions  of Euclid,  Newton, and
Leibnitz.
   In what, then, is the progress of  this stirring age ?  It is  not in the-
ology, law, belles-letters, the fine arts, architecture, politics,  mathemat-
ics, or metaphysics.   It is in mechanics and  the chemical and  physical
sciences, in which our science forms an integral part.  Man is  strug-
gling to regain what was  his primeval inheritance " before  the fall
brought ruin on our race,"  when God  said, showing  him animate and
inanimate nature, "have dominion."  We see this in his control of  the
electrical element, which enables  him to  imitate the  ubiquity  of God;
in employing the winds to waft his graceful ships; in the ocean steamer,
which drives its prow in  the  teeth of the  powerful north-wester, and
beats down the waves that vainly dispute its passage; in the  tunneled
mountain, whose icy peaks are  reared in  vain to barricade the  route of
his locomotive; in employing the sun's  rays to stamp his features on
the metalic plate, that the perfect image of his loved ones may remain
long after their frames have mouldered into dust. 
xii
translator's  preface.
    Medicine relates to nature, its preservation and defence, and nothing
 that man possesses surpasses it in ameliorating the condition of the race.
 Our progress is not only in the structural knowledge of the system,  and
 its life laws, but our resources for the treatment of diseases are enlarged.
 The horror of  surgical operations is abated by the fact that the severest
 work of the knife may now be endured while the  mind  is as blissful
 as if wandering in Elysian fields.
   But  I must  not deal in words only.  We have  undisputed figures to
 prove that our science is a vast blessing to the race.   I will not allude
 to individual cases, to which every one can bear  some testimony of its
 success, but take the broad results of vital statistics.
   The  epidemics that formerly terrified the nations, leaving in their
 trail desolations worse than the tornado, have been shorn of their terrors.
 The prevalence of small pox has been almost prevented by Jenner's discov-
 ery  of vaccination.   The treatment of cholera is now so well understood
 that it has lost its former desolating power.   Human life has been greatly
 lengthened  in  the last hundred  years.  The reports of the Parisian
 hospitals  show that while in 1805 one died in seven who were admitted,
 now only  one dies in  twelve, thus showing that our science has increased
 in its ability to save life in the same order of  diseases, and in the same
 buildings, seventy-one per cent in a period  of fifty  years.  In  other
 words, in  the Paris hospitals, where, formerly, fourteen men died in each
 hundred  admitted, now only  eight die, a saving of  six  persons in a
 hundred;  and  in the eighty thousand who annually pass through  those
 wards, a saving of five hundred human beings.  And this is  not  all;
 the period of their stay is very much lessened.   The average time of
 residence  was formerly thirty-nine  days, now  it is twenty-four days, a
 a difference  of  fifteen days since 1805.  In the treatment of special dis-
 eases,  the most remarkable  evidences  of  improvement  are  shown.
 Thus, in syphilis, in 1805, one died in fifty-six cases;  now (1850) only
 one died in two hundred and ninety-four.
   In England,  according  to Macaulay, "the  term  of human life has
 been greatly lengthened in the whole  kingdom.  In  1685,  not  a  sickly
year, one in twenty of the inhabitants of London  died, while  at  pres-
 ent  only  one  in  forty dies.   The  difference  between London in  the 
translator's  preface.
xiii
seventeenth and London in the nineteenth century is as great as between
London in ordinary years and London in the cholera."
  In surgical practice, the  saving  of life  at present exceeds by more
than thirty-five per cent, the results at  the beginning  of this century.
The returns of the Eegistrar General of England show a steady and nota-
ble  decrease in the rate of mortality from  1838 (the beginning of the
returns) to 1845 ; in 184G it rose again, ascribable to the prevalence of
epidemic intestinal diseases.   In France, according to Dapin, the dura-
tion of  life has been increasing, equal to  fifty-two days  for each year
from 1776 to 1842, or nine and a half years for the whole period.  The
increase per annum was at no  time  less than nineteen days, although
that revolutionary and warlike nation  shed seas of blood, not only in
her cities, but upon every battle field  in Europe.   In midwifery prac-
tice, one hundred  and fifty years ago,  according to  Dr. Merriman, one
in forty died.  At the close of his tables, (1828,) only one in  one  hun-
dred and seven died, and at this time perhaps  not  one in two hundred
and fifty dies.   The hospital  practice  in our own country exhibits the
same gratifying success in treatment.   1 find by comparing the statistics
of the Philadelphia and  New York  hospitals, that they show the same
results, almost to a fraction, with those of Paris.  In short, whether we
examine the reports of the Eegistrar General of England, the data of the
Carlisle and Northampton life tables, the statistics  of the  Bureau  Cen-
trale of Paris,  or  the  publications of the great hospitals of our  own
country, the same results are presented.   Life has been prolonged more
than twenty-five per cent, in the past seventy-five years, and  the dura-
tion of  treatment  lessened more than  one-third.  Now, it may be said
that the cessation of wars, and the amelioration of the general condi-
tion of the masses, explain this gain in  human life, and deprive Medicine
of her claim to such titles  of glory.  But we present  these irrefutable
hospital reports;  their  wards are  the peculiar battle-ground  of  the
doctors, and showing these results, we demand that they shall be expo-
nents  of what has  been done for society at large—that  this  increased
longevity is due to our science.
  Who supposes its power  to  benefit  mankind  can  not be  immensely
augmented?  Who is content that it should be stationary ?   Certainly
not medical men.  Its higher success is the dream  of  their lives; they 
 xiv                  translator's preface.
 gaze into a hopeful future, and are filled with glowing and bright pic-
 tures of the era when this science shall be

               " Above the reach of sacrilegious hands,
               Whose honors with increase of ages grow,
               As streams roll down, enlarging as they flow."

   Another important fact is well established by the perusal of this his-
 tory, viz :  that Medicine has never flourished and been cultivated in the
 highest degree in  any country where  it  has had no legal recognition.
 The want of such recognition and legislation is painfully felt in most of
 the States of our Union.  The medical profession is wholly unprotected
 except by its own  organization, by its own  regulations; it attempts to
 encourage a sound state of education and  ethics, yet  we are  assailed
 continually for what are  termed   our   prejudices against irregular
 practitioners.
   The whole series of phenomena in the human system is in accordance
 with the  laws of vitality, precisely as the endless  phenomena of the
 universe are developed in obedience to certain  laws. V When, therefore,
 the human mechanism becomes deranged, and a great contest is set up
 between the forces of disease and the vital forces, who shall attempt to
 interfere—the man who has made these  laws  a  study, who knows the
 operations of their final causes, who comprehends as  far as science has
 shed light upon the subject, their special and general operations, or the
 man who is  ignorant of the entire mechanism,   and laying aside all
 such labor and investigation, attempts to rescue the suffering system by
 remedies which, according to his gross views, have been  successful  in  a
 similar case ?   Legislation  offers no  obstacle to the latter.   It is true
 that it has legalized the medical college  and  its diploma,  but the
 learned and laborious graduate has no legal level above the quack; the
 latter  has just as full authority to practice.   If  any one, deceived by
the puffing of the self-styled doctors, falls a victim to  their ignorance,
 the law kindly allows a prosecution  for mal-practice !  An irreparable
injury, or even death itself  may be the result of  this ignorant  interfe-
rence, and  what atonement then does the prosecution of an irrespon-
sible man afford ?
  In regard to Medicine, every one must look out  for himself.   With 
translator's  preface.
XV
the same indifference, we ought not to have a  standard of weights and
measures, nor a fixed value  of coin, nor protection against issues  of
paper  money.  Let every one  take  care  of himself.   Why not have
a board of examiners of candidates for medical practice, as we have for
law and teaching ?   No man can assume to be a respectable minister of the
gospel without the  license of a church organization; no man can prac-
tice law without an approved examination  before a court; no man can
teach without a certificate of qualifications; no man can sell goods  or
peddle goods, or drive  a dray, or a cab, or an  express wagon, without
registering and a license.   The  public is defended from the impositions
of the hackney coachman, but not from the quack doctor and patent
medicine vender.   No man is believed te be a carpenter, or a machinist,
or a master in any  other profession, unless he has served an apprentice-
ship to it.   Then why, I ask, in the name of humanity  and civilization,
when we come to consider the human  frame, the most wonderful struc-
ture of God, the divine idea of mechanism, in whose structure a thous-
and  wonderful and complicated actions  are  in play,  many of whose
laws, after  more than  two thousand years of investigation, are still
unknown,  why, I  say, do  our governments surrender this beautiful
structure to be prostituted to the mercenary practices of charlatans ?
  When we think what interest Deity has taken in diseased humanity,
inspiring  Moses to write those extraordinary precepts found in  Deu-
teronomy, how he conferred on priest  and prophet healing powers ; that
Jesus performed the functions of a physician as well as  that of a divine
teacher, and endowed  his apostles with power to  heal the  sick, thus
sanctioning  the profession  of Medicine, as well as giving proofs of a
divine nature;  that the ancient civilization of  Greece  and Eome legal-
ized  Medicine,  and all  modern Europe  lavishes upon it favors and
protects it from impostors; why, I repeat, in this great Eepublic, is this
learned and valuable profession unsustained, and society unprotected?
  The profession must appeal to legislation, not to ask for  laws that
shall compel a man  to profess  the doctrines of a  certain school, but
that no one shall be allowed to treat diseases, whether he  calls  him-
self allopath, homeopath, isopath, physiopath,  eclectic, botanic, or  by
any  other  name, until he  has shown before  a proper tribunal that
he has made the organism of man and  his diseases, a special study. 
xvi                   translator's preface.
This is simple and fair, and society owes this, not only to itself as self-
protection,  but also as a tribute of respect to the  medical profession.
" For," in the language of Dr. Willis, "who, since the revival of learning,
have done more for every undertaking whose object has been to extend the
boundaries of knowledge and to exalt  mankind ?   Who knows half so
much of the wants and the wishes,  of  the joys  and sorrows  of the com-
munity ?   Who are the friends and comforters in  adversity especially,
of persons  in every grade  of  life, from  the  sovereign  to the wretched
outcasts  of the  streets, houseless,  homeless, friendless, alone?  Who
disarms pestilence of its powers, and gives Jenners to the world ?  Who
follow in the battle field, through the thickest of the fire, not that they
may aid destruction in her work, but that they may staunch the wounds
she makes ?  The servant  of religion hath  not more  of true sanctity
about him than the good physician.   The service, indeed, that was ren-
dered of old in special temples to the  Divinity, conceived in one of his
most beautiful  attributes, is not yet  extinct upon earth,  but has its
ministering \priest, ennobled by Christianity, in  every  worthy member
of the profession.  Oh, let society cherish and  exalt its medical com-
munity ;  let it become aware that if science  can not aid it  in its strug-
gles with disease, neither can ignorance ;  that nothing can by possibility
be known to the  quacksalver and ignorant empiric  that is not famil-
iar to the  educated physician ; that  a  youth of devotion  to his Art,
is all too little to familiarize him with all the varieties  of  disease, and
the means of meeting them  successfully ; and that there is  no access to
the temple  of Medicine save  through the intimate knowledge  of the
laws by which we live, and move, and have our being."
  Cincinnati, No.  258 Race Street, November  1, 1855. 
INTRODUCTION.
  " In order to study and practice Medicine in  a proper manner, it is
necessary to be impressed with its importance ;  and to be so impressed,
we  must  believe in it." °   These words of a philosophic physician,
whose life and writings breathe a sincere philanthropy, contain a deep
sense, which constitutes, according to my opinion, the moral base of all
Medical Practice.   It  is  evident, indeed, that the practitioner who has
no faith in the efficacy of his art, can not devote himself to the study
and practice of it, with the necessary zeal, and  perseverance.  But, it
will not suffice for the physician only to be convinced of the utility of
the remedies he prescribes ; it is also very advantageous to the success
of the treatment, if the  patient share his confidence in them.   It is,
then, important to all of  us, to form  early a reasonable  opinion on the
degree of efficacy and certainty that may be attained in medicine.  Now,
we shall not be able to draw the motives of such an opinion from any
better source than the history of this science.
   Another question which, though less important, does not lack interest,
is, What is the  origin of the Healing  Art?  Has it sprung from the
natural wants of man, or rather, as some ancient and modern  philoso-
phers have pretended,  is it only  an evidence of the degeneration of the
human species ?  It belongs to  history alone to resolve this question in
a decisive manner; for, if it  appears from the most undoubted tradi-
tions, that there does not exist, and never has existed a  people,  whether
savage or civilized, who have  not had some species or other of Medicine,
we are compelled to conclude  from this, that  this art is destined to sat-
isfy an irresistible, imperious and natural want;  and  not a factitious
one proceeding from effeminate habits, or some other vice of civilization.
   Medicine, whose history I have endeavored to trace, was  called, in its
origin, the  Art  of Healing.   It consisted at that time, in a succinct
D Cabanis.  " Du Degre de Certitude de la Medecine," Preface, page 1.
       1 
X
INTRODUCTION.
description of diseases, which had been observed, and the indication of the
remedies employed to combat them.   These two parts correspond to what,
at this day, are named Nosology and Therapeutics; they relate to man
in a state of disease only.
   Subsequently, those who devoted themselves to the practice of Medi-
cine, enlarged, gradually, the field of their observations.  Nosological
descriptions became more extended and numerous,  and  the  therapeu-
tical indications more precise.   They  became convinced, that  to un-
derstand diseases well, it was necessary to study man in a state of health.
Thus Anatomy, or the knowledge of the structure of the human body, and
Physiology, or the knowledge of Organic  functions, became important
branches of  medical science.    Experience, also, taught men  that it is
always more  important, and often easier, to prevent the development of
certain  diseases, than to arrest their  progress when once developed.
Consequently, physicians  turned  their attention  toward  this  object.
They traced the  rules for the preservation of health, and the collection
of these rules constituted a new branch of the art called Hygiene.   These
successive additions necessitated a change in the definition of Medicine;
the first, not embracing any longer all the  departments of  the science,
the following was then nearly  unanimously adopted:
   " Medicine is a science which has for its aim, the promotion of Health,
and the cure of Disease."
   This was, for a long time, the limit  of the Medical horizon ;  and it
can not be doubted, but that the field was vast enough  for the  investiga-
tions of those who cultivated it.   Nevertheless, they aspired to extend it,
so constantly does the genius of man deride the limits which are assigned
to it.  Two interesting ramifications are developed recently, from this
majestic  trunk of science devoted  to physical man.   The first,  named
Orthopsedia, teaches how to correct certain  exterior deformities, whether
accidental  or  congenital; the success it has attained, and the extension
it has  acquired, make it already a special branch  of Medicine.  The
second  ramification is called Phrenology, a  Greek word, which signifies,
literally, a discourse on thought, or on the faculties of the soul.  But, by
thought,  here, is meant the organ which serves, more particularly, for its
manifestation.  It is then the organ of thought, that is to say, the en-
cephalon,  of  which Phrenology treats.  Those who have made a  special
study of this branch, believe that the development of the faculties of the
soul, or rather,  the manifestation of these faculties,  depends on  the
volume and the form of certain parts of the encephalon.  They hope even
to determine, by the exterior examination of the cephalic box, the  varia-
tions in the volume, and the form  of the  brain, and, consequently, the
degree  of development of  its faculties.   If  Phrenology ever realizes 
INTRODUCTION.
xi
its promises, it will become a great aid to the physical  and moral educa-
tion of man.   However  this may  be, the last  definition  that  we have
given to  Medicine, appears to me a little too restrained, and it may be
advantageously replaced, I think, by the  following:—"  Medicine is a
Science, which aims at the Preservation of Health, the cure of Diseases,
and the Physical perfection of Man."
  We see already, by this simple  announcement, what Medical Science
strives to attain,  and how much it merits the attention not only of those
who make it a special study,  but also of the Philosopher, the Statesman,
and whoever  appreciates the  advantages of good  health  as  well as the
influence of the physique on the morale of man.
  To the historian, Medicine  presents itself in three  principal phases,
viz: as a Profession, as an Art, and as a Science.
  As a Profession, Medicine was practiced,  primitively, by the  chiefs of
families, of tribes, and of nations,  and by generals and legislators.   Af-
terward, it was joined to the Sacerdotal  office for a very long time.  At
last, it constituted a distinct Profession, which was, at a later period, sub-
divided even into several departments.   I have indicated, summarily, all
these revolutions, with the circumstances that have led to them, and the
good or evil consequences that have resulted.
  In  the point of view of an Art, that is to say, in regard to the rules
which have been established at divers epochs  for the cure  of diseases
and the preservation of health, Medicine appears to me to have followed
a constantly progressive  march from its origin  to the death of  Galen.
Then it remained stationary, or even retrograded, at least in Europe, until
the end of the fourteenth century of  the Christian era.   But from this
epoch, the Healing Art took a new bound, and acquired, from  generation
to generation, remarkable perfection.   Those who  deny the progress of
Medicine, have never seriously studied its history.
  If  it is true, and it can not be doubted, that Therapeutics is really the
essential part of Medicine—if it, in fact, combines all the advantages of the
science, it can not be questioned, but that the ancients are far in  our rear.
To  prove this, it is sufficient to glance at any class of diseases, and com-
pare the treatment employed formerly with  that of our times.    Exam-
ine, for  example, that  of acute  diseases,  intermittent fever, apoplexy,
most of the anatomical lesions, the prophylactic treatment for variola,
and then tell me if the therapeutics of the ancients, in  all these  diseases,
can be compared with that of the moderns !   The same result we  find in
regard to chronic affections, such as scrofula, syphilis, favus, etc.   After
this, is it not an exhibition of ingratitude or ignorance in those who pretend
that Medicine rests stationary in the midst  of universal progress ?  But
man is so oblivious of benefits he has received,  it may be  said  that he 
xii
INTRODUCTION.
has a memory only for the evils he has suffered!  The storm which destroys
in an instant the hope of the laborer, makes an ineffaceable impression on
his memory, while the gentle sprinkling that fructifies his furrow, passes
unperceived.   Thus  the discovery of the sulphate of quinia has made
less noise in the world than that of the congreve rocket, and the name
of Jenner is less known than that of Attila!
   As a Science, so far as regards theories, Medicine offers the picture of
a republic delivered up to many rival factions, which  dominate by turns,
without ever obtaining lasting power.  Theory is an  arena of intermin-
able discussions, a real tower of Babel;  it is the apple of discord among
physicians.   Who can flatter himself to hold the equal  balance among
so many diverse or contrary opinions, to distribute  equitably praise and
blame;  to mark the precise limit in each where truth  ends and error
commences ?
   This difficult enterprise I  undertook, not  with a view  of  instruct-
ing others, but myself; not with the intention of publishing the result of
my research,  for  I  was ignorant what it would  be, but pressed by a
desire to assure  myself  if  there exists in  Medicine anything useful
and certain, any principle whose evidence is striking as that of a math-
ematical axiom, some practical rule whose utility would be incontestable,
I think that a physician who is animated with a sense of his  duty  can
not remain indifferent on these questions, and that he must at least once
in his life examine them  seriously.   If  something  of this  kind exist
in Medicine,  I said to myself, the history of this  science must make it
apparent; and consequently I  embraced with ardor and  perseverance
the study of  this history.   Now, in  deciding to publish the result of my
studies,  I have no other aim than that of saving to  my brethren a part
of the labor which I have performed, by abridging  for them  the road  I
had to travel.
   The only historian who has attempted to unravel the chaos of medical
theories from the beginning to an epoch near our own (Kurt Sprengel,)
has arrived at this conclusion—"that skepticism in Medicine is the  top
stone of the science, and that it is the wisest part to regard all opinions
with indifference, and adopt none."0  This maxim I hold to be erroneous,
hopeless, and  impracticable.    No,  whatever  this erudite historian in
Medicine may say.^doubt is not the last word of science, it is only the com-
mencement of  it, the point of departure.   It is merely a favorable  dis-
position for  acquiring knowledge, certainty, or at  least  conviction.   So
taught Aristotle, so proclaimed Descartes, and the intimate sense of each
  ° " Hist, de la Me'dicine," trad, par, A. J. L. Jourdan, Paris, 1815, t. I, Intro-
duction pp. 10, 11.  See also the " Preface du Traducteur," p. 22, et suivantes. 
INTRODUCTION.
xiii
one of us confirms the same.   When we undertake the search for truth,
it  is with the  desire and hope of attaining it, and if persuaded in ad-
vance  that  this desire and  hope are vain, (as  Sprengel pretends,) we
would rest in careless  repose, rather than uselessly fatigue ourselves  in
the pursuit  of a chimera.  Nevertheless, it may happen  that our inves-
tigations will only produce a  negative result, that we  may remain in the
ignorance and doubt whence  we were anxious to emerge ; but that is only
an accidental or particular result, not the general or necessary one at which
infallibly all human researches must  arrive.   We are  ordinarily con-
ducted to this negative conclusion by a bad method of reasoning, in the
same manner that a false road  conducts the traveler far from  the  true
aim of his journey.
   But if doubt should  be  rigorously maintained,  concerning specula-
tive truths, it  must not  be  so  in relation to those propositions destined
to regulate  our conduct.   In regard to these, we are  constrained to take
a  part whether we will  or  no; in  other words, we must decide upon
some conviction more or less strong.    A  physician,  for example, may
well doubt,  when in his  cabinet, if  the difficulty of respiration realized
by an asthmatic, proceeds from a lesion of  the heart, or great vessels, or
from an  accumulation of mucus, or from a rheumatic condition  of the
muscles, or, lastly, from  the nerves of the chest.  But this physician
once in the  presence of his patient,  after having examined him, will  be
obliged  to  make  a prescription.   Can  there be for him any possible
choice between doing something or nothing ?  Now, if he orders nothing,
does he not so conclude from an opinion ? and  he does  the  same if  he
prescribes;  the choice of doing nothing or  something, supposes a motive
more or  less strong.   Pure  skepticism, then, is  impossible in  a  practi-
tioner who  each day finds himself placed in the necessity of making a
decision on which will depend,  perhaps, the life of his fellow-man.  A
practitioner can, therefore, not  indulge  in  the  skeptical  indifference of
which the  historian I have  cited, boasts; he must, on the contrary, use
every effort to  free  himself  from it, and rise to the  point  of rational
conviction.
   It is with this disposition of mind that  I have undertaken the exam-
ination of ancient and modern  medical  doctrines.   I  have  studied and
compared them with all the  attention of which I am capable; for I wished
to form  an  opinion based on  the absolute or relative value, on the advan-
tageous  or injurious influence, of each  one  of them.   The reader,  then,
must not be astonished if, in the course of this history,  I emit often and
in  a very explicit manner, my own opinion  on the theories under consid-
eration.   But, in fine, that the reader may be in a condition to appreciate
 for himself  these theories, and the judgment that I form of them, I shall 
xiv
INTRODUCTION.
 present them with all the exactness I possibly can, employing for this
 purpose, the text even of the authors who have written in our own language,
 and that of the translations of the most esteemed foreign authors.   I
 shall not pretend  to translate them myself, except in cases where no trans-
 lation has  been made.  I act thus,  in the persuasion  that a man who
 makes a particular and profound  study of a work, translating  it entire.
 must be penetrated with  the spirit of the author much  better than  he
 who extracts from it a few pages only.   Beside, I  hope by this method
 to avoid the  reproval of misrepresenting the opinions of others, either
 unknowingly or by design, and  so preserve, as far as  I  am  concerned,
 their color and original forms.
   Celebrated physicians influence the progress of their Science  and the
 value of their Art, not by their writings only, but by their oral  teach-
 ings, character, and conduct.  Their lives offer, often, models for imita-
 tion,  and  sometimes, also,  faults  and  errors  to be  avoided.   Often,
 too, the early education of a man, and the circumstances in the midst
 of which he was reared, explain the peculiarity of his  genius, and  give
 the key to  his successes and reverses.  For these reasons, I could not
 neglect entirely some biographic details  relative to the most famous
 physicians, especially when these  details had some connection  with the
 general history of the Art, or embraced some moral considerations.
   The sciences do not pursue their march isolated from each other,  they
 go hand in hand, and it is rare  that their progress is not simultaneous.
 An exception to this rule, however, presents itself  in the history of the
 human mind in Europe.  During the middle ages, dialectics and  the-
 ology are cultivated successfully, while  the other branches  of human
 knowledge, and Medicine in particular, merely vegetate in deep neglect.
 But with the fourteenth  century, industry, the sciences, and the arts,
 awake from their long sleep.
   On the  one hand,  the  civil and  political  organization of European
 nations becomes regulated, their material good increases; on  the  other,
 the intellectual and moral faculties of individuals are developed—the
 mind makes efforts freer, bolder, and in a  better direction.   The  histo-
 rian  of  Medicine would fail,  it seems to me, in  one of his  duties, if he
 did not  now  and then give a general view of  the state  of society.
 Therefore, at the commencement of  each of my Chronological divisions,
 I give a rapid sketch of the aspect which civilization then presented.
   Another  fact extremely remarkable, and of capital interest  in the his-
tory  of medical theories is, that they are all derived more or less direct-
ly, from  some  system of  philosophy;  so  that only an incomplete  idea
 of them could be obtained if the  philosophic sources from which they
were  drawn were  unknown.  But too much  importance must not be 
INTRODUCTION.
XV
 attached to these  analogies, nor must the value of medical  theories be
 judged by them.   It must not be forgotten that a philosophic system
 may be false as a whole, and yet true  in  its particular application to
 Medicine.   On the other hand, we may,  by false logic, deduce  an erro-
 neous medical theory from an irreproachable philosophic system.  Thus,
 then, after having indicated the philosophic ideas with which each medi-
 cal doctrine may seem to be  related, we shall judge  this in itself, and
 relative to its practical consequences.
    The principal systems of antiquity concerning Cosmogony, or general
 physics, may be ranged in three sections, as follows:
    1. Those that have  at  their head Pythagoreanism—representing the
 universe  as inhabited by active and intelligent principles, which  ani-
 mate, fashion, and govern each material substance in a determinate way,
 and for a  preconceived end.   The  animals, plants, and even minerals,
 possess, each, a vivifying spirit.   Above these secondary principles rules
 the Supreme principle, who superintends the whole,  harmonizing indi-
 vidualities, and causing them  to concur to one common end.
    2. Another class of philosophers, of whom Leucippus and Democritus
 seem to be the chiefs, considered the formation of the universe as a pure
 result of  chance.   They pretend to explain all the phenomena of nature
 without having recourse to the intervention of any intelligent principle.
 According  to them, the world in  general, and each being in particular,
 exists as  a necessary result of the eternal laws of matter.   They deny
 that different substances, such as plants and animals, were created for a
 preconceived end.   They ridicule what was  termed in the  language of
 philosophy, final causes.
   Finally, a third sect, which recognizes Parmenides and Pyrrho  as their
 founders,  who, believing that there exist in the natural movement of bodies,
 in their reproduction and endless  changes, motives equally powerful to
 admit or reject the presence of immaterial and intelligent principles, con-
 cluded, from this ambiguity, that wisdom consists in remaining in doubt.
 " What is  the use," say  those sectators, " of  fatiguing the mind in
 efforts to comprehend what is beyond its capabilities ?   The research after
 principles or first essences, has only resulted, thus far, in useless and in-
 terminable disputes.  We  receive no real knowledge but through our
 sensations, and we have no certainty in these beyond  the objective  ex-
 actitude."   Such was, in short, the language of this sect, which sometimes
 took the name of Skeptic, to designate the perpetual  doubt which they
professed,  and sometimes  that of Zetetic, to  indicate that they  were
always in  search of truth,  without flattering themselves to have found it.
To  these  three systems of  Philosophy among  the ancients, correspond 
xvi
INTRODUCTION.
three systems of Medicine, of which I shall merely indicate, now, the prin-
cipal traits.
  The first of all, known  by the  name of Dogmatism, is  attributed to
Hippocrates, its culminating idea being, that " there is a simple principle
and multiple in its effects,  that presides over the body and all its func-
tions, creating contraries,  and vivifying the whole  and each  part."—
(Hippocr.,  de VAliment, § 7.)   This idea  is reproduced many  times in
the  same work, and  in  others also, by  the same  author.   It is  the
foundation of Vitalism, or modern  Hippocratism, a  doctrine that  M.
Professor Cayol has explained in so lucid a manner, in his introduction
to the " Medical  Clinic,"  and which  M. Gibert has sustained with  all
the vigor and  logic for which he is distinguished.0
  One of  the  most celebrated nosologists  of  the last age, Pinel,  has
given an idea  of disease  conformable to this doctrine, when he says:
" Disease   should be considered,  not as  a tableau always in motion,
an incoherent  assemblage  of recurring affections that are unceasingly to
be combated by remedies, but as an  indivisible unit, from its beginning
to its  termination—a regular totality of characteristic symptoms,  and
succession  of periods with  a natural  tendency, most frequently favorable,
though sometimes fatal, "f
  This definition, which presents disease to us as a  regular succession
of actions  and movements sustained by the vital  principle with a man-
ifest purpose,  shows  already the connection that exists between the  doc-
trines   of  Hippocrates  and  the  Pythagorean  philosophy;  but  this
connection becomes more and more striking  by the details which will be
given hereafter, in the course of this history.  For it would be a great
error to suppose  that the passages above  quoted are a resume of  the
entire  medical theory  of the physician  of Cos.  They must only be
considered as  one of the principal phases of his theory—one of its char-
acteristic  dogmas—the only  one which has maintained its place down
to our times.
   The second system which is offered for our examination has received
the name of Methodism, and recognizes as its founders, Asclepiades and
Themison.   The former studied, with great care, chronic diseases, in which
the medicative force of nature is often imperceptible.   He felt justified
in denying the existence of this force, and turned into ridicule the Hip-
pocratic dogmas  on this  subject.    On the  other hand, seduced by the
s " Considerations sur l'Hippocratisme et PAnatomisme."  Paris, 1833, in 8.
f " Nosogr. Philosophique."  1st edition, Introduction, p. 7. 
INTRODUCTION.
xvii
Atomic theory of Democritus, which Epicurus had developed and rejuve-
nated,  he hastened to make an application of it to Medicine.  He repre-
sented  the human body as pierced by an infinity of pores, through which
the atoms of various forms and sizes must pass and  repass without  ces-
sation.   These  corpuscles,  excessively  attenuated,  were  supposed to
move about automically, in virtue of the inherent force of  matter.  As
long as the s'ze and form of these  atomic  corpuscles were in exact  pro-
portion to the passage through which they had to move, was  the health
of the  individual maintained.  But as soon  as  the  exactness  of these
relations was destroyed, the health was deranged; but  this could only
occur,  says this physician, in two ways, viz:  either by an excessive  con-
traction or dilatation of the pores.   In this system,  the  animal  economy
is regarded as entirely passive; no reaction,  no  spontaneity, no  natural
tendency whatever is attributed to it.  The  physician had but  to direct
the movement of the economy by means of modifying agents which art
placed at his disposal.
   The two preceding systems, as is plainly seen, were diametrically oppo-
site ; the one never lost sight of the natural  activity of  the organism in
diseases; the other considered the human body as  in  a passive state
only.  But if pathological phenomena are observed without prejudice, it
soon becomes evident that in the production of these  phenomena, the
organism is, by turns, both active and passive.   Thus, when, from the
infliction of  a  severe wound, general  symptoms  appear, such as fever,
delirium, and convulsions, it is evident that  under these circumstances
the organism is at once active and  passive;  passive, in relation to the
local lesion, the  pain, and the shock  experienced;  active,  relatively to
the general functional derangement which is an effect of the vital reac-
tion.   If I may be permitted to make use of a vulgar  illustration,  bor-
rowed from antiquity, to show the double action of the  animal  economy
in the  production of morbid  phenomena,  I will  simply  refer to  the  ser-
pent, which, biting his own tail, is simultaneously the cause and the object
of the action.
  The Dogmatists did not deny that the organism is passive at the moment
when it receives the impression  of a nosogenic influence;  but  they
regarded this impression as a simple occasional cause;  they pretended that
the disease only commences, really,  with the  reaction of the vital prin-
ciple.  This  reaction, according to them, is the primitive and essential
phenomenon, the proximate or occult cause of the morbid affection.
  The Methodists, on the contrary, considered vital reaction  as a sec-
ondary phenomenon, a species of oscillatory change, of which  the proxi-
mate or primitive  motor  cause  was  the  impulsion produced  by  the
morbific agent. 
xviii
INTRODUCTION.
  A third class  of physicians, at the head  of which it  has been cus-
tomary to place Philinus and Serapis, thinking that the proximate cause,
or the primitive phenomena of diseases, was  inaccessible to observation,
hence concluded that all which was affirmed on that subject, is arbitrary,
hypothetical, and unworthy of consideration  in the choice of a rational
treatment.   They asked that in  the description and treatment of dis-
eases, only such  symptoms should be recorded as fall under the notice of
our senses.   The totality of  these phenomena constituted, in their eyes.
the whole morbid affection, or at least all that could be known or affirmed
in regard to it.
  Consequently, they assumed, that in any  given case, only such reme-
dies as had appeared to be valuable in similar cases, should be employed.
without any regard to the proximate, essential, or occult cause, of which,
they say, nothing reveals to us the mode of  action.   As their  reasoning
did not go beyond those things which have  already, or may yet become
matters of observation and experience, they  took the  name of  empirics,
which signifies experimenters.  They have been classed with the skeptical
philosophers, who place nothing in the rank of  certain  and positive
knowledge, but the sensations.
  A considerable  number of physicians would not adopt any of these
systems,  exclusively, but drew from each what  to them  seemed to  be
most conformable to reason and experience.   They called themselves
Eclectics, from a Greek word, which signifies, to choose;  by which they
wish to imply, that they made a rational choice  of what  appeared to be
best, of all doctrines.   It must be admitted,  that this is a very laudable
design, though somewhat pretentious.  They should, however, have indi-
cated the rule by which they were guided in this choice,  what principle
they followed in  discerning,  among  so  many  contradictory  opinions,
truth from error, the reality from fallacy, and the  good from evil,
  This  is what  the Eclectics ought  to have been able to do,  but what
they have not done.   They contented themselves by affirming  that they
followed, in every case, the  voice of experience  and of reason, without
permitting themselves to be influenced by any prejudice, or systematic-
idea.   But we must take their  word for it, for they have emitted  no
axiom which enables us to see it for ourselves.  Eclecticism is, in reality,
neither a system nor a theory ; it is, uniquely, an individual pretension,
elevated  to  a dogma.  Each Eclectic recognizes no other rule, than  his
particular taste, his individual  reason, or his fancy.  Two,  so  called,
Eclectics have seldom anything in common, but the name.
  The Eclectic  carefully avoids  the discussion  of principles.  He has
little taste,  or little capacity for  high abstractions.   He believes them
useless, not to say injurious to the practice and  progress  of the art.   In 
INTRODUCTION.
xix
 a word, the assumption of the name of Eclectic conveys a very unfavor-
 able idea as to the fixity of their philosophic principles.  But the Eclec-
 tic  may be, and  often  is indeed, a good practitioner.  If, on  the one
 hand, he disregards the fundamental principles of science, on the other
 he concentrates his attention on details;  and we all know that practical
 skill is based,  particularly,  on specialties.   To such may, with  good
 reason,  apparently, be  applied the  proverb,  "good  practitioner,  bad
 theorist."  Not that he, necessarily, has no theoretic ideas;  that is im-
 possible ; but his ideas  form  no system, and are not based upon general
 principles.   With him,  medical tact, that is, cultivated instinct, takes
 the place of principles.  Such was the erudite Barckausen,  who, in
 reviewing medical theories, found in all,  something to blame, and some-
 thing to praise, without giving to any one a marked preference.
   The Eclectic of our times is, ordinarily, only an empiric in disguise;
 but an empiric, in an  honorable sense of that term;  that is to say, a
 man whose opinions are based on  the pure and simple observation of
 facts,  carefully compared; whose theoretical  ideas do not  go  beyond
 phenomena.  In order to form a system, his ideas only need to be united
 by a common tie, under the guidance of a philosophic principle.
   I have just expressed the idea that it is impossible for a  man to prac-
 tice Medicine without any species of theory.   This is an  axiom which
 has no need of demonstration, says Professor Bouillaud.0
   Doctor Auber unites in this opinion.  "Be well convinced," says he,
 " of one thing, that there is  no practitioner who  has  not, however lim-
 ited, his theory, and who may not, also, be carried away by it at the  bed-
 side, seeing that it is, necessarily, by reason of some idea, false or true,
 wise or foolish, scientific or vulgar, that even  the  most senseless physi-
 cian determines, or is compelled automatically, to  act in one way rather
 than in any other, and on  this  account it is said, with infinite  reason,
 that the practice must ever submit to the  yoke and exigencies of even
 the most contemptible theories."—(" Traite de la Philosophic Medicale.'-
 Paris,  1839, p. 185.)
   To those readers who may accuse me of attaching too much importance
 to the examination of theories, I must respond,—theories have been,  and
will forever  be, the compass of the practice.
   Anciently,  philosophy embraced the  whole of  human knowledge,
physics, natural history,  medicine, morals, metaphysics, theology, math-
ematics, etc.   The philosopher was not permitted to be unacquainted with
any of them.  Now, physics, natural history, medicine, and many other
  * " Essai sur la Philosophie Medicale et sur les Generalite's de la Clinique Med-
icale."  Paris, 1836, page 302. 
XX
INTRODUCTION.
branches of philosophy have  been detached from  the  main  trunk, and
constitute separate sciences.  From this separation, it results that mod-
ern Medicine has borrowed less from philosophy, properly so called; but
in compensation, it has been influenced by other sciences, such as physics
and chemistry.
   From the end of the fourteenth century of our era, to the commence-
ment of the nineteenth, we count, in Medicine, five classes  of principal
theories, namely: the ancient Humoralism or Galcnism, the Iatro-Chem-
ical, the Iatro-Mechanical, Animism or Vitalism, which is confounded
with modern Hippocratism, and finally, Organo-Dynamism.
   I shall not extend further these general considerations, or I should
encroach on what will be said in the course of this history, where the
theories to which I have alluded,  and some less important  ones,  will be
properly treated.
   The following is  the chronological order which  I have thought it
proper to adopt:  I divide into  three Books,  or three Ages,  all past
time.   The First Age  commences with the infancy of society,  as  far
back  as  historic tradition carries  us, and terminates  toward the end
of the second century  of the  Christian  era,  at  the  death of Galen,
during the reign of  Septimus Severus.  v This lapse of time constitutes,
in  Medicine, the Foundation Age.   The germ of the Healing Art, con-
cealed, at first, in the instincts of men, is gradually developed ; the basis
of the science is laid, and great principles are discussed.   The  human
mind, always impatient, surpasses in its  speculations, the  limits of the
known and possible.   Many branches of the art, such  as Symptomatol-
ogy and Prognosis, are carried to a remarkable degree of perfection.
   The Second Age, which may be called the Age of Transition, offers very
little  material to the history of Medicine.   We see  no longer the con-
flicts and discussions between partisans of different doctrines ; the medi-
cal sects are confounded.  The  art remains stationary, or imperceptibly
retrogrades.  I can not better depict  this epoch  than by comparing  it
to the life of an insect in the nympha state;  though no exterior change
appears, an admirable metamorphosis is going on, imperceptibly, within.
The eye of man only perceives the wonder after it has been finished.
   Thus, from the fifteenth century, which is the beginning of the third
and last Age of Medicine,  or the Age of Eenovation, Europe offers us a
spectacle of which the  most glorious eras of  the republics of Greece
and Eome only can give us an  idea.  It would seem as if a new life was
infused into the veins  of the  inhabitants of  this part of the  world •
the sciences, fine arts,  industry, religion, social institutions,  all are
changed.   A multitude of schools  are opened for teaching Medicine.
Establishments which had no models among the  ancients, are created 
INTRODUCTION.
xxi
for the purpose of extending to the poorer classes the benefits of the
Healing  Art.   The  ingenious  activity of modern  Christians explores
and is sufficient for everything.
  These  three grand chronological divisions do not suffice to classify, in
our minds, the principal phases of the history of Medicine;  conse-
quently,  I have subdivided each age into a smaller number of sections,
easy to be retained,  and which I have named Periods.   The first Age
embraces four periods, the second and third ages, each, two.
  I  will now  indicate succinctly,  each of these secondary divisions,
without attempting, at present, to justify them, for this will be done in
its proper place in the course of the work.

  The first period, which we name Primitive Period, or that of Instinct,
ends with the ruin  of Troy, about twelve centuries before the Christian
era.

  The second, called  the Mystic  or Sacred Period, extends from the
dissolution of the "Pythagorean Society" to about the year 500,  A. C.

  The third period, which ends at the foundation of the Alexandrian
Library, A. C, 320, we name the Philosophic Period.

  The fourth, which we designate the Anatomic, extends to the end of
the first age, i. e., to the year 200  of the Christian era.

  The fifth is called the Greek Period ; it ends at the destruction of the
Alexandrian Library, A. D. 640.

  The sixth receives the surname of Arabic, and closes with the four-
teenth century.

  The seventh period, which begins the third age, comprises the fifteenth
and sixteenth centuries; it is distinguished as the Erudite.

  Finally, the eighth, or last period, embraces the  seventeenth and
eighteenth centuries.  I call it the Reform Period.

  In this division  of the past, there  is wanting  that  portion of the
nineteenth century which  has already passed.  I have  omitted  it for
the  following  reasons: First—I have asked  myself, is it possible to
write cotemporaneous history with the same independence of mind as
that  of the past?   Secondly—Is it suitable,  in  speaking of living
authors, to omit  all  biographic details ?  Thirdly—Is  there not dan-
ger of exaggerating cotemporaneous opinions and discoveries ?  Lastly—
Can we seize the general physiognomy of an epoch while living in  its 
xxii
INTRODUCTION.
midst ?   Does not one  in such a position resemble a man who, placed
at the foot of an edifice, thinks himself capable of appreciating  the
effect of the whole structure ?
  All these considerations, have led me to fear that  I could  not trace
the history of our own times  after the same plan as that of the history
of the past,  and I have  therefore  taken, as my limit, the end of the
eighteenth century.
  I propose, however, to give hereafter, under the title of Materials for
Cotemporaneous Medical History, a discussion of  the theories, discov-
eries, and improvements that have signalized the first half of the pres-
ent century.   This will form  a supplement to the second volume.0
°See Appendix. 
 
SYNOPTIC  TABLE
OF THE AGES AND PERIODS OF
THE   HISTORY   OF   MEDICINE
/ I.  Primitive Period, or   Ending with the destruction of
     that of Instinct.         Troy,  1184 years before
                            Christ.
II. Sacred, or
    Mystic Period.
Age of Foundation, ~\
Ending at the dispersion of the
    Pythagorean Society, 500
    vears before Christ.
III. Philosophic Period.  Ending at the foundation of the
                          Alexandrian Library, 320
                          years before Christ.

IV. Anatomic Period.    Ending at the death of Galen,
                          A. D. 200.
V. Greek Period.
Age of Transition
4
VI.  Arabic Period.
Ending at the  burning of the
    Alexandrian Library, A. D.
    640.

Ending at the revival of letters,
    A. D. 1400.
( VII. Erudite Period.     Comprising the XV. and XVI.
                            centuries.
Age of Renovation, -<
VIII. Reform Period.    Comprising  the  XVIT.  and
                          XVIII. centuries, 
HISTORY  OF  MEDICINE.
                    BOOK   I.

            AGE  OF  FOUNDATION.
EXTENDING FROM THE  ORIGIN OF SOCIETY TO  THE  END OF THE
           SECOND CENTURY OF THE CHRISTIAN ERA.
           I  PRIMITIVE  PERIOD.

OF VARIABLE DURATION  AMONG DIFFERENT PEOPLE.
                GENERAL CONSIDERATIONS.
  This period, which corresponds with the early'infancy of human society,
is enveloped  in profound obscurity, and mingled with a multitude of
fables   It embraces an indefinite lapse of time, during which, Medicine,
did not constitute a Science, that is to  say, a systematic assemblage of
rational knowledge, but formed rather an undigested collection of ex-
perimental notions, vaguely described, and  more frequently disfigured by
a series of incomplete  traditions.  It is easily understood, that such a
state of things must have existed, a longer  or shorter time, in different
parts of the  globe, in proportion  to the progress, more or less rapid,
that  the inhabitants of those parts made in the career  of civilization.
This state of things still exists among certain tribes in the center of
Africa,  in some parts of America, and especially in Oceanica.  But for
Greece, which has transmitted to us  the most precious memorials of
antique Medicine,  the Primitive Period ended, as we shall see further on,
at the destruction  of Troy, in the course of the twelfth  century before
the Christian era.
        2 
26
PRIMITIVE PERIOD.
  Before following the trace of the Art of Healing, on the classic ground
of the Hellenists,  we  shall seek the first vestiges  of it  among  other
nations that preceded the hellenic nation, on the route  of social progress,
and who  furnished it, in those remote times, models, in more  than one
sense.  Consequently, we shall,  in  the first place, cast a glance  at the
antique  Medicine  of  the  Egyptians, the Jews, the  Indians and the
Chinese;  then we shall describe the state of Greek Medicine, before the
Trojan war, and finally say a  few words  on the  manner in which this
Art was cultivated, primitively, among some nations less celebrated, both
in the Old and New World.
                         CHAP TEE  I.

          MEDICINE OF  THE ANTIQUE NATIONS.

                    I. MEDICINE OF THE EGYPTIANS.
  If we accord the first place, in this history, to Egyptian Medicine, it is
not without a motive.  It seems  to  us  to merit this honor, not only
because its antiquity is based  on monuments, the  most authentic, but
also because it has been the source whence  the  Greeks drew  the first
elements of this science; and in this respect also the Egyptian  nation
may be justly named, the instructress of the human race.   We read in
the Bible, that when Jacob died,  " Joseph commanded his  servants, the
physicians, to  embalm him;  and  the physicians embalmed Israel, and
forty days were  fulfilled for him,  for so are fulfilled the days of those
that are embalmed." (Gen. chap. 1.)   Thus, at the  death of the Patri-
arch Jacob, about 1700 years before  the birth of Christ, Egypt possessed
men who practiced the art of medicine.   This passage, in the writings of
Moses, is the most ancient authentic monument that we possess of the
Healing Art;  all that is  more remote in the history of Egypt,  and of
other nations, is enveloped in  uncertainty and  obscurity, at least so far
as medicine is concerned.
   Nevertheless,  it is certain, that before the time of the emigration of the
sons of Jacob to Egypt, the arts and sciences had already attained, in that
country, a degree of perfection which could only be the  result  of long
experience, that required  very many years or rather  centuries of obser-
vation.  The books of the Hebrews, furnish other more valuable infor-
mation on this  subject.   We  read  in them, that  when  Abraham was
constrained by the famine, to quit the land of Canaan, he entered Egypt,
where he found  an  abundance of  everything to  nourish  his  household
and his flocks.  At this epoch, which preceded the  death of Jacob 230 
MEDICINE  OF THE EGYPTIANS.
27
years, Egypt rejoiced in a very advanced state of civilization.  Agricul-
ture, Geometry, Architecture, Metallurgy, had all then made a  remark-
able progress.  Thebes, the city of a hundred gates, existed  as well as
some  of those  gigantic  edifices,  destined to  transmit  to posterity,
the evidence of the power  and wisdom of the Pharoahs.0
   But through how many phases must the Egyptian nation have passed,
before its intelligence and industry had acquired such  a  development!
How many centuries must have run by, before her men possessed the
means of perpetuating the memory of great events and useful inventions!
The arts of speaking and writing, these two indispensable instruments for
the transmission of ideas, how were they created ?   By what series of
gradual improvements did they arrive at that point  of  clearness, requi-
site to  produce exactly the image  of  the thoughts?    The most ar-
duous and subtle researches, teach us nothing, or next to nothing on  these
interesting questions; the science of Champollion is mute on this point;
the  sacred  books alone  clear up this difficulty,  in saying that God
taught to man, the names of all animate and inanimate  things.
   So then, the generations that have bestowed upon the human race the
most useful  discoveries, have themselves  passed away, without leaving
any other impression of their passage.  Those who undertook, in after-
times, to collect the records of humanity, in place of transmitting  pure
and intact, the few documents of which they yet held possession, envel-
oped them with fiction, which renders the truth more and more uncertain.
But it must be said, for  their justification, that these first chroniclers
had especially in view, the inculcation to man of the principles of socia-
bility, morality, and religion, and that their marvelous, or  allegorical
recitals attained much more directly the end they aimed at, than if they
had stated the naked truth.   It  is for this reason, doubtless,  that in-
stead of seeking, laboriously, the primitive source of the arts and sciences,
on the earth, they placed  it in the heavens, and that they attributed to
their gods, or to men they deified, all great discoveries.   On this account,
therefore, the cradle of Medicine, as well as all the arts of first necessity,
is surrounded with fables  and allegories.
   I shall glide slightly over this medical mythology, which, in this day,
can neither delude  any one, nor  furnish any satisfactory light on the
state of the  science in  primitive  times, and would constitute  nothing
more than a display of erudition as sterile as it would be out of place
in an elementary work.    I shall only say on this subject, what is indis-
  3Lettres de Champollion jeune, relatives au Muse'e Egyptien de Turin, p. 25 et
suivantes. 
28
PRIMITIVE PERIOD.
pensable to be  known, in order not to appear ignorant in the eyes of
men who have a smattering of the history of our Art.
   Thoth, or Theyt, whom the Greeks name Hermes, and the Latins Mer-
curius (Mercury), passed, among the Egyptians, as  the inventor  of all
sciences and arts.   He has been supposed to be the author of an ency-
clopedic collection, in which,  it is said, was comprised all the wisdom of
the ancient priests of the country.   But this collection has been lost, at
an unknown period, and no writer, who refers to it, speaks of having seen
it: all refer to it as traditionary.  There are  also various statements as
to the number of  books of which  it was  composed.   Some say there
were  twenty  thousand;  others thirty-six thousand;  others, on  the
contrary, reduce the number to forty-two volumes, only.   It  appears
difficult, if not impossible, to  reconcile these opinions, so adverse ; never-
theless some have  attempted  so to  do; among others, Galen, Hornius,
and Bochard; but none of their explanations  are reliable.
   Neither is there  a better agreement as to the person of Hermes, nor
of the time in which he lived.   According to many conjectures, which
have about equal claim to truth, this personage was Bacchus,  Zoroaster,
Osiris, Isis, Serapis,  Orus, or  Apollo, or Shem  the son of Noah.  Others
think that Hermes was a god, to whom the Egyptian  priests dedicated
all their scientific  productions, by inscribing his name at the head of
their writings.   Benjamin Constant emits a conjecture, more reasonable
if not more true.  "In the great religious corporations," says he, "the
sacerdotal instinct warns (l'avertissait) them, never  to permit any indi-
viduality to be manifested.  What we have taken for  the proper names
of the Chaldean and Phenician writers, was probably only the designation
of a class.  The word sanchoniaton, signifies, among the Phenicians, a
savan, a philosopher, or,  in other words, a priest.   Many East-Indians
have assured the Chevalier Jones, that Boudda was a generic name.  In
Egypt, all  the works on  religion and the sciences bore  the name of
Thoth, or Hermes."0
   M. Houdart, who agrees with this last view, and fortifies it by proofs
Gertainly more numerous than decisive, gives, beside, on the contents of
this hermetic  encyclopedia,  details which are nowhere else found as
well deduced.   I think I cannot do better than give a  textual statement
of his remarks.  " Finally," says Houdart, " that the reader may judge
of the immensity of the knowledge of the savans of ancient Egypt, I
place before him the titles of the forty-two volumes of this hermetic collec-
tion.   The first two contained hymns to the  gods, the others, duties of
°De la Religion. Paris, 1824,1.11, p. 120. 
MEDICINE  OF THE EGYPTIANS.
29
the kings.  The four following treated of the order of the wandering
stars, of light, and of  the rising and setting of the sun and  the moon.
In ten others was given the key to their hieroglyphics; a description of
the Nile, of sacred ornaments, of holy places; and beside these,  instruc-
tions in astronomy, in cosmography, and the geography and topography
of Egypt.   Ten other  volumes related to the choice of victims, divine
worship, religious ceremonies, festivals, public celebrations, etc.   A like
number of volumes, which were  called Sacred, were consecrated to the
laws,  to the gods, and to all the discipline of the priesthood.   Finally,
the last six treated of Medicine.  We leave to the reader the care of
deducing  all the results of such an encyclopedia.   What we wish par-
ticularly to refer to, is, that the last six volumes, which related to Medi-
cine, embraced a body of doctrines, complete and well arranged.   The
first treated of anatomy, the second of diseases, the third of instruments,
the fourth of  remedies, the fifth  of  diseases  of the eye, and the last of
diseases of women.   It must be  agreed that this distribution was very
methodic.   In the  first  place there  was given, a description of the
human body, showing, by this, that it was necessary to commence with
a knowledge of the system  on which it was necessary to operate;  then
they pass to the study of diseases ; thence to medicines and instruments
employed in their  treatment.   As  the affections  of the eye, and the
diseases  of women  are very frequent, and as they demand  particular
attention, they were studied separately.   This is  certainly a complete
and well arranged body  of medical  matter.0
  No  one will contest the  excellency of  this plan of Medical studies
that M. Houdart has just traced, but what  is most doubtful, is, that a
plan- so well arranged  can be referred  to a period so early in  human so-
ciety.  Without  attempting to discuss this point, I will simply remark,
that the  Hippocratic  collection  posterior to this, by a thousand years,
according to the  supposed date of the encyclopedia, does not  present as
complete and as methodic a  system.  Further,  how can we admit  that
the Egyptian priests would attach a  very  high value to anatomical
studies, when it is known that the school at Cos, initiated in the doc-
trines  of  these  priests, and much  more  advanced than  they, in all
branches  of medical science, possessed,  nevertheless, but very vague
notions on the conformation of  the human body, except in what relates
to osteology.  Everything justifies us in believing that the plan of med-
ical education which is attributed to the  priests of Egypt, is the work
of some writer of the Alexandrian school; for it was about the epoch
  3 " Etudes Historiques et Antique sur la Vie et la Doctrine d'Hippocrate, et
sur 1' etat de la Medecine avant lui," par M. Houdart.  Paris, 1840, p. 135. 
30
PRIMITIVE PERIOD.
of the foundation of that city, that anatomical researches  and medical
philosophy began to flourish.
   Nevertheless, the description that M. Houdart gives of the progress-
ive march of the  sciences  in Egypt, and in  particular of the method
followed by the  priests in the practice of medicine, is both interesting
and instructive.   On this account, I continue to quote his remarks, but,
at the same time, expressing my doubts of the exaggerated appreciation
of the results which this writer conceives are  derived from the Egyp-
tian school.   " It is not necessary to suppose," he adds, " that Medicine
reached, suddenly, in Egypt, this degree of perfection.  As was common
among  other  people of high antiquity, they  commenced,  in the first
place, as we learn from Strabo, by exposing the sick in  public, so that
any of those who passed by, that had been similarly attacked and cured,
might give their advice for the benefit  of  the sufferers.0   At a  later
period, this plan was much  better calculated to accelerate the progress
of the art; for all who were cured of disease were  required  to go and
make an inscription in the  temples,  of the symptoms of their disease,
and  the curative agents which had been beneficial to them,   The temples
of Canopus  and Vulcan, at  Memphis, became the principal depots of
these registers, and they were kept with  the same  care as the archives
of the nation.   For a long  time, every one  had  the  privilege of going
to consult them, and of choosing  for his  sickness, or that of his neigh-
bors, the  medicaments  of which  experience had  confirmed  the value.
This method was very good,  notwithstanding  its inconveniences,  to
advance science, because it  rested  entirely upon  observation.  In this
way, must have been  collected  a prodigious quantity  of facts,  from
which might be deduced correct principles in the practice of Medline,
and  this, indeed, was brought about.  The priests, who  were charged
with the study of these observations, did not hesitate to seize upon the
exclusive practice of the Art, and when they had collected a great  mass
of facts, they formed a Medical Code, the fruit of the experience of  ages,
which is called by Diodorus, of Sicily, the Sacred Book, from the direc-
tions of which they were never permitted to vary.  It was, doubtless,
this code, which was afterward attributed to Hermes, that made up the
collection spoken of by Clement, of Alexandria, and which the Pasto-
phores followed in the practice of Medicine   If, in following the rules
there laid down,  they  could  not save  their patients, they were not
held responsible; but, according to Diodorus, of Sicily, they were  pun-
ished with death if, after departing from them the result did not justify
  ° According to Herodotus and Strabo, the same usage  appears to have existed
among the Babylonians and Lusitanians. 
MEDICINE  OF THE EGYPTIANS.
31
their course.   Unquestionably this was  an atrocious law, and must
have arrested all ulterior progress in the Healing Art.   Nevertheless,
it should be stated, that it was not made before the correctness of those
principles had been well established.  Diodorus is decisive on this sub-
ject; he says, positively, that the design of a law, so severe, was, that
a practice confirmed by long experience, and supported by the authority
of the greatest masters of the Art, was preferable to the  limited expe-
rience of each particular physician.0
  I  have already indicated my objections to M. Houdart, for exaggera-
ting so much the progress of Egyptian Medicine in these remote times,
and I shall not add to what I have said, but  one simple question.   I
will ask of this erudite, who attempts to justify, like Diodorus, this
foolish and iniquitous Egyptian law, what judgment  he would give,  to-
day, upon  the  Sovereign or Senate who would attempt to re-establish
and execute a similar one, under the pretext that our  medical code is
the fruit of the experience of ages, and that the solidity of the princi-
ples which serve  as its base,  is sufficiently established ?   Doubtless, he
could not sufficiently curse such a senseless tyranny, so contrary to the
progress of science and  the  best  interests of the diseased.   Finally, I
will ask, how is it  that he  has conceived so  high an idea  of  the
Egyptian doctrine,  which rests upon some vague and doubtful traditions,
while he blames, with  excessive severity, the Hippocratic doctrine, of
which there remains to us irrefutable monuments which have excited the
admiration of the greatest masters ?
  It is usually supposed that the  practice of embalming, which goes
back to an immemorial period, as  already indicated, was well calculated
to familiarize the Egyptian priests  of that  early day with anatomical
researches.  But Sprengel has justly observed, that this process was
too  rude to have  contributed very much to the advancement of the sci-
ence.  He adds, that according to Herodotus, the  people  had a horror
of these proceedings, and  that they pursued  and threw  stones at the
parachute who made the incision, through which were introduced into
the corpse the ingredients destined to dry and preserve  it.  This sub-
altern operator was obliged to fly immediately after he  had done  his
work, in order not to become the victim  of the  animadversion  of his
assistants.  When Pliny assures us that the kings of  Egypt permitted
the opening of the  corpse, for the purpose of discovering  the causes of
diseases, he always means the Ptolomies, under whose reign anatomy
was carried to a  very high degree of perfection.!
  °" Etudes Historiques et Critiques," etc., p. 136.
  fC. Sprengel, "Histoire de la Medicine, traduction de M. Jourdan," t. I, p. 60
et suiv.  See " l'Histoire de l'Anatomie," par Th. Lauth. Strasbourg, 1815, liv. 1, 
32
PRIMITIVE  PERIOD.
  According to the authors I have just named, there were three sorts of
embalmments, namely:  that of the first class, reserved for men of qual-
ity and wealth, which cost one talent; that of  the  second  class, which
was adopted by families of moderate  means, which cost about twenty
mines; lastly, a mode  of embalmment  for  the  poor, which  consisted
simply in washing the body and macerating  it for seventy days in lye.
In the process of embalming the first  and middle classes, the brain
was removed by an opening through the nasal  fossae, and  an incision
was made on the  left side  of the abdomen, through which the intes-
tines  were withdrawn,  and spices and  more or less  costly aromatics
were introduced;  after  which, the body was washed, as above stated,
then spread over with gum, and wrapped in bandages of linen.0
  The Egyptian nation was divided, from the earliest times, into six orders,
as follows: the king and princes, priests, soldiers, shepherds, laborers,
and lastly, artisans.  The  order of the  priesthood was most respected
and the most powerful;  it was the depot of the  laws, science, and reli-
gion.   The  sovereign,  before taking  the  reins of government in his
hands, was affiliated to  the sacerdotal order, and initiated into its mys-
teries.  The care of the priests to conceal their doctrines is well known,
and that they might do it more effectually, and transmit them to their
successors, they employed a peculiar  language and mode  of  writing,
termed hieroglyphical  or sacred,  which differed essentially from  the
common  language  of the people.   While the vulgar prostrated them-
selves before rude images, emblems of the attributes  of the divinity,
or of the wonders  of creation, the learned classes, which included med-
ical men, recognized an invisible and eternal Sprit, the Supreme Gov-
ernor of the universe.

                   II. MEDICINE OF THE  HEBREWS.
  The Sacred History says,  positively, that Moses, having been rescued
from the  river by one of the daughters of Pharaoh, was reared in  the
court of that Prince, and instructed in all the knowledge of the Egyp-
tian  priesthood, in which he became  a  proficient.  On this  account,
when he presented himself before his sovereign, to demand, in the name
of the God of  Israel, the freedom of his  brethren, who were reduced to
an unjust and cruel servitude, he was not at all embarrassed by the
where the question, if the Egyptians possessed an anatomical knowledge, is exam-
ined and thoroughly answered negatively.
  °C. Sprengel, ibidem.—Herodotus liv. II, chap.  LXXXV-LXXXVI.  Diodorus
chap. XCI. Pariset, " Memoire sur les Causes de la Peste."  Paris, 1837, page
4, et suiv. 
MEDICINE OF THE  HEBREWS.
33
prestiges of the magicians and savans that Pharaoh so frequently sum-
moned to meet him in  the palace.   He proved  the  legitimacy of his
mission, in confounding the pride of the magicians by prodigies more
wonderful than theirs, and finally overcame the interested obstinacy of
the king, and had the glory of delivering his  brethren from the yoke
that had pressed  so heavily upon them for nearly two hundred years.
All are familiar with the great obstacles he overcame in  leading them
back to the land  of their forefathers, and how well he availed  himself
of long and weary wanderings in the wilderness, to give to them  the
moral and political laws inspired by God.
   The writings of Moses constitute a precious monument for the history
of Medicine ;  for they embrace hygienic rules of highest sagacity, and
which  may be  regarded as a  detached fragment of  Egyptian science.
It is  in Leviticus that the  prophet-legislator  has recapitulated  the
greater part of the rules concerning the care to be given to the health.
The eleventh chapter contains a long enumeration of animals reported
impure, that is, unhealthy ; among which are mentioned the rabbit and
the hog, whose flesh produces no injurious effects in European climates,
but might have done  in Egypt and India, among men whose habits dif-
fered so much from ours.   It may be, moreover, that the species  desig-
nated by these names were not the same as those with which we  are  so
familiar.  In  short, it is possible that Moses, in making these prohibi-
tions, had other views than those ascribed to him.
   The twelfth and fifteenth chapters of the  same book were designed
to regulate the relation of a  man to his wife.  In reading these pre-
cepts,  one  can not repress a sentiment of  admiration  for the wis-
dom and foresight which made  such salutary regulations a religious
duty.   The following extract will  enable the reader  himself to judge
of this.
   1. " The Lord spake again to Moses, and  said to him,
   2. " Speak  to  the  children, saying, if a  woman have conceived seed,
and borne a man child, then shall she be unclean seven days; according
to the days of the separation of her infirmity shall she be unclean.
   3. " And in the eighth day, the flesh  of his foreskin shall be circum-
cised.
   4. "And she shall then continue in the blood of her purifying three
and thirty days;  she shall touch no hallowed  thing, nor come into the
sanctuary, until the days of her purifying be fulfilled.
   5. "But if she  bear a maid child, she  shall be  unclean  two weeks, as
in her separation,  and she shall continue in the blood of  her purifying
threescore and six days.                   ' 
34
PRIMITIVE PERIOD.
   6. "And when the days of her purifying are fulfilled, for a son or for
 a daughter, she shall bring a lamb of the first year for a burnt-offering,
 and a young pigeon or a turtle-dove for a sin offering, unto the  door of
 the tabernacle of the congregation, unto the priest,        °  and  the
 priest shall make an atonement for her, and she shall be clean."
   Chap, xv, v. 19, "And if a woman have an issue, etc., she shall be put
 apart seven days.
   20.  "Whatever shall touch her shall be impure till even."
   24.  "And if any man lie with her at all, and her flowers be upon him,
 he shall be unclean seven days,  and all the bed whereon  he lieth  shall
 be unclean.
   25.  "And if a woman have an issue of her  blood, many days out  of
 the time of her separation; all the days of the issue of her uncleanliness
 shall be as the days of her separation: she shall be unclean."
   28.  " But if she be cleansed of her issue, then  shall  she number  to
 herself seven days;  and after that she shall be clean.
   29. "And on the eighth day she shall take unto her two turtles, or
 two young pigeons, and bring them unto the priest, to  the door of the
 tabernacle of the  congregation."
   Apart from  the religious  ceremonies, the utility of which  is incon-
 testable, in order to secure the execution of the hygienic precepts—might
 it not be said that these are extracts from a modern work on hygienics ?
 What could be more salutary than the momentary separation of married
 persons at the periodical return of certain functions which almost amount
 to an infirmity with women ? or what could be  more ingeniously con-
 trived to prevent the disgust that  might  arise from  an uninterrupted
 cohabitation?   The  author  of Emilius gives similar counsel,  three
 thousand years later.
   The Bible also prescribes frequent ablutions, a custom which has al-
 ways appeared  to be necessary in hot, dry countries, and among a people
 who made  no use of body-linen.   But  what more excites the  astonish-
 ment of physicians,  is the tableaux that Moses has made  of the white
leprosy, and the regulations he  established to prevent its propagation.
 He has  given the  following characteristics of this disease, in  the thir-
 teenth chapter of Leviticus.
   2.  "When a man shall have in the  skin of his flesh a swelling, as a
 scab or  bright spot, and it be in  the skin of his flesh, like the  plague of
 leprosy, then he shall be brought unto Aaron, the  priest, or unto one of
 his sons, the priests.
   3.  " And the priest shall look on the plague in the skin of  the flesh,
 and when the hair in the plague  is  turned white,  and the plague  in 
MEDICINE  OF THE HEBREWS.
35
sight be deeper than the skin of his flesh, it is a plague of Leprosy;  and
the priest shall look at him and pronounce him unclean," etc.
   Ancient authors have confounded under the name of Leprosy, a great
number of diverse affections;  hence it results, that these descriptions do
not agree with each other, nor with the writings of Moses.   Cutaneous
pathology was a real  chaos, which  has only been reduced to a system
very  recently, so  that it is  impossible now to give  an opinion on the
exactness of the signs  above indicated.   Some of them conform to a dis-
ease called White Leprosy, by modern dermatologists, but others do  not.
What augments  our uncertainty, is the opinion universally admitted,
and very probable too, that by the influence of hygienic conditions, en-
tirely different,  certain diseases  may  have disappeared, or  become so
modified, as to be  of  no  importance, while new ones may have  been
developed.   Without this consideration we would be led to suppose,  that
it was  a mere prejudice, very excusable at so early a period in medical
science, that caused Moses to write  concerning  the leprosy which clung
to the  clothing, and to the walls of houses, and which, according to the
sacred writer, manifested its  presence  on inanimate objects by evident
characteristics.0
   After the promulgation of the Decalogue, the man most prized in the
Holy Scriptures for  his science, was Solomon.  They  tell us  that  this
monarch surpassed in wisdom all the Orientals,  and even the Egyptians,
that "he spoke five  hundred  proverbs, and his songs were three thou-
sand.   He spoke of  plants, from the cedar of Lebanon, even  unto  the
hyssop  that springeth  out  of the wall; he  spoke  also of beasts  and
of fowl,  and of creeping things, and of fishes."  The historian Josephus
adds, "that God gave to this prince  a perfect knowledge  of the proper-
ties of all the  productions of nature, and that he availed himself of it,
to compound remedies, extremely useful, some of which had even  the
virtue to cast  out devils, "f
   It is  clear from the  above,  that Moses always gave  his  instructions
concerning   leprosy  and other  infirmities,  to the priests  only; from
which it may be inferred that at  this epoch, the Levites joined  the
practice of Medicine,  to  their  sacerdotal functions.  It appears that
they maintained for a long time, this double relationship to society, for
there is no mention made  of lay physicians among the  Jews,  except in
the Book of Ecclesiastes, the author of which lived in the third century
before Jesus Christ.  The following references are made on this subject:
  ° Lev. Chap. XIII. et XIV.
  f Liv. VIII. Chap, n.—Leclerc, " Hist, de la Medecine."   Ire partie, Liv.
Chap. in. 
36
PRIMITIVE PERIOD.
  " Honor the physician, because he is indispensable, for the Most High
has created him."
  "For all Medicine is a gift from God, and the  physician  shall re-
ceive homage from the King."
  " The Science of Medicine shall elevate the  physician to honor, and
he shall be praised before the great."
  "The Most High has created the Medicines  out of the earth, and he
that is wise will not abhor them."0

               III.  MEDICINE  OF THE ORIENTAL INDIANS.

  Under the name of Indians, we comprise all those tribes that inhabit
that vast extent of country, bounded on the east by China, on the west
by Persia, on tb.e north by little Thibet,  and on the south by the sea.
Though now divided into many kingdoms or principalities, the inhabit-
ants of these countries appear to have had  in antiquity, a common
origin, the  same religion,  and similar institutions.   The  mildness  of
the climate, and  the  fertility of  the soil, which produced  abundantly
the  necessities  of life, must have invited  early the occupation  of
man; and authentic monuments attest that India  possessed the bless-
ings of civilization, while Europe was still plunged in the  darkness  of
barbarism.   Some writers even go so far, as to pretend that the torch of
civilization, was transported from the banks of the Ganges, to the banks
of the Nile;  but this is only a simple conjecture, devoid of proof, while
the contrary view is at least as probable.
   The Indians are divided into many castes,  of which the most  noble
is that of the priests or bramins.   These only have the privilege to  ex-
ercise the functions of priests and  physicians; they alone  learn  the
Sanscrit, which is the language of the learned  of  those countries, and
in which all their books are written.   Their medical knowledge is col-
lected in  a book which  they name Vagadasastir.  We possess of this
work only a few extracts, the exactness of which I dare not guarantee;
for such as they are, they give too poor an opinion of the knowledge
and judgment of the Hindoo doctors.
   This organon of Medicine, is divided into eight parts ; the first  treats
of diseases of children ;  the second of bites of venomous  animals;  the
 third of affections of the mind, which are produced, as generally sup-
posed,  by demons; the fourth part, is  consecrated to diseases of the
 sexual organs;  the fifth  to  hygiene and prophylactics;  the sixth to
 surgery;  the seventh to treatment of diseases of the eye, and of the head;
0 Ecclesiastes, Chap. XXXVIII, verses 1, 2, 3, 4. 
MEDICINE  OF THE ORIENTAL INDIANS.
37
the eighth gives directions for the preservation of youth, and the beauty
of the hair.   It is plain that no philosophic idea, lies at the foundation
of the arrangement of this medical encyclopedia.
  They admit three principal sources of internal diseases, viz: flatulency,
wodum, vertigo, bittum, impure humors, t'chestum.   They further believe
that all cutaneous diseases,  were caused by worms.  According to them
there were in the human body, one hundred thousand parts, of which seven-
teen thousand were vessels.  Each one of these is composed of seven tubes,
giving passage to ten species of gases, which, by their conflicts, engend-
ered a crowd of diseases.   They placed  the origin of the  pulse, in a
reservoir, situated beneath the  umbilicus.   This reservoir  was  four
fingers  wide, by  two  long,  and divided into seventy two  thousand
canals,  which were distributed to all parts of the body.   Upon a physi-
cian examining the pulse of a patient, he observed at the same time
very carefully, his countenance, believing that every change in the pul-
sation of the artery, answered to a corresponding change in the expres-
sion of his face.   He examined also  the  feces and  the urine,  consulted
the stars, the flight of birds,  the accidental incidents in  his visit, he
drew, in a word, his prognosis from a  thousand different circumstances,
but  omitted those which alone could be available to him,  namely, the
symptoms indicating the  state of the organs.
  The following  maneuver,  admirably illustrates the silly  credulity or
arrant charlatanism of the  Hindoo  physicians.  He let fall  from the
end  of a straw, a drop of oil,  in the vessel containing a specimen of his
patient's urine.   If the oil was precipitated, and attached  itself to the
bottom  of the vessel, he predicted an unfavorable result; if, on the con-
trary, the oil floated, he announced a favorable termination;  from which,
according to this method,  an unfavorable prognosis  must have been
rarely made.
  With ideas so  ridiculous, on  the  origin and diagnosis of diseases, it
would seem to follow, that their  therapeutics must have been  miserable
indeed.   Nevertheless, we are assured that they were very successful in
the choice of remedies, the proper time for their use, and in the manner
of preparing and presenting them.   They are said  to have had an oint-
ment, that caused the  cicatrices  of  variola to disappear.   They cured
the bites of venomous serpents, with a remedy, whose composition is un-
known  to Europeans.  In health, as in disease, their attention was es-
pecially directed to the regimen.  They observed in their persons, and
in everything about them, a minute and even excessive cleanliness.  In
short, we find in this country still, as in ancient Egypt, several classes
of physicians, each of which treats certain kinds of diseases only.   They
pretend that their science  is derived directly from heaven;  and it is 
38
PRIMITIVE PERIOD.
owing  to  this belief, doubtless, that they have not made any improve-
ments on it, for  thousands of years.

                   IV. MEDICINE OF THE CHINESE.
  The Chinese  offer to our  observation the  unique  spectacle, in  the
records of the human race, of a people who  have  preserved, for more
than four thousand years, their manners, laws, religion, literature, lan-
guage, name, and territory.  This remarkable phenomenon is certainly
related to a concourse of  extraordinary circumstances, well worthy the
attention of the philosopher and statesman;  but we can not dwell on
this subject especially, as we do not possess  the documents necessary
thereto.
  We simply remark,  that in  all time, the  sovereigns of China have
taken extraordinary care  to  prevent all contact or exchange  of ideas
between their subjects and foreigners.0   Police regulations, customs, su-
perstitions, and national prejudice, have all united to isolate the Chinese
from the rest of the world.   The language  and  writing of the manda-
rins and savans are so difficult, that it requires nearly an  entire life
to learn them.   It  is  only by force  of  perseverance in surmounting a
thousand obstacles, and braving a thousand dangers, that  the  intrepid
missionaries have been enabled to lift  a corner of  the vail with which
the  science and history  of  this  country  are enveloped.   We owe to
their apostolic zeal, the little we have to say  on these subjects.f
   The antiquity of the Chinese, as that of every nation, is  mingled
with traditions more or less  uncertain and fabulous.  But from the
year 2357, before Jesus Christ, their chronology, says  Father Du  Halde,
is perfectly well arranged; their tables exhibiting  the names of their
emperors, the duration and principal events of their reigns, the revolu-
tions, and interregnums;  and the whole is narrated in a simple manner,
without any admixture of supernatural statements.   This chronology
is supported, beside, by the observations of eclipses, whose dates coin-
cide exactly with  the calculations of  the most eminent astronomers of
Europe.   In fine, Confucius, the greatest Chinese  philosopher,  a  sage

   0 But a new era commences; the barriers which have excluded all  strangers
from entering this empire, have just been broken down by British cannon.   The
 day is not far distant when the learned curiosity of Europeans may be gratified
 by the study of Chinese monuments.
   I The description and history of China, by Father Du  Halde;  the fragments
 of Chinese medicine, translated into Latin, by Father Michael Boym, and pub-
 lished by Cleyer, have furnished the materials of  nearly  all that has been writ-
 ten up to this time on that country. 
MEDICINE  OF THE CHINESE.
39
whose opinion is of great weight, on account of his worth and probity,
has never questioned its correctness.
  They attribute the invention  of  Medicine to one  of their emperors,
named Hoam-ti, who was the third of the first dynasty.   He is said to
have  reigned 2687  years before the Christian era, which goes back
many ages before the universal  deluge, to an epoch of which their his-
tory does not treat in the same authentic manner as is referred to above.
He is regarded as the  author of a work entitled Nuy Kim', which still
serves as a guide for medical practice.  In  this work is found a theory
of the pulse, extremely minute, which clearly reminds us of the sphyg-
mics  of  the  successors of Erasistratus.  For this reason,  it has been
supposed, and not without probability, that the disciples of this physi-
cian, who were established in Bactriana, after the  invasion  of Alexan-
der the Great, communicated to the Chinese doctors  their ideas on this
subject.   The  chronicles  of the mandarins confirm this conjecture, for
they state that at that epoch the savans of Samarcand fixed their resi-
dence among them.   It is, then, very reasonable  that Nuy'Kim' is an
Apocryphal book, or rather a collection of fragments belonging to vari-
ous authors of different eras.  This is made probable by the following
resume extracted from the articles edited by Cleyer.0
   There  are set forth in it two  radical hidden  principles, heat and
moisture, which  give life and movement to all things.   The spirits are
the vehicles  of heat, just as the blood is the vehicle of  moisture.  The
harmony or disunion  of  these two principles,  their  excess or their
deficiency, in a word,  their combinations and their various proportions,
produce  that infinite variety of phenomena that are seen in the world.
 They  produce,  also, the  good  and the  bad  constitution,  health  and
disease,  life and death.
   An immoderate  degree of heat  causes  cold, and vice versa, just as
autumn  succeeds summer, and spring succeeds winter.
   Heat  naturally ascends and occupies the highest places.  It is in
perpetual agitation  by diffusion,  expansion,  rarefaction,  and penetra-
 tion.  Moisture, on the contrary, tends downward, and seeks repose;  it
 becomes condensed and viscid, and stops the pores.
    As in the universe,  we see three chief objects, the heavens above, the
 earth beneath, and  man, who, placed between these two, participates in
 the celestial as well  as  terrestrial nature;  so we  distinguish in the
 human body, three  principal regions, namely: the  superior, extending
  0 Cleyer, " Specimen Medicse Sinise."  Francofurti, anno 1682.  See, especially,
the fragment No. 2, entitled, " Tractatus de Pulsibus.'; 
40
PRIMITIVE PERIOD.
 from the  head  to  the epigastrium, which contains the  heart,  the
 pericardium and the lungs, which are all  above the diaphragm ;  the mid-
 dle,  which is bounded below by the umbilicus, and incloses the stomach
 with its annexes, the spleen, the liver and its gall-bladder, and the dia-
 phragm ;  lastly, the inferior, which comprehends the kidneys the blad-
 der,  the intestines, and the abdominal members.
   To each of  these three described regions, correspond three  kinds
 of pulse  on the hand.   The supreme or  celestial pulse, which is
 placed at the articulation of the forearm with the wrist.   It is  undu-
 lating,  full, and prominent, and is governed by heat.   That on the right
 arm  shows the state of the heart  and pericardium ; that  on the left
 side, the state of the lungs and mediastinum.  The  inferior, or terres-
 trial pulse, situated lower  down, at  the  articulation of the  wrist with
 the hand, is influenced particularly by moisture; on this  account it is
 deep-seated.  That on the  right side indicates the state of the ureters,
 the  corresponding kidney  and  small intestine;  that on the left side
 shows the condition of its corresponding  kidney and the large intestine.
 Finally, the middle pulse, or that of man, properly speaking,  is between
 the other two, on the middle of the carpus.   It is produced by a ming-
ling  of heat and  moisture, neither too high nor too  low, but properly
 combined.   On the right hand, it  marks the  state of  the stomach and
 spleen ; on the left, that of the liver and diaphragm.
   These three kinds of pulse are sometimes compared to a tree, of which
 the  superior pulse constitutes  the superior branches  and leaves; the
 middle  pulse, the trunk; and the inferior, the roots.
   The  examination of the  pulse, not only enables the Chinese physi-
 cians to show the seat of the disease, but also to judge of  its duration
 and  gravity.   They proceed to  this  examination after a method which
 appertains  to them  alone.   They place the  arm of  the  patient on a
cushion, then they apply the index, the middle and ring-fingers on the
 anterior face  of his wrist, in such a way that the index-finger may be
 nearest  the arm, and  the ring  finger nearest the hand.   They elevate
 and  depress each  finger, alternately, with more or less force, like one
 playing on an organ.   At the same time, they observe closely the move-
 ments of respiration, being persuaded that  there  exists  between  them
and  the arterial  pulse  an  intimate  connection.   They examine,  also,
 during a limited number of respirations, each of the nine pulses, which
 are formed, according to their doctrine, on each hand,  and  they deduce
 from these their diagnosis  and prognosis, which they immediately an-
 nounce  without any uncertainty or  hesitation.   They make  their pre-
 scriptions on the spot, and usually administer  their  remedies, receive
 their fees, and retire, not to return unless they shall be recalled. 
MEDICINE  OF THE CHINESE.
41
   Independently of the two active principles of which we have spoken,
the Chinese admit five elements, namely:  water,  wood, fire, earth, and
metal.  The following  is  the order in which  they are supposed  to be
produced;  water, the source of all  fertility, engenders wood or plants;
these, when they are dry, inflame and cause fire, or ignited spirits.   The
remains of the fire, or the ashes, form the earth, which in its turn pro-
duces the metals.
   The Chinese physicians  imagine a multitude of odd connections be-
tween the viscera of the human body, the elements, the  seasons of the
year, the  stars, colors,  variations of the pulse,  and numerous  other
objects  no less dissimilar.    We give but one example.
   The heart, they say, is analogous to fire, to the planet  Mars, to  sum-
mer, to spring, and to southern climes.   It comes  from the liver, begets
the spleen and the stomach, is antipathic with the kidney, and receives
no injurious influence from its contact with the lungs.
   The  natural pulse of the heart is bounding, like a full swelling wave.
Explored lightly with the finger, it appears large  and free;  but, under
a strong pressure, it becomes feeble and fugitive.   It has for an antag-
onist, the deep-seated pulse.   During the spring-time, the pulse of the
heart is like a tense cord;  in  summer it is more developed and becomes
exuberant; in  autumn it appears as if floating;  in winter it is rather
quiet.
   The heart has a predominant influence on the blood, the forehead, the
tongue, and the palm of the hands.  It  is sympathetic with  odors, red
colors, such as the comb of the cock, and lively, gay sounds, laughing,
the exhalation of a roast, bitter taste, and sweat.   Excess of joy,  heat,
inquietude, fixed attention, and bitters, injure the heart and the blood.
A black tongue, which cannot be run out of the mouth, and swelling in
the palms of the hands, are concomitant signs.   Boiling  the eyes back-
ward, with a pulse like a floating cord, announce the destruction of that
organ.
   Some writers  have been willing to accord to the  Chinese the honor of
a knowledge of the circulation of the blood, but we shall  see that they
mean by this word a phenomenon entirely different from that to which
we apply it.  They think that the spirits and the blood, both vehicles of
heat and vital humidity, run through all parts of the body in twenty-
four hours.  This diurnal circulation, they say, commences in the lungs,
at three o'clock in the morning, and ceases next day at same place, and
at the same instant.   The knowledge of the canals through which this
is effected, constitutes, in  the eyes of Chinese physicians, the fullness
of anatomical  science.   They count six canals which  pass  directly
from above downward, and an equal number which  return  from below
        3 
42
PRIMITIVE PERIOD.
 upward ;  eight run transversely, and fifteen obliquely.  The plates that
 Pleyer has placed in his memoirs, suffice to give an idea of the grotesque
 manner in which the Chinese represent these imaginary canals, and the
 principal viscera of the human body.
   Such is a summary of the doctrine contained in the Nuy' Kim'.  The
 physicians regard it as an infallible guide, and when they are mistaken
 in their prognostics, which very frequently happens, far from suspecting,
 in any respect, the excellency of the  precepts of the Nuy' Kim', they
 rather think that  they  have not well understood, or not properly fol-
 lowed them.
   These physicians relate that one of their ancient  emperors directed
 the dead bodies of criminals to be opened, that the interior arrangement
 of the body might be studied.   This  tradition  is  questionable, for it
 appears certain that,  from  time  immemorial, the  Chinese have not
 allowed researches  on  dead bodies, whether of men or animals, which
 explains their profound ignorance on  the structure  of our organs, and
 the long reign of a physico-pathologic system so replete with ridiculous
 hypotheses and  glaring  errors.   Nevertheless,  one  of  their emperors
 ordered the translation by the Jesuit  Father Parrenin, of the anatomical
 treatise of Dionis;  but this work, though  one  of  the best, previous to
 the last century, is, up to the present time,  a dead letter, a light under
 the bushel, to the Chinese doctors.0
   They divide all  diseases  into two great  classes, accordingly as  they
 attatk an organ  adjoining the vital center, such as the heart, the lung, the
 stomach, or an organ separated from the fictitious center, as the kidneys,
 the bladder, the extremities on the skin.   They have,  also, multiplied to
 infinity, the nosological scale.   Thus,  they count forty-two kinds of vari-
 ola, distinguished from each other by  obscure and  insignificant  charac-
 teristics.  They have  a variola  of the alae of  the nose,  and  of the
 circumference of the eyes, one which  is characterized by pimples, sur-
• rounded by  a red circle; others, whose pustules are acuminated  or flat-
 tened, or black, or transparent, etc.
   Notwithstanding the egregious errors of these pathological classifica-
 tions, and the absurdity of their theories, the physicians of China  must
 have been able to make, in the space of four thousand years, some precious
 observations on the march, symptoms and prognosis  of diseases, and
 some discoveries of the means for their cure.   It  is,  therefore, probable
 that there may be found, in their  voluminous  repositories, as  some
 judicious  writers  believe, a  quantity of useful  material, both  for the
  °Pere Dionis was Professor of Anatomy and Surgery at the Jardin du Roi i
1673. 
MEDICINE  OF THE CHINESE.
43
history and treatment of certain morbid affections.0   It is known, for
example, that  inoculation, by  the variolic virus, was generally  em-
ployed by them a long time before it was known n Europe.
   The Chinese appear to have cultivated, particularly, Materia Medica
and Pharmacology, if we may judge by the number of works they have
written on these subjects.' They possess  more than  forty of them, of
which one  alone, the most complete  of all, is composed of fifty-two
quarto volumes.   But the extracts that  have been made from them,
only contain a long enumeration of substances employed in Medicine,
without describing the natural  characteristics by which  they or their
preparations might be recognized by us.
   There are  no  apothecaries in that  country.  The  physicians  are
accustomed to prepare and administer their own remedies.   Some of the
most distinguished, however, simply give a formula, and leave to others
of less rank, the task of  executing it.   They daily retail in  the mar-
kets considerable  quantities of  drugs, and various compositions, which
are boasted to have an efficacy against a host of diseases.  One of the
most famous is the ginsengf root.  Incomparable virtues are attributed
to it; among others, those of reanimating the vital  forces, putting  off
the  infirmities of age,  and  prolonging the life  beyond  the  ordinary
term.   The people who believe in its  fabulous properties, buy it, lite-
rally, with its weight of gold.   Their frightful abuse of opiates is also
well known.
   Having no anatomical knowledge, surgery is uncultivated, so that it
may be said that in China this branch of medical science has  never
passed its infancy.  No  one dare attempt a bloody operation, however
slight.   The  reduction  of  hernia is  unknown,  and  a cataract is
regarded as beyond the resources of Art; even blood-letting  is wholly
unpracticed.  On the other hand,  they frequently  employ  cups and
acupuncture, which they execute with needles of gold or silver ;  fomen-
tations, plasters  of all kinds,  lotions, and baths.   They make  much
use  of fire, by means of moxas, or red-hot  buttons.   They have  even
their magnetizers, whom the author of the " Chinese Letters "  compares
to the convulsionists of Saint Medard.  In a  word, their therapeutics,
whether internal or external,  recalls that of tlie Europeans during the
darkest period of feudal times.
  ° See the excellent "Dissertation sur la Me'decine des Chinois," by M. Lepage.
Paris, 1815, and the article of the Diet, des Sciences Medicales, by M. Bricheteau,
sur " Me'decine des Chinois."
  f See Merat et Delens, " Dictionnaire Universel de Matiere Me'dicale."  Paris,
1831, t. Ill, p. 356. 
44
PRIMITIVE PERIOD.
  Formerly, there existed, at Pekin, imperial schools of  Medicine,  and
no one could then practice Medicine without having  served an appren-
ticeship, and given proof  of  his capacity.   Beside, it is said, there was,
for each district of six leagues square,  a physician  chosen  to  instruct
those who were required to serve the inhabitants of the country.  At
this  time,  there  is no  such organization, every one has  the right of
selling, prescribing, and  administering remedies, without any exami-
nation, authorization, or restraint.
  How inconceivable is the stupid  indifference  of a government which
requires no guarantee of knowledge or  morality on the part of  individ-
uals who are every moment the arbiters of the health and  the life of
their fellows, whose profession  renders them the  depositories of the
most sacred family secrets, by giving them easy access to persons of all
sexes,  ages, and conditions.  It is  said that physicians in China  are,
generally, but little respected, nor do they deserve  more consideration,
excepting those in whom the profession  is  hereditary.   This deep  dis-
credit into which  the Art of Healing  is fallen, or rather of those  who
cultivate  it, need not astonish us; it is the  natural result of the
absence of all law regulating the practice of Medicine.   The  same is
true among all nations  under analogous circumstances, as  this history
will prove.   We might refer the reader, by anticipation, to the picture
that Galen has drawn of the deplorable effects of the medical  anarchy
which reigned at Kome  in  his  time ; we might also refer to the low
state of  Medicine during the first ages  of the feudal period, before the
establishment of universities.  But, without searching so far back  into
the  annals of the race, it will suffice  to  place before the eyes of the
reader the  reflections which such  a  state  of things suggested to the
author of the Medical Law of the 19th of March, 1803.
   "Men united in society," says  Thouret, "have, in all times, been
subject to evils  growing  out  of their intercourse,  which  have often
caused philosophers to think that this intercourse itself was more inju-
rious than useful to humanity.  The utility of this consolatory Art has
been felt among all nations and in  all ages.   There  exists no govern-
ment which does not  render it a favorable support, and which is not
interested, more or less, in its progress.  Anarchy only, which respects
no  institution,  could  ignore the  importance of  the Healing Art; it
belongs to every reformative government to restore to this branch of
instruction its ancient splendor and advantageous results.   Profoundly
penetrated with the necessity of re-establishing order in the exercise of
a profession which interests essentially  the security  of the  lives of  citi-
zens, the government presents to you a project of a law, having  for its
object the regulation of the practice of this salutary Art. 
MEDICINE  OF THE CHINESE.
45
  " Since the decree of the 18th of August, 1792, which suppressed the
universities,  faculties, and learned corporations,  there is no longer any
regulation for the  privilege of practice of Medicine or Surgery.   The
most complete anarchy has taken the place of the former organizations.
Those who have studied the  Art find themselves  confounded with  those
who have not the least notion of it.  The lives of citizens are in  the
hands  of greedy and ignorant men; the most  dangerous empiricism,
and  shameless  charlatanism impose, everywhere, upon credulity and
good faith.   No proof of knowledge and skill is required; the country
and cities  are equally infested with  quacks, who deal out  poison and
death with  an audacity that our present laws can  not repress.0   The
most murderous practices have usurped  the place of  the  principles of
the Art of Midwifery.  Impudent barbers and bonesetters assume  the
title of " health officers," to cover their ignorance and greediness.  Never
has the  list  of secret remedies, always  dangerous, been so extensive as
since the  suppression  of the faculty of  Medicine.   The  evils  are so
grave and so multiplied, that many mayors have  sought  a  means of
remedying them, by establishing a kind of jury, charged with power to
examine the men who wish to practice  Medicine in  the  departments.
But these local  institutions, independently of  the variety of tests of
qualification that they  have adopted,  open  the door to  new abuses,
arising from the superficial nature of the examinations, and sometimes
from  a  still more impure  source.   The  Minister of the  Interior  has
been compelled to annul the permits of  several mayors, from the abuses
and irregularities they connived at.  It is, then, urgent to  destroy all
these evils at  once,  and to organize a uniform and regular mode of
examination and reception for those who wish to devote themselves to
the cure of the  sick."f

   V.  MEDICINE AMONG  THE GREEKS DURING THE PRIMITIVE PERIOD.
   Greece, which will, hereafter, furnish  us  the most interesting and best
preserved debris of the Healing Art of the ancients, does not give us, in
regard to the history of  this Science, during the ages  that precede the
Trojan War, anything more than dim lights and  tradition  stamped with
a fabulous  character,  and  often borrowed from other nations.   The
learned and  modest Daniel Leclerc, details  at great length  her medical
mythology ;  he names  more than  thirty gods  or goddesses,  heroes or
heroines, who were supposed to have invented or cultivated, with distinc-
tion, some of the branches of Medicine.   He interrogates, successively,

  ° These remarks are very applicable to most of our state governments.
  f "Jurisprudence de la Medecine, de la Chirurgie et de la Pharmacie en France,"
by Adolphus Trebuchet.  Paris, 1834, page 408, etc. 
46
PRIMITIVE PERIOD.
history, poetry, chronicles, and inscriptions;  he neglects nothing in the
hope of shedding some light on the chaos of improbable or contradictory
traditions ;  but his praiseworthy though unfruitful efforts have not drawn
from them any valuable truths,  nor well established  facts.   Sprengel,
who undertook the same task, two  hundred years later,  with germanic
patience, has only succeeded  in  displaying a vast  and confused erudi-
tion.0  It would  then  be temerity on my part to enter into a labyrinth
where men of such great wisdom have lost  themselves.   I shall content
myself by extracting from these  fabulous legends a few anecdotes, and
some of the best credited names, that have become common knowledge,
and which a physician  ought  to know, or suffer the imputation of ignor-
ance of the history of his Profession.
   Melampus is the first of the Greeks, following the chronological order,
who immortalized himself by extraordinary cures, and  to  whom, from
gratitude, altars were erected.  He  lived in the times of Proetus, king
of Argos, nearly two hundred years before the  Trojan  war.   He is said
to have  cured Iphiclus  of impotency, by giving him  the  rust of iron.
But this is difficult to accredit, when we are  assured that Iphiclus took
part in the Argonautic expedition, one hundred and fifty  years later.
   The most famous of the cures attributed to Melampus. were those of
the daughters  of Proetus.    These princesses, who had  taken  vows of
celibacy, became subject to fits of hysteria or monomania, during which,
they imagined themselves  transformed  into  cows, and would leave the
palace to run wild in the forests,  lowing like  those  animals.  This ner-
vous  affection  was communicated,  sympathetically, to other women of
Argos, who followed the Proetides, imitating their deranged conduct.
The shepherd, Melampus, having observed that his goats purged them-
selves by eating white hellebore,  gave his young patients milk in which
this plant was infused, and then caused  some  robust young boys to chase
them over the field- until they were thoroughly f tigued.   Then he en-
chanted them, and made them bathe in  a fountain of Arcadia, called Cli-
torian,  which  completed their cure.   In pay for  so great  a service,
 Proetus offered to Melampus the hand of one of his daughters with the
third of his kingdom.   The herdsman showed, on this occasion, as much
fraternal affection as  medical perspicacity, for he would not  accept the
offer of the monarch, except on condition that his brother  Bias should
 have a reward equal to his own.
   Chiron is less illustrious in the great acts  that he performed than in
 the pupils he reared.   He held his school  in a grotto in Thessaly, and,
  °See also "l'Histoire de la Chirurgie," commenced by Dujardin.and continued
byPeyrilhe.  Paris, 1774-1780. 2vols.in4to. 
MEDICINE OF THE  GREEKS.
47
if the chronicle may be believed, no philosopher of antiquity, no pro-
fessor in modern times, could count in his audience as many celebrities
as the Centaur saw in his cave.  A majority of the  heroes who distin-
guished themselves at the capture of the fleece of gold, or in the Trojan
war, boasted of having been his disciples.  Among these are enumerated
Hercules,  Jason, Theseus,  Castor and  Pollux, the  subtle Ulysses, the
fiery Diomedes, the prolix  Nestor, the  pious Eneas, and the invincible
Achilles.   The hermit, it is said, taught them philosophy, music, astron-
omy, the military art, political science, and medicine.   He cured Phoenix,
son of Amyntor, of a blindness supposed to be incurable, and  his renown
for the treatment of ulcers was so great, that the name of Chironians was
given to those which resisted all curative means, and presented a malig-
nant  appearance.   The  etymologists derive  the word Centaureus, from
Centaur, in order to  remain true  to the mythological  tradition, and
doubtless  from  having no  better substitute.  Finally, it is said,  that
this hero  or demigod, so  skillful in dressing wounds of  all kinds, met
his death from the wound  of an arrow, poisoned by the blood of the
hydra of Lerna.
   Esculapius,  of all the disciples of Chiron, was the most eminent,  in a
medical point  of view.   He passed for the son of Apollo,  by  the nymph
Coronis.  Several  cities of  Greece have contended for the honor of his
birthplace ;  but the general opinion  is, that he was born  at  Epidaurus
a city of Argolis, where  he had  a temple and  a famous oracle.   The
twins, Castor  and Pollux,  were  anxious that he should accompany the
Argonautic expedition, which shows  that he was famous  at that epoch,
as a physician, or rather, as a surgeon.
   The Esculapius of the Hellenists, being of a  date posterior to the
Hermes of the  Egyptians, and these two characters, having between them
many traits of  resemblance,  certain authors have  thought that the
latter might probably only be a  copy of  the former.   They have denied
the individuality  of the god of Epidaurus, and have accused him of
being a twin  brother of his colleague  of  Memphis.   Leclerc,  after
having  deeply studied this grave question, in  every respect,  has not
dared to decide it.  My views correspond with his.
   However  this may be, Esculapius obtained  in  antiquity,  nearly a
universal  veneration.   His  worship, which passed  from  the Greeks to
the Romans, extended into  all countries, penetrated  by the arms of these
two nations.   We  shall speak elsewhere of the principal temples erected
to his honor, of the priests  that were  connected with them,  and the
progress they made in Medical Science.   For the present, we shall  con-
tent ourselves  with relating some of the cures attributed to him,  and 
48
PRIMITIVE PERIOD.
glance at the opinions of the ancients, relative to his manner of treat-
ing diseases.
  It is said he brought from death to life, Hippolytus, son of Theseus,
a Capaneus, a Lycurgus, an Eryphile, and many others.  Pluto, god of
Hell, alarmed to see the number of new arrivals to his gloomy kingdom,
diminishing  day by  day—complained  to Jupiter, who destroyed  the
audacious healer.   On this account says a wit, the modern children of
Esculapius abstain from performing  prodigies.  But the witty writer
forgot, that there  has always existed, and now exists, a class  of self-
styled physicians,  who have  never  ceased to perform miracles.   They
are called, according  to circumstances, charlatans,  quacks, theosophs,
thaumaturgs,  etc.   Such were, among others, Asclepiades of Bithynia,
who resuscitated a corpse, in a public  place  in Borne, in open day;
Paracelsus, who boasted of keeping in a vial, a living little man, man-
ufactured by  himself; Robert Fludd, the  oracle of modern theosophs;
Mesmer,  the magnetizer, and their adepts.
  In regard to the method which Esculapius followed, in the treatment
of diseases, as well as to all else relating  to this god, we possess no doc-
uments, entitled to much credit.  The poet Pindar, who lived seven or
eight hundred years later, is the first to  describe it  in the following
terms: "Esculapius," says  he, " cured the ulcers, wounds,  fevers and
pains  of  all who applied to him, by  enchantments, calming potions,  in-
cisions, and by external application?."0
  The greatest number of writers, after the Boeotian poet, such as Galen,
Plutarch, Pausanias, Pliny and others, have reiterated the same  views.
Plato, comparing the practice of Esculapius,  with that of  his cotempo-
raries, gives the preference to  the former, for reasons which deserve  to
be reported.
  In the third dialogue on the republic, Socrates, when interrogated by
Glaucus,  responds  as follows:
  "Is it  not a shameful thing to be compelled to call upon a physician,
not for the cure of wounds, or the diseases of the seasons;  but for such
as are produced by the indulgent life I have described, which  fills  us
with humors  and  unhealthy vapors,  like swamps; thus  obliging  the
worthy sons  of  Esculapius,  to  invent such new names, as catarrhs,
fluxions,  etc."
  " Indeed, Socrates,  these  are  new  and  extraordinary names of dis-
eases."
  "Yes!  such as  did  not exist in the times  of Esculapius, I think, and
what leads me to believe it, is, that  his sons  (Machaon and Podalirius),
3 Third Pythian Ode. 
MEDICINE OF THE GREEKS.
49
during the siege of Troy, did not blame the women who gave as a bever-
age to the wounded Eurypylus,  Pramnian wine, upon which  she had
sprinkled flour  and grated cheese, both of which have an inflammatory
tendency; nor Patroclus, who cured wounds with herbs."
  "It was strange,  nevertheless,  to  give that  beverage to a wounded
man."
  "It was not, if  you reflect that before Herodicus,  the art of treating
and curing diseases, as is now attempted, was not put in practice, by the
disciples of Esculapius.   Herodicus was the master of a Gymnasium ;
becoming a valetudinarian, he combined gymnastics and medicine, by
which combination he tormented himself, and many  others after him."
  "In what  way?"
  "By producing  a slow death, for as his disease was mortal, he followed
it step by step, without being able to cure it, and neglecting everything
else to take care of himself.   Distressed by anxieties, if he varied ever so
little from his  regimen, by force of art he  reached old age, by a life
of real agony."
  "His art rendered him an excellent service! "
  "He well merited it, for not having seen, that if Esculapius  did not
teach to his descendants that  system  of Medicine, it was  neither from
ignorance,  or defect of understanding, but because he knew,  that  in
every well-ordered government,  each  citizen  has a  task to fulfill, and
that no one has leisure to pass his life  in sickness, and in taking care of
himself.   If  we see the absurdity of this method, for artisans, we see it
none the less for the rich, and the pretended happy of the world."
  "Explain yourself?"
  "Let a carpenter be sick, he is benefited by a physician, who  relieves
him by a vomit or a purge, or rids him of his disease by fire or steel, but
if one comes to him  and prescribes a long  regimen,  enveloping his head
in cloths, and other similar treatments, he very  soon must say,  that  he
has no time to be sick, and  that there is no  advantage in  living thus,
occupying  himself with  his  disease,  and neglecting his labor which
awaits him.  He says, away with such medical treatment, and resuming
his ordinary  style of living, recovers his health, and  goes to^work again;
or, if his system can  not resist the disease, death  comes  in to relieve
him from his embarrassment.   These  are, according to my opinion, the
considerations that led Esculapius to  prescribe a treatment,   suitable
only for the diseases  of persons of strong constitutions, and good habits;
and to limit his remedies to potions and incisions, without changing their
manner of living, wishing not to harm society.  But in regard to those rad-
ically unsound, he was not willing to assume the responsibility of prolong-
ing their lives and sufferings, by injections or ejections, given according 
50
PRIMITIVE PERIOD.
to circumstances, and thus put them in a condition, to beget other beings,
destined most likely to  inherit their diseases.  He thought that  it was
not required to treat those who could not fulfill the career marked out by
aature,  because it was  neither advantageous to themselves, nor to the
state."
  '•You make a politician of Esculapius.''
  "It was evident that he was one, and his children furnish  the proof
of it; for  while they fought with intrepidity under the walls of Troy,
they practiced Medicine, as I have just stated."0
  The above argument, tending to prove that Medical Science must not
be occupied with valetudinarians or individuals of a debilitated  consti-
tution,  is  destroyed by the simple remark of one of the interlocutors,
" You make  a politician of  Esculapius."   It is certainly  wrong in
Socrates, or Plato, as explained by him, to  desire that the  physician
sacrifice the sentiments of his nature, and the right of suffering human-
ity, to the exigencies of an unpitying political economy.  No, whatever
this sage may say, a physician must not ask himself, if the preservation
of the individual who claims his  services is likely to be  burdensome
or useful to the State.   In ancient republics, such atrocious patriotism
was praised,  but modern civilization repudiates it.   It does not  permit
the physician to consider any  such question  in regard  to his patients;
he must do all he can for them.
  Such is the view that the medical  corps  of France has held of its
duties,  under all  phases of our internal dissensions.   A striking proof
of this  has been given but very recently.   It may be remembered that,
at the close of one of the bloody contests in  the capital, which  took
place during the  first  years of the reign of Louis-Philippe, a chief of
police endeavored to force the physicians to tell the names of the wounded
whom they attended.   The magistrate thought this an honest way of dis-
covering the  enemies of the  government;  but the public, as well as the
medical corps, saw in  this a  shameful abuse of confidence, the espio-
nage  hiding itself in the cloak of the minister of benevolence.
  Policy was obliged to bend before the morale, and this is not  one of
the least glories of  our epoch.  This would not have taken place in the
time of Plato, for the opinion which we combat here, and of which the
philosopher has made himself the  echo,  appertains much less to him
than  to his age, it  reigned  in all  the ancient  republics  prior  to  the
advent  of Christianity.
   Machaon and Podalirius touched the limits that separate  mythology
from  history; these two personages participate  in this double charac-
0 De la Republic, Book III, translation of M. Cousin, p. 167, et suiv. 
MEDICINE OF  THE GREEKS.
51
ter;  their biography is a mixture of fabulous and probable narrations.
Their existence, for  example, can  not be considered doubtful, for the
Homeric songs, and other ancient writings, agree in representing them
as valiant captains and skillful physicians, who  took an active part in
the siege of Troy, but the statement of their genealogy does not inspire
us with the same confidence.   They are said to be the sons of Escula-
pius, and we know that the reality of this famous individual is exceed-
ingly problematical.  Beside,  the words, children  of Esculapius,  are
often employed figuratively by ancient authors,  to  designate  men who
devoted themselves to the medical profession.
  Machaon was regarded as the elder of the two brothers.   He treated
Menelaus,  when that  prince  was treacherously wounded by Pindar.
He   cured, also, Philoctetes, who  was lame from  a wound which he
inflicted upon himself, by letting fall upon his  foot one  of the arrows
of Hercules.   This illustrious  surgeon met his death in a singular com-
bat  under the walls  of Troy.
  Podalirius survived him, and assisted in the ruin of the kingdom of
Priam, but on his return he was cast by a tempest  on the shore of  Ca-
ria.   A shepherd rescued him,  and learning that he was  a physician,
he conducted him to Dametus,  the king of the country, whose  daughter
had lately, accidentally, fallen from  the top  of the house.   She  was
insensible and  motionless, and the  attendants  already supposed  her
dead, but this skillful  surgeon bled  her from both  arms,  and had  the
happiness of restoring her life.
  Here is the first example of bleeding practiced for the  purpose of a
cure; unhappily, it  is not very authentic.   Stephen, of Byzance, who
reports it, wrote in the fifth century, nearly 1600 years after the event,
and he does not indicate the source whence  he obtained  it.  However,
the  habit of bloodletting goes back far beyond the  era of Hippocrates,
for  he speaks of it, in several  places, as a common practice in his time.
  The other members of the  family  of Esculapius are  all  fictitious
beings, whose symbolical names only remind us of some attribute in
Medicine.   Thus, the name of  Epion, his wife, is derived from a Greek
word, which signifies  to  quiet;  those  of Hygeia and  Panacea,  his
daughters, express, the  one health, and  the other, a remedy for all
diseases.
  Moreover, many of the gods and goddesses of  Olympus  assumed  the
honor of fulfilling some medical function.  Apollo, or  Phoebus,  the
father of  Esculapius, usurped  nearly everything.   Under the  name of
P;von, he assumed the privilege of exciting or appeasing epidemics.   It
is well known that Juno  presided at accouchements, and took at  those
times the  surnames of Lucina, Ilithyia, or Natalis.  In  short,  by the 
52
PRIMITIVE PERIOD.
ingenious  connection of many passages in the Iliad and  the Odyssey,
M. Malgaigne indicates that Apollo was considered as the author of all
the natural deaths among men, and Diana of those among  women.
  At an  epoch  when  yet  the earliest inhabitants of Greece,  called
Pelages, lived on the acorns of their forests,  and were covered with the
skins of wild beasts, making their homes in caves ; Egypt, Phenicia,
and Chaldea already rejoiced in the blessings of an  advanced  civiliza-
tion.   The emigration of successive parties from  Sais, Tyre, and Mem-
phis, carried to the hellenic peninsula the germs  of the arts  and sci-
ences.   Inachus, the victim of a revolution, conducted to Greece the
first  Egyptian colony,  and laid  the foundation of the city of  Argos,
1856 years before Christ.   Several ages later, Cecrops, obliged to fly
from the banks of the  Nile, landed on the shores  of Attica, and became
the founder of Athens, which he  consecrated to Minerva.   Cadmus
came from Tyre with a company of Phenicians, and established himself
in Bccotia.  He  built the walls of  Thebes, which  citadel bore his name.
   The major  part of the aborigines embraced, either from  taste or com-
pulsion, the habits of civilized life, and adopted the worship  and laws
of the new comers, while a certain number, still preferring the indepen-
dence and idleness of a nomadic life, formed themselves into wandering
bands that devastated  the country, driving off the flocks, and despoil-
ing and murdering travelers.   The founders of the new colonies made
a war of extermination, and the first men who signalized themselves by
victories over the chiefs of  the brigands, or the  savage monsters of the
wild country, were considered as heroes, and benefactors of humanity.
Gratitude mingled their praise with  that of the  gods.  Gradually the
recollection of these events became dim, because the narrations were
not committed to writing.  The adventures of  these earthly  heroes
were confounded with those of the gods imported from foreign countries.
Names and dates were mingled together, and the  national  vanity grati-
fied itself in  giving Greek  origin to both, and in  transferring the thea-
ter of all the celebrated events, and great  discoveries, to the hellenic
territory.   The  earliest chroniclers appearing a long time afterward,
made no effort to go back to the source of the  traditions, and clear up
their obscurity, by comparing them with each other; they only made
themselves the  echoes of popular belief.   This  is the reason why the
mythology of the  Greeks, although sufficiently modern, offers  as much
uncertainty and obscurity as that  of nations much more ancient. 
THE ORIGIN  OF MEDICINE.
53
                       CHAPTER  II.

MEDICINES OF SOME OTHER NATIONS OF THE OLD AND NEW WORLD.

  The history of other nations offers nothing peculiarly remarkable,
in a medical point of view.   All that can be affirmed of each one of
them is, that just as far"as we can go back in their annals, we always
find some  vestiges  of  Medicine.   Thus, Hippocrates mentions certain
medical practices, in use among the Scythians.  We have stated before
the practice of the Portuguese and  Babylonians, of exposing  the sick
before  the doors of the houses, in order that passers-by might give
them their advice.  In short, we  also know, that in Gaul and in the
Britannic isles, the Druids were at the same time priests, legislators and
physicians, and  that  their women shared with them their offices and
prerogatives.
  In the New World, the same phenomena are produced among a people,
who have had no species of communication with the inhabitants of the
Old World.  Antonio  de Solis  states,  that Montezuma,  emperor of
Mexico, possessed gardens, where great numbers of plants were culti-
vated,  whose properties  were well-known to  the  physicians of the
country, who employed them with success.  Cortez having been  attacked
with a grave disease, assembled a  council of the most skillful native
physicians, who employed various  remedies, and in a short time restored
the eminent  patient to health.   In  the  island of St.  Domingo, the
priests named butios, were both physicians and  apothecaries.   Among
the Apalachicolas, a tribe in Florida, the sacrificers to the sun, practiced
Medicine, to the exclusion of other castes.  Finally, now that all parts
of the globe have been  explored, we are  able to repeat with  assurance,
that sentence of the elder Pliny, which says, "no nation has existed,
entirely destitute of Medicine, though some  may be found, that  have
had no men, especially occupied as physicians."
                      CHAPTER  III.

                 THE ORIGIN OF MEDICINE.

  If we should be asked, what has  taught men to provide themselves
with things indispensable to life; to prepare  their food and  clothing,
and habitations against the inclemencies of the seasons, etc.; our unem-
barrassed and prompt reply would be: it is necessity, it is the instinct 
54
PRIMITIVE PERIOD.
of preservation.  Again, if we are asked, what has inspired the same
men to aversion for pain,  the  fear of disease and  death, the desire to
prevent sickness, not only for themselves, but also  for all those that are
dear to them;  we should  again  promptly and  readily  answer, it is  a
natural, irresistible instinct, which is realized by the savage of the wilder-
ness, as well as by the inhabitants of cities;  by the poor, as well as by
the rich—by the philosopher and ignorant; in the frozen regions  of the
north, as well  as under the burning heats of the tropics.  There  is but
one step between this instinct and the invention of Medicine; and we shall
proceed to see  how this has been achieved.   This  will be comparative-
ly an easy task, as we possess one  of the most ancient books,  which
furnishes  on this subject,  very positive and  explicit  testimony; it will
be sufficient to make a textual extract.
  "Necessity  itself," says the author, "forced men to seek  the inven-
tion of the Medical Art,  for they saw as well  as  we do now, that  the
regimen proper in health,  is injurious in sickness.  Moreover,  in  going
back into  past ages, I think that the kind of life and nutrition in vogue
now-a-days, would not have been discovered, if man,  for his drink  and
food, could have employed that which is used by the ox, the horse,  and
all  other  animals of an inferior order, namely, the simple productions
of the earth, fruits, herbs and grass.  Animals are nourished by  these,
and grow and live without any inconvenience.   Doubtless in  the earliest
times, man had no other  nourishment, and  that which he  employs at
present, seems to be an invention that has been elaborated during  a long
course  of  years;  for  rude and  coarse  diet  must have caused  much
violent suffering,  just as is realized now, from a similar alimentation.
Those who make use of such crude and undigestible  materials for food.
are subject  to pains, diseases and  sudden death.  But the people of
those times, being habituated to it, doubtless suffered less than we suffer ;
nevertheless, the evil was great, even for them;  and  many, especially
those of a feeble constitution, must have perished.   Such,  it seems to
me,  was the cause of men seeking food, more in harmony with  our
nature; which led to the  discovery of that which is now employed.
   " The men who sought and discovered the Art of  Medicine, having the
same ideas as  those of whom I have spoken above,  did I presume, when
not feeling well, withdraw something from  their accustomed food;  and
in place of a full diet, directed the sick to eat less.   It  happened that
this regimen was sufficient to arrest diseases in some persons, not  in all,
however;  for some of them, were  in such a state, that they could  not be
relieved,  even by the use of a  smaller quantity of their  usual food.
Then it was suggested to prescribe a weaker diet, and soup was invented,
in  which a small  quantity of solid substance, is mingled  with much 
UTILITY OF  MEDICINE.
55
water, and well diffused by boiling.   Finally, those who could not even
support soup, were  supplied with  simple drinks;  care being taken to
give them neither too much nor too little.
   " Did not he then, who in the opinion of all was called a physician,
who discovered the  dietary of the sick, follow precisely the same course,
as he who changed  the savage and brutal manner of living of the earli-
est men, by substituting  a diet more like ours ?  In my opinion  their
method was the same and the discoveries identical."0
   This  explanation, of remarkable simplicity and exactness, shows us
how men were gradually led  to  lay  the foundations of Medicine.  It
sufficed them to observe that certain  things were good, and others bad,
so that the  former  might be  employed, but the latter abstained  from.
Thus,  as the application of a hot cataplasm on the side soothes the
pain of pleurodynia,  in Thrasimenus; it was naturally supposed that
the same  remedy  would  relieve  Eurimedon of a  similar  trouble;
so a venesection, having  cured the daughter of Damatia,  deprived of
consciousness by a  fall from the roof, it  was concluded that all  simi-
lar  cases  should  be  treated  in a  like  manner.   The  reasoning
under these circumstances was very simple; no inquiry was made as to
the mode of cure  by the remedy, it was sufficient  to show that they
were cured, in order to feel authorized to apply the same  treatment to
analogous oases.  Observation  and memory then, which constitute ex-
perience, were the principal faculties put in exercise; reason entered very
little into their therapeutical considerations.   Such was the first step of
the human mind, in the Medical career; it  consisted in substituting
the lights of experience for the brute  suggestions of instinct, a substitu-
tion rational and advantageous, as we shall demonstrate hereafter.
                      CHAPTER   IV.

    THE UTILITY OF MEDICINE DURING THE PRIMITIVE PERIOD.

  Those who boast of the certainty and perspicacity of instinct—those
who wish that man, in imitation of animals, followed only his appetites
in health and disease;  have never reflected on the daily and often fatal
errors of the appetites uncontrolled.   It will suffice to give them some
examples to unprejudice their minds, and  convince the reader, that the
lights of experience are less faulty than our instinctive tastes, especially
among the  sick.

  0  Works of Hippocrates, translation  by M. Littre. Traite' de l'Ancienne
Medecine. 
56                      PRIMITIVE PERIOD.

  1. Let a traveler, after  a long walk under an ardent sun, covered
with dust and sweat, and dying of thirst, come to the side of a cool and
limpid spring; instinct would lead him to take long, deep draughts of its
waters; but woe to him if he does not resist the temptation.  It is not
necessary in this place, to recall  the example of  Alexander the Great,
arrested in the midst of his triumphant career, for having yielded to a
similar temptation,  to  bathe in the waves of the Cydnus.  No  one
reaches the years of discretion,  without  knowing,  either by personal
experience, or the hearsay of others, how dangerous  such  conduct is,
and how fatal it has been in many instances.
  2.  A miserable shipwrecked sailor, who has endured the  torment of
hunger for many days, is  finally  rescued by a vessel fully provisioned.
Do  you suppose that the commander of  that ship, would  allow him to
eat and drink to full satisfaction ?  No,  certainly,  for it would cause
the speedy death of  the unfortunate sufferer;  the blind and imperious
cravings of his  appetite, would permit only  a  partial gratification.
  3.  A woman in labor, is attacked either with hemorrhage, or convul-
sions,  or  her child has a bad  presentation.   Would you  abandon  this
accouchement entirely to the resources of nature ?   There is much reason
to fear, that under such circumstances, the mother or the child, or even
both would succumb, if Art comes not to  their relief; but by a simple
and painless maneuver, the skillful accoucheur will, in most cases, save
the lives  of both.
  4.  Let an individual be attacked with an  intermittent fever; instinct
suggests to him to employ much covering,  during  the cold stage, and
cast it off during the fever ; and quench his burning thirst with copious
draughts of water.   The  paroxysm passed,  he  resumes his ordinary
life without any precaution, because he is sensible  of  no  change in his
condition, except a  slight diminution of strength  and appetite.   Du-
ring each paroxysm, his instinct suggests only a  repetition  of the same
acts.   Now what will be the result?
   If the attack is mild, the climate healthy, and  the patient  have  a
"ood constitution, he will recover by the efforts of nature alone, after a
few repetitions of the paroxysm;  but in most cases, one or more of these
favorable conditions are  wanting, then the scene  is changed, and the
results are very different.   Sometimes the subject succumbs in a few
days; at others, the fever assumes a remitting type, and goes on indefi-
nitely, producing  at  length, visceral  congestions, chronic  inflamma-
tions, and incurable  degeneration of organs;   in  fine,  in cases  less
 severe, the subject  has a slow convalescence, and is  for a long time,
 incapable of active labor.  Thanks to the progress of  science, these 
UTILITY  OF MEDICINE.
57
 sort of  affections, formerly so common and  disastrous, are now rarer,
 and much less formidable.
   5. A man has a luxation of his arm, or a fracture of his leg;  what
 does his instinct counsel ?  To keep it in  such repose, as prevents any
 movement  of  the  injured  member, because   the slightest  motion
 excites severe pain;  but experience teaches us, that unless he will sub-
 mit to the momentary increase of pain, which the manipulations of his
 surgeon will cause in his efforts  to adjust it, he will infallibly lose the
 use  of  his member, and very probably too, endure a great amount  of
 subsequent suffering.
   In a multitude of cases more, it could be shown that the suggestions
 of instinct are faulty and pernicious.   After having proved a thousand
 times the danger of  following so untrue  a  guide, a surer method was
 sought in the lessons of experience.
   The first discoveries that were made on this plan, appeared so admi-
 rable and useful, that they were  conceived to be a  divine inspiration,
 and those who were regarded as the inventors and propagators, received
 divine honors.   Thus we see,  there  was a  real progress,  an efficient
 amelioration, by adding the lights of experience to the brute  sugges-
 tions of instinct—in  passing  from  the  state  of simple  nature,   to
 that of the commencement of medical  science.  It belonged to  history
 and medical philosophy to establish this fact, which sanctions and jus-
 tifies these early efforts of the race, to lay the foundation of the Healing
 Art.  Thus a serious examination,  refutes the eloquent declamations
 of those philosophers who propose to us, to make the animals our models;
 proclaiming continually the unfailing sagacity of instinct; and so, also,
 is swept away the apparent wisdom of  the following  words of J.  J.
 Rousseau, put in the mouth of his pupil; "If I become sick," says Emi-
 lius, in a letter to Sophia, "a very rare  circumstance in a  man of my
 temperament, who indulges in no excess of food or care, or labor or rest,
 do not torment me with efforts to cure me, nor frighten me to death.
 The young animal that is sick, rests  in one place, gets well, or  dies:
 I would do likewise,  and I should be the better by it."°
   The grave philosopher of Geneva had never reflected, it is reasonable
 to suppose, on the serious inconveniences of  that method, in an  infinite
 number of cases; among those cited above, there are several  in which  it
 would have been fatal.
   To his authority, we are able to oppose that of another philosopher,
 who was his cotemporary,  and no less celebrated than  himself.  "It is
admitted," says Voltaire, "that a good physician may save our lives in a
 "' Traite' de l'Education.  2de Lettre d'Emile a Sophie.
4 
58
PRIMARY PERIOD.
hundred cases, and restore to us the use of our members.   A man  falls
with apoplexy: it will not be a captain of  infantry, nor  a  counselor of
state that will cure him;  cataracts form in my eyes:  my neighbor can
not remove them.  I make no distinction here between  the physician
and the surgeon ;  the two professions have been inseparable for a  long
time.   Men who would occupy themselves with studies and efforts to give
health to  other men, from the sole  principles of humanity, should be
considered far  above the grand of the world;  they were  kindred to
divinity.  To preserve and repair, is  nearly as admirable as to create.
The Roman  people were satisfied to remain five hundred  years without
physicians.   That people only  occupied  themselves with killing, and
made no efforts to  save life.   What became of those who had  a putrid
fever,  an  anal fistula, a  carbuncle, or an inflammation  of  the lungs?
They died.0
  But the greater number of the detractors of Medicine, do not deny in an
absolute manner, the utility of the Art, in a thousand instances;  they
do not contest, for example, the utility of certain surgical  operations,
nor the regimen in  acute diseases; but  they reject in general, scien-
tific Medicine, Medicine as an Art.   Thus the elder Cato pursued  with
his ordinary obstinacy, the philosophers, rhetoricians and physicians of
Greece, whom he accused  of corrupting the manners of the Romans, and
he finally  succeeded in obtaining a decree  for their expulsion;  but not-
withstanding all his efforts, the physicians were excepted in the decree.
This same Cato wrote a work  on domestic and veterinary Medicine; he
treated the men of his household and his animals with remedies  prepared
by his own  hands, and report says, that his wife fell a  victim to his
prejudices in Medicine.   The encyclopedist Pliny, who wrote a materia
medica entirely drawn from  Greek  authors,  did not dissimulate any
more, the  sentiment of profound jealousy that he felt,  on  'account of
the superiority of that nation in science and  letters.   He declaimed
against foreign physicians with a blind violence, that led  him even to
proscribe  the use of exotic plants.
  At this point naturally belongs  the relation of an anecdote, which 1
once heard told of an old doctor, which I will  endeavor to  state in his
own words.   "I was one day," says the worthy practitioner, "at the
house  of  one of my patients, who  had recovered from a  rather severe
attack  of illnesss, when  an  inhabitant  of the  neighborhood,  who had
lately  come  from Paris, called to pay him a visit.  After the first  com-
pliments the conversation  fell, as is usual in such cases, on medicine and
physicians.  ' As for me,' said the provincial,' I have no faith in Medicine;
0 Dictionnaire Philosophique. 
RESUME  OF THE PRIMITIVE  PERIOD.
59
 I believe that one would recover just as well without, as with it.  But then,
 I  have never had a serious attack of sickness.'  Your incredulity, then.
 I replied, arises from that condition, and you will do well to maintain it.
 ■ I speak only for myself,' added our provincial, ' for, as to  others, I am
 the first to administer remedies to them.   As  I dwell in the country,
 far from the residence of all  physicians, I  have  in my house a little
 pharmacy, which I  am  careful to keep  supplied, and when one of my
 family or a neighbor falls sick, I always give them the first aid; and often
 I effect a cure, before the  arrival  of the doctor.'  But then,  said I,
 you do prepare some medicines, and probably have some little faith  in
 them.   ' Oh, doubtless, said the countryman, I have  faith in my medi-
 cines, because they are so very simple and natural, as I employ neither
 strong remedies nor instruments.'"
   What  difference  then is there, between  the practice of Cato,  the
 censor; of Pliny the naturalist;  of our rustic citizen,  and that of the
 physicians of their times; or to speak more generally, what difference is
 there between the practice of laymen, and that of men of science ?  This
 only: the former are ignorant and timid; the latter are relatively more
 enlightened,  firmer,  and  consequently more efficacious.
   There is another  class of unbelievers  in  Medicine whom we  should
 pity more than blame; I mean those persons who are suffering from in-
 curable diseases, and have exhausted all the resources of cotemporaneous
 science, without obtaining  any notable advantage.  Such was  the case
 with our  skeptic Montaigne, who, afflicted with  a urinary calculus, at
 an epoch, when surgery,  impotent by ignorance, dared  not attempt the
 operation of Lithotomy, gave vent to his spite in epigrams against the Art.
 Alas, whatever may be done, whatever perfection this Art may attain, there
 are, and there always will be,  cases in which its aid will be inefficacious,
 and then  the patient who  demands of us relief for his suffering, who
 asks of us life,  however inexorable may be the law which condemns him
 to suffer and to die, seeing the  impossibility of  our  aiding  him, will
 accuse us of this inevitable result; and will  declaim  against us, unless
 he be endowed with a lofty philosophy, or profound resignation.


                  RESUME OF  THE PRIMITIVE PERIOD.

   We  have seen that the  first  notions  of  Medicine  go  back to the
earliest infancy of society, in all the countries of the world; so that we
may repeat the statement  of Pliny, that if there exists  any nation
which, at any epoch of its history, was without physicians, there is not one
in which we do not find some vestiges of Medicine.   We conclude from
this, in opposition to Plato, and some other philosophers, that the first 
60
PRIMITIVE PERIOD.
elements of the Healing Art are not at all the result of the degenera-
tion of human nature, brought about by softness and luxury; but  that
they spring from  that  natural  instinct, which makes a man fly from
danger and death, and  sympathize with the afflictions of his  fellows.
  We have, therefore, endeavored to  penetrate further than has been
done, up to this time, into the workings of the  human mind, by which
the first materials of medical  science were developed, and we have
found that  this process consists, principally,  in the addition of the
lights of experience to the brute impulses of instinct.   In  fine, having
sought to appreciate the results of that antique revolution, we have
established, by a severe analysis, that the  results  have been advan-
tageous to humanity.   We now proceed to follow science through a new
phase; we shall behold  it expand, from its beginning, by  successive
development, as a river swells and grows broader from its origin, by the
tribute of its branches.   We shall have to notice more than once, the
errors and abuses which have disturbed, diverted, and sometimes turned
it backward in its course; but let come what will, in  the  labyrinth of
contradictory opinions into which we must plunge, we shall take for our
motto, that of the Deontologie  Medicale, of Dr. Max.  Simon:  " Truth
in  Science, and Morality in Art."0
- See the dedication of that work. 
GENERAL CONSIDERATIONS.
61
                II.  MYSTICAL  PERIOD.

COMPRISING A SPACE OF TIME EXTENDING FROM THE TROJAN WAR, B. C. 1184,
       TO THE DISSOLUTION OF THE PYTHAGOREAN SOCIETY, B. C. 500.
                  GENERAL  CONSIDERATIONS.

  The Trojan war, celebrated in the Songs of Homer, appears in Greek
antiquity as a luminous point in the  midst of profound  darkness.
Before this  memorable  expedition,  and for a long time afterward, the
history of Medicine rests on uncertain traditions, often mingled with
fables.  The hellenic nation, which was one day to become the instruc-
tress of the  human race, had not yet shaken off the rust of barbarism.
Egypt, Phenicia, and Chaldea, marched at the head of civilized nations.
  But after  the Grecian chiefs had overturned the throne of Priam, and
destroyed his capital, the freedom of the seas was attained.  Their ves-
sels could cruise, unmolested,  from Palus-Moeotidus to the Straits  of
Gibraltar.   After that event, the Hellenists covered, with their colonies,
the coasts of Asia-Minor, the isles of the Archipelago, and the south of
Italy.  They sent emigrants as far as  Gallia, Spain,  and the shores  of
Africa.   Their navigators dared even  to  pass the pillars of Hercules,
and adventure upon the ocean.
  It was not solely the desire of riches and power, that  caused them to
undertake long peregrinations;  a more noble sentiment, the love of wis-
dom, or of science, animated some  of  these travelers.  They  are  seen
renouncing their families and friends  for a great number of years, and
returning afterward to  share freely with their fellow-citizens  the trea-
sures of light they had amassed in foreign lands.   Thus, a  Lycurgus
and a Solon  were worthy to give laws to their country, and place in the
constitutions, which are still admired, the foundation of  the grandeur of
Sparta and Athens.   So a Thales, a Pythagoras, and  a Democritus, be-
came the chiefs of schools, or of sects,  which shed upon  their names  so
much glory.
  Nevertheless, science  and letters had  advanced but  very slowly,  in
Greece, during the  space of seven hundred years, which separates the
Trojan war  from the  dispersion of the Pythagoreans.   A very small 
62
MYSTICAL PERIOD.
number of men devoted themselves to the study of the liberal arts,  and.
with the exception of the poems of Hesiod and Homer, there remains to
us no literary monument of that long period.   Medicine shared the fate
of the other sciences; buried  in the depths of the temples  of Escula-
pius, it made an unseen progress, which it is impossible for the historian
to trace.
                         CHAPTER  I.

           THE PRACTICE OF MEDICINE IN THE  TEMPLES.

  Fifty years after the destruction of the kingdom of Priam, there was
elevated at Titanus, a city of the Peleponnesus, the first temple  in honor
of Esculapius.  Very soon the worship of this god was spread through-
out Greece, whence it passed into  Asia, Africa, and Italy.   Among a
multitude of temples which were consecrated to him, those at Epidaurus,
in the Peleponnesus, at Pergamus, in Asia, on  the island of Cos, and at
Cyrene, a  city of  Lybia, are particularly remarkable.
  In the temple at Epidaurus, there was a statue of  colossal size, repre-
senting the god of Medicine under the figure of an old man seated on a
throne,  holding in one hand a scepter, and resting the other on  the head
of an enormous serpent.   A dog, an emblem of vigilance, reposed at his
feet.  This statue, made of gold and ivory,  was  the work  of Trasyme-
dus.  Socrates, in his last discourse with his friends, requested them to
offer a cock, as a  sacrifice for him,  to Esculapius;  whence we infer that
this bird was sacred to the god of Medicine.0
  The priests attached to his worship were  named Asclepiadae, a word
which signifies  descendants of  Esculapias.  They formed  a particular
caste, governed by sacred laws, like the priests of Egypt.   One of their
ancient laws said, " that it is  not permitted to reveal sacred things.
except to the elect, and strangers must be admitted to this  knowledge
only after  having  submitted to the tests of initiation."
  The temples of the god of Medicine were  generally very salubriously
situated;  sometimes  on the  summit  of  a  hill,  or  the declivity of a
mountain; sometimes on the shore, somewhat distant from  the  sea, and
near to a thermal  spring, or fountain of living water.  Groves of trees
refreshed the sight of  the  sick, and afforded  to them  cool  and solitarv
retreats in their beautiful and spacious avenues.
'Dialogues of Plato, the Phedon. 
PRACTICE OF  MEDICINE  IN THE TEMPLES.           63
  The people came from all quarters on pilgrimages to these places, sacred
to the god of Medicine.   The sick and  the convalescent found there,
both  agreeable and  healthful diversions.   The wholesome regimen to
which they were subjected ; the  pure and temperate air they breathed ;
the faith  and hope  by which some of them were animated; the miracu-
lous cures that were testified to, all united to affect their minds agreeably,
and exercise a happy influence on their  constitution.
  Beside these hygienic means, the Asclepiadse employed  special reme-
dies appropriate to each disease,  according to the notions they then had
of it.   They prescribed according to circumstances, venesection, purga-
tion, vomits, friction, sea-bathing  and mineral waters;  in a word  they
neglected none of the therapeutical means they possessed in those times.
  Knowing the great influence of the  morale  on  the physique, these
priest-doctors employed every means to  control the  imagination of  their
patients.   These were not permitted to interrogate the oracle, until they
were  purified by abstinence, fasting, prayers  and sacrifices.  When all
these purifications were accomplished, the consultants were introduced
to receive the response of  the oracle.  Sometimes they were obliged to
lie  in the temple for one or more nights.  Sometimes  the  god  spoke in
a mysterious  manner, without showing himself to the eyes of the faith-
ful ;  sometimes  he appeared to them under the  form of  a serpent, de-
vouring the cakes on the  altar ;  again, he manifested his will in dreams,
which were interpreted by the priests.
   The patients who recovered, went to their homes  blessing the divine
author of their recovery, and leaving behind them testimonials of  their
gratitude.   Those who received  no beneficial nor favorable response, be-
lieving that their offerings were rejected, because  insufficient, redoubled
their zeal  and  their  liberality.  So that  bad as well  as good results
added equally to the glory of the god, and the profit of his ministers.
   There existed in  the country about  Epidaurus, and in various other
localities, serpents of a yellowish-brown  color, whose  bite was  not ven-
emous,  and which were easily tamed.   The priests employed  them in
those supernatural performances which  filled the people with astonish-
ment and superstition.  Aurelius Victor relates, " that during  the year
350 of the foundation of Rome, the city  was ravaged by a terrible pesti-
lence ; the Senate sent six deputies to consult the oracle of Epidaurus.
After they had  arrived  at the temple, and were admiring the colossal
statue of the god,  suddenly, an  enmorous  serpent  issued from beneath
the pedestal.  The sight  of it impressed every mind more with venera-
tion than terror.  He moved tranquilly through the  astonished crowd
and  entered the vase of the Romans, in the chamber  of Ogulnius, the
chief of the embassadors. 
54                       MYSTICAL PERIOD.

  " The sacred reptile was piously borne away, and when  the vessel  of
the embassadors was approaching the city  of  Romulus, he sprang into
the waves and swam to an island in the  Tiber.  A temple was immedi-
ately erected to Esculapius, on that spot, and the pestilence ceased.'
  Many other grave historians of antiquity, report the prodigies effected
by the intervention of the god of Medicine.   Nevertheless, every one did
not credit them, as witness the testimony of the valet to whom Aristo-
phanes in one of his comedies, attributes the following language:  " The
Priests of the  temple of Esculapius, after having  extinguished all the
lights, told us to go to sleep, adding, that if any one should hear a hiss-
ing, which indicated the arrival of the god, he should  not move in the
slightest manner.   So we all laid down without making any noise ; but
[ could not sleep, because the odor  of an  excellent broth, that an old
woman held near me,  agreeably excited  my olfactories.  Desiring most
ardently to  slide along  to it, I raised my head very quietly, and saw
the  sacristan, who took away the cakes  and  figs  from  off the  sacred
tables, going  the round of  the  altars,  putting into his sack  every-
thing he could find.   I believed that I had a right to follow his example,
so I raised to go to the old woman's pot,"
                        CHAPTER  II.

                           OF DREAMS.

  All antiquity has  had faith in dreams, prophets and philosophers-
strong and weak minds, all believed that the  Divinity employed these
means to reveal  the future and instruct us in his designs.   Sacred and
profane history are full of examples that attest the universality of  this
sentiment.   It is, then, more than probable that the  Asclepiadae shared
in it  and, moreover, as  it was  advantageous to them, they must have
tried to maintain this belief, by pious frauds.  Thus, while they endeav-
ored to draw from dreams some natural  indication, they affected to  con-
sider them also as a divine manifestation, above the laws of nature.   In
all ages, the signs  furnished during the sleep  of the sick, have been
profitably studied in a semiotic point of view; and in this sense, dreams
have an importance, which was, doubtless, very much exaggerated by the
ancients, but has been too much neglected by moderns.
  Mv readers, I think, will not be displeased to find here some extracts
from one of the most ancient treatises that exists on this subject. 
OF  DREAMS.
65
   " Whoever," says the author of this book, " desires  to  know the  in-
ferences  that may be drawn  from dreams, will find, in the first place,
that they are closely related to what has transpired during ,the previous
day.  The soul, during sleep, is untranimeled;  but while it is distracted
by its service to the body, its existence is, as it were, divided ; it is not
entirely itself, but  belonging, in part, to the bodily wants, it  subserves
the senses, as sight, hearing, touch, and the faculty of voluntary move-
ments ; it directs the various operations of business ; in short, it gives aid
to every act of  the body requiring thought, which  prevents it, in  some
degree, from enjoying its own innate reflections.
   " AVhen the body is asleep, the soul visits every part of this her habita-
tion, and regulates all its various functions.   The  body is then uncon-
scious, but the soul is  awake, it possesses all its intelligence, it sees
visible things,  it hears sounds, it feels, it moves, it is  pained  and irri-
tated.   In brief,  the soul during sleep, performs everything  that relates
to the  body and the soul, and wisdom is largely possessed by him who
is able thus to  comprehend it.
   " We see persons much occupied with this art, who pretend  to under-
stand and explain dreams sent by the gods to announce beforehand, the
good and the evil with which cities or persons are menaced.  Sometimes
they are  correct, at others they are mistaken;  but no one  knows why it
is so.
   " They say there is  something to  be done to guarantee  persons or
places against certain evils, but not knowing really what,  prayers to the
gods are  prescribed.   It is, doubtless, good to pray to the gods; it is
always  apropos; but it is necessary also, for a person to concur with
the divinity, and  endeavor to help himself while invoking  his aid."0
   We remark, first, that the author of the passages just quoted does
not deny the possibility of dreams  being sent by the  gods, but  he
questions the art of those who pretend to interpret them.  He judiciously
observes that these persons happen sometimes to be right,  and  at others
are mistaken ; that is, that the event sometimes justifies their prediction,
and sometimes  contradicts it, without any one knowing  how or  why.
   He gives a theory of dreams, which he thinks is perfectly natural and
which may be summed up as follows : the soul, or the vital principle, or
to use the language of anatomists, the encephalic organ, being  free from
external  distractions  during sleep, perceives  much better the sensa-
tions that proceed from the viscera, and manifests them more distinctly.
This is a theory which we may find to be contrary to  observation, but
which,  at first sight, is neither absurd nor unreasonable.

          o« GSuvres Hippocratiques," Gardeil,t. Ill—Songes, § 1.. 
66
MYSTICAL PERIOD.
  Unhappily,  the author of it does not exhibit the  same spirit of wis-
dom in the applications he makes of it.   He gives  as the true results of
observations,  the most  singular fancies,  only worthy of a theosoph of
the sixteenth century.   I will cite but one of them  :
  " When  one sees, in his dreams, either the sun or the moon, or the
sky with the pure and serene stars, it is a good sign ; it  indicates the
health of the  body.   Observation has proved that the firmament res-
ponds to the surface of the body ; the sun to the muscles, and the moon
to the cavities that  contain the viscera.   When in the dreams, one of
these stars appears to be changed or is obscured, or arrested in its course,
the seat of the malady is its corresponding part in the body.   If there
appears any disorder in the  sky, occasioned  by the air or the clouds,
the evil is less than if produced by rain or hail; it indicates a separa-
tion of watery humors  and phlegm, which are carried to the skin. In
this case it is necessary to take exercise by running, being clothed; com-
mencing gently,  then quicker, so  as to sweat  freely.   On  leaving  the
gymnasium, long walks should be  taken, while  fasting.  For five days,
one-third of the food should be left off to be gradually assumed again.
[f the above sign was very strong, a vapor-bath should be used, as it is
necessary then to  deplete  the skin, because the disease is in the peri-
phery of the body.   Dry food  should be used, with bitters, astringents
and  spices, and  such  exercise be taken as will produce free perspira-
tion." °
  The treatise from  which I have  drawn these fragments belongs to
the historic period that follows this ; but I have inserted  them in this
chapter to  complete what I have to say concerning dreams, for I shall
have no other occasion to recur to  this matter ; the great physicians of
following ages having occupied themselves with other objects which thcv
judged better calculated to improve the diagnosis of diseases.
                       CHAPTER III.

               MEDICAL TEACHING IN THE TEMPLES.

  The priests of Esculapius formed, as we have before said,  a separate
caste, transmitting from one to another their  medical knowledge as a
family heritage.  In the  remotest times, no  layman, according to the
report of Galen, was admitted to participate in the  sacred science, but

         °"03uvres Hippocratiques," Gardeil, t. Ill—Songes, § 111. 
MEDICAL TEACHING IN  THE  TEMPLE.
67
at a later period, this  severe secrecy was relaxed.   They consented to
reveal their secrets to strangers, provided they would fulfill the tests of
initiation.   There was, then, according to every probability, some  sort
of Medical  instruction given in each temple.   Indeed, history has pre-
served  the memory of three schools that had a great reputation, viz:
that of Rhodes, the most ancient of all, which  had already ceased to
exist, at the time of Hippocrates, and  of whose doctrines we  have no
accounts whatever;  that of Cnidus, which was  the first to publish a
small repertory, with the title of the Cnidian Sentences ;  finally, that of
Cos, the most  celebrated of all, and which  has giverf birth to a great
number  of illustrious physicians, whose writings constitute  the most
valuable memorials of antique Medicine.  Among  the means of instruc-
tion offered by the priests of Esculapius, there is one that  deserves to
arrest  us for  a moment, because it is specially relative to the historic
period with  which  we are now occupied; I mean,  the  votive tablets
which it was customary to faster to the walls and columns of the temples
after the example of  the Egyptians.  These tablets showed, generally,
the name of the patient, the kind of disease with which he was attacked,
and the manner of his cure.
   One of these tablets, found at Rome, on the island in the Tiber, the
site of the ancient Esculapian temple, bears the following  inscription,
in Greek characters:
   " Lately a certain Ca'ius,  who was blind, came to consult the oracle.
The god required that he approach the sacred altar to perform  adora-
tions ;  at once he passed  from the right to the left, and having rested
his fingers on the altar, he raised his hands and  applied  them  to  his
eyes.   He recovered his sight immediately, in the presence of the people,
who rejoiced to see such marvels accomplished under the reign of our
august Antonius."
   " Lucius was attacked with a  pleurisy, and every one despaired of his
life.  The god ordered  that  the ashes of the altar be taken, mingled
with wine and applied to his side.  He was saved, and  gave thanks to
god before the people, who congratulated him."
   " Julian vomited  blood, and  appeared  lost beyond  recovery.   The
oracle ordered him to take the pine  seeds of the altar and eat them for
three days, mingled with honey.  He did so,  and was cured.  Having
solemnly thanked god, he went away."
   " The god gave this direction  to a blind soldier named Valerius Aper:
Take the blood of a white cock,  mingle  it with honey, and  make a col-
lyrium, which you are to apply  to the eyes for three days.   The soldier
having  fulfilled the direction of the oracle, was restored to sight, and
returned to make a public thanksgiving to God." 
68
MYSTICAL PERIOD.
   Narratives of this kind, and written  in such style, were well calcu-
lated to fortify the piety of the faithful; but certainly, they do not serve
any great end for the advancement of science.   The writers  who have
boasted of this method  of instruction, have  not  reflected, apparently,
upon  its glaring defects.  Of what advantage, for example, is the record
of the third case—" Julian vomited blood, and appeared  to be beyond
recovery ?"  What physician would dare rest a  prognosis or direct a
treatment on so vague an indication ?  Can  we treat  indifferently, in
the same manner, a stout man, or an infant, or an old man—a plethoric
or an anaemic  patient—a hemoptysis, or a hematemesis, or a scorbutic
hemorrhage of the buccal mucous membrane ? °
   It requires no reflection to say that a disease cannot be announced
by  one or two symptoms;  but rather it is necessary to recall, 1st, all
the anterior circumstances which could have contributed, directly or in-
directly, to promote it; 2d, to ascertain the age, sex, temperament, and
usual  habits of the  patient; :>d, finally, to describe with the greatest
care the actual  general  state of the patient, and make every possible
effort to know the organ  principally affected, as well as the  nature of
the lesion of which it is suffering.
  It  is presumable that the Asclepiadae wrote down in secret the his-
tory of each disease,  and the means employed  to combat  it; but we are
ignorant through how many degrees science  passed before  it  attained
the stage of development exhibited  in the'  Hippocratic works.   But we
may,  at all events, judge  from the exquisite  taste and  precision which
characterize some of  these books, that they had for a long time been in
the habit of closely observing and clearly describing diseases.
                        CHAPTER  IV.

         THE ORIGIN OF CLASSIFICATIONS IN PATHOLOGY.

  When a great number of pathological descriptions, sufficiently detailed,
were collected, the embarrassment of such an accumulation began to be
realized.  Indeed, how could such a mass of material, arranged  with-
out any order, be made  serviceable ?  How find in this pell-mell the
  ° " I have seen a woman attacked with a hemorrhage of this nature who threw
off mouthfuls of blood:  she had already filled several basins.  The liquid was
seen running from the surface of all the  gums.  This fearful affection brought
the patient within two fingers' length of the grave, and only yielded at last  to
reiterated cauterization  with the nitrate of silver." 
ORIGIN  OF CLASSIFICATIONS.
69
record they wished to consult—the tableau which answered  best  the
symptoms of the disease before them ?   No man's memory was equal to
such a task.
  In proportion as clinical observations multiplied, it became every day
more  necessary to arrange them after a method  which would  impress
them upon the memory, and facilitate a recurrence to them when desi-
rable.  Such was the origin of the first pathological classification.  The
idea was suggested, as is seen, by the necessity of relieving the memory
and the desire of facilitating researches.  We are  ignorant of the mode
of classification first employed. We only know that, from the beginning
of the philosophic period, diseases were arranged  by groups, according
to the locality  affected, descending from the head to the  feet.   Fevers
and other affections that attack the whole economy, or a  great number
of parts, at the same time, were arranged in separate groups.  This dis-
position, which is met with in the works of Hippocrates, was adopted,
with improvements and variations, down to an epoch not far  from our
own.
  The first men who reflected on the phenomena of nature, in endeavor-
ing to solve their causes, principles, and ends, did not imagine anything
better to  explain the  movements of bodies and their continual trans-
formations, than to people the  universe with spirits ; that is, with invisi-
ble  and impalpable substances endowed with force,  intelligence and will,
in different degrees.   Each body was supposed to contain at  least one of
these spirits.  This presided over and gave impulsion to all  the changes
and anatomical phenomena which occurred in the  body to which it was
attached.  Man,  whose organization is so complicated and whose func-
tions  are so numerous—whose intelligence is carried to the  highest ab-
stractions, to the idea of infinity—who is lost in  the interpretation of
the most simple phenomena, as the movement of the finger or the form-
ation of an atom of matter—whose will controls  the surrounding  ele-
ments,  but who  cannot prevent a hair  turning white—man, I repeat,
appeared to the early sages as a multiplied being, a little representation
of  the universe:  consequently, his body was divided into many regions
or departments, which were supposed to be governed by spirits of different
orders.   The system of Pythagoras, which we shall soon describe, offers
the first  example of this physiological polygarchy:  it  is the source
whence are derived a multitude of ancient and modern theories. 
70
THERAPEUTICS.
                         CHAPTER  V .

                           THERAPEUTICS.
   We have heretofore said that the physicians of primitive times rea-
 soned very little on morbid phenomena, or the effects of remedies ;  that
 they contented themselves to observe  which were  the remedies  that
 would heal certain diseases, and to employ thereafter the same  means
 in like cases.
   It appears that during the mystical period no other plan was followed.
 Hippocrates, Celsus, Galen, and all the historiographers of Medicine,
 agree in  saying that before  the introduction  of philosophy into  this
 science, i. e., before the age of Pythagoras,  there was no other rule than
 empiricism.  But by this, these authors do not allude to rational empiri-
 cism, which had its origin much later, in the school at Alexandria: they
 speak of instinctive or natural empiricism, which we  have referred  to
 in the primitive period, and which is  still daily followed  by persons,
 strangers to  the art, when they obtrude themselves  to  give counsels to
 the sick.   These persons  have constantly in their mouths these words:
 ■' I have seen a disease similar to this cured by such  a remedy."  Their
 reasoning, however gross it appears to us, is  based on an incontestable
 [irinciple, that  may be stated  as  follows: Remedies which have cured a
 disease, must be equally efficacious in curing analogous cases.
   Nothing is clearer,  nothing  is truer, than this aphorism: it has all
 the  infallibility  of  a mathematical axiom; and as  the medical prac-
 tice  of ancient times rested  on  this, an author that we have already
 quoted says with truth: " Medicine for a long time  has been in posses-
 sion  of all that is really necessary in regard to  principles and method.
 With these guides, numerous and valuable  discoveries  have been made
 luring a long course of centuries;  and the rest will  be discovered, if
 capable men, instructed  in the discoveries of the ancients, shall take
 these for  the  point of departure in their researches.   But they who
 reject and disdain the  past, and attempt other methods and other ways,
pretending to have found something new, will be mistaken and will mis-
lead  others."0
  Nevertheless, complaints are ceaseless of tbe  uncertainty and  insta-
bility of medicine.   The science  is accused of having no stable princi-
ples  to  shelter it from the caprices of fashion  and in  the changes of
 °03uvres d'Hippocrate.  " Traite de l'Ancienne Me'decine," § n.  Translation
jf M. Littre.  Paris, 1839. 
THERAPEUTICS.
71
systems.  The masters of the art themselves furnish often the examples
for this exaggerated declamation.
   Pinel, frightened  by the  difficulties of medical practice,  blames
justly the  presumption  of  a writer of the last century,0 who prom-
ised  nothing less than the solution of this general problem—" A disease
being given, to find  the remedy."  But does he not  himself fall into a
contrary excess, and  does he not mistake the true destination of Medi-
cine, when he proposes for the end of his labors nothing  but the resolu-
tion of the following question: " Determine  the true character of a given
disease,  and  its  position  in the nosological scale, "f   Does not  this
take from the medical arch  its  most essential  support, its keystone—
therapeutics ?
   Bichat expresses himself in these terms, on the same subject:  " Mate-
ria medica,  an assemblage of incoherent opinions, is  perhaps, of all the
physiological sciences, that which most  exhibits the contradictions of the
human mind.   In fact, it is not a science for a methodic spirit; it is a
shapeless assemblage  of inexact ideas, of observations often puerile, of
imaginary  remedies strangely conceived and  fastidiously arranged.  It
is said that the  practice of Medicine  is repulsive.   I will go further:
no reasonable  man can follow it,  if he studies its principles as set forth
in our materia medicas." J
   Broussais is not less explicit nor less vehement in his condemnation of
the therapeutics of his predecessors.   (See, among others, the xv. chap-
ter of l'Examen des Doctrines Medicale, entitled, " De la  Certitude en
Medecine."
   Complaints so unanimous have a cause that it is the duty of the  his-
torian to explain.   Those who make them are not ignorant, certainly, of
the axiom  set forth above, and  which is  in accordance with common
sense.   Thus  it is not, as think  the vulgar, the absence of a fundamen-
tal principle  in practical  Medicine which  pains them, but rather  the
difficulties,  always  great and sometimes  insurmountable, that  are  met
with in its application.
   To obtain a conception of these difficulties, it will suffice to glance at
one of the most simple cases in the practice. Suppose, for example,  that
a case of palpitation of the heart is to be treated.   On this simple an-
nouncement a medicaster or an  apothecary would not hesitate  to  pre-
scribe digitalis, or thridace, or some other remedy indicated in the for-
mulary, to combat this symptom.
 e Picairn.       f " Nosographie Philos.," introd., page iv.
I Bichat, " Anat. Generale."  Consid. Generates, § n. 
72
MYSTICAL  PERIOD.
   The true  physician, one who  adds to the lights of science a sense of
 duty,  would not be so prompt: he would, in the first place, know all the
 associated circumstances;  then he would proceed to examine the patient
 by commencing at the organ where the functional trouble was the most
 apparent:  in short, it would  be  only after having carefully explored all
 the viscera and all the functions of the body, that he would feel  author-
 ized to prescribe  the treatment; for  he is  aware, that often the mute
 suffering of an organ distant from the heart may be the cause of the pal-
 pitations, so that  of ten  individuals who  complain of palpitation, per-
 haps in not  more than two would  the same remedies be  applicable.
 Moreover, all is not finished when a practitioner has properly established
 his diagnosis.  It is yet necessary for him to choose the remedies proper
 to fulfill the curative indications; that is, he must be well posted in all
 the internal  and external resources of therapeutics.  Finally, it is neces-
 sary that he secure, on the part of the patient and the attendant, the
 faithful execution of his directions, and that  he carefully observe their
 effects.
   If the enlightened  and conscientious practice  of  Medicine offers  so
 much difficulty in the simpler cases,  what must it be when it is neces-
 sary to treat complicated  and insidious affections,  such as  constitutional
 syphilis, or tetters, or scrofula, or leprosy, etc., which, concealed  in the
 economy for months and years, deepening  their roots, and changing the
 fluids, reveal themselves only in  an ambiguous manner,  after having in-
 vaded the entire system, whence it is almost impossible to dislodge them ?
   But these cases, embarrassing  as they are, afford the practitioner,  at
 least,  the opportunity of studying and reflecting  upon  them, aiding
 himself by the opinions of authors, and trying various  means of cure.
 It  is  not  so,  though, when  he  finds himself in  the  presence  of the
 plague, the  cholera, pernicious  fevers, and other epidemics, which fall
 like a tornado upon the  people, carrying off, without  distinction, the
 young, the old, the feeble,  and the robust, overturning at  once  all the
 functions of  the organism, assuming the most varied forms, and striking
 so  rapidly that they allow the  physician neither time to collect  his
 thoughts or to make experiments.
   Under these calamitous circumstances, he has  need, not only of sci-
 ence  and discernment, but also of sang-froid, devotion, and  courage to
 contest some victims, at least, with the devastating scourge.   And at last,
 when, notwithstanding so many causes of error, he arrives at the estab-
 lishment of an efficacious mode  of treatment,  it  often  occurs that the
• constitution of the epidemic  is so modified  that  he  is  obliged to com-
 mence his researches anew. 
ORIGIN OF SYSTEMS.
73
  In other sciences, as physics and chemistry, there is an opportunity of
reiterating the same experiment as often as necessaiy.  The agents which
concur to produce these, are at our disposal, and we can so isolate them
as to obtain only their pure effects, and free from all foreign influences.
In practical Medicine it is entirely different; here, nature and accidents,
i, e. diseases, furnish us the opportunities of experimenting; but, in the
first place, the elements of these experiments are  never identical; sec-
ondly,  much time may  elapse  before   an  occasion presents itself  for
renewing  them; and, thirdly, it is impossible  to isolate the  patients
from a multitude of influences  that  alter the therapeutical  results.
Hence it follows, that it is  impossible rigorously to infer one  medical
fact from  another.
  These views show why along series of observations, collected by a great
number of observers, at different epochs and in different climates, are
necessary to arrive at the discovery of a curative method—to the acqui-
sition of a therapeutical principle.  It is this which has, in all time, dis-
couraged great practitioners, and has driven one  of the most illustrious of
them to write this sentence, in which he betrays a profound melancholy:
" Art is long, life is  short, opportunity  fleeting, experience deceptive,
and judgment difficult.    It is necessary, not only that the physician do
all he can, but also the patient  himself, as well  as his  attendants and
friends, co-operate with him."—Hippoc. App. liv. 1.
  Notwithstanding so many obstacles, which have  been  supposed insur-
mountable,  man has  come,  by force   of  research, perseverance, and
genius, to find some remedies of marvelous efficacy in certain cases, and
to trace some rules which approximate therapeutics to the exact sciences,
as we shall hereafter show.
                        CHAPTER  VI.

                     ORIGIN OF  SYSTEMS.

  We have said that one of  the greatest difficulties, perhaps the great-
est that is encountered in the use of a fundamental axiom in therapeu-
tics,  comes from  the impossibility of applying,  rigorously, a past fact
in treatment to a case in hand;  in  other words, whatever precision may
be obtained in diagnosis, whatever may be the degree of similarity that
exists between two pathological states, as there is never identity between
them, it follows, that a course of medication which has succeeded per-
fectly in one case, may,  strictly speaking, fail in another. 
74
MYSTICAL  PERIOD.
  It is not less evident, that  the best means of avoiding, or rather of
diminishing this  permanent cause of mistakes, consists  in perfecting,
more and more, the diagnosis of diseases, so as to give it  the  highest
degree of exactness possible.   By this means, on the one hand, the con-
founding of essentially different morbid states will be avoided ;  and, on
the other,  the distinction of others but slightly differing  in  aspect, be
established.
  The importance  of diagnosis once recognized, as it has  been  by the
great physicians of all ages, there is no effort that the mind has not
made, no expedients that have not been attempted, in order to give it the
highest perfection possible.
  The first plan  suggested  to the minds of observers was, to  take
account of all the  symptoms that presented themselves in  the course of
the disease, and to record  them in regular  succession, as they appeared.
According to this plan, a great number of nosological tables were formed,
so that for any disease, a comparison  of the  phenomena that appeared
was made  with the  symptomatic tables that had been framed, and  from
this comparison an  appropriate treatment was deduced.
  This method, which appears, at first sight, so natural and exact, is, at
bottom, extremely defective.   In the first place, it has the serious incon-
venience of attributing an equal  value to all the symptoms, while daily
observation proves that notable differences  exist.  In the second place,
a long enumeration of morbid phenomena, recorded one  after another,
without choice  or discernment, is no more  a portrait of a  disease,  than
colors, thrown  at  hazard  upon  the  canvass, that of a person  sitting
for  a  likeness; lastly, all classification of diseases becomes  impractic-
able on this plan, for, before attempting a work of this kind, it is neces-
sary to inquire how many analagous symptoms would be required to
place two  affections in the same class, and  assign them alike treatment;
it would be absurd to attempt to  answer the question.
  Thus we see that there is no pathological classification  possible, by a
simple enumeration of symptoms, yet, nevertheless, without the aid of a
classification, the practice of Medicine is  a mere  groping  in the dark,
and does  not  merit the  name of Art.  Without the advantages of a
classification, the physician may justly be likened to a  blind  person
armed with a club, and striking indifferently at the disease or at the
patient.
  Hippocrates  strongly felt the errors of this manner of observing and
describing diseases, when  he  reproached  the Asclepiadae  of  Cnidus for
having adopted this plan, which led them to multiply, innumerably, the
division of diseases.  " Those who have collected," he says, " the  sen-
tences that are termed Cnidian, have well  traced the morbid symptoms 
ORIGIN  OF SYSTEMS.
75
as they are exhibited, as well as the manner in which certain  affections
terminate;  but any one may do as much as this, without being a phy-
sician, by asking sick persons  the symptoms they experience.   Much
has been neglected in the Cnidian sentences, which it  is important  for
the physician to know, without questioning the patient, and which is
essential to the exact appreciation of the disease.  Some were not igno-
rant,  however, of the various characters of diseases, and their different
forms, but erred whenever they attempted to make a rational  classifica-
tion.   Such errors  are easily  committed,  if distinctions are made  in
diseases from mere shades of difference, and if other names are given
to all those which are not exactly identical."0
   It  is thus well demonstrated that all the symptoms  of a  pathological
state  are far from  having the  same  degree  of  importance.   This is
almost a trivial statement to make to  physicians; only dull dreamers
and their stupid adepts, can have classed  together a frightful headache
and a simple wrinkling of the  forehead, an intense gastralgia with an
itching of the lobe of the ear.   Posterity could not believe that such
absurdities  were ever perpetrated, if there  were not  authentic  docu-
ments to attest it.f
   From  the moment that the necessity was felt  of making a choice
among morbid phenomena,  they have  been  divided into  durable and
transient, essential and accessory, primary and  secondary, etc.   Then
commenced  the discussion on the essence of diseases, their causes, signs,
march, termination, etc.  Thence, in short, sprung Medical Philosophy,
and with it, systems of Medicine.

                  RESUME OF  THE MYSTICAL PERIOD.
   During the space  of about seven hundred years, which this period
embraces, Medicine underwent, in Greece,  a first transformation; from
having been domestic and  popular,  it became sacerdotal, and wrapt
itself in a mysterious habit.  Until that  time, the world  had princes,
oaptains, shepherds  even, acquiring reputation for their skill in  the
Art:  but after the Trojan war, we only hear of consultations given  in
the name of the divinity, in the temples,  or in some celebrated caves,
such  as  those of Trophonius  and Charonium.   Not  but  what  there
were, in  those times even, men  also, not of the clergy, who  assumed to
treat diseases, and dispense remedies; but it appears that scientific
Medicine, if we may be allowed so to call the limited notions that were
  0 " Traite du Re'gime dans les Maladies Aigues," § 1, II, traduc. de Gardeil.
  f Such, and even more silly statements are found in Hahneman's " Materia
Medica." 
76
MYSTICAL  PERIOD.
in their possession, was  entirely possessed  by the priesthood, and was
perpetuated only in their order by an uninterrupted  tradition, where it
slowly developed itself in the quiet of seclusion.
  "The practice  of Medicine in the temples of Esculapius," says M.
Aug. Gauthier, " may be divided into two epochs.   In the first,  which
extends down to Hippocrates, the Asclepiadae, though employing, for the
most part,  superstitious means,  have rendered service to science by the
taste developed among some of them for observation.   It must be agreed,
that in those barbarous  times, Medicine  could  make more progress in
the hands of a corporation like the Asclepiadae, than if it had been
merely a domestic or popular Art.   It is not probable  that, at a  period
so remote, when the arts and  sciences  were still  in  their infancy, a
man of genius could be  suddenly raised  up,  who would  elevate  Medi-
cine to the rank of a science.  In the second epoch, which extends from
Hippocrates to Christianity, Medicine in the temples gradually declined.
and was more frequently a gross jugglery."0
  The same writer adds, a little further on:  " It is  difficult to  appre-
ciate, to-day, what amount of  learning was in the  possession  of  the
priests of the temples, and what progress Medicine made  in their hands.
As there have always been men  who have shown a tendency to admire
what is ancient, we must not be surprised  to find in antiquity, as well
as in modern times, writers who have lauded  immeasurably the medical
knowledge of the  Asclepiadae.   On the other  hand, there are physicians
who deny that  they  ever possessed any.  Thus,  M. Malgaigne would
consign the Asclepiadae to that oblivion from which they  never ought to
have emerged.   He censures M. Littre for mentioning them, and pro-
poses to erase their deeds from  the  history of Medicine  and Surgery.f
We think it better to avoid extravagance on both sides.  It is probable
that the reading of the  inscriptions  in  the temples, and the habit of
seeing a great number  of sick, gave, in the end, a certain  amount of
medical instruction to the priests."J
   This is, it seems to me, what  may be  most reasonably said of that
part of medical history  so profoundly enveloped in  obscurity.   Where

  °" Recherches Historiques sur l'Exercice de  la Me'dicine  dans les Temples,"
etc., par Auguste Gauthier, 1844, chap, II.
  f " Lettres sur l'Histoire de la Chirurgie," inserted in the Gazette des Hopi-
teaux, 1842.  M. Malgaigne  founds his  opinion, principally, on the four votive
inscriptions  heretofore given;  but these inscriptions are of  the epoch of the
Antonins, and can not give us a correct idea of those that were in the temples of
the times of the ancient Asclepiadse, nor especially of the clinical notes made by
the prieBts themselves
  I A. Gauthier, loc. cit. chap. IV. 
RESUME  OF THE MYSTICAL  PERIOD.
77
there is default of positive documents, free course is unsually given to
the imagination, and it is seen that on  this point, that of the erudite
has not been sterile.   But in the midst  of  diverse opinions, which have
been emitted as to the actual  knowledge of the Asclepiadae, some of
which I have mentioned,  that of M. Gauthier, I repeat, appears  to me
the most reasonable,  the best  founded,  as well as most universally
accredited.
  Finally, we touch  an  epoch  in which the Healing Art undergoes a
metamorphosis far more interesting for  history and for philosophy, and
far more advantageous to humanity.  Until  this  time, in  fact, the
medical  edifice  had been formed of materials taken at hazard,  and
gathered, generally, without  taste or method; no harmonious thought,
or premeditated design, directed the researches  of  the men who made
the first  discoveries ; but  afterward, reason and genius unite  to extend
and improve what accident and instinct had suggested.   The  scientific
monument of  this difficult Art begins to rise, grand and majestic, grad-
ually harmonizing all its parts.   We shall no longer follow its progress
through  ages,  by the light of vague conjecture; but, with the help of
authentic memorials, and debris more  or less well founded.   We shall
no longer be compelled to divine the intimate thought of the laborers in
the different phases  of its progress, but we shall read it, stamped in
intelligible characters upon the remaining fragments of their labors. 
78
PHILOSOPHIC PERIOD.
             III.  PHILOSOPHIC  PERIOD.

COMPRISING THE PERIOD OF TIME BETWEEN THE DISPERSION OF THE PYTHAGO
 RIAN SOCIETIES, IN THE YEAR B. C. 500, AND THE FOUNDATION OF THE ALEX-
 ANDRIAN LIBRARY, IN THE YEAR B. C. 320.
                 GENERAL  CONSIDERATIONS.

   Until now, we have groped our way, having to guide us in the obscu-
rity of remote ages only feeble lights, scattered  here and there at  long
intervals.   But  now  we  have reached  an epoch, where science  is
striped of its mystic vail, and reveals her secrets in open day.  The
priests who had so long been in possession of the doctrine of the  peo-
ple, yield now the grasp  of the scientific scepter to the philosophers:
they retained only the  exclusive control of sacred rites, the monopoly of
religious ceremonies.   Never  was  a happier revolution accomplished
with less effusion of blood;  the mind rests with satisfaction on the
circumstances which prepared and accompanied  it.
   It is a fact worthy of remark, and which has not escaped the atten-
tion  of ancient observers, that the inhabitants of Asia,  after having
discovered the first elements  of the  sciences and  the arts, and after
having carried them to a certain degree of development, paused  in the
pathway of improvement, or even retrograded;  while  the inhabitants
of Europe, though entering much later into the career of civilization,
promptly surpassed their predecessors, and raised themselves to a hight
that the former were never able to attain.
   Hippocrates signalized this remarkable phenomenon in his treatise on
"Airs, Waters, and Places."   He sought its cause, and traced it with
an admirable sagacity,  to the combined influences of climate, manners,
and government.   A temperature, mild and uniform, which dispenses in
man to provide against sudden vicissitudes of the  seasons; a soil, un-
broken and fertile, from which he obtains, with  but little labor, a suffi-
cient  alimentation; the  use  of food  almost exclusively  vegetable; a
despotic government, under which  the fortunes and the lives  of the
people are at the mercy of the caprices of the monarch, where advance-
ment  depends  on favor rather than  on  merit;  civil  and  religious 
GENERAL CONSIDERATIONS.
79
institutions, which parcel off the various  classes of society, like flocks,
and assign to each individual, from his birth, a rank out  of which it
is impossible for him to move ;  all these circumstances  appeared to the
the philosopher of Cos, eminently calculated  to enervate  the  physical
constitution  of the people, to blunt  their intelligence, and extinguish
their moral energy;  while the opposite conditions, such as  a tempera-
ture extremely variable, a broken  soil, and a  government  surrounded
by liberal institutions, seemed to him calculated to produce on the body
and the mind, effects entirely contrary.   In this he explains the  cause
of the  superiority of the nations of Europe over the greater part  of those
of Asia.
  To  these considerations,  taken  outside  of the nature  of man,  the
modern physiologists  add others, very important, drawn from  his  ori-
ginal  conformation.   They  teach, from numerous  observations, and in
particular from the researches in comparative anatomy, that the  develop-
ment of the intellectual faculties is always proportionate to the volume
of the cerebral hemispheres, and especially  of the anterior lobes.   This
law, they say, governs not only all the species and varieties of the great
family of man, but also the entire animal scale.  Now in this anatomi-
cal aspect,  it appears that the  Mongolian race, to which belong the
natural inhabitants of Egypt, the  East Indies, and China,  share much
less in these physical advantages than  the Caucassian race,  from which
most of the inhabitants of Europe  take  their origin.  It would follow
from this  view, that the inferiority of  the first,  compared with the last,
holds  to an  imperfect innate organic constitution, as much, at least, as
to external influences.
   However  true or  false this theory may be, the ancient Greeks found
themselves,  at the commencement of the  period which we named Philo-
sophic, in the most  favorable condition,  according to the views of Hip-
pocrates,  for the development of their  physical and  moral faculties.
They  occupied,  besides  Greece  proper,  Rhodes, Crete,  Sicily, and a
multitude  of other  islands.   They  possessed  an  immense extent of
coast  in Europe, Asia, and Africa.    The Hellenic peninsula, which
does not equal  in extent the half of France, had an exceedingly irreg-
ular and  broken surface; great extremes  of temperature, mountains
covered with eternal  snow, narrow gorges excavated by torrents, fertile
plains, delightful valleys, arid hillsides scorched by the rays of a tropical
sun, a  sea  subject to frequent  tempests, a coast full  of  dangers,  and
indented  with  deep gulfs.  In short,  this  nation  was endowed, if we
judge from their statuary, with the most noble physical  forms, calcu-
lated to display, according to modern views, beauty, genius,  and power.
   The political  institutions  prevalent in most  of  the Grecian states, 
80
PHILOSOPHIC PERIOD.
 were in harmony with that happy concourse of circumstances to which
 we have alluded.  Nearly everywhere a republican government or a
 limited monarchy had replaced the absolute power of kings.   As the
 inhabitants were not very numerous  in  these small states, they could
 know,  watch, and mutually estimate each other, so that public  opinion
 was not much exposed to error.   Public honor generally followed merit,
 and to obtain  this  it was  necessary  to  show oneself  worthy by some
 important act, by skill in counsel, by  extraordinary talents, or by emi-
 nent virtue.
   The era of brute force, of combat hand to hand  with  monsters and
 brigands,  had passed away, and the reign  of intelligence, of strategy
 in war and in politics, was conspicuous.  The Mythological heroes whose
 prodigious  labors were so much boasted, such as a Hercules, a Perseus,
 and a Bellerophon, were succeeded by those great men, whose lofty acts
 have been  celebrated  in  history,  such  as  Leonidas,  Miltiades, and
 Themistocles.
   The gymnasiums were no longer, as formerly, places devoted entirely
 to bodily exercise ;  they were surrounded  by halls and  porticos  where
 philosophers, rhetoricians,  artists, and physicians, assembled to hold
 their schools and dispute on questions of  art.
   The  theaters and public amusements,  also, realized this social transfor-
 mation.  Strength and  address no longer solely excited the admiration
 of the  multitude ; a taste had  been  created, at least in some cities, for
 the charms of  the productions of the mind.   We touch that epoc when
 the spectators of the Olympic games, filled with enthusiam on hearing
 the reading of the books of Herodotus,  gave to each of them the name
 of one  of the nine muses.   If  Crotona was proud in sending the most
 vigorous Athletus to those national  solemnities which attracted a con-
 course  from all Greece, Athens was not less so of the crowns that were
 obtained there by her poets,  her painters, and her sculptors.
   Gradually science unrobed herself of the grave and mysterious forms
 with which  she  had  always been clothed in the East, to assume a dress
less  severe  and  more transparent, and of the taciturnity that she had
had  in Egypt,  to become  more communicative and  even  somewhat
loquacious.  The vestiges of this antique  Egypto-Indian  civilization
which  had  served as a model  for that  of  Greece was insensibly dis.
appearing.   Soon the sages of  Greece ceased their journeys in  search
of light in foreign countries, for their  own  country became in its turn
a center of illumination for all  nations.
   Pythagoras affords us the last celebrated example of distant peregri-
nations in search of wisdom.  He is, also, the last of the sages who have
transmitted  their doctrines in an unusual language, and who made use 
PYTHAGORAS.
81
 of hieroglyphical writing.   As  he was desirous  to continue in Greece
 the traditions of the Egyptian school, the history of  his life, and of the
 society that he founded, interests us  in a very high degree; for it shows
 us the contrast and the transition, from an old to a new and more perfect
 social state.
   Born at Samos, one of the most flourishing of the islands of the iEgean
 sea, Pythagoras was, at first, an  Athlete, but having  heard  one day
 Pherecydes lecture  on the  immortality of the soul, he was so charmed,
 that he renounced every other occupation to devote himself, exclusively,
 to philosophy.   After having followed the course of this eminent master
 for some time,  he felt desirous of knowing, for himself, the customs and
 manners of other nations.  He travelled in Egypt, in Phenicia, and  in
 Chaldea; and  it  is  said, that he  pushed  his travels as far as India,
 where he communed with the Brahmins and  Magi, and was initiated
 into  the  secrets of  their worship,  laws  and doctrines.  After a great
 number of years employed in schooling his mind by the  practice of vir-
 tue, and enriching  it with the most varied knowledge, he returned  to
 his country, and was honorably received  by the tyrant Polycrates, who
 endeavored to efface his usurpation by the mildness of his government,
 and by the prosperity he brought upon the citizens who had become his
 subjects.   Notwithstanding the efforts of the usurper, the philosopher,
 not being able to habituate himself to the servitude of his country, left
 it to  seek  an asylum in some other  land, from which liberty had not
 been banished.    Whilst traversing the Peloponnesus, he assisted at the
 Olympic games, and being recognized, he was greeted  with universal
 acclamations.
   From this place  he  sailed for the southern part of Italy, or Great
 Greece.  He landed at Crotona, say  the  biographers, and lodged with
 Milo, the  Athlete, with whom his family was united by the  bond  of
 hospitality.  It was  in this city that he commenced his mission as a
 reformer.   His discourses had such success that in a very little time he
 drew  around him  a great number of disciples.   He required of them a
 very severe  noviciate, which lasted for five or six years.  During the
 season of trial,  they were required  to abstain almost entirely from con-
 versation.   They ate in common, using a very frugal diet; they assisted
 the master  in  his lessons,  executed  the orders they received without
 making any observations, and in a word,  led a pure, modest, temperate
 life.   Those, only, who persevered,  were admitted  to a participation in
 the mysteries of the order.
   The veneration  of the disciples of  Pythagoras, for their master, was
so great, that many  sold their property and gave  the  proceeds to him,
for the general good. 
82
PHILOSOPHIC PERIOD.
  An end was put to all discussion  by the words, " The master has
said it."  This philosopher joined to an immense knowledge, an easy
and attractive elocution.   It is said, that he invented the theorem of
the square of the hypothenuse;  that he was the first to divide the year
into 365 days, 6 hours;  that he had an  idea of our planetary system;
that is  to say, that he suspected  the movement of the other planets
around the sun.   But the greater part of these assertions have no solid
foundation.   The sect of which he was the founder, is called the Italian,
from the name of the country in which it originated.
  Pythagoras did not limit his teachings to the city of Crotona:  he
visited  the  principal cities of  Great Greece,  among others, Heraclea,
Tarentum, Metapontum, and established Communities in each of them,
subject  to the common rules.  These institutions exercised, at first, the
happiest influence: a sensible reform was developed in the dissolute
manners of  the inhabitants of  those cities.  The Pythagorians gained
the esteem of the magistrates and the people; they were consulted on  all
difficult matters, and the superiority of their knowledge, joined to a rare
abnegation,  drew upon them the public confidence.
  It appears  that  their success rendered them  bold.   Some of  them
began to mingle in intrigues and  cabals, which was against the formal
precept  of their  master,  who often  repeated  to  them, " abstain from
party interests, according to the general  understanding of  that term,
and do  not  frequent public assemblies at periods of elections."  The
politicians, who felt that their presence was injurious to their projects,
accused them of aspiring to domination in public affairs ; the priesthood
launched their anathemas at them,  because they did not share the  super-
stitious  prejudices of  the  multitude.   The simplicity of their costume,
their  symbolical  language, their  habitual silence, their avoidance of
pleasure parties,  and every thing, even  to the  purity of their lives,
became  a subject of reproach or umbrage.  Mobs were excited against
them; they were  menaced  and  pursued  by the populace in every city,
and because they were obliged to seek  concealment, in  order to save
their  lives,  the greater number expatriated themselves: in  this way
their society was broken  up, even during the life time of its  founder,
who never again attempted its reconstruction.
   Before detailing the results of the dispersion of the Pythagorians, we
shall  present a sketch of the  doctrine  of their chief, a doctrine very
important in  the history  of medicine and philosophy;  for  it  is  the
source of many theories which  have  exerted a  great  influence on  the
march of the human mind; and moreover, it is a key to the pretended
occult sciences, the reign of which extended  down, even as far  as  the
close of the eighteenth century. 
DOCTRINE  OF PYTHAGORAS.
83
                         CHAPTER  I.

                DOCTRINE  OF  PYTHAGORAS.

  There remains to us of the  memorials of antiquity, concerning that
doctrine, but a single,  very incomplete,  and very obscure fragment.   It
is a collection of sentences, which are attributed to Lysis, a Pythagorian
philosopher,  and the  friend and preceptor of Epaminondas;  but it
would  be impossible for us  to  avail ourselves  of the  doctrines of this
precious document, without the able commentary of M. Fabre d' Olivet.
Thanks to this skillful  interpreter, we are able to  lift a corner of the
veil that covers the famous  dogmas of the philosopher of Samos.0
  This commentator, in  order to give a general idea of the nature of his
work, explains himself as follows: " I have followed, in my translation,
the Greek text, as it is given at the head of the Commentary of Hiero-
cles, expounded by the son of  Casaubon, and  interpreted in Latin by
Carterius: London edition,  1673.   This work, as all those that remain
to us of the ancients, has been  the subject of a great number of critical
and  grammatical constructions.  The authenticity of  the greater part
of it seems to be unquestioned, and although there  are some variations
of opinion, they are of  too little importance for me to pause and consider
at this time.  Nor is it my place to do so; beside, each one must do his
own work.
  The  labor of the  grammarians is  complete, or must so be regarded;
for  nothing would ever  be  finished,  if we continually recommence our
investigations at the same point, without being willing to rely upon the
previous researches of others.
  As far as possible, I have extracted literally from the Commentary of
d'Olivet all that I give of the  system of Pythagoras;  nevertheless, for
the purpose of abbreviating, I  have contented myself sometimes to ana-
lyze certain passages,  which I  have indicated by the suppression of the
brackets.
   " Pythagoras considered  the universe as a unit  animated  by Divine
intelligences,  each, according to its  perfections, occupying its proper
sphere.  It was he who designated, first of all, this totality by the  Greek
word Kosmos, to express the beauty, order, and regularity  that therein
reign.   The Latins translate this word by mundus. from which  we have
derived the  French word monde.  It is from unity,  considered  as the
  -Vers Dores de Pythagore, explained and translated into French verse, by M.
d'Olivet.  Paris, 1813. 
84
PHILOSOPHIC  PERIOD.
principle of the world, that we get the word universe, which we  apply
to it.
   " Pythagoras considered unity as the essential principle of all things.
He designated  God by the figure 1, and matter by 2;  so  he expressed
the universe by 12, because this  results from  the  juxtaposition of the
figures 1 and 2."   (3e Examen.)
   As on the other hand, the number 12 results from the multiplication
of 3 by 4, the philosopher conceived the universe composed of three dis-
tinct worlds bound closely to each other, each of which was developed in
four concentric  spheres.   The ineffable Being who, placed in the com-
mon center of these twelve spheres, filling  them all without being com-
prehended by any of them, was God.
   The four spheres from which are  formed  each one of its three distinct
worlds, correspond to four elementary modifications of inert or amorphous
matter.   These primitive modifications  are called fire,  air, earth, and
water, and are the elements which constitute all material substances.
   " The application  of the  number 12 to express the universe, was not
an arbitrary invention of Pythagoras; it was common to the Chaldeans
and Egyptians, from whom he had  received it, and also to the chief na-
tions of the earth. It was the origin of the  institution of the Zodiac, the
division of which into twelve  constellations  has been  found to exist
everywhere, from time immemorial  "   (3e  Examen.)
   " According to  this system, absolute unity, or God,  was considered the
spiritual soul of the universe—the essence of being—the light of lights.
Between the Supreme  Being and man an incalculable chain of interme-
diate  beings was conceived, whose perfections or attributes decreased in
proportion to their separation from the creative principle."0 (3e Examen.)
   "Pythagoras, in conceiving  this  spiritual  hierarchy as a geometrical
progression, regarded the beings which compose it  under harmonious
relations, and founded, by analogy,  the laws of the  universe, on those of
music.  He termed harmony the movement of the celestial spheres, and
employed figures to express the faculties, relations, and influences of the
different beings."   (3e Examen.)
   Everything that appeared to have  an existence proper, was supposed
to proceed from  the reunion of  three modalities.  Thus,  the universe,
the grand whole or macrocosm, included, as we have  said,  three second-
ary worlds.  Man, the little world,  or microcosm, was composed, accord-
ing to Pythagorean views, of a  body, soul, and spirit, manifested  by
three distinct faculties: viz., sensibility, thought, and intelligence.  On
  0 The author explains in what cases secondary spirits were angels, deities,
intelligences, or demons. 
DOCTRINE OF PYTHAGORAS.
85
the other hand, each ternary, from the one that embraced immensity, to
the one that constituted the feeblest individual, being comprised  in  a
perfect  whole — a unity, relative or absolute — concurred to form the
quaternary or the sacred tetrad.  (3e and 12e  Examen.)
   Consequently, 1  represented  the  active and hidden principle of all
things; 2, its passive principle, or matter; 3, the  totality of the facul-
ties;  and 4, the plenitude of  its essence.   The  quaternary, was the
general type of all  living beings, manifesting  themselves  by facultative
modifications.  It could thus become the representative sign of any being
whatever;  but the  being to which it was  most ordinarily applied, was
man.  (3e and 12e Examen.)
   " The language of numbers, which Pythagoras, after the example of
ancient sages, frequently employed, is  now lost.   The fragments  of it
which remain, serve rather to prove its existence, than to furnish any light
on its elements; for they who wrote these fragments, used a  language
that they supposed known, in the same manner that  our modern savans
do, when they employ algebraic characters.   It would certainly be ridicu-
lous,  before  having acquired any notion  of these algebraic  signs,  to
attempt to explain a problem written in them; or what would be worse
still, to attempt  to employ  them, without  knowing their  value, to lay
down a proposition.  But this  is precisely what has been  attempted,
often, relative to the language of numbers.   Some have pretended, not
only to explain it, before having learned it, but even to write it — thus
rendering themselves contemptible.   The learned, finding this language
thus  travestied,  very naturally despised  it, and very  unreasonably
extended their contempt to the ancients who made use of it; acting  thus,
in this case as in many others: creating,  themselves, the alleged stupidity
of the antique sciences, and ended by saying,  'antiquity was stupid.' "°
(3e Examen.)
   The philosopher  of Samos admitted  two eternal, uncreated  essences:
namely, spirit and matter; and by the agency of these two principles he
explains the various phenomena of sensibility, intelligence, and thought.
" Whenever any one has pretended, or shall pretend to found the universe
on the existence of  one  sole nature, material  or  spiritual, and deduces
from  the hypothesis, the explanation of all phenomena, he encounters,
and always will encounter insurmountable difficulties.  It has always
been by asking what is the origin of good  and evil, that an  irresistible
overthrow has  been given to  all systems  of  this kind, from  Moschus.
  "'The little sketch that we have given above of the language of numbers, will
Berve, imperfect as it is, to  give an idea of the  importance that the ancients
attached to ternary and quaternary periods, in the determination of critical days. 
86
PHILOSOPHIC PERIOD.
Leucippus, and Epicurus, down to Spinosa and Leibnitz:  from Parnieni-
des,  Zeno  of  Elea, and Chrysippus, down  to  Berkley  and  Kant."
(31e Examen.)
  " Homogenity in nature was, with the unity of God, one of the great-
est secrets of the mysteries.   Pythagoras founded this  homugenity on
the unity of the spirit, with which it is penetrated, and from which  all
our souls, according to him,  took  their origin.  This dogma, which  he
had received from the Chaldeans,  and the priests of  Egypt, was admit-
ted by all the sages of  antiquity,  as is amply shown  at length by Stan-
ley and the judicious Beausobre.    Those  sages established a harmony
in principle, and a perfect analogy between heaven and earth, the intel-
ligible and the sensible, divisible  and indivisible substances, in  such a
manner that what transpires in one of the regions  of the universe, or of
the modifications of the primordial ternary, was the exact image of what
transpired in the other.  Beside, I must say, that  it is on the homogen-
ity of nature  that rest, in  principle; all  the occult sciences, of which
the four principal ones are connected with the human quaternar, beign
theurgy, astrology, magic, and chemistry."—(28e Examen.)
  " Man, in this system, was  considered as holding the middle between
intellectual  and sensible things, the last of superior and the  first of
inferior beings, free to move  upward or downward,  as influenced by the
passions that control the power of the will to ascend or descend.   Some-
times they bring him  into  union with immortals, and,  by his return
to virtue, enable him to recover his  proper position; and  again, some-
times replunging him into mortal association, and by  transgression of
the divine laws, cause him  to be stripped  of his  dignity.   It is based
on this rule, that we find everywhere, though differently explained, the
foundation of  the dogma of  the transmigration of  souls.   This  dogma,
explained in the mysteries of  antiquity, and received by all the people,
has been so disfigured by what the moderns  have  called metempsycho-
sis, that it would surpass very much the limits  of  these comments to
give it an explanation that could be understood."—(32e Examen.)
  " This same philosopher taught that the  soul has a body, which is
given to it according to its good or bad nature, by the  interior labor of
its faculties.   He calls this  body the subtle car of the  soul, and saye
that the mortal body is only a gross envelope."—(:)7e Examen.)0
  The indefinite perfectibility of  nature, founded on the homogenity of
its essence, is also one  of the  dogmas  of  the  Pythagorian school, that
moderns have appropriated, and which they have fortified by considera-
  te shall show, at proper time and place, the analogy that exists between this
doctrine and that of the monads invented by Leibnitz. 
DOCTRINE OF  PYTHAGORAS.
87
tions nearly demonstrative.   Among those who have  developed it with
most success, we cite Leibnitz, Lecat, Ch. Bonnet, Buffon, Linaeus, Kant,
Schelling, and lastly, the author of the articles, " Nature" and " Ani-
mal," of the Novveau Dictionaire d'Histoire Naturelle.   The following
is his explanation :  (3oe Examen.)
  " All animals and plants are only modifications of an  original ani-
mal or  vegetable.   Man is the point of union between divinity and
matter,  connecting  heaven  and earth.   The light of  wisdom  and
intelligence that beams in his thoughts, is reflected on  nature.  He is
the bond of communication between all beings.''0
  " There may have been a time when the insect,  the shell-fish, or the
unclean reptile, knew no master in the universe, and found itself at the
head of organized beings.   Who knows if, in the eternal night of ages,
the scepter of the world  shall  not pass  from the hands of man into
those  of a being more perfect  and worthy to  bear it.   It may be  that
the race of negroes, now secondary, was once the ruler of the earth, be-
fore the white race was created.   If  nature  has  successively accorded
empire  to  the species  more  and more perfect which she  has created,
why  should  she stop now?   Who   shall   define the  limits of  her
power ?   She is ruled by God alone, and it is his might and hand that
governs  her."0
  Attracted by the grandeur, beauty, and connection of these ideas, I
have given to the extracts  of the doctrine of Pythagoras a more con-
siderable extension  than I  was willing to, but the precious illumina-
tion that is found there, on a multitude of things and opinions that are
supposed new, have repaid  the reader, I hope, and will recompense him
more and more hereafter.   A system  which embraces and  unites, by a
common bond, God, the universe,  time, and  eternity; which  includes
an explanation  of  all the phenomena of nature, if not true, at least
acceptable, at an epoch when nothing  could be put in parallel with it,
but the gross mythology of pagan priests—such a system, I  say, was
well calculated to captivate, at once, the imagination and  understand-
ing.   It is now easy to conceive the admiration and enthusiasm  of  the
adepts, in proportion to  their progress in the autopsy of the mysteries,
and their submission, respect,  and gratitude  toward the superior man
who initiated them into such lofty conceptions, seems entirely reasonable
and natural.
0 See the " Nouveau Diet. d'Hist. Nat.," at the word Nature.
0 Same work, at the word Animal. 
88
PHILOSOPHIC PERIOD.
                        CHAPTE1I  II.

                   PERIODIC  PHYSICIANS.

   When  the storm  of persecution  had  dissolved  the  Pythagorian
societies, the members that composed it were scattered in different parts
of Greece.   Being no longer held by the bond  of the community, many
of them  revealed in whole or in part the secrets of their doctrine,  and
to this circumstance we owe  the little  light that we possess  on  the
subject.
   A great number of the disciples of Pythagoras became illustrious in
different  careers, but  we can only speak  in  this work  of those who
followed  the practice of Medicine.   History states that the latter first
introduced the custom of visiting their patients in their own  houses ;
that they went from city to city, and from house to house, fulfilling the
duty of physicians, as is done at present.  On this account they were
called  periodic,  or  ambulant physicians,  in  opposition to the  Ascle-
piadae, who  were consulted by and treated the sick only in the temples.
As to the charlatans who retailed drugs in shops, or at market, it appears
that they have  never had a  rank  in the  medical hierarchy, however
numerous they may have been at  certain  epochs.
   Among the Pythagorians who cultivated  Medicine, is cited Alcmoeon,
of Crotona,  who is said to have written  on anatomy and  physics.   It
is pretended that he was the first to dissect animals ; but this is quite
doubtful,  as Anaxagoras and  Democritus  were  already much  earlier
occupied  than he, in zoology.  At any rate, we are  not able now to
judge either of the reality or merit of his discoveries, as no part of his
writings have come down to us.0
   Empedocles, of Agrigentum, was more famous than Alcmoeon.   Many
remarkable cures are ascribed to him which  attest his sagacity.  Among
many instances  that prove this,  we select the following.   From time
immemorial  pestilential fevers ravaged, periodically,  his native city.
He observed that the  appearance of these fevers coincided with  the
return of a  wind named Sirocco, which  blows in Sicily, from the east
and south.   He therefore advised to close by a wall the  narrow gorge
which  gave  passage  to this wind when  it blew on Agrigentum.   His
counsel was  followed, and from that time  the pest ceased to make its
appearance  in the city.   Some modern travelers  have confirmed this
remark ;  among others, Doctor Brayer has alluded to it, in his excellent
0 Lauth, Histoire de l'Anatomie, Strasbourg, 1815, Liv. n. 
          THE  PRACTICE OF MEDICINE IN  THE GYMNASIA.       89

work, entitled, Nine Tears of Residence in Constantinople.  The inhabi-
tants of  Selinus were a prey to  an epidemic disease.   A stream,  by its
sluggish course, filled the city with stagnant waters, from which were
evaporated, daily, mephitic vapors.   Empedocles saw  this, and caused
two small creeks to be conducted into it.  This gave a new impulse to
the waters, which ceased to be  stagnant and to  exhale the noxious
effluvia.   The scourge disappeared.0
   Agrigentum  saw flourish, about the same epoch, another  physician,
named Acron, who was not of the  sect of Pythagoras.   He rejected in
medical practice every species of physiological theory, and insisted upon
the value of pure experience only.   On this  account he is regarded by
some as the chief of  the empirists.  But it  is impossible for us to
judge of the value of this opinion, because, no  fragment of his writings
has come down to us.   All that can be  said, is, that the separation of
physicians into several sects, each one having  principles, rules, and in
some sort distinct symbols, did  not  take  place for two centuries later,
until the establishment of the Alexandrian school.
                        CHAPTER  III.

         THE PRACTICE OF MEDICINE IN THE GYMNASIiE.

  It is an incontestible fact, that Medicine was practiced and  taught
in the gymnasise of Greece, a long time before the  Asclepiadae had
divulged the secret of their doctrines.f  There were in these establish-
ments three orders of physicians.   A director termed the gymnasiarch,
whose duties consisted in regulating the diet of the Athletae, and of the
young men  who  frequented  these  schools; a sub-director, or gymnast,
who directed the pharmaceutic treatment of the sick ; lastly, subalterns,
named jatraliptes, who put up prescriptions,  annointed, frictioned, bled,
dressed wounds and ulcers, reduced luxations, fractures, etc.
  Marvellous stories are told  of the  sagacity of the gymnasiarchs, in
discerning the slightest variation in the prescribed regimen.   They pre-
tended to recognize by certain signs, if any one  had  been guilty of the
  0 Diog. Laert. in EmpedocL  Des Sciences Occultes, par Eus. Salverte, Paris,
1843, pag. 334.
  f See Plato—Laws: Daniel Leclerc, Hist, de  la Medicine:  C. Sprengel, Hist.
de la Medicine: M. Houdart, Etudes Historiques et  Critiques sur la Doctrine
d'Hippocrate.  Paris, 1840, in 8vo.
        6 
90
PHILOSOPHIC  PERIOD.
slightest excess in drinking or eating, if the accustomed promenade had
been neglected, or if there had been any indulgence in the pleasures of
Venus.   Though the author  who gives these accounts appears to ques-
tion their veracity, yet, nevertheless they do prove that  the  doctors  of
the gymnasiae had a high reputation, and possessed a certain degree of
skill.0
   History has transmitted to us the names of two gymnasiarchs, cotempo-
raries of Hippocrates, but slightly older than he.   The  first  was Iccos
of Tarentum, celebrated for his sobriety and continence; the proverb,
" repast of Iccos," was used to signify its frugal character.
   The second was Herodicus, or Prodicus, of Selymbria, the same who
is named  in  the  passage of Plato that we have  heretofore quoted  (see
page 49.)   That  philosopher accuses him of being  the first who employed
gymnastics, in  the cure of diseases, and he reprimands him severely on
that occasion for having succeeded too Well in  prolonging the lives of
valetudinarians.   But  the author  of the sixth  volume  of  Epidemics
reproaches him in an entirely  opposite manner ;  he accuses him  of kill-
ing his fever  patients by excessive fatigue, f  It is said that this gym-
nasiarch obliged  his patients to run without stopping, the distance from
Athens to Megara,  and back again, equal  to three hundred  and sixty
stadia, which are about equal  to nine French leagues.  These two con-
tradictory reproaches may be easily explained; for such exercise, though
useful in some slight chronic disorders, must have been  fatal in acute
diseases.
                        CHAPTER  IV.

              SCHOOLS  OF THE ASCLEPIAD^).

  We have already said, that nearly everywhere the temples of Escula-
pius were dispensaries, in which advice was given and remedies adminis-
tered, and that  the  young  sacerdotal  aspirants were there trained in
the practice  of  Medicine.   The Asclepiadae had  preserved, until that
epoch,  the  tradition  of the Egypto-Indian school, which  only allowed
them to transmit their doctrines to the  members of their  caste, and to
such strangers as fulfilled  satisfactorily the iniatory tests.   But when
the disciples  of  Pythagoras had  revealed the secret of their mysteries,
and the philosophers had dared  to teach and discuss publically the
3 CEuvres d'Hippocr., 2e livre des Prorrhetiques, at the beginning.
f Ibid, livre 6e, section 3e, § 48, edition of M. Littre. 
SCHOOLS OF  THE  ASCLEPIADAE.
91
principles of morals, physics, and  theology, and when the  itinerant
physicians, and  the professors of the gymnasiae, had  acquired the con-
fidence of the public, the priests  of Esculapius could no  longer keep
silence, under the penalty of seeing  the scepter  of Medicine, which they
had held until then, fall from their hands.   They were constrained to
bring to the light of discussion the principles and rules of their medical
practice.  In this way the science, whose aim is the preservation and
re-establishment of  health, came forth at last from the shadow of the
sanctuary, and,  vivified by public  discussion,  made in a short  time
extraordinary progress.
   The  priests  who served in the  temples at Cnidus were  the first to
follow the impulse of the age.  They published the  little collection of
Cnidian sentences, of which we have already made mention.  The Ascle-
piadae, of Cos,  did not  hesitate to  follow  their example.   They  pub-
lished a series of treatises,  that were collected  at  a later period  under
the  title  of the  Hippocratic Works.    This  collection,  which over-
shadowed all the medical publications of that period, constitutes one of
the most precious monuments of  ancient Medicine.  But before speak-
ing of the matter which it  contains, we shall  say a word or two about
the personage whose name it bears.
                     ART. I. HIPPOCRATES.
  Hippocrates was born in  the isle of Cos, of a family in which the
practice  of  Medicine was hereditary.  They pretended  to  trace their
ancestry, on the male side, to Esculapius, and on the female side to Her-
cules.  They count as many as seven of its members that had borne the
name of Hippocrates; but the most celebrated of all was the second in this
range.   His birth goes back about as far as the year 460, before Christ.
But few particulars are known of his life, and we know  not his age at
death.  Some say he lived to one hundred and ten years; others, to ninety;
and others, again, to eighty, only.  It is certainly known, that he traveled
in Asia Minor, Thrace, Macedonia,  Thessaly, and  many other countries.
because,  in various passages of his writings, he names these countries,
and the diseases he had occasion  to treat in them.   From  these  it is
ascertained  that he was a cqtemporary of  Socrates, and slightly younger
than he; therefore, he belongs to the  famous age of Pericles, when the
sciences and arts attained, in Greece, so high a degree of splendor.
  The isle of Cos, now Stan-co, situated between Milet and Rhodes, not
far from the  coast of Ionia,  was favored with a delicious climate, and,
in former times, was considered, also,  as one of  the most salubrious 
92
PHILOSOPHIC PERIOD.
countries; but it has lost its antique reputation since it  has been under
the dominion of the Turks, for  it is  now regarded  as one  of the most
unhealthy countries.  It possessed then a temple dedicated to Esculapius.
and a  Medical school,  which was the most  celebrated of all the Ascle-
pidian schools.   Hippocrates was thus placed under  very favorable
circumstances to receive a most careful and  complete Medical education.
Nevertheless, he was not  satisfied with this domestic instruction.  He
visited the principal Greek  cities of Europe and Asia, communing with
philosophers, examining  the gymnasiae, giving attention to all persons
who asked his services, collecting, at all points, observations on special
diseases, epidemic  constitutions,  also,  on  the influence of manners,
climate, regimen, etc.
   After his return to his native country,  being now rich in the materials
he had collected,  and especially in those that his ancestors had amassed
for a considerable  length of time, he published those  immortal works
that astonished the world, and made the  physical science of man, one of
the most  important branches of Natural Philosophy.   Already whilst
living, he  had  an  unequaled  renown  in  his profession.   Plato,  his
cotemporary, and even  Aristotle himself, rest on  his  authority when
referring to  the organization of the human  body.  The habit of  calling
Medicine  the Art of Esculapius, was gradually  lost, and learned men
more frequently spoke of it  as the Science of Hippocrates.
   His sons, son-in-law, and grand-children, followed the same  career,
and added much to his professional  labors.  But the greater  number
of them published their writings  in his name, either to honor his memory,
or to obtain more weight for their opinions  and precepts, or to  conform
to a usage immemorial  in clerical families, or, for all these three reasons
together:  thus, even in a short time after the death of the great Hippoc-
rates, it had already become very difficult to distinguish  his own works
from  those  of his  disciples.  This  difficulty continued  to  increase in
proportion as the texts became impaired  by  the ignorance or inexactness
of copyists, and  above all  by the bad faith of bookmongers.   These,
according to Galen, had not the least scruple in the world, to write the
name of Hippocrates on the medical writings of  unknown or  obscure
authors.
   By this  fraud they  augmented, very much, the  venal value of the
volumes which they had in  possession; and  on this account, says Galen,
they had  frequent recourse  to it, especially at an epoch when  the sove-
reigns of  Egypt and Pontus, rivals in zeal  for the increase  of the libra-
ries they had founded, purchased in every country all  the books  that
could be procured, and paid  for them a price proportional to the reputation
of the authors.   The savans having charge of the library at Alexandria 
SCHOOLS OF  THE  ASCLEPIADiE.
93
very soon discovered the fraud;  so  from the commencement  of  that
collection,  they  were careful  to place in  a  separate  column,  the
writings which appeared to them to  have really come from the pen of
the physician of Cos; and they designated them as volumes of the little
tablet, ra ex too [lcxpoo  izcvaxidcov.  This disposition of them in the
library, was still seen in the time of Galen.
   A great number of commentators  have attempted to  arrange a cata-
logue of the legitimate writings of Hippocrates; but, guided by different
views, and resting on diverse documents, they have all  varied  in their
enumeration.   Galen gives a list of these writings that  differs from all
preceding ones;  and the moderns, in their turn, have  each, after his
own notion, changed the list of Galen.   After the learned researches of
Mercuriali, Foes, Grimm, Gruner, Ackermann, Sprengel, and many others,
one might suppose the subject exhausted.  Nevertheless,  at this moment
there appears an edition  of the works of Hippocrates, in French, in which
the  author,  M.  Littre,  in  a remarkable introduction  which occupies
nearly the whole of the  first volume, passes in review all  the questions
relative to the  authenticity of the Hippocratic books, and throws upon a
track, so well beaten, and apparently so sterile, a new light, and percep-
tions, sometimes profound, sometimes ingenious, which could scarcely have
been expected:  so true is it of the facts of antiquity, as says the poet,

            " On ne peut dans ce champ tellement moissonner
             Que les derniers venus n'y trouvent a glaner."

   But they are not simply gleanings, that  the modern  translator of
Hippocrates has  gathered in the field of erudition; it is  a  beautiful and
excellent harvest.   After the example  of  his predecessors,  M. Littre
examines the  catalogue of writings attributed  to the father of Greek
Medicine, and  changes it again.
   To  guide me  in  the  midst of this  labyrinth of divergent opinions,
without involving myself in researches, or dissertations, which is foreign
to my plan, I  have adopted  the following rule:  I admit, as legitimate,
those  works only, which the principal critics unanimously recognize as
such ; and I set aside the others, as doubtful or apocryphal.  This rule.
it seems to me, is the best to get at the truth as nearly as possible; as
the  commentators and interpreters have a  greater propensity to extend
the  domain of their favorite author, than  to limit it.   In  accordance
with this rule, I now give what appears  to me to be an undoubted list
of the authentic writings of Hippocrates the  Second:
           The Prognostic;
           Some Aphorisms;
           The Epidemics, 1st and 3d books ; 
94
PHILOSOPHIC PERIOD.
           On the Regimen in Acute Diseases ;
           On Airs,  Waters, and Places;
           On Articulations or Luxations ;
           On Fractures;
           Mochlic, or Treatise on Instruments for Reduction.
   This list does not  comprise the fourth  part of  the entire Hippocratic
collection ; but, thus reduced, the portion ascribed to  Hippocrates still
suffices, when we consider the era in which they were  composed, to
justify the enthusiasm of  his cotemporaries, and  the admiration of
posterity.
        ART. II.  THE HIPPOCRATIC  COLLECTION.
   M. Littre establishes, by convincing proofs, that the collection which
we now possess, was not published as a whole until  the  foundation  of
the great libraries of Alexandria and Pergamos.   Until then, there
had been only a few books put in circulation ; the major part of these
writings had  remained  in  the hands of the successors of Hippocrates,
who had only communicated them to their  disciples.  This  collection
includes a small number of complete treatises, with a more considerable
number of  incomplete  ones, extracts,  fragments, notes,  and  detached
thoughts, the  imperfections  of which prove,  for some of them, at least,
that they were not destined to be made public.  It is composed of writ-
ings of several authors who succeeded each other, from Pythagoras until
the death of Aristotle, extending over all the space comprehended by us
in the philosophic period.
   United to some fragments of Plato and  Aristotle, the Hippocratic
collection forms the most ancient authentic monument in medical science;
it  is the first visible link of the chain that binds the doctrines and dis-
coveries of ancient Medicine to the doctrines and discoveries of modern
Medicine.    Even on this account  alone, it merits at once all our atten-
tion, by the correctness of the observations, the  grandeur of the ideas,
and the clear perceptions which adorn several portions of  it.
                     § I. Anatomy and Physiology.
  Neither  Hippocrates  nor his  descendants  ever  dissected the human
body ;  the  religious respect  that was had for the dead in all Greece,
prevented it.  We, therefore, find in their writings  some generalities,
merely, on  the form, volume, and  respective  positions of the  principal
viscera.  Osteology, only, is treated there with sufficient exactness, and 
SCHOOLS OF  THE  ASCLEPIAD.&.
95
this fact  is explained  by a tradition, which says that the Asclepiadae,
of Cos,  kept in their school a human  skeleton, for the instruction of
their pupils.   They had been able moreover to acquire  some knowledge
on the conformation of  the  internal parts, in examining the entrails of
victims, in the  case  of the wounded,  whose splanchnic cavities were
opened,  and in dissecting animals.   Such are, according to the opinions
of nearly all historiographers and critics, the sources whence the members
of the Hippocratic family obtained their anatomical knowledge.   Never-
theless,  I must say, that the author of the History of  Anatomy, whom
I have already cited, denies that Hippocrates ever dissected animals, or
even had  in his possession a veritable skeleton.  Be this as it may, the
following  are the books of the collection in which are found the most of
the anatomical details:  Regions in man ; Wounds  of the  Head; The
Mochlic;  The Heart;  The Glands;  The Nature of Bones;  A Frag-
ment on the Dissection of the Body.
   The prejudice which forbade the touch of the human corpse, did  not
begin to abate until toward the close of the philosophic  period, at which
time the  family of Hippocrates appears to be extinct, the name of any
his decendants no  more appearing in the history of Medicine.
   Physiology, as we conceive it in our day, that is, that branch of  the
science of man which is devoted to the  description  of  the functions of
each organic apparatus, can not make one step without being guided by
the light  of anatomy.   It  is, therefore, not astonishing that  we  en-
counter scarcely any traces of it in the Hippocratic  writings.   We
read in them that the glands are spongy viscera,  destined  to secrete
humidity  from the surrounding parts, and that the brain, the largest of
the glands, attracts the vapors of all  the interior  of the  body.  The
muscles, which they called  flesh, were for  the purpose of covering  the
bones;  the nerves, the tendons, the ligaments, the membranes, are all
represented as analogous organs, concurring in the  same manner to the
production of motion.   The arteries and veins are generally confounded.
or if they are  distinguished, it is only on the supposition that the former
contained air  and the latter  blood.   Respiration was  supposed to
moderate  the heat of  the lungs, and especially of the heart.
   But if  the physiologists of those times neglected  the special study of
the organic functions, in lieu of it, they gave themselves up to transcen-
dental  speculations on  the nature and seat of  the  principle  of life.
Some placed  the  source of life in moisture,  others in fire, others in the
union of  two or  four  elements, etc.  Each  one endeavored  to  sustain
his hypothesis by arguments  more or less specious, and aspired to the
glory of going back to  first principles.   Intermediate knowledge, or the
study of  details, was considered as of but little value.  Such was the 
96
PHILOSOPHIC PERIOD.
general direction  given  to  scientific researches by  the philosophers.
Many books of the collection contain  speculations of this  kind, as we
shall see when we come to expose their theories.
                             § II. Hygiene.
   We remarked,  in speaking  of Medicine among the  Hebrews, with
 what care Moses had regulated  everything that concerned health.   The
 Asclepiadae, who,  like him,  owed their first scientific  instructions to
 the  Egyptian  priests, gave  special  attention, also, to  hygiene.   Their
 writings on this branch of the art have in general all the completeness
 that could be attained from the lights of  that era.  They are, first, a
 treatise on Airs, Waters, and Places, a work written with  great firm-
 ness, and  ornamented with all the pomp of style.  The  author there ex-
 plains methodically, and on the authority of his experience, the influence
 of climates, seasons, and various topographical circumstances,  on  the
 constitution of man.   The work has been reproached for its superficial
 treatment of the subject; but it  must not be forgotten that experimental
 physics was not yet born, and that without it such a subject could  not
 be treated in a profound  manner.   We have already  spoken  of  the
 book at  the  commencement of our  account  of  the  present  period,
 and  it may be inferred from what was there said,  that no other book of
 the period contains views of higher philosophic import.   I shall add, in
 support of my assertion, but this single remark: it contains the germ of
 two  modern productions, justly regarded as chefs-d'oeuvre—the " Spirit
 of Laws," by Montesquieu, and  the " Relation of  the Moral and Phy-
 sical Man," by Cabanis.0
  2. A treatise on Regimen,  divided into three books; a well-conceived
 and  well-executed composition,  notwithstanding some  digressions and
 strange associations that impair  the first part.  The author considered
 man as formed of two  principles, fire  and  water, the just  balance of
 which constituted  health.  The  first book is entirely devoted to the de-
 velopment of that theory: in the  second he examines the various hygienic
 modifiers,  relative to their faculty  for causing dryness or  moisture;
 finally, in the third  book he regulates the use  which is to be made of
these modifiers,  as regards the  social position  and the occupation of
persons, the seasons of the year, and especially in regard to the bulk
 and  fullness of the  body.   Already we see appear the dichotomy, to
"' See his Lettre sur les Causes Premieres. 
SCHOOLS OF THE  ASCLEPIAD^!.
97
which  so many physiologists  have  since  endeavored,  under various
names, to refer all the modifications of the animal economy.
  3. The small  treatise on Salubrious  Diet, summarily abridged from
the preceding work, and free from all physiological dissertation:  it is,
however, obnoxious to the single reproach of being  too succinct.   The
author mentions in it the custom of certain persons taking one or two
vomits a month, as being an ordinary hygienic proceeding of  his time.
" He who is  in  the habit  of vomiting  himself twice a month," he re-
marks, " will  find more advantage  in doing so on two successive days
than once every  two weeks."
                  § III.  Pathology and Therapeutics.
  We have given a glance of the views which the Asclepiadae had acquired
on the structure and functions of different parts of the human body, as
well as of means employed to maintain their integrity of function.  We
now proceed to say something on the ideas they had touching the disor-
ders of these functions,  and the means employed to restore them to their
normal state.  These last two branches of  medicine are designated by
the names of Pathology  and Therapeutics, each of them to be subdivided
in different ways, according to the views of authors and the extent of
the knowledge of their age.
  One of the most ancient divisions of pathology and therapeutics con-
sisted in dividing  diseases and modes of  treatment into two classes, one
called internal or medical, the other, external or chirurgical.  We shall
preserve this distribution; not that it is so philosophic, but because the
greater part of writers whose labors we must examine have followed it,
and because it yet exists in science, notwithstanding its evident defects.
  I will make only one  prefatory remark, the truth of which will stand
out more and more in the course of this history; it is,  that a scientific
classification is nothing else than an artificial arrangement of the facts
and  ideas that constitute  a science.  Now, as new facts and  ideas were
added  each day by the  ancients, it follows that the same  arrangement
would  not  always  be suitable.  For example, a pathological classifica-
tion which  may have been satisfactory in the time of Hippocrates, would
to-day be very  defective.   The Nosology of Sauvages, so celebrated in
the last  century,  has already  become superannuated.   To pretend to
trace a systematic  and an  immovable list which should include all the
ideas and discoveries of future generations,  would in some sort be  like
digging a pit, out  of which the  genius  of man could  never emerge.
Some  have attempted this, but no one  has ever  succeeded.   The merit 
98
PHILOSOPHIC PERIOD.
of a methodic  repartition consists,  as I think, in  embracing as  far  as
possible the totality of the materials of which science is composed at a
given period, and presenting them in lucid order, so as to aid the mem-
ory and the judgment; but it is plain that such a plan must vary with
the different phases of science.
   During the  philosophic period  the animal economy was considered as
a whole, nearly indivisible; the morbid phenomena being regarded  as
the expression of a general derangement of the organism, rather than as
the index of the derangement of any part.  Consequently, the symptoms,
their  progress, gravity, and indications, were often studied without re-
gard  to any particular  species of  disease.   It  was  said, for example,
"The physician should find  his patient lying on the right or left side,
having the arms, the neck, and the legs a little flexed, and the entire
body moist; for so the greater part of men in good health repose on their
beds,  and the most favorable position in a patient  is that which is as-
sumed in  a state of health.   To lie  on the back,  with the arms and legs
extended, is less favorable.   The  tendency to sink in the  bed and slide
down  to the foot is still more unfavorable." °
   This study of symptoms, considered in a general and abstract manner
was pushed  very far in the school of Cos.  It gave birth to a branch of
Pathology which is termed Semeiotics, which we  will now first consider.
                          § IV.  Semeiotics.
  Semeiotics occupies a very considerable place in the medical works of
the Asclepiadae.  Two of the most complete and best achieved treatises
of the collection—that on Prognostics, and the second book on Predictions,
or Prorrhetics—are  devoted  to this branch of Pathology.  Beside,  the
first book on  Predictions and Coan Prenotions,  a species of treatises
believed to belong anterior to Hippocrates, as well as the book on Dreams,
which is appended to the treatise on Regimen, relate entirely to the same
subject.  Now, all these portions united, form more than  the eighth
part of the entire collection, without counting a great number of Semei-
otic sentences scattered in other works, and especially among the Apho-
risms.
  Hippocrates, at the beginning of his work on  Prognosis, gives us  a
very precise idea  of  the  sense that was formerly attached to this word,
while,  at  the  same  time, he appreciates, in the highest manner,  the
importance  of  this  branch  of Pathology.   " The best physician,"  he
0 Prognostics. 
SCHOOLS OF  THE  ASCLEPIAD.E.
99
says,  " is the one who  is able to establish a prognosis;  penetrating and
exposing first of all, at the bed-side, the present, the past, and the future
of his patients, and adding what they omit in their statements ; he will
gain  their confidence;  and  being convinced of the  superiority of his
knowledge, they will not hesitate to commit themselves entirely into his
hands.   He can treat, also,  so much better their present condition, in
proportion as he shall be able from it to foresee the future.  To restore
to health all the sick is impossible; and although this would be better
than  being able to predict the successive progress of symptoms, yet, since
men must die, some, succumbing before calling a physician, are carried
off by the violence of the disease; others, immediately after having sum-
moned one, surviving only a day or so, expiring before the physician has
been able to combat by his art, each of the accidents ; nevertheless, it is
important to understand the nature of such affections, and how much
they exceed the constitutional forces, and, at the same time, discern if
there be any thing to divine  in the disease; this is the great thing yet
to learn."   In this way the physician will be justly admired, and will
practice his art  skillfully; indeed,  those who can be cured, he  will be
much more capable of  preserving  from peril,  in advising them,  long
before-hand, against certain  casualties; and, on the other hand,  in fore-
seeing and  pointing out  those who must perish, and those  who  will
recover,  he will exempt himself from all blame.0
   We perceive in this passage, that the word prognostics had a much more
extended signification among the ancients, than it has among moderns—
that it includes, at the same time, prognosis and diagnosis.  The second
paragraph of the same  book, shows in what way the first Hippocratists
established their prognosis, and gives an idea of the extreme difference
that exists between the Medicine of their times, and that  of ours.   " In
acute diseases," says the author,  "the physician must make the follow-
ing observations: first, let him examine the countenance of the patient,
and see if the physiognomy is similar to that of men in health, but
above all, if it is  like itself.   Such an appearance will be most favor-
able, but the danger will  be greatest in proportion as the expression is
unnatural.  The features have attained  the last degree of alteration,
when the nose becomes  pointed, the eyes sunken, the temples flattened,
the ears cold and contracted, their lobes shrunken; the skin of the fore-
head  dry, tense, and parched; the skin of the entire face of a yellow,
dark  livid,  or  leaden hue.   If from  the  beginning of  a disease the
patient's countenance presents these  traits, and if  other signs do not
furnish sufficient explanation, the patient should be asked if he has lost
° Prognostics, § 1. 
100
PHILOSOPHIC PERIOD.
much rest, or has a severe diarrhea, or is suffering from hunger.   An
affirmative response on either of these points, would cause the peril to
be regarded  as less imminent;  such a morbid condition, resulting from
any of the  causes  above mentioned, may be arrested in the course of
twenty-four  hours; but if the patient does not communicate any of these
causes, and  if the affliction does not cease in the interval above-men-
tioned, it may be predicted that death is not far distant."0  How much
time and observation were necessary to unite thus in a single tableau the
evidences of decomposition in the human body at the moment of approach-
ing death ;  to associate this frightful train of symptoms, sometimes with
a slight affection,  that  may be  cured in a day, and again, with a des-
perate state, whose fatal termination can not be arrested !  Remark, that
on these occasions  the  physician  forms his judgment, and  makes his
prognosis, without  occupying himself with the  interior organs, which
require much more sagacity, and would  be, however much attention he
might give  them,  a source of frequent  error.   To-day, a physician, in
presence of  such an assemblage of symptoms, would seek and find their
cause in some visceral  lesion; but this was not possible in the age of
Hippocrates, and for a long time after him.  Deprived of the light of
post-mortem examinations, the physician of that  time was forced to
make his observations on superficial phenomena, and deduce his prog-
nosis and treatment from them.
   He who is in the habit of seeing patients,  and knows by experience
the  inconceivable  variety,  and inconstancy of morbid symptoms,  can
alone appreciate the time, labor and patience  it required to deduce some
general  propositions from the observation of phenomena; to trace, in a
word, those  rules of Semeiotics  which ancient Medicine has transmitted
to us, and some of which still preserve all their original value.   If more
perfect and  more varied means of investigation allow us now to carry
our observations still further, we must  at least admire the perspicuity
of the ancients, who, in many  cases,  were able to foresee  the  future
events in diseases, with as much certainty as ourselves.
   Observe  also  that the greater part  of the  rules of Semeiotics are
announced in an absolute manner, and in the form of aphorisms, which
indicate the way in which they were established.   They must have pro-
ceeded in nearly the following manner: when the identical or analo-
gous symptoms were presented a certain number of times  in the
same order, the fact of their  habitual  succession was established by
a general proposition, often without exception, because experience had
not  yet made these known to them.   But afterwards, in proportion as
0 Prognostics. § 2. 
SCHOOLS OF THE  ASCLEPIAD,E.
101
such exceptions were observed,  they were noted, and new  aphorisms
drawn  from them, which sometimes merely  limited  the  first, or even
contradicted them.   At length the exceptions  to the first observa-
tions  became  so multiplied that  those axioms lost  much of  their
value.   The authors who adopted at a later period that style of writing,
were less  affirmative and less absolute in their sentences, and therefore
inspired less confidence.  This  change is already seen to take  place
between the writings of the treatise on Prognosis and the second book
of Predictions.   The  author of the latter, whoever  he was, exhibits
less self-confidence, and is less positive than his predecessor.   He com-
mences  even by cautioning the reader  against  the  marvelousness of
certain  predictions, and cites for examples those that were  attributed
to the directors of the gymnasia?:  "As for me," he adds, "I can not
divine, but I will describe the symptoms that  will enable you to judge
which  of  your  patients  will recover and which will  succumb, and
whether they will recover soon, or be long sick." °
   It appears from  some  passages in the  same book, and from a frag-
ment  on dreams, which is a part of the Hippocratic  collection, that it
was the custom of physicians  of  that  time, to announce  the probable
issue of the disease at the first or second visit.  This custom  still pre-
vails in China.   It likewise prevails in Turkey, as is attested by my
respectable friend, M. le Doctor  Brayer, who relates  on this subject a
curious anecdote, in which he was  in some sort obliged to play the part
of a diviner.f   Such an usage indicates the infancy of art, and can only
exist  as the effect of ignorance and superstition.  It supposes that a
physician  is consulted as an oracle — as a man endowed with super-
human science,  and not as a simple mortal, who by reason of  study and
observation has attained the fixed impression in his mind of the natural
progress of a given number of diseases, and  groups certain  character-
istics, by means of which he can in some cases announce their probable
issue.  Hippocrates blames loudly these physicians,  who abandoning
the route of truth  and rectitude, assume the position of thaumaturgs
before their patients, constructing  their replies in a vague and  ambig-
uous manner, so that they may be  adapted to the most diverse develop-
ments ; in short, the usage of all such artifices as are now  employed by
sorcerers, card-drawers, and somnambulists, to deceive those men that
disease, ignorance, or  love of the marvellous  renders, and always will
render, easy to  be imposed upon.
3 Second Book of Predictions, by Gardeil.
f Ibid. 
102
PHILOSOPHIC PERIOD.
                      § V. Internal Nosography;
  Nosography is the eye of therapeutics.   In proportion as the firrt  is
lucid, methodic, and complete,  the  second is sure and rational.   The
possession of the most efficacious curative agents is of no avail to us if
we can not distinguish the cases in which their use is advantageous,
from those in which they would  be injurious.  In fact the  more the
means that the therapeutist dispensers have of power and energy, the
more they become dangerous in  the hands of the ignorant.  That which
distinguishes the sage and enlightened practitioner from the  blind and
headlong routinist, is the knowledge of indications.   Now this  know-
ledge is only  acquired by  the comparison  of the morbid phenomena
that are before him, with those that he has before observed,  and with
the most faithful nosological descriptions of others.
  In many passages of  the  Hippocratic works, diseases  are  termed
sporadic, epidemic,  and endemic, a useful and well founded distinction,
of which  the  practitioner should never lose sight while the same affec-
tion changes in gravity and requires different treatment, accordingly  as
it exists under one  or other of  the above forms.
   The  same writers  also divide diseases  into acute and chronic, but
they do not seem to attach a near and precise idea to this separation —
they  only  indicate  it, and in their  pathological works  they mingle
indifferently, and confound  these two classes of morbid  affections ;  in
general they observe no order.   In  one of them alone  they are distin-
guished from each other by a more methodic arrangement, and that is the
work on Affections, a summary abridgment of nosography, the  most com-
plete of the collection.   In it  the  diseases  are  classified according  to
their  localities,  beginning  at  the  head  and going  down to the feet.
Thus  phrenitis, that was supposed to be a  disease  of the diaphragm,
is  described immediately after pneumonia;  and what is  remarkable,
fevers  follow  phrenitis,  because supposed to have  their seat  in the
 superior viscera of the abdomen.
   The following is the list of the Hippocratic books devoted wholly or
 in  part to internal  nosology:

    1. The  treatise  on the Regimen in acute diseases, from the 29th to
          the 44th paragraph,  inclusive.
    2. The treatise on the Regions in man,  from the 16 th  paragraph to
          the end.
    3.  A small monograph  on Epilepsy, which was called the  sacred
           disease.
    4.  A treatise on Diseases, in four volumes. 
SCHOOLS OF  THE  ASCLEPIAD^.
103
   5. A treatise on Affections.
   6. On Internal Affections.
   7. A fragment on Diseases of Girls, relating particularly to histeria.
   8. A book on the Nature of Woman.
   9. A treatise on Diseases of Women, in two volumes.
   10.  A monograph on Sterility.

   All  these books  and fragments united, are far  from constituting a
 complete nosography of internal diseases.  In the first place the greater
 part of chronic affections  are only designated by their  names.   Some
 are  not even named, and  a very small  number are described.   The
 omission of all that class of  diseases, so important, is owing to the fact
 that they were  generally  regarded  as inconveniences which did not
 merit  the  attention  of physicians.   We  have  already  quoted  and
 refuted the opinion of Plato, who blames  Herodicus for striving to pro-
 long the existence of valetudinarians by the  aid  of gymnastics.   Here
 is a passage from  another author, cotemporaneous with that philosopher,
 who  agrees  very  nearly with  him:  "Leprosy,  pruritis,  teter, white
 spots on the skin, baldness,  etc , it  is said,  proceed from the  pituite ;
 on  this account  remedies are employed to evacuate this humor; but
 they are rather deformities  than diseases."
 ^ In the second place, though the attention of the Asclepiadae was prin-
 cipally  directed to  acute diseases,  the descriptions  which they  have
 transmitted to us, are, for the most part,  so defective, that it would be
 difficult, if not impossible,  to report  a single  one of them that offers a
 tableau at all complete or well  arranged,  of any morbid species what-
 ever.
  I conclude from this, that the remains of medical antiquity have now
little interest in  a didactic  point of  view; but though they  are  com-
pletely  sterile for the student and young practitioner, they will  always
interest, to  the last degree, the erudite man and  the philosopher, to
whom these deliis  are one, as  stakes that indicate the route followed in
antiquity by science, and serving to measure  the stages through which
 she has passed.
  On this account, my readers will not be  displeased, I presume, to find
here two descriptions of diseases, chosen from  amongst those which have
appeared the best defined in the Hippocratic collection.

                        ON peripneumonia.0

  "Peripneumonia shows itself in the  following manner: a great fever is
developed; the respiration is  hot and frequent; the  patient  does not

             'Traite- des Maladies, liv. 3e, § 17, trad, de Gardeil. 
104
PHILOSOPHIC PERIOD.
know how to contain himself; he is feeble and totters.   The pain is felt
at the shoulders, above and in front of the chest, as far  as the breasts.
He grows worse—sometimes  delirium  supervenes.   There is a species
of peripneumonia where the pain is only felt when the patient begins to
cough.  These are more dangerous  and longer continued.  At first the
expectoration  is small and frothy; the  tongue is yellow, and becomes
darker.  When it is black from the commencement, the  disease is more
rapidly developed;  it is slower in its  progress when the blackening of
the tongue comes on later;  afterwards  it becomes rough and cracks, the
finger adhering to it when applied.   The changes in  the  state of the
tongue  announce those of  the  disease, the same as in pleurisy-   Peri-
pneumonia continues at least fourteen days, or twenty-one at farthest.
  " During this time the cough is severe, and the lungs are depleted by
the cough.   At first, the expectoration is frothy and copious; about the
seventh or eighth day, when the fever  is in full force, if the peripneu-
monia is  moist,  it becomes  thicker;   unless it shall become on the
seventeenth  day  a  green color, it will be slightly sanguinous.  From
the twelfth to the fourteenth  day, it will be abundant,  and of a puru-
lent character.   Such is  the state amongst those who have  a humid
temperament and constitution, and in whom  the  disease is severe ; but
those in whom  the  temperament  and character of the disease  are dry,
the attack is less dangerous.
  " If then, on the fourteenth day, the cough is not accompanied by puru-
lent  expectoration, and the lung becomes dry, the patient is cured.   In
an opposite case, give attention on the eighteenth or twenty-first day, to
see if the expectoration is abating;  if  it is not, ask the patient if it is
sweetish.  If he says yes, you may know that the lung is  suppurating__
this condition is determined.   It may  last a year  unless all  the pus is
cast off in forty days.  When the patient shall respond that the expec-
toration has a very  bad taste, his condition is mortal.
  " One may thus know what to expect from the first;  for when the pa-
tient expectorates all the bad pus  in twenty-two days, and no new injury
is developed, he will recover.   In the other case, he will die.   The first
of these two species of peripneumonia  leaves no vestige of itself in the
lungs.   It is essential to be aware of all the sufferings the patient real-
izes, and what  are the therapeutical resources to combat them.  When
the symptoms  are moderate,  success is certain;  the peripneumonia  is
not mortal in its nature, and it will  be mild.   I will now give the
treatment." 
SCHOOLS OF  THE  ASCLEPIADAE.
105
                             PLEURISY.0
  When an individual is attacked with pleurisy, the following are the
symptoms: pain in the side, with fever, shiverings and frequent respi-
ration ;  there  is cough, and difficulty in breathing while lying  down.
The expectoration  is bilious, and of  the color of  the bark of the  pome-
granate when  there is no  lesion in the  lungs; if such exists, it will be
sanguineous;  when  it is bilious and there is no lesion, the attack is
milder.  In an opposite case, it is graver, and even mortal if hiccup su-
pervenes ;  the cough brings up saliva and  clots of  black  blood;  the
patient dies on the seventh day.  When he survives to the tenth day,
the pleurisy is healed;  but if it goes on to the  twentieth,  suppuration
is established, and pus is expectorated,  which is finally vomited, and the
cure is rendered difficult.
  " There  are dry  pleurisies  without expectoration, which  are very
grave.   The crises occur as in humid pleurisies,  but there is more need
of drinks.   The bilious and sanguineous crises take place at the ninth
and  eleventh days.   It is cured more  easily when from the commence-
ment the pain is moderate, and becomes  acute about  the fifth or sixth
day; the disease continues then until the twelfth;  if the patient pass that
he will  get well.   When the suffering  has been  moderate from the be-
ginning, but violent from  the seventh  to the eighth day, the crisis is
not determined until  the fourteenth, after which the danger is passed.
  " Pleurisy of the back differs from the preceding, in its pain seeming
to be more like that of a wound.  The patient groans, and the respira-
tion  is frequent.   Very soon expectoration occurs in  small quantities;
general prostration follows.  On the third or fourth day a  bloody urine
is voided.   Death occurs commonly about  the  fifth or seventh day.
Those who pass these days may recover. The disease after this, becomes
more tractable.  It  is necessary, however, to be  watchful till the four-
teenth day ; beyond that, the patient is safe.
   " Some  pleuretics expectorate pure phlegm only, whilst their urine is
sanguineous, resembling the fluids of roast meats : they feel very acute
pains in the front  of  the chest and  groins.   If,  however, they pass the
seventh day, they  will get well.
   " When in  pleurisy there supervenes redness on the back, with heat
at the  shoulders,  a feeling of weight and uneasiness in the  abdomen,
with green and fetid  discharges,  the patients will die on the twentieth
day  in consequence  of this evacuation,  but if they  live  beyond the
twentieth,  they will get well."

         °Traite' des Maladies, Vol. Ill, § 18, 19, 20, trad, de Gardeil
             7 
106
PHILOSOPHIC PERIOD.
   Such descriptions, as already remarked at the commencement of this
chapter, have no utility for a reader unacquainted with medical studies,
or for a beginner ; but they are valuable as historic record, to establish
the state of the Science at a very remote epoch, of which we have but few
remains.  The  experienced practitioner will discover in  them  many
interesting features of the diseases which he has himself observed, and
which prove to a certain point, the exactness of the tableaux.
                         § VI.  Therapeutics.
  The physicians of the two preceding periods have not emitted any gene-
ral law in Therapeutics; they regulated their practice instinctively upon
the following plan: when a remedy has cured any disease, it should cure
all other identical diseases.  This axiom, incontestably true in itself, is
but a fragment of one much more general, which  embraces the  whole
philosophy of causes,  and  may be  expressed thus:  the  same agents,
placed in the same  identical circumstances, will  always produce  the
same effects.   But a proposition so universal, which appertains to medi-
cine no more than to the other sciences, and which takes no account of
the internal action of medicines, appeared too superficial to philosophical
physicians, and  too vague to practitioners who desired a rule less com-
mon ;  in short, one  more directly related  to  the  healing art.   Conse-
quently,  both parties  sought another fundamental principle, and  the
following is the result of their speculations on this subject: it was held
that there always exists a species  of antagonism between the cause of
the morbid  phenomena and the active  properties of the  remedies that
cured them; or rather, between the pathological modification of  the or-
ganism and the curative impulse given to the economy  by the treatment.
This law was expressed by the following aphorism:  contraria contrariis
curantur.
  The greater number of medical writers adopted  this  principle,  and
endeavored to establish the practice of medicine upon it.   Now,  two
things were necessary for that:  first, to discover the  essential cause of
each disease, or  the  primitive lesion  that  constitutes  each morbid spe-
cies ; secondly, to determine the mode of action and the degree of energy
of therapeutic agents,  so that the  practitioner may choose from among
them, those which were more directly  contrary to the affection he is
called upon to combat.   The course of this history will show us the re-
sults of the efforts made  at different epochs to attain this double end,
and we  shall  have occasion more than  once to discuss the validity of
hypcenantiosis, or the doctrine of contraries. 
SCHOOLS OF  THE  ASCLEPIAD.E.
107
   At present it will suffice  to  say, that from its commencement this
principle has not  been universally adopted.   Thus, the  author of the
book entitled "Ancient Medicine," one of the  most philosophic of the
collection, devotes  several paragraphs to the refutation  of this  axiom.
And we read in the treatise on the Regions of Man, that diseases are
sometimes cured by contraries, sometimes by similars, and, finally, some-
times by remedies which have neither similitude nor opposition.°
   We shall conclude this chapter  by giving examples of  the manner in
which the practitioners of those times applied the general principles of
Therapeutics to the  treatment  of particular diseases.   The  following
cases appear to me to be the best arranged and most complete of any of
those recorded in the collection:

             TREATMENT OF PLEURISY AND PERIPNEUMONIA.
   "It is necessary to examine in the following manner the peripneumo-
nic and pleuritic affections: if the fever is acute; if there is pain in one
or both sides of the chest; if the  patient suffers during  expiration; if
he coughs, and the expectoration is rusty or livid, or thin and frothy, or
of a blood-red—if, in fine, it differed at all from that which is natural,.
the following course must be pursued: the  pain extending above and
towards the clavicle, or towards the vein and the arm, the internal vein
of the arm on that side should be opened.  The quantity of blood drawn
should be proportional to the constitution of the body, the season of the
year, the age and  color of the patient; and  if the pain is acute, the
bleeding should  be boldly pushed to syncope; afterward  an injection is
to be administered.
   " If the  pain occupies the inferior region of the chest, and if the ten-
sion is great, you should prescribe for pleuritics a mild purgation; but
they must taste nothing else while the  medicine is operating.  After the
purgation they should have an oxymel.  The purgation  should  not be
administered till the fourth  day:  during the first three days injections
should be employed;  but if they are not sufficient,  the purge should be
given, as above said.   He must be watched until the fever  ceases and the
seventh day is attained; after that, if he appears out of danger, he may
take a little barley-water, weak  at first, and sweetened with honey.   If
the convalescence progresses and the respiration is good, the tisane may
be  given  twice  a day,  and  be gradually increased  in  quantity and
strength;  but if the convalescence is slow, the drink must be  lessened,
and for nourishment a small  quantity  of a weak tisane once a  day.  It
-See §  67, 68, 69, 70, Gardeil. 
108
PHILOSOPHIC PERIOD.
should be given when the patient is in the best condition, which may be
known by the appearance of the urine.
  " To those who approach the close of the disease, it is not necessary to
give the tisane, before you see the coction manifested in the urine or ex-
pectoration;  nevertheless, if,  when  purged,  the patient has abundant
evacuations, it is necessary to give the tisane, but in less quantity and
weaker, otherwise the emptiness of the vessels would allow him neither
to sleep, nor to digest  or  await the crisis.   With this exception, the
crude humors should be liquefied, and whatever has been the obstacle, be
ejected: then nothing prevents alimentation.   The expectoration is per-
fectly concocted when it appears  like  pus:  the urine, also, when it has
a red sediment, like brickdust.
  "As to the pains in  the side, nothing  contra-indicates the use of fo-
mentations and wax plasters.   The legs and loins should be rubbed with
warm oil and then anointed with fat.  The hypochondria should be cov-
ered as high as the breasts with a flaxseed poultice.   When the  peri-
pneumonia has reached  its height, nothing can be accomplished without
purgation: it is bad if the patient has dyspnea, or the urine be thin and
acrid, or there be sweats around the neck and head.   These sweats indi-
cate danger in proportion to the violence of the disease, which is known
by the  suffocation  and rattling, which increases and  produces death,
unless there supervene an abundant  flow of viscid urine or of concocted
sputa.   Whichever of these  two phenomena supervenes,  it indicates
resolution."
  An eclegma is prescribed for peripneumonia, with galbanum and grains
of pine-seed,  in Attic honey.   Other expectorants are employed, such as
worm-wood  {Artemisia  abrotanum, Lin.), and pepper in oxymel; pur-
gatives: boil black hellebore  (Helleborus orientalis, Lin.), and give it as
a drink to pleuritics, at the commencement, and while  the pain is felt.
A useful remedy in affections of the liver, and in pains proceeding from
the  diaphragm,  is  a drink of  opoponax (Pastinacce opoponax,  Lin.),
boiled in oxymel and strained.   In general, a remedy, which  is to act
on the  stools or urine, should be given  in  wine, and in honey;  if to
act on the stools alone, it should be given in a much larger quantity of
diluted oxymel.
        § VII.  External Nosography and Therapeutics, or Surgery.
  The following is a list of the books of the Hippocratic collection, that
treat of external nosography and therapeutics, according to the transla-
tion of Gardeil: 
SCHOOLS OF THE  ASCLEPIAD^l.
109
1.  The Laboratory  of the Surgeon, in which dressings, bandaging, and
           the use of apparatus is taught.
2.  On Fractures, a treatise which appears above the anatomical knowl-
           edge of the times.
3.  On Articulations or Luxations, which seems to be a continuation  of
           the preceding work.
4.  The Mochlic, an extract, or small abridgement of the book on frac-
           tures, and the one on luxations.
5.  Wounds of the  Head, a monograph,  extremely remarkable  for the
           perfection with which the subject is treated.
6.  On Sight, and  Diseases of the Fye,\ mere  fragments,  not of much
7.  On Wounds,                      )      value.
On Fistula,   \
Hemorrhoids,  J monograPH passably good.
   A glance of the eye is sufficient to show that a great amount of matter
that belongs to Surgery, is not mentioned—such as penetrating wounds
of the chest and abdomen, hernia, and vesicular  calculi.   The Hippo-
cratic works describe only a very small number of surgical operations,
and with the exception of the treatises on fractures, luxations, and the
monograph on  wounds of the  head, it may  be said of all the  other
books mentioned  above, that they only glance at the subject whose title
they bear.  In fine, all the fragments, re-united, are very far from com-
posing a complete treatise  on surgery, or a  treatise that may  be compared
with those  that belong to the next historical epoch; but it is probable,
and  even certain that we  do not possess all the surgical works of the
Hippocratic authors;  what we  have, though, prove that the Asclepiadae
carried this branch of the  healing art to a degree of perfection no less
remarkable than that of internal Medicine.
                          § VIII.  Obstetrics.
  If there are occasions, when the aid of medical knowledge is palpably
necessary and efficacious, they present themselves especially in the prac-
tice of obstetrics.  There, often,  the life of one or two individuals, in per-
fect health, depends on  a manoeuver, more or less skillful, or  an indica-
tion, more or less well fulfilled.   Beside, the duty of the accoucheur, or
sage-femme, is not limited to watching and giving assistance  in the act
of parturition: their care often extends throughout the entire period of
gestation and lactation.  It is  not, then, astonishing, that physicians
were  occupied,  in  the earliest times, with this branch of the art, and 
110
PHILOSOPHIC  PERIOD.
that legislators have subjected it to special  regulations.  It may be
inferred, that the Asclepiadae did not neglect it, from the simple enume-
ration of the writings that they have left on the subject.

                          T. II, OF  GARDEIL.
1.  A monograph on Generation.
2.        Do.    on the Nature of the Infant.
3.        Do.    on Pregnancy, in the seventh month.
4.        Do.    on Pregnancy, in the eighth month.
5.  A small  treatise on Accouchement,  entitled,  On  Superfetation; an
            excellent abridgement of Obstetrics, for the epoch.
6.  A small fragment, on Dentition.

                               T. IV.
7.  The first book of the treatise on Diseases of Women.
8.  A fragment, on the Extraction of a Dead Fetus.

  The treatise on superfetation does not, in  fact,  include but a  single
paragraph that responds to its  title; all  the rest is relative to accouche-
ments.   We there find a succinct and methodic resume of the knowledge
of the Asclepiadae on this subject, and I  can not do better than refer to it
the reader, who is desirous to inform himself on the state of  the art, in
the age of Hippocrates.   This abridgement is distinguished for its  inter-
esting observations, and  by the absence of certain  barbarous and gross
practices, that impair other writings of the same  collections.
  The practice of sacades, for  example, is not mentioned there,  which
proves that  the author did not approve of  it;  for  he could not have
been ignorant of this odd  proceeding, which is mentioned in several of
the Hippocratic works;  notably in the first book of the treatise on the
diseases of women, where it is minutely described.0
  Apropos to this last treatise, I will observe, that its author, whenever
he speaks of matters  relating to accouchements, addresses himself to
midwives, which makes it probable that the ordinary practice of obstet-
rics was  committed  to them,  and physicians were only called, in  grave
or extraordinary cases.
                            § IX. Clinics.
  The clinic does  not form a particular branch of medical  science; it
embraces all,  and makes the application  of  them  at the bedside—it
0 G3uvres d' Hippocrate, § 81 de Gardeil. 
SCHOOLS OF  THE  ASCLEPIADJ3.
Ill
constitutes the highest degree of medical teaching.   There, the master
unites,  constantly, example to precept—practice to theory.   Nothing
is better calculated to mature the experience of young men, than those
lessons which  are given at the bedside of the  sick,  when  he  who  has
charge of the  patients, unites profound  instruction with great probity;
and by this last term we comprehend, with a modern professor, candor,
frankness, justice, humanity, and disinterestedness.   M. Bouillaud
insists, justly, on the necessity of joining moral qualities to knowledge
in the practice and  teaching of  Medicine.   He  clearly demonstrates,
that in default of morality, the  most beneficent act is only an instru-
ment of deception, and a dangerous weapon, in unsafe  hands. He defines
the true physician to be an honest man, instructed in the art of healing.
 Vir probus medendi peritus; a definition which  cannot be too much
popularized, for it shows to the public what are the qualities they must
seek in  a man to whom they confide their health.0
   It was as  much by  his virtues as  by his genius, that  Hippocrates
gained universal  approbation.  These virtues shine with great eclat in
the  clinical observations which  he has transmitted to us.  He never
appears there  as laboring for a reputation ; the sole desire that  animates
him is, to be useful to  his fellows, in  enlightening them on the means
of preserving health,  or in curing diseases.   He avows, with an ingenu-
ousness that  finds few  imitators,  his  reverses and  faults, convinced,
doubtless, that instruction is as much given  in pointing out an error, as
in showing the truth.
   The most ancient  collection of clinics bears the title of Epidemics.
These sort of afflictions leave in  the minds of the people such impres-
sions of astonishment and terror, that other  than medical  writers have
not disdained to trace their history, as  extraordinary events of interest
to posterity.  It was then entirely natural that  physicians should relate
detailed accounts of them;  not for the simple purpose of interesting or
gratifying the curiosity of the reader, but in the hope of finding some
means to prevent the  return of similar pests, or of moderating their
effects.
   To attain this end, physicians proposed, in the first place,  to ascer-
tain the cause of epidemics.   The following  is their reasoning,  to prove
that it is always in the  atmosphere: " Some diseases," say  they, "come
from the regimen,  others from the air which we breath to maintain life.
Where several persons  are attacked at  the same time and  place by the
same disease, we must seek the cause in that which  is most common to
all, and this is the atmosphere.   It is manifest, then, that these affec-
- Essai de Philos. Medicale.  Paris, 1837, p. 239. 
112
PHILOSOPHIC  PERIOD.
tions do not proceed  from the regimen, because  they attack every one
indifferently;  men as well as women; hard drinkers as well as those who
drink only water; the industrious  as well  as  the idle; those who live
luxuriously as well as  those who have only bread for food.  So then,
when an epidemic prevails, the cause certainly does not exist in our re-
gimen, but in the air we  inspire,  receiving  from it  some deleterious
element.0
   This reasoning cannot be objected to unless it be thought too absolute,
for epidemic affections  may  be developed under the influence of a bad
alimentation, in countries where famine prevails,  in besieged cities, in
ships, etc.; others spring from moral causes, such as the discouragement
which  follows a retreat, religious  exaltation  produced  by fanatical
preaching,  or from persecutions.!
   Nevertheless,  it cannot be denied that the air is the most active me-
dium—the most powerful vehicle of  epidemics, especially of those that
ravage large districts, and for a considerable length of time.
   Another very  important observation,  which did not escape the Ascle-
piadae, is that during the reign of  epidemics, the most varied  intercur-
rent affections have a particular physiognomy which is common to all,
and which  gives them a familiar likeness.
   Resting upon this double basis, the Hippocratic writers  believe it im-
portant to note with care, the state  of the atmosphere before and during
the epidemics, and they have described with not less exactness, the gene-
ral character  of intercurrent  diseases.  In this  way, connecting the
meteorological phenomena with the morbid ones observed during a season
or a year, they describe what has been  named the epidemic constitution
of that season or year.  They hoped, that after having thus described a
great number  of medical constitutions,  they would be  able to ascertain
what atmospheric conditions  habitually preceded  and accompanied dif-
ferent epidemics, so that it would be possible, in certain cases, to foresee
the advent of  the scourge, and  prepare  for it.
   Such was the  hope also of Sydenham and Stohl, worthy emulators of
Hippocrates, when they, with admirable patience, prepared  their tables
of medical constitutions.  Too  few physicians have had the courage to
follow in their footsteps.   The happy  mortal to whom is reserved the
honor of determining the relation or law that  connects epidemics with
certain states of the atmosphere, has  not yet appeared.
  0 Hippocratic Works. Treatise on  the Nature of Man, Vol. 1, sec. 10 and 11.
Gardeil.
f Raphania, or the disease of fanatics, scurvy, and convulsions of St. Medard, etc. 
SCHOOLS OF  THE  ASCLEPIAD.E.
113
   Seven books of the Hippocratic collection bear the title of Epidemics.
Nevertheless, the first and the third alone are devoted, effectively, to the
description of epidemic constitutions, and appear  to  follow each other.
On this account,  they are considered as being connected, and are sepa-
ated  from the others, which are not supposed to belong to Hippocrates.
He describes in the first place, the most remarkable atmospheric condi-
tions ; afterwards, the general character exhibited by intercurrent dis-
eases  by the constitution;  finally, he traces the  particular  history of
some diseases.  The following extract will enable the reader to judge of
the method and talent for observation displayed  by the author.

                         FIRST  CONSTITUTION.0

   " In the island of Thasos, during  autumn, towards  the equinox, and
whilst the  Pleiades were at the  horizon, (that is, for those fifty days
after  the autumnal  equinox), there were gentle, continuous and abund-
ant showers, southerly winds,  and open winter, with slight breezes from
the north,  and dryness ;  in  sum the whole winter seemed like spring.
The spring season, in its turn, was marked by south winds, coolness and
slight showers.   The summer was in general, cloudy without  rain;  the
monsoon seldom blew, and with but little force or regularity.
   " All the atmospheric conditions having been southern and dry, an in-
terval in this constitution,  opposite  and northern, occurring  in the be-
ginning of spring, developed some cases of remitting fever; but they were
generally moderate.  There were but few attended with nasal hemorrhage,
and no one died.  Tumors were developed in several persons—on one side
only in  the greater number; but no one  had  so much  fever as to be
obliged to keep his bed;  though some had a little  heat of skin.  These
tumors disappeared in all cases without any difficulty;  there was  no
suppuration, which so often happens  with  tumors  arising from other
causes.   They were  large, soft,  diffused, without  inflamation or pain,
and disappeared without any critical sign.   They were  manifested  in
youths, in men in the flower of their age, and especially in those who took
gymnastic  exercises; few women were attacked.  The greater number
of the afflicted had dry  coughs, with hoarseness, but no expectoration."
   Very soon, in some, but later in others, there was developed a painful
inflamation of the testicle, some times on one side,  then on both.  Fever
was not always present,  but  there was much suffering. It is to be added,
that the Thasians did not seek medical " advice."
   The above is an account of the Medical Constitution  for the  end of
0 Works of Hippocrates, by Littre', Vol. 2, p. 599.  Epidemics, Book 1, sec. 1. 
114
PHILOSOPHIC PERIOD.
winter and the spring.  The author describes consecutively, that of  the
summer and autumn, after which he reports some historical particulars.
   " First patient—Philiscus—lived  near the wall.   He took to bed.
First day:  acute fever,  sweat;  a bad night.   Second day:  general  ex-
acerbation ;  in the evening, a small injection procured favorable evacua-
tion ; a tranquil night.  Third day: in the morning, and until mid-day,
the fever appeared to have ceased, but towards evening, acute fever, with
sweat; tongue begins to be dry ; urine dark; he passed a painful night.
without sleep, and  had hallucinations on all  subjects.   Fourth  day :
general aggravation;  dark urine; the night was passed  better, and  the
urine better colored.  Fifth day ; towards the middle of the day, he had
a slight epistaxis of very dark  blood ; urine varied,  a cloudy substance
similar to sperm, floating in it,  but without precipitating ;  after a supo-
sitory, he passed a little feces, with wind. The night was uncomfortable ;
short naps; he talked much in  a rambling way; all  the extremities
were cold, and could not be warmed; he passed dark urine; slept a little
towards day; became speechless;  cold sweat and livid extremities.   He
died  about the middle of the sixth day.
   " In this patient the respiration was, to the end, full and slow, as if
he had to remember to breathe.  The spleen was swelled and formed a
round tumor: the cold sweat continued till the last:  the access was
every other day."
   The above tableau gives an idea of the whole of the morbid phenom-
ena,  though it leaves something  to desire, as  we shall show presently.
There is no comparison possible between  a narration thus made and  the
miserable votive tablets suspended on the columns of the temples.  The
first  and  third books on Epidemics include together forty-two particular
histories, similar to that given  above.  Twenty-five of these terminated
fatally, and seventeen, only, favorably.
   Certain critics have taken occasion, from this frightful  mortality, to
blame the curative method of Hippocrates; but they show that they are
superficial  observers, or they would have seen that Hippocrates only
gives the detailed history  of the gravest and most  remarkable cases.
The  proportion of fatal cases would have been much less, if he had  in-
cluded all  his cases.   This conclusion is not a conjecture—it is proven
from many  passages  of  our author;  among others,  in a remark cited
above, in the description of the first medical constitution:  "All  the
atmospheric conditions  having  been southern and dry,  an interval in
which  the  constitution  was opposite  and  boreal, at the beginning of
spring, originated some fevers.   These fevers  were generally moderate;
a few had nasal hemorrhages, but none died."
   A reproach much better founded might be  made to the clinical rela- 
SCHOOLS OF THE ASCLEPIAD^I.
115
tions of the old man of Cos, viz:  for having said nothing, or next to no-
thing, of the regimen  and treatment to which he submitted the  sick.
This omission  is keenly felt, rendering  it impossible for the  reader to
appreciate the curative method of the physician.  It forms an important
vacuum in the history of the disease; for it is evident that the thera-
peutic or hygienic means employed during the course of a disease affect
the progress and duration  of it, however simple they may have been.
It is not a matter of indifference, for example, whether a sick person be
placed  in a convenient chamber, warmed and ventilated, or in a small,
obscure, cold, and infected apartment;  or whether he is permitted to
drink wine without discretion, or only to have pure water.
   The  five other books on Epidemics contain clinical observations, col-
lected without order, and relating to all  sorts of diseases.  A great num-
ber of these histories are only simple notes or detached reflections; some,
however, are edited with  taste and completeness.  The mention made in
these, of the treatment, shows a  progress, compared with the preceding
ones.   Here is one of the best, I think, though not one of the longest.
   Edematous swelling during pregnancy; great dyspnea ; expectoration
of a large amount of pituitous matter; improvement.
   " The sister of Harpalides, being in the fourth or fifth month of preg-
nancy, an aqueous swelling commenced at the feet and around the eyes;
the skin became swelled up,  as in phlegmatic persons; dry cough; some-
times orthopnea; the dyspnea and suffocation were such that the patient
sat up  in her bed, being unable to lie down;  and if she felt sleepy, it
was when sitting up.   Beyond this there was little fever: the fetus was
for a long time still,  as if it were dead,  and  it fell about, following the
position of the woman.  The dyspnea persisted for two months; but the
patient making use of Egyptian beans, (nymphcea nelumbo, Lin.), pre-
pared with honey and with a honeyed eclegma, and drinking the cumin
of Ethiopia, in wine, her condition improved;  her expectoration  became
abundant, looked mucoid and white ; the dyspnea ceased.   She brought
forth a female child." °
                          § X.  Aphorisms.

  I will terminate this succinct review of the Hippocratic collection, by
the examination of a work which was intended as a recapitulation of all
that is set forth in the others.  I mean the  collection of Aphorisms, in
seven of his books.  No medical work of antiquity has had a more colossal
0 Works of Hippocrates,—Epidemics, book vn. 
116
PHILOSOPHIC PERIOD.
reputation than this;  physicians and philosophers have professed  for it
the same veneration as the Pythagorians manifested for  their golden
verses.  The aphorisms of Hippocrates were long regarded as the crown-
ing glory of the medical scientific edifice—as the most sublime effort of
medical genius.   Only a few years past, the faculty of Paris required of
the aspirants to the doctorate to  insert a certain number of them in their
theses;  and perhaps nothing less than the political revolution in France
was sufficient to overthrow this old relic of a superannuated adoration.
  For some propositions that express general truths of recognized util-
ity, and some clear and profound observations, how many are there that
contain exceptional truths, vulgar reflections,  and even errors and con-
tradictions.  In a practical point of view, the Aphorisms  appear to me
to be nearly an absolute  nullity; because, having no  union with each
other, they make only a superficial impression on the mind of the reader,
and are easily effaced from his memory.  Besides, in admitting even
that a practitioner might have them all at his fingers' ends, they would
not render  him much more skillful in treating diseases.   Such reading,
then, can offer no solid  instruction  to the student, nor is  it valuable to
any but a practitioner whose judgment is ripened by experience, for he
alone is capable of discerning what is true and what is false, or the good
and the bad in these general maxims: to him  they are merely a recapit-
ulation  of scattered notions and  observations.
   This  was my judgment of them long before M. Littre had published
his translation  of this Hippocratic treatise.  Since  I have read  the
learned explanations of  this commentator I have not changed my mind,
for it seems to me that both of us consider these  famous sentences from
different points of view—he as an erudite and a philosopher, and I as a
simple  practitioner.  "The Aphorisms form," says M. Littre, "a suc-
cession  of  propositions  in juxtaposition, but not united.   It  is, and
always  will be, disadvantageous, for a work to be written in that style,
and this disadvantage is increased if the Aphorisms are considered with
modern ideas, and with the notions we now have of physiology and path-
ology :  they thus lose all  their general signification, and the aphorism,
already so  isolated in itself, becomes more so when introduced into mod-
ern science, with which it has but little practical relationship. But it is
not so when the mind conceives of the ideas which prevailed when the
Aphorisms were written:  then, in those parts where they seem most dis-
jointed, we  see that they are related to a common doctrine, which unites
them together;  and in  this view, they no longer appear  as detached
sentences.0
c'Aphorismes, Argument, § 11, Tome IV., page 405, des CEuvres d'Hippocrate. 
SCHOOLS OF  THE  ASCLEPIAD.E.
117
               ART. III. THEORIES AND SYSTEM8.
 ^ Now, after having considered  the state of Medicine under the Ascle-
piadae, in the isle  of Cos, in  an exclusively practical manner,  and, in
some sort, material also, it remains for us to examine it in a theoretical
point of view — to seek the invisible bond that unites all parts of their
doctrines, and connects them to a common principle, as the branches of
the same tree.
   In all times, and perhaps in ours more than any other, systems have
been decried.   They have been  and are  still accused of being only a
tissue of errors and  a source of eternal  discussion.   The epithet sys-
tematic, (theoretic — with us.   Tr.)  applied to an author or a book, has
become an expression of disdain.   Many would banish from Medicine all
theory, all system,  and preserve only the facts and results of experience.
Their plan  appears very commodious and sure, at first sight,  but when
more closely examined,  it is  impracticable.  Those  who  have recom-
mended it the most, have not been able  to avoid  violating the plan, in
their writings as well as in their practice.   M. Bouillaud ° demonstrates
this in a positive manner;  and M. Monfalcon, but little favorable to
systematic writers, is also forced to say :  " Much  has  been said  against
systems  and certainly with truth.    We condemn them and still  we
are  not  able to  do without them.  Every instructed physician has a
way of  explaining  to  himself  life and  diseases;  he wishes to form an
opinion of what he sees as  well  as of  what he  docs.  If the received
doctrines do not satisfy him,  he modifies them,  in a way most satis-
factory to himself." f
   I will add, that learned physicians are not the only ones that essay
to interpret the phenomena of  life; for  in this respect the most  igno-
rant  are no less  prodigal  in explanations, nor less prepossessed in
their manner of regarding  them ;   so natural and irresistible  is the
impulse to try to explain the phenomena that strike our senses.
   In fact I  may say, without a theory, without some systematic arrange-
ment of partial opinions that tend  toward a common end, there exists
no science.   Clinical observations, collected with care, but  arranged with-
out  art and method, in a word, without  system,  constitute no  more a
scientific edifice, than a confused pile of materials constitutes a monument
of architecture.
   Theories  and systems concur  to  the  advancement  of the sciences by
uniting by an artificial bond the diverse notions of which they are com-

  ° Essai de Philos. Medicale.  Paris, 1837, deuxieme partie, chap, in, art. 1, § 1.
  f Diction, des Sciences Medicales, the words System and Theorie. 
118
PHILOSOPHIC PERIOD.
 posed, in a way to assist the memory, and enlighten the judgment.  It is
 true that scientific systems sometimes propagate illusions and ridiculous
 prejudices, but the illusions and prejudices that spring from ignorance
 and barbarism, that is to say, from the absence of all reasonable system,
 are no less numerous, ridiculous, and absurd.
   A system is true, when it is founded  on real  analogies ;  it is false,
 when it rests  on imaginary analogies.   A system may be true in certain
 parts,  and false in others ; but  there are few systems that are entirely
 erroneous.  This is also the opinion of the writer that I have just cited.
 " If systems," says M.  Monfalcon, " were composed only of errors, of
 conjectural opinions, they would make but few partisans; but there is
 not one that  does not repose on some important fact or some well recog-
 nized physiological law.   Those who  propose them do no other wrong
 than exagerate these laws and make the whole of  Medicine subordinate
 to them: those who adopt them see only one side of the subject, and sub-
 mit too blindly to the reason of  one single man.0
   Thus  then  the most common  defect of medical  systems is not a lack
 of foundation, nor the want of a support  derived from correct  observa-
 tion, but it is rather the exageration of  certain truths, to the neglect
 of others not less  important — the consideration  of objects too exclu-
 sively under  one  aspect.   " The fault,"  says  Bichat, " with those who
 have a general idea on Medicine, is to bend  all the phenomena to this
 idea.   The defect of generalizing too much has perhaps been more injuri-
 ous to science, than that of seeing each phenomenon in an isolated manner, f
  Being convinced of the necessity of theories  to harmonize the various
 ramifications of science, persuaded that without their aid  the human
 understanding could not grasp a great extent of knowledge, nor elevate
 itself  to the highest considerations, we  shall accord to this  important
 branch of Medicine all the attention that it merits, without forgetting
that it offers only an ideal and  an imperfect image of phenomena, and
that it can not in any case replace the study of real nature, or take the
 place of  direct observation.
                   § I. Theory of Coction and Crisis.
  The theory which prevails the  most universally in the  Hippocratic
works, is that of coction and crisis.  It is met with at every step, some-
times isolated, sometimes  combined writh others ;  but especially is it
united to the system of four elements  and four humors.   It forms an
0 Diction, des Scienc. Me'dic, the word System.
f Anat. Gen., Considerat. Gen., p. 13. 
SCHOOLS OF  THE  ASCLEPIAD^.
119
integral part and is the most characteristic trait of the ancient Dogma-
tism, and it is retained even in our time, while all its eotemporaneous
doctrines have been abandoned.
   The Asclepiadae, of the isle of Cos, regarded disease as an association
of phenomena, resulting from the efforts made by the conservative prin-
ciple of life to effect a coction of  the morbific matter in the  economy.
They thought that it could not be advantageously expelled  until it was
properly prepared, that is, until after its elements  were  separated and
united with the natural humors of the body, so as to form an excremen-
titious material.
   The vital  principle  that  effected this preparatory work, as well  as
sustained all  other physiological  functions, has received various names
among ancient authors, according  to their notions of its particular attri-
butes.   Som  ecalled it nature, (puai^, when  they  wished to indicate
the totality of forces and phenomena over  which  it presided;  motor,
svop/ua)^, impetum faciens, to signify the prompt impulse which it gave
to the  whole  machine; soul, spirit, <puy-q, to signify its  immaterial
essence, and  the  noblest of  its faculties—the  intellect.   The word
~u£Ofj.a, breath,  designated, more particularly, the way in which  the
vital principle sustained  itself, the substance from which it  drew its
nourishment:  and  the word dep/wu, heat, expressed one  of  the most
immediate effects, and the most indispensable to life.
   When the morbid substance approaches the period of maturity, nature
seems to redouble  her efforts; the fever augments, the patient is over-
whelmed, or delirious, all  the symptoms are aggravated  and announce
the approach  of  a  revolution; this was  the moment of the  crisis, or
judgement of  the disease.   The day on which  it was accomplished, the
signs which preceded or accompanied it were termed critical, and required
the special observation and attention of the physician.   He  must be
able to  discern whether these signs were good or bad, and predict, on
seeing them, what will be the fate of the patient.   He must respect the
critical  labor  of  nature, if it proceed properly, nor disturb it by vio-
lent  remedies, and  in no case attempt to aid the vital principle, unless
in urgent necessity.
   When the coction was effected, which might  be known by the amend-
ment of the symptoms, it only remained to evacuate the  heterogeneous
material.   Nature  often accomplishes this last effort, herself, and the
disease terminates by a critical sweat, urination, or stools.   But it also
frequently happens, that the vital principle,  fatigued and broken down
by the efforts  of  the crisis, requires aid, and then  the physician must
come  to  its relief.  To accomplish this, say the authors, he must push the
material toward the emunctory. to which it naturally tends; that is,  he 
120
PHILOSOPHIC PERIOD.
must give  sudorifics, or purgatives, or diuretics, according to the indi-
cations  of nature, whose faithful minister he must show himself to be, in
all things. In this way diseases terminated, in the most favorable cases.0
  But it might happen, that the coction could  not be effected, or only
imperfectly.  In such cases, one of two  things  must occur:  either the
vital  principle,  overcome by the morbid element, succumbs,  and  the
patient dies, or the struggle  between  the vital element and the morbid
goes on, and a new effort at  coction commences, and  is continued for a
limited number of  days, in the same manner as at first.  This second
effort may have a termination, complete or incomplete, and so on succes-
sively.
  The number of days necessary for the coction, or the elaboration of
the morbigenous matter, was termed the critical period.   The most per-
fect period was supposed to be the quaternary, or that  of four days;
next, the third; finally, in addition  to  these two, was the septenary,
which had  a high consideration.
  In the treatise on Prognostics, section 20, we read as  follows: " the
same number of days which brings about the cure,  or death of the  sick,
regulates the crises of fevers.   The most benign, those which are accom-
panied  with the most  encouraging signs,  terminate  in  four  days, or
sooner; the most malignant, or those accompanied  with the most mena-
cing signs,  destroy  life  in  four days, or  less: such is the limit of the
first period.  The second period reaches the seventh day; the third, the
eleventh day; the fourth, the fourteenth day; the fifth, the seventeenth
day; the  sixth, the twentieth day.  Thus, these periods, in the most
acute diseases, go from the first, in four days, to the sixth in twenty days.
But none of these periods, they say, can be calculated, rigorously, by entire
days, for neither the year, nor the  months, are counted by entire days.
Still farther, by the same calculation, and  same progression, we have a
first period of thirty-four days, a  second of forty,  and a third of sixty
days.   The most difficult part of the  diagnosis is, to determine from the
beginning  the  favorable, or unfavorable termination of those cases in
which the crises are slowest; for, in the beginning, all protracted dis-
eases are very similar.   It is necessary  to make observations from the
first day, and then examine  the state of  things,  after each  quaternary is
passed; in this way, mistakes in regard to the termination of  diseases
are avoided.   The  nature of the quartan fever is submitted to a similar
course.  The  good or  bad termination of a case, when the  crisis  is
reached in the shortest time,  is more  easily known, for the accessions
are extremely dissimilar.   The patients who  will recover, have easy
°(Euvres d' Hippocrate, par M. Littre', T. V. Traite' des humeurs, § 3, et als. 
SCHOOLS OF  THE  ASCLEPIAD.2E.
121
respiration, not much suffering, sleep at night, and offer otherwise encour-
aging symptoms: on the other hand, those that are to die, have dyspnoea.
delirium, sleeplessness, and all the most alarming signs.  Since these
affections thus act, it is necessary to establish conjectures according to
the time, and according to each additional  period, in  proportion as the
diseases proceed  toward  the  crisis.  With  women,  the crisis, after
accouchement, follows the same rule."0
   In the above scale of critical days, it may be observed that each pe-
riod is formed by adding the r umber four or three  to the preceding one.
To properly conceive of the origin of this progression, we must recur to
the system of Pythagoras, already described, f  The number four, it may
be remembered, represents in that system all substances endowed with
proper faculties, having an existence distinct from  other beings, as God,
man, a plant, or a mineral;  hence it follows that the Asclepiadae, inhe-
ritors of the doctrines and symbolical language of the Egyptians, were
naturally led to designate by the number  four the morbid entity come
to its complete development.   For the  same reason, the number three,.
which represented the whole of the essential properties of all  beings,
might also indicate to them the plenitude of the faculties of the morbid
entity.
   If any doubt yet remains on the connection that exists between the
system of Pythagoras and the theory of critical days, the following pas-
sage will remove them:—"A physician, says one,  who neglects nothing
that may contribute to the establishment of his patient's health, must
observe carefully what passes each day.  Among those days of even num-
bers, the most important are the fourteenth, the twenty-eighth, and the
forty-second.  This is supposed to arise from the perfection  of those
numbers, and the manner in which they are composed  of other whole
numbers.  It would take up too much time to give their reasons: it will
be sufficient to say that they refer to the ternary and quarternary. "J
   As nature is not  subjected  to our arbitrary limitations, it often hap-
pens that the duration of diseases does not respond exactly to an exact
number of ternary or quarternary periods; they were  therefore  obliged
to change more than once the manner of counting critical days.  Opinions
varied very much in that respect, even in ancient times.   The author of
the treatise on Diseases developed in his fourth book a  physiological and
pathological theory, according to which  all  the odd days are assumed to
be critical days.  But this rule was found  in many cases to be at fault,
-CEuvres d' Hippoc, translated by E. Littre, Paris, 1840, T. II, p. 169.
■j- See page 83.
I See the Traite de la Grossesse a sept mois, § 3;  translation of Gardeil.
    8 
122
PHILOSOPHIC PERIOD.
 so that they were forced to admit that the rule of odd days was excep-
 tional in numerous cases.   Hippocrates himself points out several.  In
 the third book on Epidemics, section third, it is said that " all diseases
 offer, it  is true,  difficulties in  crises, the absence of  crisis, and a long
 duration, which was especially remarkable in those to which I refer: in
 some, the crisis was retarded for eighty days ; in most of them the dis-
 ease ceased without a distinct crisis."
   Notwithstanding the vagueness that existed in the determination of
 critical days, the  doctrine of crisis is maintained in  our  times.   Pinel,
 one of the most philosophic spirits of our epoch, wrote at the end of the
 last century: "I suppose that  no  one  is so little  enlightened, as to
 think  he can suspend, by  the aid of remedies, the  course of an acute
 disease, such as an essential fever, or a phlegmasia.   On the contrary,
 he must commence by counting  the days, from the beginning, so as to
 recognise what their actual period is.  It is known that inflammatory
 fevers, as well  as gastric, continue, in general, to the end of the first,
 second, and sometimes, third septenary; but the gastric remitting fevers
 continue to the sixth or seventh week, whatever method of treatment
 may be employed, and may continue many months, if exasperated by a
 too active treatment.0"
  Landre" Beauvais, author of a treatise on Semeiotics, expresses himself
 as follows:   "Hippocrates,  excellent observer and  reliable historian,
 has established the doctrine of crisis.  Asclepiades and the methodists,
 guided by prejudice, denied the crisis and critical days.  They accused
 Hippocrates of being led by the dogmas of Pythagoras,  or numbers, and
they attacked Galen, who remained faithful to the principles contained
 in the writings of the father of medicine.  Asclepiades had many imi-
tators in succeeding ages; Celsus was the most illustrious; but can  one
adopt the sentiments of those who refuse to admit the crisis, when it
has been  so  successfully sustained  by Galen, Duret,  Baillou,  Fernel,
 Sydenham, Forestus, Stahl,  Baglivi, Van  Swie'ten, Stohl and Pinel, and
when every day, clinical  observations confirm  the views of these great
masters."!
  A medical  opinion which has traversed  so many ages, and come down
 to us supported by such respectable names, merits a profound examina-
tion.  We must conclude, until the contrary is established, that it is
not a pure play of the imagination, but that it has some  foundation in
the observation of the natural progress of diseases.
  I will remark, in the first place, that  the connection that exists be-
 "Nosogr. Philos. Introduction, p. 35.
f Diction, des Scienc. Me'dicales, the word Crisis, T. II, p. 376. 
SCHOOLS OF  THE  ASCLEPIAD^I.
123
tween the doctrine of crisis  and the dogmas of Pythagoras—a connec-
tion that it is vain to deny—proves nothing for or against this doctrine.
The real question is, are there diseases which proceed, or  seem to pro-
ceed from  some  solid, liquid, ©r  gaseous, deleterious substance, intro-
duced  into the economy, exciting  there a reaction, which  is manifested
by a succession of nearly constant symptoms ?   Now it is not doubtful
that there are diseases of this kind.   We cite, in the first  place, fevers
caused by vegetable emanations—formerly so common, and so destruc-
tive, which assume  usually, a periodic form, as a quotidian, tertian or
quartan.   I will  also cite the eruptive fevers, such as variola, rubeola,
vaccinia, miliary, etc., which have well  marked phases of incubation,
eruption and  desquemation.  It is true, that certain  authors  pretend
that these last diseases are of modern origin—I had almost said inven-
tion ; but that is a controverted, and  a very controvertible opinion, as I
shall prove, at a proper time.  But admitting they are so, it cannot be
denied that if new periodic diseases have arisen since  Hippocrates, the
old ones could become extinct, and in this hypothesis, there would be,
therefore, a compensation.
   Thus, then, there has existed, and there still exists a very numerous
elass of diseases,  of nearly constant periods, and it is in a great measure,
upon the observation of this remarkable phenomenon, that the doctrine of
coction and crisis has been founded.   Recall now a remark  that I have
already made, namely, that  the attention of the Asclepiadae was especi-
ally directed to acute diseases, and amongst these, principally to epidem-
ics.  The greater number of the clinical relations that have been trans-
mitted to  us, relate  to  epidemics.   Now  febrile  affections, of  regular
periods, generally prevail as epidemics.
   What then is the reproach that can be legitimately applied to Hippo-
crates and those who have adopted his theory of crisis ?   It is that of
extending to all diseases  that which  is true only of a certain number;
in a word,  for having generalised too much an  idea;  and this is the
most common defect of all systems, as has  been already remarked.

         § II. Theory of the Four Elements and the Four Humors.
   After the theory of coction and crisis, that which prevails the most in
the Hippocratic books, is the doctrine of the four  elements, or the four
elementary qualities, heat, cold, dryness and moisture, and the four car-
dinal humors, blood, bile, atrabile and phlegm.   This doctrine was sup-
posed to  be an invention of the father of Greek medicine.   Such is the
opinion of all the commentators and historiographers, among  others
Galen, who extended and perfected it in his manner, and it reigned, ex-
clusively, after him.   The theory of  four  elements  and  four humors, 
124
PHILOSOPHIC PERIOD.
harmonizes very well with that of coction  and crisis, of  which it ap-
pears to be the complement.
  Empedocles,  of  Agrigentum, who  has  been mentioned heretofore,
was  the first who introduced  into physics,  the consideration of four
elementary forms,  the first  termed  terrestrial or  solid, the  second
aqueous or liquid, the third aerial or gaseous, the fourth igneous or ethe-
real.  The latter, of which the ancients  had only a vague notion, cor-
responds to what is termed an imponderable fluid, in modern physics.
  Empedocles admitted, according to the  doctrine of his master, Pytha-
goras, two principles in  every thing: the one  active, intelligent and
impalpable, which  is God; the  other passive, and devoid of properties,
having no definite form, but susceptible of assuming any that the Crea-
tor might  give it, named amorphous matter.   The philosopher of Agri-
gentum, conceived, also, that amorphous  matter had received from  the
Supreme Intelligence, four fundamental  or elementary modes of exist-
ence,  and these four principal modalities of  matter, variously com-
bined, constituted all the bodies in nature;  so that,  according to this
system,  there is no material substance which does not  include four ele-
ments, united in variable proportions.
  The element which constitutes the largest proportion in a body, de-
termines its permanent form : thus, the terrestial element predominates
in solids;  the aqueous in liquids;  the aerial  in vapours or gases ;  the
igneous  in the ether or imponderable  fluid.   In this way, this philoso-
pher explained the varieties of bodies, at the same time preserving the
Pythagorean doctrine of homogenity in matter.
  The assumption of four elementary or primitive forms was not, as
may be  thought, the  dream of an exalted imagination;  the attentive
observation of some very remarkable phenomena had suggested the idea,
and  gave  it  the appearance of reality;  thus, water  can  pass from  a
liquid to a solid or gaseous state, without changing its nature; so, also,
in the phenomenon of combustion, the wood, especially when it is green,
oozes out water from its surface, exhales  smoke, which the ancients re-
garded as  crude air, deposits  ashes, the terrestrial element, and  lastly.
gives off light and heat, or fire, the most subtle of the elements, which
ascends, and  is dissipated in the ethereal regions.   Here  the chemical
analysis of the ancients stopped.
  I will not carry  farther this  exposition of  the four elements, or four
primitive  forms which  served  to  explain  the infinite diversity of the
body without destroying  the dogma of the homogenity of matter.   It
is sufficient to have  shown  that  it  was neither ridiculous nor absurd
before the discoveries  of modern chemistry.   I will add that the chem-
ists themselves, after having augmented  indefinitely the number of ele- 
SCHOOLS OF  THE  ASCLEPIADAE.
125
ments, now tend to limit them, and are not  far from returning to the
dogma of the homogenity of matter, by the theory of equivalents.0
   Such  was,  at its  origin, the doctrine  of the four elements, which
Plato and Aristotle  adopted, and sustained by new and extremely sub-
tle considerations, as we shall see hereafter.   This doctrine, when  Hip-
pocrates appeared, had all the  force and attraction of freshness, and it
is not astonishing that that philosopher made it the basis  and model of
his medical theory.   We now proceed to show by what course of reason-
ing he was led to it.
   He commences by saying, that to properly understand man, it is neces-
sary to study him with the lights of Medicine, i. e., in a state of health,
and disease.  He  refutes the opinion  of the  philosophers who pretend
that man  is  formed of a single element, and relies especially upon the
little accord  that exists among them, as to the nature of that  unique
element — some affirming  that it is  air, others water, others fire, and
others earth.   " Now," says he, " since they all contend  for the  same
principle, and yet all  come to different conclusions  about it, it shows
that they do not properly understand each other."
   " In regard to physicians," he adds, " some contend that man is all
blood, others  that he is all bile, others all  phlegm,  and some all gas.
Each one adopts the same mode of reasoning ; they insist that the being
is one, whatever name may be given to  it, and that this unique substance
changes  its form  and its powers accordingly  as it is affected by heat or
cold.   As for my views: I say, that if man  were a simple  element  or
being, he would never feel pain ; for what could excite pain in him if
he is only of one substance ?  Suppose  that he was susceptible to it: the
remedy must  be single also ;  but we know  that there are various reme-
dies for pain.    He who  affirms that  man  is  all blood, ought to show
himself unchangeable, or at least, he should assign a season, or  an epoch
of life, in which we can see in man nothing but blood ; for in order to
be sure that his opinion is correct, we should be able to see, at some time
or other, at least, that  only in  man  which exclusively constitutes  him,
viz : blood; these remarks  are applicable also to the assertions of those
who pretend that he is all bile  or phlegm.
   " At  first the generation of man can not proceed from a single sub-
stance, for  how can a single substance be developed without a union
with something else ?   If it does not mingle with other different beings,
of the  same nature,  there could be no generation  of an  economy like
ours.   Moreover if the heat and cold, the dry and humid, are not pro-
  J And especially is this further illustrated in the correlation of the physical
and vital forces.—Trans. 
126
PHILOSOPHIC PERIOD.
perly tempered together, if one predominates too much, the generation
could not take place.   In like manner when a man dies, each of the
elements of which he is composed takes a different  direction, according
to its  nature —the humid to the humid, the dry  to the dry, the heat
to the heat, and the cold to the cold.
   " The human body contains blood, phlegm, and two sorts of bile, yel-
low and black.   Such is its nature, and their condition determines the
state of health.   It  is healthy when each of these  fluids is in due pro-
portion to the  other as to quantity and character, and  especially when
they are well mixed; it is diseased when  any one is in  excess, or lacks
its due proportion to the  rest, or is evacuated without being properly
mixed — for when it is thus evacuated, not only the region where the
admixture  should take place must be affected, but still  more, the organ
through which it passes  off,  becomes  surcharged  and  suffers  painful
struggles.
   " I  have  said  that I would  show that the things of which  man  is
composed  always remain the same.  This is generally admitted, and is
proved  by the examination of his  nature.   Now  the  blood,  phlegm,
yellow or black bile, by common consent, are always the same, for neither
of these words has  an equivocal or doubtful  meaning.   Again,  these
elements are very distinct in their nature ; the phlegm has no resem-
blance to the blood, nor the blood to the bile, nor the bile to the phlegm.
How then can  they  be confounded ? — for these differences are recog-
nized by the sight alone, as they differ very much in color.  So, if  they
are touched, there are manifest differences in the sensations they impart.
So also, are they  unlike in temperature and consistence.  If  a remedy
is taken that acts on the phlegm, it is phlegm that is discharged ;  if it
acts on the bile, that is cast off; or if the body is  wounded, it  is  blood
that flows out.   These results  occur at all seasons, all periods of life,
and  at all times.   Thus man is really constituted of four humors, which
are manifest to our senses, and there is no need of special  arguments to
prove it." °
   The author,  after  having established his doctrine by unquestionable
arguments and observations, and having refuted the objections of those
who professed  contrary  views,  continues thus the exposition of his
own:  " The phlegm augments in  man  during the winter,  and this
humor  is more analogous in  its nature  to that season;  for it is the
coldest of all, as can be readily proved.  If the phlegm, blood,  and bile,
are touched successively, it will be found that  the  first is the coldest.
In the  spring the blood augments ; for there is an  affinity in its nature
; De la Nature de l'Homme ;  Gardeil. 
SCHOOLS OF THE  ASCLEPIAD.E.
127
with the constitution of that part of the year — it is hot and  moist.
The  bile increases in summer for the  same reason,  and the atrabile
becomes most abundant and strongest in autumn."
  Hippocrates  then explains summarily, how diseases are engendered,
namely, by the influence  of the  seasons, or  by the regimen, the tem-
perament, or the air that is breathed.  Finally, he establishes a general
rule for their cures, which consist, according  to him, in inducing  action
in the system contrary to  that produced by the cause of the diseases.
  Whatever view may be formed of this system, comparing it with our
present knowledge, we are forced to admit that united  to the doctrine of
coction and crisis, with which it perfectly affiliates, it offers an interpre-
tation, sufficiently reasonable, of the physiological phenomena which had
attracted the  attention of the observers  of that  epoch.  In fact,  all
phenomena, of whatever  character, can only result from the combined
action of vital and physico-chemical forces,  that  act  similtaneously on
the animal economy.   Now, the theory of coction  explains the laws by
which the vital principle is supposed to exercise its influence ; that on
the elements and humors  exhibits the influence of the inorganic  forces,
and the laws  according to which that influence is applied to organized
bodies.
   These two  theories united,  constitute the  ancient Dogmatism — a
doctrine originally of the school  of Cos, and of which Hippocrates is
regarded as the principal  author.  In  that  doctrine  the  humors play
the  part of secondary or  physiological elements;  they are  agents  en-
dowed with diverse, or even contrary properties, placed at the disposal
of the vital principle, which alone gives to them a good or evil direction.
But these agents can contract,  sometimes, deleterious properties,  in con-
sequence of external forces not controlled by the vital principle.
   The external forces admitted by the ancients, as we have seen, are of
four  kinds, heat, cold,  dryness,  and  moisture, which may be easily
reduced to two by the augmentation or diminution of caloric and mois-
ture.   This shows  the poverty  of the physics and  chemistry  of the
ancients.   They had no idea either of  atmospheric  pressure or its com-
position ; neither of electricity, the chemical phenomena of respiration,
nor  a multitude of other phenomena and influences.   They possessed
even on the  effects  of caloric  and moisture, but vague and  super-
ficial perceptions, and considered their actions only in relation  to the
humors of the human body, without taking  any account of the not less
important  modifications which they produce  upon the solids.  Besides,
they attributed  to  the humors  imaginary  qualities, derived from the
elements that were supposed to predominate in their composition.  They 
128
PHILOSOPHIC PERIOD.
 also conceived relations to exist between these humors and  the  seasons
 of the year, which were more poetic than real.
   The Asclepiadae, imbued with the same dogmas as Pythagoras, believed
 in a perfect harmony between the universe, or the macrocosm, and man,
 or the microcosm.   For this reason they admitted four humors in their
 physiology; though observation could only distinctly demonstrate three—
 the blood,  bile, and phlegm.   The fourth humor was an object of much
 uncertainty and obscurity, among the Hippocratic authors.  Some assimi-
 lated it to the terrestrial element, and called  it atrabile, attributing
 to it extremely active properties, and regarding it as the cause of the
 gravest affections ; others assimilated it to the liquid element, gave it
 the name of water, and regarded it nearly as a nullity, in the produc-
 tion of  diseases.   It was said, by one:  the heart is the reservoir of the
 blood, the  head of the phlegm, the  liver of the bile, and  the  spleen of
 the water.
   If the physicians had  been less subjected to  their philosophic pre-
 judices, and relied more upon observation, they  would  have been able
 to discover more reasonable relations between the humors of the body
 and the seasons of the year ;  they  would have found, for example, that
 the prolonged  action of cold, damp weather, at the close of autumn and
 the commencement of winter,  in the temperate climate of Greece, devel-
 oped the lymphatic or pituitary temperament and  humor, as well  as
 catarrhal affections ; that the damp, warm constitution of the weather at
 the end of winter,  and  in spring, disposed to open inflammatory diseases
 and  hemorrhages; and lastly, that the dry  heat of  summer and the
 beginning  of autumn, increased the secretion of bile, and favored the
 prevalence  of  inflammatory bilious and putrid  bilious  fevers;  but to
 see this they would have had to renounce the Pythagorian harmony of
 the four humors with the four elements  and four seasons.
  Notwithstanding its  errors  and imperfections, the doctrine of Dogma-
 tism is the most  ingenious and the most complete of all the medical
 doctrines of antiquity ; it  responds better than any other to the wants
 and  tendencies of antique science, and it was received  and adopted
 with admiration, not only  by  the generality  of physicians, but  also by
 the greatest philosophers.   We shall have occasion to speak of it more
 than once,  in  considering the modifications it has undergone in its long
 reign.
  What shall be said now  of those who  attributed to Hippocrates the
glory of having separated  Medicine from philosophy; and of those,  on
the contrary, who  attributed  to him the glory of uniting philosophy
 with Medicine ?   It must be said of them,  what Hippocrates says of 
SCHOOLS OF THE  ASCLEPIAD.E.
129
those who saw only one element in man: they do not well understand
themselves.
  It is certain that Medicine had been philosophized  upon before Hip-
pocrates ;  it is also equally certain that  Hippocrates philosophized as
others, and that he shared the prejudices of his age in many particulars ;
but  in some respects  his  philosophy is distinguished from that of his
cotemporaries by greater and more profound wisdom.   He reminds the
philosophers  and physicians, continually, of the maxim  too often neg-
lected by them, and even by himself, that the nature of man can not be
well known without the aid of medical observation, and that nothing should
be affirmed concerning that nature, until after having acquired a  cer-
tainty of it, by the aid of the senses ;  a maxim diametrically opposed to
the dogmas of Pythagoras, and which includes the germ of an entirely
new philosophy, that Plato misconceived, and  of which  Aristotle  had
only a glimpse, as I shall show hereafter.
  The other  theories that are found in the Hippocratic collection, have
not now the importance of the two preceeding;  they  are only met with
in a small number of works, sometimes in one alone.   They were never
adopted by a large number of physicians, and must  be considered as
the individual or particular opinions  of some writers.   A few of them,
however,  have furnished the first suggestions of the great systems in-
vented at later  periods, and on this account they merit  special atten-
tion ; for they show us the origin and connection of the prevalent ideas
of past ages.
                       § III. Theory of Fluxions.
   This theory, one of the most simple that can be imagined, is regarded
as being anterior to Hippocrates.  It is predominant in two treatises,
viz., those on the  Regions in Man,  and on the Glands.   A few extracts
from these two books will give us a sufficient idea of the doctrine.
   It is said in the first, " Fluxions are'caused by cold, which causes the
condensation of the tissues  and veins  of the head,  if the cold strikes
them when they are heated ;  then by their contraction the humors con-
tained in them are expelled.   All  the tissues are obliged to pour out
their fluids  when  they contract.  The contraction of the skin, by com-
pressing  the roots of  the  hairs, causes them to become erect.  The
liquids thus compressed are diffused in every possible direction.
   " Fluxions are also caused by heat, because the tissues become rarified
when they are heated, their pores enlarge,  and the  humor they contain
is attenuated,  so that it flows easily when compressed.  The greater the 
130
PHILOSOPHIC PERIOD.
rarification, the more the effusion, especially when the tissues are full of
humors ;  what they can no longer contain, escapes.   When a channel is
once formed, they pass off by it until the body, becoming dry, contracts
and closes the passage.  As all parts are in communication, the moisture
that exists is attracted by the dryest.   The body being permeable,  it is
easy, in those parts which have not imbibed so as to augment their vol-
ume, to attract the humors; especially is  this the case, if the  inferior
extremities are dry, the superior being charged with humidity; for there
are more veins in the upper part of the body, than in the lower,  and the
soft parts of the head are thinner, and need less humidity.   The fluxion
in this way becomes easy from the moist parts toward  the dry ; beside
this, all the dry parts attract moisture.   Nor can it be  denied, that the
humors tend downward, naturally, however light the force may be  that
affects them."
   It would be difficult to exhibit, in so few words, more ignorance on the
conformation of our tissues, and the laws of physiology and physics.   It
will not be expected that I should seriously attempt to refute the gross
errors that are crowded together in these few lines.   I will  simply say,
that the body of  man  is  there likened, sometimes to a sponge, which
absorbs water or allows it to escape, according to the degree of pressure
acting upon it; sometimes to a sieve, the pores of which are dilated  by
heat, giving a free passage to the fluids,  or contracted by cold, and pre-
venting their passage.   There is no more mention of the organic or vital
forces, the  effects  of which are so manifest and wonderful, not only in
the human  economy,  but also  in  the vegetable, than  if they did  not
exist at all!
   The author of this  book admits seven species of fluxions:  the  first
tends to the eyes; the second to the nose; the third to the ears ; the fourth
to the chest;  the fifth to the spinal marrow;  the sixth  to the vertebra
and general tissues;  finally, the seventh, which  flows slower than  any
other, producing sciatica and rheumatism.   In this way he explains the
origin of all diseases.
   As  to the treatment, it  is worthy of  such an etiology.   I will quote
only one method, which will be sufficient to give an idea of others.  " To
cure convulsions  it is necessary to place a furnace of coals on each side
of the bed, and give  an infusion of the root of mandrake, but not so
strong  as  to  excite frenzy,  and  apply  hot cloths to  the  ligamentum
nuchce."   The translators and commentators  are much  at a loss to find
any common sense in this passage, because  the  curative method  laid
down is so absurd; but they omit to notice, that that method  proceeds,
naturally, from the etiology above given.  In fact, if convulsions result 
SCHOOLS OF THE ASCLEPIAD^l.
131
from  too much humidity in the head, it  is  entirely natural  that  an
effort should be made to diminish this excess of  humor, by a large sup-
ply of heated furnaces and hot bags.
  I will complete the exposition of this theory, by some extracts from a
little monograph on  the  glands.  The author commences thus: "The
structure of the glands is such as I have just  stated.  They  are of a
loose, spongy nature,  and  of a fatty color.  Their tissue is not like that
of other parts  of the body, and may be distinguished from all other
parts by being  granular.   They have many veins.   When they are cut,
the blood that flows  out  is whitish and  watery.  When handled, they
feel like greasy wool, and  if strongly pressed between the fingers, a juice
oozes out, which  looks somewhat like  oil, and their  organization is
destroyed.
  " The glands are found in great numbers in the interior of the body:
more numerous in the cavities than around the articulations.  They are,
also, found in  all moist  and sanguineous regions.   Some attract and
take up the humors that come from above, into the cavities, others absorb
those which are poured out in large quantities in the cavities themselves,
or those which  are expressed by the working of the joints.  Thus they
prevent the superabundance of humors in the tissues.  Observe too,
that where there is  hair, there are glands also.   There is a connection
between the hair and the glands;  these attract the  humors, as above
said; the hair  profits by it: it is developed by  the nourishment which
the glands procure, and grows by leading outward the excess of  humors.
In dry parts of the body we see neither hair nor glands."
  A little further  on, the  author observes, that certain parts, as the
intestines and the omentum, have glands,  but no hair, but he is not
embarrassed to explain this anomaly.   " We see," ho says, " that in
marshes and very wet places, the seeds do  not germinate; they perish,
smothered by excess of moisture.  So in the intestines, the abundance
of fluids prevents the development of glands, and there is, therefore, no
hair."
  These efforts to explain everything, often throws the best minds into
strange ramblings.   We shall see many,  and even celebrated examples
of  it.  The  philosophers and physicians of  antiquity  would  have
thought themselves without reputation, if  they  had announced a single
phenomenon without giving some interpretation  of it.   Rather than fail
in this, they made use of  the most ridiculous explanations.   The little
treatise that suggests these reflections is certainly not one of the worst
executed of the Hippocratic collection ;  it  exhibits its subject, on the
contrary, with all the details and comprehensiveness  that the  anatom-
ical light of that epoch would allow, yet what vagaries it contains ! 
132
PHILOSOPHIC PERIOD.
  One example more, and the last: " The head  has glands;  the brain
itself resembles a gland, it is white, and divided into lobes, like glands.
It produces, also, the same effects, abstracting from  the head, as before
said, the humors which there abound.   The  brain relieves the head
from humors, and distributes them to the extremities, by means of cur-
rents that flow in different parts.   Observe, also, that the brain is larger
than  the  glands.0  The  hair on the head  is longer than  elsewhere.

It is from the continued flow of the humors toward the head,  which can
not contain them, as well as from their unceasing currents toward the
parts which need them for their nutrition, that  proceed  the  alteration
of humors, and thus diseases.   Either of these results, if not checked,
may exhaust nature entirely, although there are  great differences in the
intensity of diseases."
     § IV. Theories Founded on the Consideration of Two Elements.
  The four elementary forms of matter described  in  the  chapter before
the last, are  so well  determined, and  so constantly referred to in all
these works, that it would  be impossible to mistake them;  beside, no
ancient  author has attempted to deny their existence; but  some have
assumed that only two  of them are  primitive  elements, or even one
alone, the others being regarded as secondary.
  I. In the little  treatise,  entitled,  " On  Fleshes,  or the  Origin
of Man," fire and earth alone, are designated as  elements.   Fire  is
the active principle, which the author supposes to be  endowed with
intelligence, wisdom, and will;  he confounds  it with  the soul  of the
world, or God.   The earth is the passive principle;  it receives, by the
action of fire, or its mixture with it,  all the apparent forms of the body.
The physiology developed  in  this  book is very  odd, as the  following
extracts show:
  " I think that what we have called heat  is immortal, that it knows,
sees, and understands all things in the past and  in  the future.   When
all  things were created,  it was  developed  in  larger quantities  in the
upper regions.  The ancients, I believe, gave it the name of ether.  The
other element, which remained below, is called the earth ; it is cold, dry,
in active motion,  and contains  much heat.   The  third  part, which is
located  in mid-air, is somewhat warm ; the fourth, which is nearest the
earth, is damp and crude.   After all had been impressed with a circular
3 The author does not include the liver among the glands. 
SCHOOLS OF THE ASCLEPIADiE.
133
motion, they became mingled, and much  more heat  accumulated  in
some  parts of the earth than in others.   The quantity was consider-
able, but the volume was small."
   " The earth, after a long time, becoming dry, a  mould was found on
it, as  is often on old clothes;  and after another very long lapse of time,
what  there was of fat and moisture in this mould, proceeding from the
earth, being at last burned, formed bones.
   " That which was  sticky, and contained the cold element, could not
burn,  though made hot, nor become moist.  It then took a form differ-
ent from the rest, and was  developed into solid nerves,  for there was no
cold in them.
   " The veins required much of the cold element.  The exterior part of
this element, acted  upon by  the  heat, formed a dense envelope and
became a membrane.  The interior of the veins,  melted by the  heat,
became liquid.
   " In  this way, in man  and  in other  animals, the wind-pipe, the
stomach, the abdomen, and intestines, all became hollow.
   " The cold element continually growing warmer, the exterior was
burned and became an envelope or membrane; the interior cold that
existed, being neither fatty nor viscous, became humid, and was changed
into a liquid."0
   The author explains, after the same manner, the formation of all the
structures  of the human  body, their nature, nutrition, and various
functions.
   "The brain," he says, "is the center of the cold element;  the fat.
that of heat.
   " The veins that come from the belly and the intestines, continually
attract  or  absorb  what is  thinnest, and  most  liquid  in the food and
drinks.   After the mixture has become heated, the grossest remains and
becomes excrement, and passes to  the large intestine.  The nutritive
substance, reaching the various tissues, is distributed, furnishing to each
what  is to  be permanent of its structure.   These tissues, moistened by
the nutritious juice, all grow by the hot, cold,  viscous, fatty, sweet, and
bitter elements.
   II.  The treatise on regimen, of which we have spoken in  our article
on hygiene, includes a doctrine which is very analogous to the preceding,
but differs from  it, in that  water takes the place of earth, and  is
a passive element.   The author commences by discussing the prelimi-
nary  knowledge necessary  to write well, on the regimen of man, and
places in the first rank the knowledge of the human nature,  of its
0 Traite des chairs, ou du commencement de l'homme, §§ 2,3,4,5,6, 7. Gardeil. 
134
PHILOSOPHIC PERIOD.
 origin,  and the parts or elements that concur to form it.  "If," he
 says, " a physician is ignorant of what man is made at first, and what
 predominates in him, how can he prescribe what may be useful to him."
 After these general physiological considerations, on which  he dilates at
 large,  he enters  into  his  subject-matter  as  follows :  " Man and  all
 animals combine,  each  in  themselves, two principles, very different in
 regard to their relative powers, but which concur for  various purposes:
 namely, fire and water.   These two  principles, alone, are sufficient to
 act on all the rest, and to maintain the general movements.  One with-
 out the other would  not be sufficient for the  animal  economy, nor any
 other being.  Now I will state the powers of each.   Fire  is the source
 of all  motion, and water of all  nutrition.  Each one possesses certain
 necessary qualities;  fire is hot and dry, water, cold and moist.  They
 borrow, also, qualities from each other; fire borrows from water, humid-
 ity, for there is in fire a humidity that comes from water;  water bor-
 rows from fire, dryness, for there  is a dryness  in water that comes from
 fire.
   " Nothing is entirely lost, and nothing  new is made; only different
 combinations are formed.  Men think that what is born comes from a
 state of death, and what disappears, perishes, and that it is necessary to
 rely more, in this matter, upon  the  senses than upon reason, in which
 they are wrong.   Listen to reason!"  The author then enlarges upon
 this beautiful thought, but only spoils it by a miserable concoction of
 physics and metaphysics.
   At last, he comes to the generation  of man,  which he explains as fol-
 lows: " The mixture of semen is vitalized by agitation, and it draws its
 nourishment partly from different aliments, and partly from the air that
 penetrates  the  body of  the woman.   At first, the mixture is entirely
homogeneous, but  becomes swollen and rarified. It is  next  dried by the
 action of heat, which renders it firm, and consumes its internal humi-
 dity.   That which is more firm in its  nature, becomes  compact and dry,
 and  still being  acted  upon by heat, it  hardens, and forms what  are
 called  bones and  ligaments.   Fire thus effects all  the  changes in the
 body, according to the structure of each part, by means of  its effects
 upon moisture."
   With this somewhat fanstastic  anthropogeny, the author attempts to
 show connections, not less curious, between vital and astral heat.   The
 heat of the abdomen, which he terms the cavity of humidity, is, accord-
 ing to him, under the influence of the moon:  the heat  which goes to
 the surface of the body, to the  fleshes,  (tissues), is similar to that of the
stars; finally, the central heat of the body, which is carried by the vessels
from within outward, is the most  potent of all; it exerts  an influence 
SCHOOLS OF  THE  ASCLEPIADAE.
135
analogous to that  of the  sun.   " It is,"  continues our physiologist,
" this  central fire which directs  every thing, according to the laws of
nature, in an unseen, intangible, and noiseless manner.   In it resides
the soul, the intelligence,  prudence, augmentation, motion, diminution,
alternation, sleep, and wakefulness.   It governs all things, every where,
and at all times ; being never in repose."
   After making so poor an application of astronomical  knowledge, he
next passes in review, the most common occupations of life, such as melt-
ing of metals,  fulling, shoemaking, woodsawing, architecture, music,
and divining.   He  finds that each of these offers an imitation of the
regimen of man—a  similitude with certain acts  of the economy.   For
example, in speaking of goldsmiths, he says, " the goldsmith washes the
gold, beats, and melts it in a moderate fire.   Intense heat is  not best
adapted to it.   After being  thus prepared, he employs it for every pur-
pose.   So man gathers wheat, washes, grinds and bakes it, and  employs
it for food, without using  intense heat.  It is submitted  during diges-
tion, to a notable change, by the  mild heat of the body."
   When Empedocles reduced  the  primitive forms of matter to  four;
when Hippocrates put  forth his  beautiful  theory of coction and crisis,
they both started on correct observations, both rested on the real  rela-
tions, that a wise analysis had revealed  to them; whilst the inventors
of the two theories that we have  just read, have  established  their syn-
theses, on  false  or trivial bases only, and by forced relations.  They
were anxious to invent  something new, but have only succeeded in the
hypothetical and ridiculous.  It would have been much better to have
followed the already beaten  track,  than the vagaries of a wild imagination.
   III.  To the physico-physiological  systems, in which only two genera-
tive principles  are  allowed for the whole body, responds  the pathologi-
cal theory, according to which all diseases are supposed to proceed from
two humors only.   This last predominates in the two principal treatises
on pathology, in the Hippocratic collection ; but it is not pure,  and ex-
empt from admixture, for we see  in them, also, the doctrine of four hu-
mors.   The following is in substance, what we read in one of these trea-
tises:  "all  diseases,  if they are internal,  proceed from the  bile or
phlegm; if they are external, from various accidents—such as excessive
heat or cold, dryness or humidity.  Melancholy, produced by black bile,
causes paralysis.0"   A  little farther on, we read,  "those whom  atrabile
torments become diseased whenever the blood is overcharged by bile and
phlegm."f
0 Traite des Maladies, livre premiere, Gardeil.
flbid. 
136
PHILOSOPHIC PERIOD.
  The  second treatise on pathology, in which the theory of two humors
reigns, is entitled " on Affections." In this, we find the same mixture of
doctrines above  stated, as may be seen by reading  only paragraphs 1
and 36.
                  § V. Theory of One Single Element.
   The physiologists who see in the  animal economy only one element,
do not pretend to say, by this, that man is formed of a unique substance,
diversely modified, but they wish to inculcate, that among the elements
that enter into the constitution of man, there is one which predominates
over the rest, by its energy or its activity, and concurs in a preponderat-
ing, if  not exclusive manner, to  the production  of  physiological  and
pathological phenomena.  To establish  the unity of the  active forces
of nature, has been  the dream of many physiologists and physicians ;
but up to this time, all  the hypotheses conceived to this end, have been
Utopian.
   The Hippocratic collection  includes two books in which the doctrine
of a " single  element" reigns.  One, a treatise on embryology, is en-
titled, " on the Nature of the Child," and is  well executed and complete
enough  for that epoch.   It seems to be  the conclusion  of the book on
Generation.   The other is a very short  treatise on general  pathology,
which has for a title,  " On Air."   The air, breath,  or as the Greeks call
it, pneuma, plays the principal part in the two treatises, but its influ-
ence is considered in a much less clear and exclusive manner in the  first
than in the second.
   We read in the latter as follows: "An important thing to discover,
is the cause of diseases — the origin, the source of the  evils that are
engendered in the body.  Whoever can comprehend the  cause of a dis-
ease will be capable of curing it, by employing  a remedy which is the
opposite of the evil from its commencement."
   After having  shown  the necessity of going back to the cause of dis-
eases, to effect their  cure, the author continues thus :  " The nature of
all affections  is  the same ; they differ only in relation to their seat.  I
think that they only show themselves under so many different forms on
account of the great diversity of parts  where the disease is located.
Their essence is  one, and so is the cause that produces them.   But what
is this cause ?  This is  what I will endeavor to explain."
   " The body of man is  nourished by three things — food, drink,  and
air ; he eats, drinks, and breathes.   The  air in the body is called spirit,
or breath;  that external to the body is called wind.   It is the  breath
that produces the  greatest  phenomena, and its influence merits all our 
SCHOOLS OF  THE  ASCLEPIAD.E.
137
attention.  Nothing can be done without air ;  it is everywhere present;
it fills the immense interval that separates the earth from the heavens ;
it is the food of fire ; how could fire subsist without  it ?   It could not
exist long.  It is not difficult to conceive that the interior of the sea
participates equally in its benefits.   The animals that swim there could
not exist without respiration.  There is nothing, in fine, that does not
feel its  effects.0
  The  author  examines  next, more particularly, the  influence of the
breath for the support of human life.   He observes that  its influence is
uninterrupted;  that man may abstain more  easily from  drinking and
eating than breathing, from which he concludes that, air, being the thing
most indispensable to the human economy,  is also that which  occasions
in it the gravest and most frequent disorders.   " Thus  I can conceive
that  the principle  cause of disease  is in the air.   This may be  too
strong or too feeble, or be precipitated in the  body, or enter it charged
with miasms.   It suffices to have established this as a general princi-
ple ;  then, by descending into details, I will  explain how each disease,
in particular, proceeds from the breath or air."
   Because the air is one  of the most necessary things to  life, and if you
please,  the most  necessary,  does  it inevitably  follow  that  it is  the
unique source, or at least the most common  source of diseases ?  This
does  not appear to  me to be demonstrated.   But I do not insist on this
general objection ;  it is particularly in the face of facts or detailed
observation,  that  our systems are demolished.   Let us see  how  the
pneumatic system stands this test;  this will dispense with the necessity
of longer argument.
  The fever which supervenes after an improper diet, is explained, accord-
ing to this system, as follows : " Much food introduces necessarily much
air;  for the air enters  more or less into the body, in proportion to the
quantity swallowed of liquids  or solids.   For this reason, wind is
belched up after eating  or  drinking too  much.  The  air being thus
compressed, bursts  the  little cells in which it is contained, and mounts
 upward.   The body swells, by the excess of  air, and the food remains
 in  the stomach, prevented by the  great quantity of air from  passing
 into  the intestines. The air is diffused into all parts of the body, and
 cools even the most sanguineous portions ;  it goes even to the origin and
 source  of the blood, whence  it is  spread everywhere, and produces the
 shivering that precedes fevers.  The more air,  the more refrigeration,
 and  the greater the shivering."
   I  will limit here my quotation ;  the reader  is,  I think, sufficiently
            3 Traite' des Vents, § 1.  Gardeil.
9 
138
PHILOSOPHIC PERIOD.
edified  on the value of this pathological system,  by the explanation
which is offered for the  first symptoms of fever.   Let him guard  him-
self, nevertheless,  from sentiments  of  pity toward  the ancients,  on
account of the theoretical errors  he discovers in their writings;  let
him remember that in regard to theory, even the most eminent moderns
are not exempt from illusions, which will, in a future day, excite the
smiles of those who shall look  upon them in another and superior  light
to ours.   The deceptions of antique science  should render us  circum-
spect, and cause us to accept with reserve the  assertions of cotempo-
raneous science.
                    § VI. Theory of Any Excedent.
   We have seen, in the preceding chapter, synthesis pushed to its utmost
limit, and all the phenomena of the animal economy assimilated to each
other,  and united  by the bond of a common cause,  notwithstanding
their infinite variety and enormous differences.  But in order to arrive
at that, to perceive in  the formation  of  man, in the development of his
parts and the exercise  of his faculties, only the various modifications of
one  single agent, such as  air  or  fire, it was necessary to  clothe this
material agent with  imaginary faculties — to  suppose  it possessed of
instinct, intelligence, and will, which  no  observation could demonstrate ;
it was necessary, in short, to torture the  facts, and create an ideal world,
such as is seen by those  patients to whom all objects appear of the same
color.
   These Utopias that the mind invents, by means of abstractions, in the
solitude  of the cabinet, vanish, ordinarily, in the presence of the real
world, or phenomenal  truths.   To dissipate them, it is only necessary
that they be compared with  daily observations — to test them  by the
necessities of practice.   This is  done in a very creditable manner by
the author of the theory which we now proceed to examine.   The work
which  contains it is  entitled,  " On Ancient  Medicine," and  is justly
considered one of the  most creditable  of the collection.   Going back
to the  infancy  of the Art, it developes its principles,  traces its progress
with much sagacity, and indicates the best method to follow, to insure
its progress in the future ;  it lays,  in short, the true foundation of
medical philosophy.
   The critics  and historians  are nearly unanimous in  classing this
little work among the writings posterior to Hippocrates.  M.  Littre,
alone, of moderns, charmed by the excellent doctrines contained in this
book, is not willing that any other than that illustrious man shall have 
SCHOOLS OF THE  ASCLEPIADAE.
139
the honor of its  authorship.0  The principal  document on which  he
bases  an opinion  contrary to the common sentiment, is a passage from
Plato, in which  that philosopher, without designating  precisely  the
book  of Ancient  Medicine, seems to make allusion to it.   I avow, that
after  having read the passage, and the learned commentary with which
M. Littre accompanies  it, I am  still with  the common opinion.    I
have  preserved, also, in  the  passages which I quote from  the  book,  the
translation of  Gardeil, because it is on that translation that I made my
first study, and  consequently  it  is  better adapted  to  my arguments;
besides, it does not differ materially from that of M. Littre ; for it is seen
by comparing them, that these interpretations express the same ideas in
different forms, f
   The author opens with an argument, in which he shows that Medicine
has not been founded on uncertain or  obscure hypothetic opinions, but
on the manifest observation of the good or evil results which follow a
certain regimen and treatment, or action.  He asserts, that the best
method for making any improvement on  the discoveries of past times  is,.
not to jump foolishly into eccentric and unknown ways,  but follow with
perseverance the beaten route of experience, which alone will conduce to
real progress.
   Like all the hypotheses emitted at that epoch, to explain the phenom-
ena of the animal economy, that of the  four elementary qualities  had for
  ° He expresses himself about it as follows: " The hook, Ancient  Medicine, so
remarkable for the correctness of judgment, and depth of thought, is no less so
in the beauty and excellence  of its  style.  The arrangement is worthy of its
matter.  The periods, generally long, are constructed with perfect regularity;
the members of the phrases are balanced and finished in a way to please the ear,
as well as the mind; the style, clear, and full of truthfulness, is always grave and
firm, yet, nevertheless, it is enriched, (se colore) from interval to interval, in a
way that shows a writer, who, master of his subject and of himself, is restrained
within the limits of a natural taste.  It is certainly a fine specimen of Greek
literature, and a finished model of scientific discussion, on the  general  and most
important points in Medicine."  (GSuvres d'Hippocrate, De l'Ancienne Me'dicine,
page 565.)
  f I can only summarily indicate the reasons which make me take the common
view.   1st. The book of Ancient Medicine  refutes the system of four elements,
which was that of  Plato;  it proclaims  the superiority of the experimental
method, and Plato, as we shall  see  hereafter, is the Corypheus of an entirely
opposite method.  How then could this philosopher have proposed, as a model, a
doctrine contrary in all points to his own ?  2d. The passage in Plato, considered
in itself, seems to relate, according to Galen, as well to the book, on the  Nature
of Man, as it  does,  according to M. Littre', to the work on Ancient  Medicine.
(See  the introduction  to the QLvures d'Hippocrate, by M. Littre, t. 1, p. 294, et
suiv., and to the first paragraphs of the book on la Nature de l'Homme.) 
140
PHILOSOPHIC PERIOD.
its support the most respectable authorities, such as Hippocrates, Plato,
Aristotle, and the majority of physicians;  but our philosopher  boldly
attacks that hypothesis, and refutes it in an entirely special manner.
  "All those," he says in the commencement, " who have  undertaken
to speak or write on Medicine, and who have established their doctrines
on the hypotheses of cold or heat, of dryness or moisture, reducing thus
to one or two principles the causes of the death and diseases of men, are
manifestly mistaken in the greater part  of the things that they have
advanced.  I  think,  therefore, in  this art it  is  not  proper to have
recourse to vain conjectures, as is necessary in treating of things entirely
above our appreciation, and which are  of no benefit to those who under-
take to discuss or write about them."0
  After pointing out,  rapidly, what it is necessary to avoid in the study
of Medicine, the author indicates, immediately,  what it is proper to do,
and  his entire method may be summed up by the following aphorism:
Observe attentively what is useful or injurious to health; examine in
what each thing is good or bad; but  put no subtlety in this research;
hold simply and purely to the testimony of  the senses.
  This method  was not entirely new; Hippocrates had alluded to it,
somewhat, in  his work on the " Nature of Man," but it was not expressed
in terms as formal  and explicit as are found in  the work on Ancient
Medicine.  The author of this labors constantly to join  example to pre-
cept ; he appropriates to  himself, in  some  degree, this method, by the
developement he has given it,  and the proofs by which he sustains it.
  " It seems to  me, -primarily," he says, " that in treating of the heal-
ing  art, we must advance views, the accuracy of which every one  can
appreciate,  because the discourses and researches  of physicians should
aim only at the  diseases to which every one  is subject.   It  is, therefore,
necessarily the observation of  the manifestation of good or evil results
which has  led to the search for  and discovery of this Art.  Indeed, it
has been discovered, by observing, that the sick were made  worse by the
use  of the same food that  healthy men employ, which is still verified
every day.
   " What difference can be put between the invention of a man who has
marked out the regimen suitable to the sick, who  practices what every
one  calls Medicine, and who  is  recognized, generally,  as  a physician,
and the invention of him, who, in  the earliest times,  changed  the
ancient, wild,  crude food, for those various preparations of aliment now
in use.  For myself,  I  think  it  is the result of the same method__a
similar discovery.  The first led to the suppression of food, too gross to
3 De l'Ancienne Me'dicine. § 1, 2. Gardeil. 
SCHOOLS OF THE  ASCLEPIAD2E.
141
be assimilated, even  in  a state  of health; the second, has interdicted
aliment too indigestible in  certain  cases, considering  the particular
circumstances.  There is no other difference, according to my view,
except  that  the field  of  the  latter, being more varied and extensive,
requires, consequently,  more discrimination aud  experience;  but the
first invention is nevertheless the mother of the second."0
   In this  way the author refers the  creation of Medicine  to the first
essays made  by man  to ameliorate the conditions of his existence.  He
demonstrates that the same instinct, which led him, so early, to make a
choice among the articles of food at his  disposal, prepare them by cook-
ing,  and in various other ways, for the  purpose of gratifying his taste
and  rendering digestion more easy;  the same instinct, I  repeat, alfeo
suggested  to him to seek means to alleviate pain;  and that experience
taught  him,  gradually, not to follow the same regimen in disease as in
health,  and to employ for his  restoration to health,  a variety of means.
   The  first  rules  of hygiene and therapeutics, not being the fruit of
any  hypothesis, but of experiment, he concludes that  we may not hope
for perfection in these sciences,  except  by the  experimental method.
"Every man," he  cries out,  "who rejects  approved rules, and takes a
new path,  and  boasts  of  having added  something  to the art, deceives
himself, as well as others."   He  proscribes all the transcendental specu-
lations in which men were in the  habit of indulging, in his times, on the
nature of man, and the essence of diseases.   He regards them as a mere
amusement—a play of the imagination.
   "There  are,"  says he " certain sophists, among whom may be counted
even  some  physicians, who pretend, that to comprehend Medicine well,
it is  necessary, in  the first  place, to understand  what man is in his
nature,  how he was first made,  and from what he was formed.  For
myself,  I think that all which the sophists wrote on the human nature, is
less  useful to physicians than to the makers of books, and that we can
not hope to  arrive at any certainty touching the constitution of man,
unless we obtain it by medical observations.   All  that  is necessary for
any practitioner, who wishes to succeed in his art, to understand concern-
ing nature, is the relation of man to his food and drink, and the changes
which different kinds of these may effect in him."
  We see with what sagacity our philosopher connects the question  in
physiology  with the experimental method.   He does  the  same for the
problems of pathology and therapeutics.   If it is required, for example,
to explain  the generation of diseases, he  does not have  recourse to occult
causes, such as elementary fire, or radical  moisture, but to causes apparent
0 Traite' de l'Ancienne Medicine, § 5. 
142
PHILOSOPHIC PERIOD.
and appreciable by everybody, such as excess of eating and  drinking,
the fault in preparation, or the bad quality of articles of food.   He
does not deny that the excess of heat or cold, of dryness or humidity,
may become, in certain cases, the causes of diseases;  but he insists that
these primitive elements  do not possess the  character of morbid  agents
in all affections, nor even in the greater number, and he proves it from
examples drawn from daily observation.
   " Let us take," he says, " a man of feeble temperament.  Suppose he eats
grain from the garner, with raw flesh, and drinks pure water; this will
cause him much pain, his stomach will become deranged, his body waste
away, and he will  not live long.   What must be given to him ?   Heat,
cold, dryness, or moisture ?   If it is pretended that either of these ele-
ments has caused the disease, the cure is to  be effected by employing its
opposite.  The surest and promptest remedy will always be found to be a
change of food: to give bread instead of  grain, cooked meat instead  of
raw flefeh, and to add wine to his drink."0
   The substances on which man sustains  himself are endowed with
secondary qualities, such as bitter, saline, sweet, acid, and many others,
the effects of which are  more  sensible, and more  persistent than the
effects of the primary  qualities ; from which, our author concludes that the
first more frequently give rise to diseases than the last.   He represents
the action of the secondary principles, on the  animal economy, as follows:
" There are  in man, bitter,  salt, sweet, acid,  and a hundred other similar
humors of different  powers, according to their quantity and  degree of
energy.   All these things, when well mixed  and tempered by each other,
are harmless and  unfelt; but when  one of them is  separated, and  is
alone, it is felt, and makes great havoc in  the body.  It is  the same
with articles of food; those which are not fit for  use, are either bitter,
salt, acid, or too strong; on this account they cause the same inconveniences
as the humors of which I have  spoken;  but those which  are suitable
for us, have none of  these violent or excessively strong qualities."
   In  the other theories, no account is made of secondary qualities,
because they are regarded as simple compounds, but nothing proves that
they are so.   No observation or analysis has shown how the bitter, salt,
sweet, and acid resulted from the combination of heat, cold, dryness,  or
moisture.   It was, then, just as rational to study the effects of secondary
qualities as those that were  pretended to be primary.   It was  rational
to observe how each  of these principles  acted, either when manifested
spontaneously in the natural humors  of  the body,  or when introduced
into the economy by  alimentary substances.
0 De l'Ancienne Medicine, § IL 
SCHOOLS OF THE ASCLEPIAD^l.
143
   The following extract  shows the general course of action  of these
violent humors, according to this system:   " We  have," says the same
writer, " as above shown, one example, among others, which seems to me
to be clear and conclusive.   When we have a stoppage in the nose, from
a cold, and a coryza supervenes, is it not true that this humor becomes
more piquant and caustic, in  proportion  to the abundance of the  dis-
charge ; that it causes the nose to  swell, which  becomes inflamed  and
heated to such an extent that the heat may be felt when the  hand is
carried to it ?  If the same fluxion continue long, the humor makes exco-
riations on this hard and fleshless part.   This ardor is at length dissi-
pated ; but how ?   Not while the humor flows, and there is inflammation,
but when the humor  becomes  thicker, less sharp, more  concocted,  and
perfectly tempered."
   "It is the same for  all the other derangements that I suppose to pro-
ceed  from the acridity and severe  nature  of the  humors; they cease
only when the humors  are all matured and tempered.   How many times
do we see fluxions from the eyes, caused by every  sort of acridity, which
ulcerates  the lids,  excoriates  the cheeks, breaking up and destroying
even the thick membrane that envelopes the pupil  of the eye!  When
and  how do pains and  inflammations here cease ?   It  is only after the
humors have been matured, become denser,  and have been changed into
purulent matter.   Now this coction is effected by the proper tempering
of the humors."
   The author cites  still other examples, and concludes in these terms:
" Must we not take, for the cause of a disease, that which, when appear-
ing in one form, is  invariably followed by this  disease, then, changing,
brings about a corresponding change in the state of the disease, and, at
last, by disappearing, leaves the patient without any affection."
   The rule  here  laid  down to discern the causes of  diseases, is not as
well founded nor  as infallible as the author thinks;  in following it with-
out discernment,  we would be liable frequently to take for the cause of
a disease, that which is only an essential  symptom or constant effect.
Thus, in the examples  reported above, the acrid humors which flow from
the nose in coryza, and from the eyes attacked with ophthalmia,  are no-
thing more than symptoms or  effects, that accompany these affections
nearly as constantly as the shadow does the body.  The  author is then
mistaken  in supposing  these humors to be  the causes of the concomitant
diseases, and the pathogenetic rule that he has laid down admits of many
exceptions.   Nevertheless, his theory is less erroneous than any of  the
preceding that I  have  cited, because it never, or very rarely ever, for-
sakes observation ; while the others, disregarding observation, lose them-
selves  almost immediately in the shadowy field of fictions.   If it is 
144
PHILOSOPHIC  PERIOD.
untrue, to say that the humors which  flow from the eyes and nose when
these organs  are diseased, are the primary causes  of the disease, it  is
nevertheless certain that these humors give rise, at least, to some second-
ary accidents, such as ulceration of the lids, and margin of the nose, etc.
They are thus at once cause and effect, as are all organic phenomena.
  Neither has the author of the Treatise on Ancient  Medicine totally
overlooked the solid parts of the body ; he says something of them in the
last paragraphs, and insists on the necessity of studying their structure
and configuration.  If the reader finds the reflections of our physiologist,
on this subject, deficient in development and depth, I shall not deny it;
but I will say, that it is also necessary to  bear in mind the little ad-
vancement of the lights of his age on this branch of physiology.  It must
be recollected that at that epoch descriptive anatomy was in its infancy,
and that pathological anatomy did  not yet  exist, from the impossibility
of making regular  dissections.  This writer has done all which was pos-
sible to do in this  respect.   By insisting  on the necessity of  acquiring
positive notions concerning the form  and  structure of organs, he has
traced  the route that should be followed, and which since  has success-
fully been done.
  Moreover, he did not overlook the influence of the vital  force  or the
organic reaction on  the development,  progress, and termination of dis-
eases.  He speaks of it more or less explicitly in several places; notably,
when he recommends  particular attention to be  paid to the  crises and
critical days.
  Thus, then, as I announced at the commencement of this chapter, we
find  in the book on Ancient Medicine, precious researches on the origin
and progress of the Art; a reasonable  development of the experimental
method already advised by Hippocrates; the largest pathogenetic system
which  had yet appeared—a system, in short, which may be summed up
as follows:  the causes of diseases  must  be  sought  in every agent that
affects  our constitution beyond certain limits, whether coming from with-
out or  residing within us.


              § VII.  Resume of the Hippocratic Theories.
  The  first  of these theories, that of coction and crisis, is founded on
the capital observation that there exists in  the organized  body an in-
trinsic force, diffused in all its parts,  creating a mutual sympathy, and
harmonizing  their various  functions for a  common end, by a kind  of
instinct.  One of the most distinct characters of this force is its inter-
mittence in regard  to some  of these functions, which  is never seen  in
brute forces.  These  intermissions, which are seen in certain diseases, 
SCHOOLS OF THE  ASCLEPIAD2E.
145
produce in them periods, more or less  regular, named critical periods
or crises.   But there are also  many diseases in which these periods do
not occur, or are not appreciable;  and the fault of the ancient Hippo-
cratists consisted in extending the theory of crisis to all pathology.
   Force,  or  vital forces, would appear to be inherent to the organs,
being dependent entirely or in part on the constitution of these ;  it was
then essential to study that constitution ; but the Asclepiadae were pre-
vented from proceeding to that study, by cotemporaneous prejudices.
   On the other hand, the vital or organic forces act upon the substances,
liquid, solid, or gaseous, whether existing in the body or coming from
without.   These substances, endowed with properties more or less ener-
getic, modify the functions of the organs, which made it  necessary for
the physician to  be acquainted with their properties.   Now, as physics
and chemistry, which  alone can furnish this  knowledge, were too incom-
plete to afford  the  ancient physiologists but vague or false notions, the
medical theories varied much  in this respect.
   The greater part of  the naturalists of antiquity, recognised  four pri-
mary forms of matter, and pretended to derive from them all the physi-
cal properties of the body.  In like manner, the  majority  of the phy-
sicians supposed four cardinal humors,  on which depended  all  the phy-
siological and pathological phenomena.
   Again, a  small  number of naturalists  recognised but  two, or even
one element; and also, following their example, a few  physicians would
only admit two physiological elements, and again,  others only one.
   In  the midst of this conflict, a few men, more attentive, and less pre-
judiced, made the observation, that  there is no proof that   all  material
substances proceed  from one or two, or  four elements only,  and that no
one has ever seen the combination of a given dose of heat, cold, dryness,
and humidity, engender either bitter, acid, sweet, or any other pretended
secondary quality.   They concluded that  this division of  the  physical
properties of bodies into primitive and secondary, was false, or at least hy-
pothetical, and were desirous that only dogmas, which are experimentally
demonstrated, should be  admitted into the science. This was calculated
to provoke a theoretic  reform, for  which the age was not yet prepared.
We shall see its advent in the next period.

          The Medical  School of Cos, after Hippocrates.

   The eclat  that  Hippocrates had given  to the teaching of the Ascle-
piadae of  Cos, survived him:  many members of his family followed in
his footsteps, and sustained the honor of his school.  Among others,
may be mentioned  Thessalins and  Draco, his sons, and  Polybius,  his 
146
PHILOSOPHIC PERIOD.
son-in-law, to whom  are  attributed some of the writings that form  a
part of the Hippocratic collection.
  Not long after  them,  Diodes of  Carystus flourished in  the same
schools,  who was surnamed by the Athenians, the second Hippocrates,
and Praxagoras, of Cos, the last  of the Asclepiadae, of  whom mention
is made in the history of  medicine.   Both composed several works that
are entirely lost.   Praxagoras, who is supposed to have belonged to the
family of Hippocrates, was distinguished  principally for his anatomical
knowledge.  He supposed, like Aristotle, that the veins originated at the
heart.   He did not confound these vessels with the arteries, as many of
his predecessors, and Hippocrates himself, had done.  He supposed they
only contained air, or the vital spirit.  It is thought that he dissected
the human body.
  Praxagoras was the first to remark  the close connection between  the
changes in the pulse, and the dynamic state  of the economy.   He was
also  the first who  attempted  to give an explanation of that singular
phenomenon, and thus laid the foundation of sphygmology,  for before
him, medical men had not given this much attention. The Hippocratic
works rarely allude  to the arterial pulsations, among the symptoms of
diseases, and when spoken of, only a secondary importance is attached
to  them.  But,  ultimately,  the  observations of Praxagoras  became  a
fruitful  source  of  indications; this  order of  signs  was  even  greatly
exaggerated, as always happens in  great discoveries, and efforts were
made to  build on  this unique foundation, an entirely  new  system of
semeiology.
  The reigning theory in the school at Cos, as we have before said, was
that which made the health depend on the exact proportion of the ele-
ments of the  body,  and on the perfect combination of the  cardinal
humors—the blood, bile, phlegm, and atrabile. This theory was generally
attributed  to Hippocrates.   According to it, all diseases proceed from
one  of  the four elements,  heat, cold, dryness, or moist, the excess of
which engendered some humor badly  concocted, or too abundant,  which,
by  extravasation  from its  natural  reservoirs, passes into  parts  not
habituated to its presence.  The equilibrium is  established by the coction
and evacuation of the piccant humor.   This doctrine, which was taught
almost  exclusively, until the foundation of the   school  at Alexandria,
constituted the ancient Dogmatism, so named,  doubtless,  because it  em-
braces the most anciently professed dogmas in medicine.
  Amongst the most famous sectators of the  Hippocratic Dogmatism,
we shall name two  philosophers, Plato and  Aristotle, whose opinions
have exercised a great  influence  on the  march of the human mind in
general, and particularly in respect to medicine. 
SCHOOLS OF  THE  ASCLEPIADJ5.
147
                          ART. I. PLATO.
   The first of these philosophers  was endowed with a lively and  bril-
liant imagination, and clothed with the charms of a seducing language,
the purest morals in  paganism.   In  lending to  the grave teachings of
Socrates,  the graces and liveliness  of his spirit, Plato secured for them
immense  popularity,  and an  eternal  duration, which they would not,
perhaps, have obtained without these foreign ornaments.   But we  have
not  to  consider  here, either  the  profound moralist or  elegant writer,
worthy  of the surname of the Swan  of the  Academy;  we can  only
occupy ourselves with Plato in his character of physician, and especially
in that  of physiologist.
   Let us sec,  in the first place, what mode of  acquisition he employed
in the study of the physical sciences.   We shall let him speak for  him-
self.  " Very  well," he says, in the Phaedon, "  is anything more rational
than to think by the  thoughts alone,  disengaged from all foreign or sen-
sible agency ;  to apply at once the pure essence  of thought in itself, to the
research of the pure essence of each thing in itself, without  the ministry
of the eyes and  ears, without, in  short,  any intervention of the body,
whose slightest influence only troubles the soul, and prevents it finding
wisdom  and truth.  If we  are  ever to attain the knowledge of the
essence  of things, must it not be in this manner?"0
   It is clear, from what we have just quoted, that  Plato undertook the
study of the physical diseases, not by method of observation and exper-
iment, but by  that  of pure meditation—by mental intuition.   The
following passage proves that  he applied that method, not only to meta-
physics  and morals, but also to physics and physiology:  "During my
youth," he continues, "lhad an  intense desire to learn  that science
which is termed physics.   I felt that it would  be sublime  to know the
cause of each thing ;  what created, destroyed, and sustained it in exist-
ence.  I was  tormented, in a thousand ways, by  my efforts to learn
whether it is the cold and hot elements in a state of corruption, as some
pretend, which form animated beings;  if it is  the blood, or air,  or
fire that causes us to think, or whether it is either of these, or the brain
alone, that produces in  us all our  sensations, sight, hearing, and smell,
which, in their turn, produce memory and imagination ; which, by reflec-
tion create science.  I  reflected, also, on the decomposition of all these
things, of the changes which  take place  in  the heavens and the earth,
and at last would find myself  confused and wholly disqualified for such
researches."f
  0 QSuvres completes de Platon, translated by M. Cousin, page 203.
  t Ibid., p. 273. 
148
PHILOSOPHIC  PERIOD.
   The meditations of our philosopher having  resulted  in  no positive
knowledge touching the  questions  that  he was anxious  to understand,
he did not deduce therefrom  the very natural  consequence, that it was
possible that he might have followed a false course, and that the method
which conducts most certainly to the discovery of abstract truths, such
as the axioms of metaphysics, and morals, was not as sure to attain the
knowledge of material things,  of  the  truth  of  observation.0  Plato
never suspected the excellence of his method, and he was never tempted
to try any other;  thus despairing,  he returns to the origin of  things,  to
explain in what  their essence consists, when, having heard read in  a
book  of Anaxagoras, the  following  proposition: mind is the regulator
and principle of all things—"this  idea," he  says,  "struck  me like a
stream of light."
   Nothing more was necessary to  inflame the imagination of the phi-
losopher of the Academy, and create in his brain an entirely new system
of physics.   See  how he reasons:   " Since the intelligence is the first
cause of all things, it  must have ordered all things for the best possible
end;  then, if any one desires to find the  cause of everything, how  it
originates, perishes, or exists, he has only to ascertain to  what end such
thing is  destined.  Therefore," he  adds,  " I  comprehend  no  longer,
all the other  learned causes that  are offered us,  but if  any  one
comes to tell me what  it  is that makes  a thing beautiful, or gives  it
liveliness  of colors, or forms, or  other  similar things,  I leave  aside all
these reasons, which only perplex me, and I assume, myself, without plan
or art,  and  probably too simply,  that  nothing gives beauty but the
presence or communication of  the original beauty, in whatever way this
coummunication  may take place on  this subject.  I affirm nothing, ex-
cept that all things beautiful are beautiful by the presence of beauty."^
   The reason which Plato has given for the beauty of  things, naturally
recalls that famous response of  the schools of the Middle Ages, to the
question, Why does opium produce  sleep?  Because it possesses the sleepy
principle.  But the passage we have just quoted, merits the attention  of
the reader for more serious  reasons; for it shows how and why the con-
sideration of final causes was introduced into the natural sciences ;  a
consideration that has played an important part in more than one sys-
tem of physics and physiology—one of the most unfortunate  results  of
  0 This is not the place to examine if the same mode of acquisition is  applicable
to all branches of human knowledge, as many ancient and modern philosophers
have thought.  This important question will become more proper in  another
chapter, where we shall treat it with all the consideration it merits.
  f QEuvres Completes de Platon, page 2 S3. 
SCHOOLS OF  THE  ASCLEPIADAE.
149
which has been to divert the human mind from the path of observation
and experiment, and  lull it into a species  of  quietism, extremely con-
trary to the progress of light.
  But  without anticipating  the results  that the  Platonic method was
destined to produce—results which we shall hereafter see develope them-
selves—let  us be content, for the moment,  with examining the benefit
that Plato himself realised from it. in regard to the explanation of  natu-
ral phenomena.   As all parts of his philosophy  are intimately connected,
as is the case in that of Pythagoras, I shall be compelled to  say  some-
thing of his cosmogony before exposing his physio-pathologic ideas: and
if I  am not always able to shed upon these abstract matters the  clear-
ness I  would desire, I  pray the  reader to remember that the subtle
Aristotle himself, the assiduous auditor of Plato, sometimes found the
conceptions of his master too difficult to follow.   It is in the dialogue
entitled Timaeus, that the founder  of the Academic sect has deposited the
products of his  meditations touching the  nature of created  beings in
general, and of man in particular; and it is from it  that we extract the
following summary.
   Plato, like  Pythagoras, maintained the  idea,  that God  and matter
existed from all eternity;  but that matter in itself  had  no form,  prop-
erty, or force.   God  gave it, from the  beginning, a  triangular  form ;
afterward,  taking a certain  number of primitive triangles,  he composed
the four primary elements, which we, in  this lower world, term fire, air,
earth,  and  water.  Fire, which is the most subtle,  is  made  up of the
smallest number of triangles;  it has the figure of a pyramid.   The air
represents  a solid of twelve faces,  a dodecahedron.   Water has the form
of an  icosahedron, or a solid  of  twenty faces.  Finally, the  earth, the
heaviest of all the elements, constitutes a hexahedron, that is to  say,  a
perfect cube, composed of right-angled triangles.
   Thus, Plato,  having borrowed  from  the philosopher  of Samos the
dogma of the homogenity of matter, went yet farther than he in the field
of hypothesis, for he attempts even  to  determine the primitive  figure
that the Creator must  have given to atmospheric matter.   He pretends
that this figure is a triangle, because, of all the surfaces, the  triangular
is the most simple, and there is no geometrical figure which may  not be
divided into triangles.
   While matter remains in its elementary state, it does not affect our
senses  in any way.   For matter to  become perceptible, it  is necessary
that several elements unite, and form an aggregate.   Thus  all the mate-
rial substances which we know, and to which we assign particular names,
result  from the assemblage of various  elements.  Water,  for example,
which we see, feel, and employ in so many various ways, is not elementary 
150
PHILOSOPHIC PERIOD.
water.  The liquid body which we  call water  is,  according to  Plato,
a  compound, in which the aqueous  element enters in a  much  larger
proportion than the other elements.
   This philosopher also admits, with Pythagoras, the existence of differ-
ent orders of created  spirits.  He says, that the Supreme Intelligence
charged  the secondary gods  with the  formation  of mortal animals.
These gods,  having received from the hands of the Celestial  Father the
immaterial  principle  of the  human soul, fashioned a body for it with
the most regular and  polished of the primitive triangles.   This lumin-
ous and  incorruptible body, which envelopes the immaterial soul, was
placed in the brain of man.  The gods endowed, also, the visible and
grosser body of the  animal with another, mortal soul, the seat of the
violent and  fatal passions.   This occupied the length of the spinal mar-
row, leaving between it and  the divine soul, the interval  of the neck,
for fear  that the  two  substances, of a nature  so different, being  too
closely connected, the least pure might tarnish or embarrass the other
by its contact.
   " Therefore," says the same author, " the gods placed the mortal soul
in the chest and the trunk; and as  this soul contains a  good and  bad
principle, they divided the cavity of the  trunk  into two departments.
just as is done with the apartments of males from females, by means of
the diaphragm, placed in  the middle as a partition.   Nearer the head,
between the diaphragm and the neck, they placed the manly  and coura-
geous, or bellicose  principle of the soul; so that being submitted to, and
in concert with  the reason, it naay restrain the revolts of  the passions
and desires,  when these are unwilling to be controlled by the influences
which reason sends down from its citadel.
   " That  portion of the soul which  requires food and drink, and  all
that the  nature of our body renders necessary, is located  between the
diaphragm and  the umbilicus.   The gods have extended it over this
entire region, like a rack,  where  the body may find its food.   They have
confined it there, like a ferocious beast, which it is necessary, neverthe-
less to feed,  so that the mortal race may subsist.
   " The  authors of the human  species having  foreseen that we would
be intemperate in  eating and  drinking, and  that by gormandizing we
should exceed very much  the limits  of what is  proper and  necessary;
therefore, in order to prevent us from destroying ourselves  at once by
diseases, and for fear that the race would thus soon become  extinct, they
arranged what is termed the lower  bowels, to serve as a receptacle for
the superfluous food and drinks, and  they surrounded  it with the folds
of our intestines,  for fear  that the aliment, by passing too rapidly
through the body,  would create,  too soon, the necessity for its renewal, 
SCHOOLS OF THE ASCLEPIAD^.
151
which in making us insatiable gourmands would divert  us from the
cultivation  of philosophy, and the  muses, and from the  obedience we
owe to that which is Divine, within  us."
   Plato enumerates this way the principal parts of the  body, and sup-
poses that he  had sufficiently explained the manner in  which each one
was generated, when he  announced its functioms ; or,  to use  his own
expression, when he enumerated their final causes.   But I  think I have
shown enough to convince the reader of the emptiness and nothingness
of this kind of explanations, in the  physical sciences.
   As to the physiology of the same author, it is extremely  succinct, and
limited to some generalities.  It emits  no new  idea, no principle, which
has not been explicitly developed in  the Hippocratic works, with the
exception of the idea of  elementary triangles,  that Plato  found  means
to bring in everywhere.   " The  nature of diseases,"   he says,  " has
something in common with  that of animals.   They are developed within
a limited period, the same as each species; each animal is born to live
for a  certain determined period, barring the accidents that may occur;
for the triangles which constitute each  animal  are disposed to last for a
certain length of time, beyond which the animal can not survive.  It is
the same with diseases ;  but if they are disturbed before a fixed  time,
by the employment of remedies, the smallest grow larger, and a single
one attracts many.   It  is  better to treat  them  by regimen, as far as
possible, and not disturb them by medicines.   Let this  suffice for the
animal  and his corporeal part."
   In bringing out some of the physico-psychical naivetes of Plato, I am
far from desiring to cast ridicule on the conceptions, sometimes  bold,
but always brilliant, of one of  the most splendid geniuses of antiquity.
I am aware that seen in the lights of his age, the fictions of this philo-
sopher are not as eccentric as they appear to us at first sight, since they
have  been reproduced in many writings, in totality or  in part, almost
as far down as  our times ; but I wish to show by a great example, in the
first place, that the introduction of final causes into Physics and Medi-
cine, has only been a source  of deceptions; next, that the purely specu-
lative  method, so exact and fruitful in mathematics, has  only led to
futile dreams, and  the  play of the  imagination, the sublimest minds
that have attempted, by this method, to seek  the  properties of matter,
and  the explanation of the  phenomena of nature.   This will be  more
and more apparent, as we advance in this history, and  new examples,
not less illustrious than  the preceding, will come to confirm this.   I
will deduce, for the present, two practical results : first, that it requires
above all things, to choose a good method by which to acquire and culti-
vate the sciences; second, that every system of  physics,  or  of medicine, 
152
PHILOSOPHIC PERIOD.
which does not repose on accessible facts, or the immediate appreciation
of the senses, is, at  least, very hazardous, for where the senses can not
penetrate, imagination reigns as sovereign.
   Philosophers point out two principal modes of acquisition: the one,
which they name logical, or rational,  consists in establishing, at  the
commencement, some general propositions, or abstract principles, whence
they deduce,  by reasoning, the solution of all particular causes: thus, in
mathematics  is deduced from the axiom,  "two quantities  equal to a
third, are equal to each other," the solution of a multitude of problems.
So, also, from  the following moral principle, " do unto others, as you
would have them do unto you," the casuist  deduces a mass of special
precepts.   Plato, who knew no other method, is then, very excusable for
having  pretended to derive an entire system of cosmology and physio-
logy, from that antique  dogma: the Supreme Intelligence has ordered
every thing for the best possible ends."
   The other mode of acquisition, called the empirical, or experimental,
consists in observing, first, a great number of particular cases or phenome-
na, comparing  them with each  other, and  noting  their similitudes and
differences;  finally, to express what they  have in  common,  by general
or abstract  propositions, which  constitute axioms.   In this way, Hip-
pocrates, having  seen, time and again, patients who had  many parts of
their body affected, yet complained of one only, deduced from his  obser-
vations, the following aphorism :  "in  two  simultaneous pains, the more
intense obscures  the other ;" and so the  natural  philosophers, having
observed  that water rises in the body of  a pump,  in proportion  as the
piston is withdrawn, a little too hastily concluded  that nature abhors a
vacuum.
   The  first  method, it is seen, proceeds   from generals to particulars,
from the  abstract to the  concrete, from the  axiom to the phenomenon ;
the second, on the contrary, advances from particulars to generals, from
the concrete to the abstract, from the phenomenon  to the axiom.   Both
methods have their  advantages, their  inconveniences, and their  proper
uses.  Far from being  opposed to each  other, as has been  pretended,
these two methods fortify and enlighten each other, and the  truth never
takes hold of us in a more irresistible manner, than when it is attained
by both routes at once.   Certain ideologues have erroneously called the
first method, the synthetic, and second, the analytic: the words synthesis
and analysis, employed in this acceptation, make nonsense,  as has been
well remarked by a modern  metaphysician, and as I shall  demonstrate
hereafter myself.0
» See end of the volume—the doctrine of Barthez on the Vital Principle.
« 
SCHOOLS OF THE ASCLEPIADAE.
153
                       ART. II.  ARISTOTLE.
  Aristotle was born at Stagyrus, a city in Macedonia.   Having lost
his  father at an early age,  he was, though a mere youth, abandoned to
himself, and  expended his patrimony in dissipation.  At first he fol-
lowed the carreer of arms,  but soon becoming disgusted with this pro-
fession, he left it to resume the  favorite studies of his early youth —
philosophy and medicine.
  The teachings of Plato  at that  time shed a splendid influence over
Greece.   Young  men flocked to Athens, from all  parts,  to  hear him.
Aristotle went also, and showed himself one of his most assiduous and
constant auditors.  His ardor in study was incredible ;  he consecrated
to it entire days, and a great part of the  nights.   It is  said that he
was obliged,  for a living, to take a  place in the  shop  an herbalist, and
doubtless he gave  medical advice,  also, according  to  the  habit  of the
pharmacopolists of those times.   Thus, the philosopher of Stagyrus, the
future chief of  the Peripatecian  sect, belongs to the history of Medicine
in  several respects, namely, by his  birth, and early  education:  for he
was the son of  a physician, and received from his  father the first ele-
ments of science;  secondly, by the profession  he  practiced during
many years  of  his life ; thirdly, by researches in comparative  anatomy
and physiology ;  finally, by his  philosophic doctrine, which maintained
its  empire for so long a  time, over every branch of human knowledge.
  When Philip, king of Macedonia, whose finesse and political discern-
ment  became proverbial, wishing to  give a preceptor to his son Alexander,
then  fourteen years of age, fixed his choice on Aristotle, and wrote to
him on that occasion that well known letter, which not less honors the
monarch than  the  philosopher,  we all know how well the young prince
responded to the hopes of the father, and the lessons <of the  master.   I
shall  say nothing here of the  invincible  hero who overran and con-
quered Asia ; but I must not be entirely silent in  regard to him, as an
impassioned  amateur of science  and letters, who, in  the  midst  of the
embarrassments of  the vastest government of the world, and unceasing
wars, maintained with his  preceptor a scientific correspondence, and not
only furnished him the necessary funds to form the first known museum
in natural history, but also occupied himself in the collection of animals,
plants, and every sort of rare objects, which he transmitted to him from
the depths of Asia.
  Thanks to the munificence of  his royal pupil, Aristotle was in a con-
dition to gather an  immense collection of the products of nature — a
fruitful mine whence his genius drew an incredible mass of observations,
that antiquity never surpassed,  in many particulars, and  which has
        10 
154
PHILOSOPHIC PERIOD.
been  the astonishment of all  ages.  Certain critics, not being  able to
explain how a single man was able to treat  so great  a number of sub-
jects, and shed so much light on the greater part, have suspected Aris-
totle of having wickedly destroyed the  writings  of his predecessors, so
as to appropriate their discoveries to himself, just as they accused Hip-
pocrates of having set fire to the temple  of Cos, with the design of
destroying the archives whence  he  had drawn  the  materials  of  his
works — pure calumnies, which fall before the  slightest examination,
and of which  all  history has made itself the eternal echo.   Every one
should read, in the introduction to the Hippocratic works of M. Littre,
the natural explanation that this learned philologer gives  of the loss
of a multitude of ancient  .vcrks,  without  resorting to hazardous con-
jectures against the best established reputations.  But the  founder of
the Peripatecian sect, so far from leaving unmentioned the names of the
authors who had  written before him on the same subjects, quotes them
on nearly every page — he often gives their opinions, and many of them
are indebted entirely  to his quotations for the  advantage of having
escaped entire oblivion.
  The earliest philosophers who meditated on the origin  of  our  know-
ledge,  or the  manner  in  which we acquire it, and the degree of cer-
tainty which it offers, were greatly shocked  at  the frequent and gross
errors into which we are drawn by the senses, while they were agreeably
surprised, and marvelled  at  the character  of infallibility that certain
abstract truths presented, and  particularly  those that belong to mathe-
matics.  To give  only one example of this  contrast, but one which is
everywhere known, do  not  the  most remote astronomical observations
demonstrate that  the sun and the moon have, in reality, dimensions enor-
mously greater than their objective appearance would lead us to suppose ?
From this example, and an  infinity of similar ones, philosophers drew
this general  indication, that the senses transmit false, doubtful,  or
illusory impressions, and that the  soul, to attain  the possession of truth
and certainty,  must isolate itself as much  as possible from  the inter-
vention of the body, and reflect within itself.  Hence arose the contem-
plative philosophy that Pythagoras recommended  in secret  to his dis-
ciples, and which Plato taught publically, with all the prestige of his
imagination and eloquence.
  Nevertheless, men who devoted  themselves to  the  study of physical
phenomena, physicians, above all  others, could not question the neces-
sity of the intervention of the senses, to obtain a  faithful image of these
phenomena.  Daily experience  demonstrated to them how vain are  the
anticipated conceptions of the mind touching the operations of nature.
Each day new deceptions came to lead them to mistrust the principles 
SCHOOLS OF  THE ASCLEPIADAE.
155
established a priori; for these  principles conducted them to conse-
quences that the facts frequently  contradicted.  Thus, we  have found
in the Hippocratic collection,  authors  who proclaim  the necessity of
banishing from medicine all hypothesis, and holding to immediate observ-
ation only; authors who say  that there  is no fixed  principle  of treat-
ment; that the  cure  of diseases  is  effected sometimes by  contraries,
sometimes by similars, and sometimes in  other ways, without our being
able to say in virtue of what principles.0   These are, evidently, empiri-
cal maxims, but mere isolated ones, simple perceptions,  which consti-
tute neither a system nor a method.
   It  was reserved for the greatest naturalist of antiquity to lay the
first philosophic  basis of  empiricism; Aristotle, in emitting  his famous
axiom, " all ideas come from the senses,"  (nihil est in intellectu quod non
prius fuerit in sensu,) introduced  into science a new principle, in mani-
fest contradiction to  the  revered dogmas  of Pythagoras and  Plato.   It
is, then,  very important  to know how the  chief of the  Peripatecians
would justify, from the beginning,  the bold principles which became, two-
thousand years later, the germ of a scientific revolution.!
   We read, in the treatise on Analysis, " It appears that all animals have
received, from nature, the faculty of sensation and judgment; but after a
sensation has been produced,  some preserve the remembrance of it,  and
others do not.   Those who retain no reminiscence of the impressions, have
no idea of the things,  beyond immediate sensations.  Those, on the con-
trary, whose soul retains some trace of  passed  sensations,  can, at the
end of a  great number of such, reason from the recollection which they
keep of them.  In this way, the memory comes from the faculty of feel-
ing.   The remembrance of a thing  often repeated creates experience, and
experience, that is to  say, every general  notion which  becomes fixed in
the soul,  relative to the common properties of certain  things,  abstrac-
tion made from their differences—this notion,  I say, is the  principle of
science and art."|
  In another work, the philosopher of Stagyrus  recalls the distinction
that he has just  established between animals which have  memory,  and
  °Traite des Lieux dans l'Homme.   Traite' de l'Ancienne Me'decine.
  f This principle was not entirely new, since Plato makes allusion to it in the
passages  we have cited, when he  asks himself if it is not  the brain that
produces all our sensations, "which  produce, in their turn, the imagination and
memory, whose operations at last develop science."  But Plato scarcely deigned
to pause and consider the opinion, while Aristotle adopted and developed it.
  JAristotelis Opera Omnia quae extant Graace et Latine. Authore  Guillemo
Duval.  Lutitise Parisiorum, anno M. DC.XIX.  Analyticorum posteriorum, lib.
u, cap. xix. 
156
PHILOSOPHIC  PERIOD.
those which have not; he adds, that the  first  are  susceptible of educa-
tion, while the others  possess instinct only.   Finally, he says that man
alone is capable of instruction  and reason ;  after which he continues in
these terms:   "To  deduce, from a great number of experiments, a uni-
versal idea on an entire class of similar objects,  this constitutes art.
Thus, to possess the knowledge that a remedy has been useful in a certain
disease, in the hands of Callias, Socrates, and several others, is experi-
ence ; but to know that such a remedy is  good  for all  individuals of the
same species, attacked by a  given affection,  for example, for all  men
who are tormented with phlegm, bile, or a hot fever, this is what con-
stitutes art."0
   Might not we believe, in reading these fragments,  that they are ex-
tracted from some chapter of the modern school  of sensualists ?   How
then does it  come that Condillac, one of the coryphae of this school,
could write the following lines :   " Long ago  it was  said that all our
knowledge originated  in the senses.   Nevertheless, the  Peripatecians
were so far from knowing this truth,  that notwithstanding the minds of
several had appreciated, they were unable  to  develop it; so that for
several ages afterward it was still a discovery to be made.  I am igno-
rant of the motive of Aristotle, when he advanced his doctrine on the
origin of human knowledge; but I do know that he has left no work in
which this doctrine is  developed, and that,  besides, he sought  to be in
everything the opposite of the opinions of Plato, "f
   The best excuse that can be given for the epigrammatic insinuation  of
this last phrase of Condillac  is,  that he had never read, or had com-
pletely forgotten the passages of Aristotle  that  I  have quoted  above.
There are yet  other discoveries, claimed by moderns, the germs of which
are found in the writings of this  prince  of ancient philosophers.   The
philosophic doubt, for  example,  which forms one of the  pillars  of the
method of Descartes, is clearly indicated by  Aristotle, when he  says,
" Men who desire to learn,  must  previously  know  how  to doubt • for
science is only the resolution of previous  doubts ; but he who  does not
know the knot is unable  to untie it." J   The doubt  that Aristotle has
recommended is very different, as is plain, from that which the Pyrrhor-
nian  or Zetetique sect professed.   The latter regarded doubting as the
highest degree  of  science; the Peripatecian, on the contrary, saw  only
in it, the first  step toward the  light—a simple disposition of the soul
to elevate itself to the  intelligence and demonstration of the truth.
  °Opera Omnia, Metaphys., lib. i. cap. i.
  f CEuvres completes de  Condillac—analytical extract from the Traite des Sensa-
tions.  Paris, 1798.
  I Metaphys., liv. in., chap. i. 
SCHOOLS OF THE  ASCLEPIADAE.
157
  Having thus established clearly the claims of Aristotle, as the founder
of the sensualist or experimental doctrine, it remains to show in what
particular he afterward separated himself from  the doctrine, and esta-
blished a method diametrically opposite to that  of modern sensualists.
To show this I will recall the second  axiom emitted  by this philosopher.
on the development  of ideas.  " The first  ideas," he  says, " that  the
sensations create in  our  minds, are  general ones."  Here, we observe.
the ancient school of the  sensualists is entirely separated from  the
modern, and here, also, commences their antagonism.  It is, then, essen-
tial to examine upon what considerations Aristotle rests,  in advancing
such a maxim.  He involves in the support of this proposition, the case
of a man, who, perceiving at a great  distance an opaque mass  of vague
or undetermined forms, conceives, at first, the general idea of some kind
of a body.   Then, as he approaches this mass, and sees it  moving auto-
matically, he conceives the idea of an animal;  then, finally, when he is
near enough, he will not only recognize of what  species  this animal is,
but, also, if he  gives attention to certain marks, and particular quali-
ties, he will be able to distinguish it  from every other individual of the
same species ;  in this way he obtains his individual ideas.   It  is thus.
according to this philosopher, that the human mind advances from the
most general notions, to those that are particular and individual.   He
also cites the example of a little child, who calls all men papa, and all
women mamma ; but as he grows, his ideas become special,  and he learns
to discern his father and mother from all  other persons.0
  The argument of Aristotle  is  captious, and may deceive more than
one reader.   It will not, then, be out of place, I think, to recall here
the manner in which Locke,  one of the chiefs of the modern  school of
sensualists, explains the succession of our ideas, and the progress of our
knowledge.  " The ideas," says  this writer, " which children form of
persons with whom they are  familiar, are similar to the persons  them-
selves, and are only special ones.  The ideas they have  of their nurses
and mothers, are very well defined in  their minds, and, as so many faith-
ful pictures, represent to them only those individuals.   The names that
they give them, at first, are limited to them ; thus the  names of nurse
or mamma, which children  employ, are connected entirely to these per-
sons.   But after they acquire a greater knowledge of things, and observe
that  there are several other  beings, who, in respect to figure, and other
particulars,  resemble their fathers, mothers, and other persons that they
are accustomed to see, they  form an idea  which includes, also, these
  0 Aristotle, On Analysis, 2e partie, chap, h and xix.  Natural  Principles, liv.
i, chap, i; and in several other books. 
158
PHILOSOPHIC PERIOD.
 particular beings, and they call them with all others, men.  In this way
 he obtains a general  name, and a general idea.   In doing so, however,
 they form nothing new,  but separating  themselves from the complex
 idea they had of Peter, of James, Mary,  and Elizabeth, and which was
 particular to each of them, they retain what is common to them  all." °
   The last two quotations, one taken from the writings of Aristotle, the
 other from those of Locke, offer us the  curious spectacle of two meta-
 physicians,  who, starting with  the same principle, that  all ideas are
 derived from the senses, separated immediately, to follow opposite routes:
 the one pretending that the first ideas formed in our minds, by the inter-
 vention of the senses, are  general  ones;  the other  affirming that they
 are always individual in their  character.   But it is easy to see, that
 Aristotle, in the sample that he  gives, confounds  obscure, vague, and
 undetermined ideas with general  ideas, which is a  grave  mistake, and
 scarcely conceivable on the part of  such  a logician  as he.   Thus, when
 I say, that the whole is greater than any one of its  parts, I  express a
 general idea  very clearly; instead of that, if I perceive an object very
 distant, not being able to distinguish its form, I have only an individual
 idea, and that vague and confused.  This divergence, so slight in appear-
 ance, and nearly  imperceptible at first sight, nevertheless, misled in a
 very unfortunate manner, the philosopher of Stagyrus, and plunged him
 into an inextricable labirynth of sterile subtilties.   Let us follow him
 for a few moments, in this mistaken route, and see where he ends, rela-
 tive to the physical and medical sciences.
   From the moment our philosopher believed he had proved incontestibly,
 that general ideas are the first  that are formed in the human under-
 standing, he  deduced  from it the conclusion, that the study of all the
 sciences must commence  in  generalities, or axioms, which  he named on
 that account, principles or elements, and  then must pass to particular
 or individual notions—to the phenomena.  So,  after having assigned to our
ideas an  origin, entirely different from Plato, he proceeds to advise the
 same didactic method, the same mode of acquisition that he does.   Apply-
ing this erroneous method to the study of physics, Aristotle commences
by asking how many principles there ars in nature.   He exhibits all the
opinions  emitted before him on this thorny subject, and  after having
discussed them, one by one, he ends with the following conclusion, which
I translate literally:  " Every body knows that the principles or  elements
exist in  antagonism, and it is perfectly reasonable;  for principles can
not produce each other, nor be produced by any thing; every thing, on
  3 Lockete Essay on the Human Understanding, book in, chap, in, § 7.  See
also Condillac, Essai sur l'Origine de nos Connaissance, sec. 5. 
SCHOOLS OF  THE  ASCLEPIAD.E.
159
 the contrary, proceeds from them.   Thus, we have exhibited what forms
 the essence of first  oppositions—on  the one hand,  they proceed from
 nothing, being original;  on the  other, they do not mutually produce
 each other, because  they are antagonistic.0
   Immediately after, he proves, by an argumentation of the same force
 that natural principles are in number, two or three, namely, the opposi-
 tion of heat and cold, of dryness and moisture, and finally, the base, or
 the subject on which these two primitive oppositions must exercise their
 energy, to which he gives, in another place, the name of ether.
   Aristotle admits,  moreover, four elements, fire, air, earth, and water,
 which he believes susceptible of mutual transmutation,  and whose laws
 he describes.   Above them,  in  the most  elevated zone of the heavens,
 floats a fifth element, so called, because it moves  rapidly, and eternally
 in a circle.  This was the first and most divine of all the elements,  the
 only one which  is  imponderable,  and immutable; the  only one which
 was original in its  character, being  the offspring  of none,  and yet  the
 basis of all."f
   We have seen that  Plato endeavored to explain all the phenomena of
 nature,  by the consideration of final  causes only;  but Aristotle, who
 piqued himself on being more exact, assigned to each phenomenon, four
 causes, namely, the  material, formal,  efficient, and final.   Thus, the clay
 which the potter uses to fabricate  a vase,  is the material cause of that
 vase; the  model, or mould after which he  forms it, the formal cause;
 the potter himself the efficient cause;  and lastly, the purpose for which
 it is destined, the final cause. J
   If some of my readers find these details on the Peripatecian philoso-
 phy a little too  technical—if they do not comprehend  what utility  the
 remembrance of  these subtile and  superannuated distinctions  can have
 for medical men of  our times, I pray them to consider that the greater
 part of the writings of the ancient and middle ages are more or less
 imbued with them;  so that it would be impossible to read those writ-
 ings,  and particularly the history of  medicine, without  having at least
 a superficial notion  of the doctrine of  Aristotle;  for the medical theory
 of Galen, which has reigned in the schools  down to our own  era, is a
 patent deduction from it.   With this  short digression, I  pass to consider
 matters which have a connection, more or less direct, with medicine.
   Faithful to his  method  of  commencing  by principles,  Aristotle

  °CEuvres d'Aristotle, Des Principes Naturel, liv. i, chap. vi.
  f Aristotle, Traite du ciel, liv. i, chap. 11, in, liv. iv, chap, v; also in Traite de
la Generation, et de la Corruption, liv. n, chap. iv.; also on Traite  des Me'teores,
liv. i, chap. in.
  I Aristotle.  Des Principes Naturel, liv. 11, chap, m., et suiv. 
160
PHILOSOPHIC  PERIOD.
approaches physiology in the most obscure manner.   He inquires, in the
first place: What is the nature of the soul—what are its faculties and
functions ?  To his view, the soul constitutes the essence of all  living
bodies, vegetable and animal.  It is simple, indivisible, and resides in
whole in  each  part of the organized being, as one may assure himself,
he says, by dividing a plant, and even certain animals, called  insects:
for after the division, the separate parts continue to have  the same life
as the whole structure, which  proves that each of  them contains the
soul integrally.0
   The soul is endowed with four primitive faculties, viz:  the nutritive,
or vegetative, the sensitive, motive, and intellectual.   The first  three
reside equally in all parts of the body, and they are inseparable.   The
last one—that is to  say, the intellectual or contemplative—being of a
different species, must have, says our  physiologist, a distinct and par-
ticular seat.  Aristotle does not say positively where its  locality is, but
we may infer, from various passages  in his writings, that he regarded
the heart as the special residence of the intelligent soul.f
   The vegetative faculty presides over nutrition  and reproduction.  It
is indispensable to all things that are born, live, and die, and is common
to plants and  animals.   The  sensitive  faculty,  on the contrary, exists
only in the latter, of whom it  constitutes  the  essence.  Vegetables are
deprived  of  it, because they  are formed of only homogeneous  parts;
that is to say, they originate from one element alone, whilst animals are
formed  of organic  parts,  i.  e.,  are  composed  of  various elements.
Among animals, there are some which  have the faculty of locomotion;
others are deprived of this; and lastly, according to him, a very small
number  of the animal species appear to be endowed with  intelligence
and reason. |
   This physiologist had no distinct notion of the locomotive apparatus;
moreover, he confounded the tendons and ligaments with the nerves, as
we shall show presently, and he designated  the  muscles by the term
flesh.§
   He places the  principle of the motive faculty in the centre of the
body, for the reason that, in  every object that moves,  it is  necessary
that there be  a fixed and immovable point which  shall serve to sustain
all the other parts, and give them impulse. ||
   See how the  desire to give a reason for every thing may lead minds of
the keenest perception to  offer words  void of sense, for veracious and

   0 Traite de Fame, livre i, ch. ix.       J Aristotle.  On the Soul.
   f Sprengle.  History of Medicine.      || Du movement des Animaux.
                §De la Locomotion.  Histoire des Animaux. 
SCHOOLS OF  THE  ASCLEPIAELE.
161
grave explanation!   We have already seen examples  of  this, and we
shall see many more in the course of this history.   In place of observ-
ing  carefully the natural phenomena, and describing them  with the
greatest  possible exactness, man  always seems  to  prefer to  carry his
judgment beyond sensations;  and  this is the source of the greatest
errors in the domain  of physics.   Aristotle regards heat and  humidity
as  the two conditions indispensable to  life; the  duration  of which,
according to him, is generally proportionate to the volume of the fluids.
It is on this account, he adds, that large animals live longer than small
ones.  That rule, however, is subject to many exceptions, of which the
author himself cites  examples;  but he is not embarrassed to explain
them.0
   He had no idea of the true functions of the brain, though he describes
that viscus much more minutely than any of his predecessors.   The fol-
lowing are his remarks:  " That which is first found in opening the head,
is the brain, and it is placed in the  anterior part.   All animals possess-
ing a brain, that is to say, all those which  have  blood, as well as  those
of  the order of molusca, have it generally placed in the same  position;
but the brain of man is much more  considerable than that of other ani-
mals, proportionably to the size of his body, and is also the most humid.
The brain is enveloped in two membranes; that nearest to the cranium
is the strongest—the other, which rests immediately upon it, is weaker.
The brain is always  composed of two lobes,  independently of the cere-
bellum, which lies beneath, and whose form  and  structure differ from
that of  the brain.  There is usually a little cavity in the  middle of the
mass of the brain;  its  substance  is  naturally cold to the touch, and
neither veins nor blood are ever found in its interior; but the membrane
which envelopes it is full of veins, f
   There  is nothing  in all this which refers to the elevated functions of
the encephalic organ.  Aristotle did not even suspect  them; for he
places, as we have just seen, the  seat  of the  soul and of sensation  in
the heart.
   Nor did he know better the  functions of the nervous system, what-
ever Sprengle, the historian, may say, who attributes to him very gratui-
tously, in my opinion, the discovery of that apparatus.!
   Let every one judge by the following extract: " Let us speak now of the
nerves," says the Greek  naturalist; " they proceed also from  the heart,
   0 De la longueur et de la brievete de la vie, chap. v.  De la jeunesse et de la
vieillesse, de la vie et de la mort, chap.  iv.
   f Histoire des Animaux, trud. by Camus, Paris, 1783.
   j Sprengle, Histoire de la Medicine, translated into French byJourdan.  Paris.
1815, T. I, p. 384. 
162
PHILOSOPHIC PERIOD.
that viscus containing nerves in its structure—in its largest cavities;
and what is termed the aorta is a  nervous vein, whose extremities are
nothing else than nerves.   At the points where these extremities termi-
nate around the joints of bones, they are  not hollow, and  are  suscep-
tible of  the same tension as the  actual  nerves.   But  the difference
between the nerves and the veins  is,  that the nerves do not proceed
without interruption, from one unique  substance to all parts of the body,
like the veins.   The nerves, on the contrary, are distributed on all sides,
and to the articulations of the bones.  If they proceeded  from the same
trunk, their continuity would be apparent in emaciated animals."
   " The principal nerves are those of the ham,  on  which  depend the
power of leaping; then another double  nerve, called the  tendon; then
the extensor and the  nerve of the shoulder, which contribute  to the
strength of the body.   No particular name is given to the nerves which
belong to the articulations,  because all  articulations of  the bones are
bound together by the nerves.   In general, the nerves  are found in
great abundance around the bones,  except the bones of the head, which
are united by sutures." °
   It is evident that in this  entire description, Aristotle describes, under
the name  of nerves,  only  tendons and  ligaments.  But Sprengle  formed
his opinion on  the following paragraph:  "In the space between the
eyes we find three canals  which  go to the brain; the largest, the  middle
one, proceeds to the cerebellum; and the smallest,  the one which is near-
est the nose, leads to the brain, "f
   He infers from this phrase, that very probably Aristotle had observed
the optic and  olfactory nerves in fish, where they follow this direction.
Whether or not this naturalist has  observed a few nerves, it is  never*
theless certain  that he did not at all infer their functions.
   Aristotle is  rich  enough in  his own merits, without  needing to be
adorned with the plumes of others.   No man in antiquity studied  and
searched out more things  than he, and no one introduced  into science so
many new  facts.  To  keep to  our  subject, we assert  that, though he
never dissected human corpses, he nevertheless  corrects many  errors
on  the anatomy and physiology of man, in the Hippocratic collection.
For example, he refutes the opinion of Polybius, who supposed that the
veins commence at the occiput, from which  they descend in pairs the
length of  the anterior, lateral,  and posterior surfaces of  the body; he
asserts that they originate at the head.   He combated also the opinion
  a Aristotle, History of Animals, livre in, chap. v.
  f Sprengle, History of Medicine, t. I, p. 38.   Aristotle, History of Animals,
livre i, chap. xvi. 
SCHOOLS OF  THE  ASCLEPIAD^l.
163
 that a part of the fluids  drank went directly to the lungs, for the  pur-
 pose of cooling them.0
   As he had  dissected a considerable number of animals of every spe-
 cies, he compares, with a sagacity astonishing  for  his era, the  organic
 apparatus by means of which each of them lives, propagates, and fulfills
 the various functions to which it is destined.   In speaking of the heart,
 for instance, he signalized the varieties of form and structure that this
 organ  presents amongst quadrupeds, birds, reptiles, fishes, etc.   He does
 the same in regard to  the digestive tube, the lungs, and the other organs
 successively.   He does  not  group together, according to the method of
 naturalists, all the characters that appertain to the same species of ani-
 mal, so as to distinguish each of them from all the others;  yet his method
 is not less philosophic nor less fruitful  in interesting ideas;  he presents
 the history of each  apparatus of each organic function successively, and
 shows the varieties and shades in the whole range of the animal scale.
 In a word, he created comparative  anatomy and physiology;  and the
 plan that he traced is so appropriate to the subject, that, twenty centu-
 ries later, George Cuvier  did not choose another.
   If the founder of the  Peripatecian  sect can be  reproached for hav-
 ing propagated a taste for scholastic subtilties, it must be acknowledged
 also, that he has furnished an example of patient and attentive observa-
 tion of nature.   His history of animals is a treasure of  curious details
 on the manners and habits of that class of beings, their modes of fecun-
 dation and incubation, and their diseases.   His disciples,  excited by his
 example and his counsels, cultivated with a praiseworthy zeal, anatomy,
 physiology and natural history.   Theophrastus, his successor, was the
 most eminent botanist of antiquity.   Their reputation in that  class  of
 studies, was  so well established, that  an ancient  satirist makes  Mer-
 cury  say, in  showing  a  Peripatecian,   whom  he  wishes  to  sell,
 " behold a man who can tell you,  in a moment, the duration of  the life
 of a fly; to what  depth the rays of the  sun penetrate the  sea ; and what
 is the nature of the soul of an oyster ; he will recount to you, a quantity
 of other things, more  difficult still, on the semen,  generation, and the
 manner in which the fetus is formed in the womb of the mother, "f
   Plato  and  Aristotle were  among the  ancients, the  most eminent
propagators of two antagonistic opinions, that have divided philosophers,
from the  origin  of science.   One  of  these opinions  supposes  all  our
knowledge to be derived from mental intuition, without the intervention
  0 History of Animals.
  f Luciani Opera,—towards the end of the dialogue entitled, Vitarum Anctio; p.
108, edition of Bourdelat.  Paris, 1605. 
164
PHILOSOPHIC PERIOD.
of the senses; the other claims that all our ideas are due to sensations.
We shall see these two scientific methods, so to speak, parallelly increase,
and become more perfect, without either obtaining  any decided preemi-
nence  over its rival.   Both  count  amongst  moderns, partisans  of the
highest intelligence.  It will suffice to name Descartes,  Leibnitz, and
Kant, for the spiritual school, and Bacon, Locke, Hume, and Condillac,
for the sensualist school.  We shall, in the course of this history, make
it our duty to study, and compare, seriously, the opinions and methods
professed by both of these  schools, being well convinced that it would
be neither just nor reasonable, to agree, exclusively, with the dogmas of
either, before  diligently examining the teachings of both;  and  if my
confreres in medicine accuse me of separating myself from my subject,
by according too much space to the examination of  medical philosophic
methods, I reply in this aphorism of the most learned interpreter of the
doctrine of Cuvier: " the first question in all science, is always a question
of method."
                  RESUME OF THE PRIMITIVE PERIOD.

  During the  short period through which we have just passed, we have
seen medical science, stripped of its mystic veil,  take, suddenly, a rapid
bound.   The principal foundations of its edifice have been laid, and we
see appear an  outline of each of its parts, which is to form, at a later
period, a vast structure—an outline  whose  totality offers already an
imposing, although somewhat vague, aspect.  " Antique science," as M.
Littre most eloquently says, " has a great resemblance to modern science.
From the epoch which we are forced to regard as the aurora of medicine
—from the first memorials that we possess of it, the fundamental ques-
tions are debated, and the limits of the human mind are touched.  But
within these  limits,  science  finds an  immensity of  inexaustible combi-
nations, the materials for its growth."0
   This remark is as true  of philosophy, as of medicine.   Plato  and
Aristotle indicate to us two sources whence flow all our natural knowl-
edge ;  but do  not both of them lead us into error, by proclaiming in an
exclusive manner, as a mode of acquisition, the one mental intuition.
the other exterior observation ?
   Hippocrates forms the transition period between the preceding periods
and this;  he  belongs equally to mythology and history;  for, if some
circumstances of his  life, and  some  of his  works  are authentic,  the
greater part are doubtful,  or controverted.   His doctrine  was received
by his cotemporaries, and by posterity, with a veneration which  resem-
:> OEuvres d'Hippocrate.  Paris, 1839.  Iutroduction, p. 567. 
SCHOOLS OF THE ASCLEPIADiE.
165
bles  a worship, no less, probably, on  account of the real merit of his
doctrines, than by reason of the mystery which shrouds his birth.  After
him, no physician has ever obtained an homage so elevated, so constant,
and  so universal.  Very soon, anarchy prevailed in the midst of the
school which he had rendered celebrated;  a crowd of methods and theo-
ries  were surreptitiously propagated  there,  under  the  shadow of his
name and authority; so much so, that as a result, it became impossible
to discern, in the midst of so many writings and facts, placed to his
account, what was really legitimate of all that was imputed to him.
  Medical science, in changing its  locality, proceeds also to  change  its
aspect.  After a few years of confusion, we shall see medical men divided
into three great sects,  which will struggle  with  each other during
several ages, with balanced success, and end by uniting with, or becom-
ing embosomed in the most powerful. 
166
ANATOMICAL PERIOD.
              IV.  ANATOMICAL  PERIOD.

COMPRISING THE PERIOD OF TIME WHICH EXTENDS FROM THE FOUNDATION OF
 THE ALEXANDRIAN LIBRARY, SOME THREE HUNDRED AND TWENTY YEARS BE-
 FORE CHRIST, TO THE DEATH OF GALEN, IN THE YEAR TWO HUNDRED, OF THE
 CHRISTIAN ERA.
                 GENERAL  CONSIDERATIONS.

   It was truly a royal idea, and worthy of the successors of Alexander,
that of collecting together all the intellectual  riches of the universe,
and placing them at the disposal of studious men, who were desirous to
use them for their improvement,  and the advancement of science.
   In order to conceive all the grandeur and munificence of such a crea-
tion, it is necessary  to recall under what circumstance it  was undertaken,
It should  be remembered, that manuscripts were then  extremely rare,
and consequently of an exorbitant price;  that of the greater number of
works there were but  very few copies, and often one only, so that  those
who  possessed, would not part  with them easily,  and scarcely  allow
copies even to be made.   All the literary treasure of a family consisted
often of one work only, and fewer families yet were in possession of such
a heritage.   Before  the foundation of the  libraries of  Alexandria and
Pergamos, there is no mention made of any considerable collections  of
books, except those of  Pericles and Aristotle.  In such a state of things,
the inferior  classes  of society were deprived of  all written instruction,
and a poor man was able to acquire, except under  very extraordinary
circumstances, only  a  very limited degree of knowledge.
   Under such circumstances, the establishment of a library,  accessible
to the public, was an act of philanthropy and liberality, above all eulogy.
It was, at the same  time, one of  those happy creations that immortalize
a reign—an epoch,  and that concur to consolidate a dynasty;  for  the
good that they produce, and the  gratitude they inspire, extend to  the
latest posterity.  It  does not belong to me to refer to the political advan-
tages of which  such an institution  is the source; besides, others  have 
GENERAL CONSIDERATIONS.
167
acquitted themselves of this task so well, as to leave nothing to desire
on that subject.0
  But, to indicate, in brief, the influence that the foundation of public
libraries must have exercised upon ancient civilization, it would be suffi-
cient for me to say that it has been compared, very justly, to that which
the art of printing has exerted on modern civilization.
  Two of the lieutenants  of  Alexander appear to have conceived  the
same project about the same  time, so that  it is  now very difficult to
decide, to which of the two belongs the priority.   One was Eumenes,
governor of Pergamos and  Mysia; the other, Ptolomy Lagos,  who had
command of Egypt. At the death of the conqueror of Asia, the generals
that he placed at the head of the provinces of his vast empire, shook off
all  dependence on the  central government, and endeavored to consoli-
date their authority in every possible way.   The greater number  turned
their attention  entirely to arms, either to maintain their  own govern-
ment, or to invade those of their colleagues.   The sovereigns of Alexan-
dria and  Pergamos were the only ones, amongst so many captains, who
occupied themselves with the interests of commerce and arts, and it was
about that time, that they laid  the foundation of the first two public
libraries.   They took hold of  the enterprise so actively, that they, and
their immediate  successors, within about a century, had gathered two
hundred thousand volumes for  the library at Pergamos, and six to seven
hundred thousand for that at Alexandria.  This  last was  divided into
two  parts, which were called  the great and little library.   The first
contained nearly four hundred  thousand volumes, and was located in
the quarter named Bruchion, near the Museum and the palaces,  and in
the neighborhood of the port, where the grain ware houses were situated ;
the second was in the temple of Serapis, or Serapium, situated in a dis-
tant quarter, nearer the center of the city.
  It is not possible, from the above enumeration, to form an exact idea
of the accumulated riches in these  two great book depots; for writers
differ very much, when on the  subject of estimating the volumes, or rolls
of the ancients, compared with modern books.   Some presume  that the
six  hundred  thousand  Alexandrian  volumes  represent two  hundred
thousand  of ours; others one hundred and  twenty thousand;  others
ninety thousand.  However it  may  be,  literary collections  of such
magnitude were a wonderful and happy result under the circumstances.
The kings of  Egypt, and those  of Pontus, felt perfectly, what eclat such
  0 Notably M. Matter, author of the History of the School at Alexandria, from
whom we have borrowed the major part of the details we here  furnish on that
school. 
168
ANATOMICAL PERIOD.
institutions would throw upon their capitals and their names.   At first,
their efforts to collect works, excited a praiseworthy rivalry, but this
subsequently degenerated into a contemptible jealousy, in some of their
successors,  which led  the  sovereigns of  Alexandria  to interdict the
exportation of papyrus, so  as to  prevent  their  emulators of Pergamos
from being able to make copies of manuscripts.  This  illiberal prohibi-
tion had a contrary effect than was expected, for it  led to the invention
of the paper of Pergamos, otherwise called parchment, the use of which
became  general, and displaced, advantageously, the bark of the papyrus.
  Nevertheless, the institute of Alexandria always preserved a great
superiority over that of Pergamos; it had  especially a marked influence
on medical studies, and merits, on that account, a particular notice on
our part.
                         CHAPTER  I.

                  THE SCHOOL OF ALEXANDRIA.

   The chief of the  dynasty of the Lagides, Ptolomy Soter, was not
contented with collecting, at a great expense, an enormous quantity of
books; he felt also the necessity of having order and  choice  in his col-
lection.   To effect this, he called around him men, the most renowned
for their erudition, and gave them residences near the  library, and cre-
ated a revenue  for their maintenance.  Some were charged with the
classification, collation and annotation of the manuscripts; and the
copies that  underwent this labor of revisal were then entered in the
catalogue.   Other savans, equally at the expense of the State, occupied
themselves with the investigations and studies of their taste, being con-
fined  to no particular task; only, they were  required to meet together
on certain days, to deliver lectures and discuss various subjects.   The
king himself sometimes took a part in these re-unions, by proposing dif-
ferent questions for solution, and taking part in the discussions.
   These re-unions became still more frequent and formal under Ptolomy
Philadelphus, son and successor of Soter.   They were called ludi musa-
rum et, Apollinis, literary contests or feasts, and the palace where they
were held was named the Museum.  Often the subject for discussion was
announced beforehand.  Those who succeeded best, received public eulo-
gies and rewards proportionate to the merit of their compositions.   All
the savans,  artists^ and professors, that lived  in  Alexandria, were  not
lodged in the Museum, nor pensioners of the king; that honor, and the
privileges which were attached to it, were accorded to a very small num-
ber.  Amongst those who enjoyed it, under the reign of  the first  two 
SCHOOL OF  ALEXANDRIA.
169
Lagides, only two physicians are named, viz: Herophilus and Erisistra-  >.
tus.   The latter, it is said, was the grandson of Aristotle, and pupil of
Theophrastus.   He did not reside in the capital of Egypt till the close
of his life; for it appears that, in his old age, he retired to Smyrna,
where he founded a school.
   It was under Philadelphus that the Hebrew savans were charged with
the translation into Greek, of the Holy Scriptures; and it is well known
that the translation they made, called the  Septuagint, has always been
highly esteemed.   An Egyptian priest always presided over the museum,
so that  the Alexandrian Institute included the debris of the antique sci-
ence of  Egypt, the doctrines of the Jews,  and the more  recent compo-
sitions  of the  philosophers and  literati of Greece.  Besides, the sover-
eigns of Egypt sent more than one expedition into the interior of Africa,
along the coasts of the Bed Sea,  and as far as the East Indies, to make
discoveries and establish relations in the interests of commerce and  the
sciences.   Thus the  torch of civilization, which  had anciently shone
upon the  banks  of  the  Nile with  a mysterious  and  isolated light,
returned, after being  increased and vivified at the free  fires of the genius
of Greece, to  shed an eclat more resplendent than  ever on  its early
cradle; and  thus the city of the Ptolomies became not only the entre-
pot  of  Greek  and Boman commerce, but also a scientific focus, whose
light was  shed for ten centuries upon the antique  universe.
   Amongst the sciences which received the most encouragement in  the
Institute of the Lagides, we must place in the first rank that of Medi-
cine.   By a concourse of happy circumstances which we shall presently
enumerate, the school of Alexandria eclipsed, from its origin, the ancient
schools  of Cridas, Cos, and Pergamos; and while  it existed, it was not
equaled by any other.  In the time of Galen, it sufficed to have studied
in that city, or even to have  resided there for a time, to obtain the repu-
tation of  a physician.  Nearly all  the men who  became distinguished
in the different branches of the healing art,  for a considerable length of
time, had received instruction in that school, or had been there, to per-
fect  their knowledge  in their profession.
   The  success  in the cultivation of Medicine in  the Greco-Egyptian
Institute, was  due, as we  have said, to several causes, at the  head of
which we must place the authorization accorded by the founders of that
establishment, for the dissection of  human corpses.  Doubtless  that
authorization, nearly unique in antiquity, gave to the anatomical, physio-
logical  and surgical sciences an extraordinary impulse.   But the princes
of the family of the  Lagidae did not content themselves with delivering
over to  the scalpel of the  anatomists the corpses of criminals; they par-
ticipated themselves sometimes, it is said, in the  labors  of  dissection.;
        11 
170
ANATOMICAL PERIOD.
so anxious were they to penetrate the secrets of nature  and life.  Per-
haps, also, they did  so  to  destroy, by the  force of their example, the
odium to which the physicians exposed themselves  by their anatomical
researches.0
   The Ptolomies did not favor less  the progress of natural history and
the materia medica, by the collection of rare  animals and plants that
were made for the museum, near their palace.   They spared, if we may
believe the tradition respecting it,  neither expense  nor care to render
these collections as complete  as possible;  they were proud to exhibit
them to the savans and travelers of distinction whom the renown of their
intellectual riches attracted to their capital; a policy both  eminent and
liberal, and which, even after the destruction of the kingdoms of Egypt,
maintained the city of Alexandria  in the rank of the first  cities of the
empire.
   Nevertheless, the practice of dissections did not long continue in favor,
even  in the city where  it had its origin; scarcely did it continue to
exist to the end of the second century.   Consequently, science  very soon
took a bad direction at Alexandria; natural researches were replaced by
subtile discussions on subjects idle  or inaccessible to the  human under-
standing.    But of  all  the  scourges which hindered  the progress of
medical science in Egypt, that of the Boman domination was  the most
fatal.  That royal people, who delighted to see blood flow, not only on
the  battle-field, but also  in  their diversions and daily  exhibitions,
regarded as a profanation the contact of  a corpse;  so that  not a  single
anatomist of any reputation had his origin  in  Borne.   If,  on  any occa-
sion a foreign  physician, attached to the  persons  of the  Emperors or
Generals,  desired to avail himself of the occasions that were afforded, to
examine the structures of the internal parts of the human body, he was
obliged to conceal  and carry off, during the night, some body abandoned
to the birds of  prey.
   To complete  our  misfortune, the labors  of the physicians who illus-
trated the first epoch of  the school  of Alexandria, are all lost; we only
know of them now by tradition, and by fragments that writers of a later
period have preserved.    The  burning of the great library, by Julius
Caesar, was the beginning of a chain of disasters with which the Roman
domination cursed the  Alexandrian  Institute.  However,  Queen Cleo-
patra, whose enlightened zeal for the sciences has rendered  her quite as
celebrated as her beauty, her frailties, her crimes, and her death—Cleo-
patra, I say, repaired as much as possible  this loss, by obtaining from
  ° Pliny, Natural History, T. XIX., p. 5.  Lanth. Hist, de PAnatomie, Stras-
bourg, 1845. 
ANATOMY AND PHYSIOLOGY.
171
her spouse,  Mark Antony, the transportation of the library of Perga-
mos to Alexandria.  But a more grievous and irreparable blow was given
to this establishment, by the  atrocious and  imbecile  Cavacalla, who,
after having assassinated the greater part of the inhabitants of the city,
took from the pensioners of the Museum the privilege of living together,
and the other advantages which they enjoyed, and suppressed the public
exhibitions  and discussions.0
   We can  now only trace the progress of science through that period,
by collecting  and comparing the debris which have  been preserved by
Galen, Aretseus,  Ccelius, Aurelianus,  Celsus, Dioscorides, Pliny,  and
some others.   It is  by the  aid  of these  scattered documents that we
proceed to  reconstruct the scientific edifice of Medicine, as it existed at
the end of the second century of the Christian era.  In attempting this,
we shall  follow the same order  that we have already adopted, namely,
commence by showing the material progress of each branch of the art,
and reserve for  the  end the discussion of the  themes and systems of
the  time.
                        CHAPTEB  II.

                   ANATOMY AND PHYSIOLOGY.

  We  have seen, that after bringing together all  the  fragments the
Hippocratic writers have transmitted to us, relative to the structure of
the human body, it would be impossible to compose from them a regular
or complete treatise on anatomy ; for, with the exception of the skeleton,
they possessed very limited and imperfect notions  of any organic appa-
ratus.   They confounded, under a common name, the nerves,  ligaments,
and tendons; they did not distinguish, or very imperfectly, the arteries
and veins, and  the muscles, in their eyes, were inert  masses, designed
solely to cover  the bones, and -serve as  an  envelope  or  an  ornament.
They possessed, in short, only gross and false  ideas,  on the structure
and functions of the brain,  heart, liver, lungs,  digestive and generative
apparatus — for the  reason that they  had never been able, as well
remarks the author of the History of Anatomy, to devote themselves to
regular dissections ;  but this did not prevent them from adducing very
decisive opinions on the organs and their  functions, which no one could
either verify or deny.
  Let us now see what additions and what improvements the physicians
of the following period conferred upon  that state of the science.   Galen
3 Hist, de l'Anatomie, p. 117. 
172
ANATOMICAL PERIOD.
 is the sole author of that period, whose writings on anatomy and physi-
 ology have not entirely perished.   We have  several works of his on
 these subjects, which treat especially on these two branches, viz :  First,
 a monograph on the Skeleton, in which he recommends that the bones be
 not studied in books only, but  that they be seen and  handled ; and to
 do that, he advises the  student to  go to Alexandria,  where the pro-
 fessors, he says, will place before him the human skeleton.  This advice
 of Galen proves, that in his time there was  not in Borne a single skeleton,
 on which to demonstrate osteology. Secondly, a complete treatise on Ana-
 tomy, divided into fifteen books,  of which six are wanting, entitled, On Ana-
 tomical Administration.   Thirdly, an anatomo-physiological treatise on
 the Functions of the Regions of the human body—distributed in seventeen
 books, which we have entire.   And finally, a quantity of anatomical and
 physiological details, scattered  in various writings, which relate to other
 subjects.   It is, then, from the writings of Galen, chiefly, that we draw
 what we have  to say on the progress of anatomy and physiology, in the
 period extending from the foundation of the  Alexandrian library, to the
 end of the second century of the Christian era.

                           skeletonology.
  We have said that the osseous system was, of all the organic appara-
 tus,  the one best understood  by the Asclepiadae ; nevertheless, their
 successors  added many details  to the descriptions they had given of it.
 They studied  especially, with more care, the formation  of bones, their
 internal structure, and mode of union.   Galen says, that the bones are
 hard, cold, dry bodies, of an earthy nature, possessing  no sensibility,
 because they are destitute of nerves, but able to realize pain through
 the membrane covering them, which  is  named  the periostium.   They
 served to sustain the whole  mass of  the body,  and are formed directly
 from  the  semen ;  the greater number have a marrow, from which they
 obtain nourishment.  Their various modes of union, he reduced to two,
 namely, symphysis  and articulation.   By symphysis,  two bones  are
joined or  glued strongly together, so that  they  can not  move on each
 other.  By articulation, on the contrary, they are placed in juxtaposi-
 tion,  and move more or less freely on each other.   The ligaments main-
 tain  and  fix the articulations  ; they are white structures, flexible, and
 elastic,  harder and thicker  than membranes.  The cartilages,  which
 terminate certain bones, or even take their place in certain structures,
 such as the nose, ears, and wind-pipe, have almost the hardness of bones,
 with  the  flexibility and elasticity of ligaments.0  The  author of the

  5 Galen, De Ossibus, edition of Chartier, T. IV.  De Anatomicis Administra-
 tionibus, lib. i, T. IV. 
ANATOMY AND  PHYSIOLOGY.                 173
History of Anatomy says,  that Galen  was profoundly versed in the
knowledge of the bones;  that he described them nearly all, individually,
and that there are few of them, which  are  not  mentioned by name in
his works.
                             MYOLOGY.
   The muscles (chairs) were no longer considered as inert masses,
serving only to cover  the  bones,  and  protect other parts; they were
divided into distinct fasciculi, and named muscles.   The form, compo-
sition, and uses of each muscular faciculus, was studied separately, and
they were recognised  as constructed of minute fibres,  or filaments,
between which the veins, arteries,  and nerves ramified,  carrying nutri-
tion, life,  and sensation.  It was proved by convincing experiments, that
the muscles are indispensable  to the accomplishment of voluntary move-
ments.  Galen, being  desirous  to teach the mechanism of locomotion,
and to prove that the muscles take an active part in it,  was accustomed
to expose on  an animal, the extensor and flexor muscles of a member,
and then  demonstrate  how the alternate tension and relaxation of the
muscular  fasciculi set the bones in motion, after the manner of levers.
   He says that the muscles are so numerous, that they cannot be easily
counted, and unite in such a manner, that several seem to form but one,
and when they divide, there appears to be as many as there are tendons.
It is not wonderful, after this avowal, that  he omitted  several; never-
theless, he pointed out, and named a great  number.  He classed  them
according to their uses, and this method, which has been followed even
till our day, by many anatomists,  is the most advantageous with which
to arrive  at  the knowledge of the movements  executed  by the parts,
though it  may not be the most commodious to guide us in an anatomical
examination.0
                             ANGIOLOGY.

   The Hippocratic authors confounded the arteries with the veins.
   Praxagoras was the first who distinguished these two orders of vessels,
but he supposed that  the arteries contained air, and  not  blood.  He
therefore gave them the name they still  bear, which signifies, according
to their etymology, aerian  canal.  Aristotle and Erisistratus, having
adopted this view, it prevailed until the time of  Galen, for this author
devoted an entire book to refute it, sustaining himself upon the observa-
tion, that at all times, when an artery is wounded, the blood gushes out.

  " Galen, De Constitutione  artis medic, cap. in., Chartier, T. II, De Anatomicis ad-
ministration ibus, lib. i., u.,  in., iv., v.  De usu partium corporis humani, lib. in.,
cap. v. 
174
ANATOMICAL PERIOD.
He added to this experimental  proof, many theoretical  reasons, which,
doubtless, he supposed appropriate  to fortify it, but which now appear
very obscure and useless.0
   He placed the origin of the veins in the liver, which  he regarded as
the organ of sanguification, by which he  shows himself less advanced
than Aristotle, who considered  the heart as the common source of the
arteries and veins.  He  compares the arterial  and venous  system to a
tree fixed by its roots in the soil, from which the trunk  arises, and is
developed by ramifications.   The divisions of the vena portoe form  the
roots of the venous tree, the vena cava its  trunk, whence proceeded the
boughs and twigs, distributed to every part.    So, also,  in  the arterial
system,  the pulmonary artery constitutes the roots, the aorta the trunk,
which is  ramified like branches  and twigs, to all parts of the body.
Among  the branches of the vena cava  superior, he  reckons the vena
azygos, the internal, mammary, etc.,  etc., and among  those of the vena
cava inferior,  he describes the renal,  spermatic, uterine,  and other veins
of the inferior  extremities.   In the table of  the  arterial  system, he
erroneously distinguishes a superior and inferior aorta.   The history of
the ramifications of the  superior aorta is a little confused, but  the
description of aorta inferior is more exact.  Our author makes mention
of umbilical veins and arteries.  He is also not ignorant that the veins
are more numerous than the arteries; for while the latter, he says, are
always accompanied by veins, the veins are  often found separately from
arteries, f
                             NEUROLOGY.
   Galen states that all the nerves are derived from the brain and spinal
marrow, which  was contrary to the views of Aristotle, who  supposed
them to originate at the heart; but  the physician of Pergamos proves
that he, as well as those who followed him, confounded the nerves with
the ligaments and tendons.  He points out also two sorts of nerves, one
of which, those of sensation, are soft, and proceed from the brain; the
nerves of motion, are harder, and  originate in the spinal marrow.   He
enumerates seven pairs of cerebral nerves, which comprises  all that are
admitted now, except the sympathetic, and the external motor of the
orbit; thirty  pairs of spinal nerves,  which he divides as follows: eight
cervical, twelve dorsal,  five lumbar, and five sacral.   " Thus," observes
M. Daremberg, " Galen describes distinct nerves of sensation and motion ;
but he did not know that each nerve, by its double origin on  the anterior

   a Galen.  An in Arteriis natura sanguis contineatur.  Chartien, Tome III.
   flbid., De Venarum et Arteriaram  discestione, T. VI.  De usupartium.  Th. Lanth
Hist, d PAnatomie, liv. v., part i., sect, i., chap, in., § 4. 
ANATOMY AND  PHYSIOLOGY.
175
and posterior  parts of the spinal marrow, contained  both sensory and
motor filaments."   The  ganglions of the  nervous  system, were well
known to him, and he claims their discovery. " Nature," he says, " has
done an  admirable thing, of which all anatomists, to the present time,
were ignorant.  When she conducts, for a long distance, a fine nerve,  or
one is destined to excite violent muscular movements, she locates a little
mass on its track, that resembles it in structure.  Seen externally, this
body appears to rest upon, and surround the nerve;  but when it is dis-
sected, its substance  is found  to  be in continuity with  the nerve com-
bining with its structure, and  resembling it in every particular.  It is
by means of this  substance, which resembles a ganglion,  that  nerves
augment in size.0
  Lastly, this eminent anatomist had some notions of the great sympa-
thetic, though he may not have formed a complete idea of that nerve.
  To prove that the faculties of motion and sensation were transmitted
from the encephalor to other parts of the body, by the nervous apparatus,
he advised that the principal nerve of any member be  divided; at once,
he remarks, the parts situated  below  the section, loose their faculties of
sensation and motion, while those above retain both.f

                            ADENOLOGY.

  " Galen," says the author of  the History of Anatomy, before quoted.
"gives no anatomical description of the  glands, though he  may have
been acquainted with the fluids  secreted  by several of these  organs.
After enlarging on the secretion of the prostrate gland, he passes to the
mucus and saliva contained in the mouth,  to  the  bile secreted by the
liver, and to the humors furnished to the  intestines by various glands.
Sustaining the opinion of Marinus, on the functions of glands,  he says
that the salivary glands transmit the saliva into the mouth by particular
veins.   He terms  the mammae also, glandular bodies.  Is  it  not, then,
strange, that with the knowledge this great man possessed of the fluids
furnished by the various glands, the idea was never suggested  to him,
to attribute to those  bodies, the special function of preparing a useful
fluid, instead of regarding them as  receptacles of an excremsntitial
humor of the emunctory vessels ?   That  happy idea never occurred to
him; the  preparation of a fluid  was always, in his eyes, a very secondary
affair in  the functions of glands; the supposition of  veins which carried
  0 Galen, De usu partium.  Lanth. Hist, d l'Anat., liv. v., part i., sect, i., chap, in.,
§5.
  f De Constitutione artis., cap. in. 
176
ANATOMICAL PERIOD.
the saliva into the mouth, was only imaginary, for his idea of them has
no agreement at all with the salivary duct, now called the duct of Steno.'

                           SPLANCHNOLOGY.
  Galen divided the interior of the body  into three cavities; namely,
the abdominal, thoracic, and cranial, of which last, the vertebral canal
is an extension.   He distinguishes in each of these, the viscera from their
envelopes ; of the latter, which  are common to all, he reckons the skin,
composed of two  lamina, the dermis and epidermis ; the fat; the muscles
with their aponuroses, vessels and nerves ; the bones ;  and some mem-
branes.  The  viscera being  different  in each cavity, require to be enu-
merated separately.
                          I. ABDOMINAL CAVITY.
  It includes  the apparatus of  the  natural faculties, which he divides
into the organs of nutrition  and reproduction.   The nutritive  organs
are of three  kinds.   The first  receive the food, dispose of, and  distri-
bute it to all parts ; they are the mouth, esophagus, stomach, intestines,
and veins of the liver.  The second, which appear destined to eliminate
excrementitial particles, are the  liver, which attracts the bile, the  spleen,
the kidneys, and their appendages.   Lastly, the third class, which serves
for the expulsion of fecal matter, and which, in order to be controlled
by the will, is furnished with  muscles.   Galen describes in detail  the
form, situation,  and structure of each  of these organs.   (See especially
the Anatomical Administrations and the treatise on the Functions of the
Organs; see also the Hist, de l'Anatomie, already cited.)
   The  reproductive apparatus is composed in man  of testicles, placed
out  of the body, in the scrotum, sanguineous  vessels, and nerves;  the
epididymus, a small body placed on the upper part of the testicles ;  the
spermatic canal, or vas deferens; the vesiculae seminalae ; the prostrate
gland ; and the  penis, which is  a nervous and hollow body, springing
from the ossa pubis, but containing no humor.  In women, whose nature
is colder than that of man,  the  sexual parts are  placed  in the interior
of the body.   The testicles, which are smaller, are situated on the sides
of the uterus, and within the abdomen.   The spermatic ducts (uterine
tubes) unite  the testicles  to  the uterus, which  is placed between the
bladder and the rectum.   Galen speaks of two uterine  cavities, one on
the right, destined for the male fetus, the other on the left, for the  female.
From  this statement we may question  whether he ever examined the
uterus of a woman.  The presumption is, that he had studied this organ
in animals only, for he says, that the number of the departments in the
Q Lanthion, Hist, de PAnat. 
ANATOMY AND  PHYSIOLOGY.
177
uterus is equal to the number of mammae.  The bottom of the uterus
is turned toward the stomach;  its  neck looks  downward, and is con-
tinuous with  the vagina,  which is a membranous canal,  terminating
externally at  the vulva.   In coition the  semen of the male, which is
hotter than that of the female, mingles with the latter, which serves as
an excipient and  nutritive material; from this results fecundation.  The
semen changes at first into membranes, then a portion of these are trans-
formed into cartilages and bones ; another portion is folded and hollowed,
and extends  itself in the form  of pipes, which constitute the arteries
and veins; another  is drawn out like fine threads, whence proceed the
fibers and nerves, and so on, for the rest of the tissues.0

                         n. THE THORACIC CAVITY.
   It is  separated from the abdomen by the  diaphragm,  a  species of
round muscle, large, flat, and  thin, having its tendons in the middle.
It  includes, among  other  things, the heart and lungs,  organs  of the
vital faculty.  The heart, situated in the middle of the breast, a little
to  the left side, lies upon the lungs, as on a downy bed.   It has the
appearance of a  muscle, but differs from one in many respects.  In the
first place, its substance is much harder, and more resisting than mus-
cular flesh; in the second place, it is formed of straight, transverse, and
oblique fibers;  in a word, the fibers run  in all directions, which  is not
the case in ordinary muscles.  Lastly, the heart possesses its own pro-
per movements, which do  not  depend upon nervous agency, as may be
seen by opening  the chest  of a living animal;  for when the heart is
separated from all other parts, it continues its movements for some time
with much force.   This  organ  is the source of natural heat, and the
vital spirits ; the seat of anger,  and violent passions.  His opinions on
the movement of the blood, will be alluded to  hereafter.
   The lungs, a  spongy viscus, which nearly  fills the  whole cavity, is
 divided in its length into two unequal cavities ; the right half, which is
 the largest is separated into three lobes ; the left one  into two.   These
lobes all comunicate, by means  of cartilagino-membranous tubes, with
 a common tube, which is called  the traohea-arteria.   This proceeds
 upwards, along  the median line, in front of the esophagus, to the back
 of the mouth, where it terminates by an  orifice called  the  larynx.   He
 divides the acts of respiration into two  periods ; in the first, which he
 names inspiration, the thoracic cavity is enlarged, and  the external air
 is drawn through the trachea into the lungs.   During the second period,
 which is that of expiration,  the  impure  and grosser part  of the  air
0 Galen, De usu partium.  De semine, et alibi. 
178
ANATOMICAL PERIOD.
contained in the chest are expelled  outwards, with the fuliginosities of
the heart, while the more subtle part passes into the venous artery, to
be carried to the left cavities  of the heart, where it aids in the support
of the natural heat, the formation of vital  spirits, and the completion of
the arterial blood.0
                        III. CEREBRO- SPINAL CAVITY.

   This  differs from the two preceding;  first, in that it is shut in on all
sides by bones;  secondly, in place of being lined interiorly by a single
membrane, like the thorax and abdomen, there  are two—one thick, hard
and fibrous, the other thin and smooth, precisely like  the peritoreum, or
pleura.   This cavity encloses the organs of the noblest of the faculties.
the animal faculty, of which the essence is nothing less than the reason-
ing and immortal  soul.
   In the upper and anterior part of the cavity is found the brain, an
oval, but not very consistent  mass, of a gray color on the surface, but
white otherwise, and divided into two halves or hemispheres, by a very
deep longitudinal  furrow.   Beneath it, and behind, is the cerebellum or
smaller brain, whose substance appears to be firmer, though its volume
scarcely equals the fourth of the brain.    These two fill the  cranial
cavity,  but they are distinct and separated in nearly their whole extent
by membranes; they have a common bond of union, which is called the
meso-cephelon, which is situated at the base of the cranium.   At this
point the spinal marrow commences, which descends the whole length of
the spinal canal.  Its substance is analogous to that of the cerebrum and
cerebellum, and is a prolongation of the latter.   Galen describes  sepa-
rately each of the three portions of these viscera.  He  describes their
exterior form and  connections with neighboring parts: then, penetrating
into their interior by methodic sections, he studies their intimate struc-
 ture, the disposition of  their smallest parts, the origin and distribution
 of their vessels, etc.   He follows each nerve into the structure  of  the
 brain,  until it is  lost in the mass.
   When the brain of  a living animal is uncovered, by removing  a por-
 tion of  the vault  of the cranium, that viscus is seen  rising and falling,
 alternately.  This phenomenon did not escape Galen,  who compared it to
 the  pulmonary respiration, and attributes it to the  same cause.  He
 thinks  that the  brain  expands like  the  lungs, to draw in the air, and
 then contracts to expel it.   According  to him, the atmospheric fluid
 penetrates  the cavity of the  cranium, through the cribi-form  plate of
 the  ethmoid bone, and passes out by the same route, carrying with it
0 Galen, De Usu Partium.  De Anatomcis Administrationibus. 
SCHOOL OF  ALEXANDRIA.
179
the excrementitial humors of the brain, which run into the nasal fossa?.
Nevertheless, says this physiologist, the air introduced into the cephalic
cavity, by inspiration, is not entirely rejected by expiration.   A portion
insinuates itself into the anterior ventricles of the brain, and unites with
the vital spirits, which are carried there by the arterioles of the choroid
plexcus.   From this combination originate the animal spirits, the imme-
diate agents of the rational soul, and the most subtle of all the spirits.
These acquire their last attenuation in the fourth ventricle,  where they
are instilled, if  one may say it, drop by drop, through a round, narrow,
vermiform tube  (the acqueduct of Sylvius).  Then the animal spirits are
transfused into the substance, even, of the brain, little brain, and spinal
marrow, where they are kept in reserve, to be distributed by the agency
of the nerves to all parts of the body;  and they give to each region,
according to the direction  and wants  of the  animal faculty, sensation,
motion, and energy.0
   The above  sketch  of the anatomy and physiology of Galen, though
very brief, represents to us the state  of these  two branches of medical
science, at the end of  the second century of the Christian era,  and gives
us an idea of the progress that was made during the Anatomical Period.
This progress was immense ; and when we consider that the greater part
of it  was effected in  the  first  two centuries  of the foundation of the
Alexandrian school, and that it was due chiefly to the labors  of Hero-
philus and Erisistratus, we are astonished at the rapid development, as
well as the  happy direction, that these two great men gave to anatomico-
physiological studies.   Not only did they devote themselve to numerous
dissections  of the human  body, but they often resorted  to vivisections
of animals also.   The chronicle says that  one  of them, Herophilus, did
not hesitate to employ his scalpel on living criminals that were subjected
to his experiment, for the interests of science;  but it is  proper to  say
that this is not alluded to by any  cotemporary  author—it  was only
recorded as  a popular  tradition, three or four centuries later ;|  so that
it is  considered doubtful  by many historians, who remarked, besides,
very correctly, that the same report has been falsely circulated at differ-
ent epochs,  against other celebrated anatomists.   However this may be,
the manners, too often unpitying, of the ancients—the contempt which
they generally expressed for the sufferings of criminals and slaves, per-
mit us to  believe that, occasionally, men may have been found so  lost
to the sentiments of humanity, as to deliver to the knife of the anatomist
the unfortunate  condemned, in the hope of discovering, in  the  depths of
0 Galen, De Anatomicis Administrationibus.  De Usu Partium.
f Celse, Traite' de la Me'decine, Pre'face.—Tertullien, De l'Ame, chap. x. 
180
ANATOMICAL PERIOD.
the palpitating entrails, the secret of life and the means of prolonging
it;  nor is it more improbable that some fanatic in science may have lent
himself to this odious research;  for, alas!  all fanaticism is pitiless.
  Nevertheless,  as  before  remarked, the  zeal for dissections  rapidly
cooled off, as Galen barely mentions five  or six men who devoted them-
selves  to  it, from the first anatomists of  Alexandria down to his own
time—i. e., through the space of nearly four hundred years.   He cites
a Bufus of Ephesus, who lived probably  under Trajan; a Marinus, who
wrote in the beginning of the second century of the  Christian era;  a
Quintus, who did not compose any work on  anatomy, but who instructed
several pupils, among whom are counted Pelops and Satyrus, who were
the preceptors of Galen.   None  of these anatomists have left a  reputa-
tion approaching that of  Herophilus and Erisistratus.   Galen alone can
sustain a comparison with these  last, by the great number of his experi-
ments and anatomico-physiological discoveries.  In vain he strove, by
his  example and exhortation, to  awaken in his cotemporaries  a desire
for  the study of anatomy, which, within  proper limits, is the surest
guide in practical medicine; but he could  not overcome their indiffer-
ence.   After him, the practice of dissection appears to have been  lost,
either from  the  redoubled  prejudice  of the superstitious, who opposed
dissections, or as the result of the ignorant apathy  of  the physicians.
                        CHAPTER  III.

                             HYGIENE.

  Hygiene, during  this  period, did not progress as rapidly as anatomy
and  physiology;  nevertheless, it was  not  entirely stationary.   Celsus
has recapitulated, in his first book, the most accredited hygiene precepts
of his  time.   He commences by addressing some general counsels  to
men in robust health.  Then he explains, more  at length, the regimen
which  is  suitable to delicate persons;  amongst whom he  classes the
greater  part  of  the inhabitants  of cities, and,  in  particular,  men  of
sedentary lives.  Lastly,  he traces the  rules applicable to different ages,
seasons, sea voyages, in certain idiosyncrasies, and other circumstances,
His prescriptions relate principally to the choice of food and drinks, the
use of  baths, the alternation of repose and labor, the repast, gymnastic
exercises, artificial dejections excited with a view to health, either up-
wards or downwards.   If he adds but little to the materials transmitted
by the writer of the Hippocratic  collection, he has at least the merit of
presenting them with more order  and precision. 
SCHOOL OF  ALEXANDRIA.
181
   The  writings  of Galen,  on hygiene, are numerous; they  form the
whole of the sixth volume  of the  edition of Chartier, in  folio.  The
most considerable are, a treatise  on  the Preservation of Health, divided
into six books, and a treatise on the Qualities of Food, in three books.
He divides life into four periods—infancy, adolescence, manhood, and old
age.  He- insists on the  precepts relative  to the first and last of these
periods, much more than any of  his predecessors had done; he enters,
especially, into new and interesting  details concerning infancy.   He has
also better  appreciated  than any other writer, the  influence of habit,
and was the first to feel  the  necessity of making the regulation of the
passions a part of hygiene.  This was the limit of the effective progress
of this  branch  of the  art,  from  the foundation of the Alexandrian
library down to his epoch.
   The pure observation of the good or evil which we realize after the use of
certain articles, was  the first source of hygienic researches,  as is also
shown by the following passage of an author  whom I have frequently cited:
" In going back," he  says, " to past ages, I think  that  the  regimen of
life and nutrition which are  employed in health, in our days, would not
have been discovered, if man, for his food  and drink, had  been able to
content himself with that  which suffices  for  a bullock or a horse, and
other creatures out of the pale  of  humanity; that is, on simple pro-
ductions of  the earth, such as fruits, herbs, and hay.   Animals are nour-
ished by these, and grow, and live, without any inconvenience, and without
the necessity of any other alimentation.  Doubtless, in the earliest times,
man had no other food than the above, and that which he now employs,
it appears to me, is an  invention elaborated in a long course  of years.
But food  so  strong and crude,  would cause  much  violent suffering.
as is realized now, among  those who  sustain themselves on  crude,
coarse, indigestible, and  exciting food; intense pain and  diseases are
developed,  and  a  speedy death.   Men suffered less, doubtless, in the
beginning than now, on  account  of  its habitual use; nevertheless, the
evil was great even for them, and the greater part, especially those of  a
feeble constitution, perished, while the more  vigorous could longer resist
its  injurious  tendencies.  Such  was, it seems  to me, the  cause  that
engaged men to seek a preparation of food in harmony with our nature,
and they gradually discovered that which we now employ.   Thus learn-
ing  how to  macerate, thresh, sift, grind, and  knead the  grains,  they
fabricated wheat bread  and  barley  dough, which they have used  in  a
thousand different forms.  They  have boiled, roasted, made  compounds
of, and reduced  with weak  substances, those  articles which  were too
strong,  and  prepared everything to suit the nature of man."0

  0 OSuvres d'Hippocrate, De l'Ancienne Medicine.  § 3; translated by M. Littre'. 
182
ANATOMICAL PERIOD.
  This method, both simple and sure, but slow and timid, did not suit
the taste of certain philosophers; they imagined  one much more com-
plicated, and which appeared to them more transcendant  and direct.
The following quotation shows in what terms their method is  described
by one of those philosophic physicians:  "I maintain," he says, " that
to write well on the regimen of man, it is necessary, in the first place,
to be well  instructed as to his nature, to know what  man  is, in his
origin, and what are the parts of which he is composed.   If one is igno-
rant of his earliest composition, and what predominates in his constitu-
tion, how can he prescribe what may be useful to him ?"°
  Such a course has something very seducing in it, at first sight.   It
attracts by an appearance of exactness and profundity ; but, if we judge
it by its results, we  shall be  convinced, very soon, that  it is only cal-
culated to obscure and  perplex by philosophic  speculations, entirely
ideal, the most enlightened and experienced minds.   The author from
whom I have taken the last extract, furnishes  himself a proof  of this.
He devotes very vainly, as we have heretofore remarked,  under head of
Philosophic Period, all the first part of his work  to  demonstrate  that
man and animals are a compound of two principles, water and fire, and
he  endeavors, then,  to rest on this philosophic base, his maxims of
hygiene.
  Galen has followed the sa^me course;  that is, he endeavors to rest  on
his physiological  theories,  the laws  relating to  the preservation of
health ;  but this  plan only leads  to  digressions, as fastidious for the
reader as sterile for science.   On this foundation, he wrote a  book, to
teach what is the best constitution of the human body, and what are the
signs by which we may know it, and how it resists the perturbating influ-
ences ;  also, another, to explain what is to be infered from the complex-
ion, and  in what  a good  complexion differs from an athletic one ; a
third, in which  he agitates, at great length, this question, which  may
be  reduced to a few lines—is hygiene within the jurisdiction  of  medi-
cine or gymnastics ?   Thus, four-fifths of his  writings  on hygiene, at
least, may be dropped or shortened, without any real loss to the art.
   Galen gives to  health a definition conformed to  his theoretic ideas;
but so unintelligible is  it, that he is obliged  to accompany it with
an explanatory commentary  of many  pages.  Here  is  his definition:
 " Health consists  in  a just proportion of heat, cold, dryness, and mois-
ture, for similar parts ; and in the good conformation, the exact number,
 and proper  extent of all organic  parts." f  In  short, he pretends  to
 make all the precepts  of hygiene proceed from an unique principle.
0 03uvres d'Hippocrate, Du Regimen, liv. i. § 2  Gardeil.
f De Sanitate Tuenda, lib. i, § 1. 
GENERAL PATHOLOGY.
183
" We know," he says, " that we must give similars in a state of health,
in the same way as we give contraries in a state of disease."  He attempts
to justify this hygienic axiom, by the authority of Hippocrates, by logic
and examples ; but his arguments are based on subtilties, only, and his
axiom is not equal to that simple rule, dictated by instinct, and confirmed
by experience : Fat only when you are hungry, and drink only when you
are dry.
  This  would be  the place to speak of exercises, baths, annointings, and
frictions, which the Greeks and  Romans so  frequently employed, and
which constitute  a part so important, and so curious, of  their hygiene ;
but this subject is too vast, and I fear being drawn into too long details,
even if  I should only attempt to touch it.  I prefer referring the reader
desirous to  acquire a satisfactory notion of it, to the learned  work of
Mercurialis, De Arte Gymnastica, and the Histoire  de la Chirurgie,  by
Peyrilhe, vol. II. book v., page 316.
                        CHAPTER  IV.

                       GENERAL PATHOLOGY.

  We have seen that in the Hippocratic works, the various branches of
medical science are not well distinguished, and  that  often,  the  same
treatise contains subjects very distinct from each other.  It is not so with
the most of the treatises which we possess of the  present period ; they
are marked, in general, by a much more rigid, didactic order.  After
Aristotle, and by the influence of  his expample, the authors were much
more methodic in their compositions.  Diseases were divided, as hereto-
fore, into  internal and  external, acute  and chronic, according to their
supposed seat; but  the authors conformed more to these classifications,
than the  former had done.  The treatment was divided into hygienic,
pharmaceutic, and surgical.   In  fine, it may be said, that  the love of
method was carried to an excessive degree.  There were authors, such as
Galen, who, from a desire to be very methodic, fell  into distinctions more
subtle than real, and lost  that  greatest of the advantages of method,
clearness.
  Many historians, among whom are Leclerc and Sprengel, supposed, that
at that epoch, the medical profession was divided into three orders, which
correspond to the three divisions of the science, shown above.   They
say, that  from that time,  there were dietetic  physicians, who confined
themselves to the regulation of the regimen of the sick ; pharmaceutists, 
184
ANATOMICAL PERIOD.
who prescribed  internal remedies;  and surgeons, who  made dressings
and performed all manual operations.  Goulin was the first to show that
these statements are erroneous.0  Afterwards, Shulze demonstrated, that
the division of Medicine into hygiene, pharmacy, and surgery, as intro-
duced by Celsus, must be  understood in a  scientific, and not in a pro-
fessional sense.f  Lastly, B. Peyrilhe, after  having quoted the opinions
of his two predecessors, corroborates them by new considerations.   " To
these opinions," he  says, " so much the more respectable, because  they
come from two physicians  profoundly versed in the history of their art,
we join a reflection which  could  have been  made  before, though it has
not been: that  if this division of Medicine existed in  the  profession,
as it did in the  Art — if it was  civil, as  it is certain that it  was
scholastic,  we  should be  able to discern,  very distinctly, among the
Romans, three classes  of physicians.   Now, where shall  we find them ?
All the efforts of some modern investigators,  have not been able to show
the existence of a single one of these classes alone.   Such, for example,
as surgeons, that is, men who limited themselves to surgical operations.}
                         CHAPTER  V.

                      INTERNAL PATHOLOGY.
                            § I. Semeiotics.
   The  Asclepiadae, as we  have already observed, considered  morbid
phenomena, not  as the  expression  of the  suffering of any particular
part, but of that of the entire economy — the  result of vital reaction,
excited by a morbid element.   Starting with this philosophic idea, they
studied each  symptom,  independently, without  reference to the sup-
posed state of the internal  organs of the body.  On this account, they
carried Semeiotics, or the  knowledge of  symptoms, to a very high
degree of perfection.   These priest-physicians were remarkable  for the
certainty  and boldness of their  prognosis,  as  we have proof in many
treatises of the Hippocratic collection. ||  We owe to one of them a capi-
tal discovery,  and which seemed destined to give a new impulse  to  this
branch  of  the science.
  ** Me'moires Litteraires, pour servir a l'Histoire de la Me'dicine, anne'e 1775, p-
28, et suiv.
  f Historia Medicime, a rerum principio, 177o, p. 28, et al.
  | Histoire de la Chirurgie, de Dujardin et Peyrilhe, Paris, 1780.
  ||  See, among others, the Traite' du Prognostic, and the second book on Prorrhe'-
tiques. 
                        INTERNAL PATHOLOGY.                   185

   Praxagoras was the first to observe, at the termination of the preced-
 ing period, the close connection between the variations of the pulse and
 the energy of vital reaction; from that time, it was  thought that the
 regulator, or the exact measure, of all the vicissitudes which the vital prin-
 ciple experiences in the  course  of  the life, was  found.   The slightest
 shades of variation in the arterial pulse were noted with the most scru-
 pulous attention, and an effort was was made to  attach to each variety
 a determinate signification.   Consequently, there was defined a pleuritic
 pulse, that is, a condition of the  pulse indicating pleurisy; a suppura-
 tive and phthisical pulse, and so on for each disease.   So, also, there
 was a  hepatic,  splenic,  nephretic pulse, indicating  the conditions of
 these  organs;  in a word, they pretended to be able  to distinguish, by
 appreciable variations  of the pulse,  all the  modifications, normal or
 abnormal, grave or slight, of the organic functions.  Galen has written
 on this subject a complete treatise, in four sections, each comprising four
 books, and several monographs.0  In the first section of the first book,
 he points out more than sixty species of the pulse.-j:.   He also presents
 and discusses  the three opinions, which prevailed in his  time, on the
 efficient cause of  arterial pulsations.  Some  attributed them  to  the
 blood, that each contraction of the heart caused to flow in the arteries;
 others, that they were the effect of the passage of the  spirits;  others,
 again, believed with Galen,  that  the pulsative  faculty  is transmitted
 from the heart to the arterial tubes,  by continuity of tissue. J
   The  Greek Sphygmology was carried to the Indies by  the disciples
 of Herophilus  and Erasistratus, under the  successors of  Alexander the
 Great: thence it was carried to  China, where it still reigns, but dis-
 figured and contemptible.   In  Europe, the Sphygmic theory of Galen
 was not subjected to any notable variation,  till the discovery of the  cir-
culation of the blood.  Next to the signs manifested by the  examination
of the pulse, those furnished by the inspection of the urine  occupied the
 highest place in the semeiotics of the ancients; but the chief writings
on uroscopy being posterior to the  epoch of Galen,  we shall  not further
allude to this subject now.
   To  resume:  if we compare the labors of the school of Cos on semei-
otics with those of the school of Alexandria, we shall remark between
them  a well-defined difference.  The Asclepiadse grouped together  the
most apparent symptoms of a disease, and the  circumstances attending
  ° See vol. VIII, of his complete works, edition of Chartier.
  flbid., Des differences des Pouls, liv. i.
  | See the book in which he examines if the arteries naturally contain blood;
chap, vm., edition of Chartier, vol. III.
           12 
186
ANATOMICAL PERIOD.
their course ; they founded upon these the rules of their  diagnosis and
prognosis.  The Erasistratians, or Herophilians, on the contrary, regarded
each symptom, or a single order of symptoms,  separately; they studied
these in every aspect—examining their most delicate shades, and search-
ing,  minutely, their  causes  and various significations.   The synthetic
method of the first  is imposing, but is superficial, and often defective.
The  analytic method of the  second affects exactness, and deep research;
but it is also often contracted  and  subtile, and is lost in infinite minute-
ness.
                           §11. NOSOORAPHY.
  The  Asclepiadae, as before  remarked,  have left us only a very small
number of  nosological descriptions worthy to be consulted.   In their
treatises on  pathology, they follow  no rigorous classification,  and  do
not  well  distinguish  the morbid  species from  each  other, and  make
no effort to present, in a lucid and natural order, the symptoms, pro-
gress and termination appropriate  to  each;  in  a word,  they have
neglected to establish the basis of  the specific and differential diagnosis
of diseases.  This neglect of  so important a branch  of pathology may
be explained as  follows: in  the first place, the defect of precise notions
on anatomy  and physiology incapacitated  them, often,  from connect-
ing  the  functional  derangements which they observed,  with determi-
nate organic lesions of any of the viscera;  in other words, it was often
impossible for them  to localize diseases; now that localizationSs one of
the most solid bases of all nosological classifications.  In the second place,
the  general idea that the  ancient  Hippocratists had of  diseases, pre-
vented them from attaching a major  importance  to the distinctions of
the morbid species.  In fact, they regarded the pathological  symptoms
as the expression of  a universal disorder, rather than as an index of
the particular lesion of an organ; they had not  made  researches, very
assiduously, to discover what  is the special viscus affected, when  such
or such a group  of symptoms  was  manifested.
  Therefore, it may  be said, that nosography was still  in its infancy at
the  commencement  of the  anatomical period; but it  was carried to a
very high degree of perfection during this period, as  is  seen  in what
remains on this  subject, in the writings  of  Aretaeus  and  Coelius Aure-
lianus.   These  two  authors  lived, according to the  most reasonable
opinion, in  the  second century of our era.  We know nothing of the
lives of either of them; all that can be said positively is, that the first
was  born in Cappadocia, in  Asia Minor, and that  the  second was a
native of  Sicca,  in Numidia.
   However this may be, we possess, of each of them, a treatise, almost
complete, on all  the  diseases observed in their time; and these treatises 
INTERNAL PATHOLOGY.
187
constitute, without question, one of the most precious and useful memo-
rials of antique medicine.  These two writers have arranged their sub-
jects  in nearly the same order.   They have  divided them  into eight
books, of which the first four are devoted to the description and treat-
ment of acute diseases, and the  following four include the description
and cure of chronic diseases.   But C. Aurelianus mingles, occasionally,
with  his subjects,  somewhat prolix,  though  interesting theoretic and
historic dissertations; while Aretseus goes straight forward to  the end.
without indulging in any digression.
   The work of the  latter is written  in Greek, in an elegant, concise.
and picturesque style, which has gained  him  the reputation of giving
the finest descriptions  of  diseases of  any writer  in antiquity.   The
work of Coelius, on  the contrary, is  written in bad Latin, mixed with
many barbarous words, very difficult to read, which is probably the
cause of its  not being rendered into our  language.   It is, however,
worthy of being translated, for,  in the opinion of all  critics, there are
few among the works of antiquity that equal it in practical utility.
   Galen has  also written, and even lengthily, on all diseases; but his
accounts are  scattered in various treatises, and  buried among diffuse
and subtile theoretic digressions; so that to form an opinion, after him.
on the progress, signs, and treatment of a single morbid affection, one
is compelled to turn over a quantity of books, and to confront  a multi-
tude of passages, oftentimes difficult to understand;  an operation always
long and inconvenient for the practitioner, and often impracticable.   In
short, this writer is neither an  easy  guide  to  follow, nor an excellent
model to propose, in what concerns nosography.
   The authors of this  period describe, with much detail, the  leprosy.
tetters, nervous headache, and a  multitude of other chronic affections,
which the  Hippocratic writers  have barely mentioned, either because
they supposed them incurable  infirmities, or  because, like Plato, they
regarded them as simple inconveniences, unworthy of the meditations of
men  of science.   Thus, then, for this extensive class of diseases, the
physicians of the school of Alexandria had considerably enlarged the
nosological scale.  In  this respect, there is no comparison to  be made
between their works and those of the  school at Cos.
   In regard to acute affections, with which  the Hippocratists were more
particularly occupied, the writers of the anatomical  period have  also
added much to improve their diagnosis, as  may be seen by comparing
any disease described by Aretseus, with a corresponding description in
the Hippocratic books.   In order to  facilitate  this comparison, I sub-
join a  description of pneumonia, which  the  reader may compare with 
188
ANATOMICAL  PERIOD.
that which  has been  previously quoted, and which  is  one of the very
best descriptions of disease, in the Hippocratic collection.

                             ON PNEUMONIA.<s
   " Two principal things sustain animal life,  food and respiration ; but
the latter more immediately, for when it is suppressed, life can not long
be sustained, and death occurs almost  instantly.   Several parts  sub-
serve this function;  the nostrils, where it begins, the trachea,  which is
its channel,  the lung, which is its proper seat, and the  chest, which  is
an inclosure and receptacle of the lung.   But while the other structures
named are only accessory instruments, the lung contains the  cause  of
respiration: for the heart, which is the  seat of life  and attraction, is
situated in the midst of this viscus, and  communicates to it  the heat
which it generates, exciting,  thus, a  desire  for cool  air, which  is the
cause of respiration.   On this account,  when the heart is  attacked,
death is close at hand; but if the lung  is the point  of attack, and  it
be moderate, the breathing of the patient  is difficult  and  painful, but
death does not occur till a much later period, if treatment be employed.
If, on the contrary, the attack is  severe, as, for example, in inflamma-
tion, then the  suffocation, aphonia, and difficult breathing put the life
in jeopardy.   It is this last disease, named pneumonia,  that I now pro-
pose to discuss.
   " This disease manifests itself by an  acute fever, with a sensation of
weight  in the  chest, without any pain, if the lung alone is inflamed;
for this organ, being  of a  spongy tissue  similar  to  wool, is naturally
insensible, as well as the cartilagenous arteries which are inserted into
it.   It has no muscles, and its nerves, being small and few, do not aid
its movements.   The pain  is manifested  when some of  the membranes
which envelop and and attach it to the thorax are inflamed.
   " The breath  becomes hot, the  respiration  difficult, and the patient
seeks to be upright, so that his breathing  may be easier.  The counte-
nance becomes red, especially the cheeks; the white of the eye pearly;
the nose flat, and the veins of the temples and neck  distended.   The
aversion for food is considerable.   The pulse, full  at  first, becomes soft
and small, then is accelerated, as when one walks  quickly.  The skin
is moderately warm and moist, but the patient realizes,  internally, a fierce
and burning heat, which causes the hot breath, dry tongue, thirst, the
  •Aretaeus, liv. n, chap. 1.  Note.—This  author prefaces,  admirably, the his-
tory of each disease with some anatomical, physiological considerations on the
part where it is seated, and these are generally quite interesting. 
INTERNAL PATHOLOGY.
189
insatiable desire to breathe fresh air, and continual anxiety.  The cough is
ordinarily dry, but when it  is  accompanied with expectoration, it is a
frothy phlegm, or nearly pure bile, or something sanguinolent, of a rusty
color.   This last kind has a graver signification than the former.
   " When the disease assumes a graver caste, the insomnia augments, the
patient sleeps but  little, though he  may appear to sleep.   His mind,
agitated by a multitude of incoherent thoughts, wanders, but  is easily
aroused to consciousness.  It is seldom that the alienation is complete.
He does not know his condition, and if he is interrogated on that sub-
ject, he replies that he feels very well.  The  extremities become  cold,
the nails livid, and hooked in shape; the pulse small, frequent, and
scarcely perceptible, and  death closes  the scene, generally about the
seventh day.
   " When a change takes place for the better, there  is most generally
bleeding at the nose, or a copious evacuation  from the bowels, of bilious
matter, mingled with froth, which appears to proceed from the breast,
also a flow of similar material in the urine.   If it happens that both of
these evacuations occur at the same time,  the patients  soon recover.
   " Sometimes a formation of pus takes place in the lungs: in such a
case,  it is  very fortunate if it passes off by the intestines  or  blad-
der;  or, if  it should make  a metastasis  to  the pleura, and  an  issue
be established in the side of the chest, so  that  it may pass off,  then the
pneumonia  is at an  end.   An ulcer is formed, it is true, which may con-
tinue for a  length of time; but it is  finally  cicatrized.   If  it happens
that  the abcess  bursts suddenly in the lung, this rapid effusion of a
great quantity of pus  suffocates  the  patient, who is too  feeble  to reject
it at once;  or if he is able to overcome this, an ulcer remains, which
causes long continued suffering,  and ends by throwing him into phthisis.
It is as rare for old  men to survive such an ulceration, as it is for young
men, and persons in the vigor of life,  to resist the violence of the  infla-
mation."
   The  above is  a  well drawn picture of a  disease,  in  which nothing
essential is  wanting, nor is  the  description too lengthy.  More details
might have been  given ; but none of  the principal features of peripneu-
monia, as the disease  was then  known, have  been omitted.  All  its
features are traced  in a natural order, and easy to be remembered ;  so
much so, that after having read and meditated  on this nosological tableau,
the whole picture may be recalled at  any future time, when in the
presence of a disease that offers such  characteristic traits, and a judg-
ment  be established of the  present  condition and  future  prospects of
the patient, and the therepeutical course that should be  adopted.   The
Hippocratic collection contains not a single description of a disease, that 
190
ANATOMICAL PERIOD.
can be put  in  comparison with this.   The work of Aretaeus contains,
besides, a series of nosological descriptions equally as good.  An opinion
may be formed  by the comparison, of the  progress that this branch of
the science made since the last of the Asclepiadae.
                       CHAPTER  VI.

                     INTERNAL THERAPEUTICS.

   No new therapeutical axiom was proclaimed during this period;  the
edifice of the profession was  still based on  the foundation laid by the
Hippocratists, which consisted, it is said, in  employing such curative
means as would be contrary in their  action in the economy, to the gene-
rative cause of the disease, or to the primitive and  essential lesion, to
which all the other symptoms  are connected.  Consequently, great efforts
were made to ascertain  exactly, for each nosological  species, its origin,
its determining cause, or the phenomena which essentially constitute it.
Then search was made among  known remedies, for those whose physio-
logical action was the most directly opposite to the essence of the disease.
Such was, in general, the  mode of reasoning, of  the  physicians of this
epoch.
   However,  a famous  sect called  the Empirics,  arrayed  themselves
against this method.   They  pretended that the immediate cause, or
essential lesion of  diseases being impenetrable, so is also, the primitive
action of curative  agents; and to establish medicine  on  such a founda-
tion, was nothing more than building on the sand, or rather on chimeras.
We shall recur, at a proper time, to the  arguments  adduced  on both
sides;  for a very lively and interesting discussion arose on this subject,
amongst the various  medical sects of the Alexandrian school, and great
light emanated from the midst of these discussions.   But, at present, I
wish only to take  a  practical  view of the science, and  in this respect,
therapeutics made great acquisition during this period.
   Medical natural history did not exist in the  times of the Asclepiadae;
for we  do not  find in their  writings, any methodic descriptions of sub-
stances  employed  in medicine, nor any  effort to  classify remedies.
Aristotle offers the first model of a collection of the  products of nature,
undertaken with a  scientific aim. His attention was directed particularly
towards zoology, and he made in that  branch of the science of natural
history,  discoveries  which would have been sufficient  to immortalize
his name. 
INTERNAL  PATHOLOGY.
191
   After  him, Theophrastus,  inheritor of  his  manuscripts  and his
museum, continued to direct the Peripatecian school, in natural studies.
He did for botany, what his master had done for zoology.   He  observed
the internal  and external  conformation  of vegetables, their  modes of
nutrition,  flowering and fructification; in a  word, created vegetable
physiology.  He described the physical qualities and medicinal virtues
of more than five hundred plants.
   The sovereigns of Egypt  made still  more extensive collections, which
they placed at the disposal of  the savans of Alexandria; consequently,
they studied the properties of a mass of new substances, with  which
they enriched the materia medica.  Towards the end of this period, the
luxury of  compound preparations and exotic remedies became  common
at Rome,  and throughout the empire, and  polypharmacy was pushed to
a ridiculous  extent.  Then were invented those famous antidotes known
by the name of mithridate, theriaque, in which were compounded from
forty to sixty different ingredients.   It was supposed that each of these
medicinal  substances preserved its proper virtues, in  the  midst of the
common amalgam, which possessed the properties  of all the drugs that
entered into its composition, and  thus formed a sort of panacea, good
for all diseases.
   The description of a great  number of morbid  conditions created the
necessity  of  a pathological  classification; so, in  like manner,  from the
multiplicity  of medical substances, originated the  want of a pharmaceu-
tical  classification.   Three authors,  towards the close of this  period,
Dioscorides, Pliny, and Galen, undertook to supply this vacancy. Their
works on  materia medica have been preserved; but that of  Dioscorides
is the most esteemed, for its order, clearness, and exactness; therefore I
shall say  a few words about it.
   The author states in  the preface, that he is the first who has made
mention of aromatic substances, as well  as remedies  drawn  from the
mineral kingdom.   He divides his  treatise into six books:  the first
treats of odorous  substances, such  as  oils,  ointments,  woods, juices,
fruits, gums, and resins;  the  second, of animals, of  honey, milk, fats,
and  the  herbs and  seeds of  the  gardens;  the  third, of roots, herbs,
juices, and grains, which serve for domestic uses;  the fourth,  perennial
herbs and roots; the fifth, of the vine, wines of all kinds, and minerals;
lastly, the sixth of vegetable and animal poisons. It is plain,  that such
 a classification of medical  substances is confused and arbitrary.
   The natural characters  of these same substances are no better deter-
mined ;  sometimes, indeed, they are pointed out with  so little exactness,
 and so few of them are mentioned, that it is impossible to recognize the
plant or the mineral in question.  Again, they are not indicated at all; 
192
ANATOMICAL PERIOD.
and, after naming a substance, he has contented himself with describing
its medical virtues.   The following is one  of the  best descriptions in
the whole collection:  "The nettle is of two species;  in one of which,
the leaves are more irregular, rougher, larger, and blacker, than in  the
other, and the seeds are like those of flax, but smaller.   The leaves of
the other species are not so rough, and the seeds are not as thick.   The
leaves  of both, rubbed  up with  salt, form  a good  salve with which to
dress the bite of dogs, gangrenous sores, chancres, open  ulcers that  are
difficult to consolidate;  also, denuded parts, small  tumors, or ruptured
abcess, and those which are named parotidotic.    Applied with wax, it
relieves the difficulties of the spleen.  Rubbed up with syrup and applied
to the nostrils, it restrains the flow of blood; bruised with myrrh and
applied as a pessary, it  provokes the menstrual flux.  In touching  the
womb with it, fresh, it relaxes, and assumes its natural position.   The
seeds, drank in boiled wine, excite wanton desires.  It opens the mouth
of the  uterus.   When used sparingly with honey, it is advantageous in
difficulties in the chest, pains in the side, and inflammation of the lungs.
It purges the chest.   It may be mingled with corrosive medicines.   The
leaves, stewed with  some other substances, increase the urine, and
relieve flatulency.   Drunk with  myrrh, they produce the menstrual flux.
The syrup, used as a  gargle, heals inflammation  of  the soft palate.0
   The materia  medica was,  therefore,  considerably enriched  by  the
labors  of the anatomical  school; on the other  hand, the diagnosis of
diseases was  greatly  improved.   The curative  indications had become
more precise, from which  we may conclude, a priori, that the therapeu-
tics of the physicians of  this period became more  rational and precise
than that of the Asclepiadae.   The treatment of acute diseases is  also
described with more  method  and exactness, than in the authors of the
Hippocratic collection.  This may be seen by comparing the treatment
of peripneumonia, traced  by the latter, with that laid down in the work
 of Aretaeus.
                         CUBE FOB PERIPNEUMONIA.
   " When the lung is inflamed and swollen, the affliction  is acute, and
promptly fatal;  for suffocation is close at hand.  Prompt  aid  must be
afforded, equal to  the severity of the  attack.   A venesection must be
made at once, and from  both arms, in  order to effect on both sides a
revulsion of humors from the lung.  The bleeding must not be carried to
syncope, for fear of augmenting the suffocation.  When the patient com-
mences breathing  more freely, the bleeding should be stopped;  to be

   0 Dioscorides d'Anazarbas:  De la Matiere Medicale, book iv, chap, lxxix.—
French translation, by Mathiolus, Lyons, 1580. 
INTERNAL PATHOLOGY.
193
employed again, if necessary.  There is nothing, in fact, but the bleed-
ing, that can  destroy the disease, if it  proceeds from the blood;  and
even in cases where the phlegm, froth, or any other humor of that  spe-
cies, distends  the lungs, it would still be useful in disgorging it, and
procuring a free space for respiration.
   " After the bleeding, an effort should be made to direct the humor and
wind  by the  inferior  channels.   To effect  this,  the anus should be
anointed with a liniment composed of honey,  rue,  a terebinthenate
liquid and  nitre, mingled together.   In a  case where venesection is
impracticable, on account of  great effusion, an injection should be made
into the fundament,  in the form of clysters, of some tart substance—for
example, of salt with nitre; turpentine with honey; or rue boiled in oil;
or a decoction of hyssop.  The pulp of colocynth, boiled in water, is also
very convenient.  It will also be useful to apply dry cups, along the
spine, on the hypochondria, and wherever they can be used.   The fleshy
parts of the chest are to be preferred, from fear that the cup will fall off.
If, by this means, the humors can be attracted to  some other part, and
the flatus  that swells the lungs  be dispersed, the patient will obtain
great relief; but it is necessary, in some way, to besiege  every part, in
pneumonia.
   " In the meanwhile, those  remedies which  can  be  taken with most
advantage  by the mouth, should not  be  neglected,  especially as the
lung,  whether sound or diseased, attracts  humidity.  Therefore, reme-
dies should be employed that attenuate the  humors, and render them
less tenacious, more mobile,  and easier to be expectorated.   To effect
this speedily,  and thus relieve the patient, a decoction of nitred hyssop
should be given ; or of brine, mingled with vinegar and  honey; or an
infusion of mustard, in  an  emulsion of water.   If to  each of these
preparations there be  added, freely, those  of the root of the iris, and
pulverized pepper, it will be found very good.   So, also, these powders
may be sifted, mingled with honey, and given to the patient. If he
pass several days  and nights without sleep, there  is reason to fear that
he will fall into a furious delirium.   Unless the disease abates, somni-
ferous medicines are to be used, to calm the  patient, produce sleep,  and
prevent this unfortunate  state.   There is a great variety of such reme-
dies, which may be employed ;  but care must be taken not to give them
when the patient is on the point of  suffocation by the fluxion, for fear
of creating an  impression in the bystanders, that your  remedy has
killed him.
   " Aliment must be used, that acts in harmony with the remedies, and
should, therefore, be somewhat bitter, sharp, attenuating, and detersive.
Among the legumes,  leeks, cresses, nettles, and cabbage, cooked in 
194
ANATOMICAL PERIOD.
vinegar, should be chosen.  Among the farinaceous substances, vegetable
soup, to which is added marjoram, or hyssop, spiced with a little pepper,
or nitre, instead of salt,  alique, boiled in sweetened  water.   All these
substances should be boiled, in order to expel the air, which is very
incommodious to  peripneumonics.
   " When the patients are without fever, a little wine may be allowed,
provided  it  is  not  too astringent; for in this disease  there is need  of
relaxation, rather than constriction, so that expectoration may be facili-
tated.  In general, the patient should have but little to drink, for the
lung attracts  the humidity of the  esophagus and  stomach, which  is
injurious.
   " The chest should be  covered with wool, saturated with oil, in which
a little nitre or salt has been dissolved.   Fomentations should be made,
occasionally, with snail  oil.  A useful liniment, in such cases, is com-
posed of dry mustard, mixed with cerato.   In short, everything that
can draw  outward the humors, heat, and wind, must be employed; such
as irritant  substances to the nostrils, different kinds of ointment, and
ligatures  on the  extremities, are some of the  means to be  employed.
If, after all  these things  have been employed, the disease does not abate,
the case must be regarded as desperate."
   The above account, except in  some small particulars, would not detract
from a modern  work on  the  practice of Medicine.  If placed in par-
allel with the prescriptions directed  by the  Hippocratic writers, it will
be seen, that there is no comparison, whatever, to be established.   Thus,
in the space of four centuries, which separate the last of the Asclepiadae
from the epoch  in which  Aretteus lived, a greater progress in  the diag-
nosis and  treatment of certain diseases was made, than has been effected
since, in a course  of more than  sixteen hundred years.
                       CHAPTER   VII.

           EXTERNAL  PATHOLOGY  AND THERAPEUTICS.

  The want of anatomical  knowledge was an  insurmountable obstacle
to the progress of surgery,  under the Asclepiadae.  They did not lack
boldness  to  attempt difficult and dangerous operations, but they lacked
methodic and correct procedures, because the hand of the operator was
not guided by a knowledge of anatomy.  But after the anatomical labors
of the school of Alexandria  had thrown  so much light on the conforma-
tion of our organs, operative medicine must have assumed a new phase; 
EXTERNAL PATHOLOGY AND THERAPEUTICS.        195
 and this we see exhibited in the works of Celsus and Galen, in which
 the surgical parts are incontestably superior to those of the Hippocratic
 books.   A short analysis  of the surgery of Celsus will suffice  to make
 this evident.
   This author, according  to  all evidence,  lived toward the close of the
 first century of the Christian era, that  is  to say, a little in  advance of
 Galen.   He wrote on a great number of subjects, such as architecture,
 rhetoric, philosophy, military tactics, etc., but of all  his  works, those
 on Medicine alone have reached us.   It forms a methodic abridgement,
 extremely complete and concise, of all ancient  Medicine.  The  author,
 in the commencement, gives a rapid view of the origin  and first develop-
 ment  and  progress of the Art, and  the sects into which the medical
 men of his time were divided.  He exercises, on each of these subjects,
 an excellent judgment;  then he traces a regimen  for men  in  good
 health, and for those who are valetudinarian.   With these subjects he
 fills the  first  two books  of the Compendium.   The four following, are
 devoted to the description and cure of diseases  susceptible of being
 cured by the aid of regimen and pharmaceutical means.
   Finally, the last two books, i. e., the seventh and eighth, include the
 accounts  of cases in which the  aid of surgery is judged indispensable,
 with a description of the operations then in use.   Celsus has  contracted
 in a small space all the surgical knowledge of the ancients.   He treats
 not only of all matters contained in the Hippocratic writings, but also
 of a multitude of  others, of  which these books  make no mention.
 Among the chapters entirely new, we cite those relating to the relief of
 hernja, vesicular calculi, cataract, wounds of  the abdomen and intes-
 tines, etc., which form, as we  know,  a considerable  part of surgery.
 His  arrangement of the work  is sufficiently correct and natural.   He
 commences by treating of  the diseases which  attack all parts of the
 body;  then he  passes to those which relate especially to each part.  His
 work is the only one, of that distant period, in which we find  the opera-
 tive  processes  described with clearness and precision; the writings of
 all the distinguished surgeons, from the  foundation of the Alexandrian
 school until his time, being entirely lost.  He names, himself, several of
 them, such as Triphon, Evelpist, and Meges, the wisest of all.
   I will not examine the question,  so many times asked and still unde-
 cided, if Celsus himself was a practitioner; that is of  little moment to
 us; but it is important for us to have a  summary idea of the progress
made in surgery during the course of the  Anatomic Period.   Now,  to
 obtain this, it will suffice, I think, to exhibit some fragments  of the
latter author, in parallel with those of the Hippocratic collection, which
 treat of the same subjects. 
196
ANATOMICAL PERIOD.
                            ON HEMORRHAGE.
  " In Hippocrates, the word at/uoppayai always signifies a hemorrhage,
in which the blood flows freely and forcibly.  When less blood flows,
and slower, he calls it eppvaiv, and avaXajfioo when it flows only drop
by drop.  He prognosticates that, when an unnatural effusion of blood
takes place  in  any cavity of the  body whatever,  it  certainly becomes
spoiled.  It appears that he stopped the hemorrhage of wounds by filling
them with a substance so as to produce compression. Sometimes, again, by
the application of fire.   In dressing wounds, he used a sponge rather than
charpie, which was improper, because  the  sponge, by imbibing pus and
other fluids, swells up, separates the edges, and prevents re-union."°
  This is all that the author of the history of surgery has been able to
collect in the Hippocratic works, concerning hemorrhage.  Let us now
see what the same author has extracted from the work of Celsus.  "As
soon as we are assured," he says, " by the signs heretofore  given, that
the wound may be healed, Celsus directs that attention be given to pre-
vent the hemorrhage, or inflammation, from  causing the death  of  the
patient.  Now, we know that a hemorrhage is to be dreaded, according to
its seat, the extent of the wound, and the rapidity  of the flow of blood.
Then he directs that the wound be filled with dry charpie, and a sponge,
dipped in cold water, be held upon it.  If, however,  the hemorrhage con-
tinues, he suggests that the charpie  be  frequently wet  with vinegar.
Some surgeons of his time  poured it into  the wound; but he  objects to
this proceeding; fearing that the sudden  retention of the fluids would
lead to a violent inflammation; but this could only relate to aponeurotic
parts.   This view led him, also, to proscribe the use of corrosives^ and
escarotics, though proper to  arrest hemorrhage.   If  they must be em-
ployed, he recommended that the mildest  be chosen.
   " If the hemorrhage resists these remedies, he advises that two ligatures
be made of  the vessel, at the point of injury, and the intervening  por-
tion be divided.  There was only one step to take,  between this and the
ligatures of the vessel, in amputations; yet it required centuries to take
it.   If the ligature was impracticable, he proposes the actual cautery,
provided the wound has bled enough, and that  there are no nerves or
muscles in the wounded part, as on the forehead and top of the head;
parts which they believed destitute of these tissues; but this application
could only afford a doubtful result. It was still the habit to apply cups to
an opposite part, in order to determine the flow of blood from  the wound;
but it  is plain that, under the circumstances, they could be of no utility.f"
"Dujardin, Histoire de la Chirurgie, vol. I, book ni, p. 210.
flbid., vol. I, book rv, p. 372. 
EXTERNAL PATHOLOGY AND THERAPEUTICS.         197
  There is no necessity for me to  show in what respect  the  advice  of
Celsus, on this occasion, is  more detailed, more methodic and rational,
than that of the Hippocratic writers.   I shall content myself  by adding
another example.
                    ON THE EXTRACTION OP THE DEAD FETUS,
  " If we compare,"  says the same  historian, " the cruel method em-
ployed  by Hippocrates, to take away the fetus, with the practice of our
time, we shall  see that,  in this  respect, surgery has  also made much
progress.   To extract a dead fetus,  he introduced his hand, covered with
cerate, into the womb, having  his  thumb  armed with  a  sharp instru-
ment, which was termed a claw.  He cut off first, the arms, and with-
drew them;  the hand was then returned to the womb, and the abdomen
of the fetus  was opened,  and the entrails slowly withdrawn; lastly,
the ribs were broken, in order to reduce  the size of the  chest, so as to
render the extraction easy.  He gives another process, quite as terrifying.
When  the dead fetus  is situated obliquely in the uterus,  presenting an
arm, he covered the head and  chest  of the mother, in order to prevent
her seeing the operation ; then he  seized the  arm, drew it without, and
amputated it at the shoulder-joint.   He next made an opening  in its
chest, below the clavicle, and several smaller ones in the abdomen, to
allow the air  to escape.  An effort was  now made, to get hold of the
head,  so as to withdraw the fetus entire.   If  this was unsuccessful, he
crushed the head, and brought away  the body piecemeal.0
  " It remains, now,  to detail  with Celsus, how the accouchement was
terminated,  when the infant was  presented  dead.   After  placing  the
woman on her back,  across the bed, the thighs were  to be  held  apart,
the indicator, greased with oil, was introduced into the uterus, and then,
in the interval of the pains, the other fingers, successively, and, finally,
the whole hand.  There were occasions, he says, when both hands were
introduced, which is not easily conceived.  Celsus remarks,  very  pro-
perly,  that when the hand is introduced into the uterus, it is at  once
recognized whether  the  infant presents the head, or the feet, or trans-
versely.  In this latter situation, the hands  or the  feet are  not  very
far from the os uteri, and the practitioner should endeavor to  make  the
head or the feet the presenting part;  for it is well known, that next to
the head, the feet are the more natural and advantageous presentation
for delivery.    This plan is a great  improvement in obstetrics, since  the
time of Hippocrates.
  " When the child presents an arm, an effort should be made to deliver

  * Dujardin,  Histoire de la Chirurgie.  QSuvres d'Hippocrate, De  la Superfeta-
tion.  De PExtraction du fetus mort.  Maladies des femmes. 
198
ANATOMICAL PERIOD.
by the head ;  if it was a foot, the other should be sought.   In this case,
the accouchement can not be supposed difficult, even by the hand alone.
When the head comes down, a very smooth and short-beaked crotchet is
to be  fastened in the orbit, or the mouth, or in the ear, and sometimes
in the forehead, so as to hasten the delivery.   Celsus says, if traction
is made  while  the  orifice of the womb  is contracted, the crotchet may
slip from the part to which it is fastened, fall upon the undilated orifice,
excite convulsions, and place the life of  the mother  in the  most  immi-
nent danger.   Consequently, he orders, that traction  be made gradually,
and only at  periods  of relaxation, and without violence.   While the
operator draws upon the instrument with his right  hand, the left is to
be engaged in directing the crotchet, and the position of  the child."
  " If version  can  not be  effected, when the fetus is in the transverse
position,  the crotchet  must be  fastened in the  axilla, and  traction be
made  gradually.  As  the head is carried backward, it is  to be separated
from  the trunk, and then the separated portions are to be removed suc-
cessively.   To do  this, a crotchet similar to  the first  was employed,
excepting that its internal edge was sharp.  The head was  first with-
drawn, because it was thought that if the trunk, which is the most vol-
uminous, was first delivered, the head could not afterwards be  taken
away  without extreme danger ;  nevertheless, if the operator must finish
with  the head,  he commenced by laying on the abdomen  of the woman
a piece of linen, folded double; then, an  intelligent and strong man
must  be plaeed at the left side of the woman, and apply both his  hands
to the abdomen,  one placed on the  other, and press the head toward the
orifice of the womb, which the  surgeon must  seize with the crotchet,
and withdraw,  in the manner  prescribed.  Though  this procedure  is
unnatural, it can not  be denied that, in general, this manual of diffi-
cult labor, described by Celsus,  is more rational and methodic than that
of Hippocrates ; notwithstanding  the few occasions in which men were
called upon to act, in  the important function of maternity." °
  I should have been willing  to  abridge these quotations, and  many
others that are  passed, as well as those  that are to come; but after
deliberate reflection, I have concluded to  present the thoughts of authors
in their own style, rather than  abridge them by incomplete quotations;
or alter them by analysis ; I employ this last means, only when I can
not do otherwise.   It has appeared  to  me, that one of the principa
objects of the history being to offer the reader a succinct narration, as
exact as possible, of  the  vicissitudes of  medical science,  it would be
better to furnish him, often, with  the means of  judging  for himself, by
0 Histoire de la Chirurgie, T. I, liv. rv, p. 496.  Celse, liv. vn, chap. xxix. 
                               CLINICS.                           199

placing before him, in some sort, the various documents on the subject,
than  to  present him a ready formed opinion.   The  advantages of this
method seem to me so clear, that I do not think it necessary to argue it
at length.
                      CHAPTER  VIII.

                               CLINICS.

   Clinics, as before remarked, is not a  particular branch of medical
science ;  it  is  the  science itself,  in its practical application;  it is
the  battle-field of the physician ;  the theater where  he displays not
only all the resources of his art, but, also, of his genius, as well as the
qualities  of his soul.   A high intellectual capacity is doubtless the
first condition that constitutes the great practitioner ; but this is not
sufficient; there are, also, necessary, constant watchfulness, and pres-
ence of mind, which will enable him to seize passing indications ; firm-
ness of character,  that prevents him being  troubled  under  the most
painful circumstances,  and which  gives  him  courage to take a resolu-
tion, without being disturbed by unjust and calumnious conversation —
fearlessly risking his reputation for the salvation of his patients.
   A great practitioner must show himself, in  all his acts, a constant
advocate  of truth.   He  must  not palliate  his  reverses, or his faults,
nor  exagerate his  success, for he  is not ignorant that  both  serve  as
lessons; and  that, in his elevated position,  to hide the truth, or speak
falsely, is to pave the way for future homicides.
   Such are the qualities that shine  in the clinical histories unanimously
attributed to Hippocrates, in the  first and  third books on  Epidemics.
In no  other part  of his writings  are they so conspicuous as  in  these
books.   The anatomic  period,  during which the Art made  such  great
progress, has not transmitted to us any collection of clinical observations
worthy to be compared with these ;  whether the works of the illustrious
practitioners  of this period perished in the  destruction of the  great
libraries,  or whether, during  this long period, there did not exist any
man who united  in himself, in so  eminent a degree as the old man  of
Cos,  all the qualities which constitute the great practitioner, I do not
pretend to say.   Galen, who alone,  among the physicians of this period,
can sustain advantageously a comparison with  Hippocrates, by the gen-
eral  character of his acquirements, and the multitude of  his writings,
has left us no collection of clinical  observations.  He reports,  now and
then, the history of some diseases, but for the evident purpose of showing 
200
ANATOMICAL PERIOD.
the superiority of  his  diagnosis, and the excellency of his theory.   We
do not see in his recitals, as in Hippocrates' lively pictures of epidemical
constitutions,  the  naive' and  impartial historian, who  gives his  facts
without comment;  but we everywhere find, on the contrary, the prolix and
subtle dialectician, who lets no phenomenon escape him, without  inter-
preting and discussing it, in a lengthy manner.

                               APHORISMS.
   Many writers of this period, and Galen among  the  rest, commented
upon the Hippocratic aphorisms, but no one attempted to construct new
ones.  The greater part were  doubtless maintained, from  the  respect
which was held for the ancient oracles, whose reputation was colossal;
it may be, too, they feared the abuse to which this kind of literature in
Medicine, more pretentious than  solid,  would lead.  Be this as it may,
we shall not reproach the authors in  this period, for having abandoned
them.
                          CHAPTER  IX.

                       THEORIES AND SYSTEMS.0

                  GENERAL  CONSIDERATIONS.

   In proportion as the physical science  of man was cleared up by the
researches in experimental anatomy and physiology, or, the diagnosis of

  ° The words theory, system, and doctrine, have been many times already placed
before  the eyes of my readers; nevertheless,  there is nothing more vague than
the various acceptations that authors attach to them—especially the first two.
If, to clear up this uncertainty, we have recourse to the most modern and best
esteemed lexicons, we find nothing in them satisfactory.  No one gives a rational
explanation of the synonymy of these terms, and the shades of difference between
them, (a)  Some of  the more recent writers have attempted to introduce  the fol-
lowing distinction: "A theory," say they, "is the production of a genius who
sees nature as it is ; a system is a product of the imagination, which bends every
thing in nature to its taste."  But it is evident that such a definition rests on an
uncertain and arbitrary base; for each author and his partisans being inclined to
consider their opinions the only true ones, will attribute to  those of their adversa-
ries such qualifications as give them an erroneous character, as is clearly shown
by M. Raige-Delorme, in  the Dictionary of Medicine, in 21 volumes, at the word
Doctrine.
  M. Bouillaud complains very bitterly of the  want of accuracy and precision in
philosophical  terminology,  and more especially of the ambiguity of the words
  (a) Consult, on this subject, Dictionaire de l'Academie.—Dictionaire de Laveaux.—Dictionaire
de M. Napoleon  Landais.—Dictionaire des Sciences Medicales, in 60 volumes.—Dictionaire des
Synonymes, by Boinvilliers, 
CLINICS.
201
diseases became more perfect, as the conquests in natural history multi-
plied the resources of therapeutics, it became more and more necessary
to classify the material acquisitions of science, in a  methodical order,
that could  be recalled easily by the memory;  and to unite by a theory,
more or less reasonable, the multitude of old and new facts, that made
up the treasure of Medicine.
   A  great  number  of philosophic writers,  holding different views,
attempted this difficult enterprise; some, in fact, endeavored  to unite
the traditions of the past with the conquests of the present, without
changing at all the fundamental principles of the accredited doctrine, and
by the aid only of a few modifications of details. Others, on the contrary,
judging these principles to be erroneous or insufficient, aspired to nothing
less than the  overthrow of the ancient edifice of science, in order to
reconstruct it on new foundations.
   If the  historian  should attempt to  record the  particular opinions
emitted, on  each of  the  phenomena of the animal economy, he would
find nearly as many different theories  as there exist authors in Medi-
cine ;  for there is not a single physician who has  not modified,  in  some
point, by his own experience, the doctrine which  he  has  received  from
his masters.   But if regard  be had only to  the capital  differences—
to the divergence in principles—the theories which most divided physi-
cians of this period may be ranged under four heads, namely: Dogma-
tism, Empiricism,  Methodism, and Eclecticism or  Syncretism.
theory, system, doctrine, etc.; but he has not remedied it. (6)  M. Coutanceau  is
the only one in my knowledge, who has given a ,clear and logical definition of the
theory and system.   A theory, he says, indicates the relation of facts among
themselves;  it marks their order of succession and dependence.   A system (in
medicine)  is a general theory of the  laws and mechanism of life, by means  of
which we endeavor to reduce to a small number  of principles, sometimes even,
to one alone, all the phenomena of health and disease, (c)
  Thouo-h  M. Coutanceau has limited to medicine his definition of system, whilst
his definition of theory is  applicable to all sciences, he has nevertheless appre-
ciated and expressed, more  happily than any other writer, the shade of difference
between the two expressions, and the similitude which unites them, in saying that
a system is a general theory.  Such is the sense which we have ourselves attached
to these words, when we would make  a distinction; thus we say, the theory of
inflammation and of fever; the  system of Hippocrates, of Themison and Stahl.
Lastly, the word doctrine has a still more extended signification; for it signifies
all that one believes  or teaches, on any matter whatever.  It embraces, in its
scope, theoretical and practical notions, systems, facts, and hypotheses; it is what
must be understood by the following expressions, which recur so often in medical
language: the doctrine of Cos, of Montpelier,  of Leyden, etc.
  (6) see his Essai de Philosophie Medicale, Paris, 1836, page 176, note.
  (c) See Diet. Med., in 21 vols., words Theory, System.
         13 
202
ANATOMICAL PERIOD.
                        ART. I.  ON  DOGMATISM.
      We know, already, the principles of Dogmatism, its origin, its authors,
   and its most illustrious partisans.  We know that this doctrine, taught
   in the school of Cos, and sustained by Plato and Aristotle, had reigned
\i  in the medical world for several centuries before the school  of Alexan-
   dria was established.  The earliest, and the most celebrated professors
   of that school, brought up in the tenets of Dogmatism, made few changes
   in it.   Herophilus admitted the sentiments of Hippocrates, and  Praxa-
   goras, his master,  on the effect of the  mingling of humors, in health or
   disease, and followed nearly their  rules in the practice.   Besides great
   discoveries  in anatomy, he  made  many experiments with  medicines,
   which he termed  the hands  of the gods when properly employed, but
   useless, and even injurious instruments, if a practitioner is  ignorant of
   their  appropriate use.0
      Erasistratus, though adopting the  greater part  of the Hippocratic
   dogmas, thought  that  fever  and inflammation  proceeded from the pas-
   sage of the  blood from the  veins  to  the arteries.   According to him,
   these  last vessels contained, naturally, only air, or spirits ; " but," said
   he, "  when there  is an excess in the veins, extravasation takes place,
   into the arteries, and creates all the  inflammatory and febrile symptoms."
   The sanguineous plethora appeared to  him to be the most frequent cause
   of diseases ; nevertheless, to  combat it, he rarely employed bleeding.
      He preferred  abstinence or fasting, dieting, mild injections, vomits,
   exercise, and baths.  He was not very partial to  purgatives, and did
   not believe, with Hippocrates, that certain  of these remedies had the
   property of eradicating some particular humor, exclusively.   He  said,
   that  the  thinnest,  and most  subtile humors,  were  first carried  off;
   then  the more tenacious followed.   According to him, the mildest pur-
   gatives produce only slight,  watery  evacuations;  those which are  a
   little  stronger, carry off the bile; and the strongest of all, the atrabile.
      But of all  the sectators of Dogmatism, the most  fruitful, the  most
   skillful, and the  most powerful, was Claudius Galen.   He was a native
   of Pergamos, a city of Asia-Minor, celebrated  for its temple  dedicated
   to Esculapius, its school of Medicine,  and its library — which in  rich-
   ness was only second to that of Alexandria.   His father was his first
   master, who placed him, also, under professors very distinguished in all
   the sciences.   The young Galen  profited by  their instructions,  with
   extraordinary success.   He was already in a state to dispute with the
   most  erudite, on grammar, history, mathematics, and philosophy, when,
Galen, De Compos. Medicam. local., lib. vr, cap. in, (Luler, p. 322.) 
THEORIES AND SYSTEMS.
203
on the  express advice of the gods, he decided to study Medicine.  He
recounts with complacency, how this counsel was twice given to him in
a dream, by Apollo, and that he could not resist  the  divine will, so
clearly  manifested.   But his numerous and  learned writings justify
much better his medical vocation, than all these mysterious reminis-
cences.
   He undertook several voyages, for instruction,  and visited, among
other cities, the capital of Egypt, where he remained some time.  On
his return to his country, he was charged by the Pontiff, to dress the
wounded in the circus, which furnished  him an opportunity to display
his anatomical knowledge and surgical  skill.   Very soon afterward he
left again his native city, to go and  exhibit himself in a much grander
theater.  He went to Rome, preceded by his great renown, and where his
easy and brilliant elocution, his profound and varied erudition, and prac-
tical skill, secured him the esteem  of the  highest personages; but his
rapid success, his boasting, his disdain for his  confreres, which he  took
no pains to disguise,  and his natural jealousy, raised up against him a
crowd of enemies, who rendered his stay at Rome very disagreeable.  A
conception of this may be had, by the following picture, which he draws of
the physicians of that capital, in his work  on Prenotions °   He accuses'
them of base jealousy, and  stupid ignorance,  and pours out upon them
such epithets as thieves, and poisoners, and closes by saying, that  after
 having unmasked them, he would shield himself from their hidden and
evil designs, by abandoning the great and  populous city—where a man
 has consideration only in proportion to the luxury he displays; where
a shameless charlatanism usurps the confidence of a  stupid and frivolous
public — to seek a  home in  some smaller city, where the citizens are
mutually acquainted, and therefore know the  birth, education, fortune,
 and private life of each other.
   He left Rome, but very soon returned, on the  invitation of the emperors
 Marcus Aurelius and  Lucius Verus.   He had also  the confidence of
 their successors, Commodus  and  Septimus Severus.  It is supposed that
 he died in  the  seventy-first year of his  age,  toward the close of the
 second century of the Christian  era, either at  Rome or Pergamos,  or on
 the passage from one city to the other.  A monk has  imagined that he
 finished his days during a pilgrimage to the Holy Land.
   Galen asserts, that  he was not attached to any  of  the sects that
 divided the physicians of his time.  He treats as slaves those who took
 the title of Hippocratists, Praxagoreans, Herophilians, etc.; but  he  is
 not to be credited, when he affects to hold  an  equal balance among the
« De Proenotione ad Posthumum, edition of Chartier, Tom. VIII, page 
204
ANATOMIC  PERIOD.
 various doctrines.  It is probably only an absence of mind, very pardon-
 able in a man who has written so much;  or an oratorical artifice, to show
 an air of independence and impartiality.  His predilection in favor of
 the doctrine of Hippocrates is well marked: he explains, comments upon,
 and amplifies it at length; he  refutes the objections of its adversaries,
 and strives to give it the ascendancy over all others.  " No one," he
 says, " before me, has given the true method of treating diseases.   Hip-
 pocrates,  I confess, has  heretofore shown the  path, but as  he was the
 first to enter it, he was not able to go as far as he wished.   The order
 he adopted is bad; he omits certain important indications, and has not
 made all  the distinctions necessary.   Often, he is obscure, as is usually
 the case with the ancients, when they attempt to be concise.  He says
 but very  little of complicated  diseases; in a word,  he has only sketched
 what another was to complete; he  has opened the path, but has left it
 for a successor to enlarge and make it plain."0
   This short quotation shows  the point  assumed by Galen, and how
 slightly he regards  the labors  of the physicians, who  lived between
 Hippocrates and himself.   Let us now see how he has acquitted himself
 of the task he so arrogantly undertakes.
   There are, according to him, three sorts of principles in man, viz.,
 spirits, humors,  and solids, which he  also named parts.
   Among the solids, some are simple, or similar; that  is to say, if they
 are divided, each fraction is homogeneous with  the rest.   Such are the
 bones, flesh,  nerves, membranes, etc.  These  structures have, in  vain,
 been divided into as many fractions as were desired,  but there always re-
 main in each, pieces of bone, flesh, or membrane, similar to the entire bone,
 flesh, or membrane, that has  been  broken up.   Other  parts are called
 organic, or compound, as the arm, leg, head, or  eye; because they exe-
 cute the most striking and perfect  acts, and because they are formed of
 several similar parts.
   There are  some simple parts  that  take their origin from the semen;
 such as nerves, membranes, bones,  and veins.   These are not very sus-
 ceptible to corruption,  and are  not  regenerated after  they  have  been
 destroyed,  There are other simple parts which degenerate  easily, and
 are reproduced with  the same  facility.   They are those that come from
the blood, as the fleshes, f
   Galen  refutes, with Hippocrates,  and by the same arguments,  the
opinion of those  philosophers who  recognize but one element; neither
 does he share the  advice of those who, in  admitting several elements,

  0 Method Medendi. lib. ix, chap. vin.
  ■j- De Constitutione Artis Medicae.  Also, De semine. 
THEORIES AND SYSTEMS.
205
regard the corpuscles as incommunicable in their essence.   When the
tissues are divided, he says, both pain and heat are excited; now, both
of these results would not transpire if they were composed of one ele-
ment alone, or if the elements that  enter into their  constitution were
unalterable.   Nothing more  would be realized, in such  a  case, than
when one finger is  separated  from  another, which  excites  not the
slightest pain or heat.  In consequence of this reasoning, Galen ranges
himself on the side of Hippocrates and Aristotle, who admitted, as we
know, four elements  or primordial qualities,  heat, cold,  dryness, and
moisture.  He thought that all the changes which occur in the body are
due to one of these elements;  but he regards heat as the most active of
all, and cold next to it.   The natural bodies,  he says, in which the
primitive qualities show themselves in the highest  degree, are  fire, air,
earth, and water.   These  are called elementary, because  the  others are
derived from them.0
   We perceive, therefore,  that Galen  reproduces and amplifies the Hip-
pocratic Dogmatism.   What follows is a continuation  of the same sub-
ject;  but the reader  who is aufait in the doctrine of  Cos, will discern,
without my pointing  them out, expressly, the additions  and pretended
improvements which  the physician of Pergamos makes to this doctrine.
I proceed, then, without interruption to exhibit the system of Galen.
   There exists between the elementary or similar parts of the human
body, four simple variations: that is to say, one part may be hotter than
the other, or colder,  or dryer, or moister.  There exists,  also, or may
exist, between these same parts, four compound variations, namely, one
may have more heat and dryness than another, or more heat and mois-
ture,  etc.   The exact proportion and mixture of these  qualities produce
the best constitution, or perfect health.  But  this  perfection is rather
an ideal type than  a reality;  the most healthy men are always a little
removed from it.
   Between perfect health and  disease there  are, according to Galen,
eight kinds of temperaments or imperfect mixtures, compatible with the
free exercise of the functions of life.   Four of  these elements are sim-
ple, and four compound.   If a man has in every part  of his  body, or in
some  one part, an excess of heat, it may be said  that  his temperament
is simply hot; or if the  excess  be in moisture, his temperament  is
humid,  and so on for the rest.   But if there exist an excess of heat and
moisture at the same time, in the body of  an individual, or in  any por-
tion of  his system, then that individual would  have a  hot and moist  or
  0 De Constitutione Artis Medicse — Introductio sen Medicus — De Elementis ex
Hippocrate. 
206
ANATOMICAL PERIOD.
 a compound temperament.   Disease, says Galen, is not a temperament,
 but an intemperament.0
   After this somewhat subtle and  arbitrary classification  of tempera-
 ments, Galen  designates  the signs that characterize each of  them.
 Here, for example, are  those  that indicate a cold  brain:  the natural
 emunctories of this viscus,  viz., the palate, ears, nose, and eyes pour out
 excretions  too freely.  The hair is straight, red, rather stiff, thin, and
 poorly nourished; it grows slowly.   Persons in this condition are very
 sensible  to refrigerant influences, and very subject to catarrhs and heavi-
 ness of  the head.   The skin about the  cranium  is  neither hot  nor
 flushed.  The veins of the eyes are  scarcely visible: in  short, these
 persons  have  a remarkable  propensity to sleep.f   Our physiologist
 passes in review in this manner all the principal organs of the human
 body, and describes the signs  of their various temperaments.
   Then  he describes the temperaments of the  natural humors  of the
 body, and those of certain  substances foreign to the  animal economy.
 In  these descriptions we still see,  as  in  all that precedes them,  the
 evident traces of the Hippocratic Dogmatism.   Thus, according  to  the
 opinions of the physician  of  Pergamos, the blood, air, and  the  spring
 season are  hot and humid; the yellow bile, summer, and fire are  hot
 and dry; the earth and autumn are  dry and cold;  the phlegm, water,
 and winter are cold and wet.  It is  indispensable that the  humors of
 the body be reciprocally transmutable—just  as are all  the  primitive
 elements; for, though they exist in all  parts  mingled  together, and
 mutually temper each  other, there is nevertheless an organ, a period of
 life, and  a season in which  some one  of them more particularly abounds.
 The blood,  for instance, predominates in the heart among the adolescent
 and in the  spring; the yellow bile in the liver, in  middle life and in
 summer.}
  Beside the structures and humors, there is, also, in the animal  econ-
 omy, a third principle, which is called spirits.  These  spirits are  of
 three kinds, namely, natural spirits,  which Galen compares to a subtile
 vapor that  arises from the venous blood.  They originate in the  liver,
 which is  also the source of  the blood; thence they proceed to the heart,
where they mix with the air which that viscus attracts from the  lungs,
and unite with it to form the vital spirits.  These  last are thrust by
  ~ De Constitutione Artis Medica, chap, ix ; Ars Medica, cap. iv; De  Tempera-
mentis, lib. i, chap, vin; De Optima Nostri Corporis Constitutione; De Sanita
Tuenda.
  f Ars Medica, cap. vin ; De Temperamentis, lib. i, n, in.
  J De Humoribus Introduces  seu Medicus, cap. xn; De Placitis Hippocratis et
Platonis. 
THEORIES  AND SYSTEMS.
207
the arteries into all parts of the system, but chiefly into the brain, where
they are convertc ! into animal spirits.
   The spirits are the instruments or servants of the soul, which governs
the animal economy.
   Galen thought, with Plato and Aristotle, that the human soul is com-
posed of three faculties, or, rather, of three parts:  the vegetative, which
resides in the liver; the irascible, which has its seat in the  heart;  and
the rational, which dwells in the brain.0
   Each faculty of the soul has in its service, according to Galen, inde-
pendently of the spirits, a certain number of secondary faculties.   Thus,
the vegetative soul held in its  department, the generative, growing, and
nutritive faculties.  These secondary faculties, in their turn,  fulfilled
their functions, aided  by faculties of a third order.  The nutritive, for
example, which has its principal locality in  the stomach, is  assisted by
attractive, retentive, assimilative, and expulsive faculties.f
   Aided by this hierarchy of souls, spirits, and faculties, Galen  and his
sectators had no difficulty in giving an account of all the functions of the
animal economy.   If the question was asked of one of them, how nutrition
is performed, the answer was:  nutrition  is a natural function, to which
four faculties concur, namely:  the attractive, which draws the food; the
retentive, which keeps it for a sufficient time, for coction to  take place;
the assimilative, which transforms it into particles analogous to the  sub-
stance of our bodies;  the  expulsive, which eliminates their  excrementi-
tial residuums.  When, I say, the candidate had made this response, pro-
fessors and assistants must show themselves equally satisfied, for he had
explained, according to the language of the times, what was  supposed to
constitute the essence of the nutritive function.
   Pathology offers us the  same  assemblage of imaginary  or  abstract
entities,  to which attributes were ascribed, as to real beings.  We  find
accounts of  diseases  that  had their seats  in  the solids, humors, and
spirits.
   Diseases of the solids were divided into three orders: the first com-
prises  affections  of similar parts, and  also named distempers.   There
are two  species of distempers, namely: the  simple  distemper, which
proceeds from the excess of a single element,  whether heat, cold, dryness,
or moisture; the double, or complex distemper, which  results from an
excess of two of these elements at the same time, as an excess  of heat
and dryness, or an excess of heat and moisture, etc.  The second order
comprises affections of organic parts, which  consist in irregularities of

               - De Facultatibus Naturalibus, lib. i., n., in.
               f De Facultatibus Naturalibus. 
208
ANATOMICAL PERIOD.
conformation, errors in number, size, or situation.   Finally, the third
order, which is common to similar parts, and organic parts.   It includes
all the accidents connected with the solution of continuity.  Galen dis-
tinguishes, also, among the diseases of the solids, various complications,
which constitute so many new species.0
  The essence of fever consists in an unnatural heat, which sometimes
is kindled in the tissue, even, of the heart;  again, in the humors of this
viscus;  and, lastly, occasionally in  the  spirits.   The latter are  most
promptly  inflamed; next,  the  humors;  lastly, the  solids.  Fevers of
the shortest  duration have their seat in the first;  those of medium
duration, in the second; and those  that  are  longest continued, in the
parenchyma, f
  Ardent fevers degenerate into the hectic, or consumptive, in two ways;
first, when they are prolonged to such an extent as to consume all the
humidity  of  the  heart,  and then  seize  upon the tissue, even, of the
organ;  second, when they invade the substance of the heart, before  all
its  humidity is consumed.   Hectic fevers are recognized  by the  tem-
perature of the body of the arteries, which is more elevated than the con-
tiguous  parts.   This difference  is especially marked, at the moment of
the diastole of the  artery.J
  Among the fevers which proceed from the humors, Galen distinguishes
three orders,  viz: the continent,  continued, and intermittent.  Each of
these orders he divided into many species.  Of intermittent fevers, the
most  common are  the quotidian, the  tertian,  and the quartan.    The
first  is  produced by the phlegm;  the second, by the yellow bile; the
third, by  the atrabile.   Galen admits, besides these,  many other species
of fevers, both simple and compound.
   In regard  to the progress of  these febrile  affections, our pathologist
recognizes, with  Hippocrates,  four periods, which he names  invasion,
augmentation,  stasis,  and decline.   He  compares these  periods to the
four ages of man, in the following order:  the  first age, or that of  gene-
ration ;  the  second, or that of  growth;  the third, or that  of force and
 vigor;  the fourth,  or age of decline.  When the patient succumbs, it is
 always  in one of the first three  phases; never in the last.||
   In other respects, in regard to coction,  crises, and critical days, our
 author  concurs in the pure doctrines of Cos.
   He divides  the  action of remedies into primitive, and consecutive.
 The primitive action depends on one or two qualities, which exist in the

        Q De Morborum Differentiis liber.—De Morborum  Causis, liber.
        f De Differentiis Februm, lib. i, cap. i.
        I De Differentiis Februm, lib i, cap. x., xin.
        || De Morborum Temporibus, etc., lib. n. 
THEORIES AND  SYSTEMS.
209
medicine.  Thus, one substance will excite heat or warmth, because the
element of fire predominates in it; another is cooling, because it has the
cold element in excess.   There are also substances that  produce heat
and dryness at the same time; others which excite heat and  moisture.
Among therapeutic agents endowed with the same property, for example,
that of heating, some have it in an eminent, and others in  an inferior
degree.  Thus, bitter substances are extremely heating; the  sweet are
only moderately so, their heat but  little  surpassing ours.  The  saline
taste proceeds from the  excess of  the igneous and terrestrial principle.0
  There are substances which produce their effects immediately ; for exam-
ple, fire heats at once ; and ice cools in like manner.   The effect of others
is not so prompt, such as the anthemis pyrethrum and castor, which pro-
duce  a sensation of heat only after some time has elapsed; and hyosci-
amus and mandragore cool, also, slowly.   A thing may be said  to possess
a quality,  naturally, or  accidentally, accordingly as  it  is a natural or
accessory attribute.   Water,  for example, which is naturally  cold, may
become hot,  accidentally, but its acquired  heat is  not long retained,
while its natural coldness persists, habitually.   After other distinctions,
still more  subtile, on the various ways in which  we may observe the
primitive effects  of  medicaments, Galen traces  the rules to  be followed
in  order to recognize their effects; he indicates the  precautions  to be
observed, so  as not to be deceived by false appearances.  Passing then
from  precept to example, he demonstrates by a series of experiments and
arguments, that  water  has a cold and humid temperament;  vinegar a
cold  temperament, with  a certain mixture of heat proceeding from  its
acridness.f
   The consecutive action of medicines is so called, because it is manifest
after the primitive effect, and as a consequence of it.   This action is
very varied ; thus, there are medicines that open the pores, others which
close them ;  some harden, others soften the tissues; some  purge the hu-
mors,  others  alter them;  some hasten their maturation and the formation
of pus; others give relief to pain, etc.   There are, also, remedies whose
consecutive action is especially related to certain organs, or certain func-
tions; such  as diuretics, vomits, drastics,  emmenagogues, etc.   Galen
sought to  establish  the  connection which exists between  the  primitive
and secondary action of remedies; for example, he supposed, that reme-
dies which harden the  tissues, are  of a  cold and moist temperament;
those which  increase the flow of urine, are hot and dry; and  those that
increase the secretion of  milk and semen, are moderately  hot and humid. J

  •■"' De Simplicium Medicamentorum, Temperamentis Facultatibus, lib.  i, n, in, iv.
  f Ibid., lib. i, n, in, iv.                 t Ibid., lib. v. 
210
ANATOMICAL PERIOD.
   As to the principles which should guide the practitioner in the choice
 of therapeutic means applicable to each disease, the physician of Per-
 gamos adopted fully the axiom proclaimed by the school  of Cos, which
 says, that diseases  are  cured by  their  contraries.   Consequently, all
 researches and pathological dissertations aimed to  penetrate the essence
 of diseases, to make it evident, and  distinct from all accessory accidents;
 in short  to apply to this essence  a  treatment whose action would be
 diametrically opposite to its  mode of  existence.   Now, he  considered
 this essence to be, sometimes, the excess of one or two elementary quali-
 ties of the diseased part;  again, the re-action of the vital  principle, the
 efficient and primary cause of all  the  symptoms.   In this  respect his
 doctrine is confounded with the Dogmatists; it is nothing else than Dog-
 matism itself, amplified, explained, and pushed to its last  consequences.
 Occasionally, however, he had regard to the constriction and relaxation
 of the pores, which approaches the views of the Methodists.   Finally, he
 professes, in many passages, a great consideration  for the pure concourse
 of symptoms and  experience; fundamental principles, which the Empi-
 rists placed above every thing.  Notwithstanding these rare and slight
 digressions, Galen has been, and must be regarded as one of the pillars
 of the Hippocratic Dogmatism.
   Though he  has  written a great number of treatises on pathology and
 therapeutics, it would be difficult,  if not to say impossible, to treat  a
 single disease  by his directions, so  bad is the  method  he  has adopted,
 and so defective was his manner of studying each case.  I except, always,
from this proscription, the last four books of the treatise on Local Affec-
 tions  (de Locis Affectis), where he  gives excellent counsel  how to ascer-
tain  the anatomical seat of diseases, particularly of a mental and nervous
 character.  This treatise, joined  to his writings on anatomy and physi-
ology, of which notice has already been taken, constitute for the physician
of Pergamos imperishable titles  of glory, and justify and excuse the
infatuation of which he was the object during more than twelve cen-
turies.
  In an historical sense, this encyclopedic writer has rendered immense
services ;  for he has preserved the opinions of a great number of physi-
cians whose writings have perished, and especially of the  chiefs of the
sects.   Thanks to him, we are able to raise  a corner of the veil that
covers the great contests between the Dogmatists, Empirics, and Meth-
odists.  If the numerous works he has published are not now a trea-
sure, easy for the practitioner to explore, they are an arsenal from which
the erudite, and the dialectician, may draw arguments, on  all  kinds of
medical questions.  Now, we approach an epoch  in which  physicians
showed  themselves more anxious to shine by the subtilties  of dialectics, 
THEORIES  AND  SYSTEMS.
211
and  the glitter of a vain erudition, than by the wisdom of their prac-
tice ; so much so,  that the defects, even of  this author, shall contribute
yet,  to maintain  in  his  hands the scepter of Medicine;  because, for
erudition,  subtility of reasoning, and universal knowledge,  he was
second only to Aristotle, and excelled even him, in elegance, purity, and
strength of style.0
                     ART.  II.  ON EMPIRICISM.
   The  epoch in which the school at Alexandria was founded, was, as
we have  seen, one of the  most brilliant in the  history of the human
mind.    The love  of letters,  art, and philosophy, generally diffused
throughout Greece, had endowed her with chefs d'ceuvre  of every kind.
The companions of Alexander had carried the lights of her young and
vigorous civilization to the center of Asia, the first cradle of a decrepid
civilization.   In short, the radiant and communicative  science of the
Greeks, eclipsed, on the shores of the Nile, the pale and  shadowy rays
of antique Egyptian wisdom.  While the successors of Plato and Aris-
totle continued to teach the doctrines of their great masters, other philo-
sophers elevated rival schools, and strove to propagate diverse views.
Epicurus revived and embellished the system of Leucippus and Demo-
critus, on atoms, vacuum, and perpetual motion.  Pyrrho developed the
maxims of Parmenides and Zeno, on the uncertainty of  our knowledge
and judgment.  He founded the sect of Skeptics, or Zatetics, who have
been styled the indifferent, in matters of science, as the Epicurians were
indifferent in matters of morals.  On the other hand, Euclid invented
the useless  art of embroiling  all questions, and silencing  his antago-
nists, by captious and odd arguments.  His sect, which was named con-
tentious, sought victories only in public debates, at that time very much
in fashion; and  they put in vogue a prating and cavilling dialectic,
which gradually infected the other schools.
   Medicine, as usual, followed  in the track of philosophy, and was
divided into  several opposing  camps.   Herophilus and Erasistratus,
though  dissenting from some of the points of the Hippocratic doctrine,
respected it as  a whole; but their  disciples, Philinus of Cos, Serapio
of Alexandria, and  others,  did not maintain the  same  veneration for
it;  they  attacked  even the principles  of that  doctrine, and asserted
that all which it affirms touching the elements,  and elementary quali-
ties, cardinal humors, coction,  crisis  and critical days,  the occult,  or

  w It is said that he composed more than five hundred volumes on Medicine, and
nearly half that number on other subjects.  But it must be observed, that among
these volumes there are counted many little manuscripts of a few pages only. 
212                   ANATOMICAL  PERIOD.

proximate causes, and the  essence of disease, was  altogether false, or
hypothetical.  They rejected, as doubtful, hazardous, and  useless,  the
famous therapeutic axiom that forms the basis of Dogmatism,  (diseases
must be cured by their contraries) and dared  to reconstruct the Art on
new foundations.
  This medical  reform, or rather revolution, made rapid progress, and
the names of a  number of physicians of high standing, are  cited  as
supporting it; but the most celebrated, after the two coryphei, whom
we  have  named, was Heraclidus of Tarentum, who lived cotemporary
with them,  or a  few years later.  The Methodist,  Coelius Aurelianus,
who, following the expression of the historian, Daniel Leclerc, was accus-
tomed  to  maltreat the physicians of other sects, speaks of Heraclidus,
only in most honorable terms,  giving  him the epithets of noble and
famous ;  calling him the last, and the most estimable of the Empirics.0
Galen's opinion  in relation to  him is nearly the same:  " Heraclidus
never speaks contrary to truth to defend the  interests  of his  sect—he
announces only his own experience ; and he practiced Medicine as well
as any other physician of the time, j
  The Empirics  composed a great number of books, which are  lost.   It
is only from the reports of writers of other sects, that we are acquainted
with their doctrines.  It is probable, therefore, that they have  not been
exhibited in the most favorable light.  The  Empirics  go back to  the
infancy of the Art; they recount  how the first sick were treated, and
they deduce from this the rules for the perfection of medical science.
  The following argument of theirs is copied from Celsus:  " Among the
sick, who, in the  commencement, were without physicians, some, tor-
mented by hunger, could eat from the first days of their illness; others,
on  the contrary, disgusted with  food, could eat nothing, and recovered
much sooner than the former.   Again, some  ate, even  during  a fever;
others, a little in  advance  of its accession;  others  again, after it had
ceased; and these did better than the first or second.   Also, those who
had eaten largely at the beginning of their disease, were in a much more
dangerous  condition  than  those who had eaten but little.   As these
things occurred every day, attentive  persons  soon  observed what was
best suited  to the sick, and thereafter prescribed it.   Thus  medicine
originated, which, from the essays  that have  been made,  sometimes to
the advantage, and again  to the  detriment, of the sick, has  been the
means of establishing a judgment between what was good, and what
  ° Acutorum, lib. i, cap. xvn.  Ibid., lib. n, cap. rx.
  f Galen, in lib. Hippocr. des Articcul. Comment. 3.  Ibid., De Composit. Medical.,
per genera, lib. rv, cap. vn. 
THEORIES  AND  SYSTEMS.
213
was evil.   It was only then, after men had found  remedies, that they
commenced to reason on the manner of employing them." °   If, now, we
compare this passage with those taken from the work on Ancient Medi-
cine, it will be seen that, between them, there is perfect conformity; but
I shall have occasion, hereafter, to  show other  analogies between the
doctrines of the Hippocratic works and the system of the Empirics.
  They ranged under three heads the method of acquisition adapted to
Medicine:  first was personal observation on autopsy ; second, the study
of the observations collected by others—or history; third, the induc-
tions drawn  from autopsy and  history, which would serve  to  discover
things, for the moment concealed, but which had been before observed.
The  last method was  termed epilogism, or, in other words,  consecutive
reasoning,  to indicate that it was deduced from  anterior observations;
at other times, it was called analogism, because it rested on a similarity
of features.  These three sources of medical instruction: autopsy, his-
tory and epilogism, formed the base, or what was termed the tripod of
Empiricism.
                               AUTOPSY.
   The Empirics realized fully the maxim of Hippocrates, "experience is
deceptive;" for they took the most minute precaution, to avoid the causes
of error to which this mode of acquisition is subject; though it is the first
of all, and the true foundation of the Art.  They thought, for  example,
that  a disease should be studied a great number  of times,  from  its
accession to  its  end ;  in a simple,  and in  a complicate state;  in indi-
viduals of different temperaments, ages, and sexes; and the knowledge
attained, of what conditions favored or prevented its development, etc.,
before any one could pretend to have made its autopsy.   They  thought,
also, that the same treatment should have been employed a great number
of times, in the same disease, and under different circumstances, before
it could be affirmed that it would be efficacious in similar cases.
   They did not confound symptoms with the disease; they called a symp-
tom  an isolated phenomenon,  or separate  consideration, for example:
pain, swelling, redness, cough, and difficult  respiration.   They gave the
name disease to an assemblage of morbid phenomena, or, in other terms,
to a concourse  of pathological occurrences, which were not fortuitous,
 but which were nearly always developed in the same form.
   Though they banished from their pathology the research of what the
Dogmatists named essential, or  consecutive phenomena, they  believed,
nevertheless, that all the symptoms  were not of  equal value.  They
estimated  the  importance of  a pathological  phenomenon,  not on its
0 Celsus, Trad, de Ninnin, liv. i, chap i. 
214
ANATOMICAL PERIOD.
pretended essence, which nothing, they said, revealed, but on the mani-
fest or sensible circumstances, which every one could appreciate.  Thus, a
symptom that persisted throughout a disease, appeared to them  to merit
more attention than one whose duration was much shorter.   A symptom
related to the functions of an organ essential  to life, or which announced
a grave alteration of an essential organ, was,  in their eyes, more serious
than one which involved a secondary function, or indicated a superficial
derangement.
  But, however grave a symptom, they were not willing to accord  to  it
an exclusive consideration ; they directed their attention to the general
state of the patient, or the concourse  of symptoms.  Thus, while  some
physicians attached an exaggerated importance to the character of the
pulse, urine, or other dejections, or to the state of  the skin, etc., for the
diagnosis of certain diseases, they asserted that, as  far as  possible, no
circumstance should be neglected, and an exploration be made,  in every
case, not only of  the organ or function specially  affected, but also of all
the functions and organs, or at least the principal ones.   They taught,
also, that an observation should be made of the accession and disappear-
ance of  the different symptoms, their order, course, and, in short, of all
their relations to  age, sex, habit, complexion,  climate, season, etc.
  An individual who had observed, frequently, the same disease from its
origin to its close, and who preserved a faithful memory of its symptoms,
course, and most ordinary complications, and the  means to combat them,
possessed  a theorem.  Any one, then,  who  had thus  stored in his mem-
ory a considerable number of theorems, possessed experience or practical
skill.  Thus, autopsy, or clinical observation often repeated, established a
theorem, and the reunion of a number of theorems constituted experience.
  An Empirical  theorem, then, was nothing else than an exact tableau
of all the known  phenomena of a  disease,  arranged  according  to  their
importance and accustomed order, with  the specification of their varie-
ties, and of the appropriate  treatment, either separately or conjointly
considered.   Each theorem,  or each morbid  concourse, in Empiricism,
was designated by a particular name, which was the  symbol or abridged
expression of all  the phenomena which made up the  theorem.   This
name was  derived, sometimes, from the part  principally affected;  thus,
the word pneumonia designated a concourse of symptoms, whose prin-
cipal  seat was the lung; gastritis, a collection of  symptoms,  relating
principally to the stomach;  thus avoiding all prejudice as to the nature
of the symptoms, and the cause of the  disease.    Sometimes, the name
of the theorem,  or morbid assemblage, was  derived from  a dominant
symptom, as icterus, mania;  again, from the resemblance  to a foreign
object, as cancer, elephantiasis, etc. 
THEORIES AND  SYSTEMS.
215
  The Empirics, we thus observe,  attached but a secondary importance
to the name of a disease, for that did not indicate to them its  essence,
but only an assemblage of morbid symptoms.   The  essential  matter,
with them,  was, that  each concourse be traced with great  exactness,
following,  at  first, its  habitual, march, then  its irregularities and
complications.

                              HISTORY.
  If it were necessary for a man to have seen, with his  own eyes, most
diseases, with all their varieties and almost infinite shades of difference,
and to have directed the remedies employed in each case, and  to keep
faithfully in his mind, or in his note book, the account of all these mat-
ters, he must have reached  a very advanced age before commencing the
practice of Medicine.   Few men could have been found, endowed with
patience, sagacity, and memory sufficient to finish so long and complicated
an undertaking.   Moreover, the experience of preceding generations, and
that of our cotemporaries, would be almost lost to us.  The scientific edi-
fice of Medicine, in place of being extended and perfected from age to age,
would have remained stationary, or made but little progress.   To supply
the insufficiency of autopsy, the Empirics had recourse to  history, that
is to say,  to clinical relations and theorems, committed to writing.  By
the aid of history, we participate in the experience of all other men;
we correct our own observations ; we are able, in a word, in a few years,
to acquire more knowledge and practical skill than if we had passed all
our lives in collecting notes at the  bedside.
  But to  be able to appreciate the value  of this source of instruction,
we must know how to make  a judicious use of  it, and besides, must
only confide in  such  histories as  present  sufficient characteristics of
truth,  some of which we will mention.   1. The reputation of an author
is an essential thing to consider.   Faith is much more  readily given to
the recitals of a man  like  Hippocrates, who  has  the reputation of an
attentive observer and truthful writer, to whatever sect he  may belong,
than to the narration  of  one like  Andrews, who  has the  character of
being  an inexact observer and an insincere writer.  2. When several
histories, of different  epochs and countries, recount the  same fact, with
analogous circumstances, it is a powerful motive to confidence.  3. A
still surer guarantee  of the correctness of a history is, that it accords
with our own observations.   It is  necessary, then, before receiving  the
statements of a writer, to submit his narration to a critical  and severe
examination, and to accept it only in proportion to the degree of certainty
it presents.  Thus illuminated, history becomes a  sure guide, and an
extremely useful repertory for a practitioner. 
216
ANATOMICAL PERIOD.
                         EPILOGISM OR ANALOGISM.
  It may happen, that a new disease  is presented  to  the practitioner,
which has not before been described.   In that case, neither autopsy nor
history  can offer examples  as  a guide.  It may happen, also, that in
treating a well-known affection, the ordinary remedies  indicated are not
at our  disposal; here, again, history and autopsy do  not aid  us.   In
both these cases, one is obliged to have recourse to reason,  and  be
guided  by analogy.  For example,  a  physician  has a case  not before
seen, nor  described by  authors.   Search, say the Empirics,  among the
historical relations,  or  in  your  own  experience,  what  there  is  that
approaches nearest to the present disease,  then treat it with those reme-
dies which have succeeded with the former.   Thus, the treatment which
has been employed  successfully in  erysipelas, may be  tried  in certain
skin affections which  strongly resemble that  disease.   So, also, a  rem-
edy which had cured  a rheumatism  of  the  leg, would  very probably
cure it in the arm.   If it is desirable to replace a remedy whose efficacy
is known, but which is not to be had, by an equivalent  remedy, seek, say
they, among the medicines at your disposal, that which is most similar
to the one you lack.   Thus,  you  may substitute  the juice  of  the  per-
simmon for that of the quince, on account of the astringent taste which
is common to both of these fruits, in  the  treatment of a diarrhea, the
result of mere relaxation ; and a decoction of  flaxseed  may well replace,
in certain cases, that of the root of the althea.
  To illustrate epilogism or analogism still further, suppose a patient
is attacked with pain in the hypogastric region, which is sometimes  very
acute, again less so; returning irregularly, and then sometimes entirely
disappearing.   If these pains are increased by walking, and especially
by riding on horseback;  if the emission of urine is occasionally inter-
rupted  suddenly, to  commence again after  an irregular interval;  if a
metallic sound  introduced through the urethra into the bladder, comes
in contact with a body that creates  a sensation of rubbing against a
rough and solid substance, this concourse of circumstances would autho-
rize the physician  to think that a vesicular  calculus is the  probable
cause of these  symptoms.  Likewise, if the cranium  of  an  individual
who has accidentally lost his reason, presents cicatrices, and a depression
of bone, it would be permitted to conjecture that a wound of  the  head
is the cause of  this mania.   Finally,  if an individual  has been bitten
by a strange dog, though the wound may present nothing  peculiar in its
character, it would be prudent to treat it as an envenomed wound, because
observation teaches that the bite of a mad dog  resembles entirely that
of any other dog, and when  there is doubt,  it is best to take the surest
method  for the prevention of hydrophobia. 
THEORIES  AND  SYSTEMS.
217
                        DEFINITIONS OP THE EMPIRICS.
  As these  physicians  rejected, absolutely, the latent causes, and the
so called  essential elementary  or  primitive properties of disease, they
could not admit the definitions of the  Dogmatists, which are based, for
the most part, on the pretended essence of things, or on their proximate
or occult cause.   They replaced them, therefore, by a simple description,
called hypotyposis, which consists  in an  abridged  enumeration of the
sensible phenomena.   Thus, instead  of defining fever, like Galen,  to he
an unnatural fire fixed in the heart; or, with Asclepiades, an accelerated
movement of the blood, occasioned by the obstruction of  the  pores ; or,
with Erasistratus, an affection proceeding from the passage of the blood
from the veins into the arteries, they say, fever  is an affection which
manifests itself by an acceleration of the pulse, the augmentation of
heat,  accompanied  often by thirst.  While Galen made  health consist
in the normal temperament of the heat, cold, dryness, or moisture, of
the different parts; in the  exact  proportion,  number, and situation of
compound parts, and in the perfect mixture of the humors, the Empirics
said,  very simply, that a man  was supposed to be in good health,  when
he enjoyed the complete exercise of all his functions.

                              EXPLANATION.
   I must remark,  apropos  to the definitions, that the doctrine of the
ancient Empirics is very singularly related to that of modern Sensualists.
The Empirics rejected occult  causes, and the properties called essen-
tial, or primitive ;  they denied that we  are  able to know the  intimate
nature of things, that is to say, what things are, in themselves.   They
assumed,  that we are able to seize only the relation  of things to us, and
among themselves, because these relations are due to our sensations, and
all our knowledge comes through the organs of sense.   They  insist that
our judgment and reason,  in the facts of Medicine, can never pass the
limits of the capacity  of our  senses.   In fine, they replace  definitions
by simple descriptions, which  accords  with  thepractice of  modern Sen-
sualists.0
                         ANATOMY AND PHYSIOLOGY,
   The Empirics are reproached with having neglected anatomy and
physiology.   This is supposed by some, however, to be exaggerated; they
did not  deny, absolutely, the utility of these  two branches of medical
science, but regarded them  as  accessory ;  yet they placed clinical obser-
vation before all.   It is difficult to know the truth, on this point, while
we only know the opinions  of  the Empirics  through  their adversaries.

          0 See Art de Penser, de Condillac, part. 1, chap, vm and x.
        13 
218
ANATOMICAL PERIOD.
 It  does  not  appear reasonable, that the disciples of the greatest anato-
 mists of antiquity could  have denied  the  importance of  the discoveries
 of their masters.   However this may be, if the coryphei  of Empiricism
 have committed this medical heresy,  they are so much the more culpa-
 ble, as it is in flagrant contradiction  to the  fundamental principle  of
 their doctrine.   How could  the philosophers, who supposed all  ideas
 derived from sensations, depreciate anatomy—the only one of the depart-
 ments of Medicine which owes  almost nothing to reasoning, and which
 obtains, on the contrary, all its light from observation?  Besides, is it not
 evident,  that a knowledge  of anatomy is necessary for the practice  of
 surgery ?  As to physiology, the ancient Empirics are somewhat excusa-
 ble for having  despised  it;  because,  in their time, the science was, in
 general,  made up of long dissertations on the principle of life, the ele-
 ments  of the body, the primary  cause  of generation, and a crowd  of
 other mysteries, just as impenetrable.  But  by the side  of this  tran-
 scendental and  empty physiology, they reared  another, less ambitious,
 which  following anatomy, step by step, was limited  to the  description
 of the functions of organs  of which  anatomy showed the form, situa-
 tion, and structure.   This  last physiology,  which  I  call  organic,  to
 distinguish  it from the other,  is  eminently useful, and, I will  say.
 indispensable, to the pathologist and practitioner.
                             THERAPEUTICS.
  In the remote ages, as we have  heretofore said, there was no thera-
peutic axiom.   When a treatment was successful in one  affection, and
there occurred afterward other analogous cases, or that appeared as such,
the same treatment was  employed,  without  inquiring whether it acted
 in virtue of one principle or another.  The conduct of those who practiced
Medicine  in  those  primitive  times, was purely instinctive;  but proper
reflection  will show,  that that instinct had  for a basis  an infallible
axiom, which  we have  announced heretofore, and which it will be well
to repeat now:  Those remedies which have cured one case  of disease,
will cure all cases analogous to it.°
  This axiom has  no need of demonstration; its truth strikes us like
an  axiom in mathematics.  Nevertheless, Hippocrates and his disciples
believed  it their duty  to substitute another in its place ; not surer,
but which they believed of more easy application in Medicine,  to  wit:
Diseases are cured by their contraries;  which was  adopted  almost
unanimously, and is now invoked by most physicians.
  We have, it is true, heretofore, pointed out two books  of  the Hippo-
cratic collection, whose authors, without contradicting the axiom,  deny
c See Mystical period. 
                      THEORIES  AND  SYSTEMS.                  219

that it is applicable to the cure of all cases.  These authors affirm that
certain affections have been cured by similars, while others again  have
been cured by remedies which appear neither to be similar nor contrary
to the nature of the disease.0
   The Empirics went much farther; they assumed that the intimate
nature of diseases, as well as their proximate or essential causes, being
impenetrable, we can not hope to discover the  species of relation that
exists between  this nature, or these causes and the action of any remedy.
Bleeding, they  said, cures certain inflammations and exasperates others.
Experience teaches us this ;  but who would be able to foresee the result ?
What connection is there between the subtraction of a liquid necessary
to life, and the resolution of a phlogosis ?  A small dose of opium often
produces sleep, while a stronger  dose causes  insomnia.   Is there, then,
an opposition between two unequal quantities of the same substance, that
it should produce two contrary  effects ?  Wine, taken immoderately,
plunges  certain  individuals  into a lethargic sleep ; but in others  it
excites a furious delirium.   Is it similar to the nature of the first, and
contrary to that of the second, or vice versa ?
   Those who maintain that it is necessary to know the essence of a dis-
ease,  before  treating it, should at least agree  on what the essence is.
But if you ask  some of them, in what consists the nature of a phlegmon,
one will  respond, that it is a tumor, caused by the excessive heat of the
blood; others, by the acridity of the bile; a third, by the closing of the
pores; a fourth, by  the  extravasation  of the  blood, etc.   But, while
waiting  for the dispute to terminate, if  ever, what guide shall we take,
to treat  properly a tumor of this kind ?  Certainly there is none other
than  experience.   Experience, alone, has taught us what we must do in
such a case.
   All that may  be affirmed  for a treatment  which has been successful
in disease, is, that it will procure the same success  afterward,  if it be
employed against the same concourse of pathological phenomena.   Thus,
therefore, the important and essential matter in order to make the cura-
tive indications as precise as possible, is to observe carefully, and define
well,  the pathological  phenomena.
   As the practitioners of the same epoch employed very  nearly  the
same  means  of cure, notwithstanding the divergence in their theories.
the Empirics concluded that in reality all were influenced  to do so by
experience, which varies but  little, while theoretical explanations con-
tradict themselves incessantly.
  0 QSuvres d'Hippocrate, trad, par Littre', T. I: Traite de l'Ancienne Me'dicine,
from § 10 to 20, inclusive.  Traite' des Lieux dans PHomme, §§ 67, 68, 69, 70.
  Note.—Every physician knows the aphorism : A vomit will often cure vomiting. 
220
ANATOMICAL PERIOD.
                               COROLLARY.
   Moreover,  the question which we now discuss is one of the most inter-
esting and intricate.   It constitutes the basis of therapeutics, or of the
Art, properly speaking.   It  has been,  at various epochs, the subject of
long debates, and  must, therefore, be presented more than once in the
course of this history, and  particularly apropos to modern theories.
It is not yet, therefore, the proper time  to discuss it in full.   I will only
say, in anticipation, that a disease is never the result of a  unique
influence.
   Take, for example, several individuals wounded by a sharp  instru-
ment, in the same manner, and  in the same region of the body.  Here
is a very simple affection; nevertheless  it is probable that it would not
run the same course in all, on account of individual peculiarities, which
are so different.  Thus, in the most simple cases, the disease is always
subjected to several simultaneous, or successive influences, so that it may
be regarded as the result of  several forces.   Now, to neutralize the bad
effects of this  result,  and to destroy it, it  is  not always  necessary  to
oppose to it an irifluence directly contrary, and of an equal or  superior
energy.  Ordinarily, we may suppose that it will suffice to change the
direction of this result, or moderate its intensity,  by modifying one
alone, or a few of its component forces.
                ORIGIN OP PHILOSOPHIC, OR RATIONAL EMPIRICISM.
  Some authors think that Empiricism is a deduction from the Skeptical,
or Pyrrhonean doctrins.  Galen seems  to be  of  this opinion,  when  he
advises an Empiric to imitate the modest conduct of a Pyrrhonean phi-
losopher, to prove himself as simple, sincere, exempt  from all ambition,
and seeking to prove the  excellency of his  doctrine, by a  skillful and
happy practice, rather than by  a long discourse.0
   Kurt Sprengel  adopts  the above sentiments of Galen,  and  asserts
that medical Empiricism is  a  consequence and off-shoot of philosophic
Skepticism.f   Nevertheless,  Sextus Empiricus, a medical philosopher
who lived  at the commencement of  the third  century of the Christian
era, and who has left an apologetic explication of the Pyrrhonean phi-
losophy, denies that there is, between that doctrine and Empiricism, the
analogy that many persons have supposed they have seen. J
   This difference of opinion  obliges me to  throw a  comparative coup
a"ceil  on the  two   systems.   1.  The  Pyrrhonean philosophy  rests in
doubt  in  regard to every thing, because there exist, according to it,

      0 De Subfiguratione Empirica, cap. xin.
      f Histoire de la Me'dicine, Paris 1815,  T. I, p. 469, et suiv.
      J Text. Empir.  Pyrrhon. Hypotyp. lib. i, cap. xxxiv. 
                      THEORIES AND SYSTEMS.                  221

equal reasons for  affirmation  and negation, in all questions.   The
Empiric rejects the opinions which are not immediately derived from the
senses, but  admits the certainty of facts,  and truth of observations.
2.  The Pyrrhonian philosopher says, that there are sensations which are
pleasant, and others that are disagreeable;  it offers as an example, that
honey is  sweet to  the taste—that pain is distressing; but if asked,, in
what consists  the essence of  the sweet taste, and the suffering of pain,
he ingenuously acknowledges his ignorance, and replies,  that he knows
nothing about it.  The Empiric accords with the Pyrrhonean in this: he
confesses that he is completely ignorant of the essence  of  things, and
affirms, moreover, that the question is impenetrable, because it  is inap-
preciable to the senses.   The Dogmatist on the contrary does not hesi-
tate  to give an  explanation of the essence; he will tell you that  pain
proceeds from a disjunction of the elements, and that the sweet taste is
derived from the temperate mixture of heat, cold, dryness, and moisture.0
3.  The Pyrrhonean is naturally inclined to  inaction, never feeling a
positive motive to take a part.  In medicine he will follow, from predi-
lection, the expectant plan.   The Empiric employs, on the contrary, an
active medication.   Convinced of the truth of the rules of his art, which
he believes deduced from exact and repeated observation, he does not
hesitate to put them in practice.
   This parallel  between the two doctrines  proves  that,  while there  is
between  them  some similitude, there  exist, also, capital  differences,
which prevent us regarding them as proceeding from a common source.
On the other hand, in following attentively the phases of this history, it
is easy to see that Empiricism has an origin purely medical.   We have
seen, in the first place, that physicians of primitive times followed by
instinct the Empirical method; much later, Acron of Agrigentum, cotem-
porary of Pythagoras, affirms, that experience is the  only true founda-
tion of the Healing Art.   Hippocrates, himself, although  endeavoring to
attach his medical  doctrine to the  Pythagorean  dogmas does not  less
proclaim, in  many cases, the  superiority of  observation to theory;  and
in  his clinical observations he  shows himself more careful to report,
faithfully, the facts, than to justify his theoretical views.
   The surprising progress of anatomy and physiology, during the first
ages of the Alexandrian Institute  having confounded several  points of
the  Hippocratic  doctrine, the  confidence which it inspired began to
diminish.  Then a thousand new speculations were hazarded, to explain
the functions of the animal economy, which nullified each  other.   In
the  midst of  this  anarchy,  wise  practitioners, to whom  experience
0 See Galen and Hippocrates. 
222
ANATOMICAL PERIOD.
demonstrated  every day the utility  of certain  remedies,  continued,
naturally,  to  seek  in experience alone, a refuge from the  incessant
variations of Dogmatism, and the sterile incertitude of the Skeptics.
  If, now, the question be asked: to what philosophical doctrine Medical
Empiricism is attached, there is  not  one of my readers who is not in a
state to respond, that it is intimately united to the  sensual philosophy; a
philosophy, of which the foundations were laid by Aristotle, but  who
abandoned it almost immediately, to trace the rules of metaphysics, and
the logic of rationalism.   In short, that philosopher, deceived by superfi-
cial observation, asserts that general ideas are the first that are formed
in our minds,  by the aid of the senses, and that they constitute the prin-
ciples—the beginning of the sciences.  Now, modern metaphysicians have
demonstrated, that the sensations give us only individual ideas; and that
general ideas, being the  result  of an operation of the  understanding,
called  abstraction, are the last  formed; whence it follows, that,  so far
from  being the foundation stone of the scientific edifice, they are the
key stone of the arch.
  The Empirics adopted the basis laid down  by the  chief  of  the Peri-
patecians;° but, instead of engaging, as he, in seeking at first the gene-
ralities of science,  malapropos  termed  principles, they confined  them-
selves  to  a careful collection of facts,  and an exact narration of  them,
in order to deduce  therefrom rules  of  practice.   We see that, in  this
way, they laid the true basis of  the Art;  but by not  attempting to ele-
vate themselves to the most abstract generalities, and  universal axioms,
they left their work incomplete, not  indicating, even to their successors,
the final end to which they should direct their labors.
                         PROGRESS OP EMPIRICISM.
  The Empirical doctrine took, at  first,  a rapid extension; we have
already cited  the  names of  three  celebrated authors, who  taught it
towards the epoch  of its foundation.   Galen cites  a much  greater num-
ber, of whom  several wrote much, but  whose  works are entirely lost to
us.   It appears that in the time, even, of that author,  the term Empiric
was not yet a disgrace,  and that men  of high public estimation were
attached to it.  Galen,  who was not accustomed  to flatter his adversa-
ries, and who covered with  contempt the Methodists, speaks of the
Empirics  with much regard; he avows, more than  once, in combating
their system, that their arguments unsettled him.f  We have seen that

   °In a passage heretofore cited,  Aristotle says, formally, that the sensations
beget ideas and remembrance, from which flows,  subsequently, experience, the
common origin of the sciences and the arts.
   f Galen, De Subfiguratione Empirica, cap. xm., et passim. 
THEORIES AND  SYSTEMS.
223
the Methodist,  Aurelianus,  spoke of some of them in very honorable
terms.  Finally, the Eclectic,  Celsus, judges them still more advan-
tageously.
  The moderns  who have given themselves the  trouble of studying the
ancient doctrines,  have nearly  all  admired the wise  and ingenious
economy of the system of the Empirics.  I will  cite,  among others.
the historians Daniel LeClerc and Kurt  Sprengle.  The last expresses
himself thus,  in one of the passages where he eulogises Empiricism:  " I
see, in all these principles, the most evident proof of the great sagacity
and  sound judgment of the ancient Empirics.   Certainly, they were
more inspired by the true genius of  medicine, than most of their prede-
cessors (the Dogmatists), who gave themselves up to vague theories."0
   The  circumstances  in the  midst of which  Empiricism was pro-
claimed,  were  most favorable for its propagation.   Medical theories
had fallen, as we have seen, into confusion.  All the principles, meth-
ods, and  opinions,  were questionable.  The recent  discoveries  in anat-
omy;  the introduction of a considerable quantity of new medicines,
whose properties were  yet undetermined;  the furor of the philosophic
disputes,  which increased,  all disturbed the antique dogmas, without
substituting  anything  better in their place, or, nothing which obtained
general favor.  In the midst of such conjectures, a doctrine which pro-
posed to  put  an end to the perpetual variations of Dogmatism,  and avert
the sterile incertitude of Skepticism, by resting solely on the evidence
of facts, ought to have been received with enthusiasm, especially by those
practitioners, to whom daily experience demonstrated the uselessness of
dialectics to advance medicine.
                   DECADENCE OF THE SYSTEM OF THE EMPIRICS.
   Although  Empiricism was founded  on pure observation, we can not
hesitate to perceive that it did not put an end to differences of opinion,
nor incertitude;   for  if rationalism, which  proceeds  from generals to
 particulars, is  subject to deception, the  experimental method, or sensi-
 tiveism,  which proceeds from particulars to generals, has also  its grop-
 ings.   Moreover, the ancient Empirics, by stopping at secondary gene-
 ralities,  without  striving to  go up  to first principles, or, better  still, to
 definite axioms, resemble workmen who  stop in the middle of  the erec-
 tion of  an edifice.  Finally, the greatest wrong of Empiricism, in the
 eyes of  antiquity, was, in  not attaching itself to any philsophic theory
 then  known.  Such  a doctrine, though able to captivate practitioners
 by its simplicity, could not satisfy speculative minds.   It had  not, then,
 the elements of life required by the learned world at that epoch; so ite
                       * Hist de la MecL, T. i, p. 476. 
224
ANATOMICAL PERIOD.
fall was complete.   Empiricism has been in disgrace for many ages, and
its name has become synonymous with ignorance.  Nevertheless, we shall
see  it revive from this long humiliation, and aspire, even rashly, under
the name of the Experimental  method, to universal dominion  in the
sciences, after  the  labors  of  Bacon, Locke and  Cordillac shall have
cleared up, somewhat, its metaphysics.
                    ART. III. ON METHODISM.
  The doctrine of  Empiricism had been proclaimed about a century and
a half, and  in that time  a great number of  celebrated physicians
endeavored to  establish  the Healing Art on its principles.   They col-
lected clinical observations with  as  much care as possible, and made
from them, model descriptions of  each species of  disease, with the indi-
cation of those remedies that had produced  the most  advantageous
effects.   But they  had vainly multiplied  these  model descriptions or
paradigms ;  cases were incessantly appearing, in practice, that presented
different features from those that had  been observed, which required
the construction of new theorems; for, according to this doctrine, every
concourse of symptoms not before described by  authors, was thought to
represent a new disease.   In this way, there was a tendency to an
indefinite multiplication of morbid species, and  the Empirics fell  into
the same defect of  which Hippocrates had  reproached  the Cnidians ; a
defect which must inevitably lead to confusion, so long as similar kinds
were not united in a common species,  and analogous species  into other
groups of a superior order ; in short, so long as  they  did not rise from
secondary generalities to more elevated  ones.   Thus, pure Empiricism.
such as  its  founders had conceived,  had reached  its  limit, and could
render no further services to science,  and though it had  laid the  true
foundation of the edifice, was incapable  of continuing and completing
perfectly the structure.
   In the meanwhile,  a man endowed with rare intelligence,  and a
remarkable faculty of elocution, but  better versed in the doctrines of
the philosophers and grammarians than  in the practice of Medicine,
Asclepiades, of  Bythinia, came to Bome with the intention of teaching
rhetoric.  The charms of his mind, his talents, and  his address,  gave
him, immediately, access to the most  illustrious  persons  of the Bepub-
lic.   He  taught eloquence, for a time, with great eclat, and as early
as  the one hundred and  fiftieth year before Christ, enjoyed  a  high
reputation as a rhetorician, for Cicero honored  him with  his intimacy.
Notwithstanding this, he  abandoned the career of letters,  to under- 
THEORIES AND  SYSTEMS.
225
take the practice  of  Medicine; but, being unwilling to follow in the
tracks of his predecessors, he took  upon himself to create a new sys-
tem.   Imbued  with the philosophy of Epicurus, then in high repute
among the higher  classes of Boman society, he deduced from it a theory
which united to its merit as a novelty, that of being in harmony with
the philosophic ideas  most in vogue.
   Asclepiades taught, as a consequence of the dogmas of Democritus
and Epicurus, that the elements of the body existed  from all  eternity ;
that  they  are  incommutable in their essence, indivisible, impalpable,
and perceptible to reason only.   These elements, which he named atoms,
possessed no quality,  per se, but were of various shapes, and  animated
by a  perpetual motion ;  and that  from their frequent encounters  and
fortuitous  combinations, all sensible things, all  the phenomena of the
universe, were  supposed to result.   When any one  asked  this  innova-
tor, how it was that  the body could be endowed with properties, when
its constituent parts  had  none, he replied, that compounds and aggre-
gates  differ very much from  their elements; that the order and num-
ber in which the  atoms became  united, the shape  and size  of bodies
which resulted from their aggregations,  were the sole causes of the
properties  observed in them.  Solid silver, he said, is white, but reduced
to powder, it appears black; the horn  of  the goat, on the  contrary, is
black, but if it be rasped, the particles are white.
   Passing  from general physics to physiology, Asclepiades affirmed that
the human body  is  formed of tissues every  way  permeable, that is,
pierced with  invisible holes, which he named  pores, through  which
passed and repassed, continually, atoms  of various  shapes and sizes.
He pretended to explain all the physiological and pathological functions,
the secretions,  sensibility,  pain, etc., by the  spontaneous movements of
the atoms, and their continual passage through the  pores of the body.
Health depended on the extent of the exact symmetry of the pores with
the atomic molecules.  Besides, he repelled, with derision, the hypothe-
sis of a motive principle  in the animal economy, endowed with instinct,
and watching  over  the preservation  of the entire  body or any of its
parts.  He ridiculed the  theory of Hippocrates, on coction, crisis and
critical days, for he did not expect any beneficial action from the efforts
of  nature,  and relied entirely, for the cure of the sick, upon the skill of
the physician.   He called the circumspect therapeutics of the venerable
man of Cos, a meditation on death.
   If  the physiological explanations of Asclepiades were  but little  cal-
culated to  deceive a thoughtful mind, and especially physicians,  who
were  accustomed  to watch the progress of diseases, his therapeutical
maxims were eminently calculated  to  secure to  him the confidence of 
226
ANATOMICAL PERIOD.
the sick.   He proposed no other aim in his treatment, than to  enlarge
the pores when they were too contracted, as the result of the constric-
tion of  tissues, and to close them when they were too  open.   To attain
this end, he said, only certain, prompt, and agreeable means should  be
employed.   Consequently, he rejected  all  violent  remedies,  such  as
vomits, drastics,  incisions,  and the cautery.   He  employed blood-
letting rarely,  and  recognized  only a  small  number  of   surgical
operations.   His favorite  remedies were generally taken from hygiene,
such as walking  and  other  physical  exercises, riding  on horseback,
in carriage, and  in  boat-rowing; frictions executed  in  various  man-
ners, and wine,  which  he administered  frequently, either pure  or med-
icated,  etc.
   Unquestionably, these means are useful in  many cases;  employed
appropriately, and concurrently with others, they render  great  service,
especially in chronic affections, and  during convalescence ;  but to limit
medical counsel to their use alone, and to abstain voluntarily from many
other resources,  more powerful,  is to exhibit a desire to please patients,
and obtain their good will, rather than to be desirous of  restoring them
to health. Thus, Asclepiades,  aiming at a circumstantial  success, rather
than  at solid reputation, obtained, notwithstanding all his  talents, but
an ephemeral celebrity.
   Themison of Laodicea, a disciple of Asclepiades, was led by the teach-
ings of  his  master, to  lay the  true foundation of Methodism.   After
having  divided, like him, all diseases into two great  classes, under the
title of  acute  and chronic affections, he separated each class into  three
species, viz: the constrictive or  contracted ; the fluxionary  or relaxed ;
and the mixed.  Then  he established the distinction of these  species,
not on the occult qualities of  the Dogmatists, nor on  the consideration,
no less  hypothetical, of the state of the pores, but on  the sensible  char-
acters drawn  from medical observation.  He called  these characters,
sometimes, communities, because they were common  to diseases of the
same species, and again similitudes, because they  indicated certain like-
nesses or similitudes in diseases.
  The communities of the constrictive species, are swelling,  tension, and
hardening  of structures,  the  partial  or  complete suppression of some
natural evacuation, all  the signs, in short, that  indicate the constric-
tion of  tissues.  The communities of the relaxed species are softening
of tissues, the diminution of the entire volume of the  body, or  some of
its structures; the increase of ordinary evacuations, or the appearance of
some abnormal evacuation.  Lastly, the communities  of  the mixed
species  consisted  in  a mixture, a coincidence of signs that  indicated
both constriction and relaxation. 
THEORIES AND  SYSTEMS.
227
   Themison had attained an advanced age when he published  his plan
 of reform, and we are ignorant to what  degree of perfection he carried
 it.   We know, simply, that Thesalus of Tralles, and Soranus of Ephesus,
 made changes in, and additions to it; but it is  impossible to say pre-
 cisely, what part each of these authors took  in the creation of the sys-
 tem of the Methodists, now when all their works have been lost.  There
 exist none of the writings of  this sect, but the treatise of Ccelius Aure-
 lianus, of whom I have already spoken;  and it is the work, from which
 we have extracted, almost entirely, what we  have said  concerning the
 doctrine of Methodism.   The  following  will show the  arrangement of
 diseases: first, the constrictive of  the acute variety;  apoplexy, angina,
 lethargy, convulsions, ileus, madness, etc.; of chronic affections, cepha-
 lalgia, vertigo,  epilepsy, mania, jaundice, amennorrhea,  obesity, etc.;
 secondly, the relaxed  species: cardialgia or  gastralgia, cholera,  hema-
 temesis, and other hemorrhages, including the hemorrhoidal flux ; thirdly,
 and lastly,  of the mixed species:  peripneumonia, pleurisy, colic,  disen-
 tery, etc., asthma, paralysis, catarrhs, phthisis, etc.
   It is plain that there is much that is  arbitrary in  the above classifi-
 cation.  Besides, the Methodists were not agreed amongst themselves, on
 the class in which several of these  should be placed ; some, for instance,
 insisting  that hydropsy belonged  to the constrictive class, others  to the
 relaxed;  some thought  asthma should  be enrolled among the mixed,
 others, that it belonged to the fluxionary  speciss,  and so forth.   But the
 greatest reproach that can  be brought against the classification of the
 Methodist, is the  union of very different diseases, in one community,
 and  the separation of  analogous ones.   However this may be, this
attempt at a pathological classification, founded on the evident characters
of diseases,  and not on occult causes, or imaginary qualities, was a great
 progress.
  It followed from  this division of diseases, that with the Methodists
 there were only two kinds of therapeutical indications to fulfill, viz.: to
 relax when there was constriction, and to constrict where there  was a
 flux or relaxation.   Also, they admitted  but two modes of treatment,
 which they named curative communities.   All therapeutic agents were
 comprised in one or the other of these communities.   Blood letting, for
example, cups, emollient cataplasms, warm and  laxative drinks, sudo-
rifics, warm  air, sleep, exercise carried to fatigue, etc., form a part of
the community of  relaxants.   Darkness,  fresh air, cold and acidulated
 drinks, decoction of the quince, red wine, or vinegar,  solution of alum,
etc., were ranked in the  community of astringents.
  Some  Methodists  admitted a third curative  resource,  which they
named prophylactic.   It comprised  all  the  special  means in use, to 
228
ANATOMICAL PERIOD.
prevent or arrest the toxic effects of poisons and venemous substances
But the pure Methodists, such as Aurelianus, rejected this community,
and would not admit specific remedies, any more than specific diseases-
They  erased  from their materia medica, purgatives, diuretics, emmena-
gogues, anodynes, somnifera, etc., excepting from this general proscrip-
tion vomits only,  which  they gave,  not  with a view of evacuating  the
bile  or phlegm, like the  Dogmatists and Empirics, but to  give  the
economy a shock  which  would open its pores,  and  change the general
disposition of things.
  In  the progress of diseases, the Methodists distinguish three periods,
or temporary conditions, viz.: the periods of  development, stasis and
decline.  Each of these temporary conditions required  particular care,
and became the source of the curative indications.
  Lastly, there was added a fourth or last community, called chirurgical,
that embraced all the operations of surgery.   It consisted in removing
from the body the things which were foreign to it, and unnatural. This
 lass was subdivided into several others, accordingly as the foreign or
unnatural things were of external origin, as a thorn, an arrow, etc., or,
as they were from within, as  a tumor, an abscess, an excrescence, an
ulcer, or hair-lip, etc.
  By the help of these  summary considerations, touching the common
symptoms of diseases,  and their  curative indications, the Methodists
believed they might dispense with all ulterior research.  They did  not
inquire for the causes,  whether occasional or  proximate, because they
said from the moment  that the disease is developed, it is necessary to
cure it.  The indications in diseases were  to be drawn from its nature,
characters  and progress, and not  from anterior circumstances, which
exert no influence.  Now, the nature of diseases  consisted,  uniquely,
according to  them, in the  conditions or communities of which I have
spoken.  Neither did they attach much value to the  precise knowledge
of the seat of the disease, or affected parts;  nor to the consideration of
the age of the patient—his habits—the general state of his forces—nor
to climate  and season.   They assumed that these details were superflu-
ous,  and could  not affect any notable modification of the treatment.
For, according  to their system, an affection of the  constrictive species,
such, for example, as an inflammatory tumor, always requires the same
kind  of treatment,  whatever may  be  its locality, or the age  of  the
patient, the climate or  the season.  If, sometimes, they gave  attention
to the region particularly affected, it was only  for the purpose of apply-
ing the topical treatment indicated, more exactly at the seat of  the
disease.
   The Empirics, anxious to secure themselves from the error into which 
THEORIES AND  SYSTEMS.
229
the search for proximate causes, first principles and elements, had drawn
their predecessors, the Dogmatists, could  think of nothing better than
to banish from science all transcendent generalities.  Finally, then, to
keep as  near as possible to the truth, based on observation, they estab-
lished  as many morbid species as they had encountered different assem-
blages of symptoms.   This resulted, at length, in  such  a multitude of
species, that it became extremely difficult to recognize them, separately,
especially as  some among them were only separated from each other by
light shades of difference.   To obviate this embarrassment, it was neces-
sary, as we  have already said, to unite together all the analogous morbid
species, and form them into genera, which being few in number, and dis-
tinguished  from each other in a marked manner, could easily be recog-
nized ;  then, with a  knowledge  of the  genus,  the mind could easily
descend to  a determination of the species.   In  this way, a philosophic
method serves as a lever to the feebleness of our understanding.
   But the Methodists misconceived the true use  of the groups of the
second order, i.  e., the genera which  they had established.  Instead of
making  use of them  to  arrive more  conveniently at  the determination
of the species, they rejected them as  useless, and preferred to rely exclu-
sively upon their general principles; so that they would treat by the
same means, mania, jaundice, amenorrhea,  etc., which are chronic affec-
tions of the constrictive genus; and, on the other hand, peripneumonia,
colic, dysentery, etc., acute affections of the mixed order, were also all
treated alike.   They had  no  regard,  either to  the natural tendency of
the vital forces, or to coction or crisis, or a multitude of other  essential
circumstances which  we  have lately enumerated.   Lastly,  they  had
much less regard for anatomy and physiology than the Empirics.  Their
desire to simplify the practice of  medicine  was so  great, that  they  sub-
mitted all their patients to a uniform regimen.  They were all required
to fast for the first two or three days.  During the second ternary,  they
 allowed them a small quantity of food, and so on,  increasing their nour-
 ishment gradually, every three days.   Their  mania for  uniformity is
 nowhere revealed more  sensibly, than in  the mode of  treatment called
 the metasyncritic circle, or, more simply, metasyncrisis, which  they
 employed in very obstinate affections, after having exhausted their ordi-
 nary means.  The following is a description of the famous metasyncritic
 circle, as given  by Coelius Aurelianus, in  his treatise on chronic diseases.
 Book first,  chapter first:
    " The first day, the patient must fast; the next day, after being car-
 ried into the open air for a  short time, he  is  to be anointed, and  even
 bathed,  if  his pain permit; then he is to receive one-third the quantity
 of bread which he was  in  the habit of using in health.  He is also 
230
ANATOMICAL PERIOD.
allowed to eat salted  and roasted  meats, dressed with mustard, green
olives preserved in salt, and other things of the  same nature;  but he
must abstain from pork, from garlic, onions, and other herbs which excite
the brain.   As a beverage, he shall have wine; and this  diet is to be
continued for two or three days, if he can  support it: and sometimes
fish  and brain are  to  be added  to the above mentioned meats.   After
this, the second third of the  bread of which  he was deprived  may be
allowed, with brain  and fish, and herbs, for two or three days.  Finally,
his full amount of bread is to be given to him,  and the former meats
exchanged for that of fowls; which latter is  to be continued as long as
the preceding; and, lastly, is to be followed  by the use of pork.
   "If it  is  desirable  to change more frequently, the bread may be
divided into four parts—so that one part may be  given at  each  change
of the meats—thus, the first part is given with the middle diet, another
with fowl, a third with game, and the fourth  with  pork; but, to prevent
the patient becoming disgusted by eating, for so  many days, the same
sort of meats, it is necessary to vary as much as  possible, each  kind of
food.   The first day, for example, when he  uses  salt meats, he  should
make the meal with a  sardine,  and a little sea-fish.  When  he uses
middle diet, which is composed of fowl, he must use sometimes a  thrush,
and, at others, the  titlark,  or  snow-birds, or young pigeons.   Apples
may also be given, in small quantities, so as not to produce flatulency.
When  pork is used, vegetables  must be added, taking care not to allow
too many nor too rich articles.  In changing from one sort  of  diet to
another, frictions, and  water as an exclusive beverage,  are  to be used;
but,  on the following days, wine may be given, and a bath be taken.  It
is unnecessary, nevertheless, to bathe every day;  because too frequent
bathing may renew the headache.   The movements of the body must
be augmented and diminished by turns.
   "This first part of the metasyncritic circle being achieved, we come
to the second, in which no other treatment than vomiting is to be pur-
sued.  During the intervals, the nutrition drawn  from salt meats  and
sour substances shall  be suspended.  The  first day, the  patient, after
being exercised a little, shall  endeavor to procure vomiting by  the use
of horse-radish, or with other medicines, if that fail.  It is to be pro-
cured as follows: one  pound of  the  bark  of the root is taken, which,
being cut up very fine, is soaked in honeyed water, called hydromel, to
which is added a little vinegar, or vinegar of squills.  The bark bein»
thus prepared, it is all  eaten a little before  meal-time, and the liquor in
which it was infused, drunk in  small quantities at a time.   Afterward,
he must walk slowly, and then  rest when he  feels  a sour and hot sensa-
tion, which takes place  in  about an hour.  Then,  he must take  two 
THEORIES AND SYSTEMS.
231
glasses of lukewarm water—not more, for fear of weakening the medi-
cine—and put two fingers  down his throat, so as to excite vomiting.
This is to be continued, until every thing is thrown up that has been
taken.   Then a large quantity of  water is to  be drunk, to wash the
stomach, and extinguish the remains of fire that the  horse-radish may
have kindled  there.  After this, vomiting must be excited afresh ;  and
thus the water and vomiting must be repeated three or four times con-
secutively, until the water is thrown up as clear as it is  swallowed.
   " The vomiting being ended,  the head is to be fomented, and the
mouth rinsed with  warm  water.   After awhile, a  gentle promenade
should be taken, to relieve the head from the agitation and excitement
which  has been brought about by the shock of the vomiting ; or, what
will have the same effect,  anointing the body and rubbing it with the
hands, from  above downward, exciting everywhere an  easy and equal
perspiration.  After  this, two glasses of warm water are to be drunk,
and the patient put to bed; where he rests in great repose of body and
mind,  without eating, or drinking,  or sleeping, for some time, or  until
the agitation caused by the remedy ceases.   If  the patient be  allowed
to sleep, while the brain is excited  from the effect of  the treatment, the
effect of the sleep  being  to produce contraction  of  the head, it would
effect the contrary of what is desired.   It is necessary, also, to  abstain
from meats, for fear of its decomposition by the heat and irritation of
the stomach, resulting from  the vomitings, as well as the remains of
the horse-radish sometimes left  behind, which, mingling  with the food,
corrupts it, and gives rise to flatulency;  which,  rising toward the head,
increases the danger instead of  diminishing it.
   " The following day,  the patient  must bathe, and live on the  middle
diet, and after two or three days, he should complete  the other parts of
the circle commenced.  If it  is observed that  the patient is sensibly
better, and that he  has  intervals  of perfect  calm,  after having gone
through  again the resumptive circle, the vomiting should be resumed,
joined with drimyphagy or the use of salt food.   In fine, the  rest of
the metasyncritic circle must  be boldly achieved."
   I terminate here this very long quotation, though I have not half fin-
ished the metasyncritic circle;  those who wish to know it in full, will
find it by consulting the  original, or History  of Medicine, by Daniel
Leclerc,  (2 part, liv.  iv, sect. 1, chap. XI,) what  I have reported will
suffice to convince the reader that this series of proofs, somewhat severe,
through  which the patient is made to pass, is, at bottom, only a  system-
atized perturbating method.
   The founders of  Methodism  mistook the true use of the generali-
ties that they established.   Instead of regarding  them as a progress, a 
232
ANATOMICAL PERIOD.
perfection of Empiricism, as a means of retaining and classing in the
memory the numerous and precise details furnished by that sect, they
rejected their details; they did not consider each genus as a collection
of distinct species, necessary to  be distinguished from each other, but
believed, rather, that the knowledge of the genus  dispensed with that
of the distinction of species.  They were ignorant, that the more an
idea is general, the more it is separated from objective  truth and phe-
nomenal reality;  and how could it be otherwise, when the greatest meta-
physician of antiquity, Aristotle, had  said that the first ideas formed
in  our minds  by the intermediation of the senses,  are  general ones,
while it was  demonstrated,  two thousand years  later, that our first
ideas are particular ones, always relating to individual  objects ?
   The Methodist doctrine abridged, singularly, the study of Medicine,
and to such an extent, that one of  the  coryphei  of the doctrine, Thes-
salus, of Tralles,  could  say, without too  much  exaggeration, that he
felt able to teach the whole Medical Science in six  months.   It  is true,
that  inculcating  solely in  the  minds  of his  adepts some superficial
notions  on the general characters of diseases, and  the virtues of reme-
dies, he placed them, without scruple, in the ranks  of the profession,
but not without frequently  committing blunders.   Unfortunate were
those who imprudently placed themselves in the hands of these off-hand
doctors ; for they, not knowing how to discern the delicate shades which
separate many morbid species, overlooked a multitude of precious indi-
cations,  and prolonged the  sufferings  of  their patients,  or sent them
into the other world, without supposing for a moment that it was the
fault of their treatment.
 I'  Methodism made a rapid  progress, from its advent  in the  medical
world.  It had,  in the first place, as its admirers, the  numerous  vulgar
herd of neophytes, who were anxious to finish their apprenticeship,  to
rush into  practice.   Secondly, it satisfied a natural  penchant of the
human  mind,  the love of generalizations, particularly felt at that epoch, '
and which Empiricism had not gratified.  In short, it rested between
Dogmatism and  Empiricism, as  a  mediator,  combining  the   advan-
tages of both doctrines, without having  any of their inconveniences.
The Methodist said to the Dogmatist: I adopt, like you, rational truths
only; I deduce them from sensible phenomena, and not from circum-
stances insusceptible to observation.
   He said  to the Empirics, like you I take observations for a  guide;
but I do not embarrass the Art with a multitude of precepts difficult to
retain,  and more difficult still, to put in practice.  I deduce from expe-
rience a small number of rules, based on evident signs.
   The  above  is,  without contradiction, a fine programme, as are all the 
THEORIES AND  SYSTEMS.                  233
programmes of system-makers ;  but we know very well how little its pro-
mises have been fulfilled.   Galen was not duped by this reasoning.  He
demolished the sophisms of the Methodists, and demonstrated the insuffi-
ciency of their  doctrine,  and the  dangers of their practice;  he over-
whelmed  them  with  strokes of his satire, calling them  the  asses of
Thessaly, alluding  to the want of  literary and medical instruction in
a great number of them.
                    ART. IV.  ON  ECLECTICISM.
   If we now take a retrospective glance of the systems we have detailed,
we shall see  that in all  of  them  there  are some valuable truths.
confirmed by the reason and experience of all ages, while all are at the
same time tarnished by some exaggeration or error.
   The first  of  all and the  most ancient, Dogmatism, directs our atten-
tion especially to the animal economy, in  health as well as disease ;  it
describes admirably the union of the vital forces,  sympathies of the
organism, and  natural efforts, to repel both  internal  and external dele-
terious  influences.   One of the most characteristic and one of the most
striking traits  of these phenomena of life, is their combined tendency
toward  a common end, which  seems to be premeditated, for the preser-
vation of the individual, for  a certain  period of time.  This nearly
providential tendency manifests itself, particularly, in certain acute dis-
eases, and those who first studied the progress of these affections, applied
themselves,  with a praiseworthy perseverance, to discover the laws which
control  the vital principal, or the organic forces, in each  disease.   This
is the fair side of Dogmatism ;  the one which has  resisted the caprice
of opinion, and the progress of light.
   But beside the organic force, there exist other forces which modify the
action of the first—sometimes deranging and even masking and destroy-
ing it.  These  latter ones, which are named inorganic or physico-chemi-
cal, act sometimes in an obvious manner, as when  a man is killed or
wounded by a mechanical agent or a violent poison: again, in  a latent
form, as when there is developed in the human body  a chronic disease,
by the influence of regimen, air, or some similar cause.   The Dogma-
tists divided the external forces acting on the animal  economy, into four
species,  viz.: heat, cold, dryness, and moisture, which correspond to the
four general forms of matter acknowledged by the  physicians  of those
times—fire,  air,  earth, and water.  Then, to maintain  uniformity or
harmony, they imagined in the  living body the continual presence of four
humors; blood, bile, atra-bile, and  pituite, each one characterized by a
predominance of one of the elementary qualities.  Now, this classification
          15 
234
ANATOMICAL PERIOD.
 of elementary qualities or organic forces, their presumed analogy with
 the  humors  of  the body,  their  mode  of action on the economy, was
 entirely  founded on  imaginary  hypotheses  or presumptions.   How-
 ever, the causes of  diseases being supposed to consist in the excess of
 some one of  these qualities or  humors, the  treatment was directed
 against these supposed causes.  That was the weak side of Dogmatism,
 and on which its enemies attacked it.
   The Empirics were right in opposing the idea of  inaccessible  and
 occult  causes becoming the basis  of  a rational treatment.   They said,
 that the nature of diseases existed in the totality of their  appreciable
 phemomena;  or, in other terms, in the  concourse of these symptoms.
 They affirmed that there was no constant relation of antagonism or
 similitude between a disease and the remedy which cures it.
   The Methodists added a remarkable improvement  to Empiricism, by
forming secondary groups, destined to unite the primitive groups or the
 species of the Empirics.  I will  not recapitulate here the  defects of
these systems, because they  must yet be fresh in the memory of the
reader.   I have sufficiently well proved, I presume, what I advanced at
the commencement of this chapter, that, in each one of the  three great
 systems of Medicine which prevailed during  this historic period, there
were excellent things, mingled with  defects and errors.
   Many  physicians of  antiquity held the same view: they compre-
hended vaguely,  that the entire truth of Medicine did not exist in  any
one  of these  systems; but  they  could  not precisely state, as we  have
 done, that there was both good and  evil in  each, for the philosophic
principles that guide us in our choice were yet unknown.   These physi-
 cians, not being  able to establish any general  rule, which could serve as
 a basis for their judgments,  decided each particular question according
 to their taste, fancy, or reason.  They assumed the name of Eclectics 01
 Episynthetics, to convey  the idea that  they  adopted no system exclu-
 sively, but took from each whatever was best  in it.
   The Eclectics do  not form a sect, since they had no precise dogma or
 theory of practice which was  common  to each and all who were  con-
 nected with  them.   They professed  to  follow,  on every occasion, the
 lights  of reason and experience only; but that is a common idea  which
 all the sects invoke, and  which is not characteristic of any one in  par-
 ticular.   The habitual state of an Eclectic is that of doubt and  incer-
 titude, so that they may be confounded with the Pyrrhonians at  first
 sight; but reflection will show, that the doubt of the  latter was abso-
 lute and universal,  being the result of the principle they held, while the
 doubt  of the Eclectic had no foundation in principle, but was only the
 effect of  uncertainty. 
THEORIES  AND  SYSTEMS.
235
  Eclecticism, in Medicine, is the absence of all fixed principle, or, as
I have said in my introduction, it is individualism erected into a dogma.
Like  the Proteus of the fable, it can not be seized, because it has no
regular form; it escapes refutation, because it is entirely deficient in
principles.   Many practitioners were, or called themselves, Eclectics, to
avoid the discussion of principles, to which they were little inclined or
apt.  Besides, with  this profession they had the greatest  possible lati-
tude, on  any particular occasion, to adopt  the sentiments which  they
thought best.  In fine, an Eclectic is a  man destitute of any profound
conviction, like  a citizen who, in the midst of internal dissentions, sides
with  no party, wears no colors, is committed to  no person, and who, on
account of his  indifference even,  is perhaps, the  better  prepared to
judge with impartiality the acts and arguments of each faction?0
                 RESUME OP THE ANATOMICAL PERIOD.
   We have now seen that medical studies, which were already flourish-
ing in the  isle of  Cos, under the  successors of Hippocrates, received
a new impulse by the foundation of the school at Alexandria, and sud-
denly attained  in that city a degree  of prosperity unheard of before.
We have pointed  out  some of the circumstances which  concurred to
this happy revolution;  such as the formation of a great library, and a
museum of natural  history, open, if not to the public,  at least to all
professional  men who  fixed their residence in the  capital of Egypt;
the influence of the  learned, drawn to that  capital by the  honors,
rewards, and especially the perspective of  an  easy and  secure  life;
finally,  the  dissection of the human body,  which  could  nowhere else
be  practiced openly without peril,  was not only authorized, but  even
encouraged by the sovereigns, who were above the prejudices of the age.
By this union  of circumstances, the school  of  Alexandria became the
most  famous in  the world, for natural and medical sciences ; and though
the Boman invasion cut off a part of the advantages which it enjoyed,
it still held the first rank.
   During the historic period that we  have just passed over, anatomy
and physiology made  the  most progress; next followed  internal and
external nosography ;  lastly, medical and surgical therapeutics acquired
great perfection.  Two works on Internal Nosography, that of Aretaeus.f
  0 Whatever  yet remains of vague and indecisive, in the expression of our
thoughts concerning the ancient systems of  Medicine, will completely disappear,
when we shall have exhibited the modern systems which are derived from them:
because, then, we shall better know the real origin of the ideas and the mode of
formation of the physical sciences.
  f Aretsei Cappadocis,  De Causis  et  Signis Acutorum et Diuturnorum libri,
nova editio, Grsece et Latine cum notis Kuhn, Lipsias, 1828, in 8vo. 
236
ANATOMICAL PERIOD.
 and that of Coelius Aurelianus,0 have left far in the rear  all that  the
 preceding period has transmitted to us on this branch of science ;  never-
 theless, the medical fame of no one of that period has reached the hight
 of that of Hippocrates ; no man united in himself, perhaps, in the same
 degree as he, all those qualities that constitute the great practitioner —
 intelligence,  sincerity, disinterestedness, the love  of  his  Art,  and of
 humanity.
   In regard to theory,  Medicine made also remarkable progress.  Instead
 of a few general considerations, and a few incomplete essays at system-
 ization, met with in the Hippocratic writings, the present period offers us
 complete systems, whose parts, closely co-ordinated, are  more or less well
 adapted  to  the  various forms of diseases, and practical details.   Dog-
 matism* enlarged  and  improved, represents, as exactly  as  possible,  the
 combined influence of the  vital principle, or organic  forces, with  the
 properties of the  physico-chemical elements, or general forces.   Empi-
 ricism  laid the  foundation of a new  scientific edifice ;  an edifice which
 it not  only left unfinished, but  of  which, also, it did not perceive
 the definite end.   Methodism, which  should have been contented with
 indicating this  end, in accepting  the  experimental contributions  fur
nished by Empiricism, rejected these, and flattered  itself to  be  able to
 construct a medical edifice by commencing  at  the summit—that is to
 say, with the general  properties of matter.  It  seduces, by an appear-
ance of simplicity and rigorous exactness, but in  fact constitutes only
an ideal monument, which falls  before  the result of daily observation
and practice.  The Eclectic, not perceiving in any of these systems  the
 truth in full, and  seeing  that none of them embraced the plenitude of
science, but only a part—one aspect—refused to  all his adhesion, and
boasted of choosing from each what he considered best.  Nevertheless,
 he does not  define in  what this consists ; he gives no rule by which it
 can be known ;  he refers to the reason and experience of each one, i. e.,
 he proclaimed individualism, doubt, and isolation.   In the midst of this
 conflict, Dogmatism, resting on  the highest  philosophical and medical
 illustrations, developed and sustained by the immense erudition and
 subtile dialectics  of  Galen, offers  the  most  extended  and reasonable
 explanation of the  phenomena of the living  economy.  It  thus must
triumph, as in fact it did, its errors even contributing to establish  it;
for  they  were in harmony with the prejudices of the dominant  philo-
 sophy.
  s Coelius Aurelianus, De  Mortris  Acutia et Chronicis, nova editio, Amst.,
1709, in 4to. 
BOOK    II.
             AGE  OF   TRANSITION.

COMMENCING AT  THE DEATH OF GALEN, DURING  THE  REIGN OF
  THE EMPEROR  SEPTIMUS  SEVERUS,  A. D.  201, AND ENDING AT
  THE REVIVAL OF LETTERS IN EUROPE, ABOUT THE YEAR  1400.
                  V.   GREEK  PERIOD.

INCLUDING THE PERIOD OF TIME BETWEEN THE  DEATH OF GALEN AND THE
  DESTRUCTION OF  THE ALEXANDRIAN  LIBRARY,  WHICH OCCURRED  IN THE
  YEAR 640.
                 GENERAL CONSIDERATIONS.

   At the time when this historic  period commences, all  the  known
parts of  the  ancient  world were  under the dominion  of a single
man.  The empire of Septimus Severus had more extent than that of
Alexander the Great, and inspired the hope of a  much longer exists
ence.  The Boman dominion, cemented by seven hundred  years  of a
skillful, bold, and persevering government, appeared seated  ©n immov-
able foundations.   The people of the adjoining frontiers  troubled yet,
occasionally, the peace of this vast territory, but none were strong enough
to penetrate as far as its center, and place this gigantic power in any
real peril.
   The great civil wars 3aad ceased, or had changed  their object.  The
people and the Senate, those two eternal competitors, no longer contended
for supreme power; they had both given over the struggle.  The monar-
chical form was now accepted, not only as a fact, but as a habit and a
necessity.   The citizens no longer took up arms to  change the form of
government, but only for the choice of a master.
   A revolution is progressing in the  domain of the mind, analogous to
that which had changed the political world.  The discussions of the
philosophers, so interesting in the schools of Greece, where the most 
238
GREEK PERIOD.
difficult questions in physics, morals, and metaphysics were discussed in
full liberty, have already lost much of their interest, and very soon will
cease entirely.   The supremacy of one  tends  to  be established  in  the
whole intellectual world.  The disputes  relate but little  to principles,
but rather to the true meaning of the language  of the teacher.   In
morals,  Blato,  Epicurus,  and  Zeno are followed, until a purer and
more sublime morality,  that of Jesus, son of  Mary, takes the place of
all the rest.  In physics and metaphysics, Aristotle soon reigned des-
potic, and the authority of Galen is unrivaled in Medicine.
  History, which should be the faithful  image of society, becomes con-
tracted, also, during this age, justly called the age of transition, because
it serves as a transition from one social state  to  another.  In  place of
offering the scene of great contests and movements, it is summed  up in
some sort in the biographies of individuals—in interior manifestations;
and, to  keep to our special  subject, we will say, that the history of
Medicine will no longer be  taken up with discussion  among various
sects, and of choice  between different methods;  for there is now, and
will  be for ages, but one sect  and one  sole method.  The progress of
medical science, slowly retrograding, will no more  be thwarted by any
remarkable revolution;  only,  the scientific  scepter will pass from  the
hands of one nation to that of another, and the language  of Hippocra-
tes and  Galen will be replaced by that of Avicenna and Albucasis.
  The first period of the age  of transition  offers for our consideration,
only the lives and writings of four Greek physicians, all of whom had
studied  in  the  school of  Alexandria, and whose  reputations were sus-
tained until the  time  of the  invasion of the Arabs.  Though  these
writers  had  made, for the most part, only a  compilation  of the works
of Galen and other authors, they have rendered,  nevertheless,  a  signal
service in presenting science  under an  abridged  and more commodious
form, and in  enriching it with several new particulars, and especiallj-
in preventing  its  torch  being extinguished among  their  indolent
cotemporaries.


                         CHAPTEB I.
                   CELEBRATED COMMENTATORS.
                                §1.
  Oribasius  is the first author of any importance  in  the history of
Medicine, after Galen.   He was also born  at Pergamos, and  lived in
the  fourth century.  He  attached  himself,  early, to the fortunes of
Julian,  surnamed the Apostate, and followed him into Gaul, when that 
CELEBRATED COMMENTATORS.
239
prince was named its governor.   He recalls, himself, this circumstance,
in the preface to one of his works.  The young  Caesar appreciated the
great qualities  of Oribasius, and  became very intimate with him, and
after he was made  emperor, appointed him Questor at Constantinople.
After the premature death of that philosophic ruler, Oribasius remained
faithful to his memory, but those who were envious  of him, falsely rep-
resented his fidelity.  He was disgraced, spoiled of his office and  his
property, and banished among a barbarous people.   The courage which
he displayed on that occasion, the extraordinary cures that he effected,
the eloquence of his discourses, attached to him very soon the love and
respect of semi-savage men, who wished  to  honor him  as a god.   The
fame of the homage he received reached the ears of the emperors Valens
and Valentinianus.  They saw their error, recalled Oribasius, reimbursed
him for his losses in his property  and dignities,  and permitted him  to
enjoy peaceably to the end of his days, his high  reputation and fortune.
Eunapius, a cotemporary of Oribasius, and a physician, gives a very flat-
tering account of him.   He was,  he says, the wisest man  of his time;
the most skillful in Medicine,  and the most amiable in conversation.
   Oribasius has written several  works, of which the most important,
entitled  Collections Medicinales, was dedicated to Julian, when he was
only as yet Caesar.   It  includes seventy books, of which seventeen only
have reached us.   The following passages, forming  the preface, exhibit
for what end, and in what spirit the work was undertaken.
   " I have finished long since, divine  Caesar,  the  abridgement of the
books of  Galen, which you charged me to make,  during our residence in
the nearer Gaul.   You deigned to express your satisfaction on the sub-
ject, and you enjoined  upon me, at the same time,  another work—that
of reducing to a single volume, all that the most illustrious physicians
have taught, of utility, on the Healing Art.   I have, therefore, resolved
to  gratify you  according  to my  abilities.   I shall be careful to omit
nothing  of what Galen had said, because  he is, of all  those who  have
written on these matters, the one who has treated his subject with most
clearness, reason, and method.   He shows himself,  besides, the faithful
interpreter of the principles and sentiments of Hippocrates."
   Oribasius edited, at a later  period, an abridgment of his great work,
for the benefit of his son.  This abridgment, divided into nineteen books,
has reached us complete, as well  as another compendium, on the prepa-
ration of remedies and the cure of  diseases, undertaken at the solicita-
tion of his friend Eunapius,
   This writer, as  is seen, does  not  hesitate  to avow that  he borrows
from the authors that have preceded him, and particularly from Galen-,
the greater part of his materials.  Nevertheless, there are in his books, 
240
GREEK PERIOD.
certain fragments which are no where else  found; but we are ignorant,
whether they are his own, or borrowed from  some authors whose works
are lost; for he cites several, whose works  are  entirely lost, such as
Herodotus,  chief of the pneumatic  sect, Archigenes, Posidonius,  and
Antyllus.   However this may be, his principal merit consists in repro-
ducing the ideas of others with so much clearness, order, and precision,
that the summaries he has given of them are often preferable  to the
originals themselves. What he has said of pregnant women, nurses, and
the earliest education of the child, has appeared so perfect to the writers
that have followed him, that the most of them have copied him literally,
to the beginning of fifteenth  century.  We  shall quote an example of
this in speaking of  Paulus ^Egineta.
   Oribasius has written very little concerning  surgery, but he is much
more extended on anatomy, on which he follows Galen exclusively.  His
prepossession in favor of the latter  is so great, and  he  makes of it so
little concealment—he adopts so servilely, his theoretic idea, even to his
expressions—that he has been surnamed the ape of Galen.

                                §n.
   Aetius flourished towards the close of the fifth century, and in the
commencement of the sixth.   He  was born  in the  city of Amida, in
Mesopotamia, and studied  medicine  at Alexandria,  as  we learn  from
him.   He went afterwards  to Constantinople, where  he was attached to
the court,  with the grade of Count of the Palace, or chamberlain.
Aetius appears to  have been the first physician of any note, who pro-
fessed Christianity.  The  following  passages leave  no doubt  as to his
religion,  but they show, at  the same time,  that  his faith was more
enthusiastic than enlightened.   In stating  the  composition of a certain
ointment, he recommends that the following words be repeated in a low
voice: " may the God of Abraham,  the God of Isaac, and the  God of
Jacob, deign to bestow upon this medicament, such and  such virtues."
   In another place, he recommends, that to extract a bone from the
throat the following words be pronounced: " bone, as Jesus Christ caused
Lazarus to  come forth  from  the sepulchre,  as Jonah came out of the
whale's belly, come out of the throat;"  or  in this form: "bone,  I con-
jure you, by Blaises, martyr and servant of Jesus Christ, come forth, or
go down."   He exhibits the same credulity in not doubting the miracu-
lous virtues attributed by the charlatans of his age,  to a mass of their
remedies.
   Nevertheless, this author recommends himself to us in the same way
as Oribasius. Like him, he has collected all  that he has found  remark-
able in the writings of his predecessors, and  has instituted a body of 
CELEBRATED COMMENTATORS-
241
doctrines, in such a way as to omit nothing essential.  We are indebted
to him,  for the preservation of several  fragments of antiquity,  which
otherwise would have been  entirely lost.   His work, divided into four
sections, of  four books each, formed a complete manual of medicine and
surgery, except that it lacked anatomical  descriptions, and what relates
to luxations and fractures.   His surgery consisted of external  applica-
tions only.  He points out  the composition of a multitude of plasters
and ointments, and recommends  the frequent use of the cautery, both
actual and potential.  In his materia medica, the remedies are arranged
according to the kingdom to which they belong, and in alphabetical
order;  but  he does not describe, like Dioscorides,  the natural characters
of the substances ;  having been content to  enumerate their medicinal
properties, in which he adopts the ideas of Galen.

                                §m.
   Alexander was of Tralles, a city of Lydia, where the Greek language
was very correctly spoken.   His father Stephen, like  himself,  a  physi-
cian, had five sons, whom he carefully educated, and who were all dis-
tinguished for their learning; but Alexander was the most celebrated
of his family.   After having traveled in many parts of Asia, Egypt,
Spain, Gaul, and Italy, he fixed his residence at Borne, where he  imme-
diately acquired a brilliant reputation.   Living to a very advanced age,
and being no longer able to sustain the fatigues of practice, he was still
willing to be useful by giving to the public the fruits of  his long  expe-
rience.   To this end, he composed a treatise in twelve books, exclusively
devoted to affections that do not require the aid  of surgery.   The  first
ten books treat of diseases  of a  special  seat, commencing with  those
of the  head, and  finishing with those of the abdomen.   The  eleventh
treats of gout alone, and  the twelfth of fevers.   It seems, nevertheless,
the last should  be placed the first, and  such was the intention  of the
author, as expressed in his preface.
   " Since you desire," says he, "dear Cosme, that I inform you  of the
remedies whose efficacy I have  frequently  proved in diseases,  I feel
impressed to  acquiesce in your  request, on remembering the kindness
with which  you and your father have honored me.  I feel myself happy
in having, in my old age, this occasion to gratify you, and since I can
no longer support its fatigues, I have resolved to embody here, succinctly,
the knowledge I have acquired in  a long practice.  I hope that  those
who shall read this book without prejudice, will be charmed by the exact-
ness of my  teachings, and the clearness and conciseness of my style.  I
have studied to employ, as much as possible, common and usual  terms,
so as to  have my diction comprehended by the vulgar even.  We shall 
242
GREEK PERIOD.
commence with ephemeral  fevers, following the method of the divine
Galen, to whom we shall endeavor to conform in this, as in everything
else."
  We see by the above that he professes, after the example  of  his pre-
decessors, a great veneration  for Galen; but  he does  not adopt, like
them, his opinions blindly, at least in regard to practice.  He allows him-
self, at  times, to take  an opposite view, not, he says, from a desire to
contradict so great a man,  but with  a wish to  present  things  in their
true light; and though he makes no  innovation, in a theoretical point
of view, yet we place him in the same category as the two compilers of
whom we  have just  spoken.  From  the manner in which he describes
diseases and directs the treatment, we regard him as a good observer.  He
speaks of several, of which no one before him has made mention.  Such,
among others, is the case of a woman tormented  by excessive  hunger,
called bulimia—a perpetual gnawing in the stomach, accompanied with
a violent pain in  the head.  This  woman was cured  by taking iera,
which caused her to pass a worm twelve cubits  in  length.   This is  the
first time that a condition of this  kind was  attributed to intestinal
worms.   He  advised bleeding in the foot in  hemoptysis, and he says
that he found it more efficacious than at the  arm;  because,  he adds,
performed thus distinct from the diseased part, it acts as a powerful
revulsive.  No better reason could  be offered now, even, for-a similar
course.   In  tertian fevers, more particularly than in  the quartan,  he
was accustomed to procure  vomiting  before the  accession, and affirms
that he obtained great  success in this way.  AVe conceive that  it must
have been one of  the  most efficacious remedies, before  the discovery of
the febrifuge par excellence.  But what is most  difficult  to conceive, and
which at the same  time astonishes  and afflicts us, is, that a man of
judgment so sound, and a mind so enlightened, had faith in the virtue
of amulets and talismans,  the use of which he recommends on various
occasions.   Such was  the  universal  prejudice  of his  age, that it was
necessary for every man to pay tribute to the  errors of his cotempora-
ries.  Alexander has at least  this  excuse, that the whole world in his
time was plunged in the same superstition; and we shall  see, that up
to an epoch very near our  own, physicians of  reputation,  and learned
men, partook of this weakness without having  the same excuse.
  Without pretending to place this author in  parallel with Aretseus of
Cappadocia, there exist, nevertheless,  some traits of resemblance, which
unite them.  In the first place, they have both treated of a small num-
ber of diseases, only about sixty, which proves that they were only will-
ing to speak of those they had  seen and studied.  Their plan of arrange-
ment is similar, and is the most natural that could  have  been adopted 
CELEBRATED COMMENTATORS.
243
in their  times.   They were equally exact  in  describing the symptoms
of diseases, and in tracing out the characteristic signs of those which
are most likely to be confounded, on account of their similarity.   Though
the style of Alexander is much less elegant and pure than that of the
physician  of Cappadocia, it closely resembles it in clearness,  concise-
ness, and energy.   There is also  this  difference between  them: Alex-
ander  does not give an  anatomical description of the  affected parts  in
each disease.   But the reader himself shall be  able to make the com-
parison,  by placing the following description  in  comparison with that
which  has  been given on  a previous page.
   " I do not give the name pleurisy,"  says Alexander, " to every species
of pain  in the side, for  true pleurisy is the inflammation of the mem-
brane which lines the chest.  It is accompanied with  an  acute fever,
which  is owing to the proximity of the heart, which suffers sympatheti-
cally.   If, then, you observe in a sick person,  a  difficult respiration,
with acute fever, cough,  and pungent pain, you may be sure that he is
a true pleuritic.   Those who are affected with an  inflammation of the
liver have  also a fever, and breathe with pain ; their side is also tender
and painful, and  they have a sympathetic cough ;  but  the stitch in the
side, and the hardness of pulse are absent.
   " The following is  the rule by which  to  distinguish pleurisy from
hepatitis:  they are distinguished,  particularly, in the nature of the
pain, and the character of the pulse.   The pleuritics have  a hard pulse,
which  gives  to the touch the sensation of a saw ;  it is not the  same in
persons  affected  with  hepatitis, nor do pulmonics experience anything
similar,  on account of the softness of the affected organ.   The cough is
also different in  pleurisy from that in hepatitis.   In the former, it is
more violent, and is promptly followed with expectoration.   During the
progress of the disease the color of the expectorated substance indicates
what humor it is which has given rise to the inflammation.  Bed matter
shows  that it comes from the blood ; yellow, from the bile ; that which
is white and viscid  announces the phlegm; dark, the atrabile.    In
hepatitis,  there is cough, but no expectoration.  Bemember,  though.
that in  pleurisy, sometimes, there is no expectoration; from which it
follows,  that it would  be wrong  to consider as  a hepatitic, every indi-
vidual who coughs without expectorating ; for there are obstinate pleu-
risies,  of difficult coction,  and these are the most dangerous.   The inflam-
mation may also be seated below the false  ribs, without extending  into
the chest; it may also be exterior.  In these cases there can be no
expectoration; but, then,  the humors which cause the  inflammation
form an abscess, unless  it is discussed, which rarely  happens.  Give,
then, attention to all these signs,  as well  as to  the color  of the face. 
244
GREEK  PERIOD.
Patients attacked with hepatitis  are  usually pale;  it is  the opposite
with  those  who have  pleurisy.   In  this  way you  may discern  the
latter." °
                                 §IV.
  Paul, surnamed iEgineta, because he was a native of the isle of ^Egina,
is the last Greek physician who will interest us.  Though  the time  in
which he lived is somewhat uncertain, the most probable opinion places
it toward the end of the sixth century, and  the first half of the seventh.
He travelled much, and doubtless spent some time in Alexandria, either
to gain  instruction in his Art, or to teach it.   His skill in surgery, and
especially in obstetrics, rendered him celebrated, even among the Arabs,
whose midwives sent for him  in consultation,  it is said, from great dis-
tances, in difficult cases.   On this account their writers frequently give
him the  surname of accoucheur; which does not signify that he limited
himself to that branch  specially, in  surgery, but that he had  acquired
in it a great reputation, and rendered himself celebrated.
  Paul   of ^Egina composed  a compendium of Medicine, divided into
seven books ; after the  example of others, he does not hesitate to borrow
from  his predecessors,  or  even to copy  them literally.  A number of
chapters can be cited,  taken  entirely from  Oribasius,  and especially
those that concern pregnant women, and the earliest life of infants.   I
will content myself by  placing  an  example of this before the eyes of the
reader, so that he may judge  for himself the  manner  in which authors
of those times  plundered their predecessors.
     aORIBASII SYNOPSEOS.               PAULI .EGINET^E.
          LIBER QUINTUS.                      LIBER PRIMUS.
              CAP. V.
          Educatio pueruli.
  Puer nuper in lucem editus  melle
primum nutriator;  deinde lacte bis in
die, aut ter ad summum.  Quumque id
alacriter puer assumit, spesque est cum
esse concocturum, turn cibus jam offeri
potest qui ipsum non  impleat:  si vero
nobis  ignaris impleatur, tiim ad som-
num proclivior et segnior efficitur, ven-
terque intumescit et inflatur, et urina
redditur aquosior:  quibus  notis per-
spectis, nihil dandum est  priusquam
quod  in  ventre  habet  consumpserit.
Satis erit biennium lacte nutrire; de-
inde vero ad  cibos transeundudum est.
              CAP. v.
           Educatio pueri.
  Primum alimentum recens  nato in-
fanti mel exhibere oportet; postea vero
lac praebere bis in die, aut ad summum
ter.  Quum autem et ipse promptus
fuerit ad accipiendum, et spem exhib-
uerit concoctionis, tunc jam etiam cibus
dandus est qui non impleat.   Si vero
nobis non advertentibus repleti fuerint,
somnolentiores  statim et  segniores
hunt, et tumor in ventre adest et fla-
tus, et urinse sunt aquosiores.  Ex qui-
bus signis repletione deprehensa, nutrix
nihil exhibere  debet, donee fuerit con-
sumpta.  Sufficit autem biennium lacte
nutrire; deinde ad cibos transgredi.
0 De Arte Medica, lib. vi, cap. i. 
MEDICAL ORGANIZATION.
245
  But Paul of iEgina makes no secret of this course, which saves  him
from the reproach  of plagiarism.  " While it would be extremely diffi-
cult, not to say impossible, to retain in the memory the general principles
of the  Healing Art, and all the particular means advised by the ancients
I have made this abridgement of what  there is best of their writings.
They are not my own conceptions which I propose, if exception be made
of some details of  observation noted in my practice; but, being versed
in the reading of a number of excellent authors, and principally Oriba-
sius, I have attempted, in imitation  of him, to collect the  cream of what
others have said concerning the means of preserving health."
  Notwithstanding this modest avowal,  Paul is not deficient in  origin-
ality.  The surgical part of his book includes a quantity of observations
which are  his own, and which prove that he had performed many opera-
tions ; and so far  from following, always, the rules of others, he knew
how to modify them according to circumstances, and to extend even the
narrow limits of his art.  He is often more explicit than Celsus, whether
in the description of diseases and  the curative indications, or in the
exposition of a plan  of operations.   I  will refer, among  others, to the
chapters relative to hydrocephalus, paracentecis of  the thorax and abdo-
men, the extraction of vesicular calculi, and aneurisms.   He is the first
who pointed out and  described varicose aneurisms; the excision of hyper-
tophied mammae in men, etc.   He appears also to have been the first to
perform the operation of bronchotomy, after a method which he  borrowed
from Antyllus, of which he has transmitted us a very detailed account.
I will close what concerns this author, by the single remark, that Fabri-
eius of Aquapendente, the famous  surgeon of the sixteenth  century,
draws from him and  Celsus the basis of his doctrines.
                         CHAPTER II.

                     MEDICAL ORGANIZATION.

  I have already said a few words on the medical organization of the
most  celebrated people of antiquity.  I now proceed to examine this
organization in a more special manner.   I shall describe the principal
changes to which the profession of Medicine was subjected, in proportion
as civilization progressed, from the infancy of society to  the ruin of the
Alexandrian school.   I shall speak of the few laws that regulated  its
teaching and  practice in remote ages, and I  shall show the origin of
some institutions destined to extend the benefits of the Healing Art to
the inferior classes of society. 
246
GREEK PERIOD.
   I have put off, to the end of this period, what I have to say on thi^
 subject, so as to bring together, in a single view, everything that relates
 to  it.   By the aid of this concentration, the reader will be able, at one
 glance, to compare among themselves the various phases of the  medical
 profession, throughout antiquity; for the extinction of the Greek domi-
 nation in Egypt constitutes, in the history of Medicine, the separation
 of ancient from modern times.  At that epoch, a  new language and new
 authors made their appearance in  the medical  world—the scepter of
 letters and arts passed from the Greeks to  the Arabs—and then com-
 menced a new era.
   If a general view be taken of the organization of medicine among the
 ancients, four distinct phases may be recognized; each of which corres-
 ponds to a form and particular state of civilization.

                             FIRST PHASE.
   At the origin of society, among  the wandering tribes and small  set-
 tlements,  before  the existence of  great  cities,  and especially  before
 the invention of writing,  the treasury of  human knowledge was very
 limited,  and the  memory of one man sufficed to contain it.   It  was
 composed of a few  simple notions  which were  transmitted, verbally,
 from father to son—from  the master to the disciple—and formed, often,
 the patrimony of a family.   At this epoch, the same person often united
 in himself the authority of  sovereign, priest and man of science.
   Such were the patriarch Jews, Abraham, Isaac, and Jacob, and those
 whom Homer paints as the heroes of Greece—Hercules,  Theseus, Jason,
 Achilles, Ulysses, etc.  We see them after the combat, sometimes, dress-
 ing the wounds  of  their companions in  arms,  or preparing them a
repast, or a sacrifice, or a funeral ceremony.   We have before remarked
 that Machaon and Podalirius, surnamed  the  sons of  Esculapius, on
 account of their  surgical skill, were at the  same time  distinguished
 captains,  and that most  of the generals who' served at the  siege of
 Troy, boasted of having been the pupils of the centaur Chiron, renowned
 for his great skill  in Medicine.
   We know,  also,  that the Egyptians attributed the invention of  the
 Healing Art, and  all other arts, to several of their kings ; but chiefly
 to Hermes, who was regarded as the author of several books that inclosed
 the secrets of Medicine.  The Chaldeans attributed the honor of  the
 same  discovery to  Zoroaster; the  Chinese to  Cinningo and Hohanti.
 In a word, we find the same tradition, with but slight variations, among
 all the famous nations of antiquity, which proves, evidently,  that the
 chiefs of the people were nearly all,  at the same time, priests and physi-
 cians,  ' We shall give to this  first phase of the medical profession,  the 
MEDICAL  ORGANIZATION.
247
name of patriarchal,  because the practice of Medicine constitutes  a
species of patronage and protection.

                             SECOND PHASE.
   When the  tribes or settlements had  become nations, industry had
made progress, and intellectual riches were increased by the aid, espe-
cially, of the admirable artifice which enables us to fix  thought, and
to give a visible body  to the passing word; then the treasure of human
knowledge could no longer be contained in the memory of a single man,
and the highest function of society could no longer be executed by one
individual;  then a division was made, varying according to numerous
circumstances, but which presented this remarkable  peculiarity, that
the priesthood and the practice of Medicine remained a long time united
in many countries.
   It was so in Egypt, when the priests of the time of- Moses  practiced
Medicine,  and all the learned professions.   They were divided into
several orders, of which  each received only the  species of instruction
appropriate to the  functions  he professed to fulfil.   The legislator  of
the  Hebrews, reared among the priests, introduced  the  greater  part  of
their institutions  among the Jews.   We have seen, that he confided  to
the  Levites the duties of religious worship, and sanitary police or public
Medicine, the only kind that is alluded to in his laws.   In Greece, from
the  ruin of Troy to the dispersion of the Pythagorean society, the Ascle-
piadae, or priests of Esculapius, appear to have been the only physicians
of any public consideration.   Their  temples were transformed into dis-
pensaries, where patients from the most distant countries came to receive
counsel and  treatment.   The same phenomenon is reproduced in nearly
all countries of the earth,  at a certain epoch in civilization ; we find it
in the history of the ancient Greeks and of the  inhabitants of the
Brittanic Isles, in China and Japan, among the Tartars, in Africa, and
in the Xew World ; we see the same in Europe, in modern times, when
feudal anarchy replaced Boman civilization.
   This coincidence, which may be said to  be universal, could not have
been the result of  accident;  and  it is  easy to explain, by a little reflec-
tion, that in the ages  of ignorance, credulity, and  superstition, diseases
were regarded  as  a celestial chastisement, an evidence of the divine
wrath, or as the result of  some  malign influence, rather  than as the
effect of natural  causes; and  therefore,  it was deemed more advisa-
ble  to resort to prayers, expiations, sacrifices, exorcisms, etc.—as much,
at least, as to the natural resources of Medicine.   In this condition  of
the public mind, it was almost inevitable for the priests to take hold of
the practice  of Medicine; for they shared, also, the  common opinion, 
248
GREEK PERIOD.
 and supposed the cure  of diseases a part of their attribute.   I will,
 therefore, designate this phase of the  profession by  the epithet  of
 sacerdotal.
                              THIRD PHASE.
    Nevertheless,  the clergy did  not always, in certain countries, remain
 in exclusive possession of the secrets of Medicine.  There came a time
 when the Art was no longer taught in an occult manner, and when its
 practice was accessible to every citizen.   That revolution, we have seen,
 first took place in Greece, about the commencement of  the fifth century
 before Christ, after the dispersion of the Pythagoreans.    We have
 appreciated  a few of the circumstances that accompanied  it;  among
 others the  promulgation of the medical  doctrines of Cnidus and Cos.
 We have shown how the families that had the direction of these institu-
 tions, and who assumed to be descendants of Esculapius, acceding, either
 willingly or unwillingly, to this  general movement of mind, divulged the
 secrets of their practice,  and opened the schools to the  profane.
   It is probable that  long  before  this epoch there were in Greece, as
 well as elsewhere, individuals not  adjuncts to the priesthood, who pre-
 tended to practice Medicine.  These were medicasters  of a  low grade,
 herbalists, holders of some panacea or family recipes ; but these were not
 the true depositories of the medical science of their time.  The Asclepiadae
 alone were such,  and they made no communications to  the uninitiated.
 It was not so after the revolution referred  to ; then medical  science fell
 within the public domain, and to be admitted to the profession required
 only  leisure, and the means to pay for books  or teachers.   Science
 gained very much by this transformation ;  but the profession was much
 lowered in the minds of the people,  who now only saw it  in the light of
 a lucrative occupation.
   From Greece this revolution  was extended into Asia and Egypt; it
 penetrated Borne  about the  time of the second Punic war,  but made
 little progress there until at a later period, by the  talents and address
 of Asclepiades  of Bithynia.  Until  that time  Medicine had been prac-
 ticed at Borne  under  the  patriarchal  form.    The oldest  and  best
 instructed  of the relatives treated  the  diseases of his  family,  as he
 understood them ; and  it does not  appear that the priests, more than
 others,  assumed this  function.   Cato, the censor, was  much  engrossed
with this domestic Medicine.   He wrote a book on the subject, in which
 he  recommends cabbage as a sovereign remedy  in many cases.   He
venerated the number three, after the fashion of the Pythagoreans, and
disdained not to  transmit to posterity the magical words  which he
believed were useful  to  repeat for the  reduction of luxations  and
fractures. 
MEDICAL ORGANIZATION.
249
  If this practice is not usually the  most enlightened,  or  the most
efficacious, it is in general the mildest and most disinterested.   Besides,
the old Censor carried to the end of his life a profound hatred  against
the men  of the  medical profession.   Let us  see  in  what  terms he
endeavors, by his familiar correspondence, to inculcate this hatred to
his son  Marcus.   " I will  tell you," he writes,  " when I have an
opportunity, what I think  of these Greeks, and what I esteem most of
what  there  is in Athens.   It is good to study,  to  some  extent, their
letters and sciences, but it is not necessary to learn them fully.  I shall
be done with this wicked  and proud race; nevertheless, be assured, as
if a prophet had told you,  that as soon as this  nation  shall have com-
municated to us its literature, it will spoil and corrupt everything, and
this will be so much more easily effected if  it sends  us also its physi-
cians.  They have  sworn  among themselves, to kill all barbarians by
means of medicine, and yet they require pay from those whom they
treat, in order to gain their confidence, and thus ruin them more easily.
They are insolent enough  to call us barbarians,  as  well as others, and
they treat us even more disdainfully, by calling us opiques.  In short,
remember that I have forbidden you to employ physicians." °
   If  the  hatred of Cato appears to be blind and  ridiculous, like every-
thing which is exaggerated, it  must be borne  in  mind that the Greek
physicians who came to Borne merited, in part, these invectives.   The
greater number were  only intriguants, without instruction  or manners.
having  no other aim than  to make a fortune, and capable of every
baseness to attain  it.   Such is the picture that Galen has  drawn of
them, as we have shown elsewhere.   Asclepiades himself, whose superior
talents did not require for  success the vile deceits of charlatanism, had
recourse to  these shameful means.   We have seen that he promised all
his patients  an easy, prompt, and perfect cure, and I now add  another
proposition attributed to him: " whoever understands Medicine thor-
oughly  is never sick."  Fortune,  it is  said,  seemed  to  confirm  this
aphorism on his own person,  for he  reached a  great old age, and died
from an accident.  Such an example never  lacks imitators, and long after
Asclepiades, Thessalus, who was much inferior to him in  merit, exhibited
a much greater amount of impudence.  He would  only appear in public
accompanied by a troop of bakers, boys, butchers,  weavers, carders, and
other  artisans of the  lowest classes of society, to whom  he  gave the
title of pupils, whose  vulgar language, it  is said, he used.   We can
conceive the stir that such a suit must have made, and  how much it
served to increase his reputation  among the ignorant.  He carried his

                          Cato, De re rustica.
        16 
250
GREEK PERIOD.
audacity  so  far  as  to write to the  Emperor  Nero,  that previous to
himself, no physician had found anything certain  for the preservation
of health  and  the cure of diseases, and that he alone  had discovered
the true  method of treatment.   The chronicle reports  that he  had
extraordinary success ;  but in what an age !  and under what a prince !
   The number  of these false physicians was much more considerable at
Borne than elsewhere.   Galen has indicated the reason of this in the
following passage : "In a vast and populous city, like the capital of
the Soman Empire,  it is easy for a stranger, and even for a  citizen, to
conceal his  name, his  birth, his fortune, and his conduct.   A man is
only judged by the luxury he displays, and the arrogance he  exhibits.
If accidentally he is discovered, it will  suffice for him to change his
location:  while in a small town, all the  inhabitants know each other;
a man's relatives, education, and manner of  life, are so well understood
that fraud is impossible."
   In  the  midst  of  this overflowing of  charlatanism, the health of the
citizens was  given  over to the mercy of the first imposter who called
himself a doctor; for how could the  cheat and usurper of the title be
distinguished from the man of knowledge and probity, who had acquired
it by  study ?  No examination, no legal  proof was imposed on any one
who wished  to practice Medicine ; there was  no security for the sick.
Such  a disorder  could not always exist, and the excess of the evil led
to its suppression, which in fact was brought about.   Thus finishes the
third phase of the medical profession, which we shall call the unlicensed.
laity phase.
                         FOURTH AND LAST PHASE.
   The abuse to  which this indefinite  liberty led, in  the  practice of
Medicine, having become intolerable, the legislative power was obliged
to interfere.  Now commences  for the medical profession a new phase,
which I shall call the legal or organized laity phase.
   The Emperor Anthony  the Pious, was the first who occupied himself
with  this subject.  He made mention,  in several of his rescripts, of the
immunities to which those physicians had a right, who were employed in
the public service, whether  civil or military;  but there is no evidence
yet of examinations or proofs of qualifications, and we can only suppose
their existence.0  It is necessary to  go as  far back as the  Christian
Emperors to  discover the traces of a regular medical organization.  It
was then, only, that the title of Archiater received  a legal  sense, and
that certain functions were attached to it; while it does not appear to have
  ° Justiniani Codocis, lib. x. tit. lii. De Professoribus et Medicis, i.  Digestorum,
lib. xxvn, tit. i.  De Excusationibus, vi, §1, 2. 
MEDICAL  ORGANIZATION.
251
been, ever before, more than an honorary title—an ambitious distinction,
excited by vanity, and often usurped.  Andromachus, physician to Nero,
was decorated with it; but Galen, physician to Marcus Aurelius, never
bore it. From the time of Constantine the Great, the name of Archiater
is frequently  met with in the edicts of the  Emperors.   It served to
designate, sometimes, the physicians attached  to the person of the sov-
ereign, sometimes physicians fulfilling certain public functions in cities.
   There were, consequently, two sorts of Archiaters;  one named Palatine,
who belonged to the household of the prince, holding rank amongst the
officers of the court, and having at their head a count or duke, who was
a peer with the higher dignitaries  of the Empire.   He bore the  title of
Count Archiater, or Count of the Archiaters, for historians differ in
opinion in  regard to  these two  denominations.0    The  others,  called
Popular Archiaters, formed in each town a kind of  college, charged with
the supervision of everything that related  to  salubrity.   No one could
practice medicine in their jurisdiction without having been examined by
them,  and recognized as sufficiently  instructed.  Whoever transgressed
this regulation, was  punished  with  a fine of two thousand drachms.
These Archiaters were honorably pensioned by the State, and enjoyed
various privileges.   In return for these advantages, they were obliged to
wait upon the poor gratuitously; but they had the right to charge those
who were rich or in easy circumstances.   The practitioners who were not
members  of the College of Archiaters, had no immunity, and  lived upon
the product of their practice.
   The Popular  Archiaters amounted to ten in the metropolis; seven, in
cities of the second order, and five in those below.   They were not chosen
by the Governor, but elected by the citizens, from among the  candidates
who had-given proof  of their capacity before the  College,  and obtained
its approbation.! Such was the first medical  organization  destined to
remedy the frightful evils of anarchy.  It subsisted until the dismem-
berment of  the Empire by the barbarians.
   It was during this period, about the year 400 of our era, that we  see
designated for the first time in medical books a class of citizens to whom
was confided the duty of preparing the drugs ordered by physicians.}
Their functions had some analogy with those of our apothecaries, though
in knowledge  and social  position no comparison  can be made between
the pharmaceutists of  our day and their obscure predecessors.  Before
this epoch the physicians prepared, themselves, or caused their students

        "Histoire de la Chirurgie, T. II,  lib. vi, p. 715.
        ■j- Degest, T. IX, lib. l.  De decretis ab ordine faciendis.
        | Oribas.  In proemio Euporistorum, ad Eunapium. 
252
GREEK  PERIOD.
or servants to prepare, the remedies which they needed in their practice,
as is shown from various passages  in  Hipprocrates and Galen.   The
Pharmacopolists who were  mentioned by writers anterior to the fourth
century, were only druggists, or herbalists, to whom the physicians went
to obtain  simple substances,  necessary for  the confection of compound
remedies.    Perhaps, also, some of these pharmacopolists kept  always
ready some remedies of frequent and daily use, such as the theriac.0
                           CHAPTER  III.

                 INSTITUTIONS ACCESSORY TO MEDICINE.

     I comprehend under this title the hospitals and hospices, the dispen-
   saries and all the establishments which enable the necessitous classes to
   participate in the relief afforded by medicine.  Pagan  antiquity has
   transmitted us no  model of institutions of this order, unless one of the
   gymnasia of Athens,  called Cynosarge,  be  called such, in which aban-
   doned children were nurtured and brought up at the public expense, until
   they reached  an age  to be able to serve the Bepublic; or  also those
   retreats which were established by several cities of Greece for the relief
   of meritorious citizens.   Borne never had, either under the Bepublic or
v   under her idolatrous Emperors, similar establishments.   She effected the
   same  thing by frequent  distributions  of provisions or  lands,  by the
   remission of  unpaid taxes or some special  duties, by  the permission
   accorded to parents  to  destroy newly-born  children whom they were
   unable to maintain, by the bond of patronage which united patrician to
   plebian  families, and made it a duty of both to  succor  each other in
   times of their distress.   As to the slaves, they were cared for by their
   masters  as his  property, like  his  cattle or  his flocks.   The  rights of
   hospitality established  between  families, cities,  and  provinces, and
   religiously observed, assured to travellers subsistence and shelter;  but
   none of these institutions resemble our modern hospitals—nothing of all
   this  bears  the  character  of an establishment destined  to receive the
   afflicted  poor.
  -Dujardinet Peyrilhe, Histoire de la  Chirurgie, liv. v,  T. iv, p. 61, et sui.
According to this author, the first attempt at medical organization in the Roman
Empire goes back to the fourth or even the third century of our era; while Cu-
vier says it only commenced in the fourth century, on the model of the scientific
establishment founded in Persia by the Nestorians.  Hist, des Scienc. Natur., by
Cuvier, edited by M. Magdeleine de Saint-Agy, Paris, 1841, T. i, p. 409. 
INSTITUTIONS ACCESSORY TO MEDICINE.           253
   It  is to Christian charity that we owe the foundation of the first
alms-houses and asylums.0   Modern researches teach us that at the end
of the fourth century, Saint Pauline, a Boman lady of illustrious birth,
after exhibiting the spectacle of the rarest virtue in the midst of worldly
pomp, resolved to retire from society, in order to continue, more uninter-
ruptedly, a^life entirely devoted to charity and self-denial.   She went to
Jerusalem, first cradle of the faith, and theater of the greatest wonders,
where she united  with other  Christian women of the same mind, and
formed  with them, under the direction of St. Jerome, a pious congrega-
tion, who divided their time between the  reading of sacred  books  and
the practice of good works.
   The faithful, who came in crowds to  visit these  venerated  places.
actuated  by pious motives, and had established there  their  residences,
were often exposed to severe privations, and though they supported them
with stoic fortitude,  or rather with the  resignation of  martyrs,  their
sufferings could not fail to touch the hearts of their brethren in Jesus
Christ.   Their lot appeared particularly to excite pity, in regard to their
diseases or infirmities.  To offer them, in these  severe  circumstances.
an asylum, where they would receive the attention of the kindest charity,
united to the counsels of art, was to fulfil for them the offices of Provi-
dence ;  it was, also, in the opinion of those who  discharged  them, the
best means in  the eyes of  God, of redeeming all the imperfections and
weaknesses of  human nature.  Such a thought was well calculated  to
excite  instinctive  compassion  in  a sex eminently sympathetic.   These
holy women agreed  to execute  the project of founding a  hospice  for the
benefit of the  indigent sick;  and for the purpose of putting the  last
seal to this work of mercy, they bought a house out of the city, to which
they sent the  convalescent, to  breathe a pure air, and  rejoice  in the
charms of the country, so  salutary for persons who are recovering from
disease.
   In  the end, the Emperors, Kings and Califs signalized their  zeal in
the erection of sumptuous edifices for the relief of human misery,  and in
bestowing upon them rich legacies.  Then  dispensaries and benevolent
societies were instituted,  to complete the work of public charity.   In
fine, these establishments, which  had, at first, only a philanthropic end,
turned to the  advantage of the Art, and   contributed admirably to the
progress of the  science.

  0 Consult, on this subject, Percy et Willaume's Memoir on this question: "Had
the ancients public establishments for the benefit of the indigent orphan, or aban-
doned children, or for sick and wounded soldiers ?  If they had not, what supplied
their place?" Paris, 1813, in  8 vo. 
254
GREEK PERIOD.
                   RESUME OP THE GREEK PERIOD.
  In the times of Galen, animals were still dissected, and this professor
tells us that he made his anatomical demonstrations on monkeys, whose
conformation so closely resembles that  of  man.  Sometimes the  physi-
cians who followed the armies obtained permission to open the  corpse
of some barbarian  taken from the field of battle;  but, ultimately, the
practice of dissection entirely ceased, and the conformation of the human
body was  only studied in books, as the horror of the early Christians
against cadaveric   researches was more decided  even  than  that of
Pagans; and the fathers of the primitive church launched their anathe-
mas against the violation of the mortal remains of man.
  This abandonment of anatomy contributed, doubtless, to the decadence
of the  healing Art; but other causes concurred no less powerfully.   In
the first rank must be placed the rapid extension of Christianity, which
disorganized  the Pagan schools, discredited  the profane sciences, and
ruined  their  teachers.   It engendered in every mind the  passion for
religious  controversy,  which  excited  so much trouble  in the  rising
Church,  and  hastened, as is known, the fall  of  the Empire of the
East.
  In the  second place, the limited number of those who continued at-
tached to  the culture of the Natural  Sciences, enchained by a vicious
method, only sought the explanation of the phenomena of  Nature  in the
writings of  the ancients;  and not daring to advocate  any change in
regard to  the received doctrines, dragged heavily in the rut  of the past.
Two men, only, Alexander, of Tralles, and Paul, of ^Egina, in the lapse
of more than four centuries, showed the least originality ;  the one
enriched internal pathology and therapeutics with a few  observations—
the other  added more marked  improvements to surgery.
  But  if  the period we have passsed  over was  unfruitful in scientific
progress, it was not so in social amelioration.  The commencement of
organization  that the teaching and  practice  of medicine received was
probably more profitable to humanity than might have been discoveries
in the  science ; for we have seen that charlatanism had reached its acme.
A law  destined to keep it in check, by requiring certain conditions of
capability and good character on the part of the aspirant to the medical
profession, responded then,  under  the  circumstances,  to an  urgent
necessity,  and such a law is at all times  a benefit to society.   In fine
the charitable institutions of which this epoch offered to the  world the
first model, prepared for the future valuable means of medical instruc-
tion.   The first period, then, of the age of transition, was  not entirely
lost to  the future of science, and especially to  that of humanity. 
GENERAL  CONSIDERATIONS.
255
                  VI.  ARABIC PERIOD.

COMMENCING AT THE DESTRUCTION  OF THE ALEXANDRIAN LIBRARY, IN THE
   YEAR 640 OF THE CHRISTIAN ERA, AND ENDING AT THE CLOSE OF THE FOUR-
   TEENTH CENTURY.
                 GENERAL  CONSIDERATIONS.

  At the epoch when this period commences, the Empire of the West no
longer existed.   The finest provinces which  composed it had  been over-
run and subdued by barbarous tribes from the forests of Germany.  From
its ruins had already arisen several independent kingdoms, of which the
most considerable were  those of the Francs  in Gallia,  of the Visigoths
in Spain, and that of the Lombards in Italy.  Justinian, who reigned a
century previously, was the  last of the Boman Emperors whose arms
threw a passing glory  over Italy, Sicily, Africa, and  Spain, thanks to
the skill of some of his generals, and especially to the genius and heroic
devotion of Belisarius.
  The Empire of the East, attacked at all  points, still sustained itself
with vigor, though losing daily  some one of its supports, similar to a
fortress reputed to be impregnable, which, encircled by its enemies, sees
fall one after another, the works destined to  defend their approach.  The
Turks had begun to show themselves on the banks of the Danube.  The
Persians, those eternal enemies of the Boman name, made incessant war
upon it, sometimes openly, again covertly.   At last, a more redoubtable
enemy, and who at this time made greatest havoc of the  Empire, had just
sprung up in the deserts of Arabia.   There a man arose, who was at the
same time legislator, prophet, and conqueror, having united under  one
domination and one worship the  tribes heretofore divided and rivals;
forming of them  a powerful and  enthusiastic  nation, animated by a
thirst of conquest and an ardor of proselytism.  Finally, century had not
passed since the first preaching of Mahomet, and already Arabia entire,
India,  Syria, and Egypt,  were in the hands  of his followers.   In 640 or
641, Amrou achieved the conquest of this flatter  kingdom by seizing
Alexandria, its capital.   The library of that city, composed  of  500,000
volumes,  was delivered to the flames, by the order of Omar  the Second,
successor of Mahomet,  and these books, says the historian Abulpharage, 
256
ARABIC PERIOD.
served to heat, for six months, the public baths, which numbered nearly
four thousand.   Such were  the  first  fruits  of  the establishment of
Islamism.°
  Happily the fervor of proselytism abated somewhat among the Mussul-
man princes, and policy more frequently guided their conduct than relig-
ious zeal.  The Arab Califs showed themselves, in general, the protectors
of the Arts, Sciences and Commerce.  Several among them  endeavored
to collect the debris of the scientific treasures  of  antiquity, which had
escaped the ignorant fanaticism of their predecessors.  More tolerant in
matters of religion than the Christian  Princes  of their  times, they
received, without distinction of country or religion, all the men of merit
who took refuge in their States, gave them employment, and recompensed
them for their services.  On this account, the philosophers  and perse-
cuted heretics  often sought an asylum among  the Infidels, and carried
to them, in return,  the light of Greek civilization.
  Among the sovereigns of this nation, who distinguished themselves by
an enlightened love of letters, I  will cite, in first rank, Haroun-al-Ba-
schid, the Charlemagne of the East—cotemporary and emulator of  the
glory of the Emperor of the Francs—the  hero  of so many Arabic tales
and poems, and whose  dominion extended over Asia, Africa and Europe,
from the borders of the Indus to  the heart of  the Spanish  Peninsula.
He  embellished, considerably, the city of Bagdad, his capital, and estab-
lished  there public  schools, mosques and hospitals.   Almamon,  his  son
and successor, made still greater efforts than he, in favor of the Arts
and Sciences.   He  founded the  academy of  Bagdad, which was  one of
the most celebrated of the middle ages; and spared no efforts to  attract
there the most illustrious savans of all countries.  He enjoined on  his
embassadors to buy all the writings of the philosophers and  physicians
that could be  found, and as fast as  they were forwarded  to him he
caused them to be translated into Arabic.   The interpreter Honain, who
was a Christian, was emploped in this work for forty  years, and for each
book he translated,  he was paid, literally, its weight in gold.
  The eclat that the dominion of the Moorish Kings  shed upon  Spain,
from  the  tenth to  the thirteenth centuries, is well  known.  Several
cities possessed  schools, public libraries and  academies.   Those  of Cor-
dova, Toledo, Seville and  Murcia were  celebrated in all  the West, and
students went  to them, from all parts of Europe, to be instructed in what
were termed at that epoch, the Arts and Sciences of the Saracens.  The
  ~ Some modern  critics have  questioned  the burning of the Alexandrian
Library by the Arabs;  but M. Matter has established that fact on incontestible
proofs. 
MEDICINE OF THE ARABS.
257
library of Cordova, the capital of the kingdom, embraced more than
224,000 volumes.  Thus the literary and scientific scepter passed from
the hands of the Greeks and Bomans into those of the Arabs.  We now
proceed to see what became of Medicine,  among them.
                        CHAPTEB   I.

                     MEDICINE OF THE  ARABS.

                                § I-
  Bhazes, or Basis, is the first physician of any eminence, who wrote
in the Arabian language.   He was of Persian origin, and  flourished
toward the end of  the ninth century and  the beginning of  the tenth.
If we may believe the  historians of his nation,  who  are  naturally
inclined  to  exaggeration and the marvelous, he was a universal genius,
who had acquainted  himself with  music,  astronomy, mathematics,
chemistry, medicine, etc.  It is certain that  at the age of  thirty years
he was one of the most distinguished professors of the academy of Bag-
dad, and that students came from a great distance to hear his lectures.
Chosen from among a hundred of the most skillful physicians, to direct
the grand hospital  of that capital, he displayed in the exercise of his
functions an indefatigable zeal, even to his old age.   He had attained
his eightieth year when the loss of sight compelled him to quit his prac-
tice.  His reputation was then at its height.  It is easily conceived that
a man of his acquirements, nurtured in the writings of the ancients, and
placed for so many  years in  a post so favorable for medical  observation,
must have acquired rare skill  in  the  knowledge and treatment of dis-
eases.  He  was surnamed the Experienced, on account of  his  great
experience.
  Bhazes wrote much on philosophy, medicine, history and chemistry;
but the greater part of his works are lost, or are buried in the depth of
of some  library.   We have, from him, two treatises on medicine, the
briefest of which, dedicated to the Calif Almanzor, contains  excellent
counsel on the choice of a good  physician.   Here are some of the recom-
mendations  he has  given on the subject:   "Study, carefully, the ante-
cedents of the  man to whose  care you propose confiding all you have
most dear in the world;  that is to say, your health, your life, and  the
health and lives of your wife and children.  If the man is dissipating
his time  in frivolous pleasures; if he cultivates with too much zeal the 
258                      ARABIC PERIOD.
                                               I
arts that are foreign to his profession, such as music and poetry ;  still
more, if he is addicted to wine and debauchery, refrain from committing
into such hands a  trust so precious.   He  merits your  confidence, who,
having early applied himself to the study of medicine, has sought skill-
ful instructors and seen much disease; who has united  to the assiduous
reading of good authors, his  personal observations ; for it is impossible
to see everything and try everything in one's  own practice; and  the
knowledge  and experience of a  single  individual, compared to  the
knowledge and skill of all men, of all ages,  resembles  a  slender brook
of water that flows by the side of a great river."
   The greatest work of Bhazes, entitled " Continens,"  is a collection of
extracts, which  he  compiled  from all authors, for  his  own use.   It is
divided into two parts, which comprise,  together,  thirty-seven  books,
and form an  abridgment, somewhat confused, of Medicine and Surgery
entire.  The first part treats of diseases which attack a particular organ,
and commences with  the  head and finishes with the inferior members.
The second part treats of diseases whose seat is sometimes in one part
of the body and then in another, as  phlegm, erysipelas, wounds, etc.,
as well as those which affect, or seem to affect, all the economy at once,
such as fever, the plague, etc.
   The books  which make up the Continens, though arranged after  a
certain order, do not constitute a work fixed upon any uniform  plan,
whose parts follow each other regularly, but is rather  like  a collection
of notes, extracts and souvenirs, which were probably not designed to be
published, or, at least, not in the state in which we possess them.  This
collection, rich  in facts and erudite quotations, is  more interesting in a
historical  than  a scientific point of view; for it embraces nothing, or
next to nothing, which is not found in Greek authors, unless we except
the indications for some remedies, introduced by  the  Arabs into  the
materia medica, and a special mention of  eruptive fevers, comprised
under the name of variola.  These diseases having been  described for the
first time  by the Arabian physicians, it has  necessarily been  concluded
that  they originated  in  Arabia, and had  not been seen  by the Greek
and Latin physicians of  the previous age.   This opinion  is  certainly
easy to sustain, but before admitting it in an absolute manner, let us
see what the most ancient  authentic  documents  that we possess, say
concerning these diseases.  Bhazes expresses himself as follows, in the
thirtieth book of the Continens :
    "Galen says, in his fourth  book, on Habits, that the ancients called
a  phlegmon  a  disease in which heat caused an  effervescence, as  in
erysipelas and  variola.   These affections are caused by the bile.  He
repeats the same in his treatise on the pulse, and in the ninth book, on 
MEDICINE  OF THE ARABS.
259
Internal Diseases, in these terms:  ' Superfluous matters, which are not
converted into blood, become putrefied, and at length attenuate, giving
rise to erysipelas and variola.'
   '• He says again, in his fourth book, on the Pulse: ' The blood becomes
so much  putrefied  in apostema, variola, and eruptions, as to burn  the
skin.'   I affirm, also, that Galen has designated variola by its name, has
laid down its special  treatment, and it may be inferred from his expres-
sions, that he considered  its pustules as indicating a species of crisis."
   It is evident from the above, that Bhazes did not consider variola as
a new disease, nor  peculiar  to his country.  His testimony is of great
weight in the question under consideration ; but it would have  more, if
the passages  he  has  cited from Galen existed  in the editions that we
possess.  I avow that I have not been able to find them,  which should
not, however, invalidate what he advances ;  because, the copies which
the  Arabian  physician  possessed,  differed, probably, very  much  from
ours.   Besides, I will add, with Doctor Bruno, a learned Hellenist of
the seventeenth century : " This question  does not appear to me to have
as much importance as  it  formerly was  supposed to possess, and it is
not improbable, that  the ancients may have designated these diseases by
the names of pustules and exanthemata, (sxO'j/iarcou, vel t^avdrjfxazcov^
which are so  frequently  met with in their books." °
   The Continens, notwithstanding the imperfect state in which it exists,
has been held in great esteem among the Orientals, and even among the
Latins.   The  Arabian writers, posterior  to  Bhazes,  have drawn  from
this collection  as  from  a common fund  of knowledge.   For the most
part, they have only disposed  in  a better order, or edited with  more
elegance and correctness, the abundant material which they found in it.f
                                 §n.
   Haly-Abas, also a Persian,  flourished  toward the close of the tenth
 century, about fifty years after  Bhazes.  He wrote under  the  title of
 Almaleki  (opus regium)  a treatise in twenty books, which  forms  a
 complete system of the theory and practice of Medicine, and which is
 extracted, in a great measure, from the "Continens."  It is generally
 argued, in regard to this composition, that it is the  best which has
 proceeded from the pens of the Arabian writers.  It has the preference,
 even now, over  the  " Canon " of  Avicenna, of which  we  shall speak
 presently, though the latter had much greater vogue during  the middle
 ages, among the Occidentals.

   0 Lexicon Medicum Graeco-Latinum.  Vide Morbilli.
   f G. Cuvier  thinks that the Continens was not written by Rhazes, but is a
 collection of his oral lectures, published by some one of his pupils. 
260
ARABIC PERIOD.
                               §111.
  Avicenna, surnamed the  Prince of Physicians, was born at Bokhara,
a considerable city of Khorassan, in the year  of grace 980.   He mani-
fested, from the most tender  age, an extraordinary disposition for  the
sciences.  His  ardor for study was  so great that he devoted to it entire
days, and the greater part of his nights.  Having gone to study philo-
sophy and medicine in the  university of  Bagdad, his talents  were soon
exhibited.   He was received at court, loaded with favors, and elevated
to the dignity even of a Vizier.  Then, suddenly, he fell into disgrace,
was stripped of all his property, cast into prison, and menaced with  the
loss  of his life.  After two years  detention, he recovered his  liberty,
acquired  anew  the  consideration   of  the public and  the court,  and
travelled in various countries.  But he did not long enjoy this return
of fortune.    Excessive  labors, and  the intemperance  to  which  he
surrendered himself, gradually undermined  his robust constitution ; he
died of  dysentery, at the age of  fifty-six.
  Avicenna composed several works, of which the  principal is called
the " Canon,"° from a Greek word which signifies rule, law.  The Canon
was, indeed, for five or six centuries, a classic book, and may be said
to have been the medical code of Asia  and  Europe.   The  professors of
the faculties confined their teachings for a long time, to reading it from
their desks, explaining,  translating, and making extracts or compen-
diums from it.   No author, after Galen, enjoyed so wide and  durable
an authority in the medical world.   Although now dethroned from this
high  position,  my readers  will not object,  I think, to  acquire  some
knowledge of an author so renowned in former times.
  His entire book is divided into  five volumes, of which the first two
embrace the general principles of physiology, pathology, hygiene, and
therapeutics, arranged in  conformity  with the doctrines of Aristotle
and  Galen,  and  may be  termed the  philosophic part  of the science.
The  third and fourth  books  contain the description and treatment of
all  the  diseases then known ; the  last treats of the composition and
preparation of remedies.   The entire work,  from  one end  to  the other,
as all other  works of this period,  is a compilation, neither  better  nor
worse than  the Almaleki.   This may  be inferred  from the following
fragments.
                         DEFINITION OF MEDICINE.
  " I say that Medicine is a science which  gives the knowledge of  the
conformation of the human body, and its susceptibility of being amended
Q Canon Medicinse. 
MEDICINE OF THE ARABS.
261
or  modified  for the  preservation  or restoration  of  health."   This
definition is  somewhat obscure and refined, but it is nothing  in com-
parison to the commentary which the author makes upon it.
   " Some one may say,"  he continues,  " that Medicine  being divided
into theory and practice,  I am wrong in calling it a science, which indi-
cates that it is in  the same rank of purely speculative  knowledge.  I
reply that if there  are arts exclusively theoretical and others exclusively
practical, Medicine, the same  as philosophy, is at once theoretical and
practical.
   " When we admit into  a science two branches, the one theoretical and
the other practical, we attach  to the words theory and practice a differ-
ent signification from  the vulgar acceptation of the terms, which it  is
proper  to  explain.  We  are not willing to say, for example, that one
branch of  Medicine is devoted to demonstration and the other to opera-
tion ;  but we wish to have it  understood that  there are two parts in
Medical Science—one  which treats of principles without having in view
their application, and the other which sets forth the  rules according to
which we should operate.  Thus, when it is said that there are  three
sorts of fevers, and  nine temperaments or complexions,  the science is ren-
dered speculative ;  on the contrary, when it is said that we must employ
repercussives, refrigerants and incrassants in  the onset of an inflamed
tumor,  then repercussives concurrently with the emollients, and finally,
toward the close of the disease, emollients united with  resolvents, then
we treat of the practical part of the science."0
   I avow, that after having read and re-read,  with  the most scrupulous
attention, this passage in the  Latin translation, it  has appeared  to me
difficult, if not impossible,  to  attach to it any clear and  precise sense.
Avicenna here  seems  to  play  upon  words;  he surpasses, in subtilty,
Aristotle and Galen, whom he  takes for models, even exaggerating their
defects.  Besides, the  philosophic teachings of the  schools consisted at
that time  only in the subtilties of language.   The book, or the author
whom they took for a  guide, was tortured in a thousand ways;  they
exhausted  themselves in seeking the thoughts of  others, in place of
thinking for themselves; the  struggle consisted in who  should  refine
most a word or a phrase.  In this disposition of their minds, they were
frequently disposed to regard  as sublime and  transcendent what was
obscure  and  even unintelligible;  so that the  philosophic part of the
Canon of Avicenna, that which treats of the generalities of science, and
which now appears  the most defective, seems to have been most admired
then, and has  contributed most to the prodigious success of  the  work.

        Q Canonis, lib. i, fen i, doctrina 1; Venetiis apud Juntas, 1562. 
262
ARABIC PERIOD.
   In the second part, which is devoted  to  the  exposition of practical
 knowledge, the  author strays farther still into the labyrinth of theory,
 which renders the reading of his work difficult and fatiguing; but there
 are  some chapters relative  to eruptive fevers, that all judges agree in
 regarding as the best, and which throw some light on the history of these
 diseases, in  showing  the  views  held in regard to  them  at the time of
 their first appearance.  I will now give a few extracts about them.

                              ON  VARIOLA.
   " The blood manifests, occasionally, an ebullition similar to that which
 is seen  in vegetable  juices, producing the disaggregation of  their  par-
 ticles.  The natural  cause  of this ebullition is  nothing else than  the
 residue  of the menstrual  blood,  which  remains in the womb  at  the
 moment of impregnation, or a residuum  subsequently engendered from
 food of a bad  quality, and deposited  there—that kind of food which
 rarefies  the blood, causing its ebullition, until its sound parts predomi-
 nate, as occurs naturally in the juice of the grape, in a state of ferment-
 ation, by which  it is  converted into a liquor of uniform composition.
 after having expelled  the thick froth and  earthy dregs."0
   This  analogy must  appear very  gross and ridiculous to many young
 physicians of the present time,  so much is it unlike the doctrine  now
 accredited in  the schools;  but, after  an  unprejudiced  examination, it
 will be  found  to give  a very good  account of the principal phenomena
 which  characterise eruptive fevers,  and  particularly variola.   These
 affections, as is well known, attack so universally the human race, as to
 lead to  the belief that they were inherent  to our nature;  and that each
 individual contracted  the germ of it in the womb of his mother.  In  the
 second place, would not the  regularity and violence of the febrile symp-
 toms, and the enormous quantity of  excrementitial matter ejected from
 the economy by the eruption, taken all together,  seem to prove a depu-
 rative effort—a synurgy of the vital  forces, for the purpose of eliminat-
 ing a mischievous humor or  element ?
   This  hypothesis, clear, simple, and natural, has been admitted almost
 without contradiction  even down to our day;  and so profoundly was  the
public mind imbued with it, that doctors in theology proscribed innocu-
lation and vaccination as a derogation of the order of things established
by Providence;  and doctors in medicine  repulsed  the  same  means, as
tending  to retain in the economy a venom whose expulsion it was impor-
tant to  favor.   But,  even if the above  views had been much more
rational than was supposed, they  did  not authorize the consequences
0 Canonis, lib. vr, fen. i, tractatus iv, chap. vi. 
MEDICINE  OF THE ARABS.
263
deduced from them.   Indeed, even if it were  true  that we contain, on
coming into the world, the germ of certain diseases, or a proximate dis-
position to contract them, it need not follow that the  germ or the  ten-
dency must be left to develope themselves to the  point of giving  origin
to such formidable phenomena, if we have a milder and surer means of
destroying such a bad predisposition.

                     BIGNS OF THE APPEARANCE OF VARIOLA.
   " The precursory  symptoms  of variola are, ordinarily, pain in the
back,  itching of  the nose,  fright  during sleep, a pricking  sensation
all over  the face, and general lassitude.    The  face  and  the  eyes
become red,  the  latter being constantly suffused with tears; and nu-
merous inflamed spots  appear  on  the  skin.  The patient yawns fre-
quently, and respiration is  difficult; the voice  is  hoarse,  and a thick
saliva is  expectorated.   The head  feels heavy and aches, while the
mouth is very dry.   The  patient realizes, in the  throat  and chest, a
painful constriction ; the feet tremble  and fall backward.  All  this
morbid train is accompanied by fever."
   This graphic tableau  does not approach the perfection of those  that
Aretseus and Alexander of Tralles have left us.  No distinction is made
here, either  in regard to the gravity or the frequency of the symptoms,
or  of the manner in which they succeed each other.   The author  does
not tell us whether it is necessary for all of  them to  appear  united, or
if the apparition of  a few of them only is  necessary, to  prognosticate
the imminence of variola.   He  indicates, no better, the march, charac-
ters, and  duration  of the  eruption; nor the phases, so remarkable, of
the fever, which attracted particularly the attention of the ancients.

                             ON THE  MORBILLI.
   The writers of the middle ages  comprised  under  this term  all the
febrile exanthemata,  such as rubeola, scarlatina, and roseola.   " The
morbilli," says Avicenna,  "are  a species of bilious variola.   There is
scarcely any difference  between these two classes  of affections,  unless
that morbilli, proceeding from the bile and  a  smaller quantity of mor-
bid matter, do not, so to say, affect  more than the surface  of  the skin,
nor produce, in general, any elevations which  require particular treat-
ment ; while variola  produces, from its beginning,  elevations  and  pus-
tules.   The  morbilli are  less grave  and less apparent than variola;
but the signs of their invasion  are  pretty much the same.   However,
the irritation of the  stomach, difficult respiration, and general inflam-
mation have more intensity in morbilli, while the pain in the bones is
less severe.  This pain, in variola,  is caused by the  abundance of the 
264
ARABIC PERIOD.
 blood, which distends the vein  that runs the whole length of the spinal
 column, for variola  depends upon  the  quantity of corrupt  blood, while
 the morbilli  depend  on the quality of it.   The variola  irruption is
 gradually developed,  while that  of  morbilli  occurs, ordinarily,  in a
 sudden  manner."
   We see, by the  above,  that  the physicians  of those  times divided
 eruptive fevers into two classes only.   The  first  class comprehended'
 under the denomination of variola,  all the eruptions which consist in
 pimples, more or less prominent,  filling up with any liquid—such as
 pustules, bullae, and vesicles.   The second embraces, under  the title of
 morbilli, eruptions in which the skin is covered with spots, large patches.
 or  pimples, barely  salient, and containing  no liquid.   That was,  un-
 questionably,  a very philosophic division, and it still  remains in  our
 science.   The  second species received the name of  morbilli, which sig-
 nifies a little  disease  or little  pest,  because the affections which they
 represent were regarded as less  grave, and as engendered by a smaller
 quantity of   morbific matter,  than  the affections  of the  first order.
 Finally, it  is to be  remarked, that  all the authors of  that period
 range  eruptive  fevers  in  the  class  of pests, or epidemic  pestilential
 fevers.
   In going back to  antiquity, the history of diseases seems to me  to
 offer three distinct  phases:  in  the first, no  allusion is made to erup-
 tions ;  they were considered as  epi-phenomena of little importance—a
 sort of crisis, according to Bhazes ;  whereas the febrile symptoms, which
 indicate the state of the vital forces  and the  intensity of the danger.
 attracted all  the attention  of  observers.  The  Asclepiadae, who  even
 made no account of tetters, lepra, or other infirmities of that kind,
 might  well neglect  transient eruptions, which generally leave no trace,
 or of which the cicatrices constitute,  at most, a mere disfiguration.   In
 the  second  phase,  whether  eruptive  fevers  had suddenly taken  an
 extraordinary development, or that they passed for  the first  time the
 limits  of Arabia, the attention  of  physicians was more directed to the
 characters of  the eruption,  and they distinguished, consequently, two
 species of it.   Finally, the third phase, which extends down to us, in
 which  each genus  is  divided into several  species,  founded  upon the
 nature of the  eruption.
                                §IV.
  Albucasis, or Alsaharavius, a native of Cordova, lived in the beginning
 of the  twelfth century,   He wrote an  abridgment  of the  theory and
practice of Medicine, a mere compilation, in which is found, absolutely,
nothing new, unless it be a little treatiss on  surgery, which terminates
the work, as a kind of supplement, and which does him more  credit than 
MEDICINE OF THE ARABS.                  265
all the rest of the work.  This  last fragment, one of the  most curious
monuments  of Arabian Medicine,  includes,  among other  interesting
matter, a description of the instruments  then employed in surgical
operations,  with  explanatory figures.    The  reasons  which  decided
Albucasis to  write this treatise on operative Medicine, are worthy of
being known.   He gives them himself, in the following language:
  " After having terminated, happily enough, the work  on Medicine
which  I undertook for your instruction,  my sons, I have  thought it
proper to add to  it a small  treatise on manual operations,  seeing that
this  part of our  science  is  so much  neglected in our  country  at the
present time,  that there remain scarcely any vestiges of  it.  We  can
only find a few  short  descriptions of operations  in the  books  of the
ancients ; they are, however,  disfigured by the ignorance  of the  book-
makers ; the  manuscripts are so faulty, that at every  step we  are in
such doubt  as to the sense of the authors, that no one dare enter into
the study of surgery.  I have, therefore, undertaken this  little treatise
for the purpose of reviving this  most  important  and useful branch of
our Art.    I  have detailed  briefly  the methods  of operation, I have
described all  the  necessary instruments, and I present  their forms, by
means of drawings ;  in a word, I have omitted  nothing  of what  can
shed light on the practice.   But one of the principal  reasons why it
is so rare to meet  a skillful surgeon is, that  the apprenticeship to this
branch is very long, and he that  devotes himself to it  must be versed
in the  science of anatomy,  of  which  Galen  has transmitted us  the
knowledge.   He should know the functions of organs, their shape, and
their relations; the number  of the bones, and their modes of union;
the origin and termination of the muscles, the nerves, the arteries, and
the veins.  In fine, no one should permit himself  to  attempt this diffi-
cult art without having a perfect knowledge  of anatomy, and the action
of remedies."  °
  Observe, that Albucasis, who felt so much the necessity of acquiring
extended and precise notions  touching  the structure of the  human body,
contents himself, by referring those who desire to instruct themselves in
this  branch, to the descriptions of the physician  of Pergamos.   He
says not one  word about dissections,  which leads us to conclude that
they were not tolerated  in his time, and that he never  practiced them
himself—at least in an  ostensible manner.
  He divides his treatise on surgery into three books.  In the first, he
shows  the  diseases that  require  the  cautery, the various methods of
  0 Albucasis, lib. i.  The best  edition of this work has for a title, Albucasis,
De Chirurgia : Arabice et Latine, cur. J. Channing.  Oxonii, 1778, 2 vol. quarto.
        17 
266
ARABIC PERIOD.
applying it by fire and escarotics, the instruments which were used, and the
cautions that must be taken.   Enthusiastic partisan of this medication,
he counsels it in a  multitude of cases: among others, in spontaneous
luxations, and in the commencement of curvatures of the spine.  The
second  book is  devoted to the operations which are  performed by
cutting instruments.   The author describes a great number of these,
and even some of the most formidable.   But among the chapters which
have appeared to me the most interesting, I will cite in particular those
relative to forcible delivery and the extraction  of the  afterbirth, the
mode  of administering clysters, and blood letting.  A fact  worthy of
remark, and which the reading of the book confirms, is, that whenever
it became necessary to explore  the genitals of the female, the physician
must  never proceed  himself in  that research, but always employ  the
ministry of a sage-femme—an uncertain course, which the excessive
modesty of one  sex, and the unbridled jealousy  of the other, imposed
on the  man  of  art.   The  third book  treats  of the methodic cure of
luxations and fractures.  The  author remarks  that this part of surgery
was abandoned to men of vulgar and uncultivated minds, and for that
reason had fallen into the deepest contempt.
  Though he assures us that he had seen with  his own eyes all that he
reports,  it is difficult to believe what he recounts of multiplied concep-
tions,  in his chapter on  abortion.   He speaks of several women  who
threw off more than ten embryos in a single fausse couche, and  of one
among the rest,  who cast off  seventeen !   It  seems  probable that our
surgeon, being obliged,  under the circumstances, to believe the account
of the matrons, shows himself  a little too credulous in  regard to their
statements.  I will terminate what I have to say relating to this author,
by the following statement of Fabricius of Aquapendente:  " Celsus,"
he says, " among the  Latins,  Paul iEgineta,  among the Greeks,  and
Albucasis, among the Arabs, form a triumvirate to which I confess I  am
under great obligations."
     § V.  Retrospective Considerations of the Scientific Progress op
                     Medicine among the Arabs.

  During  this period the Arabs embraced  with much ardor the study
of Medicine: they endeavored to translate into their  language all  the
treasures  that  Greece  had  amassed on this science,  and we owe to
them the conservation of  some fragments of  Greek authors, which have
not in any other way come down to us ;  nevertheless, we possess a much
greater number of  them, of which the former were entirely  ignorant;
such, for  example,  as the writings of Aretaeus and  several books of 
MEDICINE OF THE GREEKS.
267
Galen.  On the other hand, the  Arabs neglected entirely  the  Latin
authors—they did  not know Celsus, nor Coelius Aurelianus—so that
they had, on the antiquity of Medicine, less complete notions than we.
though placed much nearer the sources of antique knowledge.
   Anatomy and physiology,  far  from  making  any  conquests  under
Arabian rule, followed, on the contrary, a retrograde movement.  As
those physicians never devoted  themselves to dissections,  they were
under the  necessity of conforming  entirely to the accounts of Galen;
consequently,  they translated  his  descriptions in  the most faithful
manner possible.   Now, in  a work  of  this kind, the  inexactitudes of
the  translation  are  always added  to  those  of the  original, if the
translator  does  not correct and prevent them by his own direct obser-
vations on the subject.   It is  thus  easily  seen, how much the anatomy
of the Arabs must have been inferior  to  that of  the  Greeks,  which
served them as a model.
   Pathology was enriched in the  Arabian  writings by some  new obser-
vations,  the most  important  of  which we have  pointed  out.    The
physicians of  this  nation were the  first, as we have already said, who
began to  distinguish  eruptive fevers by the exterior characters  of the
eruption, while the Greeks paid but  little attention to  these signs.
   Therapeutics  made  also some interesting acquisitions under the Arab
physicians.   It owes to them, among other things, the introduction  of
mild purgatives, such as cassia,  senna, and  manna,  which  replaced
advantageously, in many cases, the drastics employed  by the ancients ;
it is indebted to  them, also, for  several chemical  and pharmaceutical
improvements,  as  the confection of  syrups,  tinctures,  and  distilled
waters, which are very frequently  and usefully employed.   Finally,
external therapeutics,  or surgery, received some minor additions, such as
pomades, plasters, and new ointments;  but these additions  were  very
far from compensating for  the considerable losses which it  suffered by
their abandoning a multitude of operations in use among the Greeks.
                        CHAPTEB  II.

     MEDICINE OF  THE GREEKS  DURING THE ARABIC  PERIOD.

  While the Arabian nation was elevated  to the summit of the social
scale, by power,  intelligence, and renown, the  Greek nation declined
from day to day.   Its genius, its courage, all its  antique virtues, became
gradually weaker, and seemed on the point of extinction.  The historian 
268
ARABIC PERIOD.
of Medicine can  find only one single  name  to  cite, during a period of
nearly seven hundred years, and he is not  an  original author, and is
out of the regular  line;  but he  is  an elegant writer,  and  skillful
compiler.
  Actuarius, whose  true  name  is John,  son of Zacharia,  lived at the
close of the thirteenth,  or beginning  of  the fourteenth  century.   He
was employed at the court of Constantinople,  as his surname, Actuarius,
by which  he is designated, proves, it being only the honorary title of
the physicians of the palace.   We have no details of his  life, but we
know that he  has written much, and that several  of his  works have
not come  down to  us.   The most considerable  of these, extant, is an
abridgment  of  Medicine, in six volumes, entitled, "On the Cure  of
Diseases," ° in  which  is  found,  absolutely, the doctrines of Galen,
presented  in a compact manner, and  in  perfect order.   The theory of
critical days is explained there in the most lucid manner, and sustained .
by astronomical hypotheses, very ingeniously combined.  It is  the first
Greek work in which mention is made of the new remedies introduced
by the Arabs,  such as mild  purgatives, syrups, juleps, and  distilled
liquors.   The  author,  however, says not  one  word  of  variola,  the
morbilli, spina ventosa,  and other affections described by the physicians
of that nation.
   His treatise on animal spirits, divided into two books, is  remarkable
for the connection of its ideas; it offers the quintescence of the theory
of Galen  on that subject.   After having established the principle  that
man is formed by the union of two contrary  substances, the  soul and
the body,  he demonstrates that the human soul differs  from the soul  of
brutes; that it is  an emanation  of the  Divinity, a  simple substance
endowed with various immortal and  intelligent faculties, insensible  in
its nature, though capable of realizing pain and pleasure, by the inter-
mediation of spirits, which connect it closely to the body.
   These spirits being supposed to be the bond  that places  the  soul  in
communication  with the body,  it became very important to acquire exact
notions on their nature, origin, and the changes to which  they are sub-
ject, and the means to prevent or combat their degeneration.  Our physi-
ologist explains their formation as follows : the purest  juice of the food
digested by the stomach is transported to the liver, where it serves for
the  composition  of natural spirits, which are the  instruments of the
concupiscible faculty of the soul.   These are carried by the blood into
the  lambdoidal vein, one branch of which descends toward  the inferior
regions, and the other mounts upward to the right ventricle  of the heart.
De Methodo Medendi, lib vi. 
MEDICINE  OF THE LATINS.
269
There the spirits and the blood pass into the left ventricle, to be elabo-
rated and changed into vital spirits, which the arteries distribute to all
parts of the body.   Now, there exists  at  the base of the brain, an
extremely minute plexus of arterial and venous vessels, which is called
the plexus reticulaire.  It is there that  the vital spirits contained in
the blood, undergo a third alteration, which transforms them into animal
spirits.   These last are in immediate relation to the soul; by their aid,
that immaterial substance  perceives the sensations  of  exterior objects,
and executes the most elevated functions." °
   I shall not show the anatomical and physiological errors of this theory.
I will simply observe, that the admirable plexus in which were elaborated
the animal spirits, does not exist in man.  But if we admit the hypoth-
esis of Actuarius, which is that of Galen, and nearly all  the  physiolo-
gists of antiquity,  we are  forced  to admit  that no one has explained
more methodically than  he, the functions of the animal economy, and
the generation of diseases.   He says  that health may become affected
in two ways: first, when the humors of the body, being too abundant
or  vitiated in  their  composition, permit the exhalation of  confused
vapors,  which trouble the lucidity of the spirits, obscure the sensations
of the soul, and cause disorder in its operations;  secondly, when one of
the elementary qualities, heat, cold, dryness, or moisture, is in excess in
any part, and causes derangement.  It is in this manner that our physi-
ologist appreciates successively the influence of various kinds of food, sleep,
watchings, exercise, repose, the passions, remedies, and, in one word,  of all
hygienic and therapeutic agents.   The precepts which he gives, have for
their end to conserve the clearness of  the spirits,  to favor the coction of
the humors, and prevent their alteration or superabundance, and to re-es-
tablish  the equilibrium  of elementary qualities.  In short, we see that
his system is perfectly co-ordinated according  to logical rules,  but that
it is based on gratuitous hypotheses and material errors.
                       CHAPTEB  III.

       MEDICINE OF THE LATINS DURING THE SAME PERIOD.
                 GENERAL  CONSIDERATIONS.
  At the commencement of this period, the provinces of the Empire of
the West present a most painful spectacle.   Swarms of barbarians from
the forests of Germania  and Scandinavia sweep successively  over it,
pillaging, and killing many of the inhabitants, and  reducing the rest to
°De Spiritu Animali, lib. i, chap. vi. 
270
ARABIC PERIOD.
a state of slavery.  Everything in southern Europe is changed ;  laws,
manners,  customs,  language,  institutions,  monuments!   Each  genera-
tion sees break forth some  new and unknown  horde of invaders, which
comes to demand its share of the booty and renown, leaving a more or less
deep trace  of its passage over the countries,  lately so flourishing, but
now ruined.  For a moment the genius of Charlemagne, reuniting under
the same dominion these diverse races, seemed to resuscitate the Empire
of the West, but scarcely had he breathed his last sigh, when the ele-
ments of this incongruous empire, having no affinity among each other,
became separated.  The great vassals of the crown, no  longer being held
by so vigorous an arm, united at first against it, then against each other ;
so that for several ages there was nothing but an  uninterrupted succes-
sion of wars and invasions,  without definite  results.   A species of organ-
ization gave some sort of legitimacy to this military anarchy, under the
name of feudalism.   There was, at that time, neither repose nor secu-
rity for any one;  the weak were  trampled  under  foot, the great were
constantly under  arms  for  defense or attack.   With  difficulty, a few
men found, in  the pale of the Church, a little calmness  and leisure  to
devote themselves to the study of theology and ecclesiastical law.   Pro-
fane letters, as well as  the natural sciences, had  fallen into the most
complete neglect.
  However, toward  the end of the eleventh century, the enthusiasm  of
the Crusades offered a new aliment to  the turbulent ambition of the
Christian Barons.  But while the higher and inferior  lords of western
Europe  carried their bellicose humor to the East, the  people, though
always oppressed, began  to  breath freer; a few States recovered  their
independence ; the reign of  law was slowly established ; municipal insti-
tutions were organized and consolidated,  and establishments consecrated
to public instruction were multiplied and acquired importance.   Finally,
in the course of the thirteenth and fourteenth  centuries, the darkness
which covered the face of Boman  Catholic Europe, began to give  way;
a few men of talent, and even genius, appeared on the  horizon of letters
and science, though all is in obscurity around  them—they shone in the
midst of their ignorant cotemporaries, like  the stars  that  glow in the
firmament  before the appearance  of  Aurora.   Such, in letters,  were
Dante, Petrarch, Boccacio, whose writings recall the good taste and purity
of the happiest ages ; such, in mathematics, was Leonard of  Pisa, who
was the first in Europe to understand and employ the Arabic figures and
algebraic characters.0

  55 Cuvier attributes the honor 0f this importation to Gerbert, a learned Benedic-
tine of the tenth  century, who wore the tiara under the name of Sylvester II.—
His. desScien. Nation.; Paris, 1811, t. i, pp. 396. 
MEDICINE  OF THE LATINS.
271
  The physical sciences, also, had representatives at that epoch, when
the questions of scholastic  philosophy and theology had, almost alone,
the privilege  of engaging  the human mind.f   Boger  Bacon, by  the
force of his genius, was in advance of  the scientific reform  which was
accomplished  three centuries later.  He attempted to introduce  the
experimental philosophy; and he succeeded so well in communicating to
his auditors the convictions with which he was penetrated, that they
subscribed, in equal shares, the sum of two thousand pounds sterling, to
provide for the expenses of his experiments.   It was,  unquestionably,
money well employed, and served to make a prodigious  number of dis-
coveries for such an age.  Thus, it is  said, that  Bacon  knew the prop-
erties of convex and  concave glasses, and was  the first  to conceive  the
idea of making microscopes and telescopes.   His astronomical observa-
tions led him to demand a reform of  the calender, which was  executed
three centuries  later,  under Gregory XIII.  He had, also, some knowl-
edge of gunpowder and its effects;  in short, he rejected the physics of
Aristotle.   So much  boldness  and superiority  could not fail to draw
down upon him persecution;  he was condemned to imprisonment for life,
by the chief of  the Grey Friars, and to live on bread and water ;  but he
was brought forth in 1266, on the demand of Pope Clement IV.   He left
a large number of works, of which several  still exist, but only in manu-
script, the friars having always forbidden their publication, because they
believed them to be tainted with magic and sorcery.
  ART.  I.  THE  MEDICAL  ORGANISATION  OP  THE WEST.
  We  have  seen what  was  the medical organisation of  the  Boman
Empire, down to the seventh century.  The palatine archiaters, attached
to the palace of the prince ; the popular archiaters, forming in each city
a, college, charged with  the  sanitary  police,  and  the  instruction and
and examination  of  aspirants to the practice of medicine, and required
to give gratuitous  attention to the  afflicted poor;  such is the sum of
the positive knowledge we possess on  the subject, down to the destruction
  j The philosophers were at that time divided into two camps, under the names
of Realists and Nbminals.  The first believed with Plato, that ideas are self-existent)
and independent of the mind—that they are veritable entities; the second, on the
contrary, affirmed with Aristotle, that general ideas are pure abstractions, which
our minds form by the aid of sensations, and which, without these, could never
exist.  These two sects kept up a very active war; and as  they called to their aid
the civil and ecclesiastical authority, the result was persecution against each
other, according as either party had momentarily the power. 
272
ARABIC PERIOD.
of the school of Alexandria.  It is probable that after the ruin of this
celebrated  school, the  same  medical  organisation subsisted in  those
provinces which  continued to form  a part of  the Greek  Empire  of
Constantinople.
  In those countries subjected to Arab  sway, we are ignorant  of what
rules existed regulating the practice of  Medicine.   We know, only, that
schools and academies were founded in several cities, for the teaching and
perfection of the art; but we have nothing positive  on the interior regi-
men of the schools and academies, or  the degrees that were conferred by
them,  and the manner  in  which they ascertained  the capacity of the
aspirants to  academical titles.   These countries,  as we  have already
said, did not long enjoy an enlightened and liberal  government.   From
the moment that they fell under the  yoke of  the  Turks, they lost the
greater part  of their scientific institutions, which  have not  since been
resuscitated; and, if one may judge by what still exists to-day in  those
unfortunate countries consumed by the leprosy  of ignorance and despot-
ism, the  most complete medical anarchy followed the old organization.
  In Europe, things took a different  course.   At first, the invasion  of
the barbarian  threw every thing into disorder  and  confusion.   The
Christian states of the west presented, during three  or four centuries, a
chaotic condition.  The  sovereigns of these states,  constantly occupied
with the care of self-defense, or the desire of usurping  the heritage  of
their neighbors and relatives, scarcely  dreamed of bestowing upon the
people useful laws and  institutions;  or, if any among  them  wished  to
labor for the happiness of their subjects, all their plans were paralyzed
by a  multitude of obstacles that  prevailed within as well as without.
In the midst of these circumstances, the ecclesiastic schools, placed under
protection of the bishops, preserved, alone, a course  of  literary and sci-
entific instruction.   In  the time of Charlemagne,  the colleges  of the
cathedrals and some monasteries taught  Medicine, in  a limited way,
under  the name of physics.   In this way, all the liberal professions, and
the practice of Medicine in  particular, fell into the hands of the clergy.
We see  priests, abbots,  and bishops  become  the physicians of kings.
The monks of Mount Cassin, of the order of St. Benoit, enjoyed, for a
long time, a great reputation for skill in Medicine.   Among  others are
cited Berthier,  abbot of this convent,  in the ninth century; Didier, who
wore the tiara toward the close of the eleventh century, under the name of
Victor III.; and Constantino, called the African, of  whom I shall speak
presently, when on the subject of the school at Salerno.  Among the num-
ber of ecclesiastics who distinguished themselves by their  knowledge of
Medicine, from  the  ninth  to  the eleventh centuries, must be mentioned
Hugues, abbot of St. Dennis, who was physician to  the king of France; 
MEDICINE  OF THE LATINS.
273
Didon,  abbot of Sens; Sigoal, abbot of Epernay;  Milo, archbishop of
Benevent, and others.  Finally, several religious orders of women in-
gratiated themselves, also, in the practice of Medicine, and Hildegarde,
abbess  of the  convent of Bupertsburgh, near Bingen, is mentioned as
the authoress of a treatise on materia medica.0
   From the ninth to the  thirteenth century, the Jews shared with the
clergy the monopoly of the healing art.   The knowledge that several of
them had  acquired of the Arabic tongue, by the  commerce they held
with the Saracens,  facilitated their study of the  medical works of that
nation, which stood, at that time, at the head of civilization; also, not-
withstanding the canons of the church which forbade the Israelites from
prescribing or administering remedies to  a Christian, they were obliged
to call upon them in time of need, and the Jew had access not only to
the courts, but also to the palace of the Boman pontiffs.
   The  education of these Christian or Jewish medicasters, clergy and
laiety, embraced generally but a very few things ; it consisted, often, in
the possession  of some recipes and the knowledge of a few symptoms.
The extreme rarity of books, and the absence of  capable professors, ren-
dered a good medical education entirely impossible.  We may form  an
idea of what was,  at  that epoch, the  teaching of Medicine, when we
learn that, in the thirteenth century, John of Gaddesden, the author of
the Rosa Anglicana, an informal collection of odd formulae, was the
oracle of the University of Oxford, the doctor a la mode of the court of
England; and that, about the same time, Bernard de Gordon, the author
of Lilium Medicines, a work of the same character of the Rosa Angli-
cana, shone in the first rank among the professors of Montpelier.   Guy
de Chauliac thus speaks of the work of  Gaddesden; " Finally appeared
a pale English rose, which was  sent  to  me, and I  perused it.   I did
hope to find in it sweetness of perfume; but I only found the fables of
the Spaniard Gilbert and of  Theodorus."f  M. Malgaigne  esteems this
critic too severe;  but he does  not show  himself very indulgent in regard
to a man who dishonored  his ecclesiastical character, and his character
of physician, by the juggleries of the most impudent  charlatanism;  of
a man who took  pleasure in  displaying the  shame of his  most  illicit
gains.   The  following  among his acts is one that will  excite  most
hilarity: he  speaks of having sold, at a high price, to the barber-sur-
geons, a recipe for a preparation of green  frogs, and boasted  of having
duped  them.|  What  confidence could  this vender of secret  remedies
  0 See Histoire de la  Medicine, by Sprengle, translated by Jourdan, T. II,  p. 351'
et suiv.
  f La Grande Chirurgie de Guy de Chauliac, restored by Laurent Joubert, Rouen,
1632, p. 10.
  I Freind, Hist. Med., Paris, 1728, quarto ed. 
274
ARABIC PERIOD.
inspire ?—this constant puffer of a multitude ofridiculous proceedings,
to whom all means of gaining money appeared equally good.
   No law, no  rule of public administration, had for its object to insure
the capacity of individuals who aspired to the medical profession.   Each
one at his risk and peril, entered upon the cure of diseases; also, besides
the priests and the Jews, who stood at the top of the scale, there was still
a multitude of healers and practitioners of the lowest order, such as bath
keepers, barbers, and resuscitators, and even a few women.  The morality
of this vulgar medical mass was  on  a level with its knowledge, as is
proven  by a law of Theodoric,  king  of the Visi-Goths, which code was
in force in the greater part of the West, from the sixth  to  the twelfth
century.  This law says that no physician  could bleed  a woman, or  a
daughter of noble birth, without the  assistance of a relative or a domes-
tic, and in case of contravention, he  should pay a  penalty of ten sous,
quia difficillimum non est ut in  tali occasione ludibrium interdum  adh<z-
reseat.  When a  physician is called to treat a disease  or dress a wound,
it is necessary, immediately after having seen the patient, to give secu-
rity and agree upon the price of his attention.  If he happen to harm a
gentleman, he must pay a forfeit of one hundred sous,  and if the patient
died from the effects of  his operations, he should be handed  over  to the
relatives of  the deceased, who could do with him  whatever they pleased.
If in any way he  crippled a serf, or caused his death, he was held account-
able for the  restoration of another to the lord.0
   We see by the  above guarantees  of knowledge and morality  which
were required of  the aspirant to the medical profession, that  the legisla-
tor held in constant suspicion all who devoted themselves to its practice.
It is possible, as  M. Malgaigne observes, that  these severe restraints
were only applicable to surgical cases, the practiee of which  was at that
time abandoned  to individuals  of the  lowest conditions,  against  whom
the law might and should show itself suspicious; while the  practice of
internal medicine formed part of the privileges of the clergy, who alone
were the  depositories of  letters and science, and enjoyed  the highest
consideration.  It is not probable that the secular power ever dreamed
of handing over to the relatives of the dead, a man protected by the title
of clergyman, f
   It is probable that it was from this time,  i. e.,  from the seventh cen-
tury, that Medicine was separated from  Surgery.  This  change,  which
was contrary  to the views of the greatest  masters, and which in itself
  ° Lindenbrog, Cod. Leg.  Antiq. Wisigoth, lib. xi, tit. i.  Sprengel  Hist, de la
Med., translated by Jourd m.  Paris, 1815, t. II, p. 49.
   tOEuvres completes d'Ambrose Pare'.  Paris, 1840,1.1, introduction, § 1. 
MEDICINE  OF THE LATINS.
275
is not very rational, was not the effect of any civil law, but the gradual
result of custom caused by the general prohibition against the spilling of
blood by ecclesiastics.  Nevertheless, it appears that the practice of Medi-
cine, though thus  separated from the practice of surgery, led to such
irregularities in the manners and discipline of  the clergy, that from the
twelfth century, we observe the councils  and popes interdict its practice
under the most severe  menaces, by men in holy orders and bound by
monastic vows, and yet this prohibition was often violated,  as is attested
by the frequent reiteration of this law.0
  In the course of the twelfth century, the secular authority began also
to be moved by the abuses which had entered into the practice of Medi-
cine.   Boger,  founder of  the kingdom of Sicily, and one of the greatest
men of his time, seems to have been the  first among Christian princes of
the Middle Ages,  who occupied himself  with this subject.   In 1140, he
published an ordinance, by which every  man who  wished to devote him-
self to the practice of Medicine in his  State, was  obliged to  present
himself before the magistrate, to obtain  their authorization, under pain
of imprisonment and the  confiscation  of  all his goods.  From this time,
many other sovereigns followed his example, and established ordinances
to regulate the practice of Medicine.   In the end, the medical organiza-
tion was completed by the institution of  faculties and university degrees.
                  ART.  II.  SCHOOL OF  SALERNO.
   The origin of this school,  so celebrated in the Middle  Ages, is some-
what obscure.  The common opinion  carries it back to the  epoch of the
destruction of the library of Alexandria, by the Arabs.  It is pretended
that after this mournful event for the sciences, the  professors  and phy-
cians, who were very numerous in that city, were scattered in  different
countries; that some sought refuge at Salerno, where  they  laid the
foundation of a medical school, which grew rapidly.   It  had already a
reputation, as early as the  eighth century, but  the epoch of its great-
est splendor was from the tenth to the thirteenth century.
   Several circumstances concurred, at this time, to  secure to  it extra-
ordinary eclat:  first, the number and  skill  of its  professors, who were
unquestionably the  most capable in  all Christendom;  in the second
place, the unexceptional situation of the  city of Salerno, lying in the
route which travelers had almost necessarily to  follow in passing from
Europe  to  Asia, and of the  fleets that transported the armies of the
"Sprengel, Hist. Med., by Jourd., t. II, p. 350. 
276
ARABIC PERIOD.
Crusaders.  This city offered to pilgrims and warriors a  safe haven ;  a
delicious and salubrious  climate;  all the  means  and recreations which
most contribute to the establishment of health and the oblivion of every
species of fatigue and suffering which they had encountered.
  The reputation of its medical school attracted those who had  diseases
or wounds difficult of cure, from all parts of Europe.   Bobert, Duke of
Normandy,  the  son of William the Conqueror,  stopped there on his
return from the Crusades, to be treated for a wound of  the arm.  John
of Milan  composed for his benefit a summary of  the  hygienic  aphorism
of the school, which was published in 1100, with the title of " Dietetic
Precepts of  the School of Salerno," and made much noise in the world.
This compilation was honored by several commentaries,  the most famous
of which  is  that of d'Arnaud  de Villeneuve.  It begins as follows:
   "The  faculty  of  Salerno  wrote  to the  king  of  England as  fol-
lows:   If you  wish good  health,  banish  despondency  and  avoid
anger.  Drink but little wine; eat light  suppers, and do not disdain to
take  some exercise after meals.  Do not sleep during the day.  Do not
retain too long the urine and evacuations from the bowels.   By observing
these precepts, your life will be prolonged."0
   Among the professors of the school of Salerno, the most illustrious was
Constantine of Carthage, surnamed the African.  He flourished during the
latter half of the eleventh  century.   While yet young,  the desire for
knowledge urged him to travel.  He passed through Arabia, Persia, India,
Egypt, Ethiopia, and all  the  countries where any knowledge  could be
gained.   On his return to his country, in  place of the honors he had a
right to expect, he found only persecutions; he  was looked upon  as a
magician, and came near being put to death, but escaped and took refuge
at Apulia, near the Duke Bobert Guiscard, who made him his secretary.
Afterward, he was adjunct professor in the College of Salerno, and taught
Medicine for some  time in  that capacity.  Finally, disgusted with the
world, he retired to the monastery of Mount Cassin, where he  found a
safe retreat, where he could indulge, without distraction, in his penchant
for study.   While there, he translated and compiled a great number of
the medical works of the  Greeks and Arabs,  compilations extremely
useful at an  epoch when the originals could not be  read, and which
            Q Anglorum regi scripsit schola tota Salerni:
             Si vis incolumen, si vis te reddere sanum,
             Curas tolle graves ; irrasci crede profanum.
             Parce mero; cenato parum; non sit tibi vanum
             Surgere post epulas.  Somnum fuge meridianum.
             Non mictum retine, nee comprime fortiter anum.
             Hsec bene si servas, tu longo tempore vives.
                              Regimen Sanitatis Salerni, Paris, 1493. 
                    MEDICINE OF THE LATINS.                 277

contributed powerfully to popularize, in  Europe, the letters and science
of the East.   Though written in barbarous Latin, the translations  of
Constantine served, in a very efficacious  manner, for the propagation  of
medical knowledge in those ignorant times.
  In  the course of the thirteenth century, the Emperor Frederic II.,
grandson  of  Boger, issued  an edict, in  virtue of  which no  individual
could practice Medicine, in  the  Kingdom of Naples, who had not been
examined previously, and created a master, by the College of Salerno.
To effect this, he must study logic  three years, and pursue a.course  in
Medicine which must continue—(including surgery, which made a part
of Medicine)—five years, according to  the interpretation  of Sprengel,
and  two years  only according  to  that of Malgaigne.0  However this
may be, to have been admitted  to  an  examination at the end of  term,
the student must furnish a certificate  of his legitimate  birth, and that
he had attained his  twenty-fifth year, or  his twenty-first  according  to
another version; after which he was  examined, publicly, on  the thera-
peutics of  Galen, the first book  of  Avicenna, and the aphorisms of Hip-
pocrates.   These proofs being satisfactorily fulfilled, he took an oath  to
be faithful to good conduct, to submit to the  rules of the profession, to
give gratuitous attention to the poor,  and  not to share  in  the profits  of
the apothecaries.  His diploma was afterward to be confirmed  or legal-
ized by an officer of state;  still he could not enter fully into practice,
but was obliged to continue  a year longer under an experienced physician.
  He, who wished to devote himself exclusively to surgery, was obliged to
follow the teachings  of the faculty for  one year only ; but he must devote
himself, above all, to acquiring  anatomy, without which, said the act,  he
could not safely perform any surgical operation, nor direct the  subsequent
treatment.   Afterward, he  underwent an examination which gave him
authority to  practice, and take the title  of master.  Thus, says M. Mal-
gaigne, there were two  masterships:  one, which gave the right to  prac-
tice medicine and surgery; and the  other, which conferred the  right
to practice surgery only.
  ART.  III.  ON  THE ORIGIN  AND GROWTH OF UNIVERSITIES.
                                 §1-
  In the times of Charlemagne, as before observed, each cathedral pos-
sessed a school, where writing, arithmetic,  singing, theology, and some-
times, also Medicine, were taught.  The Episcopal College, of Paris, had

  ° Lindenbrog, Constit.  de Naples  et de Sicile, liv. m, chap, xxxiv.—Sprengel,
Histoire de la Medicine, sec. 7, chap,  n, T. II,  p. 363.—M.  Malgaigne, GSuvres
d'A. Pare, introduc, § 4, p. 30. 
278
ARABIC PERIOD.
medical teachers, who gave advice and dressed wounds before the portals
of Notre Dame, or even in the interior of the church.   The same  thing
was done in several other cities ;  but when the  medical profession had
been  declared  incompatible  with the  saserdotal office, by a series of
councils, the popes, in order to preserve the high jurisdiction which they
had exercised from time immemorial over the medical corps and the bar.
erected certain Episcopal schools into  universities, combining at once
instruction in philosophy, theology, layJ, and medicine, or only some one
of these faculties.  Thus were created  during the thirteenth century,
the most of the great universities of Christian  Europe; among others,
those of Bologna, Padua, and Naples, in Italy; those of Paris, Mont-
pelier, and  Toulouse,  in France; those of  Valencia  and Tortosa,  in
Spain, and that of Oxford, in England.  Pope  Innocent III., issued a
bull which guarantied  the  professors  and students  of Paris from  all
excommunication which should not proceed directly from the  Holy See.
Other bulls confirmed and extended  these immunities.  The kings of
France, themselves, assumed the  honor of  conferring  special  privileges
upon the  universities of their capital, to such an extent that very soon
the members of the university formed  in  the midst  of Paris a second
city, having  laws, customs, police, inhabitants,  and magistrates, differ-
ing from those of the rest of the city.   "All  science," says M. Mal-
gaigne, " appertained to the clergy, and teaching, though removed from
the cloister, did not become less  Boman Catholic.  These  new clergy-
men, connected to the Chief of the Church  by their oaths and  privileges,
were unto him  a numerous  and powerful  militia, and while by the
clergy  proper the popes reigned  over the  consciences of the  people, by
the  clergy of the  universities they reigned over their minds.  Who
can be astonished, then, that they bore impatiently the fact of not being
able to concentrate, also,  all other powers  in  their hands ?"°   Neverthe-
less, we must do  justice to the pope, the monks, and the Catholic clergy
in general, who prepared the intellectual movement of modern Europe.
The universities,  by associating together studious men, offered them  the
opportunities and means of mutual instruction, excited their emulation
by the  prospect  of honors and rewards—concurred, in  short, in a very
efficacious manner to elevate Christian  civilization, above all  others.
   The great effects of these  liberal institutions were  not  immediately
realized, it  is  true;  it  required several  generations to  develop their
results, and  ripen  their fruits.   On this account, the end of this his-
toric period, though  less barbarous  than its beginning,  has transmit-
ted to us but very few writers  worthy to arrest our attention.   The men
0 QSuvres d'A. Pare',  introduction, p. 28, 
MEDICINE OF THE LATINS.
279
who made themselves a  reputation  in  the sciences, and especially in
Medicine, shone less by the merit of their works, than by the love for
instruction, and by the zeal which  they  displayed  in  its research and
propagation.  To-day, when literary riches  abound, we can with diffi-
culty form an idea of the price they cost our ancestors.  We  are aston-
ished to see them  undertaking expensive, as well as wearisome voyages,
without any  encouragement  or  hope of remuneration, to obtain some
manuscript, or hear some renowned professor.   Such was the devotion
and zeal of the greater part of the authors  of  whose  lives and labors
we now proceed succinctly to  speak.
                                §n
   The first who presents himself is Gerard de Cremona,  in Lombardy.
" You will seek in vain," says M. Malgaigne,  " the name of Gerard  in
the historical medical dictionaries; he has been rejected even by many
others,  and yet there  are few sciences which do not owe him some grati-
tude.   A man of  study and piety, he had ardently perused  all that the
Latin authors could teach him, but not having been able, in Italy,  to
procure the Almageste of Ptolomy, he determined to go in search of an
Arabian translation, at Toledo.   He was not acquainted with the Arabic,
but he learned it,  and armed with this powerful resource, which none of
the Occidentals since  Constantine the African had possessed, he could
not see  before him so  many Arabic works  on all  the  sciences, without
feeling an intense  desire to transmit them to the Latins, as to a cherished
heiress,  says his naive biography, and the  rest of  his life was occupied
in translations.  Among a mass of  his translations are found those  of
some of the treatises of Hippocrates and Galen; the work of Serapion,
the books of Bhazes to Almansor, the immense canon of  Avicenna, and
the treatise on surgery, by Albucasis.   He died at Cremona, in 1187,
at the age of seventy-three, and  left all his  books to the convent  of
Saint Lucy, in which he  was buried."0
   William of Salicet  had a less wandering  life.  Born at Plaisance,
in the first years of the thirteenth century, he was professor, at first at
Bologna, afterward at Verona.  It does not appear that he ever quitted
Italy.   Though he has written on Medicine and Surgery, it is  especially
as a surgeon that he is worthy of the recollection  of posterity.   He  is
the first, in that period of ignorance, who wrote on that branch of our
Art  from his personal experience,  and who  has not always  followed,
blindly, the opinions of his masters.  He died in 1277 or 1280.
  Arnold de Villeneuve was a man passionately fond of the sciences.
He studied ten years at Montpellier, twenty years at Paris, and visited
i; QLuvres of d'A. Pare',  p. 27. 
280
ARABIC PERIOD.
all the universities in Italy.   He passed into Spain, to be instructed in
the Arab works.  He wrote  on medicine, theology and chemistry, and
enjoyed considerable reputation among  several sovereigns and  popes.
He was especially renowned as a chemist.   " We owe to him," says M.
Dezeimeris, " the discovery of the spirits of wine, of the  oil of turpen-
tine, aromatic waters, and some other preparations.   He introduced into
medicine the use of chemical remedies.   His  death is stated to have
occurred in several  ways;  but it  is generally believed to have  taken
place in  1313, when he went from Sicily to Avignon, to  attend upon
Clement V., who was sick."0
  Lanfranc was  from  Milan,  and studied  under William  de Sali-
cet.  All that we  know of  the early years of his life, is,  that  he
practiced surgery in that city at the time of the greatest  dissensions of
the Guelfes and the Gibelins.   The party to which he was attached was
the weaker.  Matthew de Vincenti, chief of the other party,  exiled our
surgeon.   He went to seek an asylum in France, and stopped first at
Lyons, where  he remained several years,  and where he wrote his  Minor
Surgery.  In 1295 he went to Paris, and, at the instance of John  Passa-
rant, dean  of the faculty of Medicine, he opened a  course on  Surgery,
which  had  great success.  It was  then that  he achieved  his  Great
Surgery, which was published in the following year.   We do not know
the period  of his death, but from the way Henry de Mandeville  speaks
of him in 1306, we suppose he was  not then alive.
  " We are, unhappily, compelled to add," observes M. Malgaigne, "that
in the  hands of Lanfranc,  and much less, doubtless,  from his fault than
by that of  his age, Surgery began  to decline.  We have seen that from
the times of Brunus (who practiced in Padua in 1250), the barbers did
the scarrifying and  bleeding; from the times of Lanfranc there were
others  who applied leeches, and what is much more serious, even  caute-
ries.   The women, who  meddled thelnselves with surgery, in all these
operations  competed with  the barbers.  On the other hand,  the lay-
surgeons held themselves  as  the rivals of  the clergy.   Lanfranc, who
had inherited for them all the aversion of his master, had more  than one
contest to sustain with them in his practice, and if they had less success
they had more boldness.   The  clinical surgeons began to regard the
operations  as too much  beneath them;  Lanfranc, who deplored these
whims, and who declared that he  sometimes bled with his own  hands.
never,  however, operated for ascitis, hernia,  cataract or stone."0
  j M. Hcefer denies all the chemical discoveries attributed te this physician, and
proves that they were anterior to him.  Hist, de la Chimie; Paris, 1842.
  ° QSuvres  de A. Pare; Paris, 1840, Introduc, § 6, pp. 4G. 
MEDICINE OF THE LATINS.
281
  John Pitard was, in 1306, surgeon  of the King of France, Phillip
le Bel,  and,  also, the sworn surgeon  of  Chatelet.   He  has  left no
writings on his art;  but he is regarded as  the founder of the surgical
school of St. Come and St. Damien, which occupies so eminent a position
in the surgical annals of  France.  This college, which was, in 1311,
only a little brotherhood of lay-surgeons, insensibly increased in impor-
tance, as the  result of the obstinate struggle which they sustained, on
one hand against the faculty of  medicine—on the other against the
barber-surgeons.  M. Malgaigne, who has unravelled, with the patience of
an erudite, the origin and title of this community, proves  that at  first
its importance was greatly exaggerated by its historians.0  Afterwards,
on another occasion, looking especially on the facetious side of its long
quarrels, he  has traced  their various  turns of  fortune in  the comic
vein of Aristophanes, or of the chorister of Lutrin.f
  Guy de Chauliac,  the most famous of the physicians and surgeons in
Christendom, during the Arabic Period, was born in a village of the diocese
of Mende, in Gevaudan.   " He was already clerk," says M. Dezeimeris,
" and at least twenty-five years of age, in 1325.   In this way we fix the
epoch of his birth at the end of the thirteenth century.  It is supposed
that he studied the humanities  in  the College of the Cathedral, at
Mende, which  enjoyed, at that  time,  a great celebrity.   He  studied
medicine at Montpellier.   Among the  masters he heard, he cites with
gratitude  Baimond de  Molieres, Pierre  de Toulouse, Pierre d'Horlac or
d'Aurillac, and Master Barthelemy, or Barthomieu, called,  also, Bertru-
cius orBertrand, in the copies printed of the surgery of other authors."
It is probable that Guy followed the course of the faculty of Paris ; for he
recounts, himself, how a shoemaker of that city removed a corn from his
foot.  He studied, also, at Bologne, where he saw several dissections made.
   " Little satisfied with  the science drawn  from  the schools," adds his
biographer, " Guy de Chauliac made himself familiar with the writings
of the ancients, and acquired an erudition infinitely more extended than
any of his cotemporaries.   He practiced in various cities,  but fixed his
residence for  a longer time at Lyons than  elsewhere.   He entered the
service of Pope Clement VI., at Avignon, where the Holy See was trans-
ferred—at latest in 1348.   We  have reason to believe that he enjoyed
the same honor under Innocent V., at the death of  whom Guy de Chauliac
was welcomed by Urban V., his compatriot, who was crownedPope in 1362;
he  became his chaplain,  commencal or reader in his chapel.   We know
not the length of time he enjoyed that  dignity.   All our knowledge on

           * 03uvres d'A. Pare', § 16, pp. 120.
           t See his eleventh letter on the  History of Surgery.
          18 
282
ARABIC PERIOD.
 this subject comes from himself;  and it does not appear that he wrote
 anything after 1363, at which time he published his Surgery.0
   He  composed several  works, which are enumerated by M. Malgaigne,
 but the only one which requires our attention now, is his Great Surgery,
 which he calls Inventory, to signify, as he explains,  that it  contains the
 succinct exposition of all that was essential, that had been taught up to
 that time, on each branch of the art.  In his singular chapter—capitu-
 lum singulare—which seems as an introductor}r, he glances at the pro-
 gress of surgery since Hippocrates.  He names a great number of Greek.
 Arabian,  and Latin authors, and of all those whose writings have reached
 us, he omits only Celsus and Aetius.   He cites some Arabian physicians
 of whom  we have no knowledge at present.  No one has known better
 than  he,  how  to  unite respect for the  ancients with justice toward
 moderns.    " The sciences," he remarks,  " are created by  successive
 additions; the  same man can not  lay the  foundation, and perfect the
 superstructure.   We are as children  carried on the neck of a giant:
 aided by the labors of our  predecessors we see  all that they have seen,
 and something besides."  In the same chapter,  in tracing the character
 of a surgeon, he recommends that he be learned, expert, ingenious, and
 Men morigene, that is to say, following the interpretation that he gives
 himself of the last word: that he be bold where he is sure, and timid
 when in doubt; that he avoid bad cures and practices  ; be gracious  to
 the sick ;  generous to  his companions; wise  in predictions; chaste,
 sober,  pitiful, and merciful; not covetous, nor an extortionate of money,
 but receive a moderate fee, according to  his labor, the  abilities of  his
 patient, the character of the issue or  event,  and his  own  dignity.
 " Never, since Hippocrates," exclaims M.  Malgaigne,  " has  Medicine
 heard a language stamped with such nobility, and in so few words."
  The entire work is divided into  seven  treatises or books.  The first
 is  devoted to anatomy, but contains nothing new; the description he
 has given of the  body  is drawn  entirely  from Galen, or  some other
 nearer  and less pure  source.   But  he insists  on the  necessity  of
 dissections, and states that the practice had been introduced for  some
 time, in the school at Montpellier,  of making anatomical demonstrations
 on animals.   He proposes, also, to  make use of the corpses  of executed
 criminals.  He  speaks of drawings representing parts of  the human
 body, which had been drawn by the direction of Henri d'Hermondaville,
 or Mondeville.   As to his surgery proper, he extracted it from Galen,
Oribasius, Paul  d'^Egina, Bhazes,  Avicenna, Albucasis, Boger, Boland,
 and other writers, but he selects from them with discretion ; he discusses.
0 M Dezeimeris Dictionnaire de Medicine, article Guy de Chauliac. 
MEDICINE  OF THE LATINS.
283
judges, chooses, and makes summaries of their opinions and  methods.
" At that period," says M. Dezeimeris,  " an inventor would have rendered
less important services  than a judicious compiler.   Books were of an
extreme  rarity, and from  their price within the reach  of but few sur-
geons ; to  unite  them  nearly all in one, to collect all  that there was
useful, so  as  to  form but one  small volume, was to place the  science
within the reach of all fortunes, to give facility for learning  to him
who was doomed to ignorance by the scarcity of books, and to create, not
surgery,  it is true, but surgeons."
   In the second book,  which treats  of abscess,  our author  gives the
word a more extensive meaning than it has at this time.   He designates
by it every species  of tumor, excressence,  and  swelling, partial  or
general.   " The  great abscesses," he remarks,  "are, according  to Galen,
considerable tumors, which  are  developed in  fleshy parts.   The little
abscesses are, according to Avicenna, eminences,  pustules, and pimples,
which appear on  the surface of the skin."  He  divides abscesses into hot
and cold.  The hot are caused by too much blood, such as the phlegmon,
anthrax, gangrene, and pustules :  sometimes from the bile, as erysipelas,
vessicles, and effervescences.  Among  cold  abscesses he classed oedema,
tympanitis, dropsies,  scrofula, scirrhus, and cancer.
   The practice of Guy de Chauliac, though timid, was more active than
that of Lanfranc.  He never cut  for stone; he left to the travelling
surgeons  that operation,  which he desribes  according  to the  Arabic
writers, and as he had seen it performed ; but he incised the  abdomen.
in  ascitis, and did  not hesitate to attempt the radical  cure of hernia ;.
he  speaks of cataract  like  a man thoroughly acquainted with  it, and
who had operated.0
   The plague which raged during the  fourteenth century in all parts of
the known world, and which depopulated the globe, according  to his-
torians, of a fourth of its inhabitants, appeared  twice in the city of Avig-
non,  at the  time Guy resided  there.   He  acknowledges, ingenuously,
that  he  desired  to fly, like others,  that theater of death;  but was
prevented by the  shame  of the  thing.   Et ego, he  says, propter infa-
miam, non fui ausus recedere.  He remained at his post, continuing to
visit the sick, and giving them consolations as well as counsels, notwith-
standing the uselessness  of remedies.  Being attacked himself, he saw
all abandon him and leave him for  dead.  In this frightful position, he
preserved enough presence of mind, to follow the  progress of his disease,
analyze his sufferings, and give a description of them, worthy of  Hippo-
crates.
'•'' M. Malgaigne, CEuvres d'A. Pare. 
284
ARABIC PERIOD.
   Here finishes the list of men  rendered eminent by services to medical
science during the Arabic period.  The work of Guy dc Chauliac became
very soon the surgical code of Europe;  translated and commented upon
in all tongues, and reproduced  under different forms, it was  for a long
time classic, and  still preserves its interest, as representing the state  of
science at the close of the middle ages.   He has  written, moreover, in a
clear, concise, and even picturesque style, very superior to the barbarous
Latin of most of the writers of his time.
                         CHAPTEB  IV.

                 ACCESSORY  INSTITUTIONS.

   Charitable institutions were  astonishingly multiplied during this
period, as well among the  sectators of Mahomet as in the Christian
states.  By the  side of each  mosque, the same as by each  cathedral,
there were usually a school and a hospital, endowed with more or less
munificence by emperors, califs, kings, bishops, or the opulent, who hoped
to buy a redemption from  their  sins by pious  liberality, and secure an
eternity of happiness.   A great number of religious communities were
established during the middle  ages, to give  succor to  the necessitous
sick.   The most considerable were the orders  of St. Mary, St. Lazarus,
the Knights of St. John of Jerusalem,  and the Daughters of God.  In
the end, some of these orders  departed  from their primitive undertak-
ings, and became so rich as to excite the covetousness of  sovereigns, and
so powerful as to resist their authority.   More than  once, the laxity of
morals and the spirit of discord entering into these religious societies,
rendered their reform or even their suppression necessary; but  in their
origin all  had an aim for  charity and sanctification.
   The charitable zeal for  the sick was never  more fervent than at this
epoch; we see princes, bishops,  and popes give  an example of heroic
devotion, in dressing, with their own hands, the ulcers of the leprous, of
which no  one at that time had doubted  the contagious properties;  never,
besides, were  the occasions for their exercise more frequent.  The leprosy
that the crusaders had contracted in the Orient, spread with  frightful
rapidity ;  misery, uncleanness, and the  want of hygienic care had multi-
plied, to the  last degree, cutaneous diseases of every species; ignorance
and fear aggravated still more the evil,  by confounding with the leprosy
affections  of a nature less  formidable; so that, in the thirteenth century. 
ACCESSORY  INSTITUTIONS.
285
it was estimated that there were not less than two thousand leprous per-
sons in  France,  and nineteen thousand in Europe entire.
  The excessive severity of a  mass of ordinances enacted against  the
leprous, proves how great was the terror which that hideous disease in-
spired.   They were forbidden  to enter the cities; if they encountered
any one in their walks, they were compelled to turn aside, so that their
breath should not taint  them.  If a healthy  person  was  convicted of
having  touched a leper, or any thing which they had been using, he
was immediately separated from society.   Lastly, the least infraction of
any of these rules entailed severe punishment, often even that of death.
What superhuman courage, what abnegation did it not require in those
who devoted themselves to the service of these unfortunates !
  Another institution, which  would tend more effectually than  coercive
measures to the  diminution of these cutaneous diseases, was that of pub-
lic baths.   They were established in nearly every city, and the number
increased to such an extent that, in the  fifteenth century, the bathers
formed  in  Paris a powerful brotherhood.0  Jaques Despars, physician
to Charles VII., and one of the most renowned professors of the faculty,
having spoken too openly against the abuses of public baths, was obliged
to quit the capital to avoid the persecutions of that brotherhood.

                   RESUME OF  THE ARABIC PERIOD.

  Three grand  facts  predominate  in  the history of this period, and
reflect, to some extent, the progress of the human mind.
  1. The Arab  nation, until that time  obscure, and  almost a stranger
to the progress of civilization, passed rapidly from a demi-savage to the
first rank of polished nations.   After having, for several years,  carried
over the conquered countries  the  fury of a religious vandalism, they
embraced, with  enthusiasm, the culture of the muses, and endeavored to
repair their early ravages, by collecting  the debris of  the  literary and
scientific movements of Greece.  Medicine is one of the sciences which
they cultivated  with most zeal and success, though they added but little
to the  treasures amassed  by the genius  of the Greeks.   Very soon a
people more barbarous and unknown, issued from the deserts of Tartary
and subjugated, in their turn,  the Arab nation, in all parts of the world
where they had established  themselves, enervated them under a brutal
despotism, and degraded them to a  state akin  to  their primitive igno-
rance.   Thus, wherever the Turk dominates, humanity retrogrades.
  0 See P. S. Gerard, Recherches sur les etablissments de Bains Publics a Paris,
from the fourth century to  the present  time. (Annales d'Hygiene Publique
et de Medicine Legale, Paris, 1832, T. VII, p. 5, et suiv.) 
286
ARABIC PERIOD.
  2. The Greek nation, which  marched  for so many ages at the head
of civilized nations, is stripped, one  by one, of the gems of its antique
crown—power,  virtue, courage, glory,  independence,  all successively
pass away.   It  descends  by  a slow,  but continued degradation,  to
the lowest rank of modern nations.   In the course of this period, but a
single physician merits a historic mention on  account  of his writings,
and we find in these nothing new, with the exception of a few remedies
borrowed from the Arabians, and without giving credit for them.
   3.  The western part of the Boman Empire,  subjugated  by the barba-
rians  who issued  from the forests  of Germany and Scandinavia, fell
into the the thickest darknes from the  first ages of this period; but the
inhabitants of these unhappy countries, though loosing the independence,
order, and security which  they enjoyed under the  Boman institutions,
preserved, at least, their manly courage.   Their blood received new life
by being mingled with that of  the rude children of the North.   They
repulsed, in the first place,  the Saracens, who poured upon them like a
torrent  from the  South of Spain.   Tranquil  on that side, they turn
their arms against each other, and bring ruin  upon  themselves for sev-
eral centuries:  then, excited by religious  fanaticism, as were formerly
the Mohamedans, they rushed by thousands to the plains of Asia Minor,
Syria, and Egypt,  which had been occupied for several centuries by the
Saracens.   These distant and adventurous enterprises, the aspect of an
entirely new  civilization, inspired the Francs with a taste for poetry and
works of imagination, then in great  honor among the  Arabs.  During
the twelfth and thirteenth centuries, the governments of Europe become
regulated and stable, liberal institutions  are  created, the  mind of the
people of  the West shakes off, gradually, the rust of ignorance, and at
the end of the Arabic period, we already see some brilliant  streaks  of
light  in  the  horizon  of European nations.  Medicine  participated in
this progressive movement.  From  the  fourteenth  century, we see  it
worthily represented  in Italy, in Paris, and  especially in Montpelier.
Nevertheless, physicians as yet  only knew how to follow, timidly, the
track of the  Arabs; scarcely any of them had approached their lips to
the purer sources of Greek medicine.
   Here I close the Age of  Transition, or the middle ages, and now opens
before us an  era more glorious,  which we may  salute by exclaiming with
the poet, " Already commences  a new order of famous ages."
                Magnus ab integro saeclorum nascitur ordo.
                                           Virg.  Eclog. 
                    BOOK    III.

            AGE  OF  RENOVATION.

EXTENDING FROM THE COMMENCEMENT OF THE FIFTEENTH CENTURY
                      TO THE  PRESENT TIME.
     VII.  ERUDITE  PERIOD.
INCLUDING THE FIFTEENTH AND SIXTEENTH CENTURIES
                 GENERAL CONSIDERATIONS.

  This age, which includes a space of a little more than four hundred
years, or only about one-third  of the  duration  of the preceding age,
offers, nevertheless, to the  history of science in  general, and that of
Medicine in particular,  much more  abundant, varied, and  interesting
materials.  The mind of Occidental Europe, long  plunged into a species
of torpor, gradually awoke, and  seemed  to have acquired by the repose
an extraordinary  vigor.   Soon breaking its Gothic  bonds, it  launched
forth, in every direction,  with  youthful  ardor;  some remounting the
chain of ages to seek the debris  of antique  science, in order  to restore
and offer to it a species of  worship ; others endeavored to associate an-
cient with modern ideas, and elevate on  this double base the edifice of
human knowledge ; others, finally, bolder and more precipitate, cut loose
from the past, rejected its traditions, and assumed to build the scientific
structure with new materials entirely.
  I have already  announced some of the circumstances that contributed
to the awakening  of the mind of Europe; such as the diminution of the
internal conflicts between the princes and their vassals, a better  social
organization,  the  creation of establishments calculated to disseminate
knowledge, etc.; and, I must add here, that  this awakening was consid-
erably favored  by some industrial  discoveries of  capital importance. 
288
ERUDITE PERIOD.
The invention of the  compass, for example, rendering  long maritime
voyages less dangerous and more  frequent, opened to cosmography and
many other sciences a vaster field.  By the aid of the telescope, astron-
omy was able to seize some of  the most scattered rays in the  immensity
of  the  skies;  to calculate more exactly  the  revolutions of  celestial
bodies; to assign to our globe its true form, and to the sun its  gigantic
dimensions and legitimate place, in the center of our planetary system.
The eye  of the naturalist, armed with the  microscope, penetrated  into
the domain of the infinitely minute, and perceived there a multitude of
phenomena which the ancients had not even suspected.  Engraving oa
copper, multiplying almost at pleasure the chefs-d'oeuvre of painting and
drawing, united to the verbal description of objects, their graphic, and,
if we may say so, living representation, whenever that appeared  neces-
sary, as in the works on natural history and anatomy.
   But of all  the discoveries  that inaugurated this modern  age,  and
illustrated its commencement,  no  one  has thrown such eclat or has ex-
ercised so great an influence on the development of ideas, as  the  art of
printing.   After  writing, nothing has been found to the present time so
favorable to the transmission of thought,  as  the typographical art. This
art, in which the first attempts were made between the years 1435  and
1440, was  carried from its origin to a degree of notable perfection by
the united efforts of  three industrious men,  Guttcnberg,  Faust,  and
Shoeffer.   Thanks to  their ingenious combinations,  language,  repeated
an infinite number of  times, was able to carry ideas and light  even to
the most obscure  ranks in society.   Thence the triumphs of intelligence
and reason were secured;  thence might be seen, in the future,  more or
less  distant, the  end  of the dominion of brute force; for, by means of
this happy artifice, thought was  thereafter to be as imperishable as
its source.
   At the beginning of the erudite period, the Arabic literature  was  still
predominant in the school of  Medicine.   The only authorities that were
then invoked  and explained, were Bhazes, Haly-Abbas, and  Avicenna.
Jacques Despars,  one of the most  distinguished professors of the faculty
in Paris, in the first half of the fifteenth century, distinguished himself
by his compilations of the books  of Avicenna and Mesue.   The taste
for Greek  literature began, however, to  prevail in the  universities of
Italy, and  finally grew so as to be extended into other parts  of Europe,
after the taking  of Constantinople, in 1483, by Mahomet II., emperor
of the Turks.   This mournful event, which  seemed to be a mortal blow
to the Greek language and literature, hastened, on the  contrary, their
resurrection in the Occident.   This city having been given over to  pill-
age, a large number  of learned  men expatriated themselves,  carrying 
HUMANIST PHYSICIANS.
289
away all the manuscripts they were able to save.  The most  of them
sought refuge in Italy, where they found enlightened  protectors in the
all-powerful princes of the  house Medici,  in Florence,  in  the Boman
pontiffs, and Alphonso d'Aragon, sovereign of Naples and Sicily. These
fugitives made their hosts acquainted with chefs-d'oeuvre of  Greek  anti-
quity, so long forgotten ; and paid thus their adopted country, for the
hospitality that was accorded to them, by disseminating the models of
a good literature.   Among these strangers,  who contributed  the most to
popularize Greek works, history gratefully cites the names of Theodore
Gaza, Agryrophile,  and Lascaiis.
  Thence the taste for books, libraries, and sound erudition was diffused
throughout Europe.   The monuments  of Greek and Latin antiquity
were hunted up  and published with indefatigable patience  and ardor;
A mass  of ancient works  were  edited, translated,  and  commented
upon, with extreme care, and a. great  number of these translations  and
commentaries are still most estimable.   The authenticity of manuscripts
and purity of texts were discussed with sagacity ;  and efforts were made
to free the new editions from faults, omissions, and interpolations, which
had glided into the  manuscript copies in the lapse of time, by the igno-
rance or cupidity of the copyists.   Scholars of the first merit devoted
themselves to this wearisome  and thankless, though  eminently useful,
task; and they opened for their successors the  pathway of science, and
removed the obstacles that encumbered it.   Let  thanks be rendered to
them.
  For a short time, now, we will glance at the labors of some  of those
laborious critics  who have elucidated for us the  memorials of antique
Medicine.
                         CHAPTEB  I.
                  HUMANIST  PHYSICIANS.
   1. The first who presents  himself to us in  chronological order, is
Nicholas Leonicenus, who was born  at Lonigo, near Vincenza, in the
year 1428.  He studied Medicine at Fadua, and taught it for more than
sixty years at Ferrara.  His lectures and his numerous writings contrib-
uted effectually to  propagate a taste  for a sound literature.  He was
the first to translate directly from  Greek into Latin the Aphorisms of
Hippocrates, and several books of Galen.  He enjoyed, during his long
career, unalterable  health and vigor  of mind, which failed not for an
instant—rare  and precious advantages, due to his temperance, purity of 
290
ERUDITE PERIOD.
manners, and serenity of soul.   He died at the age of ninety-six,  regret-
ted by the learned and by the people.
  Leonicenus  combated perseveringly the infatuation  of  his  cotem-
poraries for the Arabs and Arabists; and he had the satisfaction to see
them  gradually return to the study of the Greek  and  Latin models.
His letters on  the  errors of Pliny, the naturalist, and  those of some
other  physicians, are written with  an elegance and  purity unknown
before him; they offer the first  example  in  this age  of an impartial
critic  of the ancients.   He demonstrates that the Boman encyclopedist,
for whom he testified  otherwise a  profound veneration, fell  into errors
and manifest contradictions, for want of understanding well the  Greek
authors whom he compiled,  and attaches the same  reproach, but with
more  severity, to the Arabian writers.   " These men," he says, in speak-
ing of the latter, " never knew the plants which they described; they
obtained their description from authors who had preceded them, and whom
they have badly translated.   On this account, there exists  a chaos of
various denominations and descriptions, more  and  more erroneous.
Unfortunate the patient for  whom  the physician should  order remedies
on the faith of  Mesue or Serapion l"°
   This wise critic maintained  always a  tone  of perfect urbanity and
kindness against his cotemporaries, whose scientific opinions he combats.
Here  is what he wrote to Politien,  in the letter we have just cited:  "1
had proposed to respond, by simple missive, not by a book, to the rea-
sons that you alledge  to justify Pliny in having confounded the ivy with
the rock-rose, not being willing to  make public my literary discussions
with  a man who is my intimate friend, and whom I honor from the bot-
tom of my heart; but  the  matter requires more  ample developments
than  I had supposed."
   II.   Thomas  Linacre, of Canterbury, was the cotemporary of Leoni-
cenus, though somewhat younger.  After having made his first  studies
at the University of Oxford, he  sailed for Italy, in  1484, for the pur-
pose of perfecting his university instruction.   He followed, at Florence,
the lectures of Demetrius Chalcondylus, one of the  Greek  refugees of
whom I have spoken, where  his happy disposition, joined to his modesty,
gained him the notice  of Lorenzo de  Medicis.   That prince proposed
to him to become the  companion of his children in  their studies, whose
preceptor was Angel Politien, the  same to whom Leonicenus addressed
the affectionate expressions that we have given above.  The young Eng-
lishman accepted with joy an offer so honorable to him, and which gave
him an opportunity to satisfy his penchant for study, and he profited so
0 Letter to Politier. 
HUMANIST PHYSICIANS.
291
well by the lessons of his masters, that in a short time he became as
learned as themselves.
  After being thus nurtured on the cream of the finest literature of his
time, he returned to his native country, where his talents were worthily
appreciated and remunerated.   Having become physician in ordinary to
Henry VII., and the princess Mary, who afterward mounted the throne
of England, Linacre showed himself worthy of his high fortune, by the
zeal he displayed  all his life in favor of sound education.   He was the
first of  his nation who spoke purely, the language of the Bomans.  He
translated  several treatises of  Galen, and  his  translations  are still
esteemed.   These caused the erection of two chairs, one at Oxford, and
the other at Cambridge, the incumbents of which had to explain the
works of Hippocrates and Galen;  but what  entitles  him  most to the
gratitude of his countrymen, is the foundation of the College of London.
   To  appreciate  properly the importance of such a  creation,  and the
merit of its  author, we must reflect on the  circumstances that sur-
rounded this rising institution, and take into consideration the obstacles
that had to be surmounted.  At that epoch,  the bishops alone  had the
right  to give  in their dioceses the  permission  to practice medicine,
whence it resulted that the practice of the Healing Art was abandoned
entirely into the hands of monks and illiterate empirics.   Linacre had
need of all his credit at court  to obtain the reform of  such abuses; but
his persevering and enlightened zeal triumphed over all opposition.  He
obtained the  issue of letters patent, which prohibited the practice of
Medicine by any one who had not received his degrees in one of the two
universities in  the kingdom, and who had not been  examined by the
President of the College at  London, assisted by  three physicians dele-
gated  especially for that purpose.  Behold by what a  series of intelli-
gent and generous efforts this estimable man  merited  and  obtained the
title of  the restorer of Medicine in England.0
   The two personages whose works and influence  on the minds  of their
compatriots we have just succinctly traced, belong  to the commence-
ment  of the Erudite Period.   They merit particular attention, not only
on account of the importance of their literary labors,  but  also  because
they were the first among physicians who embraced the culture of the
Greek classics, and contributed efficiently to propagate it.   Many others
afterward followed the same course, and distinguished themselves in the
same  career,  such as  Gontier  d'Andernach,  Jacques Houlier, Louis
Duret, and others; but I can not enumerate here the  titles of all the
men of  talent who devoted  their lives to restoring the monuments of
cHist. Med., by Freind; article Linacre. 
292
ERUDITE PERIOD.
ancient Medicine; it is sufficient  to  have signalized  the general ten-
dency of the mind for bibliographic researches at the  epoch of intellec-
tual regeneration—a tendency which denotes a want profoundly felt,
and which resulted from the new direction their studies began to take.
   Indeed, from the moment that they began  to realize the superiority of
Greek models over their prolix  Arab commentators, they were  anxious
to go back  to the  source of excellence, and sought  with avidity the
originals, which had till then remained covered up  in  the rubbish and
dust of libraries.   But at this time the  copies of Greek authors were
few in number, and in a deplorable state, owing to  the neglect they had
suffered during so many ages.  It then became necessary and urgent to
draw them  from obscurity,  to  purify, co-ordinate, and multiply them,
especially by  the aid of printing.   This work, too little appreciated
to-day, required very extensive and varied knowledge,  rare sagacity, and
admirable disinterestedness and patience.   The  most eminent  men  in
science did not disdain to be  thus occupied.  On  this  account, the epi-
thet, erudite, seems  to  me to be very characteristic  of this period, in
which the grammarians enjoyed such  great and worthy consideration.
   Among the publications in medical  literature, belonging to this epoch,
is one which is  out of  the  ordinary  line of  enterprises of this nature,
and therefore merits special notice.  I allude to the complete edition of
the  Hippocratic  writings, with a Latin translation  of Anuce  Foes.
"In the midst of the dearth of correct  manuscripts," says  a  modern
historian,0 " defective texts, and numerous alterations introduced suc-
cessively by the copyists, an exact  and complete Greek  edition  of the
works of Hippocrates was as earnestly desired as vainly  expected for a
long time.   At last, the press groaned, and there was seen issuing from
Frankfort on the Main, in 1595, a volume much less frightful by its
mass, than by the idea  of the time, application, and sacrifices of  every
kind, that  its  composition  must have cost  its  learned  and laborious
author."  Foes was a distinguished practitioner, whom fortune had not
much favored.   He  lived on the product of his business, and on his
income as pensioned physician of the  city of Metz.   He  had consecra-
ted to this immense work, the leisure and labors of forty years of his
life.   His name is henceforth immortal, by its association with that of
Hippocrates, as the ivy shares in the strength of the oak to which  it
is attached.
   I can not pass in  silence  another publication which dates, also, from
the last half of the sixteenth century, less capital than the preceding, in
a  medical point  of view, but in  which the author has  displayed an
0 M. Dezeimeris, 
ANATOMY AND  PHYSIOLOGY.
293
erudition scarcely credible;   it is the treatise on the gymnastics of the
ancients, by Jerome Mercurialis, a classic work, not less precious to the
historian than the antiquarian.
   After having thus rendered a just homage to the bibliographic labors
which concurred to the restoration of a good taste in Europe, it is time
to examine, in detail, what became of each of the branches of medical
science during this period.
                         CHAPTEB II.

                ANATOMY AND  PHYSIOLOGY.

   About the year 1315,  Mondini, professor at Bologna, dissected the
bodies of two women.  Shortly after,  he published an Epitome of Anat-
omy, illustrated with wood  cuts, which obtained  general  success, and
served for more than two centuries,  concurrently with the writings of
Galen and the Arabs, for anatomical demonstrations.   But this abridg-
ment contained nothing new: the parts were indicated only, rather than
described.   Lauth  expresses  himself  about  this  author, as  follows:
*'■ Mondini may be considered an anatomist who has examined, with dis-
cernment, the corpses that he has dissected, but we must stop at splanch-
nology, if we would not lose this good opinion.   Let us see how he
proceeds to reach the deep  muscles of  the extremities.   ' Beneath the
veins of the  fore-arm,' he remarks, ' we see many muscles, and many large
and strong cords, (tendons) ; of which it is not necessary to attempt the
anatomy on  such a corpse  (a recent one), but  on one dried in the sun
for three years, as I have shown  otherwise, in developing the number
and the anatomy of  those of the superior and  inferior extremity.'  He
takes an opposite and unanatomical course to discover the nerves,  advis-
ing maceration in running water."0  At  that era, and  still for a long
time after, it was the custom to  demonstrate anatomy on hogs and other
animals, and it was great  boldness on the part of Mondini to apply the
knife to the human body.   The prejudice against  dissection  of the
human body was so general, for more  than a century afterward, no one
dared renew, at least ostensibly, the undertaking of the  Bolognese  pro-
fessor.   His own conscience  did not seem to be  well satisfied by the ope-
ration, since he was not willing to open  the head, for fear of committing
a mortal sin.  To comprehend his scruples, and those of his cotemporaries,
! Hist, de l'Anat., Strasbourg, 1815, t. I., liv. v, par. iv, sec. 2, p. 303. 
294
ERUDITE PERIOD.
it will suffice to add that Pope Boniface VIII. issued a bull in  1300,
which forbade the evisceration  and anatomical cooking preparation of
the dead.  This prohibition, it is true, says Holfinx, was  only designed
to abolish the  absurd custom introduced  by the crusaders, of cutting
up and boiling the bodies of their relatives, deceased in infidel countries,
so as to send them to their families to give them a burial in holy ground;
but it is certain that the same  bull  was interpreted, whether right or
wrong, as prohibiting anatomical dissection, for, in 1482,  the university
of Tubingen had recourse to the authority of Pope Sixtus IV. to obtain
permission for dissection.0
   It was only toward the close of the fifteenth century, and in the earl}'
years of the  sixteenth, that this prejudice began to abate.   The  popes
themselves, who stood then  at the  head of scientific  movements, with-
drew their interdictions, and the universities of Italy  gave the first ex-
amples  of  public dissections.  Achillini, Benedetti, and, perhaps also,
Jacques  Berenger, dissected  previously to the year 1500, at Bologna, Pa-
dua, and Pavia.  Soon after, their example was followed in many other
places.   Toward the close of the sixteenth century, Dubois, called Syl-
vius,  following the fashion of the times,  demonstrated anatomy at Paris,
on the  dead body.   He gave for  forty years, very frequently, special
courses,  and  contributed very much to popularize the taste for this
science.  He dissected  a great  number of animals, and  as many dead
bodies as he could procure, which was no easy matter  at  that time, as
we shall presently see.   He subordinated, however, all his researches
to the authority of Galen:  so much  so, that  he would not  admit any
remark  contrary to  the statements of  this  author, unless that which
contradicted  him was considered as a freak of nature,  or a result of the
degeneration  of the human species.
   In like manner, all the other anatomists followed this vicious  course;
no one would permit himself to  contradict the assertions of the oracle
of Pergamos; until, at last, a man  of genius and  courage, prepared for
literary discussion by severe study—a true  reformer—appeared.  He was
Andrew Vesalius.   Born at  Brussels, in 1514, of a family for a long
period illustrious in  Medicine, he  studied  the humanities at Louvain.
under Guinther, or Gonthier d'Andernach, who was there  professor of
the Greek language.  Already the inclination of  the young scholar, for
anatomy, revealed itself in  his pastimes;  he amused himself in dis-
secting, during the recreations, rats, moles, dogs,  etc.   He made a con-
quest, literally, of his  first skeleton, on the place of^ execution  near
Louvain.   Having observed the body of a criminal, of which  the  birds
°Hist. de l'Anat., t. I., lib. v, part iv, sect. 2, p. 303. 
ANATOMY AND PHYSIOLOGY.
295
had so perfectly cleaned away the soft parts, that there remained of it
only the bones and ligaments, he detached successively the extremities;
but when he attempted to carry off the  trunk, he found it  so  strongly
bound to the stake  by the  iron chains,  that  he was compelled to work
all night to get it loose.
  Afterward, he went to Paris, attracted by the course of Sylvius, which,
as we have remarked, had  acquired great reputation.  While there, he
was not content with the lessons  of his  master, but wished  to observe
nature himself; to  accomplish which he had, more than once, to dispute
with the dogs and vultures at the hill of Montfaucon, for the remains of
criminals, or to introduce himself stealthily into the cemeteries, to dis-
inter a body, at the risk of incurring the accusation of the capital crime of
sacrilege.   His progress was as rapid as his ardor, for his application was
great.   From his twentieth year,  he gave instructions  at Paris,  to  his
fellow students, and  exhibited to them the  semi-lunar  valves of the
aorta,  which Sylvius  had not found.  At  the age  of twenty-three, he
was nominated  to the chair of anatomy in the faculty at Padua, by the
senate of Venice ;  at twenty-nine,  he published his  great work,  in which
this  science is placed in a new light,  and with a completeness which left
far in  the rear  all that antiquity had transmitted on the subject.0  The
year following,  Vesalius, no less renowned as a practitioner  than  as an
anatomist,  was  called by the  Emperor Charles V., to the court  of Mad-
rid, then the most brilliant in Europe, in the character of first  physi-
cian.   From this time he abandoned his anatomical labors, to resume
them no more.
   Vesalius dared  subordinate the authority of Galen to anatomical  in-
spection.   He refuted many errors  in his anatomy, and  asserted that
the greater part of  his descriptions,  having been made from monkeys,
did not correctly represent the human structure.  This audacity raised
up against him numerous opponents, among whom  his old master, Syl-
vius, showed himself the most animated and the least reasonable ; but
the  young reformer vigorously made head  against the storm, and  as
truth was on his side, at last  triumphed.  He was not,  however, him-
self  free from censure, notwithstanding the multiplied dissections which
had served as the basis of his anatomy.  He was amenable to the reproach
brought against him by Columbus and Eustachius,  that his descriptions
of the eyes, muscles of  the larynx,  and tongue are not  in  accordance
with nature.    But, as said Lauth  on this subject, "these irregularities
and defects in his work do not destroy his glory ; there results  from it,
;De Humani Corporis Fabrica, libri septem., Basle, 1843, with wood cuts. 
296
ERUDITE PERIOD.
simply, that the route which he  had traced was the true one, and was
still open to conduct other learned investigators to celebrity."0
   The minds of men generally, were ripe for  the revolution of which
Vesalius  gave  the signal;   what  proves it is, that scarcely had he
appealed  from the decision of Galen to the observations of nature, than
a crowd of anatomists struggled to follow his method.  We have already
cited Columbus, who was his pupil—his co-laborer, and successor to the
chair in Padua;  B.  Eustachius, professor  at  Borne, who shared with
Vesalius the honor of having founded human tinatomy, and of having
made astonishing progress in it.  We place on  the same line, Fallopius,
disciple and friend of Vesalius,  who  was  professor,  successively, at
Ferrara, Pisa and Padua.   He died prematurely for the  science which
he had cultivated with so much ardor and success; and his name must
rest united  to that of Vesalius in  the history of modern anatomy, as
those of  Herophilus  and Erasistratus  are in the  history of  ancient
anatomy.  Lauth gives the following opinion of his labors: " Fallopius is as
much distinguished for the delicacy of his language as for his anatomical
talents.   Under the modest title of " Observations," he has  published a
treasury of  discoveries on all parts  of the human structure; and when
he sees himself obliged to correct Vesalius, he always softens the style of
his criticism, though  he does not abate its depth; so that the work of
Fallopius  is an  excellent commentary on that of Vesalius."
   The researches  of Jerome Fabricius,  on  the  formation  of  the  egg
and of  the fetus—on the valves of the  veins  and  the viscera, have
equally a capital  importance.  They were designed  for a  treatise  on
human  and comparative  anatomy,  which the  author had not  time to
complete.   But here I feel that I must pause ;  very  many other names,
and many other works, have a right to be mentioned,  but I am forced to
pass them in silence,  and refer the reader to  the special  histories of
Anatomy for them.
   At this epoch, many modifications were introduced in the regulations
of the Faculties of Medicine;  permanent amphitheaters for dissection
began to  be established—for till  then,  the anatomists had  dissected
either  in  their  chambers  or  in some provisional  hall.   Anatomical
chairs were created, and the salaries paid out of the public treasury.   In
some cities the supply of material was not limited to  the bodies of crim-
inals, but permission was also given to dissect the dead at the hospitals.
The Boman Pontiffs seem to have taken  the initiative in this respect,
which explains the great number of subjects with which Eustachius wa,«
supplied, compared with Vesalius, who obtained only two or three in a
°Hist. de PAnat.,p. 373. 
ANATOMY AND  PHYSIOLOGY.
297
year.   The razor, a very incommodious instrument, was also replaced in
dissection by the pointed  scalpel, which has remained in  use  till now.
  This concourse of circumstances elevated anatomy very promptly, to
a degree of perfection  it had never attained under the Greeks.  Plates,
designed by skillful artists after very careful  anatomical  preparations,
represented our organs with more exactness and detail than had been
supposed possible.   The nerves were entirely separated from the tendons
and ligaments. They were traced  as far as possible, from their origin
to their finest ramifications; and the anatomists assured themselves that
the muscular  fibre was not produced by an expansion of the nervous
fiber.   A glimpse was also  obtained of the lymphatic vessels.
  Capital discoveries  were also made in  the vascular apparatus.   It
was discovered that there was no bony structure in the  tissue of  the
heart, as the ancients believed; that the partition which separates the
cavities of that viscus, was  not at all porous, so that the blood  could not
pass  from one cavity to  another,  through  the  septum.   The  attentive
examination of the valves led, finally, to the discovery of the pulmonary
circulation.  Michael Servetus, the same whom Calvin burned at the
stake, was the  first to discover this important phenomenon.   He saw that
the sanguinary fluid could not penetrate, directly, the left, from the right
cavities of the heart, owing to the impermeability of the partition, so that
it was necessary for the whole mass of the liquid to pass through  the lung,
where it became impregnated with the vital spirit contained in the atmos-
phere, and reached, afterward, the left auricle.   The disposition of  the
valves of the pulmonary artery  and veins, plainly confirmed this conjec-
ture.   Besides, the  caliber of the pulmonary artery  appeared enor-
mously  disproportioned to the quantity  of blood  necessary for  the
nutrition of the lungs; which seemed to prove that such was not, as had
been believed true till then,  the unique purpose of that vessel.  About the
same period  Fabricius d'Aquapendente,  pointed out  the valves in the
veins of various parts of  the body:  and  shortly after,  Columbus and
Andrew Cesalpine explained in  a more explicit manner the mechanism
of the pulmonary circulation.
   All these discoveries were an immense progress made toward the dis-
covery of the  great circulation.  It seemed that there remained only a
small step, to arrive at it;  and we feel  astonished that those great
anatomists of  the  sixteenth century should have paused  in so plain a
path.  Andrew Cesalpine  so closely approached this conception that
some have thought that he attained it; but the passage on which they
sustain themselves does not authorise  that opinion.   The following is
his statement: " The openings of the heart are disposed in such a man-
ner that the passage is free from the vena cava into the right ventricle
           19 
298
ERUDITE  PERIOD.
and from that cavity into the lung;  further, there exists a communica-
tion from  the  lung  to  the left ventricle, and from this last into the
aorta.   Membranes are placed at the orifices of the various conduits, in
such a way that a retrogade flux of the liquid column is impossible.   In
this way is effected, continually, the passage of the blood from the vena
cava into the right cavities of the heart,  and from these into  the lungs,
and thence into the aorta by the intermediation of  the left ventricle, as
we  have explained in the Peripitecian questions.   Now while awake,
the movement of the innate heat is  from within  outward, and during
sleep  it  is the  reverse;  hence  it follows,  that  while awake a  great
quantity of the vital spirit and blood are carried to the arteries, which
transmit them  to the nerves; and, during sleep, the same heat returns
to the heart, not by the arteries, but by the vena cava,  which alone com-
municates with  this organ.
  " The proof of this is drawn from the arterial  pulsations,  which are
large, vehement, prompt and frequent, with a species of vibration at the
moment of awaking, while they are small, languishing and  slow during
sleep—for at this time the  natural heat is carried less to the arteries;
but it flows freely there, as soon as we are aroused.
  " The  veins  act  entirely different;   they enlarge during  sleep, and
diminish when we  are awake,  which is easily seen  in those on the
hands.  This occurs,  because during sleep the natural  heat passes from
the arteries into the veins, by means of their anastomases,  and in that
way returns to  the  heart.   In the same manner the flux and reflux of
the blood toward the superior and inferior parts,  like the waves of  Eu-
ripus, manifest themselves  during  sleep, and when we are  awake also.
The same species of movement is manifested  either by applying a liga-
ture around some part of  the  body,  or by pressure on the veins in any
other way.   For when the course of  a  stream is interrupted, it swells
above the obstacle.   Perhaps in this case the blood returns back to its
source (son  principe), so that  this interruption may not (ne Veteigne)
destroy it."0

  Q This passage is of extreme importance, because upon it is founded the right
of Cesalpine to the greatest discovery of modern physiology.  I have, therefore,
thought it proper to transcribe here the text, even, of the author, so that each one
may judge for himself, having the passage in his hands :
  "Ilud sciendum est: cordis meatus ita a naturu paratos esse, ut ex vena, cava
intromissio  fiat  in cordis ventriculum dextrum,  unde patet exitus in pulmo-
nem:  ex pulmone praeterea alium ingressum esse in  cordis ventriculum sinis-
trum, ex quo tandem patet exitus in arteriam aortam, membranis quibusdam ad
ostia vasorum appositis, ut impediant retrocessum: sic enim perpetuus quidam
motus ex vena cava per cor et pulmones in arteriam aortam, ut in quaestionibus
peripateticis explicavimus.  Ciim autem in vigilia motus caloris nativi fiat extra, 
HYGIENE.
299
   Observe first, that this passage includes all  the elements necessary to
arrive at the  knowledge of the  circulation of the blood.   The author
says,  positively, that the blood cannot flow backward, through the arte-
ries,  toward the  heart, on  account of the  membranes which close the
orifice of  the aorta;  and he adds that the vena cava is the only vessel
which permits  its entrance into that viscus.    He speaks, also, of the
anastamoses of  the arteries  and veins.   He remarks, that if  a band is
applied around  a member, the veins tumefy below the ligature.   Does it
not seem.that the author needed  only to pronounce the word circulation,
to have  resolved  the problem ?   But this word fell not once from his
pen;  but he compares it to the flux and reflux of Euripus, as Aristotle
had done.   It is evident that he tortured  his mind to conciliate two
irreconcilable theories, viz.: the opinions of the ancients on the move-
ment of the blood, with the recent discoveries of anatomy.   Thus, the
glory of Harvey is untouched by this discussion, as will appear more
evident still, in its place.
                         CHAPTEB III.

                             HYGIENE.

  Next to anatomy, hygiene was one of the branches of Medicine least
cultivated in the middle ages.   The governments  being entirely occu-
pied with the care of maintaining and extending their dominions,  never,
scilicet ad sensoria:  in somno autem intra, scilicet ad cor:  putandum est in
vigilia multum spiritus et sanguinis ferri ad arterias, inde enim in nervos est
iter.   In somno autem eumdem calorem reverti ad cor, non per arterias: ingres-
sus enim naturalis per venam cavam datur in cor, non per arteriam.  Indicio
sunt pulsus, qui  expergiscentibus fiunt  magni, vehementes, celereres et crebri
cum quadam vibratione:  in somno autem parvi, languidi, tardi et rari (3 De
caus. put., 9 et 10).  Nam in  somno  calor nativs minus vergit in arterias: in
easdem erumpit vehementiiis, cum expergiscuntur.
  " Vena? autem contrario se  modo habent:  nam in somno fiunt tumidiores in
vigilia exiliores,  ut patet intuenti eas quas in  manu sunt.  Transit enim in
somno calor nativus ex  arteriis in venas per osculorum communionem, quam anas-
tomosin vocant, et inde in cor.   Ut autem sanguinis exundatio in superiora, et
retrocessus in inferioria, instar Euripi, manifesta est in somno et vigilia, sic non
obscurus est hujusmodi motus, in quacumque parte corporis vinculum adhibea-
tur, aut alia  ratione  occludantur vena3.  Cum  enim tollitur permeatio, intu-
mescunt rivuli qua parte fluere solent.   Forte recurrit eo tempore sanguis ad
principium, ne intercisus extinguatur."  (Andrew Casalpini, Qucestionum medica-
rum, lib. (8c/)  quaestio xvn.   Venetiis, apud Juntas, ].j71. 
300
ERUDITE  PERIOD.
or very rarely, inquired into what concerned public health.  In the capi-
tals even  of European states, no measure of police, no  administrative
rule, existed for keeping the streets and houses  clean, the free circula-
tion of air, the soundness of the food employed by the  people, and  the
propagation of hygienic habits.  Those who founded or  endowed hospi-
tals, asylums, and monasteries were not moved by any thoughts of social
amelioration, but by a pure sentiment of Christian charity—or the fear
of hell.   In the establishments for public instruction, nothing was fore-
seen or ordered, in view of the  physical  perfection  of  man;  none but
the most ordinary and urgent  cares were  bestowed upon the health  of
the pupils.   There was, moreover, an opinion universally diffused, and
received almost as an article  of  faith, that there was no better  means
for increasing the intelligence and enlarging  the empire of the soul,
than to mortify the body.   The statutes of most of the  religious  orders
had no other object.   The clergy, placed at the  head of  instruction and
of the liberal professions, were profoundly imbued with  this prejudice,
which explains their indifference to the  physical education  of  youth.
During the lapse of several ages, no other hygienic  code was in vogue
than the dietetic maxims of the school  of Salerno, in which there was
nothing to justify its high reputation.0
   On the  revival of letters, the attention of physicians was early  turned
toward the means of  preserving health  and preventing  diseases.  But,
at first, they only compiled, with more or  less erudition, the  teachings
of the ancients on this matter.   The earliest writings, at all original on
this subject, belong to the  second half of the sixteenth century, and
appertain to a man unconnected with Medicine.
   Louis Cornaro, a Venetian noble, had never enjoyed robust health, and
at the age of thirty-five he saw that his health was growing worse.   He
was a prey to pains in  the  stomach, with  loss of appetite, and  attacks
  °My manuscript was finished, and already in the hands of the  printer, when
I saw the work of M. Levy, in which I find a just and elevated appreciation of
the Salernian Sentences.  I  think I can not do better than copy them for the
reader :  " If  we place ourselves in the perspective of the progress accomplished
during the last four or five hundred years, to judge of this book, which is a sum-
mary of the  spirit  of that celebrated school, we perceive  only  an  undigested
mass of  Medicine and dietetics:  a fragment of Galenism, united  to the recipes
of the Arabian polypharmacy; the  maxims of antique wisdom, and  the accred-
ited echoes of the popular superstitions.  But let us not judge the works of past
centuries by the light of our day.  The Medical Testament  of Salerno is a his-
torical document, and not a work to study, in  regard to the present state of
science.   Nevertheless, we find, on several of its pages, distinct reflections of the
Hellenic school, and more than one sound hygienic maxim strikes us as being of
Hippocratic origin." 
HYGIENE.
301
of gout more and more  frequent.  Besides, he felt himself slowly con-
sumed by a slight continued fever, and was a prey to a thirst which he
could not satisfy.  For five consecutive years, he employed  all sorts  of
remedies without obtaining any relief;  on  the  contrary, his  condition
became worse every day, and he saw in prospect only an untimely death,
preceded by long sufferings.  Finally, his physicians told him that  there
was only one resource left, and that was, to renounce his habits of in-
temperance, and adopt a course of life extremely sober, from which he
must  never vary.  Cornaro took a firm resolution, and held  it.  In the
first  place,  he  studied  to  know the various  species of aliment which
suited his stomach, and the quantity to take,  in order not to be incom-
moded.  After  some  experiments, he fixed on  twelve  ounces of solid
food,  composed of bread,  yolk of eggs,  meat, fish,  etc., and fourteen
ounces  of liquid.   Every morning, he weighed out his rations for the
day.   This regimen  suited him so well that, at the end of a year, he
was  freed from all his afflictions.   At  the same  time, his appetite
returned: he recovered his former gaiety, equanimity of humor, apti-
tude for mental efforts, and bodily exercises.   In short, he lived without
infirmities to the age  of one hundred  years.
   The whole life of Cornaro offers us a striking example of the salutary
effects of sobriety; but there is one trait in it which shows the power
of habit.   At the age of seventy-eight, overcome by the solicitations  of
his friends and kinsfolk, who pressed him to relax a little the severity
of his diet, he consented to add to it, two ounces of solids,  and two  of
liquids, each day.   His  stomach was very  soon  deranged;  he  lost,
gradually, his appetite, and his  manner  became taciturn;  in fine, he
soon fell into a  severe fever, which lasted thirty days  and  nearly de-
stroyed him.  He  was not re-established  until he had resumed his
former way of living.   In  his account of the advantages  of  sobriety,
Cornaro takes pleasure in enumerating all the happy  effects which he
realized from his manner of living.   He states, that he composed, in his
eightieth year, a comedy, characterized by refined and pointed wit, and
written in a lively style.  At this age, he mounted his horse easily, and
climbed the steepest hills, and was always in a good humor.   In his old
age, nevertheless, he endured some severe trials; but he overcame them
well,  thanks to the happy disposition of mind and body with which his
regimen endowed him.  On one occasion, among  others, he was obliged
to sustain a severe law-suit, which caused the death of his brother from
chagrin;  but, though the suit concerned  himself especially, his health
was not altered  nor his courage  shaken,  and he came out of it  victo-
rious in  every respect.  Nevertheless, the  enthusiasm of the old man
did not go so far as to believe that the same diet would suit everybody: 
302
ERUDITE  PERIOD.
he only asserted that if men never went beyond the limit of need, in
eating and drinking, they would avoid a great many infirmities, and pro-
long their days much beyond the period usually attained.w
  The history of  Cornaro, say  Halle and Nysten, may  be placed with
the number of fine experiments which have been made in hygiene ;  and,
consequently, which have contributed to fix its principles, and concur to
the progress of the art.f
  I shall say nothing of the memoir of the Jesuit Lessius, on the same
subject, because it is only a paraphrase of the treatise of Cornaro ; but
I must mention here the treatise, on Gymnastics, by Mercurialis.   This
work, whose literary merit I have already appreciated, does not develop
any new notion, it is true,  but directs the attention of men of  the Pro-
fession, and the public at large, to hygienic considerations, so long aban-
doned and forgotten.  It must, therefore, contribute to  the restoration
of hygiene.
                        CHAPTEB   IV.

                   GENERAL  PATHOLOGY.

  We now return to the ancient divisions  of Medical science, such as
Galen and Celsus adopted: that is to say, that after having studied man
in the normal state, in anatomy, physiology, and hygiene, we proceed to
study him in the abnormal state, in pathology and therapeutics.   These
last two departments will be  divided, as heretofore, into  internal  and
external.   However irregular may appear this distribution of diseases,
we are forced to follow it, because it was adopted by all the authors of
that period.   Pathology is a subject so vast, so complex, and so change-
able,  that it is impossible to establish  an irreproachable  classification ;
we  must, therefore, content  ourselves with an exactness  more or less
approximative.  But  let it be  remembered, that  a classification even
vicious, is much better than none  at  all, for this latter state is nothing
less than chaos—the negation of all general ideas, of all science.   The
distinction of diseases into acute  and chronic, existed  then as at pres-
ent ;  but in their treatises, no separation was made of the first from the
second,  as the ancient  Methodists  had done;  the acute  and chronic
states were considered as two forms of the  same morbid entity, not as
  c'On Sobriety and its Advantages, by Lessius and Cornaro; new translation,
by M. de la Bonardiere, Paris, 1701.
  f Dictionaire des Sciences Medicales, in sixty vols.; art., Hygiene. 
INTERNAL  PATHOLOGY.
303
two different species.  Etiology was  treated with much more subtilty,
in conformity with the  Peripitecian  doctrine, as we shall show in the
chapter on theories.  In short, we see  commenced in this period the
rudiments of a new branch of pathology, which is  styled pathological
anatomy, and which is destined to acquire a capital importance in mod-
ern times.
                         CHAPTEB  V.

                   INTERNAL  PATHOLOGY.

                            § I. Semeiotics.
   The section  of pathology which  is devoted to the  interpretation of
symptoms, considered in a general and abstract manner, made but few
acquisitions after Galen.  The Arabs added to the science  only a small
number of observations, the  most interesting of which belong to erup-
tive fevers; and the Greeks and  Latins of the middle ages did little
more  than copy each  other.  At the epoch of the revival of letters,
writers occupied themselves in collecting the discoveries of anterior ages,
to withdraw them from the oblivion into which most of them had fallen,
to elucidate and put them in order.  They made, to use the expression
of Guy do Chauliac, an inventory of all the acquisitions of the past, and
this was  the best which at that  time could be  done;  for, before  inno-
vating and reforming,  it is necessary to  know what exists, and to be
acquainted with the actual state of  science.
   The savans of the fifteenth and sixteenth centuries  acquitted them-
selves  perfectly of  this task, as we have already shown.   If  they did
not make many discoveries,  they  prepared  the way for their successors,
for the rejuvenation of ancient ideas so long forgotten.  Can not this,
to some extent, be called an  invention ?   Among  those whose  writings
contributed to  elucidate  semeiotics, may  be cited  Vallesius,  Prosper
Alpin, Lommius, Thomas Fyens, and especially, J. Fernel.  The latter
offers us, in the second and third books of his pathology, the most  suc-
cinct and lucid summary of the  notions  and ideas  that composed the
science of  symptoms among the  ancients.  After having defined what
he understands by signs  and by  symptoms, and how these  phenomena
must be distinguished  from the disease itself, he exposes the  signs of
various species of  plethora,  namely, the sanguineous, bilious, melan-
cholic, pituitous, and serous; then he devotes  the whole of the third
volume to an examination of the pulse and the urine.   In this we find
sphygmology and uriscopy forming the basis of prognosis and of curative 
304
ERUDITE PERIOD.
indications; further, that they did not  hold  to  the plan of grouping
symptoms to form tableaux, according to the synthetic method, of which
Hippocrates has given so fine an example in his  treatise on Prognosis,
but that a separate examination was made of each phenomenon, which
was isolated, and an effort made to go back to its cause,  so as to deduce
all the indications it could furnish, according to  the analytic method
introduced by  Aristotle  and continued by Galen.
  " The pulse and the urine," remarks Fernel, " furnish the surest indi-
cations  concerning  the force  of diseases;  the  first,  by revealing
the state  of the heart  and the arteries; the second, by indicating the
state of the liver  and  the  veins; for  these  organs hold under their
dominion the whole economy.   The pulse shows clearly the  energy pos-
sessed by the vital  faculty, as well as the whole body, and  shows the
present  condition  of the  heart and  arteries.  The urine  reveals the
qualities of the humors and the state of  the liver in a very (istinct
manner, it enlightens us on the diseases derived  from them, but it fur-
nishes but little light as to the vigor of the vital  movements, and of the
body in general."0   The whole of  the third book is only the  develop-
ment of the proposition just quoted, namely, the  theory of the pulse
and the urine.
                     § II.  Pathological Anatomy.
  Toward the end of the Erudite Period, pathology was enriched from a
new source, and one destined to shed great  light on the diagnosis of dis-
eases, and which establishes a line of demarcation between  ancient and
modern Medicine;  this is pathological anatomy.  The idea of studying
the sensible traces that disease leaves in our organs after death, began to
germinate in the minds of physicians at the close of the fifteenth century.
Anthony Benivieni, a physician of Florence, appears to have been the first,
or at least one among the first, who conceived of the knowledge that might
be attained by opening bodies with the view of ascertaining the location and
causes of diseases.   M. Malgaigne remarks as follows about this  author:
" A eulogy which he merits without reserve, which he shares with no other
person, and which has not been  accorded  to  him, up to  this time, by
the many historians of surgery who have superficially searched in these
precious sources, is, that  he was the first who had  the habit, and felt
the need, and  set  the  useful example which he  transmitted  to his
successors,  of searching  on the cadaver, according  to the  title of his

  0 FernePs Pathologiae, lib. in,  cap. 1
  |  De Abditis Nonnullis ac Mirandis Morborum et Sanationum Causis, a work
printed after the death of  Benivieni,  under the care  of his brother Jerome.
Florence, 1507. 
INTERNAL  PATHOLOGY.
305
book, for the concealed causes of diseases." f  Benivieni did  not  limit
himself to opening the bodies of his own cases ; he  sought occasions
for autopsy with the same  ardor that c1 > aracterizes the anatomists of
our times.   In fine, he explored the bodies of those who had been hung,
without any hope of attaching  anatomical lesions to the symptoms he
had not been able to see, but always thinking to find on them something
of interest, so as to be able to turn his researches to the profit of descrip-
tive  anatomy and  physiology." °  After him, Bartholomew Eustachius
was one of those who showed most zeal in anatomical researches. We owe
to him  precious observations on the structure, functions, and diseases,
of the kidneys.   He shed on these subjects a clear and new light.   He
was  also  the first  in  modern  times,  who attempted  to clear  up the
anatomy and physiology of  man, by comparing them with that of the
animals.
   After Eustachius, we must mention, as  at the head of the  physicians
who cultivated pathological anatomy in the sixteenth century, Bembert
Dodoens  and Marcellus Donatus.    The latter  refutes the  prejudice
which in his time, in  many localities, still  opposed autopsies, in the
following  terms: " Let those who interdict the opening  of bodies well
understand their errors.  When  the  cause of a  disease is obscure, in
opposing  the dissection of a corpse  which must  soon  become the food
of worms, they do no good to the inanimate mass, and they cause a grave
damage to the rest of mankind ; for they prevent the physicians from
acquiring a  knowledge which  may  afford the  means of great relief,
eventually, to individuals attacked by a similar disease.  No less blame
is applicable to those delicate physicians, who, from laziness  or repug-
nance, love better to  remain  in the darkness  of  ignorance, than to
scrutinize, laboriously, the truth ; not reflecting  that  by such conduct
they render  themselves culpable toward  God, toward themselves, and
toward society at large." f
  Nevertheless,  pathological anatomy had  no considerable  extension
during  this period.  Few men cultivated it  in  a regular manner, and
the totality of their discoveries do  not  constitute  the elements of a
doctrine;  but their labors merit the attention  of the historian,  as
indicating a new tendency which makes an epoch  in science.
                          § in. NOSOGRAPHY.

  Of all the treatises that appeared during the period we have named
Erudite, that of Fernel obtained the most universal and durable success.

             '* Introduction to the works of Pare, p. 119.
             f Marcellus Donatus, Medica Historia, lib. vi. 
306
ERUDITE PERIOD.
It became  classic throughout Europe.   It is, in fact, the complete and
lucid resume of  the  Galeno-Arabic doctrine, at  that time  taught
exclusively, in the schools of Medicine.  In reading the work of Fernel,
we can form a correct idea of the manner in which diseases were studied,
at that epoch, and the general state of the  science.  On this account it
merits a special attention on our part, and we proceed to present a short
analysis of it.
   Fernel has included pathology  entire in  seven  books.    The  first
three are  devoted  to  the most abstruse  generalities  concerning the
essence  of diseases,  their causes,  signs,  and symptoms.    The author
explains each of these  with  much subtility ;  he traces the  rules which
he  believes infallible, in order to  arrive at  a knowledge  of them in
every instance.   The material  contained in these  three books embraces
all the   questions relative to  etiology and  semeiotics,  and forms a
treatise on general  pathology.   WTe will  recur  to  it  in speaking of
theories.
   The last four books include particular descriptions of all diseases then
known, and their methodic classification, which constitutes  nosography
proper.   The diseases to which  men are subject are therein classified as
general  and  special; the former  includes those whose locality is unde-
termined, (morbi incertce sedis) and the latter, those  which  appertain
to a part, or to an organ,  exclusively.
   The first class, then, or general diseases, only comprehends fevers, of
which Fernel admitted three genera,  viz:  simple, putrid,  and pesti-
lential.   Each of these genera was subdivided into a small number of
species or types, to the  description of which the fourth  book on patho-
logy is devoted.
   The second class,  or special diseases, is also divided into three orders,
viz.: First, diseases  which affect a part, situated above the  diaphragm.
Secondly, those affecting parts  below that partition.   Lastly, external
or surgical diseases.  The description of morbid  species, comprised in
these three orders, fill the last three books on pathology, viz.:  the fifth,
sixth, and seventh.
   Notwithstanding  its defects, the nosological classification, at which
we have just glanced, was very  superior to  all those which had preceded
it.   It possessed, in a very high degree, the merit  of clearness and pre-
cision, which is  an essential quality in a work of  this  kind.   At  that
time, considered in regard to cotemporaneous  science, it included, easily,
all the derangements of health.    Such a  division of diseases sufficed for
the epoch in which it was proposed; but science  has greatly enlarged
since that time, so  that  now the nosography of Fernel is  extremely
defective.  I shall not attempt to point out its numerous imperfections, 
INTERNAL  PATHOLOGY.
307
but will  signalize one only,  extremely grave, which  the  author might
have avoided.
  In all  nosography the important capital condition consists in portray-
ing, exactly, the morbid species, and tracing the characters of  each  of
them so  faithfully, that the  practitioner can not  confound them with
each other.   Now, the work  of the  French nosologist is especially de-
fective, in this respect;  his  descriptions are insufficient, too short, and
sometimes worthless.   He makes no special mention of eruptive fevers,
nor of other affections then newly observed;  such as scurvy, hooping-
cough, raphania,  or cereal convulsions, etc.   He  names,  among  new
affections, nothing but syphilis, of  which he  gives a sufficiently exact
description, though rather too succinct.   In regard to the known  ancient
diseases,  instead of taking for models the tableaux of Aretseus, Coelius
Aurelianus, and Alexander of Tralles, he adopts, a little too servilely,
the ideas and method of Galen ;  besides, his descriptions are generally
inferior to the authors we have just named, as maybe judged by the .fol-
lowing example:
  " Peripneumonia," says Fernel, " is a phlegmasia of the lungs, which
is related sometimes to phlegmon, and sometimes to erysipelas.  There is
great difficulty in respiration;  the cheeks  are a bright red; the  eyes
appear swollen and prominent.  If the inflammation is phlegmonous,
the patient spits blood, according to  Hippocrates, unless the expectora-
tion is extremely crude.  He feels a constriction under the hypochon-
dria and  throughout the chest,  a great weight beneath the sternum, and
in the back; the  fever, however, is moderate.   When the inflammation
is erysipelatous, the cough brings  up  yellow  matter, mingled  with a
little blood; the  tightness of the chest and the sensation of weight are
less, but  there is more fever.
  " These two forms of fever  arise sometimes primitively, and, again,
succeed  an acute angina, or a pleurisy,  when the humor  is thrown  sud-
denly from  the  throat or the  side upon the lungs.   According  to
Hippocrates, a peripneumonia which proceeds from an  inflamed side is
bad; for  if, in a violent pleurisy, the pain in the side ceases suddenly,  or
diminishes considerably, it  makes, ordinarily, a metastasis to the lungs ;
the cough and suffocation  augment, or  peripneumonia, accompanied by
a bloody  expectoration, appears ; and but few patients recover.   When
peripneumonia  does not  succeed another affection, but is  an original
affection, it is caused by thinness and biliousness of the blood, which the
right ventricle of the heart throws vehemently, and in too large quan-
tities, into  the lungs.  The blood fills  up not only the veins  and arte-
ries of the organ,  but, also,  it  invades the parenchyma itself;  it distends
it too much, coagulates, putrefies, and lights up an  inflammation, which 
308
ERUDITE PERIOD.
is not limited, as in other circumstances, but is diffused  throughout the
viscus.   True peripneumonia is, however, extremely rare.   Hippocrates
attributes it, especially, to drunkenness;  the use of fish whose sticky
flesh is contrary to the  nature  of  man, such as  the  mullet and eel;  or
to the habit of eating too  much; or to a  change of  water.   Sometimes
a thin and acrid humor flows abundantly from the brain into the lungs,
assumes an unnatural character, and produces heat with fever.  Many
persons give the name of peripneumonia to  that species of disease in which
the cough, the difficult respiration, and a slow fever consume the patient,
without ulceration of the  lungs, or sanguineous expectoration.   If this
be called peripneumonia, it must be borne in mind that it differs very
much from legitimate peripneumonia, in the nature of the cause and the
extent of symptoms."0   This  tableau, it is plain,  is  inferior to that
drawn by Aretseus of the  same disease, which was heretofore given.
  About the end of  the sixteenth, or the commencement of the seven-
teenth century, a Swiss  physician, named  Felix Plater, a very distin-
guished practitioner and professor at Basle, published an abridgment of
Medicine,f in which  diseases are classified in an entirely new manner.
He treats, in  the first  place, of lesions  of functions, which he divides
into lesions of sensation and lesions  of motion;  secondly, he  speaks of
pains, of which he admits  only one  kind; finally,  he  treats  of  vices,
which he distinguishes into vices of the  body and vices of excretions.
This, it is seen, is an entirely new  and very defective classification.  We
have alluded to this book, less on account of its intrinsic value, than as
a first step in an unexplored route, where a new era in nosography begins.
The author does not class pathological affections  according to  the pre-
sumed state of the interior  of  the body,  i. e.,  according the  intimate
phenomena which are fulfilled, or  are supposed  to  be  fulfilled in the
structure of  the organs, but according to the totality of their  apparent
symptoms.
                        CHAPTEB   VI.
                INTERNAL  THERAPEUTICS.
  Everything  in  Medicine  is connected, or should  be connected with
therapeutics.  Ars medica est id quod est propter therapeuticen : such
is the maxim that should never be  lost sight of by men who write on

  0 J. Fernelli, Pathologiae, lib. v, cap. x.
  f Praxeos seu de Cognoscendis, Curandis Affectibus Humani Incommodantibus
Tractatus, Basilae, 1602. 
INTERNAL THERAPEUTICS.
309
any branch of the Healing Art.  Anatomy, physiology, pathology, etc.,
must all converge toward  therapeutics as  a common  center.   Each of
these has an effective value only in  proportion to the succor it gives in
the treatment of diseases.  This is a truth which needs no demonstra-
tion—it is barely necessary to announce it;  nevertheless, it  has been
forgotten or mistaken sometimes, by eminent minds.  We see the ultra
sectarians of the autocratism of nature, or animism, make the  perfection
of the Art consist in the knowing in advance and predicting the course,
crisis, and probable issue of a disease, limiting,  to  some extent, the
 duties  of the physician to the idle contemplation of the sufferings of
the patient.   We see the blind partizans of another school  attach such
a high interest to  the determination of the  anatomical  lesions whose
traces are seen after death, that they lose sight of the treatment, or  say
a  word  about it, for  form's sake, and occupy  themselves  exclusively
with the alterations observed in the dead  body.   It is to the zealots of
this school  that  the sentence of Asclepiades may be justly addressed:
" Your Medicine  is  only meditation on death."
   What are, in the eyes of men matured by practice, and undeluded by
the  pompous  promises of anatomism, what are,  I say, diagnosis  and
prognosis, if their light does not serve to improve treatment and render
it more efficacious ?   For the true practitioner, as well as for the patient,
therapeutics is the cap-stone of the  Science,  the  criterion  of the  real
progress of the Art.   On this point it  merits  a very particular atten-
tion, and the details into which I proceed to enter on this subject,  will
interest, I presume, those readers who seek in  this history  something
more than the vain satisfaction of curiosity.
   The epoch  of the revival  of letters  forms,  as  is  shown,  the limit
between the  middle ages and  modern times.   The physicians  of that
famous epoch attempted less to create new methods of treatment, than
to restore the ancient ones; they attempted  to conciliate  the Greeks
with the Arabs;  Galen with  Avicenna,  and  to study their writings is
to converse still with the classics of antiquity.  It will be, then, a  last
glance which we proceed to take of the doctrines of the fathers of Med-
icine—a definite judgment which we shall  render on the rules  they have
transmitted to us, before  passing to the changes that the  moderns have
thought it their duty to make.
   Among the writers of the Erudite Period who have  shown themselves
zealous partisans of the Greek  theories, no one has better penetrated
their spirit than John Fernel, no one has  succeeded  better than he, to
attach to them the practical facts of his times;  no one, in fine,  has con-
nected with as much art as he the  ancient theories with modern  dis-
coveries, so  as to form a complete body of doctrines, and develop clearly 
310
ERUDITE  PERIOD.
the principles for the guidance of his cotemporaries in the treatment of
diseases.  It will be, then, in his writings that we obtain the knowledge
of these principles, and the consequences that were deduced from them.
  Fernel has divided his therapeutics into seven books, the same as his
pathology, following in the two treatises an analogous  if not uniform
plan.   He explains, in the first place, the generalities, or  as was  said
then, the principles; afterward, he  passes  to  the particular  rules  of
practice, and he shows  how each of them is  comprised in the principles
he has established.   He  proceeds  constantly from generals to particu-
lars, according  to  the method of Aristotle and Galen, to which he
strictly conforms, true Peripatecian as he was.
  Fernel commences by laying down the fundamental axioms  of thera-
peutics, the pivot around which  must turn  all the particular rules  of
treatment, which axiom was nothing else than  the famous law of  con-
trarieties, which we  have already brought before  our readers and dis-
cussed, but which we have promised to submit anew to a more thorough
examination.  The time has now arrived  to devote  ourselves to  this
examination, because no author, ancient  or  modern, has supported  this
great axiom with as numerous, subtile, and specious arguments as  Fer-
nel.  He opens  the  subject  as  follows:  "Every disease  must be com-
batted  by contrary remedies—for a remedy is that which can drive out a
disease; now, that which drives, acts violently—that which  uses vio-
lence, is in opposition:  therefore, the remedy is  always opposed to the
disease, and no  healing can take place  except in virtue of the law of
contraries."0
   This argument, notwithstanding its apparent precision and  its  scho-
lastic form,  is evidently a begging of the question.  It amounts to this:
diseases must be combatted by their contraries, since all  that  cures  a
disease is contrary to it.   But is it not plain that he offers as a reason.
and alleges as proof, the very thing itself which he undertakes to prove ?
It is affirmed that all that cures a disease is contrary to it, and that is
really  what should be proved.  This reasoning reminds us very much of
that which a celebrated comic poet puts sometimes in the mouths of his
characters, as,  for example, when  he makes  one of them say, "  your
daughter is dumb because she does not speak."f   Such  is the  sophism
with which one  of the loftiest intelligences of the  sixteenth century
deceived himself, and imposed on the whole  Medical world!
   Fernel, however, did  not content  himself with the  subtile and arid
  'Joanis Fernelii,  Therapeuticus Universalis,  seu Methodi  Medendi, lib. i,
cap. in.
  \ Moliere, dans la Comedie du Medecin malgre lui. 
INTERNAL THERAPEUTICS.
311
argumentation which we have  given above.   He  knew too well, that a
rule of medicine must be verified, especially, by practice, consequently,
he essayed to demonstrate that each particular case of healing  enters,
necessarily, into the law of contraries.   Let us follow him  as he devel-
opes this law.  We call contraries, he says, not only those things which
are endowed with opposite elementary qualities, as heat and cold, dry
and wet, but also, all things  which differ among themselves in any way,
whether as  to quantity, number, situation,  figure, etc.   Thus, the hard
and the soft; the dense and  the diffuse;  the great and the small; that
which is in excess, and that which is deficient; the high  and the low;
the full and the empty ;  what is pure, and  what is impure;  that which
is entire, and  that which  is broken; such  as  these  are what  Fernel
understands as contraries.
   The above is an example of  the  puerile subtilties into which  a supe-
rior mind is forced to descend, when it proceeds upon a false principle.
According to the language of Fernel, a  drop of water would be the  oppo-
site of a lake; a giant the  opposite of a dwarf; a pitcher empty, the
opposite of a full one ; a mountain  the opposite of a valley, etc.   Who
does not see, at  the first glance, that these  are  the opposites of the
painter,  the poet, or the rhetorician, or, in  other terms, contrasts; but
not at all real opposites, founded on the antagonisms of forces, or ele-
mentary properties, according  to the understanding of physicians, phi-
losophers,  and  mathematicians ?  In  the  language of these, the term
contrary  is  applied  either  to  qualities which  neutralize  each other,
such as heat and cold, dry and moist, or to forces which act in a  manner
diametrically opposite, such  as the south and  north wind, and  the cen-
tripetal and centrifugal forces.
   In giving to the word contrary, the unlimited extension of our thera-
peutist, we make it the synonym of the word  different, but then the
famous precept to treat diseases  by contrary remedies, signifies  nothing
else than to treat them by remedies  which differ from the disease  itself,
 or its cause, which amounts  almost  to nonsense.   Such an axiom  is not
 worth the trouble of being laid down, and certainly this is not the sense
 which the early writers, such as  Hippocrates, Galen, and  their  innu-
 merable ancient  and modern sectators attach to it.  When these advised
to  give  in  each  affection remedies  contrary to the disease, they meant
remedies whose properties or  curative virtues  would be in  opposition,
real or direct,  with the hidden cause  or  principle of the  disease.  It
results from this, that Fernel,  in order  to justify his fundamental dogma
 of medical practice,  is obliged to torture the sense of words, after hav-
 ing tortured logic.
    Moreover, notwithstanding the exorbitant extension which was given 
312
ERUDITE PERIOD.
to the word contrary, this  author still fearing that his therapeutical
axiom did not embrace every possible case of cure, hastens to go beyond
all the doubts and objections that could be given to it by the following
interpretation: " Many men conceive  that this sovereign principle is
annulled, when it  is  said,  that  there  are  diseases which are cured by
similars: but these persons do not reflect that such remedies, though
apparently similar  in  their effects, to  the  symptoms of the disease, are
opposed to  the causes which produced it, so that they destroy the disease
by  removing  its cause ; thus, rhubarb,  though  heating, extinguishes
fever by purging the matter which  feeds the fire.   Exercise fatigues us
by aiding the elimination of the humors  effused into the muscle.  A
purgative arrests a dysentery by evacuating the  peccant  matter, which
causes, and sustains it.°
  Certainly, Fernel has interpreted the axiom of contraries in a way
so wide and flexible, that it is impossible to suppose a case of cure which
is not comprised in it.  Order whatever remedy you please; employ any
curative procedure of which you may get an idea; if the remedy or pro-
cedure is successful, according  to Fernel, it will  be always on the  prin-
ciple of contraries, even if there should be identity between  the cause
of a disease  and the  means of cure;  as when we cause the  pain in a
small burn to cease, by heating the burnt part for an instant at the fire;
or when the frozen fingers are warmed by rubbing them with snow.
  But let  us leave these vain artifices, which  have not caused ancient
science to advance an  iota, and let  us explain how it happened that so
many eminent men, with  their  light,  could content themselves with it,
during a long series of ages.   In  clearing up  this psychological phe-
nomenon in one single individual, we do it for all.   Fernel possessed a
mind  essentially logical.   Before embracing the profession of medicine,
he was distinguished by his discoveries in mathematics and astronomy.
When he emitted a principle which he believed well founded,  he pushed
it to its last consequences, as do all minds of his stamp.   Now, in his
philosophical and medical education he had acquired a great veneration
for the ancients ; he could not persuade himself that a principle adopted
almost unanimously  by the most  sublime geniuses of  antiquity—by
Hippocrates, Aristotle, Galen, and  so many others—as the basis of phy-
sics and medicines could  be false.   To doubt  the  infallibility  of the
axiom of contraries, was to sap the foundation of the elementary theory
of Plato and Aristotle, as  well as the thereapeutics of Galen.  A single
man was not capable of so  grand an effort: it required  generations for
that, as the result of this history  shall show.   Fernel admitted, then,
°Methodi Medendi, lib. i, cap. n. 
INTERNAL THERAPEUTICS.
313
the principle of contraries, as an article of faith;  in place of discussing
it with complete independence of mind, he exerted himself, only, to seek
arguments to convince himself  and others of its reality.   Could  he
foresee that  before  an age  this  famous law of contraries, by which
physicians and  natural philosophers explained at  that time the  phe-
nomena of nature, would be banished from  the domain of physics and
chemistry, and  replaced by the law of affinities; in other  words, that
thereafter the composition and  decomposition of bodies, their formation
and their destruction, would only be explained by the affinities more or
less great of their material  elements ?  Could  he presume that experi-
mental analysis would be substituted by the chemists, at a future time,
for the mental analysis of the philosophers ; that the number  of elements
would increase  in a manner indefinitely, and  the qualities  of the ele-
ments would no longer present the pretended  antagonism imagined  by
the ancients ?  Fernel, then, had only to believe and repeat an old error
which time had  sanctioned, and which seemed to preclude all  discussion;
but he had the advantage  over  most of those who professed  the same
faith  with him in  medicine, of endeavoring to sound  to the bottom of
science,  and of  seeking  to strengthen his faith by proofs, which,  in
their turn, have furnished us the occasion to refute him.
                              OBJECTION.
   If you overturn,  say some, the fundamental dogma of ancient thera-
peutics, if you pretend that remedies do not cure  diseases by properties
contrary to them, then say by what virtue do they cure: is it  by prop-
erties similar  to those of  the  morbific  cause, or solely diverse?  For
remedies can only act in three ways—by antipathy, homoeopathy, or by
some virtue which may be neither antipathic nor homoeopathic, but only
different, that is to say, allopathic.   Which one  then,  of these three
modes of action, must we choose,  in the treatment of diseases?
   An ancient author, whose authority  I have often invoked, answers for
me this question.   We read in  the  Hippocratic  treatise on Ancient
Medicine: "diseases are cured sometimes• by contraries, sometimes by
similars, and sometimes by remedies the action of which is neither con-
trary nor similar, but operate in an inexplicable manner.   There is no
fixed rule on this subject."
   The author of the treatise " On Diseases," professes the same opinion
as the above:  " there is," he says, "no manifest principle of cure that
may be properly termed  a universal principle  for every case to which
our Art is applicable."0
   If there is no fixed rule, then, replies  our censor, Medicine is not an

      0 Traite de V Ancienne Medecine, liv. i. § ii, translation of Gardeil.
        20 
314
ERUDITE PERIOD.
 Art, and the treatment of diseases is subject to the caprices of the phy-
 sician ; and their cure depends entirely on chance, not on the observation
 of rules.
   This is a grave accusation, and one which has rested for a  long time
 against Medicine.   My confreres, I presume, will not be angry, if 1 make
 a peremptory  response  to  it.  Before there were any physicians, and
 before any discoveries had been made of the properties of any medica-
 ment, how were the sick treated ?  Every one treated them according to
 his fancy or  instinct, or they had the counsel of some neighbor or passer
 by, who knew no more about it than they, not having, himself, any other
 guide than  a  very questionable experience.   But when the efficacy of
 certain remedies had been established by repeated trials in certain dis-
 eases, thereafter they did not fail to administer the same remedies when-
 ever the same diseases were presented.  The number of known diseases
 and remedies then experimentally ascertained, being very much increased
 in the course of  ages, men  made a particular study of them, and  col-
 lected their  knowledge in  a body of doctrines.   Then Science and Art
 were constituted, and then only they began to reason on the essence of
 diseases, and the mode of action of  remedies.   This  reasoning  might
 possibly contribute  to the perfection of the science, but it did not consti-
 tute  it, nor form its base.   The true foundation of practical  Medicine
 was, and still is, observations, collected from age to age, from which it
 results, that  such a mode of treatment cures, or relieves, such  a species
 of disease more efficaciously than any other known means.   If, now, it
 is asked, in virtue  of what rational  principle the practitioner is sup-
 posed to act,  when  he rejects the action of contraries,  and the  action of
 similars, it will be  easy to respond—in virtue of that incontestible and
 incontested principle, that diseases must be treated  by remedies which
 have been experimentally recognised as the most efficacious.
   What  more can  be required  of a  physician who  is called  to  see a
 patient, than that he discern clearly the affection before him, and bring:
 to bear all the light that commemorative and present circumstances can
furnish him, and that he  then employ the curative means which  the
observation of  all  ages,  deposited  in  the writings of  the masters, and
confirmed on suitable occasions by his own  experience, demonstrates to
possess the most efficacy in such  a  case.   This  is  all that  can  be
demanded of a physician, and it is of little import to the patient whether
he is  cured by antipathy, homoeopathy, or allopathy: the essential thing
for him is, to be treated  by the method which experience has proved to
be the best.
  Thus, then, in  reversing the dogma of contraries, we do  not sap the
scientific edifice of Medicine, nor do we break the chain of tradition ; but 
INTERNAL THERAPEUTICS.
315
we restore the practice of medicine to  its real basis, experience, and in
this way go back  to the primitive traditions, which the  fictions of the
philosophers had obscured.  In this system—for Empiricism is one, and
even the most rational, as will appear  more and more, in proportion as
we shall advance in this history—in this system, I say, we do not  com-
mence the  science with  Hippocrates,  Diocles,  Herophilus, Serapion, or
any other celebrated  physician, but we begin with the origin of time.
Neither does this  system conduct us  to  the following conclusion  of a
distinguished professor of the school of  Paris, which I have read with
alarm, and which he has let fall from his pen, doubtless, by inadvertence:
"Bichat has very well established,"  says this  professor,  " that all the
systems of pathology have influenced therapeutics, and as these  systems
were often tarnished with error, the therapeutics, which were only a con-
sequence, and, as  we may say the conclusion  of them, must  be equally
false, bad or injurious.   It is a great misfortune, certainly, but it was
inevitable, and it  will recur unceasingly, until  the time when we  shall
have ideas that are perfectly correct, on the nature of  diseases;  and not
treat diseases without having regard to their nature, which is as absurd
as it is impossible."0  Empiricism conducts, logically and historically,
to the following conclusion, which is  less absolute and more consoling
and true:  The knowledge of physicians in former times was very imper-
fect, yet they knew  how to  cure certain  diseases.   Now, we know a
greater number less imperfectly, and we have still more extended knowl-
edge of the means for their cure ; and those who shall succeed us will
have still more extended  and sure means than ours.   According to this
doctrine, we do not  say our predecessors had  only false  ideas  on the
nature of diseases, that is to say on the  totality and corelation of  their
phenomena; but  we  say, our predecessors had notions more  limited
than ours, on the nature of diseases;  and in proportion as the human
race shall  improve, it is probable that  the  notions  acquired will be
extended and perfected more  and more, for each day we discover  new
phenomena  in the diseases  already observed, and new means of curing
them, or to prevent some  of their symptoms.
  There exist,  then,  and there have existed  from time  immemorial,
rules of medical practice, founded on  the  pure and simple observation
of phenomena, independent of all  interpretation, true  or false, judicious
or extravagant, of those phenomena; in other words, free from all specu-
lation on the essence of diseases, and on the intimate action of remedies.
These rules are not unchangeable, but they change and improve in  pro-
portion as, by more careful and delicate observation, new objects are
0 Bouillaud, Essai de Philosophic Medicale, 3e partie, chap, vi, art. 1. 
316
ERUDITE PERIOD.
discovered,  unperceived  or neglected  heretofore.   Nor  arc  rules arbi-
trary, for they must  have been sanctioned by experience.   Those who
conform to them cannot  be accused of acting in a  hazardous manner,
because they  know, in advance, the probabilities of success they offer,
and  their therapeutics cannot be charged with  being bad or injurious,
because it is the best and the most successful known at the time.
   I  had terminated my  refutation of  the  axiom of contraries,  when  I
read in the translation  of the works  of  Hippocrates by M. Littre\ an
extract from a work published in Germany, on  the same subject.   As
we cannot have too much light on these subjects, when it is a question
of condemnation of an opinion almost universally embraced by antiquity,
and  sustained to  our day by respectable authorities,  I  have been
charmed with  the reading of this work,  which arrives at the same con-
clusion as  my own, though elaborated  in a different way, and presented
under another color.  I give the remarkable fragment as M. Littre has
reproduced it, and I hope it will afford the same pleasure to my readers
as to myself:   "We  think we are able to sustain," says  M.  F. W.
Becker,  " that the hypenantiose, or the  principle contraria contrariis
curantur, does not rest  on experience, free from hypothesis—that  it
originated  in  the mechanico-chemical manner, in which life was  sup-
posed to exist, and thus  it falls with  this view.   When  an opposition
seems to exist  between a disease and the remedy, it is only in  appear-
ance, and not in  reality.  We propose  to establish this by examples
drawn from the different  methods:
   " We observe that an indisposition produced by a surcharge of the
stomach is cured by dieting; that a disease of the skin produced by
uncleanliness,  is cured by bathing; that a man  fatigued by excessive
efforts, is refreshed by repose.   At the first glance it certainly seems,
that there is,  here, an  opposition between the disease  and the treat-
ment ; but, in fact, the  cure  is the result, not of  a  veritable  opposi-
tion, but  of the removal  of  the  cause  which  produced  the  evil, or
aggravated it, and of  the  restoration  of the  organism  to a condition
favorable to the exercise  of its recuperative powers.
   " We see, also, that the end of the treatment is obtained by arousing
or re-exciting,  by external means, the diminished or suspended function:
constipation is cured by evacuants ; atonic ulcers are put in the way of
cure by exciting ointments ; a fever, with a small pulse, is cured by the
use of wine, which excites a fullness of the pulse.   These  are  some of
the phenomena which have been brought  forward to  prove the principle,
contraria contrariis curantur.   But it is easy to prove that in  any one
of these  cases, or in others  to which the method  termed excitant  is
applied, the vital activity is not  absolutely augmented.   All these 
INTERNAL  THERAPEUTICS.
317
modes of treatment  are  not founded  on the opposition of the medica-
ment to the disease, but on  the result of experience—particular and
very important  physiological  results,  namely, that the organism, when
an action is excited  in  it,  produces, at the same time with this action,
and on account of it, similar or identical actions.  It seems, that when a
function is morbidly increased, the cure must be sought  in the diminu-
tion  of  that activity ; and  it is pretended that there is hypenantiose in
such a case.   But the functions,  in such a morbid state, are the objects
of a depressing,  sedative treatment,  not  because  they  vary  from the
laws of health, but  simply because they become the  occasion of other
morbid  states, which menace the organ, or the organism.   We  do not
arrest a diarrhea with  opium  because the intestinal evacuations are
more frequent or more  abundant  than in a state of health,  (for many
diarrheas may be left to the control of nature,  and some  are  even
treated  by purgatives,) but  we  give  opium in  the  case when we have
reason to fear the prolonged evacuations may determine an inanition, or
the exhaustion of the entire organism.   We do not prescribe  digitalis,
which reduces the pulse, because  the pulse  is frequent,  (for in every
accession of fever, when  the pulse is no less frequent, we do nothing for
the symptom,) but simply in cases where the shock of the  blood excites
the fear of a derangement in the  movements of the liquid, or in the
texture of  the heart, vessels, or lungs.
   " Besides the three classes of curative methods indicated thus far—
dietetic, excitant, and sedative—all of which have a direct relation to
vital  activity, there are still  two  others, namely,  those which act
immediately on the mass and the movement of  the blood,  (as  emission,
infusion,  transfusion, hsemostasis,  ligation,  etc.,)  and  those  which
change  the form of the  solid parts, as surgical operations.   To these
two classes, the  principle contraria, etc.,  is as little applicable as to
the preceding ones,  and  we have always particular ends in view, which
are attained by the immediate action, on the liquid or solid substances
of the organism.
   " If,  then,  contraria  contrariis curantur  is not founded  on  pure
experience—if it has the appearance of truth only in the  eyes of those
who mistake the true connection between a disease and  its cure—how
is it, that this principle,  which has been so universally recognized, from
the ancients  down to Paracelsus,  has,  notwithstanding its  victorious
refutation by  reformers  of past  times, assumed again an authority so
general ?   We think the reason  may  be found  in the necessary connec-
tion  in which  hypenantiose stands, as a therapeutic  principle,  with the
mechanical and  chemical manner in which most objects in physiology
and  pathology are represented.  This mode  of representation, though 
318
ERUDITE PERIOD.
refuted in different ways, in its primary and grosser forms, and replaced
by organic Medicine, is still  frequently reproduced in medical  history,
in other forms, less definite, and, it appears, more scientific.   The hypen-
antiose which constantly accompanies it must maintain an extraordinary
influence, and we are led to think, that this influence will be abolished,
only when it shall have been understood what is the subordinate rank
which mechanics and chemistry hold in physiology." °
  Another reason  why  the  principle, contraria contrariis curantur,
preserved,  and  still preserves  much of its authority, notwithstanding
its more  or less victorious refutation at different times,  arises from  the
fact that its adversaries have  substituted nothing which  can take its
place.   Now, in a science  of daily and urgent  application,  like Medi-
cine, it does not suffice to prove that a doctrine  is doubtful, or false, or
incomplete; it  is necessary at once to present in its stead one surer,
truer, and more general; this is what  no one has yet done, not even the
author of the extract I have just quoted, who thinks that  the hypenan-
tiose will not lose its influence until it shall be in accordance with  the
subordinate rank that mechanics  and chemistry hold  in  physiology,
which  is probably to await the coming of the Greek   Kalends.  The
animists, vitalists or modern Hippocratists, have  attempted  to  substi-
tute for the axiom of contraries that of coction and crisis, or the auto-
cratism of  nature;  but we shall demonstrate, in the next period, that
the theory of the autocratism of nature is very far from embracing all
cases of cures,  all  modes  of  treatment, and we shall then  propose
another  therapeutic axiom, more sure, more evident, and more general
than any of those that have been proposed up to this time.
  After  this somewhat  long, but  necessary digression,  in view  of the
importance of the subject,  I return to the examination of the therapeu-
tic doctrine of  Fernel.   The second precept which this author gives,
relates to expectorant medicine, which  seems to me is worthy of all
approbation, as it circumscribes the employment of that method within
just limits.   When a disease, he says, is not well known to you, and
you do not see clearly its nature, do not be in haste to apply remedies;
let  nature conduct the  case for a season if  there  be  no urgency, for
nature, aided by a  suitable regimen, will cure the  affection, or declare
its true character.  A doubtful and vain medication is nearly always
injurious.  In fine, if you are  forced to attempt something, do it with
circumspection, in such a way as not to cause a  grave prejudice to  the
patient.
  ° Berliner Med. Zeitung, 1831, p. 15.  ffiuvres Hippocratiques, T. IV, de M
Littre, p. j20.  Aphorismes, Argument, § 13. 
INTERNAL  THERAPEUTICS.
319
  Another recommendation on which Fernel insists very much, is, to
endeavor to destroy the cause or causes of any disease, before attacking
the  disease  itself.  This  recommendation forms  one of  the  capital
points of his therapeutic doctrine, and he sustains  it by considerations
that may be thus summed up:  While the cause of a disease exists, the
affection derived  from it  can not  h?  completely uprooted—it recurs
unceasingly; on the other hand, after the extirpation of the cause, the
disease will often cease of itself, unless it be too  inveterate.   Again, it
must be remarked that there is,  in certain affections, not a single cause,
but  a series of causes, which it is necessary to destroy successively,
according to the order of their development, that is, to commence with
the  first, or  oldest,  and finish  with the  last, or  most recent.   This,
exclaims Fernel, is what is  termed a methodic cure, a cure which does
not consist simply in the employment  of such or such  a remedy, but
also in the manner and order of proceeding.0
   He quotes, in  the same  chapter, several examples of this  curative
method, from among which  I extract the following, which is one of the
most simple.   Suppose that by prolonged  use  of a diet too heating,
there should be formed in the stomach an acrid chyle, which, carried to
the liver, creates there an excessive quantity of bile and vicious humors.
These, after having passed from the  great veins into the less, are easily
vitiated, and give rise to all the symptoms of fever.   Now it is certain
that we can not calm the symptoms  of this fever without having previ-
ously evacuated the  putrid matter which gives rise to it.   To eliminate
properly the  putrid matter,  it is necessary to commence  by drying up
the source whence it flows;  that is to say, the excess of bile and vicious
humors engendered by the liver.   Finally, this excess of humors  being
due to an impure chyle formed in the stomach, it follows: first, that we
must suppress the evident causes that give rise to the formation of bad
-chyle, in other words, change the heating diet; second, purge the mass
of  vicious  humors  arising from the  putrid matter;  third,  evacuate
this; fourth, and lastly, suppress the  excess of unnatural  heat, if  it
still remains, whether in the liquids or solids.
   What a chain of causes  to  follow, and how many indications to ful-
fill in the cure of a simple  fever!   What would it be when one had to
treat a somewrhat complex disease, or a  complication of several diseases ?
How could we untangle the inextricable interlacement of causes inac-
cessible to observation ?  To return  to  the example cited by FerneL I
will ask, by what kind of investigation  is he assured that the symptoms
jf a simple fever are due to that series  of intimate causes or phenomena
: Methodi Medendi, lib. i, cap. iv. 
320                     ERUDITE  PERIOD.
which he paints as if he had seen them ?  Did he follow the course and
development of these phenomena in the interior of the living economy,
or at least, did he find the incontestable traces of  them on the cadaver V
Not at all.  Some ancient physiologists had figured to themselves that
these things occurred thus, and those who followed them were contented
with this explanation, having none better to offer.  In this way has the
doctrine of occult  causes  and the essence of things been  sustained.
This doctrine was  generally admitted, because it  emanated  from the
reigning philosophy, as we have already shown, and because it flattered
the pride of the human mind.  Indeed, it seems to initiate us into the
most intimate mysteries of the animal economy;  but in reality, it offers
us nothing but fictions.
  In the above example Fernel considers only a single order of causes,
while in his pathology he admits, truly, a frightful  number of  them.
There are, he says,  according to the philosophers, four sorts of causes.
viz: the material, the formal, the efficient, and the final.  The human
body is the material cause of all diseases; that is to say, the subject in
which our diseases  necessarily reside.   The appearance  under which a
morbid affection presents itself, the form with which  it is clothed and
which determines its species, is its formal cause; the end towards  which
it tends is its final  cause, and this end  can only be suffering or  death.
Finally, the efficient cause of a disease, that which  it most imports the
physician to understand, is nothing else than the  force which modifies
the body and  causes it to pass from the state of health to that of dis-
ease.   The author afterwards divides  the causes in several other ways,
which  would be too long for me to enumerate, and  I shall only report the
subdivisions of the most important of all—the efficient cause:
   1. The efficient cause is divided into congenital and accidental.
   2. The congenital is either natural or  unnatural.
   3. The accidental may  be exterior or interior.
   4. The interior accidental is divided into antecedent and continent.
   5. The efficient cause produces its effect sometimes immediately, that
is to say, by itself;  sometimes in  a consecutive manner or by accident.
   6. Finally, the efficient cause is divided  into the principal, adjuvant
and indispensable.   For  example,  when we administer a drastic, the
principal  efficient cause of the purgation is the purgative virtue of the
medicament;  the adjuvant are the various substances that are added to
the principal medicament—the preparation to  which it is submitted; the
indispensable is only the natural heat of the body, without which the
virtue of the remedy is inoperative.0
0 Pathologiae, lib. i., cap. xi. et xn. 
INTERNAL THERAPEUTICS.
321
  What a rigmarole !  Does it not seem as if they had undertaken the task
of surcharging science with idle considerations, so as to render it unintel-
ligible and ridiculous ?  Unfortunate were those patients, who fell into
the hands of recent graduates, from whose minds clinical experience had
not yet removed  the  jargon of the schools!   What may be said most
favorable of the physicians of those times  is, that they soon unburdened
themselves in the presence of  their patients, of their theoretic baggage,
and contented  themselves with treating each case of disease with reme-
dies that had succeeded best in analogous  cases, without troubling them-
selves with  abstruse  questions in regard to their pathogeny.   They
reserved this pretended  scientific lumber  for the official dissertations of
the schools or for books.  In short, we can only justify the medical prac-
tice of past ages in the eyes of the present generation, by admitting that
these physicians followed, in their treatment of diseases, not the illusory
indications of physiological theories, but  the positive facts of a rational
empiricism.
  Fernel  reduced to  three genera all methods of medication;  namely:
first, evacuate  the excedent of the  humors;  second, purge, or in other
words, purify the humors;  third, alter, that  is, restore to the normal
state, the parts which have been vitiated  in their temperament or their
composition.  He examines in detail the effects of each of these plans of
treatment, and the various modes of instituting them.
                        ON EVACUATING MEDICATION.
  There are two modes of evacuation, says Fernel, the one general,  the
other  particular.  The first mode draws  the  humors  from all parts of
the body, as the sweat, sanguineous emissions, vomitings, and alvine
dejections.   Vomiting, for example, discharges  first the stomach, then
the larger veins, afterwards the veins of small calibre, finally, the whole
body.   The sanguine  emission empties at first  the vein%and the arteries,
which anastamose with them; lastly, the  mass of the body and the vis-
cera.  Perspiration evacuates first the mass of the body;  next, the great
veins  and arteries; finally, the viscera and deep-seated parts.0
  A particular evacuation is  that which  relates to a special region or
organ.  Thus,  the excretions  of  the nose and palate  relieve  the brain
only;  cough  and expectoration, the lungs and chest.  So the rectum is
relieved by a hemorrhoidal flux; the uterus, by the menses ; the kidneys,
by the sand or  the pus mingled with the urine; the belly, by a clyster
or a supository;  the whole superfices of the body, by a cutaneous erup-
tion.  An artificial issue may be placed in any region whatever.f
0 Methodi Medendi, lib. n., cap. n.    f Loc. cit. 
322
ERUDITE PERIOD.
   Of all artificial evacuations, that of phlebotomy is the most powerful,
according to Fernel, because it withdraws the venous blood, which con-
tains the four principal humors—the  bile,  pituite, atrabile, and the
pure or impure blood.   It is applicable in  all cases of plethora, either
simple,  or accompanied by cacochymy.  The author raises apropos to
blood-letting,  the following questions:  What are  the immediate  and
secondary effects  of blood-letting ?   How does it operate—by revulsion,
or derivation ?  What  are the diseases which claim its employment ?
Is it more advantageous before or after the invasion ?  Wrhat vein is it
best to choose in a given  case ?  AVhat is the utility  of a spontaneous
sanguineous discharge ?  WThat are the indications for blood-letting, and
of the quantity to be drawn ?  At what period of the disease, or on what
day, and at what hour, is it best to practice  phlebotomy ?  How shall
the patient be prepared for it ?  How must the physician act, before and
after the operation ?
                        DERIVATION AND  REVULSION.
   The question of derivative and  revulsive bleedings has been a  matter
of controversy, for a long time, among  physicians, but it has lost much
of its interest since the discovery of the circulation of the  blood.  At
this time the words derivation and revulsion are indifferently employed,
or rather, between the two there  is only an insignificant shade of differ-
ence. The veritable demarkation between derivative and revulsive blood-
letting, says M. Guersant, Sr., is a scholastic subtilty, which originated, at
first, among the Dogmatists, who departed more and more from the obser-
vation of nature.   A  little further  on he  adds,  " these  distinctions
between  derivation and revulsion, are purely systematic and abstract,
and do not rest on  any positive differences.  We cannot even admit an
essential difference between words which, having the  same etymology,
must be  regarded as synonymous."0   The ancients, on  the contrary,
attached to these words very distinct significations,  founded  on  the
errors in  anatomical  and  physiological science, which time has since
corrected, but of which it  is necessary to have a  notion,  in  order to
conceive  of the importance which they put on the distinction of these
two things, and the history of their long disputes on the subject.
   Hippocrates and  Galen had  given the precept to bleed largely from
the  arm, on the diseased side, in pleurisy and peripneumonia.   They
directed,  even, that the blood be permitted to flow till syncope was pro-
duced.  That practice  was gradually abandoned, when the sound tra-
ditions of Greek  Medicine began to be  lost sight of; finally, the Arabs
substituted for it  one entirely opposite ; they prescribed  pricking slightly

       0 Dictionnaire de Medecine, in 21st vol., at the word Derivation. 
INTERNAL THERAPEUTICS.
323
the vein  of the foot, to let the blood flow drop by drop.  Their method
prevailed throughout Europe, until the commencement of the sixteenth
century ; then, a pleuritic epidemic having appeared several times in the
capital of France, a physician of  Paris, named Pierre Brissot, distressed
to see the most of  his  patients perish, and encouraged also by reading
the Greek authors,  dared  to  revive  their  practice.   The success  he
obtained filled  him  with enthusiasm;  he hastened to publish it, and
proclaimed boldly the  superiority of the method  of  Hippocrates to that
of Avicenna.0
   This created a great  uproar in  the medical world.  The innovation
found  partisans  and  adversaries, equally bitter.  The  dispute  grew
warm; on both sides learned papers appeared, which gave no new light,
and persuaded no one.   The Arabists clamored that they were slan-
dered, and that the other side  was heretical, so that but little was
wanting in Spain, to invoke the auto-da-fe for the defence of the Arabic
method.   Nevertheless, the contrary method triumphed,  less, perhaps,
because  clinical  observation  sustained it,  than because  the  fashion
changed  from Arabia  to  Greece.   However this  may have  been,  the
question was nearly settled at the epoch when J. Fernel  wrote;  but it
was not extinct, and preserved something still of its vitality.  On this
account he discusses it very thoroughly, and conformably to the ideas of
the times.  I will now give the substance of what he says on the subject:
When  the blood makes  an irruption on any part, the promptest means
to repress its impetuosity consists in evacuating it in an opposite direc-
tion, from the most distant point possible; in other  words we must ope-
rate by revulsion;  for the most  natural  course  of  the humors is in a
direct line, especially in the veins, whose  longitudinal fibers have  the
property of attracting the liquids.  Now, the veins of all  the right side
of the trunk are continued into the right arm, and the veins of the left
side into the left arm.   Thus, then, in pleurisy and pneumonia, we must
open the vein in the diseased side, as taught by Hippocrates, as well as
by reason.  In  hepatitis the bleeding is always from the right arm.
   It is not the  same for the pelvic members;  they, being  in direct com-
munication with each other by their veins, when  there is an inflamma-
tion in the right leg, the revulsion must be made  by bleeding in the left
foot and vice versa.
   Derivation is effected by attracting the humor toward a point near the
affected part.   To  accomplish it, that vein is opened which communicates
  0 Apologia qua docetur per quae loca sanguis mitti debeat in viscerum inflam-
mationibus, praef. in pleuritide.  Paris, 1525, 4to. 
324
ERUDITE PERIOD.
with  the point itself,  and we thus  direct  to the  orifice sometimes
the nutritious juice, and sometimes the bad humor  that keeps up  the
disease.  Then the excess of humor, running off at  the opening estab-
lished, relieves very much the diseased part, especially if care be taken,
previously, to moderate the impetuosity of the fluxion by a revulsive
bleeding.   But if the engorgement is such that the humor can no longer
flow, which happens in inveterate inflammations that turn into scirrhus,
derivation must be attempted, not by phlebotomy, but by fomentations,
emollient plasters, and digestives.8
   From the errors, obscurity, and anatomical nonsense  disseminated in
this chapter of Fernel, we can judge that the question of revulsive and
derivative bleedings was far from being clear at an  epoch when it was
thought to have been entirely resolved.   We see here, also, an example
of the facility with which the most sagacious minds  satisfied themselves
with explanations where they knew absolutely nothing.
   Fernel speaks, in the same  book,  of the effects of local blood-letting,
which is effected by leeches or scarifications, either with or without the
aid of cups; he explains, also, succinctly, the physiological effects of diet,
exercise, baths, sweating-rooms, anointings, and frictions; for such  are
the means which, according to him, evacuate insensibly all  the  humors
of the body.
                         II. PURGATIVE MEDICATION.
   The third  book  is devoted to the explanation  of this sort of  medica-
tion.   Now, we know that by purgative medication is understood all the
means proper to provoke the evacuation of a peccant  humor through  any
channel.  Thus, vomits, cathartics, drastics,  sialagogues, errhines, ex-
pectorants, etc., were comprised in the number of purgative  medica-
ments.   In this sense, to purge signifies, as we have said, to purify the
economy—to relieve it from any injurious humor.
   We can conceive how much importance this kind of treatment had in
a pathological system, where nearly all diseases were supposed  to origi-
nate by the excess or vitiation of some of the humors of the body.   We
are not  astonished, then,  that  our  therapeutist speaks of it  with so
much  detail.  He professes, in regard  to  this  class  of remedies, the
opinion of Hippocrates and Galen, who assumed, as  has been heretofore
shown, that certain substances have the property of  attracting such  and
such humors:  some, the bile ; others, the atrabile ;  others, the  phlegm,
etc.  He unfolds,  very skillfully, this  theory, and supports  it  by argu-
ments more subtile than solid.
0 Methodi Medendi, lib. n, cap. v. 
INTERNAL THERAPEUTICS.
325
                         in. ALTERANT MEDICATION.
  The fourth book treats of alterant medication;  that  is, of a  medica-
tion destined  to modify the state  or  temperament of parts.   That is
termed a medicament, says our author, which has  the faculty of chang-
ing the natural  constitution of the body in any  way whatever.  Now,
there are, in medical substances, three sorts of faculties, which  are con-
sidered as primitive, secondary, and tertiary.  The primitive  qualities
depend upon the preponderance of one or two elements.  The substances,
for  example, in which the igneous element predominates alone, are sim-
ply hot; those in which fire and moisture  exceed, are hot  and humid,
and so on.  These  primitive  qualities constitute what was  formerly
named the temperament of  substances.
  The secondary qualities result from the union of the primitive quali-
ties with  the greater  or less density  of  substances.    In  regard to
density, a substance maybe tenuous or thin, thick or gluey, or medium—
that is, between the two  extremes.  The combinations  of various de-
grees of density with the temperament or primitive qualities of sub-
stances, form  the secondary qualities, of  which,  according to Fernel,
the following are the chief: the incisive or attenuant and the incras-
sant, detersive and inviscant or emplastic, the exasperative and demul-
cent, the aperient and obturative, dilatant and constrictive, rarefiant and
condensing, laxative and  tonic or  confortant,  the attractive, digestive,
dissolvent,  repulsive, emollient,  astringent, maturative  or supurative,
septic, agglutinative and exulcerant or vesicant, sarcotic and corrod-
ing, epulotic, escarrotic or caustic.
  The savory, having the same origin  as the secondary qualities, are the
best indicators for these.   There  are nine sorts  of this kind that are
distinguished by the taste, namely, the pungent, the acid, the greasy or
mucilaginous,  the saline, the astringent, the sweet, the bitter, the acrid,
and the insipid.   The pungent taste, for example, which is remarkable in
pepper, pillitory, and euphorbia, indicate the tenuity of  matter, united
to a dry and hot temperament, for all that is acrid and biting partakes
of  the nature of fire.   Fernel  explains, in the same manner,  the con-
nections which  he  believes to  exist  between the  taste of  the above
named articles,  and the corresponding secondary qualities ;  but we shall
not follow him in  the details of this more curious than useful theory.
   The tertiary qualities of  medicaments proceed  neither from  the tem-
perament,  nor the density of the substance, but from its mass and form.
For this reason, these qualities are denominated the occult properties of
the entire  substance.   Properties of this class are not manifested either
by  the taste or any sensible quality, but by experimenting.  Thus,  it is
by  experiment alone, that  certain  medicaments are ascertained to have 
226
ERUDITE PERIOD.
the property of attracting and  evacuating from the  body a particular
humor, such as diuretics, which provoke  the  emission of urine, chola-
gogues, which increase the flow of bile—hydragogues, crrhines, emmena-
gogues, emetics, drastics, etc.   Others neutralize and expel animal and
vegetable poisons, such as alexiteric  or  alexipharmics.   These various
agents produce  the effects that we have just enumerated, in virtue of
an occult principle, depending  upon  their substance and form, which
principle, clinical observation only  can reveal.
   If we wished to establish  a  species of comparison between antique
and  modern  science, we could say  that the primitive qualities of the
ancients respond, in some sort, to our chemical properties; their secon-
dary qualities to our physical  ones, and  their tertiary to our  specific
medical  properties.   But the  existence of most  of the  primitive  and
secondary qualities of the ancients,  is purely fictitious  and nominal;
their classification  is confused,  their  origin imaginary:  for it all rests
on the mental analysis of the philosophers, and not on an experimental
or empirical analysis, like that of our modern  chemists.
  As regards the faculties which are named tertiary, they have generally
more reality, and their denominations have been, for the most part, pre-
served in medical  language;   because  they  are founded on  clinical
observation.   It  is  not questionable that there are remedies which
excite alvine evacuations, others that  increase  the flow of urine, others
that excite the menstrual flux, others the saliva, etc.   These substances,
it is true, do not produce their effects in an absolute and necessary man-
ner,  but only under  given circumstances, that  is to say, when the indi-
vidual  to  whom they  are  administered  combines certain favorable
conditions.   It is the same with other medicinal properties; they arc
nearly all conditional, which, however, does not prevent us from classing
and  giving them names;  so that, whatever may be the physo-pathologi-
cal theories  in vogue, we shall always have substances which arc cathar-
tics,  diuretics, emmenagogues, sialagogues, errhines,  etc.
  The ancients, by  abstaining from giving any explanation touching the
nature and origin of this order of  faculties, and by saying that expe-
rience alone  could determine them, showed themselves more than usually
wise and circumspect.   They have  emitted, on  this point in the science,
a reasonable doctrine which no scientific revolution  has  yet overturned.
They may be reproached only for not  having been sufficiently critical in
their clinical experiments—for  having  too carelessly  attributed to a
mass of substances, admirable virtues, which the observations of succeed-
ing ages have not confirmed : so that, before inscribing in their formu-
laries  that a given substance was  endowed of certain properties, they
should have submitted it to repeated and varied experiments—they 
INTERNAL  THERAPEUTICS.
327
should have, in a word, conformed themselves to the excellent precepts
given by the Empirical physicians of the school at Alexandria.
  Fernel shows, in the same book, the reasons which may justify, in many
cases, the employment of compound remedies, and he lays down the rules
which must be observed  in  the process of mingling various substances.
He enumerates the pharmaceutical and magisterial forms, in which they
were accustomed  to administer  medicaments, as well as  the particular
advantages attached to each of these  forms.  He speaks,  among other
preparations of  distilled  waters, essential  oils, infusions, decoctions,
extracts, syrups, powders, conserves—in short, of nearly all  the prepara-
tions  now used in pharmacy and medicine.   The last three books of the
same  work, namely,  the fifth, sixth,  and seventh, embrace materia
medica proper, and a small  formulary.   The medicamental substances
are there  classed according  to their  mode of action on  the  animal
economy, that is, according to the physiological  effects they produce in
the organism.  This basis of  classification  would have  been  excellent,
if the action of remedies had been established on careful  clinical obser-
vation ;  but we have seen that of the three  orders of faculties, the first
two were imaginary or hypothetical, and the third only was founded on
medical  observation.    Unhappily, yet, the  observations  which had
served to establish the third class of faculties  were not always made
with  proper care.  Thus, therefore,  among the virtues attributed to
medicamental substances in  the ancient formularies,  the greater part
should be regarded as hypothetical, exaggerated, or false.
  The judicious  Fernel  had well felt this defect,  and he alludes to it in
the preface of his fifth book, where he says  that he  will  admit into his
materia medica only such substances as are well proved by long expe-
rience ;  preferring a  small number of well known and well studied
remedies, to a great number of doubtful ones.   Nevertheless, he  assigns
to many of the substances, properties which are entirely  imaginary;
because, to avoid this defect, he would  have found it necessary to have
reconstructed science, which is  the work of ages, and  not  of one man
alone.  He  does not  mention  some  substances from the  mineral king-
dom,  newly introduced into medicine, such as certain salts of antimony,
mercury, gold and copper.   The effects of these  energetic agents, which
now render  such signal  service in medicine,  were at that  time but little
known.   They were scarcely employed, except in the hands of charlatans,
barbers and alchymists, who administered them,  right or wrong, without
precise indications or in proper  doses, so that their use did more harm
than  good.   We  must, then,  approve the circumspection of Fernel,
which led him to exclude from his formulary these  powerful  remedies,
yet too little tested, when we reflect  that he was placed  at  the head of 
328
ERUDITE PERIOD.
medical teaching—that his book, destined for the instruction of young
men, became classic throughout  Europe, from its first appearance—and
that these heroic  remedies, which may be employed by a skillful hand
without danger,  produced, at that epoch, effects nearly as formidable as
those of the disease against which they were administered, as the result
of the ignorance and temerity of the medicasters who proclaimed them
to be panaceas.
                       CHAPTEB   VII.

           EXTERNAL PATHOLOGY  AND THERAPEUTICS.

   In all time, external pathology and therapeutics  have surpassed in
progress, the career of internal pathology and therapeutics.  It is a law
that holds  to the nature of things.   External diseases are more easily
discerned than internal;  they may be better observed  from the com-
mencement, with their progress, phases, and various modifications.   The
remedies can be applied  immediately to the parts  affected, and  their
effects  be  observed with exactness.   All these  advantages in  favor of
surgery render it more permanent than  Medicine, so that its  progress
is more constant and certain.
   Nevertheless, this law appears inverted during the middle ages.   In
the midst of  the general decadence of the sciences in Europe, surgery
fell yet lower than  medicine, for the reason that the  latter was in the
hands of the priests, the only men who had, at that  time, a tincture of
a liberal education; while the practice of surgery was abandoned to a
class of ignorant  barbers, bathers and  bone-setters.   I will  mention
one fact, which will give  some idea of the extreme contempt  in which
this class of  operators was held.   " No artisan," says Sprengel, " could
take a  young man as an apprentice, without an attestation showing that
he was born of honest parents,  the fruit of a legitimate marriage, and
the issue of a family in which there were neither barbers, bath-keepers,
shepherds nor butchers; nevertheless," says this historian,  " these men
were, to the middle of the fifteenth century, the  surgeons of most of the
cities in Germany.   The other countries of Europe were but little more
advanced than Germany, with the exception of Italy, where, as we have
seen, from the thirteenth and fourteenth centuries, several physicians did
not  disdain, entirely, surgical  operations;  and  France, where  Lan-
franc and Guy de Chauliac gave it a  temporary  eclat towards the close
of  the  Arabic period.   But  these  rare exceptions did  not prevent 
EXTERNAL THERAPEUTIS.
329
surgery in France, and even  in Italy, as in Germany  and the rest of
Europe, from being  abandoned  completely by the clergy, who devoted
themselves to the practice of Medicine.
  If it be now asked how it was that an art as useful as the surgeon's—
the practice of  which requires extended and various knowledge, as well
as sagacity, courage and  address—an art, the necessity of which must
have been so frequently felt in those calamitous times of continual war and
combat, and  the services of  which are so much more manifest than
those of internal therapeutics—was so neglected by  men who  could
best comprehend its utility, namely, the doctors in medicine, the re-
sponse is easy, and  our readers can make it  themselves, by  recalling
what we  have  said  of  the  constitution of society in  general, and  the
medical  profession  in particular, during the  middle ages.  The Chris-
tian nations of the West were at that time divided into three very dis-
tinct orders, namely:  the  noblesse,  unceasingly at war;  the clergy,
filling all the liberal professions; the populace, in all  the  lowest occu-
pations,  supporting all the  rest,  but having no privileges.  In this
division, the practice of the Healing Art was a clerical right; but,  as
we have before  observed,  a  canon of  the Church  prohibited them  from
drawing blood, under pain of excommunication ; consequently the most
of  them abandoned  the practice of  surgery to the ignorant and vulgar
laity, who acquitted themselves in it as a pure mechanical work, without
any idea of the art or its progress.
   Another reason, no less  powerful, also removed the clerical doctors
from the practice of surgery ;  it was the lack of all detailed and precise
anatomical notions,  which are as indispensable to the  physician as the
surgeon, but the defect of which is more sensible and opprobrious in the
latter.   The absence of anatomical knowledge was, it is true, common to
both the clerical doctor and lay operator, but the latter, being less en-
lightened, did not feel so  much its  need;  being also less elevated in the
social hierarchy, he bad less fear of compromising himself.   Moreover,
a great number of the operators had no fixed residence ; they  went from
city to city, and stopped  in each place as long  as they had any cases
submitted to them,  or until some reverses forced them to depart.  The
most of them limited themselves to one or two sorts of operations;  some
operated for cataract, others for stone, others for hernia, etc., according
to methods which they kept secret, and which they transmitted to their
children as an heritage.   The  History of Medicine has preserved the
names of some of those  families  of  itinerant operators, such  as the
Branca,  the Norsini in Italy, and the Colot in France.
   In hands so unskillful the art could not grow, and the profession must
be mean.  Neither began to  revive until the  prejudice which opposed
           21 
330
ERUDITE PERIOD.
anatomical dissections, and which prevented physicians from practis-
ing surgery,  began to  abate.   But  this revolution was effected  very
slowly.   The dawn of it began from the thirteenth to the fourteenth
centuries, during which a very few of the clergy dared, in a timid man-
ner, to perform surgical operations.  The number increased in the course
of the fifteenth century, and at last became considerable, in the sixteenth.
The most of the great anatomists  of that period were at the same  time
distinguished  surgeons, such as Benivieni, Berenger de Carpi, Vesalius,
Fallopius, Fabricius d'Aquapendente, and others.
   While the  clerical  physicians were willing to descend to the rank of
operators, the  lay surgeons aspired to the level of doctors in medicine.
This latter  transformation took place  especially in France, the  only
country where at that epoch there existed a special college of surgeons.
This college was no other than the small brotherhood of St. Come, which,
always contending against the faculty on one hand, and the barber-sur-
geons on the other, sometimes defeated, sometimes triumphant, but never
submissive, asked at last a peace with the university, and was benignly
received by it  among the number of its scholars,  and enjoyed thereafter
without molestation the privileges  and immunities attached to this title.
This took place in 1515.   "From that  moment," says  M. Malgaigne,
" a new state of things commenced for surgery in Paris.   The Faculty
reigned over the surgeons and barbers, who were admitted together to their
lectures.  The barbers followed the course on anatomy and surgery, which
gradually drew them nearer to  the surgeons of St. Come, and prepared
them to wear worthily their new title of barber-surgeons.  But  they did
not obtain these unexpected results  without giving up some  of their
former rights.   Thus, besides their initiation by a proper tribunal,  to
the privilege of barbering, they had to  pass an examination before the
physician and the two surgeons of the king, at Chatelet, for the right  to
practice surgery.   The surgeons, as the price of their submission to the
faculty, had, then, besides  the  university privileges, acquired a sort of
supremacy over the barbers;  also, their daily association in study and
hierarchy,  dissipating the memory of old divisions, prepared for the
new epoch results which perhaps never before took place; the barbers
were admitted to the rank of  surgeons of St. Come, and the surgeons
of St. Come  were admitted as  doctors regents of the  Faculty  of
Medicine.0
   Thus surgery offers during this period a double upward movement,
on one hand it approaches as a  profession medicine  proper, from which
it should never have been separated;  on the other, it received as an art
Q Introduction to the works of A. Pare, 1.1., p. 153. 
EXTERNAL THERAPEUTICS.
331
numerous improvements.   Among the men who contributed to extend
it, we  have already cited  the names of some celebrated anatomists; to
these we will add those of John de Vigo, Fabricius of Hilden, Maggi
Peter Franco, Felix Wurtz, Jacques  Guillemeau, and above all, that of
Ambrose Pare,  who from a simple journeyman barber, elevated  himself
by ol stinate labor and his genius to  the rank of the first surgeon of his
age.
  The life of  Ambrose Pare is so closely related to the progress of sur-
gery during that epoch, that by tracing it we give, in  some sort, the
history of its  progress.   On this account I do not think I am  leaving
my subject, by extracting  from  his  biography the  passages which  con-
nect him most directly to the history of the art itself.   Ambrose, born
at Laval, of parents not in easy circumstances, did  not receive a univer-
sity education, having never learned  the Latin, the only language at that
time in the books and schools of  Medicine.  The date of his birth, though
uncertain,  must have been between the years 1510 and 1517.  His first
apprenticeship was to a provincial barber-surgeon, after which the desire
for  improvement led him  to Paris,  about the year 1532 or 1533.  He
studied for three years at the Hotel Dieu  in that  city, and it  appears
that he obtained so  fully the confidence of his masters, that they some-
times  made him perform their  operations.  Pare  loved to recall his
sojourn in that hospital; he counted it among his highest honors, which
permits us  to  presume  that these functions were coincident only with
important duties, and  even not a common right nor an ordinary favor.
" Be it known," he says in his Preface, to the reader, " that for the  space of
three years I resided at the Hotel Dieu of Paris, where I had an oppor-
tunity to see and know (owing to the g^eat diversity of patients going
there) everything that concerns operations and diseases pertaining to the
human body;  and besides, I learned there, on an infinite number of
bodies, all that can be said and considered on anatomy; also, that often
I made very satisfactory proofs of it, and that very  publicly, in Paris at
the schools  of medicine."   And in  his  Apology, when a physician of
Milan  seemed  astonished  at the young  man's knowledge, he remarked,
not without some  pride, " But the good man did not know that I had
been house-surgeon for three years at  the Hotel Dieu  of Paris."0
  In regard to the functions of these  barber apprentices in the hospitals.
and the kind of instruction they received there, we  have no positive
knowledge, but it is probable that they made  the  dressings, bleedings
and post mortems ordered by the master surgeon—that they assisted him
in his operations, and perhaps took his place in cases of urgency, about
0 Introduction to the works of A. Pare', 1.1., p. 232. 
332
ERUDITE PERIOD.
as commonly as  the Internes do in  our hospitals at  present.  They
learned by watching  the operations of their chief—by listening when
they deigned to converse with them, and  by carefully studying the pa-
tients.  They found there, also, opportunities, precious and rare at that
time,  for anatomical dissection ;  but it does not  appear that they had
any regular instructions in clinics—the  communications between  the
master and his pupils being optional, depending absolutely on the plea-
sure of the former.
   It was not long after his leaving the Hotel Dieu, in the year 1536, that
Ambrose made his first campaign.   He held the position of surgeon to
the Marshall de Monte-Jan, colonel-general  of the French  infantry, of
the army which Francis I. assembled in Provence to repulse the invasion
of Charles V.   " He had never seen war, nor recent  gun-shot wounds,
and only knew of them by what he had read in John  de Vigo.  I shall
not repeat what he has so well recounted himself; it should be read both
in his first discourse, in the book on Arquebuse Wounds,  and in his great
apology, how. after  the affair of the Tas-de-Suze, he watched  the other
surgeons, dreaming of  nothing else but  to  imitate them as  far as he
could ; how the boiling oil -giving out, with which all  wounds were cau-
terised, anxiety about it prevented him from sleeping soundly, and how,
to his great admiration, he found that the wounded who had been sub-
mitted to the operation,  suffered  more than the others.   This accident
put him in the way of his  first  discovery :  but the rapidity and depth
of his judgment, and the boldness of resolution which led him, a young
man, without name or  authority, and moreover,  without letters or philo-
sophical studies, at once to observe, to point out, and combat a doctrine
universally admitted and sustained by the  highest surgical renown of
the epoch, was not an accident."
   The earliest authors who had  spoken of gun-shot wounds, considered
them as poisoned, and complicated with burning.  Consequently, they
gave the precept to cauterise them with boiling oil, or red hot iron,  and
administer internally at the same time alexipharmics,  for the purpose of
arresting the progress of the poison.   John de Vigo, who was physician
of Pope Julius  II., assures us that  the danger of these wounds results
from the round form of the balls, their  degree of heat, and the poison-
ous qualities that the  powder communicates to  them.    His theory,  and
the method, doubly incendiary,  which  was  its necessary consequence,
had been adopted without contradiction, till the day that Ambrose Pare"
dared protest against them.
   After a campaign of three years, having  lost his master,  he returned
to Paris, where he married  the daughter of  the valet-chauffe-cire  of the
Chancery of France. In 1543, we find him with the army of Pcrpignan, 
EXTERNAL THERAPEUTICS.
333
in the  service of M. de  Bohan, grand lord of Brittany, and  he gave
proofs there, on several occasions, of his sagacity.   " I  presume," con-
tinues M. Malgaigne, " it was after this campaign that his reputation,
so well  established among warriors and  great lords, inspired Sylvius
with the desire of seeing him.  In fact, Pare recounts that in the con-
versation they had together, he insisted on the special and entirely new
precept, of which he made so happy an application on M. Brissas, that
of placing the wounded  in order to extract balls, in the position they
were at the moment they were shot.  This  interview was  honorable in
all respects to both.   Sylvius, whose teachings  attracted more  auditors
than  those of Fernel, even  invited the young surgeon  to dinner, and
heard, with great attention, the observations and  experiments on which
Pare had established his doctrines on gun-shot wounds, and was so much
struck with them, that  he besought him with great warmth,  to write
them out, and make them public.  Pare felt, sensibly, this encourage-
ment coming  from so high a source, and prepared  his text, drew the
figures,  and in the year 1545, at Vivant Gaulterot's,  sworn  bookseller in
the University of Paris,  that little work, which marked in a manner so
glorious the revival of French Surgery was published, with the following
title: The Manner of Treating Wounds made  by Arquebuses and other
Fire Arms, and those made by Arrows, Darts, and the like ;  and also of
Burns made  especially  by gunpowder: Composed by  Ambrose Pare,
Master barber-Surgeon, Paris.0
   "In a  few  months Pare published  his second edition, in which he
recommends  still, the aetual cautery in hemorrhage ;  but each day
he made it a  subject of meditation, and on one occasion  he discussed
the subject with Stephen  de la Biviere and Francis Basse, both surgeons
of Saint-Come, and submitted to  them  the  idea, so simple  and  so lumi-
nous, that since ligatures were applied to veins and arteries in  recent
wounds, there  was nothing to prevent their  being  equally applied after
amputation.   Both agreed with him, and he only needed the opportunity,
which soon presented itself at the siege of  Damvilliers.  A gentleman
of M. de Bohan had his leg crushed by a shot from the fortress.   Pare
made an amputation, and for the first  time did not apply the  cautery.
He had  the happiness to  save his patient, who,  full of joy at having
escaped the red-hot iron,  said that he had got clear of his  leg  on very
good terms.  This last discovery was not less fortunate than the former.
of which  it was, if I may say so, the complement.   By the first step
the young surgeon saved from cauterization  all  who had simple gun-shot
wounds; by the second, he spared all  subjects of amputation  dreadful
0 Introduction to the works of A. Pare, p. 236. 
334
ERUDITE PERIOD.
suffering.   Military surgery, which till that time  had been  a torture,
became a blessed  art, and it was a barber-surgeon who produced the
double marvel." °
  This took  place in  1552.   In the month of October, in  the  same
year,  one  of  the  most eminent  of the generals of Charles V. having
besieged Metz, the Emperor came in person to join the army, on the
twentieth  of  the  following month.  " The city, defended by  the Duke
de Guise, with seven princes under his orders, and  a number  of gentle-
men, had  to  suffer  at the same time  the  attacks of the  enemy, the
fatigues of the siege, and the rigors of a frightful winter.  The Duke
had  established  two hospitals for the soldiers.   He had put in requi-
sition the  barber-surgeons of the city, and had even advanced to them
the money to get  supplies of ointments and  drugs ; but  the  ignorance
of the surgeons unfitted  them  to struggle against a combination of cir-
cumstances so unfavorable, and nearly all the wounded perished, which
caused a  suspicion among the troops  that  they were poisoned.   The
Dr$ft de Guise dispatched one  of his captains, named Thomas  Delveche,
to the king, to say, that  the place could hold out  for ten months, but
asked, at  the same time,  for fresh medicines.   The king sent  for Pare,
handed  him  one hundred  crowns, and directed him to take  all the
medicine  he  thought necessary,  and gave him  also a letter  to Marshal
St. Andre\  who  commanded  in Verdun.   The  Marshal  and  M. de
Vieille-Ville bribed an Italian  captain, who engaged, for fifteen hundred
crowns,  to introduce into  the besieged city, A. Pare\  his valet, or his
man, and the captain of  the Duke de  Guise.    The expedition was
perilous, and, to tell the truth,  says our naive author, he would very
willingly have remained in Paris.   He passed, however, without acci-
dent, and  the little caravan entered  Metz the  eighth  of December, at
midnight, by the Moselle gate.  He was  known to the chiefs and
common soldiers, for he had already passed  sixteen years in war, and
enjoyed the  highest renown in  military surgery.   The next day after
his arrival, the duke, who knew how to strike the imagination, presented
him on the rampart to all the princes, lords, and captains, who embraced
and received him with  acclamations.   On  the same day he began to
treat the leg of M.  de Magnane, who for four days had been  in  charge
of a  charlatan, and had suffered horrible tortures.   The next day he
decided to trephine M. de Bugueno, who had been struck by a fragment
of stone on the head, and had laid insensible for fourteen days.   He
cured them both.  His success,  which  the surgery of our period must
pronounce extraordinary, appears to  me  as  a  strong testimony of the
° Introduction to the works of Ambrose Pare\ 
EXTERNAL THERAPEUTICS.                 335
confidence with which Pare* inspired the wounded, and which facilitates
such cures."
  The little brotherhood of Surgeons of St. Come, recently erected into
a college, ready to seize on every circumstance which could redound  to
their advantage, desiring to possess in its community a man who enjoyed
such great renown, and  of such  high standing at the Court, decided  to
admit  him to an  examination, in despite of the statute which required
that the candidate should  understand Latin;  and besides, what was
unheard  of before, they awarded him the  honor of a  gratuitous recep-
tion.   In the course of the  year 1554, Ambrose Pare* submitted  to all
the examinations, and obtained successively the  grades of bachelor,
licentiate, and master in surgery.
  Notwithstanding the correctness and firmness of his character,  of
which  he gave a thousand  proofs, his favor at the Court never dimin-
ished.   He was surgeon in ordinary to Henry II., and Francis II., first
surgeon of Charles IX.,  and of Henry III., which caused the witty and
true remark, that the kings  of France transmitted him  to their succes-
sors as  a legacy of the crown.   In the midst of the excitement  of
camps, and a very extended  private practice, he found time to read all
that had been published on  his Art, and to compose a great number of
works  himself.  He enriched nearly  all the branches of surgery with
some discovery or improvement; but instead of making a secret of his
inventions, as was very much the custom at that time, he thought it his
conscientious duty to  give the public the benefit of them.  " For my
part,"  he says, in the preface of his large  work on Surgery, "I have
dispensed liberally to  every body the gifts that God has conferred upon
me, and  I am none the worse for it, just as the light of  the candle does
not diminish, however many may come to light their torches by it."
  The doctrine of A.  Pare, on gun-shot wounds, was rapidly dissemina-
ted.   From the year 1550 Bartholomew Maggi, a physician  of  Bologna,
advocated it  without  naming its author,  and sustained it by decisive
experiments.   He observed that none of the wounded by arquebuse shots
felt any heat, and that their clothing did not present any trace of burn-
ing.   He shot balls through packets of powder, without setting them on
fire.  John Lange made these views known in Germany.   Leonard Botal,
a celebrated physician of Turin, was also one of the first to take it up,
but like  those I have named, kept back the true author's name."0
  I have dwelt somewhat at length on the theory and the treatment of
gun-shot wounds,  because this class of lesions, unknown to the ancients,
had at that time acquired a major importance, to increase  from day  to
0 ffiuvres d' A. Pare. 
336
ERUDITE PERIOD.
day, as a result of the  incessant employment of that species of weapon.
I shall  not enter into a detail of the additions and improvements that
the other branches of surgery received  at that epoch ; these details will
be more in place in the following period, when we shall give a retrospec-
tive glance at the history of each of the principal surgical operations.

                             Obstetrics.
  I have already said, but it may not be  improper to repeat it, that
obstetrics is a branch of surgery which, from its importance, merits to be
examined separately; there, as before observed, the life of two individuals
depends on a skillful maneuver,  or on an indication clearly understood.
The great surgeons of the sixteenth century felt this truth, and did not
neglect  the art of accouchement;  but none of them occupied themselves
with it  in. so special a manner as Jacob Guillemeau, pupil and friend of
Ambrose Pare.  Wre owe to him  the first improvements that the moderns
made in this art.  I will cite, as one of the most capital, the formal pre-
cept, to terminate the accouchement artificially, in the case of consider-
able hemorrhage, or when the woman is taken with convulsions, during
labor.   Guillemeau supports the precept on the authority of Hippocrates,
and what is much better, on a  great number of facts which prove the
value of the  practice, and how great the danger of its neglect, when it
is indicated.
  The Cesarian operation was known to the ancient Greeks and Bomans,
but during the middle ages, like many others, it had been abandoned.
Some of the  surgeons of  the sixteenth century attempted to re-establish
it;  among others Francis Bousset, physician to the duke of Savoy, who
recommends  it very warmly.   He reports several cases, where it  had a
happy issue,  both for the mother and the child.  The most remarkable
of all is that of a woman of Milly, who was delivered six times by this
operation, and perished in her seventh confinement, because, according
to Bousset, the surgeon who had been  accustomed to operate  upon her
was absent.   Unhappily, these facts are not well established.
                      CHAPTEB  VIII.

                            CLINICS.

  Clinics, as has been said, is not a branch of medical science:  it is
the science in totality, taught or put in practice  at  the bedside ;  it is
there that theory is put face to face with reality.  In vain will we have
stored our minds with the precepts of the greatest masters, in vain shall 
EXTERNAL THERAPEUTICS.
337
 we have heard for years together, the most learned professors, and gra-
 ven their lectures in our memory : if we have not  followed them  to the
 bedside, if we have not seen them make a test of their methods  upon
 the living, we shall  know very  imperfectly their  doctrine.  You may
 possess very extensive general or theoretical notions, but you will be
 ignorant of a crowd  of details which language can  not describe, and
 which sight  alone  can  supply.   You may be  capable,  perhaps, to dis-
 course on the most difficult questions in science, and excite the applause
 and admiration  of an auditory, but you  may  still be  an ordinary or
 feeble practitioner.  Let you be placed in the  presence of a grave and
 complicated disease, and you are required  to  point out, from the midst
 of  a crowd of symptoms, those which shall form the bases of  a curative
 indication, and you will be embarrassed and troubled.  When, in a peri-
 lous  and urgent case, it is necessary to  make a prompt decision,  on
 which depends the life of the patient, you will have neither that correct
 judgment, that prompt  appreciation of the  case at  a  glance, nor that
 firmness of  resolution necessary for the emergency; all  this is acquired
 by practice, and it is clinical teaching alone that lays the foundation of
 this practice.  By this, though the pupil does not practice himself,  he
 at  least sees practice, and mingles with it; he participates in the prac-
 tice of the teachers, and acquires experience,  without any danger to the
 patient.  Clinical teaching is, in a word, the indispensable complement
 of all medical education.
   In  primitive times, when the  science  was only composed of a few
 notions, easy to seize and retain in the memory, and which were perpetu-
 ated  by tradition,  without the  aid of books, there was no other mode
 of transmission in medicine than by clinical teaching.  Then the lessons
 consisted  more in  example than precepts.  The pupil attached himself
 to  his  master, in the character  of  an aid,  servant,  or adjunct.   He
 became accustomed, under his  directions,  to  discern  diseases, and pre-
 pare and administer medicine.  At a later period, when Medicine became
 the exclusive domain of  some sacerdotal families, this mode of teaching
 was continued in the Asclepidian schools.   The Hippocratic  collection
 offers, under the title of Epidemics, admirable clinical narrations, for the
 time when they were  written.
   But  after the  foundation of  the  school at Alexandria, there  is no
 further mention made in the history of Medicine, of  instructions being
 given at the bed-side.   Collections of clinical relations, traced after the
 model of  the Epidemics of  Hippocrates, became more  and more  rare,
 because less value was attached to direct observations.  The  professors
loved  better to descant on the nature  of man, the essense of diseases, the
 elementary action of medicines, than patiently to observe the phenomena, 
338
ERUDITE  PERIOD.
and  describe them with simplicity, accordingly as they were presented
to the senses.
   The invasion of the  philosophers into the domain of Medicine, was
one of the principal causes of the abatement of  clinical  observations.
These men, strangers to the practice of the Art,  imagined themselves,
and persuaded others, that it was not necessary, in the study of nature,
to pause   at  the phenomena;  but that  the mind  must  penetrate
beyond  these  sensible  things,  and  seek the  internal constitution  of
entities—their elementary and invariable principles, on which depended,
they said, the  forms and actions apparent to our senses.  This was, if
we may believe them, the unique means of  placing  science on a solid
and  immovable basis;  while the phenomena, they added, offer  only a
shifting ground, on which  nothing  stable can be  erected.  The physi-
cians, misled by these sophisms, attempted to go  back, by the  aid  of
some  anatomical and  physiological  notions, to the  principle of life;
they hoped to unravel the mechanism of  the most internal acts  of the
animal economy;  and  pretended  to determine the  primitive mode  of
formation of diseases, or their latent causes, and to direct the action  of
therapeutic  agents against the primary affection.  They substituted
transcendental  hypotheses for the simple results of observation,  and
believed that they had raised the edifice of  Medicine on an immovable
foundation, because they had established it on a basis inaccessible to the
appreciation of the  senses, and consequently,  they  said, secure from
their illusions and instability.
   By this doctrine, clinical observation  lost much of  its importance;  it
was  no  longer  a  torch which  could illuminate every step in science,
and supervise, constantly, its progress;  it was only a feeble and  uncer-
tain light, which, after having enlightened the cradle of human reason,
and served as a basis to the mind, on which to elevate  itself to greater
truths, could henceforth be useful only  to direct the artist in the appli-
cation of immutable rules which the mind had discovered.
   In vain some sages, undeluded, from experience, by the fictions of theory,
strove to  recall the  medical world  to the study of phenomena, by pro-
claiming that our light on the nature of things does not go beyond the
perception of the  senses ;  in vain they affirmed that  the only  means
of enlarging our knowledge consists in adding, unceasingly, new to ante-
rior  observations; their voice was not  heard, for  the human mind does
not willingly accede to a slow pace, and the imagination loves better to
anticipate the march of time.  To the laborious, incessant and exhaust-
ing  study of  phenomena,  they prefered a  science fully made, having
invariable dogmas, which were supposed to be founded on the essense of 
EXTERNAL THERAPEUTICS.
339
things.   Idleness  and vanity found much more satisfaction in this  last
doctrine.
  Nevertheless, the habit of observing and describing facts as they were
developed, was not entirely lost.  The coryphii of the Empirical  sect
always  remained faithful to it; and tradition says that they had  col-
lected  in the earliest years of  the  Alexandrian  school, a considerable
number of historical clinics, after which the later nosographers, Aretseus,
Coelius  Aurelianus, and others drew the portraits of a number of  dis-
eases so well that but little has been added to them since.
  After the death of Galen, during the lapse of time which we have
named the Second Age of Medicine, and which extends from the eleventh
to the fifteenth century, the princes of the science, in the midst of their
habitual sterility have transmitted to us but a small number of inter-
esting clinical facts, some of which have been  pointed out.   It should
be remembered that we owe to the writers  of that stationary epoch,
among other acquirements, the  knowledge of certain eruptive  fevers, of
which  they have  given the  first  description;   but  they are  justly
censurable  for reporting none  but extraordinary cases, and for having
omitted, in  the most of their clinical relations, important details.
  Long after the  revival of letters, clinical  teaching,  so useful to  the
progress of science, and so  indispensable ^to young practitioners, was
still in oblivion, and this  fact  led  Ph. Pinel  to make the  following
reflections, which  may be  thought  too severe:   "It  seems," says the
learned  professor,  "  that  the first editions of-  the  ancient  works  of
the Greek physicians, published at the commencement of the fifteenth
century, should have  led to the restoration of clinical studies as the sole
guarantee of solid instruction, and of the ulterior progress of medical
observation; but this happy impulse of the mind was  still retarded for
more than two  centuries;  they plunged into  all the subtilties of an
indigested erudition—that is to say,  they  were  occupied solely with
commentaries and disputes and controversies, as in the other physical
sciences ;  and they left the sole method of settling all uncertainties,  and
repressing the wanderings of a deranged imagination, viz.: the historic
description  and progress of diseases in the hospitals."
  I believe  that in the above passage our celebrated nosologist did  not
fully appreciate the  services rendered  to science during the Erudite
Period.   In fact, these physicians had  not the  happy idea of  founding
clinical teaching, such as it now exists in a great number of hospitals ;  it
is also  true, that they occupied themselves  more with philological
researches than with  the observation of  nature;  but what better could
they have done in order to free the human mind from the rust which a 
340
ERUDITE  PERIOD.
long  course  of years had heaped  upon  it, than  restore  the Greek
science in its original purity ?  This was a painful and ungrateful, but
necessary task, and which must precede the labors of reformation.
   Nevertheless, they did not neglect entirely, as is  affirmed above, the
study of phenomena, and  the historic description  of  diseases.  They
began, from the fifteenth century, to make relations of epidemics, on the
model of those of Hippocrates; they observed a mass of new pathological
states, and attempted means of cure unheard of by the ancients.  In
fine, in  the course of the sixteenth century, the spirit of  innovation
made progress, and some physicians carried it even to the point of abuse,
as we shall see in the next chapter.   But among those who remained
faithful to the  worship of tradition, enriching, nevertheless,  the science
by valuable clinical observation,   I will cite  particularly,  Nicholas
Massa of Venice, John Crato of Craftheim, Bembert  Dodoens,  John
Schenck, Felix Plater, Peter  Forcest, or Forestus, Marcellus  Donatus,
Louis Duret, and finally William Baillou, worthy by his great character
and his high intelligence and  talent for observation, to be the precursor
of the medical reform that commenced in the following century.
   Nothing proves better how much the art of observation  and  descrip-
tion of pathological phenomena made progress at the epoch of the revival
of letters, than the great number of new diseases of which the authors
of that period  make  mention.  We read in their writings for the first
time, the names  of  whooping-cough, milliaria, scurvy,  plica polonalis,
syphilis  and raphania.   Is it credible that  alt these diseases, some of
which  modify the economy profoundly, fell upon Europe at the  same
time ?   Is it reasonable that the changes occurring in the political and
commercial relations of the  people—the discovery of the new world,
giving rise  to long voyages at sea—in a word, the modifications intro-
duced in public  and private  hygiene, resulting from  so  many events
which marked that epoch, could have suddenly given birth to this flood
of new diseases ?  No one, I think, dare sustain it. It is more probable,
I might almost  say certain, that  the most of these diseases  had an
ancient  existence; but they were not recognized before, by attentive
observers who could  discern their true characters, and there were no
exact historians to describe them.
   Medical men in our days, are divided in opinion on the origin of only
one of these affections—syphilis; some inclining to believe that it was
developed spontaneously in  Europe,  toward the close of  the  fifteenth
century ; others think that it was imported from the new world ; others,
and the greater number, see in the venereal diseases only a degeneration,
or one of the numerous ramifications of leprosy.  We  now proceed to 
EXTERNAL THERAPEUTICS.
341
discuss  each of these opinions,  and will  endeavor to make a choice
of one of them :
   I. The first view accords with  the opinions of the most  ancient his-
toriographers of syphilis.  Indeed, the most of the authors that  have
first made mention of this disease, have  considered it as a  sort of pest
(lues venerea), developed under the influence of a particular epidemic
constitution.   They agree in saying that  it appeared nearly simulta-
neously in all parts of Europe—at Berlin, Halle, Brunswick, inLombardy,
Apulia, Auvergne, etc.   They  regard  it as impossible that  the conta-
gion could be propagated in so short a time, and at such widely separated
points, as the sole result of impure sexual commerce, consequently they
are forced to admit the influence of an epidemic constitution.
   But they differ very much among themselves on the causes that could
have given  rise to the development of such a constitution.   Some, like
Leonicenus, attributed it entirely to natural causes.   He thought that
it was the result of the  extraordinary inundation that occurred in  all
parts of Italy toward the close of the fourteenth century—the sun
having heated by  his rays  the soil soaked by the  pools of stagnant
water that covered the low ground, there resulted unhealthy exhalations,
which gave rise, he said, to  the variolus epidemic.  He supported  his
views on the authority of Hippocrates  and Galen.  These authors say,
indeed, that in damp seasons, when  the  south wind blows, or when no
wind disturbs the air, there are developed a running from the eyes and
ears, ulcerations of the mouth,  pustules,  and suppurations of the genital
organs.
   Others attributed the  appearance of the pest to astrological influences,
such as, for example, the meeting of Saturn in the  sign of the Bull, or
the union of Jupiter, Mars, Mercury, and  the  sun, in the  sign of  the
Balance, etc.  A large number rejected  all these learned explanations,
and saw in the propagation of this  new plague only the finger of God,
who laid it on men, to punish them, and  turn them away from unbridled
libertinism.  Van Helmont regarded syphilis as the result  of the con-
nection of a man with a mare affected with farcin.   Andrew Cesalpine,
as the product of the mixture that the Spaniards had made of the  blood
of a leprous person with wine.   Gabriel Fallopius thought the venereal
vice was engendered  by  a poison which the perfidious Neapolitans had
thrown into the wells  whence the French  drew their water.   These
reveries would not  be  worth mentioning,  if they did not indicate
admirably the spirit of the age, and show to what a degree of aberration
a love of the marvelous  may draw the most clear-sighted men.
   II.  Gonzalvo Ferdinand of Oviedo, Intendant-General of the commerce
of the  New World, under Charles V., and author of a History of  the 
342
ERUDITE PERIOD.
East Indies, printed in 1545, was the first writer who said, positively,
that syphilis originated in America.  He says that Christopher Columbus
having returned from his second expedition to the new hemisphere, in
1496,  the sailors and soldiers  of his suit enlisted, for the  most part,
under  the flag of Gonsalvo de Cordova, to go and fight the French, who
had invaded the  kingdom  of  Naples.   They communicated, he  adds,
to the French and  Neapolitans  the affection  they had brought from
St. Domingo,  where, he  asserts, the disease  is  endemic among  the
natives of the country.   The statement of Oviedo was admitted almost
without examination, by most of the physicians of the sixteenth and
seventeenth centuries ; but  in  the early part of the eighteenth, Astruc
sustained it by very erudite researches, which  gave it for a time  the
authority of a settled decision.
   Unhappily for the veracity of the Spanish historian, it is certain, from
authentic testimony, that the pox broke out in Naples  toward the close
of the year 1493, or in the beginning of the following year, that is, two
years before the arrival of the Spanish  fleet.   We read, in a decree of
the parliament of Paris, relative  to venereals, as follows : " This day,
the sixth of March,  (1496 or 1497) because in this city of Paris  there
are several  persons  afflicted with a contageous disease, called big pox,
which  for two  years has made great progress in this  kingdom, as well
in the city  of Paris as  in  other places, etc."   If there  were needed
other proofs to  invalidate the narative of Oviedo, we might add, that
he exhibits in many places a manifest prejudice against the inhabitants
of the New World.  He likens them to the Canaanites, and the Spaniards
to the people of God, so as to give a color of justice  to the  atrocities
which he inflicted upon the unhappy Indians during his government.
   Other  later writers have pretended that it was on the first return  of
Christopher Columbus, that  his sailors and soldiers carried into Europe
the syphilitic  infection ; but this assertion falls to the ground, like the
preceding, before a serious  examination.  In fact, it is known, that on
his return  in his first  voyage, this bold navigator  was assailed by a
tempest that forced him to put into Lisbon, where King John II. retained
him seven days in the midst of continual festivals.   Thence he made sail
for Palos, where he landed in the  course of the  month  of March, 1493.
From this  city he went by land to Barcelona, with eighty-two men of
his equipage, and nine Indians.   There he met King Ferdinand, with
Isabella and the whole court.  After remaining some weeks at Barcelona
he started for Cadiz, to prepare for a second expedition.   Now, at none
of the  points where he touched  during  his route, in none of the cities
where  he stopped  with his retinue, did  the slightest  symptom of  the
venereal  poison manifest  itself for several years, while from the year, 
EXTERNAL THERAPEUTICS.
343
 even, of his arrival in Europe, or the year following, numerous attacks
 of a  venereal  nature were observed in many and  very distant places
 in Italy, France, and Germany.
   The authors of this  epoch, who assumed that syphilis originated in
 America, insist very much  on the following  consideration, which  they
 think of great value.   The Supreme Intelligence, they say, is accustomed
 to place the antidote by the  side of the poison; now, guaiacum wood,
 which may be considered  as the most precious  specific against venereal
 accidents, is indigenous to the West Indies, and it follows, therefore, that
 the affection it was destined to combat must have originated in the same
 regions.   This  argument has lost so much of its force in its progress
 down to us, that there is to-day no necessity for refuting it.
   III. The opinion that syphilis is a degeneration of leprosy, or one of
 the numerous forms of  this affection,  seems not to be as  old as the  two
 preceding ones; but it has  not ceased to make progress in the course of
 time, and  now it  reigns almost exclusively in  the  medical world.   In
 order to appreciate to  what extent  this  is probable,  it  is necessary to
 place in comparison the principal symptoms attributed formerly to  the
 two diseases under consideration.
   The writers who wrote  first on the  venereal disease  say, that it com-
 monly commenced with large pustules on the genital  parts, invading
 subsequently the entire body, and hence obtained the vulgar name of
 big-pox.   The pustules were not accompanied  by fever, as are those in
 small-pox;  they never came to perfect maturity, but were converted into
 pustules adhering to the skin, or phagedenic  ulcers.  Very soon pains
 were  felt in the  extremities, which  increased  by the heat of the bed.
 Then there supervened, after a period more or less long, a formidable
 cortege  of  consecutive  developments: such as bubos,  chancres in  the
 mouth, nose, eyes, and vegetations or excrescences of every form, alope-
 cia, macules, exostosis,  necrosis, etc.
  Blennorrhagia (les ecoulements) now so common, and which constitutes
 often in itself  the whole disease, was  not observed till twenty years
 later as a symptom of the syphilitic  infection.  It was  also remarked,
 that the greater part of the developments called consecutive or constitu-
 tional, might, in rare  cases, show themselves from the commencement:
 that is, without having been preceded by any other symptom of  the
 infection.
  Some observers, struck with the rapidity with which this epidemic was
 propagated at its first appearance, believed that the  contagion could be
 communicated by the breath,  even, of the diseased.   However, greater
numbers were of the opinion that it required the immediate contact of
the ulcerated parts, or of the running matter, and this view soon became 
344
ERUDITE PERIOD.
universal.   Such are, in substance, the characters that were presented
at the first appearance of the syphilitic disease.
   Now, let us see some of those which the ancient writers attributed to
lepra.   AVe read in the sacred books of the Jews: " The man on whose
skin or flesh a diversity of color  shall appear, or a pustule or any bright
spot which seems to be the sore of leprosy, shall be taken to the priest
Aaron, or to some  one of his  sons," etc.   " The man who suffers  with
that which should only happen in the marriage relation, shall be impure.
And it shall be judged that he suffers this  accident when there  is  a
constant accumulation of an impure humor which adheres to his person.
Every bed in which  he  sleeps, every place on which he  sits  shall be
impure."0
   Hippocrates, Aretseus, Galen, Celsus,  and  the Arabian physicians
make mention of gonorrheas  or issues, of the  semen; they  speak of
pustules,  ulcers,  phlegmons, excrescences and  crusts located  on  the
genitals and neighboring structures.   The Latin satirists, Horace, Juve-
nal,  and others, describe  some symptoms of this kind as being the  fruit
of a shameful lubricity.
   The writers of the middle ages are  more explicit  than  those  of
antiquity.   William  de  Salicet, who lived in the thirteenth century,
which is about two hundred years before the outbreak of the syphilitic
epidemic, says  bubos  often occurred after an impure  coition—quum
accidet homini in virgd  corruptio, propter concubitum cum fcedd  mit-
liere, aut ob aliam causam.   Lanfranc expresses himself more clearly
still: "The ulcers  of the penis," he says, "proceed either from hot
pustules which burst, or acrid humors, or from commerce with a woman
who has been previously  affected in the same manner.   If one wishes to
preserve himself from all infection,  it is necessary immediately  after
connection with a suspected person, to wash himself in a basin of water
mingled with  vinegar."!   John Ardern  makes mention  of   scalding
urine, vulgarly called chaude-pisses, which was caused by ulceration of
the canal, or by gonorrhea.
   "It can  not be dissimulated," says a modern writer  of great weight
on this subject, " that the resemblance is such in the different varieties
of cutaneous diseases of  the present time, when compared with those of
remote times, that it is impossible in many cases  to decide if an  affection
is venereal or  not;  the only thing that can be alleged against the  iden-
tity is, that the ancients did not represent these  diseases as contagious,
if we except some tetters, corroding ulcers, and the leprosy.
   0 Leviticus, chap, xin, verse 2; xv, 2, 3, 4—translation of Le Maistre de Sacy.
See, also, in the  Traite d'Hygiene of M. Levy, Paris, 1811, T. I, note to page 7.
   | Liv. in. chap. n. 
EXTERNAL THERAPEUTICS.                  345
  " Moreover, one disease can succeed another without presenting the
same symptoms:  it suffices if the last  has some resemblance to the
preceding, if it controls and displaces the other.   Did not this occur  at
the end of the fifteenth century and  at the  commencement  of the six-
teenth ?  In those times leprosy and elephantiasis were  frequent, and
there were special hospitals for these diseases ; but gradually these hos-
pitals were deserted, and were employed for other purposes."0
  The sudden appearance of syphilis in  nearly all  parts of Europe  at
the same time, which the first observers have reported as an extraordi-
nary, and nearly miraculous thing, being persuaded that the disease was
new—this species of sudden ubiquity for which they could not account,
is explained very naturally,  when the venereal affection is regarded as a
degeneration or  modification of leprosy, a disease  extremely common  at
that epoch.   We can conceive that  from  the moment physicians began
to establish a line of demarkation between the symptoms of leprosy and
those of syphilis, the  first must diminish in proportion as  the latter
increased.
  All the authors of the times signalize the marked similitude between
the  two diseases; they even say that one may be converted  into the
other.   Analogous  precautions were  taken  to prevent the extension of
syphilis, as had been employed against leprosy.   The regulations for the
leprous hospitals served  as a model for those of the lupanars,  for in the
commencement, the pox inspired  a horror nearly equal to that of leprosy,
and this horror did  not diminish until increasingly efficacious means
were found to cure it.  Therefore the opinion which  assumes that vene-
real diseases have always existed, is sustained by the greatest probabili-
ties, and if it was not the first  one embraced, it  is to be accounted for
in the fact that  it flattered less the taste of an age passionately fond of
the marvelous.
  Sanchez, a Portugese physician, was one of the  first to oppose the idea
of the American origin of syphilis, and collected a number of passages
which would authorize  us to think that this  affection commenced  in
Italy, as an epidemic, whence it  rapidly spread throughout Europe.f
  He  submits the work of Astruc to a luminous  and severe  criticism,
and refutes, triumphantly, his conclusions. But this effort was fruitless,
and almost  forgotten, when  Hensler  took  it up nearly ten  years later,
  Q Cullerier, Dictionnaire des Sciences Medicales, on Syphilis.—Dictionnaire de
Me'dicine  et de Chirurgie Pratiques, art. Syphilis, T. XV, p. 176.—M. Lagneau
holds the same opinion on this point.—See Dictionnaire de  Medicine, in 21 vol.,
at the word Syphilis.
  t Dissertation  sur  l'origin de la Maladie  Venerienne. Paris, 1752:  Examen
historique sur Papparition de la Maladie venerienne en Europe.   Lisbonne, 1774.
             22 
346
ERUDITE  PERIOD.
and  supported it by new  researches, which attracted the attention of
all Europe, and created doubts in many minds.0
  M. Jourdanf having examined, scrupulously, all the opinions emitted
up to that time, on the  origin of these diseases, concludes with Hcnsler,
that all the symptoms which it had been usual to connect with syphilis,
have  been known and described from  the  remotest  antiquity, but they
were  not  supposed  to proceed from a  common source,  (an  impure
coition) and as being attached to the same cause, until after the  close of
the fifteenth century. This last opinion, we have said, is  the most gene-
rally received at present, nevertheless, all  the syphiligraphs are not
united in this view,  and we  must  cite among  those who oppose it, M.
Gibert, whose authority is of so much  more  weight, because  he has
made on this subject very erudite researches.J
                        CHAPTEB  IX.

                 THEORIES  AND  SYMPTOMS.

  The prevailing theory during this period, as we have already observed,
was a mixture of Galenism and Arabism.   Nothing else was taught in
the university schools of Italy,  France, Germany, England, and Spain.
Men standing at the head either of science  or  teaching, employed all
their sagacity to  unite together the ancient doctrines—to put in agree-
ment, Plato and Aristotle, Hippocrates and Galen, Bhazes and Avicenna.
They can all be ranked in the class of the conciliators, with a  few excep-
tions, of whom I shall speak in the next chapter.   But among them,
Fernel occupies the first place, and merits special notice on our part.
  John Fernel, surnamed  the modern  Galen,  was born at  Clermont, in
Beauvoisis.  He exhibited, from an early age, an extraordinary aptitude,
and application above his years.   He had made himself a reputation in
letters,  philosophy, and mathematics, when he began the study of medi-
cine.   Beceived as doctor in  1530, says his biographer, G. Plancy, with
the unanimous applause of all the  faculty of  Paris, yet he did not feel
  '~' Geschichte der Lustseuche die zu Ende des XV.  Jahrhunderts in Europa
ausbrach.  Altona, 1783, 1794, 2 vol., 8vo.
  f Traite' complet de la Maladie venerienne.   Paris, 1826, 2 vol., 8vo.
  | See the commencement of his memoir on the  Syphilides, inserted in the Me-
moires de VAcad€mie de Medicine.  Paris, 1843, T. X., p. 503, et als., and his Re-
marques Historiques sur la Le'pre, inserted in  the Revue Me'dicale, in the July
and August numbers, 1840. 
THEORIES AND  SYMPTOMS.
347
that his precocious success  dispensed with the future study of  authors,
as is the practice of so many laureates, inflated by their juvenile erudi-
tion.   On the contrary, he commenced reading with new zeal the mas-
ters in the Art, stealing from the hours of sleep and repose, every moment
he could, and when  his  friends, alarmed for  his health, represented to
him his excesses in study,  and persuaded  him  to take repose, he was
accustomed to reply:
  Longa quiescendi temporafata dabunt: Destiny reserves for us repose
enough.
  The king of France, Henry II., was desirous of  attaching him to his
person, in the quality of first  physician; but the philosopher  refused
that honor,  saying that it belonged, by right of succession,  to Bourgeois,
who had been physician to the late king,  Francis  I.  But after the death
of Bourgeois, he had no  further excuse to make,  and was constrained to
accept the eminent post, the object of so much solicitation.
  It was  in the midst of a very extensive private  practice, and the duties
of his new charge, that  he  undertook to collect all the medical knowl-
edge scattered in the Greek, Latin  and Arab books, and to  form from it
a body of doctrines, all  parts of which would  be united together, as
branches  are to the same  trunk.  To  this  end,  he collected  in each
author  whatever he  found  most substantial, then making  a judicious
choice of  the materials he had collected, he gave them a form appropri-
ate to the taste of the age, and composed from the mass a work perfectly
regular in its arrangements, and which was regarded  by his cotempo-
raries as the most complete  and just expression of medical science, as it
was at  that time  understood.   His work, written with a Ciceronean
purity and elegance, offers an extremely  able fusion of the  most accred-
ited ancient dogmas.  We  have already exhibited some parts of that
doctrine, and there  remains but little more for us to do, in order to
obtain a  complete  idea of the work, and the relations of its parts.
  Fernel  emits, in the first place, his opinion on the source of our attain-
ments, and  on the best method to  follow in  the study and teaching of
Medicine.   He unites, on this  subject, the doctrines of Plato and Aris-
totle,  which appear to be irreconcilable:  the first affirming that ideas
come  to us by recollection, the second that they  originate in our minds
as the effect of sensations.  He attempts to  show each of them correct,
as follows:
  " Before the mind." he says, " is united to the body, it enjoys its full
liberty;  it perceives distinctly the essence of  things, and  possesses an
instinctive knowledge of their nature; but as long as it is retained in its
material prison, the body, oblivion obscures its view,  like a thick cloud,
and plunges it into profound ignorance.   Nevertheless, it still retains a 
348
ERUDITE PERIOD.
slight remembrance of  its divinity; and this pleasant reminiscence of
celestial  things  becomes a ray  which  inflames  it with  an  insatiable
desire to  learn and to know.  Hence that ardent zeal and constant appli-
cation, with which it struggles to recover, by means of sensitive impres-
sions, the mass of its  knowledge.  It commences,  at  first,  with the
observation  of sensible  objects; then  it seizes,  by  its thought,  those
which are accessible to the intelligence only.   This, then, is the process
by which have been established, with the aid of  the senses, the princi-
ples from which human  sciences  have been  deduced, and  carried  to  a
very high degree of perfection."0
  What  an  agreeable mixture of  truth and  fiction, which the progress
of light  dissipated, as we shall see in the commencement of the follow-
ing period.  The philosophical theory, whose essential and fundamental
dogma we have just read, was eminently appropriate, to kindle in young
hearts a  love for study,  and to console the learned for the fatigues and
privations that it imposed.
  " The  philosophers,"  continues the same  author,  " desirous to rest
their doctrines on a lucid chain of rigorous proofs, have employed analy-
sis.  Such was  the method  adopted by  Euclid,  in  the  exposition  of
geometry and  arithmetic; of Ptolemy in astronomy;  such, also, the one
which Aristotle adopted, in order to transmit  to posterity his philosophy,
and lay the solid foundations of so many truths, incomprehensible to the
vulgar, and  which produce  astonishment like prodigies or fables."
  W7hat  would the metaphysician Condillac have said, if this passage
had been shown him; he  who believed analysis  a scientific  method of
modern invention ?   We have already seen, that this writer was deceived
in  regard to  Aristotle—the effect of not having read, or badly com-
prehended him.   We shall see, further on, that the description he gives
of the analytic  method, is imperfect, according to Barthez, one of the
most competent judges of our epoch.
  Fernel adds, in another  book, " Seeing that the knowledge of those
individual objects is not science, for the purpose of following a sure and
rational  method, I  shall commence by general considerations."!   This
method, we  see, is  in perfect conformity to  the doctrine  of  Aristotle,
which we have already set forth, and the artificial sophistry of which we
have unraveled.   Here  is the judgment that  a sage of our century gives
upon it:  " how happy we would  be, said Laromiguiere,  if these general
propositions, whose extent of application seems  unlimited, and which
have  been placed  with so  much confidence at  the  portals of science,
were as  valuable as they are confidently announced to be.   It would
-Physiol, lib. i, cap. i.        f Pathol., lib. i, cap. i. 
THEORIES  AND SYMPTOMS.
349
then suffice to understand well a few axioms, to be able to comprehend,
thoroughly, all that it is possible to know.  But, I ask if it is for those
who already possess the sciences, or for those who are ignorant of them,
that they are embraced in a few hasty formula ?  Certainly these are
not for the ignorant; who will  dare maintain this ?  Now, if they are
only the abridged expression of acquired ideas, they are only results,
and not principles."0
   Our philosopher concludes, from  these reflections, that  the general
propositions, and the axioms, which it had been customary to place at the
commencement of most  treatises, would have been more properly placed
at their  end.   But that was not the gravest inconvenience of this bad
method; it has another, much  more  capital,  which  we have already
pointed  out,  but to which  it is important to  recur.   This consists in
what the axioms of physics and of medicine of the ancients proclaimed.
These pretended principles, on which  they were willing to rest the edi-
fice of our acquirements, instead of being the result of repeated observ-
ations, are the  fruits of preconceived opinions, and of hastily formed
judgments on things imperceptible to the senses.  It is on this account,
that when we come to compare their principles with particular facts, or
reality, we often find the former in opposition to the latter.   Whence it
follows, that  their principles would be defective or insufficient guides in
practice, which has been  proven by the ancients themselves.   Fernel
was compelled  to avow it, notwithstanding  his prejudice in favor of
principles, that " no one could accomplish any thing great by the simple
knowledge of  generalities, without the  habit of studying  particular
cases."f  An old adage establishes,  in a very explicit manner, the
antagonism of this philosophic method, to observation, for it  says,  posi-
tively, " good theorist, bad practitioner."  Here, unquestionably, is a for-
mal condemnation of the theoretic principles of antiquity !
   Fernel divides medical science into  three great sections, namely, phy-
siology,  which  comprehends  the anatomical  description of  the parts,
pathology, and therapeutics.   Each of these  divisions  contains seven
books:—
    1. In the  first section we find again the doctrine of Galen  on the ele-
ments, humors, temperaments,  innate heat,  radical  moisture; on the
formation of natural, vital, and animal  spirits; in a word, on  all the
functions of  the animal economy, as they were understood by the physi-
cian of Pergamos.   In it  is  given the explanation of the most impene-
trable mysteries of the organism, in conformity with the ideas of the age,
and with a firm conviction of  their truth.  Would you know on  what

   * Lecons de Philosophic, 1826.  First part, § 5.   f Pathol, lib. iv., Prsefatio. 
350
ERUDITE PERIOD.
depends the sex of infants ?  Fernel replies, in the faith of the ancients,
that it depends on  the quality of the semen  of the father and  the
mother.   If heat and  dryness, he says, predominate in the two liquids,
a male will be generated;  if coldness and moisture predominate, it will
be a female.  Ask whence  proceeds the resemblance and want of resem-
blance between the parents  and  their offspring?   Our  physiologist
answers you that it appertains chiefly to the imagination of the mother.
   2.  The second section, that is, the treatise on  pathology, offers us, in
the  first  place, abstract dissertations  on the essence, the causes, and
symptoms of diseases.   We shall not recur to this point, which has here-
tofore been alluded  to.  Afterwards the author exposes the specific and
individual differences that  distinguish morbid  affections from each other,
and  on this subject he proposes a programme very difficult to fill  up.
" As for myself," he  says, "I shall never believe I have profound knowl-
edge of any affection if I do not know positively, just as if I could see
with  my eyes, in what part  of  the human body is its primitive seat,
what species of organic lesion constitutes  it, whence  it  proceeds, if it
exists idiopathically or by  sympathy, or if it is kept up by the presence
of some exterior cause.  He who pretends to be a rational physician must
sound each of these subjects,  and discern them by certain signs."0
   Where  is the pathologist who  would  now dare to promise  himself  the
solution of such a problem, in most diseases ?  Fernel regarded it solved
for a long time, and aspired  only  to  the  glory  of thoroughly compre-
hending the sense of the solution which had been given by the founders
of the doctrine, and faithfully reporting it.  Here are  some propositions
from his pathology, which might be said to be extracted from the writings
of Galen:
   " Fever is an unnatural  heat, which  is propagated from the heart into
all parts of the body.   The febrile essence exists in the heart, and being
opposed to the innate heat, falls furiously upon the organ, like an enemy
changing and troubling all its functions. 7
   " Ephemeral fever resides especially in the vital spirit, of which the
heart is the great reservoir.   Now, this spirit being extremely subtile,
it  results  from  that that this fever is the most transient of all.
   " Synocha, or continued  fever, is  seated  in the humors of the heart
and great veins.
   " Hectic is fixed in  the substance itself of the  heart."
   These propositions, which now appear so  strange to us, passed for fixed
truths in  the days of Fernel.   Skepticism  was at that epoch as rare in
philosophy and medicine as in religion.  They believed as much in the
0 Pathol., lib. v.    flbid. 
THEORIES AND  SYMPTOMS.
351
infallibility of Aristotle, Hippocrates, Galen, and Avicenna, as in that
of St. Paul or  St. Augustine.   When  an axiom in  philosophy  or an
aphorism  in medicine had obtained the assent of the great geniuses of
antiquity, faith was  given to them, without examination, as to a dogma
of theology consecrated by the sanction of a Council.  This shows us how
so many errors were  taught and defended with entire conviction, by men
of lofty intelligence.
   3. In regard to therapeutics, I have exposed sufficiently at length the
principles on which it was founded, and the manner  of their application.
I shall content myself by adding here some examples of'cure, which can-
not be explained  either by the  rule of contraries or similars, and which
completes the refutation  already given of these two rules, and proves
more and  more  the  necessity  of  banishing  them from therapeutical
language.
   First example.—A man  having swallowed,  by mistake or design, a
concentrated solution of corrosive sublimate, the physician called at the
moment hastens to obtain the whites of eggs, and gives them to the pa-
tient to drink.   How could a chemist explain the anti-venomous  action
of the remedy ?   Shall he say  that the force of the albumen, being op-
posed to that of the  poison, formed  an  equilibrium  and neutralized it?
No.   He will say that the mercurial is decomposed by the albumen and
brought into a state of protochloride, a substance insoluble  and much
less deleterious than the sublimate.  There is not, as we see in this ex-
planation, any idea of antagonism or similitude between the poison and
the antidote.
   Second example.—A young  woman  is  afflicted  with chlorosis; her
blood contains less fibrin and less red globules than  in the normal  state;
the menstruation is  effected imperfectly  or  not at  all.   Feruginous
preparations are  ordered, and  exercise  on horseback, with a nutrition
composed  mostly  of meats.   At the end of some months, on this regi-
men, the patient  recovers her health.   What relation  of similitude  or
opposition is there between the  pathological state of this person and the
treatment employed ?  It would need very keen eyes to perceive between
these things, so separate, any analogy or antagonism.  All that can be
said is, that the diseased organs  have been  put  in contact with new
modifiers,  by the  aid of which they have returned to their normal state.
   Third example.—A traveler,  overcome by cold, is  carried into an inn.
He is very cautiously kept from the fire, and is rubbed with  snow.   In
this case the remedy has much  similitude with the morbific cause.   The
examples of this  order  are  rare, yet  they have sufficed to suggest the
strange system of Homoeopathy—so much is the spirit of  man inclined
to generalize even the most exceptionable facts. 
352
ERUDITE PERIOD.
   Fourth example.—Let an individual  suffer a luxation  of the  femur,
by any accident whatever.   To restore the bone to its natural  position,
the surgeon must act in a  contrary sense to that of the forces which
produced the displacement.   In this maneuver there is a manifest oppo-
sition between the morbid cause and the remedial process.
   These  examples suffice to demonstrate materially, that neither the
law of contraries nor the law of similars can be rationally elevated into
a general therapeutic axiom.   If it be  desirable to establish an axiom
which embraces every case of curing, we must seek it  in  another class
of ideas, as we have already insinuated on more than one  occasion, and
which we shall formally demonstrate in the next period.
                        CHAPTEB  X.

                     OCCULT  SCIENCES.

   The  doctrine which we have developed  in the last chapters reigned
almost  universally in  the medical world, during the fifteenth and  the
sixteenth centuries.   Nothing else was taught in the schools, so that it
may be  regarded as the orthodox doctrine of those times.   Nevertheless,
a few voices protested against it, and attempted to overturn the  ancient
edifice of Philosophy and Medicine.   But these voices had only a  pass-
ing echo; they could not arouse the mass of minds, because they pro-
posed nothing, in the place of a doctrine which had the sanction of ages
and genius, but informal  essays and undigested lucubrations.   The most
of the partisans of the occult sciences  were restless minds, such as  are
found in all ages, who bear impatiently the yoke of authority, and who,
full of confidence in their own abilities, will receive a law from no other
person.   Some of these did not lack sagacity, imagination, or audacity ;
but  most of them  lacked  connection  of ideas,  propriety of language,
and  dignity of conduct.   Prophets or demons, they  had among them-
selves no community of  principles—living most of  the  time isolated
from each other  and the rest of the world.  They became  remarkable by
their oddities, their  adventures, and even their  misfortunes.  Instead
of setting up again the car of reason, the sectators of the occult sciences
who  gave the first  signal of revolt against  the accredited doctrines,
would have caused  the  world to  deviate  still more, if it had followed
their foolish direction.   Nevertheless, we meet in  their writings  some
useful truths,  mingled  with a mass of reveries.  They have founded no 
OCCULT SCIENCES.
353
doctrine worthy of a philosophic regard; but, by their declamation, they
forced the true savans to leave the track of the past, and revise the ele-
ments of our knowledge, which led to the dawn, in the following period,
of an admirable scientific reform.0
  I. The first promoter of the occult sciences who is mentioned in the
history of Medicine, is Cornelius  Agrippa.   Issue of a noble family of
Cologne, he received a distinguished  education, and possessed varied and
extensive attainments; but his natural inconstancy and caustic humor
raised  up enemies  every where against him, and prevented him from
becoming permanent in any locality.   He led a wandering life, some-
times honored with the  favor of the great, and again plunged  into
extreme misery.  Entering early  into the service of  the Emperor Maxi-
milian I.,  he obtained at first  the post of secretary, and followed that
monarch in the army, where he distinguished himself by his bravery on
several  occasions, and merited the  title of  knight.   Disgusted very
soon with the profession  of  arms, he quit it to  devote himself to the
study of jurisprudence and medicine, between which he  divided his
time.  His intemperate and bold  pen soon drew him into quarrels and
persecutions.  At Dole,  he fell  out with  the monks; at Paris  and
Turin, he  compromised  himself with  the  theologians; at  Metz, he
drew upon himself the formidable animosity of the Jacobins, for having
attacked, imprudently, the prevailing opinion at that time,  which gave
three husbands to Saint Ann.   His oddities and incessant controversies
obliged him to fly from country to country.  He was  a vagabond, and
almost a mendicant, in Germany, England, and Switzerland.   Thence
he went to Lyons, where at that time resided  Louisa de Savoy, mother
of Francis I., and regent  of the  kingdom, who honored him with the
title of her physician.   But Agrippa found these functions  beneath his
merits and birth, and he  did  not fulfill them long.   Having dared  to
predict  to  the superstitious princess the reverses  which  he  believed
announced by the course  of the  stars, he was  disgraced and banished
from the court of France.   From thence  his evil star led him  to the
Low Countries, where he was cast into prison on account of  his treatise
on  the  Vanity of the Sciences, and  on Occult  Philosophy.   Afterward
he dared return to Lyons, and was there  incarcerated anew for a libel
which he had published against  his old protectrice, Louisa de Savoy.
Finally, his adventurous life was  terminated in a hospital of Grenoble,
in 1535, at the age of  nearly fifty years.
  Among the works proceeding from his satiric pen, the most considera-
ble,  the one in  which the bitterness of  his  spirit,  and  the  caustic
  ° Eusebe Salverte, Des Sciences Occultes, or Essai sur la Magie, les Prodiges et
les Miracles, Paris, 1843. 
354
ERUDITE PERIOD.
character of his genius is most liberally displayed, is his treatise on the
 Uncertainty and Vanity of the Sciences, in which he proposes to demon-
strate, "that there is nothing more pernicious and injurious to common
life, and nothing  more pestilential  to  the  salvation of souls, than the
arts and sciences"—a paradox renewed and sustained with much more
eloquence in the last century,  by J.  J. Bousseau.  Agrippa approached
his subject in a manner more extended than the philosopher of Geneva.
He commenced, according  to  the  cust.m of the times, by establishing
his proposition  on scriptural  authority ; then he supported it by testi-
mony drawn from profane authors.   Afterward, he passed in review the
various departments of human knowledge, the diverse occupations and pro-
fessions,  and concludes from this detailed examination, that each of them
does man more  harm than  good.  Courtiers,  warriors, magistrates,
churchmen,  proletarians, all, are  cited  to  his tribunal, where they are
judged and condemned.   He  only  acknowledges the value of laborers
and shepherds,  who, he says, have produced the necessaries of  life, since
the fall of Adam.
   He speaks as follows of alchymy, which he had practiced a good deal:
" In fine, having lost the time and the money which you have devoted to
it, you will find yourself old,  ragged, hated, famished, always smelling
the sulphur, soiled with sweat and charcoal, paralytic by frequent mani-
pulation of  quicksilver, and gaining nothing but a running nose ;  in a
word, so  unhappy, that you will be willing to sell your body, and even
your soul.0
   As to lawyers and physicians, we may judge how he treated them, by
the following facetiousness:  " Some jurisconsuls and physicians were
disputing once for preeminence: the suit was heard by a magistrate, who
examined both parties, and noted their answers.   ' What is the custom,'
asked the judge, ' when criminals are led to punishment; in what order
do the  hangman  and the thief march to the scaffold ?'  They having
answered, that  the thief went first,  and the executioner followed; the
judge founded  upon this report, his sentence: Let  the lawyers, then,
proceed, and the physicians follow next; showing in  this way, his views
of the grand larcenies of  the former,  and the bold homicides of the
latter."f
   He did not show himself more gallant  towards the fair sex.   " The
court women," he says, " have also their particular vices.  We see some of
them handsome in person, gracious, agreeable, genteel, and besides well
  0 Paradoxe, or the Uncertainty, Vanity, and Abuse of the Sciences, by Agrippa.
French translation, 1608, chap. xc.
  tlbid.,c. 83. 
OCCULT SCIENCES.
355
dressed, ornamented, and enriched with gold rings and precious stones.
But it is not easy for every one to penetrate with the eye, under those
fine veils, which cover often hideous monsters. On this account,  Lucian
has justly compared them to Egyptian temples, which are beautiful and
rich externally, constructed of elegant stones, and adorned with sump-
tuous works; but if the gods were  asked what was within, to which
these  superb edifices were dedicated and consecrated, they would  answer
a stork, a monkey, a stag, a cat, or some other ridiculous animal."
  We will terminate the extracts from this martyrologist, by the  follow-
ing passage, relative to monastic  sects.  " They are joined," says our
sarcastic writer, " like all free receptacles for wanton sinners, by all those
who, affrighted by their evil consequence, fear the rigor  of the laws,
and who can find no other safe retreat; and by those who have led infa-
mous  and dishonest lives, and are reduced to want  and beggary,  after
having  wantonly dissipated their goods  in  brothels and taverns, and
become  hopelessly in debt to all of them.  Behold the great sea in which
live, with other fish, Behemoth and  Leviathan, enormous monsters and
strange reptiles, whose number is infinite."0
  Let us  now look at the morality of  the work, and we shall find it, I
think, worthy of an adept of  the occult philosophy.  " If you desire to
obtain wisdom from the tree of life, and not that from the tree of know-
ledge  of good and evil, reject all human  doctrines, all  the curiosities
and discourses on the flesh and the blood, re-enter into yourselves, and
there  you will  learn every thing; but if you cannot perceive them by
clear  and manifest  intelligence, as well as the saints, it is  necessary to
have recourse to Moses,  to the prophets, to Solomon, to the  evangelists,
to the apostles—for all  the secrets of God and nature, the reason and
basis  of all  laws and  customs—the  knowledge of  all things present,
past and future, are contained in the holy writings of the Bible."
  The definite conclusion that Agrippa drew from this book was not as
strange to the eyes of his cotemporaries as it appears to us  now.   Long
before him, erudite men of the first order, such as Bessarion, Pic de la
Mir an dole, Angel Politien, Marcellus Ficin, had attempted  to introduce
the ideas of Plato into  physics.  They thought, with that  philosopher,
the best means of acquiring science and  mastering the truth, consisted
in mental reflection and in isolation as much as  possible from all exter-
nal sensation; besides, they admitted a correspondence, sympathetic and
antipathetic, between the celestial bodies and the beings of our sublunary
  * Paradoxe, or the Uncertainty, Vanity, and Abuse of the Sciences, by Agrippa.
French translation, 1608, chap. cm. 
356
ERUDITE PERIOD.
globe.   They were persuaded that a great  number of phenomena and
events in this world have their origin in astral influences.
  From this system to the extravagances of the  Cabal  there is but one
step, and which was easy to  take in times of superstitious prejudice and
religious excitement.   The ascetic Christians have,  in fact, a belief that
approaches very much  the system of the Platoneans.   They attribute a
great number of events and phenomena, not to the influence of the stars,
but to the direct intervention of the Divinity or  the demon.   According
to them, also, the surest way to acquire science  and wisdom  consists  in
uniting the soul  to God by meditation,  prayer, and  the renunciation
of all exterior distractions.
  The following is a summary of the Cabalistic theory:—All the events
of life and all the phenomena of nature proceed from the immediate in-
fluence which God, or  demons, or the stars exercised  on the  archetype,
that is to say, on the essential spirit of substances.   He who is able  to
withdraw this spirit, and knows how to ally it to other bodies, possesses
the faculty of creating new  beings; he can  fabricate gold at pleasure.
The day and the hour  of our birthplaces are under the domination of a
particular star. Besides, each one of our principal members corresponds
to some planet and shares its constitution.
  Such is the foundation of  the occult philosophy which is divided into
four branches, namely,  theurgy or theosophy, to which a man raises him-
self by prayer,  meditation, and extasy, and which  gives the faculty of
producing,  like the saints, supernatural phenomena by the intervention
of God; magic, or the  art of controlling demons, and imitating by their
intermediation  true miracles; astrology,  or the  art  of reading future
events in the stars, and predicting the fate  of nations, the destiny of
men,  and the issue of diseases ; lastly, alchymy, which teaches the secret
of extracting the quintessence or the archetype of substances, otherwise
called the philosopher's stone, by means of which the metals can be trans-
muted, gold fabricated, and many diseases cured.
  Thus the errors of  science, superstitious  prejudices, religious excite-
ment, and the thirst for riches, concurred  at the  same time to propagate
the follies  of the Cabal  at  the close of the middle ages.   Never were
there seen  so  many sorcerers, demoniacs, astrologers,  and alchymists.
Never were prophecies, visions, and prodigies of all  sorts, so  common.
Not one remarkable event occurred, but  immediately it was pretended
that it had been announced  by some previous sign or token.   How many
times was the end of the world predicted as very close at hand, putting
in great agitation entire communities—not only the inmates of cottages,
but even of palaces. 
OCCULT SCIENCES.
357
  But in no country were the Cabalistic reveries as universally adopted
as in Germany, where mysticism maintained them longer than elsewhere.
Luther himself seemed  to  share the vulgar prejudices of superstition,
and contributed  much to spread them.   He  spoke  often of struggles
with the devil.  He said that the evil spirit was accustomed to appear
unto him in the figure of a monk, opposing him with captious syllogisms.
He blames the physicians for attributing to natural causes many diseases
of which the demon alone was the author.
  The history of this period offers us everywhere the  spectacle  of the
reign  of darkness struggling, with forces nearly equal, and with balanced
successes, against the reign of light and of truth.
  II.  The second propagator of cabalistic Medicine was Jerome Cardan,
who was born at Pavia, the first year of  the  sixteenth century.  His
life, like that  of Agrippa, was  full of vicissitudes, his character full of
oddities.  His mother  attempted, vainly,  during  his  uterine life,  to
produce  abortion, by the  use of certain drinks.  After  his  birth  she
took an  affection for him,  and devoted to him all  the care that his
delicate health required.  But his father  never loved him ; he treated
him like a beast during his  childhood, imposing upon  him painful labor,
above his strength.   However, at the solicitation of his mother, he con-
sented,  rather late, to  send him to a  gymnasium,  where  the  young
Cardan learned the first elements of the Latin  language, grammar, and
dialectics.   Afterward he embraced with very great  ardor the study of
mathematics, philosophy and medicine.   He made such rapid progress
that at twenty-two years he was capable  to discuss  publicly, all  ques-
tions.  Two  years  after  he received the  doctor's hat.  He practiced
medicine in various places till the age of thirty-three years, when he
was named  professor of mathematics at Milan.   He  kept this place
only two years,  after  which  he traveled in  Germany,  France, and
England, and  returned to  Italy.   He was imprisoned six  months at
Bologna, for debt, and went at last to Borne, where he obtained a pension
from the Pope, and where he died, in the year  1576.
  The following is the opinion of M. Dezeimeris respecting him :  " His
immense acquirements, extraordinary sagacity, great  liberty in thought,
his style, in general manly and elevated, would  have  placed  him at the
head of the most celebrated writers  of the sixteenth  century, if he had
not united to so many qualities a taste for paradoxes and the marvelous—
an  infantile  credulity and  superstition hardly conceivable,  an insup-
p'ltable vanity, and  endless  boasting."0  Leibnitz, a good critic in
regard to talents and merit, judges him  still more advantageously ;  he
s Dictionaire Hist. Med., at the word Cardan. 
358
ERUDITE PERIOD.
says, " Notwithstanding his faults, Cardan was a great man, and without
his defects would have been incomparable."
   He wrote a great number of works  on philosophy, mathematics, and
Medicine.0   Sometimes he admits without any criticism the most absurd
stories, visions, dreams, sorceries  of  all sorts, and explains them by the
theories  of the  Cabal.   Again,  he affirms  that  he had  never devoted
himself to the cabalistic art;  he blames those who practiced them, and
jeers at those who have faith in them ; he ridicules those persons who
believe in apparitions, charms, and prodigies.
   The following principles on Chiromancy are extracted from one of his
works:  " The indications of strength, of valor, and voluptuousness, are
revealed  by the thumb, which is under the  influence of Mars ;  those of
honorable positions, civil or ecclesiastical dignities, are located in the
forefinger, which is controlled  by Jupiter.   The middle finger, which is
under Saturn, indicates capacity for the  Magical art;  it  also indicates
melancholy,  poverty, care,  quartan fevers,  and captivity.   The  ring
finger submits to  the  reign of the sun, and presages friendship, honor,
and power.   The little finger,  which is influenced by Venus, designates
children, handsome women, and sensual pleasures.   Mercury reigns over
the triangle on the middle of  the hand, where are found  indications of
erudition, cunning, robbery, etc." f
   The history he  has written of his life is no less curious than his
works, and no less  strange from the freedom,  somewhat cynical,  with
which  he confesses  his  errors and even  his  vices.  It  is true  that
he attributes his faults, as well as all the misfortunes of his life, to the
influence of the  stars.   Moreover, he loves to speak of himself so much,
that he omits no particular; he gives the size of his  inkstand,  the cost
of his knife,  the color of his hair at birth, the age at which he lost his
teeth, and other trifling minutige.   Nevertheless, neither the great num-
ber of his writings  nor  the versatility of his humor, would suffice to
explain his tediousness, his numerous  repetitions,  and frequent contra-
dictions,  if we did not know that he composed most of his works under
the pressure of want;  that in his haste to finish them, he  often let his
pen run at hazard, without any other desire than to increase his volume
so as to obtain a better price.
   III.  Paracelsus,  native  of  Marien-Einsiedeln,  a  village  of  Switzer-
land, twenty miles from Zuerich, had no cause, like the preceding two,
to complain of his lot, or of men.  He made more noise  in the world
while he lived than many savans of  superior merit, and  after his death
he obtained a celebrity which  his writings are far from justifying.   His

  0 Hier. Cardani Opera, Cura Car. Sponii.  Lugduni, 1663. Ten vol. in fol.
  | Cardan, De Rerum Varietate, lib. xv., cap. lxxix, 
OCCULT SCIENCES.
359
father, who was a physician, gave him his preliminary education.  After-
ward, he made him travel, according to the custom of the scholastics of
those times, to visit the universities and hear the  most celebrated pro-
fessors.  But instead of frequenting the schools, young Paracelsus sought
the conversation of clever women, barbers, renovators, magicians, alchy-
mists, in whose society he boasted he  had obtained valuable secrets.
A very marked taste led him at once to the chimeras of the Cabal.   He
declares that he did not open  a book  for ten years.  He neglected to
such an extent his academical  studies, that he forgot the little gram-
mar and literature he  had  acquired  in  the  paternal  mansion,  and
became incapable  of  expressing himself in Latin in an  intelligible
manner.
   From the age of twenty-five years, he contracted the degrading habit
of strong drink, and the passion augmenting from day to day,  ended by
absorbing entirely his reason and virility.  It is certain that  he never
exhibited any inclination for  women, whom he continually slandered.
In regard to the feebleness of  his  intellectual faculties, hear  what his
secretary and  faithful disciple, Oporin, says:  " During the two years
which I  passed with him, he was  so strongly inclined to drunkenness
and constant debauch, that he  could scarcely be seen an hour or two in
the day without being full of  wine, especially after his  departure from
Basle for Alsace, where that condition did not prevent him being admired
by every one as a second  Esculapius.   Nevertheless, drunk as he was,
he did not leave off dictating to  me something of his philosophy, when
we had returned to our lodgings.   Very often  he would get up in the
middle of the night and take his sabre, which he boasted had been given
to him by an executioner, and  whirl  it  around, striking great blows
upon the walls and the floor, so that I would  tremble, expecting every
moment  that he would split my head open."0
   At that  time, Paracelsus was  between thirty-three and thirty-five
years of age, which was the most brilliant period of his life.   His wri-
tings, in which he gives with great emphasis, accounts of his numerous
successful cures, after the fashion  of charlatans, and in which he  says
he is possessed of infallible secrets against the most incurable diseases,
had at last drawn on  him public notice.   He  had  just been  called to
Basle to fill the chair  of Physic and Surgery.   A crowd of curious and
idle persons, and  of enthusiasts  attended his  first lectures,  which he
delivered, not as was customary, in the Latin, but in the vulgar tongue.
The thaumaturgist.inorderto astonish his auditors, commenced by burning
  0 Oporini de vita, et moribus Paracelsi, ad Solenandrum et Wierum epistola,
Sennerti libro de consensu et dissensu chimicorum cum Gal. et Arist. inserta. 
360
ERUDITE PERIOD.
the works of Galen  and Avicenna; then he began to read and develope
his own writings, breaking off from time to time in declamations of this
kind:  " Know, ye doctors, that my hat knows more than you—that my
beard  has more experience than your academies.   Greeks, Latins, Arabs
French, Italians, Jews, Christians, and Mohammedans, you must follow
me ; I shall  not follow you, for I am your monarch,  and sovereignty
belongs to me !" °
   His  vogue as professor was not of long duration; before two years had
expired, no one was willing to  listen  to him.  He was not less under-
rated as a practitioner; so that being obliged to quit Basle, in consequence
of some mishaps, his  precipitate departure created no  sensation.   He
resumed then the wandering life which he always loved, and  continued
in  it till the  end  of his  days.   We find him in Alsace in 1528, at
Nuremberg in 1529, at St. Galle in 1531, at  Mindelheim in 1540, and
the year after at  Saltzburg, where  he died at  the age of forty-eight,  in
the hospital of St. Stephen.
   There are few medical men of whom so much of good and evil has been
said, as Paracelsus, and there are few of whom it  would be as difficult to
form a proper and equitable opinion.   If we consult the testimony of his
cotemporaries, we find little agreement among them—they are often  in
direct opposition; and if we essay to  enlighten ourselves by the writings
even of the  author himself, we fall  into a chaos still more inextricable.
Those who have attempted to analyse his doctrines, have abandoned the
attempt, after efforts more or less obstinate and superfluous. " It would
be an impossible enterprise," says a modern historian, " to arrange  the
writings of Paracelsus into  a systematic form.  Ideas without connection,
observations which contradict  each other, and incoherent phrases,  defy
the comprehension of the best reader.  Fancy a man who  in certain
moments gives proof of an  admirable  penetration, and who, in  the next,
writes  the veriest nonsense in  the  world;  a man who is sometimes
devoted to  science, proclaiming the absolute authority of experience—
launching the  most  violent anathemas  against the theories of   the
ancients—and who again, as if deranged, seems to converse with demons,
and to  believe  in their omnipotence;  a man, in fine, who, fasting in the
morning  and  drunk  at night, yet put down all his  ideas in exactly
the order they were presented to his mind.   Such was Paracelsus, whose
name entire, was Aurelius Phillippus Theophrastus Parcelsus Bombas-
tus ab  Hohenheim.
   " No one can contest the influence that  Paracelsus exerted upon his
age.  That  influence was  certainly  immense.  Why?  How?   Was it
c Preface to the book entitled Paraganum, et alibi. 
OCCULT SCIENCES.
361
because he  allied medicine and chemistry with the mystical doctrines
of the Cabal ?   Others, wiser than he, had already done this.  All the
Hermetic philosophers had done it.   Was it because, as some think, he
was the representative of the alchymists ?  It is in the middle ages, and
not in the sixteenth century, that we must seek such a representative;
for from the epoch of Paracelsus, alchymy began to be exposed, and true
chemistry  to  be developed.   He  should, then, have exercised a retro-
grade, instead  of the progressive  movement which  he brought  about.
Besides, the true alchymists  of the sixteenth century did not  recognise,
in any manner, Paracelsus for their  patron;  they  do not even allude to
him, no more than if he had not even existed.
   "Let us endeavor  to solve this  question, which will  enable us  to
comprehend all the influences that this man  exerted on his age ;  and in
the first place let us establish, once  and for all, that it is to physicians,
and  not to alchymists, that Paracelsus addresses  himself,  and with
whom he  has controversies.  As to alchymy, his  writings  embrace
nothing which has not been said, and a thousand  times repeated, by
the theosophs of Alexandria, by the Arabians, Albert the great, Boger
Bacon, Baymond Sulle, etc." °
   Behold  Paracelsus  thus  disowned  by the chemists  and alchymists,
with whom, however, he was supposed to be  connected, whose works he
boasted that he possessed, and whose teachings he  had followed;  whose
doctrines  he was  incessantly praising, for he disdained the science  of
Hippocrates, Galen, the Arabs, and the Arabists.  He despised the course
of instruction  given in the  universities, but highly valued what was
drawn from the writings and experiments of the alchymists.  He cites,
with ostentation, the names  of the latter, whom  he had the honor  to
know, and whose experiments and writings he had followed.   " I have
diligently  studied," he says, "under excellent  masters, who  were pro-
foundly versed in that most abstruse and secret philosophy which they
called adept philosophy.  Now, my masters were,  first, William Hohen-
heim, my father, who instructed me diligently, and several others, who
were faithful in their teachings and  concealed nothing from  me.  Addi-
tionally, I have studied the writings of several  distinguished person-
ages, the  reading of which has been  of great profit  to me: namely,
those of Scheit, bishop of  Settgach, Erard Levantal, of  the  bishop
Nicholas of Yppon,  of Matthew Schacht, the suffragan of Phreisingen,
of  the abbot Spanheim, and those of several other  great chemists.   I
have  also  become  enriched with  numerous and varied  experiences,
which I learned from the chemists, among whom  I will  name the very
° F. Hoefer, Hist, de la Chimie.  Paris, 1813 ;  T. II., epoch 3, sect, i., § 3, p. 9. 
362
ERUDITE PERIOD.
noble Sigismund de Fugcr  de  Schwats,  who has  added very much  to
chemistry, and greatly extended it, having maintained at great expense
several  servants,  whom he kept continually at work."0
   Since Paracelsus must be erased from  the number of men who have
.contributed to the progress of chemistry, though he boasts on all occa-
sions to have improved it, let us see what was his influence on Medicine.
Let us take the best, or rather the least  exceptionable of his works, the
one in which we meet the most sensible  things  and the least extrava-
gance—his " Great Surgery."   M. Malgaigne, desirous of extracting
the quintescence of this work, to use  a common expression of Paracel-
sus, quotes, as an  admirable  extract, the following passage—the sole
one, moreover, in which he has found any  traces of a rational philoso-
phy :  " There are two  kinds  of ways and paths, or two methods and
fashions,  by which to  arrive  at a knowledge  of the arts.  The one
teaches  and conducts to the  truth; the other, to illusions.   The  erring
and  vagabond  discourses on  the understanding  and  reason, are the
causes of error, which  occurs when they  are permitted to guide us.
Experience, and that which is found  familiar  and in  accordance with
nature,  and  which produces like actions, is  the  cause of  truth  and
certainty, "j
  The entire chapter to which this fragment belongs, is  devoted to show
that arts  in general, and Medicine in particular,  are formed and im-
proved by experience, and not by reason; for nature can and wishes  to
be known by the aid of the senses only, without needing to have recourse
to ratiocination; thus, we do not know, by reason, what is concealed
within the bowels of the mountain—but by the  senses, only, which are
impressed  with the things that are seen, and reveal to our  minds
their  nature.J  M.  Malgaigne is so astonished  with the doctrine pro-
fessed in  this chapter, that he  does not hesitate to proclaim Paracel-
sus the precursor  of Francis Bacon, the  great reformer of philosophy
and the physical sciences—as  if this was the  first time  that  such a
doctrine was put forth;  as if Aristotle himself had not taught that  all
our ideas come  from the senses, and that the sciences are the result  of
observation and memory!   Even  Fernel, so reverential toward the an-
cients, teaches also, that our first ideas arise from sensations.
  Yet this doctrine has not prevented Aristotle, nor Fernel, nor Para-
celsus, nor Bacon, nor a crowd of others, from departing in their theo-
ries from  the testimony of the senses, to  follow the phantom of their

  3 Grande Chirurgie, translated into French by Dariot, liv. ni, part i, chap. i.
  f Ibid, liv. u, tr. u, chap. i.—Introduction aux QSuvres d'A. Pare, part n, § v,
pa. 225.
  | Ibid, 
OCCULT SCIENCES.
363
imagination.  Who, more than  Paracelsus,  has falsified  experience ?
Open his works wherever you may, and you will not find  one chapter,
not one page, which is in accordance with it.   " He proscribes," says
M. Malgaigne, (who endeavors, however, to sustain him), "he banishes
from Medicine the doctrine of four humors,  upon which,  after Galen, all
explanations had been  founded;  but he replaces one hypothesis only by
another, and all his theory, resting on a doubtful basis, crumbles in its
turn when it is  submitted to the test which this supreme judge thim-
self has invoked—experience.  The following is the sum total of it:
   " The human body,  like the great world of which  it is  an  image, is
composed of four elements—fire, air,  earth, and water.   The  fire, in
man, is the soul;  the  earth is represented by the dry parts;  the water,
by the  liquids; the air, by that which  we  now-a-days call  gas,  and
which he terms vacuum: now these four elements may cause diseases.
But, if we  leave  this high analysis, to get at the more immediate  ele-
ments, the body of man is composed of mercury or  liquor, of sulphur,
and of salt.  And  now, see how  this  is  demonstrated by alchymy:
there are, in the first place, in the body, liquids;  these are the mercury;
then  the  solids which may be burnt, and the portion which burns is
sulphur, while the residue, or the ash, is salt.   But  this doctrine  does
not belong to Paracelsus; it  is found before, in  the writings  of Basile
Valentin, and even, it is said, in those of another alchymist, anterior to
Paracelsus, Isaac Hollandus."0
   The above is what may be  collected,  most rational, on physiology, in
the writings of this pretended reformer.  As to anatomy, he says not a
word about it, and for good  reasons, because he was, on  this subject,
profoundly ignorant;  besides, he shows for it  a sovereign  contempt.
However, he recommends that great attention be paid to the  correspon-
dence which  exists between  certain  regions of  the great world, or the
universe, and certain parts of the little world, or the human body.   He
insists, that the physician should have at his fingers' ends, the knowl-
edge of the regions  in man, named (after  constellations), the dragon's
tail, the ram,  the polar axis, the  meridian line,  the east, and  the
west, etc."f
   The pathological doctrine of Paracelsus is distributed in a great num-
ber of writings; but  M. Malgaigne  having  analyzed  only the Great
Surgery, has extracted only  what  concerns ulcers,  because it is espe-
cially in the knowledge of this  kind of lesions  that the  physician of
Zurich passes for an expert.   The substance of his doctrine on  this
  Q0]3iivres d'A. Pare; introduction, 1.1., p. 215.
  f Paragrani, tract n, De Origine Morborum,  lib. iv, et  alibi.  See  Daniel Le
Clerc, Essay on a Plan to serve as  continuation of the History of Medicine, p. 806. 
364
ERUDITE  PERIOD.
subject, is as follows:  Ulcers all proceed from the corruption of the salt
that is in us, and they vary in nature according to the variation of  the
salt  itself.   Consequently,  Paracelsus proposes to  divide  ulcers  into
ulcers from nitre, scrofula;  ulcers from common salt, certain ulcers  not
painful, whose seat is generally at the  bend of the arm, or in the ham:
ulcers from vitriol,  corroding ulcers of the legs ;  ulcers from  alum, gan-
grenous and  fetid;  ulcers from realgar, malignant ulcers of all  species,
etc., etc."  I put  aside, adds  M.  Malgaigne, after this enumeration,
that which treats of ulcers  of  another sort; those which are caused by
celestial influences, or the corresponding constellation of the parts; or
from special  fluxes, comparable to springs which issue from the ground.
There are those which originate in chaos, that is, from the air which is
in us; others are produced  by enchantment; in a word, it is a multiple
doctrine, odd and  difficult  to comprehend  in  its totality, and we may
occasionally  doubt  if the author understood it all himself."0
   Since, then, if in considering only a single work of Paracelsus,  and
that the best of all, it  is impossible  to deduce from it a  pathological
theory, at all sensible, what  would it be if  founded upon all, or  the
greater part  of the  writings of this prolific author ?   We would fall  into
an inextricable labyrinth, into a mass of unintelligible nonsense.  Some-
times  he says that all diseases arise from  two sources, one of which he
 calls ex Cagastro,  the other ex lliastro.   The diseases of the order ex
 Cagastro, come from natural seeds, like apples, pears and other fruits;
these are hydropsy, gout, jaundice, etc.  The diseases of the order ex
lliastro are  formed by  the decomposition of something.   In this order
are  comprised,  the plague, pleurisy, fever, etc.  Sometimes he  admits
five causes of  diseases,  to  which  he gives the odd  name  of  morbific
beings.  The first  of these  causes is the Divinity himself, ens Dei; the
second, the  influence  of the  stars, ens astrale; the third, the forces of
 nature, ens naturale ; the fourth comprehends the errors of the imagina-
 tion, evil influences, and enchantments, under  the denomination of ens
.spirituale, or pagoycum ; the fifth and last, the ens veneni, comprising
 venoms and  poisons, whether natural  or artificial.
   Moreover, he invokes another etiology; mercury, sulphur, salt, enjoy
 here the role of universal nosogenic agents.   He assures you, for exam-
 ple, that the mercury which is in the animal body, being in close  rela-
 tionship to  ordinary quicksilver,  produces,  by its  volatility, mania,
 mortification of the ligaments,  tremblings, etc.; that if this volatility
 becomes excessive, or if it is joined to acrimony, mania, phrenzy, mad-
 ness, etc., occur; if. on  the contrary, the mercury is chilled, it causes

         5 Introduction aux OZuvres d'A. Par& Paris, 1840. t. i., p. 217. 
OCCULT SCIENCES.
365
tremblings of the hands and feet, or of the head alone, lethargy, contor-
tions of the mouth, eyes, etc.
   Sulphur  produces  various  kinds of fever,  apostema or  phlegmons,
jaundice, etc.  In  separating itself from the  salt, it causes pleurisy,
inflammation of the  stomach  and liver, megrim, diseases of the eyes,
tooth-ache, ear-ache, etc.
   The salt  gives the  colic, causes stone and gravel, gout of the feet and
hands, sciatica,  etc.  When  it becomes dissolved it causes a diarrhea;
if it coagulates,  it causes indurations,  obstructions; if it volatilizes too
soon, it causes ulcers, the itch, prurites, erysipelas,  cancer, herpes, etc.0
   I have not shown  by far, all  the phases of  this fantastic nosology;
but I pause for  fear of  annoying the reader, without  being able to offer
him in remuneration, any thing valuable.   I  pass to his therapeutics,
where  we shall  have, possibly, the happiness to meet with  something
useful: some ingenious perception; for  this author does not cease to repeat
that it is not  by  vain words  that the physician  is to make himself
known, hut by his works in curing the patients who are confided to him ;
and on that point, he boasts of having cured a crowd of strange diseases,
in persons abandoned  by all  physicians.   Nevertheless, here are some
witnesses who diminish considerably the success with which he  praises
himself. Andrew Libavius, a distinguished physician, and great chemist,
and who was director of the gymnasium at Cobourg, and nearly cotem-
poraneous with  Paracelsus,  assures us that  the latter injured a multi-
tude of people, and did not cure them; that he killed a good number,
or put  them  in a worse state than he  found  them ; in  short,  that he
could not cure himself of a cough, the  gout, and a muscular contraction
with which he was affected.-j-  Oporinus, his fervent disciple,  recounts,
that when  his master was called any where to treat internal diseases, he
could never  stay there more than one year, and  he was accustomed to
say that he should  not  practice any longer in  one place."   It appears,
indubitably, from these evidences, that if the rash practice of Paracelsus
procured some unhoped for cures, it was prejudicial  to a much  greater
number, and that, in  short, he did much more  harm than good.
   Pretended reformer, who counts as nothing the  authority of the most
worthy writers,  and relies on  nothing but  his own experience,  did he
really  consult experience when  he proposes, as an excellent means to
disjovcr the specific virtues of remedies, to observe what he  calls  the
  ° Daniel Leclerc, Essai d'un plan pour servir a la continuation de P Histoire de
la Medecine, pp. 809, 810.
  f Neo. Paracelsica inquibus vetus  Medicina defenditur adversus G. Amwald,
cujus liber de Panacea excutitur.  Francofurti, 1591, 8vo. 
366
ERUDITE PERIOD.
  signature of things ? The partisans of the occult sciences, designated by
  this term certain marks and  variations  of color or figure  which are
  met with in various substances, and which indicate,  according to them,
  the essential properties of these substances.  Thus, the little yellow spot
  that is seen on the flowers of the euphrasia, which they compared to the
,  pupil of the eye. was, according to their system, an  indication of the
  curative  virtue  of  this  plant, in  diseases  of the  eye.  So the seeds
  of the pomegranate, and various kernels,  from their resemblace to the
  teeth, appeared to them as a proper remedy in tooth-ache.  The  pulmo-
  nary or lung wort,  on account  of its spongy tissues, and the dark macu-
  lae on its leaves, had the credit of  being exceedingly efficacious in lung
  affections.  Citrons were supposed  to be excellent cordials, because their
  form represented, rudely, that of the heart, and  because their  golden
  colour resembled that of the sun, which corresponds to the heart, in the
  macrocosm.  See., also,   in the work of  Oswald  Croll,  entitled Basilica
  Chymica, the signatures of a multitude of other substances.
    Paracelsus has been very much praised for having made use of chemi-
  cal or spagyric remedies.  It is true,  that though he did  not  invent
  them, since they were  known before  him, he has at least contributed
  powerfully to vulgarise  their use, and this is the sole merit which no
  one can contest with him.   But was this merit very great and very
  profitable to humanity ?  I will briefly examine this  question.
    In the first place, it will be admitted, that the  more a remedy is
  energetic, the more the circumspection  and discernment which is required
  in  its employment.   In the second  place, every one knows that  the
  chemical preparations recommended by Paracelsus, such as the salts of
  gold, antimony, mercury, etc.,  have in general very  great energy.  If,
  then, we demonstrate that he  administered these remedies with a blind
  rashness, it will be at once conceded, that in his  hands, and those of his
  disciples, they  would produce infinitely more  harm  than good.   Now,
  it is  an agreed fact, the proof of  which may be seen in the writings of
  this author, that he advised  a  crowd of very energetic medicaments,
  without any decided indication,  without prescribing  the doses in which
  they  should be  administered, or  the manner of preparing  them—an
  omission so much the more reprehensible,  as he employed  remedies  but
  little known.   Each one of his recipes,  as he says, is nothing less than
  an admirable secret, which cures all diseases, or nearly all, and he alone
  possessed the knowledge of its preparation, which he describes,  for the
  most  part, in an unintelligible manner.    Let  us see how he describes
  the philosophers' tincture, the  tincture of antimony, of  corals, of  potable
  gold,  etc.   A  single example will suffice to  show  how little care  he
  exercised in pointing out their curative indications.  " It should be 
OCCULT SCIENCES.
367
known," he says,  " that as  antimony purges gold only, and consumes
all other metals, it is the proper  agent to  purge the human body, and
no others;  for in  regard  to forces  and  perfection, man has  a  great
similitude  to gold ; whence  it follows, that antimony only brings man
and gold to a supreme degree of perfection  and purity, while it destroys,
consumes, and corrupts, everything else.  The nature, then, of antimony,
is purgative; yet it does  not produce  evacuation of feces, and  other
excrements, but above  all other remedies which act insensibly, it drive*
out that which renders man  impure, and  having  purged the cause  of
diseases and ulcers, it  brings man to a supreme degree of health.  Now,
the  most eminent philosophers have labored hard to prepare it, but in
vain ;  nevertheless, it was  finally perfectly elaborated, but I must say
by my own efforts.   This, then,  is the great remedy with which  we
must commence all cures, because the  ruin and destruction of many
patients, caused by the errors and obstinacy of physicians, would thus
be prevented." °  He describes, immediately afterward,  the manner  of
extracting the very noble, very precious, and most  divine essence of  the
flower of antimony, which cures all diseases.
   When we reflect on the energy of a great number of spagyric  com-
positions,  when we think that  several of  them are violent  poisons,
instead of blaming the wise circumspection with which most physicians
have admitted them into practice, they are  entitled  to  our  praise  for
this prudence, especially at an epoch  when the process for obtaining
them in a uniform and pure state was not  known.  We  are frightened
at the  idea of the ravages which the reckless and exaggerated adminis-
tration of these heroic  remedies must have produced.  Now that  their
effects  are  much  better  known, and when  we know how  to obtain  them
in a uniform and pure state, where  is  the man who dares  generalize
their use ?   Who would dare proclaim  a  salt of  gold,  or antimony, or
other preparation, as an infallible  remedy in all diseases  ?  None but a
shameless charlatan, or a physician of the  lowest degree of ignorance,
would  pretend to do it.  Thus, then, the extravagant  eulogies which
the Paracelsists offer to certain chemical  preparations,  the blind and
abusive employment  which  they made  of  them, the  frequent and
formidable  accidents of which they were then the source, far from hav-
ing recommended such remedies to rational practitioners, must have, on
the contrary, discredited them, and would doubtless have retarded  their
introduction into the  materia  medica,  if  more sensible experimenters
had not not been found—men more patient and skillful, to connect with
veritable indications these heroic but dangerous  agents.  Thus, then.
Q Grande Chirurgie, lib. in., part 1, chap. v. 
368
ERUDITE PERIOD.
 from whatever point of view we  regard  the influence of Paracelsus, in
 physiology, pathology,  and therapeutics,  we find it  injurious, and even
 retrograding, when submitted to the test of a severe analysis.
   Nevertheless, we ask ourselves how it is that in an age eminently
 erudite, a man of scarcely any learning, whose skill in practice was very
 questionable, whose successes were  mingled with  many reverses, was
 able to exert on his cotemporaries so remarkable an influence, and fill the
 world with the  echo of his renown ?  A  historian who has made a par-
 ticular study of the doctrine of Paracelsus, to which he has devoted the
 half of a volume, shall answer this question for us.
   " A revolution," says Sprengel, " which is based upon mysticism, finds
 access much more easily to the  common people, than  one which  is ef-
 fected  by good sense ;  because the chimeras of the  imagination always
 present themselves under the liveliest colors, and  excite the mind to
 much more activity than the severe conclusions of cold reason.  In the
 sixteenth century Germany had enlightened entire Europe by her spirit
 of reformation.   The mighty genius of Luther rendered  to his cotempo-
 raries, and to the  latest posterity, the inestimable service of giving  so
 heavy  a  blow to  mysticism, that Catholicism  and  scholastic theology
 were forever put down.0  Paracelsus  adopted the same plan, but  the fol-
 lowing circumstances prevented his system  finding as favorable and  as
 general a reception as that of the  reformer in theology.
   " First, Medicine is a science of experience, and to possess it,  it must
 be learned.   It rests on reasonable principles drawn from observation;
 consequently, a doctrine which rejects the testimony of reason, and which
 represents experience as a useless thing, could not  have much  success
 among physicians.  Secondly, the system of Paracelsus was based not only
•on mysticism, but also  on the grossest fanaticism.  In fact, superstition
 reigned despotically throughout  the whole course of the sixteenth cen-
 tury ; but to give to these same prejudices the appearance of a scientific
 doctrine, was an idea that shocked good  sense too much to be generally
 received.   Finally, Paracelsus was not the man to insure  success  to
 his  system; he was a  barbarian, an ignoramus, who despised  all  the
 sciences, for the sole reason that  he was ignorant of  them all.   Though
 he speaks much of divine light as the source of universal knowledge, his
 manners and  his vagabond life certainly  did not prove that he  enjoyed
 much  of its blessed influence.
   " Nevertheless,  his doctrine found  in Germany, especially, more  par-
 tisans than could have  been reasonably supposed.   From the calculation
 which I have made of the known successors of Paracelsus, it results that

      0 It must not be forgotten that these are the views of a Protestant. 
OCCULT SCIENCES.
369
three-fourths of them were German  born, but, for the most part, men
without education, and without any knowledge of the sciences, who threw
themselves, soul and body, into the arms of his mystic system, because
they found there amply what could supply their lack of instruction, and
incompetency.  Others held to the medicaments and  secrets of Paracel-
sus,  seeking to reconcile his theory with the system of Galen, or at least
to purify, perfect,  and render it more plausible." °  Finally, the Society
of the Bose of  the Cross applied his  theories much more logically than
had ever been done before, to theology and philosophy.
   Thus this pretended reformer, though feigning to  invoke reason and
experience, addressed himself to the imagination, to superstitious  preju-
dices, and mysticism.  His system, if we can so name an informal assem-
blage  of incongruous propositions, by  dispensing with  all  university
studies, favored idleness and  ignorance, and tended to replungc the hu-
man  mind into the darkness of barbarism, from which  it had with so
much difficulty extricated  itself.  The school which he founded or prop-
agated is nothing  else than a school of ignorance, deception, and  boast-
ing—in a word, of medical dishonesty; a school of which  Thessalus of
Tralles had been the corypheus in antiquity, which John de Gaddesden
revived  in  the middle ages,  and to which  Paracelsus  gave a new
development.!

                      CONCLUSION OP THE WHOLE CHAPTER.
   The men whose portraits we have  just sketched, formed,  with their
numerous sectators, a separate  class of physicians, who, abandoning the
slow march of observation  and reason,  flattered  themselves with having,
at a stroke, attained  omniscience without  having made scarcely any
effort at study, by the direct inspiration of the Divinity, or by commerce
with demons, or by the discovery of the secrets  of magic and  alchymy.
The  importance of  the part which they played for  several centuries,
required of  us  to  say something of them ; but we think  that we  would
be far from our aim if we accorded any more space to the exposition of
their errors, which seem to belong to  the history of mental diseases, as
much, at least, as to the history of the transformation of  science.   If
some of  these fanatics were impostors  and tricksters,  the greater  num-
ber were miserable hypochondriacs of the monomanial  species—dupes of
  eHist. de la Medecine, sec. ix., chap, in., t. hi., p. 333.
  f See the portrait of Paracelsus drawn by Francis Bacon, cited by Tourtelle in
his Histoire Philosephique de la Medecine;  Paris, 1804, t. II., p. 343. See also my
pamphlet on Charlatanism en  Me'decine, inserted in  the Revue Medicale, April
number, 1839. 
370
ERUDITE  PERIOD.
their  own hallucinations.  History shows  us that such pretended  sor-
cerers, alchymists or astrologers—such self-styled inspired of  God or
possessed of the devil, were so fully convinced of the  reality their vis-
ions as to contend  for them in the  midst of tortures, to their latest
breath.
                         CHAPTEB  XI.

             PARTIAL  EFFORTS FOR REFORM.

  While the partisans  of  the Occult  sciences strove to  overturn, com-
pletely, the scientific edifice of antiquity, other reformers, less bold and
more  sensible, without  attacking in its whole the old monuments, the
object of veneration for  so many ages,  disclosed partially its defects, and
so opened the way to a radical  reform.  Without repudiating in toto,
like preceding  ones, all the traditions of antique science, they desired
that they should not be  blindly received but  after subjecting each one
to a serious examination, those only should be accepted which appeared
in conformity with  reason  and experience, while  the  rest  should be
rejected, or subjected to such modifications as were deemed  necessary.
These were generally enlightened  men,  and,  at the same  time,  free
thinkers—friends of regular progress,  and not of destruction, which has
always, a momentary retrograde effect.  They were few in number dur-
ing the  sixteenth century, and did not produce any capital work ; but
history must take note  of  their  efforts, because they were the  first to
foresee the new route in which succeeding generations must  enter, and
which would lead to a  complete renovation of science.
  I.  I place at the head of the reform physicians of the sixteenth century,
John Argentier of Castel-Nuovo, in Piedmont.  He taught successively in
Naples, Pisa, and Turin. In his iutroductory discourse, pronounced in the
University of Naples, he divides physicians into two classes.   " The first,
persuaded," he says, " that no improvement can be made on the writings
and doctrines of the ancients, limit themselves to  their study, and to
ascertain their  true sense,  without  permitting themselves  to  add or
retract anything; the  other are equally convinced of the necessity of
reading and meditating on these  great authors of antiquity,  yet do not
think  that  all  which they  advance is  to be  received without discus-
sion, but that it is proper to modify, change and improve them as far
as possible."0
Q In Artem Medicinalem Galeni Commentarii. 
PARTIAL EFFORTS  FOR  REFORM.
371
   He does hesitate to pronounce against various points of the theory of
Galen, and contends with those who have adopted  them  too  servilely,
like J. Fernel,  and others.  He assumes,  for example, that all parts of
the body take their nourishment from the blood, and denies that there
is any part which is nourished by the semen.   He proves that the secon-
dary qualities  of the body, such  as hardness,  softness,  asperity,  etc.,
do not  depend  on  primitive or elementary qualities.   He  rejects the
multiplicity of spirits with which the Galenists peopled the human  ma-
chine, and recognises only one kind, and especially treats of the class of
animal  spirits as chimerical, for the reason that  the  reticular tissue,
which is supposed to prepare them, does not exist in man.0  Unhappily,
these few new and sound  ideas are overwhelmed in long and futile dis-
sertations.  After having displayed  very great subtilty, and  expended
a quantity of words to  refute a definition of Galen, the author proposes
for it  another, which is  neither clearer nor more correct.  He devotes
seven large folio pages to a discussion  on the first aphorism of Hippo-
crates:  "Life is short."   In fine, though styled a  reformer, Argentier
clings too much to the ideas of Hippocrates, Aristotle and Galen ; which
he explains, comments upon,  and discusses, with great prolixity, limiting
his  reform to  changing a few definitions and divisons, without making
any remarkable innovation in the practice.
   II. Such was not Leonard Botal, who, without pretending to revolu-
tionize science, like  the former, introduced into the practice very impor-
tant and bold innovations.  Before him, the employment of blood-letting
was excessively restrained.  We  have  seen that Brissot, after  a  long
struggle, only succeeded in establishing it  a little  oftener in  pleurisy:
Botal undertook to generalize it, or, at  least, to extend it to numerous
affections in which  it had not  been employed.  He advised abundant
and repeated sanguineous  emissions, not  only in pleurisy, peripneumonia,
apoplexy, and  angina, but also in  gout,  dysentery and  putrid fevers;
not only among subjects vigorous  and in  the strength of age, but also
among children, old  persons, pregnant women, and cacochymic individu-
als.  He carried the paradox so far as  to sustain that an  infirm  old
man should be  bled from four  to six times a year, and that it was a
good custom to open a  vein every six months, in healthy individuals.
   Botal, native of Astia,  in Piedmont, served at first in the character of
surgeon in the  French army.   Later, he became successively physician
to  the kings Charles IX. and Henry III.   His position, as we  see, must
have given weight  to his assertions, which,  however,  did not prevent
the Faculty of Paris from condemning  his method as  heretical  and
0 In Artem Medicinalem. 
372
ERUDITE PERIOD.
dangerous.   He composed several works, the most remarkable of which
is a memoir entitled, On the cure  of Diseases by Blood-Let ting.  In  this
book he develops his paradoxical  ideas on the  utility of  frequent vene-
sections.   " The blood," he says, •' being destined to nourish and sustain
the body, not to injure and clog it, can only fulfil its destination in  pro-
portion to its purity and  proper quantity.  If,  then, it  surpasses  the
just quantity, and if it offends in any of its qualities, so  as to be incon-
venient,  it is necessary to correct it;  now,  this is done efficaciously by
blood-letting, according to the  testimony  of Hippocrates,  (ialen,  and
especially as is demonstrated by the happy results of this practice."
  If the  theory of  Botal is very contestable,  the  numerous facts on
which  he supports it are very much less so.  It can not  be denied that
he obtained extraordinary success by  emissions of blood ;  but as he cites
only his successes, it is reasonable to  suppose that he does not  cite all
the cases in his  practice.   In the second place, it is necessary to remem-
ber, that this physician having  collected  his  earliest observations in
camp,  on young  and vigorous subjects in the full strength of age, it is
probable that he was influenced  afterward by the  recollection  of  the
happy  results which hisjnethod produced  for him in the  beginning.
Finally,  it may  be said in his defense, that if he exaggerated the employ-
ment of  sanguineous emissions, his cotemporaries made  use of it  too
timidly,  whence it follows that, all things considered, his  practice would
be as advantageous, and even more so, than that of his rivals.
  The memoir of Botal goes out of the line of  ordinary compositions of
this epoch, as well in regard to its form as to its matter.   We do not find
in it, as in the others, subtile arguments and long  theoretical digressions.
This author says scarcely anything on theory, but,  on the  other  hand,
mentions many facts.   Without disdaining the authority of the ancients,
on which he sometimes depends, he invokes, especially, observation.  In
fine, he  unites  independence and  energy  of thought to  elegance  and
purity of style.
   III. Laurence Joubert, Chancellor  of the University  of Montpelicr,
and consulting physician of the king  of Vranee,  Henry III., was also a
liberal thinker.   In his annotations  on the books of Galen, he some-
times  approves, and again he condemns  the  doctrine of this author.
Among other new opinions, he  emits the following:  " That the humors
never  putrify in the living body, that there is only an effervescence in
them, in fevers called putrid."  His treatise on Popular Errors had an
unheard of success for the epoch when it was published.   In less than
six months, there were retailed*4600 copies, which  must appear prodi-
digious,  when we consider the small number of persons who were at  that
time able to read.  Some of the  circumstances that contributed to this 
PARTIAL EFFORTS  FOR REFORM.               373
popularity, may be summed up as follows:  First, the book was written
in the common language, which was a  new thing  in works treating of
subjects connected with Medicine,  and which placed  it within reach of
a  crowd of new readers of all classes.   In the  second  place, it was
diversified with jovial and vulgar  anecdotes.  In  short, it  includes,  on
the subject of generation and parturition, certain technical details, for
which men of the world, unused to these  matters, are always greedy.
The author, moreover, though affecting a light, paradoxical and wanton
manner, respects, at heart, religion and good manners.   He justifies as
much as possible, in his preface, the nudity of some of his illustrations,
and to shelter it from too severe censures,  he dedicates his book to the
very high, very excellent, and studioiis  Marguerite de France, the  very
illustrious Queen of Navarre, daughter, sister, and wife of kings.
   I shall not essay to analyze a  work which treats of a multitude of
disconnected and often unsuited subjects;  but I  will detach some  frag-
ments, by which the  style  and  spirit in which  it was written may be
judged.   The  author  commences by  a question of high philosophy,
which he discusses with independence  and discernment.  " There is,"
he says, " a great contest between the princes of philosophy, Plato and
Aristotle, on the condition of the rational  soul,  which they both  agree
to be celestial, divine, immortal, and  separable  from the body.   But
Plato thinks that it does in itself know all things, which become effaced
from its memory and are lost the moment  it  is  submerged  and,  so to
say, mired in our humid and soft bodies.   Then, in proportion as the
body gradually dries, the soul becoming again  clearer and  more bril-
liant, is restored, and gradually recognizes everything,  as if it learned it
anew ;  for, according  to the views  of  Plato, what we  call  learning is,
really, only remembering.
   " On the  contrary, Aristotle  affirms that our  soul  unites with the
body in entire ignorance of all things, but is capable, and very promptly,
of conceiving of all things,  being at first a simple spirit, but capable of
 all things by degrees.   He compares it to a polished  tablet on which
nothing has  been drawn, but ready to receive every color  and  figure
 which may be put upon it.  This opinion has had more partisans than
the former, and is conceived  to be true, by the  best  philosophers.   For
 if we become wise by the mere dessication of the body, it follows that
 we should have no  need of doctrines,  or in other words, of instruction ;
 and  the  mind  could commit no  error,  (provided  that  the  exterior
 senses were entire and sound,) both of which conclusions are notoriously
 absurd."
   °Erreurs Populaires au fait de la Medecine et Regime de  Sante, par Laurent
 Joubert.  Paris, 1587.  Preface to the first part. 
374
ERUDITE PERIOD.
    We, shall not follow farther this author, in the development of his phi-
 losophic thesis.   We will only observe that he did not seek, as Fernel,
 to conciliate the opinions of Plato with those of Aristotle, but  that  he
 clearly pronounces himself in favor of those of the two which  seem to
 him the best.   We see  here already a free and  clear thinker, who pro-
 fesses for the ancients neither an idolatrous worship nor a blind contempt,
 but who chooses according to  his knowledge and taste.  After having
 sustained the conclusion just stated, Laurence Joubert explains  the mo-
 tives which  have  induced him to undertake the work,  and the end he
 proposes to attain.
   " Madam," he says, " I leave, for the present, to the theologians the
 instruction of the soul in the Christian faith, to engrave this early upon
 it, to color it with piety, to  feed it  with sound doctrine, and to perfume
 it with odors agreeable to  God and profitable to our neighbor, by a holy
 and exemplary life, conforming to doctrine and  proceeding  from piety,
 having its strength in faith of the highest character.  I hold to  what is
 my vocation, that is, the care of the human body, to preserve its health
 and restore it when deranged, by the help of the grace of Almighty God,
 who has created Medicine  and  established the  physician for the  necessi-
 ties of man.  In this vocation I have for a long time (for at least twenty-
 five years) labored,  for a double aim—the one, to instruct the youth in
 the said science, as well by writing  as by verbal teaching, sincerely and
 diligently giving them the first traits, watering it with good precepts,
 making them acquainted with the most secret remedies, and exercising
 them in discussion and practice; the  other, to  extinguish  and annul
 several false opinions and errors (offsprings  of ignorance) which  have
 long been valued and in fashion in Medicine, Surgery, and Pharmacy—I
 say, among  the professors of the three departments  of our Art,  from
 which has resulted many abuses and nullities.
   " But all this is trifling, compared with the popular  errors in Medi-
 cine and the regimen of health, which for the most part are  so stupid
 and vulgar as to merit much more ridicule  than reprehension.   Never-
 theless, because they are very prejudicial to the life of man, it seems to
 me that we must neither despise nor dissimulate them, but rather remon-
 strate with the ignorant vulgar in regard to what and  how they err and
go astray, trying to  lead them in a better  path.   For  they do  not act
 maliciously or with an intention to injure, but for the  best, according to
their opinion.   It belongs, then, to  physicians to remedy this  evil, to
correct which I have taken great pains for a long time,  and remonstrated
with many.   But that has been of little moment,  as long as the greater
number are incapable of reason and discussion.   Finally, I have deter-
mined to remonstrate with the people, showing  up their errors by writing, 
PARTIAL EFFORTS FOR REFORM.
375
and  in order to set up a judge wholly unsuspected by them, yet, never-
theless, capable of correcting such abuses.
   "  Now, having long reflected who this judge should be, the excellency
of your majesty,  madam, has seemed to me  the most  proper one in the
world, by the rare virtues which every one  admires in you, your most
angelic spirit, your exquisite judgment, your honest curiosity and stu-
dious desire to know  all things, and also on  account of the leisure you
possess for such a pastime, which will  serve you as a great recreation for
several  hours a  day, to  understand  and  examine the  reasons I have
deduced against popular errors, in order to overturn them.  I shall, how-
ever, fear the venomous  and envious  tongues who will  endeavor to find
something unbecoming in what I propose to your majesty on this subject;
for I am constrained  frequently to say things which appear too filthy and
lascivious;  but knowing that one may honestly speak, as I have done,
on all the natural functions, as well as on all, even the most secret and
hidden  parts of  the  human body, which chaste eyes do not fear to see
represented  in public by drawings and sculpture; remembering, too,
what Dion recounts of  the virtuous Boman  princess Livia, wife of the
emperor Augustus, who saved the lives of men condemned to death be-
cause they had exposed themselves before her entirely naked—she say-
ing,  that to the observation of a virtuous woman they differed in nothing
from statues, I consider myself fortified by  such  reasons, as by defen-
sive  arguments, against which the poison of slanderers can avail nothing
with you."°
   We see by these  citations—first, that Joubert, in writing the book we
have mentioned, proposed for himself a serious and useful end—that of
combating prejudices  no less injurious than ridiculous; secondly, that he
justifies very adroitly the  licenses  of expression in which he has  in-
dulged, as well as the odd idea he had, of dedicating such a book to a
woman.   Besides, it  appears that the very studious queen of Navarre
does not show herself on this occasion  more severe than the Boman em-
press, and that she deigned to accept the dedication of the Chancellor of
the  University of Medicine at Montpelier.  We may judge, by the fol-
lowing announcement of several of the questions agitated in this work,
if it was not calculated to excite the curiosity, I will not say of a
princess, but of the generality of readers.
   The entire work  is divided into two parts,  at  the close of which, is
added a mixture and  collection of other questions and  popular errors,
collected by him and his friends.   The following are some of the propo-
sitions, each of which forms the title of a  chapter.   " Why are there
Erreurs Populaires au fait de la Medecine et regime de sante. 
376
ERUDITE PERIOD.
more physicians than other sorts of people ?'  ' It is not profitable to sick
persons to have several physicians, but one alone, who should  be very
assiduous.'   ' Can a woman conceive  without having her  courses ; in
other words,  without her natural purgatives ?' ' Against those who keep
up sexual intercourse,  with a view of having children, and of those who
indulge but seldom, in order to have less.'  ' If there is any certain know-
lege whether the child will be male or female, and whether there will be
one or two ?'  ' Why is a pregnant woman advised to put her hand on her
posteriors, if she cannot satisfy her desires ?'  ' Is it good  to  make a
woman sit on the bottom of a hot kettle, or put on her belly the cap of
her husband, in order  to have a better delivery; and what are the best
means for accouchement ?'   ' Is it  true  that a woman delivered in  full
moon, will afterwards have  a boy, and if  in new moon,  a girl ?'  ' An
exhortation to all mothers, to nurse their own children.'  ' Is there a cer-
tain sign of the maidenhood of a girl ?'  ' On the superstitious and false
opinions of women, who believe that the milk of a woman will dry up
in her breast, if some of it be heated.'   ' Is it true that truffles, arti-
chokes,  and oysters render  men more keen for venereal pleasures?' &c."
  The author treats these delicate matters in a manner worthy of the
subject, mingling, as  we have said, his serious dissertations with amusing
anecdotes.  Thus,  after having shown  the ridiculous presumption of so
many men assuming  to act  as physicians without understanding any
thing about it,  and that  too, in the presence of physicians, he narrates
the following adventure : " It is said that the duke of  Ferrara, Alphonso
d'Este, at one time proposed, in a  familiar way, the question, in what
calling are most men engaged:  One said shoemakers,  another tailors, a
third carpenters,  mariners,  pettifogers.  and laborers.   Oonclle,  his
famous buffoon, said there were more physicians than  any other class of
men, and made a bet with the duke, who denied it, that he would prove
it in twenty-four hours.   The  next  morning Gonelle left his lodgings,
wearing a great night-cap, and a cravat tied around his chin, then a hat
over alb and his mantle drawn up over his shoulders.  In this attire,
he took a route leading to the  palace of his excellency, through Angel
street. The first one he met asked  him what was the matter ; he replied
that he  had a raging tooth-ache.  Ha!  my friend, said the other, I
know the best recipe in the world  against it,  and told it to him.  Gon-
elle inscribed his  name on his tablets,  pretending that he was writing
down his recipe.  A step further on he found two or three together, who
all asked the same  question, and each one  gave him a remedy.   He
inscribed their names as the first;  and thus he pursued his course very
gingerly to the end of  the  street, not meeting a single person who did
not  offer him a recipe different from the rest, each one saying that his 
PARTIAL EFFORTS FOR REFORM.
377
was well established, certain, and nearly infallible.  He wrote down the
names of all.   Coming  to the lower court of the palace, he found him-
self surrounded with gentlemen, (for  they all knew him,) who, after
having learned his affliction, compelled him to take their recipes, which
each one said was  the best  in the world.   He thanked them all, and
wrote down their names.  When he entered  into  the  chamber of the
duke, his excellency cried out, ' Eh ! what have you got Gonelle?'   He
replied  very piteously and complainingly,  ' tooth-ache,  the worst that
ever was.' To which his excellency replied,' ha ! Gonelle, I know a thing
which will drive off  the pain at once, without touching the tooth.  Mr.
Antonio Musa Brussavola has .never employed a better one.  Do so and
so, and incontinently you will be healed.' Suddenly, Gonelle threw down
his head dress, and his attire, crying out, ' and you also, my lord, are a
physician!  Look at my list,  and see how many others I  have found,
between my lodgings and your palace.  Here are nearly two hundred,
and I have only passed  through one street.   I will engage to  find ten
thousand in this city, if I go every where.   Find  me as many persons
in any other business.'  This is an appropriate story; in fact, every one
meddles with medicine,  and there are  few men who do not  think that
they know a great deal  about  it,  and even more than  physicians them-
selves."0
   I have dwelt somewhat at length on  this work because, under its light
form  and without affecting any  pretension to scientific depth, it has,
nevertheless, an end eminently useful, namely, to  dissipate  a multitude
of errors which, when practiced, produce bad results; and in attempting
to enlighten the vulgar, was  he not laboring for the propagation  of sound
doctrine ?   However, I must say that we  find in  the book  of Joubert
the sanction of certain erroneous theories  which then reigned  suprem
in science;  but this  was an inevitable  defect,  for an author would  not
be able to combat vulgar prejudices with other lights than those of his
own age.
"Erreurs Populaires, part., liv. i., chap. ix.
24 
378
ERUDITE PERIOD.
                        CHAPTEE XII.

      MEDICAL ORGANIZATION AND ACCESSORY INSTITUTIONS.

  The separation of Medicine from the priesthood, which began  to take
place at the close of the preceding period, was completed during  this, te
the great advantage of both professions, for though the Pagan priest
could practice the Healing Art without derogation to the rules  of his
order, the Catholic priest  could not, without defilement  and a violation
of the  canons of the  church, descend into  a mass of sensual  details
which the study and practice of Medicine required.  From the sixteenth
century,  celibacy ceased to  be  obligatory on physicians in the kingdom
of France, and they no longer obtained ecclesiastical benefices.   At the
same time, Surgery, which had long been separated from Medicine, reap-
proached it, and this approach, as we  have seen,  turned to the profit
of science.
  From this date, the  professors of the Surgical College of St. Come
were put on the same level with the professors  of the  University, and
enjoyed equal privileges.
  In fine, the establishments destined  to propagate medical instruction,
faculties  and  schools of Medicine, increased, and those which already
existed were  developed.  Amphitheaters for dissection were opened  in
every State in Europe.   The hospitals  and dispensaries—in  a word, all
the institutions devoted to the comfort  of the afflicted poor, followed the
upward  march.   The  governments turned  more of  their  solicitude
toward the regulation  of medical  police and  hygiene, and  then com-
menced an amelioration in the sanitary state of the people.

                   RESUME  OF  THE ERUDITE PERIOD.

  The  historical period whose state we have just sketched, offers  a most
interesting spectacle.  We have seen the human mind, long buried in a
lethargic sleep, gradually awake, and mark its first steps by discoveries
of the  highest importance;  the love of letters  became  general,  as  the
means  of instruction multiplied;  science, enclosed in the cloisters during
the middle ages, became secularized as in the times of  Hippocrates,
Plato, and Aristotle, but with the means of propagation more numerous
and efficient.  The first effect of this expansive movement of the mind
was, to re-direct the attention of the learned world toward the primitive
sources of  the beautiful and the  true; the debris of Greek literature
was exhumed from the dust  of the  libraries  of the convents,  and it
gradually took the place of the Arabic literature, its degenerate daughter. 
MEDICAL ORGANIZATION.
379
Soon the monuments of  antique science were insufficient for the expand-
ing human mind.  They were submitted to a criticism more clairvoyant
and severe, which revealed many defects, and weakened very much the
respect in which these precious relics had been held.   Then adventurous
and impatient minds attempted to overturn the entire edifice of human
acquirements, and rebuild it in a day; but their work—fruit of a mor-
bidly excited imagination, having neither reason  nor experience to sus-
tain it—fell before the light of discussion, as the dreams of an unquiet
night fly at the approach of  day.  A few men, however,  succeeded in
uniting the worship of antique traditions with the love  of novelties;
they comprehended that to reform was better than  to  destroy, and that
all change is justifiable only as it includes a progress and  an ameliora-
tion.   Consequently, they contented themselves with proposing partial
modifications of the ancient doctrines,  with a view to  improve, not to
destroy them. 
380
REFORM  PERIOD.
           VIII.  REFORM   PERIOD.

COMPRISING THE SEVENTEENTH AND THE  EIGHTEENTH CENTURIES.
                 GENERAL CONSIDERATIONS.

   We have just seen  the systems of Aristotle  and Galen  resist the
premature attacks of the partisans of the occult sciences, and gather
around  them  the great  majority of minds, by means of some partial
modifications claimed by  the less bold though  more sensible innovators.
The long duration of these systems, the almost unanimous accord of the
great men of antiquity and of the middle ages, in their favor, formed  a
precedent so respectable that  a general disposition to disdain  them had
not yet been learned.  It is not then astonishing that the most eminent
men in  science should prefer them  to the eccentric  and mal-elaborated
theories of the founders  of the occult doctrines—to  those of restless,
capricious, and haughty minds, who pretended to arrogate to themselves
the sceptre of  knowledge, without taking the trouble to prepare a scien-
tific reform whose wisdom and greatness would justify, in the eyes of
enlightened men,  so high  a pretension.
   In the meantime the domain of natural sciences enlarged from day to
day;  observation had enriched it with a multitude of new facts which
harmonized  with, or discredited prevailing  doctrines.  The moment
approached when  the need of a radical reform was felt in nearly every
branch of human science.  Men whose knowledge equaled their genius,
began to appear and take the direction  of the intellectual movement,
and substitute for the decrepid theories of the  schools, those which  were
younger, stronger, and harmonized  better with the  totality  of known
phenomena.   The worship of  the ancients is  succeeded by an immode-
rate desire to  shake off  their yoke, and  to revenge  in  some sort their
long tyranny.   On this account I have given to this the name of Beform
Period, which  characterizes  perfectly, if I am not  mistaken, the gene-
ral tendency of minds, the predominant  thought  and culminating fact
of the epoch. 
GENERAL CONSIDERATIONS.
381
  At the beginning of this period a  Florentine nobleman, one of the
finest geniuses of modern times, Vincent  Galileo, carried the torch of
regeneration in physics.   Without other guide than  his  intelligence he
abandoned the route of subtile speculation to follow that of observation
only.  In this way he reaped an ample harvest of surprising truths, one
of which would suffice to immortalize his name.  He first calculated the
law of gravity;  he discovered the weight of the  atmosphere, and he
asserted  the movement of the earth on its own axis and around the sun.
Nothing was wanting to his glory, not even the seal of persecution.   He
was cast into the dungeons of the holy inquisition, for creating too daz-
zling a light before the eyes of his  cotemporaries.   At  the  same time
Kepler  traced the  course of the  heavens for Newton, by his bold  and
happy hypotheses.
   While the astronomers, extending the limits of the universe, and with-
out pretending  to  read  in the stars, as the astrologists, the destiny of
kings and of nations,  determined with a marvelous exactitude the laws
which maintain harmony in the movements of these sublime  bodies, the
naturalists discovered by the aid of the microscope, a new world close
by us, under our hands, which the ancients had not even  suspected.
Their eye  perceived  in  a drop of liquid  myriads of organised  beings,
living and moving in the narrow space, as  in the midst of an immense
lake.  The chemists,  abandoning the  vain and darkened researches of
alchymy, reaped on their part an ample harvest of useful  and unheard of
discoveries.  In place of reasoning theoretically, after the manner of the
philosophers, on the nature, form and combinations of the material ele-
ments, they studied every thing experimentally ; they learned to modify
and  overcome them  at  pleasure—in  short they endowed man in some
degree with a secondary creative power.  The ancient philosophers  had
no more rude adversaries than they, and  their labors contributed  more
to destroy their dogmas than those of any other class of savans.  Bernard
 Palissy,0 a simple  potter of Agen, and Andrew Libavius, doctor in medi-
 cine, native of Halle, in Saxony, were, during the sixteenth century, the
 true princes of chemistry, the precursors  of the experimental doctrine of
 Chancellor Bacon.
    Medicine made also, at the same time,  numerous and great conquests.
 which  led to  frequent revolutions in its theory.   The truth  of  that
 aphorism, " experience is deceptive, and judgment diffiadt," was never
 more evident than during  this period, in which we see  melt away, not
 only Galenism,  but also several  other newly hatched  systems, all of
 which had had the  pretention of  being  founded  in  experience,  and
°See CEuvres de Bernard Palissy, by M. Cap, Paris 1813, 12mo. 
382
REFORM PERIOD.
had  been emitted and extolled by men of superior merit.   But, as will
appear in the course of this history, all these systems had the defect of
considering  the phenomena of the animal economy in one aspect  only,
and neglecting  others  not less important.  All committed the  no less
grave error of passing, in their abstractions, beyond the limits of sensible
phenomena.  For this reason they have all vanished, or suffered great
modifications, after an  existence more or less ephemeral.
  We proceed  now, according  to our custom, to expose, in the first
place, the material progress in each principal branch of the science, and
then  the  varieties of the most important doctrines.   Nevertheless,  it
will  happen more than once,  as  has  already frequently occurred, that
after having reported a fact, or an observation, we shall join it  at once
to some  theory; because it is  sometimes impossible, or at least  very
inconvenient, to separate from a phenomenon its theoretical explanation.
                          CHAPTEB  I.

                ANATOMY AND  PHYSIOLOGY.

   The anatomists of the sixteenth century had described  the  apparent
and easily accessible parts of the human body with such scrupulous exact-
ness, that they had left little for their successors to do in this particu-
lar ; consequently, the latter turned their attention in another direction.
Minute and comparative anatomy, and experimental  physiology,  offered
a vast field of new truths,  till  now but  little explored.   They directed
their observations toward  these  objects, and their efforts, as  we shall
see, were crowned more  than once with brilliant success.

                        CIRCULATION OP THE BLOOD.
   Before describing the researches which have immortalized the name
of William  Harvey, it will be proper to  recall, succinctly, what  were
the acquisitions of his predecessors,  on this  function of the  animal
economy.
   The liver  was considered, from time immemorial,  as  the  organ of
sanguification.   It was supposed  that the veins took their  origin  in this
viscus, and that they  were the sole order of vessels  that contained,
naturally, the blood.  It was imagined that the fluid flowed  from its
principal reservoir to all parts of the body, and returned to its source
through  the  same canals,  by an  undulating movement, similar  to the
flux and reflux of the  sea.  The arteries were supposed  to contain, in 
ANATOMY AND  PHYSIOLOGY.
383
 their normal state, vital spirits only, of which the heart was the great
 reservoir ; but it was admitted that in certain diseases, the blood  could
 make an irruption into the  arterial channels.   Such was the doctrine
 of the Asclepiadfo, and particularly of Erasistratus.
    Galen modified it by demonstrating that the arteries contained blood,
 at every period of life.  Neither was  he ignorant that this liquid  is
 poured  into the right cavities of the heart by the great veins ; but he
 believed that only a small quantity passed from the right ventricle
 into the lungs,  by means of the pulmonary artery,  while  the major
 part came directly, according  to  him,  to the left ventricle, by passing
 through the porosities of the interventricular septum.   This  opinion of
 Galen was uncontested till the middle of the sixteenth century.
   At that epoch the theologian Michael Scrvetus, the same who perished
 a victim of the  jealousy of Calvin, dared  to deny the passage of the
 blood through the septum of the ventricles.  He contended that the
 blood which  comes into the right  cavities of the heart, passed by the
 pulmonary artery to be distributed in the lung, whence it returned into
 the left ventricle, by the pulmonary  veins.    This was  a luminous
 thought, and a great step,  in fact, toward the  truth.  Shortly after.
 R. Columbus demonstrated, anatomically,  the  conjecture of Servetus,
 by showing the real use of the valves of the heart.
   A. Cesalpin approached still nearer the truth.  He explained, in the
 same manner as Columbus, the course of the blood through  the lungs,
 and added, that the last arterial ramifications communicated with the
 veins—that the blood  and vital spirits passed from the arteries  into the
 veins during sleep, which seems  to  him  proven by the  swelling of the
 veins and the diminution of the pulse, at that time.
   They knew, also, the existence  of valves  in the veins.  It was dem-
 onstrated by experiment, that if an artery is tied, on a living animal, the
 blood ceases to flow, and pulse stops below the ligature; but if, on the
 contrary, a vein was tied, it shrunk above the ligature, and tumefied
below it.  Such was the state of science at the beginning of the seven-
 teenth century.   There was only one step to take to find the true course
 of  the  blood, but that  step  was  difficult,  as  we  may  now  readily
 understand.
   William Harvey, native  of Folkstone, in  the  county of Kent, made
his first  studies in his own country.   Afterward, he traveled  for his
instruction, in France, Germany,  and Italy,  and remained at  Padua
during four years, to  hear the lectures of  Fabricius  d'Aquapendente.'
He returned to his country with the title of Doctor, in 1602,  and estab-
lished himself in London, and was elected sometime  afterward, a mem-
ber of the College of Medicine.   Named regent in 1613, he commenced 
384
REFORM PERIOD.
to make known his doctrine on the circulation of the blood, in his public
lectures, but he did not publish the result of his researches till  1628,
after having submitted  them for fifteen  years to proofs and  counter
proofs of every kind.
  Here is his own story, in which he depicts the obstacles he met with
in his efforts  to discover the truth: "Devoting myself to discern the
use and utility of the movements  of the  heart in animals, in  a great
number of vivisections, I found at first the subject so full of difficulties
that I thought, for a long time,  with Fracastor, that  the secret was
known to  God alone.   I could distinguish, neither, in what manner the
systole and dioistole took place, nor at what moment the  dilatation and
constriction  occurred, owing to the celerity  of the movements of the
heart, which, in most animals, is executed  in the twinkling of an eye,
or like the flash of lightning.   I floated, undecided, without knowing on
what opinion to rest.   Finally,  from  redoubled care and attention,  by
multiplying and varying my experiments, and by comparing the various
results, I  believed I  had put my finger on the truth, and commenced
unraveling the labyrinth.   I  believed I had  seized  the correct  idea of
the  movement  of the  heart  and  arteries, as  well as  their true use.
From that time I did not cease  to communicate my views either to my
friends, or to the public in my academical course."0
   M. Dezeimeris appreciates as follows  the  discovery of  the English
physiologist: " To its intrinsic merits, the work  of Harvey on the cir-
culation of blood has,  besides, the merit of arrangement.   The author first
clears up  his course,  by removing the  errors of  antiquity ;  he describes,
next, the movements of the heart in  the  living animal, he shows  its
muscular structure, the alternate contractions  of the auricles and ven-
tricles, the influence  they must exert to drive the blood with force into
the  arteries, determined  in  that  direction  by the mechanism  of  the
valves; in fine, he establishes the whole system of the  circulation.   He
terminates the treatise by original observations on the  difference of its
structure, in different animals,  at different periods in life."f
   So much care and circumspection in the research for truth, so  much
modesty  and  firmness  in his demonstration, so much clearness and
method in the development of his ideas, should have prepossessed every
one to favor the theory of Harvey; but, on  the contrary, it caused  a
general stupefaction  in the medical world,  and gave rise to much oppo-
 sition.   This theory, which appears to us to-day so natural that we con-
 ceive with difficulty why it was not  found  much  sooner, was  nothing
:i Guillelmi Harvey, Exercitatio Anatomica de Cordis et Sanguinis motu, cap. i.
f Dictionaire Historique de Medicine, at the word Harvey. 
ANATOMY AND  PHYSIOLOGY.
385
less than a revolution in physiology.  I shall not pause to describe all
the phases of the controversy it excited; it will be sufficient to say that
it continued no less  than twenty-five years, and that there  was not a
man at the time who made any pretension  to  a knowledge of anatomy
and physiology, who did not take an active part in it.  Even  the natu-
ralists and philosophers themselves, did not remain  indifferent.   Bene
Descartes was  one of the first  to  declare  himself in favor of the new
doctrine of  the circulation,  and supported it by some experiments, but
especially by the authority of  his • name.   John Waloeus, a  celebrated
anatomist, and professor in the University of Leyden, confirmed it by
new observations.   Finally, Plempius,  of Louvaine, one  of the  most
fiery adversaries of this theory, gave way to  the force of truth,  and
passed with a free will and publicly over to the ranks of its  defenders,
in 1652.   This was a great triumph for Harvey, and brought so much
additional support to his doctrine as nearly to  silence all  opposition.
   During these long debates  the conduct of Harvey was always digni-
fied and  firm.   He mingled in the polemic which his discoveries had
excited, only to add new proofs and  new experiments to those he  had
 already published.  One, only, of his adversaries  obtained a direct re-
sponse from him.   This was  John Biolan, professor in  the  faculty of
Paris, and one of the greatest  anatomists of his age.  Harvey attached
 much  value to his  support.   In  seeking to convince him,  he spoke
always with the greatest deference, giving him, several  times, the epi-
thet  of  prince of the  Science.   The opinion of J. Biolan was,  in fact,
of  immense weight  among  his cotemporaries; but whether from  excess
 of  respect for the ancients,  or from envy against moderns, he  combatted,
 with as much  violence as obstinacy, the two finest discoveries  of the age,
 namely,  that   of Harvey, and  that of  Pecquet, which we shall  soon
 consider.0
   Harvey had the satisfaction before his death, to see his theory of the
 movements of  the heart and of the blood universally adopted.  He left,
 besides, interesting observations on generation, in man and in animals—
 on midwifery—and on the  structure and diseases of  the uterus.
    The further progress of science only confirmed the doctrine of the circu-
 lation of the blood.  In 1661, Malpighi, professor at Bologna, demonstrated
 for the first time, by the aid of the microscope, the  progression  of the
 blood globules in the small vessels.   He confirmed the reality of the
 communication which had  been said to  exist  between the arteries  and
 the veins, and gave a  clear demonstration of  their  last branches.  In
  1690, Anthony de Leeuwenhoek, naturalist of Delft, was enabled to see,
0 See Lettres de Gui Patin, new edition, with notes by M. Reveille.  Paris. 
386
REFORM PERIOD.
with his perfected microscope, the movements of the blood in the small-
est vessels, and gave to several  persons important  testimony of his
observations.
   Leaving far in  the rear his precursors, B. Lower and J. M. Lancisi,
J. Senac published in 1749,  his  great work on  the  Structure of the
Heart, its Actions and Diseases.  The author puts forth, in his preface,
some maxims of medical  philosophy stamped with wisdom, among which
we find  the  following:  "Theory reduced to consequences drawn from
facts  alone, is the light of practice.  But  in  following the track of
nature by the light of experiments and observation, we soon arrive at the
barriers  where  the  mind is  abandoned to itself.  In going  beyond
these limits,  it can rest  only on conjectures, where  error is inevitable."
" Wrhile  some elevated the force of the heart to a weight of three mil-
lions of pounds, others reduced it to the weight of eight ounces.   A rival
of Newton and Leibnitz  (M. d'Alembert), was more wise, who said that
none  but the foolish attempted to  estimate the force  of the heart's
action."0  Notwithstanding this  severe  criticism given against those
who attempted to  calculate the vital  forces, Senac, in the course of his
work, gives a conjecture on  this subject.   Having remarked  that  a
weight of fifty pounds, attached to the foot, was raised by the  pulsation
of the artery,  he estimated, approximately, the force of the heart at two
hundred pounds.
   He describes with much care, the structure of  the  heart, and the
direction of its fibres, of which  the external appeared  to him oblique,
and the internal  arranged in spiral.  These latter take their origin,
according to  him,  from the fleshy columns of the aortic ventricle.  He
placed among the remote causes of the movements of  the  heart, the
animal spirit,  which is transmitted from the brain and the spinal marrow,
to the muscle, by  the intermediation of the nerves.   This  spirit, he
thought, was a fluid extremely elastic, which the impression of the blood
on the delicate tissue of  the parietes and columns, put  in action.  In
the first place, the vena cava, by these  alternate constructions, caused
the blood to enter into the auricles,  which, stimulated  by the presence
of that liquid, contract, in their turn, and  push it into the ventricles.
These last  commence at once to act, and  drive forward the blood which
they contain.  Thus, these three  machines, by  the aid of  the  fluid
which they enclose, act successively,  while the  vital spirit subsists in
the tissue of the brain and nerves.   The heart is only the prime mover,
or determining and conditional cause of the movement of the blood, but
  0 Traite de la Structure de Cceur, de son Action de ses Maladies, II. edition ;
published by A. Portal, Paris, 1774, T, I., preface, p. 32. 
ANATOMY  AND PHYSIOLOGY.
387
 its force is insufficient to produce it alone ;  we must  add to it the elas-
 ticity of  the arterial coats, and above  all  the action of their muscular
 fibres and their nerves.  In regard to the pathology of the central organ
 of the circulation, which forms the last part of the treatise, we will say
 simply, that diagnosis, in it,  is carried to as high a degree of perfection
 as could be attained prior to the discovery of percussion and ausculta-
 tion.0  This work, in  which  analysis was pushed to its utmost limits,
 made a sensation in  the medical world.  His cotemporaries spoke of  it
 only in terms of admiration.   Morgagni, when refering to it, applies to
 the author the epithet of great;  but it has become  much out of date
 since  the perfection  of auscultation and  percussion has  carried the
 diagnosis in thoracic  diseases  to  an unhoped for success.   Senac was
 physician to Louis XIV.,  after Chicoyneau, and he had the entire confi-
 dence of  his sovereign.
                             ON RESPIRATION.
   If the researches  concerning the mechanism and  end of  respiration,
 give not results as prompt and  decisive as  those relative to the circula-
 tion of the blood, they were not, however, unfruitful, as is very plain in
 comparing the notions which antiquity has transmitted to us on this sub-
 ject, with those that were possessed at the close of the last century.
   The ancient anatomists described, summarily, the exterior form of the
 lungs, their situation in the thoracic cavity, their spongy consistency, as
 well as the cartilagino-membranous structure of the trachea, and the
 first divisions of the bronchia;  they did not carry farther  their dissec-
 tions, but they thought that the  extremities of the bronchia anasta-
 mised with the radicals of the  pulmonary  veins, which they named on
 that account, arterial veins: that is to say,  veins conducting the atmos-
 pheric fluid of  the lungs into the heart.
   On these vague and  partly erroneous  anatomical data, they built the
 following theory: The air drawn into the lungs by the heat of the heart,
 the reservoir of the vital  spirits, enters by the trachea and bronchia.
 In penetrating  into the last bronchial ramifications, it is rarified: the
 thinnest part passes into the pulmonary veins, to be carried to the heart,
 where it serves as material for the  fabrication  of the vital spirit: its
 grosser parts were exhaled with  the fuliginosities of the heart,  during
 expiration.   According to  this theory, respiration had two purposes—
one to refresh the lung, which being of a porous and inflamable nature,
would  be in danger, without it, of taking fire  by the contact of the
heart—the focus of animal heat;  the other  to furnish the  pneuma or
  0 As it is no part of my plan to enter into any account of these important dis-
coveries in science, I refer the reader to the treatisis of Laasnnec and Bouillaud. 
388
REFORM  PERIOD.
ether, which was  employed by the heart in the fabrication of animal
spirits.   Such were the ideas formed on  the mechanism and end of the
respiratory function—ideas which reigned, without  submitting to  any
important modification, down to the seventeenth century.
  The discovery of the small  and great  circulation  sapped  one of the
bases of  this theory, for  they showed that the pulmonary veins carried
to the heart  no other  liquid  than the blood, and that no  substance,
liquid or gaseous, could re-flow from the aortic cavities into the lung.
In 1661, Malpighi  demonstrated  the cellular structure of this viscus.
He announced that the bronchial  ramifications  terminated in vesicules
lined by a vascular rete,  and communicated with each other.
  About this time much  more careful examinations were instituted than
had ever been before, in regard to the manner in and  forces by which the
movements of the chest  are  effected.  J. A. Borelli, Adrian Helvetius,
and many others, among whom  the  indefatigable A.  Haller holds the
first  rank, made, on the same subject, interesting  experiments, which
may be summed up as follows:  First, during inspiration  the thoracic
cavity is enlarged in all respects, by the action of  the diaphragm and
intercostal muscles, aided occasionally  by the  action of the  muscles
which extend the neck,  the  shoulders, and the  head—in short, of the
superior regions of the chest.   Secondly,  in expiration, this same cavity
diminishes by the simple relaxation of the  inspiratory muscles.  Ordi-
narily this relaxation is  sufficient to enable the thorax to diminish, and
return upon  itself.   In other cases, the triangular muscle of the  sternum,
the abdominal, the dorso-lumbar,  in a word,  all the muscles that connect
the parietes  of the thorax to  the inferior regions of the trunk, excepting
the diaphragm, concur to produce the expiratory movement.   Thirdly,
there never exists an empty space between the  lungs and  the side of
the chest.   The pulmonary organ follows the  cavity which incloses it—
 it dilitates when it expands, and diminishes when it contracts.  Fourthly,
 the air is  not drawn into  the  chest by the heat of  the parts, but by
 the tendency of all gaseous  fluids, to maintain  an equilibrium.  When
 the thoracic cavity is  expanded by the action of the  inspiratory muscles,
 the air which  it contains becomes  rarified, and is no longer in  equi-
 librium with the  external air, which rushes in through the opening  of
 the trachea.   This is the mechanism of respiration.
   That being settled, different pneumatic theories were, by turns, adopted
 and abandoned.    Here is  one  of  the most  remarkable: the Iatro-
 mechanicians assumed,  that in respiration no particle of air penetrates
 into the blood, but that the  alternate movements of the expansion and
 contraction  of the chest have the effect  of breaking and attenuating the
 molecules of the venous fluid, and mingling  them with the lymph and 
ANATOMY AND  PHYSIOLOGY.
389
the chyle, and changing thus the venous  into arterial blood.  Besides,
they  thought that the  unfolding of  the  pulmonary vessels, during
inspiration, favors the passage of the blood through the lungs.
   Some physicians renewed the theory of the ancients, in modifying it ;
they thought  that the air inspired,  being colder than that which is
expired, serves to moderate the heat of the  heart, and the effervescence
of the constituent parts of the blood;  that the  impression  of the cold
air against the  parietes of the  pulmonary vessels serves  to  condense
the venous blood, and changes it into red  blood, without the  addition of
any new principle.
   All these theories had to give way before the exact knowledge of the
changes  that occur in  the atmosphere  during  respiration.   It was
ascertained by rigorous experiments, that the air which enters into the
chest has lost, when  it  passes out, a  portion of its oxygen,  which is
replaced by a nearly  equal quantity of  carbonic  acid  and aqueous
vapor.   These phenomena, which had been  conceived by  Mayow,  in
1668, were perfectly established  by subsequent observations.  It had
always been observed  that  the  blood which  appears black in issuing
from  the vein, in phlebotomy, becomes red in  contact with the air.   In
fine, direct observation proved that a similar change of color  takes place
in the blood, in its passage through the  pulmonary vessels  during life.
Goodwin was the first, who, having opened the thorax of a frog, saw the
sanguineous fluid, which came black, and in  appearance venous, to the
lung,  acquire a fine red color in  traversing the  tissue of the  organ.
Hessenfratz filled a soaked bladder with  venous blood, and plunging
this membranous pouch into an atmosphere of oxygen gas, saw the blood
change from black to red.0
  Toward the close of the eighteenth century, Lavoisier, resting on the
facts  we have just named, proposed a pneumatic theory of  seducing
simplicity:  "When the atmospheric fluid," says the celebrated chemist,
" has  reached the pulmonary vesicles, a portion of its oxygen passes the
extremely delicate walls of these vesicles and combines with the excess
of carbon and hydrogen of  the venous  blood,  to  form the carbonic acid
and acqueous vapors which are found in  the  expired air.   The venous
fluid,  thus freed from  its excess  of carbon  and  hydrogen, acquires,
instantly, that fine red tint which characterises the arterial blood, and
constitutes, according to the views of many physiologists, hsematosis.
  The respiratory function was assimilated, by this theory, to the com-
bustion of a lamp, in  which the  carbon and hydrogen  of  the oil,  by
  0 I say nothing yet of the experiments of Bichat, which belong to the nineteenth
century, by the date of their publication. 
390
REFORM PERIOD.
 combining with the oxygen of the air, produce  carbonic acid and vapor.
 During this double combination, there  is evolved a great quantity of
 caloric, which Lavoisier regarded as the source  of animal heat. A some-
 what general law in zoology seemed to confirm this interpretation.   It
 had been observed that among animals provided with lungs, the natural
 temperature is so much the more elevated as the  respiratory apparatus has
 extent, and as they absorb a greater quantity of air.
   The purely chemical theory of Lavoisier was  received with enthusiasm
 by the  learned world.  It seemed to shed  a  clear light  on two great
 phenomena  of the  animal  economy—hsematosis and calorification—of
 which no one had before given any satisfactory explanation.   Neverthe-
 less, it was soon perceived that it was subjected to very grave objections,
 two of which, for  the present, we will  give.   If  it is  true, said one,
 that the lung is the focus of all  the animal heat, its temperature should
 be much more elevated than that of the other viscera, which observation
 does not show ; on the contrary, all experiments show that the tempera-
 ture of the lungs does not differ  sensibly from that of other organs;
 secondly, in this theory are se£ aside both the action of the lung proper,
 and of the nervous  influence—an  influence  which might have been
 inferred, a priori, and whose existence was put beyond doubt by subse-
 quent and  conclusive experiments.0

                        LYMPHATIC SYSTEMS.
   The discovery of the lymphatic vessels and their functions, was no
 less remarkable than that of the circulation of the blood.   If it had less
 eclat, it is because  it was not, as  the former, the work of one man, but
 its complete  development took  place only by a slow gradation.   Our
 mind, like our eye, is strikingly impressed only when the light reaches
 it suddenly.
   It appears  that Herophilus and Erasistratus had  perceived in  the
 mesentery  of  some animals, white vessels, which were connected with
 the mesenteric  glands.   They  took  them to  be arteries,  full of air.
 Galen, who had  an opportunity of seeing them,  treated their remarks as
chimerical.  He  believed that the veins  of the mesentery absorbed  the
chyle in the intestines, and carried it to the  liver, where  it was  trans-
formed  into blood.    This  opinion reigned  until  the  middle of  the
seventeenth century.   However, as early as the year 1563, Eustachius
had described the thoracic duct of a horse, but did not suspect its use.
In 1622, Gaspard Aselli,  professor of anatomy  at Milan, discovered  the
  0 See researches of Dupuytren, Ch. Dumas, M. Blainville, and others, on the
effects of the section of the pneumogastric nerves. 
ANATOMY AND  PHYSIOLOGY.                391
 lacteal, or chyliferous vessels, on a dog which was  killed immediately
 after eating,  for purposes of  dissection.   Accident led him  to this
 discovery, according to his own account, which is as follows:  "I per-
 ceived," he says, " on the walls of the intestines and in the folds of the
 mesentery, very fine white filaments, which I took at first to be nervous
 filaments ;  but having  pricked one  by mistake, I saw issue from it  a
 white, creamy liquid.   Struck with astonishment, I took pains to estab-
 lish this unexpected phenomenon before the eyes of spectators, among
 whom there were two very distinguished  physicians,  Louis Settala and
 Alexander Taddini."
   On the following days, Aselli repeated the same experiment  on other
 dogs, with  equal  success, and acquired the certainty that the  white
 threads  were vessels  which drew the  chyle from  the  intestines.  He
 observed  the valves with  which they are supplied, but supposed that
 they all met in the pancreas,  to be continued  to the  liver, which has
 always been regarded  as the organ of sanguification.
   Finally, in 1647, John Pecquet, being  still a student at Montpelier,
 discovered the reservoir that bears his name, and which is formed by
 the  union of all  the  lymphatic trunks  of  the inferior members, and
 those of the organs contained in the abdominal cavity.0   This reservoir,
 situated between the second and third lumbar vertebrae, is the beginning
 of the thoracic canal,  which is varied in structure, sometimes straight,
 again flexed, sometimes single, and  sometimes double, lying along the
 anterior face of  the dorsal column, and empties itself into the  left sub-
 clavian vein.  Pecquet followed the canal to its termination.  Having
 ligated it, he  saw it swell below and empty itself above the  ligature.
 He studied with closer attention than any who  had  preceded  him, the
 course of the lacteal vessels, and convinced himself  that none  of them
 were connected with the liver, but that all, on the  contrary,  emptied
 themselves into the common reservoir of which we have spoken.
   The discovery of  Pecquet gave the  last blow to the  ancient  theory
which attributed to the liver the function of hsematosis, and it confirmed
the doctrine of Harvey on the circulation of the blood,  but, like  that,
was  strongly opposed.  If we were astonished  to find  at the head of
its opponents the celebrated detractor of moderns, John  Biolan, we are
 much more astonished to  see the  illustrious AV. Harvey make, on this
occasion, common cause with the Dean of the Faculty at Paris.
  From that time the  lymphatic vessels and glands became objects of
research by  a  great  number of anatomists.   Among those whose  labors
contributed most to develop the disposition  and uses of this  order of
° J. Pecqueti Experimenta nova anatomica. Paris, 1654, 4vo. 
392
REFORM PERIOD.
organs,  we must name John Vcsling, professor in  the University at
Padua, who discovered the thoracic canal about the same time  as  Pec-
quet, the  celebrated Th.  Bartholin, Buysch, Olaiis Budbeck, W. and J.
Hunter, Hewson, Cruikshank, and above all, Mascagni, who was  the
first to give  a graphic description of this whole  apparatus.0  A cer-
tainty was now acquired that the lymphatics, disseminated  in infinite
number in all parts of the body, in a very variable and irregular form,
were arranged generally in two layers, the one superficial, the other deep-
seated; that  they were frequently interrupted in their course by small,
rounded, oblong bodies, called conglobate glands,  or better, ganglions,
and that their functions consisted in carrying into the torrent of circu-
lation, first, the chyle, which they draw from the surface of the intes-
tines ;  secondly, a transparent, colorless, or slightly pink-colored humor,
nearly tasteless and inodorous, called lymph, which they collect from all
parts of the body.

                          NERVOUS SYSTEM.

   We  have seen  that  Hippocrates  and his successors in the  school of
Cos, had no precise notion  of the nervous  system; they confounded,
under the term of vsupa,  nerves, tendons, ligaments, membranes, and
true nerves.   Aristotle was but little in advance of the Asclepiadae in
this matter ;  he regarded  the brain as an inert mass, without  sensation,
and supposed  that the nerves originated in the heart.  According to
him, they strengthen the  articulation and aid the  movements.   Spren-
gel  attributes then, wrongfully,  a  knowledge of these organs  to the
philosopher of Stagyrus,f but more correctly, further on, gives the honor
of the same discovery  to Herophilus. j
   It appears,  in fact, according to the most certain traditions, that the
physician of Chalcedonia  was the first to unravel a little, the functions
of the nervous system.  Bufus, the  Ephesian, who lived under Trajan,
says that Herophilus  distinguished three sorts of  nerves: the  first,
which serve for sensations and voluntary movements, proceed  from the
brain and spinal marrow, as ramuscles; the second and  the third are
destined to unite the bones, and the muscles to the bones.   We  see, by
this passage, that Herophilus had not yet entirely shaken off the pre-
judice which confounded tendons, ligaments, and membranes  with the
nerves.
  ° Vasorum lymphaticorum Corporis Humani Historia et Icomographia, Senis,
1787, 4vo.
       f Ibid., 1.1, p. 384.                | Ibid. t. II, p. 435. 
ANATOMY AND  PHYSIOLOGY.
393
  Galen himself was not exempt from  this error, as any one  may be
convinced by the following  glance of the description which he gives of
the nervous system.   After  having spoken of the two membranes that
envelop the encephalon, which we know as the dura-mater and the arach-
noid, he points out the great division of the encephalic mass into cerebrum
and cerebellum;  he describes each of these  parts, their respective posi-
tion, volume, consistency, the two  substances that enter  into their com-
position—the  one white, the other gray—the depressions and convolu-
tions on their surfaces, the ventricles, etc.   He regards the cerebrum as
the seat of the  rational soul and the origin of the sensitive nerves, while
the cerebellum, as well as the spinal marrow which proceeds from  it,
give rise, according to him,  to the nerves of motion, which  he thought
had more consistency than  the others.  To  prove that  the  nerves  are
the primary agents of sensibility and mobility, Galen cites the following
experiment: "If we  cut a nervous cord, or place a ligature around  it,
immediately the parts situated below the section or ligature lose  the
faculty of feeling and motion."  The alternate movements of expansion
and contraction of the encephalon, did not escape him, and he regarded
them as a species of  respiration of  the  brain.   He gives to the great
sympathetic nerve the name of intercostal, and  says it is derived from
the vagus nerves, which form  the sixth  pair  in  his classification.  He
observed  the ganglions that are met with on  their track, but he never
suspected their use.   Does it not seem, from this, that  Galen distin-
guished perfectly the nerves from the tendons and the ligaments ?  Never-
theless, he says, in another place, that the extremities of nervous ramifi-
cations are spread out  into membranes, ligaments, and  tendons.  He
places the sense of touch in the membranes which envelop the muscles,
and to which  he gave  the name of aponuroses,  on account of their
supposed nervous origin.
   The  anatomists of the sixteenth century described with more exact-
ness than Galen the various branches of the nervous system.   They dis-
tinguished  better each part, followed farther the distribution of vessels
and nerves, and corrected  some  material errors of antiquity on this
branch of anatomy.  They  assured themselves, for  example, that  the
nerves of the cerebrum,  cerebellum,  and spinal marrow, served equally
for sensation and motion.   Nevertheless, the most of the ancient preju-
dices concerning the organs of sensibility and mobility, as well  as the
manner in which they executed their functions,  still existed.  A suffi-
cient number of experiments had not yet been made, to establish a rational
opinion  on this subject, consequently only more or less  plausible con-
jectures could  be formed.   There was so much uncertainty on this sub-
ject, that a Cesalpinus  could,  without a too great paradox,  renew  the
           25 
394
REFORM  PERIOD.
 theory of Aristotle which made the heart the origin of sensation and the
 seat of the soul.  Very much later, toward the end  of the seventeenth
 century, Baglivi published a theory which referred the vital movements
 to  two structures—the heart and the dura mater.   He supposed that
 the latter is agitated  by a continual oscillation, which  is transmitted
 from the membranous envelope of the nerves and thence to all parts.0
   There remained, therefore, at the commencement of the Beform Period,
 an ample harvest of discoveries to be made on the texture and functions of
 the nervous system in general, as well as in each of its divisions, in par-
 ticular.  The progress of comparative anatomy, and experiments on living
 animals, during this  period, cast vast light on neurology.  At the close
 of  the last century, the vascular organization of the gray substance of
 the brain was known; it was no longer a question, that the encephalon
 was the organ  of sensation and voluntary motion, and the seat of the
 mind.  The splendid researches of B. Vieussens, Haller, J. F. Meckel,
 Vicq d' Azyr,  A. Scarpa, Th. Soemmerring, and  of  a great  number of
 other physiologists, had put this fact beyond question.   They had de-
 monstrated that the dura-mater receives no nerves, and that it is desti-
 tute of all  sensibility and could not be the source of any movement.  It
 was shown, also, by rigorous observations,  that all the nerves coincide
 and are united at the base of the brain, in that part termed the protube-
 rance annulare, from which it was inferred with some probability,  that
 this was the sensitive center of the animal—the place where all the sen-
 sations centered, and from which go forth all voluntary and reflex actions.
 Nevertheless, other observations, of which we shall speak farther on, led
 to the belief that the  encephalon  is a complex organ, each division of
 which fulfils a special function.  At this time  Xavier Bichat  proposed
 to divide the nervous system into two very distinct departments, though
 united by numerous  communications.  One of these  departments, com-
 posed of the encephalon, the spinal  marrow, and their annexes, subserv-
 ing, according to him, the operations of the understanding and the will,
 is the principal organ of the life of relation or animal life; the other,
 including  the great  sympathetic, its  ganglions and plexuses,  gives im-
pulse to the acts of organic or individual life—to those functions in vir-
tue of which an individual  transforms into his own structure nutritive
molecules, and casts off those which are effete, or worn out, and injurious
to the system.  This division, which  has been an object of deep criti-
cism,  offered to its  author opportunities  to develop many interesting
 observations.
  During this period  the ancient supposition, that the membranes  were
0 Baglivi, Opera Omnia, Lugduni, 1745, page 241. 
ANATOMY AND  PHYSIOLOGY.
395
 entirely derived  from  nervous ramifications, completely disappeared.
 Very delicate  dissections proved that the nerves, far from terminating
 in aponeuroses, separate from  their neurilema, and preserve only their
 medullary pulp at their termination.    Hence  it was  concluded, that
 it  is in  this  last condition  that  the  nerve  receives  the  immediate
 impression  of  objects, and transmits it to the brain, by the intermedia-
 tion  of the nervous filaments.  In this  way, exploration was made of
 all the functions of sensation—sight, hearing,  smell, taste, and touch.
   How different is  this explanation, so simple, based on the anatomical
 disposition  of parts,  and  separated from the  imaginary hypotheses
 believed by the ancients, and accepted by the moderns until  the begin-
 ning of the seventeenth century!   Empedocles  appears  to  have been
 the first who, to render an account of the sensitive impressions, supposed
 an elementary affinity between  exterior objects and the organs of sense.
 He thought that there exists  in each of our organs a force which governs
 and attracts from other bodies the molecules similar to its own.  The
 eye, for example, being of a resplendent nature, attracts, he said, the
 luminous molecules from  bodies; the ear, which is of an airy  nature,
 must attract sonorous particles.  The nose has a vaporous, the tongue a
 humid, and the organ  of  touch,  an  earthy constitution.  Aristotle,
 Galen,  and  their successors, did not make  any special modifications in
 this theory.   They added only to  the hypothesis of Empedocles the
 consideration of spirits, of which they made  as many species  as  we
 have  different  senses.   These  spirits,  invisible and  impalpable,  were
 secreted by  the brain, and transmitted  to  the external  organs of sense
 by the  nerves.   The visual spirits connected themselves with the organ
 of sight, where they put  themselves in communication with the luminous
 particles of bodies; the  auditive spirits  were connected with the ear,
 where they  were  associated into sonorous particles, and so on for the
 other senses.
   From the beginning of the seventeenth century, the celebrated  mathe-
 matician  Kepler,  announced  that the  crystalline lens  is not,  as had
 been  supposed till that time, the seat of vision, but that its function
 is to refract the rays of light.   He observed that the image of  objects
 is painted on the retina.   The Jesuit Schemer confirmed these observa-
tions, and extended them, and demonstrated that the  expansion of the
 optic nerve is the essential part in the  organ  of sight.   Many other
learned men. and especially physicians, submitted the various membranes
and humors of the eye to an attentive examination, so that this  organ,
so marvellous and complicated in structure, is one of the best understood
in the organism.   The researches of the  great  Newton,  on light and
colors, contributed also  to perfect the theory of the visual function. 
396
REFORM  PERIOD.
  At the same time, Casserius and  other anatomists studied the organ
of hearing.  The osselets and the small muscles of the internal ear, and
the semi-circular canals, were  described.  The  acoustic nerve was  fol-
lowed in its windings and ramifications.  Duverney published a remark-
able  monograph,  in which, by  the aid of comparative  anatomy,  he
corrects several errors which had escaped his predecessors, and adds new
details to what was already known.   B.  Vieussens established the true
seat of  audition in the membrane which lines the drum and labyrinth.
Lastly, Cassebohm,  Valsalva,  Morgagni, Geoffroy,  Lecat, Comparetti,
Scarpa, and others,  added several improvements to the notions of their
predecessors, on the organs of sense.0
   Many conjectures have been emitted, and many researches and  experi-
ments attempted  by moderns  to explain the functions of the nervous
system.   Some have regarded the nerves as tubes of extreme delicacy,
containing a subtle  fluid,  which receives the impression of objects and
transmits them to a central point, situated in some portion of the brain.
Others represent the nervous  fibrillae as cords,  all ending at a common
center.  Charles Bonnet renewed the hypothesis of  Hartley, according
to  which each nerve is supposed to contain as many distinct fibers as it
receives varied sensations.  For example,  the  organ of sight must be
 composed, according to the naturalist of Geneva, of as many kinds of nerv-
 ous filaments as there are colors ; that the  organ of  taste  must  have as
 many varieties as there are different flavors; and so for the rest.
    Thomas Willis was one of the first to consider the brain as an assem-
 blage of various apparatuses, and assigned special functions to some of its
 divisions.  He placed the seat of common sensation in the corpora striata
 —the imagination in the  corpus callosum—the  memory in the  cortical
 substance, etc.   Cabanis, to explain the influence of  the physical on the
 moral man, compared the functions of the encephalon to  those  of some
 other viscera.  He  said that the brain  effects all the operations of  the
 understanding, as the  stomach and intestines accomplish the digestion of
 food—as the liver secretes bile, the kidneys urine,0 etc.:  but is not this an
 abuse of induction ? and  can one establish a perfect  similitude  between
 a  material effort exercised on visible and palpable substances, as the
 alimentary bolus, which we may follow  in its successive transformations,
 and the  elaboration of   thought—the  abstract  and immaterial result
 of a function whose mechanism is  unrevealed by our senses ?
  Q Besides these several authors, great interest will be excited by consulting the
fine researches made in our times  by G. Breschet, on the organ of hearing and
audition in marj, and the mamifers, birds and fishes.
  | Rapports du Physique et du Morale, de PHomme, par M. L. Peisse. 
ANATOMY AND  PHYSIOLOGY.
397
  Thus far we  have given  only hypotheses;  the following opinions
appear less conjectural, and are the result of more attentive observations :
P. Camper, having compared a great number of heads of men and ani-
mals, remarked that, in proportion as we descend from the higher classes
to those that are inferior in the animal scale,  the forehead recedes more
and more, and  the  jaws become more elongated.  So he thought that
the  facial angle is  the  most certain  index of  the development of the
intellectual faculties.  Was it from a similar observation that the Greek
artists gave to the heads of their divinities an  elevated and  prominent
forehead ? °
  Pinel  and  other pathologists  had already  observed that in various
states of  mania, delirium, or partial insanity, certain  mental faculties,
such as the  memory, attention,  judgment, imagination,  will, etc., were
abolished or  suspended, while  others  preserved  their free exercise, or
even acquired more energy; and they inferred  from this, that each of
the faculties must have, in  the  brain, its own  seat, or, in other words
belong to  a special section  of that organ.
  After a series of patient and ingenious observations,  Gall thought he
might emit the  following  propositions: First, the development of the
mental faculties is in constant proportion to the volume of  the brain.
other things being equal; second, each part of this viscus is the instru-
ment of a distinct and independent faculty;  third, the  cranium being
molded in nearly an exact manner upon the  encephalic mass, it can be
determined, by the  inspection  of the bony box, what  is the volume of
certain portions  of the encephalon, and from this determine what facul-
ties are predominant, or are defective, in an individual submitted to an
examination.  At the same time,  Gall introduced an entirely new classifi-
cation of the faculties of the understanding ;  but though he commenced
publishing his  discoveries before the close of the eighteenth century,
their complete manifestation and propagation belong to the nineteenth cen-
tury, and for this reason we shall carry no farther  our exposition of his
system, t
                           ON  GENERATION.
  The generative functions in viviparous animals, such as man, may be
divided  into  three  periods,  namely,  impregnation,  pregnancy,  and
accouchement.   We  shall speak  here  only of the  first, the  other two
being referred to the chapter on  obstetrics.  This  subject always  occu-
pied the reflections  of philosophers and physicians, who, in  default of
positive data, did not fail to erect hypotheses, more or less ingenious.

       ° See the work of Camper, published at Utrecht in 1791-92.
       | Anatomie et Physiologie du System Nerveux; Paris,  1810-1819. 
398
REFORM  PERIOD.
   Galen describes with sufficient exactness the genital  parts of man.
 He very justly observed that the artery and spermatic vein of  the  right
 side took their origin, one from the aorta, and the other from the vena
 cava, while the artery and spermatic vein of the left side emanated from
 the renal artery and vein.  The same disposition is met with in women,
 in regard to the ovarian arteries  and veins.   Moreover, this anatomist
 believed that there existed a perfect analogy between the genital organs
 of the two sexes, with this sole difference, that in the male these organs
 have been pushed outward by the heat of his temperament, while in the
 female they are retained within the body, owing to her natural coldness-
 He called the ovaries the testicles of the female, and supposed that in copu-
 lation they secreted a spermatic liquor analogous to that in man.  He
 believed, also, that the womb was divided into two cavities,  which proves
 that he had only examined that viscus in the females of animals.
   On  these  anatomical  data, partially true, he founded the  following
 explanation of the act of generation:   " The  womb," he said,  "having
 received, at the time of coition, the seminal fluid of the man and of the
 woman, the two are mingled.  But that of the woman only serves to
 nourish the other, and to produce one of  the envelopes of the  fetus.
 The semen of  the male, almost as soon as it is received into the womb,
 is changed  into membranes.  Some of these  membranous   textures
 remain always in the same condition, others become gradually thickened
 and hardened, and are transformed  into cartilages, these  into bones,
 which serve as the framework of the body.  Others  are  folded or hol-
 lowed, and elongated in a way to form the tubes which  are  called arte-
 ries or veins.   Others, in fine, are extended into filaments, and produce
 fibers or nerves.   The body  of the animal being  thus arranged, each
 part afterward attracts that which is necessary to it."
   In relation to the  procreation of the sexes, Galen shared  the opinion
 of Hippocrates, who taught that the right testicle |n man furnishes the
 seed for males, the left for females ; that the  male embryo was always
 developed in the right cavity  of the uterus, while  the  female  occupied
 the left.
   Such is a summary of the  knowledge that  antiquity transmitted to
the middle ages, on the reproductive  function, and which  came  down,
 without  any modification, to the  sixteenth century.  Then only were
efforts made to rectify some of the material errors of  Galen, on the con-
 formation of the genital organs  of women.   It was  demonstrated, for
example, that the womb had but one cavity.  Fabricius d'Aquapendente
made the first experiments,  in order to ascertain the  particular part
 that each portion of  the sexual organ played in the act of reproduction.
 He killed pullets  after coition, and saw that  among  the little yellow 
ANATOMY AND  PHYSIOLOGY.
399
round grains, disposed like a bunch of grapes, which constituted  the
ovaries, that there was one which enlarged, in which vessels were devel-
oped, and which at length became detached and traversed the oviduct, or
the cloaca, to be thrown off in the form of an egg.
   At a later period, Harvey repeated  the  same researches, on  bitches,
and obtained analogous results.   He states positively, that the matter
furnished by  the female,  in the  generative  function, is  a germ.   He
emits the premature  and  too general opinion, that  every animal pro-
ceeds from an egg.   DeGraaf experimented on rabbits, and made still
more precise observations.   In  explaining the texture of the genital
organs of women, he substituted the word  ovaries for the  inconvenient
term of female testicles.
   In order  to ascertain  if what Hippocrates and Galen had said, was
true, touching the function of the right testicle, which they said always
generates males, and the left one females, he made the following experi-
ments : first, he took away the right testicle of a  rabbit, and afterward
coupled it with a female ;  she brought forth, in due time, young of both
sexes.  Then he took away the left testicle of another rabbit, with  the
same results.   In order to find out,  also, if each ovary furnished ovules
of both sexes, or of one only, he ligated, in one female rabbit, the right
ovarian duct, and in another one the left.  Each one bore young of both
sexes: whence it is permitted to conclude that the theory of Hippocra-
tes on this subject, which had been confirmed by Galen, and adopted by
all antiquity, must be classed among fictions.
   A mass of hypotheses were conceived,  to explain the mysterious acts
of generation, but it is not our purpose to mention  them  here.   We
shall simply say that they may be reduced to two  great classes, namely,
epigenesis and  evolution.
   In the first, it is  assumed that  the new being is formed, in all its
parts, by the aggregation of molecules possessing reciprocal  affinity,
and which arrange themselves in a certain order,  nearly as occurs in the
phenomenon of crystilization.  A special force, to which were given  in
turn the names of nature, pneuma, soul,  archeus, plastic force, essential
force, formative force, etc., presides  over the union and co-ordination of
these particles, and impresses on the new being its form, character, and
properties.
   The second class admits that the embryo pre-existed under some form,
and being vivified by the act of fecundation, it then commences a series
of developments, which must lead to the construction of an individual
similar to the one whence it proceeded.   The  partisans of this system
were divided into two sects—the ovarists and the  animalculists.
   The ovarists contended that the matter furnished by the female is an 
400
REFORM  PERIOD.
egg, containing  the  germ of the new being, and  besides, a substance
which serves for the nutrition and earliest development of the embryo.
This  system  was founded  on the observation of oviparous animals.
In  these,  indeed, the female furnishes, evidently, an  egg, which even
in a large number of cases, is laid, before the connection of the sexes,
and is fecundated externally.
   The animalculists contend that the new individual proceeds from  an
animalcule contained in the  sperm of  the male.  Leeuwenhoek was the
first who, by the aid of the  microscope, remarked in  the semen of
animals a prodigious quantity of small bodies, executing spontaneous
movements.   Later observations have  proved that these animals, termed
spermatazoa, always exist in recently ejaculated sperm,  and that similar
ones are not  found  in  any other humor  of the body—that they are
different in different species of animals, but are  not  identical in the
same species.  They are not seen in the sperm of an animal, except at an
age capable of reproduction,  and are absent before, as well as after, that
period.  Their number  is so prodigious that fifty thousand have been
estimated  in a single drop of the sperm  of  a cock,  the volume of which
is scarcely  equal to that of a grain of sand.  If in any way, as  by
electricity, distillation, etc.,  these animalcules are destroyed, or  if they
be withdrawn from the sperm, that liquor loses immediately its  prolific
virtues.   Such are,  in resume, the facts  on  which the  animalculists
support their system.   The great  Buffon  adopted this  system, after
modifying it, and popularized it by the  charms of his  eloquence.  For
ourselves,  to explain in two words  our sentiments on the subject of the
various  systems of generation, imagined up to this time, we say, in the
language of Horace: The philosophers  have disputed on this subject
from the beginning  of the world,  and the  question is still undecided,
            Grammatici certant, et adhuc subjudice lis est.

                     ON VITAL OR ORGANIC PROPERTIES.
   We  have seen that the ancients admitted that there are in crude
matter  two kinds of properties—one, which they termed elementary,
agrees with our chemical properties, and was supposed  to  proceed from
the elements  which entered into  the composition of all material sub-
stances.   These  elements, as is known, were four in number—fire, air,
earth, and  water.   The qualities  which  bodies assumed, from their
relative proportions,  amounted to eight: thus, a body could  be  simply
hot, cold, dry, or moist; or hot and dry, hot and moist,  cold and dry,
or cold and moist.
   The second order  of properties, recognized by the ancients, compre-
hended  hardness, elasticity, porosity,  etc.—in a word, what we term 
ANATOMY AND  PHYSIOLOGY.
401
physical properties.   These were supposed to depend on the figure, the
number, and arrangement, of the atoms, or unalterable particles  which
constitute  bodies.   By means of these  two  orders of  properties the
ancients flattered themselves to be able to explain all the phenomena of
inanimate nature.
   But in regard to living beings—man, for example—it was impossible
to see,  in the exercise of his  functions,  such as generation, nutrition,
locomotion, intelligence, etc., anything but the simple play of elementary
and  physical qualities.  Moreover, the greatest philosophers and physio-
logists  in  all time, agreed  to  regard each  individual of this class  as
endowed with an intrinsic, primitive force, named by different writers,
essence, nature, soul,  spirit, pneuma, etc.,  which  superintended, with
admirable  instinct,  the regular accomplishment of all  the functions,
unless interfered with by some  material obstacle.
   Among physicians some were especially attentive to the effects of this
intrinsic force;  they studied carefully its tendencies and followed most
scrupulously all its  indications: they were called Hippocratists.  Others
had  regard, principally, to the elementary qualities of the humors; these
were the Humoralists,  of whom Galen was  the  highest representative.
Others, in fine,  who  regarded  chiefly the  physical properties  of the
solids, and in  particular,  porosity, attributing to the tisssues only the
qualities of expansion and contraction.  These were named Methodists.
As to the Empirics, they disdained physiological considerations, in which
they were wrong: in a science as complicated and as difficult as that
of pathology, we must borrow light from all the  other sciences.   But
they would have been right, if they had said to the other  sects: you are
not ignorant that the  phenomena of the  animal economy are  produced
by three orders  of forces;  nevertheless, each  of you considers only one
of those orders  and  regards  the rest as of little or no value:  each one
of you is therefore in error.  Take for  example any function, say the
secretion of saliva.   Is it not  evident that in this function,  the vital
forces, the  physical forces  and the  forces or  properties elementary,
namely the chemical, concur simultaneously?  Now who can  tell the
part played by each of these three orders of forces in the  act of salivary
secretion ? No one.   It is therefore impossible  to  form  an exact idea
of this function, as long as an effort is made  to separate, by a mental
analysis, the forces  which  concur  to  produce it.   The function itself
must be studied, as  it is presented to our observation, that is to say,
synthetically and experimentally.
  At the restoration  of the sciences the ancient physiological systems were
reproduced under different  forms:  the iatro-mathematicians, versed in
the calculations  of the physical forces,  assumed to explain the functions 
402
REFORM PERIOD.
of the animal economy by the laws of mechanics.   They could see in
the secretions, the circulation, and the nutrition, nothing but the effect
of the elasticity of tissues, of the calibre of vessels, of the friction of
liquids, etc.  The chemical  physicians took  into consideration, exclu-
sively, the mixture of chemical elements : they spoke only  of alkaline
or acid humors, gases,  salts  and  fermentations.   The Hippocratists
had  especial regard  to the  influence of the intrinsic  force  of living
bodies,  a  force  which they  named archeus, soul,  or vital principle.
Up to this time as is seen, the physiologists made no distinction between
the properties  of organic  and  inorganic  matter; to  explain certain
acts of the animal economy they had recourse to the  intervention  of an
immaterial or quasi  immaterial substance, as the soul, the  archeus or
vital spirits ; they knew nothing of vital forces properly called.
  About the middle of  the  seventeenth century Francis Glisson, pro-
fessor in the University of Oxford, recognized in the  living solid tissues
a particular force which he termed irritability, and  which he regarded
as a sufficient cause for all the phenomena of life.  He said that all the
tissues  are  endowed with this  force in different degrees, and proposed
to divide  it into natural, vital, and  animal, accordingly as it is mani-
fested  by  movements more  or less  apparent, with or without the con-
currence of the will.
  These ideas  made but  little  impression on the medical world;  they
were even forgotten for more than sixty years, when John de Goester, a
Dutch anatomist, brought them again to  light. He however did not
well distinguish  irritability from  elasticity;  the   difference between
these two forces had not yet been established by  demonstrative ex-
periments.  Albert von Haller was the first who directed his investiga-
tions  towards this end,  and who,  by a  series of extremely ingenious
experiments, elevated the hypothesis of Glisson to a  demonstrated  fact.
He published in 1747 the result of his  immense researches, with the
modest title of Primce Linece Physiologies, a work in which are traced
for the first time the true characters  which  distinguish living tissues
from  dead  substances.   The  author gives,  in  it,  his opinion  on the
vital  contractility of tissues,   which he  distinguishes perfectly  from
contractility or elasticity.  He proves that the latter is seen in all the
structures, in tendons, in membranes,  as well as in muscles,  and that it
continues  for a short time after death ; while vital contractility is only
found in muscles and becomes extinct with the life.  He thinks that
the latter proceeds from nervous influence, for the nerves of the spinal
marrow being irritated, he says, the muscles,  which receive their nerves
from  these  parts, are violently convulsed, even on dead animals.   The
nerve of a muscle being tied or cut, it relaxes,  and  cannot in any way 
ANATOMY AND  PHYSIOLOGY.
403
excite  vital movement;  if the ligature is taken  off, it recovers its
vital contractility.   In fine, the weight that a muscle can elevate during
life is  sufficient to separate and tear it after death.0
  Ten years  later, in 1757, Haller published the  first  volume of his
great physiology,  with the  title  of Elementa  PJiysiologice  Corporis
Humani, the whole of which was not given to  the world  till 1766, two
years before the death of its author.  It was, if I may be permitted
the poetical expression, the song of the swan, the  crowning labor of an
existence  entirely consecrated to  the  profit of science and humanity.
Haller proceeded in the entire work with his usual circumspection, advanc-
ing nothing but what was supported on well established facts, and giving
the least possible influence to hypothesis.   Bich in a multitude of obser-
vations, which were his own, and in a vast erudition, he elevated to the
science of life an imperishable monument.  From this time physiology
had an existence, independent of physics  or chemistry.   It was demon-
strated that life has  its laws  and its  special forces, which  must be
studied after a particular method.
  These new  truths, which  were proclaimed  by Haller, excited, in a
lively manner, the attention  of  the  learned world.  On  all sides, men
hastened  to repeat  his experiments, and to  try new ones, in order to
confirm or refute his assertions.   The  celebrated naturalist, Felix Fon-
tana, was  one  of the most zealous and able advocates of the  doctrine of
irritability.   Haller, trying  to  ascertain  to what  mode of structure
muscular  contractility was  inherent, thought that this vital  princi-
ple depended  upon  gelatine, combined with an  earthy principle.  He
remarked, also, that there are stimulants  which act on certain organs,
but not on others.    Antimony, for example, which irritates the stomach,
even in small  doses,  so as to provoke vomiting,  does  not appear to have
any influence  on  the  heart;   hence originated the idea  of specific
irritability.
  Theophilus  Bordeu applied this idea to the  theory of secretions.   In
his treatise on the position of the  glands, and  their functions, he com-
bats all the chemical and mechanical explanations with which writers
had been satisfied up till that time, and attributes the various  sorts of
secretions  to  the  proper  action of the glands, all  of which,  he says,
have their specific tone and  sensibility.   He emits a  conjecture,  which
was possibly the point of  departure for the researches,of Gall, on  the
philosophy of  the brain.  He says that  all the functions commence at
this viscus, which is divided into  as  many departments as there are
organs of  the  body.   The brain communicates  its impulse to the organs
° Haller's Elements of Physiology, French translation. 
404
REFORM PERIOD.
by the intermediation of the nerves;  nevertheless, he adds, this matter
is very obscure, and it  is  necessary to multiply  experiments, to  know
the brain, and the uses of  its different parts.0
  Peter Anthony Fabre, professor in the  Faculty at Paris, was the first
one to apply the doctrine of irritability to pathology.  He refuted the
mechanical theory of Boerhave, on inflammation, and proved  that this
proceeds, not from the obstruction of  the  capillary vessels, but from the
exaltation  of their irritability.  In  his  microscopical  observations on
frogs, he perceived that the blood moves in all directions  in the  capil-
lary vessels, whence he concluded  that in these vessels the  motion of
the fluids is  no longer under the impulse  of the heart, but under the
influence of irritablity. y
  Haller had demonstrated the existence of irritability in the muscular
fiber.  His disciples assumed it also for  other tissues, as  we have just
seen, but it remained to be proved by experiments, and a severe analysis,
that it does exist in all the tissues.  It was  necessary  to  show to what
degree, and under what circumstances, it  manifests  itself in  each of
them; in a word, it was necessary to  systematize the theory of vital
properties, to extend it  to  all the functions:  this work was undertaken
and  executed with much genius and boldness, by the celebrated Bichat.
  This man, whose career  was so short and so complete, commences by
tracing clearly the characters that distinguish vital from physical forces.
"The one," he says, " varies unceasingly in  its  intensity, energy, and
development, passing often with rapidity from the last degree of pros-
tration to the highest point of exaltation ; accumulating and wasting, by
turns, in the organs, and assuming under the influence of the slightest
causes a thousand various  modifications.   Sleep, wakefulness, exercise,
rest, digestion, hunger, the passions, the action  of bodies surrounding
the animal, etc.,—all  expose them each moment  to numerous changes.
The others, on  the  contrary, fixed and invariable, are the source of a
series of always uniform phenomena.    Compare the vital faculty of feel-
ing with the physical faculty of attraction ; you perceive that the attrac-
tion is always in  proportion to the mass  in which it is observed, while
sensibility changes constantly its intensity in the same organic part and
in the same mass of matter," J
  0 Bordeu,  Recherches Anatomiques sur la Position des  Glandes et sur leur
Action.  Paris, 1751.
  | Recherches sur differents Points de Physiologie, de Pathologie  et de Thera-
peutique. Paris, 1784.
  I Bichat, Recherches Physioligiques, sur la vie et sur la mort, pre. partie,
art. vn., § 1. 
ANATOMY AND  PHYSIOLOGY.
405
  Bichat reduced the vital faculties to two species, namely, the faculty
of feeling and the faculty of contraction ; but in each of these he admits
different degrees;  thus, sensibility is divided,  according to  him, into
organic and animal.  The first consists in the  faculty of receiving an
impression; it is common to the plant and  to the animal; the zoophyte
possesses it,  as  well as  the quadruped.  The second consists  in  the
faculty of  receiving  an impression and transmitting it to a common
center; animals provided with a nervous system are only endowed with
this.  As to contractility, Bichat divides it also into organic and animal;
accordingly as it is independent of the brain, as in the heart, intestines,
secretory organs, etc., or as it is controlled  by the will, as  in the muscles
of locomotion, of the voice, etc.
  In a later work the same physiologist admits that the vital properties
are  susceptible, not only of exaltation and diminution, but  also that
they may be modified and rendered unnatural; and he bases on this con-
sideration  the utility of specific remedies.   In fine,  he recognizes a spe-
cies of vitality in the fluids of the animal economy, but he avows, at the
same time, his inability to determine in what this vitality consists.
"Its existence," he  says, "is  no less real on  that account, and the
chemist who analyzes the fluids, has  before him only their cadaver, just
as the anatomist has but that in the solids which he dissects." °
   We must not forget  that at this  epoch  numerous and beautiful re-
searches were already made, by a celebrated surgeon of London, in order
to determine the vital properties of one of the most essential liquids in
the animal economy.   The treatise of John Hunter,  on the Blood and on
Inflammation, had placed beyond question the truth  that the blood, while
it circulates in a living body, enjoys certain properties which it loses when
it issues from the  vessels, or when the animal is deprived of life.   One  of
the  vital  properties of  the blood, on which the author insists  the most,
and which he regards as the principle of most of the phenomena of in-
flammation, is  the  aptitude of that  fluid to  coagulate  spontaneously,
that is to  say, without  the  addition of any chemical agent.   In fine,  to
the authors whom I have cited  as having  contributed to the progress  of
 anatomy and physiology, during  this period,  I must add the names  of
 Winslow,  Bernard, Sigefroy, Albinus, the two Alexander Monroes, James
 Douglass,  Vicq d'Azyr, and others.
0 Anatomie Generale, Considerations Generale.
* 
406
REFORM  PERIOD.
                        CHAPTEE  II.

                           HYGIENE.

   This branch of Medicine was, during the last historical period, con-
siderably extended.   It  became the  object  of meditation, not  only of
physicians,  but also of philosophers and learned men of all classes, and
governors and statesmen, who endeavored to ameliorate the  condition of
the physical life of the nations, and  teach them  more salutary habits.
Considered  from the most elevated point of view, hygiene embraces all
the objects of nature, and all the productions of art; for there is nothing
in the universe which may not be beneficial or injurious to the health
of man.   But the limits of this work and of our knowledge,  force us to
confine it to a circle infinitely more restrained.   It is customary now-a-
days to divide hygiene into two great sections, accordingly as it refers to
man living  in society, or as an isolated  individual.   We  shall conform
to this arrangement.
                      § I. On Public  Hygiene.
   We have  already  seen  in  the  commencement of  our history, with
 what foresight  the  legislator of  the Hebrews mingled with moral
 precepts a great number of  hygienic  prescriptions, appropriate to  the
 people,  and  the climate in which  they lived.   The  first sovereigns of
 Egypt had given this example, before him.  The founders of the Greek
 cities drew from that source a part of their  religious rites, and  their
 hygienic customs, to  which they added improvements.  Among others,
 they  instituted the gymnasium, and  carried the  gymnastic art to a
 degree of perfection that has not been since equaled.  Their exercises
 had not only the purpose of imparting strength, but  also grace, supple-
 ness  and agility.  We know that the athletic temperament was  not
 ranked  by them among the good temperaments.  In  Sparta, where  the
 only object was to make soldiers, the exercises had  only the  purpose of
 hardening the body against the fatigues of war.
   In  Borne, gymnastics took a worse  direction still,  for it was aban-
doned to the gladiators and slaves, who alone combatted in the circuses.
 The baths became, also, under the emperors, objects of luxury and
effeminacy rather than  salubrity.   But the construction of  aqueducts,
fountains and sewers,  the maintenance of cleanliness in cities, the atten-
tion to the  location of cemeteries without the limits of towns, and the 
HYGIENE.
407
importance which was attached to the duties of magistrates, all attest
that the earliest legislators of that sage people did not neglect the care
of public health.  Vitruvius, architect  to the emperor Augustus,  is
worthy of being consulted, not only as regards the perfection of edifices,
but also in regard to  their salubrity.  He  gives,  next  to  Hippocrates,
the best precepts on the location of cities.   He recommends that cellars
and  public  granaries be  constructed on the northern  side, because a
southern exposure is unfavorable to the preservation of stores.   He tells
us that the ancients  consulted the  livers  of  animals to judge of  the
nature of the water of a country, and the salubrity of its alimentary pro-
ductions ;  so that the  inspection of the entrails  of the victims of the
priests, instead of appearing to our eyes as a ridicilous superstition,  was
really a rational means to discover the influence of the waters, airs,  and
locality, on living beings.
   Among modern nations,  the  Turks, alone, mix with their religious
practices some hygienic observances,  such as legal ablutions, abstinence
from  certain aliments, and particularly wine ; but this last  prohibition,
which was designed to protect the sectators  of the Koran from  the vice
of drunkenness, has created among them  a custom  more fatal still—the
the use of opium.   The Lent of Mussulmen  must not be counted among
the number of well ordered hygienic  institutions, any more than that of
Christians,  for  the results  seem to me  contrary to the true  aim  of
hygiene.  Doctor Bruyer  sets forth, as follows,  the effects of  the first,
upon  health:  " Knowing," he says,  " the repugnance of every Mussul-
man to be out of his house at night, I made it my pleasure, as far  as
possible, to avoid being late in my return at the close of the day.  But
I was most careful during Ramazan, a month in which all  the faithful
take no nutriments from the rising to the setting of the sun—not even
a pipe of tobacco, or a cup of  coffee, or a drop of water.    This fast—
always painful to a lodger—is truly intolerable for a laborer, especially
when  its observance takes place, as I  have known it, during the longest
days of the year;  so to economize their  strength,  the boatmen row us
as slowly as  possible.   How  often  have I encountered,   at the  dif-
ferent quays of Constantinople, those who, fresh and active  at the com-
mencement of the fast, were, at its close,  so dried up, thin and wrinkled
that, without my dragoman,  I could not have recognized them."0
  In the Christian church, which proposes to elevate man to the highest
degree of moral perfection, and free him  from the bondage  of  his pas-
sions,   we must  not search for hygienic  rules embodied in  ecclesiastic
  * Neuf anne'es a Constantinople.  Paris, 1836, T. I, p. 149, chap. I, sixieme ex-
cursion. 
408
REFORM PERIOD.
 ordinances, but, owing to the  intimate  union which exists  between
 hygiene and morals, it often happens that the maxims of the Church are
 excellent  hygienic  precepts.   As to the European governments of the
 middle ages, the sole general measures of salubrity of  which their history
 has transmitted to us the account, are  the regulations concerning the
 sequestration of the leprous, and the establishment of free baths for the
 poor.   Also, it must be said that the attention to the cleanliness of these
 was so badly observed that the  baths, themselves, often became a focus
 for the propagation  of contagious diseases.   When syphilis took the place
 of leprosy, a part of the ordinances relative  to  leprosy  were applied to
 syphilitics, as has been heretofore remarked.
   It was  but a short time before the beginning of  the  seventeenth cen-
 tury that the governments of Europe occupied themselves with the state
 of public  health.    The lazaretto at Marseilles, was  the first estab-
 lishment  founded  to prevent the communication of the plague from the
 East.   Wise and strict regulations were promulgated on that occasion,
 and they have served as  a model for all  lazarettos founded successively
 in the other ports of the  Mediterranean.
   The idea of a lazaretto was  first conceived by French merchants who
 resided at Cairo and Alexandria.   These merchants,  observing that the
 Coptic monks, isolated in their convents, seemed to be secure from the
 pest, confined themselves also to their houses in the times of the epidemic,
 and  communicated  with  their  neighbors only from the windows or from
 the tops of the terraces that  crown  most of  the edifices in  the  Orient.
 The advantages which they reaped from this custom were such,  that it
 is maintained perfectly as a custom to this day.  The  Frank quarter, in
 Constantinople, is  generally preserved  from the plague by  a  careful
 sequestration, while the Turks, imbued with the dogma of predestination,
 neglect  all prudent measures, and perish, victims to their blindness.
  At present, commerce earnestly protests against the  rigor, and espe-
 cially against the duration of  quarantines.   The opinion of a majority
 of physicians is favorable to a  reform in this respect, and there are  men
who  go so far  as to discredit the utility  of these establishments  and
 demand their  suppression.   Nevertheless,  if we  compare the small
ravages that the plague has made in Christian Europe since their estab-
lishment, with the frequency of its invasion before that  epoch, it will be
difficult to deny the  importance and efficacy of these preventive measures.
From 1476 to 1649—that is to say, in a space of less  than two hundred
years—the plague  prevailed  sixteen times in  the city of Marseilles.
 Now,  it was only in the  first part of the seventeenth century that any
one seriously thought  of it as a contagion, and  employed any means to
 prevent it.  Up to that time pestilential epidemics had been  generally 
HYGIENE.                          409
 regarded  as a  scourge  from heaven, whose  progress no human barrier
 could arrest, and no more efforts were made to preserve the people from
 its ravages than  are made among Musselmen.   But after 1649, i. e.
 after the establishment of lazarettos and the  rigorous observation of
 sanitary rules, the plague has  prevailed but once in Marseilles during
 the space of nearly two hundred years.0  It is possible, and very proba-
 ble,  that  in the institution of quarantines, the measure of  strict neces-
 sity may have been passed, but it does not seem to me logical from this
 to argue their inutility, f
    It would be too long to  enumerate all  that  has been done or under-
 taken within two  centuries to render cities,  camps, districts of country,
 vessels, barracks,  workshops, hospitals, prisons, etc., more salubrious.  I
 should  be compelled to refer  to the works, not only of  physicians,  but
 also of chemists,  philosophers, magistrates,  generals,  navigators, etc.;
 for public hygiene is connected with all the sciences and arts, either to
• profit by their light or in turn to benefit them by its own, so as to make
 all converge to the well-being of the  people.  The abundance of mate-
 rials, therefore, becomes an obstacle  to their just appreciation.  How
 could we discern from among so many writings, discoveries, and improve-
 ments, those which merit the  preference ?   It would be impossible for
 me to avoid omitting some works, worthy as much to be mentioned, and
 possibly more so, than certain  of those of  which I should speak.  How
 shall I depict all  the efforts attempted in the last centuries by govern-
 ments, municipal  authorities, learned societies in particular, in order to
 ameliorate the physical condition of  man ?  The enlarging and opening
 of streets, the draining of stagnant waters, the removal of filth, the re-
 location of cemeteries and insalubrious manufactories from the centers of
 population, the draining of marshes, the chemical  analysis of  the air,
 drinks,  and alimentary substances, so as to determine of their elements
 those which are advantageous  or  injurious  to  health, the  research of
 means proper to preserve food, and the regulations of a sanitary police,—
 these are some of the objects  which  have  occupied learned men and
 statesmen.
    The Boyal  Society of Medicine gave a strong impulse to the labors
 concerning  public hygiene, by  the questions  put in the public concours
  °The plague of 1720 was the last that existed in that city, although it has fre-
quently been met with at its lazaretto, where it was arrested.
  | See the Dictionnaire des Scienc. Medicales, art. Hy«ie\e, by Halle and Nysten ;
art. Lazaret, by Fode're. See also the remarkable and important report made to
the Royal Academy  of Medicine, on the Plague and Quarantine; Bulletin de
PAcade'mie Royale de Me'decine, Paris, 1816, t. xi.
           26 
410
REFORM  PERIOD.
by  the  reports of its  committees, and  by the correspondence it main-
tained with  physicians  of all  countries, who  furnished  them  their
observations  on epidemics, topography,  and in general,  on everything
that concerned public health.  John Howard  offered to the world the
first example,  perhaps, of a  man  who traveled  neither  for his own
pleasure or health, nor for any advantage or personal interest, but solely
for  the love of humanity.   Hospitals, prisons, and lazarettos, attracted
his  attention ; he devoted his fortune and his existence to the ameliora-
tion of  the  condition of the unfortunate, who were shut up  in them.
A. A. Parmentier signalized, also, his  zeal for the  poor, by occupying
himself, successfully, in regard to means to increase their alimentation.
Thompson, Count Bumford, illustrated  and  made dear his paternal
administration, in Bavaria, by  the establishment he founded  for the
purpose of procuring labor  and bread for  necessitous classes.  Guyton-
Morveau  proposed  excellent  means  of disinfection,  which  are still
employed  in many cases.  The health  of  soldiers  and seamen attracted
the  attention of many observers, and gave rise to numerous publications,
among which we distinguish  those  of  Bouppe, Lind, Poissonnier des
Perrieres,  Pringle, Donald Monro, Van  Swieten, Colombier, Gilbert and
Desgenettes.
  But of  all the conquests which public  hygiene has made in these
latter times,  there is one which merits a special mention.  Variola pre-
vailed, periodically, in both worlds;  it took from the population of Eu-
rope an annual tribute which is  estimated to have amounted to not less
than four  hundred thousand souls, and mutilated and disfigured nearly
as many more.   A woman  of great spirit and character, Lady Wortley
Montague, had, indeed, imported from  Constantinople  the practice  of
inoculation,  which  has much merit,  but is  not free  from  reproach,
because it exposes its subjects to almost as much danger as the spon-
taneous contagion.
  A physician of Barkley, a city of the  county  of Gloucester, having
heard it said, or having remarked, that the disease known in the  western
provinces  of  England under the  name of cow-pox,  was communicated to
those who  kept or milked cows habitually, and that this affection, which
was very slight, protected completely those who had passed through it,
from the  variolic affection, meditated  on this strange  fact, verified it,
and conceived  the happy idea  of inoculating children, directly, with
the  virus taken from the udder of the cow.  At the end of three, four,
or five days, he saw  pustules  developed, at all the  points  of the skin
which he had pricked, similar to those of cow-pox ; then  the pustules
broke, the pus dried and  formed a small crust, which in  falling left a
cicatrice.  Besides, there was little or no  fever, the children continuing 
HYGIENE.
411
to eat and play as usual without realizing any bad symptoms.   Not one
of those children was ever attacked by variola.
  Jenner, after having repeated his experiments for a number of years,
and  being assured of  the  inocuous character of  the virus, and its
prophylactic  virtue,  convinced, finally, of the reality and grandeur of
his discovery, decided to make it public, and  consigned  all  the details
of the subject to a volume printed at London, in the year 1798.°  Great
was the stupefaction in  the medical world at the announcement of such
an astonishing marvel.   It seemed impossible to imagine that a pest as
ancient and as formidable as variola, could be expelled forever by a pro-
cess so simple and benign as vaccination.   The discovery of Jenner met,
at first, with much opposition.  The incredulous raised against it many
objections  of every kind, and it  gave  rise to a very spirited polemic
between its defenders and opponents; but I shall not retrace the phases
of this contest now terminated, and whose ultimate result  has been the
adoption of the new specific, in every country into which European civili-
zation  has  penetrated.   I will only observe that after the victory, there
was a disposition to contest  with  Jenner the honors of his triumph  ;
some ambiguous passages from old books were uncovered from the dust
of libraries, and certain popular traditions were recalled, that had pre-
vailed in some obscure  province, to find in them the germ of the admi-
rable discovery of the English physician, as if all ideas,  all  new inven-
tions, are not the consequences of some anterior idea  or invention !  But
even this does not diminish the glory of the discoverer, for the  develop-
ment given by him to those  ancient ideas is great  in itself, and emi-
nently useful in its results.   Now when I consider the sagacity, patience,
and exquisite judgment of which Jenner gave proof  in his long experi-
ments, when  I consider  the immense benefit of his discovery,  I no longer
discuss his genius, I have language only to praise and bless him !
                        § II.  Peivate Hygiene.
   Among the original and important writings with which this department
of hygiene was enriched during this period, I  will cite, in the first place,
that of Sanctorius, entitled, Aphorisms on Static Medicine.   It was com-
posed under the following circumstances: Being desirous to estimate the
quantity of insensible humor that was exhaled each day from the human
body, and to determine the  relations  which connect this function with
the various actions of the different states of the economy, such as diges-
tion, exercise, repose, health,  disease, age, season,  etc.,  this  physician

  ; Jenner, An  Inquiry into the Causes  and Effects of the Variolas Vaccina1.
London, 1798. 
412
REFORM PERIOD.
had the idea of arranging a seat on the platform of a balance, in  such
a way as to be able to take the weight of the body at every hour of the
day, if he desired it, both before and  after sleep, meals, the emission of
urine and feces, in a word, before and after each function whose opera-
tion is important to life.  He continued, for  thirty years,  his daily
experiments;  then  he consigned the  general  results which  he had
obtained, in a small collection of aphoristic sentences, of which the fol-
lowing are specimens:
   " All diseases proceed from an excess or defect  of transpiration.   If
a physician who has the care of a man's health, has regard only to the
nutrition and sensible evacuations, without knowing how much trans-
pires each  day from those who are confided  to  him, he is ignorant  of
their true condition,  and is unworthy of the title  of doctor in Medicine."0
   "To evacuate very much by stools,  urine, or sweat, and  but little by
transpiration, shows a state of disease."!
   " Why is swooning of great utility  in high fevers ?  Because it dis-
poses the body to sweat freely. "J
   " A man in health loses in a  day, by transpiration, as much as  he
passes in fifteen days by the bowels, though  he  have a stool  of perfect
fecal matter every day."§
   " If a person drinks to excess during  the night, and the body returns,
neither by coction nor indigestion, the  next day,  to its natural state, the
following verses are applicable to his state:

                 Si Pon est malade au matin,
                 D'avoir passe la nuit a hoire,
                  II faut envoyer chez Gregoire,
                  Et se guerir avec du vin."||

                 If you find yourself sick in the morning,
                  Having passed the night in debauch,
                  The wine of Gregory will cure you,
                  Send quickly to him for a draught.

   "He who sleeps transpires  double as much as when  he  is  awake.
Hence the  following axiom: Two  hours  rest when awake, are  not worth
much more than one hour of sleep."00
   The publication of Sanctorius was hailed  as a revelation from  the
god of Medicine, a  true code of hygienic laws.  Their author was
saluted with the title of second  Hippocrates, and  his sanatory  maxims
put on a level, or above those of the old  man  of Cos.  His salary as
professor in the University of  Padua, was continued to him by a decree

  °lst section, Aphor. 2d, translation of Lebreton.  Paris, 1722.
jlbid. Aphor. 14.  JAphor. 98.  §Sec.  3d Aph.10. ||Aph.78.  : Ithsec., Aph. 18. 
HYGIENE.                          413
of the Senate, and Venice, where he finished his days, in 1636, erected
a statute to his memory.
   Nevertheless, if we  submit to a severe  critic the work of Sanctorius,
we find it reprehensible in several respects.  In the first place his con-
clusions are too  general  and too  absolute, for from  experiments made
upon one individual in one climate, he makes inductions for every body
and  for all climates.  In the second place, several inevitable causes of
error entered into his  calculations, among others, the two following:  he
took  no account  of the  pulmonary exhalation and  absorption, nor of
cutaneous  absorption.   In  fine,  several  observers  have  repeated  in
various countries  the experiments  of  Sanctorius,  and all  obtained
extremely  variable results.  From this it appears that there is nothing
more changeable than cutaneous  transpiration, and  that to  determine
its quantity would be  as  impossible, says Bichat, as to pretend to specify
the volumes of water  that are vaporised each hour, by a heat whose  in-
tensity varies each moment.   The only general conclusion which may
be drawn from these numerous experiments is, that in a state  of health
this excretion is ordinarily very abundant—that it is less when we are
awake, and that  in every case it merits the attention of the physician
as well as  the physiologist.  If then these aphorisms of Static medicine
do not justify the enthusiasm  which their appearance excited, they do
no more merit  the neglect  into which they have fallen in  our days.
H. Boerhaave, whose  judgment has  had justly much weight, says that
no other book  in medicine has been written with so much care, and
Lorry has  added to it commentaries worthy of being meditated upon in
all time to come.0
   Cheyney, a physician  in London, had very much impaired his health
by excess  of pleasure and good  living.   He became excessively cor-
pulent, and suffered all the  inconveniences  of that state,  such  as
dyspepsia, lethargy,  indolence  and  other evils.   He devoted  several
years to the care  of  his health, and had the happiness to re-establish
it perfectly, by means  of a country-life, milk and vegetable diet, exercise

   0 De Medicina Statica, Aphorismi, Parisiis,  1770,12mo.  Sanctorius has esti-
mated the quantity of transpiration, compared with that of the urine  and feces
taken together, in the proportion of 5 to 3.  Denis Dodard a physician in Paris,
found that  the transpiration is to  all other excretions as 12 is to 15.  Sauvages,
in the south of France, and Gorter in Holland, obtained results similar to  the
latter.  James Keill, who experimented in England, assumes that the quantity
of urine surpasses that of the transpiration  at the rate of 38 to 31.  Linning,
who observed this matter in South Carolina, says, that the transpiration exceeds
the urine for five months of the year, and that the opposite occurs during  the
other seven months. We see therefore that there are as various results as there
are observers, which makes the reflection of Bichat entirely true. 
414
REFORM PERIOD.
and the Bath waters;  so that he was enabled to resume his very active
occupation and continue in it, to the c'ose of his life which took place
at the age  of seventy-two.  Cheyney enjoyed a great reputation as a
practitioner.  He has  left several works, of which  the  most estimable
is a monograph  on the art of preserving health and prolonging the lives
of valetudinarians.  He gives in it precepts which are still profitably
read.   He exalts above  all, the regimen suited to his condition, as did
Carnaro, whose history we have already given.
   Among the other writings  which contributed  to  improve  hygiene
during the last century,  I will  cite the following monographs : that of
J. B. Fisher, and of  M. J.  Boberts, on Old Age  and its Diseases; that
of Bamazini, on the Diseases of Artisans, which  Fourcroy enriched by
interesting notes;  the writings of Lorry, Junckcr, Bebdoes, J. Arbuthnot,
Halle ; those of Tissot,  which  have enjoyed so  much  popularity; in
fine,  the  general  treatises of  Tourtelle,  Moreau de  la  Sarthe;  the
Treatise  on Medical Police, by J. P. Frank ; the  Code of Health,  by
John Sinclair, etc.0
                        CHAPTEB  III.

                    GENERAL  PATHOLOGY.

  Pathology  was studied, during this period, under various aspects,
which we shall here content ourselves with indicating, very summarily ;
but will  speak of it much more explicitly in other places, particularly
in the chapters  devoted to  the  exposition  of theories  and  systems.
Some gave the principal credit to humors, in the generation of diseases,
conformably to the modified Galenic doctrine, or followed the principles
of the  new chemistry ;  others  saw in every morbid disorder only an
error or trouble in the governing principle of the economy, which they
named archeus, soul, nature, or vital principle ; others considered dis-
eases as a mechanical or dynamical derangement of the  action of the
solids ; others, in fine,  banished  from pathology the consideration  of
the causes and phenomena which were not  manifest to the senses, and
insisted  on the results to be obtained from pure observations  only.
From these different modes  of regarding diseases, there followed very
different pathological classifications, and, in  definitive, a more profound
and complete knowledge of the morbid state.
  D A new edition of the Traite des Maladies des Artisans, with considerable
additions, was published by Doctor Ph. Patissier.  Paris, 1822, 8vo. 
INTERNAL PATHOLOGY.
415
                        CHAPTEB  IV.

                   INTERNAL  PATHOLOGY.

                            § I. Semeiotics.
   A great number of physicians devoted themselves,  during this period,
to  the study of symptoms, abstractly considered, and  endeavored to
establish more  precisely their value.   They were  persuaded that each
symptom has its own signification, independent of the concourse of other
accidents,  and they strove to determine that signification.   We have
seen Sanctorius seeking the indications of good and  bad health,  in the
variable quantity  of  insensible  perspiration which exhales  from our
bodies at different hours of the day.   Others flattered  themselves to be
able to find, in modifications of the pulse,  signs more certain, concerning
the seat of diseases, their cause, gravity,  and probable  issue.
   A  Spaniard,  named Solano de  Luque, was the first  who, devoting
himself  to these researches, studied the pulse.   He studied medicine
at Cordova, under Joseph  de Pablo.   During his studies  he observed
the dicrotic or rebounding pulse, so called  when two rapid pulsations are
felt, followed by a short pause.  Astonished at this phenomenon, he asked
his master what interior condition of the body agreed with that  sort of
pulse,  and he received  the odd reply, that all these insignificant modi-
fications are produced by the sooty vapors  contained  in the arteries.
The student, but little satisfied with such an explanation, redoubled his
care in researches, and  came to the conclusion, that the dicrotic pulse
is a constant indication  of epistaxis.
   He observed, also, that a modification no less remarkable,  in the pulse,
usually precedes a critical sweat.   This modification is  a  first pulsation,
followed by three others, which increase to the last, somewhat like the
billows of  the sea that  roll  upon  the shore;  then commences another
series  of four pulsations, of  which the first is always  the  feeblest, and
which gradually augment in force.   He  named this pulse the inciduus,
because  the  fourth pulsation, which  is  the strongest  of the series, is
succeeded  by the first  or the feeblest pulsation of the  following  series,
so that the pulse seems to fall in passing from one quartenary series
to another.  Besides,  it is ordinarily  compressible, soft, and in that
case it announces, as  we have remarked, a sweat;  but if it exhibits
itself  accompanied with very  much  hardness, it  is the precursor of
jaundice.
   The intermittent pulse is  that in which a certain number of  pulsa-
tions are observed, followed by a longer interval than is usual. According 
416
REFORM PERIOD.
to  Solano,  this  kind  of  pulse  habitually  announces  a  critical
diarrhea.   If  it is soft, also,  it  indicates abundant urine;  if, on  the
contrary,  it is  hard, we may expect vomiting.   These are the  only
species of pulse on which Solano made his observations.   He consigned
them to  a large folio, where they are, as it were,  drowned in the midst
of an ocean of subtilties.  They produced no sensation in the Medical
world until they were  drawn  from obscurity by  an English physician,
James Nihell, who gave a  summary of  them, to  which were added the
results of his own experience.
   Sphygmics  acquired a very different importance from the researches of
Theophilus Bordeu.   This observer, whose sagacity we have  already
appreciated, undertook  to  connect all shades of health and disease to
certain variations of the pulse.  He took, in the first place, the pulse of
a good-conditioned adult, for a type  of a natural and perfect pulse, the
character of which he traced  as follows:  " This pulse  is regular, and
 ts pulsations are perfectly identical, and occur at equal intervals.   It
is soft, supple, free, neither frequent nor slow—vigorous without being
laborious."0
   Taking this as a type, the author points out  an incredible number of
species and varieties, which  are more or less removed from each other.
He distinguishes, for example,  a particular pulse for each organ;  among
others, he has a nasal, gutteral, pectoral, stomachal, intestinal, hepatic,
splenic,  renal,  menstrual  pulse, etc.   He  allows  a specific difference
between  the pulse of organs situated above, and those situated below the
diaphragm, and another between those of the right and left half of the
body.  Then  he gives,  also, the infinite  varieties  of the pulse produced
by the passions and diseases, as well as by certain medicines.
   We shall not attempt  to  follow  this author  into the labyrinth of
distinctions,  more  subtile  than real, into which  he enters.   If it were
true  that each  physiological, pathological, and  even  psychical  act
is revealed by the different shades in the pulse,  what tact, sufficiently
exercised or refined, would  be  able to seize these shades, often as imper-
ceptible and instantaneous as those of thought ?  What light could be
obtained from the extremely delicate and fugitive variations of the pulse,
when its most remarkable permanent modifications have only an equivo-
cal signification, and are connected with very varied states of the health ?
Thus the intermittence  of pulsation is  sometimes a symptom of  no
importance, while at other times it is one of the most grave.  Analysis,
as a method  of research, has been very much and  properly praised in
our times, but every method  has  its faults, and we shall have, on more
0 Bordeu, Recherches sur le pouls par rapport au crises, chap. in. 
INTERNAL PATHOLOGY.
417
than one occasion, to observe that analysis, pushed to its utmost limits,
degenerates into deceptive subtilties.   A  great number of physicians
repeated the observations  of Bordeu, either  to  confirm or  amend his
doctrine,  and   their united  labors  carried  sphygmics,  toward  the
middle of the last century, to a very high degree of perfection.   At the
same  epoch, a  modest  German practitioner  gave  to semeiotics a new
means  of  investigation, destined to acquire,  at  a  later period, a major
importance.  Leopold Avenbrugger published at Vienna,  in 1761, the
result  of  his experience, with  the title of New Method  to  Recognise
Internal Diseases of the Chest, by the Percussion of that Cavity P  This
discovery was not  much  noticed, even  in  Germany, though Stoll  em-
ployed it and eulogised it.  Sprengel, who wrote his history toward the
close of the last century, speaks of it as follows:  "I must also mention
another sign, which was discovered by Leopold Avenbrugger, and which
he asserts  to be the most important of all those  that compose  semeiotic
pathology ; it is the  sound which the chest gives when it is struck.  It
is impossible to deny that  the thorax, struck with the palm of the hand,
resounds differently when  the lungs are free and sound, than when they
are adherent, engorged, or ulcerated.  Avenbrugger has developed, very
well, this fact, in a particular treatise;  but he does it with a little too
much subtilty, for it  is scarcely credible that  he could have recognised
the various diseases of the lungs and chest by the sole percussion of that
cavity.  Nevertheless, his  observations merit to be read, and they have
been, in part, confirmed by Isenflamm.f
   The work of Avenbrugger was translated into French by Bosiere de la
Chassagne;  but his method  of  exploration  was  almost unknown in
France  until it had  been vulgarised by the  lectures, translations  and
learned commentaries of Corvisart.J  We shall see it in the end receive
an extraordinary extension and  perfection by the addition of another
proceedure not less ingenious, designated by the  name of auscultation.
   We find in the Hippocratic books a proceedure which has some rela-
tion to  percussion.   It consists in giving the  shoulders of the patient a
shake, by means of which the sound of a liquid effused into the thoracic
cavity may be heard.  This gross proceeding, termed succussion, appears
to have been abandoned by the successors  of the Asclepiadae, because of
its uncertainty  and the great inconvenience of its employment.
  0 Inventur novum ex percussione thoracis humani ut signo abstrusos interni
pectoris morbos detegendi.  Vienne, 1761.
  f Hist, de la Med., sec. xv., cap in., art. v.
  I See translation of Avenbrugger's work, from Latin into French by Corvisart.
Paris, 1808. 
418
REFORM PERIOD.
                     § n.  Pathological Anatomy.
  Pathological Anatomy, which was created towards the middle of the
preceding period,  rapidly grew,  and formed  very soon a considerable
branch  of pathology.  From the beginning of the seventeenth  century
a great number of physicians devoted themselves, assiduously, to necro-
scopy, and by their labors a considerable quantity  of materials was
collected.  Among the collections of the necroscopic observations of this
epoch, we  distinguish those  of Thomas Bartholin, Nicholas Tulpius,
Dominic Panaroli, John James Wepfer, Frederick Buysch, John Conrad
Peyer and Stephen Blancaerd.  These  materials were capable of  shed-
ding  a bright light  on the  seat and  nature of a certain  number of
diseases; but they were lost in a multitude of volumes.  In order to be-
come beneficial to science it was necessary to collect, examine, and classify
them, according to their analogies, to deduce from them the consequences
relative to the diagnosis  of diseases, and the practice  of medicine ;—an
immense task, which did  not, however, check the patient zeal  of The-
ophilus Bonet.
  This writer did not dissimulate the difficulties of his project, nor the
numerous causes of imperfection, inherent to a first effort of the  kind.
He  appreciates them, on the contrary, with very great justness, when he
says : " this work has cost me as much fatigue and care as the reader
will draw advantage from it;  for I hazard  myself without a guide on
an unknown path, where there is no perceptible trace  of man: I tread
with fear this long, rude and difficult path.  I know, he continues, how
far I shall fall short of my aim; but I hope that I  shall receive thanks
for having taken the first step in a career so eminently useful.0
  Bonet divides  his general  repertory of pathological anatomy into
four books.   In the first he collects all the diseases of the head: in the
second those of the chest;  in the third those  of the abdominal  organs:
lastly, the fourth contains observations relative  to  diseases  whose seat
is unknown, or which may attack  indifferently  all parts of the  body,
such as fevers, gout, syphilis, tumors,  wounds, etc.
  To give an idea of the quantity of matter contained in this work, I
shall only cite one example.   The eighth section of the second book is
devoted to  the exposition of the causes  of the palpitations and  pains of
the heart.   The following is an enumeration  of  these  causes according
to  necroscopic observations reported  in this chapter: a  tubercle,  an
abscess,  excessive heat, sanguineous plethora occasioning obstruction,
worms, sudden evacuation, pregnancy, inflammation, a pouch filled with
9 Sepulchretum sive anatomia Practica.  Genevse, 1700. 
INTERNAL PATHOLOGY.
419
water  or  some putrid liquid, a  miasmatic infection whether from the
exterior or interior, and  certain unnatural  adhesions.   These causes
exist sometimes  in the cavities,  or in the substance even of the heart,
or  in  the  pericardium,  or in  the arteries;  again, they are  in. more
distant parts, as  the uterus, liver, spleen, or stomach.  For each of these
cases the author reports one or several clinical observations, accompanied
with the  opening of the corpse.  There are  at least forty, relating to
pains and  palpitations of the heart.
   These observations have been complained of for their want of sufficient
detail; some of them for not being sufficiently authentic, and others yet
for presenting, as causes of diseases, certain results occurring after death.
These reproaches are well founded, and it must be agreed that this
enormous compilation shone more for the labor and patience of its pre-
paration, than for its invention and method; but such as it is, it con-
stitutes, nevertheless, an era in  the history of pathological  anatomy-
it served as a point of departure for ulterior researches, and principally
for those of which the immortal Morgagni published the  results, nearly
a century  later.
   The latter indeed did not propose, in composing his anatomo-patholo-
gical letters, more than  to  amend, and reconstruct in some sort, the work
of Theophilus Bonet.  Profiting  by the  riches which  the science had
acquired  in this interval, and  especially by those which  his master
Valsalva had collected; joining to a very extensive erudition a severely
critical habit, he established order and  clearness  where the author of
the Sepulchretum had left  obscurity and confusion reigning.  He showed
himself original,  without making any  pretension to it; in contrast with
so many others who make  much  pretension, without doing any  thing of
value.  He does not disguise what he borrows from others,  either dead
or living;  but what is his  own, is the choice and judicious employment
of materials, and his wise  and luminous discussion  of facts.  Persuaded
that medical  science cannot go forward except in the light  of  observa-
tion, he avoids scrupulously, turning  aside into the vagueness of inter-
pretations,  so that no one could apply to him that remark of Homer,
which he  himself recalls  in  his preface, " he has told  many lies  in
speaking of probabilities." Odyss.  lib. xix.
  The following selection will show his wise and circumspect manner of
discussion  :  " The great  Senac, it  is  said in the  twenty-third letter,
denies the  absence  of the  pericardium ;  on the other hand, he confirms
by multiplied observations, its adhesion to the heart; but he  teaches the
nature of this adhesion, and its  locality when it causes or prevents pal-
pitations.    Nor does he any more conceal how much care must be taken,
when it occurs at the same time with other causes, if,  above all, they 
420
REFORM PERIOD.
are grave, not to attribute hastily the  palpitation to adhesion ;  and he
asserts,  in general,  that when  several  causes are united  at  once,
the particular effect of each cannot be  distinguished, and even  then, all
united can produce certain phenomena to which  no one in  particular
could give rise."0
   The work of Morgagni appeared in 1762. From that time to the end of
the eighteenth century, a great number of physicians occupied themselves
with  anatomo-pathological researches, and added new observations to
those already  known.   Among these I must cite, more particularly, Th.
Walter, P.  Barrere,  Santorini, Edward Sandifort,  Andrew Bonn, G.
Hunter, John Ernest Greding, John Baptiste Palletta, Joseph Lieutaud,
Anthony Portal, and, above all, Xavier Bichat, who, uniting to a genius
eminently generalising, an admirable talent for analysis and observation,
shed, not only on pathological anatomy, but on  the whole of pathology,
a clear light,  whose rays have directed the labors  of most of his suc-
cessors.   The idea of  separating  the  human  body into  elementary
tissues, which present,  in  all parts  wheie they are found, the  same
properties, and are subject to the same  alterations, was a mother idea,
which has  now for fifty years served as the basis of the researches
of all pathologists.   Bichat comprehended well all these results, and he
presents them clearly and justly:
   " Chemistry," he says, " has its simple bodies ; these, by the various
combinations of which they are susceptible, form compound bodies;  such
are caloric, light, hydrogen, oxygen, carbon, azote, etc.  So,  also, anato-
my has its simple tissues, which by their combination—four to four, six to
six, eight to eight, etc.—form the organs.   These tissues are :  first, the
cellular; second, the nervous system of animal life ;  third, the nervous
system of organic life ; fourth, the arterial system,  etc.   Here are seen
the veritable organised  elements of our parts.  Wherever they are met
with, their nature is constantly the same, just as, in chemistry, the simple
bodies do  not vary, whatever may  be the compound into which they
enter.
   " The idea, too, of considering thus abstractly the different tissues of
our organs, is not an imaginary conception, it rests on real foundations,
and I believe  will  have a powerful influence on physiology and medical
practice.   In fact, from whatever point of view these tissues are studied,
they do not at all resemble each other.   It is nature, and not science,
which has drawn the line of demarkation between them." f
  0 Twenty-third Lettre Anat.-Med., translated by Doctor Destonet. Paris, 1820.
  f Anatomie Generale, edition of Beclard and Blandin.—Paris, 1831.  Compare
J. Henle, Traite d'Anatomie Generale, translated by J. L. Jourdan.—Paris, 1843. 
INTERNAL PATHOLOGY.
421
   A  little farther on  he adds:   "I divide pathological anatomy into
two great parts.  The first includes the history of the alterations com-
mon to each system, whatever may be the organ or region in which this
structure is  found.  It is necessary to  show, in the first place,  the
various alterations of cellular,  arterial, venous, osseous, nervous, mus-
cular, and other tissues;  to examine  the mode of inflammation,  suppu-
ration, gangrene, etc., proper to each of them; to speak  of the various
tumors of which they are susceptible, the changes  in structure which
they realise, etc.   After having thus indicated the alterations proper to
each  system, in whatever organ they are found, it is necessary to re-
sume the examination  of the  diseases appertaining to each region—to
examine those  of the head, the chest, the abdomen, and the members
following their ordinary course.   This progress is incontestibly the most
natural,  although, as in all the divisions by which  man  tries to bring
nature within his conceptions, there are many points to which they do
not apply."
   We thus see that in setting forth the advantages of the innovations
which he proposes, Bichat neither disguises the difficulties nor the abuses
to which it may lead.   "Do not exagerate," he  said,  previously, "this
independent relation which the tissues of an organ  hold to  each other
in regard to diseases ;  practice would contradict  us.   We now often see
that the cellular tissue is the means of communication, not only between
two tissues of the same organ, but also between different organs.   Thus,
in many chronic  diseases, are  the  tissues of the same organ gradually
altered, and,  at the opening of the body, the totality of the organ ap-
pears  to be affected, although a single tissue was  originally diseased.
In cancer of the breast a  small tumor is moveable, at first, under the
finger; in the  end the whole glandular, cellular, and even cutaneous
tissues, are confounded  in a common and cancerous mass.  The cancer
of the stomach, intestines, etc., presents the  same condition."0   I have
permitted myself to quote thus much on these points, because it shows
the true route pathological anatomy must follow, and because it proves,
at the same time, that this branch of the science can not be  separated
from  clinical observation without  losing much  of its importance and
utility.
                          §111. Nosogkaphy.
  It is impossible to  construct a  descriptive table  of all diseases, or
even of a small number, without adopting some order—some species of
Anatomie Generale, §vii. 
422
REFORM PERIOD.
 nosological classification.  We have shown that the outlines  of such a
 plan are to be seen in the works of the Asclepiadae.   In that collection,
 diseases are  sometimes divided into sporadic, epidemic, and  endemic,
 and sometimes into acute and chronic;  but the authors who first  made
 these divisions  did not adhere  to them strictly, at least from what  we
 may judge from the fragments that form the Hippocratic collection.   It
 was only after  the foundation of the school at Alexandria, and as the
 result of the influence of the Peripatecian philosophy, that the savans
 in  general, and physicians in particular, devoted themselves to arrang-
 ing, in a more systematic manner, the subjects they had to  treat.
   The  order most generally adopted by the ancient nosographers, was
 called the anatomical, and consists in classifying diseases according  to
 the portions of the body affected.  Thus, it was customary to  divide all
 the morbid affections into internal  or external, or which  follows the
 same plan, into medical and chirurgical—a bad distribution,  which every
 one blames, but which exists still in  most of  the treatises, and we have
 consequently been obliged to preserve it.   Then, internal diseases were
 divided  into  general and special.  The first class  comprised diseases
 which  seem to affect the whole system, not having any particular seat,
 such as essential fevers, gout, syphilis, poisons, etc.   The second class
 comprised affections whose seat is in one of the three splanchnic cavities,
 the head, chest, or abdomen.   There exists still another classification,
 famous in antiquity—that of  the Methodists, which  we have explained
 at  length, and which  we  will,  therefore, not repeat.   Lastly,  some
 authors  have divided diseases according to the age, sex, climate, etc.,
 but their divisions have only been adopted in special treatises, and for
 particular views, with which, at  present, we can not occupy ourselves.
 It will be only required here to give such classifications as were adopted
 in the general treatises, embracing the totality, or greater part of known
 diseases.
   We have said a word on the classification proposed by Felix Plater,
 at the  end of the sixteenth century.   It does not appear that it exercised
 a great influence, for we see a long time after, such  medical  authors  as
 Sennet, Biviere, Morgagni, and others,  follow the old method.  Never-
theless, toward the  close of  the seventeenth  century,  an illustrious
 practitioner of England, Thomas Sydenham, expressed a desire to see
composed a history of diseases, which would be free from all hypothesis,  in
which the sole effort should be made to trace with exactness the sensible
phenomena, and to distinguish the morbid species by their essential and
constant symptoms.  At that epoch, all the branches of natural history
had gained high  ground, and acquired  a precision till that time un-
known, thanks to the perfection of systematic  classifications introduced 
INTERNAL PATHOLOGY.
423
into science.   The naturalists had attained such skill as to  distribute
all  beings  which were  the  objects of their study, into classes, orders,
genera, and  species, separated from  each  other by well-marked  and
invariable characters, by means of which, it was easy to distinguish the
different species, notwithstanding their  multitude.   Medical men flat-
tered themselves, that  if they employed  an  analogous  method,  they
would be able to diagnosticate diseases with the same  precision and  cer-
tainty, as a botanist recognises and names a vegetable.
  Boissier Sauvages, a physician of Montpelier, scarcely twenty-four
years of age, conceived  a plan of nosography formed on this model.   He
conferred with the  great  Boerhaave, who  approved of it, without con-
cealing from  him, however, the extreme  difficulties of its  execution.
But the young man, more emboldened by such suffrage than frightened
by the obstacles which were presented, pursued his  project, and a  few
years after, in 1732, he published a first rough draft, with the title of
" New Classes of Diseases, arranged in an  order similar to those of the
Botanist."  This essay  produced only a  moderate sensation ; but thirty
years later, when the author published the same work, with the title of
Nosologie  Metiiodique, but entirely remodeled, and  considerably aug-
mented, the attention of all Europe was keenly excited.   The renown
of Sauvages, already great,  was carried to its height, and what proves
best the  extraordinary vogue, as well as esteem, which  the  Nosologie
Methodique enjoyed, is,  that the learned Linnceus used no other  work in
his  course at the  University of Upsal, for the space of twenty years.
  WThatever may be the discredit into which has now fallen that spe-
cies of composition, the Nosologie Methodique of Sauvages will always
be  worthy of the regard of whoever loves to follow the march  and
development  of a  science  as  difficult  as  pathology.   Besides that, it
offers, as the first link of  a  series of interesting productions, the most
complete collection of diseases described up to that  time,  and of obser-
vations collected from all parts.  I will now give  an  extract from it;
according to Chaussier,  Pinel,  and Bricheteau.0
  Diseases were divided by  Sauvages into  ten classes, forty-four orders,
three hundred and fifteen genera, and nearly two thousand four hundred
species.
  1st Class.  Imperfections,  (Vices) ;   Superficial or cutaneous affec-
tions,  the most of which  are  susceptible  of being cured by local  and
mechanical means.
  2d Class.   Fevers;   Commencing with  shivering,   followed  by  heat
  0 Dictionaire des Sciences Me'dicales, at the word Nosography; also  the Table
des Methodes Nosologiques, of Chaussier. 
424
REFORM PERIOD.
and sweat, with a frequent pulse, general pains, feebleness, prostration,
and oppression of the forces.
  3d Class.  Inflammations; Local phlegmasia with symptomatic fever.
  4th Class.   Spasms;  Convulsive diseases, permanent  or  periodical
contraction of the muscles of locomotion.
  5th Class.   Anhelations; Difficult  respiration,  spasm  of  the  chest,
without acute fever.
  6th Class.    Debility; Inability to  feel distinctly, to act  or execute
the movements or functions with the accustomed energy.
   7th Class.   Pains; General or  local, uneasiness,  not caused by
phlegmasias.
  8th Class.    Vesania,  or Insanity;  Lesions, more or less profound, of
the faculties  of the mind.
  9th Class.   Flux ; Accidental excretion, more or less considerable, of
fluids variously colored.
  10th Class.   Cachexias;  Depravation  or alteration  in  the  form,
color, and volume of parts.
  Notwithstanding the veneration that Sauvages  professed  for Syden-
ham, whom he names the glory of England,  and the Light of our Art,
he  has  not  strictly followed the counsel given by that  physician, to
write the  history of diseases without mingling with it  any theoretic
explanation or hypothesis.  The theory which Sauvages wished to estab-
lish was a mixture of the  ideas of Boerhaave with those of Stahl, of
which we shall speak hereafter.   What  I wish  to  remark at this time
is, the inclination of medical writers to decry, in the outset, all theories,
to demonstrate their falsity and danger, and immediately propose one of
their own, as being alone founded in reason.
  " There has not existed," says Sauvages,  " up to the present, any con-
nection between  theory and practice; the latter is acquired by tradi-
tion, and no  one has confidence  enough in his  theoretical principles to
follow them  blindly, when  the  life of a man is at stake.   The  three
principal laws of nosology,  dictated by  wisdom itself, are: First, make
an  exact and purely historical division of the species and genera of dis-
eases ;  second, distinguish philosophic theory or hypothesis from history;
third, establish the characters of diseases, on their constant symptoms.0
   A little further on, after having  shown  the difference that  exists
between the  philosophic  knowledge, which he names also etiology, and
the purely historical  and descriptive knowledge, he gives  the preference
to the first, in these terms :  " Philosophic knowledge aids  the historical,
opens  the way to mathematical knowledge, and  fills  the  mind with
0 Nosol. Method. 
INTERNAL PATHOLOGY.
425
agreeable sensations.   Happy he who understands the origin of things!
Philosophic nosology, therefore, is useful to physicians, and preferable to
the historic.  It distinguishes the Dogmatists from  the Empirics, with
whom all science consists in the historic knowledge of diseases.   But
where philosophic nosology is erroneous, and founded on false principles,
we must give preference to simple historic  nosology; for  it  is much
better to have no etiology than to accept a false  one, which  would only
serve to lead physicians into grievous  errors."0
   How strange, that, after having so clearly set forth  the temerity there
is in engaging in a search for the proximate causes of diseases, this author
yet dares  adventure in the  pursuit of  this chimera!   Such is, never-
theless, the inconsistency of Sauvages, and  of  nearly every writer  in
Medicine.   Whatever  there  is  of interest, to-day, in  the  work of the
first of nosologists ( and there is much) it is  certainly not applicable  to
the department of etiology, which has so much changed since his time;
but much rather to the descriptive part, which has but slightly changed,
notwithstanding the progress  of science.
   When the enthusiasm and astonishment  excited  by the novelty  of
this production, were somewhat cooled  down, criticism had its turn.   It
was  shown that the genera and  species were  too greatly multiplied,
throwing diagnosis  into confusion, and so much  the more, as they were
not always separated  from  each other, by symptoms sufficiently well
defined and constant.  Other faults were also pointed out, more or less
real.   Then a  great number of  physicians exerted themselves to trace
other nosological classifications, which they believed to be more perfect,
because they had not yet submitted them to criticism.  Each professor
was anxious to have  his own, and to attach to it his  name; but as the
greater number  of these productions only differed from each other in a
few variations, I shall  dispense with reporting them;  and, I therefore,
pass at once to that  of Cullen, which appeared in 1772, and which con-
stitutes a veritable progress.
   The nosology of William Cullen, professor in the University of Edin-
burgh, embraces four classes; nineteen orders; two hundred and thirty
genera; and, less than six hundred species:
   1st class. Pyrexiae:  Frequent pulse, shivering, augmentation of heat,
debility of the animal functions.
   2nd class.  Neuroses:  Nervous affections, lesions of sensation and
motion, without pyrexia, or local disease.
   3rd class.   Cachexies:   Depravation of the  natural  state of  the
                 * Nosol. Method.

27 
426
REFORM PERIOD.
system, or of a considerable portion  of it; without  primitive  pyrexiae
or neuroses.
  4th class.   Locales:  Affections of a part of the body, the organic
affections of authors.   This last is, according  to  the framer, the most
irregular of all, and purely surgical.
  In  this classification, as we see, the orders,  genera and  species, are
considerably reduced;  they are  besides, distinguished  from each other
by characters better defined and less variable.   It presents, then, a real
improvement on that of Sauvages ; it also  obtained  a universal vogue,
which it maintained till  the publication of the  Nosographie  Philoso-
phique, of Ph. Pinel, in 1798.
  This eclipsed all others,  and became  classic throughout Europe.   Six
successive editions, in  the  space of twenty  years, shows  the  confidence
it enjoyed.   During this  long  period,  it underwent some  revisals, of
which I shall say but  little, because it belongs  to  the  history of the
nineteenth century, and I shall,  therefore, refer to the first edition only.
  All the preceding nosologists  had embraced, in their  classifications,
internal and  external  diseases;  but  they included  the  last  for  mere
form  only, and gave them but a very succinct  and very  insufficient
description, to  which the  Surgeons  paid no attention.   Pinel did not
follow this plan, and was unwilling to comprise, in his classification, only
the internal affections or those from internal causes,  though  he does not
dissimulate how vague and inexact the line of demarkation is, which is
pretended to be drawn between diseases from  an internal or  external
cause.   He  avows, that  there  exist  numerous  intermediary  species
which may be  called  medico-chirurgical,  the position of which it is
excessively difficult, if not  impossible, to  determine.    Notwithstand-
ing  these defects, he believed  it right to  preserve the  division of
pathology into internal  and external.
   Consequently, he divided diseases which he regarded as internal, into
six classes, twenty-one orders, and eighty-four genera, as follows :
   1 st class—Fevers:  Frequent pulse, increase of heat,  lesions in most
of the pulsations, fixed duration,  etc.
   2d class—Phlegmasice:  Local pain, heat, and  redness,  with or
without the febrile state,  terminating  by resolution, suppuration, gan-
grene, or induration.
   3d class—Active Hemorrhages :  Effusions of blood from the surface
of mucous membranes, and other tissues.
   4th class—Neuroses:   Lesions of  sensation  and  motion, without
inflammation or alteration of structure.
   5th class—Diseases of the Lymphatic and  Dermoid Systems. 
INTERNAL  PATHOLOGY.
427
   6th class—Undetermined Diseases:  Comprising  the  genera which
are not enough related to each other to form general orders.0
   The historian Kurt Sprengel, who wrote at the commencement of the
ninteenth century, speaks of the Philosophic Nosography, and its author,
in the following terms:  " Faithful to nature and experience, like Hippo-
crates, whom he took constantly  for a model, and cultivated by the pro-
found study of the best  medical works published in all time, Pinel ranks
among the most skillful and learned physicians of our day.  His book is
a veritable chef d'ozuvre, both on account of the  excellent plan he  has
adopted, and by reason of the depth and impartiality of his judgment."
   The Nosography of Pinel offers numerous differences to that of Cullen,
of which the following are the most important:  The  Scotch  nosologist
has united in the same class, under the head of pyrexiae, fevers, inflam-
mations, and hemorrhage, while the French nosographer has divided these
affections into three classes.   The first distinguishes fevers either after
their type or proximate  cause;  the  second considers the totality of their
symptoms, and the  organs which they seem principally to affect.  Conse-
quently he admits  an order of angiotenic or inflammatory fevers, which
he believes derived from the primitive excitation of the organic forces of
the vascular system—an order of meningo-gastric or bilious fevers, pro-
ceeding from a  primitive affection of the membranous system of  the
primes vice, etc.   In regard to phlegmasia and hemorrhage, Pinel distin-
guishes them, also, according to the tissues where they are seated.  This
was an important innovation and happy thought, which has been made
more  fruitful, as  before  said,  by  the genius of Bichat, in his Anatomie
Generale, and  has  shed upon  pathology a clear light, and introduced a
new order of things.
  Among the nosologists who appeared before the close of the eighteenth
century, and  of whom we have not  yet made account, we shall cite,  as a
memoir only, and following their  chronological order, first, the  classifica-
tion of  Linnaeus, which  closely resembles that of Sauvages,  and  was
published twenty years later ;  second, the Prcelectiones de  Cognoscendis
et  Curandis  Morbis Prcecipius corporis Humani Affectibus, of B. A.
Vogel, professor at Gottingen;  third, the classification proposed by David
Macbride, an Irish physician, in  his Methodic Introduction to   the
Theory and  Practice  of Medicine;  fourth,  that  of  Melchior Sagar,
based almost entirely on that  of  Sauvages ; fifth, the Nosological Table
of  Louis Vitet, which may be  found in his Treatise on Materia Medica;
  0 In the sixth edition, these two  classes have been reduced to one, under the
title of Organic Lesions. 
428
REFORM  PERIOD.
sixth, that of Erasmus Darwin, published under the title of Zoonomia,
and remarkable for its originality, and the  poetical imagination of its
author, much more than for its severity of analysis  and exactness  of
observation;  seventh, and lastly, the essay of a  general classification of
diseases,  presented by Selle  at the end  of his Pyrethologie Methodique;
an essay which does not respond to the reputation of its author, and
which he did not finish.
  Sauvages after having examined at length, in his Prolegomena, what
should be the basis of a good nosology, concluded with Sydenham, that
it should  be based only upon the constant phenomena  and  sensible
characters  of diseases.  Nevertheless he did not unite example to pre-
cept, as we have before  said, for he does not  fail to seek the principles
or causes which constitute the essence  of each disease.  Let us see, for
example, what he says on the  subject of fevers  : "the cause of fever is
the distribution of the nervous fluid or forces, greater in the nerves of
the heart, than in the nerves of the members.  This  unequal distribu-
tion is  made to  destroy the obstacles which oppose  the circulation of
the blood in the capillary vessels, to disembarrass the sanguineous ves-
sels, and re-open a passage for the blood.   The heart and the  arteries
are the  principal  agents  in  fever."   All  the other nosologists,  not
excepting the sage Pinel, have fallen into the same contradiction, that
is to say, after having blamed loudly, the research after occult causes—
are themselves subsequently,  insensibly led  into this research, under
some pretext or other.
   One, alone, perhaps, forms  an exception to  this general statement.
This was Joseph  Lieutaud,  physician of Louis XVI., and author of an
anatomo-pathological  compilation, which we  have  before  mentioned.
M. Dezeimeris expresses himself #s follows, on the subject of his treatise
 on Practical Medicine : " this is the best work  of the last century, and
nearly the only one, up to a period very near our own, in which we find
 an author untrammeled by any system, consulting more the phenomena
 furnished by observation, at the bed side and in the amphitheatre, than
 the oft repeated  opinions of books;  and not seeking to fill by hypotheses
 the vacancies which  experience  has permitted  to  exist in the  science.
 Most  of the defects of  this remarkable  work may  be refered to its
 brevity; the author, from  having  sought to be short, is often  too  con-
 densed,  incomplete, and  obscure for  a reader who  is not sufficiently
 instructed.  These same defects are carried to  a still higher degree, and
 have destroyed the utility of another work  of Lieutaud, of which  the
 object was certainly the  most important which could have been chosen
 during  the  last  century:  I mean the treatise on pathological anatomy,
 in which Lieutaud undertakes to comprise all that had been learned up 
INTERNAL PATHOLOGY.
429
 that time, on the seat and causes  of diseases, by autopsy.   The  object
 is missed for the most part, because the  history of the symptoms  of
 diseases is nearly always  cut short—the  description of the alteration
 of the  organs often  insufficient; and because one can only with great
 difficulty fill  its vacancies, owing to the absence  of all references to the
 sources whence the facts were drawn."0
   In his  Precis de  Medicine,  Lieutaud has followed the anatomical
 order as much as he possibly could; for he  says there are many diseases,
 on which the opening of  the body teaches us nothing, and  it is good
 not to loose sight of this fact, in order not  to regard as an  omission the
 silence  which I maintain on this subject, in several articles.  As  to the
 research of occult causes, he was sensible enough not to engage in them,
 and gives the  following excellent reason; " as I have not been willing
 to bring into this collection  any hypotheses, I have  not  paused to con-
 sider the immediate and proximate causes  exposed with so  much vanity
 and presumption  in books,  though  always  impenetrable; but I have
 mentioned those that are termed evident  and remote,  which may unveil
 with much less ambiguity the character of diseases."
   These are sentiments worthy  of  all approbation, and we  can not too
 much praise those authors who have remained faithful to them.   But it
 does not suffice to avoid hypotheses in a nosology: it is also necessary,
 and this is capital, to give exact and detailed descriptions of each mor-
 bid species.   Too  much  brevity in  the description of diseases causes
 obscurity, which  is, after error, the greatest defect  in  a work of this
 kind.   The classifications may vary infinitely, because they depend  on
 the manner in which an author  surveys his subject, and as diseases are
 very complicated subjects, they  may be considered in a great number of
 aspects, but  the description   of each  morbid species, when well  made,
 preserves its value, independent of all changes of classification and sys-
 tem.   This is seen in some of the description of  Hippocrates, Aretseus,
 Alexander de Tralles, and all great observers.f

  0 Dictionnaire Histor. de Med.  Art.  Lieutaud.
  f At the moment of correcting this leaf, I  am put  in possession of the new
 work of Professor Bouillaud, entitled, Traite" de  Nosographe Me'dicale, Paris, 1846,
 5 vol. 8vo.  A work of this importance, by a clinical teacher, and a profound
 observer, like M. Bouillaud, can not  fail to fix the attention of the medical world;
 besides,  I think I ought to exhibit the plan adopted by the author in his nosolog-
 ical treatise.  This work is divided into Twelve Classes of Diseases, viz.;— Class I.
 fevers and inflammations, or pyrexiae.— Class II, affections consisting in a want
 of vital  excitation; appendix, excess  and defect of hsematosis.— Class III, ataxise
 of the nervous centers.— Class IV, miasmatic and virulent diseases.— Class V,
heterotrophic,heterocrinic, and heterogenetic diseases, not originating from inflam
mation.— Class VI, effusions in general, and effusions of blood or hemorrhage, in 
430
REFORM PERIOD.
                          CHAPTEB  V.

                 INTERNAL THERAPEUTICS.

   I examined, in the preceding period, the ancient therapeutical axiom,
diseases are cured  by their contraries,  and the result at  which we
arrived was, that this axiom neither clears up nor explains anything in
many cases, and that in others, it is in flagrant  contradiction  to  the
facts.   I concluded, therefore, that it should be erased from therapeutics,
at least as a general axiom, if  we wished to rest this science  on a solid
basis, whose certainty no one could contest.  During the present period,
the same  principle  appears under new forms;  at  the same time other
axioms will be proclaimed, concurrently with it,  some  of which are con-
nected with the ancient  doctrines, others  with  those  that are  entirely
modern; but as all the general principles of therapeutics are derived,
without exception, from some cotemporary physico-pathological  system,
we shall exhibit them conjointly with those systems, and submit them
to a thorough examination.   Consequently, we shall not discuss  them in
this chapter, and only speak for the moment of a small number of mate-
rial conquests of  therapeutics, of some evident ameliorations attained in
the treatment of  certain diseases,  the utility of  which is incontestible,
and whose merits are independent of all theory.

                          TREATMENT OF SYPHILIS.
   We have seen the venereal disease, taking the place of the  leprosy of
the middle ages, extend its ravages with a frightful rapidity, and throw
the people  into a terror nearly equal  to that which  its predecessor had
inspired.   The learned physicians sought in vain, in the Greek authors,
the means to combat this scourge ;  such as they found there were perfectly
inefficacious.    The surgeons, on the  contrary, who  had borrowed from
the Arabs certain mercurial preparations, which they employed against
tetters,  were naturally influenced to make a trial with the same prepa-
rations  against venereal pustules.   The  success that they  obtained
encouraged them to  persist in their use.   The  celebrated anatomist,
particular.— Class VII, solutions of continuity, and abnormal communications.
Class  VIII, changes in position and direction, or displacements and deviations.
Class IX, adhesions, connections, and abnormal insertions.— Class X, changes in
extension, volume, and capacity.— Class XI, foreign and retained bodies.— Class
XII, changes in respect to form, number, and existence of organs, and their
constituent parts. 
INTERNAL  THERAPEUTICS.
431
Berenger de Carpi, was the first who prescribed mercurial frictions with
discretion,  and watched their effects.   He  effected, by this  medication,
numerous cures.  Before him, Conrad Gilinus had made known, in the
year 1499, the composition of an ointment, in which quicksilver formed
the fourteenth, and  the bi-chloride the twenty-eighth part.  Gaspard
Torella, physician to the pope Alexander  VI.,  and of his son,  Caesar
Borgia, to whom he dedicated his work on the pox, in 1499, also  makes
mention of a mercurial ointment.
   This ointment was the first mercurial preparation used in Medicine,
and for a long time no  other was  known.0   An  old  prejudice opposed
the internal  administration  of any composition  of which quicksilver
formed a part, because  this metal was  regarded as a virulent  poison.
Paracelsus was, perhaps, the first  one who had the boldness to admin-
ister it- in this way.   He says that he did not consider mercury as a real,
efficacious  anti-venereal, and exempt from all danger, only when taken
in this way; and corrosive sublimate was  thought to form  a part of
some of his numerous secret formulae.
   Besides, under whatever form and by whatever way, mercurial salts
are administered, their employment requires precautions that were not
then known.   On this account, formidable accidents, such  as dysente-
ries, profuse and obstinate salivations that exhaust the  patient, convul-
sions,  paralyses,  and mortal  consumptions,  were often  observed  in
persons who  had used mercurials.  Such grave  accidents following a
mercurial treatment, most physicians abandoned it, and it fell into the
hands  of greedy charlatans, ignorant medicasters, and alchymists, who
employed it without stint  or precaution, after the example and faith of
Paracelsus, and thus brought it into discredit.
   At the same time, it was supposed  that  other means of healing, less
dangerous, and not less sure, were found.   The  decoction  of the wood
of guaiaeum produced excellent effects on many patients who had made
abuse of hydrargyria  preparations.  Thus  the chevalier Ulric de Hut-
ten, after having been in some sort saturated with mercury, found him-
self in a deplorable condition; he employed this decoction, and recovered
his health, against  all  hope.   Full of joy and gratitude,  he  wrote  a
book, to recount the marvels of this sovereign  specific.  Fracastor
devoted to its eulogy the major part of the third volume of his poem on
syphilis, published  in 1530.   Practitioners of the first  order  recom-
mended it, such as Nicholas Massa, who was also  a skillful anatomist,
and Musa Brasavolo, who  was decorated with  the title of  archiater, by
  °Guy  de Chauliac gives the formula of an ointment  into which mercury
entered for a tenth part. 
432
REFORM PERIOD.
four Popes, and with that of consulting physician by Charles V., Francis
I., and Henry VIlI.,-king of England.   Divine Providence was praised
for having created  this  precious tree in the  country even, which was
regarded as the cradle of the venereal pest, placing thus the remedy,  as
was said, by the side of the evil.  Shortly after, sarsaparilla and china-
root shared the antisyphilitic reputation of the guaiacum.
   But after a half century, the renown  of  these exotic vegetables fell
considerably.   The cures  effected  by their means,  became more and
more rare, and finally it was ascertained that alone, they had but little
efficacy, and that in our  climates they only succeeded when used  with,
or after, mercurial preparations.  The chemical physicians had  never
discontinued their employment  of the latter, but they studied to  mask
them, and prevent dangerous results, by all sorts of combinations.   A
prejudice, which  was  derived from the reigning theories, opposed the
perfection of treatment  by mercury.  The prevailing opinion was, that
the venereal virus  should  be expelled either by sweats or salivation, or
by some other emunctory, and in no other way was it supposed that a
radical  cure could be obtained.   Bichard Wiseman, surnamed the Pare
of England, signalized,  among  the  number  of mercurial preparations
used in 1676, corrosive sublimate, dissolved  in water, and taken  inter-
nally, in a dose sufficient to excite vomiting,  or produce  salivation.
   Nicholas  Pechlin, and Francis Chicoyneau, were the first who  stood
up against this prejudice, at the beginning of the seventeenth  century.
This idea became the signal of a great progress.  In 1750 Van Swieten,
disciple of H. Boerhaave,  and physician to the  queen of Hungary, directed
all physicians of the military and civil hospitals of the Austrian empire,
to treat syphilis after a uniform method, whose efficacy and  harmless-
ness a long  experience had revealed to him.   It consisted principally in
prescribing  each day  about a third  of a  grain of corrosive sublimate,
dissolved in six ounces of some  vehicle.   All the reports were favorable
to this plan, and the public eulogies bestowed upon it, encouraged very
many practitioners to adopt the use of the liquor  of Van  Swieten.
Pringle introduced it into  the military hospitals of Great Britain, and
the English army-surgeons gave good accounts of  it.
   As may be supposed, the formula and the  doses prescribed by Van
Swieten  were modified,  in  certain  circumstances, to  satisfy particular
indications.   Mercury still continued to be  associated with the  sudor-
ifics, sometimes with opium.  It was given in pills, solution, friction, etc.
Thus, at the date of this epoch, the Healing Art could boast of possess-
ing,  against  the  great generality of venereal  accidents, an  almost
infallible specific, which, handled with circumspection, is never, or very
rarely, followed with bad results. 
INTERNAL  THERAPEUTICS.
433
                     TREATMENT OF PERIODICAL DISEASES.'
   Under this denomination  we now comprise a multitude of diseases
 extremely common  aud varied.   They constitute two very distinct
 genera,  accordingly as  they present themselves  under  the form  of
 pyrexia, or apyrexia.  The first, which are the most  common and the
 gravest, have been known from all antiquity.   They are described by
 ancient  authors  under the title of intermittent and  remittent  fevers.
 The second, that is to say, the periodical affections without fever, have
 only  been observed since  the middle of the eighteenth century—the
 time  when Casimir Medicus  first  assimilated  them to  intermittent
 pyrexiae.   The ancients did not know any specific treatment against
 periodicity.  The following  is what Hippocrates prescribed in inter-
 mittent  fevers of various  types: "When  any one is tormented with
 bile, he has every day a fever,  which arises at midday, and then ceases.
 In this  state a  purgative should  be given, on the ninth day.   If the
 patient has  no evacuation by the mouth, he should be purged;  but if
 he is feeble, injections of water should be  employed, only.  When the
 fever permits, a hydromel should be administered in the  morning, before
 the purgatives.   Pure water should be given the following days,  and as
 much  as the patient  wishes to take, during the whole duration  of the
 fever.   As soon  as the fever appears to be  over,  a tisane with cream, a
 a little milk, followed by good wine, diluted with water.
   2.  In the tertian fevers,  a purgative should be given after the fourth
 paroxysm.  When  it is thought best  not to  purge, give about  two
 ounces of the juice of the  quintifolium, in  water;  if this is  not bene-
 ficial,  a bath should be given, and immediately the  juice of the  syl-
 phium  (ferula tingatana,  Lin.), with  clover, in equal parts of wine
 and water.   The  patient should be  kept well covered in bed, to produce
 perspiration.  During the  perspiration, if  he thirsts he is  to drink
 water  whitened with flour.   In the evening  he should take a little millet
 cream with some  wine  in addition.   He must use sound  food until he is
 cured.
   3.  In the quartan fever,  the  purgation must begin at the head, after-
 ward  through the bowels.   During the two days of intermission, a bath
 is to be given, and the patient  must drink  wine, in which some  grains
 of henbane and  mandragora have been infused, with a  drachm  of the
juice of sylphium and  of clover.  When the stomach is full, an  emetic
 is to be given.   After the following  paroxysm, in coming from the hot
 bath, he must be kept covered until the perspiration begins, when he
 must take a second vomit.   If the  fever does not cease,  the head must
 be purged again, and  the patient be placed upon the use of  emollient 
434
REFORM  PERIOD.
and  bitter aliments, and continue to take the hot baths in the days of
intermission.0
  No notable amelioration  was introduced in the treatment  of inter-
mittent fevers, from Hippocrates till toward  the middle of the seven-
teenth century of the Christian  era.   Those which  were of a benign
nature and reigned sporadically, were cured well enough after  a longer
or shorter period;  but those which were developed under the influence
of a pernicious epidemic constitution,  prevailed with murderous  fury,
carrying off  the  patients in the  third or fourth paroxysm.   A good
number even of  these, which were  not of a malignant nature,  after
having  resisted all remedies, degenerated into visceral obstructions,
hydropsies and phthisis, which  conducted the patient by slow degrees
to the tomb.
  In 1638,  the Countess  of Cinchon, the wife of the Vice-king  of
Peru, was a  prey to a fever from which nothing would deliver her.   A
Spaniard,  some say that it was  the  Governor of Loxa,  having learned
from the natives of the country the secret of the febrifuge  qualities of
the cinchona, advised the countess to employ  it.   She, after much hesi-
tation, resolved to try it, and recovered her health as by enchantment.
Such is, according to the most accredited opinions, the origin of the great
reputation of this  bark; nevertheless,  M.  A.  de  Humbolt discredits a
part of the story.   He asserts that the aborigines of the neighborhood
of Loxa, as well as other provinces of  South America, where intermit-
tent fevers are very common, far from suspecting the febrifuge virtue
of the bark,  often prefer to die rather  than make use of it.  They be-
lieved, formerly, even, that the Europeans sought this substance with so
much earnestness only as dye stuff.   Humbolt infers from  this, that it
is not very probable  that  the Indians furnished to the Spaniards  the
first indications of the medical  properties of cinchona.   However this
may be, it is not questionable that  in 1639, the Countess of Cinchon
and her physician, Juan Lopez de Vega, imported into Spain a certain
quantity of this bark, reduced to powder, and distributed it to various
persons.   But  it was not made an  article of commerce till ten  years
later, by the Jesuits of Bome, who had received a considerable  mass of
it.   It was retailed in Spain as the " Countess' Powder," and in Italy
as the "Jesuits', or Cardinal's Powder."   As it was very dear, it was soon
adulterated in  so many ways as to make it very difficult in the end to
procure it of pure and good quality.
  Accident thus had  placed in  the possession of Medicine a  precious
remedy;  but there remained an immense  task for science to fullfil.   It
° Hippocrates, Treatise on Disease. 
INTERNAL THERAPEUTICS.
435
 was necessary:  First, to determine the botanical characters of the plant
 which furnished it, in order that it might be recognised wherever found;
 Second, to ascertain the chemical elements of good cinchona, in order to
 uncover the sophistications of which it was the subject, and to separate,
 if possible, its active principle from the other elements; Third, and lastly,
 to  establish its curative properties, to fix the curative indications it
 should fullfil, the most  advantageous modes of administration,  suitable
 doses, etc.
   La Condamine was the first who gave a description  sufficiently com-
 plete, of the tree which  produces the cinchona.   This illustrious geome-
 trician having been sent to America  to measure several degrees of the
 meridian  of Quito, found himself placed, from the nature of his opera-
 tions, in  the regions where these  trees grow.   He  described several
 species of them, furnished precise instructions  concerning the qualities
 of  the barks, the size and thickness  of the trees, the places  where they
 are found, etc.   His  work, which  was printed in the memoirs of the
 "Academy of Sciences," in the year 1738, served as a guide for Linnaeus,
 to trace the characters of the genus,  to which he gave the name of cin-
 chona, in memory of the lady who first introduced the plant into  Europe.
   Many other naturalists endeavored to complete the natural history of
 the  genus cinchona.   They discovered a great  number of new species,
 which they found north and south of the equator, and  in very different
 latitudes.   Among these, I will cite  first, Celestino Mutis, to whom we
 owe the description of the britannic riches of New Grenada, and espe-
 cially of several species of cinchona, unknown till then; Buiz and Pavon,
 authors of the flora of Chili and Peru;  MM. de Humboldt and Bonpland,
 whose travels in the equinoxial regions have thrown so much light on all
 the departments of the physical sciences and natural history.
  A great number of chemists have attempted to penetrate the intimate
 constitution of cinchona.0 Poulletier de la Salle made the first important
 remark on the alcoholic extract of the substance.   Instead of consider-
 ing it, according to the  common opinion of his times, as a resine, he
 observed that water  dissolved  it;  and he called it resiniform matter,
 because its resinous characters appeared to him  more marked than the
 gummy ones.   I will  cite, also,  because it has  shed some light on the
 intimate constitution  of the bark of Peru, the  analysis of Buquet and
 Cornette, charged by the Boyal  Society of Medicine, of France, in 1779,
to examine two specimens sent from Santa Fe de Bogota; that of Four-
croy in 1791; and that of Doctor Westring, consigned in the memoirs of

  0 Merat et Delens, Dictionnaire Universal of Materia Medica and Therapeutics.
Paris, 1833. 
436
REFORM  PERIOD.
the Academy of Stockholm for 1800-1801.  He directed his researches
toward an end eminently useful;  he proposed to determine, among the
constituent principles of  cinchona, the one to which its curative virtues
belonged.   If he had not the glory to attain an end so desirable, he had,
at least, the merit of  indicating it.   Later, we  shall see  the labors of
two French chemists crowned, in this respect, with complete  success.
  Nevertheless, the most important and most difficult questions to solve, on
the subject of the new medicament, did not lie within the reach of either
botany or chemistry, but rather of practical medicine.  It is the latter
which had to pronounce definitely upon the value of the curative proper-
ties attributed to the substance, on the modes of its administration and
proper doses, and on the pathological circumstances which  may indicate
or contra-indicate  its  employment.
   The first  one who wrote  on the  medicinal virtues of cinchona, was a
Spanish physician named Barba.   He demonstrated the efficacy of this
powder in a tertian fever,  and  replies to the objections of some physi-
cians of his country, who condemned its use.   His book was printed at
Seville, in 1642.   Morton  speaks of  a short treatise drawn up in 1651,
by the physicians  of Bome, which fixed the dose of  the powder at two
drachms, and recommended the employment of laxatives before adminis-
tering it.  They advised, after its administration, to await, tranquilly,
the sweats it usually provoked, before recurring to any other remedy.
   About the same time,  cinchona was introduced  into England, but it
soon fell into contempt,  owing  to the ignorance of the  true manner of
administering it.   Several patients perished from its improper use—
among others Senator Underwood and Captain Potter—which disgusted
many physicians with its use, but instigated others, especially the sage
Sydenham, to seek a better method for its  administration.
   A charlatan named Talbot, or Talbor, profited by  the discredit  into
which this  substance  had fallen, to  administer it as a  secret  remedy.
After having astonished  London by his  numerous cures, and amassed a
fine fortune, he went to Paris, where he obtained no less brilliant success;
among others, he cured the Dauphin of an intermittant fever, which the
court physicians had not been able to  cure.  The king bought his secret
for the sum of two thousand louis d'or, and a pension during life of two
thousand  francs.   After the death of Talbot, the French Government
published his recipe, the principal ingredient of  which was  nothing but
cinchona, disguised by the  addition of other substances.
   At the head of those persons who contributed to propagate the methodic
employment of the Peruvian bark,  I must name Sebastian  Badio, or
Baldies,  whose dissertation, published in 1663, had especially for  its
aim to refute the attacks of Chifflet and Plempius against this remedy; 
INTERNAL THERAPEUTICS.
437
Bichard Morton, a celebrated practitioner of London, whose Pyretology,
published in 1692, had, for a long time, a distinguished reputation ; and,
above  all the preceeding, Francis Torti,  professor of medicine at the
Gymnasium of Modena, and author  of  a classic treatise on pernicious
fevers.0  No one had before demonstrated with so much force and reason,
the superiority of cinchona over all other remedies, in that class of dis-
eases, and no one had refuted in so victorious  a manner, the objections
of its adversaries.  He wrote at the beginning of the eighteenth century,
from which  period we  may regard  the cause of cinchona as  gained.
After him, Werlhof  published  new observations, which fully confirmed
those of the professor of Modena.  He demonstrated the futility of the
arguments founded on theories, and demanded only the proofs of expe-
rience.   His writings are a model of  urbanity, elegance, and sound eru-
dition.   After having proved how vain were the high controversies on
the essence and  proximate  causes of  fevers, he recounts, among others,
the following anecdote :  " The empiric  Talbot was one day called to a
patient attacked with a chronic fever.  His physician, who had  been in
attendance a  long time without effecting anything, consented to admit
Talbot to consultation, with very great repugnance.   As soon   as they
were assempled,  the dean of the consultation gravely asked Talbot this
question: ' What is a  fever?'   'A  fever,' responded the latter, very
reverently, ' is something which I cannot define, but which I can cure;
while you, perhaps, may be able to define, but cannot cure it.' " -j-
   In the second  half of the eighteenth century, Casimir Medicus  assimi-
lated, under certain  aspects, periodical affections without fever to inter-
mittent pyrexia?, and  applied  the same  treatment to them with great
success.   This happy employment of cinchona against a new order of
diseases,  added very much to the importance, already very great, of this
exotic medicament.
                    TREATMENT OF OTHER, DIVERSE DISEASES.
   We have mentioned the prophylactic treatment  of  variola,  in the
chapter on  Hygiene, and endeavored to appreciate  the extent of the
services rendered to  humanity by the practice of inoculation, and above
all, by the  discovery of  vaccination, which we shall not dwell  upon
again.  But,  besides these capital  ameliorations, several others, less
striking, which  have also their utility, were introduced  into the treat-
ment of  several diseases.   Therapeutics essayed to  appropriate to its
use a quantity of new substances but  little known to the ancients;  such

  0 Therapeutice specialis ad febres periodicas perniciosas, Mutinse, 1712.  Nova
editio curantibus Tombeur et Brixhe, Leodi, 1821.
  f Werlhof, Observations de febribus. 
438                     ERUDITE PERIOD.

as the different gases,  electricity,  galvanism, tartar emetic, proscribed
by  a decree of the  parliament  of Paris,0  ipecacuanha,  belladonna,
digitalis, etc.
  In short, the period through which we have just passed has effected
in therapeutics ever memorable improvements:  the ravages of variola,
so to say, annihilated in its source; those of intermittent  fevers, and
periodical affections in  general, arrested at their beginning;  the repul-
sive contamination of syphilis, which menaced the human species with a
progressive degradation by its hereditary transmissibility, unmasked and
vanquished  in the  most of its metamorphoses;  in fine, a multitude of
secondary ameliorations introduced into  the  treatment of many other
diseases, without counting  the  improvements  so  remarkable in surgery
and obstetrics, of which account will  be taken  hereafter: behold, un-
questionably, imperishable  titles to the gratitude of all generations; and
if the modern tables of mortality do not lead us into error, if the exten-
sion of the mean duration of life, established by them, is a reality, as we
are all led to believe, what  science can claim, in this happy result, a part
equal to that of medicine ?
  An  important remark on the subject of all these beautiful improve-
ments remains still to be made,  which is, that they were all accomplished,
not in  virtue of prevailing theories, but in spite of them; that the great-
est obstacles they had to surmount, to become established, came from these
very theories.  If mercurial medication was continued, so  as  to excite
salivation, or to the production of those injurious effects which made it
formidable, it was in perfect harmony with the Galenic theory, according
to which  it was not doubted  but that the syphilitic virus  circulated
with the humors of the body;  whence it  followed,  that it was necessary
to provoke some evacuation or other to expel this virus.   What was the
reproach that the adversaries of cinchona brought against that medica-
ment ?  It was, that it produced no sensible evacuation.  Now, in their
opinion, founded on the authority of Hippocrates, Galen, and others, the
proximate cause of intermittent fevers could be nothing else than vitiated
bile or phlegm; so that a medicament which expelled neither the bile
nor the phlegm, could not,  according to their doctrine, radically  cure an
attack of fever.  The Stahlites made a more specious  objection still, to
the employment of cinchona; they said that fever is a natural and salu-
tary effort of the soul, to free itself from an injurious substance, and that
to suspend or arrest the accession, was contrary to the  tendency of the
vital principle,  and  produced, in reality, more harm than  good.   If
vaccination itself  has  encountered opponents,  was  it not  especially
-See Lettres de Gui Patin, with Notes by Reveille' Parise; Paris, 1816. 
            EXTERNAL PATHOLOGY AND THERAPEUTICS.         439

because the Arabs, who first described variola, had at the same time prop.
agated the opinion that the principle of this disease is innate in man;
whence it was concluded, that to prevent its spontaneous development,
was  to oppose  the proper  action of nature—to keep the enemy in his
place ?
   In the opinion of every one, the progress that therapeutics made, and
which  we have just  pointed  out,  was due  to  the  pure experimental
method, i. e., to Empiricism ; not to that blind and ignorant empiricism
of charlatans, and medicasters, and pharmacopolists, who content them-
selves with asking the name of a disease, and without  other knowledge
deliver, without  hesitation, their  drugs, but  to  the  enlightened and
methodic Empiricism  which calls to its aid all the positive indications
of physiology, pathology, and the accessory sciences—to the empiricism
of Sydenham, Morton, Torti, Werlhof, Berenger de Carpi, Van Swieten,
Lieutaud, Stoll, Jenner, and other practitioners of such merit;  to that
Empiricism  for  which Kurt  Sprengel  offers  apologies,  in so  many
instances, and notably, in chapter second and third,  of the sixteenth
section of his History of Medicine.
                       CHAPTEB  VI.

           EXTERNAL  PATHOLOGY AND  THERAPEUTICS.

  We have seen that surgery, after having been so long disdained and
oppressed by the Clinical physicians  of  the middle  ages, was gradually
elevated from this abasement, and signalised its resurrection in Europe
by discoveries and improvements of the highest interest.   The sixteenth
century had produced some surgical reputation out of line, but  the
first half of the seventeenth was less  fruitful in illustrations of this
kind.  During  this lapse of time, Severin Pinau and John Bienaise are
nearly the sole representatives of  French surgery;  Marcus  Aurelius
Severino and Peter de Marchetti sustained still, somewhat, the glory of
the Italian school,  which declined,  after  them,  to  flourish  again  only
toward  the close of the  eighteenth century; Germany  saw arise no
worthy successor of Fabricius de Hilden; in Switzerland, no one replaced
Felix Wurz ; Holland possessed only John Van Horn; and England,
until then one of the countries most in arrears, in the progress of sur-
gery, gave birth to a man  who revived, and was the  dawn in her, of the
genius of surgery.   Bichard Wiseman was the A. Pare of the Brittanic
nation ; his collection of  treatises has always preserved its  interest, as
one of the most precious monuments of  English surgery. 
440
REFORM  PERIOD.
   Toward the close of the seventeenth century, and during the whole
 course of the eighteenth,  this branch of the Healing Art emerged anew
 from its state of stagnation, and took a development, of which no other
 period in  its history offers us an  example.   Among the causes which
 contributed, in France, to give it a strong impulse, we shall cite, in the
 first place, the creation of five chairs of demonstrators of anatomy and
 surgery, instituted in the college  of Saint Come, by letters patent, in
 September, 1724.   G. Mareschal, first surgeon of  Louis  XV.,  and
 La Peyronie, his friend and  colleague,  who was destined to be his  suc-
 cessor, were the first  instigators of that measure.   La Peyronie com-
 pleted it,  in  adding to the  five royal  demonstrators, a  sixth, for the
 course on accouchements,  and  six adjuncts, whose salaries he paid him-
 self.  This enlightened philanthropist did not limit his benefits to the
 capital; he obtained for  Montpellier the nomination of four professors
 and four adjuncts, who were required to include in their lectures all
 branches of surgery.   But he lacked an  amphitheater, and no emolu-
 ments were attached to the chairs which were just created.   La Peyronie
 removed all these  difficulties,  and provided  everything from  his  own
 purse.  In fine, he secured the future of these  institutions, by leaving
 in his will provisions for their support.
   It  is to him, also, and to Mareschal, that  France was indebted for
 another  endowment, which exercised, during more than half a century,
 a  powerful influence  on  the  progress  of surgical  studies in Europe.
 The Boyal  Academy of Surgery, instituted in  1731, became, from its
 origin, a focus toward which converged the labors of a crowd of surgeons
 of France and foreign nations.   It  received, among  others, communica-
 tions  from  John Louis Petit, Ledran, Garengeot, Lafaye, Cresar Verdier,
 S. Morand,  Quesnay, Hevin, Fabre, Lecat, Puzos, Bordenave,  Sabatier,
 and above all  from A. Louis.   To the  Boyal Academy of Surgery we
 must  attach the names of  Lamotte, Bavaton, Friar Come,  Master John,
 Anthony Petit, Pouteau, etc., who shared its fame, and enriched science
by their writings.   Then succeeded, in the history of this Art, the School
of Practical  Surgery, (Ecole Pratique de Chirurgie) established by  a
decree of council, in 1750.  It was here that Chopart taught with so
much zeal,  and where his intimate friend, P. J. Desault, commenced, as
clinical  professor.  That  clinic, the first  which France offered  as  a
model, soon acquired  a European  renown, and, to such  a hight, that
neighboring nations sent  to  Paris pensioned  students, to follow the
course of Desault.  From this school  came forth Anthony Dubois, A.
Boyer, and so many others that the  enumeration would be too long.
  While, by a happy concourse of circumstances, French surgery shone
thus,  in the first rank, the neighboring nations  advanced in the same 
EXTERNAL PATHOLOGY AND THERAPEUTICS.         441
career with a praiseworthy emulation.  England could  enumerate with
pride Cheselden, Douglas, the two Monros, Sharp, Cowper, Pott, B. Bell,
J. Hunter, etc.; Italy had her Molinelli, Bertrandi, Guattani, Moscati,
Scarpa;  Holland  possessed Deventer, and P. Camper; Germany, and
the  countries  farther north,  saw flourish  L. Heister, John Zacharia
Platner,  Stein, Bcederer, Brambilla, Acrel, Callisen, Theden, Augustus
Bichter,  etc.
   From  the concourse of all these celebrated men, and a great number
of others,  external  pathology and  therapeutics  were  elevated  to an
unheard  of degree of perfection.   Surgery showed itself worthy to march
the  peer of Medicine,  and the  inseparable union  of those two  twin-
sisters, was sanctioned in  France, at the time of the restoration of its
Medical  schools, in 1795.   To give an idea of the numerous ameliora-
tions accomplished in external pathology and  therapeutics, during the
Beform  Period, we  will take a rapid glance  over the  history of some
of the principal Surgical operations.
                          WOUNDS OP THE HEAD.
   Among the  operations to which the wounds of the  superior part of
the body may give rise, one of the gravest and most delicate, is,  beyond
contradiction,  that of trephining, which  is  often  alluded to in the
Hippocratic works.   The manner  of  executing it;  the cases  where
it is indicated; the dangers to which it exposes the patient; the  pre-
cautions  that  it  requires,  are  all  traced with  a correctness  which
proves, that, for a long time,  the Asclepiadae  had been in the habit of
practicing it.
  The Surgeons of the Alexandrian  school, notwithstanding the supe-
riority of their anatomical  knowledge, added very little to the precepts
of the Hippocratists,  concerning  this operation.   Celsus furnishes only
a few details on the modes of  operation and on the form of  the  instru-
ments.0   The Greek and  Latin physicians  of the   following  ages
abandoned the great opsrations,  and limited  themselves  in the  treat-
ment of the  wounds of the head, to the use of ointments, cataplasms and
other external applications,  which  they decorated with the  title of
vulnerary.   Among the Arabs, Albucasis alone, seems to have employed
the trephine.   Among the clergy who monopolized the  Healing  Art
during the  middle ages, Guy de  Chauliac was  the  first, to draw  from
oblivion  this  instrument,  and  the   operation it recalls.   From  that
period trephining  never fell into  disuse  again.   The  forms  of the
instruments employed by the  ancients were modified in various  ways,
0 Liv. viii, chap, iii, edition of Ameloveen, Amsterdam, 1713.
   28 
442
REFORM  PERIOD.
but efforts were especially made to establish the indications with exact-
ness ; but, in short, no capital improvement was introduced by moderns
into  this branch of Surgery.

                          DISEASES OP THE EYE.
   Cataract.—The ancients had only very confused ideas on the nature
and seat of this affection.  Celsus, who was the first to speak of it, says:
 ' Often as the result of a blow or a disease, the humor contained in the
empty space which I have  said exists  behind the two tunics (the
transparent cornea and the  iris) becomes concrete, gradually hardens,
and  obstructs the  sight; there results  from it an  infirmity  which is
sometimes curable and sometimes not.°   Then the Boman encyclopedist
enumerates the cases in which an operation  may be  attempted with
some  hope of success, and  those in which it appears formally con-
tra-indicated.    These last  are, according to him,  much  the most
numerous.
  As to the mode of operating, he describes only the one that is known
as the method of couching.   However, he does not doubt  but that the
method  by extraction was known to the  ancient Greeks.   Bhazes, who
gives a detailed description of it, assures us that it was practiced  by
Antyllus, a celebrated surgeon, who lived at the commencement of the
second century of the Christian era.f
  Paul of iEgina,  and Albucasis, followed the  method of Celsus; the
ecclesiastical physicians of the middle ages knew no other; and those of
the Erudite Period did not  show themselves any  more bold, notwith-
standing the progress of anatomy.  During all this  period of  time, the
method by extraction  was completely abandoned by instructed  surgeons.
A few  intinerant  operators  only, dared practice  it; but the men of
the Art  rejected it because  it occasioned the loss of the humors con-
tained in the chambers of the  eye, an occurrence which  they believed
very formidable.
  It was only towards the close of the seventeenth century, that sounder
ideas on the nature and seat  of cataract began to prevail.   It  was then
ascertained that it did not proceed from a condensed humor, as had been
taught by Celsus, nor from a thin pellicle  spread before the  pupil, as
had  been believed in the  middle ages;  but that it consisted  in the
opacity of the  crystalline lens, or its capsule.   This was a great step
towards  the rational  treatment of this disease.   From that  time two
species were distinguished, namely, the crystalline  and the capsular;
and the signs were established to determine each of them.  The certainty
!S Loc. Cit.            -J- Continens, lib. iii., chap. iii. 
EXTERNAL PATHOLOGY AND THERAPEUTICS.        443
of the renewal  of  the  humor of the chambers of the  eye was  also
ascertained, which removed all apprehension about any injury from its
discharge.   Consequently they established much better than ever had
been done before, the indications which should determine the surgeon to
prefer, in certain cases, such or such a mode of operation.

   On Fistula Lachrymalis.—It is also in the work of Celsus, that we
find the first mention of this disease, which the Greeks named cegilops.
The ulcer, he  says, sometimes attacks  the os unguis and penetrates
to the nostrils.   When it assumes a  carcinomatous form, it would  be
not only useless, but also dangerous to touch it.   If on the contrary
the disease is recent,  and is not  too  extensive,  a cure may be hoped
for.  To effect  this, the superior part  of the ulcer should be seized
with a crotchet, and  incised  to  the  bone.  Then the  osseous  canal
should be penetrated with a red hot  iron, care having been taken pre-
viously, to protect the eye and surrounding parts,  so as  to  guarantee
them from the  contact  of the heat.   Some prefer the use of caustics,
as the green or blue copperas, but these remedies act slowly, and in a
variable manner.0
   To this method the Arabs added three others, namely, compression,
injections, and tents.  Bhazes was the first to remark, that  a  continued
pressure, seconded by frictions, suffices to cure certain fistulae lachry-
malia.   He speaks also of injections that may be used through cannulae.
Avicenna counsels  the  introduction into the nasal canals, of a thread
saturated with  depuratives,  which must be withdrawn every  day, until
the passage be entirely free.  We see by this the Arabs knew  nearly all
the methods in use  among moderns, in this disease.
   The  Latins of the middle ages employed only escharotics and the
actual  cautery.  Those  of the Erudite Period employed exactly the same
means; but  in  the course of the seventeenth,  and especially of the
eighteenth  centuries, all the proceedures known to the Arabs were still
honored, and considerably perfected, and a better judgment was formed
of their advantages and particular inconveniences.

   On  the Synizesis or Synechia.—The pupil  is  susceptible  of a
morbid constriction, and even  a complete obliteration,  which  con-
stitutes the  affection  called synizesis.   This  occlusion is rarely con-
genital ; however it may be  in  the  newly born,  resulting from the
persistence  of the  pupillary membrane.   Such  individuals  are born
blind, though their eyes  possess otherwise all the conditions  requisite
0 Celsus, lib. vii. chap. vii. § viii. 
444
REFORM  PERIOD.
for seeing.  Accidental  synizesis is much more common, and occurs
from  varied causes:   sometimes it arises  as the result  of an opera-
tion for cataract, or a violent inflammation  of the eye:  again, it has
been  attributed to the repercussion of any morbid vice,  such as that
of tetter,  gout, etc., and  it may manifest itself without any apparent
cause.
  The ancients did not  attempt the treatment  of this infirmity, and
the unfortunate who were attacked with it, went the  rest  of  their days
deprived of sight.  In 1732, William Cheselden published the history
of a very delicate  operation for its relief, which he had  successfully
performed.  This operation consisted in making an opening or artificial
pupil, in the center of the iris.   The same operation was repeated several
times afterwards, but never  or  rarely ever  succeeded; the  process of
Cheselden was therefore judged defective.   Other surgeons made useful
corrections in it,  by  means of  which,  they  obtained  better results.
Thenceforth the operation was a  therapeutical conquest, and  took  rank
among the discoveries of  modern  surgery.

                         DISEASES OE THE NOSE.
  Nasal Polypus—The Hippocratic works mention four species or varie-
ties of this disease, and they indicate a curative method appropriate to
the nature of the excrescence in each case.   If the polypus is soft and
adheres by a small pelicle, it was advised to tear it loose and draw it forth.
If it was hard, it was to be cauterised with the actual cautery.   If it was
soft and adhered by a large pelicle, a ligature was used.   If of a stony
hardness it was to be excised.   In all cases, the cure was terminated by
mild caustics and emolients.
   The Greeks of  the  following ages added very little to these precepts.
The Arabs  and the Latins of the middle ages adhered to the ligature
and caustics only; but at  the epoch of the restoration of the sciences in
Europe, all the means  employed in  antiquity, were restored to  practice
and examined.   A closer study of the effects  of  each  of these applica-
tions  was carefully  made.   Gabriel Fallopius  and  Andrew Levret
concurred, especially   to  clear  the  diagnosis and treatment of this
disease.
   Rhinoplasty—This word is  intended to designate an operation which
is designed to reconstruct the  entire, or a considerable part of the  nose.
Peter Banzano, Bishop of Lucern, is the first who made mention of it in
his Annals of the World.   According to the report of this historian,  there
lived in Sicily, in  1442,  a family of the  name  of Branca, which pos-
sessed the art of  reconstructing the nose and other  parts of tbe  face,
from the flesh of  the arm.  This art passed  from Sicily into Calabria, 
            EXTERNAL PATHOLOGY  AND THERAPEUTICS.         445

where  it was practiced by the  family Viarco, or Bojano, at the com-
mencement of the sixteenth century.   Alexander Benedetti, a celebrated
physician of that time, furnishes us exact notions of the mode of opera-
ting practiced by the Calabrians.0  But toward the  close of the same
century, we find no  longer in  Calabria any trace of Bojano, or rhino-
plasty.   Gaspard Tagliacozzi, professor of surgery in the University of
Bologna, was then the only man who practiced  this  operation, whether
as his  own invention, as he pretends, or as acquired from the descend-
ants of the Calabrians.  Ambrose Pare recounts the history of a cheva-
lier Bof Saint Thoan, who after having for a long  time worn a silver
nose, was by the skill of  the  Italian professor, furnished with  a well-
formed nose of flesh.  In 1597, Tagliacozzi published a treatise  on  the
art of  restoring the nose  and ears, which had been  destroyed or muti-
lated, f   Thomas Fyens, who made  an extract from  this work, assures
us that he had  seen several persons upon whom the author had very
happily operated.|  Fabricius of Hilden, reports that  a  surgeon of
Lausanne, named Griffon, having possessed the knowledge of the pro-
cess of Tagliacozzi, repaired  so well the nose  of a young girl,  that
twelve years after,  the cicatrice was scarcely perceptible.   In fine, John
Baptist  Cortesi, a  cotemporary of Tagliacozzi, and his colleague at the
University of Bologna, gave a detailed description of  rhinoplasty, which
he assures us he had himself practiced.
  Notwithstanding these  undoubted proofs,  the  art of restoring  the
nose, fell again into oblivion, for nearly two hundred years, and  to  such
a point, that at  the close of the last century some physicians considered
it doubtful whether it had ever  existed, when a journal of Madras pub-
lished,  in 1794, an observation  of rhinoplasty executed with success on
an Indian, after a method formerly known in the country.   This pro-
cedure  consisted in detaching from the skin  of the forehead, a flap, out
of which the nose was to be formed, while the Tagliacotian operation
consisted in taking the flap from the arm, in the deltoid region.   The
same operation was afterwards repeated in France,  England, Germany,
and other places, with various modifications and results, so that a doubt
about its reality was no longer permitted.
                         DISEASES OF THE MOUTH.
  Hare-lip, or  split-lip, an infirmity ordinarily  congenital and some-
times  accidental, is not described  in any Greek  author.   Celsus, who
is the first to mention it, speaks of it and its treatment,  only in a very
succinct manner.   The Arabian writers are not more explicit, with the

  c De Remedica Opus Basil 1/539.  f ^e Curtorum Chirurgia, Venice, 1597.
              I De Praecipuis Artis Chirurgiae Controversiis. 
446
REFORM  PERIOD.
exception of Albucasis,  who  expresses himself  about it with  more
exactness and detail than all  his  predecessors.   He advises  sometimes
that the separated borders of the lip be cauterised, to excite suppuration;
sometimes to excise them, so as to sew them together, and to  cover  the
wound with  an ointment  of  dates.  After him,  A. Pare was  the first
who described the hare-lip and its operation.   He employed, to join the
freshened edges of the lip, steel  needles,  around which  he wrapped  a
waxed thread, in the form of the figure oo •   Peter  Dionis proved that
the resection is always more prompt and sure than  cauterisation.  His
idea was generally  adopted  and still prevails.   He performed the exci-
sion with scissors;  others preferred the bistoury, but this difference is
of but little importance.   The steel needles  have been  replaced, on
account  of their rusting, by needles of silver or gold, which  are with-
drawn more easily,  without  tearing the flesh.

                         DISEASES OP THE TEETH.
  The Art of Dentistry formed among the Egyptians, as it docs yet in
many countries, a particular branch  of Surgery, and was  practiced by
men more or less ignorant of the rest of the science.   Nevertheless, phy-
sicians have  also occupied  themselves with it, from the earliest times.
Erasistratus  speaks of an odontagogue of lead, which was suspended  in
the temple of Delphos, to indicate that only such  teeth as were greatly
decayed, should  be extracted.  Hippocrates  gives  the  same precept:
" Extract," he  says, " the carious  teeth ; but when they are neither rot-
ten nor movable, and yet cause various pains, it is proper to apply fire."
Celsus shares the same opinion, but he enters into much more detail, on
the subject of the operations usually  performed on the teeth.   " Some-
times," he says, "the teeth  are movable because the roots have  little or
no hold,  and the gums are soft and fungous;  in either case the surface
of the gum should  be touched lightly with the hot iron, whenever the
tooth is carious.  Do not determine too quickly to extract a tooth, unless
it  be utterly necessary.  It will  be better to add  to the  remedies pre-
scribed above, more efficacious compositions still, to calm the teeth, such
as opium, pepper, and sory, rubbed up together, and incorporated with
galbanum, which is to be applied to the tooth.   If medicaments can not
appease the pain, and it is thought best to extract the tooth, it  must be
laid bare, and  moved about so as to  make its removal easy, for there is
extreme danger in  attempting to  draw a tooth which is firmly  fixed  in
its  alveolus.   When the teeth are black, and  covered with  tartar, the
dark spots must be removed  with a rasp, and the teeth  rubbed with
an  opiate composed, in part,  of  bruised rose-leaves, and one-fourth of
nut-galls  and  myrrh."  Celsus recommends, also,  to attach the loose 
EXTERNAL PATHOLOGY AND THERAPEUTICS.         447
 teeth to the adjoining sound ones by a gold thread.   When in children the
 permanent  tooth  begins to press  upon  the  deciduous one, before it has
 dropped out, the latter one must be extracted, and pressure be made upon
 the new one every day, so as to constrain it to  take the place of the other.
   Albucasis is the first who spoke of dental prothesis; he substituted for
 a lost tooth another, either  natural or artificial, which  he  fixed to its
 place by means of a  thread of gold or silver.
   The ecclesiastic physicians of the middle  ages,  neglected this part  of
 the art.   Guy de Chauliac complains loudly, that these operations had
 been abandoned to the barbers, bath-keepers,  and other artizans,  deficient
 in the technical knowledge of  the evolution  of the teeth ; operations  of
 such  importance that no  physician  should  disdain to undertake, or  at
 least to assist in them.  A. Pare" adds  to the laboratory of the dentist
 several instruments, some of which very much resemble those that are
 now employed.   He is the first one who reports an authentic example of
 an extracted tooth being immediately returned to its place, and become
 consolidated.
   In the course of the eighteenth  century the Dentist's Art reached  a
 degree of perfection it  had never before approached.  Several surgeons
 of  Paris, Pierre  Fauchard,  Anselme Jourdain, Bunon,  and  Bourdet,
 contributed especially  to  its advancement,  as well by their  practical
 skill  as by their  writings.  They conferred upon  the  hygiene of the
 mouth, and Dental Surgery,  numerous sage  precepts and useful inven.
 tions.
                 DISEASES OP THE TONGUE, PALATE, AND TONSILS.

   The operations that these diseases require, sometimes consist in scari-
 fications, excisions, and cauterizations.    We find them mentioned,  more
 or  less explicitly, in the  Hippocratic works.  Celsus  describes  them
 with  more or less details; he speaks, the first, of  the resection of the
frenum, and the  treatment of  ranula.   Paul of iEgina adds something
 to the precepts given before his time; but the Arabs only  copied the
 Greeks on this branch of the Art.
   The moderns have contributed  additions and  improvements to the
 above, which render these diseases less dangerous and more easily cured.
 They have  also  signalized some  diseases of which the ancients  have
not spoken, such as salivary fistulae, which  are frequently met with in
practice.  That of the duct of Steno, which is the  most frequent, was
described for the first time, by Bartholomew Saviard, and also the opera-
tive proceeding which he made use of for its cure.   He recounts that  a
man named De Boy, having pierced his  cheek, from without inwards,
with a red  hot iron,  at  the  point  of the fistula, the external  opening
cieatrised, while the internal remained open. 
448
REFORM PERIOD.
                       DISEASES OP THE  EAR.
  Among the affections which cause a loss, more or less considerable, of
the faculty of hearing, and are susceptible of being relieved by the aid
of surgery, the ancients knew only the occlusion of the external meatus,
whether congenital or accidental.   Paul of iEgina is the only one of all
the old writers, who furnishes on this  subject the most circumstantial
and rational instruction.  Those who followed  him changed none of his
prescriptions,  up to the epoch when the discoveries of Valsalva, on the
structure of the internal ear, gave a new direction to the therapeutics of
the affections of this organ.   That illustrious anatomist was the first to
recognise  that deafness proceeds,  often, from the obstruction  of the
Eustachian tube.   He perceived, also, that the cavity of the tympanum
communicates with  the cellules of the mastoid apophysis.   This dis-
covery was accidentally made.   While injecting a carious condition of
that bony eminence, he ascertained that the liquid passed into the eso-
phagus.   Cheselden several times observed that the hearing was but
little, or not at all affected by the perforation of the tympanum.
  These various observations led to the discovery of several ingenious
processes,  for the cure of deafness arising from some  affection of the
internal ear.   The first effort made  to this end, was by injection through
the Eustachian tube.   Anthony Petit, John Douglass, and other sur-
geons of the eighteenth century,  recommend very highly  this means.
Jasser,  a surgeon of the Prussian army, attempted to cure the deafness
arising from the occlusion of the  Eustachian  tube, by trephining the
mastoid process, and pushing injections through  the cells,  in which he
succeeded perfectly.  In fine, Sir Astley Cooper conceived  the idea of
perforating the tympanum,  to  replace the opening of the obliterated
Eustachian tube;   and he  performed the  operation, successfully, three
times.

                  OBTURATION OP THE AIR  PASSAGES.
  When the  air passage is stopped  by any  obstacle, the  anguish is
extreme, the  suffocation iminent, and the  patient speedily  dies, unless
promptly succored.   This accident  has sometimes occurred in a violent
quinsey, but more frequently in the fibrinous effusion in children, called
croup.   The  Hippocratic works indicate  as the  only resource in this
extremity, to pass a leek leaf, or any elastic tube,  into the  throat of the
patient;  but this agent is  very difficult  of  application, and I  doubt
whether it was ever done advantageously.  Asclepiades of Bythinia, had
the idea of opening a passage for the air, by making an incission into the
larynx or trachea; but  the authors who report this fact do  not describe 
EXTERNAL PATHOLOGY AND THERAPEUTICS.         449
the operation he adopted.  After him, no one dared attempt tracheotomy
until Antyllus, who practiced it several times, and described his  mode
of  operating.   We owe  to  Paul of iEgina  the preservation  of this
precious fragment.  The Arabs, and the Latins of the middle ages had
so  little anatomical knowledge that  they very much exaggerated the
dangers  of  the operation, and, without condemning it absolutely  in
theory, abstained from its practice.
   Anthony Benivieni, a physician of Florence, who lived  at  the end of
the fifteenth century,  saved the life  of a patient by opening the trachea?
and giving issue to the  pus of an abscess that was formed within it.
This is the first account we have of a tracheotomy, after  an interruption
of twelve hundred years ; but its author does not state the  manner in
which  he performed it, and it does not  appear that he employed this
method in other cases.   Fabricius d'Aquapendente is the first among
moderns who gives a detailed description of this operation.   He proves
that it may be executed without injury to any other  important organ;
and that by it, we may often  save a patient  from  impending death.
The invention of  the canula has been attributed to him,  which  has
usually been left for some time  in the  artificial opening thus made.

                         DISEASES OP THE CHEST.
   Empyema.—According to  its etymology, the  word  signifies a collec-
tion of  pus, formed in  any part of  the body.   Many authors have
employed it in this extended sense; thus they have spoken of empyema
of the brain—the maxillary sinus,  joints, etc.   But a greater number,
especially among moderns, use  the word  empyema, in a more restricted
sense, only employing it to designate a purulent or aqueous  collection,
enclosed in a part of the  thoracic cavity.  This is the signification, also,
which we give to the words.  Thus we understand by the operation for
empyema, an  opening practiced through  the  parieties of the chest,
to give passage to a liquid contained in one of its cavities.
   We  are  astonished,  in  reading the  Hippocratic Works, at  the
assurance with which  they frequently repeat  the advice to open  the
throracic  cavity, to give  issue to the  empyema.   It seems, from these
works, that nothing was easier than to recognize the presence and seat
of a liquid contained  in the chest.  Nevertheless, they do not always
agree among  themselves  on the  symptoms of that affection:  thus,  the
author of the  treatise on  the Begions in  Man, declares, that a patient
affected with empyema expectorates purulent matter;  while the author
of the treatise on Internal Affections, asserts that there is  no  pus either
in the substances expectorated or vomited.   It  is said  in a passage of
the second book on Diseases, that the  patient cannot  lie on the painful 
450                     REFORM PERIOD.
side; and, in  another passage  of the same book, that he cannot  lie
on the sound side.
  Apart from these small contradictions which may be blamed upon the
copyist, the following are some  of the signs  given of thoracic  effusion :
when at the termination of a pleuro-pneumonia, which has existed  for
some time, or a penetrating wound of the chest,  or a fluxion, the  fever
persists,  with cough,  expectoration,  and  oppression—and the  patient
feels  pain in  the  side or flanks,  and realizes  an extreme lassitude—
sweats on all  parts of  the  body,  with alternations of heat and  cold,
swelling  of  the  feet, and  hooked nails,  there is every sign  of the
formation of  an  empyema.  To  assure   yourself better  and to know
the precise point of collection, require the patient  to be seated on a solid
chair, and direct an assistant to hold his hands, then seize yourself both
shoulders,  and shake him, and  listen, attentively, to ascertain  from
which side comes  the  sound of fluctuation.  You  will realize  the  same
sensation as  when you  agitate  a  leather  bottle  containing  liquid.
When this sign is absent, which  happens often,  on  account, either of
the quantity or viscidity of the  liquid, an examination must be made, to
ascertain if one side of the chest is not more  swollen than the other;
and,   in  that case, the opening  should  be  made  a  little  below or
in the rear  of the tumor, as low as possible, without wounding the
diaphragm.   In fine,  if  we have to  guide us  neither  fluctuation nor
tumor, and, nevertheless,  the symptoms of  empyema exist, it is neces-
sary  to spread, on a cloth, potter's-clay, softened with warm water, and
apply it  to  the chest; then, with  a brush, dipped  in some  coloring
liquid, mark the  portion of the skin where  the clay dries the soonest;
this will mark the point where the pucture should be made.
  Thoracic  paracentesis is performed as  follows: after having  incised
the skin  with a scalpel, take a lancet having the blade wrapped nearly
to the point, or a red  hot iron, and plunge the  instrument into the
collection of pus,  and  let it flow in a small quantity.  The opening  must
be closed with a tampon of charpie,  fastened to  a thread, which will
serve to draw it out;  the whole is to be supported by a bandage around
the body.  Twice a day the dressing is withdrawn,  giving issue,  each
time, to a small quantity of liquid.   Wrhen it is sensibly diminished,
an injection is to  be made of warm wine and oil, to  prevent the  lung,
which is accustomed to humidity, from drying  too quickly.  The dress-
ing is thus to be continued, twice  a day,  allowing the injection of the
morning to flow out in the evening, and that of the  evening to flow out
in the morning.   When the cavity furnishes but a very small quantity
of humor, a curved metallic sound should be introduced every day, to 
EXTERNAL PATHOLOGY AND THERAPEUTICS.        451
 draw off what is collected.   Sometimes, instead of  incising an inter-
 costal space, a rib may be perforated, with a trephine, which will allow,
 afterwards, greater facility for the use of the tampon.   Galen cites the
 history of a child whose sternum he had trephined, to give  issue to an
 abscess.
   After him the operation for empyema was more  and more neglected;
 neither the Greek physicians of  the  following ages, nor the Arabs, nor
 the  Latins  of the  middle ages  practiced it, except  in extremely rare
 cases.  But it began to be revived in the course of the sixteenth cen-
 tury.  Fabricius d'Aquapendente recommends it as  the  sole resource
 that the art possesses against pleuritic inflammations with effusion—in-
 ternal abscesses, penetrating wounds—hydro-thorax—in a word, against
 every species of liquid collection which cannot be evacuated  directly by
 expectoration, the urine, or the stools.  Being an enthusiastic partisan
 of the ancients, he  complains that in his time thoracic paracentesis was
 not  practiced as frequently  as it had been under the Asclepiadae.   But
 perhaps  they may be  reproached for  having practised it too often !  The
 progress of surgery is not measured by the  multiplicity  of its opera-
 tions ; on the contrary, its greatest  improvement  consists in  avoiding
 those which are useless or very dangerous.  Now, that the diagnosis of
 empyema is  carried to a degree of perfection much higher than among
 the ancients, as the result  of the recent discoveries of auscultation and
 percussion, thoracic paracentesis  is much less  practiced than  in the  age
 of Hippocrates.
                     DISEASES OP THE ABDOMINAL OBGAN8.
   Wounds of the  Abdomen and Intestines.—Celsus is the first who traces
 the rules for the suture of the abdominal parieties and the  intestines.
 He remarks as follows: When a wound has opened the abdominal walls,
 it often happens that the intestines  escape.    It is necessary in  the
 first place  to examine if the gut has been injured, and  preserves its
 natural colour.   If the small  gut is wounded, there  is  no resource;
 but we may attempt to cure a wound of the large intestine  by sewing
 together the lips of the wound."   He also indicates a  very complicate*
 method to execute  a  suture  on the abdominal  walls, and like Galen,'
 describes two others which  differ from his, which in  all make three
methods  of gastroraphy which have  been  transmitted to  us  by  the
 ancients.
  During the middle ages no improvement was  made  in the cure of
 abdominal and intestinal wounds.  Some physicians conceived the idea
of introducing into the wounded  intestine, before  uniting  the edges of
the wound, a tube of  elder pith,  in order to prevent the escape of the
feces between the points of suture ; but this odd procedure, and others 
452
REFORM  PERIOD.
still more incredible, such  as the bites of ants, were justly abandoned
at the restoration  of great surgery.   There was a return to the plans
of the ancients, which were modified in an advantageous manner, while
at the same time  new additions were  made.  Thus Stalpaart  van der
Wiel invented the method of establishing an artificial anus, and for the
cure  of  wounds  of the  large intestine,  and Peter Dionis generalised
this plan.
                        PARACENTESIS ABDOMINALIS.
   While the Asclepiadae  showed themselves  empressed  and  bold to
advise thoracic paracentesis, they on the other hand appeared to have
a repugnance of paracentesis abdominalis.  It is only recommended in
a  single passage of the Hippocratic writings, and in a  very succint
manner,  the  author simply says that a puncture of the abdomen must
be made near the umbilicus,  or in the  rear, in the  region  of the flanks.
An aphorism directed that but a small amount should be permitted to
flow at a time, wtJen an opening was made, either with the knife, or the
actual cautery, in dropsy, or  an internal abscess.   This is all that is
found in that  antique collection, relative  to  abdominal  paracentesis.
It is shown, on the contrary, by a  great number  of physicians, that
ascitis was regarded by  the  physicians of that epoch,  as an  affection
entirely beyond the resources of art,  and nearly always mortal,  which is
doubtless the reason why they  so rarely had recourse to an operation,
which they judged to be  more injurious than useful, in such cases.
   As to  the  other  species of dropsy, anasarca, tumors of the liver and
spleen, they  advised in general  to treat them by scarifications and cau-
terizations.
   Celsus is much  more explicit in what regards the diagnosis,  or treat-
ment of dropsies,  of which he distinguishes three  kinds, namely,  tym-
panitic, leucophlegmatic or anasarca, and ascitis.  After having described
the characters, and the means of cure proper to each of these species, he
says, on  the subject of the last, that if the remedies employed to dry the
bowels,  and  arrest the humor, do not produce the desired effect, it is
necessary to evacuate  the  fluid  in a  shorter  way,  by making  a punc-
ture.  Then, in another book,  he describes in detail the method of
making  the  puncture.  He  directs that the abdomen be incised at the
umbilicus, even, or at four fingers width from the left side, with a nar-
row bistoury, and then, that a cannula, with a projecting and  reversed
edge, be introduced at the opening.   That being done, a good part of the
water is permitted to run out; then the cannula is plugged with a
tampon,  and  is kept in its place by a bandage around the body.  The next
day the remaining water is gradually evacuated.   There are surgeons,
he adds, who  withdraw  the  cannula on the first day, and  who  fix 
EXTERNAL PATHOLOGY AND THERAPEUTICS.         453
in the opening a piece of sponge saturated with vinegar, or water.   The
next day the cannula is re-introduced, and the evacuation is completed.
   During the centuries  after  Galen, not  only were no improvements
made on the rules given by Celsus, but  rather a retrograde  movement
took place toward the practices of the Asclepiadae, viz : they preferred
cauterizations and scarifications to the paracentesis.   This latter method
did not come into vogue again till the  fourteenth century.   Mondini
objected to  its being practiced at the linea alba, because, he says, the
tendinous nature of the structure  here, makes the cicatrization  more
difficult, and often provokes spasmodic  accidents.   Fabricius d'Aqua-
pcndente believed that it could be executed at the umbilicus with less
danger than at any other point. John Palfyn chose the middle of a line
drawn  from the navel  to the left anterior superior process of the ilium,
and  this is to-day the  point selected,  when any particular circumstance
does not require some other one to be chosen.  At the same time much
attention  was paid to the improvement of the instruments employed in
the operation.  Sanctorius invented one which made much noise, because
he kept it secret for a long time.   It consisted in a round needle, con-
tained in a cannula.   It was in fact almost the same as our trochar.  In
short, we owe to two  modern surgeons, and particularly to those of the
last century, the knowledge of encysted dropsy, which  had escaped the
attention of the  ancients.   H. F. Ledranwas the first to trace, in a pre-
cise manner,  the diagnosis and  treatment of this affection.

                               HERNIA.
   This word, in its  vulgar  and primitive acceptation, and  it is that
which we adpot here, signifies nothing more than a tumor formed by the
displacement of  some of the viscera of the bowels.  Though the tumors
of that sort may show themselves on  nearly all parts of the abdominal
surface, the ancients have only  signalized those that appear at the groin,
or umbilicus.   They studied  particularly the  former, because they were
most frequent, their diagnosis  often obscure,  and their treatment very
difficult.
   Celsus, who was the first to  describe inguinal hernia, expresses him-
self  in  the  following terms.   " The  peritoneum, which  separates the
intestines from the parts above  the groin, is subject to be torn, either as
the result of inflammation, or  the  effect of  a violent blow:  then the
epiploon, or intestine, being drawn down by its own weight, becomes
engaged in  the  opening, separating gradually the nervous tunics that
envelope the  testicle."  In  this  manner  the Boman encyclopedists
explained the formation of  inguinal hernia.   The other writers of anti-
quity and of the middle ages,  made no change in this explanation, and 
454
REFORM  PERIOD.
it was only at an epoch very close to our own that the error was discov-
ered and demonstrated, as we shall  show presently.
  In regard to its cure, Celsus advised to attempt it without using the
bistoury, but  he laid  down no rule for the practice of the taxis.   He
contents himself by saying, after having returned the intestine, that it
was necessary to retain it by means of a truss, which often provokes the
adhesion of the membranes, especially  in very young children.  When
it is necessary  to use  a  sharp  instrument, let it  be done as follows:
after having incised the first tegument of the tumor, the envelopes of
the testicle must be  dissected as carefully as possible, so as not to injure
that organ ; the herniated viscus is freed from its envelopes and returned
to the abdominal cavity, through the peritoneal opening, which is enlarged
as much as is needed.   As the incision of the tissues goes  on, it is neces-
sary to  tie the larger vessels.   At the close of the operation the borders
of the wound  are brought together by some points  of suture, and  the
threads are left to fall off of themselves, which takes place as soon as
suppuration is established.
  Celsus, as is seen, gives directions to have as much care of the testi-
cle  as possible.  Paul d'Jigina confirms the  precept  of Celsus, and  the
Arabian writers only copy the Greeks on this subject; but they abstain
from practicing  the operation themselves;  their natural  repugnance to
the employment of cutting instruments being fortified on this occasion
by  a misplaced modesty.   They limit  themselves, in the cure of this
infirmity, to the use of agglutinative  and astringent  plasters.   The sur-
geons of the middle ages established the absurd rule of tying, in  these
cases, the spermatic  cord,  and taking  away the testicle.
  Ambrose  Pare brings  back  the  treatment  of   inguinal hernia to
sounder  ideas.  He proscribes  the removal of the  testicle, except in
cases of gangrene or sarcocele only.   Pierre Franco  refutes  the  errors
of the ancients,  relative to  the  rupture of the peritoneum;  he  shows
that  ordinarily that membrane accompanies  the  viscera, when they
emerge  from the abdominal cavity, without rupturing it.  From  that
time, the diagnosis and  therapeutics  of hernia acquired a  precision
which they had never before approached, thanks to the labors of a great
number  of  surgeons,  of  the  seventeenth  and eighteenth centuries,
among whom we may cite Jean-Louis  Petit, Leblanc,  P. Camper, Samuel
Sharp, A. Louis, Percival  Pott, Auguste Bichter, Antoine Gimbernat,
and A.  Bonn.

                       DISEASES OP URINARY ORGANS.
   Among the  very varied operations to which these  diseases have  given
rise, up  to this period, the  gravest,  undoubtedly, are nephrotomy  and 
            EXTERNAL PATHOLOGY AND THERAPEUTICS.        455

cystotomy.   The  first is recommended in the Hippocratic writings, but
the manner of executing it is nowhere described.  The second, though
less dangerous, is mentioned in only one of the works of that collection,
and only to proscribe it.   We read in the oath of Hippocrates, " I swear
not to cut any person attacked with stone.   I will abandon that prac-
tice  to  the mercenaries who devote themselves to it."   Why did the
Asclepiadae, who  did not hesitate to  recommend the  cutting into the
kidney, show so much repugnance for cutting into the bladder, an opera-
tion less difficult  and less fatal than the other ?   However this may be,
the  prejudice  that  excluded cystotomy from  the  domain  of the Art,
became extinct, or was very much abated in the school at Alexandria,
since Celsus names two distinguished lithotomists of that school, Ammo-
nius and Meges, whose  methods of operation, as well as their intentions
and curative views,  he does not disdain to mention.
   " We are  sometimes obliged," he  says,  " to employ the  aid  of the
hand, not only among men, but also  in women, to press  out the urine
which is retained, either because the  urinary conduit  is diminished by
reason of  advanced age, or because there is  some stone or clot of blood
which stops the passage, or a slight inflammation, which  often  occurs,
and stops the natural flow of the urine.  To effect  this, sounds, made
of brass, are employed, and the  surgeon must  never have less than
three for men and two for women, so as to be able to assist all persons,
 great or small.  Since we have  mentioned the bladder and  stone, it
would appear that this  is the place to speak of the operation which we
are obliged to  practice on  those who are attacked with stone, when a
cure can not otherwise be effected: for no haste must  ever be made  to
perform this dangerous operation, neither must  it be executed  at all
seasons or ages, nor  in all  kinds  of cases, but only in the spring, and
on children from nine to fourteen years of age, and when the suffering
is so great that, not  yielding to other remedies, the patient is continually
in danger of perishing."
   After having  thus  presented the  indications which  establish the
necessity  of operating, Celsus describes, with great detail, the sole opera-
 ive  proceeding known  in his  time, and designated by moderns under
the  name of  minor operation,  petit appareil.  His description has
remained  as a model,  which  the writers  who  followed him, whether
Greeks, Arabs, or Latins, did in  no respect  change until within a period
 not far removed from ours.   During the middle ages, cystotomy left the
domain of the regular practice, and fell  into  the hands  of men, stran-
gers to medical  science, who went from city to city, according  to the
expression of  the times, to cut the calculous,  (couper  les  calculeux.)
 Guy de Chauliac appears to have been the sole surgeon of that age who 
456
REFORM  PERIOD.
dared attempt or advise such  an operation, and he  followed, literally,
the method of the Boman encyclopedist.
   About the commencement of the sixteenth century, John de Bomani,
surgeon of Cremona, and  the  Neapolitan. Mariano  Santo de  Barletta,
made some changes in the old  method; they added several instruments
of their invention to those which had been employed up  to that time.
Mariano, having made known his changes in a memoir, ex-professo, the
new method of operation was termed the method of  Mariano, from the
name of its  author, or  great  operation,  grand appareil, on account
of  its complication, and of  the  number  of instruments  that were
employed  in  it.   The  family of Colot  has given  to France several
lithotomists who became  celebrated by the employment of the  grand
appareil.
   About the time that Mariano published the details of his operation,
another surgeon, a native of  France, and residing  at Lausanne, was
led by necessity to the discovery of another procedure, more important
still, and named, afterward, the high operation.  We will  let him tell
himself the circumstances which led him, very much against his will,
to open a new route.   " I will  recite," he says, " what happened  to me
once.   Desiring to take a stone from a child of about two years of age,
but finding a stone nearly of the size of a pullet's egg, I did all I could
to withdraw it downward, and  seeing that I could not advance it with
all my efforts, and that the patient was excessively tormented, and also
that the parents, wishing that  he might die, rather than live in such a
condition, joined,  also, to the feeling that I was not willing to bear the
reproach of not being able to  take it away, (which was very foolish in
me)  I deliberated,  with the  importunity  of the father,  mother, and
friends, to cut the child above the os  pubis, inasmuch as the  stone
could not descend downward.   He was cut over the pubis, a little to
one side, for I held the stone there with my fingers, which were in the
fundament, and  it was  also held on the other side by the hands of an
assistant,  who compressed the little  belly, above  the stone.   I then
extracted  it,  and the patient was  cured, though he was very ill, and
the wound consolidated."
   Notwithstanding  this  result, the method imagined  with so much
success by Peter Franco, remained in obscurity until  in the year  1580,
when Francis Bousset attempted to  revive it, and argued that it pre-
sented no more inconveniences  than the others, and had  several advan-
tages above  them.   Nevertheless, his argument did  not succeed in
establishing the operation above the  pubis, as  the  common operation,
but only as one that might be  employed in rare cases.  John Douglass,
a  celebrated  surgeon of  the  eighteenth  century,  was  the first  who 
EXTERNAL PATHOLOGY AND THERAPEUTICS.        457
employed, habitually,  the high operation,  in preference  to  the  other
methods.
  A man, whose complete defect of anatomical knowledge would exclude
him from the practice of surgery in an enlightened age,  named Baulot,
or Beaulieu, better  known under the name  of Friar James, enriched
science  with a  process  of cystotomy which  is not behind  any of the
preceding, and is designated as the lateralized method.   The Hollander,
Baw, being  initiated by  him into this method, employed it with extra-
ordinary success;  but he dishonored himself in not communicating it
to any  one, and carried the  secret to his grave.   After his death,  a
crowd of surgeons,  desirous  of discovering  the  lost  secret, devoted
themselves to researches which were not fruitless.  On one  hand, Wil-
liam Cheselden resuscitated the lateral method, and after having added
several  improvements, gave it a perpetual existence, by the  description
which he published ; ° on the other hand, Peter Foubert invented a new
method, which has taken rank in science under the name of  the  lateral
method,  and which  Thomas,  surgeon-in-chief of  Bicetre, adopted the
first, and modified it.
   Thus,  to a single  method, which the ancients  transmitted to us, the
moderns have added, before the close of the last  century, four others,
each of which  presents particular  advantages and  disadvantages; so
that the man of art  may accord his preference to either, according to
circumstances and the occasion.

                    DISEASES OP THE GENITAL ORGANS IN MAN.
   Hydrocele.—Celsus was the first who treated of this disease, which
he  described  very imperfectly, under ohe name of  aqueous hernia.  He
advised the excision of the organs, in order to evacuate  the  liquid, and
to wash the wound afterward in a salt of nitre.   Galen  employed the
seton to cure the same disease, the diagnosis  of which he did not estab-
lish  in  a manner more explicit than Celsus.  Leonidas of Alexandria
described hydrocele with  more exactness;  he  endeavored  to fix the.
characters which  separate  it from  sarcocele, enterocele, and epiplocele.
Paul of iEgina first distinguished dropsy of  the tunica vaginalis, from
 infiltration of the cellular tissue.  He treated both, either by excision
 or  cauterisation.  Albucasis  preferred the actual cautery to excision ;
nevertheless, he also taught the manner of evacuating  the  water with
 a trochar, or to excise the sack, when there was one.
    Thus, at the epoch of the revival of letters, four methods of treating
 hydrocele were known,  namely, excision, the seton, cauterization, and
"■* Treatise on the High Operation for Stone.  London, 1723.
  29 
458
REFORM PERIOD.
puncture.  The moderns have added a fifth, stimulating injection after
paracentesis, the first mention of which was made by Alexander Monro.
Besides, they have determined much  better its seat, and  the various
characters and species of the disease.
   Sarcocele, or cancer of the testicle, is the only disease which requires
the sacrifice of the organ of virility ; but this terrible operation was for-
merly  much more employed.   Celsus,  who  first names  it,  enumerates
three species of tumors which require its employment, namely:  circocele,
or the varicose dilatation  of  the spermatic cord, sarcocele, and violent
inflammation of  the  testicles.   In the  course  of time,  the  supposed
necessity for the operation  was not even thus limited; it was extended,
as before said, to hernia ; recourse was also had  to it in the treatment of
elephantiasis, leprosy, gout, and even mental alienations.  There was a
time when ignorance and cupidity, united, seemed to have determined on
the destruction of the  reproductive organs in  man.  These  pretended
■jurors overspread the country,  and, for a  moderate sum,  castrated chil-
dren, under the pretext of curing  them of hernias which they did not
have, or which  they  might  have been rid  of without  this  odious
mutilation.  The abuse was carried to such an extent that  the Boyal
Society of Medicine became excited.   In  1776 it named a committee to
make a report on the subject, and devise  means to  put  a  stop to this
prodigality of mutilations.   It was shown that  in the diocese of  Saint
Papoul alone, more than five hundred  little boys were cut by the auda-
cious charlatans, who  received  thirty-five livres for every operation of
that nature.   Haller assures us that in the  Swiss cantons, there existed,
in his time, a number of  men deprived of testicles for the same cause.
Let us felicitate modern surgery for having reduced the necessity of cas-
tration to excessively rare cases.
   Though we have limited ourselves to present the history of this opera-
tion in a medical point of view, it is proper to say that long before science
had dared avail herself of this  extreme resource, in diseases deemed
incurable, human passions, politics, jealousy and vengeance, had invented
this cruel means, and had not hesitated  to exercise  it on a  grand scale.
Eunuchs were  common in Egypt,  Assyria,  and other countries of the
East, even before Moses, while castration, as a therapeutic resource, was
not employed till after Hippocrates.   But do the passions count the suf-
ferings, or even the lives of men  as anything, when they wish to  gratify
their ends ?   The custom  of mutilating young boys to  preserve their
tone and extent of voice, which is lost at puberty, was kept up in Italy
to a recent period, notwithstanding the denunciation of both religion and
the laws; and avaricious parents have  been known to offer their children
to this degradation. 
            EXTERNAL PATHOLOGY AND  THERAPEUTICS.        459

                      DISEASES OP THE ANUS.
   A single one of these diseases, the anal fistula, demands special aid
from  surgery.   We are astonished in reading the little  Hippocratic
treatise relative to this affection, at the exactness with which the treat-
ment it requires is there traced.   The raost of the curative means now
advised in such circumstances, are there already enumerated ; and the
writers of later periods, until the period of the revival of learning, added
very little to the details furnished in this monograph, which is  one of
the most precious treatises of Hippocratic surgery.
                     DISEASES  OP  THE MEMBERS.
   External Aneurisms.—Aneurisms may exist in all parts of the body,
but they are not susceptible of surgical  treatment except when seated in
the members;  and it is on this supposition only that we take it up.
Before the anatomical discoveries of the  Alexandrian school, only inexact
and erroneous ideas could be held on the subject of aneurisms.  At that
time the arteries and veins were confounded together;  and when they
were known to be distinct, the  arteries were  supposed to contain  air,
and not blood.   Celsus was not ignorant that the  arteries contained
blood,  for he affrms that a  wounded artery does not cicatrise, and some-
times allows the blood to escape with great violence; but he makes no
mention of the morbid dilatation of that order of vessels.   Philagrius
is the first who has spoken of it, and who has indicated the means to
remedy this accident.  That  bold surgeon passed a ligature above and
below the tumor;  then he  excised it and filled the wound with medica-
ments, to establish supuration.   Antyllus employed, equally, the double
ligature;  but instead of  excising the tumor he was contented  with
emptying  it of the clot of  blood which it  contained, and filling up the
cavity with materials to  promote supuration.   In fine, in the fifteenth
century John de Vigo conceived the plan of treating aneurismal tumors
by gradual compression and styptics.   Nothing has been added since,  to
the modes of treatment  we have just  enumerated;  on the contrary
excision has been abandoned as  always useless, and often dangerous;
but great  improvements have been made in the manner of executing the
ligature and compression, as well as everything that belongs to the diag-
nosis of the disease.
                       ON AMPUTATION OP  MEMBERS.
   A multitude of circumstances may demand the necessity of having
recourse to this melancholy resource—the last of all, but sometimes the
only one to save the life of the  patient; nevertheless,  there is only one
allusion made to it in the Hippocratic writings,  which is in the following 
460
REFORM  PERIOD.
terms:  " When, as  the  result of a fracture, gangrene with discolora-
tion supervene suddenly,  the whole body perishes.  If the bone has been
taken off, the flesh which must fall is promptly separated;  but if the
bone remains sound,  though the flesh  quickly falls, it exfoliates slowly
where it has been left uncovered by  the  gangrene.  Everything must
be removed from the articulation, above the gangrene, having care not to
touch any living part; for if the operator touches that which is sensible,
in cutting a part which is  not entirely dead,  the patient is  exposed to
pains which produce sometimes their death."   It is easy to see by this
passage, even, that the complete  amputation of a member, of both flesh
and bone, was rarely, if ever, practised among the Asclepiadae: for they
were  not ignorant that  it  was less the pain than  the  hemorrhage or
inflammation that causes  patients to  perish.  But what most proves
how little skillful they were to practice amputation, is, that they make
no mention of this surgical means even where it would be  most indi-
cated.  It was probably  the surgeons of Alexandria who dared the first
to attempt this grave operation.   Celsus counseled it in cases where
gangrene attacks a member  without  having  also  attacked  the trunk,
though  he  avows that there  is extreme peril in doing it.  " But," he
adds, " when it is the only  resource, there must be no hesitation about
employing it, whatever uncertainty may accompany it." He  also recom-
mends  that the amputation be made between the dead and the sound
parts, in such a manner as  to affect much  more the latter, and  always
keeping as far as possible from the articulation.  AVhen the bone was
reached, he advised to saw the bone as high as possible, so  that  more
flesh would remain to cover the stump.
   The method of great amputations received but few modifications in the
centuries of decadence which followed.  As the most immediate danger
in all these cases is always from  hemorrhage, it was conceived best, in
order to avoid it, to cauterize the stump with a red-hot iron, with boil-
ing pitch, or other escharotic substances.   But  there  resulted  from
these methods,  as may well be supposed, atrocious pains and  fearful  in-
flammations, which  must  have carried off most of the patients,  and
disgusted, likewise, the operators.  It was on this account that Guy de
Chauliac recommended to  let the part fall off itself, rather than recur
to the operation.
   A  new era dawned on this capital  branch of surgery, when A. Pare
substituted the ligature of  the  arteries  for  cauterization, in the first
dressing.  From  that epoch successive improvements were  introduced
both  in the mode of  operation, as well as  in the consecutive treatment.
There was much discussion, also,  on the dangers and advantages of im-
mediate or deferred amputations.  At the  head of the surgeons who 
EXTERNAL PATHOLOGY AND THERAPEUTICS.         461
concurred in these improvements, and took an honorable part in those great
discussions, I will cite D. Anel, Jean Louis Petit, H. F. Ledran, Anthony
Louis, Ulric Bilguer, Brasdor, Benjamin Bell, Peter Joseph Desault, and
John Hunter.
                           ON ORTHOP^EDIA.
   The  first who wrote a special treatise on this branch of surgery was
Nicholas Audry, who defined  it an  art to  correct the deformities  of
the  body, in young subjects.   That definition is  clear, conformable  to
etymology, and seems to us to indicate well the end that is proposed  in
this branch of the Art, and we therefore think we cannot do better than
retain it.  We find in the most ancient  books of  Medicine some traces
of orthopaedia, and notably in the Hippocratic treatise on Articulations,
where we read, among others, the  following  passage:  "There  are also
some congenital luxations which, if the displacement is small, are sus-
ceptible of being reduced, especially those  that affect the articulations
of the  feet.   The natural club-foot of birth is curable,  in most cases,
when the deviation is not very great, and the child is not too old.   The
best way is  to treat the deformity as  speedily as possible—before the
bones are greatly diminished and the flesh is  greatly reduced.   There is
not only a single species of club-foot—there  are several of them ; but the
greater part are not complete luxations, but deviations of the foot in-
ward, and retained by some means in a constant position.  The following
points are necessary to observe in  the treatment."0   The author then
traces, with much detail, the curative method in these deformities.
  All the surgical works which have  been written since, include  some
fragments relative to the same subject; but these documents disseminated
in the midst of other subjects, in various chapters, do not form, in any
respect, a body of doctrine.   Before the last century, no one had dreamed
of extracting them and uniting them, with special reference to ortho-
paedia ;  it was  then a rare and happy idea to  call the attention of prac-
titioners to this special object, which must sooner or later contribute  to
the physical perfection of the human species.   Though the work of M.
Andry,  which was the most important  that was published in the course
of the  eighteenth century, contains the usual  imperfections of a first
essay,  it is  not without merit at the present time ; for it contains judi-
cious precepts—observations  full of sagacity,  though  occasionally in
contact with prejudices and errors, often ridiculous.   We will also point
out, as worthy of being  consulted,  the works  of Levacher  de la Feutrie,
J. Venel, Anth. Portal, etc.
Q GSuvres d'Hippocrate, by Littre—on Articulations. 
462
REFORM PERIOD.
                        C H A P T E R  VII.

                          OBSTETRICS.

  We have seen that the art of accouchement remained very much in the
rear of other branches  of surgery, notwithstanding the very estimable
efforts of some surgeons, to draw it from the state of abjection in which
it vegetated.   But a very particular cause was an  obstacle to its  pro-
gress.   The most of the  women employed in childbed, were ignorant old
matrons, who, attached  to their old routine, which had been followed
from  time  immemorial, repelled  all  innovation.   Accoucheurs were
called in extraordinary cases only, where, from  the  grave and urgent
circumstances, they could not acquire, except with  difficulty,  the expe-
perience that inspires  useful reforms.   However,  the  prejudices  that
excluded them from the  practice of  midwifery, gradually gave way, and
a new era opened for obstetrics.
  In  the beginning of  the  seventeenth century a sage-femme, Louisa
Bourgeois,  called Boursier, sage-femme of Marie  de Medicis,  made an
exception to the common rule, by publishing a collection of observations,0
in which we meet with several new ideas.f  Finally,  the art of  accouche-
ments came forth from its beaten path, to assume a reform truly scientific,
based on rational principles, when  Francis  Mauriceau, accoucheur-in-
chief  of the Hotel Dieu, in Paris, published his treatise on the diseases
of pregnant women, and those in childbed, which was a complete  and
methodic collection of the observations derived from those who had pre-
ceded him, with those which his own extended practice had furnished.
The first edition of this work appeared in  1068.   It was translated
into nearly all the languages of Europe, and powerfully contributed to
vulgarise sound obstetrical doctrines.  The way once opened, a crowd of
competitors came forth, and by their labors enlarged it very much.   In
that number  we particularly distinguish Paul Portal,  Deventer, Peu,
Amand, and Delamotte,  who were cotemporaries, and formed the transi-
tion from the seventeenth to  the eighteenth centuries.
  ° Observations diverses curia Sterility, Perte de Fruit, Fecondite, Accouchement,
et Maladies des Femmes, et Enfants nouveau—nes.  Paris, 1G09 or 1026.
  t We will mention, also, as forming an exception to the  common rule in these
latter times, two women, whose works are marked by sound observations: Madame
Lachapelle, sage-femme in chief of the Maison d'Accouchement of Paris (Pra-
tisque des Accouchements, Paris, 182/5;)  Madame Boivin,  sage-femme in  chief of the
Maison Royale de Sante.  {Memorial de Vart des Accouchements, Paris 1836, 4th Ed.
Traite des Maladies de V Uterus, Paris, 1833). 
OBSTETRICS.
463
   About this time, the Chamberlains, a family of English practitioners,
 who devoted themselves  exclusively to the practice  of  accouchements,
 invented an instrument to facilitate the extraction  of the head, when it
 was arrested in  its passage.  One of them, Hughes, came to  Paris to
 try his instrument, but not succeeding in a difficult case, he passed on
 to Holland, where he obtained more success.   Two  accoucheurs of that
 country,  Boonhuyson and Buysch, bought his secret, which they kept
 too  faithfully for the sake of their own memory and humanity.   But in
 1721, a  surgeon  of Gand, named John Palfyn, in  seeking to discover
 the secret of the  Chamberlains, conceived the  idea  of contriving a tire-
 tete  (literally,  a head-drawer,)  composed  of two steel  spoons.   He
 hastened to publish  it, and merits, by this very praiseworthy act, the
 title of  first inventor of  the forceps.   His tire-tete, advantageously
 modified  by Smellie, of England, and Levret, of France, has taken rank
 under the name of  forceps, among the most useful discoveries of modern
 surgery.   It has rendered much less frequent the employment of crochets,
 and murderous instruments, and although it has not come into common
 use, only within a hundred years, we can say, without exageration,  that
 it has already saved the lives of a multitude of women and children.
   During the eighteenth century obstetrics advanced in several respects
 to a degree of perfection similar to that of the exact  sciences, by the con-
 course of a. great number of distinguished surgeons,  who occupied them-
 selves in  its  study, in  a  special manner.   It  is  impossible to mention
 here the names  and titles of all those who rendered  some service to this
 branch of art; we shall mention in first rank, Levret and Smellie; then,
 Puzos, Burton, Bcederer, Denman, Stein, Deleurye,  Saxtorph,  Solayres,
 and his  disciple  J.  L.  Baudelocque,  the most  celebrated  among the
 last mentioned.0   While  the art became more perfect, establishments
  ° Baudelocque was not only the most renowned accoucheur of the close of the
 last  century; but he recommends himself to us, also, by his  grateful recognition
 of the instruction received from his medical preceptor, as follows : " if a large
 number of men, in  perpetuating by their writings the art  of Midwifery, have
 rendered great services to the race, there is also a large number of others whose
 knowledge, so to  say, has been buried with them, and to whom society would
 have been  no less indebted, if their incessant labors or premature death, had not
 prevented them from publishing the fruit of their toil and  experience.  There is
 one of these latter, of whom the recollection will  perpetuate  unceasingly our
 regrets, and to whose memory we shall always pay with pleasure the tribute of
gratitude  we justly owe him :  I mean Solayre's.  It is  less  the man, whom we
esteemed, and whose death we regret, than  the loss of that profound knowledge
of the art which he cultivated, and which he taught among us with the  greatest
distinction.  What I have been able to collect of his  doctrines, will  not  compen-
sate for his loss, because a man cannot transmit his genius  with the knowledge
he had acquired/'   L'Art des Accouchements, p. 10.  3d edit. 1796. 
464
REFORM  PERIOD.
destined to propagate  its lights and benefits, were multiplied.   There
were erected in all the capitals of Europe, and in other cities, practical
schools of accouchements, where a crowd of pupils of both sexes entered,
to receive from  skilful masters  sound obstetrical  doctrines.   These
young accoucheurs—these  new  sage femmes—spread  afterwards in
the most remote  provinces the  excellent precepts which  they  had
acquired,  and combatted  with success the  time-honored prejudices of
ignorance.
  To  better  appreciate  the progress effected in  obstretrical  science
during the Beformative Period, we will examine successively some of the
capital points of the science.
                              PREGNANCY.
  In order to recognize a state of pregnancy, the ancients had admitted
a mass  of insignificant signs and ridiculous  practices, in  the midst of
which we find symptoms of a real value, such as the augmentation of the
volume  of the uterus,  the  movements realized by women, in the womb,
the cessation of the menses, the developement of the mammae, and the
secretion of the milk.   This collection of signs constitutes, doubtless,
a strong presumption of pregnancy, if not a certainty:  but it is rare to
find them all associated in the same person, so that in the greater number
of cases, the  ancients  could  only arrive at  a  probability,  more or  less
great.   Moderns have added to the preceding symptoms, other signs,
by means of which we  may reach much sooner, and more certainly, the
recognition of the state of pregnancy:  these  signs are, first, those ob-
tained  by the vaginal touch, which have a great  value ;  secondly,
those  furnished by  auscultation,  which has  been  recently applied to
this subject.
                            NATURAL  LABOR.
  The ancients were entirely ignorant of the relation  that must exist
between the dimensions of the head of the infant, and the pelvis of the
mother, so that the labor might terminate by  the sole forces of nature;
neither had they any but false and vague ideas on the  mechanism of this
function, and the true agencies that concur to effect it.  They believed
for example, that the expulsion of the fetus was due to its own efforts,
which it made in order to get clear  of its  envelopes:  while it is  now
well known that in the act of parturition the fetus is  entirely  passive,
and that its  expulsion  from the womb  of its mother is determined
principally, by  the  contractive  action  of  the uterus and abdominal
muscles.  The ancients  also imagined that  the head engages in the
pelvis in  a transverse  position: when the most simple inspection of the
parts suffices to show that  this is not the case.  In fact it  is necessary
that the head, as it advances in the  pelvic excavation, execute a spiral 
OBSTETRICS.
465
movement of nearly a quarter  of a circle, so that its  smaller diameters
shall constantly correspond to the  least ones of the  osteo-membranous
canal.  The knowledge of these particulars, and a multitude of others,
is not,  as may  be supposed by those who are  strangers to the art of
accouchements,  a pure speculative knowledge; so far from it, it is on the
contrary an indispensable knowledge, to enable  the accoucheur to  keep
himself unceasingly acquainted with the  progress of the  parturition;
that he may be  able at each phase of labor to appreciate with exactness
the nature of the obstacles which retard or arrest the accomplishment
of this  function.

                            DIFFICULT LABOR.
   The death of  the infant in  the womb of its mother, or its  extreme
feebleness, constituted, in  the  eyes of the ancients, a very grave  acci-
dent, which they regarded as an insurmountable obstacle to the natural
termination of  the accouchement, as  the result  of  the  opinion  they
entertained, that parturition depended  on  the efforts  of the fetus.
Consequently, they did not hesitate, in this juncture, to employ crotchets
to extract the infant, an operation always fatal to it, in  case  it still
retains  vital manifestations, and which is not  without  danger to the
mother.  Experience, and  a  better theory of the mechanism of partu-
rition, have demonstrated  that the death of the fetus opposes no great
obstacle to the  accomplishment of this act—that  it obstructs it only a
little, and this circumstance by itself could never justify the  employ-
ment of murderous instruments.
   Hippocrates considered the  presentation of the  feet, also, as  excess-
ively dangerous, and he advised recourse, in such a case, to various
maneuvers which would have  a tendency  to bring the  head  again to
the straight/—maneuvers nearly always fruitless, and very often  injuri-
ous.   Moschion,  a celebrated  accoucheur of the second century of the
Christian era, Celsus, and Paul of iEgina, appreciated  better the incon-
vencies of this position ; they regarded it, truly, as much less advantageous
than that of the head, but not  as opposing an insurmountable obstacle
to the spontaneous termination of the accouchement.   In the presenta-
tions of the shoulder, and other parts of the trunk, the  same  accouch-
eurs established the principle, that it was  necessary, in the first place,
to endeavor to  bring the  head to  the passage,  and  if  that could
not be done, to  search for the  feet, and take away the fetus  by  that
extremity.0
  aPaul. iEgin., lib. in, cap. lxxvi.—Aeteus, Tetr. IV, serm. 4, cap. xxm.—Cels.
lib. vii, cap. xxix. 
466
REFORM  PERIOD.
   The moderns, finding that the efforts made with the view of bringing
the head again to the straight, are  scarcely ever successful, and that
they were not without danger, both to  the mother and  the fetus, have
given the formal precept to get hold  of the feet  in all the presentations
of the trunk, and terminate the accouchement by the hand.  They pre-
scribe the same plan whenever a hemorrhage or convulsions impose the
necessity of hastening the labor.
   When the head,  engaged  in the excavation of the pelvis, no longer
advances or recedes, on account of the inertia of the uterus, or the gen-
eral exhaustion of  the  forces of the mother, the forceps  now offers a
precious means for her delivery, without compromising  the life of the
child; while, before the invention  of that  instrument, the accoucheur
was compelled  to pierce  the cranium, and  afterward make  extraction
with a crotchet.  Becourse,  however, in such  a  case, could be had to
symphyseotomy, if  the narrowness of the inferior straight would not
permit to act efficaciously with the forceps.
   Lastly, though the Cesarian operation had  been known  from the
remotest antiquity,  it does not appear that it was practiced on the liv-
ing, in the earliest times.  It was an extreme resource, which was only
resorted to on women who died in  the act  of labor; in fact, a Boman
law, attributed to  Numa Pompilius  (lex regia,) prescribed that all
women should be opened who died while pregnant,  so  as  to save the
infant if possible.   The first authentic example of hysterotomy execu-
ted on a living woman does not go further back than the fifteenth cen-
tury  of our  era,   as  we have before remarked.   Wrhen a  vice  of
malformation of the  pelvis, or an  extraordinary volume in the  fetus,
rendered its passage  impossible through  the  natural passages,  the
ancients knew no other expedient than to cut the infant in pieces in
the womb of its mother, and withdraw  it in sections.  The moderns
have dared,  in such cases, to attempt the Cesarian operation, and  have
sometimes succeeded in saving the lives of both  mother and child.0

                             THE PLACENTA.
   The Asclepiadas had very well felt the importance  of this last period
of the accouchement; their  books allude to it in more than  one place,
but  in the  midst  of a  crowd of useless or odd remedies, which they
recommend as proper to procure the evacuation  of the after-birth; the
following  proceeding only, is worthy  of notice.  Place, they  say, the
  0 See observations of MM. Professors Stoltz, (Memoires de l'Acadomic Royale
de Medicine.  Paris, 1836); P.Dubois, (Bull, de PAcademie Royale de Medicine,
vol. Ill, p. 694, vol. V. p. 25.) 
LEGAL MEDICINE.
467
woman on a chair with a hole in it, or if she is too feeble, lay her  in
a bed very much inclined; then place the child, which is still connected
with the umbilical cord, on recently carded and very soft wool, so that
its weight  shall draw gently, and without a jerk ; or better still, have
two leather bottles  full of water, tied  together, cover them with wool,
and lay the child  upon  them;  then pierce each with a small instru-
ment, so that the water  shall  slowly run out, and the weight  of the
child be thus gradually made to draw upon the after-birth.0
  Celsus, to fulfil  the  same indication, gives  much more simple and
rational directions.   " The physician," he says,  " should give the infant
in charge of an assistant; then he should make moderate traction on the
umbilical cord, with the left hand, so as not to  break  it.   If that does
not suffice, he must carry the  right  hand  along the umbilical cord  to
the after-birth, detach the vascular and membranous connections which
unite it to the body of  the womb, and  then withdraw it entire, as well
as the clots of blood which may have accumulated in the uterine cavity." f
  The accoucheurs  who followed Celsus have all  repeated  the precept
which we have just transcribed ;  but the  moderns only have completed
it, in pointing out the cases  in which it is necessary to  hasten the deliv-
ery of the  after-birth, and those where it is  proper to  delay;  and  in
indicating  the course to  be  pursued  when there is  an hour-glass con-
traction,  or the umbilical cord is ruptured.
                       CHAPTEB  VIII.

                         LEGAL MEDICINE.

  If, with Fodere, legal Medicine be defined, the rational application of
all  physical, natural, and medical knowledge to  the  execution  of  the
laws, and the conservation of public health, there  is no doubt  but that
the  history of the ancients would  offer us numerous  examples of this
species of Medicine.   We have already signalized remarkable examples
of it in the legislation of the Egyptians, the Hebrews, and other cele-
brated nations of antiquity.   The old Boman laws, attributed  to Numa
Pompilius, and designated by the  title,  Leges Regies, contained also a
very judicious  application of the physical knowledge of the  times, in
  c Traite' de la Superfetation.  Also, De la Nature de la Femme.  Maladies des
Femmes.
  f Lib. ii., cap. xxix. 
468
REFORM PERIOD.
several of their enactments  relative to  testaments, to the separation of
the spouse, to the nullity of marriages, to abortion, to the presumption
of survivorship, etc.  But it seems to me that such a definition embraces
too many objects, and that medical science, considered, as has just been
said, in all the application that  can be made of it, by governments, to
the  public health, has  been better denominated by recent writers,
political Medicine.  Consequently, we shall define legal Medicine, with
some jurist physicians of great reputation, the whole of medical and phy-
sical knowledge proper to enlighten magistrates in the administration of
justice fi
   The custom  of summoning physicians into the sanctuary of justice, to
enlighten  the magistrate on certain questions which require special  no-
tions in physics  and in medicine,  does  not  go back to a very ancient
epoch.   Fodere,  from whom we borrow nearly all  the substance of this
chapter, says that it commenced under the first Christian emperors,  and
that it owes its  origin  to  ecclesiastical authority.   Charlemagne con-
firmed  afterwards what  Justinian had prescribed.   He ordered,  in  his
Capitularies, that in the questions that pertain to man, the judges shall
support themselves on the advice of physicians, and that the visits, as
well as the reports, be made by men recognized as masters in the Art, and
of high moral  character, by intelligent jurors  acquainted with  matters
belonging to the case.  The tribunal of Chatelet  appears to  have been
the first which comprehended the utility of consulting with expert phy-
sicians, whose  knowledge they could invoke whenever they felt its need.
An edict of Philippe le Bel, of 1311, qualified Master John Potard with
the title of sworn surgeon of Chatelet.
   Nevertheless,  legal medicine  was not yet, at that epoch, but in  a
rudimentary state.  It was composed only of a small number of princi-
ples, disseminated in the general treatises of medicine  or surgery, and
obscured by many prejudices.   There were connected with the tribunals
sworn sage femmes, as well as sworn physicians.  Laurent Joubert cites,
in his Recuil des Erreurs Populaires, three reports of sage-femmes, rela-
tive to accusations of violation and defloration.   The reports—one pre-
pared at Paris, another at Beam, the third at Carcassone—agree among
themselves in pointing out certain lesions, as indicating violent attempts
upon chastity.   The author concludes that the  opinions of the experts of
his  time was unanimous on  these  points; but he does not hesitate to
combat  that opinion in  discussing  in  succession  the  pretended signs
  s See Prunelle's Discourse before the Faculty at Montpelier, 1811; Orfilla, Logons
de Me'decine Legale, t. I., lee. i.  Diet, de Medecine., in  21 vols.,  art. Medecine
Politique. 
LEGAL  MEDICINE.
469
alleged in the reports, and  he demonstrates, from the most respectable
authorities in Medicine, that they are superficial or false.   The follow-
ing is  one of the reports alluded to, by which we may judge of the value
of the  others.0
   The constitution published by the Emperor Charles V., in 1552, gave
great importance to  Legal  Medicine, by extending, and determining
much better than had been done before,  its attributes;  that legislator,
treated, in detail, questions of infanticide, wounds, poisoning, abortion,
and he mentions  the means proper  to be employed,  to  establish these
sorts of crimes.   He requested that  medical men commence to establish,
in  a positive  manner, what  was  the  sum of  the offense;  and  he
traced  the rules for  drawing up reports of cases tried in the  courts.
The one  hundred  and forty-seventh  article of that constitution pre-
scribes a public  examination  when  a questionable hurt is followed by
death, if the death  was really the  necessary effect of  the  wound ;  or,
if it proceeded  from  some  other cause,  as, for  instance,  negligence, or
bad treatment, etc.   Several ordinances of the  Kings of France contain
analagous sections ;  notably, that of Henry III, dated 1570.
   At  the beginning of the  seventeenth century,  Fortunatus  Fidelis,
having drawn together all  that had been written on this matter, pub-
lished the first special treatise on  Legal Medicine.  From  that  time
this  branch  of science. had a separate and  distinct  existence,  and
rapidly  increased.   Paul  Zacchias,  physician to  Pope Innocent X.,
contributed  very much to its  extension,  by making public  his  Medico-
legal questions, which enjoyed, for more  than a  half century, a universal
reputation,  and  still preserve, notwithstanding the  incessant progress
of physico-natural sciences, a part of their interest.f
   Q " Nous Marion Teste, Jane de  Meaux, Jane de la Guigans, et Magdeleine de la
Lippue, matrones jure'es de la ville de  Paris, certifions a tous qu'il appartiendra
que, le lie jour de juin 1532,  par ordonnance de M.  le prevost de Paris, ou son
lieutenant en ladite ville, nous sommes transporters en la rue de Frepaut, oil
pend pour enseigne la Pantoufle, oil nous avons vu et visite Henriette Peliciere,
jeune fille de quinze ans ou environ, sur la plainte par elle faite a, justice, contre
Simon le Bragard, duquel elle a dit avoir e'te forcee et deflore'e.  Le tout vu et
visite  au doigt et a Pceil, nous trouvons qu'elle a:  1.  les barres froissees, 2. le
baleron de'mis, 3. la dame du  milieu retire'e, 4. le ponnant debiffe, 5. les toutons
devoye's, 6. l'enchenart re'tourne', 7. la babolle abattue, 8. l'entrepont ride, 9. Par-
riere-fosse ouverte, 10. le guilloquet feridu, 11. le lippon  recoquille', 12. le barbi-
dant tout e'corche, 13.  tout le lipandis pele', 14. le quillevard elargi, les balunans
pendans: le tout vu et visite feuillet par feuillet, avons trouve qu'il y avait trace
de v..  Ainsi nous dites matrones, certifions etre vrai, a vous, M. le prevost, au
serment qu'avons a ladite ville."  (Ire partie, liv. v. chap, iv.)
   f Qu£estiones medico-legales.  Ire Ed., Amsterdam, 1651.   This work had a
 great  number of Editions. 
470
REFORM PERIOD.
   Legal Medicine does not constitute, rigorously speaking, a particular
branch of science;  it is nothing else than the  special application of the
light furnished by it, to the clearing  up of certain judicial questions.
But this special application requires to be well directed, a tact and
skill  which  all practitioners cannot possibly acquire;  and,  even a
knowledge of laws, to which they are often  strangers.  On that account,
several Kings  of France, Henry IV. and  Louis  XIV.  among others,
established, in  all the communes  and principal cities, royal  sworn physi-
cians, charged to make the report in legal trials.  " This establishment,"
says Fodere,  " did not do all the good that it promised, because it was
stricken, from its birth, with a mortal disease, the venality of officers!"
Nevertheless, this  philosophic  writer does not  hesitate to express a
desire  to see re-established in our days, a similar institution; but, free
from the original vice that reproached it.
   Among the legal physicians of the eighteenth century, whose writings
have contributed most to  advance science.  I will  particularly mention
John Bohn, professor  at Lcipsic;  Michael-Bernard Valentin, professor in
the University  at Halle, and one  of the most distinguished sectators of
Stahlism ; Herman Frederic Teichmeyer, professor in the University at
Jena, who had  A. Haller for a pupil  and a son-in-law ; Oliver Mahon,
professor in the School of Paris ;  John Daniel  Metzger, professor in the
University at Kcenigsburgh,  J. P. Frank, and many others; but, above
all, the Savan  from whom we have borrowed  the greater  part of the
ideas emitted in this chapter.
                        OHAPTEE   IX.

                             CLINICS.

  We  have heretofore said, that two modes of clinical  instruction may
be pointed out, namely, oral and written.  In the first, the patients are
put under the observation of the students, who observe, for themselves,
the symptoms, the course and  termination of the diseases, as well as the
effect of the remedies prescribed by the  professor.   This is clinical
instruction  properly  said, such as  was practiced in the sacerdotal
families of Egypt  and  Greece,  who were devoted to the worship of
Esculapius and such as it exists now, in all the faculties and schools of
Medicine.  The second  method of clinical instruction consists in the
observation, or the histories of diseases, gathered at the bed-side of the 
CLINICS.
471
sick,  with all the  details of  treatment,  and  published  afterward,
both  for  the  instruction of pupils  and the advancement  of science.
These kind of clinical repertories are, indeed, of great  utility.   The
nosologist may, and must draw from them the natural characters of the
morbid species he describes; the therapeutist finds there, also, models
of treatment for each disease, which enables him to deduce the  general
and  particular rules of his  art.   Thus  the  facts of daily practice,
observed with attention,  and  traced  with fidelity, serve to constitute
and  develope  science: science,  in its turn, presents, in abridged  for-
mulae, the  summary of the  experience of all ages—directs  the  prac-
titioner with greatest certainty, from day to day—spares him  infinite
gropings,  and deplorable errors.
                      § I. Oral Clinical Teaching.
  We have already stated why this mode of instruction, the most effica-
cious of all, and the best to form excellent practitioners, was maintained in
the Asclepidean families, particularly in that of Cos, till the foundation
of the school at  Alexandria, and why it was afterward abandoned, to be
revived only at an  epoch very close to our own.   Some erudites have
thought  that they have discovered traces  of  clinical  teaching in  the
histories of the  Arabian Universities, and cite, in support of this opin-
ion,  a passage of Ali-Abbas, in which that  author assumes to have col-
lected at the bedside the most  of the descriptions of diseases which ho
reports ; and in another passage, where he recommends young physicians
to frequent the hospitals.  But the presence of a few pupils during the
visitations and consultations of the physicians of a  hospital, constitutes
no more clinical  teaching, than the  practice adopted by some practi-
tioners of antique Bome, to train after them in the streets, and in  the
houses of their clients, a group of men of every class, whom they deco-
rated with the title  of disciples.
  The first essay in clinical  teaching, of which the history of medicine
makes  mention,  since  the  dissolution of  the  Asclepidean  schools,
occurred in  1578, at the hospital of St. Francis, in Padua.  The pro-
fessors, Albert Bottoni and Mark Oddo, had charge of it:  one had the
female, the other the male ward.*  We are ignorant whether this mode
of instruction was continued, after them, but we are led to think it was
discontinued, from the fact that none are  named  as their immediate
successors.   About the commencement of the  seventeenth century, Otto
de Heurn, professor of  practical medicine in the University of Leyden,
introduced the practice of giving bedside instruction.  Francis of Lebo,
  c Comparetti Saggio della Scuola Clinica nello spedale di Padova.  p. 6.   Thoma-
aius,  De Gymnasio Patorino, lib. iv., p. 420. 
472
REFORM  PERIOD.
called Silvius, who succeeded him, adopted  the same plan; his clinical
lessons had great repute, and  drew a numerous concourse of auditors
from the year 1658 to 1672, which has  caused him to be regarded  as
the founder or restorer of this mode of teaching.
  Notwithstanding the eclat of this innovation, and its well recognised
utility, the successors of Sylvius let it fall into disuse.   Clinical instruc-
tion ceased to exist for more than forty years, till  the epoch when Her-
mann Boerhaave, already invested with several functions in the Uni-
versity  of Leyden, was charged  also  with the duties  of the chair  of
practical medicine.   The illustrious  professor conceived  at once what
advantage must accrue to the students, if the teacher made an applica-
tion, in their presence, of the principles he had  inculcated.   Though
the hospital at Leyden offered few resources  for clinical teaching,  on
account of the small number of beds it contained,  Boerhaave made such
good use of them, that very soon auditors came to  his course from  all
parts of Europe.   His renown, which was already great, for he had pub-
lished  his  two principal works, the Institutes,  and Aphorisms, became
immense.   Persons came to consult him, from the most distant countries.
He was in correspondence with several  sovereigns, and  even with the
Pope, though he was a Protestant.   Finally, he  received, on a memo-
rable occasion,  a very touching testimonial  of the regard of his fellow-
citizens.  A disease having  forced him  to interrrupt  his teaching  for
six months, the first day of his convalescence was  celebrated by a gene-
ral and spontaneous illumination.
   Now, if we seek to ascertain the real merits that recommend this illus-
trious  man to  the  admiration  of posterity, we shall find them  clearly
deduced in the following passage from one of his  biographers.   " Boer-
haave," he says, "exercised during  his life,  and  long  afterward,  an
immense influence in medicine.   Inferior in genius to his cotemporaries,
Frederick Hoffman and Stahl,  he had a reputation more universally dif-
fused, and  his doctrines  have long prevailed over  those of his rivals.
He owed  this advantage to the eclat of his teachings, and the brilliant
qualities  of his mind.   Endowed with  activity  and  rare  facility,  he
acquired  the most varied  and  extended knowledge.   He formed from
this a system,  united in all its parts with infinite art;  presented in  his
lectures and in his works with  method, clearness, precision,  and embel-
lished with an uncommon grace of elocution, it acquired, as may easily
be conceived,  universal  commendation.   This system, which may  be
 considered as a veritable Eclecticism, is made up of some ideas of Them-
 ison and the ancient Methodists, of  those  of the medico-chemist Lcbo,
 and especially of the mechanical theories of the iatro-mathematicians,
 toward whom his taste,  and his studies in the mathematical sciences, 
CLINICS.
473
naturally carried him.   The latter theories are predominant, which have
justly caused Boerhaave to be ranked among  mechanic physicians.   It
is to be regretted that with such  happy faculties for observation, Boer-
haave allows himself to be drawn, against his  principles even, into the
vortex of systems and hypotheses.  He commences by preaching, enthu-
siastically, the method of Hippocrates, and ends by following the bril-
liant  but unsafe example of Galen."°
   The prodigious success of the clinic at Leyden, was decisive in favor of
that mode of teaching.   From the following year, 1715, the sovereign pon-
tiff established,  at Bome, a similar  institution, directed by the cele-
brated Lancisi.   Soon, Edinburgh,  in  Scotland, Vienna, in Austria,
Pavia, and other cities in Italy, as well  as  in England and  Germany,
were endowed with clinical chairs.  France followed a little  later these
examples.  In 1795, was established, at Paris, the first chair of clinical
medicine  which the school of that city ever possessed.   Corvisart, who
occupied  it at first, with J. J. Leroux, elevated his teaching  to  a level
with those of the highest reputation.   In fine, the close of the eighteenth
century saw clinical instruction  established in  all the  schools of Europe,
and even in  some of those of the New World.
   After the death of Boerhaave, the faculty of Leyden, which had been
elevated to the  highest degree  of splendor,  rapidly declined.  That of
Edinburgh,  and above  all, that  of Vienna, occupied thereafter the first
rank, and so existed, without rivals, during more than  half  a century.
The clinical  chair of Vienna, founded in 1733, by  Van  Swieten, under
the auspices of the Empress Maria  Theresa, was occupied successively
by Anthony de  Hacn, Maximillian Stoll, and John  Peter Frank, who
still  occupied it  at the commencement  of  the present  century, after
having been one of the glories  of the school of Pavia.   Thus, after an
interruption of more  than  two thousand years, clinical teaching  was
revive 1 more brilliant  than it ever had been.f
   0 Diet. Hist, de Med. by M.  Dezeimeris, art. Boerhaave.
   f We have  sketched in this  section the history of public and official clinical
instruction.   As to private and free instruction, everything leads us to believe
that it never  entirely ceased; but it can not be traced with certainty.  It is more
than probable that in all  time, physicians  attached  one or  more young men to
their business, who accompanied them in their visits, both in private and hospital
practice, whom they trained in the healing art, both by their example and their
counsels.  In this way the popular archiaters, created by the edict of the Emperor
of Rome, were charged to instruct and examine the aspirants to the practice of
medicine.   In this way also were instituted temporarily, several clinics in Persia
and other countries under Arab  dominion, and so, also, in 1780, L. Desbois de
Rochefort (born in Paris, October 9,1750, died 26th of January, 1786), gave at
La Charite Hospital, Paris, clinical medical instruction, which  attracted anumer.
ous assemblage of auditors,
          30 
474
REFORM  PERIOD.
                § II. Collection op Clinical Observations.
   We have seen that the  physicians  of  the Erudite Period, having
 observed and described diseases with more care than  physicians  of the
 middle ages, discovered  a great  number of morbid  species, which had
 escaped  their  predecessors, such  as syphilis,  scurvy, raphania,  etc.
 During  the Beformative Period,  the  number of  medical  observers
 still increased, but they devoted  themselves less to attempts to discover
 new species, than to determine well the characters of those which already
 existed,  to the  formation  of more exact  and methodic  descriptions  and
 classifications, as before remarked, in the section on nosology.   Studies
 were especially directed during this period, to the influence of climates,
 seasons,  regimen, and  epidemic constitutions.   On these subjects obser-
 vations had long been  neglected,  and they promised an ample harvest of
 discoveries, for the progress of physics and  chemistry offered to  men
 of Art  the means of establishing, with a precision  unknown  to  the
 ancients, the variations in temperature,  the qualities of the air, of food
 and  drinks, in  a  word, the influence of all hygienic agents.  It is then
 principally under this  aspect, that we proceed to consider the results of
 clinical observations collected during the last two centuries.
   Hippocrates had  left to his successors a brilliant  outline  of medical
topography, in  his  treatise on Airs, Waters and Places.   So, also, he
 left them, in his  first and third book on Epidemics, some tableaux  of
 epidemic constitutions, worthy of serving as models in the epoch  when
 they were  traced.   But  the physicians of succeeding  ages  occupied
 themselves but little  with these objects, notwithstanding their  recog-
 nized utility, because they required continued observations during  a long
 course of years, and a  patience, abnegation  and stability, which became
 more and more rare among physicians after the decadence of the Ascle-
 pidean schools.
                    § III.  Epiuemic Constitutions.
  It was only at the end of the sixteenth century, when the Hippocratic
method began to obtain a preference over  Galenism, that men devoted
themselves to the study of  the influence of the  air, regimen, and epi-
demic  constitutions.  William Baillou  was the first among  moderns,
who was distinguished for his researches on this subject.  By his educa-
tion, writings, and genius, as well  as by the  times in which  he  lived,
this physician forms the transition from the Erudite  to  the Befonn
Period, and presents the insensible passage from the  Galenism of J.
Fernel, to the Hippocratism of Sydenham and Stoll.  Profoundly versed 
CLINICS.
475
in the Greek and Latin classics, prompt at repartee, subtile and eloquent
in argument, he was surnamed, in his youth, the Plague of the Bachelors.
By these qualities, he belongs to the class of philosophic, or erudite
physicians,  who followed in the tracks of Galen ; but what is extraor-
dinary,  he joined to this accuteness and vivacity of  spirit, a gentleness
and modesty of character  which excited  the  love of his  colleagues as
much as his talents excited their respect.  They gave him an irrefutable
proof of esteem and affection, by conferring on him twice, unanimously,
the  title of Dean.   A lover of  independence,  but much  more of
humanity,  while he refused positions at  court, the poor always  found
him ready to give them, prodigally, his time, his attention, and succor of
every kind.   At the expiration of his deanship, Baillou devoted himself
entirely to the  practice of his profession, in which he displayed a talent
for observation, and a sincerity and exactness in his epidemic tableaux,
of which there  had been no  example since  Hippocrates.  It was as a
practitioner  that  he acquired his finest titles  to  glory,  and became
worthy  to be placed at the  head of modern Hippocratists.Q
   Baillou observed and described  the  epidemic constitutions that reigned
in  Paris from the year 1570 to 1580.  The following is the tableau he
traced,  of one of these constitutions:  " The year of  Grace  1573, the
weather was extremely variable  during the whole course of the year,
during which a  great  many abnormal diseases were seen—particularly
quartan fevers; and what was more  astonishing is, that these fevers
assumed this type from the very  first.  The old physicians stated that
twenty years before there had existed a similar temperature, and that a
considerable number of persons had died of quartan fevers.  After death,
the spleen was found  soft  and shrunken, the  bile  evaporated, and con-
creted in the gall bladder.  Those  who were  attacked with  double
quartans, or complicated fevers,  or who attempted  to cure themselves
with remedies, nearly all succumbed.   In the  beginning of January, the
fever  changed in character, and became, in some cases a double tertian,
and in others  a benign,  continued fever.   Afterward, an infinite  num-
ber of persons were tormented with itching, inflamed pustules, redness,
and articular pains—chiefly those whom the fever had wasted  and dried
up.   Did the perspiration  which was observed in these sufferers from
fever, proceed from the dryness of the liver, or the general condition of
the body?"
   He joined to the general sketch of each epidemic, the particular history
  0 He was born in Paris in 1538, and died in 1616, aged 78 years.  The best
edition of  his works  has  been published under the title of  Opera Medica
Omnia.  Geneva, 1762. 
476
REFORM PERIOD.
 of some diseases, and commentaries, which develop, confirm, and explain,
 the principal traits of the general description.  The following is one of
 these histories,  which I have purposely chosen among the briefest:  The
 spouse of the Consul Lysseus was taken, in the seventh month of preg-
 nancy, with a flux like a dysentery, accompanied with tenesmus.   Very
 soon a  continued  fever lighted  up.   She went  to stool thirty times,
 during the night, and only made ineffectual efforts.  An abortion was
 feared.    The  disease was sustained  especially  by an  abundance  of
 humors, which seemed to proceed from the region of the liver.   Bhubarb
 and cassia were administered successively, as well as clysters variously
 composed.   A  vein  was  opened twice.   Injections  into rectum were
 administered, and  anodynes were  given in every form, a day  and a
 night,  to prevent abortion.    The patient was  re-established."   This
 clinical observation, like  the one which precedes it, is conspicuous,  as
 is seen, by the clearness and conciseness which distinguish the legitimate
 writings of Hippocrates.  Possibly, we have a right to reproach Baillou,
 as well as his  model, for the  absence of  sufficient details, but it  is
.necessary to recall that the French Hippocrates was accustomed to add
 to his particular histories an explanatory commentary.
   A curious  remark  to make,  in the course of this historic period, is,
 that in  proportion as the authority of Hippocrates increased, that  of
 Galen declined; nevertheless, until the end of the sixteenth  century,
 these two  princes in medicine were confounded  in  a common  worship,
 and  Baillou  himself quotes  both  indifferently,  in his commentaries.
 But, after  him, the  reaction  against Galenism became general; very
 soon no one dared  invoke  the  authority of the Pergamian, while, until
 the  latest times,  men of the  highest reputation—the Baglivi,  the
 Sydenhams, the Stahls, and the Pinels—boasted for themselves the title
 of Hippocratists.  What, then,  is the difference between  the Galenism,
 or the Dogmatism of Galen, Oribasis, Avicenna, and J. Fernel, and modern
 Hippocratism ?  No writer  has taken  the trouble to show us ; no one,
 perhaps, has  stated it in a well-defined manner.  We will undertake to
 supply their  silence, and trace  the line of demarkation which separates
 these two doctrines.
   For this  purpose  we recall here what  as said in the Anatomical
 Period on the subject of the ancient Dogmatism : that it is composed
 of two distinct  theories, namely, the  theory of coction and crisis, and
 the theory of four elements, or four  primordial  humors.  Galen  and
 his successors  embraced  this  doctrine in its totality;  they enlarged,
 commented upon, and endeavored to explain by it, all the phenomena of
 animated nature.   But the progress  of physics and  chemistry, in the
 sixteenth century having demonstrated the errors of the theory of  four 
CLINICS.
477
elements,  it  was irresistably necessary  to  renounce that part of the
ancient Dogmatism, and cling only to the first.   It was then  that  the
sect of modern Hippocratists was formed,  which preserved of the doctrine
of Hippocrates only the dogma  of coction  and crisis, founded  on  the
existence  of a principle, or intrinsic force, inherent in every living
being, and presiding over, or at least co-operating in, all the phenomena,
whether physiological  or pathological, that are developed in  it.  The
consequence  of this theory is, to consider every derangement of the
health as an effort of nature, or the vital principle, tending to remove
the obstacles which oppose  themselves to the free exercise of its func-
tions ; hence the aphorism, that the physician is the minister of nature—
that  he must study its tendencies, and respect them, insomuch as they
are not evidently bad, and, in short,  to interfere  with remedies  only
when the vital forces appear inefficient, or sur-excited, or deviated.  One
is a Hippocratist, in the modern sense, from the moment he  admits the
autocratism of nature, or the vital forces, no matter otherwise how much
he tend, with Sydenham, toward humoralism, with  Stahl, to  animism,
or with Pinel, to solidism, etc.  There is, as is seen in  our  days, great
latitude in  the qualification of  Hippocratists, and many  physicians to
whom it is applied, and who themselves  profess it, have advocated
doctrines extremely diverse.
   However  this may be, we have not to  examine here the value of the
fundamental  axiom of modern Hippocratism.  That examination will
be more appropriate in  the  chapter  on theories and systems.   It  has
sufficed for  the  moment to  show in what modern Hippocratism differs
from the ancient Dogmatism—that is, from  Galenism.
   Thomas  Sydenham,  who flourished during the second half of  the
seventeenth century, merits the surname  of  the English Hippocrates, as
much on account of his medical doctrine, as  of the profound study he
made on the influence of epidemic constitutions.   Partisan of  the  phi-
losophy of Locke, of whom he was the cotemporary and friend,  he was
one of the first who strove to bring physicians back to the observation
of pure and simple pathological phenomena, of which Hippocrates had
given the example in some of his writings.
   We give here some  maxims extracted  from the works of  Sydenham,
which seem to us to comprise  the  medical  philosophy of  that author:
" In the first place," he says, "it is necessary to reduce all  diseases to
precise and determined species, with the  same care and the same exact-
ness that the botanists  have  displayed in their treatises on plants.  In
the second place, whoever desires to give  a history of a disease, should
renounce every philosophic  system and  hypothesis,  and mark exactly
the smallest morbid phenomena which are clear and natural; imitating 
478
REFORM PERIOD.
 thus, the painters, who, in their portraits, have great  care  to  express
 even the slightest marks of the persons whom they desire to represent,
 In the third place, it is necessary, in the  description  of a  disease,  to
 expose separately the proper or essential, and the accidental and foreign
 symptoms.   In fine, the seasons that  favor most  each order of symp-
 toms must  be carefully marked.   These are not the only things neces-
 sary to  observe in writing  the  history of diseases, but  they are the
 principal."0  Such are, in regard to pathology, the general principles of
 Sydenham.
   In regard to therapeutics, he expresses himself in these terms:  " The
 great Hippocrates, after having established as a solid basis of his Art,
 this incontestible axiom, namely:  nature cures diseases;  has exposed,
 clearly, the symptoms of each  of them, without having recourse  to any
 hypothesis or system, as may be seen in his works.  He has,  also, given
rules for treatment, founded on the course which nature takes  in the pro-
 duction and cure of diseases.   This is very nearly in what consists the
 theory of the father of Medicine, and all he demands of a physician is,
 to succor nature when she is overcome, to correct her when she errs, and
 to bring her back into the circle which she has just abandoned.   It  is
 absolutely impossible for a physician to know the morbific causes which
 have no relation to the senses;  neither is it necessary."!
   It is easy to recognize in  this expose of principles, the doctrine of a
 modern Hippocratist, but we find  there, also, some  maxims borrowed
 from the ancient Empirics;  such as the following:  "It  is  necessary to
 describe the pathological symptoms  as  they manifest themselves, with-
 out the aid  of any hypothesis, and to  reduce diseases  to  precise  and
 determined species, like  the vegetable  species formed by the botanist.
 It is absolutely impossible for a physician  to  know the  morbific causes
 which are not all appreciable to the senses."  The first of these propo-
 sitions recalls, evidently, the symptomatic groups, or  the theorems of
the ancient Empirics; the second excludes the research of the so-called
occult or  essential causes  against which those philosophic physicians
constantly protested.   It it on this account doubtless, that some writers,
among others, Kurt, Sprengel,  have ranked Sydenham among the secta-
tors  of Empiricism.   But he is distinct from them  in  several respects,
principally in that he does not  conform  to his own sage maxims which
we have just quoted, but, on the contrary, he  transgresses and contra-
dicts them at every step.  I might quote  a crowd of these  contradic-
tions, but shall content myself with the two following:  " Every specific
°CEuvres de Medicine Pratique, preface, sec. 7 to 12.  Translation of Janet.
 t Ibid., 10 to 15. 
CLINICS.
479
disease," he says, " is an affection which proceeds from an exaltation or
specific alteration of some of the humors of the body."0  Again, wish-
ing  to  explain  the generation of spring-fevers, he reasons as follows:
" In winter, the spirits being concentrated  by the  cold, become  strong;
afterward, the heat of the spring puts them in motion, and as they find
themselves mixed among the viscous  humors which  nature, during  the
winter,  has accumulated in the mass of the blood, (though these humors
may be still less tenacious than those which, dried by the heat of sum-
mer,  cause  autumnal fevers,)  the  spirits, I  say,  finding themselves
embarrassed and overwhelmed by these viscous humors,  make an  effort
to disencumber themselves, and by this  effort produce the ebulition
which occurs in spring fevers.   In like manner, if bottles full of beer,
which have been long kept in a cool cellar, be brought  close to  a fire,
the liquor soon  bubbles and  seeks to escape."f   I have no need to
remark, I  think, how far the pathogenetic explication  which we have
quoted, passes the limits of sensible  phenomena to enter into the laby-
rinth of hypotheses—how much they are opposed  to the  sage maxims
proclaimed above, which the author has borrowed, possibly without sus-
pecting it, from the Empirical  doctrines.
   Sydenham, after having  studied with admirable patience for fifteen
consecutive  years, the  influence of epidemic  constitutions, thought he
could emit,  on that subject, the following theory:   "There are various
constitutions of  the year, which come neither from heat, cold, drouth
nor humidity, but rather from a concealed and inexplicable alteration,
which occurs in the bowels of the earth.  Then the air is found  affected
with  pernicious exhalations,  which  cause  special  diseases,  as long
as the same constitution is predominant.    In  fine, at the end of a  few
years this constitution ceases, and gives place to another.  Each general
constitution produces a  fever which is proper to it, and which, outside of
that, never appears.  For this reason, I call these sorts of fevers stationary,
or fixed." J
   " What appears to me especially difficult," he says, further on, " is to
know, in the commencement of a constitution, the species of fever which
is going to prevail,  since, until then,  no  specimen of it  has been seen.
o  o   o  jjufc though it may be difficult to  foresee, certainly, the new
species of fever which is about to commence—and  when even that must
be supposed entirely impossible, we have, at  least,  always  the resource
of directing the treatment upon general  principles.   By this means we
0 Preface to CEuvres de Medicine Pratique.  Translation of Janet.
t History and Curation of Acute Diseases.  Sec. i, chap. 5.
J Ibid. 
480
REFORM PERIOD.
are enabled to place our patient out of danger, provided we proceed cau-
tiously, without too much haste—for there is nothing, according to my
view, more pernicious than precipitation, nor anything which causes the
death of more persons who are attacked with fevers."0
   There is no questionIxrt that we see epidemics frequently developed,
the production of which, possibly, can be attributed neither to variations
in the atmosphere, nor to  the qualities of the regimen, nor to any other
known  cause.  It  is equally evident from common experience,  that
when an epidemic reigns with a high degree of intensity, it impresses on
all intercurrent diseases a  particular character, which requires a modi-
fication of the treatment, according to the nature of the epidemic.   This
is what all  attentive  practitioners  have observed, and which  did not
escape the notice of any physician in Paris during the cholera epidemic
in 1832.   But to pretend that there exists  all the time, an epidemic
constitution,  or stationary fever, independent  of the  influence of the
regimen and  atmospheric vicissitudes, a  constitution  that would change
the natural character of diseases and necessitate grave modifications in
their treatment, is to generalise  a particular observation—is to erect an
exceptional fact into a rule.  A similar theory, if it  could be admitted,
would take from therapeutical  precepts all stability, and would trans-
form medical practice  into  a continual groping—a   consequence  that
Sydenham himself  did not  disown in the last quotation, and which is
in itself sufficient to cause  the rejection of his doctrine.
   This doctrine has, however, a  great number of sectators of the highest
merit, among whom we must place in the first rank,  Maximillian  Stoll
and Philip Pinel.   The celebrated  professor of Vienna, whose talents
for observation cannot be  questioned, strives, with  a  zeal  more  merito-
rious than fortunate, to unravel the theory of epidemic constitutions;
but though  he expresses  himself, on this  subject, with more precision
than any  other, he has not  been able to dispel the  obscurity that rests
upon it;  because he has  himself extended beyond measure, the idea of
stationary fevers, as is  easy  to be seen by the following passage:
   "The stationary," he  says,  "is embraced in a  certain  number of
years ;  it gradually increases till  it attains  its hight, then declines,
giving place to another stationary,  which succeeds it.  Do these  same
stationaries return  in a fixed and certain order, after a certain number
of years ?   Are they limited in number?  Or do they produce,  sometimes,
new ones?   These  questions cannot be determined, on account of the
absence of observations made during a long course of years by skillful
physicians in one locality,  and compared with similar observations  made
*' Hist, et Cur. Maladis Aigues, sec. iv., chap. vi. 
CLINICS.
481
by others.   Thus we are ignorant, up to this time, of the nature, num-
ber,  extent, and period of stationary fevers:  Solely it is established
after the observations of Sydenham and my own, that a  stationary fever
extends its influence on all absolutely febrile diseases, and  that it con-
trolls them, whether they are independent of the changes of the season,
or proceed  from any  isolated cause.  It is no less certain that the
stationary fever exercises a great influence on chronic diseases, whether
febrile or not." °
   Independently of the stationary fever, a species of protean, present  in
all places, in all time, associated  with all diseases,  clothed in all forms,
without  having any of its own,  the same authors admit  other fevers,
which they name,  sometimes sporadic,  or intercurrent,  and  again,
annual, or cardinal.f  There are,  according to Stoll, four sorts of annual
fevers, namely: the inflammatory, which  prevails   most in  the  winter,
and at the commencement of spring; the bilious, which  predominates  in
the  heat of summer, and  at the  beginning of  autumn  ; the pituitous,
which shows itself in the passage of autumn into winter, and of winter
into spring; finally, the  intermittent, which appears in the spring and
autumn.   Annual  fevers  take,  often, their vulgar name  from some
dominant symptom; thus they are called pleuritic, miliare, petechial,
rheumatic,  morbilous,  variolic,  etc.,  when they are accompanied with
pleurisy, miliary, or petechial eruptions, rheumatism, etc. J
   Notwithstanding my respect for  such  observers  as Sydenham, Stoll,
and Pinel,  I can regard their stationary fevers only as an allusion, a
Utopia,  which  resembles  the  quid divinum, re decov,  of the ancients,
an expression "by which they were accustomed to designate the unknown
cause of all strange and inexplicable  phenomena.   In regard to annual
or  sporadic fevers, no one  doubts their  reality,  for  each of them
manifests  itself by evident and palpable  signs  that  are appropriate
to it.  Thus the pathological state which is designated under the name
of inflammatory fever, is very distinct from that which is named bilious
fever,  whatever opinion, otherwise, one may have on  the origin and
reciprocal relations of the  two  states ; so, pleuritic  fever, or pleurisy, is
perfectly distinct from miliary eruption, rheumatism, variola, etc., when
however these divers affections do not co-exist,  nor are   complicated  in
the  same  subject.
  ° Aphorisms on the Knowledge and Cure of diseases.  Translated by Corvisart.
  f "The stationary fever," says Stoll, "is disguised frequently, and in various
ways.  It imitates different diseases, though at bottom, its character may be
everywhere  the same, and the method of treatment the same in every case."
(Apho. 391.)                      f Aphor. 39, 41. 
482
REFORM PERIOD.
                      § IV. Medical Topography.

   The study of Medical Topography is intimately united with that of
epidemic constitutions; these two branches of science should go together;
they  mutually  enlighten  and complement each other.   The cultiva-
tion of both  commenced about  the same epoch, namely,  during  the
second half of the sixteenth  century.   Prosper Alpin was  one of  the
first to occupy himself with  topography, in  a medical  point of view.
He wrote a book on  the natural history of Egypt, the  diseases of its
inhabitants, the ancient and  modern  medicine of the country—full of
judicious and erudite reflections, in which the good taste of the author
is prominent.   James Bontius  collected  interesting observations on
the natural productions of the West Indies, and on the diseases which
habitually prevail there.    William  Pison wrote a   similar work on
Brazil, and united  afterwards, in the same edition, his work  with that
of Bontius, under  the title of  Historia Naturalis  et Medica Indice
Orientalis.    The  celebrated  traveler  Koempfer,   collected  a mass of
excellent observations on medicine and botany, during  the ten years he
employed in travels in Persia, Armenia,  Japan,  the Kingdom of Siam,
and other parts of Eastern Asia.
   In his history of the diseases of St. Domingo, J. B.  Poupe  Desportcs,
arranged  the medical topography  of  the island, and  described  the
epidemic  constitutions which he had  observed  there, from  1732  to
1747.   George  Cleghorn  studied,  with  much care and sagacity,  for
thirteen  years,  the endemic  and epidemic affections  of  the  island of
Minorca, the manners of the people,  the qualities of its atmosphere, and
the nature of the  soil and its productions.  He remarked a great
analogy between the diseases of that  country, and those described by
the ancients, which he attributed to the conformity of the  climate of
Greece, with that of  the above  mentioned islands.0  J. Lind wrote an
excellent treatise on the Diseases of Europeans in hot climates, and on
the means of preserving  the  health  of  sea-faring men during long
voyages.    William Hillary, made meteorological  and  medical observa-
tions  in  the  island  of  Barbadoes.f  Lionel  Chalmers,  wrote  on  the

  0 Observations on the Epidemical Diseases in Minorca, from 1744—1719.  Lon-
don. 1779, in-8.
  f Observations on the change of the air, and  the  concomitant epidemical
diseases, in the Island of Barbadoes. London, 1759, in-8.—Comparez J. Hendy.
Memoire sur la maladie  glandulaire de Barbade (Memoires  de la Socie'te Me'di-
cale d'emulation,  Paris, an ix, T. IV, p. 11,)  et Alard.   De  l'inflammation des
Vaisseaux absorbants,  lymphatiques,  dermoides et  sous-cutanes, etc.  Paris,
1824,  in-8, fig. 
CLINICS.
483
 climate  and  diseases  of South  Carolina.   Bajon,  addressed to  the
 Academy  of   Natural  Sciences  of  Paris,  several  memoirs,0  which
 obtained the  approbation of that learned  association,  concerning  the
 medical  topography of Cayenne, and of French Guiana, the mal rouge
 of Cayenne,  and  the  effects of  the  climate  on  newly arrived Euro-
 peans, etc.
   In Europe  a strong impulse was  given to the  study of topography:
 a multitude of researches were undertaken  with this object.   Learned
 societies  often put, in  concours,  questions  relative to  the medical
 topography of the  places  in which they were held ; many physicians
 published spontaneously the result of their observations in the countries
 where they practised; aspirants to the doctorate often took as a subject
 for  their  theses,  the  description of localities  where they designed to
 locate for the practice of their profession.  There was not a province
 or a city of considerable size, which did not become the  subject of  one
 or several topographical monographs.f
   Finally, an effort was made to collect all  the observations  that had
 been published on this  subject, in every  part of the  world, and to
 compose from them a general geography for the use of physicians, in
 which all the diseases proper to each climate, and each country, should
 be clearly defined, with the  probable  causes of their development and
 the  method of treating them.   William Falconer was the  first  who
 published  a work  of this character, entitled, Bemarks on the Influence
 of Climate, Geographical Situation, Nature of the  Soil,  Inhabitants,
 Quality  of Food,  and  Mode of Living;  Dispositions, Temperaments,
 Manners  of the  People,  Intelligence,  Laws  and Customs, Forms  of
 Government, and  Beligion  of the Human Bace.  But the execution of
 the  work  so  pompously  announced, was far from responding to  the
 promises of the title.   Some years after, Leonard Louis Finke published
 a general geography of practical medicine—an incomplete and undigested
 compilation,  but  richer  in  facts, and exact  observations,  than  the
 preceding.
   To give  an  idea of the  multitude of objects included in  the medical
 topography of  a country, I will here  transcribe the programme  which
 was summed up by the Boyal Society of Medicine,  of Paris, in proposing
 for a prize essay, the examination of the geographical situation of that
 capital, and its environs :

  ° Me'moires pour  servir a P Histoire  Naturelle de Cayenne  et de la Guiane
 Francaise.  Paris, 1777, 2 vol.  in-8.
  f Several  Medical Topographe's worthy to be consulted, are published  in  the
Memoires  de la Societe' Royal de Med.  Paris, 1776-1790, 10 vol. 4vo.  See also
Recueil d'Observations de Medicine des Hospitaux  Militaire, etc. 
484
REFORM PERIOD.
   " Determine what are the mountains or hills that concur  in the
formation of the Paris basin, and that are found in its environs.  What
is their extent, their form, and  their elevation above the ordinary level
of the Seine ?   What is their  position  relative to the four  cardinal
points of the horizon, their respective distance, their connections among
themselves,  by their projecting and receding angles, their situation and
direction in relation to the city ?  What  is their internal  composition,
the nature  of  their soil, and of that of the valleys formed by them.
and lastly, what is  the  extent  and direction of  these valleys ?   What
are the position and extent of the forests planted in the environs, their
distance from the city, the quality of their soil, the species and average
hight of their trees ?
   " What are  the running or stagnant  waters  that are found in the
neighborhood, either constantly or only  at certain times  of the year ?
What  is, independently of the riv^r water, the quality  of drinking
water, and the changes  it undergoes at  different  seasons ?  What are
the courses of the usual  winds, and what  obstacles, what deviations and
modifications,  do they  undergo  from the forests, the  mountains, and
valleys ?  Lastly,  what  are the  different productions for the use of men
and animals, furnished by the surrounding country."
   This programme, as is seen, includes  only a  part of the  documents
which  compose medical topography ; to complete  it, it  would be neces-
sary to add a general  view  of the city, its streets, squares, and the
public and private  edifices of  the population; to describe  the physical
constitution of  the inhabitants, their  tastes,   inclinations, manners,
nutrition, clothing,  civil and political  state,  etc. ;  lastly, to  give  an
account of their endemic and  epidemic diseases.
   A scheme so vast is not easy to  fill, for a city like  Paris, and  much
less still for a great province or  a kingdom.  It  requires extended and
varied knowledge,  an immense number of positive  observations,  a spirit
of analysis  to decompose the facts, and  to  ascertain  their elements, a
synthetical  genius, to  connect  them according to their analogies, and
deduce from  them  general consequences.   How would  it be  if one
wished, in  work  of this  kind, to comprehend  one of the  four  great
divisions  of the terrestrial globe, or of the entire globe  itself?  The
life of a man would not be sufficient for it, whatever might be his capa-
city, and  we  feel  that  an enterprise  of this  importance  can not  be
attempted except by a learned society, and executed in  the period of a
great number of years, with the concurrence of savans and physicians
disseminated over all parts of the earth.0
   w The late lamented and eminent Prof. Daniel Drake, M.D., made a contribution
to Medical Science on  this subject, that has no  parallel in medical literature.  See 
THEORIES AND  SYSTEMS.
485
                        C H A P T E B  X .

                  THEORIES  AND  SYSTEMS.

                      PRELIMINARY  REFLECTIONS.

   The philosophic system of Aristotle, and the medical system of Galen,
had resisted the attacks, more violent than skillful, of the innovators of
the sixteenth century.  By the  help of some  modifications in details,
these systems had appeared sufficient to the majority of minds to explain
the rationale of observed phenomena in the mental, moral, and physical
world.   Those, even, who found them insufficient  or defective  in  some
respects, still preferred them to most of the  hypotheses, more  brilliant
than solid, of the modern  Platoneans, and to the crude lucubrations of
the  propagators  of the Occult Sciences.  Thus,  the  doctrines of the
schools sustained themselves less, perhaps, by their intrinsic merits than
by the  feebleness of their adversaries, because  these  had up to  that
time proposed nothing better, or that was even comparable to them.  It
may be said, perhaps, that under this  state of things it was wiser to
rest in doubt and waiting, without pronouncing  in favor of any party.
To this counsel I shall offer  only this  objection: it was impracticable.
Indeed, of speculative truths we may certainly rest in doubt  and wait-
ing ; thus, we may doubt all our lives if there are several sorts of spirits
in the animal economy, as  indicated by Galen, or if there is  only one
sort, as  is asserted by Laurent Joubert; but  in regard  to practical
truths,  doubt and waiting  are impossible.  For example, let a physician
be  called  to  a  patient:  he must necessarily  prescribe something or
nothing.  Now, if he order nothing, he  takes a position, just as much as
if he had ordered something.   We thus  see that the  practitioner can
not remain  indifferent in  regard  to therapeutical methods, and  that,
from  taste  or compulsion, with or  without conviction, he  is obliged,
every day and at each moment, to adopt one  of  them.    It is, therefore,
important that he study and compare them well beforehand, in order to
adopt the best, or, if you please, the least defective—the one which offers
the best guarantee of  success.  To defer this examination, to  take no
thought in each  circumstance,  except  from  the inspiration of the
moment, is to exhibit ourselves unworthy of  the medical priesthood—is
to play  odd and even with  the lives of our fellows.

his Systematic Treatise, Historical, Etiological, and Practical, on the Principal
Diseases of the Interior Valley of North America, as they appear in  the Caucas-
ian, African, Indian, and Esquimaux varieties  of its population.  Vol. I.   Cin-
cinnati, 1850.—Tr. 
486
REFORM  PERIOD.
   But the time approached when men more powerful in genius and sci-
ence, began to demolish the antique edifice of human knowledge, in order
to reconstruct it  on new foundations.   Already Martin Luther, the
boldest of  the innovators  of the  sixteenth  century, having  proclaimed
the  liberty of investigation in matters of religion, drew after  him  a
notable part of Europe.   Copernicus and Galileo had opened the route
in which Newton afterward  immortalized  himself by almost fabulous
conceptions.  Natural history, Physics, Chemistry,  and Medicine  were
enriched, every day, by  facts  that were in manifest contradiction to
received theories.   The necessity  of a general  recast of the sciences
was more and more felt;  the ancient philosophic doctrine  could not sus-
tain itself  in the midst of the crumbling ideas which had served to build
it up.
   Thus the  Beform Period  witnessed  the appearance  no  longer of
mere simple outlines, such as we have signalized in the preceding period,
but complete systems of philosophy, wisely elaborated by minds  of the
first  order: systems which have  exercised  a marked influence on  the
march of the human mind, and on that of Medicine  in particular; sys-
tems of which it is indispensable to have a summary idea, in order to
comprehend and appreciate modern medical theories.
ART. I. HISTORIC SKETCH OF PHILOSOPHY DURING THE  SEVENTEENTH AND
                       EIGHTEENTH  CENTURIES.

                   § I.  Retrospective Considerations.
  The magi of the East, the  priests of Egypt, and  the most ancient
philosophers of Greece, were persuaded that to make a grand progress
in science, as  well as in wisdom, there were no better means than to
separate from  the crowd and the noise of life, become isolated from all
external  sensations,  and  meditate deeply on  the  great truths  which
constitute real knowledge and lead to  true  happiness.   Such was  the
aim  of the  institutions which Pythagoras founded in Italy—imposing
silence on his  disciples;   and  such was the advice that  Plato, heir of
the doctrine of Socrates, gave  to his scholars.   It is necessary, he says,
in order to arrive  at a  knowledge of the truth, to retire within one's
self, and be  freed, as much as possible, from all outward impressions, so
that the soul, disengaged by thought from the bonds  of the body, may rise
in full liberty, toward  the eternal  essence whence it  emanated ;   for
there is  the source  of  all light; it is there only that our spirit will
find  science, and repose in recalling its celestial origin. 
THEORIES AND  SYSTEMS.
487
   This method, which we  name intuitive, or reflective,  led the earliest
sages  to the discovery of  the moral and religious truths which are the
base of the social order.   By it, they elevated themselves to the idea of
one  God, eternal and infinite—Sovereign  Arbiter of  the destinies of
the world ;  to the idea of  the immortality and spirituality of  the soul;
to the ideas of justice,  virtue, future  rewards, etc.   It is also by this
intuitive  method that mathematical  axioms are discovered;  axioms
which charm us  by their infallibility,  and from which are deduced, by
reasoning from irresistible evidence, an infinity of  theorems, more  and
more  admirable.  It was  especially this infallibility of  mathematical
reasoning that led the philosophers to introduce the same method into
all the sciences.  They flattered  themselves that by following exactly
the same course  for every  class of ideas, they could advance with  the
same certainty.  AVas it not natural,  indeed, to  desire to generalize a
mode of acquisition which had  produced such satisfactory results in so
many  respects;  and must we not excuse Plato when he seeks in ideas,
purely abstract, the secret  of the creation of the world,  and the explana-
tion of natural phenomena;  when he  essays to establish a system of
cosmogony on  geometric abstractions,  by supposing, for example, the
number of primitive triangles that should compose each of the material
elements.
   Nevertheless, the  men who made a  particular study of the physical
world, such as  Democritus, Hippocrates, and  Aristotle, did not  fail to
perceive  that, in order  to arrive at a knowledge of  the properties of
matter in general, and of  bodies in particular, mental  reflection, apart
from all impressions on the senses, was not sufficient;   but that we
must, on the contrary, give great weight to these impressions, and make
them the basis of our  judgment in what relates to the order of sensible
things.  Hippocrates was one of the first who proclaimed the necessity
of observation in medicine,  and  the  impossibility  of discovering  the
causes of diseases, their  nature, their  course and their effects, by any
other plan.   Aristotle generalised to  excess, perhaps,  the thoughts of
Hippocrates, when he affirmed that all  our knowledge  is  derived from
sensation—"Nihil est in intellectu quod non priits fuerit in sensu." But
he did  not mean to say by this that we acquire ideas by the senses only;
he meant, merely, that the first ideas that arise within us, and which are
the foundation of all the rest, are derived from the senses.
   Aristotle, though having an opinion  diametrically  opposite  to that of
Plato,  on the origin of our acquirements, agreed with him in saying that
the first notions that are formed in our minds are very general  ones—
mother ideas—principles.  Now, as we  have demonstrated in  a  former
section, this is a very grave philosophic heresy, and it drew these two 
488
REFORM  PERIOD.
philosophers and their successors  into  an  inextricable labyrinth of
subtilties  and contradictions.  For more  than two  thousand years  it
was the established rule to place at the head of  all treatises, general
axioms, which were very improperly named principles; and efforts were
subsequently made to deduce from these principles a series of proposi-
tions, more or less logically connected.   Observation, when one deigned to
consult it, served only to lay the first foundation of the scientific edifice ;
reasoning must do the rest.  Such was, with some exceptions, the mode
of proceeding of all  the authors  and philosophers, particularly till
toward the close of the sixteenth century of the Christian era.
   At that epoch the  method of pure observation had  partially pene-
trated  into  some branches  of human  knowledge,  such  as physics,
chemistry, and  astronomy, and had produced admirable results, which
had  greatly shaken the scholastic philosophy.  It now needed only the
the  advent  of  a generalizing  and  profound mind,  who  would  dare
penetrate to the base of our ideas, and succeed  in  finding a form  of
reasoning less  defective than that generally adopted.   Now, two  men
of a  character and  genius very different, appeared nearly at the same
time, both attempting  this great enterprize.   The first  was Francis
Bacon—the second Bene  Descartes.
        § II.  On Modern Sensualism and Reasoning by Induction.
  Bacon, versed early in the management of men and affairs, endowed
with a fine and positive mind; cultivating by predilection the natural
sciences, physics and chemistry, was one of the first to feel and point
out clearly the defect of the method adopted till then, of placing at the
foundation of the  sciences, the most general axioms.   " There are  and
can  exist but two ways of  investigating and discovering truth.   The
one  hurries on  rapidly from the  senses and particulars, to the  most
general axioms, and from them, as principles,  and their supposed indis-
putable truth, derives and discovers intermediate axioms.   This is the
way now in use.   The other constructs its axioms from the  senses and
particulars, by  ascending  continually  and gradually,  till  it finally
arrives at  the most general  axioms, which  is the true but unattempted
way." °
   This is a very important passage, and merits to fix our attention ;
for it lays down in the clearest manner the difference that exists between
modern sensualism and  the  sensualism of Aristotle.    Let us recall,
0 Novum Organum, Book i., chap, i., Aphorism xix. 
THEORIES AND  SYSTEMS.
489
indeed, the extremely subtile sophisms by which the Macedonian philo-
sopher proved that the  first  ideas  which  are formed in  our minds
through  the  instrumentality  of  the senses,  are  very general ideas;
whence he concludes, that in all  sciences we  should  commence by the
most universal axioms.0   Bacon, without seeking  to  unravel the  knot
of  this  sophism, contents himself  with establishing a rule entirely
contrary, which consists in passing from  sensations to particular facts,
then from these  to more extended notions,  and so on, rising by grada-
tion from  individual facts to notions more and more  general, up to the
most universal axioms, which form the  crown, and  not the  base,  of
natural  sciences.
   It has been customary to regard Bacon  as the restorer of the method
of  observation,  and, in fact,  he  continually  asserts  it in  his works;
but many others before him have proclaimed it with no less  persistence,
and have consequently been able to  avail themselves of a much better
method  to reach  great discoveries.   Whence,  then, the exclusive honor
attributed to  him, of having re-established this method ?   Because  he
gave it a new development, and was  the first  to teach that particular
ideas are the  base of the scientific pyramid,  and axioms are  its summit.
 This was, indeed, a radical innovation, full of the future, the importance
of  which was completely  realized by Bacon  ;  for he  often speaks of it
with enthusiasm, and  praises it as  an unparalelled  discovery.   "  No
one has  yet been found possessed of sufficient firmness and severity  to
resolve upon  and undertake  the task of entirely  abolishing common
theories  and notions, and applying the mind  afresh,  when thus cleared
and elevated,  to particular researches;  hence our human understanding
is a mere farrago, and crude mass, made up  of a great deal of credulity,
and accident,  and the puerile notions it originally contracted.   But if a
man of  mature age, unprejudiced senses, and  clear mind, would betake
himself  anew to experience and particulars,  we might hope  much  more
from such a one ;  in which respect we promise ourselves the fortune of
Alexander the Great! " f
   In another work, the English  metaphysician,  desiring to signalize
more and more  his method,  and  its difference from the ancient one,
expresses himself in these terms :  " The end of our new logic is to find,
not arguments, but arts ;  not what agrees with principles, but principles
themselves;  not probable reasons, but plans  and  designs of works—a
  0 See his philosophic doctrine: Phil. Period.  In  this sophism Aristotle con-
founds, without knowing it, general ideas  with confused ideas, which are very
different.   Hence his errors, and those of the writers who have followed him.
  f Loc. Cit., Aphorism xcvn.
          31 
490
REFORM PERIOD.
different intention, producing a different effect.   °   °  °   The nature
and order of the demonstrations agree with this object.  For in common
logic, almost our whole labor is spent upon  the syllogism.   Logicians,
hitherto, appear scarcely to have noticed induction, passing  it over with
some slight comment.   But we reject the syllogistic method, as being
too confused, and allowing nature to escape out of our hands.         °
We therefore  think that induction is  the  true method which guards
our senses  against all error, which clearly follows nature,  is akin  to
practice, and is almost practice itself." °
   Unfortunately, it is not the form of argument, not the logical method,
that secures a man from false  reasoning.  Bacon himself furnishes us
the proof of this in his Organum—in that work, even,  which  he believed
was destined  to direct the human mind,  with certainty,  toward the
truth.   In fact, after having exposed his method,  this philosopher,
desiring to show its application, and prove  its  excellence, by examples,
essayed to  resolve by  it several  problems,  one of the  first of which I
will give :  What is the nature of heat ?  After an infinite number of
exclusions and circumlocutions, he arrives at the  following  conclusion :
" Heat is an expansive motion, restrained, and  striving to  exert itself,
in the smaller particles, but with the following modifications : first, by
its tendency to rise, though expanding toward the  exterior ;  second, this
effort is modified  by its not being sluggish, but active, and somewhat
violent." f   I leave to more skilful critics the  task of  explaining  this
definition,  as  well as the premises  from which  it is  derived ;  but I
doubt  if one  more obscure and  puzzling can  be found  among those
transmitted to us from antiquity.
   A little  farther on the same author, desiring to determine the nature
of tangible bodies, expresses himself thus :  " All tangible bodies inclose
an invisible and intangible spirit, to which they  serve as envelope, and
as  clothing, whence result  three  orders, or modes of  action, which are
the triple source of the powerful effects of the spirits exerted on tangible
bodies.   When this spirit exhales, the body contracts and  dries ; if it
is retained, it softens or liquifies it;  finally, if it is neither entirely
emitted nor entirely retained,  then it is developed, and forms the mem-
bers,  assimilates,  evacuates, and  organizes.   °  °   °  We  may dis-
tinguish three species or modes  of spirit,  namely, the  unconnected
spirit, the  branching spirit,  and the  branching  and cellular  spirit,
or the one  which is ramified and distributed in different cells or  little
cavities.  The first is that of all  inanimate  bodies;  the second, that of
" The Dignity and Advancement of Learning.
| Nov. Organ. 
THEORIES AND  SYSTEMS.
491
vegetables;  the third, that of animals."  This  is  not  as obscure, cer-
tainly, as the definition of heat, but is it any more conformed to obser-
vation ?   Does not the author surpass, in his description of the spirit
of tangible bodies, the teaching of experience, to which alone he should
attach himself?
   Induction, as we see, does  not  shelter us from error any  more than
syllogism, and the merit of the change introduced by the English phi-
losopher in the manner of cultivating  the sciences, does not  consist,  as
he supposed, and as many others  after him did, in the substitution of
the inductive for the  syllogistic form.  It consists, abovo  all, in the
emission and propagation of  that fundamental truth  above announced,
that from sensations and particular facts, our mind must not spring, at
one leap, to the most general axioms, but that  it  must  gradually rise
from particular notions transmitted by the  senses to  ideas  more and
more general.   This single proposition contained the germ of the whole
philosophic  revolution; for,  from  the moment  it was admitted as a
principle, that the first ideas which are formed in our minds are partic-
ular  ideas, related  to individual  objects, and  not, very general  ideas
comprising a multitude of things,  the whole edifice of ancient philo-
sophy began  to crumble down, and  it was necessary to reconstruct it  on
a  new base,  viz. : the careful study of facts.
   Bacon proposed to describe all  the forms of experience, as Aristotle
had  described  all  the forms  of  reasoning;  but his enterprise  has
remained more defective and vain, considered as a whole, than  that  of
the Greek philosopher, for no one has  ever made use of the  logic elab-
orated by Bacon, while  that of Aristotle was employed exclusively
during more  than twenty centuries, and is still, occasionally.  We may
judge of the inextricable confusion which  reigns in the work  of the
English philosopher, by the following fragment, which forms  a  part of
the  conclusion:  "We must say, in  conclusion," he  says, "that our
Organum is only a simple logic, and not a treatise on positive philoso-
phy.  The object of this  logic  is  to direct the  understanding, and  to
teach it not to  hang upon, if we may so say, vain abstractions, and the
pursuit of chimeras, like  the vulgar logic, but  to grasp nature, and  to
analyze her—to discover the  true properties of  bodies, the real and well
determined actions in  matter;  in a word, to  discover a  science which
results not only from the nature of the mind, but also from  the nature
of the things themselves.   Therefore, the reader must not be astonished
to see this work strewed  and enriched with  observations, experiments,
and views which belong to the science  of nature, and which, in enlight-
ening our precepts, serve  as  so many models of our philosophic course.
Now, these  prerogatives  of  facts or instances, as has been seen,  are 
492
REFORM PERIOD.
twenty-seven  in  number,  viz. :  solitary, migrating,  ostensible, clandes-
tine, constitutive, similar  and singidar; also,  instances  of deviation,
limitation, powers, agreement, and hostility, and subjunctions ;  instances
of alliance,  of the cross, of divorce, of  the door, citation, carrying for-
ward,  route  or passage,  supplement,  dissection,  radiation,  course,
doses of nature,  of struggle or predominance, of indication,  of those
generally useful, and,  finally,  of magic."'"  Thus Bacon, after having
advanced  from one degree, the theory  of Sensualism, falls into chaos;
but he has, nevertheless, opened the route and indicated, though confus-
edly, a new theory, which others proceeded to study and elucidate much
better than  he.
  John Locke, born at Wrington, near Bristol, in 1632, six years after
the death of Bacon, embraced first the study of Medicine; but the del-
icacy of his health did not permit him to practice that profession.  The
reading of the writings of B. Descartes  awakened in him a  taste for
philosophy.    However,  he rejected  the  Cartesian doctrine  on innate
ideas, and embraced the Peripetecian  principles renewed by Bacon—
that all our ideas come from the senses  and from reflection, that is to
say, by operations of the mind, or the comprehension of these sensations.
Here, he  says,  are the only two  sources  of all our  knowledge:  the
impression that objects make on our senses, and the proper operations
of the soul concerning these impressions, on which it reflects as so many
veritable objects of contemplation.f  Thus proceeding from  the simple
perception, or, in other words, from the  conscience which our mind  has
of sensitive impressions, this philosopher conducts us, by an uninter-
rupted  gradation,  to  the  most complex and  abstract  operations  of
thought.  He shows how the ideas  arise, multiply, arrange and connect
themselves in our  understanding; how  we arrive at representing these
ideas by  language; what is  the  real  value of words ; what  are  the
abuses of language, and into what errors we are drawn, by the habit we
early contract, of considering the abstractions of our minds as having
an existence apart from us.
  Bacon had believed  and taught, that, the first ideas which are formed
in our  minds, through  sensation,  must be particular ideas, related to
the objects or individual facts; he had protested, energetically, against
the plan of approaching the sciences  by generalities, or axioms.  Locke,
analyzing with a rare sagacity the functions of the understanding, from
the simplest perception, to the highest abstractions, demonstrated what
Bacon  had  only asserted, and  destroyed without  attacking  it directly,
9 Organ. Nov., liv. II, partn, sec. n, chap. 2, § ru.
f Philosophic Essay on the Human Understanding, chap, i, § 24. 
THEORIES  AND SYSTEMS.
493
the famous sophism of Aristotle, and exhibited in a style as neat as per-
suasive, the doctrine of  Sensualism or Empiricism.   This doctrine made
rapid progress  in  England  and in France.   The greatest philosophers
and naturalists of these two countries, during the  eighteenth century,
adopted, extended, and drew from it consequences more or less legitimate.
   Stephen Bonn at,  of  Condillac, born at  Grenoble,  the thirtieth  of
September, 1714,  (died near Beaugency,  third of August,  1780,) was
one of the  most distinguished representatives of this  philosophy.  He
contributed more than any other person to  vulgarise it,  by simplifying it
still more,  and applying it to all the sciences.  He pretended to  demon-
strate that all our  knowledge comes from our  sensation;  or, in other
words, is nothing else  than  sensations transformed.   He  reduced  all
the rules of  reasoning  to  a single  one,  identity in  propositions, and
wished, also, to bring back all modes of acquisition and demonstration
to one only, analysis.   The writings of this  philosopher having  become
classic,  in France,  we  proceed to  extract  from  them some  general
maxims, now admitted  as  incontestable rules in the  sciences devoted
to sensible objects, such as physics,  chemistry,  natural history, and
medicine.
APHORISMS  OF PHILOSOPHY, PARTICULARLY APPLICABLE  TO THE PHYSICAL
                              SCIENCES.*
   I.   The ideas  we form from sensible objects, are, in their origin, but
the consciousness of impressions which these  objects make upon our
senses: now,  as  there  are in nature  only individuals, it necessarily
follows, that we have, in  principle, only individual ideas—ideas that
are related to such and such an object.
   II.   We have  not imagined names for each individual; we have
only distributed the beings in different classes, which we distinguish by
particular names,  and those  classes are what are termed genera, species.
   III.  To form  a class of certain objects,  is, then, nothing more than
to give a common name to all those  we judge  to be similar.  But we
would  strangely deceive ourselves, if we imagined  that there  are, in
nature, species and genera, because there are species and genera  in our
manner of viewing her.
   IV.  The more  our  discernment is perfected, the more the  classes
will be multiplied, because there are no two  individuals  who  do not
differ in some particulars.   But, if it is important to make distinctions,

  °The exclusive partisans of the Sensualist doctrine derive from the same source,
moral and metaphysical truths; but the legitimacy of this derivation is warmly
contested hj other philosophers. 
494
REFORM PERIOD.
it is, perhaps, more important  not to make too many of them.   Do you
desire to know within  what limits we may divide  and sub-divide our
ideas ?   I reply, or rather, nature replies for me, until we have enough
classes to guide us in the use of things relative to our wants.
  V.   Sensible objects being known to us only by the impressions they
make on our senses, our minds perceive  nothing in the objects beyond
the  sensations they excite.   Thus,  when we are  asked  what  is the
nature or essense of a body, we are only able to respond by announcing
the sensible qualities of that body.
  VI.   All the qualities of  a being, considered in itself,  are  equally
essential, for they all appertain to its nature and its essence;  but they
are not all  equally essential,  in relation to  us, and  the  abstract idea
which we have formed of that being ; so that, what is termed essential,
or non-essential,  in  any thing,  is  only so, relatively,  to our  ideas.
  These aphorisms  may, henceforth,  be considered immutable ; for they
not only flow from the theory of sensualism, but they are also  confirmed
by the  sectators of a philosophic doctrine opposite to this, as we shall
see  in the following paragraph.  But,  beforehand, it is necessary that
we refute two errors  propagated by  the  authority of Condillac, errors
strongly accredited, in the schools of philosophy, and which  are only
calculated to retard the progress  of the science of observation.

                          FIRST PARADOX.
  The   art  of reasoning,  says Condillac, may  be  reduced to a well-
formed  language;  and, all sciences  would be exact if they  employed a
simple  language.
  This celebrated ideologist supports this proposition by a very  spe-
cious argumentation, founded, principally, on the certainty and facility
of reasoning in mathematics; advantages which he attributes to the
perfection of algebraic  language.  He  cites, in point, the  following
problem :  " If a man holding '  counters' in  both of his  hands, passes
one from the right to the left, the number of counters is alike in both ;
if, on the contrary, he passes one  counter  from the left  hand to the
right, he has  double as  many  counters in the right one;  the question
is,  how  many counters  had   he, at  first, in each  hand?  Condillac
in the first place  resolves this problem  in common  language ; then  he
shows how much more easy it is to obtain its  solution, when the problem
is  translated  into  algebraic language.   Hence he concludes, that if
the  sciences are but  slightly inexact, it is only because their vocabu-
laries are badly formed; a defect which is  not usually perceived,  or
which  we do not know how to correct."   " Must we be astonished,"  he
exclaims, " that men  cannot  reason, when the language of the sciences 
THEORIES AND  SYSTEMS.
495
is  only a jargon, composed of  too  many words, some of which are
common, with no determined meaning, and others are foreign or barba-
rous ones, and not well understood ?  All  sciences would be exact if we
knew how to speak their respective languages."
   It  seems  from  this  argument  that  the  exactness of the  sciences
reduces itself to the work of the grammarian,  which is a paradox unsus-
tainable, and falls before  the investigation of good common sense.   WTho
will dare affirm  that the modern progress of physics, chemistry, natural
history, etc., are due, entirely, or even principally, to  mere modifications
introduced  into the language of  these  sciences ?  Who does not know,
on the contrary, that this progress is almost exclusively the result of ob-
servation and of experiment ?  Do we not see every day, that men almost,
or entirely unlettered,  make discoveries that  have escaped the learned ?
   The proposition of the French metaphysician is false,  even in relation
to mathematics; it is not true that algebraic  language has given to the
reasonings  of mathematicians more certainty   or  conviction;   their
reasonings were as infallible before the introduction of algebra as since,
only they were  less prompt, less easy, and less general.   The Bomans,
with their very  defective figures, calculated everything as exactly as the
Arabs, whose figures are much more perfect;  but they calculated less
rapidly and less conveniently.
   Therefore, if  Condillac had  limited  himself to saying that the per-
fection of the language adds much to the clearness, facility and power
of reasoning,  and consequently notably to the progress  of science, he
would have been correct;  but he surpasses, evidently,  the limits  of
truth, when he affirms that all the sciences would be exact if they were
expressed in  appropriate  language.   He  takes,  in this  respect,  the
shadow for   the substance—the  image for the  reality;  and, by  this
mistake, he  diverts,  so far as he is followed, the  human mind from the
route which leads to  discoveries in  the science  of  observation.   The
proposition of Condillac would  be more exact if it was reversed; so that
it  might  be  said without being  paradoxical, that the  more a science
approaches  exactness or  truth, the more  its  language acquires perfec-
tion ; which reminds us of this axiom  of the legislator of the French
Parnassus:

              Ce  que l'on concoit bien s'edonce clairement,
              Et  les mots, pour le dire, arrivent aisement.0
Thus,  the  poet shows himself  a more  profound  thinker than  the
philosopher.
              0 What is well conceived  is announced clearly,
               And  the words to  utter it flow easily. 
496
REFORM  PERIOD.
                           SECOND PARADOX.
    Analysis is the sole method for the acquisition of knowledge.   Such
 is the proposition of Condillac, developed in  several chapters, which he
 strives to establish by an argument that he believes  irrefutable.   We
 will now see how far he has succeeded.
    According to  this philosopher, analysis consists  in decomposing, in
 the first place, the object which it is desired to comprehend, in order to
 study separately each  of  its parts or qualities, as well as their mutual
 relations;  afterward,  to  connect all these  qualities or parts in their
 natural order,  so as to contemplate the same object as a whole.   He
 cites, in this view, the  following example:   "I will suppose," he says,
v " a castle which overlooks a vast and fertile domain, where nature has
 been pleased to spread a great variety, and where art has availed itself
 of these natural advantages, to embellish it  still more.  We reach the
 chateau during the night; the next day the windows are opened, just at
 the moment when the sun  begins to gild the horizon, and in an instant
 afterward they are  closed again.   Although  the scenery was  exhibited
 to us but for one moment, we have certainly had a view of the whole.
 But this first sight does not suffice to make us acquainted  with it—in
 other words,  to look separately at the  objects it contains, and therefore,
 it would be impossible for us, when  the windows are  closed, to give an
 account of what we  have  seen.   This illustrates how we may see many
 things without learning anything.
    " Finally the  windows are opened again, not to be closed as  long as
 the sun is above the horizon, and we see again, for a long time, what we
 saw before.  But if, like men in extacy, we contemplate all  at once the
 great multitude of different objects before us, we shall  know no more
 when the""iliglit comes than we knew after the  first glance  we obtained
 of them in the morning.   To get  a clear knowledge of that scene, it will
 not  suffice, then, to look at  every part at  once—the parts must be
 studied in  succession ;  and, instead of embracing the whole in a single
 coup  d'oeil,  it  is necessary  to  pass successively from  one object to
 another. This is what nature teaches all of us.  We  commence, then, by
 the principal objects; we observe them successively, and compare them, in
 order to judge of their  relations  to each other.   When, by this means,
 we have recognised their respective situations, we observe, progressively,
 all those that fill up the intervals, or compare each one with the nearest
 principal object, and determine from this, its position.   Then, only, we
 separate all  the objects whose form  and situation have  been compre-
 hended, and embrace them all in  a single view. 
THEORIES AND  SYSTEMS.
497
   " If, now, we reflect on the manner in which we  acquire  knowledge
 by sight, we remark  that any very complicated object, such  as a vast
 landscape, is, so to say, decomposed, since we comprehend it only if its
 parts have presented themselves one after another, to  arrange themselves
 in regular order  in our minds.   We have shown in what order  this
 analysis takes place.  The principal objects first strike our minds, then
 the others follow,  and arrange themselves according to the relations they
 bear  to the  first.   We  make  this mental analysis, only because  an
 instant is not sufficient  for the  study of  all these objects;  but  we
 decompose, merely to reconstruct;  and when the knowledge of the whole
 is acquired, its parts, instead of  being successive, have in the mind the
 same simultaneous order which they possess in reality.   In this simul-
 taneous order, consists the knowledge which we possess  of them, for if
 we could not recall them  as a whole, we would never be able to conceive
 the relations which they have among themselves, and we would have,
 therefore, but an imperfect knowledge  of the objects."
   If  analysis consists, as Condillac pretends, in decomposing an object
 into its elements,  and at once recomposing it, what  then is synthesis ?
 The response to this question seems to me  difficult; I seek in  vain for it
 in the writings of  that  philosopher;  I  find nothing there clear and
 satisfactory.  "Synthesis,"  he  says,  "is  a  dubious method,  which
 commences, always, where it ought to end.  I cannot give  a more precise
 notion of it, either because I do not comprehend it, or because it is not
 possible to do  so.   It escapes  examination  because it assumes  the
 mental characteristics of all those who  employ it, and  especially of
 illogical minds." °
   P.  J.  Barthez,  of whom we shall  speak at  length  hereafter, has
 better comprehended  and defined synthesis; though  he has but briefly
 alluded to it.   He expresses himself on the subject as follows :  " Con-
 dillac, in what he has said on  analysis,  in various places in his Art
 of  Thinking, gives what  he terms  analysis,  so extended a sense that it
 includes, also, synthesis, or the recomposition of analysed objects.   The
 denomination  of the analytic method becomes, then, so vague that it
 may be said  that  analysis  is employed in all the operations by which
 any discovery  is  made  in natural  philosophy.   The method  which
 Condillac terms analysis,  has  nothing in it truly  analytic, except  the
 decomposition which is made at first of the qualities or elements of the
 object to be studied." f

  0 Logique, part n., chap. vi.
  f Nouveaux Elements  de la Science de  PHomme. Paris, 1806, Preliminary
Discourse, sect, i., note iv. 
498
REFORM  PERIOD.
  This  passage  of Barthez is  very important; for it  not only shows
us in what synthesis  consists, but also why Condillac is embarrassed
when speaking of that method.   It is clear, that  this metaphysician,
having comprised under the name of analytical  method, both analysis
and synthesis, that  is  to  say, the decomposition  and reconstruction  of
the object under consideration, there remains  nothing for him  to  say,
when he  wishes  to  define  the  synthetic  method;  for this reason he
indulges in pure declamations.
  Synthesis, according  to Barthez, and according  to the  etymology of
the word, consists, then, in the reconstruction of the object  which has
been decomposed by analysis ; it is the necessary complement of analysis,
and  its  proof.   Thus, when a chemist  has decomposed a substance—a
mineral water, for example—and when he  has  studied all its elements
separately, he should afterward reunite them,  so  as to  reconstitute, if
possible, the primitive  substance, in its natural state.   It is only after
reproducing, by synthesis, the natural  compound,  that  one is  sure  of
the exactness  of his analysis.   The following is a brilliant example of
the satisfaction received by the mind by the alliance of synthesis with
analysis : If a solar ray is permitted to penetrate a darkened room, and
is received  on a prism of triangular crystal, this ray forms, on the
opposite wall, an elongated, finely-colored image, with all shades, from
red  to  violet.   Then,   if a thin board, pierced with  seven holes, be
interposed between the prism and the image, termed the solar spec-
trum, there  appear,  behind this  diaphragm, seven circular  images,
presenting the red,  the orange, the yellow,  the green,  the blue, the
indigo,  and the  violet.   To be assured that  these seven colors, thus
obtained, are,  in fact, the constituent parts of  the  luminous ray, all of
them may be converged on the  same surface, by  means of reflecting
mirrors, in such a way that white light is  produced again.
   I  agree with Condillac, that synthesis united to analysis, is the best,
yea, the  only method, to acquire exact  notions  of nature ;  and this
metaphysician was only wrong  in  confounding, under a single  denomi-
nation two different things ; but this mistake draws him into more than
one error.  When he advances,  for example, that the ancients, Aristotle
among others, did not  know analysis, he is strangely deceived ; for not
only did Aristotle employ, frequently,  the  analytic  method, but he also
greatly abused it.   The reproach  which, rather, should be made to the
philosopher of Stagyrus, and  to all the physicians of antiquity, is, not
to have verified the results of their analysis by synthesis ; or for having
been contented with a mental analysis, where they should have employed
a material one.   Thus, when they affirmed that all bodies were formed
of four  elements—fire, air, earth,  and water—they should have been 
THEORIES  AND SYSTEMS.
499
able to prove, materially, the existence of these four elements  in  each
body, and reconstruct  again the  body,  by bringing  together  its con-
stituent elements.0
   I have  dwelt somewhat at length on the errors of Condillac, in regard
to  the  analytic  method, and the influence of language;  because the
doctrine  of  this  philosopher reigned almost exclusively,  in  France,
during  the  last half of the eighteenth century, and the beginning of
the nineteenth, and because  it is  still predominant, and is very seduc-
tive, by its clearness, simplicity, and the logic of its deductions ; hence
results the necessity of  guarding the public against the illusions which
it has a tendency to foster.
           § III.  On Rationalism, and Reasoning by Deduction.
  In reasoning by induction our  minds associate a quantity of particular
facts, united together by certain  analogies, and draw from their relation
a more or less general conclusion.   Example : put carbonate of potassa
into water, it is dissolved ; put into the same fluid a sulphate, a nitrate,
in a word, an}r salt, with potash  as a  base, and  all will be  dissolved.
From the sesuccessive experiments, sufficiently often repeated, you will
be right in drawing the general conclusion, that all the salts of potassa
are soluble in water.
  In reasoning by  deduction, on the contrary, we proceed to draw from
one fact,  or a simple proposition, a series  of propositions, which  follow
each other so logically that they seem to  flow from  the first, as a com-
mon source.   Example :  a triangle is a surface bounded by three right
lines.  From this definition the geometricians are able to deduce a great
number of curious  and useful theorems.
  Seasoning by induction, and reasoning by deduction, or, if you please,
the inductive and deductive methods, have each their  particular advan-
tages and inconveniences, which  render them more  or less valuable in
different sciences.  Natural philosophers,  chemists, and physicians pre-
fer  the inductive method, and draw from  it excellent  practical rules ;
  0 We have seen, in one of the Hippocratic books, a commencement of  the
material proof of the existence of the four elements.   The author of the book
cites the example of the results in burning green wood: he saw the igneous
element in the flame; the aerian element in the  gas, that sometimes escapes
with noise; the aqueous element in the water which stews out, and, lastly, the
terrestial element in the ash or residuum.  But this gross  attempt at chemical
analysis lacked the proof of synthesis.  Besides this, the author commits the
common error of inferring general from particular facts. 
500
REFORM PERIOD.
but they should not  forget that  a single  experiment badly made, or
omitted, suffices to vitiate a general conclusion.  The metaphysicians,
moralists and  mathematicians reason nearly always  by deduction and
we are indebted to this method  for the finest  precepts  in morals  and
natural religion, the base  of all society;  we  owe  to it, also,  the inven-
tion and perfection of  mathematics.  But it must not be forgotten that
if the primitive proposition is not of incontestable certainty, or if the
least error, or the  slightest  omission  occurs in the propositions which
follow, the entire structure falls.
  Bene Descartes, born at Hague, in Touraine, in  159G, exhibited in
early  life  an independent and creative genius.  He had already dis-
tinguished himself by important discoveries in physics, astronomy, and
especially in mathematics, when he undertook  to  effect, by the method
of abstract reasoning,  in opposition to that of Empiricism, a reform in
philosophy, an enterprise  whose results were brilliant and immense, and
which created, says the historian of philosophy, Tenneman, admiration
as well  as a very lively  opposition.   Descartes  commenced,  like Aris-
totle and  Bacon, by ignoring  all  existing  knowledge.   "To  attain the
truth,"  he says, " it is necessary  to free ourselves at  one time  in our
lives,  from all  the opinions which we have previously  acquired, and
reconstruct anew from the foundation the whole system of knowledge."!
This precept, old though it was, appeared as a bold novelty, and made
a great  noise in  the learned world, to such an extent had they lost the
habit of the methodic  doubt, particularly in philosophy.
  This  fearless metaphysician did not limit here his reform in regard to
method; he overthrew, with  a single  stroke, the whole  framework of
the Peripatecian logic so  subtily  elaborated by Aristotle,  that pedantic
apparatus capable of retarding the advancement  of the  human mind,
but unable to prevent  it from falling or going  astray.  " In  my exam-
ination,"  he says, " I observed  that logic,  its syllogisms, and the
greater  part of its teachings serve, at  most, to explain to others things
which  they  already know, or yet, like  the art of B. Lulle, to  speak
without judgment of those  things of which they are ignorant, rather
than to teach them."0  He replaces this complicated  logic by a simple
and sure  rule, of  which the following is the substance:  the  mind may
affirm of a thing  all  that is embraced in  the  idea  of  that thing, or,
evidence  is the only certainty of the truth of  our judgment. J

  0 This sentence is repeated in various ways, in numerous passages of his
writings.
  f Discours sur la Methode.
  J Condillac has defined this rule more clearly by showing that evidence consists
in the identity of the propositions which follow each other. 
THEORIES  AND  SYSTEMS.
501
  Having thus cleared the ground from every species of prejudice,  and
having  created a method easy for the arrangement of the materials of
thought, Descartes attempts to rebuild the edifice of human knowledge,
by starting from the phenomenon of consciousness: / think,  from which
he draws, at once,  this consequence:  therefore, I exist.   From this he
rises, by a series of deductions, to the most sublime  moral truths;  but
I shall not follow him in this region, because it does not  belong to my
subject,  and, therefore, I pass, at once,  to the physical phenomena.
Descartes takes, as the basis of his cosmogony,  this proposition of the
Pythagorean philosophy: matter is inert, and has, of itself, no form or
energy.  It  is possible, that, at bottom, this principle is true; but, if
we  consult  observation,  which must  be  the point of departure of all
reasoning in physics, we shall agree that it proves the  contrary of the
Cartesian principle.   Up to this  time, chemistry has not been able to
discover any matter  absolutely inert; that is to say, matter deprived
of properties, and  susceptible to  acquire all those which it might be
desirable to give  it; for, this would be the philosopher's stone,  the
primitive matter so much sought  after by the alchymists.
  The illustrious philosopher of Touraine has placed himself, from the
first, outside of the real world; I  shall  not, therefore, follow  him in
his brilliant  fictions,  but  shall  content myself here, in offering to my
readers, a small part  of his physiology, to  show how  little it is con-
formed  to observation:  "I assume,"  he   says,  "that the body  is
nothing  more  than a statue or  machine of earth,  which  God forms
expressly to make it as similar to us as possible.  Thus he gives to it,
externally, not only the color and  the  shape of  all  our members, but,
also, he puts within it all the parts which are requisite, to enable it to
move, eat, respire,  and, in short, that it be  able to imitate  all of these
functions,  which  may be imagined to proceed  from matter,  and to
depend only  on the disposition of the organs."0
   Behold a  machine  perfectly organized, possessing all the material
conditions for the  exercise  of its  functions, but  which, nevertheless,
according to our physiologist,  accomplishes  none.   This hypothesis  is
also in opposition  to daily  observation and common  sense.  When a
child is born, well-formed, that  is  to say, with all the  apparent condi-
tions necessary to life, we cannot conceive that it does not live ;  and, if
by accident it  is dead-born, we are  always  moved to ask, why it is
dead, or in other words, what is the material  obstacle which  prevented
it from living?  Let  us follow, however,  the hypothesis of Descartes,
to see where it will lead us.
Q Partie philosophique des Traite de P Homme. 
502
REFORM  PERIOD.
   " If you  have ever had the curiosity to observe  the  organs in our
churches, you know how the bellows forces  the  air into certain recep-
tacles, which, I think,  are named  air-chambers;  and how this air
enters into the different pipes, accordingly as the organist touches the
keys of the  instrument.   Now you are able to conceive, that the heart
and arteries, which force the animal spirits into the cavities of the brain
of our machine, act like the bellows of the  organ, which  force  the air
into  the air-chambers; and,  that,  exterior objects  acting  upon  the
nerves which they excite, cause the  spirits  contained in these cavities,
to pass from them into some of the pores, and thus resemble the fingers
of the organist, who, according to the key which he touches,  makes the
air enter from the air-chambers  into some of the  pipes.   Now,  as
the harmony of organs does not  depend on the arrangement of their
pipes which  are visible, nor upon  the  shape of their  air-chambers or
other parts,  but solely upon three things, viz., the air which  comes
from the bellows, the pipes that give sounds, and the distribution of
the air in those pipes:  so, also, I assume, that the bodily functions in
question, do  not  at  all depend on  the external shape of the  visible
parts which the anatomists distinguish in the substance of the brain,
nor upon that of the cavities, but solely upon the  spirits which came
from the heart, the  pores of the brain through which  they pass, and
the manner  in which these spirits are distributed in these pores,  so that
it is  only required of me to explain  here, in order,  all that there is
most important in regard to these three things."0
   The tendency of our philosopher to throw himself outside of sensible
phenomena is here  still  striking.   Three  things appear to  him  only
necessary in the study of physical man, namely:  the  spirits  that come
from the heart, the  pores of the brain which give them passage, and
the manner  in which these spirits  distribute themselves in  the  pores  ;
now, not one of these three things is tangible.   On  the other hand, he
annihilates completely  the study of anatomy, in affirming that the play
of the human organs does not depend at all on their external  conforma-
tion.   I doubt if many naturalists and physicians would subscribe to
such a doctrine.  This example  shows us how dangerous it is  to attempt
the explanation of physical phenomena by means of pure thought; for
the method preferred by speculative minds conducts us almost inevita-
bly into the imaginary world, and causes  us to loose sight of observa-
tion  and reality.  To go back to the primordial fact of our existence,
and from that fact deduce all the others by a rigorous chain of propo-
sitions :  such has been, in all times, the utopia of strong imaginations,
M Partie philosophique des Traite de P Homme. 
THEORIES  AND SYSTEMS.
503
and men of transcendental genius.   Many great minds, before and since
Descartes, have failed in the enterprise, and  many more will  yet  fail.
But Descartes has rendered an eminent  service to philosophy in ridding
it of its scholastic apparel,  and replacing all  the rules, so complicated
of Peripatetic logic, by a single safe and easy rule.
  Leibnitz, a universal genius, and eminently a generaliser, who shares
with Newton  the glory of having invented  the differential  calculus,
conceived, from his sixteenth year, the project of a universal  alphabet,
which would represent all  possible shades  of thought, with  the same
precision and the same generality as the algebraic  characters represent
the relations of numbers.   " It is  only requisite," he  says, " to  find
certain terms or forms with  which to announce metaphysical propositions,
which terms could serve as a guide in this labyrinth, in order to resolve
the most complicated questions by a method  similar to that of Euclid,
preserving always  that clearness, or  that  distinctness of ideas which
the vague and undetermined signs of  our common languages do not per-
mit."   He dreamed all his life of this great problem, and died without
having found its solution, though convinced of the possibility of arriving
at it.°   Descartes had, also, this conviction, for he  wrote  in one of his
letters:  "Ideological  characters  might  be  invented to  express  all
thoughts, as has already been  done  for arithmetic  and  music ; but to
do this, it would be necessary to analyze all simple  ideas, and apply to
them  signs which would imitate, in  their combinations, those of  our
thoughts."]  These two great men then imagined that, by perfecting the
language of  metaphysics, the same precision could  be given to  this sci-
ence as  is given to  mathematics.   In this  they committed  an error,
which Condillac renewed at a later period,  though  he  adopted  a philo-
sophic  method wholly contrary—an  error which we have already suffi-
ciently refuted, j
   Leibnitz, knowing the objections which had been raised  against  the
system  of Descartes,  and  the singular consequences  which  had been
deduced from it, by the spiritualist,  Malebranche, on one hand, and the
materialist, Spinosa, on the other, thought to guard himself from these
various difficulties by choosing for the basis of his  cosmological theory,
  0 Works of Leibnitz, v. n, p. 49.  Historia et Commendatio Linguae Caracteris-
tioe Universalis, p. 535.
   f Letter 46.
  I Godfrey William Leibnitz was born at Leipsic, in 1616, or four years after
the birth of Newton.   He was, incomparably, says Cuvier, the most encyclopedic
mind that has appeared since Aristotle. 
504
REFORM  PERIOD.
 a hypothesis diametrically opposite to that  of the  French  philosopher.
 This latter had started with the generally received  opinion  of his time,
 that matter is homogeneous and completely inert;  the German philoso-
 pher took, as a point of departure, the  observed fact, that there only
 exist in  nature individual  beings, and that each individual differs from
 all others in some particulars.   To explain this diversity, he supposes
 that the germs of all living beings having been created from all eternity,
 never perish ; that they only enlarge  and become visible, when we say
 that they are born ; and that they only diminish and cease to be appa-
 rent, when we suppose that they die.   He gives to these imperceptible
 and invisible germs the name of monads.  He developes his hypothesis
 as follows:
   " Very exact experimenters have already  perceived in our time, that
 it may be doubted if an entirely new  species of animal is ever produced,
 and if all animals are not  already living in a minute state before con-
 ception, in the semen of animals, as plants are in their seed.  This doc-
 trine being accepted, it would be reasonable to  suppose that what has
 no commencement of life, has also no  ending of it,  and that  death, like
 generation,  is  only the transformation  of the same animal, which  is
 sometimes augmented,  and  sometimes  diminished.   What opens  to  us,
 still, the marvels of the divine artifice which no one has  ever supposed
 is,  that  the machines of  nature, being  machines  even  to their most
 minute parts, are indestructible, on account of their  enclosing  a little
 machine in a greater one, ad infinitum.  Thus, we find ourselves obliged
 to accept, at the same time, the pre-existence  of the soul, like  that  of
 the animal,  and the subsistence of the animal  like that of the soul.  In
 this way we  perceive that not only the soul, but also the animal must
 always subsist in the ordinary course  of  things."0
  The reader must have already remarked  that  there is a resemblance
between  this system and  that of Pythagoras  on the transmigration of
 souls.  In vain does Leibnitz deny this similitude ; the subtile distinc-
tions by means of which he strives to show  the difference, prove, them-
selves,  that  there exists analogy between them,  if  not  identity.   The
 system of Metempsychosis is  too little  known to  us;  it has been too
much disfigured by successive traditions  for  us to be able now to form a
 decisive  judgment  on the exact degree of its homogenity with any
 modern system.   But if this homogenity were proven—far from consti-
tuting  an unfavorable precedent for  the system  of monads—it would,
on the contrary,  sustain that  doctrine,  by showing its  origin  in the
s Considerations on the Principle of Life. 
THEORIES AND  SYSTEMS.
505
remotest periods.   The strongest objection to the hypothesis of monads
is,  that it  is not  founded on any observations, and is offensive to our
common sense.
   "Leibnitz," says the historian Tenneman,  "was led to his philosophic
system by a profound comparison of the most celebrated systems, placed
in  relation with the demands of his epoch by an imagination fertile
in  ingenious hypotheses  and full  of sense,  as well  as in means of
reformation and concilliation; finally, by his great learning in mathe-
matics.  His  aim was to rebuild philosophy, so that it might  boast of
a precision analogous to that  of mathematics, and put an end to all the
disputes of the various schools, as well as to those of theology, by occu-
pying, itself, this ground.   He dreamed then, principally, to perfect his
method, and to establish some positive principles, in the hope of remov-
ing the causes of dissensions  among the opposing sects.  In short, he
thought that  philosophy should  be  treated  like mathematics.  In this
respect he favored  the demonstrative method, and the system of ration-
alism, as Plato and Descartes had believed it to be.
   " Leibnitz  has nowhere given a  complete exposition of all  parts of
his system ; each of his doctrines remained more or less separatedTrom
the whole.   His ideas  are, for  the  most  part, the  result of a certain
kind of analysis and combination,  or of a learned  artifice to reconcile
the difference between theology and  philosophy, and of an exclusive and
incomplete examination  of the faculty of  understanding.   Preoccupied
with the idea  that  by thought we may arrive at the knowledge of the
reality of things, he  addressed  himself to the  understanding alone, as
Locke had addressed  himself  to sensibility alone—to discover the abso-
lute principle of  life  and knowledge.   Thereby,  he confounds the
logical possibility and reality with positive reality; he intellectualizes the
phenomena, and ignores the part which observation plays in the acqui-
sition  of  knowledge.   Nevertheless,  his  philosophy,  full  of  bold
hypotheses and  superior views, has made new steps  in   science;  it has
put in circulation a crowd of new ideas, with so much more success as it
was published in the  French language." °
  We have I think, sufficiently established, by  the example of Descartes
and of Leibnitz,  to whom we  may join that of Plato, and many other
authors who have been cited  in the  course of this history—we have, I
say, sufficiently established how the  deductive method  is deceptive in
regard to physical  sciences, and how it  tends to separate us from the
material reality of  the  observation of phenomena.   It  should  be now

  0 Manuel de PHistoire de Philosophie, translated from the German by Victor
Cousin.  Paris, 1839.
          32 
506
REFORM PERIOD.
demonstrated for us, that this method is not anything like  as sure as
that of induction, in this particular order of knowledge.
   Kant, rendered circumspect by the  shipwreck of so many superior
minds turned his speculations toward another object:  in place of seeking
the origin or essence of things  in  themselves, he proposed to determine
what is the mode of comprehension of the human mind, and  what  are
its natural limits.   He devoted himself, for the attainment of this aim,
to the most patient and profound examination of which the annals of
philosophy have any example, and after forty years  of meditations, he
published the result he had reached, which is summed up  as  follows,
relative to the knowledge that we are able to acquire of sensible things:
Reason was only given  to  us to  form experience ;  and  our mind, in
desiring to pass the limits of  sensation, in phenomena  of the  material
order, mistakes its rights, as well as its powers.°
   This result is very remarkable, and  merits  our fixed  attention, for
it offers, under another form, the  confirmation of the aphorisms of  the
Sensualist philosophy,  which  we  have  heretofore  announced.   Thus,
Kant, starting from  idealism, that is to say,  from  the pole opposite  to
that of Locke, arrives at the same conclusion  as the former, relative to
the knowledge of sensible objects; he stops at the same limit, also—
the sensations—in the  domain of the physical sciences.   This was a
fact important to establish, and which should give us an entire confi-
dence in the aphorisms heretofore  stated, f
                           § IV.  Conclusion.
   This rapid and very incomplete sketch of the history of  philosophy,
during the last two centuries, shows us two sects of philosophers, seeking
the truth by two different ways.   The one, more particularly addicted
  0 Critique de la Raison Pure.
  f The reform introduced by Kant, in philosophy, relates principally to moral
and metaphysical ideas, for which the  doctrine of Locke does not offer  a solid
basis.  Emanuel Kant was born in Konigsberg, in 1721, and died  while pro-
fessor in the same city, in 1804.  " He was," says Tenneman, " a second Socrates,
who, by a new method, reanimated the mind  for researches, taught it to know
its whereabouts, and led  reason  into  a scientific  route, by teaching it to know
itself.  Possessed of rare talents, cultivated and developed with care, he rendered
himself worthy of such a vocation. His moral and religious character prevented
him  from following pure speculation, and made him the  impersonation of his
doctrine.  A constant  love of truth, joined to the purest moral disposition, was
the soul of his philosophic genius, which united, in an eminent degree, originality,
strength, depth, and sagacity."   (Man. de VHist. de  la Philosophic, T. II, p. 225. 
THEORIES AND  SYSTEMS.
507
to the study of the  physical sciences, connects all our ideas with sensa-
tions, assuming to deduce  from that  source, not only the knowledge of
sensible objects,  but also  that of moral and  religious truths, such as
the existence of God, the free will of man, etc.   Their favorite mode
of reasoning is that of induction; but they  also make  use of syllo-
gisms.  They have been called sensualists, because they regard the sensa-
tions as the basis of all our acquirements;  empirics, because the rules
which  they  trace have  for  their  object, to direct experience, and take
their foundation in observation.  Their method is the most favorable for
the advancement of the  natural sciences, properly  said ;  it was adopted
by the greatest  philosophers or  naturalists of antiquity and modern
times,  such  as Aristotle,  Galileo, Newton,  Linnaeus,  and Cuvier.   It
should be preferred in medicine, for it is according to it that the philo-
sophic  aphorisms, or axioms, were established, which  guide  us in  the
appreciation of medical  doctrines.
   The  other sect, more attentive to the phenomena of pure thought, or
consciousness, endeavors to comprehend the material world by the same
plan, and desires  to explain physical phenomena by  the laws of the
mind.  They have been  called idealists, because they pretend to deduce
all our knowledge from ideas ;  rationalists, because the rules which they
trace have for their object the direction of reasoning.   They proceed,
ordinarily, by the deductive or syllogistic method.   Now, we have seen
the deceptive nature of this  method  in  the  physical sciences;  how it
tends to divert our attention from  the real world,  and carry it to the
fictitious world.  Nevertheless, the metaphysician of Konigsberg attained
by this route the confirmation  of the aphorisms which the sensualists
had  formed ; which proves that no  method necessarily leads either to
error or truth, in any department of knowledge.  The deductive method
is more favorable than  the inductive one, for the discovery and demon-
stration of moral  and metaphysical  truth;  it has generally been pre-
ferred by the great moralists and  profound thinkers  of every age, such
as Plato, Descartes, Pascal, Leibnitz, Kant.
  Nearly all the philosophers of both sects, charmed by the infallibility
of mathematical propositions, strove  to imitate the mathematical mode
of reasoning, hoping to reach by  it convincing demonstrations, and be
sheltered from  all controversy.  Vain efforts !  they pursued  a chimera
which it is permitted to no man to attain;  the essence of things cannot
be changed by formula  of language  or reasoning.  If they had well
reflected on the nature of  mathematical propositions, they would have
perceived that their character of certainty does not  depend either on the
signs or the method which mathematicians employ; but upon the nature
itself of the propositions, which is such that they reach our understandings 
508
REFORM  PERIOD.
by the double way of experiment and  pure reason, which leads to the
conviction of our minds in an irresistible manner, without leaving any
open door to doubt or hesitation.  Let a geometrician, for example, take
the hight of a tower by a trigonometrical  process, and afterward mea-
sure its  hight with  a line;  he will find by these two processes nearly
identical results, which will confirm in  his mind the demonstrability of
the theories of trigonometry.  For ages the predictions of astronomers,
on the appearance  and duration of eclipses, are verified with a punc-
tuality which must inspire  us with full confidence in the exactness of
their  theories and calculations.  Experimental  proof, it may be said,
adds nothing to the certainty of the theoretic demonstrations of geometry.
That is true, but the experimental proof adds to the  conviction of the
mind; it strikes the  ignorant like the learned—forbids doubt and dissi-
pates obscurity.
  It is not the same with the other sciences:  in  examining  them  care-
fully, we shall see that none of them shares with mathematics the privi-
lege of seizing upon our understanding by the double route of reason and
experiment.  Moral  and metaphysical truths, for example, are not sus-
ceptible of any experimental  demonstration; it  is only  by reason that
we prove the existence of God, his infinite attributes, the immortality of
the soul, the blessedness of virtue, etc.  Physical truths, on the contrary,
cannot be demonstrated in any other way than by experiment; thus, the
property possessed by acids, of uniting with alkalies to  form salts, has
been ascertained  and can only be proved by experiment.  Thus, obser-
vation alone has shown, and proves every day, that the abuse of alcoholic
drinks enfeebles the  brain ; but our intelligence cannot define any neces-
sary connection between these causes and their respective effects.   It is
the same for all  the  phenomena of the material universe which are not
within the range of mathematics; these phenomena, as well  as the laws
which regulate them, can  only be demonstrated by experiment.
  I could have wished to spare my readers this digression into the field
of philosophy; but it has appeared to me indispensable, and I hope will
not prove unfruitful.  It has furnished us,  in the first place, with an
occasion  to make choice  of a method with  discernment; then it has
shown us the limits where must be  arrested our faculty of acquiring
knowledge of sensible things; finally, we have established some aphorisms,
which, like guide-posts planted on the route which we are to follow, will
direct us in the examination of medical doctrines, and abridge considerably
our labor. 
THEORIES AND  SYSTEMS.
509
             ART. II.  SOURCES OF ANIMISM AND CHYMIATRIA»
  Among the men who  contributed the most to discredit the ancient
doctrines, and to introduce the taste for novelties  in Medicine, we shall
cite, in the first p!ace, John Baptist Van Helmont, Lord of Merode and
of several other estates.  He distinguished himself early by his applica-
tion to study, his piety, and the independence of his opinions.   At the
age of seventeen years he was offered the degree of master in philosophy,
but he refused it; knowing, he said, that  his  head was furnished with
words only,  and he was not willing to be dubbed master in the sciences,
when he was scarcely a scholar.  Having renounced the academic dig-
nities, and the schools where futile matters only were taught, to devote
himself, in all the independence of his genius,  to researches after truth,
he read  at  first the writings of  the pagan philosophers, and  acquired
some taste for the doctrines of the stoics; but afterwards the books of
Thomas a Kempis and of John Taulerus falling into his hands, decided
his inclination toward mysticism.   " I saw," he  said,  " that all truth
and wisdom comes from  God, to whom  man  unites himself by prayer,
contemplation, and good works."  Henceforth he studied to regulate his
conduct by the example of Jesus Christ; and in order to copy closer this
divine  model in the  relief of human  misery,  he resolved  to study
Medicine.
  He embraced  this study with the ardor of an  enthusiast and the
obstinacy of  a fanatic;  he  consecrated to it  thirty consecutive years,
and after having read, annotated  and extracted from more  than  six
hundred Arab and  Latin authors, he found himself  in a condition to
dispute  on  all diseases, in a way to excite the admiration of  the most
skillful.  He took,  then,  the  title of Doctor.   Afterward, he  passed
through Italy, France, England and  Spain, in short, Europe entire, in
order to initiate himself directly in the  process of the Healing Art  in
use in each  country, and to collect all the  secrets of alchymy.   On his
return to Brussels, the capital of his country, he divided his time there-
after between the practice of medicine and labors in his laboratory, in
which he sometimes shut  himself up for entire days.   His discoveries
in chemistry have secured him a distinguished  place in the  history of
that  science; but  we can only occupy ourselves at  present with his
opinions in  medicine.
   Van Helmont proscribed blood-letting as injurious in all cases ;  and,
without rejecting purgatives in  an absolute manner,  he made  a very
moderate use of them.  His favorite  remedies were opium, wine, and

  ° Doctrines which assumed, respectively, for all the healthy and morbid phe-
nomena of the economy, the influences of a presiding soul and the laws of chemistry. 
510
REFORM  PERIOD.
compositions  which he  prepared himself, into which, like Paracelsus
and other chemical physicians, he incorporated  substances  taken from
the mineral  kingdom.0   He  cured, with  these  preparations,  certain
diseases which had resisted ordinary means;  but how many individuals
found themselves  made worse  by the improper use of  remedies yet too
little proven !
   His writings abound in new words and odd ideas, which  render their
reading  fatiguing.  We  meet there,  entire chapters of impenetrable
obscurity, so  that  they form the natural transition from  the ramblings
of Paracelsus to  the learned theories which we  shall  soon  have to
examine.  Nevertheless, no one could place Van Helmont in parallel with
the Swiss thaumaturg, to whom he was superior  in all  respects, and for
whom he professed a profound contempt.   Bich in an uncommon erudi-
tion, and his own proper experience, the Belgian  physician knew how to
avail himself of these to sap the prejudices of the schools ; and he is
never so  clear and so precise as when  he wishes to uncover the naked-
ness of  the hollow verbiage of the physics of Aristotle,  and the  physi-
ology of  Galen.   He asks, for example, on what foundation the schools
sustain, with their Aristotle,  that  the air is humid at  eight degrees,
and hot at four degrees ? By what experiment they prove  that condensed
air is  turned into water, and becomes  thus a  perpetual  food for the
springs ?   At the  same time he cites, in support of a contrary opinion,
the experiment by which air is compressed in a gun-barrel without
exhibiting the least particle of water, whatever the degree of condensation
to which it may have been submitted.
   But when  he abandons the role of the critic, and attempts  to  found,
in his turn, a system of  natural philosophy, he  falls into such a confu-
sion of ideas that it would  be impossible to analyse his  doctrine.  All
that we are able to do, is to report  here some of the propositions which
appear to  form its basis.  Van  Helmont admits  two material principles
for all things;  the one  is water, which furnishes matter,  the other is
the ferment  or seminal  breath which  gives it  form.   At  other times
he says,  that the two principles of all created beings are air and water,
because they cannot be  transmuted into each other.   In regard to the
earth, he believed that  it proceeded from water, by a secondary forma-
tion.   Tha§ archeus  is  a spiritual  gas,  which gives impulsion  to the
fecundated seed, by means of  a  ferment.  It regulates,  like  a skillful
architect, all the  movements with which the natural body  is endowed;
and it remains in them until their dissolution.  Without it no organized
being could acquire the form that is proper to it—everything would be
0 See letter of Guy Patin.  Paris, 1846. 
THEORIES AND  SYSTEMS.
511
confounded, and  the universe would re-enter into chaos.  Besides the
archeus and the ferments, Van Helmont sometimes endows the animal
economy with a third motor, which he names bias.  The nature of this
is double;  one part produces the natural, and the other the voluntary
movements.  The stars, also, have a double bias ;  the first moves them
in space; the second excites the special revolutions to which their sub-
stance is subject.  The bias of the  stars and of man agree with  each
other; so that we may predict certain  atmospheric vicissitudes  by the
aspect of the infirmities which afflict the human body,  and better still by
those which are seen in brutes, because the animals were created before
man.
   If from these general notions we  descend,  with this author, to
the particular functions of each part of the body, we  shall find that he
accords to  the stomach and  the spleen  a sort of omnipotence  over the
rest of the body,  which he characterizes  by the  picturesque  expression
of duumvirate.   The archeus or conscious soul resides on one or other
of these two viscera, and  more especially on the  pylorus.  From this
position it directs all the functions of the other  organs, watching the
integrity of each, and maintaining the harmony of the whole.
   There are six digestions: the first takes place  in the stomach, by the
aid of an acid ferment which the  spleen  supplies; the second, in the
duodenum, where the bile, mingling with the alimentary bolus, changes
its acidity into a volatile salt; the third, in the mesenteric veins, where
the chyle is transformed into venous blood, otherwise  called cruor; the
fourth digestion is effected in  the heart, by means  of  heat,  agitation,
and  a particular ferment,  which causes the venous blood to become arte-
rial ; the fifth digestion takes place in the brain, where the vital spirit
is extracted from the arterial blood; the sixth consists  in the work  of
assimilation, which  each part executes in appropriating by virtue of its
innate  spirit, the aliment  that  is natural  to  it.   With the number
seven, nature keeps  a sabbath, in other words, rests.
   Let us now take a glance at the pathology of this author.  When
the archeus is offended by any injurious or disagreeable agent, it becomes
furious, or it is seized with fear, which produces  disordered movements,
and the image which this trouble  depicts in it  becomes the seminal
idea of the disease.   There are as many species of diseases as  there are
morbid seminal ideas of different characters, and the  primitive  seat of
all our affections is  in the tunic of the stomach,  which  is the habitual
residence  of the archeus.   Morbific causes  were of two  sorts, those
from without, as miasms, epidemics, poisons, virus,  unsound  food and
drinks, etc. ; the others  are from within, and  consist  in some excre-
mentitial matter not evacuated at the proper time. 
512
REFORM  PERIOD.
  Fever is the result of extraordinary efforts made by the archeus to
disembarrass itself of  the morbid  idea which troubles  it;  from this
struggle proceed those intervals of excitement and  agitation  that suc-
ceed each  other.  The chill indicates the state of terror  or exhaustion
of the archeus;  the  heat  announces the violence of the efforts and
struggle which  it undertakes.   Vesicular calculi are formed by the acci-
dental combination of three sorts of  spirits which exist in the urine', in
the ordinary state of isolation.   The first is a salino-volatile spirit;:  the
second is of a vinous and inflammable character ; the third of an earthy
nature.  The tophaceous concretions in gouty persons are engendered
by the synovia, a species of transparent liquor, destined to lubricate  the
joints, which, in becoming acid, looses  its aqueous part, and becomes
dry and hard.                                    .
  In regard to  therapeutics, Van Helmont laid down the  principle that
the first condition for the favorable operation of a medicine was, that it
comport with and be agreable to the archeus; then, that  it be adminis-
tered in proper doses and at proper times.   He thought that the actual
virtue of  remedies resides especially in  their odors;  these  being, he
said, the symbol of the seminal ferment, and the cause of all  the trans-
mutations that are effected in  the human body.  Besides, he  had  faith
in the efficacy of certain words, as well as in  amulets and talismans.
He believed  in the  efficacy  of a  universal  remedy, which  he named
alkaest, ens primum, primus metallus, etc.
  Van Helmont had  no disciples, properly said;  he founded no sect,
but several modern medical sects have borrowed their  ideas from him.
The  chemical school owes to him the idea  of ferments;  the animists or
vitalist school,  that of the sensitive  soul  or vital  principle, formed  on
the model of the archeus.  The thaumaturgs, the Bosicrucians, and  the
magnetisers regard him as  one of  their adepts, or  pretend, at least, to
find in his writings  some traces of their doctrines.  The partisans of
scholastic  traditions never had a ruder adversary.   " At an epoch  when
there were still found on all sides  those who held to the doctrines of  the
middle ages,  when the forces  of nature, interrogated with fear, seemed
always to  present themselves under a mysterious and supernatural form,
it is not astonishing that the  mystical  spirit of Van Helmont saw in
the ecstacies of his soul, and  in his dreams, the revelation of  the solu-
tion of the most embarrassing problems.   Nor is it any more astonish-
ing,  that he substituted hypotheses for hypotheses, and errors  for errors.
The men of those times were,  in regard to  a thousand  questions now
clear to us, in the same condition as we are at present, in regard to  the
difficulties insoluble by our  means of investigation.   What  theory is
sufficient  for the cure of intermittents by Peruvian bark, the origin of 
THEORIES AND  SYSTEMS.
513
variola, and  the  destruction of its  germ by vaccine ?  Who has not
made a desperate effort to  pierce this obscurity, to get a glance beyond
this horizon?  Very well, let us  turn  the  eye upon this  past, which
was their future, or our light, which was darkness to them, and repre-
sent to ourselves the false lights, and the gropings:of our predecessors—
so much  easier to go astray, as they had not, like'us; a' guiding compass,
in  the method of observation, and as they could scarcely abstain from
hypotheses in the absence of facts."  °
                    ART. III.  IATRO-CHYMIA. .
  Francis  de Lebo, called' Sylvius,  was  the  first  who  pretended to
explain all the phenomena of the living economy by the laws of chem-
istry alone.   He was in his forty-fourth year, and enjoyed the reputation
of being the most skillful physician in Amsterdam, when he was called
to teach'practical medicine  in  the  University of Leyden.   Before his
time, the professors contented themselves by reading from the chair, and
commenting  upon, before their pupils, the  most renowned  authors.
Lebo had the happy thought of admitting his young  auditors to visit
the sick in the city hospital, and to choose for the subject of his lectures
the diseases they had before them.   He was thus one of the originators
of clinical teaching, and it is to this day his best  claim to  distinction.
He cultivated, with signal success, anatomy and chemistry, and  at the
epoch when  the discovery of the circulation of the blood  excited the
whole medical world, he was  one of the first to declare himself in favor
of the  doctrine of W. Harvey, and  sustained it by new  proofs, drawn
from the examination  of  dead  bodies.  In  short,  he was accustomed to
recommend  anatomy, chemistry, and  clinical observation,  as  the true
basis  of medical instruction.   This  celebrated iatro-chemist died  in
1672, aged fifty-eight years.
   Sylvius declared, in substance, that nothing must be held as true, in
medicine, which had not been confirmed by the testimony of the senses—
an opinion conformable to our fifth philosophic aphorism.   AVe will now
proceed to see, if in the development of his physico-pathological theory,
he is always true to this wise maxim.
PHYSIOLOGY.
  He describes the act  of digestion as follows:  The food, he says, is at
first triturated  in  the  mouth, where it  is impregnated with  saliva, a
liquid endowed  with great  fermenting properties.  Thence it  descends
- M. Littre', Journal Hebdomadaire de Me'de'cine, Paris, 1830, T. VI., p. 
514
REFORM PERIOD.
into the stomach, and there encounters the residuum of the preceding
digestion, a species of leaven very favorable to  stomachal digestion, by
means of which it undergoes a second preparation ;  after which it passes
into the intestine, in the form of a viscid and whitish humor.   A little
below the pylorus this alimentary humor undergoes a third fermentation,
by the united action of the bile, pancreatic juice, and the saliva.   Then
the purest and most fluid part separates from the thickest and  crudest
part.  The latter, carried on to the large intestine, takes the form and
name of feces, while the other, deprived of its  excrementitious  matter,
is termed chyle,  and goes through the lacteal veins to the thoracic canal,
where  it unites with the lymph.   The  humor resulting from this union
is carried to the vena cava superior, where it is mingled with the blood,
and communicates to that fluid its nutritive quality.   The venous blood,
thus restored, reaches the right cavities of the heart, and  thence goes to
the left cavities, by traversing  the  lungs.   In  its  passage through the
lungs,  the blood undergoes  a last  effervescence, which brings it to its
highest degree of perfection.0
  This description of the function of digestion is distinguished from
that of Van Helmont  by much greater anatomical exactness,  and by
no intervention of the archeus.  The saliva, bile, and  pancreatic juice,
have in  this the  active agency—an agency that  Sylvius denominates
triumvirate.   The  bile, he says, which holds  the  first rank, owes its
virtue to  an  alkaline  salt, tempered  by  an oily,  volatile spirit.   The
saliva  obtains its virtue from the acid and volatile spirit that enters with
water  into its composition.  The pancreatic juice owes its  activity to an
acescent volatile spirit.
   The animal spirits are extracted from the blood, which reaches the
cerebrum and cerebellum by the carotid arteries.   This liquid in pene-
trating into the capillary vessels loses its  watery part, which is filtered
through the pores, and acquires a  character that  very much resembles
the  spirit of wine.
   Thirst arises  from the  saline exhalations that  rise  from the  small
intestines, through the stomach to  the throat, where they excite a sen-
sation of dryness.  These exhalations are  the  product of effervescence
of acid bile mingled with  the pancreatic juice.   Natural  hunger  arises
at first from the fermentation engendered  in the stomach  by a  mixture
of the residue of alimentary residuum with the saliva that we  continu-
ally swallow.   This  fermentation  developes a halitus  of an agreeable
acidity, which titillates softly the  superior orifice  of the stomach, and
creates the desire for food.j
° Sylvii Praxeos Medicse Idea Nova, cap. x., §§ 2, 3, 4.          f Ibid. 
THEORIES AND  SYSTEMS.
515
                            PATHOLOGY.
  The immediate cause of continued fevers is referred to  a vice in the
bile or lymph ;  a vice which is calculated to excite in the right ventricle
of the heart an  increase of effervescence, from which results the con-
tinual vehemence of the pulse.
  The cause  of  intermittent fevers consists in the excessive acrimony of
the pancreatic juice.  By its mixture with the bile and pituite, this
vitiated  juice provokes an abnormal fermentation, which occasions a
chill, more or less marked, until the bile, flowing in its  turn  in abund-
ance,  causes  an  increase  of  caloric   in  the  right  cavities of  the
the heart, and creates  a heat to succeed the chill.   However, in what-
ever way the thing takes place, it appears beyond  all  doubt, that the
algid period in all fevers arises from acidity of the pancreatic juice or
lymph, while the hot  period  is the effect of the bile, whose alkaline
salt united to oil conserves and developes eminently the  element of fire.

                          THERAPEUTICS.
   It is on the hypothesis that we have just read, and other similar ones,
that Sylvius  founded his curative indications ; he opposed purgatives to
diseases proceeding from the effervescence of the bile ; he pretended to
correct the acridity of  that humor by opium and other narcotics; he was
prodigal in volatile salts and diaphoretics, sometimes with the purpose of
combatting  the acidity of the lymph, or the  pancreatic  juice; again,
in order to arouse the  sluggishness of the vital spirits,  and favor the
secretions.   In  a word, he created an incendiary medicine, based on a
fictitious theory,  which he believed  in good faith to be the only pure
expression of the truth.
   But if we judge this theory by the light of the philosophic principle
which he himself has laid down in the beginning, and which consists,
as must be  recollected, in holding in  Medicine  as true only what is
attested by the  testimony of the senses, we shall find that it is very far
from fulfilling such a  condition.  In fact, of the three humors that con-
stitute his physiological triumvirate, one  only, the bile,  possesses in  a
very feeble degree the alkaline quality that he attributes to it; the other
two, namely, the saliva and the pancreatic juice, do not  at  all appear
endowed with the acidity that he attributes to them, and by which he
assumes their co-operation  in  the digestive act, as well as in the  gen-
eration of diseases.   It might also be asked, on what direct observation
he bases himself, to affirm that the animal spirits  are  distilled in  the
capillary tubes of the encephalon, like  the  spirits of wine; or, for
teaching that the acidity of the lymph, or the pancreatic juice produces 
516
REFORM PERIOD.
the fever chill, and that the return of the heat, or  reaction, is due  to
the acridity of the bile.   Finally, his whole system  is radically wrong,
on account of its insufficiency and errors;  and no account is taken in it
of the state of the solids, or their action.
  We must believe,' for the honor of a practitioner so renowned as Syl-
vius,  that he departed  somewhat from his theoretic prejudices at the
bedside of his patients, and that  he remembered there  that sentence
which he had himself emitted:   How many of the specious  and rea-
sonable things, in theory,  are known to be vain and faulty in practice !
  His doctrine made rapid progress in Germany and in England, but it
obtained less favor in France and Italy, where the partisans of the
ancient Dogmatism  opposed it with a lively resistance.  The novelty of
the phenomena on which he rested, the small number and clearness of his
principles—the facility of their application in the treatment of diseases,
were  all well  calculated  to seduce  enthusiastic  minds,  anxious  for a
change.  Besides, as we have already remarked, the  circumstances were
favorable for all attempts at innovation in Medicine; for the antique
edifice of the Healing Art was yielding to the attacks on  all sides.
  Thomas Willis, cotemporary of Lebo, and a still more celebrated anato-
mist than he,  contributed  more than any other to the propagation of the
taste  for chemicakexplanations among physicians.  After having taught
natural philosophy for six  years, and practiced medicine with distinction
at Oxford, he  resigned his chair  to go and exhibit himself on a much
greater theater.   He moved to London, and became, in a short time, one
of the most distinguished  practitioners.  Being adjunctto  the College  of
Physicians of that capital, he gained the friendship of his colleagues,
by the  integrity and gentleness of his character, as he  merited  their
esteem by the extent and  variety of his learning.
  The system of this iatro-chimicus differs notably  from  that of Lebo,
though established  on the same order of  considerations.  Willis  laid
down the principle,  that if any substance whatever is submitted to the
analysis of fire, it is resolved into spirituous, sulphurous, saline, aqueous
and terrestrial particles:   from  which he concluded that  there are five
elements, namely: spirits,  sulphur, salts, water and earth.   He excluded
air  and fire from the  number of elementary bodies, because  they are
neither visible nor palpable.   "For," he  adds ironically, " my intelli-
gence is obtuse, and my reason cannot penetrate beyond the reach of my
senses."  We perceive that  most of  the physicians  of  this period
accepted, at least in principle, the aphorisms of the Sensual Philosophy;
but they were not  in the habit of submitting to them  their medical
theories;  thus the  "spirits" which Willis placed at the head of the
elements, do not appear to me in  any manner more visible or palpable 
THEORIES  AND SYSTEMS.
517
than air or fire.   Could any one so soon forget the philosophic maxim that
he seemed to take  for  a  motto ?  This is what we now proceed to see.
   The " spirits," according to him, are an ethereal  substance, extremely
subtile, an emanation of the Divine breath, which a  benificent providence
had placed in  the sublunary world, to impress all things  with vital
action.   Sulphur is an element of a  little more consistency; it evapo-
rates less promptly than spirits; the heat,  shape and beauty of bodies,
as well as their  colors, aroma and taste, depend upon the proportion of
this element.  Salt has still more density;  it gives  to substances weight
and solidity, and is the  element of their duration and reproduction.
Water is the vehicle of spirits and sulphur, and favors their admixture
with salt; deprived of this dissolvent, the other elements could form no
union.  Earth fills the pores of all solid bodies ;   it hinders a too inti-
mate contact of  the active elements, and prevents them from bruising
each other—retains by its viscidity those which are too volatile, in fine,
gives to bodies their mass and volume.0
   Most decidedly, the qualities and functions which Willis ascribes to his
elements are not  more real than the ancients ascribed to theirs.  There
is no more reason to believe  that heat, beauty, form, colors,  aroma and
taste come  from sulphur, than  to  admit  that air is humid at eight
degrees, and cold at four  degrees.  All is  equally  fictitious  and imag-
inary ;  but in this respect, Willis appears to me more faulty than the
ancients, for he puts himself  in manifest  contradiction with his philo-
sophic principles.
   Let us  follow now the  application of his theory  to the phenomena of
organized bodies, and in particular to the animal  economy,  as fermen-
tation enjoys here a great role;  let us in advance see what he means by
the term: " Fermentation," says our chemist, "is an internal movement
of the particular elements of any body whatever, having for its object
the  improvement of the  body or  its transformation to another  sub-
stance.   It  occurs  in  the  three  kingdoms—among minerals  buried
in the  bosom of  the earth,  as  among vegetables and minerals.  It is
sometimes the effect of art, as well  as a natural result."

                            PHYSIOLOGY.
   The mind perceives the first development of life in the heart; that
viscus, whose rapid movements are seen  by the eye, offers the represen-
tation  of a fermenting  point—punctulum  fermentescens.   The spirit
bounds from this rebounding point (punctum saliens) as from a prison ;
but  the  sanguineous liquid, which  serves it as a vehicle, prevents  it
0 De Fermentatione Sive de Motu Corporum Inorganico, cap. n. 
518
REFORM PERIOD.
 from flying off, and constrains it to keep on the track ; so that the spirit
 going  and coming,  unceasingly, from the  center to the circumference,
 cuts out and fashions the arteries and veins that subserve the circulation
 of the  blood  in all parts of the body.
   The chyle is extracted from the food by coction, which is  effected  in
 the stomach  by the aid of an acid ferment.  " Some pretend," continues
 Willis,  " that this ferment comes from the spleen; but anatomy has
 not, up to this time, discovered any direct communication between that
 viscus  and the stomach.   However this  may be, the chyle acquires a
 milky color by the coction of the sulphurous and saline parts, mingled
 with the ferment of which I have just spoken."
   It was also by  the intermediation of  a ferment that the  animal
 spirits were separated from the purest  sulphurous portion of the blood,
 in the cortical substance of the brain and the cerebellum.  But though
 the process by means  of which this operation was effected was  a little
 obscure  it  appeared  nevertheless demonstrated, that in this  circum-
 stance, the encephalon, covered by its bony case, and furnished with its
 nervous  appendages, fulfilled an office similar to  that of the upper part
 of an alembic of  glass, enclosing a sponge, for the  rectification of the
 spirit of wine.
   In short, each apparatus of the  organic body possessed a particular
 ferment, indispensable to the exercise of its functions, so that it might
 be said that our life commenced and was sustained by ferments.0
                             PATHOLOGY.
   If ferments are  the source and sustenance of life, they are equally
 the cause of our death, for they harbor, after Willis, the germs of all
 diseases.   Sometimes,  he says, the  sulphurous and  spirituous  parts  of
 the  blood are exhaled in excess, producing an ebullition in the vessels
 like the fermentation of wine, and giving rise to febrile affections of all
 species;  again, the saline part effervesces, communicating to the blood
 an acid,  austere, or bitter quality, which causes  it to coagulate in vari-
 ous  ways; from  this  proceed most of the chronic diseases, such  as
 scorbutis, dropsies, lepra, etc.
  All  the intermittents were due to a  superabundance  of the  non-
 assimilated digestive juice, which, in circulating with the blood, excites
 an ebullition  which continues until all the morbific matter has  been
 expelled; then only is  a calm  re-established—an  intermission more
or less  long succeeds the febrile agitation.
   Continued  fevers are engendered  in  the following  manner;   the

       0 De Fermentatione Sive de Motu. Corporum Inorganico chap. v. 
THEORIES AND  SYSTEMS.
519
spirituous portion of the blood being agitated or heated, produces an
ephemeral fever, or a legitimate synocha.  If the fermentation extends
to the  sulphurous particles, a  putrid fever  results.   In fine, when a
poisonous miasm enters into the circulating fluid, it provokes not only
the effervescence of  the  spirituous and  sulphurous molecules, but also
separates  the  elements of  the blood,  giving rise to putridities and
strange coagulations, and those alarming and  extraordinary symptoms
supervene that mark extreme peril, and which characterize malignant
fevers—the  plague, small pox,  etc.
   Phrensy consists in the irritation by the spirits of the brain, which,
abandoning  themselves to confused and disordered movements, derange
all the functions of the soul.   But when the  spirits  realize another
order of alteration,  when,  for  example, their substance  changes its
nature  and  becomes  ascesent, sour, or insipid, instead of its former
salino-spirituous  condition,  then,  I say,  they engender  other  sorts of
madness, such as melancholy, dementi^, idiocy, etc.

                           THERAPEUTICS.
   It was also by the aid of  ferments that all diseases were cured, and
the office of the physician, says Willis, resembles very much that of the
butler,  who watches that  the  fermentation of the  wine  takes  place
regularly, and removes every foreign substance  that would be calculated
to trouble it.   They act at first on the spirits or their  humors; they
appease, excite, or change in a thousand ways their fermentative move-
ment ;  in this  way they produce  all sorts of  effects on  the  body,  the
solids of which they modify secondarily.
   Such are  the principal traits in the medical doctrine of Willis.   The
reader   must have remarked what I announced in the commencement,
that they resemble very much those of Lebo, in certain  connections,
and differ from them in others. The system of  Willis was more vast,
complicated and subtile than   the preceding, was less comprehensive to
the vulgar,  and, therefore, pleased better, minds  accustomed to abstract
speculation ; but there are at bottom the same defects, and it merits the
same reproaches.   The English nosologist made no more account of the
form and  constitution of the solid  parts, than  did the nosologist of
Leyden.  Nor  did he keep any better  the promise he made not to go
beyond, in his  speculations, the limits of sensible  phenomena: he pre-
sents to us, on the  contrary, a series of deductions purely  fictitious,
resting on materials, placed, for the most part, beyond our senses.   I
am then, compelled, in  order  to justify, in  the eyes of posterity, the
reputation  of  this  great practitioner,  to repeat what I have said in
favor of Sylvius and so many others, namely: that they laid aside their 
520
REFORM  PERIOD.
fictitious theories when visiting the sick, and consulted their experience
only.   I have the  more reason to think that Willis acted in this way
from what  he says on the subject of Peruvian  bark, whose effects con-
tradict  his theory—that it is  better in every case to be  guided  by
observation.
  The disciples of. these two celebrated men made some secondary mod-
ifications, in their systems, of which it would be useless here to give  a
sketch ;  I therefore pass at once  to another class of  theoreticians.
                       ART. IV.  IATRO-MECHANICS.
   The progress of chemistry had given rise to the idea of explaining
 the functions of organized beings by the laws which  regulate the  inti-
 mate and elementary  combinations of crude bodies; so, also, the pro-
 gress of experimental physics, mechanics, and mathematics, suggested
 the thought of applying mathematical calculations to the phenomena of
 the living economy. They were vainly filled with the hope, that they could
 arrive to the determination,  with  mathematical precision, of the  least
 vicissitudes in health,  as well as the means to remedy them ; and to this
 purpose they devoted themselves to  patient and ingenious researches.
   Sanctorious was the first who entered upon this path, in  essaying  to
 estimate by exact experiments the quantity of insensible  perspiration
 that exhales from the body in a given time.   As all the functions of the
 organism are so bound together that no one can be deranged without the
 others becoming affected, he thought that each  variation in the quantity
 of exhaled vapor would indicate a shade of change in the general state
 of the body.   This opinion had nothing in  itself very unreasonable  or
 unreal;  nevertheless, the researches attempted in  this sense, by Sanc-
 torious, and  by many other observers of the greatest merit, only pro-
 duced results more curious  than useful, and  consequently have  been
 abandoned on account  of the  little benefit which has accrued to the
 Healing  Art.
   Alphonso Borelli, professor  of Mathematics in the University of Pisa,
 member of the Academy del  Cimento, instituted in 1657,  by Leopold,
 prince of Tuscany, for the purpose of propagating the doctrine and method
 of Galileo, is the veritable founder of the sect of latro-mathematicians.  It
 was  in the  halls of that  academy that he read his first essays on the
 mechanics of animals.    Soon after he quitted Pisa, from some particular
 discontent, and went at first to Messina, where he did not long remain,  on
 account of the political  troubles that agitated Sicily; lastly, he went
to Bome,  where he was welcomed and  protected by Christina, ex-queen 
THEORIES AND SYSTEMS.
521
 of Sweden, to  whom he  dedicated  his  famous  treatise  on  Animal
 Mechanics.
   Fruit of patience and genius, this work created a new department in
 Medicine.   Until then, in fact, only vague and  erroneous  ideas were
 held, on the sum of the forces expended by animals in their movements,
 and on the mode of employment of the  same forces.   Proceeding from
 the  principle  that nature attains her ends by the most direct route and
 the most simple means, it had always been thought that men and ani-
 mals are constituted in a way to be able  to  execute  great  movements
 and carry  heavy burdens by employing the least possible force.  Borelli
 refuted this idea by convincing arguments, founded on anatomy  and the
 laws of statics.   Comparing the bones put in  play by the  muscles, to
 levers moved by cords,  he  proved  that man expends an enormous
 quantity of power in  his movements.  If,  for example, there be attached
 a weight of twenty-six pounds to  the extremity of the hand, the arm
 being extended horizontally, and then be brought  to  a state of  flexion,
 the biceps  muscles must employ, he says,  to execute this  movement, a
 power which will not  be  less than  eleven hundred and sixty pounds.0
 The street porter, having on  his shoulders a package of one hundred
 and  twenty-nine pounds weight, consumes, according to the calculations
 of the same author, a sum of forces equal to 17,266  pounds, when he
 sustains himself on one foot alone.
   However it may be  in regard to  the exactness of these calculations,
 which  must be  accepted only as  a very  elastic approximation, it is
 unquestionable that a man developes, in his movements, a muscular
 energy  incomparably  greater than the weight he sustains; a truth
 which  was not  supposed before the publication of the discoveries of
 Borelli.  His work embraces, besides, a prodigious quantity of fine and
 new observations on the various modes  of rest and locomotion of animals,
 such  different attitudes  as  standing, sitting, or lying down, walking,
 running, leaping, swimming, flying, etc.   To give only one example in
 a thousand, he presents a very ingenious explanation of the process by
 means of which  a bird sustains itself while sleeping, resting on one foot
 only, and supported by a frail branch  moved by the wind.
   It was, then, not without reason  that this author writes at the  head
 of his preface:  "I undertake to speak on the mechanism of animals,
 an arduous subject, which a great number  of ancients and moderns have
attempted,  but which  they merely  touched.  Not  one  of them  has  as
yet suspected  the numerous and interesting problems that belong to
it, much  less resolved  them by rigorous demonstrations."  He developes
      °De Motu Animalium, chap, x, prop. 35.
33 
522
REFORM  PERIOD.
then the plan of his work in these words:   "This treatise will be
divided into two parts;  in the first, we shall examine the visible move-
ments of animals, which are affected by the alternate flexion and exten-
sion of  the exterior parts.     °                     In the second, we
shall search  for  the cause of muscular movements, and all internal
movements, such, for example, as the progression of liquids in the ves-
sels and viscera."
  The first part, as may be judged by the  above  compte-rendu, has all
the perfection  that  comports with the  lights of the age, and  merits
eulogy.   The second has not obtained as unanimous an approval, though
it was, in the eyes of the author,  the  most essential, and had cost  him
more pains, more calculations and researches than the preceding.0  It
includes a complete physiological  theory, a summary of  which we  now
proceed to give.
  One  of the fundamental theorems of this  theory is  that by which
Borelli explains the intimate or immediate  cause  of muscular contrac-
tion.   There occurs, he says, a continual flux of the nervous  fluid, and
of the blood, into the spongy cellules  of the muscles.  Now, when the
sensitive soul, which resides in the brain, wishes  to employ the  motive
faculty, it communicates a simple excitement to the nerves, or lather, it
pr:jects throughout the  nervous  tubes a subtile fluid, called animal
spirits.   In an instant, the mixture of the nervous  juice  and the  san-
guineous liquid which impregnates the muscular vescicles is put in ebul-
lition,  and in expanding distends the  muscular mass, the extremities of
which are forced to approach each other.   Our author devotes three long
chapters to the development of this theorem, which is the corner stone
of his physo-pathic edifice.  He compares the effect of the animal spirit
on  the mixture of the nervous juice and  blood which  fills  the muscular
areolae, sometimes to the spark that flies when the steel strikes the flint;
again, the flame excited by friction ;  or the vapor which  escapes when
water is thrown on quick-lime ; or the effervescence produced when  cer-
tain acids are poured into alkaline solutions, etc.f
   But  in vain  does  he accumulate  subtilties and metaphors ;  all the
artifices of language could not change a hypothesis into a veritable fact.
Now, no observation has established that any humor flows through the
extremities of the nervous fibrilbje,  nor,  for a much stronger  reason,
that this humor mingles with the blood in the muscular  interstices, or

   °This subject has been studied anew, first  by the illustrious P. J. Barthez, in
his work, Nouvelle Mecanique des Movements de PHomme et des Animaux;  then
by G. and E. Weber, in their Traite de la Mecanique des Organs de la Locomotion,
translated from the German, by Jourdan.
   | Le Motu Animalium. 
THEORIES  AND SYSTEMS.
523
 of an  effervescence, instigated by the animal  spirit.   What shall we
 think, now, of the calculation which this author pretends to establish, of
 the  expansive  force of  the  nervo-sanguineous molecules, which,  are
 supposed to fill  the muscular interstices V   Need we be astonished, that
 proceeding  from this  fictitious idea, he arrives  at  such ridiculous and
 exaggerated results  as  the following, viz:  that the heart overcomes, at
 each contraction, a total resistance equivalent to the weight  of 180,000
 pounds!
   He  regards stomachal digestion as a simple trituration,  which  is
 sometimes  facilitated by the concurrence of a  corrosive ferment.   He
 explains, in a manner entirely  mechanical, the nutrition of parts, or
 assimilation.  The humors, he says, as well as the solids, allow portions
 of their substance to escape, which evaporate by transpiration,  and form
 little spaces at the points from which the particles  are  detached.   The
 sanguineous globules, pressed with violence by the  heart and arteries,
 become engaged  in these little lacunae.  But all the globules do not enter
 indiscriminately into all the interstices ; each  globule  insinuates itself
 into  a vacuole, whose configuration is  analogous  to  its  own;  thus, the
 osseous globules  penetrate  the pores  of the  bones only;  the  fleshy
 globules, into  those  of  the  flesh ; the membraneous, into the pores of
 the  membranes,  etc., so that each tissue, receiving the aliment which is
 appropriate to it, is nourished, and repairs its losses.
   All the secretions are explained, in this system, in the same way as
 as the nutrition.    See, for instance, how he represents the formation of
 the urine.  The  blood  being projected with force through the emulgent
 arteries,  comes,  on one hand, in contact with the  orifices of the san-
 guineous capillary tubes, on the other,  with  the orifices  of the urinary
 canals: suddenly its molecules, united by simple apposition, separate, as
 in passing through a sieve—the aqueous globules of the urine passed
 into the proper renal tubes,  whose configuration is analogous to theirs,
 the sanguineous globules insinuate themselves into  the  veins  that  are
 conveniently disposed to receive them, and can not give  passage to  the
 urinary globules.  " Certainly," exclaims our mechanical physiologist,
 "  as  well have faith in dreams and delusions,  as to imagine that there
 exists a magnetic virtue,  and particular ferment, endowed with a very
 subtile discernment, and placed there expressly in the kidney,  to separate
 the urinary from the sanguineous molecules,  and dispose each  of  them
 in their appropriate reservoirs ! "
   According to him, respiration is not for the purpose of introducing a
 new principle into the blood, but to moderate the raging passion of the
vital  spirit, in about the  same way as the  balance wheel of a  clock
regulates  the movement of  all the wheels by its alternate oscillations. 
524
REFORM PERIOD.
Bespiration has also  for an  object, to give to the sanguineous globules,
which have been changed during their passage through the various parts
of the body, their primitive and normal form.

                   PATHOLOGY AND THERAPEUTICS.
   These two  branches,  so important for medical science, have a very
small consideration in the work of Borelli; they are  merely mentioned,
en passant.
   This  writer attributes all  the  painful sensations to the itching or
irritation of the  fibrillated extremities of the nerves.   He assures us
that fever is  produced  by the acridity, or by the fermentation of the
nervous juice  which is diffused in the cellules of the tissue of the heart,
and he adds, that this acridity of the nervous juice proceeds  either from
irritation, or from obstruction of the radicles  of  the nerves, which are
distributed in  the glands, and principally in those of the mesentery.
   The fever decreases and becomes calm, according  to him, when the
blood, projected with  force into the glandular  organs, has  sufficiently
washed  and carried off  the viscid or corrosive matters which obstruct
the nervous radicles.   But after an  indefinite  time, the  excrementitial
residue, deposited in the glandular cavities, occasions a new development
of  viscous and acrid matter,  which excites a second paroxysm ; such is
the cause of the periodical return of the febrile accessions.
   The definite cure depends on the complete elimination of the febrigin-
ous ferment;  this elimination is effected  by insensible transpiration, or
by the sweat or urine on some other emunctory.  If  the fever is  of a
benign nature, it is equally cured, whatever may be the method of cure
employed; if  it is of a malignant character, every species of treatment
will fail;  thus, then, the surest part, in all cases, is to  attempt nothing
without  an urgent necessity.   If, however, we judge  it proper  to do
something, it  should  be remembered that during the fever the principal
indication consists in dissipating the obstruction of the excretory vessels,
and in tempering the acrimony of the febrifacient ferment, by  the intro-
duction of a salt of an opposite nature.
   If we did not know already what to think of a medical doctrine based
on a theorem  so  hypothetical, it would be  sufficient, by considering the
poverty of the curative indications which were deduced from it, to declare
it insufficient and erroneous.   Without attempting to make apparent all
the nonsense and contradictions it embraces, I shall content  myself with
asking:  By what experiment has any one established the obstruction of
the venous radicles, which was supposed to be the  cause of so many
diseases ?  How is it that Borelli, after ridiculing those who admitted
the presence of a  particular ferment in each secretory gland, had recourse 
THEORIES AND  SYSTEMS.                  525
to the intervention of a febrifacient ferment to explain the generation of
fever? etc., etc.
   This theory, although as little founded in reason, as that of the iatro-
chemists, presents itself  under a  much more  attractive and  scientific
dress.   It  rests  on  extremely delicate considerations  in anatomy and
hydraulics—on  calculations  which  it  would be extremely  difficult to
verify, and still  more, to contradict, which lends to it an air of mathe-
matical precision, to which no other system of medicine could approach.
It renewed the ingenious idea of Asclepiades of Bythinia, on the atoms,
their shapes,  their continued passage through the  pores, and the obsta-
cles that accidentally arrest them  ; but it drew these ideas from recent
microscopic  observations, which resembled  demonstrations.   In  fine, it
gave rise to the hope that it would be possible, some day, to represent by
algebraic formulae, all the combinations of the vital forces, and all the
rules of the Healing Art.
   Vain illusion, which was calculated to, and did seduce many eminent
minds, among whom I will mention for Italy, Laurent  Bellini, a cotem-
porary of Borelli, and member, like  him, of the society del Cimento;
George Baglivi,  surnamed  the Boman Hippocrates ; Joseph  Danzellini:
for France, Bossier de Sauvages, the first of nosologists ; J. Senac, whom
Morgagni scarcely ever mentioned  without  giving to him the  epithet the
great; for Germany and Holland, Herman Boerhaave, the propagator of
clinical teaching;   John  Bernouilli,  who  shares  with Newton and
Leibnitz the glory of the invention of  the differential calculus ;  in
Great Britain, Archibald Pitcairn, who proposed nothing less  than  the
solution of this vast problem: " A disease being given, find the remedy ;
James Keill, who joined the Newtonian attraction to the mechanical prin-
ciples  of  Borelli;  John Freind, who continued the history of  Daniel
Leclerc ;  Bichard Mead, celebrated by the nobility of  his character, as
well as by the variety of his learning.
   The limits of this work do not  permit me to indicate all  the changes
which the iatro-mechanical doctrine underwent by  the pens  of so many
distinguished men.  Besides, those details have lost very much of their
interest since the doctrine  has fallen into complete  discredit.  It will
suffice to notice  the principal phases through which it passed during its
short and brilliant career.
   George Baglivi, a native of Bagusa,  being left an orphan  at an early
age, was  adopted by one  of his  relatives,  who was a physician,  and
gave him his  first  instructions.   He received the doctor's  hat at the
University  of Salerno, or Padua; afterward, he  traveled  throughout
Italy to hear the most famous professors.   At Bologna, he followed  the
anatomical course of the illustrious Malpighi.  Finally, he located at 
526
REFORM  PERIOD.
Bome, where he devoted himself to the  practice of Medicine, and very
soon acquired a great reputation  for skill.   The pope, Clement XL,
immediately conferred upon him the chair of Theoretic Medicine in the
college of Sapientia;  afterward, that of Anatomy and Surgery, which
Lancisi had just left  for a more elevated station.  Though young, Bag-
livi showed himself worthy to succeed such a predecessor, and sustained
the eclat of the chair.  His renown, already European, increased every
day, when he was arrested in the middle of  his career by a long  and
painful disease, by which he  was lost to science on  the 17th of June,
1707, in the thirty-eighth year of  his age.
   Baglivi endeavored to  complete the theory  of Borelli, by applying
it to pathology and therapeutics, which the  latter had  barely touched.
He comprehended very well  that  the  physicians  of  his time, whether
Galenists or  latro-chemists, were so entirely  occupied with the study of
humors as to neglect  very greatly  the examination of the solids ;  con-
sequently, he proposed to redirect his cotemporaries to the  study of  the
latter, by demonstrating that the solids have a great preponderance over
the humors  in all the organic functions, whether in  health  or disease.
" Full of this  opinion,"  he  says,  " I  devoted  myself entirely  to  the
observation of  the symptoms during life, and to the study  of the ana-
tomical lesions after death, and I have been convinced by my own eyes,
that the influence of  the solids is greater than that of the liquids, even
in the generation of diseases.'0
   He admits for the simple or primitive fiber, only two orders of affec-
tions: one proceeding from  an excess of relaxation or softening,  the
other  from  an  excess of tension or  rigidity.   This  hypothesis was
renewed by Themison, and  is, in  short, that on which all the Solidist
theories rest, which pretend to go beyond the sensible phenomena.  He dis-
tinguishes two orders of fibers, namely: the fleshy fiber, which has  its
origin in the heart, and constitutes the muscles, tendons, bones, and lig-
 aments ; second, the  membraneous fiber which is derived from the men-
inges of the brain, and serves to  form  the  membranes, vessels, glands,
 and other tissues.  Consequently, he recognized  also two motor princi-
 ples in the  animal economy, namely: the heart, which  gives impulsion
 to fleshy parts, by sending to them a  liquid without which  their fibers
 could not be  nourished or act,  and the brain,  whose envelopes  give
 impulse to the movement and life of  all the membranes and viscera.
   The manner in which Baglivi conceived the influence of the  encepha-
 lic meninges has, according to my view, no  merit for originality, and is
  ° Specimen quatuor Librorum de Fibra Motrice et Morbosa.  Animadversiones
in Theoricem Veterem, sec. n. 
THEORIES AND  SYSTEMS.
527
not worth the trouble of contesting with him its invention.   This phy-
siologist, in comparing  the structure  and  functions of the dura mater
with the structure and functions of the heart, finds between them a per-
fect analogy.  He further says, that as the central organ of circulation
projects the blood into all parts of the body, through the arterial canals,
so also the dura mater embraces closely the brain in its  movements of
systole and diastole, and expresses a fluid which it causes to flow to the
utmost extremities  of the  nerves.   He  gives next an  explanation no
less odd, of sympathetic phenomena; according to him, the oscillations
of the dura mater extend  by  continuity of  tissue to the  nerves,
to the membranes and viscera in general, and  to  the  heart  itself:  in
their  turn, the  particular movement of  each  organ tending  the  same
way, reflects itself in some sort upon the brain; hence the manifestation
of a universal sympathy, a constant undulation from the encephalic cen-
ter to the periphery of the body,  and from the  periphery to the center.
A simple observation destroys this whole scaffolding : it has been avered
that the dura mater has no sensible movement in itself; those that are
seen,  proceed either from the impulsion of the heart and arteries, or  from
the influence of respiration  on the venous  circulation  of the  brain.
Moreover, the pretended continuity of tissue of  the meninges with the
other membranes, vessels, and viscera, is purely visionary.
   If  Baglivi merits our remembrance by his theoretic dissertations only,
we should not, perhaps, occupy our time with this notice ; but he has
more  solid titles to our attention.   His  treatise  on Practical Medicine
was remarkable  for qualities not common  at that epoch.  The author
gives in  it unceasing counsel to be  guided by observation, to sacrifice
the arguments of theory to  the  prescriptions  of experience.   Here we
see a man whom the prejudices of his medical  education sometimes led
astray, but who, by the strength of reason and the depth of his genius.
was often led to return to the path of truth.
   He does not show himself in this work an exclusive partisan of Solid-
icm he was willing to acknowledge that chronic  affections might pro-
ceed  from a cachochymy, or  vice  of the humors.   He  was also led to
think that the  fevers which prevailed  in  Bome during the summer,
 originated in an alkaline excess,  as they are frequently jugulated in the
 outset by acidulous drinks.   He protested against the custom of many
 physicians of his time, who prescribed alkaline solutions, tinctures, and
 volatile salts in acute inflammatory diseases.   All that class of  anti-
 acids augments,  as  he thought, the acridity  and impetuosity of the
 blood, the dryness of the  tongue, thirst, insomnia, headaches, general
 heat,  and,  in  a word, exasperated  all  the  symptomatic features of
 inflammation. 
528
REFORM PERIOD.
  He pronounced  a very wise judgment on  the manner in which wc
should appreciate the ancients and moderns.   "I  have seen," he says,
" in some academies, men so prejudiced against the ancients, that  they
feared it would degrade their intelligence to  devote  a little time and
trouble to read the works of the Galenist  writers.  They preferred to
torment their minds miserably, in order to imagine something new and
unheard  of; and if by accident they encountered something of the kind,
they think they have great claims upon science—enough for their glory.
Others, on the contrary, were so religiously  attached  to the opinions of
antiquity, that they unceasingly criticised modern discoveries, however
fine or useful they may be."0
  Again he says:  "Medicine is not  a production bursting suddenly
from the genius of  man,  but  is the  child of time.  In old times it was
believed  to be an inspiration from  the gods, but it can be  said  with
more truth,  that it is the fruit of observations collected from age to age,
for a great number  of centuries.   Those who pretend that experience
and reason are  opposed to each other, seem to  me to be rambling ration-
alists and Empirics."  This last sentence is a trait of genius, a ray of
light which  the author himself very soon abandons, but which we must
keep in view;  no,  reason and experience are not  two opposing authori-
ties which condemn each other, and  all  medical doctrines which  do not
satisfy, at the same time, both of these modes of acquisition,  are mani-
festly defective.
  Baglivi, despairing of being able  to resolve  such a problem, that  is to
say, to put practice and theory in agreement,  essayed to draw between
them  a line of  demarkation,  by  assigning to  each its department—an
enterprise inconsistent on the part of a man who had  declared  that
reason and  experience, or in other words, theory and practice,  should
always go together.   " It is proper," he says,  " for the theorist to  give
reasons  for the  apparent phenomena of  diseases—to  compare  past
circumstances  with the present—to scrutinize  the hidden  causes of
morbid  accidents,  and the  true origin  of the  causes themselves—to
develop,  in fine, all that relates  to  the subject,   so that the  physician
may appreciate clearly, and with  precision,  the curative indications;
but it belongs to the practitioner to arrange the history of diseases—to
pronounce  on the  appropriateness  of remedies, and  the  indications to
fulfil, and  to judge by the light of experience  all that relates to the
cure of diseases.   Whoever shall act differently, and pretend to submit
the rules of practice  to the principles  of theory, will obtain no success
in the treatment of diseases."
0 Opera Omnia Medica.  Pref. 
THEORIES AND  SYSTEMS.
529
  No one could contradict himself more openly than Baglivi has done,
in the passages we have just quoted ; but this must not astonish us—
on the contrary, we must expect to see these contradictions frequently
renewed, for as soon as  an eminent logician leaves the true route, he
has more difficulty than any other to re-enter it—the chain of his ideas
leads him always straight forward in the track on which he has entered.
Here is  another remarkable example of the contradictions of this author,
in the portrait  he has drawn of the Empiric sect:  " This sect," he
says, in one place, " banishes from medicine all theories, and even every
species of reasoning, and follows experience only, in the cure of diseases ;
not an experience guided by reason, and multiplied proofs,  but a stupid
experience, guided by accident,  and worthy of  market  houses only.
This  sect introduced so many absurdities into medicine,  that  the Art
would have been  destroyed  if Galen, about  the first century of the
Christian era,  had not raised a dyke to oppose that torrent of errors,
and founded, with as much courage as prudence, the Bational  sect, on
an immovable  basis."
  Farther on,  this  same author holds a very different language : " The
Bational sect," he says,  " persecuted with hatred the Empirics, describ-
ing  them as vile, and unworthy of cultivated minds,  and fit only for
the  populace in market places.   I should approve of their  conduct if
by Empiricism they meant the method of stupid and blind  experimen-
tation, not  subjected to repeated  tests—not matured by  reflection, in
short, serving only as a basis of false inductions and monstrous precepts.
But I can not  agree with them, if they had in view a rational or learned
Empiricism, the fruit of method, not of hazard, directed and  fructified by
intelligence, and aspiring to the highest truths by the attentive and per-
severing observation of  sensible phenomena.   Such an Empiricism has
obtained in all time the approbation of enlightened men, who strove to
increase it, as  a mode of acquisition conformable to our nature."
  In many other passages still, the Boman Hippocrates emits an opinion
favorable to Empiricism, only one  more of which  I will give : " Accord-
ing to Pliny, we are ignorant of  what makes us  live; but, if I dare
give my opinion, we are much more ignorant of what  makes us sick;
for the infinitessimal  substance that gives the  first  and  immediate
impulse  to disease,  is entirely  incomprehensible.  How,  then, in the
midst of so much obscurity, can  we  deduce  the  therapeutical indica-
tions ?   I avow, that in so  much embarrassment, the testimony of the
senses is our only refuge ;  in other terms, it is necessary to have observed
long  and patiently, by what process nature engenders disease—how she
effects the coction  and separation of the peccant humor—then establish,
on  this  base,  a curative  method, which, following nature  step by step, 
530
REFORM  PERIOD.
never loses sight of the injurious or  useful  effects  of  the remedies.
Now, it is important  in  this  task  that reason, so much vaunted  by
physicians, submit  itself to Empiricism—to that Empiricism which
letters have  polished,  which several series of observations  have con-
firmed, and which intelligence vivifies by its light;  for the  aid which
theory alone  promises us,  swells at first our hopes, und then leaves us
in perplexity."
   Hermann Boerhaave was endowed with a comprehensive and subtile
mind.   Profoundly versed in the writings of the ancients, and no less
familiar with all  the  works of moderns, he undertook to unite in one
body, the  doctrines of all  the  branches of medical  science,  and to con-
ciliate among them the reigning theories of his times.  He was eclectic,
after the manner of Galen and Fernel; but as the mechanical explana-
tions predominate in his writings,  he has been classed  among the Iatro-
mechanics, the same as Galen and Fernel are classed among the Dog-
matists.   After the  example of these he divided his entire course on
Medicine, or his Institutes, into five parts, which are, physiology, pathol-
ogy, semeiotics, hygiene, and therapeutics.  The first part forms, alone,
two-thirds of the work; so that the four following occupy, each, but a
small space,  and embrace only a general view of the matters of which
they treat.
   Physiology being then the most complete part of this course on medi-
•cine, we proceed to take a rapid view of it.  He represents the action
of the  stomach or food as follows:   "If you consider that the food is
continually diluted by a great quantity of saliva which flows, unceas-
ingly, from the mouth and the  esophagus, into the stomach, and by the
humor which transudes the coats of the  stomach itself; that these are
mingled and agitated with the rest of the food, which has  been previ-
ously taken—that their most intimate parts are moved by the action of
the air, which  is ground up, if I may  say so, with it, and that all this
is augmented by the heat  of the organ: you can conceive that the effect
of the concave part of the  velvet  tunic, is to dilute, macerate, swell,
attenuate, and produce the commencement of fermentation, putrefaction,
rancidity, and  the solution of food, and fit them  for a change into a
nature similar to that of the humors of our body.  You do not yet com-
prehend by this how the  stomach can  digest  the solid food which has
been but  slightly masticated.   But to find the cause which we seek, cast
your eyes on the muscular structure of the stomach and see what action
depends on it.              In several animals the digestion is almost
wholly accomplished by the sole contractile movement of the stomach—
a movement  which is so considerable that it is heard and felt."
   We see here a very  skillful  amalgam of ideas drawn from anatomy, 
THEORIES AND  SYSTEMS.
531
physics, and chemistry.   The  rest of the doctrine of Boerhaave  offers
throughout the same assemblage of ideas, and for  that  reason I shall
not  multiply the quotations.   I will add only the following, to show
how much the greatest  minds are  liable to  be deluded  in  regard  to
theories, and to take for demonstrated truths  the simplest conjectures.
" The fluid which has been filtered," he says, " through the corticle sub-
stance of the brain and cerebellum is pressed continually by  the action
of the heart and arteries into the nerves, and  by means of the nervous
canals into  all  parts of  the body, forming a circulation as real and as
constant as that of the blood and the lymph.   This humor is  so simple,
so mobile, and so perfectly volatile,  that it has been  called the  nervous
spirit, and is sub-divided  into  natural, vital,  and animal.  But as the
secretion of these  spirits  is never interrupted, as it is constantly sup-
plied anew,  in order to repair what is lost or consumed, it appears  that
those which have fulfilled, entirely,  their  purposes,  pass  from  the last
filaments of the nerves into the small lymphatic veins, by which they
are carried into other veins a little larger, then into the  common lym-
phatic vessels, whence they flow to the heart by the  sanguiferous veins,
and thus  this subtile fluid circulates, incessantly, in its vessels, like the
other humors."°
   In his writings on practical  Medicine,  Baglivi abandons theories,  or
pays but  little  attention  to them,  and advises  to  rely entirely upon
experience.   Boerhaave, on the contrary,  does not appear to doubt for a
single instant the exactness of  his theoretic speculations,  and endeavors
to base upon them all the  phenomena of diseases, and all the rules  of
Art.   Herein he shows himself a more refined dialectitian, but a poorer
observer than the Boman Hippocrates.   The  latter appears  to me  to
have more depth and genius ; he rises, often, above the prejudices of his
medical education and of  his age;  he  sheds  frequently brilliant light
in the midst of  his contradictions.   The  other had  a larger  mind and
more extended  erudition ;  he  adopts  the teachings  of his masters  as
infallible dogmas,  and appears  to have no other ambition than to co-or-
dinate and  conciliate, and to unite them into  a  complete system.   He
says in one of his first aphorisms, that the study of pathology must be
commenced in the most simple affections, those of which we  have the
clearest idea, which are the easiest to heal, and the knowledge of which
is indispensable for the understanding of  other diseases.   Now, accord-
ing  to him, the diseases   of the primitive fiber are those which fullfil
these conditions in the highest degree, as may be seen in  the following
passage:
0 Instit. Med. 
532
REFORM PERIOD.
   " The primitive fiber," he says, " is composed of small simple terres-
trial particles, separated from the fluid contained  in the vessels.  They
are reciprocally applied to each  other  by the forces  of  life, in such  a
way that the perturbating causes which exist in  the  living  body  are
scarcely able to change or alter  their nature.  On this account, each
molecule in particular is not subject to any disease that physicians have
seen or treated ; but the smallest fiber which results from  the reunion
of these molecules is subject to the following diseases:  excess of soft-
ening or relaxation, excess of tension or elasticity."0
   Thus  the professor of  Leyden favors us with  the  affections of  the
microscopic molecules  of which the primitive fiber is composed,  while
no physician up to this moment has seen or treated any affection of this
order.   In regard to diseases of the fiber itself, he shows them to  us in
their smallest details,  so well that we could scarcely doubt that he had
seen them  and  followed them  in all  their  phases.  Now, as no  one
before  or since has pointed out this class of  diseases, it must be thought
that Boerhaave has seen the marvellous things which he  recounts above,
with a particular microscope, or rather with the eyes of  faith.
   Let  us then turn away from these microscopic  diseases,  on which it
is impossible to establish any reasoning, and come to diseases more cog-
nizable—inflammation, for  example.   If  we  define inflammation, with
the surgeons, an  affection  characterized by heat, pain, and redness,
accompanied often with tumefaction, and followed  nearly always  by an
abnormal secretion, there is  no one who may not  in a moment form  a
clear idea of this disease; and who, in  seeing scurvy, or erysipelas, or
phlegmon, or erythema, or a simple labial herpes, could not  say, from
the preceding definitions, that they are inflammations.   It would  not
require, afterward, a great effort of the imagination to suppose that this
ensemble of phenomena, to  which we give  the name of inflammation,
phlogosis, or phlegmasia, may take place internally as well as externally.
This conjecture becomes a probability, if in certain diseases of internal
organs, such as the stomach or intestines, the patient realizes  a sensa-
tion of heat and pain,  similar to that felt in external phlegmasia.   The
probability augments still more, if the natural secretion of the suffer-
ing organs is altered, augmented, or diminished, etc., etc.   In this way,
it seems to me, we may proceed from the known to the  unknown, from
perfectly apparent phenomena  to  those which are  only  partially so, or
which manifest themselves only by their connection with other sensible
phenomena.
   Boerhaave did not proceed in this way,  as is plain from the extracts
* Aphorisms. 
THEORIES AND  SYSTEMS.
533
we have already given  from his writings, and also by those which we
now proceed to add.   Phlogosis, he says, consists in the  stagnation of
the arterial blood in the smaller vessels, is agitated and pressed by the
rest of  the blood, whose force and quickness are increased by the fever.
It may  be developed in the  extremities of the sanguineous  arteries, or
in the sero-lymphatic vessels, or in other arterioles more attenuated still;
which, not being able to transmit the red globules or other grosser parts
of the fluids which have penetrated into their cavities by the dilatation
of their orifices.                          The capillary vessels, which
are barely visible,  augment  in volume and are distended with blood, and
form a red tumor.   Their parieties, formed of small fibrillae, are on the
point of rupture, which causes the severe pain.   The solids and liquids
acting and reacting on each other, produce the hardness and resistance.
Finally, the liquid globules flowing through  the now obstructed vessels,
break against the tumor, and it is this mutual attrition of the  liquids
and solids that causes the heat and the itching.   Who  can comprehend
these transcendental explanations ?  For myself, I avow that  I under-
stand nothing that is said there, or rather, I see that friction,  on which
every one may think and write what he pleases.
  If from phlogosis, considered in  general, that is, from an abstraction
made from the tissue in which it is developed, we pass  to  the examina-
tion  of  phlogosis in particular, that of  the lungs, for example, we shall
always find the same  defects  in  the  descriptions  of this author.  He
carries  us  constantly  from observation  into  the field of hypothesis.
" When the vessels  of the  lung are attacked with inflammation, it is
called peripneumonia.  Those of the vessels which may be invaded by the
phlogosis are the bronchial and pulmonary arteries, and their lymphatic
collaterals.   Thus, we may conceive of two  species of peripneumonia ;
one of which  is located in the pulmonary arteries, the  other in the
extremities of the bronchial arteries."
  Doubtless we may,  in our minds, distinguish these two  species of
peripneumonia, and others also ;  but where is the observer who has ever
discerned them on the living, or even the dead;  and, therefore, I ask, of
what practical value is  a purely ideal division, which none of our senses
can  apprehend?  Let  us  recall our fourth philosophic  axiom, which,
among other things, says that, if it is important to make distinctions, it
is, perhaps, still more important not to make too many;  and that we
must not multiply divisions any further than is necessary to regulate us
in the use of the things relative to our wants.   Now it is clear that the
distinction of these two pneumonias, admitted by Boerhaave, is not only
useless, but also inappreciable in practice.
  After the death of  the  celebrated professor of Leyden,  the iatro- 
534
REFORM PERIOD.
mechanical doctrine rapidly fell.   At this time it exists only in history,
and in some parts of physiology.  Others succeeded it, to disappear, also,
soon after,  or  submit to considerable  modifications, so  rapid was the
movement  of  ideas during the  historic period  which we have just
reviewed.
               ART. V.  ANIMISM  AND  VITALISM.
  While the teaching of  the professor of Leyden shed such a glaring
light over the  medical world,  and disseminated widely his  mechanico-
chemical doctrine, tw§ other professors, less celebrated than he, and less
profound, but more attentive and faithful observers of nature, laid  the
foundation of new theories, destined  to take  the  place of his brilliant
system.   One was Frederic Hoffman—the  other  George  Ernest Stahl.
Both had been fellow students in the University of Jena, and now found
themselves colleagues in the rising school of Halle, on which they drew,
for half a century, the attention of the learned  world.
  Stahl, of  whom we shall  speak in the first place, belongs not less to
the  history of  chemistry than to  that of Medicine,  by his  discoveries
and  his writings; but  in this work we can only occupy ourselves with
his  medical  opinions.   He was physician  to the court of  Weimar in
1694, when he  was called to the University of Halle, on the recommen-
dation of his old fellow student, Hoffman,  who showed by this circum-
stance,  all the  generosity of his soul; for he was not ignorant that he
made himself a rival, whose doctrine differed much from  his own, and
whose renown might cast him in the  shade.
  The new professor responded fully to the opinion that had been formed
of him,  by acquitting himself with a zeal and exactitude that never belie
the arduous functions of a professorship.  More inclined to observe and to
meditate than to read, he showed a somewhat affected disdain for classic
erudition, though he attempted to cover his  defect of literary culture by
some quotations from ancient authors, and by the insertion of  a quan-
tity  of  Greek  words in his Latin periods.  He  may be excused  for
having  often presented the ideas  of others as  his own,  by alledging
his  slight erudition ;  but nothing can justify the epithets of contempt
which he lavishes on  his scientific adversaries.   His principal title to
glory in Medicine, is for having recalled the attention of his cotempora-
ries to the natural tendencies of the animal economy—to the reaction of
the  vital forces—or the soul—in  diseases—a reaction and tendencies
which the physico-chemical doctrines  too much lost sight of.
  In the first place, he says, it should be  understood what  life is—in 
THEORIES AND SYSTEMS.
535
what it consists, essentially—what is its principal seat—what end it sub-
serves, and its final destination.   Afterward, it should be well understood
what constitutes health, and the signs by which it may be recognized, in
order to know under what circumstances the practice of the Art is useful
or necessary.0  Now life, according  to  Stahl, is nothing else than  the
conservation of the humors of the body in a state of integrity and per-
fect  mixture, notwithstanding their very marked  tendency to putri-
faction—a tendency  which  is rapidly developed as  soon  as they are
withdrawn from the influence of  the vital force.  It is in  this respect
that the living body is distinguished from inanimate  bodies, or simple
compounds.  " We must never," he exclaims, a little farther on, " loose
sight of that disposition according to which the mixtures of the  liquids
precede the structure of the parts;  so that  there is not, in the animal
economy, any organ or tissue, which does not presuppose the fluid mole-
cules, the reunion of which has served to form them."
   We have seen the latro-chemists present  fermentation as  the essen-
tial  and primitive phenomenon of life,—the Iatro-mechanics  attribute
that prerogative to  muscular contraction;  but now we  see  another
physiologist who regards the preservation  of  the humors in a state of
integrity and perfect mixture as the primordial and characteristic act of
a  living being.   Others will come still, who, proceeding from a new
point of view, will accord preeminence to  other phenomena.   They all
forget  that  sentence of  Hippocrates, confirmed by G. Baglivi: " The
human body has  no determined commencement.  Each of its  integral
parts may be regarded equally, as the first  or the last;  for in a described
circle,  it is  impossible  to  find either  beginning or end."f   Neither do
they remember  better  that sentence which  forms our sixth philosophic
aphorism.   " What is called essential or non essential is related strictly
to our ideas and our wants.   All  the qualities of each individual, con-
sidered in  itself, are equally essential, in the sense that they all proceed
from its essence and its nature,  and it is not therefore exact to say that
certain of  its attributes are more essential than others."|
   After having defined in his way the essence of life, by saying that it
consists  in the preservation of the mixtures  of the humors, the professor
of Halle asks what is the primitive  agent or principle of this funda-
mental act ? and  endeavors to  prove  that  it  cannot  be anything else
than the immaterial and rational soul.   He  forms from this view  two
arguments:  the first is drawn from the final destination of the human
body,  which has only been created, according to him, as an instrument

   0 Doctrince Medicae Theories part i., Physiologic de Vita et Sanitate.
   j- Hippocrates on Regions in Man.—Baglivi de Fibra Motrice.
   J Locke's Essay on the Human Understanding, Book III, ch. iv. 
536
REFORM  PERIOD.
for the soul.   "It must be remembered," he says, " the  human mind
could do nothing in this world without the intermediation of the body,
for which it is intended.  Its functions  consist in  the acquisition of
knowledge, and the exercise of voluntary acts.   It cannot  put itself in
relation with sensible things, nor have, consequently, any  idea but by
the aid of material organs.   It cannot, either, manifest and execute its
purposes except by the  same organs.   It  is also very evident, that the
body is subjected to the soul, since it employs it both in acquiring know-
ledge and accomplishing its purposes."
   The second argument that Stahl proposes is still more subtile.  " The
act," he says, "by means of which life is sustained, and the soul fulfils
its functions, is absolutely repugnant  to  matter, and agrees well with
the nature of the mind.   That act, as observation shows, is motion: by
it the mixture of the humors is preserved in integrity ; the soul acts on
the body and in the body ; compares, reasons, and moves from one object
to another ;  in  a word, it is in perpetual motion.   Now, all motion is an
immaterial act, which can only have for a principle  an immaterial sub-
stance itself."  On this our physiologist rested  without  knowing it, or
at least without saying  so,  on an axiom of Descartes, who accords  to
matter no other essential property than extension, and who requires  for
the production of any motion, the direct or indirect impulsion  of a spir-
itual agent.
   Stahl,  in supposing, with Descartes, that  all motion requires the aid
of a spiritual motive agency, affirms a thing which our common obser-
vation contradicts, every moment.   In fact,  we see constantly  produced
around us and in us, movements which no one is tempted to attribute to
a spiritual agency.   Besides, it is well demonstrated  that our informa-
tion, in regard  to physical things, cannot go beyond our sensations, and
our sensations can learn nothing concerning the presence or absence of a
spiritual being.
   Thus considered, the  opinion of Stahl on  the first motor  influences of
the animal economy, has only  the value of an hypothesis; but  compared
with the  opinions emitted in advance of him, on the  same  subject, this
hypothesis has the advantage of being more simple and less unreason-
able.   It may be therefore said, literally, that the physiologist of Halle
triumphs, when he puts his  hypotheses in comparison with those of  his
predecessors.
   " Those who first assigned to the human heart other active principles
besides the  rational soul,  imagined  two more souls,  each  endowed
with a certain degree of discernment, by means of which they  were sup-
posed to  execute  their  functions with order, measure and  propriety.
They named the one vegetative, and the other sensitive." 
THEORIES AND  SYSTEMS.
537
  " Those who hold to the opinion, more ancient still, which allows in man
only a single intelligent and rational soul, of  a nature superior to that
of brute, charged with inferior as well as with the most exalted func-
tions, from the plausible reason that what accomplished the highest, can
perform the lowest things, disfigure that doctrine, otherwise  very  sen-
sible, by the addition of numerous energies or abstract faculties, which
they transform by a figurative language into so many real entities, which
execute certain special functions under the direction of the soul.  Such
is the origin of digestive  attraction,  plastic assimilation, and other
faculties which play so important a part in Galenic physiology."
  " It was much worse, when, deluded by that absurd axiom,  that there
can exist no connection  between  an immaterial  substance and matter,
the physicians invented a host of spirits, a species of beings extremely
subtile, serving as intermediaries between the soul and the body. Although
so gross a fiction that children now could not be  imposed upon  by it, it
received so much favc.-, that the  spirits were regarded as the servants
or emissaries of the soul; their rapidity was  compared to  light,  and
realizing more and more this fiction, they ended by saying, that a spirit
was   a luminous substance.    Van Helmont  replaced these  spirits
by  the archeus, or  archei; but  while  the  soul was denied  to have
effective power, they accorded  to the spirits, or archei, the knowledge of
the functions which  devolved upon them, and  the power to fulfil them."
  After having  proved that neither chemical ferments, nor the shape of
liquid molecules, nor the  configuration  of vascular orifices, are sufficient
to  explain  the secretions and  excretions,  he  adds,  " We  must  say
as much of this invention of  some moderns, who assume that particles
destined to be secreted exert a special irritation on the secretory organs,
in such a way that each of these, by contracting itself, expresses  and
rejects  the humor which  is appropriate to it.   But, besides  the oddity
of this fiction, which represents to  us  mechanical instruments, suscep-
tible of irritation, experience contradicts such an hypothesis.  Thus, the
urine, after much drinking, is passed  more frequently, freely and abun-
dantly, and  at  the  same  time  is less  dense and more watery; when,
on the other hand, it is more  charged with salts,  or in other words, more
irritant,  it  is  passed  less frequently,  and in a  smaller  quantity,
which is contrary to the supposition above stated."
   Others have better developed, than Stahl, the influence of the physical
upon the moral man, but no one has made so sensible the influence of
the  moral upon the physical man.  He gives some very curious exam-
ples  concerning the effects of the passions and habits  on  the  vital
acts.   He  explains, very naturally,  the  birth-marks  on  children
 (nozvi materni), by the sympathy which exists between the soul, or the
           34 
538
REFORM  PERIOD.
imagination,  of the mother, and  the soul of  the  fetus.  In fine, he
concludes, from  all these physiological considerations, whether general
or particular, that it  is the soul which  presides directly, and without
any intermediary  agency, over the organization of the body, from the
moment  of the fecundation  of the germ, and  it continues to direct all
its functions  until death.
  Let us hasten to repeat a  sentence which we have already proclaimed,
that all these transcendental speculations of ancient and modern  physi-
ologists,  on  the  final  destination of  the  human body, or on its first
movement,  or on the primordial  phenomena that commence the circle of
animal life—all these  speculations, I say,  appertain rather to philoso-
phy than to medicine—they have not advanced a single line the Healing
Art.  I repeat, there is  not a single one of the  hypotheses emitted on
such  subjects, which are not connected with  absurd or injurious prac-
tical  consequences, which  is the cause of the legitimate repugnance
which practitioners feel for all the physiological systems that rest upon
assumptions,  without the pale of observation, and leads them to refuse to
discuss them, otherwise than by the practical conclusions that flow from
them; imitating in this way the mode of reasoning of  the mathemati-
cians, who, when the data of a problem conduct them necessarily to an
absurd conclusion,  conclude from  this  that they are insufficient, or
badly laid down.
  Let us see, then, what are the  practical consequences of Animism.
The author of the system, himself, deduces them  from it, in these terms:
" if the  movements of  the animal economy depart, in any respect, from
the normal mode, then the  physician should understand  that it  is his
dutv to calm them, or to excite them, or  to restrain them, in a word, to
act upon them conformably to the natural indications.   It  is of the
highest   importance to him, to  have  constantly  in view the natural
synergy of the soul, in order to  show himself the minister, rather than
the governor: in other words, the physician  should study to follow the
movements and tendencies  of  nature, rather than  to  believe himself
authorised to dare attempt something, without having due  regard to
her tendencies."
  Such a maxim made a fundamental rule of therapeutics, and, rigor-
ously observed, is nothing else than the absolute negation of the  active
concurrence of the physician in the treatment of diseases; it is to limit
the  functions of the man of the Art to a lazy  contemplation  of the
sufferings of  the patient.   If it was true as  Stahl  taught, that every
pathological  affection was the result of the reaction of the soul against
the morbific agent: if  the totality of  the  symptoms of a disease only
represent the succession of vital  movements,  designedly put in action 
THEORIES AND  SYSTEMS.
539
 by a rational agent, for the purpose of effecting a cure, could he do bet-
 ter in  any case than  remain a spectator of the struggle in which  he
 could take no part, without  running  the  reasonable  risk of deranging
 the wise combinations of the supreme  regulator of the economy ?
   Let no one accuse me of exaggerating the consequences of the thera-
 peutical axiom of Stahlism.  Many philosophers and physicians before
 me have deduced them in equivalent terms ; they have likewise advised
 that nothing  be done in most  diseases ; to await patiently till  nature
 surmounts the difficulty, which advice  is easier to give than to follow, and
 which  few physicians put in practice, even of those who proclaim  its
 excellency.   The  only active succor that the physicians and the assist-
 ants may attempt, according to this  doctrine, consists in giving to the
 patient what  he may desire, and furnishing him the means, as much as
 possible, of satisfying his instinctive appetites, which  are  supposed to
 indicate the tendencies of the  organism, or to  be the  appeal of nature.
 Those who reason  thus forget that art was invented only on account of
 defects  and frequent  errors of  instinct, and to bring aid to  this insuffi-
 ciency.   This is a fact that has been  established by all medical histo-
 rians, and that I have sufficiently amply discussed  in  the first volume
 to make it evermore  an element  of the  science.0  Nevertheless, there
 are many diseases that are cured by the natural forces only.   Then the
 functions of the physician are limited, effectively, to the  prevention of
 imprudences,  so that nothing be done rashly.   Now the Iatro-chymici
 had too greatly lost sight of this truth, which  Stahlism reminded them
 of by exaggerating it.
   The doctrine of pure Animism spread  rapidly, particularly in  Ger-
 many, but beyond that region it made very little progress; the theory of
 the vital principal which is very analagous to it was generally preferred,
 especially in  France,   but  it  differed from it in  several  important
 respects;  for  the vital  principle of the moderns resembles much more
the sensitive soul of the ancients or the  archeus of  Van Helmont, than
the immaterial soul of the  Stahlians.  Barthez, the founder, or at least
the eloquent  defender  of the doctrine of  the vital  principle, carries it
back to the plilosophy of Plato, and even to the dogmas of Pythagoras,
 He recognises it in the writings of Francis Bacon, and more distinctly
still, in those  of Van Helmont.   The latter, according to him, is among
all moderns the  one who has  indicated  the greatest  number of phe-
nomena  which announce in man  a vital principle, distinct from the
body and the  mind, and yet endowned with  sensation and perception.!

  0 See  the Primitive Period in this History.
  f Xouveaux Elements de la Science de PHomme.  Second Ed. Paris, 1806.. 
540
REFORM  PERIOD.
   Now if we demand of Barthez what is the nature of that vital  prin-
 ciple, he responds: it is neither an extremely subtile matter,  interme-
 diate between the soul  and  the body,  nor a pure  spirit,  nor a simple
 modality  of organized  matter.   " Frederic  Hoffman,"  he says, " and
 other celebrated authors, have pretended that the principle of life which
 animates a man is of a  medium nature  between the soul and  the body;
 but this middle being is one of reason, for  we cannot pass by gradations
 from the body to the  immaterial soul, and  the  essential  nature of these
 two substances causes them, necessarily, to  exclude each other.   The
 principle of life whose functions are exercised in  the human body, must
 be conceived by means of ideas entirely distinct from those by which we
 apprehend the nature of the body and the  thinking soul."
  It appears, nevertheless, very difficult to admit the existence of an
active principle, which may be neither a spirit,  nor  a body, nor a subtile
fluid intermediate between  the  soul and the body, nor a  simple attri-
bute, or property of matter.   The vital principle of Barthez,  if we may
believe him, is none of these things, but is somewhat related to each;
it  is an inconceivable  amphibological  being,  something  less  than an
hypothesis, for  it  is  a  doubt.   Hear, now, the celebrated professor of
Montpellier develop this singular  doctrine.   " We can only give," he
says, " negative assertions,  doubts, and conjectures, on the  nature of
the vital principle of man.  It is useful  to develop the  skepticism of
these considerations, in  order to study more surely  the forces and affec-
tions of this principle."  A little farther on he adds, " 1 observe, espe-
cially, that it is useless to discuss, as may  be done in following ordinary
ideas, whether  the vital principle  in man is, or  is not,  a substance;
because it seems to me  impossible to give a  clear sense  to  the word
substance, though this term is commonly employed in metaphysics.   The
question which  I should ask  myself in this  section is,  then, solely,
whether the principle  of life in man  has its proper and  individual
existence,  or whether  it is only a mode inherent  to the human  body, to
which it gives life '? "
  " It may be possible, doubtless, that,  according to a  general  law,
established  by the author  of  nature,  a vital faculty, endowed  with
motior and  sensitive  forces, supervises, necessarily, (in an indefinable
manner)  the construction  of matter, of  which  each  animal  body is
formed, and  which, in consideration of this faculty originates subsequent
movements,  necessary to animal life, in  all its duration.   But it may
be, also, that God unites to the combination of matter which is given
to  each animal,  a vital principle, which  subsists  by  itself, and which
differs, in  man, from his mind."
  I say it with regret, more absurdities could not be crammed  into so 
THEORIES AND  SYSTEMS.
541
small a space.  What! you announce that you will not discuss whether
the vital principle in  man  is  a substance, or not,  but that you are
willing to inquire whether it has a proper and  individual existence, or
if it is only a mode  of  existence inherent to the human body !   Ah !
do you not see, that it is the same question, in different terms ?   And
then,  how strangely you resolve the question !   You say that this vital
principle might be  only a modality  of the organic body; or that  it
might also have its proper existence.    Here is a solution  that resolves
absolutely nothing.   Nevertheless, Barthez soon quits his character, as
skeptic, to entertain us, throughout  two volumes, with the  faculties,
acts, and lesions, of  the vitxl principle.   He speaks of it no  longer as
of an equivocal and  hypothetical being, but as of a real and very active
being, endowed with proper forces,  and susceptible  of  modifications
distinct from those of the soul and the body.
   He  attempts in vain, in the conclusion,  to return a little  to the
skepticism he announced in the  onset; his penchant for the realization
of the vital principle is observed in his dubitable phrases.  " The results
on  the death  of men  are  as follows:  first,  the  dissolution of the
body; second, the extinction of the forces of the vital principle; lastly, the
separation  of the soul.  °      °  As is sensible,  on the one hand, the
metamorphosis of the terrestial part of man, so is doubtful, on the other
hand,  the fate of the vital principle  after death.   If this principle  is
only a faculty united  to the living body, it is certain that at  the destruc-
tion of the body, it returns into the  system  of  forces  of  universal
nature.  If it is  a  being distinct from the body and the soul, it may
perish with the extinction of its forces in the body which it animates ;
but it may also  pass into other human bodies, and vivify them by a
sort of metamorphosis.          When a man dies, his body is resolved
into its elements; his principle of life reunites with that  of the uni-
verse,  and his soul returns to God who gave it,  and who secures  it  an
immortal existence."
   If,  setting  aside the  radical  fault with  which  the  system   of
Barthez is  stamped  from its origin,  we follow  the  development  of the
system into the particular applications which the author has made of it,
we shall easily convince ourselves that no other has furnished, to this
day, as reasonable explanations on most of the phenomena  of the ani-
mal economy, whether  in  a state of health or disease.   No one, for
example, has  explained as naturally the physiological or pathological
sympathies which are manifested in  a multitude of individuals; sym-
pathies which are often very  strange, very surprising, and  always  a
useful study for the  physician.
   But  it  is  especially in  therapeutics, that touchstone  of medical 
542                     REFORM PERIOD.
 doctrines,  where Barthez shows himself superior to all the theorists of
 antiquity and modern times.   Before him, only the two following axioms
 were known in medical practice :  "Diseases are  cured by their contra-
 ries;" " The physician is the minister of nature, and  should study,
 only, to follow her indications and tendencies."
   In virtue of the first of these axioms, the latro-chemists employed
 acidulated drinks to correct the alkaline acretions of our humors, and
 they gave alkaline or spirituous drinks  to  correct the acid accretions.
 The Iatro-mechanics made use of incisives and operatives to unload the
 vessels or their obstructed pores.   In accordance  with  the second axiom,
 the Hippocratists and Animists observed  the crisis,  and extolled the
 expectant method.  For these two axioms, one of which is  false, as we
 have heretofore demonstrated, and the other of which  is susceptible of
 a multitude  of  diverse interpretations,  the physiologist of Montpellier
 substituted a more precise and philosophic language.
  M. Lordat,  the  depository and  skillful interpreter  of the thera-
 peutical doctrine of Barthez, expresses himself as follows on this  sub-
ject ; " We may include in three classes all of known therapeutical meth-
 ods: the first comprises the natural method, the  second the analytical,
 and the third the empirical."
  " I.  The natural methods are those which aim to favor, to accelerate,
 or to regulate the course of diseases which tend toward a favorable solu-
 tion.  The name indicates the end proposed,  viz: to aid  nature, and
 render her operations surer, either by retarding,  hastening,  or changing
 the proportion of the elementary acts which she employs.
  " II.  The analytical  methods are those in which, after having  decom-
 posed a disease into the essential affections of which it is the product, or
 into the  simple  diseases which compose it, the physician attacks directly
 these elements  of disease  by means proportioned to  their relations of
 force and influence.
   " These methods, as  well as those which will be discussed in the fol-
 lowing article, are employed:  First,  when  nature makes no  salutary
 effort; secondly, when she  acts  feebly and tardily, so that her efforts
 are  exhausting;  and lastly, when the natural movements add still more
 to the gravity of the disease.
  " Thus,  to give an  example of the  decomposition  of a  disease,  in
 most catarrhs, particularly in those which return periodically, Barthez
 finds:  first, a superabundance of serous humors;  second, a fluxionary
 movement  which directs them  especially toward  the mucous membranes
 of the nose or the lungs;  third, a modification  of the vital actions  of
 those membranes, which puts  them  in harmony  with the other elemen-
 tary acts,  and leads them to concur to the same end, namely: to the 
THEORIES AND  SYSTEMS.
543
 excretion of redundant  humors, but which may degenerate into exces-
 sive irritation or into atony.
   " By the analytical method, all the  symptoms  are not attacked at
 once,  and when  it  is  used,  equally  energetic  means  must  not be
 employed against  them all.   The great  art is to choose those elements
 which it is the most important to combat, and to determine the order in
 which they are to be attacked.
   " III. We now come  to the empirical methods.   To conceive their
 spirit, we have only to oppose them to those of which we have first spo-
 ken thus far.  In the natural and analytical  methods, we perceive the
 mode of utility of the means employed,  i. e., the relation of the indica-
 tions  to  fulfill,  with  the  affections   and  the  immediate  results
 brought about by these means.   AYe see, for example, that an artificial
 flux, occasioned by  a venesection,  or  by other  attractives, resolves an
 inflammation completely, by destroying the natural  flux, which enters
 into the constitution of that disease.      °  °  The empirical methods
 are those  whose efficacy has  been  established by experience, but whose
 immediate and primitive effects have, in regard to the cure of the  dis-
 ease, no connection that  our minds can appreciate.    Barthez recognises
 three sorts of empirical methods, which he distinguishes as  imitative,
 perturbative, and  specific."0
   The following method  of considering the operation of therapeutics is
 as new as it  is luminous and fruitful.   We  may say that it lays the
 true basis of the philosophy of  this science, and includes the germ of a
 revolution in its ideas and its  language.  The new methods  of treat-
 ment which  Barthez has described are  of too  high importance to be
 admitted by  us before having proved them in the crucible of severe crit-
 icism.   We now proceed, therefore, to examine them in succession,  with
 the most serious attention.

                         NATURAL METHOD.
  This method aims, says one, to favor, accelerate,  or regulate  the pro-
 gress of diseases which have a favorable tendency.   When the physician
 observes that a disease has a favorable tendency, he can do nothing bet-
 ter  than to watch its progress, in order to obviate the untoward changes
 that may ensue, and to prevent  the imprudences that the patient or his
friends  are  liable to commit.  The epithet  natural, given  to  this
method exclusively, seems  to  me inexact, for  it conveys  the idea, that
we follow better in it the indications of nature than in the others, which
the  author, doubtless, does not mean to say, for it would be  erroneous.
M. Lordat, Exposition de la Doctrine Medicale de Barthez.  Paris, 1818. 
544
REFORM  PERIOD.
There exists, in fact, no method  of  treatment which  does not  rest, or
pretend to,  at least, on the  natural  indications  of disease—on the
knowledge of their  symptoms, course  and tendencies. The  particular
method which is now in question, would be much better designated by
the epithet expectant, which many writers give to it.   This last expres-
sion characterises much better the  position  the physician assumes in
this method, and creates no unfavorable prejudices against the other
curative methods which he believes it  proper to employ, where different
indications require it.   The expectant  method is convenient,  first,  when
the affections tend,  spontaneously, to  a happy termination ;  second, in
new affections, not well understood.  It has been recommended, particu-
larly by the Hippocratists and Animists.

                         ANALYTIC  METHOD.
   This method is perfectly defined and  developed by M. Lordat.   " It
consists," says this writer, "in decomposing a disease into the  elemen-
tary affections, of which it is the product—or into the more simple dis-
eases of which it is composed, in order  to attack separately each  of these
elements,  by means proportionate to their relations of force and influence,
We have  recourse to such a method in diseases which have no tendencies
in themselves to a happy termination, and which we cannot cure by an}-
direct specific medication."
   I will add  to these statements, that the analytic method is the most
difficult in application,  because it requires more investigation than all
the rest;  namely, the decomposition  of a disease under treatment.  But,
as by this decomposition our minds seem to get  a more intimate knowl-
edge of the circumstancss of the  disease, and to penetrate farther into
the  secret operations of nature,  it has  happened that several writers
have  called the analytic  method,  exclusively, the  rational—a very
improper  designation,  because it conveys the  idea that  reasoning is
excluded from the other curative  methods, or that there is less reasoning
in them than in this.  These writers measure the exactness of our judg-
ments by  the labor which they have  cost us;  they resemble a mathema-
tician, who supposes that  one reasons more justly in  transcendental
geometry  than in arithmetic.
   The third method which  this author describes, is designated by the
term empirical—but it must be  granted that all that is said  on this
subject is inexact—even its name.   In fact, the word empiric, joined to
the substantive, method, signifies a manner of  treating diseases in con-
formity with experience.  Now, I ask,  is there any method of treatment
which must not be established both on  experience and on reason ?  Let
us recall  that  sentence of  Baglivi,  which we  have heretofore quoted: 
THEORIES AND  SYSTEMS.
545
" Those who suppose that reason and experience  are opposed to each
other, are deceived;"  and we must conclude from this that nothing is
less  sensible than to  attempt to  distinguish one curative method  from
others, either by the term rational or empirical.  M. Lordat himself has
felt the impropriety of this  denomination, for he  adds, a little further
on:  "Bigorously, all the modes of treatment, considered in their imme-
diate effects on  the elementary affections, are  empirical, because the
results of their action could never have been anticipated."   But instead
of rejecting an improper expression, which leads  to a confusion of  ideas,
he endeavors to justify it by a sophism.
  How has it happened  that Barthez, having discovered a curative
method founded upon analysis, or the decomposition  of a disease into
elementary affections, did not conceive of another, founded on synthesis,
that is, on the consideration  of the totality of the morbid  phenomena ?
It was, too,  a natural consequence, to which it would seem  that the most
simple  reflexion  would  conduct  him: but  genius  sometimes  sleeps,
aliquando bonus dormitat Homerus. It suffices by giving a little attention
to what passes in our minds,  when we  have to treat certain diseases, to
be convinced that after having examined, separately,  each symptom, we
re-unite them all together, to form  the  idea of a single  disease.  For
example, let an individual present himself, who has small ulcers on the
prepuce, with a dirty greenish base; also having a small tumor in the
groin, of an oblong form, without any red color, but hard, and slightly
painful:  let  such an individual  recall that  he has  had, fifteen days
before, connection  with a suspected woman.   From  all these circum-
stances united, aud there might  be  many more, I  should form, in my
mind, an idea of a single affection, termed syphilis; and I would  direct
against it a treatment which would  attack all the symptoms together,
and which, on that account, I should  call anti-syphilitic.   I am ignorant
how  a  small quantity of a salt of mercury removes all  the accidents of
syphilis, as  by enchantment, in  a multitude of cases:  but  what does
this  import?  The essential for me and the patient is, that I know that
this  result will take  place, and under what  conditions it will be pro-
duced.  I know no  more in regard to any other therapeutical phenome-
non,  though many authors have given us, for  three thousand years past,
very wise explanations  on most of these phenomena.  It is true that
nearly all their  explanations  have the  inconvenience of differing  from
each other, and of contradicting themselves even.  On this account it is
prudent to suspend  a judgment, until the parties are  put  in agreement,
and hold on to the crude fact,  without interpretations.  To the physicians
who  seek the explanation of  therapeutical  facts, and  to those who pre-
tend to have found them, for a certain number of cases, I will content 
546
REFORM  PERIOD.
 myself by citing the following words of Barthez: " Hume has justly said:
 it does not appear that any corporeal operation, nor any action of the soul
 on its proper faculties or on its ideas, can make us conceive the production
 of causes, or the necessary relation which they sustain to their effects.  In
 the succession of natural phenomena, nothing presents to us the idea of
 causality, or the necessary connection between  cause and effect; but
 when  the succession of one phenomenon after another is  constant, the
 human mind which  observes  it assiduously, and which can frequently
 even foresee it, is led to believe that these phenomena succeed each other
 because they are bound together."0
   Thus, then,  without seeking  to understand why  mercury  removes
 venereal accidents, or why vaccine prevents the variolic infection, why
 bark  cures the intermittent fever, etc., I shall employ these  agents  in
 cases where they are indicated, with as much certainty and reason as I
 would employ blood-letting against an inflammation.   I call the method
 of treatment used in  such cases, the synthetic method.  I shall not say, with
 a crowd of theorists, that such a method is not rational, but will say,  on
 the contrary, that it is very rational, or rather that it is, as the preceding,
 both rational and empirical.   In the first place I maintain it is rational,
 for the best reason that one can give for the use of a remedy is the cer-
 tainty of its success; now, every one will consent, that Medicine possesses
 no remedies whose efficacy is  more constant  than those which I have
 enumerated  above.   In the second place, the method is empirical, because
 it  is founded on experience.   No  one can contest this quality.
   But what is most singular  is, that in giving to this method the epi-
 thet, empirical, there is a design  to tarnish it, and exclude it from the
 class of means acknowledged by science.   Is it possible that the theorists
 pretend to banish from the domains of  art, the most precious, the most
 efficacious, in a word, that which is the true glory of the Art ?   When
 a doctrine leads to such a conclusion, it is done for;  in the eyes of prac-
 titioners, and of all men of good sense,  it is judged and condemned.
   Would to God that medicine possessed a greater number of remedies
 called specific, which are employed  in the mode of treatment which we
 shall hereafter name synthetic.  Then it would not be so often impotent.
 But  well  established specifics are very rare, and on  this account we
 have recourse the more frequently to  the expectant method, or to the
 analytic method, the results  of which  are much  less  certain.   It too
 often  happens, also,  that none  of these  methods succeed.  Then the
practitioner  is reduced to experimentation,—he must attempt  some
exploration;  but in  these cases even,  he does not go by chance, but  is
0 Preliminary Discourse. 
THEORIES AND  SYSTEMS.
547
always guided by certain analogies more or less remote.   His conduct
does not then cease to  be rational, and on this account we denominate
this way of proceeding, the perturbative or explorative method.   This
latter method is doubtless the least satisfactory and the most defective
of all.  The aim of science should be to restrain  its employment more
and more,  and to enlarge, on the other hand, the domain of the other
methods, and, principally, of the one we have called synthetic.
   "Barthez," says one of his biographers, "possessed, in  a very high
degree, all  the  faculties of the mind, especially those which constitute
a  genius  for sciences, viz:  a prodigious  memory, a vast capacity
for facts,  an  inconceivable patience  to consider  all  their  aspects,
the strength of mind necessary to seize all their relations,  and a great
aptitude to form and follow the  connections  of  abstract  ideas.  He
understood whatever he studied.   His  immense reading, and the  know-
ledge which he had of numerous languages, had rendered him familiar
with  the philosophers and wise  men of all  time and  every country.
The works of Barthez should have exercised an influence on the whole
medical world,  but they were scarcely felt beyond the school in  which
he taught.   Besides, many  have confined themselves simply to condemn-
ing them, and sometimes, even, without knowing them."0
   If the influence  of Barthez on the medical world has  not been as
general as  might have been expected, it is owing to some of the follow-
ing circumstances:  First, his  system rests, as we have shown,  on  an
amphibological  base ;  and nothing is less  proper than doubt, to  excite
the imagination, and make  a conquest of proselytes.   Secondly,  he
affects a little too much in his demonstrations, an abstract form,  which
is not within the comprehension of every mind.  Thirdly, and  lastly,
the epoch of his greatest renown  corresponds with that of our revolu-
tionary  troubles,—with  the  terrible  catastrophes  that  overwhelmed
France,  and excited entire Europe,—an epoch  most unfavorable for the
propagation of  a scientific System.
                 ART. VI. ORGANIC  DYNAMISM.

  While Stahl, the severe logician and bold reformer, pushed his analy-
sis to the last limits, and pretended  not only to determine the essential
and  fundamental function of life, but also to go back to the primitive
agent of that function, which  he affirmed  to be nothing else than the
rational  and immaterial  soul,  Frederick  Hoffman,  a less renowned
reasoner and more timid reformer, confined  himself to seeking what is

             °Dezeimeris' Diet. Hist, de Medecine, Art. Barthez. 
548
REFORM PERIOD.
the essential and fundamental  phenomenon  of life, without explain-
ing himself on its motor  nature.   This was, as is  seen, to  simplify
the question, or  lower  the problem  a degree.   But, reduced to these
terms, the problem is still insoluble, as is proven from our philosophic
aphorisms—the certainty of which  is seen in  the fruitless  efforts made
to that end up  to this time.
   The latro-chemists and the Iatro-mechanics had attempted in vain to
explain the  functions of organized bodies by the general laws of matter.
Their theories,  more or less subtile  and brilliant, had captivated only  a
part of the medical public ; a certain number of judicious and attentive
observers had always rejected them.  They recognized that  organized
bodies are endowed with  particular forces  distinct from  the  general
forces of crude matter:  from which they concluded, justly, that physi-
ologists should deduce the laws of living or organic forces from the direct
observation  of vital phenomena, in the same manner as the philosophers
and chemists deduce the laws of the  general or inorganic forces, from
the observation of the phenomena in crude matter.
   The school of Cos, the Hippocratists, the Animists, the Vitalists, had
already proclaimed this truth ; but they had all supposed the existence of
a principle,  distinct from  the organs, and giving an impulsion to the
organism, and directing its acts towards an end, and according to a pre-
conceived plan.   This principle was called by some, nature; by  others,
the soul,  or archeus, or vital principle; but always the same idea
reproduced under different forms.
   A class of modern physiologists have thought that we should consider
the vital forces as inherent to the organs, and study the action of these
forces, in order to discover their laws, without  engaging in the considera-
tion of the organizing principle—just as the philosophers and chemists
regard the general forces of crude matter as inherent to that matter, and
seek to determine the laws which regulate  the action of these  forces.
Setting aside the idea of the primary motor force, I give to this class
of physiologists  the name of organo-dynamists, to indicate  that they
do not separate  the active power or force (dynamis)  from  the organ in
which it resides.
  Frederic Hoffman lopped off from philosophy the ferments and acridities
of the chemists, the considerations of the mechanicians on  the contractile
force  of the heart, the capacities  of the vascular orifices, and the form
of liquid molecules ; also the conjectures of the Animists, touching the
essence of the soul, or the vital principle.  By all  these retrenchments,
his doctrine acquired a  simplicity which is its principal merit.   Besides
it is presented  with  an elegance and clearness that renders its perusal
both easy and agreeable.   Unhappily, the translation which I have been 
THEORIES AND  SYSTEMS.
549
obliged to use is not marked by these same qualities, as may be seen by
the following extracts.
   " I will give," says this author, " as a basis to my reasoning on the
whole theory and practice of medicine, the definition of life.  Now, this
is what I understand by this word: life is the  movement of circula-
tion of the blood, and other humors, produced by the systole and diastole
of the heart and arteries, or, to speak more properly, of  all the vessels,
and all the fibers, maintained by the contact of the blood and the spirits,
and which,  by  means of the secretions  and excretions, preserves the
body  from all corruption, and sustains the functions of every organ.
The circulation is, indeed, a vital  movement, that preserves the blood
from  putrefaction, to which it  is extremely subject.   The  heat, forces,
elasticity, firmness, and tension, depend on it;  and so, also,  the different
inclinations of men, the traits and characteristics  of the mind,  and even
wisdom and folly.
   " To guarantee, then, the human body from  disease, pain and melan-
choly, requires nothing more than  to give to  the blood  the necessary
aid and succor, and especially to prescribe a regimen appropriate to main-
tain the circulation  and the excretions  in  a  normal state.   To treat
disease is nothing else than to cause to return to their natural condition
the blood and liquids which have become deranged.
   The advantages  of the  circulation being so evident, and as nothing
is able to move of itself, is it not natural to seek its cause ? This research
is not from pure curiosity, for he who knows the  causes of the circula-
tion, can see much more easily what can promote or retard it, or what
would be salutary or injurious  to the health—two points, the knowledge
of which constitute, principally, medicine.
   " After having seen that the causes of the circulation are the con-
traction and dilatation of the  solid parts of the body, and that all the
movements of the fluids depend  on these, we  can not avoid going back
to the study of the causes of this contraction  and dilatation.    Now, I
can see none other than the blood ; for it is not only composed of solid
and humid principles, but  also of  a sulphurous  matter, susceptible of
a  very active movement, of air,  and of the ethereal matter,  which is
secreted in part in  the brain, with  an extremely  tenuous lymph, which
serves it as a  vehicle.
   " Let  us  examine,  now, how  the concourse of the blood,  and  the
nervous juice, in the organic parts,  produce in  them the vital movement
of contraction and  dilatation.    All the fibers  of which  the organic
parts are composed  have naturally very much  elasticity, and being
stretched by the influx of the liquors,  not only contract  and relax,
but eveji  return from a point  of too great contraction to their natural 
550
REFORM PERIOD.
 state.   The diastole is, then, always the  cause of the systole, and rice
 versa.   Thus, the  machinery  of the heart  is the  perpetual motion,
 sought unsuccessfully for a long time ; for the blood excites the heart,
 which  gives motion to the  blood, and  by this mechanism the cause
 produces an  effect, from  which  arises the reproduction  of the cause
 itself." °
   This physiological theory is,  as I have said, one  of the  most simple,
 but it must be  seen,  also,  that it  is not  remarkable for strength of
 reason.   I  shall not  attempt to uncover, in  detail, the errors that it
 includes; I will only call the attention of the reader to the final pro-
 position, which is the top stone  of the whole doctrine: the  blood excites
 the heart, which in  its turn gives  motion to the blood; and behold,
 exclaims the  author,  with  artless admiration, the  perpetual motion
 found !   But the reader has easily seen that the explanations of Hoff-
 man  turn in a vicious circle, and that, in short, they explain nothing.
   Let us see, now, some practical consequences  of this  theory:  " Dis-
 eases of every species  being only a union of the natural movementsf
 may then, as all  the vital movements, be  associated in two classes: the
 systole and diastole ; in other words, contraction and dilatation ; for if
 the contraction is too strong, or too long,  it is  called spasm;  if the dila-
 tation err in excess or duration, it is called atony.  Now, what serious
 trouble do both these defects produce in the  circulation !   In one, its
 equality is broken, in the other its free course is greatly interrupted.!
   " Since the movements can err only by augmentation  or diminution,
 we must conclude, from this, that there is only need  of two classes of
 remedies, namely:  one capable  of calming the  convulsive movements,
 called in the schools, sedative and anti-spasmodic remedies;  the  other,
 called confortatives or tonics, which are appropriate to give to the  flabby
 and relaxed parts their natural  tension. "J
   Thus the illustrious Dean  of  the University of Halle leads us, by a
 circuit, to the pathological and therapeutical  dichotomy of the ancient
 Methodists;  a dichotomy which considered diseases and remedies from
 two points of view only, and is entirely insufficient in  the practice of
 the Art,  since it rests on a hypothesis contrary to observation; that is
 to say, that there are  only two sorts  of  modifications  in  the animal
 economy.
   The argument of Hoffman  is weak, and lacks depth ; it is very  super-
ficial, and never carries a principle to its  extreme  censequences,  which
 denotes a mind more observing than logical.   This judgment, which wc
0 Medecine Raisonne'e d'Hoffman, translated by Bruhier.  Paris, 1739.
             t Ibid.                         I Ibid. 
THEORIES AND  SYSTEMS.
551
should form a priori,  in reading the  " Bational  Medicine " of this
author, is confirmed by his  biographers.  Hoffman, they say, enjoyed
during his  life the reputation of the  greatest physician in Europe.
Boerhaave himself seems to have rendered him this testimony on a
memorable occasion.  Having been consulted by the  king of Prussia,
William I., he replied to that sovereign that the best counsel that he
could give him was, to apply to Hoffman.
   A practitioner so eminent should have made theory subordinate  to
practice;  that is to say, estimate the first only in regard to the services
it could render the second, and judge of  the truth of a doctrine by its
accordance with pathological and therapeutical facts.  Such is, indeed,
the rule that F. Hoffman establishes to appreciate  the value  of a med-
ical doctrine.   "The character," he says, "of a  true  and solid  theory
in  Medicine consists  in its  appositeness to the practice, or, in other
words, in its  abliity to explain all the circumstances in the histories of
diseases,  in the  succession in which they have appeared,  and to draw
from them useful consequences in  the practice,  in order to  give rational
and advantageous counsels."
   But none of the theories professed in his time could fill these condi-
tions in a complete and absolute manner, and he could do nothing bet-
ter than to take, in each one of them,  what appeared  to  him to be the
most useful and rational, without  being able to account perfectly for the
motives of these determinations, and justify them by a solid argument,
acting, in that respect, like those whose choice would result from instinct
rather than reason; in a word, he was eclectic, as he also  declares him-
self in his  eulogy of that  ambiguous  doctrine.  Still, he  inclines to
Solidism, which he had freed from the calculations with which the iatro-
mechanics had loaded  it.  "We must  admire," he  says,  "a physician
free from all bondage to all sects or hypotheses, who puts  everything in
the balance, and adopts only what is conformable to reason and experi-
ence,  and rejects, carefully, that which is opinion  only."  Very well!
nothing is better than to adopt for  guides, reason  and experience; but
the difficulty is, never to be  separated from  either.   Now,  up to this
time, none of the medical theories that we have announced, without even
excepting that of Hoffman, has resisted the  test of  this double light.
   Perhaps we shall be more successful in the future ;  possibly we shall
encounter, at last, a physiological doctrine which will account perfectly
for the phenomena of the animal economy, both in a pathological and
normal state.  AAre proceed now to enter into an order of new ideas, of
which antiquity offers us no model, and to which  the theory which we
have just studied serves in some sort  for an introduction.  Up  to this
time, no  one had considered the movements of the organized solids but 
552
REFORM PERIOD.
as the effect of elasticity.  Hoffman himself represents them to us in
no other manner, in the  passages which we lately quoted.   But when
the great Haller had demonstrated, by a series of experiments, that the
contractility of muscular  fibers, and other tissues, is a special property
of living solids, essentially distinct from elasticity—from that moment,
it began to be suspected  that  this property recently discovered,  which
was  named  irritability, might well be  considered as the characteristic
sign of  organization, the source of all the phenomena of life.
  Cullen,  author  of  a very  remarkable  nosological  classification, of
which we have already spoken, attempted the first to establish a medical
doctrine on  the  development  of the phenomena of irritability.   Pos-
sessed of a cool  and  observing mind,  he comprehended, in the onset,
that  if he  would assume this property as the  base  of the functions
of the animal  economy, he must not  push his  researches farther, but
admit it as  a  primitive  fact, whose causes escape  our investigations;
else he might fall into the vicious circle into which Hoffman and so many
others had been drawn, who, after having taken the circulation of the
blood, or any other phenomenon, as a starting point, were obliged after-
ward, to make this primordial phenomenon depend upon some other func-
tion.  Nevertheless, he could not avoid these contradictions ; for when
we have adopted a false  principle, it is impossible for us  to escape the
consequences that flow  naturally from it.  We are thus drawn  from
deduction into deduction, in spite of  ourselves, by a  current stronger
than  our will.
  Cullen may tell us  as much as he pleases,  that  irritability, being a
primitive fact, there is no necessity for seeking  its cause;  nevertheless,
an instant after,  he violates,  himself, this  injunction, in affirming that
irritability is aroused and put in play by an  extremely  subtile  fluid
which the brain  secretes, and which is  distributed everywhere by the
nerves.   If  you, then, demand whence comes this  nervous  fluid, this
physiologist will  respond that it originates in the most subtile portions
of the blood and lymph,  which are carried to the brain by means of the
contraction of the  heart and arteries.  In short, according to this system
the irritability of the heart is sustained by the nervous fluid, which fluid
is itself a consequence of the irritability of the heart.  Beaching this
result, and perceiving that he had fallen into a vicious circle, which
he had hoped  to  avoid,  Cullen ends by avowing, as  all the great physi-
ologists before him had  done, that the phenomena of life forming  a
circle, it was a matter of  no importance where we begin or end in their
study.  It is  not, therefore, to be wondered at, that sometimes the cir-
culation of the blood was  supposed to be the principle on which depended
all the  functions of the animal economy;  and again,  that the nervous 
THEORIES AND SYSTEMS.
553
 system is the most important of all  the organic aparatus—the one that
 first feels the  impression of excitants, and  transmits  it to others ;  in
 a word, that gives impulsion to all the movements of  the  organism.
 " We adopt," he says, at the commencement of his " Treatise on Materia
 Medica," "this maxim:  Remedies do not act upon a dead body, because
 their action depends neither on the laws of matter nor those of motion,
 but on  the  principles  of  life.   These  are,  then, the  principles which
 should be the object of our researches, and they form a  circle  in such a
 way as to leave us in uncertainty as to what  point we should  commence
 or end.  The circulation of the  blood appears to be, nevertheless, the
 principle of  vitality on which all  others depend."   Cullen did not take
 the trouble to  prove in what the  circulation of  the blood appeared to
 him to have  priority over the other principles of life; he contented him-
 self with recalling the opinions  of  Boerhaave on that subject.   How-
 ever, we shall find him, further on,  giving  the priority to  the nervous
 system.
   Let us leave, for the present, this discussion  of  general  principles,
 and pass to the application which the author makes of them to pathology
 and therapeutics.  He commences  by declaring that the autocracy of
 nature, adopted under whatever form, by different sects, has been preju-
 dicial  to the practice of many physicians,  from Hippocrates down to
 Stahl.   He avows himself, also, the adversary of  the empirical method,
 and of all  specific remedies, the number of  which he thinks every one
 ought to diminish as much as possible.   " I would go," he says, " much
 further, and  show how much the autocracy of nature, adopted under
 whatever form by the different sects,  has been prejudicial to the practice
 of all  physicians,  from Hippocrates to  Stahl."   In  his Institutes of
 Medicine he proscribes, rigorously,  the  employment of specifics; how-
 ever, he  is forced to admit them in his treatise on materia medica, and
 makes the following avowal, which is worthy  of  being transcribed:
 " I have testified elsewhere my repugnance  for  specific medicines;
 but we shall, perhaps, be forced to retain many of them still, though we
 should make  efforts to diminish their number as much  as  possible."
   Thus Cullen repelled the expectant method, the  only one that we could
 or  should employ on  many occasions,  and the synthetical method,
 vulgarly named the empirical, the most efficacious of all.  He declares
that the cure of  diseases  should  be  particularly and  nearly uniquely
 founded on the knowledge of their proximate causes, or, in other words,
he rejects all methods of treatment as irrational, except the analytic—a
method often defective, but  which seduces us by an  illusory appearance
of profundity.  Besides, this author makes use of analysis with admir-
able sagacity, whether he attempts to explain the generation of morbid
          35 
554
REFORM PERIOD.
phenomena, or to justify the employment of remedies.  The following
are examples of the application  of  this method to two  of the most
important and difficult cases in pathology:
   I.   " Our doctrine of fevers," says  Cullen, " is  reduced to the fol-
lowing principles : The remote causes are certain sedative influences act-
ing on the nervous system, which, diminishing the energy of the brain,
produce, necessarily, debility in all the functions, and particularly those
of the minute vessels of the surface.   Nevertheless, such is at the same
time the nature of the animal economy, that this debility or atony (the
proximate cause of the fever) becomes an indirect  stimulant to the vas-
cular system.   This stimulant,  aided  by the accession of the chill and of
the spasm which accompanies it, augments the action of the heart and
great arteries, and continues thus until it is able to re-establish the energy
of the brain, and communicate this  energy to the small  vessels, and
re-animate their  action, and especially, by this means,  destroy  their
spasms.  The latter being relieved, the  sweat, and all the other signs of
relaxation of the excretory conduits, take place."
   II.  " All the phenomena of inflammation concur to prove that the
impetuosity of the circulation of the blood is accelerated in the affected
part; but, in this case, the action of the heart is not always augmented;
we may therefore, presume that the acceleration of the circulation of the
blood in  the affected part is  due especially to the  augmented action
of the vessels of  the  affected part  itself.    °              The  spasm
of the  extremities of  the  arteries that  sustain the increased action  of
the blood,  which is pushed into  them,  must  then be regarded as the
proximate cause of inflammation, at least in all cases where the  inflam-
mation  is not produced by the direct action of stimulants, and even
under such circumstances we may suppose  that these  occasion a spasm
in the extremities of the vessels."
   I have no need to remark how much this doctrine agrees with that of
F. Hoffman ; in one, as in the other, only two general causes of diseases
are admitted: spasm, or  the augmentation of tension,  and atony,  or
relaxation.   Only the Scotch pathologist places the point  of departure
of morbid phenomena in the nervous fibrillse, which are always supposed
to receive the first impressions of morbific agents,  and communicate
them at once to the last arterial ramifications, while the German pathol-
ogist considers  the  excessive afflux  of  the  blood  as the first motor of
abnormal movements in the parts, as  the primitive cause  of the alter-
nate tension and relaxation of the fibers.
   Cullen, like Hoffman, was  a circumspect practitioner  and  skillful
observer, rather than a profound dialectician.   He did not hesitate  to
abandon  his theory  whenever it  appeared  to disagree with his 
THEORIES AND  SYSTEMS.
555
 experience.   So, notwithstanding his repugnance for specifics, he readily
 admitted a goodly number into his Materia Medica;  and notwithstand-
 ing his inclination for Solidism, he admits remedies which are supposed
 to act on  the humors, such  as alternants, anti-acids, anti-alkalies, etc.
 We do not bring against him any reproach for this; we praise him, on the
 contrary, for  having stated, in many cases with great  precision, the cura-
 tive indications from the apparent phenomena of the diseases, without
 stopping to  inquire whether they conformed or not  to his theoretical
 explanations.  In continued fevers, for example, he recognizes three^gen-
 eral indications to be fulfilled: First, to moderate the violence of the reac-
 tion ;  second, to remove the causes, and prevent the effects of  debility;
 third, to arrest or correct the  tendency of the  fluids to putrefaction.
 In intermittents, he points out three curative indications : First, during
 the period of intermission, to provide against the return of the parox-
 isms ; second, during the paroxisms to take such steps as would procure
 a perfect  crisis of the  disease ; third, to remove obstacles which might
 might prevent the fulfillment of the first two indications.  If we consult
 the most recent treatises  of  Medicine, we shall  see  that the curative
 indications laid down in them are  almost the same for these same
 classes of diseases; so that in regard to  therapeutics, the general views
 have changed but little since Cullen.   Besides, to carry out these views,
 he employed nearly the same means as ourselves, though his manner of
 studying diseases and the action  of remedies  was very different from
 ours;  which  proves that the greater part  of the rules of practice  are
 founded on pure observation, and  independent  of all theoretical inter-
 pretation,  or  comply equally with a variety of different interpreta-
 tions.   This is a consoling fact that history alone could make evident,
 and which justifies  in our eyes the practice of past ages, notwithstand-
 ing the incessant variations of theories, as it will justify in the eyes of
 our successors, our present practice.  Cullen had the pain to see spring
 up at his side, in his own home, a doctrine which, though hardly hatched,
 became a menacing rival  of his own.
   John Brown, born of obscure parents in a village of Berwick, in Scot-
 land, was remarkable, from his  early youth, for  an extraordinary apti-
 tude for acquiring languages, a decided inclination for scholastic dispute,
 a pedantic tone and manner, and somewhat irregular conduct.   Having
 abandoned theology for medicine, he fixed his  residence  in  Edinburgh,
 where he assiduously followed the lectures of the  professors.  He after-
 wards repeated and explained them to  other students for a  compensa-
 tion.   He also translated into Latin the theses of those who were not
 sufficiently familiar with  the language, and wrote in it on every subject,
for those  who preferred  paying for  such labor, rather than perform it 
556
REFORM  PERIOD.
themselves.   He was particularly entertained and countenanced by Cul-
len, who even took him into his family in the character of preceptor of his
children.   This agreeable relation subsisted during twelve consecutive
years between these two men, whose characters and minds were so differ-
ent.  The protege  was grateful for the countenance of his preceptor,
aided him in his  labors, and unceasingly praised him.  But some tri-
fling  matters  of  mutual discontent  grew  at length  into  coldness,
and changed the old friendship which had united them into an irrecon-
cilable hatred.
   Their  rupture broke  out  about the year 1778, and in a short time
after, Brown published his Elements of Medicine.   The eulogies which
he received on that  occasion, and  the encouragement  of some friends,
determined him to make this work the foundation  of a public course of
lectures,  in which he gave   his  theory every possible development.
Then commenced between the master and the pupil an obstinate conflict,
which agitated the  University of  Edinburgh for  several years ;  a con-
flict but  little interesting to posterity,  on account of the personal vanity
and interests, which are  much more conspicuous there than its scientific
interest.   Brown, whose  pride, inflated by partial success, made him
indifferent to every one—whose impassioned  eloquence overwhelmed
with  satiric strokes whoever  shared not his opinions, was in the end
alienated from the whole Faculty, who endeavored,  henceforth, to inter-
fere with his teaching,   In vain, though sustained by the  zeal of some
enthusiastic  partisans, and  by his natural pride, he essayed to make
head against the storm ;  he was  compelled  to  give way before the con-
tinual increase of his enemies.   In 1786 he put in execution the project
which he had meditated  for some time, of going to exhibit  himself in a
greater theater. He embarked for London, where he died in 1788, aged
fifty-two years, a victim  to his intemperance and medical delusions.
   Brown employed  some of the ideas of his master to develop a doc-
trine much more simple  in appearance, but founded entirely on abstract
considerations; a  doctrine in  which every provision seems to be made
for discussion, but none for practice.   Cullen had said  that the nervous
system receives the first  impression of excitants, and transmits it after-
wards to the other organs endowed  with motion and  vitality.  Brown
explains  thus, the  same thought:  " Life is only sustained by incita-
tion.   It is only the result of the action of incitants on  the incitability
of organs." °   Cullen  regarded the atony of the small vessels as the
proximate cause of fever.  Brown, improving on this hypothesis,  admits,
with hardly any exceptions, only hyposthenic diseases.  These are the
Q Elements of Medicine, Part I, chap. n. 
THEORIES AND  SYSTEMS.
557
only relations that exist between these congenerous doctrines.  On all
other points they differ,  or are  in  opposition.   One  is the work  of a
skillful practitioner, who  departs as little as possible from observation,
or who hastens to  return  when his arguments have carried him away
from  it—loving much better to renounce, for the moment, his theory,
than the testimony of his senses.   The  other  is  the  conception  of a
mind essentially logical, and possessing a strong imagination,  hut of an
observer preoccupied or distracted, who sees objects  only through the
prism of his ideas,
   " AVe do not  know," says Brown, " what  incitability is, nor how  it is
affected by inciting agencies;  but whatever it may be, every being which
begins to live,  is provided with  it to  a certain  degree.  Our  ignorance
on the nature of this faculty, the poverty of ordinary language, and the
novelty of  the  doctrine, obliges  me  to  employ peculiar expressions.  I
will  say, that commonly,  incitability abounds, when  we apply a slight
stimulus; that at other  times  it fails—is crushed or consumed, when
the stimulus is too violent.   Here,  as  elsewhere, we must  hold to the
truth.  Avoid carefully, since they are nearly incomprehensible, the  dan-
gerous question of causes, that  venomous serpent  of philosophy.  Let
no one, then, believe, from what I have just  said  in regard  to the
nature of incitability, that I pretend to decide,  if it is a substance, and
therefore sometimes augments  and again diminishes, or if it is a faculty
inherent in  matter which is  sometimes excited and again languishes ;
nor that I wish to resolve  in any manner a question so abstract.   These
researches have  nearly always done much injury to science."
   Brown employs here the same artifice  as Barthez.  To  evade  the
objections  that might be brought against it, if he should affirm  that
incitability is a substance, or if he affirmed that it is a faculty inherent
only to the organs, he shelters himself behind the doubt.  By this  arti-
fice, he reserves to himself the advantage of being able to consider this
equivocal being, sometimes, as distinct from all  parts of the body,  hav-
ing its own proper existence, and again, as united to  the organs in an
inseparable manner.   But the doubt  of Brown is only the ruse of the
sophist.  In every other part of his work we do not find the least appear-
ance of skepticism;  everywhere  its tone is dogmatic  and  affirmative.
The author considers so  well incitability as a being distinct from the
organism, that  he even goes so far as to attribute to it  the formation of
the organs.   "  The first  cause," he says, " of the formation of  the sol-
ids, and the sole means of their subsequent sustenance is  incitation."
   This is rapid progress  in a little time.   This timorous philosopher,
who  dared  advance  nothing touching  the nature  of  incitability,  who
would banish from his doctrine the venomous serpent of causes, does not 
558
REFORM PERIOD.
 hesitate now to say, that incitability is the first cause of the formation
 of solids,  that it is what creates and what determines the state of the
 simple solids and the humors.   The skepticism which he affected at the
 commencement is but an oratorical artifice, made use of to introduce his
 physiological  principles without  discussion.   In fact,  this principle
 could not  resist a serious examination, for in  the onset,  an impassable
 objection could be made to it, for it might be said: If the first cause  of
 the formation  of the solids is incitation, on what  does  it exercise itself
 anterior to their existence ?   There is no response  possible to such  a
 question,  in Brown's entirely Solidist system.
   Now, as we  have  shown  the weakness  and nothingness of the basis
 on which this  whole system rests, let us follow a little its developement.
 The Scotch physiologist distinguished only two pathological states—one
 consisting  in an excess x){ incitability,  which he names the sthenic dia-
 thesis ;  the other, constituted by a want, more or less notable, of the
 the same  faculty,  which  he  designates as  the  asthenic  diathesis.
 Besides, Brown considers these two state as affecting the entire economy,
 rather than any organ  in particular.   A  local  affection rarely appears
 to him to  be worthy the attention of a practitioner:  he gives but little
 attention except to the general state of the body,  sustaining this method  of
 the study  of disease by a singular calculation.
   "Let the principal  affection,"  he says  "be as  six, and the minor
 one of each  part as three:  the number  of parts  but slightly  affected
 as  one thousand; the  partial affection will be to  the general affection
 of  the  rest of the  body,  in  the  ratio  of six  to  three  thousand."
 He concludes  from this, that in general  disease, each local affection,
 however redoubtable it may be otherwise,  must be considered as a part
 of the first, and therefore the remedies  must be directed, not to the part
 chiefly affected, but to the whole organism.  This strange calculation  is
 not the result of observation—it had no foundation but in his imagina-
 tion, and is in  flagrant contradiction to the results of daily observation.
   After having reduced all diseases to  two genera, and withdrawn from
 pathology  the study of local  lesions, Brown  arrives,  by a subtile argu-
 mentation, to  consider the affections of the sthenic order  as prevailing
 in a very small number of instances, so that the diseases of the asthenic
 type  comprehend  nearly the totality of affections.   According to this
 theory, a physician is rarely ever mistaken if he orders, in  all his cases,
 remedies of an exciting nature.  When I  say always, I exaggerate, for
 he would err three times in a hundred, which is sufficiently accurate in
 medical practice." °
  0 The following explanation is thus given by one of the fervent expounders  of
the Brunonian doctrine:  " However this may  be, as in  general, the diseases in 
THEORIES AND SYSTEMS.
559
   Never since the days of  Thessalus (of charlatan memory) had any
 one  simplified to such  a point the study  and  practice of medicine.
 We may even say that in this respect the Scotch  pathologist left far in
 the rear the  physician of Nero.   To this attraction, well calculated  to
 tempt  students  and practitioners, the  doctrine of Brown joined the
 advantage of being presented in an energetic and captivating style, full
 of imagery, which suffices to explain its  rapid  progress.  But this doc-
 trine, so seductive in its exposition, so easy  in its application, is one of
 the most disastrous that man has been able to imagine, for it  tends to
 propagate the abuse of diffusible stimulants, of which spirituous liquors
 make a part,  an abuse excessively injurious to health in  general, and the
 intellectual faculties in particular—an abuse to which man is too much
 inclined, naturally, and which the sophisms of Brown may have contrib-
 uted to spread in all classes of English society.-
   One is frightened in  reading the long list of diseases against which
 the Scotch pathologist does not hesitate to prescribe  the most energetic
 stimulants.   Here is a  sample of this list, extracted  from the table
 of Linch: plague, confluent  variola,  apoplexy, paralysis, gangrenous
 angina, synocha,  typhus, hydrothorax, phthisis,  dysentery,  etc.;  such
 are the  affections which this bold theorist advises to be treated by
 electricity, opium, ether, spirit  of wine,  and other  stimulants  of  this
 nature, to be  employed in increasing doses, in proportion as the diseases
 progress.  " No other systematic  author,"  says  M. Cotanceau, " has
 less known the  totality and the details of medicine, and one has reason
 to be astonished, on each page of his book, at the imperturbable assur-
 ance with which he accommodates the particular  facts  of pathology to
 the consequences of his theory.  As a nosographer, he is below all;  and
 I know no treatise on popular medicine, that does not include a history
 of diseases very superior  to  his.   Though he continually pleads, as is
 usual, the increased number of facts in favor of his doctrine, we recog-
 nize every moment the absolute  want of observation, and  the most
 superficial judgment.  Neither is there anything  in his work to lead
 you to suppose  that he  has studied authors any more than nature; or
 if he has read any, it was without meditating upon  them, for he never
 quotes  any, scarcely, nor combats  any theory—he believes that he has
 extinguished all by the exposition  of his own.  He advises his students,

 which stimulants are useful, are, from the number of those that require evacua-
 tions, in the proportion of ninety-seven to three.  It is very probable that the
 alexipharmic was universally more useful than the antiphlogistic or evacuant
method."  Nouvelle Doctrine de  Brown, translated  from the Italian by Lafont
Gonzi, introduction, p. 125.  Paris, 1807.
  0 Journal Hebdomadaire de Med., 27 Feb., 1830. 
560
REFORM PERIOD.
nevertheless, to learn what is necessary in anatomy, to open dead bodies.
and  study the illustrious Morgagni.   If he  had done  this  himself he
would have seen himself refuted on every page." °
  Notwithstanding its  defects, the system of Brown made  rapid pro-
gress, principally in Germany and Italy ;  but  it  is  not  difficult to
understand  this success,  when  we  think  that this  system favored,
remarkably, the indolence  of physicians,  in  reducing  the science and
the art to an extreme simplicity,  and which  was not less agreeable to
the  patient,  as it countenanced intemperance.  Joined  to this,  the
attraction  of novelty,  the charms  of  a passionate language  which
indicates conviction, and you  will  comprehend  that nothing more was
needed, or even as much, to obtain numerous and enthusiastic proselytes.
In Italy, Brunonism was soon modified in an important manner, which
changed  entirely its economy.   Basori, while admitting  two orders of
diseases, founded  on the excess  or want of incitation, reversed their
numerical proportions.  According  to him,  the  asthenic  affections  are
rare, and the sthenic much more common.  According to Brown, we must
stimulate  unceasingly,  but with Basori  contra-stimulants were much
more frequently  used,  viz : antiphlogistics  and sedatives.   Moreover,
the  Italian  school did  not  judge  the value  of remedies  from pure
theoretical considerations, but from experiments, undertaken with  the
view to determine their value.
  Brunonism  did not  find  as  easy  access into  France,  which  was
doubtless owing to the anatomical direction of studies in  the school  at
Paris, and  the  influence of the Vitalism of Barthez  in the school at
Montpellier.   Nevertheless, it had commenced a progress there, and had
gained some ground, when  it encountered an  impassioned  and powerful
adversary, who, employing by turns the lights of observation, and the
weapons of dialectics, assaulted it, piece by piece, and gave it  no quarter
until he had laid bare, and fully  exposed, its vices and its dangers.
Brown stopped to consider, at this superficial and common observation,
that in  the greater number of diseases there is a diminution of the
general  forces;  and without  troubling himself about  the condition of
the organs, he hastened to  conclude that it is necessary in nearly every
case to administer tonics and stimulants.  Broussais, penetrating further
in his observations of morbid phenomena, demonstrated that the  general
debility of the sick coincides more frequently with an exaltation of the
sensibility of  organs ;  whence he  concludes, that far  from attacking
these organs with stimulants stronger than usual, it  is necessary,  on
the contrary, to diminish the energy of the habitual  stimulation—that
s Biographie Medicale, art. Brown.  Paris, 1820. 
THEORIES AND  SYSTEMS.
561
is to say, employ debilitants and sedatives.0   If we may reproach the
French pathologist for having maintained the narrow base of Brunonism
in establishing  his  nosological classification  on the want or excess of
irritation, it is no less true that he has rendered an eminent service to
science and humanity, in giving the precept, to proportion the degree of
stimulation to the receptive condition of the organs, rather than to the
general  state  of the  forces, because, in the greatest number of cases,
extreme prostration  is accompanied with great irritability ;  in other
words, a very slight tolerance  for stimulants.
                     ART. VII.  EMPIRICISM.
  From Galen to an epoch very close to ours, the Empirical doctrine was
not professed  openly by any  physician  of reputation.   This doctrine,
which threw  so  much  eclat over the school at Alexandria, had fallen
into such discredit that not a single writer of the middle  ages, or on
the revival of letters, had dared declare himself in its favor.   Its name
became the  synonym of folly and charlatanism, and implied, then, the
absence of all rational notions in the Healing Art.  An  empiric was a
man who ordered remedies without  any appreciation of their therapeu-
tical  effects,  without any discernment of the diseases for which  he
employed  them.
  AVe have developed, heretofore, the causes of the fall  of Empiricism,
and the contempt which was attached  to  its name.  We have demon-
strated that the principal  of these causes  consisted in  the  opposition
that existed between this medical system and the philosophical theories
then prevailing.  All the ancient philosophers, in fact, to whatever sect
they belonged, agreed in saying that  the  study  and exposition of any
science whatever, must  commence at its  principles.   Now, the  word
principle signified, sometimes,  a  general proposition, from which might
be drawn  a certain number of  particular properties, as a source, afonte.
For example, the proposition, two quantities equal  to a  third,  are equal
to each other, is  a principle, or an  axiom of  mathematics whence are
deduced a crowd of theorems.   Sometimes the  same word designated a
simple substance, indivisible, or so considered, and concurring to the
formation of compound  substances;  thus, fire,  air, earth, and  water
were  thought to be the elements or principles of all  bodies.   In philo-
sophy, the word principle designated, sometimes, the first rudiment of an
organized  body, the elementary fiber, or, also, the intrinsic and natural
° See his Examen des Doctrines Medicales.  Paris, 1816 et 1829. 
562
REFORM PERIOD.
force which resides in living beings, and concurs with exterior  circum-
stances to the production of all the phenomena  of their existence.   In
fine, from  etymology,  and  common use, principle  is the  synonym of
commencement.
   Consequently, it would have  been supposed  as  directly opposite to
common sense, if any one had commenced the study of a science by any
thing else  than  its principles ; thus, the study of physics was begun by
the examination of the theory of the elements, of  that of the atoms,
etc.; in a word, by the examination of  all the cosmogenic  theories pos-
sible ;  that is to say, he must engage, from the onset, in  insoluble ques-
tions, the source of interminable discussions.  In physiology, he  must
attend, in the first place, to  the research for the principle  of life, and
the elements of the human body ;  in pathology, he must, before every-
thing else, determine the essence, the proximate cause, otherwise called
the principle of diseases.
   The Empirics came and declared all these researches  chimerical, and
insoluble,  and regarded as mere dreaming all  the  speculations of the
philosophers  and  physicians  in this  respect.   Bold  reformers,  they
attempted to overturn entirely the established dialectic order, and com-
menced the  study of  the  sciences, by  the examination  of  facts,  by
means  of  observation  and  pure experience !  They assumed that rea-
soning  should not surpass the  limit of  sensible  phenomena.   This
was, as is seen, to sap the scientific edifice at its base and overturn all
received ideas.  The minds of men were not ready for a reform so rad-
ical, and they therefore must fail.   The philosophers, menaced by Empi-
ricism  in regard to what they held  most dear, their  theories and  their
systems, in which  was  constituted the major part of their scientific lum-
ber,  repelled  the  new doctrine  as an  enemy of all knowledge;  they
loaded it with their disdain, denied it the title of rational, and banished
it  to the  domain  of stupidity.   Such  is  the  history,  summarily,  of
Empiricism, up to the  seventeenth century of the  Christian era,  when
our Beform Period begins.
   At this epoch, a sect of modern philosophers  started  up, who demol-
ished the Platonico-peripatetic philosophy, and rebuilt the scientific edi-
fice on new foundations.   Taking the sensations as the point of departure
of our knowledge, they demonstrated that the first ideas which are formed
in  our  minds by impressions upon the senses, are particular ideas, relating
to  individual objects ; they proved, at least for the physical sciences, that
general ideas and axioms, instead of being the commencement, the base
of the scientific pyramid, are its termination, its summit.  They assumed
that our understanding can not surpass,  in its conceptions, the limit of
observed facts, without falling into the emptiness of hypothesis.  This 
THEORIES AND  SYSTEMS.
563
 was to run full  sail into Empiricism.   Thus  the  new philosophy was
 called experimental, which signifies  the  same  thing  as  empirical, and
 those who cultivated  it were  named sensualists,  or  better, sensitists,
 because they referred all our ideas  to sensations.   These philosophers
 proceeded, in all their reasonings, from particulars to generals, that is to
 say, by induction.
   On the other hand, the partisans  of an opposite doctrine, those who
 are now called rationalists, or spiritualists, because they admit either
 innate  ideas, or modes of acquisition proper to the mind and innate to
 it, held to the ancient method, that which goes from generals to partic-
 ulars, or deduction;  but they modified their doctrine  in  the sense that
 they agreed that in the order of sensible things, reason  can not pass the
 limits of experience, without mistaking its rights and  its powers.
   A change so profound  in philosophy, and at the same time so favora-
 ble  to  Empiricism,  should have  opened the  eyes of physicians,  and
 caused them to give up their prejudices against this system.  But Med-
 icine is a  science  so abstruse, the truths  of which are so difficult  to
 discern,  and experience  itself is  so deceptive,  that  their prejudices
 resisted for a long time  the progress of light, and they could  not  be
 eradicated but with great pain.   Thus we see the most eminent physi-
 cians of the Beform Period embarrassed  on the subject of Empiricism,
 sometimes branding this  doctrine and its advocates with the  most oppro-
 bious epithets;  again representing them under  much more favorable
 colors,  and  even  advantageously;  sometimes  repelling  their  maxims
 with disdain, again accepting and  eulogising them.  This  subject was,
 for the  writers  of  the  two  last  centuries,  a source of perpetual
 contradictions.
   We  have already quoted passages in  which  Baglivi  condemned,
 entirely, the Empirical sect; a little farther on he changes his  opinion
 and speaks of them in an entirely different manner.   Let us recall only
 the last reflection which he has made on  this subject.   " I  should not
 think thus," he says, "of rational  and learned  Empiricism, the fruit of
 method,  not of accident, directed and sustained by  intelligence,  elevat-
 ing itself to the highest truths by the attention and persevering obser-
 vation of phenomena.   Such an Empiricism has always obtained the
 approbation of enlightened men,  who have endeavored to enlarge it, as
 a mode of acquisition conformed to our nature."   What other species of
 Empiricism could have been had in view by those learned physicians of
 Alexandria, to whom Galen renders so honorable a  testimony,  who dis-
daining  the  titles of Hippocratists,  Herophilians,  Erasistratians, and
every other denomination borrowed from a proper name, called themselves 
564
REFORM  PERIOD.
simply, experimenters.  It was certainly not the Empiricism of market
houses and street corners that such a class of men avowed.
  Zimmerman, that eloquent though  somewhat prolix apologist of the
experimental method, does not show himself more equitable nor more
consequent in regard to the  Empirical sect, of whom  he draws two por-
traits, which no one could ever believe to have  been drawn by the same
hand.  Here is the first: " An empiric in Medicine is one who, without
dreaming ever of the operations of nature, such as signs, causes of dis-
eases, indications, methods,  and  especially discoveries of different ages,
asks, simply, the name of a  disease, and administers drugs at hazard, or
distributes them at random, following his routine  and  recognizing no
art.   The  experience of such an Empiric is always false, because he
practices  his  art without knowing it—he follows the recipes of others
without examining  their causes, their spirit,  and aim."0
  Here, now, is his second portrait, which resembles  but very little the
preceding one :   " Serapion and  his successors opposed the research for
hidden causes and only paused to consider those that strike the senses.
In this they were  right;  it was  reserved to anatomy to uncover these
secret causes,  but  anatomy was  still  in  its  infancy in the  times of
Serapion: moreover, causes at that time were only sought in philosophy,
so that, necessarily, they must fall from one  error into another, in the
midst of so much obscurity.  We see, therefore, that  the authors of the
Empirical  sect had  a design praiseworthy only in itself.           °
They accepted only what is  appreciable by the senses, and consequently,
they thought that the senses and memory were  alone necessary for the
practice of Medicine.  If they admitted some reasoning, it was  so  sim-
ple that it was  not possible to be misled by it, and  so natural that it
seemed to be  self-evident.   They did not  proscribe  reasoning  then,
except when it was based  on false principles, and  when nature was
judged by false reasoning.  Philinus  and  Serapion, therefore, are not
to be blamed if their sectators  or successors  have  turned away from
their manner of thinking, and if they have condemned  erudition, anat-
omy, physiology, and philosophy which is the soul  of Medicine.  The
founders of Empiricism sought true experience and their  stupid suc-
cessors content  themselves  with that which is false."
   It would be easy for me to establish, by a crowd of  other  examples
that the same contradictions in regard to the Empirics and Empiricism
are met with among the greater part of the most celebrated practitioners
and most  renowned  nosologists of the Beform Period.  To do this I
0 Traite de PExperience, translation of Lefebre, Montpellier.  1824. 
THEORIES AND  SYSTEMS.
565
would  only have to open  the writings of Torti, Sydenham, Stoll, Mor-
gagni, Sauvages, Cullen, Borsieri, Barthez, Ph. Pinel. I. P. Frank, and
others ; in all I could show the maxims of the  experimental philosophy
adopted, proclaimed, ancLthe name of Empiric repulsed and falsified.
   The  tendency  of physicians  toward Empiricism,  became more and
more  marked toward  the  end  of the eighteenth century.  It did not
escape the historian Sprengel, who signalized  it as having had birth  in
Great Britain, and assigned for it, as principal causes, on one hand the
propagation of the philosophic  principles of Bacon, Locke and Hume;
on the other, the discovery of several new  medicaments, the employment
of which contradicted all  the systems adopted  till to that  time, and
whose mode of operation could not be reconciled with any of the reign-
ing  theories.0   He  shows,  afterward,  the  same  tendency  toward
Empiricism in other countries; first France, then Germany,  and extend-
ing finally into  all parts  of Europe.   " In general," he says, "all the
physicians who wrote during the last ten  years of the eighteenth cen-
tury  seemed to be in favor of Empiricism.  They inclined not toward
a  blind  routine,  but endeavored  unceasingly to have  their opinions
accord  with  experience,   and never  outstripped  in  their  reasoning
the limits assigned by the observation of  nature.   No one invented any
new theories on the nature of the vital force, or the essence of diseases •
and if a few did appear, they were received with indifference.0   Never-
theless,  the return  toward  Empiricism  was  only partial, as I  have
already remarked.   The greater part of the writers in Medicine con-
trived to mingle with their maxims of Empirical philosophy, researches
either on the vital principle, or  the  fundamental  and primitive quality
of living beings; on  the  proximate cause of diseases, their nature or
their essence—in a word,  on a crowd of subjects that are inappreciable
to the senses.  AA^hile they criticise the explanations of their predeces-
sors touching these abstruse matters, they do not  hesitate to emit their
own opinions on the same matters, without  appearing to suspect that
they  only substitute a new hypothesis for older ones.
   Thus Borsieri  de  Kanifeld,  professor of Practical  Medicine in the
 University of Pavia from  1770 to 1785, a learned writer and excellent
 observer, wishing to give an idea of inflammation, commences by describ-
 ing it in these terms:  " When one realizes in a portion of the body an
 unnatural heat, and the part is red, tense, painful, with unpleasant pul-
 sations, there  is  said to  exist  an  inflammation  or phlogosis, because
 something similar to the effects of a burn is felt.  If all these accidents,

   °Hist. Med., section vi, chap, n,  T. V et VI.
   f Ibid.  Sec. xxn, chap, i, T. VI. 
566
REFORM PERIOD.
 or the most of them, concur together, they  constitute a  disease named
 by us inflammation, and by  the  Greeks phlogosis,—a  disease whose
 proximate cause is extremely obscure, not to say occult, as is shown by
 the varieties and difference in the  opinions emitted on this subject."0
   The above description is clear to every mind.   There  is  no student
 who, after having read and engraved  it on his memory, if he possess
 some skill in clinical observation, may not be in a state to discern an
 external  inflammation from any other  disease in a certain  phase of  its
 existence; for it is evident that phlogosis, as well as every other species
 of disease of the organism, does not preserve the same morbid charac-
 ters in all the phases of its existence.   The  botanist does not  describe
 otherwise a plant, or the chemist a salt or a mineral.   Why then physi-
 cians ?   W7hen they wish to explain a disease, do they not content them-
 selves,  in like manner, with depicting the  symptoms, the  march, the
 termination—in a word, all the sensible and known phenomena as  they
 present themselves at various stages ?   Why do they continually  pass
 in their  speculations  beyond  the  limits of pure  observation ?  It is
 because they are not sufficiently penetrated by this axiom which reigns
 in all the philosophy of the physical sciences :  Reason was only given
 to us to guide  experience; and  our minds, in trying to  pass  the  lim-
 its of sensations, mistake their rights as well as their power.
   Borsieri, after having thus described  inflammation, and stated  that
 the proximate cause of disease is nearly impenetrable, shows over twenty
different, and sometimes contradictory theories emitted by  the most emi-
nent authors, from Hippocrates to Boerhaave and  Haller, on  the proxi-
 mate cause  of  inflammation.   It would  seem,  as  a natural conse-
quence of this exposition, that Borsieri would avoid all new theories on the
same subject.   Such is, nevertheless, not the conclusion  to which he
comes; he has not failed to propose, in his turn, an explanation more or
less different from the rest, not  only on phlogosis, but on  each of its
symptoms.  He falls into a similar and more striking inconsistency still,
on the subject  of fevers;  for having at first affirmed, in  proper terms,
that it is impossible to determine the proximate cause of  this affection,
he has not hesitated to form, a little farther on, conjectures on the cause
and mode of generation of each of the febrile phenomena.   Borsieri
was, nevertheless, neither a transcendentalist nor an enthusiast;  he was,
on the contrary, a wise  practitioner and very circumspect  theorist,  who
adopted no exclusive system, but who would choose from each of the
  0Institutions Medicinse, De Inflammatione, Lipsise,  1826, t. I., p. 2.  Com-
pare this work with that of J. Rasori, Theorie de la Phlogose, translated from
the Italian by S. Pirondi, Paris, 1839. 
THEORIES AND  SYSTEMS.                  567
prevailing opinions of his time  that which appeared to him  most con-
formed to reason and experience;  in a word, he  was eclectic.   We see
by this example, and by a thousand others which have been, or might
be cited, that there is scarcely a writer in Medicine who did not surpass,
in his speculations, the limits  of  sensible  phenomena; that  is  to  say
who did not fall into the vagueness of hypothesis; but in no department
has the tendency of physicians  for arbitrary interpretations been more
striking and more injurious than in therapeutics.  See in what terms a
cotemporaneous author has  depicted the ridiculousness of  this mania:
" Intermittent  fevers," he  says,  " are cured  with cinchona.  Several
hundred volumes have been written to explain the  modus  operandi of
this marvellous remedy.  This whole  enormous  aggregation  of  science
is not worth the following line, and does not  go beyond it: for inter-
mittent fever, give cinchona.  Opium  procures sleep.   A multitude of
very learned writers have explained  the action  of this precious drug.
Moliere,  in this respect, knew as  much  as  can know to-day those who
have studied all these beautiful works:  Opium facit  dormire, quia in
eo est virtus dormitiva.   Let no one consider this a detraction of Medi-
cine, for it is the art of curing, and not the  art of-explaining cures.  A
practical notion, well established,  possesses no  less dignity than a scien-
tific principle."0
  Nevertheless, toward the end  of the last  century some men made
praiseworthy efforts to banish from practical Medicine every species of
hypothesis.   Of this  number were AVerlhof, first physician  to the  king
of England, at the court of Hanover, and Lieutaud, first  physician to
Louis XV.   The  former has left a great many writings, which are
remarkable for a spirit of pure observation, judicious principles, and an
elegant and pure style.  He professes, on the  modification  of remedies,
on the proximate cause of  fever and  its various symptoms, a  prudent
skepticism,  and recounts, in this  respect,  an  anecdote which we have
already given.f
   The second has already been mentioned advantageously in this History,
for his Historia Anatomico-Medica, one of the  good  works which the
close of the last century produced, and for his Precis de Medecine Pra-
tique, an interesting composition in several respects, but above all, by
the care  which the author has taken  to  avoid  all hypotheses, and sub-
tile and arbitrary  interpretations.   His  care is so great in this respect,
  0 Vues Pratiques sur les Ameliorations Agricoles,  °  °  par M. Dezeimeris,
inserees dans le Journal d'Agriculture Pratique, numero de juin, 1815, tirage k
part, 1st Memoire, p. 3.
  f See chap, v, of this Period. 
568
REFORM PERIOD.
that not only he abstains from all conjecture on the proximate  cause of
diseases, but also, he avoids giving  any definition, any general descrip-
tion,  either  of fever  or inflammation.  This work was written, evi-
dently, under the influence and according to the spirit of the philosophy
of Condillac, but the absence  of definitions and  generalities does not
prevent the existence of a little confusion and obscurity in the totality
of the subjects which he presents ;  so that the judgment which  Cullen
gives of it, though severe and even partially inexact, is not without some
foundation.  " It is," he says, " a collection of facts  gathered without
permitting himself to reason on their causes.  Confusion and indecision
are the results of its arrangement.   This work, moreover, is not exempt
from the reasonings that the author pretends to avoid."0
   Cullen is mistaken when  he  accuses Lieutaud of being willing to
avoid every kind of reasoning.   Lieutaud has  pretended only to avoid
the discussions which turn upon  objects impenetrable to the senses, such
as the proximate cause of diseases,  the primordial properties of bodies,
the vital principle, etc.;  but  otherwise, far from  abstaining  from  rea-
soning, he reasons very much, and  even too  much; whence it results
that his book is rather critical than didactic.  In  this  he has, perhaps,
made a mistake, and missed the end which he wished to  attain, as may
be judged by the following extract from his work, f
   Thus, parting from the seventeenth century, that is  to say,  from the
commencement of the  philosophic  reform,  we  see  Empiricism making
progress in  Medicine,  though always hidden  under   various  names.

  0 Cullen, Elements of Medicine.
  | Horror quern excipit febris; dolor alterutrius  lateris, et plurimum tamen
einistri, sterni, dorsi, etc.;  sputa cruenta, et spirandi difficultas sunt notissima
peripneumoniae, signa.  Sedulo animadvertendum quod in quibusdam peripneu-
monia decumbentibus nulla erumpant sputa cruenta, licet pulmones vera pblo-
gosi corripiantur; cur fit ut plures  clinici, duce Sydenham, hunc affectum pro
peripneumonia notha habeant; num recte e mox narrandis patebit.  Illud etiam
notandum incumbit quod pulmonum phlogosis haud semper tussi, dolore et spi-
randi difficultate stipetur; uti grassante constitutione epidemica 1751, haudrarb
inter rimanda cadavera corum quorum  cura mihi demandata fuerat, observavi.
Peripneumoniam non numguam praeeunt  ventris  tormina,  defluxio anginosa,
sliusve morbus inflammatorius: nee infida in quibusdam epidemiis  censentur
haec praBnuntia, in alia tempestate plane silentia.  De erysipelate pulmonum post
Hippocratum et Galenum,  mentionem subjecerunt Lomnius  et Boerhaavius;
sed  meris  conjecturis suffulta  est haec   opino; cum erysipelas solam cutem
respicere videatur: cujus retrogressu, materia morbosa in quod vis viscos per
metastasim ingruente, alter emergit affectus, ob partis fabricam ab erysipelatis
indole profecto dispar : Quod pace tantorum virorum per transennam annotasse
sufficiat.  (Synopsis universcepraxeos medicce, lib. I, sect. 2, Inflammatio pectoris, t. I.
p. 168.  Amstelodami, 1725) 
THEORIES  AND SYSTEMS.
569
Some call it, with Sydenham, the natural method, others the method of
observation,  experimental,  eclectic,  etc..   Some even  dare  call  it
by its true name, yet adding some  corrective, to take from the word the
idea of  contempt which physicians commonly attach to it.   Thus it is
called by some, for this end, rational Empiricism, the learned Empiricism
of Baglivi,  Sydenham, Stoll, Aran  Swieten,  and Ph. Pinel,  when  they
wished  to  have it  understood that in  many circumstances  these  great
physicians made an abnegation of their theories, in order to  follow expe-
rience only.   If we cast our eyes  over the  history of Medicine during
the first half of the nineteenth century, we shall see Empiricism gaining
more and more  ground, notwithstanding  the propagation  of Brunonism
and  other new systems, among which the system  of  irritation holds a
proper rank.   We shall see, for example,  medical statistics invoked by
the  coryphei of  all  the sects, as the supreme criterion of  therapeutic
methods.   Now statistics is pure Empiricism ;  it  is the negation of all
preconceived theory.   The mathematicians have never invoked this mode
of demonstration for their theorems, because by  reasoning they  make
them evident;  but in  therapeutics, where the evidence of  reason  does
not exist, one is obliged to have recourse to  statistics  to judge what is
the best mode of treatment applicable to such or such a morbid species.
The most determined adversaries of the  employment of calculation  in
Medicine, agree however, that it  is  legitimate  and even necessary, in
order to obtain a judgment on therapeutical methods ; they insist, solely,
on the  numerous sources of error, and   the  extreme difficulty  of its
application.0
  Yes,  Empiricism, under whatever aspect it is viewed,  is excessively
difficult, we may say  even the most difficult of all  the systems  of Medi-
cine, in its rational application, which  will be made clear by the devel-
opment  which we shall  presently give  it.   Whence it results  that far
from favoring idleness and ignorance, as some have believed, and others
have feigned to believe, it requires, on the contrary, the most  extended
acquirements and most constant attention.  It is, for the most part, to
avoid the difficulties which  it presents, that  a crowd  of  other systems
  0 F. J. Double who exhibits so well these difficulties and causes of error, does
not deny that statistics is definitively the best and even the sole means to judge
the relative value of different modes of treatment used against 6uch and such dis-
eases.  See his work Traite" de  Med.  Pratique, of J. P.  Frank,  translated into
French  by Gonderau.  Paris, 1812.—In fine, I would  formulate aphoristically
my opinion on  this subject.  I would not say  with a cotemporaneous author:
Non solum numerandae, sed etiam perpcndendoe sunt observations ;  but I would
say: Primum perpendendoe sunt observationes, deinde perpendendse et iterilm
perpendendae: demiun numerandae.
          36 
570
REFORM  PERIOD.
have been imagined, and by turn abandoned, then resumed again with
certain modifications, to  be abandoned anew as false  and insufficient.
The Empirical doctrine, alone, has never varied in its fundamental dog-
mas :  it has marked, from  its origin, the true limits to which  the mind
can attain:  it has traced the route which it must follow in the physical
sciences.   It is the most comprehensive of all medical doctrines, for it
embraces every case in the  practice ;  it makes use of notions suggested
by anatomy, physiology,  chemistry, physics, the various departments of
pathology, etc., more largely and more surely than any other doctrine—
as any one may be convinced by  reading the following chapter.
                        CHAP TEE  XI.

EMPIRI - METHODISM :  OR THE ALLIANCE OF EMPIRICISM WITH THE
                      PHILOSOPHIC METHOD.

   There is  an axiom which reigns over the philosophy of causalities,
which  presides over all  the determinations of the human will, whether
with or without our apprehension, to which we give our assent willingly
or not, as to a mathematical truth.   It is the following:   The same
cause, acting under identical circumstances, produces, always, the same
effect.   If, in order to make an application of this axiom to Medicine.
we attempt to translate it into therapeutic language, it is presented  in
the following proposition,  which I have before announced :  A  treatment
which has procured the cure of any disease whatever, will cure, also, all
diseases identical, or rather homogeneous to the first.
   I have demonstrated that the physicians of  primitive times had  no
other therapeutic rule, and that they followed it either from instinct, or
were led to adopt it by their reason;   and I have cited, among other
proofs, the established  custom among several  nations of antiquity, to
expose the sick in front of their houses, so as to attract the attention of
those who passed by, that they might suggest the remedies which they
had  seen  successfully employed in  similar cases.   I  have  also shown
that the application of  this rule, the only one in therapeutics which has
an absolute generality, offers extreme difficulties, which  has led to the
creation, successively, of the several branches of  medical science, their
numerous ramifications and infinite details.0  I now resume the subject
3 See remarks at close of Mystic Period. 
EMPIRI - METHODISM.
571
and deduce from it, by a series of evident propositions, all the develope-
ments of the Empirical doctrine.
   I pray the reader,  in the onset, to observe carefully that the applica-
tion of our fundamental axiom in therapeutic rests on  three  rigorous
conditions,  namely:   homogeneousness of diseases,  identity of curative
means, and the knowledge of a treatment applicable to each morbid
species.   Now  to  attain,  if not absolutely, which is  impossible, but
proximately, these three conditions, all the resources  of science are indis-
pensable, as we  now proceed to show.

                 FIRST CONDITION—HOMOGENEOUSNESS OP DISEASES.
   No  practitioner  has ever encountered two morbid states absolutely
identical, and nature, perhaps,  does never produce  such.   It  is neces-
sary,  then, for  the practitioner to  content himself, from this circum-
stance, with a more or less accurate approximation.  But  at what degree
of  approximation dare the physician rest, or, in other  terms, by what
signs shall  he recognise that there is enough resemblance between two
diseases, one of which is before him and the other has been previously
observed, in order to  treat  the  case  in hand with  the  same  remedies
employed in the former.   In the beginning, they were contented with a
very superficial  similitude ; it sufficed that a patient present one or two
symptoms similar to  those of another,  to whom  the  same treatment had
been applied.   It is,  thus, under this gross resemblance, that ordinary
men dare, every day,  advise the use of a crowd of remedies, and criticise
very often, even, those that a physician has ordered.  But  men habitu-
ated to the observation of diseases, cannot hesitate to see  how much this
manner of judging is  false and dangerous; consequently they endeavor
to establish with more precision the distinctive characteristics of the mor-
bid species.
  At first it was thought, and not without reason, that two  diseases
approach so much nearer identity as they present the greatest  number
of similar phenomena.  Consequently,  those only were considered homo-
geneous which offered a multitude of  analogous symptoms ; while, on
the other hand, it required but few differences to consider two affections
as heterogeneous.   This  method, very simple and sure  in appearance,
did not, however, produce excellent  results; the physicians of Cnidus
had adopted it, and were led as  Hippocrates said reproachfully, to mul-
tiply the morbid species beyond  measure.   Their pathology was  con-
fused and their therapeutics uncertain.
  It will be understood that it does not suffice to enumerate the symp-
toms of disease to obtain an  exact tableau ; but that it is necessary to
make a choice in order to  bring into  the  first sketch, in imitation of 
572
REFORM  PERIOD.
painters, the most characteristic  traits,  that is  to  say,  the  greatest
phenomena; secondly,  to lay down  the less important symptoms and
keep back,  or neglect even entirely, the  slight  ones, or  those  without
apparent value;  such was the method of which Hippocrates offers the
first model  in his Epidemic Histories.
   This  manner  of describing diseases  was  preferable to that of the
Cnideans ;  it prevailed universally.   From that time all the difficulty,
or at least  the greatest difficulty in nosography consisted in the choice  of
symptoms,  in the classification of morbid phenomena.  Which among
these  phenomena  are  those  that  should be considered  in the  first,
second,  and third rank, and  so on  for the  rest ?  AA'hich those that
should be neglected ?   Such was the great  problem that the Hippocratic
method proposed  for solution : up to that time  science  had marched
slowly,  noiselessly, and with  centenary steps.  But  at this  epoch the
philosophers having taken possession of the mind, disputed, boisterously,
for the sceptre of the intellectual  empire;  they divided themselves into
rival  sects, each  of which  pretended to explain the enigma of the
universe, and pronounced definitely  on the true method of interpreting
the phenomena of nature.  Physicians, also, after the example of phi-
losophers in  order to  give the explanation  of the phenomena of the
animal  economy—went back to  the sources of life,  to determine the
proximate  cause, the principle of  the phenomena of morbid  affections,
and deduce from them an invariable method of treatment.   They also
wished to make  science complete.
   Nevertheless,  observation  does  reveal  to us neither the primitive
causes nor principles of phenomena;  it shows everywhere a circular con-
nection  of  phenomena, which are all, by turns, both  effects and causes ;
but it nowhere exhibits the first link.  Nature, as had  said Baglivi, and
before him  Hippocrates, and  many others—nature is a circle, of which
the eye of  man can discover neither the beginning nor the end.   There-
fore, the research for  this beginning or the end, is  a vain and super-
fluous undertaking, in  which it is unreasonable to  persist.   This is the
place  to say with  Meibomius and AVerlhof: " Seek not to know what the
Supreme Master has been willing to conceal;  it is but learned ignorance."
But most of the philosophers and physicians did not possess this wise
resignation.  The physicians, for example, not being able to determine
by direct observation, the proximate  cause or the initial phenomenon  of
diseases, abandoned, like the philosophers, the route of pure  experience,
and flattered  themselves with being able to resolve the great problem
which they pursued by the aid of speculative considerations.  They were
ignorant at that time,  that in regard to  physics the human intelligence 
EMPIRI - METHODISM.
573
can never surpass the limited horizon of  the  senses ;  that beyond this
horizon, there exists nothing but fiction and hypothesis.
   It required no less than two thousand years for the  human mind to
be convinced of this truth, and to consent to restrain itself within the
limits which the Sovereign Creator  has  imposed to it;  limits  which
humilitate its pride, and put a rein on its ambition for knowledge.  It
is only after having essayed  by all  imaginable hypotheses, and after
rambling in every possible direction,  that  philosophers and physicians
have returned to their true sphere, that is to  say, that they have recog-
nized that the intelligence should not and is not able to pass the sensations,
in things of the material order. But young, inexperienced, and enthusi-
astic imaginations, are always ready  to clear  this circle, which  seems to
them too narrow, in order to wander in the fields of infinity, as if it was
not enough to leave to this faculty (imagination), which  we call folle du
logis,  the sovereign reign  over arts of amusement and  the caprices of
fashion, but that it should not be permitted to usurp the place of good
sense  and experience, in the search of means proper to  solace pain and
preserve health.  What errors has it not accredited in pathology !   Not
to recall the principal  and most recent ones,  have we not had  diseases
of the archeus, or the soul, or vital principal; those proceeding from an
excess of effervessence in  the  blood,  or an acid  or alkaline acridness;
those consisting in an obstruction of the capillary vessels, or a deformity
of the liquid molecules '?   Has it not been pretended that all the morbid
species, however numerous or various  they appear, may be reduced to an
excess  or want  of  incitation ?   Is it not possible, lastly, that ulterior
discoveries in the composition of the liquids or properties of the solids,
will yet give rise to other hypotheses on the essence of diseases ?
  But while a crowd of theorists gave themselves up to the pursuit of that
chimera called,  sometimes,  proximate cause,  sometimes, essence,  again,
principle of morbid phenomena, and did nothing more, really, than pass
from one fiction to  another, practitioners, guided  by simple good sense,
and grounded inexperience, limited themselves to describe the apparent
symptoms, with the evident causes of each morbid affection, and  estab-
lished  on these sensible  characteristics the distinction  of species  and
nosologic genera.   Such was the course followed,  not without deviation,
by the most celebrated nosographers of antiquity and modern  times ;  a
course which Torti, Werlhof, and Lieutaud  endeavored to re-establish in
all  its purity, following in this the track of  Philinus, Serapion,  and
other famous Empirics of the school of Alexandria.  These,  as should be
remembered, did not  make the  homogeneousness of diseases consist in
the ideal  conformity  of unique phenomena,  placed  beyond the reach 
574
REFORM  PERIOD.
of the senses,  and called  proximate cause, essense, intimate nature.
primitive phenomena,  etc., but on an evident conformity,  that is to say,
in the uniform concurrence of the greatest number possible of  sensible
circumstances, anterior circumstances, concomitant symptoms, and con-
secutive phenomena.   They demanded that nothing of all this should be
neglected—nothing which had been or might become  an object  of obser-
vation—because for them the totality of all these things constituted the
true essence of diseases.
   However, it is impossible, as we have  already said, in the examina-
tion  or the description of a  morbid state, that an account be made of
all the circumstances, for in that case we  should fall into the confusion
with which  Hippocrates  reproached the Cnidians.   Nosography would
then no longer offer a methodic  succession of more or less  faithful and
recognizable pictures, but an irregular assemblage of colors and traits,
drawn  at  hazard on the canvas, leaving no more trace in the  memory
than the clouds which traverse the foggy sky of our climate, during the
variable weather of spring and autumn.   The homoeopathic pathology is
an incomparable model of this kind ; the  obscurity, chaos and extrava-
gance of Paracelsus have been  surpassed  very far by Samuel  Hahne-
mann, which, however, has  not prevented  the inventor of the spiritual-
ized powder of gold horn finding, in our age, advocates and enthusiasts,
just  as  the fabricator  of potable gold found such in his.  But let us
leave, now, these  souvenirs, which are already ancient history for our
forgetful epoch, and see after what  rules we may judge the importance
and  gravity of a morbid accident, setting aside all  ideas  of the vital
principle and primitive or exclusively essential phenomena.
   The ancient Empirics estimated the value  of a symptom, or patho-
logical  circumstance, according to various considerations.  Sometimes
they had regard to the character and intensity of the symptom;  thus,
a  permanent delirium appeared to  them   more  grave than a passing
one ; a pain which nothing could assuage,  seemed to them more unprom-
ising than one which could be easily calmed by some sedative.   Some-
times they had regard to the importance  of the organs whose functions
were deranged ;  thus, difficult respiration  appeared to merit more  atten-
tion than  a difficulty in the movement of the arm  ; a  rheumatism of
the  head  more than  one  of the foot, things being otherwise  equal.
Sometimes they took  into consideration the occasional or determining
cause of a disease, when the  specific influence of this cause had been
an object  of observation  ; if, for example, they had  to treat  a person
bitten by a serpent, they believed it very necessary to ascertain whether
the reptile was of the venomous species, or not, because experience had
demonstrated that  this circumstance affected very greatly a wound of 
EMPIRI-METHODISM.
575
this kind.   In short, they were persuaded that the value of a symptom
could  vary from one stage to another,  as  the result of the  increase of
knowledge, and change of views.   The history of medicine offers several
very remarkable examples  of this kind of  variation, of which I shall
cite only  the  following:   before  the discovery  of cinchona,  and  even
for  a  long time afterward, periodicity had attracted  the attention of
observers  in fevers  only, because in these it is extremely well marked.
Nevertheless, very little account  was made  of it,  even  in them, because
this circumstance was not the source of any special curative  indication.
Thus,  Pinel has not separated, in his classification, intermittent from
continued  fevers, because  he regarded  periodicity as a secondary symp-
tom, which does not change  the nature of the disease!   AVhere is, to
day, the pathologist who  does not arrange,  in a separate classification,
periodic affections.0
   The following were, at the end of our Beform Period,  the principal
■characters which constituted the nature of  a disease, and  according to
which  one morbid  species  was  distinguished from  another,  by taking
account only of the phenomena  appreciable by the senses:  first,  the
anterior circumstances, which  comprise the predisposition,  or  diathesis,
and the determining or occasional causes, such as contagion, miasmatic
  0 Pinel would not have committed this philosophic heresy, if he had been imbued
with the spirit of our fifth aphorism, an extract from the doctrine of Locke and
Condillac: "Sensible objects being known to us only by the impressions they
make upon our senses, our minds  can  perceive  nothing in these objects beyond
the sensations tliey excite in us.   Tlius, when any one asks what is the nature
or essence of a body, we can  only reply by announcing its  sensible  qualities."
According to this axiom, if W3 are asked what  is  the nature or essence of a
disease, we can only reply by announcing its  known symptoms.  How, then
could it be said that a symptom as important as periodicity, a symptom which is
the source of  an  entirely  special kind of medication, does not  belong  to the
nature of the disease ?
  Thus, also, a few years ago, but little attention was paid to the quality of the
blood, in diseases, or at least no  one drew from  it a  curative indication ; while
now, these qualities, being better studied, furnish precious signs for the diagnosis
of several very remarkable pathological states—states that are designated, in the
most recent  writings, by the  words hyparaemia, polyoemia, hyphemia, anaemia,
hydramiia, which were formerly designated by the terms sanguineous plethora,
chlorosis, poverty of the blood, etc.  (See Essai d' IlCmatologie Pathologique, of M.
Professor Andral, and the Traite" de Nosographie Medicale, of M. Professor Bouillaud,
in the chapter entitled, Appendice aux deux Premieres Classes des Maladies.)   Among
learned men of France, and other countries, whose researches have contributed
greatly to clear up  the pathology and physiology of the blood,  we must mention
Prevost and  Dumas,  Berzelius,  Denis, Scudamore, Schultz, Nasse,  Huenefeld,
Lecauu, Gavarret and Delafond collaborators with Andral, Donne, Becquerel, and
Rodier. 
576
REFORM PERIOD.
or poisonous infection, etc.; second, the anatomical  seat of the disease,
or the designation  of the  organ or the tissue principally affected, and
sometimes, but rarely, the indication of a vitiated state of the humors ;
third, the mode and degree of alteration of these  organs  in the living;
fourth, the idiopathic and sympathetic functional  troubles, their regular
or irregular, continued or intermittent course ;  fifth, lastly, the anatomical
lesions, found in those who had succumbed to diseases of the same species.
   We see by  this summary  enumeration  of  circumstances, what this
Empiri-Methodic, or Empirico-Bational doctrine takes into consideration
in the classification of diseases ; we see, I say, that far from  neglecting,
as has been pretended, the light of  anatomy, physiology, pathological
anatomy, and other necessary  sciences  furnished to  pathology, it makes,
on the contrary, a continual and  very appropriate  use  of these lights,
only taking from  anatomy the  researches on  the elementary fiber, and
primitive elements  of bodies ; from  physiology, speculations on the vital
principle, proximate cause, and the initial phenomena of life ;  in a  word,
rejecting from  each science,  whose aid it invoked, only  the assertions
which are not sufficiently justified by the testimony  of the senses.
   According  to Empirico-Bational  doctrine,  the  essence  of  disease-
consists in  the totality of  their  known  phenomena: two diseases are
considered homogeneous, in other words, of the same species, and require the
same treatment, when  they present  a  great similitude in the whole  of
their appreciable  symptoms.   Thus, the nature or essence of inflamma-
tion  consists, according to this doctrine,  in  the  union,  in  the  same
locality, of  these four symptoms: heat, pain, redness, and swelling;  it
being understood that these four symptoms constitute only one phase  of
the disease, which may present  other  symptoms at other stages  of its
existence.   The Dogmatists, on  the  contrary, to  whatever  sect they
belong,  whether they  are  Galenists,  latro-chemists, Animists,  Iatro-
mechanicians, Dynaniists, etc., the Dogmatists, I say, make  the essence
of disease  consist  in   a  primitive  force, proximate  cause,  or initial
phenomenon, from which they imagine all these  consecutive accidents,
all  these apparent  forms to  proceed.   The essence  of inflammation
consists, according to the Iatro-chemist, in the acid or alkaline acridncss,
which irritates the affected  part;  according to  the Animist,  in the
reaction of the vital principle against the morbiginous cause ; with the
Iatro-mechanician, in the obstruction of the vessels;  with the Dynamist,
in the reaction of  the  organic  fiber against  an  irritant  principle,  or
mechanical obstacle.
  AAre can comprehend by this presentation of views, why  the Empirical
nosology always appeared superficial and changeable: superficial, because
it stopped at simple appearances, or at sensations ;  changeable because. 
EMPIRI-METHODISM.
577
 embracing but  known phenomena,  it  must change  as they  increase.
 While the Dogmatic nosology,  in whatever form  of dogmatism it is
 studied, has  always  seemed to be more profound, because it surpassed,
 by reasoning, the limits of the sensations, and more  stable, because, as
 it pretended  to go back to the initial force, or phenomenon, there seemed
 to  be nothing more essential  to  seek  after.   But the  apparent super-
 ficiality  of  Empiricism  was  wisdom,  erudita  inscitia—the  specious
 profundity of Dogmatism, an  illusion, an  optical error.  The  mobility
 of  Empiricism has  been,  also, in reality, much less great,  much less
 striking, than that  of Dogmatism;  for the  Empirical  nosography  has
 varied only in details, while the  Dogmatic nosography,  on the contrary,
 has been overthrown, from age to age, in its very foundations.0

                  SECOND CONDITION—IDENTITY OP CURATIVE MEANS.
   This condition, though  in general less difficult to fulfil than  the first,
 still presents in certain cases grave difficulties:  first,  because its accom-
 plishment does not depend alone on the skill of the physician,  but on the
 docility of the patient, or the exactness and  fidelity of  the persons who
 concur in  any manner whatever  in  the  execution  of  the  treatment:
 second, because it is not always possible to place the patient in the same
 favorable  hygienic  condition.   Notwithstanding  these  obstacles, art is
 here much  more powerful, and it is enabled to obtain, in the most of cases,
 a sufficient approximation.   Nevertheless, to attain this result,  it  is
 necessary that the man of art possess  sufficiently extended  notions on
 natural history, physics,  chemistry, materia  medica and pharmacology.
   Thus, the more we advance in the development of  the Empiri-meth-
 odic doctrine, the more we are convinced that  the rational  application of

  ° We can represent the general idea that physicians have had of disease, by
 an  algebraic formula, in the following  manner:  Let A represent  the sum of
 acquired notions on any disease by direct observation ;  let E represent the proxi-
 mate cause, or the primitive phenomenon, which, according to the Dogmatists,
 constitutes  the morbid essence—a sort  of germ, whose successive evolutions  are
 supposed to give rise to all the apparent phenomena.
  For  the Dogmatists  of any epoch or sect, the idea of the disease, M, is con-
 posed of the sum, A, of the  notions furnished by the senses, plus the  essential
 phenomenon, E, which  the mind should perceive by the aid of reasoning.  The
 general pathological formula of this  doctrine will be, then, M, the  idea of the
 disease, equals A, the  sum of the notions furnished by the senses, plus E, the
 essential phenomenon or essence :
                               Mz=A-|-E
  For the Empirics of all times, the general  idea of the disease, M, is composed
of the sum, A,  of the notions obtained by direct observation, which  sum is the
same for the Empirics and the enlightened Dogmatists of the  same epoch, plus 
578
REFORM PERIOD.
this doctrine requires extremely varied knowledge, constant attention and
great perspicacity.

  THIRD CONDITION—KNOWLEDOE OP A TREATMENT APPLICABLE TO EACH SPECIES OP DISEASE.
  It does not suffice to discern one morbid  species from another, nor to
have at our disposal excellent remedies:  it is necessary  still, and it is in
this that practical skill consists, to know how to use them appropriately.
It is not so much the remedy that procures the cure, as the opportunity
of its application.   This last condition is the supreme end of Medicine—
the crowning glory of the Art.  To arrive at  the  knowledge of  curative
indications, or the opportunity of such or such a mode of  treatment, is the
principal object of all therapeutical researches.  Now it must be avowed
that the fundamental axiom of Empiricism does not furnish any light to
direct  us in such researches ;  it does not at all indicate the route to fol-
low for the discovery of curative means;  it presupposes a  knowledge  of
these means, and limits itself to tracing the manner of their application.
Administer in  each case, say the Empirics, the remedies that have best
succeeded  in analagous cases.   Those philosophic physicians who  were
not willing to  be guided by  anything  else  than rational  experience,
could not have contented themselves with an axiom so vague ; they must
have felt the necessity of adding to this axiom some rules proper  to direct
the essential phenomenon, or proximate cause, which the  Empirics regard as
inacessible to the penetration of man, and which consequently is, in their eyes,
an  unknown  quantity, X.  We shall have, then, for the general pathological
formula of this doctrine, M, or the idea of the disease, equals A, the  sum of the
notions furnished by the senses, plus X, the essential phenomenon:

                                M=A-J-X
  These two formula differ only in the value of E, which the  Dogmatists professed
to know;  but which the Empirics considered  as inaccessible to the understand
ing, as well as to the senses.  Now, up to this time, the Dogmatists have not been
able to agree among themselves on the value of the essential or primordial  phe -
nomenon, which they suppose that they  understand.   Moreover, it is evident
that they will never know its value, if we can put some confidence in the following
great axiom of modern philosophy: Reason has been given to man only to guide expe-
rience; and the mind, in wishing to surpass the limits of sensations  in physical  things,
mistakes its rights as well as its powers.
  We conclude from the above that the pathological  formula  of  Empiricism,
though in appearance less complete and less profound than that of the Dogmatists,
is, in reality, and always will be, truer and more exact.  I do not say with  Con-
dillac, that the rendering of our reasoning into algebraic  language gives  to it
more certainty, but I say, simply, that it  must appear clearer and more precise
in the eyes of those to whom this language is familiar. 
EMPIRI - METHODISM.
579
them in experimentation with  remedies.  History teaches us that they
traced,  indeed, very wise  rules in this respect.   But  before exhibiting
these rules, let us examine, somewhat, the value of the axiom in itself.
   This axiom has been the object of the most bitter criticism on the part
of the most renowned philosophers and theorists of antiquity, and of the
middle ages.   They charge it not with falsity or error—that were impos-
sible—but with stupidity.   In their view, to use  a remedy for the sole
motive that it had cured in analagous cases, was to act without reason.
It was necessary, according to them, to be able to say,  also,  by what
property—by what concealed virtue this  remedy cured.   For myself, I
am transported with admiration and astonishment when I consider with
what precision the  coryphie of  antique  Empiricism have marked the
limits where  our minds must pause in researches touching the action of
remedies.  They were in advance, by two thousand years, of the discov-
eries of modern philosophy.  It was too great a diplay of genius:  their
cotemporaries were not  able to comprehend them,  therefore they calum-
niated them.   The Dogmatists and Methodists are not obnoxious, on the
other hand, to  the reproaches that have been made to the  Empirics ;
they have attempted  to explain the intimate action of remedies, and they
have fallen in this  respect into such ridiculous  aberrations that their
pretentious babbling has been compared  to the filthy condition of the
Augean  stables.  Let  us see  how one  of the most famous of  modern
theorists, Bichat,  has depicted the obscurity, disorder, and incoherence of
the therapeutical  language  of  the schools:  "Into what errors he  says,
" are we not drawn in the employment and the denomination of  medica-
ments ?  Deobstruents were created when the theory of obstruction was
in vogue.  Incisives sprung up when the viscidity of  the humors was
held;  the expressions of  dilutants  and attenuants, when the  ideas
attached to these terms were put forward, at the  same epoch.   When it
was  necessary to obtund the acrids,  inviscants  or  incrassants  were
created, etc.   Those who saw in diseases nothing  but the relaxation and
tension of the fibers—the laxum  and strictum,  as they called it—
employed astringents and relaxants.  The cooling and the heating reme-
dies were employed, especially by those who had  particular regard, in
diseases, to the excess or want of caloric, etc.
   "  Identical means have had.  often, different  names,  following the
manner in which it was supposed they  acted.  Deobstruents with  one,
relaxants with another, refrigerants with  a third.  The same medica
ment has been  by turns  employed with different, and  even  opposite
views; so true is it,  that the mind of man prodeeds at hazard, when h
is led by vague opinions.  °           Except the medicaments whose 
580
REFORM  PERIOD.
effects are established by strict observation, as evacuants, diuretics, siala-
gogues, antispasmodics, etc., those consequently that act on a  specific
function, and what is our knowledge of the rest?" °
   Into what strange ramblings the desire to explain the intimate action
of remedies led ancient medicine!   But what the genius  of Bichat did
not perceive (doubtless  because a  sufficiently  long experience  had not
ripened it) is,  that  all these ramblings  have for a principle and final
resume, the axiom of therapeutics generally admitted still in his time:
diseases  are  cured by  their contraries, contraria contrariis curantur.
From the moment, indeed, that this axiom was  admitted,  it  became
indispensable to determine the mode of action of the morbific cause, and
the mode of  action  of the remedy, in  order to establish  the pretended
antagonism that was  supposed  to exist  between these  two powers—
forces.
  I  have demonstrated elsewhere, in a peremptory manner, the falsity
of such a maxim, and the impossibility of its application.  Henceforth
this is a fact, accepted in science, to which I  think it unnecessary to
recur.   But we have  seen  set up, in  our  day, another axiom which
aspired  to take its  place, the  falsity of which is still more evident—
more palpable.  Indeed, all  the  arguments which  we have employed
against the rule of contraries, are equally applicable to the doctrine  of
similars—of  which  mention is made in the  Hippocratic works,  and
which a  German physician has attempted to generalize.   This physician,
having recognized by experience, as attentive and unprejudiced observ-
ers have  done at all  times, the error of the  axiom wThich  says that dis-
eases are cured by their contraries, imagined, that in order to be right,
he had only to  take the opposite of this maxim.  Consequently, he pro-
claimed that  the supreme  law of all cures was this: diseases are cured
by their  similars.   A small number of particular facts, badly observed
and badly interpreted, appeared  to  him as a  beginning  of demonstra-
tion.  There needed nothing more to  excite  his enthusiasm, and lead
him to undertake researches and  experiments, followed with admirable
patience, worthy of a better cause.
  Nevertheless, it was impossible  that experiments made in good faith
should not have demonstrated to a sensible mind the falsity of  the law
of similars.  Such appears  to have been, in fact, the result of the first
homoeopathic experiments.   But  the  author held on to  his pretended
discovery like a sovereign holds on to  his crown, a poet to his verses, a
miser to  his  treasure.  He  speaks of it with religious admiration ;  he
puts the rule of similars above all ancient and modern discoveries;  he
sAnatomie Generale, Considerations Generales. 
EMPIRI-METHODISM.
581
regards himself already as the object of grateful veneration by posterity.
When  such an illusion has once entered into the head of  a man, it is
very rare for it to leave it.   Bather than renounce it, such a man  will
shut his eyes to all evidence ; he will even become a martyr, if necessary.
   Hahnemann,  who  appeals unceasingly to pure experience when he
wishes to convince us of the falsity of the axiom of contraries,—this
same Hahnemann, rejects the proofs of experience, or what amounts to
the same, he annuls it, when the effects of his doctrine are in question;
for, is  it not annulling observation, to apply it to objects inappreciable
to the  senses.   Where is the man who can verify the observations  of a
homoeopath?   When  Hahnemann  assures us, for  example,  that the
quadrillionth of a grain of the powder of gold, mixed with one hundred
grains of  an inert powder, has  sufficed, after being triturated  several
moments, to calm at once the furors of a  maniac, who can assure him-
self whether  it is true or not°?   No'one.   AVould you reiterate the
experiment of the apostle  of homoeopathy?  If you  obtain a different
result, as must  be the case, he will respond to you, that you have not
employed the exact dose of a quadrillionth of a grain.  How will you
prove  that there is just a quadrillionth of a grain of the powder of gold
mixed with a hundred grains of the powder of sugar, in the flask that
you have made him smell?   That is an impossibility.
   It is, then, physically impossible, as I have just said, to verify the
exactness of a homoeopathic experiment.  This truth has been confirmed
in  proper  terms by Hahnemann  himself.  It is  difficult, he says,  to
comply with the request that many persons have made to me, to place
before the eyes of the public some  examples of homoeopathic cures ;  if
we should do so, the mere reading of them would be of very little utility.f
   Hahnemann has been charged with  empiricism; but  nothing  is less
founded than  this  qualification; for  he entertains  us  unceasingly on
the intimate nature of diseases—the atomic or spiritual action of reme-
dies.  He shows the medicamental atoms attaching  themselves by elec-
 tion, to the molecules of the  diseased part.  In a word, he  transports  us
 continually beyond the phenomena which are appreciable by the senses;
that is to say, into the region of chimeras.  This is clearly pure Dog-
 matism, but  a  dogmatism which  differs from the  ancient one, as the
 homoeopath attributes to the similitude of action of  the disease and the
 remedy, the curative result which  the others attributed to their antago-
 nism.   What deceives superficial readers, and leads them to believe that
  'i See the Traite de Matiere Medicale ou de PAction pure des Medicament*
Homoeopathiques, by S. Hahnemann, Paris, 1831.  ATol. I, p. 79.
  t Ibid. 
582
REFORM  PERIOD.
 homoeopathy is related to  empiricism, is the eulogy that  Hahnemann
 ceases not to bestow upon pure experiment;  for he  continually alludes
 to it.   But this appeal is only formal.  We know now how little impor-
 tance he attaches to the decisions of experience, and how hard he tried
 to annihilate them.
   If there should remain still a shadow of doubt in the minds of my read-
 ers concerning the falsity and the nullity, whether of the axiom of contra-
 ries or the axiom of similars, it will suffice to convince them irresistibly,
 by  reminding them  of this  sentence of Hume, which I have already
 quoted after Barthez,  and  upon which all  the philosophers now agree:
 " It does not appear that any corporeal action, nor any action of the soul
 upon its  own faculties or ideas, can enable us to  conceive the acting
 force of causes,  or  the necessary relation  which they sustain to their
 effects.   In the succession  of natural phenomena, nothing presents to us
 the idea of  causality, or the connection  of  cause and effect.   But when
 the  succession of one  phenomenon  to  another is constant, the human
 mind, which observes  this  assiduously,  and which often  even  can fore-
 see  it, is led to believe  that these phenomena succeed each other because
 they are linked together."
  Thus, then, when the employment  of a therapeutical agent is followed
 constantly, or very frequently, by the cure of a given disease, we are led
 to believe that the treatment employed  is the cause of the cure ;  but
 our  mind cannot seize the bond which unites these two facts together.
 It cannot, therefore, affirm  that the cure has taken place in virtue of the
 similarity or antagonism of the curative and the morbigenous principle ;
 or in virtue  of any other appreciable  connection between the remedy and
 the disease.   All that  we can know certainly—all that assiduous obser-
 vation can teach us, is, that  the cure of such a disease  succeeds  more
 or less constantly, the  administration of such a remedy.
  Besides, is not this the most important thing for us to know ; and the
 best reason  which can be  given for  the employment of a therapeutical
 agent ?  Have we not, in this, certainty, or, at least, very great proba-
 bility that it will cure ?  In truth,  the  theorists  who ask more than
 this, are very exacting, and somewhat  unreasonable ;   and Empirics,
 both ancient and modern,  have done well  not to seek  any farther in
 what consists the curative virtue of remedies, but to concern themselves,
 with all possible care,  if a remedy cures often, or seldom, or never—in
 what circumstances it  cures, and in what it does not cure.  They have
marked the veritable  limit which  our  mind can  attain, and where it
must stop in therapeutics, as well as in  pathology.   They foresaw, as I
have said above,  the discoveries of modern philosophy,  and  thus pro-
nounced in  advance, a condemnation of such strange  expressions  aa 
EMPIRI-METHODISM.
583
 homoeopathy, antipathy, allopathy—expressions as opposite to the genius
 of good medicine as sound etymology.
   According to the doctrine of Empiricism, no one should inquire why
 opium causes sleep, nor why cinchona breaks a fever, but it should be
 ascertained if it is really true that opium produces sleep—if it constantly
 has this effect—in what state of  health it procures sleep, and in what
 doses it is to be administered  to cause this result.  It should be ascer-
 tained if cinchona really breaks a fever—the  kind of fever it thus cures,
 and in what doses it is a febrifuge.   If the  authors  in  Medicine were
 only occupied with questions of this kind, the only ones which are effec-
 tually useful, the sole ones susceptible of a rational solution, they would
 not be lead away into a  labyrinth of learned interpretations,  which have
 become very ridiculous ;  they would not have furnished so many avail-
 able points  for the humor of our great Comic;  they would not have
 opposed their sottish theoretic prejudices to the admission of the  most
 efficacious remedies, such as cinchona, mercury, vaccination, etc.   For
 the doctrine  of Empiricism does not exclude in an absolute manner, any
 curative proceedure—it repels only the  means recognized  as ineffica-
 cious,  and  postpones the admission  of those whose efficacy appears
 doubtful or contestable.   To the Empiri-methodic physician  all means
 that cure are rational, and those which cure the best  are most so.  He
 would  not  reject  even the  globules, more  or  less  infinitessimal,  of
 Homoeopathy, nor  the  manipulations  of the magnetiser, if it could  be
 shown  by observations  worthy of faith,  that these  globules or these
 passes cured  frequently enough any given class of diseases.
   The Empirics, trusting  to experience only in the  appreciation of the
 value of remedies (and,  as we have just seen, there exists in therapeu-
 tics no more  rational means of appreciating them), they were  obliged to
 devote themselves, with  greatest care, to the  perfection of this means.
 And this  is what  they did, indeed, as we have reported in the Anatom-
 ical  Beriod,  when exhibiting  their antique  doctrine.   The  following
 is a resume  of the  rules which  they drew up on this subject:   The
 same medicament  must have been tried a great number of times in per-
 fectly analogous cases, by  different persons,  capable of discovering the
 homogeneousness of morbid  affections,  and who  were worthy of  confi-
 dence.   When a treatment had  offered these proofs,  and was found to
 be constantly efficacious, then the description  of the treatment, and the
disease to which applied,  formed a theorem.   The  collection  of  these
theorems  thus verified,  constituted  the  Healing  Art, and  he only
possessed Empiricism who  kept faithfully  in his memory the totality of
its theorems. 
584
REFORM  PERIOD.
   For two  thousand years these rules have existed, and  no notable
change has  been made in them, up to the epoch when  Barthez proposed
his famous  classification  of  curative methods.  This  classification,  it
must be confessed, penetrated much farther than  had been done  before
into the mechanism of the operations of the mind in therapeutics;  but
it was neither complete  nor free from  error,  as I have before shown.
Barthez only had a glimpse of  the truth—but he did not seize nor make
himself master of it;  he let it escape  almost immediately, because  he
was misled  by a false theory.  By modifying his therapeutic classifi-
cation, as I  have already done, he had rendered it nearly irreproachable
for the epoch when  it appeared.   This  classification,  modified  in that
way, is still, to-day, if 1 am not mistaken, the  best one that has  been
proposed  on this subject.   It enters,  perfectly,  into  the  Ernpirico-
rational doctrine;  it is  the direct consequence, the natural developc-
ment of the  therapeutic axiom of this doctrine—for this reason it must
find its place here.
ON  METHOD IN THERAPEUTICS;  OR CLASSIFICATION OF THE  GENERAL MODES
                           OF  TREATMENT.
  There are, in the present state of science, four general modes of treat-
ment, namely: the  synthetic, analytic, expectant,  and explorative or
perturbative.

                         SYNTHETIC MODE.
  In this mode the mind  looks  at  all  the phenomena of a  disease, as
forming an indivisible concourse of symptoms—a single morbid entity—
and it directs against  this entity, considered  thus en masse, a medica-
tion termed specific.  This mode of  treatment, when it is  administered
apropos, is the most efficacious—the most benefical of all.   But science,
unfortunately, possesses very few  well established   specifics, such as
vaccine, mercury, and cinchona, which can be opposed to a  determined
class of diseases.   It possesses a greater number of specifics for the func-
tions, such as various eccropotics, sialagogues, diuretics, emenagogues,
etc., which, without  being endowed with a specificity as admirable as
the preceding nevertheless render important service in  Medicine when
they are employed with discernment, an  indispensable  condition,  after
all, for every species of medication.
  The synthetic mode is not only the most efficacious of the  modes of
treatment, but is also the most natural, the one to which  we are  most
instinctively led.   In the  first periods of  the history of Medicine,  none 
EMPIRI-METHODISM.
585
but specific  medicaments, or those  held  as such, were employed.   As
soon as a substance or a medical  preparation appeared useful in  a  dis-
ease, it was  designated by a name  which recalled  these  properties;
hence  were  derived the  denominations, vulnerary, scabious, pulmonary
therica, etc.   However, more attentive and enlightened observation not
having confirmed eventually the correctness of  these denominations, all
confidence  was  gradually lost  in them, and  by an exaggeration  very
natural, the curative method to which it had given rise was included in
the same proscription.  The treatment by specifics was  banished from
science, in favor of a false  theory, which  pronounced the  former  irra-
tional ; but it could not be equally excluded from  practice, because, in
reality, it was the most efficacious and the most  natural.  It is time,
then, that we restore it by means of a better theory  to  the honorable
rank to which it is entitled, from the services which art  and humanity
receive daily at its hands.

                         ANALYTICAL MODE.
   This mode of treatment is the only one which has been well described
and well denominated by Barthez.  It consists in decomposing a disease
or concourse of symptoms into  its elements, that  is  to  say, into seve-
ral sepondary groups, to each of  which an appropriate treatment is
applied, either  simultaneously or  successively.  For  example, in  con-
vulsive bronchitis  or whooping cough, one may  combat the sanguineous
congestion, if it is marked, by an  application  of leeches;  the  mucous
congestion, by mild emeto-cathartics in broken doses ; finally, the nervous
element may be  attacked  by means of some narcotic  like  belladonna,
digitalis, or opium.
   This manner of treating diseases is much less sure than the preceding,
and recourse is had to it only in affections for which there is no  known
specific remedy.   It is, moreover, of more  difficult application, because
it requires, on the part of the practitioner, one operation  more than the
former, viz:  the analysis of the symptoms of a disease, which opera-
tion presents sometimes  serious difficulties, and countenances always
arbitrariness.   Thus, in  the  example   referred  to,  it may  happen
that one physician gives priority  to the  sanguineous  element, another
to the serous, a third to the nervous.   Owing to the fact that the  analy-
sis of  the morbid concourse  is  merely mental, it is ordinarily very
difficult to decide which of these elements has over the others a prepon-
derating influence.  Under these  circumstances, the practitioner too
often suffers himself to be guided in  his choice by preconceived ideas,
and the prejudices of systems.  The Animist, for example, sees in every
thing a derangement  of the soul, or vital  principle, and  nothing else;
          37 
586
REFORM  PERIOD.
 the Chemist perceives nothing but the predominance of some acridncss;
 the Mechanician, a mechanical obstacle  to the circulation of the fluids;
 and the Vitalist, some changes in the vital forces.   It results from this,
 that analysis is not only of difficult application in therapeutics, but also
 that it leads  strongly toward  arbitrariness, to hypotheses.0

                           EXPECTANT MODE.
   When a disease has a fixed  and rapid course, as  an  ephemeral fever,
or benign roseola,  a varioloid,  a simple wound not involving any impor-
tant part, etc.; when a disease,  though graver, offers no alarming symp-
tom, and seems to tend toward a happy termination by the simple forces
of nature, as an inflammatory fever without any apparent phlegmasia of
   0 We have frequently had occasion in the] course of this history, to show that
 analysis is a falacious method, and has been the source of a crowd of errors  in
 Medicine, when it is separated from synthesis.   Permit me to add en passant, that
 the same method applied to morals, has given rise to errors a hundred times more
 grievous still.  If we are not on our guard against  the  illusions with which it
 fills our minds, under the guise of exactness, truth, and profundity, it  will  soon
 dry up our hearts, and smother in our souls every germ of virtue, every impulse
 of  courage, magnanimity, and  devotion;  to substitute for them coldness, arid
 egotism, melancholy, contempt for others and one's self.   See in the romance  of
 Alfred de Vigny, entitled: Cinq Mars, ou  une Conjuration sous Louis XIII.; see
 Isay, the conversation of Friar Joseph, a man condemned by Richelieu, with Cinq
 Mars, detained in prison and awaiting execution, in vol. II, p. 352, of the fifth
 edition.  Read from one end to the other the delightful  creation of Xaintaine,
 entitled, Pecciola, of which the following is a fragment:
   "A profound sadness took possession of the Count de Charney. Philosophic analy-
 sis, notwithstanding all his efforts to shake it off, reigned over his mind, controlled
 all his affections, tarnished, contracted, and extinguished the pleasures and luxu-
 ries in the midst of which he lived.  The eulogies of his friends, the caresses of
 his mistresses, were no more to him than the  current money with which they
jaaid for the part they took of his fortune, and were only a testimony of their
 necessity to live at his expense.   Decomposing and reducing every thing to its
 first elements, by this same spirit of analysis, he was attacked with a singular
 disease.  In the tissue of the fine cloth of his dress, he thought he detected the
 odor  of the animal which furnished the wool; on the silk of rich hangings, he
 thought he saw crawl the disgusting worm which had spun it; on his elegant
 furniture, his carpets, the bindings of  his books, toys of pearl  and ivory, he saw
 nothing  but spoils of death—death set off in attractive  colors by the  sweat of
 poor artizans.  niusion was  destroyed, and the imagination paralyzed."
   Must we conclude from these abuses of analysis that we should proscribe this
 mode of acquisition,  to which the human mind is indebted for  so many discov-
 aries?  No, certainly not.  Such is not our intention; we  have  presented the
 dangers and deceptions of analysis, in  order that  it may not be embraced with
 blind faith; just as the ancient Empirics assigned limits to reason, not to  pro-
 scribe it, as they have been accused, but to prevent its abuse. 
EMPIRI-METHODISM.
587
an organ; when  a disease  presents itself in an  obscure  manner, and
there is besides nothing urgent in the case, and, in a multitude of other
cases which  it would take  too  long  to  specify, it suffices, in  order to
obtain a cure, to place the patient in favorable hygienic conditions,  pre-
vent the commission of any  imprudence,  and direct the use of a proper
regimen.
   Nature, in these cases, seems  to take upon herself the work of medi-
cation ; the physician has only to observe and hold himself in expecta-
tion,  to repress, if need be, the deviations of medicating nature, to
excite  or moderate her movements, to sustain her forces, and to aid her,
in a word, by following the indications which she furnishes.   The prac-
titioner has been compared, in such a case, sometimes  to  a  servant  or
minister who waits for his actions, only the signal of the master;  again,
to an idle spectator; but it is evident that in this  case the  listlessness
of the physician is only apparent, and the denomination of inactive
medicine, employed  to designate the treatment, appears to me improper.
   The disease, or the concourse of symptoms is here considered as a reg-
ular chain of  phenomena, which nature excites  for a curative  purpose,
and it is important not to interfere with the  spontaneous tendency with-
out absolute necessity.  This manner of  philosophizing having been put
in vogue by Hippocrates, those who adopted it were named Hippocratists,
or  Naturalists.   It suited  especially in  the infancy of the  Art, at  an
epoch  when  few or no true specifics were known, and when an enlight-
ened use of  analysis had not yet been made.  It renders the practitioner
circumspect and  attentive, which must be to the advantage of the pa-
tient ;  and it is applicable in  a multitude of cases,  both acute and
chronic.
   But it is  evident  that the expectant method does not constitute all of
the Healing Art: that the  synthetic  is much  more prompt and  sure
whenever it can be employed, and that the analytic merits  also in many
cases  the preference.   Generalizing the Expectant  method to  excess,
under the title of  Hippocratic or Natural  method, is to mistake the
progress of  light, and to chain  the genius of Medicine to  the  bed of
Procrustes.

               EXPLORING 0E  PERTUBBATING MODE.
   Ambiguous or doubtful cases often occur in practice, which our minds
can  not associate in a precise  way to any of  the known morbid species;
then the physician prescribes  often, not  at hazard, but from  choice, a
medication calculated to develop the characters  of the disease and  clear
up his diagnosis.   His conduct, under these  circumstances, may  be 
588
REFORM  PERIOD.
 compared to that of the chemist who employs a re-agent to recognize the
 nature of a saline solution.
   In other cases,  unhappily  too  numerous,  the man  of Art, after
 having  exhausted  all  the  rational  means  which  science  has put
 at  his  disposal, without  obtaining any satisfactory result, owing  to
 some idiosyncracy, or other  inexplicable circumstance,  has  recourse
 to an indirect treatment, by which he proposes to give a  shock  to the
 entire economy, or  only to the  part  affected, in  order  to produce an
 advantageous and curative perturbation.  Such was  the object had in
 view by the ancient Methodists  in  inventing  the metasyncritic circle;
 such is also now our  aim when we order sea-bathing, voyages, mineral
 waters, hydropathy, etc.   In  these cases, the physician is not acting
 blindly, nor does he prescribe at hazard, but is guided by certain anal-
 ogies; he has regard to  the  habitudes, age,  and temperament  of the
 patient.   On this account, we give also to this  mode of treatment the
 title  of rational;  we  class it  in  the  rank  of  therapeutic  methods
 acknowledged by science.   But it occupies the lowest rank among these
 methods, and the progress of knowledge will more and more restrain its
 application.
  The explorative  and the perturbative method, though  united here,
respond to two different  views of our minds, and should have formed
two  separate  paragraphs.  I have thought it proper  to unite  them
because they both constitute a sort  of groping, and both  also prove that
there is in the mind of him who employs either, about the same degree
 of uncertainty and  hesitation.

                             REMABK 8.
   It often happens  that  in  the  same disease, we are obliged to
employ  several  modes of treatment, or  even all, either  collectively or
 successively.   Example:  I attended,  some twelve years  ago,  a man
thirty-five years of age, small and fat, and of a somewhat sanguineous
appearance, whose trade was shoemaking. The first time I saw him, he
complained of a want of appetite without increase of thirst, a general
debility and insurmountable  sleepiness.  His  tongue,  his excretions,
alvine and urinary, his digestion, his pulse, his respiration and his cere-
bral functions presented  nothing abnormal.   I ordered some  mustard
foot-baths, ti middle diet, a mild  purgative and a promenade after meals.
 Three or four days  passed by without  any modification in the state of
my patient being visible, unless there was a slight increase of the debil-
ity and sleepiness.  I took from his arm eighteen to  twenty ounces of
blood, continued the foot-baths, the middle diet and mild cathartic every
 other day.   At the end of some  days there was no amelioration;  on the 
EMPIRI-METHODISM.
589
 contrary, the debility had increased.  I  questioned him anew, and he
 told me among a mass of useless circumlocution, that his greatest drowsi-
 ness was about three  o'clock  in the  day.   I called  to see him on the
 next day at that hour.   He was in bed.   His color was a little more
 than usual, but there  was  no frequency of the pulse or extraordinary
 heat of skin.   When I shook him he opened his eyes,  replied slowly but
 correctly to my questions, and  fell off  with  sleep in an  instant.   I
 learned  that  the propensity to sleep came on every day between eleven
 and twelve o'clock, and ceased towards six or seven  in the evening, and
 that it had never been preceded by shivering or followed by a sweat.   I
 prescribed six grains of the sulphate u quinine to be taken  in  the
 evening, and a similar dose to be taken at nine  in the morning.  The
 next day the somnolency  was much less urgent, and the prostration less
 sensible.   The continuation of the remedy for several days prevented
 completely the return of  the soporific accession and the debility.
   If any one now wishes to analyze my conduct in the management of
 this case, he will discover three distinct periods.  In the first I employed
 the expectant method.  Then I decomposed the concourse of symptoms
 conformably to the analytic method, and I treated the symptom of cere-
 bral congestion which  appeared to me to be  the  most predominant.
 Finally,  I considered  the  ensemble of the symptoms as a unit,  and
 treated him according to the synthetic method.
   If any one wishes to  make the analysis in the same manner of any
 other treatment  whatever, whether  simple or complicated, medical or
 surgical, it is easy to see that each part of the treatment  conforms to
 one of  the general modes  explained above.  Suppose, for example, that
 it relates to an abdominal tumor,  whose extirpation is  judged to be pos-
 sible.  It is clear that in this case the synthetic method is first employed,
 for the disease is attacked en masse, as constituting  a unit.  Then the
 wound is closed by sticking plasters, a simple dressing applied, and the
 patient is directed  to be  kept quiet and on proper diet.   This is the
 expectant  division of the treatment;  the case  is left to nature.   But
 during the course of the cicatrization, various accidents maybe developed;
 an inflammatory fever, for example, may be lighted up.  Then  recourse
 is had  to the analytic mode in attacking the  sanguineous  element by
 blood-letting, and by  withdrawing  a portion  of the  nutrition,  which
 diminishes, of course, the mass of liquids, and by combatting the thirst
and excess of caloric by abundant acidulated or mucilaginous drinks.
If hospital gangrene supervene, it is treated by topical applications of
acids or caustics,  with  a  view to change an ulceration of a malignant 
590
REFORM  PERIOD.
nature into a simple ulcer;  in other words, use  is made of the pertur-
bative method, because no safer means is known yet to arrest this griev-
ous complication.
   Thus, however varied may be the means employed in therapeutics—
however diverse  may be the views  of practitioners, it is evident that
their views and their means are all related naturally  to some one of the
methods referred  to in our category above given.   Moreover, our thera-
peutic classification presents  a regular gradation of the general modes
of treatment, from the one which offers the least chances  of success to
the  one whose success is nearly infallible.  It indicates more clearly
than has been done heretofore the end that science proposes, which con-
sists in elevating the treatment of each disease to the most perfect and
surest mode, that is to say, to the synthetic mode, contrary to the opin-
ion of so many theorists,  who falsified the art, and diverted the minds
of practitioners from  the true  path by tarnishing with an opprobious
epithet this curative method, which they believed to be injurious.

                            CONCLUSION.
   Finally,  the Empiri-methodic  or Empirico-rational  system, whose
economy we have just summarily  unfolded, includes  all  branches of
medical  science and unites them by a natural tie,  supported by reason
and history.  All, or nearly all the authors of systems of Medicine have
sought their foundation in physiology, whence  they deduced first their
pathological theories, and lastly, their rules of treatment.   This was, it
must be avowed,  following an inverse march to what  nature and reason
indicate.   It is therefore not astonishing, however great was the  intel-
ligence of these authors, that they were led astray.   Indeed, if we con-
sult history, we see that  the  first  medical researches related to thera-
peutics.  Even before the existence of the Art, therapeutics was instinct-
ively applied.  If we interrogate reason, we find that therapeutics is the
most important branch of medicine, the center to which should converge
the luminous rays that emanate from the other branches of the science.
It was, then, natural and reasonable to seek  in therapeutics the true
basis of  a medical system.  This is what was done so happily and per-
spicuously by the  philosophic physicians of Alexandria, who were  the
first to take the name of Empirics.   It is what  I have also undertaken
to bring about with  the  aid of the few remains of their doctrine, the
lights of history and  of  those  which  modern philosophy and  medical
practice have furnished me.   It has been seen how, from this axiom, so
natural and so  incontestible—each disease must be treated by those reme-
dies which have succeeded best in  similar cases—we have deduced the
necessity of all the branches  of pathology, anatomy, physiology, etc. 
GENERAL RESUME.
591
Would it be too much to affirm that the system Empiri-methodic is the
only true and complete one which has been proposed in medicine ?   So
many men  of mind and  genius have been shown in the course of this
history  to  have been in error for  having made a similar assertion in
honor of other systems, it would  be temerity in me to affirm it, whatever
may be my convictions in this respect. I affirm nothing then, but I await
with confidence the judgment of  my confreres, and in particular that of
the practitioners, to whom it appertains, at last, to pronounce on the value
of all medical systems.
                       CHAPTEB XII.
                    GENERAL  RESUME.
  The History of Medicine, considered in  its totality from  the com-
mencement of society  to  the  present  epoch, offers us three principal
phases, which we have designated by the names of Age of Foundation,
Age of Transition and Age of Benovation.
  During the first phase, which  terminated at the death of  Galen,
toward the end  of the second century of the  Christian  era,  we have
seen the Healing Art  commence among all nations in nearly the same
manner.   We have recognized that it was not a pure invention  of  the
genius of man, but that it owed its origin on one hand  to the invincible
instinct which leads us to fly from pain  and seek means  for its relief;
on  the  other, to  that inclination, eminently social, called sympathy,
which impels us to succor our fellows in their sufferings.
  The discovery of the earliest remedies was due to accident, instinct
and experience.   But  as  soon as  a knowledge of a certain number of
medicaments applicable to some determined diseases had been acquired,
it became necessary to arrange this knowledge in an order which would
render its application more easy and sure.   From  that time reason or
philosophy united with experience to give perfection to the art.   Thus
instinct, accident and observation laid the first foundations of the scien-
tific edifice, or rather furnished the first materials; reason came next,
to polish, cull and arrange these materials in a suitable manner,  and
direct observation in the search for new facts.
  Thus far, reason had marched  in  the  rear  of  experience, or by its
side,  performing  the offices  of censor or architect;  but it  did  not
precede  it, it did not pretend, especially, to create itself the material
which should serve in the construction of the monument of Medicine.   But
philosophy soon allowed itself to  creep  upon the steps of observation, 
592
REFORM PERIOD.
which furnished it but too slowly, with vague, limited and very variable
information.   The philosophers abandoned the long and tortuous path
of experience, believing they could  reach their  aim more speedily and
directly  on the  wings of intelligence,  free  from  the weight  of the
senses.   The certainty and invariableness of mathematical propositions,
the grandeur and beauty of the maxims in morals and natural religion,
admirable  discoveries, the foundation of all social  order, which  were
regarded as the fruit of the  pure perceptions of the mind—these were
the motives,  very excusable  doubtless, on which they rested, to  turn
from observation, and seek by the aid of pure mental intuition, the laws
which regulate physical phenomena.
   From that time, physicians proposed nothing  less than to  determine
the proximate cause, the  principle, the essence of life and diseases, and
the intimate  action  of remedies.  They assumed to build  upon this
basis the  scientific  monument of  Medicine.   The more, then,  objects
appeared to them removed from  the  grasp of the senses, the  more they
judged them proper  to become a solid foundation for science—one that
would  be  undisturbed by  the fluctuations of experience,  a mode of
acquisition which Hippocrates had qualified as uncertain, experientia
fallax.   Thence sprung up a crowd of hypotheses and systems, which
struggled for supremacy in Medicine, from Hippocrates to Galen.  Their
founders flattered themselves to  be able to avoid the uncertainty and
gropings of experience, but  they fell into a labyrinth  of  imaginary
speculations, and opened an illimitable field to controversy.   Physicians
were divided,  like the philosophers, into rival sects, whose disputes only
ceased in  consequence of political events,  and social  revolutions.   It
was during these conjunctures that the  physician of  Pergamos,  having
collected what he found best in the writings of his predecessors, com-
posed from them a body of doctrine,  conformed to the reigning philosophic
ideas, in which we meet,  in some degree, all the opinions that had been
in vogue, but over all of which Hippocratic Dogmatism predominates.
   The scientific monument of Medicine, thus constituted, traversed the
Second Age  without undergoing any notable change.  The theories of
Galen were  authority during all  this  lapse of time;  his  successors
aspired  only  to the  glory  of interpreting  them,  and to  add  some
particular facts, some observations of detail,  to  the  heritage  that
antiquity had left to them.   There was established, we do not know at
what epoch,  a strange but salutary opinion, which formed a  line of de-
markation, a species of antagonism between theory and practice, between
raason and experience.  The theorist, it was said, must proceed  accord-
ing to logic, and the practitioner must be guided by observation.  By
means of  this singular expedient  or this fiction, false theories, and  a 
GENERAL RESUME.
593
deceptive  science, were preserved for centuries without misleading prac-
tice too much;  the physician could reason badly, without much injury
to his patient, and without depriving himself of the lights of experience.
   Such is the aspect which medical doctrine presents at the commence-
ment of the Age of Benovation, and  even for a long time afterward.
We have seen that at this epoch the human  mind awoke from  its long
torpor, and signalized  its revival  by numerous discoveries and improve-
ments.   Astronomy, physics, chemistry, and natural history, underwent
a complete revolution, for which they were indebted to the direct observa-
tion of phenomena, and the adoption  of a logical  method, formerly
scarcely used, called induction.   The mathematicians, who were never
led astray  in  their abstract  speculations,  and  who had  made  such
beautiful discoveries,  reasoning  by  deduction, preserved this logical
method, always dearer to meditative minds than to observers.
   The philosophers were divided  into two classes—one, including Des-
cartes,  Leibnitz,  Kant, and their  disciples,  considered, above  all, the
activity of  the soul in the acquisition  of knowledge, and the production
of moral  acts;  they were called spiritualists, and remained faithful  to
the  ancient form  of  reasoning,  deduction, after freeing  it from the
pedantic  dress  of the  schools.   The other,  including  Bacon, Locke,
Condillac, and their followers, rather regarded the soul as passive, and
assumed that all its faculties, and all its acts, are  derived from sensi-
tive impressions;  they were  called,   on  this account,  sensitists,  and
adopted, for their  general  method  of reasoning,  induction, which they
strove to introduce into all the sciences.  If I dare express an opinion
on a subject so delicate, I would say that  the first,—that is, the spirit-
ualists—seem to me to have better demonstrated  moral  and intellectual
truths, while the second, or the sensitists, appear to me to have traced
with more exactness the phenomena of  matter, either organic or inorganic,
and to have better comprehended its laws.
   However this may be, the greatest number of physicians adopted the
sensitive philosophy.   They all pretended to take the sensations, or the
sensible phenomena, for the basis of their  systems, but all, or nearly all,
surpassed, in their theoretic speculations, the horizon  of these pheno-
mena, in which they violated that axiom of modern philosophy,  common
to Sensualism  and Spiritualism—reason has  only  been given  to us to
guide experience, and the mind, in  attempting  to pass the limits of the
sensations,  mistakes its  right and its power.   Hence the chimeras and
instability of recent  medical  theories;  hence,  also, the  necessity  of
prolonging, indefinitely, the divorce  of theory and practice, of reason
and experience—a divorce  which  the  greatest practitioners of  the last
centuries have often proclaimed—a divorce whose inconveniences Baglivi 
594
REFORM PERIOD.
was  the first to signalize—which  Werlhof, Morgagni,  and Lieutaud,
with a  small number of other  writers, attempted to break, but which
will only completely cease when all physicians shall be penetrated with
this truth :  that beyond rational Empiricism there is for science nothing
but illusion or hypothesis.
  WTc have demonstrated  that all systems of Medicine should be  based
on therapeutics,  which is contrary to the common opinion; for all authors
who  have been  authority, from the  successors of Hippocrates to  the
present epoch, all, I say, excepting  the Empirics, have endeavored to
found their systems on the laws of physiology.  The last, even, among
them, Broussais, was willing  to  characterize his doctrine  by the term
physiological—a title which we  are in no wise inclined to refuse to it,
no more than that of many  others which have preceded  it.   Yes,  the
theory of irritation is a reflection of the physological ideas of its author ;
the theory of incitation offers us an image of the ideas  of Brown  on
the functions of the animal economy;  the theory of  Animism is a
consequence of the manner in which Stahl conceived life to exist;  the
theory of four elements and four humors, represents the intimate play
of the organs of the living body, as men figured them  to  exist in  the
times of Galen.   It is the same with all other medical  theories—each
one of them is a deduction of some physiological idea.
  The authors of  these theories have reasoned as  follows  :  To treat a
disease properly,  we must know its nature.  Now the disease  being
nothing else than  a derangement of health, or the physiological state of
the body, it  is necessary to  know  in what health consists, in order to
appreciate  the  derangements which  take  place—that  is  to  say,  the
diverse pathological states.   This reasoning, which appears so just and
so natural at first  sight, is at bottom only an extremely subtile sophism,
which clinical experience contradicts at every step.  There is  a  crowd
of diseases  whose nature, or mode of formation,  escapes  entirely  our
researches, yet which we know very well how to cure—there are others,
whose mode of formation is much better known to us, on  whose nature
we have more exact data, whose treatment is, nevertheless, but little
improved thereby.
  If, on the other  hand, we go back to the infancy of  the Art, we shall
perceive that a great many remedies were found before reason had been
invoked, either on the intimate  nature of diseases,  or on the principles
or primordial properties  of living beings.  Finally, if we follow  the
history of science  from  its origin to our times, we shall see the physio-
logical  systems  vary  infinitely,  and often  contradict each other,  while
the manner  of  treating diseases has  undergone much  fewer  changes.
From these facts we  have concluded, experimentally, that therapeutics 
GENERAL RESUME.
595
cannot  be deduced  directly from physiology;  but  that the precepts of
the first are, and should remain, independent of  the speculations of the
latter.
   To those who pretend to  deduce the general rules of  treatment from
some opinion, or physiological experiment, we would recall the axiom of
philosophy already invoked by us more than once:   In the succession of
natural phenomena, nothing presents to us the  idea  of causality, or  the
necessary relation of cause and  effect.  But when the succession of one
phenomenon  after another is constant, the human mind, which observes
it assiduouslg, and  which often can foresee it even, is lead to believe
that these phenomena succeed each other because they are linked together.
Thus, when the cure of an order of diseases follows constantly  the em-
ployment of  a medication, we are lead to regard this medication as the
cause of the cure which follows its use;  but it  is  impossible for us to
perceive the physiological reason of this result, and it is,  consequently,
useless to seek it.
   The physiologist must limit himself to describe  the functions of the
organism, without pretending to seize the  proximate  cause of these func-
tions.  While he does not content himself with depicting the phenomena
of the animal economy as they are  shown  to us  by observation, but
flatters  himself to  be able to determine by analysis the principle, or
essential phenomenon of living beings, he mistakes  his rights as well as
his powers.   He resembles the dog in the fable, which dropped the sub-
stance to seize  the shadow.  He forgets that life is a finished circle, in
which, consequently, there is neither commencement  nor end—He, alone,
who traced this  circle, is able  to  tell us  where it  commences and
where it ends.   The man  who struggles to resolve this  problem, makes
greater proof of folly and unmeasured ambition, than depth  of mind.
Far from being able to determine the principle or essential phenomenon,
the object of so many vain speculations and researches, the physiologists
have not even been able to assure themselves, by the  most delicate obser-
vations, if life commences in the  solids  or liquids;  for wherever life
exists, we find a combination  of liquids and solids, an assemblage of
containing parts and parts contained—we cannot even  conceive of life
without this union.0
   Thus,  therefore, the physiologist must limit himself to the description
of the normal phenomena of the living economy—the pathologist  to
abnormal ones, without either of  them aspiring to  penetrate the prim-
itive mechanism of these phenomena.   So, also, the  therapeutist should
  i:; See, among other works, in the Manual of Physiology, of J. Muller, para-
graphs relative to the forms of organic matter, and organic properties of the blood. 
596
REFORM PERIOD.
base the choice of the  curative  means he employs, not on the analogies
perceptible to the understanding only, but on the material and sensible
analogies.   Such is the resume of the Empiri-Methodic doctrine, toward
which the present generation manifestly inclines, notwithstanding some
divergencies.   It does not require a great prophet to foresee that before
a long time shall have elapsed, all medical opinions will unite upon this
doctrine.  Do we not see researches on specific medications  everywhere
multiplied ?  Does not our age owe to this order of researches the discovery
of some precious remedies for diseases, and  the improvement of  several
others ?   To recall but the principal ones, we will cite the extension of
the application of the febrifuge, par excellence, to all periodic affections;
the propagation of vaccination in spite of all physiological theories ; the
introduction of iodine and its compounds in the treatment  of  scrofula
and constitutional syphilis ; the employment of ergot in inertia of the
uterus and  hemorrhages that  follow accouchement;  the use of tarter
emetic in certain forms of pneumonia, etc.,  etc.   Are these  not  results
which  speak stronger in favor  of the specificity of  certain remedies
than the sophisms and eloquence of writers who strive to lead the mind
in another direction, by taxing as irrational a mode of treatment unani-
mously recognized as the most efficacious and beneficial ?   The research
for occasional and predisposing causes, that is  to  say,  causes called
evident, by the ancient Empirics—is it not prefered in some recent books
to the research of causes called intimate, constitutive, physiological and
essential ?   From all these signs,  it is easy  to foresee that the definite
triumph of  Empiri-Methodism,  otherwise called rational  or philosophic
Empiricism, approaches.
   But let happen what will, the first among moderns, I have endeavored
to revive the name  of the  grand Empirical school of Alexandria.  I
have endeavored to resuscitate and cause to shine in greatest brilliancy
its claims to glory, forgotten or mistaken for two thousand years.  I
have not been  content to reproduce  this doctrine,  I have  sought its
enlargement and consolidation, by  basing it  on  new philosophic dogmas
of incontestible evidence, sustaining it by historic proofs sufficient  to
fasten conviction upon the most  resisting  minds.  Thus  comprehended
and  developed, Empiricism  is, of  all the systems, the only one which
furnishes a sufficient reason for the rules of the Healing Art observed
in all past and present time; the  only one which is applicable to all
branches of  Medicine and its accessory sciences;  the only one, in  fine,
which gives a solution of this capital problem, sought in vain by Bag-
livi, and so  many other  illustrious physicians: the agreement of theory
with practice, of reason with experience.  This system, it is  true, takes
from the mind  numerous illusions which flatter our vanity, and which 
GENERAL RESUME.                     597
become obstacles to its rapid propagation, for although the world grows
older, man always remains a child, whom fictions amuse.  But in a sci-
ence like Medicine, fictions are never innocent;  they have always caused
much evil, they retard the progress of light much more than doubt and
ignorance.
  In a professional point of view, the history  of Medicine has offered
us four distinct phases:
  First, a patriarchal phase, which corresponds to the origin of society,
to an epoch when the chief of a family united in himself all power, and
was the depository of all traditions ;
  Second, a sacerdotal phase,  which reigned long in  Egypt, and  flour-
ished in Greece from  the  Trojan war to Hippocrates, and which reap-
peared in Europe during the Middle Ages;
  Third,  an unlicensed lay phase, the worst of all in  regard to the dig-
nity and morality of the profession;
  Fourth, a licensed, or organized lay phase,  the most perfect of all
known professional forms, the most  appropriate to  the present state
of Europe, and the most favorable to the progress of science and art.
THE  END. 
 
APPENDIX.
             PHILOSOPHICAL LETTERS

                              ON


MEDICINE  IN THE NINETEENTH CENTURY.
FIRST  LETTER.
          MEDICINE  JUDGED BY PHYSICIANS.
   You are aware, my dear and worthy colleague,0 and it is universally
known, that Medicine and physicians have always furnished  ample
material to the wits; poets, philosophers, novelists, and writers of all
descriptions have rivaled  each other in the exercise of their satirical
humor on this inexhaustible subject.   But what is not so  generally
known, what most persons have always  overlooked, and what must seem
most singular is, that the bitterest criticisms which have ever been made
upon medical science, and upon those who cultivate it, have flown from
the pens of physicians.
   To prove my assertion,  I  need not to go back to  the dark  picture
which Galen traced of the quackery, ignorance, and avidity of his col-
leagues at Bome; neither need  I recall the vulgar wit of a Cornelius
Agrippa,  nor the  sarcasms of Guy-Patin.  We who are  disciples of
Esculapius attach, in general, but little importance to the opinions  and
labors of our predecessors.   The sharp and ridiculous pictures of Moliere,
of the physicians of his time, touch us but little, persuaded, as we  are,
that we resemble the originals in no respect.   Although only two centu-
ries separate us from that  epoch, we believe ourselves to be at an  infinite
  0 This series of Letters was addressed to the editor of V Onion Medicale in
1850. 
600
APPENDIX.
distance above the errors and the  ridiculous practices which the great
Comedian  pursued with his shafts, so much progress does  it seem to
us that science and Medicine have since made.
  I shall, therefore, not seek the proofs of the fact above asserted, in
the ancient authors, whose authority might be questioned.  I shall take
them from the most recent writings, in order to establish  the evidence
of the  truth of my proposition, that in our days, as well as formerly, the
most severe critics  of the practice and  the science  of  Medicine, have
been physicians themselves.
                      I.   School  of  Paris.

  At the commencement of our century, Bichat wrote as follows:
  " We have yet had in Materia Medica no  general systems ;  but this
science  has until now been influenced  successively by those who were
leaders  in  the profession,  and each one of  these has, if I may say so,
forced upon it his own views.  Hence  the vagueness and  uncertainty
which it presents to us to-day.   An incoherent assemblage of incoherent
opinions, it is perhaps, of all the physiological sciences, the one which
shows plainest the contradictions and wanderings of the human mind.
In fact, it is no science at all for a methodical mind, but  is a shapeless
conglomerate of  inexact ideas, of observations often puerile, of illusory
remedies, and of  formulas as oddly conceived as fastiduously arranged.
It is said that the practice of  Medicine  is repulsive.   I say more than
this:  it is, in  respect to  its principles, taken from most of  our Materia
Medicas, impracticable for a sensible  man.  Except  the medicaments
whose effects  are  fully established by strict observation, such as evacu-
ants, diuretics, sialagogues, anti-spasmodics, etc., that is, those which act
upon  a determined  function,  and to what does our knowledge of  the
other articles amount?"0
  I have quoted this passage entire, notwithstanding its length :  First,
because it  contains  the  opinion  of a man  of genius, and of an able
experimenter,  whose ideas and discoveries have exercised a capital influ-
ence upon medical studies  in France; second, because it indicates with
precision the  original, radical defect of our therapeutical denomina-
tions ; third, finally, because it points  out,  although somewhat  indis-
tinctly, the path  which must be chosen to arrive at a better nomencla-
ture  and  sounder notions  in therapeutics.  Except  the  medicaments
" Bichat, General Anatomy, General Considerations.  Paris, 1818. 
FIRST  LETTER.
601
whose effect is fully established  by strict observation, such as evacu-
ants, diuretics, sialagogues, etc., that is, those which act upon a specific
function, and what is the amount of our knowledge of the other articles ?"
   A few years later, a physician nurtured in the physiological ideas of
Bichat, and the philosophy of  Condillac and Cabanis, and strengthened
also by the observation of diseases,  and by a  large practice in armies
and hospitals,  traced  the following picture  of the effects of  Medi-
cine :   " Look back," he says,  " and recall what we have said in regard
to the vices of medical practice; imagine, in all parts of the civilized
world, legions of physicians who do not  even  suspect the  existence of
gastric inflammation, nor the influence which this phlegmasia  exercises
upon the other organs; see them pouring floods of vomits, purgatives,
heating remedies, as wine, alcohol, liquors impregnated with bituminous
substances and with phosphorus, upon the sensitive coats of the phlogosed
stomach;  contemplate  the consequences of this  medical torture, the
agitation, trembling, convulsions, andphrenitic delirium, the cries of pain,
tortured expression of face, and the burning breath of all  these unfor-
tunate ones  who beg for a drop of water  to  allay  the thirst which
devours them, and then receiving as answer but a new dose  of  the  poi-
son which has reduced them to that horrible state ;             °
and then decide whether  Medicine has, until now, been  more useful
than  injurious  to mankind.   I agree that it has rendered suffering
humanity the service of offering it  consolations, by lulling  it  continu-
ally with illusory hopes;  but you must also agree that such a utility is
far from being sufficient to elevate Medicine to  the came rank with other
natural sciences, but it  seems to  reduce it to a  level with astrology,
superstition,  and all sorts of quackery."0
  " Thank me, kind reader, for I have shown you but one-third of this pic-
ture, whose colors grow constantly darker and  darker.  What I have
given suffices to prove that the epigrams of philosophers and poets, upon
the faults of physicians and the pernicious effects of their Art, are but fee-
ble sketches by the side of this picture, at once so animated and so fright-
ful.   It would fill every honest and sensible heart with disgust  for the
practice of such a profession, if the author of this  description had  not
placed the remedy by the side of the evil  he paints.  This  remedy, as
you wiU understand, is nothing else  than  his own doctrine, in favor of
which, he says,  the statistics  of mortality have already declared, and
which  must in a short  time  have  an  influence upon population more
marked even than the discovery  of vaccination."]
  We  shall see, a little farther on,  how these  doctrines of the  Val de
0 Broussais, Examen dea Doctrine Medicales.       f Ibid.
 38 
602
APPENDIX.
 Grace were appreciated and are appreciated yet, by other schools.  But
 first permit me to quote  here the opinion of one of the most eminent
 partisans of this  doctrine, now a distinguished professor of the faculty
 of Paris.   He, after giving the opinions of Pinel, Bichat, and  others,  on
 the practice of medicine, adds :  " Considered in general, and absolutely,
 these  sentences are too severe; indeed, there are a certain number of
 diseases in whose treatment therapeutics has attained, long since, a high
 degree  of certainty  and  precision.   But it is also true that  these
 reproaches apply themselves in all their severity to several points of our
 therapeutics."0
   Mr. Bouillaud is not at all an optimist in his judgment upon the ideas
 and  the  practices of his predecessors;  still we must praise him for
 having avoided the exaggerations of his master in this respect.  He is
 astonished to  meet a  great many  laymen, and even a  few colleagues,
 who ask him  privately and in good  faith, if  he  believes  in  Medicine.
 "In their opinion," he says,  " Medicine  should,  to a certain  point, be
 assimilated to the  science of those Augurs who could  not look each other
 in the face without laughing."  M.  Bouillaud should rather be aston-
 ished that, after the declaration of so many illustrious physicians against
 this science, there  are still persons credulous enough to believe  in it, and
 bold enough to invoke its aid.   Should not the instinct which leads men
 to trust in the prescriptions of an Art which has been  so much derided
by its own adepts, be a safer  and  surer guide than the reasoning of its
 detractors?  This is a very grave'and very difficult question, whose solu-
 tion we cannot yet attempt.
  Let us  pass on  to  other medical schools, or rather to  other medical
 sects.  Toward the end of the  last century, Pinel, in the first edition of his
 nosography, declares that he does not propose  any other problem than the
 following:  " A disease being given, determine its true character and the
 rank it must take in a nosological  table."  Thus he  leaves all consider-
 ations in regard to treatment, so to say, in the rear.  He dare not lay
 down one single general proposition of therapeutics;  not because  he  is
 unaware of the extreme importance of this branch of science, but because
 he considers it too little advanced yet to be comprehended in generali-
 ties.   The proof that this was really his thought, is, that  twenty years
 later, in a note to  the  sixth edition of the same work, he declares that
 therapeutics, or the methodical treatment of diseases, is one of those parts
 of Medicine which must undergo a general reform, and upon which the
 attention of true observers cannot be too  often invited, as a serious sub-
 ject of their researches."
c M. Bouillaud, Essai sur la Philosophic Medicale. 
FIRST  LETTER.
603
   M. Louis does not accuse therapeutics alone of being still in infancy,
 but  also all other  branches of Medical  science.   " The physicians of
 antiquity have given us," he says, " very incomplete descriptions of  the
 diseases which they observed.   They have  left us numerous  therapeut-
 ical  precepts, but they are deprived of proof.     °     °    °     The
 modern physicians have scarcely been more successful.     °     °     °
 And still we count  among the physicians of antiquity,  as well as among
 their successors down to our days,  illustrious men, of rare capacities, who
 apparently wanted nothing to advance science, especially since patholog-
 ical anatomy has been allowed to be cultivated without  opposition.  How,
 then, is it that science owes them so little in general, and that its his-
 tory is in many respects only that of their errors or of  their systems." °
   M. Louis and M. Bouillaud  attributed  the errors of  the ancients to
 the faults  and imperfections of their methods of  examining  diseases.
 Consequently each of them traced  a formula or a  model for clinical obser-
 vations, to which they thought every one  should conform, in order to
 avoid the faults and errors with which they reproached their predeces-
 sors.   They insist,  also, in  having enumerated all the cases  of success
 or failure, in order to appreciate the value of the different modes of treat-
 ment proposed for each species of diseases.   This is  a condition very
 easy to fulfil, and which should never be neglected, although it does  not
 possess all the importance which these gentlemen give it.  In fine, they
 are both convinced that in following the rules which they prescribe,  we
 shall march henceforth, with a firm step,  in the path of progress.
   This  seems,  nevertheless, to  be an opinion contrary to that  of  the
 authors of a Treatise  on Therapeutics, published a few years later;  for
 we read in its preface the following paragraph : "We do not believe that
 by a work of the nature of the present one, we should or can set right an
 entire generation, which, according  to our opinion,  turns  its back  on
 truth, and which will have  to march, perhaps for some time yet,  in error,
 until that shall fall by its own consequences." f
   Thus, according to these  latter,  we have  not only been in error until
 now, but we are so yet, and are obliged to remain so for an indefinite lapse
 of time.   What, after this, shall the mass of practitioners and students
 do and believe, if the teachers themselves agree so little with each other
 that every new work which appears contains a more or  less explicit con-
 demnation of all those that have  preceded it?  Does not this popular

  0 Memoires de la Societe d'Observationes Medicales.   Year 1837.
  fMM. Trousseau  et Pidoux,  Traite  de Therapeutique et de Matiere Medicale,
 1841.   In  the third edition of their work, the  authors give a resume of their
doctrine. We shall speak of  this philosophical  conception  in  the following
letter. 
604
APPENDIX.
medical saying, which is a parody on  the  verses of a  cotemporaneous
poet, correctly say:
   " Driven thus from system to  system, shall me never be able to throw
out our anchor V
   Now, this want of union which I have pointed out as  existing among
the masters of this  science, does  not relate to details  only:  no,  it is
mostly upon the very principles which form the foundation of medical
science that they  disagree.   Each  one  of these  medical  legislators
aspires to nothing less than to build his ideal monument upon the ruins
of all  others.  They all commence  by destroying what  exists, leaving
to others to build up again when and how they can.
                    §11.  School op  Montpellier.
      There exist,  however,  medical Faculties  in  France as well  as else-
   where, among which the worship of the ancients is held in higher honor
   than it is in Paris,  and where the respect for the doctrines of the great
   masters is transmitted from generation to generation.  In Montpellier,
   for example, the physiological idea of Hippocrates, illuminated  and ex-
   tended by Barthez  forms  to  this day the foundation of  their  medical
   instruction ; and M. Lordat,  one of the most distinguished professors of
   that school,  has lately published a work consecrated to the development
   and the demonstration of  this same Hippocratic idea.0
      Not that  from time to time some  discordant voice is not  heard amid
   this harmony; but  if some heresy does show itself there, it does not
   ostensibly destroy the orthodox doctrine, but rather softens and hides its
   opposition under reverential forms.   Thus the historian of the  medical
   doctrine of Montpellier, after having enumerated  the works of Barthez,
   and paid a just tribute of praise to his genius, gives an excellent  critique
   of his system.f
     He goes  still farther.   He announces  in different places a  maxim,
   which, if true, overthrows  completely the medical doctrine of Barthez,
I   and of all  those  who have followed or may yet follow the same route.
I   It is  as  follows: " Physiology can  not serve as a basis for practical
   medicine."
     Such a proposition, I repeat it, does ruin not  only the system,  of Bar-
   thez, but  also many other ancient  and modern   systems.  But  M.
   Berard has contented himself with announcing it, without supporting it

     °Mt. Lordat,  Preuves de PInsenescence du Sens intime de PHomme.  Mont-
   pellier, 1844.
     f F. Bqrard, Doctrine medicale de Montpellier.—Paris, 1836. 
FIRST  LETTER.
605
by a single direct  proof;  on this account this bold proposition, which
contains the germ  of  an entire medical revolution, has passed by, so to
say, unperceived.  So far as I know, no one has even taken the pains either
to contradict it or  demonstrate it formally.  I shall endeavor to fill this
vacuum.  I shall  discuss, and in another letter will  try to  solve  the
following  difficult question, which should be the preliminary of every
medical doctrine: " Can  physiology form the base of the  practice of
Medicine ?"  In the  meantime let us continue our review of the opin-
ions of  physicians in regard  to the theory and  practice of their Art.
For this purpose we will take a look out of France, in  order to see if in
other countries there exist as deep dissensions on this subject as there are
in our own.  We shall, as we have done thus far, consider only the cap-
ital points of disagreement, i. e. those which have a bearing upon  the
entire science, or upon its fundamental principles.
                     § III.  Italian  School.
   At the end of the last century the doctrine of Brown was introduced
 into Italy, and was received there with  enthusiasm.  Basori, who  had
 studied it in England, contributed much to its extension.  This doctrine,
 as you well know, recognizes as  the  cause  of nearly all diseases, too
 great force  or weakness (sthenia  and asthenia).   Out of one hundred
 species of diseases there are scarcely three,  according to the tables of
 Linch, which can be regarded as being caused by  an  excess of vitality
 or incitability.   Therefore, nearly all medicaments, most all modifiers of
 the human economy, are  considered to be  stimulants,  and according to
 this system, the art of the physician consist simply in proportioning the
 force of stimulation to the degree of asthenia of the patient.  Medical
 science and practice are both reduced  by it to their utmost  degree of
 simplicity, which fact explains the rapid propagation  of such a system.
   Still, Basori himself  perceived, or thought he perceived, after a few
 years of  practice, that certain modifiers  did not act by stimulation, but
 rather by sedation, or contra-stimulation, and that a large number of dis-
 eases were based, not upon depression of vital forces, but upon their exal-
 tation.   From  that time he beeame a reformer himself, and henceforth
 Italy, as well as  France and England, had each  her own indigenous
 medical  system  founded upon the ruins, and to the exclusion of all
 others.
   " WThen we think," says one of the  most enlightened partizans of
 the Basorian doctrine, " from what sources the ancients obtained their
saotions of materia medica, we can not  be astonished that Stahl  has
 called the  pharmacology of  his  time a stable  full  of offal,  and that 
606
APPENDIX.
Bichat has judged so unfavorably of that of his epoch.0  In this we have
the condemnation en masse of ancient Medicine."
   In speaking of cotemporaneous Medicine he says:  " While the art of
diagnosis has made immense progress in France, that of the application
of medicaments has been entirely neglected.   The special doctrine of re-
vulsion plays a considerable  part  in the French schools.   Formerly all
was sympathy,  consensus, in diseases ; now every thing is antagonism
or revulsion."
   This is as much  as to say, Frenchmen understand diseases  very  well
but cannot cure them—that we treat them  irrationally.  WThat great
advantage ! to be able to explain to a patient the nature of his disease,
to discuss with more or less skill the origin, the seat, the  progress,  and
the probable consequences  of the affection  of which he suffers,  but to be
unable to relieve him ?  What would the  irritable  Broussais have  said
of such a judgment on his doctrine ; he who believed  to see already in
the diminution of mortality the happy results of its  propagation; he
who exalted its blessings as being far above those of vaccination ?  He
would,  doubtless, have cried  out  against ignorance, blindness,  and
injustice; but that would  not have prevented strangers from exercising
their judgment on our Medicine in the same manner as we judge theirs,
i. e. from a special, exclusive, and unfavorable point of view.
    § IV.  Parallel between the English, French, and Italian Doctrines.

   While in the native country of Brown most diseases are considered as
proceeding from a certain degree of feebleness, a diminution of vitality,
and are combatted by an increase of excitation, in France the  disciples
of Broussais considered most  pathological alterations as the product of
an  excess of excitability or irritation ; and they have nothing so much
at heart as to calm this irritation, to extinguish this phlogosis by means
of sedatives or  antiphlogistics.
  In  Italy they agree with the  French in regard to the nature of the
morbid affections,  which are  generally considered  as connected with a
sthenic diathesis, but the former differ widely from the latter in regard
to the appreciation and  the use of therapeutic agents.   The  same arti-
cles which pass on the north side of the Alps as energetic excitants and
powerful tonics, pass on the other side as  sedatives, or hyposthenics.
Thus  the quinine,  which,  in the eyes of the French and the  English, is
  ° Giacomini, Traite' philosophique et experimental de Matiere Medicale, et de
Therapeutique.  French translation, by M. Rognetta and M. Monjon. Paris, 1845 
FIRST LETTER.
607'
an  excellent tonic, has  in  the eyes of an Italian only a depressive
hyposthenic action ;  cantharides,  mercurials, iodides, etc., which in
France are classed among the acrid poisons and irritants, are ranged by
the Basorians among the contra-stimulants and sedatives.
  Thus, then, we may say that there exists in Medicine, as in theology,
an  Anglican,  a Gallican,  and  an Ultramontane doctrine; and these
medical doctrines are  not distinct from each other by mere shades of dif-
ference, but  they differ in their essentials—they  exclude  each other
mutually, and contradict each other reciprocally.


                     §V.  German  School.

  Germany could not remain  behind  the other countries  in  medical
inventions.   She felt the need, also, of having her own national doc-
trine for the nineteenth  century, stamped with colors  truly Germanic.
This  was  thoroughly understood by  Dr. Hahnemann;  consequently
he  commenced dreaming,  meditating,  and  experimenting,  but espe-
cially dreaming, until  at  last a ray from  on  high illuminated his
mind; the true law of past, present, and future cures  appeared to him
like a revelation, as a pure action  of divine love.   Great  physicians of
antiquity and of modern times, whose collective works of thirty centu-
ries have served to raise the scientific monument  of the Healing Art—
illustrious men, living and dead, bow before this medical messiah  !  Your
lights were but darkness, your  teachings pure deception, your  practice
a series of blunders and homicides !
  The same would be the case yet, if the pious, the modest Hahnemann
had kept to himself his great discovery.  But he did not wish to deprive
his fellow men of such immense blessings ; he hastened to propagate it
every where; and if the entire human species does not enjoy these bless-
ings to-day, it is  not from want of good will on his part.
  Do not imagine, dear reader, that I am  jesting,  or exaggerating the
mistico-emphatic language  of  the German thaumaturge, in   order to
render  him  ridiculous.   Hear  him   speak, himself.   After  having
recounted  how  he had succeeded  in  finding the  only  true   way of
obtaining veritable, easy, prompt, and certain cures, he exclaims: " For
truth is  eternal,  like divinity itself.   Man may neglect it for a long
time, but the moment  comes at last  when, in the fulfillment of the
decrees of  Providence, its rays pierce the  cloud of prejudices,  and
throw over  mankind  a beneficent light, which  henceforth nothing can
extinguish."0
0 Hahnemann.  Organon.  Paris, 1845. 
608
APPENDIX.
   " If I did  not know that I am placed in this world in order to
improve myself as much as possible, and to do to others  all the  good of
which I am capable, I should consider myself very foolish in making
the public  acquainted, before my death, with an  Art of  Healing which
I  alone  possess, and whose  advantages  I might consequently have
enjoyed alone, by concealing this Art."0
   The inventor of Homeopathy and infinitisimal doses might have been
asked—If  you had kept your secret until you descended  into the grave,
who could guarantee you that it would not have been buried with you ?
And even if it should not have fallen into  oblivion after your death,
you would not have enjoyed during your life such notoriety; you would
have passed away in some obscure  corner of the world, and your exit
would not have caused the least sensation.   You had therefore  a great
and immediate interest in divulging as early as possible your discovery,
independently of the  satisfaction which  every  man, every Christian
must feel in fulfilling  a duty toward humanity.   For nothing equals, if
we believe  you, the frightful evils which were inflicted upon mankind by
former Medicine — this fatal  Art, as you call it, which for centuries
has  enjoyed the power to decide, arbitrarily, on life and death, which
destroys  ten times more than do the most murderous wars, and which
makes millions of  others infinitely greater sufferers  than they were at
first.!

                       § VI.  C onclusion.
   I will  limit here my citations.  I believe that I have superabundantly
proved what I said at the commencement of this letter, that there exist
no  more violent detractors  of  Medicine than physicians themselves.
Can we be  astonished, after this, that we find among them so many who
are incredulous, so many sceptics, who exercise  their Art without hav-
ing faith in it ?   But I know of no  more revolting position  for a con-
scientious man, nor a more ridiculous one, than that of a physician who
has no confidence in the means he employs.   Such a man can not possi-
bly pursue  the study  and the practice of his  Art with the zeal, applica-
tion, and assiduity which alone can  secure him real, honest success.
For, in order to study and practice  Medicine well, says  a wise man of
our time, we must give it great importance, and  to  be able to do this,
we must  believe in it. J

  tt Hahnemann.  Traite des Maladies Chroniques.
   t Organon.
   I Cabanis.  Du degre de Certitude de la Medicine. 
FIRST  LETTER.                       609
   It is therefore essentially necessary that the physician, as well as the
public,  have a reasonable opinion on the degree of confidence which may
be placed in Medicine.   But where shall we find motives of conviction
in favor of this science, when its most renowned masters are so bold and
so loud in discrediting it ?   When every new medical generation accuses
all preceding ones of gross and fatal errors?   Who can assure us that
the teachings of to-day will not  be treated as vain deceptions to-mor-
row, in  a few years,  or a century hence?  Is  there in this matter any
certain  sign, any criterion by means of which we may infallibly discern
the true from the false, the certain from the mere  hypothetical ?   This
we shall examine in our next letter. 
610
APPENDIX-
                    SECOND   LETTER.

IS  THEEE IN MEDICINE ANY MEANS  OP DISCERNING THE TRUE  FROM  THE
 FALSE, THE CERTAIN FROM THE HYPOTHETICAL?

              § I.  Importance  of this Question.
   It wants only one moment's reflection to be convinced of the extreme
importance of  such a question, upon whose solution depends, if I  do not
deceive myself, the whole future of the science.  Indeed, if there exists
a criterion by the aid of which we can surely recognize truth in Medicine,
if  this  criterion is within reach of every mind,  and is applicable  to
every part of medical science, then we  understand at once that  this
science is possible, and those who devote  themselves to its erection  may
hope not to work in vain.
   But if such a criterion does not exist, or has not been found, this
science is impossible; then all our knowledge of medicine is  conjecture,
hypothesis, and opinions, more or less probable.  It is, therefore,  of the
very greatest importance, before we lay the foundation of the scientific
monument of  Medicine, that we examine  if we possess  a rule, a fixed
standard, accepted  by  all, by  means  of which  we  may judge  with
certainty the value of the facts and ideas which shall in  future consti-
tute this monument.
   As a skillful architect,  before he proceeds  to  the construction of  an
edifice, reduces all his  measures,  and  all  his calculations to  a known
and invariable quantity, called  unit, so also must physicians  choose a
fixed, uniform, and sure criterion, in  order  to  estimate  the degree of
certainty, adaptation,  and utility, of  the different propositions which
form the materials of their science.  Without this precaution they will
never  be able to  agree upon any subject.   Their discussions will con-
tinually degenerate into mere verbiage, as has been the case too frequently,
until now,  and they will continue to  offer to  the world a ridiculous
spectacle, like individuals who, desirous of appreciating a common object,
as for example, the hight of a steeple, or of a mountain, still persist, each
one according to his own caprice, in taking a different standard as  unit,
bearing no relation whatever to  the  other  measures.   Such surveyors
would most certainly never arrive at identical or even comparable results. 
SECOND LETTER.
611
  It is, therefore, essentially necessary, if we wish to put an end to this
continued  and profound conflict  of  medical opinions — a  conflict  so
injurious  to  the  progress  of science, and  to the standing of those who
cultivate it — it is necessary, I say, to choose a mode of appreciation which
belongs to all  times, and  all places, embracing all facts, and all ideas,
that compose, or  may yet compose, the science of Medicine ;  which will
bring them all back to a unique, universal, invariable standard, known
and accepted by all.  Now, in order to find such a mode of appreciation,
which is perfectly appropriate to medical researches, we must know their
final aim—just as a traveller must have fixed the point which he desires
to reach, before he decides  which route to take, without which he travels
at hazard, like a fool.
  Let us examine, therefore, first of all, what is the  final  aim  of the
science  of Medicine.
             § II. Final Aim  op  Medical  Science.
   In the primitive ages Medicine was defined to be the Art of Healing ;
 at that time therapeutics  was evidently the final aim of that science.
 Later, when the field of observation had been widened, it  was seen that
 it was often much easier, and  always more advantageous, to prevent
 diseases, than to combat them after they were developed.   Consequently,
 the tree of medical science brought forth another branch, called hygiene,
 or prophylaxy,  whose  special object consists in preserving  health, or
 preventing  the development  of  diseases.   Properly speaking, this new
 branch is an offspring of therapeutics, and was so  considered by many
 ancient as  well as modern  authors,  and  thus this science has  not
 changed its aim by this accession, but has been  enlarged  and extended
 by it.
  For some  time past, Medicine has occupied itself in a more efficacious
 manner, with two very important orders  of morbid  affections, which
 formerly were entirely  overlooked, or at least  much  neglected—I allude
 to the  deformities which are the objects  of orthopedia,  and mental
 affections, which  constitute at  this  time one of our most  interesting
 specialities.   In view of these additions, Medicine can now be defined:
 a science whose object is the preservation of health, the cure  of diseases,
 and  the physical  perfection of man.   Bemark,  I beseech you, that in
these successive evolutions the aim of the  science does not change, and
it never leaves  the sphere of therapeutics.   Therefore, it may  be said
for all epochs with equal truth :
                Ars medica est id quod est propter therapeuticen.
     Everything in Medicine is related, or should relate, to therapeutics. 
612
APPENDIX.
    § III. Answer to the Question placed at the Head of this Letter.

  Now, as the  aim of the science of Medicine is fully  known to us,
nothing is easier than to determine the route which leads us to it, or, in
other words, than to find a sure method for the discovery and the founda-
tion  of truth  in Medicine.   We can, from this moment, establish  the
following general proposition: Every notion, every idea, every hypothesis,
every system, which is useless  to therapeutics, must  be banished from
Medicine, as useless and  superfluous; every  notion, every idea, every
hypothesis, every system, which leads  to  false or  hurtful consequences
in therapeutics,  must be rejected as tainted with error.
  Then, if we ask by what means, in what way, we can assure ourselves
that any doctrine is either advantageous,  or  barren,  or  prejudicial to
therapeutics, I acknowledge that I know of none  better, or more direct,
than experience.  Thus, in my eyes, the universal  criterion of truth in
Medicine, the supreme  test of the value of all  ideas and discoveries
which  belong to this science, is none other than therapeutical proof .   It
seems to me that I see  the reader smile at this word, and hear him say:
This is certainly no new maxim !  There is no one who does  not agree
that therapeutical proof is the best and surest mode of verification which
we  possess  in Medicine—the  ultima ratio of all medical  doctrine.
Every  day the founders of new systems appeal, themselves, to this defini-
tive tribunal.   But this does not prevent  and never has  prevented the
most absurd theories,  the  most ridiculous errors, from  invading  the
domain of this science; and there reigns to-day still the most  complete
want of harmony among physicians upon the most fundamental ques-
tions of the  Art.   This objection, therefore, is serious, and  should be
closer examined ; but I do  not believe it insoluble, and I  will endeavor
to reply to it.   It is not sufficient to  proclaim in  a vague and general
manner that therapeutical proof is the best criterion, in medicine ; it is
also necessary to know how to make  a rational and methodical use of
this universally admitted criterion; just as it does not suffice to possess
an excellent musical instrument in order to obtain pure and harmonious
sounds; but we  must also understand  a  good  method of playing,  and
have practised on it.
  Now, I ask, does there at this time exist in our science a general  sys-
tem  of therapeutics,—a system which embraces as a whole, logically
arranged, all plans of treatment ?  Is it not, on the contrary, an opinion
universally accredited in all the schools, that the time has not come yet
for a rational systematizing of this  branch of Medicine ?   You have
read in my First Letter (§1) what  some of our cotemporaries think 
SECOND LETTER.
613
upon this subject.   You may appeal to any other of our modern classics—
you  will  not find in one  of them a  different opinion.   All agree in
admitting rational and irrational modes  of medication, which latter
they call  also empirical.  But what is oddest in this classification, is
that the modes of medication called irrational are generally the most
efficacious.
   It is therefore a new idea, which possesses at least the merit of origi-
nality,  to try to construct logically the entire  field  of  therapeutics—to
unite in  one plan and under  the guidance  of a  unique principle all
modes   of  internal and  external medication, without  regard  to  any
pathological  system.  Such  an idea must appear certainly very paradoxi-
cal to those who profess with M. Bouillaud that " therapeutics is neces-
sarily but a deduction, a corollary from the  ideas which are formed on
the nature of diseases," and that it cannot be anything else.
 § IV.  Inquiry after the Fundamental and Universal Principle  of Thera-
                                peutics.
   If the question were asked, what has  taught men to provide for the
 indispensable things of life, to  prepare their food and clothing, to con-
 struct habitations to shelter them against the rigor of the seasons, etc. etc.,
 no one would be at loss for an answer.  It is want, necessity, the instinct
 of self preservation.   If we now ask, what has inspired these same men
 with aversion to pain, the fear of disease and death, the desire to defend
 not only themselves but also those who are  dear to them, against these
 afflictions ? we  can answer with the same assurance : It is a  natural,
 irresistible instinct, which is felt alike by the savage on the desert and
 the inhabitant of  the city, by the poor and the rich, by the philosophic
 and  the illiterate.
  Now, experience early taught the inhabitants of the earth that nature
 alone is insufficient to aid them, in many instances.   As for example, an
 individual breaks  a limb:  nature is incapable  of bringing and  keeping
 together the two ends of the  broken bone.  Another dislocates an arm
 or a leg.  If he expects from nature the reparation of this accident, he
 will  be deprived for his whole life of the full use of his limb.   A third
 ruptures a large vein or an artery; nature, powerless in this case, will
 suffer this individual, full of  health and  life,  to succumb from  the loss
 of his  blood.  Let a woman in  labor be seized  with convulsions or vio-
lent  hemorrhage, or let her child present  itself  in an unfavorable posi-
tion, and what will mother nature do  in presence of such accidents ?
Nothing.   She  will  allow  both  victims to  perish.    In fine,  there 
614
APPENDIX.
 happen  every day in the  natural course of life, a number of accidents
 which nature alone is incapable of repairing.   Hence  men  very early
 acquired the conviction that they could only expect aid from Providence
 when trying to aid themselves by every means at their command.  Con-
 sequently, as soon as one of them received a wound or was attacked by a
 disease,  those who had  witnessed similar cases wrere invited to see it, that
 they might indicate the remedies which they had seen employed in simi-
 lar cases.  Soon  there  were found men, especially old men, who distin-
 guished  themselves by their skill and experience in these kinds of acci-
 dents, "and who transmitted to others the fruits of their observations.
 Such was, among many nations, the  origin of medical  science, as is
 attested  by tradition and authentic monuments.0  Afterward, the art of
 writing having been invented, it  became  possible, with the aid  of this
 admirable art, to preserve indefinitely the remembrance of diseases, and
 the means used for their cure.  Henceforth  they began to form nosologi-
 cal collections, i. e. collections containing more or less detailed  descrip-
 tions of  the morbid affections which were observed, and of the treat-
 ment which was employed against them.   These collections became the
 first codes of the Healing Art, and the  men  who  devoted themselves
 especially to the care of the sick studied them no  doubt as rules for
 their conduct.  Gradually these collections were enlarged by successive
 additions of new observations; so that when they had attained a con-
 siderable volume, it became necessary to arrange the materials of which
 they  were formed, in a certain  order, which  made it easy  to find at
 pleasure  the instructions  that were wanted.   This was the origin of
 pathological classifications.  The idea of it  was suggested by the desire
 to aid the memory and facilitate researches.
   At that epoch  very  little  was done in  the study of the intimate
 nature of diseases and the physiological action of medicaments.   They
 were  satisfied to  observe  and to describe  the morbid phenomena as
 they showed themselves, and to note the apparent effects of the remedies.
 And this is done yet by all persons ignorant of the science of Medicine,
 when they undertake to give their advice to the sick.   These  persons
 have no other way of expressing themselves than the following:  I have
 seen precisely the same disease cured by such or such remedy,
   At first sight the medical practice of those primitive times seems to
us gross and scarcely reasonable; but when we consider it nearer—when
 we examine with  unprejudiced eyes the motives  which directed it, we
 find that, far from being unreasonable, this  practice was based  upon a
principle of incontestible evidence, which may be stated in the following
° Primitive Period; Medicine among the Egyptians. 
SECOND LETTER.
615
words:   Every  kind  of medication  which  has  cured  one disease
must also cure analogous diseases.   No  objection can  be made to this
principle.   It possesses all the clearness and infallibility of a mathe-
matical problem; it corresponds with the following metaphysical axiom:
The same cause, the same force or the same combination of forces, acting
in identical conditions, will always produce the same effect.
   We see also by a little reflection, that the above  announced  principle
embraces all  the  operations of  internal  and  external  Medicine, as well
as all the precepts of prophylaxy.  Thus there has existed at all times
a fundamental and universal principle for the  practice of Medicine; a
principle by which the physicians of the most remote times were guided
without knowing it, and which is followed yet, though ignorantly, by
all persons without medical knowledge, when they undertake to give
advice to the sick.
   But if it may  be permitted,  as Moliere  says, to write  prose without
knowing it, it is  still better to  do so knowingly, because it is then done
much better.   So if there are now persons who employ this fundamental
principle of therapeutics without understanding it, it  is  still  better to
employ it understandingly.   This is, besides, more worthy of a practi-
tioner who  loves to understand  the motives of his conduct, and it is also
more satisfactory for the  patient.   Let us  see, therefore, how we can
make a logical application of the above proclaimed principle.
    § V.   Rational Application op the Universal Axiom of Therapeutics.

   I have said it was a new idea to try to bring therapeutics under  the
dominion of a single principle, disconnected from  all pathological sys-
tems.  This is true only in regard to modern times, for there existed in
antiquity a sect of medical philosophers who conceived the same project
and  attempted  its execution.  But  their  doctrine  did not  prevail,
because they did  not  develop it  fully,  or  did not defend it well, or it
may be that their cotemporaries did not understand  and appreciate it.
At all events, their labors  and their system have been almost completely
lost, and their name has in many instances become a word of reproach.0
   In reflecting a little upon this axiom, Each remedy which has  cured
one disease, must also cure  analogous diseases, we can not fail to perceive
that its practical application  depends upon three conditions, viz:  the
homogeneousness of the diseases, identity of the curative means, and
knowledge of the best possible treatment for every morbid species.  Let
0 See Philosophic Period. 
616
APPENDIX.
 us see, therefore, how we can fullfil these three conditions, if not in a
 perfectly exact manner, at least proximately.

         FIEBT CONDITION. — H 0 M 0 O E N E 0 U B N E 3 8  OP DISEASES.
   No practitioner during his whole life has ever met two identical mor-
 bid cases, and nature perhaps never produces them exactly alike.  We
 must therefore be contented with a greater or less  similarity.  But on
 what  degree of approximation must the  physician  rest,  or, in other
 words, in what symptoms will  he recognize similitude  enough in  two
 diseases,  one of which is under his eye and the other has been observed
 formerly, in order to treat the second by the same remedies  as the first ?
   We are  touching here the most  knotty question in pathology,  the
 question which has been the object of the most assiduous researches
 and the most profound meditations, the question which  has excited  the
 most discussions, given  birth  to  the  greatest  number  of systems,  and
 engendered the most errors:   What are the characteristic  signs  of the
 homogeneousness of diseases'?  Interrogate  the physicians of all sects
 and of all times upon this subject, and they will all give you different
 and even  contradictory answers.
   In the  beginning, they were satisfied with a  mere  superficial resem-
 blance ; it sufficed that a patient presented  one  or two symptoms similar
 to those which had been observed in another, to authorize the applica-
 tion of the same treatment.  It is upon this same gross appearance that
 quacks and charlatans judge yet, daily, of the similarity of diseases, on
 which they advise certain kinds of medication.   Let a child, for exam-
 ple,  be attacked with a slight impetigo of the face or head, and a quack
 (pharmacopole) will  not fail to prescribe bitters, depuratives, and setons.
 without even examining  the state of the digestive organs or the nervous
 susceptibility of the little  patient.  Let  an old  man cough up  some
 mucus, and at once they administer a variety of cough mixtures.
   Men accustomed  to the  observation of diseases  dare not prescribe
 remedies  so  thoughtlessly.   They know  how faulty and dangerous is
 this  manner  of diagnosticating and determining  a  pathological  state.
 "I have always felt  it acutely," says Pinel, "and I feel it yet  daily,
 how  important it is for us to cultivate, after the example of naturalists,
 the science of signs,  to become accustomed to understand well the  exter-
 nal  characteristics  of diseases, and to be  constantly guarded  against
 illusion and errors in difficult cases."
   " Notwithstanding the immortal works of Morgagni," says M. Bouil-
 laud, " notwithstanding the anatomo-pathological impulse which Bichat
and his school had given to  Medicine, and which Pinel has the credit of
following in several parts of his nosography, notwithstanding  all this, 
SECOND LETTER.
617
 the time had not yet come when diseases were, so to say, personified, by
 attaching them to the organs ; in a word, localizing  them.  This  great
 era, for which preparations had  long  been made, shone  only in all its
 splendor at the epoch when the author of Chronic Phlegmasia took the
 scepter of Medicine, which the old Pinel had borne so  long with honor,
 but whose weight he could no longer bear.   This  new era dates from
 the year 1816, when appeared the famous Examen dela  doctrine Medi-
 cale  genf.ralemcnt adoptee, with  the following epigraph,  taken from
 Bichat:  What is observation worth, if we are ignorant of the seat of the
 disease ?
   Thus the nosological formula of Pinel which had, at the commence-
 ment of the nineteenth century appeared  to  be so  exact, is judged as
 insufficient by Broussais but  a  few  years later; and the formula of
 Broussais, so highly praised by M. Bouillaud, appears  to-day as incom-
 plete in  many instances, so true is it,  that  the diagnosis of diseases
 changes in proportion to the progress  of science, and offers  at all times
 difficulties which the vulgar do not even suspect.
   It is frightful what immense and minute details  M. Louis demands
 for the true appreciation of pathological facts ;  still, after serious reflec-
 tion,  we are obliged to agree with him that these details are necessary iu
 researches after truth.
   Here is the abridged table of the principal characteristics which con-
 stitute to-day the  diagnosis of diseases, and  by which we  are able to
 discern the different morbid species, or the homogeneousness of each of
 them:  First, the circumstances anterior to the invasion  of  the disease,
 which comprise the predispositions or  diathesis, the  occasional or deter-
 mining causes, contagious infections, etc.; ° second, the anatomical seat
 of the disease, i. e., the designation of the organ or tissue  principally
 affected, and sometimes the indication of a vitiated  humor; third, the
 mode and degree of alteration of the organs;  fourth, the idiopathic and
 sympathetic functional derangements,  their regular or irregular, contin-
 ued or intermitting course;  finally, the cadaveric lesions found in those
who have succumbed to the  same morbid species.
  We see by this enumeration of the principal objects which constitute
 the diagnosis  of a disease, that in order to be able to fulfill  this condi-
tion well, we must  unite  to a most precise  knowledge  of  nosography
and  pathology, the lights of anatomy, physiology,  chemical analysis,
pathological anatomy, etc., etc.
  This immense difficulty of diagnosis is, without contradiction, one of
  0 Memoire sur PExamcn des Malades et la Recherche des Faits generaux, by
M. Louis.  Paris, 1846.
          39 
618
APPENDIX.
the greatest obstacles which we meet with in the study and practice of
Medicine.  There are no systems, no combinations  which pathologists
have not imagined, with the view of overcoming or facilitating it.   All
have  endeavored to unite the infinite number of varieties of diseases
into a small number of types, distinguished  from each other by appre-
ciable characteristics.
  Hahnemann alone, wishing to spare himself and his disciples the labors
of diagnosis, has given the singular precept to note one  after another.
without choice,  without discernment, in  the  mere order in which they
make their appearance, all the symptoms observed during  the course of
a disease, either by  the patient himself or the  physician.   But this
method, apparently so natural and exact, is in reality extremely defec-
tive and even impracticable, as will be evident by the following table :
  First, Such a method is extremely defective, for it makes the capital
error  of ascribing the same value to all morbid phenomena, while  there
exist  immense  differences among them, as the  most superficial clinical
observation proves.  What shall we think of a pathologist who considers
as signs of the  same disease, and as possessing equal value, the follow-
ing symptoms:
  Insatiable thirst,
  Palor of face,
  Scrofula,
  Sweating of  the head after sleep,
  Burning in the palms of the hands,
  Frequent attacks of suffocation,
  Furuncles,
  Vomiting of  blood,
  Hiccough after eating or drinking,
  Cutting pain in the rectum while at stools,
  Absence of venereal desires,
  Unbridled lusts,
  Somnolency during the day, after meals,
  Paroxysms of anger bordering on mental alienation,
  Tears, frequently, at the slightest causes, etc., etc.0
  Thousands of phenomena, thus thrown together without  order, consti-
tute no more clinical  observation, and give no  better idea of  a disease,
than  a number of stones piled up without plan constitute the  Pantheon,
or than lines drawn capriciously on  paper present the image of a regular
monument.   This is  certainly no method at all;  it is the absence, the
negation of all  method in pathology.  It is chaos.
0 See Treatise of Chronic Diseases by this author. 
SECOND LETTER.                      Q\g
   Second, a peremptory motive opposes the adoption of such a proceed-
ing.  This motive consists, as we have said above, in the impossibility
of  its being put into execution.   Indeed, let one try to note down all
tne slight and grave, passing  and permanent accidents which  arise  in
the course of a morbid affection,  and take account of all the changes,
all the impressions, moral as well as physical, which the patient experi-
ences every day,  every hour,  yea, every minute.   It would be  just  as
reasonable to try to count all the grains of sand driven  before a storm,
or the atoms which a ray of light  falling into a dark room, causes to
glitter in the air.   Both the undertakings are equally impracticable and
futile.
   We are therefore led by the natural  connection of ideas, and the  ir-
resistible force  of things,  to make  a choice  among  the symptoms
which present themselves in  the course of a disease.  We are obliged
to ask ourselves the question :  which are among the pathological symp-
toms, those which are of greatest importance, those which are less grave,
and those which  are  of so little value that they may without inconven-
ience, be entirely overlooked ?
        SECOND CONDITION. — IDENTITY OP  CURATIVE MEANS.
   Hygiene and materia medica being the two sources from which Medi-
cine draws its means  for combatting disease,  it is evident that the prac-
titioner must be fully acquainted with  the  resources which these sci-
ences offer him.  Now, hygiene receives its light principally from physics,
chemistry, etc.; materia  medica cannot be  understood without a knowl-
edge of pharmacology, natural history,  etc. •  Thus the practitioner dare
not remain a stranger to any of these branches of human knowledge, in
order that he may be able to choose, prepare  and superintend the use of
curative agents with  the greatest possible discernment and exactness.
It is furthermore indispensable that he obtain on the part of the patient
himself, entire obedience, and  faithfulness on the part of the attendants,
THIRD  CONDITION. — KNOWLEDGE  OF THE BEST  POSSIBLE TREATMENT  OF
                      EVEKY  MORBID SPECIES.
   The aptitude to fulfil this last condition, that  is, to discern the treat-
ment best adapted to each  pathological case,  constitutes alone the  true
practitioner.  This distinguishes him from the mere erudite;  it forms
the cap stone of all   medical  education.   But nothing is more  rarely
found than  such an aptitude ;  and nothing is more  difficult to acquire.
It can only be attained by combining the  scientific knowledge of the
century, with a large practice,  directed  by a wise method,  and  con-
ducted by a sincere desire to be useful to his fellow  man, and by a rea.
sonable faith in  the efficacy of the Art.
i 
620
APPENDIX.
   It is a truth proclaimed by all the masters of science, that it does not
 suffice to see a great number of patients, in order to become a good medi-
 cal practitioner;  but  that it is also  necessary to examine every cast.
 with a care and a zeal which cannot be shaken by the fatigue or disgust
 to which the practice of Medicine is subject.  Now, he  alone is able to
 overcome such obstacles, who devotes himself  to the study as well as to
 the practice of his Art, with a real love for mankind, and a reasonable
 confidence in the means he employs.  Even popular instinct  knows very
 well how to distinguish the  practitioner who observes his patients with
 attention and interest, from him who scarcely examines them at all,  lis-
 tens to them inattentively, and prescribes for them with indifference.
   But let  us suppose a physician to  be provided with  the necessary
 knowledge, and animated by sentiments worthy of his profession,  what
 method must he follow to arrive at the determination of the treatment
 best adapted to each morbid species ?
   We  have  already said that the first experimenters did not reason at
 all upon the intimate action of remedies, but that they contented  them-
 selves  to observe  their most  apparent  effects, and  to note those which
 had cured, or seemed to have cured certain  diseases, in order to employ
 them   again  in  similar cases.    The  first materia  medicas  were  so
 arranged that curative means  were  classed  according to  their most
 usual  and  evident  effects.   Blood letting for example,   must have
been classed among the depletives  of the  blood vessels;  hellebore
 with the eccoprotics, because it produces, generally, alvine evacuations ;
 opium  with the upnotics or anodynes,  because it often  produces  sleep.
 and allays or cures pain.  This classification,  and these denominations.
 were irreproachable, for they were founded upon  a real and incontestible
 action  of the curative  agents.   Besides, if  imperfections or  errors had
 entered into the  first collections in  consequence  of superficial or too
hasty  observations, a riper,  more attentive observation, would lead to
their expulsion.   Thus, for example, after  having  classed opium with
 the upnotics, nothing forbade to add that this substance sometimes pro-
 duces agitation instead of sleep ;  whence it follows that it is to be ad-
ministered with great circumspection, and only after determining  fully
under what circumstances and  in what doses it  produces or augments
 agitation.
  We see by these examples that therapeutics,  which from  the begin-
ning had  been founded upon  the simple results of experience, should
 have been enlarged and perfected  by the same method, that is, by con-
tinuing to take into account only the pure results of experience,  without
 seeking to explain them.   Such is, indeed, the method  to which Bichat 
SECOND LETTER.
621
seems to allude in the following sentence:  " Except the medicines whose
effects are  established by strict observation, such as the evacuants, diu-
retics, sialagogues, etc., and to what does our  knowledge of the  rest
amount ? "
   But there arrived  a  time when this manner of studying the action of
therapeutic agents appeared  to be too simple, too superficial, too much
subject to error.   Physicians wished  to penetrate deeper into the secret
of the modifications which each medicament produces upon the human
economy.  They reasoned thus:  The sensible effects vary frequently,
according to a great number of circumstances, often difficult to appreciate.
As these consecutive  effects all depend upon the  intimate molecular im-
pressions which each  therapeutical substance exercises constantly in the
organism, if we can only arrive at determining the nature of this impres-
sion,  we shall, by this means, know the secondary effects which  depend
upon them—we shall be able to foresee and explain them logically.
   This new method was considered  the most rational, the shortest  and
most direct.  It prevailed, at  length, almost universally in science,  and
is yet followed by most of our medical writers.   Still  it  has produced
but very unsatisfactory results, as we can judge from the great want of
harmony which  reigns  to day upon  this subject  in the profession, as I
have  proved in  my First Letter, and which Bichat has painted in such
energetic colors.
   " Into what errors  in the use and denomination of medicines have we
siot been lead ?  WThen the theory of obstruction was in vogue, desobstru-
ants were created.  Incisives sprang up when  the theory of the thick-
ening of the blood  became  the  favorite  idea.   The  expressions,
dilutants and attenuants, and  the  ideas which were attached to them,
arose at  the same epoch.   When  it was necessary to obtund acridity,
inviscants, incrassants,  etc., were created.  Identical means have often
had different  names,  according to the manner in which  they were  sup-
posed to  act—desobstruant with one,  relaxant with another, refrigerant
with  a third—the same medicament has  been employed in turn, with
different and  even opposite views,  so true is it  that the  human mind
marches  at hazard where the vagueness of mere opinions  guide it." °
   This would be the  place to speak of the therapeutical methods—that
is, of  the general plans of treatment which might be formed in the actual
state  of science, independently of all pathological systems.   But I can-
not treat at the end  of a letter, so important  a  subject, upon which I
have  to say so many  things which differ from the ideas  received in  our
' Anatomie Gcne'rale. 
622
APPENDIX.
schools.  I shall reserve it, therefore, for another occasion, when it will
be possible for me to treat it as widely and as much in  detail as the
subject demands.
                       §VI.  Conclusion.
   We have proved that in the eyes of the learned, as well as the ignor-
ant, those well versed  in the science and  practice of Medicine,  as well
as in those who are strangers to the  Healing Art, the  best  criterion of
truth in Medicine is  nothing else  than  therapeutical proof;   conse-
quently we have endeavored to establish this proof on a fixed,  evident,
and incontestible principle, not subject to the vicissitudes of pathological
theories—and we  have found that this principle may  be expressed  as
follows:  That  medication which  has cured  one disease,  must cure
equally, all analogous  diseases.   Whence is derived this universal and
absolute precept:  Treat each disease  by the  means whose efficacy expe-
rience has  demonstrated in homogeneous  cases.
   Then we have  shown that the rational  application of  this axiom
rests on three conditions, whose fulfillment demand that the practitioner
possess, with the scientific knowledge of his time, a consummate experi-
ence—in other words,  that  its rational application necessarily requires
the indefinite developement of all intrinsic, as well as accessory branches
of medical science.  Under the impulse of such a principle,  science has
grown from its origin,  and must continue to grow in the future.
   For this reason one  of  our most  ancient  authors could say with
deeply felt truth: " Medicine has long been in possession of a principle
and a method, both of which it has found.   With these guides,  numer-
ous and valuable discoveries  have been made in the course of centuries,
and the rest  will be ascertained when capable men, acquainted with the
discoveries of the ancients, take these  as a starting  point  for their
researches.   But  he who, rejecting and  disdaining the past, attempts
other methods and other paths, and then pretends to have found some-
thing, deceives himself, and will deceive others." °
   These prophetic words have not prevented a great  number of poste-
rior authors  from seeking other paths, and from proclaiming new prin-
ciples.  What have been the causes of this scientific revolution ?  What
are  even to-day its  consequences ?   These are questions which I pro-
pose to examine in my next  letter.
s Hippocratic works, Treatise on Ancient Medicine. 
THIRD LETTER.
623
                      THIRD  LETTER.
 § I.  Causes which induced the  Physicians to leave the Primitive Route of
                          Pure Observation.

   Art is long, life is short, experience deceptive, and judgment difficult,
 said Hippocrates, when he was about to give to the public  his Aphor-
 orisms, that summary of the  medical science of his time, collected by
 him and his associates in the  temples of Esculapius during  a series of
 centuries.   This sentence, which we must regard as the  scientific testa-
 ment of the greatest  physician  of ancient times, contains  the entire
 secret of the intellectual revolution which we are  going to trace.  Phy-
 sicians abandoned henceforth the path of  pure  and  simple observation,
 hoping to find a surer guide in physio-pathological observations, and
 with the view of hastening the too slow  progress of the Healing Art,
 of avoiding the  interminable and dangerous gropings of  experience, and
 of overcoming the difficulties of diagnosis.
   Indeed, the universal precept of therapeutics, given at the end of the
 preceding letter  in these terms : Treat every case of disease by the rem-
 edies whose  efficaciousness in similar or homogeneous  cases has been
 proved by experience ;  this precept, I say, which the physicians of  the
 primitive period had followed instinctively,  presupposes  the  knowledge
 of a treatment for every morbid species, and the capacity of discovering
 fully the  homogeneousness or similarity of diseases.  Now  science is
 yet far distant  from  this degree of  perfection,  notwithstanding  the
 incontestible progress it has made since the time of Hippocrates.  We
 meet in practice, almost daily, diseases for which  experience has until
 now discovered no sure remedy.   Again, it is often the case that a rem-
 edy which formerly was  remarkably efficacious  in certain  affections,
 now fails in cases considered as entirely analogous to them.
  In  all these unfortunately too frequent  circumstances,  the above pre-
cept leaves the physician in embarrassment; it indicates to  him in no
way the conduct he should pursue.  The  physicians of  the  Empirical
school of Alexandria recognized this void, and they endeavored to fill it
by adding to their general rule  of therapeutics a corollary,  under the
name of analogism or epilogism.   This corollary was as follows: 
624
APPENDIX.
                EXAMPLES OF  EMPIRICAL ANALOGY.
  [f you meet, said these physicians, with a morbid condition for which
neither your own nor others' experience furnishes any therapeutical indi-
cation, you can do nothing else in such a case  than experiment.  You
must seek with what known affection this new one may have any analogy,
and try in this case the remedies which succeeded in the former.  Thus
the treatment which has been employed successfully in erysipelas, might
also be tried in certain tetters; so the remedy which  cured a rheuma-
tism of the  arm, will, in all probability, cure a rheumatism of the leg.
  They adopted the  same manner of reasoning when seeking curative
agents which we call succedancous or supplementary, when the known
means were  not sufficient.  Thus, experience having shown that the juice
of the quince was useful in diarrhea,  if  they could not  procure them-
selves that substance, they tried to replace it  by another which had a
sensible analogy to the first;  for example, the juice of the medlar plant.
which is analogous to the above by its sharpness, appeared  to them  as
proper to fullfil the same indication.
  The analogies of the  Empirics were all founded on sensible and appa-
rent qualities, whether  they applied  themselves to diagnosis or to the
choice of curative agents.  These analogies appeared too superficial and
unsafe to the Dogmatists.  These preferred seeking more radical analo-
gies, that is to say, those founded  on  less superficial and more stable
qualities, which they honored with the names elementary, constitutional
essential, or occult qualities, etc.
               EXAMPLES OP  EMPIRICAL EPILOGISM.
  If a patient feels in the hypogastric  region  intermitting  and violent
pains, which are exasperated in walking or riding, but are, on the con-
trary,  quieted by repose, if in  this patient the emission of urine  is
sometimes suddenly interrupted  for a longer or shorter  period, it may
be conjectured that  the presence of a calculus in the  bladder is the
cause of  all these symptoms.
  Finally, if  a metalic  sound  introduced through the urethra into this
membraneous reservoir,  causes the hand which  directs it to  feel a sen-
sation of rubbing against a  solid and ragged body, your conjecture
becomes  certainty, for cadaveric  researches and the operation of lithon-
tripsy have  taught us that a vesicular calculus  gives rise, ordinarily, to
such a concourse  of  symptoms.  Let a man bitten by a strange dog,
which has immediately run away, present a few days afterward symp-
toms of hydrophobia, we are authorized  to think that the  animal was
mad, although he exhibited no signs of hydrophobia at the time. 
THIRD LETTER.
625
   Thus we see by what use of reason the Empirics  attempt to go back
to morbid causes, for the moment concealed, but  susceptible of falling
under the senses.   They named them the occasional or evident causes.
   The Dogmatists were not content with the knowledge of this order of
causes.   They wished to penetrate the intimate mechanism of the phe-
nomena of nature: they sought there the causes called  immediate, or
integral, or essential, etc.; and  they pretended to establish  upon these
their curative indications.
   The analogism of the  Empirics stopped at those qualities, which  are
regarded  as  superficial,  unimportant, or  too  mobile;  their epilogism
tended only to the  discovery of causes  foreign  to the organism, whose
action they did not all attempt to determine.   However, these theorists
rejected  too  absolutely the lights of anatomy and  physiology.   They
did not comprehend that  without them, diagnosis must  fail in preci-
sion, in a crowd of cases; that is  to say, that there is danger of consid-
ering, as homogeneous, very dissimilar  diseases, and as  heterogeneous
affections, those which have the greatest analogies.
   The Empirical system,  such as it has been transmitted to us by histo-
rians, confines  the human mind in a too narrow circle.   Now the  mind
is so constituted, that it prefers to go astray in attempting  to pass  the
limits which have  been  imposed to it  by the Creator, rather than  to
remain  thus contracted.   In an epoch when the philosophers pretended
to explain the enigma of the universe, or macrocosm, by speculations on
the atoms, or elements, or the harmonizing forces, how could the physio-
logists be prevented from speculating  on the  motor principal of the
animal economy, on the elementary humors of  the human body, on the
primordial causes, and the phenomena constituting diseases, on the inti-
mate action of remedies, etc. ?
   This system was therefore rejected because  it stopped  only at gross
appearances,  rested on the changing ground of experience, gave no  satis-
faction to our natural desire to understand causes, and  offered  to the
Healing Art  no fixed and solid  basis.  Consequently, the  primitive way
of pure observation was abandoned, and they sought another route, and
other principles, which seemed to guide more directly to the final aim of
medical  science, namely:  the preservation of health,  and the  cure of
diseases.  They reasoned  as follows:  In order to find the best means of
preserving the health and life  of  the body, it  is necessary to know the
parts of which it is composed, what elements constitute it, what  forces
sustain it, and what laws regulate the action of these  forces;  so, also,
to be prepared to  cure,  certainly,  diseases, they  must  be  known in
their mode of formation,  their generating  causes, and their essential 
G2G
APPENDIX.
phenomena. This was the unique source, according to them, whence could
be drawn  the rational indications of treatment.   Without this know-
ledge, the physician was likened to a blind man armed with a club, who
strikes at hazard the disease or the patient.
   Such is the argumentation, unceasingly presented, under a thousand
forms, since Hippocrates, and  on which physicians have  based their
ideas  for advancing  physiology and  pathology to the first rank of the
branches of medical science, and  for placing  therapeutics as secondary,
as being only a deduction or corrollary from the preceding.   Consult the
most famous theorists of antiquity and modern times—all, or nearly all,
reproduce the same arguments in  terms more  or less explicit.
    §11.  Consequences op this Scientific  Revolution.
   From the moment that it was admitted as a principle, that physiology
and pathology are the basis of therapeutics—that the treatment of any
disease whatever ought to be deduced logically from the idea we form of
its nature,  of its  intimate phenomena, and of  its causes—from that
moment, all the  researches of physicians  had for their chief end, to
determine the  laws of life, and  the nature and  mode of generation of
morbid  affections.  From that time, also, all medication whose effects
could be explained according to the physio-pathological ideas of the day,
was esteemed rational.   All medication,  on  the contrary, whose effects
could not be in any way explained by such reasoning, was deemed irra-
tional or illogical, whatever might be its efficacy.
   In  this order of  ideas,  as is seen, therapeutic proof ceased to be the
highest  criterion  of truth in Medicine, the ultima  ratio, that  may be
given as a justification in the choice of a treatment.   Indeed, according
to these views, in practical medicine, the  physiological explanation of the
curative action of medicines becomes  the  ultima ratio.  Such is the
plan,  such is the philosophy, from which have been constructed all of the
ancient  and modern systems, of Medicine, with the exception only  of
Empiricism—Hippocratists, Methodists, Eclectics, Mechanists, Chymiater,
Solidists, Humoralists, Animists, etc. All these medical sects, so divided
among themselves, agree so far as to subordinate their curative methods
to some  physio-pathological  idea or notion.   If  we pass by the extin-
guished theories  before  the end of the last century, and  cast a rapid
glance upon those of our age, we will be  easily convinced of  the truth of
what  I advance. 
THIRD LETTER.
627
                         ORGAN'O-DYNAMISM.

    Haller had published his great system of physiology; his experiments
 upon irritability had filled the learned world with admiration.  Brown,
 as profound a logician as he was a superficial observer, having directed his
 mind upon this physiological property, believed that he could explain by
 it, all the phenomena of life, and establish on this basis, a complete sys-
 tem  of Medicine.   He affirmed that life  itself, in health  as well as in
 disease, is an effect of stimulation, and of stimulation only; that  every
 morbid affection consists in  an excess or a deficiency of stimulus; that
 the result of every curative action reduces itself to an increase or dimi-
 nution of excitement.-'
    The Basorians, adopting the same idea, did not see  in any disease, but
 an excess or deficiency of vital force, a hypersthenia or a  hyposthenia ;
 and, in the action of therapeutical remedies, either an increase or a dimi-
 nution of this force.
    But they differed  from the Brunonians, in considering excitability as
 uniformly diffused in the animal  economy; whilst the disciples of Basori
 considered it unequally distributed  in  the various  tissues and organs.
 The  first admitted only general diseases and general excitants ;  the  latter
 recognised special affections, either in regard to their seat or their nature,
 and remedies, whose actions are manifested by preference, upon  this  or
 that  organ.
   Broussais,  also, changed nothing in the physiological idea of Brown ;
 he expressly acknowledges it  himself.  " Brown," he  says, " held  as an
 essential  principle, that  life is only supported by stimulants,  and that
 to live is nothing else than to be excited.   Thus far this is true.  It is
 very  evident that everything which sustains life  has no  other percepti-
 ble effect, to the sense of the observer, than to reanimate the phenomena
 to which  we attach the idea  of life, when they are growing feebler, and
'seem to tend to their extinction.
   " But to draw advantage from  this principle,  it is necessary to study
 all the parts  of  the body in connection with the external excitants—to
 seek  in what manner the  organs  excite each  other reciprocally—to
 study attentively the effects of external and internal excitants in each
 of the tissues of which the organs  are  composed.  Now  this is what
 Brown did not do:  for this mode  of studying excitement is nothing else
 than  the  French doctrine, which bears  the name of physiological doc-
 trine, or, if it is prefered, physiological method." f
•Elements of Medicine by Brown, chap, m, § 22, 23.
f De PIrritation et de la Folie, ch. n, p. 47. 
628
APPENDIX.
   In this passage Broussais characterises with great clearness, the theory
of Brown and that of his own.   We see that he adopts, without any
restriction, the physiological principle of the Scotchman ;  but  that he
studies the  effects of excitation, not in the economy as a whole, but in
each tissue—in each particular organ, after the manner of the Basorians.
   Perhaps you will  inquire  in what do they  differ?   In this that
the latter consider the  special action  of most of external  modifying
agents on every part of the organism as ab-irritative or hyposthenic—
while the French pathologist considers this same action as hypersthenic
or irritative.   Here, then, we have three logicians, each possessing extra-
ordinary strength, who deduce three systems  from the same  physiolog-
ical idea—whose practical conclusions are antagonistic  or widely different
—a curious and  instructive spectacle, well calculated to render us cir-
cumspect in  the application of physiology to  therapeutics.   Thus the
French reformer attributed to his doctrine the exclusive epithet, physi-
ological ; this  artifice of language can deceive no one.   It is very evident
that his  doctrine does not derive more from physiology than the two
preceding, nor more than  those which we are about  to consider.  The
only difference is that each one these systematists pretended to under-
stand physiology better than his  predecessors and adversaries.

                             VITALISM.
   Toward the end of the last century and the beginning of the present,
one of the most vast and  profound minds  which has honored French
Medicine, Barthez, proposed, likewise, to establish medical practice upon
physiology, in a work intitled  "  New Elements of the Science of Man."
He declares in his preface that such is  his aim and  hope.    " Indepen-
dently of its utility in metaphysics and morals, the physical science of
man presents  to curiosity as great an  attraction as  any other science;
and it acquires the highest degree of interest when we see that it forms
the foundation of knowledge necessary to the art of curing." °   He writes,
in several other passages, on the  necessary union which exists between
physiology and practical medicine,  and he terminates with  indignant
expressions against those who  do  not partake of  his convictions  on this
point.
   Barthez admitted in the human body three orders  of forces, or three
dynamisms :  First, a material aggregate, which  obeys physico-chemical
laws;  second, a harmonizing force, which he calls  vital principle—a
force which, spread out in all  parts, and residing in no one exclusively,
0 New Elements of the Science of Man.  Paris, 1806. 
THIRD LETTER.
629
makes them sympathize with each  other, coordinates movements  to  a
common end—the preservation of life, and acts in all things automatic-
ally under  particular laws, without having  conscience either of its
existence or its acts ;  third, and finally, an immaterial principle, called
soul, endowed with spontaneousness  of conscience and perception, capa-
ble of  influencing, accidentally, all the vital functions.   The following
passage may be cited  among many others, where  this  triple dynamism
is plainly indicated.
   "The order of the phenomena of death in man is as follows: first, the
separation of the soul from the body ; second, the extinction of the forces
of the vital principle ; lastly, the  chemical dissolution of the body. °  °
The metamorphosis of the terrestrial part of it is fully known,  but the
fate of the  vital principle after death is a mystery.   If  this principle
is  but a faculty united to the living body, it is certain that in the destruc-
tion of this body, it reenters the system of forces of  universal  nature.
If it  is a  being distinct from  the  body and the soul, it may possibly
perish by the extinction of the forces of the  body which it animates,
or it  may pass  into  other  human bodies and vivify them by a  kind
of metempsychosis." °
   Barthez doubted the independent existence of the vital principle, dis-
tinct from that of the body and the soul, or whether it be but a modality
of organized matter,  a faculty  endowed  with  motor  forces, which are
the necessary consequences of the  material combination  of which each
animal body is formed.
   M.  Lordat, the  inheritor and perpetuator of this  doctrine, does not
hesitate to raise this doubt.   He affirms that  the mysterious principle
which gives impulse  to the animal economy enjoys an independent exist-
ence, separated from that of the body and the soul.   He  consecrates to
the demonstration of this opinion  an entire  book, under  the  title of
Insenescence Du Sens Intime.
   I must confess, that the school of  Montpellier  appears to me to be in
possession of a physiological truth of high importance, which it  is right
not to abandon.   Its doctrine on the vital principle or the harmonizing
force  of organized bodies,  is very  justly  named Hippocratic.   It is
indeed stated  in several of the  writings attributed to the physician of
Cos, who gives to the harmonizing force of the living organism divers
names.   He calls this force, according to the aspect under which he
regards it, either motor evop/MV, or  nature (puccQ, etc.  We read, among
other  things in  the  Treatise  on Aliment: '• Nature  is equal  to and
sufficient for all things.   °      ° There is in the interior an unknown
Q Ibidem.  Last chap., cccxvi and cccxvn, book II. 
630
APPENDIX.
agent who works for the whole and for the parts;  sometimes for certain
ones and not for others.  °  °  °   Nature  is one in all, but infinitely
varied.  °      °   There is but  one end ; there is but one effort.   The
entire body participates in it; it is a universal sympathy." °
  This opinion, derived from the philosophy of Pythagoras, renewed by
Leibnitz, has been adopted by a large number of naturalists and physi-
cians of all countries and all times.  It appears to be generally followed
in Germany.  M. Miiller, Professor in the  University of Berlin, after
having  discussed it with  great depth and impartiality, concludes  by
inclining to it. f  But we do not intend to examine here how far s^uch a
doctrine is founded in  physiology.   We have to occupy ourselves only
in regard to its consequences upon practical medicine.
   Now, from the moment that we recognize in human  nature a triple
dynamism, to-wit:  an aggregate  material, a vital harmonizing  force,
and an immaterial essence whose determinations react sometimes on the
living organism, we must admit that each one of these  dynamisms
reveals  itself to the eyes of the observer by special functions which may
be  injured  either separately or  simultaneously.  Thence result three
general classes of diseases.   The first class comprises the physico-chem-
ical alterations of the solids and fluids;  the second, the lesions of the
vital force  or  properties; the  third,  the affections  of the soul.  Such
is, indeed, the  nosological classification  indicated by M. Barthez. J  I
do  not  intend to  consider here  the  grave objections which  might be
raised against this classification of diseases.  I  pass  immediately to
the practical consequences which result from it, according to its author,
who expresses himself in the following language: " My new doctrine on
the  faculties and  functions  of the vital  principle being  rigorously
deduced from  facts, and  independent of all the  systems  of the differ-
ent  sects in the  Science of Man,  does  not exclude any  of  the views
which are essential to recognize, to perfect and to multiply all  the meth-
ods,  natural, analytical and -empirical,  which the  art of  curing may
embrace in  the treatment  of the divers  kinds  of disease."
   But let us now permit M. Lordat to explain to us  what are the thera-
peutic methods to which he makes allusion : " The Natural methods are
those whose object  is  to favor, to  accelerate or to regulate the course
of diseases which tend to a happy solution.         °   The Analytic
methods are those  in  which, after having decomposed a disease into its
 essential affections  which  produced it, or into the more simple diseases
a Works of Hippocrates.  Treatise on Aliments, §§ 3 and 4.'
■j- Manual of Physiology.
\ New Elements of the Science of Man.  Preliminary Discourse. 
THIRD LETTER.
631
which complicate it, we then attack directly these elements of disease, by
means proportioned to their relations of force and of influence. °      °
The Empirical methods are those whose efficacy have been established by
experience, but whose immediate and primitive  effects have no connec-
tion with the cure of the disease, intelligible to our minds." °
   This classification  of therapeutical methods  is  very important, and
merits a profound discussion, upon which I shall not again enter here, as
I have treated it fully already in the Article on Animism and Vitalism.
I will add to what I have said there, but a simple reflection: How is it
that Barthez, who pretends to  found therapeutics on physiology, did not
see that there  does  not exist any  rational connection, any correlation
which the human mind may appreciate, between his triple dynamism or
his physiological ternary, and the three modes or general plans of curing
above given ?   However, far from blaming him for having tried to ren-
der practical  medicine independent of all systems of physiology and
pathology, I praise him, on the contrary, highly for it.  What I  blame
him for is, not to have been able not to render it independent of his own
system, as well  as those of others.   He  could then have established
a true and  lasting doctrine of therapeutics, instead of which he has
only  shed a ray of light on this important and difficult branch of medi-
cal science.  Nevertheless, this ray  of light is a  service rendered to pos-
terity, which has accepted it, and  by  freeing it from the shadows and
errors with which it is still enveloped, will cause it to shed forth a clear
and vivifying light.
                            HOMEOPATHY.
   No one has raised  himself with more force and perseverance against
all physiological and  pathological systems  than the author of the home-
opathic doctrine.   He wars against them from the beginning, in all his
writings, but particularly in a pamphlet entitled, " Value of Medical
Systems ;" and  in the paragraph of his  Materia  Medica, entitled, A
Souvenir,  he declares  emphatically that  Medicine is and only can be
but an  empirical science, the same as physics and chemistry.f   He
charges  the pathologist, sometimes with creating imaginary  morbid
entities, purely nominal, by means of symptoms grouped arbitrarily, and
sometimes with  seeking the cause of the  ills which afflict  man in the
  '-'Explanation of the doctrine of Barthez, by M. Lordat.
  f True, Medicine is, from its nature, simply an empirical science, and can only
be based upon pure facts and sensible phenomena belonging to its sphere.     °
In the purely empirical sciences, as Physics, Chemistry, and Medicine, the purely
speculative  mind must not be allowed any decisive influence.— Organon, the Art
of Curing. 
632
APPENDIX.
 depths  of physiological abstractions, such  as  the diverse degrees of
 lesions which sensibility, irritability, and nutrition may undergo.  He
 attacks them with the weapons of reason and ridicule.   He adjures them,
 in the name of conscience and religion, to renounce such errors.
   Who would not expect, after so many declamations, that the founder of
 Homeopathy, the inventor of infinitesimal doses, would abstain  entirely
 from all physiological explanation ?  that  he would invoke in  favor of
 his doctrine experience  only, pure experience, as he incessantly repeats ?
 Well, undeceive yourself.  The whole explanation of his system is, from
 beginning to end, but a physio-pathological  theory, a  long dissertation
 on the essence  of disease, and the intimate  action of medicines.  He
 says, for example, that  diseases are but the immaterial alterations of an
 impalpable vital principle ; hence he  concludes that we must attack them
 by forces of the  same  kind,  that is to  say.  by spiritual virtues of
 medicines.0
   He asserts, for example, that two affections alike in their symptoms,
 but different in their essence,  destroy each other when they meet  in the
 same organism;  he  proves this,  not by observation, but by the  most
 subtile argument, and  one  of the most arbitrary hypotheses.f   I will
 not dwell longer on this doctrine,  which I propose to submit hereafter
 to a special examination.  It  is sufficient for the  moment to have dem-
onstrated by striking proofs that  Samuel Hahnemann,  after having stu-
pidly reprimanded  the  theorists who pretend to base therapeutics on
considerations drawn from physiology and pathology, falls himself into
the same fault with which he  reproaches others.   Besides, a much more
eminent  physiologist, Bichat, has  committed quite the same  inadver-
tence.   After having charged the influence  of  the physio-pathological
theories  as  being the cause of the instability of  the denominations of
 the Materia Medica, and of the vagueness and incoherence of therapeu-
tics, he throws us back  into the same path, by affirming that the  action
of curative agents reduces itself  to restoring  the  vital forces  to their
natural  type, from which they were diverted fry disease. %

                           ECLECTICISM.
  I have but two words to  say here upon this doctrine, of which I shall
speak elsewhere at more length.   I wish to observe only, that it aspires,
like the preceding, to establish its curative indications on physio-patho-
logical views and facts.   The  eclectic does not  accept entirely any one
of the  physio-pathological  interpretations  proclaimed  by  the  diverse
0 Organon, sec. 53, etc.              f Ibidem, § 40.
\ General Anatomy—General Considerations, § n. 
THIRD LETTER.
633
systems, but neither does he deny any one in an absolute manner.  He
pretends to draw from each one of them what is suitable to him, with-
out subjecting himself to any fixed rule, and puts experience  and  rea-
son in the scale in order to decide on each particular case.
   But within what  limits does he interrogate these two faculties, or
these two modes of acquisition ?  This  is what the Eclectic never tells
us;  thus  he gives us no assurance  that we  shall  not make  choice of
error rather than truth, of deceptive fiction rather than reality.
   Medical Eclecticism escapes all general description by the absence of
a  common formula and a fixed symbol.   The eclectics have among them-
selves very often nothing else in common but their names, and a decided
aversion for the discussion of principles.  But it is true, that far from
denying the physio-pathological theories, they seek them, and endeavor
to deduce therefrom their methods  of treatment.
                        III.  CONCLUSION.
   We have seen that at an undetermined epoch in the history of Medi-
cine a capital revolution took place in this science; that the method of
pure observation had been abandoned, to follow another route, in appear-
ance shorter, surer, and more rational; thinking  that  the  study of the
elements of the body and their properties, of the laws which govern the
functions of the animal economy, and of the causes and  production  of
diseases, would establish  the  Art of Curing upon  a firmer basis than
crude results of experience.   Henceforth, there was established  among
physicians a general opinion, which considered therapeutics as a deduc-
tion, a corollary form the laws of physiology and pathology.
   A single sect in antiquity resisted this idea, and tried to trace another
plan of studies, and other rules  of practice; but it perished  after a
short popularity ;  its name and its memory were for a long time held
in dishonor by medical posterity.  However, since the revival of letters
in Europe, more than one philosopher,  more than one physician of high
reputation,  has dared to judge this doctrine less severely.
   The  testimonials in favor of rational Empiricism are not wanting
among the writings of the two last centuries, and these evidences become
more and more numerous and imposing as we approach the present epoch.
In our day a  multitude of  authors are animated with the spirit of Em-
piricism, and proclaim its maxims without rallying  openly under its
flag.  Those who oppose it most warmly in their books, in theory, do not
hesitate to take it for a guide in their practice at the bed side.   There
exists even in Paris an entire class of Physicians, united under  the
name of the  " Society of Medical  Observation,"  which  has  emitted
           40 
634
APPENDIX.
principles and method, evidently empirical, whose doctrine, though still in
the embryonic state, includes in France, as well as in foreign countries,
numerous adherents.-1  Upon the whole, there  prevail  at this time in
Medicine,  three  opinions, three general methods.   One  pretends to
deduce  all  therapeutical indications from  the  laws of  physiology and
pathology.   We will designate it by the term physio-pathologism.   The
other affirms that no mode of treatment can be derived  from physio-
pathological notions in a direct and immediate manner, and draws all of
its practical rules from the pure results of experience ;  this is the old
Empiricism, which we name rational Empiricism, or Empiri-methodisni.
   The third, which  derives its curative  indications, sometimes  from
physio-pathological ideas, and sometimes from crude facts of experience
is medical Eclecticism.
   These three opinions, these three methods, are contradictory, as it is
easy to see ; one of them being true, the  other  two must necessarily be
false.  It is then of the greatest importance to  make correct choice, for
on this choice depends all the future of medical  practice.   To remain in
doubt is impossible, at least in practice ; to decide by chance in a matter
which interests to such a degree the health  and  life of mankind, would
be the act neither of a philosopher, nor of an honest man.  Wre  proceed,
consequently to treat, with all the  development which it merits, in our
next chapter, the following capital question:  Can pathological physi-
ology, in whole or in part, be the direct and immediate foundation of
therapeutics.
5 See first Memoir of Medical Society of Observation, 1837. 
FOURTH LETTER.
635
                    FOURT.H  LETTER.

 CAN PATHOLOGICAL PHYSIOLOGY BE, IN WHOLE OR  IN PART, THE  DIRECT AND
                IMMEDIATE FOUNDATION OF THERAPEUTICS.

          § I.  Present state op Science relative to this Question.
   I said, in terminating my preceding Letter,  that  three contradictory
 opinions are exhibited  on the subject of the above announced question.
 The one which has for  supporters the most famous modern systematists,
 such as Stahl, Barthez, Brown, Bazori,  Bichat, Broussais, and other nu-
 merous votaries, affirms  that there is no rational therapeutics except
 what is derived from the exact knowledge of the disease, and the mode
 of action of curative agents.   All those illustrious theorists whose doc-
 trines have divided the medical world, suppose that pathological physi-
 ology  is the only rational and  necessary basis of practical medicine.
 All pretend to derive from this  unique source their methods of treat-
 ment,  and the explanation of the effects which they obtain.   I call them
 pure physio-pathologists.
  The second opinion is that of the less exclusive Vitalists, and  of less
 pure Organics, of all those, in one word, who under divers names, prac-
 tice more or less openly Eclecticism.  These physicians agree with the pre-
 ceding, that the knowledge of the intimate nature of maladies and the
 mode of action of remedies constitute, in fact,  the  best foundation of
 therapeutics.   But they add, that in default of this knowledge, which
 too often is wanting, the  crude  observation of  the effects of  agents, or
 Empiricism, may serve us as a guide, and furnish us, in certain diseases,
 surer and more efficacious means of cure than those which are indicated
by rational Medicine.   They regard  the physiological explanation of the
action  of remedies the last improvement of the Art, the final aim of the
science, but they think  we are still very far removed from this degree of
perfection,  in  many cases.0
  0 See, among others:
  Andral—Clinique Medicale, second edition, preface, page 6;  Course de Pathol-
gie Interne, preliminary considerations. 
636
APPENDIX.
  Thirdly, and finally, there are some authors who maintain  that ruch
experience, or pure observation of the sensible effects of remedies,  is the
fundamental  base of  therapeutics.   These deny,  positively, that  the
lights of physiology and pathology can ever become the immediate source
of curative indications, or furnish a rational explanation of therapeutical
effects.   I have called this sect of physicians  by the name of rational
Empirics or Empiri-methodists.0
  A general remark, to be made on all the modern writers of  Medicine.
to whatever category they belong, is, that they do not hesitate to resolve,
or  rather to settle, the  great question  which  is  the subject  of this
letter, but they do  not bring forward  any proof of  the  solution  which
they give of  it.   Each one of  them seems to imagine that the opinion
which he professes in this regard   is  so clear and evident that it is suf-
ficient simply to  announce it; they dispense, in  this belief, with all
efforts at seeking its demonstration.
  However,  they should all  consider that this evidence is not of such a
nature as to convince all minds, since there is found among their cotem-
poraries, a considerable number of distinguished savans and respectable
practitioners, who profess entirely  different and even contrary principles.
This  consideration  ought, it  seems to  me,  to shake the faith  of each
of these sections in their respective doctrine, and cause  them to  follow
us in the examination of the fundamental problem  above stated.

  Bouillaud—Nosographie Medceale.
  Forget, Professor at Strasburg—Feuilleton de V Union Medecale. 1849.
  Frank (Jos.)—Innere Pathologic
  Gendrin—Traite' Philosophique de  Medecine Pratique.  This author combats
Eclecticism, nevertheless, he must be ranked among the eclectics.
  Guein—Memoir sur Eclecticism in Medecine.  1831.
  Piorry—Traite Pathologie Iatrique ou Medicale.
  Requin—Elemens de Pathologie Medicale.
  Reveille—Parise.  Etudes de PHomme, dans PElat de Sante et de Maladie.
  Trousseau et Pidoux—Traite de Therapeutique et Matiere Medicale.
  a We cite some authors who have professed, more or less, this doctrine :
  Berard (F.)—Doctrine Medicale, de  l'Ecole de Montpellier ; pages 198  to 201,
and 423 to 459.
  Becquerel—De PEmpiricism en Medicine.  Thesis for the concour of  agrege.
Paris, 1844.
  Gibert—Fragments Therapeutique et de Medecine Pratique ; 1846.
  Laennec—Traite de PAuscultation Mediate, second edition; preface, pages 2.*>
to 31.
  Louis—Memoires de la societie Medicale d'Observation, vol. I. p. 42.
  Valleix—Guide du Medicin Praticien.   We ought to range in the same line :
  Chomel—Pathologie Generale.
  Grisolle—Traite Elementaire et Pratique de Pathologie Interne. 
FOURTH LETTER.
637
      § II. Philosophical Axioms Aiding the Solution  of this Problem.
   I.  Sensible objects being known to us only by the  impressions they
make upon our senses, the  mind  does not  perceive anything in these
objects beyond the sensations which  they excite in us.
   II.  No corporeal operation, nor any action of the soul on its proper
faculties or on its  ideas, can make us conceive the acting force of  the
causes, or the necessary connection they have with their effects.
                              corollary.
   In the succession of  natural phenomena,  there is  nothing which pre-
sents the idea of causality, or the necessary connection of cause and effect.
But,  when  a succession of phenomena is constant, the human mind,
which observes it assiduously, and which often may foresee it, is forced to
believe that these phenomena succeed each other because they are linked
together.   A ball, for example,  thrown on  a horizontal plane, strikes
another ball which was in a state of  repose; this latter moves immedi-
ately in its turn.   The impulse of  the first will be  regarded as the cause
of the movement of the second; however, the mind does not perceive
any necessary connection between these two phenomena, but their con-
stant succession, which is manifested each time that we seek the proof,
forces us to believe that these  phenomena follow because they are con-
nected.  This is an empirical truth  and certainty.
   The two  axioms  above, and the  corollary  which  follows  them,
ought to  be regarded as  incontestible principles, since  they conform
to the doctrine of all  the  modern philosophic  schools  on  this mat-
ter.   We  can  easily  find  its  substance  in the writings  of  Bacon,
Locke, Hume,  and  Condillac, for the sensitist  or  empirical  school;°
in those of Thomas Beid  and  his  disciples,  for the Scotch  school,
called school of common sense  ;f  in  these  of  Kant, for  the  spirit-
ualist or  rationalist school;+ finally,  in  those of M. Cousin and  his
numerous followers,  for  the  eclectic  school.§    To  these  authorities
we  must  add  that of Barthez, whose doctrine,  though  now  half a
century old, still prevails in spirit in  the  University of Montpellier ;j|
and that  of M. Buchez  also has put  forth very recently, on medical
  0 Bacon de Verulam.—Organum Novum, Liber I,  chap. 1.  Locke, Philos
Essay on the Human  Understanding,  lib.  IV,  ch. in, § 16  and 26.  Condillac,
Essai  sur POrigine des Connaissances Humaines.
  | Inquiries on the Human Understanding.— Th. Reid.
  f Critik der Reinen Vernunft.
  § Cours de PHistoire de la Philosophic Modern.— Cousin.
  || See different passages of Nouveaux Elemens de la Science de PHomme. 
638
APPENDIX.
 and historical  studies, some  new and profound views.  According to
 him, the aim of science  is  to foresee, and there exist two degrees of
 foresight:  the first consists in the knowledge of the order of succession
 "f phenomena;  the second, in the knowledge of the law of generation
 of these phenomena.   Two conditions are indispensable, in order that
 we may arrive at the knowledge of the order of  succession of  phcnoni-
 na :  Eirst, that the phenomena of the same order and same nature fol-
 low each other always, according to a  constant unknown but invariable
 law; second, that  the entire  succession  of these phenomena has  been
 observed once at least  in its whole extent.  This being stated, our philoso-
 pher examines  the degree of foresight which each branch of the human
 encyclopedia appears  to have  attained, and he uses the  following lan-
 guage on  the  subject of physiology:  "In  the sciences of organized
 bodies,  scientific foresight is reduced  every where to the knowledge, yet
 incomplete, of the  order  of succession of phenomena.   This  is espe-
 cially so in Medicine, for  whether you study the development of a path-
 ological  modification, or  observe the order in which  the  phenomena
 succeed each other,  to  constitute a morbid affection, or whether, finally,
 you analyze the successive effects engendered  by the introduction  into
 the animal economy of a therapeutical agent, your  only aim is  always
 to find out the order in which  the  phenomena of a  determined nature
 succeed each other,  so that in  similar successions you may subsequently
 encounter, you may be able to foresee what is to follow by means of what
 has already taken  place.   Scientific  foresight will always  stop  there,
 until  the  general  formula of the  organized bodies shall have been
 found."0
  In  presence  of  such a  mass of  eminent testimonials, scepticism
becomes impossible.   A doctrine which  has obtained the assent of so
many philosophers in  other respects so divided, could not lead  us  into
error.  We may well  therefore rely with confidence  upon it, in order to
resolve the important  and difficult problem announced  at the  head of
this letter.
III.  REPLY TO THIS QUESTrON :  CAN PATHOLOGICAL PHYSIOLOGY BE, IN TOTAL-
  ITY  OR IN PART,  THE DIRECT AND IMMEDIATE FOUNDATION  OF THERA-
  PEUTICS?
  It is easy to see that this question amounts to the  following: Know-
ing the series of phenomena which constitute a morbid affection, can we
a Introduction a PEtudedes Sciences Medicales, premier lecon. 
FOURTH  LETTER.
639
deduce from it, a priori, the knowledge of the successive  effects which
will result from the intervention of a  new force  (a  therapeutic agent)
in the midst  of these phenomena ?  Our reply to the question thus
stated is not doubtful, if we remember our philosophic axioms and the
commentary of M. Buchez.   No, we say, no, it is not possible that the
knowledge of  a succession of morbid phenomena can enable us  to fore-
see the changes which a  curative agent will  introduce into such suc-
cession, before these changes may have been observed at least once.
   The lights of pathological physiology, to whatever  degree they may
have attained, can never give us the foresight of the effect a therapeu-
tic agent must produce in the animal economy, before these effects have
been directly observed.  Erom  which it follows  that the indications
which flow from physio-pathological knowledge on the opportunity of a
treatment, are reduced to simple conjectures, before that treatment has
been tried once at least.  It is not until after  a first trial that the
veritable foresight, or in other words, science begins.   Thus the physio-
pathology can not be in any case the direct and immediate foundation of
therapeutics.
   There are some  examples which will prove and  confirm  the  truth of
this answer to the minds of those persons who do not distrust  absolute
and abstract principles, in  consequence  of the abuse which  has been
made of  these principles.   But in order not to leave in their minds any
cloud, or any motive to doubt, I will take these examples from the very
authors who are of a contrary opinion to the one I have emitted.  I shall
have on this point  but the embarrassment of a choice, for it is  now the
custom among our writers in Medicine to establish the curative indica-
tions on physio-pathological facts, rather than upon the crude  observa-
tion of the sensible effects of medicines.
  Bead most of the treatises on Medicine which have been published in
the last half century, and you will find but  few in which we  can not
distinguish two kinds of therapeutics.
  One they call rational, founded on  the  physio-pathological  ideas of
the day ;  the other they name empirical, or irrational, founded on the
common observation of the effects of remedies.  The  writers who estab-
lish such  a distinction, announce thereby that the choice of a remedy is
in their eyes not sufficiently justified by the experimental  notion of its
efficacy;  and  a  treatment merits the title of rational only  in  propor-
tion as it can he shown in virtue of what physiological modification it
effects a cure.   In a word, it is  the knowledge of the intimates modifi-
cation produced by the curative agents which constitutes,  according to
these authors, the  rationality of therapeutics,  the supreme  perfection of
the Art. 
640
APPENDIX.
   One of our cotemporaries, whose opinions arc distinguished by clear-
ness and exactness, expresses himself in the following language  on this
subject:  " Medicine is rational whenever it  bases the employment  of
any remedies on the consideration of their physiological  effects.   The
indications of these remedies are found by a process of reasoning in which
the physiological effects are the principles, and  the  therapeutic effects
the conclusion.  There is a logical connection between the  latter and
the former."                                      *
   " Second. Medicine is empirical, not  in the bad  sense of the word,
but in all the dignity of its etymological sense, whenever the remedies
it prescribes have for reason, not a physiological deduction or induction,
but clinical  experience only.   Without doubt,  physicians may  seek,
when the utility of an empirical remedy is well observed,  to  explain  it
by physiological theories more or less plausible, as on  the  other hand
they seek to  demonstrate by the evidence of experience  the value  of
rational remedies ;  for reasoning and experience ought naturally to tend
to unite themselves in the precepts of the Art.  But, in a last analysis
the distinction of therapeutical remedies into  rational  and empirical is
always fundamentally true.
   " But how will the practitioner reply, for example, when he is asked,
on the one hand, why he purges a man who  is constipated, and  on the
the other hand, why he purges a man  attacked  with lead  colic ?   To
the first  question  he will reply, rationally, I purge  to  evacuate the
fecal  matter.   To  the  second question he  will reply, empirically, I
purge because purgation cures lead colic."
   Such is the argument which I  extract  literally from  a  treatise on
Medicine  which is now being published.0
   For myself, the more  I examine and compare the two answers quoted
in the last passage, the  more I  find  them  identical, that is  to say,
equally rational  and equally empirical.  Indeed, when a person answers,
I purge in order to  evacuate  fecal matter, is  it  not equivalent to  say-
ing, I administer such a remedy because experience has taught me  that
it relieves constipation?   And  again, when one answers:  I purge  to
cure lead colic, does he not say as much as, I administer such a remedy
because experience  has taught me that it cures lead colic ?
   In the  first case, as  in the  second,  you have nothing else  but an
experimental notion of the therapeutical effect.   How do you know, for
example, that the powder of jalap will provoke the evacuation of fecal
matter ?  By clinical  observation.  How do you know that the same
3 Elemens de Pathologie Medicale; par M. Requin, 1.1, p. 250, 121. 
FOURTH LETTER.
641
substance will quiet lead  colic?   Equally by  clinical observation.
Why then do you call the knowledge of the first effect rational, and
that of the second empirical?  To this you cannot answer by subtilties
and  the quibbles of the sophist;  or rather, your enlightened reason,
directed by the philosophic axioms above given, will force you to agree
that you have established an erroneous distinction  between facts of  the
same order.
   Let us see other examples of pretended  rational Medicine.   Perhaps
they will sustain an examination better than the preceding:  " In clini-
cal surgery," says the honorable M. Bouillaud, " cases are not rare where
rational therapeutics is employed.  Indeed, to reduce a luxated bone by
bringing into play muscular action in an inverse  direction to that
which produced it; to extract, either by a bloody  operation or by lith-
otrity, a stone from the bladder; to dilate strictured canals or to make
a substitute for them by artificial  means; to ligate a wounded  artery,
etc. etc., these are purely rational therapeutical proceedings."0
   In order to judge in what respect the last examples  which we have
cited merit the title of rational,  I beg  the reader to remember the corol-
lary of our philosophical axioms.  It is as follows:  " A ball thrown on
a horizontal plane, strikes another ball which is in repose;  this latter
moves immediately.   The impulse  of the  first will be regarded as  the
cause of the movement of the second.  However, the mind does not per-
ceive any necessary connection between the  two  phenomena ;  but their
constant succession, which manifests itself every time that we  renew  the
experiment, leads us to believe that these phenomena succeed each other
because they are linked together.   This  is  empirical knowledge and
certainty."  Well then,  I  again ask, what  difference is there between
the proceeding of the player who moves one ball by the  other, and that
of the surgeon who reduces  a luxated bone by bringing into play  the
muscular forces, in an inverse direction to that of the forces which pro-
duced the luxation ?  Absolutely none.   The processes are  the same,
and the certainty exists  in the same degree.   But remember the fright
of Ambrose Pare, during an  entire night, when he  had ligated  an artery
for the first  time in order  to arrest hemorrhage after an amputation,
and  then tell  me if this proceeding, which appears to us  to-day so
rational, was judged so then  by that celebrated surgeon ?
   We conclude from this, that the surgeon who reduces a luxation or
ligates an artery, conformably to the rules of his art,  does not act with
0 Essai de Philosophic Medicale, p. 309. 
642
APPENDIX.
more reason than  the  physician  who administers a  suitable dose of
sulphate of quinine to a person attacked with  intermittent fever, or he
who vaccinates a child to protect it from small pox.  The actions of both
are  based  upon  a perfectly rational, methodical  Empiricism.   If so
many men  imagine that they  perceive with  spiritual  eyes, or seize
mentally the logical connection which unites the act of the surgeon with
the effect which results from it, while they avow that they cannot per-
ceive any rational connection between the act of the physician and its
result, it is because in the first case they  are deluded; they are dupes
of that faculty of the human understanding which Mallebranche called
folle du logis (imagination) as Barthez explains very well in the following
passage:  " The principle of motion  of which the laws are most simple,
is the force of impulse.  The action of this force  seems easy to under-
stand, because the imagination  considers  motion as a being which may
communicate  itself to bodies brought into  contact  by a shock, although
it cannot overleap any intermediate space.    However, from the moment
we set  aside  this  false view of motion, the force  of impulse, however
simple  it may be, remains  incomprehensible, as  well as the forces of
nature which follow the most complicated laws." °   M. Cousin develops
the  same doctrine in terms not less explicit, f
   Hence we conclude  that physicians who hope to found their curative
indications on physio-pathological facts are deceived by illusions of their
imagination.  There is no connection perceptible to our  mind between
the  idea of a disease, however complete  it may  be supposed, and the
determination of the curative agent applied to this  disease.  In other
words, the series  of phenomena which constitute  a  pathological state
cannot in any way enable us to foresee the succession of effects which
will  result from the  employment  of this  or that mode of treatment,
before its effects  have been observed at least once.   Finally, there exists
between physiology and therapeutics a solution of continuity, a hiatus
which the human mind can overleap only by the aid of  clinical  experi-
ence, or, in other words, by empiricism.
   However paradoxical this doctrine may appear to a large number of
my readers, it is not, however,  new.  It  goes back, on the contrary, to
the infancy of the Art.  It presided over its first acquisitions.   It is
 clearly designated in two books of the Hippocratic collection, as well as
  ° Nouveaux Elements de la Science de PHomme, chap, in, tome I, page 49.
  | Cours de PHistoire de la Philosophic  Moderne.  Edition 1846, tome I, pages
247, 268. 
FOURTH  LETTER.
643
in other writings, both ancient and modern, from which I have elsewhere
quoted extracts.
   But, as in a subject so delicate and important we cannot multiply too
much the proofs and explanations, no  one will find fault, I think, when
I add  some  other  fragments of cotemporary authors.   "If  by motives,
we understand," says M.  Louis, "that any remedy whatever ought not to
be employed but when we have recognized  that a patient is  in the situ-
ation in which this remedy has already succeeded, I understand, and  I
agree  with  this  view—it is nothing else than experience  applied to
therapeutics.   But if we understand by  motives,  as by indications,
a  priori considerations, this view is quite hypothetical; it  enters into
so called rational  medicine, experimental  medicine, to which we have
recourse only when  in want of a better  system, when  experience  has
not yet spoken ;  and I reject it with all my powers."0
   Hahnemann, desiring to demonstrate that nosography could not guide
us in the choice of remedies, expresses himself thus :   "In  general, all
science whatever can judge only the objects belonging to  itself.  It is
foolish to expect from it instruction on subjects  belonging to other sci-
ences.  ° ° °  No  matter how necessary it may be to the  agriculturist
to know exactly the form of plants,  and to know how to  distinguish them
from  each  other by their exterior parts, nevertheless, botany, which
teaches  him these things, can never teach him if any vegetable is fit
food for his sheep or hogs ; it will never enable him to know what kind
of grain or roots gives most strength to the horse, or fattens  cattle best.
Neither  the  systems of  Tournefort  or of  Linnaeus, nor the method of
Haller or Jussieu  enlightens him on this point.  He only acquires  the
knowledge which he needs, by comparative experiments, made with care,
on different animals."f
  Again, the historian of the medical doctrine of  Montpellier, Berard,
says that  "Sauvages, frightened  by the  uncertainty  of   hypothesis,
adopted  a paradox which will scandalize, without  doubt, the systema-
tists of all tmes. but which will appear, nevertheless, incontestible to the
physiologists of all sects, whenever their particular opinions are not  in
question."!   Physiology,  according to him,  connot serve as a primary,
fundamental, and unique  basis  for practical Medicine.
  The same  historian, after having exposed at great length the scien-
tific  economy of Empiricism, sums up his opinion  on it  as follows:
° Memoires de la Societe Medical d'Observation, tome I, page 42.
f Traite de Matiere Medicale.   Prolegomenes,  tome I,  page  23,  trad de
Jourdan.
I Doctrine  Medicale de L'Ecole de Montpellier: edition de 1846, page 47. 
644
APPENDIX.
'• Empiricism is the most profoundly elaborated system which  has ever
appeared in Medicine,  and merits the most to be studied with care; it is
the one whose contemplation promises to the philosophic mind  the most
useful and fruitful results, and can  serve best  in the research  of proper
methods to satisfy the  future progress of the science." °

                       §VI.  Conclusion.
   We have now arrived, basing all we have said on philosophic axioms
universally  admitted, to the demonstration, henceforth immovable,  of
this great truth :   Neither physiology nor pathology, whatever develop-
ment  they may acquire, can ever serve  as  a  primary and immediate
foundation  for  therapeutics.   There  is,  and  there always  will  be,
between the knowledge of a disease and the determination of the appro-
priate treatment, an interval, a void, which the human mind can fill but
by the aid of experiment.
   By this demonstration we have  set aside, not only all the systems  of
Medicine known  until the  present  time, which are derived from some
physio-pathological  idea, but  all those  also,  which any  one can be
tempted in the future to  extract from  the same source.  We  have
reestablished practical medicine upon a true and primary basis—clinical
experience ;  not that blind and limited experience of the first age of the
science, but an analytical and learned experience, which, collecting with
equal care the old traditions and new acquisitions, elucidates them both
in the light of a severe critic.
   Nevertheless, it is not sufficient to have recovered and  set  forth the
true foundation of therapeutics; it is still necessary to demonstrate that
upon  this  foundation we can  and ought  to raise the  entire  scientific
edifice of Medicine.  It is necessary  to prove that, far from rejecting, as
has been believed for a long time,  the  lights  of anatomy,  physiology,
pathology, physics, chemistry, and, in a  word,  all the branches which
are connected with the medical  encyclopedia,  rational Empiricism,  or
Empiri-methodism is the only one of all the systems which  uses them
appropriately, and circumscribes them in their legitimate bounds.   It is
necessary to demonstrate that it is the only system which offers to the
practice of the Healing Art an immovable basis—and yet sufficiently
accommodating to receive all ulterior improvements;  that it is the only
one which does  not  reject, a priori, any means of treatment—neither
doses  excessively small, nor imponderable fluids, from  whatever source
they  may come;  that  it  demands  of  the  most extraordinary thera-
° Doctrine Medicale d'Ecole de Montpellier ;  edition 1836, page 424. 
FOURTH  LETTER.
645
peutical  processes, in order to open to them the sanctuary of science,
only the sanction of  reiterated proofs, serious and sufficiently con-
stant in  their results.   It  is  finally necessary to prove  that Emperi-
methodism is the only one of all the systems of Medicine which resolves
in a satisfactory manner, this great problem, declared insoluble even in
our times, by men of high reputation :  " The harmony of science with
art—of theory with practice." °
   But before undertaking  this demonstration, it is useful to  refute
specially some more  recent  medical  doctrines,  which might deceive a
large number of our readers.
  ° Consult, among other writings proclaiming the insolubility of such a prob-
lem, the feuilleton of the Union Medicale, from p. 24 to 27.  February, 1847. 
646
APPENDIX.
                     FIFTH   LETTER.

           ON  ECLECTICISM  IN  MEDICINE.


§ I.  Origin  of the  New  Eclecticism  in  Medicine—Its  Difference  from
                      Eclecticism  in Philosophy.
   Xo sooner has  a philosophic doctrine  obtained any celebrity than it
is reflected in  Medicine.   This is a fact that the history of our science
confirms at  each  step,  and  of  which  the  new  medical Eclecticism
offers one more sample.   It is about thirty-five years since a young pro-
fessor of philosophy began his  teaching by a kind of protestation against
all systems of metaphysics which derive  from a single faculty of the
human  understanding,  all  the  acquisitions of  science.   He  tried to
demonstrate, contrary to the general opinion of the French philosophers
toward the end of  the eighteenth century, that Sensitism or Empiricism
show us  only  one  side of  things—the material or sensible side—and
developes in us but a single order  of ideas—the contingent ideas.
   He proved equally, that Spiritualism, or pure Bationalism, shows only
another side of things—the immaterial, or the one imperceptible by the
senses—and produces  in us but a single order of ideas—the necessary
and universal  ideas.   M. Cousin has always continued in this path, and
by his influence Eclecticism has  become, in France, quite a fashionable
doctrine.
   About the same epoch, a professor of Medicine at the military hospital
of Val-de-Grace put forth a system in which all diseases are represented
as an effect of irritation, as a simple mode or a transformation of phlogosis.
This system, owing to the favorable disposition of the minds of the profes-
sion, advantageously prepared by the philosophy of Condillac and of
Cabanis,  who also considered all the acts of the understanding as a result
of transformed sensation, took  a rapid growth, and in less than ten years
became  common in  France, and spread over  Europe.  But while the
physio-pathological system of  Broussais reached with so much  prompti-
tude the zenith of  its renown, a  doctrine more modest  raised itself
slowly by the side of it, and began its ruin. 
FIFTH LETTER.
647
   Medical  Eclecticism, the  emanation of  philosophic Eclecticism, had
 already  protested against the  pretention of deducing  all the  morbid
 phenomena from a  single lesion.   It  collected, by the aid of  clinical
 observation, pathological anatomy, and  chemical analysis,  a mass  of
 proofs before which  fell, very soon, the brilliant edifice of the professor
 of  Val-de-Grace.  This result is  now consummated.   For some years
 past the greater part of our writers in  Medicine profess an  avowed  or
 tacit Eclecticism, as we have seen in the preceding letter.
   All  have renounced the idea of connecting the innumerable anomalies
 of the  living organism with a single primitive modification.   It is, then,
 essentially important in the  present medical generation, to be fixed on
 the value of Eclecticism in Medicine.  It is for this reason that we have
 believed  it our duty to submit  this doctrine to a special examination;
 and, in the first place, we intend to find out in what Medical Eclecti-
 cism differs from philosophical  Eclecticism, a circumstance which does
 not appear in anywise to   have  entered  the minds  of our Medical
 Eclectics.
   Philosophy,  embracing  the  entire circle  of  human acquirements,
 admits, generally, of two modes of acquisition, known under the names
 Rationalism and Empiricism.   The first consists in establishing  evi-
 dent principles, or axioms,  and  deducing  consequences and  particular
 applications.   This  is the  process of deduction.   This mode of acquisi-
 tion, called very improperly,  by certain authors, the synthetical method,
 is more  especially used in  mathematics, metaphysics,  morals and dia-
 lectics.  The   second  mode  consists  in studying at  first  particular
 facts, and abstracting what they have in common, in order to form gen-
 eralities or communities, which  are named,  also, principles and axioms.
 because these generalities, once established, guide us in the research or
 production of  other  particular facts like the first.  This is the method
 of induction.   This  mode of  acquisition, called,  sometimes, wrongly, the
 analytical system, is  employed  in  preference by naturalists,  natural
 philosophers, chemists, physicians, etc.   In  Bationalism, the  principle
governs,  is fixed; the fact  is  subordinate, variable.   In Empiricism,
 on  the contrary, the fact governs, and it  must  be  constant, and well
 determined; the principle is subordinate, variable.
  We  may conceive,  from  this succint  expose,  that  the  philosopher
can, and ought even, to  be  an  Eclectic in  respect to methods, that  he
ought  to give  the  preference sometimes to one,  and sometimes to  the
 other,  according to the order of  facts he contemplates, and that he will
do wrong in adopting one exclusively, on all occasions.   The physician,
 on the  contrary, cannot be an Eclectic, since he has no  choice to make
in this respect.  The method which he ought to employ habitually, is 
648
APPENDIX.
fully indicated by the order of facts he cultivates.   These facts arising
from sensation or  observation, he ought  then to have recourse to the
Sensitic method, otherwise called the Empirical or Inductive. Eclecticism
in Medicine cannot then  consist, as Eclecticism in  philosophy, in  the
choice of this  or that mode of acquisition.   Eclecticism in Medicine is
more  confined; its object is entirely special, as we shall see from  the
exposition which  will be  made shortly.  But before entering  on this
exposition, it was necessary to establish the  capital difference between
philosophic Eclecticism and  medical Eclecticism, so that, in the end of
our discourse, no one may apply indistinctly to the former, whatever we
shall say for or against the latter.
             §11.  On Eclecticism in Pathology.

   It has been said many times, and we cannot repeat it too often, that
Eclecticism is a doctrine so vague, so undeterminate, and  so  variable,
that no one has dared until the present time, to give a complete dog-
matic exposition of it.   I do  not know of but one serious attempt of
this kind;  it was made by one of the most  eminent medical  writers of
the periodical press.   M. Jules Gruerin addressed,  in 1831, to the Boyal
Academy of Medicine, a memoir,  in  which he  treated exclusively of
Eclecticism in pathology;  at  the same  time, he  promised a second, in
which he would treat of Eclecticism in therapeutics ; but this one has
never yet appeared, and  according  to all appearances, it will  never  see
the light of day.
   However this may be, we are happy in  possessing  the work of  M.
Guerin, by the aid of which, it will be possible for us to seize this pro-
tean and parasitic doctrine, which  lives by borrowing, having  produced
nothing until  the present time, in  itself, but an  individual critic, more
or less independent  and arbitrary.    This  is the  opinion of the author
himself whom we have cited, and  it is to put an end to this sterile anar-
chy of Electicism, to constitute it  dogmatically,  that he prepared, he
said, his memoir, the first of a series of other works which would  have
the same aim.°
   Consequently, the first thing  that M. Guerin  proposes to decide, in
order to raise  the scientific edifice  of Eclecticism, is the instrument or
method by means of which the Eclectic can discern the true from the
false, the real  from  the  hypothetical, among the  facts  and  opinions
which are  furnished by other systems.  Now,  this writer arrives, by a

    0 Memoire sur PElectisisme en Medecine, par J. Guerin, page 2, 23, and 26. 
FIFTH LETTER.
649
 series of considerations, to the conclusion, that  the supreme criterion of
 the Eclectic in the selection of his materials,  is nothing else than expe-
 riment.   From which  it  results, according to his avowal, that Eclecti-
 cism confounds itself with Empiricism, in respect to method.
   Some persons have said, he says, and others may still say, that Eclecti-
 cism, as thus determined, is only the experimental method, applied to Medi-
 cine, and might ask, why change the name of this method ? Why call Ec-
 lecticism by that which could be more clearly designed under the name of
 Experimentalism ? I have a peremptory answer to make to this objection.
   I will give this answer textually :  " Empiricism is, properly speaking,
 the chaos of science;  I  may dispense  with showing its  insufficiency.
 Empiricism stops at  those  facts which  are the most  material;  it does
 not regard either  the coordination of facts, or the  explanation of the
 laws which produce them;  consequently, it rejects science.   Its obser-
 vation is isolated in the individuality of each disease, no regard being
 had to what is expressed by its general relations.  However, if it  does
 not seek analogies, if it neglects  differences, its  observation, instead of
 being analytical, is  superficial and  general, and although it does  not
 approach facts with  preconceived ideas, it sees only an obscure totality,.
 and its experience is of no benefit for the future."
   When did M. Guerin find that Empiricism  does not require either co-
 ordination of facts, or science ;  that it does not seek analogies; that it
 neglects differences, etc. ?   Is it in the writings of the ancient  or mod-
 ern Empirics, that he has collected such maxims ?
   Have not the ancient Empirics established  excellent precepts to dis-
 cern morbid species?   Are not their symptomatic assemblages the most
 reasonable, so far as pathological descriptions are concerned, which anti-
 quity has transmitted  to us ?  Now  how  could any one  range  diseases
 into classes more or less natural, without taking into account their ana-
 logies and differences—without analysing them ?
   As to the modern  Empirics, it suffices to  observe, in order to absolve
 them from the incredible accusations with which they have been charged
 in the description above, that it  is in accordance with their principles.
 as proclaimed by Sydenham, that most  of our nosologies are composed.
   By this  portrait of Empiricism who could recognize  the learned sys-
 tem of which Baglivi has spoken : " That it is the fruit of  method ele-
vating itself to the highest truths by the attentive and  persevering  ob-
servation of phenomena;  that it has  obtained  in all times the approba-
tion of distinguished men, who were forced  to enlarge it, as a  mode of
acquisition conformable to our nature."0
          0 De Praxi Medica, Lib. i., cap. 11.
41 
650
APPENDIX.
  Could you recognize it yet as that system which Berard, the historian
of the doctrine of Montpellier, regarded as the most profoundly elabo-
rated that has  ever appeared in  Medicine.   Could  you  recognize
in it the  philosophic method which, according to M.  Cousin, Bacon,
Locke,  Hume and Condillac have  developed?0  No,  certainly  not,
Empiricism,  such  as is  represented  above,  is  neither  a  system
nor a method ; it  is, to  make use of the  language of  M.  Bouillaud,
" I know not what, which has no name and does not merit  our atten-
tion here."
  M. Guerin is perfectly right in rejecting, with all his  powers, an em-
piricism so gross, and so anti-methodic as that which he  has painted for
us.   But is it loyal, is it worthy for a mind  so elevated as his, to tra-
vesty thus the opinions that he wishes to refute ?   Such was doubtless.
not his  intention.   He has been led by the habit which we have all con-
tracted, in our medical education, of considering empiricism but from
its bad  side, and in its lowest representatives ;  a habit which makes us
confound,  sometimes, scientific Empiricism or  Empiri-methodism, with
something  which  has  nc  rank in  science;  the  charlatanism of  the
mountebank, ignorance, the denial of all kinds of reasoning, of all the-
ory,  of all methodic co-ordination.
  What proves that he has acted in this way, is that the author of the
memoir in favor of medical Eclecticism, wishing to characterize a little
more his  method,  and to render it  unlike  those of other systems, ex-
presses  himself in  these terms: " The observation of Eclecticism is sep-
erated equally from the passive neutrality of Empiricism and  the  par-
tial  activity of  systems.   It  applies the experimental method to each
fact;  that  is  to  say, it  notes successively  all  the  elements of  the
facts, accordingly as they  are produced, and in the order that they are
produced." f
  For myself, I confess, the more I study the method counseled and des-
cribed by M. Guerin, the more I find it  identical with that of  Empiri-
cism.   I see no difference, absolutely, but in name.
  It remains  to  ascertain which of the  two appellations is the most
exact, his or ours.  In this respect I believe that M. Guerin has himself
decided the question, in giving to his method the epithet Experimental,
synonyme of empiric.  At the most, I felicitate myself in not disagreeing
with him, but in the meaning of  a word.  When we have reached  this
point we are not far from understanding each other.
ffl See our Fourth Letter.
j Essai sur la Philosophic Medicale. 
FIFTH LETTER.
651
        §111.  On  Eclecticism  in Therapeutics.
  Eclecticism in therapeutics consists, as we have said elsewhere:  First,
in not  admitting any universal principle of treatment; second,  in de-
ducing the curative  indications, either  from physio-pathological theo-
ries, or from pure experimentation.
   Now, we have proved in the preceding letter that  it is impossible to
deduce any rule of cure directly from pathological physiology.  Conse-
quently, we might dispense with a more ample emamination of Eclecti-
cism in therapeutics ; because, whoever has followed our argument must
have seen that this doctrine is fundamentally erroneous.  But there are so
many varieties of  eclecticism in Medicine that this refutation en  masse
does not suffice ; because a great many theories, thoroughly eclectic, are
produced under other denominations, and every one does not perceive at
the first view  the  connection which  exists  between  the most elevated
principles  of science, and  their remote  consequences.   Moreover, this
doctrine is the most fashionable one of the present day, and in this view
merits still on our part a special examination.
   I choose designedly, for the immediate object of this discussion, one
of the most recent and most remarkable specimens  of  modern Eclecti-
cism, the introduction to the  Treatise on Therapeutics, by MM. Trous-
seau and Pidoux,  third edition.  No one, I hope, will accuse me of con-
sidering Eclecticism in  its  lowest representatives.   The  fragment of
medical philosophy which I have just designated is really an eclectic
production, although its authors do not say so ; but I judge it by the
maxims which are emitted in it, and the spirit which pervades it from
the beginning to the end.
   Indeed,  after a rapid description of  the revolution that  the expe-
riments of Haller on  irritability of the tissues first  introduced into
physiology,  and  consecutively  into  therapeutics,  after  a  succinct
discussion  of the  principal  doctrines which  have  prevailed  since the
time  of Cullen till  our day, these authors  begin  the explanation  of
their own theory, of which I will  give  the following resume:  There
exists a class of diseases arising from a simple exaltation or depression
of the vitality of the organs.  These  diseases have no real specificity,
and do not differ from each other but in their seats and degrees of inten-
sity.   They are  not diseases, properly so called, they are  accidents,
purely traumatic  lesions.  In these kinds of affections there is no neces-
sity for the  resources of the  Materia Medica, properly so  called; the
resources of  hygiene are sufficient.   In this numerous class of diseases,
the curative indications ought to be drawn from physio-pathological ideas.
   There is another class of diseases whose specificity is not doubtful.
 Each one of these constitutes in the organism a distinct entity, leading. 
652
APPENDIX.
in some sort  a  particular life.   These are diseases truly essential
as syphilis, marsh fever, small pox, etc.  Against this class of affec-
tions the resources of hygiene are insufficient; we cure them only by the
aid of special agents.  In these cases, the lights  of pathological  physi-
ology furnish us but imperfect  indications;  pure experience or empiri-
cism guides us more surely.
   Such is the doctrine comprised in substance in this essay of medical
philosophy.  We read in it that the principle of general therapeutics,
the sovereign law of good practitioners, consists " in the idea of  subor-
dinating to the medication of the symptom that of the morbid unity,
when this latter is not well  determined and sufficiently specific to gov-
ern all the other indications;  and to subordinate, on  the contrary, the
medication of the symptoms to that of the  nature of the disease, when
this latter possesses  such unity and  such  specificity that  none  of its
parts or its symptoms can be detached from it, and each one of them
represents and manifests it as well as the whole."0
   All this is not very clear, but by the aid  of the antecedents we may
nevertheless satisfy ourselves  that the authors of this article  have
wished  to avail themselves of physio-pathologism and empiricism.   They
think that we should take from physio-pathology the therapeutics of the
first class of diseases,  and from common experience  the therapeutics of
the second class.  This is, as any one can see, pure  Eclecticism, if any
thing ever was.   It remains to know how we may  know if a morbid
case belongs to one or  the other of these two nosological classes.   It is
not easy to solve this question in  a large number of affections, even the
most simple.  Let  us take, for example, venereal chancres,  situated on
the  external  organs of generation.   Before laying  down a treatment
appropriate to this lesion, it will be necessary to decide if it  is  of a
physiological nature, or of a special essence.  Now,  if you interrogate a
partisan of Basori on this point, he will answer by saying that you must
treat ulcers with hyposthenia, or, in  other  words, by lowering vitality.
If you consult a follower  of  Broussais, he will affirm that you have
nothing before you but a product of ulcerous irritation, or an exaltation
of vitality.   Another theorist will  see  in  it a  particular virus, or an
essential affection.   By what rule, I demand of the authors of this phi-
losophic pamphlet, by what criterion do you make  your  final choice ?
 You have nothing else  than the  therapeutic  proof, that  is  to  say,
 Empiricism, which you have  endeavored to avoid, and which you  have
 previously condemned.
   But if your sovereign law can  not guide us in a case so simple as the
* Page 28. 
FIFTH LETTER.
653
preceding, of what aid will it be to us when we have to deal with some
of those complex affections which we encounter frequently in  practice,
such as typhoid fever, cholera, scrofulous affections, etc. ?  Writh such
a guide, we must stumble at every step against some insoluble difficulty.
You have foreseen this, and stated it in formal terms, when  you say:
" We  do not know any disease which may not have a certain unity, and
may  not  be  distinguished from  every other by something  special.
      °     °     °   Just as we know no disease which does not remain
subject to the laws of the  economy, and which does  not consequently
present some physiological indications."0
   Thus your sovereign law of good practitioners, which is based solely
on the distinction of diseases of a special nature from diseases of a phy-
siological nature, according to your own confession, crumbles to its very
foundation.   I will not stop to discuss the axiom of contraries, although
you assert that it is at the present time better demonstrated than ever
before.f  It is  a  subject of which I have disposed elsewhere, in such a
manner that I have no need to return to it.   But what astonishes me in
the last place is, that you declare afterward that no one can base the Mate-
ria Medica, in the present state of science, upon a general idea.\  Is in
your opinion the axiom of contraries no general  idea?  And your sove-
reign  law  of good practitioners, is it not, either, a general idea?
   Thus you see the inconvenience of having no fixed, determined prin-
ciple ; you are drawn necessarily into contradictions from which all the
talent in the world cannot extricate you.  The philosophic medical essay
of which I  have just given you a short and incomplete analysis, offers us a
remarkable example of this defect.  Notwithstanding the incontestable
sagacity and talent of these authors, and the profound study which they
have made  of the  vicissitudes of therapeutics,  within half a century,
the absence of a fixed and avowed principle gives vagueness, indecision,
and obscurity to the whole of their work.
                        IV.  CONCLUS ION.
  Eclecticism in Medicine, whether considered in its  foundation  or  in
its details, is a doctrine proven to be  sterile, and which, under the pre-
text of holding an equal balance among  the various systems, acts  only
as a poor amalgam without fixed proportions.   It is an individual criti-
cism calculated  at  most only to destroy some  errors,  but incapable  of
establishing anything stable; unable, in short, to create but doubt and
uncertainty; a doctrine essentially transitory, which must disappear in
* Page 28.
f Page 53.
X Page 70. 
654
APPENDIX.
the presence of the true theory, as the shadows of twilight are scattered
before the beams of the rising sun.
                      ON HOMEOPATHY.
                 PRELIMINARY  CONSIDERATIONS.
  " The time has gone by," truly remarks  the  translator of the works
of Hahnemann,  "when the pleasantries relative  to  the infinitiscmal
doses can be regarded as good  arguments  against  homeopathy."0   We
are certainly compelled to take this doctrine into serious consideration,
since men commendable by their scientific titles and  medical position,
members of faculties,  hospital physicians,  and eminent  practitioners,
have embraced it and become its public defenders; since journals  have
been established and societies instituted in different countries to make
public its principles and practice.   Before this  invading propaganda it
is not permitted to any man  clothed with  the  medical priesthood, and
comprehending  the dignity and  importance of  his ministry, to  remain
indifferent;  it is necessary for him to take a part for or against  it, and
how  can he take a part in so grave a question without a preliminary and
searching examination ?
  I regret that no one of our academical dignitaries  or teachers  have
charged themselves with such a work ;  it would have been more perfectly
accomplished, and especially more authoritative than my effort.  Unhap-
pily, none of our distinguished teachers have deigned or dared to enter the
list openly for a  combat with the partisans of this new gospel.   It is
true  that a long time past, some experiments were made, but these exper-
iments,  now almost forgotten, should have been  resumed  on  a grander
scale by different therapeutists ;  for it must be avowed that the negative
results published by M. Andral, or any other experimenter, whoever he
may have been, can not  nullify the mass  of positive  results that the
homeopaths  pretend to oppose to them.
  Moreover, what can we answer when  they say  to  us, your so-called
rational Medicine only treats more or less subtily on the evils of human-
ity, but it does not teach  you at all how to relieve  them.   The most
efficacious means possessed by the  Healing  Art, specifics which accord-
ing to common consent procure the mildest, promptest, and most durable
cases, your official medicine proscribes as much as possible ;  it excludes
them from its theory,  if not from  its  practice.   We, on  the contrary,
come to teach you a means to discover, and a method to employ these
0 Jourdan.  Preface to French translation of the Treatise on Materia Medica. 
FIFTH  LETTER.
655
admirable instruments of cure.  What have we to respond  to  such an
argumentation ?  Nothing, absolutely nothing serious and logical.
   There is not one among the old doctrines, except rational Empiricism,
which is not embarrassed by  such an objection, because rational Empiri-
cism, or Empiri-Methodism, is the only one of  all these doctrines which,
far from excluding from its theory a treatment by specifics,  admits them
on the contrary, to the first  rank of curative  methods, called  rational,
as may be seen in the article on Therapeutical Methods in the Beform
Period,  and which will be again referred  to in its appropriate place.
   Since our masters  have not entered into a struggle with the apostles
of Homeopathy, but have left their disciples as well as the public with-
out a guide, and without defense against the attractions of this novelty
and the  deceitful promises  of  these  innovators, I, though an obscure
champion, but confident  in  the principles which I have adopted, will
open the conflict, by exploring to its most minute elements, the Homeo-
pathic code.
  Philosophical, Physiological, and Pathological Doctrine of Hahnemann.

                            PHILOSOPHY.

   "The mind is  not able to recognise any thing a priori; it cannot
form  in itself a  notion  on the essence of things,  their causes and
their  effects.  Whenever  it has to pronounce truths  in regard to real
objects, each of its propositions must be founded on  sensible observa-
tions, on facts and experience.   In going a single step  from the path of
observation, it is at once  plunged into the  illimitable  spaces of imagi-
nation and  arbitrary hypothesis, parents of false opinions and of noth-
ing absolute."0
   These are maxims which a pupil of Condillac cannot disavow.   They
are, indeed, only a commentary of the famous axiom of the Sensitist or
Empiric school:  all our knowlege comes from the senses; an axiom which
I accept not as of universal  application, but limit it to physical sci-
ences, of which Medicine  is one of the most eminent.   Thus, then, I am
in harmony with the pontiff of Homeopathy,  on  the source of our lights?
in Medicine.
                             PHYSIOLOGY.

   " That which  unites the living  parts of the human body in such a
manner as  to make it an  admirable organism, that which determines
them  to harmonize  in a manner so directly contrary  to their primitive

  Q Organon  De PArt de Guerir, preface, 2d edition,  French translation of Bra.
non, p. 40. 
Q56
APPENDIX.
nature, physical or chemical, that which animates and impels them to
such surprising automatic actions, that fundamental force, in fine, cannot
be represented as a distinct being; it  can only be understood  imper-
fectly ; it escapes all investigations, and all our perceptions.  No mor-
tal can know the substratum of vitality, or the disposition a priori of
the living organism.   No mortal can sound the depths of such a sub-
ject, nor  even describe its shadow.  Let them  speak in prose or verse,
human language, in this respect, can only express chimeras or nonsense.

   " Consequently,  all that a physician can know of his subject,  the liv-
ing organism, is limited to  what the sages among us, a Haller, a Blu-
menbach, a Wrisberg,  have  understood  by the  name of physiology, and
what may be termed experimental  biology;  that  is to say, appreciable
phenomena of the  human body in  health, separately and generally con-
sidered.   The impossible, that  is to say, how these  phenomena  take
place, is  totally excluded from the circle of our necessary  knowledge in
physiology."0
   This profession of physiological faith has no need of comment.   It is
seen that its author only admits,  in  the science of life, the  pure and
simple description of phenomena observed during the natural play of the
organs, or those excited by experiments.   This is still Empiricism, and
the most  austere Empiricism, I will even  say  the narrowest.   For  the
Empirical doctrine, well understood, in all the breadth of  its principles,
does not  exclude from physiology a priori consideration, or hypotheses on
the organic  forces and  the substratum of vitality,  provided  that these
hypotheses be given as such, and not  for  realities; and especially, pro-
vided, that no one pretend to build on these abstract or imaginary enti-
ties systems of Medicine and therapeutical rules.
                             PATHOLOGY.

   In the same work, Hahnemann expresses himself in these words: " I
pass to pathology, in which  the same furor for systems which turns the
brains of metaphysical physiologists, has given birth to so many hypothe-
ses on the intimate essence of diseases, or why  diseases are diseases ; in
one word, on what is called  the proximate or interior cause.  No mortal
has  a clear  idea of what is sought here.      °      °  Nevertheless, a
crowd of sophists  have affected the important airs of men who possess
this knowledge.f"
   This is what the author of Homeopathy wrote in 1808, before he had

   0 Valeur des Systemes en Medecine, French translation of Jourdan, p. 462.
   f Ibid. p. 463. 
FIFTH  LETTER.
657
promulgated his own system.  The following was published in his Organon,
in 1819 :  " We can easily conceive that each disease supposes a change
in the interior of the human organism.   Nevertheless, this change can
be suspected only in an obscure and dubious manner, by the  symptoms
of the disease; but it will never be recognised  to its full extent, in an
infall ible  manner.''°
   These passages and a great number of others in which the same views
are held, prove that Hahnemann professed in pathology as in physiology
and philosophy the most absolute  Empiricism or Sensitism;  indeed, I
have said the  narrowest and most exaggerated.   In fact, he goes  so far
as  to be  willing  to  expunge  from medical language  those  collective
expressions which designate a concourse of symptoms or morbid phenom-
ena, such as pleurisy, pneumonia, tetanus, diabetes, hydropsy, mania,
angina, phlogosis,  etc., under  the  pretext that these  words are not
applicable to  any  real entity, to  any distinct   and  always identical
individuality.!
   But can any one mistake to such a point  the most elementary princi-
ples of  general grammar as to be willing  to banish  from scientific lan-
guage abstract terms, because these terms give rise often to very differ-
ent ideas  with those who use and understand them ?  Thus the  words
pleurisy,  tetanus,  diabetes,  inflammation,  etc., have extremely  varied
significations,  not only in pathological treatises  belonging to different
epochs,  but even in those of  the same epoch.  This is doubtless a fault,
an  imperfection;  but this fault and imperfection are common  to all the
sciences and all languages;  they are inevitable.
   Do the names of the classes, orders  and families in natural history
represent  real objects?  Is there any individual  in the vegetable king-
dom which is  termed acotyledon, or  leguminous, or labiated ?  Do not
these several words express an abstract collection of  ideas or of proper-
ties common to a multitude of different vegetables ?  Would you exclude
from philosophic language  the words  substance, body, spirit, virtue,
courage, chastity, vice, etc., because these denominations have an appli-
cation to nothing material, nothing which may be perceptible to the sen-
ses ; because they  awaken  sometimes in those who  understand  them
very  varied ideas; because, in fine, there  are  ignorant persons who
attribute  to these abstract expressions an objective reality ?
   What will you put in place of the words gastritis, variola, pneumo-
nia, etc.,  which you would exclude from  pathological  language?   The
0 Organon.  The Art of Curing, sec. 5.
Q Ibid.  Section 83, and explanatory note. 
658
APPENDIX.
 enumeration of all the symptoms or accidents realized by each patient,
 responds  Hahnemann.    Thus  a  pure homeopath must not  pay,  for
 example, I treat  a man  attacked  with an acute articular rheumatism.
 He would come greatly short of Hahnemannic orthodoxy; but he must
 say, I treat a man who, in consequence of taking cold has been attacked
 with acute pain in this or that articulation; the pain is exasperated at
 certain hours in the morning or evening.  There is  a certain degree of
 swelling,  coloration, etc. ;  a  difficulty or  complete impossibility of
 motion; so  many strong, slight or  medium pulsations in the morning,
 at noon or at night,  before or after  meals, etc.   The  patient realizes a
 vertigo when he closes his eyes at five o'clock in the morning;  his head
 swims when he looks upward after  drinking;  there  are sour belchings
 after eating sour-crout, etc. etc.  The stools are sometimes green, some-
 times gray,  sometimes of a sour or putrid odor, etc. etc.   He has itching
 of the nose the day after taking a cup  of tea, and a  violent itching at
 the  anus on awaking on the morning of  the fifth  day, etc.   He is
 inclined to  anger; sometimes  he is frightened and troubled  without
 cause, and a thousand similar futilities.
  By these absurdities Hahnemann proposes to replace the usual denomi-
 nations of diseases and the nosological  descriptions  of authors.  I am
 ashamed for the enlightened  followers  of Homeopathy to insist on the
 refutation of so gross a philosophic  heresy, which several  of them have
disavowed;  but I am forced to do so, because it constitutes one of the
 foundations  of the mother doctrine.
  It may possibly be objected, that Hahnemann does not proscribe the
 names of diseases in an absolute manner; that he even tolerates them in
 common language in the presence  of the unprofessional; that he has
 even employed them  sometimes  in his writings.  Certainly I lose nothing
 by making this concession.  But what  does  this prove ?   Nothing else
 but that this author has not been able to change the  essence of human
language ; that he has been constrained, notwithstanding his obstinacy,
 to express himself like every  one  else.  It is a law which no man, no
 Hahnemannic Society whatever, can ever change nor disturb.   It is a
specimen of folly,  or alienation, or obstinate ignorance to have attempted
 not to conform to  it,  and so directed  his disciples.
  Nevertheless, pathology not being cultivated with any particular care
by the founder of  Homeopathy, I leave this branch of medical knowledge,
to pass to therapeutics—the true battle field of Hahnemann, the special
object of his meditations and researches. 
FIFTH  LETTER.
659
                  THERAPEUTICS OP  HAHNEMANN.

   The grand axiom  of Homeopathy, the one from which the doctrine
takes its name, is this:  Cure diseases by remedies which produce symp-
toms similar to those of the disease.0
   The first question to be asked after reading this axiom, so contrary to
the received ideas of  every one, the learned as well as the ignorant, is
this:   AVhere has the author obtained his therapeutic  rule ?   On what
observations  and experiments does he found so paradoxical a proposition ?
I have sought throughout the works of Hahnemann for a clinical obser-
vation which would justify his famous  axiom, and I avow that I have
not been able to find a single one.
   Can any one cite as medical observations worthy of any confidence,
such remarks as the following:   " A  diarrhea which  had  existed for
several years, and which threatened an inevitable death, against which
all remedies had been employed in vain, was cured by an unprofessional
practitioner in a rapid and durable manner by means of a purgative, as
Fischer observes, to his great astonishment, but not to mine.   °   °  a
Boerhaave, Sydenham and Badcliff were able to cure a species of dropsy
with alder blossoms, simply because the alder, as Haller tells us, pro-
duces tumors (oedema) by its external application."
   " How many times  does not the small-pox produce deafness and dysp-
noea ?   These two chronic evils were therefore extinguished by it, when
it had  attained their  highest development, as I. Fr. Closs has remarked.
° ° °  Vaccination, which causes  as its proper sign a tumor on the arm,
has also cured after its eruption a swelled and nearly paralyzed arm."f
   If it is by observations of this  kind that Hahnemann pretends to
prove the  law  of similars, it  must be  admitted that the partisans of
Homeopathy  are not hard to please in regard  to proofs.   I can furnish
them with another, which  doubtless escaped  the  erudition  of their
patriarch : The son of Henry I., King of  England, having been attacked
with small-pox,  his  physician, a skillful man if there ever  was one,
ordered with  all convenient ceremony that the young prince be enveloped
in scarlet; that everything about him be red—-the  hangings  of  his
chamber  and the  clothes  of his servants.   " This arrangement cured
him so well," he says, " that not  a single trace of the   disease was left
upon his face."|  We see that  John of Gaddesden,—this is the name
of the  celebrated therapeutist—had a presentiment of Homeopathy !
   Since Hahnemann is contented with as gross analogies as those above
0 Organon, sec. 15.                    t Organon, § 41.
t Freind, History of John de Gaddesden. 
660
APPENDIX.
given, it was not difficult for him  to  demonstrate, that the cures of all
the authors that history  has transmitted to us were  affected in  the
homeopathic way.  Indeed, where is  the remedy, the  administration of
which may not be followed by one or  two symptoms having an analogy
more  or less  remote  with certain morbid symptoms, especially if we
relate, like Hahnemann, to the action  of the remedy all the grave or
slight phenomena  which  manifest themselves for ten, twenty or forty
days after its administration ?
   This  author affirms that there are but three ways of employing reme-
dies specifically, namely:  1,  The  Allopathic  method, which uses reme-
dies whose effects  are different from the symptoms of the disease.   2,
The Homeopathic, which employs remedies whose effects  have the closest
possible resemblance with  the symptoms of the  disease.  3,  The Anti-
pathic method, which employs remedies contrary to the disease.
   This  enumeration is not complete,  and there should have been added
to it, for greater exactness, the Isopathic, which consists in making use
of means  identical or  of the  same  essence as the disease, such  as
innoculation, etc.  But let us  pass   over this omission, to which  1
do not attach much importance.  There  is  another  much  more capital
reproach, which I make to the manner in which  the  action of curative
agents is regarded in the above.   I say that this manner of considering
therapeutic  effects is  radically defective, because it turns the human
mind from the true object  of the Art, to enter upon researches as fruit-
less as insoluble.
   What is  in fact the true aim of  therapeutics ?   Is it not to cure ?
What then is essentially important to know in regard to any remedy or
treatment ?   Is it not first, if it cures;  then  if it cures promptly and
surely.  Finally, in what  doses and  in  what morbid circumstances it
shows itself  most efficacious.  Well then, in  what way can one  be
assured  incontestibly of all these things ?  Is it not by means of thera-
peutic proof ?  Is  there any testimony that can  dispense with this ?
The homeopaths, the allopaths, the antipaths and the isopaths, are they
not all obliged to appeal to this criterion and submit themselves irrevo-
cably to its sovereign decision.
   When therapeutic proof has spoken,  what is the use  of  enquiring
if the remedy has acted by homogeneousness or by antagonism, by sim-
ilitude  or difference ?  Is  not this a vain research, since it can neither
replace  nor impair the testimony of the  supreme criterion ?   Do we not
arbitrarily restrict the field of  experimental  therapeutics  when  we
include  it, a priori, within this or that category of medicaments, either
heterogeneous or homogeneous, homeopathic or allopathic ; or when we
circumscribe it within excessively minute, or very large, or medium doses ? 
FIFTH  LETTER.
661
   Most writers in Medicine resemble the attorneys in the comedy of the
Plaideurs, who  speak interminably on matters foreign to the case, and
say nothing, or next to nothing, on what concerns the litigation. When
any  one has made experiments with  a remedy or a treatment in a cer-
tain class of diseases, he describes, as briefly as possible, the character-
istic symptoms of the state of the patient, and the manifest  results of
his experimentation,  but dwells  at great  length on  the presumed or
pathogenic or essential  cause  of  the morbid phenomena,  and on  the
intimate modification which the treatment  is supposed to  impress on the
organism;  things entirely imperceptible to the senses, and on which our
minds can  form only ephemeral  conjectures.  We  know, for example,
that opium generally causes sleep, but that frequently, also, it produces
agitation.  This double effect of the same substance has put to torture
the minds  of  the theorists of our age.   They have written a thousand
dissertations,  and imagined numerous theories to explain this apparent
anomaly, without advancing the question one iota.   Does opium possess
sedative or exciting properties ?   Notwithstanding  our progress, and
our pretentious  physiology, we know no more on this matter than did
Galen, Avicenna, the Arabists, and the scholastics of the middle ages.
If any one now asks why  opium produces  sleep, we shall  not be able to
give a better reason than that in Moliere:  " Opium facit dormire, quia
in eo est virtus  dormitiva."   Behold!  where all our curious researches
on  objects  inaccessible  to our observation  lead  us, and cause  us  to
neglect the essential and indispensable ?   Instead of expatiating learn-
edly on the excitant  or sedative property of opium, it would be better—
it would be infinitely  more useful—to seek out,  by  direct  and con-
tinued experiments, what  are the conditions of health and disease in
which this substance produces a sedative effect, and what are the condi-
tions in which it produces an opposite one;  what are the doses and the
preparations most proper to bring  about either result.
   But this way is too simple and too long, and  does not give a free rein to
the imagination.  Hahnemann preferred to follow the beaten path, by sub-
stituting in all  his  writings, transcendental  explanations for clear and
established  experience.   In justification,  for  example, of infinitesimal
doses.instead of bringing detailed and authentic facts of curing to the
support of his method, he  endeavors to persuade you  by an inextricable
tissue of subtile devices, that diseases being only immaterial alterations
of an immaterial vital  principle, must be combatted  by forces of  the
same nature—that is to say, by the spiritual virtue of medicaments,
developed  by means  of  homeopathic attenuation.0
Organ, sections 53, 66. 
662
APPENDIX.
  Another time he will tell you that the general forces of nature, such
as attraction, electricity and caloric, whose powers arc manifest to every
one, are neither ponderable nor coercible; whence  he infers that we arc
wrong  in  doubting the efficacy of any infinitesimal doses  whatever."
  This proves that he has not, then, observed that if the forces of which
we  have just spoken  are  imponderable and  inaccessible to our senses,
their substrata are not at  all  so.   Thus, the force of  attraction is in
proportion to masses;  electricity is developed in proportion to the fric-
tion of surfaces;  caloric to the quantity of combustibles—all of which
are material, and appreciable by the senses.
  It is known that Hahnemann has  composed  a treatise  on Materia
Medica and  Chronic Diseases, in  which he  attributes a multitude of
new and unheard-of properties  to several substances supposed hitherto
to be  perfectly inert.   He assures us,  for example, that the carbonate
of lime, administered in doses of  the sixtillionth part of a grain, pro-
duces no less than one thousand and ninety symptoms, from among which
I select the following:  f
  1.   In  the evening (thirteen  days  after taking it),  on going out,
unsteady  gait.
  2.   Dizziness on walking out (at the end of twenty-six days).
   145.  Sudden  deafness,  immediately after dinner.
   147.  Itching  on the border of the eyelids (after five days).
  572.  Itching  at the anterior part of the glans penis, after urination
(after  twenty-eight days).
   583.  Ardent  venereal desires, especially during a walk before dinner
(after  seventeen days).
  865.   Great heat  at the extremity  of the big toe (after twenty-one
days). \
  Pray tell us how any one can assure  himself that an imperceptible
atom of the carbonate of lime is, unquestionably,  the determining cause
of these thousand and ninety  symptoms, a great number of which arc
manifested only  at  the  end of ten,  twenty and  thirty  days  after the
ingestion of the medicamental atom ?   Who can assure us that the most
of these strange  phenomena that  are attributed  to the influence of the
infinitessimal atom, are  not, rather, the effect of a multitude  of other
forces, quite  energetic, on  the contrary, which act  unceasingly on the
economy—some permanently, others accidentally?  Is it not absurd, as
Hahnemann  himself says,  elsewhere, to attribute an effect to one force,
s Organon, sect. 305, and note.
f The figures denote the order in which the symptoms stand.
| Treatise on Chronic Diseases. 
FIFTH  LETTER.
663
while there are in  play, at the same time, other forces which often con-
tribute more than it to its production.°
  To these questions,  so  legitimate and so pressing,  the  author of
Homeopathy makes no response.  He only opposes affirmations destitute
of every species of proof, and his credulous adepts are contented.  They
accept his strangest assertions as articles of faith.   Some, however, have
separated themselves from the faithful flock, and attempted to revise the
symptomatic categories of  Hahnemann.  They have submitted each of
his propositions to scrupulous examination, and exact experiments;  and
what have they found at the foundation of this burlesque frame, pomp-
ously announced as a  divine revelation ?   I will let one of the admirers
of Hahnemann make the reply.
   M. Bapou,  historian of  the Homeopathic doctrine, in summing up,
under the title of the  " Specific School," the sum of the differences which
are exhibited among the partisans  of the new method, expresses himself
as follows:  " The law  of similars is positive, but it does not constitute
the general law of therapeutics.  Medicamental substances may operate
by the law of contraries;  enantiopathy is  as often in play as homeo-
pathy—both are secondary and accessory modes.   The great principle
is the specificity, and the  most important problem is  not  to  seek the
similarity between the remedy and the disease, but to find, directly,  the
specific appropriate to each morbid state.  Dynamization does not exist
even  where by many  its importance  has   been  greatly exaggerated.
Dilution is  incapable of developing a  medicamental efficaciousness in
most substances  which  are  inert  in their  natural  state,  and which
Hahnemann has put  among  the number of  active remedies.   Infinites-
imal  doses  have  no marked  action;   it is necessary, ordinarily, to
employ tinctures  and powders, and  never to extend them beyond  the
third or  fourth divisions.   Our medicines  may be  administered with-
out  inconvenience  in the  ordinary pharmaceutical  preparations,  and
the various allopathic  remedies may  be employed conveniently with
them.  Clinics must  become the  principal  source of  indications,  and
concur,  in the largest degree, to the formation  of our pure materia
medica.   This last part of science is to be reconstructed; an anatomical
and  physiological classification of  symptoms must be introduced into
it.   The theory of psora, and  its  pretended consequences, are false in
all respects.   We can and we must seek to combine the specific proceed-
ure with the usual  indications.  It is  proper to fall back to the use of
pharmaceutical mixtures." f
° Treatise on Materia Medica.
f Histoire de la Doctrine Homoeopathic, 1847—vol. II, chap. xrv. 
664
APPENDIX.
  These, then, are the results to which Hahnemann's own disciples have
arrived when they endeavored to verify by facts, the  astonishing asser-
tions of their master.   Each one of the fundamental propositions of the
new doctrine, receives thereby the most formal denial.   What remains
of this doctrine after so complete and  detailed a refutation ?  Nothing,
absolutely nothing which is worthy of  the attention of a man of sense.
  As to  the expose of principles which we have just read, and which
forms the programme of emancipated Homeopathists, under the name  of
the Specific School (Ecole Specificienne),  I do not  see what the most
severe critic can find to condemn, unless it be the words specificity, spe-
cifics, which might be advantageously replaced by the more exact expres-
sions synthesis and synthetical.  Apart from  this slight modification, the
programme of the Specific School agrees entirely with the principles which
we have,  ourselves, proclaimed under the head of Empiri-Methodic system.
                           CONCLUSION.
  The Hahnemannic doctrine, whose defects we have only feebly set forth.
offers to  us the strange assemblage of assertions devoid of proof, auda-
cious  paradoxes and  manifest contradictions.  Its  author, after hav-
ing declared  solemnly in  numerous passages that " the human mind
cannot form of itself a notion of the essence of things,  of  their cause
and their effects ; that every proposition must  be founded  on  sensible
observation, on facts and experiments," forgets the maxims of  his wise
philosophy, when he is laying the foundation of  his medical system and
laboring  for its development.
  From that time he did  not hesitate to affirm that all the  chronic dis-
eases that are observed in  Europe, (except syphilis,)  are the result  of
a protean impalpable miasm which he calls  the psoric or scabby.   If a
child passes worms in his alvine dejections  or by vomiting, if he is  sub-
ject to opthalmia, catarrh, convulsions, sore throat; to furuncular tumors,
scrofulous  engorgement,  etc;  it  is, according  to Hahnemann a latent
psoric miasm which is at work.   If a young girl is affected with chlorosis,
or hysteria or chorea ; if she is subject to spitting of blood or threatened
with pulmonary tubercles or aneurism of the heart,  etc., etc., psora is
committing in  her these  ravages.  If an old man has  hemorrhoids  or
tetters, if he is affected with a catarrh,  or an asthma, or dropsy, or gout,
or rheumatism or paralysis, etc., the psoric virus manifests  in him its
presence.
  By what series of transcendental observations, of delicate  experiment.
has Hahnemann  been  able to grasp and unite so many and so various
phenomena with the incoercible and immaterial miasm which he names
psoric virus.   He is silent upon this subject, which is incomprehensible 
SIXTH  LETTER.
665
and  incredible to  whoever does  not  possess  homeopathic faith ;   but
becomes lucid and indubitable to those who possess this new, pretended
divine revelation.
   An orthodox Homeopathist is very careful not to suspect the most
unimaginable assertion of his prophet. No one among them, for example,
has ever attempted to call  in  question the following anecdote by which
Hahnemann  pretends  to prove the efficaciousness of his infinitesimal
doses: "Let a melancholic patient, disgusted with life, and feeling pressed
by an insupportable anguish to commit suicide, smell for several minutes
only, a flask containing a quadrillionth of a grain of homeopathic powdered
gold, and at the end of half an hour he will be delivered from the demon
which seemed to possess him, and his flow of spirits will become again
like that of a man of  sound mind."°
   No founder of a medical philosophic sect, since Pythagoras, has pushed
as far as the   chief of  the Homeopathists, the despotism of the word of
the  master.   No one has imposed on his disciples more submissive and
blind  credulity.   In order to demonstrate  the reality  of homeopathic
cures he does not report any well established facts or observations,  he
contents himself with affirming that the  medicamental atoms given to his
patient proceed to  the imperceptible point of the economy which is  the
seat of the primary lesion,  and by acting  upon it cause the  disease to
cease, naturally, by replacing it with a stronger artificial affection, which
is subsequently extinguished  by the vital force ;  and not one of his dis-
ciples ask him how he has  been  able to perceive all  these  phenomena,
inaccessible to the human eye—how he has been able to follow the track
of the infinitessimal atom,  the course of which he recounts with so much
assurance !  Oh, Messieurs Homeopathists,  you merit well the epithet of
Hahnemanni servum pecus !
'■' Treatise on the efficaciousness of minute homeopathic doses.
42 
666
APPENDIX.
                    SEVENTH  LE  TTER.

               THERAPEUTICAL  METHODS.

      I.  Present  State of this Branch  op  Science.

   Tnis branch of the science is, without contradiction, one of the least
 advanced; only a few feeble gleams of light pierce the  thick darkness
 that envelopes it.   The classification of the therapeutical  methods, by
 Barthez, which I have previously cited, is yet the best and most rational
 that we possess.0  However, it  can  only be considered  a rough draft,
 because  it partakes, with  all the other modern therapeutical classifi-
 cations, of the capital fault of incoherence and inconsistency.  Thus the
 classification of Barthez admits  a natural method, having  for its object
 to favor, accelerate, or regulate the progress of diseases which tend to a
favorable termination.   An analytical method, in which each disease is
 decomposed into a certain number of elementary affections, which are to
 be treated separately by appropriate means; an  empirical method, by
 which certain maladies whose nature is unknown  are  combatted with
 remedies whose immediate or primitive action is not understood ; finally,
 a perturbative method, which Messrs. Trousseau and Pidoux replace by
 the substitative method.    Let  us  consider the  incoherency of  this
classification.  The first method  is called natural; the second ought to be
called, by way of opposition, unnatural.   There  is a method which  is
 designated by the term analytic; there should be  one  called the syn-
 thetic.   The fundamental rule in every classification  or division of  any
 subject whatever is, that the parts of which it is composed should recip-
rocally exclude each other, but this rule has been comparatively  forgot-
ten, as may be perceived in  the classification of Barthez; each of the
methods which have been  admitted is founded on  considerations of an
order foreign  to the preceding, instead of flowing from the  same princi-
ple, as the branches of a  tree proceed from  the  same  trunk.   What
would be  said of a naturalist, should he  divide bodies  into artificial
and organic,  or of a pathologist who should divide  diseases into  epi-
demic, endemic, and contagious ?  It would  be alleged  that they mix
0 See our Third Letter. 
SEVENTH  LETTER.
667
and confound  all their ideas.  Does  not a therapeutical  classification
based upon different principles merit the same  reproach ?  The incon-
sistency of the classification  of  Barthez is not less  palpable  than its
incoherence.   In fact,  we find a method distinguished from the others
by the title Empiric, which signifies, in the ordinary language of authors,
unreasonable  and unphysiological.   But this  method  being the one
which, by the consent of everybody, produces the  most brilliant cures,
it follows according to  its peculiar denomination, that  physicians  never
produce better cures than when  they treat diseases without being guided
by, or even contrary to their theories.   What beautiful  logic!   And
yet I venture to say, French Medicine has not produced a greater genius
than Barthez.  But what can you expect; the most adroit musician can
not produce harmonious sounds from a poor instrument. As long as theo-
rists shall  obstinately designate  certain curative methods by titles which
are appropriate, or ought to be appropriate, to all of them in general;  as
long as they will continue obstinately to call the one rational, the other
natural,  a  third exact, a fourth  physiological, another experimental  or
empirical, etc., never, no, never,  will therapeutics escape from the  chaos
into which it has been plunged ; never shall we succeed  in forming  a
truly rational classification of the different modes of treatment.
  In order to accomplish an  object so desirable, it is  necessary at first
to establish a universal principle of therapeutics, embracing all the ope-
rations of internal and external Medicine; afterward, to  deduce from
this principle the different curative methods proposed; finally,  to desig-
nate each  of these methods by a term which is applicable to it alone.
  We have already fulfilled the  first of these conditions, in forming the
following precept, whose  evidence  and generality no one will  contest;
treat each malady by those means whose efficacy in similar or homologous
cases has been demonstrated by experience*  We shall now attempt  to
fullfil the other two in the classification which follows.
  §11.  Classification  of  the Therapeutical  Methods.
                    THE  SYNTHETICAL METHOD*

  The most ancient, the most natural, and the most simple mode of cure
consists in opposing to each disease which presents  itself,  one remedy or
one combination of curative means, which  removes  the  disease  at once.
In this mode of treatment our mind considers all the  symptoms as forming
0 See our Second Letter, § 4 and 5. 
668
APPENDIX.
an  indivisible concourse, as  the  manifestation  of one simple  morbid
entity, against which  he directs a plan  of medication which seems to
attack the disease in its essence, and to put an end to all the accidents
by a virtue which is special  and peculiar to it,  and is  in some  sort
incomprehensible.   I shall give to this  method  the epithet  synthetic;
that is to say, simultaneous,  a word which represents  very exactly the
manner in which our minds consider both the morbid symptoms and the
effects of the treatment.
  The ancients,  who saw in all cures nothing but the result  of  antago-
nistic forces, designated these kinds of medication by the name of anti-
dotes, the moderns called them specifics.  By a sort of precipitation very
common to the human mind, the first therapeutists  were very quick to
arrange among the antidotes  a larger number of substances whose vir-
tues were by no  means assured.  Thus they designated a  large  number
of plants by the title of vulnerary, because they supposed  them to  pos-
sess especial virtue in the cure of wounds.  They called theriacs several
very complicated pharmaceutical preparations which, in their imagina-
tion, had a marvelous efficacy against venom and all sorts of poisons.
  It is the same with a multitude of pharmaceutical affections  of anti-
quity.   The moderns have not been less  prolific in this respect, but
have often  been less sincere;  and the pompous denominations by which
they designate numerous medicaments are only enticing labels to attract
customers.   Among  this number  are  to be classed the elixirs of  lon-
gevity, of immortality, the anti-goutous and anti-mucous nervines, the
sedative waters,  etc.  etc.
  Galen, not knowing how to explain the therapeutical effects  of anti-
dotes, has said  that  these remedies  act by  their ivhole substance, and
medical  posterity has repeated this explanation, which  was  nothing
more than a method  of concealing its ignorance: in the same way natu-
ral philosophers concealed their ignorance of  the cause of the ascension
of water in the tube of a  suction pump, by  saying that  the liquid
rises in  consequence of nature's horror of  a vacuum.   The moderns,
not  willing to  be satisfied by senseless explications, have  fallen into
excesses not less ridiculous.  Some have denied  the existence of specif-
ics ; others, without contesting either  their existence or admirable effi-
cacy, have endeavored to proscribe them, or to restrict their application
as much as possible.   They have  treated these remedies  as irrational.
They  have banished  them  from  their theories, in order  to give them
over to blind and ignorant practitioners.  I have demonstrated the error
of  this peculiar prejudice,  but it cannot be too much denounced for the
interests of humanity and for the honor of the Medical Art. 
SEVENTH LETTER.
669
  Too fortunate  indeed would be both patients and physicians, if the
occasion more frequently presented itself in which we could employ those
remedies, called specifics, or better, synthetics, which remove a disease in
totality as if by a charm, however numerous its symptoms may be, and
whatever mask it may wear !  The day is not far distant when men will
be astonished at the resistance of my cotemporaries against the restora-
tion to the method which I call synthetic, the title of rational, which it
should never have lost, and which it merits in the highest degree.   We
do not ask the natural philosopher or the chemist, why alkali combines
with an acid; why the electric spark converts the mixture of hydrogen
and oxygen  gases into water.   We do  not ask the  physiologist why the
marsh mallow is insipid to the taste;  why sugar  is sweet, and succory
bitter; why my hand is opened or shut by the act of my will ?   And
yet you dare ask the therapeutist why quinia cures intermittent fever,
mercury syphilis, digitalis idiopathic palpitations of the heart,  etc. etc.
Are these  latter phenomena more  easy to explain than the former ?
Is it not just the reverse ?  Is it not plain that our exactions in regard
to the physician are unjust and unreasonable?
   We distinguish two sorts of specifics: the  one  which acts especially
upon certain physiological  functions, as  emetics, diuretics, emmena-
gogues, soporifics,  purgatives, etc., were known to the  ancients.  The
other, whose specificity is manifest  only in certain morbid  conditions,
such  as  febrifuges,  anti-syphilitic,  anti-scrofulous remedies, etc., have
been appreciated only by the moderns.
   It  is the  greatest pride of modern medicine, and without contradic-
tion its best title to  the gratitude  of  mankind, that  it  has  discovered
genuine specifics for diseases; that is to say, remedies as sure and much
less painful  than  the most vaunted surgical proceedings.  A physician
who vaccinates a child in order to protect it against the variolous infec-
tion,  or who administers a  salt  of quinia  to arrest the paroxysms of
intermitting fever, is he not  as certain to  obtain  a decided cure, as the
surgeon who ties  an  artery affected with an aneurismal tumor, or who
attempts to break up a vesicular calculus by the ingenious maneuver of
lithotrity ?  Why then foolishly call the conduct of the first empirical—
which in our language means blind—and that of  the second rational?
Is this not in consequence of a pure  mental  hallucination,  as  I have
elsewhere peremptorily demonstrated?0
   As to  myself, firmly convinced that the  synthetical method,  which
removes diseases almost instantaneously by special medications, is the
0 See Fourth Letter, § 3. 
670
APPENDIX.
most rational as well as the most  efficacious and  sure,  I  assign to  it
the first rank  among  therapeutical methods.   I  do not  hesitate  to
proclaim loudly, that it accomplishes better than any other, the object of
our Art, and  shows its power and utility  more manifestly  than any
other, to the eyes of the world.
                  §11.   Anylitical  Method,
   Unfortunately, it is not always possible to attack a malady, that is to
say,  a collection of symptoms,  entirely en masse.  The number of spe-
cific medicines  is  still extremely limited.   In the most common  cases,
we are, therefore, obliged to resort to analysis, which consists in decom-
posing each pathological condition into a certain number of elements or
more simple maladies,  and then to direct against each one of these mor-
bid elements an appropriate medication.
   I suppose, for an example, that we have to treat a man of middle age
and  average strength, attacked with pneumonia.   Since we possess no
specific against this affection, the following  is, in the  present  state of
the science, the method generally pursued:   During  the first two or
three days, the patient will be  bled,  in order to  diminish the  san-
guineous congestion that  occurs in the lung ; and  all nourishment is
withheld for the same purpose.   Tepid emolient drinks, which diminish
the general tension, dispose to diaphoresis and moderate the internal heat,
by which the patient is often incommoded, are given.   Finally, certain
slightly  narcotic  drinks  are administered,  in order to calm the nerv-
ous irritation, which the paroxysms of coughing and difficulty of  respi-
ration  incessantly provoke.  After  continuing this treatment  a few
days, many practitioners give tartar emetic, either in large doses  (from
six to ten grains to five ounces of water), or smaller ones (one or two
grains to the pint).  Experience proves that the use of this medicine in
either form, is followed sometimes by alvine dejections, sometimes by
vomiting, again by sweats, or also by two or all three of these phenom-
ena.   But whatever may be its immediate  effects, it favors, nearly
always,  the  absorption of  the white  fluids  with which  the lung is
engorged at this period of the disease, and it  is in view of this second-
ary result that it  is thus  given.   I designedly omit to  mention a num-
ber of other means by which we propose to fulfill  different indications.
These details would be here of no utility whatever.   AVhat precedes suf-
fices  abundantly to explain the  mechanism of  the  analytical method at
the bed-side, and I must restrict myself to that. 
SEVENTH LETTER.
671
         COMPAE  SON OF  THE TWO PRECEDING METHODS.
  It is sufficient to glance at the description of each of these therapeut-
ical  methods in order to  be convinced that the first is the most  simple
and the most natural, and that its application requires no effort of  the
mind;  while the second,  more complicated and more artificial, requires
in its application  more or less thought.   This consists, as  has already
been said, in decomposing a pathological state into its several elemen-
tary lesions, or simple affections, and  in arranging the treatment which
shall respond as much as possible to each one of these morbid elements.
  It is  true  that by this mental analysis of pathological states,  our
mind seems to penetrate farther into the intimate nature of  the disease,
just as, in the combination  of a multiple treatment, it appears to enter
more into the knowledge  of the physiological action of  each modifier.
In  a word,  it is evident that the analytic method requires a series of
intellectual  operations  and  reasonings,  more or less abstract, which
the  synthetical method spares us.   For example, far less labor of the
intellect is  necessary in order to prescribe a  suitable dose of quinia for
an individual attack with  intermittent fever, than to decompose pneu-
monia,  typhoid fever, or  Asiatic cholera  into  a  certain number of
elements, and subsequently to direct against  each one of these an appro-
priate medication. It is therefore  not  astonishing that the mind, which
often judges of the value of things only by the trouble which they have
cost it, in  comparing the extreme simplicity of the  therapeutical syn-
thesis with  the complications of  analysis,  should  have been induced
to  consider the  first process  much  less wise  and  rational than  the
second. °
   But if, laying  aside  this gothic prejudice, we estimate things as we
ought to do, by their real intrinsic value—if we judge the therapeutical
methods by their degree of certainty and efficacy, then, without doubt,
we shall give the preference to the synthetical method; and we shall be
much astonished if the title of rational should be denied to this, in order
to  accord  it  exclusively to its younger sister, to whom the epithet of
arguer, or wrangler,  is much more appropriate.
  o There was also a time when the merit of the difficulties overcome was held
in high estimation in  appreciation of literary  works.  At that epoch flour-
ished the enigmas, words for  rhyming,  roundelays,  and other compositions,
ejusdem farince. The law giver himself of the French Parnassus, made sacrifice to
this bad taste when he said:
              " A faultless sonnet is better than a long poem." 
672
APPENDIX.
  That which contributes still to perpetuate the common illusion in favor
of the Analytical method is the immense service which  it has rendered
and still continues to render to chemistry;  for  at all times this latter
science has had the privilege of exercising a considerable influence upon
medical theories.   But it is not considered  that chemical differs  essen-
tially from therapeutical analysis;   the first  operates  upon palpable
objects, and obtains, by decomposing  them, fixed  and determined  ele-
ments.  The  second only acts upon objects purely intellectual;  it decom-
poses, not diseases  themselves, but the  ideas which we form of those
diseases; it does and can only obtain variable, uncertain, and imagin-
ary elements.  Consider  well  this capital  difference, dear reader,  and
you will comprehend why the Analytical method, which leads  to admi-
rable discoveries in chemistry, is in therapeutics an inexhaustible source
of errors.  You will understand why the clinical analysis  of Barthez
differs so widely  from that of Boerhaave, and why that of Broussais
does not resemble  either of the other two.   You will  comprehend why
it may happen that of two, three, or ten physicians called in  consulta-
tion each one may have a particular  notion  of a pathological state,
which must be decomposed mentally;  while, if  they  have in  hand a
disease for  which  the Science possesses an established specific,  they  will
be nearly unanimous.
  From which I conclude that in therapeutics, synthesis is incomparably
more simple,  more sure, more efficacious, and more rational than  analy-
sis;  that  the  highest aim  of  this  branch of  Medicine consists in
restoring, as far as possible, the treatment of each morbid state  to the
synthetical process;  an object that the  German specific sect has  per-
fectly understood, in proposing as an object of research, specific remedies,
without  troubling  themselves whether  they act by antipathy, homeo-
pathy, isopathy, or allopathy.
                 III.  Expectant M e t h o n .

  Synthesis and analysis are methods common  to all the sciences, but
 therapeutics  embraces others which are peculiar to it;  thus, when a
disease has a determined and rapid course, as an ephemeral fever, simple
measles, varioloid, a simple wound that involves no important part, etc.;
when a disease, although more grave, offers no alarming symptoms,  and
s„ems to tend to a favorable termination by the simple forces of nature,
as an  inflammatory fever,  without  any manifest  inflammation of an
important organ;  when a disease announces itself in an  obscure man-
ner,  and there is nothing urgent in the  case; finally, in a multitude  of 
SEVENTH LETTER.
673
other cases which it would be too tedious to specify, it  suffices to place
the patient in good hygienic conditions, and to prevent  his  committing
any imprudence, in order to obtain a cure.
   In such cases, nature appears to  supply all the means for the cure;
the physician has  only to  look on  and  hold himself in readiness, in
order to  correct, when necessary, the  digressions of nature, to excite
or  moderate  her,  to  sustain her forces,  to  aid her, in  a  word,
according to the indications which she  herself furnishes.   The part of
the medical man in these cases has been compared to that of a servant
or agent who only waits, before he  acts, for the signal of the master.
Medicus minister naturae, is an axiom  that has  become  celebrated in
many schools of Medicine,  but which is absurd when it is made appli-
cable to the entire system of therapeutics.0
   Some authors, considering the office of the physician in these circum-
stances as nearly a  nullity, have  given to the Expectant  method the
name of inactive Medicine, but this qualification is  evidently inexact,
for the inaction of  the physician is only apparent.  Although he may
prescribe nothing energetic, his mind does not cease to be attentive and
occupied ; he watches over the  progress  of the symptoms, prevents
imprudences, regulates the regimen, etc.; none but ignorant persons can
regard  as null this function of the man of  science.   Those,  on the  con-
trary, who  have been desirous to generalize the Expectant method, under
the title of Natural or Hippocratic, consider each malady, or each  con-
course  of particular symptoms as a regular concatenation of phenomena,
which nature, the soul, or the vital principle developes with the deter-
mined aim  of curing.  Natura Morborum Medicatrix.   Nature is the
sovereign curative  agent of all our diseases—this is their universal
 axiom  in therapeutics.   But if it is true that  nature alone cures cer-
 tain affections, it is not less demonstrated by daily observations  that
 she is often impotent, or even injurious, without the intervention of Art.
 I have already cited very striking  examples of this, which saves  here
 the trouble of insisting further upon this point.0

                        SECONDARY METHODS.
    The three methods which I have just described embrace all therapeu-
 tical acts, whether internal or external.  There is not a single  medical
 prescription, nor a single surgical operation which can not be referred to
 one of  the  three categories of medication above described.   However,
  :i If on many occasions a physician is the minister naturae, in  how many others
is he also magister natural.
   0 See Second Letter, § 4. 
674
APPENDIX.
many authors have given the name of therapeutical methods to modes of
treatment of a very  much less general  application.   Thus they have
admitted  methods called  anti-phlogistic,  derivative,  or perturbative,
substitutive, etc., but it is easy to see that each one of those enter into
one or the other of the three  preceding, and should not consequently be
arranged on  the same line, in a good classification.
 § III.  Application of our Theory  of  Curative  Methods.
   Let us suppose that it is desirable to appreciate and classify the treat-
 ments so numerous and so variously advised in  modern  times, in order
 to combat the cholera, a question  replete  with present importance, a
 truly inextricable chaos, according to the poor doctrines  of our classics.
 God forbid that we should wish  to pass in  review  all the means that
 have been proposed or tried, in order to  conjure this terrible plague!
 It will be sufficient to direct our attention  to  a few of them, to show
 how we may seize the prevailing  idea, and assign to each  one of them
 the  rank which  it  should  occupy in  a therapeutical classification, in
 order that every  attentive reader may be  able afterward to  accomplish
 the same work in regard to  any treatment, and in any disease whatever.

              FIRST CATEGORY — SYNTHETICAL METHOD.
   There  are  physicians who,  considering  all  the cholera phenomena
 as the  manifestations of an  indivisible morbid entity,  have endeav-
 ored to  arrest  its  development by  the aid  of  one  uniform  medi-
 cation,  the specific efficacy of  which has  appeared  to  them  suf-
 ficiently justified by certain observations, or certain analogies more or
 less  well founded.  Such are those who have had recourse  to the  saline
 medication in the use of chloride of sodium, or to  a mercurial treat-
 ment, or to the nitrate of silver; those  still, who have proposed cin-
 chona and the salts of quinia, under the title of prophylactics, etc.

             BECOND  CAT EGOEY—ANALYTICAL METHOD.
   Other practitioners, regarding the cholera as a multiple affection, or
 at least polymorphous, have decomposed it by mental  analysis into sev-
 eral  elements, or simple affections, and have first  directed their thera-
peutical resources against the one of these elements which seem to them
 to govern and give impulse to the rest.
   We arrange in this category  the treatment by diluent drinks, of which
 the obvient  object is to dissolve and  evacuate  the acrid  matters which
 are supposed to engender  the  disease;  that by evacuants, emetics, and
 purgatives,  employed in the intention to expel from the economy the 
SEVENTH LETTER.
675
deleterious principle which, corrupting the  secreted products, provokes
all the morbid accidents; third, the treatment by anaesthetics and anti-
spasmodics, such as opium, ether, chloroform, etc., which affect particu-
larly the nervous element; fourth,  the anti-phlogistic treatment, the
aim of which is  to combat the phlogosis of the alimentary canal, which
is considered as  the prime motor, the determining cause of all the other
phenomena;  fifth, the use of stimulants, such as aromatic  waters more
or less alcoholic, tinctures, ammonia, galvanism, etc., the ordinary effect
of which is to arouse the oppressed vital forces, to arrest the alarming
progress of prostration, etc., etc.
             THIRD  CATEGORY—EXPECTANT  METHOD.
  None of our practitioners have dared essay the expectant practice  in
this terrible disease;  for  the office of the temporizer which has immor-
talized the name of Fabius Cunctator, is more difficult to sustain in the
midst of the general  alarm and trouble  menacing all the functions of
the organism, than to head an  army impatient to measure its strength
with the enemy.   The value of this method cannot therefore be judged,
in epidemic cholera.   Nevertheless there are patients who, not  being
able to  obtain the counsels of  a medical man,  or being unwilling to fol-
low them,  like the lunatics in Salpetriere, have been guided by instinct
only.   May it not be said that in this class of sufferers, in which there
were several recoveries, the expectant method was illustrated ?
  Does the reader see with what facility the classification of such numer-
ous and divergent medications announced above, is effected ?  Now let
him attempt to perform the same thing by means of therapeutical clas-
sifications  in  common use; he cannot accomplish it in a satisfactory
manner.   He could never decide which of the  methods  of treatment
above enumerated merits, to  the exclusion of  the others, the  title  of
rational, or physiological, or natural, or empirical, or substitutive, etc.,
for  these epithets are nearly equally applicable to all; whence it follows
that they characterize none in  a special manner.
IV.  Classification  asd Denomination  of Medicaments.
   This section of therapeutics has been the object of bitter and  multi-
plied recriminations.   There is not a single treatise  on Materia Medica
published since a half century, in which the instability, confusion and
insufficiency of the classifications and pharmaceutical nomenclature are
not deplored.  Bichat has pointed out  to  us  the principal sources of
these defects : " There have been in Materia Medica no general systems, 
676
APPENDIX.
but this science has been  influenced  by  turns,  by those  who  have
reigned in Medicine;  each of whose opinions, if 1 may so say, has been
reflected back upon it; hence the vagueness and the uncertainty that it
now presents." °
  Must we, to avoid these causes of error,  adopt  the classifications of
the naturalists, as a recent author in Materia Medica and therapeutics
has done ? f  I think not, for this reason:  all methodical  distributions
of the materials of a science must be based on the properties which this
science entertains.  Now, what properties in medicamental  agents  are
considered in therapeutics ?   Those  which modify the animal economy.
It is necessary, then, to name and class these pharmaceutical materials
according to  the  modes  of action which  they manifest  in the living
organism.  To seek another base, less variable, as M. Dieu has done, is
to change the difficulty, and not resolve it.
  Unhappily the action of the same substance  on the animal  economy
may vary according to numerous circumstances, which it is  often diffi-
cult to appreciate with certainty.  For example,  tartar  emetic, admin-
istered to a series of patients, in different forms and doses, can produce
a sweat in  one, an increase  of bronchial  secretions  in  another, alvine
evacuations in a  third, and vomiting in  a fourth.  In  others it  can
arrest vomiting, stools, etc.  Applied to the skin, this  substance pro-
vokes an eruption of pustules, followed by ulcers,  the healing of which
is tedious.   Under what head shall we rank this medicament ?  Which
of its effects can be regarded as the more  characteristic  and essential ?
Answer: the one which is the most sensible and the most constant.
  But if it happens that a remedy produces several effects nearly equally
remarkable, to which shall  we  give preference ?  It is  not important
which is placed in the  first rank, provided  the others are carefully
stated.   Thus, I  would not hesitate to class tartar emetic among  the
emetics; but I should not complain if it is placed among  the irritants,
provided care Be taken to note  its property as a vomit.  I would class
opium, in like manner, among the anodynes or the narcotics, being care-
ful at the same time  to  notice that, instead of calming certain pains,
cephalalgia for example, it exasperates them; that instead of producing
sleep, it sometimes produces agitation.  I should be particularly careful
to indicate the circumstances that influence these various  results.
   Finally, it may happen that a medicament changes its position  in the
pharmaceutical  scale, as the result of some  newly discovered property.

  °Anatomie Generale.   Considerations Generates, § II.
  f M. Dieu, Pharmaceutist-Major and Professor in the Military Hospital of Metz,
has followed fully the  divisions of the  old naturalists, who separated, as is
shown, all substances into the three kingdoms. 
SEVENTH  LETTER.
677
Thus ether and chloroform, which two or three years ago were classed
exclusively among  diffusible  stimulants, may  now  very properly  be
ranked among the anaesthetics.
   To seek in any order of knowledge more stability and more perfection
than comports, even, with the nature of this knowledge, is  to lose time
in the pursuit of a  chimera.   Now the Materia  Medica, like Chemistry,
is a science essentially changeable.  The merit  of a therapeutic treatise
does not consist so  much in the nomenclature and classification of cura-
tive agents, as in  a scrupulous  care to  specify well the circumstances
which cause a variation in the effects of  these  agents; not  in attribu-
ting to them any imaginary virtue in connection with this or that medi-
cal doctrine, but in keeping strictly to the results of pure  observation.
                        § V.   Conclusion.
   Up to this time no one has  embraced in the  same plan  and  united
under one principle, internal and external Medicine.  The most famous
systematists of modern times have always been careful to exclude from
their therapeutical  theories surgical operations;  that  is  to  say,  the
medication whose effects are most evident, because these effects do not
aid them in their theoretic explanations.  Let a surgeon, for  example,
extirpate a tumor; no one could say that he  had acted by the  principle
of contraries or  similars, because  in this  case there is no relation of
antagonism or similitude between his operation  and the nature of  the
disease  which he treats.   But  it can be well said that he attacks, syn-
thetically, the product of the morbid affection.
   This  necessity  in systems,  other than Empiri-methodism, to exclude
from the therapeutic  scale external medication, is  alone  sufficient to
prove the imperfection, insufficiency and falseness of these systems, if
already  I had not demonstrated this falseness in various ways besides.
   It is  true that Empiri-methodism does not pretend, like most other
systems, to explain the intimate connection  which exists  between  the
nature of diseases and the mode of action of remedies.   We  willingly
confess  our ignorance on these subjects, which  are impenetrable to the
senses as well as the mind.   We avoid carefully hazarding any conjec-
ture in  this respect, not being willing to offer to our readers  arbitrary
interpretations for truth, and ideal  fictions for material realities. 
678
APPENDIX.
                     EIGHTH  LETTER.

   REPLY TO SOME OBJECTIONS CONCERNING THE KMHRI-METHODIC DOCTRINE.

                   § I.  A Retrospective View.

    The chief aim of this publication being, as I have announced from the
 commencement, to establish the practice of Medicine on an  immovable
 base, to protect it from the incessant variations of physio-pathological
 theories, and to constitute, in a  scientific manner, the Healing  Art,
 whose processes, often  disjointed or contradictory, seem to have among
 themselves no  logical union, this has, it appears to me, been sufficiently
 attained in the preceding letters.
   Indeed, after having established the necessity of a universal axiom in
 therapeutics, of a certain and incontestable evidence, embracing every
 possible mode of curing, whether  internal or external, we have  proved
 that this  axiom cannot be other than  the  following:  that medication
 which has cured a disease, must cure equally all diseases analogous to if.
 Whence is deduced at once this precept, which allows of no exception:
 treat each case by means whose efficacy  has  been demonstrated by expe-
 rience in homogeneous cases.0
   Afterward we have shown, that the rational application of the precept
 can be very well effected by means of three general methods of treatment,
 which comprise  all the operations of Medicine proper, and of Surgery,
 without any alliance with physio-pathological theories.f
   Thus is  established a foundation of a therapeutical system which is
 both rational and progressive:  thus is realized the  agreement, hereto-
 fore declared impossible, of science with  art,  of theory with practice, of
 reason with experience: thus is constituted  what may be called the great
 medical strategy, si parra  magnis componere licet.   You know that  the
 part of a physician combatting a disease has  often  been compared to
 that of a general in presence of an enemy.   Well, if I may be allowed
to continue the similitude, I would observe that  sometimes the man of
war  attacks his foe in front, and attempts to overwhelm and destroy him
at a blow;  then he employs the synthetic method.   At another time, on
0 See Second Letter.         f see Second Letter 
EIGHTH  LETTER.
679
the contrary, he seeks to disunite the  battalions of the enemy, in order
to conquer them separately;  in this case his  method of  attack is the
analytical.   Finally,  it happens  sometimes  that  a skillful  general
avoids committing himself, awaiting a favorable occasion, or hoping that
his adversary will  become exhausted by want of provisions or amuni-
tion.   Has not this tactic much resemblance to our expectant method?
   Thus you see, that according to the system of rational Empiricism, or
Empiri-methodism, as I have exhibited it in  these letters and otherwise,
the practice of Medicine is scientifically constituted, without any sup-
port from physio-pathological  theories; the Art of curing no longer offers
the strange anomaly of processes called  rational, whose efficacy  is more
than doubtful, by the side of others called non-rational, whose efficacy is
perfectly established; the practitioner is no longer reduced to the neces-
sity of making the humiliating avowal, that he can never cure better
than when he treats a patient without  knowing why.  I  might there-
fore limit here my task, and  leave to others the care of developing the
principles which  I  have established; to follow their application through
all the branches of medical science, and to show how these principles
govern, in all  their  details.   But  there  are  still  some  clouds  to  be
removed, some objections that must be resolved, concerning the ensemble
of the empiri-methodic doctrine, and in answering these I  shall termin-
ate my remarks on this subject.
                     §11.  First Objection.

  We read in the Essay on Medical Philosophy, by M. Bouillaud:  " We
have demonstrated heretofore that diagnosis is the essential foundation
of therapeutics, or rather, we  have admitted,  with all physicians, that
this is an axiom that  needs no  demonstration.   How, indeed, can we
treat a disease which we do not know ?  Therapeutics is really only a
deduction or  corollary from  ideas or  doctrines which we form on the
nature of diseases."0
  In order to refute victoriously the doctrine  emitted in this passage
by the celebrated professor of La Charite, it would suffice, doubtless,  to
refer the reader to the philosophic axioms which  I gave  in  my Fourth
Letter, and to the corollary which accompanies them.  But I will not
content myself with an indirect  refutation, especially because there  is
in the passage which I have just cited a captious sophism, whose artifice
it is necessary to reveal.  " How treat," he says,  " a  disease which we
" Essai sur la Philosophie Medicale, part in, chap, vi, p. 302. 
680
APPENDIX.
do not know ?"  The question is urgent,  and I do  not know that M.
Louis or M. Chormcl, to whom he seems to address himself personally,
has ever  made  any response to it.   I shall endeavor, therefore,  to
answer it in their place; but before doing so, I ask to  be permitted to
propose a question myself.
  Is not a gardener obliged to know the plants he  cultivates ?   Must
he not be able to distinguish a cabbage from a turnip,  a carot from  a
beet?    Certainly no  one  will  question but that  this knowledge is
necessary.  Does it follow  from this that he can deduce  by reason  the
rule of culture, the  character of soil, manure, exposure, etc., which is
appropriate to each of these vegetables ?   Every sensible man will reply
in the negative.   Take any man you please, learned  in botany or veg-
etable physiology, chemical analysis,  or  microscopy; suppose that  he
combines the knowledge of all the academics, on these various branches
of science, yet I defy his capacity to  deduce from  them  directly,  the
least horticultural rule, without some previous experience of his own or
of others.  Having laid down this proposition, I  come  to the objection
of M.  Bouillaud.
   " How treat,"' you say, " a disease which we do not know ?"  Every-
body will agree  with you that the  thing is impossible.   Every one will
consent, for example, that to treat well a variola, it is essential  not to
confound  it with a syphilitic pustule, and  that  to  treat properly an
inguinal hernia, it must not be taken for a bubo.   Thus  far you  are
right,  when you insist on the importance and  the necessity of diagno-
sis ;  when you affirm that without  an  enlighted diagnosis there is no
rational, effective medication.
   But because therapeutics can  not proceed  safely, if it  is not guided
by the light of diagnosis, does  it  follow that it  needs  no  other aid ?
Does  it suffice to diagnosticate well a  disease, in  order to know  how to
cure it?  In  a  word, is therapeutics, as you pretend, a deduction, a
corollary from our ideas on  the  nature of disease ?   This is exaggera-
tion and an  error, scarcely conceivable  on  the part of  a clinist so dis-
tinguished as  the professor by whom it  has been  emitted; an error
which the following examples will make perfectly  plain.
   Nearly a thousand years ago, variola was known  to  Europe ; it was
described by the Arabs and Arabists with  such  exactness as to leave
little for their successors to do.   Only about fifty years since was the
discovery made  for the  prevention  of  this disease by vaccination.   Do
you believe that this discovery  is a deduction, a corollary from the ideas
which were then held on  the  nature of the  disease ?   You know too
much of  the history of the propagation of vaccination  to sustain such
a heresy.  You know too well with what relentlessness and obstinacy 
EIGHTH  LETTER.
681
this  operation was  combatted  in  the  name  of  the most accredited
theories.
  Intermittent fevers were known from all antiquity.  We find descrip-
tions of them in the works of Hippocrates,  and it is probable that  the
Asclepiadae diagnosticated these diseases nearly as surely as  ourselves.
Nevertheless, we cure them incomparably better than they did.   Do we
owe the perfection of our therapeutics in this respect to more just ideas
on the nature  of these diseases ?   You well know the contrary ; you
know,  definitely, that the introduction of the great febrifuge took place
in spite of the reigning ideas and  theories on this class of affections.
  Finally, what disease is better known to  us than hydrophobia?   We
know its  origin, how it  is communicated  to man, the duration  of its
incubation, its course, symptoms, and infallible termination.   It  suffices
to have seen it once not  to  confound it with any affection of another
species.   Nevertheless, its therapeutics is no more advanced than it  was
two or three thousand years  ago.
   And you  dare  affirm  that " therapeutical indications  are evidently
derived from the diagnosis of the disease;  that when the nature of the
latter  is exactly known, it indicates  necessarily the  remedy."0   Never
was there a more illusory maxim professed  in Medicine.    Alas, the con-
trary is too well proved by the history of our Art.   No,  the  knowledge
of the remedy does  not flow from  the knowledge of the disease, as  a
conclusion drawn from the premises.   Diagnosis constitutes only one of
the premises of the  Art of curing; the other premise, no less indispen-
sable,  is  clinical proof.  Thus the  Asclepiadae  understood  very well
intermittent fevers ;  but before clinical proof had sanctioned a mode of
treatment, the Art was nearly powerless, science was lame, relatively to
this class of affections.   Thus, our diagnosis of hydrophobia leaves but
little to  desire, while our therapeutics  is  still and will always  remain
miserable, until clinical proof shall have sanctioned  some of the reme-
dies employed in this frightful malady.
   According to the opinion of M. Buchez, conformed in this respect to the
doctrine of all modern philosophers, you can not foresee the successive
effects engendered  by the introduction of  a therapeutic agent into the
animal economy, before the  entire succession of these phenomena have
been observed once  at least, to their full extent.f   So much more im-
possible  is it that the diagnosis of a disease, however exact it may be,
can  enable us to foresee the series  of modifications which  any given
treatment will produce upon this disease  before the entire series of

                     °Essai sur la Philos. Med., p. 321.
                     t See Fourth Letter.
           43 
f>QO
APPENDIX.
these modifications  have been observed at  least once,  in  their  whole
extent.
   Formerly syphilitic accidents were regarded as the indices of a  virus,
which must, by all means, be expelled from the economy.  Consequently
sweating and salivation were induced and continued almost to exhaustion,
in the individuals  attacked with some  of these symptoms ;  after all
this, they were purged.  Latterly, some pathologists have pretended that
the venereal symptoms are only the product of an irritation or a phlogosis ;
consequently, they have advised the application of antiphlogistic medica-
tion in all cases of this nature.  The Homeopaths regard these same acci-
dents as  the effects of an impalpable miasm,  and feel authorized by this
hypothesis to oppose them  with spiritualized remedies.   Both have
deduced, apriori, these rules of treatment from their respective ideas on
the nature of the malady.   Both have followed an  equally false  route,
based on  hypothesis.  We  must not proceed in  this way  in  practical
Medicine, but must reason, and conduct ourselves as follows:
   The venereal  disease is manifested by symptoms which  are distin-
guished now into primitive,  secondary  and  tertiary or constitutional.
Experience teaches  us that each of these  phases requires a  different
medication.   Thus, in the first we employ, sometimes with advantage,
astringents or diluant drinks.  In the second, the salts of mercury in
small doses, aided by opiates or sudorifics, generally succeed best, without
producing salivation or any other sensible  evacuation.   Finally, in the
third period, called constitutional, it is proved that the salts of gold and
iodine are thus far the most efficacious remedies.   Consequently  the
philosophic physician, who does not exaggerate the limits of our intelli-
gence—who does not suffer himself to be imposed upon by the phantoms
of his imagination, will  employ each of  these remedies  established by
experience, at the appropriate period of  the disease, without troubling
himself whether the disease  is a  product of  a virus, an  irritation, or a
miasm, all of which are impenetrable, both  to the  senses and  to the
mind.
                 §111.  Second  Objection,
  If  all the physio-pathological theories  are  only illusory hypotheses,
calculated solely  to  mislead  the physician, they should, then, be  ban-
ished entirely from science,  as  dangerous, or  at least useless fictions.
Nevertheless, the absolute exclusion of theories and  reasoning appears
to be impossible, and there is no example of it  in any medical treatise ;
whence  it follows that any doctrine which rests upon  such  exclusion, 
EIGHTH  LETTER.
683
and makes a formal precept of it, is  based on an  impossibility, that is
to say, on error.
   Such is the objection unceasingly  repeated, under a thousand forms,
against Empiricism;  and, on this account,  this system  is not studied
thoroughly.0  It is accused of proscribing reason,  because  it desires  to
suppress its abuse;  of rejecting all  theories, because it would confine
them to natural limits.   It is time to  make account of this prejudice,
the offspring of ignorance and thoughtlessness.
                             RESPONSE.
   It is well understood that when I  use the word  Empiricism, I do not
allude to that practiced  in market-houses, or in charlatan's shops, nor
to that which exhibits a  great display of curative facts in advertise-
ments.   These retailers of drugs  and possessors of secret remedies and
specific  treatments, who  are generally denominated Empirics, know
Empiricism  only by its name.  But when duly examined, we perceive
at once, that they never fail  to entice the credulous public by means
of some physio-pathological  theory, by which they pretend to explain
the  marvellous effects of their medication.   It is only by antiphrasis,
therefore, that they are termed Empirics ;  because in reality they are
in theory physio-pathologists, in their way.
   It  is  now well  understood that we mean  rational methodic Empiri-
cism, such as  was professed by some  of  philosophic physicians in the
ancient school of Alexandria, and such, especially, as I have heretofore
developed.   Now, I ask all who have  formed the least notion  of  this
doctrine:  is reason  excluded from  it?  Is it not, on  the contrary,
founded on very special, if not very true reasoning ?  What have I  been
doing in the whole course of this history,  except laying down principles
of the highest philosophy, and deducing consequences therefrom ?  Let
our  adversaries contest these principles,  or  the consequences we have
drawn from them ; this is fair, and it is their privilege.   But that they
should  accuse  us of  banishing reason, passes all imagination.   It is
equal to denying  the light of the sun, and shows  a profound  ignorance
of the history of medical doctrines.
   The reproach that it annihilates the physio-pathological theories, if not
entirely true, has at least some claims to  truth.   Yes, Empiricism does
proscribe the intrusion of these theories into  thereapeutics;  it declares
this intrusion to be injurious and illegitimate.   This is  a fundamental
dogma, which I have demonstrated in my  Fourth Letter,  in such a man-
ner as to leave no doubt in the minds of attentive readers.  But rational
  0 Broussais, in his Examination of Medical Doctrines, devotes to tbis system
tnly a paragraph of a few lines.  See chap, n., p. 35, edition 1821. 
684
APPENDIX.
Empiricism, or Empiri-methodism,  does  not exclude  in any fashion.
physiological and pathological theories from their natural domain, that
is to say, from  physiology and  pathology.   I am far from sharing the
opinion of Leennec, who regards these creations of genius as vain amuse-
ments of the mind.   I  consider  them for my part, as  eminently useful
inventions, and as indispensable auxiliaries to the  human understand-
ing.   These physio-pathological theories have not  been  injurious to
Medicine, except in the abuse that has been made  of them by the dog-
matists, in transporting them from their  legitimate domain into that of
therapeutics.   Some examples will  enlighten us on the use of theories
in the sciences, and on the danger of their excessive extension.
                          FIRST EXAMPLE.
   An apple becomes detatched spontaneously from its branch and falls
to the ground.   A pendulum, withdrawn  from the vertical line, oscillates
for some time.   The planets describe around the Sun an ellipsis of which
that body is  the center.   Here are facts which  seem to  have among
themselves no connection,  which thus  isolated, leave in the memory but
a slight trace.  But a man of genius conceived the happy idea of con-
necting these phenomena to an unique cause: he supposed that the apple
is drawn toward the earth by an invisible force which he called attrac-
tion ; that the pendulum oscillates from the same  cause, and that the
planets are retained  in  their orbits by a similar force.  Observations,
experiments, and calculations without number, were undertaken to verify
this hypothesis; all seem to confirm it, all lend themselves to this inter-
pretation.  From that  time, a multitude of phenomena which had been
before  unnoticed, because  they had among themselves  no apparent con-
nection, attracted the attention  of  the learned, became fixed in their
memories  by means  of this artificial  bond, and  constitute  one of the
most beautiful conquests of science.
   But if,  quitting the domain of general physics, we wish  to carry the
theory of attraction into  chemistry, if we pretend to explain by it  ele-
mentary affinities, we fall into chaos, we  abuse the hypothesis.   Indeed
the theory of  Newton supposes no difference in the particles of matter,
while chemical affinities are based precisely upon these differences.
                         SECOND EXAMPLE.
   The hypothesis of an interior agent called vital principle, or better, vital
force, which, being endowed with an admirable instinct, but not with con-
sciousness, giving impulsion to all  the movements of the organized body
and directing them to a common end, according to a wonderfully combined
plan; this hypothesis, emitted by Hippocrates, exaggerated by Von Hel-
mont, brought back to its  true terms, and elevated almost to the degree 
EIGHTH LETTER.
685
of demonstrated  truth by the  moderns, is unquestionably one  of the
most  beautiful creations of  physiological science;  without it, a great
number of the phenomena of the  living economy would  remain incom-
prehensible and without common bond of union.
   But when an effort is made to introduce this theory into therapeutics,
we arrive, if we wish to be logical, to the negation of  the Healing Art:
the position of the physician is reduced  to  a simple  contemplation  of
death, as Asclepiades reproached the Hippocratists of his time.  If  on
the contrary it  is sometimes desirable for the physician to  interfere
actively in disease, he is forced, like Stahl, Barthez and  others, to con-
tradict himself continually.0

                          THIRD EXAMPLE.
   Pinel ranked  intermittent fevers  of  the  tertian type, in the order
of bilious fevers, which he  also denominated  meningo-gastric;  those
of the  quotidian  or   quartan,  in the  order of  pituitous  or  adeno-
meningeals;  finally, the  pernicious intermittents  and remittents were
classed  by him  in the  order of ataxiae.   Hemorrhage,  neuroses, and
other periodical affections were disseminated in divers sections.   Brous-
sais  attached all these morbid  forms to  phlogosis and especially  to
gastritis.
   Nevertheles, both did not hesitate to combat all these affections with the
salts  of quinia, contrary to their pathological theories, but in order not to
renounce these, they qualified this beneficial  medication  as  irrational.
Ah, pardon me,  illustrious  masters, it is  not  the  medication  that  is
irrational under these circumstances, it is yourselves who are so illogi-
cal in pretending to unite the disease to  the  remedy by the bond  of
induction, while they can be united only  by observation and experience.

                          FOURTH EXAMPLE.
   Inflammation,   in Latin,  inflammatio,   in  Greek,  iplzypa.aia.,  or
(ployooc-, is  a subject which has  excited  as much discussion  among
physicians as the real  presence, or sufficient  grace, has excited  among
theologians, with  this  difference, however,  that the disputes of the
children of Esculapius have  not  kindled the flames  of  the stake, nor
excited persecution.  Apart from that, they have  not been less keen,
nor  less obstinate; and still, so far from  being extinguished, certain
authors deny the existence of phlogosis,  while others extend this mode
of lesion to all  pathology.   Truth, according  to us, is  not  in any  of
these extreme opinions.

   -See Second Letter, § 2, also the theory of Barthez, in the body of the work. 
686
APPENDIX.
  In fact, if we go back to the origin of science, we see that the words
phlegmasia, phlogosis, and inflammation have been employed on account
of the similitude which has been thought to exist between the effects of
this disease and those of  caloric.   Now, here is what has been remarked
in regard to the latter:  if any part of our body is exposed at a moderate
distance to a fire, we feel  at first an agreeable warmth.  Soon  this sen-
sation  grows painful, and the part begins to redden.  Next we feel
a keen sensation of burning, the  color becomes of a  deeper red, and
tumefaction begins.   Later, the skin becomes covered with phlyctaenae or
bullae, filled with serosity—the cellular subcutaneous tissue  now feels
the action of  the caloric.   Finally, mortification attacks the superficial
layers  of the tissues, and advances deeper and  deeper, until it attacks
the deep-seated layers.  But if  the  action  of caloric ceases  before it
causes the mortification,  then  the  affected part recovers its  normal
state, with or without suppuration, with or  without any loss of sub-
stance, according to the severity of the burn.
   Such is an abridged account, omitting many shades in the succession
of phenomena produced by the action of external caloric  on any part
whatever of the body.  Now, as the same  phenomenal series may be
provoked  in  the organism by other causes, either internal  or external,
the name of inflammation was primitively given  to  the assemblage of
three or four of  the following symptoms: heat, redness, pain, swelling.
   Numerous theories have been emitted on the initial phenomenon, and
the mode  of generation of the phenomenal series called inflammatory ;
and the authors  or the partisans  of these theories have all had the pre-
tention to base on each one of them an anti-phlogistic treatment, which is
the cause of the many variations in this treatment.
   Finally,  in our times, numerous researches and experiments have been
undertaken, with a patience and minuteness above all eulogy, in order
to seize the intimate molecular transformations which  the  tissues and
living liquids undergo in their passage from a normal to a phlogosed state.
Aided by the microscope, physio-chemical  analysis, dissections, etc., a
sort of scale of phenomenal gradation has been established from  simple
irritation to confirmed phlegmasia.   The caliber of the capillary  vessels
has been seen  to contract at first under the  influence of  chemical or
physical irritants, and dilate again ;  the movements  of the liquids in
the same vessels, after a momentary accelleration, move slower, then stop
entirely.   The serum of  the blood transudes the parieties of the vessels,
carrying  with it the coloring matter in  a state of solution, and  the
globules themselves have  been seen to be deformed.   The generation of
the pus has been observed from its very beginning.
   But when we  wish to pass from  this  pathogeny to therapeutics, it is 
EIGHTH  LETTER.
687
plain that no rational  tie, perceptible to our  understanding, unites the
facts which make up these two departments of Medicine.  We are con-
vinced that the most exact and profound  knowledge  of the  series of
pathological phenomena can not furnish directly the indication  of the
most suitable and efficacious remedies,  nor can  it, in a word,  take the
place of therapeutical  proof   The  following is an  avowal which the
most skillful observers do not  hesitate to make when  they are not
blinded by some preconceived theory:  " We can not  yet, unhappily,"
says  M. Lebert, " construct therapeutics on the  basis of scientific Medi-
cine, and with the best intentions  in the world, we  can  regard the
greater part of its  precepts but as the result of Empiricism."0
   I would observe, in  connection with this passage, that henceforth the
rapeutics  is established  scientifically,  not  on  pathological  physiology,
according to the desire of M. Hebert, but  on another  base, more sure
and larger, the only one  on which all  its  precepts  can rest, namely:
experience or rational   Empiricism, otherwise called Empiri-methodism.
There is not a single rule of therapeutics that can be justified otherwise
than by the results of experiment.   The precept of reuniting divided
parts has been cited as an example of rational therapeutics.  Now this
precept is neither  more nor less rational  than that which  directs the
use of cinchona in intermittent fever.  Why has  it  been advised to
unite divided parts ?   Because it is known by  observation, that in cer-
tain cases  the divided  parts are susceptible of reunion.  But there are
also  cases, unhappily but too numerous, which observation  also has
made known to us, in  which the divided parts can not  again be united.
Would in this case, the  precept to bring them together, be rational'!
 No, certainly not, for  experience has proven otherwise.
                    IV.  Third Objection.

  "Empiricism," says Broussais, "consists in finding a remedy appropriate
to the disease, without taking the trouble to explain the latter, nor the
manner in which it is modified.    °                Anorexia is cured
sometimes with water, sometimes with  wine, sometimes by purging, at
others by fasting, and again  by eating  food  more freely, or of  a more
exciting character than ordinary, etc.   What do then ?  If  we do  not
wish to reason or form a theory in order to discover which of the mean?
should be employed, it only remains to try first one then the other, "f
- Physiol. Pathol., vol. I, p. 106.  Paris, 1846.
| De PIrritation et de la Folie, p. 56. 
688
APPENDIX.
   I would not have quoted this objection, so trifling does it appear, if
 it had not emanated  from a  man who  has exercised  an incontestable
 influence on  cotemporaneous  Medicine;  the name of  Broussais im-
 poses upon me the  obligation not to pass it silently.   Nevertheless, I
 shall be short in my refutation, not being willing to avail myself of all
 the advantages which the feebleness of the attack affords me.
                              RESPONSE.
   You say that a want of appetite is cured sometimes with water, some-
 times with wine, etc.   I ask how  you have  learned  that  this affection,
 or  if you like  it better,  this symptom, may be treated by  means so
 diverse, and often so opposite ?  Is it not by observation, and observation
 alone ?   WThat physio-pathological theory could have suggested such a
 great variety of treatments,  applicable to a disease always the  same
 in  appearance ?    None ;  it  is clinical observation  only  which  has
 furnished us with this notion.
   You add, if we  do not  wish to reason  or form a theory, in order to
 discover which of these means should be adopted, it only remains to try
 them successively.  I pass the common accusation of want of reasoning,
 with  which  the partisans of Empiricism  are charged—an accusation
 unworthy of Broussais, who  knew, definitely, that the  Empirics do not
 neglect  reasoning—an accusation which  has already been  sufficiently
 refuted,  and I come to his  conclusion, that we  are compelled to try all
 methods of treatment successively, if  we have  no  physio-pathological
 theory to guide us,  and reply :
  Yes, certainly, we are obliged to attempt successively all medications,
 if after  the  example of certain reformers we take  no account of the
 observations  of  our predecessors—if it be  pretended  to form  science
 anew, from its  base  to its top  stone; but such has never  been the
 pretension of the  Empiri-methodists,  and the  first  physicians who
 assumed the title of Empirics  in  the  school  of  Alexandria,  have left
 us very wise rules  by which  to discern the degree of  confidence which
 should be  accorded to  the observations of others—which proves that
 they did not disdain to make use of them.
  Thus,  then, from whatever  point of view we  study therapeutics, in
generalities or in  details,  always  and everywhere,  induction must be
subordinate to experience;  the rules  of treatment must  have  received
the  sanction  of  clinical  proof, before obtaining  citizenship  in the
science. 
NINTH LETTER.
689
                     NINTH  LETTER.

ON THE RANK THAT MEDICINE SHOULD OCCUPY IN  A GENERAL  SYSTEM OF
  HUMAN  KNOWLEDGE, AND  THE  DEGREE  OF CERTAINTY  WHICH  IT  CAN
  ATTAIN.
             § I. Propriety of this Inquiry.

  After  having assigned  to  each  of  the branches  of Medicine its
proper place, having had regard to  the  importance of its influence for
the realization of the final aim of this science—the curing of maladies ;
after  having demonstrated, contrary to  the opinion of a great number
of theorists, that, in  this respect, therapeutics holds the first rank, and
that pathology,  anatomy, physiology, etc.,  follow as auxiliaries; after
having, in short, brought forth medical  practiee from  the  chaos  into
which it was plunged, by re-establishing the true theory of the Healing
Art, misunderstood and  misrepresented for twenty centuries, I think it
will  not be improper to examine what place Medicine should occupy in
a systematic classification of all the sciences,  and what degree of cer-
tainty it is susceptible of attaining.   This research constitutes, it seems
to me, the supreme complement of all medical doctrine and should close
properly this epistolary series.
  Nevertheless,  I am not  ignorant how little the present epoch is
favorable  to  philosophic dissertations;  that in the midst of a society
disturbed like  ours,  and menaced  in its foundations,  physicians can
only lend  a distracted ear to questions of pure theory, the examination
of which  requires calmness, security, and leisure.   Moreover, I will not
abuse  the patience of my readers ;  I shall attempt to say only what is
absolutely indispensable for the solution  of the problems announced at
the head  of this letter.  In  this manner  I pretend  to recognize  the
kind reception which  has been given to my philosophic lucubrations, and
to testify my gratitute  in particular  to the  honorable confrere  who
directs with so  much impartiality and discernment the publication of
this estimable journal.0
  Being obliged to glance at the diverse opinions of philosophy, concern-
ing the origin of our acquirements, their degree of certainty, and  the
- L'Union Medicale. 
690                         APPENDIX.

various modes  of acquisition  of our  understanding, I shall divide my
subject into two parts—one historical, the other critical and dogmatical.
Part First.—A Historical Resume" of the Opinions which have been emitted on the
  Origin of Ideas, and their Modes of Development.
                   §  II.  Antique  Period.
                           RATIONALISM.
  The first philosopher whose writings have come down to us in a suffi-
cient state of entirety to give a just idea of his doctrine is  Blato, the
elegant disciple of the sage Socrates, who from the charms of his con-
versation and the gracefulness of his style, was surnamed the Swan of the
Academy.  He thought that the  knowledge which  we acquire in this
world  is only the feeble rays of the light that our soul possessed before
its union with the body, and  he was persuaded that the  best means to
find  truth consists in isolating ourselves as much as  possible by medita-
tion, from the  influence of the senses and exterior objects,  in order to put
ourselves  in direct  communication with  the intimate  nature of things
by mental intuition.   " The  soul," he says, " never  thinks better  than
when it is undisturbed by sight, pain, or voluptuousness, and when, shut
up within itself, disdaining as much as  possible all commerce with the
body, it grasps directly what  it desires to know.      °  °  °  Indeed,
the body involves us in a thousand embarrassments, owing to the neces-
sity  of our cares for it.  Added to this, diseases which spring up obstruct
our  researches.  They fill us  with passions, desires, fears, a thousand
chimeras and follies, to such  an extent that in fact they leave us, as has
been said, not one hour for wisdom.   °   °  °  °   It is thus demon-
strated that in  order to know a thing thoroughly we must, so to say.
separate ourselves  from the body, that the soul may examine  them in
themselves.0 "
                           ON  SENSITISM.
  Aristotle, cotemporary with  Blato, was  one of  his most assiduous
auditors during twenty years; after which he  became  the  chief of a
school.  Now, he professed an  opinion entirely contrary to that of his
master, on the origin  of our ideas.  According to him, all animals have
received from nature the faculty of feeling and judging; but after the
sensation has  been produced  some  preserve the remembrance of it, while
others do not.  Those whose souls retain  some trace of the  received
0 Phedon.  French translation, of Cousin, p. 202-204. 
NINTH  LETTER.
691
 impressions, can in the course of a great number of sensations, reason
 from the recollection of  them which remains.  This explains how the
 memory arises from the  faculty of feeling.   The memory of the same
 thing often repeated, produces experience; and experience, that is to say,
 every general notion which is  fixed in the  soul, relatively to what  is
 common to several things, is the principle of Science and Art.   The first
 ideas which the  sensations create in our minds are always  ideas  of
 totality, or very general ideas.   Subsequently, in proportion as the same
 sensations are  reiterated,  they become more  distinct, and more and
 more special.0
   Aristotle insists very much  on this proposition, that the  first ideas
 which  arise in  our minds by the intervention of the senses, are always
 very general ideas.   They form a fundamental  basis for his scientific
 method ; and he supports this by examples and reasoning which he thinks
 invulnerable.  If a man, he says in one place, perceives an object at a
 distance, he will have  at first  the  idea of a body in general.   If the
 object gradually approaches him, and he sees it advance with an autom-
 atical motion, his general  idea of a body will change to the less general
 one of an animal; subsequently, to that of an animal of some particular
 species; then finally, the  object coming very close, he will  distinguish  it
 from all others, he will in short, obtain  an individual idea.   Elsewhere
 he cites the example of a little child, who calls, at first, every man papa,
 and every  woman  mama ; afterward, as he grows older, his ideas become
 special, he learns to discern his father and  his mother from all other
 persons.
   Such is, according to this philosopher, the gradation of our ideas, and
 on this basis he  establishes a scientific  method, which  all antiquity
 adopted; a method which consists in commencing  the study and the
 teaching of  any science whatever by generalities, which are also called
 principles, or elements.
   It must be borne  in mind,  that the  argumentations of the chief of
 the  Beripatetics, and the  examples with  which he  sustains them, are
 extremely  captious.  It would  be very difficult for  us to-day to  show
 its artifice, if Locke and Condillac had not demonstrated, absolutely,
 that the first ideas excited in us by the sensations are always individual
 in their character: if they had  not  taught us by their learned analyses
 of the  operations  of  the  understanding, how our mind rises from indi-
 vidual to general ideas, and in what respect  these differ from vague and
 indistinct ideas, with which  Aristotle confounds them in  the examples
  9 Aristotelis Opera Omnia quae  extant  Groece  et Latine.  Authore Guillemo
 Duval.  Analyticorum Posteriorum, lib. II., cap. xix.  De Principibus Naturali-
bus, lib. I., cap. i.  Metaphysicorum, lib. I., cap. i.; et alibi  passim. 
692
APPENDIX.
above given.   But  the ancients, deprivod  of  the lights  of modern
metaphysics, could not  shake off the yoke  of the  'Peripatetic method,
whose prestige was maintained down to an epoch very near our own.
  In Peripateticism, the sensations, though forming the point of depart-
ure of our acquirements, are not considered as our only instruments in
intellectual progress; they constitute only the materials of thought, and
reason  maintains there her supremacy over the other  faculties of the
soul.  She has the task of elaborating and setting in order the materials
for the construction of the scientific edifice.
  It is not  entirely the same in the  system of Epicurus, if we may
credit his elegant Latin interpreter.  According to him, the sensations
are all produced by images or shadows, extremely delicate, which, detached
from the surfaces of bodies, or spontaneously formed, float in space, and
impress our  senses.   The  senses never mislead  us; truth  has no surer
foundation than their authority, and our existence depends on the exact-
ness of  their impressions.  When we form false  judgments, it is  reason
alone which is  misled in its operations.0  Here, as is  plain, the  theory
of Sensitism is pushed to its extreme  limits, and  forms the most com-
plete antagonism with the doctrine of Plato.
                         ON ECLECTICISM.
   Potamo, who lived at Alexandria about the first century of the Chris-
tian era, that is to say, at an epoch when philosophic disputes were very
animated, having recognised, or supposed that he recognised, that none
of the systems  proclaimed with so much warmth by the  contending sects
were entirely true, though each contained a portion of truth mingled with
many errors, thought  that  wisdom consisted in not attaching himself
exclusively to any of the prevailing doctrines, but  to extract from each
one what  he judged most conformable to experience and reason.  History
does not  say whether  he reduced  this manner of philosophizing to  a
system, nor  that he gained disciples.   However this  may  be, he was
considered as the founder of Eclecticism, or Syncretism, a method which
had among  the ancients  many partizans,  but whose  sectators never
formed a school, properly said, because they never adopted a  precise
formula,  or common symbol of doctrine.
                             SKEPTICISM.
   I shall not pause to examine Skepticism, because absolute and uni-
 versal doubt appears to me less a scientific doctrine than the negation  of
 any species  of knowledge.   The reasoning of the  Pyrrhoneans does not
 merit, in my opinion, any serious refutation; because it offers, according
s Lucretius, Poeme de Natura Rerum, chant IV. 
NINTH LETTER.
693
to the avowal of its own philosophers, no character of certainty.  I will
content myself, then, with repeating with Lucretius,
               Denique, nil sciri si quis putat, id quoque nescit
             An sciri possit; quoniam nil scire fatetur.
                     §111. Middle  Period.
                       SUPERNATUBALISM.
  To the two modes of intellectual acquisition admitted by philosophers,
the fathers of  the Christian Church have added a third, which they con-
sidered as the surest and  the  only infallible one.   This mode which is
called  revelation or supernaturalism, consists in the direct communica-
tion which God has  made to man, of certain  truths, which could not
have  been discovered by the mere  lights of reason.  Nevertheless,
philosophy does not abdicate entirely its rights to examine these lofty
truths; for while their celestial origin is proclaimed, they present several
points which  were evidently  the offspring of human reason; thus it
might be, and has  been  asked indeed,  by what signs are we  to recog-
nise that any revelation  is really divine;  how can we  assure  ourselves
that a given  proposition comes from a supernatural source, etc.  Now,
it is evident that all  these questions are within the competency of phi-
losophy.  Thus many ancient fathers of the Church studied the Creek
philosophers,  and endeavored  to conciliate, at least in part, the doctrines
of  these philosophers with the dogmas  of religion.   Of this number
were  Justin  the Martyr, Saint Clement of Alexandria, Saint Origen,
and Saint Augustine.  Others, however, such as Quintillian, Arnobus,
and Lactantius, did not consent to this plan, and  regarded  the  study
of  philosophy as superfluous and dangerous.

                          ON  SCHOLASTICS.
   In the ages of barbarism and ignorance which followed the establish-
ment of the Christian religion, in the  midst of the long perturbations
kept up by the dismembering of the Grasco-Boman Empire, and the
establishment of new states, the taste for letters and philosophy sensibly
 declined;  the writings of the  philosophers, buried under the dust  of
libraries, remained  there unknown even  to  their owners;  and  when
 Charlemagne instituted  those  numerous schools which became  after-
 ward universities, the only remains of ancient  philosophy which had
 not been entirely forgotten were the  metaphysics and logic of Aristotle.
 During that  indefinite  lapse of centuries, which  is called the Middle
 A<*es, the ecclesiastics, who were the  sole depositories  of the treasures 
694
APPENDIX.
of human knowledge, employed at first Peripatetic dialectics, in their
essays on moral truths and the dogmas  of religion.  Subsequently they
supposed they could reach by the same  way, that is to say, by pure dis-
cussion and reason, the discovery of natural laws and the solution of all
the problems of the physical sciences.
   They usually proceeded as follows:  they laid  down  some axioms  or
universal principles of metaphysics, whence  they drew by a series  of
arguments,  the explanation of all  the phenomena  of nature.  This
method  of philosophizing was  called scholastic, from  the  name of the
schools where it originated  and  where it was employed  until very
recently.
   It required many years, many efforts, and  many contests, before the
human mind could disengage itself from  the shackles of this  vicious
method, which was still so much credited at the  close of the sixteenth
century,  that Bamus, or La Bamee, professor in the University of Paris,
exposed himself to the rudest persecutions for having dared criticise it.
                       §IV.  Third Period.
                     REVIVAL OF PHILOSOPHY.
   I will not attempt to retrace even succintly, the admirable concourse
 of circumstances which prepared the freedom of thought; the discoveries
 in the sciences and arts, the restoration of the literary monuments of
 antiquity by the art of printing, the  uprising of public opinion against
 the  abuse  of  the power  of the clergy and the feudal nobles,  etc.;
 all this would require,  even  to be  sketched only, much  more  space
 than I have at my disposal.  I come then, without  preamble, to the
 revival of philosophy, which includes in it  the  whole progress of the
 human mind.
   In the first half of the seventeenth century, two men of  a character
 and genius quite  different, started from opposite points, the one from
 sensation, the other from mental intuition,  to rebuild the entire edifice
 of science.   They agreed, however, in this, that  each  one should reject
 equually the lumber  of the  scholastic method,  and create his own
 method.  The  first,  replete in the knowledge of statesmanship, having
 filled the highest places in the state, substituted induction for syllogism
 as  the habitual form of reasoning,  and proclaimed the sovereignty of
 experience as the scientific criterion  and the true means of discoveries.
 The second, on the contrary, withdrawing from the world and its honors,
a friend of  solitude  and  meditation, a mind eminently generalizing,
 who, though still young, had acquired great renown by his discoveries in 
NINTH LETTER.
695
mathematics,  replaced all the complicated rules  of  the  Peripatetic
dialectics by a single one,  admitting as characteristic of truth, evidence
alone.   The reader has already anticipated the names of Francis Bacon
and Bene Descartes, the two restorers of the philosophy of modern times.
                          ON SENSITISJI.
   Bacon, like Aristotle, placed the  source of our  knowledge  in the
faculty of feeling ; but he maintained contrarily to the latter, that the
sensitive impressions give  rise at  first to  particular ideas, and  not to
general ones.   Thus, though adopting the scientific basis  of the philo-
sopher  of Stagyrus, he separates  at  once from him, to  follow another
route, entirely different.  The chief of the Peripatetics wished to begin
science  by the most geiieral and abstract notions, named therefore  by him
principles or elements.  The English philosopher protested on the con-
trary, with all his might, against  this course; he assumed that our minds
can never suddenly  rise at a single bound from individual ideas, excited
by the senses, to axioms or general principles.   He insists that progress
should  be gradual, and not by leaps;  that we should  pass from a par-
ticular  idea to one that is somewhat general; from this to another, more
general, and so on, till we  reach the universal axioms, which should be,
he says, the last ones laid down.   Bacon  insists obstinately on  this
method;  he recommends  it  constantly;  he renews  its  exposition in
various ways, in various terms, in several portions of his books, for fear
that it might not be sufficiently comprehended or appreciated; he exalts
its value much above all particular discoveries.
   Posterity has confirmed  the judgment  of Bacon on the excellency of
his method, which has been  adopted  and improved by learned men and
thinkers of the first order, and which has contributed much to the  pro-
gress of the human understanding, especially in the  physical sciences.
   John  Locke enlarged and cleared the route, which Bacon  has  merely
indicated by land marks.  He showed by  what  series  of  acts the  mind
rises from a sensation,  which  furnishes it a simple or individual idea, to
complex or compound ideas;  how  we  form,  by  abstraction, general
ideas, ideas of  species, genera, or  classes.   He made excellent observa-
tions on the nature, formation, and errors of language, refuted the Pla-
tonic doctrine of innate ideas, and admitted with Aristotle  and Bacon,
sensitive impressions as the only  basis of our knowledge.   He endeav-
ored to demonstrate empirically, that is to say by the  testimony of  the
senses,  the existence  of God, His  attributes,  the immortality of  the
soul, in a word, all  the truths of  natural religion and morals.
   Stephen Bonnot de Condillac was, in Erance, the extreme representa-
tive of Sensitism ; he supposed that all the faculties of the soul,  and all 
696
APPENDIX.
its determinations are derived from the faculty of feeling.   According
to this metaphysician, attention is nothing more than a prolonged sen-
sation, which  effaces all others for the moment;  that comparison and
judgment consist in two sensations, which are realized simultaneously,
or  are  united in the memory as  if  they were  really  simultaneous;
and so on for the other intellectual  faculties.   The acts of the will  he
represented as proceeding from the same origin.   Thus the sensations,
which, considered as representations of objects, are  the source of ideas,
become  the source of all the acts of the will, accordingly as  they effect
us  agreeably or disagreeably.  Hence arise, following this theory, our
diseases, our habitudes, our vices and our virtues.
   No one in France  has contributed as much as Condillac to  popularize
the taste for  philosophic  studies, by  his  clearness  and connection of
ideas.   But does he  not  turn these studies  from their true object in
making the supreme perfection of the sciences to consist in the mere
perfection of the signs of  language ?  Is it not evident that he mistakes
the effect for the cause, when he attributes the  exactness of reasoning in
mathematics to the exactness of algebraic language ?  This grave mis-
take has not a little  contributed to perpetuate in the schools, and among
the learned societies, those vain disputes on words, which  he  bad him-
self so much blamed.
   Condillac, like Locke, endeavors to derive moral and  religions ideas
from sensation  ; but other philosophers deduced from these, no less suc-
cessfully, the destruction of  these  same ideas.  Thomas Hobbs, David
Hume,  Charles Bonnet,  Claude Adrian  Helvetius, and  others, have
proved victoriously,  that the  theory of sensations is  not unfavorable to
skepticism, materialism, and  atheism.

                         OK  RATIONALISM.
   Descartes perceived, early,  that the instruction he had received in the
schools or drawn from books,  under the name of philosophy, was nothing
more than a scaffolding of words, or an art of speaking without judgment,
as he said, on  things of which we are ignorant.  His mind, habituated
to the exact researches of mathematics, could not be contented with a
science  so  visionary; consequently he resolved to reconstruct it from
top to bottom.   To this end, he commenced by erasing everything which
he  had  learned, excepting from his philosophic doubt, but the practical
truths whose application, he said, could not be dispensed with.
   Then he laid down,  as the basis of his  scientific edifice, this fact,
incontestable to every reflective mind:  il I think;"  that is to  say, I
have conscience of  my thought; from which he drew at once this con-
clusion, no less incontestable:  •' therefore  1 exist."  This is as much 
NINTH LETTER.
697
as to say:  there is in me a thinking substance, which I call soul;  a
substance essentially distinct  from matter;  a  substance,  in fine, the
reality of which is clearer and more evident to my mind than that of my
body, and all exterior objects.  This  soul, whose essence  consists in
thought, finds in itself the innate idea of a being or a spirit, absolute,
unlimited in its attributes—on the infallibility of which, the certainty of
all our knowledge rests.
   As long as this philosopher did not go beyond the sphere of pschycho-
logical phenomena, his propositions are linked, naturally ; but when he
endeavors to pass into the domain of natural phenomena, it seems as if the
route was closed to him—he is obliged  to have recourse to hypotheses
which are entirely arbitrary.  Thus he supposes, in physics, that matter
is not endowed with any activity, which is contrary to all observations.
In physiology, after saying  that the soul is present in all  parts of the
body,  he assigns to it, for a special seat, the pineal gland; he puts  at
its disposal a host of animal spirits—a species of intelligent messengers
—who go and come  from one extremity of its organic empire to the
other, either to carry  its orders or to bring back intelligence of what is
going on.°
   Notwithstanding his errors, Descartes influenced in a powerful man-
ner  the  progress of the human understanding;  he  gave, as was said, the
death-blow to the  scholastics.  The clearness of  his  conceptions, the
boldness of his hypotheses, excited the mind to think for itself, and cast
off the prejudices of a scholastic education.   A great number of learned
men studied  his  doctrine,  either to develop and  defend it, as Nicole,
Pascal,  Spinosa, Malebranche, or to combat it, as Gassendi, Hobbes, and
others.
   Godfried Wilhelm  Leibnitz,  one  of the  most universal geniuses  of
modern times, attempted to put an  end to the disputes of the various
philosophic schools, by uniting all their doctrines into one, which should
retain what was true in all, and reject what was  false or hypothetical.
 He  proceeded to the execution of his vast project by the speculative
method of Descartes, whose philosophy he called  the antechamber of
truth, while he had little regard for  the  empirical method  of Locke.
Like the French philosopher, he placed in God the foundation of all reality,
all knowledge, and all certainty.  He admits innate ideas, not as present
to consciousness from birth, but as allied to our intellectual constitution
by  a  necessary relationship.   He  accords  to  matter only the  force  of
inertia,  or resistance,  and to explain the active forces with which bodies
appear  endowed,  he supposes that each of  them  is only  the  natural
             ° (Euvres de Philosophique.
44 
698
APPENDIX.
 evolution of a monad, or a  simple,  indivisible, imperishable,  and, in
 some sort, spiritual molecule, which is the motor of all the spontaneous
 developments of  tangible bodies—the source of all active properties.
 and which reflects in miniature the entire universe.
   The philosophy of Leibnitz, though more comprehensive than that of
 Descartes, is not  less hypothetical, as is seen, nor less  distant from the
 results of daily observation.
   Emanuel Kant, before engaging in the researches  of ontology, endeav-
 ored to determine the laws and the limits of  our faculty to acquire, in
 order to avoid the principal cause  of error of human reason, which cause
 resides in the almost irresistible inclination which we have to pass, con-
 tinually, the limits within which the Author of nature  has confined our
 understanding.   Consequently  he  applied himself  with rare  sagacity
 and perseverence  to discern knowledge rational, or a priori, and knowl-
 edge empirical, or a posteriori.  Here is a resume of  his  doctrine  on
 this subject:
   Observation teaches us with certainty that  a thing exists in such or
 such a manner; but it does not teach us that  it could not possibly exist
 otherwise.  Its judgments are never strictly universal;  they possess but
 a conditional generality ;  which means that no one has  remarked to the
present, an exception to a given law of nature, as,  for example, to the
following:  all bodies  have weight.  On the contrary, a  judgment
 applied with  rigorous  universality, that is to say, in a manner which
admits of no exception, cannot come  from experience, but is absolutely
 a priori.   Such are the following propositions:  Two quantities equal to
 a third, are equal to each other.   Nothing happens without a cause.
 Thus  necessity and universality are the characteristics of all  rational
 or a priori knowledge.   Contingency and limitation form the essential
 character of all empirical or a posteriori knowledge.
   Fichte  and Schelling,  who have followed  Kant  in  the speculative
 route, appear to have  had as  a principal aim,  to  found ontology on  an
immutable basis by demonstrating the objective  reality of  the concep-
 tions of the understanding.   Have they succeeded in this great enter-
 prize ?  This is a question which I shall not undertake  to examine here,
for it is much more pertinent to metaphysics  and  morals than to the
physical  sciences, of which Medicine forms a part.  Besides, the response
to such  a question surpasses very much my  abilities:  Non nostrum
tantam componere litem.

      ON COMMON SENSE AND SENTIMENT, CONSIDERED AS A MEANS OF  KNOWLEDGE.
  Neither the  exclusive  Sensitists, nor the  pure  Bationalists having
been  able to construct an  entire system of knowledge which would 
NINTH LETTER.
699
satisfy equally observation and  reason, some philosophers flattered them-
selves to have found in common sense, or universal sentiment, a surer
guide, an infallible criterion of  truth.  The Irishman  Hutcheson, was
one of the first who emitted this opinion, but it owes its principal lus-
ter and the notice of the learned world, to the labors of several Scotch
philosophers, at the head of whom it has been usual to  place  Thomas
Beid, which has given to the doctrine itself the name of Scotch School.
   These learned men, seeing that the most common truths in morals and
experience were shaken by the speculations of certain  philosophers, and
desiring to establish them on an unapproachable base,  supposed  man to
be endowed with a moral  sense,  a sort of spiritual instinct,  which leads
him naturally to truth and  to correct  action, which inspires him only
with sound judgments, when he does  not choke this  interior voice  by
prejudices and bad passions.  According to this theory, the common sense
of humanity, that is to say, instinct, considered in its most general and
most irresistible manifestations, is a certain principle  of knowledge,  an
infallible criterion of truth.  Among  the writers who in other countries
have contributed to  popularize this doctrine, we must name J. J. Bous-
seau, in France, and Henry Jacobi, in Germany.

                            ECLECTICISM.
   There have  always been Eclectics, that is to say, learned men who,
instead of endeavoring to distinguish themselves  by the invention  of
some new system,  have been content to extract from each of the cotem-
poraneous systems as much truth as in their eyes was contained in them,
and to stitch together these various pieces, in order to  form  a body of
doctrine which would represent  as exactly as possible  the  sum of the
acquisitions  of the  human  understanding at a given epoch.  In this
way Fernel, at the commencement of the sixteenth century, united with
much skill the theory of Plato to that of Aristotle; thus  also,  in our
days, a professor in the University of  Parisdias  offered  to his auditors
the resume of modern philosophic opinions in  a highly critical work,  of
which the following is the substance, as condensed by himself:
   " The  eighteenth century," he says,  " has left us a heritage of three
grand schools, which remain to  this  time:  the French and English
school, of which Locke is  the chief, and of which Condillac is among us
the most accredited representative; the Scotch school, which presents  so
many illustrious names, Hutcheson, Smith, Reid, and Dugald Stewart;
the German school, or rather the school of  Kant, for of  all the philoso-
phers beyond the Bhine, he  of Koenigsberg is about the  only one  who
appertains to history. 
700
APPENDIX.
   " But this is only an ethnographical enumeration of the schools of the
eighteenth century.  It is especially necessary to consider them in their
analogous or opposite characters.   The Anglo-French school represents
particularly Empiricism or Sensualism ;  that is to say, an almost exclu-
sive importance is attributed in all departments of human knowledge to
experience in general, and especially the  experience of the senses.   The
Scotch school and the German school represent  a spiritualism more or
less developed.   Finally, there  are  philosophers  who, denying the
supremacy of the senses  and reason,  seek in  the sentiment the  true
guide and light of intellectual  and  moral life; for example, Bousseau,
in France, Smith  and Hutcheson,  in Scotland, and Jacobi, in Germany.
Such  are the philosophic schools  which  prevailed in  the eighteenth
century,
   " Is the truth  to  be  found in either of these schools exclusively ?
We are compelled  to  say that neither of them contains, in  our eyes,
truth in full.  We are convinced  that a considerable part of knowledge
escapes the sensations, and we  believe  sentiment is not a  basis  firm
enough or large  enough to sustain human science.   We are then rather
the adversaries than the partisans of the school of Locke and Condillac,
and of that of Hutcheson and Jacobi.
   " In general, in  the history of philosophy,  we are in favor of all
those systems which favor reason;  thus, for antiquity, we hold to Plato
rather than to Aristotle ;  among  moderns, we are for Descartes  against
Locke ; and in the eighteenth century, for Beid against Hume, for Kant
against Condillac and Jacobi.  But at the same time,  while we recog-
nize reason as a force superior to  sensation and sentiment, as  being par
excellence the faculty of knowing, the faculty of truth, and beauty, and
all good,  we are persuaded  that reason can  not  develop  itself under
conditions which  are foreign  to it, nor suffice for the government of man,
without another power;  this power, which is not reason itself, and which
it can not reject,  is sentiment; the conditions without which reason can
not develop itself, are the senses.   We now see how important to us are
sensations and sentiment; how, consequently, it is  impossible for  us  to
condemn,  absolutely,  either the philosophy of  sensation  or that  of
sentiment."0
   I pray the reader to excuse me for the extent of this quotation.  Never-
theless, I am persuaded, that after having read it, he will thank me for
not having abridged it; for  it offers, as briefly as  possible, an  expose,
nearly complete,  of the philosophic doctrine called  Eclecticism.
  * Cousin :—Cours de PHistoire de la Philosophie Moderne, vol. n, p. 366, ed.
1836. 
NINTH LETTER.                        701
Part Second.—A Critical and Dogmatical Examination of the various Systems of
                        Philosophy abovementioned.

                                 § v.
   The fragment which I  have just reported, simplifies and will abridge
singularly the  second part of  this letter.  The appreciation which is
found there,  of modern systems of philosophy, appears to me perfectly
just, and I would give to it my full assent, if the author  had better
explained the nature and special destination of each of these faculties of
the  understanding  which  he  presents as a  principle of knowledge,
namely: common sense, or the sentiment, sensation, and pure reason.
  ON INSTINC T—T HE PRINCIPLE OP SENTIMENT AND COMMON SENSE.
   When we reflect on the manifestations of this faculty which the phi-
losophers of the Scotch school  name common sense, and which others
name sentiment, we find that it  has no other source than instinct, that is
to say, that  innate  light, that  natural  aptitude for certain acts, which
develops itself spontaneously among animals as well as among men, from
the first moment of their birth, or at determined periods of their  exist-
ence.  Instinct suffices for the common  needs of life; it is the principle
of the most natural  sentiments, it guides us before experience and reason
are yet formed, it  furnishes  us sometimes the  promptest inspirations,
surer even than the teachings of experience and reason.  It is not sus-
ceptible  either of memory or education, according to physiologists, and
should not be consequently ranked among the number of the philosophic
faculties, that  is to  say, those which are perfectible.
   " A complete opposition," says M. Flourons, the interpreter of Frederic
Cuvier, " separates instinct from intelligence.   In instinct all is blind,
necessary and invariable:  in  intelligence all is elective, conditional and
modifiable.   The  beaver who  builds his cabin, the bird who constructs
her nest, act only from instinct.  The dog and the horse, who learn even
the signification of many of our words, and who obey us, do so by intel-
ligence.   All in instinct is innate: the beaver builds without having
learned it; all in him is fated; he builds in a masterly manner, from a
constantly irresistible impulse.  In intelligence, all  results from experi-
ence and observation:  the dog  obeys only because  he has been  taught;
all this is free; he  obeys only  because  he wills it.   There are,  then, in
animals, two distinct and primitive forces: instinct and intelligence."0
  ** De P Instinct et de P Intelligence des Animaux.  Resume of the observations
of F. Cuvier on this subject, by M. Flourons: 2 ed., p. 46. 
702
APPENDIX.
          ON SENSATION, THE PRINCIPLE  OF EXPERIENCE.
   WTc have seen how Aristotle supposed experience to be derived from
sensation.   He thought that the first ideas which the senses awaken in
us are very general ideas.   We have seen afterward  how Bacon, Locke,
and other modern sensitists, refuted this opinion, and  showed the true
gradation of sensible ideas, the real dcvelopement of the experimental or
empirical method.
   But, when these attempted to elevate themselves by this way to supra-
sensible things; when they would establish on this base the demonstra-
tion of universal  and  necessary truths, the existence of natural religion
and morals, they were not able to do  it on a solid basis.   Their proofs
and their arguments vanished in the light of vigorous argumentation, as
the cloudy vapor disappears under the  rays of the sun.  By endeavoring to
establish morals on sensible ideas exclusively, they disturbed them, they
opened the door, unknowingly, to skepticism, materialism,  and atheism.
   The domain  of knowledge which  is  derived  from sensation, is vast
enough, without  any  one  attempting to extend  it beyond its natural
limits; for it embraces all the sciences which are  occupied with the laws
of matter, whether organized  or unorganized; it comprehends physics,
properly said, natural history, chemistry, medicine, etc.; all the arts and
trades are  in  its dependence.   These are the sciences whose principle
lies in the faculty of sensation, which  grow by observation or experience,
and must be cultivated by the empirical method.

           ON REFLECTION OR CONSCIOUSNESS, THE PRINCIPLE OF PURE REASON.
  The human mind possesses the faculty of isolating itself from all exte-
rior sensation, to fall back upon itself and contemplate its own functions.
This faculty, which is named reflection or consciousness, is  the source of
the most^sublime knowledge; for it is by this that man rises to ideas of
the absolute, the  necessary, the universal, the infinite, the good, or the
evil;  in a word, to all the notions which constitute the exclusive domain
of pure reason.  The sciences which are derived directly from it, are, logic,
metaphysics, and morals.   This faculty alone puts  an immeasurable
distance between the human species and the animal  species nearest in
the scale to man, in the language of the physiologist, the most competent:
   " Animals," say  F. Cuvier and Flourons, " receive by their  senses
impressions similar to those which we receive by ours; they preserve,
like us, the trace of these impressions; these preserved impressions form
for  them, as for  us, numerous and  varied associations;  they combine
and deduce relations and judgment from them; they possess, therefore,
intelligence.  But all  their intelligence is reduced to what is said of it 
NINTH LETTER.
703
above.  The intelligence which they possess does not consider itself, does
not see itself, dses not know itself.  They possess, therefore, no reflection,
that faculty which the human mind possesses, with which to study itself.
Beflection, thus defined, is therefore the limit which separates the intel-
ligence of man from that of animals.   °     °   Man is the only one of
created beings to whom the power has been given to feel  that he feels,
to know that he knows, and to think that he thinks." °
   The philosophers who  have endeavored to study the material world
by the speculative  method, or pure reason, without  the aid  of  experi-
ence—such as Plato, Descartes, Malebranche, Leibnitz, and  others—have
only succeeded in making a fantastic and imaginary world, on the model
of their  supra-sensible ideas.   Sometimes they have refused  to  matter
every species of force or activity; sometimes they have despoiled it of its
existence even; they  have pushed on blindly to the denial  of the reality
of bodies; in a  word, they have found  nothing  reasonable, concerning
the objects which fall under the senses.  As a compensation, they are
sublime and admirable,  when speaking  of supra-sensible  things; they
have developed with a superior logic the soundest ideas touching religion
and morals.
                        ECLECTIC DOGMATISM.
   We see from what  has already been stated that  certain philosophers
were led astray by endeavoring to rise, by ideas derived from sensations,
to the most abstract thoughts of the human mind, and others by attempt-
ing to deduce  the laws and properties  of matter  from pure perceptions
of the mind.  Bationalists and Sensitists have all committed the same
fault; all have interrogated a faculty  of  the soul on  objects with which
this faculty is not connected.  Is it  astonishing,  then, that they have
both fallen into palpable errors—errors which shock common sense ?
   May we not represent  sensation and reflection as two windows, one of
which opens  on  the  natural or sensible world,  and the  other  on the
immaterial or supra-sensible world.  As long as our minds abstain from
looking through  but one  of  these windows, it sees necessarily but one
world ;  it acquires only one  kind of  ideas, and it is  led naturally to
doubt  the reality of  the other world, to deny the existence of the other
order of  ideas.  Wisdom consists, then, when we wish  to  make  dis-
coveries  in  a  science, in  examining without prejudice what order of
ideas  this science developes, in order to make choice of the method which
is best adapted to it.
   By a unique privilege mathematics includes  the  two grand orders of
ideas which divide  the intellectual sphere of man.   It realizes, in some
s Pages 49 and 50. 
704
APPENDIX.
sort, the union of spirit with matter ; on this account they may be studied
either by the speculative or by the sensitist method.   The mathematician
can  at his  pleasure materialize his abstract conceptions, by the aid of
signs, or idealize sensible results, and generalize particular observations,
by means of formula.  On this account mathematical propositions have
a character  of certainty which is not found in any other science, and for
this reason they irresistibly convince the mind.   Taking hold of it by
the way of speculation and experience, they leave no door open to doubt
or uncertainty.
    § VI. Classification of Medicine in a General System of Sciences.
  From what has been said nothing is easier than to determine to what
order of ideas  medical  science belongs, and what method  of  study is
most appropriate to its advancement.   No one, I presume, will attempt
to class it with sciences purely rational, as metaphysics ; but  every
body will  agree to rank it among the sciences which  treat of sensible
objects, as physics,  chemistry, etc.   Now  the method which  succeeds
best in this order of knowledge, the one which the great  observers of
all times have followed, according to common opinion and the testimony
of history, is  that which  is called by modern philosophers, indiffer-
ently, experimental  or  empirical, and consists,  as we have already
said, in abstracting  by  thought what belongs in  common  to  the par-
ticular facts furnished by observation, in order to  form at first generali-
ties  of a  limited kind, then  rising afterward by gradations to other
generalities, more and more vast and more and more abstract.
  The other method, on the contrary, that is, the one which proceeds
from generalities to particulars, from axioms to consequences, may find
its application  in  the  teaching of Medicine, whenever the question is
not one of  discoveries to be made, but of pure and simple exposition of
knowledge already acquired.

                          ON  HYPOTHESIS.
  We  have admitted hypothesis in  physiology and in pathology as a
means of uniting and co-ordinating phenomena among themselves, which
without some artificial bond of  union would  remain isolated from each
other, and would have no connection perceptible by our senses or  reason,
and therefore would  escape too easily from the memory.   But we have
added, and cannot too often repeat, that a physio-pathological hypothesis
should never be the basis of treatment.  It can, at most, be tolerated
as a provisional motive of a therapeutical essay, before experience has
spoken ;  even then, however, it is  not  without danger, though limited 
NINTH LETTER.                      705
to this transitory use; it would be better to experiment without any
preconceived  idea.   Thus comprehended,  hypothesis conforms to  the
analogism of the ancient Empirics ;  but in no case should it form any
part of therapeutics, constituted as a science.
   I am reproached for pulling down medical  practice and reducing it to
a state of pure empiricism ;  my brethren who have offered this objection
deceive themselves, because they attach to the word empiricism a trival
and  abusive  sense, which is not that of philosophic language.  Should
I, from  a  regard to a vulgar  prejudice,  abstain  from  an  exact and
established expression, and replace  it  by some one  of the common
epithets with which so many writers clothe  their medical theories ?   I
have not thought so; I think I  have made  enough concession to this
prejudice in adding to the word  empiricism the epithet methodic, to dis-
tinguish  it from that ignorant and blind empiricism with which a careless
reader might have confounded it.
            §VII.  On  Certainty  in  Medicine.

   Philosophers distinguish two species of certainty, metaphysical cer-
tainty and empirical  or  experimental certainty.   The first admits  not
even  the possibility  of  an exception; thus, the following  propositions
have  a metaphysical certainty :  two quantities equal to a third are equal
to  each  other;  a  straight line is the  shortest  distance between two
points ;  nothing happens without a cause.   Empirical certainty exists
wherever the terms of a proposition express an idea to which there is no
known exception.  Thus, all bodies have weight—the earth  turns inces~
santly around the  sun—are  propositions which  offer an  example  of
empirical certainty.
   We see by these examples, that the  word certainty, taken in its rigor-
ous philosophic acceptation, does not admit of degrees.  A thing is cer-
tain or it is not—this is all; but we cannot say that it may be more or
less certain, little certain, or very certain.  On the contrary, in  common
language, the word certainty, being synonymous with probability, admits
of numerous degrees and shades, and it is in this last sense  that we in-
quire into the degree of certainty of Medicine.
   Cabanis,  who felt  how much it is  necessary for the success of prac-
tical  medicine that the  physician  and  the patient have a reasonable
faith  in the efficacy of the Art;  in order that  the  former embrace the
study and practice of his profession with that conscientious zeal which
can alone enable him to  surmount the difficulties; and that  the latter
execute the prescriptions of science with  that confident submission and 
706
APPENDIX.
 exactness which procures most frequently success;   Cabanis,  I say, has
 devoted a long memoir to  the discussion of the question of certainty in
 Medicine ;   and Broussais, following in his track, has treated the same
 subject in nearly the same manner.  The plan adopted by these authors
 would carry us too  far;  I am  obliged to restrain myself in much
 narrower limits—but I hope I  reach the same end  by a much  shorter
 way, by looking only on the practical side of the question.
   In what respect is it important both to physician and patient, to know
 the degree of certainty in  Medicine ?  Is it not in order  to be  assured
 whether it would be better to abandon diseases  to the sole resources of
 nature, or to treat them conformably to  the  rules of Art ? Every one
 will agree that this is the only useful side of this  discussion, and the
 writers who  have agitated it, have not treated it  from any other point
 of view, whether they have decided in favor of or against science.
   Beduced  to  these terms, the  question of  the  certainty of  Medicine
 seems  to me  easy to resolve; indeed, if I consult history, I find that no
 nation, civilized or savage, has ever been without some kind of  Medicine
 either learned or ignorant, natural or superstitious.  If I interrogate
 common sense and the intimate sentiment, I find that it is impossible for a
 man who suffers, to keep  himself perfectly quiet, without asking  any
 relief  of the experience  of his fellows, as has been  advised by certain
 very stoical philosophers.   The most obstinate skeptics, the most violent
 detractors of the  Healing Art, if they dislocate an  arm or break a  leg,
 do not hesitate to call in the assistance of the surgeon, or  even a bone-
 setter.   Where is the man, who, seeing an infant  attacked with convul-
 sions, or an old man* fall down paralysed, would  not call  a physician ?
 Did Montaigne  and J. J.  Bousseau, those  two lovers of paradox, who
 were both afflicted with the gravel, deprive  themselves of the  aid  of
 surgery when they could not urinate ?
                        FIRST OBJECTION.
   But, reply those who are very incredulous  in regard to medicine, if
there are cases where the intervention of art is indispensable, and truly
efficacious, in how many other cases has not this intervention been more
injurious  than useful ?   How can we definitely establish the balance
between the good, and the evil which results from it ?
                              REPLY.
   Since you  are forced to admit that the intervention of art  is some-
times useful  and necessary, who shall decide properly on the opportunity
or ^opportunity of this intervention ?  The man who is  most familiar
with the resources of art, or he  who is completely ignorant of  them ? 
NINTH LETTER.
707
Would you call a mason to decide whether a luxation is reducible, or
if a fracture of  the  cranium requires the operation of  trephining?
Would you ask an engineer if it is proper to bleed a man attacked with
imminent suffocation, or if it would be better to vomit him, or apply an
irritating foot-bath?   You see that the question of  opportunity or
inopportunity of the aid  of medicine can be properly resolved only by
him who is in possession of medical  science.
                        SECOND OBJECTION.
   It is insisted, that if the practitioner is really more apt than any one
else of judging  the cases in which science should interfere, he has often
an interest opposed to that of the patient, and it is to  be  feared at least,
that in this conjuncture his zeal may be somewhat abated.
                                R EPLY.
   It can not be denied that, in the present state of society, the interest
of the physician is not unfrequently in opposition to that of his patient,
especially when the latter is very rich.   But this  is  no  longer a ques-
tion of science,  but one of probity and of social organization; it  is for
the legislator to devise  the means to harmonize these two  opposite
interests, to arrange them  in such a manner that both  shall  concur to
the same end—the prompt cure of the patient.   In the  meantime, the
wisest part consists in making choice of an honorable as well as a skillful
physician;  to inquire into the morality of the man to whom is confided
the care of health and life, with as much solicitude as we  inquire  into
the morality of the notary or advocate to whom we commit the charge
of our  fortunes.   We must  not hesitate on any occasion to prefer a
practitioner of limited knowledge but known  probity, to one of high
scientific renown but of suspected morality ;  for if the  case  is difficult
or doubtful, the  first will not hesitate to ask  for  a consultation with a
more skillful colleague than himself, and  the patient will thus have the
advantage of probity directed by science.  Fortunate is the patient who
encounters these two qualities united in the same physician; the  best
plan, then, is to abandon himself with confidence to the counsels of such
a director; he has put his life and his health under the  most favorable
chances, as far as the limited wisdom of  man can determine. 
 
TABLE   OF   CONTENTS.
Introduction,    --..........9
Synoptic Table of the Ages and Periods in Medicine,.....24

            BOOK FIRST.—AGE  OF  FOUNDATION.
 Extending from the Origin of Society to the end of the Second Century of the Christian Era.

I. PRIMITIVE PERIOD, of variable length among different nations, -    -  25
General Considerations,..........25
Chap.   I.  Medicine of the Antique Nations,.......26
    §   I.  Medicine of the Egyptians,.......26
    §  II.  Medicine of the Hebrews,........32
    §  III.  Medicine of the Oriental Indians,......36
    §  IV.  Medicine of the Chinese,.....-    -    -  38
    §  V.  Medicine of the Greeks, during the Primitive Period,    -    -    45
Chap.  II.  Medicine of some other nations of  the Old and New World, -    -  53
Chap.  III.  Origin of Medicine,.......-    -    53
Chap.  IV.  The Utility of Medicine during the Primitive Period,  -    -    -  55
           Resume of the Primitive Period,......59

II.  MYSTICAL PERIOD, comprising a space of time  extending from  the
       Trojan War, B. C, 1184, to the dissolution of the  Pythagorean So-
       ciety, B. C, 500,      ...-------  61
       General Considerations,  -........61
Chap.   I. The Practice of Medicine in the Temples,.....62
Chap.  II. On Dreams,..........64
Chap.  III. Medical Teaching in the Temples,......66
Chap.  IV.  The Origin of Classifications in Pathology,    ....     68
Chap.  V. Therapeutics,    -    -........70
Chap.  VI. Origin of Systems,  ---------     73
           Resume of the Mystical Period,.......75

III. PHILOSOPHIC  PERIOD, comprising  the  period of time between the
       dispersion of the Pythagorean Societies, in the year B. C, 500, and the
       foundation of  the Alexandrian Library, in the year B. C, 320,      -   78
       General Considerations,.........78
       Pythagoras,...........78
 Chap.    I. Doctrine of Pythagoras,........83
Chap.   II. Periodic Physicians,   -                  .....88
 Chap.  III. The Practice of Medicine in the Gymnasia,   ....    89 
710                     TABLE  OF CONTENTS.

Chap.   IV. Schools of the Asclepiadae,     -    -    -    -    "       .  "  91
    Art. I.  Hippocrates, -------                .94
    Art. II.  The Hippocratic Collection,    -                            '  ^
     §   I. Anatomy and Physiology,.....           -96
     §   II. Hygiene. --------                o;
     §  HI.  Pathology and Therapeutics, -----             ^
     §  IV.  Semeiotics.     ------
     §   V.  Internal Nosography,   -                                  -  103
            On Pneumonia,-     ------                  '
                                                                      IO.j
            On Pleurisy, ------                    ^
     §  VI. Therapeutics,- -------
            Treatment of Pleurisy and Pneumonia,     .                    '
     §  VII. External Nosography and Therapeutics, or Surgery,     -    -  10»
     § VIII. Obstetrics,    --.----'             ^
     §  IX. Clinics,   "   '    "    "    ~                   "       _    113
            First Constitution,     ------
            First Case,     ------
     §   X. Aphorisms,......'                _  ..,_.
     Art. III. Theories and Systems,    -    -    -    "    '    *    "    "
     8    I. Theory of Coction and Crisis,    -   -    -     -     "
     §   II. Theory of Four Elements and Four Humors,  -    -    -    -  J-J
     8   III. Theory of Fluxions,....."     '         "
     §   IV. Theories founded on the consideration of  Two  Elements,  -    -  i<"
     §   V. Theory of a Single Element,  -------   16
     §   VI. Theory of any Excedent,  -
     S  VII. Resume of the Hippocratic Theories,   -""""*
 Chu,    V The Medical School of Cos after Hippocrates,  -    -     -    -  1*>
Art.   I. Plato,
Art.  II. Aristotle,  -
      Resume of the Primitive Period,

     dIOAL PERIOD, comprising the
     he Foundation of the Alexandria
LnTtwenty years before Christ, to the death of Galen, in the year two
153
164
[V  VN VTOMIO VL PERIOD, comprising the period of time which extends
  '  X  from the Foundation of the Alexandrian Library, some three hundred
      hundred, of the Christian Era,     -
      General Considerations,    -.......'
Chap.    I. The School of Alexandria,    -------    J««
Chap'.   H. Anatomy and Physiology, -
Chat.   HI. Hygiene,     ..-----              -
Chap.   IV- General Pathology,   --------- J»
Chap.   V. Internal Pathology,     --------
      §  I. Semeiotics,-     -------         -    -  184
      § II. Nosography,  -........"    Iqq
           On Pneumonia, ---------- 1°°
Chap.   VI. Internal Therapeutics,  -    -    -.....190
           Cure of Peripneumonia,........192
PrI..  vii  External Pathology and Therapeutics,.....194
Chap. VIII. Clinics,.......-    -    -    - i»j
Chap'   ix-  Theories and Systems,  --------    200
            General Considerations,  -              .....200 
TABLE  OF  CONTENTS.
711
    Art.   I. On Dogmatism,   -.--'----   202
    Art.  II. On Empiricism,     -........211
    Art. III. On Methodism,   -             ......224
    Art. IV. On Eclecticism,     -    -.......233
            Resume of the Anatomical Period,.....235

            BOOK SECOND.—AGE OF  TRANSITION.
Commencing at the death of Galen, during the reign of the Emperor Septimus Severus, A. D.
         201, and ending at the revival of Letters in Europe, about the year 140O____

V. GREEK PERIOD, including the period of time between the death of Galen,
      and the destruction of the Alexandrian Library, which occurred in the
      year 640,............237
      General Considerations, ---         .....237
Chap.  I. Celebrated Commentators,........233
    §  I. Oribasius,...........238
    § n. Aetius,  -   -..........240
    § III.  Alexander of Tralles,     -         ------   241
    § IV. Paul jEgineta,.........     - 241
Chap. II. Medical Organization,     --------   245
Chap. III. Institutions accessory to Medicine,     ------ 252
          Resume of the Greek Period,.......254

VI. ARABIC PERIOD, commencing at the destruction of the Alexandrian
      Library, in the year 640 of the Christian era, and ending at the close
      of fourteenth century,.........255
      General Considerations,  -     -    -    -.....255
Chap.   I. Medicine of the Arabs,     -------- 257
    §   I. Rhazes   -    -     -    -.......257
    §  n. Hally-Abas, -----......259
    § IH. Avicenna,  ------.....260
    § IV. Albucasis,   -             -         ------ 264
    §  V. Retrospective considerations on the progress  of Medicine among
             the  Arabs,..........266
Chap.  II. Medicine of the Greeks during the Arabic Period,   -    -    -   267
Chap. III. Medicine of the Latins during the same Period,  .     -    -    - 269
          General Considerations,   --------   269
  Art.  I. Medical Organization of the West,     -.....271
  Art. II.  School of Salermo,.........275_
  Art. III. On the Origin  and Growth of  Universities,.....277
    §  I. From Charlemagne to the fifteenth Century,                 -  277
    § n. Efforts of some Physicians to restore the Science,      -    -    - 279
Chap.IV.  Accessory Institutions,     -.......284
          Resume of the Arabic Period.    ------- 235

            BOOK THIRD.—AGE OF  RENOVATION.
      Extending from the commencement of the Fifteenth Century to the Present Time.
VII. ERUDITE PERIOD, including the fifteenth and sixteenth Centuries,  - 237
General Considerations,..........287
Chap.    I. Humanist Physicians,     -------- 289 
712
TABLE  OF  CONTENTS.
Chap.   H. Anatomy aud Physiology,.......293
Chap.  III. Hygiene, Mondini, Berenger, Vesalius, Servetus,  R. Columbus,
              Cesalpine, Louis Carnaro,.......299
Chap.  IV. General Pathology, -    -   -......302
Chap.   V. Lnternal Pathology,   --------- 303
    §   I. Semeiotics,..........303
    §   II. Pathological Anatomy,     -    -    -     -    -    -    -     -304
    §  HI. Nosography,..........305
Chap.  VI. Internal Therapeutics, Doctrine of Contraries,  -     -    -    - 308
    §   I. On Evacuating Medication,.......321
           Derivation  and Revulsion,.....-    - 322
    §   II. Purgative Medication,   --------   324
    §  III. Alterant Medication,........ 325
Chap.  VII. External Pathology and Therapeutics,.....328
           Barber Surgeons,.........330
           Ambrose Pare,........       331
           Obstetrics,.......... 336
Chap. VIII. Clinics,...........336
    §   L Syphilis, considered as a new Disease,.....341
    §   II. Its origin in America considered,  ------   341
    §  III. A  degeneration of Leprosy,     -                   ... 343
Chap.   IX. Theories and Systems,........346
           General Considerations,    -----.._ 346
           John Fernel,  --........346
    §   I. Doctrine of Galen on the Elements, Humors, etc.,     -    -    - 349
    §   II. Dissertation on the Essence, Causes, and Symptoms of Diseases, 350
    §  III. Therapeutics, Examples  of Cures,    ...... 351
Chap.   X. Occult Sciences,.........352
    §   I. Cornelius Agrippa,    -........ 353
    §   n. Jerome Cardan,.........357
    §  III. Paracelsus,  -----......ggg
           Conclusion of Chapter X,     ----.._   359
Chap.  XI. Partial efforts for Reform,........37Q
     §   I. John Argentier,.........gjQ
     §   II. Leonard Botal,   ------.... 372
     §  III. Laurence Joubert,   -.-......070
Chap. XII. Medical Organization and Accessory Institutions     -     -    - 378
           Resume of the Erudite Period,     -    -    -     .    .       37 a

VHI. REFORM PERIOD, comprising the seventeenth and eighteenth Cen-
           turies,  --........-    - 380
            General Considerations, -.....            oo0
Chap.     I. Anatomy and Physiology,  --....           o82
            Circulation of the Blood,    ----..        q82
            William Harvey,     -.......- 383
            Malpighi,    ....
            a  ^S                             -----    385
            Senac,     -
            t>   •   ..                    ------- 386
            Respiration, ----..
            Lymphatic System,  -
            Nervous System,   - 
TABLE  OF CONTENTS.
713
           Generation,..........397
           Vital or Organic Properties,.......400
           Francis Glisson,.........402
           Albert Von Haller,........402
           John Hunter,..........405
Chap.   H. Hygiene,..........406
    §    I. Public Hygiene,.........406
           Among the Ancients,    -    --    -    -   -    -    -   406
           Fasting among Turks and Christians,.....407
           Lazarettos,..........408
           General attention to Hygiene,.......409
           Inoculation,........--   410
           Jenner,  -      ...--.---- 410
           Vaccination,  -    -    -.......411
           Private Hygiene,.........411
           Sanctorius,..........   411
           Cheyney,  ----------- 413
Chap.   TH. General Pathology,     -         ......414
Chap.   IV. Internal Pathology,.........415
    §    I. Semeiotics,..........415
           Sphygmics,..........415
           Percussion,..........417
                                                                     4.17
           Avenbrugger,   -......             "ll<
    8   H. Pathological Anatomy,.......        418
           Bonet,     -     -    -    -.......418
           Morgagni,    --......"       *±a
           Bichat,    -     -    -.....-    -    -420
    §   m. Nosography,..........421
           System of Sauvages, .    -   -    -.....423
           System of Cullen,   -........425
           System of Pinel,.........426
           Systems of Linnaeus and others,   ------   427
           System of Bouillaud.   Note,.......429
Chap.   V. Internal Therapeutics,   -......        430
           Treatment of Syphilis,    -   -......430
           Treatment of Periodical Diseases,......433
           Introduction of Cinchona, -----        -     434
           Treatment of other diverse Diseases,   -----   437
Chap.   VI. External Pathology and Therapeutics,    -     -    -    -    - 439
            General Remarks,  -    -    -.....       440
            Wounds of the Head,     -------- 441
            Diseases of the Eye,    ------         -   442
                  Cataract, -    -    -.......44^
                  Fistula Lachrymalis,  -------   443
                                                                     443
                  Synizesis,     -     -    -     -    -
            Diseases of the nose,    --------   444
                  Nasal Polypus,      -    -
                  Rhinoplasty,    --------   444
            Diseases of the Mouth,    ------- 445
45 
714
TABLE  OF  CONTENTS.
                  Hare Lip,   --------     -   445
                  Affections of the Teeth,—Dentistry,     -    -    -     - 446
                  Affections of the Tongue, Palate, and Tonsils,   -     -   447
            Diseases of the Ear, -........448
            Obturation of the Air Passages,  ------   448
            Diseases of the Chest,......-     " 449
                  Empyema,  ---------   449
            Diseases of Abdominal Organs,     -                       - 461
                  Wounds of Abdomen and Intestines, -    -    -     -   451
                  Paracentesis Abdominalis,......452
                  Hernia,     ---------   453
            Diseases of Urinary Organs,    ------- 454
                  Cystotomy,.........455
            Diseases of the Genital Organs in Man,.....457
                  Hydrocele,  -    -    -......457
                  Sarcocele,     --------- 458
            Diseases of the Anus,   --------   459
            Diseases of the Members,........ 459
                  External Aneurisms,  -......459
                  Amputation of Members,    .--... 459
                  Orthopaedia,     -.......461
Chap.  VII.  Obstetrics,.........-     - 462
            Pregnancy,..........464
            Natural Labor,..........464
            Difficult Labor,    .    -    -    -.....465
            The Placenta,   ..--.-.... 466
Chap. Vin.  Legal Medicine,.........467
Chap.  IX.  Clinics,    -.......... 470
    §    I.  Oral Clinical Teaching,.......     -   471
            Bottoni, Oddo, De Huern, Sylvius, Boerhaave,   .... 471
    §   n.  Collection of Clinical Observations,     -                     474
    §  IH.  Epidemic Constitutions,   .---.-.. 474
            Baillou,.........-        474
            Difference between Galenism and modern Hippocratism,  -     - 476
            Sydenham,..........477
            Stoll,  -   ■........... 480
    §   TV.  Medical Topography,.......        432
            Alpin, Bontius, Pison, Koempfer,     ...... 432
            Desportes, Cleghorn, Lind, Hillory,.....433
       .j,     Chalmers, Bajon, Falconer,     --..... 433
            Daniel Drake, -.........   434
Chap.    X.  Theories and Systems,    --.-.... 435
            Preliminary Reflections,.......        435
  Art.   I.  Historic Sketch of Philosophy during the Seventeenth and Eight-
              eenth Centuries,......... 436
     §    I.  Retrospective Considerations, -------   436
     §   II. On Modern Sensualism and Reasoning by Induction,    -    - 488
            Francis Bacon,    ----...__   43^
            John Locke,    ---.......40,2
            Stephen Bonnat de Condillac, ----...   49^ 
TABLE  OF CONTENTS.
715
           Aphorism of Philosophy, particularly applicable to the Physi-
            cal Sciences,.....-.....493
           First Paradox of Condillac: The Art of Reasoning may be re-
            duced to a well formed Language,......494
           Second Paradox: Analysis is the  sole Method for the Acquisi-
            tion of  Knowledge,........496
    §   ni. On Rationalism, or Reasoning by Deduction,  -    -    -    - 499
           Descartes,..........600
           Leibnitz,...........603
           Kant,........-    -    -    506
    §   IV. Conclusion,.......... 606
  Art.   II. Sources of Animism and Chymiatria,   -----    509
           Van Helmont,.......... 509
  Art.  in. Iatro-Chymia,......-    -    -    613
           Sylvius,..........- 513
           Willis,.......-    -    -    -    516
  Art.  IV. Iatro-Mechanics,.........620
           Borelli,...........520
           Baglivi,......-    -   -    -     -525
           Boerhaave,   ----------   630
  Art.   V. Animism and Vitalism,........ 534
           Stahl,...........534
           Barthez,   -     .    -    -.......639
  Art.  VI. Organic Dynamism,........547
           Hoffman, -..........547
           Cullen,...........552
           Brown,...........556
  Art.  VII. Empiricism,  -......-    -   -   561
           Werlhof,........... 567
           Lieutaud,..........567
Chap.   XL Empiri-Methodism,  or the Alliance  of  Empiricism with the
              Philosophic Method,    -------- 670
           Universal Axiom of Therapeutics,      -----   570
           First Condition required for the Application of this Axiom,   - 571
           Second Condition,  ---------   577
           Third Condition,-     -    -    -......678
           On  Method  in Therapeutics, or Classification of the  General
              Modes of Treatment,........584
           Synthetic Mode,   -     .-------   584
          ' Analytic Mode,       .........585
           Expectant Mode,  ---------   586
           Exploring or Perturbating Mode,......587
Chap.  XII. General Resume,  -.....-        -   591
           Phases in Medical History.    -    -.....591 
 
CONTENTS   OF   APPENDIX.
                           FIRST LETTER.
                         Medicine Judged by Physicians.
School  of Paris—School of Montpelier—Italian School—Comparison  of the
  English, French, and Italian doctrines—German School—Conclusion: it is not
  astonishing that there are so many skeptics in regard to Medicine, when the
  masters themselves declaim so against it,.......599

                         SECOND  LETTER.
Is there in Medicine a sure means of discovering the true from the false—the certain from the
                                hypothetical ?
Importance of the question—Final aim of Medicine: every thing in this science is
  or ought to be related to Therapeutics—The supreme and infallible criterion in
  the Healing Art is Therapeutical proof— Universal Axiom: all medication which
  has cured one disease, must cure, equally, diseases which are analagous to it—
  The rational application of this axiom rests on three indispensable conditions:
  homogeneousness of the diseases, identity of curative  means, and the knowl-
  edge of  the treatment most appropriate to each morbid  species—Conclusion:
  Medicine has always been in possession of a sure principle and method for its
  development,............610

                           THIRD  LETTER.
  On the causes which have lead physicians to leave the primitive route of pure observation.
They are included in this aphorism: Art  is long,  life is short, experience defec-
  tive, and judgment difficult—Consequences of this scientific revolution—Origin
  of Physio-Pathological Systems—Conclusion: on this account, the various sects
  in Medicine,     ..--........623

                         FOURTH  LETTER.
 Can pathological physiology, in whole or in part, be the direct or immediate foundation of
                                therapeutics 1
Present state of Science in relation to this question—Differences in opinion among
  ancient  and  modern  authors—Philosophic axioms  which  aid  in the  solu-
  tion of this problem—Negative reply to the question placed at the head of the
  letter: can pathological physiology be in any case the direct and immediate
  foundation of therapeutics ?—Examples and proofs to support this response—
  Conclusion: confirmation of this axiom in our Second Letter, clinical proof is
  the supreme criterion of truth in Medicine,......635 
718
CONTENTS  OF  APPENDIX.
                            FIFTH  LETTER.
                          On Eclecticism in Medicine.
Origin of the New Eclecticism in Medicine, which  must not be confounded with
  Eclecticism in Philosophy—Eclecticism in Pathology—Eclecticism in Therapeu-
  tics—Conclusion :  Eclecticism in Medicine  is a doctrine essentially vague,
  shifting, and destitute of foundation,.....-    - 646

                          SIXTH  LETTER.
                               On Homeopathy.
The progress of this doctrine  imposes upon us  the obli  ation to consider it seri-
  ously—The philosophy of  Hahnemann is the most absolute Sensitism; his
  physiology and his pathology conduct us to the grossest and narrowest Empiri-
  cism ; his universal  principle of Therapeutics, the law of similars, is founded
  on the most remote and false analogies—The  author continually promises
  therapeutical observations, but furnishes none which are authentic—The Spe-
  cific  School, having submitted the theorems of  Hahnemann to  experimental
  proof, find them to be false  or accidental—Conclusion : the Homeopathic doc-
  trine offers the strangest assemblage of assertions devoid of all truth, auda-
  cious paradoxes, and flagrant contradictions; in  a word, is a challenge to the
  credulity of mankind,..........654

                        SEVENTH  LETTER.
                          On Therapeutical Methods.
Present condition of this branch of the Science—New Classification of Therapeu-
  tical Methods—The Synthetic Method, the most perfect  of all, is blindly denom-
  inated Irrational—Analytic Method—Comparison of  the two methods—Expec-
  tant Method called, improperly, Natural—Secondary Methods—Application of
  our Theory of Curative Methods—Various Methods—Classification and Denom-
  ination of Medicaments—Conclusion—Empiri-Methodism is the only one of all
  the Systems  in Medicine that unites under one Principle, and embraces in
  its  scheme all  Internal and External Therapeutics, -    -        -    - 666

                         EIGHTH  LETTER.
         Response to some Objections concerning the Empiri-Methodic Doctrines.       678

                          NINTH  LETTER.
On the Rank that Medicine should occupy in a general System of the Sciences, and the Degree of
                          Certainty which it can attain.
Value of this inquiry—Division of  the subject of the Letter into two parts, 689

                              first  part.
Historical resume of the opinions emitted by philosophers on the Origin of  Ideas, aud their
                          various modes of development.
Antique Period—Middle Period—Modern Period—Revival  of  Philosophy—Sen-
  sitism of  Bacon, Locke, Condillac, and others—Rationalism of Descartes, Leib-
  nitz, Kant, Fichte, and Schelling—Common Sense and Sentiment considered
  as a means of Knowledge—The Scotch School—Philosophic Eclecticism of  our
     Times,.............690 
CONTENTS  OF  APPENDIX.
719
                             SECOND  PART.
       Critical and Dogmatical Examination of the various Systems just mentioned.
Instinct, the principle of Sentiment or Common Sense,  is not a philosophic fac-
  ulty, that is to say, perfectible—Sensation the principle of experience, is the
  source of all Physical Sciences, of all the Arts and Trades—Reflection or Con-
  sciousness, is the principle of pure Reason, and is characteristic of the Human
  Species, the source of all supra-sensible, or a priori knowledge—Eclectic Dog-
  matism—Why mathematical theorems  take  hold of  our convictions with an
  irresistible force—Classification of Medicine in a complete system of science—
  Value of hypotheses in Medicine—Certainty in Medicine,     -    -    - 701 
 
%.
%
\?/


%
 
NATIONAL L BRARY OF MEDICINE
NLfl 0DTflfiD3M  E