OGRAIAE gentis decus! let us sing with Lucretius, one of the great
interpreters of Greek thought. How grand and how true is his paean!
Out of the night, out of the blinding night
Thy beacon flashes;--hail, beloved light
Of Greece and Grecian; hail, for in the mirk
Thou cost reveal each valley and each height.
Thou art my leader, and the footprints shine,
Wherein I plant my own....
* * * * *
The world was shine to read, and having read,
Before thy children's eyes thou didst outspread
The fruitful page of knowledge, all the wealth
Of wisdom, all her plenty for their bread.
(Bk. III.--Translated by D. A. Slater.)
Let us come out of the murky night of the East, heavy with
phantoms,
into the bright daylight of the West, into the company of men
whose
thoughts made our thoughts, and whose ways made our ways--the men
who first dared to look on nature with the clear eyes of the
mind.
Browning's famous poem, "Childe Roland to the Dark Tower Came," is an
allegory of the pilgrimage of man through the dark places of the earth,
on a dismal path beset with demons, and strewn with the wreckage of
generations of failures. In his ear tolled the knell of all the lost
adventurers, his peers, all lost, lost within sight of the dark Tower
itself--
The round squat turret, blind as the fool's heart,
Built of brown stone, without a counterpart
In the whole world.
lost in despair at an all-encircling mystery. Not so the Greek Childe
Roland who set the slug-horn to his lips and blew a challenge. Neither
Shakespeare nor Browning tells us what happened, and the old legend,
Childe Roland, is the incarnation of the Greek spirit, the young,
light-hearted master of the modern world, at whose trumpet blast the
dark towers of ignorance, superstition and deceit have vanished into
thin air, as the baseless fabric of a dream. Not that the jeering
phantoms have flown! They still beset, in varied form, the path of each
generation; but the Achaian Childe Roland gave to man self-confidence,
and taught him the lesson that nature's mysteries, to be solved, must
be challenged. On a portal of one of the temples of Isis in Egypt was
carved: "I am whatever hath been, is, or ever will be, and my veil no
man has yet lifted."
The veil of nature the Greek lifted and herein lies his value to us.
What of this Genius? How did it arise among the peoples of the AEgean
Sea? Those who wish to know the rock whence science was hewn may read
the story told in vivid language by Professor Gomperz in his "Greek
Thinkers," the fourth volume of which has recently been published
(Murray, 1912; Scribner, 1912). In 1912, there was published a book by
one of the younger Oxford teachers, "The Greek Genius and Its Meaning to
Us,"(1) from which those who shrink from the serious study of Gomperz'
four volumes may learn something of the spirit of Greece. Let me quote a
few lines from his introduction:
(1) By R. W. Livingstone, Clarendon Press, Oxford, 1912 (2d
ed., revised, 1915).
"Europe has nearly four million square miles; Lancashire has 1,700;
Attica has 700. Yet this tiny country has given us an art which we,
with it and all that the world has done since it for our models, have
equalled perhaps, but not surpassed. It has given us the staple of our
vocabulary in every domain of thought and knowledge. Politics, tyranny,
democracy, anarchism, philosophy, physiology, geology, history--these
are all Greek words. It has seized and up to the present day kept hold
of our higher education. It has exercised an unfailing fascination, even
on minds alien or hostile. Rome took her culture thence. Young Romans
completed their education in the Greek schools.... And so it was with
natures less akin to Greece than the Roman. St. Paul, a Hebrew of the
Hebrews, who called the wisdom of the Greeks foolishness, was drawn
to their Areopagus, and found himself accommodating his gospel to the
style, and quoting verses from the poets of this alien race. After him,
the Church, which was born to protest against Hellenism, translated its
dogmas into the language of Greek thought and finally crystallized them
in the philosophy of Aristotle."
Whether a plaything of the gods or a cog in the wheels of the universe
this was the problem which life offered to the thinking Greek; and in
undertaking its solution, he set in motion the forces that have made
our modern civilization. That the problem remains unsolved is nothing
in comparison with the supreme fact that in wrestling with it, and in
studying the laws of the machine, man is learning to control the
small section of it with which he is specially concerned. The veil of
thaumaturgy which shrouded the Orient, while not removed, was rent in
twain, and for the first time in history, man had a clear vision of the
world about him--"had gazed on Nature's naked loveliness" ("Adonais")
unabashed and unaffrighted by the supernatural powers about him. Not
that the Greek got rid of his gods--far from it!--but he made them so
like himself, and lived on terms of such familiarity with them that they
inspired no terror.(2)
(2) "They made deities in their own image, in the likeness
of an image of corruptible man. Sua cuique deu fit dira
cupido. 'Each man's fearful passion becomes his god.' Yes,
and not passions only, but every impulse, every aspiration,
every humour, every virtue, every whim. In each of his
activities the Greek found something wonderful, and called
it God: the hearth at which he warmed himself and cooked his
food, the street in which his house stood, the horse he
rode, the cattle he pastured, the wife he married, the child
that was born to him, the plague of which he died or from
which he recovered, each suggested a deity, and he made one
to preside over each. So too with qualities and powers more
abstract." R.W. Livingstone: The Greek Genius and Its
Meaning to Us, pp. 51-52.
Livingstone discusses the Greek Genius as displayed to us in certain
"notes"--the Note of Beauty--the Desire for Freedom--the Note
of Directness--the Note of Humanism--the Note of Sanity and of
Many-sidedness. Upon some of these characteristics we shall have
occasion to dwell in the brief sketch of the rise of scientific medicine
among this wonderful people.
We have seen that the primitive man and in the great civilizations of
Egypt and Babylonia, the physician evolved from the priest--in Greece
he had a dual origin, philosophy and religion. Let us first trace the
origins in the philosophers, particularly in the group known as the
Ionian Physiologists, whether at home or as colonists in the south of
Italy, in whose work the beginnings of scientific medicine may be found.
Let me quote a statement from Gomperz:
"We can trace the springs of Greek success achieved and maintained
by the great men of Hellas on the field of scientific inquiry to a
remarkable conjunction of natural gifts and conditions. There was the
teeming wealth of constructive imagination united with the sleepless
critical spirit which shrank from no test of audacity; there was the
most powerful impulse to generalization coupled with the sharpest
faculty for descrying and distinguishing the finest shades of phenomenal
peculiarity; there was the religion of Hellas, which afforded complete
satisfaction to the requirements of sentiment, and yet left the
intelligence free to perform its destructive work; there were the
political conditions of a number of rival centres of intellect, of
a friction of forces, excluding the possibility of stagnation, and,
finally, of an order of state and society strict enough to curb the
excesses of 'children crying for the moon,' and elastic enough not to
hamper the soaring flight of superior minds.... We have already made
acquaintance with two of the sources from which the spirit of criticism
derived its nourishment--the metaphysical and dialectical discussions
practiced by the Eleatic philosophers, and the semi-historical method
which was applied to the myths by Hecataeus and Herodotus. A third
source is to be traced to the schools of the physicians. These aimed at
eliminating the arbitrary element from the view and knowledge of nature,
the beginnings of which were bound up with it in a greater or less
degree, though practically without exception and by the force of an
inner necessity. A knowledge of medicine was destined to correct that
defect, and we shall mark the growth of its most precious fruits in the
increased power of observation and the counterpoise it offered to hasty
generalizations, as well as in the confidence which learnt to reject
untenable fictions, whether produced by luxuriant imagination or by
a priori speculations, on the similar ground of self-reliant
sense-perception."(3)
(3) Gomperz: Greek Thinkers, Vol. I, p. 276.
The nature philosophers of the Ionian days did not contribute much
to medicine proper, but their spirit and their outlook upon nature
influenced its students profoundly. Their bold generalizations on the
nature of matter and of the elements are still the wonder of chemists.
We may trace to one of them, Anaximenes, who regarded air as the primary
principle, the doctrine of the "pneuma," or the breath of life--the
psychic force which animates the body and leaves it at death--"Our
soul being air, holds us together." Of another, the famous Heraclitus,
possibly a physician, the existing fragments do not relate specially to
medicine; but to the philosopher of fire may be traced the doctrine of
heat and moisture, and their antitheses, which influenced practice
for many centuries. There is evidence in the Hippocratic treatise peri
sarkwn of an attempt to apply this doctrine to the human body. The
famous expression, panta rhei,--"all things are flowing,"--expresses
the incessant flux in which he believed and in which we know all matter
exists. No one has said a ruder thing of the profession, for an extant
fragment reads: ". . . physicians, who cut, burn, stab, and rack the
sick, then complain that they do not get any adequate recompense for
it."(4)
(4) J. Burnet: Early Greek Philosophy, 1892, p. 137,
Bywater's no. LVIII.
The South Italian nature philosophers contributed much more to the
science of medicine, and in certain of the colonial towns there were
medical schools as early as the fifth century B.C. The most famous of
these physician philosophers was Pythagoras, whose life and work had an
extraordinary influence upon medicine, particularly in connection
with his theory of numbers, and the importance of critical days. His
discovery of the dependence of the pitch of sound on the length of the
vibrating chord is one of the most fundamental in acoustics. Among the
members of the school which he founded at Crotona were many physicians.
who carried his views far and wide throughout Magna Graecia. Nothing in
his teaching dominated medicine so much as the doctrine of numbers, the
sacredness of which seems to have had an enduring fascination for the
medical mind. Many of the common diseases, such as malaria, or typhus,
terminating abruptly on special days, favored this belief. How dominant
it became and how persistent you may judge from the literature upon
critical days, which is rich to the middle of the eighteenth century.
One member of the Crotonian school, Alcmaeon, achieved great distinction
in both anatomy and physiology. He first recognized the brain as the
organ of the mind, and made careful dissections of the nerves, which he
traced to the brain. He described the optic nerves and the Eustachian
tubes, made correct observations upon vision, and refuted the common
view that the sperma came from the spinal cord. He suggested the
definition of health as the maintenance of equilibrium, or an "isonomy"
in the material qualities of the body. Of all the South Italian
physicians of this period, the personality of none stands out in
stronger outlines than that of Empedocles of Agrigentum--physician,
physiologist, religious teacher, politician and poet. A wonder-worker,
also, and magician, he was acclaimed in the cities as an immortal god
by countless thousands desiring oracles or begging the word of healing.
That he was a keen student of nature is witnessed by many recorded
observations in anatomy and physiology; he reasoned that sensations
travel by definite paths to the brain. But our attention must be
confined to his introduction of the theory of the four elements--fire,
air, earth and water--of which, in varying quantities, all bodies were
made up. Health depended upon the due equilibrium of these primitive
substances; disease was their disturbance. Corresponding to those were
the four essential qualities of heat and cold, moisture and dryness, and
upon this four-fold division was engrafted by the later physicians the
doctrine of the humors which, from the days of Hippocrates almost to our
own, dominated medicine. All sorts of magical powers were attributed to
Empedocles. The story of Pantheia whom he called back to life after a
thirty days' trance has long clung in the imagination. You remember
how Matthew Arnold describes him in the well-known poem, "Empedocles on
Etna"--
But his power
Swells with the swelling evil of this time,
And holds men mute to see where it will rise.
He could stay swift diseases in old days,
Chain madmen by the music of his lyre,
Cleanse to sweet airs the breath of poisonous streams,
And in the mountain-chinks inter the winds.
This he could do of old--(5)
a quotation which will give you an idea of some of the powers attributed
to this wonder-working physician.
(5) Poetical Works of Matthew Arnold, Macmillan & Co., 1898,
p. 440.
But of no one of the men of this remarkable circle have we such definite
information as of the Crotonian physician Democedes, whose story
is given at length by Herodotus; and his story has also the great
importance of showing that, even at this early period, a well-devised
scheme of public medical service existed in the Greek cities. It dates
from the second half of the sixth century B.C.--fully two generations
before Hippocrates. A Crotonian, Democedes by name, was found among the
slaves of Oroetes. Of his fame as a physician someone had heard and he
was called in to treat the dislocated ankle of King Darius. The wily
Greek, longing for his home, feared that if he confessed to a knowledge
of medicine there would be no chance of escape, but under threat of
torture he undertook a treatment which proved successful. Then Herodotus
tells his story--how, ill treated at home in Crotona, Democedes went to
AEgina, where he set up as a physician and in the second year the State
of AEgina hired his services at the price of a talent. In the third
year, the Athenians engaged him at 100 minae; and in the fourth,
Polycrates of Samos at two talents. Democedes shared the misfortunes of
Polycrates and was taken prisoner by Oroetes. Then Herodotus tells how
he cured Atossa, the daughter of Cyrus and wife of Darius, of a severe
abscess of the breast, but on condition that she help him to escape, and
she induced her husband to send an expedition of exploration to Greece
under the guidance of Democedes, but with the instructions at all
costs to bring back the much prized physician. From Tarentum, Democedes
escaped to his native city, but the Persians followed him, and it was
with the greatest difficulty that he escaped from their hands. Deprived
of their guide, the Persians gave up the expedition and sailed for Asia.
In palliation of his flight, Democedes sent a message to Darius that
he was engaged to the daughter of Milo, the wrestler, who was in high
repute with the King.(6)
(6) The well-known editor of Herodotus, R. W. Macan, Master
of University College, Oxford, in his Hellenikon. A Sheaf
of Sonnets after Herodotus (Oxford, 1898) has included a
poem which may be quoted in connection with this incident:
NOSTALGY
Atossa, child of Cyrus king of kings,
healed by Greek science of a morbid breast,
gave lord Dareios neither love nor rest
till he fulfilled her vain imaginings.
"Sir, show our Persian folk your sceptre's wings!
Enlarge my sire's and brother's large bequest.
This learned Greek shall guide your galleys west,
and Dorian slave-girls grace our banquetings."
So said she, taught of that o'er-artful man,
the Italiote captive, Kroton's Demokede,
who recked not what of maladies began,
nor who in Asia and in Greece might bleed,
if he--so writes the guileless Thurian--
regained his home, and freedom of the Mede.
Plato has several references to these state physicians, who were
evidently elected by a public assembly: "When the assembly meets to
elect a physician," and the office was yearly, for in "The Statesman" we
find the following:(7) "When the year of office has expired, the
pilot, or physician has to come before a court of review" to answer
any charges. The physician must have been in practice for some time
and attained eminence, before he was deemed worthy of the post of state
physician.
(7) Jowett: Dialogues of Plato, 3d ed., Statesman, Vol. IV,
p. 502 (Stephanus, II, 298 E)
"If you and I were physicians, and were advising one another that we
were competent to practice as state-physicians, should I not ask about
you, and would you not ask about me, Well, but how about Socrates
himself, has he good health? and was anyone else ever known to be cured
by him whether slave or freeman?"(7a)
(7a) Jowett: Dialogues of Plato, 3d ed., Gorgias, Vol. II,
p. 407 (Stephanus, I, 514 D).
All that is known of these state physicians has been collected by
Pohl,(8) who has traced their evolution into Roman times. That they were
secular, independent of the AEsculapian temples, that they were well
paid, that there was keen competition to get the most distinguished
men, that they were paid by a special tax and that they were much
esteemed--are facts to be gleaned from Herodotus and from the
inscriptions. The lapidary records, extending over 1000 years, collected
by Professor Oehler(8a) of Reina, throw an important light on the state
of medicine in Greece and Rome. Greek vases give representations of
these state doctors at work. Dr. E. Pottier has published one showing
the treatment of a patient in the clinic.(8b)
(8) R. Pohl: De Graecorum medicis publicis, Berolini,
Reimer, 1905; also Janus, Harlem, 1905, X, 491-494.
(8a) J Oehler: Janus, Harlem, 1909, XIV, 4; 111.
(8b) E. Pottier: Une clinique grecque au Ve siecle,
Monuments et Memoires, XIII, p. 149. Paris, 1906 (Fondation
Eugene Piot).
That dissections were practiced by this group of nature philosophers is
shown not only by the studies of Alcmaeon, but we have evidence that one
of the latest of them, Diogenes of Apollonia, must have made elaborate
dissections. In the "Historia Animalium"(9) of Aristotle occurs his
account of the blood vessels, which is by far the most elaborate met
with in the literature until the writings of Galen. It has, too, the
great merit of accuracy (if we bear in mind the fact that it was not
until after Aristotle that arteries and veins were differentiated), and
indications are given as to the vessels from which blood may be drawn.
(9) The Works of Aristotle, Oxford, Clarendon Press, Vol.
IV, 1910, Bk. III, Chaps. II-IV, pp. 511b-515b.
ASKLEPIOS
No god made with hands, to use the scriptural phrase, had a more
successful "run" than Asklepios--for more than a thousand years the
consoler and healer of the sons of men. Shorn of his divine attributes
he remains our patron saint, our emblematic God of Healing, whose figure
with the serpents appears in our seals and charters. He was originally a
Thessalian chieftain, whose sons, Machaon and Podalirius, became famous
physicians and fought in the Trojan War. Nestor, you may remember,
carried off the former, declaring, in the oft-quoted phrase, that a
doctor was better worth saving than many warriors unskilled in the
treatment of wounds. Later genealogies trace his origin to Apollo,(10)
as whose son he is usually regarded. "In the wake of northern tribes
this god Aesculapius--a more majestic figure than the blameless leech
of Homer's song--came by land to Epidaurus and was carried by sea to
the east-ward island of Cos.... Aesculapius grew in importance with the
growth of Greece, but may not have attained his greatest power until
Greece and Rome were one."(11)
(10) W. H. Roscher: Lexikon der griechischen und romischen
Mythologie, Leipzig, 1886, I, p. 624.
(11) Louis Dyer: Studies of the Gods in Greece, 1891, p.
221.
A word on the idea of the serpent as an emblem of the healing art which
goes far back into antiquity. The mystical character of the snake, and
the natural dread and awe inspired by it, early made it a symbol of
supernatural power. There is a libation vase of Gudea, c. 2350 B.C.,
found at Telloh, now in the Louvre (probably the earliest representation
of the symbol), with two serpents entwined round a staff (Jastrow, Pl.
4). From the earliest times the snake has been associated with mystic
and magic power, and even today, among native races, it plays a part in
the initiation of medicine men.
In Greece, the serpent became a symbol of Apollo, and prophetic
serpents were kept and fed at his shrine, as well as at that of his son,
Asklepios. There was an idea, too, that snakes had a knowledge of herbs,
which is referred to in the famous poem of Nikander on Theriaka.(12) You
may remember that when Alexander, the famous quack and oracle monger,
depicted by Lucian, started out "for revenue," the first thing he did
was to provide himself with two of the large, harmless, yellow snakes of
Asia Minor.
(12) Lines 31, etc., and Scholia; cf. W. R. Halliday: Greek
Divination, London, 1913, p. 88.
The exact date of the introduction of the cult into Greece is not known,
but its great centres were at Epidaurus, Cos, Pergamos and Tricca. It
throve with wonderful rapidity. Asklepios became one of the most popular
of the gods. By the time of Alexander it is estimated that there were
between three and four hundred temples dedicated to him.
His worship was introduced into Rome at the time of the Great Plague at
the beginning of the third century B.C. (as told by Livy in Book XI),
and the temple on the island of Tiber became a famous resort. If you can
transfer in imagination the Hot Springs of Virginia to the neighborhood
of Washington, and put there a group of buildings such as are
represented in these outlines of Caton's(13) (p. 52), add a sumptuous
theatre with seating capacity for 20,000, a stadium 600 feet long with
a seating capacity of 12,000, and all possible accessories of art and
science, you will have an idea of what the temple at Epidaurus, a few
miles from Athens, was. "The cult flourished mostly in places which,
through climatic or hygienic advantages, were natural health resorts.
Those favoured spots on hill or mountain, in the shelter of forests, by
rivers or springs of pure flowing water, were conducive to health. The
vivifying air, the well cultivated gardens surrounding the shrine, the
magnificent view, all tended to cheer the heart with new hope of cure.
Many of these temples owed their fame to mineral or merely hot springs.
To the homely altars, erected originally by sacred fountains in the
neighbourhood of health-giving mineral springs, were later added
magnificent temples, pleasure-grounds for festivals, gymnasia in
which bodily ailments were treated by physical exercises, baths and
inunctions, also, as is proved by excavations, living rooms for the
patients. Access to the shrine was forbidden to the unclean and the
impure, pregnant women and the mortally afflicted were kept away; no
dead body could find a resting-place within the holy precincts, the
shelter and the cure of the sick being undertaken by the keepers of inns
and boarding-houses in the neighbourhood. The suppliants for aid had
to submit to careful purification, to bathe in sea, river or spring, to
fast for a prescribed time, to abjure wine and certain articles of
diet, and they were only permitted to enter the temple when they were
adequately prepared by cleansing, inunction and fumigation. This lengthy
and exhausting preparation, partly dietetic, partly suggestive, was
accompanied by a solemn service of prayer and sacrifice, whose symbolism
tended highly to excite the imagination."(14)
(13) Caton: Temples and Ritual of Asklepios, 2d ed.,
London, 1900.
(14) Max Neuburger: History of Medicine, English
translation, Oxford, 1910, p. 94.
The temples were in charge of members of the guild or fraternity, the
head of which was often, though not necessarily, a physician. The Chief
was appointed annually. From Caton's excellent sketch(15) you can get a
good idea of the ritual, but still better is the delightful description
given in the "Plutus" of Aristophanes. After offering honey-cakes and
baked meats on the altar, the suppliants arranged themselves on the
pallets.
(15) Caton: Temples and Ritual of Asklepios, 2d ed.,
London, 1900.
Soon the Temple servitor
Put out the lights and bade us fall asleep,
Nor stir, nor speak, whatever noise we heard.
So down we lay in orderly repose.
And I could catch no slumber, not one wink,
Struck by a nice tureen of broth which stood
A little distance from an old wife's head,
Whereto I marvellously longed to creep.
Then, glancing upwards, I beheld the priest
Whipping the cheese-cakes and figs from off
The holy table; thence he coasted round
To every altar spying what was left.
And everything he found he consecrated
Into a sort of sack--(16)
a procedure which reminds one of the story of "Bel and the Dragon." Then
the god came, in the person of the priest, and scanned each patient.
He did not neglect physical measures, as he brayed in a mortar cloves,
Tenian garlic, verjuice, squills and Sphettian vinegar, with which he
made application to the eyes of the patient.
(16) Aristophanes: B. B. Roger's translation, London, Bell
& Sons, 1907, Vol. VI, ll. 668, etc., 732 ff.
Then the God clucked,
And out there issued from the holy shrine
Two great, enormous serpents....
And underneath the scarlet cloth they crept,
And licked his eyelids, as it seemed to me;
And, mistress dear, before you could have drunk
Of wine ten goblets, Wealth arose and saw.(17)
(17) Ibid.
The incubation sleep, in which indications of cure were divinely sent,
formed an important part of the ritual.
The Asklepieion, or Health Temple of Cos, recently excavated, is of
special interest, as being at the birthplace of Hippocrates, who was
himself an Asklepiad. It is known that Cos was a great medical school.
The investigations of Professor Rudolf Hertzog have shown that this
temple was very nearly the counterpart of the temple at Epidaurus.
The AEsculapian temples may have furnished a rare field for empirical
enquiry. As with our modern hospitals, the larger temple had rich
libraries, full of valuable manuscripts and records of cases. That there
may have been secular Asklepiads connected with the temple, who were
freed entirely from its superstitious practices and theurgic rites, is
regarded as doubtful; yet is perhaps not so doubtful as one might think.
How often have we physicians to bow ourselves in the house of Rimmon!
It is very much the same today at Lourdes, where lay physicians have to
look after scores of patients whose faith is too weak or whose maladies
are too strong to be relieved by Our Lady of this famous shrine. Even in
the Christian era, there is evidence of the association of distinguished
physicians with AEsculapian temples. I notice that in one of his
anatomical treatises, Galen speaks with affection of a citizen of
Pergamos who has been a great benefactor of the AEsculapian temple of
that city. In "Marius, the Epicurean," Pater gives a delightful sketch
of one of those temple health resorts, and brings in Galen, stating that
he had himself undergone the temple sleep; but to this I can find no
reference in the general index of Galen's works.
From the votive tablets found at Epidaurus, we get a very good idea of
the nature of the cases and of the cures. A large number of them have
now been deciphered. There are evidences of various forms of diseases
of the joints, affections of women, wounds, baldness, gout; but we are
again in the world of miracles, as you may judge from the following:
"Heraicus of Mytilene is bald and entreats the God to make his hair
grow. An ointment is applied over night and the next morning he has a
thick crop of hair."
There are indications that operations were performed and abscesses
opened. From one we gather that dropsy was treated in a novel way:
Asklepios cuts off the patient's head, holds him up by the heels, lets
the water run out, claps on the patient's head again. Here is one of the
invocations: "Oh, blessed Asklepios, God of Healing, it is thanks to
thy skill that Diophantes hopes to be relieved from his incurable and
horrible gout, no longer to move like a crab, no longer to walk upon
thorns, but to have sound feet as thou hast decreed."
The priests did not neglect the natural means of healing. The
inscriptions show that great attention was paid to diet, exercise,
massage and bathing, and that when necessary, drugs were used. Birth and
death were believed to defile the sacred precincts, and it was not until
the time of the Antonines that provision was made at Epidaurus for these
contingencies.
One practice of the temple was of special interest, viz., the incubation
sleep, in which dreams were suggested to the patients. In the religion
of Babylonia, an important part was played by the mystery of sleep, and
the interpretation of dreams; and no doubt from the East the Greeks took
over the practice of divination in sleep, for in the AEsculapian
cult also, the incubation sleep played a most important role. That it
continued in later times is well indicated in the orations of Aristides,
the arch-neurasthenic of ancient history, who was a great dreamer of
dreams. The oracle of Amphiaraus in Attica sent dreams into the hearts
of his consultants. "The priests take the inquirer, and keep him fasting
from food for one day, and from wine for three days, to give him perfect
spiritual lucidity to absorb the divine communication" (Phillimore's
"Apollonius of Tyana," Bk. II, Ch. XXXVII). How incubation sleep was
carried into the Christian Church, its association with St. Cosmas and
St. Damian and other saints, its practice throughout the Middle Ages,
and its continuation to our own time may be read in the careful study
of the subject made by Miss Hamilton (now Mrs. Dickens).(18) There are
still in parts of Greece and in Asia Minor shrines at which incubation
is practiced regularly, and if one may judge from the reports, with as
great success as in Epidaurus. At one place in Britain, Christchurch
in Monmouthshire, incubation was carried on till the early part of the
nineteenth century. Now the profession has come back to the study
of dreams,(19) and there are professors as ready to give suggestive
interpretations to them, as in the days of Aristides. As usual,
Aristotle seems to have said the last word on the subject: "Even
scientific physicians tell us that one should pay diligent attention to
dreams, and to hold this view is reasonable also for those who are not
practitioners but speculative philosophers,"(20) but it is asking too
much to think that the Deity would trouble to send dreams to very simple
people and to animals, if they were designed in any way to reveal the
future.
In its struggle with Christianity, Paganism made its last stand in the
temples of Asklepios. The miraculous healing of the saints superseded
the cures of the heathen god, and it was wise to adopt the useful
practice of his temple.
(18) Mary Hamilton: Incubation, or the Cure of Disease in
Pagan Temples and Christian Churches, London, 1906.
(19) Freud: The Interpretation of Dreams, translation of
third edition by A. A. Brill, 1913.
(20) Aristotle: Parva Naturalia, De divinatione per
somnium, Ch. I, Oxford ed., Vol. III, 463 a.
HIPPOCRATES AND THE HIPPOCRATIC WRITINGS
DESERVEDLY the foundation of Greek Medicine is associated with the name
of Hippocrates, a native of the island of Cos; and yet he is a shadowy
personality, about whom we have little accurate first-hand information.
This is in strong contrast to some of his distinguished contemporaries
and successors, for example, Plato and Aristotle, about whom we have
such full and accurate knowledge. You will, perhaps, be surprised to
hear that the only contemporary mention of Hippocrates is made by Plato.
In the "Protagoras," the young Hippocrates, son of Apollodorus has
come to Protagoras, "that mighty wise man," to learn the science and
knowledge of human life. Socrates asked him: "If . . . you had thought
of going to Hippocrates of Cos, the Asclepiad, and were about to give
him your money, and some one had said to you, 'You are paying money to
your namesake Hippocrates, O Hippocrates; tell me, what is he that
you give him money?' how would you have answered?" "I should say," he
replied, "that I gave money to him as a physician." "And what will he
make of you?" "A physician," he said. And in the Phaedrus, in reply to
a question of Socrates whether the nature of the soul could be known
intelligently without knowing the nature of the whole, Phaedrus replies:
"Hippocrates, the Asclepiad, says that the nature, even of the body,
can only be understood as a whole." (Plato, I, 311; III, 270--Jowett, I,
131, 479.)
Several lives of Hippocrates have been written. The one most frequently
quoted is that of Soranus of Ephesus (not the famous physician of the
time of Trajan), and the statements which he gives are usually accepted,
viz., that he was born in the island of Cos in the year 460 B.C.; that
he belonged to an Asklepiad family of distinction, that he travelled
extensively, visiting Thrace, Thessaly, and various other parts of
Greece; that he returned to Cos, where he became the most renowned
physician of his period, and died about 375 B.C. Aristotle mentions him
but once, calling him "the great Hippocrates." Busts of him are common;
one of the earliest of which, and I am told the best, dating from Roman
days and now in the British Museum, is here represented.
Of the numerous writings attributed to Hippocrates it cannot easily be
determined which are really the work of the Father of Medicine himself.
They were collected at the time of the Alexandrian School, and it became
customary to write commentaries upon them; much of the most important
information we have about them, we derive from Galen. The earliest
manuscript is the "Codex Laurentianus" of Florence, dating from the
ninth century, a specimen page of which (thanks to Commendatore Biagi)
is annexed. Those of you who are interested, and wish to have full
references to the various works attributed to Hippocrates, will find
them in "Die Handschriften der antiken Aerzte" of the Prussian Academy,
edited by Diels (Berlin, 1905). The Prussian Academy has undertaken the
editorship of the "Corpus Medicorum Graecorum." There is no complete
edition of them in English. In 1849 the Deeside physician, Adams,
published (for the Old Sydenham Society) a translation of the most
important works, a valuable edition and easily obtained. Littre's
ten-volume edition "OEuvres completes d'Hippocrate," Paris, 1839-1861, is
the most important for reference. Those of you who want a brief but
very satisfactory account of the Hippocratic writings, with numerous
extracts, will find the volume of Theodor Beck (Jena, 1907) very useful.
I can only indicate, in a very brief way, the special features of the
Hippocratic writings that have influenced the evolution of the science
and art of medicine.
The first is undoubtedly the note of humanity. In his introduction to,
"The Rise of the Greek Epic,"(21) Gilbert Murray emphasizes the idea of
service to the community as more deeply rooted in the Greeks than in
us. The question they asked about each writer was, "Does he help to make
better men?" or "Does he make life a better thing?" Their aim was to
be useful, to be helpful, to make better men in the cities, to correct
life, "to make gentle the life of the world." In this brief phrase were
summed up the aspirations of the Athenians, likewise illuminated in that
remarkable saying of Prodicus (fifth century B.C.), "That which benefits
human life is God." The Greek view of man was the very antithesis of
that which St. Paul enforced upon the Christian world. One idea pervades
thought from Homer to Lucian-like an aroma--pride in the body as a
whole. In the strong conviction that "our soul in its rose mesh" is
quite as much helped by flesh as flesh by the soul the Greek sang his
song--"For pleasant is this flesh." Just so far as we appreciate the
value of the fair mind in the fair body, so far do we apprehend ideals
expressed by the Greek in every department of life. The beautiful soul
harmonizing with the beautiful body was as much the glorious ideal of
Plato as it was the end of the education of Aristotle. What a splendid
picture in Book III of the "Republic," of the day when ". . . our youth
will dwell in a land of health, amid fair sights and sounds and receive
the good in everything; and beauty, the effluence of fair works, shall
flow into the eye and ear like a health-giving breeze from a purer
region, and insensibly draw the soul from earliest years into likeness
and sympathy with the beauty of reason." The glory of this zeal for
the enrichment of this present life was revealed to the Greeks as to no
other people, but in respect to care for the body of the common man, we
have only seen its fulfilment in our own day, as a direct result of
the methods of research initiated by them. Everywhere throughout the
Hippocratic writings we find this attitude towards life, which has never
been better expressed than in the fine phrase, "Where there is love of
humanity there will be love of the profession." This is well brought
out in the qualifications laid down by Hippocrates for the study of
medicine. "Whoever is to acquire a competent knowledge of medicine ought
to be possessed of the following advantages: a natural disposition;
instruction; a favourable position for the study; early tuition; love of
labour; leisure. First of all, a natural talent is required, for when
nature opposes, everything else is vain; but when nature leads the way
to what is most excellent, instruction in the art takes place, which
the student must try to appropriate to himself by reflection, becoming a
nearly pupil in a place well adapted for instruction. He must also bring
to the task a love of labour and perseverance, so that the instruction
taking root may bring forth proper and abundant fruits." And the
directions given for the conduct of life and for the relation which the
physician should have with the public are those of our code of ethics
today. Consultations in doubtful cases are advised, touting for fees is
discouraged. "If two or more ways of medical treatment were possible,
the physician was recommended to choose the least imposing or
sensational; it was an act of 'deceit' to dazzle the patient's eye by
brilliant exhibitions of skill which might very well be dispensed
with. The practice of holding public lectures in order to increase
his reputation was discouraged in the physician, and he was especially
warned against lectures tricked out with quotations from the poets.
Physicians who pretended to infallibility in detecting even the minutest
departure from their prescriptions were laughed at; and finally,
there were precise by-laws to regulate the personal behaviour of the
physician. He was enjoined to observe the most scrupulous cleanliness,
and was advised to cultivate an elegance removed from all signs of
luxury, even down to the detail that he might use perfumes, but not in an
immoderate degree."(22) But the high-water mark of professional morality
is reached in the famous Hippocratic oath, which Gomperz calls "a
monument of the highest rank in the history of civilization." It is of
small matter whether this is of Hippocratic date or not, or whether
it has in it Egyptian or Indian elements: its importance lies in the
accuracy with which it represents the Greek spirit. For twenty-five
centuries it has been the "credo" of the profession, and in many
universities it is still the formula with which men are admitted to the
doctorate.
(21) Oxford. Clarendon Press, 2d ed., 1911.
(22) Gomperz: Greek Thinkers, Vol. I, p. 281.
I swear by Apollo the physician and AEsculapius and Health (Hygieia) and
All-Heal (Panacea) and all the gods and goddesses, that, according to
my ability and judgment, I will keep this oath and this stipulation--to
reckon him who taught me this art equally dear to me as my parents, to
share my substance with him, and relieve his necessities if required; to
look upon his offspring in the same footing as my own brothers, and
to teach them this art, if they shall wish to learn it, without fee
or stipulation; and that by precept, lecture, and every other mode of
instruction, I will impart a knowledge of my art to my own sons, and
those of my teachers, and to disciples bound by a stipulation and oath
according to the law of medicine, but to none others. I will follow
that system of regimen which, according to my ability and judgement, I
consider for the benefit of my patients, and abstain from whatever is
deleterious and mischievous.
I will give no deadly medicine to anyone if asked, nor suggest any such
counsel; and in like manner I will not give to a woman a pessary to
produce abortion.
With purity and with holiness I will pass my life and practice my art.
(I will not cut persons labouring under the stone, but will leave this
to be done by men who are practitioners of this work.)
Into whatsoever houses I enter, I will go into them for the benefit
of the sick, and will abstain from every voluntary act of mischief and
corruption, and, further, from the abduction of females or males,
of freemen and slaves. Whatever, in connection with my professional
practice, or not in connection with it, I see or hear, in the life of
men, which ought not to be spoken of abroad, I will not divulge, as
reckoning that all such should be kept secret.
While I continue to keep this Oath unviolated, may it be granted to me
to enjoy life and the practice of the art, respected by all men, in all
times! But should I trespass and violate this Oath, may the reverse be
my lot!
(Adams, II, 779, cf. Littre, IV, 628.)
In his ideal republic, Plato put the physician low enough, in the last
stratum, indeed, but he has never been more honorably placed than in
the picture of Athenian society given by this author in the "Symposium."
Here the physician is shown as a cultivated gentleman, mixing in the
best, if not always the most sober, society. Eryximachus, the son of
Acumenus, himself a physician, plays in this famous scene a typical
Greek part(22a)--a strong advocate of temperance in mind and body,
deprecating, as a physician, excess in drink, he urged that conversation
should be the order of the day and he had the honor of naming the
subject--"Praise of the God of Love." Incidentally Eryximachus gives his
view of the nature of disease, and shows how deeply he was influenced by
the views of Empedocles:". . . so too in the body the good and healthy
elements are to be indulged, and the bad elements and the elements of
disease are not to be indulged, but discouraged. And this is what the
physician has to do, and in this the art of medicine consists: for
medicine may be regarded generally as the knowledge of the loves
and desires of the body and how to satisfy them or not; and the best
physician is he who is able to separate fair love from foul, or to
convert one into the other; and he who knows how to eradicate and how to
implant love, whichever is required, and can reconcile the most hostile
elements in the constitution and make them loving friends, is a skilful
practitioner."
(22a) Professor Gildersleeve's view of Eryximachus is less
favorable (Johns Hopkins University Circular, Baltimore,
January, 1887). Plato, III, 186--Jowett, I, 556.
The second great note in Greek medicine illustrates the directness
with which they went to the very heart of the matter. Out of mysticism,
superstition and religious ritual the Greek went directly to nature and
was the first to grasp the conception of medicine as an art based on
accurate observation, and an integral part of the science of man. What
could be more striking than the phrase in "The Law," "There are,
in effect, two things, to know and to believe one knows; to know is
science; to believe one knows is ignorance"?(23) But no single phrase in
the writings can compare for directness with the famous aphorism which
has gone into the literature of all lands: "Life is short and Art
is long; the Occasion fleeting, Experience fallacious, and Judgment
difficult."
(23) Littre: OEuvres d'Hippocrate, Vol. IV, pp. 641-642.
Everywhere one finds a strong, clear common sense, which refuses to
be entangled either in theological or philosophical speculations. What
Socrates did for philosophy Hippocrates may be said to have done for
medicine. As Socrates devoted himself to ethics, and the application
of right thinking to good conduct, so Hippocrates insisted upon the
practical nature of the art, and in placing its highest good in the
benefit of the patient. Empiricism, experience, the collection of facts,
the evidence of the senses, the avoidance of philosophical speculations,
were the distinguishing features of Hippocratic medicine. One of the
most striking contributions of Hippocrates is the recognition that
diseases are only part of the processes of nature, that there is nothing
divine or sacred about them. With reference to epilepsy, which was
regarded as a sacred disease, he says, "It appears to me to be no wise
more divine nor more sacred than other diseases, but has a natural cause
from which it originates like other affections; men regard its nature
and cause as divine from ignorance." And in another place he remarks
that each disease has its own nature, and that no one arises without a
natural cause. He seems to have been the first to grasp the conception
of the great healing powers of nature. In his long experience with the
cures in the temples, he must have seen scores of instances in which the
god had worked the miracle through the vis medicatrix naturae; and
to the shrewd wisdom of his practical suggestions in treatment may be
attributed in large part the extraordinary vogue which the great Coan
has enjoyed for twenty-five centuries. One may appreciate the veneration
with which the Father of Medicine was regarded by the attribute "divine"
which was usually attached to his name. Listen to this for directness
and honesty of speech taken from the work on the joints characterized
by Littre as "the great surgical monument of antiquity": "I have
written this down deliberately, believing it is valuable to learn of
unsuccessful experiments, and to know the causes of their non-success."
The note of freedom is not less remarkable throughout the Hippocratic
writings, and it is not easy to understand how a man brought up and
practicing within the precincts of a famous AEsculapian temple could
have divorced himself so wholly from the superstitions and vagaries
of the cult. There are probably grounds for Pliny's suggestion that he
benefited by the receipts written in the temple, registered by the
sick cured of any disease. "Afterwards," Pliny goes on to remark in
his characteristic way, "hee professed that course of Physicke which is
called Clinice Wherby physicians found such sweetnesse that afterwards
there was no measure nor end of fees," ('Natural History,' XXIX, 1).
There is no reference in the Hippocratic writings to divination;
incubation sleep is not often mentioned, and charms, incantations or the
practice of astrology but rarely. Here and there we do find practices
which jar upon modern feeling, but on the whole we feel in reading the
Hippocratic writings nearer to their spirit than to that of the Arabians
or of the many writers of the fifteenth and sixteenth centuries A. D.
And it is not only against the thaumaturgic powers that the Hippocratic
writings protested, but they express an equally active reaction against
the excesses and defects of the new philosophy, a point brought out very
clearly by Gomperz.(24) He regards it as an undying glory of the school
of Cos that after years of vague, restless speculation it introduces
"steady sedentary habits into the intellectual life of mankind."
'Fiction to the right! Reality to the left!' was the battle-cry of this
school in the war they were the first to wage against the excesses and
defects of the nature-philosophy. Though the protest was effective in
certain directions, we shall see that the authors of the Hippocratic
writings could not entirely escape from the hypotheses of the older
philosophers.
(24) Gomperz: Greek Thinkers, Vol. I, p. 296.
I can do no more than indicate in the briefest possible way some of the
more important views ascribed to Hippocrates. We cannot touch upon the
disputes between the Coan and Cnidian schools.(25) You must bear in
mind that the Greeks at this time had no human anatomy. Dissections
were impossible; their physiology was of the crudest character, strongly
dominated by the philosophies. Empedocles regarded the four elements,
fire, air, earth and water, as "the roots of all things," and this
became the corner stone in the humoral pathology of Hippocrates. As in
the Macrocosm--the world at large there were four elements, fire, air,
earth, and water, so in the Microcosm--the world of man's body--there
were four humors (elements), viz.,blood, phlegm, yellow bile (or
choler) and black bile (or melancholy), and they corresponded to the four
qualities of matter, heat, cold, dryness and moisture. For more than two
thousand years these views prevailed. In his "Regiment of Life" (1546)
Thomas Phaer says:". . . which humours are called ye sones of the
Elements because they be complexioned like the foure Elements, for like
as the Ayre is hot and moyst: so is the blooud, hote and moyste. And as
Fyer is hote and dry: so is Cholere hote and dry. And as water is colde
and moyst: so is fleume colde and moyste. And as the Earth is colde and
dry: so Melancholy is colde and dry."(26)
(25) The student who wishes a fuller account is referred to
the histories of (a) Neuburger, Vol. 1, Oxford, 1910; (b)
Withington, London, 1894.
(26) Thomas Phaer: Regiment of Life, London, 1546.
As the famous Regimen Sanitatis of Salernum, the popular family
hand-book of the Middle Ages, says:
Foure Humours raigne within our bodies wholly,
And these compared to foure elements.(27)
(27) The Englishman's Doctor, or the Schoole of Salerne, Sir
John Harington's translation, London, 1608, p. 2. Edited by
Francis R. Packard, New York, 1920, p. 132. Harington's book
originally appeared dated: London 1607. (Hoe copy in the
Henry E. Huntington Library.)
According to Littre, there is nowhere so strong a statement of these
views in the genuine works of Hippocrates, but they are found at
large in the Hippocratic writings, and nothing can be clearer than the
following statement from the work "The Nature of Man": "The body of
man contains in itself blood and phlegm and yellow bile and black bile,
which things are in the natural constitution of his body, and the
cause of sickness and of health. He is healthy when they are in
proper proportion between one another as regards mixture and force and
quantity, and when they are well mingled together; he becomes sick when
one of these is diminished or increased in amount, or is separated in
the body from its proper mixture, and not properly mingled with all the
others." No words could more clearly express the views of disease which,
as I mentioned, prevailed until quite recent years. The black bile,
melancholy, has given us a great word in the language, and that we have
not yet escaped from the humoral pathology of Hippocrates is witnessed
by the common expression of biliousness--"too much bile"--or "he has a
touch of the liver." The humors, imperfectly mingled, prove irritant in
the body. They are kept in due proportion by the innate heat which, by
a sort of internal coction gradually changes the humors to their proper
proportion. Whatever may be the primary cause of the change in the
humors manifesting itself in disease, the innate heat, or as Hippocrates
terms it, the nature of the body itself, tends to restore conditions to
the norm; and this change occurring suddenly, or abruptly, he calls the
"crisis," which is accomplished on some special day of the disease, and
is often accompanied by a critical discharge, or by a drop in the body
temperature. The evil, or superabundant, humors were discharged and
this view of a special materies morbi, to be got rid of by a natural
processor a crisis, dominated pathology until quite recently.
Hippocrates had a great belief in the power of nature, the vis
medicatrix naturae, to restore the normal state. A keen observer and
an active practitioner, his views of disease, thus hastily sketched,
dominated the profession for twenty-five centuries; indeed, echoes of
his theories are still heard in the schools, and his very words are
daily on our lips. If asked what was the great contribution to medicine
of Hippocrates and his school we could answer--the art of careful
observation.
In the Hippocratic writings is summed up the experience of Greece to the
Golden Age of Pericles. Out of philosophy, out of abstract speculation,
had come a way of looking at nature for which the physicians were mainly
responsible, and which has changed forever men's views on disease.
Medicine broke its leading strings to religion and philosophy--a
tottering, though lusty, child whose fortunes we are to follow in these
lectures. I have a feeling that, could we know more of the medical
history of the older races of which I spoke in the first lecture, we
might find that this was not the first-born of Asklepios, that there
had been many premature births, many still-born offspring, even
live-births--the products of the fertilization of nature by the human
mind; but the record is dark, and the infant was cast out like Israel in
the chapter of Isaiah. But the high-water mark of mental achievement
had not been reached by the great generation in which Hippocrates had
labored. Socrates had been dead sixteen years, and Plato was a man of
forty-five, when far away in the north in the little town of Stagira, on
the peninsula of Mount Athos in Macedoniawas, in 384 B.C., born a "man
of men," the one above all others to whom the phrase of Milton may be
applied. The child of an Asklepiad, Nicomachus, physician to the father
of Philip, there must have been a rare conjunction of the planets at
the birth of the great Stagirite. In the first circle of the "Inferno,"
Virgil leads Dante into a wonderful company, "star-seated" on the
verdure (he says)--the philosophic family looking with reverence on "the
Master of those who know"--il maestro di color che sanno.(28) And with
justice has Aristotle been so regarded for these twenty-three
centuries. No man has ever swayed such an intellectual empire--in logic,
metaphysics, rhetoric, psychology, ethics, poetry, politics and natural
history, in all a creator, and in all still a master. The history of
the human mind--offers no parallel to his career. As the creator of
the sciences of comparative anatomy, systematic zoology, embryology,
teratology, botany and physiology, his writings have an eternal
interest. They present an extraordinary accumulation of facts relating
to the structure and functions of various parts of the body. It is an
unceasing wonder how one man, even with a school of devoted students,
could have done so much.
(28) The "Good collector of qualities," Dioscorides,
Hippocrates, Avicenna, Galen and Averroes were the medical
members of the group. Dante, Inferno, canto iv.
Dissection--already practiced by Alcmaeon, Democritus, Diogenes and
others--was conducted on a large scale, but the human body was still
taboo. Aristotle confesses that the "inward parts of man are known
least of all," and he had never seen the human kidneys or uterus. In his
physiology, I can refer to but one point--the pivotal question of the
heart and blood vessels. To Aristotle the heart was the central organ
controlling the circulation, the seat of vitality, the source of
the blood, the place in which it received its final elaboration and
impregnation with animal heat. The blood was contained in the heart
and vessels as in a vase--hence the use of the term "vessel." "From the
heart the blood-vessels extend throughout the body as in the anatomical
diagrams which are represented on the walls, for the parts lie round
these because they are formed out of them."(29) The nutriment oozes
through the blood vessels and the passages in each of the parts "like
water in unbaked pottery." He did not recognize any distinction between
arteries and veins, calling both plebes (Littre); the vena cave is the
great vessel, and the aorta the smaller; but both contain blood. He did
not use the word "arteria" (arthria) for either of them. There was no
movement from the heart to the vessels but the blood was incessantly
drawn upon by the substance of the body and as unceasingly renewed by
absorption of the products of digestion, the mesenteric vessels taking
up nutriment very much as the plants take theirs by the roots from the
soil. From the lungs was absorbed the pneuma, or spiritus, which was
conveyed to the heart by the pulmonary vessels--one to the right,
and one to the left side. These vessels in the lungs, "through mutual
contact" with the branches of the trachea, took in the pneuma. A point
of interest is that the windpipe, or trachea, is called "arteria," both
by Aristotle and by Hippocrates ("Anatomy," Littre, VIII, 539). It was
the air-tube, disseminating the breath through the lungs. We shall see
in a few minutes how the term came to be applied to the arteries, as
we know them. The pulsation of the heart and arteries was regarded by
Aristotle as a sort of ebullition in which the liquids were inflated by
the vital or innate heat, the fires of which were cooled by the pneuma
taken in by the lungs and carried to the heart by the pulmonary vessels.
(29) De Generatione Animalium, Oxford translation, Bk. II,
Chap. 6, Works V, 743 a.
In Vol. IV of Gomperz' "Greek Thinkers," you will find an admirable
discussion on Aristotle as an investigator of nature, and those of
you who wish to study his natural history works more closely may do so
easily--in the new translation which is in process of publication by the
Clarendon Press, Oxford. At the end of the chapter "De Respiratione" in
the "Parva Naturalia" (Oxford edition, 1908), we have Aristotle's
attitude towards medicine expressed in a way worthy of a son of the
profession:
"But health and disease also claim the attention of the scientist, and
not merely of the physician, in so far as an account of their causes is
concerned. The extent to which these two differ and investigate diverse
provinces must not escape us, since facts show that their inquiries are,
at least to a certain extent, conterminous. For physicians of culture
and refinement make some mention of natural science, and claim to derive
their principles from it, while the most accomplished investigators
into nature generally push their studies so far as to conclude with an
account of medical principles." (Works, III,480 b.)
Theophrastus, a student of Aristotle and his successor, created the
science of botany and made possible the pharmacologists of a few
centuries later. Some of you doubtless know him in another guise--as the
author of the golden booklet on "Characters," in which "the most eminent
botanist of antiquity observes the doings of men with the keen and
unerring vision of a natural historian" (Gomperz). In the Hippocratic
writings, there are mentioned 236 plants; in the botany of Theophrastus,
455. To one trait of master and pupil I must refer--the human feeling,
not alone of man for man, but a sympathy that even claims kinship with
the animal world. "The spirit with which he (Theophrastus) regarded the
animal world found no second expression till the present age" (Gomperz).
Halliday, however, makes the statement that Porphyry(30) goes as far as
any modern humanitarian in preaching our duty towards animals.
(30) W. R. Halliday: Greek Divination, London, Macmillan &
Co., 1913.
ALEXANDRIAN SCHOOL
FROM the death of Hippocrates about the year 375 B.C. till the founding
of the Alexandrian School, the physicians were engrossed largely in
speculative views, and not much real progress was made, except in the
matter of elaborating the humoral pathology. Only three or four men of
the first rank stand out in this period: Diocles the Carystian, "both
in time and reputation next and second to Hippocrates" (Pliny), a keen
anatomist and an encyclopaedic writer; but only scanty fragments of his
work remain. In some ways the most important member of this group was
Praxagoras, a native of Cos, about 340 B.C. Aristotle, you remember,
made no essential distinction between arteries and veins, both of which
he held to contain blood: Praxagoras recognized that the pulsation
was only in the arteries, and maintained that only the veins contained
blood, and the arteries air. As a rule the arteries are empty after
death, and Praxagoras believed that they were filled with an aeriform
fluid, a sort of pneuma, which was responsible for their pulsation.
The word arteria, which had already been applied to the trachea, as an
air-containing tube, was then attached to the arteries; on account of
the rough and uneven character of its walls the trachea was then called
the arteria tracheia, or the rough air-tube.(31a) We call it simply the
trachea, but in French the word trachee-artere is still used.
(31a) Galen: De usu partium, VII, Chaps. 8-9.
Praxagoras was one of the first to make an exhaustive study of the
pulse, and he must have been a man of considerable clinical acumen, as
well as boldness, to recommend in obstruction of the bowels the opening
of the abdomen, removal of the obstructed portion and uniting the ends
of the intestine by sutures.
After the death of Alexander, Egypt fell into the hands of his famous
general, Ptolemy, under whose care the city became one of the most
important on the Mediterranean. He founded and maintained a museum, an
establishment that corresponded very much to a modern university, for
the study of literature, science and the arts. Under his successors,
particularly the third Ptolemy, the museum developed, more especially
the library, which contained more than half a million volumes. The
teachers were drawn from all centres, and the names of the great
Alexandrians are among the most famous in the history of human
knowledge, including such men as Archimedes, Euclid, Strabo and Ptolemy.
In mechanics and physics, astronomy, mathematics and optics, the work
of the Alexandrians constitutes the basis of a large part of our modern
knowledge. The school-boy of today--or at any rate of my day--studies
the identical problems that were set by Euclid 300 B.C., and the student
of physics still turns to Archimedes and Heron, and the astronomer to
Eratosthenes and Hipparchus. To those of you who wish to get a brief
review of the state of science in the Alexandrian School I would
recommend the chapter in Vol. I of Dannemann's history.(31)
(31) Friedrich Dannemann: Grundriss einer Geschichte der
Naturwissenschaften, Vol. I, 3d ed., Leipzig, 1908.
Of special interest to us in Alexandria is the growth of the first great
medical school of antiquity. Could we have visited the famous museum
about 300 B.C., we should have found a medical school in full operation,
with extensive laboratories, libraries and clinics. Here for the first
time the study of the structure of the human body reached its full
development, till then barred everywhere by religious prejudice; but
full permission was given by the Ptolemies to perform human dissection
and, if we may credit some authors, even vivisection. The original
writings of the chief men of this school have not been preserved, but
there is a possibility that any day a papyrus maybe found which will
supplement the scrappy and imperfect knowledge afforded us by Pliny,
Celsus and Galen. The two most distinguished names are Herophilus--who,
Pliny says, has the honor of being the first physician "who searched
into the causes of disease"--and Erasistratus.
Herophilus, ille anatomicorum coryphaeus, as Vesalius calls him, was a
pupil of Praxagoras, and his name is still in everyday use by medical
students, attached to the torcular Herophili. Anatomy practically dates
from these Alexandrines, who described the valves of the heart, the
duodenum, and many of the important parts of the brain; they recognized
the true significance of the nerves (which before their day had been
confounded with the tendons), distinguished between motor and sensory
nerves, and regarded the brain as the seat of the perceptive faculties
and voluntary action. Herophilus counted the pulse, using the
water-clock for the purpose, and made many subtle analyses of its rate
and rhythm; and, influenced by the musical theories of the period,
he built up a rhythmical pulse lore which continued in medicine until
recent times. He was a skilful practitioner and to him is ascribed the
statement that drugs are the hands of the gods. There is a very modern
flavor to his oft-quoted expression that the best physician was the man
who was able to distinguish between the possible and the impossible.
Erasistratus elaborated the view of the pneuma, one form of which he
believed came from the inspired air, and passed to the left side of
the heart and to the arteries of the body. It was the cause of the
heart-beat and the source of the innate heat of the body, and it
maintained the processes of digestion and nutrition. This was the vital
spirit; the animal spirit was elaborated in the brain, chiefly in the
ventricles, and sent by the nerves to all parts of the body, endowing
the individual with life and perception and motion. In this way a great
division was made between the two functions of the body, and two sets
of organs: in the vascular system, the heart and arteries and abdominal
organs, life was controlled by the vital spirits; on the other hand,
in the nervous system were elaborated the animal spirits, controlling
motion, sensation and the various special senses. These views on the
vital and animal spirits held unquestioned sway until well into the
eighteenth century, and we still, in a measure, express the views of the
great Alexandrian when we speak of "high" or "low" spirits.
GALEN
PERGAMON has become little more than a name associated in our memory
with the fulminations of St. John against the seven churches of Asia;
and on hearing the chapter read, we wondered what was "Satan's seat" and
who were the "Nicolaitanes" whose doctrine he so hated. Renewed interest
has been aroused in the story of its growth and of its intellectual
rivalry with Alexandria since the wonderful discoveries by German
archaeologists which have enabled us actually to see this great Ionian
capital, and even the "seat of Satan." The illustration here shown is of
the famous city, in which you can see the Temple of Athena Polis on the
rock, and the amphitheatre. Its interest for us is connected with the
greatest name, after Hippocrates, in Greek medicine, that of Galen, born
at Pergamon A. D. 130, in whom was united as never before--and
indeed one may say, never since--the treble combination of observer,
experimenter and philosopher. His father, Nikon, a prosperous architect,
was urged in a dream to devote his son to the profession of medicine,
upon which study the lad entered in his seventeenth year under Satyrus.
In his writings, Galen gives many details of his life, mentioning the
names of his teachers, and many incidents in his Wanderjahre, during
which he studied at the best medical schools, including Alexandria.
Returning to his native city he was put in charge of the gladiators,
whose wounds he said he treated with wine. In the year 162, he paid
his first visit to Rome, the scene of his greatest labors. Here he gave
public lectures on anatomy, and became "the fashion." He mentions
many of his successes; one of them is the well-worn story told also of
Erasistratus and Stratonice, but Galen's story is worth telling, and it
is figured as a miniature in the manuscripts of his works. Called to see
a lady he found her suffering from general malaise without any fever
or increased action of the pulse. He saw at once that her trouble was
mental and, like a wise physician, engaged her in general conversation.
Quite possibly he knew her story, for the name of a certain actor,
Pylades, was mentioned, and he noticed that her pulse at once increased
in rapidity and became irregular. On the next day he arranged that the
name of another actor, Morphus, should be mentioned, and on the third
day the experiment was repeated but without effect. Then on the fourth
evening it was again mentioned that Pylades was dancing, and the pulse
quickened and became irregular, so he concluded that she was in love
with Pylades. He tells how he was first called to treat the Emperor
Marcus Aurelius, who had a stomach-ache after eating too much cheese. He
treated the case so successfully that the Emperor remarked, "I have but
one physician, and he is a gentleman." He seems to have had good fees,
as he received 400 aurei (about 2000) for a fortnight's attendance upon
the wife of Boethus.
He left Rome for a time in 168 A. D. and returned to Pergamon, but was
recalled to Rome by the Emperor, whom he accompanied on an expedition
to Germany. There are records in his writings of many journeys, and busy
with his practice in dissections and experiments he passed a long and
energetic life, dying, according to most authorities, in the year 200
A.D.
A sketch of the state of medicine in Rome is given by Celsus in the
first of his eight books, and he mentions the names of many of the
leading practitioners, particularly Asclepiades, the Bithynian, a man
of great ability, and a follower of the Alexandrians, who regarded all
disease as due to a disturbed movement of the atoms. Diet, exercise,
massage and bathing were his great remedies, and his motto--tuto, cito
et jucunde--has been the emulation of all physicians. How important
a role he and his successors played until the time of Galen may be
gathered from the learned lectures of Sir Clifford Allbutt(32) on "Greek
Medicine in Rome" and from Meyer-Steineg's "Theodorus Priscianus und die
romische Medizin."(33) From certain lay writers we learn that it was the
custom for popular physicians to be followed on their rounds by crowds
of students. Martial's epigram (V, ix) is often referred to:
Languebam: sed tu comitatus protinus ad me
Venisti centum, Symmache, discipulis.
Centum me tegigere manus Aquilone gelatae
Non habui febrem, Symmache, nunc habeo.
(32) Allbutt: British Medical Journal, London, 1909, ii, 1449;
1515; 1598.
(33) Fischer, Jena, 1909.
And in the "Apollonius of Tyana" by Philostratus, when Apollonius
wishes to prove an alibi, he calls to witness the physicians of his sick
friend, Seleucus and Straloctes, who were accompanied by their clinical
class to the number of about thirty students.(34) But for a first-hand
sketch of the condition of the profession we must go to Pliny, whose
account in the twenty-ninth book of the "Natural History" is one of the
most interesting and amusing chapters in that delightful work. He quotes
Cato's tirade against Greek physicians,--corrupters of the race, whom he
would have banished from the city,--then he sketches the career of some
of the more famous of the physicians under the Empire, some of whom must
have had incomes never approached at any other period in the history of
medicine. The chapter gives a good picture of the stage on which Galen
(practically a contemporary of Pliny) was to play so important a role.
Pliny seems himself to have been rather disgusted with the devious paths
of the doctors of his day, and there is no one who has touched with
stronger language upon the weak points of the art of physic. In one
place he says that it alone has this peculiar art and privilege, "That
whosoever professeth himself a physician, is straightwaies beleeved, say
what he will: and yet to speake a truth, there are no lies dearer sold
or more daungerous than those which proceed out of a Physician's mouth.
Howbeit, we never once regard or look to that, so blind we are in our
deepe persuasion of them, and feed our selves each one in a sweet hope
and plausible conceit of our health by them. Moreover, this mischief
there is besides, That there is no law or statute to punish the
ignorance of blind Physicians, though a man lost his life by them:
neither was there ever any man knowne, who had revenge of recompence for
the evill intreating or misusage under their hands. They learne their
skill by endaungering our lives: and to make proofe and experiments of
their medicines, they care not to kill us."(35) He says it is hard
that, while the judges are carefully chosen and selected, physicians
are practically their own judges, and that of the men who may give us a
quick despatch and send us to Heaven or Hell, no enquiry or examination
is made of their quality and worthiness. It is interesting to read so
early a bitter criticism of the famous "Theriaca," a great compound
medicine invented by Antiochus III, which had a vogue for fifteen
hundred years.
(34) Bk. VIII, Chap. VII.
(35) Pliny: Natural History (XXIX, 1), Philemon Holland's
version, London, 1601, II, 347.
But we must return to Galen and his works, which comprise the most
voluminous body of writings left by any of the ancients. The great
edition is that in twenty-two volumes by Kuhn (1821-1833). The most
useful editions are the "Juntines" of Venice, which were issued in
thirteen editions. In the fourth and subsequent editions a very useful
index by Brassavola is included. A critical study of the writings is at
present being made by German scholars for the Prussian Academy, which
will issue a definitive edition of his works.
Galen had an eclectic mind and could not identify himself with any
of the prevailing schools, but regarded himself as a disciple of
Hippocrates. For our purpose, both his philosophy and his practice are
of minor interest in comparison with his great labors in anatomy and
physiology.
In anatomy, he was a pupil of the Alexandrians to whom he constantly
refers. Times must have changed since the days of Herophilus, as Galen
does not seem ever to have had an opportunity of dissecting the human
body, and he laments the prejudice which prevents it. In the study of
osteology, he urges the student to be on the lookout for an occasional
human bone exposed in a graveyard, and on one occasion he tells of
finding the carcass of a robber with the bones picked bare by birds and
beasts. Failing this source, he advises the student to go to Alexandria,
where there were still two skeletons. He himself dissected chiefly
apes and pigs. His osteology was admirable, and his little tractate "De
Ossibus" could, with very few changes, be used today by a hygiene class
as a manual. His description of the muscles and of the organs is very
full, covering, of course, many sins of omission and of commission, but
it was the culmination of the study of the subject by Greek physicians.
His work as a physiologist was even more important, for, so far as we
know, he was the first to carry out experiments on a large scale. In the
first place, he was within an ace of discovering the circulation of
the blood. You may remember that through the errors of Praxagoras and
Erasistratus, the arteries were believed to contain air and got their
name on that account: Galen showed by experiment that the arteries
contain blood and not air. He studied particularly the movements of
the heart, the action of the valves, and the pulsatile forces in the
arteries. Of the two kinds of blood, the one, contained in the venous
system, was dark and thick and rich in grosser elements, and served for
the general nutrition of the body. This system took its origin, as
is clearly shown in the figure, in the liver, the central organ of
nutrition and of sanguification. From the portal system were absorbed,
through the stomach and intestines, the products of digestion. From the
liver extend the venae cavae, one to supply the head and arms, the other
the lower extremities: extending from the right heart was a branch,
corresponding to the pulmonary artery, the arterial vein which
distributed blood to the lungs. This was the closed venous system. The
arterial system, shown, as you see, quite separate in Figure 31, was
full of a thinner, brighter, warmer blood, characterized by the presence
of an abundance of the vital spirits. Warmed in the ventricle, it
distributed vital heat to all parts of the body. The two systems were
closed and communicated with each other only through certain pores or
perforations in the septum separating the ventricles. At the periphery,
however, Galen recognized (as had been done already by the Alexandrians)
that the arteries anastomose with the veins, ". . . and they mutually
receive from each other blood and spirits through certain invisible and
extremely small vessels."
It is difficult to understand how Galen missed the circulation of the
blood. He knew that the valves of the heart determined the direction
of the blood that entered and left the organ, but he did not appreciate
that it was a pump for distributing the blood, regarding it rather as
a fireplace from which the innate heat of the body was derived. He knew
that the pulsatile force was resident in the walls of the heart and in
the arteries, and he knew that the expansion, or diastole, drew blood
into its cavities, and that the systole forced blood out. Apparently his
view was that there was a sort of ebb and flow in both systems--and yet,
he uses language just such as we would, speaking of the venous system
as ". . . a conduit full of blood with a multitude of canals large and
small running out from it and distributing blood to all parts of the
body." He compares the mode of nutrition to irrigating canals and
gardens, with a wonderful dispensation by nature that they should
"neither lack a sufficient quantity of blood for absorption nor
be overloaded at any time with excessive supply." The function of
respiration was the introduction of the pneuma, the spirits which passed
from the lungs to the heart through the pulmonary vessels. Galen went a
good deal beyond the idea of Aristotle, reaching our modern conception
that the function is to maintain the animal heat, and that the
smoky matters derived from combustion of the blood are discharged by
expiration.
I have dwelt on these points in Galen's physiology, as they are
fundamental in the history of the circulation; and they are sufficient
to illustrate his position. Among his other brilliant experiments were
the demonstration of the function of the laryngeal nerves, of the
motor and sensory functions of the spinal nerve roots, of the effect
of transverse incision of the spinal cord, and of the effect of
hemisection. Altogether there is no ancient physician in whose writings
are contained so many indications of modern methods of research.
Galen's views of disease in general are those of Hippocrates, but
he introduces many refinements and subdivisions according to the
predominance of the four humors, the harmonious combination of
which means health, or eucrasia, while their perversion or improper
combination leads to dyscrasia, or ill health. In treatment he had not
the simplicity of Hippocrates: he had great faith in drugs and collected
plants from all parts of the known world, for the sale of which he
is said to have had a shop in the neighborhood of the Forum. As I
mentioned, he was an eclectic, held himself aloof from the various
schools of the day, calling no man master save Hippocrates. He might
be called a rational empiricist. He made war on the theoretical
practitioners of the day, particularly the Methodists, who, like some
of their modern followers, held that their business was with the disease
and not with the conditions out of which it arose.
No other physician has ever occupied the commanding position of
"Clarissimus" Galenus. For fifteen centuries he dominated medical
thought as powerfully as did Aristotle in the schools. Not until the
Renaissance did daring spirits begin to question the infallibility of
this medical pope. But here we must part with the last and, in many
ways, the greatest of the Greeks--a man very much of our own type, who,
could he visit this country today, might teach us many lessons. He would
smile in scorn at the water supply of many of our cities, thinking
of the magnificent aqueducts of Rome and of many of the colonial
towns--some still in use--which in lightness of structure and in
durability testify to the astonishing skill of their engineers. There
are country districts in which he would find imperfect drainage and
could tell of the wonderful system by which Rome was kept sweet and
clean. Nothing would delight him more than a visit to Panama to see what
the organization of knowledge has been able to accomplish. Everywhere
he could tour the country as a sanitary expert, preaching the gospel
of good water supply and good drainage, two of the great elements in
civilization, in which in many places we have not yet reached the Roman
standard.