Physicians From The Time Of Augustus To The Death Of Nero

Celsus--His life and works--His influence on Medicine--Meges of

Sidon--Apollonius of Tyana--Alleged miracles--Vettius

Valleus--Scribonius Longus--Andromachus--Thessalus of

Tralles--Pliny.





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 claim d 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 haemorrhage, 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.



Celsus also had knowledge of dentistry, for he writes of teeth

extraction by means of forceps, the fastening of loose teeth with gold

wire, and a method of bursting decayed and hollow teeth by means of

peppercorns forced into the cavity. He has described also many of the

most difficult operations in obstetrics.



When it is remembered that Celsus lived centuries before the

introduction of chloroform and ether, it is wonderful to contemplate

what was accomplished long ago.



The qualities which should distinguish a surgeon were described by

Celsus thus: "He should not be old, his hand should be firm and steady,

and he should be able to use his left hand equally with his right; his

sight should be clear, and his mind calm and courageous, so that he need

not hurry during an operation and cut less than required, as if the

screams of the patient made no impression upon him."



(2) Anatomy.--Celsus understood fairly well the situation of the

internal organs, and knew well the anatomy of the chest and female

pelvis. His knowledge of the skeleton was particularly complete and

accurate. He describes very fully the bones of the head, including the

perforated plate of the ethmoid bone, the sutures, the teeth, and the

skeletal bones generally. Portal states that Celsus knew of the

semicircular canals. He understood the structure of the joints, and

points out that cartilage is part of their formation.



Celsus wrote: "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."



(3) Medicine.--His treatment of fevers was excellent, for he

recognized that fever was an effort of Nature to throw off morbid

materials. His recipes are not so complicated, but more sensible and

effective than those of his immediate successors. He understood the use

of enemas and artificial feeding. In cases of insanity he recognized

that improvement followed the use of narcotics in the treatment of the

accompanying insomnia. He recognized also morbid illusions. He

recommended lotions and salves for the treatment of some eye diseases.



Although Celsus practised phlebotomy, he discountenanced very strongly

its excessive use. The physicians in Rome, in his time, carried bleeding

to great extremes. "It is not," wrote Celsus, "a new thing to let blood

from the veins, but it is new that there is scarcely a 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." The reason for bleeding the strong and

plethoric was to afford outlet to an excessive supply of blood, and the

weak and anaemic were similarly treated to get rid of evil humours, so

that hardly any sick person could escape this drastic treatment.



Emetics were greatly used in the time of Celsus. Voluptuaries made use

of them to excite an appetite for food, and they used them after eating

heavy meals to prepare the stomach for a second bout of gluttony. Many

gourmands took an emetic daily. Celsus said that emetics should not be

used as a frequent practice if the attainment of old age was desired.



Celsus excelled as a compiler, and had the faculty of selecting the most

admirable contributions to the art of healing from previous medical

writers. His writings also give an account of what was best in the

medical practice of Rome about his own time. He had a great love for

learning, and it is remarkable that he was attracted to the study of

medicine, for he was a patrician, and members of his class considered

study of that kind beneath the dignity of their rank.



In the Augustan age, when literature in Rome reached its highest level,

the literary style of Celsus was fit to be classed with that of the

great writers of his time. He was never quoted as a great authority on

medicine or surgery by later medical writers; and Pliny refers to him as

a literary man, and not as a practising physician. From the fact that

he elaborated no new system, and founded no new medical sect, it is not

strange that he had no disciples.



In later centuries his works were used as a textbook for students, not

only for the information they supplied, but also because of their

excellence as literature.



Parts of the foregoing synopsis of the writings of Celsus are drawn from

the writings of Hermann Baas and of Berdoe.



Meges of Sidon (20 B.C.) was a famous surgeon who practised in Rome

shortly before the time of Celsus. He was regarded by Celsus as the most

skilful surgeon of that period, and his works, of which nothing now

remains, were quoted by Celsus, and also referred to by Pliny. Meges was

a follower of Themison. He is said to have invented instruments used in

cutting for stone, and he wrote on tumours of the breast and dislocation

of the knee. There have been several famous doctors called Eudemus.

One of these was an anatomist in the third century before Christ, and a

contemporary, according to Galen, of Herophilus and Erasistratus. He

gave great attention to the anatomy and physiology of the nervous

system. There was, however, another Eudemus, a physician of Rome, who

became entangled in an intrigue with the wife of the son of the Emperor

Tiberius. He aided her in an attempt to poison her husband in A.D. 23.

He was put to torture, and finally executed by order of Tiberius.



Apollonius of Tyana was born four years before the Christian era, in

the time of Augustus Caesar, and is known chiefly for the parallel that

has been drawn by ancient and modern writers between his supposed

miracles and those of the Saviour. His doings as described by

Philostratus are extraordinary and incredible, and he was put forward by

the Eclectics in opposition to the unique powers claimed by Christ and

believed in by His followers. Apollonius is said to have studied the

philosophy of the Platonic, Sceptic, Epicurean, Peripatetic and

Pythagorean schools, and to have adopted that of Pythagoras. He schooled

himself in early manhood in the asceticism of that philosophy. He

abstained from animal food and strong drink, wore white linen garments

and sandals made of bark, and let his hair grow long. For five years he

preserved a mystic silence, and during this period the truths of

philosophy became known to him. He had interviews with the Magi in Asia

Minor, and learned strange secrets from the Brahmans in India. In Greece

he visited the temples and oracles, and exercised his powers of healing.

Like Pythagoras, he travelled far and wide, disputing about philosophy

wherever he went, and he gained an extraordinary reputation for magical

powers. The priests of the temples gave him divine honours and sent the

sick to him to be cured. He arrived in Rome just after an edict had been

promulgated by Nero against magicians. He was tried before Telesinus,

the consul, and Tigellinus, the base favourite of the Emperor. He was

acquitted by Telesinus because of his love of philosophy, and by

Tigellinus because of his fear of magic. Subsequently, at Alexandria,

Apollonius, in virtue of his magic power, affirmed that he would make

Vespasian emperor, and afterwards became the friend of Titus,

Vespasian's son. On the accession of Domitian, Apollonius stirred up the

provinces against him, and was ordered to be brought in custody to Rome,

but he surrendered himself to the authorities, and was brought into the

presence of the Emperor to be questioned. He began to praise Nerva, and

was immediately ordered to prison and to chains. It is said that he

miraculously escaped, and spent the remainder of his days in Ephesus.



The relation of Apollonius to the art of medicine is connected with his

visits, on his travels, to the temples of AEsculapius, and his healing of

the sick and alleged triumph over the laws of Nature. He was also

credited with raising the dead, casting out devils and other

miracle-working that appears to have been borrowed from the life of

Christ. No doubt he was a genuine philosopher and follower of

Pythagoras. His history is, on the whole, worthy of belief, except the

part relating to miracles. It is noteworthy that he did not claim for

himself miraculous power. Newman in his "Life of Apollonius" takes the

view that the account of the miracles of Apollonius is derived from the

narrative of Christ's miracles, and has been concocted by people

anxious to degrade the character of the Saviour. The attempt to make him

appear as a pagan Christ has been renewed in recent years.



In the realm of medical practice he succeeded by imposture probably, but

also in a genuine way by means of suggestion, and no doubt he had also

acquired medical knowledge from study and travelling among people who

had healing powers and items of medical knowledge perhaps unknown at the

present day.



Vettius (or Vectius) Valleus, was of equestrian rank but he did not

confer any honour on the medical profession. He was one of the lewd

companions of Messalina, the wife of the Emperor Claudius, and was put

to death in A.D. 48. He was a believer in Themison's doctrines, and is

said by Pliny[20] to have founded a new medical sect, but nearly all the

Methodici attempted to create a new sect by adding to, or subtracting a

little from, the tenets of Methodism.



Scribonius Largus (about A.D. 45) was physician to Claudius and

accompanied him to Britain. He wrote several medical books, and is

reputed to have used electricity for the relief of headaches.



Andromachus, the elder, was physician to Nero, and the first

archiater. He was born in Crete. He was the inventor of a compound

medicine called after himself, "Theriaca Andromachi." He gave

directions for making it in a poem of 174 lines. This poem is quoted by

Galen, who explains that Andromachus gave his instructions a poetical

form to assist memory, and to prevent the likelihood of alteration.



Andromachus, the younger, was the son of the first archiater, and was,

like his father, physician to Nero. He wrote a book on Pharmacy, in

three volumes.



Thessalus of Tralles, in Lydia, lived in Rome in the reign of Nero,

and dedicated one of his books to the Emperor. He was a charlatan with

no medical knowledge, but with a good deal of ability and assurance. He

said that medicine surpassed all other arts, and he surpassed all other

physicians. His father had been a weaver, and in his youth Thessalus

followed the same calling, and never had any medical training. This did

not prevent him, however, from acquiring a great reputation as a doctor,

and making a fortune from medical practice. At first, he associated

himself with the views of the Methodici, but afterwards amended them as

he thought fit, until he had convinced the public, and perhaps also

himself, that he was the founder of a new and true system of medicine.

He spoke in very disrespectful and violent terms of his predecessors,

and said that no man before him had done anything to advance the science

of medicine. Besides having an endowment of natural shrewdness and

ability, he was equipped with great powers of self-advertisement, and

could cajole the rich and influential. He was an adept in the art of

flattery. Galen often refers to him, and always with contempt. Thessalus

was able, so he said, to teach the medical art in six months, and he

surrounded himself with a retinue of artisans, weavers, cooks, butchers,

and so on, who were allowed to kill or cure his patients. Sprengel

states that, after the time of Thessalus, the doctors of Rome forbore to

take their pupils with them on professional visits.



He began a method of treatment for chronic and obstinate cases. The

first three days of the treatment were given up to the use of vegetable

drugs, emetics, and strict dietary. Then followed fasting, and finally a

course of tonics and restoratives. He is said to have used colchicum for

gout. The tomb of Thessalus on the Appian Way was to be seen in Pliny's

time. It bore the arrogant device "Conqueror of Physicians." The success

of Thessalus seems a proof of the cynical belief that the public take a

man's worth at his own estimate.



Pliny, the elder, lived from A.D. 23 to 79, dying during the eruption of

Vesuvius when Pompeii and Herculaneum were destroyed. He was not a

scientific man, but was a prodigious recorder of information on all

subjects. Much of this information is inaccurate, for he was not able

to discriminate between the true and the false, or to assign to facts

their relative value.



His great book on Natural History includes many subjects that cannot

properly be considered as belonging to Natural History. It consists of

thirty-six books and an index, and the author stated that the work dealt

with twenty thousand important matters, and was compiled from two

thousand volumes.



Although Pliny was not a physician he writes about medicine, and paints

a picture of the state of medical knowledge of his time. His own

opinions on the subject are of no value. He believed that magic is a

branch of medicine, and was optimistic enough to hold that there is a

score of remedies for every disease. His writings upon the virtues of

medicines derived from the human body, from fish, and from plants are

more picturesque than accurate.