INTRODUCTION AND ARRANGEMENT. "Hoc illud est præcipue in cognitione rerum sal- Livii præfatio. THE study of the history of medicine and the medical profession unquestionably offers even to the layman, from certain points of view, many features of interest. In the first place, as an extensive and important branch of the general history of culture, it is indispensable to the historian of civilization, though singularly enough, up to the present time it has not, in this point of view, been duly estimated. It shows itself requisite too for the statesman and jurist, since manifestly they can permanently and properly adjust the estimation and the position of physicians in the state, only by a thorough cognizance of the historical development of their professional relations. It likewise permits the philosopher to see the influence of his science upon medicine, and conversely the influence of medicine upon philosophy-a reciprocal influence which, from the beginning of time down to the present day, has been strongly manifested. Even for the theologian also the study of the history of medicine possesses a scientific value, because it shows that medicine and theology, now it would seem irreconcilably at variance, were in their early periods of development most intimately united, like twin sisters in the womb, whom we are unable for a long period to recognize as distinct beings, and of whom even after birth we cannot say which is the elder, since both were born at the same time. To the naturalist it teaches how the branches of his science, which lift their heads so proudly to-day, were originally mere offshoots of medicine, and have been only recently planted as independent growths upon a soil of their own. Finally it gives to the man of genuine education the best opportunity for judging medical ability and medical activity. An acquaintance with the history of his science is, however, especially indispensable to the practical physician, if he would thoroughly comprehend and penetrate the secrets of his profession. To him, indeed, it is the bright and polar star, since undoubtedly it alone can teach him the principles of a medical practice independent of the currents, the faith and the superstition of the present. Moreover, it offers him as scientific gain, through the knowledge of the past, the measure for a just and well-founded criticism of the doings of his own time, places in his hand the thread by which he unites past conditions and efforts with those of the present, and sets before him the mirror in which he may observe and compare the past and present, in order to draw therefrom well-grounded conclusions for the future. (1) An acquaintance with the views and the knowledge of epochs already submerged in the shoreless ocean of time, frees the mind from the fetters and currents of the day, with its often oppressive restraint, widens the horizon for a glance into the past, and an insight into the present of human activity, deepens the view for a comprehension of the ideas which guided the earlier and the more recent physicians, and gives, on the other hand, to our daily professional labor a higher consecration, by inserting it as a most useful and necessary link in the chain of development of past and future humanity. The significance of the work of the individual, and his true value and true position with regard to all humanity, are first revealed to us clearly in and through history. When, however, we have reviewed the labors of thousands of years, and have seen how in their course our science has been advanced, albeit in unexpectedly tedious ways; when too we have found how little service, on the whole, has been rendered to the main object of medicine-the cure of disease-and above all in internal medicine, which enjoys the most extensive field of activity, we are at first sadly disappointed. For in spite of all therapeutics, the word of the Psalmist preserves its internal truth: "As for man his days are as grass: as a flower of the field so he flourisheth. For the wind passeth over it, and it is gone." But on a closer study of the subject, this knowledge awakens another feeling. For as no other department of the medical sciences is so well adapted to educate the physician in conscious modesty, so on the other hand, none is so fitted to fill his consciousness with just pride in his often contested and self-sacrificing labors. As the history of medicine shows him the inadequacy of medical knowledge and, in the majority of cases, the absolute nullity of medical skill in the struggle with the laws of an all-powerful nature, so it places before his eyes the unwearied struggles of the physicians of all ages-struggles to investigate those laws, and to appropriate to the healing and blessing of suffering humanity the knowledge already acquired, or to be acquired, thereby. Hence we prize infinitely less the fact that history, among almost all people, presents to our eyes the immortal gods as the authors of medical art, than that it teaches us how mortal men have struggled continually after god-like aims-the prevention, the cure, or at east the alleviation lof the woe and suffering imposed as an unavoidable heritage, and in a thousand different forms, upon us created beings-even though to-day, as in the past, these aims have been only imperfectly attained. The history of medicine also teaches us to honor, indeed to admire, humanity, particularly physicians and their past and present struggles, while our daily practice and the daily actions of individuals might perhaps readily lead us to an opposite feeling. It shows us how many a noble man has served medical science, and art, and humanity, devoting his self-denying strength and life to the sick, the feeble, the persecuted, the poor, and the insane, and performing deeds which have not, indeed, dazzled and carried away the multitude by their brilliant results, but have worked on quietly and beneficently through all futurity, leading humanity nearer to the lofty aims of humane thought and action. For the consolation of these men there has often remained only the beautiful saying, that even had their life been glorious, yet it would have been but labor and sorrow. In like manner history brings before us those spirits who have struggled for such noble aims throughout the whole course of the known centuries, both the highly-gifted, victorious and great, who have borne aloft before our eyes the brightness of their immortal names, and those who, less favored by nature, have shone with a more modest light, and must thus be sought for in their homes, only that we may learn to prize and honor their struggles and their perseverance the more freely, because their desires were supported by less eminent natural endowments. History shows us, too, those whose actions have shone with a false and almost unearthly gleam in times of intellectual night. It teaches us how those spirits strove to recognize—and in some small degree did actually recognize the forces acting upon and in man, how they pointed them out, and utilized them, how in the midst of, and in spite of this constant. struggle and search. that saying from the mouth of the most gracious of mankind has proven its eternal truth : Fragmentary are all our knowl edge and our actions, and our gaze ambiguous as in a mirror." Thus change in our views seems to be the only permanent phenomenon, and in no science has the maxim: Much arises which has already perished, and what is now honored is already declining," attained such extended verification as in the very science of medicine. Even so in this same science has been proven the truth of that other saying: As long as man struggles he errs". To err in its struggles after the truth is, however, according to the resigned expression of Lessing, the portion of humanity, and absolute truth is of God alone. This observation, however, ought not to discourage us. On the contrary it should spur us on, that each individual, as a member of the great whole, in the flight of moments, days and years, may add his allotted share, however great or modest it may be, to the completion of the work of thousands of years of pure sense and sincere heart. For a thousand years are, indeed, to humanity as a watch in the night. Thou carriest them away as with a flood"; but on history and in history, great and small work equally in the service of that supreme power, whose laws, to our comprehension inherent and active in matter, are but very partially explored and understood that power to whose purposes, unfathomed, though freely discussed from the origin of the human race, we mortal creatures, living and struggling, dying and vanishing in the twilight of consolatory hopes, are inevitably committed. History-that of medicine included-seems to the mind's eye like an immense wave of past and present action, now strong and rushing, now quietly advancing, with sparkling mountains and valleys deep as night.-a wave whose ebb and flow in the eternity of the past we understand not and can but dimly conjecture. A supreme power, whatever its essence and however named of men, gives to it its direction and individual phases in accordance with a design and purpose to us forever inscrutable. The eternal wave rises up to heaven, it sinks again into the dark depths, bearing mankind ever upon its rolling crest and billowy field. through hundreds and thousands of years, uniting organically with each other the epochs and grades of human development, both past and future. Millions on millions have perished without contributing to the progress of humanity they have no history. Thousands have promoted at least the foundations of future knowledge history records their names, for they labored. But only a few chosen spirits have performed the highest services allotted to man. They summed up the past and discovered new and great truths, the intellectual product of many bygone factors of knowledge; they led humanity onward, and thus form the landmarks of its history. The study of the history of medicine, above that of all other medical branches, should give a more ideal direction to our conception of our calling by showing that its duties and its rewards are not to be found exclusively in our daily labors and scanty pay (as is, alas, too often the popularbelief), and by pointing out the fact that only in struggles and labors directed to the intellectual advancement of humanity-struggles unnoticed even in the present, and probably, too, long in the future-lie the fertile germs of futurity and a scion of improvement for all mankind. To the physician is assigned in the first place the difficult, frequently the impossible, task of preserving the corporeal health, and of restoring it when disturbed or endangered by disease; next, and partly necessarily and consequently, the duty of preserving or restoring the faculties of the mind.. Impotent, however, as it, alas, often is and must remain in opposition. to the irreversible laws of nature-and history teaches most strikingly this impotence-the medical profession when no longer able to supply the technical aid which we think ought to be expected of it, must claim as its right a still higher significance, a duty far above the technical services of its own department-the duty of being in truth and in deed a humane calling. For there can be no doubt that we physicians too are active coworkers in the sublimest task assigned to humanity: "Dass das Gute wirke, wachse, fromme, "That the good may work, increase, profit, MEDICAL SCIENCE ON THE WHOLE, as regards its various phases or epochs of development, may be likened to a large picture, whose atmosphere, tinted by unmeasured distance, displays only a few clearer cloudforms in somewhat definite outlines and masses, while the limited background exhibits in perspective lofty temples, about |