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AN INTRODUCTION ^ -^ ./
TO THE
History of Medicine
WITH MEDICAL CHRONOLOGY, SUGGESTIONS FOR STUDY JND BIBLIOGRAPHIC DATA
C3ZC)
Y-' BY
FIELDING H. GARRISON, A.B., M.D.
LIEUTENANT-COLONELj MEDICAL CORPS, U. S. ARMY, SURGEON GENERAL's OFFICE, WASHINGTONf, D. C.
THIRD EDITION, REVISED AND ENLARGED
PHILADELPHIA AND LONDON
W. B. SAUNDERS COMPANY
1921
Copyright, 1913, by W. B. Saunders Company. Reprinted May, 1914. Revised, entirely
reset, reprinted, and recopyrighted June, 1917. Revised, entirely reset, reprinted,
and recopyri<;hted September, 1921.
All Rights Reserved
PRINTED IX AMERICA.
PRE^SS OF
W. B. SAUNDERS COMPANY
I'HII.ADELPHIA
To
GENERAL WALTER D. McCAW, U. S. ARMY
LIBRARIAN OF THE SURGEON GENERAI.'s OFFICE (19O3-I3) CHIEF SURGEON, AMERICAN EXPEDITIONARY FORCES (igiS-Itj)
IN ACKNOWLEDGMENT
OF HIS KIND ENCOURAGEMENT
AND
HIS MANY COURTESIES
IN AID OF THE COMPLETION OF THIS BOOK
PREFACE TO THE THIRD EDITION
Published in 1913, this book saw its second edition shortly before our entry into the European War; the issue of the present edition, at the customary three years' interval specified in the publishers' contract, has been delayed by the pressure of the writer's military and official duties. By courteous agreement of the publishers, no subsequent revision will be made for some years to come, and for necessary and sufficient reasons. As compared with a treatise on practice of medicine or any of its branches, a history of medicine is, in the nature of things, a stationary product, dealing essentially with the past, with things that have hap- I)ened. If the author of such a work has succeeded in stating the facts in their true relations, if he has reason to believe that his views of things are, in the main, correct and expressed with suffi- cient clarity, he will not wish to make many changes, since super- added and inserted matter will, in a series of editions, destroy the freshness and individuality of any book, giving it a somewhat medieval character, through excess of overlaid material. This method of composition, with which, it need hardly be said, the writer has no sympathy whatever, was once likened by Henry .lames to a heavy suit of chain mail, which, however carefully wrought, will sink the reader in erudition but not "float him upon a deeper tide," the shifting tide of modern thought and progress. During the troul:)lous period of the European War, the author has been, at Vv^hiles, keenly conscious of the need for thoroughgoing revision in at least two of the sections, namely, those dealing with medieval and modern medicine. But recent investigation of medieval medicine, the main aml)ition of the foremost living medical historians of Europe, is still "knowledge in the making," while present-day medicine, during the war period and after, has been in a state of flux. Revision along the lines contemplated will, therefore, be made to best advantage after a period of careful consideration and study, when the civilized world has attained a period of less unstable equilibrium ; and such revision, if well considered, will require the necessary element of time.
What has been accomplished in the- present edition is as fol- lows: A careful account has been rendered of the newer findings
8 PHKKACK 1() llli: Till HI) KDITION
of SuillintV, Nfulmiiicr, W'ickcisliciinci-. Siiiii(M-, .-md oIIhm' I'liiro- pc.Mii iii\ fsliiiators of ;mcicnt nnd nu'ilicxMl incdic'mc; new matter liiis lii'cMi miUUmI oil tlic (loctrinc of the orifiin and tiansiiiission of (Mlinitr culture (convcM-jiicMico and convection); on ('liines(> inediciii(>; on the liistoiy of pediatrics, d(>iitistry, public hy<2;ieiie, military medicine, and medical lexicotiraphy ; on the (>arli(M' nuclei of med- ical education in the Tnitiul States; on nn-eiil .lapanc'se, Spanish, and Latin-American mediciiu^ and on tin* work of tiie medical departments of armies in the iMiropean War. A numl)er of new bio.uraphical sketches have becMi added, with portraits of Sym- phori(>n C'hampier, Villemin, Ciurlt, J.ittre, Salkowski, Osier, Max Neul)ur}i:er, and others. Errors of omission and commission have ])een corrected; the l)i])lio<irai)hies at the end of the volume have lieen enlar^xnl and improved; and the author index has been made as complete and exhaustive as possible. Special effort has been made to keep down the physical size and weight of the book, and to preserve something of its original plein air intention, by the use of small type in certain sections. As stated in the preface of the first edition, the author's primaiy object has been to stim- ulate the medical student or the busy practitioner to pursue his own studies in the history of medicine, and, judging from the large number of friendly and sympathetic letters received, this end has been, in some measure, attained.
In his forward-looking "Outline of History" Mr. H. G. Wells has almost nothing to say of the influence of medicine upon human progress, although, as Descartes observed, it is to the science and art of medicine that the human race must look if it is to perfect and fit itself for the gigantic social tasks and problems which are bound up with its future development. With fine perspicacity Mr. Wells signalizes three episodes in secular history as the most important in the development of the human race and its civiliza- tion, viz., the awakening of free thought in mankind by the Ionian (i reeks; the awakening of the free conscience of mankind by the Hebrew prophets; and the awakening of the sense of. soli- darity in mankind by the political and social revolutions of recent times. To these he adds a fourth, and even more momentous, coefficient, namely, the need for the self-discipline of each and evers' individual in the feeling of social obligation and for personal and international good manners, that these three forces may operate for the greatest good of the greatest number, and that the many may not continue to suffer for the crimes, whims, inepti- tudes, and insanities of the few. The object of Mr. Wells' History is to educate the individual in this sense of social obligation, and, as the Mr. Greatheart of our Pilgrim's Progress along the "eight- fold Aryan way," he has given to the historian a new and unique
PREFACE TO THE THIRD EDITION 9
function. Assuming the best will in the world on the part of the children of the future, one may at least hope that they will con- tinue to produce, not Pecksniffian prigs and pragmatical purists, but such interesting and whole-souled humans as Rubens and Helena Fourment, Richard Steele, Charles Lamb and Fanny Kelly, Franz Schubert, Rahel Levin, Theophile Roussel, Joseph Leidy, Louis Pasteur, Henri Dunant, Joseph Lister, Johannes Brahms, Ivan Turgenieff, and William Osier. Whether Schopen- hauer's famous l^alance-sheet l3etween evil and good will ever be reversed or not turns upon the balance or imbalance of social forces, in th(^ adjustment of which medicine is destined to play a part of ever-increasing moment. With the law visibly decom- posing into chicanery and the medieval mania for formalism and multitudinous verbiage, with religion too frequently debased into a cloak for fraud, modern medicine has ever been forward- looking, honest in its "aims, methods, and persistency," and fears not its audit. The signs and syml^ols are arovmd and about vis everywhere. The conquest of communicable diseases, the attain- ment of painless, shockless, deathless surgery, the manifold devices of sanitation, the recognition of an interrelation between health and disease and social-economic conditions, the wide-spread con- cern al^out industrial poisoning, trade diseases and accidents, the movement for wholesale destruction of noxious insects, parasites, reptiles, and vermin, the relation of the neuroses to crime and the sexual genesis of crime, the relation of the internal secretions to the neuroses and insanities, nay, even to cerebration itself, have been a few of the trends of recent medicine. The influence of disease itself upon the trend of human history in the past is still an unwritten chapter, thrown into striking accidental relief by the triumph of sanitation over infectious diseases in the European War. In our army camps the disease-carrier, whether contact or suspect, was taught to regard himself as a greater menace to his fellows and to the community than the disease itself. At the Harvard Library Mr. Justin Winsor made the loan of a book conditional upon the personal cleanlin(\ss of the applicant. Our overcrowded public v(4iicles are still efficient agencies in the transmission of parasitii? and respiratory diseases. Crime and Hucksichlslosigkeit are coming to be regarded as matters of social sanitation. During the European War, the science of medical anthropology, and particularly of ethnic psychology, began to loom large and acquire even military significance. All this is obviously more potent, dynamic, and understandable doctrine than the outworn patter of chanter la haute morale. The view- point of Cato the Censor does not appeal to moderns. The message of medical history to the future is: "Come clean."
10 PUKKACK r<) riii: iiiiui) I'.DirioN
Sinct> the l:i-l rt'\i--i(»ii of tliis Ixxik, in f;ii'l, in llic \('!'v tlnck of the \v;ir period, :i lai'iic amount of original work of hi^lily crcdit- al)l(' cliaiaclcr has hccn done in ihc way of nicdico-liislorical iv- sivirch. Till' most inipoitani of these investi^iitions hear upon tlie history of nitvlieval science and medicine, n<)tal)ly the massive stvulies of SudholY upon meiUeval suru'erv, tlie School of Sak'nio, the i)(>st-tracts and hygienic orchnances of the MidcUe Aj>;(>s, the liistory of mecheval anatom>', and the graphics of medieval prac- tice; tlios(> of W'ickersheimer on \\\o zodiacal and anatomi(;al diaiirams; the valual)l(> inxcsti^ations of medieval MSS. by Charles SiniicM-; the catalojiuinji of the nu^dieval scientific IMSS. in Enf>;land i)v Dorothea Waley Sin<;er; aiul the studies on Aristotk^ by Pro- fessor Charles S. Haskins (Harvard University). Through such investigations as these we are beginning to understand some- what of the vast complex known as medieval medicine. In laying down plans and supjilying building stones for this new edifice none have shown such unparalleled industry as Professor SudholY, a mighty scholar and fountain-head of genius and power; of the puzzle-headed array of ascertained knowledge, none, save AUbutt, have given so intelligil)le a synthesis as Singer. Defining science as "the making of knowledge," h(^ sets the delimitations of medieval science in time as between 400 A. D., when the ancients ceased to make knowledge, and 1453, when modern science, in the dynamic sense, began, with Copernicus and Vesalius. During the long interperiod, medieval science was mainly static and descriptive, and tlirough its central dogma, derived from Plato and familiar to us in the Divina Commedia and Goethe's Faust, phenomena were studied not as leading to anything, but as illustrating the relation of the great outer universe or macrocosm to the microcosm, man. Astrology, the doctrine^ of the four humors, and other prognostics became modes of life-insurance, in other words, only one phase of the larger insurance against "the perils of the soul." "For such an attitude of mind there could be no ultimate distinction between physical events, moral truths, and spiritual experience." As Taylor has shown in "The ]\Iedia>val Mind," science, ethics, the- ology, philosophy, art, and medicine were regarded not as sepa- rate categories, but as something interrelated and interfused. Assuming this viewpoint, it is easy to comprehend why the basic sciences — anatomy, physiology, pathology — were almost non-ex- istent in the Middle Ages, why internal medicine was backward, and wh}' such practical matters as military surgery and the applica- tion of the Biblical code of sanitation were forward, even as printing, or the use of the mariner's compass, firearms, and spec- tacle lenses came to be forward.
Of other recent contriljutions to medical history, space permits
PREFACE TO THE THIRD EDITION 11
hilt brief mention of Sir Clifford AUbutt's splendid and learned study on (ireek Medicine in Rome, the stimulatina; histories of medicine by Sudhoff and Meyer-Steinc^g, and of dentistry by Professor Sudhoff, Professor Neuburger's studies of medicine in Josephus and the Vienna School, Singer's two volumes of Oxford "Studies," tlie interesting history of medieval medicine by Dr. James J. Walsh, Dr. Mortimer Frank's translation of Choulant, Dr. Jonathan Wright's commentaries on pre-Hippo- cratic and Hippocratic medicine, the highly original investigations of Mexican medicine by Dr. Nicolas Leon, and the forthcoming volumes on the history of medicine by Sir WilUam Osier, on the history of magic by Professor Lynn Thorndike, on the medical gods by Dr. Walter A. Jayne, on medicine in Montaigne by Cap- tain J. S. Taylor, U. S. N., and on the Florentine artist-anatomists by Dr. Edward C. Streeter. Biographies of Sir William Osier by Professor Harvey Gushing and of Joseph Leidy by Dr. Joseph Leidy, jr., are in preparation; and the announcement of histories of physiological chemistry by Professor Gowland Hop- kins and of clinical methods by Dr. Erich Ebstein is a matter of keen interest to historical students. Two volumes of the medical history of German participation in the European War have already IxHMi pul)lished, much of the pndiminary material of the English his- tory has been printed in serial form (National Research Council), the Canadian history is in jireparation, and two volumes of the American history are already in press, under the editorship of Colonel Charles Lynch, U. S. Army. Very recently, university chairs of medical history have been assigned to Dr. Eugene Menetrier (Paris), to Professor Max Wellmann (Berlin) and to Dr. Charles Singer (London); Professor Max Neuburger has established an Institute of Medical History in the Jose- finum (Vienna), and it is hoped that steps along the same ])rogressive lines will l)e taken in America. During the war period, some of our l:)est have passed away — Osier, Jacobi, Payne, Ruffer, Blanchard, Hofler, Schelenz, Valentin Rose, Gaizo, Han- derson, and VIortimer Frank — and of these, none have left so dis- tinct a void in our minds and hearts through their passing as Sir William Osier. He was a source of inspiration and encouragement to us all, and to me personally, the wisest of mentors, the kind- liest of friends.
This ])ook is, in a very real sense, a product of the Surgeon General's Library, and I desire once more to thank the successive Librarians of this great institution for their encouragement and their generosity in the loan of books and graphic material. In the correction of errors, I am very genuinely indebted to Geheim- rat Sudhoff (Leipzig), whose utterances about English, French,
12 PiiKi \<K TO riii: 1-111 Ki) i:i)iri()N
and American ctilloatiucs (luiinii the war period 1kiv(^ been eliivalrous. ina^naniinoiis, sporlsinimliko; to Pnifessor William 11. Welch Jialtimore), Dr. Charles Sin<i-er (London), Sir Ilumplire\- Uolloslon (Loiulon), Professor Harvey ('ushin<j; (Boston), and many others, in particnlar to l')r. lOdwaid (". Slreeter (Boston) for his can>fnl and scholarly emendations in I he section on medie- val medicine. To my friend. Dr. I'Miniind \. ("o\\(hy (New York), and to Drs. Sadao ^()shida, Jlsieh, aiul ^'amanawa I am sincerely thankful foi- \alual)le information al)out Chinese and .lapaiH^se medicine. To the publisiiers I once mor(» (>xi)ress my liratitude for the handsome letter-press and illustrations of the book, which has been entirely reset in this edition; and to Dr. Alliert Allemann, Principal Assistant Librarian, S. CJ. O., and Mr. Cary K. Saj^e, U. S. Public Health Service,-' I render my best thanks for their efficient cooperation in the correction of the proofs.
F. H. G.
Aii.MY Medic.vl Museum,
Washington, D. C,
September, 1921.
Author's Corrections.
Page 11, line 23. "National Research Council" should be "National Health Insurance (Med- ical Research Committee)."
Page 12, line 8. "Yamanawa" should he "Yoko- gawa."
CONTENTS
I. The Identity of All Foh.ms (jf Ancient and Primitive Medicine 17 II. Egyptian Medicine 40
III. Sumerian and Oriental Medicine 54
IV. Greek Medicine:
I. Before Hippocrates 71
II. The Classic Period (460-13(3 B. C.) 86
III. The Graeco-Roman Period (156 B. C.-576 A. D.) 96
V. The Byzantine Period (476-732 A. D.) 110
VL The Mohammedan and Jewish Periods (732-1096 A. D.) 116'
Cultural A.<pects of Mohammedan Medicine . . .^ 124
VII. The Medieval Period (1096-1438) ' 130
Cultural and Social Aspects of Medieval Medicine. ^, 159
VIII. The Period of the Renaissance, the Revival of Learning,
and the Reformation (1453-1600) 185
Cultural and Social Aspects of Renaissance Medicine 229
IX. The Seventeenth Century: The Age of Individual Scientific
Endeavor 241
Cultural and Social Aspects of Seventeenth Century Medicine 280 X. The Eighteenth Century: The Age of Theories and Systems 314 Cultural and Social Aspects of Eighteenth Century Medicine. 396 XL The Nineteenth Century: The Beginnings of Organized Ad- vancement OF Science 424
XII. The Twentieth Century: The Beginnings of Organized Pre- ventive Medicine 722
Cultural and Social Aspects of Modern Medicine 771
Appendices:
I. MeiUcal Chronology 819
11. Hints on the Study of Medical History 862
III. Bibliographic Notes for Collateral Reading 867
A. Histories of Medicine 867
B. Medical Biography 869
C. Histories of Speciial Subjects 886
Index of Personal Names 901
Index of Subjects 927
13
"Civilization in its higher form tochiy, thouj^h highly complex, forms essentially a unitary mass. It has no longer to be sought out in separate luminous centers, shining hke i)lanets tlirough the surrounding night. Still less is it the property of one i)rivilege(l country or people. Many as are the tongues of mortal man, its votaries, like the Immortals, speak a single lan- guage. Throughout the whole vast area illumined by its quickening rays its workers are interdependent and pledged to a common cause." — .Siii Ahtiiur
]*]VANS.
"For intleed it is one of the lessons of the history of science that each age steps on the shoulders of the ages which have gone before. The value of each age is not its own, but is in part, in large part, a debt to its forerunners. And this age of ours, if, like its ijredecessors, it can boast of something of which it is proud, would, could it read the future, doubtless find much also of which it would be ashamed." — Sir Michael Foster.
"Take from the air every aeroplane; from the roads every automobile; from the country every train; from the cities every electric light; from ships every wireless apparatus; from oceans all cables; from the land all wires; from shops all motors; from office buildings every elevator, telei)hone and typewriter; let epidemics spread at will; let major surgery be impossible — all this and vastly more, the bondage of ignorance, where knowledge now makes us free, would be the terrible catastrophe if the tide of time should but ebb to the childhood days of men still living! . . . Therefore, whoever desires j)rogress and prosperity, whoever would advance humanity to a higher plane of civilization, must further the work of the scientist in every way he possibly can." — William J. Humphreys.
"The development of human thought and achievement, as a w-hole, has not been, as commonly supposed, a continual ujiward progression, nor even the eriuivalent of a continuous series of ascertained results. Thoughts and inventions, which seemed on the verge of practical fruition, have often been reduced to nothingness, even at the most decisive moment, through some combination of untoward circumstances; yes, even the very memory of a pathway broken into the Land of Promise is often obliterated and what seemed ac(!om[)lished fact has had to be recreated by laborious work covering years, decades and even centuries. Just the simplest, most natural and, in the end, almost self-evident facts are the hardest to evolve and elucidate, just what was most decisive and potent of result has been time and again overlooked by the seeker after truth. . . . The gold of historic thought, indeed, is as little to be found in the street as the gold of actual daily strife, and it is by no means the task of the historian of broad general scope to give the initial clew to its discovery. He, indeed, can only reproduce the i)ast with fidelity and exactitude. The intuititm of the true investigator and pathfinder of today and tomorrow must find its own way to new guiding principles from the work of yesterday, before yesterday, and the distant past." — Karl Sudhoff.
"Doctrinaire formula-worship — that is our real enemy." — M.\x Neu-
iUIUJF.H.
"It is hardly an exaggeration to summarize the hi.story of four hundred years by saying that the leading idea of a conf(uering nation in relation to the conquered was, in IGOO, to change their religion; in 1700, to change their trade; in ISOO, to change their laws, and in 1 !)()() to change their drainage. May we not then say, that on the prow of the con(iuering ship in these four centuries first stood the priest, then the merchant, then the lawj-er, and finally the phy.sician?" — A. Lawrence Lowell.
"Aims, methods, and persistency are common to the medical profession of all coimtries. On its flag is inscribed what should be the life rule of all nations: Fraternitv and .solidaritv." — Abraham .Jacobi.
15
AN INTRODUCTION TO THE
HISTORY OF MEDICINE
THE IDENTITY OF ALL FORMS OF ANCIENT AND PRIMITIVE MEDICINE
One of the best accredited doctrines of recent times is that of the unity or soHdarity of folk-ways. The collective investigations of historians, ethnologists, archeologists, philologists, and sociolo- gists reveal the singular fact that all phases of social anthropology which have to do with instinctive actions inevitably converge to a common point of similarity or identity. This is true of all myths, superstitions, laws, and social customs of primitive peoples (as also of the cruder ethnic aspects of rehgions) which are concerned with the fundamental instincts of self-preservation and reproduction. It is possible, as we shall see, that many strange cultural practices, such as mummification, circumcision, or the couvade, may have been deliberately transported by migrations from one continent or island and imposed upon another (Elliot Smith). But the fact remains that, for those human actions which have been defined as instinctive, as based upon the innate necessity which is the mother of invention, "folklore is an essential unity. "^ The mind of savage man, in its pathetic efforts to form religious and ethical systems for moral and spiritual guidance, or to beautify the commoner aspects of life with romance and poetry, has unconsciously taken the same line of least resistance, followed the same planes of cleavage. The civilized mind differs from the savage mind only in respect of a higher evolutionary development. Human races and racial cus- toms have changed as they became more highly specialized. The heart of man remains the same.
It follows that, under different aspects of space and time, all phases of folk-medicine and ancient medicine have been essentially
^ For a good. Hummary of tho matter, see the presidential address of Charlotte S. Burne in Folk-Lore, Lond., 1911. xxii, 14-41; also, her revision of "The Handbook of Folklore" (Pub. Folk-Lore Soc, No. Ixxiii, Lond., 1914). 2 17
18 IIIS'l'OUY OF MEDICINE
alike in tendency, (liflVriiia; only in uiiiinportant details. In the liiiht of anthropolofiy, this proposition may ])e taken as proved. CinuMfonn, hierosilyphic, runic, birch-bark, and palm-leaf in- scriptions all indicate that tlu^ folk-ways of early medicine, whether Accadian or Scandinavian, Slavic or C'eltic, Roman or Polynesian, have been the same — in each case an affair of charms and spells, jilant-loiH^ and psychotherapy, to stave off the effects of super- natural ajiencies.
In relation to the orij^in of othnif traits and practices, opinion is divided into two schools. The convergence theory, oriijinated by Adolf Bastian in ISSl,' aflirms that the a{)i)earan('c of identical ethnic phenomena in ditTerent relations of space and time is due to the spontaneous develojjment of certain "elemental ideas" {FAcmentarficdanke), which are common to primitive man everj"\vh(;re. The convection theory, originated by Friedrich Ratzel (1882-), asserts that no isolated action or jirimary "elemental thought" is possible to primitive races, but that each race has derived something from its neighbors or predecessors in sequence of time. Ratzel's theory of the geograi)hic flif- fusion of ethnic culture has been vigorously defended by Fr. von Luschan,' and separately maintained by Elliot Smith, in his doctrine of the convection of "heUolithic culture." The Bastian doctrine is strongly supported by the imposing array of facts which have been assembled in furtherance of the modern theory of evolution, that the development of the individual is but an epitome of the development of the race. Left to itself in a favorable environ- ment, any savage tribe will inevitably evolve a culture all its own, for the regulation of food supply, sexual and social relations, adjustment to the unknown, manifesting itself as political economy, ethics, law, medicine, rehgion and so on. The weak point in the convection theory is that it deals with accidentals and non-essentials, such as the constant recurrence of the self-same folk-tales and proverbs all over the earth, similarities in language, artistic forms, detached cultural practices, ethnic type (Hindu and Aryan, Malay and North American Indian), etc., many (not all) of which may have been mechanically transmitted from one race or culture to another. Thus, the Africans of Benin and Cameroon learned to make armor and artistic devices in metal from North-Em-opean invaders; the Ganymede in the Vatican is strikingly reproduced in a Bucldhist relief in a cloister near Sanghao; the cobra symbol is found alike in Indian, Egyptian, Scandinavian, and Aztec devices; the symbohsm of the Symplegades is the same in Greek and Mayan art; but the cherchez la femme motive may well have originated scores of Trojan or other wars, and such happenings as those of (Edipus, Siegfried, Machaon, Susanna and the Elders, are apt to occur spontaneously anywhere. Elliot Smith asserts that Americans uphold the convergence theory "as a kind of dogma" over against the convection theory, but, as a matter of fact, there are strong elements of probability in both. Hence, neither can be erected into dogma.
Of the ultimate origin of folk-ways and ideas we know little or nothing. Innumerable hypotheses have been advanced, in each case the attempt of a civiHzed or educated mind to interpret the workings of the primitive mind from isolated instances, and, in
^ A. Bastian: Der Volkergedanke, Berlin, 1881. 2 F. Ratzel: Anthropogeographie, Stuttgart, 1882.
' F. von Luschan: Zusammenhange und Konvergenz. Mitt. d. anthrop. Gesellsch. in Wien, 1918, xlviii, 1-117.
IDENTITY OF FORMS OF ANCIENT AND PRIMITIVE MEDICINE 10
almost every case, the investigator has become obsessed by his particular theory to the extent of becoming a hobby-horse rider. But all anthropologists agree that the general origin of folk-ways and mores (religious or other) is social, concerned with the great question "how to Hve," which is different at different times, in different places, among different peoples. Of the mind of primi- tive man, we know that it differs from the civilized mind mainly in respect of education and development, that is, in the power to per- ceive and assign the right causes for phenomena, which gave us science, and in certain perceptions of "values," which gave us our standards of morahty and taste. But in each of these things the primitive mind everywhere has its own natural standards, which are worthy of deepest consideration.
Aj:)art from any theories as to his origin or evolution, we may assume that prehistoric man was not different from what we often find primitive man to be — a savage sunk in his animal instincts. At this stage of his existence he killed his food and fought his ene- mies with sticks and stones, raped his women, hid himself in caves, and was probably not unaware of certain hygienic precautions which are instinctive in lower animals. A dog licks its wounds, hides in holes if sick or injured, hmps on three legs if maimed, tries to destroy parasites on its body, exercises, stretches, and warms in the sun, assumes a definite posture in sleeping, and seeks out certain herbs and grasses when sick.^ It is not unreasonable to suppose that actions hke these may have been as instinctive in a grown-up prehistoric man as they are in a primitive child of his race today. "Man has climbed up from some lower animal form," says John Burroughs, "but he has, as it were, pulled the ladder up after him." We do not know when or where, how or why, this occurred, but we do know the first rung of the ladder. In the Hall of Anthropology of the National Museum at Wash- ington (or in any other good collection of this kind) there are to be seen innumerable specimens of a small object in chipped fiint which is the symbol of prehistoric man's uplift, his first step in the direction of civihzation. With this leaf-shaped flint in hand, he had a new means of protecting himself against enemies, procuring and preparing food, and of manufacturing other weapons and im- plements of the same kind or of more highly specialized kinds. Now the interesting point about these prehistoric flints is that they are to be found wherever traces of the existence of man are found, changing in shape during the successive interglacial and post- glacial periods, but following his migrations over the surface of tiie
^ Usually Triticum caninuvi, Cynosurus cristalus, and Agrestis caninn for emesis and purgation. Cat.s have a known fondness for Valeriana officinalis and Nepeta cataria (catmint).
20 HISTORY OF MEOICINE
earth. H(mv croppinp; up as spoar or arrow-point, there as tool or ceremonial ol)jeet. these primitive "celts," as they are called, have been excavated from the river-drifts of England, France, and North America, in the caverns of Devonsliire and the Dordof!;ne, in the plains of Egyi)t and Palestine, and the frozen tvnidra of Siberia and Alaska, in each case bearing the same identical form. In the Early Stone Age (Paleolithic Period), up to the Solutrean Period, the chipped celts were little more than the result of a neces- sarily crude flaking of oval or ovoid stoiu^s. From the time of arrival of the pre-Chellean flint workers in Europe during the Second Interglacial Period, one hundred thousand years ago, each successive race had its peculiar technic of flint-chipping, its characteristic retouch, until the crude coups de poing of the Chelleans become the exquisite laurel-leaf points of Solutrean man. But in the Magdalenian period the forms are again crude, and finally dwindle away into the faultier Azilian forms and the strange trapeziform shapes of the Tardenoisian microliths.^ In the Later Stone Age (Neolithic Period) they were brought to a high point of specialization and polish, but in shape and intention they have remained the same throughout geologic space and time. Their employment in surgery by the ancient Egyptians, or in ritual circumcision by the Hebrews in the desert, goes to show the unusual veneration in which they were held ])y these peoples on account of their great antiquity. In what is perhaps the most interesting of American contributions to archeology,- Professor William H. Holmes has demonstrated inductively (by working out the initial methods of chipping and flaking himself) that even among recent American Indians, like those of the Piney Branch quarries in the District of Columbia, the process of shaping and specializing the leaf-shaped flints was probably not different from that employed by Paleolithic man or even in what seem to be the rude artefacts of Eolithic man. There is apparently no distinction in space and time in the flaking of prehistoric and primitive im- plements. Similarly, ethnologists, as we have said, find that the folklore and other traditions and superstitions of primitive peoples have a strong family likeness at all times and places.
The common point of convergence of all medical folk-lore is the notion that spirits or other supernatural agencies are the efficient causes of disease and death. Primitive medicine is inseparable from primitive modes of religious belief. If we are to under- stand the attitude of the primitive mind toward the diagnosis and
1 See H. F. Osborn: Men of the Old Stone Age, New York, 1916, passim.
-W. H. Holmes: "Stone Implements of the Potomac-Chesapeake Tide- water Province," Rep. Bur. Ethnol., 1893-4, Wash., 1897, xv, 1-152. Also: Mem. Internat. Cong. Anthrop., Chicago, 1894, 120-139, 4 pi.
IDENTITY OF FORMS OF ANCIENT AND PRIMITIVE MEDICINE 21
treatment of disease we must recognize that medicine, in our sense, was only one i:)hase of a set of magic or mystic processes designed to promote human well-being, such as averting the wrath of angered gods or evil spirits, fire-making, making rain, purifying streams or habitations, fertilizing soil, improving sexual potency or fecundity, preventing or removing blight of crops and epidemic diseases, and that these powers, originally united in one person, were he god, hero, king, sorcerer, priest, prophet, or physician, formed the savage's generic concept of "making medicine." A true medicine-maker, in the primitive sense, was the analogue of our scientific experts, philanthropists, and "efficiency engineers," a general promoter of human prosperity.
In his attempts to interpret the ways of nature, savage man, untutored l^ecause inexperienced, first of all confused life with motion. Like Mime in Wagner's "Siegfried," he was puzzled if not awed by the rustling of leaves in the forest, the crash and flash of thunder and hghtning, the flicker and play of sunlight and firelight, and he could see no causal relation between a natural object and its moving shadow, a sound and its echo, flowing water and the reflections on its surface. Winds, clouds, storms, earth- quakes, and other sights and sounds in nature were to him the outward and visible signs of malevolent gods, demons, spirits, or other supernatural agencies. The natural was to him the super- natural, as it still is to many of us. He therefore worshiped the sun, the moon, the stars, trees, rivers, springs, fire, winds, and even serpents, cats, dogs, apes, and oxen; and, as he came to set up carved stocks and stones to represent these, he passed from nature- worship to fetish-worship. Even in his artistic productions, the savage is at first animistic and ideographic, tends to vitalize inanimate objects, and aims at the portrayal of action and move- ment rather than perfection of form.^ Disease, in particular, he was prone to regard at first as an evil spirit or the work of such a spirit, to be placated or cajoled, as with other deities, by burnt offerings and sacrifice. A further association of ideas led him to regard disease as something produced by a human enemy possessing super- natural powers, which he aimed to ward off by appropriate spells and sorcery, similar to those employed by the enemy himself. Again, his own reflection in water, his shadow in the sunlight, what he saw in dreams, or in an occasional nightmare from gluttony, sug-
' That there is a strong resemblance between some of tlie concepts of savage and paranoiac art is strikingly shown in the remarkable carvings of a paranoiac collected by G. Marro, Ann. de freniat., Turin, 191.3, xxiii, 1.57-192, 6 pi. W. H. Holmes has shown that, in the savage, perfection of pattern forms and figures had to follow upon dc^'elopment of the metric and geometric arts, such as the shaping of potterv, textiles, technics, and architecture. (Rep. Bur. EthnoL, 1882-3, Wash., 188(), iv, 443-465.)
22 IllSI'Oin' OK MKDICINK
gosli^d tlu> (>\ist(Micc (if ;i si)irit -world ;ip;irl troiii his diiily life ;;iid of ;i soul :ip;iit Iroiii liis l>o(l\ , and in lliis \va\- lie hit upon a third \va>" ol' lookinij; at disease as the woik of olTeiided spii'its of the (K'ad, \vh(>ther of men, animals, or plants, "^riiesc* three views of (liseast^ are eonunon heliefs of the lowest <;rades of Jiunian life, for, as l\i\-ei-s says, the category of natui'al causes "can haidly he said to exist" anionji; them. Sava<!;es, as a rule, cheerfully accept all tiue(\ while a linjierinji; belief in human .sorcery and the displeasure of the dead is always a trait of the peasant and .sometimes of his descendants in "civilized" communities. The modern Koreans are said to number their demons "by thousands of billions." Among .savagos such beliefs usually fio hand in hand with shaman- ism, an inteiuuediate statue ])etween polytheism and monotheism, which assumes a Sujireme H(>infi; or (Ireat Sjiirit, with less(»r di- vinities and demons subordinated. With the beginnings of sham- anism' we have everywhere the advent of the medicine man and the bilbo or witch-doctor, who assvunes a sol(^mn supei'visory rela- tion to di.sease and its cure Jiot \mlike that of the priest to religion. The sliaman handles disease ahnost entb-ely by psychotherapeutic manceuvcrs, which serve to awaken a corresponsive state of auto- suggestion in his patients. Whether North American Indian or Asiatic Samo3'ed, he does his best to frighten aw^ay the demons of disease by assuming a terrifying aspect, covering himself with the skins of animals so as to resemble an enormous beast walking on its hind legs, resorting to such demonstrations as shouting, raving, slapping his hands or shaking a rattle, and pretending (or en- deavoring) to extract the active principle of the disease by sucking it through a hollow tube. To prevent future attacks, in other words, to keep the demon away for the future, he provides his patient with a special fetish or amulet to be worn or carried about his person. Furthermore, any fantastic thing he may elect to do or not to do, such as passing in or out of a door or stepping over an ol)ject with intention, he considers in the light of "making medi- cine." We may smile at these phases of shamanistic procedure, but, except for the noise, they are not essentially different from the mind-medicine or faith-healing of our own day. Both rely upon psychotherapy and suggestion, and for a sick savage, the fantastic clamor made about him might be conceivably as effective as the quieter methods of Christian Science to a modern nervous patient.
It is highly probable that in all primitive .societies, the priest, the magician, and the medicine-man were one and the same, and that the powers ascribed to these ranked with courage and the sword as means of securing leadership or
1 For the ritual of preparation and initiation of candiflates into the four degrees of shamanism, see W. J. Hoffmann: Rep. Bur. Am. Ethnol., Wash., 1891, vu, 1.51-300.
IDENTITY OF FORMS OF ANCIENT AND PRIMITIVE MEDICINE 23
kin<i;sliip. As thoso functions bocamo more spooialized and diffcivntiatod. ro- liiiioii became the exclusive lielief in and worship of some univei-sal power ^reatiT than man himself; mat^ic, a special set of processes within tlie power of man, whereby he soufiht to i)redict and control natural phenomena, usually to wreak evil and in o])])osition to the will of the god or gods; and medicine, the attemi)t to direct antl control those natural i^henomena whi(;h i)ro(luce disease and death in man (Rivers^). Thus religion, through the inhibitions which man i)ut upon himself to attain to the godlike, became the origin of law and ethics; the secret practices of magic engendered alchemy and other branches of chemical and physical sciences; astrology, astronomy; while primitive medi- cine remained moi'c or less stationary among all peoples, always following in the wake of other sciences, until it could utilize the advances made by physics or chemistry. Black magic was concerned with producing drought, famine, disease, death, or other evils; white magic, iir averting these or in such posi- tive good as rain-making, fire-making, or [)romotion of vegetation. Primitive therai)y, therefore, became a mode of white magic.
Primitive pathology ascribed disease to something projected into the body of the victim, something taken from it, or to the effect of sorcery ujion some part of or some object connected with the body of the patient. The first category corresponds with our infectious and toxic diseases; the second, r. (/., the predilection of the Australian savage for the adrenal fat of his enemies, with the diathetic (metabolic) and deficiency diseases. The third category Frazer defines as sympathetic magic (action at a distance-), including homeo- pathic or mimetic magic (action by or upon similar objects for good or evil) and contagious magic (magical effect of a thing which has once been in contact with a person or thing or formed part of it). As part of this cult, the soul was regarded as "the animal inside the animal, the man inside the man," a manni- kin, counterpart or double, sometimes a shadow or reflection,^ absent from the body in sleep, sometimes a truant and a wanderer, capable of being extracted from the body by an enemy, or of being deposited in some safe place to secure immortality, or even existing as a second self or "external soul" in various l)lants or animals, upon whose welfare the welfare of the individual de- pended.* The "perils of the soul," in primitive medicine, were averted by complex systems of totems and taboos. On Eddystone Island (Melanesia) nearly every disease is ascribed to eating the fruit of tabooed trees. In other parts of Melanesia disease follows upon any infraction of totemic ordinances, such as killing or eating the totem (Rivers).
Thus primitive medicine, magic, and religion are inseparable, although, as in ancient Egypt or some parts of modern Melanesia, leechcraft may become specialized to the point of having a doctor for every disease.
Apart from shamanism, the actual medical knowledge of primi- tive man, given his hmitations, was far from contemptible. As the folk-lorists point out, the function of the medicine man was a limited one, and the art of healing never progressed very far so long as it was under the sway of belief in the supernatural. As the savage advanced a little further in the knowledge which is gained fi'om experience, it was natural that some special talent for herl)- doctoring, bone-setting, and rude surgery should ])e developed and
1 See W. H. R. Rivers, Fitzpatrick Lectures, Lancet, Lond., 1916, i, .59: 117. - Sir James G. Frazer: The Magic Art (The Golden Bough, pt. i), London, 19i;3, i, 52-219.
' Frazer: Taboo and the Perils of the Soul (Golden Bough, pt. ii), London, 1911.
* Frazer: Balder the Beautiful (Golden Bough, pt. 7), London, 191.3, ii, 95-278.
24 TIISTOHY OK MKDICINE
oiiiployod ns n spooinl moans of liv(>lilioo(l hv oortnin individuals. Alonji witli these naturc-liealei-s Ihcrc \V(>nl, of coui-sc, llic in- evitable "\vis(>-\voni('n," who followed licih-lhciain' and midwifery, and such specialists soon i)erc(Mvcd that a numhcr of poisons are also rcMuedies uiuUm- various conditions. M(>dicinc, which Huxley has so truly styled the foster-mot hci- of nian>- sciences, ically began with this crude plant- and ])()ison-lore of primitive^ peoples.
Early man rsganlcd tlic |)i)is;)iicr witli tlic same lioirdr and Idathinn that wo f<M'l, l)ooauso, as 'Plionias ])()int'^ out/ the use of jjoison involves the idoa of (l(>ath without tjip possibiHty of motor resistance, without tjivinji; the victim a fiplitinji cliance.
ANhen I'iysses apphed to llus at Ephyra for a deadly arrow-poison, Ilus dcH'Hnod, "for lie had in awe the immortal gods" (Odyssey, i, 200). At the ancicMit Creek festival of the Tharjiclia, given at Atliens every May, two public outcasts, sot apart for the i)uri)ose, were flofigod with squills, wild fig; branches or agnus ciustus, and possibly stoned to death or flung into the sea. The scapegoat, in this case, was callerl the Pharmakos, wliich also means a poisoner, sorcerer, or magician. \Mi(>ther th(> verb from which the word drug (tpapnaKOp) is derived meant originally "to give drugs or poisons" or "to drive away evil spirits with blows" is a matter of disj)ut(>.- But it seems probable that the original pharmacologist was eyed with suspicion.
Primitive man's knowledfi:e of medicinal simples was exactly like the drug phase of our modern therapeutics — extensive, if not intensive — and where he made mistakes it was (as in our own case) due to the cause which Kant assigns for all human error — the in- veteracy of the post hoc, propter hoc tendency in the human mind. Like many physicians today, he tried to treat the disease rather than the patient, not realizing (as we are just l)eginning to realize) that the dynamic effect of a drug upon the patient's body depends as much upon the deUcate chemical adjustments of that body as upon the composition of the drug itself. Whenever many differ- ent remedies are proposed for a disease, it usually means that we know very little about treating the disease, and the same thing is true of a drug which is vaunted as a panacea or cure-all for many diseases. "In listening to the praises of these panaceas," said Peter Krukenberg, the old Halle clinician, "we seem to be actually standing before the booth of a moimtebank."^ We are not much better off than early man in this respect. Thus, the hieratic writ- ings of the Egyptian papyri reveal an unusually extensive materia medica, the excellence of which is vouched for in the Homeric poems, and which can today be duplicated, in extent at least, in the materia medica of old civilizations like China or Japan, or even in our own bulky pharmacopeias. The ancient Egyptians, Chinese,
1 W. I. Thomas: Sex and Society, Chicago, 1907, 163-167. = See Morlev Roberts: The Pharmakos, Folk-Lore, Lond., 1916, xxvii, 218-224.
^ Cited by Baas.
IDENTITY OF FORMS OF ANCIENT AND PRIMITIVE MEDICINE 25
and Aztecs had botanic gardens (Hill). We find that savages in widely separated countries easily get to know the most fatal arrow- poisons — curare, ouabain, veratrin, boundou — as well as the vir- tues of drugs, like opium, hashish, hemp, coca, cinchona, eucalyp- tus, sarsaparilla, acacia, kousso, copaiba, guaiac, jalap, podo- phyllin, or quassia. Abel and Macht have shown that the ancient European belief in the venomous nature of the toad and the power of its dried skin to cure dropsy is explained by the two alkaloids, bufagin and epinephrin, which they isolated from the tropical Bufo agua. Bufagin (C18H24O4) has a marked diuretic action.^ W. E. Safford has shown that the various narcotic snuffs used by the Indians of the West Indies and South America are all products of Piptadenia yeregrina.^ Not to go further than our own country, we find the North American Indians aware that arbutus is "good" for rheumatism; lobelia for coughs and colds; wild sage tea, golden- seal, flowering dogwood, and prickly ash berries for fevers; elder, wild cherry, and sumac for colds and quinsies ; wild ginger, ginseng, and euphorbia for digestive disorders; inhalations of pennyroyal for headache; sassafras or violet leaves for wounds and felons; and the roots of sassafras and sarsaparilla for "cooling and puri- fying the blood." In 1535-36, the Iroquois around Quebec, as Jacques Cartier relates, treated scurvy in his crew very successfully with an infusion of the bark and leaves of the hemlock spruce; and the French at Onondaga in 1657 found the sassafras leaves, recommended by the same tribe, "marvellous" for closing wounds of all kinds.3 The "Materia Medica Americana" (1780) of the old Anspach-Bayreuth surgeon Schoepf, who came over with the Hessian troops during the war of the llevolution, shows that the Anglo-Saxon settlers in the New World had already learned many wrinkles in herb-therapy from the red men, in addition to the very rich medical folk-lore which they undoubtedly brought with them from Old England. The plant-lore of rural England included a knowledge of the virtues of camomile-, sage-, and dandelion-teas as laxatives; of marjoram and primrose root for headache; of wormwood as a tonic; of valerian for the "nerves"; of agrimony and parsley for jaundice; of meadow-saffron (colchicum) for gout; of fennel, eye-bright (euphrasy), and rue for bad eyesight; of male fern and peach-leaves for worms; of tansy as a vermifuge and
1 Abol, Macht: J. Pharm. Expor. Therap., Bait., 1911-12, iii, 319-377.
2 Safford: Jour. Wash. Acad. Sc, 1916, vi, 547-562.
'See Yager: "Medicine in the Forest," Oneonta. N. Y., 1910. Yager notes the infrequency of panaceas and gunshot prescriptions among the North American Indians; each remedy was administered by itself for a given con- dition. For the theory and formuUe of Cherokee medicine, see J. Mooney: Bur. Am. Ethnol. Rep., Wash., 1891, vii, 319-369.
26 IllSTdltV ol' MKDICINK
altorlifacitMil : of liorclKUiiul, niarsliinallow oi- candied clccaiiipaiic iov CDUiilis and colds; of foxj^lovc as "tli(> opium of llic licail"; and of such "vuliwM'ary plants" as hryonx', a.uriinoii>'. hare's oars, nioon\voi-t, alchoof, and ^oldtMU-od. Mn^lish pocti-y and folk-loro ■Avc full of n>fci(Miccs to thynio and niaijorani, rosc^inaiy and rue, luistltMoc and ash. as well as poisons like hemlock, leopard's bane (aconite), tlu> deadly nijihtshade (belladonna), "the juice of cursed hebenon" (yew), and henbane (hyoscyanius), which Aretaeus re- •larded as a cause of insanit\- and to which Shakespeare refers in tlie same spirit as
tlic insane root That takes the rea.sun prisoner.
Asphodel, or dittany, is often mentioned in the Homeric poems as a balm a<j;ainst the pain of newly inflicted wounds, and the same tradition is still current among the country folk of Lancashire, Ireland, and the moors of Scotland. Kipling has summed up the whole matter in a charming verse —
Alexanders and Marigold,
Eyebrisht, Orris and Elecampane, Basil, Rocket, Valerian, Rue,
(Almost singing themselves they run), Vervain, Dittany, Call-me-to-you—
Cowslip, Melilot, Rose of the Sun. Anything green that grew out of the mould Was an excellent herb to our fathers of old.
In the use of natural or physical means against disease we dis- cover that primitive man, with his well-ventilated habitations and his hardy life in the open air, has advantages which his civilized brother often seeks or finds only on compulsion. The Indian^ knew, for example, the importance of keeping the skin, bowels, and kidneys open, and, to this end, the geyser, the warm spring, and the sweat-oven were his natural substitutes for a Turkish bath. Emesis or catharsis, followed by a vapor bath and a cold plunge, set off by a dose of willow-bark decoction (salicin), was the North American Indian's successful therapeutic scheme in the case of intermittent and remittent fevers; a vapor bath and cimicifuga were his mainstays against rheumatism. Like the ancient Baby- lonians, he had his fixed periods for ritual emesis and catharsis (e. g., the green-corn feast), much as our forefathers used zodiacal calendars for blood-letting. Massage was long known and prac- tised by the Indians, Japanese, Malays, and East Indians. In the
^ For a full account of the medicine of the twentieth century Indian, see A. Hrdlicka, Bur. Am. Ethnol.. Bull. No. 34, Wash., 1908, 220-253.
IDENTITY OF FORMS OF ANCIENT AND PRIMITIVE MEDKTNK 27
opinion of Rivers/ massage was imported into Melanesia l)y Poly- nesian castaways, since Polynesian massage is apparently a true rational therapeutic measure, while Melanesian massage is some- thing superimposcnl upon a magic rite. Hypnotism originat(Hl among the Hindus; inoculation against smallpox among the Hindus, Persians, and Chinese. Lady Mary Wortley Montagu got her idea of variolation from the East, and it is still employed among the North and Central African tribes and races (Arnold Klebs-). Th(> early Japanese employed the moxa as the Chinese did acupuncture. The Chinese of the Mongol dynasty (1260'') probably learned of the use of spectacles from India via Turkestan. Snow-spectacles have been employed l)y polar tribes.
Surgery became a science in recent times, not so much through individual skill or specialization of instruments, as through the introduction of two new factors — anesthesia and antisepsis. Prim- itive surgery included all the rudiments of the art. The earliest surgical instrument was in all probability not the speciahzed leaf- shaped flint or "celt," already referred to, but rather some frag- ment unusually sharpened as to edge and point by accidental flaking,^ as in the obsidian knives of Peru. By means of these sharpened flints or of fishes' teeth, blood was let, abscesses emptied, tissues scarified, skulls trephined, and, at a later period, ritual operations like circumcision were performed, as we hav(^ seen, with the primitive celts themselves. Decompressive trephining for epilepsy or other cerebral disorders goes back to prehistoric times, the finds showing that it was often done more than once upon the same person, the bits of skull excised ])eing used as amulets. It is said that trephining is still practised among the Aymaras of Bolivia and the Quichuas of Peru,^ and another evidence of it is the curious crosswise mutilation along the lines of the coronal and sagittal sutures, first noticed as a common practice among the Loyalty Islanders Ijy an English missionary. Rev. Samuel Ella, in 1874,'^ and which Manouvrier found afterward in neolithic female
' W. H. R. Rivers: Massage in Melanesia: Tr. xvii. Internat. Cong. Med., 191.3, Lond., 1914, Sect, xxiii, .39-42.
•' Klebs: Johns Hopkins Hosp. Bull., Bait., 1913, xxiv, 70.
3 B. Laufer: Mitt. z. Gesch. d. Med., Leipz., 1907, vi, 379-38.").
' The writer is indebted to Prof. William H. Holmes for this impcjrtant information.
* A. Bandelier: V(>ber Trei)aniereii untcr den heutigen Indiaiieni Holivias (Internat. ('ong. Americanists, 1S94). S. .). Mo/.aiis (Rev. .1. A. Zahm), in his "Along the Andes and Down the .Vitkizoii" (New York, 1911), pp. 20(), '207, is of ()])inion that the l(>aves of Eri/lhro.n/loii corn, when chewed, have anesthetic proi)erties, of which he gives a remarkable instance. This would explain how easily the Peruvians may have accomplished trephining with the aid of a sharp piece of flint or obsidian.
6 Ella: Med. Times & Gaz., Lond., 1874, i, .50.
28 iiisroin" ok MKniciXK
crania from Sciiu'-et-l >is(' niid cMllcd the "siii('ii)ital 1'" (1895'). Tr(>phinini;; has hccn i\ouv on the skull with shai-pciunl prehistoric flints in thirty-fiv(> to fifty mimilcs hy i.ucas-( 'hanipionnirrc and Hollander.'- PriniitiNc man's wounds were dressed with moss or fresh leaves, ashes or natural balsams, and, when poisoned, treated by suckinj]:; or cauterization. Ciii)i)inj; was performed by means of animals' horns. The revulsive effects of some accidental wound or hemorrhage, or the natural and |)ei'iodic process of men- sti'uation sufifi;est(>(l, no doubt, the advantaj^es of blood-lcMtinji;, which was to Ixm-ouk^ a sort of therapeutic sheet-anchor throuj^h the aues. For couchiiifi; a cataract or opening an abscess, even a sharp thorn sufliced. The Dayaks of Borneo employ a sharj) root (l)injanip()). In the more advanced i)hases of cultural develop- ment, pieces of hard wood may have been pointed and edged, like the flint knives. Neolithic saws of stone and bone, possibly im- itated from the teeth of animals, also exist, and with these Hol- lander has performed amjMitation in six to seven minutes. The characteristic signs of amputation have been found in prehistoric bones. ^ During the Bronze and Iron Ages expert skill in metal work became an accomplished fact, and surgical instrumentation was correspondingly improved. In the excavations of the Swiss Lake Dwellings, which w(M-e discovered in 1853^ the different cul- tural objects were found in successive layers, from the Stone Age (NeoHtliic or Alluvial Period, 3000-1500* B. C.) up to the Bronze and Iron Ages (1500-400 B. C), and of these, the real beginnings of northern European culture are now held to be the metal imple- ments and objects found at La Tene. The phrase "La Tene" symbolizes, for anthropologists, the starting-point of the cultural periods following upon the three Ice Ages, with their two inter- glacial periods, not because the Lake Dwelling finds are necessarily the earliest iron objects known, but because they are the most representative and characteristic. La Tene was preceded by the Eohthic, Paleohthic, Neolithic, Bronze Ages, and the Iron(Halstatt) Age (700-400 B. C). In the Bronze Age surgical saws and files were plentiful everywhere, from Egypt to Middle Europe.^ The
' L. Manouvrier: Rev. mens, de I'Ecole d'anthrop. de Paris, 1S96, vi, .57; 1903, xiii, 431. Manouvrier thinlcs the sincipital T may have been identical with the crucial cauterizations of the skull recommended by Ayicenna and others, if not a ritual mutilation. Gron regards it as a mode of judicial torture. SudhofT identifies it with a derivative procedure employed by the Alexandrian surgeons for ocular catarrhs and mentioned by Celsus (vii, cap. xii, sect. 1.5).
2 Luca.s-Championniere: Trepanation neolithique, Paris, 1912.
^ E. Hollander: Die Chirurgische Sage. Arch. f. klin. Chir., Berl., 191.5, cvi, 317-320.
* First investigated by PVrdinand Keller in 1853-4.
5 Hollander: Die Chirurgi.sche Sage. Arch. f. klin. Chir., Berl., 1915, cvi, 320-336.
IDENTITY OF FORMS OF ANCIENT AND PRIMITIVE MEDICINE 29
La Tenc finds, dating; from about 500 B. C. to 100 A. D., entirely distinct from Ejiyptian, Indian, or Greek culture, include iron knives, needles, fibulae, swords and lances, with bracelets, neck- laces, and ear-rings of Etruscan or West Celtic pattern, and funeral urns containing human remains, showing that cremation was the rule among the La Tene people. Some time later, as, for example, among the Gallo-Roman finds in France, we trace the evolution of the jointed or articulated surgical instruments, like scissors, in which cutting was done by indirect action.^ With improved metal instruments, such cosmetic operations as tattoo- ing, infibulation, boring holes for ear-rings and nose-rings, or the Mica operation (external urethrotomy), as well as amputation and hthotom}', could t)e essayed. The ancient Hindus performed almost every major operation except ligation of the arteries; ovariotomy has been done by Indian and Australian natives, and Felkin witnessed a native Cesarean section in Uganda in 1878. Both operations are said to have been performed by German sow- gelders in the sixteenth century.
The use of a soporific potion as a substitute for anesthesia goes back to remote antiquity, as symbolized in the twenty-first verse of the second chapter of Genesis: "And the Lord God caused a deep sleep to fall upon Adam, and he slept: and he took one of his ribs, and closed up the flesh instead thereof." From the soothing Egyptian nepenthe of the Odyssey, which Helen casts into the wine for Ulysses, to the "samme de shinta" of the Talmud, the "bhang" of the Aral)ian Nights, or the "drowsy syrups" of Shake- speare's time, the soporific virtues of opium, Indian hemp {Cannabis indica), the mandrake {Airopa mandragora), henbane {Hyoscy- amus), dewtry (Datura stramonium), hemlock {Conium), and let- tuce (Lactucarium) appear to have been well known to the Orientals and the Greeks-; and, in the thirteenth and fourteenth centuries,
1 See M. Baudouin: Arch. prov. de chir., Paris, 1910, xix, 228-238.
2 Poppy and Indian hemp were probably known to the Egyptians and consequently to the Cireeks; mandragora to the Egyptians, Babylonians, and Hebrews. Theophrastus and Dioscorides were the first to mention the aphrodisiac and soporific properties of Airopa nHnidragora. It is not clear whether the mandrakes which Rachel sought of Leah ((ienesis xxx, 14-16) were for the former purpose or to ease the i)angs of childbirth. Dioscorides was the first to si)eak of the employment of mandragora wine for surgical anesthesia, and his recipe was tried out with success by Sir Benjamin Ward Richardson (Brit, and For. Med. -Chir. Rev., Lond., 1874, liii). The mandrake is also mentioned bj' Celsus, Pliny, Apuleius, Paul of ^gina, and Avicenna, and the legends about the human sliape of the root of the plant, its frightful shrieks when uprooted, and the necessity of emi)l()ying a dog, hitched to it for this purpose, are a common feature of early iMiglish and German folk-lore. Drugging with Indian hemp or henbane ("tabannuj") was common among the ancient Hindus and the later Arabs, and Sir Richard Burton adds: "These have been used in surgery throughout the East for centuries before ether and
N|
'M) IllNlOin ol MKDICINK
a inixluro of some of \\\vsr iiijii-cdiciits ("oleum ^Ic lalcfihiis") was formally rccommrndcd for surgical anesthesia l)y the iiuMheval masters, Xicolaus Salernitanus, ('o|)ho, Iluffh of Lucca and his son TluMxlorie, in the iorm of a "spoiKjid somiiifcni' or "confcctio wpon's" for inlialation. Aj^ain, the use of such natural anti- septics as extreme dryness, smok(^ (creosote), honey, niter, and wine was lonp; known tit early num. In seekiuf; an "artificial paradise" by means of narcotics and intoxicants like alcohol, ojMum, hashish, or mescal, jMnority certainly belongs to primitixc man, to whom we also owe such private luxuries as tea, coffee, cocoa, and tobacco. INIedicine is curiously indebted to the non- medical man for many of its innovations. As Oliver Wendell Holmes has said:
It learned from a monk how to use antimrtny, from a .Tosnit how to cure agues, from a friar how to cut for stone, from a sol(iier how to treat gout, from a sailor how to kecj) ofT sourvv, from a postmaster how to sound the I'lustachian tuh(\ from a dairy-maid liow to jirevent smaUi)o,\, and from an old market- woman how to catch the itch-insect. It borrowed acupuncture and the mo.xa from the Japanese heathen, and was taught the use of lobelia by the American savage. 1
In the field of obstetrics, we find the midwife to be one of the most ancient of professional figures. Engehnann's careful ethnic- studies of posture in labor show the universal tendency of primi- tive and frontier w'omen to assume attitudes- best adapted to aid or hasten delivery. The obstetric chair, first mentioned in the Bible and b}' the Greek w^riters, appears to be of great anticiuity, and is still used by some races of the far East.
The development of a rational, scientific concept of the true nature of disease, not as an "entity" inside the body, but as altered physiology (dis-ease), is essentially modern, and of very recent vintage. The most difficult problem that confronts the medical historian is: how did early man acquire correct logical thinking in regard to the treatment of disease? Concerning this
chloroform became the fa.'^hion in the civiKzed West." (Arabian Nights, Denver edition, vol. iv, footnote to p. 71.) Hua, a Chinese physician, is said to have used hashi.sh in surgery about 200 B. C. According to S. J. Mozans ("Along the Andes and Down the Amazon," New York, 1911, pp. 206, 207), the ancient Peru^^an Incas probably utilized the anesthetic properties of the active principle of Erythroxylon coca in trephining. He cites a modern in- stance of a coqucro (habitual chewer of coca leaves) who was run over by a car and experienced no apparent pain, although his foot had been taken ofT in the accident.
1 O. W. Holmes: Medical Essays, Boston, 1883, 289. For a more exten- sive presentation of this interesting subject, .see George M. Gould's essay on "Medical Discoveries bv the Non-Medical," in Jour. Amer. Med. Assoc, Chicago, 1903, xl, 1477-1487.
2 George J. Engelmann: "Labor Among Primitive Peoples," St. Louis, J. H. Chambers & Co., 1882.
IDKNTITY OF FORMS OF ANCIENT AND PRIMITIVE MEDICINE 81
phase of the mens medica, still in process of evolution, Osier, in his Silliman Lectures, cites the beautiful, lucid exposition in Celsus :
"Some of the sick, on account of their eagerness, took food on the first day, some, on account of loathing, abstained; and the disease in those who refrained was more reheved. Some ate during a fever, some a httle before it, others after it had subsided, and those who had waited to the end did best. For the same reason, some at the beginning of an illness used a full diet, others a spare, and the former were made worse. Occurring dailv, such things unpressed careful men, who noted what had best helped the sick, then began to prescribe them. In this way, medicine had its rise from the experience of the recovery of some, of the death of others, distinguishing the hurtful from the salutary things."
In his analytical studies of the development of scientific medicine from prehistoric, folk and magic medicine, Hovorka postulates certain "laws of congruence, in virtue of which primitive or ancient man everywhere, in space and time, deduced identical remedies for certain disea.'='es, proceeding (1) by •repetition and imitation," evolving and adopting effective remedies by the trying-out process; (2) by establishment of such therapeutic principles along well-trodden paths; (3) by promoting belief and confidence through devices of similarity or symbolism and through the suggestive effect of verbal and ocular magic. The fundamental phases of therapeutic reasoning are thus "the device of gaining time" until nature effects recovery or a fatal termina- tion, "the inquiiy into the cau.se" where accessible; and "the fhght into mysticism" when causes are inscrutable. ^
We now come to a phase of primitive healing which is inti- mately connected with even the most recent aspects of the sub- ject, namely, the effect of therapeutic superstitions and the actual cure of disease through the influence of the mind upon the body. This is a matter which can be approached in no derisive spirit, especially in the light of modern quackery and its successes. The closer we look into the ways of primitive man, the more liable it is to take down our own conceit. The untutored savage, as we have seen, thought that motion of any kind is equivalent to life. Wherein does he differ from the ultra-mechanistic physiologist who re- verses the equation? Simply in this, that the mind of the savage is, as Black says,^ like a looking-glass, reflecting everything and retaining nothing. As soon as an object passed from his observa- tion its image disappeared from his mental vision and he ceased t o hug the fact of its existence, still less to reason about it. The primitive mind is, as Rowland scornfully said of "the ordinary cultivated or legal mind," essentially ''discontinuous." The scien- tific mind at least aims, in its methods, at continuity of thought. The folk-mind, even today, has this inevitable tendency to mix up the post hoc with the propter hoc and to confuse accidentals with essentials. Almost any one who has Uved in the country, for in-
' O. von Ilovorka: Leitmotive und Elementarmethoden der allgemeinen Heilkunde. Mitt. d. anthrop. Gesellsch. in Wien, 1915, xxxv, 125-13G. Also his Geist der Medizin, W'um and Leipzig, 1915.
2 W. G. Black: Folk-Medicine, London, 1883, p. 207.
.VJ HIsroHV OF MKDICINK
st;iiir(\ will 1)(> f;iniili;n- with Naiioiis lural supprstitions relating to walls that killinu; oi' liaiHlliiiii- a toad may causp them aiul that thry call tx' rpinoNcd liy sonic one toiicliin<z; tliciii with ix^hhlos or inuttcrinji charms oxvv them; or with the notion that stump-water is good i'or t'reckl(>s, wiiile had (>yesi<ilit can he remedied hy the water into which the hlacksmith has dipjx'd his re(l-liot iron. In some ])arts of Holland, if a hoy carr\iiig watei'-lilies in his hand falls down, it is supi)osed to render him liable to fits, l^eaders of Longfc'llow's "L^vangeline" ma_\' I'ecall the line which refei's to malaria as
Cured by wc^urinfi a spider hnufs, around one's neck in a nutslicll.
In Norfolk, England, this spider was tied up in a piece of muslin and i:)inned over the mantelpiece as a remedy for whooping-cough. In Donegal, a beetle in a bottle was regarded as a cure for the latter disease; in Suffolk, to dip the child, head downward, in a hole dug in a meadow; in northeast Lincolnshire, fried mice; in Yorkshire, owl-broth; in other parts of r]ngland, riding the child on a bear; in Scotland, anything that might be suggested by a man riding upon a piebald horse. ^ Compare these fallacies, inept as they seem, with what has happened so often in the history of thera- peutics. A patient's cure follows seemingly upon the administra- tion of some new-fangled remedy or drug. Immediately, a causal relation is established and the discoverer rushes into print with the glad tidings. Statistics begin to mount up, until presently the correlation curve is perceived to have so insignificant a slope that nothing positive can be affirmed of the remedy whatever. It is then speedily consigned to the limbo of forgotten things.^ Not so with folk-remedies. The superstition becomes, as the derivation implies, something standing over; and for a very important rea- son, namely, that in some cases "Nature cures the disease while the remedy amuses the patient"; in others a cure is, in all proba- bility, brought about by the effect of the mind upon the body.
Black, the leading English authority on medical folk-lore, has made a careful and exhaustive classification of the different super- stitions to which average suffering humanity is liable.^ These include ideas as to the possible transference of disease, sympathetic
1 Black: Op. cit., passim.
2 J. C. Bateson cites a recorded case of a Turkish upholsterer who, during the delirium of typhus fever, drank from a pail of pickled cabbage and re- covered, whereupon the Turkish doctors declared cabbage-juice a specific for the disease. The next patient dying under this regime, however, ttiej^ modi- fied the dogma by saying that cabbage-juice is good for typhus provided the patient be an uphoksterer. Dietet. & Hyg. Gaz., N. Y., 1911, xxvii, pp. 297, 298.
3 Black: Op. cit., pp. .34-177.
IDENTITY OF FORMS OF ANCIENT AND PRIMITIVE MEDICINE 33
iclationsliips, the p()ssi})ility of new-birth or regeneration, the effects of such accidental specific factors as color, number, solar and hmar influences, magic writings, rings, precious stones, parts of the lower animals, and charms connected with the names of the saints, the lore ofjjlants, the evil eye, birth, death, and the grave. To look into these is to see clearly that "wonder is of the soul." As the savage "sees God in clouds, or hears him in the wind," so his ancestors saw disease not as a quality or condition of the patient, but as something material and positive inside his body — a view held even by Paracelsus. From this idea arose a notion that disease could be transferred from one body to another, as where Pliny, in his Natural History, claims that abdominal pain can be transferred to a dog or a duck. Touching warts with pebbles, h(\aling snake-bite by clapping the bleeding entrails of a l)isected fowl to the wound (natural absorption), and the negro suj:)ersti- tion of pegging a hank of the patient's hair into a tree in order to transfer chills and fever to the tree or its owner, are well-known forms of this curious belief. Sir Kenelm Digby proposed the fol- lowing remedy for fever and ague: "Pare the patient's nails; put the parings in a httle bag, and hang the bag around the neck of a live eel, and place him in a tub of water. The eel will die, the patient will recover."^
In medical mythology the doctrine of transference of disease derives from the idea of purification (catharsis) or lustration. The scapegoat was usually a god, or his substitute in the shape of a person, animal, or inanimate object, upon which the sins of the people might be unloaded. Among the Aztecs, a human being was annually sacrificed in place of Vitzliputzli or other gods. At the festival of Xipe, the Flayed Clod, the Mexicans killed all prisoners taken in war, who were flayed beforehand, the skins being worn by those con.secrated to this cult. In the Roman Saturnalia, Saturn was personated by a man- scapegoat, who was afterward put to death. In the Greek Thargelia, as we have seen, there were two scapegoats {(papfxaKoi- ) . Ancient sacrifice was sometimes honorific {hostia honoraria), a gift to the god; sometimes cathartic or piacular {finstia piacularis) , to conciliate the wrath of the good or evil pow- ers, in which case human sacrifice was usually demanded; sometimes mj^stical or sacramental, in which the god was conceived to be slain or eaten by his worshipers (Robertson Smith). In honorific sacrifice, the god and his wor- shipers shared the sacrifice as commensals or totem-companions, of the same totem-kin, and the victim was sometimes an animal representing a hostile totem, sometimes one sacred to the god. In piacular sacrifice, a totem ani- mal or plant could be substituted for the human victim, and, in mystic sacri- fice, the god was represented by a similar animal or plant to partake of which was to enter into communion with hini.^ With this obscure set of cults, wid(>ly different in different peoples, is connected the consecration of sacrificial plants or parts of sacrificial animals as therapeutic agencies.^ The Kathar-
* Cited by (). W. Holmes, "Medical Essays," Boston and New York, 1883, p. 381.
2 Frazer: The Scapegoat (Golden Bough, pt. 6), Lond.. 1913, 2.52; 275; .306.
3 X. W. Thomas: Encycl. Britan., 11 ed.. Cambridge, 1911, xxiii, 980-984. •• M. Hofier: Wald- und Baumkult (Munich, 1892); Die volksmedizinische
Organotherapie, Stuttgart, 1908; Janus, Amst., 1912, xvii, 3; 76; 190.
34 lllsroUY OF MKIMCINK
iii:i(;i (»r rrjoots of sacrilicc, t'atcn hv tlic worshipers, wore litorally "made sacrtMl" by tlic rite. 'I'o this day the cvistoiii of "eating (lie ^od" persists in the l)rhef of iMiropcaii jtcasaiits tliat inediciTial hfrl)s arc iiiatcriahzcd hrncvo- ItMit spirits. In nearly all iMiropean countries the i)lants culled at Midsum- mer (St. John's) lOve acipiired transient magical or medicinal virtues.'
Closely coinuH'ted with this idea of ti-aiisi'ciciicc was the old tradition of a sympathy (>xistin}>; l)(>tw('(Mi parts of l)()di(>s separated in space (Frazer's "sympathetic ma^ic"), amusiiifily illustrated in Sir Kenelm I)i<j;hy's w<\ipoii-saly(\ which was applied to the \yeapoii instead of th(> wound, and in t lu^ same worthy's
Strangle hermetic powdi'r
Tiiat wounds nine miles point blank would solder,
By skilful chemi.st with fireat cost
Extracted from a rotten post.
The idea of material rep;en(M-ation or new-birth is of Hindu (Aryan) origin and sprang from the primitive worship of the genera- tive power of nature, the cult of the lingam and the yoni, the Hel- lenized form of which is so strikingly set forth in the fourth book of Lucretius. A cleft or hole in a rock or tree was regarded as sym])olic of the sacred yoni, and children (even adults) afflicted with scrofula, spinal deformity, or other infirmities, were supposed to be freed from these bodily ills when passed through it. Traces of the Saxon form of this superstition survive in the "holed stone" near Lanyon, Cornw^all, through which scrofulous children w^ere passed naked three tim&s, in the "Deil's Needle"' in the bed of the River Dee (Al)erdeenshire) which was held to make barren women fertile if they crept through it, and in the Crick Stone in Morva, Cornwall, passage through which was esteemed a cure for any one with a "crick in the back." It was White of Selborne'' who de- scribed the most recent form of this folk-l^elief in sympathetic magic, which consists in passing a child afflicted with hernia through a cleft in an ash-tree. In 1804, there was such a tree at the edge of Shirley Heath, on the road to Birmingham.^ As late as 1895-6, such trees were described as existing for this purpose in Suffolk and Richmond Park,^ and there was once a similar tree in Burlington County, New Jersey. The Scotch custom of passing a consumptive child through a wreath of woodbine, the English
'Frazer: Balder the Beautiful (Golden Bough, pt. 7), London, 1913, ii, 45-75.
2 See "The Stone in Scotti.sh Folk-Medioine," by Dr. David Rorie, in the Caledonian Med. .Jour., Glasgow, 1911, viii, pp. 410-415, giving an inter- esting photograph of the "Deil's Needle."
3 Gilbert White: Natural History of Selborne, 1789, p. 202 (cited by Black).
* Gentleman's Mag., Lond., 1804, 909. Cited by Frazer.
5 Folk-Lore, Lond., 1896, vii, p. .30.3; 1898, ix, p. 3.30, wnth photos.
IDENTITY OF FORMS OF ANCIENT AND PRIMITIVE MEDICINE 85
trait of crawlinfi!; undtM- a branilile bush for rhoumatisui, and the "eye of the needle ti'ee" on the island of Innisfallen, Killarney, squeezing through which insures long life and safe delivery to woman with child, are mentioned by Black as variants of this superstition. Frazer regards the practice as a phase of sympa- thetic magic, associated with the idea that the "external soul," the life of a person, is bound up with the life of a tree or plant. ^
Color is a factor of great moment in folk-healing ; in particular, red, which the Chinese and New Zealanders regard as hateful to evil spirits, and other peoples as a heat-producer. Red silken bands, necklaces of coral beads, red pills and red fire, as well as the red coral ring and bells with which the baby cuts its teeth, have all had their superstitious associations, and the virtues of the familiar red flannel cloth worn around the neck for sore throat and whooping-cough wei'c supposed to reside "not in the flannel but in the red color.'"- Finsen's red-light treatment, to prevent pitting in smallpox, was once an ancient folk-belief, known to the Japanese, and employed successfully by Gilbertus Anglicus, Bernard de Gordon and by John of Gaddesden in the case of the son of Ed- ward II. According to Valescus of Taranta, the rationale of the red-light treatment was the ancient "doctrine of signatures," in virtue of which a remedy was applied on account of some fancied resemblance, in shape or color, to the disease. The red cloth hang- ings around the smallpox patient were supposed to lower his tem- perature by drawing the red blood outward.
The idea that certain numerals can be sacred or malignant is of Accadian origin, connected with Chaldean and Babylonian as- trology, and familiar to us in the Horatian "nee Bahijlonios tenta- ris mimeros." Of mystic numbers, usually odd, three or a mul- tiple of three is the most popular for luck, good or bad; seven or one of its multiples for supernatural powers. Hesiod (Works and Days, 765-828) says that the first, fourth and seventh days of the month are "holy days," the eighth (4 + 4) and the ninth (3 X 3) "specially good for the works of man"; the twelfth (3 X 4) is better than the eleventh; the fifth "unkindly and terrible," be- cause on a fifth "the Erinnyes assisted at the birth of Horcus"; the ivnih is favorable for a boy to be born, the fourth for a girl; the ninth of the first month "is a good day on which to beget or be born, both for a male and a female: it is never an wholly evil day." It was not for nothing that there were three Fates, three Furies, nine Muses, twelve months and twelve signs of the zodiac,
' Frazer: Baldor the Beautiful (Golden Bouch, pt. 7), London, 1913, ii, 159-195.
2 Black: Folk-Medieine, London, 18S3, 111.
30 IIlsroUY OV MEDICINE
s(>V('n (lays to the week, twcKc liouis around IIk' clock, and so on. ThiHM' handfuls of (>arth iwo always dropped on the coHin at burial. Palmists, i'ort un(>-lcll('rs, and otlici-s of thcii' kind work assiduously (as I heir siuns read) "tVoni nine to nine," and gamblers usually bet on odd numbers. In Scotland and Poi'tufi'al, the seventh son of a se\-entli son is ol'leii iciiaided with horror or V(>neration, as one |)osse.ssed of second sijiht and other uncanny attributes. Sueh folk-r(Mnedies as the \\'est Sussex recipe for ag,\w — "eat fastinji; se\-en sa,<2;c leaves for se\-en m()iiiin<is fasting" — are coirnnon enough. \'alesous de Taranta arrangcnl his huge therapeutic Philoniiuti in sev(>n books out of a serious veneration for the solemn numlxM' .seven. In Chiiu^se medicine, five is th(^ sacred number. A reasonable aspect of number-lore in medical literature is the Hippocratic doctrine of crises and critical days^ (dies nefasti) which probably derived from the teaching of Pythagoras, who had assimilated it fi'oni the Chaldean folk-traditions. Here the folk-lore of numbers has a germ of scientific ti'uth in that there is a certain periodicity in some of the phenomena of disease. The curves of rape, murder, and general "running amok" (including wars) rise in hot weather. That certain infectious diseases recur at definite periods gave rise to the doctrine of the genius epidemicus or epidemic constitutions. The known periodicity of epidemic diseases from year to year justified the old Chaldaic superstition of the "evil year" (malus annus), which, in the Middle Ages was associated with a certain serpiginous or ])ullous eruption in man and animals {Malum malannutn-). Another superstition which came from Chaldean astrology was the belief that the heavenly bodies had an influence upon disease. The sun, moon, stars, and planets were regarded as sentient, animated beings, exerting a profound influence upon human weal and woe, and, late into the seventeenth century, European mankind resorted to horoscopes (the "judicia astrorum") before attempting any enterprise of moment, and in particular to determine the proper time for blood- letting, emesis, and purgation. Health, strength, and sexual power were supposed to vary with the waxing and waning of the moon. Moonshine was supposed to be potent alike in causing lunacy, conferring beauty, or curing warts and diseases.''' Menstruation was connected with the lunar cycles. The full-moon was a libido symbol (White'*). To let blood when the moon and tides were at
1 For a historical study of the doctrine of critical days, see Sudhoff: Wien. med. Wochenschr., 1902, lii, 210, 272, .321, 371. Also, R. Steele: Dies .^pyptiaci, Proc. Roy. Soc. Med., Lond., 1919, xii, Sect. Hi.st. Med., 108-121.
= Hoefler: Janus, Amst., 1909, xiv, 512-.526.
^ Frazer: Adonis (Golden Bough, pt. iv), London, 1914, ii, 140-150.
* W. A. White: Psychoanalyt. Rev., N. Y., 1913-14, i, 241-2.56.
IDENTITY OF FORMS OF ANCIENT AND PRIMITIVE MEDICINE 37
full (dies /Egyptiaci) was adjudged bad practice in the Middle Ages. The lunar influence is further seen in the common super- stition that death occurs, as in the case of Shakespeare's Falstaff or of Barkis in "David Copperfield," at the turning of the tide. Darwin thought that the tidal periodicity of physiological phe- nomena in vertel)rates might be explained by their descent from "an animal allied to the existing tidal ascidians."^ Arrhenius, in his study of the influences of cosmic phenomena upon the organ- ism, has compared the curves of nativity, mortality, menstruation and epileptic attacks with the periodic maxima and minima of the electrical condition of the air.- Comparable with the influence attributed to the stars is the idea, already mentioned, that disease is a scourge or punishment inflicted by gods or demons alike and remediable only through divine or diabolic intervention. The mischievous powers, whose ideas of good and evil were apparently so interchangeable, could be propitiated or conciliated only by sacrifice, which, as Jakob Grimm pointed out, had the doul)le pur- pose (like the graft given to politicians) of kcejiing the powers in a good humor or of restoring good humor when necessar3\ "To coerce the spiritual powers, or to square them and get them on our side," says William James, "was, during enormous tracts of time, the one great object in our dealings with the natural world. "'^ The Greek myth of the arrows of far-darting Apollo, Bhowani, the cholera goddess of the Hindus, the many medical divinities of the Romans, the Indian and Samoyed lore of "magic bullets" (a motif in "Der Freischiitz"), the passage in the Book of Job in which the patriarch attributes his sufferings to "the arrows of the Ahiiighty," Martin Luther's conviction that "pestilence, fever and other severe diseases are naught else than the devil's work," Cotton Mather's definition of sickness as "Flagellum Dei pro peccatis miuidi," the medieval figurations of death as a reaper, (the "Schnitter Tod" of German folk-song), the folk-superstition that erysipelas (or "wild fire") originates from fairy malice, all illustrate the strength of this deep-rooted belief, which survived in the many sermons and prayers delivered in time of pestilence throughout the seventeenth and eighteenth centuries and even crops up in our day under various guises. In process of time, medical polytheism merged into monotheism. The Egyptian Phtah became Allah; the Chaldean Ea, the Sumerian Adapa and Quia, the Babylonian Marduk, the chthonian deities of the Greeks, the complex Roman scheme of household gods, the Druidic
' Darwin: Descent of Man, London, 1S71, i, 212, footnote. '^Arrhenius: Skandin. Areh. f. Physiol., Leipz., 189S, i, 367-410. ' W. Janiee: Gifford Lectures, New York, 1902. Cited by Osborn.
38 ms'ivHiY or MKniciNE
Bolon, th(^ M(>\i(';in Ixlilloii, all hccinic imili(>(l by the syiicrc'tic process cominon lo all lolk-lorc, and cNcii \hc separate rimctioiis of \\\c (lemons of disease, from Balnlon to medieval iMnope, were eventually absorbed by tlie Devil.' Of a piec(> with this theory of disease^ was (he nialif2;iiant or benij^nant. pow(>r which was siip|)osed to attach to certain personalities. A child born on lOastcr Eve could cure tertian or (luartan fever. Persons boin *'with a caul" were supposed to be clairvoyant. The power to heal scrofula by royal touch was i)art and parcel of the divine ri}>ht of kings. In the West of Ireland, th(^ blood of th(> Walshes, Keoghs, and Cahills is held to be an infallible remedy for erysipelas or toothache.'- The medical lore of holy men, their special days, the diseases they presided over and the holy wells and other things blessed by them, form a special field in itself. The saints were supposed, as usual, to have the power both of inflicting and healing diseases, most of which were, however, associated with the names of several saints. Thus the names of St. Guy, St. Vitus, and St. With are eponymic for chorea; St. Avertin, St. John, and St. Valen- tine stood sponsors for epilepsy, St. Hubert of Ardennes, the patron of huntsmen, cared for hydrojjhobia, while St. Anthony, St. Bene- dict, St. Martial, and St. Genevieve presided over ergotism. Kerler"* has compiled a bulky volume made up of indices of these patron saints of medicine alone. Sacred bits of pastry (Heil- brote), derived, as Hofler shows, from the ancient sacrificial cakes, were dedicated to these saints and eaten to ward off the particular diseases.*
A remarkable example of belief in the malevolence of person- ality is the superstition of the evil eye which causes Orientals to wear a crescent of horns over the forehead as a safeguard, and Levantines to cross their fingers or protrude the thumb between the index and middle finger {mano fica).
This belief, as Soligmann has shown, has existed from the earliest tirnes and is common to all human races. Mentioned in the Assyro-Babylonian incantations, declared a capital crime in the tables of the Roman Decemvirs (450 B. C), this power of inflicting evil has been ascribed variously to whole races or religious sects, to dogs, wolves, and animals of the cat family, to rep- tiles and mythical creatures, like the basihsk, to statues and inanimate objects, to gods, demons, spirits and all supernatural beings. In the Purana legend, Siva destroys a whole town with one withering glance, as Wotan destroys Hunding in "Die Walkiire." Lord Byron, Napoleon III, Queen Maria Amelia of Portugal, the Popes Pius IX and Leo XIII and the compo.ser Offenbach were all feared for this hypnotic power. According to the Roman
1 A volume of studies on the innumerable medical gods of ancient civiliza- tions is in preparation by Dr. Walter A. Jayne (Denver).
2 Black: "Folk-Lore," London, 1883, p. 140.
3 D. H. Kerler: "Die Patronate der Heiligen," Ulm, 190.5. * M. Hofler: Janus, Amst., 1902, vii, 189; 233; 301.
IDENTITY OF FOKM8 OF ANCIENT AND PRIMITIVE MEDICINE 39
writers, tho evil eye was nystusimic, strabismic, dicoric or otherwise ahnorinal or diseased. Ovid (Amores, viii, lo-lO) attril)utes a double pupil to the sorceress Dipea:
"Oculis qucKjue pupilla duplex Fulminat, et geminum luinen in orbe manet,"
and says that eyes which gaze upon the diseased will suffer themselves —
"Dum spectant oculi laesos, laeduntur et ipsi."
Pcrsius (ii, 34) attributed evil power to inflamed or reddened eyes {urentes
There is a strong human prejudice against disconcerting, in- tensive, or forbidding appearances of the eye, as, indeed, for any abnormity, whether it be the fascinatio of the ancient Romans, the strabismic regard louche of the French writers, the jettatura of the Corsican, the mal-occhio of the Itahan, the fihny glance of some gypsies, the "steady, ambiguous look" which Arthiu- Synions ascribes to Orientals, or the stony stare of the blue-eyed northern races which a hne of Tennyson's likens to the effect of the Gorgon's head. We dislike a stare. The phrase, Sic fixieren mich, mein Herr! has caused many a duel in Germany. We have a natural aversion for a person having but one eye, because, as Charles Dickens neatly said, "popular prejudice is in favor of two." Parti- colored eyes or eyes each of a different color are nowise reassuring. The blind are sometimes known to develop dubious tendencies along sexual and other lines. It is easy to see from facts of this kind how the notion of the "evil eye" came to be ingrained in the beliefs of the Eastern and Levantine races, the Celts and the Afri- can Negro, and, in some cases, not without reason.
An essential part of the theory of divine or personal influence is the doctrine of amulets and talismans and, of coiu'se, the ap- propriate charms and spells that go with them. The amulet (from the Arabic "hamalet," a pendant) was an object usually hung or worn about the patient's body as a safeguard against disease or other misfortune. Amulets include a motley array of strange and incongruous objects, such as the bits of crania excised in prehistoric trephining, objects of nephrite, Egyptian scarabs, the grigris of African savages, the voodoo fetishes of Hayti and Louisiana, teeth from the mouths of corpses, bones and other parts of the lower animals, the
Finger of birth-strangled babe, Ditch-delivered by a drab
of the Weird Sisters in Macbeth, rings made of coffin-nails, widows' wedding-rings, rings made from pennies (collected by beggars at a
* For an exhaustive studv of this fascinating subject, see S. Seligmann, Der bose Bhck, 2 v., Berlin, 1910.
10 msToHV or MKnicixE
cluiich porch niul chanficd for a silver coin from the offcM'lory, "sacrament sliillintis" collected on I'lastei' Sunday, and the ikons and sraptilaiMcs Messed 1)\- the ditiiiitaiies of the chui'ch. Tyloi- lias shown that tiie brass objects on hai'ness were originally Ko- nian amulets. In the interest iiifj; (>xhil)it of folk-medicine in th(> National MusiMun at \\'ashin<iton' a bucke\<' or hoi'se-chestniit {.Et^culits Jhiru.s). an Irish potato, a rabbit's fool, a leather strap previously worn b\- a horse, and a carbon from an arc light are shown as s()vei(M<i;n charms against rheumatism, and as Dr. Oliver \\'(Mulell IIolm(\s used to point out, in his quizzical way, a belief in the efficacy of some of thes(> anti-rheumatics is by no means confined to the European peasant and the negro. Other amulets in the Washington exhibit are the patella of a sheep and a ring made out of a cofhn-nail (dug up out of a graveyard) for cramps and epilepsy, a peony root to be carried in the pocket against in- sanity, and rare and precious stones for all and simdry diseases.
The folk-lore of stones is of great antiquity, and the oldest pre- scription in existence — that discovered in Egypt by W. Max Miiller — displayed in the Museum of Natm-al History in New York, calls for the exhibition of a green stone as a fumigation against hysteria. Dr. Robert Fletcher has shown' that "scopel- ism," the ancient Arabic custom of piling up stones in a field, either to prevent its tillage or as a menace of death to the ow-ner, is to be found every w'here as a sj^mbol of the hatred of Cain for Abel, of the outlaw for the worker, of the barbarian for civilization. The lore relating to mad-stones, snake-stones, eye-stones, and wart- stones is considerable. Bezoars (enteroliths or other concretions from the bodies of animals) were supposed to prevent melancholia and all kinds of poisoning, including snake-bite. In England and Scotland, holed stones (fairy mill-stones, pixy's grindstones) and elf-bolts (flint arrow-heads) were sometimes handsomely mounted and w^orn about the person for protection. Hildburgh's extensive studies of Spanish amulets indicate a highly developed folk-cult against the evil eye and other malevolent influences. Every horse, mule or donkey is belled, as also infants' toys, and horns; claws, beads, and other objects are usually mounted in silver and help out the quaint Spanish and gypsy scheme of personal orna- mentation.^ Precious stones came to be esteemed, in the first
1 Visitors in Washington who are interested in folk-medicine and the cultural aspects of medical history will do well to see this unique collection, which was prepared by Rear-Admiral James M. Flint, Surgeon, U.S. N. (re- tired).
2 American Anthropologist, Wash., 1S97, x, pp. 201-213.
^W. L. Hildburgh: Folk-Lore, Lond., 1906, xvii, 454; 1913, xxiv, 63; 1914, XXV, 206; 1916, .xxvi, 404.
IDENTITY OF FORMS OF ANCIENT AND PRIMITIVE MEDICINE 41
instance, no doubt, for their rarity, l)ut equally for their supposed potency against disease. From the engraved stones in the High- Priest's breast-plate, representing the Twelve Tribes of Israel, to the birth-stones and month-stones of our own day, there is a continuity of belief in the power of these precious objects. Many women dread to wear an opal; there is a supposed fatality about pearls, and the diamond now, as of yore, will "{^reserve peace" and "prevent storms" in a household. M. Josse, in Moliere's "L' Amour Medecin," archly opines that nothing is so well calcu- lated to restore a tlrooping young lady to health as "a handsome set of diamonds, rubies or emeralds."
Talismans (from the Arabic "talasun") were amulets or other charms that were carefully guarded but not necessarily worn about the person. It is highly probable that the magical authority attaching to the ownership of these precious objects gave them an ( enlarged purchasing power and was thus the origin or (as in the oljolus given to Charon), at least, a symbol of money and wealth, in the sense of stored up (potential) energy.^ TaKsmans were often written charms or "characts," such as the Hebrew phylac- teries or verses from the Bible, Talmud, Koran, or Iliad. If worn about the body, such charms were termed "periapts." When the Indians saw Catlin, the explorer, reading the New York Com- mercial Advertiser, they thought it was "a medicine cloth for sore eyes."- In the category of spoken charms we must include all ircayers, incantations, conjurations and exorcisms used to drive away disease, as well as mystic words like ABRACADABRA, SICYCUMA, Erra Pater, Hax Pax Max, and the like.^ Thus ( 'ato the Censor, who hated Greek medicine, endeavored to treat dislocations by repeating the following bit of gibberish: "Hunt hannt ista pista sista domiabo danmaustra et luxato." Jakob (Irimm found a charm in Marcellus Empiricus against dust in the (\ves to be an ancient Celtic verse (Neuburger). Charles Singer cites many Greek sentences degraded by syncretism into Byzantine and British charms, notably the passage in the Greek liturgy of St. Chrysostom:
arwix-qv Ka\€is- aTUfirjv fxeri ipo^ov. Let us stand .seemly, let us stand in awe,
which became a charm for intractable hemorrhage (written on the part affected or worn as a periapt), and is still used by Macedonian peasants.^ The charms of the Byzantine period imposed a very lieavy onus of responsibility upon the several saints.
' M. Mauss: Compt. rend. Inst, frang. d'anthrop., Par., 1914, ii, 14-20. A. Reinach: Ibid., 24-27.
2 Black: Op. cit., p. 49. ^ /ft,v/^ pp jgy^ jQg
*C. Singer: Early Engli.sh Magic and Medicine, London, 1920, 31.
,
I- IllSIOliV oi- MKDHINK
III siir\"(\\iii<;- these dirieiciil sii|)eist it ions, ()i)(> point hecoiiu^s of (^spi'cial inoiueiit. It is hij>;hl\' iinpiohahle that any ol' the rem- edies mentioned actually cured disease, l)ut tiiere is ubundanl evi- dence of the luost trust\vorth>- kind that there have been sick people who ^^o\ well with the aid of nothinji; els(>. How did they }iet well? Shoi-t of accept inu; the existence of supernatural forces, we can only fall back upon such vague explanations as "the heal- ing; power of nature," the tendency of nature to throw off the niatcn'es tnorbi or to bring unstable chemical states to equilibrium, \/ the latter l)eing the mcjst j)lausible. But, in many cas(»s of a
nervous nature or in neurotic individuals, there is indubitable evitleuce of the effect of the mind ujwn the body, and in such cases it is possible that a sensor}- impression may so influence the vaso- motor centers or the internal secretions of the ductless glands as to bring about definite chemical changes in th(^ blood, glands, or other tissues, which, in some cases, might constitute^ a "cure." We know that the reverse is possible, for example, in such occurrences as the wliitening of the hair from intense grief or fear, or the production of convulsions in a suckling infant whose mother has been exposed to anger, fi-ight, or other violent emotions liefoi'e nursing it. As Loeb strongly puts it, "Since Pawlow and his pupils have succeeded in causing the secretion of sahva in the dog by means of optic and acoustic signals, it no longer seems strange to us that what the j-thilosopher terms an 'idea' is a process which can cause chemical changes in the body."^ Billings compares the sensation obtained b\' placing the hand on a cold object in a dark room with the way in which the blood "runs cold" when one realizes that this object is a corpse.^ Crile's important studies of surgical shock show the strong analogy existing between the phenomena produced In- shock, the extreme passion of fear, and the s>-mptom-complex of Graves' disease, particularly in regard to the pouring out of the thyroid secretions and the destruction of the Purkinje cells in the brain. W. B. Cannon shows that in fear, rage, or anger, the emo- tions which prepare the animal for fight or flight, the digestive and sexual functions are immediately inhil)ited, the adrenal secre- tion is rapidly poured into the blood, mobilizing sugar from the hepatic glycogen up to the point of glycosuria, counteracting the effects of muscular fatigue, and hastening the coagulation time of the blood, thus giving the organism wonderful capacity for offence, defence, flight, and repair of injured tissues. A man in a fighting or frightened mood is a ductless gland phenomenon. The patho- logical effect of ideas upon the sacral autonomic is seen in the
1 J. Loeb: "The Mechanistic Conception of Life," Chicago, 1912, p. 62. -J. S. Billings: Boston Med. & Surg. Jour., 1S8S, cxviii, p. .59.
/
IDENTITY OF FORMS OF ANCIENT AND PRIMITIVE MEDICINE 43
plienoniena of sexual perversion/ Extreme mental irritation or depression can produce dyspepsia, jaundice, chlorosis, or general (U^cline; fright has produced cardiac palpitation and heart failure can result from a shock due to a set-back in business; rage may induce anything from precordial spasm up to angina pectoris, as in the case of John Hunter; the outward manifestations of hysteria are innumerable; and it is well known that it is bad for any person lo go under a surgical operation with the idea that he or she will not recover. A number of cases are on record of persons mentally d(^pressed but not otherwise unwell who have realized the im- minence of their own death and predicted it with certainty. An impressive instance was given from personal recollection by Dr. .lohn S. Billings, in his Lowell Institute lectures on the history of medicine in 1887.- An officer of unusually strong and active physique and in the best of health had sustained a slight flesh wound at the battle of Gettysburg. Becoming depressed in mind at the start, he declared he would die, which he did on the fourth I lay. The postmortem showed that every organ was healthy and normal and the wound itself so trivial as to be a negligible factor. ( 'tile's whole philosophy of "anoci-association" in surgery turns upon these mysterious mental influences, the combating of which constitutes the essence of psychotherapy. People who have be- come dyspeptic, bilious, or melancholy from worry or hope de- ferred, green-sick girls and women grown hysteric from disap- pointment in love, usually brighten up on receipt of good news, l^abinski's dismemberment of hysteria identifies its phenomena >olel3' with those capable of being produced in the hypnotic state. In treating the different neuroses, Charcot was guided almost en- tirely by his favorite maxim (from Coleridge): "The best inspirer of hope is the best physician," an aphorism which contains the iicrm of the Freudian theory of psycho-analysis — to "minister to I ho mind diseased" by removing the spfinter of worry or misery from the l^rain, in order to restore the patient to a cheerful state of mental equilibrium. This fact has been utilized by all "nature healers" and faith-curists with varying degrees of success, and it is tile secret of all charlatans, from Apollonius of Tyana, Valentine <lreatrakes, Cagliostro, "Spot" Ward, Joanna Stevens, Mesmer, lames Graham, John St. John Long, and the Zouave Jacob down lo the days of Dowieism and Eddyism. It is also the secret of the influence of religion upon mankind, and here the priest or pastor I )ecomes, in the truest sense, ein Arzt der Seele. In practical medi- cine, the principle now has a definite footing as psychotherapj^
'■ W. B. Cannon: Bodily Changes in Pain, Hvnigcr, Fear, and Rage. New ^ ork, 1915.
-J. S. Billings: Boston Med. & Surg. Jour., 188S, cxviii, p. ,57.
44 insrouY of medicint:
PsycliothcrapN- caiiiKtl knit ;i tVnctui'cd l)()iic, aiitajionizc the action of poisons, or lu\il a spccilic inlection, bul in many hodily ills, osp(MMali>' of th(> lUM'vous system, its uso is far more cflicienl and rospoctable than that of many a drug which is clainuMl to he a specific in an uiiimaiiinahle luunber of disoi'ders.
In lin(\ lh(> lesson of the unit\- of piiinitive inedicin(\ which is only a corollary to the fi;eneral pi'oposition of the unity of folk-lore, is that certain Ix^liefs and superstitions have become inj2;rained in humanity throu<>;h space and time, and can be eradicated only through the kind of public enlightenment which teaches that pre- vention is Ix^tter than cure. The tendency of humanity to seek medical assistance in time of sickness or injury has been compai'ed with the emotional element in rehgion, both i)eing based upon "a deep-lying instinct in human nature that relief from suffering is an obtainable goal."^ As the supernatural element in religion appeals to humanity in its moments of dependence and weakness, so for the weary and heavy-laden, the down-trodden of the earth in the past, medical sujx'rstitions were simply a phase of what Stevenson calls "ancestral feelings." This explains the ascendency of quack- ery. In order to deceive their patients, as Morris holds, it w^as necessary for the older quacks to deceive themselves, just as no one can perpetrate an effective ghost story who does not apparently believe it. Fool and rogue being, as Carlyle says, only opposite sides of the same medal, the modern charlatan exploits suggestion, sensation, and mystery objectively and with intention, relying upon Rabelais' arch device for effective lying: Ilfaut nieniir -par nomhre impair.
Thus the history of medicine is also the history of human falli- bility and error. The history of the advancement of medical science, however, is the history of the discovery of a number of important fundamental principles leading to new views of disease, to the invention of new instrimients, procedures, and devices, and to the formulation of public hygienic laws, all converging to the great ideal of preventive or social medicine; and this was accom- plished by the arduous labor of a few devoted workers in science. The development of science has never been continuous, nor even progressive, but rather like that tangled, tortuous line which Lau- rence Sterne drew to represent the course of his whimsical narrative of Tristram Shandy. Ideas of the greatest scientific moment have been throttled at birth or veered into a blind alley through some current theologic prepossessions, or deprived of their chance of fruition through human indifference, narrow-mindedness, or other accidental circumstances. It is no exaggeration to say that science
1 B. IM. Randolph: Wash. Med. Ann., 1912, xi, p. 152.
IDENTITY OF FORMS OF ANCIENT AND PHIMITIVE MEDICINE 45
owes most to the shining individuahsm of a few chosen sj)irits. Apart from this, "the success of a (Uscovery depends upon the time of its appearance."
Buckle maintained that ignorance and low-grade minds are the cause of fanaticism and superstition, and, since his equation is reversible, we may consider this j^roposition true if we apply it to certain fanatical leaders of mankind, savage or civilized, who, as "moulders of pubhc opinion," have retarded human progress. ( 'hamfort said that there are centuries in which public opinion is the most imbecile of all opinions, but this reproach cannot be en- tirely saddled upon "the complaining millions of men." History leaches everywhere that permanent ignorance and superstition are the results of the oppression of mankind by fanatical over- men. In medicine, this is sometimes ludicrously true. "There is | nothing men will not do," says Holmes, "there is nothing they ' have not done to recover their health and save their lives. They have submitted to be half-drowned in water, and half-choked with j gases, to be buried up to their chins in earth, to be seared with hot \ irons like galley-slaves, to be crimped with knives like codfish, i to have needles thrust into their flesh, and l^onfires kindled on their ' skin, to swallow all sorts of abominations, and to pay for all this, as if to be singed and scalded were a costly privilege, as if blisters were a blessing, and leeches a luxury. What more can be asked to prove their honesty and sincerity?"^ Yet while the lack of public enlightenment in certain periods produced the stationary or dis- continuous mind, there are signs that the modern organized ad- vancement of science may bring forth rich fruit for the medicine of the future through the social cooperation of the mass of mankind with the medical profession. As the ancient Greeks hung upon the teachings of Empedocles and Hippocrates, as modern humanit.y responded beautifully to the ideas of Jenner, Pasteur, and Lister, so there has been at no time a greater interest in the advancement of medicine and public health, as manifested in periodicals and newspapers, than in our own. The awakening of the people to looking after their own interests in regard to the organization and administration of public hygiene is, no doubt, the hope of the pre- ventive medicine of the distant future. Yet, even under the best conditions, it is still possible and probable that many highly in- telligent and highly educated persons will continue to hug their whims and superstitions, consult quacks, and be otherwise amen- able to psychotherapy, absent treatment and "action at a dis- tance." "To folk-medicine," says Allbutt, "doubt is unknown; it brings the peace of security."
1 O. W. Holmes: "Medical Essays," Boston, 1883, pp. 378, 379.
EGYPTIAN MEDICINE
Whetiiku the hiiiiKui face is (K'scciidcd tVom scvcial distincl sptH'irs or from a sin<ile coniinon ancestor, "pi-ohahly ai'horcal in his habits." is lost in tho (Hni and uiiattaiiiahlc i)ast. The dis- coveries of the skeletal rcMuains of human fossils at Neand(!rthal (1856), C"r6-]\Iagnon (1868), Spy (1887), Krapina (1899), Ileidc^l- berg (1907), Le Moustier (1908), La (1iapelle-aiix-Saints (1908), and the recent Piltdown find fEoanthropns Dawsoni, 1911) indi- cate that, even in the jmleolithic or chi])i)(Ml-flint jx'riod, tlu^re was already considerable diversity in the cranial characters of mankind and that, in prehistoric times, the human brain, developed at the expense of a simian body, increases in volume as we go bac^k- wai'd, which would seem slightly in favor of the contention of \'irch<)w and other German anthropologists that humanity is diverse^ in origin. But whether the Pithecanthropus found at Trinil River, Java, in 1891 be simian or human or, as its discoverer Dubois claimed, a mixture of both, all craniologic evidence seems to prove that prehistoric man was more closely akin to the high(^r (anthropoid) apes in structure than the^^ are to the lower, a kinship which is also borne out by the medico-legal or "precipitin" test of blood-relationship. At the same time the gap between paleo- lithic and neolithic man is much greater than that between the people of the Later Stone Age and the civilizations of Egypt and Mesopotamia. The prehistory of man began with the origins of anthropoid life in the Oligocene, the transformations of ape-men into men in the Pleiocene, the extinction of the great mammals and the dawn of the Old Stone Age Culture in the Pleistocene or Ice Age (Osl^orn). There is no evidence of the existence of man before the Ice Age, and whether flint implements were actually chipped in the Eohthic period is not positively known; })ut the fact that all subsequent remains are found embedded in successive laj^ers of strata points to a gradual and inevitable cultural development.
In the late Pleiocene or early Pleistocene (first interglacial stage) appeared the Trinil race (Pithecanthropus); in the Middle Pleistocene (second intergla- cial period), the Homo heidelhergensis ; in the late Pleistocene (third interglacial period), the Piltdown and pre-Neanderthaloid races; at the close of the glacial period. Neanderthal man. With the disappearance of Neanderthal man came the Cro-Magnon {Homo sapiens) with larger fore-brain and greater fore- thought.i
iH. F. Osborn: Men of the Old Stone Age. New York, 1910. Sir A. Evans: Science, New York, 1916, n. s. xhv, 399-409. 46
EGYPTIAN MEDICINE 47
In the IVIousterian period' (the age of the Neanderthal sknll), man was probably more ape-like than the AustraUan savage; In the Solutrean period, he was like the Bushmen and was already skilful in (•liii)ping flints; in the Magdalenian, he resembled the Mongolians and the Esquim.aux. The Solutreans and Magdalenians were alread>' mighty big-brained warriors and skilled artists, who knew how to bridle horses, make speciahzed weapons, devise cloth- ing, and execute most striking and life-like mural paintings and line engravings on stone, bone, and ivory. That the Egyptian and Sumerian civilizations were nearer to these people than had for- merly been conceived is indicated by the results of modern cave explorations and excavations. One of the most interesting facts of recent development is that arthritis deformans or rheumatic gout, a disease found in so many Egyptian mummies, is identical with the "cave-gout" { H ohlengicht) which Virchow found in bones of prehistoric men and bears and which is also common in the skele- tons of the inhabitants of the early German forests. The chipped flint imi^lements, of uncertain age, which are found near Fayum and elsewhere, surpass all others in delicacy of form and flaking. The fact that the neohthic chipped-flint knife was continually used by the Egyptians in embalming the dead connects their al- ready complex civilization with prehistoric man.
It is possible that many phases of Egyptian culture were spread, even to the New World, by the mechanical process of convection.
Elliot Smith holds that between 2800 and 900 B. C. a curiously distinctive culture-complex was carried by trade and navigation from Egypt to the Medi- terranean littoral, and after 900 B. C, by the Phoenician navigators to India; thence to Malaysia, Indonesia, and Melanesia, ultimately reaching the shores of the Americas, picking up, on the way, many modifications and additions from the countries through which it passed. This so-called heliolithic culture included sun-worship and its symbols; the building of megalithic monuments and the rearing of gigantic stone images; the practice of mummification, or embalming the dead, even among the North American Indians (H. C. Yar- row), the practices of tattooing (Miss Buckland), piercing the ears (Park Harrison), massage (W. H. R. Rivers), circumcision, etc.
This peculiar culture, the fantastic elements of which could never have arisen spontaneously in so many distant localities, may have influenced the early Minoan civilization of Cret^ after 2S00 B. C.;. after 900 B. C. the Pha>ni- cian navigators may have been the middlemen, while the giant craft of Malay- sia and Polynesia connected the mainland of Asia with the Americas.^
^ The terms Acheulean, Mousterian, Solutrean, Magdalenian were intro- duced by the French anthropologist Gabriel de Mortillet to indicate the suc- cessive stages in the specialization of flint and other prehistoric implements found at St. Acheul, Le Moustier, Solutre, and La Madeleine, to which have since been added the pre-Cliellean (Mesvin), Chellean (Chelles-sur-Marne\ Aurignacian (Aurignac), and Azilian (Mas d'Azil). They are now used in a purely arbitrary way to indicate cranial and skeletal remains found in sites corresponding, in order of geologic time, with these localities.
2G. Elliot Smith: The Migrations of Early Culture, Manchester, 1915. Also, Bull. John Rylands Library, Manchester, 1916, iii, 48-77, 3 pi.
4S HIsroUY OK MEDICINE
Our main soiircos of kno\vl(>(l}ic of the oarliost known phases of Egyptian niodicinc are (ho nuHhcal papyri, but even antedating these an> certain pi(Hir(>s engraved on the door-posts of a tomb in the burial ground near Memphis and desci'ibed by tlieir (Hscoverer, \\'. Max Midler, as being the earliest known j)i('tur(\s of surgical operations (2r)0() B. C.^. Although we have reasons for believing tliat tlu^ h'gyptians never carried surgery to the extent of opening the body, yet here are cleai' and unmistakable representations of circumcision and i)ossi])ly of sui'gery of tlu^ (^xti'emities and neck, the attitudes and the hieroglyphic inscriptions afhxed indicating that the patients are undergoing great pain. Ai:)art from this, there is no evidence of surgery except in the splints found on the Hmbs of mummies of all i:)eriods. Egyptian anatomy and physi- ology were of the most rudimentary character.
The medicine chest of an Egyptian (lueen of the eleventh dynasty (2500 B. C.^) containing vases, spoons, dried drugs and roots is another important find. There is also an inscription on a tomb near the pyramids of Sakarah which shows it to be the resting place of a highly esteemed practitioner who served the fifth dynasty of Pharaohs about 2700 B. C. I-em-hetep ("He who cometh in peace") was a medical demigod, the ^Esculapius of the Egyptians^ of the third dynasty (4500 B. C.) who was afterward worshiped at ^Memphis and had a temple erected in his honor upon the island of Philae. He was the earliest known physician. A papyric frag- ment of the second century A. D., recently published by the Egyp- tian exploration fund, shows that he was worshiped even in the time of Mycerinus.^ A statue of the physician Iwte, of the nine- teenth dynasty (1320-1170 B. C), is in the Imperial Museum at Ley den. ^
Besides the hieroglyphics, which were usually engraved or painted on stone, like the picture-writing of American or Aus- tralian savages, the Egyptian employed certain cursive scripts (hieratic and demotic), usually inscribed upon thin^ sheets of the papyrus plant.
The principal papyri are the Papyrus Ebers, translated by H. Joachim (1S90) and Englished by Carl H. von Klein, the Westcar (Lesser Berlin) papyrus, translated by Adolf Erman (1890), the Kahun papyri of the Petrie collection, translated by F. L. Griffiths (1893), the Brugsch (Greater Berhn)
1 W. Max Miiller: Egyptological Researches, Washington, Carnegie Insti- tution, 1906. See also J. J. Walsh: Jour. Am. Med. Assoc, Chicago, 1907, xlix, pp. 1.59.3-1.59.5.
^ For a picture of the same, see Jour. Am. Med. Assoc, 1905, xlv, 1932.
3 Kurt Sethe: Imhotep, der Asklepios der Aegypter. Leipzig, 1902. Cited by Sudhoff.
* Lancet, Lond., 1915, ii, 1204.
5 A. Fonahn: Arch. f. Gesch. d. Med., Leipz., 1908-9, 375-378, pi. vi. |
EGYPTIAN MEDICINE 49
and the badly preserved London Papyrus, both translated by Walter Wres- zinski (1909, 1910), and the Hearst (Philadelphia) papyrus, containing about half the text of the Papyrus Ebers. The oldest are the gynecolof^ical and v(>terinary scripts of the Petrie Collection from Kahun (1893).
The most important of the medical papyri is that advertised for sale in 1869 and obtained by Georg Ebers at Thebes in 1872, which dates back to about 1550 B. C. It consists of 110 pages of liioratic or cursive script, the text in l>lack letter, the rubrics in rod. Ebers himself supposed it to be one of the lost sacred or Hermetic Books of Thoth (Hermes Trismegistus), the moon god, who, like Apollo in Greece, was the special deity of medicine.^ This assumption has not stood the test of time, and the Ebers PapjTus, with its marginal notes and comments, is now regarded as a simple compilation,- albeit a veritable edition de luxe, as if prepared for some great temple. The fact that it is written in several dialects indicates that it is an encyclopedia, made up of s(^veral treatises. It begins with a number of incantations against disease and then proceeds to list a large number of diseases in detail, with about 700 different remedies for the same. The most interesting parts are the extensive sections on the eye and ear including a recognition of the Egyptian trachoma noted by Baron Larrey in 1802, and the descriptions of the AAA disease, the UHA disease and the Uhedu (painful swelling), all three of which have been thought by Joachim to be identical with different stages of the hookw^orm infection (chlorosis Ji]gy ptiaca^) . In addition to the hookworm, Filaria, Taenia, Ascaris and other parasites are mentioned and prescribed for. The large number of remedies and prescriptions cited in the Papyrus points to a highly specialized therapeusis, even in the sixteenth century B. C, but it cannot be ilaimed, as many seem to contend, that these 700 odd remedies indicate any special scientific advancement of the art of healing. We do not find a few well-selected drugs, as opium, hellebore,
' The first mention of Hermes Trismegistus was found by Karl Wessely in a papjTus of the third century A. D. from Hermopolis (Mitt. a. d. Samml. Erzh. Rainer, 1892, v, 133). Cited by Sudhoff.
- The hieratic writing of the Ebers Papyrus had first to be rendered into hieroglyphics, by a method devised at the Orientalists' Congress in 1874. One of tlie first to attempt to decij)her the hieroglyphics on the Rosetta Stone (1799) was the Enghsh physician and physicist, Thomas Young. The diffi- cult task was finally accomplished by J. F. Champollion (1818-28), and car- ried further by Richard Lepsius (1810-84), Heinrich Brugsch (1827-94), who published a "Hieratic-Demotic Dictionary" (1867-82), Joseph Chabas (1817- 82), (iaston Maspero, and others.
'.Joachim, Papyros Ebers, Berlin, 1890. Edwin Pfister, however, thinks that the aaa disease of the Ebers and Brugsch papvri was bilharziosis, since its hieroglvph is a phallus. See Sudhoff's Arch., 1912-13, vi. pp. 12-20. Paul Richter {IbuL, 1908-9, ii, 73-83) maintains that to the Egyptians "uhedu" stood for a disease, while to moderns it only signifies a symptom (inflammation) .
50 IIISTOKV OV MKDICINE
hyoscyamus. uscmI, ;is llic ImIci' ( iicck |)liysici;ins ciiiploviMl Ukmii, with skill and {iiscriinination, but l^j^yptiau tiici-apy invist liave hcvii, of iuH'(\ssity, haphazard, IxM-ause as wo shall s(h\ (>a('ii l''syp- tian physician was a iianow sp(>cialisl, (•onfiniii'j; himself to one disease or to diseases affect inu; ()n(> part of the body only. Many minerals and vegetable simples ;n(> mentioned, from the salts of lead and copper to s(|uills, colciiicum, gentian, castor oil and opium, and, as in some pharmacoi)eias of even the seventeenth and eighteenth centuries, these were compounded with such filthy ingredients as the blood, excreta, fats and visceral parts of biids, mammals and reptiles. A favorite Egyptian pomade for baldness consisted of equal jiarts of the fats of the lion, hippopotamus, crocodile, goose, serpent and il)ex. Another consisted simjjly of equal parts of writing ink and cerebrospinal fiuid. An ointment for the eye consisted of a trituration of antimony in goose-fat. An- other for conjunctivitis employs a copper salt. A poultice for suppuration consisted of equal parts of a meal of dates and wheat chaff, bicarbonate of soda and seeds of endives. There is a small pediatric section in the Ebers Papyrus, mainly of prognostic and therapeutic import. Egyptian gynecology and obstetrics have been studied in the five principal i:)apyri by Felix Reinhard.' The most interesting part of the El)ers Papyrus is the last sec- tion of all, which treats of tumors. Here, as in the description of the AAA disease, we find some approach to the accurate clinical pictures of Hippocrates, and many have supposed, on this slender evidence, that the Father of Medicine was indebted to Egypt for much of his knowledge. Some ethical precepts of the ancient Egyptian physicians are very much like the Hippocratic Oath in sentiment and expression, and this alone would point to the fact that pre-Hippocratic medicine in Greece had an origin closely con- nected with Egyptian medicine. There is, however, one marked point of divergence, namely, that later Egyptian medicine was en- tirely in the hands of priests, while Greek medicine, even at the time of the Trojan War, would seem to be entirely free from priestly domination, surgery in particular being often practised by Homer's warrior kings. Our principal authorities for the state of Egyptian medicine during the fifth century B. C. are Herodotus and Diodorus Siculus. From Herodotus we learn of the hygienic customs of the Egyptians, the gods of their worship, their ideas about medicine and their methods of embalming dead bodies. "The art of medicine," says Herodotus, "is thus divided among them: Each physician applies himself to one disease only, and not
1 F. Reinhard: Arch, f./desch. d. Med., Leipzig, 1915-16, ix, 315; 1916- 17, X, 124.
EGYPTIAN MEDICINE 51
more. All places abound in physicians; some physicians are for the eyes, others for the head, otheis for the teeth, others for the intestines, and others foi' internal disorders.'" Medical practice was rigidly prescribed by the Hermetic Books of Thoth, and if a patient's death resulted from any deviation from this set line of treatment, it was regarded as a (capital crime. Aristotle, writing one century later, says, in his Politics, that physicians were al- lowed to alter the treatment after the fourth day if the patient did not improve.- The simple dress and frequent baths of the Egyp- tians were what is suitable in a subtropical climate and not unlike those of the Greeks. "They purge themselves every month, three daj^s in succession," says Herodotus, "seeking to preserve health by emetics and clysters; for they suppose that all diseases to which men are subject proceed from the food they use. And, indeed, in other respects, the Egyptians, next to the Libyans, are the most healthy people in the world, as I think, on account of the seasons, because they are not liable to change."'* This view of the old his- torian does not harmonize with the great frequency of rheumatoid arthritis in the Egyptian mummies, which was probably due to exposure to a moist climate during the inundations of the Nile. The account of Egyptian embalming in Herodotus is, in the light of all recent investigations, authentic and accurate"* and it shows that the Egyptians already knew the antiseptic virtues of extreme dryness and of certain chemicals, like nitre and common salt. The brain was first drawn out through the nostrils by an iron hook and the skull cleared of the rest by rinsing with drugs; the abdo- men was then incised with a sharp flint knife, eviscerated, cleansed with wine and aromatics, filled with myrrh, cassia and spices and the wound sewed up. The body was then steeped for seventy days in sodium chloride or bicarbonate (natron) and afterward washed and enveloped completely in linen bandages smeared to- gether with gum. The relatives put it in a wooden coffin, shaped like a man, which was deposited in the burial chamber along with four Canopic jars containing the viscera. As with our North American Indians, the departed spirit was furnished with food, drink and other appointments and conveniences, and there was a special ritual or Book of the Dead, which every Egyptian learned by heart, as a sort of Baedeker to the other world. According to Diodorus Siculus, the "paraschistes," who made the initial incision with the flint knife, was held in such aversion that he was driven away with curses, pelted with stones, and otherwise roughly handled, if caught. On the other hand, the "taricheutes," who
1 Herodotus: ii, 84. "^Aristotlo: Politics, iii, 15.
^Herodotus: ii, 77. • •• Ibid.: ii, 8t).
Oj HISTORY OF MKDICINK
oviscoratod the body and picparcd it for lli(> tomb, was revered as heloiiilinsj; to the |)riestly class. Hut this was pr()l)ably only a i)er- fuii(tor\- piece of lit ualisni. SudhofY has recently published some interi'stinji" plat(\s' r(>pr(\sc>nt inji the chai'acteristic stone knives and iron hooks used i)y tiie l*]gyptian enibalniers, and Conu'ie, in an interesting i)aper in Sudhoff's Archiv/- describes what are probably the earliest known surgical instruments of the ancient Egyptians (al)out 1500 B. ('.), consisting of three saber-shaped copper knives with hooked or incm'vated handles, found in a t(;ml) near Tlu^bes. They are characteristic specimens of the Bronze Age. Elliot Smith and Wood Jones have described the effects of splints of palm fiber employed to mend fractures, and the results of healing are surprisingly good, with little shortening.''
Tho paleopathology of Egypt was first investigated by Fouquet in 1889. In 1907, th<> Egyptian government institutf^l an aroheological surv(>y of that part of Nubia which would t)c suhscciucntly flooded by the raising of the Assuan dam. The anthropological and i)athologi(;al jihases of the investigation were entrusted to Professor Ci. Elliot Smitli, with the assistance of F. Wood Jones and others.^ The bulletins of this inquiry, with fine atlases oi plates covering nunnmies of all periods, from the Pre-Dynastic to the Byzantine, show that syphilis, canc(>r, and rickets were unknown, that rheumatoid arthritis, essentially an environmental and not a racial affection, was "jxir excellence the bone disease of the ancient Egyptian and Nubian," that the teeth of the Pre-Dynastic people were uniformly good, as might be inferred from the coarse, husky food found in the intestines, and that deposits of tartar and caries, as also true gout (yielding uric acid reactions) became more com- mon in the New Empire, when luxurious habits were formed. There was no caries in the milk dentition of children of the Pre-Dynastic period, and when caries did appear, it was followed by abscess formation spreading to the alveoli, showing that the Egyptians had not the slightest rudiments of dentistry. Evidences of mastoid disease, adhesions in appendicitis, pleural adhesions, fusion of the atlas to the occiput from spondylitis deformans, necrosis of bones, cranial ulceration in females from carrying water-jars, and fatal sword-cuts of the skull were found. Of fractures, those in the cranium and forearm (at a uniform site near the wrist) were most common, and probably caused by fending blows aimed at the skull with the Nnhooi. Fractures of the femur were more common than today, but no fractures of the patella were found, and few below the knee-joint, the immunity probably resulting from locomotion with bared teet and the absence of slippery pavements and curbstones. Similarly, the small number of fractures in the hand and wrist suggest freedom from vio- lence by machinery.
Elliot Smith and Sir Marc Armand Ruffer (1859-1917), in a most interest- ing monograph, have described a genuine case of Pott's disease in a mummy of the twenty-first dynasty [circa 1000 B. C."'). The histological examinations
1 Sudhoff : Arch. f. Ge.sch. d. Med., Leipz., 1911, v, pp. 161-171, 2 pi.
2 Arch. f. Gesch. d. Med., Leipz., 1909, iii, pp. 269-272, 1 pi. 5 Brit. Med. Jour., Lond., 1908, i, 732-737.
^ Egvpt. Mirdslry of Finance. Surrey Department. The Archseological Survey of Nubia. Bulletins, Nos. 1-7, Cairo, 1907-11. Reports for 1907^8, Vol. 11, on the human remains, by G. Elliot Smith and F. Wood Jones, with Atlas, Cairo, 1910.
* G. Elliot Smith and M. A. Ruffer: "Pott'.sche Krankheit an einer agyptischen Mumie," Giessen, 1910.
EGYPTIAN MEDICINE 53
of Kuffer dcmonstratpd spondylitis doforinans, Bouchard's nodes, ague cake, liiliary calculi, calcification anrl atheroma of the arteries in various inununies, and an eruption resenihiinfi variola in a niununy of the twentieth dynasty ridO-llOl) H. (".'). Infantile i)aralysis is apparently represented in a stela of the eighteenth dynasty in tli(> ("arlsherg Cdyptothek at (.'openhagen.^ Many ancient I']gyptian statuettes in bronze or varnished earth, rejjresenting the go(ls \ic^ and I'litah, are accurate figurations of achondro[)lasia (Charcot'').
The main interest of Egyptian niedieine lies in its proximity and relationship to Greek medicine. The references in Homer to the skill of the Egyptian physicians in compounding drugs bring to mind the fact that the word "chemistry" itself is derived from rhemi (the "Black Land"), the ancient name of Egypt, whence the science was called the "Black Art." Doubtless the ancient ( 1 reeks learned as much of medicine as of chemistry from these wise elders across the sea, who told Solon that his people were "mere children, talkative and vain, knowing nothing of the past"; who were so skilled in metallurgy, dyeing, distillation, preparing heather, making glass, soap, alloys and amalgams, and who, in Homer's time, probably knew more anatomy and therapeutics than the Hellenes. Yet, long before the Alexandrian Period, Egyp- tian civilization had become absolutely stationary in character, and, in medicine, Egypt was going to school to Greece.^ As the I'^gyptian gods — the dog or ibis-headed Thoth (the Egyptian Hermes), the cat-headed Pacht, their deity of parturition, the beak- nosed Horus, the horned Ghnum, the veiled Neith at Sais, re- mained forever the same, while the Greek mythology was a con- tinuous and consistent evolution of deific figures of permanent beauty and human interest, so Greek medicine was destined to go beyond Egyptian or Oriental medicine as surely as Greek poetry, sculpttu'e and architecture surpassed the efforts of these peoples in the same kind.
' Ruffer: Histological Studies on Egyptian Mummies, Cairo, 1911. Also, Jour. Path, and Bact., Lond., 1910-11, xv, 1; 4.53, 4 pL: 1911-12, xvi, 439, 9 pi.: 1913-14, xviii, 149, (i pi.
2 See O. Hamburger. Bull. Soc. franc;, d'hist. de med., Par., 1911, xi, 407-412.
'Charcot: Les difTormes et les malades dans I'art. Paris, 1S89, 12-26. F. Ballod: Prolegomena zur Geschichte der zwerghaften Cotter in .^gypten. Munich dissertation (Moscow, 1913).
■• See, for example, Sudhoff's studies of the Creek papyri of the Alex- andrian period (Studien z. Gesch. d. Med., Puschmann-Stiftung, Nos. o, 6, Lcipz., 1909).
SUMERIAN AND ORIENTAL MEDICINE
In tlu^ hook of (Jcnosis wc read llial Ximi'od was "a inijj;hty hunter hd'oic tlic Lord" and that "the hcjiiiiiiinji; of his ki?ij>;doin was Hal)(>l and l<]ro(^h, and Accad and Cahu'li in tlu> land of Shinar." The land of Sliinar (Shunior or "Sinner") was the southern part of Babylonia, eonipiisinj;- the strip of country betw^cen the l*]u- phrates and the Tigris down to the Persian Gulf, and northern Babylonia was ealKnl Accad. The Balndonian s()vereifj;ns and tlu>ii' Assyrian conquerors always styled themselves "kings of Sunier and Accad." Before the advent of the Ba])ylonians, it is supposed that an original non-Semitic or Sumerian race existed, about 4000-3000 B. C, who laid the foundations of modern civil- ization by the invention of pi('torial writing and the development of astronomy. Others assume that the cursive script of the Su- merians, wdiich, like Chinese writing, runs from right to left, was in the first instance only a sort of cipher-code used by the dominant Semitic race. In any case Mesopotamia was the starting-jioint of Oriental civilization, of which the Babylonians were undoubtedly the principal founders. They were skilled in mathematics and astTonomy, originated the decimal system of notation, weights and measures, made the divisions of time into twelve months in the year, seven days in the week, sixty minutes and seconds in the hour and minute respectively, and divided the circle, as we do, into 360 degrees. They invented the cuneiform inscriptions, reading from left to right, they knew much about military tactics and the art of war, and w^ere variously skilled in music, architecture, pot- tery, glass-l)lowing, weaving and carpet-making. Layard found a plano-convex lens of rock crystal in his explorations at Nineveh.
It is said that astronomy is the oldest of the sciences, and in all early civilizations we find it applied to the practical affairs of life as astrology. This trait is the essence of Sumerian or Accadian medicine. Wars, epidemics, famines, successions of monarchs, and other affairs of public or private life, were closely studied in relation to the precession of the equinoxes, eclipses, comets, changes of the moon, and stars, and other meteorologic and as- tronomic events, and from these fatalistic coincidences arose the idea that certain numerals are lucky or unlucky. Thus astrology and the interpretation of omens merged into prognosis and, as with all early civilizations, the first Babylonian physician was a priest or the first priest a physician. Inspection of the viscera, an essential part of augury, led to inspection of the urine, and, among
54
SUMERIAN AND ORIENTAL MEDICINE 5o
the Babylonians, soothsaying was concentrated upon the liv'er, terra-cotta models of which, al)out 3000 j^ears old, have been found, divided into sciuares and studded with prophetic inscrip- tions. In Ezekiel (xxi, 21) we read: "For the king of Babylon stood at the parting of the ways, at the head of the two ways to use divination: he made his arrows bright, he consulted with images, he looked in the liver." Neuburger points out how the priestly interest in omens might have led to the collection and col- location of clinical observations, such as facial expression, the ap- pearances of the urine, the saliva, the blood drawn in blood-letting, and other signs which were used as indices or tokens of recovery or death; and he goes on to say that the next step in the direction of scientific advancement would be the elimination of the super- natural from the matter.^ This step, unfortunately, is and has been the hardest one to take in medical reasoning. So we find the Babylonian physicians regarding disease as the work of demons, which swarmed in the earth, air and water, and against which long litanies or incantations were recited.
In 1849, Sir Henry Layard, during his excavations of the Mound Kouyun- jik, ojjpositc Mosul, the sit(; of Nineveh, discovered the great Hhrary of some ;3(),00() clay tablets gathered by King Assurbanipal of Assyria (668-626 B. C), which is now in the British Museum. From some 800 medical tablets in this archival collection, which probably numbered 100,000, our knowledge of Assyro-Babylonian medicine is mainly derived. In Morris Jastrow's reading- of tliese, shifting the blame for anything to demons (our disease-germs) was the Assyrian concept of aetiology; diagnosis was probably based upon simple in- spection of the patient, helped out by associative memory and terminology'; prognosis (iatromancy) was divination or augury from liver-inspection (hepa- toscopy), birth-omens, disease-omens and astrological signs and portents; therapy was exorcism by a special ritual, of which the exhibition of herbal remedies was a part; incantation was prophylaxis. From hepatoscopy the Babylonians learned the structure of the liver, and their clay models are better specimens of anatomical illustration than the five-lobed medieval figurations. Similar models of the liver have been found on ancient Hittite sites in Asia Minor, and Etruscan livers in bronze, dating from the third century B. C, have b(!en found near Piacenza. The liver, as the source of blood, was regard(>d as the seat of the soul, and as the god identified himself with the sacrificial animal, to in.spect the liver was to see into the soul of the animal and the mind of the god. The birth-omens, which have been specially studied by Dennef(>ld and Jastrow,^ led to the p.seudo-sciences of physiognomy and palmistry and stimu- lated the study of fa>tal and adult abnormities. All possible phases of par- turition and abnormities of the fcrtus (Monslra) were regarded as signs and tokens of the individual's future fate, as being the attendant phenomena of a new life issuing from another. An abnormally large organ inton.slruDi per exceatium), or an abnormity on the right side, was a token of future jjower and
1 Neuburger: Geschichte der Medizin, Stuttgart, 1900, i, '.M.
-M. Jastrow: Proc. Roy. Soc. Med., Sect. Hist. Med., Lond., 1914, vii. 109-176.
^ M. Jastrow: Babylonian-As.syrian Birth-Omens, Giessen, 191.3. L. Denncfeld: Babylonisch-assyrische Geburts-Omina, Leipzig, 1914. Jastrow: Aspects of Belief and Practice in Babylonia and As.syria, New York, 1911, ch. iii.
5() nisroHY OF MKDICINK
success. An abiiunnally small or^iaii (nioiistnnn iicr dcfirliiin), or a defect on the left side, pointed to weakness, disease and failure, 'i'lie birth omens in- dicated whether the individual was to he superman or underliufz;. 'I'he rites of exorcism and the litanies to drive away disea.ses inlluenced I^^yptian, Hindu and Chinese medicine and these were carri<Ml ovcm' into late Syi'iaii medicine ami thence to I.slam and MedievalC'hristianity. Over a hundred drufz;s were known, and two ijeneral class(>s of these, sli(iiinini, and (ihnii, rei)resent, .lastrow he- li(>ves, organic and inorganic substances respectively. 'Flic filthier remedies i Drcrk-apolhckc) were jjrobably designed to disfrnst tiie demon inside the body. Hunu'nation, acid stomach, rheumatism, neural<i;ia, and cardiac di.seases are described in the clay tablets. Liver diseases and (>ye diseases form the centric feature of Babylonian as of Arabic patholo<j;y. SudhoiP interprets the concejits hninx and .^fibhi as epilejisy and ccmtajjion (.seizure by demons), and, in the Middle Aiics, epileptic seizure' came to be refjarded as a contagion.
The l)o<;iniiin<j;.'^ of Iho practico of medicine among; the Baby- lonians have ])een deserilxMl hy Herodotus as follows: "They bring out their sick to the market place, for they have no physicians; then those who pass by the sick person confer with him about the disease, to discover whether they have themselves been afflicted with the same disease as the sick person, or have seen others so afllieted; thus the passers-by confer with him, and advise him to have recourse to the same treatment as that by which they es- caped a similar disease, or as they have known to cure others. And thej^ are not allo\ved to pass by a sick person in silence, without in- quiring the nature of his distemper."^ With the Babylonians, as Montaigne quaintly observes, "the whole people was the phys- ician." They eventually reached the stage at which, like the Egyp- tians, they had a special doctor for every disease. Whether they ever got beyond this stage we do not know, but we learn from the Code Hammurabi (2250 B. C.) that the medical profession in Babylon had advanced far enough in public esteem to be rewarded with adequate fees, carefully prescribed and regulated- by law. Thus ten shekels in silver was the statutory fee for treating a woimd or opening an abscess of the eye with a bronze lancet, if the patient happened to be a "gentleman"; if he were a poor man or a servant, the fee was five or two shekels respectively. If the doctor caused the patient to lose his life or his eye, he had his hands cut off in the case of the gentleman or had to render value for value in the case of a slave. It is clear from all this that the Babylonian phj^sicians owned slaves and sometimes operated for cataract. Here as everywhere, it was surgery that made the first step in the right direction. Internal medicine, among both the Persians and the Babylonians, was occupied mainly in endeavoring to cast out the demons of disease. Jastrow cites a number of pediatric epistles, from the phj^sician Arad-Nana to the King Assurbanipal
» Sudhoff: Arch. f. Gesch. d. Med., Leipz., 1910-11, iv, 353; 1912-13, vi, 454.
- Herodotus: i, 80.
SUMERIAN AND ORIENTAL MEDICINE 57
(•68-626 B. C), on ailments of his little son, in each of which \ineb, the god of heahng, and his consort Gula are invoked. Lists of animals, insects and plants are found in the cuneiform inscriptions. Different varieties of flies, bugs and lice were noted. The wide-spi'ead theory that a worm is the cause of toothache was of Babylonian origin. A votive object found at Susa (Persia) hears a conjuration against mosquitos. A cylinder seal in Pier- pont Morgan's collection bears the "Fly Symbol" emblematic of Xergal, the Mesopotamian god of disease and death. ^ The Assyro- 1 Sal )3'lonians protected themselves from the fierce sunlight with parasols, from insect pests with fly-flaps, wore Semitic plaids wound about the body terrace-wise, went in for boxing and other manly exercises, employed inflated bladders as water wings, reg- ulated wet-nursing, buried their dead in slipper-shaped coffins and tan-shaped tombs, and policed the battle-field with the aid of \ultures, by assembling the wounded and by burial in huge com- mon trenches (Sudhoff^). Some advance in public hygiene was made, for the excavations of the huge Babylonian drains, of which models were recently exhibited at the Dresden Exposition, show that they understood the proper disposal of sewage. A stone privy in the palace of Sargon at Chorsabad (1300 B. C.) has been excavated.
Closely connected with Sumerian medicine in point of time is the medicine of the Jewish people, in relation to the Assyrian captivity (B. C. 722) and the Babylonian captivity (B. C. 604). The principal sources of our knowledge of Jewish medicine are the I>il)le and the Talmud, the first throwing only such light upon the s\il)ject as we should expect to find in the details of a legendary historic narrative. In the Old Testament, disease is an expres- -^ion of the wrath of God, to be removed only by moral reform, prayers and sacrifice; and it is God who confers both health and • lisease: "I will put none of these diseases upon thee, which I have lirought upon the Egyptians: for I am the Lord that healeth thee" ' I'^xodus XV, 26). The priests acted as hygienic police in relation lo contagious diseases, but there is not a single reference in the IMble to priests acting as physicians. The latter were a class apart, lit" whom we read, for example, that Joseph "commanded his ser- \:ints the physicians to embalm his father" (Gen. l, 2), that King Asa consulted physicians instead of the Lord and "slept with his fathers" for his pains (II Chron. xvi, 12, 13), or that if two men tight and one of them be injured to the extent of having to keep his l)ed, the other "shall pay for the loss of his time, and shall cause
' J. Offord: Sc. Progress, Lond., 1910, x, .572.
^Sudhoff: Katalog dor Intoruationalon Hygiene-Ausstellung. Historische Abtoilung, Dresden, 1911, 2()-28.
58 IllsroltV OK Ml'.DICIN'K
him to lu> thorouiililN licnlcd" ( llxodus xxi, 1')). The Prophets, oil the other hand, iVeiiueiii ly pel roiined inii'acles, as where both I'^ijah and l-lHsha raised chihh'en froiu tlie dead. The "heaHnji;" of the \vat(Ms of Jordan hy Mhsha (II Kinjis ii, 22) is a f2;ood ex- ample of th(> ancient, primitive coneept of "makinjj; medicine," as also the i'eferenc(>s to the us(> of hyssop as an a^ent of catharsis, purification or lustration (Psalms li, 7; Exodus xi, 22; Leviticus XIV. 4-7, 49-52), and the ritual of transferrinf>; leprosy to a biid (Leviticus xiv, 1-8). A strikin{>; example of the relation between the Divine wrath and the efficacy of prayer is to be found in the case of Hezekiah, w'ho, "sick unto death," and told by the Lord to set his house in order, turned his face to the wall; his prayers w(>re an- swered by the Prophet Isaiah who, at the Divine instance, ordcM-ed that a lump of figs be applied to the afflicted part, with the result that Hezekiah recovered (II Kings xx, 1-8). Besides the physi- cians and the high priests, who acted as public health officers, there were also professional ]iharmacists (Exodus xxx, 25; Nehemiah III, 8) and professional midwives, who are mentioned in the cases oi' Rachel, of Tamar, and particularly in the striking reference to the ancient Oriental usage of the obstetric chair, in the first chapter of the second book of Exodus, where Pharaoh commands the mitl- wives to slay all Jewish infants of the male sex, "when ye do the office of a midwife to the Hebrew women, and see them upon the stools." Maternal impressions form the subject of the second half of the thirtieth chapter of Genesis, in which Jacob retaliates upon Laban for the deception which the latter practised upon him alK)ut Leah and Rachel by outwitting him in a method of raising speckled and spotted livestock hardly explicable by Mendel's law. The sign-language of crooks is indicated in Proverbs vi, 13. Dreams are rightly regarded as "visions of the head," that is, emanations of the l)rain (Daniel iv, 5, 13; vii, 1). The use of the primitive chipped flint in ritual circumcision is referred to in the second book of Exodus (iv, 25), where Zipporah, the wife of Moses, "took a sharp stone and cut off the foreskin of her son." In Joshua (v, 2), God commanded Joshua, the successor of Moses, to make sharp knives and circumcise the children of Israel born after the Exodus from Egypt. This is the only sin'gical procedure men- tioned in the Bible, but the use of the roller-bandage in fractures is referred to in Ezekiel (xxx, 22) as follows: "Son of man, I have broken the arm of Pharaoh king of Egypt; and, lo, it shall not be boimd up to be healed, to put a roller to bind it, to make it strong to hold the sword."' Wounds were dressed, as among all ancient peoples, with oil, wine and balsams. In Deuteronomy, Moses
^ The preparation of ointments by the apothecary is referred to in Exodus xxx, 25, and their therapeutic indications in Isaiah i, 5.
SUMERIAN AND ORIENTAL MEDICINE 59
l.iys down a careful dietetic regimen (xiv, 3-21) and excellent lules of military hj^giene, in relation to the policing of camps I XXIII, 9-14). The census or "numbering of the people" by Moses is described in Numbers (i, 1-49; xxvi, 1-65), and by Joab, at the instance of David, in I Chronicles (xxi, 3-7). Acromegaly, with supernumerary digits, is described in the case of the son of Goliath of Gath (II Samuel xxi, 20; I Chronicles xx, 6), epilepsy is men- tioned (Numbers xxiv, 4) and the effects of inebriety outlined (Proverbs xxiii, 20-35). Nabal's apoplexy and death, from di'unkenness and mental excitement, is noted in I Samuel (xxv, 30). ( )f the different diseases referred to in the Bible, the most impor- lant are leprosy, the "issue," and the several plagues visited upon Israel, notably the plague of Baal Peor, in which twenty-four thousand perished (Numbers xxv, 9). Yet these diseases are so \'aguely alluded to that it is impossible to identify them with any latter-day equivalents. Modern dermatologists contend, for in- stance, that Biblical leprosy (zaraath^), of which Naaman was healed by dipping himself "seven times in Jordan," and which was transferred (in the folk-lore sense) to Gehazi, so that "he went out from his presence a leper as white as snow," was, in reaHty, psoriasis. On the other hand, Iwan Bloch and others maintain that the venereal plagues mentioned in the Bible (Baal- peor and the rest) are not the same as present-day lues or gonor- rhea.- Plague after quail-eating is mentioned in Numbers (xi, 31-33). Highly significant is the episode of Ahaziah (II Kings I, 2), who, when ill, sent to Beelzebub at Ekron to learn if he might recover, for, according to Josephus, this god is to be equated with the Greek Zeus Apomuios, the "averter of flies." The fiery serpents mentioned in Numbers (xxi, 7) may have been the dra- cunculus, and Castellani holds that the disease with "emerods" in I Samuel (v, 6; vi, 4-5) was bubonic plague, because the "mice died and marred the land."^
1 Described in Leviticus xiii, 1-4G.
- Medical scholars, who speculate about these uncertain details in such dogmatic fashion, fail to consider the point, well known to mathematicians and physicists, that the inherent probability of any occurrence tends the closer to zero the further we get away from it, and that the effect of any event tends to "die out asymptotically" in indefinite or infinite time. iEsculapius was very much of a reality to Homer, Hippocrates and Celsus. To us he is well- nigh a myth. Bloch forgets that the logical opposite of the "morbus Ameri- canus" theory of syphilis, which he advances with such fanatical zeal, is just as likely to be true as the theory itself.
^ The rodents appear in Poussin's painting "The Plague of the Philistines" (.Janus, Amst., 1898, iii, 138). It is noticeable that the evidence of the asso- ciation of mice with the plague is stronger in the Septuagint than in the Vul- gate (see L. Aschoff, Janus, Amst., 1900, v, 611-(U;i). In the Revised Ver- sion the "nati sunt mures" is absent, but verse 8 of 1 Samuel v suggests the inguinal bubo of plague.
(iO HisroliV OI- MKDICINK
The i)riiicii);il intiM'cst in tlu^sc HiMical diseases Wos in (ho re- markable olYorts made to prov(Mit, (hnn. The ancitMit Ilohrews \v(>r(\ in fact, the foundiM's of prophylaxis and tlic hi^h i)rie,sts were true nu'ihcal police. ThcN- had a definite code of ritual hygiene and cult-cl(>anlin(>ss, gradually (Milarged from contact and inter- relation with dilTerent civilizations. The hook of Leviticus con- tains the sternest mandates in regard to touching unclean objects, the pi-ojier food to be eaten, the purifying of women after chikl- birth. the hygiene of the menstrual periods, the abomination of s(>xual ])er\-ei'sions and the prevention of contagious diseases. In the remarkable cliai)ters on the diagnosis and prevention of lep- rosy, gonorrhea and leukorrhea (Leviticus xiii-xv), the most definite common-sense directions are given in regard to segrega- tion, disinfection (even to the point of scraping the walls of the house or destroying it completely), and the old Mosaic rite of incineration of the patient's garments and other fomites. In the Middle Ages, these precepts from Leviticus were still in force against leprosy, and the principle of isolation of patients and suspects w^as extended to plague, syphilis, phthisis, scabies, ery- sipelas, anthrax, trachoma and epilepsy (Sudhoff). Who but does not admire the rigorous Hebrew regulation of sexual hygiene which, however severe, enforced exogamy, put a ban upon per- versions, and invested the figure of a good and virtuous woman with that peculiar halo of respect which has been preserved by all highly civilized nations down to the present time?' The institution of the Sabbath day gave tired workaday humanity a sort of per- manent splint to rest upon. In short, the chief glory of Biblical medicine lies, as Neuburger rightly says, in the institution of social hygiene as a science. How highly the physician was esteemed by the Hebrews of a later time may be gathered from the impressive language of Jesus, son of Sirach (180 B. C):
1. Honour a physician according to thy need of him with the honours
due unto him : For verily the Lord hath created him.
2. For from the Most High cometh healing:
And from the King he shall receive a gift.
3. The skill of the physician .shall lift up his head:
And in the sight of great men he shall be admired.
The wTitings of Flavins Jo.sephus (born 37 A. D.), as investigated by Max Neuburger,^ differ frequentlj' from the Biblical narrative in respect of medical details. Physicians are more frequently mentioned, and their definite independent status is emphasized. Visitation of epidemic diseases is more
1 It is worthy of note that the Mosaic mandates against bestiality, sexual inversion, etc., in Exodus (xxi, xxii) and Leviticus (xviii) are the beginnings of medical jurisprudence.
2 M. Neuburger: Die Medizin im Flavins Josephus. Reichenhall, 1920.
SUMERIAN AND ORIENTAL MEDICINE 61
froquont, and the third phigue of Egypt is dofinod as pediculosis, that of Baal I'cor as pest, that of the Philistines as dysentery. The precepts of Jewish hygiene, particularly the Mosaic rules for the isolation and purification of 1( pers, are given with drastic force. Saul's melancholia is defined as deniono- iiiania with ecstasy. Apoplexy may be inferred in the cases of Nabal and Alkimos. David is described as feigning insanity before the King of Gath. In the later narratives, psychiatric details are frequently given, particularly in the case of Herod.
In contradistinction to the written Mosaic law in the five books of the Pentateuch (Torah), the Talmud consists of the law as t lansmitted by verbal tradition (Mishna), with its several inter- pretations and commentaries (Gemara). This body of knowledge Ix'gan to accumulate after the Babylonian Captivity, about 536 B. C, and is embodied in the Palestinian Talmud (370-390 A. D.) and the Babylonian Talmud (352-427 A. D.), the latter l)oing the ordinary source of reference. The Babylonian Talmud is essentially a law book, dating from the second century A. D., and the information about Jewish medicine conveyed in it is, in consequence, of a more definite and detailed character than we sliould expect to find in the half-legendary narrative of the Bible. Its most interesting feature is the light it throws upon later Jewish anatomy and surgery and upon the knowledge of post-mortem appearances which the Hebrews gained through the inspection of meat for food. Anatomy of any kind before the time of Vesalius was a thing of shreds and patches and Jewish anatomy was no exception to the rule. Only a very few of the parts of the body :iie mentioned in the Bil^le and these references are as vague and general as those in the Iliad. In the Talmud, the number of bones in the skeleton is variously estimated at 248 or 252, and, of these, one, the bone Luz, which was supposed to lie somewhere between t he base of the skull and the coccyx, was regarded as the indestruc- tihle nucleus from which the body is to be raised from the dead ■it the Resurrection. This myth, which modern rabliinical author- it \- holds to have originated from the ancient Egyptian rite of "burying the spinal column of Osiris," was exploded by Vesalius in a striking passage in the "Fabrica."^ The Talmud chsplays consideral^le knowledge of the oesophagus, larynx, trachea, the inoml)ranes of the brain and the generative organs. The pancreas is called the "finger of the hver" and structures hke the spleen, kidneys and spinal cord are frequently mentioned but not de- s(Ti])ed. The blood is held to be the vital principle, identical with the soul, and the heart is essential to life. Respiration is likened to burning. The effect of the saliva upon food and the churning movements of the stomach are noted, and the liver is believed to
^ See F. H. Garrison, "The Bone called 'Luz,'" New York Med. Jour., ,,1911, xcii, pp. 149-151.
()2 IIIsroKV OF MKDICINK
(elaborate tlir hlood. Aiiioiiii \\\v llchi-cws, the ll(>sh of (lis('as(Ml or injured animals was al\va>s consicUM'cd unlit for food, and llic au(opsi(>s, made upon slaughtered animals lo delermine what, was "kosher" and "Ireplia," threw a lijiht upon jjatholo^ic api)eai'- aneos whii-h the ancient (Ji-eeks never j^ained. Hyperemia, caseous do^eneration and tumors of the lun^s were noted, as also atrophy and abscess of the kidneys and cirrhosis and n(^crosis of the livei-. Tiopical dys(>ntery, j)allid ana'mia, drojisy, intestinal w^ornis, phthiriasis and scorbutic stomatitis were described. .laundice and biliary disoi'ders were commonplaces of Jewish and ]\Iohanimedan medicine. Diphtheria, known as askarn (iT/dpa) or serunkr {(rnndyxyi), was SO mucli fcarcd liy the H(^bj'ews that the first case located in a community was immediately herakknl by a warninf? blast of the shofar, although the instrument was ordinarily sounded only after the occurrence of the third case of an infectious disease (Preuss). There are no Hebrew words for "cough" or "phthisis," to which the arid plains of Palestine were of old inimical. Tal- mudic surger}' included the usual 'Svound-svu'gery," with treat- ment by sutures and bandages, applications of wine and oil and the device of freshening the edges of old wounds to secure more perfect union. Venesection, leeching and cupping were common and, before attempting the major operations, a sleeping draught ("samme de shinta") was administered. Cesarean section, ex- cision of the spleen, amputations, trephining, and the operation for imperforate anus in infants were known, as also the use of the speculum and the uterine sound. Fractures and dislocations wen^ discussed, and crutches, artificial limbs and artificial teeth em- ploy ed.^ Careful rules for the hygiene and nutrition of new-born children are given. There is no evidence of specialized medical education among the Jews until the Alexandrian period, and in- dividual Hebrew physicians did not attain any particular prom- inence until the Middle Ages and, more especially, in the Modern Period.
As the Hebrews attained the highest eminence among Oriental peoples in hygiene, so the ancient Hindus excelled all other nations of their time in operative surgery. In the earliest Sanskrit docu- ments, the Rig Veda (1500 B. C.) and the Atharva Veda, medicine is entirely theurgic, and treatment consists of the usual versified spells and incantations against the demons of disease or their human agents, the witches and wizards. In the Brahminical period (800 B. C.-IOOO A. D.), medicine was entirely in the hands
1 For further information about Biblical and Talmudic medicine, see Julius Preuss, Biblisch-Talmudische Medizin, Berlin, 1911, and the article by Dr. Charles D. Spivak in the Jewish Encyclopedia, N. Y., 1904, viii, pp. 409-414.
SUMERIAN AND ORIENTAL MEDICINE 63
of the Brahmin priests and scholars, and the center of mechcal (•(Uication was at Benares. In an Indian rock inscription, King Asoka {circa 226 B. C.) records the erection of hospitals by him, and Cingalese records indicate the existence of hospitals in Ceylon 111 437 and 137 B. C. Indian and Ceylonese hospitals existed as late as 368 A. D. The three leading texts of Brahminical medicine ai(^ the Charaka Samhita, a compendium made by Charaka (sec- (ind century A. D.) from an earlier work of Agnivera, based upon tlu> lectures of his master Atreya (sixth century B. C.^), the Susruta (fifth century A. D.) and the Vagbhata (seventh century A. D.). Of these, the most remarkable is Susruta, whose work, l)(vu-ing the same name, is the great storehouse of Aryan surgery. Indian medicine was particularly weak in its anatomy, which consisted of purely fanciful numerations of unimaginable parts of I he body, as 360 bones, 800 hgaments, 500 muscles, 300 veins, and so on. Hindu physiology presupposes that the vital processes are activated by means of the air (below the navel), the bile (between the navel and the heart) and the phlegm (above the heart), from which are derived the seven proximal principles, chyle, blood, flesh, fat, bone, marrow, and semen. Health consists in a normal (luantitative relationship of these primary constituents, disease in a derangement of their proper proportions. Diseases are again minutely subdivided, the Susruta enumerating as many as 1120, \\hich are classed in the two grand divisions of natural and super- natural diseases. Diagnosis was carefully made and included inspection, palpation, auscultation and the use of the special senses. Scmeiology and prognosis combined acute observation with the nsual folk superstitions. As examples, witness the Susruta's very recognizable description of malarial fever, which is attributed to inosquitos, or the passage in the Bhagavata Purana which warns I)eople to desert their houses "when rats fall from the roofs above, jnmp about and die," presumably from plague. Essential diabetes nicllitus was recognized as Madhumeha or "honey-urine" (Jolly), and the symptoms of thirst, foul breath, and languor were noted (W. Ebstein). Evidences of variolation (inoculation against -niallpox) have been found in the Sanscrit text Sacteya, attributed to Dhanwantari.2 In therapeutics, a proper diet and regimen were cai'efully detailed, and baths, enemata, emetics, inhalations, gar- u;les, blood-letting and urethral and vaginal injections employed. In Marco Polo's travels, there is a description of a kind of mos- luito-netting used on the Coromandel Coast to keep away flies
^ Charaka's text was conipletod l)v Dridliabala. See A. F. R. Hoernle: Vrch. f. Gesch. d. Med., Leipz., 19()7-S, i, 29-40.
'Madras Coiirier, Jan. 2, 1919. Cited by E. von Schrotter: Ztschr. f. Irztl. Fortbild., Berl., 1919, xvi, 244.
M HISTORY OF MKDUINK
and vcriiiin.' Tho niatoria iiicdica of India was particularly rich. Susiula nuMitions 700 niodicinal i)lants, of which nard, cinnamon, JK'PIHM'. cardamoms, spices and sufjjar were native. Especial atten- tion was paid to aj)lir()disiacs and poisons, particularly antidotes for the ))ites of v(Miomous snakes and other animals. Jolly men- tions some 13 alcoholic drinks. The soporific effects of hyoscyamus and Cannabis indica were known, and their employment in surgical anesthesia was, according; to Burton, of fi;reat antiquity. The Bower MS., a valuable Sanscrit document on birch-hark (fifth century B. C), found by a native in the ruins of jNIingai (Turk- estan) and purchased by Lieutenant Bower in 1890 (edited by Hoernle). corresponds with the drug-lore of the Su^ruta and the C'haraka in many particulars. It contains a remarkable dithy- ramb in praise of garlic (AUinn) sativum^). In the obstetric chap- ter of the Susruta, there is an admirable section on infant hygiene and nutrition, unexcelled by anything before the time of Aulus Gellius or Soranus of Ephesus. The surgical arm of treatment in India reached, as we have said, the highest point of development attained in antiquity. The Susruta describes about 121 different surgical instruments, including scalpels, lancets, saws, scissors, needles, hooks, probes, directors, sounds, forceps, trocars, cathe- ters, syringes, bougies and a rectal speculum.^ These were properly handled and jointed, the blade instruments sharp enough to cut a hair and kept clean by wrapping in flannel in a box. The Hindus apparently knew every important operative procedure except the use of the ligature. They amputated limbs, checking hemorrhage by cauterization, boiling oil or pressure. They treated fractures and dislocations by a special splint made of withes of bamboo, which was subsequently adopted in the British Army as the "patent rattan cane spUnt." They performed lithotomy (with- out the staff). Cesarean section, excision of tumors, and the re- moval of omental hernia through the scrotum. Their mode of extracting cataract has survived to the present day and they were especially strong in skin-grafting and other phases of plastic surgery. The method of rhinoplasty was probably learned from them in the first instance by the itinerant Arabian surgeons and so transmitted through private families, like the Norsini, from generation to generation even to the time of Tagliacozzi. The Hindus were especially clever in their method of teaching surgery. Reahzing the importance of rapid, dexterous incision in operations
^ H. Schroder: Arch. f. Schiffs- u. Tropen-Hyg., Leipz., 1917, xxi, 350.
2L. Aschoff: Janus, Amst., 1900, v, 493-501.
' See "A Short History of Aryan Medical Science," by Sir Bhagvat Sinh Jee, London. lS9fi. 176-186, with pictures of surgical instruments and other apparatus, on plates 1-10.
SUMERIAN AND ORIENTAL MEDICINE 65
without anesthesia, they had the student practise at first upon plants. The hollow stalks of water lilies or the veins of large leaves were punctured and lanced, as well as the blood-vessels of (lead animals. Gourds, cucumbers and other soft fruits, or leather Itags filled with water were tapped or incised in lieu of hydrocele Ml any other disorder of a hollow cavity. Flexible models were used for bandaging, and amputations and the plastic operations were practised upon dead animals. In so teaching the student to acquire ease and surety in operating by "going through the mo- tions," the Hindus were pioneers of many recent wrinkles on the didactic side of experimental surgery.^
Whether the Hindus influenced Greek medicine before the time of Alexander the Great or were themselves influenced by it is not known; but it is certain that, at the time of Alexander's Indian expedition (327 B. C.), their physicians and surgeons enjoyed a well-deserved reputation for superior knowledge and skill. Some writers even maintain that Aristotle, who lived about this time, got many of his ideas from the East.
With the Mohammedan conquest, Indian -medicine passed under the sway of the Arabic domination and virtually ceased to b(>. Its only survival in our own time consists apparently in the \'(Mlantic practices of the various Swamis and Mahatmas who oc- easionally visit this country and whose strange cult has driven many of its American adherents insane. It is interesting to note, however, that the three Englishmen who did most to put hyp- notism upon a permanent basis in practical therapeutics — Braid, i'.sdaile and Elliotson — undoubtedly got their ideas and some of I heir experience from contact with India.
Chinese medicine is what our own medicine might be, had we l>(>en guided by medieval ideas down to the present time, that i-^, absolutely stationar3\ Its literature consists of a large number of works few of which are of the slightest scientific importance. Their characteristics are reverence for authority, petrified formal- ism and a pedantic excess of detail.
The earliest of the classics, upon which Chinese medicine is based, are the works of Huang-ti (2697 B. C). These were done in lacquer upon strips of bamboo or palm-leaves, the tadpole cliaracters, derived from the ancient device of making knots in strings, being arranged vertically, to accommodate themselves to
^ Readers of Captain Marryat's novels may recall how the apothecary, Mr. Copha^us, taught venesection to the fatherless Japhet by making him, ■'in the first instance, puncture very scientifically all the larger veins of a cabbage leaf, until, well satisfied with the delicacy of my hand and the pre- cision of my hand, he wound up his instructions by permitting me to breathe 1 vein in his own arm." Marryat, Japhet in Search of a Father, ch. iv. 5
(»(') iiisToin oi' Mi:i)i('iNio
tlu> naiTDw liMinhoo suii'nctv 'Plicsc (;i(li)()l(' i(l(Mtn;i';mis, llio aiia- loij;uo lit' I he l'<;\ pi iaii |)icl ur(>-\vi'il iii^s, \V(M'(> latci' iiiodilicd and d()iu> wil li pen and pap(M\
Ii> t 111' ( 'Imw (iyiiasl y y 1 1'JJ 15. ( ". 1, ( 'liiii ^'u(■ll Jen wrote ;i treat iso on tlio arterial and visceral systems I .\<uirliing), which f;ivcs the weights of the dif- ferent or^raiis. In the Minj; dynasty (lUtiS A. 1).), ('haiifz; Chi Titifj; wrote a similar treatise [Lvicliinf)), and in the Ching dynasty, tlie Em])eror C'hien Ijung edited an Kncyrl()i)odia of Chinese medicine (1()44 A. D.), and Shenfj; Tung wrote a hook on osteology. Chinese anatomy is mainly splanchnology, angi- ology and physical anthrojKmietry. As with all early peoples, there is a strong jiredilection for number lore. TIum'c are two cosmic ])rinciples, the celestial ^'an iligiit, h(>at, life) and the earthly Yin (darkness, cold, (leath). ]>ife con- sists in the inter-action t)f a male and female principle, e(iuilil)rium between which constitutes liealth and imbalance, disease. These principles are then distributed to the different i)arts of the body, e. g., the hand receives the great female principle of the lung and the young male prin(;ii)l(; of t\w "three burning s])aces," i. e., the thorax, abdomen and pelvis. The principles con- tain air and blood in varying quantities, e. g., "the great male principle has much blood and little air." The function of organs is to store up, that of viscera to br(>ak down and eliminate. In the Neiching {Internal Organs) of Huangti (2t)97 B. C), the liver stores the blood, which cont;iins the soul; the heart stores the pulse (spirit); the spleen the nutrition (thought); the lungs the breath (energy); the kidneys the germ principle (will). These five organs control all parts of the body, e. g., the lungs produce the skin and hair, form tlie kidneys and control the heart, which produces the blood, forms the spleen and controls the kidneys. The six viscera (stomach, colon and duodenum, gall- bladder, bladder and three burning spaces) and the five organs are similarly int<>rr(>lated in a sort of hierarchical physiology, the heart being king and dir(>ctor, the lungs his executors, the Uver his general, the gall-bladder his attorn(\v general, the spleen his granary officer who creates the five tastes, the three burning spaces (filled with fat) the sewage system, draining into the bladder. This book of Huangti gives valuable measurements of the bones and alimentary tract. Physical anthropometry is clearly of Chinese origin. In the Ching period, regional anatomy was much improved by Feng Chiao Chang (1644 A. D.). In the later Ching period (179(i-1821), Wang Chin Jen made 24 good pictures of the organs and viscera. Angiology and osteology were cultivated as topographic aids to acupuncture (2697 B. C), cauteriza- tion and osteopathy. Along the 12 pairs of travelling vessels, there arc 365 needling or puncture points for the evacuation of the pulse (air) ; also 365 capillary vessels, 365 muscular junctions, 365 bones, 365 articulations. The cranium in some .systems consists of only one bone, in others of 8 in the male sex, 6 in the female; the lung has 8 lobes, the liver 7. There is good evidence that osteology was studied from fhe skeletons in vmcovered graves, and that dissection w^as performed, usually upon the bodies of executed criminals.^
Chinese anatomy and physiology are thus dominated by the system of Huangti, with its strange antinomies of a fantastic number-lore and an exact physical anthropometry, its fabulous hierarchy of feudal and inter-social relations between the organs and viscera. Each organ is related to a color, taste, season and time of the day, has a parent and friends and enemies. The heart is the son of the liver, the son of the heart is the stomach, its friend the spleen, its enemy the kidne^^; red is its color, summer its season;
1 For the above details I am indebted to the clear, terse and ship-shape presentation of Dr. E. T. Hsieh, in Anat. Rec, Phila., 1921.
SUMKRIAN AND ORIKNTAL MEDICINE 67
it receives at mid-day (Welch). Other things being equal, the fantastic number-lore of Chinese physiology is no more con- Icmptible than the numerical system of Galen, which occupied the attention of European physicians for no less than 1700 years. But with such inadequate knowledge of human structure and function there could be very little surgery, particularly among a people whose religious convictions were against the drawing of blood or the mutilation of the body. Castration is the only operation t hey perform, and, while they use dry cupping and massage, they do not resort to venesection, but substitute the moxa and acupunc- ture. The moxa, introduced into European practice in the seven- teenth century, consists of little combustilile cones which are applied all over the body and ignited. Acupuncture is the pricking of the body with needles, coarse or fine, which are sometimes twisted in the stretched skin. Both procedures are employed for purposes of counter-irritation in gouty and rheumatic disorders. Practice in acupuncture is obtained by puncturing the strategic holes of election on bronze images over pieces of paper (Cowdry). The ( hinese were wonderfully clever at massage and were the first to employ the blind as masseurs. They were early acquainted with identification by finger-prints (dactyloscopy). Chinese pathology is characterized by an excessive amount of detail; for example, 10,000 varieties of fevers or 14 kinds of dysentery. In diagnosis they attach great importance to the pulse, the varieties of which are minutely subdivided and investigated by touching different parts of the radial artery of either hand with the fingers, after the fashion of striking the keys of a piano. In this way, six sets of pulse-data are elicited, which are connected with the different organs and their diseases. Michael Boym, a Jesuit missionary in China, first wrote on Chinese pulse-lore (1666), giving plates rep- resenting their peculiar mode of feeling the pulse. His work was resurrected and published by the physician-botanist, Andreas Cleyer (1686). In his own compilation (1682), Cleyer gives wood cuts illustrating the Chinese doctrine of the pulse and the semei- ology of the tongue, also thirty plates of Chinese anatomy, and other phases of medical sinology. The Chinese materia medica is unusually extensive and includes such well-known drugs as gin- seng, rhubarb, pomegranate root, aconite, opium, arsenic, sulphur, and mercury (for inunction and fumigation in syphihs), and many disgusting remedies, such as the parts or excreta of animals. Millions of dollars are spent annually on drugs. At a famous drug- store in Peking, 300 years old, it is said that $1000 worth of native drugs are sold daily (Cowdry). Syphilis in C'hina is said to go back to the Ming dynasty and references to gonorrhea are attributed to Huang-ti. The Hsi Yuan Lu, the official Chinese
CS HISTORY OK MKDICINE
t(.'\l-l>()()k (if lorcnsic iiu'diciiic \\)v liuiulicds of years, contains many (Mupirical ohsorvations on poisons (W'u Lion-Teh). The ancient ('liinc^si* kiunv of pr(>\-en(iv(> inoculalion against .smallpox, whit'h they |)i-ol)al)l>' got from India. Animal statistical records of disease were already estahlislied in the Cfion Li (1105 B. C.), good hygi(>nic precepts were advanced in another book of 700 B. C, and the / ('/(//( Chituj is a well-known manual of physical culture, with illustrations. The plan of eating only cooked food, the sensible costume of cotton and silk, the characteristic adapta- tion of their architecture to climate, all show the good common sense of the Chinese in these matters. But the infectious diseases are not yet notifiable, so that scarlatina and smallpox sweep away thousands. During the Manchurian epidemic of plague (1910-11), strategic centers were established along the main railway lines in North China and have availed to keep the disease out in th(^ last five years. This is also true of the systematic rat-proofing of houses in Shanghai.'
Modern medicine has l)een developed in China through the hospitals and medical schools established by the foreign mission- aries, through similar institutions established by the governments of Great Britain (Hong Kong), Germany (Shanghai, Tsingtau), France (Canton), Japan (Peking, Shanghai, Hangkow, Mukden), by the China Medical Board of the Rockefeller Foundation (Peking), and by the Chinese government.
There are now 26 medical schools in China, the best of which are the Peking Union Medical College (Rockefeller Foundation), the Medical De- partment of the University of Hong Kong, the Japanese Medical School at Mukden and the Army and Naval Medical Schools at Peking and Tientsin ^espectivel^^2
The originator of medical missions in China was Dr. Peter Parker [1804- 88], a Yale graduate, who founded the Ophthalmic Hospital at Canton (1835) and made the unique collection of Chinese surgical paintings now in Yale.^ President Charles W. Eliot, in a tour of China, stated that the most urgent need of its millions was medical education. To him was mainly duo the founda- tion of the Harvard Medical School of China, the equipment of which was taken over in 1916 by the Rockefeller Foundation, along with the medical establishment of the University of Nanking. In 1916 the cornerstone of the Hunan-Yale Medical School was laid. The Chinese government has a National Medical College at Peking, the schools of military and naval medicine men- tioned, and five provincial schools. The Japanese Medical School at Mukden, while actually o^med by the South Manchuria Railway, is under strict govern- mental control, has a full-time stafT, and publishes annual researches. The Rockefeller Foundation has spent seven million dollars on the Peking Union Medical College alone (1920). This establishment, with its splendid build- ings, is destined to be the nucleus of advanced medical teaching in China. The deficiencies in Chinese medicine being mainly due to adherence to the stationary and fantastic scheme of Chinese anatomy, the sensible course has
» Wu Lien-Teh: Nat. Med. Jour., China, Shanghai, 1916, ii, 32-36.
2E. V. Cowdry: Anat. Rec, Phila., 1921, xix.
3 C. J. Bartlett: Jour. Am. Med. Assoc, Chicago, 1916, Ixvii, 407-411.
SUMERIAN AND ORIENTAL MEDICINE 69
hron taken of hiving a firm foundation for instruction in this basic disciplino. I'rofircss is slow, owing to the i)r('])on(h'ran{'(> (^f U'cturc hours in most of the ^(■hools, the (Ufhculty in obtaining material for dissection, and the impression w hicli seems to prevail in the provincial schools that what is to be taught is |)ractice of medicine and surgery and not the fundamental sciences upon which modern medicine is based. There is, further, the intransigeance and distrust of the native population, lack of funds on the part of the government, and a conviction of forty centuries' standing that medicine is a poor fifth-rate occu- pation. Student atttnidance is slen(ler, the matriculating classes at the 26 medical schools not being more than 600 annually for a population of millions. The National Medical Association of China had its first meetings in Shanghai on February 7-12, 1916. The Anatomical and Anthropological Association ( )f China held its first meeting at Peking on February 26, 1920.i
The Japanese are noted for their remarkable power of assimi- lating the culture of other nations, and, before they came in con- tact with European civilization, their medicine was simply an ex- tension of Chinese medicine. Up till 96 B. C. the healing art in .Japan was passing through the mythical phases common to all forms of early medicine." Disease was supposed to be caused by divine influence { Kamino-no-ke) , by devils and evil spirits or by spirits of the dead. Two deities, with particularly long names, presided over heahng, which was further helped out by prayers and incantations, and at a later period, by internal remedies, \enesection, and mineral baths. The period 96 B. C.-709 A. D. marks the ascendancy of Chinese medicine, which was introduced by way of Corea. The practitioners and teachers were priests. Pupils were sent to China at government expense, and by 702 A. D. there were native medical schools, with seven-year courses in internal medicine and shorter periods for the other branches. The students were made ishi or doctors after passing a final ex- amination in the presence of the Minister, and women were oc- casionally trained as midwives. During the succeeding periods (710-1333), called the "Nara," "Heian," and so on, after the names of the different capitals of Japan, the influence of the Chinese priest-healers was still dominant, with some advances in surgical procedure, such as suturing intestinal wounds with mul- berry fiber or couching a cataract with needles. In 758, a hospital for the indigent sick was erected by Empress Komyo. The oldest Japanese medical book, the Ishinho, written by Yasuhori Tambu in 982, describes these surgical novelties, and also records the existence of lying-in hospitals and isolation houses for smallpox patients. During the medieval period, personal observations of cKnical cases were recorded. The moxa, acupuncture, and many
J Cowdry: Op. cil.
■ Most of these details arc taken from Y. Fujikawa's "Geschichte der Medizin in Japan," Tokyo, 1911. See, also, Leon Ardouin's "Apergu" (Paris, 1884).
TO lIlsroHY OK MKDICINK
of tho Chinoso horhal or mineral reiiK^dics wrw in xo^uc and mas- sage was (l(>lef>;aled 1o llie Itliiul as a siiilaMe occii|)a(i()n. A shik- inj>; contrihution of (lie aneicMit .Iai)anese lo (iierapeiitics was llieir us(> of red hanfj;in<!;s in (he (reatmen( of smallpox, (h(> remedy afterward employed hy John of (Jaddesden and Finsen. 'I'he firs( Portufjuese ship touchod Japan in 1542, and with the arrival of St. Francis Xavior in 1549 hejiins the rise of F]ur()pean influences. The physicians who came with him and with the later mission- aries- there was a Catholic chinch at Kyoto in 15(18- treated the sick gratuitously, did surgical work, founded hospitals, and l^lanted botanic gardens. After the expulsion of the missionaries, two of their Japanese pupils settled at Sakai and founded a school. The Dutch traders came in 1597 and their ship's surgeons also exerted some influence. A translation of Ambroise Fare's works was made in the seventeenth century, but the importation of European books was forbidden until the year 1700, after which time translations of Boerhaave, Van Swieten, Heister, and other writers began to apjiear. \'accination was introduced bj^ Mohnike in 1848. The medical school founded by the Dutch physicians at Yeddo in 1857 passed into the hands of the government in 1860 and became in time the present University of Tokyo. The modern or Meiji period of Japanese medicine begins with the year of revolution, 18(38, and its distinctive feature is the rise of German influences. The universities and medical academies, the state examinations, the medical societies and medical journals, are all copied after German models, and the ablest Japanese medical men of today — Shiga, Kitasato, Noguchi, Hata — have received their education and training in Germany. This influence has persisted, even since the outbreak of the pan-European war. German is still the language of science in Japan, and religious ceremonies are still held at the little shinto shrine dedicated to the memory of Koch.
To sum up what is due to Oriental medicine, the Babjdonians specialized in the matter of medical fees, the Jews originated medi- cal jurisprudence and public hygiene and ordained a w^eekly day of rest, the Chinese introduced anthropometry, finger-prints, massage (osteopathy), ocupuncture, the moxa and many drugs, and the Hindus demonstrated that skill in operative surgery which has been a permanent possession of the Aryan race ever since.
GREEK MEDICINE I. Before Hippocrates
The Greeks were a Sammelvolk, a composite people, and their I li verse elements — Ionian, Thessalian, Arcadian, Achaian, Jjlolian, Dorian — gave them the self-willed independence, the restless in- dividuality, of a mountaineer and sea-faring race, traits which were at once the secret of their greatness and their downfall. The physical geography of insular and peninsular Greece, with its deep coastwise indentations and abrupt mountain walls, isolated the whole country and its separate states in a way that made at once for intense local patriotism, and at the same time gave the cultural advantages of abundant maritime intercourse with other nations, while such grandeur in external nature could only inspire the lofti- est freedom of mind and spirit. Yet this very freedom of thought prevented Greece from becoming a nation in the end, for her peo- ple were too diverse in racial strain, pulled too many different ways, to become permanently united. Greek history is the history of several states, and these city-states "were too wiKul to combine."^
In the time of Grote, Greek history began with the first Olym- piad (776 B. C.). Today, the origins of Greek civilization go back to at least 3400 B. C., and are found outside the Greek peninsula. Schliemann uncovered the plains of Troy in 1870-73, and unveiled the JEgean civilization of Mycenae and Tiryns (1600-1200 B. C.) in 1876-84. The Minoan civilization of Crete, which goes back to Neolithic man, was revealed in the excavations of Sir Arthur Evans in 1894-1908. These investigations^ go to show that Crete, "a kind of half-way house between two continents," independent of the Eurasian and Eurafrican cultures, was the starting point of European civilization.
The early Minoan culture (3400-2000 B. C), contemporaneous with the early dynasties of Egypt, the excavations lying over Neolithic strata which go back to 9000 B. C, is characterized by polished stone axes, finely burnished pottery, steatopygous female figures of clay, with pronounced breasts, like those of Aurignacian woman, with perhaps evidences of the worship of the
1 Sir T. Clifford AUbutt: "Science and Mediicval Thought," London, 1901, p. 21.
2 Sec Sir A. Evans: Reports of Excavations, 1900-1908 in Ann. Brit. School, Athens, 1900-1908, passim. Also his "Prehistoric Tombs of Knossos" (1900), and Science, N. Y., 1916, n. s., xliv, 399; 448.
71
I'l THSTORY OF MEDK^NE
Mnijnn Mater, or Croiit MoIIut of the M;itriarcli;it(\ with (lio divino child- husband. In the Middle Minoan rcriod (•_'()()( 1 1 s.")( ) U. ('.), corn'sixtiidinn with the twelfth I'l^yptian dynasty, ijolychronie (lecorations. fine faienee and painted siierds ai)t>nnd, some specimens of which were found by I'linders l'elrii> amonp; twelfth dynasty remains at Kahim in the I'ayum. The late Minoan Period (ISaO-l KK) H. (\), correspond inji with the liyksos jieriod and the New I'jnpire in M^^pt, is best representcMl by the ])alaces (>xcavated ;it Knossos and Ila^ia Triada. The Ivnossian palace (tiie Cretan Labyrinth) is a stately, many-storied structvn'(>, with windinji corridors and subterranean passages, elaborate domestic arrangements and tli(> best sanitation, including ingenious devices for ventilation, water-ways for drainafrc, cannon-shajx-d terra cotta iiipinji, and latrines which, in construction, excel anything: of the kind bt^fore the ninet(>entli century.' I'he corridors, landinjis and ])orticos are decorated with hifih reliefs in (jc^so dura and anijnated wall-jjaintings, rei)rosentinf; jiroups of court ladi(>s in cm'iously modern jackets, fa,shionaV)le robes, with terraced flounces, and gloves. The natiu'alistic faience imajies of the Mother (loddess and her female votaries, re])resent her clithonic (eyrthly) aspect, with .serpents, a tightly-waisted figure, with the iu>olithic bell-sha])ofl gown, of approv(^d modern cut.
Ciigantic, ornate amphora^ for oil, fresco-paintings of bull-fights, with male and female toreadors (whence the Athenian legend of the Minotaur), a gaming-board of gold-plated ivory, a shrine, with cult objects and offertory ve.ss(>ls in i)lace, a gyi)sum throne of Gotliic aspect, evidence the highly special- ized culture of Knossos.
In the .Egean or Myccnajan culture revealed by Schliemann, there is the same skill in ceramics and sculpture, fresco-painting and ornamentation, the same massive architecture, as in the Lion's CJate at Mycena?. The aniconic stage of worship of trees and pillars is succeeded by the cult of the Cireat Mother, with the chthonic snakes or uranic doves. Shaft-burial of the dead in cysts sunk in rock was followed by beehive tombs. Tlie Mycenaean culture is probably synchronous with the Pelasgian, and the post-Mj'cena'an culture of the Homeric ])eriod shows Minoan influences. In jilace of the round shield and armor of the Homeric Greeks, the Minoan and Mycena?an peoples used shields covering the whole body, and their ornaments are of the Bronze Age. The Homeric Greeks used iron weapons and cremated their dead. Their Olympian Gods are not found in the Minoan and Mycenaean periods.
Of the early achievements of the historic Greeks, the Hellenes, Thucydides himself says, at the beginning of his history, that "they were no great things." He points out that ancient Hellas had no settled population, wars and factions keeping the people in a state of constant migration, so that "the richest soils were always the most subject to change of masters." Under conditions like these, a restless, athletic, warhke and sea-faring people were developed whose chief interests were the active lives they led and the influence exerted upon their affairs by the gods of their worship.
As Walter Pater has so charming^ set forth, in his studies of Dionysus and "Hippolytus Veiled," it is a common error to sup- pose that the ancient Greeks everywhere worshiped the same Pan- theon of gods. In point of fact, as being a divided people, the Hellenes of the mountains, the coast, the valleys, farms and river- sides had each a separate religion of their own, the whole forming,
^ T. H. M. Clarke: Prehistoric Sanitation in Crete, Brit. Med. Jour., Lond., 1903, ii, 597-599.
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74 IIISTOHV (IF MKDICINE
of eoui'so. nil ossoni i;il polylhcisin. in lli.-it cx-cia' lidleclan or vill;if!;o comniunily worshiped ils special god, al the same tiiiu> |)ayin<j; a vague general revei(Mic(> to the gr(\it(>r gods, "^rinis, Deiiieter was the special divinity of those who li\-ed on farms and among coni- fic>lds, Dionysus of those who cultivated vin(>vards, Poseidon of those who dwelt by th(> sea, Pallas Athene of the Athenians, whil(> the lessiM' gods had each a iiarticular locality where their worship was a cult. "Like a network ovei- the land of gracious jioetic tradition," says Pater, "the local religions hatl been never wholly superseded by the worship of the great national temples."' Thus we find, at the start, that there were many tutelary divini- ties of medicine among the (Ireeks, with overlapping or inter- chang(\ibl(> functions in different j)laces. The (lr(H>ks, as Pater says, had not a religion, but relujions, "a theology with no central authority, no link on historic time, liable from the first to an un- observed transformation." Thus, Artemis (Diana), Demeter (Ceres), Hermes (Mercury), Hera (Juno), Poseidon (Neptune). Dionysus (Bacchus) were, all of them, patron gods and goddesses of the healing art, and were able, at need, to produce disease themselves. In the Hippocratic treatise "On the Sacred Disease/' we read of epileptics that
"if they imitate a goat, or grind their teeth, or if their right side be con- vulsed, they say that the mother of the gods (Cybele) is the cause. If they speak in a sharper, shriller tone, they liken this state to a horse and say that Poseidon is the cause. . . . But if foam be emitted by the mouth and the patient kick with his feet. Ares (Mars) gets the blame. But terrors whicii happen during the night, and fevers, and delirium, and jumpings out of bed, and frightful apparitions, and fleeing away — all these they hold to be the ])l<)ts of Hecate, and the inva.sions of the Heroes, and u.se purifications and incanta- tions, and, as appears to me, make the divinity to be most wicked and impious." Thus, as appears from the deprecating Hippocratic allusion to Hecate, there existed, apart from the cult of the Olympian gods, a darker, obscurer cult, namely, the medical magic associated with the ritual of propitiating the so- called chthonian deities of the earth and the underworld. This was again not a general behef, but confined to distinct localities, vaguely including the cults of the celestial gods in their ancient chthonic aspect, the cave gods, deified heroes, heroized phy.sicians (Heroi latroi) and the perturbed spirits of the dead. The sacrificial rites were conducted in the witching hours before dawn and the deities invoked were never addressed directly by name, but plena titulo, with flattering appellations. The references to chthonic deities in the Greek authors are therefore obscure. In the Greek Pantheon, the greater x^ovml are identi- cal with Frazier's "Spirits of the Corn and the Wild." Hades (Aidoneus, Pluto), also stjded "Zeus Katachthonius," Demeter chthonia (the Corn Mother) and Persephone (Kore), goddess of death and the "poppied .sleep." Hermes Psychopompos, of the golden wand and sandals, the conductor of souls to Hades (Odyssey XXIV, 1), Cerberus, Hecate, the Erinnyes and all other malevolent spirits, were associated with this cult, and coordinate with it was the ritual of propitiating or invoking the departed spirits of the dead.*
^ Pater: "Hippolytus Veiled," op. cit., p. 162.
2 E. Rohde: P.syche, 3. Aufl., Tiibingen & Leipzig, 1903, i, 204 and 278, 'passim.
GREEK MEDICINE 75
Apart from the purely rolifiioiis ritual of the x^^ofioi and the cult of tho dead, I liiic aros(> an (^sotoric ritual thcrajn-, derived from the eireumsfance that those I irk ])o\ver.s controlled not only fruitfulness of the eartli and in man, but. could niliict or avert disease, insanity or death. Infernal deities, thirsting for the lilood of hiunan sacrifice, they were feared for their power of wreaking evil in tiie shape of insanity, ei)ilepsy, hysteria and other major neuroses. This arc^haic neurology is implicit in all the Greek poets, dramatists and philos- opliers. Thus Plato (Pha;drus, 244) speaks of insanity as due to "ancient wrath," which Rohde interprets as the anger of departed souls. Pre-Hip- pn(Tati(! medicine was entirely prognostic and prophylactic. Prophylactic iiK'dieine was threefold: (1) Apotropaic, designed to averl disease by ritual -:Mrific(>; (2) Hilastic, designecl to abo7i disease by rites of propitiation or tiiinement; (3) Cathartic, designed to cast out disease from the body by rites 111 lustration (purification). Disease, once in the body, was regarded as a miasm, contamination or taboo cast upon the soul by angered infernal gods and .spirits. The chthonian animals and plants, sacred to these deities, and iiiployed in lieu of human sacrifice to propitiate them, came to have asso- iiative remerlial functions, whether for purification from the stigma or as tonnected with the rite of communion or "eating the god," in the form of the parts of animals,! sacrificial cakes or incense plants dedicated to their worship. 1'lie ashes and rejects of sacrifice {kalhannnta) formed a kind of sacred i)har- inacopoeia, sometimes distributed among the worshipers and eaten by them, a- in the Asclepieia. Of the innumerable medicinal simples and animal ivmedies recommended by Galen, Dioscorides and Pliny, it is obvious that liiit few have any pharmacologic rationale in the laboratory sense. Each liithonian remedy became an open secret, justified by its mythologic associa- linns. Some simples are even described by Dioscorides and Pliny as the iiloofl" of different gods and chthonian animals. But even as the drug -,-aptxaKov) was sacred in a good and a bad sense, through its relation to the clitlionian idea of atonement or catharsis by means of a sacrificial scapegoat ..-apfxaKos), so this empirical therapy became detached from the priestly t liirapy of the temples, and its secret practitioners were regarded as magicians. riie careful study of Max Hofler shows that the modern theory of animal Kiiiedies did not originate with the Greeks, but with the doctrine of signatures iSnnilia .mnilibus'^. From an analysis and tabulation of 1254 ancient organo- tlifrapeutic prescriptions, Hofler shows that, except in the case of the liver, -picen and heart (all worthless), parts of the animal body were never employed "Xflusively to heal diseases of the same parts, but in the most varied and lapricious way, depending upon the tenets of the chthonian cult.^ Ancient ( Ircek organotherapy was "homeopathic magic" in the folklore sense, but by iiio means isotherapy, in the sense of "like cures like."
The chief gofl of heahng in the Greek Pantheon was Apollo, commonly called Alexikakos (the averter of ills) , whose far-darting irrows visited plagues and epidemics upon mankind and who could, at need, avert them. He was also the god of purity and well- aeing in youth, and, as Homer relates, the physician to the Olym- pian gods, whose wounds or diseases he cured by means of the root 3f the peony. Hence his name 'Ta?an," and the epithet "sons of Pffian," as applied to physicians. Legend relates that a knowledge [)f medicine was communicated by Apollo and his sister Artemis to he Centaur Chiron, the son of Saturn. As one skilled in music
1 Frazer- "The homeopathic magic of a flesh diet," Spirits of the Corn ind the Wild, 1912, ii, 138-168.
^ M. Hofler: Die volksmedizinische Organotherapie und ihr Verhiiltniss urn Kultopfer, Stuttgart, 1908.
<c.
nisroKY (»1' MKI>1("INR
Mini sur,ii(>r>' mid csiicciallN' vcM'scfl in .•niciciil l()i'(\ T'liii-on was (mi- tnistt'd with \]\v I'cai'iii^ and cdiicat ion of the heroes .lason, Iler- I'ules. Ai'hilK^s, and, in ])arti('ular, .Ivsculapius. \]\o son of Apollo by the nymph ("oronis. As Pindai- siii<i:s, in his third Pythian odo, -Esculapius luM-anie so prolicieni in the healin<i- art thai Pluto accused him of diminishiii':- the nmiii>er of shades in Hades, and he was destroyed by a thunderbolt of Zeus. Aft(>r his death ho be- came an object of worship, and the temples of his cult were the famous Asclei)i(Ma. of which the most ('(>l(»bi-a1e(l w(>re those at Cos, Epidaurus, C'nidus antl Perjiamus. These temples, commonly
situatetl on wooded hills or mountain sides, near mineral springs, became popular sanitaria, managed by trained priests and, in intention, not unlike the health-resorts of modern tim(>s. The patients were received by the physician-]iriests, who stirred their imaginations by recounting the deeds of /Esculapius, the success of the temple treatment and the remedies employed. After appropriate prayers and sacrifice, the patient was furthei' purified by a bath from the mineral spring, with massage, inunction and other methods, and, after offering up a cock or ram before the image of the god, was inducted into the special rite of ''incubation" or the temple-sleep. This consisted in 1>- ing down to sleep in the sanctuary, where during the night, the priest, in the guise of the god, presented himself before the patient to ad- minister medical advice, if he hap- pened to be awake. If he slept, as was usually the case, the advice came in a dream, which was interpi'eted afterward by the priests, who then prescribed catharsis, emesis, blood-letting or whatever remedies seemed appropriate. If the treatment was successful and the patient cured, he then presented a thank- offering to the god, usually a model of the diseased part in wax, silver or gold, while a votive tablet giving the history of his case and its treatment was suspended in the temple.
The whole rite of incubation has been facetiously described in the 'Tlutus" of Aristophanes, and in more elevated and dignified style in the third chapter of Walter Pater's romance of Roman antiquity, "Marius the Epicurean."
Colossal bust of Ji^sculapius in the British Museum.
GREEK MEDICINE 77
The votive tablets in the Asclepieia at Cos and Cnidus became the permanent clinical records of the Coan and Cnidian Schools of Medicine, of the first of which Hippocrates was himself a pupil. The Greek traveler Pausanias noticed six of these votive columns when he visited the temple at Epidaurus about 150 A. D., and two of them were excavated in recent times by Cavvadias. Enjiraved upon these last were about thirty clinical cases, giving the names of the iiatients, their bodily ills and what was done for them. The details of ~\ iiiptoms and treatment are very meager. In most cases it sufficed if the god aiKiinted the patient in his sleep or if one of the sacred dogs or snakes in the jtemple licked the diseased part. One patient came with four fingers of his iiand paralyzed, another was blind of one eye, another had carried a spear- xMiit in his jaw for six years, another had an ulcer of the stomach, another ■iiil)yema, another was infested with vermin. All were reported as cured. ^ llicse fragmentary case-histories, none of them conveying any medical infor- nition of positive value, are sometimes supposed to have been the starting- mint of the Hippocratic descriptions of disease.
Many antique images, in inarl)le or terra cotta, exist, repre- senting different parts of the body. These may be ex voto objects, or suspension in the temples, or simple plastic figurations of normal inatonn'. Those representing coils of intestines (in the Schlie- ii.iim collection, Athens or the Museo dei Termi, Rome), the chest, \ith ribs (Vatican), or the situs viscerum (Vatican), are life-like ■IK High to be simple examples of anatomic illustration in three liiiionsions, with or without didactic intention.-
Among the legendary children of J^sculapius, by his wife,
{ipione, were his daughters Hygieia and Panacea, who assisted in
lif temple rites and fed the sacred snakes. With the ancient
iiv(^ks, as with the Egyptians, Cretans and Hindus, the serpent
MIS venerated as the companion of many gods or the favorite
hrhonian shape in which they sometimes appeared, as in the cases
f the jMinoan snake-goddess (Magna Mater) and Zeus Meilichios.
11 his uranic aspect, ^Esculapius is commonly represented as a
ntidsome Jove-like figure, always attended by the sacred snake
iitwined around a rod, a miniature Omphalos, like that of the
iiiple of Apollo at Delphi — a plastic expression of his iatromantic
itt — and a grotesque, childish figure (like a tiny-hooded monk or
funchener Kindl) called Telesphorus, the god of convalescence.^
>t' the sons of ^sculapius, two, Machaon and Podalirius, are men-
nned in Homer's Catalogue of the Ships as leaders, commanding
lirty vessels and "good physicians both." ^sculapius is him-
'If referred to in the Iliad as a real chieftain of Thessaly who
1 For further details, see E. T. Withington, "Medical History," London, 594, Appendix ii (pp. 370-397).
2 See E. Hollander: Plastik und Medizin, Stuttgart, 1912. ' Telesphorus appears in the statues of J^lsculapius in the Villa Borghese
id Palazzo Massimo (Rome), in the ivory placque in the Liverpool Museum, nd in coins of Apamea and Nica^a. In certain Eastern coins he is transformed ^to a cupping glass of mushroom shape. See L. Schenk: De T(>l(>sphoro deo jottingen dissertation, 1888), and E. Hollander: Plastik und Medizin, tuttgart, 1912, 125-140.
7S nisroKY OK MKDK^TNE
IcanuMl iiuMliciiic from the (•(Mitiini- ("liiioii, from whosc^ Icachinp;, ap;aiii, Achilles was aMc to imparl liis know Icdiic of the hoaliiifj; art fo his fri(Mi(l I'alroclus. Machaon and Podalirius arc ofh'ii re- fcrnvl lo in IIoiiu>r's narrative^ as men skilled in extract inji; weapons, hiiidinii up wounds and applying; soothinji; dru^s. In th(^ fourth Iliad, Machaon is summoned to remove an arrow which was driven throujih th(> l)(>lt of Menelaus, King of Sparta. He arrives to find a circle of warriors j>;ath(>r(>(l about the hero, and "instantly tluMvupon he extracted the arrow from the w'ell-fitted belt. But while it was being extracted the sharp l)arbs were broken. Then he loosed the variegated belt and the girdle beneath, and the plated belt which brass-workers had forged. But when he perceived the wound. wh(>re the bitter shaft had fallen, having sucked out the blood, he skilfully sprinkled on it soothing remedies, which benc^v- olent Chiron had formerly given to his father." In the eleventh Iliad, Idomeneus refers to Machaon as follows: "O Neleian Nestor, great glory of the Greeks, come, ascend thy chariot and let Machaon mount ])eside thee; and direct thy solid-hoofed horses with all speed towards the ships, for a medical man is the equal of many others, both to cut out arrow^s, and to apph^ mild remedies." At the end of the same book, Eurypylus, wounded with an arrow- in the thigh, calls upon Patroclus to remove it. He is borne to a tent, and there, Patroclus, "laying him at length, cut out with a knife the bitter, sharp arrow from his thigh, and washed the black blood from it with warm water. Then he apphed a bitter, pain- assuaging root, rubbing it between his hands, which checked all his pains; the wound indeed dried up, and the bleeding ceased." In the thirteenth Ihad, Helenus, son of Pi'iam, is smitten through the hand bj^ the brass spear of jMenelaus and we have a glimpse of the "great-hearted Agenor" extracting it and binding the wounded hand "sling-wise in well-twdsted sheep's wool, which his attendant carried for the shepherd of the people." Homeric scenes of this kind are frcciuently depicted on antique vases (Daremberg) par- ticularly' on the "bow-1 of Sosias" (500 B. C), a specimen of Greek ceramics in the Antiquarium of the Berlin Museum, representing Achilles bandaging the wounded arm of Patroclus. In the eighth Iliad (lines 81-86) there is a striking picture of the rotatory move- ments made by a horse which had been wounded in the brain by an arrow\ The tenth Iliad (lines 25-31) contains, Cardamatis thinks, a reference to autumnal malarial fevers (the epiala of Theognis), which he attributes to the stagnant marshes and the destruction of forests in the Bronze Age.^ That women sometimes rendered
1 J. P. Cardamatis: Arch. f. Schiffs- u. Tropen-Hyg., Leipz., 191.5, xix, 305 et seq.
GREEK MEDICINE ' '79
iiicdical aid we gather from l)oth Iliad and Odyssey, as in the refer- ence's in the former to "yellow-haired Agamede, who well under- stood as many drugs as the wide earth nourishes," or, in the latter. In the soporific which Helen casts into the wine, a drug "which l'<ilydanima, the wife of Thon, had given her, a woman of Egypt." ill the Odyssey, a healer of diseases is said to be as welcome at a !< ist as a prophet, a builder of ships, or even a godlike minstrel. 1 lom these specimens of the war-surgery of the Iliad it is plain hat the surgeon's art was held in high esteem by the ancient lieeks, and that chieftains of high rank did not disdain to follow t . It is said that over forty different wounds are described by [lomer (250 cases in all) but no details are given as to febrile or itlier symptoms. The lesions were all the spear- and arrow- \()unds of primitive man, with no losses of lunbs or crushing n juries; the mortahty was 75 per cent.^ The anatomic terms is(>d are, according to Malgaigne and Daremberg, more or less <lcntical with those employed by Hippocrates. There is no ob- <'i\-ation of disease, but Delpech thought the description of rhersites (second Iliad) a typical picture of rickets. The scientific lisposal of the dead by cremation was a common practice of the Tomeric G reeks. -
There is no mention of the Asclepieia in the Homeric poems, ^hich date back to at least 1000 B. C, but we may assume that, xcn then, laic physicians and surgeons were a distinct class from >ii(>sts, although perhaps associated with the latter in time of K'ace. Apart from such "priests" and the medical men proper, lie healing art was studied by the philosophers, and practised in nine details by the "gymnasts," who bathed and anointed the Hidy and tried to treat wounds and injuries and even internal iseases. Greek medicine, as Osier has said, "had a triple rela- ionship with science, with gymnastics, and with theology," and • fore the time of Hippocrates, it was regarded simply as a branch f philosophy.
Greek philosophy before the age of Pericles was of Ionian origin nd was derived from Egypt and the East. Huxley regarded the rowth of the Ionian philosophy in the eighth to sixth centuries >. C. as "only one of the several sporadic indications of some power- i\ mental ferment over the whole of the area comprised between tie ^Egean and Northern Hindustan." This ferment, in the view f Zelia Nuttall and Elliot Smith, •' was the spread of a complex
1 Hollander: Berl. klin. Wochenschr., 1916, liii, -3.5.5. 2H. Frolich: Janus, Amst., 1S97-S, ii, 248-2.51.
'Nuttall: Arohspol. and Ethnol. Papers, Peabndy Mus. Harvard Univ., ambridge, 1901, ii, 526. EUiot Smith: Bull. John llylands Library, Manches- 1916, iii, 61.
80 HIsroHY OK MKDICINK
Eurasian and iMiiafiicaii cullurc 1)\- the Plurnician navigators. It is siirnificant that alonj^ tlu- o')th parallel of North latitiulo we find, almost sinuiltanc'ously in jioinl of tinu% Zoroaster, Confucius, Buddha. TiiaU's and Pytha}i;oras (\\'ri}i;ht '). The founder of the Ionic School was Thales of Miletus (039-54-4 Ji. C), who had studied under the Egj^ptian priests, and taught that water is the primary (>lement from which all else is derived. He was followed by Anaximander of Miletus (Oil), who first mapped the heavens and made a successful prediction of an eclipse, Anaximenes of IMiletus (570-500 B. C.) and Heraclitus of Ephesus {circa 550- 400 B. C), who, in succession, assumed that indivisible matter (earth?), air, or fii'e respectively are the primordial elements. These four elements, earth, air, fire, water, were assumed by Anaxagoras of Clazomena? (500-428 B. C.) to be made up of as many parts or "seed" as there are varieties of sensible or per- ceptible matter. These categories were thrown into striking relief in the teaching of Empedocles of Agrigentum in Sicily (504-443 B. C), the picturesque hero of Matthew Arnold's poem, who as philosopher, physician, poet, traveled through the Greek cities, clad in a purple robe, gold-cinctured, laurel-crowned, long haired, severe of mien, and on account of his medical skill, was held by the people to be endowed with supernatural powers. One of his poetic fragments shows the unusual reverence in which the Greek physician was held at this time:
Ye friends, who in the mighty city dwell
Along the yellow Acragas, hard by
The Acropolis, ye steward.s of good works,
The stranger's refuge venerable and kind.
All hail, O friends! But unto ye I walk
As god immortal now, no more as man,
On all sides honored fittingly and well,
Crowned both with fillets, and witli flowering wreaths.
When with my throngs of men and women I come
To thriving cities I am sought by prayers,
And thousands follow me that they may ask
The path to weal and vantage, craving some
For oracles, whilst others seek to hear
A healing word 'gainst many a foul disease
That all too long hath pierced with grievous pains.^
Empedocles introduced into philosophy the doctrine of the ele- ments, earth, air, fire, water, as "the four-fold root of all things." The human body is supposed to be made up of these primordial substances, health resulting from their balance, disease from im- balance. He holds that nothing can be created or destroyed, and
i.J. Wright: Scient. Monthly, N. Y., 1920, xi, 1.31.
- From the interesting translations of the poetic fragments of Empedocles, by William Ellery Leonard in the Monist, Chicago, 1907, xvii, p. 46S.
GREEK MEDICINE 81
that there is only transformation, which is the modern theory of conservation of energy. Everything originates from the attrac- tion of the four elements and is destroyed by their repulsion, and he applies the same idea, under the forms of love and hate, to the moi'al world. Development is due to the union of dissimilar ele- ments, decay to the return of like to like, air to air, fire to fire, earth to earth. Empedocles is said to have raised Pantheia from a trance, to have checked an epidemic of malarial fever by draining swampy lands and to have improved the climatic condition of his native town by blocking a cleft in a mountain side. Legend re- lates that he ended his life by throwing himself into the crater of Mount Etna. His pupil Pausanias is said by Plutarch to have used fire in checking an epidemic.
The Italian School of Philosophers was founded by Pythag- oras of Samos (580-489 B. C.) at Crotona. Pythagoras was a good geometer and discovered the pons asinorum (Euclid, I, 47). He had studied in Egypt, whence he probably acquired his doc- trine of the mystic power of numbers.
He held that unity being perfection and representing God, the number twelve represents the whole materud universe, of which the factors three and four represent the worlds, the spheres and the primordial elements. As the monad (1) denotes the active or vital principle in natiu^e, so the dyad (2) rep- resents the passive principle or matter, the triad (3), the world, formed by the union of the two former, and the tetrad (4), the perfection of eternally flowing nature. Heaven is made up of ten celestial spheres (nine of which are visible), the fixed stars, the seven planets and the earth. The distances of the celestial spheres from the earth correspond with the proportion of sounds in the musical scale.
Pythagoras was the first to investigate the mathematical physics of sound, and in the following way: In passing a black- smith's shop, one day, he noticed that, when the smith's hammers were struck in rapid succession upon the anvil, the chords elicited (the octave, thirds and fifths) were all harmonious; the chord of the fourth was not. Going into the shop, he found that this was due, not to the shapes of the hammers or the force with which they were struck, but to the differences in their individual weights. Upon this hint, he went home and stretched four strings of the same material, length and thickness, suspending weights at the lower end of each, equal to the weights of the four hammers respectively. Upon striking these strings, he got the chords which he had heard in the smithy, and by subdividing the strings with other weights, he was able to construct the musical scale. This was th{^ earliest recorded experiment in physics, and the scale was, j after his death, engraved on brass, and set up in the temple of i Juno at Samos. Pythagoras reasoned that the celestial spheres might produce sounds by striking upon the surrounding ether, and
6
82 msroin' ok mkdicink
tlu^so sounds would \;iiy with I lie \('l(»cily of iniiiact and (he rrlativo distance^. Tlic distances of the s|)lu'r('s troni the (>aitli coiTcspond, as we hav(> s(>(Mi, to the pi'oijoi'tion of sounds in the scale, and as the liea\('nl\ bodies move acc(>i(lin^- to fix(>(l laws, the sounds i)i'oduc(Ml hy them must he harmonious. This is the doctrine of the "harmony of the s|)hei-es." The numl)ei--lore of Pythajioras is thou<;ht to have exerted a profound in(lu(>nce upon th(> Hippocratic doctrine of crises and critical days, which assigned fixed iKM'iods to the resolution of different diseases. More than to anythinji (>ls(>, th(> (Ireek physicians aspired to the scientific power of pnHliction. In pathology, the plastic significance of the num- y her four was combined, in the teaching of Plato and Aristotle, with
the doctrine of th(> four elements, as follows:
Corrospondiiifz; with the clcinciits of curth, air, fire and water were the qualities dry, cold, hot and moist, according to the scheme:
liot + dry = fire; cold + dry = earth,
hot + moist = air; cold + moist = water.
By reversing these equations, the four elements fire, air, earth and water, which correspond with our hydrogen, oxygen, carbon, nitrogen,' could be resolved into their {}ualitative components. Long before Aristotle, probably before Hippocrates, it was held that, corresponding to these four elements, fire, air, water, earth, and the four qualities, hot, cold, moist, dry, are the four humors of the body, viz., blood, phlegm, yellow bile, and black bile. These three sets of elements, qualities and humors could then be brought, by per- mutation and combination, into a comi)lex system of arrangements, based upon the following scheme:
hot + moist = blood; cold + moist = phlegm;
hot + dry = yellow bile; cold -j- dry = black bile,
the different combinations giving the qualitative aspects of disease, and, by the same token, of the physiologic action of drugs. The whole arrangement made up the "humoral pathology" which regarded health and disease as the proper adjustment or imbalance respectively of the different components mentioned, and the scheme was further elaborated by Galen and the Arabian phy.sicians, in that remedies and their compounds were classified in numerical scales according to the "degrees" or relative proportions of their several qualities. Thus the Arabian pharmacists held that sugar is cold in the first degree, warm in the second degree, dry in the second degree, and moist in the first degree; carrlamoms are warm in the first degree, cold by one-half a de- gree, dry in the first degree, and so forth. In Galen's system, the Pj'thagorean doctrine of numbers was applied to every aspect of medicine. For example, there are three faculties, natural, spiritual, animal. There are three spirits: the natural, arising from the liver; the vital, from the heart, the animal, from the brain, the three being distributed and diffused through the body by the veins, arteries and nerves. There are four ages of man. adolescence (hot and moist); manhood (hot and dry); advanced age (cold and dry); old age (cold and moist). The eye has seven coats and three humors. There are three kinds of drinks, pure, as water; containing food, as wine; or a mixture of both, as .sjTups and medicinal draughts. There are three kinds of fevers, the ephemeral, in the spirit; the ethic (hectic?), in the sohds; and the putrid, in the humors; and the putrid are of four varieties, the continued (s>Tiochal), in the blood; the quotidian, in the phlegm; the tertian, in the yellow bile; the
1 Pagel-Sudhoff, 64.
GREEK MEDICINE 83
quartan, in the black bile.' In short, everything in Galenic and Arabic medi- cine was mathematically subdivided, usually by the sacred numerals of Pythagoras.
In Egypt, Pythagoras learned the doctrine of transmigration of souls or metempsychosis and he is credited with l)eing the first to (establish the fact that the brain is the central organ of the higher activities, a proposition which was long afterward put to experi- mental proof by Flourens and Goltz.
After Pythagoras, the most important of the Greek Philoso- j)hers, with the exception of Plato and Aristotle, were his pupil, the almost mythical Alcmaeon, who anticipated Empedocles in the doctrine that health is the equipoise, disease the maladjustment of any such forces as heat, cold, moisture, dryness, acidity, sweet- ness, etc., probably knew of the doctrine of atoms and pores, and also stated the fact that the brain is the central oi'gan of the higher activities and the origin of the nerves; and Democritus of Abdera (460-360 B. C), who first stated the theory that everything in nature, including the body and the soul, is made up of atoms of different shapes and sizes, the movements of which are the cause of life and mental activity.^
During the Heroic Age, and at the time of the Trojan war, the dominant people in the Peloponnesus were the athletic, simple- minded Achaians, whose high regard for surgery and the surgeon was in striking contrast with the attitude of the ancient Roman's. In later times, Greek civilization was made up of two main ele- ments, the Ionian or Attic, and the Doric or Spartan. The com- posite, imaginative, artistic peoples of Ionia and the islands were interested in everything, and at once ])rave and warlike, keen and business-like, serious and high-minded, or, at need, flippant and ironical. As we see them in the comedies of Aristophanes, Lucian's dialogues and the idyls of Theocritus, the city-bred Greeks were a gay, quick-minded, supremely talkative people, adoring intelli- gence for itself, fonder of speculation than of material facts, keen at taking an advantage, and cheerfully comi^laisant as to their neighbors' morals. Yet they were the same people who could listen with reverent attention to the dramas of vEschylus and Sophocles. In striking contrast were the Dorians or Spartans, who were essentially robust, unimaginative warriors, severe in
' F'or further illustrations, see the very thoroughgoing account of Galen's system by Johannitius in the "Medical History" of E. T. Withington (London, 1894), pp. 386-.396.
-For an interesting examination of the views of these philosophers, see the papers of .Jonathan Wright in Scicnt. Monthly, N. Y., 1920, xi, 127-140; and New York Med. Jour., 191S-20, pnssi777. Wright holds Alcma'on and I'jnpedocles to be more akin to Hippocrates in theory than anj' other Greek philosophers.
84 HISTOUV OF MKDICINE
such morals as llu\v had, and Hko tho Homorie Greeks and the aiu'i(>iit Ivomans, cultiwitiiii!; llu^ Ixxly i'a1h(>r than the mind, as an es.s(Milial |)art of ihcii' scheme of mihtaiy jiONCi'iimcnl . Indcr tlie harsh laws of Ly(air^us, eufrcnic iJiocivation was compulson'. C'ripjiled and deformed infants were exi)()se<l or thrown into (he Eurotas. As with all military jieojiles, the Spartans were narrowly jealous, suspicious or contemptuous of achievement or prosperity in other nations. Both lonians and Spartans were extremely curious about ihc future, and, like all people of early civilizations, attached enormous importance to oracles, presages and omens, so that prognosis was still the essential feature of Greek medicine before Hippocrates. Among the Spartans, the surgeons were held y/ in the sam(» high regard as among t he Homeric heroes, and Lycurgus classed them as non-combatant officials. Among the Attic or Ionian Greeks, the medical profession, as we apjiroach the Age of Pericles, is found to be more highly specialized. In the first place, general practitioners began, toward the later period, to receive stipulated fees for their services instead of the usual thank-offer- ings of the temjjles, and, further, city and district or public i)hys- icians came to be appointed at an annual salary which, for the times, was quite high — in the case of Democedes at Athens (circa 525 B. C.) about $2000. These existed from Homer's time, are mentioned by Herodotus, and Diodorus, and were well-known in Athens from the Periclean Age down to the first century A. D., as evidenced in Aristophanes, and many Greek inscriptions. After this time, they became known as Apytarpoi. From the Greek institution of the public physician, the Romans derived their archiater, whence the German ^'Arzt.''^ In Thessaly, the land of horses, there was a public veterinarian (Hippiatros'). There were also military and naval surgeons among the Athenians, as among the Spartans. Xenophon records that there were eight army surgeons with the expedition of the Ten Thousand, at the end of the fifth century, refers to snow'-blindness and gangrene from frostbite, and mentions the use of silver kettles for boiling water. There were again midwives, professional lithotomists, druggists and veterinarians, and finally a special class, the "rhiz- otomi," or root gatherers, w^ho wandered through the fields and forests collecting vegetable simples. The physician's office was called the latreion, and was used indifferently as a dispensary, consulting room and operating theater. In the larger cities there were public latreia, supported by special taxes.
Medical instruction was not