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OUTLINES OF GREEK AND ROMAN MEDICINE
OUTLINES OF GREEK AND ROMAN MEDICINE
BY
JAMES SANDS ELLIOTT, M.D., Ch.B.(Edin.)
Editor of the "New Zealand Medical Journal," Honorary Surgeon to the Wellington Hospital, New Zealand.
Illustrated
milford house inc. boston
This Milford House edition is an unabridged republication of the edition of 1914.
Published in 1971 by MILFORD HOUSE INC. Boston, Massachusetts
Library of Congress Catalogue Card Number 76-165987 Standard Book Number 0-87821-036-9
Printed in the U.S.A.
TO MY FATHER
PREFACE.
I was stimulated to write these Outlines of Greek and Roman Medicine by a recent sojourn in the south-eastern part of Europe. The name of the book defines, to some extent, its limitations, for my desire has been to give merely a general outline of the most important stages in the advancement of the healing art in the two Empires to which modern civilization is most deeply indebted. There are a few great works on the history of medicine by continental writers, such, for instance, as those by the German writers, Baas, Sprengel, and Puschmann, but, generally speaking, the subject has been much neglected.
I cherish the hope that this little work may appeal to doctors, to medical students, and to those of the public who are interested in a narration of the progress of knowledge, and who realize that the investigation of the body in health and disease has been one of the most important features of human endeavour.
The medical profession deserves censure for neglect of its own history, and pity 'tis that so many practitioners know nothing of the story of their art. For this reason many reputed discoveries are only re-discoveries; as Bacon wrote: "Medicine is a science which hath been, as we have said, more professed than laboured, and yet more laboured than advanced; the labour having been, in my judgment, rather in circle than in progression. For I find much iteration, and small progression." Of late years, however, the History of Medicine has been coming into its kingdom. Universities are establishing courses of lectures on the subject, and the Royal Society of Medicine recently instituted a historical section.
The material I have used in this book has been gathered from many sources, and, as far as possible, references have been given, but I have sought for, and taken, information wherever it could best be found. As Montaigne wrote: "I have here only made a nosegay of culled flowers, and have brought nothing of my own but the thread that ties them together."
I have to express my indebtedness to my friend, Mr. J. Scott Riddell, M.V.O., M.A., M.B., C.M., Senior Surgeon, Aberdeen Royal Infirmary, for his great kindness in reading the proof-sheets, preparing the index and seeing this book through the press and so removing one of the difficulties which an author writing overseas has to encounter; also to my publishers for their courtesy and attention.
JAMES SANDS ELLIOTT.
Wellington, New Zealand.
January 5, 1914.
CONTENTS.
PAGE
CHAPTER I.
EARLY ROMAN MEDICINE. 1
Origin of Healing—Temples—Lectisternium—Temple of AEsculapius—Archagathus—Domestic Medicine—Greek Doctors—Cloaca Maxima—Aqueducts—State of the early Empire
CHAPTER II.
EARLY GREEK MEDICINE. 13
Apollo—AEsculapius—Temples—Serpents—Gods of Health—Melampus—Homer—Machaon—Podalarius—Temples of AEsculapius—Methods of Treatment—Gymnasia—Classification of Renouard—Pythagoras—Democedes—Greek Philosophers
CHAPTER III.
HIPPOCRATES. 25
His life and works—His influence on Medicine
CHAPTER IV.
PLATO, ARISTOTLE, THE SCHOOL OF ALEXANDRIA, AND EMPIRICISM. 39
Plato—Aristotle—Alexandrian School—Its Origin—Its Influence—Lithotomy—Herophilus—Erasistratus—Cleombrotus— Chrysippos—Anatomy—Empiricism—Serapion of Alexandria
CHAPTER V.
ROMAN MEDICINE AT THE END OF THE REPUBLIC AND THE BEGINNING OF THE EMPIRE. 51
Asclepiades of Prusa—Themison of Laodicea—Methodism—Wounds of Julius Caesar—Systems of Philosophy—State of the country—Roman quacks—Slaves and Freedmen—Lucius Horatillavus
CHAPTER VI.
IN THE REIGN OF THE CAESARS TO THE DEATH OF NERO. 63
Augustus—His illnesses—Antonius Musa—Maecenas—Tiberius— Caligula—Claudius—Nero—Seneca—Astrology—Archiater—Women poisoners—Oculists in Rome
CHAPTER VII.
PHYSICIANS FROM THE TIME OF AUGUSTUS TO THE DEATH OF NERO. 72
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
CHAPTER VIII.
THE FIRST AND SECOND CENTURIES OF THE CHRISTIAN ERA. 86
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
CHAPTER IX.
GALEN. 96
His life and works—His influence on Medicine
CHAPTER X.
THE LATER ROMAN AND BYZANTINE PERIOD. 111
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
CHAPTER XI.
INFLUENCE OF CHRISTIANITY ON ALTRUISM AND THE HEALING ART. 127
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
CHAPTER XII.
GYMNASIA AND BATHS. 143
Gymnastics—Vitruvius—Opinions of Ancient Physicians on Gymnastics—The Athletes—The Baths—Description of Baths at Pompeii—Thermae—Baths of Caracalla
CHAPTER XIII.
SANITATION. 155
Water-supply—Its extent—The Aqueducts—Distribution in city—Drainage—Disposal of the Dead—Cremation and Burial—Catacombs—Public Health Regulations
APPENDIX.
FEES IN ANCIENT TIMES 162
ILLUSTRATIONS.
Asklepios, the ancient Greek Deity of Healing frontispiece
Machaon (Son of Asklepios), the first Greek Military Surgeon, attending to the wounded Menelaus p. 17
PLATE I.—Bust of AEsculapius face p. 13
" II.—Hygeia, the Greek Deity of Health " 15
" III.—Facade of Temple of Asklepios, restored (Delfrasse) " 18
" IV.—Health Temple, restored (Caton) " 20
OUTLINES OF Greek and Roman Medicine
CHAPTER I.
EARLY ROMAN MEDICINE.
Origin of Healing—Temples—Lectisternium—Temple of AEsculapius—Archagathus—Domestic Medicine—Greek Doctors—Cloaca Maxima—Aqueducts—State of the early Empire.
The origin of the healing art in Ancient Rome is shrouded in uncertainty. The earliest practice of medicine was undoubtedly theurgic, and common to all primitive peoples. The offices of priest and of medicine-man were combined in one person, and magic was invoked to take the place of knowledge. There is much scope for the exercise of the imagination in attempting to follow the course of early man in his efforts to bring plants into medicinal use. That some of the indigenous plants had therapeutic properties was often an accidental discovery, leading in the next place to experiment and observation. Cornelius Agrippa, in his book on occult philosophy, states that mankind has learned the use of many remedies from animals. It has even been suggested that the use of the enema was discovered by observing a long-beaked bird drawing up water into its beak, and injecting the water into the bowel. The practice of healing, crude and imperfect, progressed slowly in ancient times and was conducted in much the same way in Rome, and among the Egyptians, the Jews, the Chaldeans, Hindus and Parsees, and the Chinese and Tartars.
The Etruscans had considerable proficiency in philosophy and medicine, and to this people, as well as to the Sabines, the Ancient Romans were indebted for knowledge. Numa Pompilius, of Sabine origin, who was King of Rome 715 B.C., studied physical science, and, as Livy relates, was struck by lightning and killed as the result of his experiments, and it has therefore been inferred that these experiments related to the investigation of electricity. It is surprising to find in the Twelve Tables of Numa references to dental operations. In early times, it is certain that the Romans were more prone to learn the superstitions of other peoples than to acquire much useful knowledge. They were cosmopolitan in medical art as in religion. They had acquaintance with the domestic medicine known to all savages, a little rude surgery, and prescriptions from the Sibylline books, and had much recourse to magic. It was to Greece that the Romans first owed their knowledge of healing, and of art and science generally, but at no time did the Romans equal the Greeks in mental culture.
Pliny states that "the Roman people for more than six hundred years were not, indeed, without medicine, but they were without physicians." They used traditional family recipes, and had numerous gods and goddesses of disease and healing. Febris was the god of fever, Mephitis the god of stench; Fessonia aided the weary, and "Sweet Cloacina" presided over the drains. The plague-stricken appealed to the goddess Angeronia, women to Fluonia and Uterina. Ossipaga took care of the bones of children, and Carna was the deity presiding over the abdominal organs.
Temples were erected in Rome in 467 B.C. in honour of Apollo, the reputed father of AEsculapius, and in 460 B.C. in honour of AEsculapius of Epidaurus. Ten years later a pestilence raged in the city, and a temple was built in honour of the Goddess Salus. By order of the Sibylline books, in 399 B.C., the first lectisternium was held in Rome to combat a pestilence. This was a festival of Greek origin. It was a time of prayer and sacrifice; the images of the gods were laid upon a couch, and a meal was spread on a table before them. These festivals were repeated as occasion demanded, and the device of driving a nail into the temple of Jupiter to ward off "the pestilence that walketh in darkness," and "destruction that wasteth at noonday" was begun 360 B.C. As evidence of the want of proper surgical knowledge, the fact is recorded by Livy that after the Battle of Sutrium (309 B.C.) more soldiers died of wounds than were killed in action. The worship of AEsculapius was begun by the Romans 291 B.C., and the Egyptian Isis and Serapis were also invoked for their healing powers.
At the time of the great plague in Rome (291 B.C.), ambassadors were sent to Epidaurus, in accordance with the advice of the Sibylline books, to seek aid from AEsculapius. They returned with a statue of the god, but as their boat passed up the Tiber a serpent which had lain concealed during the voyage glided from the boat, and landing on the bank was welcomed by the people in the belief that the god himself had come to their aid. The Temple of AEsculapius, which was built after this plague in 291 B.C., was situated on the island of the Tiber. Tradition states that, when the Tarquins were expelled, their crops were thrown into the river, and soil accumulated thereon until ultimately the island was formed. In consequence of the strange happening of the serpent landing from the ship the end of the island on which the Temple of AEsculapius stood was shaped into the form of the bow of a ship, and the serpent of AEsculapius was sculptured upon it in relief.
The island is not far from the AEmilian Bridge, of which one broken arch remains.
Ovid represents this divinity as speaking thus:—
"I come to leave my shrine; This serpent view, that with ambitious play My staff encircles, mark him every way; His form—though larger, nobler, I'll assume, And, changed as gods should be, bring aid to Rome."
(Ovid, "Metamorphoses," xv.)
He is said to have resumed his natural form on the island of the Tiber.
"And now no more the drooping city mourns; Joy is again restored and health returns."
It was the custom for patients to sleep under the portico of the Temple of AEsculapius, hoping that the god of the healing art might inspire them in dreams as to the system of cure they should adopt for their illnesses. Sick slaves were left there by their masters, but the number increased to such an extent that the Emperor Claudius put a stop to the cruel practice. The Church of St. Bartholomew now stands on the ruins of the Temple of AEsculapius.
Even in very early times, however, Rome was not without medical practitioners, though not so well supplied as some other nations. The Lex AEmilia, passed 433 B.C., ordained punishment for the doctor who neglected a sick slave. In Plutarch's "Life of Cato" (the Censor, who was born in 234 B.C.), we read of a Roman ambassador who was sent to the King of Bithynia, in Asia Minor, and who had his skull trepanned.
The first regular doctor in Rome was Archagathus, who began practice in the city 219 B.C., when the authorities received him favourably and bought a surgery for him; but his methods were rather violent, and he made much use of the knife and caustics, earning for himself the title of "butcher," and thus having fallen into disfavour, he was glad to depart from Rome. A College of AEsculapius and of Health was established 154 B.C., but this was not a teaching college in the present meaning of the term.
The doctors of Ancient Rome took no regular course of study, nor were any standards specified, but as a rule knowledge was acquired by pupilage to a practising physician, for which a honorarium was paid. Subsequently the Archiatri, after the manner of trade guilds, received apprentices, but Pliny had cause to complain of the system of medical education, or rather, to deplore the want of it. He wrote: "People believed in anyone who gave himself out for a doctor, even if the falsehood directly entailed the greatest danger. Unfortunately, there is no law which punishes doctors for ignorance, and no one takes revenge on a doctor if through his fault someone dies. It is permitted him by our danger to learn for the future, at our death to make experiments, and, without having to fear punishment, to set at naught the life of a human being."
Before the time when Greek doctors settled in Rome, medical treatment was mainly under the direct charge of the head of each household. The father of a family had great powers conferred upon him by the Roman law, and was physician as well as judge over his family. If he took his new-born infant in his arms he recognized him as his son, but otherwise the child had no claim upon him. He could inflict the most dire punishments on members of his household for which they had no redress.
Cato, the Elder, who died in B.C. 149, wrote a guide to domestic medicine for the use of Roman fathers of the Republic, but he was a quack and full of self-conceit. He hated the physicians practising in Rome, who were mostly Greeks, and thought that their knowledge was much inferior to his own. Plutarch relates that Cato knew of the answer given to the King of Persia by Hippocrates, when sent for professionally, "I will never make use of my art in favour of barbarians who are enemies of the Greeks," and pretended to believe that all Greek physicians were bound by the same rule, and animated by the same motives. However, Cato did a great deal of good by attempting to lessen the vice and luxury of his age.
The Greeks in Rome were looked at askance as foreign adventurers, and there is no doubt that although many were honourable men, others came to Rome merely to make money out of the superstitious beliefs and credulity of the Roman people. Fine clothes, a good house, and the giving of entertainments, were the best introduction to practice that some of these practitioners could devise.
The medical opinions of Cato throw a sidelight upon the state of medicine in his time. He attempted to cure dislocations by uttering a nonsensical incantation: "Huat hanat ista pista sista damiato damnaustra!" He considered ducks, geese and hares a light and suitable diet for the sick, and had no faith in fasting.
Although the darkness was prolonged and intense before the dawn of medical science in Rome, yet, in ancient times, there was a considerable amount of knowledge of sanitation. The great sewer of Rome, the Cloaca Maxima, which drained the swampy valley between the Capitoline and Palatine Hills, was built by order of Tarquinius Priscus in 616 B.C. It is wonderful that at the present time the visitor may see this ancient work in the Roman Forum, and trace its course to the Tiber. In the Forum, too, to the left of the Temple of Castor, is the sacred district of Juturna, the nymph of the healing springs which well up at the base of the Palatine Hill. Lacus Juturnae is a four-sided basin with a pillar in the middle, on which rested a marble altar decorated with figures in relief. Beside the basin are rooms for religious purposes. These rooms are adorned with the gods of healing, AEsculapius with an acolyte holding a cock, the Dioscuri and their horses, the head of Serapis, and a headless statue of Apollo.
The Cloaca Maxima was formed of three tiers of arches, the vault within the innermost tier being 14 ft. in diameter. The administration of the sewers, in the time of the Republic, was in the hands of the censors, but special officers called curatores cloacarum were employed during the Empire, and the workmen who repaired and cleansed the sewers were condemned criminals. These ancient sewers, which have existed for twenty-five centuries, are monuments to the wisdom and power of the people who built them. In the time of Furius Camillus private drains were connected with the public sewers which were flushed by aqueduct and rain water. This system has prevailed throughout the centuries.
The Aqueducts were also marvellous works, and although they were added to in the time of the Empire, Sextus Julius Frontinus, curator of waters in the year A.D. 94, gives descriptions of the nine ancient aqueducts, some of which were constructed long before the Empire. For instance, the Aqua Appia was conducted into the city three hundred and twelve years before the advent of Christ, and was about seven miles long. The Aqua Anio Vetus, sixty-two miles in length, built in B.C. 144, was conveyed across the Campagna from a source in the country beyond Tivoli. Near this place there is a spring of milky-looking water containing sulphurous acid, sulphurated lime, and bicarbonate of lime, used now, and in ancient times for the relief of skin complaints. This water, at the present day, has an almost constant temperature of 75 deg..
In course of time, when the Roman power was being extended abroad, the pursuit of conquest left little scope for the cultivation of the peaceful arts and the investigation of science, and life itself was accounted so cheap that little thought was given to improving methods for the treatment of the sick and wounded. On a campaign every soldier carried on his person a field-dressing, and the wounded received rough-and-ready first-aid attention from their comrades in arms.
Later, when conquest was ended, and attention was given to the consolidation of the provinces, ease and happiness, as has been shown by Gibbon, tended to the decay of courage and thus to lessen the prowess of the Roman legions, but there was compensation for this state of affairs at the heart of the Empire because strong streams of capable and robust recruits flowed in from Spain, Gaul, Britain and Illyricum.
At its commencement, the Empire was in a peaceful, and, on the whole, prosperous condition, and the provincials, as well as the Romans, "acknowledged that the true principles of social life, laws, agriculture, and science, which had been first invented by the wisdom of Athens, were now firmly established by the power of Rome, under whose auspicious influence the fiercest barbarians were united by an equal government and common language. They affirm that with the improvement of arts the human species was visibly multiplied. They celebrate the increasing splendour of the cities, the beautiful face of the country, cultivated and adorned like an immense garden; and the long festival of peace, which was enjoyed by so many nations, forgetful of their ancient animosities, and delivered from the apprehension of future danger." Thus wrote the Roman historian, and Gibbon states that when we discount as much of this as we please as rhetorical and declamatory, the fact remains that the substance of this description is in accordance with the facts of history. Never until the Christian era was any thought given to the regular care of the helpless and the abject. Slaves were often treated like cattle, and the patricians had no bond of sympathy with the plebeians. Provisions were sometimes distributed to the poor, and taxes remitted, but for reasons of State and not from truly charitable motives. Authority was also given to parents to destroy new-born infants whom they could not support. The idea of establishing public institutions for the relief of the sick and the poor did not enter the minds of the ancient Romans.
Before considering the state of the healing art throughout the period of the Roman Empire, it is necessary to devote the next chapters to a consideration of the rise and progress of medical science in Greece, for it cannot be too strongly emphasized that Roman philosophy and Roman medicine were borrowed from the Greeks, and it is certain also that the Greeks were indebted to the Egyptians for part of their medical knowledge. The Romans were distinguished for their genius for law-giving and government, the Greeks for philosophy, art, and mental culture generally.
CHAPTER II.
EARLY GREEK MEDICINE.
Apollo—AEsculapius—Temples—Serpents—Gods of Health—Melampus—Homer—Machaon—Podalarius—Temples of AEsculapius—Methods of Treatment—Gymnasia—Classification of Renouard—Pythagoras—Democedes—Greek Philosophers.
The history of healing begins in the Hellenic mythology with Apollo, the god of light and the promoter of health. In the "Iliad" he is hailed as the disperser of epidemics, and, in this respect, the ancients were well informed in attributing destruction of infection to the sun's rays. Chiron, the Centaur, it was believed, was taught by Apollo and Artemis, and was the teacher, in turn, of AEsculapius, who probably lived in the thirteenth century before Christ and was ultimately deified as the Greek god of medicine. Pindar relates of him:—
"On some the force of charmed strains he tried, To some the medicated draught applied; Some limbs he placed the amulets around, Some from the trunk he cut, and made the patient sound."[1]
AEsculapius was too successful in his art, for his death was attributed to Zeus, who killed him by a flash of lightning, or to Pluto, both of whom were thought to have feared that AEsculapius might by his skill gain the mastery over death.
Amid much that is mythological in the history of AEsculapius, there is a groundwork of facts. Splendid temples were built to him in lovely and healthy places, usually on a hill or near a spring; they were visited by the sick, and the priests of the temples not only attended to the worship of AEsculapius, but took pains to acquire knowledge of the healing art. The chief temple was at Epidaurus, and here the patients were well provided with amusements, for close to the temple was a theatre capable of seating 12,000 people, and a stadium built to accommodate 20,000 spectators.
A serpent entwined round a knotted staff is the symbol of AEsculapius. A humorist of the present day has suggested that the knots on the staff indicate the numerous "knotty" questions which a doctor is asked to solve! Tradition states that when AEsculapius was in the house of his patient, Glaucus, and deep in thought, a serpent coiled itself around his staff. AEsculapius killed it, and then another serpent appeared with a herb leaf in its mouth, and restored the dead reptile to life. It seems probable that disease was looked upon as a poison. Serpents produced poison, and had a reputation in the most ancient times for wisdom, and for the power of renovation, and it was thought that a creature which could produce poison and disease might probably be capable of curing as well as killing. Serpents were kept in the Temples of AEsculapius, and were non-poisonous and harmless. They were given their liberty in the precincts of the temple, but were provided with a serpent-house or den near to the altar. They were worshipped as the incarnation of the god, and were fed by the sick at the altar with "popana," or sacrificial cakes.
Many of the Greek gods and goddesses were held to have power over disease. Hygeia, known as Salus to the Romans, was said to have been the daughter of AEsculapius, and to have taken care of the sacred serpents (Plate II).
Melampus was considered by the Greeks the first mortal to practise healing. In one case he prescribed rust, probably the earliest use of iron as a drug, and he also used hellebore root as a purgative. He married a princess and was given part of a kingdom as a reward for his services. After his death he was awarded divine honours, and temples were erected for his worship. The deification of AEsculapius and of Melampus added much to the prestige of doctors in Greece, where they were always held in honour; but in Rome the practice of medicine was not considered a highly honourable calling.
Something can be learned from the writings of Homer of the state of medicine in his time, although we need hardly expect to find in an epic poem many references to diseases and their cure. As dissection was considered a profanation of the body, anatomical knowledge was exceedingly meagre. Machaon was surgeon to Menelaus and Podalarius was the pioneer of phlebotomy. Both were regarded as the sons of AEsculapius; they were soldiers as well as doctors, and fought before the walls of Troy. The surgery required by Homer's heroes was chiefly that of the battlefield. Unguents and astringents were in use in the physician's art, and there is reference to "nepenthe," a narcotic drug, and also to the use of sulphur as a disinfectant. Doctors, according to Homer, were held in high esteem, and Arctinus relates that two divisions were recognized, surgeons and physicians, the former held in less honour than the latter—"Then Asclepius (AEsculapius) bestowed the power of healing upon his two sons; nevertheless, he made one of the two more celebrated than the other; on one did he bestow the lighter hand that he might draw missiles from the flesh, and sew up and heal all wounds; but the other he endowed with great precision of mind, so as to understand what cannot be seen, and to heal seemingly incurable diseases."[2]
Machaon fought in the army of Nestor. Fearing for his safety, King Idomeneus placed him under the charge of Nestor, who was instructed to take the doctor into his chariot, for "a doctor is worth many men." When Menelaus was wounded, a messenger was sent for Machaon, who extracted the barbed arrow, sucked the wound and applied a secret ointment made known to AEsculapius by Chiron the Centaur, according to tradition.
The practice of Greek medicine became almost entirely restricted to the temples of AEsculapius, the most important of which were situated at Rhodes, Cnidus and Cos. The priests were known as Asclepiadae, but the name was applied in time to the healers of the temple who were not priests. Tablets were affixed to the walls of these temples recording the name of the patient, the disease and the cure prescribed. There is evidence that diseases were closely observed. The patients brought gifts to the temples, and underwent a preliminary purification by ablutions, fasting, prayer and sacrifice. A cock was a common sacrifice to the god. No doubt many wonderful cures were effected. Mental suggestion was used greatly, and the patient was put to sleep, his cure being often revealed to him in a dream which was interpreted by the priests. The expectancy of his mind, and the reduced state of his body as the result of abstinence conduced to a cure, and trickery also played a minor part. Albeit, much of the treatment prescribed was commendable. Pure air, cheerful surroundings, proper diet and temperate habits were advocated, and, among other methods of treatment, exercise, massage, sea-bathing, the use of mineral waters, purgatives and emetics, and hemlock as a sedative, were in use. If a cure was not effected, the faith of the patient was impugned, and not the power of the god or the skill of the Asclepiades, so that neither religion nor the practice of physic was exposed to discredit. Great was the wisdom of the Greeks! These temples were the famous medical schools of ancient Greece. A spirit of emulation prevailed, and a high ethical standard was attained, as is shown by the oath prescribed for students when they completed their course of study. The form of oath will be found in a succeeding chapter in connection with an account of the life of Hippocrates.
The remains of the Health Temple, or Asklepieion, of Cos were brought to light in 1904 and 1905, by the work of Dr. Rudolf Herzog, of Tuebingen. Dr. Richard Caton, of Liverpool, has been able to reconstruct pictorially the beautiful buildings that existed two thousand years ago. They were situated among the hills. The sacred groves of cypresses were on three sides of the temple, and "to the north the verdant plain of Cos, with the white houses and trees of the town to the right, and the wide expanse of turquoise sea dotted by the purple islands of the AEgean, and the dim mountains about Halicarnassus, to the north-east."[3]
The ancient Greek Gymnasia were in use long before the Asclepiades began to practise in the temples. The Greeks were a healthy and strong race, mainly because they attended to physical culture as a national duty. The attendants who massaged the bodies of the athletes were called aliptae, and they also taught physical exercises, and practised minor surgery and medicine. Massage was used before and after exercises in the gymnasium, and was performed by anointing the body with a mixture of oil and sand which was well rubbed into the skin. There were three classes of officials in the gymnasia; the director or magistrate called the gymnasiarch, the sub-director or gymnast, and the subordinates. The directors regulated the diet of the young men, the sub-directors, besides other duties, prescribed for the sick, and the attendants massaged, bled, dressed wounds, gave clysters, and treated abscesses, dislocations, &c.
There is no doubt that the Greeks, in insisting upon the physical training of the young, were wiser in their generation than the people of the present day; and not only the young, but people of mature age, took exercises suited to their physical requirements. The transgression of some of Solon's laws in reference to the gymnasia was punishable by death.
The third stage in the history of Greek medicine has now been reached. The first stage was primitive, the second associated with religion, and the third connected with philosophy. The classification of Renouard is accurate and convenient. In the "Age of Foundation," he recognizes four periods, namely:—
(1) The Primitive Period, or that of Instinct, beginning with myth, and ending with the destruction of Troy, 1184 years before Christ.
(2) The Sacred or Mystic Period, ending with the dispersion of the Pythagorean Society, 500 years before Christ.
(3) The Philosophic Period, ending with the foundation of the Alexandrian library, 320 years before Christ. This period is made illustrious by Hippocrates.
(4) The Anatomic Period, ending with the death of Galen, about 200 years after Christ.
The earliest Greek medical philosopher was Pythagoras (about 580 B.C.). He was born at Samos, and began life as an athlete, but a lecture which he heard on the subject of the immortality of the soul kindled enthusiasm for philosophical study, the pursuit of which led him to visit Egypt, Phoenicia, Chaldea, and perhaps also India. He was imbued with Eastern mysticism, and held that the air is full of spiritual beings who send dreams to men, and health or disease to mankind and to the lower animals. He did not remain long in Greece, but travelled much, and settled for a considerable time in Crotona, in the South of Italy, where he taught pupils, their course of study extending over five or six years. The Pythagorean Society founded by him did much good at first, but its members ultimately became greedy of gain and dishonest, and the Society in the lifetime of its founder was subjected to persecution and dispersed by angry mobs. Pythagoras possessed a prodigious mind. He is best known for his teaching in reference to the transmigration of souls, but he was also a great mathematician and astronomer. He taught that "number is the essence of everything," and his philosophy recognized that the universe is governed by law. God he represented by the figure 1, matter by the figure 2, and the universe by the combination 12, all of which, though fanciful, was an improvement upon mythology, and a recognition of system.
In the practice of medicine he promoted health mainly by diet and gymnastics, advised music for depression of spirits, and had in use various vegetable drugs. He introduced oxymel of squills from Egypt into Greece, and was a strong believer in the medicinal properties of onions. He viewed surgery with disfavour, and used only salves and poultices. The Asclepiades treated patients in the temples, but the Pythagoreans visited from house to house, and from city to city, and were known as the ambulant or periodic physicians.
Herodotus gives an account of another eminent physician of Crotona, Democedes by name, who succeeded Pythagoras. At this time, it is recorded that the various cities had public medical officers. Democedes gained his freedom from slavery as a reward for curing the wife of Darius of an abscess in the breast.
The dispersal of the Pythagoreans led to the settlement of many of them, and of their imitators, in Rome and various parts of Italy. Although Pythagoras was a philosopher, he belongs to the Mystic Period, while Hippocrates is the great central figure of the Philosophic Period. Before studying the work of Hippocrates, it is necessary to consider the distinguishing features of the various schools of Greek philosophy. Renouard shows that the principles of the various schools of medical belief depended upon the three great Greek schools of Cosmogony.
Pythagoras believed in a Supreme Ruler of the Universe, and that spirits animated all life, and existed even in minerals; he also believed in preconceived purpose. With these views were associated the Dogmatic School of Medicine, and the name of Hippocrates, and this belief corresponds to modern vitalism.
Leucippus and Democritus, rejecting theology, considered vital action secondary to the operation of the laws of matter, and believed that atoms moved through pores in the body in such a way as to determine a state of health or disease. With this philosophy was associated the Medical School of Methodism, a system said to have been founded by Asclepiades of Prusa (who lived in Rome in the first century before Christ), and by his pupil Themison (B.C. 50). The third school of medical thought, that of Empiricism, taught that experience was the only teacher, and that it was idle to speculate upon remote causes. The Empirics based these views upon the teaching of philosophers known as Sceptics or Zetetics, followers of Parmenides and Pyrrho, who taught that it was useless to fatigue the mind in endeavouring to comprehend what is beyond its range. They were the precursors of modern agnosticism.
The Eclectics, in a later age, formed another medical sect, and had no definite system except that they made a selection of the views and methods of Dogmatists, Methodists and Empirics.
The Greek philosophers as a class believed in a primary form of matter out of which elements were formed, and the view held in regard to the elements is expressed in Ovid's "Metamorphoses."[4]
"Nor those which elements we call abide, Nor to this figure nor to that are ty'd: For this eternal world is said of old But four prolific principles to hold, Four different bodies; two to heaven ascend, And other two down to the centre tend. Fire first, with wings expanded, mounts on high, Pure, void of weight, and dwells in upper sky; Then air, because unclogged, in empty space Flies after fire, and claims the second place; But weighty water, as her nature guides, Lies on the lap of earth; and Mother Earth subsides. All things are mixed of these, which all contain, And into these are all resolved again."
Fire was considered to be matter in a very refined form, and to closely resemble life or even soul.
FOOTNOTES:
[1] Wheelwright's translation of "Pindar."
[2] Arctinus, "Ethiopis." Translated in Puschmann's "Hist. Med. Education."
[3] Caton, Brit. Med. Journ., 1906, i, p. 571.
[4] Dryden's translation, book xv.
CHAPTER III.
HIPPOCRATES.
His life and works—His influence on Medicine.
Hippocrates, the Father of Medicine, was born at Cos during the golden age of Greece, 460 years before Christ. He belonged to the family of the Asclepiadae, and, according to tradition, could trace his ancestors on the male side to AEsculapius, and on the female side to Hercules. He is said to have received his medical education from his father and from Herodicus, and to have been taught philosophy by Gorgias, the Sophist, and by Democritus, whom he afterwards cured of mental derangement.
There was a very famous medical school at Cos, and the temple there held the notes of the accumulated experience of his predecessors, but Hippocrates visited also, for the purpose of study, various towns of Greece, and particularly Athens. He was a keen observer, and took careful notes of his observations. His reputation was such that his works are quoted by Plato and by Aristotle, and there are references to him by Arabic writers. His descendants published their own writings under his name, and there were also many forgeries, so that it is impossible to know exactly how many of the works attributed to him are authentic; but by a consensus of opinion the following books are considered genuine: "Prognostics," seven of the books of "Aphorisms," "On Airs, Waters and Places," "On Regimen in Acute Diseases," the first and third books of "Epidemics," "On the Articulations," "On Fractures," the treatise on "Instruments of Reduction," and "The Oath"; and the books considered almost certainly genuine are those dealing with "Ancient Medicine," "Surgery," "The Law," "Fistulae," "Ulcers," "Haemorrhoids," and "On the Sacred Disease" (Epilepsy). The famous Hippocratic Collection in the great libraries of Alexandria and Pergamos also comprised the writings of Pythagoras, Plato and Aristotle.
The genius of Hippocrates is unsurpassed in the history of medicine. He was the first to trace disease to a natural and intelligible cause, and to recognize Nature as all-sufficient for healing, and physicians as only her servants. He discussed medical subjects freely and without an air of mystery, scorning all pretence, and he was also courageous enough to acknowledge his limitations and his failures. When the times in which he lived are considered, it is difficult to know which of his qualities to admire most, his love of knowledge, his powers of observation, his logical faculty, or his courage and truthfulness.
The central principle of belief of Hippocrates and the Dogmatists was that health depended on the proper proportion and action in the body of the four elements, earth, water, air, and fire, and the four cardinal humours, blood, phlegm, yellow bile and black bile. The due combination of these was known as crasis, and existed in health. If a disease were progressing favourably these humours became changed and combined (coction), preparatory to the expulsion of the morbid matter (crisis), which took place at definite periods known as critical days. Hippocrates also held the theory of fluxions, which were conditions in the nature of congestion, as it would now be understood.
In his time public opinion condemned dissection of the human body, but it is certain that dissections were performed by Hippocrates to a limited extent. He did not know the difference between the arteries and the veins, and nerves and ligaments and various membranes were all thought to have analogous functions, but his writings display a correct knowledge of the anatomy of certain parts of the body such as the joints and the brain. This defective knowledge of anatomy gave rise to fanciful views on physiology, which, among much that is admirable, disfigure the Hippocratic writings.
The belief that almost all medical and surgical knowledge is modern, though flattering to our self-complacency, is disturbed by the study of the state of knowledge in the time of Hippocrates. To him we are indebted for the classification of diseases into sporadic, epidemic, and endemic, and he also separated acute from chronic diseases. He divided the causes of disease into two classes: general, such as climate, water and sanitation; and personal, such as improper food and neglect of exercise.
He based his conclusions on the observation of appearances, and in this way began a new era. He was so perfect in the observation of external signs of disease that he has never in this respect been excelled. The state of the face, eyes, tongue, voice, hearing, abdomen, sleep, breathing, excretions, posture of the body, and so on, all aided him in diagnosis and prognosis, and to the latter he paid special attention, saying that "the best physician is the one who is able to establish a prognosis, penetrating and exposing first of all, at the bedside, the present, the past, and the future of his patients, and adding what they omit in their statements. He gains their confidence, and being convinced of his superiority of knowledge they do not hesitate to commit themselves entirely into his hands. He can treat, also, so much better their present condition in proportion as he shall be able from it to foresee the future."
He wrote about the history of Medicine, a study which is much neglected at the present time. There is no generation of men so wise that they cannot with advantage adopt some ideas from the remote past, or, at least, find the teaching of their predecessors suggestive. Hippocrates was one of the first to recognize the vis medicatrix naturae, and he always aimed at assisting Nature. His style of treatment would be known now as expectant, and he tried to order his practice "to do good, or, at least, to do no harm." When he considered interference necessary, however, he did not hesitate even to apply drastic measures, such as scarification, cupping and bleeding. He made use of the narcotics mandragora, henbane, and probably also poppy-juice, and as a laxative used greatly a vegetable substance called "mercury," beet and cabbage, and cathartics such as scammony and elaterium! He was able to diagnose fluid in the chest or abdomen by means of percussion and auscultation, and to withdraw the fluid by the operation of paracentesis, and he recognized also that the fluid should be allowed to flow away slowly so as to minimize the risk of syncope. He operated also for empyema. In regard to the methods of Hippocrates for the physical examination of the chest it is reasonable to suppose that the Father of Medicine indirectly inspired Laennec to invent the stethoscope. Hippocrates prescribed fluid diet for fevers, allowed the patients cold water or barley water to drink, and recommended cold sponging for high fever. In his writings will be found his views on apoplexy, epilepsy, phthisis, gout, erysipelas, cancer and many other diseases common at the present day.
In the province of Surgery, Hippocrates was surprisingly proficient, although he lived before the Anatomic Period. He had various lotions for the healing of ulcers; some of these lotions were antiseptic and have been in use in recent times. His opinions on the treatment of fractures are sound, and he was a master in the use of splints, and considered that it was disgraceful on the part of the surgeon to allow a broken limb to set in a faulty position. He resected the projecting ends of the bone in the case of compound fracture. He had a very complete knowledge of the anatomy of joints, was well acquainted with hip-joint disease, and could operate upon joints. Accidents were no doubt common in the gymnasia, and practice in the treatment of fractures and dislocations extensive and of a high order of excellence. Hippocrates used the sound for exploring the bladder, and understood the use of the speculum for examining the rectum, and in operations for fistula and piles. He understood the causation of club-foot, and could cure cases of this deformity by bandaging. He was skilful also in obstetric operations. He trepanned the skull, which appears to have been a common operation in his day. He had clear and sound views in reference to wounds of the head, recognizing that trivial-looking wounds of the scalp might become very serious. Hippocrates gave directions as to the indications for using the trepan, and warned the operator against mistaking sutures of the cranial bones for fracture.
He did not describe amputations as generally understood, but removed limbs at a joint for gangrene. When necessary he made use of mechanical appliances for reducing dislocations, and recommended doctors to furnish their surgeries with an adjustable table, fitted with levers, for dealing with the reduction of dislocations, and for various other surgical manipulations. Excision of tumours was not a common operation of Hippocratic surgery, although it had been a part of Hindu practice in very ancient times. On the subject of Obstetrics, Hippocrates wrote a great deal, and although many of his theories seem absurd at the present day, yet, on the whole, the treatment he recommends is efficacious. Regarding Gynaecology, in his treatise on "Airs, Water and Places," it is interesting to observe that he says that the drinking of impure water will cause dropsy of the uterus. Adams, commenting on this, has in mind hydatids, but it is evident that both Hippocrates and his translator and critic have mistaken hydatidiform disease of the ovum for hydatid disease of the womb. In the books which are considered genuine the references to diseases of women are meagre, and it is likely that the author had little special knowledge of the subject. That part of the Hippocratic collection which is not considered genuine deals rather fully with the subject of gynaecology.[5] In it are described sounds made of wood and of lead, dilators and uterine catheters. Sitz baths were in use, and fumigations were very extensively employed in gynaecological practice. Pessaries were made by rolling lint or wool into an oblong shape, and were medicated to be emollient, astringent or purgative in their local action. The half of a pomegranate was used as a mechanical pessary, and there are also references to tents, and to suppositories for the bowel.
In dealing with Dietetics, Hippocrates displays close observation and sound judgment. The views held generally at the present day coincide closely with his instructions on food and feeding. In the treatise on Ancient Medicine, he states that men had to find from experience the properties of various vegetable foods, and discovered that what was suitable in health was unsuitable in sickness, and that the accumulation of these discoveries was the origin of the art of medicine.
The Sydenham Society initiated, and Dr. Adams brilliantly accomplished, a noble work in the publication in 1849 of "The Genuine Works of Hippocrates," from which "The Law," and "The Oath" are here quoted. The former is the view of Hippocrates of the standards which should govern the practice of medicine; the latter is that by which all the AEsculapians were bound.
"THE LAW.
"(1) Medicine is of all the arts the most noble; but, owing to the ignorance of those who practise it, and of those who, inconsiderately, form a judgment of them, it is at present far behind all the other arts. Their mistake appears to me to arise principally from this, that in the cities there is no punishment connected with the practice of medicine (and with it alone) except disgrace, and that does not hurt those who are familiar with it. Such persons are like the figures which are introduced in tragedies, for as they have the shape, and dress, and personal appearance of an actor, but are not actors, so also physicians are many in title but very few in reality.
"(2) Whoever is to acquire a competent knowledge of medicine, ought to be possessed of the following advantages: A natural disposition; instruction; a favourable position for the study; early tuition; love of labour; leisure. First of all, a natural talent is required, for, when Nature opposes, everything else is vain; but when Nature leads the way to what is most excellent, instruction in the art takes place, which the student must try to appropriate to himself by reflection, becoming an early pupil in a place well adapted for instruction. He must also bring to the task a love of labour and perseverance, so that the instruction taking root may bring forth proper and abundant fruits.
"(3) Instruction in medicine is like the culture of the productions of the earth. For our natural disposition is, as it were, the soil; the tenets of our teacher are, as it were, the seed; instruction in youth is like the planting of the seed in the ground at the proper season; the place where the instruction is communicated is like the food imparted to vegetables by the atmosphere; diligent study is like the cultivation of the fields; and it is time which imparts strength to all things and brings them to maturity.
"(4) Having brought all these requisites to the study of medicine, and having acquired a true knowledge of it, we shall thus, in travelling through the cities, be esteemed physicians not only in name but in reality. But inexperience is a bad treasure, and a bad friend to those who possess it, whether in opinion or reality, being devoid of self-reliance and contentedness, and the nurse both of timidity and audacity. For timidity betrays a want of powers, and audacity a want of skill. There are, indeed, two things, knowledge and opinion, of which the one makes its possessor really to know, the other to be ignorant.
"(5) These things which are sacred are to be imparted only to sacred persons; and it is not lawful to impart them to the profane until they have been initiated in the mysteries of the science."
"THE OATH.
"I swear by Apollo, the physician, and AEsculapius, and Health, and Panacea, and all the gods and goddesses, that, according to my ability and judgment, I will keep this oath and this stipulation—to reckon him who taught me this art equally dear to me as my parents, to share my substance with him, and relieve his necessities if required; to look upon his offspring in the same footing as my own brothers, and to teach them this art, if they shall wish to learn it, without fee or stipulation; and that by precept, lecture, and every other mode of instruction, I will impart a knowledge of the Art to my own sons, and those of my teachers, and to disciples bound by a stipulation and oath according to the law of medicine, but to none others. I will follow that system of regimen which, according to my ability and judgment, I consider for the benefit of my patients, and abstain from whatever is deleterious and mischievous. I will give no deadly medicine to anyone if asked, nor suggest any such counsel; and in like manner I will not give to a woman a pessary to produce abortion. With purity and with holiness I will pass my life and practise my Art. I will not cut persons labouring under the stone, but will leave this to be done by men who are practitioners of this work. Into whatever houses I enter, I will go into them for the benefit of the sick, and will abstain from every voluntary act of mischief and corruption, and, further, from the seduction of females or males, of freedmen and slaves. Whatever, in connection with my professional practice, or not in connection with it, I see or hear, in the life of men, which ought not to be spoken of abroad, I will not divulge as reckoning that all such should be kept secret. While I continue to keep this Oath inviolate, may it be granted to me to enjoy life and the practice of the Art, respected by all men, in all times! But should I trespass or violate this oath, may the reverse be my lot!"
It would be a great task to attempt anything like a full review of the writings of this great doctor of antiquity, but enough has been written to reveal the great powers of his mind, and to show that he was far in advance of his predecessors, and a model for his successors. In the island of Cos, made illustrious by the name of Hippocrates, it is strange to find that he has no fame now other than that of being regarded in the confused minds of the people as one of the numerous saints of the Greek Church.[6]
"When," says Littre, "one searches into the history of medicine and the commencement of science, the first body of doctrine that one meets with is the collection of writings known under the name of the works of Hippocrates. The science mounts up directly to that origin, and there stops. Not that it had not been cultivated earlier, and had not given rise to even numerous productions; but everything that had been made before the physician of Cos has perished. We have only remaining of them scattered and unconnected fragments. The works of Hippocrates have alone escaped destruction; and by a singular circumstance there exists a great gap after them as well as before them. The medical works from Hippocrates to the establishment of the School of Alexandria, and those of that school itself, are completely lost, except some quotations and passages preserved in the later writers; so that the writings of Hippocrates remain alone amongst the ruins of ancient medical literature." Sydenham said of Hippocrates: "He it is whom we can never duly praise," and refers to him as "that divine old man," and "the Romulus of medicine, whose heaven was the empyrean of his art."
Hippocrates died in Thessaly, but at what age is uncertain, for different authors have credited him with a lifetime of from eighty-five to a hundred and nine years. By virtue of his fame, death for him was not the Great Leveller.
Hippocrates had two sons, Thessalus and Draco; the former was physician to Archelaus, King of Macedonia, the latter physician to the wife of Alexander the Great. They were the founders of the School of Dogmatism which was based mainly on the teaching and aphorisms of Hippocrates. The Dogmatic Sect emphasized the importance of investigating not the obvious but the underlying and hidden causes of disease and held undisputed sway until the foundation of the Empirical Sect at Alexandria.
FOOTNOTES:
[5] Vide "History of Gynaecology," by W. J. Stewart McKay. Bailliere, Tindall and Cox, 1901.
[6] Archiv fuer Geschichte der Medizin, May, 1912.
CHAPTER IV.
PLATO, ARISTOTLE, THE SCHOOL OF ALEXANDRIA AND EMPIRICISM.
Plato—Aristotle—Alexandrian School—Its Origin—Its Influence— Lithotomy—Herophilus—Erasistratus—Cleombrotus—Chrysippos— Anatomy—Empiricism—Serapion of Alexandria.
Two very eminent philosophers, Plato and Aristotle, were influenced by the teaching of Hippocrates.
Plato (B.C. 427-347) was a profound moralist, and though possessed of one of the keenest intellects of all time, did little to advance medical science. He did not practise medicine, but studied it as a branch of philosophy, and instead of observing and investigating, attempted to solve the problems of health and disease by intuition and speculation. His conceptions were inaccurate and fantastic.
He elaborated the humoral pathology of Hippocrates. The world, he thought, was composed of four elements: fire consisting of pyramidal, earth of cubical, air of octagonal, and water of twenty-sided atoms. The marrow consists of triangles, and the brain is the perfection of marrow. The soul dominates the marrow and the separation of the two causes death. The purpose of the bones and muscles is to protect the marrow against changes of temperature. Plato divided the "soul" into three parts: Reason, enthroned in the brain; courage in the heart; and desire in the liver. The uterus, he believed, excites inordinate desires. Inflammations are due to disorders of the bile, and fevers to the influence of the elements. His theories in regard to the special senses are very fantastic, for instance, smell is evanescent because it is not founded on any external image; taste results from small vessels carrying taste atoms to the heart and soul.
Aristotle, born B.C. 334, was the son of Nichomachus, physician to the King of Macedonia, and of the race of the Asclepiads. His inherited taste was for the study of Nature; he attained the great honour of being the founder of the sciences of Comparative Anatomy and Natural History, and contributed largely to the medical knowledge of his time. Aristotle went to Athens and became a follower of Plato, and the close companionship of these two great men lasted for twenty years. At the age of 42, Aristotle was appointed by Philip of Macedon tutor to Alexander the Great, who was then aged 15, and the interest of that mighty prince was soon aroused in the study of Natural History. Aristotle and Alexander the Great, teacher and pupil, founded the first great Natural History Museum, to which specimens were sent from places scattered over the then known world. Aristotle, besides his philosophical books, wrote: "Researches about Animals," "On Sleep and Waking," "On Longevity and Shortlivedness," "On Parts of Animals," "On Respiration," "On Locomotion of Animals," and "On Generation of Animals." He was greatly helped in the supply of material for dissection in his study of comparative anatomy by his pupil, Alexander the Great. Aristotle pointed out the differences in the anatomy of men and monkeys; he described the anatomy of the elephant and of birds, and also the changes in development seen during the incubation of eggs. He investigated, also, the anatomy of fishes and reptiles. The stomachs of ruminant animals excited his interest, and he described their structure. The heart, according to Aristotle, was the seat of the soul, and the birthplace of the passions, for it held the natural fire, and in it centred movement, sensation and nourishment. The diaphragm, he believed, separated the heart, the seat of the soul, from the contaminating influences of the intestines. He did not advance beyond the conception that nerves were akin to ligaments and tendons, and he believed that the nerves originated in the heart, as did also the blood-vessels. He named the aorta and ventricles. He investigated the action of the muscles, and held that superfoetation was possible.
When Aristotle retired to Chalcis, he chose Tyrtamus, to whom he gave the name of Theophrastus, as his successor at the Lyceum. Theophrastus was the originator of the science of Botany, and wrote the "History of Plants." He also wrote about stones, and on physical, moral and medical subjects.
THE ALEXANDRIAN SCHOOL.
"In the year 331 B.C.," wrote Kingsley, "one of the greatest intellects whose influence the world has ever felt, saw, with his eagle glance, the unrivalled advantages of the spot which is now Alexandria, and conceived the mighty project of making it the point of union of two, or rather of three worlds. In a new city named after himself, Europe, Asia and Africa were to meet and hold communion." The School of Alexandria became, after the decay of Greek culture, the centre of learning for the world, and when the Empire of Alexander the Great was subdivided, the Egyptian share fell to the first Ptolemy, who, under the direction of Aristotle, founded the Alexandrian Library, containing at first fifty thousand, and finally seven hundred thousand volumes. Every student who came to the University of Alexandria, and possessed a book of which there was not a copy in the Alexandrian Library, was compelled to present the book to the library. The first Ptolemy also fostered the study of medicine and of dissection. Eumenes likewise established a library at Pergamos. It is instructive to follow the history of the great Library of Alexandria. The greater part of the library, which contained the collected literature of Greece, Rome, India and Egypt, was housed in the famous museum in the part of Alexandria called the Brucheion. This part was destroyed by fire during the siege of Alexandria by Julius Caesar. Mark Antony, then, at the urgent desire of Cleopatra, transferred to Alexandria the books and manuscripts from Pergamos. The other part of the library was kept at Alexandria in the Serapeum, the temple of Jupiter Serapis, and there it remained till the time of Theodosius the Great, until in 391 A.D. both temple and library were almost completely destroyed by a fanatical mob of Christians led by the Archbishop Theophilus. When Alexandria was taken by the Arabs in 641, under the Calif Omar, the destruction was completed.
Ptolemy gathered to the museum at Alexandria a number of very learned men, who lived within its walls and were provided with salaries, the whole system closely resembling a university. Grammar, prosody, mythology, astronomy and philosophy were studied, and great attention was given to the study of medicine. Euclid was the teacher of Mathematics, and Hipparchus of Alexandria was the father of Astronomy. The teaching of medicine and of astronomy was for long based upon observation of ascertained facts. The Alexandrian School endured for close upon a thousand years, and its history may be divided into two periods, namely, from 323 to 30 B.C., during the period of the Ptolemies, and from 30 B.C. to 640 A.D. The second period was distinguished for the study of speculative philosophy, and of the religious philosophy of the Gnostics, and was not a scientific period.
Julius Caesar was not the only Roman Emperor who brought trouble upon the Alexandrian School, for the brutal Caracalla took away the salaries and privileges from the savants, and prohibited scientific exhibitions and discussions. In recent excavations in the Baths of Caracalla in Rome, the ruins of a library have been discovered, and it is believed by some archaeologists that Caracalla supplied this library with books and parchments from Alexandria.
The Asclepiadae of Cos and Cnidos had discoursed upon the phenomena of disease, without attempting to demonstrate its structural relations; like the sculptors of their own age, they studied the changing expression of vital action almost wholly from an external point of view. They meddled not with the dead, for, by their own laws, no one was allowed to die within the temple. But the early Alexandrians were subject to no such restrictions; and turning to good account the discoveries of Aristotle in natural history and comparative anatomy, they undertook for the first time to describe the organization of the human frame from actual dissections.[7]
Thus there was inaugurated at Alexandria the Anatomic Period of Medicine, which lasted till Egypt came under the sway of the Romans. Medical practice became so flourishing at Alexandria that three great specialities were established, namely, Surgery, Pharmacy, and Dietetics, and a great variety of operations were performed. Lithotomy was much practised by specialists. A foul murder was perpetrated by lithotomists at the instigation of Diodotus, the guardian of Antiochus, son of Alexander, King of Syria (150 B.C.), young Antiochus, at the age of 10, being done to death under the pretence that he had a stone in his bladder.
About 150 B.C. a sect called the Essenes was established for the study of curative and poisonous substances. The members were not all physicians, by any means, for one of the chief was King Mithridates, who invented the remedy known as mithridaticum. This celebrated nostrum of antiquity is said to have been a confection of twenty leaves of rue, a few grains of salt, two walnuts, and two figs, intended to be taken every morning and followed by a draught of wine.
Two famous physicians and anatomists, Herophilus (335-280 B.C.) and Erasistratus (280 B.C.) took part in the medical teaching at Alexandria in the early days of that seat of learning. It is recorded that they did not confine their investigations to the dissection of the dead, but also vivisected criminals. Cleombrotus, another physician at this school, was sent for to attend King Antiochus, and was rewarded with a hundred talents, equal to about L15,000 sterling.
There were several physicians of the name of Chrysippos connected with the Alexandrian School. One was physician to Ptolemy Soter, the King of Egypt, and tutor to Erasistratus. This Chrysippos introduced the practice of emptying a limb of blood before amputation, according to the recent method of Esmarch, and is said to have employed vapour baths in the treatment of dropsy.
In Alexandria, anatomy was properly studied.[8]
Herophilus made many anatomical discoveries, and some of the names he gave to parts of the body are now in use, for instance, torcular Herophili, calamus scriptorius, and duodenum. He described the connection between the nerves and the brain, and the various parts of the brain, and recognized the essential difference between motor and sensory nerves, although he thought the former arose in the membranes and the latter in the substance of the brain. He believed that the fourth ventricle was the seat of the soul. He attributed to the heart the pulsations of the arteries, but thought that the pulmonary veins conveyed air from the lungs to the left side of the heart, and he observed the lacteals without determining their function. Herophilus operated upon the liver and spleen, and looked upon the latter as of little consequence in the animal economy. He had a good knowledge of obstetric operations. His ideas in relation to pathology did not proceed much further than the belief that disease was due to corruption of the humors. He was more scientific and accurate when he taught that paralysis results from a defect in the nerves.
Erasistratus studied under Chrysippos (or Chrysippus), and under Metrodorus, the son-in-law of Aristotle. Herophilus had been a student at Cos, Erasistratus at Cnidos, so that the teaching of the two great Greek medical schools was introduced into Alexandria. Xenophon, of Cos, one of the followers of Erasistratus, first resorted to the ligation of vessels for the arrest of haemorrhage, although for many years in later times this important practice was lost through the neglect of the study of the history of medicine. Erasistratus and Herophilus, it is sad to relate, considered that vivisection of human beings, as well as dissection of the dead, was a necessary part of medical education, and believed that the sufferings of a few criminals did not weigh against the benefit likely to accrue to innocent people, who could be relieved or cured of disease and suffering as the result of the knowledge gained by dissection of the living. This cruel and nefarious practice was followed "so that the investigators could study the particular organs during life in regard to position, colour, form, size, disposition, hardness, softness, smoothness, and superficial extent, their projection and curvatures."
The followers of these teachers, unfortunately, became very speculative and fond of discussions of a fruitless kind, and, according to Pliny, it was easier "to sit and listen quietly in the schools than to be up and wandering over the deserts, and to seek out new plants every day,"[9] and so, in the third century before Christ, the school of Empiricism was established, the system of which resembled the older Scepticism. It rested upon the "Empiric tripod," namely, accident, history and analogy. This meant that discoveries were made by accident, knowledge was accumulated by the recollection of previous cases, and treatment adopted which had been found suitable in similar circumstances. Philinus of Cos, a pupil of Herophilus, declared that all the anatomy he had learned from his master did not help him in the least to cure diseases. Philinus, according to Galen, founded the Empirici, the first schismatic sect in medicine. Celsus[10] wrote of this sect that they admit that evident causes are necessary, but deprecate inquiry into them because Nature is incomprehensible. This is proved because the philosophers and physicians who have spent so much labour in trying to search out these occult causes cannot agree amongst themselves. If reasoning could make physicians, the philosophers should be most successful practitioners, as they have such abundance of words. If the causes of diseases were the same in all places, the same remedies ought to be used everywhere. Relief from sickness is to be sought from things certain and tried, that is from experience, which guides us in all other arts. Husbandmen and pilots do not reason about their business, but they practise it. Disquisitions can have no connection with medicine, because physicians whose opinions have been directly opposed to one another have equally restored their patients to health; they did not derive their methods of cure from studying the occult causes about which they disputed, but from the experience they had of the remedies which they employed upon their patients. Medicine was not first discovered in consequence of reasoning, but the theory was sought for after the discovery of medicine. Does reason, they ask, prescribe the same as experience, or something different? If the same, it must be needless; if different, it must be mischievous.
In the third and second centuries before Christ, many physicians wrote commentaries on diseases and attacked the teaching of Hippocrates. Among these, Serapion of Alexandria, an Empiric who lived in the third century before Christ, is noteworthy for having first used sulphur in the treatment of skin diseases, and Heraclides wrote on strangulated hernia. Serapion added somewhat to the system of Philinus, and was responsible for introducing the principle of analogy into the system of Empiricism. The foundation of Empiricism marked the decline of the medical school of Alexandria. We are indebted to Celsus for a full description of the teaching of this sect, and, at the same time, for an exposure of its fallacies. Serapion was a convert from the school of Cos, which was the stronghold of medical dogmatism, and, like nearly all apostates, he was consumed with animosity and bitterness towards those with whom he had formerly been in agreement. Cnidos was the stronghold of the Empirics.
FOOTNOTES:
[7] "The Medical Profession in Ancient Times." Watson, p. 90.
[8] Arctinus: "Ethiopis," Translated in Puschmann's "Hist. Med. Education."
[9] Pliny, "Hist. Nat.," xxvi, 6.
[10] "De Med.," Praefat. (Translation.)
CHAPTER V.
ROMAN MEDICINE AT THE END OF THE REPUBLIC AND THE BEGINNING OF THE EMPIRE.
Asclepiades of Prusa—Themison of Laodicea—Methodism—Wounds of Julius Caesar—Systems of Philosophy—State of the country—Roman quacks—Slaves and Freedmen—Lucius Horatillavus.
Asclepiades of Prusa, in Bithynia, was a famous physician in Rome early in the first century before Christ. He studied both rhetoric and medicine at Alexandria and at Athens. He began as a teacher of rhetoric in Rome, but, although he was the friend of Cicero, he was not very successful, and abandoned this study for the practice of medicine. He had a great deal of ability and shrewdness, but no knowledge of anatomy or physiology, and he condemned all who thought that these subjects of study were the foundation of the healing art. He specially inveighed against Hippocrates, and with some reason, for the disciples of Hippocrates had elevated the teaching of their master almost into a religion, and were bound far too closely to his authority, to the exclusion of original thought and progress.
Asclepiades had many pupils, and his teaching led to the foundation of the Medical School of the Methodists. His most important maxim was that a cure should be effected "tuto, celeriter, ac jucunde," and he believed that what the physician could do was of primary importance, and vis medicatrix naturae only secondary. He was thus directly opposed to the teaching of Hippocrates. He had little or no faith in drugs, and relied mainly upon diet, exercises and massage, and, to some extent, upon surgery. His practice of prescribing wine in liberal doses added to his popularity. It was the custom to take wine very much diluted with water, but Asclepiades ordered wine in full strength or only slightly diluted. He practised bronchotomy and tracheotomy, and recommended in suitable cases of dropsy scarification of the ankles, and advised that, in tapping, an opening as small as possible should be made. He also observed spontaneous dislocation of the hip. He was a very famous man in the Roman Republic, and was well acquainted with philosophy, especially the philosophy of the Epicureans. Although he was almost entirely ignorant of anatomy, he was far from being a quack. He had great powers of observation and natural shrewdness, and his success largely contributed to the establishment of Greek doctors and their methods in Rome. There is grim humour in his description of the Hippocratic treatise on therapeutics, which he called "a meditation on death." Pliny relates that Asclepiades wagered that he would never die of disease, and he won the wager, for he lived to old age and died of an accident!
Themison, of Laodicea, lived in the first century before Christ, and was a pupil of Asclepiades of Prusa, the founder of the School of Methodism. His views on atoms and pores led him to adopt a very simple explanation of health and disease, for he considered that these pores must be either constricted or dilated, and the aim of the physician should be to dilate the constriction, and vice versa. This epitomized system of medicine did away with the use of many classes of drugs, and, from its simplicity, was quickly learned. A jeering opponent of the system of the Methodici said that it could be taught in six months, and Galen, in later years, ridiculed it, and called its practitioners "the asses of Thessaly."
The great fault of Dogmatism was its absolute reliance on the wisdom of Hippocrates, and Methodism was marred by its insufficiency and sophistry.
In spite of his extravagant theories, Themison possessed skill in practice. He was the first physician to describe rheumatism, and he also is thought to have been the pioneer in the medicinal use of leeches. A book on elephantiasis ascribed to him is not definitely known to be authentic. It is worthy of note that he was anxious to write on hydrophobia, but a case he had seen in early youth so impressed his mind with horror that the mere thought of the disease caused him to suffer some of the symptoms.
The views of the Methodists were less extreme than those of the Dogmatists and Empirics. Celsus wrote of the Methodists: "They assert that the knowledge of no cause whatever bears the least relation to the method of cure; and that it is sufficient to observe some general symptoms of distempers; and that there are three kinds of diseases, one bound, another loose, and the third is a mixture of these."[11]
There were several physicians of the name of Themison at different times, and it is probably the founder of the Methodici who was satirized by Juvenal thus:—
"How many patients Themison dispatched In one short autumn."[12]
The joke which is based on attributing a cure to Nature alone, and death solely to the physician's want of skill, is one of the most time-honoured.
Themison lived at the close of the Roman Republic, and it will now be necessary to consider the state of the healing art in Rome under the rule of the emperors.
Julius Caesar—one of the first triumvirate—invaded and conquered Gaul and Britain, and after these great military achievements, found that he could not sheath his sword until he had met in battle his rival Pompey. Caesar defeated Pompey at Pharsalia, in Thessaly (48 B.C.), and pursued him to Egypt. Pompey was murdered in Egypt, and his last followers finally defeated in Spain, and in 45 B.C. Julius Caesar returned to Rome, and was declared perpetual imperator. On March 15, 44 B.C., he was assassinated. It is possible that the career of this great man may have promoted the surgery of the battlefield, but his reign as Emperor was too short, and the political situation of his time too acute, to permit of much progress in the arts of peace generally, and in the medical art particularly. Julius Caesar bestowed the right of Roman citizenship on all medical practitioners in the city.
Referring to the death of Julius Caesar, Suetonius writes that among so many wounds there was none that was mortal, in the opinion of the surgeon Antistus, except the second, which he received in the breast.
Octavianus was appointed one of the second triumvirate, his colleagues being Mark Antony and Lepidus. Lepidus was first forced out of the triumvirate, and Octavianus and Mark Antony then came into conflict. During these rivalries, a great civic work was accomplished by Marcus Agrippa, who built the aqueduct known as Aqua Julia. A landmark in history is the battle of Actium, in which Octavianus defeated Mark Antony and his ally Cleopatra, and within a few years Octavianus was proclaimed Emperor as Augustus Caesar (27 B.C.). Under his rule Rome greatly prospered, and we shall now consider the state of medicine and of sanitation during his illustrious reign.
In the Roman Empire there was a spirit of toleration abroad, "and the various modes of worship which prevailed in the Roman world were all considered by the people as equally true; by the philosopher, as equally false; and by the magistrate, as equally useful. And thus toleration produced not only mutual indulgence, but even religious concord" (Gibbon).
The systems of philosophy in vogue were those of the Stoics, the Platonists, the Academics, and the Epicureans, and of these only the Platonists had any belief in God, who was to them an idea rather than a Supreme Being. The great aim of both the wise and the foolish was to glorify their nationality, and their beliefs, their rites, and their superstitions, were all for the glory of mighty Rome.
Educated Romans were able to speak and write both Latin and Greek, and the latter language was the vehicle used by men of science and of letters.
The population of the city of Rome at the beginning of the Augustan age was not less than half a million of people, and probably exceeded this number. There was no middle class, a comparatively small number of gentry, a very numerous plebs or populace, and many slaves. The Emperor Augustus boasted that after the war with Sextus Pompeius he handed over 30,000 slaves, who had been serving with the enemy, to their masters to be punished. The slaves were looked upon by their masters as chattels. The plebs had the spirit of paupers and, to keep them contented and pacific, were fed and shown brutalizing spectacles in the arenas. Augustus wrote that he gave the people wild-beast hunts in the circus and amphitheatres twenty-six times, in which about 3,500 animals were killed. It was his custom to watch the Circensian games from his palace in view of a multitude of spectators.
Throughout the country generally agriculture prospered, and the supply of various grasses for feeding cattle in the winter increased the multitude of the flocks and herds; great attention was given also to mines and fisheries and all forms of industry. Virgil praised his beautiful and fertile country:—
"But no, not Medeland with its wealth of woods, Fair Ganges, Hermus thick with golden silt, Can match the praise of Italy.... Here blooms perpetual spring, and summer here In months that are not summer's; twice teem the flocks: Twice does the tree yield service of her fruit. Mark too, her cities, so many and so proud, Of mighty toil the achievement, town on town Up rugged precipices heaved and reared, And rivers gliding under ancient walls."[13]
The city of Rome was not a desirable place for medical practice, for the lower classes were degraded and thriftless, and the relatively small upper classes were tyrannical, debauched, superstitious, selfish and cruel. The younger Pliny, who was one of the best type of Romans, tried to investigate the purity of the lives of the Christians, and did not hesitate to put to torture two women, deaconesses, who belonged to the new religion, but he "could discover only an obstinate kind of superstition carried to great excess." His conduct and his opinion speak eloquently of the nature of a Roman gentleman of the Empire. As for the state of the poor under Augustus, 200,000 persons in Rome received outdoor relief. Although the rich had every luxury that desire could suggest and wealth afford, the great need of the common people was food. The city had to rely mainly on imported corn, and the price of this at times became prohibitive owing to scarcity—sometimes the result of piracy and the dangers of the sea, but often caused by artificial means owing to the merchants "cornering" the supply—and it was necessary for the State, through the Emperor, to intervene to make regulations and to distribute the grain free or below its market value. It has been computed that about 50,000 strangers lived in Rome, many of whom were adventurers.
The imperial city was the happy hunting-ground of quacks, who gave themselves high-sounding names and wore gorgeous raiment. They went about followed by a retinue of pupils and grateful patients. In some cases the patients were compelled to promise, in the event of being cured, that they would serve their doctor ever afterwards. The retinue of students, no doubt, was rather disturbing to a nervous patient, and Martial wrote:—
"Faint was I only, Symmachus, till thou Backed by an hundred students, throng'dst my bed; An hundred icy fingers chilled my brow: I had no fever; now I'm nearly dead."[14]
Besides quack doctors there were drug sellers (pharmacopola), who sold their medicines in booths or hawked them in the city and the country. In the time of the Empire the medicines of the regular practitioners were sold with a label which specified the name of the drug and of the inventor, the ingredients, the disease it was to be used for, and the method of taking it. Drug sellers dispensed cosmetics as well as medicines, and some of the itinerant dealers sold poison. The regular physicians bought medicines already compounded by the druggists, and the latter, as in our own day, prescribed as well as the physicians.
Depilatories were much in vogue, and were usually made of arsenic and unslaked lime, but also from the roots and juices of plants. They were first used only by women, but in later times also by effeminate men. Tweezers have been discovered which were adapted for pulling out hairs, and most of the depilatories were recommended to be applied after the use of the tweezers. The duty of pulling out hairs was performed by slaves.
Most of the medical practitioners in the time of Augustus were either slaves or freedmen. Posts of responsibility and of honour were sometimes assigned to freedmen, as is shown by the appointment by Nero of Helius, a freedman, to the administration of Rome in the absence of his imperial master. Cicero wrote letters to his freedman Tiro in terms of friendship and affection. The master of a great household selected a slave for his ability and aptitude, and had him trained to be the medical adviser of the household; and the skill shown by the doctor sometimes gained for him his freedom.
There were 400 slaves in one great household of Rome, and they were all executed for not having prevented the murder of their master.[15] It is recorded that physicians were sometimes compelled to do the disgusting work of mutilating slaves.[16] The price of a slave physician was fixed at sixty solidi.[17] The great majority of physicians in Rome were freedmen who had booths in which they prescribed and compounded, and they were aided by freedmen and slaves who were both assistants and pupils. The medical profession, as has been shown, never attained the same dignity as in Greece. It should be understood that there was a class of practising physicians in Rome quite distinct from the slave doctors. The following account of Lucius Horatillavus, a Roman quack of the time of Augustus, is taken from the British Medical Journal of June 10, 1911, and originated in an article in the Societe Nouvelle, written by M. Fernand Mazade:—
"He was a handsome man, and came from Naples to Rome, his sole outfit being a toga made of a piece of cloth adorned with obscene pictures and a small Asiatic mitre. Like many of his kind at that day, he sold poisons and invented five or six new remedies which were more or less haphazard mixtures of wine and poisonous substances. He had the good luck to cure his first patient, Titus Cnoeus Leno, who, being a poet, straightway constituted himself the vates sacer of his physician, and induced some of his fashionable mistresses to place themselves under his hands. So profitable was Horatillavus's practice that he is said to have saved 150,000 sesterces in a few months. But for a moment his good fortune seemed to abandon him. A Roman lady, Sulpicia Pallas, died suddenly under his ministrations. This may have been due to his ignorance or carelessness; but he was accused of having poisoned his patient. This event might have been expected to bring his career to an end; but it was not long before he recovered the confidence of the people whom he deluded with his mystical language and promises of cure. He had three methods of treatment, all consisting of baths—hot, tepid, or cold—preceded or followed by the taking of wonder-working medicines. Horatillavus treated every kind of disease, internal and external; he even practised midwifery, which was then in the hands of women. Ten years after he settled in Rome he had accumulated a fortune of some 6,000,000 sesterces. He had a villa at Tusculum, whither he went three times a month; there he led a luxurious life in the most beautiful surroundings, and there his evil fate overtook him. His orchard was his especial pride. One day he found that birds had played havoc with his figs, the like of which were not to be found in Italy. Determined to prevent similar depredations in future, he poisoned the fig trees. Continuing his walk, he plucked fruits of various kinds here and there. While eating the fruit he had culled and drinking choice wine, he put into his mouth a poisoned fig, which he had inadvertently gathered, and quickly died in convulsions. Before passing away, however, he is said to have composed his own epitaph. This M. Mazade believes he has found. It reads: "The manes of Sulpicia Pallas have avenged her. Here lies Lucius Horatillavus, physician, who poisoned himself." If the epitaph is genuine, it is a confession of guilt. The death of the quack by his own poison is a curious Nemesis. The manner of his death proves that it was accidental, as few quacks are bold enough to take their own medicines." |
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