Three representatives of post-classical medicine.
In this chapter as representatives of post-classical medicine and its influence upon medieval Latin medicine we shall consider three writers whose works date from the close of the fourth to the middle of the sixth century, Marcellus of Bordeaux or Marcellus Empiricus, Aëtius of Amida in Mesopotamia, and Alexander of Tralles in Asia Minor.[2324] They have just been mentioned in their chronological order, but although Marcellus antedates the other two by a full century, we shall consider him last, since he wrote in Latin while they wrote in Greek, and since he includes Celtic words and probably Celtic folk-lore, and since he seems to have been a native of Gaul, if not of Bordeaux,[2325] and thus is geographically closer to the scene of medieval Latin learning. Aëtius and Alexander have the closer connection not only with the eastern and Greek world but also with the past classical medicine of Galen and so will provide a better point of departure. Presumably from the places and periods in which they lived, all three of our authors were Christians, but it must be said that the chief evidence of Christianity in their works is the use of Christian or Hebrew proper names in incantations, and there are some analogous relics of pagan superstition.
Medical compendiums: Oribasius and Paul of Aegina.
As Tribonian and Justinian boiled down the voluminous legal literature of Rome into one Digest, so there was a similar tendency to reduce the past medical writings of the Greeks into one compendious work. Paul of Aegina, writing in the seventh century, observes in his preface[2326] that it is not right, when lawyers who usually have plenty of time to reflect over their cases have handy summaries of their subject to which they can refer, that physicians whose cases often require immediate action should not also have some convenient handbook, and the more so since many of them are called upon to exercise their profession not in large cities with easy access to libraries, but in the country, in desert places, or on shipboard. Oribasius, friend and physician of the emperor Julian, 361-363 A. D., had made such a compendium by that emperor’s order. In this he embodied so much of Galen’s teachings that he became known as “the ape of Galen,”[2327] although he also used more recent writers. But Paul of Aegina regarded this work of Oribasius as too bulky, since it originally comprised seventy-two books although only twenty-five are now extant, and so essayed a briefer compilation of his own. Two centuries ago, however, Friend and Milward protested against regarding Paul, Aëtius, and Alexander as mere compilers and maintained that they “were really men of great learning and experience”[2328] who “have described distempers which were omitted before; taught a new method of treating old ones; given an account of new medicines, both simple and compound; and made large additions to the practice of surgery.”[2329] Puschmann more recently states that Paul’s compendium was “composed with great originality and independence” and is of great value “particularly in its surgical sections.”[2330] After Paul, however, the Byzantine medical writers, such as Palladius, Theophilus, Stephen of Alexandria, Nonus, and Psellus, were of an inferior caliber.[2331] With Paul’s work, however, we are not now further concerned, nor with that of Oribasius, but with the somewhat similar compendiums of Aëtius and Alexander which lie chronologically between these other two. It is Aëtius and Alexander whom Payne accuses of “introducing into classical medicine the magical elements derived from the East”[2332] and whom we might therefore expect to possess an especial interest for our investigation.
Aëtius of Amida.
Of the life and personality of Aëtius we know very little, but inasmuch as he mentions St. Cyril, archbishop of Alexandria, and Peter the Archiater, a physician of Theodoric, while he himself is cited by Alexander of Tralles, he seems to have lived at the end of the fifth and beginning of the sixth century.[2333] And since Alexander cites him only in his book on fevers which seems to have been composed after the rest of his work, it seems probable that Aëtius was almost contemporary with him and wrote in the sixth rather than the fifth century. His Tetrabiblos—each of the four books subdivides into four sections and often these are spoken of as sixteen books—occupies a middle position not only in time but in length between the works of Oribasius and Paul, and resembles the latter in making a great deal of use of the former. Aëtius’ extracts from the older writers are shorter than those of Oribasius, however, and he also differs from him in combining several authorities in a single chapter, the method usually adopted by the medieval Latin encyclopedists. It has been noted that the wording of the original authorities was often preserved in the oldest medieval manuscripts of Aëtius, until the copyists of the time of the Italian Renaissance began to touch up the style in accordance with their erroneous notions of what constituted classical Greek.[2334] It may also be said that these systematically arranged handbooks of Oribasius, Aëtius, and the rest, where one could find what one was looking after, were far superior in systematic and orderly presentation to the discursive works of Galen which, like many other classical writings, often seem rambling and without any particular plan.[2335] This more logical, if somewhat cut-and-dried method, was also to be a virtue of medieval Latin learning. Whether Aëtius directly influenced the Latin middle ages is doubtful, since no early Latin translation of him seems to be known.[2336] The work of Oribasius, however, exists in Latin translation in manuscripts of the seventh century as well as in others of the ninth and twelfth.[2337]
How superstitious are Aëtius and Alexander?
The works of Aëtius and Alexander of Tralles do not impress me as containing an unusually large amount of superstitious medicine. Much less am I inclined to agree with Payne that they are responsible for the introduction into classical medicine of magical elements derived from the east. These elements, whether derived from the orient any more than any other feature of classical civilization or not, at any rate had been a prominent feature of classical medicine long before the days of Aëtius and Alexander, as Pliny’s review of medicine before his time abundantly proved and as is also shown by the extraordinary virtues which Pliny himself, his contemporary Dioscorides, and even the great Galen attributed to medicinal simples.
Compound medicines.
It is true that Aëtius and Alexander abound in recipes for elaborate medical compounds composed of numerous ingredients. Of such concoctions one example must suffice, a plaster which Aëtius recommends for tumors, hard lumps, and gout. “Of the terebinth-tree, of the stone of Asia, of bitumen three hundred and sixty drams each; of washing-soda (spumae nitri), calf-fat, wax, laurel berries, ammonia, and thyme three hundred and forty drams each; of the stone pyrites and quick-lime one hundred and twenty drams each; of the ashes of asps which have been burned alive one hundred and forty drams; of old oil two pounds. First liquefy the oil and wax, then the bitumen, which should have first been pulverized. Add to these the fat, and presently the ammonia and terebinth; and when these are taken off the fire mix in the lime and stone of Asia, then the laurel berries and washing-soda, and finally after the medicament has cooled sprinkle the ashes of asps upon it.”[2338] Such concoctions are to a large extent borrowed by Aëtius, Alexander, and Marcellus from earlier writers. Moreover, while Pliny had excluded such compounds from the pages of his Natural History, he had also made it abundantly evident that they were already in general use by his time, and they are to be found in great numbers in the works of Galen who cites many from preceding writers.