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.

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 aëroplane 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 passion-for such it is-gradually sof

tened the hard race of man-tum genus humanum primum mollescere cœpit. 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 suggestive-the 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-Championnière has covered the subject in a monograph. Broca suggests that the trephining was done by scratching or scraping, but, as Lucas-Championnière 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.

The practice is still extant. Lucas-Championnière 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 opera2 Lucas-Championnière: Trépanation néolithique, Paris, 1912.

tion 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 bestknown names of this earliest period is that of a physician-guide, philosopher and friend of the king-a 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 Esculapius.' 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 medicinæ primus inventor, as he has been called, may be gathered from Kurt Sethe's study. 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 Philæ. 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 literature. The association of Imhotep with the famous temple at Edfu is of special interest.

993

Egypt became a centre from which civilization spread to the other

3 Breasted: A History of the Ancient Egyptians, Scribner, New York, 1908, p. 104.

4 K. Sethe: Imhotep, der Asklepios der Aegypter, Leipzig, 1902 (Untersuchungen, etc., ed. Sethe, Vol. II, No. 4).