(navigation image)
Home American Libraries | Canadian Libraries | Universal Library | Community Texts | Project Gutenberg | Children's Library | Biodiversity Heritage Library | Additional Collections
Search: Advanced Search
Anonymous User (login or join us)
Upload
See other formats

Full text of "Outlines of Greek and Roman medicine"

f^l 



OUTLINES OF 
GREEK AND ROMAN MEDICINE 



1, H. CAIiEROIT. 

^7, SlIxlItBOITENE ST, 
TOUOHTO. 




From WKllcome'a Medical Diary (Copyright.) 
By perrm'^sion of Burroughs Wellcome Sc Co. 



ASKLEPIOS 
The ancient Greek Deity of Healing. 



OUTLINES OF 
GREEK AND ROMAN MEDICINE 



BY 



JAMES SANDS ELLIOTT, M.D., Ch.B.(Edin.) 

Editor of the " New Zealand Medical Journal" 
Honorary Surgeon to the Wellington Hospital, New Zealand. 



JllustrateD 



NEW YORK X ^ ^3 

WILLIAM WOOD AND COMPANY 
MDCCCCXIV. 



p 



hM 




TO MY FATHER 



PEEFACE. 



I WAS stimulated to write these Outlines of 
Greek and Koman Medicine by a recent sojourn 
in the south-eastern part of Europe. The name 
of the book defines, to some extent, its limitations, 
for my desire has been to give merely a general 
outline of the most important stages in the 
advancement of the healing art in the two Empires 
to which modern civilization is most deeply 
indebted. There are a few great works on the 
history of medicine by continental writers, such, 
for instance, as those by the German writers, 
Baas, Sprengel, and Puschmann, but, generally 
speaking, the subject has been much neglected. 

I cherish the hope that this little work may 
appeal to doctors, to medical students, and to 
those of the public who are interested in a 
narration of the progress of knowledge, and who 
realize that the investigation of the body in 
health and disease has been one of the most 
important features of human endeavour. 

The medical profession deserves censure for 
neglect of its own history, and pity 'tis that so 
many practitioners know nothing of the story of 
their art. For this reason many reputed dis- 
coveries are only re-discovenes ; as Bacon wrote ; 



Vlll PEEFACE 



" Medicine is a science which hath been, as 
we have said, more professed than laboured, and 
yet more laboured than advanced ; the labour 
having been, in my judgment, rather in circle than 
in progression. For I find much iteration, and 
small progression." Of late years, however, the 
History of Medicine has been coming into its 
kingdom. Universities are establishing courses of 
lectures on the subject, and the Eoyal Society 
of Medicine recently instituted a historical section. 

The material I have used in this book has been 
gathered from many sources, and, as far as possible, 
references have been given, but I have sought for, 
and taken, information wherever it could best be 
found. As Montaigne wrote : " I have here only 
made a nosegay of culled flowers, and have 
brought nothing of my own but the thread that 
ties them together." 

I have to express my indebtedness to my friend, 
Mr. J. Scott Eiddell, M.V.O., M.A., M.B., CM., 
Senior Surgeon, Aberdeen Royal Infirmary, for his 
great kindness in reading the proof-sheets, pre- 
paring the index and seeing this book through the 
press and so removing one of the difiiculties which 
Ci^n author writing overseas has to encounter ; also 
to my publishers for their courtesy and attention- 

James Sands Elliott. 

Wellington, 
New Zealand. 

January 5, 1914. 



CONTENTS 



CHAPTEE I. 
Early Roman Medicine. 

PAGE 

Origin of Healiug — Temples — ^Lectisternium — Temple of 
iEsculapius — Arcbagathus — Domestic Medicine — 
Greek Doctors — Cloaca Maxima — Aqueducts — State 
of the early Empire ... 1 

CHAPTER II. 

Early Greek Medicine. 

Apollo — ^sculapius — Temples — Sex'pents — Gods of 
Health — Melampus — Homer — Macbaon — Poda- 
larius — Temples of iEsculapius — Methods of Treat- 
ment — Gymnasia — Classification of Renouard — 
Pythagoras — Democedes — Greek Philosophers ... 13 

CHAPTER III. 

Hippocrates. 

His life and works — His influence on Medicine ... ... 25 

CHAPTER IV. 

Plato, Aristotlr, the School of Alexandria, an'd 

Empiricism. 

Plato — Aristotle — Alexandrian School — Its Origin — Its 
Influence— Lithotomy — Herophilus — Erasistratus — 
Cleombrotus — Chrysippos — Anatomy — Empiricism 
— Serapion of Alexandria ... ... ... ... 39 



X CONTENTS 

PAGE 

CHAPTER V. 

EOMAN MT5DICINR AT THE END OP THE REPUBLIC AND THE 
BEGINNING OP THE EmPIRE. 

Asolepiades of Prusa — Themison of Laodicea — Method- 
ism — Wounds of Julius Caesar — Systems of Philo- 
sophy — State of the country — Roman quacks — 
Slaves and Freedmen — Lucius Horatillavus ... 51 

CHAPTER VI. 

In THE Reign op the C^sars to the Death op Nero. 

Augustus— His illnesses — Anfconius Musa — Mascenas — 
Tiberius — Caligula — Claudius — Nero — Seneca — 
Astrology — Archiater — Women poisoners — Oculists 
in Rome ... ... ..• ... ••• ••• 63 

CHAPTER VII. 

Physicians from the Time op Augustus to the Death 

OF Nero. 

Celsus — His life and works— His influence on Medicine 
— Meges of Sidon — Apollonius of Tyana — Alleged 
mii-acles — Vettius Valleus — Scribonius Longus — 
Audromachus — Thessalus of Tralles — Pliny ... 72 

CHAPTER VIII. 

The First and Second Centuries of the Christian Era. 

AthensBUs — Pneumatism — Eclectics — Agathiuus — Are- 
tseus — Archigenes — Dioscorides — Cassias Felix — 
Pestilence in Rome — Ancient surgical instruments 
— Herodotus — Heliodorus — Caelius Aurelianus — 
Soranus — Rufus of Ephesus — Marinus— Quintus ... 86 

CHAPTER IX. 

Galen. 

His life and works — His influence on Medicine ,., .,. 96 



CONTENTS XI 

PAGE 

CHAPTEE X. 

The Later Eoman and Byzantine Period. 

Beginning of Decline — Neoplatonism — Antyllus— Oriba- 
sius — Magnus — Jacobus Psychristus — Adamantius 

— Meletius — Nemesius — ^tius — Alexander of 
Tralles — The Plague — Moschion — Paulus .^gineta 

— Decline of Healing Ait Ill 

CHAPTEE XL 

Influence of Christianity on Altruism and the 

Healing Art. 

Bssenes— Cabalists and Gnostics — Object of Christ's 
Mission — Stoics — Constantine and Justinian — Gla- 
diatorial Games — Orphanages — Support of the Poor 
— Hospitals — Their Foundation — Christianity and 
Hospitals — Fabiola — Christian Philanthropy — 
Demon Theories of Disease receive the Church's 
Sanction — Monastic Medicine — Miracles of Healing 

— St. Paul — St. Luke — Proclus — Practice of 
Anatomy denounced — Christianity the prime factor 

in promoting Altruism ... 127 

CHAPTEE XII. 

Gymnasia and Baths. 

Gymnastics — Vitruvius — Opinions of Ancient Physicians 
on Gymnastics —The Athletes — The Baths — Descrip- 
tion of Baths at Pompeii — Thermae — Baths of Cara- 
calla 143 

CHAPTEE XIII. 

Sanitation. 

Water-supply — Its extent — The Aqueducts — Distribu- 
tion in city — Drainage — Disposal of the Dead — 
Cremation and Burial — Catacombs — Public Health 
Eegulations 155 

APPENDIX. 
Fees in Ancient Times 162 



ILLUSTRATIONS. 



Asklepios, the ancient Greek Deity of Healing frontispiece 

Machaon (Son of Asklepios), the first Greek Military 

Surgeon, attending to the wounded Menelaus p. 17 



Plate I. — Bust of -^sculapius ... face p. 1^ 

,, II. — Hygeia, the Greek Deity of Health ... ,, 15 

,, HI. — Facade of Temple of Asklepios, restored 

(Delfrasse) „ 18 

,, IV. — Health Temple, restored (Caton) ... ,, 20 



OUTLINES OF 

Greek and Roman Medicine 



CHAPTER I. 

EAELY EOMAN MEDICINE. 

Origin of Healing — Temples — Lectisternium — Temple of 
^sculapius — Archagathus — Domestic Medicine — Greek 
Doctors — Cloaca Maxima — Aqueducts — State of the early 
Empire. 

The origin of the healing art in Ancient Rome 
is shrouded in uncertainty. The earliest practice 
of medicine was undoubtedly theurgic, and common 
to all primitive peoples. The offices of priest and 
of medicine-man were combined in one person, 
and magic was invoked to take the place of know- 
ledge. There is much scope for the exercise of the 
imagination in attempting to follow the course of 
early man in his efforts to bring plants into 
medicinal use. That some of the indigenous 
plants had therapeutic properties was often an 
accidental discovery, leading in the next place to 
experiment and observation. Cornelius Agrippa, 
in his book on occult philosophy, states that man- 
kind has learned the use of many remedies from 
animals. It has even been suggested that the 
use of the enema was discovered by observing a 



2 GEEEK AND ROMAN MEDICINE 

^ XCs-» long-beaked bird drawing up water into its beak, 
and injecting the water into the bowel. The 
practice of healing, crude and imperfect, pro- 
gressed slowly in ancient times and was conducted 
in much the same way in Rome, and among the 
Egyptians, the Jews, the Chaldeans, Hindus and 
Parsees, and the Chinese and Tartars. 

The Etruscans had considerable proficiency in 
philosophy and medicine, and to this people, as 
well as to the Sabines, the Ancient Eomans were 
indebted for knowledge. Numa Pompilius, of 
Sabine origin, who was King of Eome 715 B.C., 
studied physical science, and, as Livy relates, was 
struck by lightning and killed as the result of his 
experiments, and it has therefore been inferred 
that these experiments related to the investigation 
of electricity. It is surprising to find in the 
Twelve Tables of Numa references to dental 
operations. In early times, it is certain that the 
Eomans were more prone to learn the superstitions 
of other peoples than to acquire much useful 
knowledge. They were cosmopolitan in medical 
art as in religion. They had acquaintance with 
the domestic medicine known to all savages, 
a little rude surgery, and prescriptions from the 
Sibylline books, and had much recourse to magic. 
It was to Greece that the Eomans first owed their 
knowledge of healing, and of art and science 
generally, but at no time did the Eomans equal 
the Greeks in mental culture. 



EARLY ROMAN MEDICINE 3 

Pliny states that. " the Koman people for more 
than six hundred years were not, indeed, without 
medicine, but they were without physicians." 
They used traditional family recipes, and had 
numerous gods and goddesses of disease and 
heahng. Febris was the god of fever. Mephitis 
the god of stench ; Fessonia aided the weary, and 
^' Sweet Cloacina " presided over the drains. 
The plague - stricken appealed to the goddess 
Angeronia, women to Fluonia and Uterina. 
Ossipaga took care of the bones of children, and 
Carna was the deity presiding over the abdominal 
organs. 

Temples were erected in Eome in 467 B.C. in 
honour of Apollo, the reputed father of ^sculapius, 
and in 460 B.C. in honour of >3j]sculapius of 
Epidaurus. Ten years later a pestilence raged 
in the city, and a temple was built in honour of 
the Goddess Salus. By order of the Sibylline 
books, in 399 B.C., the first lectisternium was held 
in Rome to combat a pestilence. This was a 
festival of G-reek origin. It was a time of prayer 
and sacrifice ; the images of the gods were laid 
upon a couch, and a meal was spread on a table 
before them. These festivals were repeated as 
occasion demanded, and the device of driving a 
nail into the temple of Jupiter to ward off " the 
pestilence that walketh in darkness," and " destruc- 
tion that wasteth at noonday " was begun 360 B.C. 
As evidence of the want of proper surgical knowledge, 



4 GREEK AND ROMAN MEDICINE 

the fact is recorded by Livy that after the 
Battle of Sutrium (309 B.C.) more soldiers died of 
wounds than were killed in action. The worship 
of ^sculapius was begun by the Eomans 291 B.C., 
and the Egyptian Isis and Serapis were also 
invoked for their healing powers. 

At the time of the great plague in Eome 
(291 B.C.), ambassadors were sent to Epidaurus, in 
accordance with the advice of the Sibylline books, 
to seek aid from ^sculapius. They returned with 
a statue of the god, but as their boat passed up the 
Tiber a serpent which had lain concealed during 
the voyage glided from the boat, and landing on 
the bank was welcomed by the people in the 
belief that the god himself had come to their aid. 
The Temple of ^sculapius, which was built after 
this plague in 291 B.C., was situated on the island 
of the Tiber. Tradition states that, when the 
Tarquins were expelled, their crops were thrown 
into the river, and soil accumulated thereon until 
ultimately the island was formed. In consequence 
of the strange happening of the serpent landing 
from the ship the end of the island on which the 
Temple of ^sculapius stood was shaped into the 
form of the bow of a ship, and the serpent of 
^sculapius was sculptured upon it in relief. 

The island is not far from the ^milian Bridge, 
of which one broken arch remains. 

Ovid represents this divinity as speaking 
thus : — 



EARLY ROMAN AIEDICINE 5 

" I come to leave my shrine ; 
This serpent view, that with ambitious play 
My staff encircles, mark him every way ; 
His form — though larger, nobler, I'll assume. 
And, changed as gods should be, bring aid to Eome." 

(Ovid, " Metamorphoses," xv.) 

He is said to have resumed his natural form on 
the island of the Tiber. 

" And now no more the drooping city mourns ; 
Joy is again restored and health returns." 

It was the custom for patients to sleep under the 
portico of the Temple of ^sculapius, hoping that 
the god of the healing art might inspire them in 
dreams as to the system of cure they should adopt 
for their illnesses. Sick slaves were left there by 
their masters, but the number increased to such an 
extent that the Emperor Claudius put a stop to the 
cruel practice. The Church of St. Bartholomew 
now stands on the ruins of the Temple of 
^sculapius. 

Even in very early times, however, Eome was 
not without medical practitioners, though not so 
well supplied as some other nations. The Lex 
Emilia, passed 433 B.C., ordained punishment for 
the doctor who neglected a sick slave. In Plutarch's 
"Life of Cato" (the Censor, who was born in 234 B.C.), 
we read of a Roman ambassador who was sent 
to the King of Bithynia, in Asia Minor, and who 
had his skull trepanned. 

The first regular doctor in Rome was Archagathus, 



6 GEEEK AND EOMA.N MEDICINE 

who began practice in the city 219 B.C., when the 
authorities received him favourably and bought 
a surgery for him ; but his methods were rather 
violent, and he made much use of the knife and 
caustics, earning for himself the title of "butcher," 
and thus having fallen into disfavour, he was glad 
to depart from Eome. A College of ^sculapius 
and of Health was established 154 B.C., but this 
was not a teaching college in the present meaning 
of the term. 

The doctors of Ancient Rome took no regular 
course of study, nor were any standards specified, 
but as a rule knowledge was acquired by pupilage 
to a practising physician, for which a honorarium 
was paid. Subsequently the Archiatri, after the 
manner of trade guilds, received apprentices, but 
Pliny had cause to complain of the system of 
medical education, or rather, to deplore the want 
of it. He wrote: " People believed in anyone who 
gave himself out for a doctor, even if the false- 
hood directly entailed the greatest danger. Un- 
fortunately, there is no law which punishes doctors 
for ignorance, and no one takes revenge on a doctor 
if through his fault someone dies. It is permitted 
him by our danger to learn for the future, at our death 
to make experiments, and, without having to fear 
punishment, to set at naught the life of a human 
being." 

Before the time when Greek doctors settled 
in Rome, medical treatment was mainly under 



EARLY ROMAN MEDICINE 7 

the direct charge of the head of each household. 
The father of a family had great powers conferred 
upon him by the Eoman law, and was physician as 
well as judge over his family. If he took his new- 
born infant in his arms he recognized him as his 
son, but otherwise the child had no claim upon 
him. He could inflict the most dire punishments 
on members of his household for which they had no 
redress. 

Gato, the Elder, who died in B.C. 149, wrote 
a guide to domestic medicine for the use of Roman 
fathers of the Republic, but he was a quack and 
full of self-conceit. He hated the physicians 
practising in Rome, who were mostly Greeks, and 
thought that their knowledge was much inferior to 
his own. Plutarch relates that Cato knew of the 
answer given to the King of Persia by Hippocrates, 
when sent for professionally, " I will never make 
use of my art in favour of barbarians who are 
enemies of the Greeks," and pretended to believe 
that all Greek physicians were bound by the same 
rule, and animated by the same motives. However, 
Cato did a great deal of good by attempting to 
lessen the vice and luxury of his age. 

The Greeks in Rome were looked at askance 
as foreign adventurers, and there is no doubt that 
although many were honourable men, others came 
to Rome merely to make money out of the super- 
stitious beliefs and credulity of the Roman people. 
Fine clothes, a good house, and the giving of 



8 GREEK AND ROMAN MEDICINE 

entertainments, were the best introduction to 
practice that some of these practitioners could 
devise. 

•The medical opinions of Cato throw a sidelight 
upon the state of medicine in his time. He 
attempted to cure dislocations by uttering a 
nonsensical incantation : " Huat lianat ista yista 
sista damiato damnaustra ! " He considered ducks, 
geese and hares a light and suitable diet for the 
sick, and had no faith in fasting. 

Although the darkness was prolonged and intense 
before the dawn of medical science in Eome, yet, 
in ancient times, there was a considerable amount 
of knowledge of sanitation. The great sewer of 
Rome, the Cloaca Maxima^ which drained the 
swampy valley between the Capitoline and Palatine 
Hills, was built by order of Tarquinius Prisons 
in 616 B.C. It is wonderful that at the present 
time the visitor may see this ancient work in the 
Roman Forum, and trace its course to the Tiber. 
In the Forum, too, to the left of the Temple of 
Castor, is the sacred district of Juturna, the nymph 
of the healing springs which well up at the base of 
the Palatine Hill. Laciis Juturiics is a four-sided 
basin with a pillar in the middle, on which rested a 
marble altar decorated with figures in relief. Beside 
the basin are rooms for religious purposes. These 
rooms are adorned with the oods of healinsf, 
^sculapius with an acolyte holding a cock, the 
Dioscuri and their horses, the head of Serapis, and 
a headless statue of Apollo. \ 



EARLY ROMAN MEDICINE « 

The Cloaca Maxima was formed of three tiers 
of arches, the vault within the innermost tier 
being 14 ft. in diameter. The administration of 
the sewers, in the time of the Eepublic, was in the 
hands of the censors, but special officers called 
curatores cloacarum were employed during the 
Empire, and the workmen who repaired and 
cleansed the sewers were condemned criminals. 
These ancient sewers, which have existed for 
twenty-five centuries, are monuments to the 
wisdom and power of the people who built them. 
In the time of Furius Camillus private drains 
were connected with the public sewers which 
were flushed by aqueduct and rain water. This 
system has prevailed throughout the centuries. 

The Aqueducts were also marvellous works, and 
although they were added to in the time of the 
Empire, Sextus Julius Frontinus, curator of waters 
in the year a.d. 94, gives descriptions of the nine 
ancient aqueducts, some of which were con- 
structed long before the Empire. For instance, 
the Aqua Appia was conducted into the city three 
hundred and twelve years before the advent of 
Christ, and was about seven miles long. The 
Aqua Anio Vetus, sixty-two miles in length, built 
in B.C. 144, was conveyed across the Campagna 
from a source in the country beyond Tivoli. Near 
this place there is a spring of milky-looking water 
containing sulphurous acid, sulphurated lime, and 
bicarbonate of lime, used now, and in ancient times 



10 GEEEK AND EOMAN MEDICINE 

for the relief of skin complaints. This water, at the 
present day, has an almost constant temperature 
of 75°. 

In course of time, when the Roman power was 
being extended abroad, the pursuit of conquest 
left little scope for the cultivation of the peaceful 
arts and the investigation of science, and life itself 
was accounted so cheap that little thought was 
given to improving methods for the treatment of 
the sick and wounded. On a campaign every 
soldier carried on his person a field-dressing, and 
the wounded received rough-and-ready first-aid 
attention from their comrades in arms. 

Later, when conquest was ended, and attention 
was given to the consolidation of the provinces, 
ease and happiness, as has been shown by Gibbon, 
tended to the decay of courage and thus to lessen 
the prowess of the Roman legions, but there was 
compensation for this state of affairs at the heart 
of the Empire because strong streams of capable 
and robust recruits flowed in from Spain, Gaul, 
Britain and Illyricum. 

At its commencement, the Empire was in a 
peaceful, and, on the whole, prosperous condition, 
and the provincials, as well as the Romans, 
" acknowledged that the true principles of social 
life, laws, agriculture, and science, which had been 
first invented by the wisdom of Athens, were now 
firmly established by the power of Rome, under 
whose auspicious influence the flercest barbarians 



EAELY ROMAN MEDICINE 11 

were united by an equal government and common 
language. They affirm that with the improvement 
of arts the human species was visibly multiplied. 
They celebrate the increasing splendour of the 
cities, the beautiful face of the country, cultivated 
and adorned like an immense garden ; and the long 
festival of peace, which was enjoyed by so many 
nations, forgetful of their ancient animosities, and 
delivered from the apprehension of future danger." 
Thus wrote the Roman historian, and Gibbon 
states that when we discount as much of this as 
we please as rhetorical and declamatory, the fact 
remains that the substance of this description is 
in accordance with the facts of history. Never 
until the Christian era was any thought given 
to the regular care of the helpless and the abject. 
Slaves were often treated like cattle, and the 
patricians had no bond of sympathy with the 
plebeians. Provisions were sometimes distributed 
to the poor, and taxes remitted, but for reasons 
of State and not from truly charitable motives. 
Authority was also given to parents to destroy 
new-born infants whom they could not support. 
The idea of establishing public institutions for 
the relief of the sick and the poor did not enter 
the minds of the ancient Romans. 

Before considering the state of the healing art 
throughout the period of the Roman Empire, it 
is necessary to devote the next chapters to a 
consideration of the rise and progress of medical 



12 GREEK AND ROMAN MEDICINE 

science in Greece, for it cannot be too strongly- 
emphasized that Koman philosophy and Roman 
medicine were borrowed from the Greeks, and it 
is certain also that the Greeks were indebted to 
the Egyptians for part of their medical knowledge. 
The Romans were distinguished for their genius 
for law-giving and government, the Greeks for 
philosophy, art, and mental culture general^. 










Plate I. -BUST OF /ESCULAPIUS. 



13 



CHAPTER II. 
EARLY GREEK MEDICINE. 

Apollo — ^sculapius — Temples — Serpents — Gods of Health 
— Melampus — Homer — Machaon — Podalarius — Temples 
of iEsculapius — Methods of Treatment — Gymnasia — 
Classification of Renouard — Pythagoras — Democedes — 
Greek Philosophers. 

The history of healing begins in the Hellenic 
mythology with Apollo, the god of light and the 
promoter of health. In the "Iliad" he is hailed as 
the disperser of epidemics, and, in this respect, the 
ancients were well informed in attributing destruc- 
tion of infection to the sun's rays. Chiron, the 
Centaur, it was believed, was taught by Apollo 
and Artemis, and was the teacher, in turn, of 
^sculapius, who probably lived in the thirteenth 
century before Christ and was ultimately deified as 
the Greek god of medicine. Pindar relates of 
him : — 

" On some the force of charmed strains he tried, 
To some the medicated draught applied ; 
Some limbs he placed the amulets around, 
Some from the trunk he cut, and made the patient 
sound. "^ 

^sculapius was too successful in his art, for his 
death was attributed to Zeus, who killed him by a 

^ Wheelwright's translation of "Pindar." 



14 GREEK AND ROMAN MEDICINE 

flash of lightning, or to Pluto, both of whom were 
thought to have feared that Jilsculapius might by 
his skill gain the mastery over death. 

Amid much that is mythological in the history 
of ^sculapius, there is a groundwork of facts. 
Splendid temples were built to him in lovely and 
healthy places, usually on a hill or near a spring ; 
they were visited by the sick, and the priests of 
the temples not only attended to the worship of 
iEsculapius, but took pains to acquire knowledge 
of the healing art. The chief temple was at 
Epidaurus, and here the patients were well 
provided with amusements, for close to the 
temple was a theatre capable of seating 12,000 
people, and a stadium built to accommodate 20,000 
spectators. 

A serpent entwined round a knotted staff is the 
symbol of ^sculapius. A humorist of the present 
day has suggested that the knots on the staff 
indicate the numerous " knotty " questions which 
a doctor is asked to solve ! Tradition states that 
when ^sculapius was in the house of his patient, 
Glaucus, and deep in thought, a serpent coiled 
itself around his staff, ^sculapius killed it, and 
then another serpent appeared with a herb leaf 
in its mouth, and restored the dead reptile to life. 
It seems probable that disease was looked upon 
as a poison. Serpents produced poison, and had a 
reputation in the most ancient times for wisdom, 
and for the power of renovation, and it was thought 




From Wellcome 8 Medical Diary fCopyright) 
By pemn'^i'^Ti of Kurrnnfiha Wellcome Sc Go 



X 



Plate II.— HYGEIA 
The Greek Deity of Health. 



^-^/. .5.] £aw'f9'e£^. "hji-^f^'^ i^P^ 



EARLY GREEK MEDICINE 15 

that a creature which could produce poison and 
disease might probably be capable of curing as well 
as killing. Serpents were kept in the Temples of 
^sculapius, and were non-poisonous and harmless. 
They were given their libert}' in the precincts 
of the temple, but were provided with a serpent- 
house or den near to the altar. They were wor- 
shipped as the incarnation of the god, and were 
fed by the sick at the altar with " popana," or 
sacrificial cakes. 

V Many of the Greek gods and goddesses were held 
to have power over disease. Hygeia, known as ^' 
Salus to the Romans, was said to have been the 
daughter of ^sculapius, and to have taken care of 
the sacred serpents (Plate II). 

Melampus was considered by the Greeks the 
first mortal to practise healing. In one case he 
prescribed rust, probably the earliest use of iron 
as a drug, and he also used hellebore root as a 
purgative. He married a princess and was given 
part of a kingdom as a reward for his services. 
After his death he was awarded divine honours, and 
temples were erected for his worship. The deifica- 
tion of ^sculapius and of Melampus added much 
to the prestige of doctors in Greece, where they 
were always held in honour; but m Rome the 
practice of medicine was not considered a highly 
honourable calling, y 

Something can be learned from the writings of 
Homer of the state of medicine in his time, 



16 GREEK AND ROMAN MEDICINE 

although we need hardly expect to find in an epic 
poem many references to diseases and their cure. 
"^As dissection was considered a profanation of 
the body, anatomical knowledge was exceedingly 
meagre. Machaon was surgeon to Menelaus 
and Podalarius was the pioneer of phlebotomy. 
Both were regarded as the sons of ^sculapius; 
they were soldiers as well as doctors, and 
fought before the walls of Troy. The surgery 
required by Homer's heroes was chiefly that of the 
battlefield. Unguents and astringents were in 
use in the physician's art, and there is reference to 
" nepenthe," a narcotic drug, and also to the use of 
sulphur as a disinfectant. Doctors, according to 
Homer, were held in high esteem, and Arctinus 
relates that two divisions were recognized, surgeons 
and physicians, the former held in less honour than 
the latter^^" Then Asclepius (^sculapius) bestowed 
the power of healing upon his two sons ; neverthe- 
less, he made one of the two more celebrated than 
the other ; on one did he bestow the lighter hand 
that he might draw missiles from the flesh, and 
sew up and heal all wounds ; but the other he 
endowed with great precision of mind, so as to 
understand what cannot be seen, and to heal 
seemingly incurable diseases."^ 

Machaon fought in the army of Nestor. Fearing 



1 Arctinus, " Ethiopis." Translated in Puschmann's " Hist. 
Med. Education." 



EARLY GREEK MEDICINE 



17 



for his safety, King Idoineneus placed hiin under 
the charge of Nestor, who was instructed to take 
the doctor into his chariot, for " a doctor is worth 
many men." When Menelaus was wounded, a 
messenger was sent for Machaon, who extracted the 




FroTn Wellcome' 8 Medical Diary (CopyriSht) 
By peiTOission of Burrouglia Wellcome ac Co. 



Machaon (Son of Asklepios), 
The first Greek military surgeon, attending to the wounded Menelaus. 



barbed arrow, sucked the wound and apphed a 

secret ointment made known to ^sculapius by 

Chiron the Centaur, according to tradition. 

The practice of Greek medicine became almost 

entirely restricted to the temples of ^sculapius. 

the most important of which were situated at 

Ehodes, Cnidus and Cos. The priests were 
2 



18 GREEK AND EOMAN MEDICINE 

known as Asclepiad^, but the name was 
applied in time to the healers of the temple 
who were not priests. Tablets were affixed to the 
walls of these temples recording the name of the 
patient, the disease and the cure prescribed. There 
is evidence that diseases were closely observed. 
The patients brought gifts to the temples, and 
underwent a preliminary purification by ablutions, 
fasting, prayer and sacrifice. A cock was a 
common sacrifice to the god. No doubt many 
wonderful cures were effected. Mental sugges- 
tion was used greatly, and the patient was put 
to sleep, his cure being often revealed to him 
in a dream which was interpreted by the priests. 
The expectancy of his mind, and the reduced state 
of his body as the result of abstinence conduced to 
a cure, and trickery also played a minor part. 
Albeit, much of the treatment prescribed was 
commendable. Pure air, cheerful surroundings, 
proper diet and temperate habits were advocated, 
and, among other methods of treatment, exercise, 
massage, sea-bathing, the use of mineral waters, 
purgatives and emetics, and hemlock as a sedative, 
were in use. If a cure was not effected, the faith 
of the patient was impugned, and not the power 
of the god or the skill of the Asclepiades, so that 
neither religion nor the practice of physic was 
exposed to discredit. Great was the wisdom of 
the Greeks ! These temples were the famous 
medical schools of ancient Greece. A spirit of 




v 

(0 

(/> 

a 

Q 
Q 

LU 
GC 

O 

I- 
(/) 

UJ 

DC 

CO 

g 

LlJ 

_l 
< 

LL 

o 

UJ 



LlJ 

t- 



LlI 
Q 
< 
O 
< 



9) 



EAKLT GEEEK MEDICINE 19 

emulation prevailed, and a high ethical standard 
was attained, as is shown by the oath prescribed 
for students when they completed their course 
of study. The form of oath will be found in a 
succeeding chapter in connection with an account 
of the life of Hippocrates. 

The remains of the Health Temple, or Askle- 
pieion, of Cos were brought to light in 1904 and 
1905, by the work of Dr. Kudolf Herzog, of 
Tubingen. Dr. Eichard Caton, of Liverpool, has 
been able to reconstruct pictorially the beautiful 
buildings that existed two thousand years ago. 
They were situated among the hills. The sacred 
groves of cypresses were on three sides of the 
temple, and " to the north the verdant plain of 
Cos, with the white houses and trees of the town 
to the right, and the wide expanse of turquoise sea 
dotted by the purple islands of the ^gean, and 
the dim mountains about Halicarnassus, to the 
north-east."^ 

_j,The ancient Greek Gymnasia were in use long 
before the Asclepiades began to practise in the 
temples. The Greeks were a healthy and strong 
race, mainly because they attended to physical 
culture as a national duty. The attendants 
who massaged the bodies of the athletes were 
called aliptce, and they also taught physical exer- 
cises, and practised minor surgery and medicine." 

1 Caton, Brit. Med. Journ.^ 1906, i, p. 571. 



20 GREEK AND ROMAN MEDICINE 

*^assage was used before and after exercises in the 
gjTunasium, and was performed by anointing the 
body with a mixture of oil and sand which was 
well rubbed into the skin. There were three 
classes of officials in the gymnasia ; the director 
or magistrate called the gymiiasiarch, the sub- 
director or gymnast, and the subordinates. The 
directors regulated the diet of the young men, the 
sub-directors, besides other duties, prescribed for the 
sick, and the attendants massaged, bled, dressed 
wounds, gave clysters, and treated abscesses, dis- 
locations, &c. 

There is no doubt that the Greeks, in insisting 
upon the physical training of the young, were wiser 
in their generation than the people of the present 
day ; and not only the young, but people of mature 
age, took exercises suited to their physical require- 
ments. The transgression of some of Solon's laws 
in reference to the gymnasia was punishable by 
death. 

The third stage in the history of Greek medicine 
has now been reached. The first stage was primi- 
tive, the second associated with religion, and 
the third connected with philosophy. The clas- 
sification of Renouard is accurate and convenient. 
In the " Age of Foundation," he recognizes four 
periods, namely : — 

(1) The Primitive Period, or that of Instinct, 
beginning with myth, and ending with the destruc- 
tion of Troy, 1184 years before Christ. 



EARLY GREEK MEDICINE 21 

(2) The Sacred or Mj'stic Period, ending with 
the dispersion of the Pythagorean Society, 500 
years before Christ. 

(3) The Philosophic Period, ending with the 
foundation of the Alexandrian libraiy, 320 j^ears 
before Christ. This period is made illustrious by 
Hippocrates. 

(4) The Anatomic Period, ending with the death 
of Galen, about 200 years after Christ. 

The earliest Greek medical philosopher was 
Pythagoras (about 580 B.C.). He was bom at 
Samos, and began hfe as an athlete, but a lectm-e 
which he heard on the subject of the immortality 
of the soul kindled enthusiasm for philosophical 
study, the pursuit of which led him to visit Eg}'pt, 
Phoenicia, Chaldea, and perhaps also India. He 
was imbued with Eastern mysticism, and held 
that the air is full of spiritual beings who send 
dreams to men, and health or disease to mankind 
and to the lower animals. He did not remain long 
in Greece, but travelled much, and settled for a 
considerable time in Crotona, in the South of 
Italy, where he taught pupils, their course of study 
extending over five or six years. The Pythagorean 
Society founded by him did much good at first, 
but its members ultimately became greedy of gain 
and dishonest, and the Societ}^ in the lifetime of 
its founder was subjected to persecution and dis- 
persed by angry mobs. Pythagoras possessed a 
prodigious mind. He is best known for his teaching 



22 GREEK AND EOMAN MEDICINE 

in reference to the transmigration of souls, but he 
was also a great mathematician and astronomer. 
He taught that " number is the essence of every- 
thing," and his philosophy recognized that the 
universe is governed by law. God he represented 
by the figure 1, matter by the figure 2, and the 
universe by the combination 12, all of which, 
though fanciful, was an improvement upon mytho- 
logy, and a recognition of system. 

In the practice of medicine he promoted health 
mainly by diet and gymnastics, advised music for 
depression of spirits, and had in use various 
vegetable drugs. He introduced oxymel of squills 
from Egypt into Greece, and was a strong believer 
in the medicinal properties of onions. He viewed 
surgery with disfavour, and used only salves and 
poultices. The Asclepiades treated patients in the 
temples, but the Pythagoreans visited from house 
to house, and from city to city, and were known 
as the ambulant or periodic physicians. 

Herodotus gives an account of another eminent 
physician of Crotona, Democedes by name, who 
succeeded Pythagoras. At this time, it is recorded 
that the various cities had public medical officers. 
Democedes gained his freedom from slavery as a 
reward for curing the wife of Darius of an abscess 
in the breast. 

The dispersal of the Pythagoreans led to the 
settlement of many of them, and of their imitators, 
in Eome and various parts of Italy. Although 



EAELY GREEK MEDICINE 23 

Pythagoras was a philosopher, he belongs to the 
Mystic Period, while Hippocrates is the great 
central figure of the Philosophic Period. Before 
studying the work of Hippocrates, it is necessary 
to consider the distinguishing features of the 
various schools of Greek philosophy. Eenouard 
shows that the principles of the various schools 
of medical belief depended upon the three great 
Greek schools of Cosmogony. 

Pythagoras believed in a Supreme Euler of the 
Universe, and that spirits animated all life, and 
existed even in minerals ; he also believed in 
preconceived purpose. With these views were 
associated the Dogmatic School of Medicine, and 
the name of Hippocrates, and this belief corresponds 
to modern vitalism. 

Leucippus and Democritus, rejecting theology, 
considered vital action secondary to the operation 
of the laws of matter, and believed that atoms 
moved through pores in the body in such a way as 
to determine a state of health or disease. With 
this philosophy was associated the Medical School 
of Methodism, a system said to have been founded 
by Asclepiades of Prusa (who lived in Kome in the 
first century before Christ), and by his pupil 
Themison (b.c. 50). The third school of medical 
thought, that of Empiricism, taught that experi- 
ence was the only teacher, and that it was idle to 
speculate upon remote causes. The Empirics 
based these views upon the teaching of philosophers 



24 GEEEK AND ROMAN MEDICINE 

known as Sceptics or Zetetics, followers of Par- 
menides and Pyrrho, who taught that it was useless 
to fatigue the mind in endeavouring to comprehend 
what is beyond its range. They were the pre- 
cursors of modern agnosticism. 

The Eclectics, in a later age, formed another 
medical sect, and had no definite system except 
that they made a selection of the views and 
methods of Dogmatists, Methodists and Empirics. 

The Greek philosophers as a class believed in 
a primary form of matter out of which elements 
were formed, and the view held in regard to the 
elements is expressed in Ovid's " Metamorphoses."^ 

"Nor those which elements we call abide, 
Nor to this figure nor to that are ty'd : 
For this eternal world is said of old 
But four prolific principles to hold, 
Four different bodies ; two to heaven ascend, 
And other two down to the centre tend. 
Fire first, with wings expanded, mounts on high, 
Pure, void of weight, and dwells in upper sky ; 
Then air, because unclogged, in empty space 
Flies after fire, and claims the second place ; 
But weighty water, as her nature guides, 
Lies on the lap of earth ; and Mother Earth subsides. 
All things are mixed of these, which all contain, 
And into these are all resolved again." 

Eire was considered to be matter in a very 
refined form, and to closely resemble life or even 
soul. 



' Dryden's translation, book xv. 



25 



CHAPTEE III. 

HIPPOCEATES. 
His life and works — His influence on Medicine. 

Hippocrates^ the Father of Medicine, was born at 
Cos during the golden age of Greece, 460 years before 
Christ. He belonged to the family of the Ascle- 
piadse, and, according to tradition, could trace his 
ancestors on the male side to yEsculapius, and on 
the female side to Hercules. He is said to have 
received his medical education from his father and 
from Herodicus, and to have been taught philosophy 
by Gorgias, the Sophist, and by Democritus, whom 
he afterwards cured of mental derangement. 

There was a very famous medical school at Cos, 
and the temple there held the notes of the accumu- 
lated experience of his predecessors, but Hippocrates 
visited also, for the purpose of study, various towns 
of Greece, and particularly Athens. He w\as a 
keen observer, and took careful notes of his observa- 
tions. His reputation was such that his w^orks 
are quoted by Plato and by Aristotle, and there 
are references to him by Arabic writers. His 
descendants published their own writings under 
his name, and there were also many forgeries, so 
that it is impossible to know exactly how many of 



26 GREEK AND ROMAN MEDICINE 

the works attributed to him are authentic ; but by 
a consensus of opinion the following books are 
considered genuine : " Prognostics," seven of the 
books of " Aphorisms," " On Airs, Waters and 
Places," " On Regimen in Acute Diseases," the 
first and third books of " Epidemics,'' " On the 
Articulations," " On Fractures," the treatise on 
"Instruments of Reduction," and "The Oath"; 
and the books considered almost certainly genuine 
are those dealing with " Ancient Medicine," 
"Surgery," "The Law," "FistuL^," "Ulcers," 
"Haemorrhoids," and "On the Sacred Disease" 
(Epilepsy). The famous Hippocratic Collection 
in the great libraries of Alexandria and Pergamos 
also comprised the writings of Pythagoras, Plato 
and Aristotle. 

The genius of Hippocrates is unsurpassed in 
the history of medicine. He was the first to 
trace disease to a natural and intelligible cause, 
and to recognize Nature as all-sufficient for heal- 
ing, and physicians as only her servants. He dis- 
cussed medical subjects freely and without an air 
of mystery, scorning all pretence, and he was 
also courageous enough to acknowledge his limit- 
ations and his failures. When the times in which 
he lived are considered, it is difficult to know which 
of his qualities to admire most, his love of know- 
ledge, his powers of observation, his logical faculty, 
or his courage and truthfulness. 
L^T'he central principle of belief of Hippocrates and 



HIPPOCRATES 27 

the Dogmatists was that health depended on the 
proper proportion and action in the body of the 
four elements, earth, ^Yater, air, and fire, and the 
four cardinal humours, blood, phlegm, yellow 
bile and black bile. The due combination of 
these was known as crasis, and existed in health. 
If a disease were progressing favourably these 
humours became changed and combined (coction), 
preparatory to the expulsion of the morbid matter 
(crisis), which took place at definite periods known 
as critical days. Hippocrates also held the theory^ 
of fluxions,_which were conditions in the nature of 
congestion, as it would now be understood. 

In his time public opimon condemned dissection 
of the human body, but it is certain that dissections 
were performed by Hippocrates to a limited extent.^ 
He did not know the difference between the arteries 
and the veins, and nerves and ligaments and various 
membranes were all thought to have analogous 
functions, but his writings display a correct know- 
ledge of the anatomy of certain parts of the body 
such as the joints and the brain. This defective 
knowledge of anatomy gave rise to fanciful views 
on physiology, which, among much that is admir- 
able, disfigure the Hippocratic writings. 

The belief that almost all medical and surgical 
knowledge is modern, though flattering to our 
self-complacency, is disturbed by the study of the 
state of knowledge in the time of Hippocrates. 
To him we are indebted for the classification of 



28 GEEEK AND ROMAN MEDICINE 

diseases into sporadic, epidemic, and endemic, and 
he also separated acute from chronic diseases. 
He divided the causes of disease into two classes : 
_general, such as climate, water and sanitation; 
and " ^ersona l^ such as improper food and neglect 
of exercise. 

He based his conclusions on the observation of 
appearances, and in this way began a new era. He 
was so perfect in the observation of external signs 
of disease that he has never in this respect been 
excelled. The state of the face, eyes, tongue, 
voice, hearing, abdomen, sleep, breathing, excre- 
tions, posture of the body, and so on, all aided him 
in diagnosis and prognosis, and to the latter 
he paid special attention, saying that " the best 
physician is the one who is able to establish a 
prognosis, penetrating and exposing first of all, 
at the bedside, the present, the past, and the future 
of his patients, and adding what they omit in their 
statements. He gains their confidence, and being 
convinced of his superiority of knowledge they do 
not hesitate to commit themselves entirely into his 
hands. He can treat, also, so much better their 
present condition in proportion as he shall be able 
from it to foresee the future." 

He wrote about the history of Medicine, a study 
which is much neglected at the present time. 
There is no generation of men so wise that they 
cannot with advantage adopt some ideas from the 
remote past, or, at least, find the teaching of their 



HIPPOCRATES 29* 

predecessors suggestive. Hippocrates was one of 
the first to recognize the vis ineclicatrix natures, and 
he always aimed at assisting Nature. His style 
of treatment would be known now as expectant,, 
and he tried to order his practice "to do good, or,, 
at least, to do no harm." When he considered 
interference necessary, however, he did not hesi- 
tate even to apply drastic measures, such as scari- 
fication, cupping and bleeding. He made u ao— oL 
the narcotics mandragora, henbane, and probably 
also pop py- juic e, and as a_J[axative used greatly 
a vegetable substance called " mercury," beet and 
cabbage, and cathartics such as scammony and 
elaterium ! He was able to diagnose fluid in the 
chest or abdomen by means of percussion and 
auscultation, and to withdraw the fluid by the 
operation of paracentesis, and he recognized also 
that the fluid should be allowed to flow away 
slowly so as to minimize the risk of syncope. He 
operated also for empyema. In regard to the 
methods of Hippocrates for the physical examina- 
tion of the chest it is reasonable to suppose that 
the Father of Medicine indirectly inspired Laennec 
to invent the stethoscope. Hippocrates prescribed 
fluid diet for fevers, allowed the patients cold 
water or barley water to drink, and recommended 
cold sponging for high fever. In his writings will 
be found his views on apoplexy, epilepsy, phthisis, 
gout, erysipelas, cancer and many other diseases 
common at the present day. 



30 GREEK AND ROMAN MEDICINE 

In the province of Surgery, Hippocrates was 
surprisingly proficient, although he lived before 
the Anatomic Period. He had various lotions 
for the healing of ulcers; some of these lotions 
were antiseptic and have been in use in recent 
times. His opinions on the treatment of fractures 
are sound, and he was a master in the use of splints, 
and considered that it was disgraceful on the part 
of the surgeon to allow a broken limb to set in a 
faulty position. He resected the projecting ends 
of the bone in the case of compound fracture. He 
had a very complete knowledge of the anatomy of 
joints, was well acquainted with hip-joint disease, 
and could operate upon joints. Accidents were no 
doubt common in the gymnasia, and practice in 
the treatment of fractures and dislocations exten- 
sive and of a high order of excellence. Hippocrates 
used the sound for exploring the bladder, and 
understood the use of the speculum for examin- 
ing the rectum, and in operations for fistula and 
piles. He understood the causation of club-foot, 
and could cure cases of this deformity by bandag- 
ing. He was skilful also in obstetric operations. 
He trepanned the skull, which appears to have 
been a common operation in his day. He had 
clear and sound views in reference to wounds of 
the head, recognizing that trivial-looking wounds 
of the scalp might become very serious. Hippo- 
crates gave directions as to the indications for 
using the trepan, and warned the operator against 



HIPPOCRATES ' 31 

mistaking sutures of the cranial bones for 
fracture. 

/He did not describe amputations as generally- 
understood, but removed limbs at a joint for gan- 
grene. When necessary he made use of mechanical 
appliances for reducing dislocations, and recom- 
mended doctors to furnish their surgeries with an 
adjustable table, fitted with levers, for dealing with 
the reduction of dislocations, and for various other 
surgical manipulations.' Excision of tumours was 
not a common operation of Hippocratic surgery, 
although it had been a part of Hindu practice in 
very ancient times. On the subject of Obstetrics, 
Hippocrates wrote a great deal, and although many 
of his theories seem absurd at the present day, yet, 
on the whole, the treatment he recommends is 
efficacious. Regarding GyncBcology, in his treatise 
on "Airs, Water and Places," it is interesting to 
observe that he says that the drinking of impure 
water will cause dropsy of the uterus. Adams, 
commenting on this, has in mind hydatids, but it 
is evident that both Hippocrates and his translator 
and critic have mistaken hydatidiform disease of 
the ovum for hydatid disease of the womb. In the 
books which are considered genuine the references 
to diseases of women are meagre, and it is likely 
that the author had little special knowledge of the 
subject. That part of the Hippocratic collection 
which is not considered genuine deals rather fully 



32 GREEK AND ROMAN MEDICINE 

with the subject of gynaecology.^ In it are de- 
scribed sounds made of wood and of lead, dilators 
and uterine catheters. Sitz baths were in use, 
and fumigations were very extensively employed 
in gynsecological practice. Pessaries were made 
by rolling lint or wool into an oblong shape, and 
were medicated to be emollient, astringent or 
purgative in their local action. The half of a 
pomegranate was used as a mechanical pessary, 
and there are also references to tents, and to 
suppositories for the bowel. 

In dealing with Dietetics, Hippocrates displays 
close observation and sound judgment. The views 
held generally at the present day coincide closely 
with his instructions on food and feeding. In the 
treatise on Ancient Medicine, he states that men 
had to find from experience the properties of 
various vegetable foods, and discovered that what 
was suitable in health was unsuitable in sickness, 
and that the accumulation of these discoveries was 
the origin of the art of medicine. 

The Sydenham Society initiated, and Dr. Adams 
brilliantly accomplished, a noble work in the publi- 
cation in 1849 of " The Genuine Works of Hippo- 
crates," from which " The Law," and " The Oath " 
are here quoted. The former is the view of Hippo- 
crates of the standards which should govern the 



^ Vide " History of Gynaecology," by W. J. Stewart McKay. 
Bailliere, Tindall and Cox, 1901. 



HIPPOCRATES 33 

practice of medicine; the latter is that by which 
all the ^sculapians were bound. 

" T he Law . 

" (1) Medicine is of all the arts the most noble ; 
but, owing to the ignorance of those who practise 
it, and of those who, inconsiderately, form a judg- 
ment of them, it is at present far behind all the 
other arts. Their mistake appears to me to arise 
principally from this, that in the cities there is no 
punishment connected with the practice of medi- 
cine (and with it alone) except disgrace, and that 
does not hurt those who are familiar with it. 
Such persons are like the figures which are in- 
troduced in tragedies, for as they have the shape, 
and dress, and personal appearance of an actor, 
but are not actors, so also physicians are many in 
title but very few in reality. 

" (2), Whoever is to acquire a competent know- 
ledge of medicine, ought to be possessed of the 
following advantages : A natural disposition ; in- 
struction ; a favourable position for the study ; early 
tuition ; love of labour ; leisure. First of all, a 
natural talent is required, for, when Nature opposes, 
everything else is vain ; but when Nature leads the 
way to what is most excellent, instruction in the 
art takes place, which the student must try to 
appropriate to himself by reflection, becoming an 
early pupil in a place well adapted for instruction. 



34 GREEK AND ROMAN MEDICINE 

He must also bring to the task a love of labour 
and perseverance, so that the instruction taking 
root may bring forth proper and abundant fruits. 

" (3) Instruction in medicine is like the culture 
of the productions of the earth. For our natural 
disposition is, as it were, the soil ; the tenets of 
our teacher are, as it were, the seed ; instruction 
in youth is like the planting of the seed in the 
ground at the proper season ; the place where the 
instruction is communicated is like the food im- 
parted to vegetables by the atmosphere ; diligent 
study is like the cultivation of the fields ; and it is 
time which imparts strength to all things and 
brings them to maturity. 

" (4) Having brought all these requisites to the 
study of medicine, and having acquired a true 
knowledge of it, we shall thus, in travelling 
through the cities, be esteemed physicians not 
only in name but in reality. But inexperience is 
a bad treasure, and a bad friend to those who 
possess it, whether in opinion or reality, being 
devoid of self-reliance and contentedness, and the 
nurse both of timidity and audacity. For timidity 
betrays a want of powers, and audacity a want of 
skill. There are, indeed, two things, knowledge 
and opinion, of which the one makes its possessor 
really to know, the other to be ignorant. 

" (5) These things which are sacred are to be 
imparted only to sacred persons ; and it is not 
lawful to impart them to the profane until 



HIPPOCRATES 35 

they have been initiated in the mysteries of the 



science." 



"The Oath. 

" I swear by Apollo, the physician, and ^scul- 
apius, and Health, and Panacea, and all the gods 
and goddesses, that, according to my ability and 
judgment, I will keep this oath and this stipula- 
tion — to reckon him who taught me this art 
equally dear to me as my parents, to share my 
substance with him, and relieve his necessities if 
required; to look upon his offspring in the same 
footing as my own brothers, and to teach them 
this art, if they shall wish to learn it, without fee 
or stipulation; and that by precept, lecture, and 
every other mode of instruction, I will impart a 
knowledge of the Art to my own sons, and those 
of my teachers, and to disciples bound by a stipu- 
lation and oath according to the law of medicine, 
but to none others. I will follow that system of 
regimen which, according to my ability and judg- 
ment, I consider for the benefit of my patients, 
and abstain from whatever is deleterious and 
mischievous. I will give no deadly medicine to 
anyone if asked, nor suggest any such counsel; 
and in like manner I will not give to a woman a 
pessary to produce abortion. With purity and 
with holiness I wilL^ass my life and practise my 
Art. I will not cut persons labouring under the 
stone, buFwill leave this to be done by m en who 



36 GREEK AND EOMAN MEDICINE 

are practitioners of this work. Into whatever 
houses I enter, I will go into them for the benefit 
of the sick, and will abstain from every voluntary 
act of mischief and corruption, and, further, from 
the seduction of females or males, of freedmen and 
slaves. Whatever, in connection with my pro- 
fessional practice, or not in connection with it, I 
see or hear, in the life of men, which ought not to 
be spoken of abroad, I will not divulge as reckon- 
ing that all such should be kept secret. While I 
continue to keep this Oath inviolate, may it be 
granted to me to enjoy life and the practice of the 
Art, respected by all men, in all times ! But 
should I trespass or violate this oath, may the 
reverse be my lot ! " 

It would be a great task to attempt anything 
like a full review of the writings of this great 
doctor of antiquity, but enough has been written 
to reveal the great powers of his mind, and to 
show that he was far in advance of his predecessors, 
and a model for his successors. In the island of 
Cos, made illustrious by the name of Hippocrates, 
it is strange to find that he has no fame now 
other than that of being regarded in the confused 
minds of the people as one of the numerous saints 
of the Greek Church.^ 

" When," says Littre, " one searches into the 
history of medicine and the commencement of 

* Archiv fiir Geschichte der Medizin, May, 1912. 



HIPPOCEATES 37 

science, the first body of doctrine that one meets 
with is the collection of writings known under the 
name of the works of Hippocrates. The science 
mounts up directly to that origin, and there 
stops. Not that it had not been cultivated 
earlier, and had not given rise to even numerous 
productions ; but everything that had been made 
before the physician of Cos has perished. We 
have only remaining of them scattered and im- 
connected fragments. The works of Hippocrates 
have alone escaped destruction ; and by a singular 
circumstance there exists a great gap after them 
as well as before them. The medical works from 
Hippocrates to the establishment of the School of 
Alexandria, and those of that school itself, are 
completely lost, except some quotations and 
passages preserved in the later writers; so that 
the writings of Hippocrates remain alone amongst 
the ruins of ancient medical literature." Sydenham 
said of Hippocrates : " He it is whom we can never 
duly praise," and refers to him as "that divine old 
man," and " the Komulus of medicine, whose 
heaven was the empyrean of his art." 

Hippocrates died in Thessaly, but at what age 
is uncertain, for different authors have credited him 
with a lifetime of from eighty-five to a hundred 
and nine years. By virtue of his fame, death for 
him was not the Great Leveller. 

Hippocrates had two sons, Thessalus and 
Draco ; the former was physician to Archelaus, 



38 GREEK AND ROMAN MEDICINE 

King of Macedonia, the latter physician to the 
wife of Alexander the Great. They were the 
founders of the School of Dogmatism which was 
based mainly on the teaching and aphorisms of 
Hippocrates. The Dogmatic Sect emphasized the 
importance of investigating not the obvious but 
the underlying and hidden causes of disease and 
held undisputed sway until the foundation of the 
Empirical Sect at Alexandria. 



39 



CHAPTEK lY. 

PLATO. ARISTOTLE, THE SCHOOL OF ALEXANDRIA 

AND EMPIRICISM. 

Plato — Aristotle — Alexandrian School — Its Origin — Its Influ- 
ence — Lithotooay — Herophilus — Erasistratus — Cleombro- 
tus — Chrysippos — Anatomy — Enapiricism — Serapion of 
Alexandria. 

Two very eminent philosophers, Plato and 
Aristotle, were influenced by the teaching of 
Hippocrates. 

Flato (B.C. 427-347) was a profound moralist, and 
though possessed of one of the keenest intellects 
of all time, did little to advance medical science. 
He did not practise medicine, but studied it as a 
branch of philosophy, and instead of observing and 
investigating, attempted to solve the problems of 
health and disease by intuition and speculation. 
His conceptions were inaccurate and fantastic. 

He elaborated the humoral pathology of 
Hippocrates. The world, he thought, was composed 
of four elements : fire consisting of pyramidal, 
earth of cubical, air of octagonal, and water of 
twenty-sided atoms. The marrow consists of 
triangles, and the brain is the perfection of marrow. 
The soul dominates the marrow and the separation 
of the two causes death. The purpose of the bones 



40 GREEK AND ROMAN MEDICINE 

and muscles is to protect the marrow against 
changes of temperature. Plato divided the " soul " 
into three parts : Eeason, enthroned in the hrain ; 
courage in the heart ; and desire in the liver. The 
uterus, he believed, excites inordinate desires. 
Inflammations are due to disorders of the bile, and 
fevers to the influence of the elements. His 
theories in regard to the special senses are very 
fantastic, for instance, smell is evanescent because 
it is not founded on any external image ; taste 
results from small vessels carrying taste atoms to 
the heart and soul. 

Aristotle, born B.C. 334, was the son of Nicho- 
machus, physician to the King of Macedonia, and 
of the race of the Asclepiads. His inherited taste 
was for the study of Nature; he attained the 
great honour of being the founder of the 
sciences of Comparative Anatomy and Natural 
History, and contributed largely to the medical 
knowledge of his time. Aristotle went to Athens 
and became a follower of Plato, and the close 
companionship of these two great men lasted for 
twenty years. At the age of 42, Aristotle 
was appointed by Philip of Macedon tutor to 
Alexander the Great, who was then aged 15, 
and the interest of that mighty prince was 
soon aroused in the study of Natural History. 
Aristotle and Alexander the Great, teacher and 
pupil, founded the first great Natural History 
Museum, to which specimens were sent from places 



THE SCHOOL OF ALEXANDRIA AND EMPIRICISM 41 

scattered over the then known world. Aristotle, 
besides his philosophical books, wrote : " Re- 
searches about Animals," "On Sleep and Waking," 
" On Longevity and Shortlivedness," " On Parts of 
Animals," " On Respiration," " On Locomotion of 
Animals," and " On Generation of Animals." He 
was greatly helped in the supply of material for 
dissection in his study of comparative anatomy 
by his pupil, Alexander the Great. Aristotle 
pointed out the differences in the anatomy of 
men and monkeys ; he described the anatomy of 
the elephant and of birds, and also the changes 
in development seen during the incubation of eggs. 
He investigated, also, the anatomy of fishes and 
reptiles. The stomachs of ruminant animals ex- 
cited his interest, and he described their structure. 
The heart, according to Aristotle, was the seat of 
the soul, and the birthplace of the passions, for it 
held the natural fire, and in it centred movement, 
sensation and nourishment. The diaphragm, he 
believed, separated the heart, the seat of the soul, 
from the contaminating influences of the intestines. 
He did not advance beyond the conception that 
nerves were akin to ligaments and tendons, and he 
believed that the nerves originated in the heart, as 
did also the blood-vessels. He named the aorta 
and ventricles. He investigated the action of the 
muscles, and held that superfoetation was possible. 
When Aristotle retired to Chalcis, he chose 
Tyrtamus, to whom he gave the name of 



42 GEEEK AND ROMAN MEDICINE 

Theophrastics, as his successor at the Lyceum. 
Theophrastus was the originator of the science 
of Botany, and wrote the '' History of Plants." 
He also wrote about stones, and on physical, moral 
and medical subjects. 

The Alexandeian School. 

" In the year 331 B.C.," wrote Kingsley, " one of 
the greatest intellects whose influence the world 
has ever felt, saw, with his eagle glance, the 
unrivalled advantages of the spot which is now 
Alexandria, and conceived the might}^ project of 
making it the point of union of two, or rather of 
three worlds. In a new city named after himself, 
Europe, Asia and Africa were to meet and hold 
communion." The School of Alexandria became, 
after the decay of Greek culture, the centre of 
learning for the world, and when the Empire of 
Alexander the Great was subdivided, the Egyptian 
share fell to the first Ptolemy, who, under the 
direction of Aristotle, founded the Alexandrian 
Library, containing at first fifty thousand, and 
finally seven hundred thousand volumes. Every 
student who came to the University of Alexandria, 
and possessed a book of which there was not a copy 
in the Alexandrian Library, was compelled to 
present the book to the library. The first Ptolemy 
also fostered the study of medicine and of dissec- 
tion. Eumenes likewise established a library at 



THE SCHOOL OF ALEXANDRIA AND EMPIRICISM 43 

Pergamos. It is instructive to follow the history 
of the great Library of Alexandria. The greater 
part of the library, which contained the collected 
literature of Greece, Eome, India and Egypt, was 
housed in the famous museum in the part of 
Alexandria called the Brucheion. This part was 
destroyed by fire during the siege of Alexandria by 
Julius Caesar. Mark Antony, then, at the urgent 
desire of Cleopatra, transferred to Alexandria the 
books and manuscripts from Pergamos. The other 
part of the library was kept at Alexandria in the 
Serapeum, the temple of Jupiter Serapis, and there 
it remained till the time of Theodosius the Great, 
until in 391 A.D. both temple and library were 
almost completely destroyed by a fanatical mob of 
Christians led by the Archbishop Theophilus. When 
Alexandria was taken by the Arabs in 641, under 
the Calif Omar, the destruction was completed. 

Ptolemy gathered to the museum at Alexandria a 
number of very learned men, who lived within its 
walls and were provided with salaries, the wiiole 
system closely resembling a university. Grammar, 
prosody, mythology, astronomy and philosophy 
were studied, and great attention was given to 
the study of medicine. Euclid was the teacher 
of Mathematics, and Hipparchus of Alexandi-ia 
was the father of Astronomy. The teaching of 
medicine and of astronomy was for long based upon 
observation of ascertained facts. The Alexandrian 
School endured for close upon a thousand years, 



44 GEEEK AND EOMAN MEDICINE 

and its history may be divided into two periods, 
namely, from 323 to 30 B.C., during the period of the 
Ptolemies, and from 30 B.C. to 640 a.d. The second 
period was distinguished for the study of speculative 
philosophy, and of the religious philosophy of the 
Gnostics, and was not a scientific period. 

Julius Caesar was not the only Eoman Emperor 
who brought trouble upon the Alexandrian School, 
for the brutal Caracalla took away the salaries and 
privileges from the savants, and prohibited scientific 
exhibitions and discussions. In recent excavations 
in the Baths of Caracalla in Eome, the ruins of a 
library have been discovered, and it is believed by 
some archaeologists that Caracalla supplied this 
library with books and parchments from Alexandria. 

The Asclepiadae of Cos and Cnidos had dis- 
coursed upon the phenomena of disease, without 
attempting to demonstrate its structural relations ; 
like the sculptors of their own age, they studied the 
changing expression of vital action almost wholly 
from an external point of view. They meddled 
not with the dead, for, by their own laws, no one 
was allowed to die within the temple. But the 
early Alexandrians were subject to no such restric- 
tions ; and turning to good account the discoveries 
of Aristotle in natural history and comparative 
anatomy, they undertook for the first time to 
describe the organization of the human frame 
from actual dissections.^ 



The Medical Profession in Ancient Times." "Watson, p. 90. 



THE SCHOOL OP ALEXANDRIA AND EMPIRICISM 45 

Thus there was inaugurated at Alexandria the 
Anatomic Period of Medicine, which lasted till 
Egypt came under the sway of the Romans. 
Medical practice became so flourishing at Alexandria 
that three great specialities were established, 
namely. Surgery, Pharmacy, and Dietetics, and a 
great variety of operations were performed. 
Lithotomy was much practised by specialists. 
A foul murder was perpetrated by lithotomists 
at the instigation of Diodotus, the guardian of 
Antiochus, son of Alexander, King of Syria 
(150 B.C.), young Antiochus, at the age of 10, 
being done to death under the pretence that he 
had a stone in his bladder. 

About 150 B.C. a sect called the Essenes was 
established for the study of curative and poisonous 
substances. The members were not all physicians, 
by any means, for one of the chief was King 
Mithridates, who invented the remedy known as 
mithridaticum. This celebrated nostrum of 
antiquity is said to have been a confection of 
twenty leaves of rue, a few grains of salt, two 
walnuts, and two figs, intended to be taken every 
morning and followed by a draught of wine. 

Two famous physicians and anatomists, 
Herophilus (335-280 b.c.) and Erasistratus (280 
B.C.) took part in the medical teaching at Alexandria 
in the early days of that seat of learning. It is 
recorded that they did not confine their investiga- 
tions to the dissection of the dead, but also vivisected 



46 GREEK AND EOMAN MEDICINE 

criminals. CleomhrotiiSj another physician at this 
school, was sent for to attend King Antiochus, 
and was rewarded with a hundred talents, equal 
to about £15,000 sterling. 

There were several physicians of the name of 
Chrj/sippos connected with the Alexandrian School. 
One was physician to Ptolemy Soter, the King 
of Egypt, and tutor to Erasistratus. This 
Chrysippos introduced the practice of emptying a 
limb of blood before amputation, according to the 
recent method of Esmarch, and is said to have 
employed vapour baths in the treatment of dropsy. 
In Alexandria, anatomy was properly studied.^ 
Herophilus made many anatomical discoveries, 
and some of the names he gave to parts of the 
body are now in use, for instance, torcular 
Herophili, calamus scriptorius, and duodenum. 
He described the connection between the nerves 
and the brain, and the various parts of the brain, 
and recognized the essential difference between 
motor and sensory nerves, although he thought 
the former arose in the membranes and the latter 
in the substance of the brain. He believed that 
the fourth ventricle was the seat of the soul. He 
attributed to the heart the pulsations of the 
arteries, but thought that the pulmonary veins 
conveyed air from the lungs to the left side of 

^ Arctinus : " Ethiopis," Translated in Puschmann's " Hist. 
Med. Education." 



THE SCHOOL OF ALEXANDRIA AND EMPIRICISM 47 

the heart, and he observed the lacteals without 
determining their function. Herophilus operated 
upon the hver and spleen, and looked upon the 
latter as of little consequence in the animal 
economy. He had a good knowledge of obstetric 
operations. His ideas in relation to pathology 
did not proceed much further than the belief 
that disease was due to corruption of the humors. 
He was more scientific and accurate when he 
taught that paralysis results from a defect in the 
nerves. 

Erasistratus studied under Chrysippos (or 
Chrysippus), and under Metrodorus, the son-in- 
law of Aristotle. Herophilus had been a student 
at Cos, Erasistratus at Cnidos, so that the 
teaching of the two great Greek medical schools 
was introduced into Alexandria. Xenophon, of 
Cos, one of the followers of Erasistratus, first 
resorted to the ligation of vessels for the arrest 
of haemorrhage, although for many years in later 
times this important practice was lost through the 
neglect of the study of the history of medicine. 
Erasistratus and Herophilus, it is sad to relate, 
considered that vivisection of human beings, as 
well as dissection of the dead, was a necessary part 
of medical education, and believed that the 
sufferings of a few criminals did not weigh against 
the benefit likely to accrue to innocent people, 
who could be relieved or cured of disease and 
suffering as the result of the knowledge gained by 



48 GREEK AND EOMAN MEDICINE 

dissection of the living. This cruel and nefarious 
practice was followed '' so that the investigators 
could study the particular organs during life in 
regard to position, colour, form, size, disposition 
hardness, softness, smoothness, and superficial 
extent, their projection and curvatures." 

The followers of these teachers, unfortunately, 
became very speculative and fond of discussions 
of a fruitless kind, and, according to Pliny, it was 
easier " to sit and listen quietly in the schools than 
to be up and wandering over the deserts, and to 
seek out new plants every day,"^ and so, in the 
third century before Christ, the school of 
Empiricism was established, the system of which 
resembled the older Scepticism. It rested upon the 
"Empiric tripod," namely, accident, history and 
analogy. This meant that discoveries were made 
by accident, knowledge was accumulated by the 
recollection of previous cases, and treatment 
adopted which had been found suitable in similar 
circumstances. Fliilinus of Cos, a pupil of 
Herophilus, declared that all the anatomy he had 
learned from his master did not help him in the 
least to cure diseases. Philinus, according to Galen, 
founded the Empirici, the first schismatic sect in 
medicine. Celsus" wrote of this sect that they 
admit that evident causes are necessary, but 

1 Pliny, " Hist. Nat.," xxvi, 6. 

= " De Med.," Praefat. (Translation.) 



THE SCHOOL OF ALEXANDRIA AND EMPIRICISM 49 

deprecate inquiry into them because Nature is 

incomprehensible. This is proved because the 

philosophers and physicians who have spent so 

much labour in trying to search out these occult 

causes cannot agree amongst themselves. If 

reasoning could make physicians, the philosophers 

should be most successful practitioners, as they 

have such abundance of words. If the causes of 

diseases were the same in all places, the same 

remedies ought to be used everywhere. Eelief 

from sickness is to be sought from things certain 

and tried, that is from experience, which guides 

us in all other arts. Husbandmen and pilots 

do not reason about their business, but they 

practise it. Disquisitions can have no connection 

with medicine, because physicians whose opinions 

have been directly opposed to one another have 

equally restored their patients to health ; they did 

not derive their methods of cure from studying the 

occult causes about which they disputed, but from 

the experience they had of the remedies which 

they employed upon their patients. Medicine was 

not first discovered in consequence of reasoning, 

but the theory was sought for after the discovery 

of medicine. Does reason, they ask, prescribe the 

same as experience, or something different ? If the 

same, it must be needless ; if different, it must be 

mischievous. 

In the third and second centuries before Christ, 

many physicians wrote commentaries on diseases 
4 



50 GREEK AND EOMAN MEDICINE 

and attacked the teaching of Hippocrates. Among 
these, Serapion of Alexaridria, an Empiric who 
Hved in the third century before Christ, is note- 
worthy for having first used sulphur in the treat- 
ment of skin diseases, and HeracUdes wrote on 
strangulated hernia. Serapion added somewhat to 
the system of Philinus, and was responsible for 
introducing the principle of analogy into the system 
of Empiricism. The foundation of Empiricism 
marked the decline of the medical school of 
Alexandria. We are indebted to Celsus for a full 
description of the teaching of this sect, and, at 
the same time, for an exposure of its fallacies. 
Serapion was a convert from the school of Cos, 
which was the stronghold of medical dogmatism, 
and, like nearly all apostates, he w^as consumed with 
animosity and bitterness towards those with whom 
he had formerly been in agreement. Cnidos was 
the stronghold of the Empirics. 



51 



CHAPTEE V. 

EOMAN MEDICINE AT THE END OF THE KEPUBLIC 
AND THE BEGINNING OF THE EMPIKE. 

Asclepiades of Prusa — Themison of Laodicea — Methodism — 
Wounds of Julius Caesar — Systems of Philosophy — State 
of the country — Eoman quacks — Slaves and Freedmen — 
Lucius Horatillavus. 

Asclepiades of Prusa, in Bithynia, was a famous 
physician in Eome early in the first century before 
Christ. He studied both rhetoric and medicine at 
Alexandria and at Athens. He began as a teacher 
of rhetoric in Rome, but, although he was the friend 
of Cicero, he was not very successful, and abandoned 
this study for the practice of medicine. He had a 
great deal of ability and shrewdness, but no know- 
ledge of anatomy or physiology, and he condemned 
all who thought that these subjects of study were 
the foundation of the healing art. He specially 
inveighed against Hippocrates, and with some 
reason, for the disciples of Hippocrates had elevated 
the teaching of their master almost into a religion, 
and were bound far too closely to his authority, to 
the exclusion of original thought and progress. 

Asclepiades had many pupils, and his teaching 
led to the foundation of the Medical School of 
the Methodists. His most important maxim was 
that a cure should be effected " tuto, celeriter, ac 



52 GREEK AND EOMAN MEDICINE 

jucunde,'^ and he believed that what the physician 
could do was of primary importance, and vis 
medicatrix naturcB only secondary. He was thus 
directly opposed to the teaching of Hippocrates. 
He had little or no faith in drugs, and relied 
mainly upon diet, exercises and massage, and, to 
some extent, upon surgery. His practice of pre- 
scribing wine in liberal doses added to his popularity. 
It was the custom to take wine very much diluted 
with water, but Asclepiades ordered wine in full 
strength or only slightly diluted. He practised 
bronchotomy and tracheotomy, and recommended 
in suitable cases of dropsy scarification of the 
ankles, and advised that, in tapping, an opening 
as small as possible should be made. He also 
observed spontaneous dislocation of the hip. He 
was a very famous man in the Eoman Kepublic, 
and was well acquainted with philosophy, especi- 
ally the philosophy of the Epicureans. Although 
he was almost entirely ignorant of anatomy, 
he was far from being a quack. He had 
great powers of observation and natural shrewd- 
ness, and his success largely contributed to 
the establishment of Greek doctors and their 
methods in Eome. There is grim humour in his 
description of the Hippocratic treatise on thera- 
peutics, which he called " a meditation on death." 
Pliny relates that Asclepiades wagered that he 
would never die of disease, and he won the wager, 
for he lived to old age and died of an accident ! 



ROMAN MEDICINE AT THE END OF THE REPUBLIC 53 

Themiso7i, of Laodicea, lived in the first 
century before Christ, and was a pupil of 
Asclepiades of Prusa, the founder of the School 
of Methodism. His views on atoms and pores 
led him to adopt a very simple explanation of 
health and disease, for he considered that these 
pores must be either constricted or dilated, and the 
aim of the physician should be to dilate the con- 
striction, and vice versa. This epitomized system 
of medicine did away with the use of many classes 
of drugs, and, from its simplicity, was quickly 
learned. A jeering opponent of the system of the 
Methodici said that it could be taught in six 
months, and Galen, in later years, ridiculed it, 
and called its practitioners " the asses of Thessaly." 

The great fault of Dogmatism was its absolute 
reliance on the wisdom of Hippocrates, and 
Methodism was marred by its insufficiency and 
sophistry. 

In spite of his extravagant theories, Themison 
possessed skill in practice. He was the first 
physician to describe rheumatism, and he also is 
thought to have been the pioneer in the medicinal 
use of leeches. A book on elephantiasis ascribed 
to him is not definitely known to be authentic. 
It is worthy of note that he was anxious to write 
on hydrophobia, but a case he had seen in early 
youth so impressed his mind with horror that the 
mere thought of the disease caused him to suffer 
some of the symptoms. 



54 GEEEK AND KOMAN MEDICINE 

The views of the Methodists were less extreme 
than those of the Dogmatists and Empirics. Celsus 
wrote of the Methodists : " They assert that the 
knowledge of no cause whatever bears the least 
relation to the method of cure ; and that it is 
sufficient to observe some general symptoms of 
distempers ; and that there are three kinds of 
diseases, one bound, another loose, and the third 
is a mixture of these." ^ 

There were several physicians of the name of 
Themison at different times, and it is probably the 
founder of the Methodici who was satirized by 
Juvenal thus : — 

" How many patients Themison dispatched 
In one short autumn." ^ 

The joke which is based on attributing a cure to 
Nature alone, and death solely to the physician's 
want of skill, is one of the most time-honoured. 

Themison lived at the close of the Eoman 
Kepublic, and it will now be necessary to consider 
the state of the healing art in Eome under the rule 
of the emperors. 

Julius Caesar — one of the first triumvirate — 
invaded and conquered Gaul and Britain, and after 
these great military achievements, found that he 
could not sheath his sword until he had met in 
battle his rival Pompey. Caesar defeated Pompey 
at Pharsalia, in Thessaly (48 B.C.), and pursued 

1 "De Medic," lib. 1. ^ « q^^^^x ^^ 221. 



ROMAN MEDICINE AT THE END OP THE REPUBLIC 55 

him to Egypt. Pompey was murdered in Egypt, 
and his last followers finally defeated in Spain, and 
in 45 B.C. Julius Caesar returned to Kome, and 
was declared perpetual imperator. On March 15, 
44 B.C., he was assassinated. It is possible that 
the career of this great man may have promoted 
the surgery of the battlefield, but his reign as 
Emperor was too short, and the political situation 
of his time too acute, to permit of much progress 
in the arts of peace generally, and in the medical 
art particularly. Julius Caesar bestowed the right 
of Roman citizenship on all medical practitioners 
in the city. 

Referring to the death of Julius Caesar, Suetonius 
writes that among so many wounds there was 
none that was mortal, in the opinion of the surgeon 
Antistus, except the second, which he received in 
the breast. 

Octavianus was appointed one of the second 
triumvirate, his colleagues being Mark Antony and 
Lepidus. Lepidus was first forced out of the 
triumvirate, and Octavianus and Mark Antony 
then came into conflict. During these rivalries, 
a great civic work was accomplished by Marcus 
Agrippa, who built the aqueduct known as Aqua 
Julia. A landmark in history is the battle of 
Actium, in which Octavianus defeated Mark 
Antony and his ally Cleopatra, and within a few 
years Octavianus was proclaimed Emperor as 
Augustus Caesar (27 B.C.). Under his rule Rome 



56 GREEK AND EOMAN MEDICINE 

greatly prospered, and we shall now consider the 
state of medicine and of sanitation during his 
illustrious reign. 

In the Eoman Empire there was a spirit of 
toleration abroad, " and the various modes of 
worship which prevailed in the Roman world were 
all considered by the people as equally true ; by the 
philosopher, as equally false; and by the magistrate, 
as equally useful. And thus toleration produced 
not only mutual indulgence, but even religious 
concord" (Gibbon). 

The systems of philosophy in vogue were those 
of the Stoics, the Platonists, the Academics, and 
the Epicureans, and of these only the Platonists 
had any belief in God, who was to them an idea 
rather than a Supreme Being. The great aim of 
both the wise and the foolish was to glorify their 
nationality, and their beliefs, their rites, and their 
superstitions, were all for the glory of mighty 
Eome. 

Educated Eomans were able to speak and write 
both Latin and Greek, and the latter language was 
the vehicle used by men of science and of letters. 

The population of the city of Eome at the 
beginning of the Augustan age was not less than 
half a million of people, and probably exceeded 
this number. There was no middle class, a 
comparatively small number of gentry, a very 
numerous ^lehs or populace, and many slaves. 
The Emperor Augustus boasted that after the war 



ROMAN MEDICINE AT THE END OF THE EEPUBLIC 57 

with Sextus Pompeius he handed over 30,000 
slaves, who had been serving with the enemy, 
to their masters to be punished. The slaves 
were looked upon by their masters as chattels. 
The plebs had the spirit of paupers and, to keep 
them contented and pacific, were fed and shown 
brutalizing spectacles in the arenas. Augustus 
wrote that he gave the people wild-beast hunts 
in the circus and amphitheatres twenty-six times, 
in which about 3,500 animals were killed. It was 
his custom to watch the Circensian games from his 
palace in view of a multitude of spectators. 

Throughout the country generally agriculture 
prospered, and the supply of various grasses for 
feeding cattle in the winter increased the multi- 
tude of the flocks and herds ; great attention was 
given also to mines and fisheries and all forms of 
industry. Virgil praised his beautiful and fertile 
country : — 

" But no, not Medeland with its wealth of woods, 
Fair Ganges, Hermus thick with golden silt, 
Can match the praise of Italy .... 
Here blooms perpetual spring, and summsr here 
In months that are not summer's ; twice teem the flocks : 
Twice does the tree yield service of her fruit. 
Mark too, her cities, so many and so proud, 
Of mighty toil the achievement, town on town 
Up rugged precipices heaved and reared. 
And rivers gliding under ancient walls." ^ 

The city of Eome was not a desirable place for 
medical practice, for the lower classes were degraded 



^ Ehodes's version. 



58 GREEK AND EOMAN MEDICINE 

and thriftless, and the relatively small upper classes 
were tyrannical, debauched, superstitious, selfish 
and cruel. The younger Pliny, who was one of 
the best type of Komans, tried to investigate the 
purity of the lives of the Christians, and did not 
hesitate to put to torture two women, deaconesses, 
who belonged to the new religion, but he " could 
discover only an obstinate kind of superstition 
carried to great excess." His conduct and his 
opinion speak eloquently of the. nature of a Koman 
gentleman of the Empire. As for the state of 
the poor under Augustus, 200,000 persons in 
Rome received outdoor relief. Although the rich 
had every luxury that desire could suggest and 
wealth afford, the great need of the common 
people was food. The city had to rely mainly on 
imported corn, and the price of this at times 
became prohibitive owing to scarcity — sometimes 
the result of piracy and the dangers of the sea, 
but often caused by artificial means owing to the 
merchants "cornering" the supply — and it was 
necessary for the State, through the Emperor, to 
intervene to make regulations and to distribute 
the grain free or below its market value. It has 
been computed that about 50,000 strangers lived 
in Rome, many of whom were adventurers. 

The imperial city was the happy hunting-ground 
of quacks, who gave themselves high-sounding 
names and wore gorgeous raiment. They went 
about followed by a retinue of pupils and grateful 



EOMAN MEDICINE AT THE END OF THE REPUBLIC 59 

patients. In some cases the patients were com- 
pelled to promise, in the event of being cured, that 
they would serve their doctor ever afterwards. The 
retinue of students, no doubt, was rather disturb- 
ing to a nervous patient, and Martial wrote : — 

"Faint was I only, Symmachus, till thou 

Backed by an hundred students, throng'dst my bed ; 
An hundred icy fingers chilled my brow : 
I had no fever; now I'm nearly dead."^ 

Besides quack doctors there were drug sellers 
(pJiaj^macopola), who sold their medicines in booths 
or hawked them in the city and the country. In 
the time of the Empire the medicines of the 
regular practitioners were sold with a label which 
specified the name of the drug and of the inventor, 
the ingredients, the disease it was to be used for, 
and the method of taking it. Drug sellers dis- 
pensed cosmetics as well as medicines, and some 
of the itinerant dealers sold poison. The regular 
physicians bought medicines already compounded 
by the druggists, and the latter, as in our own 
day, prescribed as well as the physicians. 

Depilatories were much in vogue, and were 
usually made of arsenic and unslaked lime, but 
also from the roots and juices of plants. They 
were first used only by women, but in later times 
also by effeminate men. Tweezers have been dis- 
covered which were adapted for pulling out hairs, 
and most of the depilatories were recommended 

^ Handerson's translation. 



GO GREEK AND ROMAN MEDICINE 

to be applied after the use of the tweezers. The 
duty of pulHng out hairs was perforraed by slaves. 

Most of the medical practitioners in the time of 
Augustus were either slaves or freedmen. Posts 
of responsibility and of honour were sometimes 
assigned to freedmen, as is shown by the appoint- 
ment by Nero of Helius, a freedman, to the 
administration of Eome in the absence of his 
imperial master. Cicero wrote letters to his freed- 
man Tiro in terms of friendship and affection. 
The master of a great household selected a slave 
for his ability and aptitude, and had him trained 
to be the medical adviser of the household; and 
the skill shown by the doctor sometimes gained 
for him his freedom. 

There were 400 slaves in one great household 
of Eome, and they were all executed for not having 
prevented the murder of their master.^ It is 
recorded that physicians were sometimes com- 
pelled to do the disgusting work of mutilating 
slaves.^ The price of a slave physician was fixed 
at sixty solidi.^ The great majority of physicians 
in Eome were freedmen who had booths in which 
they prescribed and compounded, and they were 
aided by freedmen and slaves who were both 
assistants and pupils. The medical profession, as 
has been shown, never attained the same dignity 
as in Greece. It should be understood that there 

1 "Tacit. Annal.," xiv, 43. 

2 " Paulus ^gin.," vol. ii, p. 379. ^ " Just. Cod.," vii. 



ROMAN MEDICINE AT THE END OF THE EEPUBLIC 61 

was a class of practising physicians in Eome quite 
distinct from the slave doctors. The following 
account of Lucius Horatillavus, a Eoman quack 
of the time of Augustus, is taken from the British 
Medical Journal of June 10, 1911, and originated 
in an article in the Societe Nouvelle, written by 
M. Fernand Mazade : — 

" He was a handsome man, and came from 
Naples to Eome, his sole outfit being a toga 
made of a piece of cloth adorned with obscene 
pictures and a small Asiatic mitre. Like many 
of his kind at that day, he sold poisons and in- 
vented five or six new remedies which were more 
or less haphazard mixtures of wine and poisonous 
substances. He had the good luck to cure his 
first patient, Titus Cnoeus Leno, who, being a 
poet, straightway constituted himself the vates 
sacer of his physician, and induced some of his 
fashionable mistresses to place themselves under 
his hands. So profitable was Horatillavus's 
practice that he is said to have saved 150,000 
sesterces in a few months. But for a moment his 
good fortune seemed to abandon him. A Koman 
lady, Sulpicia Pallas, died suddenly under his 
ministrations. This may have been due to his 
ignorance or carelessness; but he was accused of 
having poisoned his patient. This event might 
have been expected to bring his career to an end ; 
but it was not long before he recovered the confi- 
dence of the people whom he deluded with his 
mystical language and promises of cure. He had 



62 GEEEK AND ROMAN MEDICINE 

three methods of treatment, all consisting of 
baths — hot, tepid, or cold — preceded or followed 
by the taking of wonder-working medicines. 
Horatillavus treated every kind of disease, internal 
and external ; he even practised midwifery, which 
was then in the hands of women. Ten years after 
he settled in Eome he had accumulated a fortune 
of some 6,000,000 sesterces. He had a villa at 
Tusculum, whither he went three times a month ; 
there he led a luxurious life in the most beautiful 
surroundings, and there his evil fate overtook 
him. His orchard was his especial pride. One 
day he found that birds had played havoc with 
his figs, the like of which were not to be found in 
Italy. Determined to prevent similar depredations 
in future, he poisoned the fig trees. Continuing 
his walk, he plucked fruits of various kinds here 
and there. While eating the fruit he had culled 
and drinking choice wine, he put into his mouth 
a poisoned fig, which he had inadvertently 
gathered, and quickly died in convulsions. Before 
passing away, however, he is said to have com- 
posed his own epitaph. This M. Mazade believes 
he has found. It reads : " The manes of Sulpicia 
Pallas have avenged her. Here lies Lucius Hora- 
tillavus, physician, who poisoned himself." If the 
epitaph is genuine, it is a confession of guilt. 
The death of the quack by his own poison is a 
curious Nemesis. The manner of his death proves 
that it was accidental, as few quacks are bold 
enough to take their own medicines." 



63 



CHAPTEE VI. 

IN THE EEIGN OF THE C^SAES— TO THE 
DEATH OF NEEO. 

Augustus — His illnesses — Antonius Musa — Maecenas — Tiberius 
— Caligula — Claudius — Nero — Seneca — Astrology — 
Archiater — Women poisoners — Oculists in Eome. 

Long before the settlement of the constitu- 
tional status of Augustus in 27 B.C., he had under- 
taken many reforms. In 34 B.C., Agrippa, under 
the influence of Augustus, had improved the water 
supply of Eome by restoring the Aqua Marcia, and 
Augustus had repaired and enlarged the cloacae, 
and repaired the principal streets. Eoad commis- 
sions were appointed 27 B.C.. The Aqua Yirgo 
was built 19 B.C. Many of the collegia, or guilds, 
founded for the promotion of the interests of pro- 
fessions and trades had been misused for political 
purposes, and Augustus deprived many of them 
of their charters. Curce, or commissions, were 
appointed to superintend public works, streets and 
the water-supply; and the Tiber was dredged, 
cleansed and widened, and its liability to overflow 
reduced. No new building could be built more 
than 70 ft. high. Augustus also established fire 



64 GREEK AND ROMAN MEDICINE 

brigades. It has been said that he found the city 
built of brick and left it built of marble. 

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

He suffered from various illnesses, although in 
his younger days he looked handsome and athletic. 
He carefully nursed his health against his many 
infirmities, avoiding chiefly the free use of the 
bath; but he was often rubbed with oil, and 
sweated in a stove, after which he was bathed in 
tepid water, warmed either by a fire, or by being 
exposed to the heat of the sun. When, on 
account of his nerves, he was obliged to have 
recourse to sea- water, or the waters of Albula, he 
was contented with sitting over a wooden tub, 



IN THE EEIGN OF THE CiESAKS 65 

(which he called by a Spanish name, Diireta), and 
plunging his hands and feet in the water by turns.^ 
His physician was Antonius Musa, to whom was 
erected, by public subscription, a statue near that 
of ^sculapius. During an attack of congestion of 
the liver when heat failed to give relief, Antonius 
Musa advised cold applications for the Emperor, 
which had the desired effect. Suetonius, the 
historian, wrote that this was " a desperate and 
doubtful method of cure." A more desperate and 
doubtful method of cure, however, was carried out 
by the same physician. He successfully banished 
an attack of sciatica that greatly troubled Augustus 
by the expedient of beating the affected part with /i^^'^^ 
a stick. Antonius Musa received honours from 
Augustus, and the Emperor also exempted all 
physicians from the payment of taxes, and from 
other public obligations. 

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

Pliny wrote that the water cure was the principal 
remedy in his day, as it was indeed throughout 

' Suetonius: " Lives of the Cgesars," Ixxxii. 



66 GREEK AND ROMAN MEDICINE 

the Empire, and it was certainly the most popular. 
Seneca was very severe on the sentiment of a poem 
written by Maecenas, the friend and counsellor of 
Augustus, but it serves to reveal some of the most 
dreaded maladies of the time : — 

" Though racked with gout in hand and foot, 
Though cancer deep should strike its root, 
Though palsy shake my feeble thighs, 
Though hideous lump on shoulder rise, 

o^eyyiond From flaccid gum teeth drop away ; 

' Yet all is well if life but stay." 

Malaria was one of the principal causes o 
mortality in and near Eome in the reign of 
Augustus Caesar. 

Augustus's fatal illness occurred in a.d. 14 from 
chronic diarrhoea, and the Emperor, like the true 
Eoman that he was, displayed great calmness and 
fortitude in his last days. 

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

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



IN THE EEIGN OF THE C^SARS 67 

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

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

Thrasyllus, a son of the astrologer who lived in 
the time of Tiberius, is said to have predicted to 
Nero the dignity of the purple. Nero would have 
been favourably disposed towards physicians if he 
had heeded the advice of his tutor, Seneca, who 
wrote : " People pay the doctor for his trouble ; 
for his kindness they still remain in his debt." 
" Great reverence and love is due to both the 
teacher and the doctor. We have received from 
them priceless benefits ; from the doctor, health 
and life ; from the teacher, the noble culture of the 
soul. Both are our friends, and deserve our most 
sincere thanks, not so much by their merchantable 
art, as by their frank goodwill." ^ The practice of 
necromancy in the time of Nero had grown to such 

1 Seneca " De Benefic," vi. 



68 GREEK AND ROMAN MEDICINE 

an extent that an edict of banishment was issued 
against all magicians, but this did not lessen the 
popularity of the magicians, who indeed prospered 
under the semblance of persecution, and were 
honoured in times of public difficulty and danger. 
The practice of astrology came from the Chaldeans, 
and was introduced into Greece in the third 
century before Christ. It was accepted by all 
classes, but specially by the Stoic philosophers. 
In 319 B.C., Cornelius Hispallus banished the 
Chaldeans from Eome, and ordered them to leave 
Italy within ten days. In 33 B.C., they were again 
banished by Marcus Agrippa, and Augustus also 
issued an edict against them. They were punished 
sometimes by death, and their calling must have 
been lucrative to induce them to continue in spite 
of the severe punishments to which they made 
themselves liable. The penal laws against them, 
however, were in operation only intermittently. 
They were consulted by all classes, from the 
Emperor downwards. 

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

An account of the archiaters is of interest. 
The name was applied to Christ by St. Jerome. 
There were two classes of archiaters in time, the 
one class called archiatri sancti palati ; the other, 



IN THE BEIGN OF THE C^SARS 69 

archiatri populares. The former attended the 
Emperor, and were court physicians ; the latter 
attended the people. Although Nero appointed 
the first archiater, the name is not commonly used 
in Latin until the time of Constantine, and the 
division into two classes probably dates from about 
that time. The archiatri sancti palati were 
of high rank, and were the judges of disputes 
between physicians. The Archiatri had many 
privileges conferred upon them. They, and their 
wives and children, did not have to pay taxes. 
They were not obliged to give lodgings to soldiers 
in the provinces, and they could not be put in 
prison. These privileges applied more especially 
to the higher class. When an archiater saiicti 
palati ceased attendance on the Emperor he took 
the title of ex-archiater. The title comes archia- 
torum means " count of the Archiatri," and gave 
rank among the high nobility of the Empire. 

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



70 GREEK AND ROMAN MEDICINE 

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

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

There was also a very ignorant class of oculists 
in Eome in the time of Nero, but at Marseilles 
Demosthenes Philalethes was deservedly celebrated, 
and his book on diseases of the eye was in use for 
several centuries. The eye doctors of Eome 
employed ointments almost entirely, and about 
two hundred seals have been discovered which had 
been attached to pots of eye salves, each seal 
bearing the inventor's and proprietor's name. 
In the time of Galen, these quack oculists were 
very numerous, and Galen inveighs against them. 
Martial satirized them : " Now you are a gladiator 
who once were an ophthalmist ; you did as a 
doctor what you do as a gladiator." " The blear- 
eyed Hylas would have paid you sixpence, 



IN THE EEIGN OF THE C^SARS 71 

Quintus ; one eye is gone, he will still pay three- 
pence ; make haste and take it, brief is your chance ; 
when he is blind, he will pay you nothing." The 
oculists of Alexandria were very proficient, and 
some of their followers, at various times through- 
out the period of the Roman Empire, were remark- 
ably skilful. Their literature has perished, but it 
is believed that they were able to operate on 
cataract. 

With the death of Nero in a.d. 68, the direct 
line of the Caesars became extinct. 



72 



CHAPTER VII. 

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

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

AuLUs Cornelius Celsus lived in the reigns 
of Augustus and Tiberius. References in his works 
show that he either lived at the same time as 
Themison or shortly after him. Verona has been 
claimed as his birthplace, but the purity of his 
literary style shows that he lived for a considerable 
time in Rome, and he was probably educated there. 
In Pliny's account of the history of medicine, 
Celsus is not mentioned as having practised in 
Rome, and it is almost certain that he combined 
the practice of medicine with the study of science 
and literary pursuits ; his practice was not general, 
but restricted to his friends and dependents. 
His writings show that he had a clinical know- 
ledge of disease and a considerable amount of 
medical experience. He wrote not only on medi- 
cine but also on history, philosophy, jurisprudence 
and rhetoric, agriculture and military tactics. 
His great medical work, "De Medicina," com- 



PHYSICIANS FROM AUGUSTUS TO DEATH OF NERO 73 

prises eight books. He properly begins with 
the history of medicine, and then proceeds to 
discuss the merits of the controversy between the 
Dogmatici and the Empirici. The first two books 
deal with general principles and with diet, and the 
remaining books with particular diseases ; the third 
and fourth with internal diseases, the fifth and 
sixth with external diseases and pharmacy, and 
the last two are surgical, and of great merit and 
importance. In his methods of treatment there 
can be discerned the influence of x\sclepiades of 
Prusa, and the Hippocratic principle of aiding 
rather than opposing nature, but some of his work 
displays originality. His devotion to Hippocrates 
hindered very much the exercise of his own powers, 
and set a bad example, in this respect, to his 
successors. 

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

(1) Surgery. — ^Although Celsus is the first writer 
in Rome to deal fully with surgical procedures, it 
must not be inferred that the practice of this art 
began to be developed in his time, for surgery was 
then much more advanced than medicine. Many 
major operations were performed, and it is very 
instructive for doctors of the present day to learn 
that much that is considered modern was well 



74 GREEK AND ROMAN MEDICINE 

understood by the ancients. There is no greater 
fallac}^ than to suppose that medical practice 
generally, and surgery in particular, has reached 
no eminence except in very recent times. The 
operation of crushing a stone in the bladder was 
devised at Alexandria by Ammonius Lithotomos, 
(287 B.C.), and is thus described by Celsus : — 

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

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

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

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

The teaching of Celsus in reference to disloca- 
tions and fractures is remarkably advanced. Dis- 



PHYSICIANS FROM AUGUSTUS TO DEATH OF NERO 75 

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

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

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

Celsus also had knowledge of dentistry, for he 
writes of teeth extraction by means of forceps. 



76 GREEK AND ROMAN MEDICINE 

the fastening of loose teeth with gold wire, and 
a method of bursting decayed and hollow teeth 
by means of peppercorns forced into the cavity. 
He has described also many of the most difficult 
operations in obstetrics. 

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

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

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

Celsus wrote : " It is both cruel and superfluous 



PHYSICIANS FROM AUGUSTUS TO DEATH OF NERO 77 

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

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

Although Celsus practised phlebotomy, he dis- 
countenanced very strongly its excessive use. The 
physicians in Rome, in his time, carried bleeding 
to great extremes. "It is not," wrote Celsus, "a 
new thing to let blood from the veins, but it is 
new that there is scarcely a malady in which blood 
is not drawn. Formerly they bled young men, 
and women who were not pregnant, but it had 
not been seen till our days that children, pregnant 
women, and old men were bled." The reason for 



78 GREEK AND ROMAN MEDICINE 

bleeding the strong and plethoric was to afford 
outlet to an excessive supply of blood, and the 
weak and anaemic were similarly treated to get 
rid of evil humours, so that hardly any sick person 
could escape this drastic treatment. 

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

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

In the Augustan age, when literature in Eome 
reached its highest level, the literary style of 
Celsus was fit to be classed with that of the 
gTeat writers of his time. He was never quoted 
as a great authority on medicine or surgery by 
later medical writers ; and Pliny refers to him as 
a literary man, and not as a practising physician. 



PHYSICIANS FBOM AUGUSTUS TO DEATH OF NERO 79 

From the fact that he elaborated no new system, 
and founded no new medical sect, it is not strange 
that he had no disciples. 

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

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

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



80 GREEK AND ROMAN MEDICINE 

Apollonius of Tyqna was born four years before 
the Christian era, in the time of Augustus Caesar, 
and is known chiefly for the parallel that has been 
drawn by ancient and modern ^writers between his 
supposed miracles and those of the Saviour. His 
doings as described by Philostratus are extra- 
ordinary and incredible, and he was put forward by 
the Eclectics in opposition to the unique powers 
claimed by Christ and believed in by His followers. 
Apollonius is said to have studied the philosophy 
of the Platonic, Sceptic, Epicurean, Peripatetic 
and Pythagorean schools, and to have adopted 
that of Pythagoras. He schooled himself in early 
manhood in the asceticism of that philosophy. He 
abstained from animal food and strong drink, wore 
white linen garments and sandals made of bark, 
and let his hair grow long. For five years he 
preserved a mystic silence, and during this period 
the truths of philosophy became known to him. 
He had interviews with the Magi in Asia Minor, 
and learned strange secrets from the Brahmans in 
India. In Greece he visited the temples and 
oracles, and exercised his powers of healing. Like 
Pythagoras, he travelled far and wide, disputing 
about philosophy wherever he went, and he gained 
an extraordinary reputation for magical powers. 
The priests of the temples gave him divine honours 
and sent the sick to him to be cured. He arrived 
in Eome just after an edict had been promulgated 
by Nero against magicians. He was tried before 



PHYSICIANS FROM AUGUSTUS TO DEATH OF NERO 81 

Telesinus, the consul, and Tigellinus, the base 
favourite of the Emperor. He was acquitted by 
Telesinus because of his love of philosophy, and 
by Tigellinus because of his fear of magic. Sub- 
sequently, at Alexandria, Apollonius, in virtue of 
his magic power, affirmed that he would make 
Vespasian emperor, and afterwards became the 
friend of Titus, Vespasian's son. On the accession 
of Domitian, Apollonius stirred up the provinces 
against him, and was ordered to be brought in 
custody to Eome, but he surrendered himself to the 
authorities, and was brought into the presence of 
the Emperor to be questioned. He began to praise 
Nerva, and was immediately ordered to prison and 
to chains. It is said that he miraculously escaped, 
and spent the remainder of his days in Ephesus. 

The relation of Apollonius to the art of medicine 
is connected with his visits, on his travels, to the 
temples of ^sculapius, and his healing of the sick 
and alleged triumph over the laws of Nature. He 
was also credited with raising the dead, casting 
out devils and other miracle-working that appears 
to have been borrowed from the life of Christ. No 
doubt he was a genuine philosopher and follower of 
Pythagoras. His history is, on the whole, worthy 
of belief, except the part relating to miracles. It 
is noteworthy that he did not claim for himself 
miraculous power. Newman in his "Life of 
Apollonius " takes the view that the account of the 
miracles of Apollonius is derived from the narrative 
6 



82 GREEK AND ROMAN MEDICINE 

of Christ's miracles, and has been concocted by 
people anxious to degrade the character of the 
Saviour. The attempt to make him appear as a 
pagan Christ has been renewed in recent years. 

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

Vettius (or Vectius) Valleus, was of equestrian 
rank but he did not confer any honour on the 
medical profession. He was one of the lewd com- 
panions of Messalina, the wife of the Emperor 
Claudius, and was put to death in a.d. 48. He 
was a believer in Themison's doctrines, and is said 
by Pliny^ to have founded a new medical sect, but 
nearly all the Methodici attempted to create a new 
sect by adding to, or subtracting a little from, the 
tenets of Methodism. 

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

AiidromacJms, the elder, was physician to Nero, 
and the first archiater. He was born in Crete. 
He was the inventor of a compound medicine 

VH. N., xxix, 5. 



PHYSICIANS FROM AUGUSTUS TO DEATH OF NERO 83 

called after himself, " Theriaca Andromachi." He 
gave directions for making it in a poem of 174 
lines. This poem is quoted by Galen, who explains 
that Andromachus gave his instructions a poetical 
form to assist memory, and to prevent the likeli- 
hood of alteration. 

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

Thessalus of Tralles, in Lydia, lived in Eome in 
the reign of Nero, and dedicated one of his books 
to the Emperor. He was a charlatan with no 
medical knowledge, but with a good deal of ability 
and assurance. He said that medicine surpassed 
all other arts, and he surpassed all other physicians. 
His father had been a weaver, and in his youth 
Thessalus followed the same calling, and never had 
any medical training. This did not prevent him, 
however, from acquiring a great reputation as a 
doctor, and making a fortune from medical prac- 
tice. At first, he associated himself with the 
views of the Methodici, but afterwards amended 
them as he thought fit, until he had convinced the 
public, and perhaps also himself, that he was the 
founder of a new and true system of medicine. 
He spoke in very disrespectful and violent terms 
of his predecessors, and said that no man before 
him had done anything to advance the science of 
medicine. Besides having an endowment of natural 



SSuj'^'iMu^:;, Of'^ 




84 GREEK AND ROMAN MEDICINE 

shrewdness and ability, he was equipped with great 
powers of self-advertisement, and could cajole the 
rich and influential. He was an adept in the art 
of flattery. Galen often refers to him, and always 
with contempt. Thessalus was able, so he said, 
to teach the medical art in six months, and he 
surrounded himself with a retinue of artisans, 
weavers, cooks, butchers, and so on, who were 
allowed to kill or cure his patients. Sprengel 
states that, after the time of Thessalus, the doctors 
of Eome forbore to take their pupils with them 
on professional visits. 

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

Pliny, the elder, lived from a.d. 23 to 79, 
dying during the eruption of Vesuvius when 
Pompeii and Herculaneum were destroyed. He 
was not a scientific man, but was a pro- 
digious recorder of information on all subjects. 
Much of this information is inaccurate, for he 



PHYSICIANS FROM AUGUSTUS TO DEATH OF NERO 85 

was not able to discriminate between the true 
and the false, or to assign to facts their relative 
value. 

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

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



86 



CHAPTER VIII. 

THE FIKST AND SECOND CENTURIES OF THE 

CHRISTIAN ERA. 

Athenaeus — Pneumatism — Eclectics — Agathinus — Aretaeus — 
Archigenes — Dioscorides — Cassius Felix — Pestilence in 
Rome — Ancient surgical instruments — Herodotus — 
Heliodorus — Caelius Aurelianus — Soranus — Rufus of 
Ephesus — Marinus — Quintus. 

AthencBus, of Cilicia, a Stoic and Peripatetic, 
founded in Rome the sect of the Pneiimatists 
about the year a.d. 69. It was inspired by the 
philosophy of Plato. The pneuma, or spirit, was 
in their opinion the cause of health and of disease. 
They believed that dilatation of the arteries drives 
onward the pneuma, and contraction of the 
arteries drives it in a contrary direction. The 
pneuma passes from the heart to the arteries. 
Their theories also had reference to the elements. 
Thus, the union of heat and moisture maintains 
health ; heat and dryness cause acute diseases ; 
cold and moisture cause chronic diseases ; cold 
and dryness cause mental depression, and at death 
there are both dryness and coldness. In spite of 
these strange opinions the Pneumatists made 
some scientific progress, and recognized some 
diseases hitherto unknown. Galen wrote of the 
Pneumatists : " They would rather betray their 
country than abjure their opinions." The founder 



FIRST AND SECOND CENTURIES OF CHRISTIAN ERA 87 

of the sect of Pneumatists was a very prolific writer, 
for the twenty-ninth volume of one of his works is 
quoted by Oribasius. The teaching of the Pneu- 
matists speedily gave way to that of the Eclectics, 
of whom Galen was by far the most celebrated. 
They tried to reconcile the teaching of the Dog- 
matists, Methodists, and Empirics, and adopted 
what they considered to be the best teaching of 
each sect. The Eclectics were very similar to, if 
not identical with, the Episi/iithetics, founded by a 
pupil of AthenaBus, by name, Agathinus. He was 
a Spartan by birth. He is frequently quoted by 
Galen, but none of his writings are extant. 
r" AretcBUs, the Cappadocian, practised in Eome 
in the first century of our era, in the reign of Nero 
or Vespasian. He published a book on medicine, 
still extant, which displays a great knowledge of 
the symptoms of disease very accurately described, 
and reliable for purposes of diagnosis. He was the 
&st to reveal the glandular nature of the kidneys, 
and for the first time employed cantharides as a 
counter-irritant (Portal, vol. i, p. 62). It is not 
surprising that Aretasus followed rather closely the 
teaching of Hippocrates, but he considered it right 
to check some of "the natural actions" of the 
body, which Hippocrates thought were necessary 
for the restoration of health. He was not against 
phlebotomy, and used strong purgatives and also 
narcotics. He was less tied to the opinions of any 
sect than the physicians of his time, and was both 



88 GREEK AND EOMAN MEDICINE 

wonderfully accurate in his opinions and reliable in 
treatment. Aretaeus condemned the operation of 
tracheotomy first proposed by Asclepiades, and held 
" that the heat of the inflammation becomes greater 
from the wound and contributes to the suffocation, 
and the patient coughs; and even if he escapes this 
danger, the lips of the wound do not unite, for both 
are cartilaginous and unable to grow together." He 
believed, also, that elephantiasis was contagious. 
The writings of Aretaeus consist of eight books, and 
there have been many editions in various languages. 
Only a few chapters are missing. 

Arcliigenes was a pupil of Agathinus, and is 
mentioned by Juvenal. He was born in Syria and 
practised in Eome in the reign of Trajan, a.d. 98-117. 
He introduced new and very obscure terms into his 
writings. He wrote on the pulse, and on this Galen 
wrote a commentary. He also proposed a classifi- 
cation of fevers, but his views on this subject were 
speculative theories, and not based upon practical 
experience and observation. To him is due the 
credit of suggesting opium for the treatment of 
dysentery, and he also described accurately the 
symptoms and progress of abscess of the liver. By 
some authorities he is thought to have belonged to 
the sect of the Pneumatici. 
_. Dioscorides was the author of a famous treatise 
on Materia Medica. At different times there were 
several physicians of this name. He lived shortly 
after Pliny in the first century, but there is some 



FIRST AND SECOND CENTURIES OF CHRISTIAN ERA 89 

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

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

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

In A.D. 79, after the eruption of Vesuvius, there 
was a great pestilence in Rome, which historians 
ascribed to the pollution of the air by the eruption. 



90 GREEK AND ROMAN MEDICINE 

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

^ For full descriptiou and plates see Dr. John Stewart 
Milne's " Surgical Instruments in Greek and Eoman Times " 
(Clarendon Press, 1907). 



FIRST AND SECOND CENTURIES OF CHRISTIAN ERA 91 

There were several physicians and surgeons of 
the name of Herodotus. A famous surgeon of that 
name lived in Rome about a.d. 100. He was a 
pupil of Athenaeus, and is quoted by Galen and 
Oribasius. This Herodotus, according to Baas, 
was the discoverer of pomegranate root as a remedy 
for tapeworm. 

Heliodorus was a famous surgeon of Rome, and 
lived about the same time as Herodotus. He was 
the contemporary of Juvenal. He performed 
internal urethrotomy, and wrote on amputations, 
injuries of the head, and hernia. 

Ccelius Aurelianus probably lived in the first 
century of the Christian era, but some writers 
believe that he was a contemporary of Galen and 
a rival, because the one never mentions nor is 
mentioned by the other ; but this view is unneces- 
sarily severe upon the standard of medical ethics 
attained by the leaders of the profession in early 
times. From the style of his writings, it has been 
deduced that Caslius Aurelianus was not a native 
of Greece or of Rome. He belonged strictly to 
the sect of the Methodici, and his writings are 
important as revealing very fully the teaching of 
this sect. He mentions some diseases not pre- 
viously described, and had a good knowledge of 
symptoms. He divided diseases into two classes, 
acute and chronic, or, more in conformity with the 
terminology of the Methodici, those of constric- 
tion and those of relaxation. Aurelianus did not 



92 GREEK AND ROMAN MEDICINE 

concern himself with inquiring into the causation 
of diseases. His method was to find out the class 
to which a disease belonged, and to treat it 
accordingly. He was very practical in his views, 
and did a great deal to place treatment upon a 
satisfactory basis. His chief weakness was his 
failure to recognize the various differences and 
gradations, and he attached far too much import- 
ance to the two classes recognized by his school. 
He withheld active treatment until he had ascer- 
tained to his own satisfaction the class to which 
the disease belonged. Caelius Aurelianus wrote 
three books on acute diseases and five on chronic 
diseases. He cites the case of a patient who was 
cured of dropsy by tapping, and of a person who 
was shot through the lungs with an arrow and 
recovered. He agreed with Aretseus in condemn- 
ing tracheotomy. His books are not written in a 
good literary style. 

Sorarius, of Ephesus, was an eminent physician 
of the Methodist school, who practised in Eome 
in the reigns of Trajan and Hadrian. He wrote 
a great work on diseases of women, of which a 
Greek manuscript, copied in the fifteenth century, 
was discovered in La Bibliotheque Royale in Paris 
by Dietz, who was commissioned by the Prussian 
Government to explore the public libraries of 
Europe. The same investigator also discovered 
another copy of the work, in a worse state of pre- 
servation however, in the Vatican library. Parts 



FIRST AND SECOND CENTURIES OF CHRISTIAN ERA 93 

of the writings of Soranus are preserved in the 
writings of Oribasius. There is no doubt that 
Soranus was a very accompHshed obstetrician and 
gynsDcologist. His description of the uterus and 
its ligaments and the displacements to which the 
organ is liable reveals a practical knowledge of 
anatomy. Unlike most medical writers of ancient 
times, he did not adopt the method of recording 
various methods of treatment copied from previous 
writers, but his textbook is systematic. In 
writing about a disease he begins with a historical 
introduction, and proceeds to describe its causation, 
symptoms, and course, and the treatment of its 
various phases. His account of obstetrics shows 
that the art was well understood in his time. His 
work on the subjects of dystocia, inflammation of 
the uterus, and prolapse is perhaps the best. He 
refers also to hysterectomy. It is interesting to 
note that he used the speculum. He describes the 
qualifications of a good midwife. She need not 
know very much anatomy, but should have been 
trained in dietetics, materia medica, and minor 
surgical manipulations, such as version. She should 
be free from all corrupt and criminal practices, 
temperate, and not superstitious or avaricious. 

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



94 GREEK AND ROMAN MEDICINE 

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

Bufus, of Ephesus, also lived in the reign of 
Trajan (a.d. 98-117). His books reveal the state 
of anatomical knowledge at Alexandria before the 
time of Galen. The recurrent nerves were then 
recently discovered. He considered the spleen a 
useless organ. He understood that pressure on 
the nerves and not on the carotid arteries causes 
loss of voice, and that the nerves proceed from 
the brain, and are sensory and motor. The heart, 
he considered, was the seat of life, and he observed 
that its left ventricle is smaller and thicker than 
the right. The method of checking bleeding from 
blood-vessels by torsion was known to him. He 



FIRST AND SECOND CENTURIES OF CHRISTIAN ERA 95 

demonstrated the investing membrane of the 
crystaUine lens of the eye.^ He wrote also a 
treatise in thirty-seven chapters on gout. Many 
of the works of Rufus are lost, but fragments 
are preserved in other medical writings. 

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

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

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

1 «' Portal," vol. i, p. 74. 



96 



CHAPTER IX. 

GALEN. 
His life and works — His influence on Medicine. 

Claudius Galenus, commonly known as Galen, 
}ias influenced the progress of medical science 
by his writings probably more than any other 
medical writer. His influence was paramount for 
fourteen centuries, and although he made some 
original contributions, his works are noteworthy 
mainly as an encyclopaedia of the medical know- 
ledge of his time and as a review of the work of his 
predecessors. There is a great deal of information 
in his books about his own life. He was born at 
Pergamos in a.d. 130 in the reign of Hadrian. 
His father was a scholar and his mother somewhat 
•of a shrew. Galen, in his boyhood, learned much 
from his father's example and instruction, and 
at the age of 15 was taught by philosophers of 
the Stoic, Platonist, Peripatetic, and Epicurean 
schools. He became initiated, writes Dr. Moore, 
into " the idealism of Plato, the realism of Aris- 
totle, the scepticism of the Epicureans, and the 
materialism of the Stoics." At the age of 17 he 
was destined for the profession of medicine by his 
father in consequence of a dream. He studied 



GALEN 97. 

under the most eminent men of his day. He went 
to Smyrna to be a pupil of Pelops, the physician, 
and Albinus the platonist ; to Corinth to study 
under Numesianus ; to Alexandria for the lectures 
of Heraclianus ; and to Cilicia, Phoenicia, Pales- 
tine, Crete, and Cyprus. At the age of 29 Galen 
returned from Alexandria to Pergamos (a.d. 158), 
and was appointed doctor to the School of 
Gladiators, and gained much distinction. 

He went to Eome for the first time in a.d. 163-4, 
and remained for four years ; and during this 
period he wrote on anatomy and on the teaching 
of Hippocrates and Plato. He acquired great fame 
as a practitioner and, if he had so desired, might 
have attended the Emperor; but it is probable 
that Galen thought that the office of physician 
to the Emperor might prevent him from leaving 
Eome if he wished to do so. He also gave public 
lectures and disputations, and was called not only 
the "wonder-speaker" but the "wonder-worker." 
His success gave rise to envy, and he was afraid 
of being poisoned by his less successful rivals. 
The reason why he left Eome is not certain, and 
the possible causes of his departure are discussed 
by Dr. Greenhill in the " Dictionary of Greek and 
Eoman Biography and Mythology." A pestilence 
raged in Eome at this time, but it is unlikely that 
Galen would have deserted his patients for that 
reason. Probably he disliked Eome, and longed for 
his native place. He had been in Pergamos only a 
7 



98 GREEK AND EOMAN MEDICINE 

very short time when he was summonei to attend 
the Emperors Marcus AureHus and L. Verus in 
Venetia. The latter died of apoplexy on his way 
home to Eome, and Galen followed Marcus 
Aurelius to the capital. The Emperor soon there- 
after set out to prosecute the war on the Danube, 
and Galen was allowed to remain in Eome, as he 
had stated that such was the will of ^sculapius- 
The Emperor's son Commodus was placed under 
the care of Galen during the father's absence, and 
at this time also (a.d. 170) Galen prepared the 
famous medicine theriaca for Marcus Aurelius, 
who took a small quantity daily. The Emperor 
Septimius Severus employed the same physician 
and the same medicine about thirty years after- 
wards. It is recorded that the philosopher 
Eudemius was successfully treated by Galen for 
a severe illness caused by an overdose of theriaca, 
and that the treatment employed was the same 
drug in small doses. 

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

He was not only a great physician, but a man 
of wide culture in every waj^ In matters of re- 
ligion he was a Monotheist. There was persecu- 



GALEN 99 

tion of the Christians in his day, and it is likely 
that he came little into contact with the disciples 
of the new religion, and heard distorted accounts 
of it, but in one of his lost books, quoted by his 
Arabian biographers, Galen praises highly the love 
of virtue of the Christians. 

He no doubt found the practice of medicine 
lucrative when he had gained pre-eminence, and 
it is recorded that he received £350 for curing the 
wife of Boetius, the Consul. 

Galen wrote no less than five hundred treatises, 
large and small, mostly on medical subjects, but 
also on ethics, logic, and grammar. His style is 
good but rather diffuse, and he delights in quoting 
the ancient Greek philosophers. Before his time, 
as we have seen, there were disputes between the 
various medical sects. The disciples of Dogmatism 
and of Empiricism had been opposed to each other 
for several centuries, and the Eclectics, Pneuma- 
tists, and Episynthetics had arisen shortly before 
his time. Galen wrote against slavish attach- 
ment to any sect, but " in his general principles 
he may be considered as belonging to theCDogmatfe) 
sect, for his method was to reduce all his know- 
ledge, as acquired by the observation of facts, to 
general theoretical principles. These principles 
he, indeed, professed to deduce from experience and 
observation, and we have abundant proofs of his 
diligence in collecting experience, and his accuracy 
in making observations ; but still in a certain sense 



100 GREEK AND ROMAN MEDICINE 

at least, he regards individual facts and the details 
of experience as of little value, unconnected with 
the principles which he had laid down as the basis 
of all medical reasoning. In this fundamental 
point, therefore, the method pursued by Galen 
appears to have been directly the reverse of that 
which we now consider as the correct method of 
scientific investigation ; and yet, such is the force 
of natural genius, that in most instances he 
attained the ultimate object in view, although by 
an indirect path. He w^as an admirer of Hippo- 
crates, and always speaks of him with the most 
profound respect, professing to act upon his prin- 
ciples, and to do little more than expound his 
doctrines, and support them by new facts and 
observations. Yet, in reality, we have few waiters 
whose works, both as to substance and manner, 
are more different from each other than those of 
Hippocrates and Galen, the simplicity of the 
former being strongly contrasted with the abstruse- 
ness and refinement of the latter."^ 

A list of the various editions of Galen's works is 
given in Dr. Smith's " Dictionary of Greek and 
Eoman Biography and Mythology " (1890 edition, 
vol. ii, pp. 210-12), and also the titles of the 
treatises classified according to the branch of 
medical science with which they deal, and it is 
convenient to follow this classification. 

1 Dr. Bostock's " History of Medicine." 



GALEN 101 

I. — WoEKs ON Anatomy and Physiology. 

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

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



102 GREEK AND ROMAN MEDICINE 

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

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

He regarded the structure of various parts, 
such as the hand and the membranes of the brain, 
as absolute perfection, although his idea of the 
human hand was derived from a study of the 
ape's, and he had no knowledge of the arachnoid 
membrane of the brain, but it would be unfair 
to criticize his conclusions because of his failure 
to recognize a few comparatively unimportant 
details. He discovered the function of the motor 
nerves by cutting them experimentally, and so 
producing paralysis of the muscles; the platysma, 



GALEN 103 

interossei, and popliteus muscles were first described 
by him. He was the greatest authority on the 
pulse, and he recognized that it consisted of a 
diastole (expansion) and a systole (contraction) with 
an interval after the diastole, and another after the 
systole. Aristotle thought that arteries contained 
air, but Galen taught that they contained blood, 
for, when an artery was wounded, blood gushed 
out. He was not far from the discovery of the 
circulation. He described the heart as having the 
appearance of a muscle, and considered it the source 
of natural heat, and the seat of violent passions. 
He knew well the anatomy of the human skeleton, 
and advised students to go to Alexandria where 
they might see and handle and properly study the 
bones. He recognized that inspiration is associated 
with enlargement of the chest, and imagined that 
air passed inside the skull through the cribriform 
plate of the ethmoid bone, and passed out by the 
same channel, carrying off humours from the brain 
into the nose. But some of this air remained and 
combined with the vital spirits in the anterior 
ventricles of the brain, and finally exuded from the 
fourth ventricle, the residence of the soul. Aristotle 
had taught that the heart was the seat of the soul, 
and the brain relatively unimportant. 

II. — WoEKS ON Dietetics and Hygiene. 

Galen was a strong advocate of exercises and 
gymnastics, and eulogizes hunting specially. He 



104 GREEK AND ROMAN MEDICINE 

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

in. — On Pathology.-^ 

Galen believed in the doctrine of the four 
elements, and his speculations led him into a belief 
in a further subdivision. " Fire is hot and dry ; 
air is hot and moist ; for the air is like a vapour ; 
water is cold and moist, and earth is cold and dry." 
He held that there were three principles in man — 
spirits, solids, and humours — and eight tempera- 
ments ranging between health and disease and 
compatible with life. He retained a good deal of 
the teaching of the Pneumatic school, and believed 
that the 'pneuma was different from the soul, but 
the vehicle for the interaction of soul and body. 
From his theory of the action of the air through the 
nose on the contents of the ventricles of the brain 
is explained his use of sternutatories, and his belief 
in the efficacy of sneezing. Galen's classification 
of inflammations shows that his pathology was 
not nearly so accurate as his anatomy and 
physiology. He described (a) simple inflammation 



GALEN 105 

caused by excess of blood alone ; (b) inilamniation 
the result of excess of both pneuma and blood ; 
(c) erysipelatous inflammation when yellow bile 
gains admission, and (d) scirrhous or cancerous 
when phlegm is present. He did good service by 
dividing the causes of disease into remote and 
proximate, the former subdivided into two classes 
— predisposing and exciting. 

IV. — On Diagnosis. 

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

V. — On Pharmacy, Materia Medica, and 
Therapeutics. 

In these subjects Galen was not as proficient as 
Dioscorides, whose teaching he adopted with that 
of other medical authors. In Galen's works there 
are lengthy lists of compound medicines, several 
medicines being recommended for the same disease, 



106 GREEK AND ROMAN MEDICINE 

and never with very marked confidence. He paid 
high prices for various nostrums, and, sad to 
relate, placed great faith in amulets, belief in which 
was general in his time, and nowhere held more 
strongly than in superstitious Eome. Medicines 
were classified by him according to their qualities, 
by which he meant, not their therapeutic effects, 
but their inherent dryness or moistness, coldness 
or heat. A medicine might be cold in the first 
degree, and not in the second degree. Paulus 
^gineta followed this strange and foolish doctrine 
of Galen very closely, as the following extracts 
from his book on Materia Medica will show: — 

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

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

Many features, however, of Galen's teaching and 
practice of therapeutics are worthy of praise. He 
enunciated two fundamental principles : (1) That 
disease is something contrary to Nature, and is to 

1 " Paulus ^gineta," vol. iii, p. 7i. 

2 Ibid., p. 242. 



GALEN 107 

be overcome by that which is contrary " to the 
disease itself " ; and (2) that Nature is to be pre- 
served by what has relation with Nature. He 
recognized that while the invading disease was to 
be repelled, the strength and constitution of the 
patient should be preserved, and that in all cases 
the cause of the disease was to be treated and not 
the symptoms. Strong remedies should not be 
used on weak patients. 

YI. — Surgery. 

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

VII. — Gynecology. 

Galen had little more than a superficial know- 
ledge of this subject, and was quite ignorant of the 
surgery of diseases of women. He was not so well 
informed as Soranus was as to the anatomy of the 
uterus and its appendages, but deserves credit for 
having been better acquainted with the anatomy 
of the Fallopian tubes than his predecessors. 

^ *' Encycl. Brit.," Surgery. 



308 GREEK AND ROMAN MEDICINE 

He had erroneous views on the causation of dis- 
placements of the uterus. Several of the books 
inaccurately attributed to the authorship of Galen 
deal with the medical treatment of various minor 
ailments of women. 

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

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



GALEN 109 

With Galen, as with Hippocrates, it is some- 
times impossible to tell what works are genuine, 
and what are spmious. He seemed to think that 
he was the successor of Hippocrates, and wrote : 
" No one before me has given the true method of 
treating disease : Hippocrates, I confess, has here- 
tofore 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 dis- 
tinctions, and is often obscure, as is usually the 
case with ancients when they attempt to be con- 
cise. He says very little of complicated diseases ; 
in a word, he has only sketched what another was 
to complete ; he has opened the path, but has left 
it for a successor to enlarge and make it plain." 
Galen strictly followed Hippocrates in the latter's 
humoral theory of pathology, and also in thera- 
peutics to a great extent. 

It is a speculation of much interest how it was 
that Galen's views on Medicine received universal 
acceptance, and made him the dictator in this 
reahn of knowledge for ages after his death. He 
was not precisely a genius, though a very remark- 
able man, and he established no sect of his own. 
The reason of his power lay in the fact that his 
writings supplied an encyclop£Edic knowledge of 
the medical art down to his own time, with com- 
mentaries and additions of his own, written with 
great assurance and conveying an impression of 
finality, for he asserted that he had finished what 



110 GBEEK AND ROMAN MEDICINE 

Hippocrates had begun. The world was tired of 
political and philosophical strife, and waiting for 
authority. The wars of Eome had resulted in 
placing political power in the hands of one man, 
the Emperor; the disputations and bickerings of 
philosophers and physicians produced a similar 
result, and Galen, in the medical world was in- 
vested with the purple. 

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

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

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



Ill 



CHAPTER X. 
THE LATER ROMAN AND BYZANTINE PERIOD. 

Beginning of Decline — Neoplatonism — Antyllus — Oribasius — 
Magnus — Jacobus Psychristus — Adamantius — Meletius — 
Nemesius — ^tius — Alexander of Tralles — The Plague — 
Moschion — Paulus ^giueta — Decline of Healing Art. 

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



112 GREEK AND ROMAN MEDICINE 

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

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

Antyllus was perhaps the greatest surgeon of 
antiquity. He lived before the end of the fourth 
century a.d., for he is quoted by Oribasius, but is not 
mentioned by Galen. The time in which he lived 
was about the year a.d. 300. He was a voluminous 



THE LATER ROMAN AND BYZANTINE PERIOD 113 

writer, but his works have perished except for 
quotations by later writers. The fragments of his 
writings were collected and published in 1799. 
Ant^^llus performed an operation for aneurism, 
which consisted in laying open the sac, turning 
out the clots, securing the vessels above and below, 
and allowing the w^ound to heal by granulation. 
As this operation was performed without anaes- 
thetics or antiseptics it was attended with great 
mortality, and the risk of secondary haemorrhage 
was very great. Antyllus had operations for the 
cure of stammering, for cataract, and for the treat- 
ment of contractm-es by the method of tenotomy. 
He also removed enlarged glands of the neck. It 
was part of the practice of Antyllus to ligatm-e 
arteries before cutting them, a method which was 
subsequently "rediscovered" owing to neglect of 
the study of the history of medicine. He gave 
directions for avoiding the carotid artery and 
internal jugular vein in operations upon the neck. 

A fragment of the writings of Antyllus is pre- 
served by Paulus ^^gineta,^ and shows the quality 
of the work done in bygone ages. It is his 
description of the operation of tracheotomy, and 
runs as follows : — 

" When we proceed to perform this operation 
we must cut through some part of the windpipe, 
below the larynx, about the third or fomlh ring ; 

1 " De re Med.," vi, 33. 
8 



114 GREEK AND ROMAN MEDICINE 

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

Orihasius was born at Pergamos, the birthplace 
of Galen, about a.d. 326. He studied under Zejion, 
who lectured and practised at Alexandria, and was 
expelled by the bishop, but afterwards reinstated 
by command of the Emperor Julian (a.d. 361). 
When Julian was kept in confinement in Asia 
Minor, Orihasius became acquainted with him, and 
they were soon close friends. When Julian was 
raised to the rank of Caesar, Orihasius accompanied 
him into Gaul. During this journey Orihasius, at 
the request of his patron, made an epitome of the 
writings of Galen, and then extended the work by 
including a collection of the writings of all preced- 
ing medical authors. When this work was finally 



THE LATER ROMAN AND BYZANTINE PERIOD 115 

completed it consisted of seventy books under the 
title " Collecta Medicinalia." He wrote also for 
his friend and biographer Eunapius two books 
on diseases and their treatment, and treatises on 
anatomy and on the works of Galen. He earned for 
himself the title of the Ape of Galen. In the " Life 
of Oribasius," by Eunapius, we find that Julian 
created Oribasius Quaestor of Constantinople, but 
after the death of Julian, Oribasius was exiled, 
and practised among the "barbarians," attaining 
great fame. In his exile he married a rich woman 
of good family, and to one of his sons, Eustathius 
by name, he addressed an abridgment of his first 
great book, the smaller work being called the 
" Synopsis." He ultimately returned from exile, 
and again reached a very honourable position, to 
which he was well entitled in virtue of the great 
fortitude with which he had borne adversity. 

An edition of Oribasius was published at Paris 
between 1851 and 1876, in six volumes, by Darem- 
berg and Bussemaker, under the patronage of the 
Erench Government. The authors of this edition 
took infinite pains to show the sources from which 
the writings of Oribasius had been derived, chief 
of which were the original writings of Galen, 
Hippocrates, Soranus, Eufus, and Antyllus. Oriba- 
sius was almost entirely a compiler, but also did 
some original work. To him is due the credit of 
describing the drum of the ear and the salivary 
glands. He described also the strange disease 



116 GREEK AND ROMAN MEDICINE 

called lycanthropy, a form of insanity in which 
the patient thinks himself a wolf, and leaves his 
home at night to wander amongst the tombs. 

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

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

Jacobus Psychristus was a famous physician who 
practised at Constantinople, a.d. 457-474. He 
was called "the Saviour" because of the great 
success of his treatment. 

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

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

Nemesius, Bishop of Emissa, at the end of the 
fourth century wrote a book called " De Natura 
Hominis," and came very close to two important 
discoveries, namely, the functions of the bile and 



THE LATER ROMAN AND BYZANTINE PERIOD 117 

the circulation of the blood. Of the former, he 
wrote, " The yellow bile is constituted both for 
itself and for other purposes ; for it contributes to 
digestion and promotes the expulsion of the excre- 
ments ; and therefore it is in a manner one of the 
nutritive organs, besides imparting a sort of heat 
to the body, like the vital power. For these 
reasons, therefore, it seems to be made for itself; 
but, inasmuch as it purges the blood, it seems to 
be made in a manner for this also." ^ 

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

This book was first translated into English 
in 1636. 



1 C. 28, p. 260, ed. Matth. 

2 C. 24, p. 242. 



118 GREEK AND ROMAN MEDICINE 

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

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

jEtius wrote the " Sixteen Books on Medicine," 
and these contain original matter, but are of value 
mainly as being a compilation of the medical 
knowledge of his time. He was the first writer 
to mention certain Eastern drugs, such as cloves 
and camphor, and had a great knowledge of the 
spells and charms used in the East, more especially 
by the Egyptian Christians. All the nostrums, 



THE LATER ROMAN AND BYZANTINE PERIOD 119 

amulets and charms that were used at the time 
are enumerated, and display a gloomy picture of 
the superstition and ignorance that prevailed. 
The surgical and gynaecological sections of the 
writings of ^tius are, in most parts, excellent. 
He treated cut arteries by twisting or tying, 
and advised the irrigation of wounds with cold 
water. In the operation of lithotomy he recom- 
mended that the blade of the knife should be 
guarded by a tube. He used the seton and the 
cautery, which was much in vogue in his day, espe- 
cially in cases of paralysis. He quotes Archigenes, 
who wrote : " I should not at all hesitate to make 
an eschar in the nape of the neck, where the spinal 
marrow takes its rise, two on each side of it . . . 
and if the ulcers continue running a good while, I 
should not doubt of a perfect recovery." 

Alexander of Tralles lived from a.d. 525 to 605. 
He was the son of a physician, and one of five 
brothers, who were all distinguished for scholarship. 
He studied philosophy as well as medicine, and 
travelled in France, Spain, and Italy to extend 
his knowledge. He took up permanent residence 
in Rome, and became very celebrated. When 
he became too old to continue active practice, he 
found leisure to write twelve books on medical 
diseases, following to some extent the teaching 
of Galen. The style of these books is elegant, and 
his description of diseases accurate. Alexander of 
Tralles was the first to open the jugular vein in 



120 GREEK AND KOMAN MEDICINE 

disease, and employed iron and other useful 
remedies, but he lived in superstitious times, and 
was very credulous. For epilepsy, he recommended 
a piece of sail from a wrecked vessel, worn round 
the arm for seven weeks.^ For colic, he recom- 
mended the heart of a lark attached to the right 
thigh, and for pain in the kidneys an amulet 
depicting Hercules overcoming a lion. To exorcise 
gout, he used incantations, these being either 
oral or written on a thin sheet of gold during 
the waning of the moon. Writing a suitable 
inscription on an olive leaf, gathered before sunrise, 
was his specific for ague. Alexander appears at 
times to have doubted the efiicacy of such remedies 
as amulets, for he explains that his rich patients 
would not submit to rational treatment, and it was 
necessary, therefore, to use other methods reputed 
to be curative. 

In the age of Justinian great scourges devastated 
the world. In a.d. 526 Antioch was destroyed by 
an earthquake, and it is said that 250,000 people 
perished, but the most dreadful visitation on man- 
kind was the great plague which raged in a.d. 542 
and the following years, and, as Gibbon writes, 
" depopulated the earth in the time of Justinian 
and his successors." Procopius, who was versed in 
medicine, was the historian of the period. This 
fell disease began between the Serbonian bog and 

' Lib. 1, c. 20. 



THE LATEK ROMAN AND BYZANTINE PERIOD 121 

the eastern channel of the Nile. " From thence, 
tracing as it were a double path, it spread to the 
east, over Syria, Persia, and the Indies, and pene- 
trated to the west, along the coast of Africa, and 
over the continent of Europe. In the spring of the 
second year, Constantinople, during three or four 
months, was visited by the pestilence ; and Proco- 
pius, who observed its progress and symptoms with 
the eyes of a physician, has emulated the skill and 
diligence of Thucydides in the latter's description of 
the plague of Athens. The infection was sometimes 
announced by the visions of a distempered fancy, 
and the victim despaired as soon as he had heard 
the menace and felt the stroke of an invisible 
spectre. But the greater number, in their beds, in 
the streets, in their usual occupation, were sur- 
prised by a slight fever, so slight, indeed, that 
neither the pulse nor the colour of the patient gave 
any signs of the approaching danger. The same, 
the next, or the succeeding day, it was declared by 
the swelling of the glands, particularly those of the 
groin, of the armpits, and under the ear ; and 
when these buboes or tumours were opened they 
were found to contain a coal, or black substance, of 
the size of a lentil. If they came to a first swell- 
ing and suppuration, the patient was saved by this 
kind and natural discharge of the morbid humour. 
But if they continued hard and dry, a mortification 
quickly ensued, and the fifth day was commonly the 
term of his life. The fever was often accompanied 



122 GREEK AND ROMAN MEDICINE 

with lethargy or delirium ; the bodies of the sick 
were covered with black pustules or carbuncles, 
the symptoms of immediate death ; and in the 
constitutions too feeble to produce an eruption, the 
vomiting of blood was followed by a mortification 
of the bowels. To pregnant women the plague 
was generally mortal ; yet one infant was drawn 
alive from its dead mother, and three mothers 
survived the loss of their infected foetus. Youth 
was the most perilous season : and the female sex 
was less susceptible than the male ; but every rank 
and profession was attacked with indiscriminate 
rage, and many of those who escaped were 
deprived of their speech, without being secure from 
a return of the disorder. The physicians of 
Constantinople were zealous and skilful, but their 
art was baffled by the various symptoms and 
pertinacious vehemence of the disease ; the same 
remedies were productive of contrary effects and 
the event capriciously disappointed their prognos- 
tics of death or recovery. The order of funerals 
and the right of sepulchres were confounded ; 
those who were left without friends or servants 
lay unburied in the streets, or in their desolate 
houses ; and a magistrate was authorized to collect 
the promiscuous heaps of dead bodies, to transport 
them by land or water, and to inter them in deep 
pits beyond the precincts of the city. . . No 
facts have been preserved to sustain an account, or 
even a conjecture, of the number that perished in 



THE LATER ROMAN AND BYZANTINE PERIOD 123 

this extraordinary mortality. I only find, that 
during three months 5,000, and at length 10,000, 
persons died each day at Constantinople; that 
many cities of the East were left vacant, and that 
in several districts of Italy the harvest and the 
vintage withered on the ground.'" 

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

Moscliion probably lived in the sixth century, 
and was a specialist in diseases of women. His 
writings were studied when Soranus was forgotten, 
but in course of time it was discovered that 
Moschion's work was nothing but an abbreviated 
translation of the works of Soranus. "Further, 
it is held by Weber and Ermerins that even the 
original Moschion is not based directly on Soranus, 
but on a work on diseases of women written in the 
fourth century by CsbUus Aurelianus, who in his 
turn drew from Soranus. . . It is interesting 
to follow the history of this book through its 
various stages in the light of these different 
editions, and we would suggest that the first Latin 

* Gibbon, " The Decline and Fall of the Koman Empire." 



124 GREEK AND ROMAN MEDICINE 

version, for the use of Latin-speaking matrons 
and midwives, was produced before the fall of 
the Western Empire in the fifth century ; its 
Greek sister just fits in with the develop- 
ment of Eastern or Greek-speaking Empire at 
Constantinople in the sixth century; and the 
version in barbarous Latin points to a later period, 
when learning was beginning to make way again in 
Western Europe."' Moschion's book is a catechism 
consisting of 152 questions and answers. 

Paidits Mgineta was the last, and one of the 
most famous, of the Greek physicians. He was 
born probably in the seventh century in the island 
of ^gina, but there is some doubt as to the exact 
period in which he lived. He quotes Alexander 
of Tralles and ^tius, and therefore lived at a later 
period than they did, either in the sixth or seventh 
century. The works of Paulus are compilations, 
but reveal the skill and learning of the author. 
He wrote several books, but only one, and that the 
principal, remains, and is known by the title of 
" De Re Medica Libri Septem." Dr. Adams, of 
Banchory, translated this book for the Sydenham 
Society, and the introduction shows the scope of 
the work : "In the first book you will find 
everything that relates to hygiene, and to the 
preservation from, and correction of, distempers 
peculiar to the various ages, reasons, tempera- 

^ Barbour, Edinburgh Medical Journal, vol. xxxiv, p. 331. 



THE LATER ROMAN AND BYZANTINE PERIOD 125 

ments, and so forth ; also the powers and use of 
the different articles of food, as is set forth in the 
chapter of contents. In the second is explained 
the whole doctrine of fevers, an account of certain 
matters relating to them being premised, such as 
excrementitious discharges, critical days, and other 
appearances, and concluding with certain symptoms 
which are the concomitants of fevers. The third 
book relates to topical affections, beginning from 
the crown of the head and descending down to the 
nails of the feet," and so on. Briefly, the fourth 
book treats of external diseases ; the fifth, of wounds 
and bites from venomous animals ; the sixth book 
is the most important and is devoted to surgery, 
and contains original observations, and the seventh 
book contains an account of the properties of 
medicines." Paulus wrote a famous book on 
obstetrics, which is now lost, but it gained for him 
among the Arabs the title of "the accoucheur." 

The sixth book on surgery, as has justly been 
observed by Adams, " contains the most complete 
system of operative surgery which has come down 
to us from ancient times." Many important 
surgical principles are enunciated, such, for in- 
stance, as local depletion as against general, and 
the merit of a free external incision. He first 
described varicose aneurism, and performed the 
operation of bronchotomy as described by Antyllus. 
He favoured the lateral operation for removal 
of stone from the bladder, and amputated the 



126 GEEEK AND ROMAN MEDICINE 

cancerous breast by crucial incision. He also had 
an operation, like that of Antyllus, for the cure of 
aneurism. In brief, Paulus performed many of the 
operations that are practised at the present day. 
He travelled in the practice of his calling, and not 
only had great fame in the Byzantine Empire and 
in Arabia in his lifetime, but exercised great 
influence for some centuries. His writings inspired 
Albucassis, one of the few surgeons and teachers 
of the Middle Ages. 

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



127 



CHAPTEK XI. 

INFLUENCE OF CHEISTIANITY ON ALTEUISM AND 

THE HEALING ART. 

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

The sect of the Essenes embraced part of the 
teaching of Christianity among their other beUefs. 
They conceived that the Almighty had to be 
propitiated by signs and symbols. Words, they 
considered, were the direct gift of God to man, 
and, therefore, signs representing words were of 
great avail. Hence arose the use of amulets and 
cabalistic signs, or, rather, the common use, for 
they had been in evidence long prior to the 
foundation of this sect. Amulets were worn on 
the person. The Jews had phylacteries or bits 
of parchment on which were written passages 
from the Scriptures. In the first century after 
Christ, Jews, Pythagoreans, Essenes, and various 
sects of mystics combined and formed the 



128 GREEK AND EOMAN MEDICINE 

Cahalists and Gnostics. Their creed embraced the 
magic of the Persians, the dreams of the Ascle- 
piads, the numbers of Pythagoras, and the theory 
of atoms of Democritus. The Sophists of 
Alexandria actually regarded magic as a science. 
A section of the early Christians were Gnostics? 
and were imbued with the philosophy of the 
Orientals. According to the beliefs of the Cabalists 
and Gnostics, demons were the cause of disease. 
These sects interrogated evil spirits to find out 
where they lurked, and exorcised them with the 
help of charms and talismans. Various geometric 
figures and devices were held to have power against 
evil spirits. One of these figures was the device of 
two triangles interlaced thus ^. This was used 
as a symbol of God, not only by Cabalists and 
Gnostics, but also by Jews. The great majority 
of the early Christians opposed the Gnostics, and 
repudiated and abhorred their strange mixture of 
the Christian religion with Eastern philosophy. 

Christ came into the world at a time when the 
evils of slavery were probably at their worst. He 
did not directl}^ condemn slavery, and the reason 
of this is to be found in the study of the nature of 
His mission. He came to regenerate the individual, 
and not, primarily, society. " His language in 
innumerable similes showed that he believed that 
those principles He taught would only be success- 
ful after long periods of time and gradual develop- 
ment. Most of His figures and analogies in regard 



INFLUENCE OF CHRISTIANITY ON ALTRUISM 129 

to ' the Kingdom of God ' rest upon the idea of 
slow and progressive growth or change. He un- 
doubtedly saw that the only true renovation of 
the world would come, not through reforms of 
institutions or governments, but through individual 
change of character, effected by the same power to 
which Plato appealed — the love-power — but a love 
exercised towards Himself as a perfect and Divine 
model. It was the ' Kingdom of God ' in the soul 
which should bring on the kingdom of God in 
human society. . . . And yet ultimately this 
Christian system will be found at the basis of all 
these great movements of progress in human 
history. But it began by aiming at the indi- 
vidual, and not at society and aiming alone 
at an entire change of the affectional and moral 
tendencies."^ 

The moral teaching of the 8toics, second only 
to that of the Christian religion, had an effect in 
preparing the way for the introduction of humane 
principles of treatment for the bond and the 
oppressed. But the Stoics, like many of the 
Christians, did not always make their actions 
accord with their principles. Seneca tells of a 
Stoic who amused himself by feeding his fish with 
pieces of his mutilated slaves. Juvenal, who wrote 
when Stoicism was at the height of its influence, 



1 " Gesta Christi ; or a History of Human Progress under 
Christianity," by C. Loring Brace, fourth edition, pp. 33, 34. 
9 



130 GREEK AND ROMAN MEDICINE 

asks " how a slave could be a man," and Gains, the 
Stoical jurist, in the reign of Marcus Aurelius, 
classes slaves with animals. 

Constantine, in his own character, did not dis- 
play the beauties of the Christian religion, though 
his advisers who framed his laws acted under 
the influence of Christian teaching. This emperor 
passed laws in reference to slavery. He wrote to 
an archbishop : "It has pleased me for a long 
time to establish that, in the Christian Church, 
masters can give liberty to their slaves, provided 
they do it in presence of all the assembled people 
with the assistance of Christian priests, and pro- 
vided that, in order to preserve the memory of the 
fact, some written document informs where they 
sign as parties or as witnesses." In pagan times 
there was a somewhat similar system of a master 
being able to redeem a slave and register the 
redemption in one of the temples. 

The laws of Justinian, influenced largely by the 
teaching of Christianity, did a great deal to relieve 
the burdens of slavery. "We do not transfer 
persons from a free condition into a servile — we 
have so much at heart to raise slaves to liberty." 
In the words of one of the Early Fathers of the 
Church, "No Christian is a slave; those born again 
are all brothers." 

Gladiatorial Games were condemned by the 
Stoics, but these philosophers did not influence the 
common people. Constantine, in the year before 



INFLUENCE OF CHRISTIANITY ON ALTRUISM 131 

his acceptance of Christianity, gave a multitude 
of prisoners as prey to the wild beasts of the 
arena. In a.d. 325 he promulgated this law : 
^' Bloody spectacles, in our present state of tran- 
quillity and domestic peace, do not please us ; 
wherefore we order that all gladiators be prohibited 
from carrying on their profession." Human sacri- 
fices, which at one time took place in Kome, 
even in the time of Pliny and Seneca, were 
abolished under the same influence as checked 
gladiatorial sports. 

Constantine passed laws against the licentious 
plays and spectacles which flourished in Greece 
and Rome in pagan times. 

Seneca wrote: " Monstrous offspring we destroy ; 
children too, if weak and unnaturally formed from 
birth, we drown. It is not anger, but reason, thus 
to separate the useless from the sound." ^ Julius 
Paulus, a Stoic, in the time of the Emperor 
Severus (a.d. 222), held that the mother who pro- 
cured abortion, starved her child, or exposed it to 
die, was, in each case, equally guilty of murder. 
The Christian Fathers, in opposing these evils, were 
acting in accordance with the teaching of their 
founder, and they incessantly condemned these 
evil practices, and with greater and more far- 
reaching power than the Stoics. Although the 
Stoics anticipated many of the reforms of the 



1 " De Ira," i, 15. 



132 GEEEK AND ROMAN MEDICINE 

Christians, Stoicism never had any penetrating 
effect on the masses of the people, and differed 
in this respect from Christianity. The chief 
obstacle to the prevention of the exposure of 
children was the great amount of pauperism which 
prevailed in the Eoman Empire, and Christian 
emperors and councils had no choice but to allow 
many of these unfortunate children to be taken as 
slaves, rather than that they should perish from 
cold and hunger, or be torn by ravenous beasts. 
The pagan emperors, it is true, had done some- 
thing to found orphanages, but these institutions 
were not common until the Middle Ages. Trajan 
in A.D. 100 supported 5,000 children at the ex- 
pense of the State, and endowments were created 
by him for this purpose. Hadrian, Antoninus, 
and Marcus Aurelius made similar benefactions^ 
and Pliny endowed a charity for poor children. 

In the pre-Christian period, social clubs existed 
for the purpose of people having meals together, 
helping one another, and providing burial funds- 
The Emperor Julian condemned the Christians for 
supporting not only their own poor, but also poor 
strangers outside their faith. For ages the Church 
took charge of the poor. Her enemies said that as 
much pauperism was created as was relieved, and, 
no doubt, as is usual in the distribution of charity,, 
the good done was not unmixed with evil. 



INFLUENCE OF CHRISTIANITY ON ALTRUISM 133 

Hospitals. 

With reference to the important question of the 
foundation of hospitals, there are two opposing 
opinions — one, attributing their foundation almost 
entirely to Christianity,^ and the other denying 
to Christianity any pre-eminent influence.^ The 
truth lies between these two conflicting views, but 
nearer to the statement of Mr. Brace than of Mr. 
McCabe. The truths and influences of Chris- 
tianity, in the mind of the latter author, are 
obscured by the many errors of the Church, especi- 
ally in the Early and Middle Ages ; and it is of the 
utmost importance to distinguish, where necessary, 
between the teaching of the Founder of Christi- 
anity as disclosed in the New Testament, and the 
teaching of the Church which made many very 
evident errors, and whose practice soon became 
different from that inculcated by its Founder, 
so that at times the Christianity of the Church 
was as different from Christ's teaching as the 
vine of Sodom from the grapes of Eshcol. The 
fact that Christianity emerged from this eclipse 
points to it as something more than a humanly 
devised system. 

In very early times, the sick were allowed to 
remain at the temples for the treatment of their 
diseases, and medical students also attended for 



1 Vide " Gesta Christi," Brace. 

^ Vide " The Bible in Europe," Joseph McCabe. 



134 GBEEK AND EOMAN MEDICINE 

instruction. This system was the hospital system 
of later times, although the temples were not 
hospitals in the present sense of the word. The 
system in vogue in the temples of yEsculapius 
in Greece and Rome has already been described 
in this book, but the temples of Saturn served 
the same purpose in Egypt four thousand years 
before Christ. Professor Ebers of Leipzig, a high 
authority on the subject, says that Heliopolis un- 
doubtedly had a clinique in connection with the 
temple. The Emperor Asoka founded many hos- 
pitals in Hindustan, and Buddhists and Moham- 
medans both possessed hospitals ("Encyclopaedia 

Britannica"). 

Patients were attracted to temples, not only by 
receiving the services of the priest-physicians, but 
also in the superstitious belief that special virtue 
attached to the precincts of sacred buildings. 
Thus, in the temples of ^sculapius, sick people 
tried to get as near to the altar as possible. " It 
may fairly be surmised that the disuse of these 
temples in Christian times made the necessity of 
hospitals more apparent, and so led to their in- 
stitution, in much the same way as in this country 
the suppression of monasteries, which had largely 
relieved the indigent poor, made the necessity of 
poor laws immediately evident." ^ During Hadrian's 
reign the first notice of a military hospital appears. 



1 C( 



Smith's Dictionary of Greek and Eoman Antiquity," 



INFLUENCE OF CHRISTIANITY ON ALTRUISM 135 

The iatria, or taherncB medicce, described by 
Galen and others, were not for in-patients, but 
of the nature of dispensaries for the reception of 
out-patients. Seneca refers to valetudinaria, rooms 
set aside for the sick in large private houses. The 
first hospital in Eome in Christian times was 
founded by Fabiola, a wealthy lady, at the end of 
the fourth century. Attached to it was a convales- 
cent home in the country. Pulcheria, later, built 
and endowed several hospitals at Constantinople, 
and these subsequently increased in number. Paul- 
ine abandoned wealth and social position and went 
to Jerusalem, and there established a hospital and 
sisterhood under the direction of St. Jerome. St. 
Augustine founded a hospital at Hippo. McCabe 
states justly : " In the new religious order a 
philanthropic heroism was evolved that was 
certainly new to Europe. In the whole story of 
Stoicism there is no figure like that of a 
Catherine of Sienna sucking the sores of a leper, 
or a Vincent de Paul." It appears evident 
that Christianity was an important factor in the 
foundation of hospitals and charitable institu- 
tions, not directly, but from its beneficent in- 
fluence on the character of individuals; and the 
Roman Church, in this respect, acted in con- 
formity with the teachings of the Christian faith. 

Of greater importance is the consideration of 
the influence of Christianity, and of the Church, 
on the investigation and elimination of disease. 



136 GEEEK AND ROMAN MEDICINE 

In this matter the Church deserves the severest 
censure. It is no exaggeration to say that she 
hindered the scientific progress of the world for 
centuries. She appKed to the explanation of the 
causation of disease, the demon theories inherited 
from Egypt, Persia, and the East. The Bible 
itself reflects the views on demonology current at 
the time of the events recorded. If demons were 
the cause of disease, logically the treatment of 
diseases should have been in the hands of priests, 
not of physicians. The priests held that they 
were the proper people to interpret the will of the 
Almighty ; diseases were direct dispensations of 
Providence. 

"It is demons," says Origen, "which produce 
famine, unfruitfulness, corruptions of the air, and 
pestilence. They hover concealed in clouds, in 
the lower atmosphere, and are attracted by the 
blood and incense which the heathen offer to them 
as gods."^ " All diseases of Christians," wrote 
Augustine, " are to be ascribed to these demons : 
chiefly do they torment fresh-baptized Christians, 
yea! even the guiltless new-born infants." Hippo- 
crates, long before the Christian era, wrote with 
great wisdom in reference to the so-called sacred 
diseases : " To me it appears that such affec- 
tions are just as much divine as all others are, 
and that no one disease is either more divine or 

^ Origen, " Contra Celsum," lib. vii. 



INFLUENCE OF CHRISTIANITY ON ALTRUISM 137 

more human than another; but all are alike divine, 
for each has its own nature, and no one arises 
without a natural cause." ^ 

The devil might be driven out in disgust, it was 
thought, by the use of disgusting materials — ordure, 
the grease made from executed criminals, the livers 
of toads, the blood of rats, and so on. The same 
belief in demoniacal possession led to the most 
inhuman treatment of lunatics, and the Church 
in this respect is put to shame when we compare 
its action with the wiser and more humane practice 
of the Moors. This belief helped to strangle medi- 
cal progress for centuries, and is directly attribut- 
able to the Church. As late as 1583, the Jesuit 
fathers at Vienna boasted that they had cast out 
12,642 devils. That God dispenses both health 
and disease is a very different belief from that in- 
volved in "demoniacal possession." Travellers in 
remote parts of the East at the present day tell of 
alleged cases of demoniacal possession, but investi- 
gation does not reveal any difference between these 
cases and epilepsy or acute mania. 

In the first centuries of the Christian era men 
demanded overt signs of the favour of God, and 
the objects of veneration kept in the churches and 
monasteries were held to be capable of curing 
disease. The Latin Church had either a saint 
or a relic of a saint to cure nearly every ill 



* Adams's translation " Hippoc," vol. i, p. 216. 



138 GREEK AND ROMAN MEDICINE 

that flesh is heir to. St. Apollonia was invoked 
against toothache ; St. Avertin against lunacy ; 
St. Benedict against stone; St. Clara against 
sore eyes ; St. Herbert in hydrophobia ; St. John 
in epilepsy ; St. Maur in gout ; St. Pernel in 
ague ; St. Genevieve in fever ; St. Sebastian in 
plague ; St. Ottila for diseases of the head ; St. 
Blazius for the neck ; St. Laurence and St. 
Erasmus for the body ; St. Eochus and St. John 
for diseases of the legs and feet. St. Margaret 
was invoked for diseases of children and the 
dangers of childbirth. 

What the influence of Christ's life on earth on the 
medical art of His time was is a difiicult question. 
It must be remembered that He came to save the 
souls and not the bodies of men, not to rapidly 
alter social conditions nor to teach science. The 
eternal life of man was the subject of transcend- 
ent importance, and it is no doubt true that 
many of the early Christians neglected their 
bodies for the cure of their souls. As against 
this, the gospel of love taught that all men are 
brothers, both bond and free, and this led to 
mutual help in physical suffering, and to the 
foundation of charitable institutions. In the times 
of persecution of the Christians many of them 
welcomed suffering and death as the portal to 
eternal bliss. 

It has been asserted that the miraculous cures 
wrought by Christ for His own purposes were an 



INFLUENCE OF CHRISTIANITY ON ALTRUISM 139 

intimation to His followers to neglect the ordinary 
means of natural cure, and that this placed a 
Christian doctor in the position of having to 
abandon his calling. This is not so. To St. Luke 
— a Christian physician and the writer of the 
third Gospel and the Acts of the Apostles — the 
performance by Christ of miracles of healing pre- 
sented no difficulties, for he was the travelling 
medical adviser of St. Paul, and accompanied 
him on three journeys, from Troas to Philippi, 
from Philippi to Jerusalem, and from Cffisarea 
to Eome (a.d. 62). St. Paul wrote: "For we 
would not, brethren, have you ignorant of our 
trouble which came to us in Asia, that we were 
pressed out of measure, above strength, insomuch 
that we despaired even of life, but we had the 
sentence of death in ourselves, that we should not 
trust in ourselves, but in God, which raiseth the 
dead : who delivered us from so great a death, and 
doth deliver : in whom we trust that He will yet 
deliver us." St. Paul exercised faith, but also 
used the means of cure prescribed by " the beloved 
physician." In a very scholarly book published 
by the Dublin University Press in 1882, the Eev. 
W. K. Hobart, LL.D., shows that St. Luke was 
acquainted with the technical medical terms of 
the Greek medical writers. St. Luke was an 
Asiatic Greek. Dr. Hobart writes : " Finally, it 
should not be left out of account that, in any 
illness from which he might be suffering, there 



140 GREEK AND ROMAN MEDICINE 

was no one to whom St. Paul would be likely to 
apply with such confidence as to St. Luke, for it 
is probable that, in the whole extent of the Koman 
Empire, the only Christian physician at this time 
was St. Luke." In later years the pretence of 
performing miracles to cure diseases had a great 
effect in advancing superstition and retarding 
scientific investigation. 

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

The priests of the Church denounced the 
practice of Anatomy, and so changed the pro- 
gress made by the Alexandrian School, and by 
men like Galen, into the ignorance of a thousand 
years. The body was the temple of the Holy 
Ghost, and should not therefore be desecrated by 



INFLUENCE OF CHRISTIANITY ON ALTRUISM 141 

dissection. " Strangers' rests " and hospitals were 
connected with the monasteries, and were ex- 
ceedingly useful, notably in the time of the 
Crusades, but these Church institutions were in 
a very insanitary condition, for the maxim that 
cleanliness is next to godliness had little applica- 
tion among the religious orders of the Middle Ages. 
Dr. Walsh attempts to show that the Eeformers 
blackened the fair fame of the Church they had 
left, and states that it is to " this unfortunate 
state of affairs, and not real opposition on the 
part of the Popes to science," that we owe the 
belief in " the supposed opposition between the 
Church and Science." ^ That the Popes did some- 
thing to foster medical science in a spasmodic 
kind of way, that papal physicians were appointed 
and that the Church exercised control over some 
seats of learning may be freely admitted. That 
the monasteries preserved some of the Latin 
classics, that they were not all corrupt, and that 
all monks were not ignorant and idle, are facts 
beyond dispute. No doubt, too, the enemies of 
Christianity have overstated their case, but when 
all is said, the fact remains that the Church enjoyed 
great opportunities for promoting knowledge and 
investigating disease, and failed to avail itself of 



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



142 GREEK AND ROMAN MEDICINE 

them to such an extent that for ages no real pro- 
gress was made. This is certainly not an extreme 
opinion. It would be nearer the truth to say that 
not only was no progress made, but that the 
advances made by Hippocrates, by the school of 
Alexandria, by Celsus, and by Galen, were lost. 

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



143 



CHAPTEE XII. 

GYMNASIA AND BATHS. 

Gymnastics — Vitruvius— Opinions of Ancient Physicians on 
Gymnastics— The Athletes — The Baths — Description of 
Baths at Pompeii — Thermae — Baths of Caracalla. 

Gymnastics. 

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

Unfortunately the baths of the Eomans and 
the gymnasia of the Greeks became in time 
the haunts of the lazy and voluptuous. The 
gymnastic exercises of the Greeks date from 



144 GBEEK AND ROMAN MEDICINE 

very early times, and at first were of a warlike 
nature, and not reduced to a system. Each town 
possessed a gymnasium, and three very important 
ones were situated at Athens. 

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

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

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



GYMNASIA AND BATHS .145 

teaching or example might be injurious to the 
young. 

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

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

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

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

The gymnasia were dedicated to Apollo, the god 
of healing, and exercises were considered of greater 
importance for restoring health than medicinal 
treatment. The directors of the gymnasia were 
in reality physicians, and acted as such. Plato 
10 



1:16 GREEK AND ROMAN MEDICINE 

states that one of these, Iccus by name, was the 
inventor of medical gymnastics. As in our own 
day, many creditable gymnasts, originally weak of 
body, had perfected their strength by systematic 
exercise and careful dieting. 

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

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

The ancient physicians had great faith in the 
efficacy of exercises in cases of dropsy, and Ascle- 
piades employed this method of treatment very 
extensively, using also pleasant medicaments, so 
that Pliny said " this physician made himself the 
delight of mankind." Patients suffering from 
consumption were commonly sent to Alexandria 
to benefit from the climate, but Celsus con- 
sidered the sea voyage most beneficial because the 
patient was exercised bodily by the motion of the 



GYMNASIA. AND BATHS 147 

ship. Germanicus was cured by riding exercise, 
and Cicero was strengthened by travelbng and 
massage. 

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

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

The athletes and gladiators of Rome were mostly 
Greeks. Both Plutarch and Galen deride them. 



148 GREEK AND ROMAN MEDICINE 

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

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

Baths {BalnecB). 

Greek Baths. — In Greece from very early times 
inability to read and to swim were considered the 
marks of the ignorant. In Homer's time over- 
indulgence in warm baths was considered effemi- 
nate. ^ The system of bathing was never so 
complete in Greece as in Home, but in the 
former country there were both public and private 
baths, and ancient Greek vases display pictures 
of swimming-baths and shower-baths, and also of 

1 Od. viii, 249. 



GYMNASIA AND BATHS 149 

large basins for men and for women round which 
they stood to bathe. The Greek baths were 
near the gymnasia. After the bath, the bathers 
were anointed with oil and took refreshments. 
Sometimes a material consisting of a lye made 
of lime or wood-ashes, of nitrum and of fuller's 
earth was applied to the body. Towels and strigils 
were employed for rubbing and scraping after the 
anointing ; the strigil was, as a rule, made of iron. 

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

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

The public baths were at first used only by the 
poor, but the mother of Augustus went to the public 
bath, and in time even the emperors patronized 
them. The baths were opened at sunrise and closed 



150 GEEEK AND EOMAN MEDICINE 

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

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

The plan of the baths at Pompeii, which was 
largely a pleasure resort, is typical of the public 
baths that were in general use. These baths had 
several entrances, and the principal one led to a 
covered portico from which a lavatory opened. 
The portico ran round three sides of a courtyard 
{atrium) in which the attendants waited, and it 
was also the exercise-yard for the young men. 



GYMNASIA AND BATHS 151 

Advertisements of the theatres and gladiatorial 
shows were exhibited on the walls of the atrium. 
The undressing room was also the reception room 
and meeting-place. The bathers' garments were 
handed over for custody to slaves, who were, as a 
general rule, a very dishonest class. The frigi- 
darium contained a cold bath 13 ft. 8 in. in 
diameter, and a little less than 4 ft. deep. It 
had two marble steps, and a seat under water 10 in. 
from the bottom. Water ran into the bath through 
a bronze spout, and there was a conduit for the 
outflow, and an overflow pipe. The frigidarium 
opened into the tepidarium which was heated with 
hot air from furnaces, and furnished with a char- 
coal brazier and benches. The brazier at Pompeii 
was 7 ft. long and 2J ft. broad. The tepidarium 
was commonly a beautifully ornamented apartment, 
while the anointing-room was conveniently situated 
off it. Pliny has described the various unguents 
used by wealthy and luxurious Romans. From 
the tepidarium the bather might enter the cal- 
darium or sweating room, an apartment con- 
structed with double walls and floor, between 
which hot air was made to pass. This room 
contained a lahrum, or circular marble basin, con- 
taining cold water for pouring over the head before 
the bather left the caldarium. The method of 
heating rooms by passing hot air between the 
" hanging " and the lower floor was in use in the 
better class of houses, and the device can at present 



152 GREEK AND ROMAN MEDICINE 

be seen in some of the buildings on the Palatine 
Hill in Eome, and in the ruins of the great Baths 
of Caracalla. After a course of sweating the 
bather had the sweat removed from his body by 
the strigil, in much the same way as a horse is 
scraped with a bent piece of hoop-iron by a groom. 
The guttiis was a small vessel with a narrow neck 
adapted for dropping oil on the strigil to lubricate 
its working edge. Pliny states that invalids used 
sponges instead of strigils. Rubbing with towels 
followed the use of the strigil, and the bather 
finally lounged in the tepidarium for a varying 
period before entering the outer air. 

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

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

The most important baths formed only a part 
of the great establishments called thermcE. 
Adjoining the baths of the thermae were a gymna- 
sium for sports and exercises, a library for the 
studious, lounging places for the idle, halls for 



GYMNASIA AND BATHS 153 

poets and philosophers, in which they declaimed 
and lectured, museums of art, and sometimes 
shady groves. These complete establishments 
were first erected by Marcus Agrippa in the time 
of Augustus. Succeeding emperors vied with each 
other in providing magnificent thermee, and the 
ruins of the Baths of Caracalla remain in a 
wonderful state of preservation to this day. The 
building of these baths began in a.d. 216. The 
structure, 1,050 ft. long and 1,390 ft. broad, was on 
a scale of almost incredible magnificence. Price- 
less statues and rare objects of art have been 
unearthed from the ruins. In recent years exca- 
vations have revealed a complicated system of 
subterranean corridors and galleries which existed 
for the purpose of carrying leaden water-pipes to 
the baths, and providing a passage-way for the 
host of slaves who acted as bath-attendants. The 
great buildings were well lit by windows in the 
walls of the courtyards, and these openings also 
allowed for ventilation. A great stadium and beau- 
tiful gardens adjoined the Baths of Caracalla. In 
the north-west section of these baths Alessio Valle 
has very recently discovered the remains of a great 
public library. When Caracalla pillaged Alexan- 
dria he probably carried off niany of the books 
from the famous library there to enrich his baths. 
The ruins of the library in the Baths of Caracalla 
reveal circular tiers of galleries for the display of 
manuscripts and papyri. There were 500 rooms 



154 GREEK AND ROMAN MEDICINE 

round these baths. The great hall had a ceiling 
made in one span, and the roof was an early 
example of reinforced concrete, for it was made 
of concrete in which bronze bars were laid. The 
lead for the water-pipes was probably brought 
from Cornwall. 

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

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



155 



CHAPTEE XIII. 

SANITATION. 

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

The Water-supply. 

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

The first Roman aqueduct, according to Fron- 
tinus, dates from 312 B.C. 

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



156 GREEK AND ROMAN MEDICINE 

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

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

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

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

In their conduits they built shafts at frequent 
intervals designed to relieve the pressure of com- 

' " Diet, of Gr. and Eom. Antiq.," Smith, vol. i, p. 150, to 

lohich the author is indebted for mucli of the information herein 
supplied. 



SANITATION 157 

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

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

The water from the aqueduct was received at 
the walls of the city in a great reservoir called 
castellmn aquariivi, externally a beautiful building 
and internally a vast chamber lined with hard 
cement and covered with a vaulted roof supported 



158 GREEK AND ROMAN MEDICINE 

on pillars. The water flowed thence into three 
smaller reservoirs, the middle one filled by the over- 
flow of the two outer ones. The outer reservoirs 
supplied the public baths and private houses, while 
the middle one supplied the public ponds and 
fountains, so that, in the event of a shortage of 
water, the first supply to fail was the least 
important. The amount of water provided for 
private use could be checked, for purposes of 
revenue, by means of this arrangement. 

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

The cnratores aquarum had very responsible 
duties. Under their orders, in the time of Trajan, 
were 460 slaves who were subdivided into various 
classes, each of which had its own particular duties 
to perform in connection with the maintenance and 
control of the water-supply. A supply of pure 
water and proper drainage are of first importance 



SANITATION 159 

in sanitation, and it is evident that the Eomans 
understood these matters well. 

Deainage. 

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

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

Disposal of the Dead. 

Both in Greece and Eome earth-burial and 
cremation were employed for the disposal of the 
dead. Near the Temple of Faustina in the Eoman 
Forum, under the Via Sacra, have been found the 
graves of some of the dwellers of the hills before 
Eomulus founded the city. In Eome, burial within 
the city was forbidden from the time of the Twelve 
Tables. Exceptions were made in the case of 



160 GREEK AND ROMAN MEDICINE 

emperors, vestal virgins, and famous men, such as 
those who had been honoured with triumphs. The 
large cemetery for the poor lay on the east side 
of the city and the tombs of the rich were along 
the roadsides. The remains of some of these can 
now be seen along the Appian Way. One of 
these tombs is the Tomb of the Scipios, which, 
as Byron wrote, " contains no ashes now." Near 
the Tomb of the Scipios can be seen a door with 
high steps which leads to the columbaria. These 
are little rooms provided with pigeon-holes for 
the reception of the ashes of the freedmen of 
notabilities. Inscriptions show that some of these 
freedmen were physicians, and others musicians 
and silversmiths. The shops of the perfumers stood 
in a part of the Forum on the Via Sacra. Per- 
fumes were much used at incinerations to dis- 
guise the smell of decomposition before the fires 
were kindled. The Christians opposed cremation 
and favoured earth burial, and in time the busi- 
ness of the perfume-sellers failed, and Constantine 
bought their shops. 

The Catacombs were used almost entirely by the 
Christians. If all the passages of the Catacombs 
could be placed in line, it is said that they would 
extend the whole length of Italy. They were hewn 
out of volcanic soil very well suited for the purpose, 
and were probably extensions, in the first place, of 
quarries made for the purpose of obtaining building 
cement. They were used by the Christians, not only 



SANITATION 161 

for the religious rite of burial, but also as secluded 
meeting places. The bodies were laid in lociUi, 
sometimes in two or three tiers, the loculi being 
filled in with earth and stone. 

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

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



11 



162 



APPENDIX. 

FEES IN ANCIENT TIMES. 

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

Seleucus paid Erasistratus about i^20,000 for 
curing his son Antiochus. Herodotus mentions 
that the ^ginetans (53-2 B.C.) paid Democedes, 
from the public treasury, X'304 a year ; the 
Athenians afterwards paid him .£406 a year, and 
at Sam OS he received £422 yearly. Pliny says 
that Albutius, Arruntius, Calpetanus, Cassius and 
Eubrius each made close upon j£2,000 a j^ear, and 
that Quintus Stertinius favoured the Emperor by 
accepting about j64,000 a year when he could have 
made more in private practice. The surgeon Alcon 
made a fortune of nearly ^100,000 by a few years' 
practice in Gaul. Pliny states that Manlius Cor- 
nutus paid his doctor .£2,000 for curing him of a 
skin disease, and Galen's fee for curing the wife 
of a consul was about X'400 of our money. 



163 



INDEX. 



Academics, 56 

Adamantius, 116 

Adams of Banchory, 31, 32, 1^4 

iEsculapius, 3, 13, H 

_, College of, 6 

— , temple of, 4, 14, 17 

^tius, 118 

Agatbinus, 87 

Agrippa, 63 

Alexander of Tralles, 119 

Alexander the Great, 38, 40, 41 

Alexandria, 42 

Alexandrian School, 42 

Anatomy, 27, 44, 46, 76, 101, HO 

Andromachus, 68, 82 

Antonius Musa, 65 

Antyllus, 112 

Apollo, 3, 13 

ApoUouius, 80 

— , alleged miracles of, 81 

Aqueducts, 9, 155 

Archagathus, 5 

Archiater, 6, 68 

Archigenes, 88 

Aretseus, 87 

Aristotle, 25, 40 

Asclepiadse, 18, 40, 44 

Asclepiades of Prusa, 23, 51, 146 

Asklepieion of Cos, 19 

Astrology, 63 

Athenseus, 80 

Athletes, 147 

Augustus, 63 

Aureliauus, 91 

Baths, Greek, 148 
_, Roman, 149 



Baths of Caracalla, 44, 153 
_ at Pompeii, 152 
Byzantine Period, 111 

Cabalists, 128 
Cselius Aurelianus, 91 
Caesar, Julius, 44, 54, 55 
Caligula, 67 
Caracalla, 44, 153 
Cassius Felix, 89 
Catacombs, 160 
Cato the Elder, 7, 8 
Celsus, 48, 72^ 
— , works of, 73 
Christ, miracles of, 138 
Christianity, 128 
_ and hospitals, 133 
Chrysippos, 46 
Claudius, 67 

Cleombrotus, 46 

Cloaca Maxima, 8, 159 

Cnidos, 17, 44, 50 

Constantine, 130 

Cornelius Agrippa, 1 

Cos, 17, 44 

Cremation, 159 

Decline of Healing Art, 111 

of Rome, HI 

Democedes, 22 
Democritus, 23, 25 
Demon Theories of Disease, Idb 
Dietetics, 32, 103 
Dioscorides, 88 
Disposal of the dead, 159 
Dogmatic School, 23 
Drainage, 159 



164 



GREEK AND ROMAN MEDICINE 



Drug-sellers, 59 

Eclectics, 87 
Elements, the four, 39 
Empirics, 23 
Empiricism, 23, 48 
Epicureans, 56 
Erasistratus, 45, 47 
Essenes, 45, 127 
Euclid, 43; 
Eudemus, 79 

Fabiola, 135 
Fees, 162 

Galen, 96, 146 
— , influence of, 110 
— , works of, 99 
Gibbon, 10, 56, 120, 140 
Gladiatorial games, 180 
Gladiators, 147 
Gnostics, 128 
Gods of disease, 3 

— of healing, 3, 15 
Gorgias, 25 
Gymnasia, 19, 145 
Gymnastics, 143 

— , inventor of medical, 146 
— , 'opinions of physicians on, 146 
Gymnasiarch, 20, 144 
Gynaecology, 31, 93, 107 

Heliodoeus, 91 
Herodicus, 25 
Herodotus, 22, 91 
Herophilus, 45, 46 
Hippocrates, 7, 25, 146 
— , sons of, 37 
— , works of, 26 
Hippocratic Law, 33 

— Oath, 35 
Homer, 15, 16, 148 
Horatillavus, 61 
Hospitals, 133 

— , founders of, 135 
Hyg^ia, 15 

TccDS, 146 



Jacobus Psychristds, 116 
Justinian, 130 

Lectistehnium, 3 
Leucippus, 23 
Library of Alexandria, 43 
Livy, 2, 4 

Machaon, 16, 17 
Maecenas, 66 
Magnus, 116 
Marinus, 95 
Meges of Sidon, 79 
Melampus, 15 
Meletius, 116 
Methodism, 23, 51, 54 
Miracles of ApoUonius, 80 

— of Christ, 138 

— of Vespasian, 140 
Mithridates, 45 
Mithridaticum, 45 
Monastic medicine, 137 
Moschion, 123 

Nemesios, 116 
Neoplatonism, 112 
Nero, 67, 69, 70 
Nerva, 81 
Numa Pompilius, 2 

Obsteteics, 31, 93 
Octavianus, 55 
Oculists, 70 
Operations, 29, 30, 73, 113 

— dental, 2 
Oribasius, 87, 93, 114 
Orphanages, 132 
Ovid, 24 

Pathology, 104 

Paulus ^gineta, 94, 113, 124 

Period, anatomic, 21, 45 

— , philosophic, 21 

— , primitive, 20 

— , sacred, 21 

Pestilence in Rome, 89 - 

Philenus of Cos, 48 

Philosophy, 56 



INDEX 



165 



Plague, 4, 120 

Plato, 25, 39 

Platonists, 56 

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

Plutarch, 5, 7 

Pneumatism, 86 

Podalarius, 16 

Poisoners, women, 70 

Priest-physicians, 1, 134 

Priests, 18 

Proclus, 140 

Ptolemy, 43 

Public health regulations, 161 

Pythagoras, 21 

Pythagoreans, 22 

Quacks, 58, 61 
Quintus, 95 

Rhodes, 17 * 

Roman quacks, 58, 61 
Rome, 56 

— , medical practice in, 58 
Rufus of Ephesus, 94 

Saints, 138 
St. Luke, 139 
St. Paul, 139, 148 
Sanitation, 8, 155 
Sceptics, 24 



Scribonius largus, 82 
Seneca, 67, 131 
Serapion, 50 
Serpents,;14 
Sewers, 8, 9, 159 
Slave-physicians, 60 
Slaves, 60 
Soranus, 92 

Stoics, 56, 129 '' 

Suetonius, 140 
Surgery, 30, 73, 107 
Surgical instruments, 90 

Tacitus, 140 

Temple of ^sculapius, 4, 14, 17 

Temples, 3, 4, 17 

Themison of Laodicea, 23, 53, 54 

Theophrastus, 42 

Theriaca, 98 

Thermae, 152 

Thessalus of Tralles, 83 

Thrasyllus, 66 

Tiberius, 66 

Vettius Valleus, 82 
Vitruvius, 144, 157 

Water supply, 63, 155 
Women poisoners, 70 
Wounds of Julius Caesar, 55 



J4LE, SONS & DANIBLSSON, LTD., 83-91, GREAT TITCHFIELD STREET, LONDON, W. 



BINIMNG SECT. IAN 30 1981 



PLEASE DO NOT REMOVE 
CARDS OR SLIPS FROM THIS POCKET 

UNIVERSITY OF TORONTO LIBRARY 



F 



R Elliott, James 

135 Outlines of Greek and Roman 

E44 medicine 



BioMed. 



a 



V