Front Page Titles (by Subject) INTRODUCTORY REMARKS. - The Writings of Hippocrates and Galen
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INTRODUCTORY REMARKS. - 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).
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During several years, whilst holding successively the Professorships of Chemistry, and of Materia Medica and Pharmacy, in the University of Pennsylvania, I endeavoured in my Introductory Lectures to afford some slight information to my class, as to the character and writings of Hippocrates; and to vindicate him from the unwarrantable aspersions that have been cast upon him, even by those who considered themselves as being among his warmest admirers. That they derived their impressions of that great man from second-hand observations, whether favourable or unfavourable to him, I have no doubt; for I consider such an imperfect and partial acquaintance with his writings, as being the only means by which we can explain the singular circumstance, that fault has been found with him, and ignorance ascribed to him on subjects, which a due and personal acquaintance with his works, would have assuredly prevented. I pursued a similar plan with respect to Galen in two or three successive Introductories, but the continuance of which was precluded by my separation from that institution. Being thereby prevented from pursuing the object I contemplated, I have long been led to think that it might not be unacceptable to the Profession, if I should, by slightly modifying the lectures, present a brief outline of the works of both those wonderful and accomplished physicians. In the preceding pages, my readers will have attained some slight view as to Hippocrates and his writings; and in those that follow, will be found an epitome of Galen—his illustrious successor, his warmest advocate moreover, and vindicator, as well as commentator; hoping that it might lead to an eventual consideration of a debt of gratitude to him, of long standing, that of giving him a complete and perfect English dress; by which thousands, unacquainted with the Greek original, or the Latin translation, might be enabled to peruse with pleasure and with benefit, his learned lucubrations.a
Not inferior, probably superior to Hippocrates, from possessing the advantage of four centuries of additional information, accumulated in the vast libraries of Alexandria, Greece, and Rome; improved moreover by the extension of that information, or rather its collection and concentration as it were into a focus, constituted of the Greek and Alexandrine schools, we cannot doubt that Medicine received its full proportion of attention; since, even prior to the time of Galen, it had obtained the fostering care of kings and princes. Mithridate, so called from the great King of Pontus, has reached the present day, though greatly modified; together with the Theriaca, prepared for use by the chief physician alone; and which last has been illustrated and described by Galen, in a curious and learned commentary, whilst it was held in the highest estimation for nearly fourteen hundred years.
That Galen and his doctrines should have so long maintained the highest rank in medicine, and been the arbiter of our science for upwards of a thousand years, will appear surprising to those alone, who are ignorant of him and of his imperishable writings! It is true, his works, originally in Greek, are from that cause a sealed book to a majority of the Profession; but numerous editions from the Juntas of Venice, and Frobinius of Basil, of the Latin translation exist, and might be obtained by all who really desire to consult them;—or at least if their high price should prove an obstacle to this, all will admit, that no public library, especially a medical one, can possibly be complete without them. Imagine them now presented in an English dress! how many embryos of the hundreds of our since discovered facts and theories, should we not behold? The plagiarists of past and present times would stand forth in bold relief, and credit would be awarded to the great original! Hinc illæ lachrymæ!—Our authors wish not to withdraw the veil, or else it might with ease be accomplished. Galen has never yet been permitted to assume the British toga, although the Roman fitted him so well.
I cannot but admire the apathy with which those extraordinary productions are regarded by many of the learned professors of our science! who, whilst they employ the lighter works of fancy to form the chief intermedia between the present and by-gone times; they look through a glass, darkly, along a vista of more than fifteen hundred years, when Galen constitutes the object of their contemplation! Fain would I hope, that his works may yet be given to the world, in such a dress, as readily to introduce them, not to our libraries only, but to our minds. May it devolve on America to discharge this debt;—but little hope can be anticipated from England, in this particular. It would present a mirror that would reflect back the images of facts and theories, long assumed and regarded as of domestic origin, with no acknowledgment of their Grecian source. Here, in the pages of Galen, would be discovered many of those great principles, both in theory and practice, which have, at different periods, been advanced as novelties; for Galen has remained a fixture only, on the shelves of medical libraries. As in the pages of Burton, the plagiarisms of Sterne have been demonstrated by Ferriar; so in those of Galen, an equally egregious memento of medical effrontery might be readily shown to exist. But who now, we may be permitted to inquire,—who reads his works?—Where indeed, with few exceptions, are they to be found, even in our public institutions for private reference? It is time that justice, so long delayed, should at length be exercised towards one of the most brilliant stars of the medical world. It is time to dispel those fanciful dreams, that in the mighty march of intellect, “all the talents” are concentrated in our present period, and that retrospection is unnecessary. The flippant usage of too many of our public writers and teachers, of denying to the ancients any merit, as if their intellects were barren as their own, cannot be too severely reprehended. Those ages which produced the poets and philosophers, whose works have reached us, and which have ever been considered as the standards of merit in their respective spheres; could never have been deficient in the yet more important and personally interesting science of medicine!a Test this, by the writings of Galen alone, and its truth will conspicuously appear, in opposition to the dicta of our would-be master spirits, who fondly please themselves that they alone are the shining lights of the Profession; and which their vanity, and ignorance of those bygone writers whom they profess to contemn, yet, as opportunity serves, most ostentatiously quote, can alone explain.b When we hear the ancients most unblushingly undervalued, let us set it down as a fact, that such persons have never examined the authors they contemn, and are therefore desirous of retaining others on a level with themselves, either of ignorance or indifference.c
In following up the plan I have marked out, it is my intention briefly to glance at the contents of the several writings of the extraordinary person in question, that my readers may know what they may expect to find in full, should they think fit to look into the venerable and nearly obsolete folios of their most illustrious predecessor; and if unable or unwilling so to do, that at least they may be checked in any attempt to decry them, by this slight epitome. It will consist, for the most part, of the simple outline (with a few exceptions more fully given), of those writings, as they have appeared to the editor; and which can scarcely be considered as even a skeleton, as it were, of the proudest work of which the science of medicine can boast, either in ancient or modern times, if estimated by its individual merits alone! No slavish and ignoble plagiarist was Galen. In thought, as in action, he appears to have been free: and those thoughts are evincive of superior genius, improved by all the arts and science of his own, and of preceding ages. In every page, his character stands forth in bold relief. His works are a library of past events, an encyclopedia of facts from every branch of medical literature; and forestalling many of the most extraordinary events of our own times; whilst even in experiments and in operations, considered as novelties in the present day, he has preceded them.
In order to comprehend the writings of Galen, he must, I think, be permitted to explain himself, through the context of other parts. That he was wrong on many points of physiology, when compared with those deemed perfect in our day, cannot be denied; but are we absolutely certain of the truth of all those we now maintain? Will not the fluctuation of the physiology of the last fifty years be adequate to set aside such flattering pretensions? The stamp of mutability is affixed to the science; now, at least as much so, as in the days of Galen; for, with all our boasted attainments, it can scarcely with justice be affirmed, that the superstructures we have erected, are more beautifully, or more securely and symmetrically arranged, than was that of Galen; or that we have, in truth, a system of physiology that is more settled or superior to his.a Let us inquire how stands the fact, in two or three particulars. Whilst Galen regarded respiration as intended to cool and ventilate the blood, we have, at one time, been led to consider it as productive of animal heat, and at another, as being required to oxygenate, or, to decarbonize the blood. Now, of all these, which is true?—If some have supposed the air to be absorbed, in whole, or in part, in the different views of respiration, Galen had, before them, thought the same; and surely the ventilation of the blood, and conveying to it an aeriform fluid or spirit, as taught by the ancients, is an hypothesis at least as beautiful; and is by Galen as well maintained, as any of the present day; even if we cannot perceive in it a complete forerunner of those systems, which as now vamped up, are proclaimed as new, though based on a groundwork of nearly 2000 years. All this has been accomplished by the magic influence of a few new-fangled, and fresh-coined terms, derived from the fluctuating vocabularies of our changing systems of medical philosophy.
With respect to the various opinions as to the power and agency, by which the circulation is enforced and continued: whether by that of the heart alone, or by that of the arteries, or of both combined; it may be allowed us to inquire whether, with all our greater and more ample anatomical researches, aided by the microscope, and by injections, and by the most powerful physiological acumen, this interesting fact is better ascertained, or more conclusively substantiated than it was by Galen, who ascribes it to the heart alone; and founds his reasons, in part, on the synchronous character of its beat, with that of all the arteries of the body.
In regarding the veins, as the channel by which nourishment was conveyed to every part, according to our present views, Galen was in error.a That he perceived the absolute necessity of a circulation, from the very facts themselves, of nourishment and growth in every part, seems to follow, as an almost necessary result; and one that can scarcely be supposed to have been beyond the speculations of his penetrating and inquiring mind. Now this is infinitely strengthened by comparing and connecting those disjointed or independent portions of his multifarious pen; in which a circulation is more than merely obscurely hinted at, as we shall endeavour to demonstrate in the progress of these pages. The assumption, (for it is nothing more,) that his idea of a circulation was simply that of a flux and reflux of the blood in the same vessel, like the rise or fall of the tide, will not coincide with the circumstances of the text in numerous parts of his works; and can only be maintained by those, who, at all hazards, uphold the sole right of Harvey to the discovery of the circulation in all, its most unlimited extent. We can at present merely surmise, that Galen could not have looked, either for a general, or partial nutrition, without some definite views as to a channel of communication, for the especial purpose of transferring to every part, an ever-moving fluid, which he undoubtedly regarded as containing the nourishment of the system at large, and that nourishment taken in, ab extra, daily, at his meals. How he supposed nutrition to be actually accomplished from the blood, as freighted with its important addition, we may partly comprehend from his ingenious doctrines of attraction and repulsion; together with other powers, which he ascribes to every organ of the body; doctrines probably not surpassed by any since promulgated; and quite as ingeniously built up and sustained. We ascribe the deposit of various matters, either of nutrition or secretion, to arterial branches of the circulating system; yet, at the same time we admit the anomaly of the secretion of bile from venous branches. It is not then, perhaps, incorrect to admit that Galen was partially right on points, in which, even now, from our absolute uncertainty as to the exact character of the capillary link of circulation, we have no positive or fixed conviction.
It may excite surprise, but it is not the less true, that by changing our present nomenclature for that of Galen, we find the doctrine of Tissues very distinctly taught by him;—a doctrine so ably and beautifully, and let us cheerfully add, more fully and satisfactorily enlarged upon by the celebrated Bichat. That a doctrine so luminous and harmonious, should have occurred to both these illustrious men, may be regarded as a strong presumption of its being founded in truth; and identifies in a powerful manner, the congeniality of their minds and pursuits. It is possible that Bichat derived his views on this subject from Galen; yet it is not improbable, considering the neglect into which the writings of Galen had fallen, that Bichat owed it to himself. Their mutual and strong attachment to anatomical research, qualified them certainly, for far more extended views of physiology and pathology, than falls to the lot of the major part of the Profession. At an interval then, of nearly sixteen hundred years, during which the doctrine had slumbered, it may be said to have again been discovered, or resuscitated and embellished, by those improvements which may be conceded to have sprung up.
Nor is the division of diseases into Functional and Organic, by any means obscurely taught by Galen. By merely a change of terms, we find the same ideas, that are now enunciated. And if, as Shakspeare says, “a rose, by any other name would smell as sweet,”—it would be difficult to say, why the doctrines of Galen should be less acceptable to us, under his primitive nomenclature, than as now set forth to the public, as novel, under a mask of newfangled names and explanatory elucidations.
I cannot forbear to repeat, what Galen himself perpetually enforces, that the fluctuation of names, has always retarded the pursuit of knowledge; and that it has been, is now, and ever will be, the principal means adopted by every dexterous plagiarist, to mystify an otherwise well-known subject; and by giving it to the world in a new dress, an aspect of novelty, it is palmed upon ignorance or apathy, as the production of genius and research, such as previously had no existence. This nomenclatural fluctuation was well known to Galen; and whilst it is wofully deplored by him as a source of infinite evil, he fails not to castigate it by those sarcastic remarks he often indulges in.a
Although in several places, Galen seems to incline to the doctrine of the unity of disease, yet the prior claim to it by Hippocrates must be admitted, if there is any force in words.—“Morborum omnium unum et idem modus est, locus autem differentiam facit.”—Lib. de Flatibus.—Or, as an annotator (Fracassini, opusc: Pathol. Leipsic, 1758, ch. 18, p. 92,) on this part has it: “Cum humanum corpus liquidis ac solidis, nempe vasis ipsa liquida continentibus, constet, et utraque in statu sano æquabili ac proportionato motu moveantur, vasa scilicet oscillatio quo dilatantur ac contrahuntur; liquida vero progressivo ac circulari, quotiescunque horum motuum interruptionis, vel perturbationis causa, in qua morbus consistit, ex uno in alium locum transferatur, essentia morbi commutatur, ac altero exsurgente, alter sæpe recedit; si vero per quodcunque organorum secretiorum materiæ trajiciundæ aptorum eliminetur, omnino extinguitur morbus.”—Whatever may be thought of the explanation here given, there seems no room to doubt, that here is to be found a complete exposition of the “Unity of Disease.”
These preliminary remarks are, however, sufficiently extended. In confining myself to the simplest outline, I shall take the liberty of making occasional observations, in order to direct attention to some particular point, in a more especial manner; and shall introduce but rarely, the appropriate quotations, on which those observations may be founded, as well as those on which I should rest my claims to the attention of the Profession, for Galen and his works.
[a ]I appeal to those who may honour these pages with a perusal, whether they have ever known fully, what were the subjects of the voluminous writings of Galen, even by name?—And I might make the same appeal with respect to a large portion of the writings of Hippocrates!—By a majority of the medical profession, if this appeal were truly replied to, I doubt not the answer would be in the negative!—And yet the names of both those illustrious authors are familiar to all the Profession as their household gods!!
[a ]“O vous qui jugez avec autant d’injustice que de légéreté la physique de Séneque, et qui payez d’un souris dédaigneux et malin les fruits utiles de ses veilles; oubliez le moment où vous existez, et ce que vous devez aux découvertes de votre siecle sur cette science: transportez-vous au temps où il a ecrit; proposez-vous les mêmes questions, et voyez si vous les résoudriez mieux que lui. Vous seriez peut-être très vains alors de rencontrer son erreur.”—Avertisement de L’Editeur des Œuvres de Séneque, sur les Questions Naturelles. Vol. 6th, Paris edition, an 3.
[b ]Did time and space permit, I could furnish from Fabricius a copious and extraordinary catalogue of “Opera deperdita,” which would probably astonish the reader, and lead him to regret the loss the world has sustained from the non-discovery of printing in those bygone times. We may, however, like the old woman and the empty cask, in Æsop’s Fables, form some judgment of our loss, by the comparatively few that have fortunately been spared from the ravages of time, under the controlling influence of despotism, barbarism, and superstition.
[c ]These gentlemen might learn a lesson from Shakspeare’s favourite knight, Sir John, at least, in relation to Galen, that would be useful to them.—Vide Henry IV. Part II. Sc. 2.“Lord Chief Justice.—
[a ]I would earnestly request the older members of the Profession, (I mean those of thirty or forty years’ standing), to cast a retrospective glance at the numerous changes in physiology, and pathology, and therapeutics, that have been given to the medical world, since their first connexion with it. Nearly a century ago, a Doctor Lizarri of Venice, published a defence of oleaginous remedies in bilious diseases, in opposition to the celebrated Tissot, who condemned their use. Lizzari affirms, that in order to favour his opinions, Tissot had even frequently mutilated the text of Hippocrates. A journalist of Venice, reviewing the work, exclaims, “Malheureux sort de l’humanité; il n’est pas encore décidé si l’huile est salutaire ou nuisible dans telles maladies, et les malades, meurent pendant la dispute!” Will not this equally apply at present, to much of medicine in its different branches?
[a ]It must be remembered that by the ancients, the term φλεψ, was a generic one for tubes of every kind capable of conveying fluids. It was not limited to the vessels alone in the human body; but in order to discriminate between an artery and a vein, the former was called a pulsating, the latter a non-pulsating vein.
[a ]It might well be demanded of these incessant coiners of new terms, “by what authority” they do this? by which almost every science is kept in a constant fluctuation, if not absolutely retarded.—Let any one compare the changes of nomenclature for the last fifty years, in Medicine, in Botany, in Mineralogy, in Chemistry!—and then ask, “Cui bono?”