Like Oribasius, he collected everything that he found remarkable in the writings of his predecessors, and has preserved certain fragments of antiquity which would otherwise have been lost. His work formed a complete manual of medicine and surgery, except that it lacked anatomical descriptions and references to dislocations and fractures.
Alexander of Tralles (525-605), a city of Lydia, where Greek was spoken, was a son of the physician Stephen, and the most celebrated of five sons, who were all distinguished for their learning. He traveled extensively, and fixed his residence in Rome, where he became celebrated. He lived to an advanced age, and, being no longer able to practice, composed a treatise of twelve books, exclusively devoted to affections that did not require the aid of surgery. He professed the greatest veneration for Galen, but did not blindly adopt his opinions. He described the first reported case of excessive hunger and pain due to intestinal worms; he advised venesection in the foot rather than in the arm; but with all his sound judgment and mental enlightenment he had faith in amulets and talismans, and widely recommended them. It may be said for him, such was the universal prejudice of his age, the whole world being plunged in superstition, that it was necessary for every one to pay some tribute to the prevailing belief; and we may add that it is necessary to make this excuse for some who practice much nearer to ourselves than did those ancient physicians.
Paul, or Paulus, surnamed Ægineta (because he was born in the Island of Ægina), was among the last of the Greek physicians who have special interest for us. It is supposed that he died about A.D. 690. He traveled extensively, and his skill in surgery and obstetrics rendered him celebrated even among the Arabs, whose midwives sent for him in consultation from great distances. He composed a compendium of medicine, divided into seven books, and not only did not hesitate to borrow from his predecessors, but quoted from them most extensively; a number of his chapters were taken almost verbatim from Oribasius; however, he made no secret of it, but rather boasted that he had judiciously sought to appropriate the best of the writings of those he most revered. He showed originality, however, in the treatment of hydrocephalus, in advising paracentesis of the thorax and abdomen, in the extraction of calculi from the bladder, in the treatment of aneurism, the excision of hypertrophied mammæ in men, etc. He was the first to describe varicose aneurism, and the first to perform the operation of bronchotomy after the method borrowed from Antyllus, of which he has transmitted a very detailed account. Of this Antyllus, by the way, it may be added, en passant, that he was one of the most distinguished and original surgeons of antiquity. He flourished during the third century after Christ; was the first to describe the extraction of small cataracts; and is, perhaps, best known to the surgical world to-day by his exceedingly bold plan of opening aneurisms, so successfully imitated a generation or so ago by James Syme.
It has already been seen that before and during the early centuries of the Christian era the secrets and learning of the physicians tended to pass gradually into the hands of the priests. It was so in the temples of ancient Greece, it was so in Alexandria, it became so in Rome, it has been so even in modern times, although only for brief periods of time. This has come about in some measure from the cupidity of the clerical orders, partly because it required a certain amount of intelligence and knowledge to become a priest, and partly because, owing to ignorance, credulity, and superstition, diseases have at all times been regarded by the ignorant as evidence of divine wrath and chastisement, or of diabolical or occult influences, rather than the effect of natural causes. Hence men have turned ever toward prayers, exorcism, and expiation, especially when exhorted thereto by the priests. This has been the sacerdotal aspect of the practice of medicine in all times, and when the priests have usurped therapeutic functions they have done harm rather than good. So long as theology and science work hand in hand, each redounds to the credit of the other, but always in the history of man when theology has appropriated that which did not belong to it it has brought ridicule upon itself and has delayed the progress of knowledge. There have been frequent rebellions against religious authority in ancient as in modern times. For instance, at the commencement of the fifth century before Christ the Pythagoreans were dispersed, and the doctrines of Cos and Cnidus—i.e. the Hippocratic teachings—were promulgated; and again, in the course of events, when the descendants of Æsculapius became servile attendants at the temple and adjuncts to the priesthood or a part of it. At first, in Alexandria, the physicians were supreme; their disciples, however, had the same blind reverence for authority that too many workers in the field of theology have evinced, and men once more practiced medicine on the traditions of the past, and in so doing allied themselves more and more to the temples in Rome. At first, the oldest and best instructed of the relatives treated the diseases of his family as he understood them; simply shared this duty with its other members. Cato, the censor, was much engrossed with this domestic medicine; he wrote a book in which he recommended cabbage as a sovereign remedy in many diseases. He venerated the number 3, as did the Pythagoreans; did not disdain to transmit to posterity certain medical words which it was believed should be repeated to assist in the reduction of dislocations and fractures. This old censor seemed to have a profound hatred for medical men, and most absurd ideas of their works and claims, although doubtless many Greek physicians who came to Rome merited the invectives which he launched against them. Then came Asclepiades, of Bythinia, as already mentioned, whose talents were far superior to those of his Roman contemporaries, and who did not need to call to his aid charlatanism and deceit. This medical hero unfortunately had many worthless and dishonest imitators, who appealed to superstition and ignorance in every dishonest way, and who desired to be judged by the luxury and elegance they displayed. Hence for a long time in Rome medicine was practiced without license. The Emperor Anthony the Pious was the first to occupy himself with regulating the practice of medicine. He granted certain immunities, but did ask for proof of qualifications. A certain physician to Nero, Adromachus, was honored by the emperor with the title of Archiater.— i.e., royal healer.—but Galen, who was physician to Marcus Aurelius, never bore it. From the time of Constantine the Great, however, the title is frequently met with in the edicts of the emperors. In fact, there were two sorts of these.—one named the Palatine, who belonged to the household of the reigning monarch and who held high rank among the nobility; and the other called the Popular Archiaters, who were public-health officers. No one could practice medicine in the jurisdiction of one of these without examination and authorization. Those who transgressed this regulation were punished with a fine of two thousand drachmas. The Popular Archiaters were pensioned by the city, enjoyed certain privileges, and had to attend the poor gratuitously. Practitioners who were not members of the College of Archiaters had no pay, no rights, nor emoluments. The Popular Archiaters were elected by the citizens from many candidates who had proved their capacity before the college of this medical organization. The evils of medical anarchy were thus remedied; this happy condition existed until the empire was broken up by barbarism.
It is during this period—about 400 A.D.—that we first find a class of citizens to whom was delegated the duty of preparing drugs ordered by physicians. Their duties were in some respects similar to those of our apothecaries, although in attainment and in social position they were far below the physicians. They were termed pharmacopolists.
It is worth while to stop a moment to inquire what were the medical charitable institutions of antiquity. Even in the days of ancient Athens there was a certain gymnasium, called the Cynosarga, in which abandoned and illegitimate children were brought up at public expense until such time as they were able to serve their country. A little later several private institutions of this kind were established. Rome in her earlier day never had such institutions. To be sure, she distributed provisions, or else remitted taxes, to parents who were unable to support their children, or even permitted them to destroy their newborn children when unable to maintain them; but there were no bonds of sympathy which induced the patricians to succor the plebeians in time of disease and distress; slaves were cared for as were cattle. It is one of the debts we owe Christianity that, under its influence, the first almshouses and retreats were established in Rome. It has been said that the Emperor Marcus Aurelius first instituted anything like a dispensary service in the Sacred City. We are told, also, of an illustrious woman, St. Pauline, living in the midst of the greatest wealth and pomp, who retired from society and devoted her life to charity and self-denial. She went to Jerusalem, united with other Christian women of the same mission, and formed, under the direction of St. Jerome, a sisterhood whose members divided their time between reading sacred books and doing good works. They offered an asylum for the faithful and a hospice for the benefit of the indigent sick, and even established a home for convalescents outside the city-walls. After the model thus set, heathen emperors, Christian kings, and Moslem caliphs showed their zeal in this good direction by the erection of sumptuous edifices and other rich endowments for the relief of suffering human beings.
Reviewing now the Greek period, let it be remembered that in the time of Galen animals were dissected, and that he made anatomical demonstrations on monkeys; that sometimes the corpses of the enemy were rudely dissected upon the field of battle, but that finally the practice of dissection fell into disuse, and human anatomy was studied only from books, the early Christians having evinced even more horror of the dead body for the purposes of anatomical study than did their pagan predecessors, while the Fathers of primitive times launched their anathemas against the dissection of human remains. Here, again, as usual, the interference of the church worked only general harm. This abandonment of anatomy contributed doubtless to the decadence of medicine; by the rapid extension of Christianity the pagan schools were disorganized and broken up, the profane sciences (such as medicine) were discarded, and the teachers still remaining in the old schools were ruined. Passion for religious controversy was engendered and took the place of study or original research, even to such an extent as to hasten the fall of the Empire of the East. In addition to these factors, reverence for authority of the past—that terribly oppressive weight which has kept down so much which would otherwise have risen early, and which has been the greatest enemy of human learning—permitted the explanation of natural phenomena to be sought only in the writings of revered ancients, and not in living beings. No one dared to advocate changes in regard to received doctrines, and there could be no such thing as progress. Only two men in the lapse of four centuries showed any originality; these were Alexander of Tralles and Paul of Ægina, whose lives have already been briefly rehearsed. It is with some relief, however, that we can think that this period, so unfruitful in scientific progress, was not so in social amelioration. By the organization of the institutions above alluded to charlatanism was checked, by the requirement of capability and good character society was benefited, and the charitable institutes of this epoch perhaps gave the world its best models in teaching and an insight into the most valuable means of medical instruction. Of the old Greek Period, then, we may say that it accrues rather to the benefit of humanity than to that of science.