232 MEN AND Booxs: Ascuia'ius, GOD OF MEDICINE Canad. Med. Ass. 3. Jan. 30, 1965, vol. 92 T HE story of the god of medicine begins in the sixth century B.C. when Asclepius* was a minor deity serving the needs of the itinerant Greek physicians. Civilized life in the ancient world sought health and freedom from disease which Asclepius, through his temple priests and physicians, offered to mankind. Because of this, his power and appeal increased until in the third century A.D. he was designated Zeus Asclepius and his cult was the predominant religion in the ancient world. The blasphemy of the Christian leaders, the disfavour of paganism manifested by Christian emperors, and the chaos of the fourth, fifth and sixth centuries resulted in the fall and extinction of the Asclepian cult. In spite of this, Asclepius survived and today remains among us as a pagan god symbolizing the Platonic idea of health and healing. The Oath of Hippocrates is solemnified by swearing to him, his father and his two daughters. A single snake curling about a staff was the ancient mark of the god and is today symbolic of medicine and of various major medical societiest (Fig. 1). Excep- tional students at many universities belong to Asclepian societies which are dedicated to pure academic advancement. Hippocrates, who accord- ing to some ancient writers was a 19th descendant From the Department of Medicine, University of Toronto, and The Toronto East General Hospital. *Asclepius is also spelt Aesculapius (Latin), ATKX7J7rLOS (Greek), Asciepins, and Askiepios. There are many ver- sions of the derivation of the word. One refers to his curing Asides of oplithalmia and another is based upon the ancient word for mildness, while Leake suggests that there is some relation to the herb of life, mistletoe. tThe snake has been worshipped by many cultures around the globe. The annual shedding of its skin symbolized new life or rejuvenation, and through its ability to assume the shape of a living circle it was regarded as the symbol of eternity. In early Greek medicine the snake reputedly had great knowledge of medicinal herbs and also had a healing lick. The association with Asciepius was a practical one: It not only symbolized the healing power but also kept the temples free of rats and mice. Today this could be inter- preted as a supplemental role for the goddess Hygieia, as the removal of rodents decreased the spread of disease at the temple sites. The harmless Elaph longissima has been identified as the temple serpent, and its distribution in Europe today follows approximately the boundaries of the Roman Empire and its Asciepian temples. The caduceus Is formed by two snakes twisting about a single staff and was erroneously introduced as a medical symbol. Its first association with a physician was in 1545 when Sir William Butts, physician to Henry VIII, adopted it into his crest. In 1856 the United States Public Health Department used It on the uniform of hospital stewards and in 1902 the Medical Corps of the United States Army adopted the caduceus as the symbol for non-combatant forces in the field. Because of this error most of the laity and many members of the medical profession equate it with the medical symbol. The first recorded caduceus appears on Babylonian cylin- ders (3000 B.C.) in which the snake was the symbol of supreme sexual prowess and fertility; in order to illustrate the bisexual nature of the snake two heads were added to a single body (Fig. 6). Later the caduceus was adopted as the symbol of Hermes or Mercury-the god of heralds. commerce, rogues, cattle rustlers, dreams and magic. This symbol is still used by financial Institutions and indeed it is displayed by the serv- ice stations of a large oil company. I' 4 Fig. 1.-Variants of the staff of Asciepius used in medical symbolism. The first is the symbol of The Canadian Medical Association, the second of the College of General Practice of Canada, the third of the American Medical Association, and the fourth of the British Medical Association. of Asclepius, was a devotee of the god of medi- cine, and reverence for the father of clinical medicine indirectly venerates Aselepius. The new mace of office of the American College of Phy- sicians will 'be carved from a slab of timber from a 2500-year-old plane tree at the Asclepian sanc- tuary at Cos (Fig. 2). At the Ninety-Fourth Annual Meeting of The Canadian Medical Asso- ciation, Dr. Wilder Penfield presented the Asso- ciation with a gavel fashioned from a branch of one of these plane trees, beneath which it is said Hippocrates taught his students in the fifth cen- tury B.C. On an earlier occasion, in 1954, the late Dr. T. Clarence Routley presented a similar gavel to the College of General Practice of Canada at their founding meeting. Fig. 2.-The plane tree of Hippocrates. Early mankind attempted to explain nature and to justify existing social systems and customs through reference to mythology and the gods. Per- haps the existence of a host of unanswered medical
Transcript
232 MEN AND Booxs: Ascuia'ius, GOD OF MEDICINE Canad. Med. Ass. 3.Jan. 30, 1965, vol. 92
THE story of the god of medicine begins inthe sixth century B.C. when Asclepius* was
a minor deity serving the needs of the itinerantGreek physicians. Civilized life in the ancientworld sought health and freedom from diseasewhich Asclepius, through his temple priests andphysicians, offered to mankind. Because of this,his power and appeal increased until in the thirdcentury A.D. he was designated Zeus Asclepiusand his cult was the predominant religion in theancient world. The blasphemy of the Christianleaders, the disfavour of paganism manifested byChristian emperors, and the chaos of the fourth,fifth and sixth centuries resulted in the fall andextinction of the Asclepian cult.
In spite of this, Asclepius survived and todayremains among us as a pagan god symbolizingthe Platonic idea of health and healing. The Oathof Hippocrates is solemnified by swearing to him,his father and his two daughters. A single snakecurling about a staff was the ancient mark of thegod and is today symbolic of medicine and ofvarious major medical societiest (Fig. 1). Excep-tional students at many universities belong toAsclepian societies which are dedicated to pureacademic advancement. Hippocrates, who accord-ing to some ancient writers was a 19th descendant
From the Department of Medicine, University of Toronto,and The Toronto East General Hospital.*Asclepius is also spelt Aesculapius (Latin), ATKX7J7rLOS(Greek), Asciepins, and Askiepios. There are many ver-sions of the derivation of the word. One refers to hiscuring Asides of oplithalmia and another is based uponthe ancient word for mildness, while Leake suggests thatthere is some relation to the herb of life, mistletoe.tThe snake has been worshipped by many cultures aroundthe globe. The annual shedding of its skin symbolized newlife or rejuvenation, and through its ability to assume theshape of a living circle it was regarded as the symbol ofeternity. In early Greek medicine the snake reputedly hadgreat knowledge of medicinal herbs and also had a healinglick. The association with Asciepius was a practical one: Itnot only symbolized the healing power but also kept thetemples free of rats and mice. Today this could be inter-preted as a supplemental role for the goddess Hygieia, asthe removal of rodents decreased the spread of disease atthe temple sites. The harmless Elaph longissima has beenidentified as the temple serpent, and its distribution inEurope today follows approximately the boundaries of theRoman Empire and its Asciepian temples.The caduceus Is formed by two snakes twisting about a
single staff and was erroneously introduced as a medicalsymbol. Its first association with a physician was in 1545when Sir William Butts, physician to Henry VIII, adoptedit into his crest. In 1856 the United States Public HealthDepartment used It on the uniform of hospital stewardsand in 1902 the Medical Corps of the United States Armyadopted the caduceus as the symbol for non-combatantforces in the field. Because of this error most of the laityand many members of the medical profession equate it withthe medical symbol.The first recorded caduceus appears on Babylonian cylin-
ders (3000 B.C.) in which the snake was the symbol ofsupreme sexual prowess and fertility; in order to illustratethe bisexual nature of the snake two heads were added to asingle body (Fig. 6).
Later the caduceus was adopted as the symbol of Hermesor Mercury-the god of heralds. commerce, rogues, cattlerustlers, dreams and magic. This symbol is still used byfinancial Institutions and indeed it is displayed by the serv-ice stations of a large oil company.
I'4Fig. 1.-Variants of the staff of Asciepius used in medical
symbolism. The first is the symbol of The Canadian MedicalAssociation, the second of the College of General Practiceof Canada, the third of the American Medical Association,and the fourth of the British Medical Association.
of Asclepius, was a devotee of the god of medi-cine, and reverence for the father of clinicalmedicine indirectly venerates Aselepius. The newmace of office of the American College of Phy-sicians will 'be carved from a slab of timber froma 2500-year-old plane tree at the Asclepian sanc-tuary at Cos (Fig. 2). At the Ninety-FourthAnnual Meeting of The Canadian Medical Asso-ciation, Dr. Wilder Penfield presented the Asso-ciation with a gavel fashioned from a branch ofone of these plane trees, beneath which it is saidHippocrates taught his students in the fifth cen-tury B.C. On an earlier occasion, in 1954, the lateDr. T. Clarence Routley presented a similar gavelto the College of General Practice of Canada attheir founding meeting.
Fig. 2.-The plane tree of Hippocrates.
Early mankind attempted to explain nature andto justify existing social systems and customsthrough reference to mythology and the gods. Per-haps the existence of a host of unanswered medical
Canad. Med. Ass. 3.Jan. 30, 1965, vol. 92 MEN AND BooKs: Asci.rius, GOD OF MEDICINE 233
problems and the mystical power of the art ofmedicine have resulted in our tacit preservationof this Greek god.
Tmi. ORIGIN OF ASCLEPIUS
Homer, Hesiod, Pindar, the Greek lyricists andmuch mythology have invested Asclepius' originwith a colourful array of fact and fancy fromwhich unffied conclusions cannot be drawn. Somefeel that Asclepius was always a god, while othersargue that he was a hero-physician who was laterdeified.
In the Iliad (circa 850 to 1200 B.C.) Asclepiusis a king, but Homer uses this as a literary deviceto maintain the dignity of the epic and the heroicrole of its participants. Asclepius' two sons,Machaon and Podalarius, are poetic princes whoin reality are the best physicians in the Greekarmy at Troy. Machaon is the surgeon who treatsMenelaus' wound, and Podalarius is the physicianwho treats Ajax's madness.
Ovid's "Metamorphosis" offers to physicians themost unified account of the Asclepian myth. Thefollowing is an extract from the Miller translationas it appears in Edelstein's "Asclepius", Volume 1:
"In all Thessaly there was no fairer maid thanCoronis of Larissa, and the raven told Apollo that hehad seen Coronis lying beside the youth of Thessaly.When that charge was heard, his heart became hotwith swelling anger, he seized his accustomed arms,strung his bent bow from the horns, and transfixedwith unerring shaft the bosom which had been sooften pressed to his own. The smitten maid groanedin agony, and she drew out the arrow, her whitelimbs were drenched with her red blood. 'Twas right,Oh Phoebus,' she said, 'that I should suffer thusfrom you, but first I should have borne my child.But now two of us shall die in one.' While she spokeher life ebbed out with her streaming blood, andsoon her body, its life all spent, lay cold in death."The lover, alas! too late repents his cruel act: he
hates himself because he listened to the tale and wasso quick to break out in wrath. He hates the birdby which he has been compelled to know the offencethat brought his grief. He fondles the fallen girl, andtoo late tries to bring help and to conquer fate; buthis healing arts are exercised in vain. When his effortswere of no avail and he saw the pyre made ready withthe funeral fires which were to consume her limbs, hepours fragrant incense on her unconscious breast andgives her the last embrace. But that his own son shouldperish in the same funeral fires he cannot brook. Hesnatched the unborn child from his mother's womband from the devouring flames, and bore him for safe-keeping to the cave of the two formed Chiron.
"Meantime the Centaur was rejoicing in his foster-child of heavenly stock, glad at the honour which thetask brought with it. His daughter not satisfied to havelearned her father's art, but she sang prophesy. Shelooked upon the child and cried: 'Oh child, healthbring to the whole world, speed thy growth. Oftenshall mortal bodies owe their lives to thee, and tothee shall it be counted right to restore the spirits ofthe departed. But having did this once in scorn of the
Gods, from power to give life a second time thou shaltbe stayed by thy grandsire's lightning. So, from a Godshalt thou become but a lifeless corpse but from thiscorpse shalt thou again become a God and twicerenew thy fates!"'
Some interpretations which might be placed onthis myth are as follows: Apollo was associatedwith the prophesies of the Delphic Oracle, andas the father of Asclepius there is a symbolic back-ground to the prognostic power of the physician.The divine father and mortal mother support themystical element of medical practice. Delivery byCesarean section was believed by the ancients tobe an indication of divinity or of outstandingpersonality. This is the first account of such sur-gery (Fig. 3).
Fig. 3.-The purported Cesarean delivery of Asciepius.From an old wood cut by A. Benedetti in 1495.
That Asclepius should be entrusted to thecentaur Chiron would be most acceptable toOvid's readers. Chiron was the inventor of herbalmedicine and the friend and patron of heroes; hishome on Mount Pelion in Thessaly was rich inmedicinal plants, which suggests that Asclepiuswas destined to be a physician rather than asurgeon.
Asclepius' healing power increased and eventu-ally he was able to raise the dead. Hades, thegod of the underworld, complained to Zeus thatAsclepius was depopulating his domain, and thehealer was punished by a bolt of lightning forhis interference with natural laws of mankind andthe universe. After death he was deified by Zeusand made god of medicine.
Asciiuius AND EARLY MEDICAL PRACTICE
The early Greek physicians were craftsmen whotoured the countryside soliciting business fromthose able to pay and treating the poor withoutcharge. They carried instruments, medicines anda staff. The last helped them over the rugged ter-rain and is still depicted in the staff of Asclepius.Physicians, like tinkers, acrobats and poets, neededa hero and a protector. The poets had chosenHomer and they distinguished themselves with theappellation Homerids, or sons of Homer. Aroundthe sixth century B.C., physicians became Ascle-
234 MEN AND Booxs: Ascuipms, GOD OF MEDIcINE
piads or sons of Asciepius. This family symbolismrepresents the earliest attempt by practising phy-sicians to band together in a group for mutualprotection and advancement. In the fifth centuryB.C. the hero of the physicians became the godof physicians because doctors needed a god tosupport and bless their difficult tasks. EventuallyAsciepius became the consultant of the day andhis temple the hospital. From this evolved thepractice of temple medicine in which the accom-panying pomp and awe it invoked would oftenspeed recovery of difficult illnesses, especially ifthese were psychological in origin. Even today avisit to a specialist or a large clinic may have,per se, a therapeutic effect.Temple medicine adopted all the standard
methods of treatment, and the sojourn in thedream room was often preceded by a lengthydelay in the temple surroundings. Here the sickreceived massage, hydrotherapy, exercise and ahealthful diet. They were given unguents andpoultices, and were subjected to hygienic mea-sures. They derived hope from the votive offeringsof cured patients which abounded in the templehalls and grounds. This modern general therapypreceded the sleep in the Abaton or incubationand dream room of the temple, where, duringhypnotic somnolence, the god appeared to thepatient and performed surgery or other treatmentand made recommendations to be followed orinterpreted 'by the temple physicians. During theserounds Asdepius was often 'accompanied by hisdaughters Hygieia (health) and Panacea (cure-all), and his treatments were sometimes carriedout by a sacred temple snake or dog licking thediseased part. No direct fee was charged, but thewealthy gave according to their status and re-sponse to treatment, while the poor were treatedfree; this represented the first venture in organizedmedical care for the needy.
AsCLEPIAN RELIGION
The worship of any god in the ancient worldwas accompanied by 'ancillary rites, sacrifices,hymns, processions and festivals. From these thecult of Asclepius evolved with devotions given topreserve health (prophylaxis) and to treat disease.
Physicians prayed daily either at temples or intheir 'homes, while the prayers of regular devoteeswere supplemented by festivals. The sick prayedat home or at temples, and often relatives orfriends would also pray for assistance.The temples had buildings to 'house the sick in
which treatment was carried out. The Abaton wasthe most sacred of these, and 'here the sick sleptat the foot of a large ornate statue of Asclepius.The god would not treat illness caused by luxuryand folly, and the dream visits occurred only aftersuitable 'hypnotic conditioning. Dying and obstet-rical patients were also excluded. A sacrifice of
Canad. Med. Ass. 3.Jan. 30, 1965, vol. 92
a cock or lamb was frequently offered, but in theAsclepian cult prayer was the most important partof the ritual. Like other gods, Asclepius had fes-tivals which attracted visitors from afar to themajor centres. The usual parades, prayers andsacrifices were supplemented by games and dramaenacted in the amphitheatres which adjoined manyof the temples.
There exists a record from Ephesus in AsiaMinor which describes in the second century amedical contest as a unique addition to the usualreligious ritual of the god. This was indeed asignificant illustration of the scientific approach ofthe Asclepiads to medical advancement and issuggestive of today's Royal 'College 'Medal andother notable prizes for scientific advancement.The plaque from Ephesus records that P. VediusRufinus won the prize essay, P. Aelius Menanderwon the prize in surgery, and P. Aeliuswon the prize for inventing new instruments.Though the last name is missing from this inscrip-tion, one is tempted to speculate that it was thesame man who won the prize in surgery. Perhapshis invention was the prototype of a modernretractor or a clamp.
Tini INFLUENCE OF AsGLEPIus
In 292 B.C. an uncontrolled epidemic was rag-ing in Rome and envoys were sent to obtain helpfrom Asclepius at Epidaurus. The god caine to thecity in the form of a snake and after controllingthe pestilence established a sanctuary on an islandin the Tiber.*Other centres of healing were established though-
out Greece, in the Aegean islands, in Italy, AsiaMinor, Carthage, Egypt, 'Cyrene, Spain, and Phoe-nicia. The Roman legions even took the god toBritain and although no sanctuaries have beenfound, there are four known dedications, and asymbol similar to the staff of Asclepius appears onpart of the temple of Sul Minerva at Bath (Fig. 4).The sanctuary at Epidaurus in Greece was foundedin the sixth century B.C. and endured until 355A.D.; archeological studies have allowed the recon-struction of that famous site which was favouredby both Alexander the Great and the EmperorHadrian. At the zenith of the god's influence therewere an estimated 800 temples. Study of all thesites is far from complete and much valuableinformation still awaits the skilled digger. Perhapssome day our medical associations and pharma-ceutical 'houses may encourage further study inthis valuable aspect of medicine.
*The island was shaped in the form of a boat and may stillbe seen today. W4th' the ascendancy of Christianity, St.Bartholomew took over the sanctuary and continued to carefor the sick. It was here that the ailing London monk,Rahere, was treated for malaria and in thanks for hisrecovery fulfilled a vow to build in London a hospital toSt. Bartholomew. St. Barts is today a major scientific andteaching Institution and is the only hospital In the cityof London (the area bounded by the original Roman andmedieval "walls).
Canad. Med. Ass. J.Jan. 30, 1965, vol. 92 MEN AND Booics: ASCLEPIUS, GOD OF MlmIcmIE 235
which stands on a serpent. The serpent is sym-bolic of both Asciepius and evil. This coin wasminted shortly after the destruction by Constantineof the Asciepian temple at Aegea. No furthercoins depicting Asclepius appear until the MiddleAges. At this time the symbol of the snake andand staff reappears on plague tokens; even numis-matically the god survived the dark ages.
Edelstein has accumulated and translated 861original Greek and Latin literary testimonies tothe god Asclepius. These supply a ready sourceof reliable references attesting to his influence.Alexander the Great dedicated 'his breast plateand spear to the god. The dying words of Socrates(406 B.C.) were said to be "We owe a cock toAsclepius, and do not neglect it." Plato (427-348B.C.) in the third book of "The Republic" re-vealed that Asclepius refused to treat those whosebodies were diseased throughout, thereby remov-ing the handicapped and their offspring from theState (a philosophy of selective breeding and asystem of therapeutics which is biased towards thetherapist's success). Hippocrates makes many refer-ences to Asclepius, and one of these (T.568)supports the establishment of the sanctuary atCos in pre-Hippocratic times.
Celsus (first century A.D.) states, "HenceAsclepius, since he is celebrated and its mostancient founder and because he cultivated medi-cine with a little more exactness, was numberedamong the Gods." Galen (129 to 100 A.D.) fre-quently refers to 'him in his writings: "the an-cestral God Asclepius of whom I declare myselfto be a servant since he saved me when I 'had thedeadly condition of an abscess." In "De Anato-micis Administrationibus", Galen writes, "I wasreceiving instructions from Satyrus who was thenspending 'his fourth year at Pergamum with Con-stunius Rufinus who was building for us theTemple of Zeus Asclepius." The equating ofAsclepius with Zeus attests to the growth andinfluence of the Asclepian cult until in the secondcentury the god of medicine was equated with thesenior gods in the Greek Pantheon.
THE DECLINE OF AscLEPLus
The cult continued to thrive until the thirdcentury when Christianity became a major oppos-ing religious force. The Christians condemnedAsclepius more than any other pagan deity prob-ably because in the early gospels Jesus was also ahealer and a physician. Lactantius, the Christianwriter and tutor of Constantine's son, the lateremperor of Crispus, refers to Asclepius as the"arch demon". Tertullian, a Christian scholar fromCarthage (circa 200 A.D.), calls him "a beast sodangerous to the world". Eusebius the Bishop ofCaesarea and a Christian historian, describes himas "the one who draws men away from their truesavi.our..
MEDIcINE Canad. Med. Ass. 3.236 MEN AND BooKs: ASCLEPIUS, GOD OF Jan. 30, 1965, vol. 92
A basic rancor is experienced even today whenphysicians are confronted by chiropractors or otherprofessed healers with a different academic orphilosophic background. Although 'both religionssought health and happiness, the Asciepian cultdiffered basically from Christianity in that it wasselective. Asclepius would heal only those dedi-cated and pure in thought; and the dying and thepregnant were even excluded from his sanctuary.Jesus healed 'body and soul of good and bad andoffered to all, even those about to die, eternal life.Both religions had a personal contact with their
respective gods, but in Christianity this was moreintimate and the people at that time sought andneeded a personal friendly god. The serpentsymbol of Asclepius served the Christian propa-ganda campaign well because for them the snakewas the symbol of evil.The third most important Asclepian sanctuary
at Pergamum was destroyed by an earthquake inthe mid-third century and it was not rebuilt. Thiswas a milestone in the decline of the Aselepiuscult, symbolically hastened by nature, as Per-gamum was a centre for teaching and pilgrimage.The adoption of Christianity as the official statereligion by Constantine around 312 A.D. furtherweakened Asclepius and the damage increasedwhen the Emperor ordered the destruction of theAsclepian temple at Aegea (331 A.D.). During thedecline of popularity the intellectuals remainedloyal to the cult.The Emperor Julian (355-363 A.D.) favoured
return to the pagan religion and during his reignthere was a temporary plateau in the downwardcourse of the Asclepian cult. At Aegea he orderedthe Christian priest to restore to the temple ofAsclepius the pillars that were removed from itwhen Constantine had ordered the temple'sdestruction. This order was carried out so slug-gishly, almost as if aided by nature, that it wasnot completed. This showed that in spite of theorders of an emperor called Apostate the cultcould not regain its former glory. History doesnot record the fate of the other temples; somebecame early Christian hospitals while others wereeroded by time, nature and 'Christianity.
CONCLUSION
The story of Asciepius spans three millennia,and a true evaluation of his contributions has notyet been reached. There is a hoard of literaryreferences on this subject but they are seldomassessed by physicians. Our casual attitude towardsour origin has allowed us to be symbolized in theminds of the public by a Babylonian phallicsymbol, or at best the symbol of messengers,thieves and commerce. That this error should befostered is a subtle tribute to the power of theU.S. Army who germinated it, but it also reflectsour lack of historical interest. The numismaticmaterial on the subject of Asclepius has been butsuperficially analyzed. Archeology will slowlysupply more knowledge of our past.The Edelsteins were the first and probably the
only authors to date who have realized the extentand religious significance of the Asclepian cult.The testimonies and dedications by every physi-cian and philosopher of the classical period sup-port their conclusions.The sources of information are so varied that
every conclusion may be disputed. Even Sigerist,the greatest medical historian of this century, feltthat the Asclepian cult followed rather than pre-ceded Hippocrates at Cos.The fact remains that Asclepius has survived
both the fall of the classical world and the riseof Christianity. He is still among us even if thehumors have been replaced by hormones and thetemples by hospitals.
REFERENCES
1. EDELSTEIN, E. AND EDELSTEIN, L.: Asciepius, Johns Hop-kins Press, Baltimore, 1945.
2. GUIRAND, F., editor: Larousse encyclopedia of mythology,Prometheus Press, New York, 1959.
3. LAUGHLIN, V. C.: J. mt. Coil. Surg., 38: 82, 1962.4. FROTHINGHAM, A. L., JR.: American Journal of Archae-
10. Editorial: J. A. M. A., 172: 245, 1960.11. SCARTH, H. M.: Aquae solis, or Notices of Roman Bath,
Simpkin, Marshall, & Co., London, 1864.12. MARTI-IBANEE, F., editor: The epic of medicine, Clarkson
N. Potter, Inc., New York, 1962.13. POTTER, B. S.: Serpents in symbolism, art and medicine:
the Babylonian caduceus and Aesculapius club, Pri-vately printed, Santa Barbara, California: The Author,1937.
14. LEAKE, C. D.: Arch. Intern. Med. (Chicago), 113: 496,1964.
PAGES OUT OF THE PAST: FROM THE JOURNAL OF FIFTY YEARS AGO
CASES FROM "THE SHAMBLES"As it has been my function to keep "Villa St. Pierre" full
of cases, and to work there at night, I have not been ableto follow up many cases closely. But some, I think, areworthy of mention.Compound fractures; tetanus; recovery: Never were the
horrors of war brought so forcibly to me as when I chancedto see a young British officer whom I knew and when I wasable to hear and read his story. As a cavalry officer hewas called upon to dismount and fight in the trenches. OnOctober 29th be was struck by an exploding shell. Hisright arm was broken in several places, and pieces of thehumerus protruded, his right shoulder was much torn and
his scapula chipped; a piece of shell made a gash over hisright lower jaw, and fractured it, and besides these woundshe had scratches elsewhere. He got to a base hospital inone day, but soon developed tetanus. He slowly recoveredand on December 7th was in good spirits, the first andonly time I saw him. The nurse outside his room was notable to say whether he had had antitetanic serum im-mediately, but he was injected later with it, and was keptunder the influence of chlorotone, and was given hypo-dermic injections of 2 per cent. carbolic. However, noattempt could be made up till that date to attend to thearm properly.-The War, T. A. Malloch, Canad. Med. Ass.J., 5: 162, 1915.
