Outlines of Greek and Roman Medicine Part 8

This book was first translated into English in 1636.

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

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

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

_Alexander of Tralles_ lived from A.D. 525 to 605. He was the son of a physician, and one of five brothers, who were all distinguished for scholarship. He studied philosophy as well as medicine, and travelled in France, Spain, and Italy to extend his knowledge. He took up permanent residence in Rome, and became very celebrated. When he became too old to continue active practice, he found leisure to write twelve books on medical diseases, following to some extent the teaching of Galen. The style of these books is elegant, and his description of diseases accurate. Alexander of Tralles was the first to open the jugular vein in disease, and employed iron and other useful remedies, but he lived in superst.i.tious times, and was very credulous. For epilepsy, he recommended a piece of sail from a wrecked vessel, worn round the arm for seven weeks.[30] For colic, he recommended the heart of a lark attached to the right thigh, and for pain in the kidneys an amulet depicting Hercules overcoming a lion. To exorcise gout, he used incantations, these being either oral or written on a thin sheet of gold during the waning of the moon. Writing a suitable inscription on an olive leaf, gathered before sunrise, was his specific for ague.

Alexander appears at times to have doubted the efficacy of such remedies as amulets, for he explains that his rich patients would not submit to rational treatment, and it was necessary, therefore, to use other methods reputed to be curative.

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

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

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

_Paulus aegineta_ was the last, and one of the most famous, of the Greek physicians. He was born probably in the seventh century in the island of aegina, but there is some doubt as to the exact period in which he lived.

He quotes Alexander of Tralles and aetius, and therefore lived at a later period than they did, either in the sixth or seventh century. The works of Paulus are compilations, but reveal the skill and learning of the author. He wrote several books, but only one, and that the princ.i.p.al, remains, and is known by the t.i.tle of "De Re Medica Libri Septem." Dr.

Adams, of Banchory, translated this book for the Sydenham Society, and the introduction shows the scope of the work: "In the first book you will find everything that relates to hygiene, and to the preservation from, and correction of, distempers peculiar to the various ages, reasons, temperaments, and so forth; also the powers and use of the different articles of food, as is set forth in the chapter of contents.

In the second is explained the whole doctrine of fevers, an account of certain matters relating to them being premised, such as excrement.i.tious discharges, critical days, and other appearances, and concluding with certain symptoms which are the concomitants of fevers. The third book relates to topical affections, beginning from the crown of the head and descending down to the nails of the feet, and so on. Briefly, the fourth book treats of external diseases; the fifth, of wounds and bites from venomous animals; the sixth book is the most important and is devoted to surgery, and contains original observations, and the seventh book contains an account of the properties of medicines." Paulus wrote a famous book on obstetrics, which is now lost, but it gained for him among the Arabs the t.i.tle of "the accoucheur."

The sixth book on surgery, as has justly been observed by Adams, "contains the most complete system of operative surgery which has come down to us from ancient times." Many important surgical principles are enunciated, such, for instance, as local depletion as against general, and the merit of a free external incision. He first described varicose aneurism, and performed the operation of bronchotomy as described by Antyllus. He favoured the lateral operation for removal of stone from the bladder, and amputated the cancerous breast by crucial incision. He also had an operation, like that of Antyllus, for the cure of aneurism.

In brief, Paulus performed many of the operations that are practised at the present day. He travelled in the practice of his calling, and not only had great fame in the Byzantine Empire and in Arabia in his lifetime, but exercised great influence for some centuries. His writings inspired Albuca.s.sis, one of the few surgeons and teachers of the Middle Ages.

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

FOOTNOTES:

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

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

[29] C. 24, p. 242.

[30] Lib. 1, c. 20.

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

[32] Barbour, _Edinburgh Medical Journal_, vol. x.x.xiv, p. 331.

CHAPTER XI.

INFLUENCE OF CHRISTIANITY ON ALTRUISM AND THE HEALING ART.

Essenes--Cabalists and Gnostics--Object of Christ's Mission--Stoics--Constantine and Justinian--Gladiatorial Games--Orphanages--Support of the Poor--Hospitals--Their Foundation--Christianity and Hospitals--Fabiola--Christian Philanthropy--Demon Theories of Disease receive the Church's Sanction--Monastic Medicine--Miracles of Healing--St. Paul--St.

Luke--Proclus--Practice of Anatomy denounced--Christianity the prime factor in promoting Altruism.

The sect of the _Essenes_ embraced part of the teaching of Christianity among their other beliefs. They conceived that the Almighty had to be propitiated by signs and symbols. Words, they considered, were the direct gift of G.o.d to man, and, therefore, signs representing words were of great avail. Hence arose the use of amulets and cabalistic signs, or, rather, the common use, for they had been in evidence long prior to the foundation of this sect. Amulets were worn on the person. The Jews had phylacteries or bits of parchment on which were written pa.s.sages from the Scriptures. In the first century after Christ, Jews, Pythagoreans, Essenes, and various sects of mystics combined and formed the _Cabalists_ and _Gnostics_. Their creed embraced the magic of the Persians, the dreams of the Asclepiads, the numbers of Pythagoras, and the theory of atoms of Democritus. The Sophists of Alexandria actually regarded magic as a science. A section of the early Christians were Gnostics, and were imbued with the philosophy of the Orientals.

According to the beliefs of the Cabalists and Gnostics, demons were the cause of disease. These sects interrogated evil spirits to find out where they lurked, and exorcised them with the help of charms and talismans. Various geometric figures and devices were held to have power against evil spirits. One of these figures was the device of two triangles interlaced thus ?. This was used as a symbol of G.o.d, not only by Cabalists and Gnostics, but also by Jews. The great majority of the early Christians opposed the Gnostics, and repudiated and abhorred their strange mixture of the Christian religion with Eastern philosophy.

Christ came into the world at a time when the evils of _slavery_ were probably at their worst. He did not directly condemn slavery, and the reason of this is to be found in the study of the nature of His mission.

He came to regenerate the individual, and not, primarily, society. "His language in innumerable similes showed that He believed that those principles He taught would only be successful after long periods of time and gradual development. Most of His figures and a.n.a.logies in regard to 'the Kingdom of G.o.d' rest upon the idea of slow and progressive growth or change. He undoubtedly saw that the only true renovation of the world would come, not through reforms of inst.i.tutions or governments, but through individual change of character, effected by the same power to which Plato appealed--the love-power--but a love exercised towards Himself as a perfect and Divine model. It was the 'Kingdom of G.o.d' in the soul which should bring on the kingdom of G.o.d in human society....

And yet ultimately this Christian system will be found at the basis of all these great movements of progress in human history. But it began by aiming at the individual, and not at society; and aiming alone at an entire change of the affectional and moral tendencies."[33]

The moral teaching of the _Stoics_, second only to that of the Christian religion, had an effect in preparing the way for the introduction of humane principles of treatment for the bond and the oppressed. But the Stoics, like many of the Christians, did not always make their actions accord with their principles. Seneca tells of a Stoic who amused himself by feeding his fish with pieces of his mutilated slaves. Juvenal, who wrote when Stoicism was at the height of its influence, asks "how a slave could be a man," and Gaius, the Stoical jurist, in the reign of Marcus Aurelius, cla.s.ses slaves with animals.

Constantine, in his own character, did not display the beauties of the Christian religion, though his advisers who framed his laws acted under the influence of Christian teaching. This emperor pa.s.sed laws in reference to slavery. He wrote to an archbishop: "It has pleased me for a long time to establish that, in the Christian Church, masters can give liberty to their slaves, provided they do it in presence of all the a.s.sembled people with the a.s.sistance of Christian priests, and provided that, in order to preserve the memory of the fact, some written doc.u.ment informs where they sign as parties or as witnesses." In pagan times there was a somewhat similar system of a master being able to redeem a slave and register the redemption in one of the temples.

The laws of Justinian, influenced largely by the teaching of Christianity, did a great deal to relieve the burdens of slavery. "We do not transfer persons from a free condition into a servile--we have so much at heart to raise slaves to liberty." In the words of one of the Early Fathers of the Church, "No Christian is a slave; those born again are all brothers."

_Gladiatorial Games_ were condemned by the Stoics, but these philosophers did not influence the common people. Constantine, in the year before his acceptance of Christianity, gave a mult.i.tude of prisoners as prey to the wild beasts of the arena. In A.D. 325 he promulgated this law: "b.l.o.o.d.y spectacles, in our present state of tranquillity and domestic peace, do not please us; wherefore we order that all gladiators be prohibited from carrying on their profession."

Human sacrifices, which at one time took place in Rome, even in the time of Pliny and Seneca, were abolished under the same influence as checked gladiatorial sports.

Constantine pa.s.sed laws against the licentious plays and spectacles which flourished in Greece and Rome in pagan times.

Seneca wrote: "Monstrous offspring we destroy; children too, if weak and unnaturally formed from birth, we drown. It is not anger, but reason, thus to separate the useless from the sound."[34] Julius Paulus, a Stoic, in the time of the Emperor Severus (A.D. 222), held that the mother who procured abortion, starved her child, or exposed it to die, was, in each case, equally guilty of murder. The Christian Fathers, in opposing these evils, were acting in accordance with the teaching of their founder, and they incessantly condemned these evil practices, and with greater and more far-reaching power than the Stoics. Although the Stoics antic.i.p.ated many of the reforms of the Christians, Stoicism never had any penetrating effect on the ma.s.ses of the people, and differed in this respect from Christianity. The chief obstacle to the prevention of the exposure of children was the great amount of pauperism which prevailed in the Roman Empire, and Christian emperors and councils had no choice but to allow many of these unfortunate children to be taken as slaves, rather than that they should perish from cold and hunger, or be torn by ravenous beasts. The pagan emperors, it is true, had done something to found orphanages, but these inst.i.tutions were not common until the Middle Ages. Trajan in A.D. 100 supported 5,000 children at the expense of the State, and endowments were created by him for this purpose. Hadrian, Antoninus, and Marcus Aurelius made similar benefactions, and Pliny endowed a charity for poor children.

In the pre-Christian period, social clubs existed for the purpose of people having meals together, helping one another, and providing burial funds. The Emperor Julian condemned the Christians for supporting not only their own poor, but also poor strangers outside their faith. For ages the Church took charge of the poor. Her enemies said that as much pauperism was created as was relieved, and, no doubt, as is usual in the distribution of charity, the good done was not unmixed with evil.

HOSPITALS.

With reference to the important question of the foundation of hospitals, there are two opposing opinions--one, attributing their foundation almost entirely to Christianity,[35] and the other denying to Christianity any pre-eminent influence.[36] The truth lies between these two conflicting views, but nearer to the statement of Mr. Brace than of Mr. McCabe. The truths and influences of Christianity, in the mind of the latter author, are obscured by the many errors of the Church, especially in the Early and Middle Ages; and it is of the utmost importance to distinguish, where necessary, between the teaching of the Founder of Christianity as disclosed in the New Testament, and the teaching of the Church which made many very evident errors, and whose practice soon became different from that inculcated by its Founder, so that at times the Christianity of the Church was as different from Christ's teaching as the vine of Sodom from the grapes of Eshcol. The fact that Christianity emerged from this eclipse points to it as something more than a humanly devised system.

In very early times, the sick were allowed to remain at the temples for the treatment of their diseases, and medical students also attended for instruction. This system was the hospital system of later times, although the temples were not hospitals in the present sense of the word. The system in vogue in the temples of aesculapius in Greece and Rome has already been described in this book, but the temples of Saturn served the same purpose in Egypt four thousand years before Christ.

Professor Ebers of Leipzig, a high authority on the subject, says that Heliopolis undoubtedly had a clinique in connection with the temple. The Emperor Asoka founded many hospitals in Hindustan, and Buddhists and Mohammedans both possessed hospitals ("Encyclopaedia Britannica").

Patients were attracted to temples, not only by receiving the services of the priest-physicians, but also in the superst.i.tious belief that special virtue attached to the precincts of sacred buildings. Thus, in the temples of aesculapius, sick people tried to get as near to the altar as possible. "It may fairly be surmised that the disuse of these temples in Christian times made the necessity of hospitals more apparent, and so led to their inst.i.tution, in much the same way as in this country the suppression of monasteries, which had largely relieved the indigent poor, made the necessity of poor laws immediately evident."[37] During Hadrian's reign the first notice of a military hospital appears.

The _iatria_, or _tabernae medicae_, described by Galen and others, were not for in-patients, but of the nature of dispensaries for the reception of out-patients. Seneca refers to valetudinaria, rooms set aside for the sick in large private houses. The first hospital in Rome in Christian times was founded by Fabiola, a wealthy lady, at the end of the fourth century. Attached to it was a convalescent home in the country.

Pulcheria, later, built and endowed several hospitals at Constantinople, and these subsequently increased in number. Pauline abandoned wealth and social position and went to Jerusalem, and there established a hospital and sisterhood under the direction of St. Jerome. St. Augustine founded a hospital at Hippo. McCabe states justly: "In the new religious order a philanthropic heroism was evolved that was certainly new to Europe. In the whole story of Stoicism there is no figure like that of a Catherine of Sienna sucking the sores of a leper, or a Vincent de Paul." It appears evident that Christianity was an important factor in the foundation of hospitals and charitable inst.i.tutions, not directly, but from its beneficent influence on the character of individuals; and the Roman Church, in this respect, acted in conformity with the teachings of the Christian faith.

Of greater importance is the consideration of the influence of Christianity, and of the Church, on the investigation and elimination of disease. In this matter the Church deserves the severest censure. It is no exaggeration to say that she hindered the scientific progress of the world for centuries. She applied to the explanation of the causation of disease, the _demon theories_ inherited from Egypt, Persia, and the East. The Bible itself reflects the views on demonology current at the time of the events recorded. If demons were the cause of disease, logically the treatment of diseases should have been in the hands of priests, not of physicians. The priests held that they were the proper people to interpret the will of the Almighty; diseases were direct dispensations of Providence.

"It is demons," says Origen, "which produce famine, unfruitfulness, corruptions of the air, and pestilence. They hover concealed in clouds, in the lower atmosphere, and are attracted by the blood and incense which the heathen offer to them as G.o.ds."[38] "All diseases of Christians," wrote Augustine, "are to be ascribed to these demons: chiefly do they torment fresh-baptized Christians, yea! even the guiltless new-born infants." Hippocrates, long before the Christian era, wrote with great wisdom in reference to the so-called sacred diseases: "To me it appears that such affections are just as much divine as all others are, and that no one disease is either more divine or more human than another; but all are alike divine, for each has its own nature, and no one arises without a natural cause."[39]

The devil might be driven out in disgust, it was thought, by the use of disgusting materials--ordure, the grease made from executed criminals, the livers of toads, the blood of rats, and so on. The same belief in demoniacal possession led to the most inhuman treatment of lunatics, and the Church in this respect is put to shame when we compare its action with the wiser and more humane practice of the Moors. This belief helped to strangle medical progress for centuries, and is directly attributable to the Church. As late as 1583, the Jesuit fathers at Vienna boasted that they had cast out 12,642 devils. That G.o.d dispenses both health and disease is a very different belief from that involved in "demoniacal possession." Travellers in remote parts of the East at the present day tell of alleged cases of demoniacal possession, but investigation does not reveal any difference between these cases and epilepsy or acute mania.

In the first centuries of the Christian era men demanded overt signs of the favour of G.o.d, and the objects of veneration kept in the churches and monasteries were held to be capable of curing disease. The Latin Church had either a saint or a relic of a saint to cure nearly every ill that flesh is heir to. St. Apollonia was invoked against toothache; St. Avertin against lunacy; St. Benedict against stone; St. Clara against sore eyes; St. Herbert in hydrophobia; St. John in epilepsy; St.

Maur in gout; St. Pernel in ague; St. Genevieve in fever; St. Sebastian in plague; St. Ottila for diseases of the head; St. Blazius for the neck; St. Laurence and St. Erasmus for the body; St. Rochus and St. John for diseases of the legs and feet. St. Margaret was invoked for diseases of children and the dangers of childbirth.

What the influence of Christ's life on earth on the medical art of His time was is a difficult question. It must be remembered that He came to save the souls and not the bodies of men, not to rapidly alter social conditions nor to teach science. The eternal life of man was _the_ subject of transcendent importance, and it is no doubt true that many of the early Christians neglected their bodies for the cure of their souls.

As against this, the gospel of love taught that all men are brothers, both bond and free, and this led to mutual help in physical suffering, and to the foundation of charitable inst.i.tutions. In the times of persecution of the Christians many of them welcomed suffering and death as the portal to eternal bliss.