When we search into the history of medicine and the commencement of science, the first body of doctrine that we meet with is the collection of writings attributed to Hippocrates. Science ascends directly to that origin and there stops. Everything that had been learned before the physician of Cos has perished; and, curiously, there exists a great gap after him as well as before him.... So that the writings of Hippocrates remain isolated amongst the ruins of ancient medical literature.—Littré. Introduction to the Translation of the Works of Hippocrates.
About eight hundred years separated the periods of Æsculapius and Hippocrates. During that long time the study of medicine in all its branches was proceeding in intimate association with the various philosophies for which Greece has always been famous. Intercourse between Greece and Egypt, Persia, India, and other countries brought into use a number of medicines, and probably these were introduced and made popular by the shopkeepers and the travelling doctors, market quacks as we should call them.
Leclerc has collected a list of nearly four hundred simples which he finds alluded to as remedies in the writings of Hippocrates. But these include various milks, wines, fruits, vegetables, flits, and other substances which we should hardly call drugs now. Omitting these and certain other substances which cannot be identified I take from the author named the following list of medicines employed or mentioned in that far distant age;—
This list may be taken to have comprised pretty fairly the materia medica of the Greeks as it was known to them when Hippocrates practised, and as it is not claimed that he introduced any new medicines it may be assumed that these formed the basis of the remedies used in the temples of Æsculapius, though perhaps some of them were only popular medicines.
The temples of Æsculapius were in all those ages the repositories of such medical and pharmaceutical knowledge as was acquired. The priests of these temples were called Asclepiades, and they professed to be the descendants of the god. Probably the employment of internal medicines was a comparatively late development. Plato remarks on the necessarily limited medical knowledge of Æsculapius. Wounds, bites of serpents, and occasional epidemics, he observes, were the principal troubles which the earliest physicians had to treat. Catarrhs, gout, dysentery, and lung diseases only came with luxury. Plutarch and Pindar say much the same. The latter specially mentions that Æsculapius had recourse to prayers, hymns, and incantations in mystic words and in verses called epaioide, or carmina, from which came the idea and name of charm.
In later times these temples were beautiful places, generally situated in the most healthy localities, and amid lovely scenery. They were either in forests or surrounded by gardens. A stream of pure water ran through the grounds, and the neighbourhood of a medicinal spring was chosen if possible. The patients who resorted to them were required to purify themselves rigorously, to fast for some time before presenting themselves in the temple, to abstain from wine for a still longer preliminary period, and thus to appreciate the solemnity of the intercession which was to be made for them. On entering the temple they found much to impress them. They were shown the records of cures, especially of diseases similar to their own; their fasts had brought them into a mental condition ready to accept a miracle, the ceremonies which they witnessed were imposing, and at last they were left to sleep before the altar. That dreams should come under those circumstances was not wonderful; nor was it surprising that in the morning the priests should be prepared to interpret these dreams. Not unfrequently the patients saw some mysterious shapes in their dreams which suggested to the priests the medicines which ought to be administered. For no doubt they did administer medicines, though for many centuries they observed the strictest secrecy in reference to all their knowledge and practices.
It need hardly be added that offerings were made to the god, to the service of the temple, and to the priests personally by grateful patients who had obtained benefit. At one of the temples it is said it was the custom to throw pieces of gold or silver into a well for the god. At others pieces of carving representing the part which had been the seat of disease were sold to those who had been cured, and these were again presented to the temple, and, it may be surmised, sold again. That cures were effected is likely enough. The excitement, the anticipation, the deep impressions made by the novel surroundings had great influence on many minds, and through the minds on the bodies. Records of these cures were engraved on tablets and fixed on the walls of the temples.
Sprengel gives a translation of four of these inscriptions found at the Temple of Æsculapius which had been built on the Isle of the Tiber, near Rome. The first relates that a certain Gaius, a blind man, was told by the oracle to pray in the temple, then cross the floor from right to left, lay the five fingers of his right hand on the altar, and afterwards carry his hand to his eyes. He did so, and recovered his sight in the presence of a large crowd. The next record is also a cure of blindness. A soldier named Valerius Aper was told to mix the blood of a white cock with honey and apply the mixture to his eyes for three successive days. He, too, was cured, and thanked the god before all the people. Julian was cured of spitting of blood. His case had been considered hopeless. The treatment prescribed was mixing seeds of the fir apple with honey, and eating the compound for three days. The fourth cure was of a son of Lucius who was desperately ill with pleurisy. The god told him in a dream to take ashes from the altar, mix them with wine, and apply to his side.
The legend of the foundation of this Roman temple is curious. In the days of the republic on the occasion of an epidemic in the city the sibylline books were consulted, with the result that an embassy was sent to Epidaurus to ask for the help of Æsculapius. Quintus Ogulnius was appointed for this mission. On arriving at Epidaurus the Romans were astonished to see a large serpent depart from the temple, make its way to the shore, and leap on the vessel, where it proceeded at once to the cabin of Ogulnius. Some of the priests followed the serpent and accompanied the Romans on the return journey. The vessel stopped at Antium, and the serpent left the ship and proceeded to the Temple of Æsculapius in that city. After three days he returned, and the voyage was continued. Casting anchor at the mouth of the Tiber the serpent again left the vessel and settled itself on a small island. There it rolled itself up, thus indicating its intention of settling on that spot. The god, it was understood, had selected that island as the site for his temple, and there it was erected.
As might be expected, some of the less reverent of the Greek writers found subjects for satire in the worship of Æsculapius. Aristophanes in one of his comedies makes a servant relate how his master, Plautus, who was blind, was restored to sight at the Æsculapian temple. Having placed their offerings on the altar and performed other ceremonies, this servant says that Plautus and he laid down on beds of straw. When the lights were extinguished the priest came round and enjoined them to sleep and to keep silence if they should hear any noise. Later the god himself came and wiped the eyes of Plautus with a piece of white linen. Panacea followed him and covered the face of Plautus with a purple veil. Then on a signal from the deity two serpents glided under the veil, and having licked his eyes Plautus recovered his sight.
It cannot be doubted that in the course of the centuries a large amount of empiric knowledge was accumulated at these temples, and probably the pretence of supernatural aid was far more rare than we suppose. In an exhaustive study of the subject recently published by Dr. Aravintinos, of Athens, that authority expresses the opinion that the temples served as hospitals for all kinds of sufferers, and that arrangements were provided in them for prolonged treatment. He thinks that in special cases the treatment was carried out during the mysterious sleep, when it was desired to keep from the patient an exact knowledge of what was being done; but generally he supposes a course of normal medication or hygiene was followed. Forty-two inscriptions have been discovered, but on analysing these Dr. Aravintinos comes to the conclusion that they record in most cases only cures effected by rational means, and not by miracles. He finds massage, purgatives, emetics, diaphoresis, bleeding, baths, poulticing, and such like methods indicated, and though the sleeps, possibly hypnotic, are often mentioned, this is not by any means the case invariably.
About a century before Hippocrates wrote and practised, the Asclepiads began to reveal their secrets. The revolt against the mysteries and trickeries of the temples was incited by the infidelity to their oaths of certain of the Italian disciples of Pythagoras. The school of philosophy and medicine founded by that mystic aimed also to keep his doctrines secret, but when the colony he had established at Crotona, in South Italy, was dispersed by the attacks of the mob, a number of the initiates travelled about under the title of Periodeutes practising medicine often in close proximity to an Æsculapian temple. The first of the Asclepiads to yield to this competition were those of Cnidos, but the school of Cos was not long after them. The direct ancestors of Hippocrates were among the teachers of the temple who became eager to make known the accumulated science in their possession, and thus by the time when the famous teacher was born (460 B.C.) the world was ripe for his intellect to have free play.
Hippocrates was born in Cos, as far as can be ascertained, about the year 460 B.C., and is alleged to have lived to be 99, or, as some say, 109 years of age. It is claimed that his father, Heraclides, was a direct descendant of Æsculapius, and that his mother, Phenarita, was of the family of Hercules. His father and his paternal ancestors in a long line were all priests of the Æsculapian temples, and his sons and their sons after them also practised medicine in the same surroundings. The family, traceable for nearly 300 years, among whom were seven of the name of Hippocrates, were all, it would appear, singularly free from the charlatanism which the Greek dramatists attributed to the Æsculapian practitioners, from the superstition which overlaid the medical science of so many older and later centuries, and especially from the fantastic pharmacy which was to develop to such an absurd extent in the following five hundred years.
It is not possible to distinguish with any confidence the genuine from the spurious writings attributed to Hippocrates which have come down to us. But the note which even his imitators sought to copy was one of directness, lucidity, and candour. He tells of his failures as simply as of his successes. He does not seek to deduce a system from his experience, and though he is reputed to be the originator of the theory of the humours, he does not allow the doctrine to influence his treatment, which is based on experience.
This portrait of Hippocrates, which is given in Leclerc’s “History of Medicine,” is stated to be copied from a medal in the collection of Fulvius Ursinus, a celebrated Italian connoisseur. It is believed that the medal was struck by the people of Cos at some long distant time in honour of their famous compatriot. A bust in the British Museum, found near Albano, among some ruins conjectured to have been the villa of Marcus Varro, is presumed to represent Hippocrates on the evidence of the likeness it bears to the head on this medal.
The medical views of Hippocrates do not concern us here except as they affect his pharmaceutical practice; but a very long chapter might be written on his pharmacy, that is to say, on the use he made of drugs in the treatment of disease. Galen believed that he made his preparations with his own hand, or at least superintended their preparation. Leclerc’s list of the medicaments mentioned as such in the works attributed to Hippocrates have been already quoted, and it will be found that after deducting the fruits and vegetables, the milks of cows, goats, asses, mules, sheep, and bitches, as well as other things which perhaps we should hardly reckon as medicaments, there remain between one hundred and two hundred drugs which are still found in our drug shops. There are a great many animal products, some copper and lead derivatives, alum, and the earths so much esteemed; but evidently the bulk of his materia medica was drawn from the vegetable kingdom.
Hippocrates was considerably interested in pharmacy. Galen makes him say, “We know the nature of medicaments and simples, and make many different preparations with them; some in one way, some in another. Some simples must be gathered early, some late; some we dry, some we crush, some we cook,” &c. He made fomentations, poultices, gargles, pessaries, katapotia (things to swallow, large pills), ointments, oils, cerates, collyria, looches, tablets, and inhalations, which he called perfumes. For quinsy, for example, he burned sulphur and asphalte with hyssop. He gave narcotics, including, it is supposed, the juice of the poppy and henbane seeds, and mandragora; purgatives, sudorifics, emetics, and enemas. His purgative drugs were generally drastic ones: the hellebores, elaterium, colocynth, scammony, thapsia, and a species of rhamnus.
Hippocrates describes methods for what he calls purging the head and the lungs, that is, by means of sneezing and coughing. He explains how he diminishes the acridity of spurge juice by dropping a little of it on a dried fig, whereby he gets a good remedy for dropsy. He has a medicine which he calls Tetragonon, or four-cornered. Galen conjectures that this was a tablet of crude antimony. Leclerc more reasonably suggests that it was a term for certain special kinds of lozenges, and points out that not long after Hippocrates physicians used a trochiscus trigonus, or three-cornered lozenge for another purpose.
Although he used many drugs, Hippocrates is especially insistent on Diet as the most important aid to health. He claims to have been the first physician who had written on this subject, and this assertion is confirmed by Plato, who, however, somewhat grimly commends the ancient doctors for neglecting this branch of treatment, for, he says, the modern ones have converted life into a tedious death. Barley water is repeatedly recommended by the physician of Cos, with various additions to suit the particular case under consideration. Oxymel is the usual associate, but dill, leeks, oil, salt, vinegar, and goats’ fat also figure.
Particular instructions are also given about the wine to be drunk, the kind, and the quantity of water with which it is to be diluted in spring, summer, autumn, and winter. In one place, at the end of the 3rd Book on Diet, a word is used which apparently means that persons fatigued with long labour should “drink unto gaiety” occasionally; but there is some doubt about the correct translation of that word.