Two great anatomists built up the structure of scientific human anatomy on the rather good foundation that had been laid on animal anatomy in the foretime. After all, the anatomy of the animal resembles that of man so much that very precious knowledge had been gained from zootomies in the previous ages. These two anatomists were Erasistratos and Herophilos. Both of them studied the brain especially, as might have been expected. For just as soon as the opportunity for dissecting man was provided, this, his most complex structure, attracted instant attention. Herophilos has named after him the torcular herophili, and the name he gave the curious appearance in the floor of the fourth ventricle--the calamus scriptorius--is still retained. He describes the membranes of the brain, the various sinuses, the choroid plexuses, the cerbral ventricles and traced the origin of the nerves from the brain and the spinal cord, recognizing, according to well-grounded tradition, the distinction between nerves of sensation and motion. [{385}] He described the eye and especially the vitreous body, the choroid and the retina. He did not neglect other portions of anatomy, however, and his power of exact observation, as well as his detailed study, may be judged from his remark that the left spermatic vein in certain cases joins the renal.
Erasistratos, his colleague, was perhaps even a more successful investigator than Herophilos. He represented the best tradition of Greek medicine of the time. He had two distinguished teachers, one of them Metrodoros, the son-in-law of Aristotle. It was probably through this influence that Erasistratos received his invitation from the first Ptolemy to come to Alexandria. The scientific work of Alexandria was founded on Aristotle's collections, on his books, for his library was brought to Alexandria as the foundation of the great University Library, and then best of all on the direct tradition of his scientific teaching through this pupil of his son-in-law. Erasistratos' other great teacher was the well-known Chrysippos of Cnidos. Cnidos was the great rival medical school to that of Cos. Owing to the reputation of Hippocrates we know of Cos, but we must not ignore Cnidos.
Erasistratos' discoveries were more in connection with the heart than anything else. He came very near discovering the circulation. His description of the valves and of their function is very clear. He looked for large-sized [{386}] anastomoses between veins and arteries and, of course, did not discover the minute capillaries which required Malpighi's microscope to reveal them nearly 2,000 years after. Like Herophilos, Erasistratos also studied the brain very faithfully.
One story that we have of Erasistratos deserves to be in the minds of young graduates in medicine, because it illustrates the practical character of the man and also how much more important at times it may be in the practice of medicine to know men well rather than to know medical science alone. Erasistratos was summoned on a consultation to Antioch to see the son of King Seleucus. Seleucus was one of the four of Alexander's generals who, like Ptolemy, had divided the world among them after the young conqueror's death. His portion of the Eastern world, with its capital at Antioch, was probably the richest region of that time. There had been no happiness, however, in the royal household for months because the scion of the Seleucidae, the heir to the throne, was ill and no physician had been able to tell what was the matter with him, and, above all, no one had been able to do anything to awaken him from a lethargy that was stealing over him, making him quite incapable of the ordinary occupations of men, or to dispel an apathy which was causing him to lose all interest in affairs around him. He was losing in weight, he looked miserable, he seemed really to have been stricken by one of [{387}] the serious diseases as yet undifferentiated at that time which were expressed by the word phthisis, which referred to any wasting disease.
As a last hope then almost, Erasistratos was summoned from distant Alexandria as a consultant in the case of young Seleucus. The proceeding, after all, is very similar to what happens in our own time. The head of an important department in medicine at a university is asked to go a long distance to see the son of a reigning monarch, or of a millionaire prince in industry, or perhaps a coal baron, or a railroad king, and a special train is supplied for him and every convenience consulted. A caravan was sent to bring Erasistratos over the desert to Antioch. It is such consultations that count in a physician's life. I hope sincerely that you shall have many of them and that you shall conduct them as successfully as Erasistratos this one.
The young prince's case proved as puzzling to Erasistratos for a time as it had to so many other physicians before him. Like the experienced practitioner he was, he did not make his diagnosis at once, however. Will you remember that when you, too, have a puzzling case? It is when we do not take time to make our diagnosis that it often proves erroneous. Not ignorance, but failure to investigate properly, is responsible for most of our errors. He asked to see the patient a number of times, and saw him under varying conditions. Finally, one day, while he was [{388}] examining the young man's pulse--and I may tell you that Erasistratos made a special study of the pulse and knew many things about it that it is unfortunate that the moderns neglect--his patient's pulse gave a sudden leap and then continued to go much faster than it had gone before. At the same time there came a rising color to the young man's cheek. Erasistratos looked up to see what was the cause of this striking change, and found that the young wife of the King Seleucus, the prince's stepmother, had just come into the room. Seleucus, as an old man, had married a very handsome young woman, and it was evident that the young man's heart was touched in her regard, and that here was the cause of the trouble. Erasistratos did not proclaim his discovery at once. He did announce that now he knew the cause of the trouble, that it was an affection of the heart that would be cured by travel, and he proposed to take young Seleucus back with him to Alexandria. In private, very probably, he told his young patient that he had discovered his secret, and then persuaded him that absence would be the thing for him. Very probably the young man considered that cure was impossible, and with many misgivings he consented to go to Alexandria, and as has happened many times before and since, in spite of the patient's assurance to the contrary, the travel cure proved effective even for the heart affection.
I hope sincerely that you shall have as much tact, as much knowledge of men and women and as much success as this great teacher at the first of our modern university medical schools, when the great consultations do come your way, for it is easy to understand that when the young man recovered under the kindly ministrations of Erasistratos and the good effect of absence from the disturbing heart factor, Erasistratos was loaded with the wealth of the East and acquired a reputation that made him known throughout all the world of that time. There is a curious commentary on this story that I think you should also know. It is Galen who has preserved the incident for us. He does so in the book on the pulse, mainly in order to show, as he thinks, the fatuity of such observations. After giving the details he says, "Of course, there is no special pulse of love." Poor Galen, how his wits must have been wool-gathering, or how forgetful he must have been of his own youth writing in the serenity of age, or how lacking in ordinary human experience if that is his serious meaning. The older man was by far the better observer, and I hope that you shall not forget in the time to come that there are many things that affect men and women besides bacteria and auto-intoxications of various kinds and metabolic disturbances and nutritional changes. Erasistratos seems to have known very well how much the mind, or as they called it in the older terminology, and we [{390}] still cling to the phrase, the heart, meant for many a phenomenon of existence supposed to be physically pathologic and yet really only representing psychologic influences apart from the physical side of the being. I may say to you that the more you know about these old teachers of medicine the more you will appreciate and value their largeness of view, their breadth of knowledge of humanity and their practical ways.
It is no wonder that students from all over the world were attracted to Alexandria for the next three centuries because of the opportunities, for the study of medicine afforded them there. After the first century of its existence not as much was accomplished as at the beginning, because what always happens in the history of medicine after a period of successful investigation, happened also there. Men concluded that nearly everything that could be, had been discovered and began to theorize. They were sure that their theories explained things. Men have persisted in spinning theories in medicine. Theories have almost never helped us and they always have wasted our time. Observation! Observation is the one thing that counts, Alexandria continued to have her reputation, however, and in the first century of the Christian era was the centre of medical interest. It was probably here that St. Luke was educated, and as we know now from the careful examination of the [{391}] Third Gospel and of the Acts, he knew his Greek medical terms very well. Harnack has shown us recently once more how thoroughly Luke converted the ordinary popular terms of the other Evangelists into the Greek medical terms of his time. Luke must have known medicine very well. His testimony to the miracles of Christ is therefore all the more valuable, and so the Alexandrian medical school has its special place in the order of Providence.
We are prone to think because of the curious way in which not only the histories of medical education, but of all education, have been written, that while there were some medical schools in the interval from the days of Alexandria and Rome down to the modern time, these were so hampered by unfortunate conditions that men practically did nothing in education and, above all, scientific and medical education until comparatively recent times. Nothing could well be more absurd than such an opinion. The great universities founded during the thirteenth and fourteenth centuries attracted more students to the population of the countries of the time than go to our universities to the number of our population in the present time. These universities are the model of our universities of the present time and, indeed, the history of many of the old European universities is continuous for seven centuries. They had an undergraduate department in which students were trained in grammar, rhetoric, logic, [{392}] arithmetic, astronomy, music and gymnastics, and graduate departments of law, theology and medicine. Professor Huxley, reviewing mediaeval education, once said that the undergraduate education of the mediaeval universities was better than our own. He doubted "that the curriculum of any modern university shows so clear and generous a comprehension of what is meant by culture as this old trivium and quadrivium did."