the evolution of modern medicine-第14节
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st to grasp the conception of medicine as an art based on accurate observation； and an integral part of the science of man。 What could be more striking than the phrase in 〃The Law；〃 〃There are； in effect； two things； to know and to believe one knows； to know is science； to believe one knows is ignorance〃？＇23＇ But no single phrase in the writings can compare for directness with the famous aphorism which has gone into the literature of all lands： 〃Life is short and Art is long； the Occasion fleeting； Experience fallacious； and Judgment difficult。〃
＇23＇ Littre： OEuvres d'Hippocrate； Vol。 IV； pp。 641…642。
Everywhere one finds a strong； clear common sense； which refuses to be entangled either in theological or philosophical speculations。 What Socrates did for philosophy Hippocrates may be said to have done for medicine。 As Socrates devoted himself to ethics； and the application of right thinking to good conduct； so Hippocrates insisted upon the practical nature of the art； and in placing its highest good in the benefit of the patient。 Empiricism； experience； the collection of facts； the evidence of the senses； the avoidance of philosophical speculations； were the distinguishing features of Hippocratic medicine。 One of the most striking contributions of Hippocrates is the recognition that diseases are only part of the processes of nature； that there is nothing divine or sacred about them。 With reference to epilepsy；which was regarded as a sacred disease； he says； 〃It appears to me to be no wise more divine nor more sacred than other diseases； but has a natural cause from which it originates like other affections； men regard its nature and cause as divine from ignorance。〃 And in another place he remarks that each disease has its own nature； and that no one arises without a natural cause。 He seems to have been the first to grasp the conception of the great healing powers of nature。 In his long experience with the cures in the temples； he must have seen scores of instances in which the god had worked the miracle through the vis medicatrix naturae； and to the shrewd wisdom of his practical suggestions in treatment may be attributed in large part the extraordinary vogue which the great Coan has enjoyed for twenty…five centuries。 One may appreciate the veneration with which the Father of Medicine was regarded by the attribute 〃divine〃 which was usually attached to his name。 Listen to this for directness and honesty of speech taken from the work on the joints characterized by Littre as 〃the great surgical monument of antiquity〃： 〃I have written this down deliberately； believing it is valuable to learn of unsuccessful experiments； and to know the causes of their non…success。〃
The note of freedom is not less remarkable throughout the Hippocratic writings； and it is not easy to understand how a man brought up and practicing within the precincts of a famous AEsculapian temple could have divorced himself so wholly from the superstitions and vagaries of the cult。 There are probably grounds for Pliny's suggestion that he benefited by the receipts written in the temple； registered by the sick cured of any disease。 〃Afterwards；〃 Pliny goes on to remark in his characteristic way； 〃hee professed that course of Physicke which is called Clinice Wherby physicians found such sweetnesse that afterwards there was no measure nor end of fees〃 （〃Natural History；〃 XXIX； 1）。 There is no reference in the Hippocratic writings to divination； incubation sleep is not often mentioned； and charms； incantations or the practice of astrology but rarely。 Here and there we do find practices which jar upon modern feeling； but on the whole we feel in reading the Hippocratic writings nearer to their spirit than to that of the Arabians or of the many writers of the fifteenth and sixteenth centuries A。 D。 And it is not only against the thaumaturgic powers that the Hippocratic writings protested； but they express an equally active reaction against the excesses and defects of the new philosophy； a point brought out very clearly by Gomperz。＇24＇ He regards it as an undying glory of the school of Cos that after years of vague； restless speculation it introduces steady sedentary habits into the intellectual life of mankind。 〃 'Fiction to the right！ Reality to the left！' was the battle…cry of this school in the war they were the first to wage against the excesses and defects of the nature…philosophy。 〃Though the protest was effective in certain directions； we shall see that the authors of the Hippocratic writings could not entirely escape from the hypotheses of the older philosophers。
＇24＇ Gomperz： Greek Thinkers； Vol。 I； p。 296。
I can do no more than indicate in the briefest possible way some of the more important views ascribed to Hippocrates。 We cannot touch upon the disputes between the Coan and Cnidian schools。＇25＇ You must bear in mind that the Greeks at this time had no human anatomy。 Dissections were impossible； their physiology was of the crudest character； strongly dominated by the philosophies。 Empedocles regarded the four elements； fire； air； earth and water； as 〃the roots of all things；〃 and this became the corner stone in the humoral pathology of Hippocrates。 As in the Macrocosm the world at large there were four elements； fire； air； earth； and water； so in the Microcosmthe world of man's bodythere were four humors （elements）； viz。；blood； phlegm； yellow bile （or choler） and black bile （or melancholy）；and they corresponded to the four qualities of matter； heat； cold； dryness and moisture。 For more than two thousand years these views prevailed。 In his 〃Regiment of Life〃 （1546） Thomas Phaer says：〃。 。 。 which humours are called ye sones of the Elements because they be complexioned like the foure Elements； for like as the Ayre is hot and moyst： so is the blooud； hote and moyste。 And as Fyer is hote and dry： so is Cholere hote and dry。 And as water is colde and moyst：so is fleume colde and moyste。 And as the Earth is colde and dry： so Melancholy is colde and dry。〃＇26＇
＇25＇ The student who wishes a fuller account is referred to the histories of （a） Neuburger； Vol。 1； Oxford； 1910； （b） Withington； London； 1894。
＇26＇ Thomas Phaer： Regiment of Life； London； 1546。
As the famous Regimen Sanitatis of Salernum； the popular family hand…book of the Middle Ages； says：
Foure Humours raigne within our bodies wholly； And these compared to foure elements。＇27＇
＇27＇ The Englishman's Doctor； or the Schoole of Salerne； Sir John Harington's translation； London； 1608； p。 2。 Edited by Francis R。 Packard； New York； 1920； p。 132。 Harington's book originally appeared dated： London 1607。 （Hoe copy in the Henry E。 Huntington Library。）
According to Littre； there is nowhere so strong a statement of these views in the genuine works of Hippocrates； but they are found at large in the Hippocratic writings； and nothing can be clearer than the following statement from the work 〃The Nature of Man〃： 〃The body of man contains in itself blood and phlegm and yellow bile and black bile； which things are in the natural constitution of his body； and the cause of sickness and of health。 He is healthy when they are in proper proportion between one another as regards mixture and force and quantity； and when they are well mingled together； he becomes sick when one of these is diminished or increased in amount； or is separated in the body from its proper mixture； and not properly mingled with all the others。〃 No words could more clearly express the views of disease which； as I mentioned； prevailed until quite recent years。 The black bile； melancholy； has given us a great word in the language； and that we have not yet escaped from the humoral pathology of Hippocrates is witnessed by the common expression of biliousness〃too much bile〃 or 〃he has a touch of the liver。〃 The humors； imperfectly mingled； prove irritant in the body。 They are kept in due proportion by the innate heat which； by a sort of internal coction gradually changes the humors to their proper proportion。 Whatever may be the primary cause of the change in the humors manifesting itself in disease； the innate heat； or as Hippocrates terms it； the nature of the body itself； tends to restore conditions to the norm； and this change occurring suddenly； or abruptly； he calls the 〃crisis；〃 which is accomplished on some special day of the disease； and is often accompanied by a critical discharge； or by a drop in the body temperature。 The evil； or superabundant； humors were discharged and this view of a special materies morbi； to be got rid of by a natural processor a crisis； dominated pathology until quite recently。 Hippocrates had a great belief in the power of nature； the vis medicatrix naturae； to restore the normal state。 A keen observer and an active practitioner； his views of disease； thus hastily sketched； dominated the profession for twenty…five centuries； indeed； echoes of his theories are still heard in the schools； and his very words are daily on our lips。 If asked what was the great contribution to medicine of Hippocrates and his school we could answerthe art of careful observation。
In the Hippocratic writings is summed up the experience of Greece to the Golden Age of Pericles。 Out of philosophy； out of a
