How often have we heard the B.B.C. announcement that there has been lost at such and such a time, in such and such a neighbourhood, a small box containing some tablets which are dangerous? Will anyone finding them please communicate with New Scotland Yard, Whitehall 1212?
Have you ever stopped to think what are the implications of these repeated announcements? Surely they suggest that medical practice have departed very considerably from the doctrine of Asclepiades, born 124 B.C. and known then as the “Prince of Physicians”, who advocated that disease should be treated speedily, safely and agreeably a very desirable aim for a physician, but which, alas! of late years the profession has apparently been losing sight of more and more.
In fact, it seems to me that much of the ordinary practice of medicine today is following the spirit of the age, which unfortunately, is one of violence and disregard of the finer ethics of conduct through far too much of present day human activities. I do not mean to imply that the finer qualities of living are entirely absent from the present stage, but there is far too much complacency abroad about the preponderant lack of those qualities which make life something to be admired and desired.
Just as we tolerate the appalling toll of the roads, the use of flame throwers and napalm bombs in present day warfare of any sort, so do I think dangerous drugs and certain surgical methods are often quite unjustifiably used in present day medicine, especially having regard to the problematic advantages they may have by suppressing certain symptoms without actually curing the patient.
How has this unfortunate condition of modern medicine arisen? To explain it, I think, we must look to the beginnings of the art of healing and trace its development through the ages. As, however, the time at my disposal will not allow of an exhaustive study of this fascinating subjects, I must ask you to be satisfied with a rapid and very superficial survey.
Ever since the advent of man on this globe there has been some form of primitive medicine, very largely based on instinct and the religious ideas of the times, which embraced much superstition, the belief in magic, and the notion the illness was a punishment for evil doing. This last is still present in the minds of even some enlightened people today. The primitive medicine men were the priests of the times. Not having time to describe in detail any of their customs, suffice it to say that primitive as they were, many of them had this virtue, that they did not separate the patient from his illness, and many of their exercising practices had some parallelism with some forms of modern psycho – therapy.
We must now hurry along, without, however, suggesting that the by – passed cults of medicine of the Egyptians, Sumerians and Orientals generally had no influence on succeeding schools of healing, until we come to the classic period of Greek medicine and especially that of Hippocrates (460 to 370 B.C.), who gave to Greek medicine its scientific spirit and ethical ideals.
He lived during the height of development of the Athenian democracy, and contemporaries of his were such men as Sophocles, Socrates and Plato. It is no wonder, therefore, that he took medicine out of the control of the golds and demons and set about looking for more natural causes of sickness.
He ascribed illness to some disturbance of one or more of the four humors of the body, as he described them, viz., blood, phlegm, yellow and black bile, from which arose the descriptions of men as being sanguine, phlegmatic, choleric or melancholic. He wrote many treaties both on medical and surgical matters and, of course, was the originator of the Hippocratic oath with contains, among other things, the high ethical principles which should inspire every physicians life, and by which medical graduates, even to this day, are expected to abide.
We must now skip five hundred years to take notice of Galen (A.D. 131-201), who was the last of the great Greek physicians, and whose influence lasted right down to the first Elizabethan era, and even beyond. He was not only a very renowned physician, but unlike Hippocrates, let his interests wander over many activities other than those of a doctor. He had a great opinion of himself and put forward his ideas so dogmatically that people hardly dared to differ from him.
His authority, therefore, on medical matters outlived him for very many years, even centuries. He agreed with Hippocrates idea of the humors of the body, but grafted on to that theory various notions based on the Pythagorean assumption that there were four elements influencing health, viz: earth, fire, air and water, and four qualities of heat, cold,. moisture and dryness. He also propounded the idea that there was a spirit or pneuma, pervading all the parts of the body. He distinguished between exciting and predisposing causes of disease.
He based a very elaborate pathology on these theories, thus departing from the Hippocratic system based upon the close observation and interpretation of observable facts. This was very unfortunate, as owing to his assumption of omniscience the fact that he was taken at his own valuation and the well – known reverence for authority that generally prevades mankind, medicine did not make the advances that one might have expected of it through so many centuries, until early in the sixteenth century.
Even in those later days Galens authority was so great that, if any facts were found to clash with his theories, the knowledge of those facts would often be suppressed rather than admit that, after all, Galen may have been wrong!
But inspite of all his theorizing he was indeed a very capable physician, a keep observer of his patients and added considerably to the knowledge of medicine by many experiments. Perhaps one of most striking of these was to demonstrate the motor power of the heart by showing that the blood pulsates between the heart and a tied artery.
He missed, however, the observation of the circulation of the blood, which was to be left for William Harvey to demonstrate 1,500 years later. As a matter of fact, Gallen believed that the blood passed from the right to the left ventricle of the heart through imaginary, invisible pores in the interventricular septum, the partition between the ventricles.
In the treatment of his patients he developed a very elaborate polypharmacy, which gave rise to the term galenicals, which term is even today sill used to describe medicines of vegetable origin.
Here we must leave this extraordinary man whose influence over medical thought was to last for so many centuries, and skip the interesting periods of Byzantine, Mahomedan and Jewish medicine, past the mediaeval period till we reach the time of the Renaissance, in which medicine underwent a radical revolution of thought, brought about by a number of original thinkers and experimenters, who were not dominated by the authoritative pronouncements of the ancients.
But before entering upon a discussion of Renaissance medicine let us take a look at life in general at this period, for I believe that through the ages even upto the very present time, the trends of medicine have been closely related to those of the period at large. Yet again we have not the time to review life at this period throughout Europe, let alone of the world generally, so let us concentrate on the English scene, i.e., of the time round about the reign of Queen Elizabeth the First, although we shall have to refer now and then to outstanding individuals other than English.
It was in in 1476 that Caxton introduced printing into England, although the Chinese had known how to print for very many years before that. It is not difficult to imagine what a great impetus to the spread of knowledge this art of printing constituted, though, of course, the proportion of the people which was literate in those days was very small indeed.
It was in Elizabeths time that the first Act of Parliament for regulating conditions of labour was passed, because the old Guilds were losing the power they had hitherto enjoyed of determining these factors. Life was very hard for the common folk and there was a great deal of actual destitution owing to the great numbers of unemployed and homeless people in the land. As a result of this, “house of correction”, as they were called, were established, in which these poor vagabonds were imprisoned and made to work. An officer was appointed as overseer of the poor and taxes were collected for poor relief.
So began the poor law and its institutions. But better still, the growth of manufacturing and the rise of English export trade led to more employment and so to a gradual betterment of the peoples condition. This desirable development was very largely due to the enterprise and valour of such men as Martin Frobisher, who sailed to North America, trying to find a way round to the Pacific Ocean, Sir Walter Releigh, who also sailed to North Americ, and Sir Francis Drake, who had circled the world in “The Golden Hind”.
This seeking after a broader life was also evident in the realms of literature, are and science, as shown, e.g., by the lives and works of such men as Sir Francis Bacon, sir Walter Releigh, Edmund Spencer, Shakespeare and William Harvey in England, Rene Descartes, Paracelsus, Vesalius and Leonardo da Vinci, amongst many others on the Continent.
On our way to consider Elizabethian medicine, let us pause for a moment to take notice of a very remarkable physician named Paracelsus, who was born in Einsiedeln near Zurich, Switzerland, in 1493. He was a most extraordinary person and was the founder of chemical pharmacology and therapeutics. He was the most original medical thinker of the 16th century, who tried to bully his hearers into agreeing with him and about whom Robert Browing wrote a very long and interesting poem.
He had a great knowledge of alchemy, astrology and other occult sciences and was an experienced traveller. He was appointed Professor of Medicine and City Physician at Basel in 1527, and inspired by his lifelong reverence for Hippocrates, began his campaign of reform, of medicine by burning in public the works of Galen and lectured out of his own experience in German, instead of the usual Latin. He was the first man to write on miners occupational diseases and to realize the relationship between cretinism and endemic goitre.
He taught that nature and not officious meddling heals wounds.
Now we come to the Elizabethians. First and foremost perhaps we should mention Francis Bacon, who stressed the point in some of his essays that truth was to be found, not by agreement about present or past theories, but by observation and experiment. He is, indeed, regarded as the father of the inductive method of science, and so many be considered to have had considerable influence on the development of experimental medicine, which had its beginnings just about that time.
But before Bacon, Andreas Vesalius, who was born in 1514, by obtaining first – hand knowledge of anatomy by the dissection of human bodies much more throughout than had been done before, disposed of the theoretical anatomy of Galen, although he was a pupil of an ardent and bigoted Galenist, Jacobus Sylvius. After five years of intensive study, he was able to publish in 1543, a magnificent work, Ce Corporis Humani Fabrica Libri Septem, which finally disposed of the Galenic tradition.
This publication brought down upon him much abuse from his old teacher and others, and much underhand persecution. Unfortunately this told upon him to such a degree, that, in a fit of indigestion, he burnt his manuscripts, left Padua, and accepted the post of Court Physician to the Emperor Charles V, and so gave up his anatomical studies. His favourite pupil, however, Gabrielle Fallopius, came to the front as a worthy successor, and rumour then had it that it was Fallopius and not Vesalius, who dragged the Galenic idol.
On receiving, in 1561, Fallopius Anatomical Observations, Vesalius desire to resume his studies was re – awakened. He went first, however, on a pilgrimage to Jerusalem, and on his way back received an invitation to resume his old Chair in Padua, just vacated by the death of Fallopius. Unfortunately Vesalius died before he could take up the invitation.
Great as were these men already mentioned, there was still a great one, in the person of Willam Harvey. Although many anatomist and physiologists before him had recognized that the blood was in motion in the arteries and veins, none of them had realized that the motion was indeed that of a complete circulation through the arteries and veins. The Galenic idea had been that the motion was that of an ebb and flow between the close arterial and venous systems, although he had inferred anastomoses by means of invisible capillaries.
Harvey established his idea by means of experimental vivisection, ligation of vessels and perfusion, and thus arrived at the inductive proof that the heart acts as a muscular pump and that the blood flows in a continuous cycle. This was the starting point of purely mechanical explanations of vital phenomena, which was to have such a very strong influence on the further development of medicine. As was to be expected, such a revolutionary ideas, although proved by experiment, was the subject of much bitter opposition.
Harvey was also one of the first to maintain that the embryo was not merely a minute replica of the adult performed in the ovum, but that the adult is evolved from it by the gradual building up and aggregation of its parts. Owing to the fact that microscopes were not yet in existence, he could not prove this theory, any more than he could prove the capillary anastomosis between the arteries and veins. So much for what might be styled Elizabethan academic medicine.
And what of ordinary medical practice in this era in which so many great men were revolutionizing medical. thought? There is not much evidence that practice was influenced to any great extent by these academic achievements. It was still very much bound up with superstition and dependent to a great extent on the authority of Galen and his followers.
Astrology was much in vogue in those times, and the doctrine of signatures was very much to the fore, by reason of which a drug is indicated by fanciful resemblance to the organ affected, e.g., the trefoil for heart disease, the turmeric or yellow celandine for jaundice, the walnut shell for head injuries because of the somewhat superficial resemblance of the structure of the walnut to the brain with its convolutions.
We must of course remember that in those days, there were no clinical thermometers, no stethoscopes, no X-rays, no pathological laboratories etc., upon all of which the modern doctor so greatly depends.
The physicians had, perforce, to be greater artists than they are to day, and had to depend upon their unaided senses to make their diagnoses. Great store was placed on what was called “casting the urine”, i.e. examining it as to its appearance, odour, etc, and usually any paintings of those times depicting a doctors visit to his patient showed that there was a specimen of urine, either being examined or awaiting such examination.
In order to illustrate rather vividly some of the ideas underlying general medical practice in those days, may I give you a few quotations from Shakespeares works?
Note how the idea of vital spirits residing in the arteries as propounded by the ancients, is evident here:
Why, universal prodding prisons up
The nimble spirits in the arteries,
As motion, long – during action tries
The sinewy vigour of the traveller.
(Loves Labour Lost, IV, 3.)
And the theory of the humours in this:
Take thou this vital being then in bed
And this distilled liquor drink thou of:
When, present through all thy veins shall run
A cold and drowsy humour which shall seize
Each vital spirit. (Romeo and Juliet, IV, 1.)
Or if that surely spirit melancholy,
Had baked thy blood and made it heavy thick:
Which else runs tickling up and down the veins
Making that idiot laughter keep mens eyes
And strain their cheeks to idle merriment
A passion hateful to my purpose.
(King John, III, 3.)
That the different types of ague or malaria were recognized in those times is shown by Dame Quciklys appeal for help for Falstaff in his illness:
As ever you came of women, come in quickly Sir John
Ah, poor heart! He is so shaked of a burning quotidian tertian
That it is most lamentable to behold. Sweet men come to me
(Henry V, 2,1.)
The infectiousness of disease supply these fine metaphors:
It is certain that their wise bearing or ignorant carriage is caught as
Men take diseases one of another: therefore let men take head of their company. (2 Henry IV, 5,1.)
Sickness is catching. Oh, were favour so!
Yours would I catch fair Hernia, ere I go. (A Midsummer-Nights Dream, I,1.)
The crisis, or rather precritical exacerbation of the fever is referred to metaphorically in this passage:
Before the curing of a strong disease
Even in the instant of repair and health
The fit is strongest: evils that take leave
On their departure most of all show evil.
(King John, 3,4.)
That the influence of the mind on the body in those times was recognized, is shown by:
The labour we delight in physics pain
The miserable have no other medicine
But only hope.
(Measure for Measure, 3,1.)
Bid a sick man in sadness make his will
Are words ill urged to one who is so ill.
(Romeo and Juliet, I,1)
Here is in interesting quotation savouring of Homoeopathy:
In poison there is physic: and these news
Having been well, that would have made me sick,
Being sick, have in some measure made me well
(2nd Henry IV,I,1.)
The different effects of the same drug on different people is suggested by
That which hath made them drunk hath made me bold:
What hath quenched them hath given me fire.
That there were different ideas as to medical treatment in
Elizabeths time is well shown by these quotations:
What rhubarb, senna or what purgative drug
Would scour these English hence?
King Henry: Then you perceive, the body of our kingdom
How foul it is: what rank diseases grow
And with what danger near the heart of it.
Warwick: It is but a body, yet distempered:
Which to his former strength may be restored
With good advice and little medicine.
(2nd Henry IV, 3,1.)
Contrast that with this:
Sir, those cold ways
That seem like prudent helps are very poisonous
Where the disease is violent.
Lets purge this choler without letting blood
This we prescribe, though no physician:
Deep malice makes too deep incision
Forget, forgive: conclude and be agreed
Our doctors say this is not month to bleed.
(Richard II, 1,1.)
Here, of course, is a reference to astrology whereby certain operations were considered indicated or not according to the time of year.
Alchemy must be included in the picture of Elizabethan medicine as shown in these few instances: The sun was symbolized by the heart as the principal of life, and by gold as the king of metals, therefore gold was used in the treatment of heart diseases. The brain and the metal silver were symbolized by the moon, hence silver was regarded as a specific for lunatics.. and so on.
Having thus briefly taken a glimpse at 16th century medicine we must now quickly press forward to consider present conditions. Experimental medicine which started so brilliantly during Tudor times has steadily developed through the ages till the present day, when it has become so scientific that it has at times almost lost sight of the sick individual in its concentration of this or that organ, on this or that infecting microbe, this suppression or that suppression of this or that symptom, so that the physician has often ceased to be the friend and counsellor of his patient, and has degenerated almost to the rank of a mere technician, who does the bidding of this or that great chemical firm, which has put the latest drug on the market.
I do not wish to suggest here that honour should not be paid to Sir Alexander Fleming and others who have developed the great anti – biotic fashion in medicine. There is no doubt that such treatment is a great advance on what the dominant school was formerly able to do for its patients in their acute infectious diseases. To my mind, however, except in certain cases, such treatment is only second best, because I believe that homoeopathic treatment should still be the first method of treatment to be considered, although, in such desperate cases as acute meningitis, we may in addition call in the help of the anti – biotic.
The Sulphonamides and anti – biotics, while having their valuable property of inhibiting the growth of pathological organisms in the body, have unfortunately, almost without exception, individual poisoning effects to a greater or less degree to the patient to whom they are administered. In the medical literature these poisonous effect ar euphemistically described as “said effects”, which I think is a pity. Another disadvantage to which the anti – biotics are subject, is that the infecting organisms have a tendency to develop a resistance to the drug, which sets up very disconcerting problems.
Again cortisone and A.C.T.H. have been much lauded to the skies. These too, are dangerous drugs to use and so far as is known act only as suppressors of symptoms and are not curative agents. Therefore in my opinion they should not be given to patients without the patients having first been warned of their possible dangers. And, as for the latest treatments in mental diseases – electric convulsive therapy and leucotomy, which is the cutting of certain tracts in the frontal lobes of the brain – are they really justified?
It is true that in a certain proportion of cases they appear to make the patient more amenable to social conventions and give them the outward appearance of being less troubled in their minds, and in some instances enable them to return to work. But form other effects which leucotomy in particular produces it would seem to me that we are here again dealing with but suppressive effects. Time will tell. In the meantime many unfortunates undergo these, to my mind, doubtfully ethical assaults upon their personalities.
Modern medicine has surely lost touch with any philosophy of medicine, let alone of life. The true physician should never lose that touch as his duty is first, foremost, and all the time to the individual who consults him and who is much more than the mere aggregation of his organs.
No amount of physics, chemistry, anatomy or physiology, whether normal or pathological, can account for our consciousness, our conscience, our appreciation of beauty and all the other attributes of our mind or personality. I know that some may object that these are functions of our brain; but surely the brain is only the organic or physical instrument through which our personality or psyche becomes aware of our environment and can communicate with other people living this present life, much as our wireless receivers are the instruments through which the broadcasting waves can be made available to our consciousness.
Therefore any comprehensive system of medicine must take account of this entity as well as the physical organs of the body: in other words, every medical problem is a psycho – somatic problem, not merely some problems as is suggested by what is regarded by many as the most modern medical thought. Indeed, any adequate system of medicine will not only be a science of medicine, it must be a wisdom of life. It should be based on man in his wholeness: and thus its theory as well as its practice will reflect an adequately comprehensive view of human life, and not merely the restricted outlook of this or that speciality. Its concern will be with persons and not simply with diseases.