mmm THE MEDICAL PROFESSION ANCIENT TIMES. AN ANNIVERSARY DISCOURSE DELIVERED BEFORE THE ' NEW YORK ACADEMY OF MEDICINE, NOVEMBER 7. 18S5, J O H% WATSON, M . D SURGEON TO THE NEAV YORK HOSPITAL. [published by order of the academy.] ♦ NEW YORK: PRINTED FOR THE ACADEMY BY BAKER & GODWIN, CORNER NASSAU AND SPRUCE STREETS. 1856 Entered according to Act of Congress, in the year 1856, by JOHN WATSON, M. D., J In the Clerk's Office of the District Court for the Southern District of New York. "^ ^ ^^ K Libraiy SI PREFACE In the preparation of tlie following discourse, I liave endeavored to trace tlie origin and progress of medicine among tlie ancients in as succinct a manner as possible consistent with perspicuity ; and at the same time to omit nothing of importance or interest in relation to the subject. Though small, the work is the result of no incon- siderable research ; much of which might have been spared, had I been disposed to rely simply on the historians. But as my investigations were under- taken for my own gratification, I have, as far as leisure and opportunity would permit, drawn the facts and opinions here embodied, from the earliest authorities. But while resorting to the ancients, I am not indisposed to acknowledge the assistance I have received from modern and recent writers. With- out the learned researches of Le Clerc, Freind, Schulze, and Sprengel, much that has since ap- peared on the history of medicine might never IV PREFACE. have seen the light. The works of these authors, as well as of Barchusen, Gcelicke, Hamilton, and Renouard ; the '' Bibliotheca Scriptorum Medicor- um" of Mangetus, the seven volumes of Bio- graphie Medicale from the " Dictionnaire des Sci- ences Medicales ;" the able articles on medical history by Bostock in the " Cyclopaedia of Practical Medi- cine," and by Bage Delorme in the " Dictionnaire de Medecine," not to speak of the medical articles in the several dictionaries of classical biography, — I have consulted on all occasions. My researches have been further expedited by Stanley's, Tennemann's, and Bitter's Histories of Philosophy, by Taylor's account of the Ancient Mysteries, by Mosheim's Ecclesiastical History, Therwell's Greece, Gibbon's Decline and Fall of the Boman Empire, Sharpe's History of Egypt, Guizot's Cours d'Histoire, and by the Oxford Tables of Chronology. The recent translations from the Greek classics published by Mr. Bohn and others, I have put under extensive contribution, particularly the works of Herodotus, Thucydides, Xenophon, Plato, Aristotle, Diogenes Laertius, Plu- tarch, Athenseus, and the writings of the emperor Julian, as well as the ecclesiastical histories of Eusebius, Socrates, Theodoret, and Evagrius. The medical writers of antiquity, from Hippo- crates to Paulus ^gineta, with one or two insignifi- PREFACE ;ant exceptions, so far as they have yet appeared in print, as well as the other works of reference al- ready mentioned, I have in my own library. From these ancient writers, and their respective commen- tators, I have drawn without restraint. Among the commentators to whom I am most indebted are, Ackermann, in Kuhn's editions of Hippocrates and Galen ; M. Littre, in his recent and elaborate Intro- duction to his French version of Hippocrates ; Mr. Adams, in his English versions of Hippocrates and Paulus JEgineta; Greive, in his introduction to Celsus ; Conrad Amman, in his preface to Cselius Aurelianus ; the numerous commentators whose names are associated with the " Medicinse Artis Prin- cipes post Hippocratem et Galenum," published under the auspices of Henric. Stephanus ; and Coc- cius, in the " Grsecorum Chirurgici Libri e collectione Nicetse." Much also bearing upon the profession I have drawn from Aristotle's treatise '' De Animali- bus ; " from Vitruvius' " De Architectura-;" from the agricultural treatises of Cato, Varro, Columella, and Palladius; from the " Mulo-medicina" of Vegetius; from AjDicius, " De Opsoniis ;" and from the writ- ings of the elder Pliny. For all that relates to the laws and usages of the Koman Empire in regard to the profession, I have drawn from the " Corpus Juris Civilis " of Justinian, 1 VI PREFACE. excepting one or two enactments from the Theodo- sian Code whicli I have taken on other authority. Led on by the attractive nature of the study, I have extended my researches beyond the period of Greek and Eoman antiquity ; and have on hand the materials for a somewhat similar account of the pro- fession among the Arabs of the East and West, among the Byzantine and Latin schools, and the monastic medical institutions of the middle ages ; which I hope on some favorable occasion also to pre- sent to the New York Academy of Medicine, to whom the present work is most respectfully in- scribed. TABLE OF CONTENTS. PAGE Preface, ....... 1 Introductory Remarks, .... 9 CHAPTER I. THE CONDITION OF MEDICINE IN THE EARLIEST ORGANIZATIONS OF SOCIETY. Nations in which the art of medicine was unknown as a distinct occupation, . . . . , 12 The first practitioner of Rome, . . . .13 The Druids of Europe, . . . . . 13 The Vaidhyas of India, ^ . . . . .14 The Lamas of Central Asia, , . . . . 14 The Tla-quill-aughs of Anierica, . . . .15 The Priests of Egypt, . . . . . 16 CHAPTER II. THE ORIGIN OF MEDICINE AMONG THE GREEKS. 1. The Gymnasia and their course of Education, . .18 2. The Schools of Philosophy, .... 20 The School of Pythagoras at Crotona, . . .20 Democedes of Crotona, . . . . 21 The Academy and Lyceum, . . . .22 3. The Temples of ^sculapius, their usages, rules, and symbols, 25 JEsculapius and his descendants, . . .29 Other Medical Divinities, .... 30 Vlll CONTENTS. PAOB 4. The Periodeutae or Itinerant Practitioners, . . 30 Progress of the Profession in Greece, before the age of Pericles, 33 CHAPTER III. THE ASCLEPIAD^. Their modes of Initiation similar to those of the other Mys- teries or Secret Associations of Greece, . . 34 The Eleusinian, Dionjsian, and other Mysteries, . . 35 Their three degrees or stages of Advancement similar to those of the early universities of Europe, ... 36 Course of Training among the Asclepiadse, . . .36 The Ceremony of Coronation, . . . . 39 The Medical Acquirements of the Asclepiadse, . . 40 Herodicus of Selymbria, .... 41 The Policy and Ethics of the Asclepiadse, . . .42 Their Social Rank, ..... 44 CHAPTER IV. HIPPOCRATES AND HIS IMMEDIATE SUCCESSORS. Personal History of Hippocrates, . . . .45 The Hippocratic Writings, .... 48 The Doctrines of Hippocrates and of his followers, . . 52 The Schools of Cos and Coidos, .... 5*7 The Plague of Athens, . . . . .61 The Anatomical and Physiological \news of Aristotle, . 66 The Last of the Asclepions of Cos and Cnidos, . . 12 CHAPTER V. PERGAMUS AND ALEXANDRIA. The Asclepion and Library of Pergamus, . . '74 The Founding and Institutions of Alexandria, . . '74 CONTENTS. IX PAGB The Temple of Serapis, its Library, . . . 16 The Museum ; its organization and courses of Instruction ; its Faculties, . . . . . .11 The Use of Papyrus and of Parchment, . . . 82 Early Libraries, . . . . . . 83 CHAPTER VI. THE SCHOOL OF MEDICINE AT ALEXANDRIA. Herophilus, Dissections of the Human Body, . .84 Erasistratus, . . . . . . 85 Writers on Dietetics, Pharmacy, and Surgery, . .81 The Business of Teaching not confined to the Museum, . 89 Devices of the Priests of Serapis, . . . .89 The Teaching of Medicine at Alexandria, after the period of Herophilus and Erasistratus, . . . 91 The Rationalists, the Empirics, and other sects, . .91 CHAPTER VII. The Schools of Smyrna, Pergamus, and Epidaurus. 93 CHAPTER VIII. THE SCHOOLS OF ROME. Section I. — From their Origin to the Else of the Eclectics. The Introduction of Grecian Learning among the Romans, 96 Cato the Censor, . . . . . .96 Caius Marius, . . . . . . 97 Asclepiades of Bithynia, . . , . .99 Antonius Musa, . . . . . . 102 Cassius, ....... 102 The Early Surgeons and Oculists of Rome, , . 105 The Doctrines of the Rationalists and Dogmatists, . . 106 The Doctrines of the Empirics, .... 108 X CONTENTS. PAGE Themison of Laodicea, and the Doctrines of the Methodic Sect, . . . . . . .110 Celsus, and his Writings, . . . . 112 Apiileius, ....... 121 Scribonius Largus, . . . . .122 Athenaeus, and the Pneumatic Sect, . . . .124 Agathinus and the Eclectics, . . . . 125 Section II. — The Later Methodists of the Roman School. Roman Authors, writing in Greek, . . 125 Andromachus of Crete, . . . 126 Thessalus of Tralles, . . . 126 Philomenus, . 127 Archigenes, . . . 12T Heliodorus, . 128 Antyllus, . . 128 Soranus of Ephesus, . 129 Caelius Aurelianus, . ... . 130 The Practice of the Later Methodists, 132 The Obstetric Art, . . . 134 Aspasia and Moschion, . . 135 The Culinary Art, Apicius Coelius, . . 136 Section III. — Pliny the Elder. Contagion and Infection, . . . . .140 The Art of Distilling Alcohol from Wine, . . 141 Progress of Medicine at Rome up to the time of Galen, . 141 CHAPTER IX GREEK WRITERS AND TEACHERS, NOT OF THE ROMAN SCHOOL, BUT CONTEMPORARY WITH IT. Dioscorides of Anazarba, Ruflfus of Ephesus, . Aretseus of Cappadocia, . 143 144 145 CONTENTS. XI PAGK 147 Marcellus of Sida, ..... Quintus, Marinus, Satyrius, and others, of tlie School of Perga- mus, ...... 14*7 CHAPTER X GALEN. His Personal History and Character, His Writings, His Discoveries and Doctrines, 149 153 162 CHAPTER XI. LATIN MEDICAL WRITERS SUBSEQUENT TO GALEN. Reasons for the Decay of the Roman School, . . 174 Serenus Sammonicus, . . . . .175 Theodore Priscian, . . . . .176 Marcellus Empiricus, . . . . .177 Vegetius Renatus, . . . . .178 CHAPTER XII. GREEK MEDICAL WRITERS AND MEDICAL INSTITUTIONS SUBSEQUENT TO GALEN. Caesarius, ...... . 179 Rivalry in the Schools of Athens, 181 Oribasius, ...... . 182 Hospitals and Medical Institutions of Christianity, 186 The Hospital of Csesarea, . . 187 Perabolani, ..... 188 The Nosocomi, ..... . 189 Nemesius, Bishop of Emessa, 189 Jacob Psychrestus, ..... . 191 The Last of the Ancient Latins, Macer Floridus, . 191 Aetius, ...... . 193 Xll CONTENTS. PA6S Alexander Trallianus, . . . . . 197 Procopius, his account of the Plague and of the Medical Men during the reign of Justinian, Human Dissections, . 200 Suppression of the Schools of Philosophy and other Institutions of Paganism, ..... 202 Theophilus, ....... 202 Stephen of Athens, John of Alexandria, and Palladius, . 203 Ahrun, ... . . . . . 203 Paul of ^gina, ...... 204 Summary view of the Progress and Decline of Medical Science among the Ancients, . . . . .206 CHAPTER XIII. LAWS AND CUSTOMS OF THE ROMAN EMPIRE IN RELATION TO THE PROFESSION. The usages of the Profession in Rome, adopted from the Greeks, ...... 208 The Term of Study, . . . . .209 System of Instruction, . . . . . 210 Servile Practitioners, . . . . .212 The Quacks of Rome, . . . . . 214 Schools of the Provincial Cities, .... 214 Their Professors, salaried by the State, . . . 215 The Edict of A. D. 370, in reference to the supervision of Stu- dents at Rome, ..... 216 Archiatri Populares, or State Physicians, their duties, privi- leges, and immunities, . . . . .217 The care of Education entrusted to them ; their modes of grant- ing licenses to practice, . . . . 118 The Archiatri Palatini, or Physicians to the Imperial House- hold, . . . . . . .220 Army Physicians, Private Practitioners, . . . 220 Christian Usages and Institutions, . . . .221 Laws of the Empire relating to the Profession, never abro- gated, ....... 222 INTRODUCTORY REMARKS. To THE E"ew York Academy of Medicine. Gentlemen : — The task which you have imposed upon me, and which I come before you this evening to fulfill, is one for which I am ill prepared. Habits of retirement long indulged, are not easily laid aside. The occupations of the sick-room favor a close, sententious manner, rather than fluency of speech. It may, indeed, be said, that in this respect I am only on a par with my associates. Few of us, it is true, are known as public speakers. Eloquence gives spirit to the pulpit, gives spirit to the bar ; but the Genius of Medicine sits pensive and alone, her finger on her lips, as if admonishing her votaries by the example of her own silence, to bury deep within the recesses of their bosoms the disclosures of the sick. Ours is the quiet profession. The prudent physician is the keeper of his own counsel ; thinking much, and speaking little. But, Gentlemen, though not given to elocution, I have not felt at liberty to refuse this opportunity of addressing you. I cannot plead the diffidence of a stranger. I am not here among you for the first 2 10 DISCOUESE. time. I stand in the midst of friends, — of brethren, — of those who for many years have been my com- panions in daily toil, moved by the same impulses, agitated by the same fears, excited by the same hopes, elated by the same successes as myself. With the associations of a quarter of a century clus- tering thick around me, on this our common hearth, I feel that I am at home, and can speak, as well as breathe, without restraint. To the initiated. Medicine is something more than a profession. It is a world within itself. It has its history, its philosophy, its politics, its literature, of which the world at large knows nothing. It has its subsidiary arts and occupations. It has its organiza- tions and institutions, its ranks and grades of honor. It has its polemics and dissensions, not always ame- nable to logic or to the learning of the schools. In ethics, traditions, and superstitions, it is older than the church. In use before the civil law, it recog- nizes no arbitrary enactments. Nature is its only court of equity. And who of us shall forget its ever- living charities; its moving scenes of joy and sad- ness ; its many sunny aspects ; its benignant, enno- bling, liberalizing influences ; which few beyond our own circle can properly appreciate, and none so well understand as ourselves ! No wonder, then, that the members of our profes- sion, drawn together by these hallowed ties, should be disposed to band together as a brotherhood. Such has always been their course. The Druids of early Gaul and Britain, the Asclepiadse of Greece, the priests of ancient Egypt, the lamas of Central DISCOURSE. 11 Asia, the Vaidhyas of India, the fraternities of the middle ages, and up to the present hour the count- less societies and colleges of our own and other lands devoted to the healing art, are in proof of this. So that wherever social freedom has existed, or tyr- anny would permit, internal organization and devel- opment has been the rule of our profession. With these facts before us, our origin and growth as an element of civilization, is a subject worthy of some attention. I propose to occupy the passing hour in contemplating it, so fair at least as relates to the condition of medicine in ancient times, and among those people from whom the usages of modern society have been derived. This subject is one which has often furnished occupation for my leisure hours. It is pleasant as well as profitable to turn, on fit occasions, from the bustle of active life, to the study of the past, — to the origin of our art, to the principles and necessities that called it into being, to the struggles of our an- cestry. We are thereby better able to understand our own position, to know how far we have ad- vanced, to whom we owe our progress, the labor still before us, and the places we ourselves are likely to occupy in the estimation of those who are to follow us. 12 DISCOURSE CHAPTER I. THE CONDITION OF MEDICINE IN THE EARLIEST OR- GANIZATIONS OF SOCIETY. The art of medicine is at the present day so ifni- versally exercised, that we can hardly suppose an organized community ever existed in which it was overlooked ; and yet such appears to have been the fact. There is reason to believe that among the Assy- rians and other early Asiatics, it was never pursued as a distinct occupation. The eastern Magi must have devoted some attention to it ; and the seers of Palestine may have had some pretensions to skill in the cure of diseases as a part of their divine calling. Job speaks of his counselors as " physicians of no value ;" and Moses, of the preparation of the sacred oil after " the apothecary's art." King Asa, when his disease was exceeding great " sought not the Lord, but his physicians ;" and Jeremiah asks, " Is there no balm in Gilead ? is there no physician there ?" From these and other allusions in the Old Testament, it is evident that among the Israelites there were, perhaps after the manner of the Egypt- ians, certain men giving their attention to medicine. But the Babylonians, as we learn from Herodotus,* * Book I. chap. 197. DISC O'U E S E . 13 were destitute of physicians, and in the custom of exposing their sick in the market-place, in order that those who had been similarly affected might com- municate to them the means of cure. The kings of Persia had no physicians of their own nation ; but were in the habit of obtaining them from Egypt, or luring them by rich rewards from Greece. The early Komans were in like condition. Their first attempt to secure competent medical attendance, was in the year of the city, 535 ; when they induced Archagathus of Peloponnesus to settle amongst them, offering him the freedom of the city, furnishing him with a residence, and providing liberally for his sup- port at the public expense. But, as we learn from Pliny,* Archagathus proved to be their '' carnifex " rather than their " vulnerarius ;" so that their first effort not turning to their advantage, they were not soon again disposed to repeat it ; and we find Cato, nearly a century afterwards, relying for medical assistance upon charms and superstitious observ- ances of his own, or upon the untutored skill of his domestics.f In the earliest stages of civilization, among most primitive people, where medicine is practiced at all, the functions of the physician are usually united with those of the priest and civil ruler. The oak-groves of ancient Europe were as sacred to medical observances as to the other mysteries of Druidism. The blossoming of the mistletoe and the ripening of its berries, at the summer and the win- * Nat. Hist, lib. xxix., cap. vi. viii- f Cato de Re Rustica, cap. 160. 14 DISCOUKSE. ter solstice, marked the seasons of the sacred feasts ; and after adorning the ceremony of the sacrifice, the. hallowed plant was carefully set aside by the ovate and physician of the tribe, to be used in case of need as a medicine."^ According to Hindoo mythology there are, be- sides Brahma, the creator, not less than six minor divinities skilled in the healing art. The ancient and still existing caste of Hindoo physicians, the Vaidhyds, trace their family descent from Virab- hadra, the fortunate, the son of Brahma. It was to the thirteen sons of this demi-god that were first re- vealed the sacred sagas, by the study of which they and their descendants to the present day, have been rendered learned pundits and skillful physicians.f ' Among the Tartars, the lama is the only physi- cian. One of these people, conversing with a recent traveler J on the subject of the war between China and England, says, " The Chinese were everywhere protesting that we were marching to certain death. * What can you do,' say they, ' against these sea- monsters ! They live in the water like fish. When least expected they appear on the surface, and throw combustible balls of iron. When the bow is bent against them they take to the water like frogs.' Thus they tried to frighten us. But we soldiers of the Eight Banners are ignorant of fear. The em- * Giles, in Richard of Cirencester's Ancient Britain. f Wise, Hindoo System of Medicine. Calcutta, 8vo., 1845. Chap, ii., p. 11. X M. Hue. " Souvenirs d'un Voyage dans la Tartaric, la Thibet, et la Chine." See Edinburgh Reviaw, April, 1851, p. 201. DISCOURSE. 15 peror has supplied eacli leader with a lama instruct- ed in medicine, and initiated in all sacred auguries, able to protect us from the diseases of the climate, and to save us from the magic of the sea-monsters. "What, then, have we to fear ? The rebels hearing that the invincible troops of Tchakar were approach- ing, * * * sued for peace ; * * * and then we re- turned to our pastures, and to the charge of our flocks." Again, among the aborigines of our own country, the functions of the physician are in the hands of the priest. The Tla-quill-augh, or man of supernatu- ral gifts, is supposed to know all things, and to be capable of throwing his good or bad medicine, with- out regard to distance, on whom he will ; and to kill or cure by magic at his pleasure. These Tla-quill- aughs are generally men beyond the meridian of life ; grave, sedate, and shy, with a certain air of cun- ning ; but possessing some skill in the use of herbs and roots, and in the management of injuries and external diseases. The people at large stand in great awe of them, and consult them on every affair of im- portance. But their personal safety is not in pro- portion to their influence. Every misfortune, unseen evil, or sudden death among the people, is immedi- ately attributed to them. And, however innocent of the calamity, they are apt to pay for it with their lives.* These customs of the savage, springing as they do out of the untutored instincts of the human heart, * Ross. "Adventures on the Oi-egon and Columbia River.' 16 DISCOURSE. may be taken as no inapt illustration of what may liave been the first estate of medicine among those people from whom it has descended to ourselves. Overlooking the juggleries of the Indian priests, the philosopher will discover that their real force lies precisely in that department of the art which, in an- cient times, was cultivated earliest, and with most success ; and that the foundation for the future de- velopment of medical science among them, is quite as broad as that upon which the enduring, but still unfinished temple of medicine was originally begun, more than thirty centuries ago ; the first architects of which, like the Tla-quill-aughs of Oregon, were also of the order of the priesthood. Among the early Egyptians the priests were a numerous and influential body ; receiving for their support about one-third of the whole income of the nation. They were of several orders ; most of them skilled in medicine, and practicing, as some suppose, gratuitously among the people.* " Here," says He- rodotusf, ''each j)hysician apj^lies himself to one disease only, and not more, — all places abound in physicians ; some for the eyes, others for the head, others for the teeth, others for the parts about the belly, and others for internal diseases." Of this same class were the embalmers,;}; whose occupation must have rendered them familiar with the internal Schulze, p. 24, from Diodorus Siculus. f Book II. c. 84. X Herodotus, Book II. ch. 86, et seg. DISCOURSE. IT structure of tlie body, and furnislied tliem witli use- ful insiglit into the nature, causes, and results of dis- eased action. The deference paid to the medical skill of the Egyptian priests, was not confined to their own people. They were sought for by the rulers of the surrounding nations, and sometimes sent abroad against their will. Cambyses, the Per- sian, demanded the daughter of Amasis, king of Egypt, at the instigation of a physician, who had been forced by Amasis from his native country, and had taken this mode of revenge for having been torn from his wife and children to gratify the re- quest of Cyrus, who had asked for the ablest oculist of Egypt."^ The attendants on Cambyses must have known something of the internal structure of the human frame ; for, having shot an arrow through the body of a child, the son of Prexaspes, to prove his skill in archery, he ordered them to open him and examine the wound ; when the arrow was found to have pierced the heart.f The practice of the Egyptian priests, as we learn from Aristotle, J was in conformity with a prescribed law. " Even in Egypt," says he, " the physician was allowed to alter the mode of cure which the law prescribed to him, after the fourth day. But if he did so sooner, he - acted at his own peril." * Herodotus. Book III. c. 1. f Ibid.^ Book III. c. 35. X Politics. Book III. c. 15. 18 DISC0TJR8E CHAPTER II THE OEIGIN OF MEDICESTE AMONG THE GEEEKS. Amon-g the Greeks fhe art of medicine appears to Tiave been derived from three sources; the Gym- nasia, the schools of Philosophy, and the Temples of^^sculapius.*^ X. At the Gymnasia the course of education con- sisted, first, of music, which, according to the ancient use of the term, included every study for develop- ing the intellectual and moral faculties ; and sec- ondly, of gymnastics, in which was included every exercise for strengthening and improving the body. It was a rule with these people that what the boy first learns in sport he will afterwards love, and ex- ercise with more ability as the serious occupation of his manhood ; and hence, that children should prac- tice as amusements such sports as are best suited to prepare them for their future occupations.f The course of intellectual training at the gymnasia, ac- cording to Plato,J began with the sixth and ended with the twentieth; or, according to Aristotle,§ began with the seventh and ended with the twenty- * Littr^, (Euvres d'Hippocrate, Introduction, tome i. p. 5. f Plato, Laws. Bk. i. ch. 12. \ Laws. Bk. vii. c. 4. § Politics. Bk. vii. c. 1*7. DISCOUESE. 19 first year. For learning to read and write, accord- ing to Plato,* three years will suffice for a boy com- mencing at ten years old ; and the three succeeding years will be sufficient for the handling of the lyre. The free-born are also to be educated in computa- tion, in geometry and astronomy ; not all, indeed, with equal nicety. But such as may be necessary for the masses, it would be, says he, shameful for the many to neglect. That, however, which tends merely to the acquisition of wealth or bodily strength, or any other cleverness apart from intel- lect and justice, he excludes from this course of training, as not worthy to be called education at all ; applying this term only to that which tends to virtue, — which causes one to feel a desire of, and love for becoming a perfect citizen, and to know how to govern, and be governed. ^ In connection with this intellectual course, the physical exercises were also systematically pursued at the gymnasia. These latter embraced not merely wrestling, racing, and other athletic sports ; but also the general rules of health; attention to the food most proper for invigorating the frame, for increasing the powers of endurance against fasting, fatigue, watching, exposure to the weather or to the vicissitudes of the seasons ; and to every circum- stance likely to prepare the youth for serving as soldiers in defense of their country, or for acquiring applause in contests with one another at the Olym- pic, Pythian, or other national festivals. These exer- * Laws. Bk. vii. c. 14, 20 DISCOUESE. cises, however, were not confined to youtli. The people of every rank engaged in them. At the Palestrae, in which they were conducted, injuries were of frequent occurrence. The Gymnasiarchs in charge of these institutions, as well as the latrolep- tists, or anointers, who assisted them, had constant opportunity of witnessing and treating accidents ; and from the experience thus acquired, these men were in some degree trained to the management of diseases originating from other causes. The Ho- meric heroes had probably acquired their surgical skill in this manner. But if some of them, as Machaon and Padalirius, possessed extraordinary ability in the treatment of injuries, they were not exclusively devoted to its exercise ; for they were quite as ready at inflicting wounds as at curing them. I 2. At the schools of philosophy some attention was always devoted to medicine- as a department of speculative knowledge. The School of Pythagoras, at Crotona in Magna Greecia, now the south of Italy, preceded that of Plato by more than a cen- tury. Before assuming the business of teaching, Pythagoras had spent much time in Egypt ; and he probably introduced something of Egyptian science in his course of instruction at Crotona, where medi- cine was first cultivated as a department of philoso- phy. Of this school were Empedocles, the author of a medical poem ; Alcmseon, who was occupied in the dissection of brute animals ; and Democedes, the most skillful physician of his time, who flour- ished more than a century before Hippocrates. Of DI800TJBSE. 21 this same scTiool also was Acron, tlie first of bis sect to give attention to practical rather than to specu- lative inquiries ; and who is said to have arrested the progress of an epidemic at Athens, by kindling large fires in different parts of the city. To him the Empirics, a sect of much later date, were ambitious of tracing their opinions. He was the author of a treatise on nutrition, which had perished before the age of Pericles. Of these philosophers, Democedes is the only one who is known to have devoted himself to medicine as an industrial occupation. Leaving Crotona and his father's house, he first settled at JEgina ; where, though poorly provided with the instruments of his art, he soon surpassed the most expert of the physicians. In the second year the ^ginetae engaged him, for a talent out of the public treasury ; in the third year, the Athenians, for a hundred minge ; and in the fourth year, Polycrates, for two talents. He subsequently accompanied this prince in a maritime expedition from Samos to Asia Minor ; where he fell into the hands of the Persians. He afterwards rose to dis- tinction by curing Darius of an injury of the ankle, which the Egyptian physicians had failed to relieve ; and thus he acquired great influence at Susa, sitting at the king's table, overwhelmed with riches, and in the enjoyment of every honor and privilege which Darius could bestow, excepting only the privilege of returning to his native country — a privilege for which he languished ; and which, after curing Atossa, the wife of Darius and daughter of Cyrus, of a tumor of the breast, he finally obtained by 22 DISCOURSE. stratagem. In the time of Democedes, the phys- icians of Crotona, according to Herodotus, were esteemed to be the ablest in Greece, and the Cyren- 86ans the second * The writings of Plato and Aristotle are filled with allusions to our art ; and from it they are continually drawing their happiest illustrations. Plato had the following inscription over the door of his Academy : " Let none ignorant of geometry enter here."-}- And whether this is to be understood literally, or as referring to previous moral and intellectual training, it is evident he sought to give instruction only to such as had already received elementary education sufficient to enable them to appreciate and profit by his discourses. Nor could his pupils have been more than voluntary listeners. For when reading to them his dialogue " On the Soul," the most of them rose and departed, Aristotle alone remaining to be edi- fied by its reasonings.^ This school was of small beginning. The little orchard adjoining the Acad- emy, constituted Plato's principal patrimony. Be- fore he began to teach, it yielded him only two aurei nummi annually. But the revenue derived from it in course of time, amounted to more than a thousand ; for it was much enlarged by well-wishers and studious persons, who bequeathed something of their wealth to the philosophers. Plato exacted no pecuniary recompense from his pupils. But Aris- * Herodotus. Bk. iii., ch. 129, et seq. f Stanley. History of Philosophy. Fol. Lond., 168T, p. 262. X Diogenes Laertius, in Life of Plato. Chap. 37. DISCOURSE. 23 tippus, who had been his fellow-pupil under Socra- tes, and was afterwards the founder of the Cyreniac sect, believing that instruction is the more highly- valued by the money paid for it, gave the first example among the philosophers of charging for his lectures ; an example afterwards followed at the Academy, where Speusippus, the nephew and succes- sor of Plato, established thS" fee for a course of dia- lectics at a mina. Polemo, the third in succession, after Plato, lived within the garden of the Academy ; whilst his disciples, to be near the school, built for themselves little lodges round about it. Cratnor, a disciple of Polemo, being in ill health, took up his abode at the temple of -^sculapius in Athens, where it was his intention to establish an inde- pendent school of his own ; but regaining his health, he relinquished this purpose, and afterwards be- queathed his possessions to the Academy. Attains, king of Pergamus, subsequently enlarged and orna- mented its public grounds; which were thencefor- ward called the " Gardens of Attains." Xenocrates, the successor of Speusippus, in consequence of the great number of youth resorting to him, was obliged, for the proper government of the Academy, to establish a regular system of police, and to appoint officers from time to time for- carrying his regula- tions into effect. The government of the Lyceum was nearly the same as that of the Academy. From the life of Theophrastus, the successor of Aristotle, we learn, that voluntary contributions were occasionally taken up for the maintenance of the philosophers ; that for 24 DISCOURSE. the order and economy of the institution, the regu- lation of its tenements, altars, statues, and ornamen- tal grounds, there were special officers appointed, and laws established, by the governor; and that, besides those who were associated together as phil- osophers, there were immense numbers of young men resorting to the institution ; some of whom ap- pear to have been occasionally admitted to the tables of their instructors. Both of these institutions were in some degree under the cognizance of the republic. The people occasionally exercised the right of closing them, and of silencing or restraining the teachers, according as their doctrines countenanced or opposed the preju- dices, policy, or religious tendencies of the com- munity. Those who had gone through the course as or- dinary students, occasionally chose afterwards to remain as permanent residents. Aristotle, before opening his own school at the Lyceum, had been a member of the Academy for more than twenty years. From among the permanent residents, the director usually selected his successor. Thus, Strato, the second after Aristotle at the Lyceum, ordered in his will, that Lyco should succeed him ; giving as a reason, that the others were either too old, or otherwise employed; and requesting them to con- firm his choice. How much of medicine may have entered into the systematic course of instruction at either of these institutions, we have not now the means of ascer- taining. That Plato was well versed in the prin- DISCOURSE. 25 ciples of tlie art, as taught by his contemporary, Hip- pocrates, his works bear abundant evidence. Accord- ing to his biographer, Diogenes Laertius,* he divided medicine into five branches: the pharmaceutic, the chirurgic, the dietetic, the nosognomic, and thebceth- etic : the first cures by means of drugs, the second by cutting and burning, the third produces a change in the diseased by a change in their diet, the fourth makes known the character of disease, and the fifth by instant assistance palliates suffering, and gives relief to pain. Aristotle, though no*t a practitioner of medicine, was of the family of the Asclej^iadse. He was well skilled in natural history and the anatomy of the lower animals, as well as in the medi- cal doctrines of his own and former times. We shall again have occasion to allude to him as a naturalist. 3. But notwithstanding the speculations of the philosophers, and the trainings of the Palestrae, the Temples of JEsculapius were the first great founda- tions of medical knowledge among the Greeks. These Temples were numerously dispersed throughout the Grecian states and colonies,f as at Titane, Epidaurus, Gyrene, Rhodes, Orope in Attica, Cylene in Ellis, Tithorea in Phocion, Tricca in Thes- saly, Megalapolis in Arcadia, Cnidos, Cos, Corona, » Chapter 85. In Plato, Bohn's edition, vol. 6, p. 21'7. f Schulze, in his Historia Medieinse, p. 118 and p. 127, quarto, Lipsise, 1*728, enumerates and describes the particulars of more than eighty of them, mostly after Pausanias and Plutarch ; and several of the states and cities appear to have been provided with more than one for each place. The temple at Epidaurus, the reputed birthplace of Ji^sculapius, is presumed to be among the most ancient of them; and from this, many of the others are known to have been off-shoots. 3 26 DISCOURSE. Pergamus, Corintli, Smyrna, and numerous other places. Here were originally tlie homes of the A33lepiad8e, the schools in which they trained their offspring; and hither the suffering and afflicted resorted for consolation and relief. The priests of ^sculapius were in the habit of turning to good account the opportunities at their command within the temples. The institution of the votive tablets on. which were inscribed the his- tory of the cases which had been relieved by them, indicates plainly that the idea of collecting the information thus recorded, and deducing therefrom a systematic code of practice, must have been contem- plated by the descendants of ^sculapius at an early day. These temples, or Asclepions, long before medicine began to assume a scientific character, had served as schools of instruction, and as asylums for the sick. They furnished the nucleus from which, in process of time, were developed other institutions and organizations. As schools, the most ancient of them is said to have been at Titane, near Sicyon. Those of Rhodes and Epidaurus, were of early repute. But the school of Cnidos is that from which issued the earliest literary performance which can be clearly traced to the Asclepiadse, namely, the " Cni- dian Sentences ;" which are attributed to Euryphon, the contemporary of Hippocrates, though somewhat his senior.* As asylums, the temples bore no inapt resemblance to the hospitals and infirmaries of modern times; into which, in fact, some of them * Littre, loco citat. p. Y. BISCOUESE. 27 were ultimately converted. The temples of Epi- daurus, Cos, Tricca, according to Strabo, were always filled witli patients ; and along their walls the tablets were suspended upon which were recorded the history and treatment of the individual cases of disease.* The choice of situation, and internal management of the temples, show with what care the priest of JEsculapius, Avhile observing the rites of his reli- gion, provided for the well-being of the sick. They usually occupied some elevated or retired and healthy locality, not far removed from the cities, surrounded by shady groves, or in the neighbor- hood of thermal springs, or fountains of medicated water. They were sacred from intrusion, and acces- sible to the sick only after suitable preparation. The invalid, on his arrival, submitted to purification, by fasting, ablution, and inunction. He afterwards passed the night within the Hicetas or common-hall of the temple. During this ceremony of incubation, the presiding deity is supposed to appear before him in the silence of the night, and, by voice or other- wise, announce to him the means of cure ; which, on the following day, the priest in attendance also ascertained, and afterwards undertook the super- vision of the treatment. The fees of these priests were the free-will ofier- ings of the sick. It was consequently to the inter- est of the priests to cherish the superstitions of the people. Their devices for this purpose, Aristoph- * Ibid, p. 9, from Strabo, boak viii. 28 DISCOURSE. anes has humorously portrayed in his comedy of Plutus. " Having bathed Plutus in the sea," says the servant Cario, "we went to the temple of JEscu- lapius; and when our wafers and preparatory sacri- fices were offered on the altar, and our cakes on the flame of Vulcan, we laid him on a couch, as was proper, and made ready our own mattresses. * * * When the priest had extinguished the lights, he told us to go to sleep, adding that if any of us heard the hissing we should by no means stir. We therefore all remained in bed, and made no noise. As for myself, I could not sleep, on account of the odor of a basin of savory porridge which an old woman had at the side of her bed, and which I longed for amazingly. Being, therefore, anxious to creep near it, I raised my head, and saw the sacris- tan take the cakes and dried figs from the sacred table, and going the round of the altars, put all that he could find into a bao^. It occurred to me that it would be meritorious in me to follow his example, so I arose to secure the basin of porridge, ^ * fear- ing only that the priest might get at it before me, with his garlands on. ^ * The old woman, on hear- ing me, stretched forth her hand. But I hissed, and seized her fingers with my teeth, as if I were an ^sculapian snake; then, drawing back her hand again, she lay down and wrapped herself up quickly, * * ^ while I swallowed the porridge, and, when full, retired to rest." The serpent to which Aristophanes here refers, was the usual emblem of the presiding Numen, or DISCOUESE. 29 divinity of the temple ; thougli other animals, as the cock and the dog, were occasionally employed for the same purpose. The figure of the serpent sculptured in stone, met the eye of the devotee at the entrance of the temple ; and the animal itself was cherished and preserved within the sacred pre- cincts. The ^sculapian serpent, according to Pau- sanias, was of a peculiar variety, of a yellowish or brown color, and found only at Epidaurus. At the founding of new temples, it was always transferred from the old to the new abodes. Such was the cere- mony, as we learn from Livy, when in the year of Eome, 461, for arresting the progress of pestilence dn that city, commissioners were sent to transfer the sacred serpent from Epidaurus to the Island of the Tiber, where the first temple to JEsculapius was erected among the Romans. ^sculapius himself was usually represented as a bearded and aged man; sometimes bare-headed, sometimes crowned ; seated, standing erect, or lean- ing on his staff, around which the serpent is seen winding in spiral folds ; occasionally he is bearing a strobile of the pine ; sometimes he is seen alone, but more frequently accompanied by one of his daugh- ters, usually Hygeia, who is robed in white, with a serpent in one of her hands and a shallow patella or cup in the other, to which the serpent is directing its attention. Not unfrequently between the figures of jEsculapius and Hygeia, a child is seen standing, the infant Telephorus or the Harpocrates of the Egyp- tians ;* and the cock is usually seen at the feet of * Schulze, p. 126, 131, et eeq. 30 DISCOURSE. ^^sculapius. By the serpent, tlie Asclepiadse are ^supposed to have symbolized circumspection and vigilance, and as Schulze supposes, the power of rejuvenescence; by the cock, their bird of sacrifice, they are thought also to have represented vigilance ; and by the dog, fidelity and honesty. The Egyp- tian symbols of Serapis, or of Isis and Osiris, and the infant Harpocrates, were occasionally associated with the emblems more properly belonging to the Greeks — a custom adopted after the settlement of Alexandria. For it was a belief among the Egyp- tians, that infants had at times the power of divina- tion ; and in the sacred ceremonies of their temples, the sports and gambols of young children were often introduced.* But in the temples of Isis and Osiris the genius of medicine was sometimes also repre- sented by the figure of Silence. "Et quoniam vero in omnibus templis ubi colebantur Isis et Serapis erat etiam simulacrum quod, digito labiis impresso, admovere videretur ut silentium fieret ; hoc signifi- cere, ut homines illos fuisse taceretur."f The Asclepions, however, were not the only tem- ples to which the Greeks resorted for relief from sickness. The temples of Apollo, and of the other gods, were also open to them, but only as places for consulting the gods; not, as at the Asclepions, to be subjected to treatment.^ 4. It is supposed that the priests of JEsculapius, * Schulze (on the authority of Plutarch and others), p. 126. f Ibid (from St. Augustine), p. 126. 1(. Herodotus, lib. i. c. 16 and 25 ; and Xenophon, Memoir of Socrates, book iii. chapter 13. N. Y. edition, p. 576. DISCOUKSE. 31 in the exercise of their art, were originally restricted to these institutions. If such ever were the rule, it must have soon been set aside, or often disregarded. Hippocrates and his disciples practiced as periodeutse, or itinerants, in different parts of Greece. Apol- lonides of Cos, practiced at the court of the elder Artaxerxes.* Euryphon of Cnidos, in consultation with Hippocrates, attended Perdiccas, son of Alex- ander, king of Macedon.f Euryximachus is intro- duced by Plato, among the friends of Socrates, as one of the wits and men of learning of his time ; and at the banquet is made to descant upon the doc- trines of his profession, to enforce the virtue of temperance in the use of wine, and, at table, to prescribe for the sudden illness of Aristophanes. J Again, we learn from Xenophon,§ that by the laws of Lycurgus, the Lacedaemonian physicians were obliged to accompany the army, to associate with the officers, sooth-sayers, and musicians ; and, to be at the immediate service of the king on the battle- fi.eld. Xenophon himself, in the memorable expedi- tion into Persia, was accompanied by Ctesias of Cni- dos, who, on the defeat of the younger Cyrus, was taken prisoner, and who subsequently rose to great distinction as physician to the court of Persia ; and more so as the historian of that country. In fur- * Le Clerc, Histoire de la Medecine. Lib. ii. chap. Y, from Ctesias. f Soranus, in his Life of Hippocrates. See Kuhn's Hippocrates, vol. iii. p. 85L :}: See the Protagoras and Banquet of Plato, Bohn's edition, vol. ii. p. 244, and vol. iii. p. 482-500. § Lacedtemonian Republic, chapter xiii. See also, Memoir of Socrates, book i. chapter ii., N. Y. edition, p. 627-8. 32 DISCOUESE. ther evidence of the unrestricted freedom of tlie Asclepiadge, we learn from the Laws of Plato,* tliat there are some persons physicians, and others the ministers of physicians, who are sometimes also called physicians. " Do you not perceive," he adds, ^' that when there are both slaves and freemen sick in the cities, the slaves do for the most part go round and cure the slaves, or remain at home in the medical shops ; and that not one of these slave -phy- sicians either gives or receives any reason respecting the diseases of the slaves ; but as if knowing accur- ately from experience, he orders as if he were a self- willed tyrant, what seems good to him, and then goes away, bounding off from one sick domestic to another ; and by this means, he affords a facility to his master to attend to other patients ? But the free-born physician for the most part attends to, and reflects upon the diseases of the free-born ; and by exploring these from the beginning, and according to nature, * * "^ does at the same time learn some- thing from, and, as far as he can, teach something to, the sick ; and does not order any thing until per- suaded of its propriety ; and then, after rendering the patient gentle by persuasion, he endeavors to finish the business by bringing him back to health." It has also been stated that the Asclepiadse were first induced to leave the temples by the success of the Pythagorean physicians after the breaking up of their school, and their expulsion from Crotona. The story of Democedes, already related, has a direct bearing upon this point, and is sufficient, of * Book iv., c. X. DISCOURSE. 33 itself, to sliow tliat prior to the dispersal of tlie Py- thagoreans, the cities of Greece were supplied with practitioners who were visiting the sick at their own abodes. Thus, then, long before the age of Pericles, even before the Persian war, the medical men of Greece were acquiring a knowledge of their art at the schools of philosophy, and at the exercises of the gymnasia, as well as at the temples ; and were prac- ticing as private individuals, as stipendaries at the royal courts, or as public functionaries with stated salaries, appointed by the people ; sometimes in the army, sometimes in the fleet ; liberally rewarded, and held in high repute. The custom in the cities of stipulating annually for the public services of medical men, is a fact w^orthy of notice. Plato in the " Statesman," and elsewhere, alludes to it. And his commentator remarks, that from numerous pas- sages in this author, as well as from others in the writings of Xenophon, Aristotle, Strabo, and the scholiasts, it is evident there were at Athens a body of medical men who were paid by the state, as well as others who were engaged in private practice.* * Burgess, in Plato. Bohn's edition, vol. iii, p. 192. 34: DISCOUESE CHAPTER III. THE ASCLEPIAD^. The course of education among the Asclepiadse, was in conformity with the national habits. The youth who were destined for the profession, if not the sons of the initiated, were probably not allowed to begin until after the completion of their prepara- tory education, from their seventeenth to the twen- tieth year. But the sons of physicians began earlier, and, with both, the course of training probably con- tinued to the close of their twenty-fifth year. The^-neophyte was inducted into his art with all the secrecy and exclusiveness which, from the remo- test ages, had prevailed among the handicraft as- sociations, the religious orders, and, at a later pe- riod, in the political clubs, and even in the schools of philosophy. For, as at Athens, so in all the other states, these unions, mysteries, or secret associations, were innumerable. Some of them were for charit- able purposes, some of them for traffic, some for the cultivation of knowledge ; and some, as among our- selves, were secret organizations for controlling the affairs of the people. The ceremony of initiation into them, varied somewhat with the chara^cter and object of each ; but from the few hints preserved respecting them, there is reason to believe that in all of them it was modeled, as nearly as possible, after that of the Eleusinian and Dionysian Mysteries. DISOOTJESE. 35 Of the Mysteries of Eleusis, there were two or- -ders, the less and the greater. The less were the most essential, and consisted of_thr.ee grades. The ceremony for the first grade was styled Illumination or the Tradition of the Sacred Rites ; that for the second was styled Inspection, or the Looking-on ; and that for the third, which was the end and de- sign of the other two, was called the Binding of the Head, or Coronation. But according to the greater order, there were two additional ceremonies ; name- ly, the introductory, which was called Purification ; and the ultimate, which was called Friendship with the Deity. For, of those who sought to engage in these mys- teries, all were not admissible ; there being certain ^aracters excluded by the voice of the crieT,_ such as those of impuLreJiands or inarticulate_voice. So that before admission, each candidate underwent the ceremony of Purification. The two succeeding cere- monies were strictly progressive ; but the Binding of the Head, or Coronation, signified the full recep- tion of those who were thus honored, and that they could afterwards communicate to others the sacred rites ; or officiate as torch-bearers, or interpreters ; or sustain any other part in the sacred offices. The fifth degree, or Friendship with the Deity, was a re- sult reached only after many years of active service by those who had attained the highest perfection in their respective occupations. In the political clubs, and in the schools of phi- losophy, the cei^mony of Purification, which in the figurative language of Einpedocles, was the act of 36 DISCOURSE. drawing from tlie ^ve fountains witli an indissoluble vessel of brass, liad reference to elementary training in arithmetic, geometry, stereometry, music, and as- tronomy. After such preparation in the schools of philosophy, came ; first, Illumination, or the study of theorems, logical, political, and philosophical ; in other words, the study of abstract principles. The next stage of advancement, or as it was called, In- spection, had reference to practical studies, or what Plato calls " intelligibles, true beings, and ideas." But the last stage, or Coronation, was the closing ceremony of education, and imparted to the recip- ient the right of leading others to the subjects of his own contemplation.* These three essential stages of advancement an- swered to the three scholastic degrees in the univer- sities of the middle ages, and to the three degrees among free-masons ; with both of whom the cere- monies were in fact derived from those of the early mysteries. And, we are told by Mr. Burgess, that the Crowning, or Binding of the head, never took place before the comj^letion of the fifth year.f Now, to return to the Asclepiad^e ; it is clear that the youth in the course of initiation, submitted to observances, and advanced by gradations, analogous to those of the other secret associations. For we are expressly informed by Hippocrates, J in reference to his own profession, that " Things which are sacred are to be imparted only to sacred persons ;" and that * Thos. Taylor. Eleusinian and Bacchic Mj^teries, p. 48-62. f In Plato. Bohn's edition, toI. iil p. 549. :}: In the Law. DISCOTJESE. " it IS unlawful to impart them to the profane until after their initiation into the mysteries of the sci- ence." With reference to Purification, or the train- ing which should precede Illumination, he says, — " Whoever is to acquire a competent knowledge of medicine, ought to possess the following advantages : a natural disposition, instruction, a favorable posi- tion for study, early tuition, love of labor, leisure.""^ And, writing to his son, the author of the Hippo- cratic Letters, says, " Give due attention, my son, to Geometry and Arithmetic. For such studies will not only render your life illustrious and useful to your fellow-beings ; but your mind more acute and perspicacious in arriving at fruitful results in every thing pertaining to your art."f The candidate having passed the first ordeal of preparation, and commencing the ceremonies of Illu- mination, was obliged to subscribe to the Oath ; which was a formula analogous to that which was enjoined among the Pythagoreans, and was in the following words : " I swear by Apollo, the physician, by ^scu- lapius, by Hygeia, Panacea, and all the Gods and Goddesses, that according to my ability and judg- ment, I will keep this oath and stipulation, to reckon him who teaches me this art equally dear to me as my parents, to share my substance with him, and relieve his necessities if required ; to look upon his offspring on the same footing as my own brothers, * In the Law. f Kuhn's edition, vol. iii. p. 822. 38 DISCOIJRSE. and to teacli them this art, if they shall wish to learn it, without fee or stipulation ; and that by precept, lecture, and every other mode of instruc- tion, I will impart a knowledge of this art to my own sons, to those of my teachers, and to disciples bound by a stipulation and oath according to the law of medicine, but to none others. I will follow that system of regimen which, according to my abil- ity and judgment, I consider for the benefit of my patients ; and abstain from whatever is deleterious and mischievous ; I will give no deadly medicine to any one, if asked ; nor suggest any such counsel ; and in like manner, I will not give a woman a pes- sary to produce an abortion. With purity and with holiness I will pass my life and practice my art. I will not cut persons laboring under the stone, but will leave this to be done by men who are practi- tioners of this work. Into whatever houses I enter, I will go into them for the benefit of the sick, and will abstain from every voluntary act of mischief and corruption ; and, further, from the seduction of females and males, of freemen and slaves. What- ever, in connection with my professional practice, or not in connec-feion with it, I see or hear, I will not divulge, as reckoning that all such should be kept secret. While I continue to keep this oath inviolate, may it be granted to me to enjoy life and the prac- tice of my art, respected by all men at all times ! But should I trespass and violate this oath, may the reverse be my lot !"^ * Adams' Hippocrates, vol. ii., p. 779. DISCOURSE. 39 The pupil tlius admitted, proceeded next to the ordinary business of . Illumination, which consisted in committing to memory certain traditionary pre- cepts ; in listening to the prelections of the instruc- tor ; in the contemplation of diseases within the temples, or at the bed-side of the sick ; in combining the knowledge thus obtained with some general ac- quaintance with the rules of health ; and where the preparatory training in the accessory sciences had not already been completed, in acquiring a knowl- edge of these, and of the higher philosophy of the day* The business of Inspection, which was next in order, and which, in philosophy, was "an occupation about intelligibles, true beings, and ideas," immedi- ately preceded Coronation ; and, as iu philosophy, had relation to practical subjects, probably the treatment of disease under the immediate supervi- sion of the instructor. The ceremony of Coronation took place at the completion of the term of study, and corresponded with the modern ceremony of Graduation. It was in evidence of the recipient's fitness for assuming the duties of his profession, it conferred upon him the privileges of fellowship, and, as a master of his art, the right of initiating others into its sacred mysteries. It is here worthy of remark, that the ceremony of placing a wreath, cap, or crown, upon the head of those who were admitted into full fellowship at these ancient schools, was continued down to the Littre, Introduction, (Euvres d'Hippocrate. 40 DISCOUKSE. period of the Middle Ages. It was the usual form of admission at Salernum, the earliest of the medieval schools of medicine. The ceremony was also the same at the school of Paris, the regulations of which were adopted in full from those of the Salernian in- stitution. At Paris, as at the other universities, the cap or bonnet was substituted for the wreath. But even at the temples the cap may have occasionally been used. The statues of the ancients usually rep- resent the head uncovered. And some have been at a loss to know why the head of Hippocrates !s some- times seen covered with a cap. The ceremonies of his school, if more minutely understood, might, per- haps, be sufficient to explain this. As a rational study, so long as medicine was taught orally, or by tradition and example only, the acquirements of its votaries could not have been ex- tensive. Their main study in the management of acute diseases, was in regulating the regimen. Epi- demic diseases they looked upon as divine dispensa- tions, with which they did not dare to interfere. A knowledge of the general rules of health, and the influence of diet, exercise, climate, and locality, at- tracted much of their attention. In the manage- ment of injuries and external diseases, they were but little inferior to their descendants of modern times. Their medical agents were, the lancet, of which they made frequent use ; certain active cath- artics, emetics, and diuretics ; cataplasms, unguents, escharotics ; and mechanical instruments and appli- ances. Of anatomy and physiology their knowledge was limited ; and as for chronic diseases, up to the DISCOURSE. 41 time of Herodicus of Selymbria, who is said to liave been one of tlie teachers of Hippocrates, they did not venture to interfere with them. This Herodicus had been a teacher of youth, and being always in delicate health, he had prolonged his life by systematic exercises and a regulated diet. The treatment which he had found useful in his own case, he recommended to others ; and thus he turned the attention of medical men to a course of practice, and a group of diseases, which they had hitherto disregarded. His innovations were for a time un- popular ; and even Plato undertakes to upbraid him for them, declaring " that no attempt should be made to cure a thoroughly diseased system, and so to afford a long and miserable life to the man him- self, as well as to his descendants. For JEsculapius," he continues, " did not think a man ought to be cured who could not live in the ordinary course, as in this case he would be of no service to himself or to the state." He goes on to deplore the necessity of using the terms then recently invented for desig- nating chronic diseases : — " Dropsies, and Catarrhs ! Do not you think these abominable 1 Truly these are very strange names of diseases ; such, I think, as existed not in the days of ^sculapius."* But though not in the habit of treating chronic internal ailments, the profession were at least supposed to be acquaint- ed with them, so far as to be able to detect them, and pronounce correctly in regard to them, in the inspection of slaves. Even Plato would hold the physician responsible for his opinion in such cases, * Republic. Book iil c. 14. 42 DISCOURSE. the object of tlie philosopher being to guard against dishonesty in the sale or transfer of slaves from one master to another."^ With respect, then, to the policy and ethics of the Asclepiadse, we learn from the Oath and Law, aa also from other passages in the Hippocratic code, that the student was formally bound to his master by indentures ; that the son of a former master, choosing to enter the profession, received his educa- tion gratuitously ; that others not thus circumstan- ced, were expected to pay for their instruction ; that the sons of the Asclepiadse did not necessarily follow their fathers' employment ; that those who were employed in the temples, or in practice elsewhere, were therefore, simply a fraternity, in the modern acceptation of that word, and not, as some suppose, an exclusive caste derived from one family ; that each practitioner was at liberty to follow his occu- pation where and when he chose, but for honorable purposes only ; and that even at this early day, there were designing men who were ^' physicians only in name," and who gave themselves up to disreputable practices ; against whom the regularly initiated had no redress, and no other advantage than that upon which we ourselves rely, a superior education, hon- esty of purpose, devotion to their duties, and the confidence of a discerning public. Many of the self-imposed restrictions of the Ascle- piadse had reference to the evil doings of the medi- cal impostors of their own times. M. Littre leads us to suppose that the injunction against lithotomy * Laws. Book xi. c. 2. DISCOURSE. 43 may have referred to the mutilating process of cas- tration, which had been from time immemorial in use among the Asiatics, as it was afterwards among the Greeks and Romans, and which was in the hands of a special class of manipulators, as it is known also to have been in Southern Europe, in comparatively recent times.'^ The remarks of Paulus ^gineta in reference to this operation, are somewhat in con- firmation of M. Littre's views. Again, the prohibi- tion against the sale and administration of poisons, is clearly in reference to those who are known to have been engaged in such traffic, — particularly the Agurtse, itinerant mountebanks, or pedler-priests as Plato calls them, who went about imposing on the unwary, and cheating them by lying prophecies.f But some of these restrictions doubtless arose from the suggestions of prudence. It has been re- marked by Mr. Adams, that professional virtue among the ancients never arose to the degree of disinterestedness recommended by Sydenham ; who maintains that the physician ought to be always ready to serve his patient, even at the risk of his own reputation. J Sydenham, however, wrote as a mem- ber of a Christian community, and knew that where his motives were unimpeachable, and his conduct that of an honorable, attentive, and skillful physi- cian, his want of success in the management of a critical case, was not likely to injure his reputation as a man. But the physician of early Greece had * Renouard. Histoire de la Medicine. Paris, 1846, tome 2, p. 288. f Republic. Book ii. c. Y. X Adams's Hippocrates, vol. ii. p. 641. 4:4: DISC0UK8E. more at risk than reputation, sometimes even life * By custom, if not by written law, lie was in some measure personally accountable for tlie want of suc- cess in what he undertook. The usages of the times imposed upon him circumspection, as well as fore- cast. Hence the injunction which he was required to observe, not to undertake the care of unmanage- able diseases ; or, if induced to take charge of them, to give timely notice of their probable result. There was no want of liberality in this ; and it is not for us to complain of that habitual caution which led to the close and attentive study of prognostics, a class of studies for which we have still reason to be thankful to the Greeks. With regard to social rank among the Asclepi- adse, it was in proportion to personal merit, rather than to any artificial status. But owing to the great number of pretenders, the regularly initiated were, then as now, disposed to look upon themselves as sufferers by the consideration occasionally bestowed upon impostors. " Medicine," says Hippocrates, " is of all the arts, the most noble ; but, owing to the ignorance of those who practice it, and of those who inconsiderately form a judgment of these, it is at present far behind all other arts. Their mistake," he adds, " appears to me to arise principally from this, that in the cities there is no punishment con- nected with the practice of medicine, and with it alone, except disgrace ; and that does not hurt those * Plato. Laws, book xi. c. 12. Galen, toI. xiv., p. 602, Kuhn's edition. Corpus Juris Civilis, Julii Paulii Recept. Sentent Lib. v. tit. xxiii., § 13. DISCOUESE. 45 who are familiar witli it. Such persons are like the figures which are introduced in tragedies : for, as they have the shape, and dress, and personal ap- pearance of actors, and are not actors, so also phy- sicians are many in title, but very few in reality * Such, then, was the condition of our profession in Greece up to the period at which it fairly emerged from the traditionary lore of the temples, and as- sumed its position as a rational and progressive science. The honor of effecting this change, the world has ascribed to Hippocrates. CHAPTER IV. HIPPOCRATES AND HIS IMMEDIATE SUCCESSOES. Of the personal history of Hippocrates, we know but little. He was born in the year 460 before the birth of Christ, and was, consequently, a few years older than Plato, and younger than Socrates. He received his professional education under his father, Heraclides, at the Asclepion of Cos ; and we are told that in his youth, at Athens and elsewhere, he had the benefit of the ablest masters in science and phi- losophy ; among whom were the sophist Gorgias, and the hygienist Herodicus, of Selymbria. It is also said that he studied under Democritus of Abdera ; or, as some suppose, Heraclitus. After the death of * The Law. Adams's Hippocrates, vol. ii., p. 784. 46 DISCOIJESE. his father, in accordance with the custom of the phi- losophers and physicians of that epoch, he traveled over many countries ; and afterwards, in the pursuit of his profession, spent much time in the cities of Macedonia, Thrace, and other parts of Greece. At Athens, about the time of the Peloponnesian war, his reputation was such, either for the professional services rendered to that city in relieving it of an epidemic, or for having refused to assist the enemies of his country when solicited to do so by Artaxerxes, that it was decreed that he should be initiated into the Mysteries of Eleusis, that he should enjoy the right of citizenship, that he should be supported in the Prytaneum at the public expense, that he should be honored with a golden crown, and that all the children born at Cos, his native island, might pass their youth at Athens, where they should be treated as the offspring of Athenian citizens. H ow much of his time may have been spent in the city where he was thus distinguished, has not been ascertained ; but his most protracted residence was at Larissa and other cities of Thessaly, where he spent his lat- ter days, and where he died, at the advanced age of eighty-five or ninety years.* Many speculations have been offered, to account for the rapid advancement of medicine in the hands of this great father of the profession. According to Celsus, his principal credit was in removing the teach- ing of medicine from the schools of philosophy, where it had always received some attention, and * Soramis. Genua et Vita Hippocratis. See Kuhn's Hippocrates, vol. iii., p. 850. DI8C0UESE. 47 treating of it apart, as a distinct department of practical knowledge. Pliny,* after Yarro, supposes tliat lie was tlie first to institute clinical instruction, " hanc qucB Olinicce vocatur^^'' tliat lie was led to this after tlie burning of the temple of Cos, and that the materials of his course were supplied mainly by the votive tablets which had been there accumulating. But his claim to our respect rests on higher ground. The great among ma nkind are not merely those who set the first examples. Examples are often the result of accident ; and the Fest of them, in a prac- tical point of view, rarely the result of forethought. He who detects the rising spirit of the age, who first gives expression and enxbodiment, or the power of progress and enduran^ie^o the wisdom, feelings, aspirations, customs, or hitherto undivulged opinions of his times, is even mor£ worthy of regard than the innovator. Such a man was Hippocrates. He lived in an age of progress. The earliest historians, the earliest and ablest dramatists, the profoundest phi- losophers, the wisest legislators, the ablest generals, the greatest architects, painters, and sculptors of Greece, were all men of the same epoch. And while other arts and sciences were thus springing into life, and rising at once to maturity, it is not surprising that some man of genius should appear in the ranks of medicine, to give to its principles form and utter- ance. This man was Hippocrates. He was not, then, the inventor of the healing art, nor of the modes of teaching it. He was not the * Hist. Nat. Lib. xxix., cap. i. 48 DISCOURSE first to write upon it. But familiar with its tra- ditionary lore, with the science and philosophy of his day, and with the practical details of his pro- fession in all its bearings, he was the first to com- bine such knowledge in systematic form, and to give to it a scientific value ; yet not so clearly scientific, as to be sufficient of itself, in the form in which he left it, and independent of oral comment or practical illustration, to qualify the aspirant who would avail himself of it alone, for the proper exercise of his calling. " The more I become familiar with the Hippocratic books," says M. Littre,* " the more I am convinced that they were prepared with reference to the accompaniment of oral instruction, without which even the clearest of them are both obscure and incomplete." Yet these books opened to the learned much that had hitherto been taught in full only to the initi- ated, and paved the way for the more exact and rational study of medicine as a liberal art. The loss of respect for the mysteries of the temples was after- wards in proportion to the general diffusion of correct knowledge. The schools of Cnidos and Cos had now entered upon the cultivation of medicine as a sci- ence ; and with them were associated not only the family descendants of this great man, but also most of the distinguished names in the profession between the days of Hippocrates and the founding of the Alexandrian Museum. Among the writings attributed to Hippocrates, it * CEuvres d'Hippocrat, tome iv, p. 625. DISCOUESE. 49 is difficult to determine wliat portion was written by himself, and wliat by his immediate disciples. On this point the critics have never been able to agree. By Erotian and Galen many works were accepted as his which the moderns are disposed to refer to other writers. Foes,* to whom we are indebted for a most careful Latin version of the whole collec- tion, was willing to accept as genuine all works pro- nounced to be such by the ancients ; but the later critics have not so readily deferred to ancient au- thority. According to Mercuriali,f not more than fourteen treatises out of the whole collection were published by Hippocrates himself. Five others, according to the same critic, may have been left by him unfinished, to be completed either by his son-in-law and suc- cessor, Polybius, by his sons Thessalus and Draco, by his grandson Hippocrates, or by other members of his family. A third portion, including about twenty-two treatises, though perhaps not even begun by Hippocrates, is in strict accordance with his doc- trines, and is believed by Mercuriali to have ema- nated from the immediate descendants of Hippo- crates or other disciples of the school of Cos. The remaining portion of the collection, according to the same authority, consists of spurious writings, and of such as contain opinions not in accordance with the doctrines of Hippocrates, though published as his. * Magni Hippocratis Opera omnia quse extant, in sectiones octo ex Erotiani mente distributa, nunc recens Latina interpretatione et annota- tionibus illustrata, Anutio Faesio auctore. 2 vols. fol. Frankfort, 1596. f See Schulze, p. 215. 50 DISCOURSE. Other distributions of tliese works have since been made, by Haller, Gruner, Schulze, Ackermann, Grimm, Sprengel, Link, Peterson, and other writers. M. Littre,* after a most careful and searching ex- amination of the whole collection, distributes the various works composing it into eleven classes, plac- ing in class first the thirteen treatises which are be- lieved to be from the pen of Hippocrates. These are, 1st, — the book on Ancient Medicine; 2d, the Prognostics ; 3d, the Aphorisms ; 4th, the Epi- demics, first and third books ; 5th, Regimen in Acute Diseases; 6th, on Air, Water, and Places; Yth, on Articulations ; 8th, on Fractures ; 9th, the Mochlicus, or Instrument for reducing Luxations, &c. ; 10th, the Physician's OfiSce ; 11th, Injuries of the Head ; 12th, the Oath ; 13th, the Law. The works of the second class he attributes to Polybius. These are, the book on the Nature of Man, and that on Eegimen for Persons in Health. In the third class he includes two books which he believes to be more ancient than the genuine writ- ings. These are the Coan Praenotions and the first book of Prorrhetics. In class fourth, he places cer- tain works which he cannot on undisputed authority assign to Hippocrates, but which may have ema- nated front his school. These are the treatises on UlcerS; on Fistulse and Hemorrhoids, on Pneuma, on the Sacred Disease, on the Places in Man, on Art, on Kegimen and Dreams, on Affections, on Internal Affections ; on Diseases, first, second, and third * Loco citato, chap. xii. DISCOUESE. 51 books ; on tlie Seventh Montli Foetus, on the Eighth Month FcBtus. In the fifth class he includes such works as appear to be merely collections of notes, or extracts from other of the genuine writings : these are the second, fourth, fifth, sixth, and seventh books on Epidemics, the book on Humors, that on the use of Liquids, and perhaps the Physician's Office, which is also mentioned in the first class. In class sixth he places several books by some nnknown author, who must have written earlier than Aristotle, and whose writings form a special series in the collection. These are the treatises on Gener- ation, on the Nature of the Infant, Diseases — fourth book, the Diseases of Women, the Diseases of Young Women, on Unfruitful Women. In class seventh he places the treatise on Superfoetation which, on the authority of Aristotle, he is disposed to ascribe to Leophantes. His eighth class is made up of works which appear to have been written about the time of Aristotle and Praxagoras ; and which he con- siders to have been of this epoch, either because they make allusion to the pulse ; or because, in ac- cordance with the teaching of Aristotle, they refer the origin of the blood-vessels to the heart ; or be- cause, by Erotian, Galen, or other of the ancient critics, they have been pronounced to be more recent than the time of Hippocrates. These are treatises or fragments on the Heart, on Aliment, on Fleshes, on the Weeks, the second book on Prorrhetics, on the Glands, and an extract from the compilation on the Nature of Bone. In class ninth he places several small treatises, 52 DISCOUESE. fragments, or compilations, whicli do not appear to liave been mentioned by the ancient critics or com- mentators. These are, on the Physician, on Honor- able Conduct, the Precepts, on Anatomy, on Den- tition, on the Nature of Woman, on Excision of the Foetus, the eighth section of Aphorisms, on the Na- ture of Bone, on Crises, on Critical Days, on Pur- gative Medicines, on Vision. In class tenth he intro- duces a notice of such works as formerly belonged to the collection, but which are now lost. These were, the book on Dangerous Wounds, that on Missiles and Wounds, and the first book on Dis- eases — the less. In the last class he places the Letters, Decree, and Discourse ; which, though very ancient, are not the less apocryphal. These are, the Letter and Decree concerning the Plague, the Let- ters relating to the Madness of Democritus, the Letter from HijDpocrates to his son Thessalus, and the Discourse relative to the war between the Athenians and the people of Cos. The classification adopted by Dr. Greenhill, of Ox- ford, and Mr. Francis Adams,* the English translator of Hippocrates, does not materially differ from the foregoing so far as relates to the writings of Hippo- crates and of his immediate family and disciples; though Mr. Adams believes that M. Littre, in re- jecting certain portions of the eighth class, has under- estimated the anatomical knowledge of the sage of Cos, and he gives good reasons for this opinion. In examining the collection with reference to its * Genuine Works of Hippocrates, vol. i. p. 46. DISCOURSE. 53 doctrines, we find Hippocrates in the first place investigating tlie influence of surrounding circum- stances on the health and diseases of the living body. In the book on Ancient Medicine he op- poses those who would attribute all diseases to a single cause, whether heat or cold, or dryness or moisture. He founds his system on realities — ^on observation, the records of science, and the deduc- tions of sound reasoningy Adopting from the schools of philosophy the doctnne of the primitive elements, and that of the primitive humors which was derived from this, he sees in the human body the humors undergoing changes in accordance with the con- ditions of health and disease. He is led to believe that health is maintained by the equable proportion and intermixture of the humors, and that disease is the result of their inequalities. He admits that dur- ing their changes the disordered humors undergo a process of coction by which they may be restored to their healthy condition ; and as time is requisite for effecting this process he undertakes to show how the critical discharge is brought about ; and to establish the days within which it is to be expected. In the book on Airs, Waters, and Places, he in- quires into the effects of particular exposures, of the seasons and their vicissitudes ; the influence of winds and the properties of waters. He alludes to the diseases prevalent in different places and during different times of the year. He contemplates the moral and physical characteristics of different na- tions, resulting from the climate, locality, and other influences to which they are subject. He rejects the 54: DISCOURSE. superstition of his times in reference to supernatural agencies. He holds that no one disease is more the result of divine wrath than another, and that all of them originate from natural causes. The predispo- sitions resulting from the different periods of life, he studies with equal attention. He holds that the innate heat of the body is at its maximum during infancy, at its minimum in old age ; and that each particular phase in this quality, like the influence of the sun in different seasons of the year, predisposes to its particular class of ailments. Among the agencies applying more especially to the individual, he dwells with becoming attention on diet and ex- ercise ; showing how excess or deficiency in the one or the other, may prove the prolific source of dis- ease. In connection with this theory of innate heat, and that of the humors, he lays much stress on the doctrine of Coction ; implying by this term, the changes which the disordered humors undergo, pre. paratory to their elimination. So long as they are floating about in a state of crudity, the disease con- tinues in full intensity ; but w^hen they are properly elaborated, the disease reaches its crisis, and they are discharged, either by the spontaneous effort of na- ture, or by the aid of medicine acting in subservi- ence to nature's laws. Where the crisis cannot thus be effected by the removal of the offending humors from the body, it may be brought about by their localization in particular organs or parts of the body, as by the development of a critical abscess, by an erysipelatous inflammation, by a diseased joint, or DISCOURSE. 55 by a circumscribed mortification. But where tbe crisis is not to be effected either by elimination or localization, the disease is said to be incurable, as in cancer. The critical discharges, where the disease is general, may be effected either by perspiration^ by the flow of urine, by alvine dejections, by emesis, or by expectoration. The cycle of changes by which the crisis is effected, he holds to be usually completed within certain definite periods of time; and the days at whifth the crisis may be anticipated, he calls Critical Days. He dwells with much care on every circum- stance likely to retard or accelerate the critical period, and on the dangers to be apprehended dur- ing those critical days, regular or irregular, in which the disease is not adjudicated. The study of the various appearances pointing to the probable result of the disease, to the character of the crisis, and to the time at which this may be expected, is summed up in his doctrine of Prognosis. By this was meant something more than is implied in the etymology of the term, and much more than is at present un- derstood by it. In the estimation of the early Grecians, Prognosis was the crowning department of medical science; furnishing them the key for ex- plaining the past and present, as well as the yet to be developed circumstances of disease ; and pointing out to them what should be left to the efforts of na- ture, and what might require the interference of art, where nature, unassisted, was unable to bring the disease to a favorable issue. It is further worthy of remark, that in the Hip- 56 DISCOURSE. pocratic school, the condition and changes of the humors, the crisis, the critical discharges, the critical days, and above all, the prognostications, were studied in the abstract, or as connected only with the condition of the living body, without reference to the distinctive traits of individual diseases. With them, prognosis was the application of medical science for determining the value of general mani- festations, not of particular morbid processes. It held the same relation to diseases in general, that diagnosis, in our use of the term, now holds to individual ailments. In his book of Prognostics, Hippocrates dwells only on the generalities of disease. In his Epi- demics he describes what he himself had witnessed, even to the progress and results of individual cases, still studied in the same spirit of generalization, without reference to the characteristic features of individual, much less of specific diseases. In his book on Regimen in Acute Diseases, he appreciates his therapeutics as subservient to the indications of nature, w^hose efforts it becomes the physician to assist, but never to interrupt. The teaching of Hip- pocrates and his disciples, is thus shown to have been theoretical, yet founded on what, at the time, appeared to them to be legitimate inferences from the observation of facts, — of facts carefully studied and cautiously generalized. And while the whole science of physiology, and nearly the whole of an- atomy, remained yet to be explored, we are not so much to be surprised at their theories, as that these theories, derived almost exclusively from the DISCOURSE. 57 study of external appearances, should have been so very near the truth. As already intimated, several treatises in the Hip* pocratic collection must have emanated from writers not of the school of Cos, but who are to be con- sidered either among the contemporaries of Hippo- crates, or of his more immediate descendants. The book on Regimen for Persons in Health, has been ascribed to Philiston, who was celebrated for his acquaintance with anatomy, and who flourished about the time of Plato. The treatise on the Seventh Month Foetus, has been attributed to Diodes of Carystus, also an early writer, — compared, for ability, with Hippocrates himself. He was- the first to point to the distinction between pneumonia and pleurisy ; he was the ablest anatomist of his age, and the author of numerous works ; among which was a treatise on Hygiene, and another on Gym- nastics as applied to the treatment of disease. About the same time also, flourished Petronas, a sort of homeopath, who, according to Celsus, treated fevers by overloading the sick with clothing, in order to increase their heat and thirst. Praxagoras, a contemporary of Aristotle, appears to have been among the first to allude to the pulse, a circum- stance, however, also mentioned by Aristotle him- self, though not as furnishing any useful indications in the treatment of disease. Plistouicus, a pupil of Praxagoras, may also have contributed somewhat to the opinions promulgated in the Hippocratic writ- ings, particularly in reference to the humors; to the study of which he and his disciples were more than 5 58 DISCOURSE. usually attentive. But the portions of tlie collection most at variance with the doctrines of Hippocrates, were probably derived from the Asclepion of Cnidos, the abode of many able teachers ; among the prin- cipal of whom, after Euryphon, was Chrysippus. Of the Cnidian school, we have no well-authenti- cated remains, and no other trust- worthy account than such as may be found in the few intimations furnished by Hippocrates himself, and by Jiis com- mentator and disciple, Galen. M. Littre,* however, has recently furnished some grounds for believing that the second and third book of Diseases, and the book on Internal Affections, as at present embodied in the Hippocratic collection, are in some respects not in strict harmony with the rest ; and that the doctrines contained in them, tested by what is known of the Cnidian Sentences, prove to be in accordance with these, and consequently, such as may have issued from the Cnidian school. Be this as it may, the doctrines of the two schools were not in every point alike.f And the rivalry between their respective writers and teachers, dur- ing the early period of scientific progress, was car- ried on with much vigor. Hippocrates, in his book on Ancient Medicine, and again in that on Regimen in Acute Diseases, takes occasion to criticise the opinions and practice of Euryphon, as expressed in the Sentences. Ctesias of Cnidos, in turn, as we learn from Galen, criticises the practice of Hippo- * OEuvres d'Hippocrat, tome vii. p. 304. f Galen (Kuhn's edition), vol. v. p. 761 ; vol. xv. p. 363, 42*7. DISCOURSE. 59 crates. Chrysippus, of the Cnidian school, and his disciple Erasistratus, oppose the use of active pur- gatives and venesection ; whilst Herophilus, at Alex- andria, writes in favor of the lancet, and is a follower of the Sage of Cos. The modes of contemplating disease in the two schools, were not alike. The Cnidians attended mainly to minute distinctions, to the characteristic traits of individual diseases, with little regard to the bearing or mutual relations of special symptoms. Thus they enumerated seven different diseases of the biliary organs, twelve of the bladder, and four of the kidneys; they described four kinds of stran- gury, three kinds of tetanus, four of jaundice, and three of phthisis. Their neighbors of Cos, on the other hand, held the study of such distinctions to be of small account, and gave their special attention to the grouping of important symptoms, — to what would now be called the constitutional condition, or the state of the system, — without regard to the par- ticular disease, but mainly with reference to the prognosis and indications of treatment. In the management of acute diseases the Cnidians employed numerous remedies, and in other affec- tions, few. The school of Cos, though at times more heroic, especially in the use of the lancet and active purgatives, were in the habit of managing acute dis- eases by a restricted regimen ; barley-water more or less diluted, hydromel, and oxymel, being among their most frequent prescriptions. In the manage- ment of chronic diseases, they favored the medical gymnastics of Herodicus ; whilst at Cnidos these dis- 60 DISCOURSE. eases were managed principally by laxatives, and a diet of milk, or of milk and water.* We might here stop for a moment to ask, what would have been the effect upon the progress of medicine in ancient times, had these two distinct modes of investigation been pursued with equal skill and perseverance by both parties. For the Cnidian method must have been laid aside at an early day, and that of the rival school universally adopted. Each method in the abstract, has its respective advantages, and each its own defects. In the early stage of inquiry, while facts are comparatively few, and insufficient to warrant sound deductions, or where their relative significance has yet to be deter- mined, the Cnidian method might not only have been the safest, but the one which would have led the most speedily and surely to those results which the rival schools were ambitious of reaching at a bound. Hippocrates and his followers, it is true, were not entirely indifferent to the study of individ- ual diseases; but, from their over-estimate of the scientific importance of prognostic indications, the individual types of disease were not so thoroughly investigated as they might have been. Had they dwelt on these with greater care, it is possible that most of the diseases which are now looked upon as of comparatively recent origin, and for accounts of which we search in vain among the ancient medical authorities, might be shown to have existed from the earliest times. In the progress of medical * (Euvres d'Hippocrate, par M. Littre ; tome ii. p. 198 ; tome vii. p. 304. DISCOURSE. 61 science, as in the growtli of individual judgment, tlie period of observation must precede that of philoso- phizing. And until facts have been accumulated in sufficient number and variety to dispel the errors involved in preconceived opinion, the inferences to be derived from them are, at most, nothing better than sagacious speculations. The descriptions of epidemic and other diseases, by the early historians, who drew from observation only, who made no pre- tensions to medical knowledge, and whose minds were unembarrassed by the training of the schools, are at the present day more worthy of reliance than the accounts rendered of the same diseases by con- temporary medical authorities. There is, even in the Hippocratic code, nothing to compare in truthful- ness and fullness of detail, with the account furnished by Thucydides, of the Plague of Athens ; a disease ' which prevailed when Hippocrates was about thirty years of age, and the description of which was prob- ably written before he began his career as an au- thor. This memorable passage from the History of the Peloponnesian "War, I must here take the lib- erty of condensing. " At the beginning of the next summer," says Thucydides,* " the Peloponnesians and their allies invaded Attica, and laid waste the country. When they had not yet been many days in Attica, the plague began to show itself among the Athenians, though it was said to have previously lighted on many places about Lemnos and elsewhere. Such a * Book ii. chap. 4*7-58. 62 DISCOURSE. pestilence as this, was nowhere remembered to have happened. The physicians were at first of no avail; treating it, as they did, in ignorance of its nature. Nay, they themselves died most of all, in- asmuch as they most visited the sick. Nor was there relief in any human art. As to the suppli- cations offered in the temples, or the divinations and other similar means, they were all equally un- availing, and were at length relinquished by the people, who were overcome by the pressure of the calamity. \] " It is said to have first begun in JSthiopia, then to have extended into Egypt and Lybia, and the greater part of the king's territory. On the city of Athens it fell suddenly, first attacking the men on the Piraeus, so that it was even supposed by them that the Peloponnesians had thrown poison into the cisterns ; for as yet there were no fountains there. It afterwards reached the upper city, where it was much more general. Now, let every one, whether physician or unprofessional man, maintain his own opinion as to the source and causes of the disease ; I, however, shall only describe its character, and ex- plain the symptoms by which it may be recognized should it ever return ; for I was both attacked by it myself, and had personal observation of others who were suffering from it. " That year, then, as was generally allowed, hap- pened to be unusually free from other diseases ; and if any such appeared, they all terminated in this. Without any ostensible cause, while apparently in good health, those about to suffer from it were sud- DISCO U E S E . 63 denlj seized, at first, with violent heats in the head, redness and inflammation of the eyes; and imme- diately the internal parts, both the throat and tongue, assumed a bloody tinge, and emitted an un- healthy and foetid odor. Next came sneezing and hoarseness, and in a short time the pain descended to the chest, with a violent cough. When it settled on the stomach it caused vomiting ; and all the dis- charges of bile mentioned by physicians, succeeded, and were accompanied with great suffering. An in- effectual retching also followed in most cases, pro- ducing violent spasms, which in some instances ceased soon afterwards, in others, much later. Ex- ternally, the body was not very hot to the touch ; nor was it pale, but reddish, livid, and broken out in small pimples and sores. But the internal parts were burnt to such a degree that the sick could not bear clothing or linen of the very lightest kind to be laid upon them, nor to be any thing else than stark naked, and would gladly have thrown themselves into cold water if they could. Indeed, many of those who were not taken care of, did so, plunging into cisterns in the agony of unquenchable thirst ; and it was all the same whether they drank much or little. Moreover, the misery of restless- ness and wakefulness continually oppressed them. The body did not waste away so long as the disease was at its height, but resisted it beyond all expecta- tion, so that they either died in most cases, on the ninth or seventh day, through the internal burning, while they had still some degree of strength ; or, if they survived this period, the disease descended into 64: DISCOURSE. the bowels, producing violent ulceration there, and in- tense diarrhoea, by which the greater part were car- ried off through weakness. For the disease, begin- ning in the head, passed downwards throughout the whole body, and whoever survived its fatal conse- quences, was afterwards affected in his extremities; for it settled on the pudenda, fingers, and toes, and many escaped with the loss of these ; others, also, with loss of their eyes ; others again, were, on their first recovery, seized with forgetful n ess, so as not to know either themselves or their friends. "The severity of the disease surpassed descrip- tion, and in the following way it proved itself to be different from other diseases. All the birds and beasts that prey on human bodies, did not come near these, though many bodies were lying unbur- ied ; or if they did, they died after they had tasted them. As a proof of this, there was a marked disappearance of birds of this kind ; while the dogs, from their domestic habits, afforded even clearer opportunity for marking the result here mentioned. " To pass over many points, one case of the dis- ease differed from another ; yet, in its general char- acter, it was such as is here described. Among those attacked, some died in neglect, others in the midst of every attention. There was no settled remedy, and what did good to one, did harm to an- other. No constitution was proof against it, but it seized on all alike, even those that were treated with all possible regard to diet. The most dread- ful part of the calamity was the dejection of those DISCOURSE. 65 who found themselves sickening, and the fact of their being charged with the infection from attend- ing on one another, and so dying like sheep ; for when seized, they fell into despair, and by abandon- ing themselves the more certainly to the disease, they were the less able to resist it. It was this that caused the greatest mortality; for if through fear they were unwilling to assist each other, they perished from being deserted ; or if they did visit, they met their death, especially such as made any pretensions to goodness, or who, from a feeling of shame, were unsparing of themselves, going into their friends' houses, where even the members of the family were worn out with the moanings of the dying, and overcome with excessive misery. Still more, however, than even these, did such as had escaped the disorder, show pity for the dying and the suffering, both from their previous knowledge of what it was, and from being now in no fear of it themselves ; for it never seized the same person twice, so as to prove actually fatal. " In addition to the original calamity, what op- pressed them still more, was the crowding of the city with new comers from the country. For, as these had no houses, and were forced to live in stifl- ing cabins at the hot season of the year, the mortal- ity amongst them spread without restraint ; bodies lying on one another in the death-agony, and half- dead creatures rolling about in the streets, and around all the fountains, in their longing for water. The sacred places also, in which they had quartered, were full of the corpses of those who died there ; for, in the surpassing violence of the calamity, men DISCOTJKSE came to disregard every thing, 'botli sacred and pro- fane. All the laws of burial were violated, and many from want of proper means, had recourse to shameless modes of sepulture ; for, on the piles pre- pared for others, some, anticipating those who had raised them, would lay their own dead, and set fire to them ; and others, while the body of a stranger was burning, would throw on the top of it the one they were carrying, and go away. " In other respects also, the plague was the origin of lawless conduct, for the deeds which men had formerly hidden from view, were now openly per- petrated. Seeing the sudden changes, they resolved to take their enjoyment quickly; regarding their lives and their riches alike as things of a day. As for taking trouble about what was thought honor- able, no one was forward to do it, deeming it uncer- tain whether before he had attained it, he would not be cut off. And as to fear of gods, or law of men — there was none to stop them. ^' Such was the calamity which afflicted the Athe- nians, their men dying within the city, and their lands being wasted without. Their fleet too, which, during the same summer, had proceeded against Potidsea, was unsuccessful ; the plague attacking the forces, and utterly overpowering them, so that out of four thousand heavy-armed men, fifteen hundred perished in about forty days ; and the soldiers of the Athenians, who had been there before the ar- rival of the fleet, became infected by the newly arrived t roops, though previously they had been in good health. "• On the following winter," adds Thucydides in DISCOURSE. 67 another place,* " the plague a second time attacked the Athenians, having, indeed, never entirely left them, though there had been some abatement of it. It lasted, the second time, not less than a year, the former attack having lasted two ; so that nothing reduced the power of the Athenians more than this, for not less than four thousand four hundred heavy- armed in the ranks, died of it ; and three hundred of the equestrian order, with a number of the multi- tude that was never ascertained. It was at this time also, that the numerous earthquakes happened at Athens, Eubsea, and Boeotia, particularly at Or- chomenos in the last-named country." One circumstance mentioned in the foregoing pas- sages from Thucydides, is worthy of particular no- tice, his direct allusion to the spread of this disease by infection, a subject rarely if ever referred to by the medical authorities of antiquity, and upon which I shall again have occasion to speak in connection with Pliny's account of the Mentagra of the Romans. Before closing our notice of medicine among the early Grecians, having already ventured beyood the strictly professional authorities, it is but proper to give some attention to an author whose writings, more than those of most other men, have been in- strumental in exciting to discussion and inquiry in every branch of science. I allude to Aristotle. I need not in this connection refer to his influence as a teacher of philosophy. In this department he III. SI, 68 DISCOUESE. divided with Plato tlie admiration of the ancient world, and throughout the middle ages was held in supreme authority among the schoolmen. I refer to him here simply as a contributor to our know- ledge of animated nature, to anatomy, and physi- ology, to the history of the lower animals, and of many of their diseases. The work of Aristotle, entitled " De Animalibus Historige,"* is divided into nine books. In book first he gives the configuration of every organ and part of the human body, accessible to the sight without the aid of dissection ; next, acknowledging his utter ignorance of the internal structure of the body, he proceeds to describe that of such lower animals as are thought to bear the greatest resem- blance to the human race. In book second he gives the organization of the various classes of animals supplied with blood, meaning such as have red blood. In book third he gives a treatise on what would now be called general anatomy, or the anatomy of the simple tissues and structures : the blood-vessels, and the heart ; the nervous, and what we would call the tendinous, and some of the mem- branous tissues and organs; the firmer fibrous tissues ; the bones, the cartilages, the tegumentary envelopes and their modifications in diff'erent classes of animals ; the substance of the brain and its en- velopes ; the envelopes of the bones ; the muscular tissue ; the fat ; the blood ; the medulla of bones ; the * Aristotelis de Animalibus Historise libri x, Lipsise, 1811, 4 vols. 8vo. of which the last book is spurious. DISCOUESE. 69 milk, and seminal fluid. In book fourtk be pro- ceeds to describe with equal care the organization, of the different classes of animals without blood, or as we would say, having only white blood. Books fifth and sixth treat of the reproductive functions of the lower animals, from the simplest upwards ; book seventh, of the corresponding functions in the hu- man race ; and the two remaining books, of the habits, localities, instincts, and propensities of the lower animals ; several chapters of the eighth book being devoted to their diseases. His division of the parts of animals into simple and compound, was adopted by most of the later writers on anatomy, and particalady by Galen. He denies the assumption of Alcmaeon, that goats are able to respire through their ears. He describes the two envelopes of the brain ; the firmer invest- ing the inner surface of the skull ; the more deli- cate or venous membrane resembling a skin, sur- rounding the brain itself; which, he says, is with- out blood, and consists of two parts, the cerebrum and cerebellum. He alludes also to the lateral ventricles. He gives a sufficiently close and ac- curate description of the respiratory organs, and their connection with the heart. It is not certain, says he, when air has traversed the arteria aspera whether it passes directly to the heart by the lungs, in all animals; though he held such to be the fact in most of them. Of all the organs the heart alone holds blood within itself; for the blood of the lungs is not proper to them, but is contained with- in the vessels in communication with the heart. TO DISCOURSE. The blood in the middle sinus of the heart is the most attenuated. He refers to the erroneous opinions of earlier writ- ers, particularly to those of Syennesis of Cyprus, Diogenes Apolloniata, and Polybius, in regard to the origin and distribution of the blood-vessels; and after alluding to the difficulty of the investigation, proceeds to give his own account of them. These vessels, he declares, have not their origin in the head or brain ; but are derived directly from the heart. Here the nerves also receive their origin. There are, he adds, two veins within the chest near the spine, the larger of which lies in front of the other, and more towards the right side. The smaller of the two is of a nervous structure when seen in the dead subject, and is called the aorta. Both of these vessels have their origin in the heart; through whatever viscera they pass, their course is continu- ous and uninterrupted. The heart constitutes, as it were, a part of them; particularly its anterior por- tion, where it is connected with veins passing both upwards and downwards ; the heart itself resting in the midst. He attempts to show a connection be- tween the branches of the vena-magna after pass- ing through the diaphragm to the liver, with other veins passing upward towards the right axilla and arm ; adding that the physicians, by drawing blood from the vessels of this arm, are enabled to cure certain diseases of the liver. A similar connection he elsewhere traces between the vessels of the spleen and those of the left arm. The blood is thicker and darker in the lower, Dl&C0rR9E, 71 than in tlie upper parts of the body. In the veins of all animals it is observed to palpitate. It is the only one of all the humors which is always present so long as life endures. It is supplied from the blandest fluids of the body, and formed within the heart. Deprived of it to a slight degree, the animal faints; to a greater extent, the animal dies. It changes in quality with the periods of life ; and if too thin," it leads to diseases. When vitiated it gives rise to hsemq^rhoidal flux, to epistaxis, to pileSy and to varices. Pus is the result of its putrefaction. The bones, deprived of their fibrous envelope, desic- cate ; the bladder and other membranous or ner- vous sacks and tissues, when cut, never heal. Among quadrupeds the hog is subject to three diseases, all of which he describes, giving the symp- toms and mode of treatment, namely, — angina, which extends from the throat to the luno^s and other parts of the body ; scrofula, affecting the head and contiguous parts ; and a disease of the bowels, which is usually fatal. Dogs are also subject to three diseases, — rabies,, angina, and podagra ; all of which are briefly described. Rabies renders the animal insane, and all others that are bitten by him, excepting man; and is fatal to all that are affected with it. And thus he treats on the diseases of other animals, savage and domestic. From the foregoing exposition it will be seen that in his acquaintance with anatomy, physiology, and, we may also add, general pathology, Aristotle was far in advance of his epoch, approaching more closely to the medical science of modern times than 72 DISCOURSE. to the humoralism of antiquity. With him the blood was the pabulum vitse, which, when dis- ordered, gave rise to disease throughout the body. He has nothing to say either of the four elements, or of the four primitive humors ; and in his study of minute distinctions, — the characteris#c trait of his writings on natural history as well as on every Dther branch of knowledge, — his doctrines were less in conformity with those of Hippocrates, than with those of the school of Cnidos. The spirit of medical inquiry, as now shown, had already far outgrown the confines of the temples. Yet, as institutions of religion, most of these still maintained their ancient ceremonies. The Ascle- pion of Cnidos is known to have continued up to the age of Constantine ; when, in common with other remaining abodes of pagan worship, by an edict of this emperor, it was leveled to the ground. But the Asclepiadse of Cos, forgetting the influence of their former mysteries, were preparing the way for a new order of institutions. By slow degrees they lost the suffrages of the multitude. Their sacred groves and fountains, no longer the resort of a con- fiding people, lay neglected and forsaken, by priests as well as patients ; and at length the Roman Pre- fect, Turullius, in the days of Mark Anthony, while at Cos, regardless of the divinity that once had ruled within the precincts of its hallowed shades, ordered the groves to be destroyed, and the timber to be converted to the uses of the navy."^ ^^Ac * Littre, loco citat. p. 11, from Lactantiue. Schulze, p. 130. DISCOUESE. Y3 minus credunt^ quoe ad mlutem suam pertinent^ si intelligunt!^ But, notwitlistauding the waning of tlie Ascle- piadse, tlie teaching of medicine continued to flourish. As early as the time of Aristotle, the profession had not only lost much of its ancient association with the priesthood, but had already be- come divided into classes, — the apothecaries, whose only business consisted in preparing and dispensing medicines ; the physicians, engaged in general prac- tice ; and the medical philosophers, who pursued the study as a liberal science only, without devot- ing their attention to it as an industrial occupa- tion. f From this latter class were probably drawn the first teachers of the Alexandrian school; the opening of which, about three-fourths of a century after the death of Hippocrates, marks the second great epoch in the progress of medical knowledge. * Pliny, Hist. Nat, lib. xxix. e. viii. t Aristotle, Politics, book iii. c. xi. and book iii, c. xvi. Aristotle him- self, if we may believe Athenseus (Deipnosophists, book viii. c. 50), was in early life, after wasting his patrimony, the keeper of an apothecary shop in Athens. 6 74: DI8C0UKSE CHAPTEE V. PERGAMUS AND ALEXANDRIA. The rapid extension of Grecian arms under Alex- ander the Great, led to the diffusion of taste and learning among the surrounding nations. Perga- mus and the new capital of Egypt, became points of scientific attraction second only to Athens; and with the spread of general knowledge, the study of medicine extended to these cities. At Pergamus, a library of immense extent had been accumulated by the predecessors of the first Attains.* The Asclepion of this city was among the earliest off-shoots from that of Epidaurus.f The . peristyle of the temple, and the avenues leading to it, were occupied as places of public instruction and scientific intercourse. Here the orators, sophists, and philosophers of the city, held their daily con- ferences, and sometimes amused themselves in ex- pounding to the sick the vaticinations of the priests. As a school of medicine, the Asclepion of Pergamus enjoyed a long-continued celebrity ; but its bright- est era was after the first decadence of the Alexan- drian school. The city of Alexandria, from which issued much * Vitruvius, lib. vii., prgefatio, § 4. t Le Clerc, lib. i. chap, xx., after Pausaniaa. DISCOURSE. 75 of the later learning of antiquity, was projected by the architect, Dinocrate?,^ commenced during the lifetime of Alexander, and carried nearly to com- pletion by Ptolemy Soter ; but many of its public works remained to be finished under his son and successor, Philadelphus.f By means of an artificial causeway, jutting three-fourths of a mile into the sea, the long and narrow island called Pharos, in front of the city, was connected to the main land, and thus converted into a breakwater for the protection of the spacious harbor ; in front of which stood most of the public edifices. From the temple of Pan, which rose like a sugar-loaf in the center, the whole of this remarkable capital could be surveyed at a glance. Its two main streets crossing at right angles, were flanked with rows of columns ; the one extended lengthwise thirty stadia, or about three miles; and the other transversly about one-fourth of this distance. Fronting the harbor in the middle of the principal avenue, stood the Soma, or mauso- leum of the Greek kings, taking its name from the body, meaning the body of Alexander, which was the first therein deposited. Ranging in a line with this along the shore, stood the temple of Neptune, the Emporium or Exchange, the royal docks, the hall of justice, the Serapium, and the Museum of College of Philosophy. Beyond the Heptastadion, as the stone causeway, from its length, was called, were seen other docks; and beyond the walls, the theater, the amphitheater, and the beautiful Gymna- * Vitruvius, lib. ii., prsefat. § 4. f See Sharpe's Egypt, pasbim. T6 DISCOURSE. sium for athletic exercises, with its stoa or portico of a stadium in length, where the pentennial games were celebrated. On one side of the city could be seen the Hippodrome for chariot races, on the other, the public groves and gardens ; still further off, the Necropolis, with its tombs and sepulchral monu- ments ornamenting the roadside for miles along the shore ; and beyond the western wall, the ship-canal connecting the harbor of Eunostus with lake Mare- otis, which lay beyond the suburbs ; and to which,^ when the city contained its three hundred thousand-" souls, these suburbs reached. The Serapium, or temple of Serapis, on the prom- ontory of Lochias, at the western extremity of the great harbor, was an object as striking to the obser- ver as the lighthouse at the other. Standing within the western gate, this temple, the most magnificent of all the buildings, was approached on one side by a slope for carriages ; on the other, by a flight of a hundred steps, widening as they ascended from the street. At the top of these was the portico, with its circular roof and its supporting columns, which gave entrance to the great court-yard ; in the middle of which stood the roofless hall of the temple, encir- cled with columns and porticos inside and out. En- closed within these porticos were chambers dedicated to the rites of the ancient religion of the country. In one of these stood, glittering with gold and sil- ver, the colossal statue of Serapis, the god whose worship became so popular irf the latter ages of the Koman empire ; and, as if to impress the multitude with superstitious awe, the light here was so ar- DISC0I7ESE. 77 ranged as to allow the sun's rays, at appointed times, to illuminate the statue's lips. But among the inner porticos at a later period, were deposited por- tions of that library which rendered Alexandria the great repository of the science and wisdom of the ancients. In the middle of the inner area of the temple stood a lofty column, visible from all the country round, and from ships far off at sea. And when the temple itself, with its fountain, its two obelisks, its gilded roofs, its painted chambers and glittering architectural ornaments, had perished, this column, under the name of Pompey's Pillar, still stood, to vie, in magnitude and durability, with the yet remaining monuments of the earlier Egyptians. But, among the public buildings of the rising capital, that which has the greatest claim upon our attention, and to which the city ultimately owed its fairest fame, was the Museum. This stood in the quarter of the Bruchium, fronting the harbor. Its chief apartment was a great hall, which served as a lecture-room and place of general concourse. Around the main building, on the outside, was a covered walk or portico ; and connected with it, was an Ex- hedra, in which the philosophers sometimes sat in the open air. This noble institution was originally designed to serve in part as a school for the training of youth in the higher walks of learning, and in part as a retreat within which men of genius and acquire- ments, free from the necessity of providing for their daily wants, might have leisure and opportunity, each in his own way, for extending the domain of 78 DISCOURSE science, or for increasing the enjoyments or im- proving the condition of their fellow-beings. It may have owed its origin, as it owed much of its early celebrity, to the intimate relation existing between the family and descendants of Aristotle, and those of Alexander the Grreat* For, Nicomachus, the father of the philosopher, was the physician and friend of Amyntas, the grandfather of the con- queror ; and Alexander himself had been the pupil and afterwards the patron of Aristotle. Again, Erasistratus, the grandson of the latter, was among the most prominent of the scientific men brought together at the Museum by Ptolemy Soter, its founder; who was, by repute, the natural son of of Philip, and consequently, brother to Alexander. And finally, we read of another Nicomachus, a. name for several generations running through the family of Aristotle, among the associates of the Museum at a later date. The men of learning in the several faculties of this institution, lived together in a sort of frater- nity, eating at a common table, supported in whole or in part at the public expense. Some of them officiated as professors under a fixed salary ; some of them as private tutors, deriving at least a portion of their income from their pupils ; some of them were engaged in the public works, or in the ser- vice of the state ; and some, as original investigators * We are told by Strabo, that Aristotle was the first to collect a library; and that the kings of Egypt, after his example, founded the library of the Museum. See Schulze, p. 359. Athenseus, however, as we shall see, mentions earlier collections. DISCOURSE. 79 in the arts, in literature or philosophy, or in works of fancy, in the exact sciences, in natural history, or in medicine. Under Ptolemy Philadelphus, the Museum had already risen to the highest rank among the Greek schools. Its library already held two hundred thousand rolls of papyrus, equal to about ten thou- sand of our modern printed volumes. At the head of this library, under Ptolemy Soter, its founder, was Demetrius Phalereus, who had formerly been chief-magistrate of Athens. The system of instruc- tion, as at first arranged, was divided among the four faculties of literature, mathematics, astronomy , and medicine ; but other faculties, or special depart- ments, must have been early adjoined to these. At the head of the mathematical department was Euclid. In that of poetry were Theocritus and Callimachus. The chair of philosophy was assigned to Hegesias of Gyrene, that of astronomy to Timo- charis. The department of natural history was under Philostephanus, then engaged in a work on the history of fishes. Manetho, an aboriginal Egyptian, was occupied in preparing an elaborate history of his own country; and Timosthenes, the commander of the fleet, had in charge the subject of geography. In the medical faculty were Gleom- brotus of Gos, Herophilus, and Erasistratus. The first of these was in high repute as a practitioner ; was sent to the relief of Antiochus when danger- ously ill, and after curing that king, received on his return a present of a hundred talents, about fifteen thousand pounds sterling, as a reward from Phila- delphus. 80 DISCOURSE. Ptolemy Sober was himself an author, and the biographer of Alexander. As a man of enlightened understanding and cultivated taste, he took delight in the society of the Museum. He was in daily intercourse with the philosophers, listening to their discourses in the lecture-room, or entertaining them at his own table. At one of these literary dinners he is said to have asked Euclid for a shorter way to the higher mathematics than that by which the pupils were led in the lecture-room ; when Euclid, as if to remind him of the royal roads of Persia which ran by the side of the public highways, but were kept clear and free for the king's use, — gave him the well-known reply, that there is no royal road to geometry. Among the rhetoricians of the museum was the sophist Diodotus Cronus, with whom Ptolemy was in the habit of jesting, and who among other para- doxes maintained the non-existence of motion, — arguing that motion was neither in the place from which bodies moved, nor in that to which bodies moved, and consequently had no existence. Cronus, however, by a fall, dislocated his shoulder; and when asked by Herophilus, who had been called to assist him, whether the fall had occurred at the place where the shoulder now was, or at that from which it had descended, he was by no means con- tented with the application of his own argument, and begged the physician to begin at once by adjust- ing the dislocation. The seven ablest literary men at the Museum, were called the Pleiades ; and they had in charge DISCOUBSE. 81 the business of adjudging prizes and rewards to tlie pupils. At one of their public sessions, a chair accidentally vacant among them, was, for the mo- ment, assigned to the grammarian Aristophanes. When the reading of the exercises was ended, and most of those present were agreed upon the one deemed best of all the compositions, Aristoph- anes dissented from the general judgment, and pointed to the very volume in the library from which this performance had been copied. Ptolemy was struck with this test of the grammarian's acquirements, and soon afterwards promoted him to the post of librarian, then the most honorable office of the Museum. The Ptolmies reserved to themselves the right of appointment to office, and occasionally silenced the professors. Hegesias, in the midst of a discourse against the fear of death, was thus silenced, lest by his eloquence he might excite a passion for suicide among his hearers. But, while watching with solicitude over the business of oral instruction, they took no official notice of books. And Hegesias, no longer able to lecture, consoled himself by recording his opinions, and circulating them among his friends. At a time when books were expensive and readers few, the influence of private reading could hardly be felt upon the social institutions or political des- tiny of the nation ; and hence it was disregarded. Not so with oral instruction. Among the Greeks this had always been the common mode of enlight- ening the people, of amusing them, and of molding their opinions. Most of the poetry, and much of 82 DISCOURSE. the written history of the nation, were prepared for public recitation. Plato,* aware of the influence of such exercises, would have had a censorship upon the poets, that they might not be permitted to recite their compositions in public before submitting them to the judges and guardians of the law, and obtaining their approbation. The business of lecturing, there- fore, was at Alexandria, as in the other cities, of more importance than that of composing for the private reader. The custom of appointing readers for familiarizing the people with Homer and other stan- dard authors, had already been introduced here. And Hegesias, after the loss of his professorial chair, was occupied as the official reader of Herod- otus. Before the settlement of Egypt by the Greeks, papyrus was only in limited use among them. Their adoption of this material in the making of books, was an improvement almost equal to the modern invention of printing. To many of the people books were now known for the first time ; and the new substance upon which they were written, re- placing the wax tablets, the rolls of bark, the cloth, and other articles formerly employed, continued in general use until it was in turn superseded by the comparatively recent invention of writing paper. The Charta Pergamenta, or parchment, introduced two hundred years later than papyrus, was always too expensive for general use, and was, indeed, an inven- tion of necessity by the scholars of Pergamus, when * In the Laws, book vii. c 9. DISCOURSE. 83 Ptolemy Euergetes Jealous of tlie rising reputation of the great library of that city, undertook to arrest its increase by prohibiting the export of papyrus from Egypt. Thus, two of our own words, — parchment from Pergamus, and paper from papyrus, — stand as monuments of the rivalry in the collecting of books, which once existed between Eumenes of Pergamus, and Euergetes of Egypt. This rivalry continued until the kingdom of Per- gamus was bequeathed to the Eomans. And not long after this event, when Julius Caesar set fire to his own fleet in the harbor of Alexandria, the flames accidentally extending to the Museum, which stood in the immediate vicinity of the docks, the building was consumed ; and with it perished in the flames that library which had been the growth of ages, and which, at this time, contained not fewer than YOOjOOO volumes. The Museum was soon after- wards rebuilt. And to supply, as far as possible, the loss of the library, Mark Anthony, when in power, presented to Cleopatra the 200,000 volumes which had hitherto been the greatest boast of Per- gamus. This literary treasure was afterwards de- posited in the Serapium, and Alexandria once more contained the largest library in the world. In connection with the libraries of Alexandria and Pergamus, it may be here observed that among the celebrated collections of earlier date, were those of Polycrates, king of Samos ; of Pisistratus, the tyrant of Athens ; of Euclides, the Athenian ; of Nicorrates, the Samian ; and of Aristotle and his librarian, Nelius.. This latter collection, or at least 84: DISCOURSE. the greater part of it, was purchased by Ptolemy Philadelphus, and, with other collections from Ehodes, constituted the nucleus of the first library of Alexandria.* CHAPTER VI. THE SCHOOL OF MEDICINE AT ALEXAKDEIA. Among the earliest members of the Museum who devoted their attention to medicine, by far the most conspicuous were Herophilus and Erasistratus. Herophilus was a native of Chalcedon, and pupil of Praxagoras of Cos.f He was an original investi- gator ; and, after Diodes of Carytus, the first of the Hippocratic school to distinguish himself as an an- atomist. To him we owe many of the anatomical terms still in use. He was the first to direct atten- tion to the pulse as an index of the varying condi- tions of health and disease ; properly attributing the pulsation of the arteries to the action of the heart. He was familiar with the course of the lac- teal vessels, and with their relation to the mesenteric glands. He experimented on living animals, and even on condemned criminals placed at his disposal in the prisons. He dissected human bodies. His * Athenseus. — ^The Deipnosophists, book i. chapter iv. f See Galen, in numerous places ; also Celsus, in his preface and else- where. DISCOTJRSE. 85 physiological researches excited the indignation of the populace to such an extent as to require the strong arm of arbitrary power for his protection. He traced most diseases to the humors. In practice he resorted to active treatment, after the manner on Hippocrates. He was a voluminous writer in various departments of medicine, treating, among other subjects, on the obstetric art. He was the first to write commentaries on Hippocrates. Professor Marx, who has attempted to collect from Galen and others, all that remains of his produc- tions, ascribes to him works bearing the following titles: — De Causis, Anatomia, Disquisitiones de Pulsu, Curationes, Commentarius in Hippocratis " Prognostica," Commentarius in Hippocratis " Aphorismos," Explicationes Dictionum Exoleta- rium Hippocratis, De Oculis, Digetetica. To which may be added, on the authority of Soranus, the two following: — Contra Opiniones Vulgares, and De Arte Obstetricia.* Erasistratusf was a native of the Isle of Chios. He had pursued philosophy under Theophrastus, and medicine under Chrysippus ; and before coming to Alexandria, had distinguished himself by dis- covering the secret ailment of young Antiochus, son of Seleucus, from observing the acceleration of the patient's pulse during the presence of Stratinice, of whom he was enamored. Like his associate, » De Herophili Celeberrimi Medici Vita, Scriptis atque in Medicina Men- tis By Professor Marx. See British and Foreign Medical Review, vol. xv. p. 110. I Galen and Celsus, a3 above. 86 DISCOUESE. Erasistratus wrote extensively, and made discoveries in anatomy and physiology. He was familiar with the general distribution of the blood-vessels. He de- scribed the anatomical structure of the heart, and like Aristotle, made this organ the source both of the veins and arteries. He held also, in common with Aristotle, that the arteries in health are filled with pneuma, or air, which they receive from the atmosphere in the process of respiration, and that the passage of blood into them from the veins, is the usual cause of disease. He was familiar with the functions of the nerves ; and as we are told by Ruflfus, he divided them into nerves of motion and nerves of sensation. He was acquainted with the use of the catheter, and was probably the inventor of that instrument. He paid no regard to the Hip- pocratic doctrine of the humors, or of the four ele- ments. He attributed all fevers to inflammation. The inflammation leading to dropsy, he placed in the liver and spleen. The animal spirits he seated in the brain ; the vital, in the heart. He rejected venesection, the use of drastic purgatives, and most other active medicines ; he treated diseases almost exclusively by diet and regimen, and was among the first to systematize gymnastics, or what would now be called hygiene, as a department of the healing art. Galen speaks of him as an accomplished an- atomist, but charges him with want of skill as a a physician. After commencing his anatomical and physiological researches, he may have been too much involved in these to attend to the minute de- tails of practice. He held medicine to be a conjee- DISCOURSE. 87 tural science. He was opposed to the sage of Cos on many points ; was said to have been envious of Ms reputation, and to have mentioned him as rarely as possible in his writings. During this period the art of medicine was usually divided into three parts ; the Dietetic, the Pharma- ceutic, and the Chiruro^ical.* The most illustrious professors of that branch which related to diet, endeavoring to extend their views, called in the assistance of natural philosophy, being persuaded that without this, medicine would be a weak and imperfect science. After these came Serapion, the first of all to maintain that the rational method of studying disease was foreign to the art; for a knowledge of which he trusted wholly to experi- ence. In his steps followed Apollonius and Glau- cias, and some time after Ileraclides of Tarentium. And thus dietetics had its two parties, — one set of physicians, rationalistic and pursuing theories ; the other, following experience alone. The pharmaceutic branch, though not rejected entirely by Erasistratus and his followers, was more particularly extolled by Herophilus and other rationalists, who resorted to medicine in all dis- eases, and some of whom wrote extensively upon the materia medica. Among the earliest of these were Zeno, Andreas, and Apollonius surnamed Mus, and several others who treated of medicines incidentally. Among the less conspicuous writers in this depart- ment was Pamphilius, in the reign of Ptolemy * Celsus. 88 DISCOUESE. Philometor, the author of a treatise on herbs ; of which he speaks in alphabetical order, treating of their agricultural as well as of their medicinal uses. Compiling from Hermes ^gyptiacus, the great medical authority of the early Egyptians, he dwells upon the use of charms, amulets, and incantations for increasing the power of herbs. Nicander, who flourished in the same reign, and spent part of his days at Pergamus, wrote in verse a treatise on poisons and the bites and stings of venomous ani- mals. Among the surgical writers of this school, were several able professors, particularly Philoxenus, who treated of this branch fully, and with great accu- racy, in several volumes. Gorgias also, and Sos- tratus, the two Herons, the two Apollonii, and Ammonius Alexandrinus, were all improvers in this department. Ammonius was the inventor of an instrument for the crushing of stone in the bladder, where the stone was too large to be extracted in the ordinary way. Apollonius of Cittium, who lived in the time of Ptolemy Auletes the father of Cleopatra, was the author of a work on the diseases of the joints, which, though never printed, is said to be still extant. Philotimus, Nileus, and Heraclides of Tarentum, coinciding with Hippocrates and Di- oles, declare that they had perfectly succeeded in reducing luxations at the hip joint, a fact which others had called in question. Andreas, JSTymph- odorus, and Protarchus, as well as some of those already mentioned, were inventors of machines for reducing dislocations; diagrams of which are still DISCOURSE. 89 extant in several of the older systems of surgery, as well as in Galen and Oribasius. Among the later writers of this school who pre- ceded Galen, and whose works have descended to modern times, were Dioscorides of Anazarba, Kuffus of Ephesus, and probably also Aretseus of Cappadocia. But of these we shall have again occasion to speak, in connection with their contem- poraries of the Roman school. The business of teaching, at Alexandria, was never wholly confined to the professors. In medi- cine, as in other departments of science, there were independent instructors. Beyond the schools, the student of medicine appears to have had access to the temple of Serapis,* which served in part as an asylum and place of refuge for the sick, and was used as such in the same way as the Asclepions in other parts of Greece. Nor were the devices of the priests here less politic than at the more ancient temples of ^sculapius. As Vespasian was one day walking through the streets of Alexandria a man with a diseased eye threw himself at his feet, begging to be cured, and declaring he had been told by Serapis that his sight would be restored if the emperor would but spit upon his eyelids. Soon afterwards another who had lost the use of his hand, preferred the same pe- tition ; having been told by Serapis that the emperor might heal him by trampling him under his feet. * Le Clerc (Histoire de la Medicine, liv. i. chap. xx. p. 66-7, on the au- thority of Tacitus, JElian and other -writers), cites several instances to show that the sick resorted for relief to the temple of Serapis. Y 90 DISCOUKSE. Vespasian at first laughed at their importunity ; but so far yielded to their wishes as to consult the medical faculty. The physicians, like skillful cour- tiers, deemed the cure by the means proposed, not impossible. The experiment was attempted before an assembled multitude. It was probably as suc- cessful as the royal touch of the kings of England and France in later times ; and the flatterers of the Emperor declared that he had healed the maimed, and restored the blind to sight. Bat the brightest era of medical science at Alex- andria thus far, was the earliest. Under the first associates of the Museum, anatomy and physiology were cultivated with spirit and success ; and from the turn given to medical education by these teach- ers, the character of the school for ages afterwards was definitely determined. The Asclepiadse of Cos and Cnidos had dwelt upon the phenomena of dis- ease without attempting to demonstrate its struc- tural relations ; like the sculptors of their own age, they studied the changing expression of vital action almost wholly from an external point of view. They meddled not with the dead. For, by their own laws, no one was allowed to die within the temple. But the early Alexandrians were subject to no such restrictions ; and turning to good account the discoveries of Aristotle in natural history and com- parative anatomy, they undertook for the first time to describe the organization of the human frame from actual dissections ; and by applying the know- ledge thus acquired to the pathological studies of their predecessors, they struck upon the course DISCOURSE. 91 wMch, if followed out by their immediate succes- sors, might have led to many early and brilliant improvements. But their successors were slow in discovering the road that had been opened to them. Occupied in teaching what had already been surmised or ascer- tained, few of them were ambitious of adding much to the general stock of knowledge. The dissection of the human body was ^oon abandoned, and the improvements in pharmacy and additions .to the materia medica introduced by them, were as much due to the commercial intercourse of Alexandria with India and southern Asia, as to the scientific, enterprise of its physicians. So that medicine, losing the independent and progressive character which it had received at the hands of Hippocrates and his early followers, was again reduced to a mere department of speculative philosophy, in- volved in futile disputations, and in formulas based on no substantial facts. Hence the several sects into which the profession in course of time became divided. Of these the Dogmatists, or Rationalists, claimed to be the followers of Hippocrates, and supporters of the academic philosophy. The Empirics origi- nated with Philinus, a pupil of Herophilus, and with Serapion, the successor of Philinus, and were advocates of the sceptical philosophy of Pyrrho. The Methodists were of later date. They are com- monly traced to Asclepiades, the founder of the Roman school ; but the lessons of his instructor, 92 DISCOTRSE. Cleopliantus of Alexandria * appear to have fur- nislied the leading principles upon which he and his followers founded this third sect, the philosophy of which was adopted from Epicu-rus. The Pneumatic sect was an offset from the Dogmatists, and advo- cated the stoic philosophy. But of these several sects, and of the Episynthetics who attempted to re- concile the whole of them, we shall have again occa" sion to speak, in connection with the school of Rome. In speaking of the profession of his own time, Galen classes them as Herophilians and Erasistratians, show- ing that the opinions of the founders of the Alex- andrian school had not yet been superseded ; and that after an interval of more than five centuries, the impression left upon it by these great men, still continued to give it character and distinction. After falling under the sway of the Romans, for a century or more the school of Alexandria lost much of its previous celebrity, and is little spoken of duriog the more active period of the school of Rome. Yet even in Galen's day, it was still the center of medi- cal science. And to have studied medicine at Alex- andria, was everywhere considered a passport to the confidence and patronage of the public. * Celsua, ill. 14. DISCOURSE. 93 CHAPTEE VII THE SCHOOLS OF MEDICINE AT SMYRNA, PERGAMUS, AND EPIDAURUS. But if Alexandria was for many centuries tlie principal seat of medical science, there was perhaps no period in which it was the only school open to the profession. The followers of Erasistratus, in consequence of temporary disturbance at the Mu- seum, are said to have removed to Smyrna, and at the Asclepion of that city to have established a rival institution. It is even asserted that the school of Smyrna originated with Erasistratus rather than with his disciples, and that he there spent his latter days in teaching. The school of Pergamus, as before remarked, had been early celebrated. Several of the Alexandrian professors also added luster to this rival institution. The older Heras, who probably flourished during the reign of Attains II., after whom the kingdom passed into the hands of the Romans, was of this school. He was among the earliest, if not the first, to introduce those compound confections, which, under the name of Theriaca, or antidotes, were afterwards almost in universal use among the ancients. Acopa, or anodyne and analeptic lini- 94r DISCOURSE. ments or embrocations, were also among his inven- tions ; some of whicli lie honored with the name of his sovereign. Attains Philometor was not only the patron of the profession, bat was himself actively occupied in the cultivation and employment of medicinal plants. We are told by Plutarch, that in his gardens he planted the hyoscyamus, hellebore, cicuta, aconite, and other poisonous 'herbs, and collected them at the proper seasons, with his own hands, for the pur- pose of experimenting with their expressed juice, their fruit, and their seed, and determining their respective properties.* Attains was not the only sovereign who, about this epoch, turned occasionally from the cares of state to mingle in the affairs of our profession. Mithridates, king of Pontus, experi- mented with poisonous plants upon himself, in order to habituate himself to their use, and thus to become unsusceptible to their deleterious effects. His composition, afterwards known as the Mithridati- cum, and employed as an antidote, was among the most celebrated nostrums of antiquity. Pompey, after overcoming this prince, ordered diligent search to be made among the archives of his palace for the formula of this famous antidote ; and sup- posed he had discovered it in a confection consisting of rue twenty leaves, salt a few grains, two walnuts, and a couple of dried figs, which was to be taken fasting every morning, and followed with a draught of wine.f * Le Clerc, part ii. liv. iii. chap. iii. p. 388-90. f Seremis Sammonicus, v. -1064-71. DISCOURSE. 95 Again, without referring to numerous other places of less repute, there is reason to believe that a school of medicine was still associated with that most ancient of all the Asclepions, the temple of Epidaurus ; which is said to have stood on the spot upon which ^sculapius was born, a promontory on the coast of Argolis nearly opposite the island of ^gina. The school here may have been dispersed when Sylla ravaged the temple, and appropriated the wealth of its shrine to the maintenance of his army during the Mithridatic war. But so late as the reign of Antoninus Pius, the temple of Epidaurus was still a place of great resort. By the bounty of this ruler its accommodations for the sick were increased, and a new edifice was erected in its vicinity for the accommodation of such patients as were about to die, and by the rules of the temple no longer permitted to remain within the hallowed bounds. This new edifice was also in part appropri- ated to parturient women, and as a lying-in asylum, sacred to the services of Lucina.* * Le Clerc, part i. liv. L chap. xx. p. 63; and Schulze, p. 127, after Pausanias. 96 DISCOTJESE CHAPTEE VIII. THE SCHOOLS OF EOME. Section I. — From their Origin to the Rise of the Eclectics. After the Romans liad acquired the mastery of the East, many adventurers from the Grecian pro- vinces resorted to the capital in pursuit of occupa- tion as teachers and physicians ; at first, with small encouragement. The people of Rome were slow in relinquishing their prejudices against Greek scholars, and were indisposed to forget the humble position of those amongst themselves who were devoted to the healing art.* Cato the Censor, as already inti- mated, rejecting the sciences not of native growth, trusted for medical assistance, to the untutored skill of servants, to a few simple preparations from do- mestic plants, and even to charms and incantations. For curing a luxation at the hip, take, says he, a green divining rod four or five feet long, split it in the middle, and let two men hold it at the hip and begin to sing : "7;^ alio^ s,f, motas vceta daries dar- daries astataries dissunapiter^^'^ until the injured parts are again united. The luxation being reduced, or the fracture set and properly adjusted in splints, repeat the incantation every day as at first, or the * Pliny, Hist Nat., lib. xxix. chap, viil DISCOUKSE. 97 following : " Huai Jianat Tiuat ista pista sista domin- abo damnaustra f or after this manner: ^'' Huat Tiaut Jiaut ista sis tar sis ardannahon dunnaustra.^'' * We have already alluded to the earliest temple of ^sculapius among the Romans, that upon the Island of the Tiber. Others were afterwards erected in the city ; one of these, according to Serenus Sam- monicuSjf was situated on the Tarpeian rock. But indications of a more enlightened spirit, are apparent towards the decline of the republic. As early as the time of Caius Marius, the city was well supplied with hardy and enterprising prac- titioners. This veteran warrior, who had been six times consul, underwent at the hands of one of » these, an operation for the cure of varices ; and after the diseased veins had been forcibly wrenched from beneath the skin of one leg, he refused to present the other limb, judging from what he had already experienced, that the proposed relief could hardly compensate for the suffering. J Still nearer the close of the republic, the Greek physicians of the city had risen to the confidence and friendship of the Patricians. Caesar on his voy- age to Rhodes, when taken prisoner by the pirates near the island of Pharmaceusa, was accompanied, among other friends, by his physician. § Cicero de- clares it to be the duty of all men — a duty particu- larly incumbent on himself — to support the dignity of the healing art. " Licet enim omnibus^ licet enim * M. Porcius Cato de ReRustica, cap. clx. f Verse 10th. \ Pliny, lib. xi. cap. 104. § Suetonius, cap. iv. 08 DISCOURSE. mihi^ dignitatem medim artis tueriP And to Ascle- piades, then the most popular physician of the city, he alludes as his personal friend, celebrated as much for his refined eloquence as for his skill in physic* In the time of Cicero, the study of philosophy had already become essential to what was considered an accomplished education. This study implied an ac- quaintance with the Greek language, and was im- perceptibly attracting attention to medicine, from which the teachers of philosophy were in the habit of deriving their aptest illustrations, and with which their own doctrines were inseparably united. The statesmen and orators of the nation, becoming in youth familiar with medicine as a department of philosophy, began at length to respect it as an art, and to give to its professors their protection and en- couragement. Hence the various laws introduced soon after the organization of the empire, for the benefit of the profession. Caesar, after reaching the summit of his power, in order to attract men of science to the capital, and to improve the condition of those already there, de- creed that all who practiced physic at Eome, and all the masters of the liberal arts therein residing, should enjoy the privilege of citizenship.f And Augustus, after having been relieved of a danger- ous illness by his freed-man, Antonius Musa, loaded this physician with wealth ; raised him, by consent of the Senate, to the equestrian rank; erected a bronze statue to his honor near that of ^sculapius ; * De Oratore. f Suetonius, Julius C^sar, cap. xlii. DISCOURSE. 99 and, at his instigation, conferred important privi- leges on the whole body of the profession then residing in the city.* Thes e privileges were after- wards confirmed and extended by Vespasian, Ad- rian, Antoninus Pius, Domitian, Alexander Severus, and other later emperors. Asclepiades, the friend of Cicero already men- tioned, was a native of Prussa in Bithynia. To him, more than to any other individual, belongs the credit of having first raised the medical profession in Rome to the confidence and respect of the peo- ple.f Educated under Cleophantus at Alexandria, he had practiced medicine, and been employed as a teacher of elocution at Athens, and other parts of Greece, before taking up his abode in Rome. Of an acute and discerning mind, he soon discovered that the principal source of mistrust towards those who who had preceded him, lay in their crude and un- feeling practice. And though at this time perhaps not deeply versed in the principles of his art, he saw the advantage of instituting an entirely difi*er- ent course. Accordingly, rejecting most internal medicines as liable to offend the stomach, he con- fined himself principally to hygienic measures, and to regulating the diet. To enforce his own views, he turned his eloquence to good account as a public teacher, and originated the first school of medi- cine in the city. He was the author of a treatise on General Remedies, in which he dwelt mainly on friction of the skin, and beyond this, only on pas- * Seutonius, Octav. August., cap. lix. _ f See Cassius, Celsus, Cselius Aurelianus, Pliny, Apuleius Madaurensis. 100 DISCOURSE. sive exercise, and tlie use of wine. The novelty and attractive character of his practice rendered him popular, and secured to him lucrative occupation, from which he accumulated a princely fortune. Adopting the atomic philosophy of Epicurus, he at- tributed all diseases to obstruction of the primary atoms in their passage through the invisible pores ; and the restoration of these atoms to their equable relation to the pores, so as to move without embar- rassment, he made the principal indication in his treatment. This theory was afterwards more fully elaborated by his successors, in whose hands it was expanded into the distinctive doctrine of the Methodic sect. The merits of Asclepiades as a reformer, have been differently estimated by different writers, some looking upon him as little more than a successful charlatan, others as a philosophical physician. Apuleius M adaurensis declares him superior to all other physicians, Hippocrates only excepted.^ Ga- len charges him with many absurdities,f and with having but little knowledge of the great fathers of the profession, whom he affected to ridicule ; for he had characterized even the writings of Hippocrates as a meditation upon the dead. But Celsus,J his more moderate defender, declares he was the first after Heraclides of Tarentum, to effect important improvements in the healing art ; and yet admits that he assumed as his own, the use of friction as a * Florida, cap. xix. f VoL ii, p. 165, and elsewhere in numerous places. I Preface to first book. DISCOURSE. 101 therapeutic agent, to wMcli lie had no claim, inas- much as it had been in use since the time of Hip- pocrates ; adding, however, that Asclepiades had treated of this more fully and clearly than any former writer. To him we owe the aphoristic phrase, " Tato^ cito^ ut jucunde^'^ or, as given by Cel- sus, ^''Asclepiades officium esse medici dicit^ ut tuto^ ut celeriter^ ut jucunde curety He was the first to announce the doctrine of the self-limitation of dis- ease, asserting that the principal cure for a fever was the disease itself. He wrote on ulcers, and on acute and chronic diseases. He recommended tra- cheotomy in threatened suffocation.* His claim to our respect appears to lie in his rejection of the com- plex, violent, and perturbing remedies in use before his day, and substituting for them such as were simple and grateful to the sick; and in looking upon his art as useful only so far as it served to alleviate actual suffering, or to administer consola- tion to his patients. Remarkable for independence of judgment, and for a certain elevation of charac- ter, he would have the presence of the physician a source of pleasure and encouragement to the patient rather than of foreboding and mistrust, and the phy- sician himself to perform the double function of cur- ing disease as became a skillful and compassionate practitioner, and of cheering and amusing the sick as became a friend. He settled at Rome in the time of Pompey, about 63 years before the birth of Christ ; and he is said to have been killed by a fall from a ladder in his extreme old age. * Cassius, Cselius Aurelianus, and Galen, vol. siv. p. 2*74, Kuhn's edition. 102 DISCOURSE. Antonius Musa, who was so higlily honored by Augustus and the Roman Senate, is spoken of as an able and judicious writer. According to Pliny* he owed his first success to having recommended to Au- gustus the use of lettuce, which his former attendant, Camilius, had prohibited. He was an advocate for the cold bath as a means of restringing the pores ; a practice which at this time appears to have been considered an innovation ; and the cure of Augustus, according to Suetonius,-}- was effected by substitut- ing cold instead of warm applications. A small treatise attributed to him, and dedicated to Marcus Agrippa, the son-in-law of Augustus, is still extant. It is entitled ^' De Herba Vetonica,"J and, in the short space of eight octavo pages, treats of this plant in its application to forty-seven different ailments. This little work is in Latin, although its author, like most of the physicians of the time, was probably a Greek. His brother was highly esteemed by Juba H., king of Numidia, who was himself a man of great learning, and the author of the first Greek history of Eome ; and who, on discovering a new medicinal plant near Mount Atlas, named it after this physi- cian ; and it is still known by the name first as- signed to it, the Euphorbia.§ Cassius, of whom Celsus speaks as recently dead, and as the most ingenious physician of his age, must * Kat. Hist. lib. xix. cap. xxxviii. I Suetonius, Octav. August., cap. Ixxxiii. ^ Liber Antonii Musee de Herba Vetoniea, et liber Apuleii de Medica- mentibus Heibarum. Per Gabrielem Humelbergium, Basilese, 8vo. 1536. § Plinj-, Xat. Hist lib. xxr. cap. xxxviii. DISCOURSE. 103 have been among the early followers of Asclepiades. Thousfh an admirer of the doctrines of this refor- mer, he was an independent observer, w"edded to no exclusive hypothesis. In his practice, he in- quired not merely whether the pores are bound or loose, but rather, what is the exciting cause of dis- ease. When called to a patient in a fever and suffering excessive thirst from free indulgence in wine, he ordered him to drink plentifully of cold water ; which, by weakening the force of the wine, induced sleep and perspiration, and in this way dis- sipated the disease. He was the author of a small work entitled " Medical Problems,"^' which is still preserved, and is highly deserving of perusal, as illustrating the style of medical logic at this epoch. This interesting treatise consists of eighty-four distinct problems, with their solutions, all briefly handled, and most of them relating to the his- tory and treatment of disease. In the first of these problems the author asks, why are round ulcers the most difficult to cure ; and, in reply, cites the mathematical reason of Herophilus and his fol- lowers, as well as that of Asclepiades ; who, as we here learn, had taught that ulcers of this shape may be induced to heal by approximating their edges so as to change their shape, or by incising their edges with a scalpel. And in the fortieth problem we learn that Asclepiades was the author of a distinct work on ulcers. In problem sixth, Cassius inquires, why are per- * Cassii Medici Questione3 et Problemata, Adriano Junio Homano, in- terprete. Medicinsa Artia Principes. Venetiis, folio, 156V. 104: DISCOIJESE. sons with disease of tlie liver, spleen, or lungs, most disposed to lie on the affected side. His answer is based on anatomical reasoning, and is the same that would be given at the present day. His problems relating to diseases and injuries of the head, evince considerable anatomical and physiological acquire- ments. In problem fortieth, he asks why parts around the seat of injury on a limb, may remain un- affected, whilst those remote from it are apt to suf- fer; as the groin, for example, after injury of the foot; the glands of the neck after wounds of the head; or axillary buboes after ulcerations of the hand. In resolving this inquiry, he differs from As- clepiades, and attributes the remote affection to the influence of the nerves ; which, says he, are of all the organs the most disposed to participate in the diseases of the members with which they act in concert. In the next problem he asks why injury of the meninges on one side of the head, is fol- lowed by paralysis on the opposite side of the body ; and, in reply, refers to the anatomy of the nerves, which, says he, derive their origin from the base of the brain, where those of the two sides decussate, so that those from the right side of the base pass into the left sinus of the head, and vice versa. In the forty-third, he asks why papulae arise from a burn on a living, and not on a dead surface -and his reply is, that in dead bodies the spirits are ex- tinct, whilst in the living, they are moving about and universally disseminated. In the fifty-sixth, he asks, why infants suffer most severely from fever ; and tells us that in them there is a superabundance BISCOITESE. 105 of native heat. In the sixty-seventh, he inquires, why do fevers modify the condition of the pulse ; and in reply, he states that when the equilibrium of the innate spirit is disturbed, and it is separated from the natural spirit, it superabounds and becomes attenuated and divided by the intrinsic heat, so that by its lightness it acquires increased celerity, and thus affects not only the pulse but also the respira- tion. Here he is foreshadowing the doctrines of the pneumatic sect, though perhaps only in expo- sition of the views previously advanced by Erasis- tratus, and even by Hippocrates. In the sixty-eighth problem he inquires why persons laboring under fe- ver, are subject to superficial ulcerations on the skin. This question is remarkable, and might lead to the belief that this acute and inquisitive observer must have been familiar with the eruptive fevers. It has been questioned whether or not the au- thor of these problems was identical with the Cas- sius mentioned by Celsus. But there is nothing in the work itself to throw doubt upon this point. Its author must have been worthy of the character which his junior contemporary has bestowed upon him. There is no allusion in the work to any writer later than Asclepiades ; besides whom and Herophi- lus, it mentions only Andreas Carystus, an Alex- andrian writer on certain articles of the materia medica. About this time there were residing and practi- cing at Rome, several professors of surgery of no small note, among whom were the elder Tryphon, Euelpistus, the son of Phleges, and Meges, who, 8 106 DISCOTJRSEr says Celsus, was the most learned of them all, as shown by his writings. This latter was the inven- tor of an instrument for incising the neck of the bladder, in the operation for vesical calculus ; which instrument, judging from Celsus' account of it, must Have been a double-cutting gorget, similar to what in this country has recently been described as the lithotome of Bushe, or prostatic bisector of Dr. Ste- vens, cutting transversely. Meges, also, contrary to the general belief, proved the possibility of anterior luxation of the tibia at the knee joint, by a success- ful case which he himself had treated. In the pathology of abscesses, he was in advance of his times ; for while the general belief then was, that all investing coats and sheaths were nervous, he affirmed that a nerve was never generated in a dis- order which destroyed the flesh ; but that the pus being lodged below for a long time, became sur- rounded with a simple callosity. Some of the fore- going were also distinguished as oculists.* As yet, the only two sects recognized in the pro- fession, were the E-ationalists and the Empirics ;f for, though Asclepiades had introduced important innovations, he was still classed as a Eationalist. Nor was Celsus willing that even the followers of Theraison should be acknowledged as a third sect. The Rationalists were those who declared for a theory in medicine, and held as essential to the proper management of diseases, that the physician should inquire into their occult or constituent causes, * Celsus, in different places. f Ibid, book i., preface. DISCOURSE. 107 and their evident or exciting causes, and that he should be acquainted with the natural actions of the body and its internal organization. By occult or con- stituent causes, they unders/ood such as are derived from the elements composing the body. By evi- dent causes, they referred to such as are adventi- tious and apparent, as 1/eat, cold, fasting, a surfeit, fatigue, and the like, ?vhich are operative at the incipient, if not also m the latter stages of a dis- temper. By natural actions they understood the functions of respiration, reception and concoction of food and drink, and the distribution of the nutri- ment throughout the body. They also investigated the causes, mo(?ifications, and indications of the pulse, and wh^t gives rise to sleep and waking. They urged tie necessity of modifying the treat- ment of dise^e in accordance with the character of the occult aiuse. But they differed among them- selves as t/> what should be considered the occult cause. 8(/me of them, in common with Empedocles and the ^arly philosophers, held it to consist in re- dundan^^e or deficiency in one or more of the four primitive elements, — fire, air, earth, and water. Some of them, with Herophilus and other earlier writers, maintained that it lay in a faulty condition of the four humors — phlegm, blood, bile, and atrabile ; others, with Hippocrates, attributed it to the quali- ties of the inspired air ; some, with Erasistratus, ascribed it to the escape of blood from the veins (or vessels designed only for blood), into the ai-teries, which they believed were designed only for air and spirits ; the escape of blood in this way, giving rise 108 DISCOIJESE. to inflammation, aad tlirough this, to a fever. Others again, accepting the new doctrine of Ascle- piades, placed the occult cause of all diseases in the interruption or arrest of the minute corpuscles in their passage through the invisible pores. They all, too, maintained the importance of a correct knowledge of concoction; but here again, their opinions varied ; some of them affirming, with Erasis- 1 tratus, that in the stomach tae food is concocted by''- attrition; others, with Plistcnicus, the disciple of Praxagoras, that it is effected by putrefaction ; others, upon the authority of Hippocrates, that it should be ascribed to the effec^.s of heat ; whilst the disciples of Asclepiades, looking upon all these opinions as futile speculations, i?iaintained that there is no such function as concoction, but that the food and drink in their crude s.ate are distri- buted, by means of the pores, throughout the body. They all held to the importance of aiatomy and correct knowledge of the internal organization of the body, and maintained that Herophilus and Erasistratus had taken the best means for ecquiring such knowledge, in procuring criminals from the prisons by royal consent, and dissecting them alive, so as to contemplate, while yet living, those parts which nature has concealed. And they declared it was by no means cruel, by the torture of a few criminals, to search after remedies for the whole innocent race of mankind in all ages. The Empirics, on the other hand, relied on per- sonal experience alone. They, indeed, admitted the advantages of occasionally studying the evident DISCOURSE. 109 causes ; but to searcli after the occult causes, or tlie natural actions, they believed to be useless ; because nature is incomprehensible, as shown even by the dis- cussions of the philosophers ; who, if reasoning were of much avail, ought to be the ablest physicians; whereas they have abundance of words, but very little skill in healing. All theories as to causes, said they, are of little account, seeing that men of opposite theories were about equally successful in the treat- ment of disease, and that whatever be the charac- ter of these causes, the diseases require to be differ- ently treated in different places and different seasons. Again, even where the apparent cause is recognized, as in lippitude, a wound, or ulcer, it does of itself point to the means of cure. And if the evident cause do not suggest these means, much less can the other, which is itself obscure. They held that medicine was not the result of reasoning, but that theory was invented after the remedy had been em- ployed, and for explaining its effects. They asked, too, whether reason prescribes the same things as experience, or different ; for, if the same, it is need- less ; if different, mischievous. On the appearance of any new disease, instead of inquiring into its oc- cult or apparent causes, they sought for its an- alogy to diseases already known, and met it by remedies analogous to such as were used in these, until the true mode of treatment could be dis- covered. They did not affirm that judgment is un- necessary, but that conjecture is of no use, and that it is of little consequence how the disease originates, so long as we are able to cure it. They admit 110 DISCOURSE. that in all discussions of this sort, mucli may be said on both sides ; yet, that diseases are not to be cured by eloquence, but by remedies. They regarded as useless the study of the natural actions and internal organization of the body ; and they denounced the dissection of living men with as much vehemence as would the moralist of modern times. Thus stood the discussion, which had been handled with great warmth for many ages, when Themison of Laodicea, the disciple and successor of Ascle- piades, entered the lists in his old age, as the leader of a third party."^ Though he was influ- ential as a teacher and reformer, his writings are not often quoted ; and as they have perished in the wreck of ages, his opinions are known to us only through his reputed followers, or the critics and historians who have noticed them. According to Cselius Aurelianus, he was the first to write syste- matically on the management of chronic diseases, upon which subject he published a work in three books. He wrote also on acute diseases. As a practitioner he was familiar with the use of opium, hyoscyamus, and other narcotics ; and his name is associated with a confection of poppies, which he employed in the diseases of the respiratory organs. But he is more especially worthy of notice as the founder of the Methodic Sect. Adopting the theory of Asclepiades as to the arrest of the ultimate molecules in the invisible pores, he * Celsus, book i. preface ; Galen and Cselius Aurelianus, at several places. DISCOURSE. Ill attributed all diseases to excessive tension or relaxa- ation; and tliis doctrine of Laxum and Strictum became the essential principle of the new party ; who, with the Empirics, abandoned th€ study of exciting causes, as having no relation whatever to the method of cure ; and maintained that the cor- rect method of treating disease may be ascertained by simply observing a few of its general symptoms. Of distempers they made three kinds, the bound, the loose, and the mixture of these two, according as the excretions are too scanty, too profuse, or some particular excretions are deficient whilst the others are in excess. These several forms they subdivided into the acute and chronic, and, also, according as they were increasing, stationary, or receding. Their rule of treatment was, that the body if bound, should be opened ; if relaxed, it should be astringed ; and if the distemper were complex, the most urgent ailment should be the first opposed ; varying the agent with the duration or stage of the disease. The observance of these rules constituted, accord- ing to their notion, the whole art of medicine ; and from their own established w^ay of proceeding by method, they claimed for themselves the name of Methodists ; for they differed from the Eationalists, in not allowing medicine to consist in theorizing about occult or other causes, — and from the Em- pirics, in holding personal experience to be but a small part of the art. The doctrine of the Meth- odists had for a time great sway. Celsus, while criticising them with his accustomed acuteness, 112 DISCOURSE. gives them but little countenance, and denies their claim to the title of a distinct sect. Aulus Cornelius Celsus, justly styled the Latin Hippocrates, was the junior contemporary of Themison, and so far as we are aware, the earliest medical writer of unequivocal Roman birth.* Of his own personal history little is known. Quin- tilian attributes to him a treatise upon Rhetoric, and gives honorable testimony to the extent of his learning. His contemporary Columella,f who often quotes from his work on agriculture, with great deference to his authority, equals him to the ablest writers on husbandry, and speaks of him as one not only skilled in agriculture, but who had fa- miliarized himself with the whole compass of natural knowledge. His treatise on Medicine,;]; in eight books, is all that now remains of his writings. According to the best critics, this work must have been written towards the close of the reign of Augustus, or, at latest, at the beginning of the reign of Tiberius. Celsus, more than any other of the ancient Latin physicians, is celebrated for the purity and elegance of his style, and for a concise and judicious manner of handling his subject. The summary history of medical doctrines, of the ma- teria medica, and of surgery, introduced at the * Columella, Pliny, and Quintilian, all speak of him as a Roman. f De Re Rustiea, lib. i. cap. 1, €t seq. \ A. Corn. Celsi Medicinpe lib. octo. ex recensione Leonard! Targa?, iscouriSE which do not, properly speaking, belong to the arts themselves, yet they may greatly improve them by quickening the genius of the artist ; wherefore the contemplation of nature, though it cannot make a man a physician, yet may render him fitter for the practice of medicine. * * And medicine itself re- quires the help of reason, if not always amongst the occult causes or the natural actions, yet often, for it is a conjectural art ; and not only conjecture in many cases, but even experience is found not consistent with its rules. "^ * A new distemper sometimes, though very seldom, appears ; that such a case never happens, is manifestly false. ^ * Nor is similitude always serviceable in this kind of practice ; and where it is, this properly belongs to the rational part." * * To the physician, he adds, " it makes considerable difference whether the distemper is oc- casioned by fatigue, or thirst, or cold, or heat, or watching, or hunger ; or whether it arises from too much food or wine, or excess of venery. And he ought not to be ignorant of the constitution of the patient, — whether his body be too moist or too dry ; whether his nerves be strong or weak ; whether he be frequently or seldom ailing ; and whether his ill- nesses are severe or slight, of long continuance or short; what kind of life he has led, laborious or sedentary, luxurious or frugal ; for from these and such-like circumstances, he must often draw a new method of cure." ', •". In reference to the Methodists, his censure is less guarded. "If they assert their maxims," says he, "to hold universally, they are still more rationalists DISCOURSE. 117 than those who pass under that name ; but if, which is nearer the truth, the art of medicine hardly ad- mits of any universal precepts, then they are in the same class with those who depend upon experience alone. ^ * Nor is any improvement made by them upon fche profession of the empirics ; but, on the contrary, something is taken fix)m it, — the empirics attending with great circumspection, to many cir- cumstances, whereas these regard only the easiest, and no more than the common things." ^' ^' * "I am apt to think," says he, "that he who is not ac- quainted with the peculiarities, ought only to con- sider the general ; and that he who can find out the particular, ought not to neglect but to take them in too, for the direction of his practice. And there- fore where knowledge is equal, yet a friend is a more useful physician than a stranger. To return to my point, then, my opinion is, that medicine ought to be rational ; but to draw its methods from the evident causes, all the obscure being removed, not from the attention of the artist, but from the practice of the art. Again, to dissect the bodies of living men is both cruel and superfluous. But the dissection of dead subjects is necessary for learners, for they ought to know the position and order of the parts, which dead bodies will show better than a living and wounded man. But as for the other things which can only be observed in living bodies, practice itself will discover them in the cure of the wounded, somewhat more slowly, but with more tenderness." As a comment on these remarks, we might refer 118 DISCOURSE. to his brief anatomical description of the internal organs, at the commencement of the fourth book, portions of which could have been derived only from the actual dissection of the human subject. It has been remarked by a recent critic, that Cel- sus paid little regard to the pulse as an index of the condition of the system. But his remarks on the variability of the pulse are perfectly just, and are intended not to show his neglect of it, but rather to put the physician upon his guard against hasty judgments. " It is the business of the skillful phy- sician," says he, " not to take hold of the patient's arm with his hand as soon as he comes in, but first to sit down with a cheerful countenance, and ask him how he does ; and if he has any apprehension, to encourage him with plausible discourse, then to apply the hand to the w^rist." In common with the elder Greeks, he recom- mends caution in undertaking the management of dangerous and incurable ailments. " A physician," says he, " should, above all things, know what are in- curable, what difficult to cure, and what more easy ; for it is the part of a prudent man first, not to un- dertake one whose case is desperate, lest he appear to have killed him whom destiny has destroyed. Next, in a case of great danger, but not quite des- perate, to make known to the friends of the patient that it is a matter of difficulty, so that if the mal- ady should prevail against the art, he may neither seem to have been ignorant himself, nor to have de- ceived them. But," adds he, " as this is the proper conduct for a prudent person, so, on the contrary, it DISCOURSE. 119 is the part of a quack to exaggerate a small matter, that he may appear to have performed the greater cure." When the case is easy, he recommends dili- gence and circumspection on the part of the physi- cian, " that what is in itself small, may not, by his negligence, become more considerable.'^ Before leaving this able author, we may notice his opinion of what a surgeon should be, and of what surgery should embrace. " Surgery, the third part of medicine," says he, " does not discard medicines and proper regimen ; but yet the principal part is ac- complished by the hand, and the effect of this is the most evident of all the parts of medicine. For, as fortune contributes a good deal to the cure of dis- tempers, and the same^ things are often salutary, often fruitless ; it may be doubted whether the re- covery be owing to physic or the constitution. * * But in surgery, it is manifest that the success, though it may be somewhat promoted by other means, is chiefly to be ascribed to this." " A sur- geon," he continues, " ought to be young, or at most, but middle-aged ; to have a strong and steady hand, never subject to tremble, and to be no less dexterous with his left than his right hand ; to have a quick and clear sight; to be bold, and so far void of pity that he may have only in view the cure of him whom he has taken in hand, and not in com- passion to his cries either make more haste than the case requires, or cut less than is necessary ; but do all as if he were not moved by the shrieks of the patient." And then, as to the province of sur- gery, " it may be asked what peculiarly belongs to m 120 T)ISCOURSE. this branch, because surgeons assume to themselves the curing of many wounds and ulcers which I have treated of elsewherie, I can very well suppose the same person capable of performing all these ; and since they are divided, I esteem him most whose skill is most extensive. For my part, I have left to this branch those cases in which the physician makes a wound where he does not find one; and those wounds and ulcers, in which I believe manual oper- ation to be more useful than medicine ; lastly, whatever relates to the bones." It would here be out of place to enter further into a notice of the individual diseases of which he treats in the several divisions of his work. I may, however, mention, as particularly worthy of perusal, his chap- ters on diet and regimen, on blood-letting, on fevers, on poison-wounds, on the extraction of weapons from the body, on the diseases of the eye ; his de- scription of ranula and his mode of treating it ; the chapter on diseases of the testicles and parts contiguous, including hernia, and the operations for these ; and above all, his chapter on the operations for suppression of urine, and for lithotomy. In this we find all the necessary details for catheterism as still employed ; and the Eoman method of operating for stone by the transverse semilunar incision in the perineum, with the horns of the incision pointing towards the hips, as lately revived by Dupuytren and other modern surgeons. In the management of wounds he advocates the use of sijuple and familiar, in preference to rare and expensive remedies, or the heterogeneous composi- DISCOURSE. 121 tions so mucli in vogue among the Komans. He was aware that certain poisons, though deleterious when received into wounds, are innocuous when taken into the mouth. In the treatment of wounds thus poisoned, he recommends suction for the ex- traction of the poison. He applies the ligature to divided or lacerated blood-vessels ; he employs this same agent for the cure of varices, and for checking the loss of blood from haemorrhoids. He enters somewhat fully into the pathology of injuries of the head ; and, when indicated, employs the trephine and other proper means for the cure of such acci- dents. He enters more minutely into the consider- ation of injuries at the hip, than many of the early surgical writers of modern times ; but in common with most of his predecessors, he fails to distinguish between fractures of the neck of the femur and dis- locations at the hip joint. Among the Latin writers practicing at Kome at this period, were Apuleius Celsus, and his pupil Scribonius Largus, the first probably somewhat the senior and the other the junior of Cornelius Celsus. Apuleius was a native of Centuripa, in Sicily. He was long in high and deserved repute at Rome, where he was engaged in teaching, as well as prac- ticing. Among his pupils was Vectius Valens, celebrated afterwards for his intrigue with Messa- lina, the wife of Claudius.* The works of Apuleius have mostly perished, though there is still extant a * Pliny, Hist. Nat., lib. xxix. cap. v. 9 122 DISCOURSE. treatise on the virtues of herbs,* which has some- times been ascribed to Apuleius Madaurensis, the author of the Golden Ass ; but which those who have examined it with greatest care, attribute to Apuleius Celsus. The author of this treatise, De Medicaminibus Herbarum, states in his preface, that it was prepared for the benefit of the public, and to relieve the common reader from the verbose stupid- ity of the profession, the greater part of whom he characterizes as ignorant pretenders, more intent on the acquisition of wealth than on the cure of the sick. Much of the work is occupied with anti- dotes, and specifics against the bites and stings of venomous animals. It is proper to remark that some recent and able critics have questioned the authenticity of this work, and ascribed it to some unknown writer of the middle ages. Scribonius Largus, who flourished during the reign of Claudius, and accompanied this emperor in his expedition into Britain, was an incorrect writer of the Latin tongue, but in a professional point of view, an author of considerable merit. Though an admirer of Asclepiades, he appears to have written in the spirit of empiricism. His treatise, De Com- positione Medicamentorum,f is devoted rather to the composition and uses of medicines, than to the consideration of the diseases to which these are ap- plied. Many of his compound confections are quoted by later writers. He abounds in remedies * Already mentioned in connection with the work of Antonius Musa, published at Bale, 1536. f See the " Medicinae Artis Principes," foL, Venitiis, 1567. DISOOUESE. 123 for the cure of particular ailments; and, as usual, his antidotes, theriacse, plasters, and embrocations, are highly illustrative of the polypharmacy of his times. He gives the formula for the celebrated mithridaticum, an antidote against all kinds of poisons, said to have been invented or employed by Mithridates, king of Pontus ; but which, as here given, differs materially as well from the formula said to have been discovered by Pompey among the archives of Mithridates, as from that which we find in Galen."^ How far this work of Scribonius Largus was original, and how far derived from other writers, we are not able to determine. By some critics it is said to have been little else than a translation from Nicander ; but careful perusal will show that portions of it, at least, could not have been from that early source. The writer himself expressly informs us that the greater part of his composi- tions he had himself prepared and used, and that the rest were mostly obtained from his friends. Among these friends must have been Apuleius, his preceptor, whose writings he may have appropriated with considerable freedom. For Marcellus Empiri- cus, who makes no allusion to this work, and ac- knowledges that he himself has copied from Apu- leius, gives numerous passages which are also found almost word for word in the writings of Scribonius. Again, this author has been charged with recom- * The Mithridaticum, according to Pliny, was a composition for the lux- urious who could afford to pay for it, consisting of fifty-four different in- gredients derived from abroad, and used where simple domestic remedies would have answered as well. See Hist. Nat. xxix. 8. 124: DISCOUKSE. mending his medicaments indiscriminately ; but he himself declares that, in the diseases for which they are intended, they will sometimes prove bene- ficial and sometimes fail, according to the condition or age of the patient, the season of the year, pe- culiarities of time and place, or other varying cir- cumstances ; and that even in bodies to all appear- ance similarly situated, the same agent will not always produce the same effects. About this same epoch also flourished Athenseus, a native of Attaleia, in Asia Minor, who, while practicing and teaching at Rome, took strong ground against the Methodists, and became the founder of the Pneumatic sect.*^ He is generally supposed to have written subsequent to the time of Cornelius Celsus, inasmuch as the latter makes no direct allu- sion to him. But the doctrines of this fourth sect were essentially the same as those promulgated by Erasistratus, in reference to th,e Pneuma, or spirit, as a fifth element ; the disturbance of which in the liv- ing body was assumed to be the essential cause of all diseases. Now, to this doctrine Celsus does allude, and even devotes a section in strenuous opposition to it, referring to Erasistratus as its author. The doctrine of a fifth element, however, was even more ancient than this writer. The term Pneuma was employed by Aristotle ; and the ^ve elements are distinctly enumerated in the " Epinomis," a dia- logue which on good authority, is ascribed to Plato, * See Galen, Kuhn's edition, vol. vii. 609, viii. 749, xix. 34*7, 356. He should not be confounded with Athenaeus of Naucratis, who flourished in the third century. DISCOURSE. 125 or at latest, to his pupil, Philip of Opuntium * As there are ^ve bodies, observes the author of this dia- logue, it is requisite to say that fire is the first, water the second, air the third, earth the fourth, and aether the fifth; and that in the domains of each of these is produced many an animal, and of every kind.f Athenseus, then, owed his reputation more to his attack upon the Methodists than to the modifica- tions of Rationalism which he adopted. His own peculiar opinions were of only temporary notoriety. Agathinus of Lacedsemonia, who had been among his followers, undertook to reconcile the doctrines of his master with those of the other sects, and thus became the founder of the Episynthetics, or Ec- lectics.J Section II. — The later Methodists of the Romcm School. Among the writers of the Roman school, it is not always easy to distinguish those who were of Gre- cian birth, from those of Roman origin. As early as the reign of Augustus, the Greek became the ac- cepted language of the court ;§ and it had always been the language of the schools, and of science. Among the early Roman Medical writers forsak- * Plato (Kuhn's edition), vol. vi. p. 195. f Ibid. vol. vi. p. 17. X Galen, vol. xix. 353. § Suetonius, in Life of Augustus. 126 DISCOTRSE. ing their native language, were Sextus Niger and Julius Bassus, who are referred to by Pliny and others, but of whose writings we have no remains. They were both of the Methodic sect, as were also most of the practitioners at Rome between the reign of Augustus and that of Marcus Aurelius ; of whom, besides those already mentioned, were the Greek physicians Andromachus, Thessalus, Philo- menus, Archigenes, Heliodorus, Antyllus, and So- ranus. Andromachus the elder, was of Crete, and a pupil of Diogenes of Babylon* He was physician to the emperor Nero, and the first to enjoy the official dis- tinction of Archiater, a title to which we shall have occasion to return. He was celebrated for his the- riaca, into which he introduced the flesh of vipers, to which, at that time, were ascribed wonderful effects as an antidote. Thessalus was a native of Tralles, in Lydia, and is spoken of by Plinyf and Galen, as a charlatan. He was a man of low origin, vulgar manners, and supercilious spirit. Though of the Methodic sect, he had too little regard for the opinions of others to be the strict follower of any theorist. With little knowledge of the literature of medicine, he held himself superior to all his predecessors, and boasted of being able to impart the whole art to his pupils in the space of six months. He flourished at Rome during the reign of Nero, and by his practice ac- cumulated immense wealth. He was the author of * Galen, in numerous passages. f Hist Nat. lib. xxix. cap. v. DISC0UK8E. 127 several works, all of which have perished. Caelius Aurelianus attributes to him a treatise, in several books, on Dietetics ; and another, also in several books, entitled " Comparatio." Philomenus, another writer of the Methodic sect, flourished about this same epoch, and is occasion- ally quoted by Oribasius, Aetius, and Alexander Trallianus. He pointed out the affinity between dysentery and the prevailing fever of the season. He was the first to recommend assafoetida and fric- tions with tepid oil, for the treatment of tetanus. He wrote on the diseases of women, and on the removal of the foetus by artificial means.* Archigenes of Apamea, in Syria, was in great repute at Rome, as a physician and surgeon. He flourished in the reign of Trajan. His works were numerous, and are often quoted with commendation, by Galen and others. He wrote ten books on fevers, three on local affections, also on the use of castor, and of hellebore in mentagra and other cu- taneous affections ; and on surgical diseases, some fragments of which are still extant in the collections of Nicetas.f His description of the operation of amputating, is worthy of notice. He begins by re- tracting the integuments of the limb ; he next applies a circular compress or tourniquet for controlling the loss of blood; he even recommends, when neces- sary, a preliminary operation for securing the blood- vessels and stitching them, before proceeding to the * See Sprengel, tome ii. p. 31. f GrjBcorum Chirurgici libri, e collectione Nicetse, eonversi et editi ab Antonio Cocchio. Flore ntiie, fol. 1754:, p. 118 and 164. 128 DISCOURSE. amputation. Tliis he performs invariably at tlie joint, by a circular incision. After tbe removal of the limb, whatever haemorrhage occurs he arrests by the actual cautery ; taking due care not to apply the heated iron to the divided extremities of nerves. Heliodorus is also more particularly noted as a surgeon. Fragments of his writings on wounds of the head, on fractures of the skull, and other in- juries, may also be found in Oribasius* and the collections of Nicetas.f His remarks on injuries of the skull are judicious, and indicative of a careful observer; and his treatment, such as might be recommended at the present day. His dressings are iight, his local applications simple, usually moist compresses, roseated oil, simple cerate, and tepid water. For controlling inflammation he resorts to low diet, and occasionally to venesection. He speaks of amputating in the continuity of the long bones, but looks upon operations above the knee and elbow as extremely dangerous, from loss of blood. To obviate this danger as far as possible at other points, he makes his incision first through those parts of the limb in which the bones are most superficial ; he next saws through the bones ; and he reserves his incision through the fleshy part of the limb, where the vessels are most numerous, to the last. Antyllus, another surgeon, though not mentioned * Collect, lib, viii. chap. 3, 4, and elsewhere, f Page 90 to 105. pp. 124, 156. DISCOURSE. 120 by Galen, is by some writers presumed to have pre- ceded him, whilst by others he is placed as late as the reign of Valerian. He is frequently mentioned by the later Greeks. In the collections of Nicetas* is a fragment of his on elastic or watery tumors of the head, superficial and deep-seated ; including among the last, congenital or chronic hydrocephalus. The superficial varieties he encounters with fair hope of success, but with those more deeply seated he is indisposed to interfere. He treated humid asthma with suffumigations, placing the patient in such a position as readily to inhale the fumes from particles of aristolochia or clematis previously sprinkled over burning coals in a chaffing-dish or brasier.f He operated on cataract by extraction ; with Asclepiades, he recommends tracheotomy in threatened suffocation; and he treated hydrocele by incision.J Soranus of Ephesus, the second of that name, was educated in part at least at Alexandria, and prac- ticed with great eclat at Eome under the reigns of Trajan and Adrian. He was celebrated both as a teacher and practitioner ; and is admitted to have been the ablest exponent of the Methodic doctrines, which he carried to their highest degree of popu- larity. He was the first to mention the Dracun- culus or Guinea worm {vena medinensis^ Among the fragments of his writings still preserved, we have a treatise on the female organs of generation, and another on fractures, which is contained in the col- * Page 121. f Oribasius, collect, lib. viii. cap. 12. \ Sprengel, tome ii. p. 94, from Rhazes and PanluES;. 130 DISCOURSE. lections of Nicetas, and is mostly made up of defi- nitions. This second Soranus is not to be con- founded with still another of the same name, also of Ephesus, a writer of later date, and the reputed author of a memoir on the life of Hippocrates. The works of the second Soranus, though mostly lost, served as the model for those of Cselius Aureli- anus, who is supposed to have embodied the greater part of them in a translation. To him, therefore, we must next direct our attention.* Caelius Aurelianus, sometimes called Lucius Caelius Arianus, was a native of Sicca in Numidia. He appears to have been a voluminous writer- Besides his work on Acute and Chronic Diseases, which is preserved entire,f he was the author of Greek Epistles addressed to Prsetextatus ; of a work on Fevers, and of another on Diseases of Females ; of distinct treatises on the Causes of Disease, on Sur- gery, on the Eules of Health, on Adjuvants or the General Remedies of the Methodic sect, and on. Medicaments ; besides several books of Medical In- terrogations and Responses ; and a book of Prob- lems ; — all of which have perished. His work on Acute and Chronic Diseases is written in impure Latin ; and much of it, as the author admits, has been borrowed from Soranus. But it can hardly be considered a translation, since much of it was evidently the result of the author's own observ- ation and experience. Of the eight books consti- * Cselius Aurelianus, and Galen in several places, f Caelii Aureliani Ciccensis de Morbis Acutis et Chronicis libri viii. 4to. Amstelaedami, 1*722. DISCOURSE. 131 tuting tills work, three are devoted to the history and treatment of acute, and five to the history and treatment of chronic diseases. The several maladies are arranged in the usual order from head to foot, considered in their relation to concomitant consti- tutional disturbances, and spoken of as accompanied or not accompanied with fever. This valuable summary of theory and practice, can scarcely be considered as advocating only the doctrines of the Methodic sect. Though its author is a favorer of these doctrines, he speaks as an independent ob- server, criticises the leading writers of his own party, and, in disposing of his materials, gives first his own proper opinions on the history or pathology of the disease in question, and afterwards those of the several leading writers of the other sects ; drawing, however, almost exclusively from the Greeks, and furnishing a systematic exposition of the theory and practice of physic, both of his own and previous times. But in referring to his predecessors he is much more solicitous to give their treatment than their pathological opinions ; which, however, he does not entirely overlook. Cselius Aurelianus, quoting from Soranus, is the first writer in whom I remember to have met with a practical distinction between what he calls the signs and the symptoms of disease, a distinction still worthy of remembrance : the signs being always present during the existence of the disease ; the symptoms being mere accidents, that may or may not be observable, without ne- cessarily implying any essential modification in the disease itself His chapters on diseases of the head are ably written, and evince much prac- 132 DISCOURSE. tical acquaintance with the subject. In his chap- ter on Cynanche he says, some forms of Cynan- che are without visible manifestations ; others are visible and manifest, either within the fauces, or externally, or both externally and internally, and in one or both sides. The transition from this de- scription to that of the monkish writers of the middle of the thirteenth century, Roger, Roland, and the author of the Four Masters, is curious and amusing. Thus, says Roland, Squinantia is an aposthem of the throat, of which there are three sorts ; and hence the verse, — " Qui (nancia) latet, squi (nancia) patet, si (nancia) manet intus et extra." While on diseases of the throat, Caelius Aurelianus takes occasion to criticise Hippocrates, particularly in reference to the inhalation of vapors medicated with hyssop, sulphur, or bitumen, by means of a tube introduced within the fauces, for the relief of threatened suffocation ; a practice against which he speaks in the strongest terms ; judging it impossible to insert a tube into the fauces already so much obstructed as not to admit even air, — or to inject thick smoke where thin air is unable to penetrate.* As Soranus and Caelius Aurelianus are considered the ablest exponents of the Methodic doctrines ; and as we learn from them what would be sought in vain elsewhere concerning Asclepiades, Themi- son, Thessalus, and others of this sect, it may be proper here to give a summary of their practice at the period of its greatest eminence. They confined themselves as much as possible to * See his works, p. 191. DISCOURSE. 133 general remedies ; to tlie exclusion of specifics, or particular remedies for particular ailments. In tlie management of disease their first care was tliat the chamber of the patient, the air surrounding him, and the arrangements of his bedding, should be well selected. Food and drink were allowed in modera- tion, provided the circumstances of the case did not clearly prohibit these. Under this course the tend- , encies of the disease were for some days sedulously watched. A generous or supporting diet was rarely employed within the first three days, during which, time they watched for the concoction of such cru- dities as might have existed in the primae vise ; and partly by abstinence, partly by friction, fomenta- tion, and inunction, they looked for the removal of these. During the second period of three days, unless the urgency of the case called for greater expedition, they employed venesection when indica- ted ; or cupping, if necessary, over every part of the body ; sometimes with scarification, sometimes dry, and sometimes in connection with leeches. Among their general remedies for resolving constriction were, warm and sunny air, a soft couch, gargarisms of tepid water or of fresh and fragrant oil, fasting, watching, inunction, emollient cataplasms, fomen- tations and baths, humid cupping, venesection, ges- tation, and passive motion generally, emollient clysters, and emetics. For astringing the body, already too much relaxed, they employed cold air, a shaded position, a hard couch, gargarism of vine- gar and water, or vinegar and posca (dilute aro- matic wine) applied with a sponge, cold lotions 134: DISCOURSE. containing the juice of plantain, of portulaca, or sempervirens ; a diet of barley meal, of lentils, or of quinces, or toasted bread moistened with vinegar, sound sleep, repose, dry-cupping. They rarely re- sorted to purgatives except in dropsies; they were equally opposed to diuretics and sudorifics, to irri- tating clysters, to opiates, and to the abstraction of blood from the sublingual vessels, as others had recommended, ad deliquium miimi, Nor would they resort to measures likely to jeopardize the safety of their patient. In the treatment of tumors, a term applied by them to all inflammatory swell- ings, while the disease was on the increase, they employed moderate astringents; when stationary, relaxing and assuaging remedies ; when on the de- cline, emollients. In diseases attended with distinct remissions or intermissions, particularly with regu- larly recurring paroxysms, they employed recuper- atives^ called also metasyncratica^ by which they meant fortifying and analeptic agents ; among which were included violent exercises, hoping thereby to expel from the body while relaxed, the worn-out or diseased flesh, and to replace this by new and healthy tissues. For checking profuse sweating, they sprinkled the surface of the body with pow- dered chalk or alum, and with various other astringents. The obstetric art among the ancients was usually in the hands of illiterate females, who acquired their information by experience. But for the instruction of the better sort of them, as well as of the matrons who had occasion for their services, several works DISCOUKSE. 135 appear to have been in use, among which was a treatise by Aspasia, now lost, but of which mention is made by Aetius ; and the essay, in one hundred and fifty-two short chapters, by Moschion, also mentioned by the same author; a work which is still extant. Moschion appears to have flourished at Rome soon after Soranus or Cselius Aurelianus. In the preface to his work on the Diseases of Wo- men,* he tells us it was intended for the benefit of mothers, and of those females who were devoted to the obstetric art, and familiar only with the Latin tongue. It must, therefore, have been originally written in Latin ; but we have only now remaining the Greek version, which was probably made long after the original work had first appeared. The author acknowledges that he had drawn most of his materials from earlier Greek writers, but with corrections and additions, for which we are indebted to himself He is usually spoken of as belonging to the Methodic sect. But he is bound to no theory ; he reasons and prescribes according to the exigencies of each case, usually with much skill and judgment. He goes over the whole subject of ob- stetrics, the diseases of the puerperal woman, and the management of the infant ; he enters into the requirements of the sick room, the qualifications of an accomplished obstetrix, and those of a good nurse, the diet and exercise for the nursing woman, and the training proper for the child. He intro- duces many acute and discriminating remarks in * Moschionis de Mulierum Pa ssionibiis liber. 12mo. Viennse, 1793, Other works of this author are also still extant. 136 DISCOURSE. connection with these subjects ; as also in his chap- ters on suppression of the menses, inflammation of the uterus, hysteria, uterine haemorrhage, fluor albus, displacements of the uterus, and the symptoms indi- cative of these. The work, in some of the editions still extant, has been subjected to objectionable interpolations; omitting which, it is worthy of the attention even of the modern practitioner. The culinary art among the Eomans was too inti- mately related to that of the apothecary, and had too close a bearing upon the practice of medicine, to be passed over in silence. Their principal writer in that department, Apicius Coelius, by birth a Span- iard, and according to Athenseus,* very rich and luxr urious, living chiefly at Minturnae, in Campania, flourished during the reign of Trajan ; and many of his preparations were as useful in the chamber of sickness as they were acceptable at the banquet. Among these might be noticed his aromatic wines, perfumed with the rose, the violet, and other fra- grant flowers, in nearly the same manner as the an- cient apothecaries prepared their aromatic oils. His formula for preserving grapes fresh throughout the year for the benefit of the sick, and his mode of preserving apples, pears, quinces, cherries, plums, and other fruits, are equally worthy of attention. His treatise is a work of much more pretension than most of our modern works on the art of cookiog.f It is divided into ten books, in which are dis- * Deipnosophists, book i. c. xii. f Apicii Coelii de Opsoniis et Condimentis, sive Arte Coquinaria, libri decern, 12mo. Amstelodami, 1709. DISCOURSE. 137 played the various mysteries of Greek and Roman luxury under the head of, — 1st, Epimeles, or condi- ments and confections ; 2d, Sarcoptes, or made dishes, mostly of animal food ; 3d, Cepuros, or Hortulanus, referring to vegetables, pickles, and car- minatives ; 4th, Pandecter, mostly prepared vegetable dishes ; 5th, Osprios, leguminous and pultaceous preparations; 6th, Aeropetes, or dishes prepared from birds of every kind ; 7th, Politeles, sumptuous preparations mostly of animal substances; 8th, Tetrapus, or dishes from the flesh of quadrupeds ; 9th, Thalassa, dishes from sea-fish, shell-fish, and the like ; and 10th, Halieus, or dishes of fish procured by the angler. From the Deipnosophists of Athenaeus,* a junior contemporary of Galen, much, also, may be learned of the luxurious habits of the Romans, Section III. — Pliny the Elder, We have next to notice a Latin writer who, though not a physician, gave much attention to medical studies ; and, as a compiler, has materially contributed to our knowledge of the profession among the ancients. I allude to Pliny the natural- ist, or the elder, as he is often called, to distinguish him from his nephew. He was born at Verona, A. D. 23, during the reign of Tiberius, and received * In 3 vols., London, 1854. 10 138 DISCOURSE. some portioQ of his early education in attendance upon tlie lectures of Appion at Rome. He was oc- cupied, during the greater portion of his life, in the service of the state, in civil offices among the pro- vinces, and in military enterprises in Germany and elsewhere, under Vespasian, who was attached to him as an intimate friend, and under Titus in Pales- tine. But notwithstanding the number and import- ance of his public duties, he found leisure for exten- sive reading, and for the exercise of his talents as a writer. He was the author of numerous works on history, on military affairs, and other subjects; but all that now remains of these is his Natural History, the last of his literary performances, compiled, A. D. 78, only two years before his death. He perished by suffocation, from venturing too near to Mount Vesuvius while in a state of active eruption. This work of Pliny* is not merely a natural his- tory in the present restricted meaning of the ex- pression, but, as rendered by an old English transla- tor, the natural history of the world, consisting of thirty-seven books, and treating of cosmography, astronomy, geography, physics, agriculture, com- merce, medicine, the useful and fine arts, the moral constitution of man, and the history of nations, as well as natural history proper. The compass of the work, of necessity, included numerous topics with which the author was not personally familiar. He has, therefore, not aimed at originality, and has * Caii Plinii Secundi Historise Katuralis libri xxxvii. vols, 6, Lipsiae, 1830. DISCOURSE. 139 mostly restricted himself to condensing and trans- cribing from other writers. Nor has he in this labor evinced much talent as a discriminating compiler. He is neither choice in his selections, accurate in his quotations, nor unbiased in his judgment. But he has condensed his materials from more than two thousand authors, and from the reading of his whole life ; and has thus furnished us with one of the most valuable of the literary remains of the ancients. Like many of his countrymen, Pliny has not con- cealed his prejudice against the profession. He was friendly to the art rather than to those who practiced it. But, from his medical reading he has given ten books on the history of plants, including their uses in domestic economy and the arts; ^ve books on the medical uses of plants ; and ^ve others on medi- cines derived from the animal kingdom. We are indebted to him for an account of several epidemics and new diseases ; particularly, for his graphic his- tory of Mentagra, a disease which appeared at Rome for the first time, during the reign of Claudius, and spread extensively among the nobil- ity, sparing women and persons in humble life ; communicated from one individual to another by the act of kissing; appearing first upon the chin, lips, and face, and afterwards extending over the surface of the body, in the form of eruptions, which degenerated into foul and offensive ulcers. The close analogy of this disease to that which first appeared in the south of Italy near the close of the fifteenth century, led many at first to the belief, that the Mentagra, or Lichen, of Pliny, was identical with 140 DISCOURSE. tlie venereal disease ; and this disease, from first ap- pearing on tlie pudendum, was, by Gasper Torrella and others, for a time called Pudendagra. An- other interesting point in Pliny's history of the Roman epidemic, is that he distinctly ^lludes to the subject of contagion. The disease, he tells us, had previously existed in the East, where it was called by the Greeks, Lichen ; and its contagion, he adds, was imported by a Roman knight, who communi- cated the infection to the inhabitants of the capital. This, it is true, is not the earliest allusion to the subject. Thucydides, as already shown, speaks of the plague as an infectious disease; and Aristotle, of rabies as spreading from one animal to an- other. Some of the medieval historians, as Eva- grius,"^ allude to the contagiousness of plague. But the medical writers and teachers of Greece and Rome were too deeply involved in humoral pathol- ogy and the doctrine of the four elements, or too much disposed to reject the study of occult and re- mote causes altogether, to understand the exact bearing of this important subject; which appears never to have seriously entered into their discus- sions, and which was equally overlooked by the Arabic, and with the exception of Bernard Gordon, by most of the European medieval writers on medi- cine.f Pliny's allusion to contagion is merely inci- * Ecclesiastical History, "book iv. chapter xxix. f Gordon's list of contagious diseases is summed up in the following distich : Febris acuta, phthisis, pediculi, scabies, sacer ignis, Anthrax, lippa, lepra, nobis contagia praestant. Particula i. cap. xxii. p llY. And when we remember that Gordon wrote in the year 1305, nearly two DISCOURSE. . 141 dental ; yet, it is tlie announcement of a truth, not of a speculation, derived from popular observation and belief; a truth, long unheeded, but which no one at the present day would venture to call in question. Pliny also enters fully into the history of ancient wines, and in speaking of the strong Falernian varieties, says they are inflammable : " Nee ulli in vino major auctoritas ; solo vinorum flamma accendi- tur."f The modern wines, with only their natural supply of alcohol, are not of strength equal to this. It is therefore reasonable to infer that the art of dis- tillation must have been known to the vintners of antiquity. If so, it must have been confined to some single fraternity of them, and practiced as one of their secret mysteries, only for the purpose of fortifying their wines ; and thus kept secret until alcohol was discovered anew by the alchymists of the middle age, and the art of distilling it made public, for the first time, as is commonly believed, by Arnold de Villa Nova, in the latter part of the thirteenth century. From what has now been stated of the progress of medicine at Rome, we may safely infer that the interval between Asclepiades and Galen, a period of about two hundred and fifty years, was, in the centuries before the venereal disease is usually supposed to have origin- ated in Europe, the following passage from his Lilium Medicinse (Particula i. cap. i. p. 107) is worthy of special observation : " Quoedam comitissa leprosa venit ad Montem pessulanum, eratque tan- dem in cura mea, cui cum quidam Bacchalarius in medicina ministraret ei, coiens cum ea, earn imprsegoavit, et perfectissime leprosus factus est." f Lib. xiv. c. viii. § 2. 142 * DISCOUESE. number and ability of its writers ; in the advance- ment of its teachers in anatomy, physiology, materia medica, therapeutics, hygiene, pathology ; in the study of nature, and in the philosophy of medicine, — one of the most active periods in the whole history of our art. As such, it is more worthy of notice, from the fact that the native Eomans were never seriously devoted to the cultivation of the sciences. But, quick discoverers of the useful, they knew how to improve upon the suggestions or discoveries of the Greeks. Their immense cloacae for the drain- age of the city, their public baths, their care in the selection of sites for new towns, villas, and private residences, their improvements in architecture, and the domestic arrangement of their dwellings, as set forth by Vitruvius and others, are sufficient to show that the lectures of their Grecian masters on the rules of health, had been properly appreciated, and the information thus diffused amongst them, turned to good account. But these improvements in the arts of civil life, were of comparatively short con- tinuance; so that Galen, who flourished during the reigns of Marcus Aurelius and Commodus, and as late as Septimus Severus, was the last, as he is also acknowledged to have been by far the most distinguished, of the medical teachers of the Roman school. But before alluding further to this great master of our art, we must for a moment return to the provincial institutions. DISOOUKSE. 143 CHAPTER IX. GREEK WRITERS AND TEACHERS NOT OF THE ROMAN SCHOOL BUT CONTEMPORARY WITH IT. Among the Greek writers not strictly of the Ro- man school, who flourished during the epoch at present under consideration, were Dioscorides of Anazarba, Ruffus of Ephesus, Aretaeus of Cappado- cia, and Marcellus of Sida. Mr. Sharpe, the able historian of Egypt, makes Dioscorides the physician of Cleopatra. But Galen speaks of him as a recent writer ; and from his own works* it is evident he must have lived as late as the reign of Claudius. He was probably educated at Alexandria, which still retained some share of its early celebrity. He subsequently traveled exten- sively in Europe and Asia, and for a part of his life was occupied as an army surgeon. His great work on the Materia Medica, the only complete treatise of the sort that had hitherto appeared, was the result of much personal inquiry and experience ; and the portions of it not thus acquired, were drawn as he informs us, from the most reliable sources. Galen speaks highly of his accuracy ; and, as an au- * Pedanii Dioscoridis Anazarbei de Materia Medica libri quinqiie, , collection of Stephanus, 1567, which gives Cornaro's version. Also, the Eiiglish Translation bj F. Adams, 3 vol?. Svo. London, 1844. And the French version of the sixth book, entitled " Chirurgie de Paul d'Egine," par Rene Brian. 8vo. Paris, 1855. DISCOURSE. 205 ing an epitome of medical science less voluminous than the cyclopediac compilations of that writer, and more useful to the physician than the imperfect synopsis which Oribasius had left of his own collec- tions. But in the execution of this task, Paulus ex- ceeds his original intention. He draws from many sources, and much from his own experience ; and in all that relates to surgery, he is more full and circum- stantial than any other of the ancient authors, not even excepting Celsus. His work is divided into seven books. In the first, he treats of hygiene and the rules of health, as applied to different ages, sea- sons, temperaments, and to the use of different articles of diet. In the second, he treats of fevers, excrementitious discharges, critical days, complicat- ing symptoms and appearances. In the third, of local affections, from head to foot. In the fourth, of external maladies limited to no particular part of the surface, including cutaneous and verminous dis- eases. In book fifth, he treats of wounds and the bites of venomous animals, of poisons and their anti- dotes. In book sixth, he describes all the diseases calling for surgical manipulations ; and in the last, he treats on the properties of medicines simple as well as compound, and particularly of such as he had mentioned in the former portions of his work ; also on the modes of preparing these medicines, and on such articles as may be substituted for one another. Paulus is also said to have written on the diseases peculiar to women ; and for his skill in this depart- ment, he was sometimes called by the Arabians, Paul the Obstetrician. By the moderns he is chiefly 206 DISCOURSE. esteemed for his able exposition of surgical diseases and operations. He had the honor of being almost wholly appropriated by Fabricius ab Aquapendente, one of the ablest sursrical writers after the first re- vival of learning in Italy. Paulus is the first to speak of rhubarb as a cathartic. The only other writer among the Greeks^ after the time of Paulus, and worthy of rank among the ancient classics of the profession, is Actuarius. He flourished at Constantinople long after the fall of Alexandria ; and is, therefore, to be reckoned among the luminaries of the middle ages. Before closino' this hurried sketch of the medical writers of antiquity, it is worthy of remark that Ga- len, whose authority was paramount to all others, from the close of the second to the middle of the seventeenth century, occupies the middle space in the thousand years which intervened between the founding of the Alexandrian school, and its ultimate overthrow by the Saracens. It has been customary to speak of the deterioration of medical science dur- ing the latter half of this period. But the decline must be taken in connection with the retrograde movement of general civilization during the same period, and attributed to the same causes. With the progressive decay of the Roman empire both of the East and AVest, the different communities of which it was composed were gradually sinking deeper and deeper into barbarism ; . and it is not DISCOURSE. 207 wonderful that the medical profession should have .felt the general influence. Yet, when we consult such writers of this period as have reached us, and compare those of the first with those of the second part of it, as Cassius, Celsus, Aretseus, Dioscorides, Ruffus and Cselius Aurelianus, all prior to the time of Galen ; with Oribasius of the fourth century, Aetius and Trallianus of the sixth, and finally, with Paulus ^gineta, the last and among the best of them ; we are struck with the general uniformity of their views and modes of reasoning, as well as with their course of practice. There is nearly as much originality, if not as much acumen, in proportion to their number, in the one group as in the other. Paulus and Tral- lianus in this respect, are the ablest ofisets against Celsus and Aretseus. Of the later group, with the two exceptions just mentioned, few ventured much beyond the business of commentators or compilers. But in this they were not corrupters of the art. With the earlier masters still before them, they have *advanced opinions of their own sufiScient to show that if medicine had not been revolutionized by them, it had never been entirely neglected. The principles and practices established in better times were still maintained. The profession of those days, conscious of their own position, were content to reverence what they, had neither the skill to equal, nor the temerity to set aside. 208 DISCOURSE CHAPTER XIII. LAWS AND CUSTOMS OF THE ROMAN EMPIRE IN RELA- TION TO THE PROFESSION. Prior to the consolidation of the empire, there were probably no well-established laws among the Pomans in regard to medical education, the term of study, or the qualifications of physicians. The system of training previously in use among the Greeks, appears in course of time to have been uni- versally adopted. The liberally educated, whether of the profession or not, were all more or less initi- ated in what was then the philosophy of medicine ; and some of the uses to which such information was applied by them, may be learnt from Varro in his directions for the building of villas ;* or from Vitru-. vius,f a writer of the Augustan era, whose au- thority in all that relates to the locality of dwel- lings, to public works, and to the planning of new cities, might with advantage be consulted in ques- tions of hygiene as applied to architecture, at the present day. The hygienic arrangements in the rural economy of Palladius, must also have been de- rived from the same source. J * M. Terentii Varronis De Re Rustica lib. i. cap. xi. and xii. f Marei Vitruvii Pollionis De Arcbitectura libri decern. Lipsiae, 1836. J Palladii Rutilii De Re Rustica lib. i. DISCOTJRSE. 209 The well-educated physician, in common with his medical knowledge, was presumed to be familiar with the grammatical structure of his own language, with rhetoric, arithmetic, geometr.y dialectics, moral philosophy, astronomy, and even architecture. Galen refers to these several branches of general education, as proper means for sharp- ening the intellect of the student preparatory to assuming the difficult and responsible duties of the profession."^ And his contemporary, Apu- leius Madaurensis, who styles himself the " not unknown priest nor recent worshiper, nor un- favored minister, of ^^culapius," addressing the people of Carthage in his figurative manner, says of the Goblet of the Muses, '^The oftener it is drained and the more unmixed it is, the more it con- duces to soundness of mind. The first cup, that of the reading-master, takes away ignorance ; the second, of the grammarian, instructs in science ; the third, the rhetorician's, arms with eloquence. Thus far most people drink. But I have drunk other cups at Athens, the cup of poetry, the inventive ; of geometry, the limpid ; of music, the sweet ; of dialectics, the roughish ; and of universal philoso- phy, the never-satiating nectarious cup." f The time usually devoted to the study of med- icine, beyond that spent in the literary course, as may be inferred from Galen and others, was not short of * De Cognoscendis Curandisque Animi Morbis lib. viii. cap. 1. Kuhn's edition, vol. v. p. 42. See also Admiaistrationes Anatomicae, lib. i. c. ii. Kuhn's edition, vol. ii. and numerous other parts of bis writings. f Florida, chap, xx 210 DISCOURSE. five years. Galen, after a philosophical course of three years, which he began at the age of fourteen, had already been a student of medicine under Sa- tyrius four years, at the breaking out of the plague in Pergamus, most of the time in daily attendance upon the sick within the temple. On the subsidence of the epidemic of that city, he resorted to Smyrna ; there to continue his course under Pelops ; he after- wards became the pupil and assistant of Kumisianus, at Corinth ; spent some time in Alexandria and other cities, and after finishing his education and his travels, he returned at the age of twenty-eight to Pergamus, to practice on his own account. Again, Caesarius, brother of Gregory Nazianzen, who, for a time, practiced at the court of Julian, and was the physician and familiar friend of Valens and Yalen- tinian, had been a student of medicine at Alex- andria five years; and may have been previously engaged in the same pursuit at Csesarea, then a cele- brated seat of learning, or at his native place. The term of study at the celebrated law-school of Bery- tus, which was instituted by Alexander Severus, occupied five years.* The laws of Justinian enjoin that no apprenticeship shall be binding after the age of twenty-five ;f which, for students of the lib- eral professions as well as of the industrial arts, was the legal limit to the period of pupilage. The system of instruction in the Roman schools was mostly practical. Anatomy, at least the dissec- * Gibbon, chapter xvii. § ii. Harper's edition, vol. i. p. 34*7. f Codex Justinian i, lib. x, tit. xlix. §1. DISCOURSE. 211 tion of tlie lower animals^ was strictly enjoined. Gralen insists with great force upon the necessity of this study, and states that in his own youth, he allowed no occasion to escape him for investigating the structure of the human body. After witnessing the dissections of his teachers, he examined with care the dried and moldering skeletons picked up among the tombs ; he inspected the bodies of men drowned, and wafted decomposing to the shore ; he turned to some account the remains of a malefactor who had been crucified and suspended near the way- side, on a gibbet, as a warning to evil-doers, and as food for birds of prey. He advises the pupil to dis- sect apes and other animals ; and where other means fail, to resort to Alexandria, if for nothing else, to have the opportunity there presented of studying the human skeleton. He labors to convince his readers that a sufficient knowledge of the art is to be acquired only by years of observation and expe- rience.* His own public course of teaching at Rome, as already shown, was of this character. And such continued to be the method of instruction up to the time of Oribasius; who informs us that the dissection of apes, in his day, still constituted a por- tion of the pupil's exercise ; an occupation in which he himself had been engaged.f Books were not then, as now, the main reliance of the student. The works at his command were few. Of these, the writings of Hippocrates and his com- * Administrationes Anatomicae, ut supra, f Collect, vii. 6. 212 DISCOURSE. mentators among the Greeks ; of Celsus and Cselius Aurelianus among the Latins, next to the works of Galen, — were the chief. Portions of these, when ac- cessible to him, he was required to ponder over, with the oral explanations or written comments of his preceptor. The temples were open to him, up to the time of Constantine ; after which he had the oppor- tunity of attending, with his instructor, upon the sick ; and was obliged to practice under him before commencing for himself. Indeed, the importance of practical training was, if possible, more highly estimated by the ancients than the moderns. Even the charlatans of Kome, who spurned all connection with the liberal arts, and professed to qualify their pupils within the short space of six months,* were duly impressed with the necessity of clinical teaching, and were in the habit of ostentatiously parading through the streets, fol- lowed by a retinue of young men, with whom they made their daily visits to the sick ; a custom to which we owe the sarcastic epigram of Martial : " Languebam ; sed tu comitatus ad me Yenisti, centum, Symmache, discipulis, Centum me tetigere manus Aquilone gelatse; Kon habui febrem, Symmacbe, nunc habeo !"f At Rome, as among the Greeks, there were physicians belonging to the servile races. And, that these might the more readily practice their profession, * Galen, Methodus Medendi, lib i. cap. i. Kulin's edition, vtl. x. p. 5. f Lib. V. Ep. 9. DISCOURSE. 213 they were usually declared freedmen by their mas- ters. The estimation placed upon slaves engaged in the practice of medicine, may be ascertained from the Codex of Justinian ;* which fixes the legal value of a maid servant at twenty solidi ; of a male slave skilled in any handicraft, at thirty solidi ; notaries, whether male or female, at fifty solidi ; and physi- cians, male or female, at sixty solidi. We have already seen that in ancient Egypt, as far back as history extends, the practice of medi- cine was divided into numerous branches. This cus- tom never became general among the Greeks or Komans ; yet in the larger cities some approach was made towards it. Galen informs us that in the less populous districts, where specialists were unable to find employment, they were in the habit of peram- bulating the country, and practicing from place to place. Pharmacy, as already shown, had become a distinct department as early as the days of Aris- totle. Gymnasiarchs and latroleptists, or anointers and bathers, in the exercise of their calling, were in some measure subservient to the profession, and had always paid some attention to the treatment of injuries. Midwifery was still in the hands of the obstetrix. And some few of these ancient hand- maids of Lucina, as Aspasia, Cleopatra, and others, were writers as well as practitioners. But sur- gery and medicine proper, though sometimes taught or practiced separately as specialities, were * Lib. vii. tit. vii, § 5. 214 DISCOURSE. never disconnected by the educated physicians of antiquity, who rejected most of the specialists as impostors.*^ Of these illegitimate sons^of ^sculapius, the num- bers and pretensions were as great in ancient as in modern times ; and they were quite as apt to re- ceive the countenance and favor of the upper classes. Chosroes of Persia was the patron of Uranus ; and Nero was the supporter of the au- dacious Thessalus, who, like Paracelsus, repudiated all learning as useless, and like the still more recent mountebank, Hahnemann, modestly assumed to be above all, and opposed to all, who had ever gone before him. Pliny and Galen are justly severe on most of these ancient impostors. And if we can credit their account of them, the host of industrial- ists, oculists, rhinoplasts, dentists, bone-setters, her- niotomists, lithotomists, gelders, abortionists, and poison-vendei-s, pervading Italy, France, and Spain throughout the middle ages, — before whom the modern group of pretenders grow pale and insig- nificant, — were at least equaled, if not exceeded, in ignorance, as well as arrogance, by the quacks of Eome.f With regard to schools, besides the cities already mentioned, Athens, Corinth, Berytus, Laodicea, and Csesarea, among the Greeks ; and at different epochs, Milan, Pavia,Traves, Aries, Marseilles, and Bordeaux * Corpus Juris Civilis Digest, lib. L tit. xiii. § iil •j- Galen, Methodus Medendi, lib. i., cap. i., ii., iii. Vol. x p. 5, et seq, Pliny, lib. xxix,, cap. viii. Corpus Juris Civilis Digest, lib. 1., tit. xiii., 1. 3. et Julii Pauli Recept. Sentent. lib. v. tit. xxiii., §§ 7, 8, 11, 12. DISCOURSE. 215 among the nations speaking the Latin tongue, — in short, most of the other large cities of the empire, — supported each its own institution ; in which the study of medicine was systematically pursued in con- nection with other liberal arts and sciences."^ Each of these schools enjoyed a degree of local reputation; and, with regard to medicine, held by custom, if not by rescript, somewhat the same relation to that of Alexandria, as the gymnasia and provincial medical schools of Prussia, Denmark, and Holland at pres- ent hold, to the more celebrated universities of these countries.f Though many of these institutions may have been of spontaneous growth, yet by degrees most of them fell under the immediate patronage and supervision of government. The number of professorial chairs in each of them was regulated By law. J The pro- fessors, in common with the Archiatri or state physicians, received a fixed salary out of the public treasury ;§ and after a faithful performance of their duties for twenty years they had the privilege of retiring with honor in the enjoyment of a pension. | Teaching, however, was not wholly restricted to the state and salaried professors, -but was open to other able and educated men.^ * Guizot, Cours d'Histoire Moderne, Legon 4m, p. 160, and Legon 16m, p. 261. \ De Medicis et Studio Medicinae iu urbe Alexandrina, hoc scitu dig- num refert, Ammian. [22 in fin.] ; ad commendandam, inquit, artis peri- tiam, medico pro omni experimento sufficit si Alexandrise dixerit se eru- ditum. [Notes to the Codex Justiniani, lib. i., tit. iii. cap. 18.] jj. Digest, lib. xxvii., tit. i., cap. vi., § 2. § Codex lib. x., tit. Iii., § 6. I Lib. xii., tit. xv. T[ Digest, lib. xxvii., tit. i. cap. vi., § 11. 216 DISCOURSE. The attention bestowed upon the schools by- some of the emperors after the time of Constantine, appears to have been extremely inquisitorial* The edict of Valentinian, Valens, and Gratian, addressed to Olybius, the prefect of Eome, A. D. 3Y0, though probably intended solely for the advancement of learniug, is sufficient to show the jealous care with which the government officials watched over all men of liberal education ; and that real liberty, even in the pursuit of knowledge, had long since given place to arbitrary power. In compliance with this edict, the youth coming to Rome for completing their literary education, were required to furnish the city magistrate with a passport from the governors of their respective provinces, stating their name, age, and rank in life ; to declare, on arrival, the course of studies to which they intended to devote themselves ; and to acquaint the magistrate with their place of abode in the city, in order that he might place them under mas- sters in charge of such branches of education as they had selected. They were held under the most rigid supervision by the city authorities, with reference to their conduct in the public assemblies of students, but more particularly in their private associations or clubs ; which were discountenanced as vicious, if not dangerous to the state. They were prohibited from frequent attendance upon the public spectacles, and from riotous feasting at irregular hours. The student conducting himself unbecomingly, was subject to be publicly scourged, * Codex, lib. x., tit lii. §§ 1 and 8. DISCOUESE. 217 expelled from the city, or sent Lome to Ms own province. Those who devoted themselves assidu- ously to their studies, were allowed to remain to the close of their twentieth year ; after which, fail- ing to return home, the magistrate was instructed to force them to do so. That these injunctions might not be disregarded, he was also required to prepare a monthly statement of the condition of each student ; who he was, and whence he came ; to be transmitted at the close of the student's course of education, to the province to which he belonged. A similar table was also to be furnished annually to the central bureau of the government, in order that the emperor might select from among those who had completed their education, such as might be wanted for the public service.^' By an edict of Alexander Severus, who reigned from A. D. 222 to 235, students in attendance upon schools not of their own municipality, as well as their parents who accompanied them, were to be considered as temporary residents without the privileges of citizens, unless remaining at the seat of the literary institution beyond the term of ten years.f We have already seen that princes, the populous cities, and the thickly-settled districts of Greece, were in the habit of stipulating annually for the public services of physicians. This custom was in course of time, under certain modifications, adopted * Guizot, legon 4m, p. 166, from Cod. Theod., 1. xiv., t. ix., 1. 1. f Codex, lib. x., tit. xxix., § 2. 15 218 DISCOURSE. by tlie Romans, and established by law throughout the empire. By a decree of Antoninus Pius,* the number of Archiatri, or state physicians, was limited in the metropolitan cities to ten ; in cities of the second class, or those provided with a forum or hall of justice, to seven ; and in the smaller cities, to five. At Rome their number was equal to the wards of the city.f They were chosen by the people of the municipalities^ in which they offici- ated, and they ranked among themselves according to seniority of appointment.§ By an edict of Severus, they drew their salary from the public treasury of their respective municipalities;! and in return for this, they were required to attend dili- gently to the business of education, and to pre- scribe for the poor gratuitously. But such citizens as were able to pay for their services, and stipulated to do so, could be obliged to pay, at the close of the attendance, provided the stipulation had not been exacted from the patient while insane, or under unreasonable alarm.^ In most of the Roman laws relatins^ to the Archi- atri, they are associated with the professors of rhetoric, philosophy, and the liberal arts ; and in common with these, they and their families enjoyed certain privileges and immunities, not usually con- ferred on other citizens. They were exempt from * Digest, lib. xxvii., tit. L, cap. vi., § 2. f Cod. Theod. lib. xiii., tit. iii., 1. 8,, as cited by Sprengel, voL ii., p. 164. X Digest, lib. 1., tit. ix.,1. 1. § Codex, lib., x., tit. Iii., § 10. I Digest, lib. 1., tit. ix., 1. 4, § 2. ^ Codex, lib. x., tit., Iii., § 9. DISCOTJRSE. 219 all painful and disagreeable employments; their property was not subject to taxation ; they were not required to provide accommodation for the soldiery or officers of justice ; they could not be summarily brought before a magistrate; and if insulted or aggrieved, they enjoyed ready and efficient means of redress in the courts of law.* Such of them as were engaged in teaching, were more liberally paid than those who devoted their whole time to prac- tice.f The term of their election and appointment to office, was limited only by their ability or dispo- sition to perform their duties. If negligent of these, their salary was withheld, and they were subject to deposition from office. J In the larger cities the Archiatri were associated together as a colIege.§ They were intrusted not only with the business of teaching, but also with that of inquiring into the merits of all applicants for occupation in the profession, and of certifying to the qualifications of each applicant befoi'e the Decuri- ones or magistrates, by w^hom the license was con- ferred.! The private practitioner, applying for a vacant seat among the Archiatri, w^as required to have studied and practiced under some reputable member of their order, and to have been regularly examined and licensed. And after having first obtained the suffrages of the public to the vacant seat, he had, by a decree of Valens and Valentinian, * Codex, lib x., tit., Hi. § 11. Digest, lib. xxvii., tit. i., cap. vi., §§ 1, 5, 8, and tit. xiii. 1. 1. f Digest, lib. I, tit. xiii., § 1. X Ibid. lib. xxvii., tit. i. cap. vi., §§ 4 and 6. § Ibid. § 2. . i Ibid. lib. 1., tit. ix. 220 DISCOURSE. still to undergo a further ordeal, and receive the consent of at least seven of tlie members of the col- lege before taking his seat amongst them.* The physicians of the imperial household, and such as were intrusted with the health of the chief- magistrate, were also styled Archiatri,f a title which was first enjoyed under Nero, by Andromachus of Crete, but, perhaps, first regularly recognized by Domitian. These court-physicians or Archiatri-Pa- latini, durinsf the reio:n of Constantine rose to greater dignity than the Archiatri Populares, or those of the municipalities. But they were occa- sionally willing to sacrifice their position at the court, in order to obtain the more lucrative office of the municipal institution. Among the Archiatri-Pala- tini there were also different grades ; as counts of the first and of the second order, and other higher dignities. During the reign of Julian these titles of honor were created in great number, and sought after with avidity. Some of the court physicians subsequent to this reign, enjoyed the dignity of Pro- consul, others that of Duke, &c. They ranked among the principal officers of State, and some of them, as Oribasius and Csesarius, were on terms of intimacy with the emperors. Army physicians, w^hen absent on duty, and pri- vate practitioners not of the constituted number, if regularly educated and licensed by the magistrate, were entitled to certain immunities in common with other members of the liberal professions. J Receiv- * Codex, lib. x., tit. lii., § 10 f Codex, lib. xii. tit. xi. xiii. X Codex, lib. x. tit. ii. § 1, §§ 5, 6. DISCOURSE. 221 ing no public appointment, they trusted to individual patronage for occupation, and had the right of claiming a fair return for their services. Privileges of the same kind were also granted to the obstetrix,* but were withheld from specialists, from medical evil-doers, from the necromancers, exorcists, the religious medical enthusiasts called Perabolani, and the numerous other pretenders who rose up among the people, especially among the Christian portion of them, before the final overthrow of the pagan insti- tutions.f But if this new order of Christian practitioners received no favor from the law, the spirit that im- pelled them was one in which the great mass of the community was eagerly participating. Scoffed at and ridiculed at first, they were* at length in the ascendant ; and they multiplied in proportion to the spread of Christianity. After Justinian had seques- trated the salary of the Pagan teachers for the pur- pose of building churches, and expelled the few remaining philosophers from their long respected abode in the Academy of Plato,J these uneducated practitioners may be said to have nearly supplanted the regularly inducted members of the profession. In the Latin portion of the empire, the debasement of learning was even more rapid and complete than with the Greeks. Yet the schools continued to lin- ger here long after the inroad of the Gothic nations. * Digest, lib. 1. tit. xiii. § 2. \ Corpus Juris Civilis. Julii Pauli Recept. Sentent. lib. v. tit. xxiii. § 7. Notes to Digest, lib. 1. tit. xiii, § 3, and Codex, lib xii. tit. viii. § 1. X Novelise, collect, ix. tit. xv. 132. 223 DISCOUESE Theodoric the Gotli even attempted the restoration of learning in the West ; and his successor, Athala- ric, restored to the professors at Rome the salaries that had been long withheld from them. He also enriched the schools of Milan, Pavia, and other cities; and Justinian on again acquiring the dominion of the West, confirmed the edict of the Gothic emperor. ^ So that learning may be said to have held some semblance to its ancient rank, up to the final sub- jugation of Italy by the Lombards. But though the ancient educational institutions, after the advent of Christianity as a political power, were by degrees discountenanced and forsaken, yet the laws in regard to them were never formally abrogated. Many of them, under the patronage at first of the Bishops, ^and afterwards of the Bene- dictine monks, were converted into Christian schools. Some of them in the Eastern portion of the empire, now under the sway of the Saracens, served as starting points for the progress of knowledge, and especially of medical knowledge, among the Arabs. In many of the cities and municipalities of which the Western portion of the empire consisted, and into which it was finally dissolved, traces of the ancient system of medical education and police con- tinued visible throughout the whole of the middle ages; and in connection with other fragments of Roman law not yet laid aside, played no unimportant part in the early development of modern science and civilization. * Aliffi Aliquot Constitutiones Justiniani, capitula xxii, pp. 237. Elzevir edition. E K E A T A For "Telephorus," page 29, last line but one, read Telesphorus. For " Burgess," page 33, last line, and page 36, tenth line from bottom, read Burges. For " Clinicee," page 4Y, fourth line from top, read Clinice. A. mm r UNIYERSITY OF CALIFORNIA LIBRARY Los Angeles This book is DUE on the last date stamped below. liomedical Library MAY 27 1994 RECEIVtD 315 SI