the evolution of modern medicine-第3部分
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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。
ORIGIN OF MEDICINE
MEDICINE arose out of the primal sympathy of man with man； out of the desire to help those in sorrow； need and sickness。
In the primal sympathy Which having been must ever be； In the soothing thoughts that spring Out of human suffering。
The instinct of self…preservation； the longing to relieve a loved one； and above all； the maternal passionfor such it isgradually softened the hard race of mantum 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 suggestivethe 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。
＇2＇ Lucas…Championniere： Trepanation neolithique； Paris； 1912。
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。
EGYPTIAN MEDICINE
OUT of the ocean of oblivion； man emerges in history in a highly civilized state on the banks of the Nile； some sixty centuries ago。 After millenniums of a gradual upward progress； which can be traced in the records of the stone age； civilization springs forth Minerva…like； complete； and highly developed； in the Nile Valley。 In this sheltered； fertile spot； neolithic man first raised himself above his kindred races of the Mediterranean basin； and it is suggested that by the accidental discovery of copper Egypt 〃forged the instruments that raised civilization out of the slough of the Stone Age〃 （Elliot Smith）。 Of special interest to us is the fact that one of the best…known names of this earliest period is that of a physicianguide； philosopher and friend of the kinga man in a position of wide trust and importance。 On leaving Cairo； to go up the Nile； one sees on the right in the desert behind Memphis a terraced pyramid 190 feet in height； 〃the first large structure of stone known in history。〃 It is the royal tomb of Zoser； the first of a long series with which the Egyptian monarchy sought 〃to adorn the coming bulk of death。〃 The design of this is attributed to Imhotep； the first figure of a physician to stand out clearly from the mists of antiquity。 〃In priestly wisdom； in magic； in the formulation of wise proverbs； in medicine and architecture； this remarkable figure of Zoser's reign left so notable a reputation that his name was never forgotten； and 2500 years after his death he had become a God of Medicine； in whom the Greeks； who called him Imouthes； recognized their own AEsculapius。〃＇3＇ He became a popular god； not only healing men when alive； but taking good care of them in the journeys after death。 The facts about this medicinae primus inventor； as he has been called； may be gathered from Kurt Sethe's study。＇4＇ He seems to have corresponded very much to the Greek Asklepios。 As a god he is met with comparatively late； between 700 and 332 B。C。 Numerous bronze figures of him remain。 The oldest memorial mentioning him is a statue of one of his priests； Amasis （No。 14765 in the British Museum）。 Ptolemy V dedicated to him a temple on the island of Philae。 His cult increased much in later days； and a special temple was dedicated to him near Memphis Sethe suggests that the cult of Imhotep gave the inspiration to the Hermetic literature。 The association of Imhotep with the famous temple at Edfu is of special interest。
＇3＇ Breasted： A History of the Ancient Egyptians； Scribner； New York； 1908； p。 104。
＇4＇ K。 Sethe： Imhotep； der Asklepios der Aegypter； Leipzig； 1909 （Untersuchungen； etc。； ed。 Sethe； Vol。 II； No。 4）。
Egypt became a centre from which civilization spread to the other peoples of the Mediterranean。 For long centuries； to be learned in all the wisdom of the Egyptians meant the possession of all knowledge。 We must come to the land of the Nile for the origin of many of man's most distinctive and highly cherished beliefs。 Not only is there a magnificent material civilization； but in records so marvellously preserved in stone we may see； as in a glass； here clearly； there darkly； the picture of man's search after righteousness； the earliest impressions of his moral awakening； the beginnings of the strife in which he has always been engaged for social justice and for the recognition of the rights of the individual。 But above all； earlier and more strongly than in any other people； was developed the faith that looked through death； to which； to this day； the noblest of their monuments bear an enduring testimony。 With all this； it is not surprising to find a growth in the knowledge of practical medicine； but Egyptian civilization illustrates how crude and primitive may remain a knowledge of disease when conditioned by erroneous views of its nature。 At first； the priest and physician were identified； and medicine never became fully dissociated from religion。 Only in the later periods did a special group of physicians arise who were not members of priestly colleges。＇6＇ Maspero states that the Egyptians believed that disease and death were not natural and inevitable； but caused by some malign influence which could use any agency； natural or invisible； and very often belonged to the invisible world。 〃Often； though； it belongs to the invisible world； and only reveals itself by the malignity of its attacks： it is a god； a spirit； the soul of a dead man； that has cunningly entered a living person； or that throws itself upon him with irresistible violence。 Once in possession of the body； the evil influence breaks the bones； sucks out the marrow； drinks the blood； gnaws the intestines and the heart and devours the flesh。 The invalid perishes according to the progress of this destructive work； and death speedily ensues； unless the evil genius can be driven out of it before it has committed irreparable damage。 Whoever treats a sick person has therefore two equally important duties to perform。 He must first discover the nature of the spirit in possession； and； if necessary； its name； and then attack it； drive it out； or even destroy it。 He can only succeed by powerful magic； so he must be an expert in reciting incantations； and skilful in making amulets。 He must then use medicine ＇drugs and diet＇ to contend with the disorders which the presence of the strange being has produced in the body。〃＇6＇
＇5＇ Maspero： Life in Ancient Eg
