CHAPTER III.
POST-HIPPOCRATIC GREEK MEDICINE.—THE SCHOOLS OF MEDICINE.
The Dogmatic School.—Praxagoras of Cos.—Aristotle.—The School of Alexandria.—Theophrastus the Botanist.—The great Anatomists, Erasistratus and Hierophilus, and the Schools they founded.—The Empiric School.
The Dogmatic School.
It was only natural that the philosophical Greeks should discuss medicine at as great a length as they discussed philosophy; accordingly, we find that no sooner had our art taken its place amongst the subjects worthy of being seriously considered by the Greek intellect, than it was as much talked about as practised, and wrangled over as though it were a system of religion. Sects arose which opposed each other with the greatest vehemence; and Hippocrates had not long formulated his teaching when his disciples elevated his principles into a dogmatism which challenged, and shortly provoked, opposition of various kinds. Then arose the schools of medicine which ultimately became famous, as those of the Dogmatists, Empirics, Methodists, Pneumatists, etc. The Dogmatists boasted of being the Rational and Logical school. They held that there is a certain connection between all the arts and sciences, and that it is the duty of the physician to avail himself of all sorts of knowledge on every subject which bears any relationship to his own. They made, therefore, the most careful inquiry into the remote and proximate causes of disease. They examined the influence on the human body of airs, waters, places, occupations, diet, seasons, etc. They formulated general rules, not of universal application, but modified their treatment according to circumstances, availing themselves of whatever aid they could obtain from any source. Hippocrates had said, “The physician who is also a philosopher is equal to the gods,” and the Dogmatists elevated this into an article of their creed. Hippocrates, Galen, Oribasius, Ætius, Paulus Ægineta, and the Arab physicians were dogmatists. The founders of the school were the sons of Hippocrates—Thessalus and Draco. The former was the eldest son of the great physician, and was the more famous of the two. He passed a great part of his life as physician in the court of Archelaus, king of Macedonia.[399] His brother, Draco, was physician to Queen Roxana, wife of Alexander the Great.
We may say, therefore, that the oldest, most famous, and worthy of the ancient medical sects arose about 400 B.C., and retained its power over the medical profession till the rise of the Empirical sect in the Alexandrian school of philosophy. We are indebted to Celsus for a lucid and admirable exposition of the doctrines professed by these two medical parties.[400]
The Dogmatists maintained that it was not enough for the physician to know the mere symptoms of his patient’s malady. It does not suffice to know the evident causes of the disorder, but he must acquaint himself with the hidden causes. To acquire this knowledge of the hidden causes, he must study the hidden parts, and the natural actions and functions of the body in health. He must know the principles on which the human machinery is constructed before he can scientifically treat the accidents and disturbances to which it is liable. It was not, therefore, a mere subject of philosophical interest to hold with some physicians that diseases proceed from excess or deficiency of one or other of the four elements, or with others, that the various humours or the respiration were at fault. It was not of merely academic interest to suppose that the abnormal flow of the blood caused inflammations, or that corpuscles blocked up the invisible passages. The doctor must do more than speculate on these things in his discussions. He must have a theory upon them which he could apply to the treatment of his patients, and the best physician would be the one who best knew how the disease originated. Experiments without reasoning were valueless; their chief use was to inform the experimenter whether he had reasoned justly or conjectured fortunately. When the physician is confronted by a new form of disease for which no remedy has been discovered, he must know its cause and origin, or his practice will be mere guess-work. Anybody can discover the evident causes—heat, cold, over-eating. These things the least instructed physician will probably know. It is the knowledge of hidden causes which makes the superior man. He who aspires to be instructed must know what we now call physiology—why we breathe, why we eat, what happens to the food which we swallow, why the arteries pulsate, why we sleep, etc. The man who cannot explain these phenomena is not a competent doctor. He must have frequently inspected dead bodies, and examined carefully their internal parts; but they maintained that it was much the better way to open living persons, as Herophilus and Erasistratus did, so that they could acquaint themselves in life with the structures whose disturbance or disease causes the sufferings which they were called upon to alleviate. What is known as the “Humoral Pathology” formed the most essential part of the system of the Dogmatists.
Humoral pathology explains all diseases as caused by the mixture of the four cardinal humours; viz., the blood, bile, mucus or phlegm, and water. Hippocrates leaned towards it, but it was Plato who developed it. The stomach is the common source of all these humours. When diseases develop, they attract these humours. The source of the bile is the liver; of the mucus, the head; of the water, the spleen. Bile causes all acute diseases, mucus in the head causes catarrhs and rheumatism, dropsy depends on the spleen.
Diocles Carystius, a famous Greek physician, said by Pliny[401] to have been next in age and fame to Hippocrates himself, lived in the fourth century B.C. He wrote several treatises on medicine, of which the titles and some fragments are preserved by Galen, Cælius Aurelianus, Oribasius, and others. His letter to King Antigonus, entitled “An Epistle on Preserving Health,” is inserted at the end of the first book of Paulus Ægineta, and was probably addressed to Antigonus Gonatus, king of Macedonia, who died B.C. 239. This treatise is so valuable a summary of the medical teaching of the time that it will be useful to insert it in this place. “Since of all kings you are the most skilled in the arts, and have lived very long, and are skilled in all philosophy, and have attained the highest rank in mathematics, I, supposing that the science which treats of all things that relate to health is a branch of philosophy becoming a king and befitting to you, have written you this account of the origin of diseases, of the symptoms which precede them, and of the modes by which they may be alleviated. For neither does a storm gather in the heavens but it is preceded by certain signs which seamen and men of much skill attend to, nor does any disease attack the human frame without having some precursory symptom. If, then, you will only be persuaded by what we say regarding them, you may attain a correct acquaintance with these things. We divide the human body into four parts: the head, the chest, the belly, and the bladder. When a disease is about to fix in the head, it is usually announced beforehand by vertigo, pain in the head, heaviness in the eyebrows, noise in the ears, and throbbing of the temples; the eyes water in the morning, attended with dimness of sight; the sense of smell is lost, and the gums become swelled. When any such symptoms occur, the head ought to be purged, not indeed with any strong medicine, but, taking the tops of hyssop and sweet marjoram, pound them and boil them in a pot, with half a hemina of must or rob; rinse the mouth with this in the morning before eating, and evacuate the humours by gargling. There is no gentler remedy than this for affections of the head. Mustard in warm, honied water also answers the purpose very well. Take a mouthful of this in the morning before eating, gargle and evacuate the humours. The head also should be warmed by covering it in such a manner as that the phlegm may be readily discharged. Those who neglect these symptoms are apt to be seized with the following disorders: inflammations of the eyes, cataracts, pain of the ears as if from a fracture, strumous affections of the neck, sphacelus of the brain, catarrh, quinsy, running ulcers called achores, caries, enlargement of the uvula, defluxion of the hairs, ulceration of the head, pain in the teeth. When some disease is about to fall upon the chest, it is usually announced by some of the following symptoms: There are profuse sweats over the whole body, and particularly about the chest, the tongue is rough, expectoration saltish, bitter, or bilious, pains suddenly seizing the sides or shoulder-blades, frequent yawning, watchfulness, oppressed respiration, thirst after sleep, despondency of mind, coldness of the breast and arms, trembling of the hands. These symptoms may be relieved in the following manner: Procure vomiting after a moderate meal without medicine. Vomiting also when the stomach is empty will answer well; to produce which first swallow some small radishes, cresses, rocket, mustard and purslain, and then by drinking warm water procure vomiting. Upon those who neglect these symptoms the following diseases are apt to supervene: pleurisy, peripneumony, melancholy, acute fevers, frenzy, lethargy, ardent fever attended with hiccough. When any disease is about to attack the bowels, some of the following symptoms announce its approach: In the first place, the belly is griped and disordered, the food and drink seem bitter, heaviness of the knees, inability to bend the loins, pains over the whole body unexpectedly occurring, numbness of the legs, slight fever. When any of these occur, it will be proper to loosen the belly by a suitable diet without medicine. There are many articles of this description which one may use with safety, such as beets boiled in honeyed water, boiled garlic, mallows, dock, the herb mercury, honied cakes; for all these things are laxative of the bowels. Or, if any of these symptoms increase, mix bastard saffron with all these decoctions, for thereby they will be rendered sweeter and less dangerous. The smooth cabbage boiled in a large quantity of water is also beneficial. This decoction, with honey and salt, may be drunk to the amount of about four heminæ, or the water of chick-peas and tares boiled may be drunk in the same manner. Those who neglect the afore-mentioned symptoms are apt to be seized with the following affections: diarrhœa, dysentery, lientery, ileus, ischiatic disease, tertian fever, gout, apoplexy, hæmorrhoids, rheumatism. When any disease is about to seize the bladder, the following symptoms are its usual precursors: A sense of repletion after taking even a small quantity of food, flatulence, eructation, paleness of the whole body, deep sleep, urine pale and passed with difficulty, swellings about the privy parts. When any of these symptoms appear, their safest cure will be by aromatic diuretics. Thus, the roots of fennel and parsley may be infused in white fragrant wine, and drunk every day when the stomach is empty in the morning, to the amount of two cyathi, with water in which carrot, myrtle, or elecampane has been macerated (you may use any of these you please, for all are useful); and the infusion of chick-peas in water in like manner. On those who neglect these symptoms the following diseases are apt to supervene: dropsy, enlargement of the spleen, pain of the liver, calculus, inflammation of the kidney, strangury, distension of the belly. Regarding all these symptoms, it may be remarked that children ought to be treated with gentler remedies, and adults with more active. I have now to give you an account of the seasons of the year in which each of these complaints occur, and what things ought to be taken and avoided. I begin with the winter solstice. Of the winter solstice: This season disposes men to catarrhs and defluxions until the vernal equinox. It will be proper then to take such things as are of a heating nature, drink wine little diluted, or drink pure wine, or of the decoction of marjoram. From the winter solstice to the vernal equinox are ninety days. Of the vernal equinox: This season increases phlegm in men, and the sweetish humours in the blood, until the rising of the pleiades. Use therefore juicy and acrid things, take labour, ... To the rising of the pleiades are forty-six days. Of the rising of the pleiades: This season increases the bitter bile and bitter humours in men, until the summer solstice. Use therefore all sweet things, laxatives of the belly.... To the summer solstice are forty-five days. Of the summer solstice: This season increases the formation of black bile in men, until the autumnal equinox. Use therefore cold water, and everything that is fragrant.... To the autumnal equinox are ninety-three days. Of the autumnal equinox: This season increases phlegm and thin rheums in men until the setting of the pleiades. Use therefore remedies for removing rheums, have recourse to acrid and succulent things, take no vomits, and abstain from labour.... To the setting of the pleiades are forty-five days. Of the setting of the pleiades: This season increases phlegm in men until the winter solstice. Take therefore all sour things, drink as much as is agreeable of a weak wine, use fat things, and labour strenuously. To the winter solstice are forty-five days.”[402]
Praxagoras of Cos, who lived in the fourth century B.C., shortly after Diocles, was a famous physician of the Dogmatic sect, who especially excelled in anatomy and physiology. He placed the seat of all diseases in the humours of the body, and was one of the chief supporters of what is known as the “humoral pathology.” Sprengel[403] and others state that he was the first who pointed out the distinction between the arteries and the veins; but M. Littré denies this, and seems to prove that the differences were known to Aristotle, Hippocrates, and other writers.[404] His knowledge of anatomy must have been very considerable, and his surgery was certainly bold; so that he even ventured, in cases of intussusception of the bowel, to open the abdomen in order to replace the intestine. In hernia he practised the taxis,[405] i.e. replaced the bowel by the hand; and he amputated the uvula in affections of that organ. He had many pupils, amongst others Herophilus, Philotimus, and Plistonicus.
Aristotle, the founder of comparative anatomy and the father of the science of natural history, was the son of Nichomachus, physician to Amyntas II., king of Macedonia. He was born at Stageira, B.C. 334. His father was a scientific man of the race of the Asclepiads, and it was the taste for such pursuits and the inherited bent of mind which early inclined the son to the investigation of nature. He went to Athens, where he became the disciple of Plato, and remained in his society for twenty years. In his forty-second year he was summoned by Philip of Macedon to undertake the tuition of Alexander the Great, who was then fifteen years old. Of his philosophical works it is not here necessary to speak; it is his scientific labours, which had so important an influence on medical education, which chiefly concern us. He wrote Researches about Animals, On Sleep and Waking, On Longevity and Shortlivedness, On Respiration, On Parts of Animals, On Locomotion of Animals, On Generation of Animals. Aristotle inspired Alexander with a passion for the study of natural history, and his royal pupil gave him abundant means and opportunity to collect materials for a history of animals. The science of comparative anatomy, so important in relation to that of medicine, was thus established. He pointed out the differences which exist between the structure of men and monkeys; described the organs of the elephant, and the stomach of the ruminant animals. The anatomy of birds and the development of their eggs during incubation were accurately described by him; he dissected reptiles, and studied the habits of fishes. He investigated the action of the muscles, regarded the heart as the origin of the blood-vessels, named the aorta and the ventricles, described the nerves which he thought originated in the heart, but he confused the nerves with the ligaments and tendons. The heart he considered as the centre of movement and feeling[406] and nourishment, holding that it contains the natural fire, and is the birthplace of the passions and the seat of the soul; the brain he thought was merely a mass of water and earth, and did not recognise it as nervous matter. The diaphragm he considered had no other office than to separate the abdomen from the thorax and protect the seat of the soul (the heart) from the impure influences of the digestive organs. Superfœtation (or the conception of a second embryo during the gestation of the first) he held to be possible, and he first pointed out the punctum saliens.