An Epitome of the History of Medicine

by Roswell Park

CHAPTER I.

Medicine Among the Hebrews, the Egyptians, the Orientals, the Chinese, and the Early Greeks.—The Asclepiadæ.—Further Arrangement into Periods ( Renouard's Classification). The Age of Foundation.—The Primitive; Sacred, or Mystic; and Philosophic Periods.—Systems in Vogue: Dogmatism, Methodism, Empiricism, Eclecticism.—Hippocrates, born 460 B.C.

Of the origin of medicine but little need be said by way of preface, save that it must have been nearly contemporaneous with the origin of civilization. The lower animals when sick or wounded instinctively lessen or alter their diet, seek seclusion and rest, and even in certain cases seek out some particular herb or healing substance. Thus, too, does the savage in his primitive state; and experience and superstition together have led nearly all the savage tribes into certain habits and forms in case of injury or disease. For us the history of medicine must necessarily begin with the written history of events, and its earliest endeavors need detain us but a very short time. Its earliest period is enveloped in profound obscurity, and so mingled with myth and table as to be very uncertain. It embraces an indefinite time, during which medicine was not a science, but an undigested collection of experimental notions,—vaguely described, disfigured by tradition, and often made inutile by superstition and ignorance. The earliest records of probable authenticity are perhaps to be met with in the Scriptures, from which may be gathered here and there a fair notion of Egyptian knowledge and practice. Thus we read that Joseph commanded his servants and physicians to embalm him, this being about 1700 B.C.. It shows that Egypt at that time possessed a class of men who practiced the healing art, and that they also embalmed the dead, which must have both required and furnished a crude idea of general anatomy. We are also informed from other sources that so superstitious were the Egyptians that they not only scoffed at, but would stone, the embalmers, for whom they had sent, after the completion of their task. The probably mythical being whom the Egyptians called Thoth, whom the Greeks named Hermes and the Latins Mercury, passed among the Egyptians as the inventor of all sciences and arts. To him are attributed an enormous number of writings concerning all subjects. Some have considered him as identical with Bacchus, Zoroaster, Osiris, Isis, Serapis, Apollo, and even Shem, the son of Xoah. Others have thought him to be a god. It is now almost certain that the books attributed to Hermes were not the work of anyone hand or of any one age. The-last six volumes of the forty-two composing the encyclopaedia, with which Hermes is credited, refer to medicine, and embrace a body of doctrines fairly complete and well arranged. Of these six, the first treats of anatomy; the second, of diseases; the third, of instruments; the fourth, of remedies; the fifth, of diseases of the eye; and the sixth, of diseases of women. In completeness and arrangement it rivals, if not surpasses, the Hippocratic collection, which it antedated by perhaps a thousand years. The Egyptians appear at first to have exposed their sick in public (at least, so says Strabo), so that if any of those who passed by had been similarly attacked they might give their advice for the benefit of the sufferers. In fact, according to Herodotus, the same custom prevailed among the Babylonians and Lusitanians. At a later date all who were thus cured were required to go to the temples and there inscribe their symptoms and what had helped them. The temples of Canopus and Vulcan at Memphis became the principal depots for these records, which were kept as carefully as were the archives of the nation, and were open for public reference. These records, being under the control of the priests, were mainly studied by them, who later collected a great mass of facts of more or less importance, and endeavored to found upon the knowledge thus collected an exclusive practice of the art of medicine. In this way they formed their medical code, which was called by Diodorus the Hiera Sacra, Sacred Book, from whose directions they were never allowed to swerve. It was perhaps this code which was later attributed to Hermes, and that made up the collection spoken of by Clement of Alexandria. If in following these rules they could not save their patients they were held blameless, but were punished with death if any departure from them were not followed by success.

I have spoken of embalming as practiced by the Egyptians. It was of three grades: the first reserved for men of position and means, which cost one talent, and according to which the brain was removed by an opening through the nasal fossæ, and the intestines through an opening on the left side of the abdomen, after which both cavities were stuffed with spices and aromatics; then the body was washed and spread over with gum and wrapped in bandages of linen. The second grade was adopted by families of moderate means; and the third was resorted to by the poor, consisting simply in the washing of the body and maceration in lye for seventy days.

Pliny assures us that the kings of Egypt permitted the opening of corpses for the purpose of discovering the causes of disease, but this was only permitted by the Ptolemies, under whose reign anatomy was carried to a very high degree of cultivation.

The medicine of the Hebrews is known generally through the Sacred Scriptures, especially through the writings attributed to Moses, which embraced rules of the highest sagacity, especially in public hygiene. The book of Leviticus is largely made up of rules concerning matters of public health. In the eleventh chapter, for instance, meat of the rabbit and the hog is proscribed, as apparently injurious in the climate of Egypt and India; it, however, has been suggested that there was such variation of names or interpretation thereof as to make it possible that our rabbit and hog are not the animals alluded to by Moses. The twelfth and fifteenth chapters of the same book were designed to regulate the relation of man and wife and the purification of women, their outlines being still observed in some localities by certain sects, while the hygienic measure of circumcision then insisted upon is still observed as a religious rite among the descendants of Moses. For the prevention of the spread of leprosy, the measures suggested by Moses could not now be surpassed, although ancient authors have confounded under this name divers affections, probably including syphilis, to which, however, the same hygienic rules should apply. Next to Moses in medical lore should be mentioned Solomon, to whom is attributed a very high degree of knowledge of natural history, and who, Josephus claimed, had such perfect knowledge of the properties of all the productions of nature that he availed himself of it to compound remedies extremely useful, some of which had even the virtues necessary to cast out devils.

The most conspicuous feature in the life of the Indian races is their division into castes, of which the most noble is that of the priests, or Brahmins, who in ancient times alone had the privilege of practicing medicine. Their Organon of Medicine, or collection of medical knowledge, was a hook which they called Vagadasastir. It was not systematically arranged, and in it demonology played a large rôle. They held the human body to consist of 100,000 parts, of which 17,000 were vessels, each one of which was composed of seven tubes, giving passage to ten species of gases, which by their conflicts engendered a number of diseases. They placed the origin of the pulse in a reservoir located behind the umbilicus. This was four fingers wide by two long, and divided into 72,000 canals, distributed to all parts of the body. The physician examined not only the pulse of his patient, but the dejecta, consulted the stars, the flight of birds, noted any incidental occurrence during his visits, and made up his prognosis from a multitude of varying circumstances, omitting only those which were really valuable, namely, the symptoms indicating the state of the organs. Ancient Hindoo charlatan priests let fall from the end of a straw a drop of oil into the patient's water. If the oil was precipitated and attached itself to the bottom of the vessel, they predicted an unfavorable result; if, on the contrary, it floated, they gave a favorable prognosis. This is, so far as we know, the earliest recorded way of testing the specific gravity of the urine.

With all their absurdities, however, the Indians appear to have done some things that we scarcely do to-day: they arè said to have had an ointment that caused the cicatrices of variola to disappear, and they cured the bites of venomous serpents with remedies whose composition has been lost.

The antiquity of the Chinese is simply lost in tradition and fable. From time immemorial their rulers have taken extraordinary care to prevent contact and interchange of ideas with foreigners. For 4000 years their manners, laws, religious beliefs, language, and territory have scarcely changed. In this respect they stand alone among the nations of the earth. They attribute the invention of medicine to one of their emperors named Hoam-ti, who was the third of the first dynasty, and whose supposititious date is 2687 B.C. He is considered to be the author of the work which still serves them as a medical guide. It is, however, more probably an apochryphal book. Its philosophy was of a sphygmic kind,—i.e., based upon the pulse, which they divided into the supreme or celestial, the middle, and the inferior or terrestrial; by the examination of which the Chinese physician was supposed not only to show the seat of disease, but to judge of its duration and gravity. It is related that one of the ancient Chinese emperors directed the dead bodies of criminals to be opened, but this is questionable, since it is certain that they have the most profound ignorance of rudimentary anatomy, and glaring errors abound in their system. Being thus replete with errors, and possessing no anatomical knowledge, their surgery was of the most barbarous type. No one dared attempt a bloody operation; the reduction of hernia was unknown; a cataract was regarded as beyond their resources; and even venesection was never practiced. On the other hand, they employed cups, and acupuncture, fomentation, plasters of all kinds, lotions, and baths. The moxa, or red-hot button, was in constant use, and they had their magnetizers, who appear to have been convulsionists. For a long time there existed at Pekin an Imperial School of Medicine, but now there is no such organization nor any regulation for the privilege of practicing medicine or surgery since 1792. At least until lately the country and the cities were infested with quacks, who dealt out poison and death with impunity. They practiced most murderous methods in place of the principles of midwifery. Only since the civilized missionaries have penetrated into their country has there been any improvement in this condition of affairs.

It is Greece which furnishes us with the most interesting and the most significant remains of the history of medicine during antiquity, as she furnishes every other art with the same historical advantages. During the period preceding the Trojan War there is little hut myth and tradition. Leclerc catalogued some thirty divinities, heroes or heroines, who were supposed to have invented or cultivated some of the branches of medicine. Melampus is perhaps the first of these who immortalized himself by extraordinary cures, especially on the daughters of Proetus, King of Argos. These young princesses, having taken vows of celibacy, became subjects of hysterical monomania, with delusions, during which they imagined themselves transformed into cows and roamed the forests instead of the palaces. This nervous delusion spread to and involved many other women, and became a serious matter.

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Melampus, the shepherd, having observed the purgative effects upon goats of white hellebore, gave to the young women milk in which this plant had been steeped, thereby speedily effecting a cure. Scarcely less distinguished than Melampus was Chiron. He was mainly distinguished because he was the preceptor of Æsculapius, the most eminent of early Greeks in this field. By some Æsculapius was considered the son of Apollo by the nymph Coronis.

Several cities of Greece contended for the honor of his birthplace, as they did for that of Homer. That he was famous at the time of the Argonautic expedition is seen by the fact that the twins Castor and Pollux desired him to accompany the expedition as surgeon. Be his origin what it may, Æsculapius was the leading character in medicine of all the ancients, with the possible exception of Hermes among the Egyptians; in fact, some scholars consider the two identical. Temples were erected in his honor, priests were consecrated to them, and schools of instruction were there established. It is related that Pluto, god of hell, alarmed at the diminishing number of his daily arrivals, complained to Jupiter, who destroyed the audacious healer—on which account, some wit has said, "the modern children of Æsculapius abstain from performing prodigies," But the true Æsculapians, the successors of the demigod, wrere imitated or copied by the crowd of charlatans and quacks, calling themselves theosophs, thaumaturgs, and so on, and not alone at that date, but for generations and centuries thereafter, Paracelsus and Mesmer being fair examples of this class. The poet Pindar, who lived seven or eight hundred years after Æsculapius, says that he cured ulcers, wounds, fever, and pain of all who applied to him by enchantment, potions, incisions, and by external applications. *

* Third Pythian Ode,

The followers of Æsculapius, and the priests in the temples dedicated to him, soon formed a separate caste, transmitting from one to another, as a family heritage, their medical knowledge. At first no one was admitted to practice the sacred science unless lie joined the priesthood, although later this secrecy was relaxed. They initiated strangers, provided they fulfilled the test which they made. Some kind of medical instruction was given in each temple. The three most celebrated temples to Æsculapius were that of Rhodes, already extinct by the time of Hippocrates; that of Cnidus, which published a small repertory; and finally that of Cos, most celebrated of all, because of the illustrious men who emanated from this school. In these temples votive tablets were fastened in large numbers, after the fashion of the Egyptians, the same giving the name of the patient, his affliction, and the manner of his cure. For example, such a one as this: "Julien vomited blood, and appeared lost beyond recovery. The oracle ordered him to take the pine-seeds from the altar, which they had three days mingled with honey; he did so, and was cured."

[Original]

Having solemnly thanked the god, he went away. There is reason to think that the priests of these temples made for their own uses much more minute and accurate accounts, which should be of some real service, since the writings which have come down to us evince a habit of close observation and clear description of disease. During the Trojan War two men are frequently mentioned by Homer as possessing great surgical skill. These were Machaon and Podalirius. They were regarded as sons of Æsculapius, the former being the elder. The first account of venesection, although not authentic, refers to the bleeding practiced by the latter upon the daughter of the King of Caria, upon whose shores Podalirius was cast by tempest after the ruin of Priam's kingdom. Whether he was the first of all men to practice it or not, it is certain that the act of venesection goes back long prior to the era of Hippocrates, who speaks of it as frequently performed.

Many of the deities upon Olympus seem at one time or another to have usurped medical functions. Apollo, the reputed father of Æsculapius, appropriated nearly everything under the name of Pæon, who assumed the privilege of exciting or subduing epidemics. Juno was supposed to preside at accouchements, and in both the Iliad and Odyssey it is indicated that Apollo was considered as the cause of all the natural deaths among men, and Diana of those among women.

The long Trojan War appears to have been an epoch-making event in the medical and surgical history of those times, as was the Civil War recently in our country. Certain vague and indefinite practices then took more fixed form, and from that time on medicine may be said to have been furnished with a history. After the dethronement of Priam and the destruction of his capital, navigation was free and unrestricted. The Hellenists covered with their colonies both shores of the Mediterranean, and their navigators even passed the pillars of Hercules. By these means the worship of Æsculapius passed from Greece into what is now Asia, Africa, and Italy. In his temple at Epidaurus was a statue of colossal size made of gold and ivory. The dialogues of Plato, especially the Phædo, make it apparent that the cock was the animal sacrificed to him, and hence sacred to the god of medicine. The priests attached to his worship were called Asclepiacloe, or descendants of Æsculapius. The temples were usually hygienically located near thermal springs or fountains and among groves. Pilgrimages were made from all quarters, and these localities became veritable health-resorts. A well-regulated dietary, pure air, temperate habits, and faith stimulated to a fanatical degree combined and sufficed for cures which even nowadays would be regarded as wonderful. The priests prescribed venesection, purgatives, emetics, friction, sea-baths, and mineral waters, as they appeared to be indicated. The imagination of the patient was continually stimulated, and at the same time controlled. Before interrogating the oracles they must be purified by abstinence, prayer, and sacrifice. Sometimes they were obliged to lie in the temple for one or more nights. The gods sometimes revealed themselves in mysterious ways, at times devouring the cakes upon the altars under the guise of a serpent, or again causing dreams which were to be interpreted by^the priests. There can be no doubt that sometimes, at least, the grossest frauds and the basest trickery were relied upon for the purpose of impressing the minds of those weakened by abstinence or influenced by drugs. Mercenary considerations were not lacking; moreover, cures were often not obtained until zeal had been redoubled by largely increased contributions to the treasury of the temples. In the neighborhood of many of these temples serpents abounded, non-venomous and easily tamed. These were employed by the priests in various supernatural performances by which the ignorant people were astonished and profoundly impressed. In fact, the serpent and the serpent-myth played a very large rôle in the early history of medicine as well as that of religion and religious symbolism.

It will thus be seen that during the space of about 700 years medicine underwent a transformation in Greece. It was first domestic and popular, practiced by shepherds, soldiers, and others; then became sacerdotal; after the Trojan War it was confined to the vicinity of the temples and practiced in the name of some divinity; and finally it was wrapped in mystery and mystic symbolism, where superstition was played upon and credulity made to pay its reward. Down to the time of Hippocrates the Asclep-iadæ rendered some genuine service to science, especially by inculcating habits of observation, in which Hippocrates excelled above all. Later, however, down to the time of the Christian era, medicine in the temples declined, and became, in fact, a system based upon the grossest jugglery.

It is time now that we make a systematic attempt to classify events in the history of medicine, and to recognize certain distinct epochs as they have occurred. For this purpose I know of no better arrangement than that of Renouard, which, in the main, I shall follow, at least during the forepart of this book. In this sense he divides the past into three ages, known, respectively, as the Age of Foundation, the Age of Transition, and the Age of Renovation. Each of these chronological divisions is subdivided into periods, of which the first contains four:—