International Society for the History of Medicine holds first meeting outside Europe in Quebec City The canny inhabitants of Quebec City long ago decided that the verdict on history of the founder of the Ford company is itself bunk. To them history is good business, and in following this practical dictum they have lovingly recreated the stones of their ancient and beautiful city. So it was appropriate that when the International Society for the History of Medicine decided to hold its 25th congress outside Europe for the first time it was to Quebec they came. Delegates from 33 countries spent 5 days together. Half a dozen Russians preregistered but cancelled out. Hosts for the conference were Laval University and the fledgling Canadian Society for the History of Medicine. The Canadian society began in Quebec and is still largely oriented toward that province. However at the society's annual meeting, held during the congress, a membership of 97 was reported. The program listed 134 presentations, including some films. Participants were able to present papers in English, French, German, Spanish or Italian. In practice nearly all were in French or English. In the absence on vacation of CMAJ's usual Francophone capability, the following report deals mostly with presentations in English. Authors are Dr. D.A.E. Shephard, scientific editor of the journal, Jim Garner, news and features editor, and Dr. Robert Jackson of Ottawa, a member of the Canadian Society for the History of Medicine. Hannah institute Prominent among the proceedings was the session sponsored by the Jason A. Hannah Institute for the History of Medical and Related Sciences. The session, held Aug. 25, was cochaired by Dr. W.E. Swinton, whose new series on the contributions to nonmedical science by physicians starts in this issue of CMAJ. The institute presented an exhibition of historical materials. Delagates also were able to view a selection of the paintings of the late Sir Frederick Banting. The conference received official blessing from Canada's health minister, Marc Lalonde, who may have been a little tongue in cheek when he pointed out that the historical beginnings of the $7 billion a year system he administers The photograph of the Aesculapius statue on CMAJ's front cover is supplied by the Bettman Archive.

were in 1655, when a Dr. Bouchard of suspicion of the myriad, colourful herbMontreal insured 26 families at $1 a als that were at one time a mainstay of year for medical care. medical practice. "If I were asked to state for you Despite the rejection of herbal remthe cardinal feature of our system, I edies by a majority of Western scienwould choose the term 'evolution'," tists, herbals have maintained their Lalonde declared. "In the real sense, place in medicine of other regions. In tomorrow's history is being written Frey's view, medical science in the today." West should, and no doubt would, be Two general questions must be an- turning more of its attention to herbal swered by all historians: how to bridge documents - just as herbalists are the gap between the past and the pres- beginning to take an interest in Westent and how to avoid interpreting his- ern concepts of scientific validity. torical findings in the light of modern Every medical student knows that knowledge. Thus some caution is es- plants produce chemicals that are pharsential in any historian's approach to macologically active, and more conhis subject, and in a technical subject sideration could reasonably be given like medicine a cautious approach is to the question whether, for example, particularly advisable. This was the herbal remedies for peptic ulcer and framework in which Professor J.O. for cancer might not be as effective Leibowitz of Jerusalem considered but less toxic than some synthetic Maimonides' 12th-century ideas on me- chemicals. tabolism. Maimonides, in his "AphorAt any gathering of medical histoisms on Medical Subjects (Part I)", rians the name Sir William Osler is based his ideas on some of Galen's always mentioned, and the 25th interconcepts and unexpectedly opened up national congress was no exception. a vista on metabolism that satisfied One paper on Osler was presented by his contemporaries. Dr. J.W. Scott of Toronto, who said Maimonides, who recognized that the that Osler's greatness lay in his being Greeks had used the word "metabol- in the vanguard of a new era and in ism" in the sense of "change", postu- his establishing a new concept of the lated four stages to metabolism of food: nature of disease. His undergraduate digestion in the stomach, passage of training may have been based on early digested elements through the intestine to the liver, change in other organs and assimilation of the nutrients in the various body organs. Considering the state of medical science, the lack of laboratory facilities and the absence of experimentation in general in Maimonides' time, such a physiological approach was sophisticated and is worthy of historical research. Maimonides erred in thinking that the stomach metabolized nutrients in fact, only alcohol is "resolved" in this manner - but his views were an advance on those of Galen, whose concepts were limited to those of "coction", "maturation", "ripening" and "resolving". The current interest in Chinese medicine has stimulated attention to the ancients' views on herbals and herbal medicine, and E.F. Frey of Galveston, TX, made the point that Westerners may be at fault in judging old herbals by modern Western standards. There is no doubt, Frey said, that beneficial natural substances have been isolated from plants - and that some are preferable to synthetic chemicals - but against this must be set the mixture of Dr. Hannah addresses congress under folklore, fancy and fact that inspired Dr. Swinton's chafrmanship. CMA JOURNAL/SEPTEMBER 18, 1976/VOL. 115 567

19th-century concepts but his postgraduate experience was forged in Virchow's laboratory and in the milieu of men like Pasteur, Koch and Lister. While these great scientists were demonstrating the pathogenic nature of agents such as bacteria, Osler could comprehend the significance of such observations and could apply them to revolutionize the concepts of disease. Scott stressed Osler's teaching that disease resulted from altered physiology and his concept that symptoms were manifestations of the pathologic process rather than of the disease itself. As a consequence, Scott suggested, the first edition of Osler's "The Principles and Practice of Medicine" ushered in modern medicine. North and South America have produced many plant-derived drugs cocaine and curare are two of the best known. Professor Francisco Guerra of Mexico City pointed out that, early in the 16th century, plants used in Europe were obtained largely from the Orient - for example, rhubarb and ginger. Later in that century, trade was opened up between Europe and the New World, and important sources of commerce for European merchants were drugs from the Americas. Thousands of drugs of vegetable origin were produced in the New World but, as Guerra pointed out, only a handful were ever of value. Some of the most useful were mescaline, ritalin and cocaine - drugs with psychotropic activity. In another category was Peruvian balm, which was used in the treatment of wounds. Undoubtedly the best-known drug was obtained from the bark of the cinchona tree. Guerra showed that the value of quinine for malarial patients was known as early as the first quarter of the 17th century and that a text on its use, by Caldera de Heredia, ap-

peared in 1663. Quinine was first used by Indians who shivered when crossing rivers and travelling in low-lying areas. Westerners who first used it were Jesuits in 1633; thereafter the Jesuits had control of cinchona for many years. In a well attended presentation, Professor Patrick Romanell of El Paso, TX gave his audience a pair of memorable definitions: a philosopher is a stretcher of minds; a historian is a shrinker of facts. But one fact, Romanell reminded his listeners, that is often forgotten is that William James, the great psychologist, had a medical background. This fact, in Romanell's view, is significant in any interpretation of James's thought. Romanell dealt specifically with medical history in the religious psychology of William James, as expounded in his "Varieties of Religious Experience". Romanell showed that James used medicine as a source for classification of his religious experiences, and that a religious experience, whether caused by a physical or nonmorphologic factor, is a valid experience. James was no mere mystic he was a medical, philosophical and religious pragmatist - and a perusal of the classic "Religious Experience,. reveals how medical history figured strategically in James's study of the religious mind and how the religious pragmatist and the medical pragmatist converged in James, the religious psychologist. A medical consultation in the 16th century might comprise "reviewing symptoms, taking the pulse, looking at the urine and offering advice." This view of health care 400 years ago was given by Dr. RH. Ackerman of Boston, MA, who based his view on a reading of Laurent Joubert's "Popular Errors and Common Sayings About

Congress was held on campus of Laval University

Medicine and the Regimen of Health". This book, written in French nearly 400 years ago, was one of the earliest medical books for the lay public. Some of the topics ventilated by Joubert have remained topical. Short visits by physicians are the essence of his question: "If a physician has to see 20 patients twice a day, isn't it enough that he spend at the bedside 15 minutes each time?" But Joubert was conscientious: he spent 10 hours each day seeing patients, plus 2 hours travelling to their bedsides. Among other problems in the doctor-patient relationship: the "ingratitude" of some patients towards their physicians, the difficulties created by calling in too many physicians and the therapeutic importance of sustaining the patient's confidence in the physician. According to Dr. S. Selwyn of London, England, the transition from mythology to medical microbiology was marked by the publication in 1589 of "Theatrum Insectorum", written by Thomas Moffett. Selwyn, who told his audience that Little Miss Muffett was the daughter of this Thomas, attached great importance to Moffett's work because it inaugurated the science of parasitology. The "Theatrum" was well illustrated with drawings of lice, fleas and other parasites, in great contrast to drawings of satyrs and pans that evidence the lack of sophistication in zoology that prevailed in Moffett's day. Selwyn paid special attention to the chapter on the scabies mite. He described Moffett's technique of observation with "lenticular optick glasses of crystal", which enabled Moffett to describe for the first time a true microorganism that caused a communicable human disease; he also described the pathogenesis of the skin lesions and their treatment with sulfur preparations. The "Theatrum", Selwyn opined, is important as an historical document because it presented a complete microbial basis for disease that was not widely accepted, even for scabies, for another 300 years. The congress wa. denied what looked, from the published abstract, to be one of the most fascinating examples of applying modern knowledge to historical fact. Dr. Pierre Rentchnick of Geneva was due to present a paper on a new theory of the "will to power", based on a study of more than 260 political and religious leaders. Unfortunately he was unable to appear. His abstract noted that a common denominator among such leaders has been that they were all orphans, illegitimate or abandoned children or had rejected their fathers. "A distinctive characteristic of the childhood of these leaders is the feeling

of 'nothing', of agonizing emptiness against which the orphaned or abandoned child has to fight," wrote Dr. Rentchnick. He proposed that the fatherless child becomes aggressive and attempts to dominate society and destiny in a search for security. There are elements of seeking revenge (consciously or unconsciously) for this bad fortune. "On the other hand," wrote Dr. Rentchnick, "theology is a systematic and organized attempt to dominate the emptiness of human existence by opposing the rigour of a metaphysical absolute." Dr. Marielene Putscher of the Netherlands viewed various interpretations of the oldest dream known to mankind - that of Jacob and the ladder - as a guide to the history of dream theory. But many of her examples were from the work of artists rather than physicians - a Rembrandt etching, for instance. Jacob's dream has been painted and sketched so often that a comparison of the different styles becomes a portrayal of the diversity of the cultures that have interpreted it. Early records Papers based on study of the medical records of early explorers to the American continent show there is a great wealth of material, and much of it remains to be sifted. Drs. R.K. Valle and A.R. Valle of Florida discussed the state of health of the Indians of the region between the Mexican border and Vancouver as written about by explorers Laperouse (1786), Vancouver (1792), Resanov (1806), Gotzebue (1816 and 1824), Beechey (1827) and Bernard du HautCilly (1828). Syphilis, phthisis, dysentery, various fevers and ophthalmias and epidemic measles were the common diseases. For many years the indigenous Indian medicine coexisted with Western medicine as practised at the pharmacies and infirmaries operated in all the missions. The records of Jesuit missionaries and such explorers as Champlain formed the basis for a paper by Dr. J.D. Griffin and Professor Cyril Greenland of Toronto. The records show the manifestation of madness in New France among the indigenous peoples. Mental disorder among early French settlers is also recorded - the first patient to be admitted to the H6pital G6n.ral de Ville Marie in 1694 was a "feeble-minded man Yet Indian medicine in North America was far from inadequate. Griffin and Greenland presented evidence of the practice of trephination in 17thcentury skulls. And Dr. W.B. Stewart of Moncton, NB suggested Indians

were ahead of Europeans. "Their social organization, especially their treatment of children, was centuries ahead of European standards," he told the international congress. "In fact the Indian doctors were some 3½ centuries ahead of their European confreres with a contraceptive pill made from the dehydrated testicles of our national emblem, the beaver." Indians knew how to prevent and treat scurvy - with a tea of the back and sap of spruce or hemlock - before the British Navy fastened the word "limey" on itself. And Indians splinted fractures and stitched wounds with sutures of the inner bark of trees or tendons of deer. "The Indian system of medicine failed in contact with white men," Dr. Stewart said. "Pestilence, firearms and rum contributed greatly to this tragic chapter that is not yet ended." But the first great historians of North America's native peoples, said the Russians, were Russians. I.V. Vengrova failed, as did other Soviet delegates, to make the congress, but in his published abstract he pointed out that the 18-century Russian explorers of Alaska collected information about its peoples, and that the first Russian governor of Alaska encouraged this activity. Russian explorers at the beginning of the 19th century gathered material on Eskimos, Aleuts and Indians, on their mode of life, customs, breeding of children, diseases and methods of treatment. If Marc Lalonde's Dr. Bouchard was the first Canadian to introduce medicare, it was a pity the minister did not remain until Friday to hear the sequel - the tale of the first recorded physician in Canada to have problems getting money out of the government. Dr.

C.G. Roland, Rochester, MN, told it. The year was 1785 and a mysterious ailment was sweeping the Baie St. Paul area, northeast of Quebec City. There was a belief that it was syphilis, but this has never been confirmed. (Another paper at the congress, by Dr. Sylvio Leblond of Quebec, discussed the disease.) Lieutenant Governor Henry Hamilton issued to Dr. James Bowman a directive to proceed to the area, treat sufferers, leave necessary supplies of medicine and collect data for an account of the epidemic. Bowman made nearly 10 000 patient visits over 2 years and sent the government a bill for £2353 12s 4d. For a year he asked for his money, then he died. His father came to Canada from Ireland to settle the account, hired a lawyer and laid siege. The wrangle lasted until 1791, when a government committee finally awarded £825. As the government also claimed to have paid an advance of £500, that left the estate with only £325 to come, and, commented Dr. Roland, one hopes it paid the father's fare from Ireland. Dr. Estrellita Karsh, Ottawa, presented an account of North America's first health spa. The healing properties of the waters at Stafford Springs, CT had long been known to Indians, and in 1757 a minister-physician, John Willard, moved there from Boston. Willard began to record notes on the spring, which by 1865 was not only well known, but almost notorious. Dr. Joseph Warren of Boston visited in 1766 and bought land on which to build a physician-supervised sanatorium. But he never got around to it; he was killed at Bunker Hill. Meantime he had sent to take the waters his friend continued on page 582

An 1810 engraving by Abner Reed of tbe Stafford Springs Spa. Tbe otiginal, at Conntway Library, Boston, was provided to tbe Connecticut Historical Society by P.T. Ratbbone.

CMA JOURNAL/SEPTEMBER 18, 1976/VOL. 115 571

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In addition to dealing directly with cases and referrals, the centre multidisciplinary staff would assist and upgrade other agencies and provide consulting services for institutions. Professionals would intern in the facilities to gain suicide training and the centre would undertake professional and public education. Volunteer agencies in the community would be designated for fee-for-service work with crisis population groups. Working under the suicide centre and a regional mental health council, the agencies would maintain adequate staffing and training standards to maintain a quality service. The regional councils would in turn coordinate planning and evaluate programs based on public input to develop the services needed in the community. A provincial health advisory council would also be established to spearhead the battle against suicide and lobby the government for improvements in the system. At the government level, the task force recommends the establishment of a separate suicide branch in the Department of Social Services and Community Health to offer administrative support and supervise standards, training and communications.

Cost of this antisuicide structure is not estimated, nor is the cost of setting up a proposed centre for the study of violent and self-destructive behaviour. The centre would be a research, training and consulting facility linked with an Alberta university and provincially funded. The report is currently undergoing the first stage of its suggested implementation procedure - public analysis. The next step calls for the formation of an interdisciplinary committee, including a suicidologist, to determine detailed implementation. A committee progress report should be produced annually; there should be a 3-year review and pilot projects should be established in Edmonton and Calgary. If the report runs into the same kind of problems task force researchers encountered from the provincial government in their attempts to study the native suicide problem, the report may not go much beyond the public study stage. The task force reports its native study was incomplete due to its inability to obtain "certain essential information" from the Department of Social Services and Community Health, the department to which the task force reported. U

CONFERENCE REPORTS continued from page 571 John Adams, later to become second president of the United States, who noted his in his diary that the journey had been worthwhile. It was left to Willard's son, Dr. Samuel Willard, a 1787 graduate of what is now Harvard medical school, to build a sanatorium in 1803. Willard invested in a turnpike company to ensure that the stagecoach brought patients directly to his doorstep; in winter the spa became a coeducational boarding school. In 1810 Willard unrealistically put up more buildings, but the onset of the War of 1812 drastically reduced the flow of patients. By 1816 he couldn't meet his overextended commitments. Dr. Karsh described how Willard fled by night disguised in his wife's clothes while irate creditors stormed the Springs House. The spa survived many years because the waters were excellent, but in 1896 the Springs House burned down; today all that is left of America's first spa is a capped well. Dr. Karsh obtained primary data from hitherto unpublished manuscripts held by descendants of the Willard family. One of the more scholarly sessions was the last, which meant that many

delegates had left and there were only two or three observers, apart from the participants who were to read papers to each other. Drs. Basil Rozos of Athens and Nicholas Padis of Philadelphia both discussed Byzantine medicine. Their presentations overlapped somewhat but mostly were complementary. Dr. Padis's thesis was that the Byzantine church established medical and social institutions in a spirit of philanthropy that has persisted and contributes to present-day systems of patient care. He said the contributions to medical science of Byzantine medicine were minimal; the contribution of Byzantine medicine was in its institutions. Dr. Rozos said that during the whole period of Byzantium there was "organized care for those suffering from various causes, whether individuals or groups of people." Nobles and the emperor himself succoured the sufferers in times of plague, fire, famine and earthquake. There were organizations for the care of the old, destitute, widows, orphans, prisoners, captives, slaves and the sick, Dr. Rozos said. He compared the welfare system of Byzantium with modern systems and concluded "that at that period the social welfare undertaken by the church was not essentially different to that of present-day social policy."E

582 CMA JOURNAL/SEPTEMBER 18, 1976/VOL. 115