_Age of Foundation (continued).--Anatomic Period: Influence of the
Alexandrian Library. Herophilus and Erasistratus. Aretæus, f B.C. 170.
Celsus, A.D. 1-65 (?). Galen.--Empiricism: Asclepiades B.C.
100 (?).--Methodism: Theinison, B.C. 50 (?).--Eclecticism. Age of
Transition, A.D. 201-1400.--Greek Period: Oribasius, 326-403. Ætius,
502-575. Alexander of Tralles, 525-605. Paul us Ægineta, 625-690._
Fourth, or Anatomic,{030} Period.--As already seen, Alexander the Great
and his successors collected the intellectual and natural riches of the
universe, as they knew them, and placed them at the disposal of
studious men to benefit humanity; their complete value has not yet been
exhausted, and never can be. This undertaking was carried out under
conditions that made it one of extreme difficulty. Manuscripts were then
rare and most costly; but few copies of a given work were in existence,
often only one, and these were held almost priceless. Under these
circumstances the establishment of a public library and of a museum was
an act of philanthropy and liberality simply beyond eulogy, and did more
to immortalize the founder of the collection than all his victories and
other achievements.
This appears to have also occurred to two of Alexander's
lieutenants--one Eumenes, Governor of Pergamos, and the other, Ptolemy,
Governor of Egypt. After the death of the conqueror his generals
shook of all dependence upon the central government, and endeavored to
centralize their own authority. But these two were the only ones among
so many leaders who did not devote all their attention to armies and
invasion, but interested themselves in commerce and arts. So active were
they in the enterprise that Eumenes had gathered two hundred thousand
volumes for the library at Pergamos, and Ptolemy six to seven hundred
thousand for that of Alexandria. The latter was divided{031} into two
parts, the greater and the lesser, the latter of which was kept in the
temple of Serapis, hence known as the _Serapium_. These notable efforts
to found enormous collections first excited praiseworthy rivalry among
contemporaries and rulers, which, however, degenerated into contemptible
jealousy, so that some of the rulers of Alexandria even went so far as
to interdict the exportation of papyrus, in order to prevent the making
of copies for the library of Pergamos. But the effect was unexpected,
since it led to the invention of the paper of Pergamos, otherwise called
parchment, which completely displaced the bark from which papyri were
made. Be this as it was, the collection at Alexandria had a much
more marked influence on the medical study of the future than that of
Pergamos, and calls for our particular notice. About it sprang up first
a collection of learned men, and then the inevitable result--a school of
learning. It was Ptolemy Soter who called around him the most renowned
men of his day. He provided them with homes adjoining the library,
endowed them with salaries, and charged them with the classification and
collation of manuscripts, or with the giving of instruction by lectures
and discussions. Ptolemy himself sometimes took part in these feasts
of reason, which became still more frequent and formal under his son
Ptolemy Philadelphia. These were called the Feasts of the Muses and of
Apollo,--_i.e., ludi musarum_,--and, consequently, the place where
they were held came to be termed the "_museum_." Often the subjects
for discussion were announced in advance, and those who gained the most
applause received rewards in accordance with the merits of their work.
Among those who enjoyed these advantages under the reign of these
two Ptolemies are prominently named two physicians, Herophilus and
Erasistratus, the latter said to be the grandson of Aristotle. It was
under this Philadelphus that the Hebrew wise men translated into Greek
the Holy Scriptures, which translation has since{032} been called the
Septuagint--so called because it is supposed to have been translated by
the members of the Sanhedrim, which was composed of about seventy
men, or because, according to another legend, it was translated by
seventy-two men in seventy-two hours. These _savants_ of ancient Egypt,
thus supported by the dynasty of the Lagides, gave the first place to
the science of medicine. As regards this study, the school of Alexandria
eclipsed almost from its origin the ancient schools of Cos and Pergamos,
and during its existence was the leading institution of its kind in the
world. At the time of Galen it was sufficient to have studied there,
and even to have resided a short time in Alexandria, to obtain the
reputation of being a physician. Nearly all the scholars of these five
centuries had received instruction in this school. The principal reason
for its eminence in medical instruction was the practice of dissection
of human bodies, which, under the Ptolemies, was allowed and
recommended, and by which the science of medicine received an
extraordinary impulse. Although the prejudice of Egyptians was very
strong against those who touched a dead body, the Ptolemies themselves
are said to have participated in this kind of anatomical study, thus
destroying by their example the odium previously attached to dissection.
Strange to say, however, the practice of dissection fell into disuse
toward the end of this Anatomic Period, and scholars preferred to
indulge in subtle metaphysical discussions rather than study human
tissues. But the principal reason for giving up this practice was the
Roman domination of Egypt, the Romans, inconsistently, being perfectly
willing to see any amount of bloodshed in the arena, and all sorts
of inhumanities practiced upon living human beings, but holding that
contact with a corpse was profanation; so that not a single anatomist
of reputation had his origin in ancient Rome. "If on any occasion," says
Renouard, "a foreign physician attached to the king or general desired
to avail himself of the occasions{033} that were afforded to examine the
structures of the internal parts of the human body, he was obliged to
conceal and carry off during the night some body abandoned to the birds
of prey." To complete the melancholy termination of the Anatomic Period,
the labors of the writers of those days were all lost by the burning of
the great library by Julius Cæsar, which was the beginning of the
chain of disasters with which Egypt was accursed under Roman
dominion. Although Mark Antony, induced thereto by the endearments
and solicitations of Cleopatra, transported the library of Pergamos
to Alexandria, even this was unavailing to restore the position of
the school, since the atrocious and imbecile Caracalla took from the
pensioners of the museum their privileges of common residence and every
other advantage, and suppressed all public exhibitions and discussions.
I can mention but few of the names most eminent during this Anatomic
Period, and but a short account of the life and work of each.
The first deserving of mention was Herophilus, who was born in Chalcedon
about the end of the fourth century before Christ, and supposed to be
the first to undertake systematic dissection of the human body. The
so-called Torcular Herophili, or common meeting-place of the sinuses at
the occiput, named after him, gives evidence of his influence upon the
study of anatomy. He wrote on all departments of medical science,
concerning the eyes, the pulse, midwifery, etc., as well as numerous
commentaries upon the Hippocratic writings,--describing the membranes of
the brain and its vessels, the choroid plexus, the ventricles of the
brain, the tunics of the eye, the intestinal canal, and certain portions
of the vascular system. He alluded to the thoracic duct without knowing
its purpose, and gave a more accurate description of the genitalia than
any previous writer. Strange to say, but little is known of his later
life, and of his death absolutely nothing.
Erasistratus{034} was the son of Cleombrotus, a student of Metrodorus,
and lived for some time at the court of Seleucus Nicator, whose son,
Antiochus, he healed of a secret ailment, which happened to be a
desperate love-affair with his mother-in-law, Stratonice. He wrote
extensively on fevers, hygiene, paralyses, therapeutics, and many other
subjects; regarded most diseases as due to overindulgence in food, which
is not digested, and consequently putrefies. Plethora was for him the
prevailing disease, against which he employed not only venesection, but
fasting, and bandaging of the extremities. He was a diligent student
of anatomy, and carefully described the brain in many of its grosser
features, regarding it as the seat of the soul and the centre of the
nerves. He also described more exactly than his predecessors the
valves of the heart, which organ he regarded as the origin of veins and
arteries. He discovered the lymph-vessels, and maintained, against Plato
and others, that the epiglottis prevents the entrance of fluids into
the lungs, but he supposed digestion to be produced by mechanical
trituration in the stomach, and preferred gymnastics, exercise, diet,
and baths to drugs or other therapeutic measures. He died about 280 B.C.
Aretæus, who died about 170 B.C., was one of the most brilliant lights
of antiquity previous to the Christian era, but, in spite of all this,
of his life very little is known. He came from Cappadocia about the
end of the reign of Nero, and lived in Alexandria. That he lived in
Alexandria is apparent from his numerous references to its location, to
the habits and therapeutics of the Egyptians, and to the geography
of the country. Furthermore, references to its diseases abound in
his writings, so that it is made to appear that he had had the best
advantages there, although he must have traveled extensively. But a
small portion of his writings remain, and these consist, for the
most part, of compendiums of pathology and therapeutics. He described
disease, not in anatomical order from head to foot, but under{035} the
classification of acute and chronic. With the exception of Hippocrates,
he has shown himself the most free from vague, arbitrary speculation,
and from the dogmatism of the schools of any writer of antiquity. He,
more than any other up to his time, endeavored to found pathology upon
a sound anatomical basis. For every picture of disease he endeavored to
provide a suitable anatomical accompaniment. This appears particularly,
for instance, in his description of intestinal ulcers due to dysentery,
or the paralyses following brain affections, or his description of
pharyngeal diphtherias, of which he gave a good account under the name
of Syriac or Egyptian ulcers. Pulmonary tuberculosis, tetanus, and anal
fistula are amply mentioned in his writings.
His therapeutics were simple and rational; he laid great stress upon
dietetic treatment. His surgical writings appear to have all been lost,
but there is every reason to think that he brought to bear upon{036}
external medicine the same good sense which he applied to internal
affections.
[Illustration: 0055]
Cornelius Celsus, the most celebrated author for a number of centuries,
was born in Rome about the time of Christ. Brilliant as he was, he
exerted a wide-spread influence for centuries. The exact date of his
death is unknown. He was a contemporary of the greatest philosophers,
poets, and _savants_ of Rome during its most brilliant period.
He studied rhetoric, philosophy, the art of war, economics, and
medicine--he was, in fact, a walking encyclopaedia of the knowledge of
his day; but it is in medicine that he shows to best advantage, and in
his capacity as a physician he was and is best known. The direction in
which Celsus appears to least advantage is in failure of power of direct
observation, and in yielding unquestioning obedience to the views and
dicta of Hippocrates, for whom he possessed the greatest reverence,
not being able to brook any serious contradiction or opposition to his
opinions. In this reverence for Hippocratic authority he was followed by
many less prominent successors, the consequence being a failure to train
men as observers, the endeavor being to make them simply storehouses of
information derived from Hippocratic writings. As a result, Celsus wrote
but little, or else his writings are lost. He contented himself mostly
with a mere commentary upon the writings which he so highly revered.
But little of his writings remain, and these pertain mostly to the
therapeutics of curable disease, dietetic, pharmaceutical, and surgical.
Although he exercised great authority during his period, he was later
totally supplanted by Galen, and his views are seldom mentioned in the
writings of those subsequent to this great physician. His death must
have taken place during the first century after Christ.
Of all the students of Hippocratic dogmatism, the most earnest,
skillful, and learned was Claudius Galen, a native of Pergamos, a place
already celebrated for its temple dedicated{037} to Æsculapius, for
its school of medicine, and for a library which had been removed to
Alexandria. He was placed by his father under the most distinguished
teachers in all of the sciences, and even as a young man showed
extraordinary progress, and became early a disputant with the most
erudite in grammar, history, mathematics, and philosophy. He has related
how in two different dreams he was urged by Apollo to study medicine. He
traveled widely for instruction, and remained some time in Alexandria.
[Illustration: 0057]
On his return to his own country he was charged by its ruler to dress
the wounded in the great circus, which furnished him opportunity
for displaying all his anatomical knowledge and surgical skill. Not
remaining long at home, he went to Rome, where his renown had preceded
him, and where, by his brilliant elocution, his accurate logic, and{038}
his profound erudition, as well as his versatility and practical skill,
he at once took the highest place. But here his rapid success, his
vanity, his disdain for his colleagues, and his useless boasting, as
well as his natural jealousy, gained him the enmity of nearly all his
contemporaries, and his stay at Rome was thereby made very disagreeable.
In his work on _Prenotions_ he accuses his colleagues of base jealousy
and stupid ignorance, lavishes upon them such epithets as "thieves" and
"poisoners," and closes by saying that after having unmasked them he
would leave them to their evil designs by abandoning the great city to
seek a home in a smaller place, where the surroundings would be to him
more congenial. This threat he carried out, but soon returned to Rome
upon the invitation of the Emperors Marcus Aurelius and Lucius Yerus,
whose confidence, as well as that of their successors, he enjoyed. He is
supposed to have lived to the age of seventy-one, and to have died about
200 A.D. Galen strongly denied being attached to any of the sects of his
day, and regarded as slaves those who took the title of Hippocratists,
Praxagoreans, Herophilists, and so on. Nevertheless, his predilection
in favor of the Hippocratic writings is well marked, for lie explains,
comments upon, and expands them at length, refutes the objections of
their adversaries, and gives them the highest place. He says: "No one
before me has given the true method of treating disease; Hippocrates,
I confess, lias heretofore shown the path, but as he was the first to
enter it he was not able to go as far as he wished.... He has not made
all the necessary distinctions, and is often obscure, as is usually the
case with ancients when they attempt to be concise. He says very little
of complicated diseases; in a word, he has only sketched what another
was to complete; he has opened the path, but has left it for a successor
to enlarge and make it plain." This implies how he regarded himself as
the successor of Hippocrates, and how littleweight{039} he attached to
the labors of others. He held that there were three sorts of principles
in man: spirits, humors, and solids. Throughout his metaphysical
speculations Galen reproduces and amplifies the Hippocratic dogmatism.
Between perfect health and disease there were, he thought, eight kinds
of temperaments or imperfect mixtures compatible with the exercise of
the functions of life. With Plato and Aristotle, he thought the human
soul to be composed of three faculties or parts: the vegetative,
residing in the liver; the irascible, having its seat in the heart; and
the rational, which resides in the brain. He divided diseases of the
solids of the body into what he called distempers; he distinguished
between the continued and intermittent fevers, regarding the quotidian
as being caused by phlegm, the tertian as due to yellow bile, and the
quartan as due to atrabile. In the doctrine of coction, crises, and
critical days he agreed with Hippocrates; with him he also agreed in the
positive statement that diseases are cured by their contraries. From all
this it will be seen that Galen must be regarded as one of the earliest
of Hippocratic dogmatists. He was a most extensive writer, and it
is said that the total number of his works exceeded one hundred. His
contributions to anatomy were not insignificant. For myology he did a
great deal. He wrote a monograph on the skeleton in which he recommended
that bones be seen and handled, not merely studied from books, and that
the student should go to Alexandria, where teachers would place before
him the real human skeleton. It has been inferred that there was not, in
his time, in Rome a single skeleton. He wrote fifteen books on anatomy,
of which six are lacking; also an extensive treatise on the lesions of
the human body, distributed among seventeen books which have come down
to us. He is supposed to have introduced the term "symphysis," and he
described nearly every bone in the human body. By him the muscles were
no longer considered as inert masses and tissue-layers{040} serving
to cover the bones, but he classified them according to their distinct
functions, and studied separately their form and uses. The location of
the vessels and nerves between them was also noted, and it was proved
that muscles were indispensable to the accomplishment of voluntary
motions. Galen was, perhaps, the first vivisector of all, since he
exposed muscles of living animals, and showed how alternate tension and
relaxation of distinct groups set the bones in motion, after the manner
of levers; he named a great number of them, but, curiously, took no note
of others. His classification according to their uses is followed down
to the present day--i.e., flexors, extensors, etc.
The Hippocratic authors confounded the arteries with the veins.
Praxagoras first distinguished two kinds of vessels which he supposed
to contain air, whence the name artery. Aristotle and Erasistratus
maintained this view, which prevailed until the time of Galen, who
devoted a book to the refutation of it, basing his argument upon the
observation that always when an artery is wounded blood gushes out.
How near he came to being the discoverer of the circulation may thus be
seen. A little less reverence for authority and a little more capacity
for observation would have placed him in possession of the knowledge,
lack of which for so many centuries retarded the whole profession.
He thought the veins originated from the liver--in this respect being
behind Aristotle--but considered the heart as the common source of the
arteries and veins. Even the portal system of veins confused him, and he
erroneously described a superior and inferior aorta, but atoned for
this by describing the umbilical veins and arteries. Aristotle also had
supposed all the nerves originated from the heart, but Galen stated that
they are derived from the brain and spinal marrow, and pointed out two
kinds of nerves: those of sensation, which he thought proceeded from the
brain, and those of motion, which he considered{041} to originate in
the spinal marrow. Thus, he described distinct nerves of sensation and
motion, but sadly confused their anatomy. He seems also to have had some
notion of the great sympathetic, although it was by no means accurate.
He suggested the division of the principal nerves, in order to prove
the fact that nervous energy is transmitted from the encephalon to other
parts of the body. He speaks of glands, and thought they discharged
their secretions through veins into the various cavities, but regarded
them rather as receptacles of excrementitious matter than as agents for
secretion of valuable fluids. He even regarded the mammæ as glandular
bodies in this sense, although he knew, of course, the value of their
secretion. To Galen we owe the division of the body into cranial,
thoracic, and abdominal cavities, whose proper viscera and envelopes he
described. He spoke of the heart as having the appearance of a muscle,
but differing from it. He regarded it as the source of natural heat,
and the seat of anger and of violent passions. He appreciated that
inspiration is carried on by enlargement of the thoracic cavity. He
thought that atmospheric air entered the cavity of the cranium through
the cribriform plate of the ethmoid and passed out by the same route,
carrying with it excrementitious humors from the brain, which were
discharged into the nasal fossæ. But some portion of air thus entering
remained, according to his views, and combined with the vital spirits in
the anterior ventricles of the brain, from which combination originated
the animal spirits and immediate agents of the rational soul. These
acquired their last attenuation in the fourth ventricle, whence they
would pass out drop by drop through a round, narrow tube.
From this brief _résumé_ of the anatomy and physiology of Galen it
will be seen that by the end of the second century of the Christian era
immense progress had been made since the foundation of the Alexandrian
school, and that it was due to the impetus in the study of anatomy
given by Herophilus{042} and Erasistratus, who not only made numerous
dissections, but resorted to frequent vivisections. It is even said that
Herophilus did not hesitate to employ his knife on live criminals
who were subjected to him for experiment; but this has been a popular
tradition about almost every anatomist of antiquity, and there is
no evidence in confirmation of the unkind rumor, although that such
experiments might be legally and justly performed has occurred to the
minds of many. But zeal for dissection rapidly cooled off, and Galen
barely mentions five or six men who devoted themselves to it in the
space of nearly four hundred years down to his time. He speaks of
_Rufus_ of Ephesus,--who lived under Trajan of _Marinus_,--who wrote
in the beginning of the second century A.D., and of _Quintus_, who
instructed his own preceptor. None of them left a reputation, however,
approaching that of Herophilus and Erasistratus, with whom Galen alone
could compare by the number of his experiments and his discoveries.
Galen strove as hard as one of his position might, by example and
precept, to awaken in his contemporaries a desire for anatomical
knowledge, but could not overcome their indifference. After him the
practice of dissection appears to have been lost, either from the
redoubled prejudices of the superstitious, who opposed it, or as
the result of the apathetic ignorance or the ignorant apathy of the
physicians.
It has been shown that, during the Hippocratic era and subsequently, the
physicians even of primitive times followed more or less by instinct the
empirical method. Acron of Agrigentum was a contemporary of Pythagoras,
and affirmed that experience is the only true foundation of the healing
art. Hippocrates, however, showed himself more anxious to report
faithfully clinical facts than to dispute theoretical views.
The surprising progress in anatomy and physiology made during the first
portion of the Anatomic Period and during{043} the better days of
the Alexandrian institute did not keep men from confounding several
different points in the Hippocratic doctrine, by which confidence in
the same was naturally shaken. Thus many new speculations were hazarded
which nullified each other. In the midst of this confusion practitioners
continued to seek in experience a refuge from the incessant variations
of dogmatism and the sterile incertitude of the skeptics. Thus,
empiricism as a school of practice became placed upon a firmer and
firmer foundation, and the empirics of that day seem to have laid the
true basis of our art. Their doctrine took at first a rapid growth, and
Galen spoke of it with great regard. The circumstances under which it
was proclaimed were most favorable for its propagation. Theories
had fallen into confusion; practice, methods, and opinions were
questionable. Everything was conjecture, and that which rested on the
evidence of facts was by the empirics received with enthusiasm. Although
founded on pure observation, it did not put an end to differences of
opinion, and in the eyes of the ancients it lacked in solidity, because
it did not attach itself to any philosophic theory then known. This
doctrine was then best able to captivate physicians on account of its
simplicity, contrasted with the general inability to satisfy speculative
minds; but for this very reason it subsequently fell into disgrace, and
the term "empiricism" became synonymous with ignorance. For centuries
condemned and despised, it was revived from its long humiliation under
the name of the Experimental Method, and achieved, after the labors of
Bacon, Locke, and Condillac, almost universal dominion in the sciences.
This doctrine had been proclaimed for about a century during the period
of which we now speak, but later led men into a fondness for secondary
generalities or for the elevation and magnifying of trifles, which
confused their minds and terminated its usefulness to science.
Meanwhile, a man of great intelligence, renowned as an
elocutionist, well{044} versed in the doctrine of philosophers and
grammarians--namely, _Asclepiades_, of Bythinia--came to Rome with the
intention of teaching rhetoric. By his talent and personal address he
soon became one of the most illustrious persons in the Roman Republic;
so early as 150 B.C. he enjoyed a high reputation as a rhetorician, and
was one of the intimate friends of Cicero; nevertheless, he abandoned
letters, undertook the practice of medicine, and sought moreover to
create a new system, being unwilling to follow in the track of his
predecessors. Imbued with the philosophy of Epicurus, who was then in
high repute, he deduced from it a theory which was in harmony with the
philosophy of the day. He thought that the elements of the body existed
from eternity; that they were indivisible, impalpable, and perceptible
to the reason only. These elements he named _atoms_, which were supposed
to be animated by perpetual motion, and from which, by their frequent
encounters and fortuitous contention, all sensible phenomena were
supposed to result. He explained the properties of the body by saying
that compounds were aggregates of atoms, differing very much from atoms
themselves. Solid silver, he said, is white, but, reduced to powder,
appears black; the horn of the goat, on the contrary, is black, but
if it be razed its particles are white. This, it will be seen, was
the parent of our present atomic theory. He ridiculed the theories of
Hippocrates concerning coction, crises, etc., and sarcastically called
the Hippocratic treatise on therapeutics "a meditation on death."
Asclepiades based his own therapeutics on endeavors so to enlarge
the pores of the human body that disease could find egress, or so to
constrict them that it could not enter; consequently he rejected
all violent remedies, such as vomits, purges, etc., and his favorite
remedies were hygienic,--for the most part bodily exercise.
A celebrated disciple of Asclepiades was _Themison_, of Laodicea
(b.c. 50), who was led by the teachings of his master to{045} lay the
foundation of the so-called _Methodism_ as opposed to _Dogmatism_ in the
school of Cos. By him and his followers a very arbitrary arrangement of
diseases was made, according to what they considered the constrictive,
or contractive; the fluxionary,--congested or relaxed; and the mixed
forms. From this division of diseases it appears that, according to
the methodists, there were only two kinds of therapeutic indications
to follow,--namely, to relax where there was constriction, to constrict
where there was relaxation. They, however, admitted a third creditable
result, which they called prophylactic; but the pure methodists, such
as Ccelius Aurelianus, admitted neither specific disease nor specific
remedies, and erased from their materia medica purgatives, diuretics,
emmenagogues, nauseants, etc.
According to the methodist doctrine, the study of medicine was so
abridged that one of its prominent exponents said that he felt able
to teach the whole of medical science in six months. It made rapid
progress, and consequently was most attractive to the numerous young
neophytes who were anxious to finish their apprenticeship and hasten
into practice. It is not one of the smallest of the services which Galen
rendered to his time and to posterity that he demolished the sophistry
of the methodists, demonstrated the insufficiency of their practice, and
brought to bear upon them the wittiest satire, calling them the asses
of Thessaly, alluding thereby to their lack of literature and medical
instruction.
In summing up, then, the basis for the various systems of medicine
during this period of antiquity, it is seen that the most ancient
doctrine of all--_Dogmatism_--directs our attention especially to the
animal economy in health and disease; that it took account of the union
of vital forces, of sympathies in the organism, and of nature's efforts
to repel both internal and external deleterious influences, which{046}
providential tendency manifests itself especially in certain acute
diseases. This was the strong side of dogmatism. Its weak side consisted
in this: that it was held that the causes of diseases inhere in the
access of certain qualities and humors along with organic forces,--such
as dryness or moisture in combination with bile or atrabile,--and the
treatment was directed against these supposed causes. It was on account
of this weakness that the enemies of dogmatism attacked it. The empirics
opposed the idea that inaccessible and occult causes of disease could
become the basis for rational treatment. They affirmed that there was no
consistent relation of antagonism or similitude between the disease and
the remedies which cured it.
The _Methodists_ somewhat improved on the doctrine of empiricism, but
ran wild in its improvement and erected over their fundamental theory
such a superstructure of secondary and tertiary generalities as to cause
the fundamental part to be entirely obscured from sight.
There were not lacking, in those days of old, certain educated
physicians who more or less vaguely comprehended that the entire truth
of medicine did not inhere in any one of these systems, but that there
was good and evil in each. These men, not being able to establish
general rules, tried to decide practical questions according to
their fancy or their reason. They assumed the name of _Eclectics_ or
_Episynthetics_, meaning thereby that they adopted no exclusive system,
but selected from each that which seemed to them best. They did not
constitute a sect, because they had no precise dogmas nor theories, but
they should not be confounded with the Pyrrhonians, who held to doubt
as a fundament doctrine, the true eclectic doubting only that which he
could not understand. True eclecticism in medicine, however, is
rather the absence of fixed principles, or, as Renouard says, it is
"individualism erected into a dogma, which escapes refutation because
it is deficient{047} in principle." Many became eclectics to avoid
discussing principles, and made of it a shelter. In one sense, then,
an eclectic is one destitute of profound convictions, who sides with
no particular party, is committed to no person or doctrine, and who
is often so indifferent that he cannot judge with impartiality;
consequently, to be truly eclectic is different from being an adherent
of a school of eclecticism.
During the historic period just reviewed, anatomy and physiology made
most progress, next internal and external nosography, and next to these
medical and surgical therapeutics, and although Coelius Aurelianus and
Aretæus have left to us by far the best books issued up to their times,
nevertheless not one of the writers of this period has achieved the
distinction in which Hippocrates is held, since he, perhaps more than
any other, combined intelligence, sincerity, disinterestedness, love of
his art, and humanity.
Under the classification of Renouard, already alluded to, the so-called
_Age of Transition_ includes centuries commencing with the death of
Galen, about A.D. 201, and ending with the revival of letters in Europe,
about the year 1400. The first period of this transition age is the
so-called Greek Period, which ends with the burning of the Alexandrian
library, A.D. 640.
At the time when this historic period commenced all the known world was
under the dominance of a single man. The power of Septimus Severus had
more extent than that of Alexander the Great, and bid fair to be of a
much longer existence. The Roman dominion, cemented by seven hundred
years of bold and persevering government, seemed almost immovable. While
the savages upon its frontiers occasionally troubled its peace, none
were strong enough to penetrate its centres or place it in real peril.
The great civil wars had ceased, or changed their object.
Both the{048} people and the senate, those two eternal competitors, had
gotten over the struggle for supreme power; monarchial government was
accepted as a matter of fact, and the citizens contended only for choice
of a master.
Similar changes had taken place in the domain of the mind; philosophical
discussions, which were so essentially a part of the schools of
the ancient Greeks, had nearly lost their interest and were being
discontinued. Such disputes as took place related less to principle
than to interpretation of the language of the teacher. In morals, Plato,
Epicurus, and Zeno were followed until the principles of Christianity
gradually supplanted their teaching; in physics and metaphysics the
authority of Aristotle, and in medicine that of Galen, were simply
undisputed.
Conditions being such as these, there was naturally but one sect
in medicine, and one method of study and practice. Medical science
retrograded rather than progressed, sad to say, and was undisturbed by
any remarkable revolution. The scepter of medicine passed from the hands
of one nation to those of another, and the language of Hippocrates and
Galen was later replaced, as will duly be seen, by that of Avicenna and
Albucassis. But this Greek Period, which is one of transition, offers
little for our consideration more than the lives and writings of four
of its most eminent physicians, who by their study in the school of
Alexandria, and by their writings and teachings, left reputations which
were sustained until the invasion of the Arabs. Of these it may be said
that, while they did little or nothing original, and simply commented
upon the writings of Hippocrates and Galen, they kept burning the torch
of medical learning which else had been almost extinguished by their
indolent contemporaries. Of these various commentators--for they were
little more than that--the first of any importance after Galen was
_Oribasius_, who was horn in Pergamos (328-403); he early attached
himself to the fortunes of Julian the Apostate, and followed him into
Gaul when he was{049} made its governor. Julian appreciated the good
qualities of Oribasius, made him an intimate friend, and after
he himself became emperor appointed his friend as quæstor at
Constantinople. After the emperor's untimely death, Oribasius remained
faithful to his memory, but his jealous colleagues so falsely and so
successfully misrepresented his fidelity that he was disgraced, spoiled
of his office and property, and banished among a barbarous people.
In this new field, however, he displayed such courage, effected such
extraordinary cures, discoursed so eloquently, and so attached to
himself the savage men around him, that he was by them regarded as a
god. The fame of this homage in time reached the ears of the Emperors
Valens and Valentinianus, who recalled him, reimbursed him for his
losses, and permitted him to enjoy his high reputation and fortune to
the end of his days. He was held to be the wisest man of his time,
most skillful in medicine, and the most charming in conversation. He
dedicated a collection of seventy books to Julian, his first patron, and
edited, at a later period, an abridgment of this work for the benefit
of his son. His principal merit consisted in reproducing the ideas of
others with such clearness, order, and precision that the summaries that
he gives of them are often preferable to the originals. What he has said
of pregnant women, nursing, and the earliest education of the child has
been copied literally by writers for twelve centuries since his time. It
must be said of him, however, that his prepossession in favor of Galen
was so great that he adopted servilely his ideas and even his words to
such an extent that he has been surnamed "the ape of Galen."
_Ætius_ was born in Mesopotamia in the year 502 and died in 575. He
studied at Alexandria, and afterward went to Constantinople, where he
became a chamberlain at court. Ætius was the first medical man of any
note who professed Christianity, as is shown by such passages as this
one: he said that{050} in the composition of certain medicaments the
following words should be repeated in a low voice: "May the God of
Abraham, the God of Isaac, and the God of Jacob deign to bestow upon
this medicament such and such virtues." In another place he recommends
that to extract a bone from the throat the following words be
pronounced: "Bone--as Christ caused Lazarus to come forth from the
sepulchre, as Jonah came out of the whale's belly--come out of the
throat or go down." But he exhibits the same credulity in not doubting
the miraculous virtues attributed by the quacks of his day to most
remedies.
Like Oribasius, he collected everything that he found remarkable in the
writings of his predecessors, and has preserved certain fragments
of antiquity which would otherwise have been lost. His work formed
a complete manual of medicine and surgery, except that it lacked
anatomical descriptions and references to dislocations and fractures.
_Alexander_ of Tralles (525-605), a city of Lydia, where Greek was
spoken, was a son of the physician Stephen, and the most celebrated of
five sons, who were all distinguished for their learning. He traveled
extensively, and fixed his residence in Rome, where he became
celebrated. He lived to an advanced age, and, being no longer able to
practice, composed a treatise of twelve books, exclusively devoted to
affections that did not require the aid of surgery. He professed the
greatest veneration for Galen, but did not blindly adopt his opinions.
He described the first reported case of excessive hunger and pain due to
intestinal worms; he advised venesection in the foot rather than in the
arm; but with all his sound judgment and mental enlightenment he had
faith in amulets and talismans, and widely recommended them. It may be
said for him, such was the universal prejudice of his age, the whole
world being plunged in superstition, that it was necessary for every one
to pay some tribute to the prevailing belief; and we may add that it is
necessary to make this excuse for some who practice much{051} nearer to
ourselves than did those ancient physicians.
_Paul, or Paulus_, surnamed _Ægineta_ (because he was born in the Island
of Ægina), was among the last of the Greek physicians who have special
interest for us. It is supposed that he died about A.D. 690. He traveled
extensively, and his skill in surgery and obstetrics rendered him
celebrated even among the Arabs, whose midwives sent for him in
consultation from great distances. He composed a compendium of medicine,
divided into seven books, and not only did not hesitate to borrow from
his predecessors, but quoted from them most extensively; a number of his
chapters were taken almost _verbatim_ from Oribasius; however, he made
no secret of it, but rather boasted that he had judiciously sought to
appropriate the best of the writings of those he most revered. He showed
originality, however, in the treatment of hydrocephalus, in advising
paracentesis of the thorax and abdomen, in the extraction of calculi
from the bladder, in the treatment of aneurism, the excision of
hypertrophied mammæ in men, etc. He was the first to describe varicose
aneurism, and the first to perform the operation of bronchotomy after
the method borrowed from _Antyllus_, of which he has transmitted a very
detailed account. Of this Antyllus, by the way, it may be added,
_en passant_, that he was one of the most distinguished and original
surgeons of antiquity. He flourished during the third century after
Christ; was the first to describe the extraction of small cataracts; and
is, perhaps, best known to the surgical world to-day by his exceedingly
bold plan of opening aneurisms, so successfully imitated a generation or
so ago by James Syme.
It has already been seen that before and during the early centuries of
the Christian era the secrets and learning of the physicians tended to
pass gradually into the hands of the priests. It was so in the temples
of ancient Greece, it was so in Alexandria, it became so in Rome, it has
been so even{052} in modern times, although only for brief periods
of time. This has come about in some measure from the cupidity of
the clerical orders, partly because it required a certain amount of
intelligence and knowledge to become a priest, and partly because, owing
to ignorance, credulity, and superstition, diseases have at all
times been regarded by the ignorant as evidence of divine wrath and
chastisement, or of diabolical or occult influences, rather than the
effect of natural causes. Hence men have turned ever toward prayers,
exorcism, and expiation, especially when exhorted thereto by the
priests. This has been the sacerdotal aspect of the practice of medicine
in all times, and when the priests have usurped therapeutic functions
they have done harm rather than good. So long as theology and science
work hand in hand, each redounds to the credit of the other, but always
in the history of man when theology has appropriated that which did not
belong to it it has brought ridicule upon itself and has delayed the
progress of knowledge. There have been frequent rebellions against
religious authority in ancient as in modern times. For instance, at the
commencement of the fifth century before Christ the Pythagoreans were
dispersed, and the doctrines of Cos and Cnidus--i.e. the Hippocratic
teachings--were promulgated; and again, in the course of events, when
the descendants of Æsculapius became servile attendants at the temple
and adjuncts to the priesthood or a part of it. At first, in Alexandria,
the physicians were supreme; their disciples, however, had the same
blind reverence for authority that too many workers in the field of
theology have evinced, and men once more practiced medicine on the
traditions of the past, and in so doing allied themselves more and more
to the temples in Rome. At first, the oldest and best instructed of the
relatives treated the diseases of his family as he understood them;
simply shared this duty with its other members. Cato, the censor, was
much engrossed with this domestic medicine;{053} he wrote a book in
which he recommended cabbage as a sovereign remedy in many diseases. He
venerated the number 3, as did the Pythagoreans; did not disdain to
transmit to posterity certain medical words which it was believed should
be repeated to assist in the reduction of dislocations and fractures.
This old censor seemed to have a profound hatred for medical men, and
most absurd ideas of their works and claims, although doubtless many
Greek physicians who came to Rome merited the invectives which he
launched against them. Then came Asclepiades, of Bythinia, as already
mentioned, whose talents were far superior to those of his Roman
contemporaries, and who did not need to call to his aid charlatanism and
deceit. This medical hero unfortunately had many worthless and dishonest
imitators, who appealed to superstition and ignorance in every dishonest
way, and who desired to be judged by the luxury and elegance they
displayed. Hence for a long time in Rome medicine was practiced without
license. The Emperor Anthony the Pious was the first to occupy himself
with regulating the practice of medicine. He granted certain immunities,
but did ask for proof of qualifications. A certain physician to Nero,
Adromachus, was honored by the emperor with the title of Archiater.--
i.e., royal healer.--but Galen, who was physician to Marcus Aurelius,
never bore it. From the time of Constantine the Great, however, the
title is frequently met with in the edicts of the emperors. In fact,
there were two sorts of these.--one named the Palatine, who belonged to
the household of the reigning monarch and who held high rank among the
nobility; and the other called the Popular Archiaters, who were
public-health officers. No one could practice medicine in the
jurisdiction of one of these without examination and authorization.
Those who transgressed this regulation were punished with a fine of two
thousand drachmas. The Popular Archiaters were pensioned by the city,
enjoyed certain privileges, and had to{054} attend the poor
gratuitously. Practitioners who were not members of the College of
Archiaters had no pay, no rights, nor emoluments. The Popular Archiaters
were elected by the citizens from many candidates who had proved their
capacity before the college of this medical organization. The evils of
medical anarchy were thus remedied; this happy condition existed until
the empire was broken up by barbarism.
It is during this period--about 400 A.D.--that we first find a class of
citizens to whom was delegated the duty of preparing drugs ordered by
physicians. Their duties were in some respects similar to those of our
apothecaries, although in attainment and in social position they were
far below the physicians. They were termed _pharmacopolists_.
It is worth while to stop a moment to inquire what were the medical
charitable institutions of antiquity. Even in the days of ancient Athens
there was a certain gymnasium, called the Cynosarga, in which abandoned
and illegitimate children were brought up at public expense until such
time as they were able to serve their country. A little later several
private institutions of this kind were established. Rome in her earlier
day never had such institutions. To be sure, she distributed provisions,
or else remitted taxes, to parents who were unable to support their
children, or even permitted them to destroy their newborn children when
unable to maintain them; but there were no bonds of sympathy which
induced the patricians to succor the plebeians in time of disease and
distress; slaves were cared for as were cattle. It is one of the debts
we owe Christianity that, under its influence, the first almshouses and
retreats were established in Rome. It has been said that the Emperor
Marcus Aurelius first instituted anything like a dispensary service in
the Sacred City. We are told, also, of an illustrious woman, St.
Pauline, living in the midst of the greatest wealth and pomp,{055} who
retired from society and devoted her life to charity and self-denial.
She went to Jerusalem, united with other Christian women of the same
mission, and formed, under the direction of St. Jerome, a sisterhood
whose members divided their time between reading sacred books and doing
good works. They offered an asylum for the faithful and a hospice for
the benefit of the indigent sick, and even established a home for
convalescents outside the city-walls. After the model thus set, heathen
emperors, Christian kings, and Moslem caliphs showed their zeal in this
good direction by the erection of sumptuous edifices and other rich
endowments for the relief of suffering human beings.
Reviewing now the Greek period, let it be remembered that in the time of
Galen animals were dissected, and that he made anatomical demonstrations
on monkeys; that sometimes the corpses of the enemy were rudely
dissected upon the field of battle, but that finally the practice of
dissection fell into disuse, and human anatomy was studied only from
books, the early Christians having evinced even more horror of the
dead body for the purposes of anatomical study than did their pagan
predecessors, while the Fathers of primitive times launched their
anathemas against the dissection of human remains. Here, again, as
usual, the interference of the church worked only general harm.
This abandonment of anatomy contributed doubtless to the decadence of
medicine; by the rapid extension of Christianity the pagan schools were
disorganized and broken up, the profane sciences (such as medicine)
were discarded, and the teachers still remaining in the old schools were
ruined. Passion for religious controversy was engendered and took the
place of study or original research, even to such an extent as to
hasten the fall of the Empire of the East. In addition to these factors,
reverence for authority of the past--that terribly oppressive weight
which has kept down so much which would otherwise{056} have risen early,
and which has been the greatest enemy of human learning--permitted the
explanation of natural phenomena to be sought only in the writings of
revered ancients, and not in living beings. No one dared to advocate
changes in regard to received doctrines, and there could be no such
thing as progress. Only two men in the lapse of four centuries showed
any originality; these were Alexander of Tralles and Paul of Ægina,
whose lives have already been briefly rehearsed. It is with some relief,
however, that we can think that this period, so unfruitful in scientific
progress, was not so in social amelioration. By the organization of
the institutions above alluded to charlatanism was checked, by the
requirement of capability and good character society was benefited, and
the charitable institutes of this epoch perhaps gave the world its
best models in teaching and an insight into the most valuable means of
medical instruction. Of the old Greek Period, then, we may say that it
accrues rather to the benefit of humanity than to that of science.