Up to the time when war broke out between Sparta and Athens (431 B. C.), the latter city had for many years easily held the supremacy, not merely in everything relating to the science and art of medicine, but also in all other branches of learning and especially in the arts of sculpture, painting and architecture. At the time named above came the beginning of her downfall. For a period of about twenty-one years she struggled against disasters of all sorts.
The Plague at Athens, the first Recorded in History.—Shortly after the war began—a war engendered by the bitter jealousy of Sparta over the ever increasing ascendancy of her rival—the latter city was visited by a devastating plague, the first European pestilence that has been recorded in history. Thucydides, who wrote the history of the Peloponnesian War, gives a most lucid description of this plague of Athens, from which I shall copy certain portions.
It first began, it is said, in the parts of Ethiopia above Egypt, and thence descended into Egypt and Libya and into most of the King’s country. Suddenly falling upon Athens, it first attacked the population in Piraeus,—which was the occasion of their saying that the Peloponnesians had poisoned the reservoirs, there being as yet no wells there,—and afterward appeared in the upper city, when the deaths became much more frequent. All speculation as to its origin and its causes, if causes can be found adequate to produce so great a disturbance, I leave to other writers, whether lay or professional; for myself, I shall simply set down its nature, and explain the symptoms by which perhaps it may be recognized by the student, if it should ever break out again. This I can the better do, as I had the disease myself, and watched its operation in the case of others.... People in good health were all of a sudden attacked by violent heats in the head and redness and inflammation in the eyes, the inward parts, such as the throat or tongue, becoming bloody and emitting an unnatural and fetid breath. These symptoms were followed by sneezing and hoarseness, after which the pain soon reached the chest, and produced a hard cough. When it fixed in the stomach, it upset it; and discharges of bile of every kind named by physicians ensued, accompanied by very great distress. In most cases, also, an ineffectual retching followed, producing violent spasms, which in some cases ceased soon after, in others much later. Externally the body was not very hot to the touch, nor pale in its appearance, but reddish, livid, and breaking out into small pustules and ulcers. But internally it burned so that the patient could not bear to have on him clothing or linen even of the very lightest description; or indeed to be otherwise than stark naked. What they would have liked best would have been to throw themselves into cold water; as indeed was done by some of the neglected sick, who plunged into the rain-tanks in their agonies of unquenchable thirst; though it made no difference whether they drank little or much. Besides this, the miserable feeling of not being able to rest or sleep never ceased to torment them. The body meanwhile did not waste away so long as the distemper was at its height, but held out to a marvel against its ravages; so that when they succumbed, as in most cases, on the seventh or eighth day to the internal inflammation, they had still some strength in them. But if they passed this stage, and the disease descended further into the bowels, inducing a violent ulceration there accompanied by severe diarrhoea, this brought on a weakness which was generally fatal. For the disorder first settled in the head, ran its course from thence through the whole of the body, and, even where it did not prove mortal, it still left its mark on the extremities; ... some, too, escaped with the loss of their eyes.... Some died in neglect, others in the midst of every attention. No remedy was found that could be used as a specific; for what did good in one case, did harm in another.... Such was the nature of the calamity, and heavily did it weigh on the Athenians; death raging within the city and devastation without.
(Translation of Richard Crawley; Dent & Sons, London.)
Athens Ceases to be the Centre of Medical Learning.—It is safe to assume that one by one the more prominent of the physicians who had survived the events which have just been narrated, must have left Athens and taken up their abode in the various cities of Asia Minor and the neighboring islands, in Sicily, in Italy, etc. Hippocrates, who was thirty years old at the time when the plague broke out in Athens, appears not to have witnessed it. He practiced his profession and taught medicine in his native city; then he spent a certain number of years in traveling about as a peripatetic physician; and finally settled for the remainder of his life in Thessaly. But the length of each of these periods of his professional life is not mentioned by any of the authorities. About forty years after the death of Hippocrates, Alexander the Great had already nearly completed his series of brilliant conquests, and was taking steps to found a city, or rather, a university, in which medicine was to take an organized shape as one of the great departments of human learning.
It may be well at this point, however, to interrupt this narrative of the regular course of events for the purpose of considering very briefly how far the physicians of that period had advanced toward gaining a permanent and honorable position in their respective communities.
The Degree of Esteem in which Physicians Were Held by Their Fellow Citizens and by the Governing Authorities During the Centuries Immediately Preceding the Christian Era.—We have at our command very little direct evidence bearing upon the question of the esteem in which physicians were held three hundred years B. C. by the communities in which they practiced their profession. We know positively that the kings and princes of that period fully appreciated the value of the services which were rendered to them by the physicians (commonly Greeks) whom they employed. In the event of war they took with them men who were skilled both in surgery and in the treatment of the ordinary ills of the body. One of the sons of Hippocrates, for example, served for some time in this capacity, and he is credited with the statement that “the physician who wishes to obtain the best training in surgery should enter the service of the army.” There were eight surgeons officially connected with the “ten thousand” whom Xenophon led back to Greece after the famous campaign in Asia Minor. The army of Alexander the Great was accompanied by the most celebrated surgeons of that period. Upon a bronze tablet found at Idalium, on the Island of Cyprus, there is an inscription which dates back to the fifth century B. C., and which commemorates the merits of a physician named Onasilos, who, aided by his pupils, rendered valuable services, without any remuneration, during one of the wars of the Greeks; and in recognition of these services, the Government had bestowed upon him a stipend and had exempted him from taxation. It is further known that the Athenians lavishly heaped honors upon Hippocrates, initiating him at public expense into the mysteries of the Eleusinia, giving him a crown of gold, and distinguishing him in still other ways. These facts show how highly the rulers of that day appreciated the services of a competent physician; but, up to a comparatively recent date, it has not been so easy to demonstrate what was his position in the esteem of the community at large. The discovery, not many years ago, of two inscriptions in Greek throw a certain amount of light upon this very point. One of these, which bears the date of 388 B. C., states that its purpose is to commemorate the fact that the physician Euenor, who had been intrusted by the people with the work of supervising the preparation of all the drugs intended for use in the public hospital, had not only fulfilled his duty but had in addition spent large sums of his own money in the accomplishment of this work. Another inscription, which was unearthed in the Island of Carpathus, between Crete and Rhodes, and which is believed to date back to the end of the fourth or the beginning of the third century B. C., reads (in a somewhat abbreviated form) as follows: “In view of the fact that, for more than twenty years, Menocritus, the son of Metrodorus of Samos, has devoted himself with much zeal and self-sacrifice to the duties of his position as parish physician, living all this time in rather narrow circumstances and not asking any pay for his services, we, the citizens of Brycontium, have resolved to erect in his honor, in the temple of Neptune, a marble column bearing an inscription that shall set forth these facts, to crown him with a wreath of gold, and to announce publicly, at the Aesculapian games, this our decision.” As apropos of this subject I may be permitted to quote the following words from Plato’s “The Republic” (Book 1, Chap. 18): “Will you call the medicinal the mercenary art, if, in performing a cure, one earns a reward? No, said he.”
The Founding of Alexandria.—Alexander the Great, after subduing the Persians and the cities of Phoenicia, marched into Egypt and founded (331 B. C.), at the mouth of the Nile, the city of Alexandria. In October of the same year he crossed the Euphrates and the Tigris and defeated, for the second time, the Persian hosts under Darius. Alexander was now the conqueror of Asia. During the following eight years he laid his plans most carefully for the consolidation of his great empire, the capital of which was to have been Babylon; but, while he was thus making provision for the welfare of his numerous subjects, who were of widely different tastes and aspirations, he succumbed (323 B. C.) to a severe attack of malarial fever, aggravated by an excessive indulgence in wine on the occasion of some festivity. In the meantime Alexandria was developing rapidly into a great centre of learning in all the departments of human knowledge. The Ptolemies, beginning with Ptolemy Soter, who reigned over Egypt from 323 to 285 B. C., contributed greatly to this result. For a period of about 250 years Alexandria remained the centre around which revolved all that was best in the domains of medicine, philosophy, geometry, mathematics, history, etc. Money was spent lavishly in collecting the writings of all those authors who had distinguished themselves in these different fields of learning, and no pains were spared to secure correct versions of the different works; the septuagint version of the books of the Old Testament of the Bible being a conspicuous example of what the Ptolemies accomplished in this direction during the third century B. C. Every possible facility was offered at the same time for the giving and receiving of instruction; and thus, with the immense library as a foundation of priceless value, the Museum at Alexandria became in every material respect a great university, the first one of which history gives us any fairly satisfactory information. Several years after the Museum library was established a second one of somewhat smaller proportions was organized in the Serapeum (Temple of Serapis). The example set by the Ptolemies was followed by Attalus, King of Pergamum in Mysia, Asia Minor (241 B. C.), and, before many years had elapsed, the great library of that city almost rivaled those of the Museum and Serapeum at Alexandria. It was the competition between these two royal collectors of books that led to the issuing of a decree that no more papyrus was to be exported from Egypt, and thus there was provided the stimulus which led to the discovery or invention of a new and better material on which books might be written—viz., Pergamentum (our parchment), a word coined from the name of the city in which it was invented.
The Development of Different Sects or Schools of Medicine.—Up to the time of the death of Hippocrates medicine maintained the character of a single organized and harmonious body; but, when this great physician had disappeared from the scene and was no longer there to guide the further development of medical science and to keep his followers working shoulder to shoulder with a single spirit and purpose, this hitherto homogeneous body split up into sects or schools, each of which had some favorite doctrine the promulgation of which seemed to each group of adherents to be of great importance. There were at first two such principal groups, viz., the Dogmatics and the Empirics. The former was composed of those who laid great stress upon speculation or theorizing,—that is, upon the use of the reasoning power,—and the latter of men who maintained that actual experience was the only thing of any serious value. The respective leaders of these two groups or sects were Plato and Aristotle.
In Raphael’s celebrated painting, “The School of Athens,” these two heroes of philosophy are represented standing side by side—Plato with his right hand elevated and pointing toward heaven, while Aristotle is looking distinctly at the earth. Pictorially, the tendencies of the two schools of philosophy could not have been better represented. Plato’s genius had taken its flight heavenward and was contemplating earthly things from this point of vantage; his method being to ignore system and to look at everything with the eyes of purest love. “Delightfully poetic, but thoroughly unprofitable speculation as to what constitutes scientific truth and perfected morality!” (Friedlaender.)