THE EVOLUTION OF MODERN MEDICINE

A SERIES OF LECTURES DELIVERED
AT YALE UNIVERSITY ON THE SILLIMAN
FOUNDATION IN APRIL, 1913

by WILLIAM OSLER

THE SILLIMAN FOUNDATION

IN the year 1883 a legacy of eighty thousand dollars was left to
the President and Fellows of Yale College in the city of New
Haven, to be held in trust, as a gift from her children, in
memory of their beloved and honored mother, Mrs. Hepsa Ely
Silliman.

On this foundation Yale College was requested and directed to
establish an annual course of lectures designed to illustrate the
presence and providence, the wisdom and goodness of God, as
manifested in the natural and moral world.  These were to be
designated as the Mrs. Hepsa Ely Silliman Memorial Lectures.  It
was the belief of the testator that any orderly presentation of
the facts of nature or history contributed to the end of this
foundation more effectively than any attempt to emphasize the
elements of doctrine or of creed; and he therefore provided that
lectures on dogmatic or polemical theology should be excluded
from the scope of this foundation, and that the subjects should
be selected rather from the domains of natural science and
history, giving special prominence to astronomy, chemistry,
geology and anatomy.

It was further directed that each annual course should be made
the basis of a volume to form part of a series constituting a
memorial to Mrs. Silliman.  The memorial fund came into the
possession of the Corporation of Yale University in the year
1901; and the present volume constitutes the tenth of the series
of memorial lectures.

CONTENTS
Chapter II. Greek Medicine
Chapter III. Mediaeval Medicine
Chapter IV.  The Renaissance and the Rise of Anatomy and
Physiology
Chapter V. The Rise and Development of Modern Medicine
Chapter VI.  The Rise of Preventive Medicine

PREFACE

THE manuscript of Sir William Osler's lectures on the "Evolution
of Modern Medicine," delivered at Yale University in April, 1913,
on the Silliman Foundation, was immediately turned in to the Yale
University Press for publication. Duly set in type, proofs in
galley form had been submitted to him and despite countless
interruptions he had already corrected and revised a number of
the galleys when the great war came. But with the war on, he
threw himself with energy and devotion into the military and
public duties which devolved upon him and so never completed his
proof-reading and intended alterations. The careful corrections
which Sir William made in the earlier galleys show that the
lectures were dictated, in the first instance, as loose memoranda
for oral delivery rather than as finished compositions for the
eye, while maintaining throughout the logical continuity and the
engaging con moto which were so characteristic of his literary
style.  In revising the lectures for publication, therefore, the
editors have merely endeavored to carry out, with care and
befitting reverence, the indications supplied in the earlier
galleys by Sir William himself. In supplying dates and references
which were lacking, his preferences as to editions and readings
have been borne in mind. The slight alterations made, the
adaptation of the text to the eye, detract nothing from the
original freshness of the work.

In a letter to one of the editors, Osler described these lectures
as "an aeroplane flight over the progress of medicine through the
ages."  They are, in effect, a sweeping panoramic survey of the
whole vast field, covering wide areas at a rapid pace, yet with
an extraordinary variety of detail.  The slow, painful character
of the evolution of medicine from the fearsome, superstitious
mental complex of primitive man, with his amulets, healing gods
and disease demons, to the ideal of a clear-eyed rationalism is
traced with faith and a serene sense of continuity. The author
saw clearly and felt deeply that the men who have made an idea or
discovery viable and valuable to humanity are the deserving men;
he has made the great names shine out, without any depreciation
of the important work of lesser men and without cluttering up his
narrative with the tedious prehistory of great discoveries or
with shrill claims to priority. Of his skill in differentiating
the sundry "strains" of medicine, there is specific witness in
each section.  Osler's wide culture and control of the best
available literature of his subject permitted him to range the
ampler aether of Greek medicine or the earth-fettered schools of
today with equal mastery; there is no quickset of pedantry
between the author and the reader. The illustrations (which he
had doubtless planned as fully for the last as for the earlier
chapters) are as he left them; save that, lacking legends, these
have been supplied and a few which could not be identified have
with regret been omitted. The original galley proofs have been
revised and corrected from different viewpoints by Fielding H.
Garrison, Harvey Cushing, Edward C. Streeter and latterly by
Leonard L. Mackall (Savannah, Ga.), whose zeal and persistence in
the painstaking verification of citations and references cannot
be too highly commended.

In the present revision, a number of important corrections, most
of them based upon the original MS., have been made by Dr. W.W.
Francis (Oxford), Dr. Charles Singer (London), Dr. E.C. Streeter,
Mr. L.L. Mackall and others.

This work, composed originally for a lay audience and for popular
consumption, will be to the aspiring medical student and the
hardworking practitioner a lift into the blue, an inspiring vista
or "Pisgah-sight" of the evolution of medicine, a realization of
what devotion, perseverance, valor and ability on the part of
physicians have contributed to this progress, and of the
creditable part which our profession has played in the general
development of science.

The editors have no hesitation in presenting these lectures to
the profession and to the reading public as one of the most
characteristic productions of the best-balanced, best-equipped,
most sagacious and most lovable of all modern physicians.

F.H.G.

BUT on that account, I say, we ought not to reject the ancient
Art, as if it were not, and had not been properly founded,
because it did not attain accuracy in all things, but rather,
since it is capable of reaching to the greatest exactitude by
reasoning, to receive it and admire its discoveries, made from a
state of great ignorance, and as having been well and properly
made, and not from chance. (Hippocrates, On Ancient Medicine,
Adams edition, Vol. 1, 1849, p. 168.)

THE true and lawful goal of the sciences is none other than this:
that human life be endowed with new discoveries and powers.
(Francis Bacon, Novum Organum, Aphorisms, LXXXI, Spedding's
translation.)

A GOLDEN thread has run throughout the history of the world,
consecutive and continuous, the work of the best men in
successive ages. From point to point it still runs, and when near
you feel it as the clear and bright and searchingly irresistible
light which Truth throws forth when great minds conceive it.
(Walter Moxon, Pilocereus Senilis and Other Papers, 1887, p. 4.)

FOR the mind depends so much on the temperament and disposition
of the bodily organs that, if it is possible to find a means of
rendering men wiser and cleverer than they have hitherto been, I
believe that it is in medicine that it must be sought. It is true
that the medicine which is now in vogue contains little of which
the utility is remarkable; but, without having any intention of
decrying it, I am sure that there is no one, even among those who
make its study a profession, who does not confess that all that
men know is almost nothing in comparison with what remains to be
known; and that we could be free of an infinitude of maladies
both of body and mind, and even also possibly of the infirmities
of age, if we had sufficient knowledge of their causes, and of
all the remedies with which nature has provided us.  (Descartes:
Discourse on the Method, Philosophical Works.  Translated by E.
S. Haldane and G. R. T. Ross.  Vol. I, Cam. Univ. Press, 1911, p.
120.)

CHAPTER I

INTRODUCTION

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:

Below lay stretched the boundless Universe!
There, far as the remotest line
That limits swift imagination's flight,
Unending orbs mingled in mazy motion,
   Immutably fulfilling
   Eternal Nature's law.
   Above, below, around,
   The circling systems formed
   A wilderness of harmony.
(Daemon of the World, Pt. I.)

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