CHAPTER XII. The State of Medicine At Rome After the Death of Asclepiades;

THE STATE OF MEDICINE AT ROME AFTER THE DEATH OF ASCLEPIADES; THE FOUNDING OF THE SCHOOL OF THE METHODISTS

In summing up the effects which were produced by the teaching and practice of Asclepiades upon the science and art of medicine, Dr. Meyer-Steineg makes the remark that the wide and ready acceptance of both depended largely upon the personal character of the man, upon the manner in which he carried out the measures which he advocated, and upon the fact that the Romans happened at that period of their history to be ready to respond favorably to such new doctrines and therapeutic methods; but that, as soon as his strong personality had ceased to exert its influence, as it did after he had passed the active period of his life, and also because Rome did not at that moment possess any physicians who were sufficiently endowed with his medical gifts and sagacity to perpetuate his art, both it and his doctrines began to lose ground. Nevertheless, as this writer states, Asclepiades had already succeeded admirably in preparing the way for a further development of the healing art, and for this valuable service full credit should be given him.

Not long after the death of Asclepiades, Antonius Musa, the personal physician of the Emperor Augustus, succeeded, by means of hydrotherapy, in curing his royal patient of a protracted gouty or rheumatic affection from which he had been a sufferer; and, as a mark of gratitude for the cure which he had effected, the Emperor raised him to the rank of a noble (about the year 10 A. D.), erected a statue in his honor in the temple of Aesculapius, and at the same time issued a decree that from that time forward the physicians who practiced in Rome should be exempted from taxation and from certain other civic burdens. These privileges, which were afterward confirmed by Vespasian (70–79 A. D.) and also by Antoninus Pius (138–161 A. D.), were of great advantage to the medical profession as a whole. Julius Caesar (100–44 B. C.), it will be remembered, had already (about half a century earlier) bestowed Roman Citizenship upon the physicians who practiced their profession in that city. Thus, at the time of which we are now speaking, the medical men of Rome occupied the enviable position of being on an equality with their fellow citizens of the better class, a position which made it attractive for young men of ability and of good social standing to enter the profession.

Among the numerous followers of Asclepiades the most distinguished was undoubtedly Themison of Laodicea, a city of Phrygia, Asia Minor, who flourished about the middle of the first century B. C. When he was well advanced in years he wrote a medical treatise in which he developed a system of pathology and therapeutics that was accepted as the professional creed of the sect known as “Methodists.” Starting from the doctrine of pores and primitive atoms taught by Asclepiades, he laid great stress upon the idea that in disease all the alterations which take place in the tissues may be classed in one or the other of these two categories--a relaxation (laxum) or a contraction (strictum) of the parts. To these two categories, which the Methodists termed “communities,” and which were the only ones at first accepted as a part of their creed, a third was soon added, viz., that condition in which both relaxed and contracted states appear side by side, although not necessarily both of them developed to the same degree; and to this third category or “community” they applied the term “mixtum.” The ideas which are here stated in a somewhat crude and imperfect manner owing to my lack of knowledge of all the facts, constitute the basis of the pathology of the “Methodists”--a pathology which held its own in the domain of medicine during a period of four hundred years, and which--in contradistinction to the humoral pathology of Hippocrates--is justly entitled to the name of “solidist pathology.” This doctrine, as might be expected, underwent certain modifications during this long period of time, but they were not serious enough to alter materially the fundamental form of the teaching as it has here been described.

Themison and his followers, like their distinguished predecessor, Asclepiades, possessed something more than a mere glimmering of the truth in pathology as we know it to-day; and this idea suggests the further thought that Morgagni, Rokitansky, Lebert, Virchow and perhaps others whose names do not now occur to me, could scarcely have developed a better pathology if they had lived during these first centuries of the Christian era--a period of time when public sentiment did not permit postmortem examinations, when Harvey’s discovery was not even dreamed of, when the microscope was unknown, and when experimental pathology was an impossibility. Many centuries had still to elapse before medicine could gain that freedom of action, that rich equipment of tools, and that stock of accumulated knowledge which enable her in these days to make such giant strides forward as we have witnessed during the past twenty or thirty years.

The question will naturally arise, How did the Methodists decide, in the presence of an actual case of illness, which one of these abnormal states (the laxum, the strictum, or the mixtum) was the condition that called for medical treatment? The answer which they gave to this question was, that the condition of the different secretions and the dejections furnished the principal indication as to what particular part or organ of the body was ailing, and also as to what was the nature of the morbid change or process that produced the malady. When, for example, the secretion from an organ or part was excessive, they inferred that the pores of such a part were relaxed and distended, thus permitting an increased flow; and when the secretion was less than it should be, they decided that the pores were contracted. The status mixtus had reference to those cases in which a condition of relaxation was observed in one part of the body, while that of contraction was noted in another.

Neuburger mentions the fact that the Methodists were somewhat arbitrary in their classification of the different diseases, most of the acute maladies being placed by them under the heading Status strictus, while they assigned the majority of the chronic affections to the category of Status laxus.

The effect of the tendency of the Methodists to classify and simplify all the departments of medicine was not wholly beneficial. It conveyed to many the impression that medicine might readily be learned in the course of a few months, and thus offered the temptation to inferior men to choose the career of physician; and yet, on the other hand, it infused into the art the essentially Roman characteristics of orderliness, simplicity and efficiency. Anatomy, for example, was studied only so far as a knowledge of this department of medicine was necessary to render the physician familiar with the location, general character and relations of the different organs. There was one field, however, in which the adherents of this school displayed a high degree of excellence, viz., in their descriptions of disease; and this is especially true of those written by Caelius Aurelianus (fourth century A. D.), whose manner of handling the subject of differential diagnosis is far more thorough and satisfactory than that of any of the medical authors who preceded him.

In their treatment of disease, the Methodists were largely guided by the principle of contraria contrariis,--i.e., in those cases in which, to the best of their belief, a status laxus existed, they administered astringents, in the hope of thereby bringing the parts back more nearly to a contracted condition; and, vice versa, when the diagnosis of status strictus was made, they gave a relaxing medicine. The terms “laxatives” and “astringents,” which are still applied to many drugs, were originated by the Methodists. Bloodletting, for example, was one of the remedies which they used for producing relaxation, and an astringent was employed when a contrary effect was desired. In the list of relaxing remedial agents (aside from bloodletting) were placed the following: warm baths, poultices, inunctions with warm oil, vapor baths, fasting and a restricted diet, diuretics (very carefully watched and employed only in exceptional cases), emetics, diaphoretics and laxatives. The following agents, on the other hand, were classed as contracting, astringent and tonic remedies: washing with cold water, cold baths, the application of cloths dipped in cold water, living in cold air, strengthening diet, wine, vinegar, alum, narcotics, etc. Themison, it should be added, is the first one among the ancient writers to mention the use of leeches as a means of extracting blood. It does not follow from this, however, that he was the discoverer of this method of local bloodletting; for it is highly probable that this procedure had been in common use for many years previous to his time.

Themison, as I have before stated, was an old man when he laid the foundations for Methodism, and it is not probable that it attained much importance as a sect until several years after his death. Then Thessalus, a native of Tralles, a flourishing commercial city of Asia Minor, and a man who had received his medical training in one of the Greek schools, materially added to the body of doctrines held by this sect, and at the same time rendered them more acceptable to physicians generally. He was of humble birth, the son of a wool carder, and his education had been rather neglected; but he nevertheless managed, by his own efforts and in no small degree by the unlimited self-confidence (Galen calls it impudence) which he possessed, to push his way to the top of the ladder. He acquired a large fortune during the reign of Nero (54–68 A. D.) and apparently succeeded in persuading this monarch that he was a great physician. Here are some facts which appear to justify Galen’s dislike for Thessalus: In a letter to Nero the latter writes: “I have founded a new medical sect, the only genuine one in existence. I was forced to do so because the physicians who preceded me had failed to discover anything that is likely to promote health or to drive away disease; even Hippocrates himself having laid down doctrines which are positively harmful.” His vanity, according to Le Clerc, reached such a pitch that he called himself the “conqueror of physicians.” Pliny corroborates the latter statement in the following words: “When he assumed the title of ‘conqueror of physicians,’ a title which was engraved, according to his instructions, on his tomb in the Appian Way.” Notwithstanding his unbounded conceit, Thessalus appears to have made several important improvements in the doctrines of the Methodists. He is also, as it appears, entitled to the credit of having been the first to inaugurate the practice of giving systematic instruction at the bedside; thus establishing for all time a most valuable precedent for the guidance of his successors.

“He was an excellent practitioner and an original thinker.... He was also a prolific writer, as is shown by the number and variety of treatises which--as we are assured by Caelius Aurelianus--were composed by him.” The same authority speaks of him as “a leader among our chiefs,” thus affording good evidence of the degree of esteem in which he was held by the members of his own school. The fact that pupils came in throngs to be taught by him shows clearly how thoroughly he understood the needs of the physicians of Rome. (Meyer-Steineg.)

Thessalus, notwithstanding his declaration that medicine might readily be taught in six months, wrote a larger number of treatises on professional topics than any student of medicine could possibly read and digest in the course of two or three years. They filled several large volumes, but not one of them is known to exist to-day. He wrote at great length, as we are assured, on the subject of surgery, a subject in which he took an active interest. He taught that ulcers, no matter in what part of the body they may be located, require the same kind of treatment.

If an ulcer is excavated, it is necessary to bring about a filling-up of the excavation; if its surface is on a level with the surrounding skin, the aim should be to make it cicatrize; if the growth of new tissue is excessive, the redundant portion should be destroyed by burning with caustic; and, finally, if the ulcer is of recent development and bleeds readily, the attempt should be made, by approximating the edges, to effect an immediate healing.

In the treatment of chronic ulcers which show little or no disposition to heal, and which, when they do finally heal, are very prone to break open afresh, Thessalus urges the great importance of ascertaining, if possible, the cause or causes of this behavior. If it be found that the trouble is due to some weakness or abnormal predisposition of the part in which the ulcer is located, or that the condition of the entire body is probably the real cause of the trouble, he recommends the employment of “metasyncritic remedies”--that is, remedial measures which effect a marked change in the individual’s vital processes throughout the body, and also such as exert an alterative effect upon the ulcer itself. Among the measures of the first class he enumerates the following: Various forms of physical exercise; alternately increasing and diminishing the amount of nourishment taken; and perhaps the taking of an emetic at the very commencement of the treatment. As to the second class of measures--those needed to bring about a change in the ulcer itself--he makes the following recommendations: Remove from the diseased tissues as much as will restore the parts, as nearly as possible, to the condition of a healthy wound, and then adopt the treatment suited for the latter condition. In cases in which the ulcer heals and then subsequently breaks open again, it will sometimes be found beneficial to apply in the neighborhood a plaster containing an irritating substance like mustard, the effect of which is often to change the disposition of the parts. In actual practice he recommends that the local measures should be employed first, and then, if they fail to accomplish the desired purpose, the physician should have recourse to those enumerated in the first class--the strictly metasyncritic remedies.

It is rather difficult to believe that a man so full of conceit and so unjust in his criticisms of his predecessors as Thessalus clearly was, could be capable of formulating such a concise statement of the nature of chronic ulcers and such a practical rule for their proper treatment. His development of the idea of “metasyncrisis”--or renovation of the body (recorporatio), as Caelius Aurelianus translates the word--seems to have been original with Thessalus. The Methodists, it should be added, deserve special credit for having been the first to introduce and carry into effect the systematic treatment of chronic diseases; and, as a general proposition, it may be said that their treatment of all forms of disease was thoroughly practical, free from all tendency to resort to magical methods, and based largely on the employment of such hygienic measures as the use of baths of different kinds (hydrotherapy), massage, moderate outdoor exercise, passive movements, sea voyages, fasting, regulation of the diet, etc. One of the favorite practices--of which Thessalus was said to have been the originator--was to begin the treatment of almost all maladies by prescribing an abstinence from all food for a period of three full days. When I come to speak of Soranus and Caelius Aurelianus I shall probably have occasion to give further details regarding the methods of treatment employed by the Methodists.

As a system, says Neuburger, Methodism was not capable of inaugurating any fundamental advances in medicine; the most that it was able to accomplish was to broaden and otherwise improve the domain of therapeutics, and some of its wiser members were diligent in collecting and sifting critically a large number of valuable experiences, which were then courteously registered by them to the credit of the sect.