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 The relation of medicine to philosophy, 
 
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THE RELATION OF xMEDICINE 
 TO PHILOSOPHY 
 
THE RELATION OF 
 
 MEDICINE TO 
 
 PHILOSOPHY 
 
 BY 
 
 .R. O. MOON, M.A., M.D.OxoN., F.R.C.P. 
 
 PHYSICIAN TO THE NATIONAL HOSPITAL FOR DISEASES OF THE HEART 
 ASSISTANT PHYSICIAN TO THE ROYAL WATERLOO HOSPITAL 
 
 LONGMANS, GREEN AND CO. 
 
 39 PATERNOSTER ROW, LONDON 
 
 NEW YORK, BOMBAY, AND CALCUTTA 
 
 1909 
 
 All right^tXeserved 
 
La Philosophie apr^s avoir renferm^ dans son sein 
 toutes les sciences naissantes, a dfl'les voir se s^parer 
 d'elle, aussitol qu'elles sont arrives k un degrd suffisant 
 de d^veloppement. Viendra-t-il un jour ou elles y 
 rentreront, non pas avec la masse de leurs details, 
 mais avec leurs rdsultats g^neraux ; un jour oil la 
 philosophie sera moins une science k part qu'une 
 face de toutes les sciences, une sorte de centre 
 lumineux ou toutes connaissances humaines se ren- 
 contreront par leur sommet en divergeant k mesure 
 qu'elles descendront aux details ? 
 
 Ren AN, DAvenir de la Science. 
 
 Le vice radical des histoires de la mddecine et qui 
 les frappe presque toutes de sterility, c'est qu'on y 
 consid^re notre science, dans son ensemble ou dans 
 ses details, comme une creation isolde, sans relations 
 ni pariente avec les autres creations de I'esprit humain : 
 " Proles sine matre creata." 
 
 Daremberg, Histoire des Sciences Midicales. 
 
PREFACE 
 
 This little book, of which the first three chap- 
 ters have already appeared in the British Medical 
 Journal, and which I am allowed here to reproduce, 
 by the kind permission of the Editor, does not profess 
 in any sense to be a History of Medicine. With 
 that we are already furnished, on a large scale in 
 the shape of Haeser's encyclopaedic work, and on 
 a smaller scale in Withington's most illuminating 
 History of Medicine from the Earliest Times. To 
 both of these works I am very largely indebted, as 
 also to Kurt Sprengel's History of Medicine, the 
 references to which are taken from the French trans- 
 lation by Jourdan (1815). 
 
 Its object is rather to show, by taking various 
 important epochs in the history of the world, how 
 intimately medicine has been bound up with the 
 current thought and philosophy of the day ; . how 
 medicine no more than art can work away by itself, 
 uninfluenced by the intellectual milieu in which it 
 finds itself. We shall thus see why some epochs 
 have been peculiarly favourable to the progress of 
 medicine, others as markedly the reverse. Speaking 
 generally, medicine has advanced in periods of great 
 intellectual activity, and remained in a state of stagna- 
 
viii PREFACE 
 
 tion during times of intellectual torpor ; though this 
 rule must not be taken too absolutely, as there have 
 been times of great intellectual awakening which have 
 given an unbridled licence to the imagination, and 
 this has almost invariably led medicine off on a false 
 track. It seems to me that this way of looking at 
 the history of medicine may not be unhelpful in the 
 practice of our profession, enabling us perhaps to 
 come to the study and observation of disease with 
 a broader outlook. The rise and fall of so many 
 systems and methods of treatment, while inculcating 
 a prudent scepticism, need not make us despair. The 
 great advantage which truth possesses over error is 
 that it may be discovered again. The study of the 
 history of medicine has this advantage over that of 
 art, that it is progressive, for " II n'y a pas pr6cise- 
 ment de progres pour I'art ; il y a variation dans 
 I'id^al. Presque toutes les literatures ont a leur 
 origine le modHe de leur perfection. La science, au 
 contraire, avance par des proc^d^s tout opposes." ^ 
 Thus, though we are rightly and reasonably proud of 
 the achievements of medicine in the nineteenth century, 
 which it has shared with science generally, we feel that 
 we may make one further demand of it : What is the 
 result of all this progress ? is it really the amelioration 
 of the human lot, or is it only the setting of a larger 
 number of ingenious puzzles — knowledge for the sake 
 of knowledge, art for art's sake — is that the conclu- 
 sion of the whole matter ? Happily, no. Knowledge 
 
 * Renan, L'Avenir de la Science. 
 
PREFACE ix 
 
 is for the sake of life. The end of Hfe is living — not 
 indeed to t^v, but to e5 f^v. 
 
 That the progress of medical science has enor- 
 mously reduced the death-rate no one can possibly 
 deny. The cry occasionally heard, that there is a vast 
 increase in diseases which were never heard of before, 
 is purely absurd ; this increase of disease is merely 
 increase in the differentiation of disease. Because at 
 one time the word fever served to cover almost 
 every affection in which the pulse and respiration 
 were quickened and the skin hot, the sum total of 
 disease has not been increased by giving different 
 names to the various fevers. To take a more techni- 
 cal instance, the disease of the nervous system called 
 " Disseminated Sclerosis " will almost undoubtedly 
 be divided up with increasing knowledge into several 
 diseases of the spinal cord, but the sum total of 
 diseases will not be larger. There is, however, just 
 this much truth in the outcry, that as man's life has 
 become more complex with advancing civilisation, so 
 the possibility of minor oscillations from complete 
 adjustment to the environment becomes increasingly 
 great ; it is more difficult to be perfectly healthy, 
 because a higher standard of health is required by 
 modern life. This is particularly seen in the case of 
 insanity ; for civilisation, by increasing the number of 
 social and moral rules to be observed, increases the 
 possibility of their infraction. 
 
 Modern medicine has been so much engaged in 
 tracking out the minutiae of disease, that it has failed 
 
X PREFACE 
 
 to give as much attention to health in general as was 
 the case in bygone days. Former epochs of medicine, 
 with their vast generalisations, co-extensive with the 
 whole of life, had not got enough positive knowledge 
 about the human organism to justify such generalisa- 
 tions. Just as the French Revolutionists thought 
 that society could be reconstructed de novo from first 
 principles in accordance with reason, without having 
 any knowledge of the laws of the historic growth 
 of society, so the system makers of medicine en- 
 deavoured to lay down laws for human life without 
 having any sufficient knowledge of the mechanism 
 of the human organism. 
 
 Plain living and high thinking must ever be the 
 rule of the wise, but the attempt to return to the 
 simplicity of the savage, or even to the elementary 
 life of a more primitive people, is neither possible 
 nor desirable ; the plain living of many nations, who 
 are called blessed because they have no history, 
 is associated with very jejune thinking, or with no 
 thought at all. No members of the great nations of 
 the West can wish to return to such a condition of 
 things : the increasing complexity of thought and 
 feeling should rather be welcomed as differentiating 
 man further and further from the brutes that perish ; 
 yet, on the other hand, the increasing complexity of 
 his physical or animal life is just what should at all 
 hazards be avoided. Here he may wisely imitate the 
 savage, for thus he will have the strongest basis on 
 which his intellectual and moral life may develop ; for 
 
PREFACE xi 
 
 surely the object of life is to combine the simplicity of 
 
 the savage with the subtlety of the sage. Medicine, 
 
 therefore, in order to take its proper place in the social 
 
 organism, must embrace the whole of life and be 
 
 prepared to suggest the type of intellectual as well 
 
 as other activity suitable to any given patient, just as 
 
 it would prescribe for a bodily ailment. To some 
 
 extent this method was practised by the Jesuits ; but 
 
 with them the object was to produce a special kind 
 
 of character with a view to a highly definite end, 
 
 whereas in our case it would simply be the endeavour 
 
 to enable each individual to make the best of his 
 
 life. To preserve life must ever be the honour and 
 
 duty of the physician, but to make life livable should 
 
 be his aim also. . If life has lost its savour, how is it 
 
 to be lived ? In a too exclusive pursuit of health, may 
 
 we not lose the object of life, " et propter vitam vivendi 
 
 perdere causas " ? The function of the _poet, Goethe 
 
 tells us somewhere, is so to represent things that we 
 
 may find life tolerable ; and the physician, in providing 
 
 for the health of the body as a sort of indispensable 
 
 prerequisite, must ever have before his mind that 
 
 wider outlook which shall enable him to cope with 
 
 the tcedium vitce, Weltschmerz, maladie de Finfini, or 
 
 by whatever name we like to call those ills which 
 
 seem inseparable from the travail of an advanced 
 
 civilisation struggling to a new birth. 
 
CONTENTS 
 
 CHAP. TAOE 
 
 I. THE RELATION OF EARLY GREEK PHILOSOPHY TO 
 
 EARLY GREEK MEDICINE .... I 
 
 II. POST-HIPPOCRATIC SCHOOLS OF MEDICINE IN RE- 
 LATION TO CONTEMPORARY PHILOSOPHY . 1 6 
 III.. THE RELATION OF GALEN TO THE PHILOSOPHY 
 
 OF HIS TIME 35 
 
 IV. INFLUENCE OF EARLY CHRISTIANITY ON MEDICINE 50 
 V. ARAB MEDICINE AND ARAB PHILOSOPHY . . 67 
 
 VI. VARIOUS INFLUENCES AFFECTING MEDICINE IN 
 
 THE MIDDLE AGES 83 
 
 VII. MEDICINE AND THE RENAISSANCE . . . 106 
 
 VIII. PARACELSUS AND THE MEDICINE OF HIS TIME . 125 
 
 IX. THE EFFECT OF PHILOSOPHY ON MEDICINE IN 
 
 THE SEVENTEENTH CENTURY. . . -144 
 
 X. THE INFLUENCE OF PHILOSOPHY ON MEDICINE 
 
 IN THE EARLY PART OF THE EIGHTEENTH 
 CENTURY . 170 
 
xiv CONTENTS 
 
 CHAP. JPAGE 
 
 XI. INFLUENCE OF CONTEMPORARY THOUGHT ON 
 MEDICINE IN THE SECOND HALF OF THE 
 
 EIGHTEENTH CENTURY 1 89 
 
 [XII. INFLUENCE OF CONTEMPORARY THOUGHT ON 
 
 MEDICINE IN THE NINETEENTH CENTURY . 207 
 
THE RELATION OF MEDICINE 
 TO PHILOSOPHY 
 
 CHAPTER I 
 
 THE RELATION OF EARLY GREEK PHILOSOPHY 
 TO EARLY GREEK MEDICINE 
 
 The tendency of modern civilisation towards a minute 
 and elaborate specialisation is apt to make us forget 
 that there was a time when such important branches 
 of human activity as religion, philosophy, and medi- 
 cine were hardly separated from one another. In the 
 earliest days of ancient Greece the mind ranged with 
 equal energy over every field of human knowledge ; 
 priests, philosophers, and doctors had not yet become 
 differentiated into their several castes. To map out, 
 divide, and to some extent isolate the several provinces 
 of the human mind was therefore an important prob- 
 lem for the early Greek thinkers. In the world of art 
 a somewhat similar state of things existed, for we find 
 music, dancing, poetry, painting, sculpture, and archi- 
 tecture inextricably blended together, so as to form 
 one harmonious whole. All these several arts, in 
 accordance with the Spencerian doctrine of a prog- 
 
 A 
 
2 RELATION OF MEDICINE TO PHILOSOPHY 
 
 ress from homogeneity to heterogeneity, have gradu- 
 ally become separated, and have developed along their 
 own individual lines to some extent independently. 
 Hence it has resulted that, in considering a picture 
 or a statue, it scarcely occurs to us to regard the 
 propriety of the architecture of the room or gallery 
 in which it is exhibited, any more than, in listening to 
 a great singer, it has been customary to give particular 
 heed to the words of the song. In this region of art, 
 however, Wagner, some fifty years ago, undoubtedly 
 effected a vast revolution, and attempted, with what 
 amount of success the annual pilgrimages to Baireuth 
 bear witness, to reintegrate the several arts and to 
 bring them all harmoniously to the service of his 
 emotional expression. On this very account he has 
 been stigmatised by Dr. Max Nordau as a degenerate 
 of a particularly evil type. 
 
 The most enthusiastic Wagnerian and keen advo- 
 cate of this reintegration and co-ordination of the arts 
 would probably admit that music, dancing, poetry, 
 painting, &c., had derived the greatest benefit from 
 their long period of isolated development, and con- 
 sequently-had been able to rise to a far higher pitch 
 of excellence than would have been possible had the 
 differentiation never taken place. 
 
 If this be true in the sphere of the arts it is surely 
 not less so in that of medicine, philosophy, and re- 
 ligion, and it is interesting to consider how far medi- 
 cine was attaining to an independent and separate 
 existence in the early days of Greek civilisation. 
 
GREEK PHILOSOPHY AND MEDICINE 3 
 
 The close connection of medicine with religion 
 has been characteristic of all primitive races, and the 
 Greek formed no exception to the rule. The earliest 
 records of Hellenic life show that the power of healing 
 was an attribute of all the gods, though possessed in 
 a pre-eminent degree by Apollo, Artemis, and Pallas. 
 Rather later, in post-Homeric times, the gods had 
 begun to specialise, and Asclepius appears" as the sole 
 god of healing, \yhile medicine was practised by the 
 priests of his temples, who were known as "ascle- 
 piads," The astonishing intellectual activity of this 
 gifted race is shown by the way in which medicine 
 emancipated itself from the trammels of religious 
 formalism and superstitious belief at a very early 
 stage of its development. When compared with 
 Egyptians, Indians, or Babylonians, the contrast is 
 the more striking. That the Greeks were as pro- 
 foundly susceptible to religious mysticism as the 
 Orientals, the strange society of Eleusis amply tes- 
 tifies ; but they differed from the Orientals in the 
 natural force and versatility of their intellect, which 
 made them impatient of truths sanctioned only by 
 external authority. 
 
 This emancipation of medicine from religion was 
 due largely to the speculations of the pre-Socratic 
 philosophers, but their usefulness to medicine has 
 perhaps been rather undervalued owing to other 
 evils which they brought in their train, and more 
 particularly the excessive employment of the deduc- 
 tive method. Their tendency to be for ever finding 
 
4 RELATION OF MEDICINE TO PHILOSOPHY 
 
 the general in the particular, and then making most 
 sweeping deductions, was doubtless inimical to a 
 sober and steady pursuit of medicine. On the other 
 hand, though the conclusions to which this method 
 led were only too often fanciful and absurd, yet it 
 was certainly better than having no method at all, as 
 was the case with the other nations of antiquity. At 
 all events, it furnished a strong stimulus to intellectual 
 activity, which is an essential pre-requisite to any 
 sound progress, whether in art or science. 
 
 One of the earliest signs of interest in medical, or 
 rather physiological, matters is the saying of Anaxi- 
 menes that the world breathes. He considered that 
 just as man is kept alive by drawing in draughts of 
 air, so the world is kept going by the draughts of air 
 which it inhales from the infinite mass beyond the 
 heavens. This philosopher, who flourished 550 B.C., 
 believed that air was the ultimate substance out of 
 which the whole world was made, just as Thales 
 had held water to be the primary substance. In 
 this instance, we have an argument from the micro- 
 cosm to the macrocosm, and Anaximenes utilises his 
 physiological observation of breathing to support his 
 cosmological theory. 
 
 Heracleitus of Ephesus {fl, 500 B.C.) exercised a great 
 influence upon succeeding philosophers, and even 
 upon Plato, who was a Heracleitean in his youth. 
 Medicine, too, was affected by his doctrines, as we 
 gather from various passages in the De Diceta of Hippo- 
 crates. His leading ideas are well known ; thus : — 
 
GREEK PHILOSOPHY AND MEDICINE 5 
 
 "All things are in constant flux, and nothing has 
 permanence; man cannot descend twice into the 
 same stream, everything is continually passing over 
 into something else, and this proves that it is one 
 nature which assumes the most opposite forms, and 
 pervades the most various conditions ... all comes 
 from One, and One from All." ^ 
 
 To this philosopher the world was an eternally 
 living fire, certain measures of which were always 
 being kindled, while like measures were always being 
 extinguished, and so the constant flux of things was 
 kept going, and yet the world in appearance was 
 relatively stable. This theory of the cosmos was 
 applied by Heracleitus to man, who, like the macro- 
 cosm, is made of fire, water, and earth ; but as in the 
 case of the world the fire is the only important 
 element, and is identified with the one wisdom, so 
 in the microcosm fire alone is conscious. When it 
 has left the body, the remainder, the mere earth and 
 water, is altogether worthless. The fire which ani- 
 mates man is subject to the " upward and downward 
 path," just as much as the fire of the world ; and 
 again, we read in the De DicBta that " all things are 
 passing, both human and divine, upwards and down- 
 wards." We are just as much in perpetual flux as 
 anything else in the world. We are not the same for 
 two consecutive instants. The fire in us is perpetually 
 becoming water, and the water earth ; but as the 
 opposite process goes on simultaneously we appear 
 
 > Zeller, Outlines of Greek Philosophy. 
 
6 RELATION OF MEDICINE TO PHILOSOPHY 
 
 to remain the same. Man, like the world, is subject 
 to a certain oscillation in his " measures " of fire and 
 water, which gives rise to the alternations of sleeping 
 and waking, life and death. Sleep was produced by 
 the encroachment of moist, dark exhalations from the 
 water in the body which causes the fire to burn low. In 
 a soul where the fire and water were evenly balanced, 
 the equilibrium would be restored in the morning by 
 an equal encroachment of the fire on the water. The 
 Heracleitean idea that the " unseen harmony " of the 
 universe and man was maintained by the strife of 
 opposites not unnaturally gave rise to some strange 
 views on dietetics and medical treatment. 
 , Pythagoras (Jl. 550 B.C.) was the most famous of all 
 these early thinkers, and his influence upon medicine 
 has certainly been the greatest. Strictly speaking, his 
 position is not quite analogous to that of the other 
 Ionian philosophers ; for he was not only a philo- 
 sopher but also a religious leader, the founder of 
 a brotherhood and teacher of a "way of life." His 
 position is rather more comparable with that of Con- 
 fucius and Laotsze in China, with whom, indeed, 
 he was contemporary. The fame of Pythagoras has 
 been kept alive rather by his religious and moral 
 teachings than by the remarkable speculations on 
 number, although at present we are more immediately 
 concerned with these. This Pythagorean doctrine of 
 number has often been misunderstood. When Pytha- 
 goras said "things are numbers," he was making an 
 attempt to explain the sensible world from a sensible 
 
GREEK PHILOSOPHY AND MEDICINE 7 
 
 origin, it was not an idealistic hypothesis. Numbers 
 
 to Pythagoras were not abstract as they are with us, 
 
 though it is difficult for us to think of them as being 
 
 anything else. Aristotle tells us that these numbers 
 
 were intended to be mathematical numbers, but that 
 
 " they were not separated from the objects of sense " ; 
 
 they could not, therefore, be mathematical numbers 
 
 in the ordinary sense of the term, inasmuch as bodies 
 
 were made up of them. In reality these numbers of 
 
 Pythagoras were spatial numbers — that is, their points 
 
 had magnitude, their lines breadth, and their surfaces 
 
 thickness. Thus, while a modern geometer regards 
 
 a line as having only one dimension, the Pythagoreans 
 
 identified it with the number two. They considered 
 
 that numbers were built up of geometrical figures, that 
 
 they were portions of space cut off and limited in a 
 
 variety of ways. The properties of number wei-e 
 
 studied by means of geometrical constructions. The 
 
 Pythagoreans spoke of square and oblong numbers, 
 
 and they called odd numbers "gnomons." ^ Being 
 
 unable to distinguish ideal or intelligible numbers 
 
 from sensible or materialised numbers, they were 
 
 forced to identify with magnitudes purely ideal things, 
 
 such as justice, which was described as an equal 
 
 number multiplied by an equal — that is, one of the 
 
 first two square numbers, four and nine — because it 
 
 returns equal for equal. 
 
 Medicine was undoubtedly influenced by this doc- 
 trine of the importance of number, and from it origi- 
 
 1 Burnet, Early Greek Philosophy. 
 
8 RELATION OF MEDICINE TO PHILOSOPHY 
 
 nated the medical teaching of " critical days." It is 
 worth noting, also, that Empedocles, who was in- 
 fluenced by Pythagorean teaching, speaks of the fetus 
 being formed in the womb on the thirty-sixth day, 
 and completed on the forty-ninth, and was probably 
 led into this speculation by the fact that these 
 numbers are the squares of 6 and 7 respectively. To 
 this number 7 Pythagoras and his disciples attached 
 a special importance ; perhaps their medical studies 
 had led them to observe that the second teeth came 
 out at the seventh year, puberty synchronised with 
 the fourteenth, and the beard appears at the twenty- 
 first. 
 
 In the matter of practice the Pythagoreans in- 
 fluenced medicine in the direction of diet and gym- 
 nastic treatment; their school used poultices and 
 salves very little, still less internal medicaments, and 
 least of all the knife and cautery. Many physicians 
 gave in their adherence to this school of thought, of 
 whom the best known is Alcmaeon of Croton. 
 
 Empedocles of Agrigentum {fl. 460 B.C.), in addition 
 to being a philosopher, was also a practical physician, 
 and Galen ascribes to him the foundation of the Italian 
 school of medicine. Certainly some of his doctrines 
 were more favourable to the scientific study of medi- 
 cine than those of his predecessors. For instance, 
 "we must not attempt to construct a theory of the 
 universe offhand, instead of simply trying to under- 
 stand each thing we come across in the way in which 
 it is clear." 
 
GREEK PHILOSOPHY AND MEDICINE 9 
 
 " We must not reject the assistance of the senses, 
 for they are the only channels through which know- 
 ledge can enter our minds at all ; we must make use 
 of them all, and neglect the testimony of none, not 
 even that of taste." 
 
 Here, indeed, we seem to breathe for a moment 
 something of the atmosphere of modern science. 
 Various physiological or quasi-medical speculations 
 have come down to us from Empedocles. Thus, 
 with regard to respiration, he said, "We breathe 
 through all the pores of the skin, not merely through 
 the organs of respiration. 
 
 " Alternate inspiration and expiration of the breath 
 are caused by the movement of the blood from the 
 heart to the surface of the body and back again, 
 
 "All things draw breath and breathe it out again. 
 All have bloodless tubes of flesh extended over the 
 surface of their bodies, and at the mouths of these 
 the uttermost surface of the skin is perforated all 
 over with pores closely packed together, so as to 
 keep in the blood while a free passage is cut for the 
 air to pass through. Then, when the yielding blood 
 recedes from these, the bubbling air i-ushes in with an 
 impetuous surge, and when the blood runs back it is 
 breathed out again." 
 
 Tears and sweat arise from a disturbance which 
 curdles the blood; they are, so to speak, the whey 
 of the blood. Again, perception is caused by the 
 meeting of an element in us with the same element 
 outside ; our knowledge varies with the varying con- 
 
lo RELATION OF MEDICINE TO PHILOSOPHY 
 
 dition of our bodies. To his views as to the dates of 
 the formation of the fetus we have already referred in 
 discussing Pythagoras, but in this connection may be 
 mentioned his curious description of the secretion of 
 milk : " On the tenth day of the eighth month the 
 white pus (ttvov) arises," which clearly means the 
 mammary secTttion. 
 
 He discovered the labyrinth of the ear by dis- 
 secting goats ; he also perceived that in plants two 
 sexes are combined, but thought that they came into 
 being in an imperfect state of the universe, and that 
 the distinction of the sexes was the result of the 
 gradual differentiation brought about by the entrance 
 of hate into the world. He further held that love was 
 the principle which was capable of bringing the four 
 elements into union, but he regarded it from an 
 entirely physiological standpoint, and so considered 
 that it was the same impulse to union as is implanted 
 in human bodies. Here, again, we have an instance 
 of a physiological observation being employed in the 
 explanation of the cosmos. 
 
 With Anaxagoras of Clazomenae (_/?. 450 B.C.) we 
 come to the end of the pre-Socratic philosophers. 
 He occupies among them a most honourable position ; 
 he was the teacher of Pericles, and Aristotle speaks of 
 him as "the only sober man amongst drunkards." 
 It was he who introduced the idea of mind (1/0O9) as 
 the cause of motion among the elements, and has 
 therefore been credited with the introduction of the 
 suprasensible into philosophy. This, however, may 
 
GREEK PHILOSOPHY AND MEDICINE ii 
 
 be going too far, and there is some ground for 
 supposing that the vov<; of Anaxagoras was only a 
 highly differentiated kind of matter ; that, in fact, he 
 conceived of it as a body, and substituted it for the 
 love and hate of Empedocles, which had been intro- 
 duced in order to explain the source of motion in 
 the world. 
 
 Whatever may have been the precise meaning 
 which Anaxagoras attached to mind, he certainly 
 considered that it was the same in all living creatures, 
 both in the animal and vegetable kingdoms, and that 
 the different grades of intelligence depended entirely 
 on the structure of the body. Plants he regarded as 
 animals fixed in the earth. His interest in physiology 
 is shown by his theory that sensation implies pain, 
 for all unlike things produce pain by their contact, 
 and this pain is made perceptible by the long con- 
 tinuance or by the excess of a sensation. In man 
 even sensible perception is the work of mind, but as 
 it. is effected by means of the bodily organs it is 
 therefore inadequate. 
 
 Such were some of the random philosophical specu- 
 lations which affected the development of Greek 
 medicine prior to the advent of the master mind 
 which was to bring some kind of order out of this 
 heterogeneous collection of generalisations. 
 
 Hippocrates, as we all know, stands in the same 
 relation to medicine as Homer does to poetry and 
 Herodotus to history. His title to this proud position 
 was earned not so much by any special observations, 
 
12 RELATION OF MEDICINE TO PHILOSOPHY 
 
 valuable as some of these undoubtedly were, far less 
 by any such epoch-making discovery as distinguished 
 our English Harvey, but because, in the words of 
 Celsus, he separated medicine from philosophy.* He 
 continued the emancipation from religion which had 
 already been in part accomplished by the dissolving 
 influence of the sixth-century philosophers, saying 
 that one disease is no more divine or human than 
 another, but that each occurs in accordance with 
 Nature (Kara <f>vai,v). 
 
 But, above all, he was the first to start medicine 
 on an independent Hne of its own and to free it from 
 the somewhat crude speculations of these early Ionian 
 philosophers on the one hand and the sterile theories 
 of the Eclectics on the other — sterile for all purposes 
 of immediate medical advancement, but fruitful indeed 
 for the birth of metaphysics in the future. For here 
 it may be well to point out that by philosophy in this 
 connection we are not meaning metaphysics, for they, 
 in the strict sense of the term, hardly existed before 
 the time of Plato and Aristotle. The latter tells us 
 that the pre-Socratic thinkers had no conception of 
 reality except as cognisable by the senses {Uepl fiev 
 T&v SvTcov rr/v oKrjdeiav iaKo-rrovv, ra S^Sptu vTriXa^ov etvai 
 TO, alaOrjTo. fiovov). 
 
 Their philosophy could not be of much direct 
 assistance to medicine in its early stages before 
 anatomy, and still less physiology, had been seriously 
 
 ' Primus quidetn ex omnibus memoria dignis ab studio sapienticC disci- 
 plinam banc separavit. 
 
GREEK PHILOSOPHY AND MEDICINE 13 
 
 studied, while on the other hand the influence of 
 medicine on philosophy was certainly at times far 
 from favourable. Thus, from the time of Thales to 
 that' of Plato and Aristotle, philosophy, with many 
 ups and downs, had gradually advanced to the 
 foundation of a stable metaphysics, in which it was 
 recognised that there may be realities of which the 
 senses could never conceivably take cognisance. For 
 the purpose of this kind of progress the mere accumu- 
 lation and observation of facts can be of little use, 
 however beneficial for the advance of medicine. In 
 fact, the influence of medicine was sometimes directly 
 harmful to advance in metaphysics ; thus, at a time 
 when all philosophic progress was necessarily in the 
 direction of pluralism, which culminated in the atomic 
 theory of Leucippus, the medical theorisers of the day 
 opposed this, believing that a monistic foundation of 
 the universe was required by medicine, as otherwise 
 it would be impossible to understand how one thing 
 could do good or harm to another. 
 
 Hippocrates was considerably influenced by all 
 these speculations, nor did he brush them aside as 
 useless, but he showed that the observation of in- 
 dividual facts was the only method of proceeding in 
 order to obtain any real progress in medicine. 
 
 It seems not unnatural to inquire how it came' 
 about that medicine, having once been set upon the 
 right line of progress by Hippocrates, did not con- 
 tinue steadily upon this more scientific course. One 
 reason would seem to be that Hippocrates perhaps 
 
14 RELATION OF MEDICINE TO PHILOSOPHY 
 
 hardly realised the importance of his own work on 
 its theoretical side. He had been led to a careful 
 observation of facts by the naturally practical bent 
 of his genius, and not because he fully comprehended 
 the importance of the inductive method for the study 
 of medicine. Then, too, being a practising physician, 
 and actually busied with technical matters and the 
 collection of facts, he had not time or occasion fully 
 to set forth the theory of his method as a logical 
 instrument for the purpose of scientific progress. 
 Bacon, on the other hand, when, nearly two thousand 
 years later, he forged anew the weapon of inductive 
 reasoning, lent the whole weight of his genius to the 
 formulation of his method ; so that though to some 
 extent he busied himself with the practicalities of 
 science, we cannot say that there are any special 
 observations of value made by him, or that he bene- 
 fited any one science in particular. 
 
 Another reason which prevented the method of 
 Hippocrates from being carried out by his medical 
 successors was the growth and development of meta- 
 physics under the inspiration of Plato and Aristotle. 
 Their highly imaginative philosophy drew away to 
 itself many of the ablest minds in Greece, so that the 
 more prosaic inductive method, whether as applied 
 to medicine or anything else, fell more and more into 
 the background. Then came the gradual decay of 
 Greece, and the decadence of all philosophic forms 
 of thought. With the advent of Galen {fl. i6o A.D.) 
 came an immense stimulus to the study of medicine. 
 
GREEK PHILOSOPHY AND MEDICINE 15 
 
 He was a man of vast erudition and immense medical 
 knowledge, and to some extent he revived the Hip- 
 pocratic tradition. But, in addition to the great 
 contributions which he certainly made to medicine, 
 he also wrote extensively on philosophy, and en- 
 deavoured to unite medicine with the metaphysics 
 of Plato. This unfortunate move arrested the further 
 progress of medicine for more than a thousand years. 
 The system of Galen was taken as a gospel by the 
 Arabian physicians, and the extraordinary reverence 
 for external authority in matters intellectual character- 
 istic of this people, combined with the growing powers 
 and influence of the Church, stifled all independent 
 thought, and consequently all medical progress, until 
 the dawn of the Renaissance. 
 
 The aim of Galen was praiseworthy enough, but it 
 was premature, for medicine at that time had not 
 been working long enough in isolation to render 
 fruitful such a union with religion or philosophy. As 
 in all ages, however, the contemporary religious and 
 philosophic thought of the day has had an influence 
 at least unconscious upon medical practice, the 
 question arises whether the time may not now have 
 arrived for making the relationship more definitely 
 conscious, and effecting for medicine that co-ordina- 
 tion with religion and philosophy which Wagner 
 accomplished for music with the sister arts. 
 
CHAPTER II 
 
 POST-HIPPOCRATIC SCHOOLS OF MEDICINE IN RELA- 
 TION TO CONTEMPORARY PHILOSOPHY 
 
 In the last chapter we attempted to explain the 
 relation of early Greek philosophy to early Greek 
 medicine. Continuing the same line of inquiry, we 
 now propose to see how far the schools of medicine 
 immediately succeeding Hippocrates were dominated 
 by the philosophic influences of the time, and were 
 indeed the expression of them. Goethe says some- 
 where that there is a certain logic in the actions 
 of men and women which enabled him in his 
 youth to write correctly about things of which he 
 had no experience, but which, on growing older, 
 he found out to be true. Similarly, in reflecting 
 on the history of the art of heahng, we are led to 
 conclude that there is a logical bond between the 
 various activities of the human mind, so that a 
 subject such as medicine, independent as it may 
 seem, does not grow up and develop in isolation, 
 separated off from the other creations of mental 
 energy, but is of necessity connected with the pre- 
 vailing philosophic theories of the day. Periods of 
 constructive medicine are the outcome of periods 
 of constructive thought, so that we must not 
 
POST-HIPPOCRATIC SCHOOLS OF MEDICINE 17 
 
 expect any serious advances in the former when 
 the latter is in a state of stagnation. 
 
 The death of Hippocrates (357 B.C.) coincided 
 with the decadence of philosophy and the cor- 
 ruption of morals which ensued after the battles of 
 Leuctra and Mantinea, when Greece fell into a 
 general condition of intellectual flabbiness and 
 moral laxity. From this mental paralysis medicine 
 assuredly did not escape. Instead of advancing 
 soberly along the path traced out for her by 
 Hippocrates, she embraced wild theories and absurd 
 practices. During the five hundred years which 
 elapsed between the death of the great physician 
 of Cos and the advent of Galen it would seem that 
 medical knowledge was in the trough of the wave. 
 No striking discoveries were made or illuminating 
 principles enunciated during that period ; men 
 either lost themselves among the hill-tops of 
 speculation or were engulfed in the quagmires 
 of doubt. The lack of intellectual fibre so charac- 
 teristic of this epoch was reflected in the medical 
 schools, for when one department of a nation's 
 mental life suffers, the whole is apt to suffer 
 with it. 
 
 The first of the medical schools of this period 
 to become famous was that of the Dogmatists. 
 The name is not very happily chosen, but it was 
 given to them by Galen, and has been followed by 
 subsequent writers, so that it must be adopted for 
 the sake of convenience. Roughly speaking, they 
 
1 8 RELATION OF MEDICINE TO PHILOSOPHY 
 
 occupy the century from the death of Hippocrates 
 to the estabHshment of medical schools at Alexandria 
 (357-264). The earlier representatives of this school, 
 ? namely, Dioxippus and Praxagoras of Cos, followed 
 I closely the doctrines of their master Hippocrates ; 
 ' they accepted his medical teaching without, how- 
 ever, in the least imbibing his spirit of sober 
 scientific observation. Thus they adopted his 
 humoral pathology and made it a most essential 
 part of their system. According to this theory, 
 all diseases are explained by a mixture of humours 
 which are four in number, namely (i) blood, (2) 
 yellow bile found in the liver, (3) mucus in the 
 head, (4) black bile in the spleen. The medical 
 treatment based upon this was that medicines work 
 upon the predominating cardinal humours, some 
 expelling mucus, others removing bile, &c. This 
 theory controlled medicine for more than ten 
 centuries, and eventually only gave way to the 
 most modern views. Far more important for this 
 school, however, was the influence of the Platonic 
 philosophy. Having taken as their motto the saying 
 of Hippocrates that " the physician who is also 
 a philosopher is Godlike," ^ they proceeded with 
 commendable zeal to try and earn this title by a 
 careful study of the Timceus. This famous 
 dialogue of Plato became their text-book of 
 philosophy, and with disastrous results, for this 
 work, though described by Jowett as obscure and 
 
 1 'I))Tp4! 7*/) 0(\6(ra0os liriOeos. Hippocrates, Uepi tiirxw<><riyris. 
 
POST-HIPPOCRATIC SCHOOLS OF MEDICINE 19 
 
 repulsive to the modern mind, had the greatest 
 influence over the ancient and mediaeval world. 
 
 " The obscurity arises from the attempt to conceive 
 the whole of Nature without any adequate knowledge 
 of the parts, and from a greater perception of simi- 
 larities which lie on the surface than of differences 
 which are hidden from view. The conception of 
 the world as a whole, whether a person or an animal, 
 has been the source of hasty generalisations, yet the 
 general grasp of Nature led to a spirit of compre- 
 hensiveness in early philosophy which has not 
 increased but rather diminished as the fields of know- 
 ledge have become more divided." ^ 
 
 The Dogmatists had the acumen to perceive that 
 a science of medicine must be based upon physiology; 
 their error consisted in attempting to erect a complete 
 edifice before there were materials suitable or sufficient 
 for the foundation. The highly imaginative tem- \ 
 perament of Plato led him into numerous fanciful 
 speculations in physiology as in other matters, which >, 
 his more prosaic followers regarded as intended to , 
 be rigidly scientific truth, whereas Plato himself pro- 
 bably looked upon them only as points of view or 
 understood them in a metaphysical sense. Many 
 instances occur in the New Testament where the 
 humble followers of the Founder of Christianity put 
 constructions upon His sayings which astonish us 
 by their naivete and literalness. 
 
 Apart from the general spirit of the Platonic philo- 
 1 Jowett's Introduction to the Timeus, 
 
20 RELATION OF MEDICINE TO PHILOSOPHY 
 
 sophy, the following specific doctrines in particular 
 influenced the Dogmatists : 
 
 1. General scepticism as to the reality of sensible 
 objects which are in a state of perpetual flux. 
 
 2. Life consists in spirit and in fire ; the heat of 
 the blood is the source of the fire. 
 
 3. The want of proportion in the physical elements 
 of the body is the immediate cause of all diseases. 
 
 4. The doctrine of final causes introduced into 
 physiology. 
 
 Such fantastic conceptions, as may readily be sup- 
 posed, led them into strange errors. Thus we find 
 the intense admiration for Plato induced Dioxippus 
 to defend the absurd notion that liquids passed into 
 the lungs ; while Praxagoras, who realised that the 
 nerves were the organs of sensation, though he did 
 not invariably distinguish them from blood-vessels 
 and ligaments, placed their origin in the heart because 
 Plato regarded that organ as the centre of sensation. 
 
 This school attached great importance to the ether, 
 and here we find the influence of earlier philosophers : 
 
 "All space between heaven and earth is filled with 
 a subtle vapour which is for mortals the principle of 
 life and the cause of disease." 
 
 Pythagoras had thought the motive force of the 
 body was aerial ; Anaxagoras assigned to the ether 
 a perpetual movement, while Heraclitus and Demo- 
 critus regarded the soul as identical with the ether. 
 The influence of Pythagoras was further seen in the 
 importance attached by this school to the number 7 
 
POST-HIPPOCRATIC SCHOOLS OF MEDICINE 21 
 
 and its multiples. Thus they thought that some of 
 the solid parts of the child were already formed at 
 the end of the twenty-eighth day, and that the fetus 
 had reached the size of a bee on the thirty-fifth. 
 The effect of this number was supposed to make 
 itself felt not only before birth, but through the 
 whole course of life. 
 
 Another striking factor in the development of this 
 school was the influence of the Sophists. This had 
 the effect of giving an enormous importance to the 
 power of talking, so that to be a skilled rhetorician 
 was a sure passport to success as a physician. The 
 ability to argue with ingenuity and subtlety about 
 disease was thought more highly of than the posses- 
 sion of any practical knowledge. Men preferred 
 frivolous speculations to careful and deep researches. 
 Words have at all times exercised a great dominion 
 over mankind, and the devil, in the form of Mephis- 
 topheles, was fully alive to this when he says to the 
 student in Faust : — 
 
 ' Denn eben wo Begriflfe fehlen 
 Da stellt ein Wort zur rechten Zeit sich ein." 
 
 The ancients, however, were much more subject to 
 this influence than the moderns, and were easily led 
 astray by false analogies. 
 
 The later members of the Dogmatic school came 
 under a very different influence, namely, that of the 
 Stoics, and they endeavoured to apply the principles 
 of Zeno to physiology and pathology. The natural 
 result of this was to give a materialistic turn to the 
 
22 RELATION OF MEDICINE TO PHILOSOPHY 
 
 Dogmatists, for, according to Stoicism, " all that exists 
 is for that very reason matter, since bodies only are 
 a reality." The animal body they regarded as the 
 result of forces purely mechanical. The soul even 
 has a corporeal nature ; it comes into being with the 
 body in the physical mode of generation ; but the 
 material is a part of the divine fire which descended 
 into the bodies of men when they first arose out of 
 the ether. This fire of the soul is nourished by the 
 blood, and the governing part of the soul has its seat 
 in the heart, the centre of the course of the blood.^ 
 This teaching of the Stoics was rather a violent change 
 from the Platonic philosophy, and indeed the way in 
 which the Dogmatists veered from one pole of thought 
 to another helps to account for the fact that their 
 practical contribution to medicine was so compara- 
 tively small. 
 
 Their great merit as a medical school lies in the 
 fact that they made an attempt to found a scientific 
 medicine. They continually sought for the hidden 
 causes of disease, and though often their efforts were 
 sufficiently fantastic and absurd, they kept alive faith 
 injthe powers^of reason without which any scien- 
 tific advance is impossible. The attempt to form a 
 complete system of medicine was premature so long 
 as the knowledge of the parts was so meagre and 
 imperfect. 
 
 ' Zeller, Outlines of Greek Philosophy. 
 
POST-HIPPOCRATIC SCHOOLS OF MEDICINE 23 
 
 The Empirical School 
 
 In sharp contrast with the school of the Dogmatists 
 came the school of the Empirics. It arose in Alex- 
 andria about 280 B.C., and its founders were Philinus 
 and Serapion, the pupils of Herophilus, whose name 
 is well known, at least to all students of anatomy. 
 Just as the Dogmatists regarded Plato as their philo- 
 sophical guide, so the Empirics took Aristotle as their 
 intellectual leader. The word "empirical" in con- 
 nection with medicine has an evil connotation. We 
 must not suppose, however, that this school was 
 empirical in the ordinary sense in which every ignorant 
 and uneducated person is an empiric. The empiricism 
 of this school and that of the vulgar have this much 
 in common, that by each reasoning is banished from 
 medicine. In the case of the ordinary man this 
 arises from ignorance of the art of reasoning, whereas 
 the physician of the Empirical school reasoned in 
 the most subtle fashion so as to prove the futility of 
 all reasoning. Readers of Marius the Epicurean may 
 remember the passage in which Pater describes his 
 hero as devoting a great metaphysical acuteness 
 to proving metaphysical speculation impossible or 
 useless : — 
 
 "Abstract theory was to be valued only so far as 
 it might serve to clear the tablet of the mind from 
 suppositions only half realisable or wholly visionary i 
 and- leave it in flawless evenness to the impressions 
 of a direct and concrete experience." 
 
24 RELATION OF MEDICINE TO PHILOSOPHY 
 
 Something of this kind constituted the intellectual 
 background of the Empirical school at Alexandria. 
 
 Several influences contributed to bring this school 
 into being : — 
 
 1. Reaction against the Dogmatists. — A natural 
 disgust was felt at the constant succession of theories 
 founded on an absurdly small number of observations 
 and at systems which had far outrun positive know- 
 ledge ; the general confusion was increased by the 
 subtleties and sophisms with which each opinion 
 was defended. 
 
 2. The immense commerce of the Ptolemies had 
 brought to light a large number of new medicines, 
 ^nd we may assume that the market was flooded 
 with them. The ancient vendor of drugs had this 
 advantage over his modern counterpart, in that 
 kings and princes took an interest in medical 
 remedies which not even the most versatile of 
 monarchs in our own day attempts to imitate. 
 Thus Attalus III., King of Pergamus, studied poisons 
 and their antidotes, even making experiments with 
 them on condemned criminals. Nicomedes, of 
 Bithynia, also employed his royal leisure in the 
 study of medicines. Best known of all these royal 
 patrons is, of course, Mithridates, King of Pontus. 
 He is said to have taken a poison and an antidote 
 every day in order to render himself immune to 
 poisons. He also wrote a book on medicines and 
 poisons. It is hardly astonishing, therefore, that 
 many doctors thought more about trying new reme- 
 
POST-HIPPOCRATIC SCHOOLS OF MEDICINE 25 
 
 dies than attempting to understand the nature and 
 cause of disease. ' 
 
 3. The influence of Pyrrho and the Sceptics, 
 who numbered many physicians in their ranks. — 
 Pyrrho {fl. 340 B.C.) had accompanied Alexander to 
 the East, and there, by means of the philosopher 
 Anaxarchus, who went on the same campaign, he 
 became acquainted with the Eleatic school of 
 thought. This school, as represented by Par- 
 menides, had constantly opposed the knowledge 
 which comes to us by the senses to that which we 
 acquire by the powers of the mind. Hence it was 
 easy for Pyrrho to believe that the one avenue to 
 knowledge was as uncertain as the other. To 
 the Pyrrhonists it seemed impossible to know the 
 true nature of things, for perception only shows 
 us things as they appear, and not as they are. 
 The only correct attitude, therefore, which a man 
 can adopt is that of a suspension of judgment 
 {hroeyrf). This philosophy of Doubt had the effect 
 of limiting investigation to the narrow sphere of 
 sense knowledge. Sterile and unsatisfactory as 
 such an intellectual standpoint must necessarily be 
 in many aspects, its influence on medicine was, in 
 a certain measure, beneficial. For, at least, it 
 drew men's minds away from the speculative fog in 
 which the school of the Dogmatists was fast losing 
 itself, and brought them back to the humble task 
 of observation, which must ever be the true founda- 
 tion of such a science as medicine. The Empirical 
 
26 RELATION OF MEDICINE TO PHILOSOPHY 
 
 school, therefore, limited the task of medicine to 
 practical ends only, regarding it as futile to press 
 forward to the ultimate causes of phenomena. 
 They paid special attention to the totality of 
 symptoms, without occupying themselves either 
 with the nature of disease or its causes. Accord- 
 ing to them, medicine is concerned with the cure, 
 not the cause, of disease ; they did not want to 
 know how we digest, but what is digestible. They 
 adopted the unanswerable attitude of the practical 
 man "that diseases are not cured by eloquence, 
 but by remedies" {morbus non eloquentia sedremediis 
 sanart), and "that a man does not even become a 
 farmer or a pilot by arguing, but by practice" 
 {ne agricolam quidem aut gubernatorem disputatione, 
 sed usu fieri). They defined disease as "a union 
 of symptoms which are observed always in the 
 same way in the human body." The whole art 
 and science of medicine became, therefore, reduced 
 
 to a jystem_^of therapeutics. Three different 
 
 methods were employed by them for finding out 
 what particular treatment would get rid of a 
 particular set of symptoms : — 
 
 (i) A man's own observations — autopsy. 
 
 (2) Learning from his contemporaries and pre- 
 
 decessors — history. 
 
 (3) In the case of new and strange diseases, 
 
 by drawing conclusions from those most 
 similar to them — analogy. 
 
POST-HIPPOCRATIC SCHOOLS OF MEDICINE 27 
 
 These three methods were known as the Tripod 
 of the Empirics. Later on a fourth method was 
 added called " Epilogism " : this was the process 
 of inferring preceding events from the present 
 symptoms. Thus the empiric might conclude from 
 the extreme inflammation of a wound that it had 
 been poisoned, and treat it accordingly, without 
 falling into the dogmatic heresy of looking for 
 hidden causes. Since the main object of medicine 
 was not to understand disease, but to remove it 
 {jton interesse quid morbum faciat, sed quid tollai), 
 they regarded the study of anatomy as super- 
 fluous, and some had the energy to write treatises 
 showing it to be unnecessary. One other intel- 
 lectual influence affected the Empirics, and that 
 was the Aristotelian logic with its definitions and 
 syllogisms. In spite, then, of their very practical 
 maxims, they expended as much mental energy in 
 word-splitting, definitions of the pulse, &c., as ever 
 the Dogmatists had done in their speculations as 
 to the hidden causes of disease. 
 
 Empiricism by imperceptible gradations easily 
 passes into charlatanism, and even this famous 
 school resolved itself eventually into a search for 
 specifics, the immediate result being the introduc- 
 tion of numerous strange drugs, for example, hare's 
 heart, camel's brain, &c. 
 
28 RELATION OF MEDICINE TO PHILOSOPHY 
 
 The Methodical School 
 Intermediate between the schools of the Dog- 
 matists and Empirics came that of the Methodists. 
 This name is doubtless more familiar to English 
 ears as the sobriquet jestingly given by a Christ 
 Church undergraduate to the small group of friends 
 who gathered round the brothers Wesley in Oxford 
 in the middle of the eighteenth century, on account 
 of their regular manner of life and behaviour.^ 
 The name as originally given had, of course, 
 reference to intellectual and not moral qualities. 
 It was not very appropriate, though the founders 
 of this school did perhaps commit themselves to a 
 more definite and precise theory of disease than 
 either the Dogmatists or Empirics had done. 
 
 The chief philosophic influence which guided the 
 Methodists was that of the Epicureans ; in fact it 
 would hardly be too much to say that their whole 
 system was the application of Epicureanism to 
 medicine. The great exponent of this doctrine 
 was Asclepiades of Bithynia, who, though not 
 usually regarded as the founder of the Methodical 
 school, was certainly its immediate forerunner; and, 
 indeed, Themison of Laodicea, to whom is ascribed 
 the honour of founding the school, was actually 
 his pupil. Asclepiades, like the Epicureans, taught 
 
 ' "One person with less irreverence and more learning, observed, 
 in reference to their methodical manner of life, that a new sect of 
 Methodists was sprung up, alluding to the ancient school of physicians 
 known by that name." — Southey's Life of Wesley. 
 
POST-HIPPOCRATIC SCHOOLS OF MEDICINE 29 
 
 that the body of man was made up of innumerable 
 atoms with pores. Health {(rvfifierpia) consists in 
 the size, mass, arrangement, and movement of the 
 atoms being normal and the width of the pores 
 being normal. The object of the physician was to 
 prevent the wrong relationship of the atoms to the 
 pores ; thus few medicines were required, and cer- 
 tainly none of a drastic nature, but the applica- 
 tion of ordinary physical, mechanical, and dietetic 
 measures. The foundation of this school synchro- 
 nises with the migration of medicine from Alex- 
 andria to Rome as the centre of intellectual activity. 
 Medicine was indeed long in making her way into 
 Rome. Such an art was regarded not only as 
 unnecessary for a strong and manly race like the 
 Romans, but also as a despicable pursuit only 
 practised and required by the effeminate and de- 
 generate Greeks. Cato was the coryphaeus of this 
 particular Chauvinism, for to him the Greeks and 
 all their works were hateful, and he would have 
 echoed the cry of the Trojan Laocoon, Timeo Danaos 
 et dona ferentes. Some of his utterances seem to 
 recall the strictures of Plato on physicians \} nor 
 have such strictures ceased entirely in our own day. 
 To Asclepiades is due the credit of having forced 
 a way for medicine into Rome ; but it had to^ 
 
 1 "Well I said and to require the help of medicine, not when a 
 wound has to be cured or on occasion of an epidemic, but just because 
 by their lives of indolence and luxury men fill themselves with waters and 
 winds, as if their bodies were a marsh, compelling the ingenious sons 
 of ^sculapius to find names for diseases, such as flatulence and catarrh ; 
 is not this, too, a disgrace?" — Republic, Bk. iii. 
 
30 RELATION OF MEDICINE TO PHILOSOPHY 
 
 appear along with literature and rhetoric in the 
 garb of the philosophy which corresponded with 
 the prevailing taste. This highly accomplished 
 physician, who among other things was renowned 
 for his eloquence, had the astuteness to perceive 
 how the medical prejudices of the Roman citizens 
 were to be combated, and therefore he founded a 
 system of medicine quite opposed to the Hippocratic 
 and all previous teaching, which he used to ridicule, 
 but in harmony with the general point of view of 
 Roman life and thought, which was at that time 
 mainly Epicurean though to some extent Stoical. 
 Having thus, as we have seen, based his medical 
 theory on the doctrines of Epicurus, he allowed 
 his practice to be determined largely by the prin- 
 ciples of Zeno. His aim was to bring back to 
 the Romans the old manly life which they had 
 lost, and which they all the more keenly sought to 
 recover. His therapeutic measures were therefore 
 entirely in accord with this object, so that he used 
 to recommend : — 
 
 1. Less food and drink. 
 
 2. Rubbing the body. 
 
 3. Active and passive movements. 
 
 4. Great use of cold water, especially rain baths. 
 Themison of Laodicea and his successors continued 
 
 this Epicurean teaching of Asclepiades; but they 
 neglected the atoms and concentrated their attention 
 on the pores, an abnormal condition of which is the 
 cause of disease. The pores, according to them, are 
 
POST-HIPPOCRATIC SCHOOLS OF MEDICINE 31 
 
 either in a state of too great relaxation (pvai^) or too 
 great contraction (aTer/vmaK) ; later there was added 
 the idea of a mixed condition (to /iefii/yp,evov). It was 
 these three fundamental forms of disease which made 
 up the famous "communities" (/toH/oTiyres) of this 
 school. Every illness is the expression of a "com- 
 munity" governing the whole body, the character 
 of which may be recognised from the general con- 
 dition of the body, and specially from the condition 
 of the secretions. Therapeutics in their hands became 
 a very simple matter ; in any given case of illness it 
 was only necessary to decide whether the pores of the 
 body were contracted or relaxed, and then to apply 
 either laxative or astringent remedies accordingly.. 
 For the latter object they employed cold air and 
 water, vinegar, alum, lead and chalk, while their 
 laxative remedies consisted in venesection, cupping, 
 leeches (which were first introduced by this school 
 into European medicine), also poultices, fomentations, 
 and warmth generally. Purgatives they rejected, main- 
 taining that they only substituted the opposite form 
 of disease. It will thus be seen that in therapeutics 
 the school adopted the principle of contraria contrariis 
 curantur, which is analogous but antagonistic to that 
 of Hahnemann and homoeopathy. Such a theory as 
 this must often have landed its exponents in a practical 
 absurdity, as when the stricter members of the school 
 held that even in cases of poisoning it was not neces- 
 sary to consider the poison, but only the state of 
 contraction or relaxation of the pores it might have 
 
32 RELATION OF MEDICINE TO PHILOSOPHY 
 
 produced. Fortunately, perhaps, for the patients, 
 common __seiis^ frequently prevailed, so that the 
 Methodists were not always consistent in the appli- 
 cation of their principles. Thus Celsus gives us an 
 instance of the physician Cassius, who, when sum- 
 moned to a patient seized with fever and very thirsty, 
 recognised that the condition had supervened on a 
 drinking bout and made him drink cold water ; when 
 the water by mingling with the wine had tempered 
 the force of it, he slept and sweated, so that the 
 fever was removed. In acting with such readiness, 
 the physician did not trouble to consider whether 
 the body was contracted or relaxed, but he was guided 
 by the cause which preceded the onset of the evil.^ 
 
 The Methodists, as the medical exponents of the 
 popular philosophy of the day, had their full share 
 of intellectual pride ; thus Thessalus of Lydia, one of 
 the most distinguished members of the school, con- 
 sidered that nothing had been known in medicine 
 before his time. Reversing the famous aphorism of 
 Hippocrates^ he held that art was short and life was 
 long, and undertook to teach his pupils medicine in 
 six months ; and on a monument in the Appian Way 
 he styles himself " Conqueror of Physicians " {larpo- 
 viKi]<s). On the whole, the Methodists had closer 
 intellectual affinities with the Dogmatists than with 
 the Empirics. Like the former, they reasoned on 
 general pathology, and admitted different classes of 
 pathological states — for example, "the contracted" 
 
 ' Celsus, Lib. i. 
 
POST-HIPPOCRATIC SCHOOLS OF MEDICINE 33 
 
 and " the relaxed " — but they refused to search after 
 hidden causes, confining their attention solely to such 
 causes as were evident. Vague and uncertain as these 
 pathological states undoubtedly were, they did at least 
 constitute the basis of a medical system, whereas the 
 Empirics rejected all system^ There was, however, 
 this in common with the Methodists and Empirics, 
 that each school allowed itself to be guided by the 
 general concourse of symptoms ; but the Empirics 
 admitted no reasoning between the symptoms and 
 the line of treatment to be adopted, whereas the 
 Methodists argued back from the symptoms to the 
 state of the pores, and adapted their treatment accord- 
 ingly. They both agreed in disregarding the study of 
 anatomy. 
 
 The history of these three schools does not present 
 us with any great names or epoch-making discoveries, 
 and on the whole medicine cannot be said to have 
 made any serious advance in the period with which 
 we have been dealing. A reason for this may be 
 found in the fact that the centre of gravity of philo- 
 sophic thought had shifted from the purely scientific 
 contemplation of the world to the solution of practical 
 questions, and philosophy became mainly valued as 
 providing men with a refuge against the miseries of 
 life. Interest became concentrated on the individual, 
 and ethics took the place of physics. The Stoics and 
 Epicureans seem to have accepted any view of physics 
 which came easily to hand, without devoting their 
 whole energies to the comprehension of the cosmos, 
 
34 RELATION OF MEDICINE TO PHILOSOPHY 
 
 as the pre-Socratic philosophers had done. Like 
 Plato, they probably regarded the consideration of 
 physics as a rational pastime only. 
 
 The most useful results would seem to have ema- 
 nated from the Empirical school, perhaps because 
 they were less dominated by theory ; at the same 
 time, from a wider standpoint, such a school must 
 always be inimical to the ultimate progress of medi- 
 cine. Some system must surely be better than no 
 system, for at least it admits the possibility of 
 a rational co-ordination of knowledge. Without a 
 belief in the uniformity of Nature, which is hardly 
 possible on a basis of pure Empiricism, all science 
 becomes a phantasmagoria of strange images, medi- 
 cine a congeries of ill-assorted facts, and life itself 
 intolerable to a rational being. 
 
CHAPTER III 
 
 THE RELATION OF GALEN TO THE PHILOSOPHY OF 
 HIS TIME 
 
 The wonderful medical system of the great physician 
 of Pergamos which dominated the civilised world for 
 some fourteen centuries, was no exception to the 
 rule that medicine, like the other arts, reflects the 
 mental temper of its time. To the student of medical 
 history, it must at first sight be a matter of no small 
 astonishment that a single man, who was admittedly 
 not of transcendent genius, should have remained an 
 absolute dictator in the medical world for so long 
 a period, particularly when many of his statements 
 would seem to be especially easy of disproof. It is 
 therefore worth while inquiring what were the intel- 
 lectual forces which moulded the mind of Galen, and 
 what were the circumstances which contributed to 
 giving him this extraordinary pre-eminence. 
 
 Born at Pergamos (a.d. 131), we are told that he 
 had a most complete and elaborate education. At the 
 age of fourteen he began to attend the various schools 
 of philosophy in his native city. Here he became 
 initiated into the idealism of Plato, the realism of 
 Aristotle, the scepticism of the Epicureans, and the 
 materialism of the Stoics. 
 
36 RELATION OF MEDICINE TO PHILOSOPHY 
 
 This education continued for the space of three 
 years, and thus was laid a broad philosophic basis for 
 his future intellectual development. On this basis of 
 philosophy his later medical studies were built up, 
 and every part of the superstructure remained in 
 intimate relation with the foundation. At the age of 
 seventeen, his father, Nicon, who was an architect 
 and a very learned man, decided in consequence of a 
 dream that his gifted son should enter the profession 
 of medicine. Accordingly young Galen was handed 
 over to the most distinguished teachers of the medical 
 art. In spite, however, of the ability of individual 
 teachers, the whole condition of medicine was in a 
 state of hopeless chaos. The various schools which 
 had sprung up after the death of Hippocrates were 
 more intent upon scoring verbal triumphs over their 
 opponents than upon either advancing medical 
 science or curing their patients. Of these schools — 
 namely, the Dogmatists, Empirics, and Methodists — 
 we have given some account in a previous chapter. 
 But in Galen's time there had also developed a 
 school of Eclectics and of Pneumatists ; the latter 
 were, in fact, a further extension of the Dogmatists, 
 and so tenaciously did they hold their opinions 
 that it was said they would rather betray their 
 country than renounce their theories. Galen deter- 
 mined not to identify himself with any of these 
 conflicting systems, but set himself the task of 
 attempting some kind of unification of them all. 
 As a philosopher, the Empirical school with its 
 
GALEN AND THE PHILOSOPHY OF HIS TIME 37 
 
 negation of knowledge could have little attraction 
 for him ; the Methodists, with their crude applica- 
 tions of Epicureanism to medicine, were still more 
 repugnant, and Galen was never tired of fulminating 
 against them. It was, then, with the Dogmatists 
 and Pneumatists that he found himself most in 
 harmony, for their systems did at least permit 
 medicine to be rational. 
 
 The first important reform which Galen effected 
 was the asseition of the importance of anatomy, in 
 contradistinclion to the prevailing doctrines of the 
 Methodists and Empirics, according to which it was 
 entirely superfluous. He saw the obvious absurdity 
 of attempting to have any sound knowledge of 
 disease without knowledge of the structure of the 
 human body. The necessity of studying anatomy 
 he further emphasised by his numerous dissections 
 and anatomical descriptions. He was the first to 
 describe the platysma, interossei, and popliteus 
 muscles, also the "ductus arteriosus" and the three 
 coats of the arteries. If nothing else had come down 
 to us but his anatomical studies, he would still take 
 a high place in the history of medicine. Without 
 entering further upon this part of his work, it is sufifi- 
 cent to say that most of the anatomical errors for 
 which he was attacked by Vesalius and the modern 
 anatomists arose not from mistaken observations, but j 
 from the fact that all his dissections were made on 
 animals, the dissection of the human body being then 
 impossible. Galen imagined that what was true of 
 
38 RELATION OF MEDICINE TO PHILOSOPHY 
 
 animals in the matter of anatomical structure would 
 be equally true of man ; this was the source of most 
 of his mistakes. 
 
 Passing next to physiology, he stands out as the 
 first experimental physiologist in the history of medi- 
 cine. He was the first to demonstrate that the 
 arteries contained blood and not air, and his work 
 on the nervous system, in which he distinguished 
 between sensory, motor, and mixed nerve trunks, is 
 a model of scientific excellence. 
 
 These researches in physiology and anatomy would 
 cause Galen's reputation with the modern world to 
 stand much higher than it does, were it not that they 
 were so closely interwoven with his philosophical 
 speculations. On the other hand, the enormous in- 
 fluence which he began to wield over the civilised 
 world some thirty years after his death cannot be 
 attributed to his scientific works alone ; it was much 
 rather by his philosophical writings, which to the 
 modern world would seem foolishness and an im- 
 pediment to true knowledge, that he attained to his 
 extraordinary position of eminence in the Middle 
 Ages. 
 
 As has been shown in a previous chapter, one of 
 Hippocrates's chief titles to fame is that he separated 
 medicine from philosophy, and Galen in the main 
 took Hippocrates for his pattern and master. He 
 wrote commentaries with warm approval on nearly 
 all his works, accepted his humoral pathology, and 
 to a large extent his therapeutics. 
 
GALEN AND THE PHILOSOPHY OF HIS TIME 39 
 
 With regard to philosophy, however, though it 
 would not be fair to say that he reversed the process 
 of Hippocrates, he certainly endeavoured to bring it 
 into closer harmony with medicine. In attempting 
 this he was doubtless influenced by his early educa- 
 tion and by the high estimation in which philosophy 
 was held, for there were already several well-estab- 
 lished philosophical systems in existence which have 
 become famous for all time. Just as from time to 
 time in the world's history there have been men who 
 aimed at bringing religion into closer touch with the 
 scientific and philosophic thought of the day, so 
 Galen seems to have been desirous of carrying his 
 own special art into a higher region on the wings of 
 philosophical speculation. 
 
 In philosophy Galen was to some extent an eclec- 
 tic ; in early life he tells us that he had natural lean- 
 ings to the sceptics, perhaps the form of philosophy 
 most attractive to early youth ; from this he tells 
 us he was preserved by his natural good sense and 
 his love of geometrical demonstrations ; at the 
 same early period his unusual precocity led him to 
 write a commentary on the dialectics of the Stoic 
 Chrysippus. 
 
 But undoubtedly the philosopher who had the 
 greatest influence upon Galen was Aristotle, and these 
 two names were continually coupled together through- 
 out the Middle Ages. This influence was twofold : 
 in the first place, it made Galen aspire to occupy the 
 same position of legislative authority in the region of 
 
40 RELATION OF MEDICINE TO PHILOSOPHY 
 
 medicine which Aristotle held in the whole sphere 
 of human knowledge ; secondly, he adopted from 
 Aristotle certain definite principles which had a most 
 direct bearing upon his work. Of these principles 
 the most important was the doctrine of final causes. 
 " Nature makes nothing in vain " (firjSh' fidrtiv iroieiv 
 TTjv <f)v<nv) had been the ex cathedrd statement of Aris- 
 totle, in which, indeed, he was only following the firm 
 belief of Plato. Convinced of the wisdom of these 
 two great philosophers in all matters, Galen regarded 
 this unproved statement as a law of the universe, and 
 proceeded to show that every structure and function 
 , of the human body subserved some profound end — 
 that, in fact, the aim or object of any structure was 
 the cause of its existence. For instance, Aristotle 
 and Galen said that man has hands because he is the 
 wisest of animals ; whereas the earlier philosopher 
 Anaxagoras, more in accordance with the spirit of 
 modern science, had said that man was the wisest of 
 animals because he had hands. Galen was never 
 tired of bursting forth into pasans of praise of the 
 Creator for His profound wisdom in the construction 
 of the universe : " The Father of all Nature has shown 
 His goodness in providing wisely for the happiness 
 of all His creatures in assigning to each what could 
 be really useful to it. Let us then magnify Him 
 by hymns and psalms. He has shown His infinite 
 wisdom for arriving at His beneficent ends, He has 
 given proof of His omnipotence in creating every- 
 thing in perfect conformity with its destiny. It is 
 
GALEN AND THE PHILOSOPHY OF HIS TIME 41 
 
 thus that His will has been accomplished." 1 In his 
 work De usu partium he endeavours to prove that all 
 the parts of the body have been so well constructed, 
 and in such exact relation with the functions they 
 have to perform, that it is impossible to conceive any 
 better arrangement ; anatomy and physiology simply 
 appear as two methods which lead to the proof of 
 the wisdom of Nature. This unfortunate doctrine 
 that Nature makes nothing in vain inevitably with- 
 draws the mind from the sober investigation of facts, 
 and induces it to accept arbitrary solutions of scien- 
 tific questions in order to establish the theory. The 
 absurdity of trying to discover the functions of an 
 organ from its structure is at once seen if we ask 
 ourselves how it would be possible to deduce the 
 functions of liver, spleen, or pancreas from their 
 structure. 
 
 In describing the hand, Galen says that the muscles 
 and tendons of it are marvellously arranged in number, 
 form, and strength, so as to fulfil all the functions with 
 which it is entrusted, and that the Creator could not 
 conceive an instrument of greater perfection : nothing 
 is wanting, and nothing could be added to improve it. 
 This is the clearest evidence of the supreme wisdom. 
 What is our astonishment, after this panegyric, to 
 discover that Galen has all the time been describing 
 the hand of an ape, which, by lacking the opponens 
 pollicis muscle, is quite incapable of executing the 
 various functions of the human hand ! Again, he 
 
 * De usu partium, Bk. iii. 
 
42 RELATION OF MEDICINE TO PHILOSOPHY 
 
 calls us to observe the great wisdom of Nature in 
 having provided the brain with two coverings for its 
 protection — not with one only, nor with more than 
 two — because the brain and the skull being substances 
 of an opposite character, Nature inserts between them 
 two membranes, which are of an exactly intermediate 
 texture between the hardness of the skull and the 
 softness of the brain. But what are we to say about 
 the supreme wisdom of Nature when a third mem- 
 
 ; brane — the arachnoid — is discovered ? The result of 
 this teleological reasoning is to make the wisdom of 
 
 \ God depend on the fallible investigations of man ; 
 since, if we make belief in the wisdom of God depend 
 on the supposed adaptation of organs to functions, 
 what was true yesterday may become false to-day, 
 and so divine wisdom becomes dependent on human 
 knowledge. 
 
 Fortunately for physiology, he did not follow Aris- 
 totle in his views of sensation. The latter regarded 
 the heart as the seat of the sensitive soul, and the 
 brain as of secondary importance, because it was the 
 coldest part of the body, being devoid of blood, and 
 having for its chief or only function the cooling of the 
 heart. Into this great error Aristotle had been led by 
 his metaphysical notion that the sensitive soul was 
 indissolubly connected with heat, and therefore could 
 not have its seat in the coldest region of the body.^ 
 
 By a lucky chance Galen inverted this view, and 
 by taking the brain as the seat of sensation, was 
 
 ' Harvey and Galen, Payne. 
 
GALEN AND THE PHILOSOPHY OF HIS TIME 43 
 
 enabled to make his valuable discoveries in the ner- 
 vous system. On questions of ethics he agreed with 
 Aristotle in regarding virtue as a mean between two 
 extremes. He was also influenced by the categories 
 of Aristotle, and accepted his doctrine of the four 
 causes. But in many minor matters Galen often 
 found himself at variance with the peripatetic school 
 of Aristotle, and complained that, though they dis- 
 coursed about anatomy, he could not persuade them 
 to dissect and so have ocular demonstration of his 
 anatomical descriptions. 
 
 The influence of Plato upon Galen was only less 
 than that of Aristotle. He adopted the Platonic tri- 
 partite division of the soul, in accordance with which 
 the soul in its rational aspect {-^vxv f^vaTiKrj) had 
 its seat in the brain, in its aspect of courage {-^vxv 
 6v/j.oeiS'q<i) in the heart, and in its aspect of desire 
 {•fp-vxv iiridvfiTiTiK'^) in the liver. He wrote a com- 
 mentary on the Timaus, and expended much energy 
 in trying to prove the agreement between Plato and 
 Hippocrates, and uniting them both in substantial 
 harmony with Aristotle. Plato probably affected 
 Galen more by the general spirit and temper of his 
 writings than by any specific doctrines. Certain 
 traces of mysticism ; the belief that some truths are 
 immediately clear to the intelligence without the 
 intervention of the senses ; the following outbursts of 
 praise in honour of the Creator — "True piety does 
 not consist in sacrificing hecatombs or in burning a 
 thousand precious perfumes in His honour, but in 
 
44 RELATION OF MEDICINE TO PHILOSOPHY 
 
 recognising and proclaiming aloud His wisdom, His 
 omnipotence, His love, and His goodness " : ' all seem 
 to have the Platonic ring. 
 
 As to the popular philosophies of the day, his 
 antagonism to the Sceptics and Epicureans, as exem- 
 plified in the doctrine of the Methodists, was very 
 pronounced. With Stoicism, which was then fashion- 
 able in court circles owing to Marcus Aurelius, he 
 was much more in sympathy, and some of his doc- 
 trines seem based on that philosophy. Thus he 
 adopted their doctrine of the " Pneuma," which in 
 some Stoical writers appears to be synonymous with 
 the deity ; it seems, in fact, to be the soul of the 
 universe, and related to the world as the soul is to the 
 body of man. " The force of the soul is due to the 
 Pneuma, which is carried to the brain with the blood 
 after having been prepared by the vital spirits." This 
 explains why changes in the soul follow on general 
 changes of the body, and why all opinions are the 
 result of our physical condition. As expressed by 
 Athenjeus, one of the leading members of the Pneu- 
 matist school, which Galen was inclined to favour, 
 " The Pneuma is the world soul, the living self-con- 
 scious god, from whom the souls of men, aniirials, 
 and plants emanate, also the maker and fashioner of 
 all matter." The health as well as the disease of the 
 body was determined by the Pneuma ; it was sup- 
 posed to pass from the lungs to the heart, and then 
 to be spread all'over the body by means of the arteries. 
 
 ^ De usupartium, Bk. iii. 
 
GALEN AND THE PHILOSOPHY OF HIS TIME 45 
 
 The pulse was thought to be due to an automatic 
 movement of dilatation on the part of the Pneuma 
 contained in the arteries. On the other hand, he did 
 not hesitate to oppose Stoic doctrines, for we find 
 him maintaining that "qualities are not corporeal" 
 (oTi at TTotoTTjTe? da-wfiaToi), in direct contravention of 
 Stoic teaching. 
 
 Though Galen was a very distinguished physician 
 in his lifetime, and attended two emperors, his real 
 fame hardly began till some thirty years after his 
 death. It was owing mainly to the philosophers that 
 his reputation was spread abroad, and it was the 
 philosophical part of his medical system which caused 
 his general acceptance in the succeeding ages. Few 
 thought of imitating the really scientific part of Galen's 
 labours, and giving the same attention to anatomy 
 and physiology which he had given. Thus they 
 accepted without questioning all his anatomical 
 observations, not realising that his dissections had 
 been made on animals only, and the descriptions 
 taken as applicable directly to the human frame. So 
 strikingly was this the case that when Vesalius in the 
 sixteenth century began to point out some of the 
 errors which had hitherto been implicitly accepted, 
 the ardent defenders of Galen maintained that the 
 structure of the human body must have changed. 
 Massaria of Pavia in the seventeenth century said he 
 would rather err with Galen than be right with any 
 other physician. Thus after his death the inquiring 1 
 and scientific spirit of Galen retreated more and more / 
 
46 RELATION OF MEDICINE TO PHILOSOPHY 
 
 into the background among his successors, while his 
 systematising, organising, and, if we may so express 
 it, intellectually bureaucratic spirit came to the front. 
 
 It would seem that in the intellectual world no less 
 than in the physical the soil is as important as the 
 seed, and so it came about that the scientific investi- 
 gations of Galen, falling upon an unfavourable soil, 
 took no deep root and led to no further researches 
 in anatomy and physiology, until the revival of learn- 
 ing at the Renaissance stimulated men's minds 
 afresh to the original pursuit of truth. On the other 
 hand, his philosophical speculations seemed to har- 
 monise with the requirements of his age. For that 
 age felt the want of authority in matters intellectual 
 no less than in matters political. In the world of 
 politics men had grown weary of the civil wars 
 and party strife, which, beginning with the struggle 
 between Marius and Sulla, continued on between 
 Pompey and Caesar, had been only finally brought to 
 an end by the battle of Actium (31 B.C.). Power then 
 gravitated more and more into the hands of one man, 
 "and the people loved to have it so. Similarly, in the 
 intellectual sphere the barren strife of rival philo- 
 sophic schools, more intent upon verbal triumphs than 
 upon the solid acquisition of knowledge, produced a 
 feeling of weariness and exhaustion which made men 
 ready to welcome with open arms any co-ordinating, 
 authoritative system of knowledge, and it was just such 
 a system which Galen was well able to supply. Pro- 
 bably for the time being this constituted an advance 
 
GALEN AND THE PHILOSOPHY OF HIS TIME 47 
 
 in both the intellectual and political worlds ; at least 
 it gave time for the confused and shattered forces 
 to recuperate themselves. But in the long run such 
 centralising systems, except as temporary b ulwarks 
 agai nst political or intellectual a narchy, can never be 
 very favourable to human progress. For the firm 
 domination of a central authority in matters intellec- 
 tual dries up the springs of original thought, just as 
 it paralyses in the political world the initiative and 
 native vigour of the average citizen, and consequently 
 we get an unprogressive and unilluminating period in 
 the history of civilisation. Even with a sage upon 
 the imperial throne land the central government de- 
 voted to the good of the people, yet it has been well 
 said that the age of the Antonines was one in which 
 no man of spirit would have wished to live. 
 
 Medical knowledge being essentially progressive, 
 systems of medicine can never be permanent, but 
 are of course useful as gathering together our know- 
 ledge and providing a sound basis from which further 
 scientific advance can be made. The astonishing 
 thing about the medical system of Galen lies in the 
 fact that it lasted for such a prodigious length of 
 time, and to this we think the political and intel- 
 lectual circumstances of the age which saw its birth 
 largely contributed. Progress of any kind has been 
 due to a very small number of races out of the vast 
 family of mankind, and among these few races the 
 actual number of persons who make any serious 
 effort to advance knowledge is exceedingly small, 
 
48 RELATION OF MEDICINE TO PHILOSOPHY 
 
 so that there is always a tendency, even among the 
 more intellectually active nations, for the effort to 
 be relaxed and the pursuit of knowledge abandoned. 
 To the vast majority of mankind thinking is an 
 extremely difficult and unpleasant process, and any- 
 body who can provide a decent escape from this 
 painful duty will usually find a ready acceptance. 
 
 Unconsciously Galen flattered this common instinct 
 of mankind. His was not one of those minds which 
 arouse, fertilise, stimulate, and invigorate the spirits 
 of men ; rather was his the kind of mind which seeks 
 to bar all avenues to further progress by the elabora- 
 
 ' tion of a system. His numerous writings, on which 
 
 . he spared no pains, and which were extremely well 
 written ; the complete and rounded-off character of 
 his conclusions, which seemed to furnish an answer 
 for every question, a solution for every difficulty ; the 
 complicated logical apparatus which accompanied 
 them, together with his vast and grandiose philo- 
 
 ' sophic conceptions, all contributed to give to him 
 an almost papal dignity and infallibility in the 
 
 '-. mediaeval medical world. Later, too, when the torch 
 of civilisation passed to the Arabs, his system came 
 among a people peculiarly fitted by their natural 
 temperament and religion for the acceptance of 
 authority ; consequently with them Galen obtained a 
 renewed lease of life. What the people of those ages 
 failed to realise was that medical science must of 
 necessity, as Plato would tell us, be immersed in the 
 particulars of sense, and although philosophy may 
 
GALEN AND THE PHILOSOPHY OF HIS TIME 49 
 
 widen its conceptions and invigorate its tone, no 
 amount of speculation or metaphysical reasoning can 
 be a substitute for the exact and detailed knowledge 
 which is so essential a part of medicine. Just as a 
 man who is navigating an unknown and winding- 
 river may profitably ascend from time to time a 
 neighbouring height and, surveying the surround- 
 ing country, take stock of his position and general 
 direction, yet if he does not come down to the 
 river's edge and note each shoal and rapid, current 
 and sandbank, his boat's voyage will be endangered 
 or indefinitely delayed — similarly, it is helpful in the 
 sphere of medicine at times to scale with Galen the 
 breezy heights of philosophy and view the position 
 of our art in the light of the economy of the whole 
 universe ; but unless we descend to the particulars 
 and methods of medical science no serious advance 
 will be made, and, like the successors of Galen in the 
 Middle Ages, we shall be tied and bound by the fetters 
 of a philosophical system which, though it may have 
 at first illuminated medicine, eventually becomes an 
 obstacle to all progress. 
 
 D 
 
CHAPTER IV 
 INFLUENCE OF EARLY CHRISTIANITY ON MEDICINE 
 
 We have alluded in the last chapter to the general 
 decadence into which medicine, together with science 
 and philosophy, sank after the death of Galen, and 
 have referred briefly to some of the possible causes 
 of its fall. One cause, however, which by many has 
 been regarded as the most important of all, re- 
 mains for a somewhat longer discussion, namely, the 
 rise of Christianity. Though it was not till the year 
 A.D. 313, when the edict of Milan gave civil rights and 
 toleration to the Christians throughout the Empire, 
 that Christianity became the official religion of the 
 State, yet long before that the small band of those 
 who originally followed Christ had been increasing 
 gradually in numbers, influence, and power, stimulated 
 rather than deterred by the obloquy and persecution 
 with which successive emperors had pursued them, 
 till by the commencement of the fourth century they 
 had become the most important political factor in 
 the Empire. In the vast network of ecclesiastical 
 machinery, with all its pomp and complicated cere- 
 monial, which now overspread the civilised world, 
 a Christian of the first century might have found it 
 
 hard to recognise much trace of the lofty spiritual 
 
 50 
 
INFLUENCE OF EARLY CHRISTIANITY 51 
 
 teaching of his Master. Consequently, in ascribing 
 any particular result to Christianity, we must remem- 
 ber that this name stood for a variety of influences, 
 beliefs, and dogmas, which cannot in any fairness be 
 said to be of the essence of the teaching of Christ, 
 although they may have seemed to be compatible 
 with it. 
 
 Among such influences was Judaism, which, if not 
 very important in the political world, was of the 
 greatest significance in the realm of thought. The 
 Jews during their captivity in Babylon had come in 
 contact with a variety of ideas which were quite 
 foreign to the Mosaic law and their own theocratic 
 government. We learn from Josephus that they 
 adopted the magic of the Chaldees, and the opinions, 
 fables, and usages of Oriental nations generally, but 
 especially those of the Medes and Persians. Thus 
 some of them were deeply impressed by the tenets 
 of the Persian theosophy, and gave themselves up to 
 the contemplative life. These ideas and tendencies 
 were further accentuated by their sojourn in Egypt 
 under the Ptolemies, and especially in Alexandria, 
 where they came in contact with Platonism. 
 
 One of the most interesting sects of the Jews were 
 the Essenes, w ho appear to have originated about 
 150 B.C. The name and origin of this sect is obscure, 
 but the former may be derived from a Chaldee word 
 " ^sjniL meaning " healers,_^ and in some way they 
 appear to have been a medico-theosophical sect. 
 According to Josephus, they studied the virtues of 
 
52 RELATION OF MEDICINE TO PHILOSOPHY 
 
 roots, herbs, and stones in order to apply them to 
 the treatment of diseases ; at a later date they 
 were regarded by the common people as capable 
 of casting out demons and healing diseases. Their 
 manner of life and customs recall the Pythagorean 
 brotherhoods ; the sacred oath, the seclusion in 
 monasteries, the asceticism, the purity of body and 
 spirit to which the associates were obliged to conform, 
 all seem to concur in connecting this theosophical 
 sect of the Jews with the ancient philosophical school 
 of Magna Graecia. 
 
 The relation of the Essenes to Christianity was 
 close and important ; John the Baptist and even 
 Christ himself are said by some to have issued from 
 their ranks. It was this sect which gave birth to 
 that curious compilation known as the Cabbala,* 
 a mixture of Zoroastrian chimaeras, Pythagoreanism, 
 and Judaism. These strange mystical doctrines in- 
 vaded the whole domain of the sciences and became 
 united with medicine in the most intimate fashion. 
 The Essenes held that in treating disease the main 
 point was to set in motion the forces of the superior 
 worlds which corresponded to the disease in question ; 
 this could only be done by him to whom the Cabbala 
 has procured the knowledge of these worlds, and who 
 by his piety and contemplation is rendered worthy 
 of communicating with the celestial powers. These 
 qualities were thought to be far more essential for 
 
 1 The Cabbala substituted an immanent God, a God who is in nature 
 and one with it, for the strict monotheism of the Jews. 
 
INFLUENCE OF EARLY CHRISTIANITY 53 
 
 the exercise of medicine than all earthly wisdom, 
 which often fails us. Hence it is easy to understand 
 the hatred which learned Jews of this sect bore to 
 ordinary doctors. 
 
 Another influence which, by certain superficial re- 
 semblances to Christianity, tended to obscure the 
 original purity of that religion was Neo-Platonism. 
 The founder of this New Platonic School was Am- 
 monius Saccas (_/?. A.D. 200). He allied the teaching 
 of the Aristotelian with that of the Platonic school, 
 and endeavoured at the same time to unite it with the 
 mysterious doctrines of the Orientals and also with 
 Christianity. The earliest germs of this philosophy 
 are to be found in the writings of Philo — the learned 
 Jew of Alexandria i^fl. A.D. 20), who sought to combine 
 Judaism with Greek philosophy — and also in the writ- 
 ings of Noumenios of Apamea {fl. A.D. 150), who 
 represented the more Christian aspect of Neo-Plato- 
 nism. Though the foundation of his views was 
 based on Platonism, " he also drew inspiration from 
 the Magians, Egyptians, and Brahmins, and even from 
 Moses (he speaks of Plato as a Matvaff; dTTiKi^cov)." ^ 
 It was Noumenios who originated the doctrine of a 
 second God, who proceeded from the Supreme Being 
 and was the Demi-urgos or Creator of the World. 
 
 The Neo-Platonists, taking the ancient "emana- 
 tion " teaching of the Indians and Persians, imagined 
 that from the eternal source of light genii emanated, 
 to whom man becomes equal by leading the con- 
 ' Zeller's Outlines of Greek Philosophy, p. 314. 
 
54 RELATION OF MEDICINE TO PHILOSOPHY 
 
 templative life. Of these genii there was an incredible 
 number ; all the phenomena of nature, and, in par- 
 ticular, diseases, were attributed to them. They have 
 no body, but their light surrounds certain objects, as 
 the reflection of the sun is seen in the water though 
 it is not contained therein.^ The mystical character 
 of this doctrine found eloquent expression in Plotinus 
 {fl. A.D. 250), the most famous representative of this 
 school, who regarded the final end of all philosophy 
 as a union of human wisdom with the divine, and, as 
 a means to that end, the falling into the inward con- 
 templation of God. He could ascribe no definite 
 property to the Deity, for the Deity is that which is 
 above all being and all thought. As there could be 
 no self-consciousness in God, so His personality is 
 denied. Happiness, according to Plotinus, consists 
 in thought, and the first condition of it is liberation 
 from the body and all that is connected with it. In 
 his view, it is the union with the body which is the 
 source of all the evil in the soul, and every activity 
 has a higher value in so far as it brings us less in 
 contact with the world of the senses. Sensuous per- 
 ception gives us but dim traces of truth. Mediated 
 thought (Bidvoia, Xoyiff/io'i) and dialectic stand on 
 a far higher plane ; they have to do with ideas and 
 the essence of things. But higher than these is the 
 self-intuition of the thinking spirit, which is at the 
 same time an intuition of the divine. This, how- 
 ever, admits of a distinction between the mind and the 
 
 ^ Kurt Sprengel, Geschichte dtr Medizin, sect. v. ch. 7. 
 
INFLUENCE OF EARLY CHRISTIANITY 55 
 
 intuition. The highest point is not reached until we 
 are completely^ buried in ourselves and elevated even 
 above thought, in a state of unconsciousness, ecstasy 
 (€K(j-Taai<s), and singleness {airXaia-K), suddenly filled 
 with the divine light. Thus we become so imme- 
 diately one with the primal being that all distinction 
 between it and us disappears.^ 
 
 Porphyrius, the disciple of Plotinus, declared all 
 knowledge to be contemptible except in so far as it 
 accomplished the inner union of man with God. By 
 lamblichus (_/?. A.D. 380) this teaching was brought 
 into harmony with what was regarded as the highest 
 wisdom among Chaldeans, Jews, and Greeks. 
 
 From the foregoing it would appear that the great 
 influence on medicine in the early centuries of the 
 Christian era was Orientalism. The constant stream of 
 immigration from the East into the Roman Empire 
 at this epoch brought with it a variety of new ideas, 
 which, mingling as they did with Greek philosophy, 
 already bereft of much of its native virility, practically 
 overwhelmed it, so that mystic contemplation became 
 the predominant note of the philosophic teaching 
 of the time. Doubtless in pre-Christian eras Pytha- 
 goreanism contained much mystical teaching, and in 
 Plato there are many mystical passages in the Dia- 
 logues, while even Aristotle esteemed the life of. pure 
 thought as the highest. But now Eastern philosophy, 
 with its strong belief in the contemplative life, became 
 absolutely in the ascendant, Christianity certainly 
 
 * Zeller's Outlines of Greek Philosophy. 
 
56 RELATION OF MEDICINE TO PHILOSOPHY 
 
 tended to reinforce this standpoint, with its teaching 
 of a future world and the importance of the spiritual 
 life ; still no such great stress is laid upon the mystical 
 union with God as we find in Neo-Platonism. But 
 f apart from the special views of Neo-Platonism as 
 i to the union with God being the end and aim of life, 
 . Eastern philosophy has always been unfavourable to 
 science and the full exercise of the discursive reason, 
 and countries or epochs in which Eastern influence 
 ■ has predominated have been stricken with intellec- 
 I, tual sterility. The external circumstances of the time 
 were still further favourable to the contemplative life 
 and the spread of a theosophical system. Thus the 
 existence of despotism was inimical to the study of 
 philosophy and the sciences, for the only means of 
 obtaining riches and honour was by intriguing for 
 the favour of the despots. The imperial tyrants 
 showed either an insensate hatred of philosophy or 
 a blind partiality to superstition ; thus, while Domitian 
 had a number of men put to death simply because 
 they bore the title of philosopher, and Caracalla 
 burnt the writings of Aristotle and ordered all the 
 Peripatetic philosophers to be exterminated, Claudius 
 erected a statue in honour of the magician Simon, 
 and even the enlightened M. Aurelius, before under- 
 taking any enterprise of importance, continually held 
 counsel with the Chaldeans. 
 
 The effect of such a condition of things upon 
 medicine may be easily predicted ; most of the 
 medical writers who succeeded Galen were frigid 
 
INFLUENCE OF EARLY CHRISTIANITY 57 
 
 compilers, quite devoid either of original conceptions 
 or the power of systematic observation. The theoso- 
 phical speculation which was now in the ascendant 
 maintained with Zoroaster "that many cures are 
 effected by the help of trees and herbs, some by the 
 knife and others by the word, for the divine word is 
 the most sure means of healing diseases, by it the 
 most perfect cures are obtained." Christians and 
 pagans were alike in laying stress upon the import- 
 ance of words for expelling demons ; according to 
 lamblichus, words which are devoid of meaning were 
 specially efficacious for this end, and hence presum- 
 ably the potency of the famous "abracadabra." Most 
 effective of all, however, were words from Oriental 
 languages, and some physicians of the time of Galen 
 even imagined that they increased the therapeutic 
 power of their medicines by giving them Baby- 
 lonian or Egyptian names. Marcellus Empiricus 
 {fl. A.D. 400) seems to have surpassed most of his con- 
 temporaries in the strangeness of his remedies ; for 
 instance, in order to cure an ulcer of the eyelid it was 
 necessary to take nine grains of barley, to touch the 
 ulcer with their ends, and say each time ; ^euye, ^eOye, 
 KpiQf) ae SuoKei (English, "Fly, fly, a barley corn is 
 pursuing you "). If the ulcer was on the right eye, one 
 had to touch it with three fingers of the left hand, spit, 
 and say three times : " Nee mula parit, nee lapis lanam 
 fert ; nee hinc morbo caput crescat, aut si creverit, 
 tabescat." He also restricted the preparation of 
 medicines to certain days of the week. To preserve 
 
58 RELATION OF MEDICINE TO PHILOSOPHY 
 
 oneself from inflammation of the eyes, one had to pay 
 attention to a falling star and to count as quickly as 
 possible from its appearance till its disappearance ; as 
 many numbers as one could count in the time, so 
 many years would one be free from this affection.^ 
 
 We gather from Gregory of Nazianzen that already 
 in the second century of the Church the special gift of 
 healing was attributed to martyrs and their relics. 
 This belief of the Christians in the power of pro- 
 ducing miracles, and their alliance with the ideas of 
 the pagans, gave rise to the most pernicious errors, 
 gross prejudices, and opinions devoid of all sound 
 sense, which dealt a mortal blow at the sciences and 
 brought on the thick darkness of barbarism. Much 
 of the opposition of Christianity to science and 
 philosophy sprang from the fact that these were so 
 closely associated with paganism, although in reality 
 they were only an accident, and certainly not the 
 essence of the pagan religion. 
 
 While no impartial observer could maintain that 
 Christianity was mainly responsible for the intellec- 
 tual obscurantism which characterised the Roman 
 world during the first few centuries of our era, it must 
 at the same time be acknowledged that the new 
 religion did little to dissipate that mental darkness. 
 It would be an entire mistake to suppose that the 
 downfall of paganism when Christianity became the 
 State religion brought about the downfall of philo- 
 sophy and science, because the decadence of in- 
 
 • Kurt Sprengel, Geschichte der Medizin, sect. vi. ch. I. 
 
INFLUENCE OF EARLY CHRISTIANITY 59 
 
 tellectual life had set in long before the time of 
 Constantine. No rehabilitation of paganism would 
 have renewed the mental vigour of the Empire. We 
 may judge of this to some extent by the reign of 
 Julian the Apostate. This prince indeed was distin- 
 guished by his moral rather than by his intellectual 
 superiority. On the whole he exercised a wise 
 clemency towards the Christians, and tried to model 
 his character largely on the philosophic doctrines of 
 the Stoics. Intellectually, however, he was the slave 
 of the crudest superstition of the time, and though 
 the decided opponent of Christianity, no one sank 
 deeper into that intellectual obscurantism of which 
 Christianity has so often been accused than the 
 Emperor Julian himself. He was imbued with a 
 blind partiality for Neo-Platonism, and most of the 
 philosophers who inundated his court were celebrated 
 by their passion for magic and the theurgic arts. 
 He chose his favourites among the sages who were 
 deeply skilled in the occult sciences of magic and 
 divination, and every impostor who pretended to 
 reveal the secret of futurity was assured of enjoying 
 the present hour in honour and affluence. For the 
 purely intellectual schools of thought, such as the 
 Epicureans and Sceptics, he had a most unphilosophic 
 hatred. As Gibbon has so well expressed it, " By a 
 strange contradiction he disdained the salutary yoke 
 of the gospel while he made a voluntary offering of 
 his reason on the altars of Jupiter and Apollo." ^ 
 
 ' Decline and Fall of the Roman Empire, ch. xxiii. 
 
6o RELATION OF MEDICINE TO PHILOSOPHY 
 
 He even gave his adherence to the view that not only 
 is the pride of the gods gratified by the devotion of 
 mankind, but also that their grosser parts derive some 
 nourishment from the fumes of sacrifice. It does not 
 require much knowledge of Plato and Aristotle to 
 realise the enormous gulf which separated Julian from 
 the pure fountain of Greek philosophy, which he was 
 ambitious of restoring. His paganism was simply an 
 eclectic amalgam of Eastern superstitions unskilfully 
 welded into union with the mythologies of Greece 
 and Rome. 
 
 Oribasius of Pergamos {jl. A.D. 360) was the 
 favourite physician of Julian, and he helped to 
 strengthen the emperor in his appetite for the mar- 
 vellous. Julian made him quaestor of Constantinople, 
 and sent him on an important occasion to Delphi to 
 consult the oracle, from which he received the cele- 
 brated answer that henceforth the oracles would be 
 dumb. Oribasius was banished by the succeeding 
 emperors Valentinian and Valens, but was recalled 
 later on when they found that they could not dispense 
 with his medical services. He made copious extracts 
 from Galen, and in fact from all the great Greek 
 writers on medicine, but there is hardly a trace of 
 any originality to be found in his works. He did, 
 however, inculcate a few special gymnastic exercises, 
 and also described the cases which are suitable for 
 venesection, and the best situation for doing it. 
 Compared, however, with other physicians in this 
 decadent era, Oribasius was a miracle of scientific 
 
INFLUENCE OF EARLY CHRISTIANITY 6i 
 
 sanity. Thus Marcellus of Sido {fl. A.D. 150) wrote 
 forty-two books on medicine in hexameter verse, of 
 which two fragments have come down to us, one 
 giving a description of a particular kind of melancholy 
 known as lycanthropia,i the other describing the 
 various fish which are useful in medicine. Vindicius 
 {fl. 370), the physician of Valentinian, wrote a poem 
 on treacle. Sextus Placitus Papiensis {fl, 350) tells 
 us of various remedies drawn from the animal king- 
 dom ; we can appraise their value by the following 
 examples : " The heart of a hare to be applied to 
 the neck in quartan fever ; in order to be free from 
 attacks of colic for the rest of one's days, one should 
 boil and eat immediately a new-born puppy." When 
 attacked by an acute fever one should cut a splinter 
 from the door beneath which a maniac has passed, 
 and say at the same time, "Tollo te ut ille febribus 
 liberetur." 
 
 Though very many of the Christians, no less than 
 the pagans and Jews, gave themselves up to magic 
 with a zeal which threatened the total annihilation 
 of science, and a certain sect of Christians — the 
 Ophianians — established the worship of serpents, yet 
 in justice to the orthodox Church in her official 
 capacity it must be admitted that she always repelled 
 the absurdities of magic, and openly bore witness to 
 the horror with which they inspired her, while the 
 first Christian emperors had issued severe edicts 
 against all kinds of divination. 
 
 ' Haeser, Geschichte der Mfdizin, vol. i. p. 340. 
 
62 RELATION OF MEDICINE TO PHILOSOPHY 
 
 The ineptitude of human reason in the light of 
 divine revelation, the vanity of things temporal com- 
 pared with things eternal — views such as these could 
 not but be unfavourable to the progress of so mun- 
 dane a science as medicine. It does not seem to have 
 occurred to the early Christians that whatever may 
 be the truth about first causes, as indicated by divine 
 revelation, the inquiry into secondary causes, with 
 which alone medicine is concerned, is neither foolish 
 nor impious ; the vanities of the present world were 
 exchanged not for the sublime metaphysical realities 
 of Plato, but for the somewhat crude materialism of 
 another world. There is no reason to suppose that 
 this attitude of the early Christians was in any way 
 representative of their Founder, but it was rather 
 due to the natural dislike of thinking which is charac- 
 teristic of the vast majority of mankind, but specially 
 of those who are dominated by Eastern influences. 
 Although the influence of Christianity upon medicine, 
 viewed as a science, was unfavourable, there was 
 another aspect in which this influence was wholly 
 beneficent. Pagan philosophy, with its eye fixed 
 upon the State, took but small account of the indi- 
 vidual, so that the poor, the sick, and the aged were 
 apt to be regarded as useless encumbrances. Certainly 
 in the ancient world there were no settled institutions 
 or hospitals for the care of the poor and sick, but 
 to some extent the existence of slavery served to 
 protect those who were in excessive wretche'dness. 
 " Valetudinaria " were infirmaries for slaves who were 
 
INFLUENCE OF EARLY CHRISTIANITY 63 
 
 exhausted by overwork, yet so little human relation- 
 ship was there between man and man that Cato 
 recommended the sale of old and worn-out sick 
 slaves. The best evidence of the fact that the ' 
 ancient world was ignorant of hospitals in our sense 
 of the term lies in the amazement of the heathen 
 when they beheld the first institution of the kind, [ 
 and by the zeal of the Emperor Julian to do like- 
 wise. "We see," said the pagan Emperor, "what 
 makes the enemies of the gods so strong, their 
 humanity to strangers and the poor, and their holi- 
 ness of life. It is a shame to think that the Gali- 
 Iseans practise their mercy not only on those of 
 the same faith, but even on the servants of the 
 gods." This large-minded charity of the early 
 Christians was certainly a new feature in the pagan 
 world, and must have aided powerfully in the spread 
 of the Gospel. The care of the sick appeared to 
 them as one of the works most pleasing to God ; 
 and many religious men and women took over the 
 care of the sick for their life's work. 
 
 In the quite early days of Christianity, in conse- 
 quence of the persecutions to which they were sub- 
 jected, the Christians were able to do but little in the 
 way of establishing institutions of mercy ; but when 
 they obtained the dominion of the heathen world, 
 and the treasures of the heathen temples flowed in 
 to their congregations, then there arose institutions 
 for the sick and poor on a truly magnificent scale. 
 Even in the time of St. Chrysostom {fl. A.D. 390) the 
 
64 RELATION OF MEDICINE TO PHILOSOPHY 
 
 churches of Constantinople had to support daily 3000 
 poor, not counting prisoners, strangers, and lepers. 
 The first great establishment for the sick and poor 
 was made by St. Basil, Bishop of Caesarea (370-379), 
 and it was regarded as more wonderful than the 
 pyramids and colossus of Rhodes. Into this vast 
 almshouse (■jrTo>^a)Tpo<}>eiov) were gathered together 
 vast numbers of the poor, the fallen, the sick, and 
 afflicted from all parts of Christendom. St. Basil him- 
 self was very liable to illness, and had himself studied 
 medicine, which he declares to be the noblest of all 
 worldly professions.^ He did not, however, believe 
 that all diseases are produced by nature, or even 
 by our own vices and bad habits ; " some are sent 
 directly from God Himself as trials of our faith or 
 punishments for some forgotten sin, and whenever 
 we are conscious of this we should not go to a 
 physician, but bear patiently the chastening of the 
 Lord till He sees fit to remove it." Christianity bore 
 witness to the value of each individual life in a 
 manner quite unknown to the pagan world, which had 
 permitted to the father the right of killing or expos- 
 ing his new-born child. To prevent this Nerva had 
 given lands to the poorest inhabitants, and Trajan 
 had insisted upon 5000 children being publicly sup- 
 ported. The care of abandoned children was among 
 the most important duties of the deaconesses in the 
 early Christian communities, but it was not till the 
 Council of Nicaea in the fourth century that foundling 
 
 > Withington, History of Medicine, p. 12 1. 
 
INFLUENCE OF EARLY CHRISTIANITY 65 
 
 hospitals were systematically established, which have 
 continued since then in the Christian world. Eudocia, 
 the wife of Theodosius, erected in Jerusalem hospitals 
 as well as churches and cloisters. We know further 
 from the Justinian code that money was often left to 
 found hospitals. The care of the sick in these hos- 
 pitals was entrusted to monks and " Parabolani," ^ 
 who regarded it as a divine service and a means 
 of assuring their salvation ; these latter also sought 
 out the sick and tended them in their own houses, 
 specially at times of epidemics ; unfortunately, they 
 too often degenerated into being the body-guards of 
 turbulent bishops, and, leaving their peaceful duties 
 among the sick, employed physical force to assert 
 or refute some theological doctrine. It was this 
 appetite for religious controversy as much as any- 
 thing else which, by absorbing the intellectual ener- 
 gies of the age, had so sterilising an effect upon the 
 progress of science. Such controversies were, of 
 course, due to rival sects within the Church, and at 
 this distance of time seem peculiarly unedifying. 
 
 While the value attached by Christianity to the \ 
 individual lives of the most wretched and outcast i 
 of mankind gave rise to the beneficent institutions 
 we have described, the truths of Christianity, being ; 
 primarily concerned with and designed to meet the 
 spiritual necessities of man, could not be extended 
 
 * Probably derived from Tapap&\\e<r6ai, " to throw oneself into danger," 
 because it was very perilous to tend the sick during an epidemic (Kurt 
 Sprengel, GeschichU d(r Meiikin, sect. v. ch. 8). 
 
 E 
 
66 RELATION OF MEDICINE TO PHILOSOPHY 
 
 to the phenomenal world without disastrous results. 
 Whatever unfavourable influence Christianity may 
 have exercised on the development of medicine and 
 science generally, was due to the confusion of thought 
 which induced the officials of the ecclesiastical hier- 
 archy to apply the truths which deal with a world 
 unconditioned by time and space to a world which 
 is so conditioned. 
 
CHAPTER V 
 ARAB MEDICINE AND ARAB PHILOSOPHY 
 
 The rise of the Arabian Empire, associated as it 
 was with the revelation of a new religion which over- 
 spread a large portion of the surface of the globe, 
 introduced a fresh and alien element into the worn- 
 out civilisation of the Old World. Everything went 
 down before this young and vigorous conquering 
 power, with its simple if somewhat crude watchwords. 
 In consequence of this energy and success in the 
 material world, as contrasted with the general supine- 
 ness of the Dark Ages, the value of the Arabian 
 civilisation to the mental development of mankind 
 has been rated too highly. Subsequent generations 
 have attached to the medicine and philosophy which 
 flourished under the sway of the Arabs an importance 
 they are far from deserving. To this day we gaze 
 with admiration at the wonderful architectural re- 
 mains of the Arab dominion in Spain, we read of 
 sciences being encouraged and magnificent libraries 
 being founded by the haughty caliphs, and we fondly 
 imagine that all this meant a great deal of intel- 
 lectural ferment and activity. As a matter of fact it 
 meant nothing of the kind. The founding of Bagdad 
 
 in the middle of the eighth century, in spite of the six 
 
 67 
 
68 RELATION OF MEDICINE TO PHILOSOPHY 
 
 thousand savants attracted to the town, the opening 
 of the library at Cordova (915), in spite of its 600,000 
 MSS., requiring forty-four volumes to catalogue them, 
 the possession by private individuals of libraries con- 
 taining 100,000 volumes, represented far more the 
 love of grandeur, inherent in the Oriental potentate, 
 than the hungering and thirsting after knowledge 
 characteristic of the Western mind. The founding 
 of universities and the opening of libraries do not 
 necessarily imply any real interest in the intellectual 
 life ; at one time it may be a mere matter of fashion, 
 at another simply a means of fostering and improving 
 the practical arts. 
 
 That a vast amount of energy was devoted by the 
 Arabs to the study of medicine is amply attested by the 
 voluminous writings of their physicians, but this con- 
 stitutes no evidence of any serious interest in matters 
 intellectual. For medicine is a subject which will 
 always appeal alike to the smallest and to the greatest 
 mind ; here the crudest materialism may join hands 
 with the loftiest idealism, and the untutored savage 
 seeking a salve for his wound may seem to be engaged 
 on the same task as the philosopher who is trying 
 to solve the mystery of pain. Neither medicine nor 
 philosophy were native products of Arab civilisation, 
 for both were borrowed from the Greeks ; on neither 
 was set by it the seal of any original thought. 
 
 Slowly filtering through a variety of tortuous 
 channels, the philosophy and medicine of Greece 
 came to the Arabs strangely altered from their ori- 
 
ARAB MEDICINE AND ARAB PHILOSOPHY 69 
 
 ginal purity. Their first teachers were the Nestorian ) 
 Christians, who, having objected to the expression 
 BeoTOKoi; (Mother of God) as applied to the Virgin 
 Mary, 1 had been expelled by the Orthodox Church 
 (a.d. 431). Thus excommunicated, these unfortu- 
 nate heretics, shut off from the teaching of theology, 
 betook themselves to the study of medicine. The 
 main scene of their labours was Edessa, a town of 
 Mesopotamia, celebrated for the famous portrait of 
 Christ, supposed to have been painted by St. Luke 
 and sent by the Saviour Himself with a letter to 
 Abgar, King of Edessa. Here they established a 
 school of medicine which for a time rivalled that 
 of Alexandria. But even this apparently innocent 
 and useful occupation did not escape the jealousy of 
 ecclesiastical orthodoxy, and in 489 the Emperor 
 Zeno, at the instigation of the Bishop Cyrus, published 
 an edict ordering the school to be closed and the 
 heretics to be banished from the Empire ; thus their 
 lecture-halls were destroyed, and from the materials 
 was built a church dedicated to Mary, " the Mother 
 of God," in defiance of the detested opinions of 
 the Nestorians. The latter fled to Persia, where 
 they were favourably received, and chose Gondisapor 
 
 ' "Nestorius revered the Blessed Virgin as the Mother of Christ, but his 
 ears were offended with the rash and recent title of Mother of God, which 
 had been insensibly adopted since the origin of the Arian controversy ; 
 as patriarch of Constantinople he preached against the use or abuse of a 
 word unknown to the Apostles, unauthorised by the churches, which could 
 only tend to alarm the timorous, to mislead the simple, to amuse the 
 profane, and to justify by a seeming resemblance the old genealogy of 
 Olympus" (Gibbon, Decline and Fall of the Roman Empire, ch. 47). 
 
70 RELATION OF MEDICINE TO PHILOSOPHY 
 
 as their medical centre, where a university already 
 existed, apparently in the hands of the Zoroastrians. 
 The town was built on the model of Constantinople, 
 and the doctors established a school of Hippocrates 
 there. In this school many Persians and Arabs were 
 trained, the professors for the most part being Nes- 
 torian Christians, who taught theology as well as 
 medicine and other sciences. Here was a public 
 hospital at which young doctors learned to treat 
 disease, but they were only admitted after passing 
 certain examinations, which involved reading the 
 Psalms of David, the New Testament, and various 
 prayers. These heretical Christians, however, seem 
 to have been liberal enough to allow the pagan 
 philosophers to take part in the teaching, and as 
 Nestorianism had spread to India and China, even 
 Hindu physicians appeared as professors at Gon- 
 disapor. " Thus there were gathered into one town 
 the ancient knowledge of the East, the remains of 
 Greek thought, and the most liberal-minded of the 
 Christians." i 
 
 On the surface, nothing could have seemed more 
 favourable for the advance alike of medicine and 
 philosophy. What development might now have 
 ensued in these two spheres of intellectual activity, 
 but for the advent of Mohammed and the Koran, 
 it is useless to discuss. If, however,, it be true that 
 in the long run every nation has the government 
 which it deserves, so certainly it seems that every 
 
 ' Withington, Medical History from the Earliest Times, p. 127. 
 
ARAB MEDICINE AND ARAB PHILOSOPHY 71 
 
 nation adopts the religion suited to its mental temper. 
 Consequently, when we speak of the effect of Moham- 
 medanism upon the progress of medicine and philo- 
 sophy, we must not look upon it as a force acting 
 ab extra, but rather as being intimately bound up 
 with and giving expression to the natural temperament 
 of the Arabs. Now, that temperament instinctively 
 craved for authority, and it was because Mohammed 
 could so amply satisfy this craving that the success 
 which he obtained at first with his own people was 
 so enormous. Once welded into unity by this means, 
 they were enabled to overcome every obstacle by 
 the fire of their enthusiasm, the simplicity of their 
 life, and the certainty of their convictions. It would 
 be a mistake to suppose that the speculative activity 
 of the Arab was crushed out by the iron fetters of 
 the Koran, Doubtless, for the true Mussulman, in 
 comparison with the Koran there was no need of 
 human wisdom or secular knowledge ; yet had there 
 been no Koran the average Arab would not have 
 shown any great intellectual appetite. Before the 
 advent of Mohammed, "in the time of Ignorance" 
 as they termed it, the only sciences cultivated were 
 those dealing with genealogy, to enable them to settle 
 family disputes, such knowledge of the fixed stars 
 as might help them to foretell the weather, and the 
 interpretation of dreams. The Koran merely elevated 
 into a virtue the innate intellectual sluggishness of 
 the Arab by condemning to hell and eternal punish- 
 ment the small number of enlightened Arabs who 
 
72 RELATION OF MEDICINE TO PHILOSOPHY 
 
 might have occupied themselves with philosophy, 
 and who would doubtless anyhow have been socially 
 ostracised and subjected to the petty persecution of 
 obscurantist zeal. 
 
 Such being the natural temperament of the Arabs, 
 
 I by an unerring instinct they seem to have sought out 
 and selected the physician among the Greeks who 
 
 \ most readily satisfied this yearning for authority, and 
 therefore they took Galen as their model and guide 
 in matters medical. But they did not imitate his 
 strenuous method and mental processes ; they simply 
 accepted his conclusions without verification as con- 
 stituting a permanent body of medical truth. His 
 all-embracing system, which had an answer for every 
 doubt, a solution for every difficulty, was just what 
 they required ; here was the high-priest of medicine, 
 and his writings a veritable Koran for the healing 
 art. In so far as the Arabs possessed any medicine 
 unborrowed from the Greeks, it was a pure empiricism. 
 All the means for curing diseases were indifferent, 
 and by preference they employed superstitious for- 
 mulas in order to exorcise the demons which they 
 thought to be the cause of most diseases. Though 
 the main influence on Arab medicine was undoubtedly 
 Greek, it was so in the letter only, and not in the 
 spirit. For the true Greek spirit never descended 
 or could descend upon the followers of Mohammed. 
 No Arab knew anything of Greek in the original ; 
 at most, Greek writings had been translated into 
 Syriac and thence into Arabic, so that the chances 
 
ARAB MEDICINE AND ARAB PHILOSOPHY 73 
 
 of textual error were considerable. Then, too, it was 
 not the authors of the most glorious time of Greek 
 history who were translated — not Homer, iEschylus, 
 Euripides, or Thucydides, &c. Even with Aristotle 
 their acquaintance was third-hand, for it was the 
 Aristotle only of the Alexandrines whom they knew, 
 and his works had become an unrecognisable cari- 
 cature by means of the pseudo-Platonic, Judaic, and 
 Christian dogmas with which they were overlaid.^ 
 This Arabianised Aristotle passed into the service 
 of the Koran, just as with the Jews he passed into 
 the service of the Talmud, and with the Christians 
 into that of the Church. The only natural history 
 which was translated was that of Dioscorides ; the 
 writings of Theophrastus and Aristotle's history of 
 animals were not translated. 
 
 Of all the sciences connected with medicine, the 1 
 most fundamental — namely, anatomy — was the one 
 which least engaged the attention of the Arab pro- 
 fessors. Not only was the practical detailed work of 
 this science repugnant to their temperament, but the 
 dissection of human bodies defiled the Mussulman, 
 and was rigidly forbidden by his religion. For the 
 Mussulman believes that after death the soul does 
 not leave the body suddenly, but passes by degrees 
 from one member to another, and finally into the 
 breast ; so that to dissect a dead man would mean 
 cruel martyrdom to him. Besides this the Moham- 
 medans, borrowing the idea from the Jews, think that 
 1 Haeser, Geschichte der Medizin, vol. i. p. 555. 
 
74 RELATION OF MEDICINE TO PHILOSOPHY 
 
 the dead are judged in their graves by two angels — 
 Nakkir and Monker — at whose tribunal they must 
 appear erect; hence the dead body must be whole 
 in order to submit to the judgment.^ As the Koran 
 forbade the representation of living beings, Arab 
 medicine had to dispense with the necessary ana- 
 tomical models. Consequently anatomy could make 
 no advance, and for all that they did know they were 
 still dependent on Galen. One Arab physician — 
 Abdollatif — did indeed establish the true principle 
 that anatomy is not to be learned from books only, 
 and that the dogmas of Galen must yield before an 
 autopsy ; but he found few disciples, although he had 
 the merit of discovering two mistakes in the anatomy 
 of Galen. Thus he pointed out that neither the 
 inferior maxilla nor the sacrum were made up of 
 several bones, as Galen had maintained. This obser- 
 vation he was able to make without defiling himself 
 with dissection, by chancing to come across a heap 
 of skeletons, which he carefully examined. He ex- 
 pressed the intention, if Providence permitted, of 
 writing a book of revised anatomy, comparing Galen 
 with nature. Had he been able to accomplish this, 
 doubtless many other Galenical errors would have 
 been brought to light, and some of the work of the 
 Italian anatomists of the Renaissance might have 
 been anticipated. 
 
 To the study of chemistry and pharmacy there 
 were not the same obstacles, and to them the Arabs 
 
 ' Kurt Sprengel, Gesckichte der Medizin, sect. vi. ch. 5. 
 
ARAB MEDICINE AND ARAB PHILOSOPHY 75 
 
 devoted extraordinary zeal. Much of the attraction 
 of chemistry was doubtless due to the vain hope of 
 transmuting the metals. There was even a chemical 
 society at Fez, thus contemptuously described by 
 Leo Africanus : " There is a most stupid set of men 
 who contaminate themselves with sulphur and other 
 horrible stinks. They are wont to meet in the even- 
 ing at the principal mosque, and there dispute over 
 their vain imaginations." ^ Their writings on materia 
 medica were most voluminous, and those of Mesiia 
 the younger (1015) formed the foundation of the 
 western pharmacopoeias, and were consulted up to 
 the beginning of the eighteenth century. 
 
 One of the best-known Arabian physicians was 
 Rhazes {fl. 850-920), who is still famous for having 
 been the first to discriminate between measles and 
 smallpox. In his youth he devoted himself to music, 
 but abandoned this in order to apply himself to medi- 
 cine, which, together with philosophy, became the 
 main object of his studies. He distinguished be- 
 tween febrile and non-febrile heat ; for the latter, he 
 says, may follow a drinking-bout, but is not fever. 
 He also distinguished between the laryngeal and the 
 recurrent laryngeal nerve. Like Hippocrates, he 
 attached great importance to prognosis, and wrote 
 a book of aphorisms modelled on that of the great 
 Greek physician, in which, with all the emphasis of 
 the Oriental, and in a mystic style, he sets forth the 
 great discoveries he has made, and shows a predilec- 
 ^ Withington, Medical Historv, p. 169. 
 
76 RELATION OF MEDICINE TO PHILOSOPHY 
 
 tion for astrology. His pathology was the same as 
 that of Galen, combined with some principles of 
 methodism. In philosophy he was a great student 
 of Aristotle, but has been accused of misunderstand- 
 ing the Peripatetic system, which caused him to 
 throw himself into the arms of Pyrrhonism. Follow- 
 ing the fashion of the age, however, he preferred the 
 philosophy of the Neo-Platonists to that of all other 
 sects, and he tried to unite it with scepticism. He 
 must have been a great student of the works of other 
 ■physicians, for we find him saying: " He who reads 
 attentively and meditates on the writings of former 
 doctors acquires in the short space of a lifetime more 
 knowledge than he could get together by tending the 
 sick for several centuries ; for it is impossible for one 
 man, however long his career, to arrive at the greater 
 part of medical truths unless he profits by the experi- 
 ence of his predecessors." His books, which were 
 largely derived from the physician Oribasius, were 
 dedicated to the enlightened Caliph Almansor, who 
 had incurred the hostility of the orthodox by favour- 
 ing philosophy, and thus diminishing the authority 
 of the Koran. Rhazes received the post of director 
 of the hospital at Bagdad. It is related of him that 
 when asked to choose a site for the hospital, he hung 
 up pieces of meat in various parts of the city, declar- 
 ing that the one in which putrefaction last appeared 
 would mark the most suitable position. 
 
 More famous than Rhazes was his successor, 
 Avicenna {fl. 98S-1036), who rivalled Aristotle and 
 
ARAB MEDICINE AND ARAB PHILOSOPHY 77 
 
 Galen in his prolonged influence over the scientific 
 world. His youth was characterised by an extra- 
 ordinary mental activity. He tells us that when he 
 experienced great difficulty in understanding a thing 
 he prayed to God to give him part of His wisdom, and 
 his prayers were always answered. The Metaphysics 
 of Aristotle was the only book he could not under- 
 stand ; after having re-read it forty times he threw it 
 aside, full of vexation with himself. According to 
 him, " Medicine is no hard and thorny science, like 
 mathematics and metaphysics, so I soon made great 
 progress " ; and indeed such seems to have been the 
 case, as at the early age of eighteen he performed an 
 important operation on the Caliph Nukh. 
 
 The great system which he elaborated, called " The 
 Canon of Avicenna," prevailed in the medical world 
 for six centuries. The reason for the remarkable^ 
 success of his system, which was out of all proportion \ 
 to its intrinsic merit, lies in the fact that the medi- 
 aeval mind regarded medicine as an apparently fixed 
 body of unchanging truth, and the various scattered 
 medical doctrines were collected by Avicenna into ; 
 one vast corpus and set forth with great lucidity and i 
 logical cogency. He dispensed with every kind of j 
 research, and this particularly suited the temper of the \ 
 Middle Ages, when even the habit of thinking was i 
 lost. Science limited itself to possessing the know- ) 
 ledge acquired by the ancients, and the Canon con- 
 tained nearly all that had been said up to that time 
 by Greek and Arab physicians. 
 
78 RELATION OF MEDICINE TO PHILOSOPHY 
 
 Avicenna was greater as a philosopher than as a 
 physician, his object being to reconcile the doctrines 
 of Aristotle with those of Galen, just as St. Thomas 
 Aquinas two centuries later reconciled them with the 
 Catholic Church.^ In speaking of the causation of 
 disease, he discusses not only the primitive, ante- 
 cedent, and conjoint causes of Galen, but also the 
 material, formal, efficient, and final causes of Aristotle. 
 This combination was very impressive to the medi- 
 aeval physician, who held that where Aristotle and 
 Galen differed none could decide, and that where they 
 agreed none could dissent. He compares the doctor 
 to the priest, and says that the former, like the latter, 
 employs reasoning but little ; however, they may both 
 be considered as philosophers, and in that capacity 
 they have a right to reason. He himsiSlf uses this 
 privilege of philosophers, but is seldom original ; he is 
 always influenced by Galen, Aetius, or Rhazes ; when 
 he forsakes them he follows Aristotle.^ His ignor- 
 ance of anatomy and natural history was astonish- 
 ing. He had odd ideas about vital spirits, and in 
 general upon hypothetical aerial substances which 
 preside over sensation, and when disturbed give rise 
 to melancholy. He showed more insight in pointing 
 out the difference made by climates to remedies ; thus 
 he says that the purgatives of the Greeks should not 
 be used in Persia, and that scammony becomes 
 entirely inactive in Bokhara. From the time of 
 
 • Withington, Medical History, p. 153. 
 
 ' Kurt Sprengel, Ges(hi(H(« dtr Medizin, sect. vi. ch. 5. 
 
ARAB MEDICINE AND ARAB PHILOSOPHY 79 
 
 Avicenna dates the absurd custom of gilding and 
 silvering pills, which arose from the idea formed of 
 the energetic properties of gold and silver. This 
 strange prejudice caused the precious metals to be used 
 for the manufacture of cauterising instruments, and 
 Albucasis wrote a celebrated book in which he combats 
 this prejudice, saying that iron, far from being inferior 
 to gold and silver, is, on the contrary, the most suitable 
 metal for surgical instruments. Stagnant and futile 
 as the intellectual life of the Eastern Caliphate seems 
 to have been, contact in Spain with an Aryan civilisa- 
 tion poured new life into the dried-up springs of Arab 
 thought. Two striking names appear before us as 
 representative of medicine and philosophy in the 
 Western Caliphate of Spain — namely, Averrhoes and ; 
 Maimonides — who gave evidence of mental activity 1 
 and speculative daring quite alien to the genius of the 
 Koran, and certainly in direct hostility to it. The / 
 seed which was then sown fell upon stony ground, as 
 it was not until the Renaissance that medicine could 
 shake itself free from the shackles of mediaevalism. 
 
 Averrhoes {fl. 1200) was a native of Cordova, and 
 his father was high-priest of Andalusia. In his youth 
 he studied law and theology, but soon turned his 
 attention to philosophy and medicine, learning the 
 elements of the latter from Avenzoar, the physician of 
 Seville. He threw himself ardently into the study of 
 Aristotle, whom, however, he appears often to have 
 misunderstood by relying too closely on the com- 
 mentators — Ammenius and Themistius — who were 
 
8o RELATION OF MEDICINE TO PHILOSOPHY 
 
 attached to the doctrines of the Neo-Platonists ; 
 consequently his theories had much analogy with the 
 pantheism of the Alexandrine Greeks. He raised up a 
 great storm of opposition, being accused of attacking 
 the precepts of Islam, while the orthodox Christians 
 charged him with horrible crimes and blasphemous 
 discourses. In medicine as in philosophy he kept 
 closer to the Arabianised system of Aristotle than to 
 that of Galen. He wrote a small treatise endeavour- 
 ing with moderation to overthrow the Galenical 
 system, and to establish in its place that of the 
 Peripatetics, making, with Aristotle, the heart the 
 origin of the whole vascular system and the seat of 
 sensation. Averrhoes tried to base the doctrine of 
 Aristotle upon a new and more solid foundation, and 
 to combine the dialectic of the Greeks with medicine. 
 His medical treatise was translated into Latin and 
 known as the Colliget, in which he applies the 
 Peripatetic philosophy to the healing art. He said 
 that no one could understand his book without being 
 initiated into the mysteries of dialectics. For the 
 most part his writings are lucid and logical. He 
 taught the doctrine of a Universal Reason (other than 
 the individual reasons), indivisible but shared in by all, 
 and denied the immortality of individual men. He 
 expounded the Koran according to Aristotle, and so 
 founded a Moslem philosophy of religion which gave 
 rise to many heresies. In opposition to Arabian 
 orthodoxy, Averrhoes appeared on the side of reason 
 as the defender of philosophy. 
 
ARAB MEDICINE AND ARAB PHILOSOPHY 8i 
 
 The other famous name was that of Maimonides 
 (Moses ben Maimon). He was born at Cordova 
 (1135), and there, under the most distinguished Arabic 
 masters of the time, he devoted himself to the study 
 of medicine, theology, and Aristotelian philosophy. 
 Though Jewish, his family outwardly conformed to 
 Mohammedanism ; but when a decree went forth that 
 all Jews and Christians must accept Islam or leave 
 the country, he emigrated to Egypt and became 
 physician to the reigning sultan, Saladin. His medi- 
 cal works, which were numerous, do not show any 
 special originality ; perhaps the best known is the 
 book on poisons and their antidotes, a more or less 
 popular work, being a sort of first aid to the poisoned. 
 He wrote also about phthisis and other diseases of 
 the lungs, a book on diet conceived entirely in the 
 Hippocratic spirit, and commentaries on the apho- 
 risms of Hippocrates. The value of Maimonides to ^ 
 medicine does not consist, however, in his medical 
 writings, but in the fresh and enlightened spirit which > 
 he introduced into the barren speculation of that 
 gloomy age. He was famous as a philosophic cham- 
 pion of reason, and endeavoured to explain the Bible 
 by the light of reason, with which, as the highest 
 divine gift in man, nothing really divine could stand 
 in contradiction. The miracles themselves, though 
 not always traceable to their immediate cause, yet 
 cannot be wrought in opposition to the physical 
 and everlasting laws of nature. Where a literal 
 interpretation of the Bible jars on the feelings of 
 
82 RELATION OF MEDICINE TO PHILOSOPHY 
 
 reverence towards God, there an allegorical explana- 
 tion is adopted without hesitation. He believed in 
 the freedom of the will, and held that Providence 
 reigns in a broad manner over humanity ; but he 
 utterly denied the working of Providence in the 
 particular events which befall the individual, who is 
 : subject above all to the great physical laws, and must 
 : learn to understand and obey them. The soul, and 
 the soul only, is immortal ; the reward of virtue con- 
 sists in the soul's bliss in a world to come, while the 
 punishment of vice is the loss of the soul. 
 
 Such were the advanced views of the last great 
 physician who wrote in Arabic, which four centuries 
 later were to inspire the noble philosophy of Spinoza ; 
 but upon medicine the effect was only indirect, as 
 helping forward the time when men should see, in 
 the words of Bishop Butler, "that things are what 
 they are, and the consequences of them will be what 
 they will be." 
 
CHAPTER VI 
 
 VARIOUS INFLUENCES AFFECTING MEDICINE IN 
 THE MIDDLE AGES 
 
 To the physician of the twentieth century the study 
 
 of medicine as practised in the Middle Ages can hardly 
 
 but seem a peculiarly barren and futile occupation ; 
 
 for the epithet mediaeval, when applied to anything 
 
 connected with the physical sciences or medicine, 
 
 carries with it the idea of all that is fantastic, absurd, 
 
 and obscurantist. Doubtless the mental energies of 
 
 the physicians of that epoch were in no way inferior to 
 
 those of our physicians to-day, but they were crippled 
 
 by an erroneous method and hampered by a false 
 
 doctrine ; starting from the outset on a wrong scent, 
 
 it is hardly surprising that but little of permanent 
 
 value was brought back from the pursuit of truth 
 
 in matters medical. The fatal doctrine of the dualism 
 
 between the soul and body, received by tradition from 
 
 the early Christians, who regarded their living bodies 
 
 with contempt, had permeated the intellectual world 
 
 of the Middle Ages. Their activities were, in conse- j 
 
 quence, largely busied with the salvation of the soul 
 
 and the affairs of the inner life, so that the sciences 
 
 devoted mainly to the study of the body seemed ; 
 
 mean and of little worth. j 
 
 83 
 
84 RELATION OF MEDICINE TO PHILOSOPHY 
 
 Medicine would, indeed, have played an even more 
 subordinate part in the Middle Ages had it not been 
 for the fact that it was practised by many of the 
 clergy ; while high dignitaries of the Catholic Church, 
 and even popes, deigned to interest themselves in 
 it from time to time. But the attempt on the part 
 of the Church to embrace all knowledge, both human 
 and divine, and to make ex cathedrd pronouncements 
 upon subjects which could only be comprehended by 
 the long result of time, had obviously a paralysing 
 effect upon all patient effort directed towards the 
 understanding of the objective world. At the same 
 time the Church, by thus making herself the arbiter 
 of all forms of knowledge, did at least bear witness 
 to the essential unity of human life and human know- 
 ledge, without which conception, all comprehension 
 of the universe becomes impossible. As we have 
 said in an earlier chapter, it is an obvious necessity 
 for the attainment of ultimate truth that all the several 
 arts and sciences, following the evolutionary law of 
 progress from homogeneity to heterogeneity, should, 
 for a time at least, shut themselves into their separate 
 compartments, and there, quietly working away, bring 
 eventually the results of their labours before the 
 master science of philosophy, in which will be mirrored 
 the essential unity of human knowledge based upon 
 a firm foundation. The mediaeval physicians were 
 so much impressed by the idea of the unity of all 
 knowledge, that they failed to see the importance 
 of ensuring a sound , groundwork for each particular 
 
INFLUENCES IN THE MIDDLE AGES 85 
 
 department of knowledge. Immersed as they were 
 in abstract speculations, they did not perceive that 
 the aim of medicine was, in the words of W. Pater, 
 " to make the body the quiet handmaid of the soul," 
 and that this must be done, not by ignoring the body, 
 but by understanding it. Their imperfect estimate 
 of the value of the body made them less strenuous 
 in tracking out the sources of disease and less careful 
 of life in general. Even the great attention which, 
 as we shall see, was bestowed upon lepers in the 
 Middle Ages, sprang not so much from natural feel- 
 ings of humanity, as from the belief that care thus 
 bestowed had a special value in the sight of God and 
 would help in forwarding the salvation of those who 
 practised it. 
 
 The Universities. — An important influence, which 
 infused an invigorating energy into the heavy and 
 stagnant intellectual atmosphere of the Middle Ages, 
 was the rise and development of the universities 
 in Europe. These admirable institutions did more, 
 perhaps, towards stimulating interest in medical studies 
 than in any other spheres of mental activity. Italy 
 rightly claims to have been first in the field as regards 
 the founding of universities. Their special excellence 
 lay in the fact that they were largely non-ecclesiastical 
 in origin ; they constituted the earliest beginnings 
 of that spirit which asserted the possibility of some 
 intellectual life outside the ordinances and enactments 
 of clerical authority. The need for some scientific 
 culture, which for centuries had been represented 
 
86 RELATION OF MEDICINE TO PHILOSOPHY 
 
 entirely by the clergy, was now gradually making 
 itself felt in wider classes. 
 
 These early Italian universities, originating from 
 the laity, were comparatively democratic in character, 
 electing their own Rector and perhaps their teachers, 
 and receiving their privileges from the Emperor. In 
 England, France, and Germany, on the other hand, 
 the universities arose out of the c^Mtedrsl schools, 
 and were quite under the dominion of the ecclesiastical 
 hierarchy. Of all these early universities, the most 
 celebrated from a medical point of view was that 
 of Salerno. Its origin is veiled in a mythical gloom ; 
 probably it already existed in the ninth century, but 
 even in the tenth nothing certain was known of its 
 foundation. Doubtless it was an entirely secular 
 institution, and probably arose from a union of doctors 
 settled in the town. Some of these doctors appeared 
 as teachers, and their example was followed by jurists 
 and philosophers, so that gradually a university 
 was developed which embraced the whole circle of 
 learned knowledge with the exception of theology. 
 Its secular character is further attested by the fact 
 that among the teachers were women, the wives and 
 daughters of the professors, whose activity was not 
 confined to gynaecology, but ranged over the whole 
 field of medicine. By the eleventh century the re- 
 putation of Salerno had so far increased that princes 
 of State and Church came there to seek medical advice, 
 and it was even consulted by Robert of Normandy in 
 consequence of a wound received in battle. 
 
INFLUENCES IN THE MIDDLE AGES 87 
 
 The great merit of the University of Salerno lay in 
 the fact that, in an epoch of endless chaos and confu- 
 sion, it provided a city of refuge for the healing art, 
 and was not unjustly called the civitas Hippocratica. 
 It was the only city in the western world where the 
 higher medical culture could be obtained. Its repu- 
 tation was still further enhanced by the decrees of 
 the Emperor Frederick II. That enlightened monarch 
 refused to permit any one to practise medicine in the 
 kingdom of Naples before he had been examined by 
 the medical college of Salerno. This examination 
 consisted in explaining publicly parts of Galen, 
 Avicenna, and Hippocrates ; the candidate was also 
 questioned on the Physics and A nalytics of Aristotle. 
 A further enactment resolved that "as progress in 
 medicine is impossible without a knowledge of logic, 
 no one should be allowed to study the art of healing 
 who has not devoted at least three years to reading 
 logic." Needless to say that no practical acquaint- 
 ance with disease was required in these examinations. 
 For a long time the medical school of Salerno held 
 firmly to Greek medicine, even at a time when Arab 
 philosophy was reigning supreme elsewhere, and its 
 fame in medical history is largely due to this fact. 
 Gradually, however, Arab influence began to under- 
 mine the Hellenic traditions of Salerno. The in- 
 spirer of this new influence was Constantine the 
 African, who, having visited the Arab schools of 
 Bagdad, India, and Egypt, and having spent thirty- 
 nine years in wandering through the most remote 
 
88 RELATION OF MEDICINE TO PHILOSOPHY 
 
 regions of Asia, finally took refuge at Salerno, becom- 
 ing the private secretary of Robert Guiscard, Duke 
 of Apulia. He then devoted the remainder of his 
 days to translating Arab writings, the study of which 
 at Salerno from that time became more fashionable 
 than that of Greek and Latin literature. In the 
 thirteenth century the victory of the Arabs over the 
 intellectual world was complete, and by the middle 
 of the fourteenth century the ancient fame of the 
 school of Salerno was irreparably lost. Shorn of 
 its ancient splendour, it lingered on till the nineteenth 
 century, when Napoleon abolished the university by 
 a stroke of the pen. The weak point of this school 
 was its ignorance of anatomy ; doctors were quite 
 satisfied if they merely knew the names of the different 
 parts of the body. In diagnosis they considered the 
 examination of the pulse and uroscopy to be most 
 important. Their therapeutics, so long as they followed 
 Hippocrates and Galen, were largely dietetic, but when 
 Arab medicine obtained the upper hand there was an 
 enormous influx of new drugs. A high development 
 of the art of cooking for the sick seems to have been 
 reached ; also attention was paid to the comfort of the 
 sick-room, which was cooled by a method of letting 
 drops of water fall and evaporate {ejus aeris infrigidatio 
 magis confert csgrotanti quam medicina interius recepta). 
 The rise of other universities helped to throw 
 Salerno still further into the background; thus, 
 Bologna, Padua, Montpellier, and particularly Naples, 
 all became serious rivals for medical supremacy. 
 
INFLUENCES IN THE MIDDLE AGES 89 
 
 Bologna, as a university, rose into importance as 
 the fame of Salerno waned. It represented the con- 
 servative aspect of medicine, still clinging to the old 
 Greek ideals which Salerno had forsaken for Arab 
 learning. The most famous exponent of this school 
 was Thaddaeus Florentinus {fl. 1260), who was famous 
 both as a practitioner and dialectician. Up to the age 
 of thirty he remained absolutely uneducated, gain- 
 ing his livelihood by selling candles at the church 
 doors. His most important works consisted in com- 
 mentaries on Hippocrates and Galen, which were 
 written in Italian, and so constituted him one of the 
 early founders of the Italian written language. His 
 Regimen Sanitatis, which was a prose paraphrase of 
 the famous Regimen Salernitanum, was written in 
 Italian, and, it is interesting to note, on account of 
 its style, was violently attacked in the Convito by 
 Dante, who was a political enemy of Thaddaeus. 
 One of his works written in Latin ends with the 
 following words, showing the difficulty with which 
 literary composition was conducted in those days : 
 " Scio tamen, quod de his obscure dixi ; sed fessus 
 sum et deficit charta." ^ Another famous physician 
 of this school was Dino di Garbo, who was a favourite 
 of King Robert of Sicily. Of him it was said, " Secu- 
 tus est Galenum sicut evangelium," thus exemplifying 
 the conservative traditions of his university. 
 
 In contrast to Bologna, the University of Padua- 
 famous to us in England as the medical school 
 1 Haeser, Gesch. der Med., vol. i. p. 701. 
 
90 RELATION OF MEDICINE TO PHILOSOPHY 
 
 where our illustrious countryman Harvey studied — 
 represented a decided movement towards progress, 
 as might have been expected from its liberal-minded 
 founder, Frederick II. (1221). At the head of this 
 school was Petrus Aponensis (1250-1315), better 
 known as Peter of Abano. He spent many years of 
 his life at Constantinople, where he attained to an 
 exceptional knowledge of ,the Greek language. He 
 then taught in Paris, where, being suspected by the 
 Dominicans as a heretic and a supporter of magic, he 
 was persecuted, and in consequence fled to Padua. 
 Here he had a great following, and a new medical 
 professorship was specially founded for him. But 
 after his death his bones were dug up and burnt ; 
 his sentence of condemnation was publicly read ; 
 his memory was devoted to eternal infamy and his 
 wealth (which was great) to the use of the Church. 
 One can hardly be surprised that he came into such 
 sharp collision with ecclesiastical authority when we 
 consider the audacity of some of his views. Thus 
 he denied the existence of the devil, and suggested 
 that the case of a patient who lay in a trance for 
 three days might help to explain some Christian 
 miracles, even the raising of Lazarus. In physical 
 and chemical knowledge he far surpassed his con- 
 temporaries ; he knew that the atmosphere had 
 weight and that the equator was inhabited. He 
 recognised the brain as the origin of the nerves, and 
 the heart as the starting-point of the blood-vessels. 
 After the manner of his time, he discussed such 
 
INFLUENCES IN THE MIDDLE AGES 91 
 
 questions as whether fire is hot, whether pain is felt 
 as pain, whether the head was intended for the brain 
 or the eyes, whether we should sleep on the right or 
 left side, and how often in the day we should eat.* 
 He received the title of Conciliator from his book. 
 Conciliator Differentiarum, which was designed to 
 settle by means of scholastic dialectic all the philo- 
 sophical and medical questions which agitated the 
 thirteenth and early part of the fourteenth centuries. 
 
 The fourth great university was at Montpellier, 
 which had come into existence in 738, with a popula- 
 tion consisting of Spanish refugees, Jews, and Arabs. 
 The university there was estabHshed in 1180 by 
 William IV., Count of Montpellier, but its most 
 brilliant representative, Arnald of Villanova, we shall 
 defer describing till we come to consider the effect of 
 scholasticism on medicine. 
 
 The Crusades. — A new and important influence was 
 experienced by the medical art in the Crusades, which 
 affected it in a variety of ways. 
 
 (i) The Crusades dealt a violent blow at the feudal 
 system, since every man who fought under the banner 
 of the Cross ceased to be under the jurisdiction of 
 his baron, so that there was a general increase in 
 freedom, and consequently zeal for the arts. The 
 number of doctors who were not monks became 
 much larger than before, and in particular the 
 Crusades afforded an opportunity to many young 
 surgeons of obtaining, on the battlefields of Pales- 
 
 1 Withington, History of Medicine from the Earliest Times, p. 202. 
 
92 RELATION OF MEDICINE TO PHILOSOPHY 
 
 tine, independent experience and practical skill in 
 the treatment of wounds and disease. 
 
 (2) An increased intercourse with the East, in- 
 troduced by the Crusades, led to an increase in 
 superstition ; because in the East men found the 
 opportunity of satisfying their taste for the mar- 
 vellous, and the translations of Arabic books of 
 medicine and philosophy were welcomed with open 
 arms. As has been remarked by Daremberg, that 
 these Arab translations should have been received 
 with such blind and unreflecting enthusiasm at the 
 moment when the Western world was hurling itself 
 against the followers of the Prophet is indeed an 
 extraordinary phenomenon. To the increasing com- 
 merce with the East may also be traced the increase 
 in the partisans of astrology, who became more 
 numerous than those in Arabia. In addition to 
 this, a vast number of foreign drugs were intro- 
 duced from the East, while those that were indigenous 
 fell into disuse. 
 
 (3) Great increase in the number of the hospitals. 
 This arose partly because the Crusaders wished to 
 imitate the Orientals, who greatly multiplied their 
 hospitals, partly because leprosy, which increased 
 considerably after the Crusades, rendered hospitals 
 more necessary. Hence was formed the order of 
 the Knights Templar, who to their twofold character 
 of knights and monks added the labours of doctors, 
 and treated without fee or reward all sick pilgrims. 
 The cloaks of these knights were the symbols of 
 
INFLUENCES IN THE MIDDLE AGES 93 
 
 their true profession, for they had the same form 
 as those which drape the ancient statues of ^scu- 
 lapius and Hippocrates. 
 
 (4) Leprosy had doubtless been known in Europe 
 prior to the Crusades, but owing to them it became 
 distinctly more prevalent. This malady was care- 
 fully observed by the European physicians, and much 
 better descriptions of the fever which ordinarily 
 accompanies the invasion of leprosy are given by 
 the English and French writers than by the Arabs ; 
 for the genius of observation belongs to the West 
 rather than to the East. In accordance with popular 
 belief, leprosy was thought to be sent immediately 
 from God, and it was regarded as a means of putting 
 the soul in the way of salvation and of becoming 
 the favourite of God and His saints. This point of 
 view not unnaturally led the devout to think that 
 one could not better mortify and sanctify oneself 
 than by tending a leper. St. Louis visited the leper 
 hospital every three months, and kissed the hands 
 and feet of the lepers. Henry III. of England did 
 the same thing for the lepers every Maundy Thursday. 
 
 The curious sanctity which was thought to attach 
 to the leper is shown by the story of Bruno, Arch- 
 bishop of Toul (afterwards Pope Leo IX.), who 
 received into his house a leper whom he had found 
 wandering about in the streets. After bestowing on 
 him every care, and even giving up to him his bed- 
 chamber, on the following morning when he entered 
 the room he found that the sick man had disap- 
 
94 RELATION OF MEDICINE TO PHILOSOPHY 
 
 peared. To the mind of the archbishop, the most 
 natural interpretation of this apparent ingratitude 
 was that Jesus Christ had taken the form of a leper 
 in order to appear to him. In the face of customs 
 and ideas such as these, one can hardly be surprised 
 that leprosy became so widespread and committed 
 such extensive ravages. Other causes which may 
 have contributed to the dissemination of the disease 
 were (a) the general use of woollen clothing, linen 
 being a comparative rarity; (i) the public baths, 
 which were so much regarded as a matter of absolute 
 necessity that the fact of Henry IV. forbidding their 
 use contributed largely to the famous excommunica- 
 tion which was hurled against him.^ 
 
 Sometimes the lepers accumulated such extraor- 
 dinary wealth that Philip V., King of France, accused 
 them of fomenting a rebellion, and wished to burn 
 them all and confiscate their goods. The police 
 regulations made against leprosy were in the main 
 an imitation of those in the laws of Moses. 
 
 Scholasticism. — The strange medley of Aristote- 
 lianism and Arab philosophy which we understand 
 by Scholasticism took its rise in the eleventh century. 
 The place of St. Augustine and John de Damas, who 
 had hitherto dominated the opinions of men, was 
 now taken by Aristotle ; not, however, the serious 
 and systematic philosopher of the ancient world, 
 but an Aristotle transformed by distorted transla- 
 tions into an Oriental anchorite; the pure Hellenic 
 
 ' Kurt Sprengel, Gesch. der Medisin, sect. vii. ch- 3, 
 
INFLUENCES IN THE MIDDLE AGES 95 
 
 spirit was drowned in a sea of mystic commentaries, 
 suited, no doubt, to the temper of the Neo-Platonists, 
 but insupportable for any one who is endowed with 
 a sane reason. 
 
 The great problem of Scholasticism, according to 
 Victor Cousin, originated from Porphyry in the third 
 century, who remarked on the difficulty of settling 
 the question as to whether genera and species have 
 a real objective existence or are merely abstractions 
 of the mind. Put briefly, the problem was whether 
 our general notions of such things as man, dog, table, 
 have any objective reality. Those who considered 
 that they did possess such objective reality were 
 known as Realists, while their opponents were termed 
 Nominalists. The great importance assumed by 
 this controversy between the Realists and Nominalists 
 lay in the question of the doctrine of the Trinity. 
 The Realists maintained that on the principles of 
 Nominalism the doctrine of the Trinity was irrational 
 and inconceivable. If, on the other hand, our general 
 notions have an objective reality, then as from the 
 totality of men we have an objective unity man, so 
 from the divine Trinity of Persons we can conceive 
 a divine unity of substance. But if, as the Nominal- 
 ists maintained, general notions are mere names, then 
 the doctrine of the Trinity in Unity becomes absurd. 
 Naturally enough, of these two theories the Church 
 adopted that of Realism, which harmonised with the 
 religious tendencies of the Middle Ages. Nominalism 
 may therefore be taken as representing the more 
 
96 RELATION OF MEDICINE TO PHILOSOPHY 
 
 liberal and free-thinking spirit, and as such was 
 championed by Roscellinus {fl. 1050) ; while Realism, 
 which was more consistent with orthodoxy, found 
 as its exponent William of Champeaux {fl. iioo). 
 A pupil of the latter was the famous Ab^lard, who, 
 however, did his best to refute the teaching of his 
 master, and startled the world by a celebrated 
 pamphlet in which he selected 158 points of Chris- 
 tian doctrine and arrayed the opinions of the most 
 revered authorities on each. From this it appeared 
 that the statements of St. Paul, Augustine, Gregory, 
 Jerome, Athanasius, and others were so contradictory 
 that no doctrine was left on which an intelligent 
 behever could rest. Although the writings of Ab^lard 
 were burnt and he himself prohibited from teach- 
 ing, the new spirit which he infused into the con- 
 troversy was never exorcised till the final triumph 
 of Nominalism in the person of William of Ockham. 
 The great importance of Ab61ard lies in the fact that 
 he was firmly convinced, and publicly taught, that a 
 faith can only be well assured which is founded on 
 reason. " Understand that thou mayest believe," was 
 his motto — not. Believe that thou mayest understand. 
 Much of the energy of the later Scholastics was 
 expended in trying to harmonise the Christian doc- 
 trine of the resurrection and the immortality of the 
 soul with the teaching of Aristotle, which, when 
 expounded by Averrhoes, seemed to deny it. In 
 this sphere of constructive energy Thomas Aquinas, 
 most famous of Scholastic teachers, was the leading 
 
INFLUENCES IN THE MIDDLE AGES 97 
 
 spirit. According to his fundamental principles, faith 
 and reason occupied two separate and distinct spheres 
 and neither could conflict with the other. His capa- 
 cious mind did not disdain to have views on medicine. 
 He maintained that the heart was the source of all 
 movement and the brain the seat of all sensations, 
 whereas Aristotle had sought for the cause of sensa- 
 tion in the heart itself. He considered the soul to 
 be united to the body as the substantial and not 
 the accidental form. The hair-splitting disputes and 
 subtle argumentations on the nature of universals 
 and kindred abstractions, which engaged and de- 
 lighted the most ingenious intellects of that time, 
 rendered any advance in experimental philosophy 
 almost an impossibility, so that one cannot feel 
 astonishment at the comparative barrenness of medi- 
 cine during these centuries. For the Scholastic con- 
 troversy mingled even with the practical details of 
 medicine ; thus, in considering whether a decoction 
 of barley-water was suitable for people affected with 
 fever, it was concluded that such a beverage would 
 not be useful, because it was a substance while fever 
 was an accident. Our English Gilbert shows the 
 influence of Scholasticism in his definition of fever, 
 which he describes as " unnatural heat starting from 
 the heart and propagating itself into the arteries so 
 as to trouble the bodily functions." He further 
 quaintly tells us that he is disposed to recommend 
 the curative method of Hippocrates, but prefers to 
 
 follow that of the moderns rather than be accused oi 
 
 G 
 
98 RELATION OF MEDICINE TO PHILOSOPHY 
 
 eccentricity.! Again we find Peter of Abano discussing 
 whether pain constitutes a disease or only an accident ; 
 he distinguished between material and formal pain. 
 
 For the most part doctors, like other professional 
 men in all times, were found on the side of orthodoxy, 
 and embraced the doctrines of Realism ; in their zeal 
 they went so far as to instigate Louis XL to proscribe 
 the Nominalists by a severe edict. Though this decree 
 was soon afterwards revoked, it had had the effect of 
 preventing the Nominalists, or the party of liberal 
 thought, from obtaining any foothold in France, and 
 they accordingly passed into Germany. Scholasticism 
 exhibited in an extreme degree the strange deficiency 
 of the Middle Ages in common sense. This was to 
 be supplied to them in no unstinted measure by our 
 own country, in the person of Roger Bacon. Born in 
 Somersetshire (1215) of a noble family, he embraced 
 all the knowledge of his time, metaphysics, language, 
 natural philosophy, and theology. His shrewd 
 common sense, which amounted to genius, opposed 
 Scholasticism with all its might. In his opinion 
 Scholasticism had falsified philosophy, theology, and 
 natural science ; this had been caused by four funda- 
 mental errors which vitiated the whole system — 
 
 (fl) The respect given to worthless authorities. 
 
 (d) Clinging to deeply rooted prejudices. 
 
 (c) The prevalence of the opinions of the uncul- 
 tured masses (this seems prophetic of the 
 idolafori of his greater namesake). 
 
 {d) The presumption of the human spirit. 
 1 Kurt Sprengel, GeschUhte der Medhin, sect. vii. ch. 6. 
 
INFLUENCES IN THE MIDDLE AGES 99 
 
 According to Bacon, in order to renew the sciences 
 and re-establish them on a sound basis, investigation 
 must everywhere go back to their origins ; thus in 
 language to Greek and Oriental idioms, in theology 
 to Holy Scripture, and in natural science to observa- 
 tion. He maintained that mathematics were the basis 
 of natural science, and that experiment was the only 
 means of discovering the processes of nature. He 
 himself possessed an extensive knowledge of physics 
 and chemistry. Such knowledge, however, did not 
 prevent him from retaining a firm belief in the Elixir 
 Vitse, alchemy, and astrology — in fact, he declared 
 the latter to be the basis of medicine ; but it is only 
 fair to add that he was under the impression that this 
 science was based upon experience. A certain halo of 
 romance surrounds the name of Roger Bacon, and 
 tradition credits him with the invention of gunpowder, 
 spectacles, and the telescope. However this may be, 
 his chief title to fame, like that of his famous name- 
 sake the Chancellor, rests on the efforts which he made 
 to free the human mind from entangling error and 
 set it on the right path for attaining truth, rather than 
 on specific contributions to science as such. The 
 world has not forgotten his wise advice to study 
 mathematics as the most certain means of acquiring 
 exact ideas in all branches of human knowledge, 
 which was certainly to bear fruit long afterwards in 
 a somewhat unexpected sphere in the hands of Des- 
 cartes and Spinoza. Bacon held that there was no 
 better way of forming and purifying one's taste than 
 
lOO RELATION OF MEDICINE TO PHILOSOPHY 
 
 by the continual reading of the ancients, but he 
 cautiously adds that one should not push respect to 
 idolatry : " Non oportet nos adhaerere omnibus quae 
 audimus et legimus, sed examinare debemus distric- 
 tissime sententias majorum, ut addamus quae eis 
 defuerunt et corrigamus quae errata sunt." 
 
 Another powerful opponent of Scholasticism came 
 somewhat later in the person of Arnald von Villanova 
 (1235-1312). Born in Spain and educated mainly 
 in France, after occupying a professorial chair 
 at Barcelona he spent some time at Montpellier, 
 Bologna, Rome, Naples, and finally at Palermo, thus 
 becoming acquainted with most of the leading 
 universities. He maintained that medicine was a 
 science, and even in its empirical parts it rested on 
 a rational basis. Consequently he endeavoured to 
 establish medicine on general principles instead of on 
 the confused, disconnected particulars found among 
 the empirics ; for Hippocrates and Galen he had 
 the greatest reverence, in particular preferring the 
 latter to Avicenna and the Arab physicians, with the 
 exception of Rhazes, whom he calls " Vir in specula- 
 tione clarus, in opere promptus, in judicio providus, 
 in experientia approbatus." Realising the importance 
 of diagnosis in medicine, he held that only mild and 
 indifferent means should be employed so long as the 
 diagnosis was uncertain. Like the school of Salerno 
 in its -best days, he emphasised the importance of 
 dietetics, especially when dealing with children and 
 young people. " The modest and wise physician 
 
INFLUENCES IN THE MIDDLE AGES loi 
 
 will never hasten to pharmacy unless compelled by 
 necessity." The extent of his intellectual activity is 
 shown by the fact that he was a doctor in theo- 
 logy* philosophy, law, and medicine, and was also 
 acquainted with Arabic, Greek, and Hebrew. His 
 violent attacks on the friars made for him numerous 
 enemies, who convicted him of fourteen deadly errors, 
 one of which was " that works of mercy and 
 medicine are more acceptable to God than the sacrifice 
 of the altar " ; accordingly they called upon the Pope 
 to deal with the heretic after the customs of the 
 Church. But Clement V. having profited by the 
 medical skill of Arnald, and even encouraged his 
 chemical investigations, turned a deaf ear to these 
 entreaties ; and when he heard of his death he issued 
 an encyclical informing the bishops of Christendom 
 of the death of that pious and learned physician, and 
 bade them search for a medical work of Arnald's 
 which had been dedicated to himself, threatening 
 with apostolic anathema any one who should conceal 
 or destroy it. Arnald was a great student of alchemy, 
 and thought that the Arabs in alcohol had made some 
 approach to the discovery of the Elixir Vit*. He 
 pointed out the property possessed by alcohol of 
 extracting the essences of herbs and roots, and laid 
 the foundation for the tinctures of our modern 
 pharmacopoeia.^ He did not escape from a belief 
 in astrology, which captivated some of the best spirits 
 of that curious age — in fact, he regarded it as an 
 
 ' Withington, History of Medicine, p, 198, 
 
I02 RELATION OF MEDICINE TO PHILOSOPHY 
 
 essential branch of the healing art. To every hour 
 of the day he attributed a special force, which, 
 according to the decision of the horoscope, influenced 
 different parts of the body. Venesection was not to 
 be undertaken on any day indiscriminately, but under 
 a particular constellation. Above all, the aspect of 
 the moon was important ; thus, the most suitable 
 moment for venesection was when the moon was in 
 the sign of Cancer, but when that planet was con- 
 joined with Saturn all action of medicines was 
 arrested. In his pamphlet De Judicii Die, published 
 in Paris, he prophesied from astrological grounds 
 the coming of Antichrist, the Last Day, and a general 
 persecution of the Church. 
 
 More rational are his observations on the dangers 
 of practising paracentesis without due consideration ; 
 also on the utility of the sulphurous baths of Naples 
 for calculus. He further advises that aperients 
 should not be administered in quartan fever, as they 
 only increase the intensity of it. 
 
 One of the most distinguished followers of Arnald 
 was Raimund Lull (1235-1315) called doctor illu- 
 minatissimus> Born at Palma in Majorca, he spent 
 his youth in dissipation, but subsequently became a 
 Franciscan, and as a penance for his former iniquities, 
 imposed upon himself the task of converting the 
 Mohammedans. For the success of this project he 
 learnt Arabic, and persuaded the king (Sancho) to 
 found a school in which that language should be 
 
 ' Kurt Sprengel, Gesch. der Med., sect. vii. ch. 7. 
 
INFLUENCES IN THE MIDDLE AGES 103 
 
 taught by the Franciscans. Although extraordinarily 
 ignorant, not even knowing Latin, he had the gift of 
 talking on every subject, and so appeared to the 
 Mussulmans as a universal sage. He was credited 
 with possessing vast erudition, but his writings on 
 medicine are those of a layman ; he was specially 
 renowned as an alchemist, and during his stay in 
 London it was rumoured that he had changed fifty 
 thousand pounds of mercury into gold for King 
 Edward I. Much of his life was spent in lecturing 
 against the Arabs, both at Naples and Rome, and in 
 particular in Paris he directed his eloquence against 
 the teaching of Averrhoes. Finally he suffered 
 martyrdom, by stoning, on one of his missionary 
 journeys to Africa. 
 
 Lull was the great representative of mysticism, 
 whose home was in Spain, where the superstitions 
 of the Cabbala were zealously studied. Mysticism 
 now began to permeate medicine, leading to the 
 view that the only way to arrive at the knowledge 
 of nature and her innermost being was by a devout 
 sinking into God and a pure mode of life.i By 
 such means the great philosophical problem — namely, 
 the finding of the philosopher's stone — was to be 
 solved. When possessed of this, one would obtain 
 health, long life, enormous riches, and remedies for 
 all the ills of both body and soul. Lull is believed to 
 have invented a machine for the acquisition of know- 
 ledge, which, perhaps, might have anticipated the 
 
 ' Haeser, Gesck, der Medizin, vol. i. p. 728. 
 
I04 RELATION OF MEDICINE TO PHILOSOPHY 
 
 Novum Organum; at any rate, in departing from 
 scholastic logic, and in his zeal for a true interpretation 
 of nature, he was a forerunner of Francis Bacon. 
 
 It has been well said by Daremberg that " le moyen- 
 ige s'est pris d'enthousiasme pour une medicine de 
 quatrifeme main." i It would be easy to comprehend 
 the mediaeval reverence for Arabic versions of Galen 
 and Aristotle, had they possessed no other ancient 
 medical writings ; but it so happened that they did 
 possess the works of Celsus, as well as translations 
 of Dioscorides, Soranus, Oribasius, Paul of ^gina, 
 Alexander of Tralles, Galen, and Hippocrates ; yet 
 these were rejected in toto and the Arabic versions 
 of Aristotle and Galen preferred. This was due in 
 part to the natural predilection of the Middle Ages 
 for all that was dark and obscure ; the fact that a 
 book was enigmatic was a certain recommendation 
 to popularity. It was an age which saw cryptic 
 meanings in sentences, words, and even letters or 
 vowel points ; perhaps, too, it may have been a 
 deliberate policy to make all knowledge difficult and 
 even inaccessible. The modern idea of spreading 
 knowledge and the means of obtaining it as widely 
 as possible would have filled the mediaeval mind 
 with horror. Men in that age were by no means 
 convinced of the utility of truth ; they were also 
 much impressed by the idea, which is not wholly 
 unreasonable, that truths grasped from the outside 
 by common minds, without a sound comprehension 
 
 ' Daremberg, Histoire des Sciences medicales, ch. xiii. 
 
INFLUENCES IN THE MIDDLE AGES 105 
 
 of their meaning, are of little real value — in fact, little 
 better than error. But then, until some educational 
 efforts have been made it is impossible to tell what 
 minds are capable of intellectual illumination. Then, 
 again, the priestly caste which dominated the Middle 
 Ages had a vested interest in darkness, and enhanced 
 their own intrinsic importance by keeping the rest of 
 the world in ignorance. Since few men of any pre- 
 tensions to learning were to be found except among 
 ecclesiastics, the influence of the Church on science 
 generally, and on medicine in particular, was enor- 
 mous, and on the whole, in spite of some liberal- 
 minded popes, inimical to their progress. The 
 necessity felt by most physicians of connecting 
 medicine in some way with a theology which was 
 rigidly fixed by stereotyped rules made serious ad- 
 vance in that science well-nigh impossible. The 
 mediaeval mind shrank from becoming immersed in 
 a chaos of particulars, from which the more auda- 
 cious modern thinker feels confident of evolving some 
 kind of order. Put briefly, the essential difference 
 between mediaeval and modern medicine lies in the 
 fact that whatever theories the modern physician 
 may propound, whether as a result of patient inves- 
 tigation of facts or the sudden intuition of genius, 
 the ultimate test of truth in his case consists in the 
 power of his hypothesis to explain the facts, whereas, 
 in the case of the mediaeval physician, the main 
 criterion of truth was that his hypothesis should 
 harmonise with certain theological dogmas. 
 
CHAPTER VII 
 
 MEDICINE AND THE RENAISSANCE 
 
 The Renaissance, like the advent of Christianity and 
 the French Revolution, forms one of the great turning- 
 points in the history of the world, when a definite 
 step forward is taken, from which there is no going 
 back ; on each of these occasions mankind has en- 
 tered upon a veritable Vita Nuova. If Christianity 
 brought deliverance to the soul of man, and the 
 French Revolution emancipation to the body politic, 
 it was the task of the Renaissance to confer the price- 
 less boon of intellectual liberty. Whether we regard 
 the taking of Constantinople by the Turks or the 
 discovery of America as the most important event 
 in the external world which ushered in this remark- 
 able epoch, the essential point about the Renaissance 
 is that it meant the rediscovery of the possibilities of 
 human life. As the scholar of the fifteenth century 
 studied the newly found treasures of Greek learning, 
 slowly there dawned upon his mind the fact that 
 there had once been an epoch in which mankind 
 had lived an open, free, and joyous life, untrammelled 
 by the authority of kings and unfettered by the ordi- 
 nances of priests ; dimly he felt that hitherto the 
 powers and faculties of men had been cabined and 
 
 io6 
 
MEDICINE AND THE RENAISSANCE 107 
 
 confined, and that human life had been shorn of half 
 its beauty by the total neglect of the intellectual life. 
 With the ingenuous ardour and childlike simplicity 
 of some primitive race which hastens to seize the 
 beads, knives, looking-glasses, and other curious pro- 
 ducts of Western civilisation from the ship stranded 
 on its coasts, so did these men of the Renaissance 
 ransack libraries, palaces, and monasteries for the 
 tattered and mildewed manuscripts which were to 
 reveal to their astonished gaze a mental world as 
 different from their mediaeval life as that of modern 
 Europe is from the life of the African savage. 
 
 Already in the fourteenth century new modes 
 of thought had begun to assail the venerable beliefs 
 of a thousand years. Scholasticism, which, as we 
 have seen, was an attempt to codify all existing 
 knowledge under certain laws and formulas and 
 so to reconcile it with the one Truth, had forti- 
 fied the old mediaeval conception of a universal 
 empire and a universal church. But now Scholas- 
 ticism had begun to give way, driven from its position 
 by the new intellectual force known as Humanism, 
 which took its origin in Italy from a new feeling for 
 the greatness of Rome. Little by little the barriers 
 imposed upon the free exercise of reason were 
 broken down, and it came to be recognised that there 
 had once been a time when men had used all their 
 faculties without fear or reproof; not restricted to 
 certain paths or bound by set formulas, but freely 
 seeking for knowledge in every field of speculation 
 
lo8 RELATION OF MEDICINE TO PHILOSOPHY 
 
 and for beauty in all the realms of fancy.^ It was 
 thus that Humanism made its appearance, bringing a 
 claim for the mental freedom of man and the full 
 development of his being, while the old Scholastic 
 philosophy lost its power over the feelings and 
 imaginations of thoughtful men. The task of the 
 Humanists was to recover a lost culture and to diffuse 
 a liberal spirit. The essence of Humanism has been 
 well defined by W. Pater as " the belief that nothing 
 which has ever interested living men and women 
 can wholly lose its vitality — ^^no language they have 
 spoken, nor oracle beside which they have hushed 
 their voices, no dream which has once been enter- 
 tained by actual human minds, nothing about which 
 they have been passionate, or expended time and zeal." 
 Chief among the early Humanists, and their most 
 brilliant representative, was the poet Petrarch (1304- 
 1374). His fame and popularity in his lifetime were 
 extraordinary. The most powerful monarchs of the 
 day competed for the privilege of his presence at 
 their courts, and so exceptional was his position that 
 he was able to say that princes had lived with him, 
 not he with princes. He was the founder of modern 
 classical culture, and it was his example of the loving 
 preservation of books which probably gave the first 
 incentive to that passion for collecting manuscripts 
 which was to bear such rich fruits in the follow- 
 ing century. Petrarch was the great opponent of 
 Scholasticism, and the chief founder of scientific 
 
 ' Cambridge Modern History., vol. i. p. 532. 
 
MEDICINE AND THE RENAISSANCE 109 
 
 criticism ; he attacked logic and dialectics as not 
 being philosophy, but only its instruments. Bene- 
 ficent to medicine beyond all measure as was the 
 mental temper which Petrarch championed, it is 
 curious to reflect how he himself was never weary of I 
 abusing medicine and physicians. Thus he tells us 
 that medicine must take a very low place, as only sub- 
 serving the life and health of the earthly body ; that 
 medical philosophy is only a perverted Aristotelian- 
 ism, and that to base everything on the authority of 
 Hippocrates and Galen was manifestly absurd. He 
 complained further of the arbitrary character and 
 contradictions of the medical dietetics and of the 
 wretched state of medicine under the influence of 
 the Arabs, specially under that of Averrhoes, which 
 caused doctors to attach importance to alchemy and 
 astrology. Petrarch does not seem to have realised 
 the possibility of medicine as a science ; nor did he 
 perceive that medicine, in protecting and maintaining 
 the bodily health of the individual and the whole 
 nation, was capable of becoming an important means 
 to the attainment of the ideal aims of existence. 
 Doubtless as a layman it was not easy for him to 
 recognise the germs of a new life which were spring- 
 ing up in medicine as in other departments of human 
 knowledge ; in his view medicine was still in bondage 
 to the Arabs, for whom he had a most cordial detesta- 
 tion and contempt. " Odi genus universum (Arabum), 
 vix mihi persuadebitur ab Arabibus posse aliquid boni 
 esse." 
 
no RELATION OF MEDICINE TO PHILOSOPHY 
 
 With the revival of learning came a renewed study 
 of Plato, which constituted one of the most striking 
 features of the Italian Renaissance. The leader of 
 this movement was the celebrated humanist Marsilio 
 Ficino {fl. 1460). This remarkable scholar had been 
 appointed by Cosmo de Medici to be president of 
 the classical academy at Florence, an institution 
 having for its aim the diffusion of Platonic doctrines. 
 Similar academies were founded elsewhere at Milan 
 and Mantua, under the protection respectively of the 
 illustrious families Visconti and Gonzaga. In these 
 places a formal cult of Plato was established, in- 
 cluding ceremonial observances. Thus they kept his 
 birthday with a banquet, after which some portion of 
 his woj-ks was read and discussed. On the anni- 
 versary of his death his bust was crowned with 
 flowers, and a lamp was kept burning before it.^ 
 This renewed study of Plato freed men's minds from 
 the cold and .stereotyped formulas of the Aristotelian 
 and Arabic schools of philosophy. The sublime 
 idealism of the Platonic school contributed more 
 than anything else to the awakening of torpid minds 
 and the revivifying of dead hearts.* In another 
 direction, however, its influence was less favourable 
 to the advance of medicine and the sciences generally. 
 The delicate elements of a subtle mysticism which 
 may be found in the dialogues of the great Athenian 
 philosopher easily pass into the ecstatic excesses of 
 
 ^ Cavibridge Modem History, vol. i. p. 560. 
 2 Haeser, GescMchle der Medizin, vol. ii. p. 6, 
 
MEDICINE AND THE RENAISSANCE iii 
 
 the Alexandrine school, which lend themselves more 
 readily to popular exposition, and as at Alexandria the 
 students of Plato became Neo-Platonists, substituting 
 intuition for reason, so again at Florence the study 
 of Plato gave birth to "the Mystics," who devoted 
 themselves to the investigation of the Cabbala and 
 the forged theosophic fragments of Orpheus, Pytha- 
 goras, and Hermes Trismegistus. Another famous 
 humanist whose vast erudition comprised studies 
 of this kind was Pico della Mirandola i^fl. 1480). He 
 has sometimes been described as the last of the 
 schoolmen, whom he resembles in his attempts to 
 reconcile the Catholic theology with mediaeval philo- 
 sophy. Possessed of a profound knowledge of the 
 Bible, the Cabbala, and Platonism, he proceeded to 
 interpret the Mosaic text by the Neo-Platonic doctrine 
 of the microcosm and macrocosm, and maintained 
 that in natural magic was to be found the strongest 
 testimony to the truth of the gospels, thus hoping to 
 reconcile the philosophers with each other and all 
 alike with the Church. For he seriously and sin- 
 cerely entertained the claims on men's faith of the 
 pagan religions, and believed that the accounts which 
 pagan philosophy had given of the origin of the 
 world might be harmonised with the account given 
 in the book of Moses — that, in fact, the Timceus and 
 Genesis were two aspects of the same explanation. 
 Moses, he thought, was possessed of a secret wisdom 
 which he only spoke of dissemblingly. " In explain- 
 ing the harmony between Plato and Moses, Pico lays 
 
112 RELATION OF MEDICINE TO PHILOSOPHY 
 
 hold on every sort of figure and analogy, on the 
 double meanings of words, the symbols of Jewish 
 ritual, &c. Every object in the material world is an 
 analogue, a symbol or counterpart of some higher 
 reality in the starry heavens, and this again of some 
 law of the angelic life in the world beyond the stars. 
 There is the element of fire in the material world ; 
 the sun is the fire of heaven ; and there is, in the 
 super-celestial world, the fire of the seraphic intelli- 
 gence. But behold how they differ ! the elementary 
 fire burns, the heavenly fire vivifies, the super-celestial 
 fire loves." But Pico, as a true child of the Renais- 
 sance, made man the centre of the universe, and thus 
 protested against that tendency of mediaeval religion 
 to depreciate man's nature, to sacrifice this or that 
 element in it, to make it ashamed of itself, and to 
 keep the degrading or painful accidents of it always 
 in view, and sought to help man onward to that 
 reassertion of himself, that rehabilitation of human 
 nature, the body, the senses, and the heart and the 
 intelligence, which is the great characteristic of the 
 Renaissance.i 
 
 This thirst after mystical and occult knowledge, 
 in spite of the general intellectual awakening, was 
 eminently favourable to those two superstitions — 
 astrology and alchemy — which are so continually 
 to be found dogging the steps of advancing science. 
 At this epoch astrological calendars were formed 
 which had a great influence on medicine. Of these 
 
 ' W. Pater, The Renaissance, pp. 42 and 47, 
 
MEDICINE AND THE RENAISSANCE 113 
 
 some prohibited the administration of medicines when 
 the moon was in the sign of Aries, Taurus, or Capri- 
 cornus, because, being ruminating animals, all medicine 
 given at such times tends to return to the mouth. 
 The astrologers issued directions as to the proper 
 times for saying one's prayers, and Jerome Cardan 
 seriously declared that 8 A.M. on ist April was a 
 peculiarly appropriate moment for offering petitions 
 through the Blessed Virgin. Even the illustrious 
 Marsilio Ficino did not escape these superstitions. 
 He wrote a book full of formulas indicating the 
 method of preserving health and prolonging life by 
 the aid of astrological knowledge. Thus he advises 
 the use of pills compounded at the time of the con- 
 junction of Jupiter and Venus. The preparation of 
 gold was regarded by him as an admirable means of 
 prolonging existence, and he recommended old men 
 to drink the blood of young men so as to keep off 
 the period of their death. James Ganivet, professor 
 of theology at Vienne, sought for the causes of epi- 
 demics in the conjunction of the planets, and main- 
 tained that every town had its sign and planet ; thus 
 Vienne was ruled by the planet Saturn and the sign 
 Libra, while Lyons was under the influence of Venus. 
 He attributed all the diseases of every individual to 
 the constellation at his birth. 
 
 A few savants, and among them Pico, had the 
 courage to unveil the absurdity of this pretended 
 science, and Gerson deserves our admiration for 
 having declared war against all superstitious methods 
 
 H 
 
114 RELATION OF MEDICINE TO PHILOSOPHY 
 
 and for having written one of the best works which 
 has ever appeared in demonstration of the futility of 
 astrology. Apart from these more serious aberrations, 
 this renewed study of Plato indirectly led to Quietism, 
 which can hardly be favourable to the advance of 
 science, though it may not prove an actual hindrance. 
 The great mystical teachers of the time were Eckhard, 
 Tauler, Ruysbrook, Gheert de Grote, and Thomas i 
 Kempis. For them "God alone is"; things only 
 exist in so far as God is in them ; the man who is 
 thoroughly interpenetrated with the spirit of God has 
 no other duty but to die to all earthly things and 
 become absorbed into God. To minds imbued with 
 doctrines such as these, human science is indeed a 
 vain thing, and medicine, occupied as it is with the 
 health of the body, perhaps the vainest of all. 
 
 It is now time to turn to that aspect of the intellec- 
 tual activity of the Renaissance which was to prove 
 so fruitful to medicine. The renewed study of the 
 classics led in the field of medicine to the investigation 
 of the writings of the Greek and Roman physicians, 
 and with extraordinary zeal doctors betook them- 
 selves to the study of language and became erudite 
 philologists ; many of the learned professions were 
 filled by doctors, who devoted much energy to the 
 elucidation of the text of the ancient physicians. In 
 these learned studies Thomas Linacre, founder of 
 the Royal College of Physicians, and himself physician 
 successively to Mary and Elizabeth, bore an honour- 
 able and distinguished part. A pupil of the Greek 
 
MEDICINE AND THE RENAISSANCE 115 
 
 Chalkondylas and a friend of the brilliant Politian, 
 he translated some of the works of Galen into Latin 
 which has been admired for its purity and elegance. 
 From these studies in philology arose a general 
 spirit of criticism. This spirit was most conspicuous 
 in the sphere of religion, where efforts were made to 
 arrive at an authentic text of the Old and New Testa- 
 ment, and one of its most striking results was the 
 exposure by Laurentius Valla of the forgery of The 
 Donation of Constantine. This celebrated document, 
 manufactured by some apostolical scribe of the Vati- 
 can in the eighth century, was published to the world 
 by Adrian I. when exhorting Charlemagne to imitate the 
 liberality and revive the name of the great Constan- 
 tine. "According to the legend, the first Christian 
 emperor had withdrawn from the seat and patrimony 
 of St. Peter, declaring his resolution of founding a new 
 capital in the East and of resigning to the popes the 
 free and perpetual sovereignty of Rome, Italy, and the 
 provinces of the West. The contemporaries of Valla 
 were astonished at his sacrilegious boldness, yet such 
 is the silent and irresistible progress of reason, that 
 before the end of the next age the fable was rejected 
 by the contempt of historians and poets and the tacit 
 or modest censure of the advocates of the Roman 
 Church. The popes themselves have indulged a 
 smile at the credulity of the vulgar, but a false and 
 obsolete title still sanctifies their reign." 1 
 The further discovery of the forgery of the works 
 1 Gibbon, Dtcline and Fall of the Roman Empire, ch. 49, 
 
ii6 RELATION OF MEDICINE TO PHILOSOPHY 
 
 which passed under the name of Dionysius the 
 Areopagite, constituting as they did a meeting ground 
 of Christian theology and Greek philosophy, was 
 additional evidence of the triumph of the critical 
 spirit. 
 
 Looking back through the vista of the ages, it seems 
 to us hardly credible that medicine could have been 
 taught and practised from the time of Galen till early 
 in the sixteenth century without any serious attempt 
 having been made to study anatomy, so essential 
 does an adequate knowledge of the structure of the 
 human body seem to be for any rational and scientific 
 study of disease. The answer to this puzzle lies in 
 the fact that the mediasval mind ' never thought about 
 there being any such thing as a science of medicine, 
 or if it did conceive of such a possibility, the idea 
 was held to be sacrilegious. Disease, like poverty, 
 was to be always with us, and any attempts to com- 
 prehend the causes of these two most undesirable 
 companions of our life would have seemed like an 
 antinomian attack upon the established order of 
 things. 
 
 Doubtless in the later Middle Ages some efforts 
 had been made to study anatomy; thus Mondino 
 {fi. 1300) of Bologna had given a new stimulus to 
 anatomy by the dissection of human bodies, which 
 was a great innovation ; but the result of his labours 
 had been small, and men contented themselves merely 
 with the inspection of the outer parts of the body and 
 a superficial investigation of the organs enclosed in 
 
MEDICINE AND THE RENAISSANCE 117 
 
 the large cavities, in order to confirm, but never to 
 criticise, the correctness of the descriptions of Galen. 
 It is true that Alessandro Achillini of Bologna, one of 
 the most learned Averrhoists of his time. Professor of 
 Philosophy and later of Medicine at Bologna, described 
 the ileo-caecal valve and the origin of the common bile 
 duct in the duodenum. Then again Alessandro Bene- 
 detti, professor at Padua, had an anatomical theatre 
 freshly built every year, where his lectures were even 
 attended by the Emperor Maximilian, to whom he 
 dedicated his great work on anatomy, which, however, 
 contained nothing that was not to be found in Galen. 
 
 But it was from the advent of Vesalius and the- 
 other great Italian anatomists that the real renais- 
 sance of medicine is to be dated ; now at last the 
 writings of Galen were to be vigorously criticised 
 and the anatomical beliefs of nearly fourteen hundred 
 years seriously impugned. 
 
 Vesalius was born at Brussels in 1514. Educated 
 at Louvain, he acquired there a thorough knowledge 
 of Greek, Latin, and Arabic, as well as mathematics. 
 At the age of eighteen he went to Montpellier, and 
 then to Paris, where he studied anatomy. This 
 science, however, was still based on the dissections 
 of animals, and when on rare occasions the human 
 body was dissected, this was done in so entirely super- 
 ficial a manner that Vesalius said he would have 
 preferred the instruction of a butcher. In spite of 
 these inadequate opportunities for scientific study, he 
 acquired so extensive a knowledge of anatomy that 
 
ii8 RELATION OF MEDICINE TO PHILOSOPHY 
 
 he became professor of it in Padua when he was only 
 twenty-three. Six years later, before he was thirty, 
 he gave to the world his famous book, On the 
 Structure of the Human Body. An enormous sensa- 
 tion was made by this work, and the effect produced 
 by it was almost equal to that of Harvey's discovery 
 of the circulation of the blood. In the preface of his 
 book he makes a bitter complaint about the decay of 
 all branches of medicine. " Dietetics are abandoned 
 to cooks, the teaching of drugs to apothecaries and 
 surgery to barbers. Professors think it beneath their 
 dignity to take a knife in their hand." Above all, 
 anatomy was in such a low state because Galen, who 
 had never dissected a human body, was regarded as 
 an absolute authority. The great work of Vesalius, 
 then, was to overthrow the anatomy of Galen by sub- 
 stituting the anatomy of man for that of the ape. 
 His description of the heart leaves little to be desired, 
 and in particular he set aside the old error of the 
 permeability of the ventricular septum ; he describes 
 the change in the shape of the heart during systole 
 and diastole, and the arrangement of the valves and 
 their functions. As regards the brain, he confines 
 himself to representing it as the central organ of 
 sensation and movement ; the question of the signi- 
 ficance of the same for the activity of the soul he 
 abandons to the philosophers ; but he was the first to 
 draw attention to the difference between the grey 
 and white matter of the brain. Vesalius also studied 
 to some extent the functions of the body, but he did 
 
MEDICINE AND THE RENAISSANCE 119 
 
 not emancipate himself from the belief that blood is 
 formed in the liver. The mistakes which he made in 
 describing the eye were due to his following the 
 example of Galen in dissecting the eyes of animals 
 instead of men. Needless to say, such a complete 
 upsetting of the ordinarily received views on anatomy 
 stirred up the most violent opposition. His former 
 teacher, Sylvius, went so far as to describe his illus- 
 trious pupil as an " insane innovator whose poisonous 
 breath infected the whole of Europe." The Emperor 
 Charles V., who seems to have regarded Vesalius with 
 as much horror as Luther, thought it necessary to 
 ask the theological faculty at Salamanca if it were 
 lawful to dissect human bodies, and the answer of 
 the faculty came that it was admissible. After 
 passing some time at Madrid in the service of 
 Philip II. of Spain, where he experienced the jealousy 
 and hatred of the Spanish doctors, he betook himself 
 to Jerusalem, and died on his way back in a ship- 
 wreck off the coast of Zante (1565). Other famous 
 anatomists of the time were Eustachius and Fallopius 
 — names now familiar to every student of medicine. 
 An unexpected assistance to these anatomists was 
 rendered by the famous painters of that age. Anato- 
 mical studies were regarded as an indispensable basis 
 of their culture, and some drawings of Raphael show 
 that the most ideal of all painters did not disdain to 
 make use of human skeletons in the composition of 
 his groups.^ Michael Angelo busied himself in the 
 
 1 Haeser, GeschUhte der Medizin, p. 27. 
 
120 RELATION OF MEDICINE TO PHILOSOPHY 
 
 cloisters of San Spirito at Florence with the study 
 of the muscles of men and beasts under the guidance 
 of the anatomist Columbo, a pupil of Vesalius. The 
 great Leonardo da Vinci, whose universal genius em- 
 braced all forms of knowledge, belonged to the first 
 anatomists of his time, and is even thought to have 
 understood the systemic circulation. In some sense 
 he was a forerunner of Vesalius, for he showed that 
 science comes by observation and not by authority. 
 He knew the anatomy of Mondino, and probably also 
 that of Galen ; but, not content with authority, he prac- 
 tised dissection himself, and indeed suffered in con- 
 sequence, for it was these anatomical investigations 
 which caused the withdrawal of papal favour and 
 Leonardo's departure from Rome in 1515. He agreed 
 that it would be better for the student to watch a de- 
 monstration in anatomy than to see his drawings, " if 
 only it were possible to observe all the details shown 
 in these drawings in a single figure ; in which, with 
 all your ability, you will not see nor acquire a know- 
 ledge of more than some few veins, while, in order to 
 obtain an exact and complete knowledge of these, I 
 have dissected more than ten human bodies, destroy- 
 ing all the various members, and removing even the 
 very smallest particles of flesh which surrounded these 
 veins without causing any effusion of blood other than 
 the imperceptible bleeding of the capillary veins. " ^ 
 
 Another powerful influence towards intellectual 
 emancipation was the Reformation, which in the 
 
 ^ Leonardo da Vinci's A'oie Booh (ti'Cnrdy), p. 6. 
 
MEDICINE AND THE RENAISSANCE 121 
 
 sphere of religion established the right of man to 
 private Judgment and abrogated the authority of 
 popes and councils. By a natural sequence of ideas, 
 authority in matters of science became weakened, and 
 insensibly was recognised the right of every man 
 to investigate nature independently. The supreme 
 importance of doing so for the attainment of 
 scientific truth was not realised till the advent of 
 Bacon and a later age. Luther himself had a high" 
 opinion of the importance and dignity of the medical 
 profession ; his own wife practised the healing art, / 
 and one of his sons, on the advice of his father,; 
 devoted himself to medicine, became a physician ati 
 Gotha, then later at Berlin and Dresden. Mingling ■, 
 with what Matthew Arnold would have considered ' 
 the somewhat crude philistinism of Luther was a, vein 
 of mysticism, which caused him to hold alchemy in 
 great reverence, not only on account of its utility for 
 medicine, but owing to its beauteous and glorious 
 resemblance to the resurrection of the dead on the 
 Last Day. On the other hand, Luther's friend 
 Melanchthon, as an Aristotelian, repudiated the 
 doctrine of alchemy, but had a firm belief in 
 astrology, which, owing to its close connection with 
 mathematics, was considered by many of t-he most 
 acute intellects of the day to be an exact science. 
 Certainly the teaching of Luther and Melanchthon 
 found numerous and keen disciples among doctors, 
 especially in the newly formed Protestant high 
 schools at Wittenberg, Marburg, and Jena. But 
 
122 RELATION OF MEDICINE TO PHILOSOPHY 
 
 after all the world moves slowly, and old mental 
 standpoints are with difficulty outgrown ; much pain 
 and anguish had to be endured before real intellectual 
 liberty could be born. Thus some of the reformers 
 seemed bent on merely substituting one form of 
 dogmatism for another, and in matters of science 
 were as obscurantist as the most uncompromising of 
 popes. The classical instance of this in medical 
 history is the case of Michael Servetus. This martyr 
 to science was born in 1509 at Villanova in Arragon. 
 He first became notorious by writing against the 
 Trinity and professing the Socinian heresy, which 
 alienated him from the leaders of the Reformation ; 
 he then studied medicine at Paris, and settled down 
 later as a practising physician at Vienna. Here he 
 made his demonstration of the pulmonary circulation, 
 recognising the impermeability of the ventricular 
 septum ; but he cannot make the least claim to the 
 discovery of the circulation of the blood, for he still 
 believed that the greater part of the blood was formed 
 in the liver, which then poured itself into the right 
 side of the heart, and from thence passed into the 
 veins ; he was still under the impression that the 
 arteries were filled by a spiritus vitalis, which he 
 regarded as a kind of vapour {quasi ex puriori 
 sanguine lucidus vapor). His distinguished position 
 as a man of science did not save him, however, 
 from the odium aroused by his heretical views on the 
 Trinity, and after engaging in controversy with Calvin 
 he was brought to trial in Geneva at the instance of 
 
MEDICINE AND THE RENAISSANCE 123 
 
 that gloomy fanatic, condemned to death, and burned 
 alive in 1553. 
 
 It has been well said that the Renaissance of the 
 fifteenth century was in many things great rather 
 by what it designed or aspired to do than by what 
 it actually achieved. This is undoubtedly true of 
 medicine, for, with the exception of a truer concep- 
 tion of anatomy — an important exception certainly — 
 the actual achievement was not great. Yet before 
 the minds of men dimly hovered the vision of great 
 possibilities. Men no longer felt that the whole field 
 of science had been accurately mapped out and sur- 
 veyed ; above all, a spirit of scepticism had arisen. 
 The great Galen had been found to have made 
 erroneous statements about human anatomy ; was it 
 not possible that he had made mistakes about other 
 things ? Could his physiology be implicitly trusted ? 
 For a while longer it was so trusted, till men realised 
 that as observation had been necessary for the proper 
 knowledge of anatomy, so experiment was equally 
 . necessary for physiology ; these being the two founda- 
 tions on which any sound system of medicine must 
 rest. When once the principle of infallibility in 
 matters of religion had been challenged by Luther, 
 the same principle in every sphere of knowledge was 
 put upon the defensive, and the great superstructures 
 which had been reared upon authority began to totter 
 and crumble, sapped and mined by the spirit of 
 criticism and revolt which was abroad in every field. 
 As in human affairs there is no principle which is 
 
124 RELATION OF MEDICINE TO PHILOSOPHY 
 
 wholly bad or wholly good, so in any great reform or 
 uprooting of long-established beliefs it is more than 
 probable that the good seed will be plucked up with 
 the tares. Thus we shall see that medicine, though 
 freed from the entangling fetters of a worn-out 
 tradition and set upon a new course along which 
 progress alone could be made, at first, like a ship 
 suddenly relieved of a cargo from which she was 
 sinking, drifted before every passing wind and 
 crossing current, and temporarily embraced doc- 
 trines no less irrational than those which she had 
 discarded. 
 
CHAPTER VIII 
 
 PARACELSUS AND THE MEDICINE OF HIS TIME 
 
 The process of reaction against authority in medicine, 
 which had begun with the earliest dawn of the Renais- 
 sance, took its most extreme and violent form in the 
 person of Paracelsus. Round this strange, mysterious 
 figure has gathered a halo of romance which a cold 
 examination of his writings is far from justifying. 
 As representing, however, an important phase of 
 thought and feeling in the history of medicine, it 
 is worth considering how far he was the exponent 
 of contemporary influences and what modes of 
 thought converged in him. His writings admirably 
 exemplify for us the great principle that life is a 
 strife of opposites ; only when we see some principle 
 carried to an absurd length do we fully realise " the 
 falsehood of extremes " ; this is often observed in 
 the realm of politics, but Paracelsus seems a good 
 instance of it in the world of thought. He set him- 
 self in opposition to authority, not merely because 
 it fettered the free development of the human mind 
 and hampered the advance of truth, but simply be- 
 cause it was authority ; like St. Just, who demanded 
 the death of Louis XVI., not for any specific wrong- 
 doing, but for the crime of being a king. Such an 
 
 "5 
 
126 RELATION OF MEDICINE TO PHILOSOPHY 
 
 attitude must inevitably lead to chaos, because it 
 regards freedom as an end in itself rather than as a 
 means to a complete and harmonious form of life. 
 The motto of Paracelsus is indeed characteristic of 
 him — " Nemo sit alterius qui suus esse potest." 
 
 Theophrastus Bombastus von Hohenheim, sur- 
 named Paracelsus, either as a Latin translation of 
 Hohenheim or, more probably, as meaning to denote 
 his superiority to Celsus, was born at Einsiedeln 
 in Switzerland in 1490, just seven years after the 
 birth of Luther and Raphael. His father, a physi- 
 cian, had him at an early age instructed in medicine. 
 When he was sixteen he studied at the University 
 of Basle, and in particular enjoyed the chemical 
 teaching of the celebrated Neo-Platonist Trithemius. 
 There has been much dispute about the character 
 of Paracelsus, but most writers are now agreed as 
 to his goodness of heart and enthusiasm for the 
 happiness of men. He held a high opinion of the 
 dignity and worth of the medical profession. His 
 thirst for knowledge made him wander through a 
 large part of Europe, visiting the most famous uni- 
 versities, where he gained a knowledge of natural 
 history, chemistry, and metallurgy. After ten years 
 of foreign travel he returned to Basle, obtaining the 
 post of physician to the town. A year later he 
 appeared as a teacher of the university, and drama- 
 tically opened his first lecture by burning the books 
 of Avicenna and Galen, declaring that his very shoe- 
 strings knew more than these two physicians. At 
 
PARACELSUS AND MEDICINE OF HIS TIME 127 
 
 Basle he seems to have been a great success, both 
 as a teacher and as a physician ; while there he 
 entered into correspondence with Erasmus. After 
 two years, however, he forsook Basle, the immediate 
 cause of his departure being a quarrel with the 
 Canon Cornelius von Lichtenfels, who, having been 
 cured of some abdominal pain by three opium 
 pills, refused to pay the fee of 100 gulden which 
 had been previously agreed upon.^ After this he 
 wandered about in Bavaria, Switzerland, Moravia, 
 and the Tyrol, finally dying at Salzburg in great 
 poverty. 
 
 Like all prophets of revolution, Paracelsus was 
 filled with a sovereign contempt for learning j he 
 prided himself on having read no book for ten years,/ 
 and he would hardly ascribe value to anything except! 
 his own writings, for which he anticipated immor- 
 tality. 
 
 The great error of the medicine of his day con- 
 sisted in the excessive stress laid upon speculation, 
 combined with the study of books. This was fully 
 recognised by Paracelsus, who said, " Lesen hat 
 kein Arzt nie gemacht, aber die Praktik, die gibt 
 ein Arzt." "Der erst Schulmeister der Arztnei 
 ist der Corpus und die Materia der Natur." The 
 only ancient physicians for whom he professed any 
 respect were Apollo, Machaon, and Hippocrates. 
 The vials of his wrath were poured out upon Galen 
 and Aristotle, whose works till recently were only 
 
 1 Haeser, Geschickte der Meditin, vol. ii. p. 75. 
 
128 RELATION OF MEDICINE TO PHILOSOPHY 
 
 known through the distorted medium of Arabic 
 translations glossed over by the Scholastic philo- 
 sophy, being thus poles asunder from the true Galen 
 and Aristotle which the labours of the New Learn- 
 ing were bringing to light. We have seen how 
 the anatomy of Galen had been already discredited 
 by the discoveries of the great Italian anatomists ; 
 it remained for Paracelsus to give the death-blow 
 to his physiology and therapeutics, so that the whole 
 tottering edifice of Galenism crumbled into ruin. 
 But how different was the method of Paracelsus 
 from that of the Italian anatomists 1 Largely it 
 consisted in shouting at the top of his voice and 
 denouncing in crude and coarse terms the traditional 
 medical writings, which, with all their errors and 
 absurdities, contained more of genuine physiological 
 truth than could ever be claimed for the system of 
 Paracelsus. His aim and object were to dethrone 
 ancient medicine, and more particularly the medico- 
 philosophical amalgam of Galen and Aristotle, and 
 erect in its place an entirely new medicine, thus 
 substituting one system for another. Had he been 
 entirely successful in this, the advance of medicine 
 would indeed have been small ; we should merely 
 have had Paracelsism instead of Galenism. Fortu- 
 nately, many of those who joined with him in the 
 attack upon the worn-out physiology of the ancients 
 had no intention of following him in his crude sub- 
 stitutes for it ; but having thus cleared away the 
 rotten foundation, it became possible, as we shall 
 
PARACELSUS AND MEDICINE OF HIS TIME 129 
 
 see later on, for a more enlightened age to build 
 something satisfactory on a new basis, 
 
 A certain parallelism between Paracelsus and Martin 
 Luther naturally suggests itself, and if with Matthew 
 Arnold we regard the latter as the philistine in 
 religion, undoubtedly Paracelsus offers us a classical 
 instance of the philistine in medicine. But, speaking 
 generally, the leaders of the Reformation did not 
 show so much intemperate zeal as the reformer of 
 medicine. Doubtless the reformers in religion, in 
 so far as they endeavoured to destroy the power of 
 the Roman Catholic Church merely in order to erect 
 in its place the Bible with its verbal inspiration, 
 were merely substituting one fetish for another ; but 
 in maintaining the right of private judgment they 
 laid the foundation of the doctrine of general tolera- 
 tion, which slowly and painfully permeated the best 
 minds of Christendom, though in practice it is hardly 
 carried out even to this day. With Paracelsus, on' 
 the other hand, it was not a question of reforming 
 medicine, but of the abolition of the entire existing 
 medical system and the substitution of a brand-new 
 one coined in the recesses of his own fantastic brain. ^j 
 Such principles as observation, experiment, and the 
 inductive method, which are the master-keys for 
 unlocking the secrets of nature, would have been 
 anathema to him. 
 
 From the Revival of Learning, which we have dis- 
 cussed in a previous chapter, flowed two main streams 
 of tendency. On the one hand, the humanistic studies 
 
130 RELATION OF MEDICINE TO PHILOSOPHY 
 
 taught men to use their senses and reason in a way 
 they had never done before ; on the other, there was 
 a great outburst of Neo-PIatonism and an enthusiastic 
 pursuit of the theosophical doctrines so intimately 
 connected with the old Alexandrine school. It was 
 by this latter tendency that Paracelsus was entirely 
 dominated, so that he was quite incapable of appre- 
 ciating the work of the Italian anatomists, whom 
 he called " Italian jugglers." The influence of Neo- 
 Platonism is clearly seen in his teaching of the unity 
 of nature, which has emanated from God and is 
 penetrated by Him. In every creature the heavenly 
 fire and the astral balsam are at work. Man unites 
 in himself all the particular forms of external nature — 
 is, in fact, a microcosm ; external nature is the outer 
 man. He calls nature visible philosophy, and philo- 
 sophy invisible nature. Christ was a ray of the 
 majesty of God, an emanation of the primitive light. 
 The end of life is the intimate union with God, the 
 father of all good spirits. Man invents nothing ; the 
 devil invents nothing ; it is God only who unveils all 
 to us by the light of nature. 
 
 The physiology of Paracelsus consisted largely in 
 the explanation of the functions of the body by the 
 laws of the Cabbala. Anatomy, as ordinarily under- 
 stood, excited his supreme contempt, though it was 
 just at that moment that the Italian anatomists by 
 their labours were overthrowing a part of the Galenical 
 superstition, but Paracelsus described his own anatomy 
 as being "not the dissection of bodies, which is a 
 
PARACELSUS AND MEDICINE OF HIS TIME 131 
 
 boorish anatomy, but the anatomy of the essence — i.e. 
 an analysis, imaginary rather than chemical, of the 
 intimate composition of man with its mystical in- 
 gredients, salt, sulphur, and mercury, which were the 
 three ultimate substances, and not the four elements 
 of Empedocles." This kind of anatomical knowledge, 
 he considered, was acquired not so much by the 
 intellect as by the illumination of the Holy Spirit. 
 Medicine itself rested upon four pillars : — 
 
 (i) Philosophy. "This is the gate of medicine, and 
 they who go not in thereat climb in by the roof and 
 become thieves and murderers." By philosophy he 
 means the whole circle of the sciences, physical and 
 magical, but especially the latter. 
 
 (2) Astronomy. " No one can be a good physician 
 who is not skilled in astronomy. The heavenly 
 bodies cause diseases by their exhalations — as, for 
 instance, the sun by excessive heat — and it is no use 
 trying to cure an astral disease while its star is in the 
 ascendant. He considered that there was an intimate 
 connection between the sun and the heart, the moon 
 and the brain, Jupiter and the liver, Saturn and the 
 spleen. Mercury and the lungs, Mars and the bile, 
 Venus and the kidneys. He was, however, an 
 opponent of astrology, saying that a child's mother 
 is its planet and star ; one cannot say that man acts 
 in accordance with Mars, but rather that Mars acts 
 in accordance with man, for the latter is more than 
 Mars and all the planets. 
 
 (3) Alchemy. "Without a perfect knowledge of 
 
132 RELATION OF MEDICINE TO PHILOSOPHY 
 
 alchemy, the physician will use all the resources of 
 his art in vain." He regarded as alchemists all who 
 attempt to improve natural substances. Thus the 
 baker who makes bread out of corn, and the vine- 
 grower who produces wine from grapes, is as much 
 an alchemist as the Archeus, who transforms food 
 into flesh and blood. The Archeus was a kind of 
 demon who presides over the stomach, and is 
 occupied with separating the poison of the food 
 from the nutritive portion of it, and giving to the 
 alimentary substances the tincture in virtue of which 
 they become capable of assimilation. This Master of 
 the Stomach who changes bread into blood is the 
 type of the physician, who ought to' come to terms 
 with him and accord him his assistance; for the 
 Archeus alone can cure diseases. 
 
 (4) Virtue. The virtuous only are permitted to 
 penetrate into the innermost nature of man and the 
 universe.^ 
 
 Therapeutics constituted by far the most important 
 part of the medical teaching of Paracelsus. His 
 remedies for disease are the Arcana. Now the 
 Arcana were such substances as, by their indwelling 
 hidden virtues {qualitates occulta), either arouse the 
 torpid therapeutic power of nature or extinguish and 
 destroy the essential condition of the disease. The 
 important problem of therapeutics is to discover 
 specific remedies. For this he relied largely on his 
 doctrine of signatures. Thus the appearance of 
 
 ' WiLhington, History of Medicine, p. 256. 
 
PARACELSUS AND MEDICINE OF HIS TIME 133 
 
 plants indicates their utility in disease. The topaz 
 and the juice of the celandine are useful in jaundice ; 
 but yellow substances are also beneficial in heart 
 disease, yellow being the colour of the sun, which 
 rules that organ. He asks, "Why' is the frog so 
 strangely made except that he should be a remedy for 
 the plague. Therefore he has his signature thereto ; 
 for see, as disgusting as is the plague, so disgusting 
 is the frog also."^ In this therapeutic doctrine of 
 signatures we see the forerunner of the modern 
 doctrine of Homoeopathy. The theosophical stand- 
 point of Paracelsus shows itself in his belief that 
 healing medicines were created for the sake of the 
 diseases, that where certain diseases are found the 
 corresponding remedies grow. The whole world is 
 a chemist's shop and God is the highest chemist.^ 
 Certain morbid conditions he compared or identified 
 with natural phenomena ; thus dropsy was a micro- 
 cosmic flood, atrophy a microcosmic drought. The 
 four kinds of colic were compared with the four 
 directions of the wind, and apoplexy with lightning. 
 Mania becomes more intense during the full and new 
 moon, because the brain is the moon of the micro- 
 cosm. By continually comparing the microcosm 
 and the macrocosm, one acquires the great advantage 
 of rendering all the sciences useless. The system of 
 Paracelsus contained no new or hitherto unknown 
 
 1 Withington, History of Medicine, p. 268. 
 
 " In the Museum at Numberg there is to be seen a curious old picture 
 representing Christ as a chemist, with His hands spread out on the 
 apothecaries' jars labelled Patience, Pity, &c. 
 
134 RELATION OF MEDICINE TO PHILOSOPHY 
 
 principle, but he recommended medicines derived 
 from the mineral kingdom, and particularly metals {e.g. 
 iron, lead, copper, antimony, and mercury), instead of 
 the useless syrups, and decoctions then in vogue. He 
 also studied a large number of remarkable diseases, 
 and specially those within the domain of surgery. 
 
 Paracelsus showed no profundity of thought, but 
 extraordinary vigour in his writings, which he ad- 
 dressed rather to the multitude than to the learned, 
 and on that account made use of German instead of 
 Latin, which constituted a most radical innovation. 
 It is not surprising, therefore, that he had a large 
 number of disciples ; for the most part they were 
 Germans, and without any education or acquaintance 
 with the sciences, who threw themselves into the 
 arms of a mystical system because they found in it 
 a means of supplying their ineptitude and want of 
 instruction. 
 
 Not unnaturally, the famous society of the Rosi- 
 crucians became earnest and devoted followers of 
 Paracelsus. By them he was termed " the noble and 
 beloved monarch, the German Hermes, the Philo- 
 sophus Trismegistus, our dear preceptor and king of 
 arts, Theophrastus of blessed memory and immortal 
 fame."i According to tradition, they had already 
 existed for nearly a hundred years before his birth. 
 The society is supposed to have originated with a 
 German named Christian Rosenkreutz in the fourteenth 
 century, who instituted it after having learnt at Fez 
 
 1 Paracelsus, A. E. Waite. 
 
PARACELSUS AND MEDICINE OF HIS TIME 135 
 
 and in Egypt the high philosophy of the Easterns. 
 The Rosicrucians were credited with being adepts in 
 the Hermetic mysteries, including metallic trans- 
 mutation and power over elemental spirits. They 
 aimed at a general reform of the arts and sciences, 
 especially of alchemy and medicine, posing as pro- 
 fessors of the healing art. In fact, by the rules of 
 their order they were forbidden to exercise publicly 
 any other profession but that of medicine, and were 
 not allowed to take any fee from their patients.^ 
 One is almost surprised that the society did not 
 become more numerous, in view of the great attrac- 
 tions held out to members, which amounted to 
 nothing less than knowledge divine, immense riches, 
 a life exempt from disease, perpetual youth, and the 
 philosopher's stone. As might be expected, this 
 society dispensed with all study, and professed the 
 greatest contempt for all knowledge acquired by toil 
 and reflection instead of by inward illumination. 
 Without exception they derived all sciences from the 
 Bible, and, after the manner of the Christian Scientists, 
 healed all diseases by faith and imagination. 
 
 Such a society seemed just made for the carrying 
 out of the doctrines of Paracelsus, and it was indeed 
 largely instrumental in spreading them throughout 
 Europe. His medico-philosophical views found 
 numerous adherents, and they were not confined to 
 the medical profession. Thus Valentine Weigel, a 
 fanatical preacher near Chemnitz, was firmly con- 
 
 ' Kurt Sprengel, Geschichte der Medizin, sect. ix. ch. 3. 
 
136 RELATION OF MEDICINE TO PHILOSOPHY 
 
 vinced of the parallelism between the macrocosm 
 and microcosm. He maintained that knowledge of 
 the human body should be derived from that of the 
 universe, because Heaven is the father and Man 
 the son. Like Paracelsus, he despised all human 
 sciences, since he believed that all knowledge pro- 
 ceeded from an internal illumination. He regarded 
 the number 666, already employed by St. Irenseus of 
 Smyrna, as the union of knowledge and wisdom. 
 Egidius Gutmann of Swabia was another follower of 
 the teaching of Paracelsus. He claimed to possess 
 the Elixir Vitae, which ennobles men, heals all diseases, 
 and enables one to manufacture gold. According to 
 this illumini, faith only is necessary in order to fly 
 through the air, to transmute metals, and to know all 
 sciences. 
 
 More celebrated and influential than the foregoing, 
 however, was Oswald CroU of Hesse, physician to 
 Prince Christian of Anhalt, and even Councillor of the 
 Emperor Rudolph II. His great object was to unite 
 the new teaching of Paracelsus, on the one hand, with 
 the Calvinistic doctrine of grace and immediate inspira- 
 tion of God, on the other hand, with the writings of 
 Hippocrates. We are indebted to him for a Pharma- 
 copoeia-Basilica Chymica, in which are introduced 
 many new drugs and others which had fallen into 
 disuse. He repeats the doctrine of the macrocosm 
 and microcosm, speaking of the latter as the son. 
 " Man can produce miracles by his thought alone ; in 
 working them he is entirely passive, shows no action ; 
 
PARACELSUS AND MEDICINE OF HIS TIME 137 
 
 he knows nothing of what is happening — grace per- 
 meates him and makes him a part of everything. All 
 medicines work in virtue of the magnetic force which 
 they have received from the stars, and of which their 
 sensible qualities are only the signatures ; every plant 
 is a star, and every star a plant. He was a great 
 believer in the doctrine of signatures ; thus, the leaves 
 of the small leek have some resemblance to the gums, 
 therefore they must be an excellent anti-scorbutic. 
 The flowers of the lily resemble drops, therefore they 
 must be useful in gout {gutta) ; the roots of the bryony 
 imitate a swollen foot, therefore they are good for the 
 dropsy. ^ 
 
 Though the enthusiasts for the new medicine of 
 Paracelsus were for the most part to be found in 
 Germany, yet in England there appeared one famous 
 exponent of the doctrine in the person of Robert 
 Fludd, who was also among the first disciples of the 
 Rosy Cross. Born in 1574 and a contemporary of 
 Bacon, he was entirely unaffected by the teaching of 
 the great English philosopher, but endeavoured to 
 proclaim a Neo-Platonic_system^ in which man, the 
 microcosm, is regarded as analogous in a physico- 
 spiritual sense to the universe or macrocosm. Ac- 
 cording to him, heat and cold are the basic powers of 
 nature, and he brings the most important diseases 
 into relationship with the chief directions of the wind. 
 In his view the special cause of disease was the fall of 
 man. The only remedy for disease is prayer and the 
 
 ^ Kurt Sprengel, Geschichte der Medizin, sect. ix. ch. 3. 
 
138 RELATION OF MEDICINE TO PHILOSOPHY 
 
 favour of God. In spite of these mystical views on 
 medicine, we find him inventing an instrument so pro- 
 saic as the thermometer for determining the heat of 
 the blood. 
 
 Other disciples of Paracelsus were Peter Severin, 
 a Dane, physician to the King of Denmark, who de- 
 rived all diseases from germs which took their origin 
 in the fall of man; and Gerhard Dorn, a physician at 
 Frankfurt, who thought all knowledge of nature was 
 to be derived from the first verses of Genesis. 
 
 To the credit of medicine and science, it must be 
 said that the tissue of irreconcilable absurdities which 
 so largely represents the system of Paracelsus was 
 not suffered to pass unchallenged in the sixteenth 
 century. First and foremost among his opponents 
 was Andreas Libavius of Halle, whose great merit 
 consisted in taking chemistry out of the hands of 
 charlatans and developing the outlines of this science 
 in a clear, simple manner, while ridiculing the Para- 
 celsists on every occasion. But the main opposition 
 came from France, and in particular from the Univer- 
 sity of Paris, so long the home of dogmatism, infalli- 
 bility, and intellectual obscurantism generally. This 
 school opposed the medical innovations of Paracelsus, 
 not on account of their intrinsic absurdity, but simply 
 because they were innovations. Had the system of 
 Paracelsus been a miracle of scientific accuracy, it 
 would have met with no less opposition from the 
 school of Paris. For this school, more than any other 
 in Europe, was tied and bound to the Galenical tradi- 
 
PARACELSUS AND MEDICINE OF HIS TIME 139 
 
 tion. Here the New Learning had made but little pro- 
 gress, and unorthodoxy in medicine seemed fraught 
 with almost as much danger to the whole fabric of 
 society as unorthodoxy in religion. 
 
 It is interesting to find the famous Rabelais in the 
 ranks of the reactionaries, solemnly lecturing at Mont- 
 pellier on the aphorisms of Hippocrates and the Ars 
 Parva of Galen, but he probably did not take himself 
 very seriously in these medical discourses. More 
 important were the attacks made on the Paracelsists 
 by Jean Riolan, the declared enemy of Mazarin, the 
 Jesuits, surgeons and chemists, and by Gui Patin, re- 
 nowned for his heroic venesections, practised on 
 infants three days old, and for his employment of 
 senna (saigner and senner).^ 
 
 It was in Italy, however, that the doctrines of Para- 
 celsus met with the least favourable reception, and 
 this for two reasons. As the original seat of the New 
 Learning which was gradually spreading over Europe, 
 there existed in Italy a higher level of culture and en- 
 lightenment than elsewhere, which was proof against 
 the crude, bombastic self-assertion of Paracelsus. 
 Secondly, the opposition to Galen and Scholasticism 
 generally was undertaken with far better taste and 
 judgment by one of their own countrymen in the 
 person of Jerome Cardan. 
 
 This celebrated physician and philosopher was 
 born ten years later than Paracelsus at Pavia in 
 1 50 1. Later on he became Professor of Mathematics 
 
 ^ Haeser, Geschichte der Medizin, vol. ii, p. 118. 
 
140 RELATION OF MEDICINE TO PHILOSOPHY 
 
 at Milan, at the same time following the practice of 
 medicine, in which he seems to have obtained such 
 a reputation that he was invited to Scotland to attend 
 Archbishop Hamilton, whom he cured of asthma. 
 In 1559 he became Professor of Medicine at Pavia, 
 and later at Bologna, where he was imprisoned either 
 for heresy or debt. When released from prison he 
 betook himself to Rome, received a pension from 
 Pope Gregory XII., and died there in 1576. It has 
 been asserted that he put an end to himself by star- 
 vation in order to fulfil a prediction which he had 
 made as to the time of his death. 
 
 Cardan appears to have known nothing of the 
 teaching of Paracelsus and his disciples, but his own 
 philosophic standpoint was based upon Pythagorean 
 and Neo-Platonic conceptions. Thus he says, " In 
 the whole creation there works the world-soul, ani- 
 mating everything." Changes in nature follow the 
 laws of number, to which God Himself has submitted 
 His works, as shown in the return of certain numbers 
 in the movements of the planets. He regarded heat 
 and light as fundamental forces, and held that there 
 were only two elements — namely, heat and moisture — 
 cold and dryness being negations. With the inspira- 
 tion of genius he perceived that water was a composite 
 body, though two centuries were to elapse before it 
 was recognised as the union of two gases. He con- 
 sidered that all beings have souls, and that even in 
 plants the passions of love and hate are at work — a 
 doctrine strangely reminiscent of Empedocles. " Man 
 
PARACELSUS AND MEDICINE OF HIS TIME 141 
 
 is not an animal, but ' all animals ' ; he is, on a higher 
 plane, an epitome of the whole animal life." The soul 
 of man, by means of its understanding (ingenium), is 
 superior to all animals, and can outwit them all ; hence 
 man should be described as " animal fallax." He 
 believed in the immortality of the "mind" (mens), 
 but, like Plato, held that God had only a fixed and 
 definite number of such "minds," and consequently 
 he adhered to the doctrine of the transmigration 
 of souls. 
 
 Cardan continued throughout his life a devout 
 Catholic, and remained so far untouched by the 
 ideas of the Reformation that, without subjection to 
 authority, he found church and religion alike un- 
 thinkable. Better, he said, to have no church than 
 one which is not respected. Since philosophy is ex- 
 clusively occupied with science and theory, it cannot 
 attack the church, which is a practical institution. 
 For a small privileged class of savants, Cardan held 
 that the utmost freedom in speculation should be 
 allowed ; but to the general public, occupied as it 
 is with the affairs of practical life, no such privilege 
 should be accorded. To maintain a sharp distinction 
 between the savants and the laity, he thought that all 
 scientific disputes in the mother tongue should be 
 prohibited. The common people should be forbidden 
 to dispute about religious subjects, nam ex his tumulius 
 oriuntur?- Here we see the principles of the Roman 
 Catholic Church applied to knowledge generally, 
 
 1 Erdmann, Gesch^ der Philosophies vol. i. p. 529. 
 
142 RELATION OF MEDICINE TO PHILOSOPHY 
 
 which would have the effect of erecting a priest- 
 hood of science, or, in more modern phraseology, the 
 deification of the expert. This horror of the //ro/anam 
 vulgus meddling in matters too high for its proper 
 understanding did not prevent Cardan from holding 
 rather advanced views as to political authority. Thus 
 he says that laws have only a binding force when 
 they harmonise with religion and philosophy ; it is 
 legitimate to break laws and murder tyrants, just as 
 one gets rid of diseases, even though they are per- 
 mitted or ordained by God. His love of truth was 
 honest and sincere, and to his motto, "Veritas om- 
 nibus anteponenda neque impium duxerim propter 
 illam adversari legibus," he was steadfastly loyal. 
 
 Paracelsus was a true child of his age. Though he 
 has been regarded as the great reformer of medicine, 
 who overthrew Galenism and Scholasticism, yet the 
 fundamental weakness of Scholasticism he entirely 
 failed to perceive. That weakness consisted in the 
 constant effort to embrace heaven and earth in an 
 exhaustive comprehension, which naturally made 
 some system a prime necessity. The human mind 
 has an ingrained appetite for system, rule, and 
 authority. Paracelsus, having destroyed one system, 
 was quite ready with another one to put in its place— 
 uno avulso non deficit alter. It is difficult now to realise 
 the extraordinary ferment taking place in men's minds 
 at the end of the fifteenth and beginning of the six- 
 teenth century. The New Learning, with its revelation 
 of an intellectual life hitherto undreamt of ; the dis- 
 
PARACELSUS AND MEDICINE OF HIS TIME 143 
 
 covery of the New World, with the strange, mysterious 
 civilisations of Mexico and Peru disclosed by Cortez 
 and Pizarro ; the universal passion for foreign travel, 
 which brought men in contact with races, n:;anners, 
 and customs hitherto unknown ; above all, Luther's 
 bold challenge to the Pope, who had seemed till then 
 to the greater part of the Western world an essential 
 part of a permanently fixed order of things : all this 
 gave rise to a wonderful mental elasticity, a great 
 scepticism towards all that was old, a great credulity 
 towards all that was new, with a feeling that anything 
 might be possible, even the medical philosophy of 
 Paracelsus. 
 
CHAPTER IX 
 
 THE EFFECT OF PHILOSOPHY ON MEDICINE IN 
 THE SEVENTEENTH CENTURY 
 
 In the annals of medicine the seventeenth century 
 will always be famous for the great discovery of 
 Harvey, which revolutionised men's conceptions of 
 physiology, much as the discoveries of Copernicus 
 revolutionised their conceptions of astronomy. Three 
 great thinkers illuminated the intellectual life of this 
 century, and fundamentally altered its ideas both on 
 science and philosophy. Least of all could medicine 
 remain unaffected by the far-reaching speculations of 
 Bacon, Descartes, and Spinoza. 
 
 The inspirations of genius know no law, and it 
 were idle to conjecture how far the discovery of the 
 circulation of the blood was indirectly brought about 
 by the author of the Novum Organum. We know 
 that Bacon was the friend and patron of Harvey, 
 but it is probable that the latter was more influenced 
 by the conversation and general mental temper of the 
 philosopher than by actually studying the Novum 
 Organum ; indeed, we are told that Harvey did not 
 value very highly Bacon's systematic reasonings, as 
 he said of him, " He philosophises like a Lord 
 Chancellor," The inductive method, which Bacon 
 
EFFECT IN THE SEVENTEENTH CENTURY 145 
 
 somewhat pompously styled "the New Testament," 
 had indeed been used from the foundation of the 
 world, or at least since men began to reason at all ; 
 it is identical with the kira^w^ri of Aristotle, but its 
 true significance had not been fully appreciated. 
 Doubtless it would be a mistake to suppose that such 
 discoveries as those of Copernicus, Galileo, or Harvey 
 were more likely to be made by the inductive than 
 the deductive method ; for the discoverer does not as 
 a rule sit down in cold blood to consider which 
 logical method he shall employ for the investigation 
 of nature, any more than a Giotto, in composing his 
 fresco, consciously goes through the elaborate reflec- 
 tions detailed for us by Ruskin. As a matter of fact, 
 it would seem that the deductive method, owing to 
 the greater opportunity it affords for the play of the 
 imagination, would be more likely to unlock the 
 secrets of the universe. Hitherto the mistake had 
 been not so much the use of the deductive method as 
 the entire omission to test the truth of the premises, 
 and the inadequate application of the method of 
 verification. The imagination ran riot, major pre- 
 mises based on theological dogmas were put forward, 
 and the strangest conclusions reached, which were 
 never questioned because the syllogistic ratiocination 
 had been correct. 
 
 Bacon was the first to draw attention to the fact 
 that, in spite of the great geniuses of antiquity and 
 the large amount of intellectual effort expended, the 
 actual amount of positively ascertained truth which 
 
146 RELATION OF MEDICINE TO PHILOSOPHY 
 
 had floated down the stream of time from the ancient 
 world was surprisingly small, and that very little had 
 been added to it during the Middle Ages. This he 
 thought must be due to a faulty method of investiga- 
 tion. In part he was right, but it was not the whole 
 truth of the matter. The fact is, the ancients, if we 
 except the pre-Socratic philosophers, did not feel 
 strongly about the importance of knowledge of the 
 external world, as they were almost wholly absorbed 
 in questions of ethics and politics. As typical of this 
 attitude we may quote the following passage from the 
 Phcedrus: "PH/EDR. — I always wonder at you, Socrates; 
 for when you are in the country, you really are like 
 a stranger, who is being led about by a guide. Do 
 you ever cross the border ? I rather think that you 
 never venture even outside the gates. Soc. — Very 
 true, my good friend ; and I hope that you will excuse 
 me when you hear the reason, which is, that I am a 
 lover of knowledge, and the men who dwell in the city 
 are my teachers, and not the trees, or the country. 
 Though I do indeed believe that you have found a 
 spell with which to draw me out of the city into the 
 country, as hungry cows are led by waving before 
 them a bough or a fruit. For only hold up in like 
 manner a book before me, and you may lead me all 
 round Athens, and over the wide world." 1 Then, again, 
 in the Middle Ages the rulers of the Church were under 
 the impression that the religious life of Christendom 
 was bound up, not only with certain spiritual truths, but 
 
 ' Jowett's translation, vol. ii. p. 107. 
 
EFFECT IN THE SEVENTEENTH CENTURY 147 
 
 with definite views as to the course of external nature ; 
 consequently the free investigation of the world was 
 only possible within the limits of fixed theological 
 canons. 
 
 The great merit of Bacon's method lies in the fact 
 that it assures the stability of science though it may 
 not have materially aided in the immediate discovery 
 of the truths of science. Above all, his doctrine of 
 the four kinds of idola did much to free men's minds 
 from the various prejudices which beset them, while 
 by the importance he attached to facts and the stress 
 laid upon careful and correct observation, he arrested 
 the progress of error. There is some truth in his 
 contention that "Aristotle corrupted natural philo- 
 sophy with logic, being all along more solicitous how 
 men might defend themselves by answers, and advance 
 something that should be positive in words, than to 
 come at the inward truth of nature." 
 
 Not unnaturally Bacon exaggerated the virtues of 
 his own child, and seems to have been under the 
 impression that the making of discoveries was largely 
 a mechanical matter. Thus he says : " Our method 
 of discovery in science is of such a nature that there 
 is not much left to acuteness and strength of genius, 
 but all degrees of genius and intellect are brought nearly 
 to the same level. (Nostra vero inveniendi scientias ea 
 est ratio, ut non multum ingeniorum acumini et robori 
 relinquatur ; sed quae ingenia et intellectus fere 
 exaequet.)"^ He believed that the facts might be 
 ' Nm). Org., I. App. 61. 
 
148 RELATION OF MEDICINE TO PHILOSOPHY 
 
 collected by one set of people and the inductions 
 made by another, but this has not been the method of 
 science. It is not the mechanical colligation of facts 
 which gives rise to the great discovery, but the happy 
 guessing {eucrroxM) or fortunate aperqu of the genius 
 which suddenly lays bare the hidden secrets of nature. 
 A serious defect of Bacon's method was the failure 
 to take into consideration the " plurality of causes," 
 the existence of which is one of the main difficulties 
 obstructing the progress of medicine. Then, again, 
 the importance of the deductive method was not 
 fully realised by Bacon owing to his want of mathe- 
 matical knowledge, for it is in those sciences in which 
 mathematics play a part that the deductive method 
 becomes specially valuable. It has often been re- 
 marked that Bacon, though the father of modern 
 science, himself made no important contribution to 
 scientific discovery. His aim was rather to secure 
 the bases of all sciences than to concentrate himself 
 on any single one, to map out the course for the 
 future torch-bearers of science rather than to be a 
 torch-bearer himself. The great and lasting effect 
 which he had upon medicine by turning men's minds 
 from vague speculations, and directing them to 
 observation and experiment and the importance of 
 common things, will appear presently. 
 
 Descartes has been justly called "The Father of 
 Modern Philosophy," and he too, like Bacon, was en- 
 gaged in fashioning a method for the comprehension 
 of the universe. The thought of Descartes, though 
 
EFFECT IN THE SEVENTEENTH CENTURY 149 
 
 clothed in less grand and noble diction, was more 
 subtle and profound than that of Bacon. He was a 
 mathematician and metaphysician, and set himself 
 deliberately to find a new method which would 
 solve the problem of the nature of knowledge. After 
 passing through a period in which he doubted 
 everything, he at last came to the conclusion that 
 the only thing about which he could have no doubt 
 was his own existence, because of the power of 
 thinking. Hence the famous phrase "cogito, ergo 
 sum." Starting thus with consciousness as the 
 basis of certitude, the method of certitude he found 
 in mathematics, which were to disclose the hidden 
 meaning of nature. Descartes considered that the 
 ground of the certainty of the proposition " I think, 
 therefore I am " lay simply in the fact that one sees 
 clearly it must be so, and therefore he enunciated 
 the rule that things which we conceive very clearly 
 and distinctly are all true. Hence the ultimate test 
 of truth is intrinsic, not extrinsic. An idea shows 
 itself to be absolutely true by its own clearness and 
 distinctness, and does not depend on any external cri- 
 terion. The essence of matter he considered to be 
 "extension," which is not resolvable into ultimate 
 atoms, but is infinitely divisible and is homogeneous 
 throughout the universe ; the apparent varieties of 
 matter being distinguished only by the different 
 division and movement of its parts. The essence of 
 mind or soul was thought, which can in no way be 
 predicated of matter ; hence mind and matter, or, as 
 
150 RELATION OF MEDICINE TO PHILOSOPHY 
 
 Descartes expressed it, "thought and extension" are 
 wholly separate from one another, neither can act 
 upon the other, a union could only be effected by 
 God. Since thought is essential to true existence and 
 animals do not think, they have therefore only a cor- 
 poreal existence. He indeed pronounced the lower 
 animals to be mere " automata," in whose nature pro- 
 cesses which go forward consciously in us are simu- 
 lated by a clock-like mechanism. His followers 
 carried out this doctrine with logical strictness, and 
 used it as an excuse for cruelties to dumb animals 
 because they only had sham feelings. Descartes, how- 
 ever, had not intended to withhold from animals the 
 power of sensibility, but only that of self-conscious- 
 ness, in that while they see, and feel, and hear, they 
 do not know that they do so or reflect upon what it 
 means, but are carried impulsively to the appropriate 
 objects or through the appropriate experience. He 
 speaks of their cries of joy or pain, and of " acting " 
 on their hopes and fears of bodily pleasure or pain, 
 which is the principle of all training of animals.^ 
 
 Descartes, more fortunate than Bacon, made several 
 happy discoveries, as, for instance, that " action and 
 reaction are equal," that heat is motion, and motion 
 changes itself into heat \ also he showed how geo- 
 metrical curves could be expressed by algebraical 
 symbols. He discovered the equality of the angle 
 of incidence and reflection, also the refraction of 
 light, and suggested the law of the conservation of 
 
 1 Martineau, Types of Ethical Theory, vol. i. p. 145. 
 
EFFECT IN THE SEVENTEENTH CENTURY 151 
 
 energy. Like Bacon he excluded final causes from 
 his conception of nature, saying, "God pursues 
 objects in the corporeal nature, but it is presump- 
 tuous to try and learn the same. Most objection- 
 able of all is the pride which regards man as the 
 end of nature." The doctrine of final causes has 
 indeed nearly always proved an obstacle to science, 
 yet it is worth remembering that both Cuvier and 
 Owen claim to have derived assistance from this 
 doctrine in making their discoveries. 
 
 Descartes did not confine himself to metaphysical 
 and mathematical studies, but physiology and path- 
 ology came within the sphere of his considerations, and 
 for eleven years he busied himself with anatomical 
 studies. As a result, he believed that the soul is every- 
 where in the body, but that its immediate effects pro- 
 ceed from the pineal gland. Here the soul, besides 
 its own processes of pure understanding, imagines and 
 perceives ; the medium of its sensations being nerves 
 running from its seat in the brain to every part of 
 the body. The movements propagated from the peri- 
 pheral extremities to the central spot excite different 
 sensations, partly according as the nerves are differ- 
 ent, partly as the motion in the same nerve is of a 
 different kind. The varying state of the blood affects 
 the nerves with different kinds of motion ; if it be 
 pure and well-tempered it quickens their sensibility 
 and gives them an action which excites natural joy in 
 the soul, if it be gross and sluggish a heavier move- 
 ment ensues which carries a feeling of depression to 
 
152 RELATION OF MEDICINE TO PHILOSOPHY 
 
 the soul. Whenever, from any other cause than the 
 state of the blood, these different movements are im- 
 parted, the corresponding feeling will recur. When, 
 for example, we contemplate the arrival of some good, 
 this imagination does not in itself carry the feeling of 
 joy but sends the "animal spirits " on an errand from 
 the brain down the muscles to the insertion of the 
 heart nerves, which are then, through dilatation of 
 its cavities, affected by the special motion felt as joy 
 at the headquarters of the soul. This joyous sensa- 
 tion, however, is to be distinguished from another and 
 purely intellectual joy of which the soul per se is sus- 
 ceptible : if we are told a piece of news, the soul first 
 considers whether it is good or bad ; if good, then 
 is it affected by a " spiritual joy " so completely inde- 
 pendent of bodily changes that the Stoics did not deny 
 it to their " wise man," exempt though he was to be 
 from every passion. But, as soon as this joy passes 
 from the understanding to the imagination, the pro- 
 cess just described is set a-going which terminates 
 in the sensational consciousness. 
 
 Descartes regarded the nourishment of the body 
 as an entirely physical process, depending on the fact 
 that the vessels, like a fine sieve, only allow the most 
 delicate particles of the food-stuffs to pass through 
 them. 
 
 The influence of Spinoza upon the medicine of 
 his time was far more indirect. Unlike Descartes 
 he seems to have taken little interest in the sciences, 
 with the exception of optics. For a time he corre- 
 
EFFECT IN THE SEVENTEENTH CENTURY 153 
 
 sponded with Oldenburg, the first secretary of our 
 Royal Society, who used to send him the treatises 
 of Boyle as they were published, and try to enlist his 
 interest in the air-pump and other kindred subjects. 
 Though living close to, and in some correspondence 
 with, the great physicist Huyghens, he seems to have 
 known nothing of the latter's pendulum clock or 
 perceived the importance of his neighbour's dis- 
 coveries. Spinoza, like Descartes and Bacon, rejected 
 final causes, and, impressed by the certainty afforded 
 by mathematical truth, employed the geometrical 
 method of the former as the best means of compre- 
 hending the problem of the universe. He perceived, 
 however, the logical weakness of the Cartesian dualism, 
 and asked himself " What is the noumenon underlying 
 all phenomena ? " This, he concluded, was "substance," 
 which embraced within itself all thought and being, 
 and was in fact identical with " God," from whom the 
 whole world of nature could be deduced. Thus this 
 one eternal and infinite substance united, in the form 
 of " attributes," the two separate existences of thought 
 and extension, or mind and body, which Descartes' 
 system had kept apart. The relation, then, of the 
 material universe to God was that the universe 
 constituted one aspect of God's infinite attribute of 
 extension, he is the identity of the Natura Naturans 
 and the Natura Naturata. Absurd as was the charge 
 of atheism with which Spinoza's philosophy was 
 long branded, and remote as his metaphysics are 
 from materialism as ordinarily understood, yet there 
 
154 RELATION OF MEDICINE TO PPIILOSOPHY 
 
 is little doubt that the immediate effect of his specu- 
 lations — by rejecting the idea of design in nature, 
 free will, and the thought of a possible beyond the 
 actual, and by reducing moral relations to natural 
 necessity — was to reinforce the materialistic deductions 
 which flowed from the systems of Bacon and Des- 
 cartes. So great a weight of philosophical genius 
 thus thrown into the scale, leaning towards apparently 
 materialistic conceptions of the universe, was doubtless 
 a powerful aid to science, and perhaps helped on the 
 great advances of medicine which distinguished the 
 seventeenth century, by making men feel that in the 
 humble, patient, prosaic method of unravelling the 
 secrets of nature they had the express sanction and 
 warm approval of the most illustrious thinkers of 
 their time, to whose more profound speculations 
 they paid but little heed. When there was so much 
 leeway to be made up by science and medicine, a 
 physician at that time might well have excused him- 
 self from metaphysical speculation in the words of 
 Goethe a century later : — 
 
 " Mein kind Ich habe es klug gemacht 
 Ich habe nie iiber das Denken gedacht.'' 
 
 Harvey's great discovery is too well known for us 
 to dwell upon here. In his early study of the heart so 
 complex did its mechanism seem to him that he began 
 to think " that the motion of the heart was only to be 
 comprehended by God." By degrees he came to see 
 that the heart was not mainly an organ of suction 
 but one of propulsion, for its work consisted not in 
 
EFFECT IN THE SEVENTEENTH CENTURY 155 
 
 sucking in air from the lungs but in driving blood, by 
 its contractile power, through the body. He also 
 showed that the active part of the heart-beat was the 
 systole and not the diastole as had been previously 
 taught.^ The experimental work of Galileo, whom 
 Harvey probably knew, doubtless determined the 
 main direction of his physiological method. The 
 discovery of the circulation of the blood has generally 
 been regarded as a particularly fine example of the 
 inductive method, because the complete proof of it 
 was not found till a later date. Harvey, from certain 
 definite observations, induced the fact that there must 
 be a connection between the arteries and veins, but 
 the actual connection by means of the capillaries 
 was not demonstrated till four years after his death 
 by Malpighi (1661), aided by the invention of the 
 compound microscope. Similarly Kepler induced 
 the fact that the planets moved in elliptic orbits, from 
 observation of some of their known positions, though 
 all the points of the ellipse were not observed. As 
 the old Galenical anatomy had been destroyed by the 
 researches of Vesalius and the lother great Italian 
 anatomists, so now the brilliant discovery of Harvey 
 set aside for ever the physiology of Galen. After the 
 publication of his epoch-making work (1628), his prac- 
 tice is said to have diminished, and people were near 
 to thinking him mad, but he lived to see the complete 
 triumph of his doctrines, which were defended with 
 energy by Descartes. However much Harvey may 
 
 ' Cambridge Modem History, vol. v. p. 726. 
 
156 RELATION OF MEDICINE TO PHILOSOPHY 
 
 have owed to the popular philosophical speculations 
 of his time, there is no doubt that his scientific 
 method harmonised with the materialistic doctrines 
 of Bacon and Descartes, and thus gave a great impetus 
 to mechanical conceptions of life. It came to be 
 thought that all bodily processes took place in accord- 
 ance with known laws of physics and chemistry. 
 Hence in medicine arose two schools, known to fame 
 as the latro-chemical and the latro-mechanical- 
 The leader of the latro-chemical school was Sylvius 
 (Franz de la Boe), whose name is known to every 
 student of anatomy from his researches on the brain. 
 Born at Hanau, in 1614, he received his scientific 
 education at Sedan, then a Protestant town ; after 
 visiting various Dutch and German towns, he took 
 his degree at Basle and settled down to practise at 
 Hanau. Later he was called to fill the vacant pro- 
 fessorship of medicine at Leyden, which he occupied 
 for fourteen years, and there gathered round himself 
 an incredible number of students. He was a man 
 of great personal attraction ; not only one of the 
 handsomest men of his time, but famous for the 
 accuracy of his knowledge, his eloquence, and un- 
 wearied zeal for science and the welfare of mankind, 
 besides which he had a most attractive cheerfulness, 
 taking for his motto "Bene agere et laetari." The 
 great aim of Sylvius was to find a scientific basis 
 for medicine. He perceived that only in connection 
 with anatomy and clinical experience could medicine 
 properly flourish. Consequently he laid great stress 
 
EFFECT IN THE SEVENTEENTH CENTURY 157 
 
 upon the importance of anatomy, and was one of 
 the early defenders of Harvey's discovery. But his 
 greatest interest lay in chemistry, and here he seems 
 to have studied the works both of Paracelsus and Van 
 Helmont. Realising that a salt was made up of an 
 acid and an alkali, he endeavoured to explain nearly 
 all chemical phenomena, both in the living body and 
 outside it, as the result of the actions of acids and 
 alkalies. Fermentation was to him the same thing as 
 effervescence, and he regarded digestion and most of 
 the changes in the body as a series of effervescences 
 aided by precipitations. Nowhere does Sylvius 
 appeal to any spiritualistic forces ; chemical action 
 seemed adequate to explain all the phenomena of the 
 living body, and the chemical action which he met with 
 there he considered to be identical with the chemical 
 actions seen in the beakers and retorts of the labor a- 
 tory.i To the spleen he ascribed a great significance, 
 mainly because in size and shape it was subject to 
 great changes, while of all parts of the body except 
 the heart it was least subject to a disease. Such a 
 view is the more surprising as he was aware of the 
 fact that the spleen could be removed from dogs 
 without causing the least disturbance. Sylvius was 
 therefore called " Patronus lienis." The function 
 of the spleen was to prepare a finer sort of ferment, 
 a kind of tincture, which should contribute to the 
 fermentation of the chyle. The object of the respira- 
 tion was to moderate the effervescence of the blood 
 
 1 Cambridge Modern History, vol. v. p. 731. 
 
158 RELATION OF MEDICINE TO PHILOSOPHY 
 
 in the right heart, which was caused by its innate 
 heat working through the medium of the bile. He 
 supported the doctrine of innate heat by the assump- 
 tion of a higher temperature in the arteries than in 
 the veins. Fever was caused by an unaccustomed 
 effervescence of the blood of the heart, through the 
 influence of one or more morbidly changed basic 
 fluids. He regarded the increased frequency of the 
 pulse-rate, and not a rise of temperature, as the most 
 essential symptom of fever. 
 
 In therapeutics he made use of alteratives, by 
 which he understood such medicines as improve 
 either the consistence of the fluid elements of the 
 body or the sensible properties of the same. The 
 most important alteratives were such as worked upon 
 "the vital spirits," e.g. aetherial oil, ammonia, and 
 opium. Some of his prescriptions have survived 
 almost to our own times, the most famous being the 
 Elixir Proprietatis, which was largely used up to the 
 middle of the nineteenth century, and which closely 
 resembled the " aromatic sulphuric acid " of our pre- 
 sent pharmacopoeia.^ More useful, perhaps, than all 
 the theories and observations of Sylvius was his 
 introduction of the habit of clinical teaching in the 
 University of Leyden, which he thus describes : " In 
 my teaching of the students I led them by the hand, 
 so to speak, to medical practice, making use of a 
 method unknown at Leyden, and perhaps elsewhere, 
 that is to say, I took them every day to the public 
 
 ' Withington, Medical History, p. 312. 
 
EFFECT IN THE SEVENTEENTH CENTURY 159 
 
 hospital. There I put before their eyes the symptoms 
 of the diseases ; I made them hear the complaints 
 of the sick, then I asked them their opinion, and the 
 reasons for that opinion, on each affection which we 
 observed, on its causes and rational treatment ; each 
 time there was a difference of opinion among them 
 I settled the difference by suggesting various other 
 arguments as sound as was possible, then I gave my 
 own judgment on each point. With me they wit- 
 nessed the fortunate result of treatment, when God 
 granted to our cases a return of health, or were 
 present at the examination of the body when the 
 patient paid the inevitable tribute to death." ^ 
 
 The teaching of Sylvius spread all over Europe, 
 for it seemed the solution of the problem of scientific 
 medicine. Most of his disciples came from the 
 Netherlands and Germany, and the school was still 
 further developed by Theodore Graanen, who suc- 
 ceeded Sylvius as professor of medicine at Leyden, 
 and tried to unite his teachings with those of Des- 
 cartes. In England powerful support was given to 
 the latro-chemical doctrine by Willis (1622-1675), 
 justly famous for his researches on the blood supply 
 of the brain. Destined originally for theology, owing 
 to the persecution of the Anglican Church during the 
 Commonwealth he betook himself to the study of 
 medicine, became professor of natural philosophy 
 at Oxford, and later practised as a physician in London 
 with most brilliant success. He regarded "spirit" 
 ' Daremberg, Histoire des Sciences midicales, vol. i. p. 571. 
 
i6o RELATION OF MEDICINE TO PHILOSOPHY 
 
 as the element which conditioned the activities of 
 bodies, the most general form of this activity is 
 "fermentation," which constitutes the molecular 
 movement of bodies. Fermentation is defined as 
 "an internal motion of the particles of any body, 
 tending either to the perfection of the same body or 
 because of its change into another." Health and 
 disease depend upon the normal or abnormal course 
 of these fermentations, and the physician may be 
 compared to a brewer or vintner, whose business 
 is to watch the process and to prevent or correct any 
 irregularities.^ 
 
 To "the animal soul" he attached special signifi- 
 cance, regarding it as the product of the fiery elements 
 {flammea substantia) of the blood and the spirit of the 
 nerves. He considered that the animal soul was the 
 essential cause not only of normal life processes, but 
 also that it was often the immediate cause of recovery 
 from disease {non raro ope medica agit)? 
 
 We must now turn to the other great school of 
 medical thought — ^the latro-mechanical, which took 
 its origin from the physical methods of investigation 
 then coming into vogue. An important precursor of 
 the school was Santorio Santoro (1561-1636), pro- 
 fessor of medicine at Padua and Venice. He seems 
 to have been a sort of scientific St. Simeon Stylites, as 
 he passed thirty years of his life both working and 
 sleeping on a weighing-machine of his own invention, 
 
 ' Withington, Medical History, p. 313. 
 
 ' Haeser, Geschichts der Medizin, vol. ii, p. 383. 
 
EFFECT IN THE SEVENTEENTH CENTURY i6i 
 
 which enabled him to discover the insensible per- 
 spiration of the skin : it was a very crude method, as 
 the evaporation from the lungs could not be separated 
 from that of the skin. He also expressed a wish that 
 every one could have a similar machine, for not only 
 are changes in weight among the earlier signs of 
 approaching illness, but by taking his meals in such a 
 chair a person would be guarded against irregularity 
 in the quantity of his food, which is one of the most 
 fertile causes of disease. He also devised various 
 ingenious instruments, in which he was doubtless 
 assisted by the famous Galileo, Thus his thermo- 
 meters, which he declares will be invaluable in cases 
 of fever, are imitations of the air and water instru- 
 ment invented by Galileo, slightly altered in shape to 
 adapt them for being held in the mouth or applied to 
 the skin. So, too, his pulsilogium is an application 
 of Galileo's principle of the pendulum to measure the 
 rate and regularity of the pulse.* 
 
 But the real founder of the latro-mechanical school 
 was Borelli (1608-79), who was Professor of Mathe- 
 matics first at Messina, then at Pisa, Following 
 strictly the philosophic teaching of Descartes, he tried 
 to show that the body was a machine and physiology 
 merely a department of physics. In this he had 
 great success with his book. On the Movement of 
 Animals, in which he demonstrated that walking, 
 swimming, flying, &c., are mechanical processes, the 
 muscles and bones playing the part of strings and 
 
 I Withington, Medical History, p. 315. 
 
1 62 RELATION OF MEDICINE TO PHILOSOPHY 
 
 levers, which forces could be estimated mathemati- 
 cally. These mathematical conceptions of the body 
 led him to make some strange statements ; thus he 
 thought that the heart expels the blood not so much 
 by contraction as by a swelling up of the walls of the 
 ventricles, just as a bullet is shot from a gun by the 
 expansion of the powder, and the forces employed 
 are not dissimilar, for Borelli calculated that each 
 heart-beat overcomes a resistance equal to 180,000 lbs. 
 
 This application of physics to physiology and 
 medicine was carried on by Bellini (1643-1704), of 
 Florence, who at the early age of nineteen published 
 his remarkable book on the structure and functions 
 of the kidneys, and became later one of the most 
 distinguished clinical physicians of his time. In his 
 teaching of inflammation and fever he lays stress on 
 the mechanical disturbances of the movement of the 
 blood, especially the friction of blood in the walls 
 of the smaller blood-vessels and the consequent 
 stoppages (or congestions). 
 
 Nowhere did this latro-mechanical school find 
 more favour than in England, as might be expected, 
 perhaps, in the country of Bacon and Harvey. 
 William Cole of Bristol {fl. 1670), the friend of Syden- 
 ham, combated the doctrines of the chemical school 
 and enunciated a mechanical view of fever, which he 
 regarded as the effect either of retained excretory 
 products or of substances produced in the body itself 
 (auto-intoxication) blocking the finest pores of the 
 vessels, and first producing a disturbance of the 
 
EFFECT IN THE SEVENTEENTH CENTURY 163 
 
 nervous parts and then, after their passage into the 
 blood, a febrile temperature. 
 
 The most celebrated, however, of this school was 
 Archibald Pitcairne of Edinburgh (1652-1713). Ori- 
 ginally devoting himself to theology, and then to 
 law, he finally studied medicine at Montpellier. In 
 1692 he went as a lecturer to Leyden, and numbered 
 among his audience the famous Boerhaave ; but, being 
 unsuccessful as a lecturer, he returned to Edinburgh. 
 Pitcairne was the most decided opponent of the 
 application of philosophy to medicine, and he was 
 equally hostile to the chemical school. According to 
 him, all the differences in physiological and patho- 
 logical processes depended on the different diameters 
 of the pores in the particular organs. The funda- 
 mental causes of all animal movements are the heart, 
 the circulation, and the nerve spirits ; the latter by 
 their streaming into the muscles cause motion, by 
 their streaming back to the brain sensation. Bodily 
 heat comes from the friction of the blood against the 
 vessel walls. Digestion was regarded as a purely 
 mechanical process, due to the rubbing action of 
 the stomach, which effected a trituration of the 
 food. 
 
 We have thus seen how the great thinkers of this ! 
 century, and particularly the fashionable Cartesian j 
 philosophy, powerfully affected the study of medicine, 
 leading men to conceive the possibility of a science 
 of medicine based upon mathematics, physics, and 
 chemistry. The immediate result was, on the whole, 
 
1 64 RELATION OF MEDICINE TO PHILOSOPHY 
 
 encouraging, as certain aspects of the bodily mech- 
 anism, depending purely on physics, were clearly 
 determined ; the application of chemical ideas was 
 less satisfactory, simply because chemistry itself 
 was entirely in its infancy and rested on a very 
 slight basis of ascertained fact. Gradually as these 
 methods worked themselves out, they were found to 
 lead to an unduly narrow conception of life, unsatis- 
 fying alike to science and philosophy. 
 
 Standing outside and apart from all this medical 
 ferment which we have been considering is Van 
 Helmont, whose system we cannot pass over alto- 
 gether in silence. Unaffected by methods of physics 
 or chemistry, unmoved by the exhortations of Bacon, 
 the speculations of Descartes, or the discoveries of 
 Harvey, Van Helmont pursued the even tenor of his 
 way, evolving largely from his inner consciousness 
 a new medical system. As an opponent of Galen, 
 and as helping to batter down that time-honoured 
 system, he harmonised with the spirit of his age ; but 
 in his attempt to substitute one system for another, 
 like Paracelsus, he entirely failed to perceive the 
 essential vice of the system he was attacking. 
 
 Van Helmont was born at Brussels, in 1578, of a 
 noble family. His youth was characterised by an 
 insatiable thirst for knowledge, and he was much 
 influenced by the lectures of Martin del Rio on 
 magic ; but, finding there no permanent satisfaction, 
 he betook himself to the philosophy of the Stoics, 
 in which he hoped to find inward peace. Realising, 
 
EFFECT IN THE SEVENTEENTH CENTURY 165 
 
 however, that this was not to be reconciled with 
 Christianity, he turned aside to more worldly studies, 
 and buried himself in law and political science. Next 
 he directed his attention to botany, and began to 
 think of taking up medicine. For a long time he 
 hesitated, fearful lest so plebeian an occupation 
 would be a stain upon his illustrious ancestry. Re- 
 ceiving, however, an inspiration from his guardian 
 angel, Raphael, who apparently took no cognisance 
 of his noble pedigree, he finally adopted the medical 
 profession, expecting to find therein a complete satis- 
 faction alike for his thirst after knowledge and his 
 love of mankind. With amazing diligence he de- 
 voured medical works, both ancient and modern, 
 reading Galen twice and knowing the aphorisms of 
 Hippocrates by heart. He then began to give a 
 course of lectures on surgery, at Louvain, till he felt 
 that his experience was insufficient. By degrees he 
 became disquieted with what he saw of medical 
 practice, and the study of mystical books, such as 
 those of Thomas a Kempis and Tauler, decided him 
 to abandon medicine altogether. He then left his 
 native land, intending never to return, and wandered 
 through Switzerland, Italy, France, and England. 
 Meeting with an alchemist he turned his attention 
 to chemistry, and began in this direction new thera- 
 peutical methods. He returned therefore to Brussels 
 in 1605, married, and settled down to a life of study 
 and medical practice till his death in 1644. 
 
 In the system of Van Helmont we again trace the 
 
1 66 RELATION OF MEDICINE TO PHILOSOPHY 
 
 influence of Neo-Platonism, which from time to time 
 seems to reappear in the history of medicine. The 
 basic principle of this system was the unity of nature, 
 which is the free creation of God, whose breath fills 
 all creatures with life. Nature, however, was not 
 regarded as a completed thing, but as something 
 which was continually passing away ; but, by the 
 power of the Creator, being continually formed anew. 
 The body of man is under the control of two souls : 
 (i) The immortal, which is derived from God, (2) the 
 animal soul, which comes through sin. Like Para- 
 celsus, he has the doctrine of the Archeus. Now the 
 Archeus Influus governs and controls the whole bodily 
 organism, working always according to a fixed plan, 
 or "seminal idea," impressed by the Creator. This 
 Archeus is not the soul itself, but is the organ of the 
 same, and has its seat in the stomach and spleen. 
 The various parts of the body have a local Archeus 
 called the Archeus Insitus, which is, of course, domi- 
 nated by the chief Archeus Influus. What precisely 
 the nature of the Archeus was Van Helmont does not 
 tell us, but he appears to have conceived of it as a 
 kind of sether-like structure. Van Helmont con- 
 sidered that there was no essential difference between 
 the conditions of normal and morbid processes. What- 
 ever causes healthy actions in the sound, the same 
 causes vitiated actions in the diseased. "Disease 
 is a morbid idea, conceived by the Archeus either 
 through his own infirmity or from the action of some 
 harmful agent, which causes him to deviate from his 
 
EFFECT IN THE SEVENTEENTH CENTURY 167 
 
 normal course and act in another way, but always 
 according to some fixed and specific plan." Fever 
 is the effort made by the chief Archeus to get rid of 
 some irritant, just as local inflammation is the reaction 
 of the local Archeus to some injury. He considered 
 that the true seat of fever was not in the heart, as the 
 Galenists taught, but in the stomach, small intestine, 
 and spleen ; the nearer the fever is to the pylorus 
 the greater the danger. Asthma in women, he said, 
 depended as a rule on the uterus, in men on a spasm 
 of the bronchi, and therefore it is related to epilepsy. 
 He makes the very suggestive remark that "dry 
 asthma " deserves the name of epilepsy of the lungs. 
 His therapeutics consisted in a union of Hippocratic 
 medicine with a belief in the arcana. Strongly op- 
 posed to venesection, which he thought likely to 
 weaken and irritate the Archeus, he combated also 
 the Galenic theory of purgatives and the use of 
 nutrient enemata, which were very common in his 
 time. The main principle of therapeutics was to 
 pacify the Archeus. Like Paracelsus, he believed that 
 each country produced the special medicines suitable 
 for its own diseases, and therefore that it was un- 
 necessary to import foreign drugs. He would, doubt- 
 less, on this principle have rejected quinine, for he 
 declares " it is inconceivable that the merciful Father 
 of mankind should have been less merciful to his 
 European children before the discovery of the Indies 
 than afterwards." On some occasions it seems to 
 have been legitimate to frighten the Archeus ; thus 
 
1 68 RELATION OF MEDICINE TO PHILOSOPHY 
 
 Van Helmont tells us that dropsy is not due to a 
 disease of the liver, as was formerly supposed, but 
 to the wrath of the Archeus presiding over the kidneys, 
 who may be reduced to order by frightening him. 
 This can be accomplished by tying a snake round the 
 patient's waist, and applying live toads to the region 
 of the kidneys.^ 
 
 Apart from such absurdities, we must recognise 
 that Van Helmont was the most important naturalist 
 of his time. He also discovered carbonic acid, and 
 knew that the gastric juice contained an acid ; further 
 he was possessed of a thorough knowledge of 
 anatomy. 
 
 Though regarded by the Catholics as a heretic, he 
 was in fact one of the greatest religious enthusiasts, 
 the most learned of all Theosophists, and a firm 
 believer in the Catholic faith ; much indeed of his 
 contempt for the teaching of Galen arose from the fact 
 that the latter was a heathen. Van Helmont was a 
 great believer in divine inspirations, and relates how 
 one day he beheld his own soul like a shining crystal, 
 and that all his doctrines had been worked out in 
 a dream. " From God alone do men receive intel- 
 lectual and moral enlightenment." His enthusiasm 
 for the well-being of mankind was boundless ; for 
 him medicine is the office of love and pity, the final 
 task of all knowledge, and the practice of Christian 
 duty. If we are prepared to say with Daremberg, 
 " II ne peut sortir rien de bon de la methode a priori, 
 
 ' Withington, Medical History, p. 308. 
 
EFFECT IN THE SEVENTEENTH CENTURY 169 
 
 ni rien du bon du mysticisme," ^ for medicine, then 
 indeed must we condemn absolutely all the system 
 and theories of Van Helmont. On the other hand 
 fanciful explanations in medicine, as in other things, 
 are often stimulating and fertilising, and are perhaps 
 better than none at all. In all scientific discovery 
 imagination is a most important factor, and though 
 in the past it had often run riot, losing itself and 
 misleading others in wandering mazes, yet with the 
 advent of Bacon, Descartes, and the scientific method 
 its excesses could be checked, and the world is more 
 likely in the future to suffer from too little rather 
 than too much imagination. 
 
 1 Daremberg, Hist aire des Sciences midicahs, vol. i. p. S3S. 
 
CHAPTER X 
 
 THE INFLUENCE OF PHILOSOPHY ON MEDICINE IN THE 
 EARLY PART OF "THE EIGHTEENTH CENTURY 
 
 The speculations of Bacon and Descartes, together 
 with the brilliant physiological discoveries of the 
 seventeenth century, had, as we have seen, given rise 
 to the latro-chemical and latro-mechanical schools 
 of medicine, which professed to find in the laws of 
 chemistry and physics a solution for all problems 
 connected with the body. The inadequacy of such 
 conceptions was early recognised by physicians like 
 Sydenham and Boerhaave, who were, in consequence, 
 led to disregard all theories about medicine and to 
 betake themselves to the old Hippocratic method 
 of observation. Sydenham, indeed, has been termed 
 the modern Hippocrates, and enjoyed the greatest 
 reputation both on the Continent as well as in his 
 own country. He reproached most physicians for 
 either giving a blind confidence to the authority of 
 the ancients, or accepting with credulity the novel 
 doctrines of more modern writers. He was of 
 opinion that the main error with regard to medicine 
 lay in the fact that man had hitherto regarded 
 diseases as being thoroughly abnormal and lawless 
 phenomena, whereas the first requirement was to 
 
EARLY PART OF EIGHTEENTH CENTURY 171 
 
 classify diseases according to their distinct species 
 with the same care that botanists employ in the case 
 of plants. Contemporary with Sydenham, and pos- 
 sessed of the same mental temper, was Boerliaave. 
 This celebrated physician was born in 1668. In early 
 life he studied theology, and cherished the hope of 
 combining it with the healing art ; but on finding 
 himself denounced as a follower of Spinoza, he 
 abandoned theology and devoted himself to the 
 practice of medicine. In this field of activity his 
 success was astounding, students flocking from all 
 parts of Europe to hear him lecture at the University 
 of Leyden, so that he was justly described by Haller 
 as " communis Europze prseceptor." For Sydenham 
 no less than for Hippocrates he professed the greatest 
 enthusiasm, but differed from the former in think- 
 ing that medicine could be developed into a science 
 by the equal use of clinical experience and the ad- 
 vancing knowledge of anatomy and physiology. Like 
 Sydenham, however, he laid the greatest stress on 
 observation and clinical investigation. Boerhaave 
 did, indeed, make some attempt to unify conflicting 
 medical systems, but in their confusion he thought 
 the most certain guide to be the history of medicine ; 
 "the light of truth and the guide of life, she alone 
 enables the physician to judge without prejudice of 
 the old and the new." The physical method can 
 only enlighten us as to the material processes of the 
 body, not as to the soul's activity ; for the final 
 metaphysical and first physical causes are undis- 
 
172 RELATION OF MEDICINE TO PHILOSOPHY 
 
 coverable, and have no significance for the medical 
 profession. 
 
 Health he regarded as consisting in the normal 
 action and reaction between the solids and fluids of 
 the body. In disease the vessels may either be re- 
 laxed, giving rise to passive congestions, or constricted 
 so as to produce obstruction and suppression of secre- 
 tions ; while in other cases there may be abnormal 
 acridity of the humours, or their circulation may be 
 impeded by an excessive viscosity.^ Inflammation, 
 he thought, arose from the friction of the arterial blood 
 stagnating either in the arterial endings or in the 
 lymph vessels. Boerhaave felt strongly the necessity 
 of medicine being based upon physiology, but his 
 energies were directed less to founding a system than 
 to arousing and spreading abroad a desire for exact 
 medical investigation. He said that he wished to 
 make good practitioners, not men of learning. 
 
 The beginning of the eighteenth century had out- 
 grown to some extent the philosophical systems of 
 Bacon and Descartes, and their somewhat mechanical 
 views of life were opposed by the celebrated theories 
 of Leibnitz. This illustrious philosopher was born at 
 Leipsic in 1646. In quite early life he became noted 
 for the vast range of his knowledge, and was indeed 
 regarded as a prodigy of learning — pro monstro erat. 
 His was one of those encyclopaedic minds to which 
 nothing comes amiss. Well versed in jurisprudence, 
 he became also famous in mathematics as the dis- 
 
 ' WithingtOD, Medical History, p. 325. 
 
EARLY PART OF EIGHTEENTH CENTURY 173 
 
 coverer of the differential calculus. Unlike Bacon and 
 Descartes, he had a great admiration for Aristotle, and 
 indeed for the ancients generally, of whom his know- 
 ledge was profound. Even the schoolmen, contemned 
 as they were by the founders of modern philosophy, 
 he knew how to appreciate, recognising in their 
 methods a cogent and ingenious logic, though resting 
 on premises unproved and frequently absurd. Like 
 his immediate predecessors, he was convinced that 
 natural processes must be explained mechanically, but 
 in order to act mechanically the things of this world 
 must be conceived as having such an original consti- 
 tution as will make it intelligible how they can act 
 according to certain fixed laws— /.g. the fixed laws 
 must be the essence and very nature of the things 
 themselves. No one understood better than Leib- 
 nitz the difference between the scientific and the 
 philosophical treatment of a subjects He was em- 
 phatic in recommending the reduction of all scientific 
 discussions to definite terms, but he was aware that 
 such definitions suffice only for classifying pheno- 
 mena — they cannot make them intelligible to us. 
 Though entirely in harmony with the masters of 
 modern science as to the right methods of scientific 
 research, he saw that to rest contented with those 
 methods would be to lose that which ancient philo- 
 sophy had established, and which he himself ad- 
 mired in Plato and Aristotle — namely, the ideal and 
 spiritual view of things. Consequently his philo- 
 sophy attempted to reconcile two ways of looking at 
 
174 RELATION OF MEDICINE TO PHILOSOPHY 
 
 things, the ancient and the modern, the theological and 
 the mechanical, the religious and the scientific. He 
 wished to give all possible scope to scientific research, 
 all possible breadth to knowledge, but not less did he 
 wish to give all possible depth and reality to religious 
 belief.i 
 
 His system was therefore, to some extent, a com- 
 promise. He reintroduced into philosophy the idea 
 of Substance which underlies all phenomena ; then 
 he fell in with the old views of the atomists. But the 
 atoms which he regarded as the ultimate basis of all 
 existence were not, like the atoms of Epicurus, phy- 
 sical and extended particles, but they were rather 
 centres of force, and had the powers of self-activity. 
 Leibnitz spoke of them as monads, and endowed them 
 with the depths of an internal life. Though in ex- 
 tension they were simply analogous to mathematical 
 points, their intension was infinite, like that of the 
 human mind. A monad includes within itself its whole 
 past, future, and all Being ; consequently all Being is 
 present in every monad, not really but ideally. Every 
 monad is a concentrated universal, and would therefore 
 lose nothing if all the other monads were destroyed. As 
 in the centre of a circle all the radii come together, 
 so does the monad contain everything or express 
 everything ; each is a living mirror of all Being. The 
 monads therefore differ toto coelo from the material 
 atoms of Democritus and Epicurus ; they should rather 
 be compared with souls, spirits, or even with God.** 
 
 ' Leibniiz, by J. T. Merz. 
 
 ' Erdmann, Gesch, der Philosophie, vol. ii, p. 150. 
 
EARLY PART OF EIGHTEENTH CENTURY 175 
 
 The body of man he regarded as a complex of 
 separate monads, but the soul was a single monad, 
 the substantial centre of man's being. Plants and 
 stones are monads, but in their case the perceptive 
 faculty of the monad is more or less blurred or 
 slumbering. Elements of mysticism and Neo-Pla^ 
 tonism are certainly to be found in the system of 
 Leibnitz. Thus in a letter to Prince Eugene he says 
 that all the simple substances to which he gives the 
 name of monads have emanated from God, as from 
 the primordial unity, and that all the forces of these 
 monads are imitations of the infinite force of the 
 Divinity. In this we may easily recognise the Neo- 
 Platonic system of emanations. 
 
 The body of man is a complex of monads, which 
 it contains as a fish-pond contains fish. The soul 
 does not receive its impressions immediately from 
 the body, but, from the beginning of its existence, 
 it contains within itself all the ideas which ought 
 to develop in time and in a determined order. The 
 soul is, in fact, a spiritual automaton. Its operations 
 are not mechanical, but it contains within itself all 
 that is beautiful in mechanics. 
 
 The old-standing antagonism between faith and 
 reason was not, according to Leibnitz, founded in 
 the nature of things, the essence of which is harmony 
 and order ; thus arose the celebrated doctrine of the 
 pre-established harmony, the soul and body being 
 compared to two clocks wound up to keep exact time 
 with each other. These metaphysical speculations of 
 
176 RELATION OF MEDICINE TO PHILOSOPHY 
 
 Leibnitz did not prevent him from taking an active 
 interest in practical medicine, of which he had the 
 highest opinion, speaking of it as an art " qua nulla 
 est praestantior neque difficilior." He was decided 
 in demanding for medicine an exact method of treat- 
 ment, and he regarded as the surest supports of 
 medicine mathematics, physics, chemistry, and the 
 microscope. He even founded a workshop for 
 making microscopes. He was also anxious for the 
 composition of a contemporary Medical History and 
 for noting down accounts of epidemics, which he 
 thought might be the joint work of many authors, 
 thus anticipating the modern " system of medicine." 
 
 Among the intimate friends of Leibnitz was the 
 celebrated physician Hoffmann, whose name is per- 
 petuated to this day in the British Pharmacopoeia 
 under " spiritus aetheris compositus " or Hoffmann's 
 anodyne. Born at Halle in 1660, Hoffmann early 
 conceived a great passion for mathematics, which he 
 retained throughout his life. In 1684-86 he travelled 
 in France and England, entering into close relation- 
 ship with Robert Boyle. At the age of thirty-four he 
 obtained the chair of Medicine in the University of 
 Halle, where his lectures aroused the 'greatest en- 
 thusiasm. His increasing reputation caused him to 
 be summoned to the Court of Berlin, where he was 
 physician to Frederick I. ; but after three years' stay 
 there he became tired of what he describes as the 
 "splendida miseria" of Court life and returned to 
 Halle, where he remained continuously till his death 
 
EARLY PART OF EIGHTEENTH CENTURY 177 
 
 in 1742. The medical system of Hoffmann was to 
 some extent a revolt from the mechanical schools 
 of medicine ; but his rupture with them was less pro- 
 nounced than that of his famous contemporary Stahl, 
 of whom we shall speak presently. Enjoying the 
 friendship of Leibnitz, he was much influenced by 
 his philosophy, though he did not rise to the abstract 
 height of regarding everything as Force, Conception, 
 and Soul ; nor could he embrace the ideas of spiri- 
 tualism, newly strengthened by the doctrine of monads, 
 so far as to renounce entirely the teachings of the 
 latro-physical school. Hoffmann held that the uni- 
 verse was pervaded by an aether-like vital fluid, which 
 supports all life, fills the juice of plants, &c., appears 
 in all parts of the body, and especially in the blood. 
 From the aether in the brain are developed "the 
 nerve fluid," "the breath," and what the ancients 
 called the " anima vegetativa." In order to set this 
 aether in motion, Hoffmann ascribed to each aether 
 monad an idea of its end, and therefore an in- 
 dependent power of motion, in accordance with the 
 philosophy of Leibnitz.^ Life consists in the continual 
 movement of the heart and arteries ; plants do not 
 live because they have no heart ; but to this one might 
 easily reply that invertebrates have no heart, though 
 it would be impossible to refuse admitting that they 
 had life. If, on the other hand, an internal move- 
 ment is the basis of life, then the earth and sea are 
 alive, for they are subject to the most remarkable 
 
 1 Haeser, Cesckichte der Medizin. 
 
 M 
 
178 RELATION OF MEDICINE TO PHILOSOPHY 
 
 movements. All diseases are caused by faults of 
 movement, which may be too strong or too weak. 
 Excessive motion produces spasms, and too little 
 motion atony ; the former are to be combated by 
 sedative medicines, the latter by tonics. 
 
 Here we see the old "methodical" doctrine of 
 Tone reappearing. But Hoffmann also considered two 
 other sources of disease — namely, altered humours, 
 which were to be met by alteratives ; and deficient 
 excretion, which was to be treated by evacuants. 
 Several diseases he attributed to the planets and 
 constellations, maintaining that the periodicity of 
 diseases depended on the phases of the moon. His 
 credulity is further displayed in that he considered 
 the devil and demons to be capable of producing 
 certain diseases.^ In the way of treatment he was 
 a great believer in dietetics, and tried to cure various 
 sthenic affections by exercise, diet, and cold water. 
 He often recommended wine, and in cases of gout 
 employed large doses of Rhine wine. Hoffmann's 
 system became widely diffused and extremely popu- 
 lar, largely because it was for the most part fairly 
 comprehensible and easily carried out in practice. 
 He was under the impression that medicine might 
 become an exact science, not less susceptible of a 
 logical and geometrical precision than a branch of 
 mathematics. Though he maintained that the human 
 body was a machine, he confessed that mechanism 
 alone could not explain everything, but that a 
 
 ' Kurt S<iiven^e\, Gescliidi/t i/er AfeJi'.tH, sect. xv. ch. 11. 
 
EARLY PART OF EIGHTEENTH CENTURY 179 
 
 " superior principle " is at work which exercises 
 a potent influence over all parts of the body. This 
 principle, which we might hastily be inclined to 
 identify with the soul, does not work with pre- 
 meditation or reflection, like, for instance, the soul 
 of Stahl, but is restrained by fixed and immutable 
 laws. If we inquire the nature of these laws ac- 
 cording to which this strange principle works, we 
 are told that they are the laws of the "higher 
 mechanism," which have not yet been discovered ! 
 This was indeed a sad lapse from the rationalism 
 of Leibnitz. 
 
 Contemporary with Hoffmann, and born in the 
 same year (1660), was his rival, Stahl. After receiving 
 a strictly religious education, Stahl studied at Jena, 
 under Wedel, and then at the request of Hoffmann 
 was summoned to Halle as Professor of Theoretical 
 Medicine. Here, however, he met with but little 
 academic success, and a gradually increasing friction 
 between him and Hoffmann led him to accept the 
 post of Court physician at Berlin in 1716, where 
 he remained till his death in 1734. Like that of 
 Hoffmann, the system of Stahl combated vigorously 
 the tenets of the latro-mechanical school. While 
 more profound in his conceptions than Hoffmann, 
 Stahl was infinitely less practical in applying them to 
 medicine. He was one of those reformers, endowed 
 with a gloomy and melancholic temperament, who 
 expend an excessive amount of energy in abusing 
 their predecessors and contemporaries, and imagine 
 
i8o RELATION OF MEDICINE TO PHILOSOPHY 
 
 their system to possess an extraordinary novelty by 
 the simple expedient of paying no attention to any- 
 body else's work. " Medicine," he said, " is the 
 science of life, and we have now only mechanics and 
 chemists." " Where the physicist ends, the physician 
 begins." In his lectures on medicine he proposed 
 to banish from the medical art the sciences foreign 
 to it — namely, chemistry, physics, and anatomy. He 
 denied that chemistry had any application whatever 
 to vital phenomena ; and as to anatomy, he declared 
 the knowledge of the finer anatomical relations of 
 the body to be for a doctor not only superfluous but 
 harmful. This perhaps is the less surprising when 
 we realise that he attached but sniall Jmpjortance 
 to the bodily side oijiie. He considered that the 
 body as such had no power of movement, but that 
 it had always to be set in motion by immaterial 
 substances. All movement is a spiritual^ action. 
 The cause of the activity of the organised body, 
 which watches over its preservation and the integrity 
 of its compound nature, is an immaterial being 
 which he termed the " soul." This soul is the 
 " nature " of the ancients, which he considers to be 
 proved by its etymology — e.£: ■^w^'? ~ ^'^ffti' ej^wv. To 
 it he attributes all involuntary movements of the 
 body, but he does not allow it either reflexion or the 
 intimate knowledge of its actions. The functions of 
 the soul take place, he says, a ratione (A«75>) not 
 a ratiocinio (Xoytafi^). He failed to perceive that 
 in this conception of the soul it differs in little but 
 
EARLY PART OF EIGHTEENTH CENTURY i8i 
 
 name from the Archeus of Van Helmont. He 
 remarked that we have a number of obscure sensa- 
 tions, and that many of our actions are performed 
 without our having any consciousness of them. These 
 obscure sensations, he suggests, are the shadows of 
 a former consciousness possessed by man before the 
 fall. The endeavour to make the soul direct the 
 movements of the body as a sort of deus ex machina, 
 independent of mechanical laws, was in opposition 
 to the philosophy of Leibnitz, who pointed out that 
 the laws of the body are those of motion, while the 
 laws of the soul are moral laws. The soul, accord- 
 ing to Leibnitz, was non-material and the prime 
 " entelechy " or realisation of the body ; but the body 
 is possessed of a second entelechy, namely, the force 
 of movement. Stahl's answer to this was to give 
 the soul extension and material being, saying that 
 he only expected immortality by divine favour. 
 
 Stahl, as a firm believer in the doctrine of final 
 causes, was much influenced by theological and 
 teleological points of view ; thus he held that the 
 bodily organs live only through and for the soul — they 
 are, in fact, not exactly alive, but inspired with a vital 
 principle. "The life of the body has significance 
 only in so far as it subserves the objects of the soul." 
 While anxious to free medicine from the domination 
 of chemistry and physics, he was yet obliged to make 
 certain concessions to the latro-mechanical school. 
 Thus he adopted the doctrine of Tone — i.e. the general 
 property of organic parts to expand and contract — 
 
1 82 RELATION OF MEDICINE TO PHILOSOPHY 
 
 which was regarded by the latro-physicists as the 
 basis of physiology. 
 
 A special difficulty about Stahl's system was to 
 explain the phenomenon of death ; for if the sub- 
 stance of the body is being continually renewed by 
 the action of a soul which is immortal, there seems 
 no obvious reason why it should not go on for ever. 
 Stahl overcomes this difficulty by saying that the soul 
 leaves the bodily machine either because it has 
 become unworkable through some serious lesion, or 
 because it does not choose to work it any longer ; 
 though he admits that the tendency to putrefaction, 
 which the soul is always endeavouring to avert, 
 increases with age, and may finally become irresist- 
 ible, so that the soul is by no means omnipotent. It 
 does, however, try to preserve the body as long as 
 possible, and most so-called diseases are efforts in 
 this direction. Thus the natural tendency of the 
 blood to putrefy having become increased, the soul 
 perceives this and at once proceeds to counteract it 
 by more rapid circulation and excretion, which give 
 rise to the whole class of fevers, these being efforts, so 
 to speak, on the part of the soul to protect the bodily 
 organism. Consequently animals, not having an in- 
 telligent soul to perceive the approach of dangers, 
 are less subject to febrile diseases ; at the same time 
 they have shorter lives. 
 
 Stahl considered that plethora of blood was one 
 of the most common causes of disease, because 
 man as a rule eats more than is necessary for the 
 
EARLY PART OF EIGHTEENTH CENTURY 183 
 
 adequate nourishment of the body. He attributed 
 gout, haemorrhoids, stone, and melancholy to the 
 slow passage of the blood through the portal 
 vein. 
 
 His therapeutics, as may be supposed, were some- 
 what nihilistic. Believing, as he did, that the soul, 
 in spite of liability to error, knows more about the 
 body than the most skilful physician, the latter could 
 only watch and assist its efforts. Fevers are not to 
 be treated unless we can remove their cause. Hence 
 he rejected quinine. He regarded opium as harmful, 
 for it tends to deprive the soul of its control over the 
 body. Finally, he contented himself with dosing all 
 his patients with salt and water, which could not do 
 much harm, and might help to counteract putrefac- 
 tion.^ In mental diseases he realised the importance 
 of psychic treatment — in fact, he seldom made use of 
 anything else. 
 
 Stahl's system, doubtless, suffered much by contrast 
 with that of his brilliant rival Hoffmann. Like a true 
 pietist, Stahl had a sovereign contempt for learning, 
 which made him expend fruitless energy in attacking 
 theories which he did not understand, and caused him 
 to write in a style at once crabbed and obscure. 
 Hoffmann, gifted with less insight and not attempting 
 to penetrate so deeply into the primordial causes of 
 things, was extremely erudite, and embroidered his 
 copious and easily flowing writings with numerous 
 quotations from non-medical authors, which assisted 
 
 1 Withington, Medical History, pp. 335, 336, 
 
1 84 RELATION OF MEDICINE TO PHILOSOPHY 
 
 in keeping medical speculation in the main stream of 
 philosophic thought. 
 
 In spite of its obscurity and practical inap- 
 plicability, the system of Stahl found numerous 
 followers after his death. Of these some were mere 
 imitators of Stahl, while others lost themselves in 
 mysticism and theosophy. But his teaching would 
 hardly have become so widely diffused had it not 
 been taken up by several distinguished English 
 physicians, and made to harmonise with the English 
 latro-mathematicians. This school, which prided 
 itself on following strictly the laws of Newton and 
 submitting all the mechanical actions of the body 
 to mathematical calculations, realised that everything 
 connected with the body cannot be explained on 
 mathematical principles. Like Newton himself, they 
 found themselves obliged to distinguish between the 
 efficient cause — i.e. the mechanical movements them- 
 selves — and the final cause. Consequently they were 
 ready to welcome some principle of action which was 
 outside and superior to matter. This the " soul " of 
 Stahl easily supplied to them, and being men of 
 learning and capacity, they were able to give to it a 
 firmer psychological basis. 
 
 George Cheyne (1671-1743) was one of the first 
 of this English school to accept the principles of 
 Stahl. He maintained and proved the insufficiency 
 of mechanism for explaining the functions of the 
 body. His writings on the theories of disease were 
 a combination of the doctrines of Newton and Stahl. 
 
EARLY PART OF EIGHTEENTH CENTURY 185 
 
 The powerful influence of Newton's works in all 
 spheres of thought is shown by a book of a friend 
 of Cheyne's, John Craig by name, entitled The 
 Mathematical Principles of Christian Theology.^ 
 
 More celebrated was Richard Mead (1673-1754). 
 Son of a Presbyterian minister in Stepney, who had 
 fled to Holland owing to the religious persecution in 
 the reign of Charles II., he studied first at Leyden, 
 then at Padua, finally settling down to practise in 
 Stepney, becoming physician to St. Thomas's Hospital 
 in 1703 and physician to George II. in 1727. In his 
 practice he followed the tenets of Stahl, while in 
 theory he adopted the latro-mathematical doctrines. 
 For him the most important proof of the supremacy 
 of the soul was the promptitude and certainty with 
 which nature cures the most dangerous illnesses. 
 Like Stahl, he was careful not to suppress a 
 fever, which he regarded as the effort on the 
 part of the soul to combat some more dangerous 
 malady. 
 
 Robert Whytt (1714-66) was another distinguished 
 advocate of Stahl's doctrines, though he very much 
 limited the importance of the soul by ascribing to 
 it sensation rather than reason. He starts from the 
 principle that the motor force of muscles is com- 
 municated to them by the nerves, because the irrita- 
 tion of the latter gives rise to more violent convulsions 
 in the muscles than when they are stimulated directly. 
 The soul is always the prime cause of movement ; it 
 * Haeser, Geschichte der Medhin, vbl. ii. p. 608. 
 
i86 RELATION OF MEDICINE TO PHILOSOPHY 
 
 » 
 
 increases the influence which the nerve fluid exercises 
 on the stimulated muscle. 
 
 In France, ardent defenders of the system were 
 found in Francois Nicholls and in Boissier de 
 Sauvages. The former went so far as to attribute 
 all the changes of the body and all violent actions 
 to the anger of the soul ; the latter speaks of the soul 
 as acting by means of a nerve fluid which is a kind 
 of electric liquid. He also endeavoured to classify 
 diseases from the standpoint of natural history, and 
 the botanical system of Linnaeus served him as a 
 model. In spite of the many distinguished disciples 
 of Stahl whom we have just detailed, opposition to 
 some of his metaphysical conceptions very readily 
 arose, and materialism returned to medicine, taking 
 for its basis the views of Hobbes. 
 
 According to this famous philosopher, substance 
 and body are synonymous words, and all bodies are 
 endowed with a more or less pronounced sensibility. 
 A zealous partisan of these views was Offray de la 
 Mettrie, who endeavoured to prove the material nature 
 of the soul. Man himself he regarded as a machine, 
 which only differed from other bodies in that the 
 material was more ripe. For him soul was a term 
 devoid of sense, and he did not find the slightest 
 difference between the functions and mechanical 
 movements of the body. 
 
 This defender of materialism deserves so little 
 esteem that Voltaire described him as " un fou qui 
 6crivait jamais qu' aprfes avoir 6ga.T6 sa raison dans 
 
EARLY PART OF EIGHTEENTH CENTURY 187 
 
 le vin," He had begun life as a theologian, then 
 betook himself to medicine and studied at Leyden 
 under Boerhaave, but occupied himself more in pro- 
 pagating materialistic views of life than in the practice 
 of medicine. In Haller's doctrine of irritability he 
 found additional proof of the non-existence of the 
 soul, much to the chagrin of its famous author.^ 
 
 The period we have just been considering was 
 hardly a brilliant one in the history of medicine, yet 
 it formed the prelude to the unwearied labours of a 
 Morgagni and a Bichat, which, synchronising as they 
 did with the intellectual ferment that preceded the 
 French Revolution, established medical science upon 
 a secure basis of ascertained facts, thus rendering 
 possible the great discoveries of the nineteenth 
 century. 
 
 It is difficult to appraise aright the influence of 
 Leibnitz upon this period. Undoubtedly it rescued 
 medicine from that purely mechanical view of all 
 vital phenomena which was fast sterilising all further 
 progress. Had his doctrine of monads fallen upon a 
 more favourable soil than that of the gloomy and 
 saturnine Stahl, results might have been different. As 
 it was, Stahl, without fully understanding the philo- 
 sophy of Leibnitz, thought that he had found in " the 
 soul " a principle ready to hand which would explain 
 everything. Consequently anatomy and all detailed 
 study of physics and chemistry became matters of 
 supererogation, and an entirely new system was 
 
 1 Haeser, Geschichte der Medhin, vol. ii. p. 581. 
 
1 88 RELATION OF MEDICINE TO PHILOSOPHY 
 
 heralded forth. We may see in Stahl the natural 
 successor of Paracelsus and Van Helmont, without 
 the grossness and crudity of the former or the 
 imaginative insight of the latter. The general result 
 of his system, as of all systems, was not favourable 
 to medicine ; his speculations lacked the verve and 
 brilliancy of his prototypes, so that, while provoking 
 opposition, they failed to stimulate thought. 
 
CHAPTER XI 
 
 INFLUENCE OF CONTEMPORARY THOUGHT ON MEDI- 
 CINE IN THE SECOND HALF OF THE EIGHTEENTH 
 CENTURY 
 
 Before we consider this period a few words must 
 be given to the great Haller, whose all-embracing 
 genius sets him on a pedestal by himself, some- 
 what apart from the main currents of thought in 
 the eighteenth century. 
 
 This distinguished physician (1708-77) was one 
 of those intellectual giants, like Aristotle, Leibnitz, 
 or Goethe, whose lot it has been to accomplish ex- 
 cellent work in the most diverse fields of activity. 
 As a poet Haller has been regarded as one of the 
 pioneers of that great literary outburst which cul- 
 minated towards the end of the century in the 
 masterpieces of Schiller and Goethe. As a botanist 
 he was among the foremost of the day, being sur- 
 passed only by Linnaeus.^ Even in this region his 
 aims were loftier than those of his illustrious Swedish 
 contemporary, for it was his endeavour to make a 
 natural instead of an artificial classification of plants. 
 For us, however, his interest consists in the new light ' 
 which he threw upon medicine by his researches in 
 
 ' Haeser, Geschickte der Medizin, vol. ii. p. 569. 
 189 
 
igo RELATION OF MEDICINE TO PHILOSOPHY 
 
 physiology. Like Boerhaave, he sought to establish 
 medicine on a new and sound basis, by means of the 
 natural sciences, history, and observation. Being a 
 decided opponent of the latro-physical school, he 
 regarded the application of physics and chemistry 
 to organic processes as thoroughly inadmissible ; to 
 penetrate into the ultimate causes of living processes 
 he held to be quite impossible : " Ins innere der 
 natur dringt kein erschaffner Geist." Like all true 
 reformers of medicine, Haller realised the importance 
 of anatomy, and in the school of Albinus became 
 an excellent dissector, busying himself with the study 
 of the brains of birds and fishes. Gradually, however, 
 his interest in anatomy waned as he became more 
 and more attracted by physiology, which he spoke of 
 as "Anatomia animata." He devised plans for the 
 complete revolution of physiology, but made the mis- 
 take of fixing too rigidly the physiological properties 
 of muscle before knowing its anatomical structure. 
 The basic substance of the animal body, he con- 
 sidered, was gelatine, of which alone the lower 
 animals consist, while the higher have in addition 
 earth, air, and iron. From this mixture arise the 
 fundamental forms of all animal changes, namely, 
 " the fibres " ; these in turn consist of small invisible 
 structures, which can only be seen by the eye of the 
 mind — "invisibilis ea fibra quam sola mentis acie 
 attingimus." But the fame of Haller as a physiologist 
 rests on his discovery of the irritability of muscle, 
 which he regarded as exclusively the property of 
 
SECOND HALF OF EIGHTEENTH CENTURY 191 
 
 muscle, while sensation was purely the property of 
 nerves. This muscular irritability is, doubtless, 
 nothing more than contractility, and he thought 
 that this power resided specially in the gelatine. 
 He did not realise that nerves also are irritable, but, 
 unlike muscles, they do not manifest this irritability 
 by contracting, but by transmitting along themselves, 
 without any visible change of form, certain molecular 
 changes which we call nervous impulses. 
 
 The phenomena thus ascribed by Haller to irri- 
 tability were regarded by Stahl and his school as 
 due to the streaming in of vital spirits into the 
 muscle fibres. This irritability is best developed in 
 the organs which immediately subserve the support 
 of liie—e.£: the heart, diaphragm, intestines, and 
 muscles of the blood-vessels ; of these the inner 
 surface of the heart is specially irritable. The 
 voluntary muscles, on the other hand, are only 
 roused into motion by the activity of the soul. 
 
 The most violent attacks on the teaching of Haller 
 came from the practising doctors, who relied upon 
 their observation of the great irritability of inflamed 
 mucous and serous membranes. At the head of these 
 opponents was Anton de Haen ; but he made no 
 effort to confute Haller's numerous and carefully 
 made experiments, appealing merely to clinical ex- 
 perience and traditional opinion; in fact, Haller's 
 opponents did not think of repeating his experiments, 
 which to the modern mind would have been the most 
 obvious way to convict him of error. 
 
192 RELATION OF MEDICINE TO PHILOSOPHY 
 
 Robert Whytt of Edinburgh wrote in opposition 
 to this new doctrine. For him, the fact that frogs 
 when decapitated showed signs of consciousness, 
 and jumped about in a purposive manner, was a 
 clear proof of the omnipresence of the soul. In the 
 contraction of a muscle, when stimulated, he saw 
 an arrangement of the soul for ridding itself of an 
 oppressive stimulus. But in spite of all opposition 
 Haller's theories gradually triumphed, and the method 
 of experiment which he had employed for the pur- 
 pose of demonstrating them was at length recog- 
 nised as the only means of creating a really scientific 
 physiology. 
 
 The latter half of the eighteenth century will be ever 
 memorable for the extraordinary intellectual ferment 
 in France, which culminated in the great Revolution. 
 For the first time in the history of the world, men 
 made a deliberate effort to break absolutely once 
 for all with their past traditions and historical con- 
 tinuity. The whole existing fabric of society had been 
 undermined by the scoffing sarcasms of Voltaire and 
 the burning indignation of Rousseau. A stupendous 
 effort was made to go back to first principles and 
 to reconstruct society afresh on a basis of reason. 
 The French Revolution is a striking instance of the 
 a priori method run mad. Take, for instance, the 
 famous opening sentence of Rousseau's Contrat 
 Social, "Man was born free, but is everywhere in 
 chains," which sent a thrill of enthusiasm through 
 Europe. Could any proposition be more absurdly 
 
SECOND HALF OF EIGHTEENTH CENTURY 193 
 
 untrue? But in those days of excitement nobody 
 stayed to examine premises. The rigid uncom- 
 promising logic which characterised the devotees 
 of the goddess of Reason, with their ready-made for- 
 mulas and cut-and-dried Constitutions, was naturally 
 impatient of the dualism of sensibility and irritability 
 which had been introduced by Haller, and sought 
 rather for some simple unifying principle in medicine. 
 This desire found satisfaction for itself in the system- 
 of the Scotch physician Brown, which we must there- 
 fore spend some time in considering. 
 
 Brown (1735-88) was born at Preston in Berwick- 
 shire of poor parents, but as so often has happened 
 in Scotland, he received a good education. At first 
 his stepfather intended to make him follow his own 
 trade, which was that of weaving, but his superior 
 abilities destined him for the ministry of a dissenting 
 Presbyterian sect. While studying for this purpose 
 at Edinburgh he attended lectures on medicine, and 
 became a sort of private tutor to medical students, 
 and in 1761 was made a member of the Royal Medical 
 Society. At first he enjoyed the friendship of Cullen, 
 then at the head of the medical profession in Edin- 
 burgh, who employed him to teach his children and 
 to go over his lectures with the students. By degrees, 
 however, it became apparent that Brown, so far from 
 believing in the doctrines of Cullen, was actively 
 opposed to them, so that their earlier friendship was 
 changed into enmity, and Brown traced all his future 
 misfortunes to the malevolent machinations of Cullen. 
 
 N 
 
194 RELATION OF MEDICINE TO PHILOSOPHY 
 
 Not till the age of forty-four did he obtain a medical 
 degree, and then only at the small University . of 
 St. Andrews. Finally he abandoned Edinburgh for 
 London, where he found himself obliged to go to 
 prison for a debt of ;^25o. He is said to have been 
 offered a post at the court of Berlin, and also one 
 at the University of Pavia ; but both fell through, 
 owing, in his opinion, to the intrigues of his enemies. 
 He died a few years later in 1788. 
 
 Few medical systems have ever been so simple and 
 easy of comprehension as that of Brown. According 
 to his theory, the animal body possesses a property 
 called " excitability," which, when acted on by stimuli, 
 gives rise to excitement or, in other words, to life. 
 Moderate excitement is equivalent to health ; too 
 much or too little is disease, which has to be treated 
 by regulating the stimuli. Excitability is a mysterious 
 something possessed by all living beings, which is 
 continually being used up and renewed during life, 
 and which varies inversely with the stimulus. Death 
 occurs when the stimulus sinks below a certain level, 
 or when it is so violent as to exhaust the excitability .1 
 The seat of this excitability is in the nerves and 
 muscles, which together are understood as the 
 nervous system. Since everything depends upon 
 irritability and excitability, knowledge of the structure 
 and functions of the organism has only a subordinate 
 significance ; anatomy, therefore, as we have seen 
 in the case of other system makers, falls into the 
 
 1 Withington, History of Medicine from the Earliest Times, p. 346, 
 
SECOND HALF OF EIGHTEENTH CENTURY 195 
 
 background. Every organism possesses an inborn 
 quantity of excitability, which Brown speaks of as 
 a power of nature ; he had, however, no belief in 
 the healing power of nature. The great charm of 
 the system was its simplicity and practical appli- 
 cability. Thus all diseases are divided into sthenic 
 and asthenic ; the sthenic diseases are cured by 
 asthenic means, and vice versa — that is to say, nega- 
 tive stimuli must be applied for the cure of sthenic 
 diseases, and positive stimuli for the cure of asthenic. 
 This system, based on a few unproved hypotheses, 
 was made to embrace all problems either of health 
 or disease. 
 
 Brown was a man of rigid mental temper, making 
 no concessions to any one, whether friends, protec- 
 tors, or masters ; as may be readily surmised, he was 
 in revolt against everybody, and had a fine contempt 
 for the medicine of his day. Thus he says : " The 
 reader will see to what a pitch of simplicity I have 
 brought medicine, which was previously a congeries 
 of hypotheses, incoherences, and errors, a science 
 mysterious and enigmatic ; health and disease are the 
 same condition depending on the same cause ; the 
 search after causes is the serpent of philosophy." In 
 consequence perhaps of his uncompromising per- 
 sonality, Brown was not a prophet in his own 
 country ; neither in Scotland nor in England did his 
 system find much vogue. On the other hand, his 
 doctrines found ready credence in America, owing 
 to the influence of Benjamin Rush (1745-1813), pro- 
 
196 RELATION OF MEDICINE TO PHILOSOPHY 
 
 fessor at Philadelphia, who was much impressed by 
 the favourable results obtained in the application of 
 Brown's system to the treatment of an epidemic of 
 yellow fever. In France the disciples of Brown 
 brought his treatise on the elements of medicine to the 
 notice of the National Convention, who received it 
 favourably. On the Continent generally it may be said 
 that he enjoyed great popularity ; thus his therapeutic 
 methods were introduced into the Austrian army, and 
 in Gottingen so much excitement prevailed about this 
 new teaching as to cause fights among the students 
 which involved the calling out of the military. It has 
 been pointed out by Haeser that in Germany Brown's 
 teaching of excitability and asthenia was readily 
 connected with the sentimental school of literature, 
 which had at that time so great an influence over the 
 upper classes, that the whole of society threatened 
 " to dissolve into sensations and feelings." ^ 
 
 Of the same mental temper, less well known though 
 more scientific than Brown, was the French physician 
 Broussais (1772-1838). As a veritable child of the 
 Revolution all traditional medicine appeared to him 
 worthless, and the various forms of disease described 
 in the schools were for him purely imaginary entities, 
 while the therapeutics seemed actively baneful. " Life 
 is maintained solely by stimuli from the external world, 
 and disease is nothing more than a modification of 
 physiological conditions by abnormal stimuli or de- 
 ficient stimuli." From Brown, however, he differed 
 1 Haeser, Gischichtt der Medhin, vol. ii, p. 760, 
 
SECOND HALF OF EIGHTEENTH CENTURY 197 
 
 in maintaining that nearly all diseases were first 
 local in origin and then gradually spread them- 
 selves over the whole body; this he even believed 
 to be true of fevers, and, in fact, considered that 
 a very large number of morbid conditions were 
 due to a gastro^enteritis, very much as we nowa- 
 days attribute innumerable symptoms to auto-in- 
 toxication. Broussais was as much enamoured of 
 systems as Brown, but his criticism of the latter is 
 severe, saying that when the Scotch physician speaks 
 of excitability, force, and weakness as if they were 
 things perceptible to the senses, with a separate 
 existence of their own, his general propositions have 
 ceased to be reducible to facts. Broussais tried to 
 prove from clinical observation that the same causes 
 may produce sthenic and asthenic diseases. He was 
 certainly less unscientific than Brown, as he main- 
 tained that each separate tissue had its own particular 
 morbid manifestation ; and in the study of disease 
 he made use of pathological anatomy, endeavouring 
 to envisage the lesions in relation to their morbid 
 symptoms. In his later years he became an enthu- 
 siastic believer in phrenology, because he found that 
 it harmonised with his theories of the localisation 
 of disease. 
 
 His therapeutics consisted in leeching the affected 
 part, poultices and mucilaginous drinks to counteract 
 the "irritation," and especially the gastro-enteritis. 
 The result of this treatment is shown by the fact 
 that the wards of the Val de GrUce military hospital 
 
198 RELATION OF MEDICINE TO PHILOSOPHY 
 
 at Paris, of which he was the head, possessed the 
 highest mortality. His use of leeching was indeed 
 generous ; without counting them, it was his custom 
 simply to turn a jar full of leeches on to the affected 
 part, and in a single year (1819) as many as 100,000 
 leeches were used in his wards, and the importation 
 of leeches into France in the year 1827 is said to have 
 reached 33,000,000.^ 
 
 The latter half of the eighteenth century was 
 characterised by as great a revolution in the world 
 of thought as was the French upheaval in the 
 realm of politics. Heine has somewhere humorously 
 compared such very unlike figures as Kant and 
 Robespierre,'' yet each of them stands for a remark- 
 able change in the world of thought and of action. 
 Kant has indeed compared himself to Copernicus, 
 feeling as he did that he was making in philosophy 
 a change analogous to that of Copernicus in natural 
 science. Kant had directed his attention to con- 
 sidering the validity of the very thinking process itself, 
 and had come to the conclusion that our knowledge 
 can only be of phenomena. Our minds being con- 
 ditioned by the categories of the understanding and 
 the forms of time and space, which are prior to all 
 experience, can only gather knowledge which is 
 
 ' Haeser, Geschichte der Medizin, vol. ii. p. 884. 
 
 ^ " Both presented in the highest degree the true type of the narrow- 
 minded citizen. Nature had destined them for weighing coffee and sugar, 
 but fate decided that they should weigh other things ; and into the scales 
 of one it laid a king, into the scales of the other a god , . . and they both 
 gave correct weight ! " — Heine, 
 
SECOND HALF OF EIGHTEENTH CENTURY 199 
 
 clothed in these categories and dependent on these 
 forms ; they cannot penetrate to the sources of 
 ultimate being ; they can never know " things in 
 themselves," the " Ding an Sich " or Noumenon. 
 Hence arose the opposition between Thought and 
 Reality. Knowledge being then united to phenomena, 
 it might not unnaturally be supposed that science in 
 general, and medicine in particular, would be with- 
 drawn from all futile and vain speculations about 
 things in themselves. It is quite possible that this 
 may have been the ultimate effect of the Kantian 
 philosophy upon medicine ; but the immediate result 
 was to give an extraordinary stimulus to the pursuit 
 of the " Ding an Sich," as shown in the philosophical 
 systems of Schelling and Fichte. Apart from this, 
 however, the enormous interest given to metaphysics 
 by the publication of the Critique of the Pure Reason 
 made it advisable for any system of medicine to put 
 on a philosophic dress. Such an attire was con- 
 spicuously absent from the medical system of Brown, 
 so that in Germany, where it became so popular, it 
 had to be clothed in the fashion of the day. This 
 task devolved upon Roschlaub of Bamberg (1768- 
 1835). His work may be regarded as a philosophic 
 introduction to general pathology; but he was 
 possessed by the erroneous notion that scholastic 
 philosophy exercised an almost unlimited dominion 
 over medicine. In order to defend the distinc- 
 tion established by Brown between internal and 
 external diseases, local and general ones, Roschlaub 
 
200 RELATION OF MEDICINE TO PHILOSOPHY 
 
 maintained that the organism is indeed a condition 
 of life, but only an external condition, that the internal 
 one is the vital principle itself. He regarded the 
 " excitability " of Brown as the primal unity and as 
 the general cause of the phenomena of life, thus 
 apparently making it analogous to the " Ding an Sich," 
 and so satisfying the conditions of the critical philo- 
 sophy. Roschlaub fell into mysticism, theosophy, 
 and the subtleties of Paracelsus, which, however, he 
 renounced in his later years.^ 
 
 Kant himself, in addition to his fame as a meta- 
 physician, was well abreast of the scientific thought 
 of his age, and had published several treatises on 
 scientific subjects before the appearance of the Critique 
 of the Pure Reason. He was fond of conversing about 
 medical subjects and the new doctrine of vaccination 
 promulgated by Jenner towards the end of the century, 
 and had quite definite views on medical practice ; 
 he did not, however, make any contributions to 
 medical speculations, but was much interested in 
 Brown's system. More direct than the influence 
 of Kant upon medicine was that of Schelling. This 
 distinguished thinker (i 775-1 854) was Professor of 
 Philosophy at Jena, Erlangen, Munich, and Berlin, 
 and originated a metaphysical system in close re- 
 lationship with natural science and medicine. Schel- 
 ling did not accept the dualism of Kant, which made 
 a sharp distinction between the realms of Phenomena 
 and Noumena ; for him a knowledge of the " Ding an 
 ' Haeser, Geschichte der Medizin, vol. ii. p. 765. 
 
SECOND HALF OF EIGHTEENTH CENTURY 201 
 
 Sich " was not impossible. Thus he says : " In all of 
 us dwells a secret wonderful power, that of retiring 
 out of the changes of time into our own innermost 
 selves, freed from everything that comes from out- 
 side, there to behold the Eternal under the form of 
 immutability. Such intuition is the innermost and 
 most real experience on which all depends that we 
 know and believe of a spiritual world." ^ For the 
 subjective idealism of Kant he substituted an objective 
 idealism in which nature is seen to be slumbering or 
 petrified intelligence; the ego is everjrthing, because. 
 ever5rthing is the Ego. He showed that the whole 
 of nature may be regarded as an embodiment of a 
 process by which spirit tends to rise to consciousness 
 of itself. Because of this affinity which nature has 
 with spirit, Schelling thought that it would be possible 
 to say what nature is, prior to empirical research, 
 and he therefore tried to explain nature by a logical 
 manipulation of such opposites as the Self and Not- 
 Self, attraction and repulsion, together with such 
 principles as polarity, excitability, light, &c. He Jield 
 that it was only the imagination and reflecting under- 
 standing which causes us to separate things, or to 
 conceive of them separately ; Reason beholds all 
 things in their totality or oneness ; the Absolute is 
 not only the unity of all contradiction, but the unity 
 of unity, and itself unendingness. Schelling's specu- 
 lations extended over a wide field of science ; thus 
 with regard to light, he came near to the Undulatory 
 
 ' Schelling's Works, vol. i. p. 318. 
 
202 RELATION OF MEDICINE TO PHILOSOPHY 
 
 theory of Euler, as opposed to the Emanation theory, 
 which was then in vogue. In electricity he tried to 
 unite Franklin and Symmer. With regard to medicine, 
 he opposed the latro-chemical school, and also the 
 idea of a specific vital power ; life consists rather in 
 the fact of the chemical process being prevented 
 froi^i coming to a standstill, while diseases owed 
 their origin to the negative condition of life. His 
 interest in medicine led him, in conjunction with 
 Marcus, to edit annuals about medicine as a science.' 
 To estimate in a few words the influence of Schelling 
 upon our art would indeed be a difficult task. All 
 attempts, however, to construct nature a priori must 
 have a prejudicial effect upon medicine, as tending 
 to draw men's minds away from searching out the 
 truths of nature by way of observation and experi- 
 ment. On the other hand, Schelling's system was 
 highly intellectual, and quite unfavourable to a careless 
 dilettantism ; by his spiritual conceptions of nature he 
 helped to raise all science, and medicine along with 
 it, on to a higher platform. It was this philosophy 
 of Schelling which stirred the two greatest of German 
 poets to busy themselves with science ; thus Schiller, 
 the army surgeon, took for his doctor's thesis the 
 most profound medical problem, namely, " The Philo- 
 sophy of Physiology." Goethe busied himself in his 
 later years very largely with science, and his dis- 
 coveries in anatomy, botany, and physics are too 
 well known to dwell upon here. The great point 
 1 Erdmann, Geschichtt dtr Philosophies vol. ii. pp. 473, 474. 
 
SECOND HALF OF EIGHTEENTH CENTURV 203 
 
 to realise is that medicine was caught up in this 
 general philosophical and poetical idealism, which, 
 synchronising as it did with the mighty effort to 
 reanimate the fallen fortunes of Germany, marks the 
 zenith of that nation's intellectual and moral revival. 
 More particularly we may recognise the influence 
 of Schelling in Kielmeyer (1765-1844), first professor 
 at Carlsruhe and then at Tubingen. He came to 
 the conclusion that the various classes of the animal 
 kingdom are gradual realisations of a common basic 
 idea ; he took an important part in the study of com- 
 parative anatomy, which became famous through 
 the labours of Cuvier. 
 
 Oken (1779-1851) was another distinguished dis- 
 ciple of Schelling. At first he appears quite mystical : 
 "Water is the earthly light," the separated earthly 
 God. Next he followed the doctrine of the all unity 
 of nature and the law of the development of the higher 
 from the lower, specially in the province of zoology. 
 The particular forms of animal life he describes as 
 the limbs of a great ideal whole, and the entire animal 
 kingdom he regarded as man laid out in his separate 
 limbs. In his writings also are to be found the germ 
 of the Cell theory. As early as 1805 he described the 
 elements of organic bodies as vesicles (Blaschen). 
 Many of the followers of Schelling, however, fell into 
 the most unbridled fancies, indulging in empty plays on 
 words and ingenious analogies in proportion as they 
 were wanting in positive knowledge. In particular 
 they made great use of the expression "polarity," 
 
204 RELATION OF MEDICINE TO PHILOSOPHY 
 
 in which they saw every phenomenon and relation 
 of life. Thus they spoke of the polar opposition 
 between the head and lower parts of the body, the 
 brain and the solar plexus, the arteries and veins, the 
 processes of nutrition and secretion, and positive and 
 negative diseases. This doctrine of polarity induced 
 many of these " nature philosophers " to devote them- 
 selves to animal magnetism.' The immediate effect 
 of endeavouring to construct the world according to 
 the laws of human thought has been thus described 
 by Hamann : " Natural philosophy, in consequence of 
 an excessive impulse towards systematic production, 
 passed from a general knowledge of the possible to a 
 general ignorance of the actual." It must not, how- 
 ever, be forgotten that for medicine it was a great 
 advantage to be regarded in its theoretical aspect as 
 a part of natural science, and in its practical aspect 
 as a science subserving the ideal aims of mankind. 
 The reaction which followed on this transcendental 
 standpoint caused a separation between the philoso- 
 phers and men of natural science, though the best of 
 the latter have recognised the truth of Schelling's 
 saying, "Where one seeks to know the objects of 
 nature in their isolation, there one sees wide tracts of 
 science going to waste, heaping up grains of sand in 
 order to construct an universe." Before we take 
 leave of Schelling we ought to mention Schonlein 
 ( 1 793-1 864), who must be regarded as one of the 
 followers of the philosopher ; but he also possessed 
 
 ' Haeser, Geschichte der Medizin, vol. ii. p. 820. 
 
SECOND HALF OF EIGHTEENTH CENTURY 205 
 
 the merit of introducing into Germany the more 
 exact methods of clinical investigation which obtained 
 in France and England. His great aim was to elevate 
 medicine to the rank of an exact science, after the 
 pattern and method of natural philosophy. "Medi- 
 cine can only make true progress when the whole of 
 physics, chemistry, and all natural sciences are ap- 
 plied to it, and it is in complete harmony with the 
 brilliant advances made by these sciences." The 
 pupils of Schonlein called his method "the Natural 
 History school." He laid the foundations of a 
 thorough clinical instruction, based upon the most 
 elaborate investigation of the diseased condition, by 
 means of every aid which could be drawn from 
 physical, microscopical, chemical, and pathological 
 diagnosis. He was also among the few physicians 
 who recognised the full importance of the history of 
 medicine, especially with regard to epidemics. The 
 followers of Schonlein still maintained a close con- 
 nection with the Natural Philosophy school of Schel- 
 ling. Thus diseases were regarded as independent 
 organic processes and analogous to lower normal 
 organisms. This belief was based on the evils caused 
 by Entozoa, Epizoa, and Epiphytes. Stark, the prin- 
 cipal defender of this doctrine, described disease as a 
 parasite developing itself upon the sound organism, 
 which then obeyed special laws of its own. The 
 most extreme form of these doctrines was to be found 
 in the writings of Richard Hoffmann, professor at 
 Wiirzburg, who regarded diseases as reversions of the 
 
2o6 RELATION OF MEDICINE TO PHILOSOPHY 
 
 human to lower normal stages of animal life ; thus 
 the scrofulous represented the sinking down- of the 
 human organism to the level of insects, rachitis 
 meant a descent to the level of molluscs, and epilepsy 
 to that of the Oscillaria, &c. Fantastic as many of 
 these ideas emanating from the school of Natural 
 History must seem to us, they did, however, exercise 
 a powerful influence in bringing about a more exact 
 method of clinical investigation. Then again, in con- 
 tradistinction to the principle of localisation of disease, 
 which, owing to the study of pathological anatomy, 
 was in danger of being over-estimated, the school of 
 Natural History drew attention to the general rela- 
 tionship of the most important diseases, and by its 
 renewal of interest in the history of medicine and of 
 special diseases, gave to medicine a wider and more 
 philosophic outlook. 
 
CHAPTER XII 
 
 INFLUENCE OF CONTEMPORARY THOUGHT ON 
 MEDICINE IN THE NINETEENTH CENTURY 
 
 The past century has brought with it the greatest 
 development of scientific research which the world 
 has ever seen, and with it the attempt to regard 
 medicine as an organic whole has been definitely 
 abandoned. The old idea of finding some key which 
 was to unlock the secrets of all imaginable diseases 
 has been given up, and no serious person considers 
 the possibility of forming a system of medicine in the 
 ancient sense of tliat expression. The last attempt in 
 this direction, which began in the eighteenth century 
 and carries on a chequered existence to the present 
 day, deserves, however, a brief notice. 
 
 The founder of Homoeopathy was born in an 
 age when men still believed that it was possible for 
 medicine to be taken by storm and an entirely new 
 system evolved, much as the French revolutionists 
 imagined that by an absolute break with the past and 
 a few strokes of the pen the whole organisation of 
 society could be regenerated. We have seen how 
 the love of system at this epoch obtained for the 
 doctrines of Brown a great popularity on the con- 
 tinent of Europe ; but the theories of Hahnemann, 
 
2o8 RELATION OF MEDICINE TO PHILOSOPHY 
 
 though less profound than those of Brown, were 
 destined to become far more famous. 
 
 Hahnemann, the son of a painter on china, was 
 born at Meissen in Saxony in 1755. He took his 
 doctor's degree at the University of Eriangen, and 
 then wandered about from town to town in search 
 of a suitable practice, till he finally settled at Leipsic. 
 For many years, he tells us, he refrained from treat- 
 ing the sick, owing to his doubts about the truth of 
 medicine. At last he made his well-known experi- 
 ment with quinine, in which he observed that that 
 drug, which was usefully employed for the cure 
 of ague itself, produced some of the symptoms of 
 ague when taken by a healthy person. Hence he 
 came upon his doctrine of the treatment of disease 
 known to fame as "Similia similibus curantur." It 
 is, however, a mistake to suppose that this idea was 
 a new one, for it was known to Hippocrates, who 
 recommended mandrake as a cure for mania ; and 
 the old legend of the spear of Achilles, which 
 heals the wounds it had itself inflicted, shows how 
 ancient is the belief in the doctrine of similars. Basil 
 Valentine also declared that disease might be likened 
 to a poison which may be either driven out by con- 
 traries or drawn out by similars, and the latter is by 
 far the best method and causes least disturbance.^ 
 But to Hahnemann belongs the credit, if there be 
 any, of erecting this idea into an elaborate principle 
 which should embrace the whole therapeutic side 
 ' Withington, Medical History, p. 267, 
 
MEDICINE IN THE NINETEENTH CENTURY 209 
 
 of medicine, all other aspects of the medical art 
 being entirely disregarded. Following the stereotyped 
 course of all reformers in every department of life, 
 Hahnemann began with the wholesale abuse of his 
 predecessors and a general contempt for all existing 
 medical theories and practice. The supreme import- 
 ance in medicine of searching out the causes of 
 disease was totally unrecognised by him — in fact, he 
 regarded the study of the causes of disease as utterly 
 futile and absurd. For, in his opinion, the health of 
 man is maintained by a purely spiritual vital power ; 
 disease depends on a discord in this vital power. 
 Hence the immediate cause of disease is of a dynamic 
 nature and is not to be comprehended by the senses. 
 Naturally, therefore, he neglected pathological ana- 
 tomy, which at that time was making great strides 
 under the inspiring genius of Bichat. Symptoms, and 
 symptoms only, were all that he considered worthy 
 of attention in the matter of disease. The division 
 of diseases into local and general, feverish and the 
 reverse, he considered absolutely untenable, for he 
 maintained that every disease was general. Hence 
 the local treatment of local ills with poultices and 
 external applications was superfluous or even harmful, 
 since the removal of the local evil renders a judgment 
 of the general underlying condition impossible, and 
 often raises the same to a dangerous height.. 
 
 There are points in the system of Hahnemann 
 which show him to be the lineal successor of Para- 
 celsus. The latter, as we have seen in a former 
 
 o 
 
210 RELATION OF MEDICINE TO PHILOSOPHY 
 
 chapter, believed in the curative powers of spiritual 
 entities immanent in the human body. Hahnemann 
 thought of these spiritual powers as existing not in 
 the body but in the drugs themselves ; for him medi- 
 cines were not dead substances in the ordinary sense 
 — rather was their true Being dynamically spiritual. 
 "All drugs contain dynamic spiritual powers, which 
 are awakened and brought to life, not by chemistry 
 but by dynamisation, a process unknown before my 
 time, and consisting in rubbing the dry substances 
 in a mortar and shaking the fluids — ^which is a kind 
 of rubbing. This rubbing sets free the more deeply 
 situated medical powers, which can then act upon 
 our life in an almost spiritual manner, and so cure 
 diseases ; for diseases are solely spiritual derangements 
 of the spiritual vital force which animates the human 
 body." Here, in this fond belief that by certain 
 external material manipulations of drugs, usually in 
 the way of extreme dilution, some super-sensuous 
 power is set free of wondrous therapeutic efficacy, 
 stands revealed that element of_m^ticism which is 
 at once the strength and weakness of homoeopathy. 
 For it appealed powerfully to the popular uneducated 
 mind, ever ready to believe in the fanciful and mar- 
 vellous, especially in the realm of medicine, and 
 which, clouded and trammelled by the world of the 
 senses, is unable to travel out of the sphere of time 
 and space to the region of Noumenal Being, in which 
 the true mystic lives and moves, but with a certain 
 intellectual coarseness accepts ideas as spiritual which 
 
MEDICINE IN THE NINETEENTH CENTURY 211 
 
 are really only a refined form of materialism. Such 
 a crude form of mysticism, however, clearly belongs 
 to the world of phenomena, and must therefore, if it 
 is to maintain itself, be based upon observation and 
 experiment. 
 
 Health, according to Hahnemann, is the work of 
 the " autocracy of nature," which he describes either 
 as possessed of mind or as undeveloped and without 
 understanding, according to the exigencies of the 
 argument. Though powerless against the original 
 disease, yet it is capable, by increased energy, of 
 removing the disease caused by the medicines, al- 
 though this latter is more powerful than the original 
 disease.^ A favourite saying of Hahnemann's was 
 that ancient medicine never cured any disease. As 
 there were obvious exceptions to this paradoxical 
 statement, he asserted that in such cases homoeo- 
 pathy had been employed by accident ; but he failed 
 to see how this confession entirely invalidated his 
 other assertion, that medicines only developed the 
 healing properties when they had been " raised to a 
 higher power," i.e. by an excessive dilution. 
 
 Homoeopathy resembled the system of Brown, in 
 that both laid the greatest stress on the symptoms 
 of disease, only Brown studied them in order to 
 arrive at a judgment as to the degree of excitability 
 of the organism, whereas Hahnemann rejected every 
 attempt at comprehending a connection of symptoms 
 with an underlying cause. Brown's system was 
 
 ' Haeser, Gesckichte der Medizin, vol. ii. p. 798. 
 
212 RELATION OF MEDICINE TO PHILOSOPHY 
 
 founded on an undeniable truth, namely, the doctrine 
 of irritability ; but it is only absolute caprice which 
 maintains the principle that diseases can only be 
 healed with such remedies as produce similar symp- 
 toms in the healthy. The system of Hahnemann, 
 however, became far the more popular. It repre- 
 sented a reaction against the heroic measures of 
 Brown and Rasori, and was certainly infinitely less 
 dangerous ; for its treatment was so mild as to amount 
 almost to therapeutic nihilism, and many physicians 
 considered that its apparent success was due to the 
 discontinuance of bleeding, excessive purgatives, and 
 all violent measures, and the recommendation of a 
 simple, non-irritating, and non-medicinal diet. In 
 further explanation of the success of homoeopathy 
 it has been said that its zenith coincided with a time 
 when medicine in Germany was in a most unsatis- 
 factory state, so that the complaints of Hahnemann 
 and his followers against it do not seem so wholly 
 unreasonable. Hahnemann, apart from his peculiar 
 theories, was a great advocate of hygiene, and in his 
 book. The Friend of Health, appears to have been 
 far in advance of his time as regards preventive 
 medicine. In his treatment of the insane, too, he 
 seems to some extent to have anticipated Pinel. 
 
 Medical thought having once been started on this 
 line of pseudo-mysticism, there were not wanting 
 followers to push Hahnemann's theory to the farthest 
 extreme. Among these, perhaps the best known is 
 Rademacher (1772-1850). Born at Hamm in West- 
 
MEDICINE IN THE NINETEENTH CENTURY 213 
 
 phalia, he studied under Hufeland in Jena and Berlin. 
 His was an entirely natural, pure, and noble char- 
 acter ; he regarded the practice of the medical art 
 as a religious duty, and he pursued it with untiring 
 industry and loyalty. His doctrine was an attempt 
 to call into life again the teachings of Paracelsus as 
 to the Arcana. With Paracelsus and Hahnemann he 
 shared the desire for specific remedies, considering 
 that the salvation of medicine was to be based on the 
 foundation of therapeutics as an independent science, 
 diagnosis resting solely on the success of the remedies 
 employed. He had no belief in the Vis medicatrix 
 naturce, and the expectant method of treatment he 
 regarded as almost immoral.^ He made use of three 
 chief remedies — namely, nitrate of sodium, copper, 
 and iron — which he said corresponded and gave title 
 to the three primary diseases ; and though the diseases 
 were unknown to him, they were to be cured by these 
 remedies. 
 
 We have now reached the period of scientific 
 medicine for which the nineteenth century will be for 
 ever famous, as greater progress has been made in 
 medicine during the past century than in the whole 
 previous history of the world. Three main causes 
 have been responsible for this remarkable result. (I.) 
 The systematic study of pathological anatomy which 
 had been begun by the brilliant investigations of 
 Morgagni, revivified during the short and meteoric 
 career of Bichat, and finally established on a firm 
 * Haeser, Geschichte der Medizin, p. 804. 
 
214 RELATION OF MEDICINE TO PHILOSOPHY 
 
 basis by Rokitansky and the school of Vienna, which 
 regards the history of the development of morbid 
 processes as the most important task of pathological 
 anatomy. (II.) The foundation of physical diagnosis. 
 So large a part do percussion and auscultation play 
 in the activities of the modern physician, that it is 
 hard to realise that a century ago these important 
 aids to diagnosis scarcely existed. True indeed that 
 percussion had been known to Auenbrugger in the 
 middle of the eighteenth century ; but this remarkable 
 discovery, in spite of the favour bestowed upon it by 
 the great Haller, fell upon stony ground, and only 
 became fruitful early in the nineteenth century 
 through the influence of Corvisart. Laennec's dis- 
 covery of auscultation (1819) opened up a still wider 
 field for diagnosis, increasing enormously the scientific 
 basis of medicine. Then, too, came the use of the 
 clinical thermometer. Though not unknown to 
 Boerhaave and studied by his pupils Van Swieten and 
 de Haen, it was not till 1850 that it came into general 
 medical practice, owing to the influence of Traube 
 and Barensprung. In still more recent times the 
 medical armamentarium has been enriched by the 
 invention of the ophthalmoscope and laryngoscope, 
 which have so powerfully developed our knowledge 
 of the diseases of the eye and throat. (HI.) The 
 immense advances made during the nineteenth cen- 
 tury in the sciences of biology and chemistry, the 
 doctrine of evolution, the discoveries of Pasteur and 
 the brilliant application of them by Lister, into the 
 
MEDICINE IN THE NINETEENTH CENTURY 215 
 
 discussion of which we cannot now enter, have given 
 us almost new conceptions of disease. 
 
 The past century has been one of reaction against 
 the idealism of the preceding age, placing the in- 
 dividual rather than the idea in the foreground, and 
 the mutual influence of medicine and philosophy is 
 now less conspicuous than formerly. The process of 
 differentiation which we spoke of in our first chapter 
 has been continuing almost in geometrical ratio during 
 the past century, so that there is hardly a part or 
 function of the human body which is not presided 
 over by specialists with their associations and trans- 
 actions. Medicine, of course, has not been alone in 
 this ; it but shares in the universal tendency to special- 
 ism in all civilised nations in every department of life,i 
 from the humblest kind of manufactured commodity 
 to the most exalted products of the human mind. 
 The progress from homogeneity to heterogeneity, 
 which is so marked in the whole physical evolution of 
 man, seems hardly less obvious when we consider 
 man in bis aspect of a social animal. That the vast 
 progress of medicine during the past century has 
 been mainly due to the increasing development of this 
 principle it would be difficult to deny. Clearly, the 
 careful mapping out of the field of medicine and the 
 elaborate research carried on in each several depart- 
 ment has furnished us with an enormous body of 
 accurate information and detailed knowledge which 
 could hardly have been obtained in any other way. 
 
 ' Haeser, Geschichte der Medizin, vol. ii. p. 260. 
 
2i6 RELATION OF MEDICINE TO PHILOSOPHY 
 
 Such an achievement it would be difficult to over- 
 estimate ; for in the past the great obstacle to the 
 advance of medicine had been the entire absence 
 of any co-ordinated body of accurately ascertained 
 facts. Resting, as so much of it did, upon unproved 
 hypotheses, it was constantly at the mercy of every 
 fresh speculator of genius, whether a Paracelsus, a 
 Brown, or a Hahnemann. From such outbursts of 
 crude theory in the future it is to be hoped that 
 medicine is now for ever secure, owing to the large 
 amount of sound knowledge which has been gathered 
 up in its various departments. 
 
 From the point of view of medicine, therefore, in 
 and for itself, all this tendency of differentiation cannot 
 but have been of the greatest advantage. It is only 
 when we come to think of medicine not as a separate 
 art or science, but in its wider relation to the art of 
 life in general, that doubts and hesitations arise in 
 our mind as to whether there has not been some set- 
 off to the great progress that has been made in the 
 nineteenth century. In spite of the vastly increased 
 knowledge of the causes and treatment of individual 
 diseases, are we much nearer than our forefathers 
 to a knowledge of the laws of health as they affect 
 each individual citizen of the community ? That a 
 vast deal more about sanitation and public hygiene 
 is known and actually put into practice nowadays 
 than was the case a century ago, not the most in- 
 transigeant conservative would deny. But when we 
 come to the effect of medicine on the life of the 
 
MEDICINE IN THE NINETEENTH CENTURY 217 
 
 individual, do we see a commensurate progress? 
 Given a healthy man, is the modern physician, trained 
 in the methods of modern science, able to give him 
 better advice as to how that health is to be preserved 
 than a physician of a century ago ? The old saying 
 that a man is either a fool or a physician at forty 
 indicates no doubt the truth that a man of sense can 
 find out for himself the laws of health as they affect 
 himself without any scientific training, though it will 
 not enable him to treat disease. Owing to the vast 
 accumulation of strange and varied diseases in the 
 hospitals of a large town, physicians are apt to have 
 a false perspective and to suppose that disease is 
 more common than it really is ; and yet for how many 
 of those who are to all appearance in health are 
 not the times out of joint ? Without entering into 
 a metaphysical discussion as to where health ends 
 and disease begins, we may say at least that wherever 
 there is a maladjustment between the individual and 
 his environment, there to some extent is a deflection 
 from sound health. In the upper classes especially 
 much of this maladjustment is either moral or in- 
 tellectual or both. A man is weak on the moral side 
 and cries aloud with the Roman poet, " Video meliora 
 proboque, deteriora sequor." To such an one the medi- 
 cal knowledge of the schools will not be of much avail 
 unless combined with philosophy, which Hippocrates 
 regarded as essential to a physician. Then again, 
 in the intellectual sphere, surely it often happens 
 that a man does not know how to use his talents. 
 
2i8 RELATION OF MEDICINE TO PHILOSOPHY 
 
 Possessed perhaps of decided abilities, he yet lacks 
 the power of self-direction which should organise and 
 adjust his mental aptitudes ; hence he never comes to 
 the full realisation of himself, but pursuing paths un- 
 certain with an unsettled determination, brings forth 
 no good fruit for his fellows, and much inward dis- 
 satisfaction for himself. Here again we may see how 
 a medicine based upon philosophy and embracing 
 the whole range of life, both intellectual and moral 
 no less than physical, would be of enormous service 
 to the community. This, indeed, was the aim of 
 early medicine, which ranged over the whole of life, 
 but it was then premature ; no adequate demarcation 
 had been made between the organic disease which 
 requires definite technical and scientific treatment 
 and those minor deflections from moral and in- 
 tellectual health which we have indicated above. 
 The ancient Greek, at all events, regarded disease 
 as an entirely exceptional thing ; perfect physical 
 health was the normal and natural state of life, and 
 we can hardly imagine the Greek artisan feeling it 
 necessary to put by money for a time of sickness — 
 as we know from the Republic, the Platonic artisan 
 "had not leisure to be ill." Certainly the Greek 
 physician thought it his duty to envisage the whole 
 of life no less than the whole body. Doubtless the 
 task of us moderns is infinitely more difficult ; so 
 much is now definitely ascertained, that to take the 
 whole of knowledge for one's province must seem 
 at once chimerical and absurd. And yet something 
 
MEDICINE IN THE NINETEENTH CEN'^'URY 219 
 
 of the kind must be done if the physician is to attain 
 to the higher aspects of his art. To some extent he 
 would become an authority on education no less 
 than on public health, not mapping out pedantically 
 the exact number of hours which must be allotted 
 to sleep or play to children of different ages, but 
 having a clear idea as to what type of subjects should 
 be taught at the varying epochs of a child's life. 
 Religion and philosophy would not be entirely out- 
 side his province. He would learn to realise that 
 in this sphere absolute truth may be less valuable 
 than relative. How often do we come across men 
 who have acquired some knowledge of truths which 
 they have not entirely comprehended ; such know- 
 ledge is often an incubus to them, impairing the 
 effectiveness of their life. A religion or a philosophy 
 less in accordance with absolute truth, yet more 
 suited to the moral and intellectual apprehension of 
 the given individual, and more capable of educing 
 all that is best from him, may surely be regarded as 
 the religion or philosophy which is the absolute 
 truth for that man. It has been well said that the 
 aim of all religion is to make the inner man pre- 
 dominate over the outer ; but all religions do not 
 effect this purpose in the same way, and the " Spec- 
 tator of all Time and all Existence " would see how it 
 may best be effected in the case of one individual in 
 one way, in another case in another. 
 
 It seems a not unreasonable speculation to think 
 that we have now gone as far as it is profitable in the 
 
220 RELATION OF MEDICINE TO PHILOSOPHY 
 
 way of differentiation in medicine, unless the sight of 
 the whole is to be lost in the contemplation of the 
 parts. Ancient medicine had its gaze for ever fixed 
 upon the whole, but then the parts were so few and 
 meagre that there was little temptation to spend much 
 time in thinking about them. But with our present 
 knowledge, so much of which has been garnered 
 during the past century, it seems almost time for a 
 reintegration of medicine to be attempted : just as 
 Wagner endeavoured to bring the sister arts of music, 
 poetry, painting, dancing, which had so long been 
 labouring and perfecting themselves apart, to sub- 
 serve a unity in his musical dramas, so it would seem 
 to be that the time has come when medicine in all 
 her several departments and with the sister sciences 
 might be brought to such a focus as to subserve 
 the purpose of a sane and rational life. We shall 
 thus find medicine no longer studied only as an 
 isolated science like political economy in the days 
 of Adam Smith and the earlier economists, but 
 forming with it an integral part of sociology, and 
 making its influence felt more and more every 
 day as statesmen and politicians come to realise 
 the gradually increasing importance of public health 
 to the welfare of the community. It is not enough 
 for sound laws to be passed, as in matters of 
 public health it is the administration of them which 
 is all-important ; as Montesquieu acutely observed, 
 "All states have good laws — the important question 
 is how they are administered." But Medicine should 
 
MEDICINE IN THE NINETEENTH CENTURY 221 
 
 not stop here ; rather should she now come with the 
 collected results of her researches to the aid of Philo- 
 sophy, which is for ever seeking to establish among 
 mankind the basis of a rational existence. Formerly 
 physicians went to Philosophy to get help for their 
 own special problems and to enable them to frame 
 vast systems which should be co-extensive with the 
 universe ; now it will be rather the custom for Philo- 
 sophy to come to Medicine, and taking from her 
 all the truths which through the ages she has been 
 slowly winning from ignorance and chaos, gather 
 them up into one vast generalised truth which will 
 at length enable men to lead the lives of intellectual 
 and moral beings. Medicine in her turn, even in her 
 special researches and more immediate occupations, 
 will derive benefit from the contact with Philosophy. 
 No longer imagining that a few a priori theories will 
 yield up complete knowledge of the functions of the 
 body in health and disease, she will yet feel that even 
 in the smallest and narrowest investigations, or the 
 humdrum round of everyday practice, she is hasten- 
 ing the time when the life of the modern man, though 
 infinitely more difficult and complex, shall be as sane 
 and dignified as that of the ancients. 
 
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