It is difficult to understand how Galen missed the circulation of the blood. He knew that the valves of the heart determined the direction of the blood that entered and left the organ, but he did not appreciate that it was a pump for distributing the blood, regarding it rather as a fireplace from which the innate heat of the body was derived. He knew that the pulsatile force was resident in the walls of the heart and in the arteries, and he knew that the expansion, or diastole, drew blood into its cavities, and that the systole forced blood out. Apparently his view was that there was a sort of ebb and flow in both systems—and yet, he uses language just such as we would, speaking of the venous system as ". . . a conduit full of blood with a multitude of canals large and small running out from it and distributing blood to all parts of the body." He compares the mode of nutrition to irrigating canals and gardens, with a wonderful dispensation by nature that they should "neither lack a sufficient quantity of blood for absorption nor be overloaded at any time with excessive supply." The function of respiration was the introduction of the pneuma, the spirits which passed from the lungs to the heart through the pulmonary vessels. Galen went a good deal beyond the idea of Aristotle, reaching our modern conception that the function is to maintain the animal heat, and that the smoky matters derived from combustion of the blood are discharged by expiration.
I have dwelt on these points in Galen's physiology, as they are fundamental in the history of the circulation; and they are sufficient to illustrate his position. Among his other brilliant experiments were the demonstration of the function of the laryngeal nerves, of the motor and sensory functions of the spinal nerve roots, of the effect of transverse incision of the spinal cord, and of the effect of hemisection. Altogether there is no ancient physician in whose writings are contained so many indications of modern methods of research.
Galen's views of disease in general are those of Hippocrates, but he introduces many refinements and subdivisions according to the predominance of the four humors, the harmonious combination of which means health, or eucrasia, while their perversion or improper combination leads to dyscrasia, or ill health. In treatment he had not the simplicity of Hippocrates: he had great faith in drugs and collected plants from all parts of the known world, for the sale of which he is said to have had a shop in the neighborhood of the Forum. As I mentioned, he was an eclectic, held himself aloof from the various schools of the day, calling no man master save Hippocrates. He might be called a rational empiricist. He made war on the theoretical practitioners of the day, particularly the Methodists, who, like some of their modern followers, held that their business was with the disease and not with the conditions out of which it arose.
No other physician has ever occupied the commanding position of "Clarissimus" Galenus. For fifteen centuries he dominated medical thought as powerfully as did Aristotle in the schools. Not until the Renaissance did daring spirits begin to question the infallibility of this medical pope. But here we must part with the last and, in many ways, the greatest of the Greeks—a man very much of our own type, who, could he visit this country today, might teach us many lessons. He would smile in scorn at the water supply of many of our cities, thinking of the magnificent aqueducts of Rome and of many of the colonial towns—some still in use—which in lightness of structure and in durability testify to the astonishing skill of their engineers. There are country districts in which he would find imperfect drainage and could tell of the wonderful system by which Rome was kept sweet and clean. Nothing would delight him more than a visit to Panama to see what the organization of knowledge has been able to accomplish. Everywhere he could tour the country as a sanitary expert, preaching the gospel of good water supply and good drainage, two of the great elements in civilization, in which in many places we have not yet reached the Roman standard.
CHAPTER III — MEDIAEVAL MEDICINE
THERE are waste places of the earth which fill one with terror—not simply because they are waste; one has not such feelings in the desert nor in the vast solitude of the ocean. Very different is it where the desolation has overtaken a brilliant and flourishing product of man's head and hand. To know that
. . . the Lion and the Lizard keep
The Courts where Jamshyd gloried and drank deep
sends a chill to the heart, and one trembles with a sense of human instability. With this feeling we enter the Middle Ages. Following the glory that was Greece and the grandeur that was Rome, a desolation came upon the civilized world, in which the light of learning burned low, flickering almost to extinction. How came it possible that the gifts of Athens and of Alexandria were deliberately thrown away? For three causes. The barbarians shattered the Roman Empire to its foundations. When Alaric entered Rome in 410 A. D., ghastly was the impression made on the contemporaries; the Roman world shuddered in a titanic spasm (Lindner). The land was a garden of Eden before them, behind a howling wilderness, as is so graphically told in Gibbon's great history. Many of the most important centres of learning were destroyed, and for centuries Minerva and Apollo forsook the haunts of men. The other equally important cause was the change wrought by Christianity. The brotherhood of man, the care of the body, the gospel of practical virtues formed the essence of the teaching of the Founder—in these the Kingdom of Heaven was to be sought; in these lay salvation. But the world was very evil, all thought that the times were waxing late, and into men's minds entered as never before a conviction of the importance of the four last things—death, judgment, heaven and hell. One obstacle alone stood between man and his redemption, the vile body, "this muddy vesture of decay," that so grossly wrapped his soul. To find methods of bringing it into subjection was the task of the Christian Church for centuries. In the Vatican Gallery of Inscriptions is a stone slab with the single word "Stercoriae," and below, the Christian symbol. It might serve as a motto for the Middle Ages, during which, to quote St. Paul, all things were "counted dung but to win Christ." In this attitude of mind the wisdom of the Greeks was not simply foolishness, but a stumbling-block in the path. Knowledge other than that which made a man "wise unto salvation" was useless. All that was necessary was contained in the Bible or taught by the Church. This simple creed brought consolation to thousands and illumined the lives of some of the noblest of men. But, "in seeking a heavenly home man lost his bearings upon earth." Let me commend for your reading Taylor's "Mediaeval Mind."(1) I cannot judge of its scholarship, which I am told by scholars is ripe and good, but I can judge of its usefulness for anyone who wishes to know the story of the mind of man in Europe at this period. Into the content of mediaeval thought only a mystic can enter with full sympathy. It was a needful change in the evolution of the race. Christianity brought new ideals and new motives into the lives of men. The world's desire was changed, a desire for the Kingdom of Heaven, in the search for which the lust of the flesh, the lust of the eye and the pride of life were as dross. A master-motive swayed the minds of sinful men and a zeal to save other souls occupied the moments not devoted to the perfection of their own. The new dispensation made any other superfluous. As Tertullian said: Investigation since the Gospel is no longer necessary. (Dannemann, Die Naturw., I, p. 214.) The attitude of the early Fathers toward the body is well expressed by Jerome. "Does your skin roughen without baths? Who is once washed in the blood of Christ needs not wash again." In this unfavorable medium for its growth, science was simply disregarded, not in any hostile spirit, but as unnecessary.(2) And a third contributing factor was the plague of the sixth century, which desolated the whole Roman world. On the top of the grand mausoleum of Hadrian, visitors at Rome see the figure of a gilded angel with a drawn sword, from which the present name of the Castle of St. Angelo takes its origin. On the twenty-fifth of April, 590, there set out from the Church of SS. Cosmas and Damian, already the Roman patron saints of medicine, a vast procession, led by St. Gregory the Great, chanting a seven-fold litany of intercession against the plague. The legend relates that Gregory saw on the top of Hadrian's tomb an angel with a drawn sword, which he sheathed as the plague abated.
(1) H. O. Taylor: The Mediaeval Mind, 2 vols., Macmillan Co.,
New York, 1911. (New edition, 1920.)
(2) Ibid., Vol. 1, p. 13: "Under their action (the Christian
Fathers) the peoples of Western Europe, from the eighth to the
thirteenth century, passed through a homogeneous growth, and
evolved a spirit different from that of any other period of
history—a spirit which stood in awe before its monitors divine
and human, and deemed that knowledge was to be drawn from the
storehouse of the past; which seemed to rely on everything except
its sin-crushed self, and trusted everything except its senses;
which in the actual looked for the ideal, in the concrete saw the
symbol, in the earthly Church beheld the heavenly, and in fleshly
joys discerned the devil's lures; which lived in the unreconciled
opposition between the lust and vain-glory of earth and the
attainment of salvation; which felt life's terror and its
pitifulness, and its eternal hope; around which waved concrete
infinitudes, and over which flamed the terror of darkness and the
Judgment Day."