Old-Time Makers of Medicine — Ch. 2 Great Physicians in Early Christian Times, part 1/3

GREAT PHYSICIANS IN EARLY CHRISTIAN TIMES

What we know of the life of the Founder of Christianity and how much He did for the ailing poor would make us expect that the religion that He established would foster the care and the cure of suffering humanity.

As we have outlined in the Introduction, the first of the works of Christian service that was organized was the care of the sick.

At first a portion of the bishop's house was given over to the shelter of the ailing, and a special order of assistants to the clergy, the deaconesses, took care of them.

As Christians became more numerous, special hospitals were founded, and these became public institutions just as soon as freedom from persecution allowed the Christians the liberty to give overt expression to their feelings for the poor.

While hospitals of limited capacity for such special purposes as the sheltering of slaves or of soldiers and health establishments of various kinds for the wealthy had been erected before Christianity, this was the first time that anyone who was ill, no matter what the state of his pecuniary resources, could be sure to find shelter and care.

The expression of the Emperor Julian the Apostate, that admission to these hospitals was not limited to Christians, is the best possible evidence of the liberal charity that inspired them.

The ordinary passing student of the history of medicine or of hospital foundation and organization, can have no idea of the magnitude of some of these institutions, and their importance in the life of the time, unless it is especially pointed out.

St. Basil, about the middle of the fourth century, erected what was spoken of as "a city for the sick," before the gates of Caesarea.

Gregory of Nazianzen, his friend, says "that well built and furnished houses stood on both sides of streets symmetrically laid out about the church, and contained rooms for the sick, and the infirm of every variety were intrusted to the care of doctors and nurses."

There were separate buildings for strangers, for the poor, and for the ailing, and comfortable dwellings for the physicians and nurses.

An important portion of the institution was set apart for the care of lepers, which constituted a prominent feature in Basil's work in which he himself took a special interest.

Earlier in the same century Helena, the mother of the Emperor Constantine, had built similar institutions around Jerusalem, and during this same century nearly everywhere we have evidence of organization of hospitals and of care for the ailing poor.

Not only were hospitals erected, but arrangements were made for the care of the ailing poor in their own homes and for the visitation of them, and for the bringing to places adapted for their care and treatment of such as were found on the street, or neglected in their homes.

The Church evidently considered itself bound to care for men's bodies as well as their souls, and many of the expressions in common use among Christians referred to this fact.

Religion itself was spoken of as a medicine of the soul and the body.

Christianity was defined as the religion of healing.

The word salvation had a reference to both body and soul.

Baptism was spoken of as the bath of the soul, the holy Eucharist as the elixir of immortal life, and penance as the medicine of the soul.

It is not surprising to find, then, that Harnack has found among the texts that illustrate the history of early Christian literature this one: "In every community there shall be at least one widow appointed to assist women who are stricken with illness, and this widow shall be trained in her duties, neat and careful in her ways, shall not be self-seeking, must not indulge too freely in wine in order that she may be able to take up her duties at night as well as by day, and shall consider it her duty to keep the Church officials informed of all that seems necessary."

The saving of deformed and ailing infants or children whose parents did not care to have the trouble of rearing them, required the establishment by the Christians of another set of institutions, Foundling Asylums and Hospitals for Children.

Until the coming of Christianity parents were supposed to have the right of life and death over their children, and no one questioned it.

In every country in the world until the coming of Christianity this had always been the case.

Besides, there were institutions for the care of the old.

These are the classes of mankind who are especially liable to suffer from disease, and the opportunity to study human ailments in such institutions could scarcely help but provide facilities for clinical observation such as had not existed before.

Unfortunately the work of Christianity was hampered, first by the Roman persecutions, and then later by the invasion of the barbarians, who had to be educated and lifted up to a higher plane of civilization before they could be brought to appreciate the value of medical science, much less contribute to its development.

Harnack, whose writings in the higher criticism of Scripture have attracted so much attention in recent years, began his career in the study of Christian antiquities with a monograph on Medical Features of Early Christianity.

[1] He mentions altogether some sixteen physicians who reached distinction in the earliest days of Christianity.

Some of these were priests, some of them bishops, as Theodotos of Laodicea;

Eusebius, Bishop of Rome; Basilios, Bishop of Ancyra, and at least one, Hierakas, was the founder of a religious order.

The first Christian physicians came mainly from Syria, as might be expected, for here the old Greek medical traditions were active.

Among them must be enumerated Cosmas and Damian, physicians who were martyred in the persecution of Diocletian, and who have been chosen as the patrons of the medical profession.

Justinian erected a famous church to them.

It became the scene of pilgrimages.

Organizations of various kinds since, as the College of St. Come, and medical societies, have been named after them.

Some idea of the interest of ecclesiastics in medical affairs may be gathered from a letter of Bishop Theodoret of Cyrus, directed to the prefect of the city, when he was about to leave the place.

He wrote (see Puschmann, Vol. I.

, p. 494): "When I took up the Bishopric of Cyrus I made every effort to bring in from all sides the arts that would be useful to the people.

I succeeded in persuading skilled physicians to take up their residence here.

Among these is a very pious priest, Peter, who practises medicine with great skill, and is well known for his care for the people.

Now that I am about to leave the city, some of those who came at my invitation are preparing also to go.

Peter seems resolved to do this.

I appeal to your highness, therefore, in order to commend him to your special care.

He handles patients with great skill and brings about many cures."

Distinguished Christian writers and scholars, and the Fathers of the Church in the early centuries, evidently paid much attention to medicine.

Tertullian speaks of medical science as the sister of philosophy, and has many references to the medical doctrines discussed in his time.

Lactantius, in his work, "De Opificio Dei," has much to say with regard to the human body as representing the necessity for design in creation.

His teleological arguments have much more force now than they would have had for people generally twenty years ago.

We have come back to recognize the place of teleology.

Clement of Alexandria was an early Christian temperance advocate, who argued that the use of wine was only justified when it did good as a medicine.

The problems of embryology and of diseases of childhood interested him as they did many other of the early Christian writers.

AETIUS

The first great Christian physician whose works meant much for his own time, and whose writings have become a classic in medicine, was Aetius Amidenus, that is, Aetius of Amida, who was born in the town of that name in Mesopotamia, on the upper Tigris (now Diarbekir), and who flourished about the middle of the sixth century.

His medical studies, as he has told us himself, were made at Alexandria.

After having attracted attention by his medical learning and skill, he became physician to one of the emperors at Byzantium, very probably Justinian, (527-565).

He seems to have been succeeded in the special post that was created for him at court by Alexander of Tralles, the second of the great Christian physicians.

There is no doubt that Aetius was a Christian, for he mentions Christian mysteries, and appeals to the name of the Saviour and the martyrs.

He was evidently a man of wide reading, for he quotes from practically every important medical writer before his time.

Indeed, he is most valuable for the history of medicine, because he gives us some idea of the mode of treatment of various subjects by predecessors whose fame we know, but none of whose works have come to us.

His official career and the patronage of the Emperor, the breadth of his scholarship, and the thoroughly practical character of his teaching, show how medical science and medical art were being developed and encouraged at this time.

Aetius' work that is preserved for us is known in medical literature as his sixteen books on medical practice.

In most of the manuscript it is divided into four Tetrabibloi, or four book parts, each of which consists of four sections called Logoi in Greek, Sermones in Latin.

This work embraces all the departments of medicine, and has a considerable portion devoted to surgery, but most of the important operations and the chapters on fractures and dislocations are lacking.

Aetius himself announces that he had prepared a special work on surgery, but this is lost.

Doubtless the important chapters that we have noted as lacking in his work would be found in this.

He is much richer in pathology than most of the older writers, at least of the Christian era; for instance, Gurlt says that he treats this feature of the subject much more extensively even than Paulus AEginetus, but most of his work is devoted to therapeutics.

At times those who read these old books from certain modern standpoints are surprised to find such noteworthy differences between writers on medicine, who are separated sometimes only by a generation, and sometimes by not more than a century, in what regards the comparative amount of space given to pathology, etiology, and therapeutics.

Just exactly the same differences exist in our own day, however.

We all know that for those who want pathology and etiology the work of one of our great teachers is to be consulted, while for therapeutics it is better to go to someone else.

When we find such differences among the men of the olden time we are not so apt to look at them with sympathetic discrimination, as we do with regard to our contemporaries.

We may even set them down to ignorance rather than specialization of interest.

These differences depend on the attitude of mind of the physician, and are largely the result of his own personal equation.

They do not reflect in any way either on his judgment or on the special knowledge of his time, but are the index of his special receptivity and teaching habit.

Aetius' first and second books are taken up entirely with drugs.

The first book contains a list of drugs arranged according to the Greek alphabet.

In the third book other remedial measures, dietetic, manipulative, and even operative, are suggested.

In these are included venesection, the opening of an artery, cupping, leeches, and the like.

The fourth and fifth books take up hygiene, special dietetics, and general pathology.

In the sixth book what the Germans call special pathology and therapy begins with the diseases of the head.

The first chapter treats of hydrocephalus.

In this same book rabies is treated.

What Aetius has consists mainly of quotations from previous authors, many of whom he had evidently read with great care.

Concerning those "bitten by a rabid dog or those who fear water," Gurlt has quoted the following expression, with regard to which most people will be quite ready to agree with him when he says that it contains a great deal of truth, usually thought to be of much later origin: "When, therefore, any one has been bitten by a rabid dog the treatment of the wound must be undertaken just as soon as possible, even though the bite should be small and only superficial.

One thing is certain, that none of those who are not rightly treated escape the fatal effect.

The first thing to do is to make the wound larger, the mouth of it being divided and dilated by the scalpel.

Then every portion of it and the surrounding tissues must be firmly pressed upon with the definite purpose of causing a large efflux of blood from the part.

Then the wound should be deeply cauterized, etc." There are special chapters devoted to eye and ear diseases, and to various affections of the face.

Under this the question of tattooing and its removal comes in.

It is surprising how much Aetius has with regard to such nasal affections as polyps and ulcers and bleedings from the nose.

In this book, however, he treats only of their medicinal treatment.

What he has to say about affections of the teeth is so interesting that it deserves a paragraph or two by itself.

He had much to say with regard to the nervous supply of the mucous membranes of the gums, tongue, and mouth, and taught that the teeth received nerves through the small hole existing at the end of every root.

For children cutting teeth he advised the chewing of hard objects, and thought that the chewing of rather hard materials was good also for the teeth of adults.

For fistulas leading to the roots of teeth he suggests various irritant treatments, and, if they do not succeed, recommends the removal of the teeth.

He seems to have known much about affections of the gums and recognizes a benignant and malignant epulis.

He thought that one form of epulis was due to inflammation of a chronic character, and suggests that if remedies do not succeed it should be removed.

His work is of interest mainly as showing that even at this time, when the desire for information of this kind is usually supposed to have been in abeyance, physicians were gathering information about all sorts even of the minor ailments of mankind, gathering what had been written about them, commenting on it, adding their own observations, and in general trying to solve the problems as well as they could.

Aetius seems to have had a pretty good idea of diphtheria.

He speaks of it in connection with other throat manifestations under the heading of "crusty and pestilent ulcers of the tonsils."

He divides the anginas generally into four kinds.

The first consists of inflammation of the fauces with the classic symptoms, the second presents no inflammation of the mouth nor of the fauces, but is complicated by a sense of suffocation--apparently our croup.

The third consists of external and internal inflammation of the mouth and throat, extending towards the chin.

The fourth is an affection rather of the neck, due to an inflammation of the vertebrae--retropharyngeal abscess--that may be followed by luxation and is complicated by great difficulty of respiration.

All of these have as a common symptom difficulty of swallowing.

This is greater in one variety than in another at different times.

In certain affections even "drinks when taken are returned through the nose."

Hypertrophy of the tonsils--Aetius speaks of them as glands--is to be treated by various astringent remedies, but if these fail the structures should be excised.

His description of the excision is rather clear and detailed.

The patient should be put in a good full light, and the mouth should be held open and each gland pulled forward by a hook and excised.

The operator should be careful, however, only to excise those portions that are beyond the natural size, for if any of the natural substance of the gland is cut into, or if the incision is made beyond the projecting portion of the tonsil, there is grave danger of serious hemorrhage.

After excision a mixture of water and vinegar should be kept in the mouth for some time.

This should be administered cold in order to prevent the flow of blood.

After this very cold water should be taken.