Part 6 (1/2)
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 ac.u.men, 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 const.i.tutes 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 sc.r.a.ppy 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 a.n.a.lyses 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 pract.i.tioner and to him is ascribed the statement that drugs are the hands of the G.o.ds. 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 pa.s.sed 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 a.s.sociated 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 ill.u.s.tration 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 fas.h.i.+on.” 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 ma.n.u.scripts 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 pa.s.sed 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 pract.i.tioners, 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, ma.s.sage 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 Allb.u.t.t(32) on ”Greek Medicine in Rome” and from Meyer-Steineg's ”Theodorus Priscia.n.u.s 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 ma.n.u.s Aquilone gelatae Non habui febrem, Symmache, nunc habeo.
(32) Allb.u.t.t: 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 cla.s.s 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 h.e.l.l, 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.