"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 mighty 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 dissection. Eumenes likewise established a library at 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, Rome, 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 ma.n.u.scripts 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 whole 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 Alexandria 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, 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 Roman 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 Rome, 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 discoursed 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 restrictions; 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.[7]

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 mithridatic.u.m. 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 investigations to the dissection of the dead, but also vivisected criminals. _Cleombrotus_, 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 _Chrysippos_ 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.[8]

_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 the heart, and he observed the lacteals without determining their function. Herophilus operated upon the liver 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 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,"[9]

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 a.n.a.logy.

This meant that discoveries were made by accident, knowledge was acc.u.mulated by the recollection of previous cases, and treatment adopted which had been found suitable in similar circ.u.mstances. _Philinus 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[10] wrote of this sect that they admit that evident causes are necessary, but 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 pract.i.tioners, 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.

Relief 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 and attacked the teaching of Hippocrates.

Among these, _Serapion of Alexandria_, an Empiric who lived in the third century before Christ, is noteworthy for having first used sulphur in the treatment of skin diseases, and Heraclides wrote on strangulated hernia. Serapion added somewhat to the system of Philinus, and was responsible for introducing the principle of a.n.a.logy 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 was consumed with animosity and bitterness towards those with whom he had formerly been in agreement. Cnidos was the stronghold of the Empirics.

FOOTNOTES:

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

[8] Arctinus: "Ethiopis," Translated in Puschmann's "Hist. Med.

Education."

[9] Pliny, "Hist. Nat.," xxvi, 6.

[10] "De Med.," Praefat. (Translation.)

CHAPTER V.

ROMAN MEDICINE AT THE END OF THE REPUBLIC AND THE BEGINNING OF THE EMPIRE.

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

_Asclepiades of Prusa_, in Bithynia, was a famous physician in Rome 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 knowledge 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 jucunde_," and he believed that what the physician could do was of primary importance, and _vis medicatrix naturae_ 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 ma.s.sage, and, to some extent, upon surgery. His practice of prescribing 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 Roman Republic, and was well acquainted with philosophy, especially 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 shrewdness, and his success largely contributed to the establishment of Greek doctors and their methods in Rome. There is grim humour in his description of the Hippocratic treatise on therapeutics, 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!

_Themison, 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 constriction, and _vice versa_. This epitomized system of medicine did away with the use of many cla.s.ses 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 pract.i.tioners "the a.s.ses 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.

The views of the Methodists were less extreme than those of the Dogmatists and Empirics. Celsus wrote of the Methodists: "They a.s.sert 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."[11]

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."[12]

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 Roman Republic, and it will now be necessary to consider the state of the healing art in Rome 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 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 Rome, and was declared perpetual _imperator_. On March 15, 44 B.C., he was a.s.sa.s.sinated. 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 pract.i.tioners 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.

Octavia.n.u.s was appointed one of the second triumvirate, his colleagues being Mark Antony and Lepidus. Lepidus was first forced out of the triumvirate, and Octavia.n.u.s 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 Octavia.n.u.s defeated Mark Antony and his ally Cleopatra, and within a few years Octavia.n.u.s was proclaimed Emperor as Augustus Caesar (27 B.C.). Under his rule Rome greatly prospered, and we shall now consider the state of medicine and of sanitation during his ill.u.s.trious reign.

In the Roman 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 G.o.d, 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 superst.i.tions, were all for the glory of mighty Rome.

Educated Romans 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 Rome 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 cla.s.s, a comparatively small number of gentry, a very numerous _plebs_ or populace, and many slaves. The Emperor Augustus boasted that after the war with s.e.xtus 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 mult.i.tude of spectators.

Throughout the country generally agriculture prospered, and the supply of various gra.s.ses for feeding cattle in the winter increased the mult.i.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 summer here In months that are not summer's; twice teem the flocks: Twice does the tree yield service of her fruit.