Outlines of Greek and Roman Medicine Part 2

[3] Caton, _Brit. Med. Journ._, 1906, i, p. 571.

[4] Dryden's translation, book xv.

CHAPTER III.

HIPPOCRATES.

His life and works--His influence on Medicine.

_Hippocrates_, the Father of Medicine, was born at Cos during the golden age of Greece, 460 years before Christ. He belonged to the family of the Asclepiadae, and, according to tradition, could trace his ancestors on the male side to aesculapius, and on the female side to Hercules. He is said to have received his medical education from his father and from Herodicus, and to have been taught philosophy by Gorgias, the Sophist, and by Democritus, whom he afterwards cured of mental derangement.

There was a very famous medical school at Cos, and the temple there held the notes of the acc.u.mulated experience of his predecessors, but Hippocrates visited also, for the purpose of study, various towns of Greece, and particularly Athens. He was a keen observer, and took careful notes of his observations. His reputation was such that his works are quoted by Plato and by Aristotle, and there are references to him by Arabic writers. His descendants published their own writings under his name, and there were also many forgeries, so that it is impossible to know exactly how many of the works attributed to him are authentic; but by a consensus of opinion the following books are considered genuine: "Prognostics," seven of the books of "Aphorisms,"

"On Airs, Waters and Places," "On Regimen in Acute Diseases," the first and third books of "Epidemics," "On the Articulations," "On Fractures,"

the treatise on "Instruments of Reduction," and "The Oath"; and the books considered almost certainly genuine are those dealing with "Ancient Medicine," "Surgery," "The Law," "Fistulae," "Ulcers,"

"Haemorrhoids," and "On the Sacred Disease" (Epilepsy). The famous Hippocratic Collection in the great libraries of Alexandria and Pergamos also comprised the writings of Pythagoras, Plato and Aristotle.

The genius of Hippocrates is unsurpa.s.sed in the history of medicine. He was the first to trace disease to a natural and intelligible cause, and to recognize Nature as all-sufficient for healing, and physicians as only her servants. He discussed medical subjects freely and without an air of mystery, scorning all pretence, and he was also courageous enough to acknowledge his limitations and his failures. When the times in which he lived are considered, it is difficult to know which of his qualities to admire most, his love of knowledge, his powers of observation, his logical faculty, or his courage and truthfulness.

The central principle of belief of Hippocrates and the Dogmatists was that health depended on the proper proportion and action in the body of the four elements, earth, water, air, and fire, and the four cardinal humours, blood, phlegm, yellow bile and black bile. The due combination of these was known as _crasis_, and existed in health. If a disease were progressing favourably these humours became changed and combined (coction), preparatory to the expulsion of the morbid matter (crisis), which took place at definite periods known as critical days. Hippocrates also held the theory of fluxions, which were conditions in the nature of congestion, as it would now be understood.

In his time public opinion condemned dissection of the human body, but it is certain that dissections were performed by Hippocrates to a limited extent. He did not know the difference between the arteries and the veins, and nerves and ligaments and various membranes were all thought to have a.n.a.logous functions, but his writings display a correct knowledge of the anatomy of certain parts of the body such as the joints and the brain. This defective knowledge of anatomy gave rise to fanciful views on physiology, which, among much that is admirable, disfigure the Hippocratic writings.

The belief that almost all medical and surgical knowledge is modern, though flattering to our self-complacency, is disturbed by the study of the state of knowledge in the time of Hippocrates. To him we are indebted for the cla.s.sification of diseases into sporadic, epidemic, and endemic, and he also separated acute from chronic diseases. He divided the causes of disease into two cla.s.ses: general, such as climate, water and sanitation; and personal, such as improper food and neglect of exercise.

He based his conclusions on the observation of appearances, and in this way began a new era. He was so perfect in the observation of external signs of disease that he has never in this respect been excelled. The state of the face, eyes, tongue, voice, hearing, abdomen, sleep, breathing, excretions, posture of the body, and so on, all aided him in diagnosis and prognosis, and to the latter he paid special attention, saying that "the best physician is the one who is able to establish a prognosis, penetrating and exposing first of all, at the bedside, the present, the past, and the future of his patients, and adding what they omit in their statements. He gains their confidence, and being convinced of his superiority of knowledge they do not hesitate to commit themselves entirely into his hands. He can treat, also, so much better their present condition in proportion as he shall be able from it to foresee the future."

He wrote about the history of Medicine, a study which is much neglected at the present time. There is no generation of men so wise that they cannot with advantage adopt some ideas from the remote past, or, at least, find the teaching of their predecessors suggestive. Hippocrates was one of the first to recognize the _vis medicatrix naturae_, and he always aimed at a.s.sisting Nature. His style of treatment would be known now as expectant, and he tried to order his practice "to do good, or, at least, to do no harm." When he considered interference necessary, however, he did not hesitate even to apply drastic measures, such as scarification, cupping and bleeding. He made use of the narcotics mandragora, henbane, and probably also poppy-juice, and as a laxative used greatly a vegetable substance called "mercury," beet and cabbage, and cathartics such as scammony and elaterium! He was able to diagnose fluid in the chest or abdomen by means of percussion and auscultation, and to withdraw the fluid by the operation of paracentesis, and he recognized also that the fluid should be allowed to flow away slowly so as to minimize the risk of syncope. He operated also for empyema. In regard to the methods of Hippocrates for the physical examination of the chest it is reasonable to suppose that the Father of Medicine indirectly inspired Laennec to invent the stethoscope. Hippocrates prescribed fluid diet for fevers, allowed the patients cold water or barley water to drink, and recommended cold sponging for high fever. In his writings will be found his views on apoplexy, epilepsy, phthisis, gout, erysipelas, cancer and many other diseases common at the present day.

In the province of _Surgery_, Hippocrates was surprisingly proficient, although he lived before the Anatomic Period. He had various lotions for the healing of ulcers; some of these lotions were antiseptic and have been in use in recent times. His opinions on the treatment of fractures are sound, and he was a master in the use of splints, and considered that it was disgraceful on the part of the surgeon to allow a broken limb to set in a faulty position. He resected the projecting ends of the bone in the case of compound fracture. He had a very complete knowledge of the anatomy of joints, was well acquainted with hip-joint disease, and could operate upon joints. Accidents were no doubt common in the gymnasia, and practice in the treatment of fractures and dislocations extensive and of a high order of excellence. Hippocrates used the sound for exploring the bladder, and understood the use of the speculum for examining the r.e.c.t.u.m, and in operations for fistula and piles. He understood the causation of club-foot, and could cure cases of this deformity by bandaging. He was skilful also in obstetric operations. He trepanned the skull, which appears to have been a common operation in his day. He had clear and sound views in reference to wounds of the head, recognizing that trivial-looking wounds of the scalp might become very serious. Hippocrates gave directions as to the indications for using the trepan, and warned the operator against mistaking sutures of the cranial bones for fracture.

He did not describe amputations as generally understood, but removed limbs at a joint for gangrene. When necessary he made use of mechanical appliances for reducing dislocations, and recommended doctors to furnish their surgeries with an adjustable table, fitted with levers, for dealing with the reduction of dislocations, and for various other surgical manipulations. Excision of tumours was not a common operation of Hippocratic surgery, although it had been a part of Hindu practice in very ancient times. On the subject of _Obstetrics_, Hippocrates wrote a great deal, and although many of his theories seem absurd at the present day, yet, on the whole, the treatment he recommends is efficacious.

Regarding _Gynaecology_, in his treatise on "Airs, Water and Places," it is interesting to observe that he says that the drinking of impure water will cause dropsy of the uterus. Adams, commenting on this, has in mind hydatids, but it is evident that both Hippocrates and his translator and critic have mistaken hydatidiform disease of the ovum for hydatid disease of the womb. In the books which are considered genuine the references to diseases of women are meagre, and it is likely that the author had little special knowledge of the subject. That part of the Hippocratic collection which is not considered genuine deals rather fully with the subject of gynaecology.[5] In it are described sounds made of wood and of lead, dilators and uterine catheters. Sitz baths were in use, and fumigations were very extensively employed in gynaecological practice. Pessaries were made by rolling lint or wool into an oblong shape, and were medicated to be emollient, astringent or purgative in their local action. The half of a pomegranate was used as a mechanical pessary, and there are also references to tents, and to suppositories for the bowel.

In dealing with _Dietetics_, Hippocrates displays close observation and sound judgment. The views held generally at the present day coincide closely with his instructions on food and feeding. In the treatise on Ancient Medicine, he states that men had to find from experience the properties of various vegetable foods, and discovered that what was suitable in health was unsuitable in sickness, and that the acc.u.mulation of these discoveries was the origin of the art of medicine.

The Sydenham Society initiated, and Dr. Adams brilliantly accomplished, a n.o.ble work in the publication in 1849 of "The Genuine Works of Hippocrates," from which "The Law," and "The Oath" are here quoted. The former is the view of Hippocrates of the standards which should govern the practice of medicine; the latter is that by which all the aesculapians were bound.

"THE LAW.

"(1) Medicine is of all the arts the most n.o.ble; but, owing to the ignorance of those who practise it, and of those who, inconsiderately, form a judgment of them, it is at present far behind all the other arts.

Their mistake appears to me to arise princ.i.p.ally from this, that in the cities there is no punishment connected with the practice of medicine (and with it alone) except disgrace, and that does not hurt those who are familiar with it. Such persons are like the figures which are introduced in tragedies, for as they have the shape, and dress, and personal appearance of an actor, but are not actors, so also physicians are many in t.i.tle but very few in reality.

"(2) 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 an early 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.

"(3) Instruction in medicine is like the culture of the productions of the earth. For our natural disposition is, as it were, the soil; the tenets of our teacher are, as it were, the seed; instruction in youth is like the planting of the seed in the ground at the proper season; the place where the instruction is communicated is like the food imparted to vegetables by the atmosphere; diligent study is like the cultivation of the fields; and it is time which imparts strength to all things and brings them to maturity.

"(4) Having brought all these requisites to the study of medicine, and having acquired a true knowledge of it, we shall thus, in travelling through the cities, be esteemed physicians not only in name but in reality. But inexperience is a bad treasure, and a bad friend to those who possess it, whether in opinion or reality, being devoid of self-reliance and contentedness, and the nurse both of timidity and audacity. For timidity betrays a want of powers, and audacity a want of skill. There are, indeed, two things, knowledge and opinion, of which the one makes its possessor really to know, the other to be ignorant.

"(5) These things which are sacred are to be imparted only to sacred persons; and it is not lawful to impart them to the profane until they have been initiated in the mysteries of the science."

"THE OATH.

"I swear by Apollo, the physician, and aesculapius, and Health, and Panacea, and all the G.o.ds and G.o.ddesses, 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 the 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 judgment, 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 pa.s.s my life and practise my Art. I will not cut persons labouring under the stone, but will leave this to be done by men who are pract.i.tioners of this work. Into whatever 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 seduction of females or males, of freedmen 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 inviolate, 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 trespa.s.s or violate this oath, may the reverse be my lot!"

It would be a great task to attempt anything like a full review of the writings of this great doctor of antiquity, but enough has been written to reveal the great powers of his mind, and to show that he was far in advance of his predecessors, and a model for his successors. In the island of Cos, made ill.u.s.trious by the name of Hippocrates, it is strange to find that he has no fame now other than that of being regarded in the confused minds of the people as one of the numerous saints of the Greek Church.[6]

"When," says Littre, "one searches into the history of medicine and the commencement of science, the first body of doctrine that one meets with is the collection of writings known under the name of the works of Hippocrates. The science mounts up directly to that origin, and there stops. Not that it had not been cultivated earlier, and had not given rise to even numerous productions; but everything that had been made before the physician of Cos has perished. We have only remaining of them scattered and unconnected fragments. The works of Hippocrates have alone escaped destruction; and by a singular circ.u.mstance there exists a great gap after them as well as before them. The medical works from Hippocrates to the establishment of the School of Alexandria, and those of that school itself, are completely lost, except some quotations and pa.s.sages preserved in the later writers; so that the writings of Hippocrates remain alone amongst the ruins of ancient medical literature." Sydenham said of Hippocrates: "He it is whom we can never duly praise," and refers to him as "that divine old man," and "the Romulus of medicine, whose heaven was the empyrean of his art."

Hippocrates died in Thessaly, but at what age is uncertain, for different authors have credited him with a lifetime of from eighty-five to a hundred and nine years. By virtue of his fame, death for him was not the Great Leveller.

Hippocrates had two sons, Thessalus and Draco; the former was physician to Archelaus, King of Macedonia, the latter physician to the wife of Alexander the Great. They were the founders of the School of Dogmatism which was based mainly on the teaching and aphorisms of Hippocrates. The Dogmatic Sect emphasized the importance of investigating not the obvious but the underlying and hidden causes of disease and held undisputed sway until the foundation of the Empirical Sect at Alexandria.

FOOTNOTES:

[5] _Vide_ "History of Gynaecology," by W. J. Stewart McKay. Bailliere, Tindall and c.o.x, 1901.

[6] _Archiv fur Geschichte der Medizin_, May, 1912.

CHAPTER IV.

PLATO, ARISTOTLE, THE SCHOOL OF ALEXANDRIA AND EMPIRICISM.

Plato--Aristotle--Alexandrian School--Its Origin--Its Influence-- Lithotomy--Herophilus--Erasistratus--Cleombrotus--Chrysippos-- Anatomy--Empiricism--Serapion of Alexandria.

Two very eminent philosophers, Plato and Aristotle, were influenced by the teaching of Hippocrates.

_Plato_ (B.C. 427-347) was a profound moralist, and though possessed of one of the keenest intellects of all time, did little to advance medical science. He did not practise medicine, but studied it as a branch of philosophy, and instead of observing and investigating, attempted to solve the problems of health and disease by intuition and speculation.

His conceptions were inaccurate and fantastic.

He elaborated the humoral pathology of Hippocrates. The world, he thought, was composed of four elements: _fire_ consisting of pyramidal, _earth_ of cubical, _air_ of octagonal, and _water_ of twenty-sided atoms. The marrow consists of triangles, and the brain is the perfection of marrow. The soul dominates the marrow and the separation of the two causes death. The purpose of the bones and muscles is to protect the marrow against changes of temperature. Plato divided the "soul" into three parts: Reason, enthroned in the brain; courage in the heart; and desire in the liver. The uterus, he believed, excites inordinate desires. Inflammations are due to disorders of the bile, and fevers to the influence of the elements. His theories in regard to the special senses are very fantastic, for instance, smell is evanescent because it is not founded on any external image; taste results from small vessels carrying taste atoms to the heart and soul.

_Aristotle_, born B.C. 334, was the son of Nichomachus, physician to the King of Macedonia, and of the race of the Asclepiads. His inherited taste was for the study of Nature; he attained the great honour of being the founder of the sciences of Comparative Anatomy and Natural History, and contributed largely to the medical knowledge of his time. Aristotle went to Athens and became a follower of Plato, and the close companions.h.i.+p of these two great men lasted for twenty years. At the age of 42, Aristotle was appointed by Philip of Macedon tutor to Alexander the Great, who was then aged 15, and the interest of that mighty prince was soon aroused in the study of Natural History. Aristotle and Alexander the Great, teacher and pupil, founded the first great Natural History Museum, to which specimens were sent from places scattered over the then known world. Aristotle, besides his philosophical books, wrote: "Researches about Animals," "On Sleep and Waking," "On Longevity and Shortlivedness," "On Parts of Animals," "On Respiration," "On Locomotion of Animals," and "On Generation of Animals." He was greatly helped in the supply of material for dissection in his study of comparative anatomy by his pupil, Alexander the Great. Aristotle pointed out the differences in the anatomy of men and monkeys; he described the anatomy of the elephant and of birds, and also the changes in development seen during the incubation of eggs. He investigated, also, the anatomy of fishes and reptiles. The stomachs of ruminant animals excited his interest, and he described their structure. The heart, according to Aristotle, was the seat of the soul, and the birthplace of the pa.s.sions, for it held the natural fire, and in it centred movement, sensation and nourishment. The diaphragm, he believed, separated the heart, the seat of the soul, from the contaminating influences of the intestines. He did not advance beyond the conception that nerves were akin to ligaments and tendons, and he believed that the nerves originated in the heart, as did also the blood-vessels. He named the _aorta_ and _ventricles_. He investigated the action of the muscles, and held that superftation was possible.

When Aristotle retired to Chalcis, he chose Tyrtamus, to whom he gave the name of _Theophrastus_, as his successor at the Lyceum.

Theophrastus was the originator of the science of Botany, and wrote the "History of Plants." He also wrote about stones, and on physical, moral and medical subjects.

THE ALEXANDRIAN SCHOOL.