As an outstanding example of his power of clinical observation we may recall the facies Hippocratica, an accurate study of the countenance of a dying man.
His ideals for the profession are embodied in the “Hippocratic oath.”
Anatomy. Impressed by this view of the organism as a unity, the Hippocratic school tended in some degree to overlook the importance of its constituent parts. The balance was re-adjusted later on by the labours of the anatomical school of Alexandria, which, under the aegis of the enlightened Ptolemies, arose in the 3rd century B.C. Two prominent exponents of anatomy belonging to this school were Herophilus and Erasistratus, the latter of whom we shall frequently meet with in the following pages (v. [p. 95] et seq.). [Pg xiii]
The Empirics. After the death of the Master, the Hippocratic school tended, as so often happens with the best of cultural movements, to show signs itself of diminishing vitality: the letter began to obscure and hamper the spirit. The comparatively small element of theory which existed in the Hippocratic physiology was made the groundwork of a somewhat over-elaborated “system.” Against this tendency on the part of the “Dogmatic” or “Rationalist” school there arose, also at Alexandria, the sect of the Empiricists. “It is not,” they said, “the cause but the cure of diseases that concerns us; not how we digest, but what is digestible.”
Greek
Medicine
in Rome. Horace said “Graecia capta ferum victorem cepit.” Political domination, the occupation of territory by armies, does not necessarily mean real conquest. Horace’s statement applied to medicine as to other branches of culture.
The introducer of Greek medicine into Rome was Asclepiades (1st century B.C.). A man of forceful personality, and equipped with a fully developed philosophic system of health and disease which commended itself to the Roman savants of the day, he soon attained to the pinnacle of professional success in the Latin capital: he is indeed to all time the type of the fashionable (and somewhat “faddy”) West-end physician. His system was a purely mechanistic one, being based upon [Pg xiv] the atomic doctrine of Leucippus and Democritus, which had been completed by Epicurus and recently introduced to the Roman public in Lucretius’s great poem “De Rerum Natura.” The disbelief of Asclepiades in the self-maintaining powers of the living organism are exposed and refuted at considerable length by Galen in the volume before us.
The
Methodists. Out of the teaching of Asclepiades that physiological processes depend upon the particular way in which the ultimate indivisible molecules come together (ἐν τῇ ποίᾳ συνόδῳ τῶν πρώτων ἐκείνων σωμάτων τῶν άπαθῶν) there was developed by his pupil, Themison of Laodicea, a system of medicine characterised by the most engaging simplicity both of diagnosis and treatment. This so-called “Methodic” system was intended to strike a balance between the excessive leaning to apriorism shown by the Rationalist (Hippocratic) school and the opposite tendency of the Empiricists. “A pathological theory we must have,” said the Methodists in effect, “but let it be simple.” They held that the molecular groups constituting the tissues were traversed by minute channels (πόροι, “pores”); all diseases belonged to one or other of two classes; if the channels were constricted the disease was one of stasis (στέγνωσις), and if they were dilated the disease was one of flux (ῥύσις). Flux and stasis were indicated respectively by increase and diminution of the natural secretions; [Pg xv] treatment was of opposites by opposites—of stasis by methods causing dilatation of the channels, and conversely.
Wild as it may seem, this pathological theory of the Methodists contained an element of truth; in various guises it has cropped up once and again at different epochs of medical history; even to-day there are pathologists who tend to describe certain classes of disease in terms of vaso-constriction and vaso-dilatation. The vice of the Methodist teaching was that it looked on a disease too much as something fixed and finite, an independent entity, to be considered entirely apart from its particular setting. The Methodists illustrate for us the tyranny of names. In its defects as in its virtues this school has analogues at the present day; we are all acquainted with the medical man to whom a name (such, let us say, as “tuberculosis,” “gout,” or “intestinal auto-intoxication”) stands for an entity, one and indivisible, to be treated by a definite and unvarying formula.
To such an individual the old German saying “Jedermann hat am Ende ein Bischen Tuberkulose” is simply—incomprehensible.