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Books: The Harvard Classics Volume 38

V >> Various >> The Harvard Classics Volume 38

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Produced by David Turner, Charles Franks
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The Harvard Classics Volume 38
Scientific Papers (Physiology, Medicine, Surgery, Geology)




CONTENTS

THE OATH OF HIPPOCRATES


THE LAW OF HIPPOCRATES

JOURNEYS IN DIVERSE PLACES ... AMBROISE PARE
TRANSLATED BY STEPHEN PAGET

ON THE MOTION OF THE HEART AND BLOOD IN ANIMALS
WILLIAM HARVEY. . . TRANSLATED BY ROBERT WILLIS

THE THREE ORIGINAL PUBLICATIONS ON VACCINATION
AGAINST SMALLPOX . ... .. EDWARD JENNER

THE CONTAGIOUSNESS OF PUERPERAL FEVER
O. W. HOLMES

ON THE ANTISEPTIC PRINCIPLE OF THE PRACTICE OF SURGERY
LORD LISTER

THE PHYSIOLOGICAL THEORY OF FERMENTATION
LOUIS PASTEUR
TRANSLATED BY F. FAULKNER AND D. C. ROBB (Revised)

THE GERM THEORY AND ITS APPLICATIONS TO MEDICINE AND
SURGERY (Revised) . ... .. LOUIS PASTEUR
TRANSLATED BY H. C. ERNST

ON THE EXTENSION OF THE GERM THEORY TO THE ETIOLOGY
OF CERTAIN COMMON DISEASES (Revised) LOUIS PASTEUR
TRANSLATED BY H. C. ERNST

PREJUDICES WHICH HAVE RETARDED THE PROGRESS OF
GEOLOGY. ... . ... .. SIR CHARLES LYELL

UNIFORMITY IN THE SERIES OF PAST CHANGES IN THE
ANIMATE AND INANIMATE WORLD SIR CHARLES LYELL




INTRODUCTORY NOTE

Hippocrates, the celebrated Greek physician, was a contemporary
of the historian Herodotus. He was born in the island of Cos
between 470 and 460 B. C., and belonged to the family that
claimed descent from the mythical AEsculapius, son of Apollo.
There was already a long medical tradition in Greece before his
day, and this he is supposed to have inherited chiefly through
his predecessor Herodicus; and he enlarged his education by
extensive travel. He is said, though the evidence is
unsatisfactory, to have taken part in the efforts to check the
great plague which devastated Athens at the beginning of the
Peloponnesian war. He died at Larissa between 380 and 360 B. C.

The works attributed to Hippocrates are the earliest extant Greek
medical writings, but very many of them are certainly not his.
Some five or six, however, are generally granted to be genuine,
and among these is the famous "Oath." This interesting document
shows that in his time physicians were already organized into a
corporation or guild, with regulations for the training of
disciples, and with an esprit de corps and a professional ideal
which, with slight exceptions, can hardly yet be regarded as out
of date.

One saying occurring in the words of Hippocrates has achieved
universal currency, though few who quote it to-day are aware that
it originally referred to the art of the physician. It is the
first of his "Aphorisms": "Life is short, and the Art long; the
occasion fleeting; experience fallacious, and judgment difficult.
The physician must not only be prepared to do what is right
himself, but also to make the patient, the attendants, and
externals cooperate."




THE OATH OF HIPPOCRATES

I swear by Apollo the physician and AEsculapius, and Health, and
All-heal, and all the gods and goddesses, that, according to my
ability and judgment, I will keep this Oath and this stipulation
--to reckon him who taught me this Art equally dear to me as my
parents, to share my substance with him, and relieve his
necessities if required; to look upon his offspring in the same
footing as my own brothers, and to teach them this art, if they
shall wish to learn it, without fee or stipulation; and that by
precept, lecture, and every other mode of instruction, I will
impart a knowledge of the Art to my own sons, and those of my
teachers, and to disciples bound by a stipulation and oath
according to the law of medicine, but to none others. I will
follow that system of regimen which, according to my ability and
judgment, I consider for the benefit of my patients, and abstain
from whatever is deleterious and mischievous. I will give no
deadly medicine to any one if asked, nor suggest any such
counsel; and in like manner I will not give to a woman a pessary
to produce abortion. With purity and with holiness I will pass my
life and practice my Art. I will not cut persons labouring under
the stone, but will leave this to be done by men who are
practitioners of this work. Into whatever houses I enter, I will
go into them for the benefit of the sick, and will abstain from
every voluntary act of mischief and corruption; and, further,
from the seduction of females or males, of freemen and slaves.
Whatever, in connection with my professional practice, or not in
connection with it, I see or hear, in the life of men, which
ought not to be spoken of abroad, I will not divulge, as
reckoning that all such should be kept secret. While I continue
to keep this Oath unviolated, may it be granted to me to enjoy
life and the practice of the art, respected by all men, in all
times. But should I trespass and violate this Oath, may the
reverse be my lot.




THE LAW OF HIPPOCRATES

Medicine is of all the arts the most noble; but, owing to the
ignorance of those who practice it, and of those who,
inconsiderately, form a judgment of them, it is at present far
behind all the other arts. Their mistake appears to me to arise
principally from this, that in the cities there is no punishment
connected with the practice of medicine (and with it alone)
except disgrace, and that does not hurt those who are familiar
with it. Such persons are like the figures which are introduced
in tragedies, for as they have the shape, and dress, and personal
appearance of an actor, but are not actors, so also physicians
are many in title but very few in reality.

2. Whoever is to acquire a competent knowledge of medicine, ought
to be possessed of the following advantages: a natural
disposition; instruction; a favorable position for the study;
early tuition; love of labour; leisure. First of all, a natural
talent is required; for, when Nature leads the way to what is
most excellent, instruction in the art takes place, which the
student must try to appropriate to himself by reflection,
becoming an early pupil in a place well adapted for instruction.
He must also bring to the task a love of labour and perseverance,
so that the instruction taking root may bring forth proper and
abundant fruits.

3. Instruction in medicine is like the culture of the productions
of the earth. For our natural disposition, is, as it were, the
soil; the tenets of our teacher are, as it were, the seed;
instruction in youth is like the planting of the seed in the
ground at the proper season; the place where the instruction is
communicated is like the food imparted to vegetables by the
atmosphere; diligent study is like the cultivation of the fields;
and it is time which imparts strength to all things and brings
them to maturity.

4. Having brought all these requisites to the study of medicine,
and having acquired a true knowledge of it, we shall thus, in
travelling through the cities, be esteemed physicians not only in
name but in reality. But inexperience is a bad treasure, and a
bad fund to those who possess it, whether in opinion or reality,
being devoid of self-reliance and contentedness, and the nurse
both of timidity and audacity. For timidity betrays a want of
powers, and audacity a lack of skill. They are, indeed, two
things, knowledge and opinion, of which the one makes its
possessor really to know, the other to be ignorant.

5. Those things which are sacred, are to be imparted only to
sacred persons; and it is not lawful to impart them to the
profane until they have been initiated in the mysteries of the
science.




JOURNEYS IN DIVERSE PLACES

BY AMBROISE PARE

TRANSLATED BY STEPHEN PAGET


Ambroise Pare was born in the village of Bourg-Hersent, near
Laval, in Maine, France, about 1510. He was trained as a barber-
surgeon at a time when a barber-surgeon was inferior to a surgeon
and the professions of surgeon and physician were kept apart by
the law of the Church that forbade a physician to shed blood.
Under whom he served his apprenticeship is unknown, but by 1533
he was in Paris, where he received an appointment as house
surgeon at the Hotel Dieu. After three or four years of valuable
experience in this hospital, he set up in private practise in
Paris, but for the next thirty years he was there only in the
intervals of peace; the rest of the time he followed the army. He
became a master barber-surgeon in 1541.

In Pare's time the armies of Europe were not regularly equipped
with a medical service. The great nobles were accompanied by
their private physicians; the common soldiers doctored
themselves, or used the services of barber-surgeons and quacks
who accompanied the army as adventurers. "When Pare joined the
army" says Paget, "he went simply as a follower of Colonel
Montejan, having neither rank, recognition, nor regular payment.
His fees make up in romance for their irregularity: a cask of
wine, fifty double ducats and a horse, a diamond, a collection of
crowns and half-crowns from the ranks, other honorable presents
and of great value'; from the King himself, three hundred crowns,
and a promise he would never let him be in want; another diamond,
this time from the finger of a duchess: and a soldier once
offered a bag of gold to him."

When Pare was a man of seventy, the Dean of the Faculty of
Medicine in Paris made an attack on him on account of his use of
the ligature instead of cauterizing after amputation. In answer,
Pare appealed to his successful experience, and narrated the
"Journeys in Diverse Places" here printed. This entertaining
volume gives a vivid picture, not merely of the condition of
surgery in the sixteenth century, but of the military life of the
time; and reveals incidentally a personality of remarkable vigor
and charm. Pare's own achievements are recorded with modest
satisfaction: "I dressed him, and God healed him," is the
refrain. Pare died in Paris in December, 1590.




JOURNEYS IN DIVERSE PLACES

[Footnote: The present translation is taken from Mr. Stephen
Paget's "Ambroise Pare and His Times" by arrangement with Messrs.
G. P. Putnam's Sons.]


1537-1569

THE JOURNEY TO TURIN. 1537


I will here shew my readers the towns and places where I found a
way to learn the art of surgery: for the better instruction of
the young surgeon.

And first, in the year 1536, the great King Francis sent a large
army to Turin, to recover the towns and castles that had been
taken by the Marquis du Guast, Lieutenant-General of the Emperor.
M. the Constable, then Grand Master, was Lieutenant-General of
the army, and M. de Montejan was Colonel-General of the infantry,
whose surgeon I was at this time. A great part of the army being
come to the Pass of Suze, we found the enemy occupying it; and
they had made forts and trenches, so that we had to fight to
dislodge them and drive them out. And there were many killed and
wounded on both sides,--but the enemy were forced to give way and
retreat into the castle, which was captured, part of it, by
Captain Le Rat, who was posted on a little hill with some of his
soldiers, whence they fired straight on the enemy. He received an
arquebus-shot in his right ankle, and fell to the ground at once,
and then said, "Now they have got the Rat." I dressed him, and
God healed him.

We entered pell-mell into the city, and passed over the dead
bodies, and some not yet dead, hearing them cry under our horses'
feet; and they made my heart ache to hear them. And truly I
repented I had left Paris to see such a pitiful spectacle. Being
come into the city, I entered into a stable, thinking to lodge my
own and my man's horse, and found four dead soldiers, and three
propped against the wall, their features all changed, and they
neither saw, heard, nor spake, and their clothes were still
smouldering where the gunpowder had burned them. As I was looking
at them with pity, there came an old soldier who asked me if
there were any way to cure them; I said no. And then he went up
to them and cut their throats, gently, and without ill will
toward them. Seeing this great cruelty, I told him he was a
villain: he answered he prayed God, when he should be in such a
plight, he might find someone to do the same for him; that he
should not linger in misery.

To come back to my story, the enemy were called on to surrender,
which they did, and left the city with only their lives saved,
and the white stick in their hands; and most of them went off to
the Chateau de Villane, where about two hundred Spaniards were
stationed. M. the Constable would not leave these behind him,
wishing to clear the road for our own men. The castle is seated
on a small hill; which gave great confidence to those within,
that we could not bring our artillery to bear upon them. They
were summoned to surrender, or they would be cut in pieces: they
answered that they would not, saying they were as good and
faithful servants of the Emperor, as M. the Constable could be of
the King his master. Thereupon our men by night hoisted up two
great cannons, with the help of the Swiss soldiers and the
lansquenets; but as ill luck would have it, when the cannons were
in position, a gunner stupidly set fire to a bag full of
gunpowder, whereby he was burned, with ten or twelve soldiers;
and the flame of the powder discovered our artillery, so that all
night long those within the castle fired their arquebuses at the
place where they had caught sight of the cannons, and many of our
men were killed and wounded. Next day, early in the morning, the
attack was begun, and we soon made a breach in their wall. Then
they demanded a parley; but it was too late, for meanwhile our
French infantry, seeing them taken by surprise, mounted the
breach, and cut them all in pieces, save one very fair young girl
of Piedmont, whom a great seigneur would have. ... The captain
and the ensign were taken alive, but soon afterward hanged and
strangled on the battlements of the gate of the city, to give
example and fear to the Emperor's soldiers, not to be so rash and
mad as to wish to hold such places against so great an army.

The soldiers within the castle, seeing our men come on them with
great fury, did all they could to defend themselves, and killed
and wounded many of our soldiers with pikes, arquebuses, and
stones, whereby the surgeons had all their work cut out for them.
Now I was at this time a fresh-water soldier; I had not yet seen
wounds made by gunshot at the first dressing. It is true I had
read in John de Vigo, first book, Of Wounds in General, eighth
chapter, that wounds made by firearms partake of venenosity, by
reason of the powder; and for their cure he bids you cauterise
them with oil of elders scalding hot, mixed with a little
treacle. And to make no mistake, before I would use the said oil,
knowing this was to bring great pain to the patient, I asked
first before I applied it, what the other surgeons did for the
first dressing; which was to put the said oil, boiling well, into
the wounds, with tents and setons; wherefore I took courage to do
as they did. At last my oil ran short, and I was forced instead
thereof to apply a digestive made of the yolks of eggs, oil of
roses, and turpentine. In the night I could not sleep in quiet,
fearing some default in not cauterising, that I should find the
wounded to whom I had not used the said oil dead from the poison
of their wounds; which made me rise very early to visit them,
where beyond my expectation I found that those to whom I had
applied my digestive medicament had but little pain, and their
wounds without inflammation or swelling, having rested fairly
well that night; the others, to whom the boiling oil was used, I
found feverish, with great pain and swelling about the edges of
their wounds. Then I resolved never more to burn thus cruelly
poor men with gunshot wounds.

While I was at Turin, I found a surgeon famed above all others
for his treatment of gunshot wounds; into whose favour I found
means to insinuate myself, to have the recipe of his balm, as he
called it, wherewith he dressed gunshot wounds. And he made me
pay my court to him for two years, before I could possibly draw
the recipe from him. In the end, thanks to my gifts and presents,
he gave it to me; which was to boil, in oil of lilies, young
whelps just born, and earth-worms prepared with Venetian
turpentine. Then I was joyful, and my heart made glad, that I had
understood his remedy, which was like that which I had obtained
by chance.

See how I learned to treat gunshot wounds; not by books.

My Lord Marshal Montejan remained Lieutenant-General for the King
in Piedmont, having ten or twelve thousand men in garrison in the
different cities and castles, who were often fighting among
themselves with swords and other weapons, even with arquebuses.
And if there were four wounded, I always had three of them; and
if there were question of cutting off an arm or a leg, or of
trepanning, or of reducing a fracture or a dislocation, I
accomplished it all. The Lord Marshal sent me now hire now there
to dress the soldiers committed to me who were wounded in other
cities beside Turin, so that I was always in the country, one way
or the other.

M. the Marshal sent to Milan, to a physician of no less
reputation than the late M. le Grand for his success in practice,
to treat him for an hepatic flux, whereof in the end he died.
This physician was some while at Turin to treat him, and was
often called to visit the wounded, where always he found me; and
I was used to consult with him, and with some other surgeons; and
when we had resolved to do any serious work of surgery, it was
Ambroise Pare that put his hand thereto, which I would do
promptly and skilfully, and with great assurance, insomuch that
the physician wondered at me, to be so ready in the operations of
surgery, and I so young. One day, discoursing with the Lord
Marshal, he said to him:

"Signor, tu hai un Chirurgico giovane di anni, ma egli e vecchio
di sapere e di esperientia: Guardato bene, perche egli ti fara
servicio et honore." That is to say, "Thou hast a surgeon young
in age, but he is old in knowledge and experience: take good
care, of him, for he will do thee service and honour." But the
good man did not know I had lived three years at the Hotel Dieu
in Paris, with the patients there.

In the end, M. the Marshal died of his hepatic flux. He being
dead, the King sent M. the Marshal d'Annebaut to be in his place:
who did me the honour to ask me to live with him, and he would
treat me as well or better than M. the Marshal de Montejan. Which
I would not do, for grief at the loss of my master, who loved me
dearly; so I returned to Paris.




THE JOURNEY TO MAROLLE AND LOW BRITTANY. 1543


I went to the Camp of Marolle, with the late M. de Rohan, as
surgeon of his company; where was the King himself. M.
d'Estampes, Governor of Brittany, had told the King how the
English had hoist sail to land in Low Brittany; and had prayed
him to send, to help him, MM. de Rohan and de Laval, because they
were the seigneurs of that country, and by their help the country
people would beat back the enemy, and keep them from landing.
Having heard this, the King sent these seigneurs to go in haste
to the help of their country; and to each was given as much power
as to the Governor, so that they were all three the King's
Lieutenants. They willingly took this charge upon them, and went
off posting with good speed, and took me with them as far as
Landreneau. There we found every one in arms, the tocsin sounding
on every side, for a good five or six leagues round the harbours,
Brent, Couquet, Crozon, le Fou, Doulac, Laudanec; each well
furnished with artillery, as cannons, demi-cannons, culverins,
muskets, falcons, arquebuses; in brief, all who came together
were well equipped with all sorts and kinds of artillery, and
with many soldiers, both Breton and French, to hinder the English
from landing as they had resolved at their parting from England.

The enemy's army came right under our cannons: and when we
perceived them desiring to land, we saluted them with cannon-
shot, and unmasked our forces and our artillery. They fled to sea
again. I was right glad to see their ships set sail, which were
in good number and good order, and seemed to be a forest moving
upon the sea. I saw a thing also whereat I marvelled much, which
was, that the balls of the great cannons made long rebounds, and
grazed over the water as they do over the earth. Now to make the
matter short, our English did us no harm, and returned safe and
sound into England. And they leaving us in peace, we stayed in
that country in garrison until we were assured that their army
was dispersed.

Now our soldiers used often to exercise themselves with running
at the ring, or with fencing, so that there was always some one
in trouble, and I had always something to employ me. M.
d'Estampes, to make pastime and pleasure for the Seigneurs de
Rohan and de Laval, and other gentlemen, got a number of village
girls to come to the sports, to sing songs in the tongue of Low
Brittany: wherein their harmony was like the croaking of frogs
when they are in love. Moreover, he made them dance the Brittany
triori, without moving feet or hips: he made the gentlemen see
and hear many good things.

At other tunes they made the wrestlers of the towns and Villages
come, where there was a prize for the best: and the sport was not
ended but that one or other had a leg or arm broken, or the
shoulder or hip dislocated.

There was a little man of Low Brittany, of a square body and well
set, who long held the credit of the field, and by his skill and
strength threw five or six to the ground. There came against him
a big man, one Dativo, a pedagogue, who was said to be one of the
best wrestlers in all Brittany: he entered into the lists, having
thrown off his long jacket, in hose and doublet: when he was near
the little man, it looked as though the little man had been tied
to his girdle. Nevertheless, when they gripped each other round
the neck, they were a long time without doing anything, and we
thought they would remain equal in force and skill: but the
little man suddenly leaped beneath this big Dativo, and took him
on his shoulder, and threw him to earth on his back all spread
out like a frog; and all the company laughed at the skill and
strength of the little fellow. The great Dativo was furious to
have been thus thrown to earth by so small a man: he rose again
in a rage, and would have his revenge. They took hold again round
the neck, and were again a good while at their hold without
falling to the ground: but at last the big man let himself fall
upon the little, and in falling put his elbow upon the pit of his
stomach, and burst his heart, and killed him stark dead. And
knowing he had given him his death's blow, took again his long
cassock, and went away with his tail between his legs, and
eclipsed himself. Seeing the little man came not again to
himself, either for wine, vinegar, or any other thing presented
to him, I drew near to him and felt his pulse, which did not beat
at all: then I said he was dead. Then the Bretons, who were
assisting at the wrestling, said aloud in their jargon, "Andraze
meuraquet enes rac un bloa so abeuduex henelep e barz an gouremon
enel ma hoa engoustun." That is to say, "That is not in the
sport." And someone said that this great Dativo was accustomed to
do so, and but a year past he had done the same at a wrestling. I
must needs open the body to know the cause of this sudden death.
I found much blood in the thorax. ... I tried to find some
internal opening whence it might have come, which I could not,
for all the diligence that I could use. ... The poor little
wrestler was buried. I took leave of MM. de Rohan, de Laval, and
d'Estampes. M. de Rohan made me a present of fifty double ducats
and a horse, M. de Laval gave me a nag for my man, and M.
d'Estampes gave me a diamond worth thirty crowns: and I returned
to my house in Paris.




THE JOURNEY TO PERPIGNAN. 1543


Some while after, M. de Rohan took me with him posting to the
camp at Perpignan. While we were there, the enemy sallied out,
and surrounded three pieces of our artillery before they were
beaten back to the gates of the city. Which was not done without
many killed and wounded, among the others M. de Brissac, who was
then grand master of the artillery, with an arquebus-shot in the
shoulder. When he retired to his tent, all the wounded followed
him, hoping to be dressed by the surgeons who were to dress him.
Being come to his tent and laid on his bed, the bullet was
searched for by three or four of the best surgeons in the army,
who could not find it, but said it had entered into his body.

At last he called for me, to see if I could be more skilful than
they, because he had known me in Piedmont. Then I made him rise
from his bed, and told him to put himself in the same posture
that he had when he was wounded, which he did, taking a javelin
in his hand just as he had held his pike to fight. I put my hand
around the wound, and found the bullet. ... Having found it, I
showed them the place where it was, and it was taken out by M.
Nicole Lavernot, surgeon of M. the Dauphin, who was the King's
Lieutenant in that army; all the same, the honour of finding it
belonged to me.

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