Fig. 8. THEOPHRASTUS From VILLA ALBANI Copy (second century A. D.?) of earlier workFig. 8. THEOPHRASTUSFrom VILLA ALBANICopy (second century A. D.?) of earlier work
Theophrastus has a perfectly clear idea of plant distribution as dependent on soil and climate, and at times seems to be on the point of passing from a statement of climatic distribution into one of real geographical regions. The general question of plant distribution long remained at, if it did not recede from, the position where he left it. The usefulness of the manuscript and early printed herbals in the West was for centuries marred by the retention of plant descriptions prepared for the Greek East and Latin South, and these works were saved from complete ineffectiveness only by an occasional appeal to nature.
With the death of Theophrastus about 287B. C.pure biological science substantially disappears from the Greek world, and we get the same type of deterioration that is later encountered in other scientific departments. Science ceases to have the motive of the desire to know, and becomes an applied study, subservient to the practical arts. It is an attitude from which in the end applied science itself must suffer also. Yet the centuries thatfollow were not without biological writers of very great ability. In the medical school of Alexandria anatomy and physiology became placed on a firm basis from about 300B. C., but always in the position subordinate to medicine that they have since occupied. Two great names of that school, Herophilus and Erasistratus, we must consider elsewhere.[37]Their works have disappeared and we have the merest fragments of them. In the last pre-Christian and the first two post-Christian centuries, however, there were several writers, portions of whose works have survived and are of great biological importance. Among them we include Crateuas, a botanical writer and illustrator, who greatly developed, if he did not actually introduce, the method of representing plants systematically by illustration rather than by description. This method, important still, was even more important when there was no proper system of botanical nomenclature. Crateuas by his paintings of plants, copies of which have not improbably descended to our time, began a tradition which, fixed about the fifth century, remained almost rigid until the re-discovery of nature in the sixteenth. He was physician to Mithridates VI Eupator (120-63B. C.), but his work was well known and appreciated at Rome, which became the place of resort for Greek talent.[38]
Celsus, who flourished about 20B. C., wrote an excellent work on medicine, but gives all too little glimpse of anatomy and physiology. Rufus of Ephesus, however, in the next century practised dissection of apes and other animals. He described the decussation of the optic nerves and the capsule of the crystalline lens, and gave the first clear description that has survived of the structure of the eye. He regarded the nervesas originating from the brain, and distinguished between nerves of motion and of sensation. He described the oviduct of the sheep and rightly held that life was possible without the spleen.
The second Christian century brings us two writers who, while scientifically inconsiderable, acted as the main carriers of such tradition of Greek biology as reached the Middle Ages, Pliny and Dioscorides. Pliny (A. D.23-79), though a Latin, owes almost everything of value in his encyclopaedia to Greek writings. In hisNatural Historywe have a collection of current views on the nature, origin, and uses of plants and animals such as we might expect from an intelligent, industrious, and honest member of the landed class who was devoid of critical or special scientific skill. Scientifically the work is contemptible, but it demands mention in any study of the legacy of Greece, since it was, for centuries, a main conduit of the ancient teaching and observations on natural history. Read throughout the ages, alike in the darkest as in the more enlightened periods, copied and recopied, translated, commented on, extracted and abridged, a large part of Pliny’s work has gradually passed into folk-keeping, so that through its agency the gipsy fortune-teller of to-day is still reciting garbled versions of the formulae of Aristotle and Hippocrates of two and a half millennia ago.
The fate of Dioscorides (flourishedA. D.60) has been not dissimilar. His workOn Materia Medicaconsists of a series of short accounts of plants, arranged almost without reference to the nature of the plants themselves, but quite invaluable for its terse and striking descriptions which often include habits and habitats. Its history has shown it to be one of the most influential botanical treatises ever penned. It provided most of the little botanical knowledge that reached the Middle Ages. It furnished the chief stimulus to botanical research at the time of the Renaissance. It has decided the general form of every modern pharmacopœia. It has practically determined modern plant nomenclature both popular and scientific.
Translated into nearly every language from Anglo-Saxon and Bohemian to Arabic and Hebrew, appearing both abstracted and in full in innumerable beautifully illuminated manuscripts, some of which are still among the fairest treasures of the great national libraries, Dioscorides, the drug-monger, appealed to scholasticized minds for centuries. The frequency with which fragments of him are encountered in papyri shows how popular his work was in Egypt in the third and fourth centuries. One of the earliest datable Greek codices in existence is a glorious volume of Dioscorides written in capitals,[39]thought worthy to form a wedding gift for a lady who was the daughter of one Roman emperor and the betrothed of a second.[40]The illustrations of this fifth-century manuscript are a very valuable monument for the history of art and the chief adornment of what was once the Royal Library at Vienna[41](figs. 9-10). Illustrated Latin translations of Dioscorides were in use in the time of Cassiodorus (490-585). A work based on it, similarly illustrated, but bearing the name of Apuleius, is among the most frequent of mediaeval botanical documents and the earliest surviving specimen is contemporary with Cassiodorus himself.[42]After therevival of learning Dioscorides continued to attract an immense amount of philological and botanical ability, and scores of editions of his works, many of them nobly illustrated, poured out of the presses of the sixteenth and seventeenth centuries.
Fifth-century drawings from JULIANA ANICIA M.S., copied from originals of first century B. C. (?)Fig. 9 ΣΟΓΚΟΣ ΤΡΥΦΕΡΟΣ = Crepis paludosa, Mœn.Fig. 9ΣΟΓΚΟΣ ΤΡΥΦΕΡΟΣ= Crepis paludosa, Mœn.Fig. 10 ΓΕΡΑΝΙΟΝ = Geranium pyrenaicum, L.Fig. 10ΓΕΡΑΝΙΟΝ= Geranium pyrenaicum, L.
Fig. 9 ΣΟΓΚΟΣ ΤΡΥΦΕΡΟΣ = Crepis paludosa, Mœn.Fig. 9ΣΟΓΚΟΣ ΤΡΥΦΕΡΟΣ= Crepis paludosa, Mœn.
Fig. 10 ΓΕΡΑΝΙΟΝ = Geranium pyrenaicum, L.Fig. 10ΓΕΡΑΝΙΟΝ= Geranium pyrenaicum, L.
But the greatest biologist of the late Greek period, and indeed one of the greatest biologists of all time, was Claudius Galen of Pergamon (A. D.131-201). Galen devoted himself to medicine from an early age, and in his twenty-first year we hear of him studying anatomy at Smyrna under Pelops. With the object of extending his knowledge of drugs he early made long journeys to Asia Minor. Later he proceeded to Alexandria, where he improved his anatomical equipment, and here, he tells us, he examined a human skeleton. It is indeed probable that his direct practical acquaintance with human anatomy was limited to the skeleton and that dissection of the human body was no longer carried on at Alexandria in his time. Thus his physiology and anatomy had to be derived mainly from animal sources. He is the most voluminous of all ancient scientific writers and one of the most voluminous writers of antiquity in any department. We are not here concerned with the medical material which mainly fills these huge volumes, but only with the physiological views which not only prevailed in medicine until Harvey and after, but also governed for fifteen hundred years alike the scientific and the popular ideas on the nature and workings of the animal body, and have for centuries been embedded in our speech. A knowledge of these physiological views of Galen is necessary for any understanding of the history of biology and illuminates many literary allusions of the Middle Ages and Renaissance.
Between the foundation of the Alexandrian school and the time of Galen, medicine was divided among a great number of sects. Galen was an eclectic and took portions of his teaching from many of these schools, but he was also a naturalist of great ability and industry, and knew well the value of theexperimental way. Yet he was a somewhat windy philosopher and, priding himself on his philosophic powers, did not hesitate to draw conclusions from evidence which was by no means always adequate. The physiological system that he thus succeeded in building up we may now briefly consider (fig. 11).
Fig. 11. Illustrating Galen’s physiological teaching.Fig. 11.Illustrating Galen’s physiological teaching.
The basic principle of life, in the Galenic physiology, is aspirit,animaorpneuma, drawn from the general world-soul in the act of respiration. It enters the body through therough artery(τραχεια αρτηρια,arteria asperaof mediaeval notation), the organ known to our nomenclature as the trachea. From this trachea the pneuma passes to the lung and then, through thevein-like artery(αρτηρια φλεβωδης,arteria venalisof mediaeval writers, the pulmonary vein of our nomenclature), to the left ventricle. Here it will be best to leave it for a moment and trace the vascular system along a different route.
Ingested food, passing down the alimentary tract, was absorbed as chyle from the intestine, collected by the portal vessel, and conveyed by it to the liver. That organ, the site of the innate heat in Galen’s view, had the power of elaborating the chyle into venous blood and of imbuing it with a spirit or pneuma which is innate in all living substance, so long as it remains alive, thenatural spirits(πνευμα φυσικον,spiritus naturalisof the mediaevals). Charged with this, and also with the nutritive material derived from the food, the venous blood is distributed by the liver through the veins which arise from it in the same way as the arteries from the heart. These veins carry nourishment andnatural spiritsto all parts of the body.Iecur fons venarum, the liver as the source of the veins, remained through the centuries the watchword of the Galenic physiology. The blood was held to ebb and flow continuously in the veins during life.
Now from the liver arose one great vessel, the hepatic vein, from division of which the others were held to come off asbranches. Of these branches, one, ourcommon vena cava, entered the right side of the heart. For the blood that it conveyed to the heart there were two fates possible. The greater part remained awhile in the ventricle, parting with its impurities and vapours, exhalations of the organs, which were carried off by theartery-like vein(φλεπς αρτηριωδης, the mediaevalvena arterialis, our pulmonary artery) to the lung and then exhaled to the outer air. These impurities and vapours gave its poisonous and suffocating character to the breath. Having parted thus with its impurities, the venous blood ebbed back again from the right ventricle into the venous system. But for a small fraction of the venous blood that entered the right ventricle another fate was reserved. This small fraction of venous blood, charged still with thenatural spiritsderived from the liver, passed through minute channels in the septum between the ventricles and entered the left chamber. Arrived there, it encountered the external pneuma and became thereby elaborated into a higher form of spirit, thevital spirits(πνευμα ζωτικον,spiritus vitalis), which is distributed together with blood by the arterial system to various parts of the body. In the arterial system it also ebbed and flowed, and might be seen and felt to pulsate there.
But among the great arterial vessels that sent forth arterial blood thus charged with vital spirits were certain vessels which ascended to the brain. Before reaching that organ they divided up into minute channels, therete mirabile(πλεγμα μεγιστον θαυμα), and passing into the brain became converted by the action of that organ into a yet higher type of spirits, theanimal spirits(πνευμα ψυχικον,spiritus animalis), an ethereal substance distributed to the various parts of the body by the structures known to-day as nerves, but believed then to be hollow channels. The three fundamental facultiesδυναμεις), thenatural, thevital, and theanimal, which brought into action the corresponding functions of the body, thus originated as an expression of the primal force or pneuma.
This physiology, we may emphasize, is not derived from an investigation of human anatomy. In the human brain there is norete mirabile, though such an organ is found in the calf. In the human liver there is nohepatic vein, though such an organ is found in the dog. Dogs, calves, pigs, bears, and, above all, Barbary apes were freely dissected by Galen and were the creatures from which he derived his physiological ideas. Many of Galen’s anatomical and physiological errors are due to his attributing to one creature the structures found in another, a fact that only very gradually dawned on the Renaissance anatomists.
The whole knowledge possessed by the world in the department of physiology from the third to the seventeenth century, nearly all the biological conceptions till the thirteenth, and most of the anatomy and much of the botany until the sixteenth century, all the ideas of the physical structure of living things throughout the Middle Ages, were contained in a small number of these works of Galen. The biological works of Aristotle and Theophrastus lingered precariously in a few rare manuscripts in the monasteries of the East; the total output of hundreds of years of Alexandrian and Pergamenian activities was utterly destroyed; the Ionian biological works, of which a sample has by a miracle survived, were forgotten; but these vast, windy, ill-arranged treatises of Galen lingered on. Translated into Latin, Syriac, Arabic, and Hebrew, they saturated the intellectual world of the Middle Ages. Commented on by later Greek writers, who were themselves in turn translated into the same list of languages, they were yet again served up under the names of such Greek writers as Oribasius, Paul of Aegina, or Alexander of Tralles.
What is the secret of the vitality of these Galenic biological conceptions? The answer can be given in four words.Galen is a teleologist; and a teleologist of a kind whose views happened to fit in with the prevailing theological attitude of the Middle Ages, whether Christian, Moslem, or Jewish. Accordingto him everything which exists and displays activity in the human body originates in and is formed by an intelligent being and on an intelligent plan, so that the organ in structure and function is the result of that plan. ‘It was the Creator’s infinite wisdom which selected the best means to attain his beneficent ends, and it is a proof of His omnipotence that he created every good thing according to His design, and thereby fulfilled His will.’[43]
After Galen there is a thousand years of darkness, and biology ceases to have a history. The mind of the Dark Ages turned towards theology, and such remains of Neoplatonic philosophy as were absorbed into the religious system were little likely to be of aid to the scientific attitude. One department of positive knowledge must of course persist. Men still suffered from the infirmities of the flesh and still sought relief from them. But the books from which that advice was sought had nothing to do with general principles nor with knowledge as such. They were the most wretched of the treatises that still masqueraded under the names of Hippocrates and Galen, mostly mere formularies, antidotaries, or perhaps at best symptom lists. And, when the depression of the western intellect had passed its worst, there was still no biological material on which it could be nourished.
The prevailing interest of the barbarian world, at last beginning to settle into its heritage of antiquity, was with Logic. Of Aristotle there survived in Latin dress only theCategoriesand theDe interpretatione, the merciful legacy of Boethius, the last of the philosophers. Had a translation of Aristotle’sHistoria animaliumorDe generatione animaliumsurvived, had a Latin version of the Hippocratic workOn generationor of the treatises of TheophrastusOn plantsreached the earlier Middle Ages, the whole mental historyof Europe might have been different and the rediscovery of nature might have been antedated by centuries. But this was a change of heart for which the world had long to wait; something much less was the earliest biological gift of Greece. The gift, when it came, came in two forms, one of which has not been adequately recognized, but both are equally her legacy. These two forms are, firstly, the well-known work of the early translators and, secondly, the tardily recognized work of certain schools of minor art.
The earliest biological treatises to become accessible in the west were rendered not from Greek but from Arabic.[44]The first of them was perhaps the treatiseπερι μυων κινησεως,On movement of musclesof Galen, a work which contains more than its title suggests and indeed sets forth much of the Galenic physiological system. It was rendered into Latin from the Arabic of Joannitius (Hunain ibn Ishaq, 809-73), probably about the year 1200, by one Mark of Toledo. It attracted little attention, but very soon after biological works of Aristotle began to become accessible. The first was probably the fragmentOn plants. The Greek original of this is lost, and besides the Latin, only an Arabic version of a former Arabic translation of a Syriac rendering of a Greek commentary is now known! Such a work appeared from the hand of a translator known as Alfred the Englishman about 1220 or a little later. Neither it nor another work from the same translator,On the motion of the heart, which sought to establish the primacy of that organ on Aristotelian grounds, can be said to contain any of the spirit of the master.[45]
A little better than these is the work of the wizard Michael the Scot (1175?-1234?). Roger Bacon tells us that Michael in 1230 ‘appeared [at Oxford], bringing with him the works of Aristotle in natural history and mathematics, with wise expositors, so that the philosophy of Aristotle was magnified among the Latins’.[46]Scott produced his workDe animalibusabout this date and he included in it the three great biological works of Aristotle, all rendered from an inferior Arabic version.[47]Albertus Magnus (1206-80) had not as yet a translation direct from the Greek to go upon for his great commentary on theHistory of animals, but he depended on Scott. The biological works of Aristotle were rendered into Latin direct from the Greek in the year 1260 probably by William of Moerbeke.[48]Such translations, appearing in the full scholastic age when everything was against direct observation, cannot be said to have fallen on a fertile ground. They presented an ordered account of nature and a good method of investigation, but those were gifts to a society that knew little of their real value.[49]
Yet the advent of these texts was coincident with a returning desire to observe nature. Albert, with all his scholasticism, was no contemptible naturalist. He may be said to have begun first-hand plant study in modern times so far as literary records are concerned. His bookDe vegetabilibuscontains excellent observations, and he is worthy of inclusion among the fathers of botany. In his vast treatiseDe animalibus, hampered as he is by his learning and verbosity, he shows himself a true observer and one who has absorbed something of the spirit of the great naturalist to whose works he had devoted a lifetime of study and on which he professes to be commenting. We see clearly the leaven of the Aristotelian spirit working, though Albert is still a schoolman. We may select for quotation a passage on the generation of fish, a subject on which some of Aristotle’s most remarkable descriptions remained unconfirmed till modern times. These descriptions impressed Albert in the same way as they do the modern naturalist. To those who know nothing of the stimulating power of the Aristotelian biological works, Albert’s description of the embryos of fish and his accurate distinction of their mode of development from that of birds, by the absence of an allantoic membrane in the one and its presence in the other, must surely be startling. Albert depends on Aristotle—a third-hand version of Aristotle—but does not slavishly follow him.
‘Between the mode of development (anathomiam generationis) of birds’ and fishes’ eggs there is this difference: during the development of the fish the second of the two veins which extend from the heart [as described by Aristotle in birds] does not exist. For we do not find the vein which extends to the outer covering in the eggs of birds which some wrongly call the navel because it carries the blood to the exterior parts; but we do find the vein that corresponds to the yolk vein of birds, for this vein imbibes the nourishment by which the limbs increase.... In fishes as in birds, channels extend from the heart first to the head and the eyes, and first in them appear the great upper parts. As the growth of the young fish increases the albumen decreases, being incorporated into the members of the young fish, and it disappears entirely when development andformation are complete. The beating of the heart ... is conveyed to the lower part of the belly, carrying pulse and life to the inferior members.
‘While the young [fish] are small and not yet fully developed they have veins of great length which take the place of the navel-string, but as they grow and develop, these shorten and contract into the body towards the heart, as we have said about birds. The young fish and the eggs are enclosed and in a covering, as are the eggs and young of birds. This covering resembles the dura mater [of the brain], and beneath it is another [corresponding therefore to the pia mater of the brain] which contains the young animal and nothing else.’[50]
In the next century Conrad von Megenberg (1309-98) produced hisBook of Nature, a complete work on natural history, the first of the kind in the vernacular, founded on Latin versions, now rendered direct from the Greek, of the Aristotelian and Galenic biological works. It is well ordered and opens with a systematic account of the structure and physiology of man as a type of the animal creation, which is then systematically described and followed by an account of plants. Conrad, though guided by Aristotle, uses his own eyes and ears, and with him and Albert the era of direct observation has begun.[51]
But there was another department in which the legacy of Greece found an even earlier appreciation. For centuries the illustrations to herbals and bestiaries had been copied from hand to hand, continuing a tradition that had its rise withGreek artists of the first centuryB. C.But their work, copied at each stage without reference to the object, moved constantly farther from resemblance to the original. At last the illustrations became little but formal patterns, a state in which they remained in some late copies prepared as recently as the sixteenth century. But at a certain period a change set in, and the artist, no longer content to rely on tradition, appeals at last to nature. This new stirring in art corresponds with the new stirring in letters, the Arabian revival—itself a legacy of Greece, though sadly deteriorated in transit—that gave rise to scholasticism. In much of the beautiful carved and sculptured work of the French cathedrals the new movement appears in the earlier part of the thirteenth century. At such a place as Chartres we see the attempt to render plants and animals faithfully in stone as early as 1240 or before. In the easier medium of parchment the same tendency appears even earlier. When once it begins the process progresses slowly until the great recovery of the Greek texts in the fifteenth century, when it is again accelerated.
During the sixteenth century the energy of botanists and zoologists was largely absorbed in producing most carefully annotated and illustrated editions of Dioscorides and Theophrastus and accounts of animals, habits, and structure that were intended to illustrate the writings of Aristotle, while the anatomists explored the bodies of man and beast to confirm or refute Galen. The great monographs on birds, fishes, and plants of this period, ostensibly little but commentaries on Pliny, Aristotle, and Dioscorides, represent really the first important efforts of modern times at a natural history. They pass naturally into the encyclopaedias of the later sixteenth century, and these into the physiological works of the seventeenth. Aristotle was never a dead hand in Biology as he was in Physics, and this for the reason that he was a great biologist but was not a great physicist.
With the advance of the sixteenth century the works of Aristotle, and to a less extent those of Dioscorides and Galen, became the great stimulus to the foundation of a new biological science. Matthioli (1520-77), in his commentary on Dioscorides (first edition 1544), which was one of the first works of its type to appear in the vernacular, made a number of first-hand observations on the habits and structure of plants that is startling even to a modern botanist. About the same time Galenic physiology, expressed also in numerous works in the vulgar tongue and rousing the curiosity of the physicians, became the clear parent of modern physiology and comparative anatomy. But, above all, the Aristotelian biological works were fertilizers of the mind. It is very interesting to watch a fine observer such as Fabricius ab Acquapendente (1537-1619) laying the foundations of modern embryology in a splendid series of first-hand observations, treating his own great researches almost as a commentary on Aristotle. What an impressive contrast to the arid physics of the time based also on Aristotle! ‘My purpose’, says Fabricius, ‘is to treat of the formation of the foetus in every animal, setting out from that which proceeds from the egg: for this ought to take precedence of all other discussion of the subject, both because it is not difficult to make out Aristotle’s view of the matter, and because his treatise on the Formation of the Foetus from the egg is by far the fullest, and the subject is by much the most extensive and difficult.’[52]
The industrious and careful Fabricius, with a wonderful talent for observation lit not by his own lamp but by that of Aristotle, bears a relation to the master much like that held by Aristotle’s pupil in the flesh, Theophrastus. The works of the two men, Fabricius and Theophrastus, bear indeed a resemblance to each other. Both rely on the same group of general ideas, both progress in much the same ordered calm from observation to observation, both have an inspiration whichis efficient and stimulating but below the greatest, both are enthusiastic and effective as investigators of fact, but timid and ineffective in drawing conclusions.
But Fabricius was more happy in his pupils than Theophrastus, for we may watch the same Aristotelian ideas fermenting in the mind of Fabricius’s successor, the greatest biologist since Aristotle himself, William Harvey (1578-1657).[53]This writer’s workOn generationis a careful commentary on Aristotle’s work on the same topic, but it is a commentary not in the old sense but in the spirit of Aristotle himself. Each statement is weighed and tested in the light of experience, and the younger naturalist, with all his reverence for Aristotle, does not hesitate to criticize his conclusions. He exhibits an independence of thought, an ingenuity in experiment, and a power of deduction that places his treatise as the middle term of the three great works on embryology of which the other members are those of Aristotle and Karl Ernst von Baer (1796-1876).[54]
With the second half of the seventeenth century and during a large part of the eighteenth the biological works of Aristotle attracted less attention. The battle against the Aristotelian physics had been fought and won, but with them the biological works of Aristotle unjustly passed into the shadow that overhung all the idols of the Middle Ages.
The rediscovery of the Aristotelian biology is a modern thing. The collection of the vast wealth of living forms absorbed the energies of the generations of naturalists from Ray (1627-1705) and Willoughby (1635-72) to Réaumur (1683-1757) and Linnaeus (1707-1778) and beyond to the nineteenth century. The magnitude and fascination of the work seems almost to have excluded general ideas. With the end of this period and the advent of a more philosophical type of naturalist,such as Cuvier (1769-1832) and members of the Saint-Hilaire family, Aristotle came again to his own. Since the dawn of the nineteenth century, and since naturalists have been in a position to verify the work of Aristotle, his reputation as a naturalist has continuously risen. Johannes Müller (1801-58), Richard Owen (1804-92), George Henry Lewes (1817-78), William Ogle (1827-1912) are a few of the long line of those who have derived direct inspiration from his biological work. With improved modern methods of investigation the problems of generation have absorbed a large amount of biological attention, and interest has become specially concentrated on Aristotle’s work on that topic which is perhaps, at the moment, more widely read than any biological treatise, ancient or modern, except the works of Darwin. That great naturalist wrote to Ogle in 1882: ‘From quotations I had seen I had a high notion of Aristotle’s merits, but I had not the most remote notion what a wonderful man he was. Linnaeus and Cuvier have been my two gods, though in very different ways, but they were mere schoolboys to old Aristotle.’
Charles Singer.
Ἡροφιλος δε εν τω Διαιτητικω και σοφιαν φησιν ανεπιδεικτον και τεχνην αδηλον και ισχυν αναγωνιστον και πλουτον αχρειον και λογον αδυνατον, ὑγιειας απουσης.{Hêrophilos de en tô Diaitêtikô kai sophian phêsin anepideikton kai technên adêlon kai ischyn anagôniston kai plouton achreion kai logon adynaton, hygieias apousês.}
Ἡροφιλος δε εν τω Διαιτητικω και σοφιαν φησιν ανεπιδεικτον και τεχνην αδηλον και ισχυν αναγωνιστον και πλουτον αχρειον και λογον αδυνατον, ὑγιειας απουσης.
{Hêrophilos de en tô Diaitêtikô kai sophian phêsin anepideikton kai technên adêlon kai ischyn anagôniston kai plouton achreion kai logon adynaton, hygieias apousês.}
Herophilos, a Greek philosopher and physician (c.300B. C.), has truly written ‘that Science and Art have equally nothing to show, that Strength is incapable of effort, Wealth useless, and Eloquence powerless if Health be wanting’.[55]All peoples therefore have had their methods of treating those departures from health that we call disease, and among peoples of higher culture such methods have been reduced in most cases to something resembling a system. In antiquity, as now, a variety of such systems were in vogue, and those nations who practised the art of writing from an early date have left considerable records of their medical methods and doctrines. We may thus form a fairly good idea of the medical principles of the Mesopotamian, the Egyptian, the Iranian, the Indian, and the Chinese civilizations. Much in these systems, as in the medical procedure of more primitive tribes, was based upon some theory of disease which fitted in with a larger theory of the nature of evil. Of these theories the commonest was and is the demonic, the view that regards deviation from the normal state of health as due either to the attacks of supernatural beings or to their actual entry into the body of the sufferer. A medical system based on such a view is susceptible of great elaboration in a higher civilization, but not being founded onobservation is hardly capable of indefinite development, for a point must ultimately be reached at which the mind recoils from complex conclusions far remote from observed phenomena. The medicine of the ancient and settled civilization of such a people as the Assyro-Babylonians, for instance, of which substantial traces have been recovered, is hardly, if at all, more effective, though far more systematized, than that of many a wild and unlettered tribe that may be observed to-day. Of such medicine as this we may give an account, but we can hardly write ahistory. We cannot establish those elements of continuity and of development from which alone history can be constructed.
It is the distinction of the Greeks alone among the nations of antiquity that they practised a system of medicine based not on theory but on observation accumulated systematically as time went on. The claim can be made for the Greeks that some at least among them were deflected by no theory, were deceived by no theurgy, were hampered by no tradition in their search for the facts of disease and in their attempts at interpreting its phenomena. Only the Greeks among the ancients could look on their healers asphysicians(= naturalists,φυσις= nature), and that word itself stands as a lasting reminder of their achievement.[56]
At a certain stage in the history of the Western world—the exact point in time may be disputed but the event is admitted by all—men turned to explore the treasures of the ancient wisdom and the whole mass of Greek medical learning was gradually laid before the student. That mass contained much dross, material that survived from early asfrom late Greek times which was hardly, if at all, superior to the debased compositions that circulated in the name of medicine in the middle centuries. But the recovered Greek medical writings also contained some material of the purest and most scientific type, and that material and the spirit in which it was written, form the debt of modern medicine to antiquity.
It is a debt the value of which cannot be exaggerated. The physicians of the revival of learning, and for long after, doubtless pinned their faith too much to the written word of their Greek forbears and sought to imprison the free spirit of Hippocrates and Galen in the rigid wall of their own rediscovered texts. The great medical pioneers of a somewhat later age, enraged by this attempt, the real nature of which was largely hidden from them, not infrequently revolted and rightly revolted against the bondage to the Greeks in which they had been brought up. Yet it is sure that these modern discoverers were the true inheritors of the Greeks. Without Herophilus we should have had no Harvey and the rise of physiology might have been delayed for centuries; had Galen’s works not survived, Vesalius would never have reconstructed Anatomy, and Surgery too might have stayed behind with her laggard sister, Medicine; the Hippocratic collection was the necessary and acknowledged basis for the work of the greatest of modern clinical observers, Thomas Sydenham, and the teaching of Hippocrates and of his school is the substantial basis of instruction in the wards of a modern hospital. In the pages which follow we propose therefore to review the general character of medical knowledge in the best Greek period and to consider briefly how much of that great heritage remained accessible to the earlier modern physicians. The reader will thus be able to form some estimate of the degree to which the legacy has been passed on to our own times.
It is evident that among such a group of peoples as the Greeks, varying in state of civilization, in mental power, ingeographical and economic position and in general outlook, the practice of medicine can have been by no means uniform. Without any method of centralizing medical education and standardizing teaching there was a great variety of doctrines and of practice in vogue among them, and much of this was on a low level of folk custom. Such lower grade material of Greek origin has come down to us in abundance, though much of it, curiously enough, from a later time. But the overwhelming mass of earlier Greek medical literature sets forth for us a pure scientific effort to observe and to classify disease, to make generalizations from carefully collected data, to explain the origin of disease on rational grounds, and to apply remedies, when possible, on a reasoned basis. We may thus rest fairly well assured that, despite serious and irreparable losses, we are still in possession of some of the very finest products of the Greek medical intellect.
There is ample evidence that the Greeks inherited, in common with many other peoples of Mediterranean and Asiatic origin, a whole system of magical or at least non-rational pharmacy and medicine from a remoter ancestry. Striking parallels can be drawn between these folk elements among the Greeks and the medical systems of the early Romans, as well as with the medicine of the Indian Vedas, of the ancient Egyptians, and of the earliest European barbarian writings. It is thus reasonable to suppose that these elements, when they appear in later Greek writings, represent more primitive folk elements working up, under the influence of social disintegration and consequent mental deterioration, through the upper strata of the literate Greek world. But with these elements, intensely interesting to the anthropologist, the psychologist, the ethnologist, and to the historian of religion, we are not here greatly concerned. Important as they are, they constitute no part of the special claim of the Greek people to distinction, but rather aid us in uniting the Greek mentality with that of other kindred peoples. Here we shall rather discuss the course of Greek scientific medicine proper, thetype of medical doctrine and practice, capable of development in the proper sense of the word, that forms the basis of our modern system. We are concerned, in fact, with the earliest evolutionary medicine.
We need hardly discuss the first origins of Greek Medicine. The material is scanty and the conclusions somewhat doubtful and perhaps premature, for the discovery of a considerable fragment of the historical work of Menon, a pupil of Aristotle, containing a description of the views of some of the precursors of the Hippocratic school, renews a hope that more extended investigation may yield further information as to the sources and nature of the earliest Greek medical writings.[57]The study of Mesopotamian star-lore has linked it up with early Greek astronomical science. The efforts of cuneiform scholars have not, however, been equally successful for medicine, and on the whole the general tendency of modern research is to give less weight to Mesopotamian and more to Egyptian sources than had previously been admitted; thus very recently an Egyptian medical papyrus of about 1700B. C.has been described which bears a distinct resemblance to some of the Hippocratic treatises.[58]A number of drugs, too, habitually used by the Greeks, such asAndropogon,Cardamoms, andSesame orientalis, are of Indian origin. There are also the Minoan cultures to be considered, and though our knowledge is not yet sufficient to speak of the heritage that Greek medicine may or may not have derived from that source, it seems not improbable that Greek hygiene may here owe a debt.[59]Omitting, therefore, this early epoch, we passdirect to the later period, between the sixth and fourth centuries, from which documents have actually come down to us.
The earliest medical school of which we have definite information is that of Cnidus, a Lacedaemonian colony in Asiatic Doris. Its origin may perhaps reach back to the seventh centuryB. C.We have actual records that the teachers of Cnidus were accustomed to collect systematically the phenomena of disease, of which they had produced a very complex classification, and we probably possess also several of their actual works. The physicians of Cos, their only contemporary critics whose writings have survived, considered that the Cnidian physicians paid too much attention to the actual sensations of the patient and to the physical signs of the disease. The most important of the Cnidian doctrines were drawn up in a series ofSentencesor Aphorisms, and these, it appears, inculcated a treatment along Egyptian lines of the symptom or at most the disease, rather than the patient, a statement borne out by the contents of the gynaecological works of probable Cnidian origin included in the so-called ‘Hippocratic Collection’. A few names of Cnidian physicians have, moreover, come down to us with titles of their works, and a later statement that they practised anatomy. There can be little doubt too that the Cnidian school drew also on Persian and Indian Medicine.
The origin of the school of the neighbouring island of Cos was a little later than that of Cnidus and probably dates from the sixth centuryB. C.Of the Coan school, or at least of the general tendencies that it represented, we have a magnificent and copious literary monument in the Corpus Hippocraticum, a collection which was probably put together in the early part of the third centuryB. C.by a commission of Alexandrian scholars at the order of the book-loving Ptolemy Soter (reigned 323-285B. C.). The elements of which this collection is composed are of varying dates from the sixth to the fourth centuryB. C., and of varying value and origin, but they mainly representthe point of view of physicians of the eastern part of the Greek world in the fifth and fourth centuries.
The most obvious feature, the outstanding element that at once strikes the modern observer in these ‘Coan’ writings, is the enormous emphasis laid on the actual course of disease. ‘It appears to me a most excellent thing’, so opens one of the greatest of the Hippocratic works, ‘for a physician to cultivatepronoia.[60]Foreknowing and foretelling in the presence of the sick the past, present, and future (of their symptoms) and explaining all that the patients are neglecting, he would be believed to understand their condition, so that men would have confidence to entrust themselves to his care.... Thus he would win just respect and be a good physician. By an earlier forecast in each case he would be more able to tend those aright who have a chance of surviving, and by foreseeing and stating who will die, and who will survive, he will escape blame....’[61]
Just as the Cnidians by dividing up diseases according to symptoms over-emphasized diagnosis and over-elaborated treatment, so the Coans laid very great force on prognosis and adopted therefore a largely expectant attitude towards diseases. Both Cnidian and Coan physicians were held together by a common bond which was, historically if not actually, related to temple worship. Physicians leagued together in the name of a god, as were the Asclepiadae, might escape, and did escape, the baser theurgic elements of temple medicine. Of these they were as devoid as a modern Catholic physician might beexpected to be free from the absurdities of Lourdes. But the extreme cult of prognosis among the Coans may not improbably be traced back to the medical lore of the temple soothsayers whose divine omens were replaced by indications of a physical nature in the patient himself.[62]We are tempted too to link it with that process of astronomical and astrological prognosis practised in the Mesopotamian civilizations from which Ionia imitated and derived so much. Religion had thus the same relation to medicine that it would have with a modern ‘religious’ medical man as suggesting the motive and determining the general direction of his practice though without influence on the details and method.
During the development of the Coan medical school along these lines in the sixth and fifth centuries, there was going on a most remarkable movement at the very other extreme of the Greek world. Into the course and general importance of Sicilian philosophy it is not our place to enter, but that extraordinary movement was not without its repercussion on medical theory and practice. Very important in this direction was Empedocles of Agrigentum (c.500-c.430B. C.). His view that the blood is the seat of the ‘innate heat’,εμφυτον θερμον, he took from folk belief—‘the blood is the life’—and this innate heat he closely identified with soul. More profitable was his doctrine that breathing takes place not only through what are now known as the respiratory passages but also through the pores of the skin. His teaching led to a belief in the heart as the centre of the vascular system and the chief organ of the ‘pneuma’ which was distributed by the blood vessels. This pneuma was equivalent to both soul and life, but it was something more. It was identified with air and breath, and the pneuma could be seen to rise as shimmering steam from the shed blood of thesacrificial victim—for was not the blood its natural home? There was a pneuma, too, that interpenetrated the universe around us and gave it those qualities of life that it was felt to possess. Anaximenes (c.610-c.545B. C.), an Ionian predecessor of Empedocles, may be said to have defined for us these functions of the pneuma; ὁιον ἡ ψυχη ἡ ἡμετερα αηρ ουσα συγκρατει ἡμας, ὁλον τον κοσμον πνευμα και αηρ περιεχει {hoion hê psychê hê hêmetera aêr ousa synkratei hêmas, holon ton kosmon pneuma kai aêr periechei}, ‘As our soul, being air, sustains us, so pneuma and air pervade the whole universe’;[63]but it is the speculation of Empedocles himself that came to be regarded as the basis of the Pneumatic School in Medicine which had later very important developments.
Another early member of the Western school who made important contributions to medical doctrine—in which relation alone we need consider him—was Pythagoras of Samos (c.580-c.490B. C.). For him number, as the purest conception, formed the basis of philosophy. Unity was the symbol of perfection and corresponded to God Himself. The material universe was represented by 2, and was divided by the number 12, whence we have 3 worlds and 4 spheres. These in turn, according at least to the later Pythagoreans, give rise to the four elements, earth, air, fire, and water—a primary doctrine of medicine and of science derived perhaps from ancient Egypt and surviving for more than two millennia. The Pythagoreans taught, too, of the existence of an animal soul, an emanation of the soul of the universe. In all this we may distinguish the germ of that doctrine of the relation of man and universe, microcosm and macrocosm, which, suppressed as irrelevant in the Hippocratic works, reappears in the Platonic and especially in the Neoplatonic writings, and forms a very important dogma in later medicine.
A pupil of Pythagoras and an older contemporary of Empedocles was Alcmaeon of Croton (c.500B. C.), who began to construct a positive basis for medical science by the practiceof dissection of animals, and discovered the optic nerves and the Eustachian tubes. He even extended his researches to Embryology, describing the head of the foetus as the first part to be developed—a justifiable deduction from appearances. Alcmaeon introduced also the doctrine that health depends on harmony, disease on discord of the elements within the body. Curiosity as to the distribution of the vessels was excited by Empedocles and Alcmaeon and led to further dissection, and Alcmaeon’s pupils Acron (c.480B. C.) and Pausanias (c.480B. C.), and the later Philistion of Lokri,[64]the contemporary of Plato, all made anatomical investigations.
The views of Empedocles, and especially his doctrine that regarded the heart as the main site of the pneuma, though rejected by the Coan school as a whole, were not without influence on Ionia. Diogenes of Apollonia, the philosopher of pneumatism, a late fifth-century writer who must have been contemporary with Hippocrates the Great, himself made an investigation of the blood vessels; and the influence of the same school may be traced in a little workπερι καρδιης,On the heart, which is the best anatomical treatise of the Hippocratic Collection. This work describes the aorta and the pulmonary artery as well as the three valves at the root of each of the great vessels, and it speaks of experiments to test their validity. It treats of the pericardium and of the pericardial fluid and perhaps of the musculi papillares, and contrasts the thickness of the walls of right and left ventricles. The author considers that the left ventricle is empty of blood—as indeed it is after death—and is the source of the innate heat and of the absolute intelligence. These views fit in with the doctrines of Empedocles, so that we may perhaps even venture to regard this work as a surviving document of the Sicilian school. It is interesting to observe that we have here the first hint of human dissection, for the author tells us that the hearts of animals may becompared to that of man. The distinction of having been the first to write on human anatomy, as such, belongs however, probably to a later writer, Diocles, son of Archidamus of Carystus, who lived in the fourth centuryB. C.[65]
We may now turn to the Hippocratic Corpus as a whole. This collection consists of about 60 or 70 separate works, written at various periods and in various states of preservation. At best only a very small proportion of them can be attributed to Hippocrates, but the discussion of the general question of the ‘genuineness’ of the works is now admitted to be futile, for it is certain that we have no criteria whatever to determine whether or no a particular work be from the pen of the Father of Medicine, and the most we can ever say of such a treatise is that it appears to be of his school and in his spirit. Yet among the great gifts of this collection to our time and to all time are two which stand out above all others, the picture of a man, and the picture of a method.
The man is Hippocrates himself. Of the actual details of his life we know next to nothing. His period of greatest activity falls about 400B. C.He seems to have led a wandering life. Born of a long line of physicians in the island of Cos, he exerted his activities in Thrace, Abdera, Delos, the Propontis (Cyzicus), Thasos, Thessaly (notably at Larissa and Meliboea), Athens, and elsewhere, dying at Larissa in extreme old age about the year 377B. C.He had many pupils, among whom were his two sons Thessalus and Dracon, who also undertook journeys, his son-in-law Polybus, of whose works a fragment has been preserved for us by Aristotle,[66]together with three other Coans bearing the names Apollonius, Dexippus, and Praxagoras. Thisis practically all we know of him with certainty. But though this glimpse is very dim and distant, yet we cannot exaggerate the influence on the course of medicine and the value for physicians of all time of the traditional picture that was early formed of him and that may indeed well be drawn again from the works bearing his name. In beauty and dignity that figure is beyond praise. Perhaps gaining in stateliness what he loses in clearness, Hippocrates will ever remain the type of the perfect physician. Learned, observant, humane, with a profound reverence for the claims of his patients, but an overmastering desire that his experience shall benefit others, orderly and calm, disturbed only by anxiety to record his knowledge for the use of his brother physicians and for the relief of suffering, grave, thoughtful and reticent, pure of mind and master of his passions, this is no overdrawn picture of the Father of Medicine as he appeared to his contemporaries and successors. It is a figure of character and virtue which has had an ethical value to medical men of all ages comparable only to the influence exerted on their followers by the founders of the great religions. If one needed a maxim to place upon the statue of Hippocrates, none could be found better than that from the bookΠαραγγελιαι,Precepts:
ην γαρ παρη φιλανθρωπιη παρεστι και φιλοτεχνιη
‘Where the love of man is, there also is love of the Art.’[67]
The numerous busts of him which have reached our time are no portraits. But the best of them are something much better and more helpful to us than any portrait. They are idealized representations of the kind of man a physician should be and was in the eyes of the best and wisest of the Greeks.[68]