"Better than purges or emetics is a temperate diet, which induces the bodily functions to act for themselves."

We have now reached the period of the history of medicine when we have to consider the career of Claudius Galenus, who was born at Pergamus, Mysia, 130 A. D., and whose labors in behalf of medicine mark him as one of the leaders of medicine in thought, in knowledge, and in experience of both its principles and practice. Galen studied medicine at Pergamus, and afterwards visited Smyrna, Corinth and Alexandria to gain wider experience and greater knowledge. In his thirty-fourth year he went to Rome, where he remained the greater part of his life, practicing medicine most successfully.

Galen was the most skilful and learned student of the Hippocratic dogmatism that the world ever produced. He is supposed to have lived to the age of 71 years, and to have died about 201 A. D. Galen found the medical profession of the time in which he lived and practiced split up into a number of sects, and he became aware of the fact that the social status and the moral integrity of the medical profession was very much degraded, so much so that it was looked upon with contempt even by such a man as Pliny, the elder. Galen appears to have made it his object to reform these evils, to reconcile scientific acquirements and practical skill, to bring back the unity of medicine as it had been understood by Hippocrates, and at the same time to raise the dignity of the medical profession. Before Galen's time, the medical profession was divided into several sects who were always disputing with one another about the theory of medicine, but the bulk of the practicing physicians followed more or less by instinct the empirical method in practice. For many centuries they continued to seek in experience a refuge from the incessant variations of dogmatism and the sterile incertitude of the Sceptics. The Methodists agreed with the Empirics in their contempt of anatomy and of much study. One of their champions, Thessalus of Tralles, a half-educated, boastful pretender, promised his followers to teach them the whole of the theory and practice of medicine in six months, and claimed that he was the superior of all living and bygone physicians. How like the osteopaths and other like pretenders of the present day-"You can learn all you need in fourteen days by correspondence, and at once gain a large practice."

It is not one of the smallest of the services which Galen rendered to posterity that he demolished the sophistry of the Methodists and the Empirics, demonstrated the insufficiency of their

practice, and brought to bear upon them the wittiest satire on account of their lack of literature and medical instruction. Galen strove as hard as one in his position might, by precept and example, to awaken in his contemporaries a desire for accurate anatomical knowledge, but could not overcome their indifference. After Galen's time the practice of dissection appears to have been lost, either from redoubled prejudices of the superstitious who opposed it, or as the result of the apathetic ignorance or the ignorant apathy of the physicians. A symptom of "dry rot" seemed to have attacked the medical profession, and but for Galen and a few other prominent physicians, who did all they could to arouse their medical brethren to renewed activity, the great system of medicine founded by Hippocrates would have been lost to posterity.

Galen wrote works on anatomy and physiology, works on dietetics and hygiene, works on pathology, works on diagnosis, works on pharmacy and materia medica, works on therapeutics, works on surgery, works on semiology, and commentaries on the writings of Hippocrates. His anatomical and physiological works are the most valuable, and contain undoubted evidence of his familiarity with practical anatomy. His pathology was very speculative and imperfect. In his diagnosis and prognosis he laid great stress on the pulse, on which subject he may be considered as the first and the greatest authority, for all subsequent writers adopt his system. He was also a firm believer in critical days, a theory propounded by Hippocrates. Galen's practice was based on two fundamental principles: First, that disease is something contrary to nature, and which is to be overcome by that which is contrary to the disease itself; second, that nature is to be preserved by that which has relation to nature. Hence arise two general indications for treatment: the one taken from the affection contrary to nature, which affection requires to be overcome; the other from the strength and natural constitution of the body, which requires to be preserved.

All the medical knowledge of the period of time during which Galen lived was based on the teachings of Esculapius and Hippocrates, which could not at first be carried any further for lack of knowledge of anatomy and of physiology. Whatever addition was made to the medical science by Galen and the other great pupils of Alexandria and Pergamus came through their studies of anatomy by means of dissections of the bodies of animals, and such human bodies as they could get under their control by stealth

or through accident. Galen dissected apes, as being most like human subjects, though he occasionally obtained bodies of children exposed in the fields, or of persons found murdered, which, however, he was obliged to dissect in secret. Dissection of the human body was at that time forbidden under heavy penalties. Nevertheless, Galen studied anatomy in despite of all difficulties, and wrote on anatomy so successfully that for more than a thousand years every surgeon of any note depended on Galen for his anatomical knowledge with a reverence that smacked of idolatry.

From Galen's writings we learn that he came near being the discoverer of the circulation of the blood, the lack of knowledge of which retarded the whole profession for centuries. He made the observation that when an artery was wounded blood gushes out, but stopped there, probably having too much reverence for ancient lore and not enough reliance on his own observations. Galen considered the heart as the common source of the arteries and veins. He also stated that the nerves came from the brain and spinal marrow, and divided the nerves into two kinds, those of sensation, which he thought proceeded from the brain, and those of motion, which he considered to originate in the spinal marrow. He also had some notion of the sympathetic system of nerves, but sadly confused the anatomy of all nerves. To Galen we owe the division of the body into cranial, thoracic and abdominal cavities. He also speaks of the heart as having the appearance of a muscle.

Galen seems to have had some idea of legal medicine, for we find in his works remarks on abortion, on legitimacy, the relative fatality of wounds, etc.; also, writings on "feigned diseases," and on the lungs of the fetus and the adult. Suits for malpractice were little known during the time of Galen, for surgery was purely a mechanical art in the hands of bathers, barbers and gymnasts, and so was handed down by tradition. Indeed, Galen describes surgery as "the manual interference, by means of instruments or otherwise, in cases of bodily injury or external diseases, as distinguished from the practice of medicine, which denotes the treatment of diseases by means of drugs." Bleeding was adopted as a treatment applicable to a great number of complaints. Galen made the following reservation: not to bleed children under four years of age, and rarely to bleed old people. The ancients practiced phlebotomy with various instruments; generally a spearpointed fleam, called fossorium, was thrust into the vein. Galen

employed a cutting instrument, which he described under the name of phlebotomon.

In every respect the name of Galen stands preeminent in the history of medicine. He is the central figure, representing at once the culmination of medical science and art in the old world, and their preservation for further development under a new civilization. He lived at a time when the Roman Empire had reached its highest point of prosperity, without yet showing the signs of its deterioration. A Greek by birth and education, he practiced his profession at Rome, where he was the medical adviser of the imperial family, and the most eminent among his colleagues in public estimation. He was, therefore, for some years the leading physician in the first city of the world. He had no successor who could be called a rival. His age was followed by the disin tegration of the Roman Empire and the disappearance of learning in the middle ages; and for a long time, many centuries, his works were the principal depository of medical knowledge to which other writers resorted for their supply of materials. In the thirteenth century the recognized text-books for instruction in the School of Salernum were the authentic works of Hippocrates and Galen. So late as the sixteenth century, the lectures of the professors in the Faculty of Medicine at Paris consisted mainly of commentaries on the same authors, and at that time the authority of Galen in anatomy was still so great that it was considered presumptuous to question the accuracy of his descriptions, even from the evidence of actual dissection. In such esteem were the writings of Galen held by the medical profession of many ages that it was considered almost sacrilege to doubt any of his assertions. The records of the London College of Physicians afford a striking illustration of this fact, in so far as England was concerned. In 1559, Dr. Geynes "was cited before the college for impugning the infallibility of Galen. On his acknowledgement of his error and humble recantation, signed with his own hand, he was received back into the college."

This extraordinary supremacy, which lasted for over fourteen centuries, was due partly, but not entirely, to the ignorance of the middle ages, which made it impossible for them to compete with the best writers of antiquity. As a matter of fact, Galen was the medical teacher of Europe during the period of its intellectual pupilage; but his reputation had been established beforehand, from the real superiority of his talent, the extent of his knowledge, and the value of his discoveries and investigations. To Galen must

be given the credit of having revived the great system of medicine established by "The Father of Medicine," Hippocrates, and by giving it new life Galen deserves the everlasting gratitude of the modern physician.

The history of medicine after Galen affords little evidence of anything but a gradual decline, both in theory and practice. But one physician and author of any prominence appeared as a Roman medical writer after Galen, and his works are valuable only because they are an evidence of the state of the medical practice in his time. An abridgement of one of his writings or works, with the title of "Aurelianus," became the most popular of all Latin medical works, and was especially esteemed later by the Benedictine monks for the study of medicine during what is frequently called the "Dark Ages of Medicine." Outside of the writings of Aurelianus, little else was produced in these times but compilations of the most meagre kind, chiefly of the nature of the herbals or domestic receipt books. From Hippocrates to Galen was a very important part of the history of medicine, and both men are equally to be considered by the men who are now following in their footsteps, namely, you and I.

THE PHENOMENISM OF HIPPOCRATES.

By CHARLES GREENE CUMSTON, M.D.,
Boston, Mass.

The name Hippocrates is assuredly the greatest of Greek medicine and up to his advent philosophers applied their general speculations, which were more or less transcendent, to biology and pathology. But with Hipprocrates one enters into the true scientific domain of practical medicine. Pathology, hygiene, philosophy, biology and therapeutics were all studied by this great man, whose writings consist of a certain number of works collected under the name of the Hippocratic Collection.

It is not our intention to enter into a consideration of the discussions to which these works have given rise and it is not for us to show whether they were the work of a single writer or simply represent the fruit of researches of an entire school. In this paper we will only consider the works of Hippocrates in their ensemble and details, for the simple purpose of extracting the doctrine contained therein. We will more particularly