Professor of Principles and Practice of Medicine in the Medical
Department of the Western Reserve University, Cleveland, Ohio.
It may not be inappropriate to give in your journal a brief sketch of
the history of medicine, by the consideration of which we may come to a
better appreciation of our present standpoint as medical men. We may
also the better understand how much we, as medical men, and the world at
large, are indebted to the methodical, plodding workers of the past in
the field of inquiry pertaining to the nature and cure of disease. Such
review may have the effect of stimulating medical men to more careful
observation and the recording the results of observations that they may
be given to others for mutual benefit.
Science may be defined as “classified knowledge.” But all our knowledge
is based on experience and observation. Medical science, like other
sciences, taking the definition of Sir John Herschel, is “the knowledge
of many, orderly and methodically digested and arranged so as to become
attainable by one.”
In all cases art and observation precede and beget science, and give
origin to its gradual construction. But soon science, so built up,
begins to reflect new light upon its parents—observation and art—helps
them onward, expands the range of vision, corrects their errors,
improves their methods and suggests new ones. The stars were mapped out
and counted by the shepherds watching their flocks by night, long before
astronomy assumed any scientific form.
From the earliest ages the pains and disorders of the human body must
have arrested men's anxious attention and claimed their succor. The
facts observed, both as to hurts and diseases, and as to their attempted
remedying, were handed down by tradition or by record from generation to
generation in continually increasing abundance, and out of the repeated
survey and comparison of these has grown the recognition of certain laws
of events and rules of action, which together constitute “medical
science.”
There is good reason for the belief that Egypt was the country in which
the _art_ of medicine, as well as the other arts of civilized life, was
first cultivated with any degree of success, the offices of the priest
and the physician being probably combined in the same person. In the
writings of Moses there are various allusions to the practice of
medicine amongst the Jews, especially with reference to the diagnosis
and treatment of leprosy. The priests were the physicians, and their
treatment mainly aimed at promoting cleanliness and preventing
contagion. The same practice is approved by the light of latest science.
Chiron, the Centaur, is said to have introduced the art of medicine
amongst the Greeks, but the early history of the _art_ is entirely
legendary. Æsculapius appears in Homer as an excellent physician of
_human_ origin; in the later legends he becomes the god of the healing
art. His genealogy is obscure and altogether fabulous. He, however, soon
surpassed his teacher, Chiron, and succeeded so far as to restore the
dead to life (as the story goes). This offended Hades, who began to fear
that his realm would not be sufficiently peopled; complained to Zeus
(Jove) of the innovation, and Jove slew Æsculapius by a flash of
lightning. After this he was deified by the gratitude of mankind, and
was especially worshiped at Epidaurus, where a temple and a grove were
consecrated to him. His statue in this temple was formed of gold and
ivory, and represents him as a god seated on a throne, and holding in
one hand a staff with a snake coiled around it, the other hand resting
on the head of a snake; a dog, as an emblem of watchfulness, at his feet
(an intimation very appropriate for the medical profession). The
Asclepiades, the followers of Æsculapius, inherited and kept the secrets
of the healing art; or, assuming that Æsculapius was merely a divine
symbol, the Asclepiades must be regarded as a medical, priestly caste,
who preserved as mysteries the doctrine of medicine. The members of the
caste were bound by an oath—the Hippocratis jusjurandum—not to divulge
the secrets of their profession.
In Rome, in the year 292 B. C., a pestilence (probably malarial fever)
prevailed. The Sibyline books directed that Æsculapius (statue!) must be
brought from Epidaurus. Accordingly, an embassy was sent to this place,
and when they had made their request, a snake crept out of the temple
into the ship. Regarding this as the god Æsculapius, they sailed to
Italy, and as they entered the Tiber the snake sprang out upon an
island, where afterwards a temple was erected to Æsculapius and a
company of priests appointed to take charge of the service and practice
the art of medicine. The name Æsculapius, then, is only an impersonation
of medicine in the remote ages, or early ages of Grecian history.
Hippocrates is the first writer of medicine whose works have come down
to us with anything like authority other than fable. Indeed, he was the
most celebrated physician of antiquity. He was the son of Heracleides,
also a physician, and belonged to the family of the Asclepiades, said to
be about eighteen generations from Æsculapius. His mother was said to be
descended from Hercules.
Hippocrates was born in the island of Cos (more anciently Meropis), an
island of the Grecian archipelago of about one hundred square miles,
probably about the year 460 B. C. Instructed in medicine by his father
and other contemporary medical men, he traveled in various parts of
Greece and Asia minor. He finally settled and practiced his profession
at Cos, but died in Thessaly at the age of one hundred and four years
(B. C. 357). Little is known of his personal history, other than that he
was highly esteemed as a physician and an author, and that he raised the
reputation of the medical school of Cos to a high degree. His works were
studied and quoted by Plato. He was famous in his own time, and his
works, some sixty in number, have in them many things that are not
unworthy of consideration even after the lapse of twenty-two hundred
years. Many of the works ascribed to Hippocrates are _not_ well
authenticated.
He divided the causes of diseases into two principal classes—the first
consisting of the influence of seasons, climates, water, situations,
etc.; the second of more personal causes, such as the food and exercise
of the individual patient. His belief in the influence which different
climates exert on the human constitution is very strongly expressed. He
ascribes to this influence both the conformation of the body and the
disposition of the mind, and hence accounts for the difference between
the hardy Greek and the Asiatic.
The four humors of the body (blood, phlegm, yellow bile and black bile)
were regarded by him as the primary seats of disease; health was the
result of the due combination (or crasis) of these humors, and illness
was the consequence of a disturbance of this crasis. When a disease was
progressing favorably these humors underwent a certain change (coction),
which was the sign of returning health, as preparing the way for the
expulsion of morbid matters, or crisis, these crises having a tendency
to occur at definite periods, which were hence called critical days.
His treatment of disease was cautious and what we now term expectant,
_i. e._, it consisted chiefly, often solely, in attention to diet and
regimen; and he was sometimes reproached with letting his patients die
by doing nothing to keep them alive.
His works written in Greek were at an early period translated into
Arabic. They were first printed in Latin in 1525, at Rome. A complete
edition in Greek bears a date a year later.
Several editions in Latin and other languages have appeared from time to
time. An English translation of 'The Genuine Works of Hippocrates,' was
published by the Sydenham society in 1848, in 2 vols., by Dr. Adams. The
advance which Hippocrates made in the practice of medicine was so great
that no attempts were made for some centuries to improve upon his views
and precepts. His sons, Thessalus and Draco, and his son-in-law,
Polybius, are regarded as the founders of the medical sect which was
called the Hippocratean or Dogmatic school, because it professed to set
out with certain theoretical principles, which were derived from the
generalization of facts and observations, and to make these principles
the basis of practice. The next epoch in the history of medicine is the
establishment of the school at Alexandria, which was effected by the
munificence of the Ptolemies, about B. C. 300. Indeed the whole race of
Ptolemies (from Ptolemy I. to Ptolemy VII. B. C. 323 to 117) seem to
have been patrons of learning and learned men. (Less so Ptolemy VIII. to
XIII., B. C. 117 to 43. Ptolemy II., Philadelphius, was born in Cos
about 150 years after Hippocrates.) It was by the patronage of these
kings of Egypt that learning flourished in Alexandria during their
reign.
In some of them this seems to have been the only redeeming feature of
their character. Otherwise vicious, cruel, bloodthirsty in an extreme
degree, they uniformly encouraged learning and learned men. (It seems to
have been a hereditary trait.) Amongst the most famous of the medical
professors of the School of Alexandria are Erasistratus and Herophilus.
The former of these was a pupil of Chrysippus, and probably imbibed from
his master his prejudice against bleeding and against the use of active
remedies, preferring to trust mainly to diet and to the _vis medicatrix
naturae_.
Herophilus, born in Chalcedon, in Bythinia, flourished in the latter
part of the fourth and the beginning of the third century B. C., and
settled in Alexandria, especially was distinguished by his devotion to
the study of anatomy. He is said to have pursued this to such an extent
as to have dissected criminals alive. Several names which he gave to
different parts of the body are still in use, as the torcular Herophili,
calamus scriptorius, and duodenum. He located the seat of the soul in
the ventricles of the brain. Only a few fragments remain of what he
wrote.
About this time the Empirics formed themselves into a distinct sect and
became the declared opponents of the Dogmatists. The controversy really
consisted in the question, “How far we are to suffer theory to influence
over practice.” While the Dogmatists, or as they were sometimes styled,
the Rationalists, asserted that before attempting to treat any disease
we ought to make ourselves fully acquainted with the structure and
functions of the body generally, with the operation of medicinal agents
upon it, and with the changes which it undergoes when under the
operation of any morbid cause, the Empirics, on the contrary, contended
that this knowledge is impossible to be obtained and if possible is not
necessary; that our sole guide must be experience and that if we step
beyond this, either as learned from our own observations or that of
others on whose testimony we can rely, we are always liable to fall into
dangerous and often fatal errors. According to Celsus, the founder of
the Empirics was Serapion, who was said to be a pupil of Herophilus. At
this period, and for some centuries later, all physicians were included
in one or the other of these rival sects, and from the evidence of
history the two sects or schools were about equal. From Phiny, who wrote
about the middle and sixth, seventh and eighth decades of the first
century, we learn that medicine was introduced into Rome at a later
period than the other arts and sciences.
The first person who seems to have made it a distinct profession,
separate from priestcraft, was Archagathus, a Peloponnesian, who settled
at Rome about B. C. 200. His treatment of his patients was so severe and
unsuccessful that he was finally banished, and no other mention is made
of a physician at Rome for about a century, when Asclepiades of
Bythinia, acquired a great reputation. His popularity depended upon his
allowing his patients a liberal use of wine, and of their favorite
dishes, and in all respects consulting their inclinations and flattering
their prejudices; and hence it is easy to understand the eminence at
which he arrived, for we see even in our own time men building up great
reputations by similar practices.
This man with a long name—Archagathus—was succeeded by his pupil,
Themison of Laodicea, the founder of a sect called Methodics, who
adopted a middle course between the Dogmatists and Empirics. During the
greater part of the first two centuries of our era the Methodics were
the preponderating medical sect, and they included in their ranks C.
Aurelianus, some of whose writings have come down to us.
They soon broke into various sects of which the chief were the
Pneumatics, represented by Aretaeus of Cappadocia, whose works are still
extant; and the Eclectics, who claimed as do the Eclectics of to-day, to
select the best from all the other systems and to reject the hurtful.
The most remarkable writer of this age is Celsus (about A. D.), whose
work (De Medicina) gives a sketch of the history of medicine up to that
time and the state in which it then was. He is remarkable in being the
first _native_ Roman physician whose name has come down to us.
Dioscorides of Cilicia flourished about the end of the first century. He
accompanied the Roman army in their campaign through many countries and
gathered a great store of information and observations on plants. In his
great work 'De Materia Medica,' he treats of all the then known
medicinal substances and their properties, real or reputed, on the
principles of the so-called humoral pathology. Two other works are
ascribed to him but their genuineness is questionable. For fifteen
centuries the authority of Dioscorides, in botany and materia medica,
was undisputed, and still holds among the Turks and Moors.
[_To be Continued._]