FOOTNOTES

"Nor those which elements we call abide,Nor to this figure nor to that are ty'd:For this eternal world is said of oldBut four prolific principles to hold,Four different bodies; two to heaven ascend,And other two down to the centre tend.Fire first, with wings expanded, mounts on high,Pure, void of weight, and dwells in upper sky;Then air, because unclogged, in empty spaceFlies after fire, and claims the second place;But weighty water, as her nature guides,Lies on the lap of earth; and Mother Earth subsides.All things are mixed of these, which all contain,And into these are all resolved again."

Fire was considered to be matter in a very refined form, and to closely resemble life or even soul.

FOOTNOTES[1]Wheelwright's translation of "Pindar."[2]Arctinus, "Ethiopis." Translated in Puschmann's "Hist. Med. Education."[3]Caton,Brit. Med. Journ., 1906, i, p. 571.[4]Dryden's translation, book xv.

[1]Wheelwright's translation of "Pindar."

[2]Arctinus, "Ethiopis." Translated in Puschmann's "Hist. Med. Education."

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

[4]Dryden's translation, book xv.

His life and works — His influence on Medicine.

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

There was a very famous medical school at Cos, and the temple there held the notes of the accumulated experience of his predecessors, but Hippocrates visited also, for the purpose of study, various towns of Greece, and particularly Athens. He was a keen observer, and took careful notes of his observations. His reputation was such that his works are quoted by Plato and by Aristotle, and there are references to him by Arabic writers. His descendants published their own writings under his name, and there were also many forgeries, so that it is impossible to know exactly how many ofthe works attributed to him are authentic; but by a consensus of opinion the following books are considered genuine: "Prognostics," seven of the books of "Aphorisms," "On Airs, Waters and Places," "On Regimen in Acute Diseases," the first and third books of "Epidemics," "On the Articulations," "On Fractures," the treatise on "Instruments of Reduction," and "The Oath"; and the books considered almost certainly genuine are those dealing with "Ancient Medicine," "Surgery," "The Law," "Fistulæ," "Ulcers," "Hæmorrhoids," and "On the Sacred Disease" (Epilepsy). The famous Hippocratic Collection in the great libraries of Alexandria and Pergamos also comprised the writings of Pythagoras, Plato and Aristotle.

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

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

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

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

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

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

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

He did not describe amputations as generally understood, but removed limbs at a joint for gangrene. When necessary he made use of mechanical appliances for reducing dislocations, and recommended doctors to furnish their surgeries with an adjustable table, fitted with levers, for dealing with the reduction of dislocations, and for various other surgical manipulations. Excision of tumours was not a common operation of Hippocratic surgery, although it had been a part of Hindu practice in very ancient times. On the subject ofObstetrics, Hippocrates wrote a great deal, and although many of his theories seem absurd at the present day, yet, on the whole, the treatment he recommends is efficacious. RegardingGynæcology, in his treatise on "Airs, Water and Places," it is interesting to observe that he says that the drinking of impure water will cause dropsy of the uterus. Adams, commenting on this, has in mind hydatids, but it is evident that both Hippocrates and his translator and critic have mistaken hydatidiform disease of the ovum for hydatid disease of the womb. In the books which are considered genuine the references to diseases of women are meagre, and it is likely that the author had little special knowledge of the subject. That part of the Hippocratic collection which is not considered genuine deals rather fullywith the subject of gynæcology.[1]In it are described sounds made of wood and of lead, dilators and uterine catheters. Sitz baths were in use, and fumigations were very extensively employed in gynæcological practice. Pessaries were made by rolling lint or wool into an oblong shape, and were medicated to be emollient, astringent or purgative in their local action. The half of a pomegranate was used as a mechanical pessary, and there are also references to tents, and to suppositories for the bowel.

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

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

"(1) Medicine is of all the arts the most noble; but, owing to the ignorance of those who practise it, and of those who, inconsiderately, form a judgment of them, it is at present far behind all the other arts. Their mistake appears to me to arise principally from this, that in the cities there is no punishment connected with the practice of medicine (and with it alone) except disgrace, and that does not hurt those who are familiar with it. Such persons are like the figures which are introduced in tragedies, for as they have the shape, and dress, and personal appearance of an actor, but are not actors, so also physicians are many in title but very few in reality.

"(2) Whoever is to acquire a competent knowledge of medicine, ought to be possessed of the following advantages: A natural disposition; instruction; a favourable position for the study; early tuition; love of labour; leisure. First of all, a natural talent is required, for, when Nature opposes, everything else is vain; but when Nature leads the way to what is most excellent, instruction in the art takes place, which the student must try to appropriate to himself by reflection, becoming an early pupil in a place well adapted for instruction.He must also bring to the task a love of labour and perseverance, so that the instruction taking root may bring forth proper and abundant fruits.

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

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

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

"I swear by Apollo, the physician, and Æsculapius, and Health, and Panacea, and all the gods and goddesses, that, according to my ability and judgment, I will keep this oath and this stipulation—to reckon him who taught me this art equally dear to me as my parents, to share my substance with him, and relieve his necessities if required; to look upon his offspring in the same footing as my own brothers, and to teach them this art, if they shall wish to learn it, without fee or stipulation; and that by precept, lecture, and every other mode of instruction, I will impart a knowledge of the Art to my own sons, and those of my teachers, and to disciples bound by a stipulation and oath according to the law of medicine, but to none others. I will follow that system of regimen which, according to my ability and judgment, I consider for the benefit of my patients, and abstain from whatever is deleterious and mischievous. I will give no deadly medicine to anyone if asked, nor suggest any such counsel; and in like manner I will not give to a woman a pessary to produce abortion. With purity and with holiness I will pass my life and practise my Art. I will not cut persons labouring under the stone, but will leave this to be done by men whoare practitioners of this work. Into whatever houses I enter, I will go into them for the benefit of the sick, and will abstain from every voluntary act of mischief and corruption, and, further, from the seduction of females or males, of freedmen and slaves. Whatever, in connection with my professional practice, or not in connection with it, I see or hear, in the life of men, which ought not to be spoken of abroad, I will not divulge as reckoning that all such should be kept secret. While I continue to keep this Oath inviolate, may it be granted to me to enjoy life and the practice of the Art, respected by all men, in all times! But should I trespass or violate this oath, may the reverse be my lot!"

It would be a great task to attempt anything like a full review of the writings of this great doctor of antiquity, but enough has been written to reveal the great powers of his mind, and to show that he was far in advance of his predecessors, and a model for his successors. In the island of Cos, made illustrious by the name of Hippocrates, it is strange to find that he has no fame now other than that of being regarded in the confused minds of the people as one of the numerous saints of the Greek Church.[2]

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

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

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

FOOTNOTES[1]Vide"History of Gynæcology," by W. J. Stewart McKay. Baillière, Tindall and Cox, 1901.[2]Archiv für Geschichte der Medizin, May, 1912.

[1]Vide"History of Gynæcology," by W. J. Stewart McKay. Baillière, Tindall and Cox, 1901.

[2]Archiv für Geschichte der Medizin, May, 1912.

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

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

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

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

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

When Aristotle retired to Chalcis, he chose Tyrtamus, to whom he gave the name ofTheophrastus, as his successor at the Lyceum. Theophrastus was the originator of the science of Botany, and wrote the "History of Plants." He also wrote about stones, and on physical, moral and medical subjects.

"In the year 331B.C.," wrote Kingsley, "one of the greatest intellects whose influence the world has ever felt, saw, with his eagle glance, the unrivalled advantages of the spot which is now Alexandria, and conceived the mighty project of making it the point of union of two, or rather of three worlds. In a new city named after himself, Europe, Asia and Africa were to meet and hold communion." The School of Alexandria became, after the decay of Greek culture, the centre of learning for the world, and when the Empire of Alexander the Great was subdivided, the Egyptian share fell to the first Ptolemy, who, under the direction of Aristotle, founded the Alexandrian Library, containing at first fifty thousand, and finally seven hundred thousand volumes. Every student who came to the University of Alexandria, and possessed a book of which there was not a copy in the Alexandrian Library, was compelled to present the book to the library. The first Ptolemy also fostered the study of medicine and of dissection. Eumenes likewise established a library atPergamos. It is instructive to follow the history of the great Library of Alexandria. The greater part of the library, which contained the collected literature of Greece, Rome, India and Egypt, was housed in the famous museum in the part of Alexandria called the Brucheion. This part was destroyed by fire during the siege of Alexandria by Julius Cæsar. Mark Antony, then, at the urgent desire of Cleopatra, transferred to Alexandria the books and manuscripts from Pergamos. The other part of the library was kept at Alexandria in the Serapeum, the temple of Jupiter Serapis, and there it remained till the time of Theodosius the Great, until in 391A.D.both temple and library were almost completely destroyed by a fanatical mob of Christians led by the Archbishop Theophilus. When Alexandria was taken by the Arabs in 641, under the Calif Omar, the destruction was completed.

Ptolemy gathered to the museum at Alexandria a number of very learned men, who lived within its walls and were provided with salaries, the whole system closely resembling a university. Grammar, prosody, mythology, astronomy and philosophy were studied, and great attention was given to the study of medicine. Euclid was the teacher of Mathematics, and Hipparchus of Alexandria was the father of Astronomy. The teaching of medicine and of astronomy was for long based upon observation of ascertained facts. The Alexandrian School endured for close upon a thousand years,and its history may be divided into two periods, namely, from 323 to 30B.C., during the period of the Ptolemies, and from 30B.C.to 640A.D.The second period was distinguished for the study of speculative philosophy, and of the religious philosophy of the Gnostics, and was not a scientific period.

Julius Cæsar was not the only Roman Emperor who brought trouble upon the Alexandrian School, for the brutal Caracalla took away the salaries and privileges from thesavants, and prohibited scientific exhibitions and discussions. In recent excavations in the Baths of Caracalla in Rome, the ruins of a library have been discovered, and it is believed by some archæologists that Caracalla supplied this library with books and parchments from Alexandria.

The Asclepiadæ of Cos and Cnidos had discoursed upon the phenomena of disease, without attempting to demonstrate its structural relations; like the sculptors of their own age, they studied the changing expression of vital action almost wholly from an external point of view. They meddled not with the dead, for, by their own laws, no one was allowed to die within the temple. But the early Alexandrians were subject to no such restrictions; and turning to good account the discoveries of Aristotle in natural history and comparative anatomy, they undertook for the first time to describe the organization of the human frame from actual dissections.[1]

Thus there was inaugurated at Alexandria the Anatomic Period of Medicine, which lasted till Egypt came under the sway of the Romans. Medical practice became so flourishing at Alexandria that three great specialities were established, namely, Surgery, Pharmacy, and Dietetics, and a great variety of operations were performed. Lithotomy was much practised by specialists. A foul murder was perpetrated by lithotomists at the instigation of Diodotus, the guardian of Antiochus, son of Alexander, King of Syria (150B.C.), young Antiochus, at the age of 10, being done to death under the pretence that he had a stone in his bladder.

About 150B.C.a sect called the Essenes was established for the study of curative and poisonous substances. The members were not all physicians, by any means, for one of the chief was King Mithridates, who invented the remedy known as mithridaticum. This celebrated nostrum of antiquity is said to have been a confection of twenty leaves of rue, a few grains of salt, two walnuts, and two figs, intended to be taken every morning and followed by a draught of wine.

Two famous physicians and anatomists,Herophilus(335-280B.C.) andErasistratus(280B.C.) took part in the medical teaching at Alexandria in the early days of that seat of learning. It is recorded that they did not confine their investigations to the dissection of the dead, but also vivisectedcriminals.Cleombrotus, another physician at this school, was sent for to attend King Antiochus, and was rewarded with a hundred talents, equal to about £15,000 sterling.

There were several physicians of the name ofChrysipposconnected with the Alexandrian School. One was physician to Ptolemy Soter, the King of Egypt, and tutor to Erasistratus. This Chrysippos introduced the practice of emptying a limb of blood before amputation, according to the recent method of Esmarch, and is said to have employed vapour baths in the treatment of dropsy.

In Alexandria, anatomy was properly studied.[2]

Herophilusmade many anatomical discoveries, and some of the names he gave to parts of the body are now in use, for instance, torcular Herophili, calamus scriptorius, and duodenum. He described the connection between the nerves and the brain, and the various parts of the brain, and recognized the essential difference between motor and sensory nerves, although he thought the former arose in the membranes and the latter in the substance of the brain. He believed that the fourth ventricle was the seat of the soul. He attributed to the heart the pulsations of the arteries, but thought that the pulmonary veins conveyed air from the lungs to the left side ofthe heart, and he observed the lacteals without determining their function. Herophilus operated upon the liver and spleen, and looked upon the latter as of little consequence in the animal economy. He had a good knowledge of obstetric operations. His ideas in relation to pathology did not proceed much further than the belief that disease was due to corruption of the humors. He was more scientific and accurate when he taught that paralysis results from a defect in the nerves.

Erasistratusstudied under Chrysippos (or Chrysippus), and under Metrodorus, the son-in-law of Aristotle. Herophilus had been a student at Cos, Erasistratus at Cnidos, so that the teaching of the two great Greek medical schools was introduced into Alexandria. Xenophon, of Cos, one of the followers of Erasistratus, first resorted to the ligation of vessels for the arrest of hæmorrhage, although for many years in later times this important practice was lost through the neglect of the study of the history of medicine. Erasistratus and Herophilus, it is sad to relate, considered that vivisection of human beings, as well as dissection of the dead, was a necessary part of medical education, and believed that the sufferings of a few criminals did not weigh against the benefit likely to accrue to innocent people, who could be relieved or cured of disease and suffering as the result of the knowledge gained bydissection of the living. This cruel and nefarious practice was followed "so that the investigators could study the particular organs during life in regard to position, colour, form, size, disposition, hardness, softness, smoothness, and superficial extent, their projection and curvatures."

The followers of these teachers, unfortunately, became very speculative and fond of discussions of a fruitless kind, and, according to Pliny, it was easier "to sit and listen quietly in the schools than to be up and wandering over the deserts, and to seek out new plants every day,"[3]and so, in the third century before Christ, the school ofEmpiricismwas established, the system of which resembled the older Scepticism. It rested upon the "Empiric tripod," namely, accident, history and analogy. This meant that discoveries were made by accident, knowledge was accumulated by the recollection of previous cases, and treatment adopted which had been found suitable in similar circumstances.Philinus of Cos, a pupil of Herophilus, declared that all the anatomy he had learned from his master did not help him in the least to cure diseases. Philinus, according to Galen, founded the Empirici, the first schismatic sect in medicine. Celsus[4]wrote of this sect that they admit that evident causes are necessary, butdeprecate inquiry into them because Nature is incomprehensible. This is proved because the philosophers and physicians who have spent so much labour in trying to search out these occult causes cannot agree amongst themselves. If reasoning could make physicians, the philosophers should be most successful practitioners, as they have such abundance of words. If the causes of diseases were the same in all places, the same remedies ought to be used everywhere. Relief from sickness is to be sought from things certain and tried, that is from experience, which guides us in all other arts. Husbandmen and pilots do not reason about their business, but they practise it. Disquisitions can have no connection with medicine, because physicians whose opinions have been directly opposed to one another have equally restored their patients to health; they did not derive their methods of cure from studying the occult causes about which they disputed, but from the experience they had of the remedies which they employed upon their patients. Medicine was not first discovered in consequence of reasoning, but the theory was sought for after the discovery of medicine. Does reason, they ask, prescribe the same as experience, or something different? If the same, it must be needless; if different, it must be mischievous.

In the third and second centuries before Christ, many physicians wrote commentaries on diseasesand attacked the teaching of Hippocrates. Among these,Serapion of Alexandria, an Empiric who lived in the third century before Christ, is noteworthy for having first used sulphur in the treatment of skin diseases, and Heraclides wrote on strangulated hernia. Serapion added somewhat to the system of Philinus, and was responsible for introducing the principle of analogy into the system of Empiricism. The foundation of Empiricism marked the decline of the medical school of Alexandria. We are indebted to Celsus for a full description of the teaching of this sect, and, at the same time, for an exposure of its fallacies. Serapion was a convert from the school of Cos, which was the stronghold of medical dogmatism, and, like nearly all apostates, he was consumed with animosity and bitterness towards those with whom he had formerly been in agreement. Cnidos was the stronghold of the Empirics.

FOOTNOTES[1]"TheMedical Profession in Ancient Times." Watson, p. 90.[2]Arctinus: "Ethiopis," Translated in Puschmann's "Hist. Med. Education."[3]Pliny, "Hist. Nat.," xxvi, 6.[4]"De Med.," Præfat. (Translation.)

[1]"TheMedical Profession in Ancient Times." Watson, p. 90.

[2]Arctinus: "Ethiopis," Translated in Puschmann's "Hist. Med. Education."

[3]Pliny, "Hist. Nat.," xxvi, 6.

[4]"De Med.," Præfat. (Translation.)

Asclepiades of Prusa — Themison of Laodicea — Methodism — Wounds of Julius Cæsar — Systems of Philosophy — State of the country — Roman quacks — Slaves and Freedmen — Lucius Horatillavus.

Asclepiades of Prusa, in Bithynia, was a famous physician in Rome early in the first century before Christ. He studied both rhetoric and medicine at Alexandria and at Athens. He began as a teacher of rhetoric in Rome, but, although he was the friend of Cicero, he was not very successful, and abandoned this study for the practice of medicine. He had a great deal of ability and shrewdness, but no knowledge of anatomy or physiology, and he condemned all who thought that these subjects of study were the foundation of the healing art. He specially inveighed against Hippocrates, and with some reason, for the disciples of Hippocrates had elevated the teaching of their master almost into a religion, and were bound far too closely to his authority, to the exclusion of original thought and progress.

Asclepiades had many pupils, and his teaching led to the foundation of the Medical School of the Methodists. His most important maxim was that a cure should be effected "tuto, celeriter, ac jucunde,"and he believed that what the physician could do was of primary importance, andvis medicatrix naturæonly secondary. He was thus directly opposed to the teaching of Hippocrates. He had little or no faith in drugs, and relied mainly upon diet, exercises and massage, and, to some extent, upon surgery. His practice of prescribing wine in liberal doses added to his popularity. It was the custom to take wine very much diluted with water, but Asclepiades ordered wine in full strength or only slightly diluted. He practised bronchotomy and tracheotomy, and recommended in suitable cases of dropsy scarification of the ankles, and advised that, in tapping, an opening as small as possible should be made. He also observed spontaneous dislocation of the hip. He was a very famous man in the Roman Republic, and was well acquainted with philosophy, especially the philosophy of the Epicureans. Although he was almost entirely ignorant of anatomy, he was far from being a quack. He had great powers of observation and natural shrewdness, and his success largely contributed to the establishment of Greek doctors and their methods in Rome. There is grim humour in his description of the Hippocratic treatise on therapeutics, which he called "a meditation on death." Pliny relates that Asclepiades wagered that he would never die of disease, and he won the wager, for he lived to old age and died of an accident!

Themison, of Laodicea, lived in the first century before Christ, and was a pupil of Asclepiades of Prusa, the founder of the School of Methodism. His views on atoms and pores led him to adopt a very simple explanation of health and disease, for he considered that these pores must be either constricted or dilated, and the aim of the physician should be to dilate the constriction, andvice versa. This epitomized system of medicine did away with the use of many classes of drugs, and, from its simplicity, was quickly learned. A jeering opponent of the system of the Methodici said that it could be taught in six months, and Galen, in later years, ridiculed it, and called its practitioners "the asses of Thessaly."

The great fault of Dogmatism was its absolute reliance on the wisdom of Hippocrates, and Methodism was marred by its insufficiency and sophistry.

In spite of his extravagant theories, Themison possessed skill in practice. He was the first physician to describe rheumatism, and he also is thought to have been the pioneer in the medicinal use of leeches. A book on elephantiasis ascribed to him is not definitely known to be authentic. It is worthy of note that he was anxious to write on hydrophobia, but a case he had seen in early youth so impressed his mind with horror that the mere thought of the disease caused him to suffer some of the symptoms.

The views of the Methodists were less extreme than those of the Dogmatists and Empirics. Celsus wrote of the Methodists: "They assert that the knowledge of no cause whatever bears the least relation to the method of cure; and that it is sufficient to observe some general symptoms of distempers; and that there are three kinds of diseases, one bound, another loose, and the third is a mixture of these."[1]

There were several physicians of the name of Themison at different times, and it is probably the founder of the Methodici who was satirized by Juvenal thus:—

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