As a medical student, there is a very natural inclination to regard Medicine as a rather static subject — the facts are pre- sented as they stand at present and the ten- dency is to assume that Medicine is a modern science with an immovable concrete founda- tion. It is only when one examines the subject historically that it can be seen how changeable it all is, and yet certain features never seem to alter.
One of the more remarkable aspects has been the opposition to medical progress which was a feature for so many centuries.
This was partly due to religious domination of thought, and for about a thousand years most of the progress made was in spite of this domination.
This religious preponderance was due partly to the fact that the Church was the repository of much of the contemporary learning, partly to the desire of the Church to stifle independent thought, and partly due to the concept that disease was inflicted on man because of his sin. Cure of disease in many cases lay in the hands of the Church, and indeed some healing is still attempted by various denominations to this day.
An example which we might quote is that of hysteria which was supposed to be due to the wandering of the womb about the body. The following is part of an invoca- tion which was used to try and counteract this: "To the pain in the womb. In the name of God the Father, God the Son, and God the Holy Spirit. Amen Amen Amen.
O womb womb womb, cylindrical womb, red womb, white womb, fleshy womb, bleed- ing womb, large womb, neufredig womb, bloated womb, 0 demoniacal one . . . stop the womb of thy maiden and heal its afflic- tions for it is moving violently. I conjure thee 0 womb, in the name of the Holy Trinity to come back to the place from which thou shouldest neither move nor turn away . . . to return without anger to the place where the Lord has put thee originally.
I conjure thee 0 womb by the nine choirs
of angels and by all the virtues of heaven to return to thy place with every possible gentleness and calm . . . " and so on.
Much religious opposition was directed against major medical advances even as late as the introduction of anaesthesia for child- birth last century. Slightly earlier smallpox vaccination had been violently opposed by some who said it was not only opposed to the will of God to perform such unnatural acts, but also quoted evidence such as this:
"a lady who complained that since her daughter was inoculated she coughs like a cow and has grown hair all over her body."
When Simpson tried to introduce chloro- form for childbirth he met with intense op- position: "chloroform is a decoy of Satan, apparently offering itself to bless women;
but in the end it will harden society and rob God of the deep, earnest cries which arise in time of trouble for help." Even the Lancet in May, 1853, said: "In no case could it be justifiable to administer chloroform in a perfectly ordinary labour." (This was a month after Queen Victoria had chloroform for her seventh child). Ultimately however the use of this anaesthetic became standard practice and when Simpson was knighted, Sir Walter Scott wrote to him and suggested his coat of arms should portray "a wee naked bairn" with the motto beneath "Does your mother know you're out?"
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Through all the centuries of progress how- ever, there are some ideas and techniques which have changed practically not at all.
Some of such procedures which are still widely used are of very ancient and wide- spread use. Of these one of the most funda- mental is the enema.
The enema is used today not only by civilised medicine, but by many of the primi- tive races such as those of Africa. We also know they have been given for at least twenty-four centuries — Herodotus in the fifth century B.C. wrote "The manner of life of the Egyptians is this. They purge them-
selves every month three days successively, seeking to preserve health by emetics and clysters for they suppose that all diseases to which men are subject proceed from the
•food they use." Pliny incidentally wrote that that wily bird, the Ibis "makes use of the curve of its beak to purge itself through the part by which it is most conducive to health for the heavy residue of foodstuffs to be excreted."
Desfosses et Martinet Enema Apparatus (18th Cent.)
Through the Middle Ages many fantastic machines were invented to introduce equally fantastic enemata. Tobacco smoke was all the vogue at one time and was supposed to be very good for reducing incarcerated her- nias. Some of the machines made are very interesting — one of the most comfortable must have been a small table with a little nozzle sticking up from the end on which you sat, and an enormous plunger larger than a car tyre pump at the other. One picture which has been preserved for pos- terity shows the master and mistress of a
household each seated astride one of these contraptions, each with a servant standing by (presumably for moral support), all bearing pleasant smiles. They are looking towards one another and each is about to plunge — almost in the manner of a con- test. All good clean fun, no doubt.
The poorer classes of course had to forego such luxuries as these, and among them the most popular purge was a small round blob of antimony known as a "perpetual pill."
It derived this name from the fact that after being swallowed it irritated the. intestinal mucosa in a manner sufficient to bring about the desired result. It was afterwards recov- ered and could then be used to similar ad- vantage by the next member of the family.
Of these pills one could literally say that they passed through one generation after the other.
Once a procedure such as the enema or some particular drug becomes firmly en- trenched in the structure of medicine and/or popular belief, it is unfortunately very diffi- cult at times to get rid of it. While the enema still has its uses, purging is abused far more often than used by the public at large, and this is unfortunately encouraged by patent medicine manufacturers and others.
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In the field of drugs, there are still a great many listed in current materia medica books which might well be dispensed with. How- ever we must not despair of some of the useless substances listed in profusion therein
— the carminatives, counter-irritants, and so on. These along with extract of witch hazel will presumably ultimately go the way so many of their predecessors have gone.
After all we no longer prescribe excreta (either human or animal) in various exotic forms (mainly repulsive), nor crabs eyes, nor live spiders rolled in butter (which were once included in the official Pharmacopeia of the College of Physicians). Nor do we still use menstrual blood, powdered mummy or eunuch's fat which all had their vogue as did usnea. Usnea. was moss — but not of course ordinary moss — it had to be moss scraped from the skull of a criminal who had been hung in chains. This substance I might add was an official drug in the phar- macopeia until the nineteenth century, and the first edition of the Encyclopaedia Britan-
SPECULUM 49 nica devoted a section to its curative pro-
perties.
It is well to remember such things today, as we often hear of the "miracles of modern medicine", and it would be interesting to see in a century's time just which of our present concepts were no longer held in very high esteem. We are not very far re- moved — speaking from the point of view of people rather than time from what we now regard as the shocking conditions of
Cupping for Sciatica. Note the flame in the cup
on the floor.
"bygone days". After all it is quite con- ceivable that the teachers of some of our present clinicians might well have been stu- dents in the pre-Listerian era.
As examples we will quote from the works of Sir Arthur Keith and Sir Frederick Treves. The former was able to write that in 1888 he saw dry cupping performed by a general practitioner for a violent attack of lumbago which was completely relieved by it: "This operation of dry cupping which
I had just seen applied with success . . . Whatever the foundation might be it gave relief when applied to my friend."
Cupping was a very ancient art dating back at least to the time of Hippocrates. It was performed by applying a cup to the skin after the air within it had been re- moved by heat or suction. Many and varied were the diseases which it was supposed to cure — a typical list might be taken from the works of Avicenna. He advised cupping as follows: to the nape of the neck for heavi- ness of the eyelids, itch of the eyes, foetor of the mouth, tremor of the head and lesions of teeth, eyes, ears, nose, throat and face;
under the chin for sore throat, toothache, and loss of countenance; between the shoulder-blades for pain in the throat or upper arms, and to relax the cardiac orifice of the stomach; over the loins for scabies, gout, pustules, piles, inflammatory masses in the upper part of the thigh, and for blad- der, kidney and uterine lesions; to the front of the thigh for orchitis, hernia and leg ulcers; over the malleoli for retained menses, sciatica and gout; and over the buttocks near the anus to draw humours from the whole body and head (presumably as a sort of insurance against having missed something), to benefit the intestines, cure decomposition of the menses and thereby alleviate the whole body.
On a par with cupping was the use of leeches — even today a current textbook recommends their use for relief of pleuritic pain. However their use has considerably decreased over the past hundred years — when, for instance, over twenty-seven mil- lion leeches per year were imported into France. Both cupping and leeching sur- vived into this century and were accorded an active place in some textbooks early in the century.
Hospitals too, in the middle of last cen- tury, were exceedingly primitive by today's standards. But even they had improved on their earlier counterparts of which this is part of a description : "On the same couch, body against body, a woman groaned in the pangs of labour, a nursing infant writhed in convulsions, a typhus patient burned in the delerium of fever, a consumptive coughed his hollow cough, and a victim of some "disease of the skin tore with furious nails his infernally itching integument . . . The whole building fairly swarmed with the most horrible vermin . . . The bodies of
the dead ordinarily lay twenty-four hours, and often longer, upon the death-bed be- fore they were removed, and the sick during this time were compelled to share the bed with the rigid corpse, which in this infernal atmosphere soon began to stink, and over which the green carrion-flies swarmed . . . "
While Medicine had progressed far be- yond this level by the end of last century, it may surprise some to read what Sir Fred- erick Treves wrote in 1923 of his student days: "In this theatre was a stove which was always kept alight, winter and summer, night and day. The object was to have a fire at all times ready whereat to heat the irons used for the arrest of bleeding as had been the practice since the days of Eliza- beth . . . Practically all major wounds sup- purated . . . The surgeon operated in a slaughter - house - suggesting frock coat of black cloth. It was stiff with the blood and filth of years . . . Owing to the suppurating wounds the stench in the ward was of a kind not easily forgotten . . . There was one sponge to a ward. With this putrid article and a basin of once-clear water all the wounds in the ward were washed in turn twice a day. By this ritual any chance that a patient had of recovery was eliminated.
I remember a whole ward being decimated by hospital gangrene."
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One aspect of Medicine that is more un- changeable than most; is the gamesmanship of the medical practitioner — as illustrated by the following written in 1140. "When called to a patient . . . on the way learn as much as possible from the messenger, so that if you discover nothing from the patient's pulse or water, you may still as- tonish him and gain his confidence by your knowledge of the case . . . Do not be in a hurry to give an opinion, for the friends will be more grateful for your judgment if they have to wait for it. Tell the patient you will cure him, with God's help, but in- form his friends that the case is a most serious one."
A slightly later author wrote: "When you go to a patient always try and do something new every day, lest they say you are good at nothing but books. If you unfortunately visit a patient and find him dead, and they ask you why you are come, say you knew he would die that night, but want to know
at what hour he died." This same author suggested that if the patient didn't seem to want to pay his account, then "contrive that he shall take alum instead of salt with his meat; this will not fail to make him come out all over spots"!
Possibly the most important progress in Medicine now being made is due to the changed outlook. No longer is every new innovation met with opposition from the public — indeed these days it is very fashion- able to have the "latest American drug and,' or operation". When new diseases make their appearance, or old ones surge forth with a newly acquired virulence, it is not greeted as was the appearance of syphilis in the late fifteenth century. Instead of accusations and fantastic theories as to nature and origin as was the case in this instance, today there is a more dispassionate scientific approach.
Syphilis was apparently introduced to Europe by the sailors under Columbus who brought the disease back with them from the New World. A century and a half later
— in 1646 — it returned to America where it has since apparently fostered, again via a seaman. This sailor infected his wife who developed a sore on her breast.
"Whereupon (I quote from a contemporary diarist) divers neighbours resorted to her;
some of them drew her breast and others let her children suck them .(no such disease be- ing suspected by any), by occasion whereof about sixteen persons, men, women and children were infected."
When this new disease appeared in Europe, it spread with startling rapidity. Each coun- try blamed some-one else for it — the Spanish called it the disease of Espanola, the French called it the Italian disease, the Russians named it the Polish disease, the Italians, English and Turks called it the French disease, while the Indians and Jap- anese blamed it on the Portuguese.
Speculations as to its cause were wild and varied. The conjunction of Saturn and Mars and the rainy weather in Italy were both blamed for it. Astrologers, observing that the bodily parts affected were under the influence of Venus called it lues venerea or venereal infection. St. Job — because of his skin affliction — became its patron saint.
The disease was also attributed to the wear- ing of linen shirts which were then replac- ing wool and leather. The most fanciful theory—in the words of Paracelsus—was:
"The French disease derives its Origin from
SPECULUM 51 the Coition of a leprous Frenchman with an
impudent whore, who had venereal Bubas, and after that infected everyone that lay with her; and thus from the Leprosy and venereal Bubas, the French Disease arising, infected the whole world with its contagion, in the same manner as from the Coition of a Horse and Ass the race of Mules is produced."
One of Louis XIV's physicians dismissed another theory with these words — "if the Venereal Disease could be produced by in- visible living things swimming in the Blood, one might with equal Reason allege the same Thing, not only of the Plague . . . but also in small pox . . . and other con- tagious Diseases . . . than which nothing can be more absurd."
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During all these centuries of change, pos- sibly the most unchangeable thing has been the Medical Student himself. Dickens thought of them as "a parcel of lazy, idle fellars, that are always smoking and drink- ing and lounging . . . a parcel of young cutters and carvers of live peoples' bodies, that disgraces the lodgings."
There is more than a modicum of truth in this, though I cannot feel that the Ameri- can who wrote the following at the turn of the century was not guilty of a certain degree of exaggeration: "I will tell the story of a dissecting-room where the first touch of the lancet made the supposed corpse rise from her long trance; and as the sight burst upon her of those butchering students with their garments stained with blood, standing round her, all aghast with fear, holding their knives in their hands, she realised the horrible fact that she had been carried there for dis- section, and she instantly died from the shock and from the wounds inflicted by their knives . . . The very best men in the pro- fession will tell you that nineteen-twentieths of the dissections are unnecessary. But they please the devils who are preparing the doc- tors, and accustom the youths to the atmos- phere of profanity as they hear the filthy and unclean remarks which are made as they stand over the dead bodies and handle the sacred secrecies of humanity and laugh with diabolical glee over the consequences of a poor woman's fall or a degraded youth's syphilitic body. I tell you this, that pollu- tion, damnation, and hell are holding high carnival there, and a young man who es-
capes from that without life-long injury is only one in a large number."
In some respects Students have perhaps changed: they are a little less rowdy. At least the Faculty here has not yet had to issue a reminder to Students of the nature of that issued by the Paris University in the late sixteenth century. This was to the effect that it was explicitly forbidden to throw stones or dung during lectures, further it was not proper to billing sweethearts into lec- ture rooms or to have intercourse in public.
In other matters there has been little if any change over a period of many centuries.
How many present-day patients might reiter- ate this complaint uttered by a Roman about two thousand years ago—
"I'm ill . . . I send for Symmachus, he's here, A hundred students following in the rear.
All paw my chest with hands as cold as snow, I had no fever but I have it now."