HIPPOCRATES AND THE HIPPOCRATIC WRITINGS (part three)

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 answer—the 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 philosophy—a 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 empire—in 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 mind—offers 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.

Dissection—already practiced by Alcmaeon, Democritus, Diogenes and others—was 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 point—the 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 vase—hence 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 vessels—one 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 easily—in 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 a few centuries later. Some of you doubtless know him in another guise—as the author of the golden booklet on "Characters," in which "the most eminent botanist of antiquity observes the doings of men with the keen and unerring vision of a natural historian" (Gomperz). In the Hippocratic writings, there are mentioned 236 plants; in the botany of Theophrastus, 455. To one trait of master and pupil I must refer—the human feeling, not alone of man for man, but a sympathy that even claims kinship with the animal world. "The spirit with which he (Theophrastus) regarded the animal world found no second expression till the present age" (Gomperz). Halliday, however, makes the statement that Porphyry(30) goes as far as any modern humanitarian in preaching our duty towards animals.

     (30) W. R. Halliday:  Greek Divination, London, Macmillan &
     Co., 1913.