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OUTLINES OF
GREEK AND ROMAN MEDICINE

[Illustration: From Wellcome's Medical Diary (Copyright) By permission
of Burroughs Wellcome & Co.

ASKLEPIOS

The ancient Greek Deity of Healing.]




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
     Æsculapius--Archagathus--Domestic Medicine--Greek
     Doctors--Cloaca Maxima--Aqueducts--State of the early Empire


CHAPTER II.

EARLY GREEK MEDICINE.        13

     Apollo--Æsculapius--Temples--Serpents--Gods of
     Health--Melampus--Homer--Machaon--Podalarius--Temples of
     Æsculapius--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 Cæsar--Systems of Philosophy--State of the country--Roman
     quacks--Slaves and Freedmen--Lucius Horatillavus


CHAPTER VI.

IN THE REIGN OF THE CÆSARS TO THE DEATH OF NERO.        63

     Augustus--His illnesses--Antonius Musa--Mæcenas--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

     Athenæus--Pneumatism--Eclectics--Agathinus--Aretæus--Archigenes--
     Dioscorides--Cassius Felix--Pestilence in Rome--Ancient surgical
     instruments--Herodotus--Heliodorus--Cælius 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--Ætius--
     Alexander of Tralles--The Plague--Moschion--Paulus Ægineta--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--Thermæ--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 Æsculapius                                _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
     Æsculapius--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 Æsculapius, and in 460 B.C. in honour of Æsculapius 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 Æsculapius 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 Æsculapius. 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 Æsculapius, 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 Æsculapius
stood was shaped into the form of the bow of a ship, and the serpent of
Æsculapius was sculptured upon it in relief.

The island is not far from the Æmilian 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 Æsculapius, 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 Æsculapius.

Even in very early times, however, Rome was not without medical
practitioners, though not so well supplied as some other nations. The
Lex Æmilia, 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 Æsculapius 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 Juturnæ_ 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, Æsculapius 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°.

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.

[Illustration: Plate I. BUST OF ÆSCULAPIUS.]




CHAPTER II.

EARLY GREEK MEDICINE.

     Apollo--Æsculapius--Temples--Serpents--Gods of
     Health--Melampus--Homer--Machaon--Podalarius--Temples of
     Æsculapius--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 Æsculapius, 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 charmèd 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]

Æsculapius 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 Æsculapius might by his skill gain
the mastery over death.

Amid much that is mythological in the history of Æsculapius, 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 Æsculapius, 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 Æsculapius. 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 Æsculapius was in the house of his
patient, Glaucus, and deep in thought, a serpent coiled itself around
his staff. Æsculapius 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 Æsculapius, 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.

[Illustration: From Wellcome's Medical Diary (Copyright) By permission
of Burroughs Wellcome & Co.

Plate II.--HYGEIA

The Greek Deity of Health.]

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 Æsculapius, 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 Æsculapius 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 Æsculapius;
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 (Æsculapius) 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 Æsculapius by Chiron the Centaur, according to tradition.

[Illustration: From Wellcome's Medical Diary (Copyright) By permission
of Burroughs Wellcome & Co.

MACHAON (SON OF ASKLEPIOS),

The first Greek military surgeon, attending to the wounded Menelaus.]

[Illustration: From Wellcome's Medical Diary (Copyright) Permission of
Burroughs Wellcome & Co.

Plate III.-FACADE OF TEMPLE OF ASKLEPIOS--RESTORED (Delfrasse).]

The practice of Greek medicine became almost entirely restricted to the
temples of Æsculapius, the most important of which were situated at
Rhodes, Cnidus and Cos. The priests were known as Asclepiadæ, 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.

[Illustration: Plate IV.--HEALTH TEMPLE--RESTORED (Caton).

_Face p. 20._]

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 Tübingen.
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 Ægean,
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 _aliptæ_,
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, Phœnicia, 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
Asclepiadæ, and, according to tradition, could trace his ancestors on
the male side to Æsculapius, 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," "Fistulæ," "Ulcers,"
"Hæmorrhoids," 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 naturæ_, 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 _Gynæcology_, 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 gynæcology.[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
gynæcological 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
Æsculapians 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 Æsculapius, 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 Littré, "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 Gynæcology," by W. J. Stewart McKay. Baillière,
Tindall and Cox, 1901.

[6] _Archiv für 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 superfœtation 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 Cæsar. 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 Cæsar 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
archæologists that Caracalla supplied this library with books and
parchments from Alexandria.

The Asclepiadæ 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 £15,000 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 hæmorrhage, 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.," Præfat. (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 Cæsar--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 naturæ_ 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 Cæsar--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.
Cæsar 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 Cæsar 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 Cæsar bestowed the right of Roman citizenship on
all medical practitioners in the city.

Referring to the death of Julius Cæsar, 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 Cæsar (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 _Société 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 Cnœus 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."


FOOTNOTES:

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

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

[13] Rhodes's version.

[14] Handerson's translation.

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

[16] "Paulus Ægin.," vol. ii, p. 379.

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




CHAPTER VI.

IN THE REIGN OF THE CÆSARS--TO THE DEATH OF NERO.

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


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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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


FOOTNOTES:

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

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




CHAPTER VII.

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

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


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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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


FOOTNOTES:

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




CHAPTER VIII.

THE FIRST AND SECOND CENTURIES OF THE CHRISTIAN ERA.

     Athenæus--Pneumatism--Eclectics--Agathinus--Aretæus--Archigenes--
     Dioscorides--Cassius Felix--Pestilence in Rome--Ancient surgical
     instruments--Herodotus--Heliodorus--Cælius Aurelianus--Soranus--
     Rufus of Ephesus--Marinus--Quintus.


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

_Aretæus, 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
Aretæus 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. Aretæus 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 Aretæus consist of eight books, and there
have been many editions in various languages. Only a few chapters are
missing.

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

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

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

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

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

There were several physicians and surgeons of the name of _Herodotus_. A
famous surgeon of that name lived in Rome about A.D. 100. He was a pupil
of Athenæus, 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.

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

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

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

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

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

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

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

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


FOOTNOTES:

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

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




CHAPTER IX.

GALEN.

     His life and works--His influence on Medicine.


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

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

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

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

He no doubt found the practice of medicine lucrative when he had gained
pre-eminence, and it is recorded that he received £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 titles of the treatises classified
according to the branch of medical science with which they deal, and it
is convenient to follow this classification.


I.--WORKS ON ANATOMY AND PHYSIOLOGY.

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

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

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

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

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


II.--WORKS ON DIETETICS AND HYGIENE.

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


III.--ON PATHOLOGY.

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


IV.--ON DIAGNOSIS.

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


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

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

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

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

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


VI.--SURGERY.

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


VII.--GYNÆCOLOGY.

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

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

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

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

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

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

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

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


FOOTNOTES:

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

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

[25] _Ibid._, p. 242.

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




CHAPTER X.

THE LATER ROMAN AND BYZANTINE PERIOD.

     Beginning of Decline--Neoplatonism--Antyllus--Oribasius--Magnus--
     Jacobus Psychristus--Adamantius--Meletius--Nemesius--Ætius--
     Alexander of Tralles--The Plague--Moschion--Paulus Ægineta--Decline
     of Healing Art.


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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

This book was first translated into English in 1636.

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

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

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

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

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

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

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

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

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

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


FOOTNOTES:

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

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

[29] C. 24, p. 242.

[30] Lib. 1, c. 20.

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

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




CHAPTER XI.

INFLUENCE OF CHRISTIANITY ON ALTRUISM AND THE HEALING ART.

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


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

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

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, classes 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 passed 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
assembled people with the assistance of Christian priests, and provided
that, in order to preserve the memory of the fact, some written document
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 multitude of
prisoners as prey to the wild beasts of the arena. In A.D. 325 he
promulgated this law: "Bloody 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 passed 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 anticipated many of the reforms of the Christians, Stoicism
never had any penetrating effect on the masses 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 institutions 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 Æsculapius 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 ("Encyclopædia Britannica").

Patients were attracted to temples, not only by receiving the services
of the priest-physicians, but also in the superstitious belief that
special virtue attached to the precincts of sacred buildings. Thus, in
the temples of Æsculapius, 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 institution, 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 _tabernæ medicæ_, 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 institutions, 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 gods."[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 God 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 God, 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 institutions. In the times of
persecution of the Christians many of them welcomed suffering and death
as the portal to eternal bliss.

It has been asserted that the _miraculous cures_ wrought by Christ for
His own purposes were an intimation to His followers to neglect the
ordinary means of natural cure, and that this placed a Christian doctor
in the position of having to abandon his calling. This is not so. To St.
Luke--a Christian physician and the writer of the third Gospel and the
Acts of the Apostles--the performance by Christ of miracles of healing
presented no difficulties, for he was the travelling medical adviser of
St. Paul, and accompanied him on three journeys, from Troas to Philippi,
from Philippi to Jerusalem, and from Cæsarea to Rome (A.D. 62). St. Paul
wrote: "For we would not, brethren, have you ignorant of our trouble
which came to us in Asia, that we were pressed out of measure, above
strength, insomuch that we despaired even of life, but we had the
sentence of death in ourselves, that we should not trust in ourselves,
but in God, which raiseth the dead: who delivered us from so great a
death, and doth deliver: in whom we trust that He will yet deliver us."
St. Paul exercised faith, but also used the means of cure prescribed by
"the beloved physician." In a very scholarly book published by the
Dublin University Press in 1882, the Rev. W. K. Hobart, LL.D., shows
that St. Luke was acquainted with the technical medical terms of the
Greek medical writers. St. Luke was an Asiatic Greek. Dr. Hobart writes:
"Finally, it should not be left out of account that, in any illness from
which he might be suffering, there was no one to whom St. Paul would be
likely to apply with such confidence as to St. Luke, for it is probable
that, in the whole extent of the Roman Empire, the only Christian
physician at this time was St. Luke." In later years the pretence of
performing miracles to cure diseases had a great effect in advancing
superstition and retarding scientific investigation.

Tacitus and Suetonius record miracles alleged to have been performed by
Vespasian. He is said to have anointed the eyes of a blind man at
Alexandria with the royal spittle, and to have restored his sight.
Another case was that of a man who had lost the use of his hands, and
Vespasian touched them with his foot and thus restored their function.
It is interesting to follow the career of Proclus, the last rector of
the Neoplatonic School, "whose life," says Gibbon, "with that of his
scholar Isidore, composed by two of their most learned disciples,
exhibits a most deplorable picture of the second childhood of human
reason." By long fasting and prayer Proclus pretended to possess the
supernatural power of expelling all diseases.

The priests of the Church denounced the practice of _Anatomy_, and so
changed the progress made by the Alexandrian School, and by men like
Galen, into the ignorance of a thousand years. The body was the temple
of the Holy Ghost, and should not therefore be desecrated by
dissection. "Strangers' rests" and hospitals were connected with the
monasteries, and were exceedingly useful, notably in the time of the
Crusades, but these Church institutions were in a very insanitary
condition, for the maxim that cleanliness is next to godliness had
little application among the religious orders of the Middle Ages. Dr.
Walsh attempts to show that the Reformers blackened the fair fame of the
Church they had left, and states that it is to "this unfortunate state
of affairs, and not real opposition on the part of the Popes to
science," that we owe the belief in "the supposed opposition between the
Church and Science."[40] That the Popes did something to foster medical
science in a spasmodic kind of way, that papal physicians were appointed
and that the Church exercised control over some seats of learning may be
freely admitted. That the monasteries preserved some of the Latin
classics that they were not all corrupt, and that all monks were not
ignorant and idle, are facts beyond dispute. No doubt, too, the enemies
of Christianity have overstated their case, but when all is said, the
fact remains that the Church enjoyed great opportunities for promoting
knowledge and investigating disease, and failed to avail itself of them
to such an extent that for ages no real progress was made. This is
certainly not an extreme opinion. It would be nearer the truth to say
that not only was no progress made, but that the advances made by
Hippocrates, by the school of Alexandria, by Celsus, and by Galen, were
lost.

In conclusion, in spite of the dreadful blunders and perversions of the
Church in the Early and Middle Ages, and the partial eclipse which
Christianity suffered, the teaching of its Founder slowly but surely
ended the harsh and cruel ways of the pagans, and was the prime factor
in promoting the altruism of later times, of which medical knowledge and
medical service form a very important part.


FOOTNOTES:

[33] "Gesta Christi; or a History of Human Progress under Christianity,"
by C. Loring Brace, fourth edition, pp. 33, 34.

[34] "De Ira," i, 15.

[35] _Vide_ "Gesta Christi," Brace.

[36] _Vide_ "The Bible in Europe," Joseph McCabe.

[37] "Smith's Dictionary of Greek and Roman Antiquity."

[38] Origen, "Contra Celsum," lib. vii.

[39] Adams's translation "Hippoc.," vol. i, p. 216.

[40] "The Popes and Science: The History of the Papal Relations to
Science during the Middle Ages, and down to our own Time," J. J. Walsh,
M.D., 1911.




CHAPTER XII.

GYMNASIA AND BATHS.

     Gymnastics--Vitruvius--Opinions of Ancient Physicians on
     Gymnastics--The Athletes--The Baths--Description of Baths at
     Pompeii--Thermæ--Baths of Caracalla.


GYMNASTICS.

Gymnastics were held in such high repute in ancient Greece that physical
training occupied as much time in the education of boys as all their
other studies, and was continued through life with modifications to suit
the altering requirements of age and occupation. The Greeks fully
recognized that mental culture could not reach its highest perfection if
the development of the body were neglected. Lucian attributes not only
the bodily grace of the Ancient Greeks, but also their mental
pre-eminence, to the gymnastic exercises which they practised. They were
also an important factor in the excellence of Greek sculpture, and
probably the most important part of their medical treatment.

Unfortunately the baths of the Romans and the gymnasia of the Greeks
became in time the haunts of the lazy and voluptuous. The gymnastic
exercises of the Greeks date from very early times, and at first were
of a warlike nature, and not reduced to a system. Each town possessed a
gymnasium, and three very important ones were situated at Athens.

Vitruvius describes the general plan of an ancient gymnasium. It
comprised a great stadium capable of accommodating a vast concourse of
spectators, many porticoes where athletes exercised and philosophers and
sages held discussions and lectured, walks and shady groves, and baths
and anointing rooms. The buildings, in true Grecian fashion, were made
very beautiful, being adorned with statues and works of art, and
situated in pleasant surroundings.

Up to the age of 16 boys were instructed in gymnastics, in music and in
grammar, and from 16 to 18 in gymnastics alone. The laws of Solon
regulated the use of the gymnasia, and for very many years these laws
were strictly enforced. It appears that married women did not attend the
gymnasia, and unmarried women only in some parts of Greece, such as
Sparta, but this custom was relaxed in later years.

The office of Gymnasiarch (Superintendent of Gymnasia) was one of great
honour, but involved also a great deal of expense to the holder of the
office. He wore a purple cloak and white shoes. Officers were appointed
to supervise the morals and conduct of the boys and youths, and the
Gymnasiarch had power to expel people whose teaching or example might
be injurious to the young.

Galen relates that the chief teachers of the gymnasia were capable of
prescribing suitable exercises, and thus had powers of medical
supervision.

Before exercises were commenced, the body was anointed, and fine sand or
dust applied. Regulation of the diet was considered of very great
importance.

The games of the gymnasia were many and various, including games of
ball, tug-of-war, top-spinning, and a game in which five stones were
placed on the back of the hand, thrown upwards, and caught in the palm.
One kind of game or exercise consisted in throwing a rope over a high
post, when two boys took the ends of the rope, one boy on each side, the
one trying to pull the other up. The most important exercises, however,
were running, walking, throwing the discus, jumping, wrestling, boxing,
and dancing.

The first public gymnasium in Rome was built by the Emperor Nero. In the
time of the Republic Greek exercises were held in contempt by the
Romans, and the first gymnasia in Rome were small, and connected only
with private houses or villas.

The gymnasia were dedicated to Apollo, the god of healing, and exercises
were considered of greater importance for restoring health than
medicinal treatment. The directors of the gymnasia were in reality
physicians, and acted as such. Plato states that one of these, Iccus by
name, was the inventor of medical gymnastics. As in our own day, many
creditable gymnasts, originally weak of body, had perfected their
strength by systematic exercise and careful dieting.

Hippocrates had occasion to protest against prolonged and laborious
exercises, and excessive massage, and recommended his own system, that
of moderation. He applied massage to reduce swellings in suitable cases,
and also recognized that the same treatment was capable of increasing
nutrition, and of producing increased growth and development.
Hippocrates described exercises of the kind now known as Swedish,
consisting of free movements without resistance.

Galen generally followed the teaching of Hippocrates on gymnastics, and
wrote a whole book on the merits of using the strigil. Oribasius, and
Antyllus, too, in their writings, recommend special exercises which
appealed to their judgment.

The ancient physicians had great faith in the efficacy of exercises in
cases of dropsy, and Asclepiades employed this method of treatment very
extensively, using also pleasant medicaments, so that Pliny said "this
physician made himself the delight of mankind." Patients suffering from
consumption were commonly sent to Alexandria to benefit from the
climate, but Celsus considered the sea voyage most beneficial because
the patient was exercised bodily by the motion of the ship. Germanicus
was cured by riding exercise, and Cicero was strengthened by travelling
and massage.

From the writings of Greek and Roman physicians there is no other
conclusion to be drawn but that exercises and gymnastics were in great
vogue for medical purposes, and were of the utmost benefit. It seems
likely that the exercises of the Greeks, and the baths of the Romans,
both freed from the abuses which took away in time from their merits,
could be adopted at the present day and encouraged by physicians with
great advantage to their patients. There is a strong tendency at present
in that direction.

Belonging to a different class were the contests of the athletes, who,
except in very early times in Greece, were people of the baser sort
whose bodies were developed to the neglect of their minds. Those who
underwent the severest training ate enormous quantities of meat, and
tried to cultivate bulk and weight rather than strength. They did not
compete, as a rule, after the age of thirty-five years. Euripides
considered these athletes an encumbrance on the State. Plato said they
were very subject to disease, without grace of manner, violent, and
brutal. Aristotle declared that the athletes had not the active vigour
that good citizens ought to possess.

The athletes and gladiators of Rome were mostly Greeks. Both Plutarch
and Galen deride them. The former condemned the whole business, and
Galen wrote six chapters to warn young men against becoming athletes. He
said that man is linked to the divine and also to the lower animals,
that the link with animals was developed by athletics, and that athletes
were immoderate in eating, sleeping, and exertion, and were therefore
unhealthy, and more liable than other people to disease and sudden
death. Their brutal strength was of use only on rare occasions and
unsuited for war, or for useful work.

In the time of St. Paul, the athletes were evidently abstemious, for he
wrote "every man who striveth in the games is temperate in all things,"
but in Rome, at most periods of their history this class of men was
notorious for grossness and brutality.


BATHS (_Balneæ_).

_Greek Baths._--In Greece from very early times inability to read and to
swim were considered the marks of the ignorant. In Homer's time
over-indulgence in warm baths was considered effeminate.[41] The system
of bathing was never so complete in Greece as in Rome, but in the former
country there were both public and private baths, and ancient Greek
vases display pictures of swimming-baths and shower-baths, and also of
large basins for men and for women round which they stood to bathe. The
Greek baths were near the gymnasia. After the bath, the bathers were
anointed with oil and took refreshments. Sometimes a material consisting
of a lye made of lime or wood-ashes, of nitrum and of fuller's earth was
applied to the body. Towels and strigils were employed for rubbing and
scraping after the anointing; the strigil was, as a rule, made of iron.

Natural warm springs used for curative purposes are mentioned by ancient
Greek writers.

_Roman Baths._--Bathing, which was not much in vogue in Rome in the most
ancient times, was more common during the Republic, and became a factor
in the decay of the nation in the time of the Empire. Seneca informs us
that the ancient Romans washed their arms and legs every day and their
whole bodies once a week. The bath-room was near the kitchen in the
Roman house, to be convenient for the supply of hot water. Scipio's bath
was "small and dark after the manner of the ancients." In the time of
Cicero, the use of baths, both public and private, was general, and
hot-water and hot-air baths are both mentioned. It has been computed
that there were 856 baths in Rome in the time of Constantine.

The public baths were at first used only by the poor, but the mother of
Augustus went to the public bath, and in time even the emperors
patronized them. The baths were opened at sunrise and closed at sunset
except in the time of Alexander Severus, when they were open also at
night. The charges for admission were very low. The ringing of a bell
announced that the bath was ready. Baths were taken seven or eight times
in succession when the people were given to luxury, and some of them
wasted almost the whole day there. The voluptuaries of the Empire bathed
not only before the principal meal of the day, but also afterwards to
promote digestion as they thought. The perspiration induced by the bath
took the place of honest sweat induced by work or exercise, and
excessive hot-bathing and perspiring in some cases had a fatal ending.

Galen and Celsus differ in their directions to bathers. Galen
recommended first the hot-air bath, next the hot-water bath, then the
cold bath and finally rubbing; Celsus recommended sweating first in the
tepid chamber, then in the hot chamber, and next the pouring of hot,
then tepid, and lastly, cold water over the head, followed by the use of
the strigil, and anointing and rubbing.

The plan of the baths at Pompeii, which was largely a pleasure resort,
is typical of the public baths that were in general use. These baths had
several entrances, and the principal one led to a covered portico from
which a lavatory opened. The portico ran round three sides of a
courtyard (_atrium_) in which the attendants waited, and it was also the
exercise-yard for the young men. Advertisements of the theatres and
gladiatorial shows were exhibited on the walls of the atrium. The
undressing room was also the reception room and meeting-place. The
bathers' garments were handed over for custody to slaves, who were, as a
general rule, a very dishonest class. The _frigidarium_ contained a cold
bath 13 ft. 8 in. in diameter, and a little less than 4 ft. deep. It had
two marble steps, and a seat under water 10 in. from the bottom. Water
ran into the bath through a bronze spout, and there was a conduit for
the outflow, and an overflow pipe. The frigidarium opened into the
_tepidarium_ which was heated with hot air from furnaces, and furnished
with a charcoal brazier and benches. The brazier at Pompeii was 7 ft.
long and 2½ ft. broad. The tepidarium was commonly a beautifully
ornamented apartment, while the anointing-room was conveniently situated
off it. Pliny has described the various unguents used by wealthy and
luxurious Romans. From the tepidarium the bather might enter the
_caldarium_ or sweating room, an apartment constructed with double walls
and floor, between which hot air was made to pass. This room contained a
_labrum_, or circular marble basin, containing cold water for pouring
over the head before the bather left the caldarium. The method of
heating rooms by passing hot air between the "hanging" and the lower
floor was in use in the better class of houses, and the device can at
present be seen in some of the buildings on the Palatine Hill in Rome,
and in the ruins of the great Baths of Caracalla. After a course of
sweating the bather had the sweat removed from his body by the strigil,
in much the same way as a horse is scraped with a bent piece of
hoop-iron by a groom. The _guttus_ was a small vessel with a narrow neck
adapted for dropping oil on the strigil to lubricate its working edge.
Pliny states that invalids used sponges instead of strigils. Rubbing
with towels followed the use of the strigil, and the bather finally
lounged in the tepidarium for a varying period before entering the outer
air.

The boilers in use at Pompeii were three in number. The lowest one,
immediately over the furnace, contained the hottest water. The next
above and a short distance to the side held tepid water, and the
farthest removed contained cold water. This system was economical
because as the very hot water was drawn off from the lowest boiler a
supply of tepid water flowed down from the boiler next above, and from
the highest to the middle boiler.

A smaller suite of bathing apartments adjoining the men's establishment
was for the use of women.

The most important baths formed only a part of the great establishments
called _thermæ_. Adjoining the baths of the thermæ were a gymnasium for
sports and exercises, a library for the studious, lounging places for
the idle, halls for poets and philosophers, in which they declaimed and
lectured, museums of art, and sometimes shady groves. These complete
establishments were first erected by Marcus Agrippa in the time of
Augustus. Succeeding emperors vied with each other in providing
magnificent thermæ, and the ruins of the Baths of Caracalla remain in a
wonderful state of preservation to this day. The building of these baths
began in A.D. 216. The structure, 1,050 ft. long and 1,390 ft. broad,
was on a scale of almost incredible magnificence. Priceless statues and
rare objects of art have been unearthed from the ruins. In recent years
excavations have revealed a complicated system of subterranean corridors
and galleries which existed for the purpose of carrying leaden
water-pipes to the baths, and providing a passage-way for the host of
slaves who acted as bath-attendants. The great buildings were well lit
by windows in the walls of the courtyards, and these openings also
allowed for ventilation. A great stadium and beautiful gardens adjoined
the Baths of Caracalla. In the north-west section of these baths Alessio
Valle has very recently discovered the remains of a great public
library. When Caracalla pillaged Alexandria he probably carried off many
of the books from the famous library there to enrich his baths. The
ruins of the library in the Baths of Caracalla reveal circular tiers of
galleries for the display of manuscripts and papyri. There were 500
rooms round these baths. The great hall had a ceiling made in one span,
and the roof was an early example of reinforced concrete, for it was
made of concrete in which bronze bars were laid. The lead for the
water-pipes was probably brought from Cornwall.

The Thermæ of Diocletian could accommodate 3,200 bathers. Its tepidarium
was 300 ft. long by nearly 100 ft. wide, "vaulted in three bays with
simple quadripartite groining, which springs from eight monolithic
columns of Egyptian granite about 50 ft. high and 5 ft. in diameter"
(Middleton).

From the medical point of view, these great bathing institutions were
capable of being used for the treatment of various diseases, and for
physical culture. No doubt, they were extensively employed for these
purposes and with good results, but their legitimate use became
increasingly limited, and abuse of them was a prime factor in promoting
national decay. To show to what an extent luxurious bathing was carried
in some instances, it is interesting to read that baths were taken
sometimes in warm perfumes, in saffron oil, and that the voluptuous
Poppæa soothed her skin in baths of milk drawn from a herd of 500
she-asses.


FOOTNOTES:

[41] Od. viii, 249.




CHAPTER XIII.

SANITATION.

     Water-supply--Its extent--The Aqueducts--Distribution in
     city--Drainage--Disposal of the Dead--Cremation and
     Burial--Catacombs--Public Health Regulations.


THE WATER-SUPPLY.

In ancient Greece, the cities were supplied with water from springs over
which beautiful fountains were erected. The Greek aqueducts were not on
the same grand scale as the Roman, but were usually rectangular channels
cut in the rock, or made of pipes or masonry. Great care was taken in
the supervision of these public works.

The first Roman aqueduct, according to Frontinus, dates from 312 B.C.

Pliny wrote of the Claudian aqueduct: "But if anyone will carefully
calculate the quantity of the public supply of water, for baths,
reservoirs, houses, trenches, gardens and suburban villas, and, along
the distance which it traverses, the arches built, the mountains
perforated, the valleys levelled, he will confess that there never was
anything more wonderful in the whole world."

Frontinus, who was controller of the aqueducts in the time of Nerva and
of Trajan, describes nine aqueducts, of which four belonged to the days
of the Republic, and five to the reigns of Augustus and Claudius.

"The total water-supply of Rome has been estimated at 332,306,624
gallons a day, or, taking the population at a million, 332 gallons a
head. Forty gallons a day is now considered sufficient."[42]

The ancient Aqua Virgo at the present day supplies the magnificent
Fontana di Trevi, and the glorious fountains in the Piazzo di Spagna and
the Piazzo Navona.

The Romans not only provided great aqueducts for the Imperial City, but
also built them throughout various parts of the Empire. In Rome, the
aqueducts were built to supply both the low and the high levels of the
city. The reason why the Romans did not build underground aqueducts, as
is done at the present day, has been variously explained. Perhaps they
did not fully understand that water will find its own level over a great
distance. They also would have found great difficulty in overcoming the
high pressure of the water.

In their conduits they built shafts at frequent intervals designed to
relieve the pressure of compressed air in the pipes. The water from the
neighbourhood of Rome rapidly encrusted channels and pipes with
calcareous deposits. Probably the great advantage of accessibility to
leaks and defects gained by building unenclosed aqueducts appealed
strongly to the ancient Romans. They did not fully understand the
technical difficulties involved in the "hydraulic mean gradient." No
machinery was used to pump the water or raise it to an artificial level.
A strip of land 15 ft. wide was left on either side of the aqueducts,
and this land was defined at intervals by boundary stones. No trees were
grown near the aqueduct, to avoid the risk of injuring the foundations,
and any breach of the rules for the preservation of the aqueducts was
severely punished by fines.

Vitruvius gives rules for testing the water, and points out that water
led through earthen pipes is more wholesome than water coming from
leaden ones. He states that the "fall" of an aqueduct should be not less
than 1 in 200. A circuit was often made to prevent the too rapid flow of
the water, and intermediate reservoirs were constructed to avoid a
shortage of water in the case of a broken main. Reservoirs were also
used for irrigation.

The water from the aqueduct was received at the walls of the city in a
great reservoir called _castellum aquarum_, externally a beautiful
building and internally a vast chamber lined with hard cement and
covered with a vaulted roof supported on pillars. The water flowed
thence into three smaller reservoirs, the middle one filled by the
overflow of the two outer ones. The outer reservoirs supplied the public
baths and private houses, while the middle one supplied the public ponds
and fountains, so that, in the event of a shortage of water, the first
supply to fail was the least important. The amount of water provided for
private use could be checked, for purposes of revenue, by means of this
arrangement.

At first the aqueducts were not connected with private houses, but,
later, private persons were allowed to buy the water which escaped from
leaks in the aqueducts. Next, private connections were made with the
public mains, and, finally, reservoirs were built at the expense of
adjoining households, but these reservoirs, although built with private
money, were considered part of the public property. Water rights were
renewed with each change of occupant. The water-supply to a house was
measured by the size of the pipe through which it passed at the in-flow
and at the out-flow of the reservoir.

The _curatores aquarum_ had very responsible duties. Under their orders,
in the time of Trajan, were 460 slaves who were subdivided into various
classes, each of which had its own particular duties to perform in
connection with the maintenance and control of the water-supply. A
supply of pure water and proper drainage are of first importance in
sanitation, and it is evident that the Romans understood these matters
well.


DRAINAGE.

The drains of Athens, built of brick and stone and provided with
air-shafts, ran into a basin from which pipes carried the sewage beneath
the surrounding plain which it helped to fertilize.

The chief drain of Rome was the Cloaca Maxima, and there was a great
network of smaller drains. The privy in private houses was usually
situated near the kitchen, and a common drain from the kitchen and the
privy discharged into the public cloaca. A pipe opened just above the
floor of the closet to supply water for flushing. Ruins of very small
rooms have been discovered in the Via Sacra of the Roman Forum, and it
has puzzled archæologists to discover their use, but they are thought to
have been sanitary closets. The sewers of Rome drained into the Tiber.


DISPOSAL OF THE DEAD.

Both in Greece and Rome earth-burial and cremation were employed for the
disposal of the dead. Near the Temple of Faustina in the Roman Forum,
under the Via Sacra, have been found the graves of some of the dwellers
of the hills before Romulus founded the city. In Rome, burial within the
city was forbidden from the time of the Twelve Tables. Exceptions were
made in the case of emperors, vestal virgins, and famous men, such as
those who had been honoured with triumphs. The large cemetery for the
poor lay on the east side of the city and the tombs of the rich were
along the roadsides. The remains of some of these can now be seen along
the Appian Way. One of these tombs is the Tomb of the Scipios, which, as
Byron wrote, "contains no ashes now." Near the Tomb of the Scipios can
be seen a door with high steps which leads to the _columbaria_. These
are little rooms provided with pigeon-holes for the reception of the
ashes of the freedmen of notabilities. Inscriptions show that some of
these freedmen were physicians, and others musicians and silversmiths.
The shops of the perfumers stood in a part of the Forum on the Via
Sacra. Perfumes were much used at incinerations to disguise the smell of
decomposition before the fires were kindled. The Christians opposed
cremation and favoured earth burial, and in time the business of the
perfume-sellers failed, and Constantine bought their shops.

The _Catacombs_ were used almost entirely by the Christians. If all the
passages of the Catacombs could be placed in line, it is said that they
would extend the whole length of Italy. They were hewn out of volcanic
soil very well suited for the purpose, and were probably extensions, in
the first place, of quarries made for the purpose of obtaining building
cement. They were used by the Christians, not only for the religious
rite of burial, but also as secluded meeting places. The bodies were
laid in _loculi_, sometimes in two or three tiers, the loculi being
filled in with earth and stone.

Many of our public health regulations had their counterpart in ancient
times, for instance, any factory or workshop in Rome which created a
public nuisance had to be removed outside the city. The _spoliarium_ of
the Coliseum was an ancient morgue.

A detached building or room, _valetudinarium_, was provided in large
houses for sick slaves. This was for the purpose of preventing infection
as well as for convenient attendance on the sick.


FOOTNOTES:

[42] "Dict. of Gr. and Rom. Antiq.," Smith, vol. i, p. 150, _to which
the author is indebted for much of the information herein supplied_.




APPENDIX.

FEES IN ANCIENT TIMES.


The professional incomes of doctors in ancient Greece and Rome varied
greatly as at the present day. A few were paid very large fees, but the
rank and file did not make more money than was equal to keeping them in
decency.

Seleucus paid Erasistratus about £20,000 for curing his son Antiochus.
Herodotus mentions that the Æginetans (532 B.C.) paid Democedes, from
the public treasury, £304 a year; the Athenians afterwards paid him £406
a year, and at Samos he received £422 yearly. Pliny says that Albutius,
Arruntius, Calpetanus, Cassius and Rubrius each made close upon £2,000 a
year, and that Quintus Stertinius favoured the Emperor by accepting
about £4,000 a year when he could have made more in private practice.
The surgeon Alcon made a fortune of nearly £100,000 by a few years'
practice in Gaul. Pliny states that Manlius Cornutus paid his doctor
£2,000 for curing him of a skin disease, and Galen's fee for curing the
wife of a consul was about £400 of our money.




INDEX.


Academics, 56

Adamantius, 116

Adams of Banchory, 31, 32, 124

Æsculapius, 3, 13, 14
 ----, College of, 6
 ----, temple of, 4, 14, 17

Ætius, 118

Agathinus, 87

Agrippa, 63

Alexander of Tralles, 119

Alexander the Great, 38, 40, 41

Alexandria, 42

Alexandrian School, 42

Anatomy, 27, 44, 46, 76, 101, 140

Andromachus, 68, 82

Antonius Musa, 65

Antyllus, 112

Apollo, 3, 13

Apollonius, 80
 ----, alleged miracles of, 81

Aqueducts, 9, 155

Archagathus, 5

Archiater, 6, 68

Archigenes, 88

Aretæus, 87

Aristotle, 25, 40

Asclepiadæ, 18, 40, 44

Asclepiades of Prusa, 23, 51, 146

Asklepieion of Cos, 19

Astrology, 68

Athenæus, 86

Athletes, 147

Augustus, 63

Aurelianus, 91


Baths, Greek, 148
 ----, Roman, 149

Baths of Caracalla, 44, 153
 ---- at Pompeii, 152

Byzantine Period, 111


Cabalists, 128

Cælius Aurelianus, 91

Cæsar, Julius, 44, 54, 55

Caligula, 67

Caracalla, 44, 153

Cassius Felix, 89

Catacombs, 160

Cato the Elder, 7, 8

Celsus, 48, 72
 ----, works of, 73

Christ, miracles of, 138

Christianity, 128
 ---- and hospitals, 133

Chrysippos, 46

Claudius, 67

Cleombrotus, 46

Cloaca Maxima, 8, 159

Cnidos, 17, 44, 50

Constantine, 130

Cornelius Agrippa, 1

Cos, 17, 44

Cremation, 159


Decline of Healing Art, 111
 ---- of Rome, 111

Democedes, 22

Democritus, 23, 25

Demon Theories of Disease, 136

Dietetics, 32, 103

Dioscorides, 88

Disposal of the dead, 159

Dogmatic School, 23

Drainage, 159

Drug-sellers, 59


Eclectics, 87

Elements, the four, 39

Empirics, 23

Empiricism, 23, 48

Epicureans, 56

Erasistratus, 45, 47

Essenes, 45, 127

Euclid, 43

Eudemus, 79


Fabiola, 135

Fees, 162


Galen, 96, 146
 ----, influence of, 110
 ----, works of, 99

Gibbon, 10, 56, 120, 140

Gladiatorial games, 130

Gladiators, 147

Gnostics, 128

Gods of disease, 3
 ----, of healing, 3, 15

Gorgias, 25

Gymnasia, 19, 145

Gymnastics, 143
 ----, inventor of medical, 146
 ----, opinions of physicians on, 146

Gymnasiarch, 20, 144

Gynæcology, 31, 93, 107


Heliodorus, 91

Herodicus, 25

Herodotus, 22, 91

Herophilus, 45, 46

Hippocrates, 7, 25, 146
 ----, sons of, 37
 ----, works of, 26

Hippocratic Law, 33
 ----, Oath, 35

Homer, 15, 16, 148

Horatillavus, 61

Hospitals, 133
 ----, founders of, 135

Hygeia, 15


Iccus, 146


Jacobus Psychristus, 116

Justinian, 130


Lectisternium, 3

Leucippus, 23

Library of Alexandria, 43

Livy, 2, 4


Machaon, 16, 17

Mæcenas, 66

Magnus, 116

Marinus, 95

Meges of Sidon, 79

Melampus, 15

Meletius, 116

Methodism, 23, 51, 54

Miracles of Apollonius, 80
 ----, of Christ, 138
 ----, of Vespasian, 140

Mithridates, 45

Mithridaticum, 45

Monastic medicine, 137

Moschion, 123


Nemesius, 116

Neoplatonism, 112

Nero, 67, 69, 70

Nerva, 81

Numa Pompilius, 2


Obstetrics, 31, 93

Octavianus, 55

Oculists, 70

Operations, 29, 30, 78, 113
 ----, dental, 2

Oribasius, 87, 93, 114

Orphanages, 132

Ovid, 24


Pathology, 104

Paulus Ægineta, 94, 113, 124

Period, anatomic, 21, 45
 ----, philosophic, 21
 ----, primitive, 20
 ----, sacred, 21

Pestilence in Rome, 89

Philinus of Cos, 48

Philosophy, 56

Plague, 4, 120

Plato, 25, 39

Platonists, 56

Pliny, 3, 52, 65, 72, 84, 146

Plutarch, 5, 7

Pneumatism, 86

Podalarius, 16

Poisoners, women, 70

Priest-physicians, 1, 134

Priests, 18

Proclus, 140

Ptolemy, 43

Public health regulations, 161

Pythagoras, 21

Pythagoreans, 22


Quacks, 58, 61

Quintus, 95


Rhodes, 17

Roman quacks, 58, 61

Rome, 56
 ----, medical practice in, 58

Rufus of Ephesus, 94


Saints, 138

St. Luke, 139

St. Paul, 139, 148

Sanitation, 8, 155

Sceptics, 24

Scribonius largus, 82

Seneca, 67, 131

Serapion, 50

Serpents, 14

Sewers, 8, 9, 159

Slave-physicians, 60

Slaves, 60

Soranus, 92

Stoics, 56, 129

Suetonius, 140

Surgery, 30, 73, 107

Surgical instruments, 90


Tacitus, 140

Temple of Æsculapius, 4, 14, 17

Temples, 3, 4, 17

Themison of Laodicea, 23, 53, 54

Theophrastus, 42

Theriaca, 98

Thermæ, 152

Thessalus of Tralles, 83

Thrasyllus, 66

Tiberius, 66


Vettius Valleus, 82

Vitruvius, 144, 157


Water supply, 63, 155

Women poisoners, 70

Wounds of Julius Cæsar, 55

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