!ection of the lbiztorp of Mebicctne.

[January 6, 1932.]
Alcmaeon of Croton: His Life, Work, and Fragments.
By PAN. S. CODELLAS, M.D.
CRoTON became a medical metropolis through the distinction of its medical
school and the ability of its doctors, of whom Democedes is one of the best known.
This famous physician came to Croton from Cnidus in 530 B.C., and remained there
until 525 B.C., when his services were retained by Athens as State physician.
In another sphere than medicine, but one which at that time had more than a
superficial connection with medicine, namely, philosophy, Croton is distinguished
by its association with Pythagoras, who migrated to that city from Samos.
Pythagoras introduced philosophical methods into medicine, and was at pains to
reason out and explain the causes of disease. His medicine was preventive rather
than curative, and resembled in principle the contemporary medicine of Egypt and
Babylonia. Iamblichus gives the main features of Pythagorean medicine (Vit.
Pyth., § 163), where he says: "Of the sciences they honour more Music, Medicine,
and Auigury; the kind of medicine they chiefly emphasize is the dietetic . . . They
make greater use of poultices than did their predecessors. Drugs are employed to a
less extent and only on ulcers. . . . For some ailments they use incantations, also
music, as being beneficent to health if properly so used. At times it was accompanied
by Homeric or Hesiodic verses for "psychic complaints."' The Pythagoreans were
interested in Generation and Decay, Vision, the nature of the Sperm, the possible
production of Sperm by the Female, and Embryology.
Knowledge of Alemaeon himself and of his works is very meagre and debatable,
and the account which follows here is gathered together from scanty fragments
which have survived in literature and tradition. His name is variously given as
Alcmaeon, Alcman, Alemaon or Alemeon, the variations being largely exolicable as
dialectic forms. His father was Peirithus or Perithus. He was most probably born
at Croton; at all events he lived in that city for a number of years.
A short parenthetic remark from Aristotle refers to the time in which he
flourished, but is disputed by philologists. Pythagoras must, however, have been an
old man when Alemaeon came of age or came to him. This view is reinforced by the
statement of Iamblichus (Vit. Pyth., §104) that "disciples of Pythagoras in his old
age were the young men Philolaus . . . and Alcmaeon." This is further corroborated
by the text of Asclepius, Aristotle's commentator (Hayduck, p. 39, 21). The
flourishing period of the school of Pythagoras was 532 B.C., so that Alcmaeon may
be placed in the latter half of the sixth century B.C.
Of Alemaeon's family nothing is known except the name of his father; of his early
or later schooling nothing. He may have been a Pythagorean, but his natural
bent was towards things of more practical import than abstract thought.
According to Clemens of Alexandria (Strom. I, 26, 78) and Favorinus (referred
to by Laertius), he was the first to write natural history, but this view is not
supported by the extant Greek literature.
His writings are naturalistic, astronomical, psychological and biological. Laertius
remarks that the contents of his books are for the most part medical, although he
also wrote on nature. Fragment II of the present collection contains the opening
of one of Alemaeon's books and suggests also the title.
He must have written several books, if one correctly interprets Galen and
Laertius; the latter writer enumerates the books of Aristotle, among which is one
MAY-HIIST. OF MED. 1
1042 Proceedings of the Royal Society of Medicine 26
bearing the title, " Against the Works of Alcmaeon." It appears to have been of
polemic nature, and is among the lost works of Aristotle.
Theophrastus seems to have possessed a complete knowledge of Alemaeon's
writings and his quotations lead one to suppose that he follows Alemaeon's order.
Alcmaeon wrote in mixed Doric and Ionian dialect.
Modern writers, accepting the comment of Chalcidius (Tim. 244): "primus
exsectionem aggredi est ausus," call Alemaeon " Father of Human Anatomy." He
recognized, at all events, the Eustachian tubes and the acoustic nerves, and was the
first to practise anatomy by cutting off organs and dissecting them. It is also true
that he made " the earliest records of anatomical observations" (Singer, p. 9).
FRAGMENTS.1
I. METAPHYSICS.
(i) Differentiation of man and animals.
Theophrastus, De sensu, § 25 (Dox. 506, 19) "Alcmaeon, one of those who
do not regard sense perception as similar (to thinking), first points out the
difference from animals. He says that man differs from other animals, because
he alone comprehends, while the other animals perceive but do not understand,
because understanding and perception are different things, contrary to what
Empedocles states."
(ii) Divine and human knowledge.
Laertius, Diog. VIII 83.
(iii) Dualism of opposites.
Arist., Metaph., A 5, 986 a 22.
Alexander Aphrodisiensis ad 1, 1 (pag. 42, 3 Hayduck).
Asclepius ad 1, 1 (pag. 39, 21 ed. Hayduck).
Isocrates (Or. 15), § 268.
(iv) Immortality Circle.
Arist., Problem. XVII 3, 916 a 33.
Michael Apostolius, Proverb. Cent. XVIII 50 (Corpus Paroemiogr., ed.
Leutsch et Schneidewin II 674).
(v) Immortality of the Soul.
Arist., de An., I 2, 405 a 29.
Simplicius ad 1. 1. (pag. 32, 3 Hayduck).
Sophonias 1. 1. (pag. 14, 31 Hayduck).
Themistius, in paraphrasi 1. 1. (II 24 Sprengel): And Alemaeon the
Crotonian Naturalist, stated, similarly to these, that it (the soul) is immortal
through being similar to the immortal objects, by moving for ever, because it
and all the others are moving continuously, sun, moon, stars, heaven."
Laertius, Diog. VIII 83.
Cicero, De nat. deor., I 11.
Clemens, Alexandr. Protrept., V 66.
Boethus, apud Eusebium praepar. ev., XI 28.
Arist., de An., I 2, 404 a 20.
Sophonias (11, 25 Hayduck).
Philoponus, ad Arist. de An., I 2, 404 a 20 (page 71, 6 Hayduck).
Stobaeus, Ecl. Phys., I 52 (Dox. 386 b 4) ex Aetio.
Theodoretus, Cur. graec. aff., 5 (pag. 195 Gaisf.) ex eodem A6tio.
1 Only those of medical interest are given in full ; the rest are given by reference.
27 Section of the History of Medicine 1043
II. ASTRONOMY.
(vi) Sun.
Stob., Eel. phys., I 25 (Dox. 352 p 8) ex Aetio.
(vii) Eclipse of the Moon.
Stob., Ecl. phyys., I 26 (Dox. 359 b 17) ex Aetio.
(viii) Planets.
Aetius, Plac., II 16, 2. 3 (Dox. 345 a 19, b 22).
(ix) Stars.
Arist., de An., I 2, 405 a 29.
La6rtius, Diog. VIII 83.
III. ETHICS.
(x) (Ps.-) Alcmaeonis fragmentum ethicum.
Clemens Alexandr. Strom. VI 2, 16 (III 106 Klotz).
IV. EMBRYOLOGY.
(xi) Origin of Sperm.
Plut., Epit., V 3, 3 (Dox. 417 a 10) ex Aetio: Alemaeon (states that the
sperm is) part of the brain."
Censorinus, D. d. nat., V 2, 3: Some refute this opinion, as Anaxagoras,
Democritus, and Alemaeon the Crotonian (that the sperm is derived from the
marrow).
(xii) Maternal Sperm.
Censor., D. d. nat., 5, 4: "That also makes the question ambiguous among
authors, whether offspring is born from the semen of the father only, as
Diogenes and Hippon and the Stoics wrote, or from some seed in the mother
also, as is accepted by Anaxagoras and Alemaeon and Parmenides and
Empedocles and Epicurus."
(xiii) Sex determination.
Censor., D. d. nat., 6, 4: Alemaeon said, the sex of that parent is
represented, from whom comes a greater quantity of sperm."
(xiv) Sterility of Mules.
Plutarchus, Epit., V 14, 1 (Dox. 424 a 30) ex Aetio:-" Alemaeon has said
that of the mules the males are sterile on account of the thinness (and)
coldness of the sperm, the females because their uteri do not "open their
mouths wide enough. This was his own expression."
(xv) Nutriment of the Chick.
Arist., De gen. an., III 2,752 b 22:-" The viviparous animals produce the
food for the young, which is called milk, in another part (of the body), in the
mammae; in the birds this is made by nature in the eggs. It is, however, the
opposite to what men think and what Alcmaeon the Crotonian states: the
white (of the.egg) is not the milk, but the yellowish part. This is the food for
the chick. People think that the white is the food because of the similarity of
colour."
(xvi) Foetal Nutrition.
Plut., V 16, 3 (Dox. 426 a 28) ex Aetio:-Alcmaeon says that (the foetus) is
nourished through the body: it takes up the nourishing parts from the food
like a sponge."
Oribasius, III 156, edd. Bussamaker et Daremberg:-" From Rufus. The
first nourishment that should be offered is some honey, for it acts as a
stimulant by its sweetness, and besides, it clears the body right through as
1044 Proceedings of the Royal Society of Medne 28
well as the bowel. For at this period the bowel contains some residue which
must be expelled: not, as Alcmaeon thinks, because the baby swallowed with
its mouth while in the womb, for that is absolutely impossible."
(xvii) Foetal Development.
Plut., Epit., V 17, 3 (Dox. 427 a 8) ex Aetio:-" Alemaeon (said) that the
head in which resides the governing faculty (principatum), (is first completely
formed in utero)."
Censor., D. d. nat., V, 5, denies this statement, thus disagreeing with
Plutarch.
V. DEVELOPMENT.
(xviii) Puberty.
Arist., Hist. anim., VII 1 p. 581 a 13:-" Alemaeon the Crotonian says that
the male begins to produce sperm for the first time in the majority of cases on
the completion of twice seven years; at the same time hair begins to grow in
the pubic region, just as the plants preparing to produce seed first bloom."
(xix) Mental Maturity.
Schol. ad Plat. Alc. prior pag. 121 E (Dial. Plat., ed. K. Fr. Hermann, VI
281); "Then (at the fourteenth year) perfect reason appears in us, as Aristotle
and Zeno and Alemaeon say."
VI. ANATOMY.
(xx) Dissection.
Chalcidius, in Plat. Timaeutm, pag. 279, ed. Wrobel:-" The nature of the
eyes has been demonstrated by Alemaeon and several others. He was a well-
versed naturalist and was the first to undertake dissection."
VII. SPECIAL SENSES.
(xxi) Vision.
Theophr., 1. 1. 26 (Dox. 506, 28) :- The eyes see by means of the
wateriness about them, but it is evident that the eye contains fire, for a blow
on the eye produces flashes. Sight depends on brilliancy and transparency of
reflection, and the clearer this is, the more perfect (is vision).
Stob., Ecl. phys., I 52 (Dox. 404 b 23) :-" Alcmaeon states (that vision
takes place) according to the degree of transparency."
(xxii) flearing.
Theophrastus, De sensu, 25 (Dox. 506, 23):-" He (Alcmaeon) says that we
hear with the ears because there is an empty space in them; this space
resounds. Sound is produced by the cavity, and the air (in it) produces
resonance.
Aetius, Plac. 16, 2 (Dox. 406 a 21):-Alcmaeon says "that we hear by the
empty space in the ears, because this is what resounds owing to the presence of
the air; all hollow objects (sic Stob.: voids, Plut.) produce sound."
(Aristotle (De an., II 8, 419 b 33) amplifies this idea that hearing is dependent
upon empty space or cavity: hearing, he says, is correctly attributed to
emptiness, because air is thought to be emptiness.")
(xxiii) Smell.
Theophr., 1.1. (Dox. 506, 26) We smell through the nostrils by drawing
up the air to the brain during inspiration."
Aetius, lV 17, 1 (Dox. 407 a b 1):-" Alcmaeon says that the governing
faculty is in the brain; through this we smell, because it draws up the savours
by the breath."
(xxiv) Taste.
Theophr., 1.1. (Dox. 506, 26):-" We distinguish tastes with the tongue;
00 Section of the History of Medicine 1045
for being warm and supple it dissolves substances by its heat, and receives and
distributes (the sensation of taste) in virtue of its porous and soft texture."
Plut. Epit., IV 18 (Dox 407 a 12) :-Alemaeon says " that determination of
tastes depends upon the moisture and warmth which are inherent in the tongue
in addition to its supple character."
(xxv) Touch.
Theophr., 1. 1 (Dox. 507, 3),:-With regard to touch he makes no statement
as to the mode or means of its operation. Alemaeon's exposition goes so far
and no further.
(xxvi) Cerebral Correlation of Senses.
Theophr., 1.1.26 (Dox. 507, 3):-(Alcmaeon states) " that all the senses are
connected somehow with the brain so that when the brain is agitated and
displaced, maiming (of limbs or senses) follows; since the passages, through
which the sensations pass, are occupied."
VIII.-PHYSIOLOGY.
(xxvii) Seat of Intelligence.
Aetius, IV 17, 1 (Dox. 407 a b 1):-Alemaeon says "that the governing
faculty (hegemonic) is in the brain."
In chapter V, where Plutarch expounds the various sites which are given as
seats of the 'hegemonic,' there is no opinion mentioned prior to Alcmaeon.
(xxviii) Respiration of Goats.
Arist., UIist. an., I 1 pag. 492 a 14 :-" Alemaeon is wrong in his belief that
goats breathe through the ears."
(xxix) Sleep, Awakening.
Plut., Epit., V 24, 1 (Dox. 435 a 11) ex Atio :-Alcmaeon says "that
sleep results from retreat of the blood to the blood-carrying veins; awakening,
by its pouring forth."
IX. IATRICA.
(xxx) Origin of health and disease.
Aetius, Plac., V 30, 1 (Dox. 442 a 3): Alcmaeon states that the
maintenance of health depends upon equilibrium of the faculties, moist and dry,
cold and hot, bitter and sweet and so on, and that the predominance of any is
productive of disease: for the predominance of any single one of them is
disastrous. He says that disease occurs in some instances from excess of heat
or cold, in some owing to excess or deficiency (Stobaeus has a varia lectio 'from
excess of food') and in some (from fault of) the blood, marrow or brain. With
these must be included the occasional occurrence from extraneous causes such
as qualities of water, soil or district or some unavoidable cause or things
akin thereto. Health depends upon an evenly proportioned combination of
qualities."
X. DEATH.
(xxxi) Cause of death.
Plut., Epit., V 24, 1 (Dox. 435 a 11):-" Total retreat (of blood to the blood-
carrying veins) is death."
Alemaeon's philosophical, biological, and medical opinions, whether specifi-
cally quoted as his or not, were the objects of discussion for about a thousand
years, as it is shown from the extant Greek medical literature up to that of the
4th century A.D.
Many of his theories can easily be detected in the Corpus Hippocraticum.
In conclusion one may perhaps quote from Charles Singer's Evolution of
Anatomy:-" Alcmaeon began to construct a positive basis for medical science
1046 Proceedings of the Royal Society of Medicine 30
by the practice of dissection of animals. He discovered the optic nerves, and
the tubes called in after ages (1562 A.D.) by the name of Eustachius. He even
extended his researches to embryology, describing the head of the fretus as the
first part to be developed-a justified deduction from the appearances. Curiosity
excited by him as to the distribution of the vessels led his followers, Acron (c.
480 B.C.), Pausanias (c. 480 B.C.), and later Philistion of Locroi (c. 390 B.C.),
the contemporary of Plato, to make anatomical investigations."
RE FERENCES.
The basis of the present paper is Doxographi Graeci, Wachtler's de Alcmaeone, Aristotelis Opera and
the Commentaries on the works of Arist(tle. Sources met in the paper and not given below are
from Wachtler's study.
Aristoteltis Opera, ex recognitione Immaniielis Bekkeri, Berolini, 1831.
Commentaria in Aristotelem Graeca, Alexandri Aphrodisiensis, Ioannis Philoponi, Sophoniae, Asclepii,
edidit Michael Hayduck, Berolini, 1883-1903.
Aur. Cor. Celsus, on Medicine, Latin and English by Alex., Lee, London, 1831.
Doxographi Graeci by Hermannus Diels, Berolini, 1879.
Diogenes Liiertius, Lives of Eminent Greek Philosophers, The Loeb Classical Library, by R. D. Hicks,
London, 1925.
Claudii Galeni Opera Omnia, ed. D. Carolus Gottlob Kiihn (Vols. I 487, XV 5, XIX 272, 343), Lipsiae.
1830.
The Genuine Works of Hippocrates, Tr. from the Greek by Francis Adams, New York.
TAs7 AvOpoTLJ'l scripsit et edidit Ludovicus Philippson, Berolini, 1831.
Oeuvres d'Oribase en grec et en franfais, Bussamaker et Daremberg, Paris, 1858.
Charles Singer, The Evolution of Anatomy, New York, 1925.
Ioannes Wachtler, de Alcmaeone Crotoniata, Lipsiae, 1896.

[March 2, 1932.]
The History of the Introduction of Biochemistry into Medicine.
By W. LANGDON BROWN, M.D., F.R.C.P.
[ABRIDGED].
IN the following account I have endeavoured to concentrate my subject into a
small compass by laying stress on the recent rather than on the more remote past.
Organic chemistry deals with the structure and relationships of the chemical sub-
stances to be found in animals and in plants; physiological chemistry dealt, it is true,
with the changes such substances undergo in the living body, but did so largely by
the study of the finished end-products, while biochemistry, in attempting to study
those changes in relation to the tissue-cell, concentrates its attention on the internal
medium of exchange-the blood-rather than on the secretions and excretions.
Obviously no hard-and-fast line can be drawn, but I may illustrate my point by two
examples.
However much I confined my remarks to the more recent past, it would, I am
sure, be unnatural if I omitted to mention the well-known fact that Wohler, in 1828,
prepared urea in the laboratory, and thus, by making the first gap in the wall between
the organic and inorganic compounds, dealt a shrewd blow at prevailing theories of
vitalism. Organic chemists are interested in the fact that urea is carbamide, and
that there are many substituted ureas; physiological chemists are inteiested in the
formation of urea in the liver from amino-acids and in its excretion by the kidney,
but a modern biochemist like Van Slyke is concerned with what he calls urea
clearance, that is to say, a comparison between the concentrations of urea in the
blood and in the urine, and the efficiency of the kidney in effecting that clearance.
In the same way it would be inexcusable if I omitted to note that Thomas Willis
in 1679 discovered a saccharine substance in the urine of patients afflicted with the
disease known since the time of the Greeks as diabetes. But this observation assumed
a new physiological importance when Claude Bernard demonstrated the glycogenic
function of the liver in 1857. The conditions modifying the excretion of sugar in the
urine were closely studied by many clinicians, among whom Pavy calls for special