CHAPTER XIII. The Further History of Methodism At Rome, and the Development

THE FURTHER HISTORY OF METHODISM AT ROME, AND THE DEVELOPMENT OF TWO NEW SECTS, VIZ., THE PNEUMATISTS AND THE ECLECTICS.--A GENERAL SURVEY OF THE SUBJECT OF SECTS IN MEDICINE

Among the Methodists there were many physicians who attained more or less distinction during their professional career, but only two of them, beside those whose contributions to medical knowledge have already been mentioned in these pages, gained sufficient celebrity to justify me in devoting some additional space to the description of the work which they accomplished. Soranus, of Ephesus on the coast of Asia Minor, and Caelius Aurelianus, of Sicca in the north of Africa, are the physicians to whom I have reference.

It was Soranus, says Le Clerc, who gave the finishing touches to the system of the Methodists, and the work which he did was of such excellence that he may with justice be called the ablest and most skilful of all the members of that school. Caelius calls him “a chief among the leaders of our sect.” He received his medical training at Alexandria and came to Rome about the year 100 A. D. His professional career covered the period corresponding to the reigns of Trajan and Hadrian (98–138 A. D.). He is known to posterity chiefly through his two treatises--one on obstetrics and gynaecology and the other on acute and chronic diseases. The first of these treatises, in the original Greek, was rediscovered in 1838 by Reinhold Dietz, Professor of Medicine in the University of Königsberg, Prussia, and a German translation of the work (by Lüneberg and Huber) was published in Munich in 1894. Moschion, who was probably a pupil of Soranus, wrote a popular treatise on the same subject for the use of midwives, and in this book he has reproduced much of the material which is to be found in the work of his master. The treatise written by Caelius Aurelianus on acute and chronic diseases is admitted by him to be founded on that which Soranus wrote on the same subject. In fact, as Daremberg states, the work of the former represents almost a translation (into Latin) of Soranus’ treatise. The sources just named are the principal ones from which our knowledge of this author is derived.

Soranus was a prolific writer; the treatises which he wrote and which deal with a great variety of subjects, number thirty in all. The majority of these works, however, have been lost. He had many followers and his influence upon medical science was very great, not simply during his lifetime, but also for several centuries after his death. He commanded the respect and confidence of the opponents of Methodism as well as of the members of his own sect. One of his most pronounced traits of character was his readiness to condemn, on every possible occasion, superstitious practices, such as the employment of amulets, magnets, etc. He was also a very persistent and earnest advocate of the gentler and more rational obstetric methods. For example, he disapproved of the reckless employment of remedies for hastening the expulsion of the foetus, of the practice of succussion (which was carried out by the aid of a ladder), of making the pregnant woman run up and down stairs, of a resort to rough mechanical procedures for extracting the placenta, etc. The following quotation from one of Soranus’ treatises (Gynaeciorum, Lib. I., cap. 19) reveals clearly what sort of a man and physician he was:--

There is a disagreement; for some reject destructive practices, calling to witness Hippocrates, who says, “I will give nothing whatever destructive” and deeming it the special province of medicine to guard and preserve what nature generates. Another party maintains the same view, but makes this distinction, viz.: that the fruit of conception is not to be destroyed at will because of adultery or of care for beauty, but is to be destroyed to avert danger impending at parturition, if the uterus be small and cannot subserve the perfecting of the fruit, or have hard swellings and cracks at its mouth, or if some similar condition prevail. This party says the same thing about preventing conception, and with it I agree.

(Translated from the Greek by the late John G. Curtis, M.D., of New York.)

Soranus was not only a great obstetrician,--admitted by all the authorities to have been the greatest in ancient times,--he was also in high repute for the work which he did in other departments of medicine--in gynaecology, for example, in the instruction of midwives, in the management of children’s diseases, in the diagnosis and treatment of both acute and chronic diseases, in surgery, etc. While in general he adhered to the fundamental teachings of the Methodists, he did not hesitate to depart from the beaten pathway of that sect in his explanations of certain pathological conditions; for he was more of a clinical observer than a sectarian, and it was probably his independent manner of thinking that gave the sect new vigor and thus enabled it to live on through such a long period of time. Galen, who was not at all disposed to speak favorably of the Methodists, says that he tried a number of the remedies recommended by Soranus and found them good.

Caelius Aurelianus probably flourished during the third century A. D. The different authorities, however, do not agree as to the limits of the period during which he lived; some saying that his career antedated that of Galen, while others claim that he came upon the scene after the death of the latter, which occurred early in the third century A. D. His chief merit appears to have been that, through his translation of the writings of Soranus into Latin, he placed within reach of the physicians of Rome the teachings of that admirable diagnostician and therapeutist; for it must be remembered that the great majority of the Roman medical men were not able to read Greek. On the other hand, Caelius Aurelianus, who was himself a thoroughly practical physician, deserves considerable credit for having enriched the text of his book with many very appropriate examples (chiefly with regard to questions of diagnosis) drawn from his own personal experience, which must have been extensive. During the Middle Ages, as we are informed by Friedlaender, this work furnished the chief source from which the monks derived their knowledge about diseases and their proper treatment. The Latin in which the book is written is described by nearly all the authorities as barbaric.

The Pneumatists.--Methodism had been established only a very few years when Athenaeus of Attalia, a city on the coast of Pamphylia, Asia Minor, founded (about 50 A. D.) a new sect--that of “Pneumatism.” He was not the discoverer of the “pneuma” or “vital spirit,” for that had already been admitted by the earlier schools of philosophy as a fifth primary creative element, supplementary to the four well-known substances--fire, air, earth and water. He believed that heat, cold, moisture and dryness (the primary qualities of these four bodies) were not the veritable elements of living beings. Heat and cold, he maintained, were “efficient causes” and moisture and dryness “material causes.” To these he added “spirit” as a fifth element; and he taught that this spirit enters into the formation of all bodies and preserves them in what may be termed their natural state. It was from the Stoics, more particularly, that Athenaeus borrowed this belief, and it was the latter fact, as Le Clerc says, which led Galen to speak of Chrysippus--one of the most famous of the Stoics--as “the Father of the Sect of the Pneumatists.”

In his application of the doctrine of Pneumatism to the science of medicine, Athenaeus maintained that the majority of diseases owed their origin to some disturbance or disorder of the spirit; but it is almost impossible to understand, from the scanty data which have come down to us, what Athenaeus really meant by the term “spirit,” and by the expression “disorder of the spirit.”

From the definition which he gives of the word “pulse” one is justified in drawing the conclusion that he considered the spirit to be an actual substance, capable of undergoing, to a greater or less degree, such changes as expansion and contraction. The same obscurity of meaning is encountered when one endeavors to discover how the new doctrine affected the practice of medicine. (Le Clerc.)

In view of all these circumstances it is not at all surprising that Pneumatism was not very popular with the physicians of Rome, and that, after a brief period had elapsed, many of the adherents of this doctrine abandoned it and gave their preference to the more practical teachings of the Methodists. Meyer-Steineg goes so far as to remark that, to all intents and purposes, such a thing as a sect of Pneumatists did not exist.

The most prominent of the disciples of Athenaeus were Theodorus, Agathinus, Herodotus, Magnus and Archigenes.

Haller speaks of Theodorus as the inventor of a remedy which, as he claimed, cures all cases of poisoning.

The Eclectics.--Agathinus, a native of Sparta, was the teacher of Herodotus and Archigenes. His chief distinction is to be found in the fact that he gave to the offshoot from the school of the Pneumatists the name of “Eclectics,” his object being, as we are assured by Neuburger, to bring the three sects (Pneumatists, Empirics and Methodists) into closer union.

Herodotus--who, it is perhaps desirable to state, is a different person from the famous historical writer of the same name--lived during the latter part of the first century A. D., and was more closely allied to the Methodists than to the Pneumatists. It appears from the text of a fragment of one of his treatises that he wrote a description of the disease now called small-pox and directed attention to its contagious character.

Magnus, a native of Ephesus in Asia Minor, is reported to have been the writer of a collection of letters on medical topics and also of a history of the discoveries made in medicine subsequently to the time of Themison.

Archigenes, the fifth member of this group of Pneumatists, was born in Apamea, Syria, and lived in Rome under the reigns of Trajan (98–117 A. D.) and Hadrian (117–138 A. D.). Le Clerc speaks of him as belonging to the Eclectics rather than to the Pneumatists. This is a matter, however, of small importance, as the sects were, at that period, very much mixed. The poet Juvenal, who was a contemporary of Archigenes, refers to him briefly as a physician who had a large practice; and the historian Suidas says that he wrote a great deal about physics as well as about medicine. That he was esteemed highly as an authority in practical surgery is shown by the fact that Galen, when he discusses surgical topics, makes frequent quotations from the writings of Archigenes. Only fragments of the latter, however, have come down to our time. His popularity as a practitioner was very great; notwithstanding which he managed to write several treatises on a variety of topics--on the pulse, on feverish diseases, on the different types of fevers, on local affections, on the diagnosis and treatment of acute and chronic maladies, on the right moment when surgical operations should be performed, on drugs, and on therapeutic procedures in general. He applied ligatures to blood-vessels and also arrested further bleeding from them by passing needles through the adjacent parts in such a manner as to exert pressure upon the vessel (a procedure which is termed “acupressure”); he operated for the removal of both mammary and uterine cancers; he employed the red-hot cautery iron for the arrest of hemorrhage and also for the relief of coxalgia, and he was familiar with the use of the vaginal speculum.

Antyllus, another prominent surgeon of that period, joined the Methodists at a considerably later date. He was also the author of an excellent treatise on surgery, the greater part of which, unfortunately, has been lost or destroyed.

Aretaeus of Cappadocia, a district of Asia Minor, lived during the second century A. D. He was a man of very broad culture. From the fact that he assigned an important rôle to the pneuma, he is usually classed among the Pneumatists. He does not appear, however, to have taken a very active interest in the doctrines of that school, and both Le Clerc and Daremberg seem disposed to call him an Eclectic, and we may therefore rank him as one of the independent physicians of that period. It is doubtful whether he ever practiced in Rome. His two treatises--one on the causes and means of identifying acute and chronic diseases, and the other on the treatment of these diseases--are written in Greek, and are characterized by the clearness and simplicity of his descriptions, which very closely resemble those of Hippocrates, and by the soundness of the advice which he gives in regard to the methods of treatment. In his conceptions of what a physician should aim to be, Aretaeus maintained a very high standard. Some of his views regarding human physiology and pathology are given here very briefly: Respiration serves the purpose of cooling the warmth of the heart, and the lungs are therefore prompted by the latter organ to draw cool air into their cavities; digestion takes place not only in the stomach but also in the intestinal canal, and owes its origin to warmth; the cerebral nerves, close to the spot from which they originate, cross from one side to the other, and by the aid of this fact paralysis on one side of the body may be explained. Aretaeus has gained considerable fame, says Puschmann, from his description of the “Syriac ulcer,” the picture of which he draws agreeing perfectly with what is known to-day as pharyngeal diphtheria. In various places throughout his writings he displays a thorough knowledge of normal anatomy--as, for example, when he describes the ramifications of the vena portae and gall-ducts of the liver. He was also well informed in matters belonging to the domain of pathology, for he gives admirable descriptions of many of the diseases--for example, pleurisy with empyema, pneumonia, pulmonary consumption, cerebral apoplexy, paraplegia, tetanus, epilepsy, diabetes mellitus, gout, etc. From the character of these descriptions one is strongly tempted to believe that he must have made a certain number of postmortem examinations.

According to Neuburger, Aretaeus enters very fully into details when he discusses the subject of diagnosis; his statements in one place warranting the belief that he even auscultated the heart. His methods of treatment were based largely upon his own experience and were generally of a simple character. He attached great importance, for example, to a very careful regulation of the diet, muscular exercise, massage, etc., and his employment of remedies was confined to a very small number of such drugs as exert a mild action. When the case, however, was of such a character as to call for more vigorous interference, he did not hesitate to resort to the use of opium, emetics, cathartics, venesection, blistering, the red-hot cautery iron, etc.

Rufus, a native of Ephesus, a city of Asia Minor, about thirty-five miles from Smyrna, is reckoned by most authorities among the Eclectics; in other words, he was an independent, or one who adopted from the teachings of the different sects such doctrines as met with his approval, but who, at the same time, did not care to pose as the disciple of any one of them. He received his medical training at Alexandria, but it is not known where he practiced his profession. Almost no details concerning his life or his professional career have come down to our time. It is simply known that he flourished during the reign of the Emperor Trajan (98–117 A. D.). Ebn Ali, an Arabian physician and author, says that he was the leading medical authority of his time and that his works were highly esteemed by Galen. His treatise on anatomy (entitled “The Names of the Different Parts of the Human Body”), which is one of the few that have escaped destruction, is described as a treatise which was written for students, and which possesses great value for the history of anatomical nomenclature. The same authority says that Rufus was the first to describe the chiasma, that he came very near establishing the existence of two different kinds of nerves--motor and sensory--and that he attributed the control of all bodily functions to the nervous system. He also states that he was one of the first to furnish a description of the oriental bubonic plague. Some idea of Rufus’ style of writing may be gathered from the following quotations which have been taken from his short treatise entitled “The Questioning of Patients”:--

It is necessary to question the patient, for by so doing one may gather more exact information concerning the nature of the malady, and will then be able to treat it more intelligently. In this way also one may learn whether the patient’s mind is in a normal or an excited state, and whether any change has taken place in his physical strength. Some idea regarding the nature and seat of the disease is usually obtained from such questioning. If, for example, the patient answers clearly and to the point, and does not hesitate; if his memory does not play him false; if his speech is not thick or indistinct; if, being a well-bred man, he gives his responses in a polite and cultivated manner; or if, in the case of a person who is naturally timid, the answers reflect this timidity, then you may feel confident that your patient’s mind is not affected. But if, on the other hand, you ask him about one thing and he gives you a reply about something entirely different; if, as he talks, he appears to forget what he was talking about; if he has a trembling tongue the movements of which are also uncertain; and, finally, if from a certain state of mind he passes rapidly to one of a totally different character,--all these changes are evidences that the brain is beginning to be affected.... If the patient speaks distinctly and with a fairly strong voice, and is able to tell his story without stopping from time to time in order to rest, the inference is warranted that his physical strength is not materially affected....

The following quotation is from his treatise on gout:--

If the patient complains that one of his joints is painful, he should be asked whether or not the part has received a blow. If he replies that it has not, then (you may infer that the pain is due to gout and) you should forthwith put him on a suitable diet, order a clyster and bleed him at a spot not far (from the seat of the pain).... The withdrawal of nourishment is ordered for the purpose of arresting any further formation of new blood and thus preventing the joints from growing more sluggish in their movements. The clyster is ordered because we believe that it is beneficial (in this condition) to evacuate the bowels. The bleeding will be found useful, but to a less degree in the lower than in the upper limbs.... One must be careful not to assume that the patient is cured when he has been entirely relieved of his pain, because with the lapse of time fresh attacks are liable to occur; this disease, like certain other affections, possesses a periodic character.... Therefore it is well, immediately after the bloodletting, to employ friction, to get rid of the excess of moisture in the body by some laborious form of exercise, to take such articles of food as are easily digested,--in brief, to aim chiefly at reducing as much as possible the moisture of the body.

One cannot but feel a keen regret that so few of the writings of this thoroughly practical and highly educated physician should have come down to our time. So far as I am able to learn, Rufus wrote no fewer than 102 treatises, all of which, with the exception of the seven about to be mentioned (together with a number of fragments preserved by different writers of antiquity) have either disappeared or been destroyed. The titles of the treatises which have been preserved are as follows: (1) Diseases of the Kidneys and Bladder; (2) On Satyriasis and Gonorrhoea; (3) Purgatives; (4) The Names of the Different Parts of the Human Body; (5) On the Questioning of Patients; (6) On the Pulse; (7) On Gout.

A General Survey of the Subject of Sects in Medicine.--During the sixth century B. C.,--that is, about two hundred years before the formation of the more distinctly medical sects of which mention was made in Chapter IX.,--Pythagoras of Samos and his disciples put forward certain beliefs or doctrines with regard to the mode of action of some of the functions or vital processes of the human body, and all those who accepted these teachings as affording a true and satisfactory explanation of the phenomena in question constituted what is generally termed a school or sect. Some of these individuals were physicians--that is, men who undertook to cure or at least to relieve those who were ill; but probably the majority were simply philosophers, mere “lovers of wisdom,” who by studying problems of this nature sought to satisfy their longing for a more perfect knowledge of the truth respecting the various phenomena of life.

A few years later, Heraclitus of Ephesus, who, like Pythagoras, was both a philosopher and a practicing physician, taught the doctrine that all things owe their origin to fire. One is not at all surprised to learn that he had relatively few followers, for history tells us that he was both a misanthrope and a slanderer of the medical profession, as shown by the following saying which is attributed to him: “Next to physicians the grammarians are the biggest fools in the world.”

Hippocrates attached much importance to the value of experience and to the necessity of studying disease at the bedside; at the same time he upheld what is commonly known by the name of humoral pathology--a doctrine which refers all maladies to some abnormal change in the humors or fluid portions of the body. His writings also show that he made full use of the reasoning power. The followers of this great physician did not form a sect in the ordinary sense of the term; they were his adherents simply because he was an able diagnostician, a successful teacher, an excellent therapeutist, a skilful surgeon, a man of very high moral character,--in short, a great physician. Every sect which developed in the centuries following his death contained a goodly proportion of Hippocratists.

Nearly two centuries after the active period of the professional life of Hippocrates, Erasistratus and Herophilus gathered about themselves in Alexandria (about 280 B. C.) large groups of followers, who held for their respective teachers a degree of esteem which amounted, according to Galen, almost to veneration. As there was little or no antagonism or lack of harmony between the doctrines taught by these physicians, the two groups cannot properly be classified among the sects. In fact, it would be more correct to say that Erasistratus and Herophilus contributed facts of permanent value to our stock of knowledge rather than doctrines which might prove highly popular for a few scores of years, but which would probably in due course of time be set aside as no longer of value.

The four most characteristic types of sects in medicine were the following: the Dogmatists--or Rationalists, as Daremberg calls them in one place; their great rivals, the Empirics; the Methodists; and the Eclectics. The oldest sect, the Dogmatists, did not come into prominence until after the medical schools at Alexandria had already been in operation for a long time. The development of the rival sect of the Empirics at this late period brought with it endless discussions regarding the merits of their respective teachings, and thus both of them gained a degree of prominence which seems to us moderns to have been out of all proportion to the importance of the subject-matters discussed. The Dogmatists, says one writer, insisted that it is just as necessary to be acquainted with the “hidden causes” of disease as with those which are plainly recognizable, and that it is only by aid of the reasoning power that we gain some knowledge of this class of causes. They claimed that, while a knowledge of anatomy is of very great service to the surgeon, it usually renders this service through the aid of the reasoning power; as when, in the performance of a lithotomy, the operator selects the fleshy (i.e., vascular) neck of the bladder as the spot in which to make the opening with the knife, in preference to the base of the organ, which is chiefly membranous in structure and therefore less likely to heal solidly.

The plausible but rather shallow response made by the Empirics to the arguments advanced by their rivals consisted in quoting certain maxims, as, for example: “The farmer and the helmsman do not acquire knowledge of their respective occupations from discussions, but from actual practice”; “It is not of vital importance to know what are the causes of the different diseases, but what remedies are competent to cure them”; and “Diseases are not cured by eloquence, but by remedial agents.”

Among the comments made by Celsus with regard to the differences which distinguished the Dogmatists from the Empirics we find the following statement: “The two sects employed the same remedies and pursued very much the same course of treatment, but their reasonings about such matters were different.”

Modern physicians will, at first thought, be disposed to wonder how men as clever as many of these physicians were could have split up into separate and more or less antagonistic sects because of such apparently trivial differences of opinion. It must be remembered, however, that these men were groping in comparative darkness whenever they tried to advance their knowledge of pathology, and that in this imperfect light many things seemed of much greater importance than they appeared to be in the brighter light of later centuries. It is only fair, therefore, to withhold criticism and to ask ourselves whether this strong desire on the part of those men to advance their knowledge of pathology--a desire which manifested itself in the formation of sects--was not in reality an evidence of the great vitality of Greek medicine on Roman soil in those early centuries.

The remarks made above with regard to the Dogmatists and the Empirics apply in a general manner to the sects known as the Methodists and the Eclectics, a sufficiently full account of which has been given in the preceding chapter.