Certain Branches of Medical Work Begin to Assume more Distinctly the Character of Specialties.—At the time of Hippocrates there were no specialists, or at least none who received any sort of official recognition from the general body of physicians; and yet, there were, even then, a few practitioners who devoted themselves preferably to the treatment of certain maladies, like the affections of the eye and the teeth; and, beside these, there were undoubtedly, in the larger communities, men who were ready and competent to undertake the more serious surgical operations. But even these men, as appears from the language of the so-called Hippocratic oath, could not honorably perform an operation for stone in the bladder; this particular work having been left from time immemorial entirely in the hands of the lithotomists, a class of men who performed no other kind of surgery and who, in fact, were considered outside the pale of the medical profession—merely surgical artisans.
During the Alexandrian period the attitude of the best physicians with reference to specialization in medical practice evidently underwent a change,—not a very marked one, it is true, but yet sufficient in degree to attract some attention. We read, for example, that a certain Demetrius of Apamea, a follower of Herophilus, was skilled as an obstetrician and was also a clever diagnostician; that Andreas of Carystus, another disciple of Herophilus and the physician upon whose authority the incredible story of the burning of the Cnidian archives by Hippocrates was spread abroad, was considered at this time an expert in the science of obstetrics; that, toward the end of the period (first century B. C.), Alexander Philalethes, a disciple of Herophilus and well known as an author of treatises on the pulse and on the doctrines taught by different physicians of that period, acquired widespread celebrity as a gynaecologist; that Straton, a disciple of Erasistratus, had gained considerable distinction as a gynaecologist; and, finally, that two physicians—Gaius of Naples and Demosthenes of Marseilles (Massilia)—were widely celebrated for their skilfulness in the treatment of eye diseases. The latter was also a successful author, for his treatise on ophthalmology retained its popularity down to the Middle Ages. All these men, it should be noted, were directly and indirectly connected with the work at Alexandria, and were physicians of some degree of prominence. It is fair to assume, therefore, that specialization in medical practice had by this time become an accepted fact and was certainly not frowned upon by those in authority. The result is entirely in accord with what might be expected from a body of physicians as enlightened as were the men gathered together at Alexandria during the centuries immediately preceding and that immediately following the birth of Christ; but many additional centuries were yet to elapse before anything like the well-defined specialism of modern times was to become an established fact.
CHAPTER XI
ASCLEPIADES, THE INTRODUCER OF GREEK MEDICINE INTO ROME
The seventh Ptolemy, Ptolemy Euergetes or Physcon, whose reign lasted from 146 to 117 B. C., drove all men of learning away from Alexandria and closed the famous schools in that city. It was only a few years after these events, and at a time when that city was fast losing its supremacy as the great centre of medical learning,[27] that there appeared at Rome a Greek philosopher and physician who was destined to become the founder of a new set of medical ideas and of a new kind of medical practice. Being a man of general cultivation and attractive personality, and not afraid to encounter the prejudices and ill will which almost always greet a foreigner when he first establishes himself in a strange country and among a people of a different race, he soon overcame those obstacles and was eventually successful in making Rome the starting-point and centre of the best medical thought and practice of that period of the world’s history. To understand clearly, however, the character of the work which Asclepiades accomplished in the city which was soon to be the capital of the world as then known, it is desirable that a brief account should be given of the condition of medical affairs in Rome at the time of his arrival.
The Practice of Medicine at Rome During the Century Immediately Preceding the Christian Era.—Foreigners were not encouraged to settle in Rome until toward the latter part of the second century B. C., and consequently the treatment of the sick in that city maintained its distinctly Roman character for an unusually long time. In the households of the better classes the head of the family commonly prescribed for any illness which might befall its members. In not a few instances one of the slaves—who was known as a servus medicus, and who might perfectly well have been a regularly educated Greek physician—took charge of the patient in place of the master of the house. A book of domestic remedies was the usual source of information from which the latter derived his knowledge of therapeutics. Marcus Porcius Cato, the distinguished Roman censor (234–149 B. C.), was the author of one of the most popular of these books of recipes. The text of this work has come down to our time. There were, at this period, no regularly established physicians and no such thing as a medical practice. For several hundred years the Romans were almost constantly at war with the neighboring tribes or nations, and this life of outdoor exposure and active exercise kept them free from the numerous and very varied bodily ills of the later generations. This state of society alone was quite sufficient to prevent the thoroughly trained physicians of Greece and Alexandria from settling in Rome. But there were still other forces at work which greatly delayed their taking such a step, viz., the unwillingness on the part of the authorities to grant to foreigners the rights of citizenship, and the very strong prejudice which the Roman aristocracy cherished with regard to the Greek nation. Some idea of the strength of the latter feeling may be gathered from the letter which Cato the Censor, perhaps the most influential citizen of Rome at that time, wrote to his son Marcus. Daremberg gives the following quotation from this epistle: “The Greeks are a perverse and unteachable race. Believe that an oracle is speaking to you when I say—Every time that the Greeks bring to us some branch of knowledge they will not fail to corrupt our manners; and it will be far worse for us if they should send us their physicians, for they have bound themselves by an oath to kill all Barbarians by the aid of medicine—and they have the insolence to reckon us also as Barbarians. Remember that I have forbidden you to call in a physician.” Daremberg adds: “The old man Cato must have been very simple-minded to believe for a moment that physicians would be such egregious fools as willingly to kill the patients from whom they derive their support.” But even this strong prejudice on the part of the Roman aristocracy had to give way in course of time to forces of a much stronger character. During the second century B. C., the Romans, no longer fearing the encroachments of their warlike neighbors and having overcome all danger of an invasion on the part of their once powerful Carthaginian foe, entered upon a career of conquest. The capture of an ever increasing number of cities and towns in Greece, Asia Minor, Egypt and Africa brought great wealth to Rome, and, with it, increasing luxury, an increase in the prevalence and variety of diseases, and an increased need of men who were competent to deal successfully with such diseases. The physicians who first attempted to meet this need were men of an inferior stamp, to whom the situation appeared simply to afford an excellent opportunity for making money; and very naturally they failed to gain the respect and confidence of the better citizens. At a later date Julius Caesar, who was, at that time, Consul (about 90 B. C.), extended the right of citizenship to all foreign physicians who were practicing in Rome, and thus was removed one of the greatest obstacles which prevented the better class of Greek medical men from settling in that city.
More than a hundred years before the time of which I am speaking (i.e., about 218 B. C.), a Greek physician named Archagathus had the courage to take up his abode in Rome. He was the son of Lysanias, a native of Peloponnesus. At first he appeared to gain the favor of the community in which he practiced, for they bought and placed at his disposal a shop, or office, in the cross-way of Acilius, and gave him the name of vulnerarius—healer of wounds. Later, however, they disliked his rather too free use of the knife and the actual cautery, and thereafter he was spoken of as the carnifex, or executioner. Medicine was thus brought into disrepute and we hear nothing further about physicians in Rome for more than a century—that is, until about 90 B. C., when Asclepiades,[28] a native of the city of Prusa, Bithynia (northwest part of Asia Minor), made his appearance in that city. At first he taught rhetoric, but, finding this occupation unprofitable, he began the practice of medicine. Pliny says that he acquired a knowledge of this art through the studies which he carried on after his arrival in the city of Rome, but Neuburger makes the statement that he began the study of rhetoric, philosophy and medicine in his youth and then spent some time in perfecting his knowledge at Parion, a city of Mysia on the Hellespont, at Athens, and probably also at Alexandria.
As a practitioner Asclepiades appears to have met with unusual success. He was well educated and possessed of agreeable manners, and was the friend as well as the physician of Cicero, one of the most polished men of whom history furnishes us any knowledge. He was also on terms of intimacy with Atticus and other eminent citizens of Rome. The possession of such friends was more than sufficient to render him one of the favored and prosperous physicians of his day in that city. As Meyer-Steineg aptly says, “he owed not a little of his success to the happy manner in which the scientist, the clever physician, and—to a slight degree—the charlatan were combined in his character.” The following anecdote which is told of him by Lucius Apuleius shows, on the one hand, that he possessed remarkably keen powers of observation, and, on the other, that there were some grounds for the charge that his behavior was at times somewhat theatrical in character:—
One day, as Asclepiades was returning to the city, from his place in the country, he observed the approach of a long funeral procession. Desiring to learn whether the deceased was a person of his acquaintance, and also in the hope of perhaps gaining other information of a professional nature, he approached as nearly as possible to the bier. The face of the corpse was anointed with sweet-smelling ointments over which spices had been sprinkled; but, notwithstanding this, he was able to detect certain signs which led him to suspect that the man might not yet be dead; and accordingly he examined the body very closely and thus satisfied himself that such was indeed the fact. Whereupon he called aloud that the man was still alive, and told the bearers to extinguish the torches, to carry away the materials for the pyre, and to remove the funeral feast from the grave to a table. Some at once objected to the carrying out of these measures and made sarcastic remarks about the healing art—probably because they were already in possession of the man’s estate, and were afraid that they might have to give it up. The more influential ones, however, insisted that the physician’s words should be heeded. Then Asclepiades, notwithstanding the opposition which was made by the relatives, succeeded in securing a brief delay, during which he had the supposed corpse removed to his own house. Restorative measures were employed, respiration was re-established, and the man was brought back to life. At the succeeding festivities unlimited praise was bestowed upon the wise physician.
Whether this tale, which I have copied from Neuburger, is true or not, it seems to fit in well with the bold and independent character of Asclepiades as it is revealed to us by the different writers of the history of medicine. In his comment upon this narrative the distinguished Viennese historian makes the remark that Asclepiades was very conceited, and—like most reformers—showed a disposition to ignore the work accomplished by his predecessors. He also expresses the belief that Asclepiades possessed a leaning toward the methods of the charlatan; the episode just narrated revealing a love for theatrical display in his professional activity. On the other hand, in the further course of the chapter which he devotes to this famous Roman physician, Neuburger gives fuller recognition to the value of the services which he rendered to medicine, and thus, in the light of these services, one is justified in overlooking any little weaknesses of character which he may have displayed. Perhaps the most important of the services which Asclepiades rendered was that of having introduced Greek medicine into Rome—an important connecting link in the transmission of medical knowledge from Greece to Modern Europe.
The Views of Asclepiades with Regard to Physiology and Pathology.—The human body, according to the philosophy of Asclepiades, is composed of atoms—that is, small bodies which are invisible, have no definable quality, are in continual motion, through mutual pressure undergo modifications in form, and break up into innumerable smaller fragments or particles that differ both in size and in shape. The arrangement of these small bodies is such that intercommunicating spaces or pores are left between them, and through these channels flows a sap or juice containing larger and smaller particles; the larger ones composed of blood, and the smaller of vapor or heat. Health, according to Asclepiades, is that state in which the primitive atoms are properly distributed or placed and the flow of the juices in the pores takes place normally. When, however, the flow is arrested and the primitive atoms are disordered in their relations to each other and to the pores, or when the elements composing the fluid contents of the latter become mixed, disease results. Alterations in the pores themselves, as contradistinguished from the fluid contained within them, may also cause disease. Farther on, when the proper time arrives for considering the sect of the Methodists, I shall have occasion to discuss this subject again, and particularly that part of it which relates to pathology. In the meantime, however, I cannot resist the impulse to say a few words about the remarkable insight possessed by Asclepiades into the manner of construction of the human body, as manifested by this very brief but very significant anatomical and physiological description. Upon a first reading one might easily get the impression that Asclepiades has reference to only one kind or system of “pores” or channels—viz., such as serve for the circulation of tissue juices alone. But, upon a closer scrutiny of the text, one finds some warrant for suspecting that he had in mind more than one system of such channels; for he states distinctly that the fluid circulating in these pores contains larger particles composed of blood and smaller ones which consist of vapor (spiritus) or heat. The question suggests itself: Could a man who had no knowledge of Harvey’s discovery, who did not possess a microscope, and who at the same time believed—as did all the ancients—that air circulated in the arteries and blood in the veins, come any nearer to the actual truth than did Asclepiades? His description needs very few alterations and additions to make it fit correctly the system of terminal arterio-venous channels known to-day as arterioles and capillaries.