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| Duncan M. The father of medicine (1876) 22(6): 482-499.
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| ==The father of medicine==
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|
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| By J. MATTHEWS DUNCAN, M.D., LLD.
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|
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| * The opening Address of the 139th Session, 1876-77, of the Royal Medical
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| Society, delivered 10th November.
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|
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| Among the greatest men of all times appears the majestic figure of
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| Hippocrates, called the Father of Medicine, Who should, in all his
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| main features at least, be familiar to students of the Healing Art.
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| There existed not one only, but a line of physicians bearing this
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| name, in which the second is held to be the chief, and to be referred
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| to when another is not specially designated. The works of Hippocrates consist of a considerable collection of articles or pamphlets
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| on the history, philosophy, and ethics of medicine, on the causes,
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| prognostics, and treatment of disease, and on special diseases and
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| accidents. In this discourse reference is made exclusively to his
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| medical writings. He was a surgeon as Well as a physician; but
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| his position and merits as a surgeon, great though they are, do not come within the scope of the present discussion.
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| The ingenuity of the learned has been extensively and laboriously exerted to decide which among the heap of Hippocratic treatises are the genuine works of Hippocrates the Second, which are not.
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| The questions raised in their erudite Writings, while they are of
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| secondary importance, and will probably never be conclusively
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| settled, do not come within the reach of the present discourse. In
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| accordance with common practice, Hippocrates and the Hippocratic
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| writings may be treated as a unity, Whose further decomposition
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| can produce no important result beyond the satisfaction of a 1a1idable literary curiosity. The grandeur, the beauty, the value of the
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| Homeric poems will be little modified should it come to be decided
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| that they are the Work of several men at different times, not of one
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| man, as is popularly believed; and so it is with the import and
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| value of the Works of the Father of Medicine.
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|
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| The-purpose of this discourse is to justify the reverence and
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| honour given to Hippocrates, and, if possible, to deter the ignorant
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| and the pedantic from calling upon his name in vain. To prove
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| the present desirability of these objects by special examples would be both painful and invidious ; we require only to refer in a
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| general way to modern medical literature. No name is more frequently cited than that of Hippocrates, yet almost never with a
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| just or full appreciation of this merits, while his authority is on
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| innumerable occasions called in to support views with which he
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| had nothing in common. The most recent and advanced discoveries are recognised in an author who lived more than two
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| thousand years ago, and who was ignorant of the elements of the
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| subject. This process is not of recent growth, for the discoveries
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| even of Harvey were, soon after being published, found to be
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| anticipated by Hippocrates.
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|
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| In my own day, his writings have been referred to by eminent
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| men as authoritative for us in regard to pleurisy, to Bright’s
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| disease, and to heart disease, and many others. If the old gentleman were alive, he might with complacence and pride receive
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| the homage due to his great merits, and especially to his, the
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| earliest, attempts to discriminate and describe diseases. He might
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| admit that he occasionally succeeded in drawing faint and inaccurate outlines of some maladies, scarcely to be recognised and
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| identified by us now; but he would spurn the foolish flatterers
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| who ascribe to him knowledge which was not dreamt of till two
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| thousand years after his time. The ordinary practitioner of our day knows almost infinitely more of disease than did the great
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|
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| Father of Medicine. It would be as easy to find the latest discoveries of astronomy and of chemistry 1 in the works of the astrologers and alchemists, as to find recent medicine anticipated
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| in the Hippocratic writings.
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|
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| In the history of Medicine there are only two great cpochs—that
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| of Hippocrates, about 400 B.C.; and that of the fifteenth century.
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| The former was that of the birth of medicine, and the father was
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| Hippocrates. The latter was the foundation of medical science by
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| the anatomists and physiologists, of whom Vesalius and Harvey
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| are generally made the representatives. The former was one of
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| the many glorious products of Greece. The latter was one of the
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| many glorious products of Northern Italy. At present we cannot
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| foresee even the probability of the advent of another era so great in
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| medicine as these, but may reasonably anticipate a series of
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| periods marked by brilliant discoveries, such as have already been
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| continuously produced since the revival of learning, or by wide generalizations for which the way would seem to be already prepared.
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| I It is the custom of historians to describe the curative proceedings of the priests in their temples as the first stage or epoch in the progress of medicine, as distinguished from surgery; but it is much
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| more correct to say that it began with Hippocrates. There was, in
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| truth, no medicine before him, but only a seeking from the gods
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| by prayers, or by incantations and charms, such aid as resulted in
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| cures properly so called. There was no substantial approach to
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| knowledge of the human frame and constitution, and there had
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| been no methodical observation of disease; there could be nothing worthy of the name of medicine. These aiite—Hippocratic days
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| were the era of cure, not of treatment; or of cure as distinguished
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| from treatment: and one of Hippocrates’s chief claims to our
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| honour is that he despised and rejected the whole affair. His
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| chapter on the morbus sacer, considering the time when, and the
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| circumstances under which, it was written,‘ is an imperishable
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| monument to his glory, a proof of his courage and his wisdom.
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| Its teaching is nearly as much needed now as ever it was ; for, considering our time and circumstances, we have, in the specifics and many other cures of. our day, grosser superstition than Hippocrates had to encounter. Cures occur only in the hands of the
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| ignorant and superstitious; and the light of science should, ere
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| this, have rendered them ridiculous. But it is not so. One of
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| the most renowned physicians of modern times deliberately
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| recommends a metallic salt for headache, as he had seen it cure a
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| case! another most eminent and respected physician recommends
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| a peculiar saline as a cure of a rare and ill-understood kidney
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| disease, for he had tried it in one case!
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|
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| The cures in the temples of ./Esculapius are said to have been
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| resuscitated in another form soon after Hippocrates showed their
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| utter vanity. But they have been, indeed, never extinct. They
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| flourished vigorously in the middle ’ages, under the priestly garb
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| of the Christianity of the time, and they still survive in various
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| quarters. They flourished notoriously even in the time of Harvey,
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| for then (and long after) the king touched for the “evil.” They
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| are almost daily produced now by our most renowned physicians,
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| as I have just exemplified, and- as I could further abundantly
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| prove, did I not prefer to avoid exciting the nausea of all scientific
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| men. The whole homoeopathic system, so far as it is peculiar, is
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| composed of this nonsense, and of this alone.
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|
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| Hippocrates was the Father of Medicine—not any priest, or
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| priestly system. There were, no doubt, before Hippocrates, much valuable medical skill, and many useful appliances; but these do
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| not constitute medicine as he established it, and as we teach it.
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| These were an humble but valuable class of proceedings, ‘as much
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| used now as ever they were; but, even as accumulated in our day,
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| not constituting, indeed contributing very little towards constituting, a system of medicine. Were it just to go back to the priests
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| of Esculapius as forming a step in the progress of medicine, I
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| should not allow the retrospective historical scrutiny to stop there ;
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| for I would, with equal justice, invoke the principles of Darwin,
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| and date the beginning of medicine further back than the
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| historical period. It may be held as certain that before the inedicine to be found in the history of the creation of man, there was
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| the medicine of the brutes; and the simple faith and uncomplicated proceeding of the dog who seeks his _cure by an emetic,
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| chosen among the herbs of the field, is more to be admired and
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| respected than the falsities of a credulous priesthood; or, in legitimate succession, the mystery of the aqua epidemica, or the
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| Mithridate, or the Venice treacle, as used by the so-called Father
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| of English Medicine, or the specifics of this day.
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|
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| The first epoch of medicine was an era of medical knowledge, as
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| distinguished from medical science. Till the structure of the healthy
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| human frame was revealed by the labours of the anatomists, there
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| could be no science of medicine properly so called. Anatomy is itself, in this sense, not a science, unless, indeed, that name is attached to mere observations. Observation is the essential foundation of
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| science, and in the works of Hippocrates there is a marvellous
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| accumulation of it; just as there is in the medical writings of our
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| own day. But, in our day, anatomy and physiology have come to
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| form the foundations of Medical Science, which can scarcely be
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| said to have existed before decided progress was made in them.
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|
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|
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| To exclude mere observations from science is not to throw discredit on them. A good observer is a man endowed with a rare
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| faculty, which may amount to genius; as is attested by many of
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| the works of our justly renowned mere naturalists or mere
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| anatomists. Hippocrates was a great observer, as his works
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| abundantly testify. At his time, observations were the first and
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| great desideratum, as is the _oase still; but in his day there was
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| room for little elsethan this accumulation of materials; and this
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| cannot now be said of large departments of medicine.
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|
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|
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| Although in the early periods of medicine the cultivation of
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| observation was, as Hippocrates carefully stated, the great, almost
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| the only, requirement, it was impossible to repress theorizing; and
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| of this Hippocrates himself furnishes many remarkable examples.
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| But the tendency could not then, and cannot now, be kept within
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| due bounds. The true mode of progress, by observation, came to
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| be neglected; and the field of medicine was divided between the
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| dogmatists and the empirics. We should nowadays call them the philosophizers and the mere practitioners. Of. course there are considerable differences between the dogmatists of ancient times
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| and the philosophizers of our day, arising from the great increase
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| of medical knowledge and advance of medical science; and, for
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| the same reason, there is much difference between the empirics
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| and our mere practitioners. But, in scientific method, or rather
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| in despite of scientific method, the two modern classes are
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| identical with the two old divisions. The dogmatists trust too
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| much to mere reason, struggle too ardently to anticipate the solid
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| progress of science, conduct their inductions "on too narrow a basis,
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| reason from general principles which have themselves insufficient
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| foundation. The empirics have a blind and unreasoning confidence
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| in what they call experience; and, neglectful of the errors of their
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| predecessors, allow themselves to be guided by mere appearances.
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| In our day, neither of these classes avows a disregard for science,
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| but they really have it, if they are to be judged by their works,
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| not by their professions.
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|
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| This digression will facilitate the estimate of Hippocrates which we propose to sketch. He was neither a mere dogmatist, nor a
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| mere empiric ; and, if he had lived in our day, would not be
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| classed among the philosophizers or mere practitioners, but he would have taken his place among the limited class of scientific
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| practitioners, or those who cherish science as the only substantial
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| basis of practice (but who, nevertheless, allow themselves an extravagant amount of pseudo-philosophic and empirical digressions).
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|
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|
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| The historians of medicine, in pursuing their tedious and almost
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| profitless task, describe system after system, that of Hippocrates
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| being nearly the earliest; a historical mimicking of the progress of
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| science, which seems delightful to them, but it is the mistake of
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| the bobbing about of a bear for real dancing. There is no science
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| in the philosophic basis of the system of Hippocrates; in his four
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| humours, his coction, and crasis. It is a philosophic toy which he
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| invented, or a hypothesis which he introduced. In all times these
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| hypotheses have been supplied, as they are still; and they are, no
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| doubt, necessary to satisfy the philosophic cravings of mankind.
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| They represent stages in the historical, not the real progress of
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| medicine. They are partially embodied in such terms as “Nature,”
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| “ Vis medicatrix naturae,” “ Archwus,” “ Anima,” “Vita principle.” They embrace too little of that physical and chemical
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| knowledge, which, combined with due observation, dconsfitutelsl.
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| the whole of medical science. So far as they pro uce suc
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| hypotheses, Hippocrates, Galen, Van Helrnont, Stahl, Hoffmann, fioerhaave, and Cullen, are mere pliilosophic _triflers_; prematurely,
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| but yet as impelled by necessity mimicking scientific theory,
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| and guiding generations of medical men by ignes fatmj. They are
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| the jigging bears, and all the doctors jig after them, and noisily
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| rejoice and believe they are gracefully dancing to the music of the
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| s heres.
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|
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|
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| There are only two classes of great medical men and medical
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| writings, the scientific and the non-scientific ; and these last are subdivided into the dogmatists or philosophizers, and the empirics or
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| mere practitioners. The dogmatists caricature true philosophy, the
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| empirics genuine experience. it 1S not to be supposed that every
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| individual physician or every individual work can be_ ranged under
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| these categories. Even the greatest men are very imperfect, and
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| almost necessarily commingle in their productions the fancy of the
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| philosophizer, the rashness of the empiric, and the caution of the
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| scientific man. Philosophizing . and empiricism are probably
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| necessary evils, and may even in some obscure way contribute to
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| real rooress.
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|
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|
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| As there really was no medical science, and as it was scarcely
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| possible there should be any, before Harvey, so none 1S to be
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| looked for in the writings of Hippocrates. What then of everlasting work did all the great medical men before Harvey do, and
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| what are most great medical men now doing? In addition to being, in some degree, philosophizers and empirics, they have been
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| and are, by diligent observation and research, accumulating the
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| materials necessary for the construction of science. This is the
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| evidently necessary and everlasting Work which they are doing,
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| and in this work Hippocrates was the leader, and a great deal
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| more.
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|
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|
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| Probably no man has ever done more or more difficult Work, in
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| theway of observation and research, than the great Hippocrates.
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| Considering that before his day the ignorance of diseases, their
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| classification, causes, symptoms, prognosis, and treatment, were as
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| a tabula msa, We cannot sufiiciently admire and Wonder at his
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| genius, his labours, his success. He truly begat medical knowledge and medical Work ;—a good parent, to be admired, respected,
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| imitated, by his loving children of all time: , Had he done nothing
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| else than this work, he would have been the greatest figure among
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| the heroes of Medicine.
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|
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|
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| The individual feats in observation and research achieved by
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| Jenner, by Laennec, by Bright, not to speak of some in our own time, were as grand as, and probably more difficult than, any done by Hippocrates; but they are small when compared with his in
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| extent and in epoch.
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|
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| But it is time now to state categorically what are the great
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| things which Hippocrates did, and which entitle him to the
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| undying fame which is his.
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|
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|
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| First of all, he was, I repeat, the Father of Medicine, and in this
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| respect he must ever stand alone. Before his day, Medicine was a
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| department of the duties of priests. The sick came to the temples
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| to be healed, and no doubt they often were healed by the holy men,
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| who could not fail to gather from the rawest experience some
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| practical knowledge and skill, and to acquire confidence in their
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| nostrums, whether they were useful, or ridiculous and useless. It
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| is to be supposed that in those days, as in ours, priests were not disposed to part with their privileges; and the task of Hippocrates, in taking from them this great department of their labours and of
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| their sources of emolument, must have been a very difiicult one.
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| The difficulty was, no doubt, enhanced by the fact that this great man, as one of themselves, born and bred in the cloth, would be naturally looked to as a friend and supporter. But for this work,
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| his force of character was sufficiently great, and We may guess from
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| his strong expressions regarding the divinities of disease and cure,
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| that he had much opposition to encounter in his efforts to place
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| the practice of medicine on a new and better footing than it held
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| among the priests. He Was, indeed, as we may judge from what
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| he says, quite as clear from superstition and priestly influence as
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| those supposed to be the most heterodox in our own day. He
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| anticipated Lord Palmerston many ages, and would certainly have
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| applauded that statesman’s advice (to look to the drains), given
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| to a clergy and people who were clamorous for prayers against
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| the approaching scourge of cholera. There is one department of medicine which was greatly studied by Hippocrates, namely,
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| prognostics; and it is justly surmised that he may have derived
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| much assistance here from the learning of the temples; for we
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| know how ardently the priests strove to satisfy the cravings of all
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| their devotees to peer into the future—a laudable craving, and one
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| from the indulgence of which some of the skill may have been
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| acquired which we find in many of his sagacious aphorisms.
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|
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|
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| But it was not the priests alone that Hippocrates had to
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| encounter in carrying out his great work of establishing the
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| separate individuality of his great child. Medicine was, if not a
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| department of philosophy, at least a frequent topic for philosophic
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| dialectics. Many of the great philosophers of his time dabbled in
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| it; and he, no doubt, saw that they made a horrid mess of the
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| matter; just as they continue to do to this day, whether the
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| philosophers are regulars and profess in academic chairs, or
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| the irregulars of lofty philosophical ambition. As he took the
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| practice from the priests, so he took the theory from the philosophers; and it is devoutly to be wished that some of his followers would do a like service in our day—a more subtle and difficult work, but one of the same kind. N o doubt Hippocrates himself
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| went too far in the mere philosophic direction, in founding his
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| system. But, as we have already said, no man is perfect; and
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| there could be suggested ‘many palliations of the proceeding of
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| Hippocrates in substituting for older hypotheses that of the
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| humours and their elaboration. We must be thankful to him for
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| what he did, confessing that he at the same time made many,
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| because nearly inevitable, errors.
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|
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|
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| It is difficult and vain to arrange in order of merit the various
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| great achievements of Hippocrates, yet that which most clearly
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| demonstrates his intellectual depth is the method of advancing
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| medicine which he inculcated—the method of observation. .He
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| expelled philosophy and philosophers from medicine, and would not
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| in his own day, nor in ours, be called a philosopher; yet he was
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| the only genuine and true philosopher of them all. He brought
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| medicine down from heaven to earth, and insisted on the prime
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| necessity, truly the necessity of his day, to observe,.to observe, to
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| observe. That observation, which is the basis of science, the first step in the philosophy of medicine, he not only inculcated, but also liberally exemplified. Till long after his day, there could be no other philosophy for medicine; but his preaching was soon for
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| gotten, and his ardent, but too little instructed immediate , successors, soon came to neglect the accumulation of observations, and
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| ran riot in dogmatic and empirical philosophizing, just as his
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| latest successors still do.
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|
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|
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| It would be easy to point out striking evidences of his powers
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| of observation, but it is a work of supererogation. The literature
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| of the healing art was enriched by his cases, detailed accounts of single instances regarded as worthy of particular attention. Many medical writers, even of our own day, have despised the laborious
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| taking of cases; and they are foolish in thus rejecting the example
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| of this great master. But the merit of Hippocrates, which we now
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| insist upon, is not in his observations themselves, but in his
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| recognition of the value of observation. We have already alluded
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| to the common error of trying to find actual instruction in his
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| observations, and laying in this the chief claim of Hippocrates to
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| be studied nowadays. This is a great mistake. His observations
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| are no doubt admirable, and would be more so, if we could, in
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| regard to many important words, be sure of his meaning; but it is
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| his method of advancing medicine by observation that forms his
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| chief glory.
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|
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|
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| Some of his observations are very erroneous; many are very
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| true, and have passed into common use and remain, as the facies
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| Hippocmtica. On" one of his observations—the so-called Hippocratic succussion—I shall say a few words, because it has been
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| often described as an indication of his genius; and it really was
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| so, but not in the sense understood by most of his admirers. It
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| was, in itself, a crude, and for us a worthless, observation; but
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| it indicated a high kind of intellectual forethought amounting
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| to genius. It showed that he strained after the true ‘method of
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| investigating diseases of the chest, when fluids were accumulated
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| in it, that he was ready to test the value of all kinds of observation.
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| Hippocrates is generally said to have used succussion to distinguish
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| empyema from hydrothorax; but this is not well settled, for he
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| certainly speaks of the use of succussion in the latter. Unfortunately, there is no sign derivable from succussion either in empyema
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| or hydrothorax; and it is difficult to understand how Hippocrates
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| should have expected it. It is, of course, only when these diseases
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| are complicated with pneumothorax, that there can be use of
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| succussion ; but the error is perhaps palliated by our finding that, so
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| lately as the time of the “ First Lines of the Practice of Physic,” the
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| great Cullen made the same egregious mistake. Some attempts
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| have been made at explaining the error, by supposing that an
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| empyema was mistaken for a large vomica containing pus and air.
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| But the fact’ is that nothing, in this point of view, can come of
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| this investigation, nothing instructive to us as practitioners. Yet
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| the investigation reveals to us the genius of Hippocrates, who, by
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| his false or erroneous observations, anticipated, though in a very
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| limited sense, the grand discoveries of Avenbrugger and Laennec.
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|
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|
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| It has been repeatedly said that Hippocrates anticipated Bacon; that his philosophy is really according to the inductive method;
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| and while this is partially true, it is mainly a great exaggeration.
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| All men who make elementary progress in science must follow
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| this inductive method; they must accumulate facts by exercise of
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| the faculty of observation. Had Hippocrates not done this, we
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| should neverhave heard of him as the Father of Medicine. He did
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| this systematically, and it is his chief title to immortality. The accumulation of pertinent facts, however, is not the inductive method of Bacon, still less is it the inductive method as further
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| expounded by recent philosophers. Hippocrates did nothing more as a distinct contribution to method. Yet, though he did not
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| inculcate the next step in induction, the framing of hypotheses, he
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| fully exemplified it. But the exemplification of a method does
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| not indicate knowledge of it. A man may reason very well
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| without knowing logic. So Hippocrates made the second step
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| in induction, without knowing he was doing so; he framed
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| hypotheses. He framed them very badly; or, he committed the
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| commonest error, and perhaps an inevitable one, of scientific
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| explorers, he framed hypotheses, the chief of which constitute his
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| system, and regarded them as valid theories, while they were only
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| too eager and erroneous anticipations. How much too eager and
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| ambitious may be conceived, when we consider that his system
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| has fallen, has been succeeded by many others, all of which have also fallen; and that the wise medical men of the present day,
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| while they smile at such ruins, even those of our own Cullen,
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| attempt to rear no portentous edifices, but satisfy themselves with
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| humbler, more solid, and more contracted structures.
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|
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|
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| But facts and hypotheses are only steps in an induction, and
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| we find no indication in Hippocrates that he knew how to test a
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| hypothesis, by trying how it can be Worked from deductively, or
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| how to make it secure by various methods of what is called
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| verification. We may almost ven'ture to say that the true
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| inductive method was scarcely desiderated in the days of Hippocrates. Medical knowledge was not ripe for it, as it is now.
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| Enough that the great Father of Medicine set it on its right
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| course for becoming a science; a position which we can say it
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| has reached, though not even now in the grand comprehensive
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| generalizations which he and many of his followers vainly thought
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| they had - achieved, but which the best moderns only recognise as
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| objects to be aimed at.
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|
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|
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| Hippocrates, like other philosophers, scems to have known the
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| untenable character and practically misleading quality of some
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| hypotheses of his predecessors; but not of his own. Yet his great
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| hypothesis or system was as weak as any other: He went as far In
| |
| the true way of advancing medicine as, at ll1S time, he could, when
| |
| he insisted on observation. He did not foresee the use of numbers
| |
| as Louis used them; and, had Bacon lived in his time, he could
| |
| not have systematized the inductive philosophyyfor science had
| |
| made too little progress to furnish a suflicient field of observations
| |
| on method, from which to draw the generalization implied in that
| |
| which is called Baconian. But, after all, philosophic methods are
| |
| more interesting, as themselves forming a department of science,
| |
| than as teaching scientific men how to succeed in their pursuits.
| |
|
| |
| We now pass to an entirely different matter, namely, the
| |
| Hippocratic practice; an extremely interesting subject, but in all respects less important for us than what may be called the
| |
| Hippocratic philosophy. As in the philosophy we distinguished
| |
| the method from the result; observation from its fruits; so in the
| |
| practice We have to distinguish the principles from the details.
| |
| Just as it is extensively and erroneously held that the specific
| |
| observations of Hippocrates are more important for us than his
| |
| plan or method ; so it is extensively and erroneously held that the
| |
| chief interest of his practice lies in the details, not in the underlying principles.
| |
|
| |
|
| |
| The details of his medical practice I shall say almost nothing about. For the poor suffering patient they are of supreme im
| |
| portance. Nothing else, indeed, is of importance at all. But who
| |
| can give any rational account of them as practised by Hippocrates,
| |
| or as practised now; except so far as they are easily proved by
| |
| lay, as distinguished from instructed experience? That there is
| |
| daily given out by professional men, as there was by Hippocrates,
| |
| a mass of valuable advice, I have no doubt; but it is lamentably
| |
| unscientific, and therefore here undescribable. Two points in the
| |
| practice of this ancient are worthy of special notice and admiration. First, in accordance with his peculiar prognostios, which
| |
| included the causation of disease, he attached great importance to
| |
| diet and regimen, including residence and climate; and much
| |
| advice, still considered valuable, is to be found in the records of
| |
| this department of his practice. Second, his prescriptions were
| |
| simple, compounded nearly exclusively from the plants of Greece.
| |
| We have no trace of the ridiculous confections which were introduced in later times, and which Sydenham used, such as the
| |
| Mithridate of the London Pharmacopoeia, with its fifty ingredients.
| |
| The superstitious belief in imaginary remedies, so prevalent in our
| |
| day and in the time of Hippocrates, is not less useful nor less
| |
| injurious than that of Sydenham ; but it is greatly less absurd.
| |
| In his history of medicine, Dunglison says that superstition is
| |
| now restricted to the vulgar. There never was a greater mistake.
| |
| Among the highest and most learned in our profession, and out of
| |
| it, superstition, or belief in idle and unproved things, is as rife as
| |
| ever it was. Regarding what remedy in common use can a
| |
| physician give a reason, suflicient for all, for the faith that is in
| |
| him? He knows many juvantia and laedentia in different cases,
| |
| with some degree of assurance, but tangible remedies are the
| |
| favourites of the physician and of the vulgar. They are for the most part now, as heretofore, mere ‘matters of fashion. On the principle of doing his best, the physician may be bound to use
| |
| them, but it IS almost" a humiliating proceeding at this time of
| |
| day. “Ubi physicus des1nit,” says Stahl, “medicus incipit.” There is no exercise of faith in medical science; but without it medical practice is hardly to be imagined. What a tissue of
| |
| superstition is embodied in our dispensatories! We have not
| |
| now, neither had Hippocrates, such a complication of solemn nonsense as the “sovereign syrup for melancholy,” the “theriaca
| |
| Andromachi,” or the “Mithridate,” all of the London Phar1nacopoeia, and some of them in use within the memory of people
| |
| still living; but we have in active use, if not in our Pharmacopoeias, little else than such solemn nonsense in a less complicated form. What is the value of our beloved “bromide,” at
| |
| present used for all diseases? What the value of the rest?
| |
| Alas! we can only say with Hippocrates, that We do what we can.
| |
| The details of Hippocrates’s practice are just as valuable or valueless as those of our own, and I may give one example. He lays it down as a rule that bleeding causes abortion, and must therefore
| |
| be avoided in the treatment of pregnant women. Some centuries
| |
| later, Celsus discovered that it was possible to bleed a pregnant
| |
| woman without causing abortion. Then bleeding became a
| |
| panacea for the diseases of pregnancy, and especially valued for
| |
| the prevention of abortion. It was not a remedy of common
| |
| potency, it was specific; and Robert Boyle, in his work on specific
| |
| medicines, points out “hoW prejudicial it may be to many patients
| |
| that physicians be prepossessed with a bad opinion of a useful
| |
| remedy, may be guessed by him that shall consider what multitudes of teeming women that probably might have been saved by
| |
| the skilful use of phlebotomy have been suffered to dye for wan_t
| |
| of it, upon a dislike of that remedy that physicians for many ages
| |
| thought to be grounded upon no less authority than a positive
| |
| aphorism of Hippocrates.” Alas for Robert Boyle’s opinion, the
| |
| practice which he inculcated, and which has endured till the
| |
| present day, is, so far as I know, rapidly becoming extinct; and
| |
| all authorities would now agree that the evil foreboded by Hippocrates, and the benefit asserted by Boyle, are equally fallacies.
| |
|
| |
| The fact is that, in science, we can only say that we know nothing about it, that the assertions of Hippocrates, of Boyle, and of
| |
| modern authorities are equally without proof, and that We only
| |
| know with Celsus that a woman may be bled without causing
| |
| abortion. Practitioners must meantime abide in their ignorance,
| |
| and use this remedy with as much wisdom as they can bring to
| |
| bear on thecase for which its use is suggested.
| |
|
| |
| A main guidance in treatment Hippocrates found in his system.
| |
| He might retard or he might hasten the coction of the humours in order to their crasis. He might watch the crisis, and act
| |
| accordingly. On all this high-flying wisdoml shall say nothing,
| |
| merely dismissing it with the remark, that most of us have some
| |
| favourite system, avowed or not, on which we act, and which we
| |
| foster to our inward delight, much as Hippocrates did.
| |
|
| |
|
| |
| The great principle on which Hippocrates conducted his practice, and for the divulging of which he must ever be had in re
| |
| (not medicines) ; and this, Do good, and do no harm.
| |
| The latter teaching of Hippocrates is often quoted as a good spectful remembrance, is this: Nature or our natures cure diseases ,
| |
| maxim in the somewhat altered form,——Be sure that, if you do no
| |
| good, you do no harm; and it is certainly, for all and always, a
| |
| good rule, that should never fall out of mind. But, unfortunately,
| |
| it is one of that numerous class which it is easy to apply to others,
| |
| not to ourselves; and he who fails to apply it to himself, is very
| |
| likely to be the sanguine enthusiastic, even conscientious practitioner. Such an one, if not rendered extremely cautious by studying the history of his profession, is sure to argue of all he does that
| |
| it is doing good, especially if it is old and orthodox practice he
| |
| pursues. He, of course, wishes only to do good, and is doing good.
| |
| So argued the profuse bleeders and salivators who have only now
| |
| become extinct, much to the gain of mankind.
| |
|
| |
|
| |
| The grand misleading influence is crude theory or hypothesis;
| |
| and it is both amusing and instructive to remark that the great
| |
| Hippocrates well knew this, elaborately illustrated it, then shut his
| |
| introspective eyes and leapt into the very gulf of error against which
| |
| he warned others: and in like manner do we act nowadays, full
| |
| though our conceited pates are of medical knowledge. Hippocrates
| |
| demolished the treatment founded on the hot and cold, dry and
| |
| moist, hypothesis, then framed his own system of the four humours,
| |
| and diligently treated according to it, forcing diseases to adapt
| |
| themselves to it; and his treatment had not the great advantage
| |
| of the innocency of homoeopathic cures by infinitesimal doses,
| |
| founded on the grossly absurd homoeopathic hypothesis; for he
| |
| believed in his theory, and his patients had to suffer severely for it,
| |
| like the Greeks for the folly of their kings. One of his notions
| |
| was to evacuate the humour, and he used the hellebore and other
| |
| violent and certainly not harmless medicines to effect his purpose.
| |
|
| |
|
| |
| The maxim to do no harm is one for all time, to be inculcated
| |
| and re-inculcated, for it is always getting forgotten and lost faster
| |
| than it is instilled. Had it been duly attended to, medicine would
| |
| have stood immeasurably higher in the public confidence than it
| |
| does stand; and quackery and charlatanry would scarcely be able
| |
| to find footing, instead of flourishing as they do, a standing and not
| |
| undeserved reproach to the ranks of the regular profession. Had
| |
| this golden rule of practice been followed; had it been kept in mind not only that judgment is diflicult, but that experiment is
| |
| dangerous, as Hippocrates taught,—then Celsus could not have said that the best medicineis to take none; nor Hoffman advised the
| |
| patient to flee doctors and drugs if he wished to be safe; nor Radcliffe have said that when young he had fifty remedies for every
| |
| disease—when old, one remedy for fifty diseases; nor James Gregory
| |
| have said that young men kill their patients, old men let them die;
| |
| nor William Hunter have said that to medical theories perhaps
| |
| more of the human species have fallen a sacrifice than to the sword
| |
| itself or pestilence ; nor Sir Benjamin Brodie have said of John
| |
| Hunter, that, by teaching us when not to interfere, he had done
| |
| more for the healing art than all the inventors of remedies who had gone before him; nor James Johnston have declared his conviction that, if there was not a single physician, surgeon, apothecary,druggist, nor drug on the face of the earth, there would be less sickness and less mortality than now. These expressions are all, in my opinion, either imperfect or wide of the truth, but they show
| |
| how lamentably the teaching of the Father of Medicine has been
| |
| and is neglected.
| |
|
| |
|
| |
| The chief principle of Hippocrates in regard to the cure of disease cannot be said to be a principle of treatment, yet it is above
| |
| all treatment, and it is under it that, according to him, treatment
| |
| should be conducted. The enunciation of this great principle is
| |
| one of the chief glories of "Hippocrates, and will always redound
| |
| immensely to his credit. Our natures, says he, cure our diseases ;
| |
| or, nature cures disease; or, there is a vis meclicatmlx natwroe. He
| |
| did not hold, as Sydenham represents, that nature by herself determines disease, and is of herself sufficient in all things, against all of them; for then his system, or method as Sydenham calls it, and
| |
| his diligent treatment according to it, would have been vain. But
| |
| he "held that it was not the physician nor his drugs that cure disease ; and here was his great strength and merit. But, like all his
| |
| successors, or at least like most, when the Father of Medicine
| |
| descends to the subject of his practice, he totters; and this great
| |
| and, in many respects, glorious enunciation of Hippocrates demands
| |
| some criticism.
| |
|
| |
|
| |
| We know too little of the times of Hippocrates to judge of his actual practice. Its results are too much hidden from us. Yet we,
| |
| may safely believe he was a great practitioner, for he knew what he
| |
| was about probably better than any one else, and he was certainly
| |
| a profound thinker, and full of all the knowledge of his time. The
| |
| fact, -that his practice has been much admired and followed till
| |
| comparatively recent times, is favourable evidence, but of very little
| |
| force with him who has paid even a very slight attention to the
| |
| history of the profession. The vitality of error and even of mischievous error is quite marvellous. The Hippocratic method or
| |
| system and all other systems are now fortunately withered, if not
| |
| dead, unless we recognise their revival in the weedy growth of
| |
| homoeopathy. The profession is loosed from such useless and injurious trammels, and looks anxiously for some philosopher of the
| |
| true inductive character who may on a solid basis establish some
| |
| humble and probably only partial method. Meantime we must be
| |
| patient, and take care to avoid the hasty adoption of any new
| |
| generalization for the guidance of practice. Till we make advance
| |
| in scientific manner we must do the very best we can: acquire
| |
| knowledge, practise the numerical method, gain experience. Then,
| |
| although we may be fairly taunted with our endless variations,
| |
| each physician’s practice deserving a title compounded of his
| |
| name with ism affixed to it, we may rest in the meantime in satisfactory consciousness that we have striven to increase our knowledge to the utmost, and have used it mixed with all available
| |
| wisdom for behoof of our patients.
| |
|
| |
|
| |
| About the time of the revival of learning in England appeared
| |
| the famous Sydenham. He has been called the Father of English
| |
| medicine, and I cannot deny him a right to'the title, for I know
| |
| not what in the world English medicine is. There is only one kind
| |
| of medicine, and of it Hippocrates was the father, and the anatomists and Harvey the revivers and much more. Sydenham was a
| |
| worthy sagacious bold man, a distant imitator of Hippocrates, whose
| |
| method of observation he has the great merit of restoring. But
| |
| he displaced the ambitious and well-designed but premature
| |
| medical systems founded on physics or on chemistry, and restored
| |
| the old Hippocratic system or theory of disease and of treatment.
| |
| He was a retrograde philosopher. As Hippocrates is justly supposed to have been a great and useful practitioner, so is Sydenham.
| |
| He is called the chief of English practical physicians. But, for the
| |
| true philosopher or for the scientific physician, this enviable distinction is as valuable an indication of real usefulness as a knighthood or a baronetcy; no more. It is a matter of faith or of
| |
| reputation, probably having some good foundation, possibly only
| |
| some bad one. As we cannot tell even now who are good practi
| |
| E tioners a postem'07°7§, how can we judge of Sydenham or of Hippo
| |
| crates? Yet we can confidently assert that, as they made the
| |
| greatest progress in.their day towards scientific eminence, they were, probably, on that account, the safest guides in practice.
| |
|
| |
| When Broussais vaingloriously says that the real physician is the
| |
| one that cures, and that the observation which does not teach the
| |
| art of healing is not that of a physician, but is that of a naturalist, he
| |
| is at issue with the teaching of Hippocrates and of good sense. Hippocrates and the real physician do not cure; they pretend only, and in a very humble way, to treat disease ; they know that observation,
| |
| and experiment have not yet taught us the art of healing, and they
| |
| further know that the only kind of observation or the only valuable
| |
| kind is that of the naturalist. It is the quack——honest quack it may
| |
| be—who founds his system, and builds on it his cures; as Laennec
| |
| gently hinted that Broussais did. Every one knows that the doctor
| |
| can cure some diseases. He can overcome constipation. He can smother the itch insect. But these are not cures in the sense of
| |
| the present discussion, and of them perhaps Hippocrates had as
| |
| many as we now have. The great diseases of mankind—the
| |
| inflammations, the fevers, the degenerations——Hippocrates did not
| |
| pretend to cure; he treated them according to his system. In the
| |
| great sense there are no cures, except those miracles which are
| |
| appropriately so designated.
| |
|
| |
|
| |
| Hippocrates says that nature cures’ disease ; and, in his chapter on art, and elsewhere, limits the sphere of medical treatment to diminishing the sufferings of patients, and lessening the violence of
| |
| diseases when this IS possible, by the resources of art. He makes
| |
| no pretensions to curing diseases.
| |
|
| |
|
| |
| The declaration of Hippocrates that nature cures disease, cannot,‘ however, be passed over without pointing out two great errors
| |
| 111 it. One lurks in the word nature, the other in the word disease.
| |
|
| |
| A modern philosopher might, without offence against truth, say that nature cures disease, but he would use the words in a quite different meaning. He would imply, by the word nature,
| |
| merely that collocation and arrangement of forces and materials
| |
| which produced the desired result; he would use the single word
| |
| merely for the sake of brevity. But most moderns use the word
| |
| erroneously, as Hippocrates did, to imply some new power or
| |
| force evoked by disease, a ms medicatriac, which opportunely comes on the field to combat with, and perchance overcome, the enemy. Now, this is an utterly unjustifiable assumption, an error
| |
| against true philosophy, for there is not the slightest knowledge
| |
| of such a force as the 72733 medz'catm'a3, nor the slightest reason to
| |
| expect its discovery; quite the contrary. In the Hippocratic
| |
| system there are many such errors, and they are, comparatively
| |
| speaking, easily excusable there. When he solemnly describes
| |
| the black bile as a cause of many and ‘various diseases, he is
| |
| inditing nonsense, which nobody now believes; although our best
| |
| physicians habitually and carelessly speak equal nonsense when
| |
| they shake their heads and mutter “liver,” or “bile,” to their
| |
| patients. But, for the black bile (and the liver) hypothesis, there
| |
| is this to be said, that there are such things as black bile a.nd
| |
| liver, whereas we know absolutely nothing of this beneficent
| |
| nature, or 7/‘is med*£cato"ia:. Diseases are cured, we know not by
| |
| what forces. When Hippocrates raised up nature to take the
| |
| place of the priests and their drugs, or of the physicians and their
| |
| boasted art, he did a great work for medicine and mankind; but
| |
| the work was imperfect. We now dethrone nature, and leave the
| |
| seat of honour to be filled up gradually by the knowledge to be expected from the labours of physiologists and pathologists.
| |
|
| |
|
| |
| The error involved in the word disease nearly resembles the
| |
| former; for Hippocrates believed that by it some entirely new
| |
| matter or force, or combination of them, was introduced into the
| |
| healthy system, to disorder or to destroy it. There may be, in a
| |
| peculiar sense (as in zymotic diseases), some truth in this widely
| |
| and long established doctrine; but there is no doubt that it is
| |
| contrary to the whole tenor of modern knowledge of morbid
| |
| processes. We do not now hold that an epileptic is possessed
| |
| with devils, which have to be expelled; nor do we hold the
| |
| similar View in regard to most other diseases. Hippocrates had
| |
| no notion of the subjacent unity of the laws of health and of
| |
| disease; and it is, indeed, only now a recognised pursuit to show
| |
| the continuity of health and disease on the one hand, and of
| |
| disease and health on the other. This pursuit may indeed be
| |
| said to be one of the highest aims of modern true medical philosophy, and we must not expect too much even from the Father
| |
| of Medicine.
| |
|
| |
| We may, however, observe, to his great credit, that he did not
| |
| exhibit any tendency to the belief in specific medicines, which is a
| |
| natural consequence of the error just described. Hippocrates
| |
| treated disease; he did not pretend to cure it, as do the believers
| |
| in specifics. Hippocrates treated disease according to his system;
| |
| he did not believe in an additional method of treatment by
| |
| specifics, however much he might resort to empirical practice.
| |
| Nowadays, when systems of medicine are all in decay, treatment by the best physicians is almost exclusively a more or less rational empiricism; but’ not entirely, for the belief in specifics is still
| |
| extensively prevalent, and the venerable Alison has inculcated
| |
| the duty of searching for them as one of the great objects of
| |
| modern medicine.
| |
|
| |
|
| |
| Specific medicines were greatly believed in in the time of
| |
| Sydenham, who imitated to some extent a botanical classification
| |
| in his arrangement of diseases, and supported the doctrine of
| |
| a special medicine against each species of disease. About his
| |
| time, Jesuits’ bark was introduced into general practice, and it
| |
| soon became the model specific, a grand position which it still
| |
| retains. Indeed, if we look over the innumerable panegyrics of therapeutical medicine by medical men, we have the cuckoo cry of
| |
| quinine, with a11 occasional addition, varied according to the
| |
| credulity of the writer. Quinine, however, still survives as not
| |
| merely a medicine of_ great value in ague and other diseased
| |
| conditions, but as the great specific.
| |
|
| |
|
| |
| A specific is a medicine of the mode of whose action we are
| |
| entirely ignorant; it works by an occult quality. Each specific
| |
| encounters its own disease; it enters the body, and, searching,
| |
| finds out the spirit of the malady, and, when it finds it, it there
| |
| and then smites it, as an ox is smitten in the shambles. “Any
| |
| one who objects,” says Sydenham, “to me that a sufficiency of
| |
| specific remedies is already known to the world, will, upon a due
| |
| considerationof the subject, take the same view with myself. I
| |
| am sure of this, since the only medicine that supports his doctrine
| |
| is the Peruvian bark. Medicines that specifically answer to the
| |
| indications of treatment, and medicines that specifically cure
| |
| diseases, are as wide as the poles asunder. In the first case, we
| |
| satisfy the curative indications, and drive away the ailment; in
| |
| the second, we take no cognisance of the indication or intention at
| |
| all, whilst we destroy the disease directly and immediately. For
| |
| instance, mercury and sarsaparilla are commonly called specifics
| |
| in syphilis. Nevertheless, they are no proper and direct specifics
| |
| at all; nor will they be considered as such, until it be shown by
| |
| cogent and irrefragable proofs that the one produces its beneficial
| |
| effects Without salivation, and the other without diaphoresis. In
| |
| this way, many different diseases are cured by their different
| |
| appropriate evacuations; but it is the evacuation that performs the cure, the medicine being specific to the evacuation. To the
| |
| disease itself, self-sufficiently and directly, they are no more
| |
| specific than a lancet is specific to a pleurisy.
| |
|
| |
|
| |
| Specific medicines, in the restricted sense of the word, are by no means of everyday occurrence. They do not fall to every man’s lot. Nevertheless, I have no doubt but that out of that abundant plenitude of provision for the preservation of all things»
| |
| Wherewith nature bourgeons and overflows (and that under the command of the great and most excellent Creator), provision also has
| |
| been made for the cure of the more serious diseases which afflict humanity, and that near at hand, and in every country. It is to be lamented, indeed, that the nature of plants is not more
| |
| thoroughly understood by us. In my mind, they bear off the
| |
| palm from all the rest of the materia medica They offer also the
| |
| most reasonable hopes for the discovery~of remedies of the sort in
| |
| question. The parts of animals are too like those of the human
| |
| body; minerals are too unlike. , That minerals, however, are more
| |
| energetic in satisfying indications than either of the two other
| |
| Classes of remedies, and that the difference in character is the
| |
| reason for their doing so, I freely confess. Still, they are not
| |
| Specific remedies in the sense and manner explained above.
| |
|
| |
|
| |
| The restriction in the definition of specifics here carefully stated
| |
| by Sydenham is one which we may neglect, for it is based on his firm but vain belief in his method, which no one now entertains.
| |
|
| |
|
| |
| Mercury, and even sarsaparilla, have as much right to be included
| |
| among specifics as quinine, for We are utterly ignorant of their
| |
| mode of action.
| |
| by producing evacuations, eliminate the poison. Robert Boyle’s
| |
| use of the term is accordingcto a better definition. He does not
| |
| hold that these medicines cure diseases “ directly and immediately,”
| |
| but that they have ‘f the virtue to cure, by some hidden property,
| |
| this or that particular disease, as a pleurisy, an asthma, the colick,
| |
| the dropsy, etc.” A specific is “ such a medicine as very often, if
| |
| not commonly, does very considerably, and better than ordinary
| |
| medicines, relieve the patient, whether by quite curing, or much
| |
| lessening, his disease, and which acts privzcipally upon the account
| |
| of some property or peculiar virtue; so that if it have any manifest
| |
| quality that is friendly, yet the good it does is greater than can
| |
| reasonably be ascribed to the degree it has of that manifest
| |
| quality, as hot, cold, bitter, sudorifick, etc.
| |
|
| |
| This passage, given above, from Sydenham is purely Hippocratic,
| |
| except the utterly groundless, andtherefore meantime unscientific,
| |
| doctrine of specifics. Robert Boyle, a friend of Sydenham’s, to whose book I have referred, laboured to show that the docrine of specific remedies is reconcilable to the corpuscular philosophy; but this goes no further in relieving it of untenability an the only theoretical argument of Sydenham in its favour,
| |
|
| |
| We do not believe, as Sydenham did, that they, peutical extravagance namely, that the existence of such remedies for the graver diseases
| |
| is rendered probable by a consideration of the goodness of God.
| |
| Similar arguments would justify‘a belief in witchcraft; and, when
| |
| we read of the specifics of bygone ages, or even of recent but past
| |
| times, we would all nowadays regard them as quite as absurd as
| |
| the feats of witchcraftor of ‘ charms; and the many specifics,‘even
| |
| of our own day, have only the same claim on our belief as witchcraft has, faith. Robert Boyle’s specifics and Sydenham’s excite
| |
| our laughter and derision. Our own specifics do not, only because
| |
| they are our own. Boyle and Sydenham would appeal to experience, just as we do now. Facts, they would exclaim; but the
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| wise man will say, as Laennec did to Broussais, that he cannot
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| recognise the facts. Cullen has, in banter, expressed this by
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| saying that in medicine there are as many false facts as false
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| theories. There are many wonderful survivals of error quite as
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| striking as the belief in specifics or in quinine. It is a disgrace to
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| practical medicine that, in the days of the useful but limping
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| numerical method, we have no unanswerable evidence of the value
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| of quinine. We have abundant evidence of its frequent apparent
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| utility, of its frequent failure, of its being in no sense a Syden[hamian specific; and Pereira denies to it the right to any such
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| pretension. It may be safely asserted that it is not nearly so
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| well entitled to be ranked as a specific as the humble poultice,
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| or lying-a-bed, is, in many inflammatory diseases. Considering
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| the failure of physicians in their searches for specifics, and considering our present limited knowledge of pathology, we cannot
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| too much deprecate the recommendation of many great men to
| |
| continue the pursuit. Few things have retarded medicine more
| |
| than this doctrine and the discovery of Jesuits’ bark; were the
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| only evil produced the diversion of ingenuous youth from work
| |
| that is abundantly supplied, and cannot fail to produce good
| |
| results. The search for specifics is, from its conditions, likely to
| |
| -be not more successful than a boy’s attempt to shoot crows with
| |
| his eyes bandaged. Hippocrates is the father of no such therapy. The best moderns do not treat diseases
| |
| according to his method or system, or according to any method
| |
| whatever; but they join with Hippocrates in doing their best,
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| with all humility as empirics utterly, or as rational empirics, if
| |
| any reason can be found.
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|
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|
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| It may be truly affirmed that actual practice is not necessarily
| |
| modified by the doctrine of specifics, that a disease may be treated
| |
| honestly in the same way by a practitioner who believes in specifics,
| |
| and by one Who denies that there is any ground for such belief; but this admission does not justify a groundless hypothesis. While no practical advantage is claimed as arising from this hypothesis, it is very certain that, as already pointed out, and in other ways, much practical evil must arise from holding it. Erroneous and groundless doctrines have an inalienable ‘tendency to mislead, and this
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| is at least as well exemplified in practical medicine as in any other branch of human activity. The believer in specifics has a
| |
| constant and strong bias to evade the application to himself of the
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| rule to do no harm.
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|
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|
| |
| If one dared to step forward to defend the doctrine of specifics,
| |
| he would assuredly take as the ground of his argument the present, theories of the etiology of some zymotic diseases, implying thus
| |
| a limitation of the applicability of such remedies that has, so far
| |
| as I know, not been hitherto stated. But, even were a sweet
| |
| reasonableness admitted in this argument, it would not" justify, far
| |
| less call for, the search for specifics ; for assuredly the logical'and
| |
| only proper proceeding in such a case is to find out the specific
| |
|
| |
| In essence of the disease, and its mode of operation, before trying to
| |
| Jifind out its cure. One does not set about conquering an enemy without first ascertaining who and where he is, and how he works.
| |
| One cannot attempt the solution of a problem which has not even
| |
| been stated. Besides, our really justifiable anticipations of benefit
| |
| from specifics in the zymotic diseases are restricted to the prevention of the attack, and scarcely reach the process of cure.
| |
|
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|
| |
| In order to do justice to Hippocrates, reference should be made
| |
| at length to other matters, and especially to his great and highly
| |
| esteemed contributions to medical ethics. But the subject is
| |
| remote from those which have occupied this discourse, and cannot
| |
| be now dwelt upon.
| |
|
| |
|
| |
| Hippocrates established on a sure basis medical observation
| |
| and research. He made extensive contributions to the natural
| |
| history of disease. He separated medicine from priestcraft and
| |
| much pseudo-philosophy. He improved the principles of medical
| |
| practice. He commenced medical literature. He established
| |
| medical ethics.
| |
|
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|
| |
| Had Hippocrates not been truly great, the envious tooth of
| |
| corroding time would have long ere this_ laid him low. He still
| |
| stands proudly; admired of a whole profession; recognised as
| |
| having done more for it than any other man. Let us JO1I1 with
| |
| his most enthusiastic disciples, and hail him as divine; and if any
| |
| one presumes to cavil at this grand epithet, let hlm be told that
| |
| Hippocrates, as a great practical physician, had warm human
| |
| sympathies. Has he not himself said, that where there is medical art, there also there is love for men?
| |
