The Century of Columbus Part 26

Puschmann in his "History of Medical Education" says of Fallopius (p.

297): "He furnished valuable information upon the development of the bones and teeth, described the petrous bone more accurately, enriched myology by admirable descriptions of the muscles of the external ear, of the face, of the palate and of the tongue, made explicit statements upon the anastomotic connections of certain blood-vessels--for instance, of the carotid and vertebral arteries--and discovered the nervus trochlearis. He inst.i.tuted accurate investigations upon particular parts of the organ of hearing and of the eye, by which he was able to give fuller information upon the _ligamentum ciliare,_ the _tunica hyaloidea,_ the lens, and other anatomical points."

As great, if not greater, than either as an anatomist was Eustachius, to whom we owe a series of important discoveries. He studied particularly the renal system and the head. His name is enshrined in the Eustachian tube named after him. It has been said that after Eustachius' time very little was added to our knowledge of the gross anatomy of the teeth. He also made important discoveries in brain anatomy. Unfortunately his text-book was never finished, and the beautiful ill.u.s.trations, the first copperplates for an anatomical work ever made, were {368} not published in his lifetime. They were faithfully preserved, however, in the Library of the Vatican, for, like Columbus, he was a professor at the Papal Medical School in Rome, and were published at the beginning of the eighteenth century by Lancisi, himself, another Papal physician.

Another of the distinguished anatomists of the time was Aranzius, who was the Professor of Anatomy in the Papal University of Bologna for some thirty-two years just after the close of our period, having received his training, however, in our century. He gave the first correct account of the anatomy of the foetus and was the first to show that the muscles of the eye do not arise from the dura mater but from the margin of the optic cavity. He confirmed Columbus' views with regard to the course of the blood in pa.s.sing from the left to the right side of the heart, and made a number of discoveries in the anatomy of the brain. To him we owe the term _hippocampus_, and he described the fourth ventricle very accurately, calling it the cistern of the cerebellum.

The scientific development of physiology followed immediately, as might be expected, on that of anatomy. Indeed, Vesalius deserves almost as much credit for what he did for physiology as for his researches in anatomy. The functions of bones, muscles and organs were, as we have said, carefully discussed in connection with the descriptions of their form, location and relations to other organs.

Probably the best way to present the advance made in physiology at this time is to review the important steps of progress toward that greatest generalization in modern physiology, the circulation of the blood. Much more had been known of it before this time than is usually thought, and probably even the ancients, especially in Greece, had more than a hint of it. Before Columbus' Century closed, the discovery of the pulmonary circulation was an accomplished fact, and there was more than an inkling of the existence of the general circulation. The full description of this was not made until afterwards, but it was not long delayed, and it came from a man who belongs to our time. It did not receive that thorough scientific statement which was to make it a fundamental principle in the biological science of the time until Harvey's day, nor indeed for some {369} time after Harvey's thoroughly scientific description and demonstration. [Footnote 32]

[Footnote 32: How clearly Rabelais understood the function of the circulation, though he did not properly appreciate its physiological anatomy, may be readily seen from his famous pa.s.sage on the circulation, in which he talks about the blood as "the rivulet of gold which is received with such joy by all the organs because it is their sole restorative." A portion of the pa.s.sage is worth while quoting because it represents a popularization of the scientific knowledge of the time. Rabelais was writing not for physicians nor even medical students, but for the educated general public of the time. He said:

"The Spleen draweth from the _Blood_ its terrestrial parts, _viz._, the Grounds, Lees or thick Substance settled in the bottom thereof, which you term _Melancholy;_ the Bottle of the Gall subtracts from thence all the superfluous _Choler:_ whence it is brought to another Shop or Workhouse to be yet better purified and refined, that is the Heart, which by its agitation of Diastolick and Systolick Motions so neatly subtiliseth and inflames it, that in the _right-side_ Ventricle it is brought to Perfection and through the Veins is sent to all the Members; each Parcel of the Body draws it then into itself, and after it's own fashion, is cherished and alimented by it: Feet, Hands, Thighs, Arms, Eyes, Ears, Back, Breast, yea, all; and thus it is that who before were _Lenders,_ now become _Debtors,_ The Heart doth in its _left-side_ Ventricle so thinnify the Blood that it thereby obtains the name of Spiritual; which being sent through the Arteries to all the members of the Body, serveth to warm and winnow or fan the other Blood which runneth through the Veins; The Lights never cease with its Lappets and Bellows to cool and refresh it; in Acknowledgment of which good the Heart through the Arterial Vein imparts unto it the choicest of it's Blood: At last it is made so fine and subtle within the _Rete Mirabile,_ that thereafter those _Animal Spirits_ are framed and composed of it; by means whereof the Imagination, Discourse, Judgment, Resolution, Deliberation, Ratiocination, and Memory have their Rise, Actings and Operations."]

Harvey himself indeed has acknowledged his indebtedness to these men of preceding generations, and any fair-minded review of the subject makes it clear that there was a gradual progress towards this all-important generalization for several generations, and not that sudden discovery which is sometimes thought to have taken place. In 1546 Servetus, who had been Professor of Anatomy at Paris, but who had a tendency to dabble in theology that subsequently proved unfortunate for him, for, as will be recalled, he was burnt to death by Calvin {370} at Geneva in 1553, sent to Curio, who was teaching anatomy at Padua, a ma.n.u.script copy of his _"Rest.i.tutio Christianismi,"_ "The Restoration of Christendom," in which he described completely the circulation of the blood in the lungs.

Because Servetus' description first appeared in a theological work, it has sometimes seemed to commentators that his expressions were scarcely more than accidental and that it was only by chance that he reached such a generalization. To say this, however, is to ignore Servetus' career. He was an investigator of a thoroughly scientific spirit, living in a time when discoveries, particularly in the biological sciences, were being made all round him, and he had made many dissections, had taught anatomy at the University of Paris and was exactly in the most appropriate position to make such a new discovery. He had done some distinguished work in botany, he had suggested some modifications in pharmacology which met with violent opposition, but have since been approved, and like so many of the men of the Renaissance he had "taken all knowledge for his province" with a wonderful degree of success. Unfortunately he invaded theology and then got into trouble. He had to fly from Paris, though probably the prosecution of him was due not a little to the enemies created by his uncompromising spirit in the controversy over the use of syrups. He was protected by the Archbishop of Vienne, who had him as physician for a dozen of years, and it was Calvin who denounced him to the Roman authorities in such a way that even the friendly Archbishop could no longer protect him. He was allowed to escape from jail by connivance, went to Geneva and there met his sad fate.

It may not be true, as has been said, that by putting him to death Calvin put back the development of physiology for three-quarters of a century until Harvey's time, but undoubtedly Servetus' death was a very unfortunate incident for science.

Just about this same time a series of discoveries in Italy led up to the thought of the existence of a circulation of the blood in lungs and body. Already in the first edition of his great text-book of anatomy in 1543, Vesalius had expressed doubts {371} with regard to the Galenic doctrine that the blood pa.s.sed through the septum of the heart from one ventricle to another, and these doubts he emphasized in the second edition. In 1547 Cana.n.u.s, Professor of Anatomy at Ferrara, observed the valves in the veins, and these are said to have been described even before this, though the doctrine of their existence and function was not generally accepted in science until after the more complete description made by Fabricius of Aquapendente, who was born in our century but did his important work afterwards. Columbus, who was teaching anatomy at the Papal University of the Sapienza in Rome, was even more complete and explicit in his description of the pulmonary circulation than had been Servetus. The question as to whether he knew of Servetus' discovery has never been absolutely settled, though there seems very little likelihood of it. Apparently the one possibility is that a copy of the edition of the _"Rest.i.tutio Christianismi"_ which was burned with its unfortunate author, may have been spared and found its way to Rome. Rome is indeed the least likely place for such a book to have wandered, and only two copies of that first edition are definitely known to have escaped. Of these Columbus could have known nothing. Harvey himself, to quote Professor Foster in his "History of Physiology," spoke of Columbus with respect as of a great authority.

Columbus' work has sometimes been minimized in Western Europe, especially by the English, apparently in the fear lest recognition for him should lessen Harvey's glory. Harvey himself, however, quotes Columbus as an authority in his work on the circulation, and the Italian anatomist, who had been Vesalius' a.s.sistant, was undoubtedly a great teacher, investigator, dissector, experimenter, observer and writer with regard to a number of phases of medical science. He was the first to insist on demonstrations of living animals as valuable in the teaching of medicine. He declared that one could learn more about the functions of the body from the dissection of a single dog than from feeling the pulse for hours and merely studying Galen. He made demonstrations on living animals and was constantly engaged in trying to find out function as well as anatomical details. A number of workers in the medical {372} sciences toward the end of Columbus'

Century were making experiments of various kinds on living and dead animals in order to develop physiology. Eustachius studied the kidneys experimentally, and the sensory functions were investigated very carefully and with the true scientific spirit.

The completion of the discovery of the circulation of the blood came in the person of Caesalpinus, who had received all of his education in Columbus' Century. Anyone who reads his description of the systemic circulation cannot fail to recognize that he really understood it. His discovery did not impress his generation as did that of Harvey in the next generation, nor did he understand so thoroughly the significance of his discovery. The Italians, however, have quite rightly insisted on vindicating for him the merit of having discovered the circulation of the blood, and some of them have even suggested that Harvey learned of it from him, but nothing can dim Harvey's glory as a great trained observer and original genius, who appreciated thoroughly the nature of the revolution that his discovery would work in the medical sciences.

Harvey himself would have been the first to deprecate the lessening of the glory that was due to his predecessors or to his great teachers in Italy, one of whom, Fabricius da Aquapendente, belongs partly to our century. Indeed, in his book on the circulation, Harvey has given more credit to his predecessors than many of his ardent English advocates are p.r.o.ne to do in the modern time.

Professor Foster in his "Lectures on the History of Physiology During the Sixteenth, Seventeenth and Eighteenth Centuries," which were delivered as the Lane Lectures in San Francisco, and some of them also at Johns Hopkins, concedes Caesalpinus' priority of description. He says (page 33):

"He thus appears to have grasped the important truth, hidden, it would seem, from all before him, that the heart, at its systole, discharges its contents into the aorta (and pulmonary artery), and at its diastole receives blood from the vena cava (and pulmonary vein).

"Again in his 'Medical Questions,' he seems to have grasped the facts of the flow from the arteries to the veins, and of flow along the veins to the heart"

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On page 35 of the same work Professor Foster says: "We must, therefore, admit that Caesalpinus had not only clearly grasped the pulmonary circulation, but had also laid hold of the systemic circulation; he recognized that the flow of blood to the tissues took place by the arteries and by the arteries alone, and that the return of the blood from the tissues took place by the veins and not by the arteries."

Foster is p.r.o.ne to make little of Caesalpinus as a man of book-learning rather than experimental or observational knowledge and as a scholarly writer rather than a scientific discoverer. It must not be forgotten, however, that Caesalpinus, besides being a great anatomist, is one of the most important contributors to the botany of this time. He was the director of the first botanical garden regularly established in Italy, that at Pisa, which still exists, and he is called by Linnaeus the first true systematic botanist. His work on plants distributed more than 1500 plants into fifteen cla.s.ses distinguished by their fruits.

Every detail of the circulation is thus seen to have been understood, and Professor Foster has quoted the pa.s.sages from Caesalpinus' books which make the necessity for such an admission very clear. The Italians have always claimed the discovery of the circulation for Caesalpinus, and the Southern nations of Europe generally have been inclined to favor that claim, though the Germans and English have refused to admit that even Caesalpinus' description, with all its clearness of detail, can be taken to mean that he understood the new doctrine that he thus was teaching. Besides, it is pointed out that Caesalpinus' new doctrines met with very little response and indeed scarcely any notice from his contemporaries. It must not be forgotten, however, that Harvey himself hesitated for some dozen years to publish his demonstration of the circulation of the blood, and there is good reason to believe that while he presented his views to his cla.s.s in 1616 and wrote his treatise in 1619, he delayed its publication until 1628 and was even then apprehensive lest its appearance make "mankind his enemy." It is not surprising, then, in the light of this recognized att.i.tude of the scientific mind of the time that Caesalpinus' declarations of half a century before should have been pa.s.sed {374} over by scientists without proper recognition of their significance.

Any account of the development of the biological sciences at this time would be quite incomplete without the great story of the botanists who laid the broad, deep foundation of their favorite science during this century. The first distinguished name among them is that of Leonardo da Vinci, the story of whose work in botany seems almost incredible until the actual notes of his observations are before one. While Leonardo has been thought of always as a painter and only recently has the idea of his greatness as a scientist become generally known, he deserves eminently to be cla.s.sed as one of the greatest of scientific geniuses. It was in the biological sciences that he did his most wonderful work. He knew the anatomy of men and animals very well and studied whole series of questions touching living beings. He did work in botany, palaeontology, zoology, physiology, so that Duval did not hesitate to speak of him in the _Revue Scientifique_ [Footnote 33] as A Biologist of the Fifteenth Century. He made special observations on flying, on swimming, on the saving of life in shipwreck, on the mechanics of joints, on horse movement, so that he antic.i.p.ated what we have learned by the camera. His special contribution to physiology was that certain acts of the nervous system are reflex, that is, without requiring attention from the higher centres.

[Footnote 33: December 7, 1889.]

His studies in color are among the most interesting done up to his time. These were not merely taken up from the physical standpoint but especially from the physiological, and his theory of color vision still attracts attention. He studied sound and made many valuable observations once more physiological as well as physical. His most interesting scientific conclusion was doubtless that with regard to fossils. Having met with them deep below the surface of the earth, he declared that they were not there by accident nor by any incompleteness of creation, but that they represented living things which had been covered up. He even suggested that marine fossils pointed to the fact that the sea had at some time covered this spot where {375} the fossils were found, though this was now far from water and well above its level.

Some of his information with regard to botany was far ahead of his time. He not only knew that the rings seen in the wood of the trunk of a tree represent its age, one ring for each year, but he also knew how to deduce from the differing thickness of the various rings the particular kind of season and how favorable it was for growth. In Italy moisture represents to a great extent the most important element in a favorable year for plant growth. Leonardo seems to have shown by the story of certain years in the past that when moisture was abundant the rings of the trees were thicker than they had been in other years.

He pointed out, too, that the core of the trunk of a tree, the heart of the wood as we call it, was not in the centre of the tree as a rule, but always a little to one side because the tree had more sunlight and heat on one side and grew more in that direction. He pointed out too that when a tree is injured an abundance of sap is carried to that spot in order to bring about repair, and that these processes of repair always make a super-abundance of tissue, as if to overstrengthen a weaker part--hence the irregularities that are likely to exist on a tree where injuries have been inflicted. The sketches of dissections of flowers found in his notebooks show how well he antic.i.p.ated many methods of study and details of knowledge in botany supposed to be much more modern. They have proved as great a surprise as his anatomical plates.

The professional botanists of this period have been very thoroughly reviewed by Professor Edward Lee Greene, Professor of Botany at the Catholic University and a.s.sociate in Botany in the United States National Museum, in his "Landmarks of Botanical History," which forms part of Volume LIV in the Smithsonian Miscellaneous Collections. He has called attention particularly to the work of the great German Fathers of modern botany during the late fifteenth and early sixteenth centuries. There are five of them who deserve a prominent place in the history of botany. Otho Brunfelsius (1464-1534), Leonhardus Fuchsius (1506-1566), Hieronymus Tragus (1498-1554), Euricius Cordus (1486-1535) and Valerius Cordus (1515-1544). The four first named represent two distinct {376} kinds of botanical work. Brunfels and Fuchs busy themselves almost wholly with medical botany. Their one idea was to describe plants that could be used in medicine or make special additions to the diet. Most of their plant descriptions are copied from older authors, some of them even the Greeks, but for practical purposes they sought to render the identification of medical plants more easy and certain by supplying pictures of them. There had been botanical pictures before but they were miserable as a rule, and both Brunfels and Fuchs greatly improved the representations. As Greene says "these two might worthily have been styled Fathers of Plant Iconography."

Books of botany must have been popular before this and indeed it was probably because of the ready sale of such works that Brunfels and Fuchs took up their elaboration of them. Their large picture books now made it possible for all sorts and conditions of men, lettered and illiterate, to identify some hundreds of useful plants; a thing which had never happened in the world before that day. They added little to scientific botany, however, but fortunately other men, Tragus and Valerius Cordus, laid serious scientific foundations for the true science of botany. Neither of these men wished to popularize botany so much as to make it possible for plants to be so described as to be readily identifiable by description. As Greene says "on Cordus' part it is unmistakable that there is a deliberate plan of creating a new phytography. Therefore and by study of the men and their books I think we shall perceive that in the Germany of the first half of the sixteenth century there were two fathers of plant iconography and two fathers of descriptive botany."

Greene can scarcely say too much of the work of young Cordus. He says (page 272): "To understand the exalted character of this genius it is only necessary to canva.s.s what the youth had also attained to along other and different lines at the same time.

"In field work in Germany--for botany alone--not to speak of geology and mineralogy, in both of which he was, for his time, an expert--he had wrought out more results than had his older contemporaries, Brunfelsius, Tragus, and Fuchsius combined. In his repeated journeys to the great forests and {377} wildest mountain districts, it is estimated that he discovered several hundred new plants. Sprengel has given the Linnaean names of some twenty-five of these new discoveries of Cordus; and that is perhaps double or treble the number of novelties gathered in by the whole three above named; and they both were men of longer life and more or less extensive travel."

Greene re-echoes the praise of a contemporary in terms which show us that this young man, who lived less than thirty years, had all the qualities of a modern successful scientific investigator. Indeed that contemporary description is worth while having near one as a catalogue of qualities of the men who in every age succeed in science as a rule.

It comes from Riffius' Preface to Cordus' "Annotations on Dioscorides":

"To the best possible education of an intellect naturally keen, there was united in him that happy temperament to which nothing is impossible, or even difficult of attainment. To these gifts he added a truly marvellous industry and a.s.siduity in research; and above all, a most wonderfully retentive memory for everything he either saw in nature or read in books. In this he so greatly excelled as to be able to carry in mind in their entirety descriptions of things which he had not seen but was looking to find; thus having the descriptions always available whenever occasion called for the use of them."

Conrad Gesner at Zurich declared that the four books of Cordus are "truly extraordinary because of the accuracy with which the plants are described. A century and a half later, Tournefort named Valerius Cordus as having been the first of all men to excel in plant description. Haller, the distinguished botanist and historian in Linnaeus' time, credited Valerius Cordus with having been "the first to teach independence of the poor descriptions of the ancients and to describe plants anew." Greene says of him: "One sees that in all his descriptions the same attention is given to the morphology and also to the life history of the plant in as far as this is known to him. In his practice of describing each species, both morphologically and biologically, he is a herald of our late nineteenth and early twentieth century writers who now that we have the microscope give life histories with minuteness of detail before impossible."

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Evidently Columbus' period gave birth to men as great in the investigation of plants and as ardent in their desires to get the last details of truth as were the geographers and the navigators of the time to reach the ends of the earth and be able to map it out. There was a great wind of the spirit of investigation abroad and everywhere there were magnificent results from it. This school of botany in Germany with Valerius Cordus as the climax of it, whose untimely death before thirty was indeed an irremediable loss to science, ill.u.s.trates this very well.

While the most important contributions to the science of botany during that period came from the Germans, Italy did not lag far behind in this subject, and France, Spain and Portugal supplied their quota to the science. Above all, it is to the Italians that we owe editions of Theophrastus, Dioscorides and the elder Pliny, works which contained so much of information with regard to the science of botany in ancient times and the modern publication of which brought about a reawakening of interest in that subject corresponding to what was noted in connection with every other republication of cla.s.sical thought in the various departments of the intellectual life. The most important of the botanists of Italy was Caesalpinus, professor of botany at Padua and director of the botanic garden there at the close of the Columbus'

Century, but who was afterwards physician to Pope Clement VIII. To him, as we have seen in discussing the physiology of the time, we owe a complete description of the circulation of the blood in the century before Harvey. Caesalpinus is called by Linnaeus _primus verus systematicus,_ the first true systematic botanist. His work, _"De Plantis,"_ contains an immense amount of information and a complete cla.s.sification of all the then known plants, some 1520 in number, into fifteen cla.s.ses. The distinguishing characters of this cla.s.sification are taken from the fruit and show careful observation and thoroughly scientific attention to details.

Caesalpinus' place in the history of botany can be best appreciated from the praise of his colleagues in this department of science. John Ray, the English botanist of the end of the seventeenth century, in his history of plants declared that {379} Caesalpinus' book "On Plants" was indeed a work from which much might be learned. Fabrucci and Carl Fuchs declare Caesalpinus' treatise to be of first rank.

Thomas Garzon, Pona of Verona and Balthazar and Michael Campi in the eighteenth century praised his work as thoroughly scientific. We have already quoted Linnaeus' opinion of him and the modern father of botany gladly accepted the suggestion of Plumier that a newly discovered plant should be given the name of Caesalpinus, in order that that name might be forever memorable in botany. Boerhaave, whom we think of much more as a physician than a botanist, but some of whose greatest work was done with regard to medical botany in the University garden of Leyden, advised a friend and disciple if he could buy any of Caesalpinus' works, to do so, for they were among the best on the subject.

In France Ruellius, whose life is about equally divided between the fifteenth and sixteenth centuries, was the physician to Francis I and a distinguished botanist. He wrote scientific descriptions of a large number of plants and put beside them the ordinary names which they were called in various countries as he had obtained them from peasants, farmers and country-people generally in his travels. His work was an important contribution to the science of botany. Toward the end of his life Ruellius, like his distinguished contemporary and colleague, Linacre in England, became a priest. Another important French contributor to the science is Pierre Belon of the first half of the sixteenth century, though he had an interest in many other biological sciences. He wrote a valuable treatise on coniferous plants and a monograph on birds. This has attracted particular attention, because in it "he compared the skeletons of birds and man in the same posture and nearly as possible, bone for bone." As Garrison in his "History of Medicine" (New York, 1913) says: "this was the first of these serial arrangements of h.o.m.ologies which Owen and Haeckel made famous." Belon travelled in Greece, Egypt and the Orient as well as widely in Europe, mainly in the interests of _materia medica,_ but everywhere picking up scientific information.

In Spain and Portugal writers in botany are the medical {380} scientists and especially those who searched the Indies, West and East, for plants with medicinal virtues. They did much both for pure science and for medicine and some account of their work will be found in the chapter on "Medicine" and "America in Columbus' Century." As acc.u.mulators of information the biological scientists of all the countries of Europe during Columbus' Century probably contributed more to their various departments than their colleagues of any other corresponding period in the history of science, even our own. They had, of course, the advantage of fields ripe for the harvest, but they undoubtedly took full advantage of their opportunities. Of all of them might be said what Oliver Wendell Holmes said of the anatomists of the Renaissance. They gathered in the rich harvest of discovery like the harvesters in a grain field. After them in the next century came the gleaners, who found many scattered precious grains of knowledge that their predecessors with their rich harvest to care for had neglected.

Finally, in the later time, came into the field the geese, who found here and there a grain of knowledge missed even by the gleaners and who made a great cackling whenever they found one. The kindly satirist was himself an anatomist, and we may take the exaggeration of his picture with proper discount, yet with a recognition that it has much more of truth than we always like to confess even to ourselves.

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CHAPTER XII

MEDICINE

It is not surprising that there should have been a magnificent century of achievement in medicine at this time because their standards of medical education were at a high level and were well maintained. The medieval requirements for medical education had been three years of preliminary work at the university, four years in the medical schools, special courses in surgery if practice was to be in that department, and a year's experience with a physician before personal practice on one's own responsibility was allowed. The laws of the Emperor Frederick for the Two Sicilies in the thirteenth century were very strict in this matter and they const.i.tuted the standard which came to be very generally adopted. In the Italian universities the Papal charters explicitly demanded these requirements. [Footnote 34]

[Footnote 34: For full details of this surprising, too little known formal development of medicine, see Walsh, "The Popes and Science,"

Fordham University Press, N. Y., 1907, where all the doc.u.ments will be found.]

We have a series of re-enactments on this subject just about the middle of the fifteenth century. Above all, clinical experience was required before the license to practise would be issued. In 1449 the medical Faculty of Paris required that graduates in medicine should diligently visit the hospitals or accompany a skilful pract.i.tioner in his visits to patients and refused to grant the license when this rule was not observed. In Ingolstadt graduates in medicine, according to the statutes of 1472, were obliged to take an oath that they would practise only as the representatives of their teacher, or of some other doctor of the faculty of that place, until they were considered skilful enough to receive the license for practice on their own responsibility.

In the hospitals of this time, which were large and well arranged, thoroughly ventilated and capable of being well cleansed, {382} there was ample opportunity for clinical teaching and we know that it was taken. A ma.n.u.script of Galen of the fifteenth century which is preserved at Dresden has a number of initial miniatures, in which groups engaged in clinical instruction are noteworthy. In his "History of Medical Education," [Footnote 35] Puschmann notes the details of some of these. There is a picture of a patient suffering from some wasting disease, near whose bed stand a doctor and two nurses, while the doctor dictates a prescription to his pupils. There is a demonstration of leg ulcers by a physician to a pupil and a surgical operation on the leg performed by the pupil in the presence of his teacher, as well as the opening of an abscess in the axilla. There were hospitals in every town of 5,000 and this gave ample opportunities for clinical experience. When hospitals are numerous and well managed there must be physicians to attend on them and this provides opportunities for thorough study of patients.