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PHYSICIANS WHO ATTAINED DISTINCTION IN SOME OF THE DEPARTMENTS OF MEDICINE DURING THE FIRST HALF OF THE EIGHTEENTH CENTURY

In looking over the list of medical men who attained distinction during the first half of the eighteenth century, one can scarcely fail to note two important facts, viz., that they hailed from widely separated localities in Western Europe,—for example, from England, Holland, Northern Germany, France, Austria, Switzerland and Italy,—and also that the advances which they effected in medical knowledge were not confined to one or two departments of this science but included very nearly all the fundamental branches. Hence it could not rightly be claimed by a citizen of any one of these countries that his own nation was entitled to be considered the leader in this advance. It would be a waste of time, and would require more space than can be spared for such a purpose, to furnish here even an incomplete list of the anatomists, biologists, chemists, pharmacologists, diagnosticians, therapeutists and surgeons who during the period named took a very active part in the work. Probably Boerhaave of the University of Leyden, Holland, of whose career I have given some account in the preceding volume, deserves to be reckoned one of the first physicians who exerted a strong stimulating influence upon the movement as a whole. From a superficial examination of his writings the modern physician finds it difficult to understand why Boerhaave attained so great a degree of popularity as he indisputably did,—a popularity, too, which was of the best sort; for during the period of his professorship both students and practicing physicians flocked to Leyden from all parts of Europe, and they never tired of speaking about the great benefit which they derived from Boerhaave’s teaching. Many of them attributed this popularity more especially to his practice—which at that time was a novelty—of laying great stress upon bedside teaching and upon the importance of studying disease from direct observation of its manifestations in the living subject. Then, in addition, there is evidence that, as a teacher, Boerhaave undoubtedly possessed the gift of exerting a personal charm upon his auditors.^[3]

Not a few of those who were privileged to receive instruction from this celebrated physician became themselves distinguished afterward as teachers or authors, and thus Boerhaave’s method of teaching was perpetuated. Among the physicians to whom reference has just been made were such men as Albrecht von Haller, of Berne, Switzerland, Van Swieten, of Vienna, and Hoffmann, of Halle, Prussian Saxony, many of whom are well known to-day in a general way to students of the history of medicine, but who, nevertheless, in at least a few instances, are worthy of having their careers described in further detail. In the following pages I propose to supply biographical sketches of these men and to show in what respects they exerted a beneficial influence upon the great body of their confrères, and also to what extent they made contributions to the science of medicine in its various branches.

It will undoubtedly surprise some of my readers, as it did me, to learn that during the comparatively barren period of the eighteenth century, to which brief reference has been made on a previous page, there were in Northern and Central Germany several anatomists and biologists who did creditable work as original investigators in these departments of medicine. Of this small number, however, I shall mention here only one—Reil. While he spent the greater part of his life in Germany, he was in reality a native of Holland.

Johann Christian Reil was born at Rhaude, East Friesland, in 1759. His father, who was the pastor of the village church, gave his son an excellent preliminary training, which enabled him, at the age of ten, to enter the high school (Gymnasium) in the neighboring town of Norden. On attaining his twentieth year, Johann entered the University of Goettingen, but he remained there only a short time, as he had become convinced that the Halle University offered greater facilities for those who intended, as did Reil, to follow a medical career. Three years later, armed with the degree of Doctor of Medicine, he began the practice of his profession at Norden. In the course of five years he managed to build up such a reputation as a successful practitioner that the University of Halle invited him to occupy the position of Professor Extraordinary of Clinical Medicine. Then, after the lapse of only a short year from the time of his acceptance of this invitation, he was promoted to the full professorship. Almost simultaneously he was appointed (1789) to the position of City Physician of Halle. It was probably while serving in the latter capacity that he began to reveal to the Government that he was not only an excellent physician but also possessed, at the same time, unusual executive ability.

Between the years 1789 and 1806, at which latter date the German army met with a disastrous defeat at the hands of the French (battle of Jena), the almost constant warfare brought all official university work to a stop. But Reil was not idle during this long period, for it was at this time that he devoted himself chiefly to laboratory research work with reference to the anatomy and physiology of the brain and nerves. The products of this work are recorded in the Archives of Physiology which Reil published in 1796 in association with Autenrieth, and they are pronounced by Sudhoff to be masterly. One of the cerebral structures which Reil was the first to describe is that known to all anatomists as “the island of Reil.”

Another important series of studies which were made by Reil were published by him under the title: “On the Diagnosis and Treatment of Fevers” (Halle and Berlin, 1799–1816; 3d edition, 1820–1828).

Finally, mention should be made of a memoir on “Vital Force” which Reil published in the first volume of his Archives, in July, 1795; an essay which—according to Sudhoff—should be read with very close attention, for it, more than all his other published writings, has carried Reil’s name (and will continue so to carry it in the future) triumphantly through the history of the science of biology. The author states his final conclusion as to the nature of vital force in the following words: “Every part of an organism accomplishes its work through its own inherent power, and the latter is a characteristic phenomenon that is dependent upon the manner in which the material of which it is composed is mixed and also upon the form that it takes.” Dezeimeris gives a slightly different rendering of this passage, viz., “It is absurd to search for the source of life (vital force) elsewhere than in the tissues themselves, and in them the vital phenomena vary partly according to the manner in which their elements are mixed and partly according to the form in which they are arranged.” Farther on in this volume, as I shall show, Claude Bernard, the distinguished French biologist, furnishes a third definition of “vital force.”

When the terrible fighting that occurred at the battle of Leipzig in 1813 necessitated the rapid construction and organization of hospitals large enough to accommodate the many thousands of sick and wounded^[4] that had accumulated after this battle, the King of Prussia promptly assigned to Reil the entire management of this important business; and the result proved that he had entrusted this work to the right man.

Reil’s death from typhus fever occurred at Halle on November 12, 1813.

Sudhoff thus sums up the most striking traits of this distinguished physician’s character: “He was never satisfied with half-way measures, and bold schemes and great undertakings occupied his thoughts at all times. At the bedside he gave himself up unreservedly to the interests of the patient.”

Samuel Hahnemann was born at Meissen, Saxony, in 1755. Although his parents were poor he managed to obtain a good education, not only in the fundamentals usually taught at the schools, but also in the knowledge of the various languages, such as Latin, Hebrew, Arabic, Spanish, English, French and Italian. In his medical training he advanced so rapidly that already at the comparatively early age of thirty-five he was recognized as one of the leading physicians of Germany. Even Hufeland, who at this period (about 1790) was the highest medical authority in the nation, accorded him full confidence both as a man and as a chemist; and yet at the same time there is no evidence to show that he frankly adopted his teachings with regard to the new doctrine of homoeopathy.

Hahnemann’s first experiments in relation to the action of drugs—says Wheeler, the most recent translator of the “Organon”—were made upon cinchona bark, which at that period was universally admitted to possess remarkable power in relieving and curing “ague,” as the usual form of malarial disease was then termed. “Hahnemann’s experiment”—he goes on to say—“consisted in taking a large dose of cinchona bark while he was in good health and noting its effects upon his healthy body. To his surprise he found reproduced upon himself all the chief phenomena (and even many of the minor symptoms) of a paroxysm of ague. When the attack passed off, a second dose produced a second paroxysm, and Hahnemann was presently face to face with the fact that this drug, which so often cured ague, was capable of reproducing in his own healthy body the phenomena of ague. Like, in fact, cured like.... As soon as the cinchona experiment suggested to Hahnemann the possibility that the principle of like to like (similia similibus) might prove a general law of healing, he began a systematic study of the records of medicine in the search for instances.... Over and over again he found that a drug prescribed empirically had proved itself capable of curing conditions similar to those which it could produce. The records of medicine, in fact, gave plenty of encouragement to his now dawning belief that similia similibus is a genuine Law of Cure.”

It is at this point, as it seems to me, that Hahnemann displays the first and most important defect in his reasoning machinery. He allowed what seemed to him to be a most important and highly beneficent therapeutic truth immediately to take possession of his whole being,—indeed, to take such complete possession that, from this moment forward, throughout the remainder of his life, he was utterly unable to weigh with a calm and unprejudiced mind the various facts and considerations which ultimately relegated homoeopathy to its proper place in the medico-historical museum, alongside those hoary relics of methodism, incantations, the weaving of charms, Stahlism, Brunonianism, etc. In short, he lacked those immensely important mental characteristics which enabled Harvey to discover the more important facts relating to the circulation of the blood, and which made it possible for Jenner to place in the hands of his fellow men an effective weapon of defense against the deadly ravages of small-pox. If asked to say what are these characteristics, I would reply: A state of mind so open and so unprejudiced that it can weigh with absolute fairness all the evidence laid before it, and an imagination so clever and so fertile in resources that it is able to invent the means of reproducing at will all those phenomena which it is desirable to study more closely. These, I believe, are the characteristics which Hahnemann lacked and which are absolutely necessary for the creation of a permanently useful creed and principles of therapeutics.

In Hahnemann’s “Organon,” he provides quite a long series of aphorisms in which the new doctrine is somewhat fully developed. I have transcribed, below, a few of these in order that my readers may be able to learn at first hand just what their author had in mind when he wrote them.^[5]

Aphorism 5.—It may be granted that every disease must depend upon an alteration in the inner working of the human organism. This disease can only be mentally conceived through its outward signs and all that these signs reveal; in no way whatever can the disease itself be recognized.

Aphorism 6.—... A thing or a condition demands a first proximate cause only in order to come into existence; where the thing or condition actually exists it requires no further originating, no first and proximate cause, for its continued existence. Thus a disease, once established, endures independently of its proximate, exciting, primal cause: endures without further need of its cause: endures even if its cause no longer exists. How, then, can the removal of the cause be held to be the principal condition of the cure of the disease?

Aphorism 8.—The unprejudiced observer ... is unable, however acute he may be, to take note of anything, in any single case of disease, except the changes in the condition of the body and soul which are perceptible by the senses, the so-called disease phenomena, symptoms in fact; in other words, he can note only such fallings away from a former state of health as are recognizable by the patient himself, the friends in attendance, and the physician. All these perceptible signs make up together the picture of the disease.

Aphorism 9.—... And thus this symptom-complex ... is the only means whereby it is possible to discover a remedy for it (the disease), the only means which can indicate the most appropriate agent of cure.

Aphorism 13.—Now since, when cure is effected through the removal of the whole range of the perceptible signs and symptoms, the inward change which caused the symptoms is also removed (that is, the totality of the disease), it follows that the physician has only to clear away the entire symptom-complex in order also to get rid of the inward alteration—in other words, to remove the whole disease, the disease itself, a feat which must always be the only aim of the rational healer; for the essence of the art of medicine consists in compassing the restoration of health, not in searching for the change in the inward and hidden things; a quest which can tend to nothing but fruitless speculation.

And then follows, in the form of an “Author’s Note,” the subjoined commentary by Hahnemann:—

It is only through a misuse of the desire to reach the eternal, sown in the spirit of man for nobler purposes, that these impudent attempts have been made upon the realm of the impossible, those speculative broodings over the essential nature of the medicinal powers of drugs, over vitality, over the invisible working of the organism in health and over the changes of this hidden inner working which constitute disease—in other words, over the inner nature and essence of illness.... When the physician maintains that research into such things is necessary, then he shows a misconception of the capacities of men and a misunderstanding of the requisites for the work of healing.

... If only it had served the practice of medicine in the slightest degree,—if all this subtile investigation had revealed the true remedy for the least of diseases, it might yet pass for desirable!

Aphorism 31.—The great homeopathic law of cure rests on this law of man’s nature, revealed by experience, that diseases are only destroyed and cured by similar diseases. The homeopathic law may be thus formulated: that a disease can only be destroyed and cured by a remedy which has the tendency to produce a similar disease, for the effects of drugs are in themselves no other than artificial diseases.

The preceding more or less disconnected portions of the text of Hahnemann’s great work—“Organon of the Rational Art of Healing”—are quoted here, not with the idea that they will convey to the reader a very clear idea of the doctrine of homoeopathy and of the way in which it is to be applied in the practice of medicine, but rather for the purpose of showing the extraordinary manner in which Hahnemann utilized his reasoning powers in his efforts to create a new pathology and a new system of therapeutics that would harmonize with this new doctrine.

A further inquiry into the manner in which the disciples of Hahnemann acted upon these principles of homoeopathy in the practice of their profession establishes the fact that they believed in the remedial efficiency of doses that contained as small a quantity as the billionth or the decillionth of a grain of the drug. In a report which he makes to the Medico-Chirurgical Society of Edinburgh, James J. Simpson, the distinguished professor of midwifery in the University of that city, comments (1851–1852) upon these infinitely small doses in the following terms:—

If a grown-up man were gravely and seriously to assert to the world that two and two make five, the world would be inclined to look upon him as doubtfully rational, inasmuch as he defied the principles of common sense. And when other grown-up men tell the world that they can cure this or that disease with a billionth or decillionth of a grain of this or that common and probably inert drug, they express an opinion perhaps even more intensely and directly absurd than the doctrine of two and two making five; but they do not equally see through the absurdity and impossibility of the more complicated, but equally ridiculous idea, of the billionth or decillionth of a grain of oyster-shell, or chamomile, or belladonna, or the like, having any possible effect whatever upon the economy, for, resting contented with the mere name, they never once think or dream of what in reality a billionth or a decillionth amounts to.... For it is a sum the mere figures of which can scarcely give us any conception of its infinitesimal amount, viz., 1 followed by sixty ciphers.... Surely men holding such fantastical doctrines, are not men mentally fit to be members of such a Society as this.

In further corroboration of Dr. Simpson’s remarks, I may be permitted to furnish here a few brief extracts from Jahr’s “Manual of Homoeopathic Medicine” (Vol. I., pp. 386 et seq.):—

Symptoms produced by common House-Salt.—Rigidity of all the joints, which crack when they are moved,... Bad effects of a disappointment.... Frightful dreams of quarrels, murders, fire, thieves, etc.... Typhus fever with debility.... Awkwardness.... Numbness and insensibility of one side of the nose.... Speech embarrassed in consequence of the heaviness of the tongue.... Loss of appetite, especially for bread, and repugnance to tobacco smoke.... Numerous flaws in the nails.... Redness of the great toe, etc. (The list contains at least thirty additional symptoms.)

At the present day it is hard to believe that as recently as during the first half of the nineteenth century there existed an editor who was willing to publish such childish reading matter as the above. And yet one is obliged at the same time to admit that the appearance of text like this in a reputable book furnishes good evidences that there was no lack of readers to whom the information imparted proved acceptable.

Between the years 1850 and 1860, homoeopathy assumed a good deal of prominence in the city of New York. Many of the leading families during this period turned their backs on the regular practitioners,—the “Allopaths,” as they were then frequently called,—and confided themselves and their maladies to the care of members of the new school. This naturally led to much bitterness of feeling between the two groups of physicians, just as had happened at an earlier date in the larger towns of England and Scotland; and this condition of things lasted for at least twenty years. Hostile action on the part of the county and state medical societies proved of very little use in diminishing the popularity of the new method of treating diseases; and so it was finally decided to withdraw all further opposition to the new sect and to see what an attitude of indifference and the stopping of all persecution would accomplish. Thanks largely to this wise and sensible policy, homoeopathy gradually lost its short-lived ascendancy, and the more sensible members of the community returned to their former allegiance. What I have said in regard to the rise and fall of homoeopathy in New York is, I am confident, true in a general way of its fate in most of the other large cities of the United States, but I am personally familiar only with the conditions that prevailed in my native city.

I wish that I might speak with a larger measure of authority in regard to the causes that led to the favorable reception of this new sect in New York, but I am not able to do this, and I doubt whether anybody among my contemporaries is able to do much better than merely to suggest some of the more obvious causes which favored the popularity of the new school of practice. Among such causes I may mention the fact that in those days the practitioners of the regular school were in the habit of prescribing drugs in large doses and with very little effort to render them palatable. Take, for example, senna tea, of which bad-tasting medicine the patient was expected to take a large teacupful shortly after the early crowing of the cock; and if, a day or two later, a repetition of the same dose was ordered by the attending physician, can anybody wonder if the remedy was quickly pronounced by the patient much worse than the disease? Experiences like the one just narrated were by no means uncommon, and, as a consequence, many families did not hesitate to transfer their patronage to a class of physicians who never prescribed any remedy that had a bad smell or taste or that caused the slightest bodily discomfort. Then, beside, it is a well-known fact that, during the period now under consideration, the regular practitioners had, in not a few instances, been guilty of prescribing therapeutic measures which actually inflicted harm. Such, for example, were the giving of mercurial preparations in too large doses, the too frequent resort to bloodletting, etc. For all these reasons, it is not at all strange that for a period of several years (1850–1875) homoeopathy flourished in New York. In all fairness, therefore, it may be said that the great improvement in the manner of administering drugs which took place, both here and in European countries, during the period from 1860 to 1880, may be attributed indirectly to the influence of the new sect.

Hahnemann died in Paris in 1843, at the age of eighty-eight.

HUFELAND

(From Eugen Hollaender’s “Medizin und Plastik,” by permission.)

Christoph Wilhelm Hufeland, who was born in 1762, at Langensalza, in the district of Thuringia, Central Germany, founded, about the year 1795, a medical journal that bore the title, “Hufeland’s Journal der Practischen Heilkunde,”—the first German medical journal that was devoted largely to matters of interest to the practitioner. It was published regularly every month and was in almost every respect similar to the best medical journals of the present day. It was kept in active circulation up to the time of the founder’s death in 1836, and was highly appreciated by physicians generally. Hufeland’s reputation, however, rested less upon this journal, notwithstanding its great popularity, than it did upon his famous treatise entitled “The Art of Prolonging Life” (Makrobiotik). This book, which has been translated into every modern language, and which during the past century and a half has never had a rival in the field of which it treats, continues to-day to furnish entertaining reading to hundreds of men and women, laymen as well as physicians, who desire to learn the well-established facts regarding human longevity. Farther on, I will furnish a few extracts from both of these publications, thus enabling those of my readers who have not yet had an opportunity to become acquainted with Hufeland’s writings or with his work as a journalist, to learn something more definite about the man.

So far as I am able to ascertain, Hufeland’s only other important activities were those connected with the positions which he held in the Universities of Jena (1793–1798) and Berlin (1798–1835). In the former institution, he held the Chair of Medicine; in the latter he held the same chair, but he was also acknowledged to be the guiding spirit in all matters relating to the organization and management of that important centre of medical education.

Among the items of special interest in Hufeland’s “Makrobiotik,” I find the following:—

On the 2nd of August, 1790, a carabinier named Petit jumped into the Rhine from one of the windows of the Military Hospital at Strassburg. Half an hour later,—as nearly as could be learned from an inquiry that was made at the time of the occurrence,—his body was taken from the water and carried into the hospital. To all appearances the man was dead; no evidences of life were discovered. Nevertheless, efforts were made to revive him. The body was placed in a thoroughly warmed bed, with the head lying high up on a pillow, the arms resting on the trunk, and the legs extended side by side. The only other measures adopted were the following: At short but regular intervals of time heated cloths were placed over the region of the stomach and over the legs; and heated stones wrapped in cloths were placed in different parts of the bed. At the end of seven or eight minutes a slight twitching of the man’s upper eyelids was observed, and a short time afterward his lower jaw, which up to that moment had been in firm contact with the upper jaw, became separated from it and permitted a little frothy mucus to escape between the lips. After this discovery had been made, a little wine was cautiously introduced into the man’s mouth. Apparently it was swallowed, and then other small doses of wine were administered, all of them apparently being swallowed. Under this stimulation the pulse beats at the wrist became perceptible, and at the end of one hour the man was able to answer questions.

In his comments upon this interesting case of restoration of life after apparent death from drowning, Hufeland makes the following remarks:—

It is evident, therefore, that artificial heat acts with the same vigor immediately after the appearance of what seems to be death as it does at the very first dawn of life; it gradually fans into a living flame the few vital sparks which may still be present in the body.

In the preceding account of the means adopted for resuscitating the soldier who was believed to be dead from the effects of drowning, no mention is made of friction of the surface of the body as a procedure of some value. Hufeland, very properly, lays great stress upon the need of applying heat. Friction, however, if employed intelligently, may prove a most efficient adjunct; and, when I use the expression “intelligently,” I mean that friction may be utilized as a powerful agent for propelling toward the heart the artificially heated blood contained in the cutaneous blood-vessels, thus contributing in no small degree toward the reëstablishment of the circulation. The kind of friction required—it seems scarcely necessary to say—should always be directed from the extremities toward the heart.

In another part of the same work Hufeland gives an account of several instances of exceptional longevity. One of these relates to Terentia, the wife of Cicero, who, despite the sore trials to which she was subjected, and despite the occasional attacks of gout with which she was afflicted, attained the great age of 103. A second instance is that of Livia, the wife of the Emperor Augustus, a woman who possessed a domineering and passionate character, but who, nevertheless, was blessed with a full share of happiness. At the time of her death she was ninety years old. Two other Roman women are mentioned by Hufeland as having attained a great age. They were both of them distinguished actresses. The first one, whose name was Luceia, began her theatrical career at a very early age and was 112 years old on the occasion of her last appearance on the stage; her entire theatrical career having covered a period of one hundred years. Galeria Copiala is the name of the other actress, who was at the same time famous as a danseuse. Ninety years after her first appearance on the stage she took part in a complimentary performance in honor of Pompey; and even at a still later date she acted in a play which was intended to celebrate the distinguished reign of the Emperor Augustus.

Hufeland mentions further instances of great longevity which he had gleaned from Jewish history, and from these I select the following: Abraham lived to be 175 years old, and his wife, Sarah, the only woman of that remote period of time of whom we possess a precise knowledge, died at the age of 127; Isaac attained the age of 180; Jacob lived to be 147; Ishmael, a son of Hagar (one of Abraham’s hand-maids) and a man of warlike habits, attained the age of 137; and Joseph, the next to the youngest of Jacob’s sons, a political leader and a man of great wisdom, died at the age of 110. Moses, a man of conspicuous intellectual capacity and possessing a strong will, lived to be 120 years old. But even he complained that “the life of a man usually lasts only seventy years, or, in exceptional instances, eighty years”—a statement, says Hufeland, which justifies the belief that 3000 years ago the duration of human life was about the same as it is to-day. Joshua, who led a very active life and was a good deal of a warrior, died at the age of 110; Eli, the High Priest, a man of a phlegmatic temperament, lived to be a little over ninety years of age; and Elisha, who despised all the conventionalities of life and cared nothing for wealth, lived far beyond the limit of 100 years.

The Greek philosopher Pythagoras, who recommended care in the choice of one’s food, moderation in eating, and the cultivation of gymnastic exercises, attained a good old age. He claimed that after a man reached his eightieth year, no matter how great an age he might afterward attain, he should be reckoned among those who have ceased to live.

The measures which Hufeland enumerates as being specially conducive to longevity are those with which my readers—it may safely be assumed—are already familiar. The list comprises both those things which a man or a woman should carefully avoid, and those which often prove helpful in prolonging the period of one’s life, and which may be summed up in that old device: “Moderation in all things.”

On turning over the pages of the volume of Hufeland’s Journal in which are contained the issues of the first half of the year 1833, I came across the report of a very unusual case that was observed by a Dr. Heymann in the village of Oldendorf. His report reads as follows:—

A very poor working-woman, who in addition to her poverty was obliged to live in a house that was overrun with mice, retired to her bed one night in company with her child who was about three years old. One of the last things she did, after going to bed, was to hand to the latter a crust of bread, in the hope that the little one might thus, by quieting its hunger, fall asleep more readily. Having done this the mother herself soon fell asleep. But shortly afterward she was awakened by the terrified cries of the child, who insisted that there was a mouse in its throat. Having quickly obtained a light the mother discovered that not only was the child retching violently, but that it was bringing up visible quantities of blood from the stomach. In the contortions caused by the pain the child indicated the pit of the stomach as the source of all its agony. The severe pain persisted for about two hours and then suddenly ceased, but the retching and bringing up of blood continued at intervals for some time longer. On the following morning the child was given plenty of sweetened milk to drink. At the end of forty-eight hours the remains of the mouse were found in the stool. The creature’s body presented a collapsed appearance and the skin lacked its covering of fur in several places.

For quite a long time subsequently the child remained in an ailing condition, with symptoms of disordered digestion. Its death, however, which occurred at a somewhat later period, was apparently dependent upon an entirely different disease,—one that had no connection whatever with the incident just described.

After reviewing all the evidence in this extraordinary case, Hufeland sees no reason for doubting the correctness of the preceding report in all its essential features. As to the manner in which a mouse may find its way into the human stomach, the following statement is permissible. To begin with, it is a matter of common knowledge that mice often run about an occupied bedroom at night in search of food, and that their sense of smell is extraordinarily acute. Furthermore, it is easy to understand how a mouse, after tracing the odor of food to the partially open mouth of a sleeping child, would not hesitate, if pressed by hunger, to enter that cavity for the purpose of securing possession of the particles of food lodged therein; and it is also easy to understand how the intruder might then be caught as in a trap by the closing of the mouth which spontaneously followed. Under such circumstances the creature’s choice of the oesophageal route into the stomach as a way of escape was most natural, and equally so were the efforts made by the beast—as shown by the pain at the pit of the stomach and by the retching of a bloody fluid—to gnaw its way through the gastric mucous membrane.

Although Hufeland yielded to the prevailing tendency among German physicians of the eighteenth century to adopt doctrines, both in pathology and in therapeutics, which are based upon hypotheses rather than upon facts established by experimentation, or by direct observation at the bedside or at the autopsy, and which as a consequence played a very small part in the genuine advance of the science of medicine, he nevertheless, as I have tried to show in the preceding pages, should be classed as a most useful and honorable member of our profession.

Remember—he is reported to have said to his younger confrères—that there are two maxims which you should keep in mind, viz.:—

1. Natura sanat, medicus curat morbos; (Nature cures disease, the physician merely does what he can to facilitate the operations of nature);

and

2. Ne noceas, si prodesse credis. (In your efforts to afford relief be careful not to do permanent harm.)