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VOLUME XIX.
CONTAINING
O--
A comprehenlive Treatife on PATHOLOGY ;
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DESCRIPTION OF THE FRONTISPIECE ILLUSTRATING
PATHOLOGY.
APOTHEOSIS OF HIPPOCRATES.
SEATED IN AN ANTIQUE CAR, DRAWN TOWARDS THE TEMPLE OF IMMORTALITY BY CHIRON AND ANOTHER CENTAUR EQUALLY VERSED IN THE ART OF HEALING,— HIPPOCRATES HOLDS IN HIS RIGHT HAND THE PATERA OF HEALTH, AND IN HIS LEFT THE STAFF AND SERPENT OF jESCULAPIUS, WHOSE DAUGHTER HYGEIA IS REPRESENTED ABOVE,— STREWING MEDICINAL FLOWERS ON THE HEAD OF THE FIRST PATHOLOGIST IN THE WORLD ; WHILST APOLLO, SHOOTING FROM THE CLOUDS 4T THE SERPENT PYTHON, AN EMBLEM OF PESTILENCE, SETS FREE FROM THE CAVERN OF THE MONSTER THE VICTIMS OF DISEASE. DEATH AND THE DEMONS OF LINGERING ANGUISH AND EXCRUCIATING PAIN ARE SEEN FLYING OFF; AND NAUSEATING SICKNESS IS EXEMPLIFIED BY AN EMACIATED FIGURE ON THE FOREGROUND
ENCYCLOPAEDIA LONDINENSIS
OR, AN
UNIVERSAL DICTIONARY
OF
ARTS, SCIENCES, and LITERATURE.
PATHOLOGY.
PATHOL'OGY, f [from the Gr. waOo?, fufFering, and Aoyos, a difcourfe.] The fcience or doitrine of difeafes. — 'This tree may naturally be conceived to have been under fome difeafe indifpofing it to fuch fruftifi- cation. And this, in the pathology of plants, may be the difeafe of fuperfoliation mentioned by Theophraftus. Sir T. Browne’s M if cell.- — That part of medicine which relates to diftempers, with their differences, caufes, and effects incident to the human body.
As Physiology teaches the nature of the fundtions of the living body in a Hate of health; fo Pathology relates to the various derangements of thefe fundtions which conftitute difeafe. Its objedts, therefore, are to afcertain the various fymptoms which charadterife the different diforders of each organ of the body, and efpe- cially the diagnojlic and pathognomonic fymptoms, which afford the means of difcrimination between difeafes that referable each other; to determine the caufes, both pre- difpofing and exciting, by which difeafes are induced ; to point out the prognojis, or the tendency and probable event of each difeafe, from the changes and combination of the fymptoms ; and daftly, to teach the indications of cure, and the nature and operation of the remedies adapted to the various circumftances and periods of difeafe.
The ftudy of pathology prefuppofes an intimate ac¬ quaintance with anatomy and phyf.ology ; or, in other words, with the ftruiture, laws, and operations, of the animal body in a ftate of health. An obfervance of the figns or fymptoms which denote a deviation from this ftate, conftitutes the firft branch of medicine, or J'ympto- matology : an acquaintance with the ufual concatenations obferved by thofe figns, diagnofis. Nqfology regards the arrangement of thefe figns or fymptoms; and atiology ap¬ plies to the cognizance of their caufes, whether external or internal. The application of the properties of inani¬ mate matter to the removal of thefe caufes, or figns, is denominated therapeutics. The fubftances ufed for this latter purpofe are termed materia medica.
Before entering into any further examination of thefe fubjeits, it will be neceffary to give a fiiort Iketch of the hiftory of this art; in the courfe of which it will be feen, that its profeffors have been employed for the moft part in endeavouring to explain the phenomena of difeafe and the operation of remedies according to the principles of fome favourite or faftiionable ftudy. Thus mechanics, che- miftry, and metaphyfics, have each in their turn formed the bafis of celebrated medical theories : theories long fince exploded, but of which the recollection may ferve as beacons to warn us from the like errors. It is not, however, for this purpofe only that the writings of the ancients merit our regard. The perufal of them en¬ larges the field of our experience : we often find in them, Vol. XIX, No. 1283,
remarks which ferve to explain anomalies in difeafe, and defcriptions which their beautiful and forcible language renders more interefting, and imprints more firmly on our minds. They likewife furnifti hints for the further profecution of inquiry, by fliowing the various lights in which the fame circumftances have been viewed by diffe¬ rent men ; and the long chain of fads they difplay to our view enables us in fome meafure to appreciate the effeds of climate, diet, and even manners, on theconfti- tution of our fpecies. It may be remarked moreover, that fcarcely any fyftem of medicine has been framed, however abfurd, which has not contributed, by the fpirit of inveftigation it excited, and by the new flock of fads its eftabliftiment neceffarily developed, to advance the pro- grefs of the art.
RISE and PROGRESS of MEDICINE.
The origin of the medical art is involved in great ob- fcurity : yet, its antiquity is undoubtedly great, fince, from its intimate relation with the life of man, the difco- very of it muft have been coeval with that of the moft fimple mechanical arts.
The little we know of the earlieft hiftory of our race, leads to the fuppofition, thatfurgery was the firft branch of medicine cultivated. While mankind fubfifted prin¬ cipally by hunting or filhing, they muft, of neceffity, have been fubjeded to a variety of accidents ; fradures, luxations, &c. muft have been frequent among them, and to cure or alleviate thofe obvious maladies muft have been their firft care. It is impoflible to conjedure what means were purfued for the attainment of this end, yet, it is natural to fuppofe, they w'ere, fora long period, very in¬ efficient, and that the knowledge acquired in this ftate of fociety was very confined. It is probable, however, that anatomy was not wholly negleded in this barbarous age. The frequent daughter of wild beafts, and the various purpofes of food, raiment, &c. to which their different parts were appropriated, muft have led to a curfory ac¬ quaintance with the ftrudure of thofe animals ; and thus laid the foundation of comparative anatomy, an acquifi- tion by no means ufelefs in chirurgical operations. En¬ gaged, too, in perpetual hoftility, thefavage probably re¬ garded the examination of human bodies with little or none of that horror which has proved fo inimical to the ftudy of anatomy in more civilized times ; and indeed, (if we may judge from the accounts handed to us by the ancients,) he feems to have felt a brutal pleafure in man¬ gling and deforming the perfons of his deceafed enemies. Thus Homer relates of the Greeks over the body of Heitor, that, OvJ’ ago. oi ti; aiwrw ys tcciq soto.
It was in times when more refined habits of life ob¬ tained, and in fituations where gentler purfuits occupied B the
Vs a
2
PATHOLOGY.
the attention of mankind, that the application of reme¬ dies to the cure of internal maladies took its rife. The tending of flocks and herds, which then became a very general employment, mull have induced habits of leifure and contemplation extremely favourable to theacquifition of experimental knowledge : we may fuppofe that the paf- tors obferved the effects of certain plants on their flocks ; and by a natural and eafy tranfition were induced to admi- nifter the fame fubftances in ailments of their own bodies : a fuppolition which the faffs related by Herodotus and others feem to confirm. The above-mentioned author obferves, that Melampus difcovered the melampodium, or black hellebore, to be poffeffed of a purgative property from having obferved its effect on goats which had broufed in paftures where this herb was indigenous and frequent. Again, we are informed, that the firft ufe of enemas was taught mankind by the Ibis, a bird which is reported to have the power of introducing its bill into the anus, and injefting thereby a quantity of water up the inteftines. Pliny likewife mentions a circumftance to which he attributed the introduflion of phlebotomy; viz. that the Hippopotamus has a cuftom, whenever it becomes large and unwieldy, of opening a vein in its leg by means of a (harp reed which grows on the banks of the Nile. The accuracy of the two latter relations may be queftioned ; yet probably they had their origin in fads, though tradition and the lapfe of time had altered or ex¬ aggerated them. However this may be, there can be little doubt, but that in this branch of medicine, as in anatomy, the phenomena difplayed in the brute creation furniflied man with ufeful hints, and contributed, in a few inftances, to introduce medical herbs to his notice. The confideration of the more or lefs falubrious qualities of his own food led to the introduction of certain regimen, or fyftem of diet, which in thefe times, with the occafional ufe of a few Ample cathartics, was probably fufficient for the cure of mod internal complaints ; and thefe obferva- tions, naturally communicated from father to fon, from one generation to another, and eftabliflied by long and multiplied experiments, at length laid the bafis of materia medica and therapeutics. This empirical pradice, how¬ ever, being often found to fail in affording the expeded relief, a minute attention was paid to the concomitant circutnftances under which previous cures had been ef- feded, and they were imitated accordingly. Thus one plant was direded to be gathered in the night, another when the moon was on the wane, See. accompanied with abfurd and fuperflitious incantations.
With refped to the modus operandi of thefe remedies, their firft employers mud have been totally uninformed, in confequence of their ignorance of natural philofophy ; to divine agency therefore they referred the effeds of medicinal herbs, rather than to any innate virtue in the fubftances themfelves. To this agency likewife they af- cribed the occurrence of difeafe, or the reftoration of health ; an idea which appears in feme meafure conneded with that branch of heathen mythology which attributed to every member of the body its guardian genius.
Up to this period every man was more or lefs a phy- fleian, and contributed his individual flock of experience to the general good ; but, when the increafing wants and number of the human race compelled them to adopt the forms of political government, and they eftabliflied the military ruler or chieftain on the one hand, and the prieft, druid, or brahmin, on the other, the pradice of medicine fell exclufively into the hands of thofe who executed the facerdotal fundion. They feized with avidity the exer- cile of an art, the unknown or uncertain origin of which favoured the illufion that it was derived immediately from the gods : an art which, clothed in fuperftition, and ve¬ nerable from its antiquity, lent them increafed influence over the vulgar, and was indeed hardly lefs ufeful for that purpofe than the facred or legiflatorial offices which they likewife affumed. They taught that peftilence or difeafe was inflided by the angel of the enraged gods,
and eafily found means to perfuade the futferers that fuch dire vifitations were only to be removed through the me¬ dium of prieftly interceffion, joined with lacrifices and offerings.
From that paffage in Genefis in which it is faid, that “ Jofeph commanded his fervunts the phyficians to em¬ balm his father,” (Gen. 1. 2.) the writer of the article Medicine in the Encyclopaedia Britannica concludes that the firft phyficians of the Egyptians were not priefts; becaufe, in that age, the Egyptian priefts were in fuch high favour, that they retained their liberty, when, through a public calamity, all the reft of the people were made flaves to the prince. This, however, we do not think a valid objedion; for we cannot doubt that every rank of perfons, priefts as well as others, might, under an abfolute monarchy, be very properly ftyled fervants of the prince, and alfo of his prime minifter.
The fame writer feems more founded in his conjedure that the phyficians of the Jews were originally diftind from their priefts ; for we read that, when king Afa was difeafed in his feet, “ he fought not to the Lord, but to the phyficians.” (2Chron.xvi. 12.) Now, feekingtothe priefts, had they been the phyficians, would have been the fame thing as feeking to the Lord; and hence it is fuppofed, that among the Jews the medical art was looked upon as a mere human invention ; and it was thought that the Deity never cured difeafes by making people acquainted with the virtues of this or that herb, but only by his miraculous power. That the fame opi¬ nion prevailed among the nations who were neighbours to the Jews, is alfo probable from what we read of Aha- ziah king of Judah, who, having fent meffengers to in¬ quire of Baalzebub, god of Ekron, concerning his dif¬ eafe, did not defire any remedy from him or his priefts, but limply to know whether he ffiould recover or not. (2 Kings i. 2.)
We ffiall now quote a few verfes from a book of Scrip¬ ture (Apocrypha), written “ in the latter times, after the people had been led away captive, and called home again, and almoft after all the prophets.” In this book phy¬ ficians are fpoken of with a much greater degree of re- fpeft, but not as if they were priefts. “My foil, in thy ficknefs be not negligent : but pray unto the Lord, and he will make thee whole. Leave oft" from fin, and order thine hands aright, and cleanfe thy heart from all wick- ednefs. Give a fweet favour, and a memorial of fine flour; and make a fat offering. Then give place to the phyfician, for the Lord hath created him : let him not go from thee, for thou haft need of him. There is a time when in their hands there is good fuccefs. For they fhall alfo pray unto the Lord, that he would profper that which they give for eafe and remedy to prolong life. He that finneth before his Maker, let him fall into the hand of the phyjician. Ecclefiafticus xxxviii. 15.
“ What feems moft probable on this fubjeft therefore is, that religion and medicine came to be mixed together only in confequence of that degeneracy into ignorance and fuperftition which took place among all nations. The Egyptians, we know, came at laft to be funk in the moft ridiculous and abfurd fuperftition ; and then, indeed, it is not wonderful that we fliould find theirpriefts com¬ mencing phyficians, and mingling charms, incantations, &c. with their remedies. That this was the cafe, long after the days of Jofeph, we are very certain ; and in¬ deed it feems as natural for ignorance and barbarifm to combine religion with phyfic, as it is for a civilized and enlightened people to keep them feparate. Hence we fee, that among all modern barbarians their priefts or conju¬ rors are their only phyficians.” Ency. Brit. vol. xiii.
However this may be, the union of medicineand religion continued for many centuries; but, whatever difeoveries may have been made, the myftery attendant on moft fa¬ cred inflitutions has prevented communication of them to pofterity. Neverthelefs this union was not perhaps fo prejudical to the interefts of fcience as many have fup¬ pofed.
3
PATHOL O G Y.
pofed. Conftant facrifice and the frequent habit of in- fpeftingthe “ /pirantwexta” of tire victims, matt have ma¬ terially advanced the progrefs of comparative anatomy ; and the written records firlh adopted by the priefts at lead prevented eftablilhed faffs from falling into oblivion, even if further experience in the cure of difeafe was but (lowly attained.
The Egyptians afcribed the invention of medicine to Thoth, ( the Hermes Trifmegiftus of the Greeks,) to whom divine honours were paid ; and they reported that he was the founder of all ufeful knowledge. But there is fome confufion in this account 5 for, on fome occafions, this difcovery was attributed to Ifis or Ofiris, while at other times Apis and Serapis laid claim to the merit of it. It Ihould be recollected, however, that thefe deities werenot like Thoth, mortals who had divine honours paid to them after their deceafe, but embodied or perfonified agents, by means of which the philofophers of the time en¬ deavoured to explain all the laws and operations of matter. They were not likely therefore to be commemorated as the inventors of medicine, although they were undoubt¬ edly invoked as prefiding over health. Athotis, one of the Egyptian kings, left writings on anatomy, a fcience in which the nation could hardly have been deficient, on account of the frequent opportunities they enjoyed of acquiring it while engaged in embalming the bodies of the dead. But the other branches of medicine remained a long time ftationary, fettered by abfurd regulations. In the firft place, the chief-priefts confined themfelves entirely to the exercife of magic rites and prophefies, which they confidered the higher branch of the art, and left the exhibition of remedies to th epajiophori, or image- bearers. Secondly, the priefts of every denomination ■were compelled to follow implicitly the medical precepts of the facred records contained in the fixhermetical books ; for, if they deviated from thefe eftablilhed rules, or intro¬ duced new modes of pra&ice, their temerity was punifhed with death, whether their meafures were fuccefsful or not; thus precluding all idea of improvement. We know very little of the details of their pradtice, as they concealed them with myftic ceremonies ; but that they did not interfere much with the operations of nature may be inferred from a circumftance mentioned by Ariftotle, viz. that they did not adopt adfive treatment till after the fourth day of the difeafe. They had, however, a com- prehenfive fyftem of diet ; for they excluded filh,pork, and fuch other aliments as they confidered injurious to health. They were alfo acquainted with a few valuable remedies, among which may be enumerated fquills, which they ad- miniftered to dropfical patients, and iron, which they ufed as a tonic in cachedlic difeafes ; but they were la¬ mentably deficient in furgery, fince they were unable to cure a common luxation of the foot, which Darius the foil of Hyftafpes met with in hunting.
We pafs briefly over the hiftory of this fcience among the Jews, becaufe we find little recorded on the fubjedt except miraculous cures, which cannot properly be faid to apply to natural medicine. Indeed the Jews feem to have been wholly ignorant of the art of phyfic until their in¬ troduction into Egypt, when they found its principles eftablilhed.
The alleviation of human infirmity, as recorded in Scrip¬ ture, forms a fubjedl rather to exercife the faith of the theologian than to engage the attention of the patho- logift. It is true, Mofes has arranged a code of medi¬ cinal and dietetic maxims, and has defcribed feveral va¬ rieties of leprofy with the minutenefs of a practical phy- fician ; but it does not appear that he attributed much to the virtue of medicines in thofe complaints. Indeed the adminiftration of remedies could hardly feem necef- fary to a people who were informed by a direCt revelation from the Lord, that, if they would diligently hearken unto his voice, and do that which was right in his fight, he would put none of thofe difeafes on them with which
he had afflidfed the Egyptians. To the tribe of Levi was appropriated the adminiftration of the facred remedies. Solomon was celebrated for his knowledge of plants and animals ; and he compofed a treatife on the cure of dif¬ eafes which was deltroyed by Ezekias, left it fliould caufe the facred remedies, rendered more efficacious by the fa- crifices of the priefts, to fall into difufe. Ifaiah the pro¬ phet was likewife famed for medical knowledge : he re- itored Ezekias to life by applying to his wounds cata- plafms of figs. Soon after this period the Jews were dif- perfed in Media and Aflyria, and fubmitted to the yoke of Babylon.
It is fuppofed that medicine was cultivated at a very early period among the Hindoos. Of this there can be little doubt. Whether this people were originally de¬ rived from the Egyptians, or the Egyptians from them, the fimilitude in arts, manners, and religion, clearly in¬ dicates that the one nation arofe from the other. Ac¬ cordingly we find the art (food in former times nearly on the fame footing in Hindooftan as it (food in Egypt. The brahmins held the two offices of priefts and phyficians; and, as among the Egyptians, allotted a few difeafes only to the notice of each individual among themfelves.
In China, the progrefs of this art feems to have fol¬ lowed a retrograde courfe. For this we are at a lofs to account : certain it is, however, that the authority of the Chinefe'on medical fubjeCts was formerly held in much greater eftimation than it isatprefent. Thejefuits have informed us, that the kings of China paid particular at¬ tention to the encouragement of medicine ; and that Eu¬ ropeans were wont to put greater confidence in the phy¬ ficians of this country than in thofe of any other. More¬ over this fcience was taught in their public fchools, in conjunction with aftronomy. Thefe fchools no longer exift : the Chinefe phyficians implicitly follow the direc¬ tions of the medical code of Hoang-Ti, written, as they aflert, 4000 years ago; and their knowledge is fo fmall and inaccurate, that the emperor Cam-hi commanded Parenhi totranflate the anatomical treatife of Dionis in¬ to the Tartarian language.
In Greece, medicine was profecuted with greater ar¬ dour, and its collateral fcience anatomy was inveftigated more fully, than had been the cafe in any country before. The Greeks, like the Egyptians, afcribed the introduc¬ tion of this art to divine revelation: their Apollo and Minerva anfwered to the Ifis and Ofiris of the latter nation ; and Orpheus, the prieft, poet, and phyfician, ufurped the place of Thoth ; and the fable of his bringing his wife Eurydice from Hell probably applies to his fkill in difeafes. But the priority has been given by fome to Me- lampus, who was a phyfician of great celebrity at Pylos. He cured the daughters of Praetos king of Argos, who were afflidfed with leprofy and madnefs ; and he removed like¬ wife the impotence of Iphiclus, by which cure he alfo faved his own life.
The next on record i3 the centaur Chiron, who was preceptor to moll of the warriors and great men of his age, but with the greateft fuccefs to Aifculapius, or Afclepias, a king of Theffaly (and reputed fon of Apollo), who made fo great proficiency, that the fable fays Jupiter was obliged to remove him from the earth to preferve his brother Pluto’s kingdom from depopulation. His fons, Podalirius and Machaon, received from their father the art of healing, which they exereifed with fuccefs at the fiege of Troy, and tranfmitted to their defcendants the Afclepiades. At firft, the Afclepiades promulgated their doCtrines as priefts in the temples of the god of health; but, as fchifms arofe among the different fe&s, each tem¬ ple became in time a diftinCt medical fchool. Thus the fchool of Ceredos and Cos were founded, in which for fome time the defcendants of Asfculapius alone were per¬ mitted to pra&ife : but it was afterwards judged necef- fary to admit a limited number of pupils from other fa¬ milies, who bound themfelves by oath to obferve the
rules
4 PATHOLOGY.
rules of the Afclepiades. From the fchool of Cos arofe Hippocrates, the fourteenth in defcent from Aifculapius.
But the ftudy of medicine was not confined to this fa¬ mily ; it formed part of the education of kings and heroes. Hercules received from Chiron, in earlier times, the ru¬ diments of medicine. Ariftasus, king of Arcadia, was likewife a fcholar of the centaurs : to him we owe the in¬ troduction of the herb Jylphium, fuppofed by fome to be aflafcetida. Jafon, Telamon, Thefeus and Peleus,Ulyfles, Diomed, Hippolytus, and Achilles, were proficients in this art. Achilles is faid indeed to have firft ufed verdi¬ gris for the purpofe of cleaning foul ulcers. But all of them were inferior to the accomplilhed, the injured, Pa- lamedes ; by the excellent rules of diet and exercife to which he fubmitted the foldiers, he prevented the plague from entering the Grecian camp after it had carried its ravages over raoft of the cities of the Hellefpont and even Troy itfelf.
./Efculapiusflouriftied about 50 years before the Trojan war 5 and we have feen that his two Tons diftinguilhed themfelves in that war both by their valour and by their ikill in curing wounds. This indeed is the whole of the medical Ikill attributed to them by Homer ; for, in the plague which broke out in the Grecian camp, l.edoes not mention their being at all confulted. Nay, what is (fill more ftrange, though he fometimes mentions his heroes having their bones broken, he never takes notice of their being reduced or cured by any other than fupernatural means; as in the cafe of ^Eneas, whofe thigh-bone was broken by a Hone call at him by Diomed. The methods which thefe two famous furgeons ufed in curing the wounds of their fellow-foldiers, feems to have been the extracting or cutting out the darts which inflicted them, and applying emollient fomentations orftyptics to them when neceflary : and to thefe they undoubtedly attributed much more virtue than they could poflibly poflefs ; as appears from the following lines, where Homer defcribes Eurypylus as wounded and under the hands of Patroclus, who would certainly praCtife according to the directions of the furgeons of that time :
Patroclus cut the forky fteel away ;
Then in his hand a bitter root he bruis’d,
The wound he walh’d, the llyptic juice infus’d.
The clofing flefli that injtant ceas’d to glow;
The wound to torture, and the blood to flow. Iliad, xi.
The philofophers of Greece, by adapting their fpecula- tions to the elucidation of this fcience, lent it material aid. Pythagoras vifited Egypt and India, collected the therapeutic and dietetic maxims of thofe nations, and in¬ troduced them into his own country: unfortunately, in fo doing, he forgot the difference of climate and habits, .and endeavoured to apply the vegetable regimen too ftriCtly. He attended diligently to the ltudy of the ani¬ mal economy ; and he founded the fchool of Crotona, whence arofe Alcmaeon, an anatomift of great repute. With refpeCt to the knowledge this latter perfonage pof- fefled of the human ftruCture, it admits of doubt ; but his /kill in comparative anatomy is well attefted by Ariftotle, Diogenes, and Plutarch: with him too originated the firft theory of fleep : he fuppofed, that, when the blood flows in the larger veflels only, fleep is induced; but, when it returns in the finaller ones, waking occurs. Empedocles, the diftinguiflied philofopher, was another ornament of the Pythagorean feCt.
Befides thefe philofophers, and the Afclepiades, there were, at this period, other perfons who devoted them¬ felves to the profeflion of phyfic, and who occafionally were remunerated by a fixed falary. Thus Democetes of Crotona was retained at the court of the Samian tyrant Polycrates, with an allowance of two talents yearly : being afterwards taken prifoner, and carried as a flave in- do Perfia, he acquired great repute by curing Darius of a •fprained foot, after the Egyptian phyficians had failed ; iand alfo by his fuccefsful treatment of a tumour of the
breaft, under which Atofia, the daughter of Cyrus, and wife of Darius, had laboured for a confiaerable time. (Herodot. iii. 133.) Such pradlitioners, from their wan¬ dering lives, were fometimes defignated by the name of s-Egio&vrat. Of this clafs, one of. the moll confpicuous was Acron of Agrigentum, the contemporary and rival of Empedocles, refpedting whom Pliny has fallen into a ftrange error, in defcribing him as the founder of the empiric fedt “under the fandtion of Empedocles.” Ac¬ cording to Diogenes, he was the author of fome books on medicine and dietetics, written in the Doric dialed! ; and he fignalized himfelf at Athens, in the time of the great plague, by introducing the pradtice of fumigations, and thus affording relief to many. (Plut. de Ifld. et Ofir.) The gymnafia of ancient Greece feem alfo to have con¬ tributed to the improvement of the art. It belonged to the gymnafiarch, or pulajlrophylux , to regulate the diet of the youths who were trained in thefe feminaries ;_the yt //Avaran were prefumed to be converfant with difeafes; and it was the bufinefs of the ctXtiiflai to perform venefec- tion, to drefs wounds, fradtures, &c. They were fome¬ times called phyficians. It was in thefe feminaries that the gymnaftic fyftem of medicine originated, under the au- fpices of Iccus of Tarentum, and Herodicus of Selymbria.
About this time, and contemporary with Hippocrates, flourilhed Democritus of Abdera, who made the firft public difledtion on record: he applied himfelf to this talk for the purpofe of afcertaining the nature and courfe of the bile; and difledted with fo much afliduity, that the Abderites fufpedted him of infanity, and accordingly fent for Hippocrates (as it is reported) to cure him : but the latter, fo far from finding him mad, difcovered that he was extremely wife, as he exprefles himfelf in a letter to his friend Damagetus.
As we are now arrived at an era in which the hiftory of pathology will afl’ume, as it were, a tangible fliape, we fliall divide our large field of information into three fec- tions ; the firft reaching to the decline of the art during the dark ages ; the fecond from that time to the end of the fixteenth century; and the third, to the prefent time.
I. From the Time of Hippocrates to the dark Ages.
Hippocrates has juftly been ftyled the Father of Me¬ dicine, fince his writings are the moft ancient exprefsly on this fubjedt which have been preferved. His tran- fcendent merit alone would, however, fecure to him that title. He has left behind him uleful hints on almoft every branch of medicine; and has inveftigated fome of them with an exadtnefs which has left us little to defire. On anatomy, though probably he did. not himfelf make dif- fedtions, he has compiled all the information extant in his time ; and his theory of medicine, though long fince exploded, merits, in comparifon with the hypothetical and extravagant notions that had preceded it, much en¬ comium. It was certainly more comprehenfible, and more explanatory of known fadts, than the dodtrine of Pythagoras, which accounted for every thing by the fcience of numbers ; or than that of Empedocles, which referred all phenomena to the agency of an ethereal fpi- rit. It is, however, the practical part of medicine that Hippocrates has fo much elucidated. We difcard his theory of Nature, his concodtions* and infpiflations ; but in his account of difeafes, in the accurate hiftories he has afforded us of figns or fymptoms, their relations and ef- fedts, he Hands unrivalled. His prognojlics, too, have comparatively been little improved in the prefent day : indeed he carried them to fo great a degree of perfedtion, that he and his pupils were regarded by the vulgar as prophets. It ftiould be likewife recorded of him, that he endeavoured to dived the art he profefled of all that myl- teryand fuperftition in which he found it enveloped, and that he gave the firft outline of a fubjedt of great impor¬ tance, medical ethics. His authority has been revered for ages, and his maxims have been received as dogmas, not only in the fchools, but in the courts of law. We need 1 not
PATHOLOGY.
not therefore be furprifed that many men of inferior ce¬ lebrity fhould have endeavoured to render their works popular by afcribing them to this famous phyfician. Ac¬ cordingly we find many writings extant bearing his name, which are evidently fpurious. It fhould be remarked however, that thefe writings are nearly of the fame date as his genuine cOmpofitions, and contain the prevalent doftrines of his time.
The pathology of Hippocrates was founded on the af- fumption, that a principle exifis in the animal, tending to the prefervation of health, and the- removal of difeafe. To this principle, which he denominates Nature, heap- pears to have attributed fome degree of intelligence, and even in one place applies to it the epithet of juji. “ The manner in which Nature adts, or commands her fubfer- vient power to adt, is by attracting what is good and agreeable to each fpecies, and by retaining, preparing, and changing, it ; and on the other fide in rejedting what¬ ever is fuperfluous or hurtful, after fhe has feparated it from the good.” This is the foundation of the dodtrine of depuration, concoction, and criiis, in fevers, fo much infilled upon by Hippocrates and many other phyficians. He fuppofes alfo, that every thing has an inclination to be joined to what agrees with it, and to remove from every thing contrary to it ; and like wife that there is an affinity between the feveral parts of the body, by which they mutually fympathife with each other.
Hippocrates referred the production of mod difeafes to diet and air ; to the former of which he attached fo much importance, that he compofed feveral books concerning it : yet in another part of his works he gives the judicious maxim, that while in health we fhould by no means at¬ tach ourfelves to nice and delicate habits of living, or live with too much regularity; becaufe thofe who have once begun to live by rule, become difordered if they depart in the lead from it. In the choice of fituation with regard to the purity of air, he was particularly care¬ ful ; and noted efpecially the winds, the times of the fol- dices and equinoxes, & c. He likewife took into con- lideration the effects produced by deep, watching, exer- cife, &c. and attached great importance to certain hu¬ mours, particularly blood and bile. His claffification of difeafes was arranged according to the circumdances of their danger, duration, or locality : thus fome difeafes were mortal, dangerous, or curable; others acute or chronic; and again others were divided into endemical, epidemical, and l'poradic. Hereditary difeafes he likewife noticed.
We are obliged to Hippocrates for the remark, that there are certain ftages in every didemper; a point of great practical importance. He generally noticed four; the beginning, the augmentation, the height, and the decline. In mortal difeafes, death took place indead of the decline ; on which account this latter was reckoned by Hippocrates to be worthy of particular in vedigation. He conceived that during this dage a crifis took place ; i. e. that the mortified matter which. produced the difeafe was by fome means feparated from the body ; but this feparation never occurred until the humour was fuffi- ciently concoded ; that is to lay, brought into a fit date for expuifion from the body, by the efforts of Nature. Moreover, this author fuppofed, that, as every fruit has a limited time to ripen in, fo concottion could not be ac- complilbed unlefs within a certain period. He took much pains to edabiilh critical day*, or the times when thefe concoctions and crifes fnculd take place; and he deemed them moll favourable when they occurred on odd days.
In noting the ligns and characters of difeafe, Hippo¬ crates was extremely minute, and that chiefly with a view to foretelling the event of the malady. He obferved the altered appearance of every feature of the face, the com¬ plexion ; the dim, fierce, fparkling, or other exprefiion, of the eyes. He paid attention to the poflure and atti¬ tude of the fufferer •. he remarked the debility which ge¬ nerally attends the continued fupine pofition ; and he noticed the picking of the bed-clothes, the uneafy and
Vol. XIX. No. 1283.
5
tremulous motions, and likewife the fubfultus tendinum, which denote death in patients affected with fevers.
Hippocrates paid particular attention to the refpiration, the different Hates of which affilled him in forming his prognofis. He examined the urine with great care ; but, as his remarks on it chiefly regarded his humoral hypo- thelis, they are now of little intereft. He noticed, how¬ ever, that the crifis of fever was often brought about when the urine became very abundant, and the thick ap¬ pearance of it denoted difeafe of the bladder ; he was in the habit of comparing the appearance of this evacuation with that of the tongue. The faeces too were invelligated, in re¬ lation to their odour, confluence, and colour, by this au¬ thor. But he has recorded more important fails concerning the expectoration which arifes in pulmonary complaints: he fays that, when it is mixed with blood (in chronic cafes), when it is entirely wanting, or when it is fo co¬ pious as to caufe rattling in the throat, it denotes ex¬ treme danger; but that, when it is mixed with puru¬ lent matter, it indicates confumption, and terminates in death. Concerning perfpiration, Hippocrates has re¬ corded the beneficial effects derived from its occurrence in fevers; when it is general, it often produces the crifis : but he has well remarked the danger of cold and partial fweats.
It has been doubted whether this celebrated.phyfician underltood any thing about the pulfe. It has been fup¬ pofed that the paffages found in his works apply only to the pulfation which is feit in an inflamed part. But his knowledge mull have extended further than this on the fubjedt; becaufe he talks of flow and tremulous pulfes; and in his Coucce Pranotionrs he remarks, that the feniible pulfation of the artery in the elbow indicates delirium, or the prelenceof violent anger.
Exercife was not neglected by Hippocrates; but he jullly blames his preceptor Herodicus for recommending it to thofe afflidled with fevers or inflammatory affedlions. Indeed the latter phyfician was fo fond of gymnaftics, that he made his patients walk from Athens to Megara, a diftance of twenty-five miles, and return as foon as they had touched the walls of the city. Yet Hippocrates juflly appreciated the advantage of exercife in chronic difeafes; and even tells 11s that “ we mull fometimes pufh the timorous out of bed, and roufe up the lazy.”
Hippocrates gave many general rules of importance in regard to the ellablilhment of health, among which are the importantones of keeping up, in molt cafes, a regular difcharge; to deplete the plethoric by low living, and to avoid fudden expofure to increafed or diminiffied tempe¬ rature.
The therapeutical maxims of Hippocrates were few and Ample, and all founded on his theory of Nature cu¬ ring difeafes ; infomuch that all that could be done was to remove fuch things as were injurious to the agency of that principle, or to affiil it in its operations when it was deficient. He alferted, in the firft place, “That con¬ traries, or oppofltes, are the remedies for each other;” and this maxim he explains by an aphorifm ; in which he fays, that evacuations cure thofe dillempers which come from repletion, and repletion thofe that are caufed by evacuation : fo heat is deflroyed by cold, and cold by heat, & c. In thelecond place, he alferted that phyfic is an ad¬ dition of what is wanting, and a fubtr.idlion or retrench¬ ment of what is fuperfluous : an axiom which is thus ex¬ plained, that there are fome juices or humours, which in particular cafes ought to be evacuated, or driven out of the body, or dried up ; and fome others which ought to be reftored to the body, or caufed to be produced there again. As to the method to be taken for this addition or retrenchment, he gives this general caution, “That you ought to be careful how you fill up, or evacuate, all at once, or too quickly, or too much ; and that it is equally dangerous to heat or cool again on a fudden ; or, rather, you ought not to do it : every thing that runs to an excels being an enemy to nature.” In the fourth place, he allowed that we ought fometimes to C dilate.
G
PATHOLOGY.
dilate, and fometimes to lock up ; to dilate, or open the paftages by which the humours are voided naturally, when they are not fufficiently opened, or when they are clofed ; and, on the contrary, to lock up or ilraiten the paftages that are relaxed, when the juices that pafs there ought not to pafs, or when they pafs in too great quantity. He adds, that we ought fometimes to linooth, and fometimes to make rough ; fometimes to harden, and fometimes to fatten again; fometimes to make more fine or fupple; fometimes to thicken ; fome¬ times to roufe up, and at other times to ftupify or take away the fenfe ; all in relation to the folid parts of the body, or to the humours. He gives alfo this farther lef- fon, That we ought to have regard to thecourfe the hu¬ mours take, from whence they come and whither they go; and in confequence of that, when they go where they ought not, that we make them take a turn-about, or carry them another way, almoft like the turning the courfe of a river; or, upon other occafions, that we en¬ deavour, if poffibie, to recaj, or make the fame humours return back again ; drawing upward fuch as have a ten¬ dency downward, and drawing downward fuch as tend upward. We ought alfo to carry off, by con venient ways, that which is necelfary to be carried off; and not let the humours once evacuated, enter into the veffels again. Hippocrates giVes alfo the following inftruflion ; “ That, when we do any thing according to reafon, though the fuccefs be not anfwerable, we ought not eafily, or too haftily, to alter the manner of afliug, as long as the rea- fons for it are yet good.” But, as this maxim might fometimes prove deceitful, he gives the following as a cor¬ rector to it : “We ought (fays he) to mind with a great deal of attention what gives eafe, and what creates pain ; what is eafily fupported, and what cannot be endured. We ought not to do any thing raflily ; but ought often to paufe, or wait, without doing any thing: by this way, if you do the patient no good, you will at ieaft do him no hurt.”
Thefe are the principal and moll general maxims of the pradtice of Hippocrates, and which proceed upon the iuppontion laid down at the beginning, viz. that Nature cures difeafes. We next proceed to confider particularly the remedies employed by him, which will ferve to give us further inftruflions concerning his practice.
Diet was the firft, the principal, and often the only, re¬ medy made life of by this great phyfician to anfwer moll of the intentions above mentioned; by means of it he oppofed the moift to dry, hot to cold, See. and what he looked upon to be the mod confiderable point was, that thus he fupported Nature, and affifted her to overcome the malady. The dietetic part of medicine was fo much the invention of Hippocrates himfelf, that he was very de- firous to be accounted the author of it ; and, the better to make it appear that it was a new remedy in his days, lie fays exprefsly, that the ancients had written almoft no¬ thing concerning the diet of the fick, having omitted this point, though it was one of the mod ed'ential parts of the art.
There were many difeafes for which he judged the bath was a proper remedy ; and lie takes notice of all the cir- cumdances that are necelfary in order to caufe t lie pa¬ tient to receive benefit from it, among which the follow¬ ing are the principal. The patient that bathes himfelf mud remain dill and quiet in his place, without fpeaking, while the adidants throw water over his head or are wiping him dry; for which lad purpofe he defired them to keep fponges, indead of that indrument called by the ancients Jtrigil, which ferved to rub od’ from the fkin the dirt and nadinefs left upon it by the unguents and oils with which they anointed themfelves. He mud alfo take care not to catch cold; and mud not bathe immediately after eating or drinking, nor eat or drink immediately after coming out of the bath. Regard mud alfo be had whether the patient has been accudomed to bathe while in health, and whether he has been benefited or hurt by it.
Ladly, he mud abdain from the bath when the body is too open, or too codive, or when he is too weak ; or if he has an inclination to vomit, a great lofs of appetite, or bleeds at the nofe.
When he found that diet, exercife, and bathing, were not fufficient to Vale nature of a burden of corrupted hu¬ mours, he was obliged to make ufe of other means ; of which vomiting, bleeding, and purging, were the chief.
Vomits were a favourite remedy with Hippocrates. He preferibed them to people in health, by way of preventa- tives, direfling them to be taken once or twice a-month in the winter and the fpring. The mod fimple of thefe was a decoftion of hyfl'op, with the addition of a littie vinegar and fait. With regard to the fick, he fometimes advifed them to the fame, when his intentions were only to cleanfe the domach. But, when he had a mind to re- cal the humours, as lie termed it, from the in mod recedes of tiie body, he made ufe of brifker remedies. Among thefe was white hellebore; and this indeed he mod fre¬ quently ufed to excite vomiting. He gave this root par¬ ticularly to melancholy and mad people; and from the great ufe made of it in thefe cafes by Hippocrates and other ancient phyficians, the phrafe, to have need of helle¬ bore, became a proverbial exprefiion for being out of one’s fenfes. He gave it alfo in deduxions, which come, accor¬ ding to him, from the brain, and throw themfeives on the nodrils or ears, or fill the mouth with faliva, or that caufe dubborn pains in the head, and a wearinefs or an extra¬ ordinary lieavinefs, or a weaknefs of the knees, or a fwel- ling all over the body. He gave it to confumptive per- ions in broth of lentils, to fuch as were afflicted with the dropfy called leucnphlegmatia, and in other chronical dif- orders. But we do not find that he made ufe of it in acute didempers, except in the cholera morbus, where he fays he preferibed it with benefit. Some took this medi¬ cine fading; but mod took it after fupper, as was com¬ monly praftifed with regard to vomits taken by way of prevention. The reafon why he gave this medicine mod commonly after eating was, that by mixing with the ali¬ ment, its acrimony might be fomewhat abated, and it might operate with lefs violence on the membranes of the domach.
In the didemper called empyema (ora colleftion of mat¬ ter in the bread), he made ufe of a very rough medicine. He commanded the patient to draw in his tongue as much as he was able; and, when that was done, he endea¬ voured to put into the hollow of the lungs a liquor that- irritated the part, which, railing a violent cough, forced the lungs to difeharge the purulent matter contained in them. The materials that he ufed for this purpofe were of different forts; fometimes he took the root of arum, which he ordered to be boiled with a little fait in a fuffi- cient quantity of water and oil ; difl'olving a little honey in it. At other times, when he intended to purge more drongly, he took the flowers of copper and hellebore; after that he (hook the patient violently by the fhoulders, the better to loofen the pus. This remedy, according to Galen, he received from the Cnidian phyficians ; and it has never been ufed by fucceeding ones, probably be- caufe the patients could not fuller it.
Blood-letting was another method of evacuation pretty much ufed by Hippocrates; and in inflammatory affec¬ tions he praflifed it in a large and decided manner; for he fometimes opened the veins of both arms, and kept them running till the patient fainted. The principal maladies in which he had recourfe to bleeding were in¬ flammations of the liver, fpleen, lungs, or other vifeera ; quinfy, pleurify, and pain in the head; but in fome in- liances of chronic difeafe, as dropfy and jaundice, he likewife performed this operation. In fevers he difap- proved of venefeflion, becaufe he conceived thofe difeafes were produced by certain humours which could not be expelled by that means : it muff, however, be underftood, that he did not extend this rule to fymptomatic fevers, but rather to thofe which were not preceded by figns of
local
PATHOLOGY.
local inflammation. Indeed, in his writings, the term fever is only applied to that clafs which we call idiopathic ; and there feems good reafon to fuppofe, that, in the com¬ mencement of a fever ariling out of vilceral inflammation, he bled very copioufly. He likewife performed cupping ■with fcarificators ; and occafionally ufed the femicupium, which he fuppofed would draw the humours from the affeCted part by means of aUrudiion.
As molt of the purgatives in ufe in the time of Hip¬ pocrates were very violent in their operation, often pro¬ ducing ficknefs, he prefcribed them with great caution. He did not give them to pregnant women, old people, or children ; nor during the dog-days. He ufed them more frequently in chronic than acute difeafes, and chiefly with a view to the expulfion of fome particular humour; to each of thel'e humours he applied a leparate kind of pur¬ gative ; hence the diltinCtion of thofe fubftances into hy- d-ragogues, cholagogues, &c. now juflly exploded. Hip¬ pocrates likewife ufed errhines, which he laid relieved pain in the head by drawing the phlegm from the brain; i'udoriflcs and diuretics, which were likewife for the pur- pofe of evacuating fome peccant humour, and narcotics, or, as he called them, hypnotics, to produce fleep. But of thefe laft he was very lparing. To medicines which ex¬ perience had proved to be efficacious, but of which the operation was inexplicable by this humoral pathology, he applied the term Jpecifics. He ufed fomentations, in which different herbs were boiled, either by direCt application or in the form of vapour. Nor did he neglect cataplafms, ointments, cauftics, and collyria ; all of which he pre¬ pared himfelf, or caufed to be made by his fervants un¬ der his own immediate infpeCtion. The pharmaceutical diftinCtions of medicines into mixtures, powders, and pills, were obferved in this time, and likewife fomething analogous to our lozenge was ufed ; it was called a lum- lative, was of a foft confidence, and was retained in the patient’s mouth until flowly diffolved. The practice of Hippocrates was beneficial to himfelf; for it is generally underftood that he reached the age of a hundred years, and died about 360 years before the birth of Chrift.
Soon after the death of Hippocrates, the profeffors of medicine became divided into two feCts ; the Dogmatifts and the Empirics.
The feed of the Dogmatists was founded by Theffalus and Draco the fons, and Polybus the fon-in-law, of Hip¬ pocrates. Their leading tenets are recorded in the book “On the Nature of Man,” which has falfely been attri¬ buted to Hippocrates. Ariftotle conjedtures that it was written by Polybus. The Dogmatilts were fometimes coiled logici, or logicians, from their ufing the rules of logic and reafon in the fubjedts of their profeflion. They fet out with the rule, that, “when experience fails, rea¬ fon mayfuffice.” Unfortunately, however, they took lit¬ tle pains to confult experience, but were perpetually oc¬ cupied with endeavouring to trace difeafe to its fecret and remote caufes.
The fyftem of the Empirics, as the term imports, was founded altogether upon experience-, and thofe who be¬ longed to this fedt have remarked, that there are three modes by which we learn, from experience, to diltinguith what is advantageous and what is prejudicial, in regard to our health. 1. The firlt of thefe, and the molt Ample, arifes from accident. A perfon, for example, having a violent pain in the head,' happens to fall, and divides a veffel in the forehead ; and it is obferved that, having loll blood, his pain is relieved, Under the fame mode, they include the experience which is acquired by obfer- ving the fpontaneous operations of the conftitution, where no remedy has been applied, as in the following cafe : a perfon labouring under a fever, finds his difeafe mitigated, after a hemorrhagy from the nofe, a profufe perfpiration, or a diarrhoea. 2. The fecond mode of gaining experience is, that in which fomething is done by deftgn , with a view to afeertain what will be the fuccels of it; as, for inftance, when a perfon, having been bitten
?
by a ferpent, or other venomous creature, applies to the bite the firft herb that he finds ; or when a mart' attempts to alleviate the fymptoms of an acute and burning fever, by drinking as copioufly as he is able of cold water ; or when a perfon tries a remedy, fuggefted tohimby a dream, as was frequently done in heathenilh times. 3. The third mode of experimenting is, that which the empirics termed imitative; W'hicb is purfued in cafes, when, after having remarked the e fleets refulting from accident, or the fpontaneous aCtions of the fyftem, on the one hand, or from dejign on the other, we make an attempt to ac- complilh afimilar refult by imitating that which u!as done on thofe occafions.
This laft fort of experience, they contend, is that which peculiarly conftitutes the art of medicine, when it lias been frequently repeated. They call that obj'ervation (r'/5p7j(7K,) or autopfia, (avr ottcicc,) which each individual fees himfelf ; and ufe the term hijlory or record, (i{Topi:t,) for fuch obfervation, when committed to writing; that is, the autopfia , or perfonal experience, confifts of the obfer- vations which each perfon has made, by his attention to the progrefs of a difeafe, whether in regard to its fymp¬ toms and changes, or to the remedies employed ; while the record is a fort of narration or regifter of all that was obferved by thofe individuals ; which regifter being com¬ pleted, (i. e. including all the difeafes incident to man¬ kind, and the remedies adminiftered for their alleviation, ) the art of medicine w'ould be eftabliflied with a confider- able degree of certainty. But, as new difeafes fometimes occur, in regard to which neither our perfonal experience, nor the obfervations of others, can furnilh us with any afliftance; and we meet with diforders in particular fitua- tions, where the means of relief, fanCtioned by experience elfewhere, are not within our reach ; we mull neceffariiy have recourfe to fome other expedient in order to allevi¬ ate the bufferings of the patient. The empirics were pro¬ vided againfl this particular difficulty, in what they termed a J'ubjiitution of fimilar means, ( tranjltus ad fimile , as the Latins have tranflated it.) This was a new experi¬ ment, which they inftituted, after having compared one difeafe with another ; or one part of the body with ano¬ ther, of fimilar ftruCture; or, lartly, one remedy, the na¬ ture of which was afeertained by experiment, with ano¬ ther which refembled it. “ They tried, for example, in herpetic eruptions the remedies which had relieved eryji- pelus ; and, in the difeafes of the arms, they employed the expedients which had been praCtifed in thofe of the /egs ; &c. & c.” Obfervation, then, record, and the j'ubjiitution of fimilar means, were the three fundamental refources of the art of medicine, according to the empirics: and thefe were denominated, by Glaucias and others, “ the tripod of medicine.”
There is obvioufly a great deal of good fenfe and found philofophy in this doctrine of empincifm. It points out the true mode of invelfigating the phenomena of nature by unwearied experiment; the mode which Bacon la¬ boured to inculcate, which Newton fuccefsfully purfued, and which has led the philofophers of later times to the development of that fund of natural knowledge in the fciences of electricity, chemiltry, mechanical, and every branch of natural, philolophy, by which modern inquiry is diftinguifhed. Compared with this fpecies of invefti- gation, how futile are the lpeculations, mifnamed philo- lophy in the fchools, relative to elements and ellences, which had no exiftence except in the imagination of the difputants.
At firft much rancour and animofity fubfifted between thefe two parties ; but, in procefs of time, their practice was found to coincide in many material points; for, though the dogmatifts were much addicted to hypothefis, they could not fail to make clinical obfervations when en¬ gaged in practice; and the empirics did not entirely con- tine tliemlelves to their profeffed mode of acquiring know¬ ledge, but occafionally indulged in that paflion for the¬ ory and generalization which is fo common in a philofa-
phic.
8
PATHOLOGY.
phic age. It is evident, then, that both the dogmatic and empiric phyficians appealed to experience, and that nei¬ ther excluded altogether the dictates of reafon and re¬ flexion. The principal difference in their tenets appears to have confided in this : that the empirics real'oned only from the facts afcertained by obfervation, without at¬ tempting to explain their effential and infcrutable nature by hypothefesj and that the latter fpeculated upon the mode and nature of every phenomenon in the animal body, and took thefe fpeculations as the bafis of their reafoning: an error in the inveftigation of nature, which, as we have before faid, was fo well expofed by lord Bacon in modern times; and which was practically illuf- trated in the triumph of Newton’s empirical doXrines, over the dogmatical hypothefes of Des Cartes.
The empirical feX had not enjoyed great influence or diffemination till Serapion of Alexandria, in the year be¬ fore Chrift 280, took up and defended their doXrines with great fpirit : hence fome have called him the foun¬ der of the feX. His works are loft; hut what has been tranfmitted of his opinion by other authors, tends to prove that he followed the praXice of Hippocrates with great fidelity, though he feverely criticifed his reafon- ings.
It is chiefly to the induftry of the ancient empirics that we are indebted for the introduction, or rather for the full knowledge, of fedative and n'arcotic remedies; on the liberal ufe of which probably depended the l'upe- rior reputation acquired by fome of them over their more cautious antagonifts. Of this fuperiority, a lingular in- ftance occurs in the many exifting teftimonies to the fame of Heraclides of Tarentum. Celfus Aurelianus calls him “Empiricorum Princeps;” and Galen fpeaks of him in very high terms. He fo far deviated from the praCiice of the flriCt empirics, that he fearched after the caufes of difeafe with almoft as much pertinacity as the dogmatifts; by no means however negleCting the practical obferva- tions which were taught in the empirical fchool. This union of theory and praCtice led him to many ufeful refults, more particularly in refpeCt to acute and dangerous difeafes, his treatment of which appears to have been extremely judicious. He feems to have made a more liberal ufe of aCtive medicaments, efpecially of the narcotic clafs, than his predeceflbrs, having been the firft to introduce opium into ufe as a medicine-; and was very induftrious in his inveftigation of animal, vegetable, and mineral, fubftances, with a view to enrich the catalogue of the materia medica. To the books Which he wrote upon this fubjeX, he gave the name of the individuals to whom he dedicated them, according to Galen; entitling one “Aftydamas,” and another “ Antiochis.” He likewife wrote on the fubjeX of diet, and the regimen to he obferved in difeafes, in which abftinence feems to have been pufhed to a great extent.
It is eafy to fee, however, that the direXion of medical inquiry, given by the empirical phyficians, to the difeo- Very of the qualities of medicinal fubftances, or drugs, would in all probability lead to many abufes and evils. Experiment of this fort being much eafier, at lealt when careiefsly made, than that unremitting and accurate ob¬ fervation of the phenomena of difeafes which alone can conftitute the fcientific phyfician, the ignorant and idle would content themfelves with pharmaceutic experi¬ ments, and negleCf the talk of pathological inveftigation ; and fejfilh craft and dilhonefty would loon learn toimpofe on the credulity of the people, in the adminiftration of fe£ ret remedies, when the ufe of a particular drug, and not the general treatment of a difeafe, was fuppofed to be the efler.ee of medicine. Hence it actually happened, even in the early ages of phyfic, that thefe ignorant and illiberal pretenders to panaceas, and infallible remedies, who did not know one difeafe from another by its l'ymp- tonis, appeared in Egypt, Greece, and Arabia, and were much complained of by their more rational contempora¬ ries. In all fucceeding ages, the race of thefe illiterate
pretenders has been multiplied, under the abufed name of empirics, by which we now underftand thofe perfons who fell or adminifter a particular drug, or compound, as a remedy for a given diforder, without any confidera- tion as to the variations of that diforder, in its different ftages, or degrees of violence, or as it occurs in different conllitutions, climates, or feafons, or in perfons of dif¬ ferent age, fex, ftrength, &c. Such a practice implies a total ignorance of the nature of the human conftitu- tion, both in health and difeafe ; and therefore is ge¬ nerally found to be the refort of the illiterate and felfifli, not to fay difhoneff, part of mankind.
After the death of Heraclides, the ftudy of the materia medica took a new direXion, in confequence of the at¬ tention that was paid to the fubjeX of poifons and their antidotes, by the kings of Pergamus and Pontus. The antidote which was invented by the latter is well known, though its efficacy has never been proved. Even Sere- nus, who is in general fufnciently credulous, feems to have had no very high opinion of its virtues :
Antidofus vero multis Mithridatica fertur Confociata modis, fed Magnus ferinia regis Cum caperet viXor, viiem deprehendit in illis Synthefin, et vulgata fatis medicamina rifit.
Nicander of Colophon, who was the contemporary of Attalus king of Pergamus, acquired great fame as a grammarian, a poet, and a phyfician. He endeavoured with the vvorft fuccefs to clothe medicine in flowing num¬ bers? Kis only pieces extant are the Alexipharmica and Theriaca, which contain obfervations concerning poifon and their antidotes, which (as we have faid) became a very favourite purfuit about his time. See Nicander, vol. xvii. p. 45.
■ At the time that the fons of Hippocrates founded the dogmatic feX ; Eudoxus of Cnidos framed a lylleni of medicine founded on the philofophy of Pythagoras, and the praXice of the Egyptians. It was therefore princi¬ pally direXed to the dietetic part of medicine. He was followed by his pupil Chryfippus, of wliofe praifice we have nothing memorable to relate, but that he regarded cabbage as a very important remedy, and was very averfe to the operation of bleeding or the exhibition of purga¬ tives. He was the preceptor of the renowned Erafiftratus. Diocles of Caryflus was about this period a praXitioner of repute ; though placed by the Biographia Literaria as low as A. D. 500. an error of 800 years ! Pie applied himfelf to comparative anatomy with fome fuccefs, and invented an inftrument, which was called after him Dlo- cleus graphifeus, for the extraXion of arrow-heads. His contemporary Praxagoras rendered important fervices to medicine ; he firft difeovered the difference between arte¬ ries and veins, deferibed the cotyledons of the human uterus, and explained the phenomenon of the pulfe, a fubjeX which had been very imperfedfiy underftood by Elippocrates himfelf. It is remarked, however, by Galen, that his information was not fo correX, but that he in¬ volved himfelf in many difputes and contradiXionS. This phyfician was very fond of emetics : he adminiftered them in the iliac paflion, and in dofes fo large and fo fre¬ quently repeated, that the ftoois were ejeXed by the mouth. His furgical treatment of the fame difeafe ihows him to have been a bold and fkilful operator: Aurelian fays, that he direXs an incifion to be made through the belly and inteftines, the indurated feces to be removed, and the bowels then fowed up.
The progrefs of this art now became advanced by the labours of men not exaXly interefted in its praXice. Ariftotle, who, from the unbounded liberality of his pa¬ tron Alexander, poffefled opportunities of difleXing ani¬ mals on a moft extended fcale, acquired a.mafs of infor¬ mation which we read with inftruXion and admiration even in the prefent age. Nor were his metaphyfical doc¬ trines without their influence on the philofophy of me¬ dicine ; they continued to influence it (fometimes un¬ favourably)
4 ■
9
PATHOLOGY.
favourably) for ages. The beautiful fyftem of ethics, likewife, to which Zeno and Epicurus gave birth, were not developed without a fubfequent change in this fci- ence. The tenets of Epicurus and Pyrrho were adopted by the empirical fedft, while the dogmatifts attached themfelves to the ftoical fyftem, particularly the dietetic method. For, we mull remark, that, foreign as thefe fubje&s may appear. to the pradlice of phyfic, yet its higher branches cannot be fuccefsfully ftudied without occafional reference to every branch of phiiofophy, whe¬ ther moral or phyfical.
The eftabliftmient of the Alexandrian School forms an important epoch in the hiftory of medicine. But we have to regret that the deftru&ion of its fplendid library, by the hands of barbarous conquerors, has left us little to relate concerning its doftrines or its practice. We have little hefitation, however, in faying, that the advancement of medicine muft have been very great in a fituation where it derived aftiftance from long cultivation of its principles in Greece, Egypt, and India, a fituation too where fcience in general was patronifed with fo much earneftnefs by illuftrious kings. Moreover this city of Alexandria, on account of the connexion it held with all the world as a commercial emporium, muft have been frequently vilited by foreigners whole diet, clothing, ha¬ bits of life, not to mention a free communication of their own medical rules, muft have ill uftrated the fpeculations of the Alexandrian phyficians in a very luminous manner. The long feries of fafts collefted by the Egyptian priefts was here treafured up; the obfervations of the Hebrews, who, long difperfed over the plains of Aflyria and Media, had united their own medical doctrines with the tenets of Zoroafter and Ham, were examined; while the Greeks, uniting the ufeful part of this defullory and obfcure in¬ formation with the found practice of their anceftor Hip¬ pocrates, with the anatomical knowledge they were ra¬ pidly acquiring, and with their own profound phiiofophy, advanced the progrefs of the healing art in an unexampled manner.
Erafiftratus and Herophilus were the firft phyficians of note in this fchool. The former flourifhed about the time of Seleucus, B. C. 270. His attention was directed for the inoft part to furgery and anatomy; but, that his medical tact was of no mean defcription, we have ample proof in the ftory told of his difcovering the love of Antiochus for Stratonice, whom Seleucus his father had then lately married. He made this dil'covery from ob- ferving, that the colour of the prince changed, and his pulfe quickened, when Stratonice entered the room, and that no fuch effects followed the prefence of any other woman. Erafiftratus was likewife confirmed in this opinion, becaufe he was unable to trace elfewhere the caufe of the prince’s extreme illnefs ; for it fhould be re¬ marked, that Erafiftratus held the lame opinion as the dogmatifts, that a difeafe could not be cured without a knowledge of its caufe. The fame incident likewife Ihows the high rank which the phyficians held in thofe days ; fince, by the influence of Erafiftratus, Seleucus was perfuaded not only to give up his wife, but alfo part of his kingdom, to Antiochus.
Erafiftratus fuppofed that inflammation was produced by the coagulation of blood in the fmall arterial veflels. In his practice he was fond of Ample remedies, more efpe- cially of J'uccory ; and he even delcended to defcribe the beft mode of boiling it. He taught that medicines did not operate on the bowels by attraction, as had been fuppofed ; and that the humours which they difcharged were not the lame in the body as they appeared after their evacuation, but were altered by the adtion of thofe remedies. To purging, however, he had an objedlion, and fupplied the want of it by clyfters. Emetics were frequently prefcribed by him ; and he recommended abltinence in a great de¬ gree. Venefedtion he difapproved of for fome very fool- ilh reafons ; among which, it may be fuflicient to mention, ift. That we cannot fee the vein; 2dly. That we may
Vol. XIX. No. 1283.
cut the artery ; 3dly. That we do not knowhow much to take. His attachment to his theory of inflammation was the principal theory, however, why he objedted to bleed¬ ing, becaufe it did not appear to him, that the abftradtion of blood was likely to relieve the coagulation of that fluid in its veflels.
Some very barbarous adds are related of this phyfician ; for inltance, that he fometimes cut open the bodies of pa¬ tients afflidted with complaints of the liver, and applied remedies immediately to the fubftance of that organ. Yet he objedted to the operation of parucentefis, or tap¬ ping, becaufe he conceived that, the water being evacu¬ ated, the furrounding vifcera would prefs upon the liver, and produce fatal confequences. He had a notion, that death changed the ftrudture of the body, as well as^the relation of its parts. In this opinion he was ftrongly fup- ported by Herophilus; and we turn with horror from the contemplation of 600 victims whom thefe barbarians are reported to have difiedted alive, and blulh that fuch a re¬ cord fhould be found in th.e annals of medicine. Yet the refined Celfus, after enumerating the advantages which accrued from this atrocious deed, excufes the cruelty of it by obferving, that “It cannot be juftly deemed cruel to put a few guilty individuals to torture, with a view to afcertain means of relief for all the innocent among man¬ kind in all fucceeding ages.”
Herophilus added, to the anatomical refearches in which he aflifted his contemporary, an intimate acquain¬ tance with pharmacy. He made ufe of a great number of medicines, both Ample and compound. In his works, we find the firft mention of a difeafe which he calls palfy of the heart ; it produced fudden death, and it has been fup¬ pofed that this muft anfwer to what we now call angina pedoris.
About this period, according to Celfus, the practition¬ ers of medicine w'ere formed into three divifions: 1. Thofe who attended to diet, regimen, and domeftic ma¬ nagement, who were particularly careful to diftinguifh the caufes and fymptoms of difeafes, and were of the firft rank. 2dly. Thofe who adminiftered remedies, in the preparation of which they affeCted to be particularly care¬ ful. And, laftly, thofe who performed the operations of furgery. Anterior to this time, the preparation of medi¬ cine among the Greek phyficians was entrufted to their or ftudents, as well as the chirurgical depart¬ ment, though the latter was often executed by the phy¬ ficians themfelves. The combination of the three branches continued, however, for ages, in a few inftances, among the Greeks, the Romans, and the Arabians.
The Romans, as Pliny affures us, had continued without phyficians, if not without phyfic, during a period of 600 years. The few manual operations which W'ere found indifpenfably necefiary were performed by their Haves or freedmen ; and inftances are not wanting, in which their ficill was rewarded by the honour of citizen- fh ip. On the occafion of a deftruClive epidemic, in the year 463 A.U.C. however, they fent a deputation to the temple of ZEfculapius at Epidaurus. Inftead of an oracle, they received one of the facred ferpents ; and, following the indication of its fpringing from the fhip upon theifland of the Tiber, they there founded a temple to the god of medicine, and eftablifhed his worfhip on the fame footing as at Epidaurus. Shortly afterwards, a temple was dedi¬ cated to the Grecian Hygeia, and the worfhip-of Ifis and Serapis was borrowed from the Egyptians : but, befides thefe, the Romans afterwards ereCted fanes in honour of medical deities peculiar to themfelves. A prevalent dread of certain maladies caufed them to offer up prayers to the deities who were fuppofed to inflict them. Hence they worftiipped Febris on the Palatine Mount, and Mephitis at Cremona. They had likewife a goddefs Offipaga, who prefided over the growth of bones, and Carna, who took care of the vifcera, and to whom they offered bacon and bean-broth, as being nutritious articles of diet. The firft perfon who praftifed medicine at Rome in a regular man-
D ner.
10
PATHOLOGY.
ner, was one Archagathus, a Greek, B. C. 219. The Roman fenate at firft Teemed to give him much encou¬ ragement, and even bought a (hop Tor him, and prefented him with the freedom of the city. But his frequent ufe of the knife, and of the adtual cautery, Toon brought him into difrepute. The populace were loud in their clamours againlt his cruelty, attached to him the name of Carriifex, Butcher, and eventually baniflied him from Rome.
Afclepiades, of Prufa in Byth.ynia, was the next phy.fi- cian of note who appeared at Rome after Archagathus, hut feparated from him “ longo intervallo.” He had ftudied at Alexandriaand Athens, and came toRome,in the 654th year A.U.C. or 100 years before the Chriltian era, as a teacher of rhetoric: but, not finding that profeflion fufficiently lucrative, he fuddenly turned phyfician ; and, by his confummate addrefs, in a fhort time brought him- Telf into great notice. The prototype of all fucceeding quacks, Afclepiades affefted to contemn every thing that had been done before him — “ omnia abdicavit ; totamque medicinam, ad caufam revocando, colijedturam fecit.” He ridiculed Hippocrates for his patient obfervation of nature, and called his fyftem “a meditation on death.” His fame, however, would have been incomplete, if he had not introduced a fyftem of his own. Accordingly, taking for the bafis of it the philofophy of Epicurus and Heraclides of Pontus, he attempted to explain all the functions of the human body, and all the operations of health and difeafe, by means of eorpvjcles and pores. He aflerted, that matter confidered in itfelf was of an un¬ changeable nature; and that all perceptible bodies were compofed of a number of final ler ones, between which there were interfperfed an infinity of final! fpaces totally void of all matter. He thought that the foul itfelf was compofed of thefe fmall bodies. He laughed at the prin¬ ciple called Nature by Hippocrates, and alfo at the ima¬ ginary faculties faid by him to be fubfervient to her ; and Hill more at what he called Attradion. This laft principle Afclepiades denied in every inftance, even in that of the loadftoneand fteel, imagining that this phenomenon pro¬ ceeded from a concourfe of corpufcles, and a particular difpofition or modification of their pores. He alfo main¬ tained, that nothing happened or was produced without fotne caufe ; and that what was called nature was in reality no more than matter and motion. From this laft principle he inferred that Hippocrates knew not what he faid when he fpoke of Nature as an intelligent being, and aferibed qualities of different kinds to her. For the fame reafon he ridiculed thedodlrine of Hippocrates with regard to crifes; and aflerted that the termination of difeafes might be as well accounted for from mere matter and motion. He maintained, that vve were deceived if we imagined that Nature always did good ; fince it was evident that (lie often did a great deal of harm. As for the days particularly fixed upon by Hippocrates for crifes, or thole on which we ufually obferve a change either for the better or the worfe, Afclepiades denied that fuch alterations happened on thole days rather than on others. Nay, he alferted that the crifis did not happen at any time of its own ac¬ cord, or by the particular determination of nature for the cure of the dilorder, but that it depended rather on the addrefs and dexterity of >lve phyfician ; that we ought never to wait till a diftemper terminates of its own accord, but that the phyfician by his care and medicines mull haften on and advance the cure. He accufed Hippocrates and other ancient phyficians of “attending their patients rather with a view to obferve in what manner they died than in order to cure them;” and this under pretence that Nature ought to do all herfelf, without any afiiftance.
The practice of Afclepiades was principally geftation, fridtion, and the ufe of wine.' By various exercifes he propofed to render the pores more open, and to make the juices and fmall bodies, which caufe difeafes by their re¬ tention, pafs more freely ; and, while the former phyficians had not recourfe to geftation till towards the end of long- continued diforders, and when the patients, though en¬
tirely free from fever, were yet too weak to take fuffleient exercife by walking, Afclepiades ufed geftation from the very beginning of the moll burning fevers. He laid it down as a maxim, that one fever was to be cured by another; that the ftrength of the patient was to be ex- haufted by making him watch and endure thirft to fuch a degree, that, for the two firft days of the diforder, he would not allow them to cool their mouths with a drop of water. Celfus alfo obferves, that, though Afclepiades treated his patients like a butcher during the firft days of the diforder, he indulged them fo far afterwards as even to give directions for making their beds in the fofteft manner. On feveral occafions Afclepiades ufed fridlions to open the pores. The dropfy was one of the diftempers in which this remedy was ufed; but the moll fingular at¬ tempt was, by this means, to lull phrenetic patients afleep. Though he enjoined exercife fomiuch to the fick, he denied it to thofe in health ; a conduit not a little furprifing and extraordinary. He allowed wine freely to patients in fevers, provided the vioience of the diftemper was fomewhat abated. Nor did he forbid it to thofe who were afflicted with a phrenfy : nay, he ordered them to drink it till they were intoxicated, pretending by that means to make them deep; becaufe, he faid, wine had a narcotic quality and procured fleep, which he thought ab- folutely neceflary for thofe who laboured under that dif¬ order. To lethargic patients he ufed it on purpofe to excite them, and roufe their fenfes : he alfo forced them to fmell ftrong-feented fubftances, fuch as vinegar, caftor, and rue, in order to make them fneeze; and applied to their heads cataplafms of muftard made up with vinegar.
Befides thefe remedies, Afclepiades enjoined his pa¬ tients abftinence to an extreme degree. For the firll three days, according to Celfus, he allowed them no ali¬ ment whatever; but on the fourth began to give them victuals. According to Caslius Aurelianus, however, he began to nourilh his patients as foon as the acceffion of the difeafe was diminilhed, not waiting till an entire re- mifflon ; giving to fome aliments on the firft, to fome on the fecond, to fome on the third, and fo on to the feventh, day. It Teems almoll incredible to us, that people Ihould be able to fall till this laft-mentioned term; but Celfus allures us, that abftinence till the feventh day was en¬ joined even by the predeceflors of Afclepiades.
The divifion of difeafes into acute and chronic appears to have originated with him. The remedies which he employed (as we have feen) were chiefly dietetical ; but he was no enemy to phlebotomy, though he dilcouraged vomiting and purgation: inftead of the latter he recom¬ mended clyfters. He was a great advocate for the ufe of cold water externally as well as internally; though he probably ingratiated himfelf with the Romans more by his free adminillration of wine in diforders where it had not formerly been allowed. Sprengel fuppoles him to have been the inventor of the balnea penjilis, or Ihower-bath.
That: Afclepiades, notwithllanding his arrogance, was a man of obfervation and difeernrnent, is evident from his defeription of difeafes ; and from the faCl, that he always continued to enjoy great reputation among the Roman people, and l^iat his leClures, which, according to Pliny, embraced the three branches of pathology, midwifery, and pharmacy, were very numeroully attended. Galen accufes him of humouring the caprices of his patients at the expence of his own better reafon and judgment. The principles of this author’s pathology gave the firft outline of the methodic pradlice of phyfic, which was more fully developed by Themifon and Theflalus, and afterwards by Soranus.
The Methodics, or Methodists, endeavoured to fleer a courfe unconnedled with the Dogmatifts or the Empirics. They objedled to the former fedl, on account of their hypothetical principles; and to the latter, on ac¬ count of the tedious manner in which they acquired their knowledge. In confequence of this, they began to claffify and generalize ; and obferved, as they conceived,
two
PATH
two dates or conditions of body which attended all forts of complaints. To one of tliefe dates they gave the name of fir icl urn, which implied a general conftridlion of the whole body; to the latter, the epithet of luxum, by which they meant a correfponding relaxation. Cafes, however arofe, that were not referrible to either of thefe claffes : confequently, the Methodifts were obliged to in¬ vent a third, which partook of the properties of both the others. Hence they admitted the contradiftion of a (late of relaxed contraction, an expreffion of which no conception can be formed.
It has been fuppofed, however, by M. Cabanis, that this mixed (late of laxutn and JlriClum meant an irregular dif- tribution of vital power, or irregularity of tone. If his idea be corredl, this clafs would comprehend all difeafes, without the afliftance of the other two ; for we know of no difeafe that is not marked at times by an unequal dif- tribution of vital energies. As to the praSice of the me¬ thod ills, it may be obferved, that they wholly overlooked the healing powers of the fyltem, and, without regard to the peculiar circumftances of the cafe, or the nature of the part affedled, were l'olely intent on fulfilling thofe general indications that were conformable to their theo¬ ry. It is true, that they paid particular attention to days ; not, however, as connedled with the dodlrine of criles, for which the founders of this left entertained a marked contempt ; but only as affording them a meafure of the duration of the diforder, and a guide for the method of treatment. In the firft days, they followed the llarving fyftem ; afterwards they purfued the fuppofed general in¬ dications of conftri&ing, or of relaxing: during the ex¬ acerbation of the difeafe, they endeavoured to moderate the violence of it ; during its decline, they fupported the powers of the fyllem by nutritive diet. This was their mode of proceeding in all acute difeafes : but, in chronic complaints, to which it was lefs applicable, they had re- courfe to what they termed the ^T-oco-vyr.^ait, or re-in¬ corporation, of which the profeffed object was to reltore the proper relations between the atoms and pores, and for which they prepared the patient by the ocvx or re- fumplrtie circle. It was, in fadl, little elfe than their practice in acute difeafes reverfed : they firft fought to ftrengthen the patient by a generous diet, and then they adminiftered a fucceffion of violent remedies, to fubdue the original malady.
Among the difciples of Themifon, one Theflalus of Trallis, a man of low birth and coarfe manners, made himfelf confpicuous by the fhamelefs audacity with which he fought to difparage the labours of others, arrogating to himfelf the title of I&t ^ony.ri;, or Conqueror of Phy- ficians, and that, it would appear, without the flighted: pretenfions to either learning or talents. (Plin. xxix. i.) He held forth, that he could qualify any one for a phy- fician in the fpace of fix months, and aftually fucceeded in obtaining a great number of pupiTs ; but they were from among the lowed order of artifans, fuch as rope-makers, weavers, cooks, butchers, fullers, and fuch like. Thefe he took with him to vilit his patients for the ftipulated time; and then he conferred upon them the privilege of pradlifing for themfelves. From his time it became the cuftom for the Roman phyficians to vifit their patients attended by all their pupils; in allufion to which, we have the epigram of Martial :
Languebam ; fed tu eomitatus protinus ad me Venifii, centum , Symmache, dijcipulis.
Centum me tetigere manus aquilone gelata :
Non habuifebrem , Symmache : nunc habeo !
I’m ill. I fend for Symmachus ; he’s here.
An hundred pupils following in his rear.
All feel my pulfe with hands as cold as fnow :
I had no fever then ; I have it now.
The methodic fcliool acquired much greater repute from the labours of Soranus and Caelius Aurelianus. The former a native of Epliefus, who had ftudiedat Alex-
O L O G Y. 11
andria, and came to Rome during the reign of Trajan ; the latter an African by birth. Free from the prejudices which had difgraced his predeceffors, Soranus cultivated the ftudy of anatomy, and wrote a book on the female organs of generation, which is dill extant, and difplays conftderable acquaintance with the fubjedt. Many of his obfervations (how that he was pofleffed of great fagacity and ftrength of judgment. To Cadius Aurelianus, on the other hand, we are indebted for an account of his doc¬ trines and pradlice, and for one of the bed works on me¬ dicine which have come to us from ancient times ; writ¬ ten it is true, in a barbarous ftyle, but highly deferving of perufal, on account of the accurate defcription of dif¬ eafes,. and the different methods of treatment, which it contains.
Anatomy and the other auxiliary fciences, though they had been fo much negledled by the Methodifts, were now receiving important additions from other quarters. Rufus of Ephefus, who lived in the time of the emperor Trajan, applied himfelf zealoufly to the dilTe<5lion of ani¬ mals, particularly of apes, and defcribed from analogy the different organs of the human body. Fie traced the nerves from their origin in the brain, and divided them into- thofe of fenfation and thofe of voluntary motion. The heart he believed to be the feat of life, of animal beat, and the caufe of pulfation ; and he (bowed the difference of ftrudlure and capacity between the right and the left ventricle. The fpleen he held to be an ufelefs organ. Marinus, whom Galen calls the reftorer of anatomy, and to whofe labours he was himfelf probably indebted for much of his knowledge on the fubjedl, rendered dill greater fervices to the fcience. He inveftigated the ab¬ sorbent fyftem with great care, and difcovered the me- fenteric glands ; he diftributed the nerves into feven pairs: the N. palatinus (then called the fourth pair) was firft defcribed by him; and he is faid to have been the dif- coverer alfo of the par vagum, which he termed the fixth pair. Flis numerous writings have all perilhed.
The ftudy of the materia rnedica, and of the other branches of natural hiftory, was profecuted with no lefs vigour ; and we owe to the firft century of the Chriftian era the invention of many remedies which are (till retained in our pharmaceutical fyltems. The elder Pliny, fecond only to Ariftotle in the univerfality of his genius, but furpafiing even that great man in his infatiable third for knowledge, had collected in his Hiftoria Mundi all that the ancients knew of natural fcience. Diofcorides of Anazarba, devoting himfelf to botany and materia rae- dica, produced a work which ferved for a guide in thefe fciences till a very late period. His defcriptions of fome of the more valuable drugs, fuch as myrrh, laudanum, af- fafoetida, ammoniac, opium, fquills, and their different preparations, are entitled to great praife. The efficacy of feveral remedies, which he recommends, has been ad¬ mirably confirmed by later experience, fuch as of the elm-bark in cutaneous difeafes, of potafti as a cauftic, of the male fern againft worms, &c. &c. Some of the con¬ temporaries of Diofcorides, as Scribonius Largus, Xeno- crates, and Andromachus, cultivated the materia rnedica, but with lefs fuccefs. To Menecrates, who lived in the reign of Tiberius, and who, according to an infcription in Montfaucon, appears to have been the author of 15s books, we are indebted for the invention of the diachy- lon-plafter; and Damocrates is well known as the author of feveral complicated remedies which bear his name. Herennius Philo, of Tarfus, is mentioned by Galen as the inventor of an anodyne compofition, called, after him, Philonium, and which confided of opium, euphor- bium, and different aromatics ; and Afclepiades Pharmacion was the introducer of numerous remedies from the animal kingdom, which, though long honoured with a place in our pharmacopoeias, have now defervedly fallen into difrepute.
Before quitting this period of medical hiftory, it will be neceflary to fay a few words refpedting two other fedls,
which
12
PATHOLOGY.
which arofe foon after the eftablilhment of the Methodic fchool : we mean the Ecledic and Pneumatic feds. The founder of the latter, Ariftseus of Cilicia, flourilhed as a phyfician at Rome about the middle of the firft: century, and diftinguilhed himfelf by his oppofition to the-tenets of Afclepiades, and his attachment to the Stoical fyftem : he extended the theory of pre-exiftent germs ; treated the dodrine of the pulfe with dialedic fubtlety, referring its varieties to the exhalation of the nvBv^a. from the heart and arteries ; and cultivated feveral branches of patholo¬ gy ; but was more fuccefsful in his dietetic researches, particularly with refped to the influence of the atmof- phere.
His pupil Agathinus, endeavouring to reconcile his principles with thofe of the Methodic and Empiric feds, acquired the name of Epifynthetic or Ecledic; and thus eftablilhed the Ecledic fyftem, on which, however, he does not appear to have conferred much repute by his own labours. That merit was referved for Archigenes and Aretasus, who, adopting the leading tenets of the Pneumatic theory, gave it a more fcientific form, and enriched it by many valuable obfervations. The former attempted to reform the language of medicine, but with¬ out much effed 5 for even Galen has occafion to complain of the obfeurity of his phrafeology ; he was, befides, too fond of fubtleties: but many of his practical obfervations, which Galen has recorded, are excellent. The merits of Aretasus, as a tkilful and attentive obferver, and as an elegant deferiber of difeafe, are familiar to every one. To Caflius the Iatrofophilt, another Eclectic, we are in¬ debted for many valuable pathological remarks concern¬ ing the difeafes of afi’oeiation, and the fympathies of the nervous fyftem.
On the fubjed of Aretasus and Archigenes, Dr. Huxham has the following note. “ It is pretty furprifing that none fliould take notice of Aretasus Cappadox before Aetius Amidenus, in the fifth century; (he is indeed named in the Euporifta attributed to Diofcorid.es, but few think that piece to be the genuine work of that au¬ thor.) Neither Galen, Caslius Aurelianus, nor Oribafius, mention him; though fo particular in enumerating all the phyficians of note, antecedent to, or cotemporary with them. And yet Aretteus feems to have been a very confiderable practitioner, and a man of great learning and judgment : he aft'eds a very Angular ftyte, ufing many oblolete words, Homeric and Hippocratic phrafes, and the Ionic dialed ; which, at the time he wrote in, was almoft entirely difufed : for, notwithftanding the conceit of Voflius, he undoubtedly did not write till after the time of Nero. All this one would think fliould have made him remarkable ; efpecially if he praCtifed in or near Rome ; which is not improbable, as he advifes Roman wines to the lick ; particularly the Falernian, Surrentine, Signine, and thofe of Fundi. But Galen and Aetius quote from Archigenes feveral paffages, which are exadly the fame, as to fenfe, dodrine, method of cure, and manner of expreflion, with what we find in Aretasus ; only the latter gives them the Ionic turn. They both coincide in recommending fome particular medicines, which are fcarce to be met with in any others, particularly the external ufe of cantharides ; which I think is not to be found in any preceding author, except Celfus. Did Archigenes then borrow from Aretasus, or the latter from the former? It is certain, Archigenes pradifed at Rome with a very great reputation, was a very celebrated phyfician and author, and as fucli is re¬ ferred to by Juvenal, Galen, Caslius, Oribafius, Aetius, Sec. He is ftridly criticifed by Galen, fometintes cen- fured, fometimes commended, but never reckoned a mere compiler. Aretasus, on the contrary, is mentioned by none but Aetius and Paulus Avgineta; nay, which is not a little to be wondered at, he is not fo much as found in Photius’s Bibliotheca. This is really ftrange, and not eafily accounted for, and would incline one to think that Aretasus borrowed from Archigenes ; or ra¬
ther tranferibed and new-modelled him, giving him the Hippocratic didion and Ionic dialed. Poftibly Aretteus might do by Archigenes fomething like what Caslius Aureliar., not long after, did by Soranus: but, iffo, he hath vaftly much better grascifed Archigenes than Caslius hath latinized (as he calls it) Soranus. Upon this fuppo- fition, we need not wonder at finding the Roman wines recommended in Aretasus, though lie might pradife and write in Cappadocia, or any where elfe, at the greateft diftance from Rome. Be the matter as it will, in Aretasus we have a molt valuable work, a moft accurate defeription of difeafes, and in general a very proper and judicious method of cure ; and it is greatly to be lamented, that the work comes fo maimed to us.” Huxham on Fevers, Pref.
During this period, furgery received confiderable im¬ provement; particularly from the labours of Heliodorus and of Antyllus. Of the former, who was an eminent furgeonat Rome in the time of Trajan, Nicetas has pre- ferved feveral pradical obfervations on injuries of the head and difeafes of the bones, which evince no mean profi¬ ciency in his art. The latter is perhaps (till more deferv- ing of notice, as being the firft who gives any account of the extradion of the catarad : he recommends this ope¬ ration to be performed while the catarad is final!, being of opinion, that, when enlarged, it cannot be extraded without bringing the humours of the eye along with if. His diredions concerning the preparation of plafters and ointments, and concerning the choice of veins in phle¬ botomy, are very minute. In dangerous cafes of cynunche, he advifes bronchotomy ; and in hernia humoralis he ope¬ rated by incifion. Philagrius, who lived about the time of Valens, appears to have been the firft who attempted to extrad a ftone from the bladder by the high operation. Aetius has alfo tranfmitted to us an account of the fur- gical pradice of one Leonides of Alexandria, whofe ob¬ fervations on hernia, fcrofula, and glandular fwellings, on hydrocele, and on inflammation of the ferotum, fhow confiderable difeernment. In canceroqs affedions of the bread, he reforted to amputation, and the adual cautery ; in fiftula, his method of operation differed but little from that recommended by Pott.
Having difpatched feveral names of fmaller eminence, we now come to the illuftrious Celfus, who lived at Rome, as fome think, about the reign of Tiberius. His native place is unknown ; and many writers have fuppofed that lie was never in pradice. Yet his minute deferiptions of many pharmaceutical preparations could hardly have been acquired unlefs he had compounded them with his own hands; nor could his excellent diredtions in furgery have been penned without fome knowledge of the manual operations. In many parts of his works, he follows the Father of Medicine fo clofely, that he has been called the Latin Hippocrates ; though that name is equally appli¬ cable to him on account of the purity of his language. (See Celsus, vol. iv.)
In his work on furgery, all the improvements from Hippocrates to his own days are colleded ; the moft mi¬ nute and trifling difeafes are not omitted. An eminent furgeon of the moderns emphatically exhorts every perfon in that profeflion “ to keep Celfus in his hands by day and by night.” He follows Hippocrates, but with much improvement in his chirurgical diredions ; efpe¬ cially in the mode of trepanning, in applying fplints, bandages, Sec. in the manner of extending and fixing fradured limbs and likewife in the medical treatment of the patient. In luxations of the fhoulder, he mentions feveral methods of giving force to the extenfion, and of replacing the diflocated bone. One method fimilar to that of Hippocrates was, to fufpend the patient by the arm ; the fore part of the fhoulder, at the fame time, refting upon the tep of a door, or any other fuch firm fulcrum. Another method was to lay the patient lupine, fome af- fiftants retaining the body in a fixed pofition, and others extending the arm in the contrary diredion ; the furgeon.
PATHOLOGY.
in the mean time, attempting, by his hands, forcibly to reduce the bone into its former place.
He made the diltin&ion into fnnple and compound fractures, as it exifts in the prefent day ; and his direc¬ tions in the cure of fractured ribs are extremely judicious. The different fpecies of hernias are well defcribed by him ; and he feems to have pfed a bandage and comprefs after the reduction of the bowels, on the fame principle as we now ufea trufs. In fome cafes, after the return of in- teftitial ruptures, he diminiflied the quantity of loofe fkin, and formed a cicatrix, fo as to contract over the part, to render it more rigid and capable of relilting. He defcribes various dil'eafes of the genital parts, the hy¬ drocele or dropfy of the fcrotum, a difficulty of urine, and the manner of drawing off the water by a catheter ; the figns of ftone in the bladder, and the method of founding or feeling for that ftone. Lithotomy was at that time performed by introducing two fingers into the anus ; the done was then preffed forward to the perinteum, and a cut made into the bladder ; and by the finger or by a fcoop the ftone was extracted. He defcribes the manner of performing this operation on both the fexes, of treat¬ ing the patient, and the figns of recovery and of danger.
Celfus gives excellent inltruftions with regard to in¬ flammation in general ; and mentions fome ufeful topical applications in ophthalmia. The operations for the cata¬ ract (which confifted in depreffing the cryftalline lens), and for fiftula, are likewife defcribed by him ; as alfo the mode of performing the operation of paracentefis. The external application of arfenic as a cure for cancer origi¬ nated with Celfus. In external gangrene, he cut into the found flefli ; and, when the difeafe, in fpite of every effort, fpread, he advifed amputation of the member. After cutting to the bone, the fleffi was then feparated from it, and drawn bach, in order to fave as much fleffi as poffible to cover the extremity of the bone. He de¬ fcribes the fymptoms of that dangerous inflammation the carbuncle, and direfls immediately to buril or corrode the gangrened part. To promote the fuppuration of abfceffes, he orders poultices of barley-meal, or of marffimal- lows, or the feeds of linfeed and fenugreek. He alfo mentions the compofitions of feveral repellent cataplafms. In the eryjipelas, he applies cerufe, mixed with the juice ofSolanum, or nightlhade. He is very diffufe in thofe parts of his works which relate to pharmacy, giving for¬ mula for a great many external and internal remedies now' defervedly aboliftied.
Though Celfus followed the praClice of Hippocrates in many refpefts, yet he very much differed from him in others. He particularly ridiculed his dodtrine of critical days, which he attributed to anabfurd application of the Pythagorean dodlrine of numbers ; and he differed from that phyfician in regard alfo to bleeding; for he held it dangerous to take much blood from patients at once, and rather preferred the abllradlion of it at repeated intervals. In regard to abflinence, he feems to have followed Afclepiades, enjoining the fick to endure hunger and thirft during the firft days of their illnefs, and afterwards allowing them plenty of food. He entirely difregarded the indications of the pulfe, from having obferved that it was accelerated or depreffed by many adventitious cir- cumllances, as well as from having found it very different in complaints of a fimilar nature.
The moft confiderable of the Roman pathologifts, and the laft of any great eminence, was Galen, who flourilhed about a hundred and thirty years after Celfus, and was phyfician to the emperor Marcus Aurelius. This great man was confidered for many centuries afterwards the moft infallible authority in all matters relating to patho¬ logy. Impreffed at an early age with the important truths contained in the writings of Hippocrates, he viewed with contempt and difguft the jargon and obfcurity which en¬ veloped them in the fchools of medicine. Accordingly he became lrimfelf the expofitor of Hippocrates. He re¬ peated and extended his obfervations, prefented his opi-
Vol. XIX. No. 1283.
13
nions in new lights, and fupported his dodtrines with all the aids which w'ere derivable from fpeculative reafoning or the comparifon of fadls. Yet Galen in fome meafure fell into the fame error of which he accufed his predecef- fors and contemporaries. He obferved the naked faffs and fimple truths related almofl without comment by the coarle fage. He applied himfelf too much to explain, arrange, and fyftematize, a very fmall ftock of informa¬ tion ; and, by endeavouring to illullrate a very uncertain fcience by means of others not more exadl, he permitted his imagination to frame hypothefes in the higheft degree gratuitous and aflumptive. Thefe obfervations are fully exemplified by the following Iketch of his fyftem.
He firft begins with eftablilhing four qualities in the ani¬ mal body; heat, cold, moifture, and drynefs. The pe¬ culiar combinations which thefe qualities undergo, or in other words the changes which may be rung on them, pro¬ duce eight conftitutions, or temperaments; i. e. hot, cold, moilt, and dry ; hot and moift, cold and moift, hot and dry, and cold and dry. (See Galen, vol. viii.) Idiofyncracy is that temperament which cannot be referred to any of thefe qualities, and is therefore fuppofed to arife from occult caules. With Hippocrates, Galen admitted the operation of Nature ; but to this agent he added three other faculties, or, as we thou Id call them, vital properties. The firft and molt important, he calls the animal faculty ; it has its feat in the brain, .performs the operations of mind, and by means of the nerves diftributes the proper¬ ties of motion and fenfation to all parts of the body. The fecond is called the natural faculty ; it has its feat in the liver, and is the principal agent in giow’th, generation, and nutrition. The third, denominated the vital facul¬ ty, is lodged in the heart, and from thence, by means of the arteries, dilleminates heat and vitality through the whole fyftem. Thefe three faculties were adled upon by Nature as a primum mobile. Their production was fuppo¬ fed to be owing to the agency of certain Jpirils, or faille vapours, which he likewife divided into three kinds, bear¬ ing the names of vital, natural, and animal. Galen ad¬ mits the exiftence of the four humours of blood, phlegm, yellow, and black bile, firft infilled on by Hippocrates. With that phyfician he likewife divides the body into three component parts ; fpirits, humours, and parts, or, as we call them ,folids. The laft-inentioned fubllances he divides into organical and fimilar.
It were ufelels to enter into a detail of the minute diftinc- tions of difeafesand their caufes in which Galen has in¬ dulged. Suffice it to fay, that the increafe, deficiency , or ir¬ regular diftribution,of the different humours,qualities,&c. which we have enumerated, was regarded by him as the eflential caufe of difeafe ; confequently the abllradlion of redundant, the reproduction of deficient, or the correc¬ tion of peccant, humours, formed the principal indications in his pathology. In anatomy and phyfiology, Galen dil- covered or arranged many important fadls. His affiduous diffedlions of animals furnifhed him with many ufeful ob¬ fervations : he likewife preferved in his writings much of the anatomical knowledge of the Alexandrian fchool ; and has indeed corrected by experiment the errors into which that fchool had fallen, particularly in regard to the circulation of the blood. Hippocrates had afierted, that all the veffels communicated with each other, and that the blood underwent a kind of flux and reflux to and from the heart, like the ebbing and flowing of the lea; and he mentions the throbbing of the temporal arteries, as an evidence of this fail. The.anatomifls at Alexandria had adopted a different ©pinion ; as they found the ar¬ teries empty, and the veins containing blood, in their diffedlions, they imagined that the former were tubes for the diftribution of air, (and gave them that name which they have borne ever fince;) and that the veins were the only channels for the blood. The heart of man confid¬ ing of two lets of cavities not communicating with each other, and its connexion with the lungs, were to them delufive circumftances, and feemed to favour their opi- E nions.
34
PATHOLOGY.
nions. If is true they fometimes found blood in the ar¬ teries, and in the left cavities of the heart ; but then they believed that the air or fpirit had efcaped, and that the blood had oozed through the fides of thefe air-veflels, and fupplied its place. Galen refuted this opinion by expe¬ riment. He laid bare one of thefe vetfels in a living ani¬ mal, and by tying it in two places, and opening it between the ligatures, he afcertained that it contained blood and nothing elfe. He therefore concluded, that both veins and arteries ferved the fame purpofe-, that of diftributing blood for the fupply of the body, but that the florid ar¬ terial blood contained more air than the purple blood of the veins. We need hardly remark, that Galen did not underhand the natural courfe of the blood, though he had thus made known its containing vefl'els.
Galen did not apply himfelf much to the furgical de¬ partment of the art : however, he occafionally performed the operation of arteriotomy, and opened the jugular veins ; and he defcribed with accuracy the different kinds of hernia.
In a hiftory of this kind it feems right to mention the effect of anatomical ftudies on the mind of Galen. After contemplating the ftrufture of the bones of a fkeleton, and their "adaptation to their different fundiions, he breaks out into an apoftrophe, which has been much ad¬ mired, and in which he isfaid to have exceeded any an¬ cient in pointing out the nature, attributes, and proper worfhip, of the Deity. “In explaining thefe things,” he fays, “I efteem myfelf as compoiing a folemn hymn to the author of our bodily frame ; and in this I think there is more true piety than in facrificing to him heca¬ tombs of oxen, or burnt-offerings of the moft coftly per¬ fumes : for I firffc endeavour to know him myfelf, and af¬ terwards to (how him to others, to inform them how great is his wifdom, his virtue, his goodnefs.”
Medicine improved very flowly after the time of Galen ; his fucceflors were more employed in compiling and com¬ menting on the works of their predeceflors, than in en¬ deavouring to extend the bounds of fcience by original obfervation. Among the moft diftinguilhed of thefe we may record the names of Oribaftus, Aetius, Alexander Trallian, and PaulusAEgineta.
Oribafius flourifhed about the year 360, and was phy- ffcian to the emperor Julian. Though commonly rec¬ koned a Sardian, he was born at Pergamus, and bred up, together with Magnus and Ionicus, in the ichool of Zeno the Cyprian, who taught then at Sardis, though after¬ wards he removed to Alexandria, where he became a famous profeflbr. Eunapius reprefents Oribafius as the greateft fcholar and phyfician of his time, and a very en¬ gaging and agreeable man in converfation. He defcribes him as no lefs confiderable in his intereft than in his learning : according to his account, he contributed very much to the advancement of Julian to the empire, who in return made him quasftor-of Conftantinople, and who, as appears by one of his letters, had an entire confidence in him. Ip. the fucceeding emperor’s time, through the envy of his enemies, he fell into difgrace, had all his ef- tates confifcated, was banifhed, and delivered into the hands of barbarians ; amongft whom, in a little time, by his courage and flcill, he gained fo much love and' reve¬ rence, that they, feeing what great cures he performed, adored him as a god. At laft he was recalled by the Ro¬ man emperor, and flourithed in reputation and riches at the very time when Eunapius wrote this account, which muft be near the year 400.
Oribafius wrote feventy (according to Photius) or (ac¬ cording to Suidas) feventy- two books of colledtions, which he compiled not only from Galen, but from all the preceding phyficians, and his own experience, at the defire of Julian; the fifteen firft of which are only remain¬ ing, and two others treating of anatomy, Afterwards he made an epitome of this great work, and reduced it into nine books for the ufe of his fon, Eullathius. Paulus mentions this epitome ; but it is now loft, as are fome
other tradfs which Suidas takes notice of. Thefe works, though chiefly compilations, are, by no means without their ufe to the medical ftudent ; for both Oribafius and Aetius have preferved fome fragments of antiquity, and thofe of fome value, which are no-where elfe to be met with ; that is, they compiled from the now-loft-vvorks of Galen and others, and added much original matter of their own. We will give only one inftance of what is either omitted by Galen, or is loft together with fome other of Galen’s works; namely, the firft defeription of the lalivary glands, which is this : “ On each fide of the tongue, iie the orifices of the vefl'els, which difehargethe fpittle, and into which you may put a probe. Thefe vef- fels take their rile from the root of the tongue, where the glands are fituated. They rife from thefe glands, in much fuch a manner as arteries ufually do, and convey the falivary liquor, which moiftens the tongue, and all the adjacent parts of the mouth.” Oribafius, lib. xxiv. c. 8.
Oribafius, either from Apollonius or himfelf, fpeaks very fully of the good eftedts of bleeding by way of fca- rification, a thing little taken notice of by former writers : and allures us, from his own experience, how fuccefsful he had found it in a fupprelfion of the menfes, defluxions of the eyes, headache, lfraitnefs of breathing, even when theperfon was extremely old. He tells his own cafe par¬ ticularly, when the plague raged in Afia, and he himfelf was taken ill, that the fecond day he fcarified his leg, and took away two pounds of blood; by which method he en¬ tirely recovered, as did feveral others who ufed it. Here we may obferve, that this was a different method of fca- rifying from that performed by the help of cupping. The Arabian phyficians feem to have'had a notion only of the latter practice : but, from this place, as well as from fome pafiages of Galen, it is plain, that the ancients made deep incifions into the Ikin by the knife ; and therefore thought, by the large quantity of blood they could draw off, that this method was equivalent to opening. a vein. The Egyptians make ufe of it to this very day; and Profper Alpinus defcribes at large the apparatus : they make, firft a ftrait ligature under the ham, then rub the leg, and put it into warm water, and beat it with reeds to make it fwell, and fo fcarify. A procefs in every par¬ ticular differing from cupping ; and therefore, in the cure of giddinefs, Oribafius himfelf fpeaks of them as two diftindt operations.
We find in this author the firft account of a ftrange and lurprifing diftemper Avy.a.vfya'rrix, a fpecies of melancholy and madnefs, which he defcribes thus : “The perfons af fedied go out of their houfes in the night-time, and in every thing imitate wolves, and wander among the fepul- chresofthe dead till day-break. You may know them by thefe fymptoms: their looks are pale; their eyes heavy, hollow, dry, without the leaft moifture of a tear : their tongue exceedingly parched and dry : no fpittle in the mouth, extreme thirft ; their leg', from the falls and bruifes they receive, full of incurable fores and ulcers.” Aetius gives the very fame defeription, with fome little variation ; only calls it K.v'jxvitjco'mx as well as Av/.xv^^ani and obferves it prevails moft in February. Aetius takes this paflage, as he fays, that is, makes a paraphrafe of it, from Marcellus Sidetes, an author who lived under Adrian and M. Antoninus; and who wrote forty-two books concerning diftempers, in heroic verfe. Paulus has tranforibed the fame account of this difeafe word for word. The Greek term ufed to denote this difeafe ex- prefles the nature of it veryjuftly; and yet Vanderlindenis fo carelefs a writer, that lie makes it a fynonymous term for the madnefs of the wolves themfelves. We conceive the difeafe to have been a fpecies of mania, in which the aflociation of the mind with deceafed relatives produced an inclination to wander among the tombs.
Of the epilepfy, Oribafius defcribes the cure both in the acute and the chronical fort ; that is, in the fit as well as out of it. When the litis over, he orders bleeding;
and.
15
PATHOLOGY.
and, after four or five days, when the body is a little re- veterate afthma, after all other remedies have been tried cruited, purging ; three days after, cupping and fcarifying. in vain. One, he fays, fiiould be made on each fide, near He repeats thefe evacuations, and fometimes finapifms, at the middle of the joining of the clavicle, taking care convenient diftances, and in the intervals gives proper not to touch the wind-pipe: two other little ones are nourilhment, and ufes warm medicines, fuch as caftor, then to be made near the carotids under the chin, one on
mint, rue, and the cyrenaic juice. Whether this be taken out of Pofidonius, as, by reading Aetius upon the fame head, there may be fome reafon to fufpeCt, we can¬ not tell ; but the method is certainly right, and agreeable to a rational practice. The epitome of what Galen had faid upon the fame argument, in the next chapter, is by no means fo full and circumflantial. Thefe few infiances will be fufficient to (how, that even this author, though he be chiefly a collector, may furnifii us with fome new and ufeful reflections in phyfic; and he who reads him with this view, may find fome other paflages of the fame kind, not to be met with in the more ancient writers.
Aetius lived very near the end of the fifth or the be¬ ginning of the fixth century. He was a native of Amida in Me!opo.tamia, ftudied at Alexandria, and was probably a Chriftian, which perhaps may be the reafon why many have confounded him with another of that name, a fa¬ mous Arian of Antioch, who lived in the time ot Julian.
In fome manufcripts he has the ftyle of Kopn; O-vJ/ixta, Comes ObJ'equii ; i.e. the chief officer of thole who ufed to go before the emperor, as his attendants and harbin¬ gers. We find in hint feveral particularities relating to the Egyptian pharmacy. He has collected a great multi¬ tude of receipts, particularly thofe which had been much celebrated, or ufed as noltrums by their inventors. Some of thefe he feems to mention with no other defign than to expofe them, and to let us fee the extravagant rate people were induced to pay for them : for inftance, the colly- riutn of Danaus, which was fold in Confiantinople for one hundred and twenty numifmata, and with great difficulty obtained from him ; the colical antidote of Nicofiratus, called very prefumptuoufly Ifotheos, bought for two ta¬ lents. He feems alfo to be the firft: Greek writer among the Chriftians who gives us any fnecimen of medicinal fpells and charms, fo much in vogue with the old Egyp¬ tians ; fuch as that of St. Blafius, in removing a bone which flicks in the throat ; and another in relation to two fiftulse.
The followfing fample of a remedy for the gout is re¬ marked by Dr. Freind as being the firll ofits kind in the hiflory of phyfic. It is an external medicine : he calls it the grand dryer : the patient is to ufe it for a whole year, and obferve the following diet befides in each month. He calls the months by the Alexandrian or Egyptian names, but in Engliffi, the direction runs thus : “ In Sep¬ tember to eat and drink milk : in October to eat garlick : in November to abltain from bathing: in December not to eat cabbage: in January fo take a glafs of pure wine in the morning: in February to eat no bete : in March to mix fweet things both in eatables and drinkables: in April not to eat horfe-radifh : nor in May the filh called polypus : in June to drink cold water in a morning : in July to avoid venery : and laftly, in Augufi to eat no mallows.” This may give us fome idea of the quackery of thofe times.
In the works of Aetius we find many obfervations omitted by Celfus and Galen, particularly on furgical operations and on difficult parturition. He firft took no¬ tice of the Dracunculus, or Guinea worm, not known to Galen. It is curious to remark the exceffive extent to which the aCtual and potential cauteries were carried in the time of this practitioner. In a palfy, he fays, that he fiiould not at all hefitate to make an elchar either way, and this in feveral places; one in the nape, where the fpinal marrow takes its rife, two on each fide of it; three or four on the top of the head, one juft in the middle, and three others round it : he adds, that, in this cafe, if the ulcers continue running a conliderable time, he fiiould not doubt'of a perfect recovery. He is ftill more parti¬ cular when he comes to order this application for an in-
each fide, fo that the cauftic may penetrate no further than the fkin ; two others under the breafts, between the third and fourth ribs ; and again, two more backwards towards the fifth and fixth ribs. Befides thefe, there ought to be one in the middle of the thorax, near the be¬ ginning of the xiphoid cartilage, over the orifice of the rtomach ; one on each fide between the eighth andninth ribs; and three others in the back, one in the middle, and the two others juft below it, on each fide of the vertebra;. Thofe below the neck ought to be pretty large, not very fuperficial, not very deep : and all thefe ulcers fiiould be kept open for a very long time. »
Alexander, who flouriffied in the reign of Jultinian, is a more original author than either of the two former. He was furnamed Trallianus, being born at Tralles, a famous city of Lydia, where the Greek language was fpo- ken in great perfection : he lived in the fixth century, fome time after Aetius. He was a man of very extend ve praftice and of great fame, whence he was emphatically called Alexander the phyfician. His therapeutical direc¬ tions are very full and explicit, aft d were chiefly the re- fults of experiments made by hirnfelf. His practice was remarkable for the judicious introduction of aperient me¬ dicines in cafes of fever, and the ufe of bleeding in fyn- cope, adifeafe which, according to his defeription, feems to apply to the epilepfy of our own times. But the molt valuable part of Alexander’s writings was his book on gout, for the cure of which he recommends purging, and particularly with the herb hermodadlylus, which is fiip- pofed to be the colchicum lately brought up again and ac¬ quiring great reputation in the. cure of the fame complaint. He is the firft author who recommended the life of- rhu¬ barb, which he had recourfe to in vveaknefs of the liver and in dyfentery. Alexander is recommended by Dr. Freind as one of the bell practical writers among the an¬ cients, and well worthy the perufal of any modern.
Paulus, the fourth and laft of the old Greek writers, was born in the ifland Aigina, and lived in the feventh century, though placed by Mr. le Clerc as high as tlie fourth. He vras a great traveller, and had opportunities of feeing an extenfive practice in different countries. He tranferibes a great deal from Alexander and other phyficians. His deferiptions are fhort and accurate. He treats particularly of women’s diforders ; and feems to be the firft inftance upon record of a profeffed man-midzoije , for fo he was called by the Arabians : and accordingly he begins his work with the diforders incident to pregnant women. He treats alfo very fully of furgehy, and gives fome direClions, according to J>r. Freind, not to be found in the more ancient writers. He direCls the manner of extruding darts, and of operating for hernia ; he deferibes one fpecies of aneurifm ; treats of the mode of opening the jugular veins, and alfo the arteries behind the ear. He likewife deferibed the operation'of bronchotomy, and ftiowed the propriety of performing it in cafes of fuffoca- tion. This operation had been derided by Aurelianus, and fome fevere objections were Halted againftit by Are- taeus. It was firft; performed by Antyllus, from whom Paulus copied it.
With Paulus clofes the period of the Greek clujjlcal phyficians: fo we venture to call them; becaufe, if we compare any of the Greek writers on pathology, from the very firfi of them, Hippocrates, to the time we are now fpeaking of, with the very bell of their contempora¬ ries in any art or profeffion whatever, they will be found not at all inferior to them either in the difpofition of their matter, the clearnefs of their reafoning, or the propriety of their language. Some of them have even written above the ftandard of the age they lived in ; an incon- teftible inftance ®f which is Aretseus. Galen, alfo, was
not
1G
PATHOLOGY.
not the only bed phyfician, but the bed fcholar and cri¬ tic, of his time. So great an honour have thefe authors done to their profefiion, by being verfed in other arts and fciences as well as their own. And the great St. Bafil, whom his own continual illnefs made a phyfician, and who has a great many allufions and fimiles taken from that art, was (to ufe the words of Photius) for the neat- nefs, the propriety, the perfpicuity, and fluency, of his ityle, one of the bed writers among the fathers ; as St. Luke’s Greek comes nearer to the ancient Aandard than that of the other evangelifls.
We cannot omit faying,fomething of one author more, whom we may reckon one of the ancients, though not properly a writer in phyfic ; Nemefius, bilhop of Emilia, w'ho wrote a treatife concerning the nature of man, near the end of the fourth century: becaufe his Oxford edi¬ tor afcribes two difcoveries to him, one of which was the mod conliderable that ever was made in phyfic. The firfl is concerning the bile, “ which is condituted (as Neme- iius fays) not only for itfelf, but for other purpofes; for it helps digeflion, and contributes to the expulfion of the excrements ; and therefore it is in a manner one of the nourifliing powers: befides, as a vital faculty, it imparts a fort of heat to the body. And for thefe reafons it feems to be made for itfelf ; but, becaufe it purges the blood, it feems to be formed for the fake of the blood.” Here, fays the editor, the fyflem of the bile is plainly and ac¬ curately delivered ; that very fydem which Sylvius de le Boe with fo much vanity boaded he had invented himfelf in 3658. And indeed fo far is true, that here is the intire foundation of Sylvius’s reafoning: and, if this theory be of any ufe in phyfic, Nemefius has a very' good title to the difcovery. But there follows a much more material point ; and the fame editor contends, that the circulation of the blood, an invention which tpe 17th century fo much boafts of, was known to Nemefius, and defcribed in very plain and iignificant terms, which are thefe : “ The motion of the pulfe takes its rife from the heart, and chiefly from the left ventricle of it : the artery is with great vehemence dilated and contrafled, by a fortiof condant harmony and order. While it is dilated, it draws the thinner part of the blood from the next veins, the exhalation or vapour of which blood is made the ali¬ ment for the vital fpirit. But, while it is contradled, it exhales whatever fumes it has through the whole body, and by fecret paflages. So that the heart throws out whatever is fuliginous through the mouth and the nofe by expiration.” Upon this Angle (lender proof does he attribute this great difcovery of the circulation to Neme¬ fius ; and thefe who have infided that it was known both to Hippocrates and Galen, have full as good arguments on their fide. But it is evident enough, from this very defeription, and from what the fame author fays of the liver in the fame chapter,- that it miniders nouriflnnent to the body by the veins, that Nemefius had no idea of the manner in which the circulation of the blood is really performed.
To refume the thread of our hiflory, we mud come now to home other Greek writers of a lower rank and a later date: but, as the greated part of thefe contain little that is new, we lhall give a very (hort account of their works, and only be as particular as we can in adjuding their fe- veral ages ; concerning which all our authors have left us in great confufion ; though indeed this is the lefs to be wondered at, confidering that from the time of Agathias, that is, from the year 560, to the reign of Ifaac Comnenus in 1060, there is a chafm of five hundred years- in the Grecian hidory; fo that we know very little of all that interval, except what fome (lender account of the reigns of a few emperors, chiefly Mauritius and Heraciius, fur- nifhes us with.
Palladius, called Sophifi or Iatrafophid, was bred, as he himfelf feems to hint, at Alexandria. We place him firfl among the more modern Greeks, but cannot agree with the Bibliotheca literaria, which computes that heflou-
rifned about theyear 126. Albinus better places him after Galen, i. e. after the year 200. In fa ft, he quotes Galen very often, and it may be proved, that he lived not only after Galen, but after Afctius and Alexander too, whofe words he frequently makes ufe of. His Commentaries upon Fradlures are imperfect; however, what of them remains is enough to let us fee that we have no great lofs by it. In thofe upon the Epidemics, he with great per¬ spicuity and exadfnefs, illuflrates not only Hippocrates, but feveral paflages of Galen ; and obferves particularly, that the done increafed much in his time, and was lefs curable; and he imputes this to the luxury of the age, to much eating, and want of exercife. He is the firfl au¬ thor now extant who has treated profefledly of urine : and he has very well explained the caufes of its colour and confidence ; what didempers thefe refpedtively indi¬ cate, and what prognodics may be drawn from them. There are feveral paflages exprefled in the fame words, as we may read in a book upon the like fubjedl, falfely af- cribed to Galen. He has written in much the fame man¬ ner concerning the faeces.
Stephen, the Athenian or Alexandrian, called fome- times the one and fometimes the other, from the place ei¬ ther of his birth or his refidence, wrote a commentary upon Galen’s Fird Book to Glauco; a book that does not feem to want any comment to make it more intelli¬ gible. But there is reafon to think, that the chief physi¬ cal learning of his time confided in reading upon Galen ; and Abi Olbeia, the Arabian biographer, tells us of feven Alexandrian phyficians, among which Stephanus is one, who digeded the works of Galen into lixteen books; which again, according to the different matter, they di¬ vided into feven clafles : that thefe were the only books they dudied, and that in their turn they made it their whole buiinefs to comment upon them and explain them to their auditors. And therefore it is not at all probable that he lived in the third century, as Mr. le Clerc, without any authority, fuppofes ; and, indeed, it is plain, from this very comment of Stephen, that he was much more modern, for he himfelf mentions very ancient expofitors of this particular book of Galen ; and, in flec¬ tion 140, concerning a quartan, he feems to allude to a wrong interpretation which Alexander had made of Galen’s fenfle in this place. If this writer be the fame with Stephen the chyrnid (as he is called), his age is ea- fily known, for that author dedicates his work, de Chry- fopceia, to Heraciius, and this will make his age confident with what has already been obferved. We read of a Ste¬ phen too, and an Alexandrian likewife, in this very em¬ peror’s reign, who was a famous aflrologer, and foretold the great power to which the Saracens fliould arrive, as they did in fome years after. Vanderlinden calls Stephen the lad of the old Greek authors, though, if this account of his age be true, it will appear that feveral others wrote in Greek after that time.
Of thefe Nonus feems to be in order next, who com- pofed a fort of phyfic-manual, in which is contained fome (hort account of mod didempers and their cure. He in- feribes it to Condantine Porphyrogenitus ; who, accord- ingto Lambecius, was the feventh emperor of that name, the fon of Leo, and died in theyear 959, and who, as he had fome tindlure of learning himfelf, was a great patron of it. But Jer. Martius, who publiflied an edition of this author in Greek and Latin, thinks the Condantine here meant (a Porphyrogenitus as well as the other) was the fon of Condantine Ducas, who died in 1067 ; for this reafon, that Ducas, though unlearned enough him¬ felf, was an admirer and encourager of letters, and had this faying often in his mouth, “ That he had rather be en¬ nobled by learning than by fovereignty;” To which of thefe Conflantines Nonus inferibed his work, is not very material ; I (hall only take notice, that we may collect from Anna Comnena’s hidory, that in the interval be¬ tween thefe two emperors, learning was extremely de¬ clining, if not quite extindf.
4 This
17
PATHOLOGY.
This epitome is little elfe than a tranfcript from Aetius, medicines, fuch as caflia, manna, fenna, myrobalans ; Alexander, and Paulus. And he is fo free with the la- the two laft he fays were brought from foreign parts to bours of his predeceflors, that he even affumes their ex- his country, i. e. from Syria and Egypt. Senna he de- perience to himfelf. He gives a particular defcription of fcribes as a .fruit, by which, no doubt, he means the fame melancholy, and, with the air of a great praftitipner, is thing as Serapion does by the vagina, and Mefue by the full of the good effects he had feen himielf from the Ar- folliculus, which contains the feed; for neither thefe au- menian lfone, and therefore prefers it to white hellebore : thors, nor Adluarius, mention any thing of the leaves;
he talks very fenfibly about the bite of a mad dog, and remarks, that when once a hydrophobia comes on, he never, in all his experience, knew one recover; and yet every word in the firft cafe is tranfcribed from Alexander, and in the latter from Paulus.
Michael Pfellus lived not long after Nonus, and in- fcribedthe book which he put together, Concerning the Qualities and Virtues of Aliments, to Conftantine the emperor. Lambecius thinks this Conftantine is he who is called Monomachus, and who reigned from 1043 to 1055; but if, according to his account, Pfellus died in 1078, it is at lead as probable it might be Conftantine Ducas: and what adds to the probability is, that it ap¬ pears from Zonaras, he was preceptor to Michael Ducas, that emperor’s fon. The fame Zonaras gives this writer the character of a perfon wholly unfit to have the tuition of a prince, as being not at all qualified in any fort of letters ; but Anna Comnena, who lived a few years after him, on the contrary, extols him as one who was a perfect mafter of philofophy, one of great natural parts, and of profound learning both in Greek and Chaldaic. The fame encomiums are bellowed upon him by Leo Allatius, who (by his diflertation de Pfellis) feems to be fond of this very name, and defcribes him as one of the firft rank of writers. However there is nothing to be found in his tfeatife which can do any author much credit ; for it is only a collection from the elder Greek phyficians, who themfelves collected this part of knowledge chiefly from Galen, as he had done before from Diofcorides. He was perfecuted and dripped of every thing by Nice- phorus Botoniates, turned monk, and foon after died, very old. There are many other trails writ by this au¬ thor, an account of which we may read at large in Leo Allatius.
And yet, though Pfellus was fuch a compiler as has been mentioned, Simeon of Antioch, writing upon the fame fubjeCl, but indeed in a very impure ftyle, copied moftly from him, which is the more extraordinary, fince the book he tranfcribed from was then frelh in every one’s memory: for Simeon mull have been his contemporary, though no doubt younger, becaufe he dedicated this trea- tife to Michael Ducas called Paripanaceus, who religned the empire in 1078, the very year in which Pfellus, as we are informed, died. There are many other works of this Simeon, particularly we owe to him the tranflation (out of Arabic into'-Greek) of a very fantaftical book. Concerning the Wifdom of the Indians, which Perzoes, a phyfician, collected at the defire of Chofroes, king of Perfia.
ACtuarius, the fon of Zachary, fo called without doubt from the employment he held as chief phyfician to the emperor, is an author of a better character than thofe we have juft mentioned. He wrote feveral treatifes, in which occur many things worth our reading. He prac- tifed at Conftantinople, and, as it appears, with fome de¬ gree of credit; his fix books concerning the method of cure being compiled for the ufe of one of the chief offi¬ cers at court, the lord chamberlain, who was fent upon an embafly into the North. Fabricius by miftake makes ACtuarius himfelf the ambaflador. Tn thefe books, though he chiefly follows Galen, and very often Aetius and Paulus, without naming them, yet he makes ufeof whatever he finds to his purpofe, both in the old and modern writers, as well barbarians as Greeks ; and, to do him juftice, we may find feveral things in him not to be met with any where elfe. Thus, for inftance, he is the firft Greek writer who has mentioned or defcribed the milder forts of purging Vol. XIX. No. 1284.
and, though thefe are chiefly in ufe now, yet the pods are fometimes made ufe of too; and, by what we can learn from thefe writers were probably the only part of fenna which was then adminiftered in phyfic. Another thing which we meet with in no Greek writer before Ac- tuarius, is the mention of diftilled liquors, as diftilled rofe-water, See. See.
There are not proofs clear enough to point out to us the time where we might fix the precife age of this wri¬ ter. He is commonly, but without any good authority, reckoned to have lived in the eleventh century by fome, and in the twelfth by others. Lambecius brings him down as low as the beginning of the fourteenth ; but from his ltyle we may conclude that he was more ancient ; for, if we compare him either with Pfellus or Simeon, he will appear to have a much greater purity in his diCtion ; and indeed after 1200, we lhall fcarce meet with any writer but who has fome mixture of modern Greek, or fome barbarifms taken from other languages.
We have brought down this feCtion to a much later pe¬ riod than we intended, in order to complete the hillory, as far as we could ground it upon any good authorities, of the few Greek phyficians who appeared after the time of Galen. There has been a prevailing opinion that no¬ thing was done among the ancients towards advancing this art, but what is comprifed in the voluminous works of that great man. What gave the firft rife to fuch a no, tion probably might be this : that becaufe thofe who fuc- ceeded Galen did tranferibe a great deal from him, many were inclined to think, without giving themfelves the trouble of examining and comparing their writings, that they did nothing elfe but tranferibe. And no editor of thefe authors has yet taken the leaft pains to undeceive them in this point, what has been left us by way of comment, being chiefly employed in grammatical or critical remarks, without any view of explaining what relates either to the hillory or the practice of phyfic in the time of each re- fpedtive writer. But we have given fome inftances, and more might be given, where the phyficians we have been fpeaking of have defcribed diftempers which were omit¬ ted before ; where they have taught a new way of treat¬ ing old ones; where they have given an account of new medicines, both fimple and compound, and where they have made large additions in the practice of furgery. And, if thefe be any real improvements of the art, it cannot be denied but that phylic was ftill making a pro- grefs till the year 600. As to furgery in particular, we may, without derogation to the more ancient writers, affirm, that whoever carefully looks into Aetius and Paulus, will be convinced that a great many improve¬ ments have been made in that branch of pathology which are not recited in Galen or any where elfe. And in general it may be remarked, once for all, that the wri¬ ters mentioned in this period, till the beginning of the 7th century, and thofe whofe remains they have preferved, were not fuch collectors (which is commonly the cafe) as had little knowledge of the fubjedt they undertook to treat of, but were every one of them men of experience and pradtice. And, if the later Greek writers who fuc- ceeded, were perfons of a lower character, and made little advancement in the art they profelfed, it is the lefs to be wondered at, fince, for many centuries, univerfal ignorance prevailed over all the world; and it could not be expedited that phyfic fliould make any progrefs, when all other fciences and all forts of learning were almoft quite extindl, or that it fliould be exempt from the common calamities of thofe times.
F
II. From
18 PATHOLOGY.
II. From the Dark Ages to the end of the Sixteenth Century.
After the downfal of the Roman empire, and when the inundation of Goths and Vandals had almoft com¬ pletely exterminated literature of every kind in Europe, medicine, though a practical art, (hared the fame fate with more abftraft fciences. Learning in general, banifhed from the feat of arms, took refuge among the eailern nations, where the arts of peace ftili continued to be cul¬ tivated. The Arabians, from their vicinity to Alexandria, from their intercourfe with the fed! of Neltorians and with the Greek philofophers, who had been compelled by the perfecution of Jultinian to take refuge in the Ma¬ hometan dates, had acquired a tafte for literature and the fciences. The knowledge which they polTeffed of medi¬ cine is a fubjedt of curious inquiry. In the anatomical branch, they did little more than tranflate and paraphrale the Greek w riters. The errors which their originals had made in anatomy became facred ; and, if the Arabs have defcribed certain parts of the body with more exadtnefs than Galen, thefe defcriptions were only conjedlures, or the confequence of the ftudy of fome Greek authors who have not defcended to us. The Mahometan laws prohibit diffedtions, becaule, in the opinion of the Muffulmans, the foul does not depart from the body at the moment of death : it paffes from one member to another till it cen¬ ters in the bread, where it remains for a coniiderable time. The examination by the angels, of the deceafed per- fon in his tomb, could not be made on a mutilated corpfe. The phyficians of the Arabs dudied, therefore, only fkeletonsdn the cemeteries, and in mod furgical cafes im¬ plicitly followed the ancients.
Chemidry, with the red of the fciences, being banilhed from the other parts of the world, alfo took refuge among the Arabs. Geber in the feventh or eighth, and others in the ninth, century of the Chridian asra, wrote feveral chemical, or rather alchymical, books, in Arabic. In thefe works of Geber are contained fuch ufeful directions concerning the manner of conducting didillation, calci¬ nation, fublimation, and other chemical preparations, and fuch pertinent obfervations refpedting various mine¬ rals, as judly feem to entitle him to the character which fome have given him of being the father of chemidry, the difcoverer of the key to the ricked treafures of nature, though he himfelf modedly confelTes that he has done little elfe than abridge the dodtrine of the ancients con¬ cerning the tranfmutation of metals. He mentions fe¬ veral mercurial preparations, fuch as the corrofive fubli- mate and red precipitate, nitric acid, muriatic acid, and many other chemical compofitions.
The Herbal of Diol'corides was enriched by the Saracens with the addition of two thoufand plants, and their knowledge of the vegetable world enabled them to infert in their pharmacopoeia feveral remedies which had been unknown to the Greeks. One great difference between the Grecian and Saracen difpenlatories was, that the me¬ dicines in the latter were of a milder nature than thofe in the former: another difference was the common ufeof fugar in lieu of hopey. Diofcorides, fpeaking of the va¬ rious fpecies of honey, fays, that there is a kind of it in a concrete date, called, Jaccliaron, which is found in reeds in India and Arabia Felix : he alfo defcribes its medicinal virtues. Galen writes upon it nearly in the fame man¬ ner; but the hidory of the artificial preparation of fugar, by boiling or other means, was very imperfedtly known. The Saracens appear, however, to have underdood the art ; for, by a mixture of fugar with other ingredients, they made various medicines with which the ancients were unacquainted.
The caliphs had done much to render the Arabians thus eminently learned. In the feventh century, Almanfor, and his famous fuccefior Harun A1 Rafchid, patronifed feveral medical fchools, founded hofpitals and academies, and afiiduoufly cultivated the introduction of Grecian learning. Unfortunately, the Arabian phyficians
mixed abfurd and myderious fuperftitions with the knowledge they thus acquired. The popular tade for the marvellous induced them to refort to every means of impofing on the vulgar. Adrology was introduced, par¬ ticular pofitions and appearances of the liars were ftudied in dangerous cafes, and amulets were in the poffellion of every fuccefsful and popular pradtifer of medicine.
As difcoverers and inventors, the Saracens have few claims to praife, but they formed the link which unites ancient and modern literature; and, fince their relative fituation with Europe fomewhat refembled the relative fituation between Egypt and Greece, they are entitled to a portion of our refpedt and gratitude. When the princes of the wed began to emerge from barbarifin, they cor¬ rectly acknowledged the Moors to be the great depofitaries of knowledge. Many ufeful treatifes, now loll in the original, for example the fifth, fixth, and’ feventh, books of the Conic Sections of Apollonius Pergamus, and fome of the commentaries of Galen and Hippocrates, were pre- ferved in the language of the Saracens, or Arabians, as they are indifferently called.
Among the moll eminent of the Arabian phyficians, we may reckon Rhazes, Avicenna, Albucafis, and Avenzoar.
Rhazes, one of the olded and mod didinguifhed, was born at Rei, in the province of Chorafan, about the year 852. There was a fchool in his native town, at which he received his early education ; but he is laid not to have commenced the dudy of medicine till fomewhat late in life, having given up his time much to the cultivation of nuific. After he was thirty years of age, he removed to Bagdad ; and then he turned his attention to philofophy, and afterwards to phyfic. He became, however, indefa¬ tigable in his application; and was continually occupied in obferving, reading, and writing, until he obtained the highed reputation ; and he was feledted out of a hundred eminent phyficians, who were then refident at Bagdad, to fuperintend the celebrated hofpital of that city. The hif- torians confidered him as the Galen of the Arabians ; and, from his long life and conftant practice, during which he paid the moll affiduous attention to the varieties of difeafe, he obtained the appellation of the Experimenter, or the experienced. He was faid alfo to be profoundly fkilled in all the fciences, efpecially in philofophy, aftronomy, and rnufic. Fie travelled much in purfuit of knowledge, and made frequent journeys into Periia, his native country, and was much confulted by feveral princes, particularly by Almanfor, the chief of Chorafan, with whom he fre¬ quently correfponded, and to whom he dedicated feveral of his writings. Abi Ofbaia enumerated 226 treatifes compofed by Rhazes, among which the ten books addrelfed to his patron Almanfor are mentioned, and therefore are doubtlefs genuine, although Haly Abbas, who has given an account of him and his works, has not noticed them. This work Rhazes defigned as a complete body of phyfic, and it may be deemed the great magazine of all the Ara¬ bian medicine : the ninth book, indeed, which treats of the cure of difeafes, was in fuch general ellimation for feveral centuries, that it was the text-book of the public fchools, and was commented upon by the moll learned profellbrs. Neverthelefs, like the rell of the Arabian writings, it contains very little more than the lubllance of the wmrks of the Greeks, from whom the Arabians borrowed almoft all their medical knowledge. They have, indeed, and Rhazes in particular, given the firlt diltindl account of the JinalL-pux, a pellilential malady which the Greeks have no¬ where accurately defcribed, and which is, therefore, gene¬ rally inferred to have been unknown among that people. This is quellionable ; but, at all events, the firlt lpecific account of the fmall-pox is to be found in the works of Rhazes. He was the author, alfo, of the firlt treadle ever compofed refpedting the difeafes of children. His book on. the affedtions of the joints is interelling, and contains an account of fome remarkable cures, effected chiefly by co¬ pious blood-letting. He defcribes the fymptoms of hy- 4 drophobia
PATHOLOGY. 19
drophobia very well ; and alfo Tome difeafes peculiar to eaftern countries, as the ignis perilous, vena medinenfis, See. and he fil'd noticed the difeafe called fpina ventofa. Rhazes had the reputation of being a ikilful alchemift; the art of chemiftry, in fa£t, originated with the Arabians; and Rhazes is the firft, as Dr. Freind has fliown, who men¬ tions the ufe of chemical preparations in medicine. He has a chapter on the qualifications of a phyfician ; and a Angular trail on quacks and impoftors, in which he has pourtrayed that claft of pretenders to the life ; and his detail of their pretenfions (flows that they were at leaft as numerous, and ingenious in their contrivances of cheatery, as in more recent times. Rhazes lived to the age of eighty, and loft his fight : he died in the year 932. His works that have come down to us, through the me¬ dium of tranflations in Latin, are, 1. A fort of common¬ place book, entitled Continent, or Libri Continent es. a. A much more perfect work, the Libri Decern, ad ' Alnutnf or em, publifhed at Venice, 1510. 3. Six books of Aphorifms,
publiflied under the title of Liber de Secretis, gui Aphorif- morum appellatur, Bononiae, 1489. 4. A trail on the
fmall-pox and meafles, entitled, De Pejlilentia. This laft was tranflated by Dr. Mead in 1747, and by Mr. Chan- ning in 17 66. As it is a fubjeil fo much in difpute, we (flail give an extrail from the very firft chapter. “ As to thofe phyficians who affirm, that the mod excellent Galen lias made no mention of the fmall-pox, and therefore that lie did not know this diftemper ; furely they have either never read his works at all, or only very curforily; nay, ,moft of them do not know, whether what he plainly fays of it is to be underftood of that difeafe. For Galen, in a certain treatife, fays, this drug does good this and that way, and alfo againft the fmall-pox. And in the beginning of the fourteenth book, of pulfes, that the blood is putre¬ fied in an extraordinary degree, and that the inflammation runs fo high, that it burns the fkin ; fo that the fmall-pox and peftilent carbuncle are bred in it, and quiteconfume it. And in the ninth treatife of the book of the Ufe of the Parts, he obferves, that the fuperfluous parts of ali¬ ments, which are not turned into blood, and remain in the members, putrefy, and in time increafing do ferment; whence, at laft, are generated the peftilential carbuncle, the fmall-pox, and confluent inflammations. Laftly, in the fourth part of his Commentary upon the Timteus of Plato, he fays, that the ancients gave the name cp\iyp.otrt to every thing which produces rednefs,as the carbuncle and fmall- pox ; and that thefe difeafes are bred in thofe in whom bile abounds. But, as for thofe who allege; that he has propofed no remedy or cure, nor explained the nature of this diftemper, they indeed fay what is true : for he men¬ tions no more than what we have cited. But God knows whether he might not have done it in fome other books, which have not yet appeared in Arabic.”
Avicenna’s Canon Medicines, or General Syftem of Me¬ dicine and Surgery, was for many ages celebrated through all the fchools of phyfic. It was principally compiled from the writings of Galen and Rhazes. The latter had, in difficult labours, recommended the fillet to aflift in the extrafilion of the foetus 5 and, for the fame purpofe, Avicenna recommends the forceps. He deferibes the compofition of feveral cofmetics to polifh the fkin, and make the hair growq or fall off. See the article Avi¬ cenna, vol. ii.
Albucafis flourifhed about a hundred years after Avi¬ cenna : the date of his birth is not known, but he died in 1106. He is chiefly eminent as a furgeon ; and, al¬ though much of what he has left on the fubjedt of his art is copied from Rhazes, from Paulus -Eginasta, and other preceding writers; he has many original obferva- tions ; and by thofe who love to fee the firft dawnings of improvement in fcience, his works will be dill turned over with pleafure. He infilled on the neceflity of a fur- geon’s being fkilled in anatomy, to enable him to ope¬ rate with fuccefs; he alfo held it to be equally neceflary that he fhould be acquainted with the materia medica, or
the properties of the medicines employed in curing dif¬ eafes ; and inveighs againft thofe who undertake for gain the cure of difeafes, of the nature and caufes of which they are unacquainted. It appears from his writings, that he extracted polypi from the noftrils, performed the operation of bronchotomy, and ufed a preparation fimilar to the lapis infernalis, as a cauftic. He enumerates a tremendous lift of operations, fufficient to fill us with horror. The hot iron and cauteries v.'ere favourite re¬ medies of the Arabians ; and, in inveterate pains, they repofed, like the F.gyptians and eaftern Aliatics, great confidence in burning the part. He deferibes accurately the manner of tapping in afeites; mentions feveral kinds of jnllrunients for drawing blood ; and has left a more ample and corredl delineation of lurgical inftruments than any of the ancients. He gives various obftetrical direc¬ tions for extrafling the feetus in cafes of difficult labour. He mentions the bronchocele, or prominent tumour on the neck, which, he tells us, was mofl frequent among the female fex. We are alfo informed by this writer, that the delicacy of the Arabian women did noUpermit male furgeons to perform lithotomy on females 5 but, when neceflary, it was executed by one of their own fex.
Of Avenzoar nearly all that is known has been com¬ municated under his article. The date of his birth is uncertain ; he is faid to have lived to the great age of 135 years ; but, as he had a fon of the fame name and pro- feflion, it is very probable that the age of both is in¬ cluded in this term. He (or his fon) died at flforocco in 1166, or at Seville in 1162. Avenzoar prepared his own medicines, reduced luxated bones, and performed other chirurgical operations. The work by; which he is principally known is a compendium of the praflice of medicine; in which fome difeafes are deferibed not found in other writers. It includes a number of cafes, candidly, it fhould feem, related, as the author does not conceal thofe in which he was unfuccefsful. See Avenzoar, vol. ii.
Thus we fee, that, in confequence of the general decay of learning in the weftern parts of the w'orld, the Greek writers were entirely neglefled, becaufe nobody could read the language ; and the Arabians, though principally copiers from them, enjoyed all the reputation that was due to the others. The Arabian phyfic was introduced into Europe very early, with the mofl extravagant ap- plaufe : and not only this, but other branches of their learning, came into repute in the weft ; infomuch that in the nth century, theftudies of natural philofophy and the liberal arts were called “ the fludies of the Saracens.” This was owing partly to the crufades undertaken againft them by the European princes ; and partly to the lettle- ment of the Moors in Spain, and the intercourfe they and other Arabians had with the Italians. For, long be¬ fore the time of the crufades, probably in the middle of the 7th century, there were Hebrew, Arabic, and Latin, profeffors of phyfic fettled in Italy and Spain. The uni- verfity of Cordova, which had been founded by Alhakem, became the molt celebrated in the world, and maintained its repute for a long courfe of years. As early as the tenth century, Cordova could boaft of the largeft library in the weft; a library of 250, ooo'books, and of which the catalogue is faid to have filled forty-four volumes. In the twelfth century, there were no lefs than feventy public libraries in Spain : Cordova had produced 1 50 authors, Almeria 52, and Murcia 62. At Seville, at Toledo, and at Murcia, academies were alfo eftablifhed, which continued to flourifh during the whole period of the dominion of the Arabians.
In the tenth century, the rich and maritime city of Salerno, in the Neapolitan territory, arrefted the attention of the predatory Muflulmen. Frequently engaged either in war or in negociation, they became mixed with the Chriftians, and gradually communicated their literary attainments ; and, in the year 802, Charlemagne founded in Salerno a fchool, which in procefs of time^ became the
moll
20 PATHOLOGY.
mod celebrated in the world. About the latter end of the nth century, Conftantine the African introduced into the Salernian fchooi the Grecian authors, as well as the learning which he had obtained from a long refidence in Babylon and Bagdad. In the twelfth century, how¬ ever, this fchooi arrived at its higheft fame; and was much frequented by the crufaders in their paftage to and from the Holy Land. Among thefe, Robert, the ion of William the Conqueror, had the honour of having the well-known “ Regimen Sanitatis Salerni” dedicated to him. In the year 1140, the emperor Frederic II. con¬ ferred particular privileges on the fchooi of Salerno, and regulated the courfe of ltudies, and the probations which phyficians and furgeons ihculd undergo before they were permitted to praftife. Many of the ordinances iliow great judgment. The Salernian fchooi continued accordingly to flouriih till the middle of the fourteenth century, when it appears to have begun to decline. “Fuiffe Salerni,” fays Petrarch, “medicinas fontem fama eft ; fed nihil eft, quod non fenio exarefcat.” Gariopontus, Nicolaus, AEgidiu-s, Enos, and John of Milan, the author of the Regimen Sanitatis, are the chief writers whom this fchooi boafts. This fchooi was perhaps, the firft that eftabliftied the form of public examination and admiftion, and pof- fefled the power of conferring medical licenfes and de¬ grees. It recognifes molt obvioufiy the exiftence of apo¬ thecaries, and enforces the propriety of difcriminating the three branches of the medical profeflion from each other. The phyfician was under the neceftity of pro¬ ducing teftimonials that he had been a medical ftudent for feven full years ; the furgeon that he had attended to anatomy for at leaft one ; and the apothecary was pro¬ hibited from charging more than an eftabliftied ratio for the medicaments he compounded or employed.
While the eaftern nations aftiduoufty cultivated the knowledge of the Greek writers, and while their caliphs and rulers encouraged fcience by a liberal patronage, a very different part was followed by the Chriftians. The clergy, actuated by avaricious motives, feized upon the province of the phyfician ; and the moft ignorant priefts and rn.onks ventured upon the practice of medicine, with¬ out any proper ftudy or preparation. At length the evil became too crying to be any longer endured ; and the firft Lateral! council, held in 1123, forbade the regular clergy to vifit any longer the lick. The prohibition was re¬ peated, in other terms, by the council of Rheims in 1131, and by the fecond general Lateran council in 1139 ; and thofe monks and canons who applied themfelves to phy¬ fic, “ordinis fui propofitum nullatenus attendentes, pro de- teftunda peeunia fmitalem pollicentes ,” were threatened with fevere penalties ; and all bifhops, abbots, and priors, who connived at their mifconduft, were ordered to be fuf- pended from their ecclefiaftical funftions. “ But the French priefts and monks,” fays Cabanis, “bade defiance to thefe thundering anathemas ; and it was not till three hundred years after, that common fenfe, and a regard to propriety and the public good, triumphed finally over their artifices. A fpecial bull, procured by the cardinal d’Eftonteville, in 145a, which permitted phyficians to marry, effected their complete feparation from the clergy ; and, l this means alone, put a flop to a variety of fliame- ful abufes.
To the honour of our country, however, be it men¬ tioned, that thefe abufes do not appear to have prevailed to fuch an extent among us. The clergy did not indeed praftife phyfic, but they were armed with great autho¬ rity over thofe who did. In the days when benefit of clergy had a laving fignification in courts of law, the minifters of religion were regarded with great reverence; and their powers over the practice of medicine are not yet quite extinft. The firft control exercifed over the practice of phyfic in England appears to have been ecclefiaftical, though the end and purpofe of the interference of the church on this occafion, as in moft others in thofe times,
.as not fo much the health of the body as the welfare
of the foul, ecclefiaJUcaUy underflood. One of the confti- tutions of Richard Wetherfhed, archbilhop of Canterbury anno 1229, in the fourteenth year of the reign of Henry III. runs as follows : “Under pain of anathema, we for¬ bid any phyfician to give advice for the health of the body which may prove perilous to the foul, which is much more precious than the body. But, when it happens that he is called to a lick man, let him firft effeftually perfuade him to call for the phyfician of the foul ; that, when the fick man has taken fpiritual cure, he may, with better effeft, proceed to the bodily medicines. Let not the tranfgreftors of this conftitution efcape the punilhment appointed by the council.” The punilhment here de¬ nounced againft phyficians fo offending, was a prohibi¬ tion from entrance into the church till they had made fatisfaftion, according to chap. xxii. of the council of Lateran, under Pope Innocent III. from whence this conftitution is taken.
It was nearly two centuries after this, namely, in the reign of Henry V. anno 9. that the firft ftatute was enafted relative to praftitioners in phyfic. The preamble to this aft, after reciting the mifchiefs arifing from illiterate praftifers, ftates, “ that if no man praftifed therein but all only conynge men, and approved, fufficiently ylearned in art, filofofye, and fifyk, as it is kept in other londes and roiaumes, therftiuld many man that dyeth for de- faute of help lyve, and no man perilh of unconnyng.” The petition then goes on to pray, that no perfon be allowed to praftice phyfic, “ but he have long time yufed the fcoles of fifyk within fome univerfitee, and be gra¬ duated in the fame.”
The next aft reftraining the praftice of phyfic in London and its immediate vicinity, to perfons of approved competency, was palled in the third year of the reign of Henry VIII. feven years prior to the eftablilhment, by charter, of the prefent College of Phyficians. Its title was, “ An Aft for the appointing of Phyficians and Sur¬ geons.” It was enafted that no perfon within the city of London, nor within feven miles of the fame, take upon him to exercileand occupy as a phyfician or furgeon, except he be firft examined, approved, and admitted, by the bilhop of London, or by the dean of Paul’s, for the time being, calling to him or them four doftors of phyfic, and, for furgery, other expert perfons in that faculty. When the Charter of the College of Phyficians was granted by the king, it was on the petition of a prieft, the cardinal Wolfey, chancellor of England, in conjunftion with John Chambre, Thomas Linacre, Ferdinand de Victoria, foreign graduates, the king’s phyficians, and Nicholas Halfwell, John Francis, and Robert Yaxley, phyficians. And the archbilhop of Canterbury can, and does to this day, by his diploma, conftitutea phyfician.
To return from this digrelfion. — After Salernum, the Univerfities of Montpellier, Paris, Boulogne, Pavia, Padua, and Ferrara, became the moft diftinguilhed femi- naries for medical education ; but the fervile attachment to ancient dogmas which obtained in their fchools ma¬ terially retarded their progrefs. In 1271, the College of Surgeons at Paris was eftabliftied by Pitard, a man who, according to Quefnay, was born for the advancement of his art ; and furgery was henceforth cultivated with much fuccefs in France, as a diftinft branch of the profeflion. Several writers on phyfic appeared in England ; among whom Gilbert has the merit of having furnilhed the belt defcription of the leprofy of the middle ages ; but he trod in the footfteps of the Arabians, and gave into the fcho- laftic ftyle. The fame remark applies to his fucceftors, John of St. Giles, Richard of Windermere, Nicolas of Farneham, John of Gaddefden, &c. It was in Italy that medical fcience was revived in the trueft fpirit. In the year 1315, Mondini de Luzzi, profeffor at Bologna, aftoniflied the whole world, to ufe vicq d’Azyr’s expref- fion, by the public difleftion of two human bodies. His example was followed in other univerfities ; but the utility of the praftice was in a great degree fruftrated by
PATH
the predilettion for ancient opinions, which made the anatomifts of the age lefs anxious to difcover new fatts, than to reconcile the appearances which they obferved with the dogmas of Galen and Avicenna. An abfurd bull of pope Boniface VIII. forbidding the maceration and preparation of Ikeletons, alfo concurred to impede the progrefs of anatomy; (Blumenbach, Hift. Med. Litterar. p. 99.) but from this time forward, the Italian profeffors maintained a high repute for anatomical fcience, and have ranked among the inoft zealous contributors to our knowledge of the human frame.
Though the crufades had conferred no direct benefits on fcience, they had given a new impulfe to the human mind, by the fpirit of commerce which they excited. They were alfo the occafion of the rapid fpreading of leprofy and fome other difeafes in the Weft, and of the confequent increafe of inftitutions for the relief of the fick, after the example of the Oriental nations. Several orders of knighthood, as the Templars, the knights of St. John, of St. Lazarus, the Hofpitalarii Santti Spiritus, &c. were founded with this charitable view ; the mem¬ bers devoting themfeives to the cure of fuch pilgrims as were afflitted with difeafe.
In the fifteenth century feveral new difeafes appear to have invaded mankind, or, at leaft, to have attacked them with a degree of violence that was before unknown. The whooping-cough was epidemic in France in the year 14.14: and, according to Mezeray, it attacked all defcrip- tions of perfons, even, the oldeft men. The fweating ficknefs, which broke out firft in the fame country, was brought to England by the foldiers of the duke of Rich¬ mond (afterwards king Henry VII.) upon his landing at Milford-haven in 1485; and fpread itfelf at London from the 21ft of September to the end of Ottober. It returned there five times, and always in fummer; firft in 14 95, then in 1506, afterwards in 1517, when it was fo violent that it killed many in the fpace of three hours, fo that numbers of the nobility died, and of the com¬ monalty in feveral towns often the one-half perilhed. It appeared the fourth time in 1528, and then proved mortal in fix hours ; many of the courtiers died of it, and Henry VIII, himfelf was in danger. In 1529, and only then, it infefted the Netherlands and Germany, in which laft country it did much mifchief. The laft return of it was in 1551 ; and in Weftrninfter it carried off 120 in a day.
At this time alfo a new difeafe overran the world, and threatened greater deftruttion than almoft all the old ones put together, both by the violence of its fymptcms,and its baffling the moft powerful remedies at that time known. This was the venereal difeafe, which is fuppofed to have been imported from the Weft Indies by the companions of Chriftopher Columbus. Its firft remarkable appear¬ ance was at the fiege of Naples in 1494, from whence it was foon after propagated through Europe, Afia, and Africa. The fymptoms with which it made the attack at that time were exceedingly violent, much more fo than they are at prefent ; and confequently were utterly un¬ conquerable by the Galenifts. At this period, as fea- voyages of confiderable duration were more frequent, the fcurvy became a more common diftemper, and was of courfe more accurately defcribed. But probably, from 1'uppofed analogy to the contagions which at that time were new in Europe, very erroneous ideas were enter¬ tained with regard to its being of an infettious natures and it is not impoflible, that, from* its being attended alfo with ulcers, it was on fome occafions confounded with fyphilitic complaints.
Dreadful as the inflittion of thefe maladies muft have been on the fuffering world, we have reafon to believe that they were not without their ufe in leading to the improvement of medicine. The phyficians of the time, finding the rules of their favourite authors quite inap¬ plicable to the cure of diftempers fo malignant, naturally began to obfefve and judge for themfeives. Manardi and Leoniceno (fee their refpedlive articles) laboured to Vol. XIX. No. 1284.
O L O G Y. 21
expofe the errors of the Arabs, and bring back, their followers to the ftudy of Nature and Hippocrates. In this laudable undertaking they were feconded by the German, French, and Englilh, profeffors ; and particu¬ larly by the labours of Dodoneus, Schenkius, Foreftus, and Platerus.
In the early part of the fixteenth century, Briffot of Poitou revived a fubjett which had before engaged phy¬ ficians in violent difputes. According to the Hippocratic mode of treating inflammation, which was to take* the blood from the inflamed part as clofely as poflible, the Greek phyficians were wont, in pleurify, to bleed in the arm of die fame fide as was affetted with pain. Avicenna had objetted to this, and recommended venefettion in the oppofite arm. This produced a great deal of alter¬ cation ; and in the end a decree of the univerfity of Palermo iffued forth which forbade any one to bleed ex¬ cept in the contrary arm ; and the profeffors endeavoured to perfuade the emperor Charles V. to fecond it by an edidt. Briffot met with almoft as much opposition in reviving the old method as the Salernitans had done in introducing the new one : but at length the difpute was fettled in favour of Briffot by the great anatomical dif- coverers of that century.
The fcience of anatomy gradually became imnroved in the hands of Zerbi, Winter, Laguna, and Sylvius ; which laft taught anatomy at Paris in 1532. But it was referved for the great and comprehenfive mind of Vefalius to throw off the fhackles which had fo long fettered the progrefs of anatomy. So far from adopting as infallible dogmas the anatomical relations of Galen, he attached himfelf particularly to difclofing the errors of that author. He firft advifed anatomifts to injett co¬ loured fluids into the veffels of the body, in order to fa¬ cilitate the labour of minutely tracing them. Wliilft he was a young man at college, he purfued anatomical in¬ quiries with great ardour and afliduity, and publilhed fome of his difcoveries before he was twenty-five years of age, and feven books on the anatomy of the human body before he was twenty-nine, A. D. 1542. Thefe books contain great difcoveries, and, in many circumftances, correct the ancients. But, although they have entitled their author to the gratitude of pofterity, they procured to him fcarcely any thing but animofity from his con¬ temporaries. The authority of Galen was ftill held in high veneration ; and, when Vefalius expofed his errors, the hatred of all feemed turned againft him. People could not bear to be fet right by fo young a man; and even Sylvius denounced perpetual enmity againft him. But, confident in the certainty with which diffettion furninied him, he acquired a complete afcendancy over liis adver¬ saries : fo much fo, indeed, that his lettures were fome- tiines attended by 500 pupils. He preffed Sylvius, his mafter, fo hard, in. thefe controverfies, that the latter, rather than admit his favourite Galen was wrong, afferted* that “ the Jtrudiure of the human body hud become altered in fomeparticularsjin.ee the time of Galen, and. that man’s nature had degenerated !” Thus, for inftance, the number of the pettoral bones occafioneda difpute, which was carried on with great acrimony between them. Galen had adopted feven in the human ikeleton ; but Vefalius proved that there were only three, and that his opponent had again been milled by the Ikeleton of a monkey. But Sylvius objetted to this, “ that men had been larger and taller in the time of Galen, and had feven pettoral bones, but that, in this dwarfilh century, three only could be found.” Vefalius afferted, that the bones of the hand are not totally deftitute of medullary fubftance, as Galen had maintained ; and Sylvius again endeavoured to re¬ fute his affertion, by the abfurd argument, “that the bones in former times had been firmer and harder, and confequently required no fuch fubftance.” Vefalius re¬ jetted the large curvature which Galen aferibed to the os humeri, and the os ilium; while Sylvius defended Galen, by afferting, that the bones had become more G ftraight
22
PATHOLOGY.
ftraight by the modern mode of drefs. He vindicated, in a fimilar manner, Galen’s neglect in defcribing the car¬ tilages of the extremities of the bones: ‘'In former times,” faid he, “ the bones were more folid, and confe- quently required no cartilages !”
Thefe prejudices had not paffed away from among the French phyficians even in the following century; for we find Moliere, in his Medecin malgri lid (Mock DoCtor), alluding to the abfurdity we have juft mentioned, of fome parts of the vifcera having changed their places.
“ Dodlor. Now thefe vapours of which I am fpeaking having palled from the left fide, which is the feat of the liver, to the right, where the heart is fituated, then the Jungs, which we call in Latin armyan, communicating with the brain, which in Greek we call nafrnus , by means of the vena cava, which is cubile in Hebrew, meets in its way with thefe vapours, which fill the ventricles of the omoplate ; and, fince thefe vapours pofiefs a certain ma¬ lignity caufed by the acridity of the humours engendered in the concavity of the diaphragm, it therefore happens that thefe vapours — in fiiort, this is precifely the reafon why your daughter is dumb.
“ Father. Nothing in the world can be clearer than this reafoning. Only one difficulty occurs to me ; namely the feat of the liver and of the heart. I always thought the heart to have been on the left fide, and the liver on the right.
e‘ Doflar. Yes ; it was fo formerly ; but we have altered all that, and medicine is now adminijiered in a manner to¬ tally new." Mock Doftor, aft ii.
Vefalius had great advantages over his predeceffors in being able to perpetuate his labours by means of the beautiful reprefentations which Titian and others painted for him. In 1561, Fallopius, in Italy, publifhed his Ob- fervationes Anatomicte ; he was an indefatigable anato- mift, and made great difcoveries. About the fame time, Euftachius made himfelf confpicuoufly eminent by pro¬ moting anatomical knowledge. He feemed calculated for fubtle inveftigations ; he drew many figures of the human body, and engraved his own plates, the accuracy of which cannot fail of exciting furprife in an anatomift of the prefent day. When the labours of thefe eminent men had, as it were, fmoothed the path, anatomy was taught with a moderate degree of correCinefs and mi- mitenefs in the different fchools of Europe.
But the moft important difcovery of this fcience was that of the circulation of the blood. Berengar, who had paid great attention to the ftruCfure of the heart, conjeffured the right ufe of the femilunar valves. In 1547, Cannani and Amatus obferved the valve at the ter¬ mination of the vena azygos; but they did not turn the difcovery to account; and it was referved for Fabricius of Aquapendente to prove the prefence of valves throughout the whole courfe of the veins. Five years afterwards, the circulation of the blood through the lungs was imperfeCHy defcribed by Servetus, who had availed himfelf of the refearches of Berengar and Vefalius. In the year 157-1, Csefalpinus had the merit of ftating it more clearly, and even of fuggefting the firft hint of the greater circulation ; but the full honour of the latter difcovery muft be afcribed to our countryman, Harvey.
This improvement in anatomical knowledge was ne- ceffarily accompanied by a ccrrefponding one in forgery. The Italian furgeon, Maggi, corre&ed the abfurd no¬ tions that his predeceffors had inculcated, viz. that gun- fhot wounds were conneCled with combuftion, and that gunpowder poifoned the wound. He fhowed that, fince the balls did not fet the wadding on fire when they came firft from, the barrel of the gun, they could not be hot; nor could gunpowder poifon a wound, fince it was com- pofed of none but harmlefs materials. Maggi likewife left fome ufefnl directions concerning amputation. Am- brofe Pare introduced into France the treatment of gun- fliot wounds eftablifhed by Maggi. The fame praCfice v.as likewife adopted by John Baptift. Carcano Leone,
profeffor at Pavia. Pare was, however, unqueftionably the moft celebrated furgeon of the 3 6th century. Be- fides the improved treatment of gun-fhot wounds, which he had the merit of introducing, together with many other peculiarmethods in operative furgery, he has ren¬ dered effential fervice to different branches of that fcience. He treated, for inftance, the hydrocele withafeton; as the dangerous confequences of incifion were in that age more frequently obferved than they are at prefent. He did not apply the aCtual cautery to wounded blood-vel- fels, according to the old practice, but fecured them by the ligature. The fraCture of the collum offis femoris, formerly confidered as a luxation of that bone, was firft afcertained by him wfith accuracy ; he alfo reprobated the frequent dreffmg of ulcers, and the application of the trepan to the futures of the cranium and the temporal bones. He made very judicious remarks on concuflions of the brain, of which Henry II. died, and on fuppura- tions of the liver arifing from injuries of the head. Wounds of the throat, in which one of the jugular veins, and even the trachea, was cut through, he did not confideras mortal. He fuccefsfully treated an injury of the nervus medianus from venefeCtion, and thereby ac¬ quired theconfidence of Charles IX. who had been fubjeCt to that dangerous accident. A perfon who, from lofing a great part of his tongue, had been fpeechlefs for a con- fiderable time, accidentally recovered the power of fpaech, by thruftiiig a table-fpoon into his mouth. Pare ingeni- oufiy imitated this method, by contriving an appropriate inftrument.
Amatus, or, according to fome, his mafter Aldaretti, had invented the ufe of bougies; and thofe inftruments now catne into very general ufe, both flmple and caufti- cated.
The doCirine of lithotomy was confiderably improved in this century, by the invention of two different me¬ thods of operating, namely, the great and the high opera¬ tion. Germain Colot had undertaken a fuccefsful opera¬ tion for the ftone, in the fifteenth century, and proba¬ bly by the high operation : but it does not appear that learned furgcons had imitated this method, till an obfcure praCiitioner at Cremona, John de Romani, in 1525, be¬ gan to adopt what is commonly called the high opera¬ tion : he taught it to Mariano Santo de Berletta, a lur- geon at Naples, who defcribed the particulars of it in a feparate treatife, publifhed at Venice in 3543, wherein he profefies to have been a pupil of Romani. It is probable that previous to this time no other method of operating was praCtifed than that known under the name of the J mailer apparatus, which can be employed only on children under fourteen years of age. In fome rare inftances which are related by Benivieni and Chrift. de Vega, par¬ ticularly in women, the ftone had been found in the ure¬ thra itlelf, in which cafes it could be more eafily ex¬ tracted. But, fince that period, the pafifage was cleared by the application of the gorget, by means of which the forceps could be introduced into the bladder. Mariano Santo made ufe of the following apparatus:' he firft em¬ ployed a curved found, which he introduced into the urethra fo as to direct the point to the left fide ; he ex- prefsly cautioned the operator againft the incifion into the perinaeum, and is therefore unjuftly cenfured for hav¬ ing attempted the incifion in the middle. His found was excavated, and he performed the incifion in the direction of the groove; then introduced the found, and along with it the conductors, and afterwards the gorget, which, ac¬ cording to its original conftruCtion, terminated in a blunt point; and laftly, he extracted the ftone with the forceps, and removed the remaining particles of it, as well as the gravel or fand, by means of the litbotomical fpoon. By the application of the blunt dilator, the parts were ne- ceffarily lacerated, and the wound occafioned by this la¬ ceration could not be healed without great difficulty. Hence Le Dran endeavoured to improve upon this me¬ thod, efpecially by making an incifion through the prof-
tate
23
PATHOLOGY.
fate gland and the bladder with his guarded knife ( cou- teuu en rondaclie); and the immortal Schmucker of Ber¬ lin was uncommonly fuccefsful in ufing the great appa¬ ratus for lithotomy in that improved ftate.
The difcovery of the high operation was the work of necefiity and accident. Peter Franco, of Turrieres in Provence, furgeon at Berne, Laufanne, and Orange, was requefted in the year 1560 to perform this operation for lithotomy, at Laufanne, on a child two years of age. He had already begun to operate with the fmall apparatus, when he found that the Hone was of the fize of a hen’s egg, and confequently too large to be removed in that manner. The child’s parents infilled that the operation Ihould neverthelefs be finilhed; and, as the bladder very much projefted above the ofla pubis, he determined upon making the incifion above thefe bones. Although he eventually fucceeded in this bold attempt, yet he pru¬ dently diffuades his brethren from imitating that practice; and indeed the danger to be apprehended from the effu- fion of the urine into the abdomen is fo great, that even the improvements made by Douglas, on the high appa¬ ratus of Franco, have not much diminilhed it. In order to remove the lione from female patients, Franco rejefts both the large and fmaller apparatus, while he propofes merely the dilatation of the urethra, by means of an in- ilrument invented by himfelf; after which he extracts the Hone with the forceps, without difiefting the parts. He likewife invented a gorgeret, and a forceps, the arms of which expand in the bladder; but the ufe of thefe inftraments has been fuperfeded by others that are more convenient.
A very painful but curious operation excited great at¬ tention during this century, although it had been pre- vioufly performed. The reader will perhaps fmile at an attempt to repair and reftore that prominent part of the human face, the nofe, when mutilated by accident. Barri, an Italian author, in his “ Italia illuftrata,” 1600, ccmfiders Vincent Vianeo as the inventor of this lingular pra&ice. However that may be, two Sicilian furgeons of the name of Branca, father and fon, had, fo early as the latter end of the fifteenth century, acquired celebrity by the fuccefsful renovation of nofes; an art which be¬ came hereditary in the family of the Bojani. But Caf- par Tagliacozzi, profefl'or at Bologna, railed this art to fuch high perfe&ion, as to render it one of the principal branches of furgery : he became fo celebrated by his ope¬ rations, that his contemporaries erefted a public monu¬ ment at Bologna, where he is reprefented with a nofe in his hand. This operation is defcribed in an interefting work, intitled, “ Tagliacot. de Curtor Chirurg.” fol. Venet. 1597 ; in which he compares it to the ingrafting of trees, expatiates on the dignity and ornament of the nofe, and endeavours to prove that there is not the leaf! danger in cutting out a piece from the biceps mufcle of the arm. With refpeft to the diet to be obferved during the ope¬ ration, he gives ample and rigid inftrudlions, while he maintains that the inoculated nofe is poflefled of a more acute fra ell, and that it generally grows much larger and ftrcmger than the organ which had been accidentally loft. We may fuppofe that this operation became lefs fuccefs¬ ful in the hands of other furgeons, and fo fell into difufe and contempt, as we find it ridiculed by Butler in the s 7th century :
So learned Taliacotius from
The brawny part of porter’s bum
Cut fupplemental nofes, which
Would laft as long as parent-breech;
And, when the date of that vras out,
Off dropt the fympathetic fnout. Hudibras, Canto i.
It has, however, been revived in the prefent day ; and has been praftifed with great fuccefs by Mr. Carpue, Mr. Linn, and others.
We might here mention the names of other practitioners who improved and illuftrated the ufeful art of furgery : as
John de Vigo, Jacob Berenger de Carpi, and Mariano Santo de Berletta ; tile latter of whom abolifhed the aftual cau¬ tery in haemorrhages, and urged the fuperiority of a pro¬ per ligature. The anatomift Fallopius, likewife culti¬ vated furgery with fuccefs, as did moft of the anatomifts of his age; and among them we might enumerate many who have contributed important improvements, would our limits permit.
The obftetric art, that important branch of furgery, began to emerge from its barbarity during the fixteenth century, and to excite the attention of furgeons more than it had hitherto done. There appeared feveral in¬ troductions to midwifery, the greater number of which, however, contained much ufelefs and abftrufe reafoning on the generation of man, and the vitality of the em¬ bryo in certain months, while they were extremely defi¬ cient in well founded and practical rules for facilitating delivery. See the article Parturition in the preceding volume.
The military furgeons of ancient times are very little mentioned in hiftory. Perhaps they were not in very great eftimation 3 as feems probable from the perfons with whom they are claffed in the military code made at Mans by Henry V. where, under the head of the perfons fubjeCt to the conftable and marfiial, the mediei are intro¬ duced in the following company : “ Whether foldiers, flioemakers, taylors, barbers, phyficians, or ■wajher-wo- men.” See Upton de Re Militari.
The low ftate of military furgery in France, even fo late as the time of Francis I. (contemporary with our Henry VIII.) may be gathered from the following extraft from an old and fcarce book called TreuJ'ure of Ancient and Modern Times : “In the year of our Lord 1536, the vic¬ torious king Fraunces fent a great army into Piedmont to vitaile Thurin, &c. I was at that time but a young chirurgion, and but little experienced in the art, becaufe I never had as yet feen the curation of wounds made by gun-fhot. True it is, I had read John de Vigo, his firfte booke of wounds in general!, chap. 8. where he faith, that thofe wounds made by fiery engines do participate of venenofity, becaufe of the powder 5 and for their cura¬ tion he commands to cauterize them with the oile of elders, mixed with a little treacle. Yet nevertheleffe, becaufe I would not be deceived, before I made ufe of the faid boyiing oile, knowing that it brought extreme paine to the patient, I obferved the method of other chi- rurgeons in the firft drefiinge of fuch wounds, which was by the application and infufion of the aforefaid oile, as hot as poflibly they could fuffer it, with tents and fetons ; wherefore I became emboldened to do as they did. But in the end ray oile failed me, fo that I was conftrained to ufe, inftead thereof, a digeftive made of the yolk of an egge, oil of rofes, and terebinth. The night following I could hardly deep at mine eafe, fearing left that, for want of cauterizing, I ftiould find my patients, on whom I had not ufed the aforefaid oile, dead and em- poyfoned; which made me rife early in the morning to vifit them, where, beyond my expectation, I found them on whom I had ufed the digeftive medicine, to feele but little paine, and their wounds without inflammation or tumour, having refted well all that night; the reft, on whom the aforefaid oile was applied, I found them incli¬ ning to feavers, with greate paine, tumour, and inflam¬ mation, about their wounds ; then I refolved with my- felfe, never to burne fo cruelly the wounded patients by gun-fliot any more. A famous chirurgion at Turin, propofed a balm for gun-lhot wounds as follows: Two young whelps, one pound of earth-worms, two pounds of the oil of lilies, fix ounces of the terebinth of Venice, and one ounce of aqua vitae. In my prefence he boiled the w'helps alive in the faid oile, untill the flelh deferted from the bones afterwards he took the worms, having before killed and purified them in white wine, to purge themfelves of the earth which they have always in their bodies ; being fo prepared, he boiled them alfo in the
3
24 PATHOLOGY,
faid oil, till they became dry; this he ftrained thorow a napkin without any great expreffion ; that doone, hee added thereto the terebinth ; and laftly the aqua vita; ; and called God to witneffe that this was his balme, which he ufed in all wounds made by gun-lhoot, and in others which required fuppuration; withall praying me not to divulge his fecret.”
How terrible muft have been the ftate of the military hofpitals, and what numbers of men muft have fallen a facrifice to ignorance, who under proper management might have been recovered to the fervice of their country! But, bad as the furgeons were, fome were neverthelefs necefiary in curarmies; and, although thegeneral modeof railing and paying them is not handed down, certainly fome regular form of doing it muft have exifted.
In the wardrobe-account of the pay of the army raifed againft the Scots, byHenryll. in the 15th yearof his reign, many of the Wellh corps have an officer ftyled Medicus ; but whether by that term a phylician or furgeon is meant, feems doubtful, as the word medicus is foinetimes ufed for both a furgeon and an apothecary. None of thefe phyficians or furgeons are charged to the Englifii levies. And to the Welch they feem to bear no regular propor¬ tion to the number of private men; a corps of 1907 men having only one, and another of 968 having two ; the wages of all, except the two laft-named, was 6d. per diem each ; thofe which were raifed on the king’s land in Cardiganfhire had only 4d. each per diem.
In the lift of the troops that attended Edward III. to the liege of Calais, only one furgeon is mentioned, who feems to have been part of the retinue of the prince of Wales; and, in the military eftablilhment of the 18th df. the faid reign, as given in the accounts of Walter Wentwayt, treafurer of the houfehold, there is one fur¬ geon for the king’s houfehold-troops ; four dodlors and one furgeon. for the army of North Wales; two doftors and one furgeon for that of South Wales ; a fupply by no means competent to the number of men to which they were appointed. Suppolingthe inferior furgeons to have been ftyled barbers, like the field-lhaver of the Germans, it feems reafonable to expefl they would fomewhere ap¬ pear on the mufter-roll.
Henry V. A. D. 14.15, engaged Mailer Nicholas Colnet, a phylician, to ferve him for one whole year, in the voyage then to be made either to the duchy of Guyenne or France. Colnet was to bring wdth him three archers. If the expedition went to Guyenne, he was to have for his own wages forty marks, and twenty marks for each of his archers, for the whole year. If to France, for his own wages is. and to each of his archers 6d. a day, with regards. In the fame year the king engaged Thomas de Moreftede, a furgeon, who contradled to bring with him twelve other furgeons and three archers. Moreftede was to be paid as a man at arms, iad. by the day; and his- twelve alfiftants and three archers, each 6d. with the ufual regard. The fame con¬ ditions were covenanted, in cafe the campaign lay in Guyenne, that were made with Colnet. Upon a peti¬ tion, the king granted Moreftede one waggon and two fumpter-horfes, for the carriage cf the baggage and ne- ceffaries for himfelf and the twelve other furgeons. He likewife petitioned for money to buy necelfaries for his office, but it was not granted. The next year the king employed Moreftede, joining with him William Brede- wardyn, with the title of his furgeons, in a ccmmilfion to imprefs as many furgeons as they thought necefiary for the expedition, with a fulficient number of artificers for making their inftruments, to be taken wherever they could be found.
Among the different perfons who indented in the 14th of Edward IV. to ferve that king in Normandy and France, for one year, are the following phyficians and fur- geor.s : Mailer jacobus Fryle, king’s phyfician, 2s. per diem, with twolervants at 6d. per diem; Mafter William Hobbis, phylician and furgeon of the king’s body, iSd.
per diem; feven furgeons at i2d. and five other furgeons every one at 6d. per diem, for their attendance in the faid fervice beyond fea. It is remarkable, that here are juft twelve furgeons, the fame number that appears to have been employed on the expedition under Henry V,
In the expedition to St. Quintin’s in the reign of Philip and Mary, 1557, an army confiding of five hun¬ dred heavy armed horfe, five hundred light horfe, four thoufand foot, and two hundred pioneers, with officers and a train of artillery proportionable, there were fifty- feven furgeons, tw’o of them belonging to the fuite of the general, one to the lieutenant-general, one to the high marifchal, one to the general of the horfeman, one to the general of the infantry, and one to the mafter of the ordnance ; all thefe at the daily pay of 1 s. each. The remainder belonged to the corps of horfe, light horfe, and infantry, in the proportion of one furgeon to an hundred men ; the daily pay of a furgeon of heavy horfe was 2s. of light horfe is. 6d. and of infantry is. No furgeon is charged for either the ordnance or pioneers.
Befides the king’s pay, it feems as if the furgeons of former times, as well as thofe of late, received a weekly ftoppage from the private men. This may be gathered from the following defcription of the duties of a mili¬