CHAPTER III.

POST-HIPPOCRATIC GREEK MEDICINE.—THE SCHOOLS OF MEDICINE. The Dogmatic School.—Praxagoras of Cos.—Aristotle.—The School of Alexandria.—Theophrastus the Botanist.—The great Anatomists, Erasistratus and Hierophilus, and the Schools they founded.—The Empiric School. THE DOGMATIC SCHOOL. It was only natural that the philosophical Greeks should discuss medicine at as great a length as they discussed philosophy; accordingly, we find that no sooner had our art taken its place amongst the subjects worthy of being seriously considered by the Greek intellect, than it was as much talked about as practised, and wrangled over as though it were a system of religion. Sects arose which opposed each other with the greatest vehemence; and Hippocrates had not long formulated his teaching when his disciples elevated his principles into a dogmatism which challenged, and shortly provoked, opposition of various kinds. Then arose the schools of medicine which ultimately became famous, as those of the DOGMATISTS, EMPIRICS, METHODISTS, PNEUMATISTS, etc. The DOGMATISTS boasted of being the Rational and Logical school. They held that there is a certain connection between all the arts and sciences, and that it is the duty of the physician to avail himself of all sorts of knowledge on every subject which bears any relationship to his own. They made, therefore, the most careful inquiry into the remote and proximate causes of disease. They examined the influence on the human body of airs, waters, places, occupations, diet, seasons, etc. They formulated general rules, not of universal application, but modified their treatment according to circumstances, availing themselves of whatever aid they could obtain from any source. Hippocrates had said, “The physician who is also a philosopher is equal to the gods,” and the Dogmatists elevated this into an article of their creed. Hippocrates, Galen, Oribasius, Ætius, Paulus Ægineta, and the Arab physicians were dogmatists. The founders of the school were the sons of Hippocrates—Thessalus and Draco. The former was the eldest son of the great physician, and was the more famous of the two. He passed a great part of his life as physician in the court of Archelaus, king of Macedonia.[399] His brother, Draco, was physician to Queen Roxana, wife of Alexander the Great. We may say, therefore, that the oldest, most famous, and worthy of the ancient medical sects arose about 400 B.C., and retained its power over the medical profession till the rise of the Empirical sect in the Alexandrian school of philosophy. We are indebted to Celsus for a lucid and admirable exposition of the doctrines professed by these two medical parties.[400] The Dogmatists maintained that it was not enough for the physician to know the mere symptoms of his patient’s malady. It does not suffice to know the _evident causes_ of the disorder, but he must acquaint himself with the _hidden causes_. To acquire this knowledge of the _hidden causes_, he must study the _hidden parts_, and the natural actions and functions of the body in health. He must know the principles on which the human machinery is constructed before he can scientifically treat the accidents and disturbances to which it is liable. It was not, therefore, a mere subject of philosophical interest to hold with some physicians that diseases proceed from excess or deficiency of one or other of the four elements, or with others, that the various humours or the respiration were at fault. It was not of merely academic interest to suppose that the abnormal flow of the blood caused inflammations, or that corpuscles blocked up the invisible passages. The doctor must do more than speculate on these things in his discussions. He must have a theory upon them which he could apply to the treatment of his patients, and the best physician would be the one who best knew how the disease originated. Experiments without reasoning were valueless; their chief use was to inform the experimenter whether he had reasoned justly or conjectured fortunately. When the physician is confronted by a new form of disease for which no remedy has been discovered, he must know its cause and origin, or his practice will be mere guess-work. Anybody can discover the evident causes—heat, cold, over-eating. These things the least instructed physician will probably know. It is the knowledge of hidden causes which makes the superior man. He who aspires to be instructed must know what we now call physiology—why we breathe, why we eat, what happens to the food which we swallow, why the arteries pulsate, why we sleep, etc. The man who cannot explain these phenomena is not a competent doctor. He must have frequently inspected dead bodies, and examined carefully their internal parts; but they maintained that it was much the better way to open living persons, as Herophilus and Erasistratus did, so that they could acquaint themselves in life with the structures whose disturbance or disease causes the sufferings which they were called upon to alleviate. What is known as the “Humoral Pathology” formed the most essential part of the system of the Dogmatists. Humoral pathology explains all diseases as caused by the mixture of the four cardinal humours; viz., the blood, bile, mucus or phlegm, and water. Hippocrates leaned towards it, but it was Plato who developed it. The stomach is the common source of all these humours. When diseases develop, they attract these humours. The source of the bile is the liver; of the mucus, the head; of the water, the spleen. Bile causes all acute diseases, mucus in the head causes catarrhs and rheumatism, dropsy depends on the spleen. DIOCLES CARYSTIUS, a famous Greek physician, said by Pliny[401] to have been next in age and fame to Hippocrates himself, lived in the fourth century B.C. He wrote several treatises on medicine, of which the titles and some fragments are preserved by Galen, Cælius Aurelianus, Oribasius, and others. His letter to King Antigonus, entitled “An Epistle on Preserving Health,” is inserted at the end of the first book of Paulus Ægineta, and was probably addressed to Antigonus Gonatus, king of Macedonia, who died B.C. 239. This treatise is so valuable a summary of the medical teaching of the time that it will be useful to insert it in this place. “Since of all kings you are the most skilled in the arts, and have lived very long, and are skilled in all philosophy, and have attained the highest rank in mathematics, I, supposing that the science which treats of all things that relate to health is a branch of philosophy becoming a king and befitting to you, have written you this account of the origin of diseases, of the symptoms which precede them, and of the modes by which they may be alleviated. For neither does a storm gather in the heavens but it is preceded by certain signs which seamen and men of much skill attend to, nor does any disease attack the human frame without having some precursory symptom. If, then, you will only be persuaded by what we say regarding them, you may attain a correct acquaintance with these things. We divide the human body into four parts: the head, the chest, the belly, and the bladder. When a disease is about to fix in the head, it is usually announced beforehand by vertigo, pain in the head, heaviness in the eyebrows, noise in the ears, and throbbing of the temples; the eyes water in the morning, attended with dimness of sight; the sense of smell is lost, and the gums become swelled. When any such symptoms occur, the head ought to be purged, not indeed with any strong medicine, but, taking the tops of hyssop and sweet marjoram, pound them and boil them in a pot, with half a hemina of must or rob; rinse the mouth with this in the morning before eating, and evacuate the humours by gargling. There is no gentler remedy than this for affections of the head. Mustard in warm, honied water also answers the purpose very well. Take a mouthful of this in the morning before eating, gargle and evacuate the humours. The head also should be warmed by covering it in such a manner as that the phlegm may be readily discharged. Those who neglect these symptoms are apt to be seized with the following disorders: inflammations of the eyes, cataracts, pain of the ears as if from a fracture, strumous affections of the neck, sphacelus of the brain, catarrh, quinsy, running ulcers called achores, caries, enlargement of the uvula, defluxion of the hairs, ulceration of the head, pain in the teeth. When some disease is about to fall upon the chest, it is usually announced by some of the following symptoms: There are profuse sweats over the whole body, and particularly about the chest, the tongue is rough, expectoration saltish, bitter, or bilious, pains suddenly seizing the sides or shoulder-blades, frequent yawning, watchfulness, oppressed respiration, thirst after sleep, despondency of mind, coldness of the breast and arms, trembling of the hands. These symptoms may be relieved in the following manner: Procure vomiting after a moderate meal without medicine. Vomiting also when the stomach is empty will answer well; to produce which first swallow some small radishes, cresses, rocket, mustard and purslain, and then by drinking warm water procure vomiting. Upon those who neglect these symptoms the following diseases are apt to supervene: pleurisy, peripneumony, melancholy, acute fevers, frenzy, lethargy, ardent fever attended with hiccough. When any disease is about to attack the bowels, some of the following symptoms announce its approach: In the first place, the belly is griped and disordered, the food and drink seem bitter, heaviness of the knees, inability to bend the loins, pains over the whole body unexpectedly occurring, numbness of the legs, slight fever. When any of these occur, it will be proper to loosen the belly by a suitable diet without medicine. There are many articles of this description which one may use with safety, such as beets boiled in honeyed water, boiled garlic, mallows, dock, the herb mercury, honied cakes; for all these things are laxative of the bowels. Or, if any of these symptoms increase, mix bastard saffron with all these decoctions, for thereby they will be rendered sweeter and less dangerous. The smooth cabbage boiled in a large quantity of water is also beneficial. This decoction, with honey and salt, may be drunk to the amount of about four heminæ, or the water of chick-peas and tares boiled may be drunk in the same manner. Those who neglect the afore-mentioned symptoms are apt to be seized with the following affections: diarrhœa, dysentery, lientery, ileus, ischiatic disease, tertian fever, gout, apoplexy, hæmorrhoids, rheumatism. When any disease is about to seize the bladder, the following symptoms are its usual precursors: A sense of repletion after taking even a small quantity of food, flatulence, eructation, paleness of the whole body, deep sleep, urine pale and passed with difficulty, swellings about the privy parts. When any of these symptoms appear, their safest cure will be by aromatic diuretics. Thus, the roots of fennel and parsley may be infused in white fragrant wine, and drunk every day when the stomach is empty in the morning, to the amount of two cyathi, with water in which carrot, myrtle, or elecampane has been macerated (you may use any of these you please, for all are useful); and the infusion of chick-peas in water in like manner. On those who neglect these symptoms the following diseases are apt to supervene: dropsy, enlargement of the spleen, pain of the liver, calculus, inflammation of the kidney, strangury, distension of the belly. Regarding all these symptoms, it may be remarked that children ought to be treated with gentler remedies, and adults with more active. I have now to give you an account of the seasons of the year in which each of these complaints occur, and what things ought to be taken and avoided. I begin with the winter solstice. _Of the winter solstice_: This season disposes men to catarrhs and defluxions until the vernal equinox. It will be proper then to take such things as are of a heating nature, drink wine little diluted, or drink pure wine, or of the decoction of marjoram. From the winter solstice to the vernal equinox are ninety days. _Of the vernal equinox_: This season increases phlegm in men, and the sweetish humours in the blood, until the rising of the pleiades. Use therefore juicy and acrid things, take labour, ... To the rising of the pleiades are forty-six days. _Of the rising of the pleiades_: This season increases the bitter bile and bitter humours in men, until the summer solstice. Use therefore all sweet things, laxatives of the belly.... To the summer solstice are forty-five days. _Of the summer solstice_: This season increases the formation of black bile in men, until the autumnal equinox. Use therefore cold water, and everything that is fragrant.... To the autumnal equinox are ninety-three days. _Of the autumnal equinox_: This season increases phlegm and thin rheums in men until the setting of the pleiades. Use therefore remedies for removing rheums, have recourse to acrid and succulent things, take no vomits, and abstain from labour.... To the setting of the pleiades are forty-five days. _Of the setting of the pleiades_: This season increases phlegm in men until the winter solstice. Take therefore all sour things, drink as much as is agreeable of a weak wine, use fat things, and labour strenuously. To the winter solstice are forty-five days.”[402] PRAXAGORAS of Cos, who lived in the fourth century B.C., shortly after Diocles, was a famous physician of the Dogmatic sect, who especially excelled in anatomy and physiology. He placed the seat of all diseases in the humours of the body, and was one of the chief supporters of what is known as the “humoral pathology.” Sprengel[403] and others state that he was the first who pointed out the distinction between the arteries and the veins; but M. Littré denies this, and seems to prove that the differences were known to Aristotle, Hippocrates, and other writers.[404] His knowledge of anatomy must have been very considerable, and his surgery was certainly bold; so that he even ventured, in cases of intussusception of the bowel, to open the abdomen in order to replace the intestine. In hernia he practised the taxis,[405] _i.e._ replaced the bowel by the hand; and he amputated the uvula in affections of that organ. He had many pupils, amongst others Herophilus, Philotimus, and Plistonicus. ARISTOTLE, the founder of comparative anatomy and the father of the science of natural history, was the son of Nichomachus, physician to Amyntas II., king of Macedonia. He was born at Stageira, B.C. 334. His father was a scientific man of the race of the Asclepiads, and it was the taste for such pursuits and the inherited bent of mind which early inclined the son to the investigation of nature. He went to Athens, where he became the disciple of Plato, and remained in his society for twenty years. In his forty-second year he was summoned by Philip of Macedon to undertake the tuition of Alexander the Great, who was then fifteen years old. Of his philosophical works it is not here necessary to speak; it is his scientific labours, which had so important an influence on medical education, which chiefly concern us. He wrote _Researches about Animals_, _On Sleep and Waking_, _On Longevity and Shortlivedness_, _On Respiration_, _On Parts of Animals_, _On Locomotion of Animals_, _On Generation of Animals_. Aristotle inspired Alexander with a passion for the study of natural history, and his royal pupil gave him abundant means and opportunity to collect materials for a history of animals. The science of comparative anatomy, so important in relation to that of medicine, was thus established. He pointed out the differences which exist between the structure of men and monkeys; described the organs of the elephant, and the stomach of the ruminant animals. The anatomy of birds and the development of their eggs during incubation were accurately described by him; he dissected reptiles, and studied the habits of fishes. He investigated the action of the muscles, regarded the heart as the origin of the blood-vessels, named the _aorta_ and the _ventricles_, described the nerves which he thought originated in the heart, but he confused the nerves with the ligaments and tendons. The heart he considered as the centre of movement and feeling[406] and nourishment, holding that it contains the natural fire, and is the birthplace of the passions and the seat of the soul; the brain he thought was merely a mass of water and earth, and did not recognise it as nervous matter. The diaphragm he considered had no other office than to separate the abdomen from the thorax and protect the seat of the soul (the heart) from the impure influences of the digestive organs. Superfœtation (or the conception of a second embryo during the gestation of the first) he held to be possible, and he first pointed out the _punctum saliens_. THEOPHRASTUS, whose real name was Tyrtamus, was born at Eresa in the island of Lesbos, 371 B.C., fourteen years after Aristotle. He was the originator of the science of plants; he first learned the details of their structure, the uses of their organs, the laws of their reproduction,—in a word, the physiology of the vegetable world. When Aristotle retired to Chalcis, he chose Theophrastus, to whom he gave that name, signifying “a man of divine speech,” as his successor at the Lyceum. This distinguished philosopher devoted himself alike to the exact and speculative sciences. The greater part of his works have perished; what is preserved to us consists of treatises on the history of the vegetable kingdom, of stones, and some fragments of works on physics, medicine, and some moral works. His _History of Plants_ enumerates about five hundred different kinds, many of which are now difficult to identify. He made some attempts at a vague kind of classification, and has chapters on aquatic, kitchen, parasite, succulent, oleaginous, and cereal plants. He carefully explains the principles of the reproduction of vegetables, and the fecundation of the female flowers by the pollen of the male. He recognises hermaphrodite and unisexual flowers, and points out how the fecundation of the latter is effected by the wind, insects, and by the water in the case of aquatic plants. He knew that double flowers were sterile. He devotes a chapter to the diseases of the vegetable kingdom; he almost recognised the characteristics which distinguish the monocotyledonous from the dicotyledonous plants. In a word, he laid the foundations on which our modern botanists have erected their science.[407] THE SCHOOL OF ALEXANDRIA. “In the year 331 B.C.,” says Kingsley,[408] “one of the greatest intellects whose influence the world has ever felt, saw, with his eagle glance, the unrivalled advantages of the spot which is now Alexandria; and conceived the mighty project of making it the point of union of two, or rather of three worlds. In a new city, named after himself, Europe, Asia, and Africa were to meet and to hold communion.” When Greece lost her intellectual supremacy with her national independence, the centre of literature, philosophy, and science was shifted to this unique position. With all the treasures of Egyptian wisdom around her, with all the stores of Eastern thought on the one hand and those of Europe on the other, Alexandria became in her schools the rallying-point of the world’s thought and activity. If we turn to an atlas of ancient geography, we shall be struck with the unrivalled facilities possessed by this city for gathering to itself the treasures, intellectual and material, of the conquered world of Alexander the Great. From the Danube, Greece, Phœnicia, Palestine, Persia, Asia Minor, India, Italy, and the Celtic tribes, there came embassies to Egypt to seek the protection and alliance of Alexander of Macedon, and each must have contributed something to the greatness of the city which he had founded. Just as every traveller in after years who passed through the place was compelled to leave a copy of any work which he had brought with him, to the Alexandrian library, so from the first foundation of the town was every visitor a donor of some idea to its stores of thought. At the dismemberment of Alexander’s vast empire, after his death, the Egyptian portion fell to the share of Ptolemy Soter. It was this sovereign who founded the famous Alexandrian Library; a great patron of the arts and sciences, he placed this institution under the direction of Aristotle. He also established the Schools of Alexandria, and encouraged the dissection of the human body. CHRYSIPPUS, the Cnidian, who lived in the fourth century _B.C._, was the father of the Chrysippus who was physician to Ptolemy Soter, and he was tutor to Erasistratus. Pliny says that he reversed the practice of preceding physicians in the most extraordinary manner. He would not permit bleeding, because the blood contains the soul; did not practise purging, though he sometimes permitted the use of enemata and emetics. He wrote on herbs and their uses, and drove the blood out of limbs previous to their amputation on the principles recently re-introduced by Esmarch. He introduced the use of vapour baths in the treatment of dropsy. As there were several physicians of the name of Chrysippus, and as their works are lost, it is very difficult to distinguish their maxims. Amongst the disciples of the Cnidian physician of this name were MEDIUS, ARISTOGENES, METRODORUS, and ERASISTRATUS, as we have said. HEROPHILUS, of Chalcedon in Bithynia, a pupil of CHRYSIPPUS of Cnidos and PRAXAGORAS of Cos, was one of the most famous physicians of the ancient world. He was a great anatomist and physiologist, and a contemporary of the philosopher Diodorus Cronos, and of Ptolemy Soter in the fourth and third centuries B.C. He settled at Alexandria, which under Ptolemy I. became the most famous centre of the science of the ancient Greeks. Here Herophilus founded with other physicians of the city the great medical school which ultimately became distinguished above all others, so that a sufficient guarantee of a physician’s ability was the fact that he had received his education at Alexandria. The foundation of the Alexandrian School formed a great epoch in the history of medicine. The dissection of the human body was of the utmost importance to the healing art. While the practice was forbidden, it could only have been performed furtively and in a hasty and unsatisfactory manner. The science of anatomy, on which that of medicine to be anything but quackery must be founded, now took its proper place in the education of the doctor. The bodies of all malefactors were given over for the purposes of dissection.[409] Herophilus is accused of having also dissected alive as many as six hundred criminals. This fact has been denied by some of his biographers, and others have attempted to explain it away; but it is charged against him by Tertullian,[410] and Celsus mentions it[411] as though it were a well-known fact, and without the least suspicion that it was an unjust accusation. Asked who is the best doctor, he is said to have replied, “He who knows how to distinguish the possible from the impossible.” In the course of his anatomical researches he made many discoveries and gave to parts of the human body names which remain in common use to this day. Dr. Baas thus sums up his anatomical and physiological knowledge. He knew the nerves, that they had a capacity for sensation, and were subject to the will, were derived from the brain, in which he discovered the calamus scriptorius, the tela choroidea, the venous sinuses, and torcular Herophili. He believed the fourth ventricle to be the seat of the soul. He discovered the chyliferous and lactiferous vessels. He described accurately the liver and Fallopian tubes, the epididymis and the duodenum, to which he gave its name, and also the os hyoides, the uvea, the vitreous humour, the retina, and the ciliary processes. He called the pulmonary artery the vena arteriosa, and the pulmonary vein the arteria venosa. He distinguished in respiration a systole, a diastole, and a period of rest. He founded the doctrine of the pulse, its rhythm, the bounding pulse and its varieties according to age. The pulse is communicated by the heart to the walls of the arteries. He distinguished between arteries and veins, and admitted that the arteries contain blood. He taught that diseases are caused by a corruption of the humours. Paralysis is due to a lack of nerve influence. He laid great stress upon diet, bled frequently, and practised ligation of the limbs to arrest bleeding. He was the first to administer cooking salt as a medicine. A good botanist, he preferred vegetable remedies, which he termed the “Hands of the gods.” He possessed considerable acquaintance with obstetric operations,[412] and wrote a text-book of midwifery.[413] ERASISTRATUS, of Iulis in the island of Cos, a pupil of CHRYSIPPUS was one of the most famous physicians and anatomists of the Alexandrian school. Plutarch says that when he was physician to King Seleucus, he discovered that the young prince Antiochus had fallen in love with his step-mother Stratonice by finding no physical cause for the illness from which he was suffering, and that his heart palpitated, he trembled, blushed, and perspired when the lady entered the room. By adroit management he induced the king to confer on the prince the object of the young man’s passion. _Similia similibus curantur._ So successful was the treatment that the physician received a fee of 100 talents, which supposing the Attic standard to be meant would amount to £24,375, perhaps the largest medical fee on record.[414] He lived for some time in Alexandria, and gave up medical practice in his old age, that he might devote his whole time to the study of anatomy. Dr. Baas, in his account of the Anatomy, Physiology, and Medicine of Erasistratus, says that he divided the nerves into those of sensation and those of motion. The brain substance is the origin of the motor and the brain membranes that of the sensory nerves.[415] Like Herophilus, he confounded the nerves and ligaments. He described accurately the structure, convolutions, and ventricles of the brain. He thought that the convolutions, especially those of the cerebellum, are the seat of thought, and located mental diseases in the brain. He knew the lymph and chyle vessels, and the chordæ tendineæ of the heart. He assumed the anastomoses of the arteries and veins. The pneuma in the heart is vital spirits, in the brain is animal spirits. Digestion is due to the friction of the walls of the stomach. He thought that the bile is useless, as is the spleen and other viscera. He shows some acquaintance with pathological anatomy, as he describes induration of the liver in dropsy. His idea of the cause of disease is plethora and aberration of the humours. Inflammation is due to the detention of the blood in the small vessels by the pneuma driven from the heart into the arteries; fever occurs when the pneuma is crowded back to the heart by the venous blood, and blood gets into the large arteries. Dropsy always proceeds from the liver. He discarded bleeding and purgation; recommended baths, enemeta, emetics, friction, and cupping. He was, thinks Dr. Baas, a forerunner of Hahnemann in the doctrine of small doses, as he prescribed three drops of wine in bilious diarrhœa. He opened the abdomen to apply remedies directly to the affected part, and invented a kind of catheter.[416] Erasistratus was the first to describe a species of hunger, to which he gave the name Boulimia—a desire for food which cannot be satisfied. In his account of the complaint he mentions the Scythians, who, when obliged to fast, tie bandages round their abdomens tightly, and this stays their hunger.[417] The ancient apologists for the human vivisections of Herophilus and Erasistratus used to say that these anatomists were thus “enabled to behold, during life, those parts which nature had concealed, and to contemplate their situation, colour, figure, size, order, hardness or softness, roughness or smoothness, etc. They added that it is not possible, when a person has any internal illness, to know what is the cause of it, unless one is exactly acquainted with the situation of all the viscera; nor can one heal any part without understanding its nature: that when the intestines protrude through a wound, a person who does not know what is their colour when in a healthy state cannot distinguish the sound from the diseased parts, nor therefore apply proper remedies; while, on the contrary, he who is acquainted with the natural state of the diseased parts will undertake the cure with confidence and certainty; and that, in short, it is not to be called an act of cruelty, as some persons suppose it, to seek for the remedies of an immense number of _innocent_ persons in the sufferings of a few _criminals_.”[418] AMMONIUS OF ALEXANDRIA, surnamed LITHOTOMUS, probably lived in the reign of Ptolemy Philadelphus (B.C. 283-247). He is celebrated as having been the first surgeon who thought of crushing a stone within the bladder when too large for extraction entire; for this reason he was called λιθοτόμος. Celsus describes his method.[419] Of the Herophilists we may mention DEMETRIUS OF APAMÆA (B.C. 276), who named and described diabetes, and was distinguished as an obstetrician. MANTIAS, who, B.C. 250, first collected the preparations of medicines into a special book. DEMOSTHENES PHILALETHES, who, under Nero, was the most celebrated oculist of his time, wrote a work on diseases of the eye, which was the standard authority until about A.D. 1000. The work has perished, but Ætius and Paulus Ægineta have preserved some fragments of it. He wrote also on the pulse. HEGETON was a surgeon of Alexandria who was mentioned by Galen as having lived there as a contemporary of several physicians who were known to have resided in that city at the end of the second or the beginning of the first century B.C. He was a follower of Herophilus, and wrote a book on the causes of diseases entitled Περὶ Αἰτιῶν, which has perished. Of the school of Erasistratus we may mention XENOPHON OF COS, who wrote a work on the names of the parts of the human body, and on botany and the diseases of women. NICIAS OF MILETUS, a friend of the poet Theocritus; PHILOXENOS, who, according to Celsus, wrote several valuable books on surgery; and MARTIALIS the Anatomist, who visited Rome about A.D. 165. He knew Galen, and wrote works on anatomy which were in great repute long after his death. The followers of Herophilus and Erasistratus, though they founded schools, did not greatly influence the art of medicine, nor did they contribute much to its advancement beyond the point in which it was left by their great masters. They fell into fruitless speculations instead of pursuing their science by accumulating facts; in the words of Pliny, it was easier “to sit and listen quietly in the schools, than to be up and wandering over deserts, and to seek out new plants every day.”[420] So Dogmatism fell into disrepute and made way for the advent of Empiricism. SCHOOL OF THE EMPIRICS. The School of the Empirics was the outcome of the system of Scepticism, introduced by Pyrrho and extended by Carneades, who taught that there is no certainty about anything, no true knowledge of phenomena, and that probability alone can be our guide. Ænesidemus carried this scepticism into the medicine of the Empirics, but the school was originally established under the title of the Teretics or Mnemoneutics. The Empirics rested their system on what was called the “Empiric tripod,”—that is, accident, history, and analogy. Remedies have come to us by chance, by the remembrance of previous cures, and by applying them to similar cases. The sect of the EMPIRICISTS was founded by Serapion of Alexandria and Philinus of Cos in the third century B.C. They were in opposition to the Dogmatists, professing to derive their knowledge only from experience; they held that the whole art of medicine consisted in observation, experiment, and the application of known remedies which have constantly proved valuable in the treatment of one class of diseases to other and presumably similar classes. Celsus,[421] in his account of the principles of this sect, says that “they admit that the evident causes are necessary, but deprecate inquiry into them because nature is incomprehensible. This is proved because the philosophers and physicians who have spent so much labour in trying to search out these occult causes cannot agree amongst themselves. If reasoning could make physicians, the philosophers should be the most successful practitioners, as they have such abundance of words. If the causes of diseases were the same in all places, the same remedies ought to be used everywhere. Relief from sickness is to be sought from things certain and tried, that is from experience, which guides us in all other arts. Husbandmen and pilots do not reason about their business, but they practise it. Disquisitions can have no connection with medicine, because physicians whose opinions have been directly opposed to one another have equally restored their patients to health; they did not derive their methods of cure from studying the occult causes about which they disputed, but from the experience they had of the remedies which they employed upon their patients. Medicine was not first discovered in consequence of reasoning, but the theory was sought for after the discovery of medicine. Does reason, they ask, prescribe the same as experience, or something different? If the same, it must be needless; if different, it must be mischievous. “But what remains is also cruel, to cut open the abdomen and præcordia of living men, and make that art, which presides over the health of mankind, the instrument, not only of inflicting death, but of doing it in the most horrid manner; especially if it be considered that some of those things which are sought after with so much barbarity cannot be known at all, and others may be known without any cruelty: for that the colour, smoothness, softness, hardness, and such like, are not the same in a wounded body as they were in a sound one; and further, because these qualities, even in bodies that have suffered no external violence, are often changed by fear, grief, hunger, indigestion, fatigue, and a thousand other inconsiderable disorders, which makes it much more probable that the internal parts, which are far more tender, and never exposed to the light itself, are changed by the severest wounds and mangling. And that nothing can be more ridiculous than to imagine anything to be the same in a dying man, nay, one already dead, as it is in a living person; for that the abdomen may indeed be opened while a man breathes, but as soon as the knife has reached the præcordia, and the transverse septum is cut, which by a kind of membrane divides the upper from the lower parts (and by the Greeks is called the diaphragm), the man immediately expires; and then the præcordia, and all the viscera, never come to the view of the butchering physician till the man is dead; and they must necessarily appear as such of a dead person, and not as they were while he lived; and thus the physician gains only the opportunity of murdering a man cruelly, and not of observing what are the appearances of the viscera in a living person. If, however, there can be anything which can be observed in a person which yet breathes, chance often throws it in the way of such as practise the healing art; for that sometimes a gladiator on the stage, a soldier in the field, or a traveller beset by robbers, is so wounded that some internal part, different in different people, may be exposed to view; and thus a prudent physician finds their situation, position, order, figure, and the other particulars he wants to know, not by perpetrating murder, but by attempting to give health; and learns by compassion that which others had discovered by horrid cruelty. That for these reasons it is not necessary to lacerate even dead bodies; which, though not cruel, yet may be shocking to the sight; since most things are different in dead bodies; and even the dressing of wounds shows all that can be discovered in the living” (Futvoye’s Translation).[422] PHILINUS OF COS, the reputed founder of the school, was a pupil of Herophilus, and lived in the third century B.C. He declared that all the anatomy his vivisecting master had taught him had not helped him in the least in the cure of his patients. He has been compared with Hahnemann. SERAPION OF ALEXANDRIA was also of the third century B.C. He must not be confounded with the Arabian physician of this name. He wrote against Hippocrates. He discarded all hypotheses. He was the first to prescribe sulphur in chronic skin diseases; and he used some singular and disgusting remedies in his treatment. One of these was crocodiles’ dung, which in consequence became scarce and costly. GLAUCIAS, who invented the “Empiric Tripod,” ZEUXIS and HERACLIDES of Tarentum, lived about this period. The latter wrote commentaries on Hippocrates, and used opium to procure sleep. He mentions strangulated hernia in one of his treatises. Many commentaries were written about this time on Hippocrates; and the art of pharmacy, especially the preparation of poisons, was much studied in the second century B.C. Botanic gardens were established, and men began to experiment with antidotes for poisons. “Mithridaticum,” so called after MITHRIDATES THE GREAT OF PONTUS, was a famous antidote which was used even to recent times. NICANDER OF COLOPHON wrote poems on poisons, and antidotes, leeches, and emetics for the first time appeared in poetry, and the symptoms of opium and lead-poisoning were not beneath the attention of the muse. ATTALUS III., king of Pergamos, was in constant fear of being poisoned, says Plutarch,[423] amused himself with planting poisonous herbs, not only henbane and hellebore, but hemlock, aconite, and dorycnium. He cultivated these in the royal gardens, gathered them at the proper seasons, and studied their properties and the qualities of their juices and fruits. Cleopatra is said by Baas[424] to have written a work on the diseases of parturient and lying-in women, etc. She paid special attention, it would seem, to maladies of a specific character. Le Clerc gives a list of the women who have exercised the profession of medicine in ancient times.[425] CLEOPATRA treated the diseases of women. ARTEMISIA, Queen of Caria, ISIS, CYBELE, LATONA, DIANA, PALLAS, ANGITA, MEDEA, CIRCE, POLYDAMNA, AGAMEDA, HELEN, ŒNONE, HIPPO, OCRYOE, EPIONE, ERIOPIS, HYGEIA, ÆGLE, PANACEA, JASO, ROME, and ACESO are the ladies of classic story who had more or less acquaintance with medicine for good or evil purposes. That women, subject to many disorders for which in any state of society their natural modesty would make it difficult for them to consult men, should become proficient in the treatment of complaints which are peculiar to their sex, is the most natural thing in the world, and it is probable that very much of our knowledge of the treatment of these cases may be due to feminine wisdom. An ancient law of the Athenians forbade women and slaves to exercise the art of medicine, so that even midwifery, which they considered a branch of it, could only be practised by men. Some Athenian ladies preferred to die rather than be attended by men in their confinements. Women acted as accoucheuses in Egypt, Greece, and Rome, and some of them in classic times wrote books on medicine. Ætius gives some fragments in his works from a doctress named ASPASIA. Although the Greek physicians did not know anything of the circulation of the blood as we understand it, they were not wholly ignorant of the phenomena of the vascular system. The arteries were so called by the ancients because they thought they contained air, as they were always found empty after death. Hippocrates and his contemporaries called the trachea an artery. Some of the ancient anatomists, however, knew that they contain blood, and they knew that when an artery is divided it is more dangerous and entails a longer recovery than the division of a vein. They knew also of the pulsation in the arteries which does not exist in the veins, and they were fully aware of the importance of this fact in its relation to diagnosis and treatment. “The ancients chiefly regarded the odd days, and called them critical (κρισίμοι), as if on these a judgment was to be formed concerning the patient. These days were the third, fifth, seventh, ninth, eleventh, fourteenth, and twenty-first; so that the greatest influence was attributed to the seventh, next to the fourteenth, and then to the twenty-first. And therefore, with regard to the nourishment of the sick, they waited for the fits of the odd days; then afterwards they gave food, expecting the approaching fits to be easier; insomuch that Hippocrates, if the fever had ceased on any other day, used to be apprehensive of a relapse.”[426] These critical days were believed by Hippocrates and most of the other ancient physicians to be influenced by the moon. Greek medicine was divided into five parts, and to this day these divisions are still maintained. They were (1) Physiology and Anatomy considered together; (2) Ætiology, or the doctrine of the causes of disease; (3) Pathology; (4) Hygiene, or the art of preserving the health; (5) Semeiology, or the knowledge of the symptoms of disease and diagnosis, and Therapeutics, or the art of curing diseases. As to the contending claims of the various Greek schools of medicine, Dr. Adams says,— “There is no legitimate mode of cultivating medical knowledge which was not followed by some one or other of the three great sects into which the profession was divided in ancient times.”[427] With respect to the professional income of Greek physicians, Herodotus states[428] that the Æginetans, about 532 B.C., paid Democedes one talent a year from the public treasury for his services, _i.e._ about £344. From the Athenians he afterwards received a sum amounting to about £406 per annum. When he removed to Samos, Polycrates paid him a salary of two talents, or £487 10_s._ A difficulty arises, however, as to this statement of Herodotus, and there may have been an error in the sums mentioned.[429] The procuring of abortion was not in ancient Greece always considered a very great crime, and amongst the Romans it seems to have been unnoticed originally. It is related by Cicero that he knew of a case in Asia where a woman was put to death for having procured the abortion of her own child. Under the emperors, the punishment was exile or condemnation to the mines. THE SCYTHIANS. Of medicine as practised amongst the Scythians, little is known. Herodotus says[430] that when the king of the Scythians was sick he sent for three soothsayers, who proceeded to discover by divination the cause of his majesty’s malady. The prophets generally said that such or such a citizen had sworn falsely by the royal hearth, mentioning the name of the citizen against whom they brought the charge. The accused, having been arrested, was charged with causing the king’s illness. When he denied it, the king sent for twice as many more prophets; if these confirmed the charge, the offender was promptly executed; if they failed to do so, the first prophets were put to death. Abaris, the Hyperborean priest of Apollo, cured diseases by incantations, and delivered the world from a plague, according to Suidas. Anarcharsis, the Scythian philosopher, flourished 592 B.C.; if he knew anything of medicine, as has been said, he was probably acquainted with such knowledge of the art as was possessed by the Greeks. The ancient physicians seemed to have had no idea of the necessity for observing any order in their interpretation of diseases; even in the middle ages, says Sprengel,[431] they merely followed the position of the parts of the body, “passing from the head to the chest, from the thorax to the abdomen, and from the belly to the extremities.” In that branch of modern medical science which treats of the classification of diseases, and which is termed Nosology, a systematic arrangement is followed, and the prominent symptoms are taken as the basis of that classification. GREEK MEDICAL LITERATURE. The following is Dr. Greenhill’s probably complete list of the ancient treatises on Therapeutics now extant.[432] Hippocrates: Seven Books (see p. 178 of this work). Aretæus, Περὶ Θεραπείας Ὀξέων καὶ Χρονίων Παθῶν, _De Curatione Acutorum et Diuturnorum Morborum_, in four books. Galen, Τέχνη Ἰατρική, _Ars Medica_; Id. Θεραπευτικὴ Μέθοδος, _Methodus Medendi_; Id. Τὰ πρὸς Γλαύκωνα Θεραπευτικά, _Ad Glauconem de Medendi Methodo_; Id. Περὶ Φλεβοτομίας πρὸς Ἐρασίστρατον, _De Venæsectione adversus Erasistratum_; Id. Περὶ Φλεβοτομίας πρὸς Ἐρασιστρατείους τοὺς ἐν Ῥώμη, _De Venæsectione adversus Erasistrateos Romæ Degentes_; Id. Περὶ Φλεβοτομίας Θεραπευτικὸυ Βιβλίον, _De Curandi Ratione per Venæsectionem_; Id. Περὶ Βδελλῶν, Ἀντισπασέως, Σικύας, καὶ Ἐγχαράξεως, καὶ Καταχασμοῦ, _De Hirudinibus, Revulsione, Cucurbitula, Incisione, et Scarificatione_. Alexander Aphrodisiensis, Περὶ Πυρετῶν, _De Febribus_. Great part of the Σύναγωγαὶ Ἰατρικαί, _Collecta Medicinalia_, of Oribasius, and also of his Σύνοψις, _Synopsis ad Eustathium_, treat of this subject. Palladius, Περὶ Πυρετῶν Σύντομος Σύνοψις, _De Febribus Concisa Synopsis_. Ætius, Βιβλία Ἰατρικὰ Ἐκκαίδεκα, _Libri Medicinales Sedecim_. Alexander Trallianus, Βιβλία Ἰατρικὰ Δυοκαίδεκα, _Libri de Re Medica Duodecim_. Paulus Ægineta, Ἐπιτομῆς Ἰατρικῆς Βιβλία Ἕπτα, _Compendii Medici Libri Septem_, of which great part relates to this subject. Theophanes Nonnus, Ἐπιτομὴ τῆς Ἰατρικῆς Ἀπάσης Τέχνης, _Compendium Totius Artis Mediciæ_. Synesius, Περὶ Πυρετῶν, _De Febribus_. Joannes Actuarius, _Methodus Medendi_. Demetrius Pepagomenus, Περὶ Ποδάγρας, _De Podagra_. Celsus, _De Medicina_, in eight books. Cælius Aurelianus, _Celerum Passionum_, Libri iii. Id. _Tardarum Passionum_, Libri v. Serenus Samonicus, _De Medicina Præcepta Saluberrima_, a poem on the art of Healing. Theodorus Priscianus, _Rerum Medicarum_, Libri iv. [Illustration: EXAMPLES OF ANCIENT SURGERY. Fig. 1. Representation of the mode of reducing dislocation of the thigh outwards, as given by M. Littré. Fig. 2. Representation of the ancient mode of performing succussion, as given by Vidus Vidius in the Venetian edition of Galen’s works (_Cl._ vi., p. 271). [_Face p._ 204.]