Modern physicians will, at first thought, be disposed to wonder how men as clever as many of these physicians were could have split up into separate and more or less antagonistic sects because of such apparently trivial differences of opinion. It must be remembered, however, that these men were groping in comparative darkness whenever they tried to advance their knowledge of pathology, and that in this imperfect light many things seemed of much greater importance than they appeared to be in the brighter light of later centuries. It is only fair, therefore, to withhold criticism and to ask ourselves whether this strong desire on the part of those men to advance their knowledge of pathology—a desire which manifested itself in the formation of sects—was not in reality an evidence of the great vitality of Greek medicine on Roman soil in those early centuries.
The remarks made above with regard to the Dogmatists and the Empirics apply in a general manner to the sects known as the Methodists and the Eclectics, a sufficiently full account of which has been given in the preceding chapter.[38]
CHAPTER XIV
WELL-KNOWN MEDICAL AUTHORS OF THE EARLY CENTURIES OF THE CHRISTIAN ERA
There were four men who were not especially identified with any of the sects described in the preceding chapters, and yet who occupied, as authors of medical treatises, very prominent places in the history of medicine of the period or epoch which we have just been considering. They are Celsus, Scribonius Largus, Pliny the Elder and Dioscorides. These men lived during the first and second centuries A. D. and they therefore all belong strictly to the period which is designated in our scheme as the fourth epoch. I shall give here brief sketches of all of these writers and of their works. While Caelius Aurelianus, another important medical author, belonged to a much later period, I shall, for reasons of convenience, describe in the same chapter with the others the part which he played in the evolution of medicine.
Aulus Cornelius Celsus, called by some the Latin Hippocrates and by others the Cicero of physicians because of the correctness and elegance of his Latin and the clear manner in which he puts his thoughts into words, flourished during the reign of the Emperor Augustus (27 B. C.-14 A. D.). The date and place of his birth are not known, but it is generally believed that he was born and received his education at Rome. The great work which he wrote and upon which he must have been engaged the larger part of his lifetime was a sort of cyclopaedia, which bore the title “Artium libri,” and in which each department of knowledge was represented by a separate treatise. It is said that five books were devoted to agriculture, seven to rhetoric, eight to medicine, etc.; but all of these treatises, excepting those relating to the latter science, have been lost or destroyed. It is not certainly known to which of the professions Celsus belonged, but the very skilful and judicious manner in which he has culled all that is best from the medical treatises published before his time, the remarkable knowledge of technical details which he displays in every part of his own work, and the fine tone of medical thought which pervades these eight books, almost compel the conclusion that the author was a very clever clinician, although probably not a physician who practiced for a money reward. In no other published treatise is a more perfect picture of the medical practice of antiquity to be found than that which Celsus gives us in his work “De arte medica libri octo.”
It is not an easy matter to select, from a treatise of several hundred pages in length, one or two passages of such a character that they may be accepted as fairly representing the author’s manner of dealing with medical and surgical questions of practical interest. The two given below are translations from Védrènes’ version (Paris, 1876), and they deal, the one with venesection and the other with the proper manner of arresting hemorrhage from a wound. Both the passages quoted represent only fragments, as sufficient space for more extensive extracts is not available.
Book II., Chapter X.—Bloodletting from a Vein.—Incising a vein for the purpose of drawing blood from it, is not a new procedure; but it is certainly a new thing to resort to bloodletting in almost all diseases. Again, it is an ancient custom to employ bloodletting in young subjects and in women who are not pregnant, but it is a new thing to perform this operation on infants and aged individuals, and on women approaching the period of confinement. It was the idea of the ancients that persons at the two extremes of life were not able to support this sort of treatment, and they were convinced that a pregnant woman, if subjected to the operation of bloodletting, would almost surely be confined before the completion of her time. Since then, however, experience has shown that there is no fixed rule about this matter, and that a physician should preferably regulate his course in accordance with observations of a different nature. The determining factor, for instance, is neither the age nor the pregnant state of the patient, but rather the degree of physical strength. In the case of a youth who is feeble, or of a delicate woman (aside from the question of pregnancy), it would be wrong to draw blood, for it would be robbing them of what little strength they possessed. But, in the case of a vigorous child, a robust old man, or a pregnant woman who is in good health, one need not hesitate to resort to this procedure. Nevertheless, there may arise, in connection with the operation of venesection, a number of questions which are quite likely to puzzle an inexperienced physician and perhaps lead him into error. For example, infants and old people possess as a rule diminished vigor, and the woman who is about to be confined needs all her strength for the period following delivery, both for herself and for the nourishing of the child. But the mere fact that one must give some thought to questions of this nature and must exercise prudence does not justify the immediate rejection of a method of treatment like that of venesection. For is it not the very essence of our art, not merely to consider the factors of age and the pregnant state, but also to form an estimate of that other and more important factor, viz., the patient’s strength,—be that patient an infant, an aged person, or a woman advanced in pregnancy,—and then to decide whether it is, or is not, great enough to bear the loss of blood? In deciding a question of this kind it will be necessary to distinguish between real vigor and obesity, between thinness and feebleness, etc.
Venesection is an easy operation for a physician who has already familiarized himself with the manner of performing it, but for one who is ignorant of these details it may prove very difficult. It is necessary, for example, to bear in mind that the artery and vein are united and that they are accompanied by nerves; and, further, that the injuring of the latter will induce spasms and violent pains. On the other hand, it must also not be forgotten that an artery once opened has no disposition to close, nor does it heal, and that sometimes the blood escapes in an impetuous manner. If, perchance, the vein is cut transversely, the edges of the opening contract and no more blood escapes. Again, if the scalpel is plunged into the parts timidly, the skin alone will be divided and the vein will not be opened. In some cases this vessel is so hidden from sight that the physician may experience difficulty in bringing it into view. Thus it will be seen that there are several circumstances which may render this operation difficult for an ignorant or inexperienced physician. The vein should be incised in a longitudinal direction, midway between its two sides. The moment the blood gushes from the opening its color and general appearance should be carefully noted, etc.
Book V., Chapter XXVI.—The Proper Manner of Arresting Hemorrhage from a Wound.—If there is fear that there may be bleeding, one should fill the wound with dry lint, place over it a sponge wrung out of cold water, and press upon it with the hand. If the bleeding still continues, it is advisable to change the stuffing of lint somewhat frequently; and, if this step proves ineffective, then lint moistened with vinegar may be tried, for this liquid acts energetically in arresting hemorrhage. Some physicians, indeed, actually pour it into the wound. There is a strong objection, however, to the use of an agent which, like vinegar, arrests the bleeding too completely—viz., that it is apt to set up afterwards an intense inflammation of the parts. The same reasoning applies with even greater force to the employment of corrosives and caustics, which produce an eschar. Despite the effectiveness of most of these in arresting hemorrhage, their use should be discouraged.... Finally, if the bleeding continues it will be necessary to grasp the vessel from which the blood is escaping, to ligature it in two places close to the wound, and then to divide the vessel between the two ligatures, in order that it may retract (both of the new orifices having already been closed by the ligatures). If the circumstances are such that the plan just recommended cannot be carried out, it will then be advisable to apply the red-hot cautery to the bleeding vessel. When a rather free hemorrhage occurs at a part of the body where there are no nerve trunks and no muscles,—as on the forehead or at the top of the head,—the simplest plan is to apply a cup at some little distance from the source of the bleeding and thus divert the current of the blood from the spot affected.