The Evolution of Modern Medicine

OF equally great importance in the evolution of medicine was the practically contemporary civilization in Mesopotamia. Science here reached a much higher stage then in the valley of the Nile. An elaborate scheme of the universe was devised, a system growing out of the Divine Will, and a recognition for the first time of a law guiding and controlling heaven and earth alike. Here, too, we find medicine ancillary to religion. Disease was due to evil spirits or demons. "These 'demons'—invisible to the naked eye were the precursors of the modern 'germs' and 'microbes,' while the incantations recited by the priests are the early equivalents of the physician's prescriptions. There were different incantations for different diseases; and they were as mysterious to the masses as are the mystic formulas of the modern physician to the bewildered, yet trusting, patient. Indeed, their mysterious character added to the power supposed to reside in the incantations for driving the demons away. Medicinal remedies accompanied the recital of the incantations, but despite the considerable progress made by such nations of hoary antiquity as the Egyptians and Babylonians in the diagnosis and treatment of common diseases, leading in time to the development of an extensive pharmacology, so long as the cure of disease rested with the priests, the recital of sacred formulas, together with rites that may be conveniently grouped under the head of sympathetic magic, was regarded as equally essential with the taking of the prescribed remedies."(14) (14) Morris Jastrow: The Liver in Antiquity and the Beginnings of Anatomy. Transactions College of Physicians, Philadelphia, 1907, 3. s., XXIX, 117-138. Three points of interest may be referred to in connection with Babylonian medicine. Our first recorded observations on anatomy are in connection with the art of divination—the study of the future by the interpretation of certain signs. The student recognized two divisions of divination—the involuntary, dealing with the interpretation of signs forced upon our attention, such as the phenomena of the heavens, dreams, etc., and voluntary divination, the seeking of signs, more particularly through the inspection of sacrificial animals. This method reached an extraordinary development among the Babylonians, and the cult spread to the Etruscans, Hebrews, and later to the Greeks and Romans. 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 illustrations from Hebrew, Greek and Latin sources illustrating 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 god in accepting the animal, which is involved in the act of bringing it as an offering to a god, 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 gods, if one can succeed in entering into the mind of a god, 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 god who accepts the animal, or, at all events, a mirror in which the god'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 association 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 passed to the Greeks and the Romans, among whom it degenerated into a more or less meaningless form. But Jastrow states that in Babylonia and Assyria, 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 passed 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 Assyria 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 God," 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 gods of the pantheon. Assyrian astronomical observations show an extraordinary development of practical knowledge. The movements of the sun and moon and of the planets were studied; the Assyrians 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 god, 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 constituted 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 analyzed 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 gods, and of the influence that Babylonian-Assyrian 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 Assyria, 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 superstition, 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 passed 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 passing 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 Assyria 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 Assyria, 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 Assyrians. The individualistic spirit led the Greek to make his