Chapter XLIII. The First Appearance of Syphilis in Europe

as an Epidemic Disease.--Medical Journalism.--The

Beginnings of a Modern Pharmacopoeia.--Itinerant

Lithotomists 542

List of the More Important Authorities Consulted 557

General Index 563

LIST OF ILLUSTRATIONS

Fig. 1. View of the Temple of Aesculapius on the Island

of Cos _facing page_ 52

Fig. 2. Bird’s-eye View of the Temple of Aesculapius and

Associated Buildings on the Island of Cos

_facing page_ 54

Fig. 3. Ground Plan of the Asclepieion on the Island of Cos

_facing page_ 55

Fig. 4. Ancient Statue of the God Aesculapius in the Berlin

Museum _facing page_ 62

Fig. 5. Head of the Marble Statue of the God Aesculapius in

the Naples Museum _facing page_ 62

Fig. 6. Bas-relief of Aesculapius, Accompanied by Women and

Children, in the Presence of an Enormous Serpent

_facing page_ 68

Fig. 7. Female Bust Showing Cancer of One Breast

_facing page_ 68

Fig. 8. Paralysis of the Left Facial Nerve _facing page_ 70

Fig. 9. The Oldest Known Pictorial Representation of a

Formal Dissection of the Human Body _facing page_ 280

Fig. 10. The Manner of Giving Public Instruction in Medicine

during the Middle Ages 281

Fig. 11. Henri de Mondeville _facing page_ 288

Fig. 12. One of the Wards in the Hôtel-Dieu of Paris

_facing page_ 304

Fig. 13. The Physician, the Surgeon and the Pharmacist

_facing page_ 306

Fig. 14. Andreas Vesalius _facing page_ 344

Fig. 15. William Harvey _facing page_ 380

Fig. 16. “The Lovesick Maiden” _facing page_ 412

Fig. 17. Thomas Sydenham _facing page_ 418

Fig. 18. Consultation by Three Physicians upon a Case of

Wound in the Chest 457

Fig. 19. Barber Surgeon (_Wundarzt_) Extracting an Arrow

from a Wounded Soldier’s Chest while the Battle

is Still in Progress 461

Fig. 20. Amputation of the Leg 463

Fig. 21. The Manner in Which the So-called Tagliacotian

Operation for Repairing a Defective Nose Should

be Carried Out 480

Fig. 22. Pierre Franco’s Forceps for Crushing Calculi in

the Urinary Bladder 497

Figs. 23–24. Forceps Devised in 1552 by Ambroise Paré for

Drawing Out the Cut Ends of Arteries after the

Amputation of a Limb, and Holding Them while

the Ligature is Being Applied 512

Fig. 25. Ambroise Paré the Famous French Surgeon of the

Sixteenth Century _facing page_ 514

Fig. 26. Frère Jacques de Beaulieu _facing page_ 550

Fig. 27. Jean Baseilhac, commonly Known in France as Frère

Côme _facing page_ 552

Fig. 28. Concealed Lithotome Invented by Frère Côme in 1748 553

PART I

ANCIENT MEDICINE

CHAPTER I

DEVELOPMENT OF THE SCIENCE AND ART OF MEDICINE

Friedlaender says that “in the temple of history, now hoary with age,

medicine also possesses its own chapel, not an accidental addition to

the edifice but a large and important part of the noble building.” In

this chapel is preserved the record of the efforts made by man, through

the ages, to maintain his body in good condition, to restore it to

health when it has become affected by disease or damaged by violence,

and to ward off the various maladies to which it is liable. It is a

record, therefore, in which every practitioner of medicine should

take a deep interest. Rokitansky, the famous pathologist of Vienna,

expressed the same idea very tersely when he said: “Those about to

study medicine and the younger physicians should light their torches at

the fires of the ancients.” Members of the medical profession, however,

are not the only persons in the community who take an interest in the

origin and growth of the science of medicine and the art of healing

the diseased or damaged body; the educated layman is but little less

interested than the physician, being ever ready to learn all he can

about the progress of a branch of knowledge which so profoundly affects

his welfare. But hitherto the only sources of information available for

those who are not familiar with French or German have been treatises

of so technical a character that even physicians have shown relatively

little disposition to read them.

The science of medicine developed slowly from very humble beginnings,

and for this earliest period the historian has no records of any kind

which may be utilized for his guidance. It is reasonably certain,

furthermore, that this prehistoric period lasted for a very long time,

probably several thousand years; and when, finally, some light on the

subject appeared, it was found to emanate from several widely separated

regions--_e.g._, from India, Mesopotamia, Egypt and Greece. Then,

after the lapse of additional hundreds or even thousands of years,

there was inaugurated the practice of making written records of all

important events, and, among others, of the different diseases which

affect mankind, of the means employed for curing them or for relieving

the effects which they produce, and of the men who distinguished

themselves in the practice of this art. While the “science of the

spade” and that of deciphering the writing of the papyri, monuments

and tablets thus brought to light, have already during the last half

century greatly altered our ideas with regard to ancient medicine,

there are good reasons for believing that much additional information

upon this subject may be looked for in the not distant future. It is

plain, therefore, that a history of the primitive period of medicine,

if written to-day, may have to be modified to-morrow in some important

respects. On the other hand, the facts relating to the later periods

are now so well established that a fair-minded writer should experience

no serious difficulty in judging correctly with regard to their value

and with regard to the claims of the different men to be honored for

the part which each has played in bringing the science and art of

medicine to their present high state of completeness and efficiency.

The subdivision of the history of medicine into separate periods

is certainly desirable, provided it be found practicable to assign

reasonably well-defined limits to the periods chosen. But, when the

attempt is made to establish such subdivisions, one soon discovers that

the boundaries pass so gradually the one into the other at certain

points, or else overlap so conspicuously at other points, that one

hesitates to adopt any fixed plan of classification. Of the four

schemes which I have examined--viz., those of Daremberg, of Aschoff,

of Neuburger, and of Pagel--that of Neuburger seems to me to be the

best. That which has been adopted, however, in the preparation of the

present outline sketch combines some of the features of both the Pagel

and the Neuburger schemes.

_Periods in the History of Medicine._--There are nine more or less

distinctly defined periods in the history of medicine, to wit:--

FIRST EPOCH: _Primitive medicine_.--This period extends through

prehistoric ages to a date which differs for different parts of the

world. The duration of this period, in any case, is to be reckoned by

thousands of years.

SECOND EPOCH: _The medicine of the East_--that is, of the cultivated

oriental races of whose history we possess only a very fragmentary

knowledge.

THIRD EPOCH: _The medicine of the classical period of antiquity_--the

pre-Hippocratic period of Greek medicine.

FOURTH EPOCH: _The medicine of the Hippocratic writings_--the most

flourishing period of Greek medicine.

FIFTH EPOCH: _The medicine of the period during which the centre of

greatest intellectual activity was located at Alexandria, Egypt_.

SIXTH EPOCH: _The medicine of Galen_--an author whose teachings exerted

a preponderating influence upon the thought and practice of physicians

in every part of the civilized world up to the seventeenth century of

the Christian era. This period is also characterized by the gradual

diminution of the influence of Greek medicine.

SEVENTH EPOCH: _The medicine of the Middle Ages_--a period which

includes a large part of the preceding epoch. Its most characteristic

feature is the important part played by the Arabs in moulding the

teachings and practice of the medical men of that time (ninth to

fifteenth century).

EIGHTH EPOCH (fifteenth and sixteenth centuries): _The medicine of the

Renaissance period_--characterized chiefly by the adoption of the only

effective method of studying the anatomy of man--the actual dissection

of human bodies.

NINTH EPOCH (from the beginning of the seventeenth century to the

present time): _Modern medicine_.--This epoch may with advantage be

divided into two periods--the first extending to about the year 1775,

soon after which time Jenner began his important work on the subject

of vaccination; and the second to the present time. No attempt will be

made in the following account to cover this second period.

_The Beginnings of Medicine._--In the early period of man’s existence

upon this earth he must have possessed an exceedingly small stock of

knowledge with regard to the maintenance of his body in health and with

regard to the means which he should adopt in order to restore it to a

normal condition after it had been injured by violence or impaired in

its working machinery by disease. With the progress of time, utilizing

his powers of observation and his reasoning faculty, he slowly made

additions to his stock of facts of this nature. Thus, for example, he

gradually learned that cold, under certain circumstances, is competent

to produce pain in the chest, shortness of breath, active secretion of

mucus, etc., and his instinct led him, when he became affected in this

manner, to crave the local application of heat as a means of affording

relief from these distressing symptoms. Again, when he used certain

plants as food he could scarcely fail to note the facts that some of

them produced a refreshing or cooling effect, that others induced a

sensation of warmth, and finally that others still, by reason of their

poisonous properties, did actual harm. Sooner or later, such phenomena

as nausea, vomiting and diarrhoea would also be attributed by him to

their true causes. In due course of time his friends and neighbors,

having made similar observations and having tried various remedial

procedures for the relief of their bodily ills, would come together and

compare with him their several experiences; and so eventually the fact

would be brought out that the particular method adopted by one of their

number for the relief of certain symptoms had proved more effective

than any of the others. Thus gradually this isolated community or tribe

of men must have learned how to treat, more or less successfully, the

simpler ills to which they were liable.

Lucien Le Clerc quotes from the Arab historian Ebn Abi Ossaïbiah the

following account of the manner in which bloodletting probably first

came to be adopted as a remedial measure:--

Let us suppose that in the earliest period of man’s history

somebody experienced the need of the medical art. He may, for

example, have felt a general sense of heaviness in his body

(plethora), associated perhaps with redness of the eyes, and

he probably did not know what he should do in order to obtain

relief from these sensations. Then, when his trouble was at its

worst, his nose began to bleed, and the bleeding continued until

he experienced decided relief from his discomfort. In this way

he learned an important fact, and cherished it in his memory.

On a later occasion he experienced once more the same sense of

heaviness, and he lost no time in scratching the interior of his

nose in order to provoke a return of the bleeding. The nosebleed

thus excited again gave him entire relief from the unpleasant

sensations, and upon the first convenient occasion he told his

children and all his relatives about the successful results

obtained from this curative procedure. Little by little this

simple act, which was a first step in the healing art, developed

into the intelligently and skilfully performed operation of

venesection.

Primitive man also increased his stock of knowledge in the healing art

by reading attentively the book of nature,--_i.e._, by observing

how animals, when ill, eat the leaves or stems of certain plants and

thus obtain relief from their disorders. The virtues of a species of

origanum, as an antidote for poisoning from the bite of a snake, were

revealed, it is asserted, by the observation that turtles, when bitten

by one of these reptiles, immediately seek for the plant in question

and, after feeding upon it, experience no perceptible ill effects from

the poisonous bite. The natives of India ascribe the discovery of the

remarkable virtues of snakeroot (the bitter root of the ophiorrhiza

Mungos) as an antidote for poisoning by the bite of a snake, to the

ichneumon, a small animal of the rat species. The instinctive desire

to escape pain taught man, as it does the lower animals, to keep a

fractured limb at rest, thus giving the separated ends of the bone

an opportunity to reunite; after which the limb eventually becomes

as strong as it ever was. Simple as this mode of acquiring useful

medical knowledge may appear to us moderns, there are good reasons

for believing that hundreds of years must have elapsed before the

accumulated stock of such experiences became really considerable.

On the other hand, it is reasonable to suppose that this growth in

medical knowledge took place more rapidly in certain tribes or races

than in others, and that when, under the action of wars, the inferior

men became tributary to those of greater intellectual powers, they

acquired, through contact with their conquerors, additional knowledge

at a much more rapid rate. One great hindrance, however, stood in the

way of such progress. I refer to the deeply rooted belief, entertained

by man in this primitive period of his existence, in the agency of

malevolent spirits (demons) in the production of disease,--a belief

which continued to exist for many thousands of years. Out of such a

belief developed the necessity of discovering some practical method

of appeasing the evil spirits and of thus obtaining the desired cure

of the ills of the body. Usually some member of the tribe who had

displayed special skill in the treatment of disease, and who at the

same time was liberally endowed with the qualities which characterize

the charlatan, was chosen to be the priest or “medicine man.” It was

his duty to employ measures suitable for expelling the demon from the

patient’s body and for restoring the latter to health. Possessing

great influence, as these superstitious people believed he did, with

the unseen gods, such a physician-priest must have discouraged all

efforts to increase the stock of genuine medical knowledge; for such

an increase would necessarily mean a diminution of his own power and

influence.

In what must still be termed the age of primitive medicine, but

undoubtedly at an advanced stage of that epoch, there were performed

surgical operations which imply a remarkable advance in the invention

of cutting instruments and in the knowledge of the location and nature

of certain comparatively rare diseases, and at the same time great

courage and wonderful enterprise on the part of those early physicians.

As evidence of the correctness of these statements the fact may be

mentioned that trepanned skulls belonging to the neolithic period have

been dug up in various parts of the world--in most of the countries

of Europe, in Algiers, in the Canary Islands, and in both North and

South America. From a careful study of these skulls it has been learned

that the individuals upon whom such severe surgical work had been

done--sometimes as often as three separate times--recovered from the

operation. The instruments used were made of sharpened flint (saws or

chisels). Pain in the head, spasms or convulsions, and mental disorders

are suggested by Neuburger as the indications which probably led to

the performance of the trepanning. This author also makes the further

statement that the ancient Egyptians employed knives made of flint for

opening the dead bodies which they were about to embalm and for the

operation of circumcision. Recent excavations have thrown additional

light upon the state of medical knowledge during this neolithic

age. Thus, there have been found specimens of anchylosed joints, of

fractured bones, of flint arrow heads lodged in different parts of

the skeleton, of rhachitis, of caries and necrosis of bone, etc. The

following quotation is taken from the printed report of a lecture

recently delivered in London by Dr. F. M. Sandwith, Consulting Surgeon

to the Khedive of Egypt. Speaking of certain excavations made in the

Nubian Desert and of the oldest surgical implements yet discovered, he

says:--

In one place a graveyard was found, and here were remains of

bodies with fractured limbs that had been set with bark splints.

One was a right thigh bone that had been broken, and was still

held in position by a workmanlike splint and bandages. All the

knots were true reef-knots, and the wrappings showed how the

strips of palm-fibre cloth were set just as a good surgeon would

set them in these days so as to use the full strength of the

fabric.

Among the most ancient remedies may be mentioned talismans, amulets

and medicine stones, which were furnished--presumably at a price--by

the physician-priests, and which were believed to afford the wearers

protection against evil spirits (the “evil eye,” for example). Various

objects were used for this purpose, and among them the following

deserve to be mentioned: disks of bone removed with the aid of a

trephine from the skull of a dead human body and worn with a string

around the neck; the teeth of different animals; bones of the weasel;

cats’ claws; the lower jaw of a squirrel; the trachea of some bird; one

of the vertebrae of an adder, etc. And where these measures failed,

the priests resorted to incantations, religious dances, and the

beating of drums or the rattling of dried gourds filled with pebbles.

Primitive races of men inhabiting the most widely separated parts of

the earth appear to have adopted means almost identical with those

just described for driving away evil spirits. The holding of these

superstitious beliefs is one of the most extraordinary characteristics

of the human race. It played an important part throughout the classical

period of Greek and Roman civilization, and also during the Middle

Ages. Christianity undoubtedly was a most potent agency in hastening

the eradication of the feeling, but even this great power has not yet

sufficed entirely to do away with superstition; for traces of this

weakness may still easily be detected in some of the men and women with

whom we daily come in contact.

CHAPTER II

ORIENTAL MEDICINE

The researches of the scholar working in combination with the engineer

have unearthed--more particularly in Mesopotamia, in Egypt and in

Greece--evidences of an ancient medical science far advanced beyond

that briefly described in the preceding chapter. These evidences relate

to nations that flourished as far back as four thousand years B. C.

While they are very fragmentary and cover historical events which

are often separated from one another by long periods of time, these

data nevertheless suffice to give one a fairly good idea of the then

prevailing state of medical knowledge. Both Pagel and Neuburger adopt

the plan of discussing these different nationalities separately, and I

shall follow their example.

_Medicine in Mesopotamia._--As appears from the most recent

investigations the Sumerians were the first occupants of the region

lying between the Euphrates and the Tigris rivers. It was from them

that their Semitic conquerors, the Babylonians and the Assyrians,

received a civilization which, already about 4000 B. C., had

reached a wonderful degree of development. The canalization of the

low-lying lands of that region, the organization of a religious and

civil government of a most efficient type, the invention first of

picture-writing and then of the cuneiform characters, the cultivation

of the arts and natural sciences and especially of astronomy and

mathematics to a high degree of perfection,--these are among the things

which were accomplished by this very clever race of men. In addition,

however, to these useful activities the Babylonians developed and

cultivated diligently the science of astrology--that is, the science

of predicting human events (such as the death of the king, the

occurrence of the plague or of war, etc.) from various telluric and

cosmic phenomena--an eclipse of the sun, peculiarities of the weather,

the condition of vegetation, etc. The deeply rooted love of the human

race for the supernatural--a characteristic to which I have already

briefly referred--facilitated the development of this harmful practice,

and kept it alive through many succeeding centuries. Walter Scott, in

his romance entitled Quentin Durward, gives an admirable portrait of

a typical astrologer whom Louis XI. of France maintained at his court

during a part of the seventeenth century.

While in other parts of the Orient the science of medicine, as

already stated at the beginning of this chapter, made a noteworthy

advance beyond the conditions observed among the primitive races, in

Mesopotamia this science, which was far more important to the welfare

of its inhabitants than all the other branches of knowledge combined,

received very little attention and consequently made only insignificant

advances. The British Museum has in its possession several thousand

tablets which were dug up from the ruins of Nineveh and which represent

a part of the library of the Assyrian King, Assurbanipal (668–626 B.

C.). Translations of the text of only a very few of these tablets have

thus far been published, and from these, which embody the greater

part of our knowledge of Assyrian medicine, it appears that, for the

present at least, the estimate recorded above must stand. A few new

facts, however, have been brought to light, and they appear to be of

sufficient importance to merit brief consideration here.

In the first place, Herodotus, who visited Babylon about 300 B. C., has

this to say in relation to the state of medicine in that city:--

The following custom seems to me the wisest of their

institutions next to the one lately praised. They have no

physicians, but, when a man is ill, they lay him in the public

square, and the passers-by come up to him, and if they have

ever had his disease themselves or have known any one who has

suffered from it, they give him advice, recommending him to do

whatever they found good in their own case, or in the case

known to them; and no one is allowed to pass the sick man in

silence without asking him what his ailment is.[2]

The Babylonians held some rather strange beliefs regarding the

construction of the human body and the manner in which its functions

are performed. The living being, as they maintained, is composed of

soul and body. The intellect has its seat in the heart, the liver

serving as the central organ for the blood, which they considered to be

the true life principle. They divided this fluid into two kinds--blood

of the daytime (bright arterial) and that of the night (dark venous).

Although the blood was held by them to be the basis of life, they

evidently attached a certain value to respiration, for one of their

prayers begins with these words: “God, my creator, lead me by the

hand; guide the breath of my mouth.” Disease was always looked upon as

something (usually personified as a demon) that entered the body from

without and that consequently had to be expelled. There were special

demons for the different diseases. Thus, Asakku brought fever to the

head, Namtar threatened life with the plague, and Utukku attacked the

throat, Alu the breast, Gallu the hand, Rabisu the skin, and so on. The

most dreaded demons were the spirits of the dead. Special amulets were

employed as protective remedies. Prayer formulae were also used. Here

is one among several that I find mentioned in Neuburger’s treatise:--

Wicked Consumption, villainous Consumption, Consumption which

never leaves a man, Consumption which cannot be driven away,

Consumption which cannot be induced to leave, Bad Consumption,

in the name of Heaven be placated, in the name of Earth I

conjure thee!

The genuine remedial agents employed in Babylonia were of a most

varied nature: a mixture of honey and syrup of dates; medicinal herbs

of different kinds for internal administration; bloodletting; the use

of cups for drawing blood to the surface of the body; warm baths and

cold shower baths; rubbing oil over the body; medicated clysters; the

use of various salves; the use of secret remedies which were composed

of various ingredients and which bore such names as “the Sun God’s

remedy,” “the dog’s tongue,” “the skin of the yellow snake,” “the

medicine brought from the mountain of the human race,” etc.

Some of the predictions made by the Babylonian astrologers are of

sufficient interest to be placed on record. Here are a few examples:--

If the west wind is blowing when the new moon is first seen,

there is likely to be an unusual amount of illness during that

month.

If Venus approaches the constellation of Cancer, there will be

respect for law and prosperity in the land; those who are ill

will recover, and pregnant women will have easy confinements.

If Mercury makes its appearance on the fifteenth day of the

month, there will be corpses in the land. And again, if the

constellation of Cancer is obscured, a destructive demon will

take possession of the land, and there will be corpses.

If Jupiter and the other planets stand opposite one another,

some calamity will overtake the land. If Mars and Jupiter come

into conjunction, there will be deaths among the cattle.

If an eclipse of the Sun take place on the twenty-eighth day

of the month Ijar, the king will have a long reign; but, if it

take place on the twenty-ninth day of the month, there will be

corpses on the first day of the following month.

If there should be thunder during the month of Tisri, a spirit

of enmity will prevail in the land; and if it should rain during

that month, both men and cattle will fall ill.

Besides these predictions, which were based upon phenomena connected

with the movements of the stars and the conditions of the weather,

there were others which the people themselves were competent to make

without the aid of the professional astrologer or the official priest.

Such, for example, are the following “omens”:--

If a woman gives birth to a child the right ear of which is

lacking, long will be the reign of the prince of that land.

If a woman gives birth to a child both of whose ears are

lacking, sadness will come upon the land and it will lose some

of its importance.

If a woman gives birth to a child whose face resembles the beak

of a bird, there will surely be peace in the land.

If a woman gives birth to a child the right hand of which lacks

fingers, the sovereign of that country will be taken prisoner by

his enemies.

The keen interest taken by the priests in the matter of predicting the

outcome of various diseases led in due time to their making records

of the nature, symptoms and progress of the latter. Although this

practice was inaugurated purely for the purpose of enabling them to

foretell with greater accuracy the probable issue of any given malady,

it nevertheless served also to establish on a firm basis the custom

of keeping records of the case-histories. Only one thing more was now

needed to render this practice the first step in a genuine advance of

medical knowledge; but this step could not be made in Babylonia, where

priestcraft and superstition had struck such deep roots in the public

life. It was only in free Greece, and at a time in its history when

the spirit of Hippocrates exerted an overpowering influence over the

minds of men, that the separation of the functions of the physician

from those of the priest became possible and was in due time effected.

(Neuburger.)

Before closing this very incomplete account of the state of medical

knowledge in Babylonia, it will be well to mention some of the items of

the law laid down by Hammurabi (circa 2200 B. C.) for the guidance of

the physicians of that land with regard to the remuneration which they

should receive. At the same time I shall make no attempt to reconcile

the statement of Herodotus (given on page 12) with the wording of

this law, which distinctly recognizes the existence of physicians in

Mesopotamia. Possibly the conditions in Nineveh in the fourth century

B. C. were different from what they had been eighteen centuries earlier.

If a physician makes a deep cut with an operating knife of

bronze and effects a cure, or if with such a knife he opens a

tumor and thus avoids damaging the patient’s eye, he shall

receive as his reward 10 shekels of silver. If the patient is

an emancipated slave, the fee shall be reduced to 5 shekels. In

the case of a slave the master to whom he belongs shall pay the

physician 2 shekels.

If a physician makes a deep wound with an operating knife of

bronze and the patient dies, or if he opens a tumor with such a

knife and the patient’s eye is thereby destroyed, the operator

shall be punished by having his hands cut off.

If a physician, in operating upon the slave of a freedman, makes

a deep wound with an operating knife of bronze and thus kills

the patient, he shall give the owner a slave in exchange for the

one killed. And if, in opening a tumor with such a knife, the

physician destroys the slave’s eye, he shall pay to the latter’s

owner one-half the slave’s value.

If a physician effects the healing of a broken bone or cures a

disease of the intestines, he shall receive from the patient a

fee of 5 shekels of silver.[3]

It would be difficult to imagine anything better adapted to arrest the

development of medical knowledge in a nation than the promulgation of a

law like that ascribed to Hammurabi; and one cannot be surprised at the

statement made by Herodotus, eighteen centuries later, “that there were

no physicians in Babylon.” Foolhardy, indeed, would be the man who, for

the sake of earning a possible reward of six shekels of silver, would

be willing to risk the danger of having both his hands cut off; and yet

every conscientious and faithful practitioner of medicine in Babylon at

the time mentioned must necessarily have been obliged to run this risk.

_Medicine in Ancient Egypt._--Of the sources of information with

regard to the knowledge of medicine possessed by the ancient Egyptians

the most important are the following: Homer’s Odyssey; Herodotus;

Diodorus; Clemens of Alexandria; Pliny’s Natural History; Dioscorides;

the Papyrus Ebers; the Papyrus Brugsch; and the Papyrus Birch, in the

British Museum. Then, in addition to these sources, there are the

inscriptions found in recent times on the walls of the temples and

the pictures painted on the wrappings of mummies, from both of which

considerable information with regard to various therapeutic procedures

and to the details of the process of embalming has been derived. Some

of this information extends back to about 3000 B. C. The healing art

was at that time entirely in the hands of the temple priests, who

formed an organized body with a sort of physician-in-chief at its head.

Two of these--Athotis and Tosorthos--attained such a high standing and

possessed such influence that they were chosen Kings of Egypt. The

practice of obstetrics was entrusted to the care of women who had been

trained to this work and who acknowledged the authority of a skilled

head-nurse of their own sex. The patients who had received treatment

for their ailments at one or other of the temples presented to these

institutions gifts in the form of sculptured or painted representations

of the diseased or injured parts of the body. In these and in other

ways medicine and pharmacy received contributions which were of no mean

value. Botanical gardens were established at various places in Egypt

and were cultivated with care. Chemistry--a name which derives its

origin from a word in the Egyptian language--also made considerable

progress as a science. On the other hand, the knowledge of the

structure and functions of the different parts of the human body was

very imperfect and remained unchanged for many centuries. This would

probably not have been the case if the work of preparing the bodies

for the process of embalming had not been entrusted entirely to mere

menials, men who had no interest in anything but the mechanical part of

their occupation.

According to the statement of Clemens of Alexandria[4] the Egyptian

science of medicine is set forth in the last six of the forty-two

hermetic books, which were composed, according to the prevailing

belief, by the god Thot or Thoüt (= Hermes of the Greeks). The first

one of these six books is devoted to the anatomy of the human body,

the second one to the diseases to which it is liable, the third to

surgery, the fourth to remedial agents, the fifth to the diseases of

the eye, and the sixth to diseases of women. As to the remedial agents,

Neuburger says that it has not been found practicable to identify more

than a very few of the Egyptian drugs enumerated by Dioscorides. Homer,

who wrote at least five hundred years B. C., has something to say on

this subject in the Odyssey.[5] His words are as follows:--

Such drugs Jove’s daughter owned, with skill prepar’d,

And of prime virtue, by the wife of Thone,

Aegyptian Polydamna, given her.

For Aegypt teems with drugs, yielding no few

Which, mingled with the drink, are good, and many

Of baneful juice, and enemies to life.

There every man in skill medicinal

Excels; for they are sons of Pason[6] all.

A physician of the present age, on reading the histories of the

ancient Egyptians, Greeks and other oriental nations, finds it almost

impossible to realize that many of the characters designated as gods

and goddesses, possibly all of them, were not mythological persons, as

they would have been termed only a few years ago, but real human beings

like ourselves. Such, for example, was the opinion of Cicero who, when

asked why these people were spoken of as gods, gave the following

reply:[7] “It was a well-established custom among the ancients to deify

those who had rendered to their fellow men important services, as

Hercules, Castor and Pollux, Aesculapius, Bacchus and many others had

done.” And I find that those modern authors of the history of medicine

whose works I have consulted, are quite ready to accept even the gods

called by the Egyptians Osiris (or Serapis), Isis, and Thoüt (or

Hermes) as genuine historical personages. Such a belief receives some

degree of confirmation from the following inscriptions which, according

to the authority of Le Clerc,[8] were found engraved upon two columns

discovered in the city of Nyoa, in Arabia:--

(On the first column): My father is Cronos, the youngest of

all the gods. I am King Osiris, who have visited with my

armies every country on the face of the earth--the remotest

inhabitable parts of India, the regions lying beneath the Bear,

the neighborhood of the sources of the Danube, and the shores

of the Ocean. I am the oldest son of Cronos, the scion of a

fine and noble race. I am related to the day. There is no part

of the earth which I have not visited, and I have filled the

entire universe with my benefits. (On the second column): I

am Isis, Queen of all this country, and I have been taught by

Thoüt. There is nobody who has the power to loosen what I shall

bind. I am the oldest daughter of Cronos, the youngest of the

gods. I am the wife and at the same time the sister of King

Osiris. To me is due the credit of having been the first to

teach men agriculture. I am the mother of King Horus. I shine in

the dog-star. It is I who built the city of Bubastis. Farewell,

Egypt, my native land.

The discovery of the art of medicine, says Le Clerc, was attributed to

Osiris and Isis, and they were also credited with having taught it to

Aesculapius.

At the cities of On (Heliopolis), Sais, Memphis and Thebes were located

the most celebrated of the Egyptian temples, which were dedicated

not merely to the worship of their numerous gods, but also to the

dissemination of knowledge of various kinds and to the care of the

sick and maimed. In a word, they were--like the Aesculapian temples at

Trikka, Epidaurus and Cos, of which some account will be given farther

on--both hospitals for the treatment of disease and schools for the

training of physicians. The chief priest of the temple bore also the

title of the “physician-in-chief,” and exercised the prerogatives of

a chief magistrate. Under this system medical knowledge advanced to

a certain stage and then made no further progress. The preponderance

of the priestly (_i.e._, the superstitious) influence was too

pronounced to permit anything like real progress.

The papyrus Ebers makes mention of a number of diseases, and among them

the following may be noted: abdominal affections (probably dysentery),

intestinal worms, inflammations in the region of the anus, hemorrhoids,

painful disorders at the pit of the stomach, diseases of the heart,

pains in the head, urinary affections, dyspepsia, swellings in the

region of the neck, angina, a form of disease of the liver, about

thirty different affections of the eyes, diseases of the hair, diseases

of the skin, diseases of women, diseases of children, affections of the

nose, ears and teeth, tumors, abscesses and ulcers.

In the matter of diagnosis the Egyptian physicians not only employed

inspection and palpation, but were in the habit of examining the urine.

A statement made in the papyrus Ebers is good ground for the belief

that they also employed auscultation to some extent.

Therapeutics constituted beyond all question the strongest part of

Egyptian medicine. As might be expected from the strange mixture of the

priest and the medical man in every physician, the remedial measures

commonly employed consisted in part of prayers and incantations, and

in part of rational procedures and the use of drugs. Among the latter

class of remedies the following deserve to be mentioned: emetics,

cathartics and clysters. Bloodletting, sudorifics, diuretics and

substances which cause sneezing were also often employed in Egypt. To

produce vomiting the favorite agents were the copper salts and oxymel

of squills. Castor oil disguised in beer was given as an aperient.

Pomegranate was the drug preferred for the expulsion of worms.

Mandragora and opium were also employed as remedies. Foreign drugs

were largely imported by the Phoenicians, and in their successful

campaigns against Asiatic nations the Egyptians learned much about

the use of these rarer remedies. The different forms in which the

Egyptians administered their remedies included potions, electuaries,

gums to be chewed but not swallowed, gargles, snuffs, inhalations,

salves, plasters, poultices, injections, suppositories, clysters and

fumigations. The physicians, in their practice, were subjected to very

strict rules regarding the amount of the doses to be given and the

manner of administering the different remedies, and consequently they

received no encouragement to indulge in any individuality of action.

The prescriptions were written in very much the same manner as are

those of to-day; that is, they contained the fundamental or important

drugs, certain accessory materials, and something which was intended

merely to correct the unpleasant taste of the mixture. In comparison

with those commonly written at a somewhat later period these ancient

prescriptions were of a very simple character.

Up to the present time the researches of the archaeologists have thrown

comparatively little light on the surgery of the ancient Egyptians.

The facts already ascertained, however, are sufficient to warrant the

statement that they had reached a degree of knowledge and skill in

this department of medicine well in advance of that reached by any of

their contemporaries. They performed the operations of circumcision

and castration, and they removed tumors, and their eye surgeons were

especially renowned for the work which they accomplished in their

special department. Their skill in manufacturing surgical instruments

is amply revealed in the specimens--instruments for cupping, knives,

hooks, forceps of different kinds, metal sounds and probes, etc.--which

have been dug up at the various sites of ancient ruins. They must also

have possessed considerable manual skill, for without it they could

not, in embalming a corpse, have removed the entire brain from the

skull with a long hook, by way of the nasal passages, and at the same

time have left the form of the face undisturbed.

From Joachim’s German translation of the papyrus Ebers,[9] as quoted by

Neuburger, I copy the following passages:--

If thou findest, in some part of the surface of a patient’s

body, a tumor due to a collection of pus, and dost observe

that at one well-defined spot it rises up into a noticeable

prominence, of rounded form, thou should’st say to thyself: This

is a collection of pus, which is forming among the tissues; I

will treat the disease with the knife.... If thou findest, in

the throat of a patient, a small tumor containing pus, and dost

observe that it presents at one point a well-defined prominence

like a wart, thou may’st conclude that pus is collecting at

this point.... If thou findest, in a patient’s throat, a fatty

growth which resembles an abscess, but which yields a peculiar

sensation of softness under the pressure of the finger, say to

thyself: this man has a fatty tumor in his throat; I will treat

the disease with the knife, but at the same time I will be

careful to avoid the blood-vessels.

These short extracts will suffice to show that the Egyptian physicians

of that early period--at least 1550 B. C.--reasoned about pathological

lesions in very much the same manner as a physician of to-day would

reason. In this same ancient papyrus, however, foolish as well as

sensible statements appear. Thus, for example, mention is made on the

one hand of the fact that, in order to give a certain remedy to an

infant, it is sufficient to administer it to the nurse who suckles the

child (a proceeding which is not uncommon in our own day); and then,

in another part of the text, it is stated that “if, on the day of its

birth, the infant does not cry, it will surely live; but, if it says

‘ba,’ it will die.”

In matters relating to personal hygiene the ancient Egyptians often

displayed a remarkable degree of common sense. They maintained, for

example, that the majority of diseases are due to the taking of

food in excessive quantity; and, in harmony with this belief, they

introduced the custom of devoting three days out of every thirty to

the taking of emetics and clysters. Perhaps it was to this custom

that they owed their good health,--a fact to which both Herodotus and

Diodorus testify. In principle this practice agrees with that adopted

by modern physicians, who omit the emetics and substitute for the

clysters the drinking of certain mineral waters during a limited period

of the summer season and under the very agreeable surroundings of a

comfortable hotel at Carlsbad, Ems, Wiesbaden or Saratoga. While the

monthly plan of purging the system of harmful elements must certainly

have been the more effective of the two, it cannot for a moment be

doubted that exceedingly few moderns would be willing to subject

themselves to such a régime.

In still other ways the ancient Egyptians displayed a most intelligent

respect for every measure that tended to promote the general health of

the community. They took care, for example, to prevent the entrance

of decomposing materials into the soil and the ground water; priests

skilled in work of this character made careful inspections of all meats

that were to be used for food; stress was laid upon the importance of

keeping the dwelling houses clean; the people were taught the value

of bathing the body frequently, of cultivating gymnastic exercises,

of clothing themselves suitably, and of employing the right sort of

diet. At a still later period of their history they adopted the custom

of drinking only water that had been either boiled or filtered. A

particular kind of beer, the gift of their first king, Osiris, was

the favorite beverage of the people. It was made from barley and

doubtless possessed intoxicating properties, as is suggested by one

of the papyrus texts in which the following charge is brought against

a student: “Thou hast abandoned thy books and art devoting thyself to

idle pleasures, going from one beer-house to another. Thou smellest so

strongly of beer that men avoid thee.”

A large proportion of the sources of information regarding the medicine

of the ancient Egyptians have been brought to light during recent

years, but so many gaps in the series still remain unfilled that it is

not possible to furnish more than a disconnected and very imperfect

account. Archaeological investigations, however, are being conducted

with vigor and new discoveries are reported almost every month. There

are therefore good reasons for hoping that, in the course of the next

few years, much additional light will be shed on the mode of life and

accomplishments of these pioneers of civilization, who, before they

passed out of history, succeeded in attaining the highest degree of

cultivation in the science and art of medicine that had up to that

time been attained by any other nation. One thing is certain, says

Neuburger, they exerted a powerful influence upon the beginning of

medicine in Greece and upon the social hygiene of the Jewish people,

and therefore upon the human race at large.

CHAPTER III

ORIENTAL MEDICINE (Continued)

_The Medicine of the Ancient Persians._--After Cyrus the Great had

put an end to Babylon as a power among the nations the Persians became

the leaders in all the affairs not merely of Asia Minor but also of

the entire country from India to the shores of the Mediterranean; in

fact, they eventually also gained control of the land of the Pharaohs.

Notwithstanding the completeness of the political power which they

possessed over these conquered races, they permitted them to retain

their respective religions and even their individual languages;

as evidence of the correctness of which last statement the modern

discovery of inscriptions written in the three principal tongues may be

mentioned. The remarkable degree of general culture which existed at

Babylon at the time of the Persian conquest, and which the Sumerians

and Semites had originally introduced, was left undisturbed by the

political change.

So far as we possess any knowledge regarding the medicine of the

ancient Persians, this information has been derived, according to

Neuburger, from the Zend-Avesta--one of the ancient religious writings

preserved by the Parsees. It furnishes comparatively few facts of

special interest to physicians. In the main, the practice of medicine

must have differed very little from that employed by the earliest

Babylonian physicians, and briefly described on pages 11–16. There are

one or two additional matters, however, which deserve to be mentioned

here. It was maintained, for example, that the touching of a corpse

produced a special contamination, a belief which interfered most

seriously with the study of anatomy, and therefore prevented any

real advance in medical knowledge. Then, again, the ancient Persians

appear to have taken comparatively little interest in surgery, for it

is said that King Darius I. was obliged, when he needed treatment for

a badly sprained ankle, to send for a Greek physician. Finally, there

may be found in Herodotus the following statement, which shows that the

Persians had learned something of value, in practical hygiene, from

their neighbors, the Egyptians:--

The Great King (Cyrus), when he goes to the wars, is always

supplied with provisions carefully prepared at home, and with

cattle of his own. Water, too, from the river Choaspes, which

flows by Susa, is taken with him for his drink, as that is the

only water which the kings of Persia taste. Wherever he travels,

he is attended by a number of four-wheeled cars drawn by mules,

in which the Choaspes water, ready boiled for use, and stored in

flagons of silver, is moved with him from place to place.[10]

Neuburger makes the remark that the ancient Persians are entitled to

the gratitude of later generations for the valuable service which they

rendered the science of medicine, inasmuch as, during the dynasty of

the Sassanide princes (fifth century A. D.) and at a time when European

culture was hastening to its destruction, they gave shelter both to

classical culture in general and to the medical knowledge of the

Greeks, and then afterward handed it over to the conquering Arabs, who

passed it on to our forefathers.

_The Medicine of the Old Testament._--There are no medical

writings which give any information concerning the science and art of

medicine as possessed by the ancient Israelites, but the Bible contains

a number of passages that refer to matters which belong in the domain

of medicine, and more particularly in that of social hygiene. The

mosaic laws were framed with a view to the good of the Jewish people

as a whole, and were directed to such matters as the prevention and

suppression of epidemic diseases, the combating venereal affections

and prostitution, the care of the skin, the systematizing of work,

the regulation of sexual life, the intellectual cultivation of the

race, the provision of suitable clothing, dwellings and food, the use

of baths, etc. Many of these laws--like those, for example, which

prescribe rest on the Sabbath day, circumcision, abstinence from eating

the flesh of the pig, the isolation of persons affected with leprosy,

the observation of hygienic rules in camp life, etc.--testify to a

remarkably high degree of the power to reason correctly; and, when

considered in the light of modern science, they seem to justify the

prediction made in Deuteronomy iv., 6. A similar prediction (supposed

to be spoken by God from Mount Sinai) is made in Exodus xix., 6: “And

ye shall be unto me a kingdom of priests, and an holy nation.” That a

large part of the credit given to Moses for the wisdom displayed in

these sanitary laws really belongs to the Egyptians is shown by the

text of Acts vii., 22: “And Moses was learned in all the wisdom of the

Egyptians, and was mighty in words and in deeds.”

As regards the manner in which the Israelites treated the diseases

which afflicted them the Bible furnishes ample proof of the fact

that they placed their chief reliance upon prayers, sacrifices, and

offerings at their temples, and made comparatively small use of

medicinal agents, dietetic measures, and external applications. The

favorable effect of David’s harp-playing upon the melancholia of King

Saul furnishes the only instance, to be found in the Bible, of the

curative value of music in certain mental disorders.

The story of Naaman (2 Kings v.) deserves to be mentioned briefly here.

He was captain of the host of the King of Syria (about 894 B. C.) and

a man of valor, highly esteemed by his master, but he was--according

to the Bible statement--a leper. Learning casually that there was

in Samaria a prophet who might be able to cure his disease, he put

a large sum of money into his sack and departed for that country.

“So Naaman came with his horses and with his chariot, and stood at

the door of the house of Elisha. And Elisha sent a messenger unto

him, saying, Go and wash in Jordan seven times, and thy flesh shall

come again to thee, and thou shalt be clean.” Naaman, at first much

displeased with the advice given to him by Elisha, and especially by

the very informal manner in which it had been communicated to him,

finally decided to follow the prophet’s instructions. “Then went he

down, and dipped himself seven times in Jordan, ... and his flesh came

again like unto the flesh of a little child, and he was clean. And he

returned to the man of God, ... and came, and stood before him; and

he said, Behold, now I know that there is no God in all the earth,

but in Israel: now therefore, I pray thee, take a blessing of thy

servant.” Elisha, however, refused persistently to accept any reward

for the advice which he had given. He simply said to Naaman: “Go in

peace.” Before he departed, however, Naaman expressed to Elisha the

hope that he would be pardoned if he yielded to the necessity of bowing

down to the god Rimmon on certain occasions--as, for example, when he

accompanied his master, the king, on his visits to the temple of that

god for the purposes of worship. From the evidence furnished by this

account, as given in the Old Testament, it is fair to assume that both

Naaman and the writer of the book of Kings believed that the cure had

been effected by supernatural means. The modern physician, however,

is not ready to accept such an interpretation of the manner in which

Naaman’s cure was effected, but prefers to believe that the supposed

leprosy was in reality some curable form of skin disease which to

the unprofessional eye appeared like the other malady. It might, for

example, have been an aggravated general eczema, dependent upon such

excesses of eating and drinking as a wealthy captain of the king’s host

would be likely to indulge in. And if this supposition is correct, one

cannot but admire the great practical wisdom of Elisha in advising

Naaman to take seven baths--one a day presumably--in the river Jordan,

a spot so far removed from his home that it would scarcely be possible

for him to obtain any but the simplest kind of diet during this

comparatively long period of time.

An interesting case of snake-bite is briefly related in Acts xxviii.,

3–6. It is stated that “when Paul (after being shipwrecked on the

Island of Melita) had gathered a bundle of sticks, and laid them on the

fire, there came a viper out of the heat, and fastened on his hand. And

when the barbarians saw the venomous beast hang on his hand, they said

among themselves, No doubt this man is a murderer, whom, though he hath

escaped the sea, yet vengeance suffereth not to live. And he shook off

the beast into the fire, and felt no harm. Howbeit they looked when he

should have swollen, or fallen down dead suddenly: but after they had

looked a great while, and saw no harm come to him, they changed their

minds, and said that he was a god.” This narrative is interesting in

several respects, but there is one feature that deserves to receive

special mention, viz., the fact that Paul experienced no harm from the

bite of a poisonous serpent--a wound which frequently proves fatal.

Inasmuch as the account distinctly states that the reptile “fastened on

his hand” and that “the barbarians saw the venomous beast hang on his

hand,” the conclusion is warranted that one or both of the creature’s

fangs had entered the hand by a curving route, and probably in such

a manner that the free end of each fang, from which the poison is

ejected, passed completely through the skin from within outward. When

the bite of a poisonous snake is of a character such as I have just

described,--and not a few of them have this character,--only a very

small quantity of the venom is lodged in the subcutaneous tissues,

where the larger blood- and lymph-channels lie, and as a consequence the

person bitten escapes serious harm. On the other hand, when the fangs

enter the flesh in a less decidedly curving direction, thus permitting

a greater quantity of the venom to reach and remain in the deep-lying

tissues, serious or even fatal results may be anticipated. The point,

then, which I desire to make is simply this: Paul’s escape from death

in this instance may perfectly well be ascribed to natural causes.

The Israelites, at a certain stage of their history, appear to have

completely divorced the practice of medicine from the priestly

function. In one place, for example, it is stated that King Asa sought

relief from his ailment, not from Jehovah, but from the physicians.

Jeremiah expresses astonishment that not a single physician is to

be found in Gilead. May this not be interpreted as signifying that

regularly established physicians were at that time (595 B. C.) to be

found in some parts of Palestine? And, at a much earlier period (1500

B. C.), Job calls his friends “physicians of no value” (Job xiii.,

iv.). From these and a number of other statements in the Bible it seems

permissible to believe that, at a very early period of history, the

Jewish physicians occupied an entirely independent position.

It would doubtless appear strange to most readers of this brief sketch

of the history of medicine if some reference were not made in this

place to Luke, the author of the gospel which bears his name and of

the Acts of the Apostles, and who was also the companion of Paul on

his journey to Rome and during a portion of the latter’s stay in that

city. Luke was a native of Antioch, in Syria, and not a Jew. He was

a physician and tradition says that he was also a painter. It is not

known where he received his medical training, but it is not at all

unlikely that he studied at Alexandria, in Egypt, where the greatest

facilities for such training, obtainable at that period, were to

be found. His style of writing shows plainly that he was a man of

considerable cultivation and endowed with a clear and logical mind; and

if he had not possessed a genial personality he would hardly have been

known as “the beloved physician”; nor could any other motive but those

of loyal, self-sacrificing friendship for his friend, and a desire to

promote the cause of Christianity, have led him to share with Paul the

dangers and discomforts of the journey to Rome.

_The Medicine of India, China and Japan._--It would be too much

of a departure from the plan which is being followed in the writing of

this history to attempt to describe, even in the briefest manner, the

mode of development of the science and art of medicine in India, China

and Japan. Unquestionably the earlier physicians of these countries

made many valuable contributions to medical knowledge, but they were

made at such a period of time, or under such conditions, that they

could not have exerted an appreciable influence upon the development

of medicine in ancient Greece,--certainly no such influence as was

exerted by Assyria and Persia, and especially by Egypt. It therefore

seems permissible to speak of the medicine of these more remote

countries only incidentally, and not as an integral part of the series

of centres of learning which made the medicine of ancient Greece the

direct ancestor--if I may use such a term--of European medicine.[11]

In conformity with this idea it will be well to mention here briefly

a few of the more important facts relating to the achievements of the

physicians of the three countries named.

The most celebrated medical authors in India were Caraka, Súsruta and

Vagbhata--“The ancient trinity,” as they were called. Caraka probably

lived during the early part of the Christian era, Súsruta during the

fifth century, and Vagbhata not later than during the seventh century

A. D. It is apparent, therefore, that none of the treatises written

by these authors could have exerted the slightest influence upon the

growth of medical knowledge in ancient Greece.

The crudeness of many of the conceptions held by these Hindu physicians

concerning pathology is revealed in the following definition:

“Health is the expression of the normal composition of the three

elementary substances (air, mucus and bile) which play a vital

part in the machinery of the human body, and it is also dependent

upon the existence of normal quantitative relations between these

three substances; and when the latter are damaged, or when they are

abnormally increased or diminished, then disease of one kind or another

makes its appearance.”[12]

Great stress was laid by the physicians as well as by the priests of

ancient India upon the observance of very elaborate rules respecting

the care of the person while in health and, very naturally, when a

patient became ill the physician in charge paid quite as much attention

to the employment of hygienic and dietetic measures in effecting the

desired cure as to the administering of drugs.

The list of the commonly employed hygienic measures is too long for

reproduction in its entirety in this brief sketch, but an enumeration

of some of the more important items may prove interesting. In

estimating the value of these rules the reader should bear in mind

that they were intended for people living in a hot climate. Daily

bathing heads the list. Then follow: regulation of the bowels; rubbing

the teeth with fresh twigs of certain trees which possess astringent

properties, and also brushing them twice a day; rinsing the mouth with

appropriate washes; rubbing the eyes with salves; anointing the body

with perfumed oils; cutting the nails every five days, etc. Two meals

a day were prescribed--the first one between nine in the morning and

noon, and the second between seven and ten in the evening. “Only a

moderate amount of water should be drunk during the meal; drinking

water at the beginning of a meal delays digestion, while a copious

draught at the end produces obesity. After the meal the mouth should

be carefully cleansed and a short walk should be taken.” Among the

more important articles of food the following deserve to be mentioned:

rice, ripe fruit, the ordinary vegetables, ginger, garlic, salt, milk,

oil, melted butter, honey and sugar cane. If meat is eaten, preference

should be given to venison, wild fowl and the flesh of the buffalo.

The meat of the pig, and beef, as well as fish, are less conducive

to health. Gymnastic exercises in moderation are beneficial. Sleep

should be indulged in during the day only after some specially severe

exercise; at night it should not be extended beyond one hour before

sunrise. Bathing immediately after eating is harmful, and it is not to

be indulged in when one is affected with a cold, with a high fever,

with diarrhoea, or with some disease of the eyes or ears. A hot bath

or washing with warm water may be beneficial for the lower half of the

body, but for the upper half it is harmful. Sea bathing and cold baths

(preferably in the river Ganges) are beneficial. The clothing worn

should be clean; soiled garments are likely to produce skin diseases.

It is advisable to wear shoes, and an umbrella or a staff should be

carried. The wearing of garlands, finery, and jewels increases the

vital powers and keeps away evil spirits. The following are good

measures to adopt for the preservation of health: an emetic once a

week; a laxative once a month; and a bloodletting twice a year. All

the measures enumerated above were subject to modification according

to changes in the season, the locality, the weather, and various other

circumstances.

In harmony with the extraordinary fruitfulness of the land the

pharmacopoeia of India is very rich. It is a remarkable fact that not

one of the numerous drugs mentioned in the official list is of European

origin. The great majority of them belong to the vegetable kingdom;

Caraka stating that he knew of 500 plants that possessed remedial

virtues, while Súsruta placed the number at 760. Then, too, the list

contains a goodly number of drugs which belong, some to the animal and

others to the mineral kingdom. It appears that the physicians of India

began using mineral substances, both externally and internally, at a

very early period of their history. Among such substances the following

may be mentioned: sulphate of copper, sulphate of iron, sulphate of

lead, oxide of lead, sulphur, arsenic, borax, alum, potash, chloride

of ammonium, gold, precious stones of different kinds, etc. The people

of India were skilled in chemical and pharmaceutical work. The drugs

were prepared by them in a great variety of ways--as, for instance,

extracts of the juices of plants, infusions, decoctions, electuaries,

mixtures, syrups, pills, pastes, powders, suppositories, collyria,

salves, etc. Practicing physicians carried with them a sort of portable

medicine chest, and they often collected, themselves, the medicinal

plants which they required. Súsruta gives instructions as to the spots

where certain plants are most likely to be found, and as to the seasons

when they should be gathered. Charlatanry and mysticism often played a

part in this business. Thus, it was maintained that drugs collected and

prepared by persons other than physicians did not produce the desired

effects. The fact that cosmetics (especially hair dyes), “elixirs of

life,” aphrodisiacs, poisons and antidotes for poisons, occupy the most

prominent place in the list of pharmaceutic preparations sold, casts

a glaring ray of light, as Neuburger states, on the degree of culture

among the people of ancient India.

The list of separate maladies recognized by the physicians of the

latter country is inordinately long. There were 26 kinds of fevers, 13

species of swellings of the lower abdomen, 20 different diseases due to

worms, 20 kinds of urinary diseases, 8 varieties of strangury, 5 kinds

of jaundice, 5 varieties of cough or asthma, 18 kinds of “leprosy,” 6

kinds of abscesses, 76 different eye diseases, 28 affections of the

ear, 65 disorders of the mouth, 31 nasal affections, 18 diseases of

the throat, a large number of mental disorders, etc. It seems scarcely

necessary to remark that these so-called diseases were in reality

only groups of certain types of loosely related symptoms. The term

“leprosy,” for example, included, besides the disease which modern

physicians call by that name, a number of different affections of the

skin. It is worth noting here that diabetes mellitus, which is one

of the twenty different kinds of urinary diseases enumerated in the

classified list mentioned above, was first described by the physicians

of India, whose attention was directed to the disorder by observing

that flies and other insects were attracted to the urine of these

patients by reason of its sweetness. It is also an interesting fact

that occasionally these physicians, who, beyond a doubt, were keen

observers of symptoms, paid some attention to the anatomical features

of the individual cases. Thus, it is stated that the particular form of

swelling of the lower abdomen, to which they applied the name “splenic

belly,” is dependent upon “an enlarged spleen which distends the left

side, is as hard as a stone, and is arched like the back of a turtle”;

whereas they spoke of “an enlargement of the liver” when very much the

same conditions were observed on the right side of the abdomen. The

accuracy of their clinical observations is particularly noticeable in

their accounts of cases of consumption, apoplexy, epilepsy, hemicrania,

tetanus, rheumatism, venereal diseases, some affections of the skin,

and insanity. It was in their surgical technique, however, that

the physicians of ancient India were distinguished above all their

brethren of the neighboring oriental countries, and this superiority

they maintained for a very long time. Among the operations which they

performed the following may be mentioned: they removed tumors by

excising them, they opened abscesses by the use of the knife, they

employed scarifications (in inflammations of the throat) and made

punctures (in hydrocele and ascites), they passed probes into fistulae,

they extracted foreign bodies, and they employed needles armed with

hairs taken from the horsed tail or with thread composed of flax or

hemp. According to Súsruta their stock of instruments was composed of

101 blunt and 20 cutting instruments. Among those which were blunt

there were forceps of different sizes and forms, hooks, tubes, probes

or sounds, catheters, bougies, etc. They made use of the magnet

for drawing out foreign bodies of iron, and they applied cups for

therapeutic purposes. Their cutting instruments consisted of knives,

bistouris, lancets, scissors, trochars, needles, etc. Steel was the

metal of which they were made; for the people of India learned at a

very early period how to make steel. In suitable cases cauterization,

either with the actual cautery or with caustic potash, was a favorite

method of treatment with the surgeons of ancient India. “Burning with

the heated iron,” they taught, “is more effective than cauterization

with potash, inasmuch as it permanently cures diseases which may not be

cured by either drugs, surgical instruments, or chemical cauterizing

agents.” In cases of enlargement of the spleen they plunged red-hot

needles into the parenchyma of the organ, presumably through the

skin and other overlying tissues. There were fourteen different

kinds of surgical dressings; cotton, woolen, linen and silk being

the materials used for bandages, and strips of bamboo or some other

wood for splints. When the conditions permitted such a proceeding,

it was customary to sew up wounds of the head, face and windpipe.

Furthermore, it was the rule to perform all surgical operations at a

time when the constellations were favorable. Religious ceremonies were

performed both before the operation and after it was completed, and

it was also considered necessary that the operator should face the

west and the patient the east. Intoxication was employed as a means

of securing narcosis. Owing to their scrupulous cleanliness and the

minute attention which they paid to details, the surgeons of ancient

India obtained for a long time a much higher degree of success than

did the surgeons of other oriental nations. At the same time they were

not lacking in that degree of boldness which enables an operator--in

critical cases which probably without such prompt and radical action

would terminate fatally--to save life. For example, they did not

hesitate to open the abdominal cavity and to sew up a wound in the

intestines; they cut for stone in the bladder, employing for this

purpose the lateral method of operating; and they performed a great

variety of plastic operations.

Some of their hygienic rules concerning pregnant and nursing women

are eminently practical; others would hardly be approved by modern

accoucheurs. Here are a few of these rules: During the period of a

woman’s pregnancy close attention should be paid to her diet, and

special care should be exercised by her to avoid excesses or errors

of any kind. When the ninth month is reached she should take up her

abode in the small cottage in which she is eventually to be confined--a

building erected with special religious ceremonies and thoroughly

fitted with everything that is likely to conduce to her comfort. At

the time of the actual confinement she should have with her four

female assistants, and all those measures, of either a religious or a

practical character, which have in view the hastening of the birth of

the infant, should be scrupulously carried out. If any delay in the

delivery of the after-birth occurs, the removal of the mass may be

promoted by the employment of well-directed pressure over the lower

part of the abdomen, by shaking the body, and also, if necessary, by

giving an emetic. The woman in childbed should not be allowed to get

up before the tenth day after her confinement, and for a period of

six weeks her diet should be most carefully watched. On the third day

the child should be put to the mother’s breast; up to that time it

should be given only honey and butter. If the mother, for any reason,

is not able to suckle the infant, a wet-nurse should be employed for

the purpose, but not until the physician shall have subjected her to

a most thorough examination and shall have instructed her minutely in

regard to her own diet. The subsequent care of the child was provided

for in the most particular manner: It was restricted to a carefully

planned diet; it was not allowed to sit or to lie except in certain

prescribed positions; its times for sleeping were strictly ordered;

it was permitted to amuse itself only in certain ways;--in brief,

everything was done according to strict rules, even special precautions

being taken to guard the child, during the first years of life, against

dangerous demons. Weaning began after the sixth month, and for a

certain length of time the child was fed largely on rice. In cases of

difficult labor and in their gynaecological practice the physicians of

ancient India did not manifest any special knowledge or skill.

One of the instructions given to young physicians in India when they

were about to enter upon the practice of their profession, may be

of interest to the reader. It is worded as follows: “Let thy hair

and finger-nails be cut short, keep thy body clean, put on white

garments, wear shoes on thy feet, and carry a staff or umbrella in thy

hand. Thy demeanor should be humble, and thy heart pure and free from

deceitfulness.” The following proverb, although it originated in India,

is well worthy of acceptance in every part of the world: “When you are

ill the physician will be to you a father; when you have recovered from

your illness you will find him a friend; and when your health is fully

re-established he will act as your protector.”

On a previous page the statement has been made that the science and

art of medicine developed in ancient Greece quite independently of

any influence that might have been exerted by the teachings of the

physicians of India. This statement should be somewhat modified, for it

is reasonable to suppose, although directly confirmatory evidence has

not yet been discovered, that, through the channels of trade between

the two countries, some knowledge of the doings of the physicians

of India must have reached the ears of their Greek brethren. On the

other hand, at a later period of history (after Alexander the Great

had invaded India), the relations between the two countries became

quite close and were kept up without a break for several hundred

years. During the earlier part of this later period, as appears from

the writings of Hippocrates, Dioscorides and Galen, various drugs and

methods of treatment employed by the physicians of India were adopted

by the practitioners of Greece.

_Medicine of the Chinese and Japanese._--The isolation of China

with respect to those countries which were within comparatively easy

reach and in which there was a civilization that, already several

thousand years before the Christian era, had attained a remarkable

degree of development (India, Babylonia and Egypt, for example); her

blind belief in authority; her unwillingness to tolerate any influences

that seemed to emanate from foreigners; and her complete satisfaction

with her own methods of doing things, with her own beliefs, and with

her own natural and manufactured products,--these, it is generally

believed, were the most important factors in keeping this remarkable

nation in a state of immobility as regards at least some departments

of human knowledge and accomplishment. This is particularly true in

respect of the science and art of medicine. But China is at last

waking up from this lethargic state. A wonderful change has come over

her during the past twenty or thirty years, and she is now beginning

to realize that, with her millions of population and wonderful

natural resources, she has an important part to play in advancing the

civilization of the world.

The preceding remarks must not be interpreted as signifying that,

during the long ages of the past, China has not been developing and

is not able at the present time to show a record of very creditable

work accomplished in many departments of human activity. In her early

history, many centuries ago, she accomplished great things, and all--so

far as we now know--without aid from neighboring nations; but there

came a time when all this creative activity ceased, and then, for long

periods of years, she appeared to rest satisfied with the advances

which she had already made, and to have no further ambition to add to

the stock of her possessions.

Among the valuable things which should be credited to the Chinese

are the following: the discovery of the compass (about 1100 B. C.),

the making of porcelain, the invention of printing, the raising of

silkworms, the manufacture of glass and of paper, the successful dyeing

with purple, embroidering with gold, working in metals, the artistic

cutting of precious stones, enameling, the making of “India ink,” etc.

Furthermore, it is a fact most creditable to the Chinese that in no

other country in the world have scholars been held in such high esteem,

or assigned so high a rank, as they have been and still are in China.

Chinese medicine possesses a very rich literature. The first medical

treatise, which deals with plants that possess medicinal virtues, is

ascribed to the Emperor Schin-Nung, who flourished about 2800 B. C.

This is the monarch who taught his people from which springs they

should drink, and who tested all the plants of his vast empire with

reference to their healing properties. According to the legend the

wall of his stomach was so thin that he could look through it and see

everything that was going on in the interior of that organ. In this way

he was able to carry on a large series of experiments upon himself in

regard to the action of different poisons and their antidotes. It is

also related that medical knowledge was still further advanced by the

yellow Emperor Hoang-Ti who lived about 2650 B. C., and who is credited

by the Chinese with having invented arithmetic and music. The treatise

called “Noi-King,” which deals with the subject of internal diseases

and gives a systematic account of human anatomy, is also credited

by the Chinese to this monarch; but Neuburger maintains that this

book, which is still in common use in China, is of much more recent

origin. There are several other medical treatises which deserve to be

mentioned. Such, for example, are the following: the celebrated book on

the pulse, written by Wang-Schu-Scho in the third century B. C.; two

very important books written by Cho-Chiyu-Kei--one bearing the title

“Schang-Han-Lun” (On Fevers) and the other that of “Kin-Kwéi” (Golden

Casket);--the different treatises written by Tschang-Ki (tenth century

A. D.) and published in the collection called “The Golden Mirror of

the Forefathers in Medicine” (I-Tsung-Kin-Kien); and, finally, the

very popular modern work (in forty volumes) entitled “The Trustworthy

Guide in the Science and Art of Medicine” (“Ching-Che-Chun-Ching”). Of

these forty volumes, seven are devoted to nosology, eight to pharmacy,

five to pathology, six to surgery, and the remainder to children’s and

women’s diseases.

Anatomy, it appears, has never played other than a very insignificant

part in the Chinese system of medicine. This is not to be wondered

at when we remember that their religion makes the dissection of a

human body a sin worthy of punishment. No mutilated person, the

Chinese believed, would be permitted, upon reaching the domain of

the dead, to rejoin his ancestors. About the year 1700 A. D. the

Emperor Kang-Hi made the attempt to incorporate anatomy as a part

of the regular study of medicine in the Chinese Empire; his first

step being the authorization of P. Perennin, a Jesuit Father, to

translate Dionis’ work on anatomy into the Chinese. His efforts were,

however, unsuccessful, owing to the strong opposition offered by the

native physicians. And the attempts made during more recent times

to accomplish the desired reform by introducing copies of European

anatomical illustrations do not appear, as yet, to have produced any

appreciable impression. In very recent years, however, the medical

missionaries, sent out, if I am rightly informed, from the United

States, are giving excellent instruction in anatomy.

Physiology, as taught by the Chinese, is something beyond the

comprehension of modern Europeans. Neuburger explains their views

in the following manner: “The cosmos is the product of the combined

action of two dissimilar forces--the male (Yâng) and the female (Yin).

When these forces work in harmony a state of equilibrium results....

Matter consists of five elements, viz., wood, fire, earth, metal, and

water; and all things are composed of these elements. In sympathetic

relationship with these five elements stand the five planets (Jupiter,

Mars, Saturn, Venus, Mercury), the five different kinds of air (wind,

heat, moisture, dryness, cold), the five quarters of the globe (east,

south, west, north and the equator), the five periods of the year (in

addition to the four which we recognize, the Chinese make a fifth

period out of the last eighteen days of spring, summer, autumn and

winter), the five times of day, the five colors (green or blue, red,

yellow, white and black), the five musical tones, etc.... As in the

cosmos, so in man the two primeval forces--Yâng and Yin--underlie all

his vital processes. Thus, his body is made up of the five elements of

which all matter is composed, and health depends upon the maintenance

of a state of equilibrium between the male and the female forces,

etc.” After this brief exposition it seems unnecessary to devote any

further space to the consideration of the physiological doctrines of

the Chinese.

With respect to the questions of diagnosis and prognosis it may be

stated that the Chinese attach great importance to the necessity of

making a most careful objective examination of the entire body; but,

when one investigates the precise manner in which this examination is

to be carried out, it soon appears that most of the details relate to

matters of a purely fanciful or mystical nature. The only steps of real

importance, according to them, are the examination of the patient’s

pulse and the inspection of his eyesight and his tongue. From the

examination of the pulse alone they believe it possible to diagnose

the nature and seat of the disease. To examine the pulse properly

is a complicated affair and can scarcely be carried out in actual

practice in less time than ten minutes; indeed, in certain cases the

physician may find it necessary to devote two or three hours to the

business. According to the Chinese scheme there are many different

kinds of pulse, and there are no less than thirty-seven different types

of condition presented by the tongue, each bearing its own special

pathological significance.

Disease, so reads the Chinese doctrine, is a discord, a disturbance

of equilibrium, caused by the preponderance of one or the other of

the primeval forces (the male or the female). It manifests itself

in some disorder of the circulation of the vital air and the blood,

and eventually involves the organs of the body. Wind, cold, dryness,

moisture, the emotions and passions, poisons, and also evil spirits and

imaginary beasts are the causes of disease.

No other nation, says Neuburger, has at its command such a large number

of remedial drugs; and it is also a fact, he adds, that the department

of therapeutics is that in which Chinese medicine has reached its

highest development. The steadfast belief that in nature there exists

a remedy for every human ill led the physicians of that country to

search diligently in all possible directions for vegetable and animal

and also, to some extent, mineral substances which might possess

remedial virtues. Although this search necessarily brought to notice

a lot of useless drugs, it cannot be denied that eventually it added a

considerable number of remedies which have proved useful to the medical

profession of the entire world. In this category belong the following:

rhubarb, pomegranate root as a cure for worms, camphor, aconite,

cannabis, iron (for the relief of anaemia), arsenic (for malarial and

skin diseases), sulphur and mercury (both of these for affections of

the skin), sodium sulphate, copper sulphate (as an emetic), alum,

sal ammoniac and musk (for nervous affections). Toward the middle

of the sixteenth century A. D. there was published, under the title

“Pen-Tsao-Kang-Mu,” a monumental work (fifty-two volumes) in which are

very fully described no fewer than 1800 remedies, mostly of a vegetable

nature. Prophylactic Inoculation with the pus from a small-pox pustule

was practised by the Chinese as long ago as during the eleventh century

A. D., “thus constituting a forerunner of our modern serum therapy.”

(Neuburger.) Vaccination was not introduced into China until during the

nineteenth century of the present era. It is a curious fact that, in

the choice of a remedy, the Chinese physicians attach a certain degree

of importance to the form and color of the drug, as symbols indicative

of the effect which they may be expected to produce. Thus, the red

blossoms of the hibiscus plant are believed to be more efficacious

than the white as an emmenagogue; saffron, being of a yellow color,

possesses the power to relieve jaundice; beans that have the shape of

a kidney should be prescribed in cases of renal disease; glow-worms

should form a part of all eye-washes, etc.

The doses prescribed are very large, and the medicines are often put up

in an attractive form, with labels on which such descriptive titles as

these are written: “Powders of the Three very wise Men,” or “Powders

recommended by Five Distinguished Physicians”--titles which are

calculated to work upon the imagination of the patient.

There are two methods of treatment which the Chinese physicians

are very fond of employing for the relief of a great variety of

diseases--viz., acupuncture and cauterization of the skin over the

seat of the malady by means of what are termed “moxae”--moxibustion.

Moxae are prepared by kneading together into a cone-shaped, tinder-like

mass the leaves of the artemisia vulgaris, then drying it thoroughly.

Such a mass is attached to the skin at the affected spot by simply

moistening the base of the cone, after which the apex is ignited. Some

physicians prefer to interpose a thin sheet of metal between the skin

and the base of the moxa. The manner in which these contrivances should

be used in the different diseases and the proper number to employ are

matters subject to fixed rules. In a strong individual, for example,

as many as fifty moxae may be used at a time. In affections of the

chest they were applied to the patient’s back, in diseases of the

stomach to the shoulders, and in venereal affections over the spinal

column. In acupuncture, which is a procedure invented by the Chinese,

slender needles of gold, silver or highly tempered steel, from 5 to 22

centimetres (2 in.-8¼ in.) in length, were forced through the stretched

skin to different depths (1¼ in.-1½ in.) and then driven farther inward

in a rotary direction by means of a small hammer. The needles, after

being allowed to remain in situ for a few minutes, were withdrawn, and

pressure was made with the hand over the small wounds, or a moxa was

burned over the spot. There are in all 388 places where acupuncture may

be performed, and a chart of the body, showing where these places are

located, has been prepared for the guidance of the Chinese physicians.

Neuburger calls attention to the fact that the latter dislike the sight

of blood, and that this is one of the reasons why acupuncture and the

use of moxae have grown to be such popular remedies. Bloodletting

is rarely employed by them; but dry cupping, on the contrary, is a

favorite procedure in certain maladies. Massage is generally performed

by old or blind women, and much attention is devoted to the “movement

cure,” which is said to have been invented about 2500 B. C.

As may readily be imagined, the Chinese--owing to their dislike for the

sight of blood and also by reason of their ignorance of anatomy--have

not advanced, in surgery, beyond the most primitive state of that art.

The science of public health is quite unknown in China. In a Chinese

treatise entitled “Long Life,” the following advice is given: “Always

rise early in the morning, take some breakfast before you leave your

residence, drink a little tea before eating, at the mid-day meal

partake of well-cooked but not too highly salted food, eat slowly, take

a nap of two hours after the meal, eat lightly at night, and, before

going to bed, rinse your mouth with tea and have the soles of your feet

rubbed until they are warm.” (Neuburger.)

Up to the latter part of the nineteenth century of the present era,

Japan, so far as medical matters are concerned, differed in no

material respect from China. During the last fifty or sixty years,

however,--that is, since the visit of Commodore Perry, of the United

States Navy, to that country,--wonderful changes have taken place; and

now Japan, as a result of her determination to adopt the methods of

education, of utilizing steam and electric power, etc., has already

taken a leading place in the council of nations. The physicians, many

of whom received their training in the best schools of Europe and

the United States, are contributing to-day their full share toward

advancing the science of medicine. That China is following in the

footsteps of Japan is already plainly evident, and no intelligent

observer entertains the slightest doubt of her ultimately--probably at

no distant day--possessing a corps of medical men as well educated,

as efficient in the treatment of disease, and as practical in public

hygiene as their European and American confrères. During thousands

of years China has suffered severely from the blighting tyranny of

superstition, priestcraft and selfish bureaucracy, and, now that the

sunlight of truth and genuine liberty is beginning to search every nook

and cranny of that great country, we who have had the advantage of this

beneficent influence for so many scores of years truly rejoice over the

change that is taking place in China.

CHAPTER IV

GREEK MEDICINE AT THE DAWN OF HISTORY

It is from Greece and from Greece alone, says Daremberg, that our

modern medicine derives its origin.

It has come down to us, in a direct line, through the sheer

force of its inherent excellence, and with little or no aid from

outside sources. Harvey, Bichat and Broussais are as much the

legitimate heirs of Hippocrates, Herophilus, Galen, Berenger de

Carpi and Vesalius, as Hippocrates is the heir of Homer, and

as this divine singer of the anger of Achilles is himself the

product of a civilization that existed before his day and that

was in all probability the creation of Hindu influences.

It is to the development of medical knowledge in Greece, therefore,

that our attention should next be directed, and more particularly to

that period which belongs to the dawn of history--the pre-Homeric

period.

_The pre-Homeric Period of Medicine in Greece._--The poems of

Homer, the Iliad and the Odyssey, furnish us with the earliest and

almost the only written evidence of the state of medicine in Greece

during that period of time. They were probably written, according

to the authority of the Earl of Derby, somewhere about 800 B. C.,

and modern investigations show that the siege of Troy, the theme

of the Iliad, occurred between the years 1194 and 1184 B. C. These

investigations also show that in this region, and especially in the

Island of Crete and in Mycenae on the neighboring mainland of Asia

Minor, at this time and probably several hundred years earlier, there

existed a high degree of civilization. Specimens of a written language,

for example, were found among the objects recovered from the ruins

of the palace of King Minos at Cnossus in Crete, but hitherto no

interpreter of this unknown language has been found. It is reasonable

to expect, however, that in due time these Minoan records will be

translated, that still other records belonging to this remote age

will be discovered, and that much valuable information regarding the

condition of medical knowledge in Greece during this long period

will then be revealed to us. Strange as it may appear, the classical

Greek writers seem to have possessed very little knowledge concerning

this highly developed civilization at Cnossus. And yet, if we stop

to consider the matter, their silence will appear less strange for

the following reasons. Some great calamity (war, an earthquake, or a

conflagration) must have destroyed many of the evidences of Minoan

civilization besides those which are now being brought to light; then,

also, several hundred years elapsed between the occurrence of this

disaster and the classical period of Greek culture; and, finally, there

is the fact that the knowledge of past historical events, when kept

alive simply by tradition, slowly vanishes, until finally it becomes

so vague as to possess very little value. The discoveries made in the

Island of Crete and at Mycenae were not known to Daremberg when he

wrote the lines quoted above, but he felt perfectly sure, from his

knowledge of the laws of development in general, that a product so

highly cultured as Homer could not have suddenly sprung into existence

out of the apparent darkness and ignorance of the centuries immediately

preceding his time.

_The State of Medical Knowledge at the Time of the Siege of

Troy._--It is from Homer’s Iliad and Odyssey that our authoritative

knowledge of the most ancient Greek medicine is derived. In the former

work mention is made of Aesculapius and his two sons, Machaon and

Podalirius, both of whom accompanied Agamemnon and the Greek host in

their expedition against Troy. According to this author’s account they

served in the double capacity of surgeons to the army and valiant

leaders of troops. In order that the reader may judge for himself just

what is the nature of the evidence furnished by Homer with regard to

the medical knowledge of that period, it seems desirable to introduce

here a few of the more characteristic references which the poet makes

to spear, javelin and arrow wounds, to the injuries caused by fragments

of rocks hurled by the assailants, and to various remedial measures,

both surgical and medical, employed for the relief of the wounded or

sick warriors. There are at least one hundred such passages in the

Iliad alone, but the few which are here cited will serve as adequate

examples of Homer’s familiarity with anatomy and with some of the

methods of treating spear and arrow wounds,--a familiarity which

indicates that the poet must have had some medical training.

Thus he; and not unmoved Machaon heard:

They through the crowd, and through the widespread host,

Together took their way; but when they came

Where fair-hair’d Menelaüs, wounded, stood,

Around him in a ring the best of Greece,

And in the midst the godlike chief himself,

From the close-fitting belt the shaft he drew,

With sharp return of pain; the sparkling belt

He loosen’d, and the doublet underneath,

And coat of mail, the work of Arm’rer’s hand.

But when the wound appeared in sight, where struck

The stinging arrow, from the clotted blood

He cleans’d it, and applied with skilful hand

The healing ointments, which, in friendly guise,

The learned Chiron to his father gave.

(Book IV. of the Iliad, Lines 221–259.)

* * * * *

He said: the spear, by Pallas guided, struck

Beside the nostril, underneath the eye;

Crashed through the teeth, and cutting through the tongue

Beneath the angle of the jaw came forth:

Down from the car he fell; and loudly rang

His glittering arms: aside the startled steeds

Sprang devious: from his limbs the spirit fled.

Down leaped Aeneas, spear and shield in hand,

Against the Greeks to guard the valiant dead;

And like a lion, fearless in his strength,

Around the corpse he stalk’d, this way and that,

His spear and buckler round before him held,

To all who dar’d approach him threatening death,

With fearful shouts; a rocky fragment then

Tydides lifted up, a mighty mass,

Which scarce two men could raise, as men are now:

But he, unaided, lifted it with ease.

With this he smote Aeneas near the groin,

Where the thigh bone, inserted in the hip,

Turns in the socket joint; the rugged mass

The socket crushed, and both the tendons broke,

And tore away the flesh: down on his knees,

Yet resting on his hand, the hero fell;

And o’er his eyes the shades of darkness spread.

(The Iliad, Book V., Lines 333–356.)

* * * * *

He said, and passing his supporting hand

Beneath his [Eurypylus’] breast, the wounded warrior led

Within the tent; th’ attendant saw, and spread

The ox-hide couch; then as he lay reclined,

Patroclus, with his dagger, from the thigh

Cut out the biting shaft; and from the wound

With tepid water cleans’d the clotted blood;

Then, pounded in his hands, a root applied

Astringent, anodyne, which all his pain

Allayed; the wound was dried, and stanch’d the blood.

(The Iliad, Book XI., Lines 958–967.)

* * * * *

But Jove-born Helen otherwise, meantime,

Employed, into the wine of which they drank

A drug infused, antidote to the pains

Of grief and anger, a most potent charm

For ills of every name.[13] Whoe’er his wine

So medicated drinks, he shall not pour

All day the tears down his wan cheeks, although

His father and his mother both were dead,

Nor even though his brother or his son

Had fallen in battle, and before his eyes.

(Book IV. of the Odyssey, Lines 275–284.)

In former years and down almost to the present time, it was the custom

among English medical writers to speak of Aesculapius only as the

“God of Medicine,” thus conveying to the minds of many readers that

he was a mythological character, not a real personage. To-day, and

especially since Schliemann has demonstrated, by his excavations at

the site of ancient Troy, that Homer’s Iliad is not merely a beautiful

creation of his poetic fancy, but a narration of events that actually

occurred about 1200 B. C., it is quite generally acknowledged that

Aesculapius[14] is an historical character, an individual whose memory

should receive due honor from the physicians of modern times. Neither

Homer nor Pindar speaks of him as a god. In Athens he was publicly

deified in 420 B. C.

When Daremberg, as quoted above, expressed the belief that Hippocrates

was the product of an earlier civilization, he undoubtedly gave due

weight to other circumstances beside those which are narrated in

Homer’s poems--circumstances, for example, which are referred to

casually by several of the classical Greek authors, and to which fresh

importance has been given by a number of recent discoveries. Thus,

there is an abundance of evidence showing that the Greeks, both before

and after Homer’s time, held the memory of Aesculapius in the very

highest honor. So great, as they believed, was his power over disease,

so wonderful were the cures which he accomplished, and so noble and

pure was his character, that they made him a god and erected temples

in his honor--not mere places where a barren worship might be carried

on, but veritable sanatoria--termed Asclepieia--where the extraordinary

healing powers of him whom they had made a god might be perpetuated

for the benefit of succeeding generations. While, on the one hand,

the ancient Greeks may have been full of superstitious beliefs, they

were at the same time as kindly disposed toward their fellow men, as

generous in their spending of money for this purpose, and as practical

in their selection of suitable methods as are the benefactors of to-day

all over the world. In course of time these so-called temples became

the prototypes of our hospitals, sanatoria and schools of medicine,

and it therefore seems only proper that they should here be described

somewhat in detail.

_The so-called Aesculapian Temples and their Chief Purpose._--The

first of these temples, or Asclepieia, were established at Trikka, in

Thessaly; at Cnidus, on the coast of Caria in Asia Minor, opposite

Cos; at Epidaurus, in Argolis, Greece; at Cyrene on the northern

coast of Lybia, Africa, opposite the Island of Crete; at Crotona,

on the southeastern coast of Italy; and, finally, at Athens. It is

said that traces of as many as eighty of these Asclepieia have been

found in different parts of the ancient world. One of them, for

example, is known to have existed on the small island (Isola San

Bartolommeo) in the Tiber, at Rome. Their management was intrusted, in

the earlier years of their existence, to men who were descendants of

Aesculapius--i.e., the sons and grandsons of Machaon and Podalirius.

They were both priests and physicians, and are mentioned in history as

the Asclepiadae. With the progress of time it became necessary, as one

may readily understand, to intrust the temple service to individuals

who were not members of the family of Aesculapius. The original

Asclepiadae guarded as valuable secrets the methods of treatment and

the pharmaceutic formulae which had been handed down to them by the

head of the family. It was therefore natural, when these newly adopted

members were installed in office, that they should be made to promise,

under oath, not to “divulge these secrets to any but their own sons,

the sons of their teachers, or the pupils who were preparing themselves

to become regular physicians.” (Neuburger.)

The divulging of these secrets, it may be assumed, would gradually

entail upon the organization of priest-physicians a serious money

loss. As will be seen further on, the oath known as “the Hippocratic

Oath” omits these mercenary features, and thus places the vocation of

physician upon a much higher level.

It is an interesting fact, as noted by Hollaender, of Berlin, that

Homer does not make the slightest mention of temples dedicated to

Aesculapius; from which circumstance it may be inferred that a long

time--perhaps several hundred years--elapsed, after his death, before

his countrymen realized fully his greatness and the value of the

services which he had rendered in his rôle of physician. Of the temples

which were then built in his honor, all have long since fallen into

ruins, but in recent years excavations have been made at some of the

more important of these sites and under the guidance of competent

scholars, and as a result our knowledge of the state of medicine in

Greece between the time of Homer and the appearance of the Hippocratic

writings has been greatly enlarged. The facts revealed by these

excavations and the statements which are to be found in classical Greek

literature, but which previously did not receive all the consideration

that they deserved, have now been pieced together and we have thus

been furnished with a fairly satisfactory picture of the relations of

the different chambers and spaces in these temples, and with a more or

less complete account of the manner in which affairs were conducted by

those in charge. The following short description which is based on the

account recently published by Professor Meyer-Steineg of Jena, Germany,

will put the reader in possession of all the more important facts.[15]

[Illustration: FIG. 1. VIEW OF THE TEMPLE OF AESCULAPIUS ON THE

ISLAND OF COS.

As it must have appeared to the traveler, in the third century

B. C., on his approach by sea to the port of that island.

Reconstitution based upon recent photographs and upon surveys by

Herzog (_Koische Forschungen_, 1904).

(Courtesy of Prof. Dr. Meyer-Steineg, of Jena, Germany.)]

There were two principal types of Asclepieia--one, like that of

Epidaurus, in Argolis, which occupied an inland situation, that had

clearly been chosen from religious motives alone, viz., because it was

believed, in accordance with an ancient tradition, that at this spot

Aesculapius had been born--and a second, like that of Cos, on the

island of the same name in the Aegean Sea, which situation without

doubt had been chosen chiefly because the locality was exceptionally

healthful. Of the first of these two types of temples, the sites of

both of which have been most carefully studied, very little need

be said in this brief sketch. The purely medical aspects of this

Asclepieion, to which at the height of its celebrity crowds flocked

from all parts of Greece, are of minor interest. The temple and its

accessory buildings, which appear to have been very extensive, were

located in a narrow valley, not far distant from the seaside village

which still to-day bears the name of Epidaurus. Then, also, the

locality is deficient in one important respect--it has an insufficient

supply of good drinking water; and, finally, it is only slightly

elevated above the sea-level. Dr. Meyer-Steineg remarks that the

patients who visited this temple must have owed whatever benefit they

derived from the visit to other influences than those of a purely

medical or hygienic character. Doubtless suggestion played an important

part in any relief which they may have obtained, and the so-called

temple-sleep was also doubtless a very effective factor in this

direction. The Asclepieion at Cos, on the other hand, occupied a most

healthful position on the northern slope of the ridge of mountains

which extends throughout the entire length of the island and attains a

maximum height of about 3000 feet. (See Fig. 1.)

It now remains for me to describe, as best I may within the limited

space which is at my command, the results of the excavations and

surveys that have been made in recent years on the Island of Cos.

Professor Meyer-Steineg’s article on this subject[16] is the source

from which I have derived the information contained in the following

account.

The temple and its associated buildings stood at an elevation of

three hundred feet above the sea-level and at a distance of a little

more than two miles from the city of Cos. The heights behind the

temple were in former times covered with forests and afforded ample

protection against the debilitating and much-dreaded south wind. A

brook of considerable size and of very pure water passed through the

temple grounds; the spring (Burinna) from which it took its origin

being located about 300 feet higher up on the side of the mountain.

Not far off, in the same neighborhood, is a mineral spring, the water

from which contains both iron and sulphur. All the physical conditions

of this site were, therefore, very favorable to the restoration of

both mental and bodily health. Professor Meyer-Steineg declares that

it is scarcely possible to determine accurately the age of the Cos

Asclepieion,--_i.e._, of the structures which the present ruins

represent,--but he believes that some of them date no farther back than

the third century B. C., at which time extensive structural alterations

were made.[17] Then, at a still later date (first century A. D.), in

consequence of the damage done by an earthquake, C. Stertinius Xenophon

(at the instigation of the Roman Emperor Claudius, whose private

physician he was) carried out some very radical changes. Not only were

the separate buildings well supplied with running water, but even many

of the individual rooms (of which there were a large number) were

equipped with the same conveniences. Hydropathy evidently formed an

important part of the treatment in the reconstructed temple. (See Fig.

2.)

As has been shown above, the climate, the freedom from disturbing

factors of all kinds, the existence at that spot of a plentiful supply

of pure water, the character of the structures composing the temple

group, and the widespread belief among the people that the Asclepiadae

were able, with the assistance of the god Aesculapius, to effect cures

which were obtainable nowhere else--all contributed to make the temple

at Cos one of the greatest sanatoria of ancient times.

[Illustration: FIG. 2. BIRD’S-EYE VIEW OF THE TEMPLE OF AESCULAPIUS

AND ASSOCIATED BUILDINGS ON THE ISLAND OF COS.

As they appeared in the third century B. C.

(Copied by permission from a model made by Prof. Dr.

Meyer-Steineg for the Medico-historical Museum of the University

of Jena, Germany.)]

[Illustration: FIG. 3. GROUND PLAN OF THE ASCLEPIEION ON THE ISLAND

OF COS.

As Ascertained by the Researches of Dr. Herzog.

The different structures are arranged as nearly as possible in

the same positions which they occupied in the third century, B.

C.

_A_, main entrance to Asclepieion; _B_, _B_,

_B_, gallery, 6 metres broad, with colonnade on one side;

_C_, open space or court, on the southern side of which is

a structure composed of recesses provided each with a bathing

basin (_D_); _H_, staircase leading to intermediate

terrace; _a_, massive series of steps leading to the upper

terrace; _b_, _b_, _b_, broad gallery similar to

that shown on the lower terrace; _d_, the temple proper.

(From Prof. Dr. Meyer-Steineg’s _Medizinisch-historische

Beiträge_.)]

The buildings which constituted what is commonly termed the “Temple

of Aesculapius” at Cos were located on three artificially prepared

terraces. The principal entrance to the group, as the excavations

conducted quite recently by Herzog show, was on the lower terrace,

and faced north--that is, toward the sea. From this lower level a

broad staircase led to the second or intermediate terrace, which, in

turn, was connected with the upper one by means of a very broad and

massive series of steps. The southern limit of this upper terrace

ended abruptly at the slope of the mountain. The arrangement of the

buildings on the three different terraces may, in harmony with the

account given by Professor Meyer-Steineg, be briefly described as

follows: That which stood on the lower terrace occupied three sides

of a parallelogram (Fig. 3), the open part of which faced south. The

longer side of the building measured about 120 metres (390 feet) in

length, and the two shorter sides each 55 metres (180 feet). The

supply of running water in every part of this great building, which

appears to have been devoted mainly, if not entirely, to therapeutic

purposes, must have been most abundant. The source from which the

water came was the Burinna spring, situated higher up on the mountain

at a spot far beyond all possibility of contamination. It is not yet

clear, says Dr. Meyer-Steineg, whether or not there were any buildings

devoted to therapeutic purposes on the intermediate terrace. (Figs.

2 and 3.) On the other hand, the great halls, contained in the large

building which surrounded the temple on the upper terrace, appear to

correspond very closely to the rooms that constituted the main portion

of the building on the lower terrace, and it is therefore probable that

this upper building also served some useful purpose in the general

scheme of the Asclepieion. It is Herzog’s opinion--according to

Meyer-Steineg--that the central idea around which everything in this

assemblage of fine buildings revolved, was a clinic conducted by the

Asclepiadae. The means chiefly employed at first for the restoration

of health were such simple agents as sunlight, pure air, pure drinking

water, dietetic measures, massage, physical exercise, etc., and yet,

when the patient’s condition seemed to require their use, there was no

hesitation in resorting to the rational employment of drugs, and even

surgical operations were performed. The numerous instruments which Dr.

Meyer-Steineg collected at the site of the ruins when he visited Cos in

1910, furnish ample corroborative evidence of the correctness of this

last statement.

Not the least important part which this famous Asclepieion played in

the history of medicine was the splendid opportunity which it afforded

to those who were preparing themselves to engage in the practice of

the healing art, for acquiring the necessary familiarity with the

different diseases and for learning how they should be treated.

The manner of conducting the preliminary treatment was probably not

the same in every particular in all the different Asclepieia, and yet

in the main the plan of procedure followed in Epidaurus, in Cos and in

Athens undoubtedly resembled closely that which Pagel furnishes in his

_Geschichte der Medizin_. It may be briefly described as follows:--

In the first place, moribund persons, the unclean, and women about to

be confined were not admitted into the temple enclosure. The management

of the latter class of patients was left entirely to women nurses, and,

when it became evident that a person was likely to die, the individual

was thereafter cared for outside the enclosure.[18] In short,

everything possible was done to keep out of sight all such objects as

might produce an unpleasant impression upon applicants for treatment.

After preliminary bathing and dieting, the patient was conducted into

the temple enclosure and encouraged to make offerings and to pray to

the god Aesculapius, an imposing statue of whom in marble was one of

the first things that confronted him. As he was led about by the priest

or an attendant, his imagination was wrought upon by the sight of

numerous votive offerings exposed to view on the walls or columns of

the buildings, by the singing of hymns in adoration of the god, and by

the reading of the records of earlier cases inscribed on tablets or on

the columns. After his mind had thus been worked upon, he was asked to

furnish to the priest a detailed history of his own case and to submit

to some sort of physical examination. As a final and most important

step in this first stage of the treatment he was subjected to what was

termed “the temple-sleep,” during which the suggestion of the proper

remedies to be employed was supposed to be communicated to him by the

god himself.

In our day it is difficult to understand how persons of a fair degree

of intelligence could for so long a period have continued to believe

in the efficacious interference of the deified Aesculapius in their

behalf. But that this belief really did exist is well known, and it was

only after the lapse of many centuries that the faith of the public

began to weaken, doubtless through the influence of several factors.

Perhaps the most important of these was the discovery of an increasing

number of instances of humbuggery or trickery, of which the officiating

priests, in some of the temples, had been guilty. The satirical writer,

Aristophanes, who flourished in Athens about 400 B. C., describes an

incident of this nature in his play entitled “Ploutos.” The following

extracts furnish an account of the doings observed by the slave Karion

on the occasion of his passing a night in the temple enclosure at

Athens:--

The Scene throughout is laid at Athens, in front of the

house of Chremulos.

* * * * *

_Blepsidemos_: Ought n’t we then to bring in some doctor?

_Chremulos_: Prythee, what doctor is there now in the city?

For their pay is no longer anything worth, nor their art.

_Blep._: Let us cast about.

_Chrem._: Nay, there is not one.

_Blep._: I believe there is not.

_Chrem._: Nay, by Zeus, the best plan is to do what I have

been long preparing--(to conduct him [Ploutos]) to the temple of

Asklepios [and] make him lie down [there].

* * * * *

_Chrem._: Karion, my man, you must bring out the bedclothes

and lead Ploutos himself in the usual way, and carry everything

else that is ready within.

(_Exeunt omnes._)

* * * * *

_Chorus of Farmers._ What is the matter, Oh thou best

friend of--thyself? For you seem to have come as a messenger of

some good news.

_Karion._[19] My master has fared most prosperously, or

rather Ploutos himself. For, instead of being a blind man, he

has been made to see again, and his pupils are clear-sighted, as

he has met with a kindly friend in Asklepios the Healer.

_Chorus._ You give me reason for joy, reason for shouts of

triumph.

_Karion._ Ye have reason to rejoice whether ye wish it or

not.

_Chorus._ I will shout aloud for Asklepios of the goodly

children, the great light to mortals.

* * * * *

_Karion._ Well, as soon as ever we came to the god,

leading a man then, indeed, most miserable, but now blessed and

fortunate, if any other is so, first we led him to the sea, and

then we bathed him.

_Wife of Chremulos._ By Zeus, then the old man was

fortunate, bathing in the cold sea.

_Karion._ Then we went to the sacred enclosure of the god.

And when on the altar the cakes and offerings were dedicated

by the flame of murky Hephaistos, we laid down Ploutos, as was

proper; and each of us made up from little odds and ends a bed

for himself.

_Wife._ Then were there certain others beside yourselves

wanting the god?

_Karion._ Yes, Neokleides, for one, and he is blind; but

in stealing has far overshot those who can see; and there were

many others with all sorts of ailments. But when the minister of

the deity put out the lights and told us to go to sleep and said

that we were to keep silent, if any of us perceived a noise, we

all lay down in an orderly manner. And I was unable to sleep,

for my attention was arrested by a certain pitcher of porridge

a little way off from the head of a certain old woman, and I

strangely desired to creep over to that pitcher. Then I looked

up and saw the priest making a clean sweep of the cakes and

dried figs from the sacred table. After this he went round all

the altars in a circle to see if any cakes were left anywhere.

Then he consecrated them into a certain wallet; and I, believing

that there was great holiness in this proceeding, rise up to go

to the pitcher of porridge.

_Wife._ Oh you most miserable of men, were you not afraid

of the god?

_Karion._ Yes; by the gods I was afraid lest he with his

fillets should reach the pitcher before me; for the priest

had already given me a lesson. But, as soon as ever the old

woman perceived the noise I made, she lifted up her hand over

the pitcher (to protect it). Then I hissed and seized (her

hand) by the teeth as if I were a reddish-brown snake. But

she at once drew back her hand again and lay down peacefully,

rolling herself up. And then I at once gulped down a lot of the

porridge; and then, when I was full, I jumped up again.

_Wife._ And didn’t the god come up to you?

_Karion._ Not up to that time. After this I at once

covered myself up, being afraid; but he made a complete circuit

examining all the ailments in a most orderly fashion; and then a

slave set by him a little mortar and box of stone.

_Wife._ Of stone?

_Karion._ No, by Zeus, certainly not,--at least, not the

box.

_Wife._ To the deuce with you, how did you see since you

say you were covered up?

_Karion._ Through my old cloak; for, by Zeus, it had holes

not a few. First of all, he took in hand to pound a plaster

for Neokleides, and he threw in three cloves of Tenian garlic.

Then he bruised them in the mortar, mixing therewith the acid

juice of the fig-tree and squill; then, having diluted it with

Sphettian vinegar, he turned his eyelids inside out that he

might feel more pain, and then applied the mixture. But he,

squalling and bawling, jumped up and was running away, when the

god said with a laugh:--“Sit down there now, smeared with thy

plaster, that I may stop thee from going to the Assembly, having

for once a real excuse.”

_Wife._ What a patriot and sage the god is!

_Karion._ After that he sat down by the side of Ploutos,

and first he touched his head, and then, taking a clean towel,

he wiped his eyelids all round, and Panakeia covered his head

and all his face with a cloth of purple dye; and the god then

whistled. Thereupon two snakes of monstrous size darted forth

from the temple.

_Wife._ Dear Gods!

_Karion._ And these two (snakes) having quietly glided

under the crimson cloth, licked his eyelids all around,

methought. And before you could drink ten cups of wine, my

mistress, Ploutos stood up and was able to see: and I clapped

my hands with delight and awoke my master. And the god suddenly

took himself off from our view with the snakes into the temple.

If one examines carefully the facts connected with the Aesculapian

temple treatment, so far as they are known to us, one cannot fail

to be impressed with their strong resemblance to what has been the

experience of similar semi-religious movements in more recent times,

not only in European countries but also in the United States. In all

of them there may be found a kernel of true religious belief, and no

candid observer can deny the fact that many persons have been benefited

thereby both in body and in mind. But, sooner or later, the method

has fallen into disrepute, either because it was employed in the vain

hope that it might accomplish a cure which surgical means alone could

effect, or else because unscrupulous persons, taking advantage of the

credulousness of those associated with the movement, utilized it for

their own selfish advantage.

CHAPTER V

THE SIGNIFICANCE OF THE SERPENT IN THE STATUES AND VOTIVE

OFFERINGS EXPOSED TO VIEW IN THE AESCULAPIAN TEMPLES