He recommends that dislocations should be reduced before inflammation sets in. When fractures fail to unite, he recommends extension and rubbing together of the ends of the bone. He goes so far as to advise cutting down to the bone, and letting the fracture and wound heal together. He cautions against the use of purgatives in strangulated hernia, and gives directions for extracting foreign bodies from the ears.
Had it not been for the works of Celsus, many operations of ancient surgery would have remained to us undescribed. He writes at length on bleeding, and describes the double ligation (or tying) of bleeding vessels, and the division of the vessels between the ligatures: an operation which the defenders of experiments on animals claim to have been discovered by vivisection. His method of amputation in gangrene by a single circular cut was followed down to the seventeenth century. He describes the process of catheterization, operations for goitre (or Derbyshire neck), the resection of the ribs, the use of enemas, and artificial feeding by them, an operation for cataract, ear diseases which are curable by the use of the ear syringe, extraction of teeth by forceps, fastening loose teeth by means of gold wire, and bursting hollow teeth by peppercorns pressed into them. He describes many of the most difficult subjects of operative midwifery, and discriminates in various mental diseases. Sleep must be induced, he says, in cases of insanity, by narcotics, if it is absent. He treats eye diseases with mild lotions and salves, and is the first writer to distinguish hallucinations of vision. He copies from Asclepiades his valuable rules of diet and simple methods of treatment, and from Hippocrates his methods of recognising the signs of diseases and their prognosis.
(I am indebted to the great work of Dr. Hermann Baas[467] for much of the above digest of the writings of Celsus.)
At the time when Celsus described the practice of medicine in Europe, bleeding was practised more freely than was the custom in the days of the great Greek physicians. The Romans went far beyond these. “It is not,” said Celsus, “a new thing to let blood from the veins, but it is new that there is scarcely any malady in which blood is not drawn. Formerly they bled young men, and women who were not pregnant, but it had not been seen till our days that children, pregnant women, and old men were bled.” And it would seem that already doctors had begun to bleed in almost every case, in every time of life, with or without reason, the unfortunate people who were under their care. They bled for high fever, when the body was flushed and the veins too full of blood; and they bled in cachexia and anæmia, when they had not enough blood, but were full of “ill humours.” They bled in pleurisy and pneumonia, and they bled in paralysis, and cases where there was severe pain.
Celsus has given us a good description of the qualities which a surgeon ought to possess: he should be young, or at any rate not very old; his hand should be firm and steady, and never shake; he should be able to use his left hand with as much dexterity as his right; his sight should be acute and clear; his mind intrepid and pitiless, so that when he is engaged in doing anything to a patient, he may not hurry, nor cut less than he ought, but finish the operation just as if the cries of the patient made no impression upon him.[468]
Celsus said,[469] “It is both cruel and superfluous to dissect the bodies of the living, but to dissect those of the dead is necessary for learners, for they ought to know the position and order, which dead bodies show better than a living and wounded man. But even the other things, which can only be observed in the living, practice itself will show in the cures of the wounded, a little more slowly, but somewhat more tenderly.”
He wrote on history, philosophy, oratory, and jurisprudence, and this in the most admirable style.
Thessalus of Tralles (A.D. 60) was the talented son of a weaver, who became a “natural” doctor. He was an utterly ignorant, bragging charlatan, with great natural ability. Had Paracelsus received no education, he might have practised medicine as a second Thessalus of Tralles. He scorned science as much as Paracelsus loved it, but like him he abused in the most violent manner all the physicians of antiquity. He called them all bunglers, and himself the “Conqueror of Physicians” (ἰατροίκης). He declared to Nero that his predecessors had contributed nothing to the progress of the science. He flattered the great and wealthy, and vaunted his ability to teach anybody the healing art in six months. He surrounded himself with a great crowd of disciples—rope-makers, cooks, butchers, weavers, tanners, artisans of all sorts. All these he permitted to practise on his patients, and to kill them with impunity. Since his time, says Sprengel, the Roman physicians gave up the custom of visiting their patients when accompanied by their pupils.[470] He used colchicum in the treatment of gout.
Philumenus (about A.D. 80) was a famous writer on obstetrics, and described the appropriate treatment for the various kinds of diarrhœa.
Andromachus the Elder (A.D. 60) of Crete was the inventor of a famous cure-all called Theriaca. It was compounded of some sixty drugs. He was physician to Nero, and his two works περὶ συνθεσέως φαρμάκων were greatly praised by Galen.