« ForrigeFortsæt »
is to his era :—he rang out the old, he completed the record. His positive additions to the practice of the art are incomparably less important than his contributions to its literature; and the innovations of an enduring character which he introduced were rather the result of thought than observation. He was the first to make the important division, familiar to us now, of the causes of disease into "remote" and "proximate," and to divide the former into the "predisposing" and "exciting;" meaning, by predisposing, those which produced some change in the condition of a person which made him liable to noxious influence, as, for example, exhaustion or debility; by exciting, these noxious influences themselves-as pestilent vapours; while, by the proximate causes, or those in immediate connection with the disease itself, he meant the unnatural actions which were thus induced, and which gave rise to pain and general disturbance. Although essentially eclectic, and grievously displeased at the rampant hostilities of the prevailing sects of Dogmatists, Methodists, &c., he was evidently deeply imbued with the doctrines of the school called Pneumatic, (from pneuma,) which we have already largely discussed as a physiological speculation, but which has also had a lasting and powerful influence in pathology. With him the pneuma was different from the soul, but instrumental as a medium for the action and reaction of soul and body. The soul resided in the brain, to which the spirit, or pneuma, had access by means of the foramina, which he believed to communicate between the nostrils and the interior of the skull.1 Hence the use of sternutatories: the sneezing was supposed to clear the ventricules of the brain, and allow the soul to be refreshed with pneuma, or spirit, of a better kind. How very material his notions of the spirit were, may be gathered from his description of the sense of sight, in which he speaks of the
1 De Usu Partium. Lib. VII.
2 Ibid. Lib. X.
pneuma as actually retained in its place by the mechanical distribution of the parts, and as receiving the rays of light and passing them on to the optic nerve.' How far Galen concurred with the Pneumatic sect in regarding this spirit as itself liable to derangement, so as to act on the whole system like a poison, it is not easy to make out. This view is thus expressed by Aretaus, a writer supposed to have lived about the same time, and whose admirable descriptions of disease, from their refreshing conciseness and graphic power, present a strong contrast to the vicious elaboration of style common at his time:-" My opinion," he says, when speaking of Cynanche, "is, that it is merely a disease of the breath (pneuma, spirit), from its being converted by some action into a very hot and acrid state, without any inflammation of the body; and there is nothing so very extraordinary in this notion, for the suffocation from mephitic caves is exceedingly severe, without there being any bodily disease, and persons die merely from a single inspiration before the body can be in any way affected; and again, a person becomes rabid from the tongue of a dog merely breathing on him in expiration, without his being bitten at all."
According to this theory, an exciting cause, such as the poison of hydrophobia, might act primarily upon the pneuma, or spirit; this, in its turn, upon the brain or other organs, so as to cause death without any disturbance or alteration of the body itself. Against such spiritual disease, it is plain that the ordinary material remedies would be powerless. One cannot physic a ghost.
Whether Galen coincided with this notion or not, he was certainly not a bit less fanciful in his pathology. Thus, he divides inflammation into the following kinds :—1st. The simple, which is caused by excess of blood alone in any part. 2nd. When pneuma enters along with the blood
1 Sprengel. Vol. II. p. 155,
2 Aretæus, p. 9.
3rd. When yellow bile gains admission, it is erysipelatous. 4th. When phlegm, it is scirrhous or cancerous.
Galen's greatest innovation was the introduction of the indications afforded by the pulse; and his chapters, or rather treatises, upon the pulse, are wonderful examples of perverse ingenuity. He gives tables of the various kinds of pulse, as, for example,
1. Long, broad, high, large;
2. Long, broad, moderate;
3. Long, broad, low (humilis);
4. Long, moderate, high;
5. Long, moderate, moderate, slender;
and so on, enumerating twenty-seven varieties of this quality alone-that is, of the sensation of the movement in respect to its fulness.
Then we have another table
1. Quick, quick, slow;
2. Quick, quick, quick;
3. Quick, quick, moderate, &c.,
also extending to twenty-seven varieties in respect to the rapidity of its beat. Besides the fulness, strength, and rate, there are a multitude of other distinctions which it has been found almost impossible to translate, such as caprizans, or jumping like a goat.' Of the reality of these nominal differences there is no doubt; but the objection to this attempt to tabulate them in the way Galen has done, is, that no two physicians would agree whether to call a pulse "long, broad, large," or "long, broad, moderate." If these qualities were fixed by a dynamometer, then such tables would have at least an objective and positive foundation to begin with, instead of a merely-arbitrary one. The pulse is, undoubtedly, a most important index of the state of the health; but it requires the cultivated tact of long experience to interpret its signification. It cannot be
1 De Different. Puls. Lib. I.
read off like a gasometer. Galen used to vaunt that he never was mistaken in his prognosis. If this be true, it was owing to his extensive practice, not to such compilations of dubious indications as he presents us with in these chapters. Were it so, there would have been reason in the question of Martial, possibly put ironically, but reported as a compliment, "How does it happen that my prognostications are not so good as yours? for I have read the prognostics of Hippocrates as well as you." Whether or not Galen possessed the wonderful gift of infallibility which he claims-" never having found himself wrong, with the help of God, in his prediction," (he seems to have been a Monotheist, though not a Christian)—it is quite certain that his practice of medicine had all the fatal faults of his idol Hippocrates, besides a large contingent due to himself. He arranged medicines according to what he called their "qualities," by which term he did not mean their action upon the body, but their inherent heat or coldness, dryness or moisture. Thus, a medicine was warm in the first, second, or third degree; and moist or dry in a similar ratio : so a medicine might be hot in the first and moist in the second degree, and if we met with a disease which was cold in the first and dry in the second degree, then we should administer to the subject of it this remedy.2 We shall best illustrate the working of this folly by a few quotations from Paulus Ægineta, who follows Galen and his school, and has left a volume on Materia Medica, from which we extract the following:
"Cistus (rock-rose).—It is an astringent shrub of gentlycooling powers. Its leaves and shoots are so desiccative as to agglutinate wounds; but the flowers are of a more drying nature, being about the second degree; and hence, when drunk, they cure dysenteries and all kinds of fluxes." 3
2 De Facult. Simpl.
1 Comment. 2, in Lib. I. Quoted by Sprengel, Vol. II. p. 169.
3 Paulus Egineta.
'Lapides (stones).—All kinds are desiccative, like earth, but the Hœmatitis, or blood-stone, is astringent and desiccative to a considerable degree, so that it agrees with trachoma of the eyelids," &c.'
What an extensive generalization !-All stones—that is, all mineral substances are disposed of as dry, and may be used in moist diseases! Lead, antimony, arsenic, mercury, are interchangeable quantities, or what Galen would call "succedanea."
"Faniculum (fennel) is heating in the third degree, and desiccative in the first; it therefore forms milk, and relieves suffusions of the eye." 2
“Ferrum (iron).—When frequently extinguished in water, it imparts a considerable desiccative power to it. When drunk, therefore, it agrees with affections of the spleen." And so on.
Given a disease, determine its character as hot or cold, moist or dry, by an effort of imagination; having done so, select a remedy which has been catalogued as possessing opposite qualities. This is the famous principle of Galen— "contraria contrariis curantur"-held in reverence among us to the present day. But Galen, besides treating diseases in this methodic way, was fond of nostrums, and used to purchase them for large sums. Indeed, his prescriptions bear a strong resemblance to those of itinerant quacks. For example, under the head of "dysentery," he gives for indiscriminate selection, according to taste, nine recipes, most of which are incorporated in the formulæ of Paulus Ægineta, of which the following are specimens :
"Of the ashes of snails, p. iv.; of galls, p. ii.; of pepper, p. i. Reduce to a fine powder, and sprinkle upon the condiments, or give to drink in water, or a white, watery wine."
1 Paulus Ægineta. Vol. III. p. 220. 2 Ibid. Vol. III. p. 242.
Vol. III. p. 331.