Asclepiades lived to a great age. In descending, one day, a flight of steps he fell and received injuries from which he died.
CHAPTER XII
THE STATE OF MEDICINE AT ROME AFTER THE DEATH OF ASCLEPIADES; THE FOUNDING OF THE SCHOOL OF THE METHODISTS
In summing up the effects which were produced by the teaching and practice of Asclepiades upon the science and art of medicine, Dr. Meyer-Steineg makes the remark that the wide and ready acceptance of both depended largely upon the personal character of the man, upon the manner in which he carried out the measures which he advocated, and upon the fact that the Romans happened at that period of their history to be ready to respond favorably to such new doctrines and therapeutic methods; but that, as soon as his strong personality had ceased to exert its influence, as it did after he had passed the active period of his life, and also because Rome did not at that moment possess any physicians who were sufficiently endowed with his medical gifts and sagacity to perpetuate his art, both it and his doctrines began to lose ground. Nevertheless, as this writer states, Asclepiades had already succeeded admirably in preparing the way for a further development of the healing art, and for this valuable service full credit should be given him.
Not long after the death of Asclepiades, Antonius Musa,[30] the personal physician of the Emperor Augustus, succeeded, by means of hydrotherapy, in curing his royal patient of a protracted gouty or rheumatic affection from which he had been a sufferer; and, as a mark of gratitude for the cure which he had effected, the Emperor raised him to the rank of a noble (about the year 10 A. D.), erected a statue in his honor in the temple of Aesculapius, and at the same time issued a decree that from that time forward the physicians who practiced in Rome should be exempted from taxation and from certain other civic burdens. These privileges, which were afterward confirmed by Vespasian (70–79 A. D.) and also by Antoninus Pius (138–161 A. D.),[31] were of great advantage to the medical profession as a whole. Julius Caesar (100–44 B. C.), it will be remembered, had already (about half a century earlier) bestowed Roman Citizenship upon the physicians who practiced their profession in that city. Thus, at the time of which we are now speaking, the medical men of Rome occupied the enviable position of being on an equality with their fellow citizens of the better class, a position which made it attractive for young men of ability and of good social standing to enter the profession.
Among the numerous followers of Asclepiades the most distinguished was undoubtedly Themison of Laodicea, a city of Phrygia, Asia Minor, who flourished about the middle of the first century B. C. When he was well advanced in years he wrote a medical treatise in which he developed a system of pathology and therapeutics that was accepted as the professional creed of the sect known as “Methodists.” Starting from the doctrine of pores and primitive atoms taught by Asclepiades, he laid great stress upon the idea that in disease all the alterations which take place in the tissues may be classed in one or the other of these two categories—a relaxation (laxum) or a contraction (strictum) of the parts. To these two categories, which the Methodists termed “communities,” and which were the only ones at first accepted as a part of their creed, a third was soon added, viz., that condition in which both relaxed and contracted states appear side by side, although not necessarily both of them developed to the same degree; and to this third category or “community” they applied the term “mixtum.” The ideas which are here stated in a somewhat crude and imperfect manner owing to my lack of knowledge of all the facts, constitute the basis of the pathology of the “Methodists”—a pathology which held its own in the domain of medicine during a period of four hundred years, and which—in contradistinction to the humoral pathology of Hippocrates—is justly entitled to the name of “solidist pathology.” This doctrine, as might be expected, underwent certain modifications during this long period of time, but they were not serious enough to alter materially the fundamental form of the teaching as it has here been described.
Themison and his followers, like their distinguished predecessor, Asclepiades, possessed something more than a mere glimmering of the truth in pathology as we know it to-day; and this idea suggests the further thought that Morgagni, Rokitansky, Lebert, Virchow and perhaps others whose names do not now occur to me, could scarcely have developed a better pathology if they had lived during these first centuries of the Christian era—a period of time when public sentiment did not permit postmortem examinations, when Harvey’s discovery was not even dreamed of, when the microscope was unknown, and when experimental pathology was an impossibility. Many centuries had still to elapse before medicine could gain that freedom of action, that rich equipment of tools, and that stock of accumulated knowledge which enable her in these days to make such giant strides forward as we have witnessed during the past twenty or thirty years.
The question will naturally arise, How did the Methodists decide, in the presence of an actual case of illness, which one of these abnormal states (the laxum, the strictum, or the mixtum) was the condition that called for medical treatment? The answer which they gave to this question was, that the condition of the different secretions and the dejections furnished the principal indication as to what particular part or organ of the body was ailing, and also as to what was the nature of the morbid change or process that produced the malady. When, for example, the secretion from an organ or part was excessive, they inferred that the pores of such a part were relaxed and distended, thus permitting an increased flow; and when the secretion was less than it should be, they decided that the pores were contracted. The status mixtus had reference to those cases in which a condition of relaxation was observed in one part of the body, while that of contraction was noted in another.
Neuburger mentions the fact that the Methodists were somewhat arbitrary in their classification of the different diseases, most of the acute maladies being placed by them under the heading Status strictus, while they assigned the majority of the chronic affections to the category of Status laxus.
The effect of the tendency of the Methodists to classify and simplify all the departments of medicine was not wholly beneficial. It conveyed to many the impression that medicine might readily be learned in the course of a few months, and thus offered the temptation to inferior men to choose the career of physician; and yet, on the other hand, it infused into the art the essentially Roman characteristics of orderliness, simplicity and efficiency. Anatomy, for example, was studied only so far as a knowledge of this department of medicine was necessary to render the physician familiar with the location, general character and relations of the different organs. There was one field, however, in which the adherents of this school displayed a high degree of excellence, viz., in their descriptions of disease; and this is especially true of those written by Caelius Aurelianus (fourth century A. D.), whose manner of handling the subject of differential diagnosis is far more thorough and satisfactory than that of any of the medical authors who preceded him.
In their treatment of disease, the Methodists were largely guided by the principle of contraria contrariis,—i.e., in those cases in which, to the best of their belief, a status laxus existed, they administered astringents, in the hope of thereby bringing the parts back more nearly to a contracted condition; and, vice versa, when the diagnosis of status strictus was made, they gave a relaxing medicine. The terms “laxatives” and “astringents,” which are still applied to many drugs, were originated by the Methodists. Bloodletting, for example, was one of the remedies which they used for producing relaxation, and an astringent was employed when a contrary effect was desired. In the list of relaxing remedial agents (aside from bloodletting) were placed the following: warm baths, poultices, inunctions with warm oil, vapor baths, fasting and a restricted diet, diuretics (very carefully watched and employed only in exceptional cases), emetics, diaphoretics and laxatives. The following agents, on the other hand, were classed as contracting, astringent and tonic remedies: washing with cold water, cold baths, the application of cloths dipped in cold water, living in cold air, strengthening diet, wine, vinegar, alum, narcotics, etc. Themison, it should be added, is the first one among the ancient writers to mention the use of leeches as a means of extracting blood. It does not follow from this, however, that he was the discoverer of this method of local bloodletting; for it is highly probable that this procedure had been in common use for many years previous to his time.