imply any connexion with the ordinary art of healing. The two
systems appear to have existed side by side, but to have been distinct,
and if they were ever united it must have been before the times of
which we have any record. The theory of a development of Greek
medicine from the rites of Asclepius, though defended by eminent
names, must accordingly be rejected.
Development of Medicine in Greece.—It is only from non-medical writers that anything is known of the development of medicine in Greece before the age of Hippocrates. The elaborate collections made by Daremberg of medical notices in the poets and historians illustrate the relations of the profession to society, but do little to prepare us for the Hippocratic period. Nor is much importance to be attached to the influence of the philosophical sects on medicine except as regards the school of Pythagoras. That philosopher and several of his successors were physicians, but we do not know in what relation they stood to later medical schools. We must therefore hasten onward to the age of Pericles, in which Hippocrates, already called “the Great,” was in medicine as complete a representative of the highest efforts of the Greek intellect as were his contemporaries the great philosophers, orators and tragedians. The medical art as we now practise it, the character of the physician as we now understand it, both date for us from Hippocrates. The justification of this statement is found in the literary collection of writings known by his name. Of these certainly many are falsely ascribed to the historical Hippocrates of Cos; others are almost as certainly rightly so ascribed; others again are clearly works of his school, whether from his hand or not. But which are to be regarded as the “genuine works” is still uncertain, and authorities are conflicting. There are clearly two schools represented in the collection—that of Cnidus in a small proportion, and that of Cos in far the larger number of the works. The latter was that to which Hippocrates belonged, and where he gave instruction; and accordingly it may be taken that works of this school, when not obviously of a different date, are Hippocratic in doctrine if not in actual authorship.
Hippocratic Medicine.—The first grand characteristic of Hippocratic medicine is the high conception of the duties and status of the physician, shown in the celebrated “Oath of Hippocrates” and elsewhere—equally free from the mysticism of a priesthood and the vulgar pretensions of a mercenary craft. So matured a professional sentiment may perhaps have been more the growth of time and organization than the work of an individual genius, but certainly corresponds with the character universally attributed to Hippocrates himself. The second great quality is the singular artistic skill and balance with which the Hippocratic physician used such materials and tools as he possessed. Here we recognize the true Greek σωφροσύνη. But this artistic completeness was closely connected with the third cardinal virtue of Hippocratic medicine—the clear recognition of disease as being equally with life a process governed by what we should now call natural laws, which could be known by observation, and which indicated the spontaneous and normal direction of recovery, by following which alone could the physician succeed. In the fourth place, these views of the “natural history of disease” (in modern language) led to habits of minute observation and accurate interpretation of symptoms, in which the Hippocratic school was unrivalled in antiquity, and has been the model for all succeeding ages, so that even in these days, with our enormous advances in knowledge, the true method of clinical medicine may be said to be the method of Hippocrates.
The actual science of the Hippocratic school was of course very limited. In anatomy and physiology little advance had been made, and so of pathology in the sense of an explanation of morbid processes or knowledge of diseased structures there could be very little. The most valuable intellectual possession was a large mass of recorded observations in individual cases and epidemics of disease. Whether these observations were systematic or individual, and how they were recorded, are points of which we are quite ignorant, as the theory that the votive tablets in the temples supplied such materials must be abandoned.
Though the Hippocratic medicine was so largely founded on observation, it would be an error to suppose that dogma or theory had no place. The dominating theory of disease was the humoral, which has never since ceased to influence medical thought and practice. According to this celebrated theory, the body contains four humours—blood, phlegm, yellow bile and black bile, a right proportion and mixture of which constitute health; improper proportions or irregular distribution, disease. It is doubtful whether the treatise in which this theory is fully expounded (περὶ φύσιος ἀνθρώπου) is as old as Hippocrates himself; but it was regarded as a Hippocratic doctrine, and, when taken up and expanded by Galen, its terms not only became the common property of the profession, but passed into general literature and common language. Another Hippocratic doctrine, the influence of which is not even yet exhausted, is that of the healing power of nature. Not that Hippocrates taught, as he was afterwards reproached with teaching, that nature is sufficient for the cure of diseases; for he held strongly the efficacy of art. But he recognized, at least in acute diseases, a natural process which the humours went through—being first of all crude, then passing through coction or digestion, and finally being expelled by resolution or crisis through one of the natural channels of the body. The duty of the physician was to foresee these changes, “to assist or not to hinder them,” so that “the sick man might conquer the disease with the help of the physician.” The times at which crises were to be expected were naturally looked for with anxiety; and it was a cardinal point in the Hippocratic system to foretell them with precision. Hippocrates, influenced as is thought by the Pythagorean doctrines of number, taught that they were to be expected on days fixed by certain numerical rules, in some cases on odd, in others on even numbers—the celebrated doctrine of “critical days.” This false precision can have had no practical value, but may have enforced habits of minute observation. It follows from what has been said that prognosis, or the art of foretelling the course and event of the disease, was a strong point with the Hippocratic physicians. In this they have perhaps never been excelled. Diagnosis, or recognition of the disease, must have been necessarily imperfect, when no scientific nosology or system of disease existed, and the knowledge of anatomy was quite inadequate to allow of a precise determination of the seat of disease; but symptoms were no doubt observed and interpreted skilfully. The pulse is not spoken of in any of the works now attributed to Hippocrates himself, though it is mentioned in other works of the collection.
In the treatment of disease, the Hippocratic school attached great importance to diet, the variations necessary in different diseases being minutely defined. Medicines were regarded as of secondary importance, but not neglected, two hundred and sixty-five drugs being mentioned at different places in the Hippocratic works. Blood-letting was known, but not greatly practised. The highest importance was attached to applying all remedies at the right moment, and the general principle enforced of making all influences—internal and external—co-operate for the relief of the patient. The principles of treatment just mentioned apply more especially to the cure of acute diseases; but they are the most salient characteristics of the Hippocratic school. In chronic cases diet, exercise and natural methods were chiefly relied upon.
The school of Cnidus, as distinguished from that of Cos, of which Hippocrates is the representative, appears to have differed in attaching more importance to the differences of special diseases, and to have made more use of drugs. A treatise on the diseases of women, contained in the Hippocratic collection, and of remarkable practical value, is attributed to this school.
The above sketch of Hippocratic medicine will make it less necessary to dwell upon the details relating to subsequent medical schools or sects in ancient times. The general conception of the physician’s aim and task remained the same, though, as knowledge increased, there was much divergence both in theory and practice—even opposing schools were found to be developing some part of the Hippocratic system. Direct opponents or repudiators of the authority of Hippocrates were rare, all generally appealing to his authority. But, insensibly, the least valuable part of the Hippocratic work, the theory, was made permanent; the most valuable, the practical, neglected.
Post-Hippocratic Medicine.—After Hippocrates the progress of medicine in Greece does not call for any special remark in such a sketch as this, but mention must be made of one great name. Though none of Aristotle’s writings are strictly medical, he has by his researches in anatomy and physiology contributed greatly to the progress of medicine. It should also be remembered that he was of an Asclepiad family, and received that partly medical education which was traditional in such families, and also himself is said to have practised medicine as an amateur. Moreover, his works on natural history doubtless furthered the progress among the Greeks of sciences tributary to medicine, though the only specimens of such works which have come down to us from the Peripatetic school are those of Theophrastus, who may be considered the founder of the scientific study of botany. Among his encyclopaedic writings were some on medical subjects, of which fragments only have been preserved. The Peripatetic school may have been more favourable to the development of medicine, as of other departments of natural knowledge, than any other; but there is no evidence that any of the philosophical schools had important influence on the progress of medicine. The fruit of Aristotle’s teaching and example was seen later on in the schools of Alexandria.
The century after the death of Hippocrates is a time almost blank in medical annals. It is probable that the science, like others, shared in the general intellectual decline of Greece after the Macedonian supremacy; but the works of physicians of the period are almost entirely lost, and were so even in the time of Galen. Galen classes them all as of the dogmatic school; but, whatever may have been their characteristics, they are of no importance in the history of the science.
