The First And Second Centuries Of The Christian Era

Athenaeus--Pneumatism--Eclectics--Agathinus--Aretaeus--Archigenes--

Dioscorides--Cassius Felix--Pestilence in Rome--Ancient surgical

instruments--Herodotus--Heliodorus--Caelius Aurelianus--Soranus--

Rufus of Ephesus--Marinus--Quintus.





Athenaeus, of Cilicia, a Stoic and Peripatetic, founded in Rome the

sect of the Pneumatists about the year A.D. 69. It was inspired by the

philo ophy of Plato. The pneuma, or spirit, was in their opinion the

cause of health and of disease. They believed that dilatation of the

arteries drives onward the pneuma, and contraction of the arteries

drives it in a contrary direction. The pneuma passes from the heart to

the arteries. Their theories also had reference to the elements. Thus,

the union of heat and moisture maintains health; heat and dryness cause

acute diseases; cold and moisture cause chronic diseases; cold and

dryness cause mental depression, and at death there are both dryness and

coldness. In spite of these strange opinions the Pneumatists made some

scientific progress, and recognized some diseases hitherto unknown.

Galen wrote of the Pneumatists: "They would rather betray their country

than abjure their opinions." The founder of the sect of Pneumatists was

a very prolific writer, for the twenty-ninth volume of one of his works

is quoted by Oribasius. The teaching of the Pneumatists speedily gave

way to that of the Eclectics, of whom Galen was by far the most

celebrated. They tried to reconcile the teaching of the Dogmatists,

Methodists, and Empirics, and adopted what they considered to be the

best teaching of each sect. The Eclectics were very similar to, if not

identical with, the Episynthetics, founded by a pupil of Athenaeus, by

name, Agathinus. He was a Spartan by birth. He is frequently quoted by

Galen, but none of his writings are extant.



Aretaeus, the Cappadocian, practised in Rome in the first century of

our era, in the reign of Nero or Vespasian. He published a book on

medicine, still extant, which displays a great knowledge of the symptoms

of disease very accurately described, and reliable for purposes of

diagnosis. He was the first to reveal the glandular nature of the

kidneys, and for the first time employed cantharides as a

counter-irritant (Portal, vol. i, p. 62). It is not surprising that

Aretaeus followed rather closely the teaching of Hippocrates, but he

considered it right to check some of "the natural actions" of the body,

which Hippocrates thought were necessary for the restoration of health.

He was not against phlebotomy, and used strong purgatives and also

narcotics. He was less tied to the opinions of any sect than the

physicians of his time, and was both wonderfully accurate in his

opinions and reliable in treatment. Aretaeus condemned the operation of

tracheotomy first proposed by Asclepiades, and held "that the heat of

the inflammation becomes greater from the wound and contributes to the

suffocation, and the patient coughs; and even if he escapes this danger,

the lips of the wound do not unite, for both are cartilaginous and

unable to grow together." He believed, also, that elephantiasis was

contagious. The writings of Aretaeus consist of eight books, and there

have been many editions in various languages. Only a few chapters are

missing.



Archigenes was a pupil of Agathinus, and is mentioned by Juvenal. He

was born in Syria and practised in Rome in the reign of Trajan, A.D.

98-117. He introduced new and very obscure terms into his writings. He

wrote on the pulse, and on this Galen wrote a commentary. He also

proposed a classification of fevers, but his views on this subject were

speculative theories, and not based upon practical experience and

observation. To him is due the credit of suggesting opium for the

treatment of dysentery, and he also described accurately the symptoms

and progress of abscess of the liver. By some authorities he is thought

to have belonged to the sect of the Pneumatici.



Dioscorides was the author of a famous treatise on Materia Medica. At

different times there were several physicians of this name. He lived

shortly after Pliny in the first century, but there is some doubt as to

the exact time. His five books were the standard work on Materia Medica

for many centuries after his death. He compiled an account of all the

materials in use medicinally, and gave a description of their properties

and action. This entailed great knowledge and industry, and is of value

as showing what drugs were used in his time. Since then practically the

whole of Materia Medica has been changed. He held largely to the

orthodox beliefs of Dogmatism, but a great deal of what he recommends is

not comprised in the doctrines of this sect, and is decidedly Empirical.

It is difficult or impossible to identify many of the drugs referred to

by Dioscorides, partly because his descriptions are brief, partly

because the mistakes of his predecessors are found in his book.



He exercised as much authority in Materia Medica as Galen did in the

practice of medicine, and the successors of each were content, in the

main, to follow blindly. A large work was published in England in 1806

to illustrate the plants of Greece described in the treatises of

Dioscorides.



Cassius Felix is supposed to have lived in the first century of our

era, but practically nothing is known of his history. He wrote a book on

medicine consisting of eighty-four questions on medical and physical

subjects and the answers to them.



In A.D. 79, after the eruption of Vesuvius, there was a great pestilence

in Rome, which historians ascribed to the pollution of the air by the

eruption. Fugitives crowded into Rome from the devastated part of the

country, and there was great poverty and an accumulation of filth in the

city, which was, doubtless, the true cause of the pestilence. Treatment

of fever at that time was very imperfect at the best, and proper means

of prevention and treatment were entirely absent in time of pestilence.

It has been computed that ten thousand people died daily at that time in

Rome and the surrounding district. Excavations at Pompeii have done a

great deal to reveal the state of surgical knowledge towards the end of

the first century of our era. Professor Vulpes has written an account of

the surgical instruments recovered from the ruins, and there is a

collection of ancient surgical instruments in the Naples museum. Vaginal

and rectal specula have been found: also a forceps for removing

fractured pieces of bone from the surface of the brain. There is an

instrument considered by Professor Vulpes to have been used as an artery

forceps. Other instruments discovered are: Forceps for removing tumours;

instruments for tapping in cases of dropsy (such an instrument was

described by Celsus); seven varieties of probes; bronze catheters; 89

specimens of pincers; various kinds of knives, bone-elevators, lancets,

spatulas, cauteries, saws, and trephines.[21]



There were several physicians and surgeons of the name of Herodotus. A

famous surgeon of that name lived in Rome about A.D. 100. He was a pupil

of Athenaeus, and is quoted by Galen and Oribasius. This Herodotus,

according to Baas, was the discoverer of pomegranate root as a remedy

for tapeworm.



Heliodorus was a famous surgeon of Rome, and lived about the same time

as Herodotus. He was the contemporary of Juvenal. He performed internal

urethrotomy, and wrote on amputations, injuries of the head, and hernia.



Caelius Aurelianus probably lived in the first century of the Christian

era, but some writers believe that he was a contemporary of Galen and a

rival, because the one never mentions nor is mentioned by the other; but

this view is unnecessarily severe upon the standard of medical ethics

attained by the leaders of the profession in early times. From the style

of his writings, it has been deduced that Caelius Aurelianus was not a

native of Greece or of Rome. He belonged strictly to the sect of the

Methodici, and his writings are important as revealing very fully the

teaching of this sect. He mentions some diseases not previously

described, and had a good knowledge of symptoms. He divided diseases

into two classes, acute and chronic, or, more in conformity with the

terminology of the Methodici, those of constriction and those of

relaxation. Aurelianus did not concern himself with inquiring into the

causation of diseases. His method was to find out the class to which a

disease belonged, and to treat it accordingly. He was very practical in

his views, and did a great deal to place treatment upon a satisfactory

basis. His chief weakness was his failure to recognize the various

differences and gradations, and he attached far too much importance to

the two classes recognized by his school. He withheld active treatment

until he had ascertained to his own satisfaction the class to which the

disease belonged. Caelius Aurelianus wrote three books on acute diseases

and five on chronic diseases. He cites the case of a patient who was

cured of dropsy by tapping, and of a person who was shot through the

lungs with an arrow and recovered. He agreed with Aretaeus in condemning

tracheotomy. His books are not written in a good literary style.



Soranus, of Ephesus, was an eminent physician of the Methodist school,

who practised in Rome in the reigns of Trajan and Hadrian. He wrote a

great work on diseases of women, of which a Greek manuscript, copied in

the fifteenth century, was discovered in La Bibliotheque Royale in Paris

by Dietz, who was commissioned by the Prussian Government to explore the

public libraries of Europe. The same investigator also discovered

another copy of the work, in a worse state of preservation however, in

the Vatican library. Parts of the writings of Soranus are preserved in

the writings of Oribasius. There is no doubt that Soranus was a very

accomplished obstetrician and gynaecologist. His description of the

uterus and its ligaments and the displacements to which the organ is

liable reveals a practical knowledge of anatomy. Unlike most medical

writers of ancient times, he did not adopt the method of recording

various methods of treatment copied from previous writers, but his

textbook is systematic. In writing about a disease he begins with a

historical introduction, and proceeds to describe its causation,

symptoms, and course, and the treatment of its various phases. His

account of obstetrics shows that the art was well understood in his

time. His work on the subjects of dystocia, inflammation of the uterus,

and prolapse is perhaps the best. He refers also to hysterectomy. It is

interesting to note that he used the speculum. He describes the

qualifications of a good midwife. She need not know very much anatomy,

but should have been trained in dietetics, materia medica, and minor

surgical manipulations, such as version. She should be free from all

corrupt and criminal practices, temperate, and not superstitious or

avaricious.



In dealing with the subject of inversion of the uterus, Soranus points

out that this condition may be caused by traction on the cord. It is

noteworthy that he recognized the method of embryotomy as necessary when

other measures had failed.



In his time leprosy was very prevalent. It had probably been brought in

the first place from the East into Italy by Pompey. Some of the remedies

used by Soranus for this disease are to be found in the works of Galen.

Soranus wrote books on other medical subjects, but there is difficulty

in deciding as to what is spurious and what is genuine in the works

attributed to his authorship. There were other physicians of the same

name. Galen quotes a book by Soranus on pharmacy, and Caelius Aurelianus

one on fevers. He is also quoted by Tertullian, and by Paulus AEgineta,

who writes that Soranus was one of the first Greek physicians to

describe the guinea-worm. Soranus, in the opinion of St. Augustine, was

Medicinae auctor nobilissimus. He was far removed from the prejudices

and superstitions of his time, as is shown by his denunciation of

magical incantations.



Rufus, of Ephesus, also lived in the reign of Trajan (A.D. 98-117).

His books reveal the state of anatomical knowledge at Alexandria before

the time of Galen. The recurrent nerves were then recently discovered.

He considered the spleen a useless organ. He understood that pressure on

the nerves and not on the carotid arteries causes loss of voice, and

that the nerves proceed from the brain, and are sensory and motor. The

heart, he considered, was the seat of life, and he observed that its

left ventricle is smaller and thicker than the right. The method of

checking bleeding from blood-vessels by torsion was known to him. He

demonstrated the investing membrane of the crystalline lens of the

eye.[22] He wrote also a treatise in thirty-seven chapters on gout. Many

of the works of Rufus are lost, but fragments are preserved in other

medical writings.



Marinus was an anatomist and physician who lived in the first and

second centuries after Christ. Quintus was one of his pupils.



Marinus wrote twenty volumes on anatomy, of which Galen gives an

abridgment and analysis. Galen says that Marinus was one of the

restorers of anatomical science. Marinus investigated the glands and

compared them to sponges, and he imagined that their function was to

moisten and lubricate the surrounding structures. He discovered the

glands of the intestines. He also wrote a commentary on the aphorisms of

Hippocrates. It is uncertain if he is the Postumius Marinus who was

physician to the younger Pliny.



Quintus was renowned in Rome in the first half of the second century

after Christ. Like Galen he suffered from the jealousy and persecution

of his professional rivals, who trumped up a charge against him of

killing his patients, and he had to flee from the city. He was known as

an expert anatomist, but published no medical writings. It has been

stated by some of the writers on the history of medicine that Quintus

was the tutor of Galen, but this statement is lacking in definite

proof.