[ THc BRIT8 8 FEB. 3, 1923) THE POST-HJPPOCRATIC SCHOOLS OF MEDICINE. IMXDICAL JO.TAu 187 I cold oil if tlle disease was one in which- the pores were l4w atrizk 3tE rtns relaxed. Yitli By means of these sumnmary metlhods of diagnosis and cure ON the Methodists tlloughlt tlley could dispense witlh all furtlher THE POST-IIPPOCRATIC SCHOOLS researchl. They made no iniquiry into causes whether remnote or proximate, for, from the momuent the causes had produced OF MEDICINE. tlleir effect-that is to say, from the muoment the disease was DELIVERED BEFORE THE ROYAIL COLLEGE OF PHYSICIANS fornmed-it was tlhis, they said, which one lhad to cure. It OF LONDON, was from thle disease itself, they said, its nature, character, BY and cause, that one had to find the indications for treatmnent, R. 0. MOON, M.D., F.R.C.P. and not from anterior circumstances, whichi liad no influence; [Abstract.] and the nature of the disease consisted in having the pores too muclh conistricted or too much relaxed. (Conlcluded fromw page 143.) Tlle best known member of this school, and by some re- garded as tlhe real foun(ler of it, thouglh an absolute clharlatan, THE METHODISTS. was undoubtedly Thessalus of Tralles. He was the son of THE school of the Methodists seems in a sense to occupy an a weaver, wlhich occupation he followed in his youth, and had intermediate position between the opposing schools of the enjoyed none of the elements of a liberal educationi; from Dogmatists and Empirics. This name of Methodist is doubt- this resulted the pride of ignoranoe and scorn for the observa- less more familiar to English ears as the sobriquet jestingly tions of his predecessors. He considered that medicine could given by a Christ Church undergraduate to the sinall group of be learnt in six montlhs. He reversed the famous aphorism friends who gathered round the brothers Wesley in Oxford in of Hippocrates tllat "Life is slhort and Art is long," by saying the middle of the eighteenth century on account of their that "Art was short and Life was long"sI On a monument regular manner of life and behaviour. The name as origin- in the Appian Way he styled himself "Conqueror of Pliy- ally given had of course reference to intellectual and not sicians," and lhe wrote to the Emperor Nero saying that his moral qualities. In any case it was not very appropriate, medical predecessors lhad contributed nothing to science-tlie though the founders of the school did perlhaps commnit tllem- kind of statement which Nero miglht well lhave appreciated, selves to a more definite and precise theory of disease than So little did he know of Greek that he accused Hippocrates either the Dogmatists or Empirics. of causing the deatlh of his patients by overfeeding them. medicine to very terms, which This school reduced simple Thessalus, "founded a new sect, which is the ways for in thera- "I have," said may remind us in some of homoeopathy, only true one, being obliged to do so because none of the physicians peutics they adopted the principle of "contraria contrariis who have preceded me have found out aniything useful for the curantur," which is analogous though antagonistic to the preservation of health nor for banishing diseases, and Hippocrates system of Hahnemann. According to the Methodists the himself has uttered many harmful maxims on this subject." body consisted of atoms and pores, a doctrine derived from By dint of great flattery Tllessalus insinuated himself into Epicurus. To the atoms they paid but little attention, con- the houses of the great. According to Galen, who was, h1ow- centrating themselves on the pores. Now these pores were ever, the bitter enemy of the Metlhodist schlool, the manners said to be either in a state of too great contraction or too of Thessalus were submissive and slavish, very different great relaxation. from those of the ancient plhysicians, the descendants of . The foundation of the school of the Metlhodists synchronized Aesculapius, wlho gave commands to their patients like a with the migration of medicine from Alexandria to Rome as general to his soldiers or a prince to his subjects. Thessalus, the centre of intellectual activity, and 'tle entry of Greek on tlle contrary, obeyed Ihis patients like -a slave his medicine into Rome had been accomplished by the well master: if his patients wished to bathe he let them do so; if known and popular physician Asclepiades of Bithynia, who they wanted to take ice or snow he gave it them. Natur-Ally had adopted tlle doctrines of atomism from Democritus and Thessalus attracted a large number of pupils, mostly frogi Epicurus. Themison of Laodicea (fI. 50 B.C.), a pupil of this the artisan class, who were anxious to become doctors in six Aselepiades, founded the school of Methodism. Thlough, like months; he lhimself wrote five large -volumes which wvould his master, he followed the doctrines of atomism, unlike require almost that length of time to read through.- Asclepiades lhe concentrated his attention entirely on the Of a far higher calibre was Soranus of Ephesus, who may pores, paying lhardly any heed to the atoms. For the Metho- be regarded as one of the chief ornaments of the Methlodist dist generally, acute disease was a state of contraction (status sclhool. He came to Rome in the time of Trajan and strictus), while a chronic disease was a state of relaxation Hadrian (fl. A.D. 93-138). He was the first of the school to (status laxus). As regards therapeutics, there were for the offer a plausible reason for tlle rejection of the use of Methodists only two indications: (1) to relax the pores when purgatives-namely, that they- got rid indiscriminately of tllere was a constriction, (2) to constrict them wlhen there humours wlhich were wholesome and those whiclh were was a relaxation. Whlat could be simupler? Among the vicious. He always used venesection in pleurisy, because it tlherapeutic agents wliich were thought to have tlle desired clearly arose from a statuis strictus. He wrote a book on effects Wvere: gynaecology which showed that he had a wide knowledge of Relaxinig Agents. anatomy, a subject as a rule despised by the Metliodist- 1. Venesection; btut they practised this with caution, because anatomy seemed to have been- "bleeding " tendled to draw off the finer, the more vital atoms first, school, and his ideas on leavino the coarser ones behind. based on human and not merely on animal dissection, as 2. Cupping; of this they made frequent use-sometimes they had been the case with most of his predecessors. The wo kld cover nearly the whole body vith cupping glasses, as they great theologian Tertullibn spoke of hjim as " methodicae paiil no attentioni to the part affected. and his reputation well 3. Softening plasters. medicinae instructissimus," laoted 4. Warm driniks. on into the Middle Ages. 5. Diaphoretics. We should know but little of the Methlodist school were 6. Warm air. it not for the writings of Caelius Aurelianus, who lived in the 7. Sleep. fifth century; he was a native of Sicca, in Numidia, but 8. Exercise carried to the point of fatigue. practised and-taught in Rome. Like most other members of been very Constrictinig Agents or Astringents. the Methodist school his education had imperfect, 1. Darkne,s. and this perhaps explains the barbarism of hiis style and his 2. Cool air. complete ignorance of the Greek language. On the otlher 3. Cold wdter and acid drinks. hand, no ancient autlhor has more clearly set forth the 4. Decoctioni of quinices. of each disease, and it was a fortunate circumstance 5. Red wine, pure or diluted with water; the cold water had to diagnosis be taken in small quantities, for fear that if the patient took much that in the Middle Ages the 'monks selected him before all it would soften the tissues aind cause relaxation. otlhers for their guidance in the treatment of disease. 6. Vinegar, solution of alum, powdered chalk, lead plasters. As examples of acute diseases which depend on constric- the first tllree days of an illness they enjoined strict tion, Caelius Aurelianus gives us (1) madness, (2) letlhargy During (3) abstinence; then they administered food only every other whicll involved a stronger constriction than madness, day. Remedies were not given till the third day. During catalepsy, (4) pleurisy and pneumonia, (5) tumours. Clhronic the days of abstinence the patients only washed their mouths diseases depending on constriction were (1) headache, (2) with water and drank a little; apart from this tley were giddiness, (3) astlhma, (4) epilepsy, (5) jaundice, (6) obesity, covered with plasters and wool steeped in warn oil if the (7) suppression of the catamenia, (8) melancholy, (9) paralysis, disease was one in whlich the pores were contracted, and in (10) phthlisis, (11) colic. Tnz Brmn I88 FuB. 3, 19231 THE POST-HIPPOCRATIC SCHOOLS OP MEDICINE. MEDICAL JOUENAZI i As an example of acute disease caused by relaxation he drinking vessels, and they celebrated his birthday avery year. gives cholera, and of chronic diseases haemoptysis and Athens honoured him with bronze statues, and the number of diarrhoea, excess of the catamenia, and wasting. his pupils and friends is said to have exceeded the population Since these two general states of the body were sufficient of whole cities. to guide the physician in the knowledge and treatment of It is well to remember that at the time when Epicurus disease all etiology became superfluous, for there is no object was living at Athens the Grecianworld had seen tbe d6wntall in knowing the cause of constriction, for instance, so long as- of Thebes, the exile of Demosthenes, and the shipwreck of we are able to cttre it. the whole Hellenic State system. Political freedom having The Methodist school certainly possessed tle merit of to a large extent disappeared, the philosophers endeavoured endeavouring to cure disease by the simplest measures, such to establish an internal freedom based upon ethical principles as air and food. In order to make use of air for thle purpose and to maintain it in spite of outward oppression. It was of relaxing the pores they put their patients into rooms which this inward freedom wlhich the Epicureans no less tllan the were very light, moderately warm, and large. When, on the Stoics set themselves to supply. Qther hand, they wanted to have the constricting effect of air It is not to be imagined that the average plhysician of the they placed their patients in rooms which were dimly lighted Methodical school busied himself much about the Epicurean Ond very cool. They also paid great attention to posture in or, indeed, any other philosophy ; but hie was none the less ed, and considered the sort of covering patients ought to surrounded by it, as the ordinary man is enveloped in the ave, whether they should sleep on a mattress or on a bed of atmosphere, about the weight and composition of wllich he is eathers, whether the bed should be large or small, and its not concerned to inquire. What we have specially to note is elation to the windows. In a word, they were most par- that the Epicurean philosoplhy, by its close conceutration on ticular about all such things as other physicians passed over the moral life of man, together with its inadequate and mosb nore lightly. superficial way of dealing with physics, helped to promote The school of the Methodists was astonishingly successful, the decidedly crude and superficial way of regarding disease at least in gaining students, partly, no doubt, because their which we have seen to be characteristic of the school of the system could be acquired in a very short time; in fact, it de- Methodists. Wpanded the minimum amount of knowledge, and so it satisfied the natural appetite of the human mind for generalizations, THE PNEUMATISTS. which the Empirical school had done nothing to supply. Thouglh in some ways the least influential and certainly Finally, it occupied an intermediate position between the most short-lived of these post-Hippocratic scllools of ogmatism and Empiricism, appearing to unite the advan- medicine, their very name has a certain fascination about it ves of both schools without the inconvenience of either. which draws one's thoughts to the schools of philosoplhy. 'the philosophy which had most influence upon the school The Pneumatists may be regarded as an offshoot o£ the f the Methodists, and which in fact formed their intellectual Dogmatists, who began to take on this name wlhen the sect background, was that of Epicurus. He was born in the of the Methodists was at its zenith. Physicians wlho did sland of Samos about 342 B.c., some two hundred years later not want to follow the Methodist school embraced that than Pythagoras. At the age of 18 he went to Athens and of Pneumatism so as to have solidly- establislhed principles began life there as a teacher of grammar, until his attention was which they might oppose to the Methodists. For, unlike tlhe Orawn to philosophy, owing, it is said, to the inability of his Methodists, the Pneumatists believed much in dialectic and teachers to explain what Hesiod meant by chaos. At the regarded it as indispensable to the perfection of science. age of 35 he purchased for 80 minae his famous garden in The name " Pneuma" was given by them to what they Athens, and there he taught for the remainder of his life, regarded as an active principle which was tlle determining till his death at the age of 72. Epicurus was one of the most factor of health and disease. Platonic theories had already prolific of Greek writers, and is said to have written some laid the foundation of the doctrine of tllis aerial substance, three hundred volumes. He prided himself on being self- but Aristotle gave the first clear idea of it when he described taught, and boasted that he was entirely independent of all the way in which the pneuma is introduced into the body and his predecessors, yet it is quite obvious that he was largely the circulatory system. indebted to Aristippus and the Cyrenaic school of pleasure Tlle doctrine was still further developed by the Stoics, and on the one hand and the atomic theories of Democritus on they exercised a great influence over tlle Pneumatists and the other. He took no part in political affairs, his maxim so upon the furtlher evolution of medicine. Tlley were of being " to live secluded." The main purpose of the philosophy opinion that the aerial substance passed from th3 lungs into of Epicurus was the moral life; thus, physics were regarded the heart and arteries and was then dissemninated throLughout as merely ancillary to ethics, which were the beginning and the body. Tlle Pneumatists maintained their theories with end of the Epicurean teaching. Thus he regarded philosophy the greatest enthusiasm and pertinacity; Galen says of them as part of the daily business of speech and thouglht witlh that they would rather have betrayed their country than a view to securing a happy life. According to Epicurus it abandoned their doctrines. was not necessarv to have read deeply or thought profoundly; Tlle founder of tllis sclhool was Athenaeus of Attalia in literature and education were often more of a hindrance than Cilicia, who practised in Rome in the reign of Claudius, about otherwise. the middle of tlle first century. In hlis teaching Athenaeus The popular conception of Epicureanism as encouraging an maintained that the Pneuma was the World Soul, the unrestrained luxury is entirely removed from the facts, and is living Self-conscious God, from whom the souls of men, due to our knowledge of his teaching having come down to us animals, and plants proceed, and who was also the creator through the writings of his enemies. A single instance will be and framer of all matter. Its unhindered movement was sufficient to show us the kind of life advocated by Epicurus. in the last resort the cause of all physiological and patlho In writing to a friend he says: " For myself I can be pleased logical happenings. As a Stoic Athenaeus adopted all the with bread and water, yet send me a little cheese in order doctrines of the Peripatetic school, but he developed the that when I want to be extravagant I may be." He is also theory of the elements more or less after the manner of the tesponsible for the saying, " It is more blessed to give than Methodists. to receive." To Epicurus the world presented itself as a It was from this school that there emanated some curious mechanism, and within the limits of this mechanism it was teaching about the pulse at different ages; tllhs, in the new- the busindss of man to arrange his life as well as he could, born the two short syllables of a verse-a short systole and but it was not necessary for him to know' more of this a short diastole; in older persons the pulse is like a trochee, mechanism than that on which his own weal or woe while in still older people the pulse with a long systole and depended. So lona as one realized that everything had long diastole becomes like a spondee. natural causes it mattered little what the causes were. He Far better known than Agathinus was his disciple adopted the atomic theory of Democritus because this Archigenes of Apamea, who practised medicine at Rome in harmonized best with his ethical individualism. the time of Trajan, and enjoyed among his contemporaries a Although the doctrines of Epicurus never took so great a great reputation which endured for several generations. Like hold upon the ancient world as Stoicism, yet his immcdiate the Stoics Archigenes placed the seat of the soul in the heartk disciples adopted and followed his teaching with scrupulous which not unnaturally made the explanation of the sensory ponscientiousness, and they became devoted to their master nervous system a matter of considerable difficulty for him. in a way which has been hardly squalled in ancient or His doctrine of the puIlse was famous in antiquity, and modern times. They are said to have committed his works he described eight different kinds of pulse according to its to memory; they had his portraitX engraved upon rings and size, force, velocity, frequency, fullness, regularity, equality, OF - FEB. --3, 19231- -1 THE POST-HIPPOC-RATIC SCHOOLS MEDICINE. MEDIVAL JOuU8AS a and rhtiythm. Each of tllese species was divided into several According to Zeno tlle world was governed by the same varieties. divine reason which dwells in the breast of each. individual, Archigenes made use of a large number of drugs, mostly of and the universe, animated by this reason, was striving to a mnild variety, preferring mild laxatives to drastic purgatives. realize values which the human reason would appreciate as At thle height of the disease he had recourse to warm fomenta- good if it could but know the wlhole. HumDan reason coincided tions, especially to sponges soaked in warm water, in order with the universal reason whlich governs nature, and this to lubricate the pores and favour coction. He gives an excel- indeed, according to Zeno, was the source of the moral law. lent account of dysentery, wlhicli he attributed to ulceration To establish a plhysical basis for hiis etlhics Zeno went back in the larae intestine, and lhe prescribed for it preparations to Heracleitus and believed tllat all individual things in the of opium and astringents. He further described the signs for world are only oppositions of one and the same tlling, and recognizing an abscess of the liver, and explained its forma- that there is but one law wicil governs the course of nature .tion and termination. With reaard to insanity, Arclhigenes, and ouglht to govern thie actions of man. The ultimately real like most Greek plhysicians, showed remarkable enlighten- was regarded by thle Stoics as corporeal, and spoken of as ment. Seeing the priests of Cybele scampering and flagel- warm vapour or fire, for it is warmtlh whlich begets, enlivens, lating, and cutting themselves after their manner, lhe said, and moves all things. "T'h'ley are insane; do not leave them to tllose bloody gods of Thle essential aim of tlle Stoic physics waas to show that the the East; send them to me." His treatment of the maniac power operating in the universe was rational; Zeno believed was to feed him up and sootlhe hlim witlh music. On the other in a rational process controlling the world. When Zeno said, hand, so little consistent is the mind of man, lie sometimes "God is bodv," he slhowed hiis repugnance to any teaclhing in his treatment had recourse to amuulets aud otlher methlods which wvould dissolve God into an abstract idea; it was the of superstition. crude expression of an intense conviction that God was real, Of the same scljool and about contemporary with was indeed concrete. For the Stoic3 tlle universe was a Arclhigenes was Aretaeus of Cappadocia, to whom we are livina beina, and we should tlherefore regard tlleir doctrine as indebted for some of the best medical writings which have pantheistic rather than materialistic.. Clhrysippus, a successor come down to us from antiquity. In all probability he of Zeno, was of opinion that withiout the study of physics it flourislhed in the second lhalf of the second centurv of our era was not possible to distinguish between good and evil, yet, as and was contemporary witlh Galen. Unlike the Empirics, a matter of fact, the Stoics did not really go very deeply into Metllodiste, and most otlher Pueumatists, lie paid great atten. the question of physics and investigation of nature. tion to anatomy, and hiis kniowledge in tlhis department was As we liave seen in the case of the Epicureans, so too witl .far superior to tlhat of his predecessors; thus he thouglht the the Stoics the free anid purely scientific contemplation of the luing was insensitive, made of sonle substance like wool, pro- world which characterized the old Ionian philosophers had vided with a very small number of nerves, and entirelv devoid disappeared coincidently with thle loss of polibical freedom the rise of the Macedonian and the chief &. muscles. On the otlher lhand, the pleura was endowed with due to hegemony, ,a Ihigli degree of sensibility anid was the seat of the pain in value of philosophy was soughlt more and more in the refuge inflam-mation of tlle clhest, wlhen the patient eixperiences keen with wlhich it provided men against thle miseries of life. The suffering. It was, lhe said, in consequence of the insensibility concentration, tlhen, of Stoicism upon conduct and the moral ,of tlle lung that plhtlhisical patients retained so muchl hopeful- life is perhaps its chief title to fame. It cannot therefore be ness as they approaclhed the enid of their existence. He said that the Pneumatist school of medicine received any credited the lheart witlh far greater patlhological significance great stimulus to the investigation of nature from the Stoic thian any other author, and syncope, of wlhicli lhe gives an phlilosophers, but what it did receive was a belief in a rational .excellent description, lhe considered to be a cardiac affection. principle pervading nature-tllat, indeed, nature is governed Aretacus in hlis dianity, inteatity, and love of his art, was a by rational laws, to wllich it is the business of man to true disciple of Hippocrates. He difTered from Hippocrates accommnodate himself. Suclh a belief was undoubtedly a in thliinking tlhat lthe phlysiciau slhould attend eveni cases of source of stability to thle intellectual life of those physicians incurable disease, thouglh he miglht be able to do nothing but among tlle Pneumatists wlho unconsciouslv followed the Stoic expiess sympatlhy. Next to Hippocrates lie was the best teaching and raised them to a loftier mental standpoint than .observer in antiquity, aud seemns hiimself to hlave seen nearly that occupied by the Empirics and Methodists. all tlhe diseases of whlichl lie gives so c'ear and graphic a In the long run the belief in reason can hardly fail to have description. Lilie Hippocrates, too, lie laid stress on in- a favouirable influence on the progress of medicine, and thlere- dividual differences of conutitution and of climate and on the fore the Stoic plhilosophy offered this indirect help to medi- changes of the seasons. Like the rest of the Pneumatist cine. But Stoicism, in ordinary parlance, calls up tlhe vision school he often derived diseases and their symptoms from of ratlher lhard, unamiable people, indifferent to all outward tthe temperature of the elements; among others, he found in things, careless- alike of the major and minor aesthetics of cold and drvness the causes of old aae and of deatlh-indeed life, and clad in an impenetrable carapace of spiritual pride. lie made various clit onic affections issue from the cold and This picture of the Stoics lhas been drawn by all the world's damp. The liver lie tlhouglht to be the organ assigned by satirists from Horace onwards. Yet it is not a true picture Nature for tlhe preparation of tlle blood, and, like tihe rest of till we come to tlle later phases of Stoicism, when that- the ancients, he made this viscus the seat of desire. philosophy was passing into the unpleasing eccentricities We lhave seen lhow the Dogmatists were influenced by of the monastic ascetic. The earlier Stoics, wvith wlhom we .Plato, the Empirical scliool by the Sceptics, the Metlhodists are more concerned, busied tlhemselves but little with physics by the Epicureans, and now, finally, it was the most fashlion- and the, structure of the external world, but they were not able philosophy of the Roman world-namely, Stoicism- averse from a life of action, thiey maintained an ideal of civic wliclh exercised most influence over the sclhool of tlle virtue, and had not learnt to be indifferent to the welfare of Pneuinatists. The whole idea of tlle Pneuma, at least the the State, even though a somnewhlat abstract cosmopolitanism elaboration of it, was, of course, Stoic in origin. No doubt was teaclhing them to transcend thie limits of nationality. the Hippocratic idea of innate heat was something of the The medical school of Pneumatists seems to me to have same nature, and the same idea in later times may be found been exceptionally free from the taint of cliarlatanism and in the Archaeus of Van Helmont, though that was perliaps to have maintained an etlhical staudard distinctly above the -a more mystical conception, and even indeed in the elan vital average of the profession in their day. Is it unduly fanciful .of Bergson. But the Stoics, like thie Epicureans, were not to imagine that the noble moral grandeur which charac- primarily interested in physics or in theories about the terized the great Stoics, such as Seneca, Marcus Aurelius, 'Cosmos, nor did they have any high opinion of medicine, for and Epictetus, may have instilled itself into the physicians their essential aim was to find some philosoplhic basis for the of the Pneumatic school ? guidance of everydav life-lhow, in fact, life was to be lived and in the unlike the monastic ideal A CONGRESS of French-speaking neurologists and alienists rationally nobly world; in under the *of the Middle Ages, whiclh was rather how life was to be lived will be held at Besangon August presidency ot Dr. Henri Colin. The subjects to be discussed will include out of the world. Zeno, the founder of tlle Stoic sclhool of crimes narcomania, pllilosophy, some three hundred years before the epoch we psycho- analysis, resulting from and nervous trouble resultina from supernumerary ribs. -are now considering had endeavoured to discover for men A SOCIETY has been organized at Copenhagen to endow a way of escape from fear and desire by adjusting their wills Pasteur scholarships for Danish medical men who desire to to everything which might befall them. "I am happy," take courses of study at the Paris Pasteur Institute or at he said, " when I do not want things to be any other than similar institutions in other countries; Dr. S. P. L. Sorensen they are." was elected president of the society.