Medicine

G

Graeco-Roman Medicine

Alexandrian Greek medicine influenced conquering Rome despite initial resistance from the Romans. Asclepiades of Bithynia was important in establishing Greek medicine in Rome in the 1st century bc. Opposed to the theory of humours, Asclepiades taught that the body was composed of disconnected particles, or atoms, separated by pores. Disease was caused by restriction of the orderly motion of the atoms or by the blocking of the pores, which he attempted to cure by exercise, bathing, and variations in diet, rather than by drugs. This theory was revived periodically and in various forms as late as the 18th century.

The chief medical writers of the 1st and 2nd centuries ad, apart from Galen of Pergamum, were: the Roman Aulus Cornelius Celsus, who wrote an encyclopedia of medicine; the Greek physician Pedanius Dioscorides, the first scientific medical botanist; the Greek physician Artaeus of Cappadocia, a disciple of Hippocrates; the Greek anatomist Rufus of Ephesus, renowned for his investigations of the heart and eye; and Soranus of Ephesus, another Greek physician, who recorded information concerning obstetrics and gynaecology, apparently based on human dissection. Although an adherent of the school of Asclepiades, he distinguished diseases by their symptoms and courses.

Galen of Pergamum, also a Greek, was the most important physician of this period and is second only to Hippocrates in the medical history of antiquity. In view of his undisputed authority over medicine in the Middle Ages, his principal doctrines require some elaboration. Galen described the four classic symptoms of inflammation (redness, pain, heat, and swelling) and added much to the knowledge of infectious disease and pharmacology. His anatomic knowlege of humans was defective because it was based on dissection of apes. Some of Galen's teachings tended to hold back medical progress. His theory, for example, that the blood carried the pneuma, or life spirit, which gave it its red colour, coupled with the erroneous notion that the blood passed through a porous wall between the ventricles of the heart, delayed the understanding of circulation and did much to discourage research in physiology. His most important work, however, was in the field of the form and function of muscles and the function of the areas of the spinal cord. He also excelled in diagnosis and prognosis. The importance of Galen's work cannot be overestimated, for through his writings knowledge of Greek medicine was subsequently transmitted to the Western world by the Arabs.

H

Roman Medicine

Original Roman contributions were made in the fields of public health and hygiene. In the organization of street sanitation, water supply, and public hospitals, the methods of the Romans were not surpassed until modern times.

IV

Medicine in the Middle Ages

The gradual infiltration of the Roman world by a succession of outside peoples was followed by a period of stagnation in the sciences. Western medicine in the early Middle Ages consisted of folklore, mingled with poorly understood remnants of classical learning. Even in sophisticated Constantinople, a series of epidemics served only to initiate a revival of magical practices. Only a few outstanding Greek physicians such as Oribasius, Alexander of Tralles, and Paul of Aegina maintained the older tradition in face of the rise of moral decadence, superstition, and intellectual stagnation.

A

Arabic Medicine

In the 7th century a vast portion of the Eastern world was overrun by Arab conquerors. In Persia, the Arabs learned of Greek medicine at the schools of the Nestorian Christians, members of a sect in exile from the Byzantine Empire. These schools had preserved many texts lost in the destruction of the Alexandrian Library. Translations from Greek were instrumental in the development of a scientific revival and an Arabic system of medicine, based on Greek and Roman thought, throughout the Arab-speaking world. Followers of the system were known as Arabists. Important among Arabist physicians were: al-Razi, a famous clinician and writer, who was the first to identify smallpox, in 910, and measles and to suggest blood as the cause of infectious diseases; Isaac Judaeus, the author of the first book devoted entirely to dietetics; and Avicenna, whose famous Canon remained the standard synthesis of the doctrines of Hippocrates, Aristotle, and Galen. Arabists of the 12th century include: Avenzoar, who first described the parasite causing scabies and was among the earliest to question the authority of Galen; Averroës, recognized as the greatest commentator on Aristotle; Averroës's pupil Maimonides, whose works on diet, hygiene, and toxicology were widely read; and Al-Quarashi, also known as Ibn al-Nafis, who wrote commentaries on the writings of Hippocrates and treatises on diet and eye diseases, and, most importantly, was the first to indicate the pulmonary transit of blood, from the right to the left ventricle via the lungs.

The Arabists did much to elevate professional standards by insisting on examinations for physicians before granting a licence. They introduced numerous therapeutic chemical substances, excelled in the fields of ophthalmology and public hygiene, and were more skilled than the physicians of medieval Europe.

B

European Medicine

Early medieval Europe suffered from complete disorganization of the lay medical fraternity. To supply the pressing need for medical care, a form of ecclesiastical medicine arose; originating in the monastic infirmary, it spread rapidly to separate charitable institutions designed to care for the many sufferers of leprosy and other disorders. The Benedictines were especially active in this work, collecting and studying ancient medical texts in their library at Monte Cassino, Italy. St Benedict of Nursia, the founder of the order, obligated its members to study the sciences, especially medicine. The abbot of Monte Cassino, Bertharius, was himself a famous physician.

Under the Frankish theologian Rabanus Maurus, Fulda became a famous centre of medical learning in Germany. By the 9th century, as a result of the efforts of Charlemagne, the Holy Roman emperor, medicine was included in the curriculum of the cathedral schools. By contrast, the French ecclesiastic St Bernard of Clairvaux forbade the Cistercian monks to study medical books and prohibited the use of all remedies other than prayer.

During the 9th and 10th centuries the ancient health resort of Salerno, situated near Monte Cassino, gradually became a recognized centre of medical activity. At the beginning of the 11th century, Salerno became the site of the first Western school of medicine. Teaching was primarily practical and secular in tone, and emphasized diet and personal hygiene. The Italian physician and translator Constantine the African, who became a Benedictine monk and retired to the abbey of Monte Cassino, prepared Latin translations from the Arabic of many Greek medical classics for students at both Salerno and Monte Cassino. By the 12th century, medical instruction had become increasingly theoretical and scholastic and spread to the medical school at Montpellier and later to the universities of Paris, Oxford, and Bologna.

By the end of the 12th century the revival of lay medicine and restrictions on activities outside the cloister brought about the decline of monastic medicine, but it had performed a valuable function by preserving the traditions of medical learning. In the 13th century, dissection of the human body was permitted, medical licensing by examination was endorsed, and strict measures were instituted for the control of public hygiene, but scholastic medicine remained largely a logical exposition of ancient dogma. Representative scientists of this period include the German scholastic St Albertus Magnus, who engaged in biological research, and the English philosopher Roger Bacon, who undertook research in optics and refraction and was the first scholar to suggest that medicine should rely on remedies provided by chemistry. Even Bacon, often regarded as an original thinker and pioneer in experimental science, was dominated by the authority of the Greek and Arabic writers.

In Italy the universities of Bologna and Padua became leading medical centres in the 13th century. At Bologna, attempts were made to confirm the classic anatomical concepts by human dissection. At Padua, Pietro d'Abano attempted to reconcile the difference between adherents of the Greek and Arabist systems.

Despite popular prejudice, anatomical study continued. The social status of the surgeon was then considered inferior to that of the physician. Nevertheless, impressive advances were made by the surgeon Hugh of Lucca, who denounced some of Galen's teachings and practised simplified treatment of dislocations, fractures, and wounds. He studied the sublimation of arsenic and is credited with founding a school of surgery at Bologna in 1204. William of Saliceto and his pupil Lanfranchi were pioneers in surgical anatomy, Lanfranchi being credited as the first to differentiate between hypertrophy and breast cancer. Two dominant figures of French surgery during this period were Henri de Mondeville, surgeon to the king of France, who advocated aseptic treatment of wounds and the use of sutures, and Guy de Chauliac, known as the founder of French surgery, whose writings stressed the importance of anatomical dissection in training the surgeon, and who is credited with being the first to recognize the plague, which first appeared in Europe in 1348. He is also thought to have been the first to describe femoral hernia (1361), and he invented several surgical instruments. The study of medicine benefited greatly from the work of the ecclesiastic Archbishop Raimundo, who, about 1140, founded at Toledo, Spain, an institute for the translation of Arabic medical manuscripts, including the works of al-Razi and Avicenna, into Latin.