Outlines of Greek and Roman Medicine

by Sir James Elliott

Aulus Cornelius Celsus lived in the reigns of Augustus and Tiberius. References in his works show that he either lived at the same time as Themison or shortly after him. Verona has been claimed as his birthplace, but the purity of his literary style shows that he lived for a considerable time in Rome, and he was probably educated there. In Pliny's account of the history of medicine, Celsus is not mentioned as having practised in Rome, and it is almost certain that he combined the practice of medicine with the study of science and literary pursuits; his practice was not general, but restricted to his friends and dependents. His writings show that he had a clinical knowledge of disease and a considerable amount of medical experience. He wrote not only on medicine but also on history, philosophy, jurisprudence and rhetoric, agriculture and military tactics. His great medical work, "De Medicina," comprises eight books. He properly begins with the history of medicine, and then proceeds to discuss the merits of the controversy between the Dogmatici and the Empirici. The first two books deal with general principles and with diet, and the remaining books with particular diseases; the third and fourth with internal diseases, the fifth and sixth with external diseases and pharmacy, and the last two are surgical, and of great merit and importance. In his methods of treatment there can be discerned the influence of Asclepiades of Prusa, and the Hippocratic principle of aiding rather than opposing nature, but some of his work displays originality. His devotion to Hippocrates hindered very much the exercise of his own powers, and set a bad example, in this respect, to his successors.

He was rather free in the use of the lancet, but not to the same extent as his contemporaries, and he advocated the use of free purgation as well as bleeding. He never could rid his mind of the orthodox humoral theories of his predecessors.

(1) Surgery.—Although Celsus is the first writer in Rome to deal fully with surgical procedures, it must not be inferred that the practice of this art began to be developed in his time, for surgery was then much more advanced than medicine. Many major operations were performed, and it is very instructive for doctors of the present day to learn that much that is considered modern was well understood by the ancients. There is no greater fallacy than to suppose that medical practice generally, and surgery in particular, has reached no eminence except in very recent times. The operation of crushing a stone in the bladder was devised at Alexandria by Ammonius Lithotomos, (287 B.C.), and is thus described by Celsus:—

"A hook or crotchet is fixed upon the stone in such a way as easily to hold it firm, even when shaken, so that it may not revolve backward; then an iron instrument is used, of moderate thickness, thin at the front end but blunt, which, when applied to the stone and struck at the other end, cleaves it. Great care must be taken that the instrument do not come into contact with the bladder itself, and that nothing fall upon it by the breaking of the stone."

Celsus describes plastic operations for the repair of the nose, lips and ears, though these operations are generally supposed to have been recently devised.

He describes lithotomy, and operations upon the eye, as practised at Alexandria, both probably introduced there from India. Subcutaneous urethrotomy was also practised in his time.

Trephining had long been a well-known operation of surgery. There is an account in detail of how amputation should be performed.

The teaching of Celsus in reference to dislocations and fractures is remarkably advanced. Dislocations, he points out, should be reduced before inflammation sets in, and in failure of union of fractures, he recommends extension and the rubbing together of the ends of the broken bone to promote union. If necessary, after minor measures have failed to promote union, he recommends an incision down to the ends of the bones, and the open incision and the fracture will heal at the same time.

It is interesting to find that Celsus knew of the danger of giving purgatives in strangulated rupture of the bowels. For uncomplicated rupture he recommends reduction by taxis and operation. Cauterization of the canal is part of the operation. He also gives careful directions for removing foreign bodies from the ears.

Celsus writes very fully on hæmorrhage, and describes the method of tying two ligatures upon a blood-vessel, and severing it between the ligatures. His method of amputating in cases of gangrene by a simple circular incision was in use down to comparatively modern times. He describes catheterization, plastic operations on the face, the resection of ribs for the cure of sinuses in the chest walls, operation for cataract, ear disease curable by the use of the syringe, and operations for goitre. These goitre operations are generally supposed to be a recent triumph of surgery.