the evolution of modern medicine-第3部分

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kester　remarks　that　Man　is　Nature's　rebel；　and　goes　on　to　say：　〃The　mental　qualities　which　have　developed　in　Man；　though　traceable　in　a　vague　and　rudimentary　condition　in　some　of　his　animal　associates；　are　of　such　an　unprecedented　power　and　so　far　dominate　everything　else　in　his　activities　as　a　living　organism；　that　they　have　to　a　very　large　extent；　if　not　entirely；　cut　him　off　from　the　general　operation　of　that　process　of　Natural　Selection　and　survival　of　the　fittest　which　up　to　their　appearance　had　been　the　law　of　the　living　world。　They　justify　the　view　that　Man　forms　a　new　departure　in　the　gradual　unfolding　of　Nature's　predestined　scheme。　　Knowledge；　reason；　self…consciousness；　will；　are　the　attributes　of　Man。〃＇1＇　It　has　been　a　slow　and　gradual　growth；　and　not　until　within　the　past　century　has　science　organized　knowledge　so　searched　out　the　secrets　of　Nature；　as　to　control　her　powers；　limit　her　scope　and　transform　her　energies。　　The　victory　is　so　recent　that　the　mental　attitude　of　the　race　is　not　yet　adapted　to　the　change。　A　large　proportion　of　our　fellow　creatures　still　regard　nature　as　a　playground　for　demons　and　spirits　to　be　exorcised　or　invoked。

＇1＇　Sir　E。　Ray　Lankester：　　Romanes　Lecture；　〃Nature　and　Man；〃　Oxford　Univ。　Press；　1905；　p。　21。


Side　by　side；　as　substance　and　shadow〃in　the　dark　backward　and　abysm　of　time；〃　in　the　dawn　of　the　great　civilizations　of　Egypt　and　Babylon；　in　the　bright　morning　of　Greece；　and　in　the　full　noontide　of　modern　life；　together　have　grown　up　these　two　diametrically　opposite　views　of　man's　relation　to　nature；　and　more　particularly　of　his　personal　relation　to　the　agencies　of　disease。

The　purpose　of　this　course　of　lectures　is　to　sketch　the　main　features　of　the　growth　of　these　two　dominant　ideas；　to　show　how　they　have　influenced　man　at　the　different　periods　of　his　evolution；　how　the　lamp　of　reason；　so　early　lighted　in　his　soul；　burning　now　bright；　now　dim；　has　never；　even　in　his　darkest　period；　been　wholly　extinguished；　but　retrimmed　and　refurnished　by　his　indomitable　energies；　now　shines　more　and　more　towards　the　perfect　day。　　It　is　a　glorious　chapter　in　history；　in　which　those　who　have　eyes　to　see　may　read　the　fulfilment　of　the　promise　of　Eden；　that　one　day　man　should　not　only　possess　the　earth；　but　that　he　should　have　dominion　over　it！　I　propose　to　take　an　aeroplane　flight　through　the　centuries；　touching　only　on　the　tall　peaks　from　which　may　be　had　a　panoramic　view　of　the　epochs　through　which　we　pass。


ORIGIN　OF　MEDICINE

MEDICINE　arose　out　of　the　primal　sympathy　of　man　with　man；　out　of　the　desire　to　help　those　in　sorrow；　need　and　sickness。

In　the　primal　sympathy　Which　having　been　must　ever　be；　In　the　soothing　thoughts　that　spring　Out　of　human　suffering。

The　instinct　of　self…preservation；　the　longing　to　relieve　a　loved　one；　and　above　all；　the　maternal　passionfor　such　it　isgradually　softened　the　hard　race　of　mantum　genus　humanum　primum　mollescere　coepit。　In　his　marvellous　sketch　of　the　evolution　of　man；　nothing　illustrates　more　forcibly　the　prescience　of　Lucretius　than　the　picture　of　the　growth　of　sympathy：　　〃When　with　cries　and　gestures　they　taught　with　broken　words　that　'tis　right　for　all　men　to　have　pity　on　the　weak。〃　I　heard　the　well…known　medical　historian；　the　late　Dr。　Payne；　remark　that　〃the　basis　of　medicine　is　sympathy　and　the　desire　to　help　others；　and　whatever　is　done　with　this　end　must　be　called　medicine。〃

The　first　lessons　came　to　primitive　man　by　injuries；　accidents；　bites　of　beasts　and　serpents；　perhaps　for　long　ages　not　appreciated　by　his　childlike　mind；　but；　little　by　little；　such　experiences　crystallized　into　useful　knowledge。　The　experiments　of　nature　made　clear　to　him　the　relation　of　cause　and　effect；　but　it　is　not　likely；　as　Pliny　suggests；　that　he　picked　up　his　earliest　knowledge　from　the　observation　of　certain　practices　in　animals；　as　the　natural　phlebotomy　of　the　plethoric　hippopotamus；　or　the　use　of　emetics　from　the　dog；　or　the　use　of　enemata　from　the　ibis。　　On　the　other　hand；　Celsus　is　probably　right　in　his　account　of　the　origin　of　rational　medicine。　〃Some　of　the　sick　on　account　of　their　eagerness　took　food　on　the　first　day；　some　on　account　of　loathing　abstained；　and　the　disease　in　those　who　refrained　was　more　relieved。　Some　ate　during　a　fever；　some　a　little　before　it；　others　after　it　had　subsided；　and　those　who　had　waited　to　the　end　did　best。　For　the　same　reason　some　at　the　beginning　of　an　illness　used　a　full　diet；　others　a　spare；　and　the　former　were　made　worse。　Occurring　daily；　such　things　impressed　careful　men；　who　noted　what　had　best　helped　the　sick；　then　began　to　prescribe　them。　In　this　way　medicine　had　its　rise　from　the　experience　of　the　recovery　of　some；　of　the　death　of　others；　distinguishing　the　hurtful　from　the　salutary　things〃　（Book　I）。　The　association　of　ideas　was　suggestivethe　plant　eyebright　was　used　for　centuries　in　diseases　of　the　eye　because　a　black　speck　in　the　flower　suggested　the　pupil　of　the　eye。　The　old　herbals　are　full　of　similar　illustrations　upon　which；　indeed；　the　so…called　doctrine　of　signatures　depends。　Observation　came；　and　with　it　an　ever　widening　experience。　No　society　so　primitive　without　some　evidence　of　the　existence　of　a　healing　art；　which　grew　with　its　growth；　and　became　part　of　the　fabric　of　its　organization。

With　primitive　medicine；　as　such；　I　cannot　deal；　but　I　must　refer　to　the　oldest　existing　evidence　of　a　very　extraordinary　practice；　that　of　trephining。　　Neolithic　skulls　with　disks　of　bone　removed　have　been　found　in　nearly　all　parts　of　the　world。　Many　careful　studies　have　been　made　of　this　procedure；　particularly　by　the　great　anatomist　and　surgeon；　Paul　Broca；　and　M。　Lucas…Championniere　has　covered　the　subject　in　a　monograph。＇2＇　Broca　suggests　that　the　trephining　was　done　by　scratching　or　scraping；　but；　as　Lucas…Championniere　holds；　it　was　also　done　by　a　series　of　perforations　made　in　a　circle　with　flint　instruments；　and　a　round　piece　of　skull　in　this　way　removed；　traces　of　these　drill…holes　have　been　found。　The　operation　was　done　for　epilepsy；　infantile　convulsions；　headache；　and　various　cerebral　diseases　believed　to　be　caused　by　confined　demons；　to　whom　the　hole　gave　a　ready　method　of　escape。

＇2＇　Lucas…Championniere：　Trepanation　neolithique；　Paris；　1912。


The　practice　is　still　extant。　　Lucas…Championniere　saw　a　Kabyle　thoubib　who　told　him　that　it　was　quite　common　among　his　tribe；　he　was　the　son　of　a　family　of　trephiners；　and　had　undergone　the　operation　four　times；　his　father　twelve　times；　he　had　three　brothers　also　experts；　he　did　not　consider　it　a　dangerous　operation。　　He　did　it　most　frequently　for　pain　in　the　head；　and　occasionally　for　fracture。

The　operation　was　sometimes　performed　upon　animals。　Shepherds　trephined　sheep　for　the　staggers。　　We　may　say　that　the　modern　decompression　operation；　so　much　in　vogue；　is　the　oldest　known　surgical　procedure。


EGYPTIAN　MEDICINE

OUT　of　the　ocean　of　oblivion；　man　emerges　in　history　in　a　highly　civilized　state　on　the　banks　of　the　Nile；　some　sixty　centuries　ago。　After　millenniums　of　a　gradual　upward　progress；　which　can　be　traced　in　the　records　of　the　stone　age；　civilization　springs　forth　Minerva…like；　complete；　and　highly　developed；　in　the　Nile　Valley。　　In　this　sheltered；　fertile　spot；　neolithic　man　first　raised　himself　above　his　kindred　races　of　the　Mediterranean　basin；　and　it　is　suggested　that　by　the　accidental　discovery　of　copper　Egypt　〃forged　the　instruments　that　raised　civilization　out　of　the　slough　of　the　Stone　Age〃　（Elliot　Smith）。　Of　special　interest　to　us　is　the　fact　that　one　of　the　best…known　names　of　this　earliest　period　is　that　of　a　physicianguide；　philosopher　and　friend　of　the　kinga　man　in　a　position　of　wide　trust　and　importance。　On　leaving　Cairo；　to　go　up　the　Nile；　one　sees　on　the　right　in　the　desert　behind　Memphis　a　terraced　pyramid　190　feet　in　height；　〃the　first　large　structure　of　stone　known　in　history。〃　It　is　the　royal　tomb　of　Zoser；　the　first　of　a　long　series　with　which　the　Egyptian　monarchy　sought　〃to　adorn　the　coming　bulk　of　death。〃　The　design　of　this　is　attributed　to　Imhotep；　the　first　figure　of　a　physician　to　stand　out　clearly　from　the　mists　of　antiquity。　〃In　priestly　wisdom；　in　magic；　in　the　formulation　of　wise　proverbs；　in　medicine　and　architecture；　this　remarkable　figure　of　Zoser's　reign　left　so　notable　a　reputation　that　his　name　was　never　forgotten；　and　2500　years　after　his　death　he　had　become　a　God　of　Medicine；　in　whom　the　Greeks；　who　called　him　Imouthes；　recognized　their　own　AEsculapius。〃＇3＇　He　became　a　popular　god；　not　only　healing　men　when　alive；　but　taking　good　care　of　them　in　the　journeys　after　death。　The　facts　about　this　medicinae　primus　inventor；　as　he　has　been　called；　may　be　gathered　from　Kurt　Sethe's　study。＇4＇　He　seems　to　have　corresponded　very　much　to　the　Greek　Asklepios。　　As　a　god　he　is　met　with　comparatively　late；　between　700　and　332　B。C。　Numerous　bronze　figures　of　him　remain。　The　oldest　memorial　mentioning　him　is　a　statue　of　one　of　his　priests；　Amasis　（No。　14765　in　the　British　Museum）。　Ptolemy　V　dedicated　to　him　a　temple　on　the　island　of　Philae。　　His　cult　increased　much　in　later　days；　and　a　special　temple　was　dedicated　to　him　near　Memphis　Sethe　suggests　that　the　cult　of　Imhotep　gave　the　inspiration　to　the　Hermetic