CHAPTER IV.

THE EARLIER ROMAN MEDICINE. Disease-Goddesses.—School of the Methodists.—Rufus and Marinus.—Pliny.—Celsus. How medical instruction was first given to the Romans cannot be ascertained with certainty; the want of it must have frequently been forced upon the attention of the authorities. It was the practice of the soldiers to dress each other’s wounds; they carried bandages with them for this purpose; but their surgery must have been very indifferent, for Livy tells us that, after the battle of Sutrium (B.C. 309), more soldiers were lost by dying of their wounds than were killed by the enemy. As the Etruscans were famous for their knowledge of philosophy and medicine, the Romans probably acquired something of these sciences from this ancient people; but that they were more apt at learning their superstitions than their arts of healing, we have proof enough. Whether the Romans were more indebted to the Etruscans or to the Sabine people for their religion is a question which has been discussed. It would seem that Numa Pompilius, the legendary king of Rome, was of Sabine origin, and that he possessed some acquaintance with physical science and philosophy. He dissuaded the Romans from idolatry. Livy’s account of his experiments, in consequence of which he was struck by lightning, has been considered by some writers as evidence that he was acquainted with electricity.[433] How intellectually inferior the ancient Romans were in comparison with the Greeks, may be learned from the fact that Pliny tells us that “The Roman people for more than 600 years were not, indeed, without medical art, but they were without physicians.” Such mental culture as the Romans possessed was imported from Greece, and until the Greeks instructed them in medicine they possessed nothing but a theurgic system of treating disease by prayers, charms, prescriptions from the Sibylline books, and the rude surgery and domestic medicine of the barbarians. Guilty of degrading superstitions unknown to the Greeks, the list of their gods and goddesses of disease reads like the accounts of the healing art from some savage nation. Fever and stench were worshipped as the goddesses Febris and Mephitis; Fessonia helped the weary, says St. Augustine,[434] and “sweet Cloacina” was invoked when the drains were out of order.[435] The itch patients invoked the goddess Scabies and the plague-stricken the goddess Angeronia; women sought the aid of Fluonia and Uterina, and Ossipaga was goddess of the navel and bones of children. There were many goddesses of midwifery; Carna presided over the abdominal viscera, and sacrifices of beans and bacon were offered to her. St. Augustine pours his satire and contempt on the women’s goddesses in the eleventh chapter of the book from which we have quoted. The Romans were cosmopolitan in the way of divinities; Isis and Serapis were imported from Egypt, the Cabiri from the Phœnicians, and the worship of Æsculapius was commenced by the Romans, B.C. 294.[436] Certain facts in the history of the Romans prove that there was a profession of medicine in Rome even in very early times. Plutarch, in his _Life of Cato the Censor_, speaks of a Roman ambassador who was sent to the king of Bithynia, and who had his skull trepanned. By the Lex Aquilia a doctor who neglected a slave after an operation was responsible if he died in consequence, and in the Twelve Tables of Numa mention is made of dental operations. A college of Æsculapius and of Health was established in Rome 154 B.C. An inscription has been discovered in the excavations of the Palatine which has preserved the memorial of its foundation.[437] The medical profession of ancient Rome was quite free, and such instruction as its followers considered it necessary to acquire could be obtained how and where they chose. There was no uniform system of education; the training was private in early times, and was imparted by such physicians as cared to take pupils for a certain specified honorarium. It was not till later times that the Archiatri in their colleges, which were somewhat on the model of the mediæval guilds, took pupils for instruction in medicine and surgery. Pure medical schools did not exist amongst the Romans.[438] Pliny complained[439] “that people believed in any one who gave himself out for a doctor, even if the falsehood directly entailed the greatest danger.” “Unfortunately there is no law which punishes doctors for ignorance, and no one takes revenge on a doctor if, through his fault, some one dies. It is permitted him by our danger to learn for the future, at our death to make experiments, and, without having to fear punishment, to set at naught the life of a human being.” Cato hated physicians, partly because they were mostly Greeks, and, partly because he was himself an outrageous quack, who thought himself equal to a whole college of physicians. Plutarch tells us[440] that he had heard of the answer which Hippocrates gave the king of Persia, when he sent for him and offered him a reward of many talents: “I will never make use of my art in favour of barbarians who are enemies of the Greeks.” He affected to believe that all Greek physicians took a similar oath, and therefore advised his son to have nothing to do with them. But there is no doubt his objection to the faculty arose from the fact that he had “himself written a little treatise in which he had set down his method of cure.” Cato’s guide to domestic medicine was good enough for the Roman people; what did they want with Greek physicians? His system of diet, according to Plutarch, was peculiar for sick persons; he did not approve of fasting, he permitted his patients to eat ducks, geese, pigeons, hares, etc., because they are a light diet suitable for sick people. Plutarch adds, that he was not in his own household a very successful practitioner, as he lost his wife and son. Pliny[441] tells us all about Cato’s book of recipes, which the Roman father of a family consulted when any of his family or domestic animals were ill. The family doctor of those days was the father or the master of the household, and no doubt Cato was a very generous, if not a very skilful practitioner. Seneca sums up the healing art of the time thus: “Medicina quondam paucarum fuit scientia herbarum quibus sisteretur fluens sanguis, vulnera coirent.”[442] Cato attempted to cure dislocations by magic songs (carmina): “Huat, hanat, ista, pista sista damniato damnaustra,” or nonsense simply. What his success in the treatment of luxations on this principle we are not informed. The practice of medicine and surgery before the time of Cæsar was not an honourable one in Rome. This may possibly have arisen from the fact that the only professors of the art were Greeks, who for the most part left their country for their country’s good and went to Rome merely to make money, honestly if possible—perhaps—but at all events to make it. Rome offered greater facilities for doing this than their native land, and the process was doubtless very similar to that with which our own colonies and the United States of America have in the past been only too familiar.[443] During the severe epidemics which often raged in ancient Rome the oracles were consulted as to the means to be adopted to be rid of them; prayers were offered up to the Greek gods of healing as well as those of the state. But Greece had done more for the art of healing by her physicians than her gods could do, and in process of time the Romans found this out, and the native doctors were compelled to yield before the advance of Greek science. The works of the Greek physicians and surgeons, who had done so much for medical knowledge and advancement, gradually made their way amongst the Romans. These paved the way for Hellenic influence, in spite of the disreputable behaviour of some of the professors of the art of medicine, on whom the Romans with good excuse looked as quacks and foreigners whose only object was gain. We read of the erection at Rome of a temple in honour of Apollo the healer, 467 B.C., and of the building of a temple to Æsculapius of Epidaurus, 460 B.C. Ten years later the Romans built a temple to the goddess _Salus_ when the pestilence raged in their city. Lucina was first worshipped there 400 B.C. In 399 B.C. the first _lectisternium_, a festival of Greek origin, was held in Rome by order of the Sybilline books; it was held on exceptional occasions, the present being a time of fresh public distress on account of a pestilence which was raging. The images of the gods were laid on a couch; a table spread with a meal was placed before them, and solemn prayers and sacrifices were offered. A third _lectisternium_ was held at Rome 362 B.C. That he might obtain a cessation of the pestilence then raging in Rome, L. Manlius Imperiorus fixed a nail in the temple of Jupiter, B.C. 360. This holding of lectisternes and driving nails in the temple walls became the recognised method of dealing with such scourges, and painfully exhibits the powerlessness of mankind to deal with disease by theurgic means. Science alone can combat disease, the bed and board offered to the gods who cannot use them are now bestowed on health officers who can; we no longer drive nails in temple walls to remind deities that we are in trouble, but we send memorials to our colleges of physicians demanding suggestions for escaping a visitation of cholera; it is not sufficient to fix “a nail in a sure place,” it must be fixed in the right one. In the year 291 B.C., on the occasion of a pestilence in Rome, ten ambassadors were sent to Epidaurus to seek aid from the temple of Æsculapius. The god was sent to the afflicted city under the figure of a serpent. He comes to our towns now under the figure of a cask of carbolic acid. ARCHAGATHUS was the first person who regularly practised medicine in Rome. He was a Peloponnesian who settled in the city B.C. 219, and was welcomed with great respect by the authorities, who purchased a surgery or shop for him at the public expense, and gave him the “Jus Quiritium.” As he treated his patients chiefly with the knife and powerful caustics, his severe remedies gave great offence to the people and brought the profession of surgery into contempt. He was called a “butcher,” and had to leave the city.[444] ALEXANDER SEVERUS (225-235 A.D.) was the first who established public lecture rooms for teachers of medicine and granted stipends to them. In return they were compelled to teach poor state-supported students gratuitously. Constantine demanded like services from the doctors in return for certain immunities.[445] There was no regular curriculum, nor period of studentship; everything depended upon the ability and industry of the individual pupil. Clinical instruction was given by the teachers, as Martial tells in a satirical verse:— “Faint was I only, Symmachus, till thou, Backed by an hundred students, throng’dst my bed; An hundred icy fingers chilled my brow: I had no fever; now I’m nearly dead!” (Dr. Handerson’s Trans.) Anatomy had been pretty thoroughly taught in the Roman Empire. RUFUS OF EPHESUS, who lived probably in the reign of Trajan, A.D. 98-117, was a very famous anatomist. He considered the spleen to be absolutely useless: a belief which lasted to quite modern times. The nerves we call recurrent were probably then only recently discovered. He proved that the nerves proceed from the brain, and divided them into those of sensation and those of motion. He considered the heart to be the seat of life, and remarked that the left ventricle is smaller and thicker than the right. He discovered the crossing (decussation) of the optic nerves, and made several important researches in the anatomy of the eye. He wrote on diseases of the mind, and discussed medicines in poetry. MARINUS, a celebrated physician and anatomist, lived in the first or second century of our era. He wrote many anatomical treatises, which Galen greatly praised, and he commented upon Hippocrates. He knew the seven cranial nerves, and discovered the inferior laryngeal nerve and the glands of the intestines. QUINTUS, Galen’s tutor, was one of his pupils. LYCUS was a pupil of Quintus, who wrote anatomical books of some reputation. PELOPS was also one of Galen’s earliest tutors, and was a famous anatomist and physician at Smyrna. ÆSCHRYON, a native of Pergamos was another of Galen’s tutors, and had a great knowledge of pharmacy and materia medica. He was the father of all those who invent superstitious remedies for the bite of a mad dog by means of cruelty. For this he directs crawfish to be caught at a time when the sun and moon were in a particular position, and to be baked alive. A worthy combination, it will be perceived, of superstition, astrology, and purposeless cruelty. Although anybody might practise medicine in Rome without let or hindrance, the Lex Cornelia ordered the arrest of the doctor if the patient died through his negligence (88 B.C.). There was a public sanitary service and other Government employments which demanded properly instructed doctors in ancient Rome, and the practice of specialism in the treatment of disease was carried to even greater lengths than at present. Martial satirises this.[446] In the time of Strabo and in that of Trajan there were public medical officers in Gaul, Asia Minor, and in Latium. In Rome there were district medical officers for every part of the city. They were permitted to engage in private practice, but were compelled to attend the poor gratuitously. Their salary, according to Puschmann,[447] was paid chiefly in articles of natural produce. The _archiatri populares_ were the district physicians. The court physicians were called _archiatri palatini_. The _archiatri municipales_ were municipal physicians. Their guild was the COLLEGIUM ARCHIATRORUM, which in constitution was not unlike our Royal College of Physicians. Different societies employed doctors; the theatres, gladiators, and the circus retained surgeons. The art of ophthalmic surgery first became a separate branch of the medical profession in the city of Alexandria. Celsus states that PHILOXENUS, who lived two hundred and seventy years before Christ, was the most celebrated of the Alexandrian oculists.[448] Oculists were a numerous but ignorant class of practitioners in ancient Rome; their treatment was almost always by salves, each eye-doctor having his own specialty. Nearly two hundred seals with the proprietors’ names have been discovered which have been attached to the pots containing the ointments. Galen speaks contemptuously of the science of the eye-doctors of his time. Martial satirises them. “Now you are a gladiator who once were an ophthalmist; you did as a doctor what you do as a gladiator.” In another epigram he says, “The blear-eyed Hylas would have paid you sixpence, O Quintus; one eye is gone, he will still pay threepence; make haste and take it, brief is your chance, when he is blind he will pay you nothing.” Under Nero, DEMOSTHENES PHILALETHES, the famous doctor of Marseilles, was a celebrated oculist, whose work on eye diseases was the chief authority on the subject until about A.D. 1000. Paulus Ægineta, in his treatise on Ophthalmology, recommends crocodile’s dung in opacity of the cornea, and bed-bugs’ and frogs’ blood in trichiasis; yet with all this absurdity he distinguished between cataract and amaurosis. The ophthalmological literature of the Greeks and Romans has for the most part perished. Puschmann says that this branch of surgery must have been able to show remarkable results. “Not only trichiasis, hypopyon, leucoma, lachrymal fistula, and other affections of the external parts of the eye were subjected to operative treatment, but even cataract itself.”[449] Although the surgeons of the time were ignorant of the true nature of some of the diseases which they treated, they could cure them. Cataract was treated by “couching,” or depressing the diseased lens by means of a needle, in order to extract it.[450] A patient would sometimes require a consultation, when several doctors would meet and discuss his case, with much difference of opinion more or less violently expressed. Regardless of the sufferings of the patient, they wrangled over his symptoms, and behaved as if they were engaged in a pugilistic encounter, each man far more anxious to exhibit his parts and display his dialectical skill than to alleviate the sufferings of the unfortunate client. Pliny, Galen, and Theodorus Priscianus have left realistic descriptions of these medical encounters. With respect to the professional income of the early Roman physicians, Pliny says[451] that Albutius, Arruntius, Calpetanus, Cassius, and Rubrius gained 250,000 sesterces per annum, equal to £1,953 2_s._ 6_d._; that Quintus Stertinius made it a favour that he was content to receive from the emperor 500,000 sesterces per annum, or £3,906 5_s._, as he might have made 600,000 sesterces, or £4,687 10_s._, by his private practice. He and his brother, also an Imperial physician, left between them at their death the sum of thirty millions of sesterces, or £234,375, notwithstanding the large sums they had spent on beautifying Naples.[452] Galen’s fee for curing the wife of the consul Boethus, after a long illness, was about equal to £400 of our money. Manlius Cornutus, according to Pliny, paid his doctor a sum amounting to £2,000 for curing him of a skin disease; and the doctors Crinas and Alcon, according to the same authority, were immensely rich men. But these were all exceptional cases, and there is no reason to suppose that Roman doctors made on the average more than sufficient to keep them decently.[453] SCHOOL OF THE METHODISTS. ASCLEPIADES, of Prusa, in Bithynia, was a physician of great celebrity and influence, who flourished at Rome in the beginning of the first century B.C. He passed his earlier years at Alexandria, then went to Athens, where he studied rhetoric and medicine. He is said to have travelled much. He ultimately settled at Rome as a rhetorician. He was the friend of Cicero. Being unsuccessful as a teacher of rhetoric, he devoted himself to medicine. He was a man of great natural ability, but he was quite ignorant of anatomy and physiology; so he decried the labours of those who studied these sciences, and violently attacked Hippocrates. His conduct was that of an early Paracelsus. He had many pupils, and the school they founded was afterwards called that of the Methodists. His system was original, though it owed somewhat to the Epicurean philosophy. He conceived the idea that disease arose in the atoms and corpuscles composing the body, by a want of harmony in their motion. Harmony was health; discord, disease. Naturally his treatment was as pleasant as that of the most fashionable modern physician. He paid great attention to diet, passive motions, frictions after the method now called massage, and the use of cold sponging. He entirely rejected the humoral pathology of Hippocrates, and totally denied his doctrine of crises, declared that the physician alone cures, nature merely supplying the opportunities. His famous motto was that the physician should cure “tuto, celeriter, ac jucunde.” In the beginning of fevers he refused his patients permission even to rinse the mouth. He originated the method of cyclical cures by adopting certain methods of treatment at definite periods. He first applied the term “phrenitis” in the sense of mental disturbance. In drugs he was a sceptic, but he allowed a liberal use of wine. He was said to have experimented in physiology, though he knew nothing of it. Tertullian ridicules him thus: “Asclepiades may investigate goats, which bleat without a heart, and drive away flies, which fly without a head.” Asclepiades must have been a great deal more than a charlatan, for many of his fundamental ideas have persisted even to the present time. He was the first to distinguish diseases into acute and chronic.[454] Acute diseases he supposed to depend “upon a constriction of the pores, or an obstruction of them by a superfluity of atoms; the chronic upon a relaxation of the pores, or a deficiency of the atoms.” Asclepiades was the inventor of many new methods in surgery and medicine. Amongst these was bronchotomy for the relief of suffocation.[455] He practised tracheotomy in angina, and scarification of the ankles in dropsy, and recommended tapping with the smallest possible wound. He also observed spontaneous dislocation of the hip joint.[456] Such things do not emanate from mere quacks. It may be remarked that there were many physicians of the name of Asclepiades. It was a way they had of assuming a connection with the famous medical family of that name. The disciples of Asclepiades were called Asclepiadists. A few of them became celebrities in their day. PHILONIDES OF DYRRACHIUM lived in the first century, and wrote some forty-five works on medicine. ANTONIUS MUSA lived at the beginning of the Christian era, and was a freedman and physician to the Emperor Augustus. When his Imperial patient was seriously ill and had been made worse by a hot regimen and treatment, Antonius cured him with cold bathing and cooling drinks. Augustus rewarded him with a royal fee and permission to wear a gold ring, and a statue was erected to him near that of Æsculapius by public subscription. He wrote several works on pharmacy. He was also physician to Horace. MUSA introduced into medicine the use of adder’s flesh in the treatment of malignant ulcers; he discovered some of the properties of lettuce, chicory, and endive. Many of his medicines continued in use for ages. For colds he used the over-potent remedies henbane, hemlock, and opium. He was also celebrated for various antidotes which he discovered.[457] His brother, named EUPHORBIUS, was a physician also, and gave his name to a genus of plants, the _Euphorbiaceæ_ (Plin., lib. xxv., c. 7). THEMISON OF LAODICEA (B.C. 50) was the founder of the school known as the Methodical. This was a rival to that of the Hippocratic system, which had hitherto been the dominant one. Themison was the most important pupil of Asclepiades. He wrote on chronic diseases, and was the first to describe elephantiasis in a treatise. He would have written upon hydrophobia, but having in his youth once seen a case, it so frightened him that he was attacked with some of the symptoms, and dreaded a relapse if he set himself to write about it.[458] He invented several famous remedies, such as diacodium, a preparation of poppies, and diagrydium, a purgative of scammony. Asclepiades had his “atoms,” Themison had his “pores.” You cannot found a medical system without flying a particular flag. Themison’s “flag” was the “status strictus,” or “laxus” of the pores; that is to say, disease is either a condition of increased or diminished tension. He was the first who described rheumatism, and probably the first European physician who used leeches.[459] He is said to have been attacked with hydrophobia, and to have recovered. Juvenal satirised him (probably) in the lines— “How many patients Themison dispatched In one short autumn!”[460] Themison’s principles differed from those of his master in many respects, and besides rectifying his errors he introduced a greater precision into his system.[461] He chose a middle way between the doctrines of the Dogmatists and Empirics. Writing of the Methodists, Celsus says: “They assert that the knowledge of no cause whatever bears the least relation to the method of cure; and that it is sufficient to observe some general symptoms of distempers; and that there are three kinds of diseases, one bound, another loose, and the third a mixture of these.”[462] Sometimes the excretions of the sick are too small, sometimes too large; one particular excretion may be in excess, another deficient; the observation of these things constitutes the art of medicine, which they defined as a certain way of proceeding, which the Greeks called _Method_. They deduced indications of treatment from analogies in symptoms, and made a bold classification of diseases; accurate as a rule in their diagnosis, they were usually successful and rational in their therapeutics. They entirely ignored any consideration of the remote causes of diseases; their only object was to cure their patients without speculating as to the reasons why they had become sick. They repudiated the _Vis medicatrix_ theory. EUDEMUS (B.C. 15) was a disciple of Themison. Cælius Aurelianus says of him that in his practice he used to order clysters of cold water for patients suffering from the iliac passion. It is probable that he was the friend and physician of Livilla, and the man who poisoned her husband Drusus. Tacitus speaks of him, saying that he made a great parade of many secret remedies, with a view to extol his own abilities as a doctor. It is possible, however, that this may not have been the same Eudemus as the disciple of Themison the Methodist, as there were several other physicians of that name. Our Eudemus made many observations on hydrophobia, and remarked how rarely any sufferer recovered who was attacked by it. He was put to death by order of Tiberius. MEGES, of Sidon (B.C. 20), was a famous surgeon, and a follower of Themison. He invented instruments used in cutting for the stone. He made observations on tumours of the breast and forward dislocations of the knee. He was regarded by Celsus as the most skilful of those who exercised the art of surgery. VECTIUS VALLENS (_circ._ A.D. 37) was a pupil of Apuleius Celsus, and was well known for his connection with Messalina, the wife of Claudius. He belonged to Themison’s sect, and is introduced by Pliny in fact as the author of an improvement upon it. It was the practice of all the adherents of the Methodist school of medicine to pretend that by the changes they had introduced into the system they had originated a new one.[463] SCRIBONIUS LARGUS (A.D. 45) is said to have been physician to Claudius, and to have accompanied him to Britain. He wrote several medical works in Latin. He was the first to prescribe the electricity of the electric ray in cases of headache.[464] A. CORNELIUS CELSUS, who flourished between B.C. 50 and A.D. 7, was a celebrated patrician Roman writer on medicine, and an encyclopædic compiler of a very high order. It is disputed whether he was or was not a physician in actual practice; probably he was not. He practised certainly, but on his friends and servants, and not professionally. The medical practice of the period was for the most part in the hands of the Greeks. We owe little to the Romans that was original or important in connection with the healing art, yet in Celsus we have an elegant and accomplished historian of the medical art as it was practised in ancient Rome; he wrote not so much for doctors as for the instruction of the world at large. His works were not studied by medical men, at any rate, as anything more than mere literature. No medical writer of the old world quotes Celsus. Pliny merely refers to him as an author. Very probably he merely compiled his treatises, of which the most celebrated is his _De Medicina_, in the introductions to the 4th and 8th books of which there is evidence of his considerable knowledge of anatomy. He seems to have understood the anatomy of the chest and the situation of the greater viscera especially well, though of course in this respect falling far short of our present knowledge of the science, and not in every case fully up to that of the Greeks. His knowledge of surgery was considerable, especially that of the pelvic organs of the female. In osteology, or the science of the bones, he excelled. He accurately describes the bones of the skull, their sutures, and the teeth. His descriptions of the vertebræ and ribs, the bones of the pelvis and the upper and lower extremities, are accurate and careful. He understood the articulations, and is careful to emphasize the fact that cartilage is always found in their formation. He must have been acquainted with the perforated plate of the ethmoid bone, as he speaks of the many minute holes in the recess of the nasal cavities, and it is even inferred by Portal that he knew the semicircular canals.[465] The 7th and 8th books of the _De re Medicina_ relate entirely to surgery; this is of course Greek, which in its turn was probably of Egyptian and Indian origin. He describes operations such as we now call “plastic,” for restoring lost or defective portions of the nose, lips, and ears. These are constantly claimed as triumphs of modern surgery, and have been asserted to have been successful as the result of information derived from experiments on living animals. His description of lithotomy is that which was anciently practised in Alexandria, and was doubtless derived from India. Trephining the skull is described, and this again is proved not to have been invented in modern times, as some have thought. Even subcutaneous urethrotomy was a practice followed in the time of Celsus. We have also the first detailed description of the amputation of an extremity. Many ophthalmic operations are described according to the methods followed by the eye specialists of Alexandria.[466] In his eight books on medicine the first four deal with internal complaints, such as usually yield to careful dieting. The fifth and sixth are concerned with external disorders, and contain many prescriptions for their treatment. The seventh and eighth, as we have seen, are exclusively surgical. Celsus followed principally Hippocrates and Asclepiades as his authorities. He transfers many passages from the Father of Medicine word for word. His favourite author was Asclepiades, and it is for that reason that he is held to be of the Methodical school of medicine. He was no believer in the mysterious numbers of the Pythagorean, and was evidently quite free from slavish devotion, even to his great authorities in medicine. He recommends that dislocations should be reduced before inflammation sets in. When fractures fail to unite, he recommends extension and rubbing together of the ends of the bone. He goes so far as to advise cutting down to the bone, and letting the fracture and wound heal together. He cautions against the use of purgatives in strangulated hernia, and gives directions for extracting foreign bodies from the ears. Had it not been for the works of Celsus, many operations of ancient surgery would have remained to us undescribed. He writes at length on bleeding, and describes the double ligation (or tying) of bleeding vessels, and the division of the vessels between the ligatures: an operation which the defenders of experiments on animals claim to have been discovered by vivisection. His method of amputation in gangrene by a single circular cut was followed down to the seventeenth century. He describes the process of catheterization, operations for goitre (or Derbyshire neck), the resection of the ribs, the use of enemas, and artificial feeding by them, an operation for cataract, ear diseases which are curable by the use of the ear syringe, extraction of teeth by forceps, fastening loose teeth by means of gold wire, and bursting hollow teeth by peppercorns pressed into them. He describes many of the most difficult subjects of operative midwifery, and discriminates in various mental diseases. Sleep must be induced, he says, in cases of insanity, by narcotics, if it is absent. He treats eye diseases with mild lotions and salves, and is the first writer to distinguish hallucinations of vision. He copies from Asclepiades his valuable rules of diet and simple methods of treatment, and from Hippocrates his methods of recognising the signs of diseases and their prognosis. (I am indebted to the great work of Dr. Hermann Baas[467] for much of the above digest of the writings of Celsus.) At the time when Celsus described the practice of medicine in Europe, bleeding was practised more freely than was the custom in the days of the great Greek physicians. The Romans went far beyond these. “It is not,” said Celsus, “a new thing to let blood from the veins, but it is new that there is scarcely any malady in which blood is not drawn. Formerly they bled young men, and women who were not pregnant, but it had not been seen till our days that children, pregnant women, and old men were bled.” And it would seem that already doctors had begun to bleed in almost every case, in every time of life, with or without reason, the unfortunate people who were under their care. They bled for high fever, when the body was flushed and the veins too full of blood; and they bled in cachexia and anæmia, when they had not enough blood, but were full of “ill humours.” They bled in pleurisy and pneumonia, and they bled in paralysis, and cases where there was severe pain. Celsus has given us a good description of the qualities which a surgeon ought to possess: he should be young, or at any rate not very old; his hand should be firm and steady, and never shake; he should be able to use his left hand with as much dexterity as his right; his sight should be acute and clear; his mind intrepid and pitiless, so that when he is engaged in doing anything to a patient, he may not hurry, nor cut less than he ought, but finish the operation just as if the cries of the patient made no impression upon him.[468] Celsus said,[469] “It is both cruel and superfluous to dissect the bodies of the living, but to dissect those of the dead is necessary for learners, for they ought to know the position and order, which dead bodies show better than a living and wounded man. But even the other things, which can only be observed in the living, practice itself will show in the cures of the wounded, a little more slowly, but somewhat more tenderly.” He wrote on history, philosophy, oratory, and jurisprudence, and this in the most admirable style. THESSALUS of Tralles (A.D. 60) was the talented son of a weaver, who became a “natural” doctor. He was an utterly ignorant, bragging charlatan, with great natural ability. Had Paracelsus received no education, he might have practised medicine as a second Thessalus of Tralles. He scorned science as much as Paracelsus loved it, but like him he abused in the most violent manner all the physicians of antiquity. He called them all bunglers, and himself the “Conqueror of Physicians” (ἰατροίκης). He declared to Nero that his predecessors had contributed nothing to the progress of the science. He flattered the great and wealthy, and vaunted his ability to teach anybody the healing art in six months. He surrounded himself with a great crowd of disciples—rope-makers, cooks, butchers, weavers, tanners, artisans of all sorts. All these he permitted to practise on his patients, and to kill them with impunity. Since his time, says Sprengel, the Roman physicians gave up the custom of visiting their patients when accompanied by their pupils.[470] He used colchicum in the treatment of gout. PHILUMENUS (about A.D. 80) was a famous writer on obstetrics, and described the appropriate treatment for the various kinds of diarrhœa. ANDROMACHUS THE ELDER (A.D. 60) of Crete was the inventor of a famous cure-all called _Theriaca_. It was compounded of some sixty drugs. He was physician to Nero, and his two works περὶ συνθεσέως φαρμάκων were greatly praised by Galen. SORANUS OF EPHESUS, the son of Menandrus, was educated at Alexandria. He practised at Rome in the reigns of Trajan and Hadrian. He was one of the most eminent physicians of the Methodical school, and was mentioned with praise by Tertullian and St. Augustine. He wrote the only complete treatise on the diseases of women which antiquity has given to us. We find from this work that a valuable instrument used in gynæcology, and thought by many to be of modern invention—the speculum—was mentioned by Soranus as used by him. Amongst the articles used by surgeons which have been recovered from the ruins of Pompeii, these instruments have been discovered, showing that they were in regular use in ancient times. He seems to have had a complete knowledge of human anatomy, for he describes the uterus in such a manner as to show that his knowledge was acquired by dissecting the human body, and not merely from that of animals. He explained the changes induced by pregnancy, and spoke of the sympathy existing between the uterus and the breasts, which is so important for the physician to know. He must have had a greater knowledge of the scourge of leprosy than his contemporaries. Soranus, in his work on gynæcology, advises that midwives should be temperate, trustworthy, not avaricious, superstitious, or liable to be induced to procure abortion for the sake of gain. They were to be instructed in dietetics, materia medica, and minor surgical manipulations. Soranus did not think it was requisite for them to know much about the anatomy of the pelvic organs, but they were to be able to undertake the operation of turning in faulty presentations. Only when all attempts to deliver a living child had failed was embryotomy to be performed. Juvenal and other writers intimate that these accomplished accoucheuses often developed into regular doctresses. In difficult cases they called in the assistance of physicians or surgeons. JULIAN (A.D. 140) was the pupil of Apollinides of Cyprus. He was at Alexandria when Galen studied there. He wrote an introduction to the study of medicine, and opposed the principles of Hippocrates. Like the greater number of the Methodists he was ill-read, and Galen blamed him for having neglected the humoral pathology.[471] CÆLIUS AURELIANUS was a celebrated Latin physician, who is supposed to have lived in Rome about the first or second century. Very little is known about him, but the fact that he belonged to the Methodical school, and showed great skill in the art of diagnosis. He wrote treatises on acute and chronic diseases, and a dialogue on the science of medicine. Next to Celsus, he is considered the greatest writer of his school. His works are based entirely on the Greek of Soranus. He was a popular writer, as is proved by the fact that in the sixth century his works were text-books on medicine in the Benedictine monasteries. He has well described gout and hydrophobia, and, according to Baas, was the inventor of condensed milk (!). Even auscultation is hinted at in his works, and he recommends the air of pine forests in chest diseases. His suggestions for the treatment of nervous and insane patients were far in advance of his age, as he disapproves of restraint.[472] GREEK AND ROMAN PHARMACY. It is very difficult to decide with certainty what the ancients actually intended by the names they gave their medicines. Exact as Hippocrates and Galen usually are in their terminology, we are often at a loss to know precisely what was the nature of the remedies they employed. Alum, for example, as we understand it, is a very different thing from the alum of the ancients. What the Greeks and Romans called _alumen_ and στυπτηρία, says Beckmann, was vitriol, or rather a kind of vitriolic earth. They were very deficient in the knowledge of saline substances. Hemlock, which is called also _Conium_, Κώνειον, or _Cicuta_, was probably not the poison employed at Athenian executions. Pliny says that the word _Cicuta_ did not indicate any particular species of plant, but was used for vegetable poisons in general. Dr. Mead[473] considers that the Athenian poison was a combination of deadly drugs; it killed without pain, and probably opium was combined with the hemlock.[474] Hellebore was of two kinds, white and black, or _Veratrum album_ and _Helleborus niger_ respectively. Galen says we are always to understand veratrum when the word Ἑλλέβορος is used alone. White hellebore was used by the Greeks, says Stillé,[475] in the treatment of chronic diseases, especially melancholy, insanity, dropsy, skin diseases, gout, tetanus, hydrophobia, tic doloureux, etc. It was mixed with other drugs to moderate the violence of its action. It fell into disuse, and is now hardly ever employed internally. It is an exceedingly dangerous drug, and was doubtless used on the “kill or cure” principle. Black hellebore was given as a purgative. Healthy people took the white variety to clear and sharpen their faculties. It fell into disuse about the fifth century after Christ. A very celebrated medicine in popular use even in modern times was _Theriaca_. Galen says that the term was properly applied to such medicines as would cure the bite of wild beasts (θηρίων), as those which were antidotes to other poisons (τοῖς δηλητηρίυις) were properly called ἀλεξιφάρμακα.[476] Andromachus, physician to the emperor Nero, invented the most celebrated of these preparations; it was known as the _Theriaca Andromachi_, and was very similar to that of Mithridates, king of Pontus, the recipe for which was said to have been found amongst his papers after his death by Pompey. This was known to the Roman physicians under the name of _Antidotum Mithridatium_. The composition of this medicine was varied greatly in the hands of its different preparers, and it underwent considerable alterations from age to age. Celsus first described it, with its thirty-six ingredients; then Andromachus added to it the flesh of vipers, and increased the number of ingredients to seventy-five. He described the whole process of manufacture in a Greek poem, which has been handed down to us by Galen. Damocrates varied some of the proportions of the compound, and wrote another poem upon it, also preserved by Galen. The medicines prescribed by the Greek and Roman physicians were all prepared by themselves. At that time materia medica consisted chiefly of herbs; some of these plants were used not only for medicinal, but also for culinary purposes, and were collected by other than practitioners of medicine. Many plants were used also for cosmetic purposes and in the baths, so that there must have been numerous collectors and dealers in herbs. Just as in our time dispensing chemists and others have acquired a certain knowledge of the medicinal virtues of the things they sell, so the _pigmentarii_, _seplasiarii_, _pharmacopolæ_, and _medicamentarii_ possessed themselves of medical secrets, and thus invaded the territory of the doctors. Beckmann says[477] that the _pigmentarii_ dealt in medicines, and sometimes sold poison by mistake. The _seplasiarii_ sold veterinary medicines and compounded drugs for physicians.[478] The _pharmacopolæ_, according to Beckmann, were an ignorant and boasting class of drug-sellers. The _medicamentarii_ seem to have been a still more worthless class, for in the Theodosian code poisoners are called medicamentarii. A great number of the medical plants mentioned by Pliny, Dioscorides, and other writers on materia medica were used for quite other purposes than those for which we employ them now. Some drugs, however, were apparently given on what we must admit to be correct scientific principles. Thus Melampus of Argos, one of the oldest Greek physicians of whom we have any knowledge, is said to have cured Iphiclus of sterility by administering rust of iron in wine for ten days. He gave black hellebore as a purgative to the daughters of Proetus when they were afflicted with melancholy. Preparations of the poppy were known to have a narcotic influence, and the uses of prussic acid—in the form of cherry laurel water—stramonium, and lettuce-opium were well understood. Squill was employed as a diuretic in dropsy by the Egyptians. The following list from the article on “Pharmaceutica” in Smith’s _Dictionary of Greek and Roman Antiquities_ contains probably the titles of all the ancient treatises on drugs that are extant: “1. Περὶ Φαρμάκων, _De Remediis Purgantibus_; 2. Περὶ Ἑλλεβορισμοῦ, _De Veratri Usu_ (these two works are found among the collection that goes under the name of Hippocrates, but are both spurious); 3. Dioscorides, Περὶ Ὕλης Ἰατρικῆς, _De Materia Medica_, in five books (one of the most valuable and celebrated medical treatises of antiquity); 4. id. Περὶ Εὐπορίστων, Ἁπλῶν τε καὶ Συνθέτων, Φαρμάκων, _De Facile Parabilibus, tam Simplicibus quam Compositis, Medicamentis_, in two books (perhaps spurious); 5. Marcellus Sideta, Ἰατρικὰ περὶ Ἰχθύων, _De Remediis ex Piscibus_; 6. Galen, Περὶ Κράσεως καὶ Δυνάμεως τῶν Ἁπλῶν Φαρμάκων, _De Simplicium Medicamentorum Temperamentis et Facultatibus_, in eleven books; 7. _id._ Περὶ Συνθέσεως Φαρμάκων τῶν κατὰ Τόπους, _De Compositione Medicamentorum secundum Locos_, in ten books; 8. _id._ Περὶ Συνθέσεως Φαρμάκων τῶν κατὰ Γένη, _De Compositione Medicamentorum secundum Genera_, in seven books; 9. _id._ Περὶ τῆς τῶν Καθαιρόντων Φαρμάκων Δυνάμεως, _De Purgantium Medicamentorum Facultate_ (perhaps spurious); 10. Oribasius, Συναγωγαὶ Ἰατρικαί, _Collecta Medicinalia_, consisting originally of seventy books, of which we possess now only about one third; 11. _id._ Εὐπόριστα, _Euporista ad Eunapium_, or _De facile Parabilibus_, in four books, of which the second contains an alphabetical list of drugs; 12. _id._ Σύνοψις, _Synopsis ad Eustathium_, an abridgment of his larger work in nine books, of which the second, third, and fourth are upon the subject of external and internal remedies; 13. Paulus Ægineta, Ἐπιτομῆς Ἰατρικῆς Βιβλία Ἕπτα, _Compendii Medici Libri Septem_, of which the last treats of medicines; 14. Joannes Actuarius, _De Medicamentorum Compositione_;