The Legacy of Greece Part 13

In the records of almost all temple cures, a great number of which have survived in a wide variety of doc.u.ments, an essential element is the process of e?????s?? {enkoimesis}, _incubation_ or temple sleep, usually in a special sleeping-place or Abaton. The process has a close parallel in certain modern Greek churches and in places of wors.h.i.+p much further West; there are even traces of it in these islands, and it is more than probable that the Christian practice is descended by direct continuity from the pagan.[80] The whole character of the temple treatment was--and is--of a kind to suggest to the patient that he should dream of the G.o.d, an event which therefore usually takes place.

Such treatment by suggestion is applicable only to certain cla.s.ses of disease and is always liable to fall into the hands of fanatics and impostors. The difficulty that the honest pract.i.tioner encounters is that the sufferer, in the nature of the case, can hardly be brought to believe that his ailment is what in fact it is, a lesion of the mind. It is this which gives the miracle-monger his chance.

[80] We are almost told as much in the apocryphal _Gospel of Nicodemus_, -- 1, a work probably composed about the end of the fourth century.

Examine for a moment the two cases from Epidaurus, which are quite typical of the series. We observe that the first is described simply as a case of 'tape-worm' without any justification for the diagnosis. It is not unfrequent nowadays for thin and anxious patients to state, similarly without justification, that they suffer from this condition.

They attribute certain common gastric experiences to this cause of which perhaps they have learned from sensational advertis.e.m.e.nts, and then they ask cure for a condition which they themselves have diagnosed, but which has no existence in fact. Such a case is often appropriately treated by suggestion. Though the elaborateness of the suggestion in the temple cure is a little startling, yet it can easily be paralleled from the legends of the Christian saints. Moreover, we must remember that we are not here dealing with an account set down by the patient herself, but with an edificatory inscription put up by the temple officials.

In the second inscription, the man with an abdominal abscess, we have a much simpler state of affairs. It is evident that an operation was actually performed by the priest masquerading as Asclepius, while the patient was held down by the slaves. He is a.s.sured that all is a dream and departs cured with the tell-tale comment 'and the floor of the Abaton was covered with blood'.

These cases might be multiplied indefinitely without great profit for our particular theme, for in such matters there is no development, no evolution, no history. There can be no doubt that a very large part of Greek practice was on this level, as is a small part of modern medicine, but it is not a level with which we are here dealing and we shall therefore pa.s.s it by. But a word of caution must be added. Such temple wors.h.i.+p has been compared with modern psycho-a.n.a.lysis. That method, like all methods, has doubtless been abused at times; but it is in essence, unlike the temple system, a purely scientific process by which the ultimate basis of the patient's delusions are laid bare and demonstrated to him.

There is indeed another side to these Asclepian temples. They gradually developed along the lines of our health resorts and developed many of the qualities--lovely and unlovely--that we a.s.sociate with certain continental watering places. On the bad side they became gossiping centres or even something little better than brothels, as we may gather from the _Mimes_ of Herondas. On the good side they formed a quiet refuge among beautiful and interesting surroundings where the sick, exhausted, and convalescent might gain the benefits that accrue from pure air, fine scenery, and a regular and regulated mode of life. It is more than probable too that the open air and manner of living benefited many cases of incipient phthisis.

Returning to the Hippocratic collection, the purely surgical treatises will be found no less remarkable than those of clinical observation. A very able surgeon, Francis Adams (1796-1861), who was eminent as a Greek scholar, gave it as his opinion in the middle of the nineteenth century that no systematic writer on surgery up to his time had given so good and so complete an account of certain dislocations, notably of the hip-joint, as that to be found in the Hippocratic collection. Some types of injury to the hip, as described in the Hippocratic writings, were certainly otherwise quite inadequately known until described by Sir Astley Cooper (1768-1841), himself a peculiarly Hippocratic character.[81] The verdict of Adams was probably just, though since his time the surgery of dislocations, aided especially by X-rays, has been enabled to pa.s.s very definitely beyond the Hippocratic position.

Admirable, too, is the Hippocratic description of dislocation of the shoulder and of the jaw. In dislocation of hip, shoulder, or jaw, as in most similar lesions, there is considerable deformity produced. The nature and meaning of this deformity is described with remarkable exactness by the Hippocratic writer, who also sets forth the resulting disability. The principles and indeed the very details of treatment in these cases are, save for the use of an anaesthetic, practically identical with those of the present day. The processes are unfortunately not suitable for detailed quotation and description here, but they are of special interest since a graphic record of them has come down to us.

There exists in the Laurentian Library at Florence a ninth-century Greek surgical ma.n.u.script which contains figures of surgeons reducing the dislocations in question. There is good reason to suppose that these miniatures are copied from figures first prepared in pre-Christian times many centuries earlier, and we may here see the actual processes of reduction of such fractures, as conducted by a surgeon of the direct Hippocratic tradition[82] (see Figs. 3, 4).

[81] Astley Paston Cooper, _Treatise on Dislocations and Fractures of the Joints_, London, 1822, and _Observations on Fractures of the Neck and the Thighbone_, &c., London, 1823.

[82] This famous ma.n.u.script is known as Laurentian, Plutarch 74, 7, and its figures have been reproduced by H. Schone, _Apollonius von Kitium_, Leipzig, 1896.

[Ill.u.s.tration: From MS. of APOLLONIUS OF KITIUM, of Ninth Century Copied from pre-christian original

Fig. 3 REDUCING DISLOCATED SHOULDER

Fig. 4 REDUCING DISLOCATED JAW]

In keeping with all this is most of the surgical work of the collection.

We are almost startled by the modern sound of the whole procedure as we run through the rough note-book ?at' ??t?e??? {kat' ietreion}, _Concerning the Surgery_, or the more elaborate treatise pe?? ??t???

{peri ietrou}, _On the Physician_, where we may read minute directions for the preparation of the operating-room, and on such points as the management of light both artificial and natural, scrupulous cleanliness of the hands, the care and use of the instruments, with the special precautions needed when they are of iron, the decencies to be observed during the operation, the general method of bandaging, the placing of the patient, the use and abuse of splints, and the need for tidiness, order, and cleanliness. Many of these directions are enlarged upon in other surgical works of the collection, among which we find especially full instructions for bandaging and for the diagnosis and treatment of fractures and dislocations. A very fair representation of such a surgery as these works describe is to be found on a vase-painting of Attic origin of the earlier part of the fifth century, and, therefore, a generation before Hippocrates (see fig. 5). There are also several beautiful representations on vases of the actual processes of bandaging (fig. 6).

[Ill.u.s.tration: FIG. 5.

A GREEK CLINIC OF ABOUT 480-470 B. C. From a vase-painting.

In the centre sits a physician holding a lancet and bleeding a patient from the median vein at the bend of the right elbow into a large open basin. Above and behind the physician are suspended three cupping vessels. To the right sits another patient awaiting his turn; his left arm is bandaged in the region of the biceps. The figure beyond him smells a flower, perhaps as a preservative against infection. Behind the physician stands a man leaning on a staff; he is wounded in the left leg, which is bandaged. By his side stands a dwarfish figure with disproportionately large head, whose body exhibits deformities typical of the developmental disease now known as _Achondroplasia_; in addition to these deformities we note that his body is hairy and the bridge of his nose sunken; on his back he carries a hare which is almost as tall as himself. Talking to the dwarf is a man leaning on a long staff, who has the remains of a bandage round his chest.

See E. Pottier, 'Une Clinique grecque au V^{e} siecle (vase antique du collection Peztel)', _Fondation Eugene Piot, Monuments et Memoires_, xiii. 149, Paris, 1906. (Some of our interpretations differ from those of M. Pottier.)]

[Ill.u.s.tration: FIG. 6. A kylix from the Berlin Museum of about 490 B. C.

It bears the inscription S?S??S ?????S?? {SOSIAS EPOIeSEN}, _Sosias made_ (_me_), and represents Achilles bandaging Patroclus, the names of the two heroes being written round the margin. The painter is Euphronios, and the work is regarded as the masterpiece of that great artist. The left upper arm of Patroclus is injured, and Achilles is bandaging it with a two-rolled bandage, which he is trying to bring down to extend over the elbow. The treatment of the hands, a department in which Euphronios excelled, is particularly fine. Achilles was not a trained surgeon, and it will be observed, from the position of the two tails of the bandage, that he will have some difficulty when it comes to its final fastening!]

Among the surgical procedures of which descriptions are to be found in the Hippocratic writings are the opening of the chest for the condition known as _empyema_ (acc.u.mulation of pus within the pleura frequently following pneumonia), and trephining the skull in cases of fracture of that part--two fundamental operations of modern surgery. Surgical art has advanced enormously in our own times, yet a text-book containing much that is useful to this day might be prepared from these surgical contents of the collection alone.

When we pa.s.s to the works on Medicine, in the restricted sense, we enter into a region more difficult and perhaps even more fascinating. We are no longer dealing with simple lesions of known origin, but with the effects of disease and degeneration, of the essential character of which the Hippocratic writers could in the nature of the case know very little. Rigidly guarding themselves from any attempt to explain disease by more immediate and hypothetical causes and thus diverting the reader's energies in the medically useless direction of vague speculation--the prevalent mental vice of the Greeks--the best of these physicians are content if they can put forward generalized conclusions from actually observed cases. Many of their thoughts have now become household words, and they have become so, largely as a direct heritage from these ancient physicians. But it must be remembered that ideas so familiar to us were with them the result of long and carefully recorded experience and are like nothing that we encounter in the medicine of other ancient nations. Such conclusions are best set forth perhaps in the wonderful book of the _Aphorisms_ from which we may permit ourselves a few quotations:

'Life is short, and the Art long; the opportunity fleeting; experiment dangerous, and judgement difficult. Yet we must be prepared not only to do our duty ourselves, but also patient, attendants, and external circ.u.mstances must co-operate.'[83]

[83] The first lines are the source of the famous lines in Goethe's _Faust_:

'Ach Gott! die Kunst ist lang Und kurz ist unser Leben, Mir wird bei meinem kritischen Bestreben Doch oft um Kopf und Busen bang.'

In this one memorable paragraph, so condensed in the original as to be almost untranslatable, he who 'first separated medicine from philosophy'

puts aside at once all speculative interest while in the actual presence of the sick. His whole energy is concentrated on the case in hand with that peculiar att.i.tude, at once impersonal and intensely personal, that has since been the mark of the physician, and that has made of Medicine both a science and an art.

'For extreme diseases, extreme methods of cure.'[84]

'The aged endure fasting most easily; next adults; next young persons, and least of all children, and especially such as are the most lively.'

'Growing bodies have the most innate heat; they therefore require the most nourishment, and if they have it not they waste. In the aged there is little heat, and therefore they require little fuel, for it would be extinguished by much. Similarly fevers in the aged are not so acute, because their bodies are cold.'

'In disease sleep that is laborious is a deadly symptom; but if sleep relieves it is not deadly.'

'Sleep that puts an end to delirium is a good symptom.'

'If a convalescent eats well, but does not put on flesh, it is a bad symptom.'

'Food or drink which is a little less good but more palatable is to be preferred to such that is better but less palatable.'

'The old have generally fewer complaints than young; but those chronic diseases which do befall them generally never leave them.'

[84] The extreme of treatment refers in the original to the extreme restriction of diet, e? a???e??? {es akribeien}, but the meaning of the Aphorism has always been taken as more generalized.

Here we have a group of observations, some of which have become literally household words, nor is it difficult to understand how such sayings have pa.s.sed from professional into lay keeping. This magnificent book of _Aphorisms_ was very early translated into Latin, probably before and certainly not later than the sixth century of the Christian era, and thus became accessible throughout the West. Ma.n.u.scripts of this Latin version, dating from the ninth and tenth centuries of our era, have survived in the actual places in which they were written, at Monte Ca.s.sino in Southern Italy and at Einsiedeln in Switzerland, and in 991 the book of _Aphorisms_ was well known and closely studied at the Cathedral school of Chartres. From France the _Aphorisms_ reached England, and they are mentioned in doc.u.ments of the tenth or eleventh century. By now, too, the book had been translated into Syriac and later into Arabic and Hebrew, so that in the true mediaeval period it was known both East and West, and in the vernacular as well as the cla.s.sical tongues. From the oriental dialects several further translations were again made into Latin. An enormous number of ma.n.u.scripts of the work have survived in almost every Western dialect, and these show on the whole that the text has been surprisingly little tampered with. In the middle of the thirteenth century some of the better-known Aphorisms were absorbed into a very popular Latin poem that went forth in the name of the medical school of Salerno, though with a false ascription to a yet earlier date. The Salernitan poem, being itself translated into every European vernacular, further helped to bring Hippocrates into every home.

But by no means all the Aphorisms are of a kind that could well become absorbed into folk medicine. It is only those concerning frequently recurring states to which this fate could befall. The book contains also a number of notes on rare conditions seldom seen or noted save by medical men. Such are the following very acute observations:

'Spasm supervening on a wound is fatal.'

'Those seized with teta.n.u.s die within four days, or if they survive so long they recover.'

'A convulsion, or hiccup, supervening on a copious discharge of blood is bad.'

'If after severe and grave wounds no swelling appears, it is very serious.'

These four sentences all concern wounds. The first two refer to the disease _teta.n.u.s_, which is very liable to supervene on wounds fouled with earth, especially in hot and moist localities. The disease is characterized by a series of painful muscular contractions which in the more severe and fatal form may become a continuous spasm, a type that is referred to in the first sentence. It is true of teta.n.u.s that the later the onset after the wound is sustained the better the chance of recovery. This is brought out by the second sentence. The third and fourth sentences record untoward symptoms following a severe wound, now well recognized and watched for by every surgeon. There were, of course, innumerable ill.u.s.trations of the truth of these Aphorisms in extensive wounds, especially those involving crushed limbs, in the late war.

'Phthisis occurs most commonly between the ages of eighteen and thirty-five.'

'Diarrha supervening on phthisis is mortal.'

The period given by the _Aphorisms_ for the maximum frequency of onset of the disease is closely borne out by modern observations. The second Aphorism is equally valid; continued diarrha is a very frequent antecedent of the fatal event in chronic phthisis, and post-mortem examination has shown that secondary involvement of the bowel is an exceedingly common condition in this disease.

No less remarkable is the following saying: 'In jaundice it is a grave matter if the liver becomes indurated.' Jaundice is a common and comparatively trivial symptom following or accompanying a large variety of diseases. In and by itself it is of little importance and almost always disappears spontaneously. There is a small group of pathological conditions, however, in which this is not the case. The commonest and most important of these are the fatal affections of cirrhosis and cancer of the liver in which that organ may be felt to be enlarged and hardened. If therefore the liver can be so felt in a case of jaundice, it is, as the Aphorism says, of gravest import. Representations of such cases have actually come down to us from Greek times. Thus on a monument erected at Athens to the memory of a physician who died in the second century of the Christian era we may see the process of clinical examination (fig. 7). The physician is palpating the liver of a dwarfish figure whose swollen belly, wasted limbs, and anxious look tell of some such condition as that described in the Aphorism. The ridge caused by the enlarged liver can even be detected on the statue.

[Ill.u.s.tration: Fig. 7. ATHENIAN FUNERARY MONUMENT Second century A. D. British Museum

Inscription reads: 'Jason, also called Dekmos, the Acharnian, a physician', followed by his genealogy. By side of patient stands a cupping vessel.]