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 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.
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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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; 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 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, 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 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.
Age of Transition (continued).—Arabic Period: A.D. 640-1400. Alkindus, 873. Mesue, 777-857. Rhazes, 850-932. Haly-Abas, 994. Avicenna, 980-1037. Albucassis, 1122. Avenzoar, 1113-1161. Averroës, 11661198. Maimonides, 1135-1204. School of Salernum: Constantinus Afri-canus, 1018-1085. Roger of Salerno, 1210. Roland of Parma, 1250. The Four Masters, 1270 (?). John of Procida.
The Arabic Period, which began with the second destruction of the Alexandrian Library—640 A.D.—ends with the fourteenth century. At the commencement of this period the Roman Empire of the West scarcely existed: the magnificent territory which composed it had been overrun and subdued by barbarous tribes from the forests of the North, while from its ruins had risen several independent kingdoms,—that of the Franks in Gallia, of the Visigoths in Spain, and of the Lombards in Italy. The last of the Western emperors of note was Justinian, whose army and generals—especially the genius and heroic devotion of Belisarius—threw some glory upon Italy, Sicily, Africa, and Spain. Meantime the Empire of the East, surrounded by enemies, and harassed from all directions, still sustained itself with vigor. The Turks had begun to show themselves on the banks of the Danube; those eternal enemies of Rome—the Persians—made incessant war; and a new and terrible enemy had sprung up in the deserts of Arabia. Then came one who was at the same time legislator, prophet, and conqueror, and united under one faith and one leader tribes hitherto divided and warring against each other. Thus arose a powerful and enthusiastic nation, animated by thirst for conquest and ardor for proselytism. In less than a century after the first preaching of Mahomet, all of Arabia, India, Syria, and Egypt were in the hands of his followers. In the year 640 Amrou effected the conquest of Egypt, seized Alexandria, and the great library of five hundred thousand volumes was, by order of Omar (successor to Mahomet), delivered over to the flames; and the historian Abulpharagius declares that these books served for six months to heat the public baths, four thousand in number. Such were the first fruits of the establishment of Islam. * Happily, zeal of proselytism somewhat abated among the Mussulman princes, and religious fervor gave place to policy; so that the later Arabian caliphs showed themselves, in general, the protectors of the arts and sciences. Some, indeed, endeavored to collect the débris of the scattered treasures that had been so fortunate as to escape the ignorant fanaticism of their predecessors; and others, more tolerant even than the Christian princes of the time, received without distinction all men of merit who took refuge in their State, gave them employment, and recompensed them for their services. On this account philosophers and persecuted "heretics" sought an asylum among infidels, and found there the protection which Christianity did not afford,—in return for which they gave their protectors the benefits of Greek civilization.
Of all the Moslem rulers, the most distinguished for love of learning and general enlightenment was Haroun-al-Raschid, the Charlemagne of the East, contemporary and emulator of the glory of the emperor of the Franks, the hero of a hundred Arabic poems, whose dominion extended from the borders of the Indus to the heart of the Spanish peninsula. He embellished Bagdad, his capital, with schools and hospitals. His son Almamon founded the Academy of Bagdad, which became the most celebrated of the age; likewise spared no pains to draw to his court the most illustrious men of all countries. He enjoined each of his ambassadors to purchase all the writings of the philosophers and physicians that could be found, and these he required to be translated into Arabic; his interpreter, Honain, a Christian, was employed at translating for forty-five years, and received, for each book rendered into Arabic, literally its weight in gold.
The eclat which the Moorish caliphs shed upon Spain from the tenth to the thirteenth century is well known. The cities of Cordova, Toledo, Seville, and Murcia possessed public libraries and academies, and students from all parts of Europe flocked to them to be instructed in arts and sciences; the library of Cordova alone embraced more than two hundred and twenty-four thousand volumes. Thus it will be seen that the dominion of mental and temporal affairs passed from the Greeks and Romans to the Saracens.
Arabian medicine constitutes one of the most interesting chapters in the history of our art. An offspring from Greek schools, it was for nearly one hundred years the fostermother of that art, and, although it gave rise to no great discovery nor wonderful step in advance during all this period, it nevertheless kept alive all the learning of the past, and clarified rather than made it turbid. In the sixth century the Nestorians (followers of Bishop Nestor), having been driven out of Syria, settled in Persia, Mesopotamia, and Arabia, and there founded schools and other institutions such as they had had at home,—schools in which, beside the ordinary philosophic studies, medicine received a share of attention. Thus it came about that by the seventh century Arabian physicians were everywhere known and in high repute. Naturally the basis for their studies embodied the writings of Hippocrates, Galen, Oribasius, and Paul of Ægina; and the first Arabian works consisted solely of translations from the Greek, first out of their Syriac rendering, and later from the originals. Indeed, so much eminence was finally achieved by Arabian physicians that more than four hundred are known by name as authors.
The first author deserving of mention was Bachtischua, of Nestorian stock, celebrated in Jondisapur, director of the medical school, and later physician to Caliph El-Mansur, in Bagdad. Of his descendants several became well known in the same field.
Alkindus—this being the Latin arrangement of his Arabic name—came from a Persian family, who lived first in Basara and later at the court of the caliphs El-Monon and El-Motasin, in Bagdad. He enjoyed a very high reputation as physician, philosopher, astronomer, and mathematician, and died A.D. 873. Mesue, the first of his name, sometimes known as Janus Damascenus, was director of the hospital in Bagdad and physician to Haroun-al-Raschid. He was born in 777, wrote extensively (since at least forty of his works have been catalogued), and died in 857 in Samarra.
Serapion the elder, also sometimes known as Janus Damascenus, and whose Arabic name was Serafiun, was born in Damascus—the exact data is not known—and died some time prior to A.D. 930. He was author of two volumes of aphorisms concerning the practice of medicine, which had at his time the greatest repute.
The most celebrated of the early Arabian physicians was Rhazes, born in the Persian province of Khorassan A.D. 850. According to the historians of his nation he was a universal genius, equally famous in music, astronomy, mathematics, chemistry, and medicine; he was surnamed "The Experienced." At the age of fifty he was one of the most distinguished professors in the Academy of Bagdad, where students came from great distances to listen to him. Chosen from among a hundred colleagues to direct the grand hospital of that city, he displayed indefatigable zeal and most scholarly learning, even to his old age and in spite of loss of sight, which overtook him at the age of eighty, when his reputation was at its height. Two years after this misfortune—i.e., in 932—he died. His generosity, which was proverbial, and his compassion for the poor left him penniless at the time of his death. Some two hundred and thirty-seven monographs of his have been catalogued, though the greater number of his works are practically lost. Two treatises on medicine remain which afford excellent counsel in many respects; among other matters he advises:—
"Study carefully the antecedents of the man to whose care you propose to confide all you have most dear in this world,—that is, your life and the lives of your wife and children. If the man is dissipated, is given to frivolous pleasures, cultivates with too much zeal the arts foreign to his profession, still more if he be addicted to wine and debauchery, refrain from committing into such hands lives so precious."
His greatest publication was Continens—extracts compiled from all authors for his own use—divided into thirty-seven books, constituting an abridgment of the science of medicine and surgery up to his time; and, notwithstanding its imperfect state, this work was held in greatest reverence, and was a common source of knowledge among Orientals long after his day.
Haly-Abbas, a Persian by birth, flourished fifty years after Rhazes, and died A.D. 994. His Almalelci, in twenty volumes, constituted a quite complete system of theory and practice of medicine, which, however, was in large measure taken from Rhazes's Continens. It is generally regarded as the best work of any of the physicians of the Arabic Period; it is divided into three parts—a book on Health, a book on Death, and a book of Signs—and it is interesting to know that the portion devoted to midwifery and obstetrics was in the hands not only of the profession, but also of the midwives.
Avicenna—Latinized form of his Arabic name, Ebn Sina—was born in Bokhara in 980. From his earliest youth he manifested a remarkable disposition for scientific study, and it is claimed that he mastered the entire Koran at the age of ten years; also that he devoted his entire days and the greater part of his nights to research, mastering philosophy, mathematics, astronomy, and, later, medicine, which he studied at the university at Bagdad, in which city his talents were chiefly exhibited. He was received at court, loaded with favors, and elevated to the dignity of Vizier, but suddenly fell into disgrace, was deprived of property, imprisoned, and even threatened with execution. After two years, however, he was restored to liberty, and once more possessed the consideration of the public and the court, becoming the recipient of new honors. Meantime he had given himself up to intemperance, by which his previously robust constitution was undermined, and this, with excessive labor, brought about his demise at the too early age of fifty-six, in the year 1037. He was author of several books, the chief being the Canon Medicinae, which remained a classic for six centuries, constituting the medical code of Asia and Saracenic Europe; no author since Galen had enjoyed so wide and extensive authority in the medical world; and in the various medical schools professors, for the most part, confined themselves to reading the Canon from their desks, explaining and commenting upon its text. The work was divided into five volumes, of which the first two comprised the principles of physiology, pathology, hygiene, and therapeutics, arranged to conform to the teachings of Aristotle and Galen; the third and fourth dealt with treatment; and the fifth wras devoted to the preparation and composition of remedies. Avicenna appears to have surpassed in subtlety both Aristotle and Galen; he was fond of metaphysical speculation, and his works were too much filled out with subtleties of language rather than with true science. Authors of this period were fond of torturing in every way possible the writings which they undertook to edit or quote from, and, instead of devoting themselves to original research, wasted time in seeking for vague and hidden meanings. That man was most esteemed as learned who could see the greatest subtlety in some passage from one of the ancient writers; consequently, that which was obscure or unintelligible was deemed the most sublime and philosophic. A very brief study of the Canon, for instance, will show this, while in graphic pictures of disease the work by no means approaches those of Aretæus or Alexander of Tralles, for Avicenna too often contented himself with mentioning merely a list of symptoms without indicating in any way their progression, characters, or duration. Undoubtedly just was the criticism of an Arabian poet: "His philosophy had no sound foundation, and his medical knowledge availed him naught for the possession of personal health and long life."
Albucassis was born in Zahra, near Cordova, about the beginning of the eleventh century, and is supposed to have died A.D. 1122, at the advanced age of one hundred and one. He was author of an abridgment, or compilation, devoted to the practice of medicine, the only novelty of which is a small portion devoted to surgery, in which are described certain instruments. He says:—
"I have detailed briefly the methods of operations; I have described all necessary instruments, and I present their forms by means of drawings; in a word, I have omitted nothing of what can shed light to the profession.... But one of the principal reasons why it is so rare to meet a successful surgeon is that the apprenticeship of this branch is very long, and he who devotes himself to it must be versed in the science of anatomy, of which Galen has transmitted us the knowledge.... In fine, no one should permit himself to attempt this difficult art without having a perfept knowledge of anatomy and the action of remedies."
Not a word is said about dissections, however, from which we conclude that they were not tolerated in his time. He resorted enthusiastically to the cautery, and recommended it in spontaneous luxations and the commencement of curvature of the spine. He refers particularly to instrumental delivery and the extraction of the after-birth, and, when speaking of fractures and dislocations, he remarks: "This part of surgery has been abandoned to men of vulgar and uncultivated minds, for which reason it has fallen into undeserved contempt."