FOOTNOTES:

[11] "De Medic.," lib. 1.

[12] "Sat.," x, 221.

[13] Rhodes's version.

[14] Handerson's translation.

[15] "Tacit. Annal.," xiv, 43.

[16] "Paulus AEgin.," vol. ii, p. 379.

[17] "Just. Cod.," vii.



CHAPTER VI.

IN THE REIGN OF THE CAESARS—TO THE DEATH OF NERO.

Augustus—His illnesses—Antonius Musa—Maecenas—Tiberius— Caligula—Claudius—Nero—Seneca—Astrology—Archiater—Women poisoners—Oculists in Rome.

Long before the settlement of the constitutional status of Augustus in 27 B.C., he had undertaken many reforms. In 34 B.C., Agrippa, under the influence of Augustus, had improved the water supply of Rome by restoring the Aqua Marcia, and Augustus had repaired and enlarged the cloacae, and repaired the principal streets. Road commissions were appointed 27 B.C. The Aqua Virgo was built 19 B.C. Many of the collegia, or guilds, founded for the promotion of the interests of professions and trades had been misused for political purposes, and Augustus deprived many of them of their charters. Curae, or commissions, were appointed to superintend public works, streets and the water-supply; and the Tiber was dredged, cleansed and widened, and its liability to overflow reduced. No new building could be built more than 70 ft. high. Augustus also established fire brigades. It has been said that he found the city built of brick and left it built of marble.

He revived many old religious customs, such as the Augury of Public Health, and identified himself closely with the rites and customs of the people. He inculcated that sense of duty which the Romans called pietas, and attempted to improve the morals of the citizens by the enactment of sumptuary laws; the philosophers hoped to do good in the same direction by appealing to the intellect and reason, a method that was equally ineffectual. Marriages and an increased birth-rate were encouraged, and parents were honoured and given special privileges. The wisdom and prudence of Augustus were strangely accompanied by credulity and superstition. He was a profound believer in omens, and attached great importance to astrology. His horoscope showed that he was born under the sign of Capricorn.

He suffered from various illnesses, although in his younger days he looked handsome and athletic. He carefully nursed his health against his many infirmities, avoiding chiefly the free use of the bath; but he was often rubbed with oil, and sweated in a stove, after which he was bathed in tepid water, warmed either by a fire, or by being exposed to the heat of the sun. When, on account of his nerves, he was obliged to have recourse to sea-water, or the waters of Albula, he was contented with sitting over a wooden tub, (which he called by a Spanish name, Dureta), and plunging his hands and feet in the water by turns.[18] His physician was Antonius Musa, to whom was erected, by public subscription, a statue near that of AEsculapius. During an attack of congestion of the liver when heat failed to give relief, Antonius Musa advised cold applications for the Emperor, which had the desired effect. Suetonius, the historian, wrote that this was "a desperate and doubtful method of cure." A more desperate and doubtful method of cure, however, was carried out by the same physician. He successfully banished an attack of sciatica that greatly troubled Augustus by the expedient of beating the affected part with a stick. Antonius Musa received honours from Augustus, and the Emperor also exempted all physicians from the payment of taxes, and from other public obligations.

In the time of Augustus natural philosophy made little progress, and Virgil strongly desired its advancement. Human anatomy, as a study, had not been introduced, and physiology was almost unknown. In medicine, the standard of practice was the writings of Hippocrates, and the Materia Medica consisted of remedies suggested by the whimsical notions of their inventors.

Pliny wrote that the water cure was the principal remedy in his day, as it was indeed throughout the Empire, and it was certainly the most popular. Seneca was very severe on the sentiment of a poem written by Maecenas, the friend and counsellor of Augustus, but it serves to reveal some of the most dreaded maladies of the time:—

"Though racked with gout in hand and foot, Though cancer deep should strike its root, Though palsy shake my feeble thighs, Though hideous lump on shoulder rise, From flaccid gum teeth drop away; Yet all is well if life but stay."

Malaria was one of the principal causes of mortality in and near Rome in the reign of Augustus Caesar.

Augustus's fatal illness occurred in A.D. 14 from chronic diarrhoea, and the Emperor, like the true Roman that he was, displayed great calmness and fortitude in his last days.

Tiberius succeeded to the throne in A.D. 14, and began a career of infamy. How little knowledge was likely to gain from his patronage is shown by the fact, recorded by Pliny, that the shop and tools of the artist who discovered how to make glass malleable were destroyed. Assassins and perpetrators of every abomination were the fit companions of this tyrant.

Thrasyllus, the astrologer, lived with Tiberius, who was a firm believer in the magic arts. This reign is made illustrious in the history of medicine by the work of Celsus.

Caligula, who became Emperor in A.D. 34, was guilty of the most inhuman conduct. Criminals were given to the wild beasts for their food, and even people of honourable rank had their faces branded with hot irons as a punishment by order of this mad tyrant.

Claudius, the successor of Caligula, completed some very important public works in his reign, including great aqueducts and drains, but learning was at a low ebb in his day. Claudius Etruscus, the freedman of the Emperor Claudius, erected baths referred to by Martial. The ruins of the arches of the Aqua Claudia still remain.

Thrasyllus, a son of the astrologer who lived in the time of Tiberius, is said to have predicted to Nero the dignity of the purple. Nero would have been favourably disposed towards physicians if he had heeded the advice of his tutor, Seneca, who wrote: "People pay the doctor for his trouble; for his kindness they still remain in his debt." "Great reverence and love is due to both the teacher and the doctor. We have received from them priceless benefits; from the doctor, health and life; from the teacher, the noble culture of the soul. Both are our friends, and deserve our most sincere thanks, not so much by their merchantable art, as by their frank goodwill."[19] The practice of necromancy in the time of Nero had grown to such an extent that an edict of banishment was issued against all magicians, but this did not lessen the popularity of the magicians, who indeed prospered under the semblance of persecution, and were honoured in times of public difficulty and danger. The practice of astrology came from the Chaldeans, and was introduced into Greece in the third century before Christ. It was accepted by all classes, but specially by the Stoic philosophers. In 319 B.C., Cornelius Hispallus banished the Chaldeans from Rome, and ordered them to leave Italy within ten days. In 33 B.C., they were again banished by Marcus Agrippa, and Augustus also issued an edict against them. They were punished sometimes by death, and their calling must have been lucrative to induce them to continue in spite of the severe punishments to which they made themselves liable. The penal laws against them, however, were in operation only intermittently. They were consulted by all classes, from the Emperor downwards.

There were many physicians in the reign of Nero, but none of great eminence. Andromachus was physician to the Emperor, and had the title of archiater, which means "chief of the physicians."

An account of the archiaters is of interest. The name was applied to Christ by St. Jerome. There were two classes of archiaters in time, the one class called archiatri sancti palati; the other, archiatri populares. The former attended the Emperor, and were court physicians; the latter attended the people. Although Nero appointed the first archiater, the name is not commonly used in Latin until the time of Constantine, and the division into two classes probably dates from about that time. The archiatri sancti palati were of high rank, and were the judges of disputes between physicians. The Archiatri had many privileges conferred upon them. They, and their wives and children, did not have to pay taxes. They were not obliged to give lodgings to soldiers in the provinces, and they could not be put in prison. These privileges applied more especially to the higher class. When an archiater sancti palati ceased attendance on the Emperor he took the title of ex-archiater. The title comes archiatorum means "count of the Archiatri," and gave rank among the high nobility of the Empire.

The archiatri populares attended the sick poor, and each city had five, seven or ten, according to its size. Rome had fourteen of these officers, besides one for the vestal virgins, and one for the gymnasia. They were paid by the Government for attending the poor, but were not restricted to this class of practice, and were well paid by their prosperous patients. Their office was more lucrative but not so honourable as that of the archiaters of the palace. The archiatri populares were elected by the people themselves.

Suetonius describes the treatment Nero underwent for the improvement of his voice: "He would lie upon his back with a sheet of lead upon his breast, clear his stomach and bowels by vomits and clysters, and forbear the eating of fruits, or food prejudicial to his voice." He built, at great expense, magnificent public baths supplied from the sea and from hot springs, and was the first to build a public gymnasium in Rome.

There is reason to believe that in the time of Nero there was a class of women poisoners. Nero employed one of these women, Locusta by name, and after she had poisoned Britannicus, rewarded her with a great estate in land, and placed disciples with her to be instructed in her nefarious trade.

There was also a very ignorant class of oculists in Rome in the time of Nero, but at Marseilles Demosthenes Philalethes was deservedly celebrated, and his book on diseases of the eye was in use for several centuries. The eye doctors of Rome employed ointments almost entirely, and about two hundred seals have been discovered which had been attached to pots of eye salves, each seal bearing the inventor's and proprietor's name. In the time of Galen, these quack oculists were very numerous, and Galen inveighs against them. Martial satirized them: "Now you are a gladiator who once were an ophthalmist; you did as a doctor what you do as a gladiator." "The blear-eyed Hylas would have paid you sixpence, O Quintus; one eye is gone, he will still pay threepence; make haste and take it, brief is your chance; when he is blind, he will pay you nothing." The oculists of Alexandria were very proficient, and some of their followers, at various times throughout the period of the Roman Empire, were remarkably skilful. Their literature has perished, but it is believed that they were able to operate on cataract.

With the death of Nero in A.D. 68, the direct line of the Caesars became extinct.

FOOTNOTES:

[18] Suetonius: "Lives of the Caesars," lxxxii.

[19] Seneca "De Benefic.," vi.



CHAPTER VII.

PHYSICIANS FROM THE TIME OF AUGUSTUS TO THE DEATH OF NERO.

Celsus—His life and works—His influence on Medicine—Meges of Sidon—Apollonius of Tyana—Alleged miracles—Vettius Valleus—Scribonius Longus—Andromachus—Thessalus of Tralles—Pliny.

Aulus Cornelius Celsus lived in the reigns of Augustus and Tiberius. References in his works show that he either lived at the same time as Themison or shortly after him. Verona has been claimed as his birthplace, but the purity of his literary style shows that he lived for a considerable time in Rome, and he was probably educated there. In Pliny's account of the history of medicine, Celsus is not mentioned as having practised in Rome, and it is almost certain that he combined the practice of medicine with the study of science and literary pursuits; his practice was not general, but restricted to his friends and dependents. His writings show that he had a clinical knowledge of disease and a considerable amount of medical experience. He wrote not only on medicine but also on history, philosophy, jurisprudence and rhetoric, agriculture and military tactics. His great medical work, "De Medicina," comprises eight books. He properly begins with the history of medicine, and then proceeds to discuss the merits of the controversy between the Dogmatici and the Empirici. The first two books deal with general principles and with diet, and the remaining books with particular diseases; the third and fourth with internal diseases, the fifth and sixth with external diseases and pharmacy, and the last two are surgical, and of great merit and importance. In his methods of treatment there can be discerned the influence of Asclepiades of Prusa, and the Hippocratic principle of aiding rather than opposing nature, but some of his work displays originality. His devotion to Hippocrates hindered very much the exercise of his own powers, and set a bad example, in this respect, to his successors.

He was rather free in the use of the lancet, but not to the same extent as his contemporaries, and he advocated the use of free purgation as well as bleeding. He never could rid his mind of the orthodox humoral theories of his predecessors.

(1) Surgery.—Although Celsus is the first writer in Rome to deal fully with surgical procedures, it must not be inferred that the practice of this art began to be developed in his time, for surgery was then much more advanced than medicine. Many major operations were performed, and it is very instructive for doctors of the present day to learn that much that is considered modern was well understood by the ancients. There is no greater fallacy than to suppose that medical practice generally, and surgery in particular, has reached no eminence except in very recent times. The operation of crushing a stone in the bladder was devised at Alexandria by Ammonius Lithotomos, (287 B.C.), and is thus described by Celsus:—

"A hook or crotchet is fixed upon the stone in such a way as easily to hold it firm, even when shaken, so that it may not revolve backward; then an iron instrument is used, of moderate thickness, thin at the front end but blunt, which, when applied to the stone and struck at the other end, cleaves it. Great care must be taken that the instrument do not come into contact with the bladder itself, and that nothing fall upon it by the breaking of the stone."

Celsus describes plastic operations for the repair of the nose, lips and ears, though these operations are generally supposed to have been recently devised.

He describes lithotomy, and operations upon the eye, as practised at Alexandria, both probably introduced there from India. Subcutaneous urethrotomy was also practised in his time.

Trephining had long been a well-known operation of surgery. There is an account in detail of how amputation should be performed.

The teaching of Celsus in reference to dislocations and fractures is remarkably advanced. Dislocations, he points out, should be reduced before inflammation sets in, and in failure of union of fractures, he recommends extension and the rubbing together of the ends of the broken bone to promote union. If necessary, after minor measures have failed to promote union, he recommends an incision down to the ends of the bones, and the open incision and the fracture will heal at the same time.

It is interesting to find that Celsus knew of the danger of giving purgatives in strangulated rupture of the bowels. For uncomplicated rupture he recommends reduction by taxis and operation. Cauterization of the canal is part of the operation. He also gives careful directions for removing foreign bodies from the ears.

Celsus writes very fully on haemorrhage, and describes the method of tying two ligatures upon a blood-vessel, and severing it between the ligatures. His method of amputating in cases of gangrene by a simple circular incision was in use down to comparatively modern times. He describes catheterization, plastic operations on the face, the resection of ribs for the cure of sinuses in the chest walls, operation for cataract, ear disease curable by the use of the syringe, and operations for goitre. These goitre operations are generally supposed to be a recent triumph of surgery.

Celsus also had knowledge of dentistry, for he writes of teeth extraction by means of forceps, the fastening of loose teeth with gold wire, and a method of bursting decayed and hollow teeth by means of peppercorns forced into the cavity. He has described also many of the most difficult operations in obstetrics.

When it is remembered that Celsus lived centuries before the introduction of chloroform and ether, it is wonderful to contemplate what was accomplished long ago.

The qualities which should distinguish a surgeon were described by Celsus thus: "He should not be old, his hand should be firm and steady, and he should be able to use his left hand equally with his right; his sight should be clear, and his mind calm and courageous, so that he need not hurry during an operation and cut less than required, as if the screams of the patient made no impression upon him."

(2) Anatomy.—Celsus understood fairly well the situation of the internal organs, and knew well the anatomy of the chest and female pelvis. His knowledge of the skeleton was particularly complete and accurate. He describes very fully the bones of the head, including the perforated plate of the ethmoid bone, the sutures, the teeth, and the skeletal bones generally. Portal states that Celsus knew of the semicircular canals. He understood the structure of the joints, and points out that cartilage is part of their formation.

Celsus wrote: "It is both cruel and superfluous to dissect the bodies of the living, but to dissect those of the dead is necessary for learners, for they ought to know the position and order which dead bodies show better than a living and wounded man. But even the other things which can only be observed in the living, practice itself will show in the cures of the wounded, a little more slowly but somewhat more tenderly."

(3) Medicine.—His treatment of fevers was excellent, for he recognized that fever was an effort of Nature to throw off morbid materials. His recipes are not so complicated, but more sensible and effective than those of his immediate successors. He understood the use of enemas and artificial feeding. In cases of insanity he recognized that improvement followed the use of narcotics in the treatment of the accompanying insomnia. He recognized also morbid illusions. He recommended lotions and salves for the treatment of some eye diseases.

Although Celsus practised phlebotomy, he discountenanced very strongly its excessive use. The physicians in Rome, in his time, carried bleeding to great extremes. "It is not," wrote Celsus, "a new thing to let blood from the veins, but it is new that there is scarcely a malady in which blood is not drawn. Formerly they bled young men, and women who were not pregnant, but it had not been seen till our days that children, pregnant women, and old men were bled." The reason for bleeding the strong and plethoric was to afford outlet to an excessive supply of blood, and the weak and anaemic were similarly treated to get rid of evil humours, so that hardly any sick person could escape this drastic treatment.

Emetics were greatly used in the time of Celsus. Voluptuaries made use of them to excite an appetite for food, and they used them after eating heavy meals to prepare the stomach for a second bout of gluttony. Many gourmands took an emetic daily. Celsus said that emetics should not be used as a frequent practice if the attainment of old age was desired.

Celsus excelled as a compiler, and had the faculty of selecting the most admirable contributions to the art of healing from previous medical writers. His writings also give an account of what was best in the medical practice of Rome about his own time. He had a great love for learning, and it is remarkable that he was attracted to the study of medicine, for he was a patrician, and members of his class considered study of that kind beneath the dignity of their rank.

In the Augustan age, when literature in Rome reached its highest level, the literary style of Celsus was fit to be classed with that of the great writers of his time. He was never quoted as a great authority on medicine or surgery by later medical writers; and Pliny refers to him as a literary man, and not as a practising physician. From the fact that he elaborated no new system, and founded no new medical sect, it is not strange that he had no disciples.

In later centuries his works were used as a textbook for students, not only for the information they supplied, but also because of their excellence as literature.

Parts of the foregoing synopsis of the writings of Celsus are drawn from the writings of Hermann Baas and of Berdoe.

Meges of Sidon (20 B.C.) was a famous surgeon who practised in Rome shortly before the time of Celsus. He was regarded by Celsus as the most skilful surgeon of that period, and his works, of which nothing now remains, were quoted by Celsus, and also referred to by Pliny. Meges was a follower of Themison. He is said to have invented instruments used in cutting for stone, and he wrote on tumours of the breast and dislocation of the knee. There have been several famous doctors called Eudemus. One of these was an anatomist in the third century before Christ, and a contemporary, according to Galen, of Herophilus and Erasistratus. He gave great attention to the anatomy and physiology of the nervous system. There was, however, another Eudemus, a physician of Rome, who became entangled in an intrigue with the wife of the son of the Emperor Tiberius. He aided her in an attempt to poison her husband in A.D. 23. He was put to torture, and finally executed by order of Tiberius.

Apollonius of Tyana was born four years before the Christian era, in the time of Augustus Caesar, and is known chiefly for the parallel that has been drawn by ancient and modern writers between his supposed miracles and those of the Saviour. His doings as described by Philostratus are extraordinary and incredible, and he was put forward by the Eclectics in opposition to the unique powers claimed by Christ and believed in by His followers. Apollonius is said to have studied the philosophy of the Platonic, Sceptic, Epicurean, Peripatetic and Pythagorean schools, and to have adopted that of Pythagoras. He schooled himself in early manhood in the asceticism of that philosophy. He abstained from animal food and strong drink, wore white linen garments and sandals made of bark, and let his hair grow long. For five years he preserved a mystic silence, and during this period the truths of philosophy became known to him. He had interviews with the Magi in Asia Minor, and learned strange secrets from the Brahmans in India. In Greece he visited the temples and oracles, and exercised his powers of healing. Like Pythagoras, he travelled far and wide, disputing about philosophy wherever he went, and he gained an extraordinary reputation for magical powers. The priests of the temples gave him divine honours and sent the sick to him to be cured. He arrived in Rome just after an edict had been promulgated by Nero against magicians. He was tried before Telesinus, the consul, and Tigellinus, the base favourite of the Emperor. He was acquitted by Telesinus because of his love of philosophy, and by Tigellinus because of his fear of magic. Subsequently, at Alexandria, Apollonius, in virtue of his magic power, affirmed that he would make Vespasian emperor, and afterwards became the friend of Titus, Vespasian's son. On the accession of Domitian, Apollonius stirred up the provinces against him, and was ordered to be brought in custody to Rome, but he surrendered himself to the authorities, and was brought into the presence of the Emperor to be questioned. He began to praise Nerva, and was immediately ordered to prison and to chains. It is said that he miraculously escaped, and spent the remainder of his days in Ephesus.

The relation of Apollonius to the art of medicine is connected with his visits, on his travels, to the temples of AEsculapius, and his healing of the sick and alleged triumph over the laws of Nature. He was also credited with raising the dead, casting out devils and other miracle-working that appears to have been borrowed from the life of Christ. No doubt he was a genuine philosopher and follower of Pythagoras. His history is, on the whole, worthy of belief, except the part relating to miracles. It is noteworthy that he did not claim for himself miraculous power. Newman in his "Life of Apollonius" takes the view that the account of the miracles of Apollonius is derived from the narrative of Christ's miracles, and has been concocted by people anxious to degrade the character of the Saviour. The attempt to make him appear as a pagan Christ has been renewed in recent years.

In the realm of medical practice he succeeded by imposture probably, but also in a genuine way by means of suggestion, and no doubt he had also acquired medical knowledge from study and travelling among people who had healing powers and items of medical knowledge perhaps unknown at the present day.

Vettius (or Vectius) Valleus, was of equestrian rank but he did not confer any honour on the medical profession. He was one of the lewd companions of Messalina, the wife of the Emperor Claudius, and was put to death in A.D. 48. He was a believer in Themison's doctrines, and is said by Pliny[20] to have founded a new medical sect, but nearly all the Methodici attempted to create a new sect by adding to, or subtracting a little from, the tenets of Methodism.

Scribonius Largus (about A.D. 45) was physician to Claudius and accompanied him to Britain. He wrote several medical books, and is reputed to have used electricity for the relief of headaches.

Andromachus, the elder, was physician to Nero, and the first archiater. He was born in Crete. He was the inventor of a compound medicine called after himself, "Theriaca Andromachi." He gave directions for making it in a poem of 174 lines. This poem is quoted by Galen, who explains that Andromachus gave his instructions a poetical form to assist memory, and to prevent the likelihood of alteration.

Andromachus, the younger, was the son of the first archiater, and was, like his father, physician to Nero. He wrote a book on Pharmacy, in three volumes.

Thessalus of Tralles, in Lydia, lived in Rome in the reign of Nero, and dedicated one of his books to the Emperor. He was a charlatan with no medical knowledge, but with a good deal of ability and assurance. He said that medicine surpassed all other arts, and he surpassed all other physicians. His father had been a weaver, and in his youth Thessalus followed the same calling, and never had any medical training. This did not prevent him, however, from acquiring a great reputation as a doctor, and making a fortune from medical practice. At first, he associated himself with the views of the Methodici, but afterwards amended them as he thought fit, until he had convinced the public, and perhaps also himself, that he was the founder of a new and true system of medicine. He spoke in very disrespectful and violent terms of his predecessors, and said that no man before him had done anything to advance the science of medicine. Besides having an endowment of natural shrewdness and ability, he was equipped with great powers of self-advertisement, and could cajole the rich and influential. He was an adept in the art of flattery. Galen often refers to him, and always with contempt. Thessalus was able, so he said, to teach the medical art in six months, and he surrounded himself with a retinue of artisans, weavers, cooks, butchers, and so on, who were allowed to kill or cure his patients. Sprengel states that, after the time of Thessalus, the doctors of Rome forbore to take their pupils with them on professional visits.

He began a method of treatment for chronic and obstinate cases. The first three days of the treatment were given up to the use of vegetable drugs, emetics, and strict dietary. Then followed fasting, and finally a course of tonics and restoratives. He is said to have used colchicum for gout. The tomb of Thessalus on the Appian Way was to be seen in Pliny's time. It bore the arrogant device "Conqueror of Physicians." The success of Thessalus seems a proof of the cynical belief that the public take a man's worth at his own estimate.

Pliny, the elder, lived from A.D. 23 to 79, dying during the eruption of Vesuvius when Pompeii and Herculaneum were destroyed. He was not a scientific man, but was a prodigious recorder of information on all subjects. Much of this information is inaccurate, for he was not able to discriminate between the true and the false, or to assign to facts their relative value.

His great book on Natural History includes many subjects that cannot properly be considered as belonging to Natural History. It consists of thirty-six books and an index, and the author stated that the work dealt with twenty thousand important matters, and was compiled from two thousand volumes.

Although Pliny was not a physician he writes about medicine, and paints a picture of the state of medical knowledge of his time. His own opinions on the subject are of no value. He believed that magic is a branch of medicine, and was optimistic enough to hold that there is a score of remedies for every disease. His writings upon the virtues of medicines derived from the human body, from fish, and from plants are more picturesque than accurate.

FOOTNOTES:

[20] H. N., xxix, 5.



CHAPTER VIII.

THE FIRST AND SECOND CENTURIES OF THE CHRISTIAN ERA.

Athenaeus—Pneumatism—Eclectics—Agathinus—Aretaeus—Archigenes— Dioscorides—Cassius Felix—Pestilence in Rome—Ancient surgical instruments—Herodotus—Heliodorus—Caelius Aurelianus—Soranus— Rufus of Ephesus—Marinus—Quintus.

Athenaeus, of Cilicia, a Stoic and Peripatetic, founded in Rome the sect of the Pneumatists about the year A.D. 69. It was inspired by the philosophy of Plato. The pneuma, or spirit, was in their opinion the cause of health and of disease. They believed that dilatation of the arteries drives onward the pneuma, and contraction of the arteries drives it in a contrary direction. The pneuma passes from the heart to the arteries. Their theories also had reference to the elements. Thus, the union of heat and moisture maintains health; heat and dryness cause acute diseases; cold and moisture cause chronic diseases; cold and dryness cause mental depression, and at death there are both dryness and coldness. In spite of these strange opinions the Pneumatists made some scientific progress, and recognized some diseases hitherto unknown. Galen wrote of the Pneumatists: "They would rather betray their country than abjure their opinions." The founder of the sect of Pneumatists was a very prolific writer, for the twenty-ninth volume of one of his works is quoted by Oribasius. The teaching of the Pneumatists speedily gave way to that of the Eclectics, of whom Galen was by far the most celebrated. They tried to reconcile the teaching of the Dogmatists, Methodists, and Empirics, and adopted what they considered to be the best teaching of each sect. The Eclectics were very similar to, if not identical with, the Episynthetics, founded by a pupil of Athenaeus, by name, Agathinus. He was a Spartan by birth. He is frequently quoted by Galen, but none of his writings are extant.

Aretaeus, the Cappadocian, practised in Rome in the first century of our era, in the reign of Nero or Vespasian. He published a book on medicine, still extant, which displays a great knowledge of the symptoms of disease very accurately described, and reliable for purposes of diagnosis. He was the first to reveal the glandular nature of the kidneys, and for the first time employed cantharides as a counter-irritant (Portal, vol. i, p. 62). It is not surprising that Aretaeus followed rather closely the teaching of Hippocrates, but he considered it right to check some of "the natural actions" of the body, which Hippocrates thought were necessary for the restoration of health. He was not against phlebotomy, and used strong purgatives and also narcotics. He was less tied to the opinions of any sect than the physicians of his time, and was both wonderfully accurate in his opinions and reliable in treatment. Aretaeus condemned the operation of tracheotomy first proposed by Asclepiades, and held "that the heat of the inflammation becomes greater from the wound and contributes to the suffocation, and the patient coughs; and even if he escapes this danger, the lips of the wound do not unite, for both are cartilaginous and unable to grow together." He believed, also, that elephantiasis was contagious. The writings of Aretaeus consist of eight books, and there have been many editions in various languages. Only a few chapters are missing.

Archigenes was a pupil of Agathinus, and is mentioned by Juvenal. He was born in Syria and practised in Rome in the reign of Trajan, A.D. 98-117. He introduced new and very obscure terms into his writings. He wrote on the pulse, and on this Galen wrote a commentary. He also proposed a classification of fevers, but his views on this subject were speculative theories, and not based upon practical experience and observation. To him is due the credit of suggesting opium for the treatment of dysentery, and he also described accurately the symptoms and progress of abscess of the liver. By some authorities he is thought to have belonged to the sect of the Pneumatici.

Dioscorides was the author of a famous treatise on Materia Medica. At different times there were several physicians of this name. He lived shortly after Pliny in the first century, but there is some doubt as to the exact time. His five books were the standard work on Materia Medica for many centuries after his death. He compiled an account of all the materials in use medicinally, and gave a description of their properties and action. This entailed great knowledge and industry, and is of value as showing what drugs were used in his time. Since then practically the whole of Materia Medica has been changed. He held largely to the orthodox beliefs of Dogmatism, but a great deal of what he recommends is not comprised in the doctrines of this sect, and is decidedly Empirical. It is difficult or impossible to identify many of the drugs referred to by Dioscorides, partly because his descriptions are brief, partly because the mistakes of his predecessors are found in his book.

He exercised as much authority in Materia Medica as Galen did in the practice of medicine, and the successors of each were content, in the main, to follow blindly. A large work was published in England in 1806 to illustrate the plants of Greece described in the treatises of Dioscorides.

Cassius Felix is supposed to have lived in the first century of our era, but practically nothing is known of his history. He wrote a book on medicine consisting of eighty-four questions on medical and physical subjects and the answers to them.

In A.D. 79, after the eruption of Vesuvius, there was a great pestilence in Rome, which historians ascribed to the pollution of the air by the eruption. Fugitives crowded into Rome from the devastated part of the country, and there was great poverty and an accumulation of filth in the city, which was, doubtless, the true cause of the pestilence. Treatment of fever at that time was very imperfect at the best, and proper means of prevention and treatment were entirely absent in time of pestilence. It has been computed that ten thousand people died daily at that time in Rome and the surrounding district. Excavations at Pompeii have done a great deal to reveal the state of surgical knowledge towards the end of the first century of our era. Professor Vulpes has written an account of the surgical instruments recovered from the ruins, and there is a collection of ancient surgical instruments in the Naples museum. Vaginal and rectal specula have been found: also a forceps for removing fractured pieces of bone from the surface of the brain. There is an instrument considered by Professor Vulpes to have been used as an artery forceps. Other instruments discovered are: Forceps for removing tumours; instruments for tapping in cases of dropsy (such an instrument was described by Celsus); seven varieties of probes; bronze catheters; 89 specimens of pincers; various kinds of knives, bone-elevators, lancets, spatulas, cauteries, saws, and trephines.[21]

There were several physicians and surgeons of the name of Herodotus. A famous surgeon of that name lived in Rome about A.D. 100. He was a pupil of Athenaeus, and is quoted by Galen and Oribasius. This Herodotus, according to Baas, was the discoverer of pomegranate root as a remedy for tapeworm.

Heliodorus was a famous surgeon of Rome, and lived about the same time as Herodotus. He was the contemporary of Juvenal. He performed internal urethrotomy, and wrote on amputations, injuries of the head, and hernia.

Caelius Aurelianus probably lived in the first century of the Christian era, but some writers believe that he was a contemporary of Galen and a rival, because the one never mentions nor is mentioned by the other; but this view is unnecessarily severe upon the standard of medical ethics attained by the leaders of the profession in early times. From the style of his writings, it has been deduced that Caelius Aurelianus was not a native of Greece or of Rome. He belonged strictly to the sect of the Methodici, and his writings are important as revealing very fully the teaching of this sect. He mentions some diseases not previously described, and had a good knowledge of symptoms. He divided diseases into two classes, acute and chronic, or, more in conformity with the terminology of the Methodici, those of constriction and those of relaxation. Aurelianus did not concern himself with inquiring into the causation of diseases. His method was to find out the class to which a disease belonged, and to treat it accordingly. He was very practical in his views, and did a great deal to place treatment upon a satisfactory basis. His chief weakness was his failure to recognize the various differences and gradations, and he attached far too much importance to the two classes recognized by his school. He withheld active treatment until he had ascertained to his own satisfaction the class to which the disease belonged. Caelius Aurelianus wrote three books on acute diseases and five on chronic diseases. He cites the case of a patient who was cured of dropsy by tapping, and of a person who was shot through the lungs with an arrow and recovered. He agreed with Aretaeus in condemning tracheotomy. His books are not written in a good literary style.

Soranus, of Ephesus, was an eminent physician of the Methodist school, who practised in Rome in the reigns of Trajan and Hadrian. He wrote a great work on diseases of women, of which a Greek manuscript, copied in the fifteenth century, was discovered in La Bibliotheque Royale in Paris by Dietz, who was commissioned by the Prussian Government to explore the public libraries of Europe. The same investigator also discovered another copy of the work, in a worse state of preservation however, in the Vatican library. Parts of the writings of Soranus are preserved in the writings of Oribasius. There is no doubt that Soranus was a very accomplished obstetrician and gynaecologist. His description of the uterus and its ligaments and the displacements to which the organ is liable reveals a practical knowledge of anatomy. Unlike most medical writers of ancient times, he did not adopt the method of recording various methods of treatment copied from previous writers, but his textbook is systematic. In writing about a disease he begins with a historical introduction, and proceeds to describe its causation, symptoms, and course, and the treatment of its various phases. His account of obstetrics shows that the art was well understood in his time. His work on the subjects of dystocia, inflammation of the uterus, and prolapse is perhaps the best. He refers also to hysterectomy. It is interesting to note that he used the speculum. He describes the qualifications of a good midwife. She need not know very much anatomy, but should have been trained in dietetics, materia medica, and minor surgical manipulations, such as version. She should be free from all corrupt and criminal practices, temperate, and not superstitious or avaricious.

In dealing with the subject of inversion of the uterus, Soranus points out that this condition may be caused by traction on the cord. It is noteworthy that he recognized the method of embryotomy as necessary when other measures had failed.

In his time leprosy was very prevalent. It had probably been brought in the first place from the East into Italy by Pompey. Some of the remedies used by Soranus for this disease are to be found in the works of Galen. Soranus wrote books on other medical subjects, but there is difficulty in deciding as to what is spurious and what is genuine in the works attributed to his authorship. There were other physicians of the same name. Galen quotes a book by Soranus on pharmacy, and Caelius Aurelianus one on fevers. He is also quoted by Tertullian, and by Paulus AEgineta, who writes that Soranus was one of the first Greek physicians to describe the guinea-worm. Soranus, in the opinion of St. Augustine, was Medicinae auctor nobilissimus. He was far removed from the prejudices and superstitions of his time, as is shown by his denunciation of magical incantations.

Rufus, of Ephesus, also lived in the reign of Trajan (A.D. 98-117). His books reveal the state of anatomical knowledge at Alexandria before the time of Galen. The recurrent nerves were then recently discovered. He considered the spleen a useless organ. He understood that pressure on the nerves and not on the carotid arteries causes loss of voice, and that the nerves proceed from the brain, and are sensory and motor. The heart, he considered, was the seat of life, and he observed that its left ventricle is smaller and thicker than the right. The method of checking bleeding from blood-vessels by torsion was known to him. He demonstrated the investing membrane of the crystalline lens of the eye.[22] He wrote also a treatise in thirty-seven chapters on gout. Many of the works of Rufus are lost, but fragments are preserved in other medical writings.

Marinus was an anatomist and physician who lived in the first and second centuries after Christ. Quintus was one of his pupils.

Marinus wrote twenty volumes on anatomy, of which Galen gives an abridgment and analysis. Galen says that Marinus was one of the restorers of anatomical science. Marinus investigated the glands and compared them to sponges, and he imagined that their function was to moisten and lubricate the surrounding structures. He discovered the glands of the intestines. He also wrote a commentary on the aphorisms of Hippocrates. It is uncertain if he is the Postumius Marinus who was physician to the younger Pliny.

Quintus was renowned in Rome in the first half of the second century after Christ. Like Galen he suffered from the jealousy and persecution of his professional rivals, who trumped up a charge against him of killing his patients, and he had to flee from the city. He was known as an expert anatomist, but published no medical writings. It has been stated by some of the writers on the history of medicine that Quintus was the tutor of Galen, but this statement is lacking in definite proof.

FOOTNOTES:

[21] For full description and plates see Dr. John Stewart Milne's "Surgical Instruments in Greek and Roman Times" (Clarendon Press, 1907).

[22] "Portal," vol. i, p. 74.



CHAPTER IX.

GALEN.

His life and works—His influence on Medicine.

Claudius Galenus, commonly known as Galen, has influenced the progress of medical science by his writings probably more than any other medical writer. His influence was paramount for fourteen centuries, and although he made some original contributions, his works are noteworthy mainly as an encyclopaedia of the medical knowledge of his time and as a review of the work of his predecessors. There is a great deal of information in his books about his own life. He was born at Pergamos in A.D. 130 in the reign of Hadrian. His father was a scholar and his mother somewhat of a shrew. Galen, in his boyhood, learned much from his father's example and instruction, and at the age of 15 was taught by philosophers of the Stoic, Platonist, Peripatetic, and Epicurean schools. He became initiated, writes Dr. Moore, into "the idealism of Plato, the realism of Aristotle, the scepticism of the Epicureans, and the materialism of the Stoics." At the age of 17 he was destined for the profession of medicine by his father in consequence of a dream. He studied under the most eminent men of his day. He went to Smyrna to be a pupil of Pelops, the physician, and Albinus the platonist; to Corinth to study under Numesianus; to Alexandria for the lectures of Heraclianus; and to Cilicia, Phoenicia, Palestine, Crete, and Cyprus. At the age of 29 Galen returned from Alexandria to Pergamos (A.D. 158), and was appointed doctor to the School of Gladiators, and gained much distinction.

He went to Rome for the first time in A.D. 163-4, and remained for four years; and during this period he wrote on anatomy and on the teaching of Hippocrates and Plato. He acquired great fame as a practitioner and, if he had so desired, might have attended the Emperor; but it is probable that Galen thought that the office of physician to the Emperor might prevent him from leaving Rome if he wished to do so. He also gave public lectures and disputations, and was called not only the "wonder-speaker" but the "wonder-worker." His success gave rise to envy, and he was afraid of being poisoned by his less successful rivals. The reason why he left Rome is not certain, and the possible causes of his departure are discussed by Dr. Greenhill in the "Dictionary of Greek and Roman Biography and Mythology." A pestilence raged in Rome at this time, but it is unlikely that Galen would have deserted his patients for that reason. Probably he disliked Rome, and longed for his native place. He had been in Pergamos only a very short time when he was summoned to attend the Emperors Marcus Aurelius and L. Verus in Venetia. The latter died of apoplexy on his way home to Rome, and Galen followed Marcus Aurelius to the capital. The Emperor soon thereafter set out to prosecute the war on the Danube, and Galen was allowed to remain in Rome, as he had stated that such was the will of AEsculapius. The Emperor's son Commodus was placed under the care of Galen during the father's absence, and at this time also (A.D. 170) Galen prepared the famous medicine theriaca for Marcus Aurelius, who took a small quantity daily. The Emperor Septimius Severus employed the same physician and the same medicine about thirty years afterwards. It is recorded that the philosopher Eudemius was successfully treated by Galen for a severe illness caused by an overdose of theriaca, and that the treatment employed was the same drug in small doses.

Galen stayed several years in Rome, and wrote and practised as on his former visit. He again returned to Pergamos, and probably was in Rome again at the end of the second century. It is certain he was still alive in the year 199, and probably lived in the reign of the Emperor Caracalla.

He was not only a great physician, but a man of wide culture in every way. In matters of religion he was a Monotheist. There was persecution of the Christians in his day, and it is likely that he came little into contact with the disciples of the new religion, and heard distorted accounts of it, but in one of his lost books, quoted by his Arabian biographers, Galen praises highly the love of virtue of the Christians.

He no doubt found the practice of medicine lucrative when he had gained pre-eminence, and it is recorded that he received L350 for curing the wife of Boetius, the Consul.

Galen wrote no less than five hundred treatises, large and small, mostly on medical subjects, but also on ethics, logic, and grammar. His style is good but rather diffuse, and he delights in quoting the ancient Greek philosophers. Before his time, as we have seen, there were disputes between the various medical sects. The disciples of Dogmatism and of Empiricism had been opposed to each other for several centuries, and the Eclectics, Pneumatists, and Episynthetics had arisen shortly before his time. Galen wrote against slavish attachment to any sect, but "in his general principles he may be considered as belonging to the Dogmatic sect, for his method was to reduce all his knowledge, as acquired by the observation of facts, to general theoretical principles. These principles he, indeed, professed to deduce from experience and observation, and we have abundant proofs of his diligence in collecting experience, and his accuracy in making observations; but still in a certain sense at least, he regards individual facts and the details of experience as of little value, unconnected with the principles which he had laid down as the basis of all medical reasoning. In this fundamental point, therefore, the method pursued by Galen appears to have been directly the reverse of that which we now consider as the correct method of scientific investigation; and yet, such is the force of natural genius, that in most instances he attained the ultimate object in view, although by an indirect path. He was an admirer of Hippocrates, and always speaks of him with the most profound respect, professing to act upon his principles, and to do little more than expound his doctrines, and support them by new facts and observations. Yet, in reality, we have few writers whose works, both as to substance and manner, are more different from each other than those of Hippocrates and Galen, the simplicity of the former being strongly contrasted with the abstruseness and refinement of the latter."[23]

A list of the various editions of Galen's works is given in Dr. Smith's "Dictionary of Greek and Roman Biography and Mythology" (1890 edition, vol. ii, pp. 210-12), and also the titles of the treatises classified according to the branch of medical science with which they deal, and it is convenient to follow this classification.

I.—WORKS ON ANATOMY AND PHYSIOLOGY.

Galen insisted upon the study of anatomy as essential, and in this respect was in conflict with the view held by the Methodists and the Empirics who believed that a physician could understand diseases without any knowledge of the exact structure of the body. His books on anatomy were originally fifteen in number. The last six of these are now extant only in an Arabic translation, two copies of which are preserved in the Bodleian Library at Oxford.

The directions he gives for dissection show that he was a master of the art. In dissecting out the portal vein and its ramifications, for instance, he advises that a probe should be inserted into the vein, and the point of the probe gradually advanced as the surrounding tissue is cut away, so that finally the minute branches are exposed; and he describes the use of the blowpipe, and other instruments used in dissection. He carried out the experiment of tying the iliac and axillary arteries in animals, and found that this procedure stopped the pulse in the leg and arm, but caused no serious symptoms, and he found that even the carotid arteries could be tied without causing death. He also pointed out that tying the carotid artery did not cause loss of voice, but that tying the artery carelessly so as to include the nerve had this effect. He was the first to describe the ductus arteriosus, and the three coats of the arteries.

It is highly improbable that Galen dissected human bodies in Rome, though he dissected a great variety of the lower animals. He writes that the doctors who attended Marcus Aurelius in the German wars dissected the dead bodies of the barbarians. The chief mistakes made by Galen as an anatomist were due to his assumption that what is true of the anatomy of a lower animal is true also when applied to man.

Galen greatly assisted the advance of physiology by recognizing that every part of the body exists for the purpose of performing a definite function. Aristotle, like Plato, had taught that "Nature makes nothing in vain," and Galen's philosophy was greatly influenced by the teaching of Aristotle. Galen regarded his work as "a religious hymn in honour of the Creator, who has given proof of His Omnipotence in creating everything perfectly conformable to its destination."

He regarded the structure of various parts, such as the hand and the membranes of the brain, as absolute perfection, although his idea of the human hand was derived from a study of the ape's, and he had no knowledge of the arachnoid membrane of the brain, but it would be unfair to criticize his conclusions because of his failure to recognize a few comparatively unimportant details. He discovered the function of the motor nerves by cutting them experimentally, and so producing paralysis of the muscles; the platysma, interossei, and popliteus muscles were first described by him. He was the greatest authority on the pulse, and he recognized that it consisted of a diastole (expansion) and a systole (contraction) with an interval after the diastole, and another after the systole. Aristotle thought that arteries contained air, but Galen taught that they contained blood, for, when an artery was wounded, blood gushed out. He was not far from the discovery of the circulation. He described the heart as having the appearance of a muscle, and considered it the source of natural heat, and the seat of violent passions. He knew well the anatomy of the human skeleton, and advised students to go to Alexandria where they might see and handle and properly study the bones. He recognized that inspiration is associated with enlargement of the chest, and imagined that air passed inside the skull through the cribriform plate of the ethmoid bone, and passed out by the same channel, carrying off humours from the brain into the nose. But some of this air remained and combined with the vital spirits in the anterior ventricles of the brain, and finally exuded from the fourth ventricle, the residence of the soul. Aristotle had taught that the heart was the seat of the soul, and the brain relatively unimportant.

II.—WORKS ON DIETETICS AND HYGIENE.

Galen was a strong advocate of exercises and gymnastics, and eulogizes hunting specially. He recommends cold baths for people in the prime of life. As old age is "cold and dry," this is to be treated with hot baths and the drinking of wine. He thought that wine was particularly suitable for the aged, and that old people required three meals a day, others two meals. He had a very high opinion of pork as an article of diet, and said that the strength of athletes could not be maintained without this form of food.

III.—ON PATHOLOGY.

Galen believed in the doctrine of the four elements, and his speculations led him into a belief in a further subdivision. "Fire is hot and dry; air is hot and moist; for the air is like a vapour; water is cold and moist, and earth is cold and dry." He held that there were three principles in man—spirits, solids, and humours—and eight temperaments ranging between health and disease and compatible with life. He retained a good deal of the teaching of the Pneumatic school, and believed that the pneuma was different from the soul, but the vehicle for the interaction of soul and body. From his theory of the action of the air through the nose on the contents of the ventricles of the brain is explained his use of sternutatories, and his belief in the efficacy of sneezing. Galen's classification of inflammations shows that his pathology was not nearly so accurate as his anatomy and physiology. He described (a) simple inflammation caused by excess of blood alone; (b) inflammation the result of excess of both pneuma and blood; (c) erysipelatous inflammation when yellow bile gains admission, and (d) scirrhous or cancerous when phlegm is present. He did good service by dividing the causes of disease into remote and proximate, the former subdivided into two classes—predisposing and exciting.

IV.—ON DIAGNOSIS.

He relied greatly on the doctrine of "critical days," which were thought to be influenced to some extent by the moon. His studies of the pulse were very useful to him in diagnosis. No doubt, he was an expert diagnostician mainly owing to his long, varied, and costly medical education, and his great natural powers of judgment. He asserted that with the help of the Deity he had never been wrong, but even his most ardent admirers would not be wanting in enthusiasm if they amended "never" into "hardly ever."

V.—ON PHARMACY, MATERIA MEDICA, AND THERAPEUTICS.

In these subjects Galen was not as proficient as Dioscorides, whose teaching he adopted with that of other medical authors. In Galen's works there are lengthy lists of compound medicines, several medicines being recommended for the same disease, and never with very marked confidence. He paid high prices for various nostrums, and, sad to relate, placed great faith in amulets, belief in which was general in his time, and nowhere held more strongly than in superstitious Rome. Medicines were classified by him according to their qualities, by which he meant, not their therapeutic effects, but their inherent dryness or moistness, coldness or heat. A medicine might be cold in the first degree, and not in the second degree. Paulus AEgineta followed this strange and foolish doctrine of Galen very closely, as the following extracts from his book on Materia Medica will show:—

"Cistus (rock-rose).—It is an astringent shrub of gently cooling powers. Its leaves and shoots are so desiccative as to agglutinate wounds; but the flowers are of a more drying nature, being about the second degree; and hence, when drunk, they cure dysenteries and all kinds of fluxes."[24]

"Ferrum (iron).—When frequently extinguished in water, it imparts a considerable desiccative power to it. When drunk, therefore, it agrees with affections of the spleen."[25]

Many features, however, of Galen's teaching and practice of therapeutics are worthy of praise. He enunciated two fundamental principles: (1) That disease is something contrary to Nature, and is to be overcome by that which is contrary "to the disease itself"; and (2) that Nature is to be preserved by what has relation with Nature. He recognized that while the invading disease was to be repelled, the strength and constitution of the patient should be preserved, and that in all cases the cause of the disease was to be treated and not the symptoms. Strong remedies should not be used on weak patients.

VI.—SURGERY.

Galen conformed to the custom of the physicians in Rome, and did not practise surgery to any extent, although he used the lancet in phlebotomy, and defended this practice against the followers of Erasistratus in Rome. He is said to have resected a portion of the sternum for caries, and also to have ligatured the temporal artery.[26]

VII.—GYNAECOLOGY.

Galen had little more than a superficial knowledge of this subject, and was quite ignorant of the surgery of diseases of women. He was not so well informed as Soranus was as to the anatomy of the uterus and its appendages, but deserves credit for having been better acquainted with the anatomy of the Fallopian tubes than his predecessors. He had erroneous views on the causation of displacements of the uterus. Several of the books inaccurately attributed to the authorship of Galen deal with the medical treatment of various minor ailments of women.

Galen was a man of wide culture, and one of his essays is written for the purpose of urging physicians to become acquainted with other branches of knowledge besides medicine. As a philosopher he has been quoted in company with Plato and Aristotle, and his philosophical writings were greatly used by Arabic authors. In philosophy, as in medicine, he had studied the teachings of the various schools of thought, and did not bind himself to any sect in particular. He disagreed with the Sceptics in their belief that no such thing as certainty was attainable, and it was his custom in cases of extreme difficulty to suspend his judgment; for instance, in reference to the nature of the soul, he wrote that he had not been able to come to a definite opinion.

Galen mentions the discreditable conduct of physicians at consultations. Sometimes several doctors would hold a consultation, and, apparently forgetting the patient for the time, would hold violent disputations. Their main object was to display their dialectical skill, and their arguments sometimes led to blows. These discreditable exhibitions were rather frequent in Rome in his time.

With Galen, as with Hippocrates, it is sometimes impossible to tell what works are genuine, and what are spurious. He seemed to think that he was the successor of Hippocrates, and wrote: "No one before me has given the true method of treating disease: Hippocrates, I confess, has heretofore shown the path, but as he was the first to enter it, he was not able to go as far as he wished.... He has not made all the necessary distinctions, and is often obscure, as is usually the case with ancients when they attempt to be concise. He says very little of complicated diseases; in a word, he has only sketched what another was to complete; he has opened the path, but has left it for a successor to enlarge and make it plain." Galen strictly followed Hippocrates in the latter's humoral theory of pathology, and also in therapeutics to a great extent.

It is a speculation of much interest how it was that Galen's views on Medicine received universal acceptance, and made him the dictator in this realm of knowledge for ages after his death. He was not precisely a genius, though a very remarkable man, and he established no sect of his own. The reason of his power lay in the fact that his writings supplied an encyclopaedic knowledge of the medical art down to his own time, with commentaries and additions of his own, written with great assurance and conveying an impression of finality, for he asserted that he had finished what Hippocrates had begun. The world was tired of political and philosophical strife, and waiting for authority. The wars of Rome had resulted in placing political power in the hands of one man, the Emperor; the disputations and bickerings of philosophers and physicians produced a similar result, and Galen, in the medical world was invested with the purple.

The effect, therefore, of Galen's writings was, at first, to add to and consolidate medical knowledge, but his influence soon became an obstacle to progress. Even in the sixteenth and seventeenth centuries, Galenism held almost undisputed sway.

The house of Galen stood opposite the Temple of Romulus in the Roman Forum. This temple, in A.D. 530, was consecrated by Pope Felix IV to the honour of the saints, Cosma and Damiano, two Arabian anargyri (unpaid physicians) who suffered martyrdom under Diocletian.

The date of Galen's death is not exactly known, but was probably A.D. 200.

FOOTNOTES:

[23] Dr. Bostock's "History of Medicine."

[24] "Paulus AEgineta," vol. iii, p. 74.

[25] Ibid., p. 242.

[26] "Encyl. Brit.," Surgery.



CHAPTER X.

THE LATER ROMAN AND BYZANTINE PERIOD.

Beginning of Decline—Neoplatonism—Antyllus—Oribasius—Magnus— Jacobus Psychristus—Adamantius—Meletius—Nemesius—AEtius— Alexander of Tralles—The Plague—Moschion—Paulus AEgineta—Decline of Healing Art.

The death of Galen marks the beginning of the decline of medical science in ancient times, and this decline was contemporaneous with the overthrow of the Roman State. As everybody knows, the decline and fall of the Roman Empire resulted from the profligacy and incapacity of the emperors, luxurious living and vice among the people, tyranny of an overbearing soldiery at home, and the attacks of barbarian foes gradually increasing in strength. Rome fell quickly into the hands of the barbarians, and her power was broken. In A.D. 395, was founded the Byzantine Empire, also styled the East Roman, Greek, or Lower Empire, which lasted for more than a thousand years, and took its name from the capital, Byzantium or Constantinople. In this empire medical science maintained a feeble and sickly existence. During this Byzantine Period there were a few physicians of note, but they were mainly commentators, and medical science retrograded rather than progressed.

Neoplatonism exerted a powerful influence upon the healing art. It was founded by Plotinus, and was for three centuries a formidable rival to Christianity. The Neoplatonists believed that man could intuitively know the absolute by a faculty called Ecstasy. Neoplatonism is a term which covers a very wide range of varying thought; essentially, it was a combination of philosophy and religion, arising from the intellectual movement in Alexandria. It covered a great deal of mysticism, magic and spiritualism, and the followers of the system, as it developed, became believers in the efficacy of certain exercises and symbols to cure diseases. They entered as Kingsley wrote, "the fairy land of ecstasy, clairvoyance, insensibility to pain, cures produced by the effect of what we now call mesmerism. They are all there, these modern puzzles, in those old books of the long bygone seekers for wisdom." It is wonderful how mankind in their pursuit of knowledge seem to have progressed in a circle.

The influence which Christianity exerted upon the investigation of medical science during the early centuries of our era will be considered at length in a subsequent chapter.

Antyllus was perhaps the greatest surgeon of antiquity. He lived before the end of the fourth century A.D., for he is quoted by Oribasius, but is not mentioned by Galen. The time in which he lived was about the year A.D. 300. He was a voluminous writer, but his works have perished except for quotations by later writers. The fragments of his writings were collected and published in 1799. Antyllus performed an operation for aneurism, which consisted in laying open the sac, turning out the clots, securing the vessels above and below, and allowing the wound to heal by granulation. As this operation was performed without anaesthetics or antiseptics it was attended with great mortality, and the risk of secondary haemorrhage was very great. Antyllus had operations for the cure of stammering, for cataract, and for the treatment of contractures by the method of tenotomy. He also removed enlarged glands of the neck. It was part of the practice of Antyllus to ligature arteries before cutting them, a method which was subsequently "rediscovered" owing to neglect of the study of the history of medicine. He gave directions for avoiding the carotid artery and internal jugular vein in operations upon the neck.

A fragment of the writings of Antyllus is preserved by Paulus AEgineta,[27] and shows the quality of the work done in bygone ages. It is his description of the operation of tracheotomy, and runs as follows:—

"When we proceed to perform this operation we must cut through some part of the windpipe, below the larynx, about the third or fourth ring; for to divide the whole would be dangerous. This place is commodious, because it is not covered with any flesh, and because it has no vessels situated near the divided part. Therefore, bending the head of the patient backward, so that the windpipe may come more forward to the view, we make a transverse section between two of the rings, so that in this case not the cartilage but the membrane which unites the cartilages together, is divided. If the operator be a little timid, he may first stretch the skin with a hook and divide it; then, proceeding to the windpipe, and separating the vessels, if any are in the way, he may make the incision." This operation had been proposed by Asclepiades about three hundred years before the time of Antyllus.

Oribasius was born at Pergamos, the birthplace of Galen, about A.D. 326. He studied under Zenon, who lectured and practised at Alexandria, and was expelled by the bishop, but afterwards reinstated by command of the Emperor Julian (A.D. 361). When Julian was kept in confinement in Asia Minor, Oribasius became acquainted with him, and they were soon close friends. When Julian was raised to the rank of Caesar, Oribasius accompanied him into Gaul. During this journey Oribasius, at the request of his patron, made an epitome of the writings of Galen, and then extended the work by including a collection of the writings of all preceding medical authors. When this work was finally completed it consisted of seventy books under the title "Collecta Medicinalia." He wrote also for his friend and biographer Eunapius two books on diseases and their treatment, and treatises on anatomy and on the works of Galen. He earned for himself the title of the Ape of Galen. In the "Life of Oribasius," by Eunapius, we find that Julian created Oribasius Quaestor of Constantinople, but after the death of Julian, Oribasius was exiled, and practised among the "barbarians," attaining great fame. In his exile he married a rich woman of good family, and to one of his sons, Eustathius by name, he addressed an abridgment of his first great book, the smaller work being called the "Synopsis." He ultimately returned from exile, and again reached a very honourable position, to which he was well entitled in virtue of the great fortitude with which he had borne adversity.

An edition of Oribasius was published at Paris between 1851 and 1876, in six volumes, by Daremberg and Bussemaker, under the patronage of the French Government. The authors of this edition took infinite pains to show the sources from which the writings of Oribasius had been derived, chief of which were the original writings of Galen, Hippocrates, Soranus, Rufus, and Antyllus. Oribasius was almost entirely a compiler, but also did some original work. To him is due the credit of describing the drum of the ear and the salivary glands. He described also the strange disease called lycanthropy, a form of insanity in which the patient thinks himself a wolf, and leaves his home at night to wander amongst the tombs.

Oribasius was held to be the wisest man of his time. There was something very charming in his manner and conversation, and the barbarians considered him as little less than a god.

Magnus, a native of Mesopotamia, was a pupil of Zenon and lectured at Alexandria. He was famous for his eloquence and dialectical skill, and wrote a book on "Urine" which is referred to by Theophilus.

Jacobus Psychristus was a famous physician who practised at Constantinople, A.D. 457-474. He was called "the Saviour" because of the great success of his treatment.

Adamantius of Alexandria both taught and practised medicine. He was a Jewish physician who was expelled from Alexandria in A.D. 415, and settled in Constantinople.

Meletius was a Christian monk who lived in the fourth century, according to some authorities, but it is probable that he belonged to a later period, the sixth or seventh century. He wrote on the nature of man, but the book is of no value as a contribution to physiology.

Nemesius, Bishop of Emissa, at the end of the fourth century wrote a book called "De Natura Hominis," and came very close to two important discoveries, namely, the functions of the bile and the circulation of the blood. Of the former, he wrote, "The yellow bile is constituted both for itself and for other purposes; for it contributes to digestion and promotes the expulsion of the excrements; and therefore it is in a manner one of the nutritive organs, besides imparting a sort of heat to the body, like the vital power. For these reasons, therefore, it seems to be made for itself; but, inasmuch as it purges the blood, it seems to be made in a manner for this also."[28]

With reference to the circulation of the blood, Nemesius wrote: "The motion of the pulse (called also the vital power) takes its rise from the heart and chiefly from its left ventricle. The artery is with great vehemence dilated and contracted, by a sort of constant harmony and order, the motion commencing at the heart. While it is dilated it draws with force the thinner part of the blood from the neighbouring veins, the exhalation or vapour of which blood becomes the aliment for the vital spirit. But while it is contracted it exhales whatever fumes it has through the whole body and by secret passages, as the heart throws out whatever is fuliginous through the mouth and nose by expiration."[29]

This book was first translated into English in 1636.

Nemesius also wrote on religion and philosophy. In regard to his medical writings, although he did not go far enough to anticipate the discovery of Harvey, his contribution to medical science was remarkable.

AEtius was born in Mesopotamia and lived at the end of the fifth or the beginning of the sixth century. He studied at Alexandria, and settled at Constantinople, where he attained to the honour of court chamberlain, and physician to the Emperor Justinian. He was the first notable physician to profess Christianity. In compounding medicines, he recommended that the following prayer should be repeated in a low voice: "May the God of Abraham, the God of Isaac, and the God of Jacob deign to bestow upon this medicament such and such virtues." To extract a piece of bone sticking in the throat, the physician should call out loudly: "As Jesus Christ drew Lazarus from the grave, and as Jonah came out of the whale, thus Blasius, the martyr and servant of God, commands, 'Bone, come up or go down.'"

AEtius wrote the "Sixteen Books on Medicine," and these contain original matter, but are of value mainly as being a compilation of the medical knowledge of his time. He was the first writer to mention certain Eastern drugs, such as cloves and camphor, and had a great knowledge of the spells and charms used in the East, more especially by the Egyptian Christians. All the nostrums, amulets and charms that were used at the time are enumerated, and display a gloomy picture of the superstition and ignorance that prevailed. The surgical and gynaecological sections of the writings of AEtius are, in most parts, excellent. He treated cut arteries by twisting or tying, and advised the irrigation of wounds with cold water. In the operation of lithotomy he recommended that the blade of the knife should be guarded by a tube. He used the seton and the cautery, which was much in vogue in his day, especially in cases of paralysis. He quotes Archigenes, who wrote: "I should not at all hesitate to make an eschar in the nape of the neck, where the spinal marrow takes its rise, two on each side of it ... and if the ulcers continue running a good while, I should not doubt of a perfect recovery."

Alexander of Tralles lived from A.D. 525 to 605. He was the son of a physician, and one of five brothers, who were all distinguished for scholarship. He studied philosophy as well as medicine, and travelled in France, Spain, and Italy to extend his knowledge. He took up permanent residence in Rome, and became very celebrated. When he became too old to continue active practice, he found leisure to write twelve books on medical diseases, following to some extent the teaching of Galen. The style of these books is elegant, and his description of diseases accurate. Alexander of Tralles was the first to open the jugular vein in disease, and employed iron and other useful remedies, but he lived in superstitious times, and was very credulous. For epilepsy, he recommended a piece of sail from a wrecked vessel, worn round the arm for seven weeks.[30] For colic, he recommended the heart of a lark attached to the right thigh, and for pain in the kidneys an amulet depicting Hercules overcoming a lion. To exorcise gout, he used incantations, these being either oral or written on a thin sheet of gold during the waning of the moon. Writing a suitable inscription on an olive leaf, gathered before sunrise, was his specific for ague. Alexander appears at times to have doubted the efficacy of such remedies as amulets, for he explains that his rich patients would not submit to rational treatment, and it was necessary, therefore, to use other methods reputed to be curative.

In the age of Justinian great scourges devastated the world. In A.D. 526 Antioch was destroyed by an earthquake, and it is said that 250,000 people perished, but the most dreadful visitation on mankind was the great plague which raged in A.D. 542 and the following years, and, as Gibbon writes, "depopulated the earth in the time of Justinian and his successors." Procopius, who was versed in medicine, was the historian of the period. This fell disease began between the Serbonian bog and the eastern channel of the Nile. "From thence, tracing as it were a double path, it spread to the east, over Syria, Persia, and the Indies, and penetrated to the west, along the coast of Africa, and over the continent of Europe. In the spring of the second year, Constantinople, during three or four months, was visited by the pestilence; and Procopius, who observed its progress and symptoms with the eyes of a physician, has emulated the skill and diligence of Thucydides in the latter's description of the plague of Athens. The infection was sometimes announced by the visions of a distempered fancy, and the victim despaired as soon as he had heard the menace and felt the stroke of an invisible spectre. But the greater number, in their beds, in the streets, in their usual occupation, were surprised by a slight fever, so slight, indeed, that neither the pulse nor the colour of the patient gave any signs of the approaching danger. The same, the next, or the succeeding day, it was declared by the swelling of the glands, particularly those of the groin, of the armpits, and under the ear; and when these buboes or tumours were opened they were found to contain a coal, or black substance, of the size of a lentil. If they came to a first swelling and suppuration, the patient was saved by this kind and natural discharge of the morbid humour. But if they continued hard and dry, a mortification quickly ensued, and the fifth day was commonly the term of his life. The fever was often accompanied with lethargy or delirium; the bodies of the sick were covered with black pustules or carbuncles, the symptoms of immediate death; and in the constitutions too feeble to produce an eruption, the vomiting of blood was followed by a mortification of the bowels. To pregnant women the plague was generally mortal; yet one infant was drawn alive from its dead mother, and three mothers survived the loss of their infected foetus. Youth was the most perilous season: and the female sex was less susceptible than the male; but every rank and profession was attacked with indiscriminate rage, and many of those who escaped were deprived of their speech, without being secure from a return of the disorder. The physicians of Constantinople were zealous and skilful, but their art was baffled by the various symptoms and pertinacious vehemence of the disease; the same remedies were productive of contrary effects and the event capriciously disappointed their prognostics of death or recovery. The order of funerals and the right of sepulchres were confounded; those who were left without friends or servants lay unburied in the streets, or in their desolate houses; and a magistrate was authorized to collect the promiscuous heaps of dead bodies, to transport them by land or water, and to inter them in deep pits beyond the precincts of the city.... No facts have been preserved to sustain an account, or even a conjecture, of the number that perished in this extraordinary mortality. I only find, that during three months 5,000, and at length 10,000, persons died each day at Constantinople; that many cities of the East were left vacant, and that in several districts of Italy the harvest and the vintage withered on the ground."[31]

The spread of disease from East to West was again exemplified in the Middle Ages, in the time of the Crusades, when the Crusaders carried home diseases to their native lands. The Knights of St. John, it is interesting to observe, superintended hospitals at home, and wore the white dress which in earlier times had distinguished the Asclepiades.

Moschion probably lived in the sixth century, and was a specialist in diseases of women. His writings were studied when Soranus was forgotten, but in course of time it was discovered that Moschion's work was nothing but an abbreviated translation of the works of Soranus. "Further, it is held by Weber and Ermerins that even the original Moschion is not based directly on Soranus, but on a work on diseases of women written in the fourth century by Caelius Aurelianus, who in his turn drew from Soranus.... It is interesting to follow the history of this book through its various stages in the light of these different editions, and we would suggest that the first Latin version, for the use of Latin-speaking matrons and midwives, was produced before the fall of the Western Empire in the fifth century; its Greek sister just fits in with the development of Eastern or Greek-speaking Empire at Constantinople in the sixth century; and the version in barbarous Latin points to a later period, when learning was beginning to make way again in Western Europe."[32] Moschion's book is a catechism consisting of 152 questions and answers.

Paulus AEgineta was the last, and one of the most famous, of the Greek physicians. He was born probably in the seventh century in the island of AEgina, but there is some doubt as to the exact period in which he lived. He quotes Alexander of Tralles and AEtius, and therefore lived at a later period than they did, either in the sixth or seventh century. The works of Paulus are compilations, but reveal the skill and learning of the author. He wrote several books, but only one, and that the principal, remains, and is known by the title of "De Re Medica Libri Septem." Dr. Adams, of Banchory, translated this book for the Sydenham Society, and the introduction shows the scope of the work: "In the first book you will find everything that relates to hygiene, and to the preservation from, and correction of, distempers peculiar to the various ages, reasons, temperaments, and so forth; also the powers and use of the different articles of food, as is set forth in the chapter of contents. In the second is explained the whole doctrine of fevers, an account of certain matters relating to them being premised, such as excrementitious discharges, critical days, and other appearances, and concluding with certain symptoms which are the concomitants of fevers. The third book relates to topical affections, beginning from the crown of the head and descending down to the nails of the feet, and so on. Briefly, the fourth book treats of external diseases; the fifth, of wounds and bites from venomous animals; the sixth book is the most important and is devoted to surgery, and contains original observations, and the seventh book contains an account of the properties of medicines." Paulus wrote a famous book on obstetrics, which is now lost, but it gained for him among the Arabs the title of "the accoucheur."

The sixth book on surgery, as has justly been observed by Adams, "contains the most complete system of operative surgery which has come down to us from ancient times." Many important surgical principles are enunciated, such, for instance, as local depletion as against general, and the merit of a free external incision. He first described varicose aneurism, and performed the operation of bronchotomy as described by Antyllus. He favoured the lateral operation for removal of stone from the bladder, and amputated the cancerous breast by crucial incision. He also had an operation, like that of Antyllus, for the cure of aneurism. In brief, Paulus performed many of the operations that are practised at the present day. He travelled in the practice of his calling, and not only had great fame in the Byzantine Empire and in Arabia in his lifetime, but exercised great influence for some centuries. His writings inspired Albucassis, one of the few surgeons and teachers of the Middle Ages.

After the time of Paulus AEgineta the practice of medicine and surgery suffered a very rapid decline, and for five centuries no progress was made. The Middle Ages form a dark and melancholy period in the history of medicine, and we have to come to comparatively recent times before we find the skill and knowledge of the Ancients equalled, while it is only at the present day that they are rapidly being excelled.

FOOTNOTES:

[27] "De re Med.," vi, 33.

[28] C. 28, p. 260, ed. Matth.

[29] C. 24, p. 242.

[30] Lib. 1, c. 20.

[31] Gibbon, "The Decline and Fall of the Roman Empire."

[32] Barbour, Edinburgh Medical Journal, vol. xxxiv, p. 331.



CHAPTER XI.

INFLUENCE OF CHRISTIANITY ON ALTRUISM AND THE HEALING ART.

Essenes—Cabalists and Gnostics—Object of Christ's Mission—Stoics—Constantine and Justinian—Gladiatorial Games—Orphanages—Support of the Poor—Hospitals—Their Foundation—Christianity and Hospitals—Fabiola—Christian Philanthropy—Demon Theories of Disease receive the Church's Sanction—Monastic Medicine—Miracles of Healing—St. Paul—St. Luke—Proclus—Practice of Anatomy denounced—Christianity the prime factor in promoting Altruism.

The sect of the Essenes embraced part of the teaching of Christianity among their other beliefs. They conceived that the Almighty had to be propitiated by signs and symbols. Words, they considered, were the direct gift of God to man, and, therefore, signs representing words were of great avail. Hence arose the use of amulets and cabalistic signs, or, rather, the common use, for they had been in evidence long prior to the foundation of this sect. Amulets were worn on the person. The Jews had phylacteries or bits of parchment on which were written passages from the Scriptures. In the first century after Christ, Jews, Pythagoreans, Essenes, and various sects of mystics combined and formed the Cabalists and Gnostics. Their creed embraced the magic of the Persians, the dreams of the Asclepiads, the numbers of Pythagoras, and the theory of atoms of Democritus. The Sophists of Alexandria actually regarded magic as a science. A section of the early Christians were Gnostics, and were imbued with the philosophy of the Orientals. According to the beliefs of the Cabalists and Gnostics, demons were the cause of disease. These sects interrogated evil spirits to find out where they lurked, and exorcised them with the help of charms and talismans. Various geometric figures and devices were held to have power against evil spirits. One of these figures was the device of two triangles interlaced thus [Symbol: David's Star]. This was used as a symbol of God, not only by Cabalists and Gnostics, but also by Jews. The great majority of the early Christians opposed the Gnostics, and repudiated and abhorred their strange mixture of the Christian religion with Eastern philosophy.

Christ came into the world at a time when the evils of slavery were probably at their worst. He did not directly condemn slavery, and the reason of this is to be found in the study of the nature of His mission. He came to regenerate the individual, and not, primarily, society. "His language in innumerable similes showed that He believed that those principles He taught would only be successful after long periods of time and gradual development. Most of His figures and analogies in regard to 'the Kingdom of God' rest upon the idea of slow and progressive growth or change. He undoubtedly saw that the only true renovation of the world would come, not through reforms of institutions or governments, but through individual change of character, effected by the same power to which Plato appealed—the love-power—but a love exercised towards Himself as a perfect and Divine model. It was the 'Kingdom of God' in the soul which should bring on the kingdom of God in human society.... And yet ultimately this Christian system will be found at the basis of all these great movements of progress in human history. But it began by aiming at the individual, and not at society; and aiming alone at an entire change of the affectional and moral tendencies."[33]