*"In Alexandria, anatomy was properly studied."
Note: Alexandria was not only a great center of learning (location of the famous Library of Alexandria), but also seemed to be very open-minded and modern in it's persuit of knowledge. E.g. dissection/the study of anatomy was allowed, where in many other places, it was outlawed.
Note: Physicians seemed to attribute the location of the soul to various different parts/organs of the body. These locations change, but are often associated with the heart. It gets more specific, eventually focusing on the '4th ventricle' as the "location of the soul". This can be compared to the Asian belief that the soul is located just below the navel, at the point where the body's center of balance is located.
Empiricism.
Note: Empiricism is one of many early, medically-alligned schools of thought.
*"The Empiric tripod: namely, Accident, History, and Analogy."
*This meant that discoveries were made by accident, knowledge was accumulated by the recollection of previous cases, and treatment adopted which had been found suitable in similar circumstances. 'Philinus of Cos', a pupil of 'Herophilus', declared that all the anatomy he had learned from his master did not help him in the least to cure diseases. Philinus, according to Galen, founded the 'Empirici', the first schismatic sect in medicine. 'Celsus' wrote of this sect that they admit that evident causes are necessary, but deprecate inquiry into them because "Nature is incomprehensible". This is proved because the philosophers and physicians who have spent so much labour in trying to search out these occult causes cannot agree amongst themselves. If reasoning could make physicians, the philosophers should be most successful practitioners, as they have such abundance of words. If the causes of diseases were the same in all places, the same remedies ought to be used everywhere. Relief from sickness is to be sought from things certain and tried, that is from experience, which guides us in all other arts. Husbandmen and pilots do not reason about their business, but they practise it. Disquisition (Dissertations/Thesis) can have no connection with medicine, because physicians whose opinions have been directly opposed to one another have equally restored their patients to health; they did not derive their methods of cure from studying the occult causes about which they disputed, but from the experience they had of the remedies which they employed upon their patients. Medicine was not first discovered in consequence of reasoning, but the theory was sought for after the discovery of medicine. Does reason, they ask, prescribe the same as experience, or something
different? If the same, it must be needless; if different, it must be mischievous (chaotic/random).
*In spite of his extravagant theories, 'Themison' possessed skill in practice. He was the first physician to describe rheumatism, and he also is thought to have been the pioneer in the medicinal use of leeches. A book on elephantiasis ascribed to him is not definitely known to be authentic. It is worthy of note that he was anxious to write on hydrophobia, but a case he had seen in early youth so impressed his mind with horror that the mere thought of the disease caused him to suffer some of the symptoms.
Note: This suggests phantom symptoms with a psychological basis, and also is an early (sortof) example of hypochondria, often associated in modern times with doctors/nurses/other health-care people.
Personal note: Hypochondria runs fairly rampant in my family, due to both of my parents having worked in the health care industry for over 50 years, cumulatively, as well as my mother-in-law working at a medical lab for over 30 years, my wife working as a vet-tech for several years, and even myself-at a hospital, and then at a group home, for a couple of years.
So this is something I can confirm from my own experience.
*In the time of the Roman Empire the medicines of the regular practitioners were sold with a label which specified the name of the drug and of the inventor, the ingredients, the disease it was to be used for, and the method of taking it. Drug sellers dispensed cosmetics as well as medicines, and some of the itinerant dealers sold poison. The regular physicians bought medicines already compounded by the druggists, and the latter, as in our own day, prescribed as well as the physicians.
*Depilatories (hair removers) were much in vogue, and were usually made of arsenic and unslaked lime, but also from the roots and juices of plants. They were first used only by women, but in later times also by men. Tweezers have been discovered which were adapted for pulling out hairs, and most of the depilatories were recommended to be applied after the use of the tweezers. The duty of pulling out hairs was performed by slaves.
*The master of a great household selected a slave for his ability and aptitude, and had him trained to be the medical adviser of the household; and the skill shown by the doctor sometimes gained for him his freedom. It is recorded that physicians were sometimes compelled to do the disgusting work of mutilating slaves.
Note: "mutilating slaves" probably refers to gelding/making eunichs, and possibly "ownership markings", or punishments.
On a Roman quack (Lucius Horatillavus):
*"He was a handsome man, and came from Naples to Rome, his sole outfit being a toga made of a piece of cloth adorned with obscene pictures and a small Asiatic mitre. Like many of his kind at that day, he sold poisons and invented five or six new remedies which were more or less haphazard mixtures of wine and poisonous substances. He had the good luck to cure his first patient, 'Titus Cnus Leno', who, being a poet, straightway constituted himself the 'vates sacer' (roughly means 'chronicler') of his physician, and induced some of his fashionable mistresses to place themselves under his hands. So profitable was Horatillavus's practice that he is said to have saved 150,000 sesterces (Note: 3.3 sesterces was about what a legionairre made a day) in a few months. But for a moment his good fortune seemed to abandon him. A Roman lady, 'Sulpicia Pallas', died suddenly under his ministrations. This may have been due to his ignorance or carelessness; but he was accused of having poisoned his patient. This event might have been expected to bring his career to an end; but it was not long before he recovered the confidence of the people whom he deluded with his mystical language and promises of cure. He had three methods of treatment, all consisting of baths--hot, tepid, or cold--preceded or followed by the taking of wonder-working medicines.
*Horatillavus treated every kind of disease, internal and external; he even practised midwifery, which was then in the hands of women. Ten years after he settled in Rome he had accumulated a fortune of some 6,000,000 sesterces. He had a villa at Tusculum, whither he went three times a month; there he led a luxurious life in the most beautiful surroundings, and there his evil fate overtook him. His orchard was his especial pride. One day he found that birds had played havoc with his figs, the like of which were not to be found in Italy. Determined to prevent similar depredations in future, he poisoned the fig trees. Continuing his walk, he plucked fruits of various kinds here and there. While eating the fruit he had culled and drinking choice wine, he put into his mouth a poisoned fig, which he had inadvertently gathered, and quickly died in convulsions. Before passing away, however, he is said to have composed his own epitaph. This 'M. Mazade' believes he has found. It reads: "The manes of Sulpicia Pallas have avenged her. Here lies Lucius Horatillavus, physician, who poisoned himself." If the epitaph is genuine, it is a confession of guilt. The death of the quack by his own poison is a curious Nemesis. The manner of his death proves that it was accidental, as few quacks are bold enough to take their own medicines."
Note: A 'manes' is the soul of a dead person, in Roman mythology.
http://en.wikipedia.org/wiki/Category:Roman_mythology*A cure for the sciatica of Emperor Augustus: Augustus's physician successfully banished an
attack of sciatica that greatly troubled Augustus by the expedient of beating the affected part with a stick.
Note: Sciatica is something else that runs in my family, and I can actually imagine this working, since it would increase bloodflow, and might "distract" the nerve, not to mention releasing lots of endorphins.
A poem from the book, that illustrated some of the feared diseases of the early Romans:
*"Though racked with gout in hand and foot,
Though cancer deep should strike its root,
Though palsy shake my feeble thighs,
Though hideous lump on shoulder rise,
From flaccid gum teeth drop away;
Yet all is well if life but stay."
*There were many physicians in the reign of Nero, but none of great eminence. Andromachus was physician to the Emperor, and had the title of 'Archiater', which means "Chief of the physicians."
*An account of the Archiaters is of interest. The name was applied to Christ by St. Jerome. There were two classes of archiaters in time, the one class called 'Archiatri sancti palati'; the other, 'archiatri populares'. The former attended the Emperor, and were court physicians; the latter attended the people. Although Nero appointed the first archiater, the name is not commonly used in Latin until the time of Constantine, and the division into two classes probably dates from about that time. The 'archiatri sancti palati' were of high rank, and were the judges of disputes between physicians. The Archiatri had many privileges conferred upon them. They, and their wives and children, did not have to pay taxes. They were not obliged to give lodgings to soldiers in the provinces, and they could not be put in prison. These privileges applied more especially to the higher class. When an 'archiater sancti palati' ceased attendance on the Emperor he took the title of ex-archiater. The title 'comes archiatorum' means "Count of the Archiatri," and gave rank
among the high nobility of the Empire.
*The 'Archiatri populares' attended the sick poor, and each city had five, seven or ten, according to its size. Rome had fourteen of these officers, besides one for the vestal virgins, and one for the gymnasia. They were paid by the Government for attending the poor, but were not restricted to this class of practice, and were well paid by their
prosperous patients. Their office was more lucrative but not so honourable as that of the archiaters of the palace. The 'archiatri
populares' were elected by the people themselves.
*There is reason to believe that in the time of Nero there was a class of women poisoners. Nero employed one of these women, 'Locusta' by name, and after she had poisoned 'Britannicus', rewarded her with a great estate in land, and placed disciples with her to be instructed in her nefarious
trade.
*There was also a very ignorant class of oculists in Rome in the time of Nero, but at Marseilles, 'Demosthenes Philalethes' was deservedly celebrated, and his book on diseases of the eye was in use for several centuries. The eye doctors of Rome employed ointments almost entirely, and about two hundred seals have been discovered which had been attached to pots of eye salves, each seal bearing the inventor's and proprietor's name. In the time of Galen, these quack oculists were very numerous, and Galen inveighs against them.
*Martial satirized them: "Now you are a
gladiator who once were an ophthalmist; you did as a doctor what you do as a gladiator." The blear-eyed Hylas would have paid you sixpence, O Quintus; one eye is gone, he will still pay threepence; make haste and take it, brief is your chance; when he is blind, he will pay you nothing."
*The oculists of Alexandria were very proficient, and some of their followers, at various times throughout the period of the Roman Empire, were remarkably skillful. Their literature has perished, but it is believed that they were able to operate on cataracts.
Celsus:
*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 does not come into contact with the bladder itself, and that nothing falls 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.
*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.
Note: Surgeries and other healing methods can realistically cause greater injury, if complications arise, or if the physician/surgeon is simply incompetent. I'm not sure if you want to portray that, however, as it would be a "failure" result, but there seem to have been a lot of "quacks" running around, who didn't have much in the way of
actual skill (and some who intentionally exploited people). Surgery is also, in a way, the flipside of combat, and not every combat is always won by a "dabbling" warrior, so I present a case for the possibility of surgical failure as an option, and leave it, for your consideration.
*Celsus 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.
*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.
*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 bone separating the nasal cavity from the brain), 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.
*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 (hallucinations). He recommended lotions and salves for the treatment of some eye diseases.
Note: Alchohol and caffiene, in excess, can both cause hallucinations, in human beings.
Things taken in excess can sometimes have unexpectedly poisonous symptons, while small doses may not have any adverse effects (or may have beneficial effects). Things considered poisonous, even in relatively small doses, can also have specific beneficial effects. An example is digitalis, an extract of the foxglove plant, used to treat the heart for specific ailments, but which is also a deadly poison.
*Although Celsus practised bloodletting, he argued very strongly against 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 healthy was to afford outlet to an excessive supply of blood, and the weak and anæmic were similarly treated to get rid of evil humours, so that hardly any sick person could escape this drastic treatment.
*Emetics (agents that induce vomiting) 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.
Apollonius of Tyana.
Note: An example of something like a healing philosopher/wizard.
(Note: You can tell here that the influence of Christianity was a pretty heavy factor on the author's opinions--and probably his publisher's. I think he did a good job towards objectivity, for the most part, but it's a good idea to keep in mind that this was obviously a firm Christian, writing about Pagan Greece/Rome.)
*'Apollonius of Tyana' was born four years before the Christian era, in the time of Augustus Cæsar, 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' (Another sect) 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.
Note: Pythagoreanism, incase you're interested:
http://en.wikipedia.org/wiki/Pythagoreanism*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' (Note: Nerva was a Roman emperor), 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 Æsculapius, 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.
Note: A wide variety of medically alligned "sects":
Dogmatists--Methodists--Empirics--Pneumatists--Eclectics--Episynthetics.
Compare philosophical schools:
Stoic, Platonist, Peripatetic, and Epicurean.
Materia Medica: Body of knowledge pertaining to pharmacology.
http://en.wikipedia.org/wiki/Materia_MedicaRecovered from the ruins of Pompeii: Specula, forceps for removing fractured pieces of bone from the surface of the brain, artery forceps, forceps for removing tumours; instruments for tapping (used to countery "dropsy", or Edema, an abnormal accumulation of fluid beneath the skin, or in one or more cavities of the body) seven varieties of probes; bronze catheters; 89 specimens of pincers; various kinds of knives, bone-elevators, lancets, spatulas, cauteries, saws, and trephines.
*Pomegranate root as a remedy for tapeworm. (Note: parasites, and other animals, might have repellants?)
Midwife (Excerpt from the book: *Soranus, of Ephesus-1st century AD Methodist-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. She should be free from all corrupt and criminal practices, temperate, and not superstitious or avaricious.)
Galen:
Most important medical writer of his time-early 2nd century AD
(Note: Galen was also doctor to the 'School of Gladiators', which is, arguably, a pretty badass job.)
Very successful in Rome. Was afraid of being poisoned by his less successful rivals.
Note: Physicians seemed to often have rivalries, and some weren't above using their knowledge to do harm--often via poison. It's a competitive environment, and I guess it always has been.
*Galen insisted upon the study of anatomy as essential, and in this respect was in conflict with the view held by the Methodists and the
Empirics (medical sects) who believed that a physician could understand diseases without
any knowledge of the exact structure of the body.
*He also advanced knowledge of nerves, and veins/arteries, and wasn't far from discovering circulation of blood. Aristotle had thought veins/arteries contained air. Galen also attributed some importance to the brain (particularly as pertains to thought), whereas Aristotle had considered the brain relatively unimportant.
Note: Just to point this out a second time, in different context, Aristotle had this view in opposition of his teacher, Plato. Plato was correct in ascribing reason to the brain. Sometimes students and teachers-even great minds-can take opposing views. Also, later views aren't always more advanced, even when they're building on prior knowledge.
*Galen thought that wine was particularly suitable for the aged, and that elderly people should have wine, hot baths, and 3 meals a day. Younger people should only have 2 meals, and cold baths.
Also took some of the superstition out of sneezing, suggesting that it had healthy and effective role.
Note: Sneezing retains it's superstitious nature, even today. Gesundheit.
Note: Different regimens could be prescribed for different age-groups.
*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.
Note: Use of verse as a memory aide/as a way of keeping an exacting recipe-such as one to be used medicinally-intact.
Theriac: Famously administered by Galen to the Roman Emperor Marcus Aurelius.
Supposedly a universal panacea, was traded as far away as China and India, was supposed to be a medicine against poisons/plagues. Contained 64 or more ingredients, with a sugar base (Note: One type of theriac was called "Venetian Treacle", treacle being another word for molasses), was aged for several years until it reached maturity. It was still being traded/sold in pharmacies in the
late 19th century (1884 AD).
http://en.wikipedia.org/wiki/Theriac*In Galen's works there are lengthy lists of compound medicines, several medicines being
recommended for the same disease, and never with very marked confidence. He paid high prices for various nostrums, and, sad to relate, placed great faith in amulets, belief in which was general in his time, and nowhere held more strongly than in superstitious Rome. Medicines were classified by him according to their qualities, by which he meant, not their therapeutic effects, but their inherent dryness or moistness, coldness or heat. A medicine might be cold in the first degree, and not in the second degree. 'Paulus Ægineta' followed this strange and foolish doctrine of Galen very closely, as the following extracts from his book on Materia Medica will show:--
*"Cistus (rock-rose)--It is an astringent shrub of gently cooling powers. Its leaves and shoots are so desiccative as to agglutinate (clot) wounds; but the flowers are of a more drying nature, being about the second degree; and hence, when drunk, they cure dysenteries and all kinds of fluxes."
*"Ferrum (iron)--When frequently extinguished in water, it imparts a considerable desiccative power to it. When drunk, therefore, it agrees with affections of the spleen."
Note: It may be that different medicinal abilities are sometimes attributed to items due to their possessing attributes which conform to the physician's theories on medicine, rather than any proven benefit.
Note: Early physicians didn't have access to our modern scientific method, so they tended to come up with a "system" for how the world worked, first, and then fit the world to their system, only correcting the system if something should happen to debase it--or they might even ignore any evidence of their system being wrong.
Note: Medicine and magic (amulets, superstitions) continued to go together, even as understanding of medicine advanced. This might be supposed to have considerably more basis in fact, in a fantasy setting, but please also note that even today, psychology and emotional state can have a lot of influence on a patient's health, so these kinds of "security blanket" items weren't necessarily useless, if only as morale support, even from a perspective completely grounded in modern scientific/medical dogma.
*Galen was a man of wide culture, and one of his essays is written for the purpose of urging physicians to become acquainted with other
branches of knowledge besides medicine. As a philosopher he has been quoted in company with Plato and Aristotle, and his philosophical
writings were greatly used by Arabic authors. In philosophy, as in medicine, he had studied the teachings of the various schools of thought, and did not bind himself to any sect in particular. He disagreed with the Sceptics (philosophical sect) in their belief that no such thing as certainty was attainable, and it was his custom in cases of extreme difficulty to suspend his judgment; for instance, in reference to the nature of the soul, he wrote that he had not been able to come to a definite opinion.
*Galen mentions the discreditable conduct of physicians at consultations. Sometimes several doctors would hold a consultation, and, apparently forgetting the patient for the time, would hold violent disputations. Their main object was to display their dialectical skill, and their arguments sometimes led to blows. These discreditable exhibitions were rather frequent in Rome in his time.
Note: Sounds like something that could happen in DF.
Next comes the late Roman age, and the era of Byzantium, in the book, and I'll be reviewing that as well, but at this point, the Greko-Roman era is pretty much complete, and I'm going to end here with Galen.
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Topic: Surgery/Medicine in DF (Read 26632 times)