But before we take up Galen’s specific labors, it will be well to inquire briefly as to the state of medical art and science in the Roman world at the time when the last great physician of antiquity came upon the scene.
The Romans, it would appear, had done little in the way of scientific discoveries in the field of medicine, but, nevertheless, with their practicality of mind, they had turned to better account many more of the scientific discoveries of the Greeks than did the discoverers themselves. The practising physicians in early Rome were mostly men of Greek origin, who came to the capital after the overthrow of the Greeks by the Romans. Many of them were slaves, as earning money by either bodily or mental labor was considered beneath the dignity of a Roman citizen. The wealthy Romans, who owned large estates and numerous slaves, were in the habit of purchasing some of these slave doctors, and thus saving medical fees by having them attend to the health of their families.
By the beginning of the Christian era medicine as a profession had sadly degenerated, and in place of a class of physicians who practised medicine along rational or legitimate lines, in the footsteps of the great Hippocrates, there appeared great numbers of “specialists,” most of them charlatans, who pretended to possess supernatural insight in the methods of treating certain forms of disease. These physicians rightly earned the contempt of the better class of Romans, and were made the object of many attacks by the satirists of the time. Such specialists travelled about from place to place in much the same manner as the itinerant “Indian doctors” and “lightning tooth-extractors” do to-day. Eye-doctors seem to have been particularly numerous, and these were divided into two classes, eye-surgeons and eye-doctors proper. The eye-surgeon performed such operations as cauterizing for ingrowing eyelashes and operating upon growths about the eyes; while the eye-doctors depended entirely upon salves and
lotions. These eye-salves were frequently stamped with the seal of the physician who compounded them, something like two hundred of these seals being still in existence. There were besides these quacks, however, reputable eye-doctors who must have possessed considerable skill in the treatment of certain ophthalmias. Among some Roman surgical instruments discovered at Rheims were found also some drugs employed by ophthalmic surgeons, and an analysis of these show that they contained, among other ingredients, some that are still employed in the treatment of certain affections of the eye.
One of the first steps taken in recognition of the services of physicians was by Julius Caesar, who granted citizenship to all physicians practising in Rome. This was about fifty years before the Christian era, and from that time on there was a gradual improvement in the attitude of the Romans towards the members of the medical profession. As the Romans degenerated from a race of sturdy warriors and became more and more depraved physically, the necessity for physicians made itself more evident. Court physicians, and physicians-in-ordinary, were created by the emperors, as were also city and district physicians. In the year 133 A.D. Hadrian granted immunity from taxes and military service to physicians in recognition of their public services.
The city and district physicians, known as the archiatri populaires, treated and cared for the poor without remuneration, having a position and salary fixed by law and paid them semi-annually. These were honorable positions, and the archiatri were obliged to give instruction in medicine, without pay, to the poor students. They were allowed to receive fees and donations from their patients, but not, however, until the danger from the malady was past. Special laws were enacted to protect them, and any person subjecting them to an insult was liable to a fine “not exceeding one thousand pounds.”
An example of Roman practicality is shown in the method of treating hemorrhage, as described by Aulus Cornelius Celsus (53
B.C. to 7 A.D.). Hippocrates and Hippocratic writers treated hemorrhage by application of cold, pressure, styptics, and sometimes by actual cauterizing; but they knew nothing of the simple method of stopping a hemorrhage by a ligature tied around the bleeding vessel. Celsus not only recommended tying the end of the injured vessel, but describes the method of applying two ligatures before the artery is divided by the surgeon–a common practice among surgeons at the present time. The cut is made between these two, and thus hemorrhage is avoided from either end of the divided vessel.