the evolution of modern medicine(现代医药的演变)-第3章
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physical evolution。 Out of the spiritual protoplasm of magic have evolved
philosopher and physician； as well as priest。 Magic and religion control
the uncharted spherethe 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。
＇1＇ Sir E。 Ray Lankester： Romanes Lecture； 〃Nature and Man；〃
Oxford Univ。 Press； 1905； p。 21。
Side by side； as substance and shadow〃in the dark backward and
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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。
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
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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
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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
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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
