An Epitome of the History of Medicine

by Roswell Park

The school of the Asclepiadæ has been responsible for certain theories which have been more or less prominent during the earlier historical days. One of these which prevailed throughout the Hippocratic works is that of Coction and Crisis. By the former term is meant thickening or elaboration of the humors in the body, which was supposed to be necessary for their elimination in some tangible form. Disease was regarded as an association of phenomena resulting from efforts made by the conservative principles of life to effect a coction,—i.e., a combination of the morbific matter in the economy, it being held that the latter could not be properly expelled until thus united and prepared so as to form excrementitious material. This elaboration was supposed to be brought about by the vital principles, which some called nature (Physis), some spirit (Psyche), some breath (Pneuma), and some heat (Thermon).

The gradual climax of morbid phenomena has, since the days of Hippocrates, been commonly known as Crisis; it was regarded as the announcement of the completion of the union by coction. The day on which it was accomplished was termed critical, as were also the signs which preceded or accompanied it, and for the crisis the physician anxiously watched. Coction having been effected and crisis occurring, it only remained to evacuate the morbific material—which nature sometimes spontaneously accomplished by the critical sweat, urination, or stools, or sometimes the physician had to come to her relief by the administration of diuretics, purgatives, etc. The term "critical period" was given to the number of days necessary for coction, which in its perfection was supposed to be four, the so-called quarternary, while the septenary was also held in high consideration. Combination of figures after the Pythagorean fashion produced many complicated periods, however, and so periods of 34, 40, and 60 days were common. This doctrine of crisis in disease left an impress upon the medical mind not yet fully eliminated. Celsus was the most illustrious of its adherents, but it can be recognized plainly in the teachings of Galen, Sydenham, Stahl, Van Swieten, and many others. In explanation, it must be said that there have always existed diseases of nearly constant periods, these being nearly all of the infectious form, and that the whole "critical" doctrine is founded upon the recognition of this natural phenomenon.

The Hippocratic books are full, also, of the four elements,—earth, water, air, and fire; four elementary qualities,—namely, heat, cold, dryness, and moisture; and the four cardinal humors,—blood, bile, atrabile, and phlegm.

Owing to the poverty of knowledge of physics and chemistry possessed by the ancients, and notwithstanding their errors and imperfections, the doctrine of Dogmatism, founded upon the theory of coction and humors, was the most intelligible and complete among the medical doctrines of antiquity, responding better, as it did, to the demands of the science of that day. That Hippocrates was a profound observer is shown in this: that he reminds both philosophers and physicians that the nature of man cannot be well known without the aid of medical observation, and that nothing should be affirmed concerning that nature until by our senses we have become certain of it. In this maxim he took position opposed to the Pythagorean doctrine, and included therein the germ of a new philosophy of which Plato misconceived, and of which Aristotle had a very faint glimpse.

Another prominent theory throughout the Hippocratic books is that of Fluxions, meaning thereby about what we would call congestions, or conditions which we would say were ordinarily caused by cold, though certain fluxions were supposed to be caused by heat, because the tissues thereby became rarefied, their pores enlarged, and their humor attenuated so that it flowed easily when compressed. The whole theorv of fluxion was founded on the densest ignorance of tissues and the laws of physics, the body of man being sometimes likened to a sponge and sometimes to a sieve. The treatment recommended was almost as crazy as the theory. Certain other theories have complicated or disfigured the Hippocratic writings, and certain have been founded on the consideration of two elements—i.e., fire and earth—or on the consideration of one single element which was supposed to be air,—the breath, or pneuma; and there was—lastly—the theory of any excedent, which is very vague; of all of these we may say that they are not of sufficient interest to demand expenditure of our time.

The eclat which the second (i.e., the Great) Hippocrates gave to the school of Asclepiadæ in the Island of Cos long survived, and many members of his family followed in his footsteps. Among his most prominent successors were Polybius, Diodes, and Praxagoras, also of Cos,—the last of the Asclepiadæ mentioned in history. Praxagoras was distinguished principally for his anatomical knowledge; like Aristotle, he supposed that the veins originated from the heart, but did not confound these vessels with the arteries, as his predecessors had done, but supposed that they contained only air, or the vital spirit. It has been claimed that he dissected the human body. He laid the foundation of sphygmology, or study of the pulse, since Hippocratic writers rarely alluded to arterial pulsations and described them as of only secondary importance.

The predominating theory in the Island of Cos was that which made health dependent on the exact proportion and play of the elements of the body, and on perfect combination of the four cardinal humors. This was the prevailing doctrine,—i.e., the Ancient Medical Dogmatism, so named because it embraced the most profound dogmas in medicine, and was taught exclusively until the foundation of the school at Alexandria.

Two men, however, more commonly ranked among philosophers than among physicians of antiquity, dissected the statements of Hippocrates, and embodied them more or less in their own teachings, and thus exercised a great influence on the progress of the human mind, particularly in the direction of medical study. The first of these was Plato, profound moralist, eloquent writer, and most versatile thinker of his day or any other. He undertook the study of disease, not by observation (the empirical or experimental method), but by pure intuition. He seemed to have never discovered that his meditations were taken in the wrong direction, and that the method did not conduce to the discovery of abstract truths. He gave beauty an abstract existence, and affirmed that all things beautiful are beautiful because of the presence of beauty. This reminds one of that famous response in the school of the Middle Ages to a question: "Why does opium produce sleep?" the answer being: "Because it possesses the sleepy principle." Plato introduced into natural science a doctrine of final causes. He borrowed from Pythagoras the dogma of homogeneity of matter, and claimed that it had a triangular form.

Aristotle, equally great thinker with Plato, but whose mental activity was manifest in other channels, was born in Stagyrus, in Macedonia. He was fascinated by the teachings of Plato, and attained such eminence as a student that King Philip of Macedon made him preceptor to his son Alexander, subsequently the Great, by whom he was later furnished with sufficient funds to form the first known museum in natural history.—a collection of rare objects of every sort, transmitted, many of them, by the royal hands of his former student from the remote depths of Asia. Aristotle, by long odds the greatest naturalist of antiquity, laid the first philosophic basis for empiricism. He admitted four elements—fire, air, earth, and water—and believed them susceptible of mutual transmutation. He studied the nature of the soul and that of the animal body; regarded heat and moisture as two conditions indispensable to life; described the brain with some accuracy, but without the least idea of its true function; said that the nerves proceeded from the heart; termed the aorta a nervous vein; and made various other mistakes which to us seem inexcusable. Nevertheless, he was rich in many merits, and no one of his age studied or searched more things than he, nor introduced so many new facts. Although he never dissected human bodies, he nevertheless corrected errors in anatomy held to by the Hippocratic school. He dissected a large number of animals of every species, and noted the varieties of size and shape of hearts of various animals and birds. In other words, he created a comparative anatomy and physiology, and the plan that he traced was so complete that two thousand years later the great French naturalist Cuvier followed it quite closely. If he be charged with having propagated a taste for scholastic subtleties, he also furnished an example of patient and attentive observation of Nature. His history of animals is a storehouse of knowledge, and his disciples cultivated with zeal anatomy, physiology, and natural history. His successor, Theophrastus, was the most eminent botanist of antiquity.

It will thus be seen that Plato and Aristotle were the eminent propagators of two antagonistic opinions. One supposed knowledge to be derived by mental intuition, and the other that all ideas are due to sensation. Both count among moderns some partisans of the greatest acumen: Descartes, Leibnitz, and Kant being followers of Plato, and Bacon, Locke, Hume, and Condillac, of Aristotle.