BOOK IVON MEDICINE[276]
ON MEDICINE[276]
TheGreek science of medicine was one which reached a high degree of development. As early as the fifth century B.C. it appears in the school of Hippocrates, divested of nearly all trace of its origin in superstition and magic, and largely relying on careful observation and interpretation of symptoms. This school already possessed a considerable body of recorded observations. At Alexandria, later, further progress was made, especially in the subject of anatomy. At this time the dissection—and even vivisection—of the human body was practiced, though there are few traces of it earlier, and later it was forbidden. The last great land-mark in the history of ancient medicine is to be found in the works of Galen (second century A.D.) who summed up, extended, and interpreted the medical knowledge of preceding times.
In medicine, however, as in Greek science generally, theoretical and philosophical elements often prevailed to the detriment of the pragmatical. Examples of this are to be seen in the theory of the four humors, first found in the Hippocratic writings; in the belief of the Methodist school,which held that disease consisted in the contraction and relaxation of the pores (πόροι); and in the doctrines of the Pneumatic school, which maintained that health and disease resulted from the influence of the universal soul (πνεῦμα). A reaction against this tendency is evidenced by the empirics, who professed to reject all general notions and to rely on experience alone. However, the increasing predominance of the theoretical is shown in the case of Galen, who secured his ascendency over succeeding ages by his extravagant theoretical system rather than by his really great practical knowledge.
No contribution to medicine was made by the Romans. Although the profession appeared among them in the second century B.C., it remained a thing apart, in the hands of Greek physicians.[277]Of the three chief writers on the subject in the Latin language, two, Celsus and Pliny, were not physicians but encyclopedists, who were necessarily compilers rather than scientists.[278]The only writer of importance who approached his work from a professional standpoint was Caelius Aurelianus, and his book is of importance chiefly because its Greek original is lost.[279]This neglect of medicine is explained in part by the fact that physicians stood low in the social scale. Another more powerful influence was the increasing fashionableness of Oriental religions with their superstition and addiction to magic practices. Toward the close of the empire the decline was rapid in medicine as in other fields. Abridgements, which cut down quality unconsciously as much as they did quantity consciously, held the field. Itinerant quacks and “folk-medicine” gradually ousted the lay profession until finally what little science remained was in the hands of priests and monks, who needed a smattering of the subject for the people of their parishes, and the inmates of monasteries and hospitals.[280]
Isidore does not say for what purpose he wrote hisDe Medicina, whether to serve as a text-book to aid in the education of the clergy in the way indicated above, or merely in the spirit of the encyclopedist. A number of considerations point strongly to the former conclusion. In the first place, medicine is placed in juxtaposition with the seven liberal arts, and is separated from subjects more nearly akin to it. Secondly, the attitude which Isidore displays in speaking of medicine is one which remembers that this subject was once classed with the liberal arts. He feels called upon to explain why “the art of medicine is not included among the liberal disciplines”, and his explanation is one drawn from the pedagogical sphere; he tells us that medicine is “a second philosophy”, by which he means to say that it belongs to the highest stage of education, but plays therein a minor part. Finally, we must remember that Cassiodorus, whose comprehensive plan of education had great influence with Isidore, had recognized the need of medical knowledge in the education of the clergy, as shown in his chapter “On monks having the care of the infirm”.
It is not known what were the immediate sources of Isidore’sDe Medicina. The ultimate authority for his account of diseases is the work of the Methodist Caelius Aurelianus, whose eight books containing a classification of diseases into acute and chronic are reproduced by Isidore in two chapters that occupy the greater part of the space that he devoted to medicine.
Chapter 1. On medicine.
1. Medicine is that which guards or restores the health of the body, and its subject-matter deals with diseases and wounds.
2. And so it includes not only those things which are presented in the art (ars) of those who are calledmediciin the proper sense, but food, drink, and covering as well; in short, all the guarding and defence by which our body is protected against blows and accidents from the outside.
Chapter 2. On its name.
1. Its name is believed to have been given to medicine frommodus, that is, moderation, so that not enough but a little be used. For nature is made sorrowful by much and rejoices in the moderate. Whence also they who drink in quantities and without ceasing of herb juices (pigmenta) and antidotes, are troubled. For all immoderation brings not welfare but danger.
Chapter 3. On the founders of medicine.
1. Apollo is called among the Greeks the author and founder of the art of medicine. His son, Aesculapius, enlarged it by his fame and work. But after Aesculapius perished by a thunder-bolt, the business of curing is said to have been forbidden and the art disappeared with its author.
2. And it remained unknown for nearly five hundred years down to the time of Artaxerxes, king of the Persians. Then Hippocrates, born in the island of Cos, his father being Asclepius, brought it back to the light of day.
Chapter 4. On the three schools (haereses) of medicine.
1. And so these three men founded as many schools. The first,Methodica,[281]was established by Apollo, and it followsremedies and charms. The second,Empirica,[282]that is, relying on experience, was established by Aesculapius, which depends not on the interpretation of symptoms, but on experience alone. The third,Logica,[283]that is, rational, was invented by Hippocrates.
2. For the latter, separating the qualities of ages, districts, and diseases, examined the practice of the art in a rational way. TheEmpirici, then, follow experience alone; theLogiciadd reason to experience; theMethodiciobserve neither the elements, nor seasons, nor ages, nor causes, but the substances of diseases alone.
Chapter 5. On the four humors of the body.
1. Health is the integrity of the body and the compound (temperantia) made by nature from hot and moist which is the blood, whence also it has been namedsanitas, as it weresanguinis status(state of the blood).
2. Under the general name ofmorbus(disease) all disorders of the body are embraced, to which the ancients gave the name ofmorbusin order to indicate by the very name the power of death (mortis) which arises from it. Between health and disease the mean is cure, and unless it harmonizes with the disease it does not lead to health.
3. All diseases arise from the four humors, that is, from blood, bile, black bile, and phlegm. Just as there are four elements so also there are four humors, and each humor imitates its element: blood, air; bile, fire; black bile, earth; phlegm, water. There are four humors, as four elements, which preserve our bodies.
4.Sanguis[284](blood) took its name from a Greek source,because it invigorates, sustains and gives life to the body.Cholera[285](bile) the Greeks named because it is ended in the space of one day, whence it was namedcholera, that is,fellicula, that is, effusion of bile (fel). For the Greeks call bile χολή.
5.Melancholia(black bile) is named because an abundance of bile has been mixed with the dregs of black blood....
6.Sanguisin the Latin is so-called because it issuavis, whence men in whomsanguisis predominant are pleasant and bland.
7.Phlegmathey have named because it is cold. For the Greeks call cold φλέγμονα. According to these four humors the well are governed, and from them the diseases of the infirm arise. For when they have grown too great beyond the course of nature, they cause illnesses.
8. From blood and bile acute disorders come, which the Greeks call ὀξέα; from phlegm and black bile troubles of long standing, which the Greeks call χρόνια.
Chapter 6. On acute diseases.
1.Oxeais acute disease which either quickly passes or more quickly kills, as pleurisy, phrensy, for ὀξὺ in Greek means swift and sharp. χρόνια is prolonged bodily disease which lingers through many seasons, as gout, phthisis.... Certain disorders have received their names from causes proper to them.
2.Febris(fever) is derived fromfervor, for it is an excess of heat.
3. Frenzy is so-called because the mind is affected, since the Greeks call the mind φρένες, or else because they gnash (infrendant) with the teeth, forfrenderemeans to strike the teeth together. It is excitement with exasperation and dementia caused by the power of bile.
17. Pestilence is a contagion, and when it seizes one it quickly passes to more. It is produced from a corruption ofthe air, and makes its way by penetrating into the inward parts. Although this is generally caused by the powers of the air, still it is certainly not caused against the will of Omnipotent God.... It is a disease so acute that it affords no time to hope for life or death, but a sudden weakness and death come at the same moment.
Chapter 7. On chronic diseases.
3.Scotomatook its name from an accidental quality, because it brings a sudden darkness to the eyes along with a whirling (vertigo) of the head. Now there is a whirling as often as the wind rises and starts the dust going round and round.
4. So too in man’s head the air passages[286]and the veins produce a windiness from the resolving of moisture[287]and make a whirling in his eyes whencevertigois named.
5. Epilepsy took its name because while seizing the mind it also holds the body. For the Greeks call seizure ἐπιληψία. And it comes from the melancholy humor whenever it becomes abundant and has turned toward the head. This disorder is also calledcaduca(the falling sickness), because the sick man falls and suffers from spasms.
6. The common herd call these alsolunaticibecause their madness[288]comes upon them according to the course of the moon....
Chapter 8. On diseases that appear on the surface of the body.
11. Leprosy is a scaly roughness of the skin, likelepidus(pepper-wort), whence it took its name, and its color now turns to black, now to white, now to red. On the body of a man leprosy is diagnosed in this way, if a varied color appears here and there between sound parts of the skin, or if it spreads everywhere in such a way as to make all of one unnatural color.
12. Themorbus elephantiacus[289]is so called from the resemblance to an elephant, whose naturally hard and rough skin gave the name to the disease among men, because it makes the surface of the body like the hide of an elephant; or it may be because it is a great disorder, like the animal itself from which it has derived its name.
Chapter 9. On remedies and medicines.
1. The curative power of medicine must not be despised. For we remember that Isaiah sent something of medicinal nature to Hezekiah when he was sick, and Paul the apostle said a little wine was good for Timothy.
3. There are three kinds of cures in all. The first is the dietetic; the second, the pharmaceutical; the third, the surgical. Diet (diaeta) is the observance of the law of life. Pharmacy is curing by medicines. Surgery is cutting with the knife; for with the knife is cut away that which does not feel the healing of medicines....
5. Every cure is wrought either by contraries or by likes. By contraries, as cold by warm and dry by moist, just as in man pride cannot be cured except by humility.
6. By likes, as a round bandage is put on a round wound, or an oblong one on an oblong wound. For the very bandage is not the same for all wounds, but like is fitted to like....
7.Antidotumin the Greek means in the Latinex contrario datum. For contraries are cured by contraries in the medical system. On the other hand likes are cured by likes, as for example, πικρὰ which means bitters because its taste is bitter. It received a suitable name because the bitterness of disease is dispelled by its bitterness.
Chapter 13. On the beginning of medicine.[290]
1. Inquiry is made by certain why the art of medicine is not included among the liberal disciplines. Because of this, that they embrace separate subjects, but medicine embraces all. For the physician is commanded to know grammar, in order to be able to understand and set forth what he reads.
2. In like manner rhetoric, too, that he may be able to define by true arguments the diseases which he treats. Moreover logic, to scrutinize and cure the causes of infirmities by the aid of reason. So, too, arithmetic, on account of the number of hours in paroxysms and of the days in periods.
3. In the same manner geometry, on account of the qualities of districts and the situations of places, in respect to which it teaches what one ought to observe. Moreover, music will not be unknown to him, for there are many things that are read of as accomplished by this discipline in the case of sick men, as it is read of David that he saved Saul from an unclean spirit by the art of melody. The physician Asclepiades, too, restored one who was subject to frenzy to his former health by music.
4. Lastly, he will know astronomy, by which to contemplate the system of the stars and the change of the seasons, for as a certain physician says, our bodies change too, along with the qualities of the heavens. Hence it is that medicine is called “a second philosophy”. For both disciplines claim the whole man. For as by one the soul is cured, so is the body by the other.