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 11

MEDICINE arose out of the primal sympathy of man with man; out of the desire to help those in sorrow, need and sickness.

The instinct of self-preservation, the longing to relieve a loved one, and above all, the maternal passion—for such it is—gradually softened the hard race of man—tum genus humanum primum mollescere coepit. 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-Championniere has covered the subject in a monograph.(2) Broca suggests that the trephining was done by scratching or scraping, but, as Lucas-Championniere 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-Championniere 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 operation 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.