HISTORY AND ETHICS IN MEDICINE 1

"Why, all the Saints and Sages who discuss'd

Of the Two Worlds so wisely, they are thrust

Like foolish prophets forth; their words to scorn
Are scattered, and their Mouths are stopt with Dust."

RULES to govern the practice of medicine began with the priests of Isis, centuries before our era, and the selfish guilds of that time were able to enjoin that healers of the sick must become part of their fold, or must cease to cumber the earth. Priestcraft was a function of government, and arrogated to itself the care of diseased bodies as well as of diseased minds.

In those days there was government supervision of practice in a sense which modern thought abhors. Such control was possible under an absolute monarchy only, in which the ruler was regarded as almost divine; but, when wars and tumults, and foreign invasion and revolution came, the old close medical corporation was broken up, and competition entered in. A class of physicians who were not priests grew up, — a class whom the law ceased to protect. They could no longer persecute and destroy their unlicensed rivals, so they betook themselves to ethics.

Egypt was not the only land which knew such changes. Throughout the ancient and mediæval worlds

'An address at the annual dinner of the New Bedford Medical Society, February 25, 1907.

fluctuations in custom occurred; at times there was a control of practice by statute, — civil or ecclesiastical; at times there was chaos, with such little decency as good ethics might enjoin and enforce.

I think that is an interesting reflection, and it is interesting also to recall that in those countries which have been the most enlightened, which have been most democratic in their customs and mode of thought, in just such countries have superstition and vapid medical tradition and routine languished, while advanced liberal thought has flourished, science has progressed, quackery and falsehood have made the least progress, mild laws have sufficed, and ethics have triumphed. Such were the conditions in the Greece of the fourth century B.C., when the great Hippocrates lived. Hippocrates and his associates were the first to see clearly and to formulate the relations which should exist between physicians, and between physicians and patients; and so to Hippocrates we owe that famous oath, -the bond to which all right thinking doctors have ever since subscribed:

"I swear. . . to follow that system of regimen which I consider for the benefit of my patients; . . I will give no deadly medicine; . . . I will not produce an abortion; with purity I will pass my life and practice my art; I will enter a house for the benefit of the sick only. Whatever I hear and see in the life of men, which ought not to be spoken of abroad, I will not divulge, as reckoning that all such should be kept secret."

There is a feeble and fatuous word, etiquette, by which

the unthinking are wont to cloak the noble qualities of ethics. Alas! that such a Turveydrop semblance should have been given a precedence by feeble minds; that the outward and visible sign should have shouldered aside the inward and spiritual grace.

Ethics signified originally character. It deals philosophically with conditions which affect the human family for good or ill. Etiquette codifies the superficial relations which govern men in the drawing-room or the club. Ethics directs that there shall be honor among gentlemen; etiquette that they shall tread softly and wear evening dress. Hippocrates marked the distinction. That great man struck at the root of the matter, and, like St. Paul himself, gave us rules that shall prove sound through all time.

So one sees, in looking back over the history of our guild, that after the banishing of privilege, and royal and priestly authority with their selfish pompous insistence and their tedious etiquette, there grew up gradually in the minds of thinking men a wiser appreciation of our purposes and a sound system of ethics.

Good ethics, then, is to be looked for among physicians who, following the teaching of Hippocrates and Aristotle, of Celsus and of Galen, maintain that he is the upright scientist who pursues his art by the light of sound reason; who draws his conclusions and guides his practice by deductions founded on accurate observation; who observes that clear inductive method which is older than history. Now, throughout its history, one sees that medicine has never been regarded as an exact science. Hippocrates himself founded his path

ology upon a hypothesis, which developed into that curious myth known to us as the humoral theory; and from his day to our own hypotheses have abounded. The master knot of human life and human fate held firm through the ages. The great mystery of life remained a mystery. Men strove, by theories and systems, to unravel it, and while they sought the unattainable through metaphysical means, they continued blind to the solution of the attainable. While they sought by specious arguments to explain the destiny of the soul, they overlooked the heart's part in the circulation, and the liver's function in producing bile. So schools arose out of little knowledge. The leaders of those schools were honest men, but having dim light and having builded upon the sand largely, their superstructures tottered betimes, and their wisdom became as vapor.

Through it all, though, and with the progress of time, one recognizes the gradual accumulation of facts. Solid surgical knowledge existed among the Egyptians, Jews, and Greeks. Galen perceived something of the nature of the blood current and the function of nerves. The Arabians Albucasis and Avicenna, and the schools of Medieval Italy, gathered up the wisdom of the ages, until, with the revival of learning in the 15th and 16th centuries, there came a rush and an enthusiasm for science such as had been unknown for a millennium.

But among the best even of those young 15th century moderns, certain ancient prejudices survived. Though Vesalius placed anatomy again upon a sound basis, and made possible a sane physiology, he despised

Paracelsus as a vain fool, and fell out with his own successor. The researches of Borelli and Malpighi and Harvey advanced our knowledge of digestion and of the structure of organs and of the course of the blood, but their very researches led those great souls to a contempt for chemistry and a vociferous decrying of those mysterious reactions whose principles the early chemists themselves ascribed to unexplained and supernatural forces. So there were materialists on the one side and mystics on the other; while out of the two types of mind there grew up two great schools of medicine which divided scientists for generations, the iatro-physicists and the iatro-chemists.

Such dissensions among the wise conduced little to the winning for physicians of popular confidence and respect; and the literature of generations abounds in sneers at the doctors and flings at their pretensions. Hudibras and Don Quixote set the pace, and those immortal works of Butler and Cervantes for centuries imposed a standard of scorn from which the writings of our own day are not exempt.

Such lack of comprehension and sympathy appear constantly throughout the medical history of the sixteenth, seventeenth, and eighteenth centuries. Scientists had no common meeting ground or point of departure. They attacked from the circumference the great central problem of pathology; and while they worked laboriously and unwittingly towards a common center they bemired each other with bad language, and looked upon their rivals as knaves. Such were the scientists, -the few and lonely pioneers. But the great mass