Roman Medicine
The Roman cannot be said to have at any time originated or possessed an independent school or medicine. They had from early times a very complicated system of superstitious medicine, or religion, related to disease and the cure of disease, borrowed, as is thought, from the Etruscans; and, though the saying of Pliny that the Roman people got on for six hundred years without doctors was doubtless an exaggeration, and not, literally speaking, exact, it must be accepted for the broad truth which it contains. When a medical profession appears, it is, so far as we are able to trace it, as an importation from Greece.
The first Greek physician whose name is preserved as having migrated to Tome was Archagathus, who came over from the Peloponnesus in 218 B.C.; but there were probably others before him. When Greece was made Roman province, the number of such physicians who sought their fortunes in Rome must have been very large. The bitter words of M. Porcius Cato, who dislikes them as he did other representatives of Greek culture, are evidence of this. The most eminent of these earlier Greek physicians at Rome was Asclepiades, the friend of Cicero (born 124 B.C. at Prusa in Bithynia). He came to Rome as a young man, and soon became distinguished both for his medical skill and his oratorical power. He introduced a system, which, so far as we know, was his own, though founded upon the Epicurean philosophical creed; on the practical side it conformed pretty closely to the Stoic rule of life, thus adapting itself to the leanings of the better stamp of Romans in the later times of the republic. According to Asclepiades all diseases depended upon alterations in the size, number, arrangement, or movement of the "atoms," of which, according to the doctrine of Epicurus, the body consisted. These atoms were united into passages (poroi [Gk.]) through which the juices of the body were conveyed. This doctrine, of which the developments need not further be followed, was important chiefly in so far that it was perfectly distinct from, and opposed to, the humoral pathology of Hippocrates. In the treatment disease Asclepiades attached most importance to diet, exercise, passive movements or frictions, and the external use of cold water, -- in short, to a modified athletic training. He rejected the vis mediatrix naturae, pointing out that nature in many cases not only help but married the cure. His knowledge of disease and surgical skill were, as appeared from the accounts given by Celsus and Coelius Aurelianus, very considerable. Asclepiades had many pupils, who adhered more or less closely to his doctrines, but it was especially one of them. Themison, who gave permanence to the teachings of his master by framing out of them, with some modifications, a new system of medical doctrine, and founding on this basis a school which lasted for some centuries in successful rivalry with the Hippocratic tradition, which, as we have seen, was up to that time the prevailing influence in medicine.
This system was known as Methodism, its adherents as the methodists or Methodists. Its main principles were that it was useless to consider the causes of a disease, or even the organ affected by the disease, and that it was sufficient to know what was common to all diseases, viz., their common qualities (communitates [Lat.], koinotetes [Gk.]). Of these there were three possible forms – (1) relaxation, (2) contraction of the minute passages or poroi [Gk.], and (3) a mixed state, partly lax, partly constricted. The signs of these morbid states were to be found in the general constitution of the body, especially in the excretions. Besides this it was important only to consider whether it was increasing, declining, or stationary. Treatment of disease was directed not to any special organ, nor to producing the crises and critical discharges of the Hippocratic school, but to correcting the morbid common condition or "community," relaxing the body if it was constricted, casing contraction if it was too lax, and in the "mixed state" acting according to the predominant condition. This simple rule of treatment was the system or "method" from which the school took its name.
The Methodists agreed with the empirics in one point, in their contempt for anatomy; but, strictly speaking, they were dogmatists, though with a dogma different from that of the Hippocratic school. Besides Themison, its systematic founder, the school boasted many physicians eminent in their day, among whom Thessalus of Tralles, a half-educated and boastful pretender, was one of the most popular. He reversed the Hippocratic maxim "art is long," promising his scholars to teach them the whole of medicine in six months, and had inscribed upon his tomb iatronikes [Gk.], as being superior to all living and bygone physicians.
In the 2nd century a much greater name appears among the Methodists, that of Soranus of Ephesus, a physician mentioned with praise even by Tertullian and Augustine, who practiced at Rome in the reigns of Trajan and Hadrian. Soranus is known by a work, still extant in the Greek original, on the diseases of women, and also by the Latin work of Coelius Aurelianus, three centuries later on acute and chronic diseases, which is based upon, if not, as some think, an actual translation of, the chief work of Soranus, and which is the principal source of our knowledge of the methodic school. The work on diseases of women is the only complete work on that subject which has come down to us from antiquity, and shows remarkable fullness of practical knowledge in relation to its subject.
It is notable that an important instrument of research, the speculum, which has been reinvented in modern times, was used by Soranus; and specimens of still earlier date, was showing great mechanical perfection, have been found among the ruins of Pompeii. The work on acute and chronic diseases is also full of practical knowledge, but penetrated with the theories of the methodists.
The methodic school lasted certainly for some centuries, and influenced the revival of medical science in the Middle Ages, though overshadowed by the greater reputation of Galen. It was the first definite product of Greek medicine on Roman soil, but was destined to be followed by others, which kept up a more or less successful rivalry with it, and with the Hippocratic tradition.
The so-called pneumatic school was founded by Athenaeus, in the 1st century after Christ, According to its doctrines the normal as well as diseased action of the body were to be referred to the operation of the pneuma or universal soul. This doctrine, crudely transferred from philosophical speculation, was intended to reconcile the humoral (or Hippocratic) and solidest (or methodic) schools; but the Methodists seem to have claimed Athenaeus as one of themselves.
The conflicts of the opposing schools, and the obvious deficiencies of each, led many physicians to try and combine the valuable parts of each system, and to call themselves eclectics. Among these were found many of the most eminent physicians of Graeco-Roman times. It may be sufficient to name Rufus of Ephesus, and Archigenes, who is mentioned by Juvenal.
Although no system or important doctrine of medicine was originated by the Roman intellect, and though the practice of the profession was probably almost entirely in the hands of the Greeks, the most complete picture which we have of medical thought and activity in Roman times is due to a Latin pen, and to one who was, in all probability, not a physician. A. Cornelius Celsus, a Roman patrician, who lived probably in the first century, appears to have studied medicine as a branch of general knowledge. Whether he was a practicing physician or not has been a matter of controversy. The conclusion supported by most evidence seems to be that he practised on his friends and dependents, but not as a remunerative profession. His well-known work, De Medicina, was one of a series of treatises intended to embrace all knowledge proper for a man of the world. It was not meant for the physicians, and was certainly little read by them, as Celsus is quoted by no medical writer, and when referred to by Pliny is spoken of as an author, not a physician. There is no doubt that his work is chiefly a compilation; and Daremberg, with other scholars, has traces a large number of passages of the Latin text to the Greek originals from which they were translated. In the description of surgical operations the vagueness of the language seems sometimes to show that the author had not performed such himself; but in other parts, and especially in his historical introduction, he speaks with more confidence; and everywhere he compares and criticizes with learning and judgment. The whole body of medical literature belonging to the Hippocratic and Alexandrian times is ably summarized, and a knowledge of the state of medical science up to and during the times of the author is thus conveyed to us which can be obtained from no other source. The work of Celsus is thus for us only second in importance to the Hippocratic writings and the works of Galen; but it is valuable rather as apart of the history of medicine than as the subject of that history. It forms no link in the general chain of medical tradition, for the simple reason that the influence of Celsus (putting aside a few scanty allusions in mediaeval times) commenced in the 15th century, when his works were first discovered in manuscript or committed to the press. Since then, however, he has been almost up to our own times the most popular and widely-read of all medical classics, partly for the qualities already indicated, partly because he was one of the few of those classics accessible to readers of Latin, and partly also because of the purity and classical perfection of his language.
Of Pliny, another encyclopaedic writer, a few words must be said, though he was not a physician. In his Natural History we dins as complete a summary of the popular medicine of his time as Celsus gives of the scientific medicine. Pliny disliked doctors, and lost no opportunity of depreciating regular medicine; nevertheless he has left many quotations from, and many details about, medical authors which are of the highest value. He is useful to us for what he wrote about the history of medicine, not for what he contributed. Like Celsus, he had little influence on succeeding medical literature or practice.
We now come to the writer who, above all others gathered up into himself the divergent and scattered threads of ancient medicine, and out of whom again the grater part of modern European medicine has flowed. Galen (see vol. i. 803 and c. 23) was a man furnished with all the anatomical, medical, and philosophical knowledge of his time; he had studied all kinds of natural curiosities, and has stood in near relation to important political events; he possesses enormous industry, great practical sagacity, and unbounded literary fluency. He had, in fact, every quality necessary for an encyclopaedic writer, or even for a literary and professional autocrat. He found the medical profession of his time split up into a number of sects, medical science confounded under a multitude of dogmatic systems, the social status and moral integrity of physicians degraded. He appears to have made it his object to reform these evils, to reconcile scientific acquirements and practical skill, to bring back the unity of medicine as it has been understood of Hippocrates, and at the same time to raise the dignity of medical practitioners.
Galen was as devoted to anatomical and, so far as then understood, physiological research as to practical medicine. He worked enthusiastically at dissection, though, the liberty of the Alexandrian schools no longer existing, he could dissect only animals, not the human body. In his anatomical studies Galen had a twofold objects, -- a philosophical, to show the wisdom of the Creator in making everything fit to serve its purpose, and a practical, to aid the diagnosis, or recognition of disease. The first led him into a teleological system so minute and overstrained as to defeat its own end; the second was successfully attained by giving greater precision and certainly to medical and surgical practice in difficult cases. His general physiology was essentially founded upon the Hippocratic theory of the four elements, with which he combined the notion of spirit (pneuma) penetrating all parts, and mingled with the humours in different proportions. It was on this field that he most vehemently attacked the prevailing atomistic and materialistic views of the methodic school, and his conception of the pneuma became in some respects half metaphysical. His own researches in special branches of physiology were important, but do not strictly belong to our present subject.
The application of physiology to the explanation of diseases, and thus to practice, was chiefly by the theory of the temperaments or mixtures which Galen founded upon the Hippocratic doctrine of humours, but developed with marvelous and fatal ingenuity. The normal condition or temperament of the body depended upon a proper mixture or proportion of the four elements – hot, cold, wet and dry. From faulty proportions of the same arose the intemperies ("distempers"), which, though not diseases, were the occasions of disease. Equal importance attached to faulty mixtures or dyscrasiae of the blood. By a combination of these morbid predispositions with the action of deleterious influences from without all diseases were produced. Galen showed extreme ingenuity in explaining all symptoms and all diseases on his system. No phenomenon was without a name, no problem without a solution. And, though it was precisely in his fine-spun subtlety that he departed farthest from scientific method and practical utility, it was this very quality which seems in the end to have secured his popularity and established his eminence in the medical world.
Galen’s use of drugs was influenced largely by the same theories. In drugs were to be recognized the same elementary qualities—hot, cold, moist, dry, &c., -- as in the human body; and, on the principle of curing by contraries, the use of one or other was indicated. The writings of Galen contain less of simple objective observation than those of several other ancient physicians, all being swept into the current of dogmatic exposition. But there is enough to show the thoroughness and extent of his practical knowledge. Unfortunately it was neither this nor his zeal for research that chiefly won him followers, but the completeness of his theoretical explanations, which fell in with the mental habits of succeeding centuries, and were such as have flattered the intellectual indolence of all ages. But the reputation of Galen grew slowly; he does not appear to have enjoyed any pre-eminence over other physicians of his time, to most whom he was strongly opposed in opinion. In the next generation he began to be esteemed only as a philosopher; gradually his system was implicitly accepted, and it enjoyed a great though not exclusive predominance till the fall of Roman civilization. When the Arabs possessed themselves of the scattered remains of Greek culture, the works of Galen were more highly esteemed than any others except those of Aristotle. Through the Arabs the Galenical system found its way back again to Western Europe. Even when Arabian medicine gave way before the direct teaching of the Greek authors rescued form neglect, the authority of Galen was increased instead of being diminished; and he assumed a position of autocracy in medical science which was only slowly undermined by the growth of modern science in the 17th and 18th centuries.
But the history of medicine in Roman times is by no means the same thing as the history of the fate of the works of Galen. For some centuries the methodic school was popular at Rome, and produced one physician, Coelius Aurelianus, who must be pronounced, next to Celsus, the most considerable of the Latin medical writers. His date was in all probability the end of the 4th or beginning of the 5th century. The works bearing his name are, as has been said, entirely based upon the Greek of Soranus, but are important both because their Greek originals are lost, and because they are evidence of the state of medical practice in his own time. The popularity of Coelius is evidence by the fact that in the 6th century an abridgment of his larger work was recommended by Cassiodorus to the Benedictine monks for the study of medicine.
Before quitting this period the name of Aretaeus of Cappadocia must be mentioned. So little is known about him that even his date cannot be fixed more closely than as being between the second half of the 1st century and the beginning of the 3d. His works have been much admired for the purity of the Greek style, and his accurate descriptions of disease; but, as he quotes no medical author, and is quoted by none before Alexander of Aphrodisias at the beginning of the 3d century, it is clear that he belonged to no school and founded none, and thus his position in the chain of medical tradition is quite uncertain. Alexander of Aphrodisias, who lived and wrote at Athens in the time of Septimius Severus, is best known by his commentaries on Aristotle, but also wrote a treatise on fevers, still extant.
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