The Evolution of Modern Medicine Part 2

Of all the organs inspected in a sacrificial animal the liver, from its size, position and richness in blood, impressed the early observers as the most important of the body. Probably on account of the richness in blood it came to be regarded as the seat of life--indeed, the seat of the soul. From this important position the liver was not dislodged for many centuries, and in the Galenic physiology it shared with the heart and the brain in the triple control of the natural, animal and vital spirits. Many expressions in literature indicate how persistent was this belief. Among the Babylonians, the word "liver" was used in hymns and other compositions precisely as we use the word "heart," and Jastrow gives a number of ill.u.s.trations from Hebrew, Greek and Latin sources ill.u.s.trating this usage.

The belief arose that through the inspection of this important organ in the sacrificial animal the course of future events could be predicted.

"The life or soul, as the seat of life, in the sacrificial animal is, therefore, the divine element in the animal, and the G.o.d in accepting the animal, which is involved in the act of bringing it as an offering to a G.o.d, identifies himself with the animal--becomes, as it were, one with it. The life in the animal is a reflection of his own life, and since the fate of men rests with the G.o.ds, if one can succeed in entering into the mind of a G.o.d, and thus ascertain what he purposes to do, the key for the solution of the problem as to what the future has in store will have been found. The liver being the centre of vitality--the seat of the mind, therefore, as well as of the emotions--it becomes in the case of the sacrificial animal, either directly identical with the mind of the G.o.d who accepts the animal, or, at all events, a mirror in which the G.o.d's mind is reflected; or, to use another figure, a watch regulated to be in sympathetic and perfect accord with a second watch.

If, therefore, one can read the liver of the sacrificial animal, one enters, as it were, into the workshop of the divine will."(15)

(15) Morris Jastrow: loc. cit., p. 122.

Hepatoscopy thus became, among the Babylonians, of extraordinary complexity, and the organ of the sheep was studied and figured as early as 3000 B.C. In the divination rites, the lobes, the gall-bladder, the appendages of the upper lobe and the markings were all inspected with unusual care. The earliest known anatomical model, which is here shown, is the clay model of a sheep's liver with the divination text dating from about 2000 B.C., from which Jastrow has worked out the modern anatomical equivalents of the Babylonian terms. To reach a decision on any point, the phenomena of the inspection of the liver were carefully recorded, and the interpretations rested on a more or less natural and original a.s.sociation of ideas. Thus, if the gall-bladder were swollen on the right side, it pointed to an increase in the strength of the King's army, and was favorable; if on the left side, it indicated rather success of the enemy, and was unfavorable. If the bile duct was long, it pointed to a long life. Gallstones are not infrequently mentioned in the divination texts and might be favorable, or unfavorable. Various interpretations were gathered by the scribes in the reference note-books which serve as guides for the interpretation of the omens and for text-books of instructions in the temple schools (Jastrow).

The art of divination spread widely among the neighboring nations. There are many references in the Bible to the practice. The elders of Moab and Midian came to Balaam "with the rewards of divination in their hand"

(Numbers xxii, 7). Joseph's cup of divination was found in Benjamin's sack (Genesis xliv, 5, 12); and in Ezekiel (xxi, 21) the King of Babylon stood at the parting of the way and looked in the liver. Hepatoscopy was also practiced by the Etruscans, and from them it pa.s.sed to the Greeks and the Romans, among whom it degenerated into a more or less meaningless form. But Jastrow states that in Babylonia and a.s.syria, where for several thousand years the liver was consistently employed as the sole organ of divination, there are no traces of the rite having fallen into decay, or having been abused by the priests.

In Roman times, Philostratus gives an account of the trial of Apollonius of Tyana,(16) accused of human hepatoscopy by sacrificing a boy in the practice of magic arts against the Emperor. "The liver, which the experts say is the very tripod of their art, does not consist of pure blood; for the heart retains all the uncontaminated blood, and irrigates the whole body with it by the conduits of the arteries; whereas the gall, which is situated next the liver, is stimulated by anger and depressed by fear into the hollows of the liver."

We have seen how early and how widespread was the belief in amulets and charms against the occult powers of darkness. One that has persisted with extraordinary tenacity is the belief in the Evil Eye the power of certain individuals to injure with a look. Of general belief in the older civilizations, and referred to in several places in the Bible, it pa.s.sed to Greece and Rome, and today is still held fervently in many parts of Europe. The sign of "le corna,"--the first and fourth fingers extended, the others turned down and the thumb closed over them,--still used against the Evil Eye in Italy, was a mystic sign used by the Romans in the festival of Lemuralia. And we meet with the belief also in this country. A child with hemiplegia, at the Infirmary for Diseases of the Nervous System, Philadelphia, from the central part of Pennsylvania, was believed by its parents to have had the Evil Eye cast upon it.

The second contribution of Babylonia and a.s.syria to medicine--one that affected mankind profoundly--relates to the supposed influence of the heavenly bodies upon man's welfare. A belief that the stars in their courses fought for or against him arose early in their civilizations, and directly out of their studies on astrology and mathematics. The Macrocosm, the heavens that "declare the glory of G.o.d," reflect, as in a mirror, the Microcosm, the daily life of man on earth. The first step was the identification of the sun, moon and stars with the G.o.ds of the pantheon. a.s.syrian astronomical observations show an extraordinary development of practical knowledge. The movements of the sun and moon and of the planets were studied; the a.s.syrians knew the precession of the equinoxes and many of the fundamental laws of astronomy, and the modern nomenclature dates from their findings. In their days the signs of the zodiac corresponded practically with the twelve constellations whose names they still bear, each division being represented by the symbol of some G.o.d, as the Scorpion, the Ram, the Twins, etc. "Changes in the heavens ... portended changes on earth. The Biblical expression 'hosts of heaven' for the starry universe admirably reflects the conception held by the Babylonian astrologers. Moon, planets and stars const.i.tuted an army in constant activity, executing military manoeuvres which were the result of deliberation and which had in view a fixed purpose. It was the function of the priest--the barqu, or 'inspector,'

as the astrologer as well as the 'inspector' of the liver was called--to discover this purpose. In order to do so, a system of interpretation was evolved, less logical and less elaborate than the system of hepatoscopy, which was a.n.a.lyzed in the preceding chapter, but nevertheless meriting attention both as an example of the pathetic yearning of men to peer into the minds of the G.o.ds, and of the influence that Babylonian-a.s.syrian astrology exerted throughout the ancient world"

(Jastrow).(17)

(16) Philostratus: Apollonius of Tyana, Bk. VIII, Chap.

VII, Phillimore's transl., Oxford, 1912, II, 233. See, also, Justin: Apologies, edited by Louis Pautigny, Paris, 1904, p. 39.

(17) M. Jastrow: Aspects of Religious Belief and Practice in Babylonia and a.s.syria, New York, 1911, p. 210.

With the rationalizing influence of the Persians the hold of astrology weakened, and according to Jastrow it was this, in combination with Hebrew and Greek modes of thought, that led the priests in the three centuries following the Persian occupation, to exchange their profession of diviners for that of astronomers; and this, he says, marks the beginning of the conflict between religion and science. At first an expression of primitive "science," astrology became a superst.i.tion, from which the human mind has not yet escaped. In contrast to divination, astrology does not seem to have made much impression on the Hebrews and definite references in the Bible are scanty. From Babylonia it pa.s.sed to Greece (without, however, exerting any particular influence upon Greek medicine). Our own language is rich in words of astral significance derived from the Greek, e.g., disaster.

The introduction of astrology into Europe has a pa.s.sing interest.

Apparently the Greeks had made important advances in astronomy before coming in contact with the Babylonians,--who, in all probability, received from the former a scientific conception of the universe. "In Babylonia and a.s.syria we have astrology first and astronomy afterwards, in Greece we have the sequence reversed--astronomy first and astrology afterwards" (Jastrow).(18)

(18) M. Jastrow: Aspects of Religious Belief and Practice in Babylonia and a.s.syria, New York, 1911, p. 256.

It is surprising to learn that, previous to their contact with the Greeks, astrology as relating to the individual--that is to say, the reading of the stars to determine the conditions under which the individual was born--had no place in the cult of the Babylonians and a.s.syrians. The individualistic spirit led the Greek to make his G.o.ds take note of every action in his life, and his preordained fate might be read in the stars.--"A connecting link between the individual and the movements in the heavens was found in an element which they shared in common. Both man and stars moved in obedience to forces from which there was no escape. An inexorable law controlling the planets corresponded to an equally inexorable fate ordained for every individual from his birth.

Man was a part of nature and subject to its laws. The thought could therefore arise that, if the conditions in the heavens were studied under which a man was born, that man's future could be determined in accord with the beliefs a.s.sociated with the position of the planets rising or visible at the time of birth or, according to other views, at the time of conception. These views take us back directly to the system of astrology developed by Babylonian baru priests. The basis on which the modified Greek system rests is likewise the same that we have observed in Babylonia--a correspondence between heaven and earth, but with this important difference, that instead of the caprice of the G.o.ds we have the unalterable fate controlling the entire universe--the movements of the heavens and the life of the individual alike"

(Jastrow).(19)

(19) Ibid., pp. 257-258.

From this time on until the Renaissance, like a shadow, astrology follows astronomy. Regarded as two aspects of the same subject, the one, natural astrology, the equivalent of astronomy, was concerned with the study of the heavens, the other, judicial astrology, was concerned with the casting of horoscopes, and reading in the stars the fate of the individual.

As I mentioned, Greek science in its palmy days seems to have been very free from the bad features of astrology. Gilbert Murray remarks that "astrology fell upon the h.e.l.lenistic mind as a new disease falls upon some remote island people." But in the Greek conquest of the Roman mind, astrology took a prominent role. It came to Rome as part of the great h.e.l.lenizing movement, and the strength of its growth may be gauged from the edicts issued against astrologers as early as the middle of the second century B.C. In his introduction to his recent edition of Book II of the Astronomicon of Manilius, Garrod traces the growth of the cult, which under the Empire had an extraordinary vogue. "Though these (heavenly) signs be far removed from us, yet does he (the G.o.d) so make their influences felt, that they give to nations their life and their fate and to each man his own character."(20) Oracles were sought on all occasions, from the planting of a tree to the mating of a horse, and the doctrine of the stars influenced deeply all phases of popular thought and religion. The professional astrologers, as Pliny(21) says, were Chaldeans, Egyptians and Greeks. The Etruscans, too, the professional diviners of Rome, cultivated the science. Many of these "Isiaci conjectores" and "astrologi de circo" were worthless charlatans, but on the whole the science seems to have attracted the attention of thoughtful men of the period. Garrod quotes the following remarkable pa.s.sage from Tacitus: "My judgment wavers," he says, "I dare not say whether it be fate and necessity immutable which governs the changing course of human affairs--or just chance. Among the wisest of the ancients, as well as among their apes, you will find a conflict of opinion. Many hold fixedly the idea that our beginning and our end--that man himself--is nothing to the G.o.ds at all. The wicked are in prosperity and the good meet tribulation. Others believe that Fate and the facts of this world work together. But this connection they trace not to planetary influences but to a concatenation of natural causes. We choose our life that is free: but the choice once made, what awaits us is fixed and ordered. Good and evil are different from the vulgar opinion of them. Often those who seem to battle with adversity are to be accounted blessed; but the many, even in their prosperity, are miserable. It needs only to bear misfortune bravely, while the fool perishes in his wealth.

Outside these rival schools stands the man in the street. No one will take from him his conviction that at our birth are fixed for us the things that shall be. If some things fall out differently from what was foretold, that is due to the deceit of men that speak what they know not: calling into contempt a science to which past and present alike bear a glorious testimony" (Ann. vi, 22).

(20) Manili Astronomicon Liber II, ed. H. W. Garrod, Oxford, 1911, p. lxix, and II, ll. 84-86.

(21) Pliny: Natural History, Bk. XVIII, Chap. XXV, Sect.

57.

Cato waged war on the Greek physicians and forbade "his uilicus all resort to haruspicem, augurem, hariolum Chaldaeum," but in vain; so widespread became the belief that the great philosopher, Panaetius (who died about 111 B.C.), and two of his friends alone among the stoics, rejected the claims of astrology as a science (Garrod). So closely related was the subject of mathematics that it, too, fell into disfavor, and in the Theodosian code sentence of death was pa.s.sed upon mathematicians. Long into the Middle Ages, the same unholy alliance with astrology and divination caused mathematics to be regarded with suspicion, and even Abelard calls it a nefarious study.

The third important feature in Babylonian medicine is the evidence afforded by the famous Hammurabi Code (circa 2000 B.C.)--a body of laws, civil and religious, many of which relate to the medical profession.

This extraordinary doc.u.ment is a black diorite block 8 feet high, once containing 21 columns on the obverse, 16 and 28 columns on the reverse, with 2540 lines of writing of which now 1114 remain, and surmounted by the figure of the king receiving the law from the Sun-G.o.d. Copies of this were set up in Babylon "that anyone oppressed or injured, who had a tale of woe to tell, might come and stand before his image, that of a king of righteousness, and there read the priceless orders of the King, and from the written monument solve his problem" (Jastrow). From the enactments of the code we gather that the medical profession must have been in a highly organized state, for not only was practice regulated in detail, but a scale of fees was laid down, and penalties exacted for malpraxis. Operations were performed, and the veterinary art was recognized. An interesting feature, from which it is lucky that we have in these days escaped, is the application of the "lex talionis"--an eye for an eye, bone for a bone, and tooth for a tooth, which is a striking feature of the code.

Some of the laws of the code may be quoted:

Paragraph 215. If a doctor has treated a gentleman for a severe wound with a bronze lances and has cured the man, or has opened an abscess of the eye for a gentleman with the bronze lances and has cured the eye of the gentleman, he shall take ten shekels of silver.

218. If the doctor has treated a gentleman for a severe wound with a lances of bronze and has caused the gentleman to die, or has opened an abscess of the eye for a gentleman and has caused the loss of the gentleman's eye, one shall cut off his hands.

219. If a doctor has treated the severe wound of a slave of a poor man with a bronze lances and has caused his death, he shall render slave for slave.

220. If he has opened his abscess with a bronze lances and has made him lose his eye, he shall pay money, half his price.

221. If a doctor has cured the shattered limb of a gentleman, or has cured the diseased bowel, the patient shall give five shekels of silver to the doctor.

224. If a cow doctor or a sheep doctor has treated a cow or a sheep for a severe wound and cured it, the owner of the cow or sheep shall give one-sixth of a shekel of silver to the doctor as his fee.(22)

(22) The Oldest Code of Laws in the World; translated by C.

H. W. Johns, Edinburgh, 1903.

HEBREW MEDICINE

THE medicine of the Old Testament betrays both Egyptian and Babylonian influences; the social hygiene is a reflex of regulations the origin of which may be traced in the Pyramid Texts and in the papyri. The regulations in the Pentateuch codes revert in part to primitive times, in part represent advanced views of hygiene. There are doubts if the Pentateuch code really goes back to the days of Moses, but certainly someone "learned in the wisdom of the Egyptians" drew it up. As Neuburger briefly summarizes:

"The commands concern prophylaxis and suppression of epidemics, suppression of venereal disease and prost.i.tution, care of the skin, baths, food, housing and clothing, regulation of labour, s.e.xual life, discipline of the people, etc. Many of these commands, such as Sabbath rest, circ.u.mcision, laws concerning food (interdiction of blood and pork), measures concerning menstruating and lying-in women and those suffering from gonorrhoea, isolation of lepers, and hygiene of the camp, are, in view of the conditions of the climate, surprisingly rational."(23)

(23) Neuburger: History of Medicine, Oxford University Press, 1910, Vol. I, p. 38.

Divination, not very widely practiced, was borrowed, no doubt, from Babylonia. Joseph's cup was used for the purpose, and in Numbers, the elders of Balak went to Balaam with the rewards of divination in their hands. The belief in enchantments and witchcraft was universal, and the strong enactments against witches in the Old Testament made a belief in them almost imperative until more rational beliefs came into vogue in the eighteenth and nineteenth centuries.

Whatever view we may take of it, the medicine of the New Testament is full of interest. Divination is only referred to once in the Acts (xvi, 16), where a damsel is said to be possessed of a spirit of divination "which brought her masters much gain by soothsaying." There is only one mention of astrology (Acts vii, 43); there are no witches, neither are there charms or incantations. The diseases mentioned are numerous: demoniac possession, convulsions, paralysis, skin diseases,--as leprosy,--dropsy, haemorrhages, fever, fluxes, blindness and deafness.

And the cure is simple usually a fiat of the Lord, rarely with a prayer, or with the use of means such as spittle. They are all miraculous, and the same power was granted to the apostles--"power against unclean spirits, to cast them out, to heal all manner of sickness and all manner of disease." And more than this, not only the blind received their sight, the lame walked, the lepers were cleansed, the deaf heard, but even the dead were raised up. No question of the mandate. He who went about doing good was a physician of the body as well as of the soul, and could the rich promises of the Gospel have been fulfilled, there would have been no need of a new dispensation of science. It may be because the children of this world have never been able to accept its hard sayings--the insistence upon poverty, upon humility, upon peace that Christianity has lost touch no less with the practice than with the principles of its Founder. Yet, all through the centuries, the Church has never wholly abandoned the claim to apostolic healing; nor is there any reason why she should. To the miraculous there should be no time limit--only conditions have changed and nowadays to have a mountain-moving faith is not easy. Still, the possession is cherished, and it adds enormously to the spice and variety of life to know that men of great intelligence, for example, my good friend, Dr. James J. Walsh of New York, believe in the miracles of Lourdes.(24) Only a few weeks ago, the Bishop of London followed with great success, it is said, the practice of St. James. It does not really concern us much--as Oriental views of disease and its cure have had very little influence on the evolution of scientific medicine--except in ill.u.s.tration of the persistence of an att.i.tude towards disease always widely prevalent, and, indeed, increasing. Nor can we say that the medicine of our great colleague, St. Luke, the Beloved Physician, whose praise is in the Gospels, differs so fundamentally from that of the other writings of the New Testament that we can claim for it a scientific quality. The stories of the miracles have technical terms and are in a language adorned by medical phraseology, but the mental att.i.tude towards disease is certainly not that of a follower of Hippocrates, nor even of a scientifically trained contemporary of Dioscorides.(25)

(24) Psychotherapy, New York, 1919, p. 79, "I am convinced that miracles happen there. There is more than natural power manifest."

(25) See Luke the Physician, by Harnack, English ed., 1907, and W. K. Hobart, The Medical Language of St. Luke, 1882.

CHINESE AND j.a.pANESE MEDICINE

CHINESE medicine ill.u.s.trates the condition at which a highly intellectual people may arrive, among whom thought and speculation were restricted by religious prohibitions. Perhaps the chief interest in its study lies in the fact that we may see today the persistence of views about disease similar to those which prevailed in ancient Egypt and Babylonia. The Chinese believe in a universal animism, all parts being animated by G.o.ds and spectres, and devils swarm everywhere in numbers incalculable. The universe was spontaneously created by the operation of its Tao, "composed of two souls, the Yang and the Yin; the Yang represents light, warmth, production, and life, as also the celestial sphere from which all those blessings emanate; the Yin is darkness, cold, death, and the earth, which, unless animated by the Yang or heaven, is dark, cold, dead. The Yang and the Yin are divided into an infinite number of spirits respectively good and bad, called shen and kwei; every man and every living being contains a shen and a kwei, infused at birth, and departing at death, to return to the Yang and the Yin. Thus man with his dualistic soul is a microcosmos, born from the Macrocosmos spontaneously. Even every object is animated, as well as the Universe of which it is a part."(26)

(26) J. J. M. de Groot: Religious System of China, Vol. VI, Leyden, 1910, p. 929.