Front Page Titles (by Subject) INTRODUCTION. - The Writings of Hippocrates and Galen
The Online Library of Liberty
A project of Liberty Fund, Inc.
Search this Title:
Also in the Library:
INTRODUCTION. - Hippocrates, The Writings of Hippocrates and Galen 
The Writings of Hippocrates and Galen. Epitomised from the Original Latin translations, by John Redman Coxe (Philadelphia: Lindsay and Blakiston, 1846).
About Liberty Fund:
Liberty Fund, Inc. is a private, educational foundation established to encourage the study of the ideal of a society of free and responsible individuals.
The text is in the public domain.
Fair use statement:
This material is put online to further the educational goals of Liberty Fund, Inc. Unless otherwise stated in the Copyright Information section above, this material may be used freely for educational and academic purposes. It may not be used in any way for profit.
Could man, as well as animals in general, invariably subsist in their natural state; in other words, if their functions always continued perfect in consequence of the perfect state of their organs, they would enjoy perpetual health, and disease being unknown, the objects of the physician could never have come into existence. This, however, not being the case, and disease from various sources springing up in his path, man necessarily was led to investigate the causes tending to such a change, and equally impelled to attempt the discovery of the means of relief. As experience could alone enlighten him on a subject so interesting to his temporal concerns, and as such experience could be elicited solely by observations, such observations long continued must have given rise to that science which is designated by the name of Medicine.
We stop not to inquire whether such knowledge proceeded from heaven, as was formerly imagined. However this might have been maintained in the early ages of the world, we must now be satisfied that reason and reflection gave the first impulse to those inquiries and researches, by which Medicine sprang into existence, and through which it has reached us in the state we find it. The Babylonians are even affirmed by Herodotus to have exposed their sick in public places, for the benefit of the advice of passersby, who might have previously witnessed similar cases of disease, and hence be enabled to apply their experience for their cure. Strabo relates the same, not of the Babylonians alone, but likewise of the Egyptians and others; hence it appears, that although in the early periods of the world there might not be physicians strictly so called, yet that medicine, practically, was pursued even by the most barbarous nations; and although we read in fable, or history (then, and perhaps even now, not much more real), that the invention of medicine is attributed to some particular individuals, we are not to suppose that such persons were actually the first who prescribed remedies, but rather that this honour was given to them, from their being among the first who particularly devoted themselves to medicine, and thereby excelled the common mass, by the superiority attained through experience more amply afforded.
If Adam and his immediate descendants were subject to the common laws of nature, disease from various causes must necessarily have produced its usual effects on their frame, and it cannot be supposed that attempts would not even then be made, and that most sedulously, from parental affection, to mitigate the sufferings that were conspicuous. Unquestionably then, in a limited view of the subject, medicine may be presumed to be coeval with the human race. Ages however probably elapsed before any individual could directly claim to be acknowledged as a physician; and, accordingly, we find but few recorded even remotely as such, or whose acquirements in this science have descended to us. We read of Bacchus, Zoroaster, Hermes, and others, who are supposed to be the same with some of the early noticed personages of Holy Writ: but speculation has been as endless as it is useless, in attempting to reconcile all the absurdities of remote antiquity, in which oral tradition was the sole intermedium of the preservation of knowledge.
In proceeding down the vista of nearly thirty centuries, or half the period since creation, little else than fable meets our research on topics connected with our professional history. Each nation claims for itself the origin of our science, and with equal justice might our aborigines do the same. The knowledge of all barbarous nations must necessarily be limited, and little else than blind empiricism must direct the progress of our science, under circumstances so unpropitious to its extension and permanent utility. We therefore pass them by, without even pausing upon Esculapius, who was regarded by the Egyptians as the pupil of Hermes, (to whom they attributed the invention of medicine,) but who was not the same with the celebrated Esculapius of the Greeks.
Among the earlier pretenders to this science, we find Melampus of Argos, who, from a shepherd, became celebrated for the cure of the daughters of Prætus, by the use of hellebore, baths, and charms; and received for his recompense the hand of one of the princesses, together with one-third of King Prætus’s dominions. Nor is the centaur Chiron, the tutor of Achilles, less celebrated as a founder of our science, with equal probability to back his pretensions. His pupils are among the most illustrious heroes of the fabulous age, as Hercules, Theseus, Telamon, Teucer, Jason, Peleus, and Achilles, all of whom were more or less acquainted with the healing art.
The Grecian Esculapius was however the first, or at least the most famous of all the presumed inventors of medicine. Galen has unfolded his history in the introduction to his writings, entitled “Medicus,” and in other parts. Charms, enchantments, amulets, magic incantations, and such like means, appear to have constituted the basis of the therapeia of most of those early aspirants to medical celebrity. It is nevertheless presumable, that, although the birth of Esculapius is ascribed to Apollo, yet such an individual really had existence, and probably possessed uncommon attainments for his time. Enveloped in the mystifications of those dark ages, it is impossible to ascertain his real merits. He was regarded as a god, and as such worshipped by the Greeks, and subsequently at Rome; temples in abundance were erected to his worship; and his sons Machaon and Podalirius are immortalized by Homer, as being actively engaged at the siege of Troy. The latter is said to have first employed blood-letting, and among his children to have had one named Hippolochus, the reputed ancestor of Hippocrates.
My object in these few details of what had preceded Hippocrates in the way of his profession, and to which he unquestionably must have had access, is to evince that we are unwittingly led, unduly to estimate his pretensions, as though he were the actual father and great head of our exalted science. Now what is already stated is amply sufficient to show, that facts known and enumerated for centuries before him, were merely embodied into writing by him, in place, as previously, of being sustained chiefly through the medium of oral tradition.—What actual portion of those writings that have reached us under his name, belonged exclusively to him, it is impossible to say. I should myself judge but few, and that one of his chief merits consists in having afforded them, through his writings, a “local habitation and a name.”
The fanciful and imaginative powers of the ancients are probably as well illustrated by the various names afforded to their medical divinities as by any other means, as evinced by the etymology of several of them. Thus, the sun, under the name of Apollo, is the presumed author of medicine; Esculapius, the asserted son of Apollo, is taken for the air; Hygeia, or health, is called his wife or daughter, because our health depends on the air we respire above all things; Æglè, or light, denotes that air, illumined and purified by the sun, is the best of all; Panacea, and Iäso, or cure and universal medicine, signified that a good air cured all diseases; and so of the rest. But imagination is a poor guide in the mysterious approaches to the temple of medical science, and it is useless to occupy time in elucidating the views detailed under the histories of Medea, Circe, Cybele, Latona, and a host of other female divinities or enchantresses, with which our ancient medical legends abound: and I proceed, therefore, to afford an outline of our science from the period of the siege of Troy, in about the twenty-eighth century, to that of the war of Peloponnesus, near eight hundred years subsequently, that is, in the thirty-sixth century of the world.
During this prolonged period, according to Pliny, medicine remained concealed in thickest darkness, until Hippocrates brought it into view. Strictly speaking, this, however, was not the fact; for, during that interval, some of the most illustrious of the ancient philosophers existed, who first began seriously to attempt an explanation of the laws of physiology and of natural science. Such were Pythagoras, Empedocles, Democritus, and, generally speaking, the descendants of Esculapius, or the Asclepiades, from whom Hippocrates traces his descent.
These descendants of Esculapius have been reputed to have preserved in their family, uninterruptedly, the knowledge of medicine, and which, but for the loss of the writings of Eratosthenes, of Pherecydes, of Apollodorus, of Arius of Tarsus, of Polyanthus of Cyrene, and of others who had carefully written their history, we might have better known. From his own account, Hippocrates was the eighteenth in descent from Esculapius, which, fabulous as it may be, we must be content to receive. By some or other branches of this family, the schools of Rhodes, of Cnidus, and of Cos, were established; and from them sprung most of the philosophers who added so greatly to the reputation of Greece.
The first scientific labours in medicine, and the first traces of medical history are probably to be alone found in the philosophic schools of Greece; for although up to the period of the siege of Troy, as we have seen, little but fable is known as to medicine, and of that little nothing of importance; and although, from that period to the thirty-sixth century, that is for a period of about seven or eight hundred years, nothing has formally reached us as a medical treatise, until Hippocrates truly brought to light what was known up to his time, yet the evidence of physiological research, of much anatomical and other knowledge, of the materia medica, of dietetics, of exercise and gymnastics, &c., as applied to medicine, is sufficiently extensive to point out the vast resources to which Hippocrates could have, and must have had recourse, to permit us to dignify him exclusively with those honourable, though specious appellations, by which his predecessors and contemporaries are entirely rejected, and himself unduly elevated. Nor can we believe that Hippocrates for an instant dreamed of assuming such a character, to the degradation of his predecessors, inasmuch as he has given us an express treatise “De prisca Medicina,” in which the preceding views of medicine are unfolded, and reference is frequently made to it in other of the treatises which under his name have come down to us.—We may cursorily indicate some of the individuals who preceded him, and notice some writings that have been ascribed to them.—Democedes, a contemporary of Pythagoras, Thales, Epimenides, who has been by some regarded as the author of the Cnidian Sentences ascribed to Hippocrates, as the Coac Prænotions have been ascribed to the physicians generally of the Coan school, anterior to Hippocrates, and of which school he was a member. Anatomy has been thought to have been known to many of them, and that in no inconsiderable a degree, since they practised surgery successfully. If we may judge from the writings of Hippocrates, they must have had a competent knowledge of osteology, of angiology, of many of the viscera, as the stomach and intestines, the liver, spleen, kidneys, bladder, uterus, diaphragm, heart, lungs, brain, &c., as well as of many of the more important humours of the body, and of the various excretions from its different parts.
Thales, the Milesian, who lived about A. M. 3330, has been regarded as the first who wrote on natural philosophy, which would seem to imply some acquaintance with medicine, and to Pherecydes of Scyros, his contemporary, has been attributed one of the books on Diet, to be found among the writings of Hippocrates. Pythagoras, by far the most celebrated of the ancient philosophers, according to Celsus, was the oldest of those who joined the study of medicine to that of physics. He lived about the sixtieth Olympiad, or nearly A. M. 3420. His science was universal to its then extent, and his disciples were scarcely inferior in their attainments. All, more or less, appear to have pursued physiology, and to have been more or less proficient in medical attainments. Empedocles, one of them, is said to have written on medicine not less than six thousand verses, and he was nearly contemporary with Hippocrates. Democritus, whose merits in comparative anatomy are attested by Hippocrates himself, was also his contemporary, and he wrote on the Nature of Man, which is the same title with one of the books ascribed to Hippocrates. He wrote also another on pestilential diseases, a third treatise on prognostics, a fourth on diet, a fifth on the causes of diseases, &c.,—and others on seeds, trees, fruits, and animals, and even one on the Stone. In short, the galaxy of science scarcely ever shone so resplendent by its cultivators than at this very point of time, when the illustrious Hippocrates began his career. Whatever then may have been the real value of the writings of Democritus, it is obvious they must have been a source of great advantage to the opening and observant genius of Hippocrates.—We may incidentally remark, that Columella quotes two books of Democritus, one on Agriculture, the other on Antipathies, in the latter of which he seems to have been the first to attach the powers of death and destruction to caterpillars and insects generally in our gardens, if a female in the menstrual period walks thrice around the borders, barefooted and dishevelled;—a ridiculous assertion, void of truth, but which is, perhaps, not even now altogether discredited.—Besides the above, Cælius Aurelianus speaks of two other books (Acut., lib. cap. 14-16, &c.) that passed under his name, but which he expresses doubts of;—one treated of convulsive diseases, the other of elephantiasis, in which bleeding is especially commended.
That Hippocrates had the highest esteem for this great man, cannot be questioned, from the facts that have reached us. Elian even remarks (Var. Hist. lib. 4, cap. 20) that on his account, Hippocrates wrote all his books in the Ionic dialect, although the Doric was his native idiom; and this fact, unquestioned I believe, has strongly led me to infer, that many of the books, even of those that have been absolutely ascribed to Hippocrates, are the writings of others given under the sanction of his name. I would not for an instant throw this aspersion on the character of this great man, were it not allowed by Galen himself, and by writers anterior to him, that very many of the books that have reached us under his name, are the absolute production of others; and that even of those ascribed to him, doubts have not been wanting as to which are really such. Now, since certainty cannot here be attained, whilst at the same time conclusive evidence is produced that some called his are not so, I do not perceive that my veneration for Hippocrates should be questioned, because in a matter of uncertainty I hold the possibility of his having employed, or rather collected (for which we owe him thanks) into one work, the writings and opinions of those who preceded him. I shall not pretend to affirm, that, as literature then existed chiefly orally and traditionally, as we have seen, he was bound absolutely to point out his respective authorities, which might have been of extreme difficulty, if not altogether impossible; but that being of that vague description which forbid him to ascribe them positively to any particular individual, he might consider them as public property, and therefore made them his by embodying them into one general mass, for which accident alone has given him the sole credit. It is very certain that many of the remedies employed by Hippocrates had been in common use long before him, such as elaterium, colocynth, hellebore, and others; and the employment of such active articles certainly implies a considerable acquaintance with the Methodus Medendi, which only wanted the facilities of printing to have established a character for the Materia Medica of the age, but the want of which, necessarily devolved it on him to rescue it from oblivion, by embodying in his writings all the medical information that had reached him.
To condense what has been said above, it would appear, that at least during the first three thousand years of the world, all that has reached us, as to medicine, is chiefly fabulous, uncertain, and of little importance; that the discoveries made were few and superficial. Notwithstanding this, if medicine consists rather in effects than in words, and if the invention or discoveries of remedial means is more important than all our reasonings on disease, then it will be perceived, that the first physicians actually were intimate with what is even now considered most essential in our science, and that prior to Hippocrates they knew and employed almost all the important and fundamental means of cure which have reached our times. Thus all those ancient physicians esteemed bleeding and purgation as universal remedies, and employed them accordingly, even in those fabulous times, quite as familiarly as Hippocrates himself. They sedulously attended to diet, to bathing, and to exercise, which are not less deserving of attention at the present day, although far too much neglected. They were acquainted with the effects of opium, if Homer is to be accredited, and apparently with specifics for many diseases.
All this, indeed, may be considered as being acknowledged by Hippocrates himself, for he expressly tells us “that medicine in all its branches had been long established; that they had found out the principle, and the route of discovery as already had been done, of many excellent things which would serve for the further discovery of more, provided those that undertook the task were fitted for it, and, possessing a knowledge of what had already been done, should pursue a similar route. He, that rejecting all (he adds) that is already known, should pursue another plan for his researches, and boasts of having found out something new, deceives alike himself and others also.” Now this ancient route of which he speaks, is that of observation and experience; and his remarks may be considered as a full acknowledgment of the important advantage his predecessors had been to him; and had he been equally generous in specifying them individually, by naming his authorities, the remarks I have made would have been altogether inappropriate. Whatever merit then we may think fit to award Hippocrates, assuredly we ought not so far to forget the other great men by whose means he was enabled to reach the pinnacle of fame, as not even to grant them a niche in that temple, of which he was indeed the brightest ornament; but in admitting his claims, which have thus rolled down the stream of twenty-three centuries, I think it must be conceded, that with the overshadowing I have thus presented, we cannot in the full force of the term admit, that the title of Father of Medicine is justly his due!—nor, indeed, of several other equally highsounding appellations, without encroaching on the rights of others; especially since it is incontestably proved that many of those treatises we admire as his, have really emanated from other sources. We follow the routine of our forefathers in this respect, and yet scarcely with any of the well-grounded reasons they possessed. They actually read, and studied thoroughly his writings, whilst now, should he happily possess a nook in our libraries, it is almost the sole communication we have with this “divine old man.” We treat him as a deity by enshrining him where no mortal eye can reach him, and are satisfied to afford him at second-hand, the tribute which we suppose to be his due.
Galen has done ample justice to the merits of Hippocrates, by stating that he held the first rank among philosophers as well as among physicians: assuring us that Plato rejected none of his opinions, and that the writings of Aristotle are chiefly commentaries on his philosophy, and that he himself had done nothing more than interpret Hippocrates and Plato. If this be true (exclusively of the vast merits of Aristotle on other points) assuredly his writings ought not to be neglected. Galen further remarks, that it is from Hippocrates and Plato that Aristotle has derived his doctrine of four primary qualities, viz.: hot, cold, dry, and humid. Hippocrates does not indeed speak in direct terms of these qualities; but he admits of four elements, air, water, fire, and earth, which he afterwards reduces to two, viz.: fire and water. Now these contradictions are presumed to be reconciled by the statement above detailed, that the various writings are mixed up with those of Hippocrates that are not his, for the book in which this appears, is one of those that very anciently was set down as supposititious. Hippocrates, however, recognised a general principle, by him called Nature,* and which is used in various senses by him; yet in all possessing great power, and superior to all others; acting through the medium of the faculties, its aids or servants: on the one side attracting what is good or expedient, on the other rejecting what may be superfluous or hurtful, and on these propositions turn nearly all the physiology of Hippocrates, which is meagre and threadbare, when compared with the extension it received from the expanded mind of Galen. To use the expression of Hippocrates himself, in his own hands, his theory is crude and unconcocted;—in those of Galen, it becomes a beautiful and imposing structure, almost the work of his own labour, based on the rude materials already existing, which, although ascribed in general to Hippocrates, are, as has been shown, when individually considered, almost without a parent, seeing that many of the books, which chiefly develope his system, are suspected not to be his (especially those entitled “De Flatibus,” “De Carnibus,” “De Natura Hominum,” “De Natura Pueri,” and “De Dieta,”)—it is consequently scarcely necessary to dwell on such apocryphal productions in order to swell the praise of Hippocrates, or to sing pæans, to what is, as it respects him, almost intangible.
We must not however omit to mention, to the credit of this illustrious man, that he was the first founder, if we may so say, of the humoral pathology. Not that he troubled his head with the absurd distinctions since made as to solidism and humoralism; for he possessed too much good sense not to perceive that a mass of matters, constituting by far the largest part of the system, and in fact, the very part from which the identical lesser proportion itself had been derived, could not be independent of the causes of disease; that if excessive or defective in amount, or modified by any circumstances, or change of place, productive of an error loci, they could not fail of inducing disease proportionate to such modifications; and in the changes induced in these respects in the blood, pituita or phlegm, yellow bile and black bile, his four cardinal humours, Hippocrates founds a large proportion of morbid actions or diseases.
According to him, the body of man is composed of the above four substances, and it is by them that disease and health ensue. We continue in a state of health so long as they continue in a natural state, and in due proportion as to quantity, quality, and mixture. On the contrary, disease ensues when either of them is deficient or excessive in amount, when either separates from the other in any part of the body, or when all of them are wanting in their requisite qualities, or are not united together as they ought to be. If these positions assumed by Hippocrates do not constitute him a humoral pathologist, we are altogether ignorant of, or mistaken in, the real nature of the term; yet, with these forcible illustrations of his doctrines before our eyes, he is absolutely set down by many, as a supporter of the dogmas of solidism! If necessary, this might be entered upon in extenso, and more largely demonstrated, but it would be only a work of supererogation, which, perhaps, after all, would not satisfy the tenacious maintainers of sympathetic solidism and ventricular centralization! I will merely add, that passages in his writings would appear to indicate that he considered the bile and pituita to be the chief causes of disease by mixing with the blood, or from defect of quantity or quality, or relatively to the part in which they ought or ought not to mix or meet. The solid parts or the containing, are the subjects of disease and health, inasmuch as they are so, only according to the good or bad disposition caused in them by the humours and spirits, or the advantageous or unfortunate impressions made on them by foreign or external bodies. It is on these principles that Hippocrates lays such stress on the coction or crudity of the humours,—a matter of no importance in the doctrines of solidism, or at least in only a secondary degree.
This coction of the humours requiring, according to his views, a certain definite period for perfection, led to the doctrine of crises or critical days, in which more particularly, certain changes were anticipated in disease; and these anticipated changes give rise to and continue to afford the chief means of forming our prognostics as to the event. Now these prognostics of course can only be formed on the presence of symptoms; and the attention of Hippocrates to symptomatology, is that which has chiefly gained him his title to immortality on the records of medicine. It is true much is absolutely false as to the prognostics he has left us; or rather it should be said that we know not precisely his own, from the admixture of his successors and predecessors. Long as was his life, however, it is impossible but that much must have been derived from the previous experience of his Asclepiadean ancestors, rejecting what he found to be erroneous, and combining together only what conformed to his own practical knowledge.
His symptoms were derived from every source; from the countenance, the eyes, the mode of decubitus, the motion of the hands, the loquacity or taciturnity of the individual, his respiration, watchfulness or somnolency, his excretions of all kinds, such as fæces, urine, sweat, crepitus, saliva, sputa, tears, &c., all considered in relation to quantity, quality, and the like. It has even been asserted by some writers that he employed the sense of taste to discriminate many; this has, however, been denied by others, who affirm that if done at all, it was effectuated by the organs of the patient and not by his own.
One thing bespeaks greatly the independence of mind of this great man, viz.: that, although living in an age in which superstition constituted a large portion of the practice of the physicians, he did not yield to its influence; his reasoning, his observations, and his remedies in no respect seem tinctured with this failing. He bled freely, and used purgatives of the most active nature; diuretics and sudorifics were also employed by him; but after all, his principal reliance was on dietetics, in which none have ever excelled him. Fomentations and other external measures were not omitted, both topical and general, and for the period in which he flourished, he may be considered as a bold practitioner. In surgery he appears to have been very proficient, and to have practised many important operations. Even now, his sentiments and maxims relative to medicine and physicians in general, are not unworthy of deep regard.
Let us now proceed to a brief consideration of the illustrious Galen, whose works may be said with truth to have bound the medical world for many successive ages in a chain of adamantine strength, superior even to Hippocrates himself. Nor will any one be surprised at this who will even cursorily glance them over. Here, we see our way, and mark with astonishment the eagle-flight of this extraordinary man. His writings are confessedly his own; few adventitious books of others swell his pages, further, than as a commentator on his predecessors this was requisite, but for which he was fully qualified, from his persevering attachment to the study and pursuit of his profession.
He was born at Pergamos, in Asia Minor, a city celebrated for a temple dedicated to Esculapius, about ad 130—in the fifteenth year of the reign of Adrian. He lived to the age of one hundred, under Antoninus, Marcus Aurelius, Lucius Verus, Commodus, and Severus. His father Nicon was a rich and learned man, skilled in the belles-lettres, the philosophy, astronomy, geometry, and architecture of the times; and who spared no pains nor expense in his education, attending to it himself in the first instance, and then supplying him with the best preceptors. He studied first in the school of the Stoics, next in that of the Academicians, then of the Peripatetics and Epicureans, so that he was fully qualified to judge of their respective merits. With this preliminary knowledge he commenced the study of medicine at the age of seventeen, and had in its pursuit several masters. In his youth he travelled much, as well to profit by the conversation of the best physicians, as to instruct himself respecting various medicines derived from different countries. He dwelt some years in Alexandria amidst the cultivators of science; then proceeded to Cilicia, Palestine, Crete, Cyprus, and elsewhere, passing to the Isle of Lemnos to investigate the properties of the Lemnian earth, at that period in high esteem: from thence he went to Syria to examine the opobalsamum, and at twenty-eight years returned to Pergamos, having acquired great skill in the treatment of wounded nerves, which he successfully pursued with the wounded gladiators of that place.
At the expiration of four years he went to Rome with the intent of there fixing himself, but the jealousy of the physicians drove him thence in a few years: however, during his residence at Rome, he became intimate with different persons of consideration in rank or knowledge, which was apparently the principal source of the ill will of rivals for public favour. Leaving Rome at about the age of thirty-seven, he returned to Pergamos; but was soon recalled by Marcus Aurelius, and thenceforth continued to reside at or near the metropolis.—It is unnecessary to pursue further the particulars of his life. His facility in writing is well established by the numerous works that have come down to us, independently of many that are lost. More than five hundred books are stated by Suidas to have been written by him on medicine and philosophy, and nearly half that number on other branches of science. Two books were written by him merely enumerating his works, and to record, as to some of them, the place and time in which he composed them, the occasion leading to it, and the order in which they were to be read; and we learn from him, that a part of his literary labours was lost by a fire that destroyed the Temple of Peace at Rome, in which they had been deposited.
His works were greatly esteemed, even by his contemporaries; and we need scarcely remark, that they were the dominant source of all medical acquirement for more than twelve centuries! Eusebius, who lived five hundred years after him, says that the veneration in which he was held was such, that he was by many regarded as a god, and that religious worship was paid him. Trallian entitles him most divine; and Oribasius, by his extracts, as well as by his praises, evinces the high estimation in which he held him. Aëtius and Paul of Ægina, as well as Avicenna and other Arabian physicians, equally copied from him. He had, however, opponents, especially of those sects whose opinions he combated; but still, the far greater part of the medical world adhered to him closely as their principal authority on every question of importance.
To enter on his various opinions in this brief outline of his life would be useless and imperfect. It is principally from the vast collection of facts embodied in his writings by which his worth is to be estimated and his actual acquirements judged of. It is this that leads me to press him on the profession as deserving of regard, and thereby appreciate fully the high extent of medical information of a period so remote, but which pride and self-sufficiency forbids us to acknowledge. Perhaps I should rather attribute it to an absolute ignorance of the subjects he treats, for to me, it seems impossible to imagine that any medical man can actually peruse his writings, without finding in them a complete encyclopedia of ancient medicine, both practical and theoretical, amply sufficient to repay him for what may at first be considered as a task, but which in its progress will be found to be in the highest degree engaging and instructive. If indeed any one can read him without admiration at his wonderful attainments, I can only say I think him greatly to be pitied.—It must not from this be supposed that I am insensible to his defects! They are unquestionably considerable; yet they ought to be rather esteemed the defects of the age than of his own immediately. It must be borne in mind, that he wrote under disadvantages that are not now experienced. The lights of science then, compared with ours, were dim and obscure; and imperfect as they were, we have the greater cause for admiration that he wrote so well. Had he lived in our time, with all our aids for his co-operation, he would have been a bright and shining light that would have dimmed the minor luminaries of our numerous aspirants for medical celebrity! Consider that we are elevated on a pinnacle of sixteen centuries, of which he constitutes the base; yet, elevated thus above him, where is the man who will now venture to dispute his superior title to the palm of medical glory, or who will venture to take a more extended view of our science in all its bearings by his own contracted vision, than Galen has accomplished so many ages in advance? We want his energy, his perseverance in preliminary attainments. The very facilities we possess, are among the chief causes of our imperfection. Like the hare in the fable, we lie down to repose, in full persuasion that the hours of indolence may be easily regained; or, trusting to the exertions of more active members, whose improvements are at once diffused over the habitable globe by means of printing, we make them ours, with no exertions, and no acknowledgments on our part.
It has been said that Galen has evinced great vanity throughout his writings! He has so; and if any man, legitimately, was entitled to show it, that man was Galen! But shall a weakness, common to every one in riding his respective hobby, be pardonable in the majority, yet reprehensible in him? I apprehend, indeed, that no one, who cannot claim to be his equal, is entitled to say what should be considered as vanity in Galen. He is undoubtedly reprehensible when he allows his contempt for his contemporaries to permit him to call them the “Asses of Thessalus.” Yet some extenuation may be made for him when we recollect that friendless and a stranger at first settling at Rome, the persecutions he met with drove him thence. The associations of early lacerated feelings must no doubt have had an important influence on his mind, more especially as time had placed him in the foremost rank in medicine: he might indeed have employed the pens of others, and probably would have done so, had parasites been in such abundance as at present! Writers were, however, few, and the requisite apparatus for writing rare and costly. I do not think this fault of Galen is exclusive; few writers of ancient times neglected the opportunity of noticing, without a blush, their own pretensions, and certainly Galen’s were at least of equal weight.
It is scarcely necessary to attempt to excuse or apologize for his superstition as to dreams, incantations, and other characteristic fooleries of the age; when, at this enlightened period, we accredit snakestones, panaceas, Perkinism, Mesmerism, clairvoyance, &c., surely we have no right to reproach him.
We have already stated that a succession of great and learned men had for ages collected together, and preserved in one family a vast assemblage of facts relating to the healing art. The observing character of Hippocrates, and his peculiar disposition to order and arrangement, led him to place them on a basis more secure; and what had previously depended on oral tradition chiefly, through twenty generations of the family of the Asclepiades, became by his care embodied into one. No contending doctrines marred their progress, nor did he deem it essential to his practical views to deface this fair autograph of medical knowledge with the fantastic garb of hypothetic observations, which soon began to shed a baneful influence. Whatever might, indeed, be his private reasons for avoiding speculation, certainly we may gather from the extravagance of his followers, down to the present era, how little the bounds of truth are thereby enlarged. Successively changing, we find presented to us even in the time of Galen, no less than six prominent sects in medicine, each one combating the others, and all equally liable to objection. These sects were, the Dogmatic, the Empiric, the Methodic, the Episyinthetic, the Pneumatic, and the Eclectic. From these, Galen was to make his choice; and although he protests he will not be called a follower of either of them, yet, so far as he can be said to choose among so many, it may be esteemed the last, or the Eclectic, for he seems to have selected from all, as his judgment indicated. It is true, the doctrines of Galen are based in great measure on those of Hippocrates; and if it could be shown clearly that Hippocrates was the sole framer of the opinions maintained in his writings, and that all the writings under his name are really his, and from which, by piecemeal as it were, the doctrines must be picked out; and further, that they were not the general sentiments of all the Asclepiadean family throughout a series of several centuries; then, indeed, we might award its merit, if any, to him,—but it is clear that the doctrines of four elements, &c., had been long previously maintained.
Galen, adopting this system, has embodied it in a more compact and beautiful manner than had previously been known, and may therefore be considered as its true founder;—but since the doctrine is fundamentally false in itself, inasmuch as the four bodies, fire, air, earth, and water, are no longer regarded as elements, it may be properly asked why the subject is dwelt upon? Now, although it is true that the above four bodies are rejected as elementary in the present day, yet it is equally true that a very large number of elementary bodies have, through the agency of chemistry, been brought to our knowledge, of which many enter into the composition of the animal machine, and by their union constitute the organization of the animal kingdom in all its diversified forms; and by the changes ensuing in the forms, sizes, and proportion of these principles, so will there be a proportionate departure from a state of health. Hence, whatever would in former times afford evidence of truth as to the doctrines founded on the former affirmed four elements, by Hippocrates or Galen, it is obvious that the same will hold with respect to the present elements assumed by us, and strengthened through the aid of chemical analysis, an engine of research unknown to the ancients; and hence, their forcible explanations and illustrations are the more surprising. In order to demonstrate this, a concise outline of the system Galen adopted will not be misplaced, as exhibiting a display of talent and power of combination in its construction, never excelled, if indeed ever equalled! Certainly, other theories, ancient or modern, compared with his, have been ephemeral; all have sunk into the common tomb of wire-drawn hypotheses; few have survived even the architect of their existence, and some have died before their authors, without a sympathetic feeling for their wounded pride by contemporary practitioners! Now, it is true, that the same fate has attended Galen; but it must be remembered to his superior merit, that his doctrines maintained a proud and universal ascendency for more than twelve centuries;—will those of present notoriety reach even to the end of the present? we are constrained to doubt it. In truth, it may be affirmed, that nearly all, if not the whole, of past and present theories, are really to be found, at least in embryo, in the writings of the two great men whose views in medicine are thus succinctly noticed.
In order to comprehend the state of medicine in the time of Galen, it is necessary to recall to mind the diversity of sects then prevalent in Rome. How many offsets of inferior interest might have merged in the six above mentioned, we cannot now determine; of these, the Methodists were chiefly in vogue, and next to them the Dogmatists, who split under the respective leaders, Hippocrates, Erasistratus, Asclepiades, and others. The Empirics were less esteemed, nor were the Eclectics much more regarded. The others were rather scintillations from the Methodists.
Though Galen protests that he will not avow himself a follower of any preceding physicians, and considers all those as slaves who in his time called themselves Hippocratists, Praxagoreans, or by other names; and therefore apparently ranks among the Eclectic division, choosing the best, from all former writers indifferently; yet, with all this, he was an undoubted Dogmatist, or Hippocratist, for he followed him alone, although differing from him in many particulars. He was his favourite author; and although not sparing him in his commentaries on his writings, he nevertheless evinces the highest esteem for him, and avows that he had laid the foundation of true medicine. Thus prepossessed, he wrote various books against the other sects, to overturn their doctrines, and reestablish the Hippocratic principles. He even affirms that all previous commentators to himself, had failed, and that he alone had penetrated the true meaning of his favourite predecessor. Had he, indeed, done nothing more than illustrate the medicine of Hippocrates, his labours would have been of high importance; for, if Hippocrates had taught the only true medicine, certainly his successors had strangely deviated from the route he pointed out. It is not this, however, from which he assumes most honour; it is that he first pointed out a just and rational method of treating medicine, and which is omitted by Hippocrates; and to fully inquire into which, would be to establish a complete essay on the institutes and practice of physic in conformity to his principles; but of which a short and general idea can here alone be given, yet sufficient to establish the relation and difference in the medicine of these two celebrated men. Attention to it will, I think, demonstrate that even thus contrasted, its merits are pre-eminent; and that a man who could write so well as often to persuade, if not always to convince, is not lightly to be rejected or forgotten, merely from being clothed in a garment not at present fashionable.
Galen sets off with the judicious remark, that in order to become acquainted with any art, we must know the end which that art proposes to attain; and that the same mode that should be followed to distinguish other arts, will equally apply to make known the art of medicine. Some arts are merely contemplative, as arithmetic, astronomy, &c., others, wherein a certain effect is obvious, but so soon as that effect ceases, the operation of the art is no longer conspicuous, as in dancing. In others, the effect is permanently conspicuous, as in architecture. There are others again, whose whole design consists in acquisition, as in venation and fishing, &c., but which may be considered as producing nothing. Medicine is of the number of those arts which produce something, and whose work is evident, although its action ceases. Hence it appears, that in arts whose effects continue, a distinction may be drawn, the one producing something that did not exist previously, the other reestablishes that which had a previous existence, as in the case of medicine, which maintains or preserves the health of the human frame, or restores it when it is lost.
This being admitted, Galen proceeds to say, that as an architect ought necessarily to know all the parts of a house, whether undertaking to build a new one, or to repair one that is old, so he who would desire to establish an art, the subject of which is the human body (viz. medicine), ought to be acquainted with all the parts composing that body, their substance, magnitude, figure, situation, number and inter-connexion; all which is attainable only by anatomical examination. But the physician is distinguished from the architect in this, that he should not only know the parts of the human body, but also the action of each part, since there is no one part that has not its own particular action or function.
The duty of the physician thus instructed, is in the first place to preserve the parts in their natural healthy state, so as to subserve their destined use, and freely perform their functions. 2d. To reestablish them in their former state, when those functions are obstructed, or even to endeavour to reproduce when possible, parts that are defective. Now, without stating further what is advanced on these points, I think it must be admitted that this foundation of the Galenic system is good, and perfectly true. It is from this point that speculation begins, but it will not yield in ingenuity to any of the systems of the present day, either in lucidness or in a firm adaptation of all its parts. Archimedes exclaimed, “Give me a place to stand on, and I will move the earth;” with equal justice might Galen say, “Admit my premises, and my superstructure is perfect.”
The first elements of all the parts above adverted to, as of all other bodies, according to Galen, are fire, air, earth, and water. The qualities of these elements are heat, cold, moisture, and dryness. So long as none of the elements or qualities are predominant, or while there is an exact proportion between them, conformable to the natural disposition of similar parts, such parts have a just temperament, and perform their ordinary functions correctly; but if any one of them is defective or excessive, an intemperies follows, which, reaching a certain point, either destroys the function, or changes it from what it should be. This temperament and intemperies has relation also to organic parts, inasmuch as they are compounds of similar parts; and it is to be remarked also with regard to organic parts, that they are, or are not in a natural state, accordingly as they do, or do not, possess their ordinary figure or magnitude, or as they are, or are not, in their accustomed place or number. Add to this, moreover, their union or defect of union, and a knowledge will be thus acquired of the good or bad disposition of the body, in which health and disease may be affirmed to consist.
In relation to the possibility or impossibility of curing disease, this has a bearing both on nature and on the physician. There are certain things which nature can accomplish, and others which she cannot. She can reproduce flesh removed by a wound or consumed by an abscess, because flesh is a part that owes its origin to the blood; but she cannot regenerate a nerve or an entire bone. Now that which nature cannot effect, neither can the physician who is only her assistant; but he aids nature by seconding her efforts, or by following her intentions in all that can at times be accomplished by herself. If nature can fill up a deep ulcer with flesh, the physician labours on his part to make the flesh grow, by removing every obstacle that can oppose it, so far as it is in his power.
Medicine, says Galen, is an art that teaches how to preserve and to restore health, or cure disease: and elsewhere, that it is a science that teaches the knowledge of what is healthy, unhealthy, or intermediate between both; which, although ascribed to Herophilus, has yet been explained or commented on very differently by Galen, and in a manner replete with ingenuity and good sense. Thus says he, there are three kinds of things that are objects of medicine, and which the physician regards as healthy, unhealthy, and neutral. These three things are, the human body, the symptoms of disease, and the causes of disease, on all which he largely reasons and explains. It is necessary here merely to notice, that the body may exist under three dispositions, viz., of health, of disease, and neutral or intermediate between both, and these comprehend all the extent or distance from extreme health to extreme disease, each disposition having its peculiar range, depending on the due or undue apportionment of the principles of heat, cold, moisture, and dryness, and the due or undue disposition, size, figure, connexion, &c., of the various parts; and these are subdivided by the greater or less predominance of the one over the other; superadded to which is a certain inexplicable peculiarity or property of the bodies of some individuals, having no connexion with the qualities stated, but depending on occult or hidden causes. This peculiarity of temperament is called idiosyncrasy; by which one person has an aversion to some peculiar food, another, to another kind; some are affected by a peculiar odour, &c. The different temperaments may deviate indefinitely from their relative existence in health, yet this does not produce actual disease, so long as the intemperies that causes them to diverge from perfection, does not hinder the action of the parts; but as soon as this ensues, the body is in a morbid state. Hence it is, properly speaking, the impediment to the proper action of parts that constitutes disease. All that space between the two is neutral, that is, a state neither of disease nor health; the individual is not yet sick, because the action of parts is not yet sensibly impeded; he is not well, because the disposition exists in those actions, not to follow their accustomed train. He then describes at large the signs of a good and bad constitution of the body, as well as of the neutral state: they are derived from his first named qualities, hot, cold, &c., when similar parts are in question, and when compound or organic parts are the subject, from the due or undue proportion of their size, figure, situation, &c., and he derives the causes of these three different constitutions from the same source.
It may be remarked, that Galen, like Hippocrates, establishes three principles of animated bodies, viz., the solid parts, the humours, and the spirits. The solids he divides into similar and organic. He also recognises the four humours of Hippocrates, viz., blood, pituita, bile, and melancholy; and his opinions relative to hot, cold, dry, and moist, are nearly the same as those of his illustrious predecessor. As to the spirits, he divided them into natural, vital, and animal, which he supposed answered to, and were instrumental to three sorts of faculties residing in those parts in which each kind of spirit was produced. Without entering further into his views, I shall merely mention that phrenological ideas were assuredly familiar to him, for in one part of his writings, according to Heurnius’ quotation, he is made to say, that when the brain is affected “apud anticos ventres suos lædi imaginationem; sin illi medios secum ventriculos trahant, perverti et cogitationem.” Now although Galen’s opinions on this point are really of no moment in deciding its truth, it is nevertheless worthy of consideration, whether the reasonableness of its investigation is not supported, by perceiving it to be the natural emanation of a strong and vigorous mind, even sixteen centuries before it was recognised as a science.
The preceding, together with some minor distinctions and terms, may be considered as the foundation of all Galen’s reasonings or theories on the causes and nature of health and disease. He presumed that health was maintained so long as the faculties are fit to produce their ordinary actions, or while those actions are entire and perfect; whilst the reverse of this induces disease. Now, as the actions cannot be free or entire unless the solids as well as the fluids are well disposed, it may be said that health depends in the first place on the symmetry of the organic parts, and in the union or connexion of them all. So long as the humours and solids continue thus, the spirits which follow the nature of the humours cannot be otherwise than well-conditioned, and consequently the actions (the result of the organs of the spirits, which are themselves directed by the faculties mentioned), cannot but be perfect. On the contrary, let the humours and solids become altered, deranged, or disunited, the spirits must become disordered, and their actions interrupted. And here I must be permitted to remark, that, at least in my opinion, this theory of Galen, embracing as it does both the solids and the fluids, is infinitely superior to the dogmas of our times, by which the doctrines of Solidism or of Humoralism are separately maintained; for it is utterly impossible that those parts, so essentially united by the Deity, can be separate and independent media of disease, individually considered. If we might be permitted to apply to these respective and equally essential parts of the animal economy, the anathema of the marriage ceremony, we might emphatically repeat on this point: “What God hath joined, let no man put asunder!”
On the principles above unfolded, Galen defined disease, to be an unnatural disposition or affection of the parts of the body, which primarily, and per se, prevents their action; and he established thereon three principal genera of disease. The first regards similar parts; the second, organic or compound parts; and the third, was common to both. It is unnecessary to enter into particulars as to each of these; I will merely say, that, admitting the premises to be correct, the superstructure is not unworthy of his expanded mind; neither can I enter into a detail as to wherein he agrees or differs from the fundamental views of Hippocrates. He has, as occasion required, added to, or retrenched from them; and has thereby constituted a whole, far superior to that of Hippocrates, more consolidated and perfect. Whoever desires more fully to investigate the respective views of these great and illustrious men, will do well closely to read their works; or if they are not attainable, at least to study them, as given in the excellent histories of medicine by Le Clerc, Friend, and Sprengel, especially the former,—who, after giving pretty fully in detail the system of Galen, says, that its faults, if examined in connexion with the Cartesian philosophy, or that of Democritus, of Epicurus, or of Asclepiades, will not permit us to disavow that it is very ingenious, and perfectly well carried out; that if we find some scholastic questions that if useless may be passed over, many things are to be discovered in it which greatly assist in forming the physician, and pointing out to him the road to practice; and that this would be especially discovered, if in place of giving a mere idea of his medicine, an abstract had been given of all his writings; which, we may add, whether referring to his particular knowledge of the individual branches of the science, or to his more extended and general views of the whole, bespeak such a profound degree of knowledge, as to call forth our warmest veneration and respect. Engaged as he was most fully in the practice of his profession, the mind is overwhelmed by the consideration of his extensive literary and scientific productions; six immense folios on medicine have reached us, besides a vast number of his writings, nearly equal in amount, that have perished by the chance of time, bespeak his indefatigable exertions, proving that not a moment passed him unattended to! Can such a man be cast into oblivion, or suffered to remain unknown to us, except by name, in these days of inquiry and research? If nothing more, curiosity alone should urge to a more full inquiry as to what a writer, of nearly the period of our Saviour, has left behind him: and should that powerful engine provoke to the research, it will soften down to the calmer desire of really becoming acquainted with him; for we shall soon discover that his pages are replete with facts and observations not less important to our science now, than at the distant period at which he flourished; and I most sincerely hope and trust that the day is not far distant when we shall be enabled to view him fully in an English translation, and thereby prove, that hundreds of the profession have derived their celebrity, from our general ignorance of the learning and attainments of Galen, by stripping the laurels from his honoured brow, with which they have unduly weaved a wreath to place around their own, altogether undeserving of it.
[* ]See Le Clerc, Hist. de la Med. p. 107. Δυναμις, faculté, pouvoir, force, vertu, proprieté.