We have seen, in the preceding chapter, synthesis pushed to its utmost limit, and all the phenomena of the animal economy assimilated to each other, and united by the bond of a common cause, notwithstanding their infinite variety and enormous differences. But in order to arrive at that, to perceive in the formation of man, in the development of his parts and the exercise of his faculties, only the various modifications of one single agent, such as air or fire, it was necessary to clothe this material agent with imaginary faculties - to suppose it possessed of instinct,
intelligence, and will, which no observation could demonstrate : it was necessary, in short, to torture the facts, and create an ideal world, such as is seen by those patients to whom all objects appear of the same color.
These Utopias that the mind invents, by means of abstractions, in the solitude of the cabinet, vanish, ordinarily, in the presence of the real world, or phenomenal truths. To dissipate them, it is only necessary that they be compared with daily observations - to test them by the necessities of practice. This is done in a very creditable manner by the author of the theory which we now proceed to examine. The work which contains it is entitled, " On Ancient Medicine," and is justly considered one of the most creditable of the collection. Going back to the infancy of the Art, it develops its principles, traces its progress with much sagacity, and indicates the best method to follow, to insure its progress in the future ; it lays, in short, the true foundation of medical philosophy.
The critics and historians are nearly unanimous in classing this little work among the writings posterior to Hippocrates. M. Littre. alone, of moderns, charmed by the excellent doctrines contained in this book, is not willing that any other than that illustrious man shall have the honor of its authorship.( He expresses himself about it as follows: " The book, Ancient Medicine, so remarkable for the correctness of judgment, and depth of thought, is no less so in the beauty and excellence of its style. The arrangement is worthy of its matter. The periods, generally long, are constructed with perfect regularity; the members of the phrases are balanced and finished in a way to please the ear, as well as the mind ; the style, clear, and full of truthfulness, is always grave and firm, yet, nevertheless, it is enriched, (se colore) from interval to interval, in a way that shows a writer, who, master of his subject and of himself, is restrained within the limits of a natural taste. It is certainly a fine specimen of Greek literature, and a finished model of scientific discussion, on the general and most important points in Medicine." (Oeuvres d'Hippocrate, De l'Ancienne Medicine, page 5G5.)) The principal document on which he bases an opinion contrary to the common sentiment, is a passage from Plato, in which that philosopher, without designating precisely the book of Ancient Medicine, seems to make allusion to it. I avow, that after having read the passage, and the learned commentary with which M. Littre accompanies it, I am still with the common opinion. 1 have preserved, also, in the passages which I quote from the book, the translation of Gardeil, because it is on that translation that I made m} r first study, and consequently it is better adapted to my arguments ; besides, it does not differ materially from that of M. Littre ; for it is seen by comparing them, that these interpretations express the same ideas in different forms (I can only summarily indicate the reasons which make me take the common view. 1st. The book of Ancient Medicine refutes the system of four elements, which was that of Plato ; it proclaims the superiority of the experimental method, and Plato, as we shall see hereafter, is the Corypheus of an entirely opposite method. How then could this philosopher have proposed, as a model, a doctrine contrary in all points to his own ? 2d. The passage in Plato, considered in itself, seems to relate, according to Galen, as well to the book, on the Nature of Man, as it docs, according to M. Littre', to the work on Ancient Medicine. (See the introduction to the CEvures d'Hippocrate, by M. Littre', t. 1, p. 294, et suiv., and to the first paragraphs of the book on la Nature de l'Homme.))
The author opens with an argument, in which he shows that Medicine has not been founded on uncertain or obscure hypothetic opinions, but on the manifest observation of the good or evil results which follow a certain regimen and treatment, or action. He asserts, that the best method for making any improvement on the discoveries of past times is,, not to jump foolishly into eccentric and unknown ways, but follow with perseverance the beaten route of experience, which alone will conduce to real progress.
Like all the hypotheses emitted at that epoch, to explain the phenomena of the animal economy, that of the four elementary qualities had for
its support the most respectable authorities, such as Hippocrates, Plato, Aristotle, and the majority of physicians; but our philosopher boldly attacks that hypothesis, and refutes it in an entirely special manner.
"All those," he says in the commencement, " who have undertaken to speak or write on Medicine, and who have established their doctrines on the hypotheses of cold or heat, of dryness or moisture, reducing thus to one or two principles the causes of the death and diseases of men, are manifestly mistaken in the greater part of the things that they have advanced. I think, therefore, in this art it is not proper to have recourse to vain conjectures, as is necessary in treating of things entirely above our appreciation, and which are of no benefit to those who undertake to discuss or write about them.(De l'Ancienne Medicine. §1,2. Gardeil)
After pointing out, rapidly, what it is necessary to avoid in the study of Medicine, the author indicates, immediately, what it is proper to do, and his entire method may be summed up by the following aphorism : Observe attentively what is useful or injurious to health ; examine in what each thing is good or bad ; but put no subtlety in this research ; hold simply and purely to the testimony of the senses.
This method was not entirely new ; Hippocrates had alluded to it, somewhat, in his work on the " Nature of Man," but it was not expressed in terms as formal and explicit as are found in the work on Ancient Medicine. The author of this labors constantly to join example to precept ; he appropriates to himself, in some degree, this method, by the development he has given it, and the proofs by which he sustains it.
" It seems to me, -primarily," he says, " that in treating of the healing art. we must advance views, the accuracy of which every one can appreciate, because the discourses and researches of physicians should aim only at the diseases to which every one is subject. It is, therefore, necessarily the observation of the manifestation of good or evil results which has led to the search for and discovery of this Art. Indeed, it has been discovered, by observing, that the sick were made worse by the use of the same food that healthy men employ, which is still verified every day.
" What difference can be put between the invention of a man who has marked out the regimen suitable to the sick, who practices what every one calls Medicine, and who is recognized, generally, as a physician, and the invention of him, who, in the earliest times, changed the ancient, wild, crude food, for those various preparations of aliment now in use. For myself, I think it is the result of the same method a similar discovery. The first led to the suppression of food, too gross to be assimilated, even in a state of health ; the second, has interdicted aliment too indigestible in certain cases, considering the particular circumstances. There is no other difference, according to my view, except that the field of the latter, being more varied and extensive, requires, consequently, more discrimination aud experience ; but the first invention is nevertheless the mother of the second." (Traite de l'Ancienne Medicine, § 5)
In this way the author refers the creation of Medicine to the first essays made by man to ameliorate the conditions of his existence. He demonstrates that the same instinct, which led him, so early, to make a choice among the articles of food at his disposal, prepare them by cooking, and in various other ways, for the purpose of gratifying his taste and rendering digestion more easy; the same instinct, I repeat, also suggested to him to seek means to alleviate pain ; and that experience taught him, gradually, not to follow the same regimen in disease as in health, and to employ for his restoration to health, a variety of means.
The first rules of hygiene and therapeutics, not being the fruit of any hypothesis, but of experiment, he concludes that we may not hope for perfection in these sciences, except by the experimental method. "Every man," he cries out, "who rejects approved rules, and takes a new path, and boasts of having added something to the art, deceives himself, as well as others." He proscribes all the transcendental speculations in which men were in the habit of indulging, in his times, on the nature of man, and the essence of diseases. He regards them as a mere amusement - a play of the imagination.
"There are," says he " certain sophists, among whom may be counted even some physicians, who pretend, that to comprehend Medicine well, it is necessary, in the first place, to understand what man is in his nature, how he was first made, and from what he was formed. For myself, I think that all which the sophists wrote on the human nature, is less useful to physicians than to the makers of books, and that we can not hope to arrive at any certainty touching the constitution of man, unless we obtain it by medical observations. All that is necessary for any practitioner, who wishes to succeed in his art, to understand concerning nature, is the relation of man to his food and drink, and the changes which different kinds of these may effect in him."
We see with what sagacity our philosopher connects the question in physiology with the experimental method. He does the same for the problems of pathology and therapeutics. If it is required, for example, to explain the generation of diseases, he does not have recourse to occult causes, such as elementary fire, or radical moisture, but to causes apparent and appreciable by everybody, such as excess of eating and drinking, the fault in preparation, or the bad quality of articles of food. He does not deny that the excess of heat or cold, of dryness or humidity, may become, in certain cases, the causes of diseases ; but he insists that these primitive elements do not possess the character of morbid agents in all affections, nor even in the greater number, and he proves it from examples drawn from daily observation.
" Let us take," he says, " a man of feeble temperament. Suppose he eats grain from the garner, with raw flesh, and drinks pure water ; this will cause him much pain, his stomach will become deranged, his body waste away, and he will not live long. What must be given to him ? Heat, cold, dryness, or moisture ? If it is pretended that either of these elements has caused the disease, the cure is to be effected by employing its opposite. The surest and promptest remedy will always be found to be a change of food : to give bread instead of grain, cooked meat instead of raw flesh, and to add wine to his drink." (De l'Ancienne Medicine, § II)
The substances on which man sustains himself are endowed with secondary qualities, such as bitter, saline, sweet, acid, and many others, the effects of which are more sensible, and more persistent than the effects of the primary qualities ; from which, our author concludes that the first more frequently give rise to diseases than the last. He represents the action of the secondary principles, on the animal economy, as follows : " There are in man, bitter, salt, sweet, acid, and a hundred other similar humors of different powers, according to their quantity and degree of energy. All these things, when well mixed and tempered by each other, are harmless and unfelt ; but when one of them is separated, and is alone, it is felt, and makes great havoc in the body. It is the same with articles of food ; those which are not fit for use, are either bitter, salt, acid, or too strong; on this account they cause the same inconveniences as the humors of which I have spoken ; but those which are suitable for us, have none of these violent or excessively strong qualities."
In the other theories, no account is made of secondary qualities, because they are regarded as simple compounds, but nothing proves that they are so. No observation or analysis has shown how the bitter, salt, sweet, and acid resulted from the combination of heat, cold, dryness, or moisture. It was, then, just as rational to study the effects of secondary qualities as those that were pretended to be primary. It was rational to observe how each of these principles acted, cither when manifested spontaneously in the natural humors of the body, or when introduced into the economy by alimentary substances.
The following extract shows the general course of action of these violent humors, according to this system : "We have," says the same writer, " as above shown, one example, among others, which seems to me to he clear and conclusive. When we have a stoppage in the nose, from a cold, and a coryza supervenes, is it not true that this humor becomes more piquant and caustic, in proportion to the abundance of the discharge ; that it causes the nose to swell, which becomes inflamed and heated to such an extent that the heat may be felt when the hand is carried to it ? If the same fluxion continue long, the humor makes excoriations on this hard and fleshless part. This ardor is at length dissipated ; but how ? Not while the humor flows, and there is inflammation, but when the humor becomes thicker, less sharp, more concocted, and perfectly tempered."
"It is the same for all the other derangements that I suppose to proceed from the acridity and severe nature of the humors ; they cease only when the humors are all matured and tempered. How many times do we see fluxions from the eyes, caused by every sort of acridity, which ulcerates the lids, excoriates the cheeks, breaking up and destroying even the thick membrane that envelopes the pupil of the eye ! When and how do pains and inflammations here cease ? It is only after the humors have been matured, become denser, and have been changed into purulent matter. Now this coction is effected by the proper tempering of the humors."
The author cites still other examples, and concludes in these terms : " Must we not take, for the cause of a disease, that which, when appearing in one form, is invariably followed by this disease, then, changing, brings about a corresponding change in the state of the disease, and, at last, by disappearing, leaves the patient without any affection."
The rule here laid down to discern the causes of diseases, is not as well founded nor as infallible as the author thinks ; in following it without discernment, we would be liable frequently to take for the cause of a disease, that which is only an essential symptom or constant effect. Thus, in the examples reported above, the acrid humors which flow from the nose in coryza, and from the eyes attacked with ophthalmia, are nothing more than symptoms or effects, that accompany these affections nearly as constantly as the shadow does the body. The author is then mistaken in supposing these humors to be the causes of the concomitant diseases, and the pathogenetic rule that he has laid down admits of many exceptions. Nevertheless, his theory is less erroneous than any of the preceding that I have cited, because it never, or very rarely ever, forsakes observation ; while the others, disregarding observation, lose themselves almost immediately in the shadowy field of fictions. If it is untrue, to say that the humors which flow from the eyes and nose when these organs are diseased, are the primary causes of the disease, it is nevertheless certain that these humors give rise, at least, to some secondary accidents, such as ulceration of the lids, and margin of the nose, etc. They are thus at once cause and effect, as are all organic phenomena.
Neither has the author of the Treatise on Ancient Medicine totally overlooked the solid parts of the hody ; he says something of them in the last paragraphs, and insists on the necessity of studying their structure and configuration. If the reader finds the reflections of our physiologist, on this subject, deficient in development and depth, I shall not deny it ; but I will say, that it is also necessary to bear in mind the little advancement of the lights of his age on this branch of physiology. It must be recollected that at that epoch descriptive anatomy was in its infancy, and that pathological anatomy did not yet exist, from the impossibility of making regular dissections. This writer has done all which was possible to do in this respect. By insisting on the necessity of acquiring positive notions concerning the form and structure of organs, he has traced the route that should be followed, and which since has successfully been done.
Moreover, he did not overlook the influence of the vital force or the organic reaction on the development, progress, and termination of diseases. He speaks of it more or less explicitly in several places ; notably, when he recommends particular attention to be paid to the crises and critical days.
Thus, then, as I announced at the commencement of this chapter, we find in the book on Ancient Medicine, precious researches on the origin and progress of the Art ; a reasonable development of the experimental method already advised by Hippocrates ; the largest pathogenetic system which had yet appeared a system, in short, which may be summed up as follows : the causes of diseases must be sought in every agent that affects our constitution beyond certain limits, whether coming from without or residing within us.