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of native heat. In the sixty-seventh, he inquires, why do fevers modify the condition of the pulse; and in reply, he states that when the equilibrium of the innate spirit is disturbed, and it is separated from the natural spirit, it superabounds and, becomes attenuated and divided by the intrinsic heat, so that by its lightness it acquires increased celerity, and thus affects not only the pulse but also the respiration. Here he is foreshadowing the doctrines of the pneumatic sect, though perhaps only in exposition of the views previously advanced by Erasistratus, and even by Hippocrates. In the sixty-eighth problem he inquires why persons laboring under fever, are subject to superficial ulcerations on the skin. This question is remarkable, and might lead to the belief that this acute and inquisitive observer must have been familiar with the eruptive fevers.
It has been questioned whether or not the author of these problems was identical with the Cassius mentioned by Celsus. But there is nothing in the work itself to throw doubt upon this point. Its author must have been worthy of the character which his junior contemporary has bestowed upon him. There is no allusion in the work to any writer later than Asclepiades; besides. whom and Herophilus, it mentions only Andreas Carystus, an Alexandrian writer on certain articles of the materia medica.
About this time there were residing and practicing at Rome, several professors of surgery of no. small note, among whom were the elder Tryphon, Euelpistus, the son of Phleges, and Meges, who,
says Celsus, was the most learned, of them all, as shown by his writings. This latter was the inventor of an instrument for incising the neck of the bladder, in the operation for vesical calculus ;, which instrument, judging from Celsus' account of it, must have been a double-cutting gorget, similar to what in this country has recently been described as the lithotome of Bushe, or prostatic bisector of Dr. Stevens, cutting transversely. Meges, also, contrary to the general belief, proved the possibility of anterior luxation of the tibia at the knee joint, by a successful case which he himself had treated. In the påthology of abscesses, he was in advance of his times; for while the general belief then was, that all investing coats and sheaths were nervous, he affirmed that a nerve was never generated in a disorder which destroyed the flesh; but that the pus being lodged below for a long time, became surrounded with a simple callosity, going were also distinguished as oculists.*
Some of the fore
As yet, the only two sects recognized in the profession, were the Rationalists and the Empirics;+ for, though Asclepiades had introduced important innovations, he was still classed as a Rationalist. Nor was Celsus willing that even the followers of Themison should be acknowledged as a third sect.
The Rationalists were those who declared for a theory in medicine, and held as essential to the proper management of diseases, that the physician should inquire into their occult or constituent causes,
*Celsus, in different places.
Ibid, book i., preface.
and their evident or exciting causes, and that he should be acquainted with the natural actions of the body and its internal organization. By occult or constituent causes, they understood such as are derived from the elements composing the body. By evident causes, they referred to such as are adventitious and apparent, as heat, cold, fasting, a surfeit, fatigue, and the like, which are operative at the incipient, if not also in the latter stages of a distemper. By natural actions they understood the functions of respiration, reception, and concoction of food and drink, and the distribution, of the nutriment throughout the body. They also investigated the causes, modifications, and indications of the pulse, and what gives rise to sleep and waking. They urged the necessity of modifying the treatment of disease in accordance with the character of the occult cause. But they differed among themselves as to what should be considered the occult
Some of them, in common with Empedocles and the early philosophers, held it to consist in redundance or deficiency in one or more of the four primitive elements,-fire, air, earth, and water. Some of them, with Herophilus and other earlier writers, maintained that it lay in a faulty condition of the four humors-phlegm, blood, bile, and atrabile; others, with Hippocrates, attributed it to, the qualities of the inspired air; some, with Erasistratus, ascribed it to the escape of blood from the veins (or vessels designed only for blood), into the arteries, which they believed were designed only for air and spirits; the escape of blood in this way, giving rise
to inflammation, and through this, to a fever. Others again, accepting the new doctrine of Asclepiades, placed the occult cause of all diseases in the interruption or arrest of the minute corpuscles in their passage through the invisible pores. They all, too, maintained the importance of a correct knowledge of concoction; but here again, their opinions varied; some of them affirming, with Erasistratus, that in the stomach the food is concocted by attrition; others, with Plistonicus, the disciple of Praxagoras, that it is effected by putrefaction; others, upon the authority of Hippocrates, that it should be ascribed to the effects of heat; whilst the disciples of Asclepiades, looking upon all these opinions as futile speculations, maintained that there is no such function as concoction, but that the food and drink in their crude state are distributed, by means of the pores, throughout the body. They all held to the importance of anatomy and correct knowledge of the internal organization of the body, and maintained that Herophilus and Erasistrátus had taken the best means for acquiring such knowledge, in procuring criminals from the prisons by royal consent, and dissecting them alive, so as to contemplate, while yet living, those parts which nature has concealed. And they declared it was by no means cruel, by the torture of a few criminals, to search after remedies for the whole innocent race of mankind in all ages.
The Empirics, on the other hand, relied on personal experience alone. They, indeed, admitted the
advantages of occasionally studying the evident
causes; but to search after the occult causes, or the natural actions, they believed to be useless; because nature is incomprehensible, as shown even by the discussions of the philosophers; who, if reasoning were of much avail, ought to be the ablest physicians; whereas they have abundance of words, but very little skill in healing. All theories as to causes, said they, are of little account, seeing that men of opposite theories were about equally successful in the treatment of disease, and that whatever be the character of these causes, the diseases require to be differently treated in different places and different seasons. Again, even where the apparent cause is recognized, as in lippitude, a wound, or ulcer, it does of itself point to the means of cure. And if the evident cause do not suggest these means, much less can the other, which is itself obscure. They held that medicine was not the result of reasoning, but that theory was invented after the remedy had been employed, and for explaining its effects. They asked, too, whether reason prescribes the same things as experience, or different; for, if the same, it is needless; if different, mischievous. On the appearance of any new disease, instead of inquiring into its occult or apparent causes, they sought for its analogy to diseases already known, and met it by remedies analogous to such as were used in these, until the true mode of treatment could be discovered. They did not affirm that judgment is unnecessary, but that conjecture is of no use, and that it is of little consequence how the disease originates, so long as we are able to cure it. They admit