(Automatic transcript - may present inaccuracies)

>> I'd like to tell you that it is the plan of the committee to publish in book form the papers delivered at this institute. The second speaker of the morning received his medical degree at the University of Leipzig. He is an authority on [inaudible] Arabic medicine, and the history of disease. He's at the present time an associate professor of history of medicine at Johns Hopkins University. It's my privilege to introduce Dr. Owsei Temkin.

[ Applause ]

>> Owsei Temkin: Mr. Chairman, ladies, and gentlemen. The history of the modern antibiotics is usually presented as following the rise of technology and chemotherapy. This approach is undoubtedly correct in as far as modern antibiotics are defined as chemical substances obtained from an organism and antagonistic to a [inaudible] organism. The definition presupposes a knowledge of organisms as causative agents of disease, which means factorial knowledge. [Inaudible] it presupposes a highly developed signs of chemistry. The history of the antibiotic in this strict sense will be discussed this afternoon and shall not concern us here. Yet, the antibiotic remedies also have a wide historical background. Antibiosis is the antonym of symbiosis and means the antagonism of two organisms. In this sense any organism or a substance produced by it, which harms another one, acts as an antibiotic regardless of whether we have any insight into the [inaudible]. If somebody applies a colony of Penicillium notatum upon an infected wound he uses antibiotic treatment, though he may be simply recommending the application of [inaudible] on a pass coming sore and he cried ignorant of the nature of the remedy and the process of infection. In this sense antibiotics haven't passed. The interest roused by the miraculous attacks of penicillin stimulated the search for always or use of antibiotics and the number of instances have been record. I may here cite an example from [inaudible] written around, shall we say, 1780, [inaudible]. The passage reads as follows, and I quote 17th Century in this translation. But the rotten stuff like [inaudible], which is gathered out of old wood and stalks of trees, being laid upon them --

[ Inaudible Speaker ]

It does also states [inaudible] which means spreading [inaudible], being netted together with a like quantity of [inaudible] and wine is also being beaten small, put into linen, and so applied. Those qualities does not speak about the wood [inaudible] organisms involved. Nor [inaudible] enquire here into the nature of the product or its possible efficiency if applied to infected wounds. In the present context it surprised us to note that [inaudible] recommends rotting wood for the treatment of putrid sores and [inaudible] follows him with a [inaudible], rotten wood, and especially that which has a [inaudible] and cleansing faculty, like the elm tree, [inaudible], and closest, moist sores. In the 16th Century [inaudible], the famous commentator of [inaudible] had this to add. "Indeed, the rotten part of [inaudible] and wasting wood should not be entirely neglected since it possesses such a powerful faculty that it [inaudible] and heals up ulcers and stops [inaudible]. It becomes more efficient by being collected from the wood of trees that have an astringent as well as cleansing power. For this reason [inaudible] will easily excel to [inaudible] since it cures not only ulcers that heal easily, but also those which are supposed to be of an evil character and have been induced by the French disease. Thus, it's sprinkled on the corroding ulcers of the genitals, it heals them miraculously. Besides, not only the mold or rottenness of wood has come into medicinal use but it will relief plenty the wounds to which originate in the rotten trunks of trees and so on. [Inaudible] probably was led to this [inaudible] remedy because of the statements of [inaudible] and the widespread use of [inaudible] in the 16th Century. Since today we do ascribe such powers to [inaudible] we may receive his grace with a good deal of skepticists. Whether or not the remedy in reality has the promised effect or any effect at all we cannot tell without having tested it. But at the moment, we are not interested in placing possibly antibiotics in the old literature. We merely wish to ask whether decaying wood, since recommended by Galen, may be called a Galenical, and whether the same really relates to another possible antibiotic, yeast -- seen in a paragraph on 11, Galen says that it draws up things from deep down and digests them, commonly referring to [inaudible]. Galenicals must obviously include the drugs used or recommended by Galen, the great physician of the Second Century, after whom they are named. On this basis we have been dealing with two Galenicals. If we use popular definitions Galenicals refer to vegetable samples used alone or compounded with other drugs in relatively simple preparations. In that case, we might even go as far as to include Fleming's penicillin [inaudible] of 1928-29. The chemical process of concentration and petrification would then appear as the [inaudible] that takes antibiotics out of the class of Galenicals. In principle, the difference would be about the same as that between opium and a chemically extracted opiate. Or between digitalis tincture and, let us say, digitoxin. While such a view is [inaudible] correct it misses a deeper understanding of both antibiotics and Galenicals. Antibiosis is a phenomenon that was observed in the outer world that is without reference to the human organism. The great achievement of antibiotic research that [inaudible] being said was the concept that the molecular weapons used by bacteria, I quote, "Could be appropriated by man and transfer from the macrocosm to the microcosm." Historically speaking the [inaudible] of microcosm plays a much greater role in the ancient ideas of cosmic sympathy and antipathy, and even more so in the medical philosophy of [inaudible] than it does in Galen's thinking. On the other hand, the popular definition of Galenicals is a mere convention originating from the clash between Galenists and adherence of [inaudible] in the 16th and 17th Centuries. In the 1832 edition of Blankoff's [assumed spelling] medical dictionary we have the following entry. Galenical medical events is the name given to first all samples of whatever kingdom and second, all compounds which meet only relatively simple preparation, for instance, [inaudible] and infusion. Those compounds which are prepared [inaudible] are called [inaudible] or chemical medical events. As is to be expected, the editor, Dr. Koon [assumed spelling] an eminent authority on Galen, was right in allowing samples from all three kingdoms, vegetable, animal, and mineral, alike. Galen himself in the preface to the ninth book of his work on the temperament and power of simple drugs, writes, "All that concerns the parts, roots, juices, and liquors of plants has been said before. Now it is our aim to go through with the remaining drugs, those produced by mining and the kinds of [inaudible] itself. Afterwards, something will also be said about the parts of animals in as far as we use them for drugs for healing." And in third chapter healing with metallic drugs Galen remarks, "Physicians are want to call metallic drugs those which originate in the mines by spontaneous growth or by means of the [inaudible]. There have to be added as a third group those which men make out of the [inaudible] in whatever way. For instance --

[ Inaudible Speaker ]

The composition of these drugs is not well-known. To be sure, Galen, by preference, used vegetable remedies and was very cautious with respect to mineral drugs, especially their internal use. Yet there was no sharp line drawn against chemical preparations and with advance of chemistry during the Middle Ages and the Renaissance new chemical drugs were accepted. [Inaudible] emphasis on the superior nature of chemical preparations, this claim that the chemist should prepare the [inaudible], the potent healing essence in drugs. Mineral, vegetable, animal alike, this together with this advocacy of poisons caused the cleavage between Galenists and [inaudible]. Now it was that Galenicals in the conventional sense became known in [inaudible] distinction to the chemical remedies. Obviously then Galenicals stood for the medical system, a system which I'll now try to analyze with reference to therapy. For this purpose we shall begin with a brief outline of Galenic pharmacodynamics and shall test their implications against later developments. The true outlines of Galen's of pharmacological system are so well-known that we need merely refresh our memory. Its roots can be found [inaudible] signs, the documents professed in certain Hippocratic writings, and a vast body of empirical material inherited from previous centuries. From Aristotle, Galen accepted the theory of the four qualities, moist, dry, cold, and warm constituting all bodies both dead and alive. The mixture of these qualities determines man's temperament as a whole, as well as the temperaments of the various body parts and organs. Since the four [inaudible] of the body will respond to the four combinations of the qualities their harmonious mixture brought this proportion can also be expressed in qualitative terms. The head cold, for instance, is characterized by a super-abundance of phlegm, which [inaudible] is cold and moist. It is therefore a cold and moist disease, as are all diseases due to phlegm. This theory of disease enables Galen to find the indication for the treatment of a disease by invoking the famous Hippocratic formula [inaudible]. Disease is cured by bringing the [inaudible] mixture back to normal. And this is done through remedies whose qualities are opposed to the disease. Our cold, which cited as an example, would have to be treated by warm and dry remedies. Perhaps going to bed and drinking a glass of malt wine. Galenic pharmacology as a science is to a large extent the finding of the qualities of the so-called [inaudible]. Now, how well they [inaudible]? As an example, let us follow Galen's attempt at elucidating the qualities of vinegar. Dressings with vinegar if applied to healthy parts of the body seemed cold at first, warm afterwards. Consequently vinegar is cold, but also to some degree warm. This is important because Galen tried to establish the degrees for all together of intensity to which the qualities were present in the drugs. Thereby it became possible to combine samples so as to achieve a well-calculated total effect. But to return to our example, testing of vinegar in the healthy is not enough' it must also be tested in the multi-conditions to find whether it really has a cooling effect. I quote from Galen now. When a person is burnt, by the application of pepsia [assumed spelling] -- badly covered I find in dictionary, it doesn't mean much to me, anyway, it's a vegetable part -- upon the skin, vinegar relieves the burning heat. And whoever wishes can learn this by experience, as we did ourselves in making an exact paste of the power of the drug. We anointed our shins in many places with pepsia and when after four or five hours they began to burn and to be inflamed we sprinkled vinegar on one place, water on another, olive oil on a third, we anointed a fourth with rose oil, and others with substances which we believed capable of blunting sharpness or of cooling heat. And the vinegar was found to be more active than any of these. I hasten to add that I am fully aware of the fallacy of these experiments. The main point is to note for later reference that Galen did a big experiment and to indicate the main feature of Galenic pharmacology, which I trust has become clear, namely the complimentary nature of disease and drug. The nature of the drug is established relative to the human body. The drug is supposed to bring out a change in the human body because the disease, too, is a change of the body, an abnormal condition, not an independent entity. A statement like this has little meaning until some of its consequences become clear. The easiest way of achieving this is perhaps to mention the difference between an apothecary and a physician. It's a familiar occurrence to see a man in drug store ask for a remedy against his [inaudible]. The apothecary will sell him something directly [inaudible] his complaint. There was a good fear of the apothecary in Galen, some of whose pharmacological work simply lists prescriptions for various diseases and symptoms. But the physician Galen, as he presents himself in his medical work, especially in his method of therapy, knew better. A disease is not only a change of the body but also a change of this particular of body. The physician must, therefore, in his treatment take account of the peculiarities of the case, which means the physician only should treat. We may hear quote from a letter Galen wrote to the father of an epileptic child, outlining the treatment the boy should follow. A large part is devoted to the dietary regimen. Finally, Galen mentions a remedy prepared from [inaudible] and expresses the hope that the disease, unless very severe and hardened, will cede completely in 40 days through this drug. He claims to have cured numerable children in this way. Now it looks as if Galen, too, is set upon curing a disease, epilepsy, by a specially prepared drug. Therefore, the [inaudible] he gives to the matter a little later is all the more interesting. Not only must the ingredients of the prescription be adapted by the attending physician but it is necessary to change [inaudible] everything else which has been mentioned according to the daily condition of the body [inaudible] all other diseases, too. The whole character permeates in the statement as all the best physicians have agreed that drugs are rather the means of assistance than assistance itself. We can, perhaps, make the Galenic principle of individualized treatment clearer by citing remarks of two physicians of the 15th, 16th Century. Leone [inaudible], possibly a teacher of [inaudible] and [inaudible] himself, concerning the treatment of syphilis. Leone [inaudible] was a Galenist and a humanist. His booklet on the disease is long as well as steeped in the tradition of finding a variety of treatments that will allow adaptation through the symptoms. His concern about the practice already involved, as I infer, to apply [inaudible] the alleged specific, indiscriminately. "Let doctors beware," Leone [inaudible] writes in 1497, "lest [inaudible] of a bad cobbler who tries to fit everybody with the same shoe, they also [inaudible] to cure the French disease in everybody with the same medicine." [Inaudible] outburst comes about 40 years later. It sounds somewhat similar, yet has a different twist. "You know [inaudible] medical contemporaries that [inaudible] is nothing but poison and daily experience proves it. Now you have this in use. You anoint patients with it, much more thickly than a cobbler anoints leather with grease. You fumigate with it, [inaudible]. You wash with it, [inaudible], and do not wish people to say this is a poison. Yet it is poison and you introduce such poison into man. And you say it is healthful and good. It is corrected with white lead, just as if it were not poison. For you know not the correction of [inaudible], nor its dose, but you anoint with as much as will go in." Unless I'm mistaken, [inaudible] indictment is not directed so much against lack of individualization as against ignorance of the true way of making a poison, [inaudible], act as a drug. In modern language Leone [inaudible] objects to standardization of treatment, while [inaudible] objects to bad and ignorant standardization. We have chosen examples pertaining to the history of syphilis because of its close connection with the development of specific therapy, chemotherapy, and antibiotic drugs, as indicated by [inaudible], and penicillin. Yet not only the treatment but the disease itself has provided the testing ground for the Galenic views. Its real or alleged novelty makes syphilis, more than any other disease, appear as an entity and led to the development of what we call the ontological concept of disease clearly and problematically formulated by [inaudible]. In the final analysis the ontological concept of disease suggests a therapy that is directed against the disease. [Inaudible] believed disease to be [inaudible] diseases, to be reactions of the body to [inaudible] causes which determine the species of [inaudible] diseases. In as far as they are reactions, diseases represent an attempt of nature at a cure. The physician should support nature in this attempt and the knowledge of the manifestations of the various diseases will lead to a methodical treatment. But this methodical treatment is not the ideal one. Nature can err, and the [inaudible] reaction at best is debilitating. Ideally it should be possible to shortcut the whole process by finding specific remedies that would destroy the disease species direct. According to [inaudible] only one such specific remedy was known, namely the [inaudible], the [inaudible] without [inaudible] of [inaudible]. Nevertheless, [inaudible] writes, I have no doubt but that out of the abundant plentitude of [inaudible] for the preservation of all things where with nature burdens and overthrows and that under the command of the great and most excellent creator. [Inaudible] also has been made for the cures of more serious diseases which afflict humanity and that [inaudible] and with every [inaudible] it is to be [inaudible] that the nature of [inaudible] is not more thoroughly understood by us. In my mind [inaudible] from all the rest of the material [inaudible]. They offer also the most reasonable hopes for the discovery of remedies of the [inaudible]. The parts of animals are too like those of the human body. Minerals are too unlike. That minerals however are more energetic and satisfying [inaudible] than either of the two other disease remedies and the difference in character is the reason for their doing so, I really confess. Still, they are not specific remedies in the sense [inaudible] explained [inaudible] expects of the plentitude of nature to help provide with each man's country for a specific [inaudible] to cure any major disease. Here in [inaudible] the Galenicals, in the conventional sense even, [inaudible]. This morning I read an inscription which may be translated as follows. The things which have been perfected by nature are better than the things which have been perfected by art. I think that [inaudible] would have subscribed to this statement. But as we [inaudible] the conventional concept of Galenicals must not necessarily harmonize with Galen's material [inaudible]. In spite of his deep veneration for nature Galen does not [inaudible] that the [inaudible] plants contained wonderful virtues ordained to heal every man until God had commanded his [inaudible]. Perhaps simply because the cleavage between God and nature did not exist for the Pagan Galen so that he could not see things this way. As far as I can presee the idea of plentitude, which as professor [inaudible] has shown, played a major role in [inaudible] philosophical and scientific thought, was of little importance to Galen. It is not our concern to find out where [inaudible] received his views. We have but to ask whether there are any Galenic elements in them, particularly in the assumption of a specific healing virtue directed against the species of the disease. The question allows us to mention an important pharmacological principle of Galen's, namely his belief in the action of drugs as proof [inaudible] of [inaudible] substance. This principle is quite different from that of the active qualities which we've considered so far. It is irrational as Galen makes clear the following words. [Inaudible] that are vested in the [inaudible] of the whole substance have been shown to [inaudible] and reason and can be known to experience [inaudible]. For we do not know why this stone, and he speaks of the so-called [inaudible], when brought in contact with a bleeding wound stops the hemorrhage. Both Galen and [inaudible] list many substances, the alleged action of which rests on experience only and can be explained no more than the magnetic property of the lodestone, the [inaudible] of [inaudible]. And since experience devoid of reason is an easy prey to superstition many of these substances [inaudible] as superstitious. On the other hand, the belief in the existence of pharmacological properties that would yield their secrets to experiment only was a powerful stimulus. It accounts for the mixture of superstition and experimental theory that we find in the therapeutics of the Middle Ages, the 16th and 17th Century. Now this idea of action by virtue of a body's whole substance was increasingly misused to account [inaudible] explicable phenomenon until it was really cured by [inaudible] in the famous [inaudible] of the [inaudible]. The candidate is asked for the cause and reason [inaudible] puts people to sleep, and he readily answers --

[ Speaking in Foreign Language ]

Now these lines have been quoted again and again to ridicule a medical science that explained the narcotic power of opium by its narcotic virtue. But be it noted that the quotation should not be directed against Galen, who ascribed to opium a highly cooling effect that could lead to stupor and death. Therefore, he adds, it calls upon the physician to use it properly by mixing it with drugs that weaken the power of the cold quality. This brings us back to the question as to whether [inaudible] for a specific [inaudible]. In answer, we may say, that although Galen admitted specific actions of drugs he did not go as far as to put too great a reliance on them. To him the methodical search for the qualitative principles that would change the abnormal condition of the body [inaudible] disease itself was a condition of man not a reaction to a specific [inaudible] influence made itself [inaudible] at a time when the Galenic system as a distinct body of medical doctrines was losing credit. This was due to the overthrow of Aristotelian Physics by the new physical and chemical sciences. As soon as metal was no longer see in terms of qualities, the Galenic system lost its presupposition. In medical therapy this application left a void for nearly 200 years. To be sure, the struggle with the chemists was now over. New drugs were added and many superstitions were discarded together with [inaudible]. Physicians tried to gather experiences as best they could, but for the rest [inaudible] or one-sided systems alternated with skepticism. There are some illuminating data available. The following data's has been calculated for the inmates of a hospital in 1798, when this hospital was under the influence of the so-called [inaudible] system that classified [inaudible] as either [inaudible] or [inaudible]. There [inaudible] 80 patients [inaudible] consumption of drugs in grams average as follows. Opium 3.6, camphor 11.7.

[ Inaudible Speaker ]

7.92. [Inaudible] 31.6, and similar allowance of [inaudible] ethyl acetate and other drugs which are considered either as stimulants, tonics, or otherwise [inaudible] patients. [Inaudible] forget the use of more than 500 grams of [inaudible] brandy. [Inaudible] recommended [inaudible] by a minute analysis of the effects of drugs. From the voluminous work of Dr. [inaudible] entitled Systematic Presentation of the Pure Medicinal Effects for the Practical Use of Homeopathic Physicians , I quote here a list of symptoms relating to cold sensations of the -- on the head, together with the drugs supposed to cause them, and that's only a partial list of this particular effect. A cold sensation on a small spot on the forehead as though someone were touching him there with a cold thumb [inaudible]. An icy cold sensation on the upper-half of the head when he puts his head on [inaudible]. A feeling of cold on a small area around the crown of the head accompanied by the hair standing on end [inaudible]. A feeling of cold on the hair [inaudible]. Simultaneous sensations of heat and cold on the head accompanied by sensitivity of the hair [inaudible]. Slight shuddering of the hairy part of the head followed by a burning itch of the integuments of the hair. This itching decreases after touching but only to return with increased intensity [inaudible]. The head feels as if it were blown upon by a cool, gentle breeze [inaudible]. This was written in 1826. Thirty years later [inaudible] and [inaudible], the authors, are [inaudible] French material [inaudible] middle of the 19th Century, still admitted that therapeutics and material [inaudible] were in the chaos of a transition and the existence of therapeutic [inaudible] testifies to the truth of this statement no less than to the various medical sects flourishing in this country. Scientific medicine was making great advances especially in pathology. But anatomical [inaudible], which pathology followed, was therapeutically speaking, in the direction of surgery. The development led to later on to [inaudible] pharmacology, that of much less spectacular nature. Beginning with morphine, several vegetable alkaloids were isolated in the early part of the 19th Century, the effect of which could be studied experimentally. As a result it was shown the Galenicals contained a number of substances active in various directions. This in itself was a victory of [inaudible] idea of extracting the [inaudible] from the [inaudible]. Indirectly and slowly the increasing [inaudible] that chemistry gained over [inaudible] changed its industry aspect, too. [Inaudible] an apothecary had been compelled to be its own chemical manufacturer, the [inaudible] of 1827 allowed him to by chemicals, which can be [inaudible] genuine form industry plants, and the preparation of which by the apothecaries is not without some danger and inconvenience. In 1862 the same apothecary was not even forced any long to prepare [inaudible] Galenicals. As a result, the Galenicals, in the conventional sense, lost their privilege of [inaudible] drugs and they were increasingly replaced by [inaudible]. The physician lost his interest in botanical studies, he became dependent on information supplied by manufacturers. [Inaudible] formally want to compose individualized prescription from a relatively small number of drugs, largely simple, [inaudible] from the prescription of medicine standardized as to dosage and mode of application. Under these circumstances it is very difficult to confirm or deny connections between Galenic ideas and the new medical treatments that evolved in the late 19th Century. For instance, the statement that pharmacology has for its object [inaudible] and study of all changes which a foreign body can undergo or produce otherwise [inaudible] in the organism would agree perfectly well with Galenic principles. It is taken from the experimental pharmacology by Herman, who, like his more famous French contemporary [inaudible] investigated the action of drugs experimentally. "It may be right," he said, "but this man tried to make pharmacology fit into pathological physiology, thus continuing in Galen's footsteps." But with equal justice one may point out the methodological differences that divide Galenic and model science and experimentation. Or should we claim anti [inaudible], or liver therapy to be Galenical because Galen, too, used antidotes and animal substances. These are formal analogies which, I am afraid, will not lead us very far. However, we have not yet completed our study of Galenism in medicine. Indeed, we omitted one of its most important features. Namely the latitude Galen allowed for health. According to Galen disease is present only when man's functions, biological as well as social, are in [inaudible]. In between the ideal disposition of the person in perfect health on the one hand, and disease on the other, there exists a wide area extending from relatively good to relatively poor health. The existence of this area allows the Galenic physician to promote health activities, since to him it is not the mere absence of a disease. This implies that everybody must constantly watch his health since it is always [inaudible] to a wrong manner of life. At last, we have reached a point where we can rightly claim Galen [inaudible]. The slogan of positive health presupposes a more or less health beyond the fair alternative of healthy or sick. Our growing emphasis on preventive medicine, too, begins to example the constant concern over health of the Greek medicine. But if there is similarity where personal hygiene is concerned, there is also a discrepancy in [inaudible] medicine, especially in the branch which, next to surgery, has to celebrate most spectacular triumphs, the cure of infectious diseases. [Inaudible] seeds of contagion and secondhand species of disease have become visible in the form of [inaudible] microorganisms and can now be [inaudible] by magic bullets to use [inaudible] in an extended way covering the various [inaudible]. But the aim of using drugs against [inaudible] of disease that come from outside seems to meet even more foreign [inaudible] medicine than treatment of a disease entity instead of a changed body. To be sure, Galen used [inaudible] and fewer antidotes against poisons but the undeveloped doctrine of infection points out the difference. The existence of infectious diseases was known [inaudible] to destroy [inaudible] in the air, and aromatic substance is used to counteract that. But these are measures of public health and preventive medicine so-to-speak. [Inaudible] with the avoidance of bad food and healthy [inaudible]. The treatment of it on the other hand occurs [inaudible] most like that of other places. The fluid boundary between health and disease is paralleled by a fluid relationship of food and drug in [inaudible]. A substance is food as far as it is assimilated by the body, but a drug in as far as [inaudible] the body. Galen's material [inaudible] is integrated into his whole system. Dietetic medicine regulates man's life in all its aspects because he sees the deviation from right living. As for magic bullets, well, the Galenical [inaudible] would never have gone straight to the [inaudible]. But more important, when the [inaudible] of the weapon seems to be the lack of intent to cure disease by shooting at its [inaudible]. We have now come back to the modern drugs including the antibiotics we started with. We raise the question as to the relationship of antibiotics and Galenicals and [inaudible] the answer be dependent upon a proper understanding of the term Galenical. In the quest for such understanding we are led to an evaluation of [inaudible] principles against the background of more recent use. Some of these principles are still valid [inaudible] today, others are not. As to our initial question we can now say that antibiotics are not [inaudible] Galenicals. In how far they fit into another historical pattern may become clearer after we have heard the next speaker and have listened to [inaudible] to the account of [inaudible]. Our answer will hardly cause surprise, and since Galenicals and Galenism are not in favor today it will not cause resentment either. On the contrary, we may be asked why such a long [inaudible] to reach the obvious. Let us answer this question by raising another one. Why has Galenism in medicine become a world of [inaudible]? Because I imagine the fear it was a system full of errors that subjugated generations into blind adherence until medicine finally got rid of it. I doubt that medicine has got rid of it. To be sure, the system must change and reform part by part until it's lost all resemblance to the original. [Inaudible] reform [inaudible]. But it was Galen who had made [inaudible] an integral part of medicine. Partly [inaudible] physiology. But it was Galen who had bequeathed experimentation to medicine. The [inaudible] chemists and [inaudible] eliminated Aristotelean Physics from medicine. But it was Galen who had integrated into medicine what went for Physics and Chemistry in his time. I need not repeat what happened to Galenic pharmacology nor elaborate the fact that new ideas were added to medicine that are [inaudible] today. In short, since the Renaissance medicine step by step has renovated its house and built new wings, tearing down old ones. But the house itself is still there. It has never been raised, though hardly any of the old bricks remain. The memory of [inaudible] accounts for our enmity, as well as for our illusion that Galenism is dead. What is Galenism? What would Galen himself have defined as Galenism? He says again and again, with great emphasis, and states it as his fundamental conviction, that the two [inaudible], as he says, of medicine are reason and experience. We may reason and experiment differently. Until we deny the validity of his conviction, in this sense and in this sense only, we are still Galenists. Profess modern beliefs and practices against Galenism, therefore, means bringing our deposition within the development of scientific medicine.

[ Applause ]

>> I'd like to make two announcements. At the conclusion of the morning session the lunch will be served in the President's Gallery, which is on the ground floor to the right of the entrance. Also, before going to lunch we have plan -- we have arranged to take a picture of the group, which will be taken down in the Rare Book Room. And to gain this room there's an exit right on the south wall right near the exit to this room. If you walk down one and a half floors and then turn to your right. The concluding speaker for the morning session is [inaudible] historian. He taught history at Northwestern University and at Western Reserve. He joined the Columbia Faculty in 1924 as a Professor of History. He's a member of many American and European historical and literary societies, a past president of the History of Science Society, and Honorable President of the New York History of Science Society. He's at the present time Professor Emeritus of History at Columbia University. And it is indeed an honor to introduce to you Professor Lynn Thorndike.

[ Applause ]

>> Lynn Thorndike: Good morning ladies and gentlemen. The collection of man as a microcosm of the universe even today characterizes the medicine from the far eastern lands as [inaudible] publication two years ago in Zurich of a book in German and the medical philosophy of a man as a microcosm in Tibet. The purpose of my paper is to show this doctrine still prevailed in Western Europe in the 17th Century. Briefly stated the doctrine is that man is a little world and [inaudible], member from member, faculty from faculty, with the universe. [Inaudible] with the Earth on the one hand and the heavens on the other. That all nature [inaudible] governed by the movements of the heavenly bodies. That exists no longer, [inaudible] before the 17th Century from that [inaudible]. I [inaudible] few specimens of this belief in the microcosm and we'll begin with three Frenchmen. One of three philosophic discourses was George [inaudible] a physician [inaudible] Normandy, published there in 1503. It was entitled -- translating the French, "It's a passion of man of the world." He compares the rational soul with God, human faculties with the intelligences which move the heavens, the head with the heavens themselves, the heart with the sun, and the liver with the moon. At the first age of other animals is under the moon [inaudible] over human instances. The brain corresponds to planet Jupiter, the generative organs to Venus, the tongue to Mercury, the gall and spleen to Saturn and Mars. [Inaudible] further relates the hair to the fixed stars and other parts of the human body to the signs of the Zodiac. But he adds that some give the eyes to sun and moon and ears to Mars and Venus, the nostrils to Jupiter and Saturn, and the mouth to Mercury. Man further comprehends the elements, meteors and minerals, plants and animals, and in the little world within the great there is republic, aristocracy, and monarchy, and cities with all sorts of citizens or artisans and instruments to play each trade. A much more exhaustive and likewise exhausting treatment on the analogy of the microcosms and the macrocosms, was turned out by Nicholas Manserus [assumed spelling] of [inaudible], physician to Lenore [inaudible] in 1611. It stretches to 13 books and 2232 columns in folio, and numerous quotations from the classic and church fathers in large capital letters cut off by leaving his face blank above and below each quotation. Indeed most of the text has little to do with the analogy of microcosm and macrocosm, which largely serves as a screen board for repeated dyes into a sea of quotations and opinions. However, we may briefly indicate the main thread of the work. The subject is said to be treated theologically, physically, medically, historically, and mathematically. After [inaudible] 44 columns on God the first book deals with the analogy of man with God, of the soul with [inaudible], the head with the sky, and the seven conjugations of nerves in the seven planets. Book two preach of the spirits of the human body in particular and the miracles of air and fire. The third book is [inaudible] and the analogy of parts of the human body with it, [inaudible] a few columns on theme of sleep and waking. Book four proceeds to esophagus and diaphragm. By book seven I reached the sexual organs with discussion of various problems of generation. Book eight considers the arms and hands the digression to [inaudible]. Later on Manserus points out the analogy of the four humors of the human body with [inaudible] waters and with the four elements. The Jesuit Pierre Bourdin, who lived from 1595 to 1653, and came from [inaudible], taught [inaudible] for seven years and mathematics for 25 years -- 22 years, that left [inaudible] in Paris. Besides a number of works in mathematics and related subjects he published together in 1646 a work on the [inaudible] flame and [inaudible] on microcosms and macrocosms. The three chief fluids in the microcosms were [inaudible], venoblood, and arterial blood. In the macrocosm, water, air, and fire. [Inaudible] of fluid in the small world were the mouth, stomach, mesentery, spleen, liver, right sinus of the heart, lungs, and left sinus of the heart. Those of the great world were Saturn, Jupiter, Mars, Venus, Mercury, the moon, [inaudible] globe, and the heart of the world once the flame of the sun bursts forth as vital spirit does from the heart of man. Solar spirits were charted the western [inaudible] spirit of planets. These solar spirits were changing the celestial spirits, which were then distributed through the world. As vital spirits corresponded to solar, so animal spirits correspond to the celestial. Air was equivalent to the empirical heaven, and the human skin to the firmament. Brain, arms, and thighs parallel to starry spaces. Above the diaphragm was akin to planetary space. Below the diaphragm to the moon and Earth. We leave France for the Baltic and the [inaudible]. Franciscas [inaudible] in 1554, a Doctor of Philosophy in Medicine became Municipal Physician and Professor of Medicine at [inaudible]. In 1670, he had published a book on theory act with aggression on [inaudible] and weapon ointment. He died in 1617 and [inaudible] by him on the microcosm contains a letter addressed to him by Bartholomew Peckerman from [inaudible], dated January 12, 1608. A [inaudible] permission to publish in 1613 and a dedicatory epistle by [inaudible] on New Year's Day 1630 [inaudible]. Well the volume doesn't seemed to have been printed until 1638 at Leipzig, 21 years after [inaudible] death.[Inaudible] by the pastor of the church of [inaudible] speaks of the book as long and pressed, and now it last published. This work of [inaudible] although not quite so long as [inaudible], is like he has built quotations often in Greek or poetry. After two [inaudible] and a general introduction the relation of man to God is considered, and that fact that man is the image of the whole world. Next he showed how the heavenly bodies with their spears are expressed in man. How he exhibits the four elements and four [inaudible] qualities. How [inaudible] animate things, plants and animals, [inaudible] and represented by man. The sun puts before our eyes the nature of science. The erratic star shows a variety of opinions. Disease and plants and man correspond. We hear the geography of bees, the generosity of the lion, examples of gratitude and [inaudible]. But man alone regards the heavens. Even works of art are held to be contained in man, he is compared to a host and is [inaudible] a roof. [Inaudible] are depicted in him, political, ecclesiastical, economic. Even there [inaudible] has kind of stopped. There's an appendix on man himself being in man himself, a marvel, yet flu like experience. There's an appendicular, a little appendix, only approaching the end of both macrocosm and microcosm. Finally there's an epilogue, 120 pages on how man by consideration of the relationship between the two worlds may progress God [inaudible]. The microcosms of [inaudible] is called an evidently new work [inaudible] in the aforesaid [inaudible] of 1613. Although [inaudible] book on the same subject did come out in 1603, and the tremendous tomb of Manserus in 1611. [Inaudible] in his Hermes [inaudible] in 1612, comparing macrocosm and microcosm made the vessels of the heart cross parallel the rivers of paradise. The aorta corresponding to [inaudible] the vena cava to [inaudible] or the Nile, the [inaudible] arteriosus the Euphrates, and the arterial venosa to the Tigris. Astroman and the [inaudible] of life are like the sun [inaudible] the stars. Diversity of color, inanimate beams depends up diverse constitution of balsam. The seven planets correspond seven chief members or organs of the human body. [Inaudible] further replace the triple action of the soul, natural, vital, and animal by a seven-fold activity relating to the seven planets. The air is diffused through the entire body as balsam or ether is through the entire universe. Air maintains the parts of man's body as it sustains the spirit of Earth in a macrocosm. Hippocrates had this in mind when he called air the vehicle of the Earth. [Inaudible] the weight of his members because the arterial air within him. Another function of air is that balsam or star may live in it. As fire burns more freely when fanned by air, so the balsam in the microcosm is stronger, more vigorous when the air is clarified. And since there is no vacuum in nature, "who will assert there is no internal cavity without air?" [Inaudible] Younger and his general Physics are 1613, discussed the spirit of oil of sweet salt and its marvelous virtues in diseases of the microcosm. In 1619, [inaudible] and [inaudible] a Dominican which studied at Bologna and [inaudible] Verona, Camona, and Venice, published in the last name city not only [inaudible] concerning elementary universe but [inaudible] concerning the conservation of man, a small mixed universe, to a ripe old age. In it he displayed a favoring attitude toward [inaudible], including even moles or spots on the nails. In the same year Robert Flood, who two years before issued the first part of the macrocosm, added the second volume of Supernatural, Natural, [inaudible] Natural, and [inaudible] Natural History of the Microcosm . Man and the microcosm corresponded to three heavens. The intellect and the head to the [inaudible] heaven. Vitality and freewill in the heart and ether. The natural functions in abdomen, to the elemental spheres. The second volumes of medical dissertations at the University of Basel, also pointed in 1619, opened with a discussion of the winds of the microcosm, [inaudible]. Daniel Becker, [inaudible] the title Medicus Microcosmus , a work which first appeared at [inaudible] in 1622, and was dealt with remedies drawn either from a living human body or from the cadaver. John Despane [assumed spelling] handbook of restored Physics was first published in 1623, still retained the time-honored conception of man the microcosm. Another chemist of some note [inaudible] Gederick [assumed spelling] gave forth at Strasburg in 1627 a eulogy of the planets, celestial, terrestrial, macrocosm, and microcosm. Johannes Kromach [assumed spelling] who lived in 1585 to 1651 quoted [inaudible] against direct influence of the stars on man, yet still regarded man as a microcosm. The noted educational reform of [inaudible] still retained that conception. [Inaudible] who maintained relations with so many men of science of his time spoke of the parts of the third region of the microcosm. The most original, the [inaudible] chemical writer since [inaudible] wrote [inaudible]. But in my poor judgment a skin disease, herpes mordax [assumed spelling] does not come from the liver but from the influence of the planet Mars, which by virtue of its near aspect converts the bomb or the [inaudible] places of the [inaudible] into a mineral salt or a salt that he sees no hope of recovery from except in a planetary remedy, which would transplant the adverse radiations. Every recurring ailment, [inaudible] says, "Are the corrected -- are they connected with the moon or other heavenly bodies [inaudible] qualitative medicines. He therefore has little hope in the waters of [inaudible] and [inaudible] liver [inaudible]. Though both macrocosm and microcosm are ruled by the invisible and the [inaudible]. However, [inaudible] doesn't have the right planetary remedy at hand he may try touching the soil with a hand, one that has died a slow death, until the patient feels a great chill. On the other hand, Sebastian [inaudible] from 1673, [inaudible] having reduced the employment of talismans in medicine by disassociating [inaudible] macrocosm [inaudible] stars and making their force depend on man in the microcosm. [Inaudible], the Castro of Portugal, [inaudible] Professor of Medicine at University of Pisa dedicated the Grand Duke of Tuscany and worked on the media's of the microcosm, which [inaudible] in 1621. The idea suggested by this title went back at least to [inaudible], the idea of [inaudible] medicine, 1571. We already said that fevers, epilepsy, dropsy, [inaudible] caused by the [inaudible] in the great world. [Inaudible] in his first book demonstrated the conformity between the world and man. He held that there is a world soul, which represented the inquisition near approbation of his work [inaudible]. And pointed out the similarity between the world's soul and the human soul. The second book [inaudible] the origin of the microcosm has been correctly stated by previous writers. [Inaudible] human anatomy [inaudible] spirits are alive and treats [inaudible] signature of a microcosm. The third book [inaudible] microcosm and various kinds of fevers are compared to the fiery impressions in the universe. [Inaudible] how the fever is a quality or a substance [inaudible] concludes that all diseases are substances. [Inaudible] last book is miscellaneous in content. It first takes up the cure of fevers, then asks [inaudible] or antidote's for poison [inaudible]. Antidotes from gold and pearls are given as well from animals, plant, minerals in general. Fires of both of them -- another fire in media's are represented by such diseases as elephantiasis. Epilepsy, apoplexy, and paralysis are the liking of thunderbolts of the microcosm. And to discussing the nature and [inaudible] of winds in the great world, he turns to wind in the microcosm. Sweat is the inundation of the microscosm, [inaudible] rain, [inaudible] stones are considered. The same conception appeared again in the anatomy of the microcosm by J.F. Kozak [assumed spelling] a friend of [inaudible] in 1636, with chapters on meteors of the macrocosm, and both solitary and [inaudible] meteors of the microcosm. [Inaudible] narrowed the comparison of lightning and fevers in [inaudible] and [inaudible] had to fight at the winds. The harmony of the macrocosm or the microcosm, like Tobias Schutz [assumed spelling] caught positioned the electrogram [inaudible] who the [inaudible] is dedicated. Feared in Germany in 1654. The [inaudible] of the [inaudible] in his 35th year. And the [inaudible] is followed by [inaudible] with a male figure for the microcosm, a female for the macrocosm, surrounded by [inaudible] of Hermes [inaudible] and diagrams of the four elements and three [inaudible] and its principles. The first part of the text describes a superior and inferior world, while a second is devoted to astrological medicine, dealing successfully with Saturn [inaudible] diseases of the spleen and remedies for them, jovial liver complaints, marshal ailments of the gall, sole diseases of the heart, venous and kidney disease, [inaudible] in the lungs, and lunar diseases of the head. And an appendix should excuse himself for not adding as he intended to do a third part of harmonic cures, sympathy and antipathy and perhaps plantation of the disease. Also in 1654, appeared a work in English by Robert Turner entitled Microcosmus, A Description of the Little World , meaning a discovery of the body of man. The continued currency of the idea that man is a microcosm is seen in Johannes [inaudible] giving that title to a work in anatomy published at [inaudible] in 1660, again in 1662, and 1665, and at Leipzig in 1673. Similarly [inaudible] had published a [inaudible] hypochondriac microcosm in 1652, chilling a physiological and anatomical discourse on the misery of the microcosm in the absence of affection in 1658, and a work on the bones of the microcosm in 1669. And [inaudible] on the genesis of the microcosm, on the generation of the fetus in the womb in 1665. [Inaudible] microcosm [inaudible] of 1682 was the description of the parts of the human body embellished with new findings of this age. The conception of macrocosm and microcosm was retained, even exploited by the [inaudible] Father Francois [inaudible] in his book in French on the corruption of the great and little worlds which first appeared in 1666, enjoyed two more editions in 1668. But instead of stressing [inaudible] man, he affirmed the effect of human sin upon the macrocosm. The sun lost seven-eighths of its light. And before Adam's fall the moon was as brilliant as the sun now is. No rain fell until after Adam did. And all the Earth was a paradise. Although I might have suspected from the conditions [inaudible] had just asserted it would be hot as hell. And men were vegetarians. He goes on to speak of changes produced by the flood, such as the separation of the American continent from the rest of the world, and the ruins of monarchs and monarchies, of which the stars are perhaps signs rather than causes. But the number seven is fatal to [inaudible] and empires. [Inaudible] some astrologists who count 3000 years before the end of the world. The second part on the corruption of the little world by [inaudible] extravagances of imagination which resulted from sin and the vanity of dreams. Sin also produced disease and monsters, and since the [inaudible] there have been giants and pygmies. Furthermore the devil exercised pure tyranny over all the states of the world before the incarnation of the word. Christ coming freed the world from the tyranny of the devil, but sorcerers and witches still keep it in his power. Daniel Duncan, and MD in Montpellier, in his newer mechanical explanation of animal actions published in French and Paris in 1678, still retained the conception of macrocosm and microcosm. Saying that there's a sun and moon [inaudible] so in the other the brain and cerebellum were the two great luminaries. In other work, [inaudible] Montpellier in Paris two years later, they say that nature followed the rules of chemistry exactly in both microcosm and macrocosm. The microcosm was still a word that [inaudible] although it might be used without fully realizing all of its astrological implications, was shown by [inaudible] in tightening his work of 1680, Operations of Nitro Aerial [inaudible] in the Microcosm . Yet the book is full of illusions [inaudible] experiments and it was said with considerable exaggeration [inaudible] to speak of oxygen and oxygenation a century before [inaudible]. In the same year, 1680, [inaudible] poem which [inaudible] had written in 1672 on microcosm and macrocosm, to celebrate a friend's first anatomical exhibition. Another [inaudible], Johann Eberhard [assumed spelling], conducted a physical seminar on the [inaudible] on why its members were [inaudible]. We find the faces of the members of this seminar sternly set against [inaudible] but they still regarded man in the most [inaudible] mirror of the entire universe. At Venice in 1690, Francesco Manitti [assumed spelling] published a short treatise on [inaudible] man in the microcosm with a plate showing the relation of the signs of the Zodiac to the parts of the human body. The relation of the man to medicinal [inaudible] vegetable kingdom was also considered. After an appendix on navigation the work closed with a collection on archaic experiments. The Physiologia Medica of George Wolfgang [inaudible] first appeared in 1680. But even the second edition of [inaudible] 1704. He was unwilling to give up astrological medicine [inaudible] that stars all [inaudible] the temperament. [Inaudible] they produced marvelous change in the macrocosm, why should they not do so in the microcosm or human body? [Inaudible] is obvious in some diseases. [Inaudible] epilepsy for example could be predicted with certainty from unfavorable aspects of the planets. The humans were surely affected by the moon. [Inaudible] celestial forces were apparent not only in diseases but also in ability and character. As [inaudible] it was exposed to the rays of the heavenly bodies and received that disposition which they then exhibited. Not everyone in the 17th Century accepted the doctrine of the microcosm and macrocosm. Daniel Senate [assumed spelling], 1572 to 1637, still believed [inaudible] qualities [inaudible] antipathy and often repeats in his voluminous works the statement that some persons cannot endure the presence of a cat even if it is concealed in a box. He held that the transportation of metals have been proved by experience and that some dreams forecast the future. He still attributed critical days and disease to the [inaudible] of the moon. But the felt the analogy between macrocosm and microcosm had been pushed too far, especially by the [inaudible]. Similarly in the second half of the century [inaudible] still defended astrological medicine but dismissed as absurd the opinion and agreement of macrocosm and microcosm. In closing I'd like to make a theoretical statement. It doesn't have much to do with my paper. And that is that the invention of a few antibiotics has worked very well indeed [inaudible] several hundred [inaudible] confusion of medieval --

[ Applause ]

>> As chairman of this morning's session I would like to thank the three speakers for their most interesting papers. I'm sure that much discussion will be evoked by these provocative papers, so that -- but at the present time, time will not allow for this discussion period. However, after luncheon and after assembling here for the afternoon session, before starting a formal presentation we will have a period of discussion then. If you'll now all go down to the Rare Book Room we will have our pictures taken.