the evolution of modern medicine-第12章

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s　an　undying　glory　of　the　school　of　Cos　that　after　years　of　vague；　restless　speculation　it　introduces　steady　sedentary　habits　into　the　intellectual　life　of　mankind。　〃　'Fiction　to　the　right！　　Reality　to　the　left！'　was　the　battle…cry　of　this　school　in　the　war　they　were　the　first　to　wage　against　the　excesses　and　defects　of　the　nature…philosophy。　〃Though　the　protest　was　effective　in　certain　directions；　we　shall　see　that　the　authors　of　the　Hippocratic　writings　could　not　entirely　escape　from　the　hypotheses　of　the　older　philosophers。

＇24＇　Gomperz：　　Greek　Thinkers；　Vol。　I；　p。　296。

I　can　do　no　more　than　indicate　in　the　briefest　possible　way　some　of　the　more　important　views　ascribed　to　Hippocrates。　　We　cannot　touch　upon　the　disputes　between　the　Coan　and　Cnidian　schools。＇25＇　You　must　bear　in　mind　that　the　Greeks　at　this　time　had　no　human　anatomy。　Dissections　were　impossible；　their　physiology　was　of　the　crudest　character；　strongly　dominated　by　the　philosophies。　Empedocles　regarded　the　four　elements；　fire；　air；　earth　and　water；　as　〃the　roots　of　all　things；〃　and　this　became　the　corner　stone　in　the　humoral　pathology　of　Hippocrates。　　As　in　the　Macrocosm　the　world　at　large　there　were　four　elements；　fire；　air；　earth；　and　water；　so　in　the　Microcosmthe　world　of　man's　bodythere　were　four　humors　（elements）；　viz。；blood；　phlegm；　yellow　bile　（or　choler）　and　black　bile　（or　melancholy）；and　they　corresponded　to　the　four　qualities　of　matter；　heat；　cold；　dryness　and　moisture。　　For　more　than　two　thousand　years　these　views　prevailed。　　In　his　〃Regiment　of　Life〃　（1546）　Thomas　Phaer　says：〃。　。　。　which　humours　are　called　ye　sones　of　the　Elements　because　they　be　complexioned　like　the　foure　Elements；　for　like　as　the　Ayre　is　hot　and　moyst：　　so　is　the　blooud；　hote　and　moyste。　And　as　Fyer　is　hote　and　dry：　　so　is　Cholere　hote　and　dry。　And　as　water　is　colde　and　moyst：so　is　fleume　colde　and　moyste。　And　as　the　Earth　is　colde　and　dry：　so　Melancholy　is　colde　and　dry。〃＇26＇

＇25＇　The　student　who　wishes　a　fuller　account　is　referred　to　the　histories　of　（a）　Neuburger；　Vol。　1；　Oxford；　1910；　（b）　Withington；　London；　1894。

＇26＇　Thomas　Phaer：　　Regiment　of　Life；　London；　1546。


As　the　famous　Regimen　Sanitatis　of　Salernum；　the　popular　family　hand…book　of　the　Middle　Ages；　says：

　　　　Foure　Humours　raigne　within　our　bodies　wholly；　And　these　compared　to　foure　elements。＇27＇

＇27＇　The　Englishman's　Doctor；　or　the　Schoole　of　Salerne；　Sir　John　Harington's　translation；　London；　1608；　p。　2。　　Edited　by　Francis　R。　Packard；　New　York；　1920；　p。　132。　Harington's　book　originally　appeared　dated：　　London　1607。　（Hoe　copy　in　the　Henry　E。　Huntington　Library。）


According　to　Littre；　there　is　nowhere　so　strong　a　statement　of　these　views　in　the　genuine　works　of　Hippocrates；　but　they　are　found　at　large　in　the　Hippocratic　writings；　and　nothing　can　be　clearer　than　the　following　statement　from　the　work　〃The　Nature　of　Man〃：　〃The　body　of　man　contains　in　itself　blood　and　phlegm　and　yellow　bile　and　black　bile；　which　things　are　in　the　natural　constitution　of　his　body；　and　the　cause　of　sickness　and　of　health。　　He　is　healthy　when　they　are　in　proper　proportion　between　one　another　as　regards　mixture　and　force　and　quantity；　and　when　they　are　well　mingled　together；　he　becomes　sick　when　one　of　these　is　diminished　or　increased　in　amount；　or　is　separated　in　the　body　from　its　proper　mixture；　and　not　properly　mingled　with　all　the　others。〃　　No　words　could　more　clearly　express　the　views　of　disease　which；　as　I　mentioned；　prevailed　until　quite　recent　years。　The　black　bile；　melancholy；　has　given　us　a　great　word　in　the　language；　and　that　we　have　not　yet　escaped　from　the　humoral　pathology　of　Hippocrates　is　witnessed　by　the　common　expression　of　biliousness〃too　much　bile〃　or　〃he　has　a　touch　of　the　liver。〃　The　humors；　imperfectly　mingled；　prove　irritant　in　the　body。　They　are　kept　in　due　proportion　by　the　innate　heat　which；　by　a　sort　of　internal　coction　gradually　changes　the　humors　to　their　proper　proportion。　Whatever　may　be　the　primary　cause　of　the　change　in　the　humors　manifesting　itself　in　disease；　the　innate　heat；　or　as　Hippocrates　terms　it；　the　nature　of　the　body　itself；　tends　to　restore　conditions　to　the　norm；　and　this　change　occurring　suddenly；　or　abruptly；　he　calls　the　〃crisis；〃　which　is　accomplished　on　some　special　day　of　the　disease；　and　is　often　accompanied　by　a　critical　discharge；　or　by　a　drop　in　the　body　temperature。　The　evil；　or　superabundant；　humors　were　discharged　and　this　view　of　a　special　materies　morbi；　to　be　got　rid　of　by　a　natural　processor　a　crisis；　dominated　pathology　until　quite　recently。　　Hippocrates　had　a　great　belief　in　the　power　of　nature；　the　vis　medicatrix　naturae；　to　restore　the　normal　state。　A　keen　observer　and　an　active　practitioner；　his　views　of　disease；　thus　hastily　sketched；　dominated　the　profession　for　twenty…five　centuries；　indeed；　echoes　of　his　theories　are　still　heard　in　the　schools；　and　his　very　words　are　daily　on　our　lips。　　If　asked　what　was　the　great　contribution　to　medicine　of　Hippocrates　and　his　school　we　could　answerthe　art　of　careful　observation。

In　the　Hippocratic　writings　is　summed　up　the　experience　of　Greece　to　the　Golden　Age　of　Pericles。　　Out　of　philosophy；　out　of　abstract　speculation；　had　come　a　way　of　looking　at　nature　for　which　the　physicians　were　mainly　responsible；　and　which　has　changed　forever　men's　views　on　disease。　Medicine　broke　its　leading　strings　to　religion　and　philosophya　tottering；　though　lusty；　child　whose　fortunes　we　are　to　follow　in　these　lectures。　I　have　a　feeling　that；　could　we　know　more　of　the　medical　history　of　the　older　races　of　which　I　spoke　in　the　first　lecture；　we　might　find　that　this　was　not　the　first…born　of　Asklepios；that　there　had　been　many　premature　births；　many　still…born　offspring；　even　live…births　the　products　of　the　fertilization　of　nature　by　the　human　mind；　but　the　record　is　dark；　and　the　infant　was　cast　out　like　Israel　in　the　chapter　of　Isaiah。　　But　the　high…water　mark　of　mental　achievement　had　not　been　reached　by　the　great　generation　in　which　Hippocrates　had　labored。　Socrates　had　been　dead　sixteen　years；　and　Plato　was　a　man　of　forty…five；　when　far　away　in　the　north　in　the　little　town　of　Stagira；　on　the　peninsula　of　Mount　Athos　in　Macedoniawas；　in　384　B。C。；　born　a　〃man　of　men；〃　the　one　above　all　others　to　whom　the　phrase　of　Milton　may　be　applied。　The　child　of　an　Asklepiad；　Nicomachus；　physician　to　the　father　of　Philip；　there　must　have　been　a　rare　conjunction　of　the　planets　at　the　birth　of　the　great　Stagirite。　In　the　first　circle　of　the　〃Inferno；〃　Virgil　leads　Dante　into　a　wonderful　company；　〃star…seated〃　on　the　verdure　（he　says）the　philosophic　family　looking　with　reverence　on　〃the　Master　of　those　who　know〃il　maestro　di　color　che　sanno。＇28＇　And　with　justice　has　Aristotle　been　so　regarded　for　these　twenty…three　centuries。　No　man　has　ever　swayed　such　an　intellectual　empirein　logic；　metaphysics；　rhetoric；　psychology；　ethics；　poetry；　politics　and　natural　history；　in　all　a　creator；　and　in　all　still　a　master。　The　history　of　the　human　mindoffers　no　parallel　to　his　career。　As　the　creator　of　the　sciences　of　comparative　anatomy；　systematic　zoology；　embryology；　teratology；　botany　and　physiology；　his　writings　have　an　eternal　interest。　　They　present　an　extraordinary　accumulation　of　facts　relating　to　the　structure　and　functions　of　various　parts　of　the　body。　It　is　an　unceasing　wonder　how　one　man；　even　with　a　school　of　devoted　students；　could　have　done　so　much。

＇28＇　The　〃Good　collector　of　qualities；〃　Dioscorides；　Hippocrates；　Avicenna；　Galen　and　Averroes　were　the　medical　members　of　the　group。　　Dante；　Inferno；　canto　iv。


Dissectionalready　practiced　by　Alcmaeon；　Democritus；　Diogenes　and　otherswas　conducted　on　a　large　scale；　but　the　human　body　was　still　taboo。　Aristotle　confesses　that　the　〃inward　parts　of　man　are　known　least　of　all；〃　and　he　had　never　seen　the　human　kidneys　or　uterus。　　In　his　physiology；　I　can　refer　to　but　one　pointthe　pivotal　question　of　the　heart　and　blood　vessels。　To　Aristotle　the　heart　was　the　central　organ　controlling　the　circulation；　the　seat　of　vitality；　the　source　of　the　blood；　the　place　in　which　it　received　its　final　elaboration　and　impregnation　with　animal　heat。　The　blood　was　contained　in　the　heart　and　vessels　as　in　a　vasehence　the　use　of　the　term　〃vessel。〃　〃From　the　heart　the　blood…vessels　extend　throughout　the　body　as　in　the　anatomical　diagrams　which　are　represented　on　the　walls；　for　the　parts　lie　round　these　because　they　are　formed　out　of　them。〃＇29＇　The　nutriment　oozes　through　the　blood　vessels　and　the　passages　in　each　of　the　parts　〃like　water　in　unbaked　pottery。〃　He　did　not　recognize　any　distinction　between　arteries　and　veins；　calling　both　plebes　（Littre）；　the　vena　cave　is　the　great　vessel；　and　the　aorta　the　smaller；　but　both　contain　blood。　　He　did　not　use　the　word　〃arteria〃　（arthria）　for　either　of　them。　　There　was　no　movement　from　the　heart　to　the　vessels　but　the　blood　was　incessantly　drawn　upon　by　the　substance　of　the　body　and　as　unceasingly　renewed　by　absorption　of　the　products　of　digestion；the　mesenteric　vessels　taking　up　nutriment　very　much　as　the　plants　take　theirs　by　the　roots　from　the　soil。　From　the　lungs　was　absorbed　the　pneuma；　or　spiritus；　which　was　conveyed　to　the　heart　by　the　pulmonary　vesselsone　to　the　right；　and　one　to　the　left　side。　　These　vessels　in　the　lungs；　〃through　mutual　contact〃　with　the　branches　of　the　trachea；　took　in　the　pneuma。　　A　point　of　interest　is　that　the　windpipe；or　trachea；　is　called　〃arteria；〃　both　by　Aristotle　and　by　Hippocrates　（〃Anatomy；〃　Littre；　VIII；　539）。　It　was　the　air…tube；　disseminating　the　breath　through　the　lungs。　　We　shall　see　in　a　few　minutes　how　the　term　came　to　be　applied　to　the　arteries；　as　we　know　them。　The　pulsation　of　the　heart　and　arteries　was　regarded　by　Aristotle　as　a　sort　of　ebullition　in　which　the　liquids　were　inflated　by　the　vital　or　innate　heat；　the　fires　of　which　were　cooled　by　the　pneuma　taken　in　by　the　lungs　and　carried　to　the　heart　by　the　pulmonary　vessels。

＇29＇　De　Generatione　Animalium；　Oxford　translation；　Bk。　II；　Chap。　6；　Works　V；　743　a。


In　Vol。　IV　of　Gomperz'　〃Greek　Thinkers；〃　you　will　find　an　admirable　discussion　on　Aristotle　as　an　investigator　of　nature；　and　those　of　you　who　wish　to　study　his　natural　history　works　more　closely　may　do　so　easilyin　the　new　translation　which　is　in　process　of　publication　by　the　Clarendon　Press；　Oxford。　　At　the　end　of　the　chapter　〃De　Respiratione〃in　the　〃Parva　Naturalia〃　（Oxford　edition；　1908）；　we　have　Aristotle's　attitude　towards　medicine　expressed　in　a　way　worthy　of　a　son　of　the　profession：

〃But　health　and　disease　also　claim　the　attention　of　the　scientist；　and　not　merely　of　the　physician；　in　so　far　as　an　account　of　their　causes　is　concerned。　The　extent　to　which　these　two　differ　and　investigate　diverse　provinces　must　not　escape　us；　since　facts　show　that　their　inquiries　are；　at　least　to　a　certain　extent；　conterminous。　　For　physicians　of　culture　and　refinement　make　some　mention　of　natural　science；and　claim　to　derive　their　principles　from　it；　while　the　most　accomplished　investigators　into　nature　generally　push　their　studies　so　far　as　to　conclude　with　an　account　of　medical　principles。〃　　（Works；　III；480　b。）

Theophrastus；　a　student　of　Aristotle　and　his　successor；　created　the　science　of　botany　and　made　possible　the　pharmacologists　of