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MEDICINE


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MEDICINE


pies, shows in the beginning a purely theurgical char- acter. Apollo is regarded as the founder of medical science, and, in post-Homeric times, his son jEscula- pius (in Homer, a Thessalian prince) is represented as the deity whose oHice it is to bring about man's resto- ration to health by means of healing oracles. His oldest place of worship was at Tricca in Thessaly. The temples of .lEsculapius, of which those at Epi- daurus and Cos are the best known, were situated in a healthy neighbourhood. The sick pilgrims went thither, that, after a long preparation of prayer, fasting and ablutions, they might, through the mediation of the priests, receive in their dreams the healmg oracles. This kind of medical science already shows a rational basis, for the priests interpreted the dreams and pre- scribed a suitable treatment, in most cases purely dietetic. Important records of sicknesses were made and left as votive-tablets in the temples. Side by side with the priestly caste, and perhaps out of it, there arose the order of temple physicians, who, as supposed descendants of the god iEsculapius, were known as the Asclepiadce, anrl formed a kind of guild or corporation. This separation of offices must have occurred at an early time, for even in Homer we find lay physicians mentioned, especially " the sons of ^Escula- pius " , Machaon and Podalirius. In the vegetable drugs of Egyptian origin mentionetl in Homer we recognize the early influence of the country of the Pharaohs upon Greek medical science. The schools of the philoso- phers likewise exerted nosmall influence upon its devel- opment, medical problems being studied by Pythagoras of Samos, Alcma?on of Crotona, Parmenides of Elea, Heraclitus of Ephesus (sLxth century b. c), Empedo- cles of Agrigentum, and Anaxagoras of Clazomenae (fifth century b. c). The earliest metlical schools were at Cyrene in Northern Africa, Crotona, Cnidus, and Cos. From Cnidus came Euryphon and also Ctesias the geographer, who was at first physician in the army of Cyrus and, after the battle of Cunaxa (401 B. c), to Artaxerxes Memnon. Of greater interest is the medical school adjoining the shrine of ^Esculapius at Cos, for from it arose the man who first placed medicine upon a scientific basis, and whose name is even to-day well known to all physicians, Hippocrates. Hippocrates and the so-called Corpus Hippo- CRATicuM. — Tradition knows seven physicians named Hippocrates, of whom the second is regarded as the most famous. Of his life we know but little. He was born at Cos in 460 or 459 b. c, and died at Larissa about 379. How great his fame was during his life- time is shown by the fact that Plato compares him with the artists Polycletus and Phidias. Later he was called "the Great" or "the Divine". The historical kernel is probably as follows: a famous physician of this name from Cos flourished in the days of Pericles, and subseciuently many things, which his ancestors or his descendants or his school accomplished, were at- tributed to him as the hero of medical science. The same was true of his writings. What is now known under the title of " Hippocratis Opera" represents the work, not of an individual, but of several persons of different periods and of different schools. It has thus become customary to designate the writings as- cribed to Hippocrates by the general title of the "Hippocratic Collection" (Corpus Hippocraticum), and to divide them according to their origin into the works of the schools of Cnidus and of Cos, and those of the Sophists. How difficult it is, however, to de- termine their genuineness is shown by the fact that even in the third century before Christ the Alex- andrian librarians, w'ho for the first time collected the anonymous scrolls scattered through Hellas, coukl not reach a definite conclusion. For the development of medical science it is of little consequence who com- posed the works of the school of C'os, for they are all more or less permeated by the spirit of one great mas- ter. The secret of his immortality rests on the fact


that he pointed out the means whereby medicine be- carne a science. HLs first rule was the observation of individual patients, individualizing in contradistinc- tion to the schematizing of the school of Cnidus. By the observation of all the perceptible symptoms in a patient, a numljer of principles were gradually derived from experience, and these, uniformly arranged, led by induction to a knowledge of the nature of the dis- ease, its course, and its treatment. This Is the origin of the famous " Aphorismi ", short rules which contain at times principles derived from experience, and at times conclusions drawn from the same source. They form the most valuable part of the Collection. The school of Cos and its adherents, the Hippocratics, looked upon medical science from a purely practical standpoint; they regarded it as the art of healing the sick, and therefore laid most stress on prognosis and treatment by aiding the powers of nature through dietetic means, while the whole school of Cnidus prilled itself upon its scientific diagnosis and, in har- mony with the East, adopted a varied medicinal treat- ment. The method which the school of Cos estab- lished more than 2000 years ago has proved to be the only correct one, and thus Hippocratic medical science celebrated its renascence in the eighteenth century w'ith Boerhaave at Leyden and subsequently with Gerhard van Swieten at Vienna. In his endeavour to attain the truth the earnest investigator often reaches an impassable barrier. There is nothing more tempt- ing than to seek an outlet by means of reflection and deduction. Such a delusive course may easily become fatal to the physicist ; but a medical system, erected upon the results of speculative investigation, carries the germ of death within itself.

The Dogil\^tic School. — In their endeavour to complete the doctrine of their great master the succes- sors of the Hippocratics fell victims to the snares of speculation. In spite of this, we owe to this so-called "dogmatic school" some fruitful investigation. Dio- des Carystius advanced the knowledge of anatomy, and tried to fathom the causal connexion between symptom and disease, in which endeavours he was imitated by Praxagoras of Cos, who estabUshed the diagnostic importance of the pulse.

Unfortunately, there already began with Aristotle (384-22 B. c.) that tendency — later rendered so fatal through Galen's teaching — to regard organic struc- ture and function not in accordance with facts but from the teleological standpoint.

The Alexandrian Period. — The desire to give to medicine a scientific basis found rich nourishment in the ancient civilized soil of Egypt under the Ptolemies. Herophilus of Chalcedon (about 300 b. c.) and Erasis- tratus of lulis (about 330-240 b. c.) are mentioned in this connexion. As anatomists, they were the first systematic investigators, and. following Hippocrates, they tried to complete clinical experience by exact methods. This tendency w-as opposed by the em- pirics, whose services lay solely in the field of drugs and toxicology. Erasistratus as well as Philinus, the empiric, attacked the doctrine of humors (humoral pathology), which developed out of the Hippocratic tendency. The former alone was a .serious opponent, since, as an anatomi.st, he lookefl for the seat of the disease in the solid parts, rather than in the four fun- damental humors (blood, mucus, black and yellow gall) and their diff'erent mixtures.

The Methodizers. — One of the opponents of hu- moral pathology was Asclepiades of Prusa in Bithynia (b. about 124 b. c). He tried to utilize in medicine the atomistic theory of Epicurus and Heracleides of Pontus. He taught that health and disea.se depend upon the motion of the atoms in the fine capillaries or pores, which, endowed with sensation, pass through the entire body. With Themison as their leader, the followers of Asclepiades simplified his doctrine by sup- posing disease to be only a contraction or relaxation,