Part 10

FIG. 6. AESCULAPIUS, originally a physician, subsequently deified as a Greek god of Medicine. He holds a staff, around which a serpent twines. From a statue in the Capitoline Museum at Rome.

The Greeks of western Asia Minor, thus drawing material from many sources, came to develop, towards the end of the seventh century B.C., a philosophical system from which the whole of their Science may be said to be a natural growth. Factors in this development were the medical schools of Cos, where Hippocrates was born, and of the opposite peninsula, Cnidus. These schools were in active operation by the sixth century B.C. By the middle of the fifth century they were important elements in the growing complexity of Greek life. Much of the so-called Hippocratic Collection, which contains the earliest Greek medical writings that have survived, must have been put together somewhere in the fourth century B.C., though its final recension is certainly later (Fig. 7). In that final recension Persian and Indian elements were also included, though to what degree is still very uncertain.

But the picture of the development of Greek Medicine is not yet complete. Although we inherit the scientific spirit from the Greeks, and although they set a standard for all time of the purest and most disinterested type of medical practice, they are also in part responsible for some of the basest forms of medical jugglery that have afflicted and still afflict mankind. The medicine of the physicians was only one of their medical systems. There was a far lower form which gradually passed into the hands of the priests. The temple jugglery of Greece is ancestor, both by imitation and by direct tradition, of much medieval and modern medical miracle-mongering.

Furthermore, in ancient as in modern times, all medical men were not equally pure in aim or scientific in method. The practice of some Greek physicians was more than flavored with magic. In justice, also, it must be said that not all priests were mere charlatans, and that there are traces of scientific method in the treatment of patients in the temples. There was, indeed, a relation between the practice of some of the physicians among the Greeks and that of some of their priestly magicians. We shall not attempt to determine the actual extent and nature of this relationship. For our purpose it is enough that the two systems were quite distinct in their most typical developments.

The temple system of Greek Medicine was associated from an early date with a deity, Asklepios, or, to give him his better-known Latin name, Aesculapius. Numerous representations of him have come down to us, and in them we see him gradually molded to a particular type. He becomes at last an aged man of noble, benevolent and dreamy aspect, holding in his hand a staff around which a serpent twines (Fig. 6). The cult of the god Aesculapius was carried on at numerous sites. The best known, both from literature and excavation, is Epidaurus. The conditions there are typical of those in other Aesculapian centers.

Epidaurus is about thirty miles from Athens. It lies between two considerable ranges of hills, and the country bears still, in its customs and place-names, some remnants of the ancient cult. One tradition tells that a certain maiden, Koronis, being with child by Apollo, brought forth the infant Aesculapius on the mountain above Epidaurus. There is still a village named Koroni hard by. She fled to conceal her shame and left the child on the mountain, where it was tended by a goat and watched over by a dog. The infant performed various miracles which we need not pursue, though the temple arose on the site where he is said to have wrought them. One of his miracles, however, has a wider interest and is worth recounting. A certain Hippolytus, falsely accused of impure relations with his stepmother, was slain by the gods in answer to the curses of his father, Theseus. Raised from the dead by the wonder-working Aesculapius, he reappears in legend at the Arician grove in Italy. ‘There’, says a Greek chronicler of the second century A.D., ‘he became a king and devoted a precinct to Artemis, where, down to my time, the prize for the victor in single combat was the priesthood of the goddess. The contest was open to no freeman, but only to runaway slaves.’

The son slain by his father and then rising from the dead; the runaway slave seeking sanctuary with Artemis in her grove, allowed his liberty and elevated to the priesthood there; the priesthood held only so long as the priest can guard it in mortal combat against the next runaway slave; this succession of slave kings and priestly murders has touched the imagination of the poets and artists in ancient and in modern times. The sacred grove of Artemis stood by the side of the lake of Nemi:

The still glassy lake that sleeps Beneath Aricia’s trees-- Those trees in whose dim shadow The ghastly priest doth reign, The priest who slew the slayer And shall himself be slain.

It is a picture utterly out of accord with the general trend of classical mythology. Long ago scholars saw therein a remnant of a submerged faith, that ancient ‘Nature worship’ which survived among the Greeks, and survives with us. From this incident is named the great classical work of Anthropology, The Golden Bough. By this story and by all that it implies, by all that learning has drawn out of it and associated with it, the history of Medicine comes into contact with the brooding spirit of savage man. Into that dark realm we shall not enter in this volume.

History is the tale of the spirit of Man unfolding itself. This process is always slow, often imperceptible, sometimes retrograde, yet over long periods of time it is sure. Where no evolution of the spirit can be traced true history cannot be written, wherefore no man can write a history of human folly. Irrational man, driven by disease and fear of death, exhibits the same follies in all ages. The medical follies and superstitions of our own days are as in those when Aesculapius claimed men’s allegiance. His garments and his names are changed, his temples are transformed, his priests assume other titles, but his face is the same, and he works the same wonders with about the same frequency. It is of Rational Medicine that we have henceforth to speak.

§ 2. The Hippocratic Physician.

We turn to the other side of the picture. Nothing could be in greater contrast to the orgies of the savage, the dark ways of the magician, or the charlatanry of the priests, than the serene spirit of wisdom which pervades the best Greek Medicine. The finest presentation of that system is to be found in a group of about a hundred works that have been associated together since antiquity under the name of Hippocrates. It is known as the Hippocratic Collection.

It will naturally be asked, ‘Which of these works is by the man whose name they bear?’ To that question, alas, no definite answer can be given. There is no single work which we can state with certainty to be the composition of the Father of Medicine. The books of which the Collection is composed are the work of a number of authors, belonging to different schools, holding various and often contradictory views, living in widely separated parts of the Greek world and writing at dates divided from each other, in the most extreme cases, by perhaps five or six centuries. Of the finest books of this collection we can but say that they contain nothing inconsistent with a Hippocratic origin, that their ethical standpoint is in accord with the Hippocratic ideal, and that they are the work of physicians of great intellectual power and experience.

If we ask what is known about Hippocrates himself, and if we seek information rather than entertainment, our answer will be almost as meager. Hippocrates is no mythical figure, for he is mentioned with high respect by his younger contemporary, Plato. He was the son of a physician, and was born at Cos about 460 B.C. The most active period of his life thus began about 420 B.C. His death is placed between 377 and 359--the latter would make him 101, an appropriate age for a great physician. He led a wandering life, and is heard of at Cos, Thasos, Athens, in Thrace and elsewhere, and lastly in Thessaly, where his grave was long shown. Among his pupils were his two sons, and his son-in-law. Of the work of the latter we have a fragment preserved both by Aristotle and in the Hippocratic Collection itself.

That is all that is known about the Father of Medicine. We have not even his portrait. Yet we have something far better; we have an idealized representation of what the Greek would wish his physician to be. It is a noble bust to which the name of Hippocrates was early attached. Many copies exist (see Frontispiece). The calm, righteous and dignified presence which it portrays has stamped itself on the consciousness and conscience of those who follow the Art of Healing. To that gracious figure the medical man will continue to pay homage.

If critical examination has dealt thus hardly with the Hippocratic writings and with Hippocrates himself, what has been left which we may surely derive from the Greek medical system? The answer is that Medicine has from the Greeks two great things: the picture of a man and the institution of a method.

The man is Hippocrates himself. His figure, gaining in dignity what it loses in clearness, stands for all time as that of the ideal physician, for the ideal is there and is clearly set forth in these great writings, whether we discern the details of his earthly features or no. Calm and effective, humane and observant, prompt and cautious, at once learned and willing to learn, eager alike to get and give knowledge, unmoved save by the fear lest his knowledge may fail to benefit others--both the sick and their servants the physicians,--incorruptible and pure in mind and body, the figure of the greatest of physicians has gained, not lost, by time. In all ages he has been held by medical men in a reverence comparable only to that which has been felt towards the founders of the great religions by their followers. The figure of the Hippocratic physician has been of incalculable spiritual value to the medical profession in the twenty-three centuries that have passed since his death.

So much for the man. We turn now to the method.

The method of Hippocratic medicine is that known to-day as the experimental or better experiential. It was employed among the Greeks for centuries after the death of Hippocrates. Then came a time when a social and philosophical upheaval prevented its further prosecution. For the thousand years that followed the break-up of the Roman Empire the medical practice of Europe was at best a corrupted imitation and misunderstanding of the Hippocratic teaching; at worst it descended to a low level of Animism and Magic. Then there was a rally. Slowly--very slowly at first--the foundations of Modern Science were laboriously laid. Among the first elements in this scientific Renaissance was the recovery of the Hippocratic works.

In the centuries that followed this Renaissance the very words of the Hippocratic Collection were taught in the medical schools in a spirit that was anything but that of Hippocrates. Gradually, however, a better understanding crept into men’s minds. The spirit of those writings and their methods and observations came now rightly to be exalted above the works themselves. The works themselves were wisely dropped from the medical curriculum. They are no longer used in any medical school. But if we turn again to contemplate the Hippocratic treatises, we may recognize in them the modern process of careful record of data and cautious inference from them--that collation of experience from various sources obtained by various methods with which we are now so familiar. We may even see in full force the actual process of case-taking, bed side instruction and clinical lecture. These methods are practised much in the way in which we know them, and are set forth with a conciseness and beauty of language and a loftiness of ethical tone which have not since been surpassed. To such a collection medical men must always return. No part of it is more impressive than the so-called Hippocratic Oath.

The physician sits in the center. He holds a lancet in his right hand, seizes the patient’s right arm with his left and is bleeding him from a vein at the bend of the elbow. The blood falls into a large basin on the floor. Above the physician’s head are suspended three cupping vessels, shaped thus:

To the right sits a patient awaiting his turn to interview the physician. His left arm is bandaged. Behind this patient stands a figure smelling a flower as a preventive against infection. Behind the physician stands a man wounded in the left leg, which is bandaged. Back to back to this last figure is a dwarf with a disproportionately large head. His body exhibits deformities typical of the developmental disease now known as Achondroplasia. In addition to his other deformities, we note that his muscular body is hairy, and that the bridge of his nose is sunken. On his back he carries a hare which is almost as tall as himself. Talking to the dwarf is a man leaning on a long staff, who has the remains of a bandage round his chest.]

The Hippocratic Oath, in its present form, is of very much later date than Hippocrates. Yet parts of it may be even earlier than he, and some suggestion of the Oath is, perhaps, to be seen in the contents of Egyptian papyri of the second millennium B.C. It need hardly be said that the late date of the Oath by no means removes the interest of this grand ethical monument. No passage better reflects the spirit of the Hippocratic physicians. The oath is clearly designed for a youth entering on his apprenticeship to such a one.

‘I swear by Apollo the healer, invoking all the gods and goddesses to be my witnesses, that I will fulfil this Oath and this written Covenant to the best of my ability and judgement.

‘I will look upon him who shall have taught me this Art even as one of my own parents. I will share my substance with him, and I will supply his necessities, if he be in need. I will regard his offspring even as my own brethren, and I will teach them this Art, if they would learn it, without fee or covenant. I will impart this Art by precept, by lecture and by every mode of teaching, not only to my own sons but to the sons of him who has taught me, and to disciples bound by covenant and oath, according to the Law of Medicine.

‘The regimen I adopt shall be for the benefit of the patients according to my ability and judgement, and not for their hurt or for any wrong. I will give no deadly drug to any, though it be asked of me, nor will I counsel such, and especially I will not aid a woman to procure abortion. Whatsoever house I enter, there will I go for the benefit of the sick, refraining from all wrongdoing or corruption, and especially from any act of seduction, of male or female, of bond or free. Whatsoever things I see or hear concerning the life of men, in my attendance on the sick or even apart therefrom, which ought not to be noised abroad, I will keep silence thereon, counting such things to be as sacred secrets. Pure and holy will I keep my Life and my Art.

‘If I fulfil this Oath and confound it not, be it mine to enjoy Life and Art alike, with good repute among all men at all times. If I transgress and violate my oath, may the reverse be my lot.’

§ 3. Hippocratic Practice.