An Epitome of the History of Medicine

by Roswell Park

[Original]

On his return to his own country he was charged by its ruler to dress the wounded in the great circus, which furnished him opportunity for displaying all his anatomical knowledge and surgical skill. Not remaining long at home, he went to Rome, where his renown had preceded him, and where, by his brilliant elocution, his accurate logic, and his profound erudition, as well as his versatility and practical skill, he at once took the highest place. But here his rapid success, his vanity, his disdain for his colleagues, and his useless boasting, as well as his natural jealousy, gained him the enmity of nearly all his contemporaries, and his stay at Rome was thereby made very disagreeable. In his work on Prenotions he accuses his colleagues of base jealousy and stupid ignorance, lavishes upon them such epithets as "thieves" and "poisoners," and closes by saying that after having unmasked them he would leave them to their evil designs by abandoning the great city to seek a home in a smaller place, where the surroundings would be to him more congenial. This threat he carried out, but soon returned to Rome upon the invitation of the Emperors Marcus Aurelius and Lucius Yerus, whose confidence, as well as that of their successors, he enjoyed. He is supposed to have lived to the age of seventy-one, and to have died about 200 A.D. Galen strongly denied being attached to any of the sects of his day, and regarded as slaves those who took the title of Hippocratists, Praxagoreans, Herophilists, and so on. Nevertheless, his predilection in favor of the Hippocratic writings is well marked, for lie explains, comments upon, and expands them at length, refutes the objections of their adversaries, and gives them the highest place. He says: "No one before me has given the true method of treating disease; Hippocrates, I confess, lias heretofore shown the path, but as he was the first to enter it he was not able to go as far as he wished.... He has not made all the necessary distinctions, and is often obscure, as is usually the case with ancients when they attempt to be concise. He says very little of complicated diseases; in a word, he has only sketched what another was to complete; he has opened the path, but has left it for a successor to enlarge and make it plain." This implies how he regarded himself as the successor of Hippocrates, and how littleweight he attached to the labors of others. He held that there were three sorts of principles in man: spirits, humors, and solids. Throughout his metaphysical speculations Galen reproduces and amplifies the Hippocratic dogmatism. Between perfect health and disease there were, he thought, eight kinds of temperaments or imperfect mixtures compatible with the exercise of the functions of life. With Plato and Aristotle, he thought the human soul to be composed of three faculties or parts: the vegetative, residing in the liver; the irascible, having its seat in the heart; and the rational, which resides in the brain. He divided diseases of the solids of the body into what he called distempers; he distinguished between the continued and intermittent fevers, regarding the quotidian as being caused by phlegm, the tertian as due to yellow bile, and the quartan as due to atrabile. In the doctrine of coction, crises, and critical days he agreed with Hippocrates; with him he also agreed in the positive statement that diseases are cured by their contraries. From all this it will be seen that Galen must be regarded as one of the earliest of Hippocratic dogmatists. He was a most extensive writer, and it is said that the total number of his works exceeded one hundred. His contributions to anatomy were not insignificant. For myology he did a great deal. He wrote a monograph on the skeleton in which he recommended that bones be seen and handled, not merely studied from books, and that the student should go to Alexandria, where teachers would place before him the real human skeleton. It has been inferred that there was not, in his time, in Rome a single skeleton. He wrote fifteen books on anatomy, of which six are lacking; also an extensive treatise on the lesions of the human body, distributed among seventeen books which have come down to us. He is supposed to have introduced the term "symphysis," and he described nearly every bone in the human body. By him the muscles were no longer considered as inert masses and tissue-layers serving to cover the bones, but he classified them according to their distinct functions, and studied separately their form and uses. The location of the vessels and nerves between them was also noted, and it was proved that muscles were indispensable to the accomplishment of voluntary motions. Galen was, perhaps, the first vivisector of all, since he exposed muscles of living animals, and showed how alternate tension and relaxation of distinct groups set the bones in motion, after the manner of levers; he named a great number of them, but, curiously, took no note of others. His classification according to their uses is followed down to the present day—i.e., flexors, extensors, etc.

The Hippocratic authors confounded the arteries with the veins. Praxagoras first distinguished two kinds of vessels which he supposed to contain air, whence the name artery. Aristotle and Erasistratus maintained this view, which prevailed until the time of Galen, who devoted a book to the refutation of it, basing his argument upon the observation that always when an artery is wounded blood gushes out. How near he came to being the discoverer of the circulation may thus be seen. A little less reverence for authority and a little more capacity for observation would have placed him in possession of the knowledge, lack of which for so many centuries retarded the whole profession. He thought the veins originated from the liver—in this respect being behind Aristotle—but considered the heart as the common source of the arteries and veins. Even the portal system of veins confused him, and he erroneously described a superior and inferior aorta, but atoned for this by describing the umbilical veins and arteries. Aristotle also had supposed all the nerves originated from the heart, but Galen stated that they are derived from the brain and spinal marrow, and pointed out two kinds of nerves: those of sensation, which he thought proceeded from the brain, and those of motion, which he considered to originate in the spinal marrow. Thus, he described distinct nerves of sensation and motion, but sadly confused their anatomy. He seems also to have had some notion of the great sympathetic, although it was by no means accurate. He suggested the division of the principal nerves, in order to prove the fact that nervous energy is transmitted from the encephalon to other parts of the body. He speaks of glands, and thought they discharged their secretions through veins into the various cavities, but regarded them rather as receptacles of excrementitious matter than as agents for secretion of valuable fluids. He even regarded the mammæ as glandular bodies in this sense, although he knew, of course, the value of their secretion. To Galen we owe the division of the body into cranial, thoracic, and abdominal cavities, whose proper viscera and envelopes he described. He spoke of the heart as having the appearance of a muscle, but differing from it. He regarded it as the source of natural heat, and the seat of anger and of violent passions. He appreciated that inspiration is carried on by enlargement of the thoracic cavity. He thought that atmospheric air entered the cavity of the cranium through the cribriform plate of the ethmoid and passed out by the same route, carrying with it excrementitious humors from the brain, which were discharged into the nasal fossæ. But some portion of air thus entering remained, according to his views, and combined with the vital spirits in the anterior ventricles of the brain, from which combination originated the animal spirits and immediate agents of the rational soul. These acquired their last attenuation in the fourth ventricle, whence they would pass out drop by drop through a round, narrow tube.

From this brief résumé of the anatomy and physiology of Galen it will be seen that by the end of the second century of the Christian era immense progress had been made since the foundation of the Alexandrian school, and that it was due to the impetus in the study of anatomy given by Herophilus and Erasistratus, who not only made numerous dissections, but resorted to frequent vivisections. It is even said that Herophilus did not hesitate to employ his knife on live criminals who were subjected to him for experiment; but this has been a popular tradition about almost every anatomist of antiquity, and there is no evidence in confirmation of the unkind rumor, although that such experiments might be legally and justly performed has occurred to the minds of many. But zeal for dissection rapidly cooled off, and Galen barely mentions five or six men who devoted themselves to it in the space of nearly four hundred years down to his time. He speaks of Rufus of Ephesus,—who lived under Trajan of Marinus,—who wrote in the beginning of the second century A.D., and of Quintus, who instructed his own preceptor. None of them left a reputation, however, approaching that of Herophilus and Erasistratus, with whom Galen alone could compare by the number of his experiments and his discoveries. Galen strove as hard as one of his position might, by example and precept, to awaken in his contemporaries a desire for anatomical knowledge, but could not overcome their indifference. After him the practice of dissection appears to have been lost, either from the redoubled prejudices of the superstitious, who opposed it, or as the result of the apathetic ignorance or the ignorant apathy of the physicians.

It has been shown that, during the Hippocratic era and subsequently, the physicians even of primitive times followed more or less by instinct the empirical method. Acron of Agrigentum was a contemporary of Pythagoras, and affirmed that experience is the only true foundation of the healing art. Hippocrates, however, showed himself more anxious to report faithfully clinical facts than to dispute theoretical views.

The surprising progress in anatomy and physiology made during the first portion of the Anatomic Period and during the better days of the Alexandrian institute did not keep men from confounding several different points in the Hippocratic doctrine, by which confidence in the same was naturally shaken. Thus many new speculations were hazarded which nullified each other. In the midst of this confusion practitioners continued to seek in experience a refuge from the incessant variations of dogmatism and the sterile incertitude of the skeptics. Thus, empiricism as a school of practice became placed upon a firmer and firmer foundation, and the empirics of that day seem to have laid the true basis of our art. Their doctrine took at first a rapid growth, and Galen spoke of it with great regard. The circumstances under which it was proclaimed were most favorable for its propagation. Theories had fallen into confusion; practice, methods, and opinions were questionable. Everything was conjecture, and that which rested on the evidence of facts was by the empirics received with enthusiasm. Although founded on pure observation, it did not put an end to differences of opinion, and in the eyes of the ancients it lacked in solidity, because it did not attach itself to any philosophic theory then known. This doctrine was then best able to captivate physicians on account of its simplicity, contrasted with the general inability to satisfy speculative minds; but for this very reason it subsequently fell into disgrace, and the term "empiricism" became synonymous with ignorance. For centuries condemned and despised, it was revived from its long humiliation under the name of the Experimental Method, and achieved, after the labors of Bacon, Locke, and Condillac, almost universal dominion in the sciences.

This doctrine had been proclaimed for about a century during the period of which we now speak, but later led men into a fondness for secondary generalities or for the elevation and magnifying of trifles, which confused their minds and terminated its usefulness to science. Meanwhile, a man of great intelligence, renowned as an elocutionist, well versed in the doctrine of philosophers and grammarians—namely, Asclepiades, of Bythinia—came to Rome with the intention of teaching rhetoric. By his talent and personal address he soon became one of the most illustrious persons in the Roman Republic; so early as 150 B.C. he enjoyed a high reputation as a rhetorician, and was one of the intimate friends of Cicero; nevertheless, he abandoned letters, undertook the practice of medicine, and sought moreover to create a new system, being unwilling to follow in the track of his predecessors. Imbued with the philosophy of Epicurus, who was then in high repute, he deduced from it a theory which was in harmony with the philosophy of the day. He thought that the elements of the body existed from eternity; that they were indivisible, impalpable, and perceptible to the reason only. These elements he named atoms, which were supposed to be animated by perpetual motion, and from which, by their frequent encounters and fortuitous contention, all sensible phenomena were supposed to result. He explained the properties of the body by saying that compounds were aggregates of atoms, differing very much from atoms themselves. Solid silver, he said, is white, but, reduced to powder, appears black; the horn of the goat, on the contrary, is black, but if it be razed its particles are white. This, it will be seen, was the parent of our present atomic theory. He ridiculed the theories of Hippocrates concerning coction, crises, etc., and sarcastically called the Hippocratic treatise on therapeutics "a meditation on death."

Asclepiades based his own therapeutics on endeavors so to enlarge the pores of the human body that disease could find egress, or so to constrict them that it could not enter; consequently he rejected all violent remedies, such as vomits, purges, etc., and his favorite remedies were hygienic,—for the most part bodily exercise.

A celebrated disciple of Asclepiades was Themison, of Laodicea (b.c. 50), who was led by the teachings of his master to lay the foundation of the so-called Methodism as opposed to Dogmatism in the school of Cos. By him and his followers a very arbitrary arrangement of diseases was made, according to what they considered the constrictive, or contractive; the fluxionary,—congested or relaxed; and the mixed forms. From this division of diseases it appears that, according to the methodists, there were only two kinds of therapeutic indications to follow,—namely, to relax where there was constriction, to constrict where there was relaxation. They, however, admitted a third creditable result, which they called prophylactic; but the pure methodists, such as Ccelius Aurelianus, admitted neither specific disease nor specific remedies, and erased from their materia medica purgatives, diuretics, emmenagogues, nauseants, etc.

According to the methodist doctrine, the study of medicine was so abridged that one of its prominent exponents said that he felt able to teach the whole of medical science in six months. It made rapid progress, and consequently was most attractive to the numerous young neophytes who were anxious to finish their apprenticeship and hasten into practice. It is not one of the smallest of the services which Galen rendered to his time and to posterity that he demolished the sophistry of the methodists, demonstrated the insufficiency of their practice, and brought to bear upon them the wittiest satire, calling them the asses of Thessaly, alluding thereby to their lack of literature and medical instruction.