Empedocles of Agrigentium, discovered the labyrinth of the ear, and explained sound by the impact of the air upon it, as upon a drum. He also solved some very important sanitary problems controlling certain prevailing pestilences by purifying a water supply and similar practical engineering feats.

These brief references will serve to give you an idea of the rational activity and public status of the medical profession just previous to the advent of Hippocrates upon the scene in Greece. It will be noticed that the way was well prepared for his master mind, as the profession was vigorously alive and inclined toward scientific discovery, and the public was sympathetic and appreciative. The medical guild, then as now, had its share of quacks and ill-trained hangers on, who were parasitic in their nature, contributing nothing to progress, and perverting and degrading scientific truths. In addition to priests and philosophers, who, more or less, attempted to practice medicine, there were the gymnastic trainers, who were not content to exercise their natural functions among the athletes, but were accustomed to give massage, dress wounds and ulcers, reduce dislocations, treat abcesses, bleed the sick, and even direct pharmaceutical treatment.

Such was the general condition of the practice of the healing art when Hippocrates, of Cos, the greatest name of ancient medicine, was born, 460 years B. C. It should be borne in mind that there were seven others of the same name, who flourished about the same time, and that he was the second of the series. He came from a family in which the practice of medicine was hereditary, and there were many such families whose sons were predestined to be physicians. He was subsequently given a fabled descent from Esculapius on his father's side, and from Hercules on his mother's. He is said to have lived to be about 100 years of age, although but little is known of his personal history, except that he traveled extensively. He was born on the Island of Cos, now called Stan-Co, near the coast of Ionia, and achieved great fame even in his lifetime, for he was called "great" by his contemporaries, and such commanding intellects as Plato and Aristotle quoted him as an authority. He not unworthily represented the science and art of medicine in the golden age of Greece, under Pericles, when that insignificant country produced more intellects of the first order in every department of mental

development than any other country of the world has ever shown, before or since, or possibly even all the rest of the world together. Celsus tells us, in a well-known passage, that Hippocrates first separated medicine, not from priestly domination, but from the hindering entanglements of philosophy. His writings were numerous, and were supplemented by many additions by his descendants under his name, and also by works written by unscrupulous impostors and attributed to him. Among his genuine writings are treatises on "Airs, Waters and Places," "Regimen," "Salubrious Diet," "The Laboratory of the Surgeon," "Articulations and Dislocations," " Fractures," "Wounds of the Head," and a surgical work called "Mochlicus;" also works on "Diseases of the Eye," "Fistula " and " Hemorrhoids," "Epidemics," "Prognostics," and others. His book entitled "Aphorisms" is perhaps his most famous production. It cannot be read, even now, without wonder and admiration. An eminent American surgeon declares that "no medical work of antiquity can compare with it." Until the revolution in France the faculty of Paris compelled aspirants for the medical degree to be familiar with these aphorisms.

The two most valuable contributions which Hippocrates made to medicine were, first, his total rejection of the supernatural in medicine, a position of incalculable benefit to the profession in the line of advancement, as all thought at that time was more or less tainted by a firm belief in witchcraft and supernatural delusions. He plainly says ("Airs, Waters and Places ") that "no one disease is more divine or more human than another," and that "none arises without a natural cause." His second contribution was the teaching of careful and accurate clinical observation, and taking notes of the same. Indeed, he seems always to have been around with his note-book in his hand. It was his substitution of recorded fact in medicine for philosophical abstractions that first made medicine a science, namely, a system of authentic knowledge arranged in an orderly and rational manner. He was curiously destitute of offensive egotism, and always gave his predecessors due credit. As showing the absolute scientific honesty of the man, I may recall the fact that of the 42 clinical records of cases which appear in his existing works 25 ended fatally.

Hippocrates proffered several dogmatic theories, however, which have not been given final acceptance. What for centuries was known as his "Humoral Pathology" was finally displaced by a more correct knowledge of anatomy and physiology; and yet this theory ruled the medical mind universally for hundreds of years, more or less, even down to the time of Harvey. According to this theory the body contains four humors blood, phlegm, yellow bile and black bile a right proportion and mixture of which constitutes health; improper proportions. or irregular distribution, disease. This doctrine undoubtedly attained a wider acceptance through the powerful influence of Galen, who incorporated it with his teachings and expanded it. Other dogmas of Hippocrates which have not stood the test of later scientific enlightenment are known as "Coction," "Crisis' and "Critical Days." In acute diseases it was supposed that the humors went through a natural process of change, or "coction," whereby they were prepared for elimination at the proper moment, called the "crisis," from the body, either through the skin, kidneys or bowels. An acute attack terminating in a sweat is an illustration of this hypothesis. "Critical days" were, of course, closely associated with the doctrine of "crisis."

In treatment this great physician attached much importance to regimen, personal habits and a proper diet, and gave minute directions concerning them. He regarded drugs as of secondary importance, but they were much used, and 265 are said to be mentioned in the entire Hippocratic collection. Exercise was much enjoined in proper cases, and blood-letting, although known, was little practiced. It is curious that with all of Hippocrates' really remarkable powers of observation that the pulse is never once spoken of in any of the works considered genuine.

The "father of medicine " held a high conception of the dignity and usefulness which pertain to the true physician. He abhorred mysticism and mercenary motives, and demanded a proper consideration for the feelings of patients. He commanded that his disciples should lose a fee rather than trouble a sick person about it, for he said, "The memory of a good deed is better than a temporary advantage." He treated the poor and stranger equally well, saying, "Where the love of the art is, there is the love of man." The oath which he required his disciples to take

stamped him as a great moral teacher. It has excited the admiration and reverence of the profession for ages, and is used occasionally even now. Perhaps nothing that he has written shows better his ineffaceable modesty, judicial judgment and fairmindedness than the opening aphorism of his immortal collection:

"Life is short and art is long; the occasion fleeting; experience fallacious, and judgment difficult. The physician must not only be prepared to do right himself, but also to make the patient, the attendants and externals co-operate."

(To be continued.)

287 STATE STREET.

For the ANNALS.

A CASE OF PULMONARY TUBERCULOSIS ASSOCIATED WITH ROUND ULCER OF THE STOMACH.

BY W. H. HAPPEL, M. D.,

AND

GEORGE BLUMER, M. D.,

Albany, N. Y.

The following case seems worthy of being put on record on account of certain clinical and pathological peculiarities which it presents:

Mr. J. E., aged 45, married, a native of Germany and a cigarmaker by occupation, was first seen on April 6, 1898. He complained that he was suffering from "catarrh of the stomach," which he had had for several years, and which he now felt was growing worse.

His family history is uncertain. There is no malignant disease or tuberculosis in his family, but he does not know whether his father and mother are alive or dead. His grandparents were long-lived.

His previous history is negative, except that he believes that he has had several attacks of "catarrh of the stomach." These attacks, he explains, consisted of a feeling of fulness after eating. together with a general bad feeling in the stomach and bowels. The attacks were not usually accompanied by spontaneous vomiting, but he sometimes felt obliged to introduce his finger into his fauces which caused vomiting and gave him considerable relief. At one time, however, he vomited frequently over a

period of several months. He does not know how long these attacks of stomach derangement lasted, nor when they first began; it may have been two or even five years ago, or longer still. He is a moderate user of alcohol as a rule, drinking beer only; at times he has fits of hard drinking. He is not certain that the attacks of stomach derangement did not always come on after these excesses. He denies all venereal history.

His present symptoms are mainly referable to his stomach. He has burning in the region of the stomach irrespective of the presence or absence of food; at times some real pain is present, but always of a dull character. He has slight nausea at times. His sense of taste is impaired, "everything tastes like straw," as he puts it. Several months ago he had some severe attacks of vomiting, extending over several days; he has not vomited now for several weeks. The vomitus is not always food, but often only a glairy fluid. At times he has a feeling of pressure across the abdomen when he is in the sitting position, and sometimes he is troubled considerably by flatus, the passing of which gives him great relief.

Symptoms referable to the chest were practically absent; there was no cough, no pain in the chest, no palpitation; there was, however, dyspnoea on the slightest exertion. The patient was forced to give up work a few days ago on account of weakness. His bowels move three to four times daily, the passages are watery. No disturbances of micturition.

The following are the notes on the condition at the first visit: The patient is a pale man, the skin being inelastic and of a slightly yellowish tinge. The sclerotics are slightly jaundiced. The tongue, when protruded, is cyclindrical and slightly coated. There is considerable chronic pharyngeal catarrh. The cervical glands are not enlarged, nor is the thryoid gland. The voice is weak and somewhat hoarse.

The chest is slightly barrel-shaped in its upper half; in the lower half over the sternum it is funnel-shaped. The supra-clavular fossæ are much sunken, the intercostal spaces not markedly so. The circumference of the chest at the nipples is 36 inches, expansion is 1 inches. The movement of the chest is symmetric but arhythmic. On percussion the pulmonary resonance is not as marked as in health, but is even over the whole extent of