PART IIMEDIAEVAL MEDICINE

CHAPTER XVIITHE CONDITION OF MEDICINE AT BYZANTIUM DURING THE EARLY PART OF THE MIDDLE AGES

The Byzantine period of the history of medicine begins about the middle of the fourth century A. D. and retains some degree of importance up to or perhaps a little beyond the beginning of the eighth century. During this period of nearly four centuries there appeared on the scene five physicians whose writings form a very creditable part of the late Greek medical literature. The names of these authors are: Oribasius, Aëtius, Alexander of Tralles, Theodore Priscianus and Paulus Aegineta.

Oribasius.—The first physician named in this list, Oribasius, was born about the year 325 A. D. in Pergamum, an important city of Asia Minor and the birthplace of Galen. He received his medical training at Alexandria, settled in Constantinople (the new name given to Byzantium), and soon afterward became the personal physician of the Emperor Julian the Apostate, the nephew of Constantine the Great. Subsequently he was appointed Quaestor of Constantinople, but, upon the death of Julian (363 A. D.) and the accession of Valens and Valentinianus to power, his property was confiscated and he himself was obliged to take refuge among the Ostrogoths, who dwelt on the shores of the Black Sea. These people received him with open arms, and he soon acquired great influence among them. After a time, however, he was recalled to Constantinople and all his former privileges were once more granted to him. He died about the year 403 A. D.

Despite his duties as a practicing physician of the very highest rank—duties which he could not wholly set aside when he accepted the office of Quaestor of Constantinople—and despite the necessity of devoting considerable time to the work which this non-medical official position entailed, Oribasius, like Pliny, appears to have been a most energetic contributor to medical literature. We possess to-day, for example, a large part of the medical cyclopaedia (72 books) which he prepared at the command of the Emperor Julian, and which—even in its incomplete state—contains very full information regarding anatomy, physiology, surgery, pathology and pharmacology. Although the work is simply a compilation, its present value is great, for it contains numerous extracts from earlier and contemporary treatises, many of which have entirely disappeared,—treatises of which we should have had no knowledge whatever if Oribasius had not introduced numerous extracts from them into his cyclopaedia.

About the year 390 A. D., when Oribasius was already an old man, he published (in nine books) a “Synopsis” of the larger work, chiefly for the benefit of his son Eustathios, who was at that time studying medicine. Surgery is omitted from this work, as that branch of medicine was assumed to belong entirely to specialists. At a still later date (about 395 A. D.), Oribasius published a third work (in four books) entitled “Euporista,” which was intended chiefly for the use of laymen. The subject-matter of this treatise consists of diet, hygiene and general therapeutics. Neuburger speaks well of all three of the published works of Oribasius, and furnishes a fairly full analysis of the contents of each one.

Bussemaker and Daremberg have published, in six volumes (Paris, 1856–1876), an excellent French version of the works of Oribasius.

Priscianus.—Theodorus Priscianus lived during the latter part of the fourth and the first part of the fifth century of the present era. Very little is known about his professional career beyond the facts that he was a pupil of Vindicianus, a distinguished physician who lived duringthe reign of the Emperor Valentinianus I. at Constantinople (364–375 A. D.), and that subsequently he was chosen the private physician of the Emperor Gratianus (375–383 A. D.). The treatise which he composed, and which bore the title of “Euporiston,” was originally written in Greek, but was afterward translated by its author into Latin. An excellent German version of the work by Meyer-Steineg was published in Jena in 1909. As the book was intended by Priscianus to serve chiefly as a guide to practitioners of the art, it contains practically nothing about anatomy and physiology. In his pathology he follows closely the teachings of the Methodists; his first question, in the presence of a case of illness, being: “Do the symptoms point to a condition ofstrictumrather than to one oflaxum, orvice versa?” “In his treatment,” says Meyer-Steineg, “Priscianus follows very closely the rule that every patient, no matter what may be the disease with which he is affected, should first undergo a certain amount of general treatment.” In his choice of remedies Priscianus invariably gives the preference to those agents which are of a simple character and easy to obtain. On the other hand, he does not hesitate to admit that he sometimes employs certain magical remedies, as is shown by the following quotation taken from Book IV., Chapter I., section 4:—

If a person wears, during the waning of the moon, a wreath of polygonum on his head, he will obtain relief from his headache.... If one drinks of the water from which an ox has just drank, he will be relieved of the pain in his head.... If a loadstone be held upon the head it will draw out the hidden pain, and the same effect may be obtained by rubbing over the forehead a swallow’s nest thoroughly mixed with vinegar.

In Book I, paragraph 2, Priscianus draws a picture of the rude and uncivilized behavior of the practitioners of his day in the sick-room. The following are his words as translated from the German of Meyer-Steineg:—

As the patient lies on his bed prostrated by the severity of the disease, there quickly comes into the room a crowd of us physicians. No feeling of sympathy for the sick man have we, nor dowe realize how impotent we all are in the presence of these forces of nature. Instead, we struggle to the utmost of our ability to obtain charge of the case; one depending for success on his powers of persuasion, a second on the strength of the arguments which he is able to bring forward, a third on his readiness to agree with everything that is said, and the fourth on his skill in contradicting the opinion of everybody else. And, as this quarrel goes on, the patient continues to lie there in a state of exhaustion. “For shame!” Nature seems to say, “you men are an ungrateful lot! You do not even permit the patient to die quietly; you simply kill him. And then, moreover, you accuse me of not furnishing sufficient means of effecting a cure. Illness is certainly a painful affair, but I have provided plenty of remedies. Poisons, I admit, are hidden in some of the plants, but the healing agents which may be extracted from them are much more numerous. Away, then, with your angry disputes and your self-glorifying chatter; for in these are not to be found the remedial agents which I have bestowed upon man, but rather in the powerful forces which reside in the seeds, fruits, plants and other objects which I have created in his interests.”

Aëtius.—Aëtius was a native of Amida, in Mesopotamia, and he lived during the early part of the sixth century A. D., under the Emperor Justinian I. He studied medicine at Alexandria and then settled in Constantinople, where he was appointed to the double office of private physician to the emperor and commanding officer of his body-guard (Comes obsequii),—an arrangement which made it practicable for the emperor to have his physician near his person on all possible occasions. Almost nothing is known about the subsequent private life and professional career of Aëtius beyond the facts that he was a Christian and that he wrote a treatise on medicine in sixteen books, which together form a large volume. The work, says Le Clerc, is almost entirely a compilation from the treatises of earlier writers on medicine and surgery; the best parts of the book being those which relate to the pathology and treatment of internal diseases, to materia medica, and to ophthalmology. The Christianity of Aëtius, like that of Alexander of Tralles, and other physicians of a later period, appears to have permitted a belief in magicalremedies. For example, Aëtius gives formulae containing the names of the Saviour and the Holy Martyrs for exorcising certain maladies, and he recommends the employment of amulets. The subject of baths is treated by him quite thoroughly, and he lays stress upon the importance of physical exercise as a means of maintaining one’s health. Freind, the author of an English history of medicine which was very popular in its day,[44]quotes the following remedy for gout from the treatise of Aëtius:—

At the end of the French version of “Les Oeuvres de Rufus d’Éphèse” (translated from the Greek by Daremberg and Ruelle) will be found fragments of some of the books of Aëtius; in 1899 J. Hirschberg translated into German Book VII. (eye diseases) of the same author; and, two years later (1901) Max Wegscheider published a German version of Book XVI. (obstetrics and gynaecology). No other translations of the writings of Aëtius into either French, German or English are—so far as I am able to learn—available.

Alexander of Tralles.—Alexander of Tralles, a city of Lydia, in Asia Minor, was born about 525 A. D. His father Stephanus was highly esteemed as a practicing physician, and his four brothers, all of them older than himself, were men of distinction in their several callings; Anthemius, the oldest, being one of the greatest mathematicians and mechanicians of his day and the man towhom the Emperor Justinian intrusted the rebuilding of the church of St. Sophia in Constantinople;[45]Metrodorus, a celebrated grammarian and the honored teacher of the youth belonging to the highest circles of that metropolis; Olympius, a leading authority in jurisprudence; and Dioscorus, a prominent physician in his native city. Alexander received his first instruction in medicine from his father, but he obtained his real training from a physician who was the father of his most intimate friend Cosmas, and who, throughout Alexander’s entire subsequent career, proved most helpful in advancing his interests. At first he traveled extensively, visiting in succession—probably in the capacity of a military surgeon—Italy, Northern Africa, Gaul and Spain. Afterward, he settled permanently at Rome and practiced medicine there during the remainder of a long life. Puschmann, the translator of his writings, seems disposed to believe that he was both a teacher and a practitioner of medicine during his residence in that city. When he became too old to bear the heavy burdens of medical practice, he wrote an account of his life,—a life which was rich in professional experience,—and thus built for himself “a monument more striking and more durable than the splendid temple erected by his eldest brother.” (Meyer, quoted by Puschmann.)

Various circumstances justify the conclusion that Alexander of Tralles was a Christian. His style of writing is simple and direct, and he states his views with a degree of modesty which wins for him at once the sympathy and confidence of his readers. He gives full and generous recognition to the great physicians who lived and wrote before his time, and more especially to Hippocrates. On the other hand, he does not hesitate, when he believes that he is right, to put forward views which are in direct antagonism with those of even so great an authority as Galen. In the domain of therapeutics, says Puschmann, Alexander was decidedly superior to Galen. His teachingsare based on experience gained in actual practice, whereas Galen was very often disposed to trust to considerations of a theoretical nature; for he was chiefly interested in establishing the pathology of the different diseases and in opening up new territories in medicine in which the human mind might display its activity.

The twelve books of which the treatise of Alexander of Tralles consists, were printed in the original Greek for the first time in 1548, by Robert Étienne, the celebrated printer of Francis I., King of France. The last and most perfect edition of the Greek text is that of the late Dr. Theodore Puschmann, which was published in Vienna in 1878 (two Vols.). It contains, in addition to the Greek version, a careful analysis of the twelve individual books, and an admirable German translation of the entire work. It is from the latter that the following brief extracts (translated into English) are taken:—

Introduction to the writings of Alexander of Tralles.—Upon a certain occasion, my dearest Cosmas, thou didst urge me to publish my rich experiences in the domain of practical medicine, and I am now gladly complying with thy wish, for I feel under deep obligations to both thyself and thy father for the kindness which you have shown to me on every possible occasion in the past. Thy father was always a most helpful patron to me, not only in my practice, but also in all other relations of life. And thou also, even when thou wert living abroad, stood staunchly by me through all the trials which I experienced and the severe blows dealt me by Fate. For these reasons I will now in my old age, when it is no longer possible for me to endure the labor and worries of practice, do as thou desirest, and will write a book in which shall be set forth the experience which I have gained during my long service in the treatment of disease. I hope that many of those who read what is here written, with minds free from jealousy, will experience real pleasure in noting the well-founded and scientific character of the rules which I have laid down and the brevity and preciseness of my descriptions. For I have done my very best always to employ simple words, in order that everybody may find it easy to understand my book.Some Magical Remedies or Amulets Recommended by Alexander of Tralles, as Effective in the Treatment of Colic.—TheThracians remove the heart from a lark while the bird is still alive, and wear it, prepared as an amulet, on the left thigh.Procure a little of the dung of a wolf, preferably some which contains small bits of bone, and pack it in a tube which the patient may easily wear as an amulet on his right arm, thigh, or hip during the attack. He must be very careful, however, not to allow the parts around the seat of the pain to come in contact with the earth or with the water of a bath. This amulet is, in my experience, an unfailing remedy, and almost all physicians of any celebrity have commended its virtues.Remove the nipple-like projection from the caecum of a young pig, mix myrrh with it, wrap it in the skin of a wolf or dog, and instruct the patient to wear it as an amulet during the waning of the moon. Striking effects may be looked for from this remedy.Let the design of Hercules throttling a lion be engraved upon a Median stone, and then instruct the patient to wear it on his finger after it has been properly set in a ring of gold.Take an iron ring and have the hoop made eight-sided. Then engrave upon the eighth side these words: “Flee, flee, oh Gaul! the lark has sought thee out.” On the under surface of the head or seal of the ring engrave the letters J. C., thus:symbolI have often made use of this amulet; and, while I should consider it wrong to keep silence about a remedial agent of such extraordinary efficacy in cases of colic, I feel bound to say that it should not be recommended to the first comer, but only to believers and to those individuals who know how to guard it carefully. The Great Hippocrates, with remarkable insight, gave the advice that things which are holy should be intrusted only to those who are of a religious character, and should be withheld from the profane. As regards the ring, however, the patient must be careful, before wearing it, to have a sketch made of it on either the seventeenth or the twenty-first day of the moon.

Some Magical Remedies or Amulets Recommended by Alexander of Tralles, as Effective in the Treatment of Colic.—TheThracians remove the heart from a lark while the bird is still alive, and wear it, prepared as an amulet, on the left thigh.

Procure a little of the dung of a wolf, preferably some which contains small bits of bone, and pack it in a tube which the patient may easily wear as an amulet on his right arm, thigh, or hip during the attack. He must be very careful, however, not to allow the parts around the seat of the pain to come in contact with the earth or with the water of a bath. This amulet is, in my experience, an unfailing remedy, and almost all physicians of any celebrity have commended its virtues.

Remove the nipple-like projection from the caecum of a young pig, mix myrrh with it, wrap it in the skin of a wolf or dog, and instruct the patient to wear it as an amulet during the waning of the moon. Striking effects may be looked for from this remedy.

Let the design of Hercules throttling a lion be engraved upon a Median stone, and then instruct the patient to wear it on his finger after it has been properly set in a ring of gold.

Take an iron ring and have the hoop made eight-sided. Then engrave upon the eighth side these words: “Flee, flee, oh Gaul! the lark has sought thee out.” On the under surface of the head or seal of the ring engrave the letters J. C., thus:symbolI have often made use of this amulet; and, while I should consider it wrong to keep silence about a remedial agent of such extraordinary efficacy in cases of colic, I feel bound to say that it should not be recommended to the first comer, but only to believers and to those individuals who know how to guard it carefully. The Great Hippocrates, with remarkable insight, gave the advice that things which are holy should be intrusted only to those who are of a religious character, and should be withheld from the profane. As regards the ring, however, the patient must be careful, before wearing it, to have a sketch made of it on either the seventeenth or the twenty-first day of the moon.

Alexander has been severely criticised for his advocacy of the employment of amulets in the treatment of diseases; but he defends himself against such criticism by saying that physicians owe it as a duty to their patients to study carefully what he calls the hidden forces of nature, and to pay unprejudiced attention to the effects produced by amulets and other magical remedies. He reminds his critics that Galen and other eminent medical authorities have insisted that a place be given to this class of agents in the list ofauthorized remedies; and he adds that Galen further emphasizes the duty of the physician to employ them when other measures fail, or when the patients themselves frankly confess that they have faith in their efficacy and therefore wish them to be tried. Alexander also makes the statement that Galen, after treating for a long time all reports about the beneficial results obtained from the employment of magical measures as old women’s tales, had finally decided that these benefits were at times marvelous and should be accepted as genuine by physicians even if they are unable to explain them.

How much Alexander of Tralles really believed in these supernatural agents, or to what extent he relied upon their effect in influencing the imagination, we may not know; but his was an age of superstition, and the conditions governing society at that time were very different from those which control the world at the present day.

Paulus Aegineta.—Paulus Aegineta[46]was born in the Island of Aegina, not far from Athens, in the early part of the seventh century A. D., and practiced medicine in Alexandria, Egypt. He is known to us as the author of a compend of medicine which was very popular during a long period of time, especially among the Arabs, who, as early as two hundred years after his death, translated his work from the Greek into their own language. At a still later period it was also translated into Latin, the two best versions in this language which we now possess being those of Guintherus Andernacus (Paris, 1532) and of J. Cornarius (Basel, 1556). There is also an English translation by F. Adams (“The Seven Books of Paulus Aegineta,” London, 1845–1847), which is favorably spoken of by Neuburger, and which is apparently at the present time the only existing version of the work of Paulus of Aegina in a modern European language; for the French translation by René Briau (“La Chirurgie de Paul d’Égine,” Paris, 1855) comprises only Book VI.

The contents of the entire work are as follows:Book I.—Dietetics of Pregnant Women and of Children;Children’s Diseases; Massage, Gymnastics, Sexual Hygiene, Bathing, etc.;Book II.—General Pathology, the Doctrine of Fevers, Semeiology;Book III.—Diseases of the Hair, Diseases of the Brain and Nerves, Diseases of the Eyes, Ears, Nose, Mouth, Teeth and Face;Book IV.—Leprosy, Skin Diseases, Inflammations, Swellings, Tumors, Wounds, Ulcers, Fistulae, Hemorrhage, Worms, Affections of the Joints, etc.;Book V.—Toxicology;Book VI.—Surgery;Book VII.—Materia Medica.

To furnish even a very superficial analysis of the contents of this treatise would call for more space than can well be given up here to such a purpose. I shall therefore simply mention a few points of special interest to which Neuburger calls attention in the course of his very full analysis of the work. He states, for example, that Paulus mentions several instances in which patients affected with lung disease, coughed up calculi or small stone-like masses. He also states that the same author was familiar with the fact that in the course of “phthisis,” the pus may find its way into the bladder and there cause ulceration [in other words, that pus containing tubercle baccilli may flow down by way of the ureters and cause tuberculous ulceration of the bladder]. Paulus’ theory regarding the origin of gout, adds Neuburger, is quite remarkable for that early period. He maintains, for example, that in persons who lead a rather inactive life and who are often affected with digestive disorders, there is produced, through the inadequate power of the tissues of the body to assimilate the excess of nutriment brought to them, amateries morbiwhich is drawn first to the parts that are weakest or least capable of resistance (the joints, for example) and then also to other structures, as the liver, spleen, throat, ears and teeth. These ideas—let it be remembered—were set down in writing in 650 A. D.

At the beginning of his analysis of Book VI., Neuburger makes this remark: “Although the description given by Paulus of the surgery of the ancients is based upon the writings of Hippocrates and Galen, as well as upon those of Leonides, Soranus and Antyllus, one finds at every stepample evidence that the writer possessed both independence of judgment and the manual skill which belongs to a physician who is familiar with surgical work.” He calls particular attention to the section (No. 88) which deals with the manner of removing the heads of arrows from wounds, and he gives special praise to Paulus for his most instructive account of the diagnostic signs to be looked for in a case of suspected wounding of a vital organ. He is extremely thorough, says Neuburger, in his teachings about fractures and dislocations, and he not infrequently differs from the views expressed by his predecessors.

In the section devoted to gynaecological operations Paulus makes it perfectly clear that he was in the habit of using a speculum of a very practical form. Here are his words:—

... and, while the operator is holding the instrument in position, an assistant turns the screw until the blades of the instrument have been separated to the distance desired.

In other chapters of Book VI., Paulus furnishes most interesting and minute descriptions of a great variety of operations in general surgery and also in obstetrics, ophthalmology, otology and rhinology. Those who desire to learn further details about these surgical matters should consult the English version mentioned on a previous page.

It is not at all unlikely that at some future day it will be found desirable—by reason of the discovery of the treatises which they are known to have written, but which have been lost—to add to this short list of ancient medical authors the names of the following men who are frequently quoted by them in their works: Antyllus, who made some really valuable additions to our knowledge of the proper manner of treating aneurysms, and who must have been a surgeon of great resourcefulness; Leonides, the Alexandrian, who lived about the time of Galen, and who appears to have been highly considered for his practical common sense in the choice of surgical measures; Hesychios of Byzantium and his distinguished son, Jacobus Psychrestus, who was highly spoken of by his contemporaries(fifth century A. D.), in whose honor a public statue was erected (Haller), and to whom is attributed the saying: “A good physician should either decline at the start to take charge of a patient, or else he should not leave him until he shall have brought about some measure of improvement”; finally, Heliodorus, and perhaps a few others who are less well known.

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