Alexandrian School of Medicine.—The dispersion of Greek science and intellectual activity through the world by the conquests of Alexander and his successors led to the formation of more than one learned centre, in which medicine among other sciences was represented. Pergamum was early distinguished for its medical school; but in this as in other respects its reputation was ultimately effaced by the more brilliant fame of Alexandria. It is here that the real continuation and development of Hippocratic medicine can be traced.
In one department the Alexandrian school rapidly surpassed its Greek original—namely, in the study of anatomy. The dissection of the human body, of which some doubtful traces or hints only are found in Greek times, was assiduously carried out, being favoured or even suggested perhaps by the Egyptian custom of disembowelling and embalming the bodies of the dead. There is no doubt that the organs were also examined by opening the bodies of living persons—criminals condemned to death being given over to the anatomists for this purpose.
Two eminent names stand in the first rank as leaders of the two earliest schools of medicine which arose in Alexandria, Herophilus and Erasistratus.
Herophilus (335–280 B.C.) was a Greek of Chalcedon, a pupil of the schools both of Cos and of Cnidus. He was especially noted for his profound researches in anatomy (see i. 802), and in the knowledge and practice of medicine he appears to have been equally renowned. He professed himself a close adherent of Hippocrates, and adopted his theory of the humours. He also made extensive use of drugs and of bleeding. The reputation of Herophilus is attested by the fact that four considerable physicians wrote works about him and his writings, and he is further spoken of with the highest respect by Galen and Celsus. By the general voice of the medical world of antiquity he was placed only second to Hippocrates.
Erasistratus (d. 280 B.C.) was the contemporary and rival of Herophilus. Little is known of his life, except that he spent some time at the court of Seleucus Nicator at Antioch before coming to Alexandria, and that he cultivated anatomy late in life, after he had taken up his abode in the latter city. His numerous works are also almost entirely lost, fragments only being preserved by Galen and others. Erasistratus, instead of following Hippocrates as Herophilus did, depreciated him, and seems to have been rather aggressive and independent in his views. He appears to have leaned to mechanical explanations of the symptoms of disease, as was especially the case with inflammation, of which he gave the first rational, though necessarily inadequate, theory.
The two schools composed of the followers of Herophilus and Erasistratus respectively long divided between them the medical world of Alexandria. The names of many prominent members of both sects have been preserved, but it would be useless to repeat them. The Herophilists still reverenced the memory of Hippocrates, and wrote numerous commentaries on his works. They produced many eminent anatomists, but in the end seem to have become lost in theoretical subtleties, and to have maintained too high a standard of literary cultivation. The school of Erasistratus was less distinguished in anatomy than that of Herophilus, but paid more attention to the special symptoms of diseases, and employed a great variety of drugs. It was longer-lived than that of Herophilus, for it still numbered many adherents in the 2nd century after Christ, a century after the latter had become extinct.
The Erasistrateans paved the way for what was in some respects the most important school which Alexandria produced, that known as the empiric, which, though it recognized no master by name, may be considered to have been founded by Philinus of Cos (280 B.C.), a pupil of Herophilus; but Serapion, a great name in antiquity, and Glaucias of Tarentum, who traced the empirical doctrine back to the writings of Hippocrates, are also named among its founders. The most striking peculiarity of the empirics was that they rejected anatomy, regarding it as useless to inquire into the causes of things, and thus, as they contended, being the more minute in their observation of the actual phenomena of disease. They professed that their whole practice was based upon experience, to which word they gave a special meaning. Three sources, and three only, could experience draw from: observation, history (i.e. recorded observation), and judgment by analogy. These three bases of knowledge were known as the “tripod” of the empirics. It should not, however, be forgotten that the empirics read and industriously commented on the works of Hippocrates. They were extremely successful in practical matters, especially in surgery and in the use of drugs, and a large part of the routine knowledge of diseases and remedies which became traditional in the times of the Roman empire is believed to have been derived from them. In the 2nd century the school became closely connected with the philosophical sect of the Sceptics, whose leader, Sextus (200 B.C.), was an empirical physician. It lived and flourished far beyond this time, when transplanted to Rome, not less than in its native Alexandria, and appears to be recognizable even up to the beginning of the middle ages.
If we look at the work of the Alexandrian schools in medicine as a whole, we must admit that the progress made was great and permanent. The greatest service rendered to medicine was undoubtedly the systematic study of anatomy. It is clear that the knowledge of function (physiology) did not by any means keep pace with the knowledge of structure, and this was probably the reason why the important sect of the empirics were able entirely to dispense with anatomical knowledge. The doctrines of Hippocrates, though lightly thought of by the Erasistrateans, still were no doubt very widely accepted, but the practice of the Hippocratic school had been greatly improved in almost every department—surgery and obstetrics being probably those in which the Alexandrian practitioners could compare most favourably with those of modern times. We have now to trace the fortunes of this body of medical doctrine and practice when transplanted to Rome, and ultimately to the whole Roman world.
Roman Medicine.—The Romans cannot be said to have at any time originated or possessed an independent school of medicine. They had from early times a very complicated system of superstitious medicine, or religion, related to disease and the cure of disease, borrowed, as is thought, from the Etruscans; and, though the saying of Pliny that the Roman people got on for six hundred years without doctors was doubtless an exaggeration, and not, literally speaking, exact, it must be accepted for the broad truth which it contains. When a medical profession appears, it is, so far as we are able to trace it, as an importation from Greece.
The first Greek physician whose name is preserved as having migrated to Rome was Archagathus, who came over from the Peloponnesus in 218 B.C.; but there were probably others before him. When Greece was made a Roman province, the number of such physicians who sought their fortunes in Rome must have been very large. The bitter words of M. Porcius Cato, who disliked them as he did other representatives of Greek culture, are evidence of this. The most eminent of these earlier Greek physicians at Rome was Asclepiades, the friend of Cicero (born 124 B.C. at Prusa in Bithynia). He came to Rome as a young man, and soon became distinguished both for his medical skill and his oratorical power. He introduced a system which, so far as we know, was his own, though founded upon the Epicurean philosophical creed; on the practical side it conformed pretty closely to the Stoic rule of life, thus adapting itself to the leanings of the better stamp of Romans in the later times of the republic. According to Asclepiades all diseases depended upon alterations in the size, number, arrangement or movement of the “atoms,” of which, according to the doctrine of Epicurus, the body consisted. These atoms were united into passages (πόροι) through which the juices of the body were conveyed. This doctrine, of which the developments need not further be followed, was important chiefly in so far that it was perfectly distinct from, and opposed to, the humoral pathology of Hippocrates. In the treatment of disease Asclepiades attached most importance to diet, exercise, passive movements or frictions, and the external use of cold water—in short, to a modified athletic training. He rejected the vis medicatrix naturae, pointing out that nature in many cases not only did not help but marred the cure. His knowledge of disease and surgical skill were, as appears from the accounts given by Celsus and Caelius Aurelianus, very considerable. Asclepiades had many pupils who adhered more or less closely to his doctrines, but it was especially one of them, Themison, who gave permanence to the teachings of his master by framing out of them, with some modifications, a new system of medical doctrine, and founding on this basis a school which lasted for some centuries in successful rivalry with the Hippocratic tradition, which, as we have seen, was up to that time the prevailing influence in medicine.
This system was known as methodism, its adherents as the methodici or methodists. Its main principles were that it was useless to consider the causes of a disease, or even the organ affected by the disease, and that it was sufficient to know what was common to all diseases, viz. their common qualities (communitates, κοινότητες). Of these there were three possible forms—(1) relaxation, (2) contraction of the minute passages or πόροι, and (3) a mixed state, partly lax, partly constricted. The signs of these morbid states were to be found in the general constitution of the body, especially in the excretions. Besides this it was important only to consider whether the disease was acute or chronic, whether it was increasing, declining or stationary. Treatment of disease was directed not to any special organ, nor to producing the crises and critical discharges of the Hippocratic school, but to correcting the morbid common condition or “community,” relaxing the body if it was constricted, causing
