Part 15

The earliest really scientific contribution to the study of this disorder may be credited to Thomas Mouffet, of London, who, in a treatise published in 1634, entitled _Insectorum sive Minimorum Animalium Theatrum_, showed not only that the animalculæ were constantly associated with the complaint, but made it clear that they were not to be found in the vesicles, but in the tunnels connected with these. For this was the stumbling block of most of the investigators. It had been so often stated that the parasites were to be found in the vesicles, that when they were not there the theory failed. Mouffet’s exposition ought to have led to a correct understanding of the cause of the complaint, but it was practically ignored.

About this time the microscope was invented, and in 1657 a German naturalist named Hauptmann published a rough drawing of the insect magnified. A better, but still imperfect, representation of it was given a few years later by Etmuller.

In 1687 a pharmacist of Leghorn, named Cestoni, induced a Dr. Bonomo of that city to join him in making a series of experiments to prove that the acarus was the cause of itch. They had both observed the women of the city extracting the insects from the hands of their children by the aid of needles, and the result of their research was a treatise in which the parasitic nature of the complaint was maintained, and the uselessness of internal remedies was insisted on. These intelligent Italians recommended sulphur or mercury ointment as the essential application.

Even with this evidence before them the doctors went on faithful to their theory of humours. Linnæus supported the view of Bonomo and Cestoni, but made the mistake of identifying the itch parasite with the cheese mite. The great medical authorities of the eighteenth century, such as Hoffmann and Boerhaave, still recommended general treatment, and a long list of drugs might be compiled which were supposed to be suitable in the treatment of itch. Among these, luckily, some parasiticides were included, and, consequently, the disease did get cured by these, but the wrong things got the credit. About the end of the eighteenth century Hahnemann promulgated the theory that the “psoric miasm” of which the itch eruption was the symptomatic manifestation, was the cause of a large proportion of chronic diseases.

Some observers thought there were two kinds of itch, one caused by the acarus, the other independent of it. Bolder theorists held that the insect was the product of the disease. The dispute continued until 1834, in which year Francois Renucci, a native of Corsica, and at the time assistant to the eminent surgeon d’Alibert at the Hôpital St. Louis, Paris, undertook to extract the acarus in any genuine case of itch. As a boy he had seen the poor women extract it in Corsica, as Bonomo and Cestoni had seen others do it at Leghorn, though his learned master at the hospital remained sceptical for some years. It was near the middle of the nineteenth century before the parasitic character of itch was universally acknowledged.

XI

MASTERS IN PHARMACY

We are guilty, we hope, of no irreverence towards those great nations to which the human race owes art, science, taste, civil and intellectual freedom, when we say that the stock bequeathed by them to us has been so carefully improved that the accumulated interest now exceeds the principal. MACAULAY: “Essay on Lord Bacon” (1837).

DIOSCORIDES.

It has been a subject of lively dispute whether Dioscorides lived before or after Pliny. It seems certain that one of these authors copied from the other on particular matters, and in neither case is credit given. Pliny was born A.D. 23 and died A.D. 79, and would therefore have lived under the Emperors Tiberius, Caligula, Claudius, Nero, Galba, Otho, Vitellius, and Vespasian. Suidas, the historian, who probably wrote in the tenth century, dates Dioscorides as contemporary with Antony and Cleopatra, about B.C. 40, and some Arab authorities say he wrote at the time of Ptolemy VII, which would be still a hundred years earlier. But Dioscorides dedicates his great work on materia medica to Areus Asclepiades, who is otherwise unknown, but mentions as a friend of his patron the consul Licinius Bassus. There was a consul Lecanius Bassus in the reign of Nero, and it is therefore generally supposed that Dioscorides was in his prime at that period, and would consequently be a contemporary of Pliny’s. It is possible that both authors drew from another common source.

Dioscorides was a native of Anazarbus in Cilicia, a province where the Greek spoken and written was proverbially provincial. Our word solecism is believed to have been derived from the town of Soloe in the same district. The Greek of Dioscorides is alleged to have been far from classical. He himself apologises for it in his preface, and Galen remarks upon it. Nevertheless Dioscorides maintained for at least sixteen centuries the premier position among authorities on materia medica. Galen complains that he was sometimes too indefinite in his description of plants, that he does not indicate exactly enough the diseases in which they are useful, and that he does not explain the degrees of heat, cold, dryness, and humidity which characterise them. He will often content himself with saying that a herb is hot or cold, as the case may be. As an illustration of one of his other criticisms Galen mentions the Polygonum, of which he notes that Dioscorides says “it is useful for those who urinate with difficulty.” But Galen adds that he does not particularise precisely the cases of which this is a symptom and which the Polygonum is good for. But these defects notwithstanding, Galen recognises that Dioscorides is the best authority on the subject of the materials of medicine.

It is generally stated that Dioscorides was a physician; but of this there is no certain evidence. According to his own account he was devoted to the study and observation of plants and medical substances generally, and in order to see them in their native lands he accompanied the Roman armies through Greece, Italy, and Asia Minor. This was the easiest method of visiting foreign countries in those days. It is not unlikely that he went as assistant to a physician, perhaps to the one to whom he dedicated his book. That is to say, he may have been an army compounder. Suidas says of him that he was nicknamed Phocas, because his face was covered with stains of the shape of lentils.

In his treatise on materia medica, “Peri Ules Iatrikes,” or, according to Photius, originally “Peri Ules,” On Matter, only, he describes some six hundred plants, limiting himself to those which had or were supposed to have medicinal virtues. He mentions, besides, the therapeutic properties of many animal substances. Among these are roasted grasshoppers, for bladder disorders; the liver of an ass for epilepsy; seven bugs enclosed in the skin of a bean to be taken in intermittent fever; and a spider applied to the temples for headache.

Dioscorides also gives a formula for the Sal Viperum, which was a noted remedy in his time and for long afterwards. His process was to roast a viper alive in a new earthen pot with some figs, common salt, and honey, reducing the whole to ashes. A little spikenard was added to the ashes. Pliny only adds fennel and frankincense to the viper, but Galen and later authors make the salt a much more complicated mixture.

His botany is very defective. He classifies plants in the crudest way; often only by a similarity of names. Of many his only description is that it is “well-known,” a habit which has got him into much trouble with modern investigators who have looked into his work for historical evidence verifying the records of herbs named in other works. Hyssop is an example. As stated in the section entitled “The Pharmacy of the Bible,” it has not been found possible to identify the several references to hyssop in the Bible. Dioscorides contents himself by saying that it is a well-known plant, and then gives its medicinal qualities. But that his hyssop was not the plant known to us by that name is evident from the fact that in the same chapter he describes the “Chrysocome,” and says of it that it flowers in racemes like the hyssop. He also speaks of an origanum which has leaves arranged like an umbel, similar to that of the hyssop. It is evident, therefore, that his hyssop and ours are not the same plant.

The mineral medicines in use in his time are also included in the treatise of Dioscorides. He mentions argentum vivum, cinnabar, verdigris, the calces of lead and antimony, flowers of brass, rust of iron, litharge, pompholix, several earths, sal ammoniac, nitre, and other substances.

Other treatises, one on poisons and the bites of venomous animals, and another on medicines easy to prepare, have been attributed to Dioscorides, but it is not generally accepted that he was the author. The best known translation of Dioscorides into Latin was made by Matthiolus of Sienna in the sixteenth century. The MS. from which Matthiolus worked is still preserved at Vienna and is believed to have been written in the sixth century.

The very competent authority Kurt Sprengel, while recognising the defects in the Materia Medica of Dioscorides, credits him with the record of many valuable observations. His descriptions of myrrh, bdellium, laudanum, asafoetida, gum ammoniacum, opium, and squill are selected as particularly useful; the accounts he gives of treatments since abandoned (some of which are mentioned above, but to these Sprengel adds the application of wool fat to wounds which has been revived since he wrote), are of special interest; and the German historian further justly points out that many remedies re-discovered in modern times were referred to by Dioscorides. Among these are castor oil, though Dioscorides only alludes to the external application of this substance; male fern against tape worms; elm bark for eruptions; horehound in phthisis; and aloes for ulcers. He describes many chemical processes very intelligently, and was the first to indicate means of discovering the adulterations of drugs.

GALEN.

No writer of either ancient or modern times can compare with Claudius Galenus probably in the abundance of his output, but certainly in the influence he exercised over the generations that followed him. For fifteen hundred years the doctrines he formulated, the compound medicines he either introduced or endorsed, and the treatments he recommended commanded almost universal submission among medical practitioners. In Dr. Monk’s Roll of the College of Physicians, mention is made of a Dr. Geynes who was admitted to the Fellowship of the College in 1560, “but not until he had signed a recantation of his error in having impugned the infallibility of Galen.”[2] This was at the time when to deny Galen meant to follow Paracelsus, and the contest was fiercer just then than at any time before or since.

Galen was born at Pergamos, in Asia Minor, A.D. 131, and died in the same city between A.D. 200 and 210. His father was an architect of considerable fortune, and the son was at first destined to be a philosopher, but while he was going through his courses of logic, Nicon (the father) was advised in a dream to direct the youth’s studies in the direction of medicine. It will be seen directly that Galen’s career was a good deal influenced by dreams.

Nothing was spared to obtain for the youth the best education available, though his father died when he was 21. After exhausting the Pergamos teachers, Galen studied at Smyrna, Corinth, and Alexandria. Then he travelled for some years through Cilicia, Phœnicia, Palestine, Scyros, and the Isles of Crete and Cyprus. He commenced practice at Pergamos when he was 29 and was appointed Physician to the School of Gladiators in that city. At 33 he removed to Rome and soon acquired the confidence and friendship of many distinguished persons, among them Septimus Severus, the Consul and afterwards Emperor, Sergius Paulus, the Prætor, the uncle of the reigning Emperor, Lucius Verus, many of whom he cured of various illnesses.

His success caused bitter jealousy among the other Greek physicians then practising in Rome. They called him Paradoxologos, and Logiatros, which meant that he was a boaster and a master of phrases. It appears that he was able to hold his own in this wordy warfare. Some of his opponents he described as Asses of Thessaly, and he also made allegations against their competence and probity. However, he quitted Rome in the year 167, and as at a later time he left Aquilea, both movings being coincident with the occurrence of serious plagues, his reputation for courage has suffered. It was at this period of his life that he visited Palestine to see the shrub which yielded Balm of Gilead, and then proceeded to Armenia to satisfy himself in regard to the preparation of the Terra Sigillata. He was able to report that the general belief that blood was used in the process was incorrect.

It was to Aquilea that Galen was sent for by the Emperor Marcus Aurelius, who was there preparing a campaign against the Marcomans, a Germanic nation dwelling in what is now called Bohemia. Marcus Aurelius was in the habit of taking Theriaca, and would have none but that which had been prepared by Galen. He urged Galen to accompany him on his expedition, but the physician declined the honour and the danger, alleging that Æsculapius had appeared to him in a dream, and had forbidden him to take the journey. The Emperor therefore sent him to Rome and charged him with the medical care of his son Commodus, then 11 years of age. Galen is said to have done the world the ill-service of saving the life of this monster. Galen retained the favour of Marcus Aurelius till the death of the Emperor, and continued to make Theriaca for his successors, Commodus, Pertinax, and Septimus Severus. He died during the reign of the last named Emperor.

Galen is sometimes said to have kept a pharmacy in the Via d’Acra at Rome, but his “apotheca” there appears to have been a house where his writings were kept and where other physicians came to consult them. This house was afterwards burned, and it is supposed that a number of the physician’s manuscripts were destroyed in that fire.

His medical fame began to develop soon after his death. In about a hundred years Eusebius, Bishop of Cæsarea, reproaches the world with treating Galen almost as a divinity. Nearly all the later Roman medical writers drew freely from his works, and some seemed to depend entirely on them. Arabic medicine was largely based on Galen’s teaching, and it was the Arabic manuscripts translated into Latin which furnished the base of the medical teaching of Europe from the eleventh and twelfth centuries to the eighteenth.

Galen aimed to create a perfect system of physiology, pathology, and treatment. He is alleged to have written 500 treatises on medicine, and 250 on other subjects, philosophy, laws, grammar. Nothing like this number remains, and the so-called “books” are often what we should call articles. His known and accepted medical works number eighty-five. All his writings were originally in Greek.

ORIBASIUS.

Oribasius, like Galen, was a native of Pergamos, and was physician to and friend of the Emperor Julian. He is noted for having compiled seventy-two books in which he collected all the medical science of preceding writers. This was undertaken at the instance of Julian. Only seventeen of these books have been preserved to modern times. Oribasius adds to his compilation many original observations of his own, and in these often shows remarkable good sense. He was the originator of the necklace method of treatment, for he recommends a necklace of beads made of peony wood to be worn in epilepsy, but does not rely on this means alone.

AETIUS.

Aetius, who lived either in the fifth or sixth century, was also a compiler, but he was besides a great authority on plasters, which he discusses and describes at enormous length. He was a Christian, and gives formulas of words to be said when making medicinal compounds, such as “O God of Abraham, of Isaac, and of Jacob, give to this remedy the virtues necessary for it.” In the works of Aetius, mention is made of several nostrums famous in his time for which fabulous prices were charged. The Collyrium of Danaus was sold in Constantinople for 120 numismata. If this means the nummus aureus of Roman money it would be equal to nearly £100 of our money. At this price, Aetius says, the Collyrium could only be had with difficulty. He also mentions a Colical Antidote of Nicostratus called very presumptuously Isotheos (equal to God), which sold for two talents.

The remedy devised by Aetius for gout was called Antidotos ex duobus Centaureae generibus, and was the same as the compound which became popular in this country under the title of Duke of Portland’s Powder. (See page 309). Aetius prescribed a regimen along with his medicine extending over a year. In September the patient was to take milk; in October, garlic; in November to abstain from baths; December, no cabbage; in January to take a glass of pure wine every morning; in February to eat no beet; in March to be allowed sweets in both food and drink; in April, no horse radish; in May, no Polypus (a favourite dish); in June, to drink cold water in the morning; in July, no venery; in August, no mallows.

ALEXANDER OF TRALLES.

This writer, who acquired considerable celebrity as a medical authority, lived a little later than Aetius, towards the end of the sixth century. He was a native of Tralles, in Lydia, and is much esteemed by the principal medical historians, Sprengel, Leclerc, Freind, and others who have studied his writings. Especially notable is his independence of opinion; he does not hesitate occasionally to criticise even Galen. He impresses strongly on his readers the danger of becoming bound to a particular system of treatment. The causes of each disease are to be found, and the practitioner is not to be guided exclusively by symptoms. Among his favourite drugs were castorum, which he gave in fevers and many other maladies; he had known several persons snatched from the jaws of death by its use in lethargy (apoplexy); bole Armeniac, in epilepsy and melancholia; grapes and other ripe fruits instead of astringents in dysentery; rhubarb appeared as a medicine for the first time in his writings, but only as an astringent; and he was the first to use cantharides for blisters in gout instead of soothing applications. His treatment of gout by internal remedies and regimen recalls that of Aetius and is worth quoting. He prescribed an electuary composed of myrrh, coral, cloves, rue, peony, and aristolochia. This was to be taken regularly every day for a hundred days. Then it was to be discontinued for fifteen days. After that it was to be recommenced and continued during 460 days, but only taking a dose every other day; then after another interval thirty-five more doses were to be taken on alternate days, making 365 doses altogether in the course of nearly two years. Meanwhile the diet was strictly regulated, and it may well be that Alexander only provided the medicine to amuse his patient while he cured the gout by a calculated reduction of his luxuries. Alexander of Tralles was the author who recommended hermodactyls, supposed to be a kind of colchicum in gout; a remedy which was forgotten until its use was revived in a French proprietary medicine. His prescription compounded hermodactyls, ginger, pepper, cummin seeds, anise seeds, and scammony. He says it will enable sufferers who take it to walk immediately. He is supposed to have been the first to advocate the administration of iron for the removal of obstructions.

MESUË AND SERAPION.

These names are often met with in old medical and pharmaceutical books, and there is an “elder” and a “younger” of each of them, so that it may be desirable to explain who they all were. The elder and the younger of each are sometimes confused. Serapion the Elder, or Serapion of Alexandria, as he is more frequently named in medical history, lived in the Egyptian city about 200 B.C., and was the recognised leader of the sect of the Empirics in medicine. He is credited with the formula that medicine rested on the three bases, Observation, History, and Analogy. No work of his has survived, but he is alleged to have violently attacked the theories of Hippocrates, and to have made great use of such animal products as castorum, the brain of the camel, the excrements of the crocodile, the blood of the tortoise, and the testicles of the boar.

Serapion the Younger was an Arabian physician who lived towards the end of the tenth century and wrote a work on materia medica which was much used for some five or six hundred years.

Mesuë the Elder was first physician at the court of Haroun-al-Raschid in the ninth century. He was born at Khouz, near Nineveh, in 776, and died at Bagdad in 855. Under his superintendence the School of Medicine of Bagdad was founded by Haroun. Although a Nestorian Christian, Mesuë retained his position as first physician to five Caliphs after Haroun. To his teaching the introduction of the milder purgatives, such as senna, tamarinds, and certain fruits is supposed to be due. His Arabic name was Jahiah-Ebn-Masawaih.

Mesuë the Younger is the authority generally meant when formulas under his name, sometimes quaintly called Dr. Mesuë in old English books, are quoted. He lived at Cairo about the year 1000. He was a Christian, like his earlier namesake, and is believed to have been a pupil or perhaps a companion of Avicenna; at all events, when the latter got into disgrace it is alleged that both he and Mesuë took refuge in Damascus. At Damascus Mesuë wrote his great work known in Latin as Receptarium Antidotarii. From the time of the invention of printing down to the middle of the seventeenth century, when pharmacopœias became general, more than seventy editions of this work, mostly in Latin, but a few in Italian, have been counted. In some of the Latin translations he is described as “John, the son of Mesuë, the son of Hamech, the son of Abdel, king of Damascus.” This dignity has been traced to a confusion of the Arabic names, one of which was very similar to the word meaning king. Nearly half of the formulæ in the first London Pharmacopœia were quoted from him.

NICOLAS MYREPSUS.