Читать книгу The Evolution of Modern Medicine A Series of Lectures Delivered at Yale University on the Silliman Foundation in April, 1913 - Osler William - Страница 10

SAIL to the Pacific with some Ancient Mariner, and traverse day by day that silent sea until you reach a region never before furrowed by keel where a tiny island, a mere speck on the vast ocean, has just risen from the depths, a little coral reef capped with green, an atoll, a mimic earth, fringed with life, built up through countless ages by life on the remains of life that has passed away. And now, with wings of fancy, join Ianthe in the magic car of Shelley, pass the eternal gates of the flaming ramparts of the world and see his vision:

And somewhere, "as fast and far the chariot flew," amid the mighty globes would be seen a tiny speck, "earth's distant orb," one of "the smallest lights that twinkle in the heavens." Alighting, Ianthe would find something she had probably not seen elsewhere in her magic flight—life, everywhere encircling the sphere. And as the little coral reef out of a vast depth had been built up by generations of polyzoa, so she would see that on the earth, through illimitable ages, successive generations of animals and plants had left in stone their imperishable records: and at the top of the series she would meet the thinking, breathing creature known as man. Infinitely little as is the architect of the atoll in proportion to the earth on which it rests, the polyzoon, I doubt not, is much larger relatively than is man in proportion to the vast systems of the Universe, in which he represents an ultra-microscopic atom less ten thousand times than the tiniest of the "gay motes that people the sunbeams." Yet, with colossal audacity, this thinking atom regards himself as the anthropocentric pivot around which revolve the eternal purposes of the Universe. Knowing not whence he came, why he is here, or whither he is going, man feels himself of supreme importance, and certainly is of interest—to himself. Let us hope that he has indeed a potency and importance out of all proportion to his somatic insignificance. We know of toxins of such strength that an amount too infinitesimal to be gauged may kill; and we know that "the unit adopted in certain scientific work is the amount of emanation produced by one million-millionth of a grain of radium, a quantity which itself has a volume of less than a million-millionth of a cubic millimetre and weighs a million million times less than an exceptionally delicate chemical balance will turn to" (Soddy, 1912). May not man be the radium of the Universe? At any rate let us not worry about his size. For us he is a very potent creature, full of interest, whose mundane story we are only beginning to unravel.

Civilization is but a filmy fringe on the history of man. Go back as far as his records carry us and the story written on stone is of yesterday in comparison with the vast epochs of time which modern studies demand for his life on the earth. For two millions (some hold even three millions) of years man lived and moved and had his being in a world very different from that upon which we look out. There appear, indeed, to have been various types of man, some as different from us as we are from the anthropoid apes. What upstarts of yesterday are the Pharaohs in comparison with the men who survived the tragedy of the glacial period! The ancient history of man—only now beginning to be studied—dates from the Pliocene or Miocene period; the modern history, as we know it, embraces that brief space of time that has elapsed since the earliest Egyptian and Babylonian records were made. This has to be borne in mind in connection with the present mental status of man, particularly in his outlook upon nature. In his thoughts and in his attributes, mankind at large is controlled by inherited beliefs and impulses, which countless thousands of years have ingrained like instinct. Over vast regions of the earth today, magic, amulets, charms, incantations are the chief weapons of defense against a malignant nature; and in disease, the practice of Asa(*) is comparatively novel and unusual; in days of illness many millions more still seek their gods rather than the physicians. In an upward path man has had to work out for himself a relationship with his fellows and with nature. He sought in the supernatural an explanation of the pressing phenomena of life, peopling the world with spiritual beings, deifying objects of nature, and assigning to them benign or malign influences, which might be invoked or propitiated. Primitive priest, physician and philosopher were one, and struggled, on the one hand, for the recognition of certain practices forced on him by experience, and on the other, for the recognition of mystical agencies which control the dark, "uncharted region" about him—to use Prof. Gilbert Murray's phrase—and were responsible for everything he could not understand, and particularly for the mysteries of disease. Pliny remarks that physic "was early fathered upon the gods"; and to the ordinary non-medical mind, there is still something mysterious about sickness, something outside the ordinary standard.

Modern anthropologists claim that both religion and medicine took origin in magic, "that spiritual protoplasm," as Miss Jane Harrison calls it. To primitive man, magic was the setting in motion of a spiritual power to help or to hurt the individual, and early forms may still be studied in the native races. This power, or "mana," as it is called, while possessed in a certain degree by all, may be increased by practice. Certain individuals come to possess it very strongly: among native Australians today it is still deliberately cultivated. Magic in healing seeks to control the demons, or forces; causing disease; and in a way it may be thus regarded as a "lineal ancestor of modern science" (Whetham), which, too, seeks to control certain forces, no longer, however, regarded as supernatural.

Primitive man recognized many of these superhuman agencies relating to disease, such as the spirits of the dead, either human or animal, independent disease demons, or individuals who might act by controlling the spirits or agencies of disease. We see this today among the negroes of the Southern States. A Hoodoo put upon a negro may, if he knows of it, work upon him so powerfully through the imagination that he becomes very ill indeed, and only through a more powerful magic exercised by someone else can the Hoodoo be taken off.

To primitive man life seemed "full of sacred presences" (Walter Pater) connected with objects in nature, or with incidents and epochs in life, which he began early to deify, so that, until a quite recent period, his story is largely associated with a pantheon of greater and lesser gods, which he has manufactured wholesale. Xenophanes was the earliest philosopher to recognize man's practice of making gods in his own image and endowing them with human faculties and attributes; the Thracians, he said, made their gods blue-eyed and red-haired, the Ethiopians, snub-nosed and black, while, if oxen and lions and horses had hands and could draw, they would represent their gods as oxen and lions and horses. In relation to nature and to disease, all through early history we find a pantheon full to repletion, bearing testimony no less to the fertility of man's imagination than to the hopes and fears which led him, in his exodus from barbarism, to regard his gods as "pillars of fire by night, and pillars of cloud by day."

Even so late a religion as that of Numa was full of little gods to be invoked on special occasions—Vatican, who causes the infant to utter his first cry, Fabulinus, who prompts his first word, Cuba, who keeps him quiet in his cot, Domiduca, who watches over one's safe home-coming (Walter Pater); and Numa believed that all diseases came from the gods and were to be averted by prayer and sacrifice. Besides the major gods, representatives of Apollo, AEsculapius and Minerva, there were scores of lesser ones who could be invoked for special diseases. It is said that the young Roman mother might appeal to no less than fourteen goddesses, from Juno Lucina to Prosa and Portvorta (Withington). Temples were erected to the Goddess of Fever, and she was much invoked. There is extant a touching tablet erected by a mourning mother and inscribed:

It is marvellous what a long line of superhuman powers, major and minor, man has invoked against sickness. In Swinburne's words:

In every age, and in every religion there has been justification for his bitter words, "tantum religio potuit suadere malorum"—"Such wrongs Religion in her train doth bring"—yet, one outcome of "a belief in spiritual beings"—as Tylor defines religion—has been that man has built an altar of righteousness in his heart. The comparative method applied to the study of his religious growth has shown how man's thoughts have widened in the unceasing purpose which runs through his spiritual no less than his physical evolution. Out of the spiritual protoplasm of magic have evolved philosopher and physician, as well as priest. Magic and religion control the uncharted sphere—the supernatural, the superhuman: science seeks to know the world, and through knowing, to control it. Ray Lankester remarks that Man is Nature's rebel, and goes on to say: "The mental qualities which have developed in Man, though traceable in a vague and rudimentary condition in some of his animal associates, are of such an unprecedented power and so far dominate everything else in his activities as a living organism, that they have to a very large extent, if not entirely, cut him off from the general operation of that process of Natural Selection and survival of the fittest which up to their appearance had been the law of the living world. They justify the view that Man forms a new departure in the gradual unfolding of Nature's predestined scheme. Knowledge, reason, self-consciousness, will, are the attributes of Man."(1) It has been a slow and gradual 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 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.