He described (_a_) simple inflammation caused by excess of blood alone; (_b_) inflammation 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 cla.s.ses--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 a.s.serted 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, 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 superst.i.tious Rome.

Medicines were cla.s.sified 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 aegineta 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."[24]

"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."[25]

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 be overcome by that which is contrary "to the disease itself"; and (2) that Nature is to be preserved by what has relation with Nature. He recognized that while the invading disease was to be repelled, the strength and const.i.tution 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.

VI.--SURGERY.

Galen conformed to the custom of the physicians in Rome, 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 Rome. He is said to have resected a portion of the sternum for caries, and also to have ligatured the temporal artery.[26]

VII.--GYNaeCOLOGY.

Galen had little more than a superficial knowledge of this subject, and was quite ignorant of the surgery of diseases of women. He was not so well informed as Sora.n.u.s 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. He had erroneous views on the causation of displacements 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 physicians 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 judgment; 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, apparently forgetting the patient for the time, would hold violent disputations.

Their main object was to display their dialectical skill, and their arguments sometimes led to blows. These discreditable exhibitions were rather frequent in Rome in his time.

With Galen, as with Hippocrates, it is sometimes impossible to tell what works are genuine, and what are spurious. 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 heretofore shown the path, but as he was the first to enter it, he was not able to go as far as he wished.... He has not made all the necessary distinctions, and is often obscure, as is usually the case with ancients when they attempt to be concise. He says very little of complicated diseases; in a word, he has only sketched what another was to complete; he has opened the path, but has left it for a successor to enlarge and make it plain." Galen strictly followed Hippocrates in the latter's humoral theory of pathology, and also in therapeutics 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 realm of knowledge for ages after his death. He was not precisely a genius, though a very remarkable man, and he established no sect of his own. The reason of his power lay in the fact that his writings supplied an encyclopaedic knowledge of the medical art down to his own time, with commentaries and additions of his own, written with great a.s.surance and conveying an impression of finality, for he a.s.serted that he had finished what Hippocrates had begun. The world was tired of political and philosophical strife, and waiting for authority. The wars of Rome 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 invested 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 progress. 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 Felix IV to the honour of the saints, Cosma and Damiano, two Arabian _anargyri_ (unpaid physicians) who suffered martyrdom under Diocletian.

The date of Galen's death is not exactly known, but was probably A.D.

200.

FOOTNOTES:

[23] Dr. Bostock's "History of Medicine."

[24] "Paulus aegineta," vol. iii, p. 74.

[25] _Ibid._, p. 242.

[26] "Encyl. Brit.," Surgery.

CHAPTER X.

THE LATER ROMAN AND BYZANTINE PERIOD.

Beginning of Decline--Neoplatonism--Antyllus--Oribasius--Magnus-- Jacobus Psychristus--Adamantius--Meletius--Nemesius--aetius-- Alexander of Tralles--The Plague--Moschion--Paulus aegineta--Decline of Healing Art.

The death of Galen marks the beginning of the decline 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 gradually 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.

_Neoplatonism_ exerted a powerful influence upon the healing art. It was founded by Plotinus, and was for three centuries a formidable rival to Christianity. The Neoplatonists believed that man could intuitively know the absolute by a faculty called _Ecstasy_. Neoplatonism is a term which covers a very wide range of varying thought; essentially, it was a combination of philosophy and religion, arising from the intellectual movement 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 efficacy 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 writer, but his works have perished except for quotations by later writers. The fragments of his writings were collected and published in 1799. Antyllus 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 wound to heal by granulation. As this operation was performed without anaesthetics 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 treatment of contractures by the method of tenotomy. He also removed enlarged glands of the neck. It was part of the practice of Antyllus to ligature 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 preserved by Paulus aegineta,[27] 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 fourth ring; 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 separating 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.

_Oribasius_ was born at Pergamos, the birthplace of Galen, about A.D.

326. He studied under _Zenon_, 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, Oribasius became acquainted with him, and they were soon close friends. When Julian was raised to the rank of Caesar, Oribasius accompanied him into Gaul. During this journey Oribasius, 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 preceding medical authors. When this work was finally completed it consisted of seventy books under the t.i.tle "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 t.i.tle 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 ent.i.tled in virtue of the great fort.i.tude with which he had borne adversity.

An edition of Oribasius was published at Paris between 1851 and 1876, in six volumes, by Daremberg and Bussemaker, under the patronage of the French 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, Sora.n.u.s, Rufus, and Antyllus. Oribasius 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 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 considered him as little less than a G.o.d.

_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.

_Adamantius_ 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.

_Meletius_ 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 circulation of the blood. Of the former, he wrote, "The yellow bile is const.i.tuted both for itself and for other purposes; for it contributes to digestion and promotes the expulsion of the excrements; 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."[28]

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 pa.s.sages, as the heart throws out whatever is fuliginous through the mouth and nose by expiration."[29]