The Later Roman and Byzantine Period : Part 3

Outlines of Greek and Roman Medicine
by James Sands Elliott

(Page 12 of 15)

In the age of Justinian great scourges devastated the world. In A.D. 526 Antioch was destroyed by an earthquake, and it is said that 250,000 people perished, but the most dreadful visitation on mankind was the great plague which raged in A.D. 542 and the following years, and, as Gibbon writes, "depopulated the earth in the time of Justinian and his successors." Procopius, who was versed in medicine, was the historian of the period. This fell disease began between the Serbonian bog and the eastern channel of the Nile. "From thence, tracing as it were a double path, it spread to the east, over Syria, Persia, and the Indies, and penetrated to the west, along the coast of Africa, and over the continent of Europe. In the spring of the second year, Constantinople, during three or four months, was visited by the pestilence; and Procopius, who observed its progress and symptoms with the eyes of a physician, has emulated the skill and diligence of Thucydides in the latter's description of the plague of Athens.

The infection was sometimes announced by the visions of a distempered fancy, and the victim despaired as soon as he had heard the menace and felt the stroke of an invisible spectre. But the greater number, in their beds, in the streets, in their usual occupation, were surprised by a slight fever, so slight, indeed, that neither the pulse nor the colour of the patient gave any signs of the approaching danger. The same, the next, or the succeeding day, it was declared by the swelling of the glands, particularly those of the groin, of the armpits, and under the ear; and when these buboes or tumours were opened they were found to contain a coal, or black substance, of the size of a lentil. If they came to a first swelling and suppuration, the patient was saved by this kind and natural discharge of the morbid humour. But if they continued hard and dry, a mortification quickly ensued, and the fifth day was commonly the term of his life. The fever was often accompanied with lethargy or delirium; the bodies of the sick were covered with black pustules or carbuncles, the symptoms of immediate death; and in the constitutions too feeble to produce an eruption, the vomiting of blood was followed by a mortification of the bowels. To pregnant women the plague was generally mortal; yet one infant was drawn alive from its dead mother, and three mothers survived the loss of their infected fœtus.

Youth was the most perilous season: and the female sex was less susceptible than the male; but every rank and profession was attacked with indiscriminate rage, and many of those who escaped were deprived of their speech, without being secure from a return of the disorder. The physicians of Constantinople were zealous and skilful, but their art was baffled by the various symptoms and pertinacious vehemence of the disease; the same remedies were productive of contrary effects and the event capriciously disappointed their prognostics of death or recovery. The order of funerals and the right of sepulchres were confounded; those who were left without friends or servants lay unburied in the streets, or in their desolate houses; and a magistrate was authorized to collect the promiscuous heaps of dead bodies, to transport them by land or water, and to inter them in deep pits beyond the precincts of the city.... No facts have been preserved to sustain an account, or even a conjecture, of the number that perished in this extraordinary mortality. I only find, that during three months 5,000, and at length 10,000, persons died each day at Constantinople; that many cities of the East were left vacant, and that in several districts of Italy the harvest and the vintage withered on the ground."

The spread of disease from East to West was again exemplified in the Middle Ages, in the time of the Crusades, when the Crusaders carried home diseases to their native lands. The Knights of St. John, it is interesting to observe, superintended hospitals at home, and wore the white dress which in earlier times had distinguished the Asclepiades.

Moschion probably lived in the sixth century, and was a specialist in diseases of women. His writings were studied when Soranus was forgotten, but in course of time it was discovered that Moschion's work was nothing but an abbreviated translation of the works of Soranus. "Further, it is held by Weber and Ermerins that even the original Moschion is not based directly on Soranus, but on a work on diseases of women written in the fourth century by Cælius Aurelianus, who in his turn drew from Soranus.... It is interesting to follow the history of this book through its various stages in the light of these different editions, and we would suggest that the first Latin version, for the use of Latin-speaking matrons and midwives, was produced before the fall of the Western Empire in the fifth century; its Greek sister just fits in with the development of Eastern or Greek-speaking Empire at Constantinople in the sixth century; and the version in barbarous Latin points to a later period, when learning was beginning to make way again in Western Europe." Moschion's book is a catechism consisting of 152 questions and answers.

Paulus Ægineta was the last, and one of the most famous, of the Greek physicians. He was born probably in the seventh century in the island of Ægina, but there is some doubt as to the exact period in which he lived. He quotes Alexander of Tralles and Ætius, and therefore lived at a later period than they did, either in the sixth or seventh century. The works of Paulus are compilations, but reveal the skill and learning of the author. He wrote several books, but only one, and that the principal, remains, and is known by the title of "De Re Medica Libri Septem." Dr. Adams, of Banchory, translated this book for the Sydenham Society, and the introduction shows the scope of the work: "In the first book you will find everything that relates to hygiene, and to the preservation from, and correction of, distempers peculiar to the various ages, reasons, temperaments, and so forth; also the powers and use of the different articles of food, as is set forth in the chapter of contents. In the second is explained the whole doctrine of fevers, an account of certain matters relating to them being premised, such as excrementitious discharges, critical days, and other appearances, and concluding with certain symptoms which are the concomitants of fevers. The third book relates to topical affections, beginning from the crown of the head and descending down to the nails of the feet, and so on. Briefly, the fourth book treats of external diseases; the fifth, of wounds and bites from venomous animals; the sixth book is the most important and is devoted to surgery, and contains original observations, and the seventh book contains an account of the properties of medicines." Paulus wrote a famous book on obstetrics, which is now lost, but it gained for him among the Arabs the title of "the accoucheur."

The sixth book on surgery, as has justly been observed by Adams, "contains the most complete system of operative surgery which has come down to us from ancient times." Many important surgical principles are enunciated, such, for instance, as local depletion as against general, and the merit of a free external incision. He first described varicose aneurism, and performed the operation of bronchotomy as described by Antyllus. He favoured the lateral operation for removal of stone from the bladder, and amputated the cancerous breast by crucial incision. He also had an operation, like that of Antyllus, for the cure of aneurism. In brief, Paulus performed many of the operations that are practised at the present day. He travelled in the practice of his calling, and not only had great fame in the Byzantine Empire and in Arabia in his lifetime, but exercised great influence for some centuries. His writings inspired Albucassis, one of the few surgeons and teachers of the Middle Ages.

After the time of Paulus Ægineta the practice of medicine and surgery suffered a very rapid decline, and for five centuries no progress was made. The Middle Ages form a dark and melancholy period in the history of medicine, and we have to come to comparatively recent times before we find the skill and knowledge of the Ancients equalled, while it is only at the present day that they are rapidly being excelled.

Published in 1971 by Milford House Inc. Boston, MA.