Page:EB1911 - Volume 18.djvu/62

From Wikisource
Jump to navigation Jump to search
This page has been validated.
44 
MEDICINE
[HISTORY


contraction if it was too lax, and in the “mixed state” acting according to the predominant condition. This simple rule of treatment was the system or “method” from which the school took its name.

The methodists agreed with the empirics in one point, in their contempt for anatomy; but, strictly speaking, they were dogmatists, though with a dogma different from that of the Hippocratic school. Besides Themison, its systematic founder, the school boasted many physicians eminent in their day, among whom Thessalus of Tralles, a half-educated and boastful pretender, was one of the most popular. He reversed the Hippocratic maxim “art is long,” promising his scholars to teach them the whole of medicine in six months, and had inscribed upon his tomb ἰατρονίκης, as being superior to all living and bygone physicians.

In the 2nd century a much greater name appears among the methodists, that of Soranus of Ephesus, a physician mentioned with praise even by Tertullian and Augustine, who practised at Rome in the reigns of Trajan and Hadrian. Soranus is known by a work, still extant in the Greek original, on the diseases of women, and also by the Latin work of Caelius Aurelianus, three centuries later, on acute and chronic diseases, which is based upon, if not, as some think, an actual translation of, the chief work of Soranus, and which is the principal source of our knowledge of the methodic school. The work on diseases of women is the only complete work on that subject which has come down to us from antiquity, and shows remarkable fullness of practical knowledge in relation to its subject. It is notable that an important instrument of research, the speculum, which has been reinvented in modern times, was used by Soranus; and specimens of still earlier date, showing great mechanical perfection, have been found among the ruins of Pompeii. The work on acute and chronic diseases is also full of practical knowledge, but penetrated with the theories of the methodists.

The methodic school lasted certainly for some centuries, and influenced the revival of medical science in the middle ages, though overshadowed by the greater reputation of Galen. It was the first definite product of Greek medicine on Roman soil, but was destined to be followed by others, which kept up a more or less successful rivalry with it, and with the Hippocratic tradition.

The so-called pneumatic school was founded by Athenaeus, in the 1st century after Christ. According to its doctrines the normal as well as diseased actions of the body were to be referred to the operation of the pneuma or universal soul. This doctrine, crudely transferred from philosophical speculation, was intended to reconcile the humoral (or Hippocratic) and solidist (or methodic) schools; but the methodists seem to have claimed Athenaeus as one of themselves.

The conflicts of the opposing schools, and the obvious deficiencies of each, led many physicians to try and combine the valuable parts of each system, and to call themselves eclectics. Among these were found many of the most eminent physicians of Graeco-Roman times. It may be sufficient to name Rufus or Ephesus (2nd century A.D.), and Archigenes (fl. A.D. 90), who is mentioned by Juvenal.

Although no system or important doctrine of medicine was originated by the Roman intellect, and though the practice of the profession was probably almost entirely in the hands of the Greeks, the most complete picture which we have of medical thought and activity in Roman times is due to a Latin pen, and to one who was, in all probability, not a physician. A. Cornelius Celsus, a Roman patrician, who lived probably in the 1st century, appears to have studied medicine as a branch of general knowledge. Whether he was a practising physician or not has been a matter of controversy. The conclusion supported by most evidence seems to be that he practised on his friends and dependants, but not as a remunerative profession. His well-known work, De medicina, was one of a series of treatises intended to embrace all knowledge proper for a man of the world. It was not meant for the physicians, and was certainly little read by them, as Celsus is quoted by no medical writer, and when referred to by Pliny, is spoken of as an author not a physician. There is no doubt that his work is chiefly a compilation; and Daremberg, with other scholars, has traced a large number of passages of the Latin text to the Greek originals from which they were translated. In the description of surgical operations the vagueness of the language seems sometimes to show that the author had not performed such himself; but in other parts, and especially in his historical introduction, he speaks with more confidence; and everywhere he compares and criticizes with learning and judgment. The whole body of medical literature belonging to the Hippocratic and Alexandrian times is ably summarized, and a knowledge of the state of medical science up to and during the times of the author is thus conveyed to us which can be obtained from no other source. The work of Celsus is thus for us only second in importance to the Hippocratic writings and the works of Galen; but it is valuable rather as a part of the history of medicine than as the subject of that history. It forms no link in the general chain of medical tradition, for the simple reason that the influence of Celsus (putting aside a few scanty allusions in medieval times) commenced in the 15th century, when his works were first discovered in manuscript or committed to the press. Since then, however, he has been almost up to our own times the most popular and widely read of all medical classics, partly for the qualities already indicated, partly because he was one of the few of those classics accessible to readers of Latin, and partly also because of the purity and classical perfection of his language.

Of Pliny, another encyclopaedic writer, a few words must be said, though he was not a physician. In his Natural History we find as complete a summary of the popular medicine of his time as Celsus gives of the scientific medicine. Pliny disliked doctors, and lost no opportunity of depreciating regular medicine; nevertheless he has left many quotations from, and many details about, medical authors which are of the highest value. He is useful to us for what he wrote about the history of medicine, not for what he contributed. Like Celsus, he had little influence on succeeding medical literature or practice.

We now come to the writer who, above all others, gathered up into himself the divergent and scattered threads of ancient medicine, and out of whom again the greater part of modern European medicine has flowed. Galen was a man furnished with all the anatomical, medical and philosophical knowledge of his time; he had studied all kinds of natural curiosities, and had stood in near relation to important political events; he possessed enormous industry, great practical sagacity and unbounded literary fluency. He had, in fact, every quality necessary for an encyclopaedic writer, or even for a literary and professional autocrat. He found the medical profession of his time split up into a number of sects, medical science confounded under a multitude of dogmatic systems, the social status and moral integrity of physicians degraded. He appears to have made it his object to reform these evils, to reconcile scientific acquirements and practical skill, to bring back the unity of medicine as it had been understood by Hippocrates, and at the same time to raise the dignity of medical practitioners.

Galen was as devoted to anatomical and, so far as then understood, physiological research as to practical medicine. He worked enthusiastically at dissection, though, the liberty of the Alexandrian schools no longer existing, he could dissect only animals, not the human body. In his anatomical studies Galen had a twofold object—a philosophical, to show the wisdom of the Creator in making everything fit to serve its purpose; and a practical, to aid the diagnosis, or recognition, of disease. The first led him into a teleological system so minute and overstrained as to defeat its own end; the second was successfully attained by giving greater precision and certainty to medical and surgical practice in difficult cases. His general physiology was essentially founded upon the Hippocratic theory of the four elements, with which he combined the notion of spirit (pneuma) penetrating all parts, and mingled with the humours in different proportions. It was on this field that he most vehemently attacked the prevailing atomistic and materialistic views of the methodic school, and his conception of the pneuma became in some respects half metaphysical. His own researches in special branches of physiology were important, but do not strictly belong to our present subject.

The application of physiology to the explanation of diseases, and thus to practice, was chiefly by the theory of the temperaments or mixtures which Galen founded upon the Hippocratic doctrine of humours, but developed with marvellous and fatal ingenuity. The normal condition or temperament of the body depended upon a proper mixture or proportion of the four elements—hot, cold, wet and dry. From faulty proportions of the same arose the intemperies (“distempers”), which, though not diseases, were the occasions of disease. Equal importance attached to faulty mixtures or dyscrasiae of the blood. By a combination of these morbid predispositions with the action of deleterious influences from without all diseases were produced. Galen showed extreme ingenuity in explaining all symptoms and all diseases on his system. No phenomenon was without a name, no problem without a solution. And, though it was precisely in his fine-spun subtlety that he departed furthest from scientific method and practical utility, it was this very quality which seems in the end to have secured his popularity and established his pre-eminence in the medical world.

Galen’s use of drugs was influenced largely by the same theories. In drugs were to be recognized the same elementary qualities—hot,