apollo, the god of medicine.—cheiron.—?sculapius.—artemis.—dionysus.—ammon.—hermes.—prometheus.—melampus.—medicine of homer.—- temples of ?sculapius.—the early ionic philosophers.—empedocles.—school of crotona.—the pythagoreans.—grecian theory of diseases.—school of cos.—the asclepiads.—the alipt?.
gods of medicine.
the origin of greek medicine is intermixed with the hellenic mythology. we must begin, not with ?sculapius (asclepios), but with the sun itself. apollo (p?an), as the god who visits men with plagues and epidemics, was also the god who wards off evil and affords help to men. he was constantly referred to as “the healer,” as alexicacus, the averter of ills. he is the saviour from epidemics, and the p?an was sung in his honour (iliad, i. 473, xxii. 391).
apollo promoted the health and well-being of man, and was the god of prolific power, the trainer of youth, and thus he was the chief deity of healing. as the god of light and purity he was truly the health-god; and as light penetrates the darkness, he was the god of divination and the patron of prophecy, acting chiefly through women when in a state of ecstasy. homer says that p?an329 was the physician of the olympian gods (iliad, v. 401, 899).
next we find cheiron, the wise and just centaur (iliad, xi. 831), who had been instructed by apollo and artemis, and was famous for his skill in medicine. he was the master and instructor of the most celebrated heroes of greek story, and he taught the art of healing to ?sculapius (b.c. 1250). this god of medicine was said to be the son of apollo. pausanius330 explains the allegory thus: “if asclepius is the air—indispensable to the health of man and beast, yet apollo is the sun, and rightly is he called the father of asclepius, for the sun, by his yearly course, makes the air wholesome.”
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in the homeric poems ?sculapius is not a divinity, but merely a human being. homer, however, calls all those who practise the art of healing descendants of p?an; his healing god is apollo, and never ?sculapius.
legend tells that ?sculapius was the son of apollo by coronis, who was killed by artemis for unfaithfulness, and her body was about to be burnt on the pyre, when apollo snatched the boy out of the flames and handed him over to the centaur cheiron, who taught him how to cure all diseases. pindar tells the story of his instruction in the art of medicine:—
“the rescued child he gave to share
magnesian centaur’s fostering care;
and learn of him the soothing art
that wards from man diseases’ dart.
of those whom nature made to feel
corroding ulcers gnaw their frame;
or stones far hurled, or glittering steel,
all to the great physician came.
by summer’s heat or winter’s cold
oppressed, of him they sought relief.
each deadly pang his skill controlled,
and found a balm for every grief.
on some the force of charmed strains he tried,
to some the medicated draught applied;
some limbs he placed the amulets around,
some from the trunk he cut, and made the patient sound.”331
it was believed that he was even able to restore the dead to life. according to one tradition, ?sculapius was once shut up in the house of glaucus, whom he was to cure, and while he was absorbed in thought there came a serpent, which twined round his staff, and which he killed. then he saw another serpent, which came carrying in its mouth a herb, with which it recalled to life the one that had been killed; and the physician henceforth made use of the same herb to restore dead men to life, the popular belief, even in these early times, evidently being that what would cure serpents would be equally efficacious for men. we may therefore consider the snake-entwined staff of the healing god as the symbol of the early faith in the efficacy of experiments on animals, though in this instance the experiment was on a dead one.
?sculapius was only too successful a practitioner; for when he was exercising his art upon glaucus, zeus killed the physician with a flash of lightning, as he feared that men might gradually escape death altogether. others say the reason was that pluto complained that by such medical treatment the number of the dead was too much diminished.149 on the request of apollo, zeus placed ?sculapius amongst the stars. his wife was epione (the soother). homer mentions podalirius and machaon as sons of ?sculapius, and the following are also said to have been his sons and daughters—janiscus, alexenor, aratus, hygeia, ?gle, iaso, and panaceia. most of these, as hygeia, the goddess of health, and panaceia, the all-healing, it will be seen, are merely personifications of the powers ascribed to their father. there is no doubt that facts are the basis of the ?sculapian story. the divinity was worshipped all over greece. his temples were for the most part built in mountainous and healthy places, and as often as possible in the neighbourhood of a medicinal spring; in a sense they became the prototypes of our hospitals and medical schools. multitudes of sick persons visited them, and the priests found it to their interest to study diseases and their remedies; for though faith and religious fervour may do much for the sick, the art of the physician and the hand of the surgeon are adjuncts by no means to be despised even in a temple clinic. the chief of the ?sculapian temples was at epidaurus; there no one was permitted to die and no woman to give birth to a child. the connection of the serpent with the divinity probably arose from the idea that serpents represent prudence and renovation, and have the power of discovering the secret virtues of healing plants.
the idea of the serpent twined round the rod of ?sculapius is that “as sickness comes from him, from him too must or may come the healing.”332 the knots on the staff are supposed to symbolize the many knotty points which arise in the practice of physic.
minerva was the patroness of all the arts and trades; at her festivals she was invoked by all who desired to distinguish themselves in medicine, as well as by the patients whom they failed to cure. as the goddess of intelligence and inventiveness, she was the greek patroness of physicians, and was the same deity as pallas athene, who bestows health and keeps off sickness.
artemis, or diana, as the romans called the greek goddess, was a deity who, inviolate and vigorous herself, granted health and strength to others. she was the sister of apollo, and though a dispenser of life could, like her brother, send death and disease amongst men and animals. sudden deaths, especially amongst women, were described as the effect of her arrows. she was θε? σ?τειρα, who assuaged the sufferings of mortals. when ?neas was wounded, she healed him in the temple of apollo.333 yet artemis ταυροπ?λο? produced madness in the minds of men.334
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she was the cretan diktynna, and that goddess wore a wreath of the magic plant diktamnon or dictamnus, called by us dittany (dictamnus ruber, or albus); it grows in abundance on mounts dicté and ida in crete.
the cretan goddess britomartis was sometimes identified with artemis. she too was a goddess of health as also of birth, and was supposed to dispense happiness to mortals.
bacchus, or, as he was called by the greeks, dionysus, as the god of wine, and an inspired and an inspiring deity, who revealed the future by oracles, cured diseases by discovering to sufferers in their dreams their appropriate remedies. the prophet, the priest, and the physician are so often blended in one in the early history of civilization, that the same ideas naturally clustered round bacchus as around apollo, and other great benefactors of mankind. the giver of vines and wine was the dispenser of the animating, exalting, intoxicating powers of nature. as wine restores the flagging energies of the body and mind, and seems to have the power of calling back to life the departing spirit, and inspiring the languishing vitality of man, bacchus would naturally enough be a god of medicine. the intoxicating properties of wine would be connected with inspiration, and so bacchus had a share in the oracles of delphi and amphicleia. he was invoked as a θε?? σωτ?ρ against raging diseases.
ammon was an ethiopian divinity whose worship spread over egypt, and thence to greece, and was described as the spirit pervading the universe, and as the author of all life in nature.
hermes trismegistus of the greeks was identified in the time of plato with thoth, thot, or theut of the egyptians.335
the egyptian thoth was considered the father of all knowledge, and everything committed to writing was looked upon as his property; he was therefore the embodied eek: λ?γο?, and so τρ?? μ?γιστο?, or the superlatively greatest. he was identified by the greeks more or less completely with their own hermes, or mercury as he was known to the romans; he was the messenger of the gods; as dreams are sent by zeus, it was his office to convey them to men, and he had power to grant refreshing sleep or to deny the blessing. as the gods revealed the remedies for sickness in dreams, hermes became a god of medicine.
thoth, the ibis-headed, was the egyptian god of letters, the deity of wisdom in general, who aided horus in his conflict with seth, and recorded the judgments of the dead before osiris. hermes κριοφ?ρο?, the averter of diseases, was worshipped in b?otia. hermes, the greek151 deity, was king of the dead and the conductor of souls to their future home. probably, therefore, we may rightly look upon thoth, hermes, and hermes trismegistus as the same person. by many thoth is considered to be the egyptian ?sculapius, as he was the inventor of the healing art; the ph?nician god esmun, one of the ancient cabiri, was invested with similar attributes, and was worshipped at carthage and berytus. the authorship of the oldest egyptian works on medicine is ascribed to thoth. these were engraved on pillars of stone. the works of thoth were ultimately incorporated into the so-called “hermetic books.” clement of alexandria, who is our only ancient authority on these hermetic works, says they were forty-two in number.
prometheus (the man of freethought) is considered by ?schylus as the founder of human civilization.
?schylus, in his prometheus chained, makes the god say how he had taught each useful art to man. as regards medicine, he says:—
“hear my whole story; thou wilt wonder more
what useful arts, what science i invented.
this first and greatest; when the fell disease
preyed on the human frame, relief was none,
nor healing drug, nor cool, refreshing draught,
nor pain-assuaging unguent; but they pined
without redress, and wasted, till i taught them
to mix the balmy medicine, of power
to chase each pale disease, and soften pain.”336
melampus, who was famous for his prophetic powers, was believed by the greeks to have been the first mortal who practised the art of medicine, and established the worship of dionysus in greece. as doctors are frequently expected to exercise the art of prophecy in conjunction with their profession, it is unfortunate that we have retrograded from the melampian type. the eminent physician who tells the over-inquisitive friends of his patients that he is “a doctor and not a prophet,” might be answered that originally the two functions were combined. melampus taught the greeks to mix their wine with water. he is fabled to have learned the language of the birds from some young serpents who had been reared by him, and who licked his ears when he was asleep. when he awoke he found that he understood what the birds said, and that he could foretell the future.
iphiclus had no children, and he asked melampus to tell him how he could become a father. he advised him to take the rust from a knife, and drink it in water during ten days. the remedy was eminently successful, and is the first instance in which a preparation of iron is known to have been prescribed in medicine. he cured the daughters152 of pr?tus by giving them hellebore (which has been called melampodium by botanists), and he received the eldest of the princesses in marriage. he cured the women of argos of a severe distemper which made them insane, and the king showed his gratitude by giving him part of his kingdom. he received divine honours after his death, and temples were raised to him.
the medicine of homer.
as homer is supposed to have lived about 850 b.c., a study of such references as are to be found in the iliad and odyssey which relate to medicine and surgery will throw an important light on the state of the healing art as it was practised at that early period of greek history.
there is little mention of disease in homer. we read of sudden death, pestilence, and the troubles of old age, but there is hardly any fixed morbid condition noticed.
although the poet exhibits considerable acquaintance with medical lore, and the human body in health and disease, he could have had little or no acquaintance with anatomy, because amongst greeks, as amongst jews, it was considered a profanation to dissect or mutilate the human corpse.
it was not till the rise of the alexandrian school in the golden age of the ptolemies that this sentiment was overcome. still homer must have known that it was the custom of the egyptians to embalm their dead, as he refers to the process in the iliad,337 where thetis poured into the nostrils of the corpse red nectar and ambrosia to preserve it from putrefaction. ambrosia is referred to by virgil as useful for healing wounds, and nectar was supposed to preserve flesh from decay. homer’s heroes seem to have been singularly healthy folk; their only demand for the services of the army surgeons arose from the accidents of war. machaon distinguished himself in surgery, and podalirius is reputed to have been the first phlebotomist. their services would be chiefly required for extracting arrow-heads and spear-heads, checking h?morrhage by compression and styptic applications, and laying soothing ointments on wounded and bruised surfaces. beyond these minor duties of the army surgeon, we find little record of their work. mention is not made of amputations, of setting of fractures, or tying of arteries. wounds were probed by machaon, surgeon to menelaus (book iv.).
whatever may have been the surgical skill of machaon, we have proof that the art of dieting the wounded was not at all understood in the homeric days. the wine and cheese was not the kind of refreshment which found favour in plato’s time with the greek physicians.153 plato, in the republic (book iii.), deals with the question at some length. he says that the draught of pramnian wine with barley meal and cheese was an inflammatory mixture, and a strange potion for a man in the state of eurypylus.
but he excuses the sons of asclepius for their treatment, explaining that their method was not intended for coddling invalids, but for such as had not time to be ill, and that the healing art was revealed for the benefit of those whose constitutions were naturally sound, and that doctors used to expel their disorders by drugs and the use of the knife without interrupting their customary avocations, declining altogether to assist chronic invalids to protract a miserable existence by a studied regimen.
le clerc says338 that plato is wrong in this explanation of the homeric treatment, and that the true one is that in those days the dietary of the sick was not understood. modern medicine will decline to accept either theory. the fact is, homer’s physicians were right. good old wine was the best thing possible to restore a man fainting from the loss of blood; as for the cheese it was grated fine, and therefore was a peculiarly nutritious food in a fairly digestible condition. the barley water at all times was at least irreproachable. although there is little evidence in the homeric poems of any medical treatment which passes the limits of surgery, this is by no means conclusive against the possession of the higher art by podalirius. in an epic poem, as le clerc points out, the subject is altogether too exalted to admit of medical discourses on the treatment of colic and diarrh?a.
neither must we be surprised, that when the pestilence appeared in the camp of agamemnon, podalirius and machaon did nothing to avert it. such a disease was at that time considered beyond all human skill, and as the direct visitation of the gods. homer clearly explains that the pestilence was due to their anger. galen adduces evidence to prove that ?sculapius did really practise medicine, by music and by gymnastics, or exercises on foot and horseback.
as le clerc says,339 this may have been patriotic exaggeration on the part of galen. to podalirius is attributed the invention of the art of bleeding. as he returned from the trojan war, he was driven by a tempest on the shores of caria, where a shepherd, having learned that he was a physician, took him to the king, whose daughter was sick. he cured her by bleeding from both arms; the king gave her to him in marriage, with a rich grant of land. this is the oldest example which we have of bleeding.
podalirius had a son hippolochus, of whom the great hippocrates was154 a descendant. le clerc devotes a chapter of his history of medicine to reflections on the antiquity of the practice of venesection, and speculates on the manner of its discovery. he says, the fact that homer is silent on the subject makes neither for nor against the theory that it was known in his time; in such works as those of the poet he was under no obligation to specify particularly the remedies employed by the doctors. he speaks, for example, of soothing medicines and bitter roots without further definition. it would be as reasonable to agree that purgation was unknown from homer’s silence on the matter.
homer knew something of the parts of the body where wounds are most fatal. he says (book iv., l. 183), “the arrow fell in no such place as death could enter at,” and (book viii., l. 326), where the arrow struck the right shoulder ’twixt the neck and breast, “the wound was wondrous full of death.”
he knew much of drugs and medicinal plants: φ?ρμακον (pharmakon) in the iliad is a remedy, an unguent or application, and is mentioned nine times; in the odyssey it is a drug or medicinal herb, and is referred to twenty times. in book xi., eurypylus, when wounded, is treated with the “wholesome onion,” a potion is confected with good old wine of pramnius, with scraped goat’s-milk cheese and fine flour mixed with it. later on in the same book, we read of the bruised, bitter, pain-assuaging root being applied to a wound; it was some strong astringent bitter plant, probably a species of geranium.
then in the odyssey (book iv. 200) occurs the reference to nepenthe, a drug which has puzzled commentators exceedingly; some say it was poppy juice, others hashish; we have also the magic moly, which mercury gave to ulysses against the charms of circe. by some this is thought to have been the unpoetical garlic, by others to be wild rue, such as josephus refers to. it was more probably the mandrake.
there is a very curious and important reference to sulphur, as a disinfectant fumigation in the odyssey (book xxii. 481):—
“bring sulphur straight, and fire” (the monarch cries).
“she hears, and at the word obedient flies,
with fire and sulphur, cure of noxious fumes,
he purged the walls and blood-polluted rooms.”
this is precisely what the sanitary authorities do with fever dens at the present day.
homer several times refers to machaon:—
“and great machaon to the ships convey.
a wise physician, skilled our wounds to heal,
is more than armies to the public weal.”
(iliad, xi. 614.)
155
with podalirius, his brother, also a “famed surgeon,” he went to troy with thirty ships. homer calls them “divine professors of the healing arts” (iliad, ii. 728), and to them was committed the care of the medical work of the expedition.
when menelaus had been wounded by the spear of pandarus, machaon, we are told by homer (iliad, iv. 218)—
“sucked the blood, and sovereign balm infused,
which cheiron gave, and ?sculapius used.”
agamede is referred to by homer (iliad, xi. 739) as acquainted with the healing properties of all the plants that grow on the earth. she was a daughter of augeias, and wife of mulius. the poet refers to her as—
“she that all simples’ healing virtues knew,
and every herb that drinks the morning dew.”340
hesiod lived about the same time as homer. he wrote the famous works and days, a species of farmer’s calendar, and the theogony.
on account of the knowledge he possessed of the properties of plants, theophrastus, pliny, and others ranked him amongst the physicians.341
both podalirius and machaon were held in great honour, not only as combatants, but as medical advisers, and homer’s account of them exhibits the medical profession of his time as one that was very highly esteemed. in the fragment of arctinus which remains to us, we find thus early the distinction made between the arts of medicine and surgery, the two principal divisions of medical science: “then asclepius bestowed the power of healing upon his two sons; nevertheless, he made one of the two more celebrated than the other; on one did he bestow the lighter hand, that he might draw missiles from the flesh, and sew up and heal all wounds; but he other he endowed with great precision of mind, so as to understand what cannot be seen, and to heal seemingly incurable diseases.”342
this very interesting extract not only shows the early separation of the arts of medicine and surgery, but it exhibits very clearly how it arose that the former was always held to be the higher branch of the medical profession. to sew up a laceration, or extract an arrow or a thorn from the flesh, demanded only manual dexterity; but “to understand that which cannot be seen,” and heal internal organs that cannot even be touched, required a skill and a mental precision that men even in those early times were able to appreciate as much the higher of the156 two arts. there seems, however, some confusion of the two branches in the lines:—
“a wise physician, skilled our wounds to heal,
is more than armies to the public weal.”
if we suppose that the account of venesection which attributes its discovery to podalirius is fabulous, this would only serve to prove the antiquity of the practice. hippocrates is said to be the first medical writer who has spoken of bleeding,343 yet we must not suppose it was unknown before his time. he advises blood-letting from the arm, from the temporal vessels, from the leg, etc., in some cases even to fainting. he is familiar with cupping and other methods of abstracting blood; it is not probable, therefore, that the operation was a new one in his day.
the discovery of the practice of purging as a remedy was attributed to melampus. but we know that the egyptians made use of purgative and emetic medicines. there were many purgatives in use in the time of hippocrates, as hellebore, elaterium, colocynth, and scammony. all these medicines could not have been discovered at once, as le clerc points out; mankind, therefore, must have gradually acquired their use. when persons were overloaded in the stomach and constipated, nothing was more natural than that they should seek relief by removing the mechanical causes of their distress. some one had taken some herb which had caused him to vomit or to be purged, and had experienced the benefit of the evacuation; he told his friends, and they perhaps had been aided by similar means. or again, some illness had been alleviated by the supervention of diarrh?a, and art was called in to imitate the beneficial effect of nature’s cure. in this way, says le clerc, bleeding may reasonably have been discovered: a severe headache is often relieved by bleeding from the nose, what more natural than that the process of relief should be imitated by opening a vein?
pliny, indeed, in his usual manner, introduces a fable to account for the discovery of venesection. he says344 that the hippopotamus having become too fat and unwieldy through over-eating, bled himself with a sharp-pointed reed, and when he had drawn sufficient blood, closed the wound with clay. men have imitated the operation, says pliny. this is matched by the story of the ibis with her long bill being the inventor of the clyster. most of the medical beast stories are probably on a level with these.
157
hygeia, the wife of ?sculapius, and her children, bore names which show the same poetic fancy as that which constituted apollo the author of medicine. ?sculapius is the air. hygeia is health; ?gle is brightness or splendour, because the air is illumined and purified by the sun. iaso is recovery, panacea the universal medicine, roma is strength.
the ancients everywhere believed that the healing art was taught to mankind by the gods. “the art of medicine,” says cicero, “has been consecrated by the invention of the immortal gods.”345
hippocrates346 attributed the art of medicine to the supreme being. as the greeks believed that the arts in general were invented by the gods, it was a natural belief that the knowledge of medicine should have been taught by the heavenly powers. the mysteries of life, disease, and death were peculiarly the province of supernatural beings, and man has ever attributed to such powers all those things which he could not comprehend.
the temples of ?sculapius.
the worship of asclepius or ?sculapius is so closely associated with the practice of greek medicine that it is impossible to understand the one without knowing something of the other. sick persons made pilgrimages to the temples of the god of healing, just as now they go to lourdes, st. winifred’s well, or other famous christian shrines for the recovery of their health. after prayers to the god, ablutions, and sacrifices, the patient was put to sleep on the skin of the animal offered at the altar, or at the foot of the statue of the divinity, while the priests performed their sacred rites. in his sleep he would have pointed out to him in a dream what he ought to do for the recovery of his health. sometimes the appropriate medicine would be suggested, but more commonly rules of conduct and diet would suffice. when the cure took place, which very frequently happened by suggestion as in modern hypnotism, and by the stimulus to the nervous system consequent upon the journey, and the hope excited in the patient, a record of the case and the cure was carved on the temple walls. thus were recorded the first histories of cases, and their study afforded the most valuable treatises on the healing art to the physicians who studied them. the priests of ?sculapius were sometimes called asclepiads, but they did not themselves act as physicians, nor were they the actual founders of greek medicine. the true asclepiads were healers and not priests. anathemata (?ν?θεμα, anything offered up) were offerings of models in gold, silver, etc., of diseased legs, feet, etc., or of deformed limbs consecrated158 to the gods in the temples by the devotion of the patients who had received benefit from the prayers to the deities who were worshipped therein. the priests of the temples sold these again and again to fresh patients.
the early ionic philosophers.
the various schools of greek philosophy were intimately associated with the study of medicine. they endeavoured to fathom the mystery of life, and the relationship of the visible order of things to the unseen world. the philosophers were therefore not only physicists, but metaphysicians, and the unhappy science of medicine, a homeless wanderer, had to shelter herself now with the natural philosophers and again with the metaphysicians. probably the philosophers never really practised physic, but merely speculated about it, as did plato. a brief notice of the various philosophers of the ionic, italian, eleatic, and materialistic schools who were more or less associated with the study of medicine must suffice as an introduction to greek medicine proper, which had its origin with hippocrates.
thales of miletus (about 609 b.c.), the ionian philosopher, introduced egyptian and asiatic science into greece. he had probably in his travels in the land of the pharaohs devoted himself to mathematical pursuits, and if not a scientific inquirer was a deep speculator on the origin of things. he held that everything arises from water, and everything ultimately again resolves itself into water. everything, he said, is full of gods; the soul originates motion (the magnet has a soul, according to him), and so the indwelling power or soul of water produces the phenomena of the natural world. he must not, however, be understood as teaching the doctrine of the soul of the universe, or of a creating deity. thales was the first writer on physics and the founder of the philosophy of greece. le clerc connects him with medicine by his converse with the priest-physicians of egypt, and that he had performed certain expiatory or purifying ceremonies for the laced?monians which could only be done by such as were divines and physicians.347
pherecydes, the syrian, a philosopher who lived about the same time as thales, is said by galen to have written upon diet.
epimenedes was a sort of greek rip van winkle, who purified athens in the time of a plague by means of mysterious rites and sacrifices. he excelled as a fasting man, so that he was said to have been exempt from the ordinary necessities of nature, and could send out his soul from his body and recall it like the mahatmas. he was of the159 class of priestly bards, a seer and prophet who was well acquainted with the virtues of plants for medicinal purposes, and as he was believed to have gone to sleep in a cave for fifty-seven years, he was credited with the possession of supernatural medicinal powers.348
anaximander, born b.c. 610, is said to have been a pupil of thales. he taught that a single determinate substance having a middle nature between water and air was the infinite, everlasting, and divine, though not intelligent material from which all things had their origin. this he called the ?πειρον, the chaos. all substances were derived thence by the conflict of heat and cold and the electric affinities of the particles. the atomic theory is foreshadowed here.
anaximenes was the friend of thales and anaximander, and all three were born at miletus. he considered that air was the first cause of all things, or primary condition of matter; all finite things were formed from the infinite air by compression or rarefaction produced by eternal motion. heat and cold are produced by the varying density of the primal element. he held the eternity of matter like his brother philosophers, and believed that the soul itself is merely a form of air. he held no divine author of the universe, motion being a necessary law of the universe, and with motion and air he required nothing else for the constitution of all things.
heracleitus of ephesus, born about 556 b.c., embodied his system of philosophy in his work on nature. he held that the ground of all phenomena is a physical principle, a living unity, pervading everything, inherent in all things—fire, that is, as he explains, a clear light fluid “self-kindled and self-extinguished.” the world was not created by god, but evolved from the rational intelligence which guides the universe—fire. fire longs to manifest itself in various forms; from its pure state in heaven it descends, assumes the form of earth, passing in its progress through that of water. man’s soul is a spark of the divine fire.
anaxagoras, born about 499 b.c., was the friend of pericles and euripides at athens. seeking to explain the world and man by a higher cause than the physical ones of his predecessors, he postulated nous—that is, mind, thought, or intelligence. as nothing can come out of nothing, he did not attribute to this nous the creation of the world, but only its order and arrangement. matter is eternal, but existed as chaos till nous evolved order from the confusion. baas349 says his physiological and pathological views may be thus described:160 “the animal body, by means of a kind of affinity, appropriates to itself from the nutritive supply the portions similar to itself. males originate in the right, females in the left side of the uterus. diseases are occasioned by the bile which penetrates into the blood-vessels, the lungs, and the pleura.” he undertook the dissection of animals, remarked the existence in the brain of the lateral ventricles, and was the first to declare that the bile is the cause of acute sickness.350
diogenes of apollonia, the eminent natural philosopher, lived at athens about 460 b.c. he was a pupil of anaximenes, and wrote a work entitled on nature, in which he treated of physical science generally. aristotle has preserved for us some of the few fragments which remain. the most important is the description of the origin and distribution of the veins, and is inserted in the third book of aristotle’s history of animals. diogenes laertius gives an account of the philosophical teaching of the philosopher: “he maintained that air was the primal element of all things; that there was an infinite number of worlds, and an infinite void; that air, densified and rarefied, produced the different members of the universe; that nothing was produced from nothing, or was reduced to nothing; that the earth was round, supported in the middle, and had received its shape from the whirling round of the warm vapours, and its concretion and hardening from cold.”351
diogenes recognised no distinction between mind and matter, yet he considered air possessed intellectual energy.
we find in this philosopher many indications that the vascular system was in some degree beginning to be understood.352 mr. lewes and mr. grote agree that diogenes deserves a higher place in the evolution of philosophy than either hegel or schwegler.
empedocles of agrigentum, born about 490 b.c., now bears forward the flaming torch of medical science, and in his hands it burns more brightly still. aristotle mentions him among the ionian physiologists, and ranks him with the atomistic philosophers and anaxagoras. these all sought to discover the basis of all changes and to explain them. according to empedocles: “there are four ultimate kinds of things, four primal divinities, of which are made all structures in the world—fire, air, water, and earth. these four elements are eternally brought into union, and eternally parted from each other, by two divine beings or powers, love and hatred—an attractive and a repulsive force which the ordinary eye can see working amongst men, but which really pervade the whole world. according to the different proportions in which these four indestructible and unchangeable matters are combined with161 each other is the difference of the organic structure produced; e.g., flesh and blood are made of equal parts of all four elements, whereas bones are one-half fire, one-fourth earth, and one-fourth water. it is in the aggregation and segregation of elements thus arising that empedocles, like the atomists, finds the real process which corresponds to what is popularly termed growth, increase, or decrease. nothing new comes or can come into being; the only change that can occur is a change in the juxtaposition of element with element.”353
he considered that men, animals, and plants are demons punished by banishment, but who, becoming purified, may regain the home of the gods. it is hardly necessary to say that he held the demoniacal possession theory of disease, and treated all complaints by means appropriate to the theory. anticipating the modern opinions of the bacteriologists, he banished epidemics by building great fires and draining the water from marshy lands. he understood something of the causes of infectious diseases, and in their treatment usurped the province of the gods who had sent them.354 he believed the embryo was nourished through the navel. we owe to him the terms amnion and chorion (i.e., the innermost and outer membranes with which the f?tus is surrounded in the womb). he believed that death was caused by extinction of heat, that expiration arose from the upward motion of the blood, and inspiration from the reverse. he is said to have raised a dead woman to life.355
empedocles believed in the doctrine of re-incarnation. “i well remember,” he says, “the time before i was empedocles, that i once was a boy, then a girl, a plant, a glittering fish, a bird that cut the air.” to his disciples he said: “by my instructions you shall learn medicines that are powerful to cure disease, and re-animate old age—you shall recall the strength of the dead man, when he has already become the victim of pluto.”356 further speaking of himself, he says: “i am revered by both men and women, who follow me by ten thousands, inquiring the road to boundless wealth, seeking the gift of prophecy, and who would learn the marvellous skill to cure all kinds of diseases.”357
the school of the pythagoreans at crotona.
although in ancient greece the art of medicine, as we have already shown, was closely connected with the temples, if not actually with religion, its entanglement with philosophy was a scarcely less unfortunate connection, and it was not able to make any real progress till162 hippocrates liberated it from both priests and philosophers. 582 years before christ pythagoras was born, the ideal hero or saint whom we faintly discern through the mythical haze which has always enveloped him. philosopher, prophet, wonder-worker, and physician, he gathered into his mind as into a focus the wisdom of the brahmans, the persian magi, the egyptians, the ph?nicians, the chald?ans, the jews, the arabians, and the druids of gaul, amongst whom he had travelled, if we may believe what is reported of him. he may have visited egypt,358 at any rate, besides acquainting himself with the countries of the mediterranean. his authentic history begins with his emigration to crotona, in south italy, about the year 529. there he founded a kind of religious brotherhood or ethical-reform society, and “appeared as the revealer of a mode of life calculated to raise his disciples above the level of mankind, and to recommend them to the favour of the gods.”359 grote believes that the removal to crotona was prompted by the desire to study medicine in its famous school, probably combined with the notion of instructing the pupils in his philosophy. he rendered great services to the healing art by insisting on the necessity of a thorough comprehension of the organs, structure, and functions of the body in their normal, healthy condition; this must be conceded, though his visionary philosophy did much to destroy the scientific value of his medical teaching.
the founder of the healing art amongst the greeks and hellenic peoples generally was pythagoras. he was imbued with eastern mysticism, teaching that the air is full of spiritual beings, who send dreams to men and cause to men and cattle disease and health. he taught that these spirits must be conciliated by lustrations and invocations. pliny says360 that he taught that holding dill (anethum) in the hand is good against epilepsy. the health of the body is to be maintained by diet and gymnastics. it is interesting to find that this great philosopher recommended music to restore the harmony of the spirits. besides the magic virtues of the dill, he held that many other plants possessed them, such as the cabbage (a food in great favour with the pythagoreans), the squill, and anise. he held that surgery was not to be practised, as it is unlawful, but salves and poultices were to be permitted. his disciples attributed the union between medicine and philosophy to him.
the pythagorean philosophy turns upon the idea of numbers and the mathematical relations of things. “all things are number;” “number is the essence of everything.” the world subsists by the principle of ordered numbers. the spheres revolve harmoniously; the163 seven planets are the seven golden chords of the heavenly heptachord. as a corollary to this notion we have the theory of opposites. we have the odd and even, and their combinations. the even is the unlimited, the odd the limited; so all things are derived from the combination of the limited and the unlimited. then we get the limited and the unlimited, the odd and the even, the one and many, right and left, masculine and feminine, rest and motion, straight and crooked, light and darkness, good and evil, square and oblong. when opposites unite, there is harmony. the number ten comprehends all other numbers in itself; four was held in great respect, because it is the first square number and the potential decade (1 + 2 + 3 + 4 = 10). pythagoras was the discoverer of the holy τετρακτ??, “the fountain and root of ever-living nature.” five signifies marriage, one is reason because unchangeable, two is opinion, seven is called παρθ?νο? and ?θ?νη, because within the decade it has neither factors nor product.361
the doctrine of transmigration of souls, metempsychosis, is pythagoras’s. he probably borrowed it from the orphic mysteries; originally no doubt it came from asia. asceticism, mysticism, and neoplatonism sprang from this noble and lofty philosophy. closely connected with his theory of numbers he held that from these points are produced, from these lines, from lines figures, and from figures solid bodies. the elements fire, water, earth, and air, account in his conception for the formation of the world. he understood the structure of the body, its procreation and development. he believed that the animal soul is an emanation from the world-soul; the universal soul is god, author of himself. demons are an order of beings between the highest and the lowest. striving for the good brings moral health. bodily health means harmony, disease means discord. diseases are caused by demons, and are to be dispelled by prayers, offerings, and music. he first among the greeks taught the immortality of the soul; he held a doctrine of rewards and punishments, and taught that of metempsychosis. for many succeeding ages the pythagorean doctrine had the greatest influence on the art of medicine.362
le clerc says that pythagoras obtained his ideas of the climacteric years from the chald?ans. the term is applied to the seventh year of the life of man, and it was anciently believed that at each change we incur some risk to life or health, on account of the bodily changes undergone at that time.363 celsus says that the medical sentiment with164 respect to the septenary number in diseases, and that of the odd and even days, is of pythagorean origin.364 the pythagoreans had a great respect for the number four. the quaternary number was sacred to the egyptians; they burned in the temples of isis a kind of resinous gum, myrrh, and other drugs, in the preparation of which they had regard to the number four. the israelites imitated them in this respect (exod. xxx. 2).365
the sacred bean of pythagoras was the object of religious veneration in egypt; the priests were commanded not to look upon it. it is thought to have been the east indian nelumbium.366
zamolxis, who was a god to the getans, is supposed by some to have been a slave and disciple of pythagoras; by others he is considered an altogether mythical personage. he is credited by those who believe him to have been a physician with having said that “a man could not cure the eyes without curing the head, nor the head without all the rest of the body, nor the body without the soul.” plato said much the same thing when he remarked, “to cure a headache you must treat the whole man.” zamolxis cured the soul, not by the enchantments of magic, but by wise discourse and reasonable conversation. “these discourses,” said plato, “produce wisdom in the soul, which having once been acquired it is easy after that to procure health both for the head and all the rest of the body.”
democedes was a celebrated physician of crotona, in magna grecia, who lived in the sixth century b.c. he went to practise at ?gina, where he received from the public treasury a sum equal to about ￡344 a year for his services. the next year he went to athens at a salary equal to ￡406, and the following year he went to the island of samos. the tyrant polycrates gave him the salary of two talents. he was carried prisoner to susa to the court of darius, where he acquired a great reputation and much wealth by curing the king’s foot and the breast of the queen. it is recorded that darius ordered the surgeons who had failed to cure him to be put to death, but democedes interceded for and saved them. he ultimately escaped to crotona, where he settled, the persians having in vain demanded his return.367 he wrote a work on medicine.
democritus, of abdera, was a contemporary of socrates; he was born between 494 and 460 b.c., and was one of the founders of the atomic philosophy. he was profoundly versed in all the knowledge of his time. so ardent a student was he, that he once said that he preferred the discovery of a true cause to the possession of the kingdom of165 persia. the highest object of scientific investigation he held to be the discovery of causes. he wrote on medicine, and devoted himself zealously to the study of anatomy and physiology. pliny says that he composed a special treatise on the structure of the chameleon.368 he wrote on canine rabies, and on the influence of music in the treatment of disease. he is, however, best known to science on account of his cosmical theory. all that exists is vacuum and atoms. the atoms are the ultimate material of all things, even of spirit. they are uncaused and eternal, invisible, yet extended, heavy and impenetrable. they are in constant motion, and have been so from all eternity. by their motion the world and all it contains was produced. soul and fire are of the same nature, of small, smooth, round atoms, and it is by inhaling and exhaling these that life is maintained. the soul perishes with the body. he rejected all theology and popular mythology. reason had nothing to do with the creation of the world, and he said, “there is nothing true; and if there is, we do not know it.” “we know nothing, not even if there is anything to know.” he died in great honour, yet in poverty, at an advanced age (some writers say at 109 years). his knowledge of nature, and especially of medicine, caused him to be considered a sorcerer and a magician. there was a tradition that he deprived himself of his sight in order to be undisturbed in his intellectual speculations. he probably became blind by too close attention to study. another story was that he was considered to be insane, and hippocrates was sent for to cure him.
the great philosophers of ancient greece believed that all the elements are modifications of one common substance, called the primary matter, which they demonstrated to be devoid of all quality and form, but susceptible of all qualities and forms. it is everything in capacity, but nothing in actuality. matter is eternal; the elements are the first matter arranged into certain distinguishing forms. some of the early philosophers held that all the materials which compose the universe existed in a fluid form; they understood by fire, matter in a highly refined state, and that it is the element most intimately connected with life, some even considering it the very essence of the soul. “our souls are fire,” says phornutus. “what we call heat is immortal,” says one of the hippocratic writers, “and understands, sees, and hears all things that are or will be.”369
bacon explains the ancient fable of proteus as signifying matter, a something which, being below all forms and supporting them, is yet different from them all.
166
sir isaac newton is not widely different from strabo when he says that all bodies may be convertible into one another.
commenting upon these opinions of the greek philosophers, dr. adams says, in his introduction to the works of hippocrates:370 “if every step which we advance in the knowledge of the intimate structure of things leads us to contract the number of substances formerly held to be simple, i would not wonder if it should yet turn out that oxygen, carbon, hydrogen, and nitrogen are—like what the ancients held the elements to be—all nothing else but different modifications of one ever-changing matter.”
the theories of the greek philosophers on the elements are poetically summed up in ovid’s metamorphoses:—
“nor those which elements we call abide,
nor to this figure nor to that are ty’d:
for this eternal world is said of old
but four prolific principles to hold,
four different bodies; two to heaven ascend,
and other two down to the centre tend.
fire first, with wings expanded, mounts on high,
pure, void of weight, and dwells in upper sky;
then air, because unclogged, in empty space
flies after fire, and claims the second place;
but weighty water, as her nature guides,
lies on the lap of earth; and mother earth subsides.
all things are mixed of these, which all contain,
and into these are all resolved again;
earth rarifies to dew; expanding more,
the subtle dew in air begins to soar;
spreads as she flies, and, weary of the name,
extenuates still, and changes into flame.
thus having by degrees perfection won,
restless, they soon untwist the web they spun,
and fire begins to lose her radiant hue,
mixed with gross air, and air descends in dew!
and dew condensing, does her form forego,
and sinks, a heavy lump of earth, below.
thus are their figures never at a stand,
but changed by nature’s innovating hand.”371
greek theories of disease.
as the greeks believed that all diseases were the consequences of the anger of the gods, it was in their temples that cures were most likely to take place. faith was the sine qua non in the patient, and everything about the temple and its ceremonies was calculated to167 excite religious awe and to stimulate faith. preliminary purifications, fasting, massage, and fomentations with herbs, were necessary parts of the initiatory ceremonies, and the imagination was excited by everything that the sufferer saw around him. he heard the stories of the marvellous cures which had taken place at the sacred fane. tablets round the walls, placed there by grateful worshippers who had been cured in the past,372 served to fill the mind with hope, when, as was the practice, the patient lay down in the holy place by the image of the healing god, that in the incubatory sleep the remedies which were to cure him might be revealed. sometimes no such revelation was vouchsafed, then sacrifices and prayers were offered; if these failed, the priests themselves would appear in the mask and the dress of the healing god, and in the darkness and mystery of the night reveal the necessary prescriptions. to interpret the dreams was the task of the priests at all times, just as it was in the temples of ancient egypt. divination, magic, and astrology largely assisted in the work of discovering the requisite remedies. if all failed, it was due not to any defect on the part of the divinity or his servants, but simply to the want of faith on the part of the patient. the festivals of ?sculapius were called asclepia, and the presiding priests of the healing god were named asclepiades. the schools of the asclepiades were a sort of medical guild, and their doctrines were divided into exoteric and esoteric. they naturally became possessed of a great body of medical teaching, which was preserved as a precious secret and handed down from generation to generation. the asclepiad? thus became the hereditary physicians of greece. medicine at this period was not a science to be taught to all comers, but was a mystery to be orally transmitted. these men pretended to be descendants of ?sculapius, just as now the imitators of medicines, perfumes,168 etc., which have become celebrated, give out that they belong to the family of the inventor, and thus know the secrets of the preparation.373
this professional class was quite distinct from the priests of the ?sculapian temples, though many writers have confused them. probably the truth is this:—certain students from reading the votive tablets in the temples, and examining the persons who came to be cured, gave their attention to the art of medicine, and established themselves as physicians in the neighbourhood of the temples; for it does not appear that the priests themselves pretended to medical skill. they were the instruments of the divine revelation, the mediums of the healing power of the god; they suggested remedies, but did not attempt their application or the treatment of cases. in process of time the pilgrims to the temples would require human aid to supplement the often disappointing divine assistance, and this the asclepiad? were appointed to supply. hypnotism was probably practised; music, and such drugs as hemlock were also employed which soothe the nervous system and relieve pain. the asclepiad? took careful notes of the symptoms and progress of each case, and were particular to observe the effect of the treatment prescribed; they became, in consequence, exceedingly skilful in prognosis. galen says that little attention was paid to dietetics by the asclepiads; but strabo speaks of the knowledge which hippocrates derived from the documents in the asclepion of cos.374 exercise, especially on horseback, was one of the measures used by the asclepiads for restoring the health.375
schools of the asclepiades.
the three most famous schools of the asclepiades were those of rhodes, cos, and cnidos. there were also that of crotona, in lower italy, established by pythagoras, and the school of cyrene, in the north of africa. famous temples of ?sculapius existed at titan?, epidaurus, orope, cyllene, tithorea, tricca, megalopolis, pergamus, corinth, smyrna, and at many other places.376
a spirit of healthy emulation existed in these different schools, which was most advantageous for the progress of medical science. the tone existing at this early period amongst the different medical societies at these institutions is shown in the famous oath which the pupils of the asclepiad? were compelled to subscribe on completing their course of instruction in medicine. it is the oldest written monument of the greek art of healing.377
169
the oath.
“i swear by apollo, the physician, and ?sculapius, and health, and panacea,378 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 the 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 judgment, i consider for the benefit of my patient, and abstain from whatever is deleterious and mischievous. i will give no deadly medicine to any one 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 practise 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.379
“into whatever 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 seduction of females or males, of freemen or 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!”
ancient authorities differ as to the respective order in which the schools of the asclepiads should be esteemed. rhodes, cos, and cnidos continually disputed for the pre-eminence, cos and cnidos170 acquiring great fame by their conflicting opinions. according to galen, the first place must be conceded to cos, as having produced the greatest number of excellent disciples, amongst whom was hippocrates; he ranks cnidos next. cos (b.c. 600) was the objective school, and devoted its studies chiefly to symptomatology. it asked, what can we see of the patient’s disorder? of what does he complain? what, in fact, are his symptoms? this is practical medicine, though not so much in accordance with modern scientific medicine as the method of cnidos, the subjective school. there the aim was to make a correct diagnosis; to find out what was behind the symptoms, what caused the morbid appearances; what it was that the sensations of the patient indicated; and its aim was not to treat symptoms so much as to treat vigorously the disorder which caused them. auscultation, or the art of scientifically listening to the sounds of the chest, those of the lungs in breathing, and of the heart in beating, was to some extent understood and practised at cnidos. the medical school of crotona was in the highest repute 500 b.c., probably on account of its connection with the pythagoreans. the school of rhodes does not seem to have had a long life.
that of cyrene was famous on account not only of its medical teaching, but from the fact that mathematics and philosophy were industriously pursued there. the teaching in all these schools must have been of a very high order; for, though unfortunately little of it has descended directly to us, we have sufficient evidence of its importance in such fragments as are to be found incorporated with the works of hippocrates, such as the coan prognostics and the cnidian sentences; the former, a miscellaneous collection of the observations made by the physician of cos, and the latter, a work attributed to euryphon, a celebrated physician of cnidos (about the former half of the fifth century b.c.).
experiment and observation were insisted upon in the study of anatomy and physiology. galen tells us in his second book, on anatomical manipulations: “i do not blame the ancients, who did not write books on anatomical manipulations; though i praise marinus, who did. for it was superfluous for them to compose such records for themselves or others, while they were, from their childhood, exercised by their parents in dissecting, just as familiarly as in writing and reading; so that there was no more fear of their forgetting their anatomy than of their forgetting their alphabet. but when grown men, as well as children, were taught, this thorough discipline fell off; and, the art being carried out of the family of the asclepiads, and declining by repeated transmission, books became necessary for the student.”
the method of the asclepiad? was one of true induction; much was171 imperfect in their efforts to arrive at the beginning of medical science. they had little light, and often stumbled; but they made the best use of what they had, and with all their deviations they always returned to the right path, and kept their faces towards the light. hippocrates was of them; and bacon of verulam, in the centuries to come, followed and developed the same method. dr. adams remarks the assiduous observation and abundant rational experience which led them to enunciate such a law of nature as this: “those things which bring alleviation with bad signs, and do not remit with good, are troublesome and difficult.”
ctesias, of cnidus, in caria, was a physician at the court of king artaxerxes mnemon. he may be called a contemporary of herodotus. it is possible that, according to diodorus, he was a prisoner of war while in persia, though the well-known fact that greek physicians were in great request, and were always received there with favour, is quite sufficient to account for his presence in that country. he wrote a history of persia and a treatise on india, containing many statements formerly considered doubtful, but now proved to be founded on facts.
the persons who anointed the bodies of the athletes of ancient greece, preparatory to their entering the gymnasia, were called alipt?. these persons taught gymnastic exercises, practised many operations of surgery, and undertook the treatment of trifling diseases. the external use of oil was intended to close the pores of the skin, so as to prevent excessive perspiration. the oil was mixed with sand, and was well rubbed into the skin. after the exercises, the athletes were again anointed, to restore the tone of the muscles. the alipt? would naturally acquire considerable knowledge of the accidents and maladies to which the human body was subject; accordingly, we find that they not only undertook the treatment of fractures and dislocations, but became the regular medical advisers of their patrons. iccus of tarentum devoted himself to dietetics. they were probably a superior class of trainers. herodicus of selymbria, a teacher of hippocrates, treated diseases by exercises. he is said to have been the first to demand a fee in place of the presents which were given by patients formerly to their doctors.380 the gymnasia were dedicated to apollo, the god of physicians.381 the directors of the institutions regulated the diet of the young men, the sub-directors prescribed for their diseases.382 the inferiors, or bathers, bled, gave clysters, and dressed wounds.
