practice and in hospital, and help to educate the people in hygienic matters. Insanitary customs and old prejudices and superstitions still obstruct to a considerable extent the carrying out of measures for the prevention of disease and the treatment of patients.

In the prefecture there are 3,197 needle and moxa practitioners licensed to practice. They are not considered as members of the medical profession proper; a knowledge of how to practice their special art only is required in order to obtain license. The needles used are of gold, silver or other metal, very slender, and from two to three inches long, varying somewhat in shape, size and length, according to the exact purpose for which they are to be used; one is for the extraction of "surplus vital spirits," one for the extraction of "pent-up vapors in the joints," etc. There are text-books on the subject, with diagrams to illustrate the mode of ascertaining the proper localities for the application of the moxa or needle in the various diseases. "All diseases are caused by obstruction of the blood and spirits; by piercing with the needle this obstruction is removed, and by the moxa healed.” The most common material used for the moxa is a preparation from the leaves of the artemesia chinensis.

Another class devoted to the alleviation of physical ills is the shampooers, who practice a kind of massage, of whom there are 1.352 licensed. Many of them are blind. They have their round of streets which they travel, blowing a sort of whistle as a signal to their patrons, which can be heard at all times of the day and night. Bonesetters are now comparatively rare, there being only eleven licensed. The number of licensed dentists is thirty-three, some of whom received their training in the United States. Opticians are numerous, and there are several firms of surgical instrument makers, which supply the home market to a large

extent.

Of the diseases common in Western countries, scarlatina is one which does not prevail here, though cases are said to have been seen in other places in Japan. Beri-beri is endemic. Cases of distoma pulmonalis coming from certain districts in the empire are frequently met with. The symptoms are cough, with expectoration of sputum, a portion of which is usually mixed with blood. This may continue an indefinite number of years without

seriously affecting the health, or hæmoptysis or pneumonitis may occur at intervals, exhausting the patient in proportion to the severity and frequency of these attacks. Microscopic examination of the sputum with one inch objective reveals numerous ova, most abundant in the part which is only slightly tinged with blood; the flukes themselves are less frequently seen. They are about one-third the size of the distoma hepatica, measuring, according to Japanese text-books, 8 to 10 millimeters in length and 4 to 6 millimeters in width; the ova being from .08 to .10 millimeters in length and .05 millimeters in diameter. Leprosy prevails to a considerable extent. For centuries past it has been considered hereditary, insomuch that in proposed marriage contracts the most searching inquiries are made with regard to the genealogy of the parties. Isolation of the family in which the disease occurs is common. The disease being considered a special punitive infliction, families affected segregate in large numbers in some of the "sacred mountains" in the country. Some go to certain mineral springs, which have the reputation of being of some benefit. Others remain in their homes. There are also some small hospitals for the treatment of leprous cases. Very recently, the contagiousness of the disease having been recognized, steps are said to have been taken toward securing individual isolation and better medical treatment of lepers, the work to be undertaken first in the three cities of Tokyo, Osaka and Kyoto. An instance showing the contagiousness of the disease is reported to have occurred lately in a village where some lepers were living, the disease gradually spreading throughout the village and from that to surrounding villages.

Tuberculosis is one of the most extensively prevailing diseases, and has been so from time immemorial. Infected beef and milk have had no part in its dissemination, inasmuch as these articles, until recent years, have not been used as food. Some of the customs of the people from a sanitary point of view evidently need no reform on Western lines; e. g., hand-shaking and kissing have no place in their graceful form of salutation. Cremation was formerly the most usual method of disposal of the dead here, as in the other densely populated towns. The practice was forbidden by the government about twenty years ago, and only earth burial allowed; but the prohibition was soon rescinded,

improved crematories were introduced, and cremation is now the prevailing, though not exclusive, custom.

Osaka being one of the treaty ports, it has a foreign concession, where the foreign residents live, under extra-territorial jurisdiction. It is a small foreign settlement situated in the western part of the city, near the custom house and principal wharf, with a Bund and river frontage in three directions. It is laid out in comparatively wide streets, with sidewalks and shade trees, is well drained, and has its own police force, fire brigade, etc., and is governed by a Municipal Council composed of the consuls of the treaty powers and three members elected by the foreign residents, the Governor of Osaka being also an ex-officio member. When the revised treaties come into operation next year extra-territoriality in Japan will become a thing of the past; all foreign residents will become amenable to Japanese law, and subjects of treaty powers will be allowed to live in any part of the country. So far as foreign physicians and surgeons seeking remunerative practice are concerned, however, it is not a field that offers any attractions, and whether they will then be permitted to practice, and, if so, what regulations may be imposed, has not yet been officially announced.

5 CONCESSION, OSAKA, JAPAN,

For the ANNALS.

THE HISTORY OF MEDICINE.*

BY WILLIAM O. STILLMAN, A. M., M. D.,

Lecturer on the History of Medicine at the Albany Medical College,

No. 2.

(Continued from the September ANNALS, page 454.)

We now come to consider the beginnings of European medicine as shown in the early Greek school. Of the age of fable and myth in Greece we have little concern. Recorded medical history began there with Hippocrates, although there can be no doubt that little of his art was original. His contributions to medicine are conceded to have been founded, in the main, upon previously existing knowledge, which he conveyed to posterity

* An abstract of the course of lectures delivered at the Albany Medical College during the

term of 1897-8.

filtered through the medium of his excellent common sense, honest and correct judgment, and superior intelligence. No one man can create a complex science like medicine, no matter how marvelous his erudition and genius. Rules and facts must have accumulated in a vast store before the days of the "father of medicine," as Hippocrates is called, for medicine was gray with age before he had been born.

Nevertheless, with the advent of Hippocrates a new era began. He must always remain a colossal figure in the history of medical science. His most noteworthy contribution to the practice of the healing art was his example of careful and accurate clinical observation. In this respect he was a reformer. It is curious that what to us seems so simple and obvious, namely, that a systematic and intelligent study of symptomatology and physical conditions in the sick can be the only key to correct diagnosis and successful treatment, should never have occurred to most of the ablest practitioners of every nation of antiquity. To be sure, Hippocrates was deficient in his knowledge of anatomy and physiology, and the world had to wait hundreds of years before these studies were rationally carried on by the very simple expedient of dissections of dead bodies, and the careful study of the excretions of the living ones. This was first most successfully and openly accomplished long after Hippocrates, during the golden age of scientific discovery at Alexandria, under the protection and encouragement of the Greek kings of Egypt. When speculation gives place to the unbiased observance of fact, then science assumes form.

The only immediate predecessor of Hippocrates who attained special eminence was Pythagoras, and he was rather more of a philosopher and a mystic than he was a physician. Pythagoras lived 580 to 510 B. C., and is credited with having first established the practice of visiting the sick at their homes. Before that they were, without exception, as far as we know, brought to the temples or physicians for treatment. He was very strict in his system of dietetics, but, as was naturally the case, not always rational or scientific. He had traveled far, and his learning was great, as he was familiar with the occult lore of Egypt, and India, and Persia. He was the last of the Greek sages to employ hieroglyphic writing, and wrote his works in these characters. He

invented, or at least first propounded, the theorem of the square of the hypothenuse, and first divided the year into 365 days and 6 hours. He seems even to have understood the movement of our planetary system, possibly deriving this knowledge from those inveterate star-gazers, the Chaldeans. His influence was great, the numbers of his disciples vast, and he founded many schools and did much good. His mystic system of numbers, which he even applied to the practice of medicine, was apparently derived from the Egyptians, and formed the basis of a philosophical conception of God and matter, of great grandeur and completeness, as contrasted with the vague speculations and insufficient cosmogony of the priests. He captivated the intellect and imagination of the young men of his day, it is said, but prodigious success on the part of his disciples begat pride, insolence and dishonesty ; and the world-famous Pythagorean Society was soon dispersed, as a result of its ultimate moral unworthiness and rapacity.

Of his two immediate successors in popular esteem, Alcymæon and Democedes, but little is known, except that the former was an anatomist of repute, and was said to have dissected the eyes and ears of animals, thereby discovering the optic nerve and the Eustachian canal. Sleeping and waking he explained were due to the ebb and flow of the blood in the great vessels, the stopping of which he claimed produced death. He was an acute observer, and described disease "as a disturbance of the equilibrium of the vital activities by the predominance of some one of them."

The history of Democedes (B. C. 520) is chiefly interesting as showing that there was a well-established and extremely wellpaid public medical service in Greek cities in the sixth century before Christ. Herodotus tells us that he was chosen public medical officer of Egina at a salary of one talent (about $1,200) a year, and money in those days was worth at least five times what it is now with us. A year later he went to Athens in the same capacity, receiving about $2,000 per annum, and finally he was invited to Samos, by Polycrates, at the yearly pay of $2,400, equivalent to about $12,000 in our times. It is worthy of note that the pay of an Athenian ambassador in the days of Aristophanes was about one-twelfth of that paid this popular physician by the government. A contemporary of the preceding.