Cos versus Cnidus and the Historians: Part 2

Théophile René Laennec Hyacinthe , Propositions sur la doctrine hippocratique relativement a la médecine-pratique (Paris, An XII (1804)).

P. 15.

P. 16. This evidence of Laennec's dissatisfaction with the Epidemics is particularly striking when we contrast it, in general, with the conventional pieties which were prompted by the Epidemics, and in particular, with Pinel's earnest recommendation of them as a model for nosology.

P. 17 and note 1. Laennec refers to the celebrated passage about the superfluity of naming diseases in Prognosticon, ch. 25 (ii, 190 Li. = ii, 55 Jones). The passage is often associated with the criticism of the Cnidian sentences in Regimen in acute diseases, ch. 3.

P. 35.

Pp. 37–38.

Moravia S. , op. cit. (ref. 56), 1100: “De Vicq d'Azyr à Alibert, de Pinel à Cabanis, la personne du grand médecin grec est en train d'acquerir la valeur d'un symbole.” See especially 1098–105 and 1129–38. I owe thanks to Dr Elizabeth Haigh for drawing my attention to this valuable article, and in particular for letting me read the relevant chapter, on the Idéologues, of her own forthcoming work on Xavier Bichat.

Pinel Philippe , Nosographie philosophique (Paris, An VII (1798)). Pinel's historical statements and his judgement on Hippocrates are to be found in the essay printed at the end of the first edition, “Principes généraux sur la méthode d'étudier et d'observer en médecine”, ii, 320ff., and also in the Introduction.

Théophile René Laennec Hyacinthe , De l'ausculation médiate (Paris, 1819), ii, 117–28.

Nosographie, Introduction passim, especially viii, xi, and xvi.

Ibid., viii.

Barthez P. J. , Discours sur le génie d'Hippocrate (Montpellier, An IX (1801)).

P. 6.

P. 8.

Pp. 19–20. Barthez's language here seems to echo that of Pinel describing the nosologist de Sauvages and others, in whom, said Pinel , “One finds an arbitrary and vacillating classification, symptomatic affections taken for the primitive diseases themselves, multiplication to excess …” (Nosographie, Introduction viii). For the attitude of this group of men to the historical question there is hardly a more illustrative quotation than Jean Pierre Cabanis George (1757–1808), Coup d'oeil sur les révolutions et sur la réforme de la médecine (Paris, An XII (1804)), 97: “The school of Cnidus, the rival to that of Cos, is known to us only through what Hippocrates himself tells us. If he is to be believed in entirety, the school united in its instruction the disadvantages of a blind empiricism with those of a passion for hypothesis; for Hippocrates maintains that, on the one hand, diseases here were considered only in individual cases, without their collection, in virtue of their resemblances into definite primary classes, genera, and families; while on the other hand, there was no hesitation in establishing, on the basis of these isolated observations, rules which being incapable of referring to any general or constant feature, could leave no impression upon the intellect.” If the reader compares this with the passage upon which it is supposedly based, he may come to some odd conclusions about the real respect which these analysts had for painstaking and careful observation.

Pinel's knowledge of Galen was of course extensive, Barthez too was aware of the same background. In a note to the passage in p. 8 of his eulogy quoted above, he refers to Martianus Prosper , Magnus Hippocrates Cous … notationibus explicates (Rome, 1626). Martianus says “the ancient physicians, directing their whole aim to cure, established as many differences among diseases as these diseases required different kinds of cure”. Martianus in turn is echoing the passage in Galen , Methodus medendi, 2.6 quoted above in ref. 35.

Broussais F. J. V. , Examen des doctrines médicales et des systèmes de nosologie, 3rd ed. (Paris and Brussels, 1829–34). This is the edition referred to by Houdart. The original work was entitled Examen de la doctrine médicale généralement adoptée and published in Paris in 1816. For Broussais's position see the article by Ackerknecht E. H. , “Broussais, or a forgotten medical revolution”, Bulletin of the history of medicine, xxvii (1953), 320–43. Ackerknecht states that the effect of Broussais's stuck upon Pinel was to polarize the field into “nosologists” on the one band and “physiologists” on the other (pp. 323ff.). This, if true, is enlightening for the favourable view taken of the Cnidians by Broussais's disciple Houdart, and the new emphasis which is thereafter laid upon the (imagined) local pathology of the Cnidians is a minor ripple of the “medical revolution” caused by Broussais.

Histoire, 183. In view of the similar comparisons, and its similar application, in Littré's second volume (Oeuvres d' Hippocrate, ii (1840), 198–205) it is probable that Houdart was influenced at least in the form of his expression by Littré. But his general attitude is clearly inspired by his much admired master.

Ibid., 185–6.

Hippocratis et aliorum medicorum veterum reliquiae (Amsterdam, 1859–64).

Prorrheticon, 1 (v, 510–73 Li.); 2 (ix, 1–75 Li.); Coan prognoseis (v, 588–733 Li.).

P. 53.

P. 151.

P. 144.

P. 148.

Preface, i (1839), 9.

Vol. i, 13.

It is astonishing how Littré, for all his mastery of the evidence and his usual clarity of insight, is content to repeat these myths. As with Sprengel, we see how fatal was the temptation to tell a coherent story in elegant prose.

Vol. ii, 198.

Ibid., 200–1. The existence of schools and of a doctrinal polemic between them is simply regarded as a fact of history.

P. 201. That the Cnidians studied “the diversity of diseases” is clearly an anachronistic interpretation of the evidence.

P. 203.

Littré expresses this even less equivocally in vol. i, 463, where he admits that “if we carried out the Hippocratic programme to the letter—if we took account of the common signs [Laennec!] and only the common signs in all diseases, we would obtain a result so meagre, we would descend to a level of generality so remote, that it would bear no fruit, whether for theory or for practice”. Admittedly Littré speaks warmly of Hippocratic observation. But it was easy to do this, and the passage given above is more revealing.

Lehrbuch der Geschichte der Medizin, 3rd ed. (Jena, 1875), 104–9: “Eigentümlichkeiten der Knidischen Schule”.

Einführung in die Geschichte der Medizin (Berlin, 1898), 50.

Sigerist H. E. , A history of medicine (ref. 2), ii, 87, 276, 283, 290–1.

Cf. ref. 17.

Kavvadias P. , Ephemeris Archaeologike (Athens, 1883–85). The inscriptions are most easily accessible in Edelstein and Edelstein (ref. 17), 221–38. Withington T. E. , “The Asclepiadae and the priests of Asclepius” in Studies in the history and method of science, ed. Singer C. , ii (London, 1921), 192–205 gives an effective demonstration of the mistake and of its survival in the teeth of the evidence.

Op. cit. (ref. 17), cf. 55, note 8: “Apart from the fact that the use of the term ‘Asclepiads’ apparently is older than the divine cult of Asclepius, no-one will share any longer the view accepted even in the beginning of the twentieth century that lay physicians were called ‘Asclepiads’ because ancient medicine originated in the temples of Asclepius, a widespread prejudice already at the end of antiquity.”.

Daremberg C. , Oeuvres choisies d'Hippocrate, 2nd ed. (Paris, 1855), Introduction, p. xcvi.

Abhandlungen der koeniglichen Gesellschaft der Wissenschaften zu Goettingen, vii (1857), 131–50.

P. 136.