Part 9

134. Diagram illustrating alteration in Age-distribution of the population of England and Wales. Reproduced, by kind permission of the authors, from Carr-Saunders & Caradog Jones, Social Structure of England and Wales (Clarendon Press) 335

135. Death-rate from Cancer of the Tongue. Reproduced, by kind permission of the Editors, from The Quarterly journal of Medicine, vol. v, No. 5 337

136. Death-rate from Cancer of the Lip. Reproduced, by kind permission of the Editors, from The Quarterly Journal of Medicine, vol. v, No. 5 338

137. Death-rate from Cerebral Haemorrhage. Reproduced, by kind permission of the Editors, from The Quarterly Journal of Medicine, vol. v, No. 5 340

138. Curve showing percentage of deaths from Phthisis to total deaths 343

139. The normal curve of error 345

140. Curve of monthly number of deaths from Small-pox during an epidemic at Warrington, Lancashire, in 1743 346

141. Curve of weekly number of cases of Scarlet Fever during an epidemic at Glasgow in 1892 346

142. Analysis of curve representing death-rates from Summer Diarrhoea in London over a long period of years 347

ANCIENT GREECE

(TO ABOUT 300 B.C.)

§ 1. Origins of Greek Medicine.

Scientific Medicine began with the Greeks. The Greeks not only started scientific Medicine upon its course, but also provided the substantial basic elements of our anatomy, physiology and pathology, and above all, perhaps, our conception of the bodily ‘constitution’, ‘habit’ or ‘temperament’. It is from the Greeks that we derive almost all our medical nomenclature. When to this we add that our medical traditions are inherited through a direct and continuous chain from the Greek practitioners, it becomes evident that the debt that Medicine owes to this marvellous people is great indeed.

Now this debt has become associated with two or three great figures. The names Hippocrates, Aristotle, Galen, are familiar to all. Yet it is not always recognized that these men were but the representatives of a widely extended and long-lasting system. Greek Medicine was, in fact, like modern Medicine, the result of centuries of carefully recorded, collated and progressive research. Greek Medicine first assumed a scientific aspect with the Ionian and Italo-Greek philosophers at the very beginning of the sixth century B.C. It continued to make important advances until the death of Galen at the very end of the second century of the Christian era. Thus the life-span of progressive and scientific Medicine among the Greeks was no less than eight hundred years. With the most tolerant use of the words ‘scientific’ and ‘progressive’, we can hardly place the beginnings of modern Medicine in Europe before the end of the fifteenth century. Thus our own system has only been developing its characteristic features for some four and a half centuries, which is but little more than half the course that Greek science ran.

It is evident, therefore, that we may have much to learn from the Greeks, not indeed in matters of actual fact or observation--for nearly all that is directly useful in their writings has been absorbed long ago into our medical literature--but in spirit and method. From a study of the character and course of Greek medical science we can gain hints of the snares and pitfalls and catastrophes into which the Art of Medicine may at times be led. Further, by study of the practice of Medicine under conditions so different from ours, we learn something of what is truly permanent in the Art of Healing. Lastly, by tracing the growth of the Science of Medicine, as it arose among the Greeks and as it died in the hands of their less worthy descendants, we may take alike example and warning. We may learn to distinguish the healthy and vigorous growth of a science from the stunted and deformed products that are often acclaimed, even in our own times, as Wisdom’s final word to Man.

It has been said that, ‘save the blind forces of Nature, nothing lives or moves which is not Greek in origin’. The saying needs modification, for there is a thing which still lives and moves that is not Greek in origin, a blind force which is not a blind force of Nature. It is the force of Superstition, of that age-old belief that Nature will give us something for nothing, which is expressed by the word ‘Magic’. The Greeks were no more free from that contemptible fallacy than are the men of our own days. But the greatest of the Greeks stood wholly above such folly, and we can watch the Greek mind gradually lifting itself from that primeval mental attitude which is older than any known culture, older perhaps than any known race, the attitude of Nature-Worship, or ‘Animism’. To give an idea of how the ‘sweet reasonableness’ of the Greek mind gradually dissipated the animistic fog, a few words must be said about the history of the Greeks. Without that amount of history it would seem a miracle that Man ever became reasonable at all.

The Medicine we call Greek might be described as the system which prevailed in ancient times in that half of the Mediterranean area which lies east and south of the Italian Peninsula.

Up to about 1000 B.C. most of the coast-lands of this Mediterranean area were inhabited by that very remarkable people, the Minoans. These have left some extraordinary remains, the full significance of which has not yet been revealed. The general development of the Minoan civilization has, however, been clearly outlined by modern archaeological investigation. This has resulted in an entirely new interpretation of the story which Homer tells in the Iliad. The siege of Troy represents an attack by the invading Greeks on one of the last Minoan strongholds. About 1000 B.C. the whole Eastern Mediterranean basin was being overrun by the Greek tribes coming in from the north. These Greeks were no pure race, but a mixed multitude of invaders who came along several lines of advance. As always happens in such invasions, the conquered were not exterminated, but mingled with the invaders. Thus the Greeks, as they advanced, absorbed much of the culture and outlook of the civilization that they submerged.

In considering the history of Rational Medicine we are concerned chiefly with two main invading streams of Greek tribes: that of the Dorians, who passed towards Crete and towards the Island of Cos and the opposite peninsula of Cnidus, and that of the Ionians, who colonized most of the remaining part of western Asia Minor. These two peoples were, between them, responsible for the main intellectual output of the Greeks of those early days. The medical system which they initiated first took shape in western Asia Minor, and thence became diffused over the whole of the Greek world. The Greek system of Medicine which thus arose in Asia Minor had various roots, as indeed the Medicine of a mixed people, living under very complex social conditions, was bound to have.

Firstly, there was the submerged civilization of the conquered Minoan folk. It is probable that the cult of the serpent--so constantly associated with Aesculapius and still used as a medical emblem--was of Minoan origin, for the serpent was a symbol much used in the Minoan religion (Fig. 2). It is probable too that some of the hygienic ideas of the Greeks were derived from the same source, for the Minoans had an excellent system of drainage. We can, however, say little on this head because the interpretation of the Minoan records is still hidden from us.

FIG. 2. IVORY AND GOLD MINOAN STATUETTE of a votaress in a state of ecstasy. In either hand she holds a serpent, illustrating the importance attached to this animal in the Minoan cult. From the Museum of Fine Arts, Boston, U.S.A.

FIG. 3. SURGICAL INSTRUMENTS recovered from Babylonian sites. There are here represented three knives, a saw and a trephine. These instruments, which illustrate the state of surgery in the ancient Mesopotamian civilization, are in the possession of Professor Meyer-Steineg of Jena, by whose permission they are here reproduced.

Secondly, we have to remember that the shores of Asia Minor lie on the outskirts of the great civilization which had grown up in the valley of the Tigris and the Euphrates. The Greeks drew from that source much of their more superstitious beliefs, as well as some, at least, of their scientific method. On the one hand, the demoniac theories that bulk so largely in later Greek medicine doubtless came from Assyria and Babylonia. The Medicine of the New Testament, for instance, with its casting out of devils, is of Mesopotamian origin. But, on the other hand, the Mesopotamian peoples had for long ages laid up a great treasury of observation, notably of astronomical data which were often applied to astrological ends. There was also some knowledge of anatomy derived from the entrails of animals used in divination (Fig. 4). Working on the basis of these records, the Greeks were able to erect a scientific method which appears as a prominent feature in their intellectual life in later centuries. Moreover, there was in Mesopotamia a standardization of both medical and surgical procedure which the nimble-witted Greeks were quick to adopt (Fig. 3). On its lower and less intelligent side, however, the Mesopotamian material was made to minister to Greek superstition and especially to astrological belief.

FIG. 4. CLAY MODEL OF SHEEP’S LIVER used for instruction in divination in a Babylonian temple school. The object is now in the British Museum. It is covered with cuneiform writing, the nature and contents of which fix its date as about 2000 B.C. The writing is here omitted for the sake of simplicity.

Various parts of the liver have their Babylonian technical terms and can be identified with parts recognized by modern anatomists. Some of these modern terms are written on our drawing.

To each hole in the original model an inscription containing a forecast is assigned. The diviner made his forecast by comparing an actual liver with this clay model at each point corresponding to a hole. His forecast was elaborated according to the state of the liver at all these points.

Thirdly, to the Egyptian civilization the Greek debt was also considerable. Many drugs were derived from Egypt and others were suggested by Egyptian practice. The basis of Greek medical ethics, too, can be traced to Egypt. Some of the practical devices of Greek Medicine, such as the forms of the surgical instruments, were of Egyptian origin. Nor can we neglect the statement made by the Greeks themselves, that mathematical knowledge--the test and index of all scientific growth--came to them first from Egypt. Lastly, we note that the Egyptians deified a physician, Imhotep (Fig. 5), in exactly the way that the Greeks deified their physician Aesculapius (Fig. 6). Both Imhotep and Aesculapius were, in fact, historic personages, and their evolution into gods presents many interesting parallels.

FIG. 5. IMHOTEP, originally a physician, subsequently deified as an Egyptian god of Medicine. From a statuette in the British Museum.