V
FROM HIPPOCRATES TO GALEN.
Medicine is a science which hath been more professed than laboured, and yet more laboured than advanced; the labour having been, in my judgment, rather in circle than in progression. For I find much iteration, but small addition.—Bacon, “Advancement of Learning.”—Book 2.
The fame of Hippocrates caused naturally a great multiplication of works attributed to him. The Ptolemies when founding the Library of Alexandria, which they were determined should be more important than that of Pergamos, commissioned captains of ships and other travellers to buy manuscripts of the Greek physician at almost any price; an excellent method of encouraging forgeries. The works attributed to Hippocrates have been subject to the keenest scrutiny by scholars, but even now the verdict of Galen in regard to their genuine or spurious character is the consideration which carries the greatest weight. Even the imitations go to prove how free the physician of Cos was from superstitious practices or prejudiced theories.
Between him and Galen an interval of some six hundred years elapsed and, especially in the latter half of that period, pharmacy developed into enormous importance. Not that it necessarily advanced. But the faith in drugs, and especially in the art of compounding them, and the wild polypharmacy which grew up in Alexandria and Rome in the first two centuries of our era, of which Galen shows so much approval, add inestimably to the chronicles of pharmacy. It was during the interval between Hippocrates and Galen that the many sects of ancient medicine, the Dogmatics, the Stoics, the Empirics, the Methodics, and the Eclectics were born and flourished. Some of these encouraged the administration of special remedies. But probably a far greater influence was exercised on the pharmacy of the ancient world by the new commerce with Africa and the East which the Ptolemies did so much to foster, and by the travelling quacks and the prescribing druggists who exploited the drugs of foreign origin which now came into the market.
Serapion of Alexandria, one of the most famous of the Empirics, who is supposed to have lived in the second century, was largely responsible for the introduction of the animal remedies which were to figure so prominently in the pharmacy of the succeeding seventeen centuries. Among his specifics were the brain of a camel, the excrements of the crocodile, the heart of the hare, the blood of the tortoise, and the testicles of the wild boar.
The Empirics were the boldest users of drugs, and so far as can be judged, were the practitioners who brought opium into general medicinal esteem. One of the most famous doctors of this sect, Heraclides, made several narcotic compounds which are commended by Galen. One of these formulæ prescribed for cholera was 2 drms. of henbane seeds, 1 drm. of anise, and ½ drm. of opium, made into 30 pills, one for a dose. Another which was recommended for coughs was composed of 4 drms. each of juice of hemlock, juice of henbane, castorum, white pepper, and costus; and 1 drm. each of myrrh and opium.
Musa, a freed slave of Augustus, and apparently a sort of medical charlatan, but a great favourite with the Emperor, is alleged to have introduced the flesh of vipers into medical use especially for the cure of ulcers.
Celsus, Dioscorides, and Pliny, whose works are recognized as the storehouses of the science of Imperial Rome, belonged to the period under review. Celsus wrote either a little before or a little after the commencement of our era. He was the first eminent author who wrote on medicine in Latin. Pliny died A.D. 79, suffocated by the gases from Vesuvius, which in his eagerness to observe he had approached too near during an eruption. Dioscorides is supposed to have lived a little before Pliny, who apparently quotes him, but curiously never mentions his name, though usually most scrupulous in regard to his authorities.
Themison, who lived at Rome in the reign of Augustus Cæsar, and who is said to have been the first physician to have distinguished rheumatism from gout, is noted in pharmacy as the author of the formulæ for Diagredium and Diacodium. He praised the plantain as a universal remedy, and is also the earliest medical writer to mention the use of leeches in the treatment of illness.
Several of the writers on medical subjects of this period adopted the method of prescribing their formulas and the instructions for compounding them in verse. The most famous instance is that of Andromachus, physician to Nero, whose elegiac verses describing the composition of his Theriakon are quoted by Galen. The idea was that the formula thus presented was less likely to be tampered with. Theriakon as invented contained 61 ingredients. Its principal improvement on the more ancient Mithridatum was the addition of dried vipers. Andromachus appears to have acquired a large and lucrative practice in Rome at the time when wealth was most lavishly squandered.
Among other medical verse writers were Servilius Damocrates, who lived in the reign of the Emperor Tiberius, and who invented a famous tooth powder, a number of malagmata, (emollient poultices), acopa (liniments for pains), electuaries, and plasters; and Herennius Philon, a physician of Tarsus (about A.D. 50), whose fame rests on his philonium, a compound designed to relieve colic pains, which appear to have been specially frequent at that period. This philonium was composed of opium, saffron, pyrethrum, euphorbium, pepper, henbane, spikenard, and honey.
Menecrates, physician to Tiberius, and said to have written 155 works, was the inventor of diachylon plaster, but his diachylon was a compound of many juices (as the name implies) along with lead plaster.
The Romans were curiously badly off for regular doctors until Julius Cæsar specially tempted some to come from Greece and Egypt by offers of citizenship. Augustus, too, warmly encouraged the settlement in the city of trained medical men.
Pharmacy in the Roman Empire.
The separation of the practices of medicine, pharmacy, and surgery, which became general though never universal, was of course a gradual process. Galen expresses the opinion that Hippocrates prepared the medicines he prescribed with his own hands, or at least superintended the production of them. According to Celsus, it was in Alexandria and about the year 300 B.C. that the division of the practice of medicine into distinct branches was first noticeable. The sections he names were Dietetics, Surgery and Pharmaceutics.
The physicians who practised dietetics were like our consultants, only more so. They were above all things philosophers, the recognised successors of the Greek thinkers and theorists, and but too often their imitators. Although they owed their designation to their general authority on régime, they prescribed and invented medicines. The pharmaceutical section came to be called in Latin medicamentarii, and their history corresponds closely with that of our English apothecaries. At first they prepared and administered the medicines which the physicians ordered. But in Alexandria and Rome they gradually assumed the position of general practitioners. To another class, designated by Pliny Vulnerarii, was left the treatment of wounds, and probably of tumours and ulcers. The necessity of a lower grade of medical practitioners in Rome is manifest from a remark of Galen’s to the effect that no physician, meaning a person in his own rank, would attend to diseases of minor importance.
It is worthy of note that the Latin designation medicamentarius, which was nearly equivalent to the Greek pharmacopolis, was similarly used to mean a poisoner, while pharmakon in Greek and medicamentus in Latin might mean either a medicine or a poison.
It is noted elsewhere (page 52) that the word pharmakeia when it occurs in the New Testament is universally translated in our versions by the term sorcery or some similar word. At the time when the Apostles wrote this was evidently the prevalent meaning attached to the term. But in earlier Greek literature the reputable and the disgraceful ideas associated with the word seem to have run side by side for centuries. Homer uses pharmakon in both senses; Plato makes pharmakeuein mean to administer a remedy, while Herodotus adopts it to signify the practice of sorcery. Apparently this word came from an earlier, pharmassein, which was derived from a root implying to mix, and the gradual sense development was that of producing an effect by means of drugs. They might produce purging, they might produce a colour, or they might produce love.
The multiplication of names for the various classes connected with medicine and pharmacy in the Roman world is rather confusing. As the language of medicine up to and including Galen was largely Greek, many of the designations employed were those which had been drawn from that tongue. The name Pharmacopeus, used in Greek to denote certain handlers of drugs, had always a sinister signification. It suggested a purveyor of noxious drugs, a compounder of philtres, a vendor of poisons. The men who kept shops for the sale of drugs generally were called pharmacopoloi. This term was not free from reproach, because it was a common appellation, not only of the shopkeepers strictly so-called, but was also applied to the periodeutes, or agyrtoi, travelling quacks or assembly gatherers, or as they came to be named in Latin, circulatores or circumforanei.
These itinerant drug sellers are occasionally referred to by the classic authors. Lucian speaks of one hawking a cough mixture about the streets; and Cicero, in his Oratia pro Cluentio, suggests that the travelling pharmacopolists who attended the markets of country towns were not unwilling to sell poisons as well as medicines when they were wanted. One of these is specifically named, Lucius Clodius, and the orator suggests that he was bribed to supply medicines to a certain lady which were to have a fatal effect.
The designation Periodeutes meant originally, and always in strict legal terminology, physicians who visited their patients. The term was also used among the Christians to describe the ministers charged to visit the sick and poor in their dioceses.
The tramp doctor in time gets tired of his vagabond life, and, it may be, a little weary of hearing his own voice. If he has saved a little money, therefore, the attractions of a shop in the city, where he can exercise his healing on people who seek him, appeal strongly to him. So in Greece and in the Roman Empire the charlatans settled in little shops and were called iatroi epidiphrioi or sellularii medici, meaning sedentary doctors. But all these were pharmacopoloi.
Peculiarly interesting is the suggestion made by Epicurus and intended as a sneer, that Aristotle was one of these pharmacopoloi in his younger days. According to Epicurus the philosopher having first wasted his patrimony in riotous living and then served as a soldier, afterwards sold antidotes in the markets up to the time when he joined Plato’s classes.
Seplasia was the ordinary name in Rome for a druggist’s shop, and those who kept them were designated Seplasiarii or Pigmentarii. These names appear to have been used without much recognition of their original meanings. Strictly the Seplasiarii were ointment makers, and though the Pigmentarii were no doubt at first sellers of dyes and colours, they evidently came to include medicines in their stocks of pigments, and Coelius Aurelianus, in writing on stomach complaints, alludes to aloes as a pigment. Greek designations corresponding to those just quoted were Pantopoloi and Kadolikoi (the latter used by Galen in referring to the trader who supplied the drugs for the theriacum prepared in the palace of the Emperor Antoninus). Kopopoloi, and Migmatopoloi, both of which words meant dealers in all sorts of small wares, were like the mercers in this country when shopkeeping first began. The shops of perfumers were myropolia or myrophecia, the perfumers themselves were myrepsi. A general term in Latin for any sort of shop where medicines were sold or surgical operations performed was Medicina. This was in the days before the Empire, when there was no usual distinction between the branches of the healing art.
Pharmacotribae, strictly drug-grinders, may have been compounders, and it has also been conjectured that they were the assistants employed by the Seplasiarii or Roman druggists.
Herbalists were of very ancient Greek lineage, under the names of Botanologoi, who were collectors of simples, and who, to enhance the price of their wares, pretended to have to gather them with many superstitious observances; and Rhizotomoi, or root-cutters. The name Apothek, which came to be appropriated to the warehouse where medicinal herbs were kept, and which is to-day the German equivalent of our pharmacy, or chemist’s shop, meant originally any warehouse, and from it has been derived the French boutique and the Spanish bodega.
The earlier Greek and Roman physicians were in the habit of themselves preparing the medicines they prescribed for their patients. But naturally they did not gather their own herbs, and as many of those used for medicine were exotics, it is obvious that they could not have done so if they had wished. The herbalists who undertook this duty (botanologoi in Greek) developed into the seplasiarii, pharmacopoloi, medicamentarii, and pigmentarii already mentioned. Beckmann says they competed with the regular physicians, having acquired a knowledge of the healing virtues of the commodities they sold, and the methods of compounding them. This could not help happening, but it ought to be remembered that the physicians of all countries had themselves developed from herbalists, that is, if we abandon the theories of miraculous instruction which are found among the legends of Egypt, Assyria, India, and Greece.
How similar the relations of the doctors and druggists of ancient Rome were with those still prevailing in this country may be gathered from a reproach levelled by Pliny against physicians contemporary with him (Bk. xxxiv, 11) to the effect that they purchased their medicines from the seplasiarii without knowing of what they were composed.