Age of Foundation (continued).—Anatomic Period: Influence of the Alexandrian Library. Herophilus and Erasistratus. AretÆus, f B.C. 170. Celsus, A.D. 1-65 (?). Galen.—Empiricism: Asclepiades B.C. 100 (?).—Methodism: Theinison, B.C. 50 (?).—Eclecticism. Age of Transition, A.D. 201-1400.—Greek Period: Oribasius, 326-403. Ætius, 502-575. Alexander of Tralles, 525-605. Paul us Ægineta, 625-690.

Fourth, or Anatomic, Period.—As already seen, Alexander the Great and his successors collected the intellectual and natural riches of the universe, as they knew them, and placed them at the disposal of studious men to benefit humanity; their complete value has not yet been exhausted, and never can be. This undertaking was carried out under conditions that made it one of extreme difficulty. Manuscripts were then rare and most costly; but few copies of a given work were in existence, often only one, and these were held almost priceless. Under these circumstances the establishment of a public library and of a museum was an act of philanthropy and liberality simply beyond eulogy, and did more to immortalize the founder of the collection than all his victories and other achievements.

This appears to have also occurred to two of Alexander's lieutenants—one Eumenes, Governor of Pergamos, and the other, Ptolemy, Governor of Egypt. After the death of the conqueror his generals shook of all dependence upon the central government, and endeavored to centralize their own authority. But these two were the only ones among so many leaders who did not devote all their attention to armies and invasion, but interested themselves in commerce and arts. So active were they in the enterprise that Eumenes had gathered two hundred thousand volumes for the library at Pergamos, and Ptolemy six to seven hundred thousand for that of Alexandria. The latter was divided into two parts, the greater and the lesser, the latter of which was kept in the temple of Serapis, hence known as the Serapium. These notable efforts to found enormous collections first excited praiseworthy rivalry among contemporaries and rulers, which, however, degenerated into contemptible jealousy, so that some of the rulers of Alexandria even went so far as to interdict the exportation of papyrus, in order to prevent the making of copies for the library of Pergamos. But the effect was unexpected, since it led to the invention of the paper of Pergamos, otherwise called parchment, which completely displaced the bark from which papyri were made. Be this as it was, the collection at Alexandria had a much more marked influence on the medical study of the future than that of Pergamos, and calls for our particular notice. About it sprang up first a collection of learned men, and then the inevitable result—a school of learning. It was Ptolemy Soter who called around him the most renowned men of his day. He provided them with homes adjoining the library, endowed them with salaries, and charged them with the classification and collation of manuscripts, or with the giving of instruction by lectures and discussions. Ptolemy himself sometimes took part in these feasts of reason, which became still more frequent and formal under his son Ptolemy Philadelphia. These were called the Feasts of the Muses and of Apollo,—i.e., ludi musarum,—and, consequently, the place where they were held came to be termed the "museum." Often the subjects for discussion were announced in advance, and those who gained the most applause received rewards in accordance with the merits of their work. Among those who enjoyed these advantages under the reign of these two Ptolemies are prominently named two physicians, Herophilus and Erasistratus, the latter said to be the grandson of Aristotle. It was under this Philadelphus that the Hebrew wise men translated into Greek the Holy Scriptures, which translation has since been called the Septuagint—so called because it is supposed to have been translated by the members of the Sanhedrim, which was composed of about seventy men, or because, according to another legend, it was translated by seventy-two men in seventy-two hours. These savants of ancient Egypt, thus supported by the dynasty of the Lagides, gave the first place to the science of medicine. As regards this study, the school of Alexandria eclipsed almost from its origin the ancient schools of Cos and Pergamos, and during its existence was the leading institution of its kind in the world. At the time of Galen it was sufficient to have studied there, and even to have resided a short time in Alexandria, to obtain the reputation of being a physician. Nearly all the scholars of these five centuries had received instruction in this school. The principal reason for its eminence in medical instruction was the practice of dissection of human bodies, which, under the Ptolemies, was allowed and recommended, and by which the science of medicine received an extraordinary impulse. Although the prejudice of Egyptians was very strong against those who touched a dead body, the Ptolemies themselves are said to have participated in this kind of anatomical study, thus destroying by their example the odium previously attached to dissection. Strange to say, however, the practice of dissection fell into disuse toward the end of this Anatomic Period, and scholars preferred to indulge in subtle metaphysical discussions rather than study human tissues. But the principal reason for giving up this practice was the Roman domination of Egypt, the Romans, inconsistently, being perfectly willing to see any amount of bloodshed in the arena, and all sorts of inhumanities practiced upon living human beings, but holding that contact with a corpse was profanation; so that not a single anatomist of reputation had his origin in ancient Rome. "If on any occasion," says Renouard, "a foreign physician attached to the king or general desired to avail himself of the occasions that were afforded to examine the structures of the internal parts of the human body, he was obliged to conceal and carry off during the night some body abandoned to the birds of prey." To complete the melancholy termination of the Anatomic Period, the labors of the writers of those days were all lost by the burning of the great library by Julius CÆsar, which was the beginning of the chain of disasters with which Egypt was accursed under Roman dominion. Although Mark Antony, induced thereto by the endearments and solicitations of Cleopatra, transported the library of Pergamos to Alexandria, even this was unavailing to restore the position of the school, since the atrocious and imbecile Caracalla took from the pensioners of the museum their privileges of common residence and every other advantage, and suppressed all public exhibitions and discussions. I can mention but few of the names most eminent during this Anatomic Period, and but a short account of the life and work of each.

The first deserving of mention was Herophilus, who was born in Chalcedon about the end of the fourth century before Christ, and supposed to be the first to undertake systematic dissection of the human body. The so-called Torcular Herophili, or common meeting-place of the sinuses at the occiput, named after him, gives evidence of his influence upon the study of anatomy. He wrote on all departments of medical science, concerning the eyes, the pulse, midwifery, etc., as well as numerous commentaries upon the Hippocratic writings,—describing the membranes of the brain and its vessels, the choroid plexus, the ventricles of the brain, the tunics of the eye, the intestinal canal, and certain portions of the vascular system. He alluded to the thoracic duct without knowing its purpose, and gave a more accurate description of the genitalia than any previous writer. Strange to say, but little is known of his later life, and of his death absolutely nothing.

Erasistratus was the son of Cleombrotus, a student of Metrodorus, and lived for some time at the court of Seleucus Nicator, whose son, Antiochus, he healed of a secret ailment, which happened to be a desperate love-affair with his mother-in-law, Stratonice. He wrote extensively on fevers, hygiene, paralyses, therapeutics, and many other subjects; regarded most diseases as due to overindulgence in food, which is not digested, and consequently putrefies. Plethora was for him the prevailing disease, against which he employed not only venesection, but fasting, and bandaging of the extremities. He was a diligent student of anatomy, and carefully described the brain in many of its grosser features, regarding it as the seat of the soul and the centre of the nerves. He also described more exactly than his predecessors the valves of the heart, which organ he regarded as the origin of veins and arteries. He discovered the lymph-vessels, and maintained, against Plato and others, that the epiglottis prevents the entrance of fluids into the lungs, but he supposed digestion to be produced by mechanical trituration in the stomach, and preferred gymnastics, exercise, diet, and baths to drugs or other therapeutic measures. He died about 280 B.C.

AretÆus, who died about 170 B.C., was one of the most brilliant lights of antiquity previous to the Christian era, but, in spite of all this, of his life very little is known. He came from Cappadocia about the end of the reign of Nero, and lived in Alexandria. That he lived in Alexandria is apparent from his numerous references to its location, to the habits and therapeutics of the Egyptians, and to the geography of the country. Furthermore, references to its diseases abound in his writings, so that it is made to appear that he had had the best advantages there, although he must have traveled extensively. But a small portion of his writings remain, and these consist, for the most part, of compendiums of pathology and therapeutics. He described disease, not in anatomical order from head to foot, but under the classification of acute and chronic. With the exception of Hippocrates, he has shown himself the most free from vague, arbitrary speculation, and from the dogmatism of the schools of any writer of antiquity. He, more than any other up to his time, endeavored to found pathology upon a sound anatomical basis. For every picture of disease he endeavored to provide a suitable anatomical accompaniment. This appears particularly, for instance, in his description of intestinal ulcers due to dysentery, or the paralyses following brain affections, or his description of pharyngeal diphtherias, of which he gave a good account under the name of Syriac or Egyptian ulcers. Pulmonary tuberculosis, tetanus, and anal fistula are amply mentioned in his writings.

His therapeutics were simple and rational; he laid great stress upon dietetic treatment. His surgical writings appear to have all been lost, but there is every reason to think that he brought to bear upon external medicine the same good sense which he applied to internal affections.

Cornelius Celsus, the most celebrated author for a number of centuries, was born in Rome about the time of Christ. Brilliant as he was, he exerted a wide-spread influence for centuries. The exact date of his death is unknown. He was a contemporary of the greatest philosophers, poets, and savants of Rome during its most brilliant period. He studied rhetoric, philosophy, the art of war, economics, and medicine—he was, in fact, a walking encyclopaedia of the knowledge of his day; but it is in medicine that he shows to best advantage, and in his capacity as a physician he was and is best known. The direction in which Celsus appears to least advantage is in failure of power of direct observation, and in yielding unquestioning obedience to the views and dicta of Hippocrates, for whom he possessed the greatest reverence, not being able to brook any serious contradiction or opposition to his opinions. In this reverence for Hippocratic authority he was followed by many less prominent successors, the consequence being a failure to train men as observers, the endeavor being to make them simply storehouses of information derived from Hippocratic writings. As a result, Celsus wrote but little, or else his writings are lost. He contented himself mostly with a mere commentary upon the writings which he so highly revered. But little of his writings remain, and these pertain mostly to the therapeutics of curable disease, dietetic, pharmaceutical, and surgical. Although he exercised great authority during his period, he was later totally supplanted by Galen, and his views are seldom mentioned in the writings of those subsequent to this great physician. His death must have taken place during the first century after Christ.

Of all the students of Hippocratic dogmatism, the most earnest, skillful, and learned was Claudius Galen, a native of Pergamos, a place already celebrated for its temple dedicated to Æsculapius, for its school of medicine, and for a library which had been removed to Alexandria. He was placed by his father under the most distinguished teachers in all of the sciences, and even as a young man showed extraordinary progress, and became early a disputant with the most erudite in grammar, history, mathematics, and philosophy. He has related how in two different dreams he was urged by Apollo to study medicine. He traveled widely for instruction, and remained some time in Alexandria.

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On his return to his own country he was charged by its ruler to dress the wounded in the great circus, which furnished him opportunity for displaying all his anatomical knowledge and surgical skill. Not remaining long at home, he went to Rome, where his renown had preceded him, and where, by his brilliant elocution, his accurate logic, and his profound erudition, as well as his versatility and practical skill, he at once took the highest place. But here his rapid success, his vanity, his disdain for his colleagues, and his useless boasting, as well as his natural jealousy, gained him the enmity of nearly all his contemporaries, and his stay at Rome was thereby made very disagreeable. In his work on Prenotions he accuses his colleagues of base jealousy and stupid ignorance, lavishes upon them such epithets as "thieves" and "poisoners," and closes by saying that after having unmasked them he would leave them to their evil designs by abandoning the great city to seek a home in a smaller place, where the surroundings would be to him more congenial. This threat he carried out, but soon returned to Rome upon the invitation of the Emperors Marcus Aurelius and Lucius Yerus, whose confidence, as well as that of their successors, he enjoyed. He is supposed to have lived to the age of seventy-one, and to have died about 200 A.D. Galen strongly denied being attached to any of the sects of his day, and regarded as slaves those who took the title of Hippocratists, Praxagoreans, Herophilists, and so on. Nevertheless, his predilection in favor of the Hippocratic writings is well marked, for lie explains, comments upon, and expands them at length, refutes the objections of their adversaries, and gives them the highest place. He says: "No one before me has given the true method of treating disease; Hippocrates, I confess, lias heretofore shown the path, but as he was the first to enter it he was not able to go as far as he wished.... He has not made all the necessary distinctions, and is often obscure, as is usually the case with ancients when they attempt to be concise. He says very little of complicated diseases; in a word, he has only sketched what another was to complete; he has opened the path, but has left it for a successor to enlarge and make it plain." This implies how he regarded himself as the successor of Hippocrates, and how littleweight he attached to the labors of others. He held that there were three sorts of principles in man: spirits, humors, and solids. Throughout his metaphysical speculations Galen reproduces and amplifies the Hippocratic dogmatism. Between perfect health and disease there were, he thought, eight kinds of temperaments or imperfect mixtures compatible with the exercise of the functions of life. With Plato and Aristotle, he thought the human soul to be composed of three faculties or parts: the vegetative, residing in the liver; the irascible, having its seat in the heart; and the rational, which resides in the brain. He divided diseases of the solids of the body into what he called distempers; he distinguished between the continued and intermittent fevers, regarding the quotidian as being caused by phlegm, the tertian as due to yellow bile, and the quartan as due to atrabile. In the doctrine of coction, crises, and critical days he agreed with Hippocrates; with him he also agreed in the positive statement that diseases are cured by their contraries. From all this it will be seen that Galen must be regarded as one of the earliest of Hippocratic dogmatists. He was a most extensive writer, and it is said that the total number of his works exceeded one hundred. His contributions to anatomy were not insignificant. For myology he did a great deal. He wrote a monograph on the skeleton in which he recommended that bones be seen and handled, not merely studied from books, and that the student should go to Alexandria, where teachers would place before him the real human skeleton. It has been inferred that there was not, in his time, in Rome a single skeleton. He wrote fifteen books on anatomy, of which six are lacking; also an extensive treatise on the lesions of the human body, distributed among seventeen books which have come down to us. He is supposed to have introduced the term "symphysis," and he described nearly every bone in the human body. By him the muscles were no longer considered as inert masses and tissue-layers serving to cover the bones, but he classified them according to their distinct functions, and studied separately their form and uses. The location of the vessels and nerves between them was also noted, and it was proved that muscles were indispensable to the accomplishment of voluntary motions. Galen was, perhaps, the first vivisector of all, since he exposed muscles of living animals, and showed how alternate tension and relaxation of distinct groups set the bones in motion, after the manner of levers; he named a great number of them, but, curiously, took no note of others. His classification according to their uses is followed down to the present day—i.e., flexors, extensors, etc.

The Hippocratic authors confounded the arteries with the veins. Praxagoras first distinguished two kinds of vessels which he supposed to contain air, whence the name artery. Aristotle and Erasistratus maintained this view, which prevailed until the time of Galen, who devoted a book to the refutation of it, basing his argument upon the observation that always when an artery is wounded blood gushes out. How near he came to being the discoverer of the circulation may thus be seen. A little less reverence for authority and a little more capacity for observation would have placed him in possession of the knowledge, lack of which for so many centuries retarded the whole profession. He thought the veins originated from the liver—in this respect being behind Aristotle—but considered the heart as the common source of the arteries and veins. Even the portal system of veins confused him, and he erroneously described a superior and inferior aorta, but atoned for this by describing the umbilical veins and arteries. Aristotle also had supposed all the nerves originated from the heart, but Galen stated that they are derived from the brain and spinal marrow, and pointed out two kinds of nerves: those of sensation, which he thought proceeded from the brain, and those of motion, which he considered to originate in the spinal marrow. Thus, he described distinct nerves of sensation and motion, but sadly confused their anatomy. He seems also to have had some notion of the great sympathetic, although it was by no means accurate. He suggested the division of the principal nerves, in order to prove the fact that nervous energy is transmitted from the encephalon to other parts of the body. He speaks of glands, and thought they discharged their secretions through veins into the various cavities, but regarded them rather as receptacles of excrementitious matter than as agents for secretion of valuable fluids. He even regarded the mammÆ as glandular bodies in this sense, although he knew, of course, the value of their secretion. To Galen we owe the division of the body into cranial, thoracic, and abdominal cavities, whose proper viscera and envelopes he described. He spoke of the heart as having the appearance of a muscle, but differing from it. He regarded it as the source of natural heat, and the seat of anger and of violent passions. He appreciated that inspiration is carried on by enlargement of the thoracic cavity. He thought that atmospheric air entered the cavity of the cranium through the cribriform plate of the ethmoid and passed out by the same route, carrying with it excrementitious humors from the brain, which were discharged into the nasal fossÆ. But some portion of air thus entering remained, according to his views, and combined with the vital spirits in the anterior ventricles of the brain, from which combination originated the animal spirits and immediate agents of the rational soul. These acquired their last attenuation in the fourth ventricle, whence they would pass out drop by drop through a round, narrow tube.

From this brief rÉsumÉ of the anatomy and physiology of Galen it will be seen that by the end of the second century of the Christian era immense progress had been made since the foundation of the Alexandrian school, and that it was due to the impetus in the study of anatomy given by Herophilus and Erasistratus, who not only made numerous dissections, but resorted to frequent vivisections. It is even said that Herophilus did not hesitate to employ his knife on live criminals who were subjected to him for experiment; but this has been a popular tradition about almost every anatomist of antiquity, and there is no evidence in confirmation of the unkind rumor, although that such experiments might be legally and justly performed has occurred to the minds of many. But zeal for dissection rapidly cooled off, and Galen barely mentions five or six men who devoted themselves to it in the space of nearly four hundred years down to his time. He speaks of Rufus of Ephesus,—who lived under Trajan of Marinus,—who wrote in the beginning of the second century A.D., and of Quintus, who instructed his own preceptor. None of them left a reputation, however, approaching that of Herophilus and Erasistratus, with whom Galen alone could compare by the number of his experiments and his discoveries. Galen strove as hard as one of his position might, by example and precept, to awaken in his contemporaries a desire for anatomical knowledge, but could not overcome their indifference. After him the practice of dissection appears to have been lost, either from the redoubled prejudices of the superstitious, who opposed it, or as the result of the apathetic ignorance or the ignorant apathy of the physicians.

It has been shown that, during the Hippocratic era and subsequently, the physicians even of primitive times followed more or less by instinct the empirical method. Acron of Agrigentum was a contemporary of Pythagoras, and affirmed that experience is the only true foundation of the healing art. Hippocrates, however, showed himself more anxious to report faithfully clinical facts than to dispute theoretical views.

The surprising progress in anatomy and physiology made during the first portion of the Anatomic Period and during the better days of the Alexandrian institute did not keep men from confounding several different points in the Hippocratic doctrine, by which confidence in the same was naturally shaken. Thus many new speculations were hazarded which nullified each other. In the midst of this confusion practitioners continued to seek in experience a refuge from the incessant variations of dogmatism and the sterile incertitude of the skeptics. Thus, empiricism as a school of practice became placed upon a firmer and firmer foundation, and the empirics of that day seem to have laid the true basis of our art. Their doctrine took at first a rapid growth, and Galen spoke of it with great regard. The circumstances under which it was proclaimed were most favorable for its propagation. Theories had fallen into confusion; practice, methods, and opinions were questionable. Everything was conjecture, and that which rested on the evidence of facts was by the empirics received with enthusiasm. Although founded on pure observation, it did not put an end to differences of opinion, and in the eyes of the ancients it lacked in solidity, because it did not attach itself to any philosophic theory then known. This doctrine was then best able to captivate physicians on account of its simplicity, contrasted with the general inability to satisfy speculative minds; but for this very reason it subsequently fell into disgrace, and the term "empiricism" became synonymous with ignorance. For centuries condemned and despised, it was revived from its long humiliation under the name of the Experimental Method, and achieved, after the labors of Bacon, Locke, and Condillac, almost universal dominion in the sciences.

This doctrine had been proclaimed for about a century during the period of which we now speak, but later led men into a fondness for secondary generalities or for the elevation and magnifying of trifles, which confused their minds and terminated its usefulness to science. Meanwhile, a man of great intelligence, renowned as an elocutionist, well versed in the doctrine of philosophers and grammarians—namely, Asclepiades, of Bythinia—came to Rome with the intention of teaching rhetoric. By his talent and personal address he soon became one of the most illustrious persons in the Roman Republic; so early as 150 B.C. he enjoyed a high reputation as a rhetorician, and was one of the intimate friends of Cicero; nevertheless, he abandoned letters, undertook the practice of medicine, and sought moreover to create a new system, being unwilling to follow in the track of his predecessors. Imbued with the philosophy of Epicurus, who was then in high repute, he deduced from it a theory which was in harmony with the philosophy of the day. He thought that the elements of the body existed from eternity; that they were indivisible, impalpable, and perceptible to the reason only. These elements he named atoms, which were supposed to be animated by perpetual motion, and from which, by their frequent encounters and fortuitous contention, all sensible phenomena were supposed to result. He explained the properties of the body by saying that compounds were aggregates of atoms, differing very much from atoms themselves. Solid silver, he said, is white, but, reduced to powder, appears black; the horn of the goat, on the contrary, is black, but if it be razed its particles are white. This, it will be seen, was the parent of our present atomic theory. He ridiculed the theories of Hippocrates concerning coction, crises, etc., and sarcastically called the Hippocratic treatise on therapeutics "a meditation on death."

Asclepiades based his own therapeutics on endeavors so to enlarge the pores of the human body that disease could find egress, or so to constrict them that it could not enter; consequently he rejected all violent remedies, such as vomits, purges, etc., and his favorite remedies were hygienic,—for the most part bodily exercise.

A celebrated disciple of Asclepiades was Themison, of Laodicea (b.c. 50), who was led by the teachings of his master to lay the foundation of the so-called Methodism as opposed to Dogmatism in the school of Cos. By him and his followers a very arbitrary arrangement of diseases was made, according to what they considered the constrictive, or contractive; the fluxionary,—congested or relaxed; and the mixed forms. From this division of diseases it appears that, according to the methodists, there were only two kinds of therapeutic indications to follow,—namely, to relax where there was constriction, to constrict where there was relaxation. They, however, admitted a third creditable result, which they called prophylactic; but the pure methodists, such as Ccelius Aurelianus, admitted neither specific disease nor specific remedies, and erased from their materia medica purgatives, diuretics, emmenagogues, nauseants, etc.

According to the methodist doctrine, the study of medicine was so abridged that one of its prominent exponents said that he felt able to teach the whole of medical science in six months. It made rapid progress, and consequently was most attractive to the numerous young neophytes who were anxious to finish their apprenticeship and hasten into practice. It is not one of the smallest of the services which Galen rendered to his time and to posterity that he demolished the sophistry of the methodists, demonstrated the insufficiency of their practice, and brought to bear upon them the wittiest satire, calling them the asses of Thessaly, alluding thereby to their lack of literature and medical instruction.

In summing up, then, the basis for the various systems of medicine during this period of antiquity, it is seen that the most ancient doctrine of all—Dogmatism—directs our attention especially to the animal economy in health and disease; that it took account of the union of vital forces, of sympathies in the organism, and of nature's efforts to repel both internal and external deleterious influences, which providential tendency manifests itself especially in certain acute diseases. This was the strong side of dogmatism. Its weak side consisted in this: that it was held that the causes of diseases inhere in the access of certain qualities and humors along with organic forces,—such as dryness or moisture in combination with bile or atrabile,—and the treatment was directed against these supposed causes. It was on account of this weakness that the enemies of dogmatism attacked it. The empirics opposed the idea that inaccessible and occult causes of disease could become the basis for rational treatment. They affirmed that there was no consistent relation of antagonism or similitude between the disease and the remedies which cured it.

The Methodists somewhat improved on the doctrine of empiricism, but ran wild in its improvement and erected over their fundamental theory such a superstructure of secondary and tertiary generalities as to cause the fundamental part to be entirely obscured from sight.

There were not lacking, in those days of old, certain educated physicians who more or less vaguely comprehended that the entire truth of medicine did not inhere in any one of these systems, but that there was good and evil in each. These men, not being able to establish general rules, tried to decide practical questions according to their fancy or their reason. They assumed the name of Eclectics or Episynthetics, meaning thereby that they adopted no exclusive system, but selected from each that which seemed to them best. They did not constitute a sect, because they had no precise dogmas nor theories, but they should not be confounded with the Pyrrhonians, who held to doubt as a fundament doctrine, the true eclectic doubting only that which he could not understand. True eclecticism in medicine, however, is rather the absence of fixed principles, or, as Renouard says, it is "individualism erected into a dogma, which escapes refutation because it is deficient in principle." Many became eclectics to avoid discussing principles, and made of it a shelter. In one sense, then, an eclectic is one destitute of profound convictions, who sides with no particular party, is committed to no person or doctrine, and who is often so indifferent that he cannot judge with impartiality; consequently, to be truly eclectic is different from being an adherent of a school of eclecticism.

During the historic period just reviewed, anatomy and physiology made most progress, next internal and external nosography, and next to these medical and surgical therapeutics, and although Coelius Aurelianus and AretÆus have left to us by far the best books issued up to their times, nevertheless not one of the writers of this period has achieved the distinction in which Hippocrates is held, since he, perhaps more than any other, combined intelligence, sincerity, disinterestedness, love of his art, and humanity.

Under the classification of Renouard, already alluded to, the so-called Age of Transition includes centuries commencing with the death of Galen, about A.D. 201, and ending with the revival of letters in Europe, about the year 1400. The first period of this transition age is the so-called Greek Period, which ends with the burning of the Alexandrian library, A.D. 640.

At the time when this historic period commenced all the known world was under the dominance of a single man. The power of Septimus Severus had more extent than that of Alexander the Great, and bid fair to be of a much longer existence. The Roman dominion, cemented by seven hundred years of bold and persevering government, seemed almost immovable. While the savages upon its frontiers occasionally troubled its peace, none were strong enough to penetrate its centres or place it in real peril. The great civil wars had ceased, or changed their object.

Both the people and the senate, those two eternal competitors, had gotten over the struggle for supreme power; monarchial government was accepted as a matter of fact, and the citizens contended only for choice of a master.

Similar changes had taken place in the domain of the mind; philosophical discussions, which were so essentially a part of the schools of the ancient Greeks, had nearly lost their interest and were being discontinued. Such disputes as took place related less to principle than to interpretation of the language of the teacher. In morals, Plato, Epicurus, and Zeno were followed until the principles of Christianity gradually supplanted their teaching; in physics and metaphysics the authority of Aristotle, and in medicine that of Galen, were simply undisputed.

Conditions being such as these, there was naturally but one sect in medicine, and one method of study and practice. Medical science retrograded rather than progressed, sad to say, and was undisturbed by any remarkable revolution. The scepter of medicine passed from the hands of one nation to those of another, and the language of Hippocrates and Galen was later replaced, as will duly be seen, by that of Avicenna and Albucassis. But this Greek Period, which is one of transition, offers little for our consideration more than the lives and writings of four of its most eminent physicians, who by their study in the school of Alexandria, and by their writings and teachings, left reputations which were sustained until the invasion of the Arabs. Of these it may be said that, while they did little or nothing original, and simply commented upon the writings of Hippocrates and Galen, they kept burning the torch of medical learning which else had been almost extinguished by their indolent contemporaries. Of these various commentators—for they were little more than that—the first of any importance after Galen was Oribasius, who was horn in Pergamos (328-403); he early attached himself to the fortunes of Julian the Apostate, and followed him into Gaul when he was made its governor. Julian appreciated the good qualities of Oribasius, made him an intimate friend, and after he himself became emperor appointed his friend as quÆstor at Constantinople. After the emperor's untimely death, Oribasius remained faithful to his memory, but his jealous colleagues so falsely and so successfully misrepresented his fidelity that he was disgraced, spoiled of his office and property, and banished among a barbarous people. In this new field, however, he displayed such courage, effected such extraordinary cures, discoursed so eloquently, and so attached to himself the savage men around him, that he was by them regarded as a god. The fame of this homage in time reached the ears of the Emperors Valens and Valentinianus, who recalled him, reimbursed him for his losses, and permitted him to enjoy his high reputation and fortune to the end of his days. He was held to be the wisest man of his time, most skillful in medicine, and the most charming in conversation. He dedicated a collection of seventy books to Julian, his first patron, and edited, at a later period, an abridgment of this work for the benefit of his son. His principal merit consisted in reproducing the ideas of others with such clearness, order, and precision that the summaries that he gives of them are often preferable to the originals. What he has said of pregnant women, nursing, and the earliest education of the child has been copied literally by writers for twelve centuries since his time. It must be said of him, however, that his prepossession in favor of Galen was so great that he adopted servilely his ideas and even his words to such an extent that he has been surnamed "the ape of Galen."

Ætius was born in Mesopotamia in the year 502 and died in 575. He studied at Alexandria, and afterward went to Constantinople, where he became a chamberlain at court. Ætius was the first medical man of any note who professed Christianity, as is shown by such passages as this one: he said that in the composition of certain medicaments the following words should be repeated in a low voice: "May the God of Abraham, the God of Isaac, and the God of Jacob deign to bestow upon this medicament such and such virtues." In another place he recommends that to extract a bone from the throat the following words be pronounced: "Bone—as Christ caused Lazarus to come forth from the sepulchre, as Jonah came out of the whale's belly—come out of the throat or go down." But he exhibits the same credulity in not doubting the miraculous virtues attributed by the quacks of his day to most remedies.

Like Oribasius, he collected everything that he found remarkable in the writings of his predecessors, and has preserved certain fragments of antiquity which would otherwise have been lost. His work formed a complete manual of medicine and surgery, except that it lacked anatomical descriptions and references to dislocations and fractures.

Alexander of Tralles (525-605), a city of Lydia, where Greek was spoken, was a son of the physician Stephen, and the most celebrated of five sons, who were all distinguished for their learning. He traveled extensively, and fixed his residence in Rome, where he became celebrated. He lived to an advanced age, and, being no longer able to practice, composed a treatise of twelve books, exclusively devoted to affections that did not require the aid of surgery. He professed the greatest veneration for Galen, but did not blindly adopt his opinions. He described the first reported case of excessive hunger and pain due to intestinal worms; he advised venesection in the foot rather than in the arm; but with all his sound judgment and mental enlightenment he had faith in amulets and talismans, and widely recommended them. It may be said for him, such was the universal prejudice of his age, the whole world being plunged in superstition, that it was necessary for every one to pay some tribute to the prevailing belief; and we may add that it is necessary to make this excuse for some who practice much nearer to ourselves than did those ancient physicians.

Paul, or Paulus, surnamed Ægineta (because he was born in the Island of Ægina), was among the last of the Greek physicians who have special interest for us. It is supposed that he died about A.D. 690. He traveled extensively, and his skill in surgery and obstetrics rendered him celebrated even among the Arabs, whose midwives sent for him in consultation from great distances. He composed a compendium of medicine, divided into seven books, and not only did not hesitate to borrow from his predecessors, but quoted from them most extensively; a number of his chapters were taken almost verbatim from Oribasius; however, he made no secret of it, but rather boasted that he had judiciously sought to appropriate the best of the writings of those he most revered. He showed originality, however, in the treatment of hydrocephalus, in advising paracentesis of the thorax and abdomen, in the extraction of calculi from the bladder, in the treatment of aneurism, the excision of hypertrophied mammÆ in men, etc. He was the first to describe varicose aneurism, and the first to perform the operation of bronchotomy after the method borrowed from Antyllus, of which he has transmitted a very detailed account. Of this Antyllus, by the way, it may be added, en passant, that he was one of the most distinguished and original surgeons of antiquity. He flourished during the third century after Christ; was the first to describe the extraction of small cataracts; and is, perhaps, best known to the surgical world to-day by his exceedingly bold plan of opening aneurisms, so successfully imitated a generation or so ago by James Syme.

It has already been seen that before and during the early centuries of the Christian era the secrets and learning of the physicians tended to pass gradually into the hands of the priests. It was so in the temples of ancient Greece, it was so in Alexandria, it became so in Rome, it has been so even in modern times, although only for brief periods of time. This has come about in some measure from the cupidity of the clerical orders, partly because it required a certain amount of intelligence and knowledge to become a priest, and partly because, owing to ignorance, credulity, and superstition, diseases have at all times been regarded by the ignorant as evidence of divine wrath and chastisement, or of diabolical or occult influences, rather than the effect of natural causes. Hence men have turned ever toward prayers, exorcism, and expiation, especially when exhorted thereto by the priests. This has been the sacerdotal aspect of the practice of medicine in all times, and when the priests have usurped therapeutic functions they have done harm rather than good. So long as theology and science work hand in hand, each redounds to the credit of the other, but always in the history of man when theology has appropriated that which did not belong to it it has brought ridicule upon itself and has delayed the progress of knowledge. There have been frequent rebellions against religious authority in ancient as in modern times. For instance, at the commencement of the fifth century before Christ the Pythagoreans were dispersed, and the doctrines of Cos and Cnidus—i.e. the Hippocratic teachings—were promulgated; and again, in the course of events, when the descendants of Æsculapius became servile attendants at the temple and adjuncts to the priesthood or a part of it. At first, in Alexandria, the physicians were supreme; their disciples, however, had the same blind reverence for authority that too many workers in the field of theology have evinced, and men once more practiced medicine on the traditions of the past, and in so doing allied themselves more and more to the temples in Rome. At first, the oldest and best instructed of the relatives treated the diseases of his family as he understood them; simply shared this duty with its other members. Cato, the censor, was much engrossed with this domestic medicine; he wrote a book in which he recommended cabbage as a sovereign remedy in many diseases. He venerated the number 3, as did the Pythagoreans; did not disdain to transmit to posterity certain medical words which it was believed should be repeated to assist in the reduction of dislocations and fractures. This old censor seemed to have a profound hatred for medical men, and most absurd ideas of their works and claims, although doubtless many Greek physicians who came to Rome merited the invectives which he launched against them. Then came Asclepiades, of Bythinia, as already mentioned, whose talents were far superior to those of his Roman contemporaries, and who did not need to call to his aid charlatanism and deceit. This medical hero unfortunately had many worthless and dishonest imitators, who appealed to superstition and ignorance in every dishonest way, and who desired to be judged by the luxury and elegance they displayed. Hence for a long time in Rome medicine was practiced without license. The Emperor Anthony the Pious was the first to occupy himself with regulating the practice of medicine. He granted certain immunities, but did ask for proof of qualifications. A certain physician to Nero, Adromachus, was honored by the emperor with the title of Archiater.— i.e., royal healer.—but Galen, who was physician to Marcus Aurelius, never bore it. From the time of Constantine the Great, however, the title is frequently met with in the edicts of the emperors. In fact, there were two sorts of these.—one named the Palatine, who belonged to the household of the reigning monarch and who held high rank among the nobility; and the other called the Popular Archiaters, who were public-health officers. No one could practice medicine in the jurisdiction of one of these without examination and authorization. Those who transgressed this regulation were punished with a fine of two thousand drachmas. The Popular Archiaters were pensioned by the city, enjoyed certain privileges, and had to attend the poor gratuitously. Practitioners who were not members of the College of Archiaters had no pay, no rights, nor emoluments. The Popular Archiaters were elected by the citizens from many candidates who had proved their capacity before the college of this medical organization. The evils of medical anarchy were thus remedied; this happy condition existed until the empire was broken up by barbarism.

It is during this period—about 400 A.D.—that we first find a class of citizens to whom was delegated the duty of preparing drugs ordered by physicians. Their duties were in some respects similar to those of our apothecaries, although in attainment and in social position they were far below the physicians. They were termed pharmacopolists.

It is worth while to stop a moment to inquire what were the medical charitable institutions of antiquity. Even in the days of ancient Athens there was a certain gymnasium, called the Cynosarga, in which abandoned and illegitimate children were brought up at public expense until such time as they were able to serve their country. A little later several private institutions of this kind were established. Rome in her earlier day never had such institutions. To be sure, she distributed provisions, or else remitted taxes, to parents who were unable to support their children, or even permitted them to destroy their newborn children when unable to maintain them; but there were no bonds of sympathy which induced the patricians to succor the plebeians in time of disease and distress; slaves were cared for as were cattle. It is one of the debts we owe Christianity that, under its influence, the first almshouses and retreats were established in Rome. It has been said that the Emperor Marcus Aurelius first instituted anything like a dispensary service in the Sacred City. We are told, also, of an illustrious woman, St. Pauline, living in the midst of the greatest wealth and pomp, who retired from society and devoted her life to charity and self-denial. She went to Jerusalem, united with other Christian women of the same mission, and formed, under the direction of St. Jerome, a sisterhood whose members divided their time between reading sacred books and doing good works. They offered an asylum for the faithful and a hospice for the benefit of the indigent sick, and even established a home for convalescents outside the city-walls. After the model thus set, heathen emperors, Christian kings, and Moslem caliphs showed their zeal in this good direction by the erection of sumptuous edifices and other rich endowments for the relief of suffering human beings.

Reviewing now the Greek period, let it be remembered that in the time of Galen animals were dissected, and that he made anatomical demonstrations on monkeys; that sometimes the corpses of the enemy were rudely dissected upon the field of battle, but that finally the practice of dissection fell into disuse, and human anatomy was studied only from books, the early Christians having evinced even more horror of the dead body for the purposes of anatomical study than did their pagan predecessors, while the Fathers of primitive times launched their anathemas against the dissection of human remains. Here, again, as usual, the interference of the church worked only general harm. This abandonment of anatomy contributed doubtless to the decadence of medicine; by the rapid extension of Christianity the pagan schools were disorganized and broken up, the profane sciences (such as medicine) were discarded, and the teachers still remaining in the old schools were ruined. Passion for religious controversy was engendered and took the place of study or original research, even to such an extent as to hasten the fall of the Empire of the East. In addition to these factors, reverence for authority of the past—that terribly oppressive weight which has kept down so much which would otherwise have risen early, and which has been the greatest enemy of human learning—permitted the explanation of natural phenomena to be sought only in the writings of revered ancients, and not in living beings. No one dared to advocate changes in regard to received doctrines, and there could be no such thing as progress. Only two men in the lapse of four centuries showed any originality; these were Alexander of Tralles and Paul of Ægina, whose lives have already been briefly rehearsed. It is with some relief, however, that we can think that this period, so unfruitful in scientific progress, was not so in social amelioration. By the organization of the institutions above alluded to charlatanism was checked, by the requirement of capability and good character society was benefited, and the charitable institutes of this epoch perhaps gave the world its best models in teaching and an insight into the most valuable means of medical instruction. Of the old Greek Period, then, we may say that it accrues rather to the benefit of humanity than to that of science.