The weakest point in Hippocratic medicine was diagnosis. There was, apparently, no taking of the pulse; fever was judged by simple touch, and auscultation was direct. Infection was understood in the case of scabies, ophthalmia, and phthisis.55 The Corpus contains excellent clinical pictures of epilepsy, epidemic parotitis, puerperal septicemia, and quotidian, tertian, and quartan fevers. There is no mention in the Collection of smallpox, measles, diphtheria, scarlet fever, or syphilis; and no clear mention of typhoid fever.56 The treatises on “Regimen” move towards preventive medicine by advocating “prodiagnosis”—an attempt to catch the first symptoms of a disease, and nip it in the bud.57 Hippocrates was particularly fond of “prognosis”: the good physician, he believed, will learn by experience to foresee the effects of various bodily conditions, and be able to predict from the first stages of a disease the course that it will follow. Most diseases reach a crisis in which either the illness or the patient comes to an end; the almost Pythagorean calculation of the day on which the crisis should appear was a characteristic element of Hippocratic theory. If in these crises the natural heat of the body can overcome the morbid matter and discharge it, the patient is cured. In any cure nature—i.e., the powers and constitution of the body—is the principal healer; all that the physician can do is to remove or reduce the impediments to this natural defense and recuperation. Hence Hippocratic treatment makes little use of drugs, but depends chiefly upon fresh air, emetics, suppositories, enemas, cupping, bloodletting, fomentations, ointments, massage, and hydrotherapy. The Greek pharmacopoeia was reassuringly small, and consisted largely of purgatives. Skin troubles were treated with sulphur baths, and by administering the oil of dolphin livers.58 “Live a healthy life,” Hippocrates advises, “and you are not likely to fall ill, except through epidemic or accident. If you do fall ill, proper regimen will give you the best chance of recovery.”59 Fasting was often prescribed, if the strength of the patient allowed; for “the more we nourish unhealthy bodies the more we injure them.”60 In general “a man should have only one meal a day, unless he have a very dry belly.”61
Anatomy and physiology made slow progress in Greece, and owed much of this to the examination of animal entrails in the practice of augury. A little brochure “On the Heart,” in the Hippocratic Collection, describes the ventricles, the great vessels, and their valves. Syennesis of Cyprus and Diogenes of Crete wrote descriptions of the vascular system, and Diogenes knew the significance of the pulse.62 Empedocles recognized that the heart is the center of the vascular system, and described it as the organ by which the pneuma, or vital breath (oxygen?), is carried through the blood vessels to every part of the body.63 The Corpus, following Alcmaeon, makes the brain the seat of consciousness and thought; “Through it we think, see, hear, and distinguish the ugly from the beautiful, the bad from the good.”64
Surgery was still for the most part an unspecialized activity of advanced general practitioners, though the armies had surgeons on their staffs.65 The Hippocratic literature describes trephining operations, and its treatment for dislocations of shoulder or jaw are “modern” in everything except anesthesia.66 A votive tablet from the temple of Asclepius at Athens shows a folding case containing scalpels of various forms.67 The little museum at Epidaurus has preserved for us ancient forceps, probes, scalpels, catheters, and specula essentially like those that are used today; and certain statues there are apparently models illustrating methods for reducing dislocations of the hip.68 The Hippocratic treatise “On the Physician” gives detailed directions for the preparation of the operating room, the arrangement of natural and artificial light, the cleanliness of the hands, the care and use of instruments, the position of the patient, the bandaging of wounds, etc.69
It is clear from these and other passages that Greek medicine in Hippocrates’ days had made great advances, technically and socially. Heretofore Greek physicians had migrated from city to city as need called them, like the Sophists of their time or the preachers of our own. Now they settled down, opened iatreia—“healing places,” or offices—and treated patients there or at the patients’ homes.70 Women physicians were numerous, and were usually employed for diseases of their sex; some of them wrote authoritative treatises on the care of the skin and the hair.71 The state exacted no public examination of prospective practitioners, but required satisfactory evidence of an apprenticeship or tutelage to a recognized physician.72 City governments reconciled socialized with private medicine by engaging doctors to attend to public health, and to give medical treatment to the poor; the best of’ such state physicians, like Democedes, received two talents ($12,000) a year.73 There were, of course, many quacks and, as always, an inexhaustible supply of omniscient amateurs. The profession, as in all generations, suffered from its dishonest or incompetent minority;74 and like other peoples the Greeks revenged themselves upon the uncertainties of medicine by jokes almost as endless as those that wreak their vengeance upon marriage.
Hippocrates raised the profession to a higher standing by his emphasis on medical ethics. He was a teacher as well as a practitioner, and the famous oath ascribed to him may have been designed to ensure the loyalty of the student to his instructor.*
The Hippocratic Oath
I swear by Apollo Physician, by Asclepius, by Hygiaea, by Panacea, and by all the gods and goddesses, making them my witnesses, that I will carry out, according to my ability and judgment, this oath and this indenture. To hold my teacher in this art equal to my own parents; to make him partner in my livelihood; when he is in need of money to share mine with him; to consider his family as my own brothers, and to teach them this art, if they want to learn it, without fee or indenture; to impart precept, oral instruction, and all other instruction to my own sons, to the sons of my teacher, and to indentured pupils who have taken the physician’s oath, but to nobody else. I will use treatment to help the sick according to my ability and judgment, but never with a view to injury and wrongdoing. Neither will I administer a poison to anybody when asked to do so, nor will I suggest such a course. Similarly I will not give to a woman a pessary to cause abortion. But I will keep pure and holy both my life and my art. I will not use the knife, not even, verily, on sufferers from stone, but I will give place to such as are craftsmen therein. Into whatsoever houses I enter I will enter to help the sick, and I will abstain from all intentional wrongdoing and harm, especially from abusing the bodies of man or woman, bond or free. And whatsoever I shall see or hear in the course of my profession, as well as outside my profession in my intercourse with men, if it be what should not be published abroad, I will never divulge, holding such things to be holy secrets. Now if I carry out this oath, and break it not, may I gain forever reputation among all men for my life and for my art; but if I transgress it and forswear myself, may the opposite befall me.76
The physician, Hippocrates adds, should maintain a becoming exterior, keeping his person clean and his clothing neat. He must always remain calm, and must make his behavior inspire the patient with confidence.77 He must
keep a careful watch over himself, and . . . say only what is absolutely necessary. . . . When you enter a sick man’s room, bear in mind your manner of sitting, reserve, arrangement of dress, decisive utterance, brevity of speech, composure, bedside manners . . . selfcontrol, rebuke of disturbance, readiness to do what has to be done. . . . I urge you not to be too unkind, but to consider carefully your patient’s superabundance or means. Sometimes give your services for nothing; and if there be an opportunity of serving a stranger who is in financial straits, give him full assistance. For where there is love of man, there is also love of the art.78
If, in addition to all this, the physician studies and practices philosophy, he becomes the ideal of his profession; for “a physician who is a lover of wisdom is the equal of a god.”79
Greek medicine shows no essential advance upon the medical and surgical knowledge of Egypt a thousand years before the various Fathers of Medicine; in the matter of specialization the Greek deve
lopment seems to have fallen short of the Egyptian. From another point of view we must hold the Greeks in high esteem, for not until the nineteenth century of our era was any substantial improvement made upon their medical practice or theory. In general, Greek science went as far as could be expected without instruments of observation and precision, and without experimental methods. It would have done better had it not been harassed by religion and discouraged by philosophy. At a time when many young men in Athens were taking up with enthusiasm the study of astronomy and comparative anatomy, the progress of science was halted by obscurantist legislation, and the persecutions of Anaxagoras, Aspasia, and Socrates; while the famous “turning around” of Socrates and the Sophists from the external to the internal world, from physics to ethics, drew Greek thought from the problems of nature and evolution to those of metaphysics and morals. Science stood still for a century while Greece succumbed to the charms of philosophy.
CHAPTER XVI
The Conflict of Philosophy and Religion
I. THE IDEALISTS
THE age of Pericles resembled our own in the variety and disorder of its thought, and in the challenge that it offered to every traditional standard and belief. But no age has ever rivaled that of Pericles in the number and grandeur of its philosophical ideas, or in the vigor and exuberance with which they were debated. Every issue that agitates the world today was bruited about in ancient Athens, and with such freedom and eagerness that all Greece except its youth was alarmed. Many cities—above all, Sparta—forbade the public consideration of philosophical problems, “on account of the jealousy and strife and profitless discussions” (says Athenaeus) “to which they give rise.”1 But in Periclean Athens the “dear delight” of philosophy captured the imagination of the educated classes; rich men opened their homes and salons in the manner of the French Enlightenment; philosophers were lionized, and clever arguments were applauded like sturdy blows at the Olympic games.2 When, in 432, a war of swords was added to the war of words, the excitement of the Athenian mind became a fever in which all soberness of thought and judgment was consumed. The fever subsided for a time after the martyrdom of Socrates, or was dissipated from Athens to other centers of Greek life; even Plato, who had known the very height and crisis of it, became exhausted after sixty years of the new game, and envied Egypt the inviolable orthodoxy and quiet stability of its thought. No age until the Renaissance would know such enthusiasm again.
Plato was the culmination of a development that began with Parmenides; he played Hegel to Parmenides’ Kant; and though he scattered condemnation lavishly, he never ceased to reverence his metaphysical father. In the little town of Elea, on the western coast of Italy, 450 years before Christ, there began for Europe that philosophy of idealism which was to wage through every subsequent century an obstinate war against materialism.* The mysterious problem of knowledge, the distinction between noumenon and phenomenon, between the unseen real and the unreal seen, was flung into the caldron of European thought, and was to boil or simmer there through Greek and medieval days until, in Kant, it would explode again in a philosophical revolution.
As Kant was “awakened” by Hume, so Parmenides was aroused to philosophy by Xenophanes; perhaps his was one of many minds stirred by Xenophanes’ declaration that the gods were myths, and that there was only one reality, which was both world and God. Parmenides studied with the Pythagoreans also, and absorbed something of their passion for astronomy. But he did not lose himself in the stars. Like most Greek philosophers he was interested in living affairs and the state; Elea commissioned him to draw up for it a code of laws, which it liked so well that its magistrates were thenceforth required to decide all cases by that code.3 Possibly as a recreational aside in a busy life he composed a philosophical poem On Nature, of which some 160 verses survive, enough to make us regret that Parmenides did not write prose. The poet announces, with a twinkle in his eye, that a goddess has delivered to him a revelation: that all things are one; that motion, change, and development are unreal—phantasms of superficial, contradictory, untrustworthy sense; that beneath these mere appearances lies an unchanging, homogeneous, indivisible, indissoluble, motionless unity, which is the only Being, the only Truth, and the only God. Heracleitus said, Panta rei, all things change; Parmenides says, Hen ta panta, all things are one, and never change. At times, like Xenophanes, he speaks of this One as the universe, and calls it spheroidal and finite; at times, in an idealistic vision, he identifies Being with Thought, and sings, “One thing are Thinking and Being,”4 as if to say that for us things exist only in so far as we are conscious of them. Beginning and end, birth and death, formation and destruction, are of forms only; the One Real never begins and never ends; there is no Becoming, there is only Being. Motion, too, is unreal, it assumes the passage of something from where it is to where there is nothing, or empty space; but empty space, Not Being, cannot be; there is no void; the One fills every nook and cranny of the world, and is forever at rest.†
It was not to be expected that men would listen patiently to all this; and apparently the Parmenidean Rest became the target of a thousand metaphysical assaults. The significance of Parmenides’ subtle follower, Zeno of Elea, lay in an attempt to show that the ideas of plurality and motion were, at least theoretically, as impossible as Parmenides’ motionless One. As an exercise in perversity, and to amuse his youth, Zeno published a book of paradoxes, of which nine have come down to us, and of which three will suffice. First, said Zeno, any body, in order to move to point A, must reach B, the middle of its course toward A; to arrive at B it must reach C, the middle of its course toward B; and so on to infinity. Since an infinity of time would be required for this infinite series of motions, the motion of any body to any point is impossible in a finite time. Second, as a variant of the first, swift-footed Achilles can never overtake the leisurely tortoise; for as often as Achilles reaches the point which the tortoise occupied, in that same moment the tortoise has moved beyond that point. Third, a flying arrow is really at rest; for at any moment of its flight it is at only one point in space, that is, is motionless; its motion, however actual to the senses, is logically, metaphysically unreal.*5
Zeno came to Athens about 450, perhaps with Parmenides, and set the impressionable city astir by his skill in reducing any kind of philosophical theory to absurd consequences. Timon of Phlius described
The two-edged tongue of mighty Zeno, who,
Say what one would, would argue it untrue.8
This pre-Socratic gadfly was (in the relative sense which our ignorance of the past compels us to give to such phrases) the father of logic, as Parmenides was for Europe the father of metaphysics. Socrates, who denounced Zeno’s dialectical method,9 imitated it so zealously that men had to kill him in order to have peace of mind. Zeno’s influence upon the skeptical Sophists was decisive, and in the end it was his skepticism that triumphed in Pyrrho and Carneades. In his old age, having become a man “of great wisdom and learning,”10 he complained that the philosophers had taken too seriously the intellectual pranks of his youth. His final escapade was more fatal to him: he joined in an attempt to depose the tyrant Nearches at Elea, was foiled and arrested, tortured and killed.11 He bore his sufferings bravely, as if to associate his name so soon with the Stoic philosophy.
II. THE MATERIALISTS
As Parmenides’ denial of motion and change was a reaction against the fluid and unstable metaphysics of Hercleitus, so his monism was a counterblast to the atomism of the later Pythagoreans. For these had developed the number theory of their founder into the doctrine that all things are composed of numbers in the sense of indivisible units.12 When Philolaus of Thebes added that “all things take place by necessity and by harmony,”13 everything was ready for the Atomic school in Greek philosophy.
About 435 Leucippus of Miletus came to Elea, and studied under Zeno; there, perhaps, he heard of the number atomism of the Pythagoreans, for Zeno had aimed some of his subtlest paradoxes at this doctrine of plurality.14 Leucippus
finally settled in Abdera, a flourishing Ionian colony in Thrace. Of his direct teaching only one fragment remains: “Nothing happens without a reason, but all things occur for a reason, and of necessity.”15 Presumably it was in answer to Zeno and Parmenides that Leucippus developed the notion of the void, or empty space; in this way he hoped to make motion theoretically possible as well as sensibly actual. The universe, said Leucippus, contains atoms and space and nothing else. Atoms tumbling about in a vortex fall by necessity into the first forms of all things, like attaching itself to like; in this way arose the planets and the stars.16 All things, even the human soul, are composed of atoms.
Democritus was the pupil or associate of Leucippus in developing the atomistic philosophy into a rounded system of materialism. His father was a man of wealth and position in Abdera;17 from him, we are told, Democritus inherited a hundred talents ($600,000), most of which he spent in travel.18 Unconfirmed stories send him as far as Egypt and Ethiopia, Babylonia, Persia, and India.19 “Among my contemporaries,” he says, “I have traveled over the largest portion of the earth in search of things the most remote, and have seen the most climates and countries, and heard the largest number of thinkers.”*20 At Boeotian Thebes he stopped long enough to imbibe the number atomism of Philolaus.22 Having spent his money he became a philosopher, lived simply, devoted himself to study and contemplation, and said, “I would rather discover a single demonstration” (in geometry) “than win the throne of Persia.”23 There was some modesty in him, for he shunned dialectic and discussion, founded no school, and sojourned in Athens without making himself known to any of the philosophers there.24 Diogenes Laertius gives a long list of his publications in mathematics, physics, astronomy, navigation, geography, anatomy, physiology, psychology, psychotherapy, medicine, philosophy, music, and art.25 Thrasyllus called him pentathlos in philosophy, and some contemporaries gave him the very name of Wisdom (sophia).26 His range was as wide as Aristotle’s, his style as highly praised as Plato’s.27 Francis Bacon, in no perverse moment, called him the greatest of ancient philosophers28