the evolution of modern medicine(现代医药的演变)-第17章
按键盘上方向键 ← 或 → 可快速上下翻页，按键盘上的 Enter 键可回到本书目录页，按键盘上方向键 ↑ 可回到本页顶部！
————未阅读完？加入书签已便下次继续阅读！
once increased in rapidity and became irregular。 On the next day he
64
… Page 65…
THE EVOLUTION OF MODERN MEDICINE
arranged that the name of another actor； Morphus； should be mentioned；
and on the third day the experiment was repeated but without effect。 Then
on the fourth evening it was again mentioned that Pylades was dancing；
and the pulse quickened and became irregular； so he concluded that she
was in love with Pylades。 He tells how he was first called to treat the
Emperor Marcus Aurelius； who had a stomach…ache after eating too much
cheese。 He treated the case so successfully that the Emperor remarked； 〃I
have but one physician； and he is a gentleman。〃 He seems to have had
good fees； as he received 400 aurei （about 2000） for a fortnight's
attendance upon the wife of Boethus。
He left Rome for a time in 168 A。 D。 and returned to Pergamon； but
was recalled to Rome by the Emperor； whom he accompanied on an
expedition to Germany。 There are records in his writings of many journeys；
and busy with his practice in dissections and experiments he passed a long
and energetic life； dying； according to most authorities； in the year 200
A。D。
A sketch of the state of medicine in Rome is given by Celsus in the
first of his eight books； and he mentions the names of many of the leading
practitioners； particularly Asclepiades； the Bithynian； a man of great
ability； and a follower of the Alexandrians； who regarded all disease as due
to a disturbed movement of the atoms。 Diet； exercise； massage and bathing
were his great remedies； and his mottotuto； cito et jucundehas been the
emulation of all physicians。 How important a role he and his successors
played until the time of Galen may be gathered from the learned lectures
of Sir Clifford Allbutt＇32＇ on 〃Greek Medicine in Rome〃 and from Meyer…
Steineg's 〃Theodorus Priscianus und die romische Medizin。〃＇33＇ From
certain lay writers we learn that it was the custom for popular physicians
to be followed on their rounds by crowds of students。 Martial's epigram （V；
ix） is often referred to：
Languebam： sed tu comitatus protinus ad me Venisti centum；
Symmache； discipulis。 Centum me tegigere manus Aquilone gelatae Non
habui febrem； Symmache； nunc habeo。
＇32＇ Allbutt： British Medical Journal； London； 1909； ii； 1449； 1515；
1598。
65
… Page 66…
THE EVOLUTION OF MODERN MEDICINE
＇33＇ Fischer； Jena； 1909。
And in the 〃Apollonius of Tyana〃 by Philostratus； when Apollonius
wishes to prove an alibi； he calls to witness the physicians of his sick
friend； Seleucus and Straloctes； who were accompanied by their clinical
class to the number of about thirty students。＇34＇ But for a first…hand sketch
of the condition of the profession we must go to Pliny； whose account in
the twenty…ninth book of the 〃Natural History〃 is one of the most
interesting and amusing chapters in that delightful work。 He quotes Cato's
tirade against Greek physicians；corrupters of the race； whom he would
have banished from the city；then he sketches the career of some of the
more famous of the physicians under the Empire； some of whom must
have had incomes never approached at any other period in the history of
medicine。 The chapter gives a good picture of the stage on which Galen
（practically a contemporary of Pliny） was to play so important a role。
Pliny seems himself to have been rather disgusted with the devious paths
of the doctors of his day； and there is no one who has touched with
stronger language upon the weak points of the art of physic。 In one place
he says that it alone has this peculiar art and privilege； 〃That whosoever
professeth himself a physician； is straightwaies beleeved； say what he will：
and yet to speake a truth； there are no lies dearer sold or more daungerous
than those which proceed out of a Physician's mouth。 Howbeit； we never
once regard or look to that； so blind we are in our deepe persuasion of
them； and feed our selves each one in a sweet hope and plausible conceit
of our health by them。 Moreover； this mischief there is besides； That there
is no law or statute to punish the ignorance of blind Physicians； though a
man lost his life by them： neither was there ever any man knowne； who
had revenge of recompence for the evill intreating or misusage under their
hands。 They learne their skill by endaungering our lives： and to make
proofe and experiments of their medicines； they care not to kill us。〃＇35＇
He says it is hard that； while the judges are carefully chosen and selected；
physicians are practically their own judges； and that of the men who may
give us a quick despatch and send us to Heaven or Hell； no enquiry or
examination is made of their quality and worthiness。 It is interesting to
read so early a bitter criticism of the famous 〃Theriaca；〃 a great compound
66
… Page 67…
THE EVOLUTION OF MODERN MEDICINE
medicine invented by Antiochus III； which had a vogue for fifteen hundred
years。
＇34＇ Bk。 VIII； Chap。 VII。
＇35＇ Pliny： Natural History （XXIX； 1）； Philemon Holland's version；
London； 1601； II； 347。
But we must return to Galen and his works； which comprise the most
voluminous body of writings left by any of the ancients。 The great edition
is that in twenty…two volumes by Kuhn （1821…1833）。 The most useful
editions are the 〃Juntines〃 of Venice； which were issued in thirteen
editions。 In the fourth and subsequent editions a very useful index by
Brassavola is included。 A critical study of the writings is at present being
made by German scholars for the Prussian Academy； which will issue a
definitive edition of his works。
Galen had an eclectic mind and could not identify himself with any of
the prevailing schools； but regarded himself as a disciple of Hippocrates。
For our purpose； both his philosophy and his practice are of minor interest
in comparison with his great labors in anatomy and physiology。
In anatomy； he was a pupil of the Alexandrians to whom he constantly
refers。 Times must have changed since the days of Herophilus； as Galen
does not seem ever to have had an opportunity of dissecting the human
body； and he laments the prejudice which prevents it。 In the study of
osteology； he urges the student to be on the lookout for an occasional
human bone exposed in a graveyard； and on one occasion he tells of
finding the carcass of a robber with the bones picked bare by birds and
beasts。 Failing this source； he advises the student to go to Alexandria；
where there were still two skeletons。 He himself dissected chiefly apes and
pigs。 His osteology was admirable； and his little tractate 〃De Ossibus〃
could； with very few changes； be used today by a hygiene class as a
manual。 His description of the muscles and of the organs is very full；
covering； of course； many sins of omission and of commission； but it was
the culmination of the study of the subject by Greek physicians。
His work as a physiologist was even more important； for； so far as we
know； he was the first to carry out experiments on a large scale。 In the first
place； he was within an ace of discovering the circulation of the blood。
67
… Page 68…
THE EVOLUTION OF MODERN MEDICINE
You may remember that through the errors of Praxagoras and Erasistratus；
the arteries were believed to contain air and got their name on that account：
Galen showed by experiment that the arteries contain blood and not air。 He
studied particularly the movements of the heart； the action of the valves；
and the pulsatile forces in the arteries。 Of the two kinds of blood； the one；
contained in the venous system； was dark and thick and rich in grosser
elements； and served for the general nutrition of the body。 This system
took its origin； as is clearly shown in the figure； in the liver； the central
organ of nutrition and of sanguification。 From the portal system were
absorbed； through the stomach and intestines； the products of digestion。
From the liver extend the venae cavae； one to supply the head and arms；
the other the lower extremities： extending from the right heart was a
branch； corresponding to the pulmonary artery； the arterial vein which
distributed blood to the lungs。 This was the closed venous system。 The
arterial system； shown； as you see； quite separate in Figure 31； was full of
a thinner； brighter； warmer blood； characterized by the presence of an
abundance of the vital spirits。 Warmed in the ventricle； it distributed vital
heat to all parts of the body。 The two systems were closed and
communicated with each other only through certain pores or perforations
in the septum separating the ventricles。 At the periphery； however； Galen
recognized （as had been done already by the Alexandrians） that the
arteries anastomose with the veins； 〃。 。 。 and they mutually receive from
each other blood and spirits through certain invisible and extremely small
vessels。〃
It is difficult to understand how Galen missed the circulation of the
blood。 He knew that the valves of the heart determined the direction of the
blood that entered and left the organ； but he did not appreciate that it was a
pump for distributing the blood； regarding it rather as a fireplace from
which the innate heat of the body was derived。 He knew that the pulsatile
force was resident in the walls of the heart and in the arteries； and he knew
that the expansion； or diastole； drew blood into its cavities； and that th
