Aristotle, whose father was a physician and a descendant of Aesculapius, was the hero and guiding spirit of those who based their philosophy on experience, on ascertained facts. Like his celebrated pupil, Alexander the Great, who brought whole nations under his sway, he too was a conqueror in every field of human knowledge. His ideas ruled supreme over the minds of men for thousands of years and to-day, although many of them are no longer accepted as valid, Aristotle himself is universally held to have been the greatest thinker and investigator who has ever lived upon this earth. (In chapter XIII. I shall have occasion to say something further regarding the Dogmatics and the Empirics.)
Out of the teachings of Plato and Aristotle developed two schools of philosophy that exerted, in course of time, a great influence upon the minds of men and upon the growth of medical science. The schools referred to are the Epicureans and the Stoics. Epicurus (242–270 B. C.), who gave his name to the first of these, taught that the highest good was happiness.
The happiness he taught his followers to seek was not sensual enjoyment, but peace of mind as the result of the cultivation of all the virtues. According to the teaching of his school virtue should be practiced because it leads to happiness; whereas the Stoics taught that virtue should be cultivated for her own sake, irrespective of the happiness it will ensure. Zeno (circa 370–260 B. C.), the founder of the Stoic philosophy, taught an ethical system according to which virtue consists in absolute judgment, absolute mastery of desire, absolute control of the soul over pain, and absolute justice. The keynote of the system is duty, as that of Epicureanism is pleasure. (Sir William Smith.)
In addition to the sects named above, there was still another known as the Older Dogmatic School, which was composed of men who had been the direct followers of the great master, but who, forgetting altogether the practical teachings of Hippocrates with regard to the importance of experience, gave themselves up to all sorts of hypotheses and theories. Among the names of the earliest followers of this school one is astonished to find those of Thessalus and Draco, the sons of Hippocrates, as well as the name of Polybus, the latter’s son-in-law. Diocles of Carystos and Praxagoras of Cos, two of the most distinguished men of that period, were also among the earliest members of this dogmatic school. Diocles, who was one of the Asclepiadae, owed his celebrity in part to his contributions to our knowledge of anatomy and in part to the work which he had done in other departments of medicine. Unfortunately, all of these writings have been lost with the exception of a few fragments which came to light toward the middle of the nineteenth century. Praxagoras was also one of the Asclepiadae. He was distinguished, as has already been stated on an earlier page, by the fact that he—and not Aristotle, as is sometimes stated—was first to recognize the difference between arteries and veins, and also by the further fact that he called attention to the practical value of the pulse as an indication, in certain diseases, of the tone of the patient’s bodily condition or vitality.
CHAPTER X
ERASISTRATUS AND HEROPHILUS, THE TWO GREAT LEADERS IN MEDICINE AT ALEXANDRIA; THE FOUNDING OF NEW SECTS
Two of the most celebrated physicians of that period (305–280 B. C.) were Erasistratus and Herophilus, both of whom were distinguished as the founders of schools or sects of medicine at Alexandria. They had received their early training as physicians from Chrysippus, a widely known Stoic philosopher, who, according to Albert von Haller, had taught at the school of Cnidus and had also written on medical topics; and, among the other teachers, it is stated that Anaxagoras of Cos had instructed Herophilus, and that Metrodorus, the son-in-law of Aristotle, had performed the same service for Erasistratus. So far as fundamental principles are concerned, the schools founded by these two physicians at Alexandria differed very little from each other, and the men themselves also gained their distinction in very much the same branches of medical knowledge, both of them having made a number of original discoveries in anatomy and both of them having become eminent practitioners.
Herophilus was born at Chalcedon, a Greek city on the Propontus, nearly opposite to Byzantium. We possess no knowledge whatever regarding the earlier years of his career, notwithstanding the fact that no fewer than four different men devoted their energies to the writing of his biography. The books themselves have been either lost or destroyed. Herophilus showed a decided leaning toward the study of anatomy, and his contributions to this branch of medicine are among the earliest which we possess. Herophilus strove to supply one of the most conspicuous deficiencies in the Hippocratic system of medicine, viz., inadequate knowledge of the nervous system; and to this end he conducted a series of the most careful investigations, as a result of which he was successful in establishing several facts previously unknown. He described the membranes of the brain, the choroid plexus, the venous sinuses, the structure which bears his name,—the torcular Herophili,—the cerebral ventricles, and the calamus scriptorius; he traced the course of the nerve trunks for some distance from their origin in the brain and spinal cord; and it was he who established the fact that two different sets of nerves exist—one for conveying sensations to the brain and the other for producing motion. In addition, he investigated the corpus vitreum, the retina, the optic nerve, etc. He also called attention to the peculiar mode of construction of the duodenum, and to the fact that the walls of the arteries are thicker than those of the veins. Some idea of the accurate manner in which he carried on his anatomical researches may be gained from the fact that he noted the circumstance that the left vena spermatica occasionally originates in the vena renalis.
Herophilus also gained distinction in the practical branches of medicine. According to Puschmann he laid the foundations for a scientific sphygmography. Thus he distinguished several varieties of pulse in accordance with the differences which he noted in its strength, regularity, degree of fulness, and rate of speed. He also must have had considerable experience in surgery, as is shown by his remark that a dislocation of the thigh, owing to the tearing of the ligamentum teres which necessarily accompanies such a dislocation, is likely to occur again in the same individual. In his writings relating to the practice of medicine, Herophilus upheld the principle that experience alone should be our guide, as theoretical considerations are not to be trusted. He is also credited with having said, in response to the question, Whom do you consider the best physician? “Him who knows how to distinguish what is attainable from what is unattainable.”
Erasistratus, the contemporary of Herophilus and his associate in the work of establishing at Alexandria a great anatomical and clinical medical school, was a native of Julis, in the Island of Ceos, not far from the coast of Attica. In the earlier part of his professional career he spent some time at the Court of Seleucus, the founder of the Syrian monarchy (312–280 B. C.). This monarch, who had been one of Alexander the Great’s distinguished generals, consigned the government of the eastern part of his vast kingdom to his son Antiochus. The latter fell ill about this time, and the most distinguished physicians of the Court were then called in to determine what was the nature of his malady and to decide upon the proper treatment. The patient grew more and more languid, showed complete indifference to all that took place about him, and steadily lost flesh. Erasistratus, who was one of the physicians summoned, observed his behavior very closely and soon noted the fact that, whenever Stratonice, his young and attractive stepmother, entered the sick room, Antiochus became agitated; his face being flushed, his voice subdued, his pulse more rapid, and his eyes brighter, all of which signs of excitement disappeared when Stratonice left the room. From these phenomena this shrewd observer drew the inference that the patient was deeply but hopelessly in love with his father’s second wife. Accordingly he informed Seleucus that his son’s illness was simply the result of having lost his heart to one who was unable to return his affection. Seleucus, who was much astonished, asked with deep interest who was the lady. “My wife,” replied Erasistratus, without an instant’s hesitation. “But tell me then,” asked Seleucus, “would you be willing to cause the death of my son, who is so very dear to me, by refusing to give up your wife to him?” “Would you, yourself, my lord, under similar circumstances,” replied the physician, “be willing to give up Stratonice to the Prince, if it had been she with whom he had fallen in love?” Seleucus having already vowed that he would not hesitate for a moment to do so, Erasistratus declared the whole truth to him, and of course there was nothing left for the King but to keep his word. History fails to state whether or not the lady made any objection to the transfer. As Antiochus lived to reign for many years after the murder of his father, it is safe to assume that he recovered his health.
This brief tale, the truth of which is not disputed by any of the authorities, reveals Erasistratus to have been a clever diagnostician, to have possessed a profound knowledge of human nature, and to have been a man of exceptional courage; in short, he was a physician admirably fitted to act as the founder and leader of one of the two great medical schools of Alexandria. The following account may suffice to convey some idea of his career after he became established at the latter city.