AN EPITOME OF THE HISTORY OF MEDICINE
By Roswell Park, A.M., M.D.
Professor of Surgery in the Medical Department of the University of
Buffalo, etc.
Based Upon A Course Of Lectures Delivered In The University Of Buffalo.
Illustrated with Portraits and Other Engravings.
1897,
The F. A. Davis Company. [Registered At Stationers' Hall. London, Eng.]
"Destiny Reserves for us Repose Enough."--Fernel.
TO MY COLLEAGUES
IN THE
MEDICAL FACULTY OF THE UNIVERSITY OF BUFFALO,
Who Authorized and Encouraged this First Attempt in the Medical Schools
of this Country to Give Systematic Instruction in the History or the
Science which they Teach,
THIS BOOK
Is Dedicated.
PREFACE.
The history of medicine has been sadly neglected in our medical schools.
The valuable and fruitful lessons which it tells of _what not to do_
have been completely disregarded, and in consequence the same gross
errors have over and over been repeated. The following pages represent
an effort to bring the most important facts and events comprised within
such history into the compass of a medical curriculum, and, at the same
time, to rehearse them in such manner that the book may be useful and
acceptable to the interested layman.,--i.e., to popularize the subject.
This effort first took form in a series of lectures given in the Medical
Department of the University of Buffalo. The subject-matter of these
lectures has been rearranged, enlarged, and edited, in order to make it
more presentable for easy reading and reference. I have also tried, so
far as I could in such brief space, to indicate the relationship
which has ever existed between medicine, philosophy, natural science,
theology, and even _belles-lettres_. Particularly is the history of
medicine inseparable from a consideration of the various notions and
beliefs that have at times shaken the very foundation of Christendom and
the Church, and for reasons which appear throughout the book.
The history of medicine is really a history of human error and of human
discovery. During the past two thousand years it is hard to say which
has prevailed. Notwithstanding, had it not been for the latter the total
of the former would have been vastly greater. A large part of my effort
has been devoted to considering the causes which conspired to prevent
the more rapid development of our art. If among these the frowning or
forbidding attitude of the Church figures most prominently, it must not
be regarded as any expression of a quarrel with the Church of to-day.
But let any one interested read President White's _History of the
Warfare of Science with Theology_, the best presentation of the subject,
and he can take no issue with my statements.
Reverence for the true, the beautiful, and the good has characterized
physicians in all times and climes. But little of the true, the
beautiful, or the good crept into the transactions of the Church for
many centuries, and we suffer, to-day, more from its interference in
time past than from all other causes combined. The same may be said of
theology, which is as separate from religion as darkness from light.
Only when students of science emancipated themselves from the prejudices
and superstitions of the theologians did medicine make more than barely
perceptible progress.
In this connection I would like to quote a paragraph from an article
by King, in the _Nineteenth Century_ for 1893: "The difficulties under
which medical science labored may be estimated from the fact that
dissection was forbidden by the clergy of the Middle Ages on the ground
that it was impious to mutilate a form made in the image of God. We
do not find this pious objection interfering with such mutilation when
effected by means of the rack and wheel and such other clerical, rather
than medical, instruments."
Written history is, to a certain extent at least, plagiarism; and I make
no apology for having borrowed my facts from whatever source could
best furnish them, but wish cheerfully and publicly to acknowledge my
indebtedness to the works mentioned below, those especially of Renouard,
Baas, and Sprengel, and to various biographical dictionaries. I have
not even scrupled to take bodily sentences or expressions from these
authorities, but have tried to so indicate them when I could.
The writer takes pleasure in acknowledging here the obligations which
both he and the publishers feel to Dr. Joseph H. Hunt, of Brooklyn, N.
Y., from whose extensive and valuable collection have been furnished the
originals for most of the portraits in the following pages, and to
Dr. F. P. Henry, Honorary Librarian of the College of Physicians of
Philadelphia, through whose courtesy was obtained the privilege of
reproducing the illustrations of instruments and operations from some
of the rare old works in the college library. The kind co-operation of
these gentlemen has given a distinct and added value to the contents of
this little work.
LIST OF PRINCIPAL WORKS CONSULTED.
Baas, Outlines of the History of Medicine. Translated by Henderson. New
York, 1889.
Berdoe, Origin and Growth of the Heeding Art. London, 1893.
Bouchut, Histoire de la Médecine. Paris, 1873.
Dezeimeris, Lettres sur VHistoire de la Médecine. Paris, 1838.
Dietionnaire Historique de la Médecine. Paris, 1828.
Haeser, Geschiehte der Medicin. Jena, 1853.
Hirsch, Biographisehes Lexikon des Hervorragendeu der Aerzte aller
Zeiten und Vülker. Wien und Leipzig, 1884.
Portal, Histoire de VAnatomie et de la Chirurgie. Paris, 1770.
South, Memorials of the Craft of Surgery in England. London, 1886.
Sprexgel, Geschicute der Chirurgie. Halle, 1819.
CONTENTS.
CHAP I.
Medicine Among the Hebrews, the Egyptians, the Orientals, the Chinese,
and the Early Greeks.--The Asclepiadæ.--Further Arrangement into Periods
(Renouard's Classification). The Age of Foundation.--The Primitive;
Sacred, or Mystic; and Philosophic Periods.--Systems in
Vogue: Dogmatism, Methodism, Empiricism,
Eclecticism.--Hippocrates...................................... 1-29
CHAP II.
AGE OF Foundation (continued).--Anatomic Period: Influence of the
Alexandrian Library. Herophilus and Erasistratus. Aretæus. Cel-sus.
Galen.--Empiricism: Asclepiades.--Methodism: Theinison.--Eclecticism.
Age of Transition.--Greek Period: Oribasins. Ætius. Alexander of
Tralles. Paulus Ægineta............ 30-56
CHAP III.
Age of Transition (continued).--Arabic Period: Alkindus. Mesue.
Rhazes. Haly-Abbas. Avicenna. Albucassis. Avenzoar. Averroës.
Maimonides.--School of Salernum: Constantinus Africanus. Roger
of Salerno. Roland of Parma. The Four Masters. John of
Procida................................................. 57-85
CHAP IV
Age of Transition ( concluded).--The School of Montpellier: Raimond
Lulli. John of Gaddesden. Arnold of Villanova. Establishment of Various
Universities. Gerard of Cremona. William of Salicet. Lanfranc. Mondino.
Guy de Chauliac. Age of Renovation.--Erudite Period, including the
Fifteenth and Sixteenth Centuries. Thomas Linacre. Sylvius. Vesalius.
Columbus. Eustaclius. Fallopius. Fabricius ab Aquapendente. Fabricius
Hildanus.. 86-113
CHAP V.
Age of Renovation (continued).--Erudite Period (continued): Beni-vieni.
Jean Fern el. Porta. Severino. Incorporation of Brother-hood of St. Come
into the University of Paris. Ambroise Paré. Guillemeau. Influence
of the Occult Sciences: Agrippa. Jerome Cardan. Paracelsus. Botal.
Joubert...................... 114-147
CHAP VI.
Age of Renovation (continued).--Stndent-life During the Fifteenth
and Sixteenth Centuries. Ceremonials Previous to Dissection.--Reform
Period: The Seventeenth, Eighteenth, and Nineteenth Centuries. Modern
Realism in Medicine and Science. Introduction of the Cell-doctrine.
Discovery of the Circulation. William Harvey. Malpighi. Leuwenhoek.
Correct-Doctrine of Respiration. Discovery of the Lymphatic Circulation.
The Nervous System. Discovery of Cinchona. Development in Obstetric
Art, in Medical Jurisprudence, and in Oral Clinical Teaching. Van
Helmont.--The Iatrochemical System: Le Bôe. Thomas Willis... 148-170
CHAP VII.
Age of Renovation (continued).--latromechanical School: Santoro.
Borelli. Sydenham. Sir Thomas Browne.--Surgery: Denis. F. Collot.
Dionis. Baulot (Frère Jacques). Scultetus. Rau. Wiseman. Cowper. Sir C.
Wren the Discoverer of Hypodermatic Medication. Anatomical Discoveries.
General Condition of the Profession During the Seventeenth Century.
The Eighteenth Century. Boerliaave. Gaub.--Animism:
Stahl.--Jlechanico-dynamic System: Hoffmann. Cullen.--Old Vienna
School: Van Swieten. De Haën.--Vitalism: Bordeu. Erasmus Darwin
.................171-202
CHAP VIII.
Age of Renovation (continued).--Animal Magnetism: Mesmer. Braid.
--Brunonianism: John Brown.--Realism: Pinel. Bichat. Avenbrugger.
Werlliof. Frank.--Surgery: Petit. Desault. Scarpa. Gimbernat. Heister.
Von Siebold. Richter. Cheselden. Monro (1st). Pott. John Hunter. B.
Bell, J. Bell, C. Bell. Smellie. Denman.--Revival of Experimental Study:
Haller. Winslow. Portal. Yieq d'Azvr. Morgagni.--Inoculation against
Smallpox: Lady Montagu. Edward Jenner.............................
203-221
CHAP IX.
Age of Renovation (continued).--The Eighteenth Century; General
Considerations. Foundation of Learned Societies, etc. The Royal College
of Surgeons; the Josephinum.--The Nineteenth Century Realistie Reaction
Against Previous Idealism. Influence of Comte, of Claude Bernard,
and of Charles Darwin. Influence Exerted by Other Sciences.--Theory
of Excitement: Roeschlaub.--Stimolo and Contrastimolo:
Kasori.--Homoeopathy: Halineiaim.--Isopatly, Electrohomoeopathy
of Mattei.--Cranioscopy, or Phrenology: Gall and Spurzlieim.--The
Physiological Theory: Broussais.--Paris Pathological School:
Cruveillier. Andral. Louis. Magendie. Trousseau. Claude
Bernard.--British Medicine: Bell and Hall. Travel's.--Germany, School
of Natural Philosophy: Johannes Müller.--School of Natural
History: Schonlein.--New Vienna School: Rokitansky.
Skoda.................................... 230-252
CHAP X.
Age of Transition (concluded).--New Vienna School (concluded): von
Hebra. Czermak and Türck. Juger. Arlt. Gruber. Politzer.--German
School of Physiological Medicine: Roser.--School of Rational
Medicine: Henle.--Pseudoparacelsism: Rademaeher.--Hydrotherapeutics:
Priessnitz.--Modern Vitalism: Virchow.--Seminalism: Bouchut.--Parasitism
and the Germ-theory: Davaine. Pasteur. Chauveau. Klebs. F. J.
Cohn. Koch. Lister.--Advances in Physical Diagnosis: Laënnec.
Piorry.--Surgery: Delpecli. Stro-meyer. Sims. Bozeman. McDowell. Boyer.
Larrey. Dupuytren. Cloquet. Civiale. Vidal. Velpeau. Malgaigne.
Nélaton. Sir Astley Cooper. Brodie. Guthrie. Syme. Simpson. Langenbeck.
Billroth.................................................. 253-275
CHAP XI.
History of Medicine in America.--The Colonial Physicians. Medical Study
under Preceptors. Inoculation against Small-pox. Military Surgery During
the Revolutionary War. Earliest Medical Teaching and Teachers in this
Country. The First Medical Schools. Benjamin Rush. The First Medical
Journals. Brief List of the Best-Known American Physicians and
Surgeons.... 276-299
CHAP XII.
The History of Anæsthesia.--Anæsthesia and Analgesia. Drugs Possessing
Narcotic Properties in use since Prehistoric Times. Mandragora; Hemp;
Hasheesh. Sulphuric Ether and the Men Concerned in its Introduction as
an Anæsthetic--Long, Jackson, Wells, and Morton. Morton's First Public
Demonstration of the Value of Ether. Morton Entitled to the Credit of
its Introduction. Chloroform and Sir Janies Simpson. Cocaine and Karl
Koller.............................................. 300-315
CHAP XIII.
The History of Antisepsis.--Sepsis, Asepsis, and Antisepsis. The
Germ-theory of Disease. Gay-Lussac's Researches. Schwann. Tyndall.
Pasteur. Davaine. Lord Lister and his Epoch-making Revolution in
Surgical Methods. Modifications of his Earlier Technique without Change
in Underlying Principles, which Still Remain Unshaken. Changes Effected
in Consequence. Comparison of Old and Modern Statistics...........
316-329
CHAP XIV.
Ax Epitome of the History of Dentistry.--Rude Dentistry of Prehistoric
Times. Early Instruments for Extraction Made of Lead. Dentistry on the
Same Low Plane as Medicine During the First. Half of the Christian Era.
Dentistry Taught at the School of Salernum. Progress of the Art on the
Continent. Prosthesis and Substitutes for Human Teeth. Introduction of
Porcelain for Artificial Teeth; of Metal and of Vulcanized Rubber for
Plates; of Plaster for Impressions. From being a Trade, Dentistry is now
a Profession, in which Americans lead the World. Statistics... 330-341
LIST OF ILLUSTRATIONS.
1. Æsculapius,..................................007
2. Offering to Æsculapius,......................009
3. Hippocrates,.................................019
4. Aulus Cornelius Celsus,......................035
5. The Conversion of Galen,.....................037
6. Averroës,....................................064
7. Andreas Vesalius,............................105
8. Title-page, Seven Books of the Anatomy,......106
9. IV, Forceps for Extracting Balls.............108
10. Gabriel Fallopius,..........................109
11. Forms of Forceps for Enlarging Wounds,......111
12. Body Showing Various Kinds of Wounds,.......117
13. Mode of Extracting Leaden Bullets,..........121
14. Ambroise Parc,..............................124
15. Pliers, Iron for Actual Cautery,............126
16. Swan's Beak, Used for Dilating..............129
17. Instruments for the Extraction of Balls,....131
18. Spéculums for the Mouth and Womb, etc.,.....133
19. Amputation Instruments,.....................135
20. Different Forms of Trephines and Pliers,....137
21. Philip Theophrastus Paracelsus,.............143
22. William Harvey, M.D.,.......................156
23. Thomas Sydenham,............................173
24. Straight Saws and Divers Scraping Tools,....179
25. Surgical Treatment of Dislocations,.........181
26. Operations on the Arms and Lower Limbs,.....185
27. Surgical Operations on the Breast, etc.,....187
28. Boerhaave,..................................193
29. John Brown, M.D.,...........................205
30. Ph. Pinel,..................................207
31. Marie François Xavier Bicliat, M.D.,........208
32. William Hunter, M.D., F.R.S.,...............217
33. John Hunter,................................219
34. J. F. Blumenbacli,..........................223
35. Edward Jenner, M.D.,........................227
36. Samuel Hahnemann,...........................242
37. Rudolph Virchow,............................257
38. Bernhard von Langenbeck,....................265
39. Theodor Billroth,...........................266
40. Sir Astley Cooper, Bart.,...................272
41. Sir Benjamin Collins Brodie, F.R.S.,........273
42. B. Waterhouse, M.D.,........................280
43. Surgeon's Hall,.............................281
44. Benjamin Rush, M.D.,........................284
45. George B. Wood, M.D.,.......................286
46. Robley Dunglison, M.D.,.....................287
47. Austin Flint, M.D.,.........................288
48. Isaac Ray, M.D.,............................289
49. Philip Sung Physick, M.D.,..................291
50. Ephraim McDowell, M.D.,.....................292
51. S. D. Gross, M.D., LL.D.,...................294
52. J. Marion Sims, M.D.,.......................296
53. D. Hayes Agnew, M.D., LL.D.,................297
54. William T. G. Morton, M.D.,.................307
55. Dr. Morton, October 16, 1846,...............309
56. Lord Lister, M.D., D.C.L., LL.D.,...........323
AN EPITOME OF THE HISTORY OF MEDICINE.
CHAPTER I.
_Medicine Among the Hebrews, the Egyptians, the Orientals, the Chinese,
and the Early Greeks.--The Asclepiadæ.--Further Arrangement into Periods
( Renouard's Classification). The Age of Foundation.--The Primitive;
Sacred, or Mystic; and Philosophic Periods.--Systems in Vogue:
Dogmatism, Methodism, Empiricism, Eclecticism.--Hippocrates, born 460
B.C._
Of the{001} origin of medicine but little need be said by way of
preface, save that it must have been nearly contemporaneous with
the origin of civilization. The lower animals when sick or wounded
instinctively lessen or alter their diet, seek seclusion and rest,
and even in certain cases seek out some particular herb or healing
substance. Thus, too, does the savage in his primitive state; and
experience and superstition together have led nearly all the savage
tribes into certain habits and forms in case of injury or disease.
For us the history of medicine must necessarily begin with the written
history of events, and its earliest endeavors need detain us but a very
short time. Its earliest period is enveloped in profound obscurity, and
so mingled with myth and table as to be very uncertain. It embraces
an indefinite time, during which medicine was not a science, but an
undigested collection of experimental notions,--vaguely described,
disfigured by tradition, and often made inutile by superstition and
ignorance. The earliest records of probable authenticity are perhaps to
be met with in the Scriptures, from which may be gathered here and there
a fair notion of Egyptian knowledge and practice. Thus we read that
Joseph commanded his servants and physicians to embalm him, this being
about 1700 B.C.. It shows that Egypt at that time possessed a class of
men who practiced the{002} healing art, and that they also embalmed
the dead, which must have both required and furnished a crude idea
of general anatomy. We are also informed from other sources that so
superstitious were the Egyptians that they not only scoffed at, but
would stone, the embalmers, for whom they had sent, after the completion
of their task. The probably mythical being whom the Egyptians called
Thoth, whom the Greeks named Hermes and the Latins Mercury, passed
among the Egyptians as the inventor of all sciences and arts. To him are
attributed an enormous number of writings concerning all subjects. Some
have considered him as identical with Bacchus, Zoroaster, Osiris, Isis,
Serapis, Apollo, and even Shem, the son of Xoah. Others have thought
him to be a god. It is now almost certain that the books attributed to
Hermes were not the work of anyone hand or of any one age. The-last six
volumes of the forty-two composing the encyclopaedia, with which Hermes
is credited, refer to medicine, and embrace a body of doctrines fairly
complete and well arranged. Of these six, the first treats of anatomy;
the second, of diseases; the third, of instruments; the fourth, of
remedies; the fifth, of diseases of the eye; and the sixth, of diseases
of women. In completeness and arrangement it rivals, if not surpasses,
the Hippocratic collection, which it antedated by perhaps a thousand
years. The Egyptians appear at first to have exposed their sick in
public (at least, so says Strabo), so that if any of those who passed by
had been similarly attacked they might give their advice for the benefit
of the sufferers. In fact, according to Herodotus, the same custom
prevailed among the Babylonians and Lusitanians. At a later date all who
were thus cured were required to go to the temples and there inscribe
their symptoms and what had helped them. The temples of Canopus and
Vulcan at Memphis became the principal depots for these records, which
were kept as carefully as were the archives of the nation, and were open
for{003} public reference. These records, being under the control of the
priests, were mainly studied by them, who later collected a great mass
of facts of more or less importance, and endeavored to found upon the
knowledge thus collected an exclusive practice of the art of medicine.
In this way they formed their medical code, which was called by Diodorus
the Hiera Sacra, _Sacred Book_, from whose directions they were never
allowed to swerve. It was perhaps this code which was later attributed
to Hermes, and that made up the collection spoken of by Clement of
Alexandria. If in following these rules they could not save their
patients they were held blameless, but were punished with death if any
departure from them were not followed by success.
I have spoken of embalming as practiced by the Egyptians. It was of
three grades: the first reserved for men of position and means, which
cost one talent, and according to which the brain was removed by an
opening through the nasal fossæ, and the intestines through an opening
on the left side of the abdomen, after which both cavities were stuffed
with spices and aromatics; then the body was washed and spread over with
gum and wrapped in bandages of linen. The second grade was adopted by
families of moderate means; and the third was resorted to by the poor,
consisting simply in the washing of the body and maceration in lye for
seventy days.
Pliny assures us that the kings of Egypt permitted the opening of
corpses for the purpose of discovering the causes of disease, but this
was only permitted by the Ptolemies, under whose reign anatomy was
carried to a very high degree of cultivation.
The medicine of the Hebrews is known generally through the Sacred
Scriptures, especially through the writings attributed to Moses, which
embraced rules of the highest sagacity, especially in public hygiene.
The book of Leviticus{004} is largely made up of rules concerning
matters of public health. In the eleventh chapter, for instance, meat
of the rabbit and the hog is proscribed, as apparently injurious in the
climate of Egypt and India; it, however, has been suggested that there
was such variation of names or interpretation thereof as to make it
possible that our rabbit and hog are not the animals alluded to by
Moses. The twelfth and fifteenth chapters of the same book were designed
to regulate the relation of man and wife and the purification of women,
their outlines being still observed in some localities by certain sects,
while the hygienic measure of circumcision then insisted upon is still
observed as a religious rite among the descendants of Moses. For the
prevention of the spread of leprosy, the measures suggested by Moses
could not now be surpassed, although ancient authors have confounded
under this name divers affections, probably including syphilis, to
which, however, the same hygienic rules should apply. Next to Moses in
medical lore should be mentioned Solomon, to whom is attributed a very
high degree of knowledge of natural history, and who, Josephus claimed,
had such perfect knowledge of the properties of all the productions
of nature that he availed himself of it to compound remedies extremely
useful, some of which had even the virtues necessary to cast out devils.
The most conspicuous feature in the life of the Indian races is their
division into castes, of which the most noble is that of the priests,
or Brahmins, who in ancient times alone had the privilege of practicing
medicine. Their Organon of Medicine, or collection of medical knowledge,
was a hook which they called _Vagadasastir_. It was not systematically
arranged, and in it demonology played a large rôle. They held the human
body to consist of 100,000 parts, of which 17,000 were vessels, each one
of which was composed of seven tubes, giving passage to ten species of
gases, which by their conflicts engendered a number of diseases.{005}
They placed the origin of the pulse in a reservoir located behind the
umbilicus. This was four fingers wide by two long, and divided into
72,000 canals, distributed to all parts of the body. The physician
examined not only the pulse of his patient, but the dejecta, consulted
the stars, the flight of birds, noted any incidental occurrence during
his visits, and made up his prognosis from a multitude of varying
circumstances, omitting only those which were really valuable, namely,
the symptoms indicating the state of the organs. Ancient Hindoo
charlatan priests let fall from the end of a straw a drop of oil into
the patient's water. If the oil was precipitated and attached itself to
the bottom of the vessel, they predicted an unfavorable result; if, on
the contrary, it floated, they gave a favorable prognosis. This is,
so far as we know, the earliest recorded way of testing the specific
gravity of the urine.
With all their absurdities, however, the Indians appear to have done
some things that we scarcely do to-day: they arè said to have had an
ointment that caused the cicatrices of variola to disappear, and they
cured the bites of venomous serpents with remedies whose composition has
been lost.
The antiquity of the Chinese is simply lost in tradition and fable. From
time immemorial their rulers have taken extraordinary care to prevent
contact and interchange of ideas with foreigners. For 4000 years their
manners, laws, religious beliefs, language, and territory have scarcely
changed. In this respect they stand alone among the nations of the
earth. They attribute the invention of medicine to one of their emperors
named Hoam-ti, who was the third of the first dynasty, and whose
supposititious date is 2687 B.C. He is considered to be the author of
the work which still serves them as a medical guide. It is, however,
more probably an apochryphal book. Its philosophy was of a sphygmic
kind,--i.e., based upon the pulse, which they divided{006} into the
supreme or celestial, the middle, and the inferior or terrestrial; by
the examination of which the Chinese physician was supposed not only to
show the seat of disease, but to judge of its duration and gravity. It
is related that one of the ancient Chinese emperors directed the dead
bodies of criminals to be opened, but this is questionable, since it
is certain that they have the most profound ignorance of rudimentary
anatomy, and glaring errors abound in their system. Being thus replete
with errors, and possessing no anatomical knowledge, their surgery was
of the most barbarous type. No one dared attempt a bloody operation; the
reduction of hernia was unknown; a cataract was regarded as beyond their
resources; and even venesection was never practiced. On the other hand,
they employed cups, and acupuncture, fomentation, plasters of all kinds,
lotions, and baths. The moxa, or red-hot button, was in constant use,
and they had their magnetizers, who appear to have been convulsionists.
For a long time there existed at Pekin an Imperial School of Medicine,
but now there is no such organization nor any regulation for the
privilege of practicing medicine or surgery since 1792. At least until
lately the country and the cities were infested with quacks, who dealt
out poison and death with impunity. They practiced most murderous
methods in place of the principles of midwifery. Only since the
civilized missionaries have penetrated into their country has there been
any improvement in this condition of affairs.
It is Greece which furnishes us with the most interesting and the most
significant remains of the history of medicine during antiquity, as she
furnishes every other art with the same historical advantages. During
the period preceding the Trojan War there is little hut myth and
tradition. Leclerc catalogued some thirty divinities, heroes or
heroines, who were supposed to have invented or cultivated some of the
branches of medicine. _Melampus_ is perhaps{007} the first of these who
immortalized himself by extraordinary cures, especially on the daughters
of Proetus, King of Argos. These young princesses, having taken vows
of celibacy, became subjects of hysterical monomania, with delusions,
during which they imagined themselves transformed into cows and roamed
the forests instead of the palaces. This nervous delusion spread to and
involved many other women, and became a serious matter.
[Illustration: 0027]
Melampus, the shepherd, having observed the purgative effects upon goats
of white hellebore, gave to the young women milk in which this plant
had been steeped, thereby speedily effecting a cure. Scarcely less
distinguished than Melampus was _Chiron_. He was mainly distinguished
because he was the preceptor of _Æsculapius_, the most eminent of early
Greeks in this field. By some Æsculapius was considered the son of
Apollo by the nymph Coronis.
Several{008} cities of Greece contended for the honor of his birthplace,
as they did for that of Homer. That he was famous at the time of the
Argonautic expedition is seen by the fact that the twins Castor and
Pollux desired him to accompany the expedition as surgeon. Be his origin
what it may, Æsculapius was the leading character in medicine of all the
ancients, with the possible exception of Hermes among the Egyptians; in
fact, some scholars consider the two identical. Temples were erected in
his honor, priests were consecrated to them, and schools of instruction
were there established. It is related that Pluto, god of hell, alarmed
at the diminishing number of his daily arrivals, complained to Jupiter,
who destroyed the audacious healer--on which account, some wit has said,
"the modern children of Æsculapius abstain from performing prodigies,"
But the true Æsculapians, the successors of the demigod, wrere imitated
or copied by the crowd of charlatans and quacks, calling themselves
theosophs, thaumaturgs, and so on, and not alone at that date, but for
generations and centuries thereafter, Paracelsus and Mesmer being
fair examples of this class. The poet Pindar, who lived seven or eight
hundred years after Æsculapius, says that he cured ulcers, wounds,
fever, and pain of all who applied to him by enchantment, potions,
incisions, and by external applications. *
* Third Pythian Ode,
The followers of Æsculapius, and the priests in the temples dedicated to
him, soon formed a separate caste, transmitting from one to another, as
a family heritage, their medical knowledge. At first no one was admitted
to practice the sacred science unless lie joined the priesthood,
although later this secrecy was relaxed. They initiated strangers,
provided they fulfilled the test which they made. Some kind of medical
instruction was given in each temple. The three most celebrated temples
to Æsculapius were that of Rhodes, already extinct by the time of
Hippocrates; that{009} of Cnidus, which published a small repertory; and
finally that of Cos, most celebrated of all, because of the illustrious
men who emanated from this school. In these temples votive tablets were
fastened in large numbers, after the fashion of the Egyptians, the same
giving the name of the patient, his affliction, and the manner of
his cure. For example, such a one as this: "Julien vomited blood,
and appeared lost beyond recovery. The oracle ordered him to take the
pine-seeds from the altar, which they had three days mingled with honey;
he did so, and was cured."
[Illustration: 0029]
Having solemnly thanked the god, he went away. There is reason to think
that the priests of these temples made for their own uses much more
minute and accurate accounts, which should be of some real service,
since the writings which have come down to us evince a habit of close
observation and clear description of disease. During the Trojan War{010}
two men are frequently mentioned by Homer as possessing great surgical
skill. These were _Machaon_ and _Podalirius_. They were regarded as
sons of Æsculapius, the former being the elder. The first account of
venesection, although not authentic, refers to the bleeding practiced
by the latter upon the daughter of the King of Caria, upon whose shores
Podalirius was cast by tempest after the ruin of Priam's kingdom.
Whether he was the first of all men to practice it or not, it is
certain that the act of venesection goes back long prior to the era of
Hippocrates, who speaks of it as frequently performed.
Many of the deities upon Olympus seem at one time or another to have
usurped medical functions. Apollo, the reputed father of Æsculapius,
appropriated nearly everything under the name of Pæon, who assumed
the privilege of exciting or subduing epidemics. Juno was supposed
to preside at accouchements, and in both the Iliad and Odyssey it is
indicated that Apollo was considered as the cause of all the natural
deaths among men, and Diana of those among women.
The long Trojan War appears to have been an epoch-making event in
the medical and surgical history of those times, as was the Civil War
recently in our country. Certain vague and indefinite practices then
took more fixed form, and from that time on medicine may be said to have
been furnished with a history. After the dethronement of Priam and the
destruction of his capital, navigation was free and unrestricted. The
Hellenists covered with their colonies both shores of the Mediterranean,
and their navigators even passed the pillars of Hercules. By these means
the worship of Æsculapius passed from Greece into what is now Asia,
Africa, and Italy. In his temple at Epidaurus was a statue of colossal
size made of gold and ivory. The dialogues of Plato, especially the
Phædo, make it apparent that the cock was the animal sacrificed to him,
and hence sacred to the god of medicine. The priests attached to{011}
his worship were called _Asclepiacloe_, or descendants of Æsculapius.
The temples were usually hygienically located near thermal springs or
fountains and among groves. Pilgrimages were made from all quarters,
and these localities became veritable health-resorts. A well-regulated
dietary, pure air, temperate habits, and faith stimulated to a fanatical
degree combined and sufficed for cures which even nowadays would be
regarded as wonderful. The priests prescribed venesection, purgatives,
emetics, friction, sea-baths, and mineral waters, as they appeared to
be indicated. The imagination of the patient was continually stimulated,
and at the same time controlled. Before interrogating the oracles they
must be purified by abstinence, prayer, and sacrifice. Sometimes they
were obliged to lie in the temple for one or more nights. The gods
sometimes revealed themselves in mysterious ways, at times devouring
the cakes upon the altars under the guise of a serpent, or again causing
dreams which were to be interpreted by^the priests. There can be no
doubt that sometimes, at least, the grossest frauds and the basest
trickery were relied upon for the purpose of impressing the minds
of those weakened by abstinence or influenced by drugs. Mercenary
considerations were not lacking; moreover, cures were often not obtained
until zeal had been redoubled by largely increased contributions to the
treasury of the temples. In the neighborhood of many of these temples
serpents abounded, non-venomous and easily tamed. These were employed by
the priests in various supernatural performances by which the ignorant
people were astonished and profoundly impressed. In fact, the serpent
and the serpent-myth played a very large rôle in the early history of
medicine as well as that of religion and religious symbolism.
It will thus be seen that during the space of about 700 years medicine
underwent a transformation in Greece. It was first domestic and
popular, practiced by shepherds, soldiers,{012} and others; then became
sacerdotal; after the Trojan War it was confined to the vicinity of the
temples and practiced in the name of some divinity; and finally it was
wrapped in mystery and mystic symbolism, where superstition was
played upon and credulity made to pay its reward. Down to the time of
Hippocrates the Asclep-iadæ rendered some genuine service to science,
especially by inculcating habits of observation, in which Hippocrates
excelled above all. Later, however, down to the time of the Christian
era, medicine in the temples declined, and became, in fact, a system
based upon the grossest jugglery.
It is time now that we make a systematic attempt to classify events in
the history of medicine, and to recognize certain distinct epochs as
they have occurred. For this purpose I know of no better arrangement
than that of Renouard, which, in the main, I shall follow, at least
during the forepart of this book. In this sense he divides the past into
three ages, known, respectively, as the _Age of Foundation, the Age
of Transition, and the Age of Renovation_. Each of these chronological
divisions is subdivided into periods, of which the first contains
four:--
AGE OF FOUNDATION.
1. The _Primitive Period_, or that of _Instinct_, beginning with myth,
and ending with the destruction of Troy 1184 years before Christ.
2. The _Sacred, or Mystic, Period_, ending with the dispersion of the
Pythagorean Society, 500 years before Christ.
3. The _Philosophic Period_, terminating with the foundation of the
Alexandrian library, 320 years before Christ.
4. The _Anatomic Period_, ending with the death of Galen, about A.D.
200.
THE SECOND AGE, OR THAT OF TRANSITION, is divided into a fifth, or
_Greek Period_, ending at the burning of the Alexandrian library, A.D.
640, and a sixth, _Arabic Period_, ending with the revival of letters,
A.D. 1400.
THE THIRD AGE, OR THAT OF RENOVATION,{013} includes the seventh, or
_Erudite Period_, comprising the fifteenth and sixteenth centuries, and
eighth, or _Reform Period_, comprising the seventeenth, eighteenth, and
nineteenth centuries.
Examining this table for a moment, it will be seen that so far we have
dealt with the Primitive Period and the Sacred, or Mystic, Period.
Before passing on to the Philosophic Period let us for a moment follow
Renouard, who likens the three schools of medical belief in the earlier
part of the Primary Age, or the Age of Foundation, to the three schools
of cosmogony, which obtained among the Greeks. The first of these
was headed by Pythagoras, who regarded the universe as inhabited by
acknowledged sentient principles which governed all substances in a
determined way for preconceived purposes. Animals, plants, and even
minerals were supposed to possess vivifying spirits, and above them
all was a supreme principle. To this school corresponded the so-called
Dogmatic School of medicine, attributed to Hippocrates, which was the
precursor of modern vitalism, and regarded diseases as indivisible
units from beginning to termination; in other words, they consisted of a
regular programme of characteristic systems, successive periods, and
of long course, either for the better or worse; that was one of the
characteristic dogmas of the Hippocratic teaching. The Second System of
cosmogony was that founded by Leucippus and Democritus, who explained
all natural phenomena without recourse to the intervention of
intelligent principles. All things for them existed as the necessary
result of the eternal laws of matter. They denied preconceived purposes
and ridiculed final causes. To this system corresponded that in medicine
which has been termed _Methodism_ (medically and literally speaking) and
which recognized as its founders Æsculapius and Themison. The believers
in this doctrine attempted to apply the atomic theory of Democritus
and{014} Epicurus to the theory and practice of medicine. Atoms of
various size were supposed to pass and repass without cessation through
cavities or pores in the human body. So long as the atoms and pores
maintained a normal relationship of size and proportion health was
maintained, but it was deranged so soon as the exactness of these
relations was destroyed or interfered with. The Dogmatists considered
vital reaction as a primary phenomenon, while with the Methodists it
was secondary. The Third System of cosmogony, founded by Parmenides and
Pyrrho, believed in the natural improvement of bodies in their endless
reproduction and change, and concluded that wisdom consisted in
remaining in doubt; in other words, they were the agnostics of that day.
"What is the use," said they, "of fatiguing the mind in endeavoring to
comprehend what is beyond its capability." Later they were known as
Skeptics and Zetetics, to indicate that they were always in search of
truth without flattering them selves that they had found it. To them
corresponded a third class of physicians, with Philinus and Serapis at
their head, who deemed that proximate causes and primitive phenomena of
disease were inaccessible to observation; that all that is affirmed
on these subjects is purely hypothetical, and hence unworthy of
consideration in choosing treatment. For them objective symptoms--or,
as we would say, signs--constituted the natural history of disease,
they thus believing that their remedies could only be suggested by
experience, since nothing else could reveal itself to them. They
therefore took the name of _Empirics_.
Finally a fourth class of physicians arose who would not adopt any one
of these systems exclusively, but chose from each what seemed to them
most reasonable and satisfactory. They called themselves _Eclectics_,
wishing thereby to imply that they made rational choice of what seemed
best. The idea conveyed in the term "eclecticism" has been fairly
criticised for this reason: eclecticism is in reality neither{015} a
system nor a theory; it is individual pretension elevated to the dignity
of dogma. The true eclectic recognizes no other rule than his particular
taste, reason, or fancy, and two or more eclectics have little or
nothing in common. If that were true two thousand years ago, it is not
much less so to-day. The eclectic carefully avoids the discussion of
principles, and has neither taste nor capacity for abstract reasoning,
although he may be a good practitioner; not that he has no ideas, but
that his ideas form no working system. With him medical tact--i.e.,
cultivated instinct--replaces principle.
The eclectic of our day, however, is only an empiric in disguise,--that
is, a man whose opinions are based on comparison of observed facts, but
whose theoretical ideas do not go beyond phenomena.
In older days philosophy embraced the whole of human knowledge, and
the philosopher was not permitted to be unacquainted with any of its
branches. Now physics, metaphysics, natural history, etc., are arranged
into separate sciences, and the sum-total of knowledge is too great to
be compassed by any one man.
Pythagoras was the last of the Greek sages who made use of hieroglyphic
writings and transmitted his doctrine in ancient language. Born at
Samos, he was, first of all, an athlete; but one day, hearing a lecture
no immortality of the soul, he was thereby so strongly attracted to
philosophy that he renounced all other occupation to devote himself to
it. He studied arduously in Egypt, in Phoenicia, in Chaldea, and even,
it is said, in India, where he was initiated into the secrets of
the Brahmins and Magi. Finally, returning to his own country, he
was received by the tyrant Polycrates, but not made to feel at home.
Starting on his travels again, he assisted at one of the Olympic games,
and, being recognized, was warmly greeted. He sailed to the south of
Italy, landed at Crotona, and lodged with Milo, the athlete. Commencing
here{016} his lectures, he soon gathered around him a great number of
disciples, of whom he required a very severe novitiate, lasting even
five or six years, during which they had to abstain almost entirely
from conversation, and live upon a very frugal diet. Those only who
persevered were initiated later into the mysteries of the order. His
disciples had for him most profound veneration, and were accustomed
to decide all disputes witlr: "The master has said it." Pythagoras
possessed immense knowledge; he invented the theorem of the square
of the hypothenuse, and he first divided the year into 365 days and 6
hours. He seems to have suspected the movements of our planetary system.
He traveled from place to place, and founded schools and communities
wherever he went, which exercised, at least at first, only the happiest
influence; but the success and influence which their learning gave them
later made his disciples bold, and then dishonest, and his communities
were finally dispersed by angry mobs, which forced their members to
conceal or expatriate themselves; and so, even during the life-time
of its founder, the Pythagorean Society was destroyed, and never
reconstructed.
With Pythagoras and his disciples numbers played a very important
rôle, and the so-called language of numbers was first taught by him.
He considered the unit as the essential principle of all things, and
designated God by the figure 1 and matter by the figure 2, and then he
expressed the universe by 12, as representing the juxtaposition of 1 and
2. As 12 results from multiplying 3 by 4, he conceived the universe as
composed of three distinct worlds, each of which was developed in four
concentric spheres, and these spheres corresponded to the primitive
elements of fire, air, earth, and water. The application of the number
12 to express the universe Pythagoras had received from the Chaldeans
and Egyptians--it being the origin of the institution of the zodiac.
Although this is digressing, it serves to show what enormous importance
the people of that{017} time attached to numbers, especially to the
ternary and quarternary periods in the determination of critical days
in illness. Pythagoras was the founder of a philosophic system of great
grandeur, beauty, and, in one sense, completion, embracing, as it does,
and uniting by common bounds God, the universe, time, and eternity;
furnishing an explanation of all natural phenomena, which, if not true,
was at that time acceptable, and which appears in strong and favorable
contrast as against the mythological systems of pagan priests. No wonder
that it captivated the imagination and understanding of the thinking
young men of that day. Had they continued in the original purity of life
and thought in which he indoctrinated them there is no knowing how
long the Pythagorean school might have continued. But after it had been
dissolved by the storm of persecution, its members were scattered all
over Greece and even beyond. Now no longer held by any bonds, many of
them revealed the secrets of their doctrine, to which circumstance we
owe the little knowledge thereof we now possess.
The Pythagoreans apparently first introduced the custom of visiting
patients in their own homes, and they went from city to city and house
to house in performance of this duty. On this account they were called
Periodic or Ambulant physicians, in opposition to the Asclepiadæ, who
prescribed only in the temples. Empedocles, of Agrigentum, well known
in the history of philosophy, was perhaps the most famous of
these physicians. Let the following incident witness his sagacity:
Pestilential fevers periodically ravaged his native city. He observed
that their appearance coincided with the return of the sirocco, which
blows in Sicily on its western side. He therefore advised to close by
a wall, as by a dam, the narrow gorge from which this wind blew upon
Agrigentum. His advice was followed and his city was made free from the
pestilence.
Again, the inhabitants of Selinus were ravaged by epidemic{018} disease.
A sluggish stream filled the city with stagnant water from which
mephitic vapors arose. Empedocles caused two small rivulets to be
conducted into it, which made its current more rapid; the noxious vapors
dispersed and the scourge subsided.
_The Gymnasia_.--Before we proceed to a somewhat more detailed, but
brief, account of Hippocrates, it is necessary to say a word or two
of the ancient gymnasia of Greece, which were used long before the
Asclepiadæ had practiced or begun to teach. In these gymnasia were three
orders of physicians: first, the director, called the Gym-nasiarch;
second, the subdirector, or Gymnast, who directed the pharmaceutical
treatment of the sick; and, lastly, the Iatroliptes, who put up
prescriptions, anointed, bled, gave massage, dressed wounds and ulcers,
reduced dislocations, treated abscesses, etc. Of the gymnasiarclis
wonderful stories are told evincing their sagacity, which, though
somewhat fabulous, indicate the possession of a very high degree
of skill of a certain kind. Of one of the most celebrated of these,
Herodicus, we may recall Plato's accusation, who reprimanded him
severely for succeeding too well in prolonging the lives of the aged.
Whatever else may be said, we must acknowledge that above all others
the Greeks recognized the value of physical culture in the prevention of
infirmity, and of all physical methods in the treatment of disease.
By their wise enactments with reference to these matters they set an
example which modern legislators have rarely, if ever, been wise
enough to follow,--an example of compulsory physical training for the
young,--and thereby built up a nation of athletes and a people of rugged
constitution among whom disease was almost unknown.
I come now to the so-called _Philosophic Period_, or the third period in
the Age of Foundation, which is inseparably connected with the name of
_Hippocrates_. This central figure in the history of ancient medicine
was born on the Island{019} of Cos, of a family in which the practice of
medicine was hereditary, who traced their ancestors on the male side to
Æsculapius, and on the female side to Hercules. The individual to whom
every one refers under this name was the second of seven; the date of
his birth goes back to 460 B.C., but of his life and his age at death we
do not know; some say he lived to be over one hundred years of age.
It is certain that he traveled widely, since his writings evince the
knowledge thus gained. He was a contemporary of Socrates, although
somewhat younger, and lived in the age of Pericles,--the golden age for
science and art in Greece.
[Illustration: 0039]
The Island of Cos is now called Stan-Co, and is situated not far
from the coast of Ionia. Formerly it was considered as having a most
salubrious climate; now that it is under the dominion of the Turks,
it is considered most unhealthy. It possessed a temple dedicated to
Æsculapius and{020} a celebrated medical school. But Hippocrates, not
satisfied with what he could learn here, visited the principal foreign
cities, and seems to have been a most accurate and painstaking observer
and collector of notes. That he achieved great renown in his life is
known, since Plato and even Aristotle refer to him as their authority
in very many matters. His children and grandchildren followed in his
footsteps, and published their writings under the same name; it has,
therefore, become difficult to distinguish his works from theirs.
Finally, authors more unscrupulous, who bore no relationship to him,
attached his name to their own writings. But the true were, as a rule,
easily distinguished from the spurious, and were carefully separated by
those in charge of the Alexandrian library.
The enumeration of his writings by different authors varies very much.
Renouard, who seems to have studied the subject very carefully, gives
the following as appearing to him to be the authentic list of writings
of Hippocrates the Second,--i.e., the Great: The _Prognostic_, the
_Aphorisms_, the first and third books of _Epidemics_, that on
_Regimen in Acute Disease_, that on _Airs, Waters, and Places, that on
Articulations and Luxations_, that on _Fractures_, and the _Mochlic_, or
the treatise on instruments and reduction. This list does not
comprise the fourth part of the entire Hippocratic collection, but its
authenticity appears to be undoubted, and it suffices, as Renouard says,
to justify the enthusiasm of his contemporaries and the admiration
of posterity. Later, joined with the writings of Pythagoras, Plato,
Aristotle, and others, they constituted the so-called _Hippocratic
collection_, which was a definite part of the great libraries of
Alexandria and Pergamos, and formed the most ancient authentic monument
of medical science.
Respect for the bodies of the dead was a religious observance in all
Greece, and prevented the dissection of the human body. Consequently
the knowledge of anatomy possessed by Hippocrates must have been meagre.
Nevertheless,{021} he described lesions, like wounds of the head, of
the heart, the glands, the nature of bones, etc. It being impossible to
establish a physiology without an anatomical basis, it is not strange
that we find but little physiology in the Hippocratic writings, and
that this little is very crude and incorrect. Arteries and veins
were confounded, and nerves, tendons, ligaments, and membranes were
represented as analogous or interchangeable tissues. The physiologists
of those days abandoned themselves to transcendental speculation
concerning the nature and principles of life, which some placed in
moisture, others in fire, etc. Speculation, thus run wild, prevented
such accurate observation as might have greatly enhanced the progress of
physiological knowledge.
Hippocrates wrote at least three treatises concerning hygiene: The
first, on _Airs, Waters, and Places_; the second, on _Regimen_;
the third, on _Salubrious Diet_,--practically an abridgement of the
preceding, in which he recommends the habit of taking one or two vomits
systematically every month. The classification of diseases into internal
or medical, and external or surgical, is not modern, but is due to
Hippocrates; neither is it philosophic, although it is very convenient.
With so little knowledge of physiology and pathology as the ancients
had, it is not strange that they ascribed undue importance to external
appearance; in other words, to what has been termed _semeiotics_, which
occupies a very considerable place in the medical treatises of the
Asclep-iadæ. Indeed, the writings on this subject constitute more than
one-eighth part of the entire Hippocratic collection. To prognosis,
also, Hippocrates ascribed very great importance, saying that "The best
physician is the one who is able to establish a prognosis, penetrating
and exposing first of all, at the bedside, the present, the past,
and the future of his patients, and adding what they omit in their
statements. He gains their confidence, and being convinced{022} of
his superiority of knowledge they do not hesitate to commit themselves
entirely into his hands. He can treat, also, so much better their
present condition in proportion as he shall be able from it to foresee
the future," etc.
To the careful scrutiny of facial appearances, the position, and other
body-marks about the patient he attributed very great importance;
in fact, so positive was he about these matters that he embodied the
principal rules of semeiotics into aphorisms, to which, however, there
came later so many exceptions that they lost much of their value. From
certain passages in his book on _Prediction_, and from the book on
_Treatment_, which is a part of the Hippocratic collection, it appears
that it was the custom then of physicians to announce the probable issue
of the disease upon the first or second visit,--a custom which still
prevails in China and in Turkey, It gave the medical man the dignity
of an oracle when right, but left him in a very awkward position when
wrong.
To Hippocrates we are indebted for the classification of sporadic,
epidemic, and endemic forms, as well as for the division of disease into
acute and chronic. Hippocrates wrote extensively on internal disease,
including some particular forms of it, such as epilepsy, which was
called the sacred disease; also fragments on diseases of girls, relating
particularly to hysteria; also a book on the nature of woman, an
extensive treatise on diseases of women, and a monograph on sterility.
That Hippocrates was a remarkably close observer of disease as it
appeared to him his books amply prove; in fact, they almost make one
think that close observation is one of the lost arts, being only open
to the objection that too much weight was attached to insignificant
external appearances, speculation on which detracted from consideration
of the serious feature of the case. His therapeutics, considering the
crude information of the time, was a vast improvement on that which
had preceded,{023} and really entitled him to his title of "Great
Physician."
Of external diseases and their surgical therapeutics he wrote fully: on
_The Laboratory of the Surgeon_, dealing with dressings, bandaging,
and operating; on _Fractures_; and on _Articulations and Dislocations_;
showing much more anatomical knowledge than was possessed by his
contemporaries. The _Mochlic_ was an abridgment of former treatises; in
_Wounds of the Head_ he formulated the dictum concerning the possible
danger of trifling wounds and the possible recovery from those most
serious, so often ascribed to Sir Astlev Cooper. Other monographs, also,
he wrote, on _Diseases of the Eye_, on _Fistula_, and on _Hoemorrhoids_.
He described only a small number of operations, however, and all
the Hippocratic writings on surgery would make but a very incomplete
treatise as compared with those that belong to the next historical
epoch; all of which we have to ascribe--in the main--to prejudice
against dissection and ignorance of anatomy.
From the earliest times physicians and writers occupied themselves
largely with obstetrics, as was most natural. The Hippocratic collection
includes monographs on _Generation; the Nature of the Infant;
the Seventh Month of Pregnancy; the Eighth Month of Pregnancy; on
Accouchement; Superfoetation; on Dentition; on Diseases of Women; on
Extraction of the Dead Foetus_. The treatise on superfcetation concerned
itself mainly with obstetrics.
On epidemics Hippocrates writes extensively, showing that he had
studied them carefully. He was among the first to connect meteorological
phenomena with those of disease during given seasons of the year,
expressing the hope that by the study of storms it would be possible to
foresee the advent of the latter, and prepare for them. Seven books of
the Hippocratic collection bear the title of _Epidemics_, although only
two of them are exclusively devoted to this subject. In these books were
contained a long{024} list of clinical observations relating to various
diseases. They constituted really a clinical study of disease.
The collection of Hippocrates's _Aphorisms_ fills seven of the books;
no medical work of antiquity can compare with these. Physicians
and philosophers of many centuries have professed for them the same
veneration as the Pythagoreans manifested for their golden verses. They
were considered the crowning glory of the collection. Even within a
short time past the Faculty of Paris required aspirants for the medical
degree to insert a certain number of these in their theses, and only the
political revolution of France served to cause a discontinuance of
this custom. These aphorisms formed, says Littré, "a succession of
propositions in juxtaposition, but not united." It has always been and
always will be disadvantageous for a work to be written in that style,
since such aphorisms lose all their general significance; and that which
seems isolated in itself becomes more so when introduced into modern
science, with which it has but little practical relationship. But not so
if the mind conceive of the ideas which prevailed when these aphorisms
were written; in this light, when they seem most disjoined they are most
related to a common doctrine by which they are united, and in this view
they no longer appear as detached sentences.
The school of the Asclepiadæ has been responsible for certain theories
which have been more or less prominent during the earlier historical
days. One of these which prevailed throughout the Hippocratic works is
that of _Coction and Crisis_. By the former term is meant thickening
or elaboration of the humors in the body, which was supposed to be
necessary for their elimination in some tangible form. Disease was
regarded as an association of phenomena resulting from efforts made
by the conservative principles of life to effect a coction,--i.e., a
combination of the morbific matter in the economy, it being held
that the latter could not be properly expelled until thus united and
prepared{025} so as to form excrementitious material. This elaboration
was supposed to be brought about by the vital principles, which
some called nature (_Physis_), some spirit (_Psyche_), some breath
(_Pneuma_), and some heat (_Thermon_).
The gradual climax of morbid phenomena has, since the days of
Hippocrates, been commonly known as _Crisis_; it was regarded as the
announcement of the completion of the union by coction. The day on which
it was accomplished was termed _critical_, as were also the signs which
preceded or accompanied it, and for the crisis the physician anxiously
watched. Coction having been effected and crisis occurring, it only
remained to evacuate the morbific material--which nature sometimes
spontaneously accomplished by the critical sweat, urination, or
stools, or sometimes the physician had to come to her relief by the
administration of diuretics, purgatives, etc. The term "critical period"
was given to the number of days necessary for coction, which in its
perfection was supposed to be four, the so-called quarternary, while the
septenary was also held in high consideration. Combination of figures
after the Pythagorean fashion produced many complicated periods,
however, and so periods of 34, 40, and 60 days were common. This
doctrine of crisis in disease left an impress upon the medical mind not
yet fully eliminated. Celsus was the most illustrious of its adherents,
but it can be recognized plainly in the teachings of Galen, Sydenham,
Stahl, Van Swieten, and many others. In explanation, it must be said
that there have always existed diseases of nearly constant periods,
these being nearly all of the infectious form, and that the whole
"critical" doctrine is founded upon the recognition of this natural
phenomenon.
The Hippocratic books are full, also, of the four elements,--earth,
water, air, and fire; four elementary qualities,--namely, heat, cold,
dryness, and moisture; and the four cardinal humors,--blood, bile,
atrabile, and phlegm.
Owing{026} to the poverty of knowledge of physics and chemistry
possessed by the ancients, and notwithstanding their errors and
imperfections, the doctrine of Dogmatism, founded upon the theory of
coction and humors, was the most intelligible and complete among the
medical doctrines of antiquity, responding better, as it did, to the
demands of the science of that day. That Hippocrates was a profound
observer is shown in this: that he reminds both philosophers and
physicians that the nature of man cannot be well known without the aid
of medical observation, and that nothing should be affirmed concerning
that nature until by our senses we have become certain of it. In this
maxim he took position opposed to the Pythagorean doctrine, and included
therein the germ of a new philosophy of which Plato misconceived, and of
which Aristotle had a very faint glimpse.
Another prominent theory throughout the Hippocratic books is that of
Fluxions, meaning thereby about what we would call congestions, or
conditions which we would say were ordinarily caused by cold, though
certain fluxions were supposed to be caused by heat, because the
tissues thereby became rarefied, their pores enlarged, and their humor
attenuated so that it flowed easily when compressed. The whole theorv of
fluxion was founded on the densest ignorance of tissues and the laws
of physics, the body of man being sometimes likened to a sponge and
sometimes to a sieve. The treatment recommended was almost as crazy as
the theory. Certain other theories have complicated or disfigured the
Hippocratic writings, and certain have been founded on the consideration
of two elements--i.e., fire and earth--or on the consideration of one
single element which was supposed to be air,--the breath, or _pneuma_;
and there was--lastly--the theory of any _excedent_, which is very
vague; of all of these we may say that they are not of sufficient
interest to demand expenditure of our time.
The eclat{027} which the second (i.e., the Great) Hippocrates gave to
the school of Asclepiadæ in the Island of Cos long survived, and
many members of his family followed in his footsteps. Among his most
prominent successors were _Polybius, Diodes, and Praxagoras_, also of
Cos,--the last of the Asclepiadæ mentioned in history. Praxagoras was
distinguished principally for his anatomical knowledge; like Aristotle,
he supposed that the veins originated from the heart, but did not
confound these vessels with the arteries, as his predecessors had done,
but supposed that they contained only air, or the vital spirit. It has
been claimed that he dissected the human body. He laid the foundation
of sphygmology, or study of the pulse, since Hippocratic writers rarely
alluded to arterial pulsations and described them as of only secondary
importance.
The predominating theory in the Island of Cos was that which made health
dependent on the exact proportion and play of the elements of the body,
and on perfect combination of the four cardinal humors. This was the
prevailing doctrine,--i.e., the Ancient Medical Dogmatism, so named
because it embraced the most profound dogmas in medicine, and was taught
exclusively until the foundation of the school at Alexandria.
Two men, however, more commonly ranked among philosophers than among
physicians of antiquity, dissected the statements of Hippocrates, and
embodied them more or less in their own teachings, and thus exercised a
great influence on the progress of the human mind, particularly in
the direction of medical study. The first of these was Plato, profound
moralist, eloquent writer, and most versatile thinker of his day or
any other. He undertook the study of disease, not by observation (the
empirical or experimental method), but by pure intuition. He seemed
to have never discovered that his meditations were taken in the wrong
direction, and that the method did not conduce to the discovery of
abstract truths. He gave beauty an abstract{028} existence, and affirmed
that all things beautiful are beautiful because of the presence of
beauty. This reminds one of that famous response in the school of the
Middle Ages to a question: "Why does opium produce sleep?" the answer
being: "Because it possesses the sleepy principle." Plato introduced
into natural science a doctrine of final causes. He borrowed from
Pythagoras the dogma of homogeneity of matter, and claimed that it had a
triangular form.
_Aristotle_, equally great thinker with Plato, but whose mental activity
was manifest in other channels, was born in Stagyrus, in Macedonia. He
was fascinated by the teachings of Plato, and attained such eminence
as a student that King Philip of Macedon made him preceptor to his son
Alexander, subsequently the Great, by whom he was later furnished with
sufficient funds to form the first known museum in natural history.--a
collection of rare objects of every sort, transmitted, many of them, by
the royal hands of his former student from the remote depths of Asia.
Aristotle, by long odds the greatest naturalist of antiquity, laid the
first philosophic basis for empiricism. He admitted four elements--fire,
air, earth, and water--and believed them susceptible of mutual
transmutation. He studied the nature of the soul and that of the animal
body; regarded heat and moisture as two conditions indispensable to
life; described the brain with some accuracy, but without the least idea
of its true function; said that the nerves proceeded from the heart;
termed the aorta a nervous vein; and made various other mistakes which
to us seem inexcusable. Nevertheless, he was rich in many merits, and no
one of his age studied or searched more things than he, nor introduced
so many new facts. Although he never dissected human bodies, he
nevertheless corrected errors in anatomy held to by the Hippocratic
school. He dissected a large number of animals of every species, and
noted the varieties of size and shape of hearts of various animals
and birds. In{029} other words, he created a comparative anatomy
and physiology, and the plan that he traced was so complete that two
thousand years later the great French naturalist Cuvier followed it
quite closely. If he be charged with having propagated a taste for
scholastic subtleties, he also furnished an example of patient and
attentive observation of Nature. His history of animals is a storehouse
of knowledge, and his disciples cultivated with zeal anatomy,
physiology, and natural history. His successor, Theophrastus, was the
most eminent botanist of antiquity.
It will thus be seen that Plato and Aristotle were the eminent
propagators of two antagonistic opinions. One supposed knowledge to be
derived by mental intuition, and the other that all ideas are due to
sensation. Both count among moderns some partisans of the greatest
acumen: Descartes, Leibnitz, and Kant being followers of Plato, and
Bacon, Locke, Hume, and Condillac, of Aristotle.
The excuse for stating these things, which apparently do not so closely
concern the history of medicine, must be that of the learned interpreter
of the doctrine of Cuvier, that "The first question in science is always
a question of method."
Hippocrates formed a transition between a period of mythology and that
of history. His doctrine was received by contemporaries and by posterity
with a veneration akin to worship. No other man ever obtained homage so
elevated, constant, and universal. A little later ignorance reigned in
the school that he made celebrated. Methods and theories were propagated
there under the shadow of his name which he would have disowned.
Medical science now changes its habitation as well as its aspect, and
from the record of Hippocrates and his work we turn to the fourth period
of the Age of Foundation,--namely, the _Anatomic_, which extends from
the foundation of the Alexandrian library, 320 B.C., up to the death of
Galen, about the year A.D. 200.