THE ARGUMENT.
Although, as stated in the second section of the Preliminary Discourse, the evidence in support of this treatise be unfortunately not such as clearly to establish its genuineness, all who read it with attention must admit that it is replete with important matters, and that if not the production of Hippocrates, it is not unworthy of his high reputation. Notwithstanding, then, that I am by no means so well convinced as M. Littré is, that the work is genuine, I have not hesitated to follow his example in placing it at the head of the list, as the nature of its contents is such as to form an excellent introduction to the study of the Hippocratic medicine.
It contains, as M. Littré remarks, a polemic, a method, and a system. The polemic is directed against those of his predecessors who had corrupted medicine by introducing hypotheses into it as the causes of disease, such as heat, cold, moisture, and dryness. These it will be seen that he combats with great force of argument and clearness of illustration. The philosophical dogmas to which he is supposed to refer in this place are those of the section of Pythagoreans, called the Eleatic, who would appear to have held nearly the same opinions as Pythagoras himself with regard to the elements.[355] But, in fact, as I trust I have clearly made out in the third section of the Preliminary Discourse, all the ancient philosophers held substantially the same opinion regarding the elements, although they did not all express themselves in the same terms. It is of little consequence, then, to attempt to find out what particular class of philosophers our author directs his attack against, it being sufficient to say that he decidedly condemns the practice of founding the rules of medical practice on hypothesis.[356] I may here remark, that the censure thus bestowed on hypothetical systems applies to modern times as well as to ancient, to those who proclaim theories by which, like Broussais, they account for all diseases upon figments which they call inflammations, and those who, like Cullen, attribute most diseases to spasms. We may rest assured, from the sensible observations which Hippocrates makes on this subject in the present work, that the causes of all diseases are realities, provided we could find them out, and that they are not vague abstractions, as the authors of these hypotheses suppose.
His method of cultivating medicine is founded on an attentive examination of all the circumstances connected with real life, and his system consists in studying the condition of the humors in the body, their origin, their coction, and their disappearance.
The most prominent feature, however, in the contents of this little treatise is the practical view which is here given of the origin of medicine, namely, from the necessities and weaknesses of the human race. The author clearly makes it out that Medicine is, as it were, a corollary to Dietetics. Nothing of the kind can well be imagined more ingenious and original than his observations and reasonings on this head in the introductory sections to this treatise. See in particular § 5.
The remarks in refutation of the hypothesis of cold, heat, moist, and dry, are very interesting. (§ 13.)
The reflections on the origin of fevers and inflammations are very just and original, but would appear not to have been properly appreciated by his successors; for among all the ancient authors who have treated of fevers, there is, perhaps, no one but himself who has stated in decided terms that there is something more in a fever than a mere increase of the innate (or animal) heat. See the Commentary on Paulus Ægineta, B. II., 1.
The remarks on the effects of the cold bath at § 16 are much to the purpose, and deserve attention.
The observations on rheums or defluxions (§ 19) are also very striking, and even at the present day, after the many vicissitudes of medical theory which we have gone through, it would be difficult to deny that the opinions here advanced are well founded. At all events they must be allowed to be highly interesting, as containing the first germ of a theory which long flourished in the schools of medicine.
At § 20 the author seems to hold that philosophy is not so necessary to medicine as medicine is to philosophy. Schulze, with a considerable show of reason, argues that Celsus had this passage in view when he pronounced, concerning Hippocrates, that he was the first person who separated medicine from philosophy. (Hist. Med. I., 3, i., 26.) Schulze contends that what Celsus meant was, that Hippocrates discarded à priori arguments in medicine, and drew all his inferences from actual observation. This would appear to me the most plausible interpretation which has ever been given to this celebrated passage in the preface of Celsus. Philosophy, then, it would appear, freed medicine from the delusions of superstition, by substituting the errors of hypothesis in their place, and the important office which he who was called the Father of Medicine conferred upon the art was by discarding both superstition and hypothesis, and substituting the results of actual observation in the room of both.
From § 22 to the end of the work the author gives important observations on the modifications which diseases undergo in connection with the peculiar organization of the part in which they are situated. It may well be doubted whether the remarks and reflections herein contained have ever obtained all the attention which they merit.
The style of this piece is certainly elegant and beautiful; and it is proper to mention that the text is remarkably improved in M. Littré’s edition. In all the previous editions it was more corrupt than that of almost any other of the Hippocratic treatises.
The following remarks of M. Littré on the present work appear to me so just, and are so elegantly expressed, that I cannot deny myself the pleasure of introducing them here in the original:
“En résumé, le livre de l’Ancienne Médecine donne une idée des problèmes agités du temps d’Hippocrate, et de la manière donts ils étaient débattus. Il s’agissait, dans la plus grande généralité de la pathologie de déterminer la cause des maladies ou, en d’autres termes, de poser les bases d’un système de médecine. Certains médecins disaient que cette cause, étant une, résidait dans une propriété unique du corps, propriété qu’ils spécifiaient. Hippocrate répétait qu’en fait, cela était en contradiction avec l’expérience, qu’en principe une hypothèse était suspecte et stérile, et qu’il n’y avait de sureté que dans l’études des faits et dans la tradition de la science qui y ramene. Ainsi, quatre cents ans avant J. C., on essayait de rattacher toute la médecine à une seule propriété hypothétique, comme on l’a essayé de nos jours; mais cette propriété était ou le chaud, ou le froid, ou l’humide, ou le sec. Quatre cents ans avant J. C., un esprit sévère et éclairé combattait de telles opinions au nom de l’expérience, montrait que les causes des maladies ne pouvant pas se ramener à une seule, le champ de la pathologie générale était bien plus vaste qu’on ne croyait; et formulait ce que l’observation lui avait permis de conclure; mais sa conclusion n’embrasse guère que la trouble dans le mélange des humeurs, que leur coction et leurs crises. Depuis lors, la méthode de ceux qu’Hippocrate avait combattus, et la méthode d’Hippocrate, l’hypothèse et l’observation se sont perpétuées, ainsi que le témoigne l’histoire de la médecine, mais ce ne sont plus ni l’ancienne hypothèse, ni l’ancienne observation.
“Il est certainement instructif d’étudier, dans le cours du temps, les problèmes tels qu’ils ont été posés, et les discussions qu’ils ont soulevées. On le voit, la science antique a de grandes ressemblances avec la science moderne; dès l’époque que nous sommes forcés de regarder comme l’aurore de la médecine, dès les premiers monuments que nous possédons, les questions fondamentales sont débattues, et les limites de l’esprit humain sont touchées. Mais en dedans de ces limites, la science trouve, dans une immensité inépuisable de combinaisons, les matériaux qui la font grandir; et il est impossible de ne pas reconnaître que, sur un sol et avec les aliments que lui fournissent les choses et l’expérience, elle se développe en vertu d’un principe interne de vie, qui reside dans l’enchaînement nécessaire de son développement successif.”[357]