CHAPTER XI. Asclepiades, the Introducer of Greek Medicine Into Rome

ASCLEPIADES, THE INTRODUCER OF GREEK MEDICINE INTO ROME

The seventh Ptolemy, Ptolemy Euergetes or Physcon, whose reign lasted from 146 to 117 B. C., drove all men of learning away from Alexandria and closed the famous schools in that city. It was only a few years after these events, and at a time when that city was fast losing its supremacy as the great centre of medical learning, that there appeared at Rome a Greek philosopher and physician who was destined to become the founder of a new set of medical ideas and of a new kind of medical practice. Being a man of general cultivation and attractive personality, and not afraid to encounter the prejudices and ill will which almost always greet a foreigner when he first establishes himself in a strange country and among a people of a different race, he soon overcame those obstacles and was eventually successful in making Rome the starting-point and centre of the best medical thought and practice of that period of the world’s history. To understand clearly, however, the character of the work which Asclepiades accomplished in the city which was soon to be the capital of the world as then known, it is desirable that a brief account should be given of the condition of medical affairs in Rome at the time of his arrival.

The Practice of Medicine at Rome During the Century Immediately Preceding the Christian Era.--Foreigners were not encouraged to settle in Rome until toward the latter part of the second century B. C., and consequently the treatment of the sick in that city maintained its distinctly Roman character for an unusually long time. In the households of the better classes the head of the family commonly prescribed for any illness which might befall its members. In not a few instances one of the slaves--who was known as a servus medicus, and who might perfectly well have been a regularly educated Greek physician--took charge of the patient in place of the master of the house. A book of domestic remedies was the usual source of information from which the latter derived his knowledge of therapeutics. Marcus Porcius Cato, the distinguished Roman censor (234–149 B. C.), was the author of one of the most popular of these books of recipes. The text of this work has come down to our time. There were, at this period, no regularly established physicians and no such thing as a medical practice. For several hundred years the Romans were almost constantly at war with the neighboring tribes or nations, and this life of outdoor exposure and active exercise kept them free from the numerous and very varied bodily ills of the later generations. This state of society alone was quite sufficient to prevent the thoroughly trained physicians of Greece and Alexandria from settling in Rome. But there were still other forces at work which greatly delayed their taking such a step, viz., the unwillingness on the part of the authorities to grant to foreigners the rights of citizenship, and the very strong prejudice which the Roman aristocracy cherished with regard to the Greek nation. Some idea of the strength of the latter feeling may be gathered from the letter which Cato the Censor, perhaps the most influential citizen of Rome at that time, wrote to his son Marcus. Daremberg gives the following quotation from this epistle: “The Greeks are a perverse and unteachable race. Believe that an oracle is speaking to you when I say--Every time that the Greeks bring to us some branch of knowledge they will not fail to corrupt our manners; and it will be far worse for us if they should send us their physicians, for they have bound themselves by an oath to kill all Barbarians by the aid of medicine--and they have the insolence to reckon us also as Barbarians. Remember that I have forbidden you to call in a physician.” Daremberg adds: “The old man Cato must have been very simple-minded to believe for a moment that physicians would be such egregious fools as willingly to kill the patients from whom they derive their support.” But even this strong prejudice on the part of the Roman aristocracy had to give way in course of time to forces of a much stronger character. During the second century B. C., the Romans, no longer fearing the encroachments of their warlike neighbors and having overcome all danger of an invasion on the part of their once powerful Carthaginian foe, entered upon a career of conquest. The capture of an ever increasing number of cities and towns in Greece, Asia Minor, Egypt and Africa brought great wealth to Rome, and, with it, increasing luxury, an increase in the prevalence and variety of diseases, and an increased need of men who were competent to deal successfully with such diseases. The physicians who first attempted to meet this need were men of an inferior stamp, to whom the situation appeared simply to afford an excellent opportunity for making money; and very naturally they failed to gain the respect and confidence of the better citizens. At a later date Julius Caesar, who was, at that time, Consul (about 90 B. C.), extended the right of citizenship to all foreign physicians who were practicing in Rome, and thus was removed one of the greatest obstacles which prevented the better class of Greek medical men from settling in that city.

More than a hundred years before the time of which I am speaking (i.e., about 218 B. C.), a Greek physician named Archagathus had the courage to take up his abode in Rome. He was the son of Lysanias, a native of Peloponnesus. At first he appeared to gain the favor of the community in which he practiced, for they bought and placed at his disposal a shop, or office, in the cross-way of Acilius, and gave him the name of vulnerarius--healer of wounds. Later, however, they disliked his rather too free use of the knife and the actual cautery, and thereafter he was spoken of as the carnifex, or executioner. Medicine was thus brought into disrepute and we hear nothing further about physicians in Rome for more than a century--that is, until about 90 B. C., when Asclepiades, a native of the city of Prusa, Bithynia (northwest part of Asia Minor), made his appearance in that city. At first he taught rhetoric, but, finding this occupation unprofitable, he began the practice of medicine. Pliny says that he acquired a knowledge of this art through the studies which he carried on after his arrival in the city of Rome, but Neuburger makes the statement that he began the study of rhetoric, philosophy and medicine in his youth and then spent some time in perfecting his knowledge at Parion, a city of Mysia on the Hellespont, at Athens, and probably also at Alexandria.

As a practitioner Asclepiades appears to have met with unusual success. He was well educated and possessed of agreeable manners, and was the friend as well as the physician of Cicero, one of the most polished men of whom history furnishes us any knowledge. He was also on terms of intimacy with Atticus and other eminent citizens of Rome. The possession of such friends was more than sufficient to render him one of the favored and prosperous physicians of his day in that city. As Meyer-Steineg aptly says, “he owed not a little of his success to the happy manner in which the scientist, the clever physician, and--to a slight degree--the charlatan were combined in his character.” The following anecdote which is told of him by Lucius Apuleius shows, on the one hand, that he possessed remarkably keen powers of observation, and, on the other, that there were some grounds for the charge that his behavior was at times somewhat theatrical in character:--

One day, as Asclepiades was returning to the city, from his place in the country, he observed the approach of a long funeral procession. Desiring to learn whether the deceased was a person of his acquaintance, and also in the hope of perhaps gaining other information of a professional nature, he approached as nearly as possible to the bier. The face of the corpse was anointed with sweet-smelling ointments over which spices had been sprinkled; but, notwithstanding this, he was able to detect certain signs which led him to suspect that the man might not yet be dead; and accordingly he examined the body very closely and thus satisfied himself that such was indeed the fact. Whereupon he called aloud that the man was still alive, and told the bearers to extinguish the torches, to carry away the materials for the pyre, and to remove the funeral feast from the grave to a table. Some at once objected to the carrying out of these measures and made sarcastic remarks about the healing art--probably because they were already in possession of the man’s estate, and were afraid that they might have to give it up. The more influential ones, however, insisted that the physician’s words should be heeded. Then Asclepiades, notwithstanding the opposition which was made by the relatives, succeeded in securing a brief delay, during which he had the supposed corpse removed to his own house. Restorative measures were employed, respiration was re-established, and the man was brought back to life. At the succeeding festivities unlimited praise was bestowed upon the wise physician.

Whether this tale, which I have copied from Neuburger, is true or not, it seems to fit in well with the bold and independent character of Asclepiades as it is revealed to us by the different writers of the history of medicine. In his comment upon this narrative the distinguished Viennese historian makes the remark that Asclepiades was very conceited, and--like most reformers--showed a disposition to ignore the work accomplished by his predecessors. He also expresses the belief that Asclepiades possessed a leaning toward the methods of the charlatan; the episode just narrated revealing a love for theatrical display in his professional activity. On the other hand, in the further course of the chapter which he devotes to this famous Roman physician, Neuburger gives fuller recognition to the value of the services which he rendered to medicine, and thus, in the light of these services, one is justified in overlooking any little weaknesses of character which he may have displayed. Perhaps the most important of the services which Asclepiades rendered was that of having introduced Greek medicine into Rome--an important connecting link in the transmission of medical knowledge from Greece to Modern Europe.

The Views of Asclepiades with Regard to Physiology and Pathology.--The human body, according to the philosophy of Asclepiades, is composed of atoms--that is, small bodies which are invisible, have no definable quality, are in continual motion, through mutual pressure undergo modifications in form, and break up into innumerable smaller fragments or particles that differ both in size and in shape. The arrangement of these small bodies is such that intercommunicating spaces or pores are left between them, and through these channels flows a sap or juice containing larger and smaller particles; the larger ones composed of blood, and the smaller of vapor or heat. Health, according to Asclepiades, is that state in which the primitive atoms are properly distributed or placed and the flow of the juices in the pores takes place normally. When, however, the flow is arrested and the primitive atoms are disordered in their relations to each other and to the pores, or when the elements composing the fluid contents of the latter become mixed, disease results. Alterations in the pores themselves, as contradistinguished from the fluid contained within them, may also cause disease. Farther on, when the proper time arrives for considering the sect of the Methodists, I shall have occasion to discuss this subject again, and particularly that part of it which relates to pathology. In the meantime, however, I cannot resist the impulse to say a few words about the remarkable insight possessed by Asclepiades into the manner of construction of the human body, as manifested by this very brief but very significant anatomical and physiological description. Upon a first reading one might easily get the impression that Asclepiades has reference to only one kind or system of “pores” or channels--viz., such as serve for the circulation of tissue juices alone. But, upon a closer scrutiny of the text, one finds some warrant for suspecting that he had in mind more than one system of such channels; for he states distinctly that the fluid circulating in these pores contains larger particles composed of blood and smaller ones which consist of vapor (spiritus) or heat. The question suggests itself: Could a man who had no knowledge of Harvey’s discovery, who did not possess a microscope, and who at the same time believed--as did all the ancients--that air circulated in the arteries and blood in the veins, come any nearer to the actual truth than did Asclepiades? His description needs very few alterations and additions to make it fit correctly the system of terminal arterio-venous channels known to-day as arterioles and capillaries.

Methods of Treatment Adopted by Asclepiades.--The prevailing methods of treating diseases in Rome were not approved by Asclepiades, and he lost no opportunity of giving expression to this disapproval. In the first place, he protested vigorously against the practice of prescribing on every possible occasion purgatives and remedies capable of producing vomiting. He had a decided preference for gentler measures, his idea being that a physician should cure his patients tuto, celeriter, et jucunde--safely, quickly and agreeably. Le Clerc adds that this is a fine sentiment, but that its realization in actual practice is something which most physicians find it very difficult to attain. Asclepiades condemned strongly the employment of magical remedies, a practice which was still much in use at that time in Rome, although it was already less common than it had previously been. Cato’s collection of household remedies contains a short list of some of these appeals to man’s superstition. In addition to the remedial measures mentioned above, Asclepiades placed his chief dependence on the following: abstinence from meat; the employment of wine under certain well-defined circumstances; massage and frictions; baths of different kinds (it is said that he devised a great variety); walking; driving and being carried about in the open air in a litter or in a boat on a quiet river or in the protected harbor. One of his remedies in the case of sleeplessness consisted in having the patient placed in a suspended couch which could easily be rocked from side to side. As all these measures were agreeable and could at the same time easily be employed by almost everybody, they met with general favor, and in consequence Asclepiades was looked upon by the Romans as “a person sent from heaven.” As a rule, he recommended the drinking of simple water, but in certain cases (to be mentioned farther on) he did not hesitate to advise the taking of wine in moderation. He advocated tracheotomy, in cases of inflammation of the throat, in preference to the then prevailing practice--both very painful and quite difficult to carry out--of introducing a tube of some kind as a means of opening a passage for the entrance of air into the lungs.

Le Clerc quotes Galen as authority for the statement that Asclepiades, who never hesitated for an instant to criticise the different therapeutic procedures of his predecessors, did not go so far as to condemn wholly the practice of bloodletting. Indeed, he was quite ready to employ it in the treatment of painful affections because, as he claimed, the pain was caused “by the retention of the larger particles or atoms in the pores or channels of the tissues, and hence--as these particles were composed of blood--bloodletting was the only remedy capable of setting them free.” Thus, he resorted to bleeding in pleurisy, because this affection is characterized by pain; but he abstained from employing the remedy in “peripneumonia” or “inflammation of the lung,” because in most cases it is not accompanied by pain; and he also did not approve of its employment in inflammation of the brain (phrenitis). On the other hand, he advocated bleeding in epilepsy and all forms of disease in which convulsions occurred, and he also advocated it in cases of hemorrhage of every description. Quinsy sore throat was another malady in which he drew blood freely from the veins of the arm, of the temple and even of the tongue; and in addition, when the disease was severe, he scarified the skin at suitable spots and applied cups to the part. In all these measures his purpose was “to open the pores”; and when this treatment failed he incised the tonsils or the uvula, and even, as a last resort, performed laryngotomy or tracheotomy. In cases of dropsy he employed paracentesis abdominis,--that is, he made a very small opening in the abdominal wall to serve as an outlet for the fluid contained in the peritoneal cavity. From these facts it is evident that Asclepiades did not always abide by his rule not to use any but very gentle remedies.

Asclepiades showed, in his manner of treating still other pathological conditions, how different was his practice from that of his predecessors. In the first place, he was very partial, as has already been stated, to such extremely mild forms of physical exercise in the open air as one can obtain from driving or from being carried in a litter or a boat. He prescribed these measures, not merely for convalescents but also for those, for example, who were still in the midst of an active fever. His idea was, that by means of such very gentle forms of exercise the pores would become less clogged and would permit the juices of the body to flow more freely. In cases of dropsy, also, he was in the habit of employing friction for precisely the same purpose. He even used this remedy in cases of inflammation of the brain, in the expectation that he might thereby induce sleep for these patients. Indeed, this subject of frictions was one on which Asclepiades wrote at greater length than on any other remedial agent.

It is a surprising fact that, in common with Erasistratus, he taught the doctrine that physical exercise was not at all necessary to persons in normal health. At the same time he approved of it, when carefully graded, for those who were affected with bodily ills of a certain nature.

Wine was another remedy which Asclepiades was fond of prescribing in all sorts of maladies, but his rules in regard to the manner in which it should be employed were quite different from those adopted by his contemporaries. A few illustrations will suffice to show the different conditions for which he was wont to advocate the taking of wine: He gave it, for example,--though probably much diluted with water--to patients affected with fever, but only after the stage of greatest activity had been passed. Strange as it may appear to-day, he was rather in favor of giving to patients ill with inflammation of the brain (phrenitis) wine in sufficient quantity to produce intoxication; his belief being that he could in this way induce drowsiness and eventually sleep--a thing so desirable for those affected with that disease. Further, he instructed sufferers from catarrh to drink twice or three times as much wine as they usually drank, in consequence of which instructions the patients found it necessary to dilute their wine with water to a less degree than usual--that is, to such a degree that the proportion would be one-half of each; thus showing, as Le Clerc remarks, how sober the ancients must have been when they were in perfect health. They probably--he adds--drank their wine ordinarily in the proportion of five-sixths water to one-sixth wine, or, at most, three-quarters water to one-quarter wine.

In some cases Asclepiades prescribed the drinking of wine (particularly the wine of Cos) to which sea-water had been added; his idea being that the addition of salt would enable the wine to penetrate farther into the tissues and thus open the pores more freely. This idea of added salt was not original with him, for Pliny states that in certain parts of Greece it was customary to place casks filled with new wine in the sea and to leave them there for some time. The wine, it was claimed, was rendered by this procedure mature and pleasanter to drink. They called wine thus treated “Thalassite wine” (from the Greek word “thalassa,” sea). In cases of jaundice he occasionally recommended the drinking of plain sea-water, whereby the bowels were stimulated to act more freely. Under ordinary circumstances he employed, for the relief of constipation, clysters, but he was sparing in their use.

The remedial measures enumerated above, together with dieting, are those upon which Asclepiades chiefly relied in his practice. In acute diseases he made very little use of drugs that were to be taken internally, but in maladies of a chronic character he employed them quite freely. Gargles, poultices and inunctions are mentioned among the external remedies which he often prescribed.

Further Particulars Regarding the Life and Career of Asclepiades.--Le Clerc furnishes a number of details which throw additional light upon the career of Asclepiades. During the latter’s lifetime his professional reputation was very great. Lucius Apuleius, the famous Roman satirist and rhetorician, and a contemporary of Asclepiades, calls him the Prince of Physicians, second only to Hippocrates the Great; Scribonius Largus, a Roman physician and writer, who flourished during the reigns of the Roman emperors Tiberius and Claudius (37–54 A. D.), speaks of him as a great medical author; Sextus Empiricus, a writer remarkable for his learning and acumen, who lived in the first half of the third century A. D., calls him a physician of unrivaled skill; and Celsus, who is termed the Cicero of physicians, on account of the purity of his Latin, holds him in high esteem as a medical authority. His fame as a physician had spread to Asia Minor, for we are told that Mithridates, King of Pontus, who reigned from 120 B. C. to 63 B. C., and who was a man of great ability and great energy, invited him to take up his residence at his court; but Asclepiades refused. Perhaps a still stronger evidence of his real worth as a man is to be found in the fact that he was the physician and personal friend of Cicero.

Notwithstanding these strongly favorable estimates of the ability of Asclepiades there were not a few men, and they too men of great authority, who were indisposed to give him so conspicuous a place in the temple of fame. Galen, for example, while admitting that he was a very eloquent physician, maintained that he was a sophist, given to quibbling, and disposed to contradict everybody. Caelius Aurelianus, a contemporary of Galen and the author of the most important practical treatise on Methodism that has come down to our time, appears to have held the same opinion as Galen with regard to Asclepiades. The complete disappearance of all the writings of the latter author makes it impossible for us at the present time to form an independent judgment as to the merits of these conflicting estimates of the man’s character. Galen was a great admirer of Hippocrates and it is very likely that he took offense at the failure of Asclepiades to accept all the teachings and therapeutic methods of his hero. As to the reasons which led Caelius Aurelianus to agree with the estimate made by Galen, we know absolutely nothing.

Toward the middle of the seventeenth century there was discovered at Rome, not far from the Capena gate, a portrait bust in white marble of Asclepiades. It was probably executed by a Greek sculptor residing in Rome, for, if the work had been done in Greece, the face would have been represented with a beard, as are the heads of Hippocrates, Soranus and other celebrated physicians of antiquity. The absence of the beard, furthermore, shows--according to the opinion of antiquarian experts--that the bust must have been sculptured before the time of the Emperor Claudius (41–54 A. D.), as he was the first of the Caesars to wear a beard. This bust, which is a little larger than life-size, is at present--if I am rightly informed--in the Capitoline Museum at Rome.

Asclepiades lived to a great age. In descending, one day, a flight of steps he fell and received injuries from which he died.