I Ancient Medicine

In the brain Erasistratus observed the convolutions, noted that they were more elaborate in man than in animals, and associated this complexity with higher intelligence. He distin guished between cerebrum and cerebellum, described the cerebral ventricles and considered that they were filled with animal spirit. He had a clear view of the action of muscles in producing move ment and regarded their shortenings as due to distension by animal spirit.

Erasistratus regarded excess of blood or plethora as the chief cause of disease. Among such diseases are coughing of blood, epilepsy, pneumonia, tonsillitis, etc. Most of these could be treated by diminishing the local supply of blood. In treatment Erasis tratus concentrated on plethora, which he treated primarily by starvation. Among his contemporaries blood-letting was habitu ally applied to almost every condition. Erasistratus employed it rarely, and his successors banned it altogether. He was consist ently opposed to violent remedies, among his favourite thera peutic measures being regulated exercise, diet and the vapour bath.

After the first generation, the activity of the Alexandrian medical school flagged. With the absorption of Egypt into the empire, Alexandria ceased to have great scientific importance.

Medicine Under the Roman Empire.

—The original native Roman medical system was that of a people of low culture. Its aspect was changed by the advent of Greek science. Yet, not withstanding the large field that the western empire provided, and the wide acceptance of Greek medicine by the upper classes, it is remarkable that the Latin-speaking peoples produced no eminent physician. At first, medical education at Rome was a private matter. The earliest scientific teacher was the Greek Asclepiades of Bithynia (d. c. 4o B.c.) a contemporary of Lu cretius and, like him, an Epicurean. Asclepiades ridiculed the Hippocratic attitude of relying on the "healing power of nature" as a mere "meditation on death," and urged active measures that the cure might be "seemly, swift and sure." His school at Rome continued after him. At first it was the mere personal following of the physician, who took pupils and apprentices on his visits.

Later such groups combined to form colleges where problems of the art were debated. As Rome became a centre of medical instruction, subsidiary centres were established in other towns, first in Italy, then in the provinces. These secondary schools produced few whose writings have survived. They were largely training places for the army surgeons. That class seldom had scientific interests, though Dioscorides, one of the most prominent physicians of antiquity, who has deeply influenced the modern pharmacopoeia, served in the army under Nero. (See DIOSCOR 1DES.) The earliest scientific medical work in Latin is the De re Medica of Celsus, prepared about A.D. 3o, and in many ways the most readable and well-arranged ancient medical work. It is, how ever, not original, but a compilation from the Greek. The ethical tone is high and the general line of treatment sensible and humane (see CELsus). An idea of the surgical instruments in use in his time can be obtained from those recovered from Pompeii.

Latin writers on architecture give much attention to the orien tation, position and drainage of buildings. Sanitation was from an early date a feature of Roman life. Rome was already provided with cloacae, or subterranean sewers in the age of the Tarquins (6th century B.C.). The Cloaca Maxima itself, still the main drain of Rome, dates back to that period. The finest monuments to the Roman care for the public health are the 14 great aqueducts which supplied the city with 300,00o,000gal. of water daily. No

modern city is better equipped.

Public Medical Service.

Under the early empire a definite public medical service was constituted. Physicians were appointed to the various towns and institutions. The Roman medical sys tem was at its best in connection with the army. There was an adequate supply of military medical attendants who were well organized. The defect of the system was the absence of any elastic scheme for ranking medical officers, and the complete sub ordination of the medical to the combatant officer.

The greatest contribution of Rome to medicine is the hospital system the organization of which is connected with the military system. It had become the custom to expose sick and worn-out slaves in a temple to Aesculapius on an island of the Tiber. The emperor, Claudius (A.D. 41-54) decreed that if such slaves re covered, they need not return to the control of their masters. Thus, the island became a form of hospital for the sick poor. Later there were established valetudinaria, "infirmaries," for such persons. This development early affected military life. At first, sick soldiers on service were sent home for treatment. As the frontiers expanded military hospitals were founded at strategic points. From this the foundation of similar institutions for the imperial officials and their families in the provincial towns was no great step. The idea passed to Christian times, and the pious foundations of the middle ages are traceable to the Roman vale tudinaria. These mediaeval hospitals for the sick must be dis tinguished from the even more numerous "spitals" for travellers and pilgrims, which may be traced to the rest-houses along the strategic roads of the Empire.

Galen.

Galen of Pergamum (A.D. 130-200) not only provided the final medical synthesis of antiquity, but also the effective scientific medical knowledge of Europe for 13 centuries. (See GALEN.) He developed a very characteristic physiological scheme which remained in vogue until destroyed by the researches of Harvey in the i 7th century. It supposes three types of so-called spirits associated with three types of the activity of living things. These were the natural spirits formed in the liver and distributed by the veins; the vital spirits formed in the heart and distributed by the arteries ; and the animal spirits formed in the brain and distributed by the nerves. The animal spirits were especially associated with the higher functions of sensation and motion. The scheme presupposed minute pores in the septum of the heart, through which venous blood charged with natural spirits passed from the right ventricle into the left where it became charged with vital spirits. Arterial blood charged with vital spirits be came converted to animal spirits in the brain and was thence dis tributed by the nerves. Galen's system, fanciful as it seems now, was, in fact, an admirable working hypothesis, based on much experimental evidence.

Galen had no effective successor. Mediaeval medicine may be summed up as a corrupted version of Galenism. To some extent a purer tradition was revived for the West by translations of Arabic works. From the point of view of cultural contacts, the history of mediaeval medicine is of great interest, but has little value for the history of scientific medicine. Practical anatomy was revived in the later 13th century, and had an able exponent in the early part of the 14th century in Mondino da Luzzi (d. 1328). The true scientific tradition does not reappear, however, till the 16th century.