[Illustration: HIPPOCRATES
Ἢν γὰρ παρῇ φιλανθρωπίη πάρεστι καὶ φιλοτεχνίη.
Where the love of man is, there also is love of this Art.
Παραγγελίαι, i.e. _Precepts_ (Hippocratic Collection), § 6
]
A SHORT
HISTORY OF MEDICINE
INTRODUCING MEDICAL PRINCIPLES TO
STUDENTS AND NON-MEDICAL READERS
BY
CHARLES SINGER
M.A., M.D., D.LITT., OXFORD
FELLOW OF THE ROYAL COLLEGE OF PHYSICIANS OF LONDON
LECTURER ON THE HISTORY OF MEDICINE
IN THE UNIVERSITY OF LONDON
Scire potestates herbarum usumque medendi
Maluit et mutas agitare inglorius artes
_It was his part to learn of the power of Medicine
and of the manner of healing and, heedless of
glory, to exercise that quiet art._
Virgil, _Aeneid_ xii, 396-7
NEW YORK
OXFORD UNIVERSITY PRESS
AMERICAN BRANCH
1928
COPYRIGHT, 1928
BY OXFORD UNIVERSITY PRESS
AMERICAN BRANCH
PRINTED IN THE UNITED STATES OF AMERICA
PREFACE
The position that Medical Science has now assumed in the social polity
demands that all educated men and women should have some knowledge
of the subject, whether they have had a medical training or no. In
these pages the author seeks to place before the reader, who is
without special knowledge, some account of Medicine as a Science. For
this purpose the historical method is peculiarly suited, since it
recapitulates, in some measure, the actual stages through which each
learner must pass. Though the story told here opens with Greek times,
the narrative of the earlier period is so condensed that more than
half the book is devoted to modern Medicine, which is presented as a
natural outgrowth of an ancient tradition. An attempt has been made to
keep the account as simple and as elementary as possible and to make
the smallest demands on the scientific equipment of the reader. The
slight divergence, in some matters, of the interests of American and of
English readers, has been held in mind, so that, it is hoped, the book
may be useful to both classes.
Throughout the work two particular aims have been steadily kept in
view: first, to stress the principles of Medicine rather than the
details of practice; second, to treat of those principles in as small a
space as may be. For ‘principles’ the author has substituted at times
the word ‘Philosophy.’ He would, however, beseech the timid reader
to take no alarm at a word, for he employs the term ‘Philosophy’ in a
time-honored fashion, and he undertakes not to plunge deep into the
labyrinth of Metaphysic. The Philosophy of Medicine stands here for the
disinterested study of the theory of the subject, without reference to
its application to particular instances.
Certain omissions in the book are justified by the author’s forthcoming
publication of a history of the biological sciences treated along
somewhat similar lines. It has thus, for example, seemed superfluous to
include here any but casual references to such highly important topics
as the study of hereditary characters or the experimental investigation
of developmental defects. It is, however, the duty of the author
to direct attention to certain other omissions necessitated by the
compression of the work into a small compass. The history of Medicine,
as here treated, is essentially a history of ideas. The personal
element has been kept wholly in the background and very little space
has been allotted to biographical matter. Nor do the limits of the book
permit any discussion of the status of medical men, and very little
even of their training. On this account many who in their day were
remarkable rather for the influence they exerted than for the advances
in knowledge which they initiated find no commemoration here. This line
of treatment has involved omission of reference to those teachers to
whom the author himself owes most, Sir William Osler and Sir Clifford
Allbutt.
A work on Medicine must be colored, in some degree, by its author’s
conception of the nature of Life. On this theme there are divers views,
for the full discussion of which there is here no place. The author
professes himself, however, an adherent of a school of thought that is
not, at present, greatly in fashion. He ranges himself as a vitalist
under the banner of Aristotle and as a follower in the goodly company
of Harvey, Hunter and Virchow, of Claude Bernard and Johannes Müller.
He believes that there is a principle in living things that cannot
be expressed in chemical or physical terms. He believes that this
principle works to an intelligible end, that it is an _Entelechy_, an
indwelling purposiveness, and that it is as real a thing as anything
that is.
_They are right who hold ‘soul’ to be not independent of body and yet
not a kind of body. ‘Soul’ is not body but something pertaining to the
body and dwelling therein, and, what is more, specific to each body.
Our forebears erred in seeking to fit the ‘soul’ into a body without
regard to the nature and qualities of the body, for the association
of ‘soul’ and body is by no means thus at random. And so indeed we
might expect, for the ‘Entelechy’ of each being comes naturally to be
developed in the potentiality of each being, that is to say in the
matter proper to it. Whence is manifest that the ‘soul’ is a certain
‘Entelechy’, a notion or form of that which has capacity to be endowed
with ‘soul’._ Aristotle, Περὶ Ψυχῆς, _II_, § 2.
The author is well aware that this conception is neither useful
nor helpful for physiological research in the present state of our
knowledge. That is a very good reason for excluding it, as the vitalist
Claude Bernard excluded it, from the physiological laboratory. But
it is not a good reason for abandoning a point of view which does
something to make existence intelligible. On the contrary, turning from
the physiological laboratory to the living being as a whole, it is just
the indwelling purposiveness that is, before all things, most worthy of
consideration. Every function, every structure, every instinct, habit,
or reflex, every mental activity that is related to health--and which
is not?--may throw some light thereon. It appears to the author that
the scientific method is by far the mightiest weapon that has as yet
come within man’s grasp, for the illumination of these multitudinous
entities. The searching accuracy and power of that superb instrument,
wielded by human reason in the quest of human health, is the theme of
this volume. And yet, notwithstanding its triumphs, the experimental
method, as applied in the separate sciences, has, of its nature,
certain limitations with reference to living beings in general and
living human beings in particular.
It is the business of each of the sciences--it is indeed an essential
part of the method of Science--to separate a circumscribed part of
the Universe for consideration in and for itself. Men of Science must
thus perforce become Chemists, Physicists, Astronomers, Botanists,
Cytologists, Statisticians, and the like. In this respect modern
_Science_ differs most profoundly from medieval _Scientia_ and from
ancient _Philosophia_. ‘Specialization’ follows modern _Science_ as
shadow follows substance. The new method has triumphed wonderfully in
these last centuries and it is mere folly and obscurantism to seek
to place intellectual stumbling-blocks in its path. Nor must we be
afraid of shadows. The author does plead, however, that, while the
Man of Science must, from the very nature of his method, cut off part
of his universe of experience from all other parts, he should bear in
mind, when not employed on his special task, that he has so cut off
and isolated his special experience, of deliberate and set intent. To
bear this fact in mind should not mean and must not mean that Science
fails to influence our view of the world as a whole, but it should
mean and must mean the basing of our view of the world as a whole on
experience as a whole, and not on an artificially separated fragment
of experience. For Man is neither a walking test-tube, nor a living
anatomy, nor a colony of cells, nor a self-repairing machine that
carries its own spare parts, nor a mere summation of the factors of
heredity and environment, nor, for that matter, is he a disembodied
spirit. But he is a being with a purpose. Of that purpose he, of his
nature, can know very little, since it is a part of that through which
he knows. Yet some glimpse of that purpose, though seen through a mist
and ever so dimly, we may perhaps gain from the view-point on which the
stony tracks of the separate sciences do ultimately converge. If the
separate sciences did not so conspire to one end, why should we ever
bother our heads or weary our limbs over their steep ascents? Are there
not rosier paths that we might tread?
Throughout this book, then, the ideal kept in view is the description
of Medicine as a Rational Discipline involving many and perhaps all the
sciences. Medicine is not now and never has been followed wholly in the
scientific spirit. But it is the story of the scientific elements in
Medicine which is here to be told, and other aspects are passed over
with a silence which must not be interpreted as the silence of contempt.
No two men undertaking the task here outlined would make quite the
same selections or allot emphasis in quite the same manner. Doubtless
the author has erred by omission and by commission, through ignorance
and through misconception, but he hopes that he has never erred
through prejudice. The ideas that he recounts are those that present
themselves to him as the most important and fruitful within the range
of scientific Medicine, and he is prepared to revise his opinions both
on matters of fact and on matters of stress. He will therefore be very
grateful for any corrections or suggestions.
The number of names mentioned in the book has been reduced to the
utmost limit that has seemed feasible. In recounting many episodes
one name has often been taken as an example or type, and thus perhaps
sometimes an injustice has been done to other workers, no less
important but perhaps less typical. When modern times and living
persons are reached the selection becomes not only difficult but also
delicate, but the reader must remember that the names are not always
chosen for their eminence but sometimes rather as typifying the various
movements that have to be discussed. There is a further complication in
that an attempt is here made to bring history right up to date. Very
few names of living men are mentioned, though the work of many living
men is discussed. Though the author has sought to refrain from passing
any judgment on such latter-day conclusions the value of which does not
seem to him clearly and firmly established, yet even this course in
itself implies a judgment, and one in which he is even more likely to
err than in other topics of which the book treats. Nevertheless, some
such judgment seems necessary to make the book a coherent whole.
There are several from whom the author has had help in the writing
of this book. Mrs. Singer has criticized every detail, and has
considerably modified its form. No English writer on the History of
Medicine can fail to refer to the great work of Lt.-Col. Fielding H.
Garrison of the United States Army and of the Library of Congress at
Washington. The author of this book owes much to Lt.-Col. Garrison’s
splendid bibliography, but even more to constant correspondence,
carried on now through a good many years, with the man who made it.
He owes a similar debt to a very old-standing friendship with Dr. E.
T. Withington of Oxford, to whom he takes the liberty of dedicating
this book. Professor Graham Wallas, Emeritus Professor of Sociology
in the University of London, and Professor J. C. Drummond, Professor
of Biochemistry in the University of London, have both read the book
in proof, and have made a number of suggestions and corrections.
Help on special points has been given by Dr. Clark-Kennedy of Corpus
Christi College, Cambridge, Dr. Raymond Crawfurd, Registrar of the
Royal College of Physicians of London, Dr. J. W. Eyre, Professor
of Bacteriology in the University of London, the Rev. Father J. R.
Fletcher, who has the unusual distinction of being both a Priest and
a Physician, Dr. K. Franklin of the Pharmacological Laboratory in the
University of Oxford, and Dr. William Robson, Lecturer in Law in the
University of London, as well as by the author’s pupils Dr. Ivor Hart,
Dr. J. F. Prendergast, Dr. Dorothy M. Turner and Mr. F. Prescott, M.Sc.
To all of these the author would tender his grateful thanks.
CHARLES SINGER.
UNIVERSITY COLLEGE, LONDON. _January_, 1928.
CONTENTS
PREFACE vii-xiv
LIST OF ILLUSTRATIONS xix-xxiv
I. ANCIENT GREECE, to about 300 B.C.
§ 1. Origins of Greek Medicine 1
§ 2. The Hippocratic Physician 13
§ 3. Hippocratic Practice 18
§ 4. Aristotle 27
II. THE HEIRS OF GREECE, from about 300 B.C. to about A.D. 200
§ 1. The Alexandrian School 36
§ 2. Medical Teaching in the Roman Empire 41
§ 3. Medical Services of the Roman Empire 45
§ 4. Roman Hospitals 48
§ 5. Galen 50
§ 6. The Final Medical Synthesis of Antiquity 53
III. THE MIDDLE AGES, from about A.D. 200 to about A.D. 1500
§ 1. The Period of Depression in Europe 61
§ 2. Arabic Medicine 66
§ 3. The Medieval Awakening 68
§ 4. The Universities 70
§ 5. Medieval Anatomy, Surgery, and Internal Medicine 72
§ 6. Medieval Hospitals and Hygiene 77
IV. THE REBIRTH OF SCIENCE, from about 1500 to about 1700.
§ 1. The Anatomical Awakening 82
§ 2. The Anatomical Reaction on Surgery 92
§ 3. The Renaissance of Internal Medicine 95
§ 4. The First Physical Synthesis 102
§ 5. The Revival of Physiology 108
§ 6. Microscopic Analysis of the Animal Body 115
§ 7. From Alchemy to Chemistry 122
§ 8. The Medical Theorists 126
V. THE PERIOD OF CONSOLIDATION, from about 1700 to about 1825.
§ 1. The Reign of Law 135
§ 2. The Rise of Clinical Teaching 138
§ 3. Physiology passes to the Modern Stage 142
§ 4. Some Physiological Advances 145
§ 5. Discovery of the Nature of the Air 151
§ 6. Morbid Anatomy becomes a Science 156
§ 7. Clinical Methods and Instruments 159
§ 8. Surgery and Obstetrics 161
§ 9. The Beginnings of the Science of Vital Statistics 166
§ 10. Military, Naval, and Prison Medicine 169
§ 11. The Industrial Revolution 172
§ 12. Control and Recognition of Epidemic Diseases 182
VI. PERIOD OF SCIENTIFIC SUBDIVISION, from about 1825 onwards.
§ 1. Origins and Implications of Scientific Specialization 186
§ 2. The Revolution in Preventive Medicine 192
(_a_) Preventive Medicine in Britain 193
(_b_) Preventive Medicine in U. S. A. 197
§ 3. The Transition to a Physiological Synthesis 203
(_a_) Anatomy and Embryology in the Earlier Nineteenth Century 204
(_b_) Chemical Physiology in the Earlier Nineteenth Century 205
(_c_) Nervous Physiology in the Earlier Nineteenth Century 207
§ 4. The Experimental Foundations of Modern Medicine 211
(_a_) The Work of Johannes Müller 211
(_b_) The Work of Claude Bernard 213
(_c_) The Work of Karl Ludwig 215
§ 5. The Cell Theory and Cellular Pathology 219
§ 6. Establishment of the Doctrine of the Germ Origin of Disease 224
§ 7. Anaesthesia 235
§ 8. The Revolution in Surgery 237
§ 9. Some Modern Surgical Advances 243
§ 10. Bacteriology becomes a Special Science 249
§ 11. Some Important Bacteriological Results 253
§ 12. The Study of Immunity 259
§ 13. Some Practical Applications of Immunity 263
§ 14. The Conquest of the Tropics 271
(_a_) Yellow Fever 273
(_b_) Malaria 280
§ 15. The Changed View of Insanity 286
§ 16. The New Movement in Psychology 293
§ 17. The Revolution in Nursing 295
§ 18. Some Modern Physiological Concepts of Clinical Import 301
(_a_) Ductless Glands and Internal Secretions 302
(_b_) Nervous Integration 308
(_c_) Vitamins 311
§ 19. Knowledge of the Eye and its Disorders 313
§ 20. Investigation of the Nature and Action of Drugs 322
(_a_) Entry of Vegetable Drugs into the Pharmacopoeia 322
(_b_) Active Principles 323
(_c_) The Alkaloids 325
(_d_) The Glucosides 327
(_e_) The Study of Pharmacology 328
(_f_) Chemotherapy 329
§ 21. Interpretation of Collective Medical Data 333
EPILOGUE 351
INDEX 364
LIST OF ILLUSTRATIONS
1. Hippocrates. British Museum, second or third
century B.C. _Frontispiece_
2. Ivory and gold Minoan statuette of a votaress in a
state of ecstasy. By kind permission of the Museum
of Fine Arts, Boston, U.S.A. 5
3. Surgical instruments recovered from Babylonian
sites. Reproduced by kind permission of Professor
Meyer-Steineg of Jena 5
4. Clay model of sheep’s liver used for instruction in
divination in a Babylonian temple school. Drawn
from the object in the British Museum 6
5. Imhotep. From a statuette in the British Museum 8
6. Aesculapius. Photograph Anderson 8
7. Scheme illustrating some of the sources of
Hippocratic Medicine 9
8. A Greek clinic of about 400 B.C. From a vase
painting 17
9. Instruments used by Greek surgeons 20
10. The _Ladder of Nature_ according to Aristotle 28
11. The womb with the names of its parts as given by
Aristotle 29
12. Embryo dogfish, _Mustelus laevis_, after Johannes
Müller 29
13. The four _Elements_ in association with the four
_Humours_ and the four _Qualities_ 34
14. Inscribed tablet of about 100 B.C. from the wall of
the temple of Kom-Ombos in Upper Egypt 40
15. Roman surgical instruments of the first century
A.D. found at Pompeii 44
16. Aqueduct of Nero from an engraving by Piranesi 47
17. Roman advanced dressing-station. From Trajan’s
column 48
18. Island of St. Bartholomew in the Tiber at Rome.
From an engraving by Piranesi 51
19. Dissection of the hand of a man 57
20. Dissection of the hand of a Barbary ape 57
21. Galen’s Physiological System 59
22. The earliest known representation of St. Luke as a
Physician 63
23. Picture of Trephining, from a thirteenth-century
manuscript 63
24. Illustrating the mode of action of the trephining
instrument used by the surgeon in Fig. 23 64
25. Scene at a siege of Salerno, from a manuscript
prepared in South Italy early in the thirteenth
century 65
26. A Jewish translator receiving an Arabic medical
volume from an Eastern potentate (right) and
handing it, translated into Latin, to a Western
monarch (left) 69
27. Medieval Bologna, from a mural painting of about
1500 in the town-hall of the city 73
28. An anatomical lecture at Padua in the fifteenth
century, from a contemporary Italian woodcut 75
29. A ward in a hospital at Paris in the sixteenth
century. Reproduced, by kind permission of M.
Édouard Champion, from D. L. MacKay, _Les hôpitaux
et la Charité à Paris au XIII^e siècle_ 79
30. Drawing of Dissection of the Heart by Leonardo da
Vinci 85
31. Title-page of the work _On the Fabric of the Human
Body_, by Vesalius, published in 1543 87
32. Skeleton from the anatomical work of Vesalius 91
33. Artificial arms and hands, designed and figured by
Ambroise Paré 93
34. The ‘Four Temperaments’, from the Guild Book of the
Barber-Surgeons of York 97
35. Earliest picture showing the use of Tobacco 99
36. Allegorical picture illustrating the venereal
plague 101
37. Sanctorius in his balance 107
38. The principle of Galileo’s thermometer 109
39. The application of the system shown in Fig. 38 by
Sanctorius, who used a curved tube 109
40. The adaptation of the instrument, shown in Fig. 39,
as a clinical thermometer 109
41. Galileo’s ‘pulsimeter’ 109
42. Dissection of a vein in the thigh and leg, from
Fabricius 111
43. The circulation of the blood 113
44. The superficial veins, from William Harvey 114
45. Lungs of a frog, showing the capillary vessels,
from Malpighi 116
46-9. Stages in the formation of the chick, from Malpighi
117
49a. One of Leeuwenhoek’s microscopes. Reproduced, by
the permission of Mrs. George Martin, from _The
Asclepiad_, II 118
50-3. Illustrating the blood corpuscles and circulation
after Leeuwenhoek 119
54. The first representation of Bacteria 120
55-56a. Drawings by Leeuwenhoek of the structure of
muscle 121
57-60. Experiments by Swammerdam 123
61. Boyle’s Air-pump 125
62. Descartes’ conception of the relation of a sensory
impression and a motor impulse 128
63. Diagram of Descartes, to illustrate nervous action
129
64. Diagrams from Borelli, to illustrate movements of
muscles 130
65. Diagram of muscular action 131
66. Two Plates from Bernard Siegfried Albinus’
_Anatomical Plates of the Muscles of Man_, Leyden, 1747 141
67. Windmill ventilator designed by the Rev. Stephen
Hales. From a print in the British Museum 147
68-70. Experiments illustrating the effects of metallic
contacts on the nerves and muscles of frogs’ legs.
From A. Galvani, _On Electric Forces_, 1792 149
71-3. Volta’s figures of the electric pile and crown of
cups 150
74-5. Illustrating the chemistry of burning and
breathing, from a work issued by Mayow in 1674 152
76. Apparatus from Joseph Priestley’s _Experiments and
Observations on different Kinds of Air_, 1774 154
77. Lavoisier in his laboratory making experiments on
breathing. From a contemporary sketch 155
78. Part of the lung of Dr. Samuel Johnson, from a
drawing published by Matthew Baillie 158
79-82. Laënnec’s wooden stethoscope, from the first
edition of his work _On Instrumental Auscultation_
161
83. Lying-in scene in the sixteenth century, from a
contemporary work on Midwifery 163
84-6. Early obstetric instruments 164
87. John Hunter’s country house at Earl’s Court,
Kensington, before its demolition in 1886.
Reproduced, by the kind permission of Mrs. George
Martin, from _The Asclepiad_, VIII 165
88. An eighteenth-century Quarantine station (Naples)
173
89-90. Illustrating the textile trade from home industry
to factory work with the consequent break-up of the
family as the labour unit. The upper picture from a
drawing by George Walker, the lower from _Economic
Botany: The Cotton Manufacture_ 175
91. Graph showing approximate growth of population in
England and Wales 1670-1830 176
91a. Tables illustrating vital conditions in the
eighteenth century 177
92. St. Bartholomew’s Hospital at Smithfield, London,
in 1720. From Strype’s edition of Stow’s _Survey_
179
93. The Pest House in Tothill Fields, London, in 1796.
From a print in the British Museum 181
94. Hand of Dairymaid infected with cow-pox, from
figure by Jenner 184
95. A cartoon by Robert Cruikshank 191
96. Annual death-rate in London per thousand living
over 85 years 196
97. The Old _Dreadnought_ Hospital Ship 199
98. Diagram of Transverse section of the Spinal Cord,
&c. 208
99. Diagram to illustrate Reflex 209
100. Diagram to illustrate Cerebral localization 210
101. Thomas Young’s Kymograph 217
102-5. Drawings by Theodor Schwann to illustrate cells
221
106. Organisms of Fermentation, from Pasteur 226
107. Pasteur’s experiment to prove that fermentation is
the result of air-borne organisms 228
108. Bacilli of Anthrax 231
108a. Screw used in the eighteenth and the early
nineteenth century to secure analgesia. Reproduced,
by the kind permission of Mrs. George Martin, from
_The Asclepiad_, VII 236
109. The ‘Donkey Engine’ designed by Lord Lister. Now in
the Royal College of Surgeons of England 241
109a. Operating table used by Lord Lister in the Glasgow
Royal Infirmary. Reproduced, by kind permission of
Messrs. Jackson, Wylie & Co., from _Lister and the
Lister Ward in the Royal Infirmary of Glasgow_ 242
110. ‘Spencer Wells Forceps’ 244
111. Spencer Wells performing an abdominal operation
245
112. An operation in the sixteenth century 246
113. An abdominal operation under modern conditions.
Reproduced, by kind permission of W. B. Saunders’
Company, Philadelphia, from _The Operating Room,
St. Mary’s Hospital, Rochester, Minnesota_ 247
114. Bacilli of Diphtheria 254
115. Bacilli of Plague 255
116. Diagram showing the Incidence of Malta fever 256
117. Bacilli of Tetanus 257
118. Bacilli of Typhoid Fever 258
119. Death-rate of cases of Laryngeal Diphtheria 263
120-1. A common Malaria-carrying mosquito and a Yellow
Fever-carrying mosquito. Reproduced, by kind
permission of the British Museum (Natural History),
from Edwards, _Mosquitoes and their Relation to
Disease_ 272
122. Distribution of Malaria in England and Wales 281
123. The Life-History of the Parasite of Malaria.
Reproduced, by kind permission of Messrs.
Baillière, Tindall & Cox, from C. M. Wenyon’s
_Protozoology_, vol. II 285
124-5. A Malaria-carrying mosquito and a common gnat.
Reproduced, by kind permission of the British
Museum (Natural History), from Edwards, _Mosquitoes
and their Relation to Disease_ 287
126. Chart of cases of Malaria reported in Italy in
recent years 287
127. ‘The Retreat’ near York. Reproduced, by permission
of Messrs. Kegan Paul, Trench, Trubner & Co., from
Tuke, _Chapters in the History of the Insane in the
British Isles_, 1882 289
128. Florence Nightingale at Scutari. Photograph,
Rischgitz Collection 299
129-30. Cretinous infant before and after thyroid
treatment. Reproduced by kind permission of the
Royal College of Surgeons 305
131. Diagram to show the structure of the eye 314
132. Diagram to show the nature of accommodation of the
eye 317
133. The Organisms of Syphilis in a smear from the Local
Infection 331
134. Diagram illustrating alteration in Age-distribution
of the population of England and Wales. Reproduced,
by kind permission of the authors, from
Carr-Saunders & Caradog Jones, _Social Structure of
England and Wales_ (Clarendon Press) 335
135. Death-rate from Cancer of the Tongue. Reproduced,
by kind permission of the Editors, from _The
Quarterly journal of Medicine_, vol. v, No. 5 337
136. Death-rate from Cancer of the Lip. Reproduced, by
kind permission of the Editors, from _The Quarterly
Journal of Medicine_, vol. v, No. 5 338
137. Death-rate from Cerebral Haemorrhage. Reproduced,
by kind permission of the Editors, from _The
Quarterly Journal of Medicine_, vol. v, No. 5 340
138. Curve showing percentage of deaths from Phthisis to
total deaths 343
139. The normal curve of error 345
140. Curve of monthly number of deaths from Small-pox
during an epidemic at Warrington, Lancashire, in 1743 346
141. Curve of weekly number of cases of Scarlet Fever
during an epidemic at Glasgow in 1892 346
142. Analysis of curve representing death-rates from
Summer Diarrhoea in London over a long period of
years 347
I
ANCIENT GREECE
(TO ABOUT 300 B.C.)
§ 1. _Origins of Greek Medicine._
Scientific Medicine began with the Greeks. The Greeks not only started
scientific Medicine upon its course, but also provided the substantial
basic elements of our anatomy, physiology and pathology, and above
all, perhaps, our conception of the bodily ‘constitution’, ‘habit’ or
‘temperament’. It is from the Greeks that we derive almost all our
medical nomenclature. When to this we add that our medical traditions
are inherited through a direct and continuous chain from the Greek
practitioners, it becomes evident that the debt that Medicine owes to
this marvellous people is great indeed.
Now this debt has become associated with two or three great figures.
The names Hippocrates, Aristotle, Galen, are familiar to all. Yet it is
not always recognized that these men were but the representatives of a
widely extended and long-lasting system. Greek Medicine was, in fact,
like modern Medicine, the result of centuries of carefully recorded,
collated and progressive research. Greek Medicine first assumed a
scientific aspect with the Ionian and Italo-Greek philosophers at the
very beginning of the sixth century B.C. It continued to make important
advances until the death of Galen at the very end of the second century
of the Christian era. Thus the life-span of progressive and scientific
Medicine among the Greeks was no less than eight hundred years. With
the most tolerant use of the words ‘scientific’ and ‘progressive’,
we can hardly place the beginnings of modern Medicine in Europe
before the end of the fifteenth century. Thus our own system has only
been developing its characteristic features for some four and a half
centuries, which is but little more than half the course that Greek
science ran.
It is evident, therefore, that we may have much to learn from the
Greeks, not indeed in matters of actual fact or observation--for nearly
all that is _directly_ useful in their writings has been absorbed long
ago into our medical literature--but in spirit and method. From a
study of the character and course of Greek medical science we can gain
hints of the snares and pitfalls and catastrophes into which the Art
of Medicine may at times be led. Further, by study of the practice of
Medicine under conditions so different from ours, we learn something
of what is truly permanent in the Art of Healing. Lastly, by tracing
the growth of the Science of Medicine, as it arose among the Greeks and
as it died in the hands of their less worthy descendants, we may take
alike example and warning. We may learn to distinguish the healthy and
vigorous growth of a science from the stunted and deformed products
that are often acclaimed, even in our own times, as Wisdom’s final word
to Man.
It has been said that, ‘save the blind forces of Nature, nothing lives
or moves which is not Greek in origin’. The saying needs modification,
for there is a thing which still lives and moves that is not Greek in
origin, a blind force which is not a blind force of Nature. It is the
force of Superstition, of that age-old belief that Nature will give
us something for nothing, which is expressed by the word ‘Magic’.
The Greeks were no more free from that contemptible fallacy than
are the men of our own days. But the greatest of the Greeks stood
wholly above such folly, and we can watch the Greek mind gradually
lifting itself from that primeval mental attitude which is older than
any known culture, older perhaps than any known race, the attitude
of Nature-Worship, or ‘Animism’. To give an idea of how the ‘sweet
reasonableness’ of the Greek mind gradually dissipated the animistic
fog, a few words must be said about the history of the Greeks. Without
that amount of history it would seem a miracle that Man ever became
reasonable at all.
The Medicine we call Greek might be described as the system which
prevailed in ancient times in that half of the Mediterranean area which
lies east and south of the Italian Peninsula.
Up to about 1000 B.C. most of the coast-lands of this Mediterranean
area were inhabited by that very remarkable people, the Minoans.
These have left some extraordinary remains, the full significance
of which has not yet been revealed. The general development of the
Minoan civilization has, however, been clearly outlined by modern
archaeological investigation. This has resulted in an entirely new
interpretation of the story which Homer tells in the _Iliad_. The siege
of Troy represents an attack by the invading Greeks on one of the last
Minoan strongholds. About 1000 B.C. the whole Eastern Mediterranean
basin was being overrun by the Greek tribes coming in from the north.
These Greeks were no pure race, but a mixed multitude of invaders
who came along several lines of advance. As always happens in such
invasions, the conquered were not exterminated, but mingled with the
invaders. Thus the Greeks, as they advanced, absorbed much of the
culture and outlook of the civilization that they submerged.
In considering the history of Rational Medicine we are concerned
chiefly with two main invading streams of Greek tribes: that of the
Dorians, who passed towards Crete and towards the Island of Cos and the
opposite peninsula of Cnidus, and that of the Ionians, who colonized
most of the remaining part of western Asia Minor. These two peoples
were, between them, responsible for the main intellectual output of the
Greeks of those early days. The medical system which they initiated
first took shape in western Asia Minor, and thence became diffused over
the whole of the Greek world. The Greek system of Medicine which thus
arose in Asia Minor had various roots, as indeed the Medicine of a
mixed people, living under very complex social conditions, was bound to
have.
Firstly, there was the submerged civilization of the conquered Minoan
folk. It is probable that the cult of the serpent--so constantly
associated with Aesculapius and still used as a medical emblem--was of
Minoan origin, for the serpent was a symbol much used in the Minoan
religion (Fig. 2). It is probable too that some of the hygienic ideas
of the Greeks were derived from the same source, for the Minoans had an
excellent system of drainage. We can, however, say little on this head
because the interpretation of the Minoan records is still hidden from
us.
[Illustration:
FIG. 2. IVORY AND GOLD MINOAN STATUETTE of a votaress in a state
of ecstasy. In either hand she holds a serpent, illustrating the
importance attached to this animal in the Minoan cult. From the Museum
of Fine Arts, Boston, U.S.A.
FIG. 3. SURGICAL INSTRUMENTS recovered from Babylonian sites. There are
here represented three knives, a saw and a trephine. These instruments,
which illustrate the state of surgery in the ancient Mesopotamian
civilization, are in the possession of Professor Meyer-Steineg of Jena,
by whose permission they are here reproduced.
]
Secondly, we have to remember that the shores of Asia Minor lie on the
outskirts of the great civilization which had grown up in the valley
of the Tigris and the Euphrates. The Greeks drew from that source much
of their more superstitious beliefs, as well as some, at least, of
their scientific method. On the one hand, the demoniac theories that
bulk so largely in later Greek medicine doubtless came from Assyria
and Babylonia. The Medicine of the New Testament, for instance, with
its casting out of devils, is of Mesopotamian origin. But, on the
other hand, the Mesopotamian peoples had for long ages laid up a great
treasury of observation, notably of astronomical data which were
often applied to astrological ends. There was also some knowledge of
anatomy derived from the entrails of animals used in divination (Fig.
4). Working on the basis of these records, the Greeks were able to
erect a scientific method which appears as a prominent feature in
their intellectual life in later centuries. Moreover, there was in
Mesopotamia a standardization of both medical and surgical procedure
which the nimble-witted Greeks were quick to adopt (Fig. 3). On its
lower and less intelligent side, however, the Mesopotamian material was
made to minister to Greek superstition and especially to astrological
belief.
[Illustration:
FIG. 4. CLAY MODEL OF SHEEP’S LIVER used for instruction in divination
in a Babylonian temple school. The object is now in the British Museum.
It is covered with cuneiform writing, the nature and contents of which
fix its date as about 2000 B.C. The writing is here omitted for the
sake of simplicity.
Various parts of the liver have their Babylonian technical terms and
can be identified with parts recognized by modern anatomists. Some of
these modern terms are written on our drawing.
To each hole in the original model an inscription containing a forecast
is assigned. The diviner made his forecast by comparing an actual
liver with this clay model at each point corresponding to a hole. His
forecast was elaborated according to the state of the liver at all
these points.
]
Thirdly, to the Egyptian civilization the Greek debt was also
considerable. Many drugs were derived from Egypt and others were
suggested by Egyptian practice. The basis of Greek medical ethics,
too, can be traced to Egypt. Some of the practical devices of Greek
Medicine, such as the forms of the surgical instruments, were of
Egyptian origin. Nor can we neglect the statement made by the Greeks
themselves, that mathematical knowledge--the test and index of all
scientific growth--came to them first from Egypt. Lastly, we note that
the Egyptians deified a physician, Imhotep (Fig. 5), in exactly the
way that the Greeks deified their physician Aesculapius (Fig. 6). Both
Imhotep and Aesculapius were, in fact, historic personages, and their
evolution into gods presents many interesting parallels.
[Illustration:
FIG. 5. IMHOTEP, originally a physician, subsequently deified as an
Egyptian god of Medicine. From a statuette in the British Museum.
FIG. 6. AESCULAPIUS, originally a physician, subsequently deified as a
Greek god of Medicine. He holds a staff, around which a serpent twines.
From a statue in the Capitoline Museum at Rome.
]
The Greeks of western Asia Minor, thus drawing material from many
sources, came to develop, towards the end of the seventh century B.C.,
a philosophical system from which the whole of their Science may be
said to be a natural growth. Factors in this development were the
medical schools of Cos, where Hippocrates was born, and of the opposite
peninsula, Cnidus. These schools were in active operation by the sixth
century B.C. By the middle of the fifth century they were important
elements in the growing complexity of Greek life. Much of the so-called
_Hippocratic Collection_, which contains the earliest Greek medical
writings that have survived, must have been put together somewhere in
the fourth century B.C., though its final recension is certainly later
(Fig. 7). In that final recension Persian and Indian elements were also
included, though to what degree is still very uncertain.
[Illustration: FIG. 7. SCHEME ILLUSTRATING SOME OF THE SOURCES OF
HIPPOCRATIC MEDICINE]
But the picture of the development of Greek Medicine is not yet
complete. Although we inherit the scientific spirit from the Greeks,
and although they set a standard for all time of the purest and
most disinterested type of medical practice, they are also in part
responsible for some of the basest forms of medical jugglery that have
afflicted and still afflict mankind. The medicine of the physicians was
only one of their medical systems. There was a far lower form which
gradually passed into the hands of the priests. The temple jugglery of
Greece is ancestor, both by imitation and by direct tradition, of much
medieval and modern medical miracle-mongering.
Furthermore, in ancient as in modern times, all medical men were not
equally pure in aim or scientific in method. The practice of some Greek
physicians was more than flavored with magic. In justice, also, it
must be said that not all priests were mere charlatans, and that there
are traces of scientific method in the treatment of patients in the
temples. There was, indeed, a relation between the practice of some
of the physicians among the Greeks and that of some of their priestly
magicians. We shall not attempt to determine the actual extent and
nature of this relationship. For our purpose it is enough that the two
systems were quite distinct in their most typical developments.
The temple system of Greek Medicine was associated from an early date
with a deity, Asklepios, or, to give him his better-known Latin name,
Aesculapius. Numerous representations of him have come down to us, and
in them we see him gradually molded to a particular type. He becomes at
last an aged man of noble, benevolent and dreamy aspect, holding in
his hand a staff around which a serpent twines (Fig. 6). The cult of
the god Aesculapius was carried on at numerous sites. The best known,
both from literature and excavation, is Epidaurus. The conditions there
are typical of those in other Aesculapian centers.
Epidaurus is about thirty miles from Athens. It lies between two
considerable ranges of hills, and the country bears still, in its
customs and place-names, some remnants of the ancient cult. One
tradition tells that a certain maiden, Koronis, being with child by
Apollo, brought forth the infant Aesculapius on the mountain above
Epidaurus. There is still a village named Koroni hard by. She fled
to conceal her shame and left the child on the mountain, where it
was tended by a goat and watched over by a dog. The infant performed
various miracles which we need not pursue, though the temple arose on
the site where he is said to have wrought them. One of his miracles,
however, has a wider interest and is worth recounting. A certain
Hippolytus, falsely accused of impure relations with his stepmother,
was slain by the gods in answer to the curses of his father, Theseus.
Raised from the dead by the wonder-working Aesculapius, he reappears in
legend at the Arician grove in Italy. ‘There’, says a Greek chronicler
of the second century A.D., ‘he became a king and devoted a precinct
to Artemis, where, down to my time, the prize for the victor in single
combat was the priesthood of the goddess. The contest was open to no
freeman, but only to runaway slaves.’
The son slain by his father and then rising from the dead; the runaway
slave seeking sanctuary with Artemis in her grove, allowed his liberty
and elevated to the priesthood there; the priesthood held only so long
as the priest can guard it in mortal combat against the next runaway
slave; this succession of slave kings and priestly murders has touched
the imagination of the poets and artists in ancient and in modern
times. The sacred grove of Artemis stood by the side of the lake of
Nemi:
The still glassy lake that sleeps
Beneath Aricia’s trees--
Those trees in whose dim shadow
The ghastly priest doth reign,
The priest who slew the slayer
And shall himself be slain.
It is a picture utterly out of accord with the general trend of
classical mythology. Long ago scholars saw therein a remnant of a
submerged faith, that ancient ‘Nature worship’ which survived among the
Greeks, and survives with us. From this incident is named the great
classical work of Anthropology, _The Golden Bough_. By this story and
by all that it implies, by all that learning has drawn out of it and
associated with it, the history of Medicine comes into contact with the
brooding spirit of savage man. Into that dark realm we shall not enter
in this volume.
History is the tale of the spirit of Man unfolding itself. This process
is always slow, often imperceptible, sometimes retrograde, yet over
long periods of time it is sure. Where no evolution of the spirit can
be traced true history cannot be written, wherefore no man can write a
history of human folly. Irrational man, driven by disease and fear of
death, exhibits the same follies in all ages. The medical follies and
superstitions of our own days are as in those when Aesculapius claimed
men’s allegiance. His garments and his names are changed, his temples
are transformed, his priests assume other titles, but his face is the
same, and he works the same wonders with about the same frequency. It
is of Rational Medicine that we have henceforth to speak.
§ 2. _The Hippocratic Physician._
We turn to the other side of the picture. Nothing could be in greater
contrast to the orgies of the savage, the dark ways of the magician,
or the charlatanry of the priests, than the serene spirit of wisdom
which pervades the best Greek Medicine. The finest presentation of that
system is to be found in a group of about a hundred works that have
been associated together since antiquity under the name of Hippocrates.
It is known as the _Hippocratic Collection_.
It will naturally be asked, ‘Which of these works is by the man whose
name they bear?’ To that question, alas, no definite answer can be
given. There is no single work which we can state with certainty to
be the composition of the Father of Medicine. The books of which the
_Collection_ is composed are the work of a number of authors, belonging
to different schools, holding various and often contradictory views,
living in widely separated parts of the Greek world and writing at
dates divided from each other, in the most extreme cases, by perhaps
five or six centuries. Of the finest books of this collection we can
but say that they contain nothing inconsistent with a Hippocratic
origin, that their ethical standpoint is in accord with the Hippocratic
ideal, and that they are the work of physicians of great intellectual
power and experience.
If we ask what is known about Hippocrates himself, and if we seek
information rather than entertainment, our answer will be almost as
meager. Hippocrates is no mythical figure, for he is mentioned with
high respect by his younger contemporary, Plato. He was the son of a
physician, and was born at Cos about 460 B.C. The most active period
of his life thus began about 420 B.C. His death is placed between 377
and 359--the latter would make him 101, an appropriate age for a great
physician. He led a wandering life, and is heard of at Cos, Thasos,
Athens, in Thrace and elsewhere, and lastly in Thessaly, where his
grave was long shown. Among his pupils were his two sons, and his
son-in-law. Of the work of the latter we have a fragment preserved both
by Aristotle and in the _Hippocratic Collection_ itself.
That is all that is known about the Father of Medicine. We have not
even his portrait. Yet we have something far better; we have an
idealized representation of what the Greek would wish his physician
to be. It is a noble bust to which the name of Hippocrates was early
attached. Many copies exist (see Frontispiece). The calm, righteous
and dignified presence which it portrays has stamped itself on the
consciousness and conscience of those who follow the Art of Healing. To
that gracious figure the medical man will continue to pay homage.
If critical examination has dealt thus hardly with the Hippocratic
writings and with Hippocrates himself, what has been left which we
may surely derive from the Greek medical system? The answer is that
Medicine has from the Greeks two great things: the picture of a man and
the institution of a method.
The man is Hippocrates himself. His figure, gaining in dignity what it
loses in clearness, stands for all time as that of the ideal physician,
for the ideal is there and is clearly set forth in these great
writings, whether we discern the details of his earthly features or no.
Calm and effective, humane and observant, prompt and cautious, at once
learned and willing to learn, eager alike to get and give knowledge,
unmoved save by the fear lest his knowledge may fail to benefit
others--both the sick and their servants the physicians,--incorruptible
and pure in mind and body, the figure of the greatest of physicians has
gained, not lost, by time. In all ages he has been held by medical men
in a reverence comparable only to that which has been felt towards the
founders of the great religions by their followers. The figure of the
Hippocratic physician has been of incalculable spiritual value to the
medical profession in the twenty-three centuries that have passed since
his death.
So much for the man. We turn now to the method.
The _method_ of Hippocratic medicine is that known to-day as the
_experimental_ or better _experiential_. It was employed among the
Greeks for centuries after the death of Hippocrates. Then came a
time when a social and philosophical upheaval prevented its further
prosecution. For the thousand years that followed the break-up of the
Roman Empire the medical practice of Europe was at best a corrupted
imitation and misunderstanding of the Hippocratic teaching; at worst
it descended to a low level of Animism and Magic. Then there was a
rally. Slowly--very slowly at first--the foundations of Modern Science
were laboriously laid. Among the first elements in this scientific
Renaissance was the recovery of the Hippocratic works.