MEDICINE 



115 



9th centuries A.D. Just as difficult is the question 

 whether the Indian medicine is an aboriginal pro- 

 duct or an importation. But its earliest position 

 was an exalted one, and its young votaries were 

 drawn from the higher castes. Their curriculum 

 lasted from the twelfth to the eighteenth year; 

 decorum, piety, benevolence, unselfishness were 

 inculcated on them as duties ; and on the threshold 

 of practice they took an oath significantly resem- 

 bling the Hippocratic. Dietetics and bodily clean- 

 liness play an important part in Indian medicine. 

 From the vegetable, mineral, and animal kingdoms 

 it draws remedial agents innumerable, including 

 many antidotes to poisoning, snake-bite especially. 



The old Persian medicine, as revealed in Zoro- 

 aster's Zend-Arexta, stood in the closest connection 

 with religion. But Greece made her medical supe- 

 riority felt in Persia, as in Egypt and India, and in 

 later times the schools founded by the Nestorians 

 were important centres whence Greek medicine was 

 ilill'iised throughout the East. 



Chinese medii-ine meets us historically only in 

 the 5th century B.C. Elaborate rules for noting 

 the pulse and a portentous array of vegetable, 

 mineral, anil animal remedies are its chief char- 

 acteristics. Old Japanese medicine was borrowed 

 from it. 



Greece is the mother-land of rational medicine. 

 Already in Homer we lind practitioners ranking 

 witli musicians and architects, and visiting patient* 

 for professional fees. Medicine, as distinct from 

 surgery, is not in the Homeric foretime subordinate 

 to religion as in the East. It has its tutelary 

 deities Apollo, Artemis, and Pallas, and its 

 tutelary demigods yKscnlapius and his daughter 

 Hygieia ; bnt these were above and outside the 

 medical art, while the sick who repaired to their 

 temples were healed, not by treatment, but by 

 such religious exercises as the ' temple-sleep,' in 

 which they dreamt the dreams from which the 

 priests divined their malady and prescril>ed the 

 appropriate sacrifice. The service of .Esculapius 

 had nothing to do with medicine or its practi- 

 tioners, and was in the time of Hippocrates resorted 

 to only by the superstitious among the lower orders. 



Early in the Greek mainland and islands medi- 

 cine had rounded itself off as a distinct science 

 with application to practice. As a profession it 

 became o|>eii to every free-born citizen, and in- 

 cluded two classes the qualified and the amateur. 

 Its votaries liegan in boyhood with the study of re- 

 medial plants, the preparation of unguents, draughts, 

 and plasters, the practice of Mood letting and minor 

 surgery, and finally treatment at the liedside. 

 Duly qualified, the physician took the celebrated 

 'oath ' ami thereafter received patients in a house 

 nf his own (iiitrrimi), or visited them under their 

 own roofs, or went on circuit. The fee included the 

 cost of prescriptions when made up the humbler 

 practitioners receiving it in advance ; but many 

 towns kept a physician for the public service; and 

 in some canes physicians of eminence became at- 

 tached to foreign courts. Such was the ]>sition of 

 the medical profession when Hippocrates (460 B.C.) 

 tiathereil up all that was sound in the floating 

 doctrine and practice, and not only augmented it, 

 but gave it a character and direction of his own. 



He strikes the keynote of his school in denying 

 to disease a supernatural origin. ' From God comes 

 one disease as well as another ; but nothing happens 

 except in conformity with nature.' In medicine 

 proper his method was threefold : to ascertain 

 tin- post, to examine the present, and to forecast 

 the future of the patient. After carefully noting 

 the previous history, generally from the patient's 

 own lips, he made a thorough review of the symp- 

 tom* as the basis of a diagnosis. This review, 

 performed preferably in the morning when the 



physician's faculties and senses were at their best, 

 included the general nutrition, the bodily, particu- 

 larly the facial, complexion, the temperature, the 

 respiration, and the state of the digestion and genito- 

 urinary systems. The pulse received ^uite second- 

 ary consideration. The Hippocratic diagnosis was 

 seen to special advantage in thoracic and abdominal 

 diseases. Percussion was not neglected ; and suc- 

 cussion (i.e. shaking the patient to induce internal 

 movements which were carefully listened to) was 

 also among the aids to diagnosis. Prognosis, 

 the third and last step in dealing with a patient, 

 was likewise based on minute examination, and 

 grew naturally out of the peculiarly Hippocratic 

 doctrine of 'critical days.' Among the favour- 

 able signs were tranquil sleep, the setting in of 

 perspiration, ease of bodily movement ; while of 

 contrary import were the fifties Hippocratica 

 (still the classic description of approaching dis- 

 solution ), sinister revelations of the eye, the breath, 

 the sputum, and the abdomen, with those of the 

 excretions, particularly the urine. Dietetics hold 

 the first place in the Hippocratic treatment. In 

 acute cases the sustenance was the barlev-ptisane, 

 the drinks water mixed with honey, with acid, or 

 with wine. External agents were oil, water, bay- 

 salt in acid solution, wine, and acidulated lotions ; 

 in chronic cases diet and gymnastics, with vocal 

 exercise in singing and declamation, sometimes 

 the artificial production of obesity were employed. 

 Venesection was sparingly employed- cupiiing more 

 frequently. Drugs of indigenous and Egyptian, 

 even of Indian origin, mostly in solution, were used 

 with discrimination. See also Si'RciERY. 



For at least a century after Hip]>ocrates medicine 

 advanced but little. His Greek successors, Diocles, 

 Praxagoras, and Chrysippus, supplemented him by 

 theorising and in a less degree by independent 

 observation, and were for the former characteristic 

 called Dogmatics by Galen. 



The break-up of the Macedonian empire into 

 kingdoms gave rise to so many foci of medical 

 culture. The Alexandrian school, purely Greek 

 in personnel and character, was represented by 

 Herophilus and Erasistratus, both of them great 

 anatomists. The former took account of the 

 immediate causes of disease and such symptoms 

 as the pulse and anatomical changes, while in 

 treatment he relied mainly on drugs and vene- 

 section. The latter, much less loyal to the Hippo- 

 cratic name, found in excess of nutrition with its 

 results, dyspepsia and plethora, the chief causes of 

 inflammation and fever. Herophilus and Erasis- 

 tratus each headed a school, botn called Dogmatic 

 from their tendency to supersede their sound 

 anatomical traditions by premature generalisation. 

 Out of the conflict of Herophilite and Erasistratean 

 sprang the Empirics, whose professional ' tripod ' 

 was clinical observation, previous history of the 

 patient (oxonuUMf ), and 'transition from like to 

 like" (analogical inference). 



Rational medicine entered Rome with the 

 Gnecising wave that followed the expulsion of 

 the learned from Alexandria and the svibjection of 

 the Hellenic world, and received a great impetus 

 from the dictator Julius Cii-sar, who extended 

 the Roman citizenship to all in the city who pro- 

 fessed the healing art. Among these was Ascle- 

 piades of UiUiiiua, recommended to the Romans 

 by his philosophy, rhetoric, and reliance on the 

 gymnastic already in favour with them. Regarding 

 the human body as composed of countless atoms 

 divided from each other by invisible interspaces 

 (pores), he made health consist in the normal 

 liehnviour of these atoms, by which the pores 

 retained their proper calibre, and illness in their 

 derangement, whereby the pores were widened or 

 narrowed. He enjoined observance of the. Stoic 



