Athenæus--Pneumatism--Eclectics--Agathinus--Aretæus--Archigenes--
Dioscorides--Cassius Felix--Pestilence in Rome--Ancient surgical
instruments--Herodotus--Heliodorus--Cælius Aurelianus--Soranus--
Rufus of Ephesus--Marinus--Quintus.
Athenæus, of Cilicia, a Stoic and Peripatetic, founded in Rome the
sect of the Pneumatists 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 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 Pneumatists 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 Dogmatists,
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 Episynthetics, founded by a pupil of Athenæus, by
name, Agathinus. He was a Spartan by birth. He is frequently quoted by
Galen, but none of his writings are extant.
Aretæus, the Cappadocian, practised in Rome 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 first 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 Aretæus 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 wonderfully accurate in his opinions and reliable in treatment. Aretæus 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 Aretæus consist of eight books, and there have been many editions in various languages. Only a few chapters are missing.
Archigenes was a pupil of Agathinus, and is mentioned by Juvenal. He was born in Syria and practised in Rome 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 classification 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 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 descriptions 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. Fugitives crowded into Rome 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 Rome and the surrounding 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.[21]
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 Athenæus, 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.
Cælius 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 unnecessarily 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 Cælius 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 previously 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 constriction and those of relaxation. Aurelianus did not 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 importance to the two classes recognized by his school. He withheld active treatment until he had ascertained to his own satisfaction the class to which the disease belonged. Cælius 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 Aretæus in condemning tracheotomy. His books are not written in a good literary style.
Soranus, of Ephesus, was an eminent physician of the Methodist school, who practised in Rome 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 Bibliothèque 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 preservation however, in the Vatican library. Parts of the writings of Soranus are preserved in the writings of Oribasius. There is no doubt that Soranus was a very accomplished obstetrician and gynæcologist. 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 noteworthy that he recognized the method of embryotomy as necessary when other measures had failed.
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 what 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 Cælius Aurelianus one on fevers. He is also quoted by Tertullian, and by Paulus Ægineta, who writes that Soranus was one of the first Greek physicians to describe the guinea-worm. Soranus, in the opinion of St. Augustine, was Medicinæ auctor nobilissimus. He was far removed from the prejudices and superstitions of his time, as is shown by his denunciation of magical incantations.
Rufus, 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 demonstrated the investing membrane of the crystalline lens of the eye.[22] 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. Marinus investigated the glands and compared them to sponges, and he imagined that their function was to moisten and lubricate the surrounding structures. He discovered 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 physician 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.
Footnotes:
[21] For full description and plates see Dr. John Stewart Milne's "Surgical Instruments in Greek and Roman Times" (Clarendon Press, 1907).
[22] "Portal," vol. i, p. 74.