Almost every important gallery of sculpture in Europe possesses at

least one marble statue of Aesculapius, and in the majority of these

the god is represented as a middle-aged or elderly man of powerful

frame, having a full head of hair and full beard, and clothed only

with the pallium or mantle, which is so placed as to leave the right

shoulder and a large part of the chest uncovered. He holds in his

right hand a knotted staff around which, in many of the statues, is

coiled a serpent whose head approaches very closely to the hand. The

expression of the god’s countenance is strikingly peaceful and serene,

yet without any evidence of weakness. In not a few instances other

animals are represented alongside the statue, usually at the god’s

feet--as, for example, the cock, the owl, the eagle, the hawk or the

ram--and occasionally his daughter Hygieia is shown at his side feeding

the serpent. The cock is the symbol of watchfulness--a physician should

be vigilant; the owl symbolizes his need of clear-sightedness and of

readiness to care for his patients in the night as well as during the

day; the eagle has a penetrating eye and it is the emblem of long

life--a benefit which the healing art is capable of procuring; the hawk

was the bird consecrated to Isis, Queen of Egypt, who was believed by

the Egyptians to have been highly skilled in medicine; and the ram

is the symbol of dreams and divination. Pliny says that the patients

who were brought to the temple of Aesculapius were made to lie down

at night wrapped in the skin of a ram, in order that they might

have divine dreams. The presence of the serpent in nearly all of the

statues of Aesculapius is explained in a variety of ways. Some say

that this reptile, which sheds his skin once a year, is emblematic of

the sick person’s need to acquire a new body, or at least cast off

his old skin in the same manner as does the snake. Others consider

the serpent as merely the symbol of wisdom, as it is admittedly the

shrewdest and most cunning of all animals. In a few instances it is

represented as drinking from a receptacle held in the hand of Hygieia.

Perhaps the sculptor’s intention here was to show that the serpent,

although the wisest of all animals, believed that he might add to

his stock of wisdom by drinking from the fountain under the control

of Aesculapius, thus conveying the impression that the wisdom of the

latter was greater than his own. But all these interpretations are too

subtle for the uneducated mind to appreciate at a glance. They fail

also to satisfy our preconceived ideas of what such a statue should

be--viz., a memorial of the godlike character of Aesculapius and of

the priceless benefits which he conferred upon his fellow men, and,

at the same time, an object which, when first contemplated by one

who is ill, would at once evoke in that person feelings of perfect

confidence in the ability and the willingness of the god represented

by the statue to effect a cure. Some, perhaps even a majority, of the

statues thus far recovered from the ruins of the different Aesculapian

temples certainly fail to arouse any such sentiments in the minds of

ordinary observers; but there are others which do in some measure

accomplish this, and among the number the statue which may be seen in

the Berlin Museum and of which a photographic copy (Fig. 4) is here

reproduced, should certainly be included. The head of the god is less

imposing and the expression less kindly than are these features in

some of the other statues (see, for example, Fig. 5), but, to offset

this, the serpent represented in the latter is of the non-poisonous

variety.[20] The addition of such a harmless creature to the figure

representing the god contributes nothing to the power of the statue

as a whole to impress the people--_i.e._, the uneducated masses,

as, for example, the peasants, etc. On the other hand, the significance

of the poisonous snake in a statue of this character will be readily

appreciated if one considers the fact that in ancient times, as it is

even to-day in India, the loss of life caused by the bites of poisonous

snakes was enormous. In the presence of such a fact, therefore, it

would be difficult for a sculptor who was desirous of emphasizing

the extraordinary healing powers of his hero to accomplish this

more effectively than by embodying in his statue, along with other

impressive features, such characters as would show him to have gained

the mastery over that terribly fatal malady--the bite of the viper

and of the still more deadly serpents of India and parts of Africa.

Although we possess no facts which would warrant the statement that

Aesculapius had been particularly successful in the treatment of this

form of poisoning, these temple statues furnish indirect proof of a

strong character that his healing power in this direction had been

very great,--so great, indeed, as to have been largely instrumental

in winning for him the appellation of a god. Such a striking object,

especially when its more important features were commented upon by

the priest who accompanied the patient on his or her first tour of

inspection of temple wonders, could scarcely have failed to produce a

very deep impression upon the imagination.

[Illustration: FIG. 4. ANCIENT STATUE OF THE GOD AESCULAPIUS IN THE

BERLIN MUSEUM.

(From Holländer’s _Plastik und Medizin_, with the author’s

permission.)]

[Illustration: FIG. 5.

HEAD OF THE MARBLE STATUE OF THE GOD AESCULAPIUS IN THE NAPLES

MUSEUM.]

In the illustration which has here been reproduced (Fig. 4), a viper,

as clearly shown by the shape of his head and neck and by the unusual

length of the jaw, has twined himself about the staff and is close

to the god’s hand, so close that in an instant’s time the fatal bite

might readily be inflicted. But Aesculapius shows by his countenance,

by the unconcerned manner in which he allows his right hand to remain

near the serpent’s head, and by the easy pose of his whole body, that

he is not at all concerned about the danger which appears to threaten

his life. In the estimation of the ancient Greeks this fearlessness was

undoubtedly attributed to the supernatural power which they believed

Aesculapius to possess over dangerous serpents as well as over diseases

of all kinds.

So far as now appears, all the statues of the god that have been dug

up in Greece or its nearest colonies represent the serpent as of

the size commonly observed in that part of the world. Hollaender,

however, furnishes (on page 118 of his work) an illustration which

represents--as he believes--the god Aesculapius in the presence of

an enormous snake, evidently a python. (Fig. 6.) As this variety of

serpent is not to be found in Greece, or indeed at any point further

north than the Mediterranean coast of Africa, it is fair to assume

that the bas-relief which depicts this scene must have been made for

exhibition in an Asclepieion located at Cyrene or at the relatively

near city of Alexandria, where patients, who were more or less familiar

with this serpent and realized its power of crushing people to death,

would have occasion to witness this suggestive work of art. And,

furthermore, as if it were for the express purpose of emphasizing the

great protective power of the god, the sculptor has introduced, on one

side of the scene, the figures of three women, two young children and

a lamb. The women nearest to the monster have folded their arms and do

not manifest the least sign of fear. The children also appear to be

unaware of the presence of a deadly danger. In short, the proximity of

the god Aesculapius has instilled into the minds of these human beings

the most complete sense of fearlessness; he himself, as in the case

of the statue of Aesculapius shown in Fig. 4, exhibiting a complete

absence of fear in the presence of the dangerous monster. Neither death

by poisoning nor death by constriction has any terrors for him to whom

the patient is about to appeal for relief from disease.

That pythons were a terror in former times to the people who inhabited

the coast regions near Cyrene is evident from a statement which

Aristotle makes in his History of Animals (Book VIII., Chapter

xxviii.). It reads as follows:--

In Libya (Africa) the serpents, as has been already remarked,

are very large. For some persons say that, as they sailed along

the coast, they saw the bones of many oxen, and that it was

evident to them that they had been devoured by the serpents.

And, as the ships passed on, the serpents attacked the triremes,

and some of them threw themselves upon one of the triremes and

overturned it.

CHAPTER VI

THE BEGINNINGS OF A RATIONAL SYSTEM OF MEDICINE IN GREECE

With the lapse of time the religious and mystical features of the

treatment carried on at the Asclepieia gave place, more and more,

to rational methods, and eventually--it is scarcely possible to

mention a date, but probably not many years before the Hippocratic

period--these institutions became centres for the spread of medical

knowledge of the most practical kind. This is particularly true of the

Asclepieion at Cos, where Hippocrates is believed to have received

his medical training. It is interesting to note that the mystical

features of the temple treatment--features which certainly did not

originate with Aesculapius himself or with his sons, Machaon and

Podalirius--eventually proved powerless to stay the slow but sure

advance of sound medical knowledge. Even during the period when these

false elements seemed to be most strongly rooted in the temple methods,

there were forces at work which in due time deprived them of much of

their pernicious power. This result was inevitable, for an organization

which, in order to prosper in its work of doing good to humanity,

depended upon the natural superstitiousness of the people, could not

possibly thrive for an indefinite length of time. That the evil results

did not develop sooner than they did simply shows how powerful and

stubborn is the force of superstition. In the absence of trustworthy

historical evidence, hypothetical statements only can be brought

forward, but there can scarcely be any doubt but that a genuine belief

in the power of Aesculapius (deified) to cure disease and restore

health persisted for centuries.

The custom of recording the case histories on tablets or on the

columns of the temple,--for at this period writing was in general

use,--and also that of dedicating to the god images which represented

(sometimes with a remarkable degree of truthfulness) the pathological

condition for which the patient sought relief, contributed very greatly

to the substitution of sound learning for religious mysticism and

poorly concealed humbuggery.

Among the interesting objects which may be seen at the Museum of the

History of Medicine in Jena, Germany, there are several of these

terra-cotta images (votive offerings) representing pathological

conditions; and among them the writer noticed more particularly one

which reproduced faithfully, though in diminutive size, the appearances

presented by cancer of the female breast. (Fig. 7.) There were also a

very carefully modeled statuette of the trunk of a woman affected with

ascites, and an admirable representation of a case of facial paralysis.

(Fig. 8.) These objects were obtained by Professor Meyer-Steineg on the

occasion of a recent visit to the ruins of the temple of Cos and other

similar ruins in Greece and Asia Minor. The British Museum possesses

many objects of the same character.

[Illustration: FIG. 6. BAS-RELIEF OF AESCULAPIUS, ACCOMPANIED BY

WOMEN AND CHILDREN, IN THE PRESENCE OF AN ENORMOUS SERPENT.

The original is in the National Museum at Athens.]

[Illustration: FIG. 7. FEMALE BUST SHOWING CANCER OF ONE BREAST.

(Courtesy of Prof. Dr. Meyer-Steineg, of Jena, Germany.)]

It is not known at what precise date the _iatreia_, or small

private hospitals, first made their appearance, but it was about the

time when the religious character of the therapeutic work done in

the Asclepieia gave place to treatment of a more distinctly medical

character. Then, in addition to these _iatreia_, there were

schools for gladiators and institutions in which gymnastic exercises

were zealously cultivated; and in these places there was a frequent

demand for advice in regard to questions of diet, and for surgical

aid in the setting of broken bones, the reducing of dislocations,

and the curing of bruises and sprains. As may readily be understood,

the Asclepieia could not furnish the sort of professional aid which

these institutions needed, and thus a further stimulus was given to

the complete separation of the two kinds of medical practice--that

connected with the temple and that conducted by outside physicians.

In Plato’s “Republic” (Book III., Chapter 15) mention is made of a

certain Herodicus (of Selymbria; about 450 B. C.) who effected many

cures by a method of treatment which combined athletic exercises

with dieting. He gained considerable celebrity in this way, and is

undoubtedly entitled to the credit of having been the first to call

serious attention to the value of this plan of treating certain

maladies. But, unfortunately, he made use of it in not a few instances

where it proved harmful rather than beneficial to the patient, and thus

brought discredit upon the method.

Already previous to the time at which the changes mentioned above

took place, there had occurred still other changes in the character

and practice of medicine. The business of cutting for stone in the

bladder, for example, had been left entirely in the hands of men who

made a specialty of this branch of medicine--men who might truthfully

be called medical artisans. Then there was another class of men who

devoted their energies to collecting medicinal roots and plants.

They were a necessity to physicians, and constituted the first

representatives of the modern apothecary. Still another change in the

status of the Greek physicians had been slowly developing throughout

this pre-Hippocratic period, a change which tended more and more to

make them men of self-reliance and of considerable importance in their

respective communities, and which indicated very clearly that they were

steadily growing in skill and breadth of knowledge. As evidence of the

correctness of this statement it is sufficient to mention the fact that

Greek physicians had established so good a reputation that they were

frequently called to see important cases at a great distance--in Egypt,

in Persia, etc. But before further consideration is given to this

subject of the development of the Greek physician during the period

immediately preceding the appearance of the Hippocratic writings,

it seems advisable to say a few words concerning the facilities for

medical instruction which were available at that time.

_Medical Instruction in Connection with the Asclepieia._--

It does not appear clearly in any of the published descriptions

of these ancient Greek sanatoria just what were the relations

between the priests and the men who utilized all this rich clinical

material--records of all sorts of diseases, and the means (other

than religious) employed in treating them, pictures or plastic

reproductions of the visible pathological lesions, etc.--for the

purpose of instructing the younger men who contemplated engaging in the

practice of medicine. The modern teachers of the art know very well how

difficult is the task of combining in a satisfactory manner these two

things--the safeguarding of the patient’s interests and the utilization

of their maladies as object lessons for men who are preparing to cure

or relieve the bodily ills of those who may at some future moment need

their professional services. To them, therefore, it would be a matter

of very great interest to learn how this difficult problem had been

solved nearly twenty-five hundred years ago. But, unfortunately, no

satisfactory data upon which a trustworthy account might be founded

are obtainable, and we are obliged to fall back upon such aid as our

imagination may furnish. From Puschmann’s work on medical teaching in

ancient times the following statement relating to the subject has been

taken:--

The priests in the Aesculapian temples were not, as is generally

assumed, physicians in the ordinary sense. They may have

acquired some knowledge of the art, and they may even in some

instances have been regularly trained physicians, but the

important fact remains that they wished it to be understood that

the treatment carried out in the temple was in accordance with

revelations made to them by the god Aesculapius, and not the

mere fruit of human knowledge. Consequently the intervention

of regular physicians in the temple management of the sick

must have appeared to them quite superfluous. For this reason,

therefore, it is not likely that there existed, on the part of

either the temple priests or the physicians, any feeling of

animosity or opposition. It is more likely that the contrary

was the case, for the evidence shows that the physicians--the

Asclepiadae--paid most humble reverence to the sacred relics

of Aesculapius, and placed the most implicit confidence in the

opinions which he was supposed to give in desperate cases.

[Illustration: FIG. 8. PARALYSIS OF THE LEFT FACIAL NERVE.

(Courtesy of Prof. Dr. Meyer-Steineg, _Jenaer

medizinisch-historische Beiträge_, Heft 2, 1912.)]

While Puschmann does not say to what period in the history of these

temples his statement applies, it is safe to assume that he had in

mind only the earlier stages. When the systematic teachings of medical

pupils began, those physicians who gave the instruction--viz., the

Asclepiadae who were not at the same time priests--took up their abode

somewhere in the neighborhood of the temple. Thus, medical schools were

formed at different places, those of Rhodes, Crotone, Cyrene, Cos and

Cnidus attaining the greatest celebrity. The pupil paid a fee for his

instruction, and when his training was believed to be completed he was

admitted into the association or brotherhood of the Asclepiadae upon

taking the following oath, which for ages past has been known as “The

Hippocratic Oath,” but which is now believed to have been formulated

long before the time of Hippocrates:--

THE HIPPOCRATIC OATH

I swear by Apollo the Physician and Aesculapius, and Hygieia and

Panacea and all the gods and all the goddesses--and I make them

my judges--that this mine oath and this my written engagement I

will fulfil as far as power and discernment shall be mine.

Him who taught me this art I will esteem even as I do my

parents; he shall partake of my livelihood, and, if in want,

shall share my goods. I will regard his issue as my brothers and

will teach them this art without fee or written engagement if

they shall wish to learn it.

I will give instruction by precept, by discourse, and in all

other ways, to my own sons, to those of him who taught me, to

disciples bound by written engagements and sworn according to

medical law, and to no other person.

So far as power and discernment shall be mine, I will carry out

regimen for the benefit of the sick and will keep them from harm

and wrong. To none will I give a deadly drug even if solicited,

nor offer counsel to such an end; likewise to no woman will I

give a destructive suppository; but guiltless and hallowed will

I keep my life and mine art. I will cut no one whatever for the

stone, but will give way to those who work at this practice.

Into whatsoever houses I shall enter I will go for the benefit

of the sick, holding aloof from all voluntary wrong and

corruption, including venereal acts upon the bodies of females

and males whether free or slaves. Whatsoever in my practice or

not in my practice I shall see or hear amid the lives of men

which ought not to be noised abroad--as to this I will keep

silence, holding such things unfitting to be spoken.

And now if I shall fulfil this oath and break it not, may the

fruits of life and of art be mine, may I be honored of all men

for all time; the opposite if I shall transgress and be forsworn.

(Translated from the Greek by the late John G. Curtis, M.D., of

New York.)

While at first, according to Puschmann, many physicians did not belong

to the Aesculapian Brotherhood, there came a time when all were known

as Asclepiadae.

_Influence of the Schools of Philosophy on the Growth of Medical

Knowledge._--About the beginning of the sixth century B. C. there

developed, in Greece and its colonies, schools of philosophy which

exerted a most excellent influence upon the growth of medicine. The

first of these was the one known as the Ionian School, whose founders

and chief representatives were Thales, of Miletus in Ionia (born in

640, died in 548 B. C.), and his pupils Anaximander and Anaximenes.

The guiding principle of these men was to study natural phenomena and

to learn, if possible, their causes and the laws of their action.

Physiology, therefore, became one of their special studies, and

thus they contributed to the laying of one of the most important

foundation-stones of medicine. Thanks to the good quality of the work

of instruction that had thus far been carried on at Cos, Cnidus, and

other Asclepieia, medicine had by this time reached a sufficient

degree of development for its devotees to derive a full measure of

benefit from the new teaching of the philosophers. Well grounded in the

observation of disease in its different forms and modes of behavior,

and also familiarized with the ordinary methods of treatment, these

physicians needed to be shown a new route along which they might

advance to greater heights of knowledge, and they also needed to be

stimulated to further endeavor. The introduction of the new school

accomplished both of these purposes. It taught the men of the older

organizations that they must make much greater use of their reasoning

powers than they had hitherto done, and at the same time, through

the creation of a group of rival physicians, it supplied them with

the required stimulus. Another important school of philosophy was

that known as the Eleatic School, which flourished at Elea, in Lower

Italy, its leaders being natives of that city. The most prominent men

connected with this school were Parmenides (born about 540 B. C.) and

Xenophanes of Colophon, in Asia Minor, whose contributions to mental

science formed the basis of Plato’s metaphysics.

The period roughly embraced between the years 500 and 300 B.

C. represents the most brilliant age of Greek intellectual and

artistic activity. During this time there came into prominence such

philosophers, historians, poets, physicians, artists and generals of

armies as had never before been marshaled in historic array in so

rapid succession. Even at this late day the names of these great men

are almost household words--such names, for example, as Pythagoras,

Alcmaeon, Anaxagoras, Aristotle, Plato, Socrates, Sophocles,

Aeschylus, Euripides, Aristophanes, Pindar, Xenophon, Demosthenes,

Democedes, Hippocrates the Great, Phidias, Praxiteles, Zeuxis,

Apelles, Darius I., Alexander the Great, and many others of almost

equal celebrity. During the centuries immediately preceding this

golden age of Greek history, there seem to have been very few men of

great merit in any of the branches of learning or in the fields of

war or art, but this impression is certainly false. It is doubtless

to be explained by the fact that large quantities of documentary

evidence relating to these years have been entirely lost. Daniel Le

Clerc, for instance, states[21] that, of the separate histories of

the descendants of Aesculapius which were written by Eratosthenes,

Pherecydes, Apollodorus, Arius of Tarsus and Polyanthus of Cyrene,

not one has come down to our time. If, then, in the single department

of medicine, the destruction of documentary evidence was as great as

is here represented, how enormous must have been the loss of precious

historical materials in all the departments of human activity taken

together. We may, therefore, safely assume that this golden age, which

lasted only about two hundred years, represents simply the culmination

of an even longer period of slow but steady development, a period of

creditable though perhaps less brilliant achievements.

Of the names mentioned above there are several that belong to men who

were in various ways connected with the early history of medicine.

Pythagoras, for example, is said to have been one of the first among

the Greek philosophers to exert a strong and double impression upon

the medical teaching of that period. He was born in the Island of

Samos, near the coast of Asia Minor, about the year 575 B. C. After

spending several years in Egypt for purposes of study, and probably

visiting Babylon, at that time a great centre of learning and of

artistic cultivation, he established at Crotona, in the south of Italy,

a school[22] where natural philosophy, mathematics, acoustics, etc.,

were taught. He also devoted some attention to anatomy, to embryology,

to physiology and to therapeutics. According to his views of what

constituted hygienic living a man should accustom himself to a diet

of the simplest character, without meat. Pythagoras was a believer in

the Chaldean doctrine that the uneven numbers possess a more important

significance than the even, and that the number seven in particular

has a special relationship to the phenomena of certain diseases; the

crisis frequently falling on the seventh, fourteenth, or twenty-first

day. Galen, it is said, expressed surprise that a man as sensible and

learned as Pythagoras should have paid any attention to such trifles.

Not a few of the disciples of Pythagoras were physicians, and when

the brotherhood (if such it may be called) broke up, as it did in the

fifth century B. C., these men traveled about from one Grecian city to

another; from which fact they were given the name of “periodeuts” or

ambulant physicians. Crotona was also celebrated as the birthplace of

Milo, the athlete.

Democedes, who was a contemporary of Pythagoras, but not one of his

disciples, was a native of Crotona. Dion Cassius, the author of a Roman

history, ranks him and Hippocrates as the two most eminent physicians

of antiquity. Daremberg, who derived his facts from the works of

Herodotus, gives the following account of the adventures of Democedes:--

Being unable to bear any longer the frequent anger and harsh

treatment of his father, Calliphon, Democedes left Crotona,

and settled in practice at Aegina, on the Saronic Gulf, not

far from Athens. Almost from the very start he attained marked

success, and already in the second year of his residence in

Aegina he was made the recipient of a pension of one talent

(equal to about £240, or $1200,) out of the public treasury.

During the following year he was induced, by the offer of a

larger pension (100 minae, or about $3000,) to settle in Athens;

and, a year later, he accepted a still larger remuneration from

Polycrates, the tyrant of Samos. Having accompanied the latter

on a trip to Sardis, the capital of Lydia, in Asia Minor, he

fell a prisoner into the hands of the governor of that city,

and was made by him a slave. Not long afterward Darius gained

possession of this governor’s or satrap’s property, including

all his slaves; and thus, despite all his efforts to conceal

his profession through fear that a knowledge of it on the part

of the king might prolong his bondage indefinitely, Democedes

was unable to do so. The discovery came about in the following

manner. During a hunting trip Darius broke his ankle. He called

to his assistance the court physicians, who were esteemed the

most skilful that could be found in all Egypt, but they failed

to give him relief. By the violence of their manipulations

they rather made matters worse. For seven days and nights his

sufferings were so great that he was unable to obtain any sleep.

Finally, on the eighth day, one of the court attendants having

told Darius that there was a Greek physician among the slaves,

Democedes was sent for, and he appeared before the king clad in

rags and with chains on his ankles. When asked whether he knew

anything about medicine he denied such knowledge, being fearful

that the discovery of the truth about himself would stand in

the way of his ever getting back to Greece. Darius, perceiving

that he was dissimulating, ordered the attendants to fetch the

whips and pinchers. Whereupon Democedes made up his mind that

he had better confess the truth. He accordingly told the king

that, while not possessing a thorough knowledge of the healing

art, long association with a physician had familiarized him

more or less with the subject. The king then asked him to take

charge of the case. Democedes, following the treatment adopted

by the Greek physicians in similar conditions, applied soothing

remedies and soon succeeded in procuring sleep for the suffering

king. Eventually he obtained a complete cure, and Darius, who

had made up his mind that he would never again be able to use

his limb, was naturally delighted with the result. He loaded

Democedes with gifts, and, being charmed with his conversation,

made him sit at the royal table and did everything possible to

render court life attractive; but liberty was denied him, which

was the one thing that Democedes most ardently desired. The only

use which the latter made of the great influence which he had

obtained over Darius was to save the Egyptian physicians from

the death by crucifixion which the king had decided to inflict

upon them for their lack of skill.

The means of escape finally presented themselves to Democedes

in a most unexpected manner. Atossa, who was the wife of Darius

and also the daughter of Cyrus, was afflicted with a swelling of

the breast which developed into an abscess and began to burrow

into the neighboring tissues. After, for a time, concealing

the trouble through a sense of false modesty, she made up her

mind to consult Democedes. He had the good fortune to cure her

of this malady in a relatively short time. As preparations

were then being made to send a number of spies to Greece with

instructions to examine the coast carefully for the purpose

of determining at what points the defenses were sufficiently

weak to render an attack by the Persians reasonably sure of

success, Democedes asked permission of Darius to accompany these

men as their guide. His request was granted; and, as soon as

the expedition reached Tarentum in Calabria, he delivered the

Persian spies into the hands of Aristophilides, the king of that

country, and then fled in all haste to Crotona, his native city.

Shortly afterward these Persians, having been set at liberty by

Aristophilides, made the attempt to capture Democedes and carry

him off by main force, but the citizens of Crotona thwarted

the attempt and compelled the men to return to Asia. Democedes

then married the daughter of Milo, the athlete, and history

furnishes no information regarding the subsequent career of this

extraordinary man.

Daremberg calls attention to certain excellent proverbs which may be

found in the writings of the Greek poets and which are of some interest

to physicians. The following may serve as examples of those most widely

known:--[23]

Joy is the best physician for fatigue.

(Pindar, 522–442 B. C.)

The good physician is he who knows how to employ the right

remedies at the proper time; the poor one, he who, in the

presence of a serious illness, loses his courage, becomes

flustered, and is unable to devise any helpful method of

treatment.

(Aeschylus, 525–456 B. C.)

Physician, heal thyself.

(Euripides, 400–406 B. C.)

Advice given to Phaedra by her nurse:--

If thou hast some ailment which thou dost not care to reveal to

men, here are women who are competent to treat the condition

properly.

(Euripides.)

Sleep is the physician of pain,

and

Death is the supreme healer of maladies.

(Sophocles, 495–406 B. C.)

In Plato’s writings there are to be found a few passages in which this

philosopher gives his views in regard to certain matters that are not

without interest to modern physicians. The following extracts are of

this nature:--

There is not then, my friend, any office among the whole

inhabitants of the city peculiar to the woman, considered as a

woman, nor to the man, considered as a man; but the geniuses

are indiscriminately diffused through both: the woman is

naturally fitted for sharing in all offices, and so is the man;

but in all the woman is weaker than the man.

Perfectly so.

Shall we then commit everything to the care of the men, and

nothing to the care of the women?

How shall we do so?

It is therefore, I imagine, as we say, that one woman, too, is

fitted by natural genius for being a physician, and another is

not; one is naturally a musician, and another is not.

(From “The Republic” of Plato, translated by Spens.)

But tell me with reference to him who, accurately speaking, is

a physician, whom you now mentioned, whether he is a gainer of

money or one who taketh care of the sick? and speak of him who

is really a physician.

One who taketh care, said he, of the sick.

* * * * *

Why then, said I, no physician as far as he is a physician,

considers what is advantageous for the physician, nor enjoins

it, but what is advantageous for the sick; for it hath been

agreed that the accurate physician is one who taketh care of

sick bodies, and not an amasser of wealth. Hath it not been

agreed?

He assented.

(Plato, 428–547 B. C., translated by Spens.)

But Plato’s knowledge of human anatomy and physiology was very crude

and in some instances decidedly fanciful. In corroboration of this

statement the following extract from the “Timaeus” may be quoted:--

And on this account, fearing to defile the Divine nature more

than was absolutely necessary, they [the junior gods] lodged

man’s mortal portion separately from the Divine, in a different

receptacle of the body; forming the head and breast and placing

the neck between, as an isthmus and limit to separate the two

extremes.

In the breast, indeed, and what is called the thorax, they

seated the mortal part of the soul. And as one part of it was

naturally better, and another worse, they formed the cavity of

the thorax into two divisions (resembling the separate dwellings

of our men and women), placing the midriff as a partition

between them. That part of the soul, therefore, which partakes

of fortitude and spirit and loves contention they seated

nearer the head between the midriff and the neck; as it is the

business of the reason to unite with it in forcibly repressing

the desires, whenever they will not obey the mandate and word

issuing from the citadel above.

The heart, which is the head and principle of the veins as well

as the fountain of the blood that impetuously circulates through

all the members, they placed in a kind of sentry-house, that, in

case of any outburst of anger, being informed by the reason of

any evil committed in its members, owing either to some foreign

cause, or else internal passions, it (the heart) might transmit

through all its channels the threatenings and exhortations of

reason, so as once more to reduce the body to perfect obedience,

and so permit what is the best within us to maintain supreme

command.

But as the gods foreknew, with respect to the palpitation of

the heart under the dread of danger and the excitement of

passion, that all such swellings of the inflamed spirit would

be produced by fire, they formed the lungs to be a sort of

protection thereto; first of all, soft and bloodless, and next

internally provided with cavities perforated like a sponge, in

order to cool the breath which they receive, and give the heart

easy respiration and repose in its excessive heat. On this

account, then, they led the channels of the windpipe into the

lungs, which they placed like a soft cushion round the heart, in

order that when anger rises in it to an extreme height it might

fall on some yielding substance, and, so getting cool, yield

cheerfully and with less trouble to the authority of reason.

(Plato’s “Timaeus,” translated by Henry Davis.)

Alcmaeon, Empedocles, Diogenes of Apollonia, Anaxagoras and Pausanias,

whose names are mentioned above in the list of eminent men who

flourished during the golden age of Greek history, are entitled to

further consideration. Alcmaeon of Crotona was a contemporary and

disciple of Pythagoras. He was specially devoted to the study of

anatomy and physiology, and is credited with the distinction of

having been the first person to dissect animals for the purpose of

learning the formation of the different parts of their bodies. With the

exception of a few fragments that are to be found scattered throughout

ancient medical literature, Alcmaeon’s writings have all been lost.

The discovery of the optic nerve is credited to him, and Neuburger

states that he deserves still greater credit for having been the first

to declare that the brain is the central organ of all intellectual

activity.

Of all the disciples of Pythagoras, Empedocles attained the greatest

celebrity. He flourished about 444 B. C., his residence being at

Agrigentum, in Sicily. Much of his reputation appears to have been

due to the mystery which surrounded many of his actions. He was even

reputed to have brought again to life persons who were believed to be

dead. His works were all in verse, but only fragments have come down

to us. He placed the seat of hearing in the labyrinth of the temporal

bone. His death occurred in Peloponnesus at the age of sixty, as the

result of an accident.

Anaxagoras was born at Clazomenae, in Ionia, 500 B. C. He was the

teacher of Euripides, the Athenian poet, and Pericles, the greatest of

Athenian statesmen. He and his contemporary, Diogenes of Apollonia, in

Crete, devoted a great deal of attention to the study of anatomy. They

dissected animals and made some genuine discoveries; Anaxagoras noting

the existence of the lateral ventricles of the brain, and Diogenes

furnishing a description--very erroneous, it is true--of the vascular

system of the body. Puschmann says that, according to Aristotle,

the philosophers of that period considered the study of man and his

diseases the most important one to which they could devote their time

and thoughts. Many of them indeed had been educated as physicians, and

not a few were actual practitioners of medicine.

CHAPTER VII

HIPPOCRATES THE GREAT

Hippocrates was born in 460 B. C. in the city of Cos, on the island of

the same name. Both his father and grandfather were eminent physicians,

descendants of Aesculapius. On his mother’s side he traced his descent

from Hercules. The famous painter, Apelles, also hailed from the city

of Cos. To distinguish Hippocrates from an earlier individual of the

same name he was called Hippocrates II., or the Great. He is said to

have received his first instruction in medicine at the school of the

Asclepiadae in his native city, but his frequently repeated and very

favorable comments on the teachings of the Cnidian school[24] have

led some to believe that he may have received a part of his medical

training at the latter institution. At a later period of his life his

popularity as a teacher of medicine, in the school of the Asclepiadae

at Cos, attracted many pupils to that city. In accordance with a custom

which prevailed among the physicians of ancient Greece, Hippocrates,

at the beginning of his career, spent quite a long time in Athens, and

then traveled about, from one city to another, in the character of a

periodeutic or itinerant physician. In this way, as he himself reports

in some of his writings, he visited Thessaly, Thrace, the Island of

Thasos, Scythia, the countries bordering on the Black Sea, and even

Northern Egypt. Owing largely to domestic troubles he left his home in

Cos, during the latter part of his career, and removed to Thessaly.

He died about 370 B. C. at Larissa, at an advanced age. Soranus of

Ephesus, the celebrated obstetrician, reported that in his time (second

century A. D.) the tomb of Hippocrates was still standing, and that

it had been taken possession of by a swarm of bees whose honey was

far-famed for its efficacy in curing ulcers of the mouth in children.

Among the pupils of Hippocrates were his two sons, Draco and Thessalus,

and his son-in-law, Polybus. Thessalus, in the capacity of a military

surgeon, accompanied Alcibiades on his expedition to Sicily, and

later in his career he served as private physician to Archelaus, King

of Macedonia. It is also believed that a number of the writings in

the Hippocratic collection are from his pen. On the other hand, it

is a well-established fact that Polybus is the author of a few of

these treatises. When Hippocrates gave up the work of teaching, his

son-in-law, who was at that time engaged in private practice in Cos,

was chosen his successor in the school.

Among the many anecdotes which are related of Hippocrates, there is one

which may with propriety be repeated here:--

On the occasion of a visit to Abdera, in the northern part of

Thrace, Hippocrates was requested to examine into the mental

condition of the philosopher Democritus, who was thought by

his narrow-minded countrymen to be insane. Hippocrates found

him deeply engrossed in the study of natural philosophy and

asked him what he was doing. Democritus replied that he was

investigating the foolishness of men. Whereupon Hippocrates

reported that he considered Democritus the wisest of men.

(Pagel.)

No better evidence of the true greatness of a man can be furnished than

that which is afforded by the praise of his contemporaries in the same

rank or walk of life; and when the appreciation comes from such men as

Plato and Aristotle, it constitutes an absolute guarantee that it is

well and honestly earned. To Hippocrates belongs the singular honor

of having won unstinted praise from both of these great philosophers,

Aristotle giving him the title of “Hippocrates the Great,” and Plato

comparing him to those famous sculptors, Polyclytus and Phidias. His

writings and those of the members of his family who were associated

with him in the work of promoting a knowledge of medicine were most

carefully preserved by his successors. When the Ptolemies began to

establish libraries at Alexandria, Egypt (285 B. C.), and manifested

a decided readiness to purchase the works of the most celebrated

authors, copies of the Hippocratic writings were among those which

found their way to that city. This eagerness on the part of the Kings

of Egypt to purchase books or manuscripts stimulated unscrupulous

persons to attribute to celebrated authors not a few of these works

which they offered for sale. The librarians, whose duty it was to

guard against such frauds, were not sufficiently well informed to

prevent them; and thus there were accepted, as genuine productions,

a few books which could not possibly have been written by those to

whom they were attributed. The collection of Hippocratic writings

did not escape this fate, and the evil was also further aggravated

by the fact that copyists and incompetent editors made all sorts of

emendations and additions on their own responsibility. Thus, it is

not surprising that a collection which originally contained only the

writings of Hippocrates and his immediate family, should in course of

time have become expanded, not only by such alterations as have just

been described, but also by the addition of entire works that had

been written by others. At the beginning of the third century B. C.,

the Ptolemies appointed a committee of learned men in Alexandria to

examine carefully the treatises reputed to be the work of Hippocrates

and to make a collection of those which appeared to them to be

genuine. They performed this task to the best of their ability, but

the result showed that they lacked the necessary critical powers; and

consequently during the past 2000 years repeated attempts have been

made to do what they failed to accomplish, but these efforts have only

succeeded in part. The French edition prepared by Émile Littré, the

distinguished member of the French Academy of Medicine, and published

in the years 1839–1861, was, until quite recently, universally

accepted as embodying the best results of modern research and criticism

with regard to this difficult question. But since 1861 other scholars

have been busily engaged in perfecting the text of the Hippocratic

writings, and their criticisms and suggestions have made it possible to

publish a German version of this great work which is of more practical

value to physicians than that of Littré, which forms a series of ten

large volumes and is no longer easy to obtain. On the other hand, the

German version by Robert Fuchs (Munich, 1895–1900), in three volumes

of moderate size, while in no respect inferior to the famous French

translation, is superior to it in several particulars: it is better

adapted to the needs of the ordinary practitioner of medicine, it

embodies the results of the excellent critical work done since 1861

(e.g., by Ermerins of Utrecht, Daremberg of France, and Ilberg and

Kühlewein of Germany), and it costs very much less than its French

predecessor and rival.

As regards the question of authenticity of the treatises contained in

the work known as “The Hippocratic Writings” the most important thing

to be determined is, not whether this or that book or chapter in the

collection was really written by Hippocrates, but whether the work in

its totality gives a correct and fairly complete picture of the best

medical thought and practice of the period during which Hippocrates

lived; and to this question a decided answer in the affirmative may be

given. As to the broad question of authenticity, Max Neuburger, the

distinguished Viennese author of the latest and most authoritative

history of medicine, thus expresses himself:--

Notwithstanding the extremely small quantity of evidence which

the so-called “Hippocratic Writings” themselves furnish as to

who were the writers of the individual treatises and as to what

Hippocrates himself actually did or thought; and although it

is true that portions of the collection often contradict one

another both in regard to questions of theory and also in regard

to methods of treatment, one fact stands out conspicuously,

viz., that the peculiar character of these writings both as a

collection and taken separately, not only gives them a unique

position in medical literature, but reveals plainly that

they owe their origin directly or indirectly to the powerful

influence of a single commanding personality.

As to the manner of teaching medicine, the Hippocratic writings show

that, at the time which is here under consideration, the mystical

features had almost completely disappeared. The science was now taught

by regular instructors, who agreed for a stipulated fee to take charge

of the pupil’s entire training from the beginning to the end of the

course. Candidates who were in delicate health were discouraged from

entering upon the career of a physician, and those who had completed

the regular course of instruction were sent out into the world equipped

with certain general principles for their future guidance in actual

practice. Some of these bear a close resemblance to the principles of

a similar nature which had been established at a much earlier period

in India. For example, the importance of cleanliness of the person is

strongly emphasized. Reticence, as well as courtesy, is classed as one

of the virtues of a good physician.

He who acts hastily and does not take sufficient time for

consideration is sure to be criticised unfavorably. If he breaks

out too readily into laughter he will be thought uncultivated.

In another of the Hippocratic writings the physician is urged not to

indulge in too much small talk, but to confine his conversation as much

as possible to matters relating to the treatment of the disorder.

In his business dealings the physician, like a genuine

philosopher, should not display a greed for money, he should

assume a modest and dignified attitude, he should appear quiet

and calm, and his speech should be simple and straightforward

and free from all superstition.

For their knowledge of human anatomy the physicians of that period

were obliged to depend on the dissection of animals. Specimens of

human bones were of course easily accessible, and consequently the

descriptions which are given of these structures are quite accurate,

even as regards many of the finer details.

It would be a very difficult matter to furnish here, within a limited

space, a reasonably clear exposition of the views held by Hippocrates

with regard to human physiology and pathology. Empedocles, a Greek

physician and high priest of Agrigentum, in Sicily, who was born about

490 B. C., founded a system of philosophy on the theory that the

universe is made up of four elements--fire, air, earth and water; and

he maintained that fire is the essence of life, the other elements

forming the basis of matter. It was upon this system that Hippocrates

founded his own theories of life, death and disease, but he disagreed

with Empedocles in regard to the manner in which the four elements

are united, his own belief being that they form together a genuine

mixture, whereas Empedocles maintains that their union represents

merely a mechanical aggregation of separate atoms. He also held that

these original four elements, to which he gave the names of heat,

cold, dryness and moisture, were represented in the human body by the

following four cardinal fluids or “juices”: blood, mucus or phlegm,

black bile and yellow bile.[25] He maintained, further, that when these

elements are mingled harmoniously so as to produce a state of perfect

equilibrium, health resulted; but that when some deficiency of one or

more of them, or some lack of harmony between them in other respects,

occurs, disease is produced. At a later date, a fifth element--wind or

air (pneuma)--was added to the other four; and when Hippocrates was

unable to account satisfactorily for certain phenomena of disease, he

was wont to refer the phenomenon observed to divine interference.

This brief exposition of the physiological and pathological views

held by Hippocrates, incomplete and superficial as it is, will have

to suffice. Those who wish to acquire a more profound knowledge of

the subject should consult some of the larger treatises like those of

Daremberg, of Max Neuburger, and of Pagel, as well as the sections

devoted to these subjects in the French (Littré) and the German (Fuchs)

versions of the Hippocratic writings. At every step in such a study,

the modern physician will encounter ideas and individual terms which he

will have great difficulty in comprehending; and later on, as he reads

the sections which deal with the more practical matters of the medical

art, he will be astonished to find that Hippocrates was a most acute

and trustworthy observer of the phenomena of disease, a remarkably

clear writer, and a standard-bearer of very high aims.

In the examination and treatment of the sick the physicians of

ancient Greece were highly trained. They paid very close attention

to the patient’s account of his symptoms, but it was to the physical

examination of the diseased body that they attached the greatest

importance. They noted with extreme care the color and other

peculiarities of the skin and mucous membranes, the condition of the

abdomen, and the shape and movements of the thorax; they tested the

patient’s temperature by placing the hand upon the body; and all

the excretions were subjected to the closest scrutiny. By means of

palpation they were able to determine not only the size of the liver

and spleen, but also the changes which occur in the form of these

organs in the course of certain diseases. They utilized succussion

both as an aid to diagnosis and as a means of favoring the breaking

through of pus into the bronchial tubes. They were familiar with the

pleuritic friction sound and with the finest râles, which they compared

to the creaking of leather or “the noise of boiling vinegar.” In

their descriptions of these sounds it is distinctly stated that the

examiner’s ear was kept tightly pressed against the patient’s chest.

In speaking of the accounts of individual diseases which appear in the

Hippocratic writings, Puschmann says that they are evidently based

on cases actually observed in practice, and that they are admirably

written. It is in the laws which they have laid down with regard to

the treatment of disease, however, that the Hippocratic writers have

gained their chief distinction, a distinction which will belong to them

through all time.

The physician should be the handy man of Nature, and he should

strive to aid and to imitate her efforts to effect a cure.

His first care should be to remove, so far as is possible,

the causes of the disease; and then, in the conduct of the

treatment, he should keep in view at all times the special

circumstances of the case, giving closer attention to the

patient than to the disease itself. In short, he should aim at

being useful, or at least he should be careful not to do any

harm.

CHAPTER VIII

BRIEF EXTRACTS FROM SOME OF THE HIPPOCRATIC WRITINGS

The statements which have thus far been made in these pages with regard

to Hippocrates are only of a general character, and it may therefore

be interesting for the reader to have placed before him a few selected

extracts from the writings which have formed the basis of these

statements. The English text here used is a translation of the German

version of Robert Fuchs, to which reference has already been made.

It would have been a pleasure to use for this purpose the admirable

English translation of Frederick Adams, published in 1849 under the

auspices of the Sydenham Society of Great Britain; but, unfortunately,

this version contains only a part of the Hippocratic writings, and,

besides, this writer did not at that time have the advantage of

consulting the French and German versions which have been published

since 1849.

It seems almost unnecessary to state here, by way of preface, that the

small amount of space which may properly be devoted to these extracts

renders it necessary to present many of them in a very fragmentary

and disconnected form, merely enough text being furnished to give the

reader some slight idea both of the manner in which Hippocrates and

those associated with him handled certain medical topics, and also of

the views which they entertained with regard to the same subjects.

BRIEF EXTRACTS FROM SOME OF THE HIPPOCRATIC WRITINGS

_Aphorisms._--I.--1. Life is short, art is long, the right

moment lasts but an instant,[26] experience is often deceptive,

a correct judgment is hard to reach.

6. For the most serious ills extreme measures cautiously

employed are the best.

8. When an illness has reached its acme the lightest diet must

be prescribed.

11. During the exacerbations nourishment should be withheld, for

at these times the giving of food is harmful; and in illnesses

which are characterized by periodic paroxysms it is also best

not to give food during the paroxysms.

13. Old people bear fasting very well, and the same is almost

true of persons of mature age; but young individuals do not bear

abstinence from food so well, and this is particularly the case

with children, especially with those of a lively disposition.

24. In acute illnesses laxative remedies should rarely be

administered, and then only in the early stage of the malady and

with great caution.

II.--2. When sleep puts an end to delirium it is a good sign.

3. When either sleep or wakefulness oversteps the proper limit

it is harmful.

5. Causeless depression is an indication of some disorder.

19. In acute diseases the prognosis as regards either death or

recovery, is very uncertain.

44. Corpulent persons are more likely than those who are slender

to die a quick death.

V.--7. When epileptic attacks occur before the age of puberty,

a change for the better may be looked for; but if the disease

makes its first appearance when the individual has already

reached his twenty-fifth year, he may be expected to carry the

affliction with him to the time of his death.

9. Consumption most commonly attacks persons who are between the

ages of eighteen and thirty-five.

14. When a consumptive person has attacks of diarrhoea, a fatal

issue may be anticipated.

VII.--1. If in the course of an acute illness the extremities

grow cold, it is an unfavorable sign.

14. If, after a blow upon the head, stupefaction or delirium

manifests itself, the outlook is bad.

[The total number of the aphorisms is 422.]

_The Book of Prognoses._--1. I believe that it is best

for a physician to acquire a certain degree of practice in the

power to predict how the disease is likely to terminate; for if,

when he is in the presence of his patient, he is able to state,

not only what is going to take place in the future course of

the malady, but also certain other facts which relate to the

past behavior of the attack, but which were omitted from the

account given to him of the previous history of the case, he

will impress the patient with the belief that he is thoroughly

familiar with the disease from which the latter is suffering,

and that consequently he is a physician in whose knowledge and

skill he can place entire confidence. Then, besides, he will be

the gainer in another respect: his knowledge of what is likely

to be the subsequent course of any given disease will enable

him to treat it in the most effective manner. The ability to

restore all his patients to health would of course be a greater

power than that of correctly predicting the future behavior

of a malady in any particular case. This ability, however, is

clearly unattainable. One patient dies by reason of the severity

of the disease itself, even before the physician is called in;

a second one, shortly after the latter’s visit; and a third

lingers on for a day or two after the doctor’s arrival, dying

before the latter’s art has had time to produce a beneficial

effect in hindering the advance of the malady. The observation

of these different events should enable the physician to become

acquainted with the nature of the diseases observed, and--more

particularly--to learn to what extent, in individual instances,

they manifest a strength greater than the patient’s power of

resistance. At the same time, he must not forget that in many

cases divine interference plays a part in directing the course

of the disease. And thus, if he pays heed to all these things,

the physician will merit the confidence of his patients and will

gain the reputation of being a clever and skilful practitioner.

IV.--It is better when the physician, upon the occasion of his

first visit, finds the patient lying upon one side, with his

hands, neck and thighs slightly flexed, and the entire body

placed in a perfectly natural position, like that which a man

assumes in bed when he is in a state of health. It is not so

well when the physician finds the patient lying upon his back,

with his hands, neck and thighs extended. But if the latter

is found curled up and sliding down toward the foot of the

bed, this is an unfavorable sign. Finally, if he is found with

rather cold feet projecting from under the bedclothes, and with

his arms outstretched and his neck and thighs exposed, his

condition may be considered dangerous, for this attitude of the

body betokens an agitated state of the mind. If the patient

sleeps with his mouth constantly open, lying upon his back and

with his thighs strongly flexed and widely separated, it may be

assumed that death is near at hand. If he lies upon his belly

when it is known that he was not in the habit of sleeping in

this manner before he was taken ill, the inference is warranted

either that he is delirious or that he is suffering from pain in

the lower part of his abdomen. Finally, if the patient shows an

inclination to maintain a sitting posture while the malady is

still in an active stage, this feature must be looked upon as a

grave symptom and especially so in inflammation of the lungs.

XIV.--Pus that has a whitish color and a uniform consistency,

that is smooth and free from clumps, and the odor of which is

only slightly unpleasant, is the least harmful. On the other

hand, a pus which possesses the opposite characteristics is very

dangerous.

XL.--Severe pain in the ear, if associated with a persistent

fever is dangerous, for the patient may become delirious and die.

[There are 47 chapters in the Book of Prognoses; in addition, there

are 740 separate sections in the Coan Prognoses (_Praenotiones

Coacae_).]

_The Epidemic Diseases._--VI.--4. The wife of Agasis

had already as a young girl been troubled with shortness of

breath. After she had reached womanhood, and soon after she had

given birth to a child, she lifted a heavy weight. Immediately

she heard, as she believed, a noise in her chest, and on the

following day she experienced some difficulty in breathing and a

certain amount of pain in her right hip. These two symptoms were

so related to each other that, whenever the pain in the hip made

its appearance, she immediately became conscious that she was

short of breath, and, vice versa, whenever the pain ceased, she

found that her breathing became easier. Her expectoration was

of a foamy character and of a rather bright color, but, after

it had been allowed to stand for a short time, it looked like

diluted biliary matter that had been vomited. The pain in the

hip troubled her chiefly when she performed manual work. She was

advised to abstain from eating garlic, pork, mutton, and beef,

and not to call loudly or to get excited while she was engaged

in work.

VII.--7. The wife of Polycrates became feverish during the

summer season, and about the time of the dog star. In the

morning her breathing was somewhat embarrassed, but after

mid-day it became more difficult and at the same time more

rapid. From the very beginning of the illness she had a cough

and expectorated purulent masses. In the throat and along the

course of the trachea one could hear a hoarse whistling sound.

The patient’s face had a healthy color, and over the two halves

of the jaw there was some redness, not of a deep hue but rather

fresh and bright. A little later her voice also became hoarse,

she began to show some emaciation, raw spots developed over

the fleshy parts of her hips, and the surface of the body grew

more moist than it had been before. On the seventieth day the

outward evidences of fever became much less noticeable, but the

respiration grew more rapid; and from that day to the time of

her death, five or six days later, she was obliged to remain in

a sitting posture. Toward the end the tracheal râle grew louder,

and dangerous sweats occurred, but the patient never lost her

expression of intelligence.

_Fractures._--II.--9. In the human body the foot, like the

hand, is composed of a number of small bones. As they are not

easily broken it may safely be assumed, when such a case of

fracture comes under observation, that some pointed or unusually

heavy object had caused the lesion, and that the surrounding

soft parts must necessarily have been injured at the same time.

(Injuries of this nature will be discussed in a later section.)

But if any part of this bony framework is pushed out of its

natural position--whether this take place in one of the toes,

or in one of the tarsal bones, it makes no difference--the

dislocated part should be forced back into position in the

manner recommended in section XXIV. In its essential features

the treatment consists in the employment of wax plaster,

compresses, and bandages, exactly the same as is done in the

treatment of fractures of the long bones, but without splints.

The same rules hold good with regard to the degree of pressure

to be applied, and every third day the dressings should be

renewed. On each occasion of such renewal the patient should be

questioned with regard to the sensations which he feels after

the bandages have been applied, and if necessary they should be

readjusted in accordance with the nature of the answers which

he gives. The great majority of these injuries heal completely

in twenty days. The exceptional cases are those in which the

fracture] involves a bone that stands in immediate relation

with the bones of the leg. It is advisable, however, that the

patient should remain in bed during the period mentioned; for,

in not a few instances, the persons thus affected, failing to

appreciate the gravity of the injury, walk about before the

parts have really healed; and then, for an indefinite period

of time, they are frequently reminded in a painful manner of

the injury which they received. There is nothing astonishing in

this when the fact is recalled to mind that the feet support the

entire weight of the body.

[Forty-eight chapters or sections, some of them of considerable length,

are devoted to the subject of fractures. The authorities are almost

unanimous in stating that this portion of the so-called Hippocratic

writings was written by Hippocrates himself. Malgaigne and Petrequin,

two of the most competent French writers on questions relating to

surgery, declare that the treatises written by Hippocrates on fractures

and dislocations (the two forming in reality one continuous treatise)

are the best and most complete books ever written by a physician.]

_Wounds of the Head._--10. The physician should, first of

all, before touching the patient’s head, inspect carefully the

wound and surrounding parts. After noting whether the injury

has been inflicted upon a strong or a weak portion of the head,

he should ascertain whether the hair has been cut by the fall

or the blow, and whether portions of it have penetrated into

the wound. In the latter event he should express his fear that

the skull at this point has been laid bare and has perhaps even

received some material injury. He should make this statement

before he has touched or probed the wound. Then afterward he

should proceed to a physical examination of the injured parts,

in order that he may learn positively whether the overlying soft

tissues have or have not been separated from the bone. If simple

inspection reveals the fact that the skull has been laid bare,

well and good; but, if the real condition is not thus revealed,

he should not hesitate to employ the probe. If he finds that the

soft parts have been separated from the bone and that the latter

has been more or less injured, he should continue this more

minute exploration until he shall have ascertained to just what

extent and in what manner the skull has been injured, and what

measures are required to remedy the damage; in brief, he should

make the diagnosis. At the same time, however, he should not

neglect to question the patient very closely about the manner

in which the wound was inflicted, for in this way he may be

able to infer the existence of a contusion, or even a fracture

of the skull, of which no material evidences are discoverable.

Important information may also be gathered by passing the hand

over the seat of injury in the bone,--information which the

employment of the probe is not competent to convey.

[Twenty-one additional chapters are devoted to wounds of the head,

every possible phase of the subject being handled by Hippocrates in the

most careful and thorough manner.]

CHAPTER IX

THE STATE OF GREEK MEDICINE AFTER THE EVENTS OF THE

PELOPONNESIAN WAR; THE FOUNDING OF ALEXANDRIA IN EGYPT, AT THE

MOUTH OF THE NILE; AND THE DEVELOPMENT OF DIFFERENT SECTS IN

MEDICINE

Up to the time when war broke out between Sparta and Athens (431 B.

C.), the latter city had for many years easily held the supremacy, not

merely in everything relating to the science and art of medicine, but

also in all other branches of learning and especially in the arts of

sculpture, painting and architecture. At the time named above came the

beginning of her downfall. For a period of about twenty-one years she

struggled against disasters of all sorts.

_The Plague at Athens, the first Recorded in History._--Shortly

after the war began--a war engendered by the bitter jealousy of Sparta

over the ever increasing ascendancy of her rival--the latter city was

visited by a devastating plague, the first European pestilence that

has been recorded in history. Thucydides, who wrote the history of the

Peloponnesian War, gives a most lucid description of this plague of

Athens, from which I shall copy certain portions.

It first began, it is said, in the parts of Ethiopia above

Egypt, and thence descended into Egypt and Libya and into most

of the King’s country. Suddenly falling upon Athens, it first

attacked the population in Piraeus,--which was the occasion

of their saying that the Peloponnesians had poisoned the

reservoirs, there being as yet no wells there,--and afterward

appeared in the upper city, when the deaths became much more

frequent. All speculation as to its origin and its causes, if

causes can be found adequate to produce so great a disturbance,

I leave to other writers, whether lay or professional; for

myself, I shall simply set down its nature, and explain the

symptoms by which perhaps it may be recognized by the student,

if it should ever break out again. This I can the better do,

as I had the disease myself, and watched its operation in

the case of others.... People in good health were all of a

sudden attacked by violent heats in the head and redness and

inflammation in the eyes, the inward parts, such as the throat

or tongue, becoming bloody and emitting an unnatural and fetid

breath. These symptoms were followed by sneezing and hoarseness,

after which the pain soon reached the chest, and produced a hard

cough. When it fixed in the stomach, it upset it; and discharges

of bile of every kind named by physicians ensued, accompanied

by very great distress. In most cases, also, an ineffectual

retching followed, producing violent spasms, which in some

cases ceased soon after, in others much later. Externally the

body was not very hot to the touch, nor pale in its appearance,

but reddish, livid, and breaking out into small pustules and

ulcers. But internally it burned so that the patient could not

bear to have on him clothing or linen even of the very lightest

description; or indeed to be otherwise than stark naked. What

they would have liked best would have been to throw themselves

into cold water; as indeed was done by some of the neglected

sick, who plunged into the rain-tanks in their agonies of

unquenchable thirst; though it made no difference whether they

drank little or much. Besides this, the miserable feeling of not

being able to rest or sleep never ceased to torment them. The

body meanwhile did not waste away so long as the distemper was

at its height, but held out to a marvel against its ravages;

so that when they succumbed, as in most cases, on the seventh

or eighth day to the internal inflammation, they had still

some strength in them. But if they passed this stage, and the

disease descended further into the bowels, inducing a violent

ulceration there accompanied by severe diarrhoea, this brought

on a weakness which was generally fatal. For the disorder first

settled in the head, ran its course from thence through the

whole of the body, and, even where it did not prove mortal, it

still left its mark on the extremities; ... some, too, escaped

with the loss of their eyes.... Some died in neglect, others in

the midst of every attention. No remedy was found that could be

used as a specific; for what did good in one case, did harm in

another.... Such was the nature of the calamity, and heavily

did it weigh on the Athenians; death raging within the city and

devastation without.

(Translation of Richard Crawley; Dent & Sons, London.)

_Athens Ceases to be the Centre of Medical Learning._--It is safe

to assume that one by one the more prominent of the physicians who

had survived the events which have just been narrated, must have left

Athens and taken up their abode in the various cities of Asia Minor

and the neighboring islands, in Sicily, in Italy, etc. Hippocrates,

who was thirty years old at the time when the plague broke out in

Athens, appears not to have witnessed it. He practiced his profession

and taught medicine in his native city; then he spent a certain number

of years in traveling about as a peripatetic physician; and finally

settled for the remainder of his life in Thessaly. But the length of

each of these periods of his professional life is not mentioned by any

of the authorities. About forty years after the death of Hippocrates,

Alexander the Great had already nearly completed his series of

brilliant conquests, and was taking steps to found a city, or rather, a

university, in which medicine was to take an organized shape as one of

the great departments of human learning.

It may be well at this point, however, to interrupt this narrative

of the regular course of events for the purpose of considering very

briefly how far the physicians of that period had advanced toward

gaining a permanent and honorable position in their respective

communities.

_The Degree of Esteem in which Physicians Were Held by Their Fellow

Citizens and by the Governing Authorities During the Centuries

Immediately Preceding the Christian Era._--We have at our command

very little direct evidence bearing upon the question of the esteem in

which physicians were held three hundred years B. C. by the communities

in which they practiced their profession. We know positively that

the kings and princes of that period fully appreciated the value of

the services which were rendered to them by the physicians (commonly

Greeks) whom they employed. In the event of war they took with them

men who were skilled both in surgery and in the treatment of the

ordinary ills of the body. One of the sons of Hippocrates, for example,

served for some time in this capacity, and he is credited with the

statement that “the physician who wishes to obtain the best training

in surgery should enter the service of the army.” There were eight

surgeons officially connected with the “ten thousand” whom Xenophon

led back to Greece after the famous campaign in Asia Minor. The

army of Alexander the Great was accompanied by the most celebrated

surgeons of that period. Upon a bronze tablet found at Idalium, on

the Island of Cyprus, there is an inscription which dates back to the

fifth century B. C., and which commemorates the merits of a physician

named Onasilos, who, aided by his pupils, rendered valuable services,

without any remuneration, during one of the wars of the Greeks; and in

recognition of these services, the Government had bestowed upon him a

stipend and had exempted him from taxation. It is further known that

the Athenians lavishly heaped honors upon Hippocrates, initiating him

at public expense into the mysteries of the Eleusinia, giving him a

crown of gold, and distinguishing him in still other ways. These facts

show how highly the rulers of that day appreciated the services of a

competent physician; but, up to a comparatively recent date, it has

not been so easy to demonstrate what was his position in the esteem

of the community at large. The discovery, not many years ago, of two

inscriptions in Greek throw a certain amount of light upon this very

point. One of these, which bears the date of 388 B. C., states that

its purpose is to commemorate the fact that the physician Euenor, who

had been intrusted by the people with the work of supervising the

preparation of all the drugs intended for use in the public hospital,

had not only fulfilled his duty but had in addition spent large sums of

his own money in the accomplishment of this work. Another inscription,

which was unearthed in the Island of Carpathus, between Crete and

Rhodes, and which is believed to date back to the end of the fourth

or the beginning of the third century B. C., reads (in a somewhat

abbreviated form) as follows: “In view of the fact that, for more

than twenty years, Menocritus, the son of Metrodorus of Samos, has

devoted himself with much zeal and self-sacrifice to the duties of his

position as parish physician, living all this time in rather narrow

circumstances and not asking any pay for his services, we, the citizens

of Brycontium, have resolved to erect in his honor, in the temple of

Neptune, a marble column bearing an inscription that shall set forth

these facts, to crown him with a wreath of gold, and to announce

publicly, at the Aesculapian games, this our decision.” As apropos

of this subject I may be permitted to quote the following words from

Plato’s “The Republic” (Book 1, Chap. 18): “Will you call the medicinal

the mercenary art, if, in performing a cure, one earns a reward? No,

said he.”

_The Founding of Alexandria._--Alexander the Great, after subduing

the Persians and the cities of Phoenicia, marched into Egypt and

founded (331 B. C.), at the mouth of the Nile, the city of Alexandria.

In October of the same year he crossed the Euphrates and the Tigris

and defeated, for the second time, the Persian hosts under Darius.

Alexander was now the conqueror of Asia. During the following eight

years he laid his plans most carefully for the consolidation of his

great empire, the capital of which was to have been Babylon; but,

while he was thus making provision for the welfare of his numerous

subjects, who were of widely different tastes and aspirations, he

succumbed (323 B. C.) to a severe attack of malarial fever, aggravated

by an excessive indulgence in wine on the occasion of some festivity.

In the meantime Alexandria was developing rapidly into a great centre

of learning in all the departments of human knowledge. The Ptolemies,

beginning with Ptolemy Soter, who reigned over Egypt from 323 to 285

B. C., contributed greatly to this result. For a period of about 250

years Alexandria remained the centre around which revolved all that was

best in the domains of medicine, philosophy, geometry, mathematics,

history, etc. Money was spent lavishly in collecting the writings of

all those authors who had distinguished themselves in these different

fields of learning, and no pains were spared to secure correct

versions of the different works; the septuagint version of the books of

the Old Testament of the Bible being a conspicuous example of what the

Ptolemies accomplished in this direction during the third century B.

C. Every possible facility was offered at the same time for the giving

and receiving of instruction; and thus, with the immense library as a

foundation of priceless value, the Museum at Alexandria became in every

material respect a great university, the first one of which history

gives us any fairly satisfactory information. Several years after

the Museum library was established a second one of somewhat smaller

proportions was organized in the Serapeum (Temple of Serapis). The

example set by the Ptolemies was followed by Attalus, King of Pergamum

in Mysia, Asia Minor (241 B. C.), and, before many years had elapsed,

the great library of that city almost rivaled those of the Museum and

Serapeum at Alexandria. It was the competition between these two royal

collectors of books that led to the issuing of a decree that no more

papyrus was to be exported from Egypt, and thus there was provided the

stimulus which led to the discovery or invention of a new and better

material on which books might be written--viz., Pergamentum (our

parchment), a word coined from the name of the city in which it was

invented.

_The Development of Different Sects or Schools of Medicine._--Up

to the time of the death of Hippocrates medicine maintained the

character of a single organized and harmonious body; but, when this

great physician had disappeared from the scene and was no longer

there to guide the further development of medical science and to keep

his followers working shoulder to shoulder with a single spirit and

purpose, this hitherto homogeneous body split up into sects or schools,

each of which had some favorite doctrine the promulgation of which

seemed to each group of adherents to be of great importance. There

were at first two such principal groups, viz., the Dogmatics and the

Empirics. The former was composed of those who laid great stress upon

speculation or theorizing,--that is, upon the use of the reasoning

power,--and the latter of men who maintained that actual experience was

the only thing of any serious value. The respective leaders of these

two groups or sects were Plato and Aristotle.

In Raphael’s celebrated painting, “The School of Athens,” these two

heroes of philosophy are represented standing side by side--Plato with

his right hand elevated and pointing toward heaven, while Aristotle is

looking distinctly at the earth. Pictorially, the tendencies of the two

schools of philosophy could not have been better represented. Plato’s

genius had taken its flight heavenward and was contemplating earthly

things from this point of vantage; his method being to ignore system

and to look at everything with the eyes of purest love. “Delightfully

poetic, but thoroughly unprofitable speculation as to what constitutes

scientific truth and perfected morality!” (Friedlaender.)

Aristotle, whose father was a physician and a descendant of

Aesculapius, was the hero and guiding spirit of those who based their

philosophy on experience, on ascertained facts. Like his celebrated

pupil, Alexander the Great, who brought whole nations under his sway,

he too was a conqueror in every field of human knowledge. His ideas

ruled supreme over the minds of men for thousands of years and to-day,

although many of them are no longer accepted as valid, Aristotle

himself is universally held to have been the greatest thinker and

investigator who has ever lived upon this earth. (In chapter XIII. I

shall have occasion to say something further regarding the Dogmatics

and the Empirics.)

Out of the teachings of Plato and Aristotle developed two schools of

philosophy that exerted, in course of time, a great influence upon

the minds of men and upon the growth of medical science. The schools

referred to are the Epicureans and the Stoics. Epicurus (242–270 B.

C.), who gave his name to the first of these, taught that the highest

good was happiness.

The happiness he taught his followers to seek was not sensual

enjoyment, but peace of mind as the result of the cultivation

of all the virtues. According to the teaching of his school

virtue should be practiced _because_ it leads to happiness;

whereas the Stoics taught that virtue should be cultivated for

her own sake, irrespective of the happiness it will ensure. Zeno

(circa 370–260 B. C.), the founder of the Stoic philosophy,

taught an ethical system according to which virtue consists in

absolute judgment, absolute mastery of desire, absolute control

of the soul over pain, and absolute justice. The keynote of the

system is _duty_, as that of Epicureanism is pleasure. (Sir

William Smith.)

In addition to the sects named above, there was still another known

as the Older Dogmatic School, which was composed of men who had

been the direct followers of the great master, but who, forgetting

altogether the practical teachings of Hippocrates with regard to

the importance of experience, gave themselves up to all sorts of

hypotheses and theories. Among the names of the earliest followers of

this school one is astonished to find those of Thessalus and Draco,

the sons of Hippocrates, as well as the name of Polybus, the latter’s

son-in-law. Diocles of Carystos and Praxagoras of Cos, two of the most

distinguished men of that period, were also among the earliest members

of this dogmatic school. Diocles, who was one of the Asclepiadae, owed

his celebrity in part to his contributions to our knowledge of anatomy

and in part to the work which he had done in other departments of

medicine. Unfortunately, all of these writings have been lost with the

exception of a few fragments which came to light toward the middle of

the nineteenth century. Praxagoras was also one of the Asclepiadae. He

was distinguished, as has already been stated on an earlier page, by

the fact that he--and not Aristotle, as is sometimes stated--was first

to recognize the difference between arteries and veins, and also by

the further fact that he called attention to the practical value of

the pulse as an indication, in certain diseases, of the tone of the

patient’s bodily condition or vitality.

CHAPTER X

ERASISTRATUS AND HEROPHILUS, THE TWO GREAT LEADERS IN MEDICINE

AT ALEXANDRIA; THE FOUNDING OF NEW SECTS

Two of the most celebrated physicians of that period (305–280 B. C.)

were Erasistratus and Herophilus, both of whom were distinguished

as the founders of schools or sects of medicine at Alexandria. They

had received their early training as physicians from Chrysippus, a

widely known Stoic philosopher, who, according to Albert von Haller,

had taught at the school of Cnidus and had also written on medical

topics; and, among the other teachers, it is stated that Anaxagoras

of Cos had instructed Herophilus, and that Metrodorus, the son-in-law

of Aristotle, had performed the same service for Erasistratus. So far

as fundamental principles are concerned, the schools founded by these

two physicians at Alexandria differed very little from each other, and

the men themselves also gained their distinction in very much the same

branches of medical knowledge, both of them having made a number of

original discoveries in anatomy and both of them having become eminent

practitioners.

Herophilus was born at Chalcedon, a Greek city on the Propontus,

nearly opposite to Byzantium. We possess no knowledge whatever

regarding the earlier years of his career, notwithstanding the fact

that no fewer than four different men devoted their energies to the

writing of his biography. The books themselves have been either lost

or destroyed. Herophilus showed a decided leaning toward the study

of anatomy, and his contributions to this branch of medicine are

among the earliest which we possess. Herophilus strove to supply one

of the most conspicuous deficiencies in the Hippocratic system of

medicine, viz., inadequate knowledge of the nervous system; and to

this end he conducted a series of the most careful investigations,

as a result of which he was successful in establishing several facts

previously unknown. He described the membranes of the brain, the

choroid plexus, the venous sinuses, the structure which bears his

name,--the torcular Herophili,--the cerebral ventricles, and the

calamus scriptorius; he traced the course of the nerve trunks for some

distance from their origin in the brain and spinal cord; and it was he

who established the fact that two different sets of nerves exist--one

for conveying sensations to the brain and the other for producing

motion. In addition, he investigated the corpus vitreum, the retina,

the optic nerve, etc. He also called attention to the peculiar mode

of construction of the duodenum, and to the fact that the walls of

the arteries are thicker than those of the veins. Some idea of the

accurate manner in which he carried on his anatomical researches may be

gained from the fact that he noted the circumstance that the left vena

spermatica occasionally originates in the vena renalis.

Herophilus also gained distinction in the practical branches of

medicine. According to Puschmann he laid the foundations for a

scientific sphygmography. Thus he distinguished several varieties

of pulse in accordance with the differences which he noted in its

strength, regularity, degree of fulness, and rate of speed. He also

must have had considerable experience in surgery, as is shown by his

remark that a dislocation of the thigh, owing to the tearing of the

ligamentum teres which necessarily accompanies such a dislocation, is

likely to occur again in the same individual. In his writings relating

to the practice of medicine, Herophilus upheld the principle that

experience alone should be our guide, as theoretical considerations are

not to be trusted. He is also credited with having said, in response to

the question, Whom do you consider the best physician? “Him who knows

how to distinguish what is attainable from what is unattainable.”

Erasistratus, the contemporary of Herophilus and his associate in the

work of establishing at Alexandria a great anatomical and clinical

medical school, was a native of Julis, in the Island of Ceos, not far

from the coast of Attica. In the earlier part of his professional

career he spent some time at the Court of Seleucus, the founder of the

Syrian monarchy (312–280 B. C.). This monarch, who had been one of

Alexander the Great’s distinguished generals, consigned the government

of the eastern part of his vast kingdom to his son Antiochus. The

latter fell ill about this time, and the most distinguished physicians

of the Court were then called in to determine what was the nature of

his malady and to decide upon the proper treatment. The patient grew

more and more languid, showed complete indifference to all that took

place about him, and steadily lost flesh. Erasistratus, who was one of

the physicians summoned, observed his behavior very closely and soon

noted the fact that, whenever Stratonice, his young and attractive

stepmother, entered the sick room, Antiochus became agitated; his face

being flushed, his voice subdued, his pulse more rapid, and his eyes

brighter, all of which signs of excitement disappeared when Stratonice

left the room. From these phenomena this shrewd observer drew the

inference that the patient was deeply but hopelessly in love with his

father’s second wife. Accordingly he informed Seleucus that his son’s

illness was simply the result of having lost his heart to one who was

unable to return his affection. Seleucus, who was much astonished,

asked with deep interest who was the lady. “My wife,” replied

Erasistratus, without an instant’s hesitation. “But tell me then,”

asked Seleucus, “would you be willing to cause the death of my son,

who is so very dear to me, by refusing to give up your wife to him?”

“Would you, yourself, my lord, under similar circumstances,” replied

the physician, “be willing to give up Stratonice to the Prince, if it

had been she with whom he had fallen in love?” Seleucus having already

vowed that he would not hesitate for a moment to do so, Erasistratus

declared the whole truth to him, and of course there was nothing left

for the King but to keep his word. History fails to state whether or

not the lady made any objection to the transfer. As Antiochus lived

to reign for many years after the murder of his father, it is safe to

assume that he recovered his health.

This brief tale, the truth of which is not disputed by any of the

authorities, reveals Erasistratus to have been a clever diagnostician,

to have possessed a profound knowledge of human nature, and to have

been a man of exceptional courage; in short, he was a physician

admirably fitted to act as the founder and leader of one of the two

great medical schools of Alexandria. The following account may suffice

to convey some idea of his career after he became established at the

latter city.

At the beginning of his residence in Alexandria, Erasistratus, like

his great rival Herophilus, devoted his energies to anatomical and

physiological researches. These two men evidently realized to the full

how important it was to medicine, if it were to make a substantial

advance beyond the point to which Hippocrates and his followers had

already carried it, that a more complete understanding of the structure

and working of the human body should be obtained; and their efforts

in this direction were greatly aided by the enlightened views of the

kings of Egypt, the Ptolemies, who did everything in their power to

furnish these two investigators with all the human dissecting material

they could use to advantage. They even went so far as to allow them

the privilege of utilizing, for scientific purposes, the living bodies

of imprisoned criminals, “in order that they might in this way learn

the location, color, shape, size, construction, hardness, softness,

smoothness, nature of external surface, protuberances and recesses of

the individual organs during life.” The defense which they offered for

permitting such vivisections was this: “It is permissible to sacrifice

the lives of a few criminals if many worthy persons may thereby be

permanently benefited in health, or have their lives prolonged.”

(Puschmann.) Those who were opposed to such examinations upon human

beings expressed their disapproval in the following terms: “This

practice is not only cruel, but useless, and at the same time it

derogates from the dignity of the healing art, which is intended to

be a blessing and not a source of pain to man; for those in whom the

abdominal cavity is first opened and then the diaphragm divided, die

before it is possible to make the scientific examination ‘during life’

which constitutes, as it is claimed, the justification for the entire

procedure.” (Puschmann.)

As regards the work done by Erasistratus in the departments of anatomy

and physiology, the following statement may be made: He threw a great

deal of additional light upon the structure of the lacteals, the valves

of the heart, the brain, the nerves, and several other portions of the

body; and he assigned to the pneuma, or breath,--of which he assumed

that two kinds exist,--the most important rôle in the mechanism of

life. According to the description given by Galen and reported by Le

Clerc, the phenomena to which Erasistratus refers take place somewhat

as follows: “When the thorax or chest expands, the lungs also undergo

dilatation and fill themselves with air. This air, entering first by

way of the trachea, ultimately reaches the anastomosing terminals of

the bronchial tubes, from which locality the heart, by the act of

dilatation, draws it into itself, and then, immediately afterward

contracting, sends it, by way of the great artery (the Aorta), to every

part of the body.” When it is considered that at this remote period

of time nothing was known about oxygen and carbon dioxide, nor about

the power of these elements to pass freely through a thin membrane

(exosmosis and endosmosis), no surprise will be felt that Erasistratus

carried the physiology of respiration no farther than he did. On the

contrary, it is remarkable that he was able to describe so correctly

this complicated process. In fact, none of his successors, up to the

time when Harvey’s great discovery was announced, was able to furnish

a better description. The physiology of gastric digestion was another

of the problems concerning which Erasistratus held views that were

different from those commonly accepted by the physicians of that time.

The stomach, he maintained, first retracts when portions of food are

introduced and then contracts in such a manner as to break them up into

smaller and smaller fragments; this process taking the place of that

of “coction,” as taught by Hippocrates. The resulting chyle passes

from the stomach into the liver and is deposited in those spots where

the finer branches of the vena cava and the terminal twigs of the

channels which lead into the gall-bladder come together. Here the chyle

breaks up into two portions, one of which--viz., that which contains

biliary elements--gains an entrance into the channels that lead to the

gall-bladder, while the other, which is composed of elements suitable

for making pure blood, finds its way into the ramifications of the

vena cava. While holding these views about the mode of transformation

of gastric chyle into the bile and pure blood, Erasistratus did not

hesitate to confess that he was unable to say whether bile was produced

within the body or whether it already existed in the food that was

taken into the stomach.

As regards the treatment of disease Erasistratus held certain views

which were decidedly at variance with those maintained by the majority

of his associates. Thus, for example, Straton, a distinguished disciple

of this master, praises him for having banished bloodletting from the

list of remedial measures, and adds that he can testify to the fact

that Erasistratus had, by other means, cured all the diseases in which

the ancients commonly employed bloodletting as the chief remedial

agent. His favorite substitutes for the latter procedure were fasting,

dieting, physical exercise, and--in cases of hemorrhage--placing

ligatures around the arms and legs. Caelius Aurelianus is authority for

the statement that, in certain very exceptional cases, Erasistratus did

resort to bloodletting. Another of the latter’s tenets was his strong

objection to the employment of purgatives and composite remedies. On

the other hand, he appears to have attached considerable importance

to the employment of chicory in the treatment of all disorders of the

abdominal organs. One of the evidences of his preference for this

drug is to be found in the care which he takes in describing how the

plant should be prepared for remedial purposes. “Boil a bunch of the

plant in water until the mass is thoroughly cooked; then cast it into

a fresh supply of boiling water (to drive out still more of its bitter

quality); and finally, upon removing it from the boiling water, place

it for conservation in a receptacle containing oil. When it is required

for use add a small quantity of weak vinegar.” Galen, in commenting

jocosely upon the stress which Erasistratus lays upon these details,

makes the remark: “As if our domestics did not know how to cook a bunch

of chicory!”

Speaking of the effects produced by venom when one is bitten by a

poisonous snake, Erasistratus remarks that “from the effects which the

poison introduced in this manner produces, we may derive a general

indication as to how a cure may be obtained. The poison, it will be

noted, destroys very quickly the parts with which it comes in contact,

and then, by spreading throughout the body, causes death. The thing to

do, therefore, is to draw it as quickly as possible out of the body

and thus arrest its further spread. To this end the wound should first

be enlarged and its sides scarified; then, after it has been sucked,

a cupping glass should be applied over it; and, finally, it should be

cauterized.”

Erasistratus cultivated surgery as well as the other branches of

medicine. He was a bold operator, as may be inferred from the fact

that, in cases of scirrhus or other variety of tumor of the liver, he

did not hesitate to incise the skin and overlying integuments, and

then, after the peritoneal cavity had been opened, to apply directly to

the seat of the disease such medicaments as seemed to him appropriate.

On the other hand, he did not approve of _paracentesis abdominis_

in cases of dropsical effusion, as a means of evacuating the fluid

accumulated in the peritoneal cavity.

It appears that the disciples and successors of Herophilus and

Erasistratus soon abandoned the exact methods which these two great

masters had inaugurated and which, in a comparatively short time, had

produced such admirable results, and then they fell back into the

less arduous, the easy-going ways of speculation. Only a very few had

sufficient strength of character to walk in the older pathway, and

among the number were some who left Alexandria and established schools

in the other cities--as, for example, Zeuxis, who organized a new

centre of medical teaching at Laodicea, in the interior of Asia Minor,

and Hikesios, who founded another school at Smyrna, on the seacoast of

Lydia. It is not strange, therefore, that before many years had elapsed

the two original schools at Alexandria died a natural death. As Pliny

aptly writes, “It was so much more comfortable to sit on the benches

of the schools and have learning poured into your ears than to wander

daily through the desert outside in search of other nourishing plants.”

As a further result of this deadness of the schools at Alexandria (that

is, of the sect of the Dogmatics) the more serious-minded physicians

espoused with eagerness the side of the Empirics--a sect which

developed about this time, but which did not, it must be confessed,

hold out much hope of solving the physiological and pathological

problems of the day, but which nevertheless satisfied in some measure

their needs as practitioners.

Philinus of Cos (286 B. C.) was looked upon as the founder of the

school of the Empirics, and among its most distinguished disciples

were: Serapion of Alexandria (279 B. C.), Glaucias, Apollonius

Biblas, and--perhaps the most celebrated of them all--Herakleides of

Tarentum (242 B. C.), who did such excellent work in the department

of pharmacology. It was he, for example, who defined more precisely

than had been done by any one of his predecessors the proper manner

of employing opium. In addition, he wrote a commentary on the

Hippocratic works and also separate treatises on medical, surgical

and pharmaceutical topics. In the latter category belongs his book

entitled “A Military Pharmacopoeia.” Last of all, Apollonius Mus, a

distinguished follower of Herophilus, deserves to be mentioned because

it was he who perfected the preparation of castor oil. At a still later

date (158 B. C.) Zopyrus proved himself to be a most worthy successor

to Herakleides. It was he who first classified drugs according to the

effects which they produce, and he also invented or discovered the

preparation named “ambrosia,” a general antidote for poisons of all

kinds. Kings and princes were, at that period, in constant fear of

being poisoned, and so it came about that those who were skilled in the

knowledge and preparation of drugs were greatly stimulated by their

royal patrons to find efficient antidotes. It is narrated that Attalus

Philometer, King of Pergamum, the native city of the famous physician

Galen, and Mithridates Eupator, King of Pontus, cultivated poisonous

plants in their gardens and tried the effects of the poisons distilled

from them on criminals. They also encouraged in every possible way

the preparation of antidotes; and thus was compounded a mixture which

even to-day is still known by the name of “_Mithridaticum_.” For

centuries it was a very popular remedy for poisoning by snake-bite. Le

Clerc states that one of the first things that the great Roman general

Pompey did, after conquering Mithridates and gaining possession of his

palace (about 64 B. C.), was to have a careful search made for the

recipe of this famous antidote. Upon finding it he was surprised to

learn what simple ingredients it was composed of--viz., “20 leaves of

rue, a pinch of salt, two nuts, and two dried figs.” The theriacum,

which one hundred years later was modeled after the Mithridaticum,

contained a great deal of honey and a large number of unimportant

drugs, introduced--as Pliny claims--“to magnify the importance of the

apothecary’s art, rather than to increase the curative effects of the

remedy.”

The scepticism which already at that period had begun to take

possession of many of the best minds manifested itself in the form of

a disbelief in the possibility of discovering full scientific truth,

and men therefore taught the doctrine that the human understanding

is not capable of attaining anything higher than probability. The

acceptance of such a doctrine naturally acted as a powerful hindrance

to all further original research. And so the Empirics neglected the

study of anatomy and physiology as something quite superfluous and

unprofitable. They gave no further thought to the causes of disease,

and were quite satisfied simply to observe its manifestations, to

investigate the factors which appeared to bring it into a state of

activity, and to search for the means of effecting a cure. In carrying

on work of this character, they of course derived help, not only from

their own experience, but also from that of others--which latter became

in time a matter of history. When they encountered new experiences

and were unable to supply a satisfactory explanation they resorted

to a third method--that of reasoning by analogy. Upon this triple

support--one’s own individual experience, the experience of others

stored up in the form of history, and reasoning by analogy--rested the

entire structure of empiricism.

Strange as it may at first appear, the science of medicine from this

time onward made no further conspicuous progress until the middle of

the seventeenth century of the present era. In certain branches of

practical medicine--as, for example, pharmacology, obstetrics and

general surgery, and also in certain special departments--the Empirics

made a number of material additions to our knowledge; but in all

essential particulars the medical science taught throughout this period

of about two thousand years varied but little from that taught at

Alexandria one hundred or two hundred years before the birth of Christ.

This extraordinary phenomenon of almost complete arrest of development

for so long a period of time should not excite surprise, for something

of a similar nature has certainly occurred in other departments of

human knowledge.

The further history of the medical sects which flourished under the

Ptolemies and for a short time afterward, when Alexandria became

a colony of the Roman Empire, need not detain us long. Daremberg

furnishes a chronological chart of the physicians who played a more

or less prominent part in the work of these sects, and from this

it appears that they numbered thirty-four in all--ten followers of

Herophilus, fourteen of Erasistratus, and ten Empirics. Callamachur

and Bacchius, who belonged to the first of these groups, deserve to be

mentioned because they were its most distinguished members and because

they were the first physicians who wrote commentaries on the writings

of Hippocrates. In the sect of the Empirics the next in importance

after Philinus of Cos is Serapion of Alexandria. Mantias, another

disciple of Herophilus, gained considerable reputation from the fact

that he was the first to collect together into a single treatise the

different pharmaceutical formulae that were then in general use. He was

also an authoritative writer on surgical topics.

_Certain Branches of Medical Work Begin to Assume more Distinctly

the Character of Specialties._--At the time of Hippocrates there

were no specialists, or at least none who received any sort of official

recognition from the general body of physicians; and yet, there were,

even then, a few practitioners who devoted themselves preferably to

the treatment of certain maladies, like the affections of the eye and

the teeth; and, beside these, there were undoubtedly, in the larger

communities, men who were ready and competent to undertake the more

serious surgical operations. But even these men, as appears from the

language of the so-called Hippocratic oath, could not honorably perform

an operation for stone in the bladder; this particular work having been

left from time immemorial entirely in the hands of the lithotomists, a

class of men who performed no other kind of surgery and who, in fact,

were considered outside the pale of the medical profession--merely

surgical artisans.

During the Alexandrian period the attitude of the best physicians with

reference to specialization in medical practice evidently underwent

a change,--not a very marked one, it is true, but yet sufficient

in degree to attract some attention. We read, for example, that a

certain Demetrius of Apamea, a follower of Herophilus, was skilled

as an obstetrician and was also a clever diagnostician; that Andreas

of Carystus, another disciple of Herophilus and the physician upon

whose authority the incredible story of the burning of the Cnidian

archives by Hippocrates was spread abroad, was considered at this

time an expert in the science of obstetrics; that, toward the end of

the period (first century B. C.), Alexander Philalethes, a disciple

of Herophilus and well known as an author of treatises on the pulse

and on the doctrines taught by different physicians of that period,

acquired widespread celebrity as a gynaecologist; that Straton, a

disciple of Erasistratus, had gained considerable distinction as a

gynaecologist; and, finally, that two physicians--Gaius of Naples and

Demosthenes of Marseilles (Massilia)--were widely celebrated for their

skilfulness in the treatment of eye diseases. The latter was also a

successful author, for his treatise on ophthalmology retained its

popularity down to the Middle Ages. All these men, it should be noted,

were directly and indirectly connected with the work at Alexandria, and

were physicians of some degree of prominence. It is fair to assume,

therefore, that specialization in medical practice had by this time

become an accepted fact and was certainly not frowned upon by those in

authority. The result is entirely in accord with what might be expected

from a body of physicians as enlightened as were the men gathered

together at Alexandria during the centuries immediately preceding and

that immediately following the birth of Christ; but many additional

centuries were yet to elapse before anything like the well-defined

specialism of modern times was to become an established fact.

CHAPTER XI

ASCLEPIADES, THE INTRODUCER OF GREEK MEDICINE INTO ROME

The seventh Ptolemy, Ptolemy Euergetes or Physcon, whose reign lasted

from 146 to 117 B. C., drove all men of learning away from Alexandria

and closed the famous schools in that city. It was only a few years

after these events, and at a time when that city was fast losing its

supremacy as the great centre of medical learning,[27] that there

appeared at Rome a Greek philosopher and physician who was destined to

become the founder of a new set of medical ideas and of a new kind of

medical practice. Being a man of general cultivation and attractive

personality, and not afraid to encounter the prejudices and ill will

which almost always greet a foreigner when he first establishes himself

in a strange country and among a people of a different race, he soon

overcame those obstacles and was eventually successful in making Rome

the starting-point and centre of the best medical thought and practice

of that period of the world’s history. To understand clearly, however,

the character of the work which Asclepiades accomplished in the city

which was soon to be the capital of the world as then known, it is

desirable that a brief account should be given of the condition of

medical affairs in Rome at the time of his arrival.

_The Practice of Medicine at Rome During the Century Immediately

Preceding the Christian Era._--Foreigners were not encouraged to

settle in Rome until toward the latter part of the second century B.

C., and consequently the treatment of the sick in that city maintained

its distinctly Roman character for an unusually long time. In the

households of the better classes the head of the family commonly

prescribed for any illness which might befall its members. In not a few

instances one of the slaves--who was known as a _servus medicus_,

and who might perfectly well have been a regularly educated Greek

physician--took charge of the patient in place of the master of the

house. A book of domestic remedies was the usual source of information

from which the latter derived his knowledge of therapeutics. Marcus

Porcius Cato, the distinguished Roman censor (234–149 B. C.), was the

author of one of the most popular of these books of recipes. The text

of this work has come down to our time. There were, at this period,

no regularly established physicians and no such thing as a medical

practice. For several hundred years the Romans were almost constantly

at war with the neighboring tribes or nations, and this life of

outdoor exposure and active exercise kept them free from the numerous

and very varied bodily ills of the later generations. This state of

society alone was quite sufficient to prevent the thoroughly trained

physicians of Greece and Alexandria from settling in Rome. But there

were still other forces at work which greatly delayed their taking

such a step, viz., the unwillingness on the part of the authorities

to grant to foreigners the rights of citizenship, and the very strong

prejudice which the Roman aristocracy cherished with regard to the

Greek nation. Some idea of the strength of the latter feeling may

be gathered from the letter which Cato the Censor, perhaps the most

influential citizen of Rome at that time, wrote to his son Marcus.

Daremberg gives the following quotation from this epistle: “The Greeks

are a perverse and unteachable race. Believe that an oracle is speaking

to you when I say--Every time that the Greeks bring to us some branch

of knowledge they will not fail to corrupt our manners; and it will

be far worse for us if they should send us their physicians, for they

have bound themselves by an oath to kill all Barbarians by the aid of

medicine--and they have the insolence to reckon us also as Barbarians.

Remember that I have forbidden you to call in a physician.” Daremberg

adds: “The old man Cato must have been very simple-minded to believe

for a moment that physicians would be such egregious fools as willingly

to kill the patients from whom they derive their support.” But even

this strong prejudice on the part of the Roman aristocracy had to

give way in course of time to forces of a much stronger character.

During the second century B. C., the Romans, no longer fearing the

encroachments of their warlike neighbors and having overcome all danger

of an invasion on the part of their once powerful Carthaginian foe,

entered upon a career of conquest. The capture of an ever increasing

number of cities and towns in Greece, Asia Minor, Egypt and Africa

brought great wealth to Rome, and, with it, increasing luxury, an

increase in the prevalence and variety of diseases, and an increased

need of men who were competent to deal successfully with such diseases.

The physicians who first attempted to meet this need were men of an

inferior stamp, to whom the situation appeared simply to afford an

excellent opportunity for making money; and very naturally they failed

to gain the respect and confidence of the better citizens. At a later

date Julius Caesar, who was, at that time, Consul (about 90 B. C.),

extended the right of citizenship to all foreign physicians who were

practicing in Rome, and thus was removed one of the greatest obstacles

which prevented the better class of Greek medical men from settling in

that city.

More than a hundred years before the time of which I am speaking

(_i.e._, about 218 B. C.), a Greek physician named Archagathus had

the courage to take up his abode in Rome. He was the son of Lysanias,

a native of Peloponnesus. At first he appeared to gain the favor of

the community in which he practiced, for they bought and placed at his

disposal a shop, or office, in the cross-way of Acilius, and gave him

the name of _vulnerarius_--healer of wounds. Later, however, they

disliked his rather too free use of the knife and the actual cautery,

and thereafter he was spoken of as the _carnifex_, or executioner.

Medicine was thus brought into disrepute and we hear nothing further

about physicians in Rome for more than a century--that is, until about

90 B. C., when Asclepiades,[28] a native of the city of Prusa, Bithynia

(northwest part of Asia Minor), made his appearance in that city. At

first he taught rhetoric, but, finding this occupation unprofitable, he

began the practice of medicine. Pliny says that he acquired a knowledge

of this art through the studies which he carried on after his arrival

in the city of Rome, but Neuburger makes the statement that he began

the study of rhetoric, philosophy and medicine in his youth and then

spent some time in perfecting his knowledge at Parion, a city of Mysia

on the Hellespont, at Athens, and probably also at Alexandria.

As a practitioner Asclepiades appears to have met with unusual success.

He was well educated and possessed of agreeable manners, and was the

friend as well as the physician of Cicero, one of the most polished

men of whom history furnishes us any knowledge. He was also on terms

of intimacy with Atticus and other eminent citizens of Rome. The

possession of such friends was more than sufficient to render him one

of the favored and prosperous physicians of his day in that city. As

Meyer-Steineg aptly says, “he owed not a little of his success to the

happy manner in which the scientist, the clever physician, and--to

a slight degree--the charlatan were combined in his character.” The

following anecdote which is told of him by Lucius Apuleius shows, on

the one hand, that he possessed remarkably keen powers of observation,

and, on the other, that there were some grounds for the charge that his

behavior was at times somewhat theatrical in character:--

One day, as Asclepiades was returning to the city, from his

place in the country, he observed the approach of a long funeral

procession. Desiring to learn whether the deceased was a person

of his acquaintance, and also in the hope of perhaps gaining

other information of a professional nature, he approached as

nearly as possible to the bier. The face of the corpse was

anointed with sweet-smelling ointments over which spices had

been sprinkled; but, notwithstanding this, he was able to detect

certain signs which led him to suspect that the man might not

yet be dead; and accordingly he examined the body very closely

and thus satisfied himself that such was indeed the fact.

Whereupon he called aloud that the man was still alive, and

told the bearers to extinguish the torches, to carry away the

materials for the pyre, and to remove the funeral feast from

the grave to a table. Some at once objected to the carrying

out of these measures and made sarcastic remarks about the

healing art--probably because they were already in possession

of the man’s estate, and were afraid that they might have to

give it up. The more influential ones, however, insisted that

the physician’s words should be heeded. Then Asclepiades,

notwithstanding the opposition which was made by the relatives,

succeeded in securing a brief delay, during which he had the

supposed corpse removed to his own house. Restorative measures

were employed, respiration was re-established, and the man was

brought back to life. At the succeeding festivities unlimited

praise was bestowed upon the wise physician.

Whether this tale, which I have copied from Neuburger, is true or

not, it seems to fit in well with the bold and independent character

of Asclepiades as it is revealed to us by the different writers of

the history of medicine. In his comment upon this narrative the

distinguished Viennese historian makes the remark that Asclepiades

was very conceited, and--like most reformers--showed a disposition to

ignore the work accomplished by his predecessors. He also expresses the

belief that Asclepiades possessed a leaning toward the methods of the

charlatan; the episode just narrated revealing a love for theatrical

display in his professional activity. On the other hand, in the further

course of the chapter which he devotes to this famous Roman physician,

Neuburger gives fuller recognition to the value of the services which

he rendered to medicine, and thus, in the light of these services, one

is justified in overlooking any little weaknesses of character which he

may have displayed. Perhaps the most important of the services which

Asclepiades rendered was that of having introduced Greek medicine into

Rome--an important connecting link in the transmission of medical

knowledge from Greece to Modern Europe.

_The Views of Asclepiades with Regard to Physiology and

Pathology._--The human body, according to the philosophy of

Asclepiades, is composed of atoms--that is, small bodies which are

invisible, have no definable quality, are in continual motion, through

mutual pressure undergo modifications in form, and break up into

innumerable smaller fragments or particles that differ both in size

and in shape. The arrangement of these small bodies is such that

intercommunicating spaces or pores are left between them, and through

these channels flows a sap or juice containing larger and smaller

particles; the larger ones composed of blood, and the smaller of vapor

or heat. Health, according to Asclepiades, is that state in which the

primitive atoms are properly distributed or placed and the flow of the

juices in the pores takes place normally. When, however, the flow is

arrested and the primitive atoms are disordered in their relations to

each other and to the pores, or when the elements composing the fluid

contents of the latter become mixed, disease results. Alterations in

the pores themselves, as contradistinguished from the fluid contained

within them, may also cause disease. Farther on, when the proper time

arrives for considering the sect of the Methodists, I shall have

occasion to discuss this subject again, and particularly that part

of it which relates to pathology. In the meantime, however, I cannot

resist the impulse to say a few words about the remarkable insight

possessed by Asclepiades into the manner of construction of the human

body, as manifested by this very brief but very significant anatomical

and physiological description. Upon a first reading one might easily

get the impression that Asclepiades has reference to only one kind or

system of “pores” or channels--viz., such as serve for the circulation

of tissue juices alone. But, upon a closer scrutiny of the text, one

finds some warrant for suspecting that he had in mind more than one

system of such channels; for he states distinctly that the fluid

circulating in these pores contains larger particles composed of blood

and smaller ones which consist of vapor (_spiritus_) or heat. The

question suggests itself: Could a man who had no knowledge of Harvey’s

discovery, who did not possess a microscope, and who at the same time

believed--as did all the ancients--that air circulated in the arteries

and blood in the veins, come any nearer to the actual truth than did

Asclepiades? His description needs very few alterations and additions

to make it fit correctly the system of terminal arterio-venous channels

known to-day as arterioles and capillaries.

_Methods of Treatment Adopted by Asclepiades._--The prevailing

methods of treating diseases in Rome were not approved by Asclepiades,

and he lost no opportunity of giving expression to this disapproval.

In the first place, he protested vigorously against the practice

of prescribing on every possible occasion purgatives and remedies

capable of producing vomiting. He had a decided preference for gentler

measures, his idea being that a physician should cure his patients

_tuto, celeriter, et jucunde_--safely, quickly and agreeably. Le

Clerc adds that this is a fine sentiment, but that its realization

in actual practice is something which most physicians find it very

difficult to attain. Asclepiades condemned strongly the employment of

magical remedies, a practice which was still much in use at that time

in Rome, although it was already less common than it had previously

been. Cato’s collection of household remedies contains a short list

of some of these appeals to man’s superstition.[29] In addition to

the remedial measures mentioned above, Asclepiades placed his chief

dependence on the following: abstinence from meat; the employment of

wine under certain well-defined circumstances; massage and frictions;

baths of different kinds (it is said that he devised a great variety);

walking; driving and being carried about in the open air in a litter

or in a boat on a quiet river or in the protected harbor. One of his

remedies in the case of sleeplessness consisted in having the patient

placed in a suspended couch which could easily be rocked from side to

side. As all these measures were agreeable and could at the same time

easily be employed by almost everybody, they met with general favor,

and in consequence Asclepiades was looked upon by the Romans as “a

person sent from heaven.” As a rule, he recommended the drinking of

simple water, but in certain cases (to be mentioned farther on) he did

not hesitate to advise the taking of wine in moderation. He advocated

tracheotomy, in cases of inflammation of the throat, in preference to

the then prevailing practice--both very painful and quite difficult to

carry out--of introducing a tube of some kind as a means of opening a

passage for the entrance of air into the lungs.

Le Clerc quotes Galen as authority for the statement that Asclepiades,

who never hesitated for an instant to criticise the different

therapeutic procedures of his predecessors, did not go so far as to

condemn wholly the practice of bloodletting. Indeed, he was quite ready

to employ it in the treatment of painful affections because, as he

claimed, the pain was caused “by the retention of the larger particles

or atoms in the pores or channels of the tissues, and hence--as

these particles were composed of blood--bloodletting was the only

remedy capable of setting them free.” Thus, he resorted to bleeding

in pleurisy, because this affection is characterized by pain; but he

abstained from employing the remedy in “peripneumonia” or “inflammation

of the lung,” because in most cases it is not accompanied by pain;

and he also did not approve of its employment in inflammation of the

brain (_phrenitis_). On the other hand, he advocated bleeding

in epilepsy and all forms of disease in which convulsions occurred,

and he also advocated it in cases of hemorrhage of every description.

Quinsy sore throat was another malady in which he drew blood freely

from the veins of the arm, of the temple and even of the tongue; and

in addition, when the disease was severe, he scarified the skin at

suitable spots and applied cups to the part. In all these measures

his purpose was “to open the pores”; and when this treatment failed

he incised the tonsils or the uvula, and even, as a last resort,

performed laryngotomy or tracheotomy. In cases of dropsy he employed

_paracentesis abdominis_,--that is, he made a very small opening

in the abdominal wall to serve as an outlet for the fluid contained in

the peritoneal cavity. From these facts it is evident that Asclepiades

did not always abide by his rule not to use any but very gentle

remedies.

Asclepiades showed, in his manner of treating still other pathological

conditions, how different was his practice from that of his

predecessors. In the first place, he was very partial, as has already

been stated, to such extremely mild forms of physical exercise in

the open air as one can obtain from driving or from being carried

in a litter or a boat. He prescribed these measures, not merely for

convalescents but also for those, for example, who were still in the

midst of an active fever. His idea was, that by means of such very

gentle forms of exercise the pores would become less clogged and

would permit the juices of the body to flow more freely. In cases of

dropsy, also, he was in the habit of employing friction for precisely

the same purpose. He even used this remedy in cases of inflammation

of the brain, in the expectation that he might thereby induce sleep

for these patients. Indeed, this subject of frictions was one on which

Asclepiades wrote at greater length than on any other remedial agent.

It is a surprising fact that, in common with Erasistratus, he taught

the doctrine that physical exercise was not at all necessary to persons

in normal health. At the same time he approved of it, when carefully

graded, for those who were affected with bodily ills of a certain

nature.