5ection

of the

lbiztorp

of MIebicine.

President-Dr. J. D. ROLLESTON.

Herophilus of Alexandria.' By J. F. DOBSON, M.A.

Professor of Greek in the Univer8ity of Bri8tol.

powers.

ABOUT the end of the fourth century B.C., very shortly after the death of Aristotle, we come to two great names in the history of medicine-Herophilus, who may be called the founder of Systematic Anatomy, and Erasistratus, the first scientific physiologist. They both migrated from their homes in Asia Minor to Alexandria, attracted thither by the prospect of material advancement and the facilities for prosecuting their advanced studies which Ptolemaic Egypt offered to all eminent students. Their works are entirely lost, but some details of their teaching may be recovered from the voluminous writings of Galen, who possessed their books in entirety, and from scattered references in later writers. Of Erasistratus it must suffice for the moment to say that he came very near to discovering the circulation of the blood, and if he had started on the investigation of the arterial system with an open mind he must almost inevitably have reached the right conclusion. As it was, however, he was handicapped by the "pneumatic " theories of his predecessors and contemporaries, and could not shake off their influence. Herophilus is described by Galen as a follower of the "logical" or "dialectical'; method, as opposed to mere empiricism. Galen sometimes accuses him of obscurity, but severer censure is generally reserved for his followers [31, who erred by misinterpreting their master's opinions. In the majority of cases he is classed by the historian among the great physicians of antiquity [1, 2], and commended for the soundness of his views, especially for the combination of observation with reasoning

He took a deep interest in general anatomy, which formed the basis of his scientific application of gymnastic exercises to remedial purposes, and also of his dietetics [4]. His chief work was in connexion with the brain and the reproductive organs-the latter being of great practical importance owing to the interest taken by Greeks of this period in gynecology-while he also wrote minor works on the eye and on the liver. He also had some reputation for the invention of a scientific vocabulary, parts of which remain in use to the present day. It is certain that he made a careful study of Hippocrates; in fact, he wrote commentaries on the great master's Prognostics and Aphorisms, and made a collection of glosses, i.e., rare words used in his writings [4]. How far his study of the whole Hippocratic Corpus, and the work of his predecessors in general and particularly of Aristotle, had extended, is a matter for conjecture; but since Galen frequently represents him as accepting or rejecting one view or another, we assume that he was thoroughly familiar with the current literature of his subject.
BRAIN AND NERVES. His work on the brain seems to have been important-the great thing being that, in opposition to Aristotle, he gave it precedence over the heart' as the centre of the nervous system. It is true that Alcmaeon had anticipated him (though what his argument was we do not know), but the Aristotelian tradition was definitely in favour of the heart being the seat of the intellect. "Herophilus," says Galen,
The reference numbers in brackets in the text relate to the " Extracts " which follow the paper. He had on one occasion seen a heart exposed in consequence, perbaps, of a wound. The fact that the patient recovered may have inclined him to assign less importance to the heart [14]. MY-H 1 (M1arch 18, 1925.
I
2

20
"

Dobson: Herophilus of Alexandria

This followed naturally from his belief that the brain is the centre of the nervous system [5]. " Since all the nerves below the head spring either from the hind-brain or the spinal cord, this ventricle must be of considerable size, and receive the animal

places the dominant principle of the 'soul' in the ventricles of the brain" [9].

spirits previously compounded in the anterior ventricles; so that there must necessarily be a passage from them to it. Therefore the latter also appears to be large, and the passage into it from the anterior ventricles is also very large, and through it only is there a connexion (emphysis) between the cerebellum and the cerebrum." He proceeds, in this context, to distinguish the cerebrum and cerebellum and to give an account of the passage connecting them, through which, he believes, the "animal spirits," which have their origin in the cerebrum, pass into the Galen further notes that his followers applied to the larger portion the general name
1

cerebellutm.

for the whole.

regretted that we have not a fuller record of his investigations into know, however, that he paid particular attention to the cavities, especially the one in the middle of the floor of the fourth ventricle, which he compared to the cavity in the pens used for writing in Alexandria [6]. The Latin translation of this term is calamus scriptorius. We must also mention here his description of the" torcutlar ":"gOn the crown' of the head the doublings of the meninges meet, converging and conveying the blood to an empty space like a cistern," which he therefore called the "wine press" (Latin torcular) [7]. He also described the meninges, which he called chorioid, owing to their resemblance to the chorionic envelope
It is to be
the brain; we

surrounding the fcetus [18]. He described the rete mirabile, or "retiform plexus," as he calls it, at the base of the brain. He had probably found it in the brain of a sheep, as it does not exist in the human body. There is no reason to believe that he supposed it to exist in man also [8]. He had carefully dissected )the eye and added much to current knowledge of its structure [13-16]. He traced the sensory nerves which lead from the brain to the eyes, which he called 7ropot or passages; and since in mentioning this fact Galen refers to the optic chiasma, it is not unreasonable to assume that Herophilus had observed it [12]. Of the salivary glands [17] he distinguished the parotid and the submaxillary, though perhaps not the sublingual. Galen charges Herophilus with obscurity in describing the functions of the nerves, but it is possible that Galen himself is responsible for some of the obscurity. He tells us that "Herophilus assigns the power of moving the body to veins, arteries and muscles, considering that the lung alone has a natural tendency to dilatation and contraction" [25]; but elsewhere we find that "He rightly recognized that it is the which "; but apparently he did not say clearly that the nerve is only the instrument, the moving cause being the power which passes through the nerves, a "power which Galen " soul,"
nervous,
not the arterial

system,

serves

to

produce

voluntary

motions

"

himself

defines

as

i.e.,

vital

force,

for

all

motion

of

muscles

and

nerves

departs [24]. ceases when "soul" quite

It is made
clear
that

Herophilus

was

among

the first
at
a

to

distinguish between
to

motor

and

sensory

nerves;

previous

observers bad

been

loss

explain

"hoow
two

some kinds of paralysis destroy sensation only, others destroy only voluntary motions, while still others destroy both" [11]. Galen recognized that both for theoretical practical purposes the kinds necessary, by dissection, of nerves back to their starting-points. This Herophilus had not done in all cases.
and
was

means of

to trace

1
"hind-brain," a term
2

by

Herophilus was

7rapf'yKceoacls,

and

it

will be convenient to regard

this

as

already in use by the time of Galen, rather than cerebellum; for it is to the hind brain in general, and not any particular section of it, that these passages refer.
He
terminology of

Aristotle,

who divided the skulls into

bregma,

crown and

inion.

Section of the History of Medicine

21

LIVER. His knowledge of the conformation of the liver was extensive. He applied to its study the methods of comparative anatomy, using in particular the hare for his illustrations. His general description is accurate; he observes that it differs in size and conformation in different individuals of the same species. He had observed cases, both in men and animals, where it occurred on the left instead of the right side [19]. We know little about his theory of the hepatic vascular system, except the following [23]: Nature made veins specially belonging to the whole mesentery, which are dedicated to the nourishment of the intestines themselves and do not pass to the liver; for, as Herophilus said, these veins end in glandular bodies, while all others are carried back to the portz; secondly, she also provided numerous vessels about the omentutn. These " veins " are undoubtedly lacteals, and to this passage I shall refer again later. From another passage we gather that though he was in doubt as to the startingpoint of some veins [20], he, like many others, began his investigations with the liver. LUNGS AND VASCULAR SYSTEM. His treatment of the lungs is closely connected with the question of pulsation, which was to him of great importance. The lung (he says) has a natural tendency to dilatation and contraction, which it passes on to other parts; its functions in respiration are to receive the fresh air from outside and distribute it through the body; then to withdraw and finally to expel it; thus it has two motions of dilatation and two of contraction [25]. His knowledge of the pulmonary blood-system was not, so far as we can see, extensive: he called the pulmonary artery the arterial vein, asserting that in the lungs the veins are like arteries in general appearance and the arteries like veins. This statement he based on their comparative thickness, estimating that elsewhere the walls of an artery are six times as thick as those of a vein [27]. NWe may note that the term " arterial vein " remained in use till, and even after, the time of Harvey. It is thus clear that though he did not fully understand their functions, he distinguished between arteries and veins, and in contrast to the majority of early anatomists, who maintained that the former were only air-passages, he firmly held to the opinion that the arteries contained blood [26]. The chief importance of the arteries was, for him, their connexion with pulsation. He appears to have been the first medical writer who made a systematic investigation of the pulse and recognized its importance as an aid to diagnosis [38]. Some writers had considered pulsation to be in part voluntary; he insisted that it was entirely involuntary, and was caused by the contraction and dilatation of the arteries [28]. Of these processes the contraction was an " energy " of the arteries, while the dilatation was their normal condition [34]. We must not be misled by the use of the word " energy " into thinking that he ascribed to the arteries a contractive power of their own. The " energy " or " activity " is simply a movement from the normal condition, but it is due not to any innate power in the arteries themselves but to an impulse received from the heart [31], which alone, according to Galen's representation of Herophilus, possesses the necessary motive power; in other words, Herophilus recognized, however vaguely, the importance of the heart as the centre of the blood system, and the connexion between the heart and the pulse-beats; but whereas as a matter of fact, as we know now, the contraction is the return of the elastic walls of the artery to their normal condition, and the dilatation is due to the pressure of blood from the heart, he went wrong

22
on

Dobson: Bierophilus
mistake he

of Alexandria

Rufus of Ephesus makes the connexion still clearer, telling us that, according to Herophilus, pulsation occurs in consequence of the filling and emptying of the and numerous passages in Galen show that Herophilus investigated arteries " and described various forms of involuntary motion, with results which are thus the arteries and the heart; palpitation, summarized: "Pulsation occurs only in " spasm and tremor in the muscles and nerves [28], [9]. Before the invention of any accurate machinery for recording time it was not possible to make careful observations of the rate of the pulse, since there was is said on doubtful authority to have means of standardization, His great used the clepsydra or water-clock as an apparatus for his research expressed in effort was to ascertain and classify the varieties of rhythm, mathematical notation with such elaborateness that it was a current jest that a knowledge of music was indispensable to anyone who wished to understand his

pulsation.

this point, using the elasticity in the wrong direction, and possibly imagining that nerves extending from the heart to the arteries were responsible for the dilatation [31]. is clear; finding, on dissecting a subject, that the The origin of the mistook the normal (or minimum) distension for arteries were not collapsed, the maximum, and must have supposed that from this state, which is apparent in the dead creature, they had the faculty of contracting still further in order to produce

[28];

though Herophilus

no

[30]. whichhe

second a greater, and the last the greatest [36]. Normal pulses are classified according to the age of the subject; thus If a child ever has an interval of ten time-units between two beats, it is a sign of extreme the otherhand, if an old man has refrigeration and indeed of a moribund condition, and onand the times of a in which dilatation of contraction are equal, this is a child, pulse the sign of a feverish condition [40]. The rhythm of a pulse is determined by observing and comparing the time taken in dilatation and contraction. Galen considers the_results obtained by this method unsatisfactory and inconclutive, for: Though he described the rhythms usually apparent in each age, he did not tell us in connexion with what natures he observed them; and secondly, it is evident that he is confused and incoherent about the diagnosis of the contraction and the periods of quiescence That is to say, Galen considered, first, that the nature of the pulse might vary in different classes of individuals of the same age, according, presumably, not to charactertemporary conditions of health but to difference in permanent physical istics, and secondly, Galen assumed two periods of quiescence, one while the 37] assumed artery is full, another while it is empty, whereas Herophilus constant reciprocal motions, reckoning as the period of dilatation the time when he could actually feel dilatation taking place as he measured the beats by pressure of the finger tips, and counting as the period of contraction the whole interval between the end of one beat and the beginning of another. Modern physiologists tell us that in this latter point was right, for there is no period of quiescence as Galen imagined.

physiology. In addition to normal pulses which follow natural rhythms he distinguished various divergent pulses-the pararrhythmic, the heterorrhythmic and the ecrhythmic, of which the first shows only a slight divergence from normality, the

[371.

[35,

but his

such His general classification of pulses was with reference to size, speed, strengtll and rhythm, in analysing which he took into account order and disorder, regularity and irregularity [39]. It is obvious that the latter four conditions do not pair with the previous characteristics, and he was sometimes accused of confusion; Herophilus
meaning is quite clear; any one of the first four might be, in a particular

Section of the History oj Medicine

23

ovarian

have approached the subject from a scientific standpoint. We find him first discussing whether women are subject to special pathological conditions, and very reasonably deciding that they are not, except in so far as the processes of conception, gestation, &c., differentiate them [53]. He was interested by the reseinblances between the male and female anatomy. He distinguished the ovaries, which by analogy he calls " testicles," attached obliquely to the sides or shoulders of the uterus (the cornua uteri), not contained in a single scrotum, but separate. They are contained in a fine membrane (the broad ligament), and are small and rather flat, like glands. The flesh is hard, as in the case of males. They have a neryesystem adjacent to the covering. They are attached to the uterus by membranes (uteroseems to

traction can be accurately observed [411. We may record here two of his ingenious names for particular kinds of abnormal pulsation-the "crawling " or " formicating pulse "-pvp,i-tqKct'WV, from yp7, an aint; and the "capering" pulse (8opKa;t&awv), with a supposed reference to the habits of the dorcas, a kind of gazelle. This latter is characterized by irregularities occurring in one dilatation, when the motion of the artery is at some point interrupted [44, 45]. Galen takes some trouble to clear away a misunderstanding which arose through the obscurity of some of Herophilus' language. Among the criteria for distinguishing different kinds of pulse he had mentioned "volume" or "multitude" (7rXi009o). Some of his followers, apparently, interpreted this as fulness" (7rwXnp&rrms) Galen maintains that he nowhere refers to a "full pulse" but that by volume he means " either frequency or speed or anything rather than fulness"; but in spite of Galen's efforts the passage still remains obscure [47]. SEXUAL ORGANS. He seems to have contributed little to the knowledge, current since the time of Aristotle, of the male organs of generation. Rufus of Ephesus affirms that he could not explain the passage of the semen to the penis [48] ; Galen, however, attributes to him the knowledge of its passage from the epididymis along the seminal ducts [49], which he called the varicose parastates," perhaps limiting the application of the term to " those parts which touch the testes." He also distinguished two "glandular seminal bodies," i.e., vesiculw semincales [50]. With the female organs he dealt more fully, embodying his views in a work which, though primarily intended as a practical treatise on midwifery (taLa,'rTOV),

same, and therefore the rhythm was described as " equal, or 1: 1 " [41]. At the other end of the scale would come the pulse of the very aged, in which, taking as a unit the time occupied by dilatation, the interval between two dilatations is represented by 10, i.e., the contraction takes ten times as long as the dilatation. Galen doubts the accuracy of this observation, wrongly maintaining, as noted above, that we ought to take into account the possibility of periods of quiescence between the two activities. He also appears to doubt whether the period of con-

case, either normal or abnorinal; and what is orderly for one age may be "disorderly" for another, as has been shown above. Many " cavillers," as Galen calls them, misrepresented Herophilus for contentious purposes. They were apt to pick out statements from his writings and, producing them apart from their context, characterize them as absurd; thus his opponents maintained that " children's pulse is small," while he, intending to compare the extent of the dilatation with the size of the vessels dilated, asserted the opposite. They refuse to recognize that the same amount of dilatation which is enormous, for instance, in an animal bladder, would be imperceptible in a balloon; and on these lines Galen fully justifies Herophilus [43]. The observations of the rhythm began with new-born children, in whom Herophilus claimed to observe that the times of dilatation and contraction were the

ligaments), and

each is connected with it by a vein and an artery. The seminal

24

Dobson: Herophilus of Alexandria

ducts are not easily discerned, but they are attached to the sides of the uterus externally. The first part is twisted, just as in the case of the male, and practically all the rest, up to the end, is curled (varicose, KLpOfOl3iS) [51]. It is stated by McKay that Herophilus had not observed the Fallopian tubes, but in my opinion he must refer to them here. It has been suggested to me that

he mistook for seminal ducts either the round ligaments or the ducts of Gartner, but neither of these interpretations suits the passage just quoted. Taken by itself, it would naturally refer to the Fallopian tubes, and the description suits the appearance of these tubes in certain lower animals. His subsequent remark that " a varicose parastate has not been observed in the female," is repeated by Rufus, who says that he has observed it in dissecting the uterus of a sheep. It is just possible that by

7rapao-raTrf79 1ctpaoe&8

'

in the male, which is very liable to become varicose. The spermatic arteries and veins, all regarded as vessels which nourish the uterus," are described with reasonable accuracy as being " inserted into the membranes" (i.e. the broad ligaments), and "starting from those vessels which lead to the kidneys"-in modern terms, the arteries arise from the aorta in the neighbourhood of the kidneys, the veins enter the vena cava, also near the kidneys. He deseribes the uterus as resembling the bladder in general form, but it has " mastoid processes " at the sides [54], inclining towards the flanks; these are of semicircular shape. Diocles had called them "ceratid processes," and Aristotle simply " ceratia " (horns). The cervix is described as muscular and cartilaginous,-increasingly so in the case of multiparwe, and he compares its form to the upper part of the throat [55]. " He did not hesitate to write," says Soranus, "that the mouth of the uterus would not admit even a probe before the woman has been delivered; that there is not the least aperture after conception has taken place, and that the opening is wider at the time of menstruation; after parturition it grows hard like the head of a cuttle fish" [57]. He considered that the fcetus had a physical but not a respiratory motion [59], and was nourished by the umbilical cord [60], of which he gives a correct account, except that he assigns to it four vessels (two veins and two arteries) instead of three. These carry material for blood and breath to the embryo. The veins connect with the vena cava, the arteries with the great artery which runs along the spine. He made observations on the various relations of menstruation to general health among [58], and gave an excellent summary of the causes of difficult labour [611-first cervix. which-he considers displacement of the embryo and insufficient dilatationof the He described the causes of prolapsus, rightly observing, as against other ancient authorities, that only the cervix, not the entire uterus, can protrude. He had observed an acute case in which, owing to the inflammation, the passing of a probe
was

Herophilus and Rufus referred to the plexus pampiniformis

impossible [62].

TERMINOLOGY.

Herophilus, though expert in the use of terms, did not find and could not always invent names for his new discoveries, and it is probable that some of his work is obscure in consequence. Thus, although in general he has a quite definite idea of a vein as a blood-vessel, he seems also to have used it in another sense, namely, for what we call lymphatics-for these he had no special name; the lacteals are described as " veins " belonging to the mesentery, which nourish the intestines and do not pass into the liver, being contrasted with others (the hepatic set) which are carried back to the portal fissure [23]. These lacteals end in glandular bodies, i.e., the lymphatic glands. In a continuation of the same passage he describes " numerous vessels about the omentum, particularly designed to give nourishment to all the adjacent parts." This description is too vague for certain identification ; according to the standard of his knowledge it would fit either veins or arteries; the probability is that he referred to both.

Section of the History of Medicine

25

A few words may be added about his contributions to terminology. A good deal of his vocabulary was taken from his predecessors, but he invented many names for parts hitherto undescribed, and in some cases endeavoured, though not always with success, to supersede the older nomenclature. His use of " parastate" has already been mentioned; he applied the same term also to the hyoid bone, because it stands beside the tonsils [63]. He first used the expression " chorioid tunic" or "chorioid membrane" for the covering of the ventricles of the brain [18]. The third tunic of the eye was originally called by him " arachnoid" [16], but he compared it to a casting net, and called it "retiform," a word from which our modern "retina " is derived. The " torcular " and " calamus scriptoriiis " in the brain, and the " dodenum " are among his successes. His attempt to re-name the tibia the pecten did not meet with the approval of posterity [641. The term was, however, in vogue during the Middle Ages. VIVISECTION. The charge of having practised vivisection on living men was in ancient times brought against Herophilus and his contemporary Erasistratus. The evidence on which it is based comes from Celsus (A.D. 30) and Tertullian (A.D. 155-222). The former definitely states that the members of the Methodist School " think it is necessary to dissect dead bodies and examine their viscera and intestines; and they think that Herophilus and Erasistratus had taken by far the best method for attaining that knowledge, for they procured criminals out of prison by royal permission, and dissecting them alive contemplated, while they were even breathing, the-parts which nature had before concealed " [65]. Celsus decides that such practices are both cruel and unnecessary; and from his further remarks in the same passage it is evident that in his time a certain section of medical opinion maintained that even dissection of the dead subject was as unnecessary as it was disgusting. Tertullian, in the next century, repeats the charge, and though his language is not quite so definite, his meaning is clear according to the natural interpretation of the words. After calling Herophilus a "butcher," who dissected1 six hundred persons that he might scrutinize nature-a passage which probably refers only to dissection of the dead-he continues, " death in his hands was not simply death, but led to error from the very process of cutting up" [66]. This, indeed, looks like a repetition of the empirical contention that, since death changes the appearance of the organs, all dissection is useless; but we may take it that Tertullian at least meant to imply, if he did not absolutely state, that the bodies cut up were living. A second passage of the same author is also ambiguous. He reprobates the use of an instrument (E' 1/3pvocPadCrTl9) for embryotomy, and says that it was used by Herophilus, " who dissected adults also "-implying, at any rate, that they, like the embryos, were alive [67]. It is strange, however, that Galen makes no reference to this supposed practice; and on this account many modern authorities have doubted the authenticity of the story. Galen was an open-minded writer who, on the whole, thought very highly of Herophilus, while he differed from and severely criticized Erasistratus in many details; but at the same time Galen pointed out the mistakes of the former and gave the latter full credit for those parts of his work of which he approved. If he had known of the practice of human vivisection by these authorities, it is inconceivable that he should not have referred to it either for praise or blame. The silence of Galen about Herophilus leads us to wonder whether, after all, it was not only a charge trumped up by partisan writers who, like some people of modern times, so disapproved of dissection in any form that, consciously or unconsciously,
1 In Latin of all periods "600 " is used vaguely, as we use "hundreds," to denote a large number.

26
however,
is

Dobson: Herophilus of Alexandria

Erasistratus,
to
cleared
of

they confused dissection of the dead with dissection of the living.

charge

by Galen

himself,

who

in reference

the

anatomy

of the brain

says:-

" If he had with living animals, as I have done not once or twice but many times, he would have definitely recognized that the hard, thick membrane exists as a protection

experimented

for the brain, &c." [67B]. Galen is hiere speaking of animals only, but if Erasistratus had never dissected living animals it is inconceivable that lhe should have dissected living men. It was in anatomy that Herophilus was chiefly interested, and to which he contributed so much that, according to Galen, no one made any advance on his method to the time of Marinus and Numesianus" (writers of the second century) [68]; but this engrossing pursuit did not preclude a practical interest in various other branches of medical science. We may believe that in all his work he had practical ends in view, and he thought that any advance in knowledge of the body was a useful contribution to the science of teaching. His researches into pulsation were
"

dowvn
not

exercises; definitely informed that they undertaken for purposes of diagnosis. His work on Dietetics was evidently an important practical work; and at the same time he considered that drugs [69], of the use of which he made a careful study, were the hands of gods" Xet^pE), and, if we may trust Celsus, would never treat any disease without medicines[701. A few of his prescriptions have been preserved [71]. His conception of his mission is expressed in him by Sextus Empiricus: ain aphorism attributed to is indemonstrable, art uncertain, strength powerless, wealth useless and speech imnpotent if health be absent," [78] and it was the health of his fellow-creatures that he endeavoured by all his
academic

are

were

"

(9eC6Jv

"Wisdom

to promote.
EXTRACTS. References to Galen are marked G anld are given by volume and
page

studies

Other references are to the following editions by Chalcidius, edited by J. Wrobel, 1876. Soranus, edited by V. Rose, 1882.

to

Kiihll's edition.

pages:

Marcellinuis, edited by H.Schone in Basler Festschrift, Rufuis, edited by Daremberg and Ruelle, 1879.

1907.

v, 879, 898; xv, 134. [2] G., i, 109. [3] G., viii, 724; xviii, 13, 14. [4] G., xix, 64, 65. [5] G., iii, 665. [6] G., ii, 731. [7 [ G., iii, 708. [8] G., iv, 155. The carotid arteries which mount to the brain, before they pass through the hard meninx (dura miiater), aie divided by it into many branches, twisting round in many layers, like a lot of niets lying olie on top of the other; they occupy a considerable space, which they called the base of the braini. [9] G., xix, 315; cf.hp Plut. it., iv, 5; Tertullian, De Animna,, c. xv, denies the truth of this. [10] G., v, 181. " As Herophilus has said, perforation of the pericardiac tunic does not involve any special danger." [ii] G3., viii, 212. When somle part is wrenchced its nerves or myiuscles must be affected. iaan So a who from dissection knows the starting-points of the nerves which lead to each part will be better able to cure loss of sensation or iotion- in each part. This was left undetermined by Herophilus and Eudemus, who were the first after Hippocrates to write accurately about the dissection of the nerves, and caused miiuch difficulty) to the doctors . . . and as to somn how e kinds of paralysis destroy sensation only, others voluntary motion, others both. [12] G., iii, 813. In the case of the sensory nerves which lead from the brain to the eyes, called by Herophilus the ducts (7rSpoL), it is remarkable that they originate in different places, but as they continue are united, and then again separate and are split up.

[1] G., x, 28; iii, 21; xiv, 683 ;

m-aotor

Section of the History of Medicine

27

[13] Rufus, p. 171. The perforated body (iris) is smooth externally, where it touches the cornea, but rough on the interior surface, as Herophilus says, since, being formed of a tissue of vessels, this surface resembles the skin of a grape.
[14] Celsus, vii, 7, 13. [15] Chalcidius, ch. 246, p. 279. [16] Rufus, p. 154. The third (tunic of the eye) encloses the " vitreous humour "; its ancient name is " the arachnoid," and it is so called on account of its fineness; but since Herophilus compared it to a casting net some authorities call it " retiform." [17] G., iv, 646. Besides these there is the secretion which comes from the brain through the palate, and the saliva from the glands near the root of the tongue, and the (contents) of the belly pass into the intestines, as well as the bile fluid from the liver, and again, from certain other glands assigned to this purpose comes a sticky fluid like saliva. Anatomists from the time of Herophilus and Eudemus have been much exercised about these glands. [18] G., ii, 719. Herophilus and his followers name these the " chorioid masses," deriving the name from the choria which surround the fretus externally and are layers of veins and arteries held together by delicate membranes. Cf. Rufus, ch. 55, p. 153, Dar. [19] G., ii, 570. Herophilus describes it accurately as follows: "The human liver is large in comparison with that of some other animals comparable to mnan in size. WVhere it touches the diaphragm, it is convex and smooth, but where it touches the belly and the external curve of the belly, it is flattened and uneven. It is like a cleft at the point where in the case of embryos the vein from the navel grows into it. It is not alike in all [individuals] but varies in different subjects in breadth, length, thickness, height, number of lobes and unevenness in front, where it is thickest, and in its surrounding extremities . . . where it is thininest. In some cases it has no lobes at all, but is altogether round and not straight at all; in others it has two or more-in many cases four." Herophilus was right in these statements, and the further assertion, in the second book of his " Anatomy," that in the case of a few men and a considerable number of other creatures, it occupies a position on the left, is also true. He referred only to the hare, and left it to us to investigate the case of other animials, which I have thought fit to describe in the preceding essay. [20] G., v, 543. No anatomist who proposed to write of the dissection of the veins has been able to find a suitable starting-point for his treatise if he neglected the liver: whether they said that they were in doubt as to the starting-point as Herophilus did, or that they were fully informed, as did my friend Pelops, among others; they nearly all began their treatises with a discussion of the liver. [21] G., ii, 780. From there (the portal fissure) grows a great vein which extends vobliquely downwards and to the other parts of the animal, near the middle of what Herophilus called the duodenal process-this is the name which he gives to the beginning of the intestine, before it becomes twisted. " [22] G., viii, 396. The process which Herophilus calls the 'lodecadactyl," naming it on account of its length. [23] G., iii, 335. [24] G., vii, 605. And here I blame Praxagoras and Herophilus, the former for calling tremor an affection of the arteries, and Herophilus for trying to show that it originates in the nervous system. Praxagoras is far from the truth, and Herophilus was mistaken in referring the affection of the faculty to the instruments. For he knew that the nervous system, not the arterial, is subordinate to voluntary motions; but since it is not the body of the nerve itself which causes their mnotion, but it (the body) is an instrument, and the moving cause is the power which passes through the nerve, here I blanme him for not distinguishing power and instrumient . . . now in the case of dead bodies, neither muscles nor nerves are subject to any such affections as Herophilus and Praxagoras suippose, but all their inotion ceases when soul departs, and inuscles and nerves are its instruments; so it is not the property of either muiscle or nerve to produce motion, but of soul. [25] G., xix, 318. Herophilus assigns the power of moving the body to nerves, arteries and muscles; he considers that the lung alone has a natural desire for dilatation and contraction, and next the others. The activity of the lung consists in drawing the breath from without; but when, being filled up from without it cannot draw any more into the thorax, it expels the surplus and drives it out to the outer air. Thus there are four motions of the lung, the first by which it receives air froii without, the second by which the air thus received from without permeates within the lung, to the thorax; the third whereby it receives again into itself the air expelled by the contraction of the thorax, the fourth by which it

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expels the air which has come again into itself; of these motions two are dilatations, twoc contractions. [26] G., iv, 731. So that when they are at a loss how the breath is to be carried from the heart to the whole body if the arteries are filled with blood, it is not difficult to resolve their perplexity, by saying that it is not forced but is drawn, and not only from the heart but from all quarters, as was admitted by Herophilus and before him by Hippocrates and numerous o-thers. [27] Rufus, p. 162, D. Herophilus applies the term " arterial vein " to the very large andthick vessel leading from the heart to the lungs; for in the lungs conditions are the opposite of what they are elsewhere; the veins are there powerful and in nature- very similar to arteries, while the arteries are weak and bear a close resemblance to veins. Cf. G., iii, 445. [28] Rufus, p. 220, D. Herophilus, who had studied the subject more carefully, found the differences to be rather in quality, pulsation occurring only in the arteries and the heart, palpitation and spasm and tremor in the muscles and the nerves. The pulse, according to him, is born with the animal and dies with it; these other functions do not. Pulsation occurs in consequence of the filling and emptying of the arteries; not so the other motions. Again, pulsation is always involuntary, since it is a purely natural movement, but the others are voluntary, for often the parts are compressed or overcharged at will. Cf. G., vii, 594; viii, 717. [29] G., viii, 498. Aegimius and others call any movement of the arteries palpitationBut the practice of Praxagoras and Herophilus holds good even to the present: they c4al1 every perceptible movement of the arteries a pulse. Cf. vii, 594. Galen's own view is contained in xvi, 335. " Palpitation is an unnatural dilatation occurring in any part capable of dilatation. I say this because bones and cartilages never palpitate, since they are incapable of dilatation. . . . When it occurs in the arteries or heart, a second motion differing from pulsation is set up in them." [30] Marcellinus, De Pulsibus, ch. xi. [31] G., viii, 702. Some say that the arteries do pulsate, for their walls dilate and contract just like the heart, but they do this not by any innate power of their own, but receive it from the heart. Herophilus is of this opinion. [32] G., viii, 744. To the statement of Chrysermus that the pulse is due to the vital and animal " faculty, Heraclides added that the faculty must have exceptional energy, for Herophilus and the "Herophilii " as they are called after him said that other things contributed to the origin of the pulse. [33] G., viii, 645. Herophilus says that the strength of the vital power in the artery is. the cause of a vigorous pulse; Athenaeus says it is the strength of the vital tension. [34] G., viii, 747. If he (Aristoxenus) followed the precepts of Herophilus exactly, the contraction is an energy of the arteries, while the dilatation is their return to the normal and natural bodily condition. For his meaning is that, just as in the case of the dead, the wall of the artery is distended, so in the case of the living it is distended as far as possible. [35] G., ix, 463. Herophilus has written about time-units in combination with dilatation and contraction, reducing the ratio to rhythm corresponding to the various ages. For as the musicians 1 establish their rhythms according to certain definite arrangements of time-periods, comparing [the periods of] arsis and thesis, so Herophilus assumes the dilatation of the artery to be analogous to arsis and its contraction to thesis. He made his observations beginning with the new-born child, assuming as the first perceptible time-unit that in which he found that the artery dilated. He says that the time of contraction is equal to this, but is not quite definite in his statement about the intervals of quiescence between them. Ibid., 465. In so far as Herophilus says that the pulse of the rhythm is equal in the case of the lately born, it seems to me that he properly distinguished the principle of contraction; but in so far as he extends the contraction of the artery in the case of the aged to ten timeunits, he no longer has a clear idea, but he recognizes the dilatation by the sensible motions, which we distinguish by feeling the beats against our fingers, and assumes contraction to take place during all the time when he did not perceive motion. [36] G., ix, 470. By comparing the time of dilatation with that of contraction, as Herophilus claimed, it can be ascertained that the patient is in an abnormal condition, and further, whether the abnormality is serious or slight. For the great eversions of the natural rhythms to unnatural ones indicate that the injury is great, while lesser ones indicate that it is "slighter." The pararrhythmic pulses show a light eversion, the heterorrhythmic a greater one, Cf. Pliny, N. H., xi, xxxviii, 88.

Section of the History of Medicine

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the ecrhythmic the greatest. For you must remember that in the first book on " Differences of Pulses " the term ecrhythmic was applied to pulses which have not the rhythm of any age; pararrhythmic to those which are nearly allied, heterorrhythmic to those which have the rhythm of a different age, not nearly related. [37] G., ix, 278; ii, ch. 3. It is now the place for a discussion of rhythms, on which Herophilus has written at length, rather recording the results of observation and experience than teaching a rational system. He described the rhythms which generally occur at various ages, but, firstly, he does not tell us in what kinds of subjects he observed them; and, secondly, from his teaching it appears that he is confused and disconnected with regard to the diagnosis of contraction and quiescence. For if he thinks that contraction can occur in the case of the aged, extending up to ten time-units, it is clear that he has never perceived the true contraction: for this is sometimes of shorter duration than the dilatation, sometimes of equal duration, at other times, as he writes, of longer duration-though not, as he thinks, five times as long, but only a little longer. [38] G., viii, 911. Herophilus himself often mentions pulses as a means of prognosis, but it is hard to discover what he means by rhythm. Is it only the ratio of the time of dilatation alone to that of contraction alone, or does he add the time of quiescence subsequent to each of these motions? Ibid., 912-13. For our present purpose let us assume that rhythm consists of the proportion between the times of the motions, and seek at our convenience what is Herophilus' view. [39] G., viii, 592. Herophilus classified the general differences of pulses as follows-size, speed, strength, rhythm; and not pairing properly with these, he mentions specifically order, disorder, regularity and irregularity; so he is accused by the cavillers of contrasting species with genus. [40] G., ix, 499. [41] G., viii, 786. Since Agathinus said that the contraction of the artery was imperceptible, while Herophilus continually speaks of it as being perceptible, it was difficult and distracting to have to believe one in preference to the other. [42] G., viii, 853. Perhaps even a child's pulse may be in excess of the normal. Herophilus sometimes calls this pulse considerable. Why then, you may ask, does Archigenes call it " little " ? I can explain the reason for the discrepancy, if you first realize that we have established the principle that for the purpose of investigating the causes of pulses a reasonable man miust know what is the normal one. [43] G., viii, 871. They pick out merely the headings of Herophilus, disregarding all the rest, so that they are quite ignorant of what he really wrote. So they say that children's pulse is small (though Herophilus states the opposite), without taking the trouble to examine and understand what people mean by a small or great dilatation. As a matter of fact we commonly speak of great or slight dilatations of bladders, bellows, bags, bellies, uteri, and anything else which contains a cavity. Often we might say that the belly is slightly distended, whereas if the bladder were distended to the same extent, we should call it a great distension. ... [44] G., ix, 453. Herophilus says that a child's pulse is " sufficiently great," Archigenes says it is little. Similarly Archigenes says that the " crawling " (1vpgniKIc'wv) pulse is fast, but Herophilus says it is not fast. [45] G., viii, 556. The "capering" pulse as Herophilus calls it, is characterized by irregularities in one dilatation; it is a compound [rhythm] not connected with any of the irregularities which are attached to the first five classes of irregularities, but occurs particularly when the artery interrupts its motion in some part. It does not occur simply, for not all this class is called " capering," but when the second motion after quiescence is quicker and more violent than the first. Cf. Pseudo-Soranus, 280. Rose, Anec. Grsc. 1870. [46] Rufus, p. 224, D. In the case of new-born children the pulse is very slight and we cannot distinguish between the contraction and dilatation. Herophilus says that this pulse is " irrational," by which he means a pulse which has no ratio to another, it has neither the ratio 1 : 2 nor 1 : 12, nor any other (proportion), but is very slight and gives an impression like the prick of a needle; so that Herophilus was justified in first calling this pulse "irrational." [47] G., viii, 955. For the benefit of all who wish to learn ancient history, and have time for it, I will state my case fully, and will prove that Herophilus never for any purpose makes use of the " full pulse." I shall begin with the statement which they adduce in the first book

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of the commentary on Herophilus On Pul8ations, which I imagine is the only book they have read. It is as follows: " In general, one pulse seems to me to differ from another in volume, speed, strength and rhythm." Adducing this passage, they ask, " What is volume ? " As if we did not know what he meant by it, and maintaining that he must be referring to fulne88. Well, I can answer them neatly, I think. I maintain that by volume he means frequency. Or, again, I would answer others that by volume he means speed, or anything rather than fulness. Cf., pp. 929, 959. [48] Rufus, p. 67. [49] (a) G., iv, 565. However, the seminal duct, which some call the varicose parastate, draws the semen from it (the epididymis) and carries it up to the base of the penis. It was on this account, I suppose, that Herophilus thought it had nothing much to do with the production of the semen. (b) Ibid., 582. . . . The seminal vessel, in which Herophilus called the part near the duct the varicose parastate. [50] Rufus, pp. 158-59. The seminal vessels are four in number, two varicose (vasa deferentia) and two glandular (vesicule seminales); they used to be called also the generative glands. Of the varicose, the parts which touch the testes are the para8tate8, though some do not hesitate to call the whole of them parastates. We must consider whether the same formations exist in the female as in the male, for Herophilus considers that the female does not possess the varicose parastates; . . . but we have seen in the uterus of a sheep varicose vessels on either side springing from the testes. These opened into the cavity of the uterus, and mucous fluid escaped from them when pressed. [51] G., iv, 596. Herophilus says that the " semen of the female is in a sense emitted" o&WT &KXELO8al), though he gave a correct account of the testicles in the third book of (OVK iO' his "Anatomy." These are his words at the beginning of the book: "Two testicles are attached to the sides of the aterus, one on each side, very little differing from those of the male." Then not long after in a subsequent chapter he writes, " Females have two (testicles) attached to the 'shoulders' of the uterus (cornua uteri), one on the right and one on the left, not contained in a single scrotum but both being separate. They are contained in a fine membranous membrane, and are small and rather flat, like glands. They have a nerve system adjacent to the covering which surrounds them, and the flesh is hard, as in the case of males. They are of great size in the case of mares. They are attached by numerous membranes to the uterus, and by a vein and an artery which pass into them from the uterus. For they are attached by the vein and artery which passes to each of the two [testicles], vein being attached to vein and artery to artery. The seminal ducts are not very apparent, but they are attached to the uterus externally, one on the right and one on the left. The first part is twisted, just as in the case of the male, and practically all the rest, up to the end, is curled (ecipaoeths, ' varicose '). " Ducts from both the testes are attached, as in the case of the male, to the fleshy part of the neck of the bladder; they are fine and are crooked in the' fore part, by which they touch the bones of the hips, at which they terminate, passing from either side into the interior of the vagina. But the varicose parastate has not been observed in the female." [52] G., ii, 895. There are four other vessels which are found in some women, but not all, according to Herophilus. They start from (&iro4vnteuva) those which lead to the kidneys, and enter the uterus. I have not found this in other animals except rarely in the case of apes; but I do not doubt that Herophilus often found it in the case of women; for in addition to a sound general knowledge of his art, he possessed a particularly accurate knowledge of the results of dissection, which he obtained not, as most people do, by experiments on brute animals but on human subjects. He also tells us that the vessels which nourish the uterus are inserted into the membranes from which we say that the bladder depends, and that these membranes always grow thicker and harder and more callous in the case of multipara3. [53] Soranus,. p. 300. Some suppose that women have special pathological conditions, others, e.g., Erasistratus and Herophilus, maintain the contrary . . . there are seven primary and simple pathological conditions, and so no special one can be assumed in the case of women. Herophilus in his " Midwifery " says that the womb is constructed of the same tissue as the other parts and controlled by the same powers and has the same substances near it; and a diseased condition in it is due to the same causes. Therefore there is no special pathological condition in women except conception, gestation, parturition, lactation, and their opposites. [54] G., ii, 890. As to the form of the uterus, in general and particularly in its base, it

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resembles the bladder but is dissimilar to it in having "mastoid processes" at the sides inclining towards the flanks. Herophilus compares their shape to the curve of a, semicircle, Diocles to growing horns. On this account he called them the " ceratid " processes. [55] G., ii, 897. [56] G., iii, 209. [57] Soranus, p. 178. After parturition the os uteri becomes more callous, like the head of a cuttle-fish, or, as Herophilus says, it resembles the top of the trachea, being hardened by the passage of the substances discharged and brought to birth. [58] Soranus, p. 192. Herophilus says that sometimes and for some women the purgation is harmful, for some enjoy uninterrupted health so long as they are free from the purgation, and often on the other hand in the process of purgation they grow paler and thinner and liable to pathological disturbances; but sometimes and in some cases it is beneficial, so that being formerly pale and ill-nourished they subsequently gain colour and are well-nourished. [59] G., xix, 330. [60] Soranus, 225. The umbilical cord is composed of four vessels, two veins and two arteries, by which material for blood and breath is conveyed to the embryo. Empedocles thinks it grows into the liver, Phaedrus into the heart; but most people think that the veins grow into the liver and the arteries into the heart. Herophilus thinks the veins grow into the hollow vein and the arteries into the great artery which runs along the spine, and before they join this they go obliquely alongside the bladder on both sides. [61] Soranus, p. 349. Herophilus in his " Midwifery" says that difficult labour is also due to frequent parturition. It is due to the embryo being in a slanting position or to the insufficient dilatation of the cervix or os uteri, or to the fact of the membrane containing the embryo, in which the waters collect, being too thick, so that it cannot burst before birth. Embryos, he says, have been seen to be born without the membrane bursting. In such cases labour is difficult; and difficult labour is also due to slackness of the uterus or the body.' Barrenness is due to the displacement of the uterus in the body. Difficult labour also occurs owing to external influences and occurrences and actions and to the discharge of excessive quantities of blood and fluid from the body. Difficulty in parturition also occurs owing to special distension of the womb by the embryo or owing to a chill or fever, or a tumour or abscess in the intestines or in the stomach. Cavity2 occurring in the loins and spine is a cause of difficulty of labour, which may also be due to a fatty condition in the stomach or ischial region which causes pressure on the uterus; or to the death of the embryo. So far Herophilus. [62] Soranus, p. 372. Some say that the whole uterus suffers prolapsus, when the membranes and muscles supporting it are ruptured by a blow or something of the kind, or relaxed and as it were paralysed; but the schools of Hippocrates and Herophilus maintain that it is only the cervix. The hardened body is found to prolapse from the soft parts, resembling the head of a cuttle-fish, as Herophilus said, and being scarcely capable of admitting a probe. [63] Rufus, p. 155. [64] Ibid., p. 149. [65] Celsus, I, pref. [66] Tert., De Anima, c. 10. " Herophilus, the physician, or rather butcher [aut lanius], dissected six hundred persons that he might scrutinize nature: he hated man that he might gain knowledge. I know not whether he explored, clearly, all the internal parts of man, for death itself would change them from their state when alive, and death in his hands was not simply death, but led to error from the very process of cutting up." [67] Ibid., c. 25. [67B] G, v, 603. [68] G., xviii, 136. [69] G., xii, 966. By persuading them to use the drugs (which they had been afraid to use) I proved to them and to you the truth of both sayings of Herophilus: for if you say that drugs by themselves are no use, you will say rightly; for they are of no use unless they find someone to use them properly; and again, you will be right if you say they are like the " hands of the gods "; for they are of great help if the person using them has been trained in the logical method in addition to being himself intelligent.
I The abdominal muscles.
2

Cavity, &c., possibly refers to spinza bifida in the fcetus.

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[70] Celsus, V, pref. The ancient physicians attached much importance to these remedies . . particularly Herophilus and his successors; so much so that they never treated any disease without medicines. They have also written a great deal about the properties of medicines. Cf. G., xi, 795; Pliny, N. H., xxvi, ii, 6; Celsus, T, pref. [71] e.g., G. xii, 843; xiii, 79, 308; xiv, 444. [72] G., x, 184. Herophilus and Erasistratus are not successful in treating ulcers. [73] G., v, 685. So not only Plato, but Aristotle, Theophrastus and the other disciples of Plato and Aristotle who have followed the theory of Hippocrates about the juices, and also the most notable of the ancient physicians, Diocles . . and Herophilus. Cf. xviii, A, 187. [74] G., xiv, 688. Herophilus defines medicine as a knowledge of healthy, morbid and neutral conditions; for it implies a knowledge of these three-of healthy, namely, all that induce this condition in the human subject, from the proper harmonization of which health results; of morbid, which dissolve the health-giving harmony; in the class of neutrals are all the helps which are prescribed in cases of sickness, and their material; for these, before they are employed by the -physician are neutral, i.e., neither healthy nor morbid. [75] Plut., Epit., v, 29. Herophilus says that some people at times become feverish from no antecedent cause. [76] G., xix, 321. Herophilus thinks that some dreams are inspired by God and come to us inevitably, while others are physical, arising when the soul pictures things which will be useful, or events in the future ; others are of a combined nature, arising naturally. The occurrence of [mental] pictures, when we see what we want to see, as happens in the case of lovers who embrace their mistresses in dreams. [77] Plut., Plac. i, 23, 6. Herophilus says that, of motion, some is cognizable by reason, other apprehensible by sense. [78] Sext. Emp., Eth. xi, 50.