Wine was another remedy which Asclepiades was fond of prescribing

in all sorts of maladies, but his rules in regard to the manner in

which it should be employed were quite different from those adopted

by his contemporaries. A few illustrations will suffice to show the

different conditions for which he was wont to advocate the taking of

wine: He gave it, for example,--though probably much diluted with

water--to patients affected with fever, but only after the stage of

greatest activity had been passed. Strange as it may appear to-day,

he was rather in favor of giving to patients ill with inflammation of

the brain (_phrenitis_) wine in sufficient quantity to produce

intoxication; his belief being that he could in this way induce

drowsiness and eventually sleep--a thing so desirable for those

affected with that disease. Further, he instructed sufferers from

catarrh to drink twice or three times as much wine as they usually

drank, in consequence of which instructions the patients found it

necessary to dilute their wine with water to a less degree than

usual--that is, to such a degree that the proportion would be one-half

of each; thus showing, as Le Clerc remarks, how sober the ancients

must have been when they were in perfect health. They probably--he

adds--drank their wine ordinarily in the proportion of five-sixths

water to one-sixth wine, or, at most, three-quarters water to

one-quarter wine.

In some cases Asclepiades prescribed the drinking of wine (particularly

the wine of Cos) to which sea-water had been added; his idea being

that the addition of salt would enable the wine to penetrate farther

into the tissues and thus open the pores more freely. This idea of

added salt was not original with him, for Pliny states that in certain

parts of Greece it was customary to place casks filled with new wine

in the sea and to leave them there for some time. The wine, it was

claimed, was rendered by this procedure mature and pleasanter to drink.

They called wine thus treated “Thalassite wine” (from the Greek word

“thalassa,” sea). In cases of jaundice he occasionally recommended the

drinking of plain sea-water, whereby the bowels were stimulated to act

more freely. Under ordinary circumstances he employed, for the relief

of constipation, clysters, but he was sparing in their use.

The remedial measures enumerated above, together with dieting, are

those upon which Asclepiades chiefly relied in his practice. In acute

diseases he made very little use of drugs that were to be taken

internally, but in maladies of a chronic character he employed them

quite freely. Gargles, poultices and inunctions are mentioned among the

external remedies which he often prescribed.

_Further Particulars Regarding the Life and Career of

Asclepiades._--Le Clerc furnishes a number of details which throw

additional light upon the career of Asclepiades. During the latter’s

lifetime his professional reputation was very great. Lucius Apuleius,

the famous Roman satirist and rhetorician, and a contemporary of

Asclepiades, calls him the Prince of Physicians, second only to

Hippocrates the Great; Scribonius Largus, a Roman physician and writer,

who flourished during the reigns of the Roman emperors Tiberius and

Claudius (37–54 A. D.), speaks of him as a great medical author; Sextus

Empiricus, a writer remarkable for his learning and acumen, who lived

in the first half of the third century A. D., calls him a physician of

unrivaled skill; and Celsus, who is termed the Cicero of physicians,

on account of the purity of his Latin, holds him in high esteem as a

medical authority. His fame as a physician had spread to Asia Minor,

for we are told that Mithridates, King of Pontus, who reigned from 120

B. C. to 63 B. C., and who was a man of great ability and great energy,

invited him to take up his residence at his court; but Asclepiades

refused. Perhaps a still stronger evidence of his real worth as a man

is to be found in the fact that he was the physician and personal

friend of Cicero.

Notwithstanding these strongly favorable estimates of the ability

of Asclepiades there were not a few men, and they too men of great

authority, who were indisposed to give him so conspicuous a place in

the temple of fame. Galen, for example, while admitting that he was a

very eloquent physician, maintained that he was a sophist, given to

quibbling, and disposed to contradict everybody. Caelius Aurelianus, a

contemporary of Galen and the author of the most important practical

treatise on Methodism that has come down to our time, appears to have

held the same opinion as Galen with regard to Asclepiades. The complete

disappearance of all the writings of the latter author makes it

impossible for us at the present time to form an independent judgment

as to the merits of these conflicting estimates of the man’s character.

Galen was a great admirer of Hippocrates and it is very likely that he

took offense at the failure of Asclepiades to accept all the teachings

and therapeutic methods of his hero. As to the reasons which led

Caelius Aurelianus to agree with the estimate made by Galen, we know

absolutely nothing.

Toward the middle of the seventeenth century there was discovered at

Rome, not far from the Capena gate, a portrait bust in white marble

of Asclepiades. It was probably executed by a Greek sculptor residing

in Rome, for, if the work had been done in Greece, the face would

have been represented with a beard, as are the heads of Hippocrates,

Soranus and other celebrated physicians of antiquity. The absence of

the beard, furthermore, shows--according to the opinion of antiquarian

experts--that the bust must have been sculptured before the time of the

Emperor Claudius (41–54 A. D.), as he was the first of the Caesars to

wear a beard. This bust, which is a little larger than life-size, is

at present--if I am rightly informed--in the Capitoline Museum at Rome.

Asclepiades lived to a great age. In descending, one day, a flight of

steps he fell and received injuries from which he died.

CHAPTER XII

THE STATE OF MEDICINE AT ROME AFTER THE DEATH OF ASCLEPIADES;

THE FOUNDING OF THE SCHOOL OF THE METHODISTS

In summing up the effects which were produced by the teaching and

practice of Asclepiades upon the science and art of medicine, Dr.

Meyer-Steineg makes the remark that the wide and ready acceptance of

both depended largely upon the personal character of the man, upon the

manner in which he carried out the measures which he advocated, and

upon the fact that the Romans happened at that period of their history

to be ready to respond favorably to such new doctrines and therapeutic

methods; but that, as soon as his strong personality had ceased to

exert its influence, as it did after he had passed the active period

of his life, and also because Rome did not at that moment possess any

physicians who were sufficiently endowed with his medical gifts and

sagacity to perpetuate his art, both it and his doctrines began to lose

ground. Nevertheless, as this writer states, Asclepiades had already

succeeded admirably in preparing the way for a further development of

the healing art, and for this valuable service full credit should be

given him.

Not long after the death of Asclepiades, Antonius Musa,[30] the

personal physician of the Emperor Augustus, succeeded, by means of

hydrotherapy, in curing his royal patient of a protracted gouty or

rheumatic affection from which he had been a sufferer; and, as a mark

of gratitude for the cure which he had effected, the Emperor raised

him to the rank of a noble (about the year 10 A. D.), erected a statue

in his honor in the temple of Aesculapius, and at the same time issued

a decree that from that time forward the physicians who practiced in

Rome should be exempted from taxation and from certain other civic

burdens. These privileges, which were afterward confirmed by Vespasian

(70–79 A. D.) and also by Antoninus Pius (138–161 A. D.),[31] were of

great advantage to the medical profession as a whole. Julius Caesar

(100–44 B. C.), it will be remembered, had already (about half a

century earlier) bestowed Roman Citizenship upon the physicians who

practiced their profession in that city. Thus, at the time of which

we are now speaking, the medical men of Rome occupied the enviable

position of being on an equality with their fellow citizens of the

better class, a position which made it attractive for young men of

ability and of good social standing to enter the profession.

Among the numerous followers of Asclepiades the most distinguished

was undoubtedly Themison of Laodicea, a city of Phrygia, Asia Minor,

who flourished about the middle of the first century B. C. When he

was well advanced in years he wrote a medical treatise in which he

developed a system of pathology and therapeutics that was accepted as

the professional creed of the sect known as “Methodists.” Starting

from the doctrine of pores and primitive atoms taught by Asclepiades,

he laid great stress upon the idea that in disease all the alterations

which take place in the tissues may be classed in one or the other of

these two categories--a relaxation (_laxum_) or a contraction

(_strictum_) of the parts. To these two categories, which the

Methodists termed “communities,” and which were the only ones at first

accepted as a part of their creed, a third was soon added, viz., that

condition in which both relaxed and contracted states appear side by

side, although not necessarily both of them developed to the same

degree; and to this third category or “community” they applied the

term “_mixtum_.” The ideas which are here stated in a somewhat

crude and imperfect manner owing to my lack of knowledge of all the

facts, constitute the basis of the pathology of the “Methodists”--a

pathology which held its own in the domain of medicine during a period

of four hundred years, and which--in contradistinction to the humoral

pathology of Hippocrates--is justly entitled to the name of “solidist

pathology.” This doctrine, as might be expected, underwent certain

modifications during this long period of time, but they were not

serious enough to alter materially the fundamental form of the teaching

as it has here been described.

Themison and his followers, like their distinguished predecessor,

Asclepiades, possessed something more than a mere glimmering of the

truth in pathology as we know it to-day; and this idea suggests

the further thought that Morgagni, Rokitansky, Lebert, Virchow and

perhaps others whose names do not now occur to me, could scarcely have

developed a better pathology if they had lived during these first

centuries of the Christian era--a period of time when public sentiment

did not permit postmortem examinations, when Harvey’s discovery was not

even dreamed of, when the microscope was unknown, and when experimental

pathology was an impossibility. Many centuries had still to elapse

before medicine could gain that freedom of action, that rich equipment

of tools, and that stock of accumulated knowledge which enable her in

these days to make such giant strides forward as we have witnessed

during the past twenty or thirty years.

The question will naturally arise, How did the Methodists decide, in

the presence of an actual case of illness, which one of these abnormal

states (the laxum, the strictum, or the mixtum) was the condition

that called for medical treatment? The answer which they gave to this

question was, that the condition of the different secretions and the

dejections furnished the principal indication as to what particular

part or organ of the body was ailing, and also as to what was the

nature of the morbid change or process that produced the malady. When,

for example, the secretion from an organ or part was excessive, they

inferred that the pores of such a part were relaxed and distended,

thus permitting an increased flow; and when the secretion was less

than it should be, they decided that the pores were contracted. The

_status mixtus_ had reference to those cases in which a condition

of relaxation was observed in one part of the body, while that of

contraction was noted in another.

Neuburger mentions the fact that the Methodists were somewhat arbitrary

in their classification of the different diseases, most of the acute

maladies being placed by them under the heading _Status strictus_,

while they assigned the majority of the chronic affections to the

category of _Status laxus_.

The effect of the tendency of the Methodists to classify and simplify

all the departments of medicine was not wholly beneficial. It conveyed

to many the impression that medicine might readily be learned in the

course of a few months, and thus offered the temptation to inferior

men to choose the career of physician; and yet, on the other hand,

it infused into the art the essentially Roman characteristics of

orderliness, simplicity and efficiency. Anatomy, for example, was

studied only so far as a knowledge of this department of medicine was

necessary to render the physician familiar with the location, general

character and relations of the different organs. There was one field,

however, in which the adherents of this school displayed a high degree

of excellence, viz., in their descriptions of disease; and this is

especially true of those written by Caelius Aurelianus (fourth century

A. D.), whose manner of handling the subject of differential diagnosis

is far more thorough and satisfactory than that of any of the medical

authors who preceded him.

In their treatment of disease, the Methodists were largely guided by

the principle of _contraria contrariis_,--_i.e._, in those

cases in which, to the best of their belief, a _status laxus_

existed, they administered astringents, in the hope of thereby bringing

the parts back more nearly to a contracted condition; and, _vice

versa_, when the diagnosis of _status strictus_ was made, they

gave a relaxing medicine. The terms “laxatives” and “astringents,”

which are still applied to many drugs, were originated by the

Methodists. Bloodletting, for example, was one of the remedies which

they used for producing relaxation, and an astringent was employed

when a contrary effect was desired. In the list of relaxing remedial

agents (aside from bloodletting) were placed the following: warm

baths, poultices, inunctions with warm oil, vapor baths, fasting and a

restricted diet, diuretics (very carefully watched and employed only in

exceptional cases), emetics, diaphoretics and laxatives. The following

agents, on the other hand, were classed as contracting, astringent and

tonic remedies: washing with cold water, cold baths, the application of

cloths dipped in cold water, living in cold air, strengthening diet,

wine, vinegar, alum, narcotics, etc. Themison, it should be added, is

the first one among the ancient writers to mention the use of leeches

as a means of extracting blood. It does not follow from this, however,

that he was the discoverer of this method of local bloodletting; for it

is highly probable that this procedure had been in common use for many

years previous to his time.

Themison, as I have before stated, was an old man when he laid the

foundations for Methodism, and it is not probable that it attained

much importance as a sect until several years after his death. Then

Thessalus, a native of Tralles, a flourishing commercial city of Asia

Minor, and a man who had received his medical training in one of the

Greek schools, materially added to the body of doctrines held by this

sect, and at the same time rendered them more acceptable to physicians

generally. He was of humble birth, the son of a wool carder, and his

education had been rather neglected; but he nevertheless managed, by

his own efforts and in no small degree by the unlimited self-confidence

(Galen calls it impudence) which he possessed, to push his way to

the top of the ladder.[32] He acquired a large fortune during the

reign of Nero (54–68 A. D.) and apparently succeeded in persuading

this monarch that he was a great physician. Here are some facts which

appear to justify Galen’s dislike for Thessalus: In a letter to Nero

the latter writes: “I have founded a new medical sect, the only

genuine one in existence. I was forced to do so because the physicians

who preceded me had failed to discover anything that is likely to

promote health or to drive away disease; even Hippocrates himself

having laid down doctrines which are positively harmful.” His vanity,

according to Le Clerc, reached such a pitch that he called himself the

“conqueror of physicians.”[33] Pliny corroborates the latter statement

in the following words: “When he assumed the title of ‘conqueror of

physicians,’ a title which was engraved, according to his instructions,

on his tomb in the Appian Way.” Notwithstanding his unbounded conceit,

Thessalus appears to have made several important improvements in the

doctrines of the Methodists. He is also, as it appears, entitled to the

credit of having been the first to inaugurate the practice of giving

systematic instruction at the bedside; thus establishing for all time a

most valuable precedent for the guidance of his successors.

“He was an excellent practitioner and an original thinker....

He was also a prolific writer, as is shown by the number and

variety of treatises which--as we are assured by Caelius

Aurelianus--were composed by him.” The same authority speaks of

him as “a leader among our chiefs,” thus affording good evidence

of the degree of esteem in which he was held by the members

of his own school. The fact that pupils came in throngs to be

taught by him shows clearly how thoroughly he understood the

needs of the physicians of Rome. (Meyer-Steineg.)

Thessalus, notwithstanding his declaration that medicine might readily

be taught in six months, wrote a larger number of treatises on

professional topics than any student of medicine could possibly read

and digest in the course of two or three years. They filled several

large volumes, but not one of them is known to exist to-day. He wrote

at great length, as we are assured, on the subject of surgery, a

subject in which he took an active interest. He taught that ulcers, no

matter in what part of the body they may be located, require the same

kind of treatment.

If an ulcer is excavated, it is necessary to bring about a

filling-up of the excavation; if its surface is on a level with

the surrounding skin, the aim should be to make it cicatrize;

if the growth of new tissue is excessive, the redundant portion

should be destroyed by burning with caustic; and, finally, if

the ulcer is of recent development and bleeds readily, the

attempt should be made, by approximating the edges, to effect an

immediate healing.

In the treatment of chronic ulcers which show little or no disposition

to heal, and which, when they do finally heal, are very prone to break

open afresh, Thessalus urges the great importance of ascertaining, if

possible, the cause or causes of this behavior. If it be found that

the trouble is due to some weakness or abnormal predisposition of

the part in which the ulcer is located, or that the condition of the

entire body is probably the real cause of the trouble, he recommends

the employment of “metasyncritic remedies”--that is, remedial measures

which effect a marked change in the individual’s vital processes

throughout the body, and also such as exert an alterative effect upon

the ulcer itself. Among the measures of the first class he enumerates

the following: Various forms of physical exercise; alternately

increasing and diminishing the amount of nourishment taken; and perhaps

the taking of an emetic at the very commencement of the treatment.

As to the second class of measures--those needed to bring about a

change in the ulcer itself--he makes the following recommendations:

Remove from the diseased tissues as much as will restore the parts,

as nearly as possible, to the condition of a healthy wound, and then

adopt the treatment suited for the latter condition. In cases in which

the ulcer heals and then subsequently breaks open again, it will

sometimes be found beneficial to apply in the neighborhood a plaster

containing an irritating substance like mustard, the effect of which

is often to change the disposition of the parts. In actual practice he

recommends that the local measures should be employed first, and then,

if they fail to accomplish the desired purpose, the physician should

have recourse to those enumerated in the first class--the strictly

metasyncritic remedies.

It is rather difficult to believe that a man so full of conceit and so

unjust in his criticisms of his predecessors as Thessalus clearly was,

could be capable of formulating such a concise statement of the nature

of chronic ulcers and such a practical rule for their proper treatment.

His development of the idea of “metasyncrisis”--or renovation of the

body (_recorporatio_), as Caelius Aurelianus translates the

word--seems to have been original with Thessalus.[34] The Methodists,

it should be added, deserve special credit for having been the first

to introduce and carry into effect the systematic treatment of chronic

diseases; and, as a general proposition, it may be said that their

treatment of all forms of disease was thoroughly practical, free from

all tendency to resort to magical methods, and based largely on the

employment of such hygienic measures as the use of baths of different

kinds (hydrotherapy), massage, moderate outdoor exercise, passive

movements, sea voyages, fasting, regulation of the diet, etc. One

of the favorite practices--of which Thessalus was said to have been

the originator--was to begin the treatment of almost all maladies by

prescribing an abstinence from all food for a period of three full

days. When I come to speak of Soranus and Caelius Aurelianus I shall

probably have occasion to give further details regarding the methods of

treatment employed by the Methodists.

As a system, says Neuburger, Methodism was not capable of inaugurating

any fundamental advances in medicine; the most that it was able

to accomplish was to broaden and otherwise improve the domain of

therapeutics, and some of its wiser members were diligent in collecting

and sifting critically a large number of valuable experiences, which

were then courteously registered by them to the credit of the sect.

CHAPTER XIII

THE FURTHER HISTORY OF METHODISM AT ROME, AND THE DEVELOPMENT

OF TWO NEW SECTS, VIZ., THE PNEUMATISTS AND THE ECLECTICS.--A

GENERAL SURVEY OF THE SUBJECT OF SECTS IN MEDICINE

Among the Methodists there were many physicians who attained more

or less distinction during their professional career, but only two

of them, beside those whose contributions to medical knowledge have

already been mentioned in these pages, gained sufficient celebrity to

justify me in devoting some additional space to the description of the

work which they accomplished. Soranus, of Ephesus on the coast of Asia

Minor, and Caelius Aurelianus, of Sicca in the north of Africa, are the

physicians to whom I have reference.

It was Soranus, says Le Clerc, who gave the finishing touches to

the system of the Methodists, and the work which he did was of such

excellence that he may with justice be called the ablest and most

skilful of all the members of that school. Caelius calls him “a chief

among the leaders of our sect.” He received his medical training at

Alexandria and came to Rome about the year 100 A. D. His professional

career covered the period corresponding to the reigns of Trajan and

Hadrian (98–138 A. D.). He is known to posterity chiefly through

his two treatises--one on obstetrics and gynaecology and the other

on acute and chronic diseases. The first of these treatises, in the

original Greek, was rediscovered in 1838 by Reinhold Dietz, Professor

of Medicine in the University of Königsberg, Prussia, and a German

translation of the work (by Lüneberg and Huber) was published in Munich

in 1894. Moschion, who was probably a pupil of Soranus, wrote a popular

treatise on the same subject for the use of midwives, and in this book

he has reproduced much of the material which is to be found in the work

of his master. The treatise written by Caelius Aurelianus on acute and

chronic diseases is admitted by him to be founded on that which Soranus

wrote on the same subject. In fact, as Daremberg states, the work of

the former represents almost a translation (into Latin) of Soranus’

treatise. The sources just named are the principal ones from which our

knowledge of this author is derived.

Soranus was a prolific writer; the treatises which he wrote and which

deal with a great variety of subjects, number thirty in all. The

majority of these works, however, have been lost. He had many followers

and his influence upon medical science was very great, not simply

during his lifetime, but also for several centuries after his death.

He commanded the respect and confidence of the opponents of Methodism

as well as of the members of his own sect. One of his most pronounced

traits of character was his readiness to condemn, on every possible

occasion, superstitious practices, such as the employment of amulets,

magnets, etc. He was also a very persistent and earnest advocate of

the gentler and more rational obstetric methods. For example, he

disapproved of the reckless employment of remedies for hastening the

expulsion of the foetus, of the practice of succussion (which was

carried out by the aid of a ladder), of making the pregnant woman run

up and down stairs, of a resort to rough mechanical procedures for

extracting the placenta, etc. The following quotation from one of

Soranus’ treatises (Gynaeciorum, Lib. I., cap. 19) reveals clearly what

sort of a man and physician he was:--

There is a disagreement; for some reject destructive practices,

calling to witness Hippocrates, who says, “I will give nothing

whatever destructive” and deeming it the special province of

medicine to guard and preserve what nature generates. Another

party maintains the same view, but makes this distinction,

viz.: that the fruit of conception is not to be destroyed at

will because of adultery or of care for beauty, but is to be

destroyed to avert danger impending at parturition, if the

uterus be small and cannot subserve the perfecting of the fruit,

or have hard swellings and cracks at its mouth, or if some

similar condition prevail. This party says the same thing about

preventing conception, and with it I agree.

(Translated from the Greek by the late John G. Curtis, M.D., of

New York.)

Soranus was not only a great obstetrician,--admitted by all the

authorities to have been the greatest in ancient times,--he was also

in high repute for the work which he did in other departments of

medicine--in gynaecology, for example, in the instruction of midwives,

in the management of children’s diseases, in the diagnosis and

treatment of both acute and chronic diseases, in surgery, etc. While in

general he adhered to the fundamental teachings of the Methodists, he

did not hesitate to depart from the beaten pathway of that sect in his

explanations of certain pathological conditions; for he was more of a

clinical observer than a sectarian, and it was probably his independent

manner of thinking that gave the sect new vigor and thus enabled it to

live on through such a long period of time. Galen, who was not at all

disposed to speak favorably of the Methodists, says that he tried a

number of the remedies recommended by Soranus and found them good.

Caelius Aurelianus probably flourished during the third century A. D.

The different authorities, however, do not agree as to the limits of

the period during which he lived; some saying that his career antedated

that of Galen, while others claim that he came upon the scene after

the death of the latter, which occurred early in the third century A.

D. His chief merit appears to have been that, through his translation

of the writings of Soranus into Latin, he placed within reach of the

physicians of Rome the teachings of that admirable diagnostician and

therapeutist; for it must be remembered that the great majority of the

Roman medical men were not able to read Greek. On the other hand,

Caelius Aurelianus, who was himself a thoroughly practical physician,

deserves considerable credit for having enriched the text of his book

with many very appropriate examples (chiefly with regard to questions

of diagnosis) drawn from his own personal experience, which must

have been extensive. During the Middle Ages, as we are informed by

Friedlaender, this work furnished the chief source from which the monks

derived their knowledge about diseases and their proper treatment.

The Latin in which the book is written is described by nearly all the

authorities as barbaric.

_The Pneumatists._--Methodism had been established only a very

few years when Athenaeus of Attalia, a city on the coast of Pamphylia,

Asia Minor, founded (about 50 A. D.) a new sect--that of “Pneumatism.”

He was not the discoverer of the “pneuma” or “vital spirit,” for that

had already been admitted by the earlier schools of philosophy as a

fifth primary creative element, supplementary to the four well-known

substances--fire, air, earth and water. He believed that heat, cold,

moisture and dryness (the primary qualities of these four bodies)

were not the veritable elements of living beings. Heat and cold, he

maintained, were “efficient causes” and moisture and dryness “material

causes.” To these he added “spirit” as a fifth element; and he taught

that this spirit enters into the formation of all bodies and preserves

them in what may be termed their natural state. It was from the

Stoics, more particularly, that Athenaeus borrowed this belief, and

it was the latter fact, as Le Clerc says, which led Galen to speak of

Chrysippus--one of the most famous of the Stoics--as “the Father of the

Sect of the Pneumatists.”

In his application of the doctrine of Pneumatism to the science of

medicine, Athenaeus maintained that the majority of diseases owed their

origin to some disturbance or disorder of the spirit; but it is almost

impossible to understand, from the scanty data which have come down

to us, what Athenaeus really meant by the term “spirit,” and by the

expression “disorder of the spirit.”

From the definition which he gives of the word “pulse” one

is justified in drawing the conclusion that he considered

the spirit to be an actual substance, capable of undergoing,

to a greater or less degree, such changes as expansion and

contraction. The same obscurity of meaning is encountered when

one endeavors to discover how the new doctrine affected the

practice of medicine. (Le Clerc.)

In view of all these circumstances it is not at all surprising that

Pneumatism was not very popular with the physicians of Rome, and

that, after a brief period had elapsed, many of the adherents of

this doctrine abandoned it and gave their preference to the more

practical teachings of the Methodists. Meyer-Steineg goes so far as to

remark that, to all intents and purposes, such a thing as a sect of

Pneumatists did not exist.

The most prominent of the disciples of Athenaeus were Theodorus,

Agathinus, Herodotus, Magnus and Archigenes.

Haller speaks of Theodorus as the inventor of a remedy which, as he

claimed, cures all cases of poisoning.

_The Eclectics._--Agathinus, a native of Sparta, was the teacher

of Herodotus and Archigenes. His chief distinction is to be found

in the fact that he gave to the offshoot from the school of the

Pneumatists the name of “Eclectics,”[35] his object being, as we are

assured by Neuburger, to bring the three sects (Pneumatists, Empirics

and Methodists) into closer union.

Herodotus--who, it is perhaps desirable to state, is a different person

from the famous historical writer of the same name--lived during the

latter part of the first century A. D., and was more closely allied to

the Methodists than to the Pneumatists. It appears from the text of a

fragment of one of his treatises that he wrote a description of the

disease now called small-pox and directed attention to its contagious

character.

Magnus, a native of Ephesus in Asia Minor, is reported to have been

the writer of a collection of letters on medical topics and also of a

history of the discoveries made in medicine subsequently to the time of

Themison.

Archigenes, the fifth member of this group of Pneumatists, was born

in Apamea, Syria, and lived in Rome under the reigns of Trajan

(98–117 A. D.) and Hadrian (117–138 A. D.). Le Clerc speaks of him as

belonging to the Eclectics rather than to the Pneumatists. This is

a matter, however, of small importance, as the sects were, at that

period, very much mixed. The poet Juvenal, who was a contemporary

of Archigenes, refers to him briefly as a physician who had a large

practice; and the historian Suidas says that he wrote a great deal

about physics as well as about medicine. That he was esteemed highly

as an authority in practical surgery is shown by the fact that Galen,

when he discusses surgical topics, makes frequent quotations from

the writings of Archigenes. Only fragments of the latter, however,

have come down to our time. His popularity as a practitioner was very

great; notwithstanding which he managed to write several treatises

on a variety of topics--on the pulse, on feverish diseases, on the

different types of fevers, on local affections, on the diagnosis and

treatment of acute and chronic maladies, on the right moment when

surgical operations should be performed, on drugs, and on therapeutic

procedures in general. He applied ligatures to blood-vessels and also

arrested further bleeding from them by passing needles through the

adjacent parts in such a manner as to exert pressure upon the vessel (a

procedure which is termed “acupressure”); he operated for the removal

of both mammary and uterine cancers; he employed the red-hot cautery

iron for the arrest of hemorrhage and also for the relief of coxalgia,

and he was familiar with the use of the vaginal speculum.

Antyllus, another prominent surgeon of that period, joined the

Methodists at a considerably later date. He was also the author

of an excellent treatise on surgery, the greater part of which,

unfortunately, has been lost or destroyed.

Aretaeus of Cappadocia, a district of Asia Minor, lived during the

second century A. D. He was a man of very broad culture. From the

fact that he assigned an important rôle to the pneuma, he is usually

classed among the Pneumatists. He does not appear, however, to have

taken a very active interest in the doctrines of that school, and both

Le Clerc and Daremberg seem disposed to call him an Eclectic, and we

may therefore rank him as one of the independent physicians of that

period. It is doubtful whether he ever practiced in Rome. His two

treatises--one on the causes and means of identifying acute and chronic

diseases, and the other on the treatment of these diseases--are written

in Greek, and are characterized by the clearness and simplicity of his

descriptions, which very closely resemble those of Hippocrates, and by

the soundness of the advice which he gives in regard to the methods

of treatment.[36] In his conceptions of what a physician should aim

to be, Aretaeus maintained a very high standard. Some of his views

regarding human physiology and pathology are given here very briefly:

Respiration serves the purpose of cooling the warmth of the heart, and

the lungs are therefore prompted by the latter organ to draw cool air

into their cavities; digestion takes place not only in the stomach

but also in the intestinal canal, and owes its origin to warmth; the

cerebral nerves, close to the spot from which they originate, cross

from one side to the other, and by the aid of this fact paralysis on

one side of the body may be explained. Aretaeus has gained considerable

fame, says Puschmann, from his description of the “Syriac ulcer,” the

picture of which he draws agreeing perfectly with what is known to-day

as pharyngeal diphtheria. In various places throughout his writings

he displays a thorough knowledge of normal anatomy--as, for example,

when he describes the ramifications of the vena portae and gall-ducts

of the liver. He was also well informed in matters belonging to the

domain of pathology, for he gives admirable descriptions of many of

the diseases--for example, pleurisy with empyema, pneumonia, pulmonary

consumption, cerebral apoplexy, paraplegia, tetanus, epilepsy, diabetes

mellitus, gout, etc. From the character of these descriptions one is

strongly tempted to believe that he must have made a certain number of

postmortem examinations.

According to Neuburger, Aretaeus enters very fully into details

when he discusses the subject of diagnosis; his statements in one

place warranting the belief that he even auscultated the heart. His

methods of treatment were based largely upon his own experience and

were generally of a simple character. He attached great importance,

for example, to a very careful regulation of the diet, muscular

exercise, massage, etc., and his employment of remedies was confined

to a very small number of such drugs as exert a mild action. When the

case, however, was of such a character as to call for more vigorous

interference, he did not hesitate to resort to the use of opium,

emetics, cathartics, venesection, blistering, the red-hot cautery iron,

etc.

Rufus, a native of Ephesus, a city of Asia Minor, about thirty-five

miles from Smyrna, is reckoned by most authorities among the Eclectics;

in other words, he was an independent, or one who adopted from the

teachings of the different sects such doctrines as met with his

approval, but who, at the same time, did not care to pose as the

disciple of any one of them. He received his medical training at

Alexandria, but it is not known where he practiced his profession.

Almost no details concerning his life or his professional career have

come down to our time. It is simply known that he flourished during

the reign of the Emperor Trajan (98–117 A. D.). Ebn Ali, an Arabian

physician and author, says that he was the leading medical authority

of his time and that his works were highly esteemed by Galen. His

treatise on anatomy (entitled “The Names of the Different Parts of the

Human Body”), which is one of the few that have escaped destruction,

is described as a treatise which was written for students, and which

possesses great value for the history of anatomical nomenclature. The

same authority says that Rufus was the first to describe the chiasma,

that he came very near establishing the existence of two different

kinds of nerves--motor and sensory--and that he attributed the control

of all bodily functions to the nervous system. He also states that he

was one of the first to furnish a description of the oriental bubonic

plague. Some idea of Rufus’ style of writing may be gathered from the

following quotations which have been taken from his short treatise

entitled “The Questioning of Patients”:--[37]

It is necessary to question the patient, for by so doing one

may gather more exact information concerning the nature of the

malady, and will then be able to treat it more intelligently.

In this way also one may learn whether the patient’s mind is

in a normal or an excited state, and whether any change has

taken place in his physical strength. Some idea regarding the

nature and seat of the disease is usually obtained from such

questioning. If, for example, the patient answers clearly and to

the point, and does not hesitate; if his memory does not play

him false; if his speech is not thick or indistinct; if, being a

well-bred man, he gives his responses in a polite and cultivated

manner; or if, in the case of a person who is naturally timid,

the answers reflect this timidity, then you may feel confident

that your patient’s mind is not affected. But if, on the other

hand, you ask him about one thing and he gives you a reply about

something entirely different; if, as he talks, he appears to

forget what he was talking about; if he has a trembling tongue

the movements of which are also uncertain; and, finally, if from

a certain state of mind he passes rapidly to one of a totally

different character,--all these changes are evidences that the

brain is beginning to be affected.... If the patient speaks

distinctly and with a fairly strong voice, and is able to tell

his story without stopping from time to time in order to rest,

the inference is warranted that his physical strength is not

materially affected....

The following quotation is from his treatise on gout:--

If the patient complains that one of his joints is painful, he

should be asked whether or not the part has received a blow. If

he replies that it has not, then (you may infer that the pain

is due to gout and) you should forthwith put him on a suitable

diet, order a clyster and bleed him at a spot not far (from the

seat of the pain).... The withdrawal of nourishment is ordered

for the purpose of arresting any further formation of new blood

and thus preventing the joints from growing more sluggish in

their movements. The clyster is ordered because we believe that

it is beneficial (in this condition) to evacuate the bowels.

The bleeding will be found useful, but to a less degree in

the lower than in the upper limbs.... One must be careful not

to assume that the patient is cured when he has been entirely

relieved of his pain, because with the lapse of time fresh

attacks are liable to occur; this disease, like certain other

affections, possesses a periodic character.... Therefore it is

well, immediately after the bloodletting, to employ friction, to

get rid of the excess of moisture in the body by some laborious

form of exercise, to take such articles of food as are easily

digested,--in brief, to aim chiefly at reducing as much as

possible the moisture of the body.

One cannot but feel a keen regret that so few of the writings of this

thoroughly practical and highly educated physician should have come

down to our time. So far as I am able to learn, Rufus wrote no fewer

than 102 treatises, all of which, with the exception of the seven

about to be mentioned (together with a number of fragments preserved

by different writers of antiquity) have either disappeared or been

destroyed. The titles of the treatises which have been preserved are as

follows: (1) Diseases of the Kidneys and Bladder; (2) On Satyriasis and

Gonorrhoea; (3) Purgatives; (4) The Names of the Different Parts of the

Human Body; (5) On the Questioning of Patients; (6) On the Pulse; (7)

On Gout.

_A General Survey of the Subject of Sects in Medicine._--During

the sixth century B. C.,--that is, about two hundred years before

the formation of the more distinctly medical sects of which mention

was made in Chapter IX.,--Pythagoras of Samos and his disciples put

forward certain beliefs or doctrines with regard to the mode of

action of some of the functions or vital processes of the human body,

and all those who accepted these teachings as affording a true and

satisfactory explanation of the phenomena in question constituted what

is generally termed a school or sect. Some of these individuals were

physicians--that is, men who undertook to cure or at least to relieve

those who were ill; but probably the majority were simply philosophers,

mere “lovers of wisdom,” who by studying problems of this nature sought

to satisfy their longing for a more perfect knowledge of the truth

respecting the various phenomena of life.

A few years later, Heraclitus of Ephesus, who, like Pythagoras, was

both a philosopher and a practicing physician, taught the doctrine that

all things owe their origin to fire. One is not at all surprised to

learn that he had relatively few followers, for history tells us that

he was both a misanthrope and a slanderer of the medical profession,

as shown by the following saying which is attributed to him: “Next to

physicians the grammarians are the biggest fools in the world.”

Hippocrates attached much importance to the value of experience and

to the necessity of studying disease at the bedside; at the same time

he upheld what is commonly known by the name of humoral pathology--a

doctrine which refers all maladies to some abnormal change in the

humors or fluid portions of the body. His writings also show that he

made full use of the reasoning power. The followers of this great

physician did not form a sect in the ordinary sense of the term; they

were his adherents simply because he was an able diagnostician, a

successful teacher, an excellent therapeutist, a skilful surgeon, a man

of very high moral character,--in short, a great physician. Every sect

which developed in the centuries following his death contained a goodly

proportion of Hippocratists.

Nearly two centuries after the active period of the professional life

of Hippocrates, Erasistratus and Herophilus gathered about themselves

in Alexandria (about 280 B. C.) large groups of followers, who held for

their respective teachers a degree of esteem which amounted, according

to Galen, almost to veneration. As there was little or no antagonism

or lack of harmony between the doctrines taught by these physicians,

the two groups cannot properly be classified among the sects. In

fact, it would be more correct to say that Erasistratus and Herophilus

contributed facts of permanent value to our stock of knowledge rather

than doctrines which might prove highly popular for a few scores of

years, but which would probably in due course of time be set aside as

no longer of value.

The four most characteristic types of sects in medicine were the

following: the Dogmatists--or Rationalists, as Daremberg calls them

in one place; their great rivals, the Empirics; the Methodists; and

the Eclectics. The oldest sect, the Dogmatists, did not come into

prominence until after the medical schools at Alexandria had already

been in operation for a long time. The development of the rival sect of

the Empirics at this late period brought with it endless discussions

regarding the merits of their respective teachings, and thus both of

them gained a degree of prominence which seems to us moderns to have

been out of all proportion to the importance of the subject-matters

discussed. The Dogmatists, says one writer, insisted that it is just as

necessary to be acquainted with the “hidden causes” of disease as with

those which are plainly recognizable, and that it is only by aid of the

reasoning power that we gain some knowledge of this class of causes.

They claimed that, while a knowledge of anatomy is of very great

service to the surgeon, it usually renders this service through the aid

of the reasoning power; as when, in the performance of a lithotomy, the

operator selects the fleshy (_i.e._, vascular) neck of the bladder

as the spot in which to make the opening with the knife, in preference

to the base of the organ, which is chiefly membranous in structure and

therefore less likely to heal solidly.

The plausible but rather shallow response made by the Empirics to

the arguments advanced by their rivals consisted in quoting certain

maxims, as, for example: “The farmer and the helmsman do not acquire

knowledge of their respective occupations from discussions, but from

actual practice”; “It is not of vital importance to know what are the

causes of the different diseases, but what remedies are competent to

cure them”; and “Diseases are not cured by eloquence, but by remedial

agents.”

Among the comments made by Celsus with regard to the differences which

distinguished the Dogmatists from the Empirics we find the following

statement: “The two sects employed the same remedies and pursued very

much the same course of treatment, but their reasonings about such

matters were different.”

Modern physicians will, at first thought, be disposed to wonder how men

as clever as many of these physicians were could have split up into

separate and more or less antagonistic sects because of such apparently

trivial differences of opinion. It must be remembered, however, that

these men were groping in comparative darkness whenever they tried to

advance their knowledge of pathology, and that in this imperfect light

many things seemed of much greater importance than they appeared to be

in the brighter light of later centuries. It is only fair, therefore,

to withhold criticism and to ask ourselves whether this strong desire

on the part of those men to advance their knowledge of pathology--a

desire which manifested itself in the formation of sects--was not in

reality an evidence of the great vitality of Greek medicine on Roman

soil in those early centuries.

The remarks made above with regard to the Dogmatists and the Empirics

apply in a general manner to the sects known as the Methodists and the

Eclectics, a sufficiently full account of which has been given in the

preceding chapter.[38]

CHAPTER XIV

WELL-KNOWN MEDICAL AUTHORS OF THE EARLY CENTURIES

OF THE CHRISTIAN ERA

There were four men who were not especially identified with any of the

sects described in the preceding chapters, and yet who occupied, as

authors of medical treatises, very prominent places in the history of

medicine of the period or epoch which we have just been considering.

They are Celsus, Scribonius Largus, Pliny the Elder and Dioscorides.

These men lived during the first and second centuries A. D. and they

therefore all belong strictly to the period which is designated in our

scheme as the fourth epoch. I shall give here brief sketches of all of

these writers and of their works. While Caelius Aurelianus, another

important medical author, belonged to a much later period, I shall, for

reasons of convenience, describe in the same chapter with the others

the part which he played in the evolution of medicine.

Aulus Cornelius Celsus, called by some the Latin Hippocrates and by

others the Cicero of physicians because of the correctness and elegance

of his Latin and the clear manner in which he puts his thoughts into

words, flourished during the reign of the Emperor Augustus (27 B.

C.-14 A. D.). The date and place of his birth are not known, but it is

generally believed that he was born and received his education at Rome.

The great work which he wrote and upon which he must have been engaged

the larger part of his lifetime was a sort of cyclopaedia, which

bore the title “_Artium libri_,” and in which each department

of knowledge was represented by a separate treatise. It is said that

five books were devoted to agriculture, seven to rhetoric, eight to

medicine, etc.; but all of these treatises, excepting those relating

to the latter science, have been lost or destroyed. It is not certainly

known to which of the professions Celsus belonged, but the very skilful

and judicious manner in which he has culled all that is best from the

medical treatises published before his time, the remarkable knowledge

of technical details which he displays in every part of his own work,

and the fine tone of medical thought which pervades these eight

books, almost compel the conclusion that the author was a very clever

clinician, although probably not a physician who practiced for a money

reward. In no other published treatise is a more perfect picture of the

medical practice of antiquity to be found than that which Celsus gives

us in his work “_De arte medica libri octo_.”

It is not an easy matter to select, from a treatise of several hundred

pages in length, one or two passages of such a character that they may

be accepted as fairly representing the author’s manner of dealing with

medical and surgical questions of practical interest. The two given

below are translations from Védrènes’ version (Paris, 1876), and they

deal, the one with venesection and the other with the proper manner of

arresting hemorrhage from a wound. Both the passages quoted represent

only fragments, as sufficient space for more extensive extracts is not

available.

_Book II., Chapter X._--_Bloodletting from a

Vein._--Incising a vein for the purpose of drawing blood from

it, is not a new procedure; but it is certainly a new thing to

resort to bloodletting in almost all diseases. Again, it is an

ancient custom to employ bloodletting in young subjects and in

women who are not pregnant, but it is a new thing to perform

this operation on infants and aged individuals, and on women

approaching the period of confinement. It was the idea of the

ancients that persons at the two extremes of life were not able

to support this sort of treatment, and they were convinced that

a pregnant woman, if subjected to the operation of bloodletting,

would almost surely be confined before the completion of her

time. Since then, however, experience has shown that there is

no fixed rule about this matter, and that a physician should

preferably regulate his course in accordance with observations

of a different nature. The determining factor, for instance,

is neither the age nor the pregnant state of the patient, but

rather the degree of physical strength. In the case of a youth

who is feeble, or of a delicate woman (aside from the question

of pregnancy), it would be wrong to draw blood, for it would be

robbing them of what little strength they possessed. But, in the

case of a vigorous child, a robust old man, or a pregnant woman

who is in good health, one need not hesitate to resort to this

procedure. Nevertheless, there may arise, in connection with the

operation of venesection, a number of questions which are quite

likely to puzzle an inexperienced physician and perhaps lead him

into error. For example, infants and old people possess as a

rule diminished vigor, and the woman who is about to be confined

needs all her strength for the period following delivery, both

for herself and for the nourishing of the child. But the mere

fact that one must give some thought to questions of this nature

and must exercise prudence does not justify the immediate

rejection of a method of treatment like that of venesection. For

is it not the very essence of our art, not merely to consider

the factors of age and the pregnant state, but also to form an

estimate of that other and more important factor, viz., the

patient’s strength,--be that patient an infant, an aged person,

or a woman advanced in pregnancy,--and then to decide whether

it is, or is not, great enough to bear the loss of blood?

In deciding a question of this kind it will be necessary to

distinguish between real vigor and obesity, between thinness and

feebleness, etc.

* * * * *

Venesection is an easy operation for a physician who has already

familiarized himself with the manner of performing it, but

for one who is ignorant of these details it may prove very

difficult. It is necessary, for example, to bear in mind that

the artery and vein are united and that they are accompanied

by nerves; and, further, that the injuring of the latter

will induce spasms and violent pains. On the other hand, it

must also not be forgotten that an artery once opened has no

disposition to close, nor does it heal, and that sometimes the

blood escapes in an impetuous manner. If, perchance, the vein

is cut transversely, the edges of the opening contract and no

more blood escapes. Again, if the scalpel is plunged into the

parts timidly, the skin alone will be divided and the vein will

not be opened. In some cases this vessel is so hidden from

sight that the physician may experience difficulty in bringing

it into view. Thus it will be seen that there are several

circumstances which may render this operation difficult for an

ignorant or inexperienced physician. The vein should be incised

in a longitudinal direction, midway between its two sides. The

moment the blood gushes from the opening its color and general

appearance should be carefully noted, etc.

_Book V., Chapter XXVI._--_The Proper Manner of Arresting

Hemorrhage from a Wound._--If there is fear that there

may be bleeding, one should fill the wound with dry lint,

place over it a sponge wrung out of cold water, and press

upon it with the hand. If the bleeding still continues, it is

advisable to change the stuffing of lint somewhat frequently;

and, if this step proves ineffective, then lint moistened with

vinegar may be tried, for this liquid acts energetically in

arresting hemorrhage. Some physicians, indeed, actually pour

it into the wound. There is a strong objection, however, to

the use of an agent which, like vinegar, arrests the bleeding

too completely--viz., that it is apt to set up afterwards an

intense inflammation of the parts. The same reasoning applies

with even greater force to the employment of corrosives and

caustics, which produce an eschar. Despite the effectiveness

of most of these in arresting hemorrhage, their use should be

discouraged.... Finally, if the bleeding continues it will be

necessary to grasp the vessel from which the blood is escaping,

to ligature it in two places close to the wound, and then to

divide the vessel between the two ligatures, in order that

it may retract (both of the new orifices having already been

closed by the ligatures). If the circumstances are such that the

plan just recommended cannot be carried out, it will then be

advisable to apply the red-hot cautery to the bleeding vessel.

When a rather free hemorrhage occurs at a part of the body where

there are no nerve trunks and no muscles,--as on the forehead or

at the top of the head,--the simplest plan is to apply a cup at

some little distance from the source of the bleeding and thus

divert the current of the blood from the spot affected.

And to these two longer extracts may be added a third:--

From these considerations the inference is warranted that a

physician cannot possibly give proper attention to a large

number of patients. (Book III., Chapter IV.)

Celsus’ treatise was ignored by physicians for many centuries, but

it was considered by the monks, in the Middle Ages, a valuable

guide in the treatment of disease; and it was probably owing to

this circumstance, says Védrènes, that the book did not altogether

disappear. It was not until the year 1443 that Thomas de Sazanne,

afterward Pope Nicholas V., discovered a copy of the work in the church

of Saint Ambrosius, at Milan, but it was only in 1478 that the book was

printed for the first time (at Florence). Then, as if to make up for

the long neglect to which it had been subjected, no fewer than sixty

Latin editions were issued during the two succeeding centuries; and,

in addition, it was eventually translated into every modern European

language.

Scribonius Largus, a Roman physician who lived during the reigns

of Tiberius and Claudius (14–54 A. D.), owes his celebrity to the

fact that he wrote and published (in 47 A. D.) a book containing a

collection of the best medical formulae and popular recipes known at

that time. He appears to have had a large private practice and to have

spent a considerable portion of his professional life in the service

of the army. He accompanied the Emperor Claudius, for example, in his

campaign against Britain (43 A. D.), and the book which he wrote, and

which has just been mentioned, was dedicated by him to that emperor.

According to Neuburger, Scribonius is to be credited with having been

the first to describe correctly the proper manner of obtaining the drug

known as opium, and also the first to recommend, in the treatment of

severe headaches, the employment of electric shocks as communicated by

the fish called the “electric ray.”

Medical practice at that period, says Le Clerc, was divided among three

kinds of practitioners--those who treated their cases exclusively by

dietetic measures, those who effected cures by surgical means, and

those who took charge only of such patients as required chiefly the

employment of external remedies. But Scribonius Largus insists that

such a division was more theoretical than real, as no one of these

classes could get along without the cooperation of the others.

C. Plinius Secundus, commonly called Pliny the Elder, was born near the

beginning of the first century of the Christian era, either at Verona

or at Como in the north of Italy, and settled in Rome at an early

period of his life. At the beginning of his career he served for some

time in the army in Germany, and upon his return to Rome practiced as

a pleader. Subsequently he held various official positions which gave

him the opportunity of visiting other countries of Europe. He perished

at Stabiae (near the modern Castellamare, on the Gulf of Naples) in 79

A. D., at the age of fifty-six years, while watching the eruption of

Vesuvius, which overwhelmed Herculaneum and Pompeii. He was in command

of the Roman fleet at the time.

Pliny was indefatigable as a writer and as a gatherer of knowledge of

all sorts, and he and Celsus are well named the Encyclopaedists. He

is said to have written twenty books on the war with the Germans, an

unknown number on rhetoric and grammar, and thirty-seven on natural

history. The latter books alone have come down to our time. Pliny’s

nephew, who is known as Pliny the Younger, and who edited the great

work of his uncle on natural history, furnishes us, in a letter

addressed to the historian Tacitus, with some interesting details

regarding the elder Pliny’s manner of life. It appears from this

account, that the latter read almost incessantly. During his meals and

while he was taking his bath, an attendant read aloud to him. He also

took his books with him on his travels and was always accompanied by

a person who could write rapidly under dictation. He continued this

practice upon his return to Rome and dictated to his amanuensis even

while he was being carried about in a sedan chair. Books 20–27 of his

great work on natural history are devoted to the subject of remedial

agents belonging to the vegetable kingdom, books 28–32 deal with those

which belong to the animal kingdom, and books 33–37 treat of mineralogy

with special reference to medicine, painting and sculpture. Pliny was a

compiler and not an original investigator. Some idea of the popularity

of his treatise on natural history may be gathered from the fact that

it was the second book to be printed after the invention of printing,

the Bible being the first. Another interesting fact connected with

Pliny’s treatise is mentioned by Neuburger, viz., that the use of

hyoscyamus and belladonna as agents capable of dilating the pupils,

owed its origin to the discovery (by C. Himly, in 1800) of a place in

the text (Book XXV., 92) where it is stated that the juice of the plant

Anagallis was rubbed into the eyes before the operation for cataract

was undertaken.

According to Pliny (Book XXXI., Chapter VI.), the ancients employed

mineral waters extensively in the form of baths, and they also

occasionally used them as internal remedies. Galen, too, mentions the

fact that these waters were in demand in the spring or autumn for

purgative purposes.

In Book XXXIX., 8, 3, Pliny--as quoted by Védrènes--makes the following

remarks:--

Very few Romans have shown an active interest in medical

affairs, and those few speedily found it necessary to pass

themselves off as Greeks. For it is a well-known fact that those

physicians who, without being able to speak Greek, attempted to

build up a practice in Rome, failed to gain the confidence of

their patients, even of those who were not at all familiar with

that language.... When one’s health is the question at issue the

readiness to place confidence in a medical adviser is apt to

diminish in proportion as one’s knowledge of the man increases.

Indeed, medicine is the only art in which one is quite ready

at first to put faith in almost anybody who calls himself a

physician, and that too, despite the acknowledged fact that in

no other circumstances of life is an imposture more fraught with

danger.

English versions of Pliny’s Natural History and of Pliny the Younger’s

Letters have been published in what is known as Bohn’s Libraries.

Pedanius Dioscorides, a native of Anazarba, a small Greek town near

Tarsus in Cilicia, lived about the middle of the first century A. D.

(during the reigns of Nero and Vespasian). From his earliest youth he

took a great interest in botany, and, after reaching manhood, traveled

extensively in the wake of different Roman armies, for the sole purpose

of studying by direct observation the plants of different countries

and of verifying the medicinal virtues which each one was reputed to

possess. In this way he visited, in turn, Greece, Italy, Asia Minor

and perhaps also the southern portion of France (the Narbonaise). He

collected great quantities of specimens of every kind of drug--animal

and mineral substances as well as objects belonging to the vegetable

kingdom; and, wherever it was possible to do so, he wrote memoranda of

the traditions of the natives with regard to the uses and medicinal

effects of these different drugs. After he had completed all these

researches and had gathered together all this vast mass of materials,

he wrote his famous treatise on materia medica--“the most complete,

the best considered, and the most useful work of its kind to be found

anywhere to-day.” (Galen.) It is from this treatise, therefore, says

Dezeimeris, that one can derive the most satisfactory idea of the

early Greek materia medica; but at the same time, he adds, it is not

a book in which will be found a detailed account of the manner in

which the practitioners of that period employed the remedies which he

describes. The same authority calls attention to the great difficulty

which modern physicians often experience in their attempts to identify

the drugs which Dioscorides describes. Le Clerc calls attention to

the fact that the physicians who were contemporaries of Dioscorides

were not in the habit of employing either iron or antimony (called by

them _stibium_) internally. Apparently they had not yet learned

that these substances possess properties which exert a curative action

in certain diseases. On the other hand, he mentions the manner of

extracting quicksilver, by chemical means, from cinnabar [red sulphide

of mercury], the steps required for preparing acetate of lead, and the

proper way of making lime water.

The work to which reference has been made above was published by

Dioscorides about the year 77 A. D. It is the earliest pharmacological

treatise that has come down to our time, and for many succeeding

centuries it served as the authoritative guide in all questions

relating to drugs. The first printed edition of the Greek original

appeared in Venice in 1499, but a still earlier Latin version was

issued in 1478. According to Pagel the best edition (in Latin and

fully illustrated) is that of Pietro Andrea Mattioli, which was printed

in Venice in 1554. Neuburger commends highly the German version by J.

Berendes. (Stuttgart, 1902.)

Of Caelius Aurelianus we possess no biographical details beyond the

facts that he was a native of Sicca in Numidia, Africa, and that he

lived toward the end of the fourth or during the first part of the

fifth century of the present era. He was the author of several works,

all but one of which, however, have been lost. The single treatise

which has come down to our time treats of acute and chronic diseases,

and is spoken of by Daremberg as being virtually a translation of

one of the lost writings of Soranus. This book, says Haeser in his

History of Medicine, is the most important source from which our

knowledge of Methodism is derived; and Neuburger not only agrees with

this statement, but adds that the treatise of Caelius Aurelianus

played a most important part, toward the end of the Middle Ages, in

the evolution of medicine. Up to the present time no translation of

this work into any modern language has been published, but Neuburger

furnishes a very full analysis of its important parts. In two places,

as appears from this analysis, Caelius Aurelianus mentions--among

the signs and symptoms of certain affections of the respiratory

apparatus--phenomena which show beyond a doubt that he (or Soranus) was

familiar with auscultation of the chest. The words which he uses are

these:--

“_Stridor vel sonitus interius resonans aut sibilans in ea parte quae

patitur,” and “sibilatus vehemens atque asper in ultimo etiam pectoris

resonans stridor._”

CHAPTER XV

CLAUDIUS GALEN

During the centuries immediately preceding the Christian era, Greek

medicine was represented by a collection of treatises which had been

written by Hippocrates and his followers on anatomical, physiological,

pathological, therapeutical and ethical subjects, and which constituted

a fairly complete but not always easily intelligible system. As

time went on, however, and especially as new and useful facts were

constantly being added to the existing stock of medical knowledge,

the more thoughtful physicians began to feel that the system, which

up to that day had proved acceptable, needed to be perfected in a

number of respects; and accordingly, as a result of this feeling of

dissatisfaction, and also as an expression of the prevailing desire

for a more perfect knowledge of the truth, there developed, as has

been stated in the preceding chapters, a number of different medical

sects. When Galen first appeared in the field as a physician of unusual

promise, these various sects were all still in a thriving condition.

The Methodists, in particular, were very popular. Galen did not favor

any special sect, but in his writings he made it manifest that he

attached more importance to the teachings of Hippocrates than to those

of any other author. “It was Hippocrates,” he said, “who laid the real

foundations of the science of medicine.” It is therefore not surprising

that Galen should have devoted so much time to the writing of elaborate

commentaries on the works of Hippocrates. The service which he thus

rendered to medicine, says Daremberg, was of very great value. But

Galen, notwithstanding his great admiration for Hippocrates, did not

hesitate to criticise a number of his teachings, and especially those

which, as he believed, were not stated with sufficient clearness.

Valuable as was the service rendered to medicine by the writing of

these commentaries, there still remained an urgent need for a service

of a different and much more difficult kind, viz., that of welding

together into a single clearly written and easily intelligible system

of medicine, all that was good in the Hippocratic writings and in the

disconnected and at times antagonistic teachings of the sects. To

accomplish this successfully required the services of a man endowed

with mental gifts of a most exceptional character--complete knowledge

of medicine in all its departments, a mind thoroughly trained in

philosophy, the power to express his thoughts in simple language,

and an independence and fairness of judgment which would render him

indifferent to the petty interests of the sects. Claudius Galen, as

subsequent events showed, possessed these very gifts in a high degree,

and he devoted the better part of his reasonably long lifetime to the

accomplishment of this much-needed work. How greatly it was needed at

that particular period of time, nobody then knew or could even suspect.

It soon appeared, however, that all the vaunted civilization of the

Graeco-Roman world--much of it of the purest gold and a great deal

of the basest alloy--was to be swept so completely off the face of

the earth that, for thirteen hundred or more years, almost no thought

whatever could possibly be given to the science and art of medicine.

Fortunate, most fortunate it was, therefore, that, before this wave

of destruction reached Rome, all the best part of Greek medical

literature--for such it was in truth--had been gathered together and

carefully systematized by Galen and stowed away in the recesses and

chambers of remotely situated monasteries and churches by clear-sighted

monks for the benefit of later generations of physicians.

_Brief Biographical Sketch._--Claudius Galen was born in Pergamum,

an important Greek city of Asia Minor, about the year 131 A. D., under

the reign of the Emperor Hadrian. His father, whose name was Nicon,

was a man of ample means, well informed in philosophy, astronomy and

geometry, and most liberal in providing for the thorough education of

his son in every branch of useful knowledge. In two or three places

in his writings Galen speaks of his father in terms of affection. On

the other hand, he does not hesitate to state in the plainest language

possible that his mother was a veritable Xanthippe. In her moments of

bad temper she would not only shout and scream in a violent manner, but

would sometimes go so far as to bite her serving-maids. Pergamum, at

the time of which I am writing, offered unusually good opportunities

for studying disease. Its Asclepieion, which was built during Galen’s

boyhood, had already become one of the famous temples of Asia Minor,

and the sick and maimed flocked to it in large numbers. Then, in

addition, the city was well equipped with able physicians, who appear,

according to Neuburger, to have been on very friendly terms with the

priests of the temple. It was under the guidance of such men that

Galen--at the early age of seventeen, and after a careful training in

philosophy, mathematics, etc.--began the study of medicine. He speaks

with special interest and respect of one of his instructors, a certain

Quintus, who had the reputation of being an excellent anatomist and at

the same time one of the most distinguished practitioners of that day.

Another anatomist, Styrus, was also one of Galen’s teachers.

On the death of his father Galen left his home and devoted the

succeeding nine years to visiting all the different cities in which

he believed he might gain some additional knowledge in medicine and

surgery. A large part of this long period was spent in Alexandria,

which still retained much of its importance as a home of all the

sciences. On attaining his twenty-eighth year he left that city and

returned to Pergamum, evidently with the purpose of establishing

himself there in the regular practice of his profession. Through

the influence of the temple officials, and especially of the High

Priest, Galen received the appointment of physician to the gladiators,

a position which he held with credit for a period of four years,

and which afforded him excellent opportunities for cultivating his

knowledge of surgery. It was while he was serving in this capacity

that he devised and put into practice a method of saturating the

dressings (in cases of severe wounds) with red wine, for the purpose

of preventing the development of inflammation in the parts affected;

and the success which he thus obtained was so great that not one of the

gladiators intrusted to his care died from his wounds. History does

not state the precise manner in which Galen carried out his method of

utilizing wine in the dressing of wounds, and we are therefore unable

to determine just how much credit he was entitled to receive for this

crude but apparently effective means of securing local antisepsis.

It is clear, however, that Galen’s treatment could only have been a

modification of a much older method, for Jesus, in his answer to a

question put to him by a lawyer, said: “But a certain Samaritan, as he

journeyed, came where he (the injured man) was: and when he saw him,

he had compassion on him, and went to him, and bound up his wounds,

pouring in oil and wine, and set him on his own beast, ...” (St. Luke

x., 33, 34).

At the end of four years there broke out in Pergamum a riot which

rendered residence there, at least for a certain length of time,

undesirable. Accordingly Galen, who was now thirty-two years old,

and who was probably glad of an excuse for leaving a place where a

physician of his education and talents had so few opportunities for

gaining distinction, decided to visit Rome, and--if circumstances

appeared to favor the plan--to settle there. His first impressions

after arriving in that metropolis were favorable to the plan of

establishing himself there permanently, but at the end of a few years

he became conscious of the growing hostility of those practitioners

who had been for a longer time than he well established in that city.

This hostility increased as he rose in favor and esteem with people

of position and influence. He had treated skilfully and with success

Eudemus, a peripatetic philosopher of great celebrity, for a quartan

fever. He had also cured the wife of Boëthus (a patrician who belonged

to the consular class) of a serious illness and had received as an

expression of appreciation a gift of four hundred pieces of gold. He

had won the friendship and esteem of such men as Sergius Paulus, the

Praetor; of Barbaras, the uncle of the Emperor Lucius; and of Severus,

who was at that time Consul, but who later became Emperor. These very

influential men took an active interest in Galen’s scientific work,

having been invited by him on more than one occasion to witness his

dissections of apes,--dissections which he made for the particular

purpose of demonstrating the organs of respiration and of the voice.

All these facts soon became known to Galen’s rivals and probably helped

to fan the spark of their envy into a flame; but it is very doubtful

whether he was justified in saying that the ill feeling thus engendered

threatened to end in some act of personal violence, for which reason

he decided to leave Rome and return to Pergamum. His secret manner

of departure, without taking leave of anybody, and the fact that the

Plague was just at that time rapidly approaching Rome, justify the

belief, says Neuburger, that it was not fear of personal violence at

the hands of his jealous rivals that drove Galen away so mysteriously

from the city in which, in the short space of four or five years,

he had won so great professional success, but an unwillingness to

face his duty, which was, to remain and aid in the approaching fight

against the great destroyer--the Plague. If Galen had been a simple

physician, one of the great body of medical practitioners in Rome, no

one would be disposed to question the justice of the criticism which

the distinguished Viennese historian makes of his decision to abandon

that city at the moment of her distress and peril. But, as a matter

of fact, Galen was not a practitioner of medicine in the full sense

of that term. He treated cases of illness because in no other way

would it be possible for him to acquire the necessary familiarity with

disease; but, almost from the very beginning, he seems to have fully

realized that he was destined to devote his time and his energies to

a very different kind of professional work,--work which was urgently

needed, which promised to be of very great value to medical science,

and which probably no other physician then living was competent to do

effectively. Furthermore, he was himself profoundly conscious that the

work in question constituted the main object of his life. His own words

(see his statement with reference to Archigenes, on page 174) show

this plainly, and the huge mass of medical treatises which he wrote

reveal in the most unmistakable manner with what untiring persistency

he pursued the path which he believed it was his duty to follow. It

being assumed, then, that such were the motives which actuated Galen,

was it a mistake on his part to conclude that duty did not require him

to remain in Rome? The question is a difficult one to answer, and I do

not feel called upon to decide it. We do not, however, brand a general

in the army a coward because he endeavors to protect himself as much

as possible from danger during a battle, that he may be able, to the

very end, to direct the soldiers under his command. Similarly, was not

Galen justified in avoiding every risk which was likely to imperil the

performance of duties which were of far greater value to medicine and

to humanity at large than that of acting as a mere soldier in the ranks

of medical men?

It seems a great pity that one of the most inspiring figures in the

history of medicine should be represented to posterity with such a

blemish upon his character, and I have therefore ventured to suggest a

possible defense of Galen’s action.

Not very long after he had returned to Pergamum, Galen was summoned

by the Emperors Marcus Aurelius and Lucius Verus, who were then with

the army at Aquileia, a few miles north of the present Trieste, to

join them at that city; and he was, of course, obliged to obey. A

fresh outbreak of the Plague had occurred and there had already been

many fatal cases among the troops. It was therefore decided by the

emperors, almost immediately after Galen’s arrival, to return to Rome

with a part of the army. A start was accordingly made, and the company

had already advanced some distance on their way, when Lucius Verus

died. This unexpected event greatly increased the difficulties of

the return journey, as it was deemed necessary to carry the remains

of the deceased Emperor back to the imperial city. Thus Galen found

himself once more settled in Rome, this time in the capacity of private

physician to the Emperor Marcus Aurelius and his sons Commodus and

Sextus. The position was extremely well adapted to the needs of Galen,

who, from that time forward, for a period of several years, had at his

disposal ample time for writing and for conducting his experimental

work in anatomy and physiology, a privilege of which he appears to have

made excellent use. He lived to be seventy years of age, his death

occurring during the latter part of the reign of Severus, or at the

beginning of that of Caracalla (about 201 A. D.).

All Galen’s critics agree that he possessed his full share of

peculiarities,--not to call them by the harsher name of faults. He was

constantly ready, for example, to praise his own doings and sayings,

and he rarely lost an opportunity of holding up the physicians of Rome

to ridicule and contempt. He was specially bitter in his criticisms of

Methodism and its adherents--“the donkeys of Thessalus,” as he called

them. At the same time, no other physician of ancient or modern times

has manifested to an equal degree such extraordinary industry as a

writer and original investigator in a great variety of departments of

knowledge. Although many of his works have been lost,[39] those which

have come down to our time are still very numerous--“a sufficient

number,” says Neuburger, “to constitute a library by themselves.” I

give here a few of the titles of these works, in order that the reader

may get at least some idea of the great variety of medical topics which

Galen has discussed in his writings. The more complete list furnished

by Daniel Le Clerc contains nearly two hundred titles, and yet even

this is believed to fall short of the actual number.

SELECTED LIST OF THE WORKS OF GALEN RELATING TO

MEDICINE. (FROM LE CLERC.)

Explanation of some of the Ancient Terms Employed by Hippocrates.

On the Establishment of the Art of Medicine.

Definitions of Medical Terms.

On the Different Sects in Medicine.

Discourse against the Empirics.

On the Importance, for a Physician, of a Thorough training in

Philosophy.

The Physician; or Introduction to Medicine.

The Elements, as taught by Hippocrates. (2 books.)

The Different Temperaments. (3 books.)

On the Nature of Man; Commentaries on two Books of Hippocrates.

(2 books.)

The Humors.

Do the Arteries Normally contain Blood?

On Black Bile.

On the Bones. (For Students in anatomy.)

Dissection of the Vocal Organs.

The Anatomy of the Eyes.

Dissection of the Veins and Arteries.

Dissection of the Nerves.

On the Utility of the Different parts of the Body. (17 books.)

On the Natural Faculties. (3 books.)

The Sentiments of Hippocrates and of Plato. (9 books.)

The Organ of Smell.

The Movements of the Muscles. (2 books.)

The Physiology of Respiration.

On Obesity.

On the Maintenance of Health. (6 books.)

The Characteristics of Different Foods. (3 books.)

Precepts regarding the Diet best suited to the Four Different

Seasons and to Each of the Twelve Months of the Year.

On the Manner of Living best suited to those who Wish to

Preserve their Health. (3 books.)

On Habit.

On the Differences between Diseases.

On the Causes of Diseases.

On Marasmus or Consumption.

On the Different Kinds of Fevers. (2 books.)

On Thirst.

On the Parts of the Body Affected. (6 books.)

The Diseases of Women.

The Different Kinds of Pulse. (16 books.)

The Different Kinds of Urine.

On Critical Days. (3 books.)

Commentaries on the Treatises of Hippocrates. (39 books.)

On the Manner of Treating Different Maladies. (17 books.)

On Venesection. (3 books.)

On the Use of Cups, Leeches and Scarifications.

On Purgatives. (3 books.)

On Colic.

On Jaundice.

On Gout.

On Stone in the Bladder.

Etc.

The numerous works of Galen, says Pagel, constitute a complete and

very satisfactory encyclopaedia of medicine. The most available

edition of his works in Greek is that of Karl Gottlob Kühn of Leipzig

(1821–1828; 22 Vols. of about 1000 pages each). There is scarcely a

department which this great physician has not treated quite fully. But,

unfortunately, the translations into modern languages are relatively

few, and they cover only small portions of the entire work. That

of Daremberg, entitled “_Oeuvres anatomiques, physiologiques et

médicales de Galien, etc._” (Paris, 1854–1857; 2 Vols.), is in every

way most satisfactory, and it is from this source that I have made a

few extracts--just sufficient to give the reader some idea of Galen’s

style of writing and of his competency to deal with such subjects as

human anatomy and physiology. To attempt anything like a complete

exposition of his views regarding pathology, therapeutics, hygiene,

etc., would necessitate my devoting more space to this part of the

history of medicine than I can afford to give. To those who desire to

obtain more ample information about Galen’s views regarding pathology

and therapeutics I would recommend a study of Daremberg’s admirable

work and a perusal of the careful analysis made by Neuburger of certain

portions of Galen’s text.

_Galen’s Contributions to Anatomy and Physiology._--At the

period of time about which I am now writing, and for many centuries

afterward, there existed among all classes of the community a very

strong prejudice against dissecting human corpses. And even Galen

himself appears to have shared this prejudice, for, in spite of his

intense eagerness to gain a more perfect knowledge of human anatomy, he

apparently did not dare to undertake any such investigation, even when

a favorable opportunity for so doing presented itself, as it did on the

occasion to which he refers in the following brief extract taken from

one of his treatises:--

A carelessly constructed sepulchre on the banks of a river had

been undermined during a season of flood, and the corpse thus

set free had floated down stream a short distance, until it

finally lodged on the shore of a small cove. Passing near by I

had the opportunity of inspecting this corpse. The fleshy parts

had already disappeared to a great extent through the process

of decomposition, but the bones were still held together by

their fibrous connections. The picture presented to the eye was

that of a human skeleton specially prepared for the instruction

of young physicians. On another occasion, a few steps from the

main road, I came across the dead body of a robber who had been

killed by the traveler whose money he had attempted to steal.

The peasants of that neighborhood were not willing to bury the

corpse of such a bad man, and they accordingly allowed it to

remain at the spot where it was first discovered. In the course

of the following two days, as might be expected, the vultures

removed every particle of flesh from the bones, so that, when

I saw what remained of the body, the only thing visible was a

nicely cleaned skeleton.

(Le Clerc: _Histoire de la Médecine_, p. 711.)

Here were two excellent opportunities for gaining the additional

knowledge of human anatomy which Galen so much desired, but he

evidently was not at all disposed to avail himself of them--doubtless

because his mind was deeply imbued with the feeling that any such

interference on his part would be a sacrilegious act. Under the

circumstances, therefore, there was nothing left for him to do but

to utilize animals for purposes of dissection, and more particularly

apes, whose anatomy very closely resembles that of the human being.

Several of Galen’s books on anatomy have come down to our time, but

quite a number of others have been lost. From those which we possess,

and especially from the one entitled “Anatomical Administrations,”

it is permissible to conclude that he was a most skilful dissector

and an extremely close and careful observer, and that he was very

particular to set down the results of his observations in admirably

clear language. Indeed, Le Clerc assures us that Vesalius, the great

Flemish anatomist of the sixteenth century, bestowed high praise upon

Galen’s anatomical descriptions; and that, too, notwithstanding the

fact that the latter sometimes erred in his statements regarding the

similarity between certain parts observed in dissections of an animal

and the corresponding parts in man. In one of his treatises[40] Galen

states distinctly that the arteries contain blood. In another he gives

a remarkably full and accurate description of the nervous system,

including the brain, spinal cord, and many of the nerves.

He describes the optic nerve, the oculo-motorius and

trochlearis, the different ramifications of the trigeminus, the

acusticus and facialis, the vagus and glossopharyngeus, the

nerves of the pharynx and larynx, the sympatheticus (with the

accompanying ganglia), and the radial, ulnar, median, crural and

ischiatic nerves. (Puschmann.)

Although it is true that certain important anatomical and physiological

facts are found recorded for the first time in the works of Galen,

this must not be accepted as evidence that Galen himself is the real

discoverer of these facts. The most that can be claimed for him is that

he is the first writer to bring the facts in question to the knowledge

of us moderns. When the ancient books that have been lost are once

more brought to light, as they very well may be at any time, we shall

be able, perhaps, to give credit where credit is due. But there is one

department in which Galen did experimental work of an entirely original

character and for which he deserves unstinted praise. I refer to the

experiments which he made concerning the physiology of the brain and

spinal cord. They are related in the following extract, which has been

translated from the account given by Neuburger (_op. cit._, Vol.

I., p. 380):--

The brain itself is not sensitive; it expands and contracts

synchronously with the respiratory movements, the purpose of

which action is to drive the pneuma from the cavities of that

organ into the nerves. The function of the meninges is to hold

the parts firmly together and to unite the blood-vessels.

Pressure upon the brain causes stupor. An injury of the tissues

surrounding the fourth ventricle or of those which constitute

the beginning of the spinal cord produces death. The seat of

the soul is in the substance of the brain, and not in its

membranes. The spinal cord serves as a conductor of sensation

and of motor impulses, and it also plays the part of a brain

for those structures of the body which lie below the head.

It gives off nerves like streamlets. Division of the spinal

cord longitudinally in its median axis does not give rise to

paralysis. Transverse division, on the other hand, causes

symmetrical paralyses. If the cord is divided between the third

and fourth cervical vertebrae, respiration is arrested, and

if the division is made between the cervical and the thoracic

portions of the spinal column, the animal breathes with the aid

only of its diaphragm and of the upper muscles of the trunk of

the body. Division of the recurrent nerves produces aphonia; if

the fifth cervical nerve is divided, the scapular muscles on

the corresponding side will be paralyzed. Galen considers the

ganglia to be organs for reinforcing the energy of the nerves.

The fact that both cerebral and spinal-cord nerve-filaments

enter into the composition of the sympathetic nerve explains the

extraordinary sensitiveness of the abdominal organs.

When we consider that these experiments are the first of their kind

of which history makes mention, that they were carried out nearly

seventeen hundred years ago, and that--so far as we know--they sprang

entirely from the brain of the experimenter, we may well express

unlimited admiration for Claudius Galen.

Daniel Le Clerc says that Galen’s principal treatise on human

physiology, entitled “Utility of the Different Parts of the Human

Body,” constitutes a _chef-d’oeuvre_ which has challenged the

admiration of physicians and philosophers in all ages. Christians,

however, he adds, are particularly gratified to learn from this work

that “Galen, although classed as a Pagan, unhesitatingly recognizes

that it was an all-wise, an all-powerful, an all-good God who created

man and all the other animals.” Further on, Le Clerc refers to another

statement which was made by Galen and which will be found on page 261

of Daremberg’s version. It reads as follows:--

If I were to spend any more time in talking about such

brutes--by which term he designates men who cannot appreciate

the wisdom of God in distributing the different parts of the

body in the manner in which He has done this--I should justly

incur the blame of sensible persons. They would accuse me of

desecrating the account which I am writing, an account which is

intended as a hymn of sincere praise of the Creator of man. I

believe that true piety consists, not in sacrificing numberless

hecatombs nor in burning unlimited quantities of incense and a

thousand perfumes, but in first searching out and then making

known to my fellow men how great are the wisdom, the power, and

the goodness of the Creator.

Galen’s work on “The Utility of the Different Parts of the Human Body”

is composed of seventeen books, all of which exist to-day in a complete

state. Taken together they form, as may be seen by the following list

of contents, a remarkably complete treatise on physiology. Books I. and

II. are devoted to the hand, forearm and arm (105 pages); Book III. to

the thigh, leg and foot (62 pages); Books IV. and V. to the alimentary

organs and their accessories (101 pages); Book VI. to the respiratory

organs (78 pages); Book VII. to the organs of the voice (67 pages);

Book VIII. to the head, the encephalon and the organs of special sense

(45 pages); Book IX. to the cranium, the encephalon and the cranial

nerves (38 pages); Book X. to the eyes and their accessories (45

pages); Book XI. to the face and more particularly the jaws (55 pages);

Book XII. to the neck and the rest of the spinal column (46 pages);

Book XIII. to the shoulder and the structure of the spinal column in

detail (40 pages); Books XIV. and XV. to the genital organs and the

parts in which the foetus develops (70 pages); Book XVI. to the nerves,

arteries and veins (43 pages); and Book XVII. Epilogue (11 pages).

There are very few modern text books in which the author treats the

subject in as exhaustive a manner as Galen has done in these seventeen

books. As may readily be imagined from the great number and length

of his writings, he often wanders off into side issues and thus lays

himself open to the charge of being a diffuse writer. At the same

time he cannot be accused of dullness, for in reading Daremberg’s

version one is seldom tempted to omit any of the text, and his style

is interesting. The following brief extracts, to which should be added

that given on a previous page, may be taken as fair samples of his

manner of treating questions in the department of physiology:--

_Reasons why the Alae Nasi are Cartilaginous and why they may

be Moved by Voluntary Muscular Action._--We have already

explained in some measure the reasons why the alae nasi should

be composed of cartilage and why it should be possible for the

animal to move them at will.[41] It is an established fact that

the movements of these parts are competent to aid in no small

degree the somewhat forcible inspirations and expirations. This

is the reason why the alae are constructed in such a manner as

to be easily movable. They are made of cartilage because this

substance is hard to fracture or to tear apart. The placing

of these alar movements under the control of the will, and

not under that of some other bodily force (like the arterial

impulse, for example), is certainly an excellent arrangement;

and, if one does not appreciate this without any further

explanation, it must be because my previous reasonings about

such matters have fallen upon inattentive ears.

(Translated from Book XI., Chapter XVII., of Daremberg’s French

version of Galen’s works.)

Another brief extract may be given here. It forms a part of the chapter

relating to the action of the sigmoid valves of the pulmonary artery,

etc., and merits special attention because it furnishes additional

evidence of the correctness of Daremberg’s statement that Galen was

the leader of the most advanced school of experimentation:--

The more strongly the thorax, in its exertion of a compressing

force, tends to drive the blood (out of the heart), the more

tightly do these membranes (the sigmoid valves) close the

opening. Invested in a circular manner from within outward,

extending throughout the entire circumference of the interior

of the vessel, these membranous valves are, each one of them,

so accurately patterned and so perfectly fitted that when they

are put upon the stretch by the column of blood, they constitute

a single large membrane which closes (watertight) the orifice.

Pushed back by the return flow of the blood, they fall back

against the inner surface of the vein, and permit an easy

passage of the blood through the amply dilated orifice (which

they, an instant before, closed so perfectly).

(Translated from Book VI., Chapter XI., of Daremberg’s French

version of the works of Galen.)

In his comments upon the account of the sigmoid valves which I have

just quoted, Daremberg says that the description of these structures

given by Erasistratus at least four hundred years earlier is admitted

by Galen to be so correct that it would scarcely be possible to furnish

a better one.

_Galen’s Remarks upon the Subject of Diagnosis._--In the treatise

entitled “On the parts of the Body Affected” (Book II., Chapter X.)

Galen gives the following advice with regard to the method which it is

desirable to adopt when one wishes to ascertain which part or organ is

affected, what is the nature of the disease there located, and whether

it is primary in its nature or secondary to some affection of earlier

development:--

It should have been the special duty of Archigenes, who

appeared on the scene next in order after a series of the most

illustrious physicians,[42] to infuse more light into medical

teaching. Unfortunately, he did the very opposite; for we who

have grown old in the exercise of the art (and should therefore

find it easy to comprehend what is written about medicine), are

at times unable to understand what he says. Such being the true

state of affairs, I now propose to undertake what Archigenes

failed to accomplish. I shall commence by indicating in a

general way what is the proper method to adopt when one wishes

to ascertain in what part or organ the disease is located and

how one should proceed when it is proposed to teach the method

to others. This method may be stated in the following terms:--

In the first place, the part should be carefully examined in

order that we may ascertain whether it presents any signs of

special value as indicating the nature of the disease. In the

next place, it is important in such an examination to know

beforehand what are the particular signs which belong to each

of the diseases that may affect the part or organ in question,

and also whether these signs vary according to the particular

section of the organ involved. In inflammation of the lung,

for example, there are: difficulty in breathing (dyspnoea) and

great general distress (malaise), the patient being obliged to

remain in a sitting posture (orthopnoea)--all of which are signs

indicating the possibility of suffocation. Furthermore, the

air expired from the infected lung is sensibly hot, especially

if the inflammation is of the erysipelatous variety, and, as

a consequence, the patient shows a disposition to draw long

breaths, knowing that the cold air which he thus draws into

his lungs will afford him some measure of relief. The sputa

expectorated when he coughs are differently colored; some

being red, yellowish, or of a rusty appearance, while others

are almost black, livid, or frothy. The patient also often

experiences the sensation of a heavy weight in his chest,

together with more or less pain, which seems to be located

deep down in that region and which shoots backward into his

spinal column or forward toward the sternum. Add to these

manifestations a high fever and a pulse such as we have already

described on another page, and you will have....

(Translated from Daremberg’s French version of Galen’s works.)

It has been said that Galen possessed more than the ordinary share of

vanity with regard to his cleverness as a diagnostician; and certainly

some of the accounts which he gives, in his clinical and scientific

treatises, of his own experiences, seem to bear out this accusation.

One hesitates to expose the weak spots in the character of one of the

really great men of antiquity lest such exposure may convey a wrong

impression; at the same time it would be an error to represent him as

a man entirely free from the foibles common to humanity,--even to the

best and wisest of men. I therefore repeat here Galen’s own account of

a professional visit which he made to a brother physician whose malady

presented to himself and to his friends many obscure features.

Upon the occasion of my first visit to Rome I completely won the

admiration of the philosopher Glaucon by the diagnosis which I

made in the case of one of his friends. Meeting me one day in

the street he shook hands with me and said: “I have just come

from the house of a sick man, and I wish that you would visit

him with me. He is a Sicilian physician, the same person with

whom I was walking when you met me the other day.” “What is the

matter with him?” I asked. Then coming nearer to me he said,

in the frankest manner possible: “Gorgias and Apelas told me

yesterday that you had made some diagnoses and prognoses which

looked to them more like acts of divination than products of the

medical art pure and simple. I would therefore like very much to

see some proof, not of your knowledge but of this extraordinary

art which you are said to possess.” At this very moment we

reached the entrance of the patient’s house, and so, to my

regret, I was prevented from having any further conversation

with him on the subject and from explaining to him how the

element of good luck often renders it possible for a physician

to give, as it were off-hand, diagnoses and prognoses of this

exceptional character. Just as we were approaching the first

door, after entering the house, we met a servant who had in his

hand a basin which he had brought from the sick room and which

he was on his way to empty upon the dung heap. As we passed

him I appeared not to pay any attention to the contents of the

basin, but at a mere glance I perceived that they consisted of a

thin sanio-sanguinolent fluid, in which floated excrementitious

masses that resembled shreds of flesh--an unmistakable evidence

of disease of the liver. Glaucon and I, not a word having been

spoken by either of us, passed on into the patient’s room. When

I put out my hand to feel of the latter’s pulse, he called my

attention to the fact that he had just had a stool, and that,

owing to the circumstance of his having gotten out of bed, his

pulse might be accelerated. It was in fact somewhat more rapid

than it should be, but I attributed this to the existence of

an inflammation. Then, observing upon the window sill a vessel

containing a mixture of hyssop and honey and water, I made up

my mind that the patient, who was himself a physician, believed

that the malady from which he was suffering was a pleurisy; the

pain which he experienced on the right side in the region of

the false ribs (and which is also associated with inflammation

of the liver) confirming him in this belief, and thus inducing

him to order for the relief of the slight accompanying cough

the mixture to which I have just called attention. It was then

that the idea came into my mind that, as fortune had thrown the

opportunity in my way, I would avail myself of it to enhance

my reputation in Glaucon’s estimation. Accordingly, placing my

hand on the patient’s right side over the false rib, I remarked:

“This is the spot where the disease is located.” He, supposing

that I must have gained this knowledge by simply feeling his

pulse, replied with a look which plainly expressed admiration

mingled with astonishment, that I was entirely right. “And”--I

added simply to increase his astonishment--“you will doubtless

admit that at long intervals you feel impelled to indulge in

a shallow, dry cough, unaccompanied by any expectoration.” As

luck would have it, he coughed in just this manner almost before

I had got the words out of my mouth. At this Glaucon, who had

hitherto not spoken a word, broke out into a volley of praises.

“Do not imagine,” I replied, “that what you have observed

represents the utmost of which medical art is capable in the

matter of fathoming the mysteries of disease in a living person.

There still remain one or two other symptoms to which I will

direct your attention.” Turning then to the patient I remarked:

“When you draw a longer breath you feel a more marked pain, do

you not, in the region which I indicated; and with this pain

there is associated a sense of weight in the hypochondrium?”

At these words the patient expressed his astonishment and

admiration in the strongest possible terms. I wanted to go a

step farther and announce to my audience still another symptom

which is sometimes observed in the more serious maladies of the

liver (scirrhus, for example), but I was afraid that I might

compromise the laudation which had been bestowed upon me. It

then occurred to me that I might safely make the announcement

if I put it somewhat in the form of a prognosis. So I remarked

to the patient: “You will probably soon experience, if you have

not already done so, a sensation of something pulling upon the

right clavicle.” He admitted that he had already noticed this

symptom. “Then I will give just one more evidence of this power

of divination which you believe that I possess. You, yourself,

before I arrived on the scene, had made up your mind that your

ailment was an attack of pleurisy, etc.”

Glaucon’s confidence in me and in the medical art, after this

episode, was unbounded.

Thirty or forty years elapsed after Galen’s death before the Profession

began to realize how great an authority he had become in all matters

relating to medicine; not perhaps among the majority of physicians, but

among the better educated and those more given to reasoning about the

various problems in physiology and pathology. Then came the invasion

of Rome by the Barbarians, and with it the scattering of nearly all

those who were at the time practicing medicine in that great city.

This was the beginning of the long period known as the Middle Ages,

a period during which, so far as Italy and Gaul were concerned, the

science of medicine made no advance whatever. The physicians living

in a precarious manner in the towns, and the monks who practiced

medicine in the country districts, took very little interest, as may

readily be imagined, in the achievements of Galen. Through all those

years they clung to the doctrines of the Methodists, as revealed to

them in the work of Caelius Aurelianus, the favorite medical treatise

of that period. It was only during the latter part of the Middle Ages

that Galen’s teachings began once more to be appreciated at their true

value; and, as time went on, they gained a stronger and stronger hold

on the minds of medical men, until finally they held undisputed sway.

Friedlaender, speaking of medicine in those dark times, uses these

words: “Galen’s colossal personality loomed up throughout that long

night as a brilliant guiding star to light the intricate pathways of

medicine.”

CHAPTER XVI

THE INFLUENCE OF CHRISTIANITY UPON THE EVOLUTION OF MEDICINE

The religion established by Jesus Christ in Judea during the early part

of the first century remained confined within the limits of that region

for a number of years, but already during the latter half of that

period groups of Christians were to be found in every part of the Roman

Empire, and in certain localities the membership of the new church had

increased so greatly in numbers as to excite the alarm and hostility

of the temple priests and of the governing officials. Persecutions,

especially in the city of Rome and at the instigation of Nero, became

more and more frequent and more and more pitiless, but they failed

utterly to destroy the new religion, so firmly was it rooted in the

followers of Jesus Christ. As a matter of fact its spread was checked

for only a few years, and then its adherents increased in numbers more

rapidly than ever. Neuburger, in his “History of Medicine,” makes the

following quotation from the account which Dionysius of Alexandria

gives of the great plague that occurred during the third century A. D.:

The majority of our brethren in their love for their neighbors

did not spare themselves, but acted as a unit in their efforts

to assist. They visited the sick without the slightest fear and

gave them the very best of care, for the sake of Christ....

Among the non-Christians, however, the very opposite was true.

As soon as any of their number fell ill they pushed them to one

side, even those who were dearest to them, and, before they were

more than half-dead, they threw them out into the street and

took no care to bury the dead bodies.

Such an example of self-sacrifice and humanity--and there must have

been very many similar examples--could not possibly have failed to make

a profound impression upon the community at large. Daniel Le Clerc says

that three physicians suffered martyrdom for their Christian faith

during the reigns of the Emperors Marcus Aurelius, Lucius Verus and

Commodus. They were Papila (of Pergamum), Alexander (of Lyons) and

Sanctus (a contemporary of Galen), whose death was of a particularly

cruel character. Credit should also be given to Christianity, says

the same writer, for having established the rule that every community

should assume the expense and responsibility of caring for its own

poor and sick. This was a step of the greatest importance; and, at

a still later period, when Christianity became largely an affair of

the state, a complete hospital organization was effected, with the

bishop as the chief officer and, under him, deacons and deaconesses.

Such well-organized institutions proved to be of the greatest possible

benefit to the advance of medical science. They were the worthy

successors of those more ancient hospitals, the Aesculapian temples,

which were first established by the Greeks in the pre-Hippocratic age,

and they have continued in an unbroken chain from the institutions of

those primitive times to the thoroughly well-equipped hospitals of the

present day.

In 330 A. D. the new capital of the Roman Empire was established

in Byzantium, afterward called Constantinople, and Rome, which for

hundreds of years had been the metropolis of the world and the source

from which a large part of Roman history had emanated, was given a

subordinate position. Then followed, in 410 A. D., the conquest of the

latter city by the Visigoths, a horde of uneducated Barbarians who had

felt the might of Rome in previous years, and who now doubtless took

immense satisfaction in humiliating her and in destroying her valuable

possessions. There are good reasons for believing that, when the

Emperor Constantine established his residence in Byzantium, the leading

physicians of Rome followed him; and it is not likely that many of

those who, for one reason or another, preferred to remain in the old

capital, continued to do so after it became known that the Barbarians

were approaching the city. But the migration of these physicians to the

new capital did not mean a renewal there of the scientific activity

which had characterized the growth of Greek medicine in Rome during

the first two centuries of the Christian Era. It is probable that

the fugitives, being obliged to travel with the smallest amount of

baggage possible, left the major part of their books and papyrus rolls

behind, hoping, no doubt, that they might be able at some later date

to recover them. But the favorable occasion never arrived, and thus a

great deal of valuable medical literature entirely disappeared. The

loss, however, might have been even more serious than it was if the

Christian church had not already (during the third century) begun to

establish monasteries in secluded and inaccessible spots. It was to

these institutions that not only books of a religious character, but

also those relating to the science of medicine, were transported for

safe keeping during the early Middle Ages. Farther on, I shall have

occasion to refer to this subject again and to discuss more fully

certain other benefits which accrued to medical science from these

monastic institutions.

But while, on the one hand, the Christian church through the

instrumentality of the monasteries was lending its aid to the

preservation of the sources of medical knowledge, it was, on the other,

doing its best to arrest all further evolution of that branch of

science; not consciously, it must be admitted, but through a mistaken

sense of its duty to God. Thus it came about that the Emperor Justinian

I. (527–567 A. D.), acting under the narrow-minded advice of his

ecclesiastical counsellors, closed the medical schools at Athens and

Alexandria and at the same time withdrew the regular allowance of money

which up to that time had been paid to the state physicians and to

special scholars. A few years later, however (_i.e._, in the early

part of the seventh century A. D.), some of the more highly educated

physicians of Alexandria got together and made the attempt to organize

a school of medicine in that city. A course of lectures was planned

and sixteen of Galen’s works, carefully chosen for the purpose, were

made the basis of the new course of instruction. The books selected

were first carefully edited and simplified, and then commentaries

were added in order that in their final shape these treatises might

be better suited to the uses of students. The invasion of Alexandria

by the Arabs, however, soon put an effectual stop to this promising

attempt to revive Greek medicine.

In this brief sketch I have thus far mentioned only the more direct

effects produced by the new religion upon the evolution of medicine.

The indirect effects, however, were also in some cases of very great

importance. At the beginning of her history there developed in the

Christian church, among her chief men, a strong disposition to quarrel

over dogmas. To apply the term quarrelsomeness to this tendency may

easily convey a wrong impression. It was, more strictly speaking, a

highly developed conscientiousness on the part of men whose minds were

deeply imbued with the idea that they were rendering God a service by

keeping what they believed to be the true and only religion free from

errors of all kinds. It took many centuries to impress the leaders

of the church with the fact that the religion of Jesus Christ, like

the science of medicine or the natural sciences, was capable of

development to an almost indefinite extent; and it is owing to our

appreciation of this important fact that we moderns look with so much

more lenient eyes upon the distressing, not to say cruel, events

of mediaeval ecclesiastical history. At the time of which I am now

writing, however, it was considered highly unchristian--especially

for one holding authority in the church--to believe otherwise than

as her doctrines taught; and accordingly, in the early part of the

fifth century A. D., Nestorius, the Patriarch of Constantinople, was

deposed from his high office by a Council of the church and imprisoned

because he was unwilling to teach the doctrine of the miraculous birth

of Jesus Christ. Those who accepted the view held by Nestorius--and

they eventually became a very numerous and a very influential body of

Christians--were driven out of Constantinople and compelled to seek

homes in distant places. This affords, perhaps, an explanation of the

fact that, during the eighth century A. D., many Nestorian Christians

were found living in the eastern part of Syria and in Persia; and it

seems fair to assume that these Christian communities represented

to some extent the direct successors of those Nestorians who had

taken refuge in this remote corner of Asia Minor three hundred years

earlier. Furthermore, it is highly probable that there were Christian

communities in this region several centuries before the Nestorians

arrived, for it is believed that the Apostles James and Thomas visited

Persia and the northeastern part of Syria in the course of their work

as evangelists. It is not known, though, how many of the descendants of

these earlier Christians adopted the peculiar beliefs of the Nestorian

refugees.

And here it should be stated that the facts which have thus far

been mentioned are not the only ones that throw some light upon the

relationship subsisting between Christianity and the spread of medical

knowledge to Western Europe. Those which remain to be considered

are of two kinds, viz., facts relating to the origin of the Arabic

Renaissance, and facts which show that the Christian church, from the

fourth century onward, was contributing not a little, through the

establishment of the great monastic orders, such as the Benedictines,

the Dominicans, and the Franciscans, to the preservation if not to the

further evolution of Graeco-Roman medical knowledge. I shall reserve

for consideration in a later chapter this particular part of the

history of medicine; and in the meantime I shall endeavor to describe

the events which preceded and rendered possible the active study of

Greek medicine on the part of the followers of Mohammed.

So far as history furnishes us with any information on the subject, the

Nestorians who lived in Persia, Syria and Mesopotamia were Christians

of a remarkably liberal type. They appear to have been an unusually

peaceable people, for not only were they kindly disposed toward one

another, but they seem to have been on the best of terms with their

Jewish neighbors, who, like themselves, were eager after knowledge.

Already at a very early period there existed at Djondisabour--a

town which had been founded in the Province of Khorassan, in the

northeastern part of Persia, about the year 260 A. D., by Sapor II.,

King of that country--a school in which the medicine of Hippocrates

was taught. Freind, in his “History of Physick” (London, 1727),

says that about the year 272 A. D. the Emperor Aurelian (Lucius

Domitius Aurelianus), as a compliment to his daughter, who was the

wife of the King of Persia, sent to Djondisabour, the city in which

she resided, several Greek physicians; and Abulpharagius, the Arab

historian (thirteenth century), intimates that these were the men

who conducted the teaching in the newly established medical school.

Another possibility suggests itself. After the death of Alexander the

Great in Babylon (323 B. C.), from malarial fever, it is not unlikely

that some of the numerous Greek physicians who accompanied the army in

an official character, and who, we are warranted in believing, were

exceptionally well educated, decided not to remain in that unhealthy

district, but to settle in some of the neighboring towns (_e.g._,

Nisibis in the hill country to the north of Babylon, or Sura to the

east of the river Tigris); and that these men also contributed their

share toward the planting and perpetuation of Greek medicine in this

district of the Orient. However, the salient fact in this period of

the history of medicine is this: When Almansur, the Caliph of Bagdad

(712 to 775 A. D.), made up his mind to introduce Greek medicine into

his kingdom and looked around for the ways and means of accomplishing

this, he found at the city of Djondisabour men who were not only well

versed in Greek medicine, but who at the same time were so thoroughly

grounded in all departments of scholarship that they could at once

begin the work of translating the writings of Hippocrates and other

classical medical authors into Arabic, the language of the Mohammedans.

But at this stage of affairs the existence of a serious obstacle was

discovered. The writings which it was proposed to translate were not

immediately obtainable, and it therefore became necessary to institute

without delay a vigorous search for the books required. In order that

the reader may appreciate fully the difficulties which Almansur had to

overcome, in this matter of a scarcity of Greek originals, it seems

best to pause at this point, and to review briefly some of the facts

which bear upon the question at issue.

_The Wholesale Destruction of Medical Literature during the Early

Centuries of the Christian Era._--The invasion of Rome in 410 A. D.

was one of the first events which entailed a serious loss of the Greek

medical books that had been accumulating for several centuries in that

city. Fortunately, not a few of these works were rescued in time by

the church authorities and deposited for safe keeping in the various

monasteries scattered all over the Roman Empire. A still more serious

destruction of books occurred about the year 638 A. D., when Amrou, a

famous Arabian warrior, captured Alexandria and--under the instructions

of his master, Omar ben Khattab--destroyed the greater part of the

contents of the famous libraries located in that city. The narrative of

this event, as told by Lucien Le Clerc, is as follows:--

John the Grammarian,[43] who was living at that time in

Alexandria, held the following conversation with Amrou on a

certain occasion: “You have inspected all the edifices of

Alexandria, and have sequestrated all their contents. I have no

objections to your appropriating everything that may be of use

to you; there are certain things, however, which you may not

wish to possess, but which are highly prized by us.”

“What are those objects?” inquired Amrou.

“The works on philosophy, which are contained in the public

libraries,” John replied.

“I can do nothing about them without a special order from the

Prince of Believers, Omar ben Khattab,” was the answer given by

Amrou.

John’s wish having in the meantime been conveyed by the General

to Omar, the latter sent this reply:--

“As to the books of which you speak, I have this to say. If

their contents agree with what is written in the word of God,

the books are of no use to us, the Holy Writ being sufficient

for our guidance. But if they are at variance with God’s word,

then surely they should be destroyed.”

Amrou therefore ordered all the books to be sent to the bathing

establishments of Alexandria, to be used as fuel in heating

the baths. So great was the number of books contained in the

libraries that it took six months to consume them all. (Sismondi

questions the correctness of this account.)

While the invasion of Rome by the Barbarians in the fifth century

and the capture of Alexandria by the Arabs in the early part of the

seventh gave rise to an enormous loss of valuable books relating to

medicine and philosophy in general, these were by no means the only

occasions when books were probably destroyed in great quantities. Wars

were frequent in those days and towns were constantly being sacked.

Everywhere throughout the East the modern traveler encounters the ruins

of large cities, and in those cities--the centres, as they were, of

wealth and culture--there must have been large collections of books. It

is not at all strange, therefore, that when the Caliph Almansur made

a serious beginning of the work which was to convert the Arabs into

rivals of the ancient Greeks, he should have found a great scarcity of

medical works which, after being translated, were to serve as manuals

of instruction. However, his ambition was very great, his wealth almost

inexhaustible, and his associates eager to aid him in realizing the

_renaissance_ which he had planned for his people; and, as will

appear later on, he and those who aided him eventually succeeded in

overcoming this apparently insurmountable obstacle.

Among the medical books which, upon the approach of the Goths,

were carried from Rome and other cities to different monasteries

for safe keeping there must have been very few that were written

in Latin, and yet these were the only ones from which the monks

individually could derive any benefit. Several centuries later, when

all the monasteries of Italy and the East were visited by those who

were searching eagerly for original manuscript copies of the Greek

medical writers,--Hippocrates, Soranus, Rufus of Ephesus, Aretaeus,

Dioscorides, Galen,--it was found that such copies existed in a number

of these institutions, thus showing that the monks had been actuated by

unselfish and far-seeing loyalty to the best interests of mankind when

they rescued these particular treasures from the hands of the enemy.

They themselves could make no use of them, being unable to read Greek,

but they knew their priceless value to medical science.

The Latin treatises which they had also rescued, and of which they made

excellent use during the succeeding centuries, were those of Celsus,

Scribonius Largus, Pliny the Elder (to a slight degree only) and

Caelius Aurelianus.