Part 7

‘While the young [fish] are small and not yet fully developed they have veins of great length which take the place of the navel-string, but as they grow and develop, these shorten and contract into the body towards the heart, as we have said about birds. The young fish and the eggs are enclosed and in a covering, as are the eggs and young of birds. This covering resembles the dura mater [of the brain], and beneath it is another [corresponding therefore to the pia mater of the brain] which contains the young animal and nothing else.’[94]

In the next century Conrad von Megenberg (1309-98) produced his _Book of Nature_, a complete work on natural history, the first of the kind in the vernacular, founded on Latin versions, now rendered direct from the Greek, of the Aristotelian and Galenic biological works. It is well ordered and opens with a systematic account of the structure and physiology of man as a type of the animal creation, which is then systematically described and followed by an account of plants. Conrad, though guided by Aristotle, uses his own eyes and ears, and with him and Albert the era of direct observation has begun.[95]

[94] The enormous _De Animalibus_ of Albert of Cologne is now available in an edition by H. Stadler, _Albertus Magnus De Animalibus Libri XXVI nach der cölner Urschrift_, 2 vols., Münster i/W., 1916-21. The quotation is translated from vol. i, pp. 465-6.

[95] Conrad’s work is conveniently edited by H. Schultz, _Das Buch der Natur von Conrad von Megenberg, die erste Naturgeschichte in deutscher Sprache, in Neu-Hochdeutsche Sprache bearbeitet_, Greifswald, 1897. Conrad’s work is based on that of Thomas of Cantimpré (1201-70).

But there was another department in which the legacy of Greece found an even earlier appreciation. For centuries the illustrations to herbals and bestiaries had been copied from hand to hand, continuing a tradition that had its rise with Greek artists of the first century B. C. But their work, copied at each stage without reference to the object, moved constantly farther from resemblance to the original. At last the illustrations became little but formal patterns, a state in which they remained in some late copies prepared as recently as the sixteenth century. But at a certain period a change set in, and the artist, no longer content to rely on tradition, appeals at last to nature. This new stirring in art corresponds with the new stirring in letters, the Arabian revival—itself a legacy of Greece, though sadly deteriorated in transit—that gave rise to scholasticism. In much of the beautiful carved and sculptured work of the French cathedrals the new movement appears in the earlier part of the thirteenth century. At such a place as Chartres we see the attempt to render plants and animals faithfully in stone as early as 1240 or before. In the easier medium of parchment the same tendency appears even earlier. When once it begins the process progresses slowly until the great recovery of the Greek texts in the fifteenth century, when it is again accelerated.

During the sixteenth century the energy of botanists and zoologists was largely absorbed in producing most carefully annotated and illustrated editions of Dioscorides and Theophrastus and accounts of animals, habits, and structure that were intended to illustrate the writings of Aristotle, while the anatomists explored the bodies of man and beast to confirm or refute Galen. The great monographs on birds, fishes, and plants of this period, ostensibly little but commentaries on Pliny, Aristotle, and Dioscorides, represent really the first important efforts of modern times at a natural history. They pass naturally into the encyclopaedias of the later sixteenth century, and these into the physiological works of the seventeenth. Aristotle was never a dead hand in Biology as he was in Physics, and this for the reason that he was a great biologist but was not a great physicist.

With the advance of the sixteenth century the works of Aristotle, and to a less extent those of Dioscorides and Galen, became the great stimulus to the foundation of a new biological science. Matthioli (1520-77), in his commentary on Dioscorides (first edition 1544), which was one of the first works of its type to appear in the vernacular, made a number of first-hand observations on the habits and structure of plants that is startling even to a modern botanist. About the same time Galenic physiology, expressed also in numerous works in the vulgar tongue and rousing the curiosity of the physicians, became the clear parent of modern physiology and comparative anatomy. But, above all, the Aristotelian biological works were fertilizers of the mind. It is very interesting to watch a fine observer such as Fabricius ab Acquapendente (1537-1619) laying the foundations of modern embryology in a splendid series of first-hand observations, treating his own great researches almost as a commentary on Aristotle. What an impressive contrast to the arid physics of the time based also on Aristotle! ‘My purpose’, says Fabricius, ‘is to treat of the formation of the foetus in every animal, setting out from that which proceeds from the egg: for this ought to take precedence of all other discussion of the subject, both because it is not difficult to make out Aristotle’s view of the matter, and because his treatise on the Formation of the Foetus from the egg is by far the fullest, and the subject is by much the most extensive and difficult.’[96]

[96] Hieronimo Fabrizio of Acquapendente, _De formato foetu_, Padua, 1604.

The industrious and careful Fabricius, with a wonderful talent for observation lit not by his own lamp but by that of Aristotle, bears a relation to the master much like that held by Aristotle’s pupil in the flesh, Theophrastus. The works of the two men, Fabricius and Theophrastus, bear indeed a resemblance to each other. Both rely on the same group of general ideas, both progress in much the same ordered calm from observation to observation, both have an inspiration which is efficient and stimulating but below the greatest, both are enthusiastic and effective as investigators of fact, but timid and ineffective in drawing conclusions.

But Fabricius was more happy in his pupils than Theophrastus, for we may watch the same Aristotelian ideas fermenting in the mind of Fabricius’s successor, the greatest biologist since Aristotle himself, William Harvey (1578-1657).[97] This writer’s work _On generation_ is a careful commentary on Aristotle’s work on the same topic, but it is a commentary not in the old sense but in the spirit of Aristotle himself. Each statement is weighed and tested in the light of experience, and the younger naturalist, with all his reverence for Aristotle, does not hesitate to criticize his conclusions. He exhibits an independence of thought, an ingenuity in experiment, and a power of deduction that places his treatise as the middle term of the three great works on embryology of which the other members are those of Aristotle and Karl Ernst von Baer (1796-1870).[98]

[97] William Harvey, _Exercitationes de generatione animalium_, London, 1651.

[98] Karl Ernst von Baer, _Ueber die Entwickelungsgeschichte der Thiere_, Königsberg, 1828-37.

With the second half of the seventeenth century and during a large part of the eighteenth the biological works of Aristotle attracted less attention. The battle against the Aristotelian physics had been fought and won, but with them the biological works of Aristotle unjustly passed into the shadow that overhung all the idols of the Middle Ages.

The rediscovery of the Aristotelian biology is a modern thing. The collection of the vast wealth of living forms absorbed the energies of the generations of naturalists from Ray (1627-1705) and Willoughby (1635-72) to Réaumur (1683-1757) and Linnaeus (1707-1778) and beyond to the nineteenth century. The magnitude and fascination of the work seems almost to have excluded general ideas. With the end of this period and the advent of a more philosophical type of naturalist, such as Cuvier (1769-1832) and members of the Saint-Hilaire family, Aristotle came again to his own. Since the dawn of the nineteenth century, and since naturalists have been in a position to verify the work of Aristotle, his reputation as a naturalist has continuously risen. Johannes Müller (1801-58), Richard Owen (1804-92), George Henry Lewes (1817-78), William Ogle (1827-1912) are a few of the long line of those who have derived direct inspiration from his biological work. With improved modern methods of investigation the problems of generation have absorbed a large amount of biological attention, and interest has become specially concentrated on Aristotle’s work on that topic which is perhaps, at the moment, more widely read than any biological treatise, ancient or modern, except the works of Darwin. That great naturalist wrote to Ogle in 1882: ‘From quotations I had seen I had a high notion of Aristotle’s merits, but I had not the most remote notion what a wonderful man he was. Linnaeus and Cuvier have been my two gods, though in very different ways, but they were mere schoolboys to old Aristotle.’

GREEK MEDICINE

Ἡρόφιλος δὲ ᾝἐν τῷ Διαιτητικῷ καὶ σοφίαν φησὶν ἀνεπίδεικτον καὶ τέχνην ἄδηλον καὶ ἰσχὺν ἀναγώνιστον καὶ πλοῦτον ἀχρεῖον καὶ λόγον ἀδύνατον, ὑγιείας ἀπούσης.

Herophilus, a Greek philosopher and physician (_c._ 300 B. C.), has truly written ‘that Science and Art have equally nothing to show, that Strength is incapable of effort, Wealth useless, and Eloquence powerless if Health be wanting’.[99] All peoples therefore have had their methods of treating those departures from health that we call disease, and among peoples of higher culture such methods have been reduced in most cases to something resembling a system. In antiquity, as now, a variety of such systems were in vogue, and those nations who practised the art of writing from an early date have left considerable records of their medical methods and doctrines. We may thus form a fairly good idea of the medical principles of the Mesopotamian, the Egyptian, the Iranian, the Indian, and the Chinese civilizations. Much in these systems, as in the medical procedure of more primitive tribes, was based upon some theory of disease which fitted in with a larger theory of the nature of evil. Of these theories the commonest was and is the demonic, the view that regards deviation from the normal state of health as due either to the attacks of supernatural beings or to their actual entry into the body of the sufferer. A medical system based on such a view is susceptible of great elaboration in a higher civilization, but not being founded on observation is hardly capable of indefinite development, for a point must ultimately be reached at which the mind recoils from complex conclusions far remote from observed phenomena. The medicine of the ancient and settled civilization of such a people as the Assyro-Babylonians, for instance, of which substantial traces have been recovered, is hardly, if at all, more effective, though far more systematized, than that of many a wild and unlettered tribe that may be observed to-day. Of such medicine as this we may give an account, but we can hardly write a _history_. We cannot establish those elements of continuity and of development from which alone history can be constructed.

[99] The works of Herophilus are lost. This fine passage has been preserved for us by Sextus Empiricus, a third century physician, in his πρὸς τοὺς μαθηματικοὺς ἀντιρῥητικοί, which is in essence an attack on all positive philosophy. It is an entertaining fact that we should have to go to such a work for remains of the greatest anatomist of antiquity. The passage is in the section directed against ethical writers, xi. 50.

It is the distinction of the Greeks alone among the nations of antiquity that they practised a system of medicine based not on theory but on observation accumulated systematically as time went on. The claim can be made for the Greeks that some at least among them were deflected by no theory, were deceived by no theurgy, were hampered by no tradition in their search for the facts of disease and in their attempts at interpreting its phenomena. Only the Greeks among the ancients could look on their healers as _physicians_ (= naturalists, φύσις = nature), and that word itself stands as a lasting reminder of their achievement.[100]

[100] The word φυσικός, though it passed over into Latin (Cicero) with the meaning _naturalist_, acquired the connotation of _sorcerer_ among the later Greek writers. Perhaps the word _physicianus_ was introduced to make a distinction from the charm-mongering _physicus_. In later Latin _physicus_ and _medicus_ are almost always interchangeable.

At a certain stage in the history of the Western world—the exact point in time may be disputed but the event is admitted by all—men turned to explore the treasures of the ancient wisdom and the whole mass of Greek medical learning was gradually laid before the student. That mass contained much dross, material that survived from early as from late Greek times which was hardly, if at all, superior to the debased compositions that circulated in the name of medicine in the middle centuries. But the recovered Greek medical writings also contained some material of the purest and most scientific type, and that material and the spirit in which it was written, form the debt of modern medicine to antiquity.

It is a debt the value of which cannot be exaggerated. The physicians of the revival of learning, and for long after, doubtless pinned their faith too much to the written word of their Greek forbears and sought to imprison the free spirit of Hippocrates and Galen in the rigid wall of their own rediscovered texts. The great medical pioneers of a somewhat later age, enraged by this attempt, the real nature of which was largely hidden from them, not infrequently revolted and rightly revolted against the bondage to the Greeks in which they had been brought up. Yet it is sure that these modern discoverers were the true inheritors of the Greeks. Without Herophilus we should have had no Harvey and the rise of physiology might have been delayed for centuries; had Galen’s works not survived, Vesalius would never have reconstructed Anatomy, and Surgery too might have stayed behind with her laggard sister, Medicine; the Hippocratic collection was the necessary and acknowledged basis for the work of the greatest of modern clinical observers, Thomas Sydenham, and the teaching of Hippocrates and of his school is the substantial basis of instruction in the wards of a modern hospital. In the pages which follow we propose therefore to review the general character of medical knowledge in the best Greek period and to consider briefly how much of that great heritage remained accessible to the earlier modern physicians. The reader will thus be able to form some estimate of the degree to which the legacy has been passed on to our own times.

It is evident that among such a group of peoples as the Greeks, varying in state of civilization, in mental power, in geographical and economic position and in general outlook, the practice of medicine can have been by no means uniform. Without any method of centralizing medical education and standardizing teaching there was a great variety of doctrines and of practice in vogue among them, and much of this was on a low level of folk custom. Such lower grade material of Greek origin has come down to us in abundance, though much of it, curiously enough, from a later time. But the overwhelming mass of earlier Greek medical literature sets forth for us a pure scientific effort to observe and to classify disease, to make generalizations from carefully collected data, to explain the origin of disease on rational grounds, and to apply remedies, when possible, on a reasoned basis. We may thus rest fairly well assured that, despite serious and irreparable losses, we are still in possession of some of the very finest products of the Greek medical intellect.

There is ample evidence that the Greeks inherited, in common with many other peoples of Mediterranean and Asiatic origin, a whole system of magical or at least non-rational pharmacy and medicine from a remoter ancestry. Striking parallels can be drawn between these folk elements among the Greeks and the medical systems of the early Romans, as well as with the medicine of the Indian Vedas, of the ancient Egyptians, and of the earliest European barbarian writings. It is thus reasonable to suppose that these elements, when they appear in later Greek writings, represent more primitive folk elements working up, under the influence of social disintegration and consequent mental deterioration, through the upper strata of the literate Greek world. But with these elements, intensely interesting to the anthropologist, the psychologist, the ethnologist, and to the historian of religion, we are not here greatly concerned. Important as they are, they constitute no part of the special claim of the Greek people to distinction, but rather aid us in uniting the Greek mentality with that of other kindred peoples. Here we shall rather discuss the course of Greek scientific medicine proper, the type of medical doctrine and practice, capable of development in the proper sense of the word, that forms the basis of our modern system. We are concerned, in fact, with the earliest evolutionary medicine.

We need hardly discuss the first origins of Greek Medicine. The material is scanty and the conclusions somewhat doubtful and perhaps premature, for the discovery of a considerable fragment of the historical work of Menon, a pupil of Aristotle, containing a description of the views of some of the precursors of the Hippocratic school, renews a hope that more extended investigation may yield further information as to the sources and nature of the earliest Greek medical writings.[101] The study of Mesopotamian star-lore has linked it up with early Greek astronomical science. The efforts of cuneiform scholars have not, however, been equally successful for medicine, and on the whole the general tendency of modern research is to give less weight to Mesopotamian and more to Egyptian sources than had previously been admitted; thus, as an instance, some prescriptions in the Ebers papyrus of the eighteenth dynasty (about the sixteenth century B. C.) discovered at Thebes in 1872 resemble certain formulae in the Corpus Hippocraticum. A number of drugs, too, habitually used by the Greeks, such as _Andropogon_, _Cardamoms_, and _Sesame orientalis_, are of Indian origin. There are also the Minoan cultures to be considered, and our knowledge is not yet sufficient to speak of the heritage that Greek medicine may or may not have derived from that source, though it seems not improbable that Greek hygiene may here owe a debt.[102] Omitting, therefore, this early epoch, we pass direct to the later period, between the sixth and fourth centuries, from which documents have actually come down to us.

[101] This fragment has been published in vol. iii, part 1, of the _Supplementum Aristotelicum_ by H. Diels as _Anonymi Londinensis ex Aristotelis Iatricis Menonis et Aliis Medicis Eclogae_, Berlin, 1893. See also H. Bekh and F. Spät, _Anonymus Londinensis, Auszüge eines Unbekannten aus Aristoteles-Menons Handbuch der Medizin_, Berlin, 1896.

[102] It is tempting, also, to connect the Asclepian snake cult with the prominence of the serpent in Minoan religion.

The earliest medical school of which we have definite information is that of Cnidus, a Lacedaemonian colony in Asiatic Doris. Its origin may perhaps reach back to the seventh century B. C. We have actual records that the teachers of Cnidus were accustomed to collect systematically the phenomena of disease, of which they had produced a very complex classification, and we probably possess also several of their actual works. The physicians of Cos, their only contemporary critics whose writings have survived, considered that the Cnidian physicians paid too much attention to the actual sensations of the patient and to the physical signs of the disease. The most important of the Cnidian doctrines were drawn up in a series of _Sentences_ or Aphorisms, and these, it appears, inculcated a treatment along Egyptian lines of the symptom or at most the disease, rather than the patient, a statement borne out by the contents of the gynaecological works of probable Cnidian origin included in the so-called ‘Hippocratic Collection’. A few names of Cnidian physicians have, moreover, come down to us with titles of their works, and a later statement that they practised anatomy. There can be little doubt too that the Cnidian school drew also on Persian and Indian Medicine.

The origin of the school of the neighbouring island of Cos was a little later than that of Cnidus and probably dates from the sixth century B. C. Of the Coan school, or at least of the general tendencies that it represented, we have a magnificent and copious literary monument in the Corpus Hippocraticum, a collection which was probably put together in the early part of the third century B. C. by a commission of Alexandrian scholars at the order of the book-loving Ptolemy Soter (reigned 323-285 B. C.). The elements of which this collection is composed are of varying dates from the sixth to the fourth century B. C., and of varying value and origin, but they mainly represent the point of view of physicians of the eastern part of the Greek world in the fifth and fourth centuries.

The most obvious feature, the outstanding element that at once strikes the modern observer in these ‘Coan’ writings, is the enormous emphasis laid on the actual course of disease. ‘It appears to me a most excellent thing’, so opens one of the greatest of the Hippocratic works, ‘for a physician to cultivate _pronoia_.[103] Foreknowing and foretelling in the presence of the sick the past, present, and future (of their symptoms) and explaining all that the patients are neglecting, he would be believed to understand their condition, so that men would have confidence to entrust themselves to his care.... Thus he would win just respect and be a good physician. By an earlier forecast in each case he would be more able to tend those aright who have a chance of surviving, and by foreseeing and stating who will die, and who will survive, he will escape blame....’[104]

[103] This word _pronoia_, as Galen explains (εἰς τὸ Ἱπποκράτους προγνωστικόν, K. xviii, B. p. 10), is not used in the philosophic sense, as when we ask whether the universe was made by chance or by _pronoia_, nor is it used quite in the modern sense of _prognosis_, though it includes that too. _Pronoia_ in Hippocrates means knowing things about a patient before you are told them. See E. T. Withington, ‘Some Greek medical terms with reference to Luke and Liddell and Scott,’ _Proceedings of the Royal Society of Medicine_ (_Section of the History of Medicine_), xiii, p. 124, London, 1920.

[104] _Prognostics_ 1.