(6) The well-known editor of Herodotus, R. W. Macan, Master of University College, Oxford, in his Hellenikon. A Sheaf of Sonnets after Herodotus (Oxford, 1898) has included a poem which may be quoted in connection with this incident:

NOSTALGY Atossa, child of Cyrus king of kings, healed by Greek science of a morbid breast, gave lord Dareios neither love nor rest till he fulfilled her vain imaginings. "Sir, show our Persian folk your sceptre's wings! Enlarge my sire's and brother's large bequest. This learned Greek shall guide your galleys west, and Dorian slave-girls grace our banquetings." So said she, taught of that o'er-artful man, the Italiote captive, Kroton's Demokede, who recked not what of maladies began, nor who in Asia and in Greece might bleed, if he—so writes the guileless Thurian— regained his home, and freedom of the Mede.

Plato has several references to these state physicians, who were evidently elected by a public assembly: "When the assembly meets to elect a physician," and the office was yearly, for in "The Statesman" we find the following:(7) "When the year of office has expired, the pilot, or physician has to come before a court of review" to answer any charges. The physician must have been in practice for some time and attained eminence, before he was deemed worthy of the post of state physician.

(7) Jowett: Dialogues of Plato, 3d ed., Statesman, Vol. IV, p. 502 (Stephanus, II, 298 E)

"If you and I were physicians, and were advising one another that we were competent to practice as state-physicians, should I not ask about you, and would you not ask about me, Well, but how about Socrates himself, has he good health? and was anyone else ever known to be cured by him whether slave or freeman?"(7a)

(7a) Jowett: Dialogues of Plato, 3d ed., Gorgias, Vol. II, p. 407 (Stephanus, I, 514 D).

All that is known of these state physicians has been collected by Pohl,(8) who has traced their evolution into Roman times. That they were secular, independent of the AEsculapian temples, that they were well paid, that there was keen competition to get the most distinguished men, that they were paid by a special tax and that they were much esteemed—are facts to be gleaned from Herodotus and from the inscriptions. The lapidary records, extending over 1000 years, collected by Professor Oehler(8a) of Reina, throw an important light on the state of medicine in Greece and Rome. Greek vases give representations of these state doctors at work. Dr. E. Pottier has published one showing the treatment of a patient in the clinic.(8b)

(8) R. Pohl: De Graecorum medicis publicis, Berolini, Reimer, 1905; also Janus, Harlem, 1905, X, 491-494.

(8a) J Oehler: Janus, Harlem, 1909, XIV, 4; 111.

(8b) E. Pottier: Une clinique grecque au Ve siecle, Monuments et Memoires, XIII, p. 149. Paris, 1906 (Fondation Eugene Piot).

That dissections were practiced by this group of nature philosophers is shown not only by the studies of Alcmaeon, but we have evidence that one of the latest of them, Diogenes of Apollonia, must have made elaborate dissections. In the "Historia Animalium"(9) of Aristotle occurs his account of the blood vessels, which is by far the most elaborate met with in the literature until the writings of Galen. It has, too, the great merit of accuracy (if we bear in mind the fact that it was not until after Aristotle that arteries and veins were differentiated), and indications are given as to the vessels from which blood may be drawn.

(9) The Works of Aristotle, Oxford, Clarendon Press, Vol. IV, 1910, Bk. III, Chaps. II-IV, pp. 511b-515b.



ASKLEPIOS

No god made with hands, to use the scriptural phrase, had a more successful "run" than Asklepios—for more than a thousand years the consoler and healer of the sons of men. Shorn of his divine attributes he remains our patron saint, our emblematic God of Healing, whose figure with the serpents appears in our seals and charters. He was originally a Thessalian chieftain, whose sons, Machaon and Podalirius, became famous physicians and fought in the Trojan War. Nestor, you may remember, carried off the former, declaring, in the oft-quoted phrase, that a doctor was better worth saving than many warriors unskilled in the treatment of wounds. Later genealogies trace his origin to Apollo,(10) as whose son he is usually regarded. "In the wake of northern tribes this god Aesculapius—a more majestic figure than the blameless leech of Homer's song—came by land to Epidaurus and was carried by sea to the east-ward island of Cos.... Aesculapius grew in importance with the growth of Greece, but may not have attained his greatest power until Greece and Rome were one."(11)

(10) W. H. Roscher: Lexikon der griechischen und romischen Mythologie, Leipzig, 1886, I, p. 624.

(11) Louis Dyer: Studies of the Gods in Greece, 1891, p. 221.

A word on the idea of the serpent as an emblem of the healing art which goes far back into antiquity. The mystical character of the snake, and the natural dread and awe inspired by it, early made it a symbol of supernatural power. There is a libation vase of Gudea, c. 2350 B.C., found at Telloh, now in the Louvre (probably the earliest representation of the symbol), with two serpents entwined round a staff (Jastrow, Pl. 4). From the earliest times the snake has been associated with mystic and magic power, and even today, among native races, it plays a part in the initiation of medicine men.

In Greece, the serpent became a symbol of Apollo, and prophetic serpents were kept and fed at his shrine, as well as at that of his son, Asklepios. There was an idea, too, that snakes had a knowledge of herbs, which is referred to in the famous poem of Nikander on Theriaka.(12) You may remember that when Alexander, the famous quack and oracle monger, depicted by Lucian, started out "for revenue," the first thing he did was to provide himself with two of the large, harmless, yellow snakes of Asia Minor.

(12) Lines 31, etc., and Scholia; cf. W. R. Halliday: Greek Divination, London, 1913, p. 88.

The exact date of the introduction of the cult into Greece is not known, but its great centres were at Epidaurus, Cos, Pergamos and Tricca. It throve with wonderful rapidity. Asklepios became one of the most popular of the gods. By the time of Alexander it is estimated that there were between three and four hundred temples dedicated to him.

His worship was introduced into Rome at the time of the Great Plague at the beginning of the third century B.C. (as told by Livy in Book XI), and the temple on the island of Tiber became a famous resort. If you can transfer in imagination the Hot Springs of Virginia to the neighborhood of Washington, and put there a group of buildings such as are represented in these outlines of Caton's(13) (p. 52), add a sumptuous theatre with seating capacity for 20,000, a stadium 600 feet long with a seating capacity of 12,000, and all possible accessories of art and science, you will have an idea of what the temple at Epidaurus, a few miles from Athens, was. "The cult flourished mostly in places which, through climatic or hygienic advantages, were natural health resorts. Those favoured spots on hill or mountain, in the shelter of forests, by rivers or springs of pure flowing water, were conducive to health. The vivifying air, the well cultivated gardens surrounding the shrine, the magnificent view, all tended to cheer the heart with new hope of cure. Many of these temples owed their fame to mineral or merely hot springs. To the homely altars, erected originally by sacred fountains in the neighbourhood of health-giving mineral springs, were later added magnificent temples, pleasure-grounds for festivals, gymnasia in which bodily ailments were treated by physical exercises, baths and inunctions, also, as is proved by excavations, living rooms for the patients. Access to the shrine was forbidden to the unclean and the impure, pregnant women and the mortally afflicted were kept away; no dead body could find a resting-place within the holy precincts, the shelter and the cure of the sick being undertaken by the keepers of inns and boarding-houses in the neighbourhood. The suppliants for aid had to submit to careful purification, to bathe in sea, river or spring, to fast for a prescribed time, to abjure wine and certain articles of diet, and they were only permitted to enter the temple when they were adequately prepared by cleansing, inunction and fumigation. This lengthy and exhausting preparation, partly dietetic, partly suggestive, was accompanied by a solemn service of prayer and sacrifice, whose symbolism tended highly to excite the imagination."(14)

(13) Caton: Temples and Ritual of Asklepios, 2d ed., London, 1900.

(14) Max Neuburger: History of Medicine, English translation, Oxford, 1910, p. 94.

The temples were in charge of members of the guild or fraternity, the head of which was often, though not necessarily, a physician. The Chief was appointed annually. From Caton's excellent sketch(15) you can get a good idea of the ritual, but still better is the delightful description given in the "Plutus" of Aristophanes. After offering honey-cakes and baked meats on the altar, the suppliants arranged themselves on the pallets.

(15) Caton: Temples and Ritual of Asklepios, 2d ed., London, 1900.

Soon the Temple servitor Put out the lights and bade us fall asleep, Nor stir, nor speak, whatever noise we heard. So down we lay in orderly repose. And I could catch no slumber, not one wink, Struck by a nice tureen of broth which stood A little distance from an old wife's head, Whereto I marvellously longed to creep. Then, glancing upwards, I beheld the priest Whipping the cheese-cakes and figs from off The holy table; thence he coasted round To every altar spying what was left. And everything he found he consecrated Into a sort of sack—(16)

a procedure which reminds one of the story of "Bel and the Dragon." Then the god came, in the person of the priest, and scanned each patient. He did not neglect physical measures, as he brayed in a mortar cloves, Tenian garlic, verjuice, squills and Sphettian vinegar, with which he made application to the eyes of the patient.

(16) Aristophanes: B. B. Roger's translation, London, Bell & Sons, 1907, Vol. VI, ll. 668, etc., 732 ff.

Then the God clucked, And out there issued from the holy shrine Two great, enormous serpents.... And underneath the scarlet cloth they crept, And licked his eyelids, as it seemed to me; And, mistress dear, before you could have drunk Of wine ten goblets, Wealth arose and saw.(17)

(17) Ibid.

The incubation sleep, in which indications of cure were divinely sent, formed an important part of the ritual.

The Asklepieion, or Health Temple of Cos, recently excavated, is of special interest, as being at the birthplace of Hippocrates, who was himself an Asklepiad. It is known that Cos was a great medical school. The investigations of Professor Rudolf Hertzog have shown that this temple was very nearly the counterpart of the temple at Epidaurus.

The AEsculapian temples may have furnished a rare field for empirical enquiry. As with our modern hospitals, the larger temple had rich libraries, full of valuable manuscripts and records of cases. That there may have been secular Asklepiads connected with the temple, who were freed entirely from its superstitious practices and theurgic rites, is regarded as doubtful; yet is perhaps not so doubtful as one might think. How often have we physicians to bow ourselves in the house of Rimmon! It is very much the same today at Lourdes, where lay physicians have to look after scores of patients whose faith is too weak or whose maladies are too strong to be relieved by Our Lady of this famous shrine. Even in the Christian era, there is evidence of the association of distinguished physicians with AEsculapian temples. I notice that in one of his anatomical treatises, Galen speaks with affection of a citizen of Pergamos who has been a great benefactor of the AEsculapian temple of that city. In "Marius, the Epicurean," Pater gives a delightful sketch of one of those temple health resorts, and brings in Galen, stating that he had himself undergone the temple sleep; but to this I can find no reference in the general index of Galen's works.

From the votive tablets found at Epidaurus, we get a very good idea of the nature of the cases and of the cures. A large number of them have now been deciphered. There are evidences of various forms of diseases of the joints, affections of women, wounds, baldness, gout; but we are again in the world of miracles, as you may judge from the following: "Heraicus of Mytilene is bald and entreats the God to make his hair grow. An ointment is applied over night and the next morning he has a thick crop of hair."

There are indications that operations were performed and abscesses opened. From one we gather that dropsy was treated in a novel way: Asklepios cuts off the patient's head, holds him up by the heels, lets the water run out, claps on the patient's head again. Here is one of the invocations: "Oh, blessed Asklepios, God of Healing, it is thanks to thy skill that Diophantes hopes to be relieved from his incurable and horrible gout, no longer to move like a crab, no longer to walk upon thorns, but to have sound feet as thou hast decreed."

The priests did not neglect the natural means of healing. The inscriptions show that great attention was paid to diet, exercise, massage and bathing, and that when necessary, drugs were used. Birth and death were believed to defile the sacred precincts, and it was not until the time of the Antonines that provision was made at Epidaurus for these contingencies.

One practice of the temple was of special interest, viz., the incubation sleep, in which dreams were suggested to the patients. In the religion of Babylonia, an important part was played by the mystery of sleep, and the interpretation of dreams; and no doubt from the East the Greeks took over the practice of divination in sleep, for in the AEsculapian cult also, the incubation sleep played a most important role. That it continued in later times is well indicated in the orations of Aristides, the arch-neurasthenic of ancient history, who was a great dreamer of dreams. The oracle of Amphiaraus in Attica sent dreams into the hearts of his consultants. "The priests take the inquirer, and keep him fasting from food for one day, and from wine for three days, to give him perfect spiritual lucidity to absorb the divine communication" (Phillimore's "Apollonius of Tyana," Bk. II, Ch. XXXVII). How incubation sleep was carried into the Christian Church, its association with St. Cosmas and St. Damian and other saints, its practice throughout the Middle Ages, and its continuation to our own time may be read in the careful study of the subject made by Miss Hamilton (now Mrs. Dickens).(18) There are still in parts of Greece and in Asia Minor shrines at which incubation is practiced regularly, and if one may judge from the reports, with as great success as in Epidaurus. At one place in Britain, Christchurch in Monmouthshire, incubation was carried on till the early part of the nineteenth century. Now the profession has come back to the study of dreams,(19) and there are professors as ready to give suggestive interpretations to them, as in the days of Aristides. As usual, Aristotle seems to have said the last word on the subject: "Even scientific physicians tell us that one should pay diligent attention to dreams, and to hold this view is reasonable also for those who are not practitioners but speculative philosophers,"(20) but it is asking too much to think that the Deity would trouble to send dreams to very simple people and to animals, if they were designed in any way to reveal the future.

In its struggle with Christianity, Paganism made its last stand in the temples of Asklepios. The miraculous healing of the saints superseded the cures of the heathen god, and it was wise to adopt the useful practice of his temple.

(18) Mary Hamilton: Incubation, or the Cure of Disease in Pagan Temples and Christian Churches, London, 1906.

(19) Freud: The Interpretation of Dreams, translation of third edition by A. A. Brill, 1913.

(20) Aristotle: Parva Naturalia, De divinatione per somnium, Ch. I, Oxford ed., Vol. III, 463 a.



HIPPOCRATES AND THE HIPPOCRATIC WRITINGS

DESERVEDLY the foundation of Greek Medicine is associated with the name of Hippocrates, a native of the island of Cos; and yet he is a shadowy personality, about whom we have little accurate first-hand information. This is in strong contrast to some of his distinguished contemporaries and successors, for example, Plato and Aristotle, about whom we have such full and accurate knowledge. You will, perhaps, be surprised to hear that the only contemporary mention of Hippocrates is made by Plato. In the "Protagoras," the young Hippocrates, son of Apollodorus has come to Protagoras, "that mighty wise man," to learn the science and knowledge of human life. Socrates asked him: "If . . . you had thought of going to Hippocrates of Cos, the Asclepiad, and were about to give him your money, and some one had said to you, 'You are paying money to your namesake Hippocrates, O Hippocrates; tell me, what is he that you give him money?' how would you have answered?" "I should say," he replied, "that I gave money to him as a physician." "And what will he make of you?" "A physician," he said. And in the Phaedrus, in reply to a question of Socrates whether the nature of the soul could be known intelligently without knowing the nature of the whole, Phaedrus replies: "Hippocrates, the Asclepiad, says that the nature, even of the body, can only be understood as a whole." (Plato, I, 311; III, 270—Jowett, I, 131, 479.)

Several lives of Hippocrates have been written. The one most frequently quoted is that of Soranus of Ephesus (not the famous physician of the time of Trajan), and the statements which he gives are usually accepted, viz., that he was born in the island of Cos in the year 460 B.C.; that he belonged to an Asklepiad family of distinction, that he travelled extensively, visiting Thrace, Thessaly, and various other parts of Greece; that he returned to Cos, where he became the most renowned physician of his period, and died about 375 B.C. Aristotle mentions him but once, calling him "the great Hippocrates." Busts of him are common; one of the earliest of which, and I am told the best, dating from Roman days and now in the British Museum, is here represented.

Of the numerous writings attributed to Hippocrates it cannot easily be determined which are really the work of the Father of Medicine himself. They were collected at the time of the Alexandrian School, and it became customary to write commentaries upon them; much of the most important information we have about them, we derive from Galen. The earliest manuscript is the "Codex Laurentianus" of Florence, dating from the ninth century, a specimen page of which (thanks to Commendatore Biagi) is annexed. Those of you who are interested, and wish to have full references to the various works attributed to Hippocrates, will find them in "Die Handschriften der antiken Aerzte" of the Prussian Academy, edited by Diels (Berlin, 1905). The Prussian Academy has undertaken the editorship of the "Corpus Medicorum Graecorum." There is no complete edition of them in English. In 1849 the Deeside physician, Adams, published (for the Old Sydenham Society) a translation of the most important works, a valuable edition and easily obtained. Littre's ten-volume edition "OEuvres completes d'Hippocrate," Paris, 1839-1861, is the most important for reference. Those of you who want a brief but very satisfactory account of the Hippocratic writings, with numerous extracts, will find the volume of Theodor Beck (Jena, 1907) very useful.

I can only indicate, in a very brief way, the special features of the Hippocratic writings that have influenced the evolution of the science and art of medicine.

The first is undoubtedly the note of humanity. In his introduction to, "The Rise of the Greek Epic,"(21) Gilbert Murray emphasizes the idea of service to the community as more deeply rooted in the Greeks than in us. The question they asked about each writer was, "Does he help to make better men?" or "Does he make life a better thing?" Their aim was to be useful, to be helpful, to make better men in the cities, to correct life, "to make gentle the life of the world." In this brief phrase were summed up the aspirations of the Athenians, likewise illuminated in that remarkable saying of Prodicus (fifth century B.C.), "That which benefits human life is God." The Greek view of man was the very antithesis of that which St. Paul enforced upon the Christian world. One idea pervades thought from Homer to Lucian-like an aroma—pride in the body as a whole. In the strong conviction that "our soul in its rose mesh" is quite as much helped by flesh as flesh by the soul the Greek sang his song—"For pleasant is this flesh." Just so far as we appreciate the value of the fair mind in the fair body, so far do we apprehend ideals expressed by the Greek in every department of life. The beautiful soul harmonizing with the beautiful body was as much the glorious ideal of Plato as it was the end of the education of Aristotle. What a splendid picture in Book III of the "Republic," of the day when ". . . our youth will dwell in a land of health, amid fair sights and sounds and receive the good in everything; and beauty, the effluence of fair works, shall flow into the eye and ear like a health-giving breeze from a purer region, and insensibly draw the soul from earliest years into likeness and sympathy with the beauty of reason." The glory of this zeal for the enrichment of this present life was revealed to the Greeks as to no other people, but in respect to care for the body of the common man, we have only seen its fulfilment in our own day, as a direct result of the methods of research initiated by them. Everywhere throughout the Hippocratic writings we find this attitude towards life, which has never been better expressed than in the fine phrase, "Where there is love of humanity there will be love of the profession." This is well brought out in the qualifications laid down by Hippocrates for the study of medicine. "Whoever is to acquire a competent knowledge of medicine ought to be possessed of the following advantages: a natural disposition; instruction; a favourable position for the study; early tuition; love of labour; leisure. First of all, a natural talent is required, for when nature opposes, everything else is vain; but when nature leads the way to what is most excellent, instruction in the art takes place, which the student must try to appropriate to himself by reflection, becoming a nearly pupil in a place well adapted for instruction. He must also bring to the task a love of labour and perseverance, so that the instruction taking root may bring forth proper and abundant fruits." And the directions given for the conduct of life and for the relation which the physician should have with the public are those of our code of ethics today. Consultations in doubtful cases are advised, touting for fees is discouraged. "If two or more ways of medical treatment were possible, the physician was recommended to choose the least imposing or sensational; it was an act of 'deceit' to dazzle the patient's eye by brilliant exhibitions of skill which might very well be dispensed with. The practice of holding public lectures in order to increase his reputation was discouraged in the physician, and he was especially warned against lectures tricked out with quotations from the poets. Physicians who pretended to infallibility in detecting even the minutest departure from their prescriptions were laughed at; and finally, there were precise by-laws to regulate the personal behaviour of the physician. He was enjoined to observe the most scrupulous cleanliness, and was advised to cultivate an elegance removed from all signs of luxury, even down to the detail that he might use perfumes, but not in an immoderate degree."(22) But the high-water mark of professional morality is reached in the famous Hippocratic oath, which Gomperz calls "a monument of the highest rank in the history of civilization." It is of small matter whether this is of Hippocratic date or not, or whether it has in it Egyptian or Indian elements: its importance lies in the accuracy with which it represents the Greek spirit. For twenty-five centuries it has been the "credo" of the profession, and in many universities it is still the formula with which men are admitted to the doctorate.

(21) Oxford. Clarendon Press, 2d ed., 1911.

(22) Gomperz: Greek Thinkers, Vol. I, p. 281.

I swear by Apollo the physician and AEsculapius and Health (Hygieia) and All-Heal (Panacea) and all the gods and goddesses, that, according to my ability and judgment, I will keep this oath and this stipulation—to reckon him who taught me this art equally dear to me as my parents, to share my substance with him, and relieve his necessities if required; to look upon his offspring in the same footing as my own brothers, and to teach them this art, if they shall wish to learn it, without fee or stipulation; and that by precept, lecture, and every other mode of instruction, I will impart a knowledge of my art to my own sons, and those of my teachers, and to disciples bound by a stipulation and oath according to the law of medicine, but to none others. I will follow that system of regimen which, according to my ability and judgement, I consider for the benefit of my patients, and abstain from whatever is deleterious and mischievous.

I will give no deadly medicine to anyone if asked, nor suggest any such counsel; and in like manner I will not give to a woman a pessary to produce abortion.

With purity and with holiness I will pass my life and practice my art.

(I will not cut persons labouring under the stone, but will leave this to be done by men who are practitioners of this work.)

Into whatsoever houses I enter, I will go into them for the benefit of the sick, and will abstain from every voluntary act of mischief and corruption, and, further, from the abduction of females or males, of freemen and slaves. Whatever, in connection with my professional practice, or not in connection with it, I see or hear, in the life of men, which ought not to be spoken of abroad, I will not divulge, as reckoning that all such should be kept secret.

While I continue to keep this Oath unviolated, may it be granted to me to enjoy life and the practice of the art, respected by all men, in all times! But should I trespass and violate this Oath, may the reverse be my lot!

(Adams, II, 779, cf. Littre, IV, 628.)

In his ideal republic, Plato put the physician low enough, in the last stratum, indeed, but he has never been more honorably placed than in the picture of Athenian society given by this author in the "Symposium." Here the physician is shown as a cultivated gentleman, mixing in the best, if not always the most sober, society. Eryximachus, the son of Acumenus, himself a physician, plays in this famous scene a typical Greek part(22a)—a strong advocate of temperance in mind and body, deprecating, as a physician, excess in drink, he urged that conversation should be the order of the day and he had the honor of naming the subject—"Praise of the God of Love." Incidentally Eryximachus gives his view of the nature of disease, and shows how deeply he was influenced by the views of Empedocles:". . . so too in the body the good and healthy elements are to be indulged, and the bad elements and the elements of disease are not to be indulged, but discouraged. And this is what the physician has to do, and in this the art of medicine consists: for medicine may be regarded generally as the knowledge of the loves and desires of the body and how to satisfy them or not; and the best physician is he who is able to separate fair love from foul, or to convert one into the other; and he who knows how to eradicate and how to implant love, whichever is required, and can reconcile the most hostile elements in the constitution and make them loving friends, is a skilful practitioner."

(22a) Professor Gildersleeve's view of Eryximachus is less favorable (Johns Hopkins University Circular, Baltimore, January, 1887). Plato, III, 186—Jowett, I, 556.

The second great note in Greek medicine illustrates the directness with which they went to the very heart of the matter. Out of mysticism, superstition and religious ritual the Greek went directly to nature and was the first to grasp the conception of medicine as an art based on accurate observation, and an integral part of the science of man. What could be more striking than the phrase in "The Law," "There are, in effect, two things, to know and to believe one knows; to know is science; to believe one knows is ignorance"?(23) But no single phrase in the writings can compare for directness with the famous aphorism which has gone into the literature of all lands: "Life is short and Art is long; the Occasion fleeting, Experience fallacious, and Judgment difficult."

(23) Littre: OEuvres d'Hippocrate, Vol. IV, pp. 641-642.

Everywhere one finds a strong, clear common sense, which refuses to be entangled either in theological or philosophical speculations. What Socrates did for philosophy Hippocrates may be said to have done for medicine. As Socrates devoted himself to ethics, and the application of right thinking to good conduct, so Hippocrates insisted upon the practical nature of the art, and in placing its highest good in the benefit of the patient. Empiricism, experience, the collection of facts, the evidence of the senses, the avoidance of philosophical speculations, were the distinguishing features of Hippocratic medicine. One of the most striking contributions of Hippocrates is the recognition that diseases are only part of the processes of nature, that there is nothing divine or sacred about them. With reference to epilepsy, which was regarded as a sacred disease, he says, "It appears to me to be no wise more divine nor more sacred than other diseases, but has a natural cause from which it originates like other affections; men regard its nature and cause as divine from ignorance." And in another place he remarks that each disease has its own nature, and that no one arises without a natural cause. He seems to have been the first to grasp the conception of the great healing powers of nature. In his long experience with the cures in the temples, he must have seen scores of instances in which the god had worked the miracle through the vis medicatrix naturae; and to the shrewd wisdom of his practical suggestions in treatment may be attributed in large part the extraordinary vogue which the great Coan has enjoyed for twenty-five centuries. One may appreciate the veneration with which the Father of Medicine was regarded by the attribute "divine" which was usually attached to his name. Listen to this for directness and honesty of speech taken from the work on the joints characterized by Littre as "the great surgical monument of antiquity": "I have written this down deliberately, believing it is valuable to learn of unsuccessful experiments, and to know the causes of their non-success."

The note of freedom is not less remarkable throughout the Hippocratic writings, and it is not easy to understand how a man brought up and practicing within the precincts of a famous AEsculapian temple could have divorced himself so wholly from the superstitions and vagaries of the cult. There are probably grounds for Pliny's suggestion that he benefited by the receipts written in the temple, registered by the sick cured of any disease. "Afterwards," Pliny goes on to remark in his characteristic way, "hee professed that course of Physicke which is called Clinice Wherby physicians found such sweetnesse that afterwards there was no measure nor end of fees," ('Natural History,' XXIX, 1). There is no reference in the Hippocratic writings to divination; incubation sleep is not often mentioned, and charms, incantations or the practice of astrology but rarely. Here and there we do find practices which jar upon modern feeling, but on the whole we feel in reading the Hippocratic writings nearer to their spirit than to that of the Arabians or of the many writers of the fifteenth and sixteenth centuries A. D. And it is not only against the thaumaturgic powers that the Hippocratic writings protested, but they express an equally active reaction against the excesses and defects of the new philosophy, a point brought out very clearly by Gomperz.(24) He regards it as an undying glory of the school of Cos that after years of vague, restless speculation it introduces "steady sedentary habits into the intellectual life of mankind." 'Fiction to the right! Reality to the left!' was the battle-cry of this school in the war they were the first to wage against the excesses and defects of the nature-philosophy. Though the protest was effective in certain directions, we shall see that the authors of the Hippocratic writings could not entirely escape from the hypotheses of the older philosophers.

(24) Gomperz: Greek Thinkers, Vol. I, p. 296.

I can do no more than indicate in the briefest possible way some of the more important views ascribed to Hippocrates. We cannot touch upon the disputes between the Coan and Cnidian schools.(25) You must bear in mind that the Greeks at this time had no human anatomy. Dissections were impossible; their physiology was of the crudest character, strongly dominated by the philosophies. Empedocles regarded the four elements, fire, air, earth and water, as "the roots of all things," and this became the corner stone in the humoral pathology of Hippocrates. As in the Macrocosm—the world at large there were four elements, fire, air, earth, and water, so in the Microcosm—the world of man's body—there were four humors (elements), viz.,blood, phlegm, yellow bile (or choler) and black bile (or melancholy), and they corresponded to the four qualities of matter, heat, cold, dryness and moisture. For more than two thousand years these views prevailed. In his "Regiment of Life" (1546) Thomas Phaer says:". . . which humours are called ye sones of the Elements because they be complexioned like the foure Elements, for like as the Ayre is hot and moyst: so is the blooud, hote and moyste. And as Fyer is hote and dry: so is Cholere hote and dry. And as water is colde and moyst: so is fleume colde and moyste. And as the Earth is colde and dry: so Melancholy is colde and dry."(26)

(25) The student who wishes a fuller account is referred to the histories of (a) Neuburger, Vol. 1, Oxford, 1910; (b) Withington, London, 1894.

(26) Thomas Phaer: Regiment of Life, London, 1546.

As the famous Regimen Sanitatis of Salernum, the popular family hand-book of the Middle Ages, says:

Foure Humours raigne within our bodies wholly, And these compared to foure elements.(27)

(27) The Englishman's Doctor, or the Schoole of Salerne, Sir John Harington's translation, London, 1608, p. 2. Edited by Francis R. Packard, New York, 1920, p. 132. Harington's book originally appeared dated: London 1607. (Hoe copy in the Henry E. Huntington Library.)

According to Littre, there is nowhere so strong a statement of these views in the genuine works of Hippocrates, but they are found at large in the Hippocratic writings, and nothing can be clearer than the following statement from the work "The Nature of Man": "The body of man contains in itself blood and phlegm and yellow bile and black bile, which things are in the natural constitution of his body, and the cause of sickness and of health. He is healthy when they are in proper proportion between one another as regards mixture and force and quantity, and when they are well mingled together; he becomes sick when one of these is diminished or increased in amount, or is separated in the body from its proper mixture, and not properly mingled with all the others." No words could more clearly express the views of disease which, as I mentioned, prevailed until quite recent years. The black bile, melancholy, has given us a great word in the language, and that we have not yet escaped from the humoral pathology of Hippocrates is witnessed by the common expression of biliousness—"too much bile"—or "he has a touch of the liver." The humors, imperfectly mingled, prove irritant in the body. They are kept in due proportion by the innate heat which, by a sort of internal coction gradually changes the humors to their proper proportion. Whatever may be the primary cause of the change in the humors manifesting itself in disease, the innate heat, or as Hippocrates terms it, the nature of the body itself, tends to restore conditions to the norm; and this change occurring suddenly, or abruptly, he calls the "crisis," which is accomplished on some special day of the disease, and is often accompanied by a critical discharge, or by a drop in the body temperature. The evil, or superabundant, humors were discharged and this view of a special materies morbi, to be got rid of by a natural processor a crisis, dominated pathology until quite recently. Hippocrates had a great belief in the power of nature, the vis medicatrix naturae, to restore the normal state. A keen observer and an active practitioner, his views of disease, thus hastily sketched, dominated the profession for twenty-five centuries; indeed, echoes of his theories are still heard in the schools, and his very words are daily on our lips. If asked what was the great contribution to medicine of Hippocrates and his school we could answer—the art of careful observation.

In the Hippocratic writings is summed up the experience of Greece to the Golden Age of Pericles. Out of philosophy, out of abstract speculation, had come a way of looking at nature for which the physicians were mainly responsible, and which has changed forever men's views on disease. Medicine broke its leading strings to religion and philosophy—a tottering, though lusty, child whose fortunes we are to follow in these lectures. I have a feeling that, could we know more of the medical history of the older races of which I spoke in the first lecture, we might find that this was not the first-born of Asklepios, that there had been many premature births, many still-born offspring, even live-births—the products of the fertilization of nature by the human mind; but the record is dark, and the infant was cast out like Israel in the chapter of Isaiah. But the high-water mark of mental achievement had not been reached by the great generation in which Hippocrates had labored. Socrates had been dead sixteen years, and Plato was a man of forty-five, when far away in the north in the little town of Stagira, on the peninsula of Mount Athos in Macedoniawas, in 384 B.C., born a "man of men," the one above all others to whom the phrase of Milton may be applied. The child of an Asklepiad, Nicomachus, physician to the father of Philip, there must have been a rare conjunction of the planets at the birth of the great Stagirite. In the first circle of the "Inferno," Virgil leads Dante into a wonderful company, "star-seated" on the verdure (he says)—the philosophic family looking with reverence on "the Master of those who know"—il maestro di color che sanno.(28) And with justice has Aristotle been so regarded for these twenty-three centuries. No man has ever swayed such an intellectual empire—in logic, metaphysics, rhetoric, psychology, ethics, poetry, politics and natural history, in all a creator, and in all still a master. The history of the human mind—offers no parallel to his career. As the creator of the sciences of comparative anatomy, systematic zoology, embryology, teratology, botany and physiology, his writings have an eternal interest. They present an extraordinary accumulation of facts relating to the structure and functions of various parts of the body. It is an unceasing wonder how one man, even with a school of devoted students, could have done so much.

(28) The "Good collector of qualities," Dioscorides, Hippocrates, Avicenna, Galen and Averroes were the medical members of the group. Dante, Inferno, canto iv.

Dissection—already practiced by Alcmaeon, Democritus, Diogenes and others—was conducted on a large scale, but the human body was still taboo. Aristotle confesses that the "inward parts of man are known least of all," and he had never seen the human kidneys or uterus. In his physiology, I can refer to but one point—the pivotal question of the heart and blood vessels. To Aristotle the heart was the central organ controlling the circulation, the seat of vitality, the source of the blood, the place in which it received its final elaboration and impregnation with animal heat. The blood was contained in the heart and vessels as in a vase—hence the use of the term "vessel." "From the heart the blood-vessels extend throughout the body as in the anatomical diagrams which are represented on the walls, for the parts lie round these because they are formed out of them."(29) The nutriment oozes through the blood vessels and the passages in each of the parts "like water in unbaked pottery." He did not recognize any distinction between arteries and veins, calling both plebes (Littre); the vena cave is the great vessel, and the aorta the smaller; but both contain blood. He did not use the word "arteria" (arthria) for either of them. There was no movement from the heart to the vessels but the blood was incessantly drawn upon by the substance of the body and as unceasingly renewed by absorption of the products of digestion, the mesenteric vessels taking up nutriment very much as the plants take theirs by the roots from the soil. From the lungs was absorbed the pneuma, or spiritus, which was conveyed to the heart by the pulmonary vessels—one to the right, and one to the left side. These vessels in the lungs, "through mutual contact" with the branches of the trachea, took in the pneuma. A point of interest is that the windpipe, or trachea, is called "arteria," both by Aristotle and by Hippocrates ("Anatomy," Littre, VIII, 539). It was the air-tube, disseminating the breath through the lungs. We shall see in a few minutes how the term came to be applied to the arteries, as we know them. The pulsation of the heart and arteries was regarded by Aristotle as a sort of ebullition in which the liquids were inflated by the vital or innate heat, the fires of which were cooled by the pneuma taken in by the lungs and carried to the heart by the pulmonary vessels.

(29) De Generatione Animalium, Oxford translation, Bk. II, Chap. 6, Works V, 743 a.

In Vol. IV of Gomperz' "Greek Thinkers," you will find an admirable discussion on Aristotle as an investigator of nature, and those of you who wish to study his natural history works more closely may do so easily—in the new translation which is in process of publication by the Clarendon Press, Oxford. At the end of the chapter "De Respiratione" in the "Parva Naturalia" (Oxford edition, 1908), we have Aristotle's attitude towards medicine expressed in a way worthy of a son of the profession:

"But health and disease also claim the attention of the scientist, and not merely of the physician, in so far as an account of their causes is concerned. The extent to which these two differ and investigate diverse provinces must not escape us, since facts show that their inquiries are, at least to a certain extent, conterminous. For physicians of culture and refinement make some mention of natural science, and claim to derive their principles from it, while the most accomplished investigators into nature generally push their studies so far as to conclude with an account of medical principles." (Works, III,480 b.)

Theophrastus, a student of Aristotle and his successor, created the science of botany and made possible the pharmacologists of a few centuries later. Some of you doubtless know him in another guise—as the author of the golden booklet on "Characters," in which "the most eminent botanist of antiquity observes the doings of men with the keen and unerring vision of a natural historian" (Gomperz). In the Hippocratic writings, there are mentioned 236 plants; in the botany of Theophrastus, 455. To one trait of master and pupil I must refer—the human feeling, not alone of man for man, but a sympathy that even claims kinship with the animal world. "The spirit with which he (Theophrastus) regarded the animal world found no second expression till the present age" (Gomperz). Halliday, however, makes the statement that Porphyry(30) goes as far as any modern humanitarian in preaching our duty towards animals.

(30) W. R. Halliday: Greek Divination, London, Macmillan & Co., 1913.



ALEXANDRIAN SCHOOL

FROM the death of Hippocrates about the year 375 B.C. till the founding of the Alexandrian School, the physicians were engrossed largely in speculative views, and not much real progress was made, except in the matter of elaborating the humoral pathology. Only three or four men of the first rank stand out in this period: Diocles the Carystian, "both in time and reputation next and second to Hippocrates" (Pliny), a keen anatomist and an encyclopaedic writer; but only scanty fragments of his work remain. In some ways the most important member of this group was Praxagoras, a native of Cos, about 340 B.C. Aristotle, you remember, made no essential distinction between arteries and veins, both of which he held to contain blood: Praxagoras recognized that the pulsation was only in the arteries, and maintained that only the veins contained blood, and the arteries air. As a rule the arteries are empty after death, and Praxagoras believed that they were filled with an aeriform fluid, a sort of pneuma, which was responsible for their pulsation. The word arteria, which had already been applied to the trachea, as an air-containing tube, was then attached to the arteries; on account of the rough and uneven character of its walls the trachea was then called the arteria tracheia, or the rough air-tube.(31a) We call it simply the trachea, but in French the word trachee-artere is still used.

(31a) Galen: De usu partium, VII, Chaps. 8-9.

Praxagoras was one of the first to make an exhaustive study of the pulse, and he must have been a man of considerable clinical acumen, as well as boldness, to recommend in obstruction of the bowels the opening of the abdomen, removal of the obstructed portion and uniting the ends of the intestine by sutures.

After the death of Alexander, Egypt fell into the hands of his famous general, Ptolemy, under whose care the city became one of the most important on the Mediterranean. He founded and maintained a museum, an establishment that corresponded very much to a modern university, for the study of literature, science and the arts. Under his successors, particularly the third Ptolemy, the museum developed, more especially the library, which contained more than half a million volumes. The teachers were drawn from all centres, and the names of the great Alexandrians are among the most famous in the history of human knowledge, including such men as Archimedes, Euclid, Strabo and Ptolemy.

In mechanics and physics, astronomy, mathematics and optics, the work of the Alexandrians constitutes the basis of a large part of our modern knowledge. The school-boy of today—or at any rate of my day—studies the identical problems that were set by Euclid 300 B.C., and the student of physics still turns to Archimedes and Heron, and the astronomer to Eratosthenes and Hipparchus. To those of you who wish to get a brief review of the state of science in the Alexandrian School I would recommend the chapter in Vol. I of Dannemann's history.(31)

(31) Friedrich Dannemann: Grundriss einer Geschichte der Naturwissenschaften, Vol. I, 3d ed., Leipzig, 1908.

Of special interest to us in Alexandria is the growth of the first great medical school of antiquity. Could we have visited the famous museum about 300 B.C., we should have found a medical school in full operation, with extensive laboratories, libraries and clinics. Here for the first time the study of the structure of the human body reached its full development, till then barred everywhere by religious prejudice; but full permission was given by the Ptolemies to perform human dissection and, if we may credit some authors, even vivisection. The original writings of the chief men of this school have not been preserved, but there is a possibility that any day a papyrus maybe found which will supplement the scrappy and imperfect knowledge afforded us by Pliny, Celsus and Galen. The two most distinguished names are Herophilus—who, Pliny says, has the honor of being the first physician "who searched into the causes of disease"—and Erasistratus.

Herophilus, ille anatomicorum coryphaeus, as Vesalius calls him, was a pupil of Praxagoras, and his name is still in everyday use by medical students, attached to the torcular Herophili. Anatomy practically dates from these Alexandrines, who described the valves of the heart, the duodenum, and many of the important parts of the brain; they recognized the true significance of the nerves (which before their day had been confounded with the tendons), distinguished between motor and sensory nerves, and regarded the brain as the seat of the perceptive faculties and voluntary action. Herophilus counted the pulse, using the water-clock for the purpose, and made many subtle analyses of its rate and rhythm; and, influenced by the musical theories of the period, he built up a rhythmical pulse lore which continued in medicine until recent times. He was a skilful practitioner and to him is ascribed the statement that drugs are the hands of the gods. There is a very modern flavor to his oft-quoted expression that the best physician was the man who was able to distinguish between the possible and the impossible.

Erasistratus elaborated the view of the pneuma, one form of which he believed came from the inspired air, and passed to the left side of the heart and to the arteries of the body. It was the cause of the heart-beat and the source of the innate heat of the body, and it maintained the processes of digestion and nutrition. This was the vital spirit; the animal spirit was elaborated in the brain, chiefly in the ventricles, and sent by the nerves to all parts of the body, endowing the individual with life and perception and motion. In this way a great division was made between the two functions of the body, and two sets of organs: in the vascular system, the heart and arteries and abdominal organs, life was controlled by the vital spirits; on the other hand, in the nervous system were elaborated the animal spirits, controlling motion, sensation and the various special senses. These views on the vital and animal spirits held unquestioned sway until well into the eighteenth century, and we still, in a measure, express the views of the great Alexandrian when we speak of "high" or "low" spirits.



GALEN

PERGAMON has become little more than a name associated in our memory with the fulminations of St. John against the seven churches of Asia; and on hearing the chapter read, we wondered what was "Satan's seat" and who were the "Nicolaitanes" whose doctrine he so hated. Renewed interest has been aroused in the story of its growth and of its intellectual rivalry with Alexandria since the wonderful discoveries by German archaeologists which have enabled us actually to see this great Ionian capital, and even the "seat of Satan." The illustration here shown is of the famous city, in which you can see the Temple of Athena Polis on the rock, and the amphitheatre. Its interest for us is connected with the greatest name, after Hippocrates, in Greek medicine, that of Galen, born at Pergamon A. D. 130, in whom was united as never before—and indeed one may say, never since—the treble combination of observer, experimenter and philosopher. His father, Nikon, a prosperous architect, was urged in a dream to devote his son to the profession of medicine, upon which study the lad entered in his seventeenth year under Satyrus. In his writings, Galen gives many details of his life, mentioning the names of his teachers, and many incidents in his Wanderjahre, during which he studied at the best medical schools, including Alexandria. Returning to his native city he was put in charge of the gladiators, whose wounds he said he treated with wine. In the year 162, he paid his first visit to Rome, the scene of his greatest labors. Here he gave public lectures on anatomy, and became "the fashion." He mentions many of his successes; one of them is the well-worn story told also of Erasistratus and Stratonice, but Galen's story is worth telling, and it is figured as a miniature in the manuscripts of his works. Called to see a lady he found her suffering from general malaise without any fever or increased action of the pulse. He saw at once that her trouble was mental and, like a wise physician, engaged her in general conversation. Quite possibly he knew her story, for the name of a certain actor, Pylades, was mentioned, and he noticed that her pulse at once increased in rapidity and became irregular. On the next day he arranged that the name of another actor, Morphus, should be mentioned, and on the third day the experiment was repeated but without effect. Then on the fourth evening it was again mentioned that Pylades was dancing, and the pulse quickened and became irregular, so he concluded that she was in love with Pylades. He tells how he was first called to treat the Emperor Marcus Aurelius, who had a stomach-ache after eating too much cheese. He treated the case so successfully that the Emperor remarked, "I have but one physician, and he is a gentleman." He seems to have had good fees, as he received 400 aurei (about 2000) for a fortnight's attendance upon the wife of Boethus.

He left Rome for a time in 168 A. D. and returned to Pergamon, but was recalled to Rome by the Emperor, whom he accompanied on an expedition to Germany. There are records in his writings of many journeys, and busy with his practice in dissections and experiments he passed a long and energetic life, dying, according to most authorities, in the year 200 A.D.

A sketch of the state of medicine in Rome is given by Celsus in the first of his eight books, and he mentions the names of many of the leading practitioners, particularly Asclepiades, the Bithynian, a man of great ability, and a follower of the Alexandrians, who regarded all disease as due to a disturbed movement of the atoms. Diet, exercise, massage and bathing were his great remedies, and his motto—tuto, cito et jucunde—has been the emulation of all physicians. How important a role he and his successors played until the time of Galen may be gathered from the learned lectures of Sir Clifford Allbutt(32) on "Greek Medicine in Rome" and from Meyer-Steineg's "Theodorus Priscianus und die romische Medizin."(33) From certain lay writers we learn that it was the custom for popular physicians to be followed on their rounds by crowds of students. Martial's epigram (V, ix) is often referred to:

Languebam: sed tu comitatus protinus ad me Venisti centum, Symmache, discipulis. Centum me tegigere manus Aquilone gelatae Non habui febrem, Symmache, nunc habeo.

(32) Allbutt: British Medical Journal, London, 1909, ii, 1449; 1515; 1598.

(33) Fischer, Jena, 1909.

And in the "Apollonius of Tyana" by Philostratus, when Apollonius wishes to prove an alibi, he calls to witness the physicians of his sick friend, Seleucus and Straloctes, who were accompanied by their clinical class to the number of about thirty students.(34) But for a first-hand sketch of the condition of the profession we must go to Pliny, whose account in the twenty-ninth book of the "Natural History" is one of the most interesting and amusing chapters in that delightful work. He quotes Cato's tirade against Greek physicians,—corrupters of the race, whom he would have banished from the city,—then he sketches the career of some of the more famous of the physicians under the Empire, some of whom must have had incomes never approached at any other period in the history of medicine. The chapter gives a good picture of the stage on which Galen (practically a contemporary of Pliny) was to play so important a role. Pliny seems himself to have been rather disgusted with the devious paths of the doctors of his day, and there is no one who has touched with stronger language upon the weak points of the art of physic. In one place he says that it alone has this peculiar art and privilege, "That whosoever professeth himself a physician, is straightwaies beleeved, say what he will: and yet to speake a truth, there are no lies dearer sold or more daungerous than those which proceed out of a Physician's mouth. Howbeit, we never once regard or look to that, so blind we are in our deepe persuasion of them, and feed our selves each one in a sweet hope and plausible conceit of our health by them. Moreover, this mischief there is besides, That there is no law or statute to punish the ignorance of blind Physicians, though a man lost his life by them: neither was there ever any man knowne, who had revenge of recompence for the evill intreating or misusage under their hands. They learne their skill by endaungering our lives: and to make proofe and experiments of their medicines, they care not to kill us."(35) He says it is hard that, while the judges are carefully chosen and selected, physicians are practically their own judges, and that of the men who may give us a quick despatch and send us to Heaven or Hell, no enquiry or examination is made of their quality and worthiness. It is interesting to read so early a bitter criticism of the famous "Theriaca," a great compound medicine invented by Antiochus III, which had a vogue for fifteen hundred years.

(34) Bk. VIII, Chap. VII.

(35) Pliny: Natural History (XXIX, 1), Philemon Holland's version, London, 1601, II, 347.

But we must return to Galen and his works, which comprise the most voluminous body of writings left by any of the ancients. The great edition is that in twenty-two volumes by Kuhn (1821-1833). The most useful editions are the "Juntines" of Venice, which were issued in thirteen editions. In the fourth and subsequent editions a very useful index by Brassavola is included. A critical study of the writings is at present being made by German scholars for the Prussian Academy, which will issue a definitive edition of his works.

Galen had an eclectic mind and could not identify himself with any of the prevailing schools, but regarded himself as a disciple of Hippocrates. For our purpose, both his philosophy and his practice are of minor interest in comparison with his great labors in anatomy and physiology.

In anatomy, he was a pupil of the Alexandrians to whom he constantly refers. Times must have changed since the days of Herophilus, as Galen does not seem ever to have had an opportunity of dissecting the human body, and he laments the prejudice which prevents it. In the study of osteology, he urges the student to be on the lookout for an occasional human bone exposed in a graveyard, and on one occasion he tells of finding the carcass of a robber with the bones picked bare by birds and beasts. Failing this source, he advises the student to go to Alexandria, where there were still two skeletons. He himself dissected chiefly apes and pigs. His osteology was admirable, and his little tractate "De Ossibus" could, with very few changes, be used today by a hygiene class as a manual. His description of the muscles and of the organs is very full, covering, of course, many sins of omission and of commission, but it was the culmination of the study of the subject by Greek physicians.

His work as a physiologist was even more important, for, so far as we know, he was the first to carry out experiments on a large scale. In the first place, he was within an ace of discovering the circulation of the blood. You may remember that through the errors of Praxagoras and Erasistratus, the arteries were believed to contain air and got their name on that account: Galen showed by experiment that the arteries contain blood and not air. He studied particularly the movements of the heart, the action of the valves, and the pulsatile forces in the arteries. Of the two kinds of blood, the one, contained in the venous system, was dark and thick and rich in grosser elements, and served for the general nutrition of the body. This system took its origin, as is clearly shown in the figure, in the liver, the central organ of nutrition and of sanguification. From the portal system were absorbed, through the stomach and intestines, the products of digestion. From the liver extend the venae cavae, one to supply the head and arms, the other the lower extremities: extending from the right heart was a branch, corresponding to the pulmonary artery, the arterial vein which distributed blood to the lungs. This was the closed venous system. The arterial system, shown, as you see, quite separate in Figure 31, was full of a thinner, brighter, warmer blood, characterized by the presence of an abundance of the vital spirits. Warmed in the ventricle, it distributed vital heat to all parts of the body. The two systems were closed and communicated with each other only through certain pores or perforations in the septum separating the ventricles. At the periphery, however, Galen recognized (as had been done already by the Alexandrians) that the arteries anastomose with the veins, ". . . and they mutually receive from each other blood and spirits through certain invisible and extremely small vessels."

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."

Galen died about 200 A.D.; the high-water mark of the Renaissance, so far as medicine is concerned, was reached in the year 1542. In order to traverse this long interval intelligently, I will sketch certain great movements, tracing the currents of Greek thought, setting forth in their works the lives of certain great leaders, until we greet the dawn of our own day.

After flowing for more than a thousand years through the broad plain of Greek civilization, the stream of scientific medicine which we have been following is apparently lost in the morass of the Middle Ages; but, checked and blocked like the White Nile in the Soudan, three channels may be followed through the weeds of theological and philosophical speculation.



SOUTH ITALIAN SCHOOL

A WIDE stream is in Italy, where the "antique education never stopped, antique reminiscence and tradition never passed away, and the literary matter of the pagan past never faded from the consciousness of the more educated among the laity and clergy."(3) Greek was the language of South Italy and was spoken in some of its eastern towns until the thirteenth century. The cathedral and monastic schools served to keep alive the ancient learning. Monte Casino stands pre-eminent as a great hive of students, and to the famous Regula of St. Benedict(4) we are indebted for the preservation of many precious manuscripts.

(3) H. O. Taylor: The Mediaeval Mind, Vol. I, p. 251.

(4) De Renzi: Storia Documentata della Scuola Medica di Salerno, 2d ed., Napoli, 1867, Chap. V.

The Norman Kingdom of South Italy and Sicily was a meeting ground of Saracens, Greeks and Lombards. Greek, Arabic and Latin were in constant use among the people of the capital, and Sicilian scholars of the twelfth century translated directly from the Greek.

The famous "Almagest" of Ptolemy, the most important work of ancient astronomy, was translated from a Greek manuscript, as early as 1160, by a medical student of Salerno.(5)

(5) Haskins and Lockwood: Harvard Studies in Classical Philology, 1910, XXI, pp. 75-102.

About thirty miles southeast of Naples lay Salernum, which for centuries kept alight the lamp of the old learning, and became the centre of medical studies in the Middle Ages; well deserving its name of "Civitas Hippocratica." The date of foundation is uncertain, but Salernitan physicians are mentioned as early as the middle of the ninth century, and from this date until the rise of the universities it was not only a great medical school, but a popular resort for the sick and wounded. As the scholar says in Longfellow's "Golden Legend":

Then at every season of the year There are crowds of guests and travellers here; Pilgrims and mendicant friars and traders From the Levant, with figs and wine, And bands of wounded and sick Crusaders, Coming back from Palestine.

There were medical and surgical clinics, foundling hospitals, Sisters of Charity, men and women professors—among the latter the famous Trotula—and apothecaries. Dissections were carried out, chiefly upon animals, and human subjects were occasionally used. In the eleventh and twelfth centuries, the school reached its height, and that remarkable genius, Frederick II, laid down regulations for a preliminary study extending over three years, and a course in medicine for five years, including surgery. Fee tables and strict regulations as to practice were made; and it is specifically stated that the masters were to teach in the schools, theoretically and practically, under the authority of Hippocrates and Galen. The literature from the school had a far-reaching influence. One book on the anatomy of the pig illustrates the popular subject for dissection at that time.(6) The writings, which are numerous, have been collected by De Renzi.(7)

(6) "And dissections of the bodies of swine As likest the human form divine."—Golden Legend.

(7) S. de Renzi: Collectio Salernitana, 5 vols., Naples, 1852-1859; P. Giacosa: Magistri Salernitani, Turin, 1901.

The "Antidotarium" of Nicolaus Salernitanus, about 1100, became the popular pharmacopoeia of the Middle Ages, and many modern preparations may be traced to it.

The most prominent man of the school is Constantinus Africanus, a native of Carthage, who, after numerous journeys, reached Salernum about the middle of the eleventh century. He was familiar with the works both of the Greeks and of the Arabs, and it was largely through his translations that the works of Rhazes and Avicenna became known in the West.

One work above all others spread the fame of the school—the Regimen Sanitatis, or Flos Medicinae as it is sometimes called, a poem on popular medicine. It is dedicated to Robert of Normandy, who had been treated at Salernum, and the lines begin: "Anglorum regi scripsit schola tota Salerni . . . " It is a hand-book of diet and household medicine, with many shrewd and taking sayings which have passed into popular use, such as "Joy, temperance and repose Slam the door on the doctor's nose." A full account of the work and the various editions of it is given by Sir Alexander Croke,(8) and the Finlayson lecture (Glasgow Medical Journal, 1908) by Dr. Norman Moore gives an account of its introduction into the British Isles.

(8) Regimen Sanitutis Salernitanum; a Poem on the Preservation of Health in Rhyming Latin Verse, Oxford, D.A. Talboys, 1830.



BYZANTINE MEDICINE

THE second great stream which carried Greek medicine to modern days runs through the Eastern Empire. Between the third century and the fall of Constantinople there was a continuous series of Byzantine physicians whose inspiration was largely derived from the old Greek sources. The most distinguished of these was Oribasius, a voluminous compiler, a native of Pergamon and so close a follower of his great townsman that he has been called "Galen's ape." He left many works, an edition of which was edited by Bussemaker and Daremberg. Many facts relating to the older writers are recorded in his writings. He was a contemporary, friend as well as the physician, of the Emperor Julian, for whom he prepared an encyclopaedia of the medical sciences.

Other important Byzantine writers were Aetius and Alexander of Tralles, both of whom were strongly under the influence of Galen and Hippocrates. Their materia medica was based largely upon Dioscorides.

From Byzantium we have the earliest known complete medical manuscript, dating from the fifth century—a work of Dioscorides—one of the most beautiful in existence. It was prepared for Anicia Juliana, daughter of the Emperor of the East, and is now one of the great treasures of the Imperial Library at Vienna.(9) From those early centuries till the fall of Constantinople there is very little of interest medically. A few names stand out prominently, but it is mainly a blank period in our records. Perhaps one man may be mentioned, as he had a great influence on later ages—Actuarius, who lived about 1300, and whose book on the urine laid the foundation of much of the popular uroscopy and water-casting that had such a vogue in the sixteenth and seventeenth centuries. His work on the subject passed through a dozen Latin editions, but is best studied in Ideler's "Physici et medici Graeci minores" (Berlin, 1841).

(9) It has been reproduced by Seatone de Vries, Leyden, 1905, Codices graeci et latini photographice depicti, Vol. X.

The Byzantine stream of Greek medicine had dwindled to a very tiny rill when the fall of Constantinople (1453) dispersed to the West many Greek scholars and many precious manuscripts.



ARABIAN MEDICINE

THE third and by far the strongest branch of the Greek river reached the West after a remarkable and meandering course. The map before you shows the distribution of the Graeco-Roman Christian world at the beginning of the seventh century. You will notice that Christianity had extended far eastwards, almost to China. Most of those eastern Christians were Nestorians and one of their important centres was Edessa, whose school of learning became so celebrated. Here in the fifth century was built one of the most celebrated hospitals of antiquity.

Now look at another map showing the same countries about a century later. No such phenomenal change ever was made within so short space of time as that which thus altered the map of Asia and Europe at this period. Within a century, the Crescent had swept from Arabia through the Eastern Empire, over Egypt, North Africa and over Spain in the West, and the fate of Western Europe hung in the balance before the gates of Tours in 732. This time the barbaric horde that laid waste a large part of Christendom were a people that became deeply appreciative of all that was best in Graeco-Roman civilization and of nothing more than of its sciences. The cultivation of medicine was encouraged by the Arabs in a very special way. Anyone wishing to follow the history of the medical profession among this remarkable people will find it admirably presented in Lucien Leclerc's "Histoire de la medecine arabe" (Paris, 1876). An excellent account is also given in Freind's well-known "History of Medicine" (London, 1725-1726). Here I can only indicate very briefly the course of the stream and its freightage.

With the rise of Christianity, Alexandria became a centre of bitter theological and political factions, the story of which haunts the memory of anyone who was so fortunate as to read in his youth Kingsley's "Hypatia." These centuries, with their potent influence of neoplatonism on Christianity, appear to have been sterile enough in medicine. I have already referred to the late Greeks, Aetius and Alexander of Tralles. The last of the Alexandrians was a remarkable man, Paul of AEgina, a great name in medicine and in surgery, who lived in the early part of the seventh century. He also, like Oribasius, was a great compiler. In the year 640, the Arabs took Alexandria, and for the third time a great library was destroyed in the "first city of the West." Shortly after the conquest of Egypt, Greek works were translated into Arabic, often through the medium of Syriac, particularly certain of Galen's books on medicine, and chemical writings, which appear to have laid the foundation of Arabian knowledge on this subject.

Through Alexandria then was one source: but the special development of the Greek science and of medicine took place in the ninth century under the Eastern Caliphates. Let me quote here a couple of sentences from Leclerc (Tome I, pp. 91-92):

"The world has but once witnessed so marvellous a spectacle as that presented by the Arabs in the ninth century. This pastoral people, whose fanaticism had suddenly made them masters of half of the world, having once founded their empire, immediately set themselves to acquire that knowledge of the sciences which alone was lacking to their greatness. Of all the invaders who competed for the last remains of the Roman Empire they alone pursued such studies; while the Germanic hordes, glorying in their brutality and ignorance, took a thousand years to re-unite the broken chain of tradition, the Arabs accomplished this in less than a century. They provoked the competition of the conquered Christians—a healthy competition which secured the harmony of the races.

"At the end of the eighth century, their whole scientific possessions consisted of a translation of one medical treatise and some books on alchemy. Before the ninth century had run to its close, the Arabs were in possession of all the science of the Greeks; they had produced from their own ranks students of the first order, and had raised among their initiators men who, without them, would have been groping in the dark; and they showed from this time an aptitude for the exact sciences, which was lacking in their instructors, whom they henceforward surpassed."

It was chiefly through the Nestorians that the Arabs became acquainted with Greek medicine, and there were two famous families of translators, the Bakhtishuas and the Mesues, both Syrians, and probably not very thoroughly versed in either Greek or Arabic. But the prince of translators, one of the finest figures of the century, was Honein, a Christian Arab, born in 809, whose name was Latinized as Joannitius. "The marvellous extent of his works, their excellence, their importance, the trials he bore nobly at the beginning of his career, everything about him arouses our interest and sympathy. If he did not actually create the Oriental renaissance movement, certainly no one played in it a more active, decided and fruitful part."(10) His industry was colossal. He translated most of the works of Hippocrates and Galen, Aristotle and many others. His famous "Introduction" or "Isagoge," a very popular book in the Middle Ages, is a translation of the "Microtegni" of Galen, a small hand-book, of which a translation is appended to Cholmeley's "John of Gaddesden."(11) The first printed edition of it appeared in 1475 (see Chapter IV) at Padua.