Methods of Treatment Adopted by Asclepiades.—The prevailing methods of treating diseases in Rome were not approved by Asclepiades, and he lost no opportunity of giving expression to this disapproval. In the first place, he protested vigorously against the practice of prescribing on every possible occasion purgatives and remedies capable of producing vomiting. He had a decided preference for gentler measures, his idea being that a physician should cure his patients tuto, celeriter, et jucunde—safely, quickly and agreeably. Le Clerc adds that this is a fine sentiment, but that its realization in actual practice is something which most physicians find it very difficult to attain. Asclepiades condemned strongly the employment of magical remedies, a practice which was still much in use at that time in Rome, although it was already less common than it had previously been. Cato’s collection of household remedies contains a short list of some of these appeals to man’s superstition.[29] In addition to the remedial measures mentioned above, Asclepiades placed his chief dependence on the following: abstinence from meat; the employment of wine under certain well-defined circumstances; massage and frictions; baths of different kinds (it is said that he devised a great variety); walking; driving and being carried about in the open air in a litter or in a boat on a quiet river or in the protected harbor. One of his remedies in the case of sleeplessness consisted in having the patient placed in a suspended couch which could easily be rocked from side to side. As all these measures were agreeable and could at the same time easily be employed by almost everybody, they met with general favor, and in consequence Asclepiades was looked upon by the Romans as “a person sent from heaven.” As a rule, he recommended the drinking of simple water, but in certain cases (to be mentioned farther on) he did not hesitate to advise the taking of wine in moderation. He advocated tracheotomy, in cases of inflammation of the throat, in preference to the then prevailing practice—both very painful and quite difficult to carry out—of introducing a tube of some kind as a means of opening a passage for the entrance of air into the lungs.
Le Clerc quotes Galen as authority for the statement that Asclepiades, who never hesitated for an instant to criticise the different therapeutic procedures of his predecessors, did not go so far as to condemn wholly the practice of bloodletting. Indeed, he was quite ready to employ it in the treatment of painful affections because, as he claimed, the pain was caused “by the retention of the larger particles or atoms in the pores or channels of the tissues, and hence—as these particles were composed of blood—bloodletting was the only remedy capable of setting them free.” Thus, he resorted to bleeding in pleurisy, because this affection is characterized by pain; but he abstained from employing the remedy in “peripneumonia” or “inflammation of the lung,” because in most cases it is not accompanied by pain; and he also did not approve of its employment in inflammation of the brain (phrenitis). On the other hand, he advocated bleeding in epilepsy and all forms of disease in which convulsions occurred, and he also advocated it in cases of hemorrhage of every description. Quinsy sore throat was another malady in which he drew blood freely from the veins of the arm, of the temple and even of the tongue; and in addition, when the disease was severe, he scarified the skin at suitable spots and applied cups to the part. In all these measures his purpose was “to open the pores”; and when this treatment failed he incised the tonsils or the uvula, and even, as a last resort, performed laryngotomy or tracheotomy. In cases of dropsy he employed paracentesis abdominis,—that is, he made a very small opening in the abdominal wall to serve as an outlet for the fluid contained in the peritoneal cavity. From these facts it is evident that Asclepiades did not always abide by his rule not to use any but very gentle remedies.
Asclepiades showed, in his manner of treating still other pathological conditions, how different was his practice from that of his predecessors. In the first place, he was very partial, as has already been stated, to such extremely mild forms of physical exercise in the open air as one can obtain from driving or from being carried in a litter or a boat. He prescribed these measures, not merely for convalescents but also for those, for example, who were still in the midst of an active fever. His idea was, that by means of such very gentle forms of exercise the pores would become less clogged and would permit the juices of the body to flow more freely. In cases of dropsy, also, he was in the habit of employing friction for precisely the same purpose. He even used this remedy in cases of inflammation of the brain, in the expectation that he might thereby induce sleep for these patients. Indeed, this subject of frictions was one on which Asclepiades wrote at greater length than on any other remedial agent.
It is a surprising fact that, in common with Erasistratus, he taught the doctrine that physical exercise was not at all necessary to persons in normal health. At the same time he approved of it, when carefully graded, for those who were affected with bodily ills of a certain nature.
Wine was another remedy which Asclepiades was fond of prescribing in all sorts of maladies, but his rules in regard to the manner in which it should be employed were quite different from those adopted by his contemporaries. A few illustrations will suffice to show the different conditions for which he was wont to advocate the taking of wine: He gave it, for example,—though probably much diluted with water—to patients affected with fever, but only after the stage of greatest activity had been passed. Strange as it may appear to-day, he was rather in favor of giving to patients ill with inflammation of the brain (phrenitis) wine in sufficient quantity to produce intoxication; his belief being that he could in this way induce drowsiness and eventually sleep—a thing so desirable for those affected with that disease. Further, he instructed sufferers from catarrh to drink twice or three times as much wine as they usually drank, in consequence of which instructions the patients found it necessary to dilute their wine with water to a less degree than usual—that is, to such a degree that the proportion would be one-half of each; thus showing, as Le Clerc remarks, how sober the ancients must have been when they were in perfect health. They probably—he adds—drank their wine ordinarily in the proportion of five-sixths water to one-sixth wine, or, at most, three-quarters water to one-quarter wine.
In some cases Asclepiades prescribed the drinking of wine (particularly the wine of Cos) to which sea-water had been added; his idea being that the addition of salt would enable the wine to penetrate farther into the tissues and thus open the pores more freely. This idea of added salt was not original with him, for Pliny states that in certain parts of Greece it was customary to place casks filled with new wine in the sea and to leave them there for some time. The wine, it was claimed, was rendered by this procedure mature and pleasanter to drink. They called wine thus treated “Thalassite wine” (from the Greek word “thalassa,” sea). In cases of jaundice he occasionally recommended the drinking of plain sea-water, whereby the bowels were stimulated to act more freely. Under ordinary circumstances he employed, for the relief of constipation, clysters, but he was sparing in their use.
The remedial measures enumerated above, together with dieting, are those upon which Asclepiades chiefly relied in his practice. In acute diseases he made very little use of drugs that were to be taken internally, but in maladies of a chronic character he employed them quite freely. Gargles, poultices and inunctions are mentioned among the external remedies which he often prescribed.
Further Particulars Regarding the Life and Career of Asclepiades.—Le Clerc furnishes a number of details which throw additional light upon the career of Asclepiades. During the latter’s lifetime his professional reputation was very great. Lucius Apuleius, the famous Roman satirist and rhetorician, and a contemporary of Asclepiades, calls him the Prince of Physicians, second only to Hippocrates the Great; Scribonius Largus, a Roman physician and writer, who flourished during the reigns of the Roman emperors Tiberius and Claudius (37–54 A. D.), speaks of him as a great medical author; Sextus Empiricus, a writer remarkable for his learning and acumen, who lived in the first half of the third century A. D., calls him a physician of unrivaled skill; and Celsus, who is termed the Cicero of physicians, on account of the purity of his Latin, holds him in high esteem as a medical authority. His fame as a physician had spread to Asia Minor, for we are told that Mithridates, King of Pontus, who reigned from 120 B. C. to 63 B. C., and who was a man of great ability and great energy, invited him to take up his residence at his court; but Asclepiades refused. Perhaps a still stronger evidence of his real worth as a man is to be found in the fact that he was the physician and personal friend of Cicero.
Notwithstanding these strongly favorable estimates of the ability of Asclepiades there were not a few men, and they too men of great authority, who were indisposed to give him so conspicuous a place in the temple of fame. Galen, for example, while admitting that he was a very eloquent physician, maintained that he was a sophist, given to quibbling, and disposed to contradict everybody. Caelius Aurelianus, a contemporary of Galen and the author of the most important practical treatise on Methodism that has come down to our time, appears to have held the same opinion as Galen with regard to Asclepiades. The complete disappearance of all the writings of the latter author makes it impossible for us at the present time to form an independent judgment as to the merits of these conflicting estimates of the man’s character. Galen was a great admirer of Hippocrates and it is very likely that he took offense at the failure of Asclepiades to accept all the teachings and therapeutic methods of his hero. As to the reasons which led Caelius Aurelianus to agree with the estimate made by Galen, we know absolutely nothing.
Toward the middle of the seventeenth century there was discovered at Rome, not far from the Capena gate, a portrait bust in white marble of Asclepiades. It was probably executed by a Greek sculptor residing in Rome, for, if the work had been done in Greece, the face would have been represented with a beard, as are the heads of Hippocrates, Soranus and other celebrated physicians of antiquity. The absence of the beard, furthermore, shows—according to the opinion of antiquarian experts—that the bust must have been sculptured before the time of the Emperor Claudius (41–54 A. D.), as he was the first of the Caesars to wear a beard. This bust, which is a little larger than life-size, is at present—if I am rightly informed—in the Capitoline Museum at Rome.