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

Alexander's first book of pathology and therapeutics treats of head and brain diseases.

For baldness, the first symptom of which is falling out of the hair, he counsels cutting the hair short, washing the scalp vigorously, and the rubbing in of sulphur ointments.

For grey hair he suggests certain hair dyes, as nutgalls, red wine, and so forth.

For dandruff, which he described as the excessive formation of small flake-like scales, he recommends rubbing with wine, with certain salves, and washing with salt water.

He gives a good deal of attention to diseases of the nervous system.

He has a rather interesting chapter on headache.

The affection occurs in connection with fevers, after excess in drinking, and as a consequence of injury to the skull.

Besides, it develops as a result of disturbances of the natural processes in the head, the stomach, the liver, and the spleen.

Headache, as the first symptom of inflammation of the brain, is often the forerunner of convulsions, delirium, and sudden death.

Chronic or recurrent headache occurs in connection with plethora, diseases of the brain, biliousness, digestive disturbances, insomnia, and continued worry.

Hemicrania has its origin in the brain, because of the presence of toxic materials, and specially their transformation into gaseous substances.

It also occurs in connection with abdominal affections.

This latter remark particularly is directed to the cases which occur in women.

For apoplexy and the consequent paralysis, Alexander considered venesection the best remedy.

Massage, rubbings, baths, and warm applications are recommended for the paralytic conditions.

He had evidently had considerable experience with epilepsy.

It develops either from injuries of the head or from disturbances of the stomach, or occasionally other parts of the body.

When it occurs in nursing infants, nourishment is the best remedy, and he gives detailed directions for the selection of a wet nurse, and very careful directions as to her mode of life.

He emphasizes very much the necessity for careful attention to the gastro-intestinal tract in many cases of epilepsy.

Planned diet and regular bowels are very helpful.

He rejects treatment of the condition by surgery of the head, either by trephining or by incisions, or cauterization.

Regular exercise, baths, sexual abstinence are the foundation of any successful treatment.

It is probable that we have returned to Alexander's treatment of epilepsy much more nearly than is generally thought.

There are those who still think that remedies of various kinds do good, but in the large epileptic colonies regular exercise, bland diet, regulation of the bowels, and avoidance of excesses of all kinds, with occupation of mind, constitute the mainstay of their treatment.

Alexander has much to say with regard to phrenitis, a febrile condition complicated by delirium, which, following Galen, he considers an affection of the brain.

It is evidently the brain fever of the generations preceding the last, an important element of which was made up of the infectious meningitises.

Alexander suggests its treatment by opiates after preliminary venesection, rubbings, lukewarm baths, and stimulating drinks.

Every disturbance of the patient must be avoided, and visitors must be forbidden.

The patient's room should rather be light than dark.

His teaching crops up constantly in the centuries after his time, until the end of the nineteenth century, and while we now understand the causes of the condition better, we can do little more for it than he did.

Alexander divided mental diseases into two, the maniacal and melancholic.

Mania was, however, really a further development of melancholia, and represented a high grade of insanity.

Under melancholy he groups not only what we denominate by that term, but also all depressed conditions, and the paranoias, as also many cases of imbecility.

The cause of mental diseases was to be found in the blood.

He counselled the use of venesection, of laxatives and purgatives, of baths and stimulant remedies.

He insisted very much, however, on mental influence in the disease, on change of place and air, visits to the theatre, and every possible form of mental diversion, as among the best remedial measures.

After his book on diseases of the head, his most important section is on diseases of the respiratory system.

In this he treats first of angina, and recommends as gargles at the beginning light astringents; later stronger astringents, as alum and soda dissolved in warm water, should be employed.

Warm compresses, venesection from the sublingual veins, and from the jugular, and purgatives in severe cases, are the further remedies.

He treats of cough as a symptom due to hot or cold, dry or wet dyscrasias.

Opium preparations carefully used are the best remedies.

The breathing in of steam impregnated with various ethereal resins, was also recommended.

He gives a rather interestingly modern treatment of consumption.

He recommends an abundance of milk with a strong nutritious diet, as digestible as possible.

A good auxiliary to this treatment was change of air, a sea voyage, and a stay at a watering-place.

Asses' and mares' milk are much better for these patients than cows' and goats' milk.

There is not enough difference in the composition of these various milks to make their special consumption of import, but it is probable that the suggestive influence of the taking of an unusual milk had a very favorable effect upon patients, and this effect was renewed frequently, so that much good was ultimately accomplished.

For hemoptysis, especially when it was acute and due as Alexander thought to the rupture of a blood vessel in the lungs, he recommended the opening of a vein at the elbow or the ankle--in order to divert the blood from the place of rupture to the healthy parts of the circulation.

He insisted that the patients must rest, that they should take acid and astringent drinks, that cold compresses should be placed upon the chest (our ice bags), and that they should take only a liquid diet at most lukewarm, or, better, if agreeable to them, cold.

When the bleeding stopped, a milk cure was very useful for the restoration of these patients to strength.

It is not surprising, then, to find that Alexander suggests a thoroughly rational treatment for pleurisy.

He recognizes this as an inflammation of the membrane covering the ribs, and its symptoms are severe pain, disturbance of breathing, and coughing.

In certain cases there is severe fever, and Alexander knows of purulent pleurisy, and the fact that when pus is present the side on which it is is warmer than the other.

Pleurisy can be, he says, rather easily confounded with certain liver affections, but there is a peculiar hardness of the pulse characteristic of pleurisy, and there is no expectoration in liver cases, though it also may be absent in many cases of pleurisy.

Sufferers from liver disease usually have a paler color than pleuritics.

His treatment consists in venesection, purgatives, and, when pus is formed, local incision.

He recommends the laying on of sponges dipped in warm water, and the internal use of honey lemonade.

Opium should not be used unless the patient suffers from sleeplessness.

Some of the general principles of therapeutics that Alexander lays down are very interesting, even from our modern standpoint.

Trust should not be placed in any single method of treatment.

Every available means of bringing relief to the patient should be tried.

"The duty of the physician is to cool what is hot, to warm what is cold, to dry what is moist, and to moisten what is dry.

He should look upon the patient as a besieged city, and try to rescue him with every means that art and science places at his command.

The physician should be an inventor, and think out new ways and means by which the cure of the patient's affection and the relief of his symptoms may be brought about."

The most important factor in his therapeutics is diet.

Watering-places and various forms of mineral waters, as well as warm baths and sea baths, are constantly recommended by him.

He took strong ground against the use of many drugs, and the rage for operating.

The prophylaxis of disease is in Alexander's opinion the important part of the physician's duty.

His treatment of fever shows the application of his principle: cold baths, cold compresses, and a cooling diet, were his favorite remedies.

He encouraged diaphoresis nearly always, and gave wine and stimulating drugs only when the patient was very weak.

He differentiates two kinds of quartan fever.

One of these he attributes to an affection of the spleen, because he had noticed that the spleen was enlarged during it, and that, after purgation, the enlarged spleen decreased in size.

Alexander was a strong opponent of drastic remedies of all kinds.

He did not believe in strong purgatives, nor in profuse and sudden blood-lettings.

He opposed arteriotomy for this reason, and refused to employ extensive cauterization.

His diagnosis is thorough and careful.

He insisted particularly on inspection and palpation of the whole body;

on careful examination of the urine, of the feces, and the sputum; on study of the pulse and the breathing.

He thought that a great deal might be learned from the patient's history.

The general constitution is also of importance.

His therapeutics is, above all, individual.

Remedies must be administered with careful reference to the constitution, the age, the sex, and the condition of the patient's strength.

Special attention must always be paid to nature's efforts to cure, and these must be encouraged as far as possible.

Alexander had no sympathy at all with the idea that remedies must work against nature.

His position in this matter places him among the dozen men whose name and writings have given them an enduring place in the favor of the profession at all times, when we were not being carried away by some therapeutic fad or imagining that some new theory solved the whole problem of the causation and cure of disease.

Gurlt, in his "History of Surgery," has abstracted from Alexander particularly certain phases of what the Germans call external pathology and therapeutics.

For instance, Alexander's treatment of troubles connected with the ear is very interesting.

Gurlt declares that this chapter alone provides striking evidence for Alexander's practical experience and power of observation, as well as for his knowledge of the literature of medicine.

He considers that only a short abstract is needed to show that.

For water that has found its way into the external ear, Alexander suggests a mode of treatment that is still popularly used.

The patient should stand upon the leg corresponding to the side on which there is water in his ear, and then, with head leaning to that side, should hop or kick out with the other leg.

The water may be drawn out by means of suction through a reed.

In order to get foreign bodies out of the external auditory canal, an ear spoon or other small instrument should be wrapped in wool and dipped in turpentine, or some other sticky material.

Occasionally he has seen sneezing, especially if the mouth and nose are covered with a cloth, and the head leant toward the affected side, bring about a dislodgment of the foreign body.

If these means do not succeed, gentle injections of warm oil or washing out of the canal with honey water should be tried.

Foreign bodies may also be removed by means of suction.

Insects or worms that find their way into the ear may be killed by injections of acid and oil, or other substances.

Gurlt also calls attention to Alexander's careful differentiation of certain very dangerous forms of inflammation of the throat from others which are rather readily treated.

He says, "Inflammation of the throat may, under certain circumstances, belong to the severest diseases.

The patients succumb to it as a consequence of suffocation, just as if they were choked or hanged.

For this reason, perhaps, the affection bears the name synanche, which means constriction."

He then points out various other forms of inflammation of the throat, acute and chronic, suggesting various names and the differential diagnostic signs.

One of the most surprising chapters of Alexander's knowledge of pathology and therapeutics is to be found in his treatment of the subject of intestinal worms, which is contained in a letter sent by him to his friend, Theodore, whose child was suffering from them.

He describes the _oxyuris vermicularis_ with knowledge manifestly derived from personal observation.

He dwells on the itching in the region of the anus, caused by the _oxyuris_, and the fact that they probably find their way into the upper part of the digestive tract because of the soiling of the hands.

He knew that the tapeworms often reached great length,--he has seen one over sixteen feet long,--and also that they had a life cycle, so that they existed in two different forms.

He describes the roundworms as existing in the intestines, but occasionally wandering into the stomach to be vomited.

His vermifuges were the flowers and the seeds of the pomegranate, the seeds of the heliotrope, castor-oil, and certain herbs that are still used, by country people, at least, as worm medicines.

For roundworms he recommended especially a decoction of _artemisia maritima_, coriander seeds, and decoctions of thyme.

Our return to thymol for intestinal parasites is interesting.

For the _oxyuris_ he prescribed clysters of ethereal oils.

We have not advanced much in our treatment of intestinal worms in the fifteen hundred years since Alexander's time.

PAUL OF AEGINA

Another extremely important writer in these early medieval times, whose opportunities for study in medicine and for the practice of it, were afforded him by Christian schools and Christian hospitals, was Paul of AEgina.

He was born on the island of AEgina, hence the name AEginetus, by which he is commonly known.

There used to be considerable doubt as to just when Paul lived, and dates for his career were placed as widely apart as the fifth and the seventh centuries.

We know that he was educated at the University of Alexandria.

As that institution was broken up at the time of the capture of the city by the Arabs, he cannot have been there later than during the first half of the seventh century.

An Arabian writer, Abul Farag, in "The Story of the Reign of the Emperor Heraclius," who died 641, says that "among the celebrated physicians who flourished at this time was Paulus AEginetus."

In his works Paul quotes from Alexander of Tralles, so that there seems to be no doubt now that his life must be placed in the seventh century.

The most important portion of Paul's work for the modern time is contained in his sixth book on surgery.

In this his personal observations are especially accumulated.

Gurlt has reviewed it at considerable length, devoting altogether nearly thirty pages to it, and it well deserves this lengthy abstract.

Paul quotes a great many of the writers on surgery before his time, and then adds the results of his own observation and experience.

In it one finds careful detailed descriptions of many operations that are usually supposed to be modern.

Very probably the description quoted by Gurlt of the method of treating fishbones that have become caught in the throat will give the best idea of how thoroughly practical Paul is in his directions.

He says: "It will often happen in eating that fishbones or other objects may be swallowed and get caught in some part of the throat.

If they can be seen they should be removed with the forceps designed for that purpose.

Where they are deeper, some recommend that the patient should swallow large mouthfuls of bread or other such food.

Others recommend that a clean soft sponge of small circumference to which a string is attached be swallowed, and then drawn out by means of the string.

This should be repeated until the bone or other object gets caught in the sponge and is drawn out.

If the patient is seen immediately after eating, and the swallowed object is not visible, vomiting should be brought on by means of a finger in the throat or irritation with the feather, and then not infrequently the swallowed object will be brought up with the vomit."

In the chapter immediately following this, XXXIII, there is a description of the method of opening the larynx or the trachea, with the indications for this operation.

The surgeon will know that he has opened the trachea when the air streams out of the wound with some force, and the voice is lost.

As soon as the danger of suffocation is over, the edges of the wound should be freshened and the skin surfaces brought together with sutures.

Only the skin without the cartilage should be sutured, and general treatment for encouraging union should be employed.

If the wound fails to heal immediately, a treatment calculated to encourage granulations should be undertaken.

This same method of treatment will be of service whenever we happen to have a patient who, in order to commit suicide, has cut his throat.

Paul's exact term is, perhaps, best translated by the expression, slashed his larynx.

One of the features of Paul's "Treatise on Surgery" is his description of a radical operation for hernia.

He describes scrotal hernia under the name enterocele, and says that it is due either to a tearing or a stretching of the peritoneum.

It may be the consequence either of injury or of violent efforts made during crying.

When the scrotum contains only omentum, he calls the condition epiplocele; when it also contains intestine, an epiplo-enterocele.

Hernia that does not descend into the scrotum he calls bubonocele.

For operation the patient should be placed on the back, and, the skin of the inguinal region being stretched by an assistant, an oblique incision in the direction in which the blood vessels run should be made.

The incision should then be stretched by means of retractors, until the contents of the sac can be lifted out.

All adhesions should be broken up and the fat be removed, and the hernia replaced within the abdomen.

Care should be taken that no loop of intestine is allowed to remain.

Then a large needle with double thread made of ten strands should be run through the middle of the incision in the end of the peritoneum, and tied firmly in cross sutures.

The outer structures should be brought together with a second ligature, and the lower end of the incision should have a wick placed in it for drainage, and the site of operation should be covered with an oil bandage.

The Arab writer, Abul Farag, to whose references we owe the definite placing of the time when Paul lived, said that "he had special experience in women's diseases, and had devoted himself to them with great industry and success.

The midwives of the time were accustomed to go to him and ask his counsel with regard to accidents that happen during and after parturition.

He willingly imparted his information, and told them what they should do.

For this reason he came to be known as the Obstetrician."

Perhaps the term should be translated the man-midwife, for it was rather unusual for men to have much knowledge of this subject.

His knowledge of the phenomena of menstruation was as wide and definite.

He knew a great deal of how to treat its disturbances.

He seems to have been the first one to suggest that in metrorrhagia, with severe hemorrhage from the uterus, the bleeding might be stopped by putting ligatures around the limbs.

This same method has been suggested for severe hemorrhage from the lungs as well as from the uterus in our own time.

In hysteria he also suggested ligature of the limbs, and it is easy to understand that this might be a very strongly suggestive treatment for the severer forms of hysteria.

It is possible, too, that the modification of the circulation to the nervous system induced by the shutting off of the circulation in large areas of the body might very well have a favorable physical effect in this affection.

Paul's description of the use of the speculum is as complete as that in any modern text-book of gynaecology.

FURTHER CHRISTIAN PHYSICIANS

Another distinguished Christian medical scientist was Theophilus Protosbatharius, who belonged to the court of the Greek Emperor Heraclius, in the seventh century.

He seems to have had a life very full of interest and surprisingly varied duties.

He was a bishop, and, at the same time, commander of the imperial bodyguard, and the author of a little work on the fabric of the human body.

The most surprising chapter in the history of the book is that for some two centuries, in quite modern times, it was used as a text-book of anatomy at the University of Paris.

It was printed in a number of editions early in the history of printing, at least one very probably before 1500, and several later.

There are very interesting phases of medicine delightfully surprising in their modernity to be found here and there in many of these early Christian writers on medicine.

For instance, in a compend of medicine written by one Leo, who, under the Emperor Theophilus, seems to have been a prominent physician of Byzantium (the compend was written for a young physician just beginning practice), we find the following classification of hydrops or abdominal dilatation: "There are three kinds; the first is ascites, due to the presence of watery fluid, for which we do paracentesis; second, tympany, when the abdomen is swollen from the presence of air or gas.

This may be differentiated by percussion of the belly.

When air is present the sound given forth is like that of a drum, while in the first form ascites the sound is like that from a sack [the word used is the same as for a wine sack]; the third form is called anasarca, when the whole body swells."

It has often been the subject of misunderstanding as to why medicine should have developed among the Latin Christian nations so much more slowly than among the Arabs during the early Middle Ages.

Anyone who knows the conditions in which Christianity came into existence in Italy will not be surprised at that.

The Arabs in the East were in contact with Greek thought, and that is eminently prolific and inspiring.

At the most, the Christians in Italy got their inspiration at second hand through the Romans.

The Romans themselves, in spite of intimate contact with Greek physicians, never made any important contributions to medical science, nor to science of any kind.

Their successors, the Christians of Rome and Italy, then could scarcely be expected to do better, hampered especially, as they were, by the trying social conditions created by the invasion of the barbarians from the North.

Whenever the Christians were in contact with Greek thought and Greek medicine, above all, as at Alexandria, or in certain of the cities of the near East, we have distinguished contributions from them.

ARABIAN CHRISTIAN PHYSICIANS

That this is not a partial view suggested by the desire to make out a better case for Christianity in its relation to science will be very well understood, besides, from the fact that a number of the original physicians of Arab stock who attracted attention during the first period of Arabian medicine, that is, during the eighth and ninth centuries, were Christians.

There are a series of physicians belonging to the Christian family Bachtischua, a name which is derived from Bocht Jesu, that is, servant of Jesus, who, from the middle of the eighth to the middle of the eleventh century, acquired great fame.

The first of them, George (Dschordschis), after acquiring fame elsewhere, was called to Bagdad by the Caliph El-Mansur, where, because of his medical skill, he reached the highest honors.

His son became the body-physician of Harun al-Raschid.

In the third generation Gabriel (Dschibril) acquired fame and did much, as had his father and grandfather, for the medicine of the time, by translations of the Greek physicians into Arabian.

These men may well be said to have introduced Greek medicine to the Mohammedans.

It was their teaching that aroused Moslem scholars from the apathy that had characterized the attitude of the Arabian people toward science at the beginning of Mohammedanism.

As time went on, other great Christian medical teachers distinguished themselves among the Arabs.

Of these the most prominent was Messui the elder, who is also known as Janus Damascenus.

Both he and his father practised medicine with great success in Bagdad, and his son became the body-physician to Harun al-Raschid either after or in conjunction with Gabriel Bachtischua.

Like his colleague or predecessor in official position, he, too, made translations from the Greek into Arabic.

Another distinguished Arabian Christian physician was Serapion the elder.

He was born in Damascus, and flourished about the middle of the ninth century.

He wrote a book on medicine called the "Aggregator," or "Breviarium," or "Practica Medicinae," which appeared in many printed editions within the century after the invention of printing.

During the ninth century, also, we have an account of Honein Ben Ischak, who is known in the West as Johannitius.

After travelling much, especially in Greece and Persia, he settled in Bagdad, and, under the patronage of the Caliph Mamum, made many translations.

He translated most of the old Greek medical writers, and also certain of the Greek philosophic and mathematical works.

The accuracy of his translations became a proverb.

His compendium of Galen was the text-book of medicine in the West for many centuries.

It was known as the "Isagoge in Artem Parvam Galeni."

His son, Ishac Ben Honein, and his nephew, Hobeisch, were also famous as medical practitioners and translators.

Still another of these Arabian Christians, who acquired a reputation as writers in medicine, was Alkindus.

He wrote with regard to nearly everything, however, and so came to be called the philosopher.

He is said altogether to have written and translated about two hundred works, of which twenty-two treat of medicine.

He was a contemporary of Honein Ben Ischak in the ninth century.

Another of the great ninth-century Christian physicians and translators from the Greek was Kostaben Luka.

He was of Greek origin, but lived in Armenia and made translations from Greek into Arabic.

Nearly all of these men took not alone medical science, but the whole round of physical science, for their special subject.

A typical example in the ninth century was Abuhassan Ben Korra, many of whose family during succeeding generations attracted attention as scholars.

He became the astronomer and physician of the Caliph Motadhid.

His translations in medical literature were mainly excerpts from Hippocrates and Galen meant for popular use.

These Christian translators, thoroughly scientific as far as their times permitted them to be, were wonderfully industrious in their work as translators, great teachers in every sense of the word, and they are the men who formed the traditions on which the greater Arabian physicians from Rhazes onward were educated.

It would be easy to think that these men, occupied so much with translations, and intent on the re-introduction of Greek medicine, might have depended very little on their own observations, and been very impractical.

All that is needed to counteract any such false impression, however, is to know something definite about their books.

Gurlt, in his "History of Surgery," has some quotations from Serapion the elder, who is often quoted by Rhazes.

In the treatment of hemorrhoids Serapion advises ligature and insists that they must be tied with a silk thread or with some other strong thread, and then relief will come.

He says some people burn them _medicinis acutis_ (touching with acids, as some do even yet), and some incise them with a knife.

He prefers the ligature, however.

He calmly discusses the removal of stones from the kidney by incision of the pelvis of the kidney through an opening in the loin.

He considers the operation very dangerous, however, but seems to think the removal of a stone from the bladder a rather simple procedure.

His description of the technique of the use of a catheter and of a stylet with it, and apparently also of a guide for it in difficult cases, is extremely interesting.

He suggests the opening of the bladder in the median line, midway between the scrotum and the anus, and the placing of a canula therein, so as to permit drainage until healing occurs.

Even this brief review of the careers and the writings of the physicians of early Christian times shows how well the tradition of old Greek medicine was being carried on.

There was much to hamper the cultivation of science in the disturbances of the time, the gradual breaking up of the Roman Empire, and the replacement of the peoples of southern Europe by the northern nations, who had come in, yet in spite of all this, medical tradition was well preserved.

The most prominent of the conservators were themselves men whose opinions on problems of practical medicine were often of value, and whose powers of observation frequently cannot but be admired.

There is absolutely no trace of anything like opposition to the development of medical science or medical practice, but, on the contrary, everywhere among political and ecclesiastical authorities, we find encouragement and patronage.

The very fact that, in the storm and stress of the succeeding centuries, manuscript copies of the writings of the physicians of this time were preserved for us in spite of the many vicissitudes to which they were subjected from fire, and war, and accidents of various kinds for hundreds of years, until the coming of printing, shows in what estimation they were held.

During this time they owed their preservation to churchmen, for the libraries and the copying-rooms were all under ecclesiastical control.

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