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the evolution of modern medicine(�峇�匳勞議處延)-及34嫗

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!!!!隆堋響頼��紗秘慕禰厮宴和肝写偬堋響��




continually ebbed and flowed for the nourishment of the body�察。�2�� the vital�察�

containing another blood and the spirits�察�ebbed and flowed from the heart�察�

distributing heat and life to all parts。 Like a bellows the lungs fanned and 

cooled this vital blood。 Here and there we find glimmering conceptions of 

a   communication        between     these  systems�察   �but   practically    all  teachers 

believed that the only one of importance was through small pores in the 

wall separating the two sides of the heart。 Observationmerely looking at 

and   thinking   about   thingshad   done   all   that   was   possible�察  �and   further 

progress had to await the introduction of a new method�察�viz。�察�experiment。 

Galen�察�it is true�察�had used this means to show that the arteries of the body 

contained blood and not air。 The day had come when men were no longer 

content with accurate description and with finely spun theories and dreams。 

It   was    reserved    for  the   immortal     Harvey     to  put   into   practice    the 

experimental      method     by   which   he   demonstrated      conclusively    that   the 

blood moved in a circle。 The ;De Motu Cordis; marks the final break of 

the modern spirit with the old traditions。 It took long for men to realize the 

value of this ;inventum mirabile; used so effectively by the Alexandrians´ 

´by Galenindeed�察�its full value has only been appreciated within the past 

century。 Let me quote a paragraph from my Harveian Oration。��33�А �To the 

age of the hearer�察�in which men had heard and heard only�察�had succeeded 

the age of the eye in which men had seen and had been content only to see。 

But   at   last   came   the   age   of   the   hand   the   thinking�察  �devising�察  �planning 

hand�察�the hand as an instrument of the mind�察�now re´introduced into the 

world in a modest little monograph from which we may date the beginning 

of experimental medicine。; 

     ��33�А�Osler�此�An Alabama Student�察�etc。�察�pp。 329´330。 



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       Harvey   caught   the   experimental   spirit   in   Italy�察  �with   brain�察  �eye   and 

hand as his only aids�察�but now an era opened in which medicine was to 

derive     an   enormous      impetus     from     the   discovery     of   instruments     of 

precision。   ;The   new   period   in   the   development   of   the   natural   sciences�察�

which reached its height in the work of such men as Galileo�察�Gilbert and 

Kepler�察    �is  chiefly    characterized      by   the   invention    of   very    important 

instruments for   aiding and   intensifying the perceptions of the senses�察 �by 

means   of   which   was   gained   a   much   deeper   insight   into   the   phenomena 

than    had   hitherto    been   possible。    Such    instruments     as  the   earlier  ages 

possessed were little more than primitive hand´made tools。 Now we find a 

considerable       number      of   scientifically    made     instruments      deliberately 

planned for purposes of special research�察�and as it were�察�on the threshold 

of the period stand two of the most important�察�the compound microscope 

and   the   telescope。   The   former   was   invented   about   1590   and   the   latter 

about 1608。;��34�А�It was a fellow professor of the great genius Galileo who 

attempted to put into practice the experimental science of his friend。 With 

Sanctorius began the studies of temperature�察�respiration and the physics of 

the circulation。 The memory of this great investigator has not been helped 

by   the   English   edition   of   his   ;De   Statica   Medicina�察─  �not   his   best   work�察�

with a frontispiece showing the author in his dietetic balance。 Full justice 

has been done to him by Dr。 Weir Mitchell in an address as president of 

the   Congress   of   Physicians   and   Surgeons�察  �1891。��35�А  �Sanctorius   worked 

with    a   pulsilogue    devised     for  him    by   Galileo�察  �with    which    he   made 

observations on the pulse。 He is said to have been the first to put in use the 

clinical thermometer。 His experiments on insensible perspiration mark him 

as one of the first modern physiologists。 

     ��34�А  �Dannemann�此  �Die   Naturwissenschaften   in   ihrer   Entwickelung。。。�察�

Vol。 II�察�p。 7�察�Leipzig�察�1911。 

     ��35�А�See Transactions Congress Physicians and Surgeons�察�1891�察�New 

Haven�察�1892�察�II�察�159´181。 

       But neither Sanctorius nor Harvey had the immediate influence upon 

their   contemporaries   which   the   novel   and   stimulating   character   of   their 

work justified。 Harvey's great contemporary�察�Bacon�察�although he lost his 

life   in   making   a   cold   storage   experiment�察  �did   not   really   appreciate   the 



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enormous       importance     of  experimental      science。   He    looked    very   coldly 

upon     Harvey's     work。    It  was   a  philosopher      of  another    kidney�察   �Rene 

Descartes�察�who did more than anyone else to help men to realize the value 

of   the   better   way   which   Harvey   had   pointed   out。  That   the   beginning   of 

wisdom was in doubt�察�not in authority�察�was a novel doctrine in the world�察�

but Descartes was no armchair philosopher�察�and his strong advocacy and 

practice of experimentation had a profound influence in directing men to 

;la nouvelle methode。; He brought the human body�察�the earthly machine�察�

as he calls it�察�into the sphere of mechanics and physics�察�and he wrote the 

first   text´book    of  physiology�察     �De   l'Homme。;      Locke�察   �too�察  �became     the 

spokesman   of   the   new   questioning   spirit�察      �and   before   the   close   of   the 

seventeenth century�察�experimental research became all the mode。 Richard 

Lower�察  �Hooke   and   Hales   were   probably   more   influenced   by   Descartes 

than    by   Harvey�察   �and   they   made    notable   contributions     to  experimental 

physiology      in  England。     Borelli�察  �author    of  the   famous    work    on   ;The 

Motion of Animals; ��Rome�察�1680´1681���察�brought to the study of the action 

of muscles a profound knowledge of physics and mathematics and really 

founded the mechanical�察�or iatromechanical school。 The literature and the 

language of medicine became that of physics and mechanics�此�wheels and 

pulleys�察�wedges�察�levers�察�screws�察�cords�察�canals。 cisterns�察�sieves and strainers�察�

with angles�察�cylinders�察�celerity�察�percussion and resistance�察�were among the 

words that now came into use in medical literature。 Withington quotes a 

good example in a description by Pitcairne�察�the Scot who was professor of 

medicine   at   Leyden   at   the   end   of   the   seventeenth   century。   ;Life   is   the 

circulation of the blood。 Health is its free and painless circulation。 Disease 

is   an   abnormal   motion   of   the   blood�察  �either   general   or   local。   Like   the 

English school generally�察�he is far more exclusively mechanical than are 

the Italians�察�and will hear nothing of ferments or acids�察�even in digestion。 

This�察�he declares�察�is a purely mechanical process due to heat and pressure�察�

the wonderful effects of which may be seen in Papin's recently invented 

'digester。' That   the   stomach   is   fully  able   to   comminute   the   food   may   be 

proved   by   the   following   calculation。   Borelli   estimates   the   power   of   the 

flexors   of   the   thumb   at   3720   pounds�察  �their   average   weight   being   122 

grains。 Now�察�the average weight of the stomach is eight ounces�察�therefore 



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it can develop a force of 117��088 pounds�察�and this may be further assisted 

by the diaphragm and abdominal muscles the power of which�察�estimated in 

the  same   way�察  �equals   461��219   pounds� �Well   may   Pitcairne   add   that   this 

force   is   not   inferior   to   that   of   any   millstone。;��36�А  �Paracelsus   gave   an 

extraordinary   stimulus   to   the   study   of   chemistry   and   more   than   anyone 

else   he   put   the   old   alchemy   on   modern   lines。   I   have   already  quoted   his 

sane   remark   that   its   chief   service   is   in   seeking   remedies。   But   there   is 

another side to this question。 If�察�as seems fairly certain�察�the Basil Valentine 

whose writings were supposed to have inspired Paracelsus was a hoax and 

his works were made up in great part from the writings of Paracelsus�察�then 

to our medical Luther�察�and not to the mythical Benedictine monk�察�must be 

attributed a great revival in the search for the Philosopher's Stone�察�for the 

Elixir of Life�察�for a universal medicine�察�for the perpetuum mobile and for 

an   aurum   potabile。��37�А  �I   reproduce�察  �almost   at   random�察  �a   page   from   the 

fifth and last part of the last will and testament of Basil Valentine ��London�察�

1657���察�from which you may judge the chemical spirit of the time。 

     ��36�А  �Withington�此  �Medical   History   from   the   Earliest   Times�察  �London�察�

1891�察�Scientific Press�察�p。 317。 

     ��37�А   �See   Professor    Stillman    on   the   Basil   Valentine    hoax�察  �Popular 

Science Monthly�察�New York�察�1919�察�LXXXI�察�591´600。 

       Out of the mystic doctrines of Paracelsus arose the famous ;Brothers 

of   the   Rosy    Cross。;    ;The    brotherhood     was    possessed     of  the   deepest 

knowledge and science�察�the transmutation of metals�察�the perpetuum mobile 

and the universal medicine were among their secrets�察�they were free from 

sickness     and   suffering    during    their  lifetime�察  �though    subject    finally  to 

death。;��38�А�

     ��38�А�Ferguson�此�Bibliotheca Chemica�察�Vol。 II�察�p。 290。 For an account of 

Fludd and the English Rosicrucians see Craven's Life of Fludd�察�Kirkwall�察�

1902。 

       A school of a more rational kind followed directly upon the work of 

Paracelsus�察�in   which the   first man   of any  importance was Van   Helmont。 

The Paracelsian Archeus was the presiding spirit in living creatures�察�and 

worked   through   special   local   ferments�察  �by   which        the   functions   of   the 

organs are controlled。 Disease of any part represents a strike on the part of 



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the local Archeus�察�who refuses to work。 Though full of fanciful ideas�察�Van 

Helmont had the experimental spirit and was the first chemist to discover 

the diversity of gases。 Like his teacher�察�he was in revolt against the faculty�察�

and he has bitter things to say of physicians。 He got into trouble with the 

Church about the magnetic cure of wounds�察�as no fewer than twenty´seven 

propositions  

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