CHAPTER XIV. Well-Known Medical Authors of the Early Centuries

WELL-KNOWN MEDICAL AUTHORS OF THE EARLY CENTURIES OF THE CHRISTIAN ERA

There were four men who were not especially identified with any of the sects described in the preceding chapters, and yet who occupied, as authors of medical treatises, very prominent places in the history of medicine of the period or epoch which we have just been considering. They are Celsus, Scribonius Largus, Pliny the Elder and Dioscorides. These men lived during the first and second centuries A. D. and they therefore all belong strictly to the period which is designated in our scheme as the fourth epoch. I shall give here brief sketches of all of these writers and of their works. While Caelius Aurelianus, another important medical author, belonged to a much later period, I shall, for reasons of convenience, describe in the same chapter with the others the part which he played in the evolution of medicine.

Aulus Cornelius Celsus, called by some the Latin Hippocrates and by others the Cicero of physicians because of the correctness and elegance of his Latin and the clear manner in which he puts his thoughts into words, flourished during the reign of the Emperor Augustus (27 B. C.-14 A. D.). The date and place of his birth are not known, but it is generally believed that he was born and received his education at Rome. The great work which he wrote and upon which he must have been engaged the larger part of his lifetime was a sort of cyclopaedia, which bore the title “Artium libri,” and in which each department of knowledge was represented by a separate treatise. It is said that five books were devoted to agriculture, seven to rhetoric, eight to medicine, etc.; but all of these treatises, excepting those relating to the latter science, have been lost or destroyed. It is not certainly known to which of the professions Celsus belonged, but the very skilful and judicious manner in which he has culled all that is best from the medical treatises published before his time, the remarkable knowledge of technical details which he displays in every part of his own work, and the fine tone of medical thought which pervades these eight books, almost compel the conclusion that the author was a very clever clinician, although probably not a physician who practiced for a money reward. In no other published treatise is a more perfect picture of the medical practice of antiquity to be found than that which Celsus gives us in his work “De arte medica libri octo.”

It is not an easy matter to select, from a treatise of several hundred pages in length, one or two passages of such a character that they may be accepted as fairly representing the author’s manner of dealing with medical and surgical questions of practical interest. The two given below are translations from Védrènes’ version (Paris, 1876), and they deal, the one with venesection and the other with the proper manner of arresting hemorrhage from a wound. Both the passages quoted represent only fragments, as sufficient space for more extensive extracts is not available.

Book II., Chapter X.--Bloodletting from a Vein.--Incising a vein for the purpose of drawing blood from it, is not a new procedure; but it is certainly a new thing to resort to bloodletting in almost all diseases. Again, it is an ancient custom to employ bloodletting in young subjects and in women who are not pregnant, but it is a new thing to perform this operation on infants and aged individuals, and on women approaching the period of confinement. It was the idea of the ancients that persons at the two extremes of life were not able to support this sort of treatment, and they were convinced that a pregnant woman, if subjected to the operation of bloodletting, would almost surely be confined before the completion of her time. Since then, however, experience has shown that there is no fixed rule about this matter, and that a physician should preferably regulate his course in accordance with observations of a different nature. The determining factor, for instance, is neither the age nor the pregnant state of the patient, but rather the degree of physical strength. In the case of a youth who is feeble, or of a delicate woman (aside from the question of pregnancy), it would be wrong to draw blood, for it would be robbing them of what little strength they possessed. But, in the case of a vigorous child, a robust old man, or a pregnant woman who is in good health, one need not hesitate to resort to this procedure. Nevertheless, there may arise, in connection with the operation of venesection, a number of questions which are quite likely to puzzle an inexperienced physician and perhaps lead him into error. For example, infants and old people possess as a rule diminished vigor, and the woman who is about to be confined needs all her strength for the period following delivery, both for herself and for the nourishing of the child. But the mere fact that one must give some thought to questions of this nature and must exercise prudence does not justify the immediate rejection of a method of treatment like that of venesection. For is it not the very essence of our art, not merely to consider the factors of age and the pregnant state, but also to form an estimate of that other and more important factor, viz., the patient’s strength,--be that patient an infant, an aged person, or a woman advanced in pregnancy,--and then to decide whether it is, or is not, great enough to bear the loss of blood? In deciding a question of this kind it will be necessary to distinguish between real vigor and obesity, between thinness and feebleness, etc.

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Venesection is an easy operation for a physician who has already familiarized himself with the manner of performing it, but for one who is ignorant of these details it may prove very difficult. It is necessary, for example, to bear in mind that the artery and vein are united and that they are accompanied by nerves; and, further, that the injuring of the latter will induce spasms and violent pains. On the other hand, it must also not be forgotten that an artery once opened has no disposition to close, nor does it heal, and that sometimes the blood escapes in an impetuous manner. If, perchance, the vein is cut transversely, the edges of the opening contract and no more blood escapes. Again, if the scalpel is plunged into the parts timidly, the skin alone will be divided and the vein will not be opened. In some cases this vessel is so hidden from sight that the physician may experience difficulty in bringing it into view. Thus it will be seen that there are several circumstances which may render this operation difficult for an ignorant or inexperienced physician. The vein should be incised in a longitudinal direction, midway between its two sides. The moment the blood gushes from the opening its color and general appearance should be carefully noted, etc.

Book V., Chapter XXVI.--The Proper Manner of Arresting Hemorrhage from a Wound.--If there is fear that there may be bleeding, one should fill the wound with dry lint, place over it a sponge wrung out of cold water, and press upon it with the hand. If the bleeding still continues, it is advisable to change the stuffing of lint somewhat frequently; and, if this step proves ineffective, then lint moistened with vinegar may be tried, for this liquid acts energetically in arresting hemorrhage. Some physicians, indeed, actually pour it into the wound. There is a strong objection, however, to the use of an agent which, like vinegar, arrests the bleeding too completely--viz., that it is apt to set up afterwards an intense inflammation of the parts. The same reasoning applies with even greater force to the employment of corrosives and caustics, which produce an eschar. Despite the effectiveness of most of these in arresting hemorrhage, their use should be discouraged.... Finally, if the bleeding continues it will be necessary to grasp the vessel from which the blood is escaping, to ligature it in two places close to the wound, and then to divide the vessel between the two ligatures, in order that it may retract (both of the new orifices having already been closed by the ligatures). If the circumstances are such that the plan just recommended cannot be carried out, it will then be advisable to apply the red-hot cautery to the bleeding vessel. When a rather free hemorrhage occurs at a part of the body where there are no nerve trunks and no muscles,--as on the forehead or at the top of the head,--the simplest plan is to apply a cup at some little distance from the source of the bleeding and thus divert the current of the blood from the spot affected.

And to these two longer extracts may be added a third:--

From these considerations the inference is warranted that a physician cannot possibly give proper attention to a large number of patients. (Book III., Chapter IV.)

Celsus’ treatise was ignored by physicians for many centuries, but it was considered by the monks, in the Middle Ages, a valuable guide in the treatment of disease; and it was probably owing to this circumstance, says Védrènes, that the book did not altogether disappear. It was not until the year 1443 that Thomas de Sazanne, afterward Pope Nicholas V., discovered a copy of the work in the church of Saint Ambrosius, at Milan, but it was only in 1478 that the book was printed for the first time (at Florence). Then, as if to make up for the long neglect to which it had been subjected, no fewer than sixty Latin editions were issued during the two succeeding centuries; and, in addition, it was eventually translated into every modern European language.

Scribonius Largus, a Roman physician who lived during the reigns of Tiberius and Claudius (14–54 A. D.), owes his celebrity to the fact that he wrote and published (in 47 A. D.) a book containing a collection of the best medical formulae and popular recipes known at that time. He appears to have had a large private practice and to have spent a considerable portion of his professional life in the service of the army. He accompanied the Emperor Claudius, for example, in his campaign against Britain (43 A. D.), and the book which he wrote, and which has just been mentioned, was dedicated by him to that emperor. According to Neuburger, Scribonius is to be credited with having been the first to describe correctly the proper manner of obtaining the drug known as opium, and also the first to recommend, in the treatment of severe headaches, the employment of electric shocks as communicated by the fish called the “electric ray.”

Medical practice at that period, says Le Clerc, was divided among three kinds of practitioners--those who treated their cases exclusively by dietetic measures, those who effected cures by surgical means, and those who took charge only of such patients as required chiefly the employment of external remedies. But Scribonius Largus insists that such a division was more theoretical than real, as no one of these classes could get along without the cooperation of the others.

C. Plinius Secundus, commonly called Pliny the Elder, was born near the beginning of the first century of the Christian era, either at Verona or at Como in the north of Italy, and settled in Rome at an early period of his life. At the beginning of his career he served for some time in the army in Germany, and upon his return to Rome practiced as a pleader. Subsequently he held various official positions which gave him the opportunity of visiting other countries of Europe. He perished at Stabiae (near the modern Castellamare, on the Gulf of Naples) in 79 A. D., at the age of fifty-six years, while watching the eruption of Vesuvius, which overwhelmed Herculaneum and Pompeii. He was in command of the Roman fleet at the time.

Pliny was indefatigable as a writer and as a gatherer of knowledge of all sorts, and he and Celsus are well named the Encyclopaedists. He is said to have written twenty books on the war with the Germans, an unknown number on rhetoric and grammar, and thirty-seven on natural history. The latter books alone have come down to our time. Pliny’s nephew, who is known as Pliny the Younger, and who edited the great work of his uncle on natural history, furnishes us, in a letter addressed to the historian Tacitus, with some interesting details regarding the elder Pliny’s manner of life. It appears from this account, that the latter read almost incessantly. During his meals and while he was taking his bath, an attendant read aloud to him. He also took his books with him on his travels and was always accompanied by a person who could write rapidly under dictation. He continued this practice upon his return to Rome and dictated to his amanuensis even while he was being carried about in a sedan chair. Books 20–27 of his great work on natural history are devoted to the subject of remedial agents belonging to the vegetable kingdom, books 28–32 deal with those which belong to the animal kingdom, and books 33–37 treat of mineralogy with special reference to medicine, painting and sculpture. Pliny was a compiler and not an original investigator. Some idea of the popularity of his treatise on natural history may be gathered from the fact that it was the second book to be printed after the invention of printing, the Bible being the first. Another interesting fact connected with Pliny’s treatise is mentioned by Neuburger, viz., that the use of hyoscyamus and belladonna as agents capable of dilating the pupils, owed its origin to the discovery (by C. Himly, in 1800) of a place in the text (Book XXV., 92) where it is stated that the juice of the plant Anagallis was rubbed into the eyes before the operation for cataract was undertaken.

According to Pliny (Book XXXI., Chapter VI.), the ancients employed mineral waters extensively in the form of baths, and they also occasionally used them as internal remedies. Galen, too, mentions the fact that these waters were in demand in the spring or autumn for purgative purposes.

In Book XXXIX., 8, 3, Pliny--as quoted by Védrènes--makes the following remarks:--

Very few Romans have shown an active interest in medical affairs, and those few speedily found it necessary to pass themselves off as Greeks. For it is a well-known fact that those physicians who, without being able to speak Greek, attempted to build up a practice in Rome, failed to gain the confidence of their patients, even of those who were not at all familiar with that language.... When one’s health is the question at issue the readiness to place confidence in a medical adviser is apt to diminish in proportion as one’s knowledge of the man increases. Indeed, medicine is the only art in which one is quite ready at first to put faith in almost anybody who calls himself a physician, and that too, despite the acknowledged fact that in no other circumstances of life is an imposture more fraught with danger.

English versions of Pliny’s Natural History and of Pliny the Younger’s Letters have been published in what is known as Bohn’s Libraries.

Pedanius Dioscorides, a native of Anazarba, a small Greek town near Tarsus in Cilicia, lived about the middle of the first century A. D. (during the reigns of Nero and Vespasian). From his earliest youth he took a great interest in botany, and, after reaching manhood, traveled extensively in the wake of different Roman armies, for the sole purpose of studying by direct observation the plants of different countries and of verifying the medicinal virtues which each one was reputed to possess. In this way he visited, in turn, Greece, Italy, Asia Minor and perhaps also the southern portion of France (the Narbonaise). He collected great quantities of specimens of every kind of drug--animal and mineral substances as well as objects belonging to the vegetable kingdom; and, wherever it was possible to do so, he wrote memoranda of the traditions of the natives with regard to the uses and medicinal effects of these different drugs. After he had completed all these researches and had gathered together all this vast mass of materials, he wrote his famous treatise on materia medica--“the most complete, the best considered, and the most useful work of its kind to be found anywhere to-day.” (Galen.) It is from this treatise, therefore, says Dezeimeris, that one can derive the most satisfactory idea of the early Greek materia medica; but at the same time, he adds, it is not a book in which will be found a detailed account of the manner in which the practitioners of that period employed the remedies which he describes. The same authority calls attention to the great difficulty which modern physicians often experience in their attempts to identify the drugs which Dioscorides describes. Le Clerc calls attention to the fact that the physicians who were contemporaries of Dioscorides were not in the habit of employing either iron or antimony (called by them stibium) internally. Apparently they had not yet learned that these substances possess properties which exert a curative action in certain diseases. On the other hand, he mentions the manner of extracting quicksilver, by chemical means, from cinnabar [red sulphide of mercury], the steps required for preparing acetate of lead, and the proper way of making lime water.

The work to which reference has been made above was published by Dioscorides about the year 77 A. D. It is the earliest pharmacological treatise that has come down to our time, and for many succeeding centuries it served as the authoritative guide in all questions relating to drugs. The first printed edition of the Greek original appeared in Venice in 1499, but a still earlier Latin version was issued in 1478. According to Pagel the best edition (in Latin and fully illustrated) is that of Pietro Andrea Mattioli, which was printed in Venice in 1554. Neuburger commends highly the German version by J. Berendes. (Stuttgart, 1902.)

Of Caelius Aurelianus we possess no biographical details beyond the facts that he was a native of Sicca in Numidia, Africa, and that he lived toward the end of the fourth or during the first part of the fifth century of the present era. He was the author of several works, all but one of which, however, have been lost. The single treatise which has come down to our time treats of acute and chronic diseases, and is spoken of by Daremberg as being virtually a translation of one of the lost writings of Soranus. This book, says Haeser in his History of Medicine, is the most important source from which our knowledge of Methodism is derived; and Neuburger not only agrees with this statement, but adds that the treatise of Caelius Aurelianus played a most important part, toward the end of the Middle Ages, in the evolution of medicine. Up to the present time no translation of this work into any modern language has been published, but Neuburger furnishes a very full analysis of its important parts. In two places, as appears from this analysis, Caelius Aurelianus mentions--among the signs and symptoms of certain affections of the respiratory apparatus--phenomena which show beyond a doubt that he (or Soranus) was familiar with auscultation of the chest. The words which he uses are these:--

“Stridor vel sonitus interius resonans aut sibilans in ea parte quae patitur,” and “sibilatus vehemens atque asper in ultimo etiam pectoris resonans stridor.”