CHAPTER IIIORIENTAL MEDICINE (Continued)
The Medicine of the Ancient Persians.—After Cyrus the Great had put an end to Babylon as a power among the nations the Persians became the leaders in all the affairs not merely of Asia Minor but also of the entire country from India to the shores of the Mediterranean; in fact, they eventually also gained control of the land of the Pharaohs. Notwithstanding the completeness of the political power which they possessed over these conquered races, they permitted them to retain their respective religions and even their individual languages; as evidence of the correctness of which last statement the modern discovery of inscriptions written in the three principal tongues may be mentioned. The remarkable degree of general culture which existed at Babylon at the time of the Persian conquest, and which the Sumerians and Semites had originally introduced, was left undisturbed by the political change.
So far as we possess any knowledge regarding the medicine of the ancient Persians, this information has been derived, according to Neuburger, from the Zend-Avesta—one of the ancient religious writings preserved by the Parsees. It furnishes comparatively few facts of special interest to physicians. In the main, the practice of medicine must have differed very little from that employed by the earliest Babylonian physicians, and briefly described on pages 11–16. There are one or two additional matters, however, which deserve to be mentioned here. It was maintained, for example, that the touching of a corpse produced a special contamination, a belief which interfered most seriously with the study of anatomy, and thereforeprevented any real advance in medical knowledge. Then, again, the ancient Persians appear to have taken comparatively little interest in surgery, for it is said that King Darius I. was obliged, when he needed treatment for a badly sprained ankle, to send for a Greek physician. Finally, there may be found in Herodotus the following statement, which shows that the Persians had learned something of value, in practical hygiene, from their neighbors, the Egyptians:—
The Great King (Cyrus), when he goes to the wars, is always supplied with provisions carefully prepared at home, and with cattle of his own. Water, too, from the river Choaspes, which flows by Susa, is taken with him for his drink, as that is the only water which the kings of Persia taste. Wherever he travels, he is attended by a number of four-wheeled cars drawn by mules, in which the Choaspes water, ready boiled for use, and stored in flagons of silver, is moved with him from place to place.[10]
The Great King (Cyrus), when he goes to the wars, is always supplied with provisions carefully prepared at home, and with cattle of his own. Water, too, from the river Choaspes, which flows by Susa, is taken with him for his drink, as that is the only water which the kings of Persia taste. Wherever he travels, he is attended by a number of four-wheeled cars drawn by mules, in which the Choaspes water, ready boiled for use, and stored in flagons of silver, is moved with him from place to place.[10]
Neuburger makes the remark that the ancient Persians are entitled to the gratitude of later generations for the valuable service which they rendered the science of medicine, inasmuch as, during the dynasty of the Sassanide princes (fifth century A. D.) and at a time when European culture was hastening to its destruction, they gave shelter both to classical culture in general and to the medical knowledge of the Greeks, and then afterward handed it over to the conquering Arabs, who passed it on to our forefathers.
The Medicine of the Old Testament.—There are no medical writings which give any information concerning the science and art of medicine as possessed by the ancient Israelites, but the Bible contains a number of passages that refer to matters which belong in the domain of medicine, and more particularly in that of social hygiene. The mosaic laws were framed with a view to the good of the Jewish people as a whole, and were directed to such matters as the prevention and suppression of epidemic diseases, the combating venereal affections and prostitution, the careof the skin, the systematizing of work, the regulation of sexual life, the intellectual cultivation of the race, the provision of suitable clothing, dwellings and food, the use of baths, etc. Many of these laws—like those, for example, which prescribe rest on the Sabbath day, circumcision, abstinence from eating the flesh of the pig, the isolation of persons affected with leprosy, the observation of hygienic rules in camp life, etc.—testify to a remarkably high degree of the power to reason correctly; and, when considered in the light of modern science, they seem to justify the prediction made in Deuteronomy iv., 6. A similar prediction (supposed to be spoken by God from Mount Sinai) is made in Exodus xix., 6: “And ye shall be unto me a kingdom of priests, and an holy nation.” That a large part of the credit given to Moses for the wisdom displayed in these sanitary laws really belongs to the Egyptians is shown by the text of Acts vii., 22: “And Moses was learned in all the wisdom of the Egyptians, and was mighty in words and in deeds.”
As regards the manner in which the Israelites treated the diseases which afflicted them the Bible furnishes ample proof of the fact that they placed their chief reliance upon prayers, sacrifices, and offerings at their temples, and made comparatively small use of medicinal agents, dietetic measures, and external applications. The favorable effect of David’s harp-playing upon the melancholia of King Saul furnishes the only instance, to be found in the Bible, of the curative value of music in certain mental disorders.
The story of Naaman (2 Kings v.) deserves to be mentioned briefly here. He was captain of the host of the King of Syria (about 894 B. C.) and a man of valor, highly esteemed by his master, but he was—according to the Bible statement—a leper. Learning casually that there was in Samaria a prophet who might be able to cure his disease, he put a large sum of money into his sack and departed for that country. “So Naaman came with his horses and with his chariot, and stood at the door of the house of Elisha. And Elisha sent a messenger unto him, saying, Go and wash in Jordan seven times, and thy flesh shall come againto thee, and thou shalt be clean.” Naaman, at first much displeased with the advice given to him by Elisha, and especially by the very informal manner in which it had been communicated to him, finally decided to follow the prophet’s instructions. “Then went he down, and dipped himself seven times in Jordan, ... and his flesh came again like unto the flesh of a little child, and he was clean. And he returned to the man of God, ... and came, and stood before him; and he said, Behold, now I know that there is no God in all the earth, but in Israel: now therefore, I pray thee, take a blessing of thy servant.” Elisha, however, refused persistently to accept any reward for the advice which he had given. He simply said to Naaman: “Go in peace.” Before he departed, however, Naaman expressed to Elisha the hope that he would be pardoned if he yielded to the necessity of bowing down to the god Rimmon on certain occasions—as, for example, when he accompanied his master, the king, on his visits to the temple of that god for the purposes of worship. From the evidence furnished by this account, as given in the Old Testament, it is fair to assume that both Naaman and the writer of the book of Kings believed that the cure had been effected by supernatural means. The modern physician, however, is not ready to accept such an interpretation of the manner in which Naaman’s cure was effected, but prefers to believe that the supposed leprosy was in reality some curable form of skin disease which to the unprofessional eye appeared like the other malady. It might, for example, have been an aggravated general eczema, dependent upon such excesses of eating and drinking as a wealthy captain of the king’s host would be likely to indulge in. And if this supposition is correct, one cannot but admire the great practical wisdom of Elisha in advising Naaman to take seven baths—one a day presumably—in the river Jordan, a spot so far removed from his home that it would scarcely be possible for him to obtain any but the simplest kind of diet during this comparatively long period of time.
An interesting case of snake-bite is briefly related in Acts xxviii., 3–6. It is stated that “when Paul (after beingshipwrecked on the Island of Melita) had gathered a bundle of sticks, and laid them on the fire, there came a viper out of the heat, and fastened on his hand. And when the barbarians saw the venomous beast hang on his hand, they said among themselves, No doubt this man is a murderer, whom, though he hath escaped the sea, yet vengeance suffereth not to live. And he shook off the beast into the fire, and felt no harm. Howbeit they looked when he should have swollen, or fallen down dead suddenly: but after they had looked a great while, and saw no harm come to him, they changed their minds, and said that he was a god.” This narrative is interesting in several respects, but there is one feature that deserves to receive special mention, viz., the fact that Paul experienced no harm from the bite of a poisonous serpent—a wound which frequently proves fatal. Inasmuch as the account distinctly states that the reptile “fastened on his hand” and that “the barbarians saw the venomous beast hang on his hand,” the conclusion is warranted that one or both of the creature’s fangs had entered the hand by a curving route, and probably in such a manner that the free end of each fang, from which the poison is ejected, passed completely through the skin from within outward. When the bite of a poisonous snake is of a character such as I have just described,—and not a few of them have this character,—only a very small quantity of the venom is lodged in the subcutaneous tissues, where the larger blood- and lymph-channels lie, and as a consequence the person bitten escapes serious harm. On the other hand, when the fangs enter the flesh in a less decidedly curving direction, thus permitting a greater quantity of the venom to reach and remain in the deep-lying tissues, serious or even fatal results may be anticipated. The point, then, which I desire to make is simply this: Paul’s escape from death in this instance may perfectly well be ascribed to natural causes.
The Israelites, at a certain stage of their history, appear to have completely divorced the practice of medicine from the priestly function. In one place, for example, it is stated that King Asa sought relief from his ailment, not fromJehovah, but from the physicians. Jeremiah expresses astonishment that not a single physician is to be found in Gilead. May this not be interpreted as signifying that regularly established physicians were at that time (595 B. C.) to be found in some parts of Palestine? And, at a much earlier period (1500 B. C.), Job calls his friends “physicians of no value” (Job xiii., iv.). From these and a number of other statements in the Bible it seems permissible to believe that, at a very early period of history, the Jewish physicians occupied an entirely independent position.
It would doubtless appear strange to most readers of this brief sketch of the history of medicine if some reference were not made in this place to Luke, the author of the gospel which bears his name and of the Acts of the Apostles, and who was also the companion of Paul on his journey to Rome and during a portion of the latter’s stay in that city. Luke was a native of Antioch, in Syria, and not a Jew. He was a physician and tradition says that he was also a painter. It is not known where he received his medical training, but it is not at all unlikely that he studied at Alexandria, in Egypt, where the greatest facilities for such training, obtainable at that period, were to be found. His style of writing shows plainly that he was a man of considerable cultivation and endowed with a clear and logical mind; and if he had not possessed a genial personality he would hardly have been known as “the beloved physician”; nor could any other motive but those of loyal, self-sacrificing friendship for his friend, and a desire to promote the cause of Christianity, have led him to share with Paul the dangers and discomforts of the journey to Rome.
The Medicine of India, China and Japan.—It would be too much of a departure from the plan which is being followed in the writing of this history to attempt to describe, even in the briefest manner, the mode of development of the science and art of medicine in India, China and Japan. Unquestionably the earlier physicians of these countries made many valuable contributions tomedical knowledge, but they were made at such a period of time, or under such conditions, that they could not have exerted an appreciable influence upon the development of medicine in ancient Greece,—certainly no such influence as was exerted by Assyria and Persia, and especially by Egypt. It therefore seems permissible to speak of the medicine of these more remote countries only incidentally, and not as an integral part of the series of centres of learning which made the medicine of ancient Greece the direct ancestor—if I may use such a term—of European medicine.[11]In conformity with this idea it will be well to mention here briefly a few of the more important facts relating to the achievements of the physicians of the three countries named.
The most celebrated medical authors in India were Caraka, Súsruta and Vagbhata—“The ancient trinity,” as they were called. Caraka probably lived during the early part of the Christian era, Súsruta during the fifth century, and Vagbhata not later than during the seventh century A. D. It is apparent, therefore, that none of the treatises written by these authors could have exerted the slightest influence upon the growth of medical knowledge in ancient Greece.
The crudeness of many of the conceptions held by these Hindu physicians concerning pathology is revealed in the following definition: “Health is the expression of the normal composition of the three elementary substances (air, mucus and bile) which play a vital part in the machinery of the human body, and it is also dependent upon the existence of normal quantitative relations between these three substances; and when the latter are damaged, or when they are abnormally increased or diminished, then disease of one kind or another makes its appearance.”[12]
Great stress was laid by the physicians as well as by the priests of ancient India upon the observance of very elaborate rules respecting the care of the person while in health and, very naturally, when a patient became ill the physician in charge paid quite as much attention to the employment of hygienic and dietetic measures in effecting the desired cure as to the administering of drugs.
The list of the commonly employed hygienic measures is too long for reproduction in its entirety in this brief sketch, but an enumeration of some of the more important items may prove interesting. In estimating the value of these rules the reader should bear in mind that they were intended for people living in a hot climate. Daily bathing heads the list. Then follow: regulation of the bowels; rubbing the teeth with fresh twigs of certain trees which possess astringent properties, and also brushing them twice a day; rinsing the mouth with appropriate washes; rubbing the eyes with salves; anointing the body with perfumed oils; cutting the nails every five days, etc. Two meals a day were prescribed—the first one between nine in the morning and noon, and the second between seven and ten in the evening. “Only a moderate amount of water should be drunk during the meal; drinking water at the beginning of a meal delays digestion, while a copious draught at the end produces obesity. After the meal the mouth should be carefully cleansed and a short walk should be taken.” Among the more important articles of food the following deserve to be mentioned: rice, ripe fruit, the ordinaryvegetables, ginger, garlic, salt, milk, oil, melted butter, honey and sugar cane. If meat is eaten, preference should be given to venison, wild fowl and the flesh of the buffalo. The meat of the pig, and beef, as well as fish, are less conducive to health. Gymnastic exercises in moderation are beneficial. Sleep should be indulged in during the day only after some specially severe exercise; at night it should not be extended beyond one hour before sunrise. Bathing immediately after eating is harmful, and it is not to be indulged in when one is affected with a cold, with a high fever, with diarrhoea, or with some disease of the eyes or ears. A hot bath or washing with warm water may be beneficial for the lower half of the body, but for the upper half it is harmful. Sea bathing and cold baths (preferably in the river Ganges) are beneficial. The clothing worn should be clean; soiled garments are likely to produce skin diseases. It is advisable to wear shoes, and an umbrella or a staff should be carried. The wearing of garlands, finery, and jewels increases the vital powers and keeps away evil spirits. The following are good measures to adopt for the preservation of health: an emetic once a week; a laxative once a month; and a bloodletting twice a year. All the measures enumerated above were subject to modification according to changes in the season, the locality, the weather, and various other circumstances.
In harmony with the extraordinary fruitfulness of the land the pharmacopoeia of India is very rich. It is a remarkable fact that not one of the numerous drugs mentioned in the official list is of European origin. The great majority of them belong to the vegetable kingdom; Caraka stating that he knew of 500 plants that possessed remedial virtues, while Súsruta placed the number at 760. Then, too, the list contains a goodly number of drugs which belong, some to the animal and others to the mineral kingdom. It appears that the physicians of India began using mineral substances, both externally and internally, at a very early period of their history. Among such substances the following may be mentioned: sulphate of copper, sulphate of iron, sulphate of lead, oxide of lead, sulphur,arsenic, borax, alum, potash, chloride of ammonium, gold, precious stones of different kinds, etc. The people of India were skilled in chemical and pharmaceutical work. The drugs were prepared by them in a great variety of ways—as, for instance, extracts of the juices of plants, infusions, decoctions, electuaries, mixtures, syrups, pills, pastes, powders, suppositories, collyria, salves, etc. Practicing physicians carried with them a sort of portable medicine chest, and they often collected, themselves, the medicinal plants which they required. Súsruta gives instructions as to the spots where certain plants are most likely to be found, and as to the seasons when they should be gathered. Charlatanry and mysticism often played a part in this business. Thus, it was maintained that drugs collected and prepared by persons other than physicians did not produce the desired effects. The fact that cosmetics (especially hair dyes), “elixirs of life,” aphrodisiacs, poisons and antidotes for poisons, occupy the most prominent place in the list of pharmaceutic preparations sold, casts a glaring ray of light, as Neuburger states, on the degree of culture among the people of ancient India.
The list of separate maladies recognized by the physicians of the latter country is inordinately long. There were 26 kinds of fevers, 13 species of swellings of the lower abdomen, 20 different diseases due to worms, 20 kinds of urinary diseases, 8 varieties of strangury, 5 kinds of jaundice, 5 varieties of cough or asthma, 18 kinds of “leprosy,” 6 kinds of abscesses, 76 different eye diseases, 28 affections of the ear, 65 disorders of the mouth, 31 nasal affections, 18 diseases of the throat, a large number of mental disorders, etc. It seems scarcely necessary to remark that these so-called diseases were in reality only groups of certain types of loosely related symptoms. The term “leprosy,” for example, included, besides the disease which modern physicians call by that name, a number of different affections of the skin. It is worth noting here that diabetes mellitus, which is one of the twenty different kinds of urinary diseases enumerated in the classified list mentioned above, was first described by the physicians ofIndia, whose attention was directed to the disorder by observing that flies and other insects were attracted to the urine of these patients by reason of its sweetness. It is also an interesting fact that occasionally these physicians, who, beyond a doubt, were keen observers of symptoms, paid some attention to the anatomical features of the individual cases. Thus, it is stated that the particular form of swelling of the lower abdomen, to which they applied the name “splenic belly,” is dependent upon “an enlarged spleen which distends the left side, is as hard as a stone, and is arched like the back of a turtle”; whereas they spoke of “an enlargement of the liver” when very much the same conditions were observed on the right side of the abdomen. The accuracy of their clinical observations is particularly noticeable in their accounts of cases of consumption, apoplexy, epilepsy, hemicrania, tetanus, rheumatism, venereal diseases, some affections of the skin, and insanity. It was in their surgical technique, however, that the physicians of ancient India were distinguished above all their brethren of the neighboring oriental countries, and this superiority they maintained for a very long time. Among the operations which they performed the following may be mentioned: they removed tumors by excising them, they opened abscesses by the use of the knife, they employed scarifications (in inflammations of the throat) and made punctures (in hydrocele and ascites), they passed probes into fistulae, they extracted foreign bodies, and they employed needles armed with hairs taken from the horsed tail or with thread composed of flax or hemp. According to Súsruta their stock of instruments was composed of 101 blunt and 20 cutting instruments. Among those which were blunt there were forceps of different sizes and forms, hooks, tubes, probes or sounds, catheters, bougies, etc. They made use of the magnet for drawing out foreign bodies of iron, and they applied cups for therapeutic purposes. Their cutting instruments consisted of knives, bistouris, lancets, scissors, trochars, needles, etc. Steel was the metal of which they were made; for the people of India learned at a very early period howto make steel. In suitable cases cauterization, either with the actual cautery or with caustic potash, was a favorite method of treatment with the surgeons of ancient India. “Burning with the heated iron,” they taught, “is more effective than cauterization with potash, inasmuch as it permanently cures diseases which may not be cured by either drugs, surgical instruments, or chemical cauterizing agents.” In cases of enlargement of the spleen they plunged red-hot needles into the parenchyma of the organ, presumably through the skin and other overlying tissues. There were fourteen different kinds of surgical dressings; cotton, woolen, linen and silk being the materials used for bandages, and strips of bamboo or some other wood for splints. When the conditions permitted such a proceeding, it was customary to sew up wounds of the head, face and windpipe. Furthermore, it was the rule to perform all surgical operations at a time when the constellations were favorable. Religious ceremonies were performed both before the operation and after it was completed, and it was also considered necessary that the operator should face the west and the patient the east. Intoxication was employed as a means of securing narcosis. Owing to their scrupulous cleanliness and the minute attention which they paid to details, the surgeons of ancient India obtained for a long time a much higher degree of success than did the surgeons of other oriental nations. At the same time they were not lacking in that degree of boldness which enables an operator—in critical cases which probably without such prompt and radical action would terminate fatally—to save life. For example, they did not hesitate to open the abdominal cavity and to sew up a wound in the intestines; they cut for stone in the bladder, employing for this purpose the lateral method of operating; and they performed a great variety of plastic operations.
Some of their hygienic rules concerning pregnant and nursing women are eminently practical; others would hardly be approved by modern accoucheurs. Here are a few of these rules: During the period of a woman’s pregnancy close attention should be paid to her diet, andspecial care should be exercised by her to avoid excesses or errors of any kind. When the ninth month is reached she should take up her abode in the small cottage in which she is eventually to be confined—a building erected with special religious ceremonies and thoroughly fitted with everything that is likely to conduce to her comfort. At the time of the actual confinement she should have with her four female assistants, and all those measures, of either a religious or a practical character, which have in view the hastening of the birth of the infant, should be scrupulously carried out. If any delay in the delivery of the after-birth occurs, the removal of the mass may be promoted by the employment of well-directed pressure over the lower part of the abdomen, by shaking the body, and also, if necessary, by giving an emetic. The woman in childbed should not be allowed to get up before the tenth day after her confinement, and for a period of six weeks her diet should be most carefully watched. On the third day the child should be put to the mother’s breast; up to that time it should be given only honey and butter. If the mother, for any reason, is not able to suckle the infant, a wet-nurse should be employed for the purpose, but not until the physician shall have subjected her to a most thorough examination and shall have instructed her minutely in regard to her own diet. The subsequent care of the child was provided for in the most particular manner: It was restricted to a carefully planned diet; it was not allowed to sit or to lie except in certain prescribed positions; its times for sleeping were strictly ordered; it was permitted to amuse itself only in certain ways;—in brief, everything was done according to strict rules, even special precautions being taken to guard the child, during the first years of life, against dangerous demons. Weaning began after the sixth month, and for a certain length of time the child was fed largely on rice. In cases of difficult labor and in their gynaecological practice the physicians of ancient India did not manifest any special knowledge or skill.
One of the instructions given to young physicians in India when they were about to enter upon the practice oftheir profession, may be of interest to the reader. It is worded as follows: “Let thy hair and finger-nails be cut short, keep thy body clean, put on white garments, wear shoes on thy feet, and carry a staff or umbrella in thy hand. Thy demeanor should be humble, and thy heart pure and free from deceitfulness.” The following proverb, although it originated in India, is well worthy of acceptance in every part of the world: “When you are ill the physician will be to you a father; when you have recovered from your illness you will find him a friend; and when your health is fully re-established he will act as your protector.”
On a previous page the statement has been made that the science and art of medicine developed in ancient Greece quite independently of any influence that might have been exerted by the teachings of the physicians of India. This statement should be somewhat modified, for it is reasonable to suppose, although directly confirmatory evidence has not yet been discovered, that, through the channels of trade between the two countries, some knowledge of the doings of the physicians of India must have reached the ears of their Greek brethren. On the other hand, at a later period of history (after Alexander the Great had invaded India), the relations between the two countries became quite close and were kept up without a break for several hundred years. During the earlier part of this later period, as appears from the writings of Hippocrates, Dioscorides and Galen, various drugs and methods of treatment employed by the physicians of India were adopted by the practitioners of Greece.
Medicine of the Chinese and Japanese.—The isolation of China with respect to those countries which were within comparatively easy reach and in which there was a civilization that, already several thousand years before the Christian era, had attained a remarkable degree of development (India, Babylonia and Egypt, for example); her blind belief in authority; her unwillingness to tolerate any influences that seemed to emanate from foreigners; and her complete satisfaction with her own methods of doing things, with her own beliefs, and with her ownnatural and manufactured products,—these, it is generally believed, were the most important factors in keeping this remarkable nation in a state of immobility as regards at least some departments of human knowledge and accomplishment. This is particularly true in respect of the science and art of medicine. But China is at last waking up from this lethargic state. A wonderful change has come over her during the past twenty or thirty years, and she is now beginning to realize that, with her millions of population and wonderful natural resources, she has an important part to play in advancing the civilization of the world.
The preceding remarks must not be interpreted as signifying that, during the long ages of the past, China has not been developing and is not able at the present time to show a record of very creditable work accomplished in many departments of human activity. In her early history, many centuries ago, she accomplished great things, and all—so far as we now know—without aid from neighboring nations; but there came a time when all this creative activity ceased, and then, for long periods of years, she appeared to rest satisfied with the advances which she had already made, and to have no further ambition to add to the stock of her possessions.
Among the valuable things which should be credited to the Chinese are the following: the discovery of the compass (about 1100 B. C.), the making of porcelain, the invention of printing, the raising of silkworms, the manufacture of glass and of paper, the successful dyeing with purple, embroidering with gold, working in metals, the artistic cutting of precious stones, enameling, the making of “India ink,” etc. Furthermore, it is a fact most creditable to the Chinese that in no other country in the world have scholars been held in such high esteem, or assigned so high a rank, as they have been and still are in China.
Chinese medicine possesses a very rich literature. The first medical treatise, which deals with plants that possess medicinal virtues, is ascribed to the Emperor Schin-Nung, who flourished about 2800 B. C. This is the monarch whotaught his people from which springs they should drink, and who tested all the plants of his vast empire with reference to their healing properties. According to the legend the wall of his stomach was so thin that he could look through it and see everything that was going on in the interior of that organ. In this way he was able to carry on a large series of experiments upon himself in regard to the action of different poisons and their antidotes. It is also related that medical knowledge was still further advanced by the yellow Emperor Hoang-Ti who lived about 2650 B. C., and who is credited by the Chinese with having invented arithmetic and music. The treatise called “Noi-King,” which deals with the subject of internal diseases and gives a systematic account of human anatomy, is also credited by the Chinese to this monarch; but Neuburger maintains that this book, which is still in common use in China, is of much more recent origin. There are several other medical treatises which deserve to be mentioned. Such, for example, are the following: the celebrated book on the pulse, written by Wang-Schu-Scho in the third century B. C.; two very important books written by Cho-Chiyu-Kei—one bearing the title “Schang-Han-Lun” (On Fevers) and the other that of “Kin-Kwéi” (Golden Casket);—the different treatises written by Tschang-Ki (tenth century A. D.) and published in the collection called “The Golden Mirror of the Forefathers in Medicine” (I-Tsung-Kin-Kien); and, finally, the very popular modern work (in forty volumes) entitled “The Trustworthy Guide in the Science and Art of Medicine” (“Ching-Che-Chun-Ching”). Of these forty volumes, seven are devoted to nosology, eight to pharmacy, five to pathology, six to surgery, and the remainder to children’s and women’s diseases.
Anatomy, it appears, has never played other than a very insignificant part in the Chinese system of medicine. This is not to be wondered at when we remember that their religion makes the dissection of a human body a sin worthy of punishment. No mutilated person, the Chinese believed, would be permitted, upon reaching the domain of the dead,to rejoin his ancestors. About the year 1700 A. D. the Emperor Kang-Hi made the attempt to incorporate anatomy as a part of the regular study of medicine in the Chinese Empire; his first step being the authorization of P. Perennin, a Jesuit Father, to translate Dionis’ work on anatomy into the Chinese. His efforts were, however, unsuccessful, owing to the strong opposition offered by the native physicians. And the attempts made during more recent times to accomplish the desired reform by introducing copies of European anatomical illustrations do not appear, as yet, to have produced any appreciable impression. In very recent years, however, the medical missionaries, sent out, if I am rightly informed, from the United States, are giving excellent instruction in anatomy.
Physiology, as taught by the Chinese, is something beyond the comprehension of modern Europeans. Neuburger explains their views in the following manner: “The cosmos is the product of the combined action of two dissimilar forces—the male (Yâng) and the female (Yin). When these forces work in harmony a state of equilibrium results.... Matter consists of five elements, viz., wood, fire, earth, metal, and water; and all things are composed of these elements. In sympathetic relationship with these five elements stand the five planets (Jupiter, Mars, Saturn, Venus, Mercury), the five different kinds of air (wind, heat, moisture, dryness, cold), the five quarters of the globe (east, south, west, north and the equator), the five periods of the year (in addition to the four which we recognize, the Chinese make a fifth period out of the last eighteen days of spring, summer, autumn and winter), the five times of day, the five colors (green or blue, red, yellow, white and black), the five musical tones, etc.... As in the cosmos, so in man the two primeval forces—Yâng and Yin—underlie all his vital processes. Thus, his body is made up of the five elements of which all matter is composed, and health depends upon the maintenance of a state of equilibrium between the male and the female forces, etc.” After this brief exposition it seems unnecessaryto devote any further space to the consideration of the physiological doctrines of the Chinese.
With respect to the questions of diagnosis and prognosis it may be stated that the Chinese attach great importance to the necessity of making a most careful objective examination of the entire body; but, when one investigates the precise manner in which this examination is to be carried out, it soon appears that most of the details relate to matters of a purely fanciful or mystical nature. The only steps of real importance, according to them, are the examination of the patient’s pulse and the inspection of his eyesight and his tongue. From the examination of the pulse alone they believe it possible to diagnose the nature and seat of the disease. To examine the pulse properly is a complicated affair and can scarcely be carried out in actual practice in less time than ten minutes; indeed, in certain cases the physician may find it necessary to devote two or three hours to the business. According to the Chinese scheme there are many different kinds of pulse, and there are no less than thirty-seven different types of condition presented by the tongue, each bearing its own special pathological significance.
Disease, so reads the Chinese doctrine, is a discord, a disturbance of equilibrium, caused by the preponderance of one or the other of the primeval forces (the male or the female). It manifests itself in some disorder of the circulation of the vital air and the blood, and eventually involves the organs of the body. Wind, cold, dryness, moisture, the emotions and passions, poisons, and also evil spirits and imaginary beasts are the causes of disease.
No other nation, says Neuburger, has at its command such a large number of remedial drugs; and it is also a fact, he adds, that the department of therapeutics is that in which Chinese medicine has reached its highest development. The steadfast belief that in nature there exists a remedy for every human ill led the physicians of that country to search diligently in all possible directions for vegetable and animal and also, to some extent, mineral substances which might possess remedial virtues. Althoughthis search necessarily brought to notice a lot of useless drugs, it cannot be denied that eventually it added a considerable number of remedies which have proved useful to the medical profession of the entire world. In this category belong the following: rhubarb, pomegranate root as a cure for worms, camphor, aconite, cannabis, iron (for the relief of anaemia), arsenic (for malarial and skin diseases), sulphur and mercury (both of these for affections of the skin), sodium sulphate, copper sulphate (as an emetic), alum, sal ammoniac and musk (for nervous affections). Toward the middle of the sixteenth century A. D. there was published, under the title “Pen-Tsao-Kang-Mu,” a monumental work (fifty-two volumes) in which are very fully described no fewer than 1800 remedies, mostly of a vegetable nature. Prophylactic Inoculation with the pus from a small-pox pustule was practised by the Chinese as long ago as during the eleventh century A. D., “thus constituting a forerunner of our modern serum therapy.” (Neuburger.) Vaccination was not introduced into China until during the nineteenth century of the present era. It is a curious fact that, in the choice of a remedy, the Chinese physicians attach a certain degree of importance to the form and color of the drug, as symbols indicative of the effect which they may be expected to produce. Thus, the red blossoms of the hibiscus plant are believed to be more efficacious than the white as an emmenagogue; saffron, being of a yellow color, possesses the power to relieve jaundice; beans that have the shape of a kidney should be prescribed in cases of renal disease; glow-worms should form a part of all eye-washes, etc.
The doses prescribed are very large, and the medicines are often put up in an attractive form, with labels on which such descriptive titles as these are written: “Powders of the Three very wise Men,” or “Powders recommended by Five Distinguished Physicians”—titles which are calculated to work upon the imagination of the patient.
There are two methods of treatment which the Chinese physicians are very fond of employing for the relief of a great variety of diseases—viz., acupuncture and cauterizationof the skin over the seat of the malady by means of what are termed “moxae”—moxibustion. Moxae are prepared by kneading together into a cone-shaped, tinder-like mass the leaves of the artemisia vulgaris, then drying it thoroughly. Such a mass is attached to the skin at the affected spot by simply moistening the base of the cone, after which the apex is ignited. Some physicians prefer to interpose a thin sheet of metal between the skin and the base of the moxa. The manner in which these contrivances should be used in the different diseases and the proper number to employ are matters subject to fixed rules. In a strong individual, for example, as many as fifty moxae may be used at a time. In affections of the chest they were applied to the patient’s back, in diseases of the stomach to the shoulders, and in venereal affections over the spinal column. In acupuncture, which is a procedure invented by the Chinese, slender needles of gold, silver or highly tempered steel, from 5 to 22 centimetres (2 in.-8¼ in.) in length, were forced through the stretched skin to different depths (1¼ in.-1½ in.) and then driven farther inward in a rotary direction by means of a small hammer. The needles, after being allowed to remain in situ for a few minutes, were withdrawn, and pressure was made with the hand over the small wounds, or a moxa was burned over the spot. There are in all 388 places where acupuncture may be performed, and a chart of the body, showing where these places are located, has been prepared for the guidance of the Chinese physicians. Neuburger calls attention to the fact that the latter dislike the sight of blood, and that this is one of the reasons why acupuncture and the use of moxae have grown to be such popular remedies. Bloodletting is rarely employed by them; but dry cupping, on the contrary, is a favorite procedure in certain maladies. Massage is generally performed by old or blind women, and much attention is devoted to the “movement cure,” which is said to have been invented about 2500 B. C.
As may readily be imagined, the Chinese—owing to their dislike for the sight of blood and also by reason oftheir ignorance of anatomy—have not advanced, in surgery, beyond the most primitive state of that art.
The science of public health is quite unknown in China. In a Chinese treatise entitled “Long Life,” the following advice is given: “Always rise early in the morning, take some breakfast before you leave your residence, drink a little tea before eating, at the mid-day meal partake of well-cooked but not too highly salted food, eat slowly, take a nap of two hours after the meal, eat lightly at night, and, before going to bed, rinse your mouth with tea and have the soles of your feet rubbed until they are warm.” (Neuburger.)
Up to the latter part of the nineteenth century of the present era, Japan, so far as medical matters are concerned, differed in no material respect from China. During the last fifty or sixty years, however,—that is, since the visit of Commodore Perry, of the United States Navy, to that country,—wonderful changes have taken place; and now Japan, as a result of her determination to adopt the methods of education, of utilizing steam and electric power, etc., has already taken a leading place in the council of nations. The physicians, many of whom received their training in the best schools of Europe and the United States, are contributing to-day their full share toward advancing the science of medicine. That China is following in the footsteps of Japan is already plainly evident, and no intelligent observer entertains the slightest doubt of her ultimately—probably at no distant day—possessing a corps of medical men as well educated, as efficient in the treatment of disease, and as practical in public hygiene as their European and American confrères. During thousands of years China has suffered severely from the blighting tyranny of superstition, priestcraft and selfish bureaucracy, and, now that the sunlight of truth and genuine liberty is beginning to search every nook and cranny of that great country, we who have had the advantage of this beneficent influence for so many scores of years truly rejoice over the change that is taking place in China.