Part 11

The work of Celsus of the end of the first century B. C. is a Latin treatise, probably translated from Greek, and is the surviving medical volume of a complete cyclopaedia of knowledge. In spite of its unpromising origin it is an excellent compendium of its subject and shows a good deal of advance in many respects beyond the Hippocratic position. The moral tone too is very high, though without the lofty and detached beauty of Hippocrates. Anatomy has greatly improved, and with it surgical procedure, and the work is probably representative of the best Alexandrian practice. The pharmacopœia is more copious, but has not yet become burdensome. The general line of treatment is sensible and humane and the language concise and clear. Among other items he describes dental practice, with the indications for and methods of tooth extraction, the wiring of teeth, and perhaps a dental mirror. There is an excellent account of what might be thought to be the modern operation for removal of the tonsils. Celsus is still commemorated in modern medicine by the _area Celsi_, a not uncommon disease of the skin. The _De re medica_ is in fact one of the very best medical text-books that have come down to us from antiquity. It has had a romantic history. Forgotten during the Middle Ages, it was brought to light by the classical scholar Guarino of Verona (1374-1460) in 1426, and a better copy was discovered by his friend Lamola in 1427. Another copy was found by Thomas Parentucelli (1397-1455), afterwards Pope Nicholas V in 1443, and the text was later studied by Politian (1454-94). Though one of the latest of the great classical medical texts to be discovered, it was one of the first to be printed (Florence, 1478), and it ran through very many early editions and had great influence on the medical renaissance.

After Celsus comes Dioscorides in the first century A. D. He was a Greek military surgeon of Cilician origin who served under Nero, and in him the Greek intellect is obviously beginning to flag. His work is prodigiously important for the history of botany, yet so far as rational medicine is concerned he is almost negligible. He begins at the wrong end, either giving lists of drugs with the symptoms that they are said to cure or to relieve, or lists of symptoms with a series of named drugs. Clinical observation and record are wholly absent, and the spirit of Hippocrates has departed from this elaborate pharmacopœia.

With the second century of the Christian era we terminate the creative period of Greek medicine. We are provided with the works of four important writers of this century, of whom three, Rufus of Ephesus, Soranus of Ephesus, and Aretaeus of Cappadocia, though valuable for forming a picture of the state of medicine in their day, were without substantial influence on the course of medicine in later ages.

Rufus of Ephesus, a little junior to Dioscorides, has left us the first formal work on human anatomy and is of some importance in the history of comparative anatomy. In medicine he is memorable as the first to have described bubonic plague, and in surgery for his description of the methods of arresting haemorrhage and his knowledge of the anatomy of the eye. A work by him _On gout_ was translated into Latin in the sixth century, but remained unknown till modern times.

Soranus of Ephesus (A. D. _c._ 90-_c._ 150), an acute writer on gynaecology, has left a book which illustrates well the anatomy of his day. It exercised an influence for many centuries to come, and a Latin abstract of it prepared about the sixth century by one Moschion has come down to us in an almost contemporary manuscript.[133] It is interesting as opposing the Hippocratic theory that the male embryo is originated in the right and the female in the left half of the womb, a fallacy derived originally from Empedocles and Parmenides, but perpetuated by Latin translations of the Hippocratic treatises until the seventeenth century. His work was adorned by figures, and some of these, naturally greatly altered by copyists, but still not infinitely removed from the facts, have survived in a manuscript of the ninth century, and give us a distant idea of the appearance of ancient anatomical drawings.[134] We may assist our imagination a little further, in forming an idea of what such diagrams were like, with the help of certain other mediaeval figures representing the form and distribution of the various anatomical ‘systems’, veins, arteries, nerves, bones, and muscles which are probably traceable to an Alexandrian origin.[135]

[133] Leyden Voss 4ᵒ 9^* of the sixth century is a fragment of this work.

[134] V. Rose, _Sorani Ephesii vetus translatio Latina cum additis Graeci textus reliquiis_, Leipzig, 1882; F. Weindler, _Geschichte der gynäkologisch-anatomischen Abbildung_, Dresden, 1908.

[135] The discovery and attribution of these figures is the work of K. Sudhoff. A bibliography of his writings on the subject will be found in a ‘Study in Early Renaissance Anatomy’ in C. Singer’s _Studies in the History and Method of Science_, vol. i, Oxford, 1917.

Aretaeus of Cappadocia was probably a contemporary of Galen (second half of the second century A. D.). As a clinical author his reputation stands high, perhaps too high, his descriptions of pneumonia, emphysema, diabetes, and elephantiasis having especially drawn attention. In treatment he uses simple remedies, is not affected by polypharmacy, and suggests many ingenious mechanical devices. It would appear that Aretaeus is not an independent writer, but mainly a compiler. He relies largely on Archigenes, a distinguished physician contemporary with Juvenal, whose works have perished save the fragments preserved in this manner by Aretaeus and Aetius. Aretaeus was a very popular writer among the Greeks in all ages, but he was not translated into Latin, and was unknown in the West until the middle of the sixteenth century.[136] He is philologically interesting as still using the Ionic dialect.

[136] First Latin edition Venice, 1552; first Greek edition Paris, 1554.

There remains the huge overshadowing figure of Galen. The enormous mass of the surviving work of this man, the dictator of medicine until the revival of learning and beyond, tends to throw out of perspective the whole of Greek medical records. The works of Galen alone form about half of the mass of surviving Greek medical writings, and occupy, in the standard edition, twenty-two thick, closely-printed volumes. These cover every department of medicine, anatomy, physiology, pathology, medical theory, therapeutics, as well as clinical medicine and surgery. In style they are verbose and heavy and very frequently polemical. They are saturated with a teleology which, at times, becomes excessively tedious. In the anatomical works, masses of teleological explanation dilute the account of often imperfectly described structures. Yet to this element we owe the preservation of the mass of Galen’s works, for his intensely teleological point of view appealed to the theological bias both of Western Christianity and of Eastern Islam. Intolerable as literature, his works are a valuable treasure house of medical knowledge and experience, custom, tradition, and history.

As in the case of the Hippocratic corpus, so in the case of the Galenic corpus we are dealing to some extent with material from various sources. In the case of Galen, however, we have a good standard of genuineness, for he has left us a list of his books which can be checked off against those which we actually possess. The general standpoint of the Galenic is not unlike that of the Hippocratic writings, but the noble vision of the lofty-minded, pure-souled physician has utterly passed away. In his place we have an acute, honest, very contentious fellow, bristling with energy and of prodigious industry, not unkindly, but loving strife, a thoroughly ‘aggressive’ character. He loves truth, but he loves argument quite as much. The value of his philosophical writings, of which some have survived, cannot be discussed here, but it is evident that he is frequently satisfied with purely verbal explanations. An ingenious physiologist, a born experimenter, an excellent anatomist and eager to improve, possessing a good knowledge of the human skeleton and an accurate acquaintance with the internal parts so far as this can be derived from a most industrious devotion to dissection of animals, equipped with all the learning of the schools of Pergamon, Smyrna, and Alexandria, and rich with the experience of a vast practice at Rome, Galen is essentially an ‘efficient’ man. He has the grace to acknowledge constantly and repeatedly his indebtedness to the Hippocratic writings. Such was the man whose remains, along with the Hippocratic collection, formed the main medical legacy of Greece to the Western world.

Some of Galen’s works are mere drug lists, little superior to those of Dioscorides;[137] with the depression of the intelligence that corresponded with the break up of the Roman Empire, it was these that were chiefly seized on and distributed in the West. Attractive too to the debased intellect of the late Roman world were certain spurious, superstitious, and astrological works that circulated in the name of Galen and Hippocrates.[138] The Greek medical writers after Galen were but his imitators and abstractors, but through some of them Galen’s works reached the West at a very early period in the Middle Ages. Such abstractors who were early translated into Latin were Oribasius (325-403), Paul of Aegina (625-690), and Alexander of Tralles (525-605). Of the best and most scientific of Galen’s works the Middle Ages knew little or nothing.

[137] e. g. περὶ κράσεως καὶ δυνάμεως τῶν ἁπάντων φαρμάκων and the φάρμακα.

[138] e. g. _De dynamidiis Galeni_, _Secreta Hippocratis_ and many astrological tracts.

Later Galen and Hippocrates became a little more accessible, not by translation from the Greek, but by translation from the Arabic of a Syriac version. The first work to be so rendered was a version of _Aphorisms_ of Hippocrates which, however, as we have seen, were already available in Latin dress, together with the Hippocratic _Regimen in acute diseases_, and certain works of Galen as corruptly interpreted by Isaac Judaeus. These were rendered from Arabic into Latin by Constantine, an African adventurer who became a monk at Monte Cassino and died there in 1087. Constantine was a wretched craftsman with an imperfect knowledge of both Arabic and Latin. More effective was the great twelfth century translator from the Arabic, Gerard of Cremona (died 1185), who turned many medical works into Latin from Arabic, and who was followed by a whole host of imitators. Yet more important for the advance of medicine, however, was the learned revival of the thirteenth century. In the main that revival was based on translations from Arabic, but a certain number of works were also rendered direct from the Greek. During the thirteenth century Aristotle’s scientific works began to be treated in this way, but more important for the course of medicine were those of Galen, and they had to wait till the following century. The long treatise of Galen, περὶ χρείας τῶν ἐν ἀνθρώπου σώματι μορίων, _On the uses of the bodily parts in man_, was translated from the Greek into Latin by Nicholas of Reggio in the earlier part of the fourteenth century. This work, with all its defects, was by far the best account of the human body then available. Many manuscripts of the Latin version have survived, and it was translated into several vernaculars, including English, and profoundly influenced surgery. The rendering into Latin of this treatise, and its wide distribution, may be regarded as the starting-point of modern scientific medicine. Its appearance is moreover a part of the phenomenon of the revived interest in dissection which had begun to be practised in the Universities in the thirteenth century,[139] and was a generally accepted discipline in the fourteenth and fifteenth.[140]

[139] Dissection of animals was practised at Salerno as early as the eleventh century.

[140] The sources of the anatomical knowledge of the Middle Ages are discussed in detail in the following works: R. R. von Töply, _Studien zur Geschichte der Anatomie im Mittelalter_, Vienna, 1898; K. Sudhoff, _Tradition und Naturbeobachtung_, Leipzig, 1907; and also numerous articles in the _Archiv für Geschichte der Medizin und Naturwissenschaften_; Charles Singer, ‘A Study in Early Renaissance Anatomy’, in _Studies in the History and Method of Science_, vol. i, Oxford, 1917.

Until the end of the fifteenth century progress in anatomy was almost imperceptible. During the fifteenth century more Galenic and Hippocratic texts were recovered and gradually turned into Latin, but still without vitally affecting the course of Anatomy. The actual printing of collected editions of Hippocrates and Galen came rather late, for the debased taste of the Renaissance physicians continued to prefer Dioscorides and the Arabs, of whom numerous editions appeared, so that medicine made no advance corresponding to the progress of scholarship. The Hippocratic works were first printed in 1525, and an isolated edition of the inferior Galen in 1490, but the real advance in Medicine was not made by direct study of these works. So long as they were treated in the old scholastic spirit such works were of no more value than those of the Arabists or others inherited from the Middle Ages. Even Hippocrates can be spoilt by a commentary, and it was not until the investigator began actually to compare his own observations with those of Hippocrates and Galen that the real value of these works became apparent. The department in which this happened first was Anatomy, and such revolutionaries as Leonardo da Vinci (1452-1518), who never published, and Vesalius (1514-1564), whose great work appeared in 1543, were really basing their work on Galen, though they were much occupied in proving Galen’s errors. Antonio Benivieni (died 1502), an eager prophet of the new spirit, revived the Hippocratic tradition by actually collecting notes of a few cases with accompanying records of deaths and post-mortem findings, among which it is interesting to observe a case of appendicitis.[141] His example was occasionally followed during the sixteenth century, as for instance, by the Portuguese Jewish physician Amatus Lusitanus (1511-_c._ 1562), who printed no fewer than seven hundred cases; but the real revival of the Hippocratic tradition came in the next century with Sydenham (1624-1689) and Boerhaave (1668-1738), who were consciously working on the Hippocratic basis and endeavouring to extend the Hippocratic experience.

[141] Benivieni’s notes were published posthumously. Some of the spurious Greek works of the Hippocratic collection have also case notes.

Lastly surgery came to profit by the revival. The greatest of the sixteenth century surgeons, the lovable and loving Ambroise Paré (1510-1590), though he was, as he himself humbly confessed, an ignorant man knowing neither Latin nor Greek, can be shown to have derived much from the works of antiquity, which were circulating in translation in his day and were thus filtering down to the unlearned.

Texts of Hippocrates and of Galen had formed an integral part in the medical instruction of the universities from their commencement in the thirteenth century. The first Greek text of the _Aphorisms_ of Hippocrates appeared in 1532, edited by no less a hand than that of François Rabelais. With the further recovery of the Greek texts and preparation of better translations, these became almost the sole mode of instruction during the fifteenth and sixteenth centuries. The translators became legion and their competence varied. One highly skilled translator, however, is of special interest to English readers. Thomas Linacre (1460?-1524), Physician to Henry VIII, Tutor to the Princess Mary, founder and first president of the College of Physicians, a benefactor of both the ancient Universities and one of the earliest, ablest, most typical, and most exasperating of the English humanists, spent much energy on this work of translation for which his abilities peculiarly fitted him. He was responsible for no less than six important works of Galen, of which one, the _De temperamentis et de inaequali intemperie_, printed at Cambridge in 1521, was among the earliest books impressed in that town and is said to be the first printed in England for which Greek types were used. It has been honoured by reproduction in facsimile in modern times. Such works as these, purely literary efforts, had great vogue for a century and more, and were much in use in the Universities. These humanistic products sometimes produced, among the advocates of the new scientific method, a degree of fury which was only rivalled by that of some of the humanists themselves towards the translators from the Arabic. But these are now dead fires. As the clinical and scientific methods of teaching gained ground, textual studies receded in medical education, as Hippocrates and Galen themselves would have wished them to recede.

The texts of Hippocrates and Galen have now ceased to occupy a place in any medical curriculum. Yet all who know these writings, know too, not only that their spirit is still with us, but that the works themselves form the background of modern practice, and that their very phraseology is still in use at the bedside. Modern medicine may be truly described as in essence a creation of the Greeks. To realize the nature of our medical system, some knowledge of its Greek sources is essential. It would indeed be a bad day for medicine if ever this debt to the Greeks were forgotten, and the loss would be at least as much ethical as intellectual. But there is happily no fear of this, for the figure and spirit of Hippocrates are more real and living to-day than they have been since the great collapse of the Greek scientific intellect in the third and fourth centuries of the Christian era.

PRINTED IN ENGLAND AT THE OXFORD UNIVERSITY PRESS