Outlines of Greek and Roman Medicine Part 5

[19] Seneca "De Benefic.," vi.

CHAPTER VII.

PHYSICIANS FROM 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 knowledge of disease and a considerable amount of medical experience. He wrote not only on medicine but also on history, philosophy, jurisprudence and rhetoric, agriculture and military tactics. His great medical work, "De Medicina," comprises 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 Asclepiades 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 understood by the ancients. There is no greater fallacy than to suppose that medical practice generally, and surgery in particular, has reached no eminence except in very recent times. The operation of crus.h.i.+ng 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. Great 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 dislocations and fractures is remarkably advanced. Dislocations, 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 ca.n.a.l 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, 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 centuries 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 impression 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 complete 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 ca.n.a.ls. 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 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 excellent, for he recognized that fever was an effort of Nature to throw off 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 treatment of some eye diseases.

Although Celsus practised phlebotomy, he discountenanced 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 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 appet.i.te for food, and they used them after eating heavy meals to prepare the stomach for a second bout of gluttony. Many gourmands took an emetic daily. Celsus said that emetics should not be used as a frequent practice if the attainment of old age was desired.

Celsus excelled as a compiler, and had the faculty of selecting the most admirable contributions to the art of healing from previous medical writers. His writings also give an account of what was best in the medical practice of Rome 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 cla.s.s considered study of that kind beneath the dignity of their rank.

In the Augustan age, when literature in Rome reached its highest level, the literary style of Celsus was fit to be cla.s.sed with that of the great 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. 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 information 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 Rome 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 dislocation 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 Herophilus 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.

_Apollonius of Tyana_ 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 extraordinary 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 Rome just after an edict had been promulgated by Nero against magicians. He was tried before 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. Subsequently, at Alexandria, Apollonius, in virtue of his magic power, affirmed that he would make Vespasian emperor, and afterwards became the friend of t.i.tus, Vespasian's son. On the accession of Domitian, Apollonius stirred up the provinces against him, and was ordered to be brought in custody to Rome, 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 aesculapius, 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 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 travelling 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 companions 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[20] 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.

_Andromachus_, the elder, was physician to Nero, and the first archiater. He was born in Crete. He was the inventor of a compound medicine 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 a.s.sist memory, and to prevent the likelihood 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 Rome 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 a.s.surance. He said that medicine surpa.s.sed all other arts, and he surpa.s.sed 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 practice. At first, he a.s.sociated 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 shrewdness and ability, he was equipped with great powers of self-advertis.e.m.e.nt, 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 Rome 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 restoratives. He is said to have used colchic.u.m 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 prodigious recorder of information on all subjects. Much of this information is inaccurate, for he was not able to discriminate between the true and the false, or to a.s.sign 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.

FOOTNOTES:

[20] H. N., xxix, 5.

CHAPTER VIII.

THE FIRST AND SECOND CENTURIES OF THE CHRISTIAN ERA.