the evolution of modern medicine

7/21/2019 The Evolution of Modern Medicine

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THE EVOLUTION OF MODERN MEDICINE

A SERIES OF LECTURES DELIVERED

AT YALE UNIVERSITY

ON THE SILLIMAN FOUNDATION

IN APRIL, 1913

by William Osler


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THE SILLIMAN FOUNDATION

IN the year 1883 a legacy of eighty thousand dollars was left to the President and

Fellows of Yale ollege in the city of New !a"en, to #e held in trust, as a gift fro$

her children, in $e$ory of their #elo"ed and honored $other, %rs& !e'sa (ly

)illi$an&

*n this foundation Yale ollege was re+uested and directed to esta#lish an annual

course of lectures designed to illustrate the 'resence and 'ro"idence, the wisdo$ and

goodness of od, as $anifested in the natural and $oral world& -hese were to #edesignated as the %rs& !e'sa (ly )illi$an %e$orial Lectures& It was the #elief of

the testator that any orderly 'resentation of the facts of nature or history contri#uted

to the end of this foundation $ore effecti"ely than any atte$'t to e$'hasi.e the

ele$ents of doctrine or of creed/ and he therefore 'ro"ided that lectures on dog$atic

or 'ole$ical theology should #e e0cluded fro$ the sco'e of this foundation, and that

the su#ects should #e selected rather fro$ the do$ains of natural science and

history, gi"ing s'ecial 'ro$inence to astrono$y, che$istry, geology and anato$y&

It was further directed that each annual course should #e $ade the #asis of a "olu$e

to for$ 'art of a series constituting a $e$orial to %rs& )illi$an& -he $e$orial fund

ca$e into the 'ossession of the or'oration of Yale 2ni"ersity in the year 191/ and

the 'resent "olu$e constitutes the tenth of the series of $e$orial lectures&


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Contents

-!( )ILLI%AN F*2N4A-I*N

PR(FA(

CHATER I ! ORI"IN OF MEDICINE

IN-R*42-I*N

*RIIN *F %(4IIN((YP-IAN %(4IIN(

A))YRIAN AN4 5A5YL*NIAN %(4IIN(

!(5R(6 %(4IIN(!IN()( AN4 7APAN()( %(4IIN(

CHATER II ! "REE# MEDICINE

A)L(PI*)!IPP*RA-() AN4 -!( !IPP*RA-I 6RI-IN)

AL(AN4RIAN )!**LAL(N

CHATER III ! MEDIAEVAL MEDICINE

)*2-! I-ALIAN )!**L5Y:AN-IN( %(4IIN(

ARA5IAN %(4IIN(

-!( RI)( *F -!( 2NI;(R)I-I()%(4IA(;AL %(4IAL )-24I()

%(4IA(;AL PRA-I(A)-R*L*Y AN4 4I;INA-I*N

CHATER IV ! THE RENAISSANCE AND THE RISE OF ANATOMY AND

HYSIOLO"Y

PARA(L)2);()ALI2)

!AR;(Y

CHATER V ! THE RISE AND DEVELOMENT OF MODERN

MEDICINE

IN-(RNAL )(R(-I*N)!(%I)-RY

CHATER VI ! THE RISE OF REVENTIVE MEDICINE)ANI-A-I*N

-25(R2L*)I)


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REFACE

-!( $anuscri't of )ir 6illia$ *sler


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hu$anity are the deser"ing $en/ he has $ade the great na$es shine out, without any

de'reciation of the i$'ortant wor? of lesser $en and without cluttering u' his

narrati"e with the tedious 'rehistory of great disco"eries or with shrill clai$s to'riority& *f his s?ill in differentiating the sundry =strains= of $edicine, there is

s'ecific witness in each section& *slersight= of the e"olution of $edicine, a reali.ation of

what de"otion, 'erse"erance, "alor and a#ility on the 'art of 'hysicians ha"e

contri#uted to this 'rogress, and of the credita#le 'art which our 'rofession has

'layed in the general de"elo'$ent of science&

-he editors ha"e no hesitation in 'resenting these lectures to the 'rofession and to the

reading 'u#lic as one of the $ost characteristic 'roductions of the #est>#alanced,

#est>e+ui''ed, $ost sagacious and $ost lo"a#le of all $odern 'hysicians&


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F&!&&

52- on that account, I say, we ought not to reect the ancient Art, as if it were not,

and had not #een 'ro'erly founded, #ecause it did not attain accuracy in all things,

#ut rather, since it is ca'a#le of reaching to the greatest e0actitude #y reasoning, to

recei"e it and ad$ire its disco"eries, $ade fro$ a state of great ignorance, and as

ha"ing #een well and 'ro'erly $ade, and not fro$ chance& @!i''ocrates, *n Ancient

%edicine, Ada$s edition, ;ol& 1, 18B9, '& 1C8&

-!( true and lawful goal of the sciences is none other than thisD that hu$an life #e

endowed with new disco"eries and 'owers& @Francis 5acon, No"u$ *rganu$,

A'horis$s, LI, )'edding


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CHATER I

ORI"IN OF MEDICINE

INTRODUCTION

)AIL to the Pacific with so$e Ancient %ariner, and tra"erse day #y day that silent

sea until you reach a region ne"er #efore furrowed #y ?eel where a tiny island, a

$ere s'ec? on the "ast ocean, has ust risen fro$ the de'ths, a little coral reef ca''ed

with green, an atoll, a $i$ic earth, fringed with life, #uilt u' through countless ages

#y life on the re$ains of life that has 'assed away& And now, with wings of fancy,

oin Ianthe in the $agic car of )helley, 'ass the eternal gates of the fla$ing ra$'arts

of the world and see his "isionD

Below lay stretched the boundless Universe!

There, far as the remotest line

That limits swift imagination's flight,

Unending orbs mingled in mazy motion,

Immutably fulfilling

Eternal Nature's law

bove, below, around,The circling systems formed

wilderness of harmony

"#aemon of the $orld, %t I&

And so$ewhere, =as fast and far the chariot flew,= a$id the $ighty glo#es would #e

seen a tiny s'ec?, =earth


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'oly.oon, I dou#t not, is $uch larger relati"ely than is $an in 'ro'ortion to the "ast

syste$s of the 2ni"erse, in which he re'resents an ultra>$icrosco'ic ato$ less ten

thousand ti$es than the tiniest of the =gay $otes that 'eo'le the sun#ea$s&= Yet, withcolossal audacity, this thin?ing ato$ regards hi$self as the anthro'ocentric 'i"ot

around which re"ol"e the eternal 'ur'oses of the 2ni"erse& nowing not whence he

ca$e, why he is here, or whither he is going, $an feels hi$self of su're$e

i$'ortance, and certainly is of interestGto hi$self& Let us ho'e that he has indeed a

'otency and i$'ortance out of all 'ro'ortion to his so$atic insignificance& 6e ?now

of to0ins of such strength that an a$ount too infinitesi$al to #e gauged $ay ?ill/ and

we ?now that =the unit ado'ted in certain scientific wor? is the a$ount of e$anation

'roduced #y one $illion>$illionth of a grain of radiu$, a +uantity which itself has a

"olu$e of less than a $illion>$illionth of a cu#ic $illi$etre and weighs a $illion

$illion ti$es less than an e0ce'tionally delicate che$ical #alance will turn to=

@)oddy, 191& %ay not $an #e the radiu$ of the 2ni"erseH At any rate let us not

worry a#out his si.e& For us he is a "ery 'otent creature, full of interest, whose

$undane story we are only #eginning to unra"el&

i"ili.ation is #ut a fil$y fringe on the history of $an& o #ac? as far as his recordscarry us and the story written on stone is of yesterday in co$'arison with the "ast

e'ochs of ti$e which $odern studies de$and for his life on the earth& For two

$illions @so$e hold e"en three $illions of years $an li"ed and $o"ed and had his

#eing in a world "ery different fro$ that u'on which we loo? out& -here a''ear,

indeed, to ha"e #een "arious ty'es of $an, so$e as different fro$ us as we are fro$

the anthro'oid a'es& 6hat u'starts of yesterday are the Pharaohs in co$'arison with

the $en who sur"i"ed the tragedy of the glacial 'eriod -he ancient history of $anG

only now #eginning to #e studiedGdates fro$ the Pliocene or %iocene 'eriod/ the

$odern history, as we ?now it, e$#races that #rief s'ace of ti$e that has ela'sed

since the earliest (gy'tian and 5a#ylonian records were $ade& -his has to #e #orne

in $ind in connection with the 'resent $ental status of $an, 'articularly in his


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outloo? u'on nature& In his thoughts and in his attri#utes, $an?ind at large is

controlled #y inherited #eliefs and i$'ulses, which countless thousands of years ha"e

ingrained li?e instinct& *"er "ast regions of the earth today, $agic, a$ulets, char$s,incantations are the chief wea'ons of defense against a $alignant nature/ and in

disease, the 'ractice of Asa @J is co$'arati"ely no"el and unusual/ in days of illness

$any $illions $ore still see? their gods rather than the 'hysicians& In an u'ward 'ath

$an has had to wor? out for hi$self a relationshi' with his fellows and with nature&

!e sought in the su'ernatural an e0'lanation of the 'ressing 'heno$ena of life,

'eo'ling the world with s'iritual #eings, deifying o#ects of nature, and assigning to

the$ #enign or $align influences, which $ight #e in"o?ed or 'ro'itiated& Pri$iti"e

'riest, 'hysician and 'hiloso'her were one, and struggled, on the one hand, for the

recognition of certain 'ractices forced on hi$ #y e0'erience, and on the other, for the

recognition of $ystical agencies which control the dar?, =uncharted region= a#out

hi$Gto use Prof& il#ert %urray


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$odern science= @6hetha$, which, too, see?s to control certain forces, no longer,

howe"er, regarded as su'ernatural&

Pri$iti"e $an recogni.ed $any of these su'erhu$an agencies relating to disease,

such as the s'irits of the dead, either hu$an or ani$al, inde'endent disease de$ons,

or indi"iduals who $ight act #y controlling the s'irits or agencies of disease& 6e see

this today a$ong the negroes of the )outhern )tates& A !oodoo 'ut u'on a negro

$ay, if he ?nows of it, wor? u'on hi$ so 'owerfully through the i$agination that he

#eco$es "ery ill indeed, and only through a $ore 'owerful $agic e0ercised #y

so$eone else can the !oodoo #e ta?en off&

-o 'ri$iti"e $an life see$ed =full of sacred 'resences= @6alter Pater connected

with o#ects in nature, or with incidents and e'ochs in life, which he #egan early to

deify, so that, until a +uite recent 'eriod, his story is largely associated with a

'antheon of greater and lesser gods, which he has $anufactured wholesale&

eno'hanes was the earliest 'hiloso'her to recogni.e $an

nosed and #lac?, while, if o0en and lions and horses had hands and could draw, they

would re'resent their gods as o0en and lions and horses& In relation to nature and to

disease, all through early history we find a 'antheon full to re'letion, #earing

testi$ony no less to the fertility of $an


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the $aor gods, re'resentati"es of A'ollo, A(scula'ius and %iner"a, there were

scores of lesser ones who could #e in"o?ed for s'ecial diseases& It is said that the

young Ro$an $other $ight a''eal to no less than fourteen goddesses, fro$ 7unoLucina to Prosa and Port"orta @6ithington& -e$'les were erected to the oddess of

Fe"er, and she was $uch in"o?ed& -here is e0tant a touching ta#let erected #y a

$ourning $other and inscri#edD

ebri divae, ebri

-ancte, ebri magnae

(amillo amato .ro

ilio meld effecto %osuit

It is $ar"ellous what a long line of su'erhu$an 'owers, $aor and $inor, $an has

in"o?ed against sic?ness& In )win#urne


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'hiloso'her and 'hysician, as well as 'riest& %agic and religion control the uncharted

s'hereGthe su'ernatural, the su'erhu$anD science see?s to ?now the world, and

through ?nowing, to control it& Ray Lan?ester re$ar?s that %an is Natureconsciousness, will, are the attri#utes of %an&=@1 It

has #een a slow and gradual growth, and not until within the 'ast century has science

organi.ed ?nowledgeGso searched out the secrets of Nature, as to control her

'owers, li$it her sco'e and transfor$ her energies& -he "ictory is so recent that the

$ental attitude of the race is not yet ada'ted to the change& A large 'ro'ortion of our

fellow creatures still regard nature as a 'layground for de$ons and s'irits to #e

e0orcised or in"o?ed&

"*& -ir E :ay 3an2ester5 :omanes 3ecture, ;Nature and 1an,; 6)ford

Univ %ress, *, . +*

)ide #y side, as su#stance and shadowG=in the dar? #ac?ward and a#ys$ of ti$e,=

in the dawn of the great ci"ili.ations of (gy't and 5a#ylon, in the #right $orning of

reece, and in the full noontide of $odern life, together ha"e grown u' these two

dia$etrically o''osite "iews of $an


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e0tinguished, #ut retri$$ed and refurnished #y his indo$ita#le energies, now shines

$ore and $ore towards the 'erfect day& It is a glorious cha'ter in history, in which

those who ha"e eyes to see $ay read the fulfil$ent of the 'ro$ise of (den, that oneday $an should not only 'ossess the earth, #ut that he should ha"e do$inion o"er it

I 'ro'ose to ta?e an aero'lane flight through the centuries, touching only on the tall

'ea?s fro$ which $ay #e had a 'anora$ic "iew of the e'ochs through which we

'ass&


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ORI"IN OF MEDICINE

%(4IIN( arose out of the 'ri$al sy$'athy of $an with $an/ out of the desire to

hel' those in sorrow, need and sic?ness&

In the .rimal sym.athy

$hich having been must ever be0

In the soothing thoughts that s.ring

6ut of human suffering

-he instinct of self>'reser"ation, the longing to relie"e a lo"ed one, and a#o"e all, the

$aternal 'assionGfor such it isGgradually softened the hard race of $anGtu$

genus hu$anu$ 'ri$u$ $ollescere coe'it& In his $ar"ellous s?etch of the e"olution

of $an, nothing illustrates $ore forci#ly the 'rescience of Lucretius than the 'icture

of the growth of sy$'athyD =6hen with cries and gestures they taught with #ro?en

words that


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had waited to the end did #est& For the sa$e reason so$e at the #eginning of an

illness used a full diet, others a s'are, and the for$er were $ade worse& *ccurring

daily, such things i$'ressed careful $en, who noted what had #est hel'ed the sic?,then #egan to 'rescri#e the$& In this way $edicine had its rise fro$ the e0'erience of

the reco"ery of so$e, of the death of others, distinguishing the hurtful fro$ the

salutary things= @5oo? I& -he association of ideas was suggesti"eGthe 'lant

eye#right was used for centuries in diseases of the eye #ecause a #lac? s'ec? in the

flower suggested the 'u'il of the eye& -he old her#als are full of si$ilar illustrations

u'on which, indeed, the so>called doctrine of signatures de'ends& *#ser"ation ca$e,

and with it an e"er widening e0'erience& No society so 'ri$iti"e without so$e

e"idence of the e0istence of a healing art, which grew with its growth, and #eca$e

'art of the fa#ric of its organi.ation&

6ith 'ri$iti"e $edicine, as such, I cannot deal, #ut I $ust refer to the oldest e0isting

e"idence of a "ery e0traordinary 'ractice, that of tre'hining& Neolithic s?ulls with

dis?s of #one re$o"ed ha"e #een found in nearly all 'arts of the world& %any careful

studies ha"e #een $ade of this 'rocedure, 'articularly #y the great anato$ist and

surgeon, Paul 5roca, and %& Lucas>ha$'ionniere has co"ered the su#ect in a$onogra'h&@ 5roca suggests that the tre'hining was done #y scratching or

scra'ing, #ut, as Lucas>ha$'ionniere holds, it was also done #y a series of

'erforations $ade in a circle with flint instru$ents, and a round 'iece of s?ull in this

way re$o"ed/ traces of these drill>holes ha"e #een found& -he o'eration was done

for e'ile'sy, infantile con"ulsions, headache, and "arious cere#ral diseases #elie"ed

to #e caused #y confined de$ons, to who$ the hole ga"e a ready $ethod of esca'e&

"+& 3ucas?(ham.ionniere5 Tre.anation neolithi7ue, %aris,*


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#rothers also e0'erts/ he did not consider it a dangerous o'eration& !e did it $ost

fre+uently for 'ain in the head, and occasionally for fracture&

-he o'eration was so$eti$es 'erfor$ed u'on ani$als& )he'herds tre'hined shee'

for the staggers& 6e $ay say that the $odern deco$'ression o'eration, so $uch in

"ogue, is the oldest ?nown surgical 'rocedure&

E"YTIAN MEDICINE

*2- of the ocean of o#li"ion, $an e$erges in history in a highly ci"ili.ed state on

the #an?s of the Nile, so$e si0ty centuries ago& After $illenniu$s of a gradual

u'ward 'rogress, which can #e traced in the records of the stone age, ci"ili.ation

s'rings forth %iner"a>li?e, co$'lete, and highly de"elo'ed, in the Nile ;alley& In this

sheltered, fertile s'ot, neolithic $an first raised hi$self a#o"e his ?indred races of

the %editerranean #asin, and it is suggested that #y the accidental disco"ery of

co''er (gy't =forged the instru$ents that raised ci"ili.ation out of the slough of the

)tone Age= @(lliot )$ith& *f s'ecial interest to us is the fact that one of the #est>

?nown na$es of this earliest 'eriod is that of a 'hysicianGguide, 'hiloso'her and

friend of the ?ingGa $an in a 'osition of wide trust and i$'ortance& *n lea"ing

airo, to go u' the Nile, one sees on the right in the desert #ehind %e$'his a

terraced 'yra$id 19 feet in height, =the first large structure of stone ?nown in

history&= It is the royal to$# of :oser, the first of a long series with which the

(gy'tian $onarchy sought =to adorn the co$ing #ul? of death&= -he design of this is

attri#uted to I$hote', the first figure of a 'hysician to stand out clearly fro$ the

$ists of anti+uity& =In 'riestly wisdo$, in $agic, in the for$ulation of wise 'ro"er#s,in $edicine and architecture, this re$ar?a#le figure of :oser


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fro$ religion& *nly in the later 'eriods did a s'ecial grou' of 'hysicians arise who

were not $e$#ers of 'riestly colleges&@C %as'ero states that the (gy'tians #elie"ed

that disease and death were not natural and ine"ita#le, #ut caused #y so$e $aligninfluence which could use any agency, natural or in"isi#le, and "ery often #elonged

to the in"isi#le world& =*ften, though, it #elongs to the in"isi#le world, and only

re"eals itself #y the $alignity of its attac?sD it is a god, a s'irit, the soul of a dead

$an, that has cunningly entered a li"ing 'erson, or that throws itself u'on hi$ with

irresisti#le "iolence& *nce in 'ossession of the #ody, the e"il influence #rea?s the

#ones, suc?s out the $arrow, drin?s the #lood, gnaws the intestines and the heart and

de"ours the flesh& -he in"alid 'erishes according to the 'rogress of this destructi"e

wor?/ and death s'eedily ensues, unless the e"il genius can #e dri"en out of it #efore

it has co$$itted irre'ara#le da$age& 6hoe"er treats a sic? 'erson has therefore two

e+ually i$'ortant duties to 'erfor$& !e $ust first disco"er the nature of the s'irit in

'ossession, and, if necessary, its na$e, and then attac? it, dri"e it out, or e"en destroy

it& !e can only succeed #y 'owerful $agic, so he $ust #e an e0'ert in reciting

incantations, and s?ilful in $a?ing a$ulets& !e $ust then use $edicine @drugs and

diet to contend with the disorders which the 'resence of the strange #eing has

'roduced in the #ody&=@C

">& 1as.ero5 3ife in ncient Egy.t and ssyria, 3ondon,*C


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really was his religion& !e had no idea of i$$uta#le laws, #ut regarded the world

a#out hi$ as changea#le and fic?le li?e hi$self, and =to $a?e life go as he wished,

he $ust #e a#le to 'lease and 'ro'itiate or to coerce these forces outside hi$self&=@8

"C& 3 Thorndi2e5 The %lace of 1agic in the IntellectualAistory of

Euro.e, New or2, *, . +


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'art of the world, and nothing so $uch& 5ut not content with this successe and good

'roceeding, to gather $ore strength and win a greater na$e, shee enter$ingled with

$edicina#le recei'ts and religious cere$onies, the s?ill of Astrologie and arts%athe$aticall/ 'resu$ing u'on this, -hat all $en #y nature are "ery curious and

desirous to ?now their future fortunes, and what shall #etide the$ hereafter,

'ersuading the$sel"es, that all such fore?nowledge de'endeth u'on the course and

influence of the starres, which gi"e the truest and $ost certain light of things to

co$e& 5eing thus wholly 'ossessed of $en, and ha"ing their senses and

understanding #y this $eanes fast ynough #ound with three sure chains, no $ar"ell if

this art grew in 'rocesse of ti$e to such an head, that it was and is at this day re'uted

#y $ost nations of the earth for the 'aragon and cheefe of all sciencesD inso$uch as

the $ightie ?ings and $onarchs of the Le"ant are altogether ruled and go"erned

there#y&=

"nine are 're'ared

fro$ the hyaena& -he 'ractice was widely 're"alent throughout the %iddle Ages, and

the 'har$aco'oeia of the se"enteenth and e"en of the eighteenth century contains


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$any e0traordinary ingredients& =-he Royal Phar$aco'oeia= of %oses harras

@London ed&, 1CE8, the $ost scientific wor? of the day, is full of organothera'y and

directions for the 're'aration of $edicines fro$ the $ost loathso$e e0cretions& Acurious thing is that with the disco"eries of the $u$$ies a #elief arose as to the

great efficacy of 'owdered $u$$y in "arious $aladies& As )ir -ho$as 5rowne

re$ar?s in his =2rn 5urial=D =%u$$y has #eco$e $erchandi.e& %i.rai$ cures

wounds, and Pharaoh is sold for #alsa$s&=

*ne for$ula in e"eryday use has co$e to us in a curious way fro$ the (gy'tians& In

the *siris $yth, the youthful !orus loses an eye in his #attle with )et& -his eye, the

sy$#ol of sacrifice, #eca$e, ne0t to the sacred #eetle, the $ost co$$on talis$an of

the country, and all $useu$s are rich in $odels of the !orus eye in glass or stone&

=6hen alche$y or che$istry, which had its cradle in (gy't, and deri"ed its na$e

fro$ ha$i, an old title for this country, 'assed to the hands of the ree?s, and later

of the Ara#s, this sign 'assed with it& It was also ado'ted to so$e e0tent #y the

nostics of the early hristian church in (gy't& In a cursi"e for$ it is found in

$ediae"al translations of the wor?s of Ptole$y the astrologer, as the sign of the

'lanet 7u'iter& As such it was 'laced u'on horosco'es and u'on for$ula containing

drugs $ade for ad$inistration to the #ody, so that the har$ful 'ro'erties of these

drugs $ight #e re$o"ed under the influence of the luc?y 'lanet& At 'resent, in a

slightly $odified for$, it still figures at the to' of 'rescri'tions written daily in reat

5ritain @R0&=@11

"**& Hohn # (omrie5 1edicine among the ssyrians and Egy.tians in

*>== B(, Edinburgh 1edical Hournal, *


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(gy't, who should in "ain use $any $edicines& !erodotus tells that 4arius had at his

court certain (gy'tians, who$ he rec?oned the #est s?illed 'hysicians in all the

world, and he $a?es the interesting state$ent thatD =%edicine is 'racticed a$ongthe$ on a 'lan of se'aration/ each 'hysician treats a single disorder, and no $oreD

thus the country swar$s with $edical 'ractitioners, so$e under ta?ing to cure

diseases of the eye, others of the head, others again of the teeth, others of the

intestines, and so$e those which are not local&=@1

"*+& The Aistory of Aerodotus, Bla2esley's ed, B2 II, CD

A re$ar?a#le state$ent is $ade #y Pliny, in the discussion u'on the use of radishes,

which are said to cure a =Phthisic?e,= or ulcer of the lungsG='roofe whereof was

found and seen in A(gy't #y occasion that the & there, caused dead #odies to #e

cut u', and anato$ies to #e $ade, for to search out the $aladies whereof $en

died&=@13

"*@& %liny, Aolland's translation, B2 I, (ha. 4, -ect+F

-he study of the anato$y of $u$$ies has thrown a "ery interesting light u'on the

diseases of the ancient (gy'tians, one of the $ost 're"alent of which a''ears to ha"e

#een osteo>arthritis& -his has #een studied #y (lliot )$ith, 6ood 7ones, Ruffer and

Rietti& -he $aority of the lesions a''ear to ha"e #een the co$$on osteo>arthritis,

which in"ol"ed not only the $en, #ut $any of the 'et ani$als ?e't in the te$'les& In

a $uch higher 'ro'ortion a''arently than in $odern days, the s'inal colu$n was

in"ol"ed& It is interesting to note that the =deter$inati"e= of old age in hierogly'hic

writing is the 'icture of a $an afflicted with arthritis defor$ans& ("idences of

tu#erculosis, ric?ets and sy'hilis, according to these authors, ha"e not #een found&

A study of the internal organs has #een $ade #y Ruffer, who has shown that arterio>

sclerosis with calcification was a co$$on disease 8K years ago/ and he holds that

it could not ha"e #een associated with hard wor? or alcohol, for the ancient


24/191

(gy'tians did not drin? s'irits, and they had 'ractically the sa$e hours of wor? as

$odern (gy'tians, with e"ery se"enth day free&

ASSYRIAN AND $A$YLONIAN MEDICINE

*F e+ually great i$'ortance in the e"olution of $edicine was the 'ractically

conte$'orary ci"ili.ation in %eso'ota$ia& )cience here reached a $uch higher stage

then in the "alley of the Nile& An ela#orate sche$e of the uni"erse was de"ised, a

syste$ growing out of the 4i"ine 6ill, and a recognition for the first ti$e of a law

guiding and controlling hea"en and earth ali?e& !ere, too, we find $edicine ancillaryto religion& 4isease was due to e"il s'irits or de$ons& =-hese


25/191

di"inationGthe study of the future #y the inter'retation of certain signs& -he student

recogni.ed two di"isions of di"inationGthe in"oluntary, dealing with the

inter'retation of signs forced u'on our attention, such as the 'heno$ena of thehea"ens, drea$s, etc&, and "oluntary di"ination, the see?ing of signs, $ore

'articularly through the ins'ection of sacrificial ani$als& -his $ethod reached an

e0traordinary de"elo'$ent a$ong the 5a#ylonians, and the cult s'read to the

(truscans, !e#rews, and later to the ree?s and Ro$ans&

*f all the organs ins'ected in a sacrificial ani$al the li"er, fro$ its si.e, 'osition and

richness in #lood, i$'ressed the early o#ser"ers as the $ost i$'ortant of the #ody&

Pro#a#ly on account of the richness in #lood it ca$e to #e regarded as the seat of life

Gindeed, the seat of the soul& Fro$ this i$'ortant 'osition the li"er was not

dislodged for $any centuries, and in the alenic 'hysiology it shared with the heart

and the #rain in the tri'le control of the natural, ani$al and "ital s'irits& %any

e0'ressions in literature indicate how 'ersistent was this #elief& A$ong the

5a#ylonians, the word =li"er= was used in hy$ns and other co$'ositions 'recisely as

we use the word =heart,= and 7astrow gi"es a nu$#er of illustrations fro$ !e#rew,

ree? and Latin sources illustrating this usage&

-he #elief arose that through the ins'ection of this i$'ortant organ in the sacrificial

ani$al the course of future e"ents could #e 'redicted& =-he life or soul, as the seat of

life, in the sacrificial ani$al is, therefore, the di"ine ele$ent in the ani$al, and the

god in acce'ting the ani$al, which is in"ol"ed in the act of #ringing it as an offering

to a god, identifies hi$self with the ani$alG#eco$es, as it were, one with it& -he

life in the ani$al is a reflection of his own life, and since the fate of $en rests with

the gods, if one can succeed in entering into the $ind of a god, and thus ascertain

what he 'ur'oses to do, the ?ey for the solution of the 'ro#le$ as to what the future

has in store will ha"e #een found& -he li"er #eing the centre of "italityGthe seat of

the $ind, therefore, as well as of the e$otionsGit #eco$es in the case of the

sacrificial ani$al, either directly identical with the $ind of the god who acce'ts the


26/191

ani$al, or, at all e"ents, a $irror in which the god#ladder, the a''endages of the u''er lo#e and the $ar?ings

were all ins'ected with unusual care& -he earliest ?nown anato$ical $odel, which is

here shown, is the clay $odel of a shee'#oo?s which ser"e as guides for the inter'retation of the

o$ens and for te0t>#oo?s of instructions in the te$'le schools @7astrow&

-he art of di"ination s'read widely a$ong the neigh#oring nations& -here are $any

references in the 5i#le to the 'ractice& -he elders of %oa# and %idian ca$e to

5alaa$ =with the rewards of di"ination in their hand= @Nu$#ers 00ii, E& 7ose'h


27/191

ree?s and the Ro$ans, a$ong who$ it degenerated into a $ore or less $eaningless

for$& 5ut 7astrow states that in 5a#ylonia and Assyria, where for se"eral thousand

years the li"er was consistently e$'loyed as the sole organ of di"ination, there are notraces of the rite ha"ing fallen into decay, or ha"ing #een a#used #y the 'riests&

In Ro$an ti$es, Philostratus gi"es an account of the trial of A'ollonius of -yana,@1C

accused of hu$an he'atosco'y #y sacrificing a #oy in the 'ractice of $agic arts

against the ($'eror& =-he li"er, which the e0'erts say is the "ery tri'od of their art,

does not consist of 'ure #lood/ for the heart retains all the unconta$inated #lood, and

irrigates the whole #ody with it #y the conduits of the arteries/ whereas the gall,

which is situated ne0t the li"er, is sti$ulated #y anger and de'ressed #y fear into the

hollows of the li"er&=

6e ha"e seen how early and how wides'read was the #elief in a$ulets and char$s

against the occult 'owers of dar?ness& *ne that has 'ersisted with e0traordinary

tenacity is the #elief in the ("il (ye the 'ower of certain indi"iduals to inure with a

loo?& *f general #elief in the older ci"ili.ations, and referred to in se"eral 'laces in

the 5i#le, it 'assed to reece and Ro$e, and today is still held fer"ently in $any

'arts of (uro'e& -he sign of =le corna,=Gthe first and fourth fingers e0tended, the

others turned down and the thu$# closed o"er the$,Gstill used against the ("il (ye

in Italy, was a $ystic sign used #y the Ro$ans in the festi"al of Le$uralia& And we

$eet with the #elief also in this country& A child with he$i'legia, at the Infir$ary for

4iseases of the Ner"ous )yste$, Philadel'hia, fro$ the central 'art of Pennsyl"ania,

was #elie"ed #y its 'arents to ha"e had the ("il (ye cast u'on it&

-he second contri#ution of 5a#ylonia and Assyria to $edicineGone that affected$an?ind 'rofoundlyGrelates to the su''osed influence of the hea"enly #odies u'on

$an


28/191

in a $irror, the %icrocos$, the daily life of $an on earth& -he first ste' was the

identification of the sun, $oon and stars with the gods of the 'antheon& Assyrian

astrono$ical o#ser"ations show an e0traordinary de"elo'$ent of 'ractical?nowledge& -he $o"e$ents of the sun and $oon and of the 'lanets were studied/ the

Assyrians ?new the 'recession of the e+uino0es and $any of the funda$ental laws of

astrono$y, and the $odern no$enclature dates fro$ their findings& In their days the

signs of the .odiac corres'onded 'ractically with the twel"e constellations whose

na$es they still #ear, each di"ision #eing re'resented #y the sy$#ol of so$e god, as

the )cor'ion, the Ra$, the -wins, etc& =hanges in the hea"ens & & & 'ortended

changes on earth& -he 5i#lical e0'ression


29/191

the #eginning of the conflict #etween religion and science& At first an e0'ression of

'ri$iti"e =science,= astrology #eca$e a su'erstition, fro$ which the hu$an $ind has

not yet esca'ed& In contrast to di"ination, astrology does not see$ to ha"e $ade$uch i$'ression on the !e#rews and definite references in the 5i#le are scanty&

Fro$ 5a#ylonia it 'assed to reece @without, howe"er, e0erting any 'articular

influence u'on ree? $edicine& *ur own language is rich in words of astral

significance deri"ed fro$ the ree?, e&g&, disaster&

-he introduction of astrology into (uro'e has a 'assing interest& A''arently the

ree?s had $ade i$'ortant ad"ances in astrono$y #efore co$ing in contact with the

5a#ylonians,Gwho, in all 'ro#a#ility, recei"ed fro$ the for$er a scientific

conce'tion of the uni"erse& =In 5a#ylonia and Assyria we ha"e astrology first and

astrono$y afterwards, in reece we ha"e the se+uence re"ersedGastrono$y first

and astrology afterwards= @7astrow&@18

"*C& 1 Hastrow5 s.ects of :eligious Belief and %racticein

Babylonia and ssyria, New or2, *F

It is sur'rising to learn that, 're"ious to their contact with the ree?s, astrology as

relating to the indi"idualGthat is to say, the reading of the stars to deter$ine the

conditions under which the indi"idual was #ornGhad no 'lace in the cult of the

5a#ylonians and Assyrians& -he indi"idualistic s'irit led the ree? to $a?e his gods

ta?e note of e"ery action in his life, and his 'reordained fate $ight #e read in the

stars&G=A connecting lin? #etween the indi"idual and the $o"e$ents in the hea"ens

was found in an ele$ent which they shared in co$$on& 5oth $an and stars $o"ed in

o#edience to forces fro$ which there was no esca'e& An ine0ora#le law controlling

the 'lanets corres'onded to an e+ually ine0ora#le fate ordained for e"ery indi"idualfro$ his #irth& %an was a 'art of nature and su#ect to its laws& -he thought could

therefore arise that, if the conditions in the hea"ens were studied under which a $an

was #orn, that $an


30/191

other "iews, at the ti$e of conce'tion& -hese "iews ta?e us #ac? directly to the

syste$ of astrology de"elo'ed #y 5a#ylonian #aru 'riests& -he #asis on which the

$odified ree? syste$ rests is li?ewise the sa$e that we ha"e o#ser"ed in 5a#yloniaGa corres'ondence #etween hea"en and earth, #ut with this i$'ortant difference,

that instead of the ca'rice of the gods we ha"e the unaltera#le fate controlling the

entire uni"erseGthe $o"e$ents of the hea"ens and the life of the indi"idual ali?e=

@7astrow&@19

"*G?+>C

Fro$ this ti$e on until the Renaissance, li?e a shadow, astrology follows astrono$y&

Regarded as two as'ects of the sa$e su#ect, the one, natural astrology, the

e+ui"alent of astrono$y, was concerned with the study of the hea"ens, the other,

udicial astrology, was concerned with the casting of horosco'es, and reading in the

stars the fate of the indi"idual&

As I $entioned, ree? science in its 'al$y days see$s to ha"e #een "ery free fro$

the #ad features of astrology& il#ert %urray re$ar?s that =astrology fell u'on the

!ellenistic $ind as a new disease falls u'on so$e re$ote island 'eo'le&= 5ut in the

ree? con+uest of the Ro$an $ind, astrology too? a 'ro$inent role& It ca$e to

Ro$e as 'art of the great !elleni.ing $o"e$ent, and the strength of its growth $ay

#e gauged fro$ the edicts issued against astrologers as early as the $iddle of the

second century 5&& In his introduction to his recent edition of 5oo? II of the

Astrono$icon of %anilius, arrod traces the growth of the cult, which under the

($'ire had an e0traordinary "ogue& =-hough these @hea"enly signs #e far re$o"ed

fro$ us, yet does he @the god so $a?e their influences felt, that they gi"e to nations

their life and their fate and to each $an his own character&=@ *racles were sought

on all occasions, fro$ the 'lanting of a tree to the $ating of a horse, and the doctrine

of the stars influenced dee'ly all 'hases of 'o'ular thought and religion& -he

'rofessional astrologers, as Pliny@1 says, were haldeans, (gy'tians and ree?s&


31/191

-he (truscans, too, the 'rofessional di"iners of Ro$e, culti"ated the science& %any

of these =Isiaci conectores= and =astrologi de circo= were worthless charlatans, #ut

on the whole the science see$s to ha"e attracted the attention of thoughtful $en ofthe 'eriod& arrod +uotes the following re$ar?a#le 'assage fro$ -acitusD =%y

udg$ent wa"ers,= he says, =I dare not say whether it #e fate and necessity

i$$uta#le which go"erns the changing course of hu$an affairsGor ust chance&

A$ong the wisest of the ancients, as well as a$ong their a'es, you will find a

conflict of o'inion& %any hold fi0edly the idea that our #eginning and our endGthat

$an hi$selfGis nothing to the ods at all& -he wic?ed are in 'ros'erity and the

good $eet tri#ulation& *thers #elie"e that Fate and the facts of this world wor?

together& 5ut this connection they trace not to 'lanetary influences #ut to a

concatenation of natural causes& 6e choose our life that is freeD #ut the choice once

$ade, what awaits us is fi0ed and ordered& ood and e"il are different fro$ the

"ulgar o'inion of the$& *ften those who see$ to #attle with ad"ersity are to #e

accounted #lessed/ #ut the $any, e"en in their 'ros'erity, are $isera#le& It needs only

to #ear $isfortune #ra"ely, while the fool 'erishes in his wealth& *utside these ri"al

schools stands the $an in the street& No one will ta?e fro$ hi$ his con"iction that at

our #irth are fi0ed for us the things that shall #e& If so$e things fall out differently

fro$ what was foretold, that is due to the deceit of $en that s'ea? what they ?now

notD calling into conte$'t a science to which 'ast and 'resent ali?e #ear a glorious

testi$ony= @Ann& "i, &

"+=& 1anili stronomicon 3iber II, ed A $ /arrod, 6)ford,*


32/191

the -heodosian code sentence of death was 'assed u'on $athe$aticians& Long into

the %iddle Ages, the sa$e unholy alliance with astrology and di"ination caused

$athe$atics to #e regarded with sus'icion, and e"en A#elard calls it a nefariousstudy&

-he third i$'ortant feature in 5a#ylonian $edicine is the e"idence afforded #y the

fa$ous !a$$ura#i ode @circa 5&&Ga #ody of laws, ci"il and religious,

$any of which relate to the $edical 'rofession& -his e0traordinary docu$ent is a

#lac? diorite #loc? 8 feet high, once containing 1 colu$ns on the o#"erse, 1C and 8

colu$ns on the re"erse, with KB lines of writing of which now 111B re$ain, and

sur$ounted #y the figure of the ?ing recei"ing the law fro$ the )un>god& o'ies of

this were set u' in 5a#ylon =that anyone o''ressed or inured, who had a tale of woe

to tell, $ight co$e and stand #efore his i$age, that of a ?ing of righteousness, and

there read the 'riceless orders of the ing, and fro$ the written $onu$ent sol"e his

'ro#le$= @7astrow& Fro$ the enact$ents of the code we gather that the $edical

'rofession $ust ha"e #een in a highly organi.ed state, for not only was 'ractice

regulated in detail, #ut a scale of fees was laid down, and 'enalties e0acted for

$al'ra0is& *'erations were 'erfor$ed, and the "eterinary art was recogni.ed& Aninteresting feature, fro$ which it is luc?y that we ha"e in these days esca'ed, is the

a''lication of the =le0 talionis=Gan eye for an eye, #one for a #one, and tooth for a

tooth, which is a stri?ing feature of the code&

)o$e of the laws of the code $ay #e +uotedD

Paragra'h 1K& If a doctor has treated a gentle$an for a se"ere wound with a #ron.e

lances and has cured the $an, or has o'ened an a#scess of the eye for a gentle$an

with the #ron.e lances and has cured the eye of the gentle$an, he shall ta?e ten

she?els of sil"er&


33/191

18& If the doctor has treated a gentle$an for a se"ere wound with a lances of #ron.e

and has caused the gentle$an to die, or has o'ened an a#scess of the eye for a

gentle$an and has caused the loss of the gentle$an


34/191

=-he co$$ands concern 'ro'hyla0is and su''ression of e'ide$ics, su''ression of

"enereal disease and 'rostitution, care of the s?in, #aths, food, housing and clothing,

regulation of la#our, se0ual life, disci'line of the 'eo'le, etc& %any of theseco$$ands, such as )a##ath rest, circu$cision, laws concerning food @interdiction of

#lood and 'or?, $easures concerning $enstruating and lying>in wo$en and those

suffering fro$ gonorrhoea, isolation of le'ers, and hygiene of the ca$', are, in "iew

of the conditions of the cli$ate, sur'risingly rational&=@3

"+@& Neuburger5 Aistory of 1edicine, 6)ford University %ress, *


35/191

the #ody as well as of the soul, and could the rich 'ro$ises of the os'el ha"e #een

fulfilled, there would ha"e #een no need of a new dis'ensation of science& It $ay #e

#ecause the children of this world ha"e ne"er #een a#le to acce't its hard sayingsGthe insistence u'on 'o"erty, u'on hu$ility, u'on 'eace that hristianity has lost

touch no less with the 'ractice than with the 'rinci'les of its Founder& Yet, all through

the centuries, the hurch has ne"er wholly a#andoned the clai$ to a'ostolic healing/

nor is there any reason why she should& -o the $iraculous there should #e no ti$e

li$itGonly conditions ha"e changed and nowadays to ha"e a $ountain>$o"ing faith

is not easy& )till, the 'ossession is cherished, and it adds enor$ously to the s'ice and

"ariety of life to ?now that $en of great intelligence, for e0a$'le, $y good friend,

4r& 7a$es 7& 6alsh of New Yor?, #elie"e in the $iracles of Lourdes&@B *nly a few

wee?s ago, the 5isho' of London followed with great success, it is said, the 'ractice

of )t& 7a$es& It does not really concern us $uchGas *riental "iews of disease and its

cure ha"e had "ery little influence on the e"olution of scientific $edicineGe0ce't in

illustration of the 'ersistence of an attitude towards disease always widely 're"alent,

and, indeed, increasing& Nor can we say that the $edicine of our great colleague, )t&

Lu?e, the 5elo"ed Physician, whose 'raise is in the os'els, differs so

funda$entally fro$ that of the other writings of the New -esta$ent that we can

clai$ for it a scientific +uality& -he stories of the $iracles ha"e technical ter$s and

are in a language adorned #y $edical 'hraseology, #ut the $ental attitude towards

disease is certainly not that of a follower of !i''ocrates, nor e"en of a scientifically

trained conte$'orary of 4ioscorides&@K

"+D& %sychothera.y, New or2, *


36/191

CHINESE AND %AANESE MEDICINE

!IN()( $edicine illustrates the condition at which a highly intellectual 'eo'le

$ay arri"e, a$ong who$ thought and s'eculation were restricted #y religious

'rohi#itions& Perha's the chief interest in its study lies in the fact that we $ay see

today the 'ersistence of "iews a#out disease si$ilar to those which 're"ailed in

ancient (gy't and 5a#ylonia& -he hinese #elie"e in a uni"ersal ani$is$, all 'arts

#eing ani$ated #y gods and s'ectres, and de"ils swar$ e"erywhere in nu$#ers

incalcula#le& -he uni"erse was s'ontaneously created #y the o'eration of its -ao,

=co$'osed of two souls, the Yang and the Yin/ the Yang re'resents light, war$th,

'roduction, and life, as also the celestial s'here fro$ which all those #lessings

e$anate/ the Yin is dar?ness, cold, death, and the earth, which, unless ani$ated #y

the Yang or hea"en, is dar?, cold, dead& -he Yang and the Yin are di"ided into an

infinite nu$#er of s'irits res'ecti"ely good and #ad, called shen and ?wei/ e"ery $an

and e"ery li"ing #eing contains a shen and a ?wei, infused at #irth, and de'arting at

death, to return to the Yang and the Yin& -hus $an with his dualistic soul is a

$icrocos$os, #orn fro$ the %acrocos$os s'ontaneously& ("en e"ery o#ect isani$ated, as well as the 2ni"erse of which it is a 'art&=@C

"+F& H H 1 de /root5 :eligious -ystem of (hina, 4ol 4I,

3eyden, *#anishing $edicinal her#s& *f greatanti+uity, 6u>is$ has changed in so$e ways its outward as'ect, #ut has not altered

its funda$ental characters& -he 6u, as e0orcising 'hysicians and 'ractitioners of the

$edical art, $ay #e traced in classical literature to the ti$e of onfucius& In addition

to char$s and s'ells, there were certain fa$ous 'oe$s which were re'eated, one of


37/191

which, #y !an Yu, of the -1KK, and

the de$on of fe"er, 'otent chiefly in the autu$n, is ad$onished to #egone to the

clear and li$'id waters of the dee' ri"er&

In the !igh %edical ollege at ourt, in the -


38/191

-wo or three s'ecial 'oints $ay #e referred to& -he doctrine of the 'ulse reached

such e0traordinary de"elo'$ent that the whole 'ractice of the art centred round its

different characters& -here were scores of "arieties, which in co$'lication and detail'ut to confusion the co$'licated syste$ of so$e of the old raeco>Ro$an writers&

-he #asic idea see$s to ha"e #een that each 'art and organ had its own 'ro'er 'ulse,

and ust as in a stringed instru$ent each chord has its own tone, so in the hu$an

#ody, if the 'ulses were in har$ony, it $eant health/ if there was discord, it $eant

disease& -hese hinese "iews reached (uro'e in the se"enteenth and eighteenth

centuries, and there is a "ery ela#orate descri'tion of the$ in Floyer?nown

#oo?&@E And the idea of har$ony in the 'ulse is $et with into the eighteenth

century&

"+G&-ir Hohn loyer5 The %hysician's %ulse $atch, etc,3ondon, *G=G

*rganothera'y was as e0tensi"ely 'racticed in hina as in (gy't& Parts of organs,

"arious secretions and e0cretions are "ery co$$only used& *ne useful $ethod of

'ractice reached a re$ar?a#le de"elo'$ent, "i.&, the art of acu'unctureGthe

thrusting of fine needles $ore or less dee'ly into the affected 'art& -here are so$e

388 s'ots on the #ody in which acu'uncture could #e 'erfor$ed, and so well had

long e0'erience taught the$ as to the 'oints of danger, that the course of the arteries

$ay #e traced #y the tracts that are a"oided& -he hinese 'racticed inoculation for

s$all'o0 as early as the ele"enth century&

("en the #riefest s?etch of the condition of hinese $edicine lea"es the i$'ression

of the a''alling stagnation and sterility that $ay afflict a really intelligent 'eo'le for

thousands of years& It is dou#tful if they are today in a "ery $uch $ore ad"anced

condition than were the (gy'tians at the ti$e when the (#ers Pa'yrus was written&

Fro$ one 'oint of "iew it is an interesting e0'eri$ent, as illustrating the state in

which a 'eo'le $ay re$ain who ha"e no ?nowledge of anato$y, 'hysiology or

'athology&


39/191

(arly 7a'anese $edicine has not $uch to distinguish it fro$ the hinese& At first

'urely theurgic, the 'ractice was later characteri.ed #y acu'uncture and a refined

study of the 'ulse& It has an e0tensi"e literature, largely #ased u'on the hinese, ande0tending as far #ac? as the #eginning of the hristian era& (uro'ean $edicine was

introduced #y the Portuguese and the 4utch, whose =factory= or =co$'any=

'hysicians were not without influence u'on 'ractice& An e0traordinary sti$ulus was

gi"en to the #elief in (uro'ean $edicine #y a dissection $ade #y %ayeno in 1EE1

de$onstrating the 'osition of the organs as shown in the (uro'ean anato$ical ta#les,

and 'ro"ing the hinese figures to #e incorrect& -he ne0t day a translation into

7a'anese of the anato$ical wor? of ul$us was #egun, and fro$ its a''earance in

1EE3 $ay #e dated the co$$ence$ent of refor$s in $edicine& In 1E93, the wor? of

de orter on internal $edicine was translated, and it is interesting to ?now that

#efore the so>called =o'ening of 7a'an= $any (uro'ean wor?s on $edicine had #een

'u#lished& In 18KE, a 4utch $edical school was started in Yedo& )ince the 'olitical

u'hea"al in 18C8, 7a'an has $ade ra'id 'rogress in scientific $edicine, and its

institutions and teachers are now a$ong the #est ?nown in the world&@8

"+C& -ee u8i2awa, /eschichte der 1edizin in Ha.an,To2yo, *


40/191

CHATER II

"REE# MEDICINE

*RAIA( gentis decus let us sing with Lucretius, one of the great inter'reters of

ree? thought& !ow grand and how true is his 'aean

6ut of the night, out of the blinding night

Thy beacon flashes0Jhail, beloved light

6f /reece and /recian0 hail, for in the mir2

Thou cost reveal each valley and each height

Thou art my leader, and the foot.rints shine, $herein I .lant my own

The world was shine to read, and having read,

Before thy children's eyes thou didst outs.read

The fruitful .age of 2nowledge, all the wealth

6f wisdom, all her .lenty for their bread

"B2 IIIJTranslated by # -later&

3et us come out of the mur2y night of the East, heavy with

.hantoms,into the bright daylight of the $est, into the

com.any of men whose thoughts made our thoughts, and

whose ways made our waysJthe men who first dared to loo2

on nature with the clear eyes of the mind

5rowning


41/191

lost in des'air at an all>encircling $ystery& Not so the ree? hilde Roland who set

the slug>horn to his li's and #lew a challenge& Neither )ha?es'eare nor 5rowning

tells us what ha''ened, and the old legend, hilde Roland, is the incarnation of theree? s'irit, the young, light>hearted $aster of the $odern world, at whose tru$'et

#last the dar? towers of ignorance, su'erstition and deceit ha"e "anished into thin air,

as the #aseless fa#ric of a drea$& Not that the eering 'hanto$s ha"e flown -hey

still #eset, in "aried for$, the 'ath of each generation/ #ut the Achaian hilde Roland

ga"e to $an self>confidence, and taught hi$ the lesson that nature


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education& It has e0ercised an unfailing fascination, e"en on $inds alien or hostile&

Ro$e too? her culture thence& Young Ro$ans co$'leted their education in the ree?

schools&&&& And so it was with natures less a?in to reece than the Ro$an& )t& Paul, a!e#rew of the !e#rews, who called the wisdo$ of the ree?s foolishness, was

drawn to their Areo'agus, and found hi$self acco$$odating his gos'el to the style,

and +uoting "erses fro$ the 'oets of this alien race& After hi$, the hurch, which

was #orn to 'rotest against !ellenis$, translated its dog$as into the language of

ree? thought and finally crystalli.ed the$ in the 'hiloso'hy of Aristotle&=

6hether a 'laything of the gods or a cog in the wheels of the uni"erse this was the

'ro#le$ which life offered to the thin?ing ree?/ and in underta?ing its solution, he

set in $otion the forces that ha"e $ade our $odern ci"ili.ation& -hat the 'ro#le$

re$ains unsol"ed is nothing in co$'arison with the su're$e fact that in wrestling

with it, and in studying the laws of the $achine, $an is learning to control the s$all

section of it with which he is s'ecially concerned& -he "eil of thau$aturgy which

shrouded the *rient, while not re$o"ed, was rent in twain, and for the first ti$e in

history, $an had a clear "ision of the world a#out hi$G=had ga.ed on Nature*?>+


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Li"ingstone discusses the ree? enius as dis'layed to us in certain =notes=Gthe

Note of 5eautyGthe 4esire for Freedo$Gthe Note of 4irectnessGthe Note of

!u$anis$Gthe Note of )anity and of %any>sidedness& 2'on so$e of thesecharacteristics we shall ha"e occasion to dwell in the #rief s?etch of the rise of

scientific $edicine a$ong this wonderful 'eo'le&

6e ha"e seen that the 'ri$iti"e $an and in the great ci"ili.ations of (gy't and

5a#ylonia, the 'hysician e"ol"ed fro$ the 'riestGin reece he had a dual origin,

'hiloso'hy and religion& Let us first trace the origins in the 'hiloso'hers, 'articularly

in the grou' ?nown as the Ionian Physiologists, whether at ho$e or as colonists in

the south of Italy, in whose wor? the #eginnings of scientific $edicine $ay #e found&

Let $e +uote a state$ent fro$ o$'er.D

=6e can trace the s'rings of ree? success achie"ed and $aintained #y the great $en

of !ellas on the field of scientific in+uiry to a re$ar?a#le conunction of natural gifts

and conditions& -here was the tee$ing wealth of constructi"e i$agination united

with the slee'less critical s'irit which shran? fro$ no test of audacity/ there was the

$ost 'owerful i$'ulse to generali.ation cou'led with the shar'est faculty for

descrying and distinguishing the finest shades of 'heno$enal 'eculiarity/ there was

the religion of !ellas, which afforded co$'lete satisfaction to the re+uire$ents of

senti$ent, and yet left the intelligence free to 'erfor$ its destructi"e wor?/ there

were the 'olitical conditions of a nu$#er of ri"al centres of intellect, of a friction of

forces, e0cluding the 'ossi#ility of stagnation, and, finally, of an order of state and

society strict enough to cur# the e0cesses of historical $ethod which was a''lied to the $yths

#y !ecataeus and !erodotus& A third source is to #e traced to the schools of the

'hysicians& -hese ai$ed at eli$inating the ar#itrary ele$ent fro$ the "iew and


44/191

?nowledge of nature, the #eginnings of which were #ound u' with it in a greater or

less degree, though 'ractically without e0ce'tion and #y the force of an inner

necessity& A ?nowledge of $edicine was destined to correct that defect, and we shall$ar? the growth of its $ost 'recious fruits in the increased 'ower of o#ser"ation and

the counter'oise it offered to hasty generali.ations, as well as in the confidence

which learnt to reect untena#le fictions, whether 'roduced #y lu0uriant i$agination

or #y a 'riori s'eculations, on the si$ilar ground of self>reliant sense>'erce'tion&=@3

"@& /om.erz5 /ree2 Thin2ers, 4ol I, . +GF

-he nature 'hiloso'hers of the Ionian days did not contri#ute $uch to $edicine'ro'er, #ut their s'irit and their outloo? u'on nature influenced its students

'rofoundly& -heir #old generali.ations on the nature of $atter and of the ele$ents are

still the wonder of che$ists& 6e $ay trace to one of the$, Ana0i$enes, who

regarded air as the 'ri$ary 'rinci'le, the doctrine of the ='neu$a,= or the #reath of

lifeGthe 'sychic force which ani$ates the #ody and lea"es it at deathG=*ur soul

#eing air, holds us together&= *f another, the fa$ous !eraclitus, 'ossi#ly a 'hysician,

the e0isting frag$ents do not relate s'ecially to $edicine/ #ut to the 'hiloso'her of

fire $ay #e traced the doctrine of heat and $oisture, and their antitheses, which

influenced 'ractice for $any centuries& -here is e"idence in the !i''ocratic treatise

'eri sar?wn of an atte$'t to a''ly this doctrine to the hu$an #ody& -he fa$ous

e0'ression, 'anta rhei,G=all things are flowing,=Ge0'resses the incessant flu0 in

which he #elie"ed and in which we ?now all $atter e0ists& No one has said a ruder

thing of the 'rofession, for an e0tant frag$ent readsD =& & & 'hysicians, who cut, #urn,

sta#, and rac? the sic?, then co$'lain that they do not get any ade+uate reco$'ense

for it&=@B

"D& H Burnet5 Early /ree2 %hiloso.hy, *C


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-he )outh Italian nature 'hiloso'hers contri#uted $uch $ore to the science of

$edicine, and in certain of the colonial towns there were $edical schools as early as

the fifth century 5&& -he $ost fa$ous of these 'hysician 'hiloso'hers wasPythagoras, whose life and wor? had an e0traordinary influence u'on $edicine,

'articularly in connection with his theory of nu$#ers, and the i$'ortance of critical

days& !is disco"ery of the de'endence of the 'itch of sound on the length of the

"i#rating chord is one of the $ost funda$ental in acoustics& A$ong the $e$#ers of

the school which he founded at rotona were $any 'hysicians& who carried his

"iews far and wide throughout %agna raecia& Nothing in his teaching do$inated

$edicine so $uch as the doctrine of nu$#ers, the sacredness of which see$s to ha"e

had an enduring fascination for the $edical $ind& %any of the co$$on diseases,

such as $alaria, or ty'hus, ter$inating a#ru'tly on s'ecial days, fa"ored this #elief&

!ow do$inant it #eca$e and how 'ersistent you $ay udge fro$ the literature u'on

critical days, which is rich to the $iddle of the eighteenth century&

*ne $e$#er of the rotonian school, Alc$aeon, achie"ed great distinction in #oth

anato$y and 'hysiology& !e first recogni.ed the #rain as the organ of the $ind, and

$ade careful dissections of the ner"es, which he traced to the #rain& !e descri#ed theo'tic ner"es and the (ustachian tu#es, $ade correct o#ser"ations u'on "ision, and

refuted the co$$on "iew that the s'er$a ca$e fro$ the s'inal cord& !e suggested

the definition of health as the $aintenance of e+uili#riu$, or an =isono$y= in the

$aterial +ualities of the #ody& *f all the )outh Italian 'hysicians of this 'eriod, the

'ersonality of none stands out in stronger outlines than that of ($'edocles of

Agrigentu$G'hysician, 'hysiologist, religious teacher, 'olitician and 'oet& A

wonder>wor?er, also, and $agician, he was acclai$ed in the cities as an i$$ortal

god #y countless thousands desiring oracles or #egging the word of healing& -hat he

was a ?een student of nature is witnessed #y $any recorded o#ser"ations in anato$y

and 'hysiology/ he reasoned that sensations tra"el #y definite 'aths to the #rain& 5ut

our attention $ust #e confined to his introduction of the theory of the four ele$ents


46/191

Gfire, air, earth and waterGof which, in "arying +uantities, all #odies were $ade u'&

!ealth de'ended u'on the due e+uili#riu$ of these 'ri$iti"e su#stances/ disease was

their distur#ance& orres'onding to those were the four essential +ualities of heat andcold, $oisture and dryness, and u'on this four>fold di"ision was engrafted #y the

later 'hysicians the doctrine of the hu$ors which, fro$ the days of !i''ocrates

al$ost to our own, do$inated $edicine& All sorts of $agical 'owers were attri#uted

to ($'edocles& -he story of Pantheia who$ he called #ac? to life after a thirty days?nown 'oe$, =($'edocles on (tna=G

But his .ower-wells with the swelling evil of this time,

nd holds men mute to see where it will rise

Ae could stay swift diseases in old days,

(hain madmen by the music of his lyre,

(leanse to sweet airs the breath of .oisonous streams,

nd in the mountain?chin2s inter the winds

This he could do of oldJ">&

a +uotation which will gi"e you an idea of so$e of the 'owers attri#uted to this

wonder>wor?ing 'hysician&

">& %oetical $or2s of 1atthew rnold, 1acmillan K (o, *Cde"ised sche$e of 'u#lic $edical ser"ice e0isted in the ree?

cities& It dates fro$ the second half of the si0th century 5&&Gfully two generations

#efore !i''ocrates& A rotonian, 4e$ocedes #y na$e, was found a$ong the sla"esof *roetes& *f his fa$e as a 'hysician so$eone had heard and he was called in to

treat the dislocated an?le of ing 4arius& -he wily ree?, longing for his ho$e,

feared that if he confessed to a ?nowledge of $edicine there would #e no chance of

esca'e, #ut under threat of torture he undertoo? a treat$ent which 'ro"ed successful&


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-hen !erodotus tells his storyGhow, ill treated at ho$e in rotona, 4e$ocedes went

to A(gina, where he set u' as a 'hysician and in the second year the )tate of A(gina

hired his ser"ices at the 'rice of a talent& In the third year, the Athenians engaged hi$at 1 $inae/ and in the fourth, Polycrates of )a$os at two talents& 4e$ocedes

shared the $isfortunes of Polycrates and was ta?en 'risoner #y *roetes& -hen

!erodotus tells how he cured Atossa, the daughter of yrus and wife of 4arius, of a

se"ere a#scess of the #reast, #ut on condition that she hel' hi$ to esca'e, and she

induced her hus#and to send an e0'edition of e0'loration to reece under the

guidance of 4e$ocedes, #ut with the instructions at all costs to #ring #ac? the $uch

'ri.ed 'hysician& Fro$ -arentu$, 4e$ocedes esca'ed to his nati"e city, #ut the

Persians followed hi$, and it was with the greatest difficulty that he esca'ed fro$

their hands& 4e'ri"ed of their guide, the Persians ga"e u' the e0'edition and sailed

for Asia& In 'alliation of his flight, 4e$ocedes sent a $essage to 4arius that he was

engaged to the daughter of %ilo, the wrestler, who was in high re'ute with the ing&

@C

"F& The well?2nown editor of Aerodotus, : $ 1acan, 1aster of

University (ollege, 6)ford, in his Aelleni2on -heaf of

-onnets after Aerodotus "6)ford, *C


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was yearly, for in =-he )tates$an= we find the followingD@E =6hen the year of

office has e0'ired, the 'ilot, or 'hysician has to co$e #efore a court of re"iew= to

answer any charges& -he 'hysician $ust ha"e #een in 'ractice for so$e ti$e andattained e$inence, #efore he was dee$ed worthy of the 'ost of state 'hysician&

"G& Howett5 #ialogues of %lato, @d ed, -tatesman, 4ol I4, . >=+

"-te.hanus, II, +*D #&

All that is ?nown of these state 'hysicians has #een collected #y Pohl,@8 who has

traced their e"olution into Ro$an ti$es& -hat they were secular, inde'endent of the

A(scula'ian te$'les, that they were well 'aid, that there was ?een co$'etition to get

the $ost distinguished $en, that they were 'aid #y a s'ecial ta0 and that they were

$uch estee$edGare facts to #e gleaned fro$ !erodotus and fro$ the inscri'tions&

-he la'idary records, e0tending o"er 1 years, collected #y Professor *ehler@8a

of Reina, throw an i$'ortant light on the state of $edicine in reece and Ro$e&

ree? "ases gi"e re'resentations of these state doctors at wor?& 4r& (& Pottier has

'u#lished one showing the treat$ent of a 'atient in the clinic&@8#

"C& : %ohl5 #e /raecorum medicis .ublicis, Berolini,:eimer, *0

also Hanus, Aarlem, *, , D


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4iogenes of A'ollonia, $ust ha"e $ade ela#orate dissections& In the =!istoria

Ani$aliu$=@9 of Aristotle occurs his account of the #lood "essels, which is #y far

the $ost ela#orate $et with in the literature until the writings of alen& It has, too,the great $erit of accuracy @if we #ear in $ind the fact that it was not until after

Aristotle that arteries and "eins were differentiated, and indications are gi"en as to

the "essels fro$ which #lood $ay #e drawn&

"*>b

AS#LEIOS

No god $ade with hands, to use the scri'tural 'hrase, had a $ore successful =run=

than As?le'iosGfor $ore than a thousand years the consoler and healer of the sons

of $en& )horn of his di"ine attri#utes he re$ains our 'atron saint, our e$#le$atic

od of !ealing, whose figure with the ser'ents a''ears in our seals and charters& !e

was originally a -hessalian chieftain, whose sons, %achaon and Podalirius, #eca$e

fa$ous 'hysicians and fought in the -roan 6ar& Nestor, you $ay re$e$#er, carriedoff the for$er, declaring, in the oft>+uoted 'hrase, that a doctor was #etter worth

sa"ing than $any warriors uns?illed in the treat$ent of wounds& Later genealogies

trace his origin to A'ollo,@1 as whose son he is usually regarded& =In the wa?e of

northern tri#es this god Aescula'iusGa $ore $aestic figure than the #la$eless

leech of !o$er


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A word on the idea of the ser'ent as an e$#le$ of the healing art which goes far

#ac? into anti+uity& -he $ystical character of the sna?e, and the natural dread and

awe ins'ired #y it, early $ade it a sy$#ol of su'ernatural 'ower& -here is a li#ation"ase of udea, c& 3K 5&&, found at -elloh, now in the Lou"re @'ro#a#ly the

earliest re'resentation of the sy$#ol, with two ser'ents entwined round a staff

@7astrow, Pl& B& Fro$ the earliest ti$es the sna?e has #een associated with $ystic

and $agic 'ower, and e"en today, a$ong nati"e races, it 'lays a 'art in the initiation

of $edicine $en&

In reece, the ser'ent #eca$e a sy$#ol of A'ollo, and 'ro'hetic ser'ents were ?e't

and fed at his shrine, as well as at that of his son, As?le'ios& -here was an idea, too,

that sna?es had a ?nowledge of her#s, which is referred to in the fa$ous 'oe$ of

Ni?ander on -heria?a&@1 You $ay re$e$#er that when Ale0ander, the fa$ous

+uac? and oracle $onger, de'icted #y Lucian, started out =for re"enue,= the first

thing he did was to 'ro"ide hi$self with two of the large, har$less, yellow sna?es of

Asia %inor&

"*+& 3ines @*, etc, and -cholia0 cf $ : Aalliday5 /ree2

#ivination, 3ondon, *


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su$'tuous theatre with seating ca'acity for ,, a stadiu$ C feet long with a

seating ca'acity of 1,, and all 'ossi#le accessories of art and science, you will

ha"e an idea of what the te$'le at ('idaurus, a few $iles fro$ Athens, was& =-hecult flourished $ostly in 'laces which, through cli$atic or hygienic ad"antages, were

natural health resorts& -hose fa"oured s'ots on hill or $ountain, in the shelter of

forests, #y ri"ers or s'rings of 'ure flowing water, were conduci"e to health& -he

"i"ifying air, the well culti"ated gardens surrounding the shrine, the $agnificent

"iew, all tended to cheer the heart with new ho'e of cure& %any of these te$'les

owed their fa$e to $ineral or $erely hot s'rings& -o the ho$ely altars, erected

originally #y sacred fountains in the neigh#ourhood of health>gi"ing $ineral s'rings,

were later added $agnificent te$'les, 'leasure>grounds for festi"als, gy$nasia in

which #odily ail$ents were treated #y 'hysical e0ercises, #aths and inunctions, also,

as is 'ro"ed #y e0ca"ations, li"ing roo$s for the 'atients& Access to the shrine was

for#idden to the unclean and the i$'ure, 'regnant wo$en and the $ortally afflicted

were ?e't away/ no dead #ody could find a resting>'lace within the holy 'recincts,

the shelter and the cure of the sic? #eing underta?en #y the ?ee'ers of inns and

#oarding>houses in the neigh#ourhood& -he su''liants for aid had to su#$it to

careful 'urification, to #athe in sea, ri"er or s'ring, to fast for a 'rescri#ed ti$e, to

a#ure wine and certain articles of diet, and they were only 'er$itted to enter the

te$'le when they were ade+uately 're'ared #y cleansing, inunction and fu$igation&

-his lengthy and e0hausting 're'aration, 'artly dietetic, 'artly suggesti"e, was

acco$'anied #y a sole$n ser"ice of 'rayer and sacrifice, whose sy$#olis$ tended

highly to e0cite the i$agination&=@1B

"*@& (aton5 Tem.les and :itual of s2le.ios, +d ed, 3ondon, *


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#etter is the delightful descri'tion gi"en in the =Plutus= of Aristo'hanes& After

offering honey>ca?es and #a?ed $eats on the altar, the su''liants arranged

the$sel"es on the 'allets&

"*>& (aton5 Tem.les and :itual of s2le.ios, +d ed, 3ondon, *


53/191

that os was a great $edical school& -he in"estigations of Professor Rudolf !ert.og

ha"e shown that this te$'le was "ery nearly the counter'art of the te$'le at

('idaurus&

-he A(scula'ian te$'les $ay ha"e furnished a rare field for e$'irical en+uiry& As

with our $odern hos'itals, the larger te$'le had rich li#raries, full of "alua#le

$anuscri'ts and records of cases& -hat there $ay ha"e #een secular As?le'iads

connected with the te$'le, who were freed entirely fro$ its su'erstitious 'ractices

and theurgic rites, is regarded as dou#tful/ yet is 'erha's not so dou#tful as one $ight

thin?& !ow often ha"e we 'hysicians to #ow oursel"es in the house of Ri$$on It is

"ery $uch the sa$e today at Lourdes, where lay 'hysicians ha"e to loo? after scores

of 'atients whose faith is too wea? or whose $aladies are too strong to #e relie"ed #y

*ur Lady of this fa$ous shrine& ("en in the hristian era, there is e"idence of the

association of distinguished 'hysicians with A(scula'ian te$'les& I notice that in one

of his anato$ical treatises, alen s'ea?s with affection of a citi.en of Perga$os who

has #een a great #enefactor of the A(scula'ian te$'le of that city& In =%arius, the

('icurean,= Pater gi"es a delightful s?etch of one of those te$'le health resorts, and

#rings in alen, stating that he had hi$self undergone the te$'le slee'/ #ut to this Ican find no reference in the general inde0 of alen


54/191

head, holds hi$ u' #y the heels, lets the water run out, cla's on the 'atient


55/191

century& Now the 'rofession has co$e #ac? to the study of drea$s,@19 and there are

'rofessors as ready to gi"e suggesti"e inter'retations to the$, as in the days of

Aristides& As usual, Aristotle see$s to ha"e said the last word on the su#ectD =("enscientific 'hysicians tell us that one should 'ay diligent attention to drea$s, and to

hold this "iew is reasona#le also for those who are not 'ractitioners #ut s'eculati"e

'hiloso'hers,=@ #ut it is as?ing too $uch to thin? that the 4eity would trou#le to

send drea$s to "ery si$'le 'eo'le and to ani$als, if they were designed in any way

to re"eal the future&

In its struggle with hristianity, Paganis$ $ade its last stand in the te$'les of

As?le'ios& -he $iraculous healing of the saints su'erseded the cures of the heathen

god, and it was wise to ado't the useful 'ractice of his te$'le&

"*C& 1ary Aamilton5 Incubation, or the (ure of #isease in %agan

Tem.les and (hristian (hurches, 3ondon, *


56/191

Protagoras, =that $ighty wise $an,= to learn the science and ?nowledge of hu$an

life& )ocrates as?ed hi$D =If & & & you had thought of going to !i''ocrates of os, the

Ascle'iad, and were a#out to gi"e hi$ your $oney, and so$e one had said to you,


57/191

"arious wor?s attri#uted to !i''ocrates, will find the$ in =4ie !andschriften der

anti?en Aer.te= of the Prussian Acade$y, edited #y 4iels @5erlin, 19K& -he

Prussian Acade$y has underta?en the editorshi' of the =or'us %edicoru$raecoru$&= -here is no co$'lete edition of the$ in (nglish& In 18B9 the 4eeside

'hysician, Ada$s, 'u#lished @for the *ld )ydenha$ )ociety a translation of the

$ost i$'ortant wor?s, a "alua#le edition and easily o#tained& Littre"olu$e

edition =*(u"res co$'letes d18C1, is the $ost i$'ortant

for reference& -hose of you who want a #rief #ut "ery satisfactory account of the

!i''ocratic writings, with nu$erous e0tracts, will find the "olu$e of -heodor 5ec?

@7ena, 19E "ery useful&

I can only indicate, in a "ery #rief way, the s'ecial features of the !i''ocratic

writings that ha"e influenced the e"olution of the science and art of $edicine&

-he first is undou#tedly the note of hu$anity& In his introduction to, =-he Rise of the

ree? ('ic,=@1 il#ert %urray e$'hasi.es the idea of ser"ice to the co$$unity as

$ore dee'ly rooted in the ree?s than in us& -he +uestion they as?ed a#out each

writer was, =4oes he hel' to $a?e #etter $enH= or =4oes he $a?e life a #etter

thingH= -heir ai$ was to #e useful, to #e hel'ful, to $a?e #etter $en in the cities, to

correct life, =to $a?e gentle the life of the world&= In this #rief 'hrase were su$$ed

u' the as'irations of the Athenians, li?ewise illu$inated in that re$ar?a#le saying of

Prodicus @fifth century 5&&, =-hat which #enefits hu$an life is od&= -he ree?

"iew of $an was the "ery antithesis of that which )t& Paul enforced u'on the

hristian world& *ne idea 'er"ades thought fro$ !o$er to Lucian>li?e an aro$aG

'ride in the #ody as a whole& In the strong con"iction that =our soul in its rose $esh=

is +uite as $uch hel'ed #y flesh as flesh #y the soul the ree? sang his songG=For

'leasant is this flesh&= 7ust so far as we a''reciate the "alue of the fair $ind in the

fair #ody, so far do we a''rehend ideals e0'ressed #y the ree? in e"ery de'art$ent

of life& -he #eautiful soul har$oni.ing with the #eautiful #ody was as $uch the

glorious ideal of Plato as it was the end of the education of Aristotle& 6hat a s'lendid


58/191

'icture in 5oo? III of the =Re'u#lic,= of the day when =& & & our youth will dwell in a

land of health, a$id fair sights and sounds and recei"e the good in e"erything/ and

#eauty, the effluence of fair wor?s, shall flow into the eye and ear li?e a health>gi"ing#ree.e fro$ a 'urer region, and insensi#ly draw the soul fro$ earliest years into

li?eness and sy$'athy with the #eauty of reason&= -he glory of this .eal for the

enrich$ent of this 'resent life was re"ealed to the ree?s as to no other 'eo'le, #ut

in res'ect to care for the #ody of the co$$on $an, we ha"e only seen its fulfil$ent

in our own day, as a direct result of the $ethods of research initiated #y the$&

("erywhere throughout the !i''ocratic writings we find this attitude towards life,

which has ne"er #een #etter e0'ressed than in the fine 'hrase, =6here there is lo"e of

hu$anity there will #e lo"e of the 'rofession&= -his is well #rought out in the

+ualifications laid down #y !i''ocrates for the study of $edicine& =6hoe"er is to

ac+uire a co$'etent ?nowledge of $edicine ought to #e 'ossessed of the following

ad"antagesD a natural dis'osition/ instruction/ a fa"oura#le 'osition for the study/

early tuition/ lo"e of la#our/ leisure& First of all, a natural talent is re+uired, for when

nature o''oses, e"erything else is "ain/ #ut when nature leads the way to what is

$ost e0cellent, instruction in the art ta?es 'lace, which the student $ust try to

a''ro'riate to hi$self #y reflection, #eco$ing a nearly 'u'il in a 'lace well ada'ted

for instruction& !e $ust also #ring to the tas? a lo"e of la#our and 'erse"erance, so

that the instruction ta?ing root $ay #ring forth 'ro'er and a#undant fruits&= And the

directions gi"en for the conduct of life and for the relation which the 'hysician

should ha"e with the 'u#lic are those of our code of ethics today& onsultations in

dou#tful cases are ad"ised, touting for fees is discouraged& =If two or $ore ways of

$edical treat$ent were 'ossi#le, the 'hysician was reco$$ended to choose the least

i$'osing or sensational/ it was an act of


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de'arture fro$ their 'rescri'tions were laughed at/ and finally, there were 'recise #y>

laws to regulate the 'ersonal #eha"iour of the 'hysician& !e was enoined to o#ser"e

the $ost scru'ulous cleanliness, and was ad"ised to culti"ate an elegance re$o"edfro$ all signs of lu0ury, e"en down to the detail that he $ight use 'erfu$es, #ut not

in an i$$oderate degree&=@ 5ut the high>water $ar? of 'rofessional $orality is

reached in the fa$ous !i''ocratic oath, which o$'er. calls =a $onu$ent of the

highest ran? in the history of ci"ili.ation&= It is of s$all $atter whether this is of

!i''ocratic date or not, or whether it has in it (gy'tian or Indian ele$entsD its

i$'ortance lies in the accuracy with which it re'resents the ree? s'irit& For twenty>

fi"e centuries it has #een the =credo= of the 'rofession, and in $any uni"ersities it is

still the for$ula with which $en are ad$itted to the doctorate&

"+*& 6)ford (larendon %ress, +d ed, *


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generally as the ?nowledge of the lo"es and desires of the #ody and how to satisfy

the$ or not/ and the #est 'hysician is he who is a#le to se'arate fair lo"e fro$ foul,

or to con"ert one into the other/ and he who ?nows how to eradicate and how toi$'lant lo"e, whiche"er is re+uired, and can reconcile the $ost hostile ele$ents in

the constitution and $a?e the$ lo"ing friends, is a s?ilful 'ractitioner&=

"++a& %rofessor /ildersleeve's view of Ery)imachus is less

favorable "Hohns Ao.2ins University (ircular, Baltimore,

Hanuary, *CCG& %lato, III, *CFJHowett, I, >>F

-he second great note in ree? $edicine illustrates the directness with which they

went to the "ery heart of the $atter& *ut of $ysticis$, su'erstition and religious

ritual the ree? went directly to nature and was the first to gras' the conce'tion of

$edicine as an art #ased on accurate o#ser"ation, and an integral 'art of the science

of $an& 6hat could #e $ore stri?ing than the 'hrase in =-he Law,= =-here are, in

effect, two things, to ?now and to #elie"e one ?nows/ to ?now is science/ to #elie"e

one ?nows is ignorance=H@3 5ut no single 'hrase in the writings can co$'are for

directness with the fa$ous a'horis$ which has gone into the literature of all landsD

=Life is short and Art is long/ the *ccasion fleeting, (0'erience fallacious, and

7udg$ent difficult&=

"+@& 3ittre5 6Euvres d'Ai..ocrate, 4ol I4, .. FD*?FD+

("erywhere one finds a strong, clear co$$on sense, which refuses to #e entangled

either in theological or 'hiloso'hical s'eculations& 6hat )ocrates did for 'hiloso'hy

!i''ocrates $ay #e said to ha"e done for $edicine& As )ocrates de"oted hi$self to

ethics, and the a''lication of right thin?ing to good conduct, so !i''ocrates insisted

u'on the 'ractical nature of the art, and in 'lacing its highest good in the #enefit of

the 'atient& ($'iricis$, e0'erience, the collection of facts, the e"idence of the

senses, the a"oidance of 'hiloso'hical s'eculations, were the distinguishing features

of !i''ocratic $edicine& *ne of the $ost stri?ing contri#utions of !i''ocrates is the

recognition that diseases are only 'art of the 'rocesses of nature, that there is nothing


62/191

di"ine or sacred a#out the$& 6ith reference to e'ile'sy, which was regarded as a

sacred disease, he says, =It a''ears to $e to #e no wise $ore di"ine nor $ore sacred

than other diseases, #ut has a natural cause fro$ which it originates li?e otheraffections/ $en regard its nature and cause as di"ine fro$ ignorance&= And in another

'lace he re$ar?s that each disease has its own nature, and that no one arises without

a natural cause& !e see$s to ha"e #een the first to gras' the conce'tion of the great

healing 'owers of nature& In his long e0'erience with the cures in the te$'les, he

$ust ha"e seen scores of instances in which the god had wor?ed the $iracle through

the "is $edicatri0 naturae/ and to the shrewd wisdo$ of his 'ractical suggestions in

treat$ent $ay #e attri#uted in large 'art the e0traordinary "ogue which the great

oan has enoyed for twenty>fi"e centuries& *ne $ay a''reciate the "eneration with

which the Father of %edicine was regarded #y the attri#ute =di"ine= which was

usually attached to his na$e& Listen to this for directness and honesty of s'eech ta?en

fro$ the wor? on the oints characteri.ed #y Littre as =the great surgical $onu$ent

of anti+uity=D =I ha"e written this down deli#erately, #elie"ing it is "alua#le to learn

of unsuccessful e0'eri$ents, and to ?now the causes of their non>success&=

-he note of freedo$ is not less re$ar?a#le throughout the !i''ocratic writings, andit is not easy to understand how a $an #rought u' and 'racticing within the 'recincts

of a fa$ous A(scula'ian te$'le could ha"e di"orced hi$self so wholly fro$ the

su'erstitions and "agaries of the cult& -here are 'ro#a#ly grounds for Pliny


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nearer to their s'irit than to that of the Ara#ians or of the $any writers of the

fifteenth and si0teenth centuries A& 4& And it is not only against the thau$aturgic

'owers that the !i''ocratic writings 'rotested, #ut they e0'ress an e+ually acti"ereaction against the e0cesses and defects of the new 'hiloso'hy, a 'oint #rought out

"ery clearly #y o$'er.&@B !e regards it as an undying glory of the school of os

that after years of "ague, restless s'eculation it introduces =steady sedentary ha#its

into the intellectual life of $an?ind&= cry of this school in the war they were the first to wage against the e0cesses

and defects of the nature>'hiloso'hy& -hough the 'rotest was effecti"e in certain

directions, we shall see that the authors of the !i''ocratic writings could not entirely

esca'e fro$ the hy'otheses of the older 'hiloso'hers&

"+D& /om.erz5 /ree2 Thin2ers, 4ol I, . +


64/191

hote and dry& And as water is colde and $oystD so is fleu$e colde and $oyste& And as

the (arth is colde and dryD so %elancholy is colde and dry&=@C

"+>& The student who wishes a fuller account is referred to the

histories of "a& Neuburger, 4ol *, 6)ford, *DF

As the fa$ous Regi$en )anitatis of )alernu$, the 'o'ular fa$ily hand>#oo? of the

%iddle Ages, saysD

oure Aumours raigne within our bodies wholly,

nd these com.ared to foure elements"+G&

"+G& The Englishman's #octor, or the -choole of -alerne, -ir

Hohn Aarington's translation, 3ondon, *F=C, . + Edited by

rancis : %ac2ard, New or2, *


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which, #y a sort of internal coction gradually changes the hu$ors to their 'ro'er

'ro'ortion& 6hate"er $ay #e the 'ri$ary cause of the change in the hu$ors

$anifesting itself in disease, the innate heat, or as !i''ocrates ter$s it, the nature ofthe #ody itself, tends to restore conditions to the nor$/ and this change occurring

suddenly, or a#ru'tly, he calls the =crisis,= which is acco$'lished on so$e s'ecial

day of the disease, and is often acco$'anied #y a critical discharge, or #y a dro' in

the #ody te$'erature& -he e"il, or su'era#undant, hu$ors were discharged and this

"iew of a s'ecial $ateries $or#i, to #e got rid of #y a natural 'rocessor a crisis,

do$inated 'athology until +uite recently& !i''ocrates had a great #elief in the 'ower

of nature, the "is $edicatri0 naturae, to restore the nor$al state& A ?een o#ser"er and

an acti"e 'ractitioner, his "iews of disease, thus hastily s?etched, do$inated the

'rofession for twenty>fi"e centuries/ indeed, echoes of his theories are still heard in

the schools, and his "ery words are daily on our li's& If as?ed what was the great

contri#ution to $edicine of !i''ocrates and his school we could answerGthe art of

careful o#ser"ation&

In the !i''ocratic writings is su$$ed u' the e0'erience of reece to the olden

Age of Pericles& *ut of 'hiloso'hy, out of a#stract s'eculation, had co$e a way ofloo?ing at nature for which the 'hysicians were $ainly res'onsi#le, and which has

changed fore"er $en#irthsGthe 'rod

the evolution of modern medicine

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