Thiere_, Königsberg, 1828-37.
With the second half of the seventeenth century and during a large part
of the eighteenth the biological works of Aristotle attracted less
attention. The battle against the Aristotelian physics had been fought
and won, but with them the biological works of Aristotle unjustly
passed into the shadow that overhung all the idols of the Middle Ages.
The rediscovery of the Aristotelian biology is a modern thing. The
collection of the vast wealth of living forms absorbed the energies
of the generations of naturalists from Ray (1627-1705) and Willoughby
(1635-72) to Réaumur (1683-1757) and Linnaeus (1707-1778) and beyond to
the nineteenth century. The magnitude and fascination of the work seems
almost to have excluded general ideas. With the end of this period
and the advent of a more philosophical type of naturalist, such as
Cuvier (1769-1832) and members of the Saint-Hilaire family, Aristotle
came again to his own. Since the dawn of the nineteenth century,
and since naturalists have been in a position to verify the work of
Aristotle, his reputation as a naturalist has continuously risen.
Johannes Müller (1801-58), Richard Owen (1804-92), George Henry Lewes
(1817-78), William Ogle (1827-1912) are a few of the long line of those
who have derived direct inspiration from his biological work. With
improved modern methods of investigation the problems of generation
have absorbed a large amount of biological attention, and interest
has become specially concentrated on Aristotle’s work on that topic
which is perhaps, at the moment, more widely read than any biological
treatise, ancient or modern, except the works of Darwin. That great
naturalist wrote to Ogle in 1882: ‘From quotations I had seen I had a
high notion of Aristotle’s merits, but I had not the most remote notion
what a wonderful man he was. Linnaeus and Cuvier have been my two gods,
though in very different ways, but they were mere schoolboys to old
Aristotle.’
GREEK MEDICINE
Ἡρόφιλος δὲ ᾝἐν τῷ Διαιτητικῷ καὶ σοφίαν φησὶν ἀνεπίδεικτον καὶ τέχνην
ἄδηλον καὶ ἰσχὺν ἀναγώνιστον καὶ πλοῦτον ἀχρεῖον καὶ λόγον ἀδύνατον,
ὑγιείας ἀπούσης.
Herophilus, a Greek philosopher and physician (_c._ 300 B. C.), has
truly written ‘that Science and Art have equally nothing to show,
that Strength is incapable of effort, Wealth useless, and Eloquence
powerless if Health be wanting’.[99] All peoples therefore have had
their methods of treating those departures from health that we call
disease, and among peoples of higher culture such methods have been
reduced in most cases to something resembling a system. In antiquity,
as now, a variety of such systems were in vogue, and those nations who
practised the art of writing from an early date have left considerable
records of their medical methods and doctrines. We may thus form a
fairly good idea of the medical principles of the Mesopotamian, the
Egyptian, the Iranian, the Indian, and the Chinese civilizations. Much
in these systems, as in the medical procedure of more primitive tribes,
was based upon some theory of disease which fitted in with a larger
theory of the nature of evil. Of these theories the commonest was and
is the demonic, the view that regards deviation from the normal state
of health as due either to the attacks of supernatural beings or to
their actual entry into the body of the sufferer. A medical system
based on such a view is susceptible of great elaboration in a higher
civilization, but not being founded on observation is hardly capable of
indefinite development, for a point must ultimately be reached at which
the mind recoils from complex conclusions far remote from observed
phenomena. The medicine of the ancient and settled civilization of such
a people as the Assyro-Babylonians, for instance, of which substantial
traces have been recovered, is hardly, if at all, more effective,
though far more systematized, than that of many a wild and unlettered
tribe that may be observed to-day. Of such medicine as this we may give
an account, but we can hardly write a _history_. We cannot establish
those elements of continuity and of development from which alone
history can be constructed.
[99] The works of Herophilus are lost. This fine passage has been
preserved for us by Sextus Empiricus, a third century physician, in
his πρὸς τοὺς μαθηματικοὺς ἀντιρῥητικοί, which is in essence an attack
on all positive philosophy. It is an entertaining fact that we should
have to go to such a work for remains of the greatest anatomist of
antiquity. The passage is in the section directed against ethical
writers, xi. 50.
It is the distinction of the Greeks alone among the nations of
antiquity that they practised a system of medicine based not on theory
but on observation accumulated systematically as time went on. The
claim can be made for the Greeks that some at least among them were
deflected by no theory, were deceived by no theurgy, were hampered by
no tradition in their search for the facts of disease and in their
attempts at interpreting its phenomena. Only the Greeks among the
ancients could look on their healers as _physicians_ (= naturalists,
φύσις = nature), and that word itself stands as a lasting reminder of
their achievement.[100]
[100] The word φυσικός, though it passed over into Latin (Cicero) with
the meaning _naturalist_, acquired the connotation of _sorcerer_ among
the later Greek writers. Perhaps the word _physicianus_ was introduced
to make a distinction from the charm-mongering _physicus_. In later
Latin _physicus_ and _medicus_ are almost always interchangeable.
At a certain stage in the history of the Western world—the exact point
in time may be disputed but the event is admitted by all—men turned
to explore the treasures of the ancient wisdom and the whole mass of
Greek medical learning was gradually laid before the student. That
mass contained much dross, material that survived from early as from
late Greek times which was hardly, if at all, superior to the debased
compositions that circulated in the name of medicine in the middle
centuries. But the recovered Greek medical writings also contained some
material of the purest and most scientific type, and that material and
the spirit in which it was written, form the debt of modern medicine to
antiquity.
It is a debt the value of which cannot be exaggerated. The physicians
of the revival of learning, and for long after, doubtless pinned their
faith too much to the written word of their Greek forbears and sought
to imprison the free spirit of Hippocrates and Galen in the rigid
wall of their own rediscovered texts. The great medical pioneers of
a somewhat later age, enraged by this attempt, the real nature of
which was largely hidden from them, not infrequently revolted and
rightly revolted against the bondage to the Greeks in which they had
been brought up. Yet it is sure that these modern discoverers were
the true inheritors of the Greeks. Without Herophilus we should have
had no Harvey and the rise of physiology might have been delayed for
centuries; had Galen’s works not survived, Vesalius would never have
reconstructed Anatomy, and Surgery too might have stayed behind with
her laggard sister, Medicine; the Hippocratic collection was the
necessary and acknowledged basis for the work of the greatest of modern
clinical observers, Thomas Sydenham, and the teaching of Hippocrates
and of his school is the substantial basis of instruction in the wards
of a modern hospital. In the pages which follow we propose therefore
to review the general character of medical knowledge in the best Greek
period and to consider briefly how much of that great heritage remained
accessible to the earlier modern physicians. The reader will thus be
able to form some estimate of the degree to which the legacy has been
passed on to our own times.
It is evident that among such a group of peoples as the Greeks,
varying in state of civilization, in mental power, in geographical
and economic position and in general outlook, the practice of medicine
can have been by no means uniform. Without any method of centralizing
medical education and standardizing teaching there was a great variety
of doctrines and of practice in vogue among them, and much of this
was on a low level of folk custom. Such lower grade material of Greek
origin has come down to us in abundance, though much of it, curiously
enough, from a later time. But the overwhelming mass of earlier Greek
medical literature sets forth for us a pure scientific effort to
observe and to classify disease, to make generalizations from carefully
collected data, to explain the origin of disease on rational grounds,
and to apply remedies, when possible, on a reasoned basis. We may thus
rest fairly well assured that, despite serious and irreparable losses,
we are still in possession of some of the very finest products of the
Greek medical intellect.
There is ample evidence that the Greeks inherited, in common with many
other peoples of Mediterranean and Asiatic origin, a whole system of
magical or at least non-rational pharmacy and medicine from a remoter
ancestry. Striking parallels can be drawn between these folk elements
among the Greeks and the medical systems of the early Romans, as well
as with the medicine of the Indian Vedas, of the ancient Egyptians, and
of the earliest European barbarian writings. It is thus reasonable to
suppose that these elements, when they appear in later Greek writings,
represent more primitive folk elements working up, under the influence
of social disintegration and consequent mental deterioration, through
the upper strata of the literate Greek world. But with these elements,
intensely interesting to the anthropologist, the psychologist, the
ethnologist, and to the historian of religion, we are not here greatly
concerned. Important as they are, they constitute no part of the
special claim of the Greek people to distinction, but rather aid us in
uniting the Greek mentality with that of other kindred peoples. Here we
shall rather discuss the course of Greek scientific medicine proper,
the type of medical doctrine and practice, capable of development
in the proper sense of the word, that forms the basis of our modern
system. We are concerned, in fact, with the earliest evolutionary
medicine.
We need hardly discuss the first origins of Greek Medicine. The
material is scanty and the conclusions somewhat doubtful and
perhaps premature, for the discovery of a considerable fragment of
the historical work of Menon, a pupil of Aristotle, containing a
description of the views of some of the precursors of the Hippocratic
school, renews a hope that more extended investigation may yield
further information as to the sources and nature of the earliest Greek
medical writings.[101] The study of Mesopotamian star-lore has linked
it up with early Greek astronomical science. The efforts of cuneiform
scholars have not, however, been equally successful for medicine, and
on the whole the general tendency of modern research is to give less
weight to Mesopotamian and more to Egyptian sources than had previously
been admitted; thus, as an instance, some prescriptions in the Ebers
papyrus of the eighteenth dynasty (about the sixteenth century B. C.)
discovered at Thebes in 1872 resemble certain formulae in the Corpus
Hippocraticum. A number of drugs, too, habitually used by the Greeks,
such as _Andropogon_, _Cardamoms_, and _Sesame orientalis_, are of
Indian origin. There are also the Minoan cultures to be considered,
and our knowledge is not yet sufficient to speak of the heritage that
Greek medicine may or may not have derived from that source, though
it seems not improbable that Greek hygiene may here owe a debt.[102]
Omitting, therefore, this early epoch, we pass direct to the later
period, between the sixth and fourth centuries, from which documents
have actually come down to us.
[101] This fragment has been published in vol. iii, part 1, of the
_Supplementum Aristotelicum_ by H. Diels as _Anonymi Londinensis ex
Aristotelis Iatricis Menonis et Aliis Medicis Eclogae_, Berlin, 1893.
See also H. Bekh and F. Spät, _Anonymus Londinensis, Auszüge eines
Unbekannten aus Aristoteles-Menons Handbuch der Medizin_, Berlin, 1896.
[102] It is tempting, also, to connect the Asclepian snake cult with
the prominence of the serpent in Minoan religion.
The earliest medical school of which we have definite information is
that of Cnidus, a Lacedaemonian colony in Asiatic Doris. Its origin may
perhaps reach back to the seventh century B. C. We have actual records
that the teachers of Cnidus were accustomed to collect systematically
the phenomena of disease, of which they had produced a very complex
classification, and we probably possess also several of their actual
works. The physicians of Cos, their only contemporary critics whose
writings have survived, considered that the Cnidian physicians paid
too much attention to the actual sensations of the patient and to
the physical signs of the disease. The most important of the Cnidian
doctrines were drawn up in a series of _Sentences_ or Aphorisms, and
these, it appears, inculcated a treatment along Egyptian lines of the
symptom or at most the disease, rather than the patient, a statement
borne out by the contents of the gynaecological works of probable
Cnidian origin included in the so-called ‘Hippocratic Collection’.
A few names of Cnidian physicians have, moreover, come down to us
with titles of their works, and a later statement that they practised
anatomy. There can be little doubt too that the Cnidian school drew
also on Persian and Indian Medicine.
The origin of the school of the neighbouring island of Cos was a little
later than that of Cnidus and probably dates from the sixth century
B. C. Of the Coan school, or at least of the general tendencies that
it represented, we have a magnificent and copious literary monument
in the Corpus Hippocraticum, a collection which was probably put
together in the early part of the third century B. C. by a commission
of Alexandrian scholars at the order of the book-loving Ptolemy Soter
(reigned 323-285 B. C.). The elements of which this collection is
composed are of varying dates from the sixth to the fourth century B.
C., and of varying value and origin, but they mainly represent the
point of view of physicians of the eastern part of the Greek world in
the fifth and fourth centuries.
The most obvious feature, the outstanding element that at once
strikes the modern observer in these ‘Coan’ writings, is the enormous
emphasis laid on the actual course of disease. ‘It appears to me a
most excellent thing’, so opens one of the greatest of the Hippocratic
works, ‘for a physician to cultivate _pronoia_.[103] Foreknowing
and foretelling in the presence of the sick the past, present, and
future (of their symptoms) and explaining all that the patients are
neglecting, he would be believed to understand their condition, so that
men would have confidence to entrust themselves to his care.... Thus he
would win just respect and be a good physician. By an earlier forecast
in each case he would be more able to tend those aright who have a
chance of surviving, and by foreseeing and stating who will die, and
who will survive, he will escape blame....’[104]
[103] This word _pronoia_, as Galen explains (εἰς τὸ Ἱπποκράτους
προγνωστικόν, K. xviii, B. p. 10), is not used in the philosophic
sense, as when we ask whether the universe was made by chance or by
_pronoia_, nor is it used quite in the modern sense of _prognosis_,
though it includes that too. _Pronoia_ in Hippocrates means knowing
things about a patient before you are told them. See E. T. Withington,
‘Some Greek medical terms with reference to Luke and Liddell and
Scott,’ _Proceedings of the Royal Society of Medicine_ (_Section of the
History of Medicine_), xiii, p. 124, London, 1920.
[104] _Prognostics_ 1.
Just as the Cnidians by dividing up diseases according to symptoms
over-emphasized diagnosis and over-elaborated treatment, so the Coans
laid very great force on prognosis and adopted therefore a largely
expectant attitude towards diseases. Both Cnidian and Coan physicians
were held together by a common bond which was, historically if not
actually, related to temple worship. Physicians leagued together in the
name of a god, as were the Asclepiadae, might escape, and did escape,
the baser theurgic elements of temple medicine. Of these they were as
devoid as a modern Catholic physician might be expected to be free from
the absurdities of Lourdes. But the extreme cult of prognosis among
the Coans may not improbably be traced back to the medical lore of the
temple soothsayers whose divine omens were replaced by indications of
a physical nature in the patient himself.[105] We are tempted too to
link it with that process of astronomical and astrological prognosis
practised in the Mesopotamian civilizations from which Ionia imitated
and derived so much. Religion had thus the same relation to medicine
that it would have with a modern ‘religious’ medical man as suggesting
the motive and determining the general direction of his practice though
without influence on the details and method.
[105] There is a discussion of the relation of the Asclepiadae to
temple practice in an article by E. T. Withington, ‘The Asclepiadae
and the Priest of Asclepius,’ in _Studies in the History and Method of
Science_, edited by Charles Singer, vol. ii, Oxford, 1921.
During the development of the Coan medical school along these lines in
the sixth and fifth centuries, there was going on a most remarkable
movement at the very other extreme of the Greek world. Into the course
and general importance of Sicilian philosophy it is not our place to
enter, but that extraordinary movement was not without its repercussion
on medical theory and practice. Very important in this direction was
Empedocles of Agrigentum (_c._ 500-_c._ 430 B. C.). His view that the
blood is the seat of the ‘innate heat’, ἔμφυτον θερμόν, he took from
folk belief—‘the blood is the life’—and this innate heat he closely
identified with soul. More profitable was his doctrine that breathing
takes place not only through what are now known as the respiratory
passages but also through the pores of the skin. His teaching led to a
belief in the heart as the centre of the vascular system and the chief
organ of the ‘pneuma’ which was distributed by the blood vessels. This
pneuma was equivalent to both soul and life, but it was something more.
It was identified with air and breath, and the pneuma could be seen
to rise as shimmering steam from the shed blood of the sacrificial
victim—for was not the blood its natural home? There was a pneuma, too,
that interpenetrated the universe around us and gave it those qualities
of life that it was felt to possess. Anaximenes (_c._ 610-_c._ 545
B. C.), an Ionian predecessor of Empedocles, may be said to have
defined for us these functions of the pneuma; οῖον ἡ ψυχὴ ἡ ἡμετέρα
ἀὴρ οῧσα συγκρατεί ἡμᾶς, ὅλον τὸν κόσμον πνεῦμα καὶ ἀὴρ περιέχει ‘As
our soul, being air, sustains us, so pneuma and air pervade the whole
universe’;[106] but it is the speculation of Empedocles himself that
came to be regarded as the basis of the Pneumatic School in Medicine
which had later very important developments.
[106] The works of Anaximenes are lost. This phrase of his, however, is
preserved by the later writer Aetios.
Another early member of the Western school who made important
contributions to medical doctrine—in which relation alone we need
consider him—was Pythagoras of Samos (_c._ 580-_c._ 490 B. C.). For
him number, as the purest conception, formed the basis of philosophy.
Unity was the symbol of perfection and corresponded to God Himself. The
material universe was represented by 2, and was divided by the number
12, whence we have 3 worlds and 4 spheres. These in turn, according
at least to the later Pythagoreans, give rise to the four elements,
earth, air, fire, and water—a primary doctrine of medicine and of
science derived perhaps from ancient Egypt and surviving for more than
two millennia. The Pythagoreans taught, too, of the existence of an
animal soul, an emanation of the soul of the universe. In all this we
may distinguish the germ of that doctrine of the relation of man and
universe, microcosm and macrocosm, which, suppressed as irrelevant in
the Hippocratic works, reappears in the Platonic and especially in
the Neoplatonic writings, and forms a very important dogma in later
medicine.
A pupil of Pythagoras and an older contemporary of Empedocles was
Alcmaeon of Croton (_c._ 500 B. C.), who began to construct a positive
basis for medical science by the practice of dissection of animals, and
discovered the optic nerves and the Eustachian tubes. He even extended
his researches to Embryology, describing the head of the foetus as the
first part to be developed—a justifiable deduction from appearances.
Alcmaeon introduced also the doctrine that health depends on harmony,
disease on discord of the elements within the body. Curiosity as to the
distribution of the vessels was excited by Empedocles and Alcmaeon and
led to further dissection, and Alcmaeon’s pupils Acron (_c._ 480 B. C.)
and Pausanias (_c._ 480 B. C.), and the later Philistion of Lokri,[107]
the contemporary of Plato, all made anatomical investigations.
[107] For the work of these physicians see especially M. Wellmann,
_Fragmentsammlung der griechischen Aerzte_, Bd. I, Berlin, 1901.
The views of Empedocles, and especially his doctrine that regarded
the heart as the main site of the pneuma, though rejected by the Coan
school as a whole, were not without influence on Ionia. Diogenes
of Apollonia, the philosopher of pneumatism, a late fifth century
writer who must have been contemporary with Hippocrates the Great,
himself made an investigation of the blood vessels; and the influence
of the same school may be traced in a little work περὶ καρδίης, _On
the heart_, which is the best anatomical treatise of the Hippocratic
Collection. This work describes the aorta and the pulmonary artery as
well as the three valves at the root of each of the great vessels,
and it speaks of experiments to test their validity. It treats of the
pericardium and of the pericardial fluid and perhaps of the musculi
papillares, and contrasts the thickness of the walls of right and left
ventricles. The author considers that the left ventricle is empty of
blood—as indeed it is after death—and is the source of the innate heat
and of the absolute intelligence. These views fit in with the doctrines
of Empedocles, so that we may perhaps even venture to regard this work
as a surviving document of the Sicilian school. It is interesting to
observe that we have here the first hint of human dissection, for the
author tells us that the hearts of animals may be compared to that
of man. The distinction of having been the first to write on human
anatomy, as such, belongs however, probably to a later writer, Diocles,
son of Archidamus of Carystus, who lived in the fourth century B.
C.[108]
[108] Galen, περὶ ἀνατομικῶν ἐγχειρήσεων, _On anatomical preparations_,
§ 1, K. II, p. 282.
We may now turn to the Hippocratic Corpus as a whole. This collection
consists of about 60 or 70 separate works, written at various periods
and in various states of preservation. At best only a very small
proportion of them can be attributed to Hippocrates, but the discussion
of the general question of the ‘genuineness’ of the works is now
admitted to be futile, for it is certain that we have no criteria
whatever to determine whether or no a particular work be from the pen
of the Father of Medicine, and the most we can ever say of such a
treatise is that it appears to be of his school and in his spirit. Yet
among the great gifts of this collection to our time and to all time
are two which stand out above all others, the picture of a man, and the
picture of a method.