Читать книгу An Epitome of the History of Medicine - Roswell Park - Страница 7

Table of Contents

1. The Primitive Period, or that of Instinct, beginning with myth, and ending with the destruction of Troy 1184 years before Christ.

2. The Sacred, or Mystic, Period, ending with the dispersion of the Pythagorean Society, 500 years before Christ.

3. The Philosophic Period, terminating with the foundation of the Alexandrian library, 320 years before Christ.

4. The Anatomic Period, ending with the death of Galen, about A.D. 200.

THE SECOND AGE, OR THAT OF TRANSITION, is divided into a fifth, or Greek Period, ending at the burning of the Alexandrian library, A.D. 640, and a sixth, Arabic Period, ending with the revival of letters, A.D. 1400.

THE THIRD AGE, OR THAT OF RENOVATION, includes the seventh, or Erudite Period, comprising the fifteenth and sixteenth centuries, and eighth, or Reform Period, comprising the seventeenth, eighteenth, and nineteenth centuries.

Examining this table for a moment, it will be seen that so far we have dealt with the Primitive Period and the Sacred, or Mystic, Period. Before passing on to the Philosophic Period let us for a moment follow Renouard, who likens the three schools of medical belief in the earlier part of the Primary Age, or the Age of Foundation, to the three schools of cosmogony, which obtained among the Greeks. The first of these was headed by Pythagoras, who regarded the universe as inhabited by acknowledged sentient principles which governed all substances in a determined way for preconceived purposes. Animals, plants, and even minerals were supposed to possess vivifying spirits, and above them all was a supreme principle. To this school corresponded the so-called Dogmatic School of medicine, attributed to Hippocrates, which was the precursor of modern vitalism, and regarded diseases as indivisible units from beginning to termination; in other words, they consisted of a regular programme of characteristic systems, successive periods, and of long course, either for the better or worse; that was one of the characteristic dogmas of the Hippocratic teaching. The Second System of cosmogony was that founded by Leucippus and Democritus, who explained all natural phenomena without recourse to the intervention of intelligent principles. All things for them existed as the necessary result of the eternal laws of matter. They denied preconceived purposes and ridiculed final causes. To this system corresponded that in medicine which has been termed Methodism (medically and literally speaking) and which recognized as its founders Æsculapius and Themison. The believers in this doctrine attempted to apply the atomic theory of Democritus and Epicurus to the theory and practice of medicine. Atoms of various size were supposed to pass and repass without cessation through cavities or pores in the human body. So long as the atoms and pores maintained a normal relationship of size and proportion health was maintained, but it was deranged so soon as the exactness of these relations was destroyed or interfered with. The Dogmatists considered vital reaction as a primary phenomenon, while with the Methodists it was secondary. The Third System of cosmogony, founded by Parmenides and Pyrrho, believed in the natural improvement of bodies in their endless reproduction and change, and concluded that wisdom consisted in remaining in doubt; in other words, they were the agnostics of that day. "What is the use," said they, "of fatiguing the mind in endeavoring to comprehend what is beyond its capability." Later they were known as Skeptics and Zetetics, to indicate that they were always in search of truth without flattering them selves that they had found it. To them corresponded a third class of physicians, with Philinus and Serapis at their head, who deemed that proximate causes and primitive phenomena of disease were inaccessible to observation; that all that is affirmed on these subjects is purely hypothetical, and hence unworthy of consideration in choosing treatment. For them objective symptoms—or, as we would say, signs—constituted the natural history of disease, they thus believing that their remedies could only be suggested by experience, since nothing else could reveal itself to them. They therefore took the name of Empirics.

Finally a fourth class of physicians arose who would not adopt any one of these systems exclusively, but chose from each what seemed to them most reasonable and satisfactory. They called themselves Eclectics, wishing thereby to imply that they made rational choice of what seemed best. The idea conveyed in the term "eclecticism" has been fairly criticised for this reason: eclecticism is in reality neither a system nor a theory; it is individual pretension elevated to the dignity of dogma. The true eclectic recognizes no other rule than his particular taste, reason, or fancy, and two or more eclectics have little or nothing in common. If that were true two thousand years ago, it is not much less so to-day. The eclectic carefully avoids the discussion of principles, and has neither taste nor capacity for abstract reasoning, although he may be a good practitioner; not that he has no ideas, but that his ideas form no working system. With him medical tact—i.e., cultivated instinct—replaces principle.

The eclectic of our day, however, is only an empiric in disguise—that is, a man whose opinions are based on comparison of observed facts, but whose theoretical ideas do not go beyond phenomena.

In older days philosophy embraced the whole of human knowledge, and the philosopher was not permitted to be unacquainted with any of its branches. Now physics, metaphysics, natural history, etc., are arranged into separate sciences, and the sum-total of knowledge is too great to be compassed by any one man.

Pythagoras was the last of the Greek sages who made use of hieroglyphic writings and transmitted his doctrine in ancient language. Born at Samos, he was, first of all, an athlete; but one day, hearing a lecture no immortality of the soul, he was thereby so strongly attracted to philosophy that he renounced all other occupation to devote himself to it. He studied arduously in Egypt, in Phoenicia, in Chaldea, and even, it is said, in India, where he was initiated into the secrets of the Brahmins and Magi. Finally, returning to his own country, he was received by the tyrant Polycrates, but not made to feel at home. Starting on his travels again, he assisted at one of the Olympic games, and, being recognized, was warmly greeted. He sailed to the south of Italy, landed at Crotona, and lodged with Milo, the athlete. Commencing here his lectures, he soon gathered around him a great number of disciples, of whom he required a very severe novitiate, lasting even five or six years, during which they had to abstain almost entirely from conversation, and live upon a very frugal diet. Those only who persevered were initiated later into the mysteries of the order. His disciples had for him most profound veneration, and were accustomed to decide all disputes witlr: "The master has said it." Pythagoras possessed immense knowledge; he invented the theorem of the square of the hypothenuse, and he first divided the year into 365 days and 6 hours. He seems to have suspected the movements of our planetary system. He traveled from place to place, and founded schools and communities wherever he went, which exercised, at least at first, only the happiest influence; but the success and influence which their learning gave them later made his disciples bold, and then dishonest, and his communities were finally dispersed by angry mobs, which forced their members to conceal or expatriate themselves; and so, even during the life-time of its founder, the Pythagorean Society was destroyed, and never reconstructed.

With Pythagoras and his disciples numbers played a very important rôle, and the so-called language of numbers was first taught by him. He considered the unit as the essential principle of all things, and designated God by the figure 1 and matter by the figure 2, and then he expressed the universe by 12, as representing the juxtaposition of 1 and 2. As 12 results from multiplying 3 by 4, he conceived the universe as composed of three distinct worlds, each of which was developed in four concentric spheres, and these spheres corresponded to the primitive elements of fire, air, earth, and water. The application of the number 12 to express the universe Pythagoras had received from the Chaldeans and Egyptians—it being the origin of the institution of the zodiac. Although this is digressing, it serves to show what enormous importance the people of that time attached to numbers, especially to the ternary and quarternary periods in the determination of critical days in illness. Pythagoras was the founder of a philosophic system of great grandeur, beauty, and, in one sense, completion, embracing, as it does, and uniting by common bounds God, the universe, time, and eternity; furnishing an explanation of all natural phenomena, which, if not true, was at that time acceptable, and which appears in strong and favorable contrast as against the mythological systems of pagan priests. No wonder that it captivated the imagination and understanding of the thinking young men of that day. Had they continued in the original purity of life and thought in which he indoctrinated them there is no knowing how long the Pythagorean school might have continued. But after it had been dissolved by the storm of persecution, its members were scattered all over Greece and even beyond. Now no longer held by any bonds, many of them revealed the secrets of their doctrine, to which circumstance we owe the little knowledge thereof we now possess.

The Pythagoreans apparently first introduced the custom of visiting patients in their own homes, and they went from city to city and house to house in performance of this duty. On this account they were called Periodic or Ambulant physicians, in opposition to the Asclepiadæ, who prescribed only in the temples. Empedocles, of Agrigentum, well known in the history of philosophy, was perhaps the most famous of these physicians. Let the following incident witness his sagacity: Pestilential fevers periodically ravaged his native city. He observed that their appearance coincided with the return of the sirocco, which blows in Sicily on its western side. He therefore advised to close by a wall, as by a dam, the narrow gorge from which this wind blew upon Agrigentum. His advice was followed and his city was made free from the pestilence.

Again, the inhabitants of Selinus were ravaged by epidemic disease. A sluggish stream filled the city with stagnant water from which mephitic vapors arose. Empedocles caused two small rivulets to be conducted into it, which made its current more rapid; the noxious vapors dispersed and the scourge subsided.

The Gymnasia.—Before we proceed to a somewhat more detailed, but brief, account of Hippocrates, it is necessary to say a word or two of the ancient gymnasia of Greece, which were used long before the Asclepiadæ had practiced or begun to teach. In these gymnasia were three orders of physicians: first, the director, called the Gym-nasiarch; second, the subdirector, or Gymnast, who directed the pharmaceutical treatment of the sick; and, lastly, the Iatroliptes, who put up prescriptions, anointed, bled, gave massage, dressed wounds and ulcers, reduced dislocations, treated abscesses, etc. Of the gymnasiarclis wonderful stories are told evincing their sagacity, which, though somewhat fabulous, indicate the possession of a very high degree of skill of a certain kind. Of one of the most celebrated of these, Herodicus, we may recall Plato's accusation, who reprimanded him severely for succeeding too well in prolonging the lives of the aged. Whatever else may be said, we must acknowledge that above all others the Greeks recognized the value of physical culture in the prevention of infirmity, and of all physical methods in the treatment of disease. By their wise enactments with reference to these matters they set an example which modern legislators have rarely, if ever, been wise enough to follow—an example of compulsory physical training for the young—and thereby built up a nation of athletes and a people of rugged constitution among whom disease was almost unknown.

I come now to the so-called Philosophic Period, or the third period in the Age of Foundation, which is inseparably connected with the name of Hippocrates. This central figure in the history of ancient medicine was born on the Island of Cos, of a family in which the practice of medicine was hereditary, who traced their ancestors on the male side to Æsculapius, and on the female side to Hercules. The individual to whom every one refers under this name was the second of seven; the date of his birth goes back to 460 B.C., but of his life and his age at death we do not know; some say he lived to be over one hundred years of age. It is certain that he traveled widely, since his writings evince the knowledge thus gained. He was a contemporary of Socrates, although somewhat younger, and lived in the age of Pericles—the golden age for science and art in Greece.