Outlines of Greek and Roman Medicine

by Sir James Elliott

CHAPTER X.

THE LATER ROMAN AND BYZANTINE PERIOD.

Beginning of Decline — Neoplatonism — Antyllus — Oribasius — Magnus — Jacobus Psychristus — Adamantius — Meletius — Nemesius — Ætius — Alexander of Tralles — The Plague — Moschion — Paulus Ægineta — Decline of Healing Art.

The death of Galen marks the beginning of the decline of medical science in ancient times, and this decline was contemporaneous with the overthrow of the Roman State. As everybody knows, the decline and fall of the Roman Empire resulted from the profligacy and incapacity of the emperors, luxurious living and vice among the people, tyranny of an overbearing soldiery at home, and the attacks of barbarian foes gradually increasing in strength. Rome fell quickly into the hands of the barbarians, and her power was broken. In A.D. 395, was founded the Byzantine Empire, also styled the East Roman, Greek, or Lower Empire, which lasted for more than a thousand years, and took its name from the capital, Byzantium or Constantinople. In this empire medical science maintained a feeble and sickly existence. During this Byzantine Period there were a few physicians of note, but they were mainly commentators, and medical science retrograded rather than progressed.

Neoplatonism exerted a powerful influence upon the healing art. It was founded by Plotinus, and was for three centuries a formidable rival to Christianity. The Neoplatonists believed that man could intuitively know the absolute by a faculty called Ecstasy. Neoplatonism is a term which covers a very wide range of varying thought; essentially, it was a combination of philosophy and religion, arising from the intellectual movement in Alexandria. It covered a great deal of mysticism, magic and spiritualism, and the followers of the system, as it developed, became believers in the efficacy of certain exercises and symbols to cure diseases. They entered as Kingsley wrote, "the fairy land of ecstasy, clairvoyance, insensibility to pain, cures produced by the effect of what we now call mesmerism. They are all there, these modern puzzles, in those old books of the long bygone seekers for wisdom." It is wonderful how mankind in their pursuit of knowledge seem to have progressed in a circle.

The influence which Christianity exerted upon the investigation of medical science during the early centuries of our era will be considered at length in a subsequent chapter.

Antyllus was perhaps the greatest surgeon of antiquity. He lived before the end of the fourth century A.D., for he is quoted by Oribasius, but is not mentioned by Galen. The time in which he lived was about the year A.D. 300. He was a voluminous writer, but his works have perished except for quotations by later writers. The fragments of his writings were collected and published in 1799. Antyllus performed an operation for aneurism, which consisted in laying open the sac, turning out the clots, securing the vessels above and below, and allowing the wound to heal by granulation. As this operation was performed without anæsthetics or antiseptics it was attended with great mortality, and the risk of secondary hæmorrhage was very great. Antyllus had operations for the cure of stammering, for cataract, and for the treatment of contractures by the method of tenotomy. He also removed enlarged glands of the neck. It was part of the practice of Antyllus to ligature arteries before cutting them, a method which was subsequently "rediscovered" owing to neglect of the study of the history of medicine. He gave directions for avoiding the carotid artery and internal jugular vein in operations upon the neck.

A fragment of the writings of Antyllus is preserved by Paulus Ægineta,[1] and shows the quality of the work done in bygone ages. It is his description of the operation of tracheotomy, and runs as follows:—

"When we proceed to perform this operation we must cut through some part of the windpipe, below the larynx, about the third or fourth ring; for to divide the whole would be dangerous. This place is commodious, because it is not covered with any flesh, and because it has no vessels situated near the divided part. Therefore, bending the head of the patient backward, so that the windpipe may come more forward to the view, we make a transverse section between two of the rings, so that in this case not the cartilage but the membrane which unites the cartilages together, is divided. If the operator be a little timid, he may first stretch the skin with a hook and divide it; then, proceeding to the windpipe, and separating the vessels, if any are in the way, he may make the incision." This operation had been proposed by Asclepiades about three hundred years before the time of Antyllus.

Oribasius was born at Pergamos, the birthplace of Galen, about A.D. 326. He studied under Zenon, who lectured and practised at Alexandria, and was expelled by the bishop, but afterwards reinstated by command of the Emperor Julian (A.D. 361). When Julian was kept in confinement in Asia Minor, Oribasius became acquainted with him, and they were soon close friends. When Julian was raised to the rank of Cæsar, Oribasius accompanied him into Gaul. During this journey Oribasius, at the request of his patron, made an epitome of the writings of Galen, and then extended the work by including a collection of the writings of all preceding medical authors. When this work was finally completed it consisted of seventy books under the title "Collecta Medicinalia." He wrote also for his friend and biographer Eunapius two books on diseases and their treatment, and treatises on anatomy and on the works of Galen. He earned for himself the title of the Ape of Galen. In the "Life of Oribasius," by Eunapius, we find that Julian created Oribasius Quæstor of Constantinople, but after the death of Julian, Oribasius was exiled, and practised among the "barbarians," attaining great fame. In his exile he married a rich woman of good family, and to one of his sons, Eustathius by name, he addressed an abridgment of his first great book, the smaller work being called the "Synopsis." He ultimately returned from exile, and again reached a very honourable position, to which he was well entitled in virtue of the great fortitude with which he had borne adversity.