Part 12

Karl Ernst von Baer, Ueber die Entwickelungsgeschichte der Thiere, Königsberg, 1828-37.

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.’

GREEK MEDICINE

Ἡρόφιλος δὲ ᾝἐν τῷ Διαιτητικῷ καὶ σοφίαν φησὶν ἀνεπίδεικτον καὶ τέχνην ἄδηλον καὶ ἰσχὺν ἀναγώνιστον καὶ πλοῦτον ἀχρεῖον καὶ λόγον ἀδύνατον, ὑγιείας ἀπούσης.

Herophilus, a Greek philosopher and physician (c. 300 B. 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’. 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 on observation 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 a history. We cannot establish those elements of continuity and of development from which alone history can be constructed.

The works of Herophilus are lost. This fine passage has been preserved for us by Sextus Empiricus, a third century physician, in his πρὸς τοὺς μαθηματικοὺς ἀντιρῥητικοί, which is in essence an attack on all positive philosophy. It is an entertaining fact that we should have to go to such a work for remains of the greatest anatomist of antiquity. The passage is in the section directed against ethical writers, xi. 50.

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 as physicians (= naturalists, φύσις = nature), and that word itself stands as a lasting reminder of their achievement.

The word φυσικός, though it passed over into Latin (Cicero) with the meaning naturalist, acquired the connotation of sorcerer among the later Greek writers. Perhaps the word physicianus was introduced to make a distinction from the charm-mongering physicus. In later Latin physicus and medicus are almost always interchangeable.

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 as from 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, in geographical 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, the type 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. 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, as an instance, some prescriptions in the Ebers papyrus of the eighteenth dynasty (about the sixteenth century B. C.) discovered at Thebes in 1872 resemble certain formulae in the Corpus Hippocraticum. A number of drugs, too, habitually used by the Greeks, such as Andropogon, Cardamoms, and Sesame orientalis, are of Indian origin. There are also the Minoan cultures to be considered, and our knowledge is not yet sufficient to speak of the heritage that Greek medicine may or may not have derived from that source, though it seems not improbable that Greek hygiene may here owe a debt. Omitting, therefore, this early epoch, we pass direct to the later period, between the sixth and fourth centuries, from which documents have actually come down to us.

This fragment has been published in vol. iii, part 1, of the Supplementum Aristotelicum by H. Diels as Anonymi Londinensis ex Aristotelis Iatricis Menonis et Aliis Medicis Eclogae, Berlin, 1893. See also H. Bekh and F. Spät, Anonymus Londinensis, Auszüge eines Unbekannten aus Aristoteles-Menons Handbuch der Medizin, Berlin, 1896.

It is tempting, also, to connect the Asclepian snake cult with the prominence of the serpent in Minoan religion.

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 century B. 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 of Sentences or 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 century B. 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 century B. C. by a commission of Alexandrian scholars at the order of the book-loving Ptolemy Soter (reigned 323-285 B. C.). The elements of which this collection is composed are of varying dates from the sixth to the fourth century B. C., and of varying value and origin, but they mainly represent the 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 cultivate pronoia. 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....’

This word pronoia, as Galen explains (εἰς τὸ Ἱπποκράτους προγνωστικόν, K. xviii, B. p. 10), is not used in the philosophic sense, as when we ask whether the universe was made by chance or by pronoia, nor is it used quite in the modern sense of prognosis, though it includes that too. Pronoia in Hippocrates means knowing things about a patient before you are told them. See E. T. Withington, ‘Some Greek medical terms with reference to Luke and Liddell and Scott,’ Proceedings of the Royal Society of Medicine (Section of the History of Medicine), xiii, p. 124, London, 1920.

Prognostics 1.

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 be expected 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. 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.

There is a discussion of the relation of the Asclepiadae to temple practice in an article by E. T. Withington, ‘The Asclepiadae and the Priest of Asclepius,’ in Studies in the History and Method of Science, edited by Charles Singer, vol. ii, Oxford, 1921.

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. 430 B. C.). His view that the blood is the seat of the ‘innate heat’, ἔμφυτον θερμόν, 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 the sacrificial 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. 545 B. C.), an Ionian predecessor of Empedocles, may be said to have defined for us these functions of the pneuma; οῖον ἡ ψυχὴ ἡ ἡμετέρα ἀὴρ οῧσα συγκρατεί ἡμᾶς, ὅλον τὸν κόσμον πνεῦμα καὶ ἀὴρ περιέχει ‘As our soul, being air, sustains us, so pneuma and air pervade the whole universe’; 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.

The works of Anaximenes are lost. This phrase of his, however, is preserved by the later writer Aetios.

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. 490 B. 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. 500 B. C.), who began to construct a positive basis for medical science by the practice of 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. 480 B. C.) and Pausanias (c. 480 B. C.), and the later Philistion of Lokri, the contemporary of Plato, all made anatomical investigations.

For the work of these physicians see especially M. Wellmann, Fragmentsammlung der griechischen Aerzte, Bd. I, Berlin, 1901.