Outlines of Greek and Roman Medicine Part 6

Athenaeus--Pneumatism--Eclectics--Agathinus--Aretaeus--Archigenes-- Dioscorides--Ca.s.sius Felix--Pestilence in Rome--Ancient surgical instruments--Herodotus--Heliodorus--Caelius Aurelia.n.u.s--Sora.n.u.s-- 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 pa.s.ses 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. .h.i.therto 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 cla.s.sification 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 ill.u.s.trate the plants of Greece described in the treatises of Dioscorides.

_Ca.s.sius 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 acc.u.mulation 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. v.a.g.i.n.al 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 Aurelia.n.u.s_ 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 Aurelia.n.u.s 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 cla.s.ses, acute and chronic, or, more in conformity with the terminology of the Methodici, those of constriction and those of relaxation. Aurelia.n.u.s did not concern himself with inquiring into the causation of diseases. His method was to find out the cla.s.s 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 cla.s.ses recognized by his school. He withheld active treatment until he had ascertained to his own satisfaction the cla.s.s to which the disease belonged. Caelius Aurelia.n.u.s 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.

_Sora.n.u.s_, 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 ma.n.u.script, 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 Sora.n.u.s are preserved in the writings of Oribasius. There is no doubt that Sora.n.u.s 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 superst.i.tious or avaricious.

In dealing with the subject of inversion of the uterus, Sora.n.u.s 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 Sora.n.u.s for this disease are to be found in the works of Galen.

Sora.n.u.s 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 Sora.n.u.s on pharmacy, and Caelius Aurelia.n.u.s one on fevers. He is also quoted by Tertullian, and by Paulus aegineta, who writes that Sora.n.u.s was one of the first Greek physicians to describe the guinea-worm. Sora.n.u.s, in the opinion of St. Augustine, was _Medicinae auctor n.o.bilissimus_. He was far removed from the prejudices and superst.i.tions 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 a.n.a.lysis. 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 Numesia.n.u.s; to Alexandria for the lectures of Heraclia.n.u.s; and to Cilicia, Phnicia, 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 pract.i.tioner 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 quant.i.ty 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 350 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 t.i.tles of the treatises cla.s.sified according to the branch of medical science with which they deal, and it is convenient to follow this cla.s.sification.

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 a.s.sumption that what is true of the anatomy of a lower animal is true also when applied to man.

Galen greatly a.s.sisted 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 pa.s.sions. 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 a.s.sociated with enlargement of the chest, and imagined that air pa.s.sed inside the skull through the cribriform plate of the ethmoid bone, and pa.s.sed 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 cla.s.sification of inflammations shows that his pathology was not nearly so accurate as his anatomy and physiology.