CHAPTER IV
THE COURSE OF STUDY: THE LABORATORY BRANCHES
(a) First and Second Years
Three characteristic stages are to be discerned in the evolution of medical teaching.[1] The first and longest was the era of dogma. Its landmarks are Hippocrates (B.C. 460— 377) and Galen (A.D. 130-200), whose writings were for centuries transmitted as an authoritative canon. Observation and experience had indeed figured considerably in their composition,2 but increasingly remote disciples in accepting the tradition lost all interest in its source. The Galenic system took its place in the medieval university with Euclid and Aristotle,—a thing to be pondered, expounded and learned; facts had no chance if pitted against the word of the master. So completely was medicine dominated by scholasticism that surgery, employing such base tools as sight and touch, was held to be something less than a trade and accordingly excluded from intellectual company.
The second era is that of the empiric. It began with the introduction of anatomy in the sixteenth century, but did not reach its zenith until some two hundred years later. At its best it leaned upon experience, but its means of analyzing, classifying and interpreting phenomena were painfully limited. Medical art was still under the sway of preconceived and preternatural principles of explanation; and rigorous therapeutic measures were not uncommonly deduced from purely metaphysical assumptions. The debility of yellow fever, for example, Rush explained by "the oppressed state of the system;" and on the basis of a gratuitous abstraction, resorted freely to purging and bleeding. His first four patients recovered; there is no telling how many lives were subsequently sacrificed to this conclusive demonstration. The fact is that the empiric lacked a technique with which to distinguish between apparently similar phenomena, to organize facts, and to check up observation; the art of differentiation through controlled experimentation was as yet in its infancy. Under vague labels like rheumatism, biliousness, malaria, or congestion, a hodgepodge of dissimilar and unrelated conditions were uncritically classed; the names meant nothing, but they answered as explanation, and even sanctioned severe and nauseous medication. Ignorant of causes, the shrewdest empiric thus continued to confound totally unlike conditions on the basis of superficial symptomatic resemblance; and with amazing assurance undertook to employ in all a therapeutic procedure of doubtful value in any. He combined the vehemence of the partisan with something of the credulity of
- ↑ Nothing would do more to orient the student intelligently than a knowledge of the history of medical science and teaching. It is a great pity that some effort is not made in the better medical schools to interest the student in the subject. A proper historical perspective would render impossible such opposition to improved medical teaching as is now based on conscientious but mistaken devotion to outgrown conditions.
