BOOKS.

THE EVOLUTION OF MEDICINE.• Tuts volume of lectures by one whom Dr. Fielding H. Garrison correctly describes in a short but excellent preface as " the most lovable of all modem physicians," constitutes the tenth of a series of memorial lectures of the Mrs. Hepsa Ely Silliman Foundation, " an annual course of lectures designed to illustrate the presence and providence, the wisdom and goodness, of God as manifested in the natural and moral world." The same intention is seen in the Gifford Lectures, but whereas in these the lecturer is asked to explain how his views of science conform to his idea of a Creator, the founder of the Silliman Lectures " believed that any orderly presenta- tion of the facts of nature and history contributed to the end" in view ; such a presentation could not fail to strengthen or awaken 8 belief in a Creator. Although many excellent books on the history of medicine have recently been written by English and American authors, as reference to the columns of the Spectator will show, yet these have dealt either with particular branches of medicine or with limited periods, and there has been no volume of moderate size, such as this, in which an attempt has been made to trace the evolution of medicine from the earliest times to the present day. For so difficult a task probably no English-speaking physician was more fitted than Osler.

Osier had long been interested in the history of medicine, and it was largely due to his efforts that the section of history was developed at the Royal Society of Medicine ; if our memory serves us right, he was the section's first president. But the very extent of his knowledge of the subject must have increased the difficulties of the task of condensation, which he overcame with much success. " I propose," says the author in his introduction to the lectures, " 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." It is no vain task, this study of the history of medicine. Does not Mr. Belloc in The Old Road say truly that history gives depth to knowledge, which other- wise is but a film ? Unless by historical research we give body to knowledge, it may be doubted whether knowledge can progress satisfactorily. As to medicine, Hippocrates, the father of medicine, expresses the right view in a passage quoted in this book :-

" But on that account, I say, we ought not to reject the ancient Art, as if it were not and had not been properly founded, because it did not attain accuracy in all things, but rather, since it is capable of reaching to the greatest exactitude by reasoning, to receive it and admire its discoveries, made from a state of great ignorance, and as having been well and properly made, and not from chance."

It is a pleasing thought that " medicine arose out of the primal sympathy of man with man " ; but though this is surely true, if, as the anthropologists claim, both religion and medicine took origin in magic, the dawn of medicine must have caused many a sufferer to regret the existence of such sympathy, so unpleasant were and still are the methods adopted by magicians to cure disease. One of the most curious of these practices, of which evidence is found in neolithic skulls, is that of trephining. The operation, which the author suggests was to give a ready means of exit to demons, was done for epilepsy, infantile convulsions, headache and various cerebral diseases. However faulty may have been the prevalent ideas as to cause, the operation no doubt was sufficiently often followed by an improvement in the patient's condition to justify the faith of the magician in his views, and no doubt he was not a whit behind his modern successor, the surgeon, in explaining away occasional failures. An illus- tration is given of a skull showing no less than five trephine holes, two of them far advanced in the process of healing. We are told that trephining is still practised by the Kabyles ; the son of a family of trephiners informed Lucas Champion.. nitre that he " had undergone the operation four times, his father twelve times, and he did not consider it a dangerous operation." It is indeed strange how many of the practices of the magicians, even those with a less satisfactory practical

• The Evolution of Medicine. By Sir William Osier, Bart., H.D., F.H.B. Now Haven : Yale University Press ; and London : H. Milford. Mo. net.]

basis than trephining, survive among the less developed races of the modern world. Take, for instance, the use of amulets.

Mrs. Rosita Forbes tells us that, when she gave pills to the Arabs of the desert, they were most grateful for them, but they did not swallow them, threading them on string and wearing them as amulets.

The dawn of medicine as we know it now took place in Egypt some 6,000 years ago, and was in the hands of priests and magicians. Incantations, prayers and amulets held the first place in treatment ; medicines were secondary, being regarded only as palliatives, but we are told that " the Egyptians employed emetics, purgatives, enemata, diuretics, diaphoretics and even bleeding." In later times Herodotus calls attention to the development of specialism : " One treats only the diseases of the eye, another of the head, the teeth, the abdomen, or the internal organs." It is curious to learn that the 4; figuring at the top of prescriptions is a modifica- tion of the Horns eye, the Egyptian symbol of sacrifice, the youthful Horns having lost an eye in a battle with Set. Now

that high blood pressure is so much spoken about, the fact that arterio-sclerosis, or hardening of the arteries, was a common disease 3,500 years ago will surprise the reader. Four thousand years ago, in the neighbouring Babylonia,

where science was more advanced than in Egypt, the medical profession was in a highly organized state, as is evidenced by the Hammurabi code of laws, civil and religious, written on a block of stone eight feet high. One cannot say whether the first paragraph quoted would satisfy the critics of Harley Street, who have been fulminating against con- sultants' fees, but the second ought at least to prove acceptable to them. They run as follows :--

" If a doctor has treated a gentleman for a severe wound with a bronze lancet and has cured the man, or has opened an abscess of the eye for a gentleman with the bronze lancet and has cured the eye of the gentleman, he shall take ten shekels of silver. If the doctor has treated a gentleman for a severe wound with a lancet of bronze and has caused the gentleman to die, or has opened an abscess of the eye for a gentleman and has caused the loss of the gentleman's eye, one shall cut off his hands."

Seeing that a shekel is said to have been worth half-a-crown, even allowing for the difference in the value of money then and now, the reward of success does not appear to have been excessive, while the punishment for failure erred not at all on the side of leniency. Interesting as are these evidences of

medical progress among the Egyptians and Babylonians, the laying of the foundations of medicine, on which has been built up the imposing fabric of the present day, took place in Greece. This has been learnedly demonstrated by Sir Clifford Allbutt in his Fitzpatrick Lectures on Greek Medicine in Rome ; but Oakes comparatively short account of the subject will appeal to the reader as a masterpiece of condensation, to

which additional charm is added- by most excellent illustra- tions. In Greek medicine are to be found the beginnings of many practices in vogue at the present time. Even auto- suggestion, or hetero-suggestion, seems to have been practised in the temples of Askkpios ; the incubation sleep, in which dreams were suggested to the patients and indications of cure were by their means divinely sent, forming an important part of the ritual. That we have not yet escaped from the humeral pathology of Hippocrates.is witnessed by the common descrip- tion of biliousness as " too much bile," or " he has a touch of the liver." To some forms of treatment assiduously developed by the Greek, such as attention to diet, exercise, massage and bathing, it would indeed be well if the modem physician paid more attention. Sir Clifford Allbutt has shown that medicine in Rome was in its essentials Greek medicine, but much lustre was shed upon it by Galen, who was born at Pergamos. Much, however, as science owes to Galen, the reverence in which he was held while living, as well as long after his death, was such that authority took the place of observation and investigation and seriously retarded the progress of medicine until the Renaissance. In Rome it was the custom for the physicians to be accompanied on their rounds by numbers of students, and in this connexion Martial's epigram (V. ix.) is quoted

Languebam : sed to comitatus protinus ad me Venisti centum, Symmache, discipulis

Centum me tetigere manes Aquilone gelata

Non habui febrem, Symmache, nuno habeo."

The last lines remind the present writer of the patient who

- under similar circumstances exclaimed, " Gam, wanting to warm yer 'ands on me."

The remaining pages are as interesting as those from which quotations have been made, but deal with a better known period of medical progress, extending to quite recent years. The editors are to be congratulated on the way in which they have carried out the difficult task entrusted to them, namely, the revising of his lectures after Sir William Osler's death, for, although the lectures were delivered in 1913, the War interrupted the author's revision of the proofs submitted to him ; and, as the editors tell us, " after the death of his son, mortally wounded in action in the Ypres Salient, he gradually lost heart for many things he had set his mind and hand to do."