the evolution of modern medicine-第15节
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In the Hippocratic writings is summed up the experience of Greece to the Golden Age of Pericles。 Out of philosophy； out of abstract speculation； had come a way of looking at nature for which the physicians were mainly responsible； and which has changed forever men's views on disease。 Medicine broke its leading strings to religion and philosophya tottering； though lusty； child whose fortunes we are to follow in these lectures。 I have a feeling that； could we know more of the medical history of the older races of which I spoke in the first lecture； we might find that this was not the first…born of Asklepios；that there had been many premature births； many still…born offspring； even live…births the products of the fertilization of nature by the human mind； but the record is dark； and the infant was cast out like Israel in the chapter of Isaiah。 But the high…water mark of mental achievement had not been reached by the great generation in which Hippocrates had labored。 Socrates had been dead sixteen years； and Plato was a man of forty…five； when far away in the north in the little town of Stagira； on the peninsula of Mount Athos in Macedoniawas； in 384 B。C。； born a 〃man of men；〃 the one above all others to whom the phrase of Milton may be applied。 The child of an Asklepiad； Nicomachus； physician to the father of Philip； there must have been a rare conjunction of the planets at the birth of the great Stagirite。 In the first circle of the 〃Inferno；〃 Virgil leads Dante into a wonderful company； 〃star…seated〃 on the verdure （he says）the philosophic family looking with reverence on 〃the Master of those who know〃il maestro di color che sanno。＇28＇ And with justice has Aristotle been so regarded for these twenty…three centuries。 No man has ever swayed such an intellectual empirein logic； metaphysics； rhetoric； psychology； ethics； poetry； politics and natural history； in all a creator； and in all still a master。 The history of the human mindoffers no parallel to his career。 As the creator of the sciences of comparative anatomy； systematic zoology； embryology； teratology； botany and physiology； his writings have an eternal interest。 They present an extraordinary accumulation of facts relating to the structure and functions of various parts of the body。 It is an unceasing wonder how one man； even with a school of devoted students； could have done so much。
＇28＇ The 〃Good collector of qualities；〃 Dioscorides； Hippocrates； Avicenna； Galen and Averroes were the medical members of the group。 Dante； Inferno； canto iv。
Dissectionalready practiced by Alcmaeon； Democritus； Diogenes and otherswas conducted on a large scale； but the human body was still taboo。 Aristotle confesses that the 〃inward parts of man are known least of all；〃 and he had never seen the human kidneys or uterus。 In his physiology； I can refer to but one pointthe pivotal question of the heart and blood vessels。 To Aristotle the heart was the central organ controlling the circulation； the seat of vitality； the source of the blood； the place in which it received its final elaboration and impregnation with animal heat。 The blood was contained in the heart and vessels as in a vasehence the use of the term 〃vessel。〃 〃From the heart the blood…vessels extend throughout the body as in the anatomical diagrams which are represented on the walls； for the parts lie round these because they are formed out of them。〃＇29＇ The nutriment oozes through the blood vessels and the passages in each of the parts 〃like water in unbaked pottery。〃 He did not recognize any distinction between arteries and veins； calling both plebes （Littre）； the vena cave is the great vessel； and the aorta the smaller； but both contain blood。 He did not use the word 〃arteria〃 （arthria） for either of them。 There was no movement from the heart to the vessels but the blood was incessantly drawn upon by the substance of the body and as unceasingly renewed by absorption of the products of digestion；the mesenteric vessels taking up nutriment very much as the plants take theirs by the roots from the soil。 From the lungs was absorbed the pneuma； or spiritus； which was conveyed to the heart by the pulmonary vesselsone to the right； and one to the left side。 These vessels in the lungs； 〃through mutual contact〃 with the branches of the trachea； took in the pneuma。 A point of interest is that the windpipe；or trachea； is called 〃arteria；〃 both by Aristotle and by Hippocrates （〃Anatomy；〃 Littre； VIII； 539）。 It was the air…tube； disseminating the breath through the lungs。 We shall see in a few minutes how the term came to be applied to the arteries； as we know them。 The pulsation of the heart and arteries was regarded by Aristotle as a sort of ebullition in which the liquids were inflated by the vital or innate heat； the fires of which were cooled by the pneuma taken in by the lungs and carried to the heart by the pulmonary vessels。
＇29＇ De Generatione Animalium； Oxford translation； Bk。 II； Chap。 6； Works V； 743 a。
In Vol。 IV of Gomperz' 〃Greek Thinkers；〃 you will find an admirable discussion on Aristotle as an investigator of nature； and those of you who wish to study his natural history works more closely may do so easilyin the new translation which is in process of publication by the Clarendon Press； Oxford。 At the end of the chapter 〃De Respiratione〃in the 〃Parva Naturalia〃 （Oxford edition； 1908）； we have Aristotle's attitude towards medicine expressed in a way worthy of a son of the profession：
〃But health and disease also claim the attention of the scientist； and not merely of the physician； in so far as an account of their causes is concerned。 The extent to which these two differ and investigate diverse provinces must not escape us； since facts show that their inquiries are； at least to a certain extent； conterminous。 For physicians of culture and refinement make some mention of natural science；and claim to derive their principles from it； while the most accomplished investigators into nature generally push their studies so far as to conclude with an account of medical principles。〃 （Works； III；480 b。）
Theophrastus； a student of Aristotle and his successor； created the science of botany and made possible the pharmacologists of a few centuries later。 Some of you doubtless know him in another guiseas the author of the golden booklet on 〃Characters；〃 in which 〃the most eminent botanist of antiquity observes the doings of men with the keen and unerring vision of a natural historian〃 （Gomperz）。 In the Hippocratic writings； there are mentioned 236 plants； in the botany of Theophrastus； 455。 To one trait of master and pupil I must referthe human feeling； not alone of man for man； but a sympathy that even claims kinship with the animal world。 〃The spirit with which he （Theophrastus） regarded the animal world found no second expression till the present age〃 （Gomperz）。 Halliday； however；makes the statement that Porphyry＇30＇ goes as far as any modern humanitarian in preaching our duty towards animals。
＇30＇ W。 R。 Halliday： Greek Divination； London； Macmillan & Co。； 1913。
ALEXANDRIAN SCHOOL
FROM the death of Hippocrates about the year 375 B。C。 till the founding of the Alexandrian School； the physicians were engrossed largely in speculative views； and not much real progress was made； except in the matter of elaborating the humoral pathology。 Only three or four men of the first rank stand out in this period： Diocles the Carystian； 〃both in time and reputation next and second to Hippocrates〃 （Pliny）； a keen anatomist and an encyclopaedic writer； but only scanty fragments of his work remain。 In some ways the most important member of this group was Praxagoras； a native of Cos； about 340 B。C。 Aristotle； you remember； made no essential distinction between arteries and veins； both of which he held to contain blood： Praxagoras recognized that the pulsation was only in the arteries； and maintained that only the veins contained blood； and the arteries air。 As a rule the arteries are empty after death； and Praxagoras believed that they were filled with an aeriform fluid； a sort of pneuma； which was responsible for their pulsation。 The word arteria； which had already been applied to the trachea； as an air…containing tube； was then attached to the arteries； on account of the rough and uneven character of its walls the trachea was then called the arteria tracheia； or the rough air…tube。＇31a＇ We call it simply the trachea； but in French the word trachee…artere is still used。
＇31a＇ Galen： De usu partium； VII； Chaps。 8…9。
Praxagoras was one of the first to make an exhaustive study of the pulse； and he must have been a man of considerable clinical acumen；as well as boldness； to recommend in obstruction of the bowels the opening of the abdomen； removal of the obstructed portion and uniting the ends of the intestine by sutures。
After the death of Alexander； Egypt fell into the hands of his famous general； Ptolemy； under whose care the city became one of the most important on the Mediterranean。 He founded and maintained a museum； an establishment that corresponded very much to a modern university； for the study of literature； science and the arts。 Under his successors； particularly the third Ptolemy； the museum develop
