Part 7

Hippocrates was considerably interested in pharmacy. Galen makes him say, “We know the nature of medicaments and simples, and make many different preparations with them; some in one way, some in another. Some simples must be gathered early, some late; some we dry, some we crush, some we cook,” &c. He made fomentations, poultices, gargles, pessaries, katapotia (things to swallow, large pills), ointments, oils, cerates, collyria, looches, tablets, and inhalations, which he called perfumes. For quinsy, for example, he burned sulphur and asphalte with hyssop. He gave narcotics, including, it is supposed, the juice of the poppy and henbane seeds, and mandragora; purgatives, sudorifics, emetics, and enemas. His purgative drugs were generally drastic ones: the hellebores, elaterium, colocynth, scammony, thapsia, and a species of rhamnus.

Hippocrates describes methods for what he calls purging the head and the lungs, that is, by means of sneezing and coughing. He explains how he diminishes the acridity of spurge juice by dropping a little of it on a dried fig, whereby he gets a good remedy for dropsy. He has a medicine which he calls Tetragonon, or four-cornered. Galen conjectures that this was a tablet of crude antimony. Leclerc more reasonably suggests that it was a term for certain special kinds of lozenges, and points out that not long after Hippocrates physicians used a trochiscus trigonus, or three-cornered lozenge for another purpose.

Although he used many drugs, Hippocrates is especially insistent on Diet as the most important aid to health. He claims to have been the first physician who had written on this subject, and this assertion is confirmed by Plato, who, however, somewhat grimly commends the ancient doctors for neglecting this branch of treatment, for, he says, the modern ones have converted life into a tedious death. Barley water is repeatedly recommended by the physician of Cos, with various additions to suit the particular case under consideration. Oxymel is the usual associate, but dill, leeks, oil, salt, vinegar, and goats’ fat also figure.

Particular instructions are also given about the wine to be drunk, the kind, and the quantity of water with which it is to be diluted in spring, summer, autumn, and winter. In one place, at the end of the 3rd Book on Diet, a word is used which apparently means that persons fatigued with long labour should “drink unto gaiety” occasionally; but there is some doubt about the correct translation of that word.

V

FROM HIPPOCRATES TO GALEN.

Medicine is a science which hath been more professed than laboured, and yet more laboured than advanced; the labour having been, in my judgment, rather in circle than in progression. For I find much iteration, but small addition.--BACON, “Advancement of Learning.”--Book 2.

The fame of Hippocrates caused naturally a great multiplication of works attributed to him. The Ptolemies when founding the Library of Alexandria, which they were determined should be more important than that of Pergamos, commissioned captains of ships and other travellers to buy manuscripts of the Greek physician at almost any price; an excellent method of encouraging forgeries. The works attributed to Hippocrates have been subject to the keenest scrutiny by scholars, but even now the verdict of Galen in regard to their genuine or spurious character is the consideration which carries the greatest weight. Even the imitations go to prove how free the physician of Cos was from superstitious practices or prejudiced theories.

Between him and Galen an interval of some six hundred years elapsed and, especially in the latter half of that period, pharmacy developed into enormous importance. Not that it necessarily advanced. But the faith in drugs, and especially in the art of compounding them, and the wild polypharmacy which grew up in Alexandria and Rome in the first two centuries of our era, of which Galen shows so much approval, add inestimably to the chronicles of pharmacy. It was during the interval between Hippocrates and Galen that the many sects of ancient medicine, the Dogmatics, the Stoics, the Empirics, the Methodics, and the Eclectics were born and flourished. Some of these encouraged the administration of special remedies. But probably a far greater influence was exercised on the pharmacy of the ancient world by the new commerce with Africa and the East which the Ptolemies did so much to foster, and by the travelling quacks and the prescribing druggists who exploited the drugs of foreign origin which now came into the market.

Serapion of Alexandria, one of the most famous of the Empirics, who is supposed to have lived in the second century, was largely responsible for the introduction of the animal remedies which were to figure so prominently in the pharmacy of the succeeding seventeen centuries. Among his specifics were the brain of a camel, the excrements of the crocodile, the heart of the hare, the blood of the tortoise, and the testicles of the wild boar.

The Empirics were the boldest users of drugs, and so far as can be judged, were the practitioners who brought opium into general medicinal esteem. One of the most famous doctors of this sect, Heraclides, made several narcotic compounds which are commended by Galen. One of these formulæ prescribed for cholera was 2 drms. of henbane seeds, 1 drm. of anise, and ½ drm. of opium, made into 30 pills, one for a dose. Another which was recommended for coughs was composed of 4 drms. each of juice of hemlock, juice of henbane, castorum, white pepper, and costus; and 1 drm. each of myrrh and opium.

Musa, a freed slave of Augustus, and apparently a sort of medical charlatan, but a great favourite with the Emperor, is alleged to have introduced the flesh of vipers into medical use especially for the cure of ulcers.

Celsus, Dioscorides, and Pliny, whose works are recognized as the storehouses of the science of Imperial Rome, belonged to the period under review. Celsus wrote either a little before or a little after the commencement of our era. He was the first eminent author who wrote on medicine in Latin. Pliny died A.D. 79, suffocated by the gases from Vesuvius, which in his eagerness to observe he had approached too near during an eruption. Dioscorides is supposed to have lived a little before Pliny, who apparently quotes him, but curiously never mentions his name, though usually most scrupulous in regard to his authorities.

Themison, who lived at Rome in the reign of Augustus Cæsar, and who is said to have been the first physician to have distinguished rheumatism from gout, is noted in pharmacy as the author of the formulæ for Diagredium and Diacodium. He praised the plantain as a universal remedy, and is also the earliest medical writer to mention the use of leeches in the treatment of illness.

Several of the writers on medical subjects of this period adopted the method of prescribing their formulas and the instructions for compounding them in verse. The most famous instance is that of Andromachus, physician to Nero, whose elegiac verses describing the composition of his Theriakon are quoted by Galen. The idea was that the formula thus presented was less likely to be tampered with. Theriakon as invented contained 61 ingredients. Its principal improvement on the more ancient Mithridatum was the addition of dried vipers. Andromachus appears to have acquired a large and lucrative practice in Rome at the time when wealth was most lavishly squandered.

Among other medical verse writers were Servilius Damocrates, who lived in the reign of the Emperor Tiberius, and who invented a famous tooth powder, a number of malagmata, (emollient poultices), acopa (liniments for pains), electuaries, and plasters; and Herennius Philon, a physician of Tarsus (about A.D. 50), whose fame rests on his philonium, a compound designed to relieve colic pains, which appear to have been specially frequent at that period. This philonium was composed of opium, saffron, pyrethrum, euphorbium, pepper, henbane, spikenard, and honey.

Menecrates, physician to Tiberius, and said to have written 155 works, was the inventor of diachylon plaster, but his diachylon was a compound of many juices (as the name implies) along with lead plaster.

The Romans were curiously badly off for regular doctors until Julius Cæsar specially tempted some to come from Greece and Egypt by offers of citizenship. Augustus, too, warmly encouraged the settlement in the city of trained medical men.

PHARMACY IN THE ROMAN EMPIRE.

The separation of the practices of medicine, pharmacy, and surgery, which became general though never universal, was of course a gradual process. Galen expresses the opinion that Hippocrates prepared the medicines he prescribed with his own hands, or at least superintended the production of them. According to Celsus, it was in Alexandria and about the year 300 B.C. that the division of the practice of medicine into distinct branches was first noticeable. The sections he names were Dietetics, Surgery and Pharmaceutics.

The physicians who practised dietetics were like our consultants, only more so. They were above all things philosophers, the recognised successors of the Greek thinkers and theorists, and but too often their imitators. Although they owed their designation to their general authority on régime, they prescribed and invented medicines. The pharmaceutical section came to be called in Latin medicamentarii, and their history corresponds closely with that of our English apothecaries. At first they prepared and administered the medicines which the physicians ordered. But in Alexandria and Rome they gradually assumed the position of general practitioners. To another class, designated by Pliny Vulnerarii, was left the treatment of wounds, and probably of tumours and ulcers. The necessity of a lower grade of medical practitioners in Rome is manifest from a remark of Galen’s to the effect that no physician, meaning a person in his own rank, would attend to diseases of minor importance.

It is worthy of note that the Latin designation medicamentarius, which was nearly equivalent to the Greek pharmacopolis, was similarly used to mean a poisoner, while pharmakon in Greek and medicamentus in Latin might mean either a medicine or a poison.

It is noted elsewhere (page 52) that the word pharmakeia when it occurs in the New Testament is universally translated in our versions by the term sorcery or some similar word. At the time when the Apostles wrote this was evidently the prevalent meaning attached to the term. But in earlier Greek literature the reputable and the disgraceful ideas associated with the word seem to have run side by side for centuries. Homer uses pharmakon in both senses; Plato makes pharmakeuein mean to administer a remedy, while Herodotus adopts it to signify the practice of sorcery. Apparently this word came from an earlier, pharmassein, which was derived from a root implying to mix, and the gradual sense development was that of producing an effect by means of drugs. They might produce purging, they might produce a colour, or they might produce love.

The multiplication of names for the various classes connected with medicine and pharmacy in the Roman world is rather confusing. As the language of medicine up to and including Galen was largely Greek, many of the designations employed were those which had been drawn from that tongue. The name Pharmacopeus, used in Greek to denote certain handlers of drugs, had always a sinister signification. It suggested a purveyor of noxious drugs, a compounder of philtres, a vendor of poisons. The men who kept shops for the sale of drugs generally were called pharmacopoloi. This term was not free from reproach, because it was a common appellation, not only of the shopkeepers strictly so-called, but was also applied to the periodeutes, or agyrtoi, travelling quacks or assembly gatherers, or as they came to be named in Latin, circulatores or circumforanei.

These itinerant drug sellers are occasionally referred to by the classic authors. Lucian speaks of one hawking a cough mixture about the streets; and Cicero, in his Oratia pro Cluentio, suggests that the travelling pharmacopolists who attended the markets of country towns were not unwilling to sell poisons as well as medicines when they were wanted. One of these is specifically named, Lucius Clodius, and the orator suggests that he was bribed to supply medicines to a certain lady which were to have a fatal effect.

The designation Periodeutes meant originally, and always in strict legal terminology, physicians who visited their patients. The term was also used among the Christians to describe the ministers charged to visit the sick and poor in their dioceses.

The tramp doctor in time gets tired of his vagabond life, and, it may be, a little weary of hearing his own voice. If he has saved a little money, therefore, the attractions of a shop in the city, where he can exercise his healing on people who seek him, appeal strongly to him. So in Greece and in the Roman Empire the charlatans settled in little shops and were called iatroi epidiphrioi or sellularii medici, meaning sedentary doctors. But all these were pharmacopoloi.

Peculiarly interesting is the suggestion made by Epicurus and intended as a sneer, that Aristotle was one of these pharmacopoloi in his younger days. According to Epicurus the philosopher having first wasted his patrimony in riotous living and then served as a soldier, afterwards sold antidotes in the markets up to the time when he joined Plato’s classes.

Seplasia was the ordinary name in Rome for a druggist’s shop, and those who kept them were designated Seplasiarii or Pigmentarii. These names appear to have been used without much recognition of their original meanings. Strictly the Seplasiarii were ointment makers, and though the Pigmentarii were no doubt at first sellers of dyes and colours, they evidently came to include medicines in their stocks of pigments, and Coelius Aurelianus, in writing on stomach complaints, alludes to aloes as a pigment. Greek designations corresponding to those just quoted were Pantopoloi and Kadolikoi (the latter used by Galen in referring to the trader who supplied the drugs for the theriacum prepared in the palace of the Emperor Antoninus). Kopopoloi, and Migmatopoloi, both of which words meant dealers in all sorts of small wares, were like the mercers in this country when shopkeeping first began. The shops of perfumers were myropolia or myrophecia, the perfumers themselves were myrepsi. A general term in Latin for any sort of shop where medicines were sold or surgical operations performed was Medicina. This was in the days before the Empire, when there was no usual distinction between the branches of the healing art.

Pharmacotribae, strictly drug-grinders, may have been compounders, and it has also been conjectured that they were the assistants employed by the Seplasiarii or Roman druggists.

Herbalists were of very ancient Greek lineage, under the names of Botanologoi, who were collectors of simples, and who, to enhance the price of their wares, pretended to have to gather them with many superstitious observances; and Rhizotomoi, or root-cutters. The name Apothek, which came to be appropriated to the warehouse where medicinal herbs were kept, and which is to-day the German equivalent of our pharmacy, or chemist’s shop, meant originally any warehouse, and from it has been derived the French boutique and the Spanish bodega.

The earlier Greek and Roman physicians were in the habit of themselves preparing the medicines they prescribed for their patients. But naturally they did not gather their own herbs, and as many of those used for medicine were exotics, it is obvious that they could not have done so if they had wished. The herbalists who undertook this duty (botanologoi in Greek) developed into the seplasiarii, pharmacopoloi, medicamentarii, and pigmentarii already mentioned. Beckmann says they competed with the regular physicians, having acquired a knowledge of the healing virtues of the commodities they sold, and the methods of compounding them. This could not help happening, but it ought to be remembered that the physicians of all countries had themselves developed from herbalists, that is, if we abandon the theories of miraculous instruction which are found among the legends of Egypt, Assyria, India, and Greece.

How similar the relations of the doctors and druggists of ancient Rome were with those still prevailing in this country may be gathered from a reproach levelled by Pliny against physicians contemporary with him (Bk. xxxiv, 11) to the effect that they purchased their medicines from the seplasiarii without knowing of what they were composed.

VI

ARAB PHARMACY.

In the science of medicine the Arabians have been deservedly applauded. The names of Mesua and Geber, of Razis and Avicenna, are ranked with the Grecian masters; in the city of Bagdad 860 physicians were licensed to exercise their lucrative profession; in Spain the lives of the Catholic princes were entrusted to the skill of the Saracens; and the School of Salerno, their legitimate offspring, revived in Italy and Europe the precepts of the healing art.--GIBBON: “Decline and Fall of the Roman Empire,” Chap. LII.

No period of European history is more astonishing than the records of the triumphant progress of the Arab power under the influence of the faith of Islam. From the earliest times this grand Semitic race was distinguished for learning of a certain character, for gravity, piety, superstition, a poetic imagination, and eloquence. Centuries of independence, jealously guarded, and innumerable local feuds made the material of perfect soldiers, and when Mohammed had grafted on the native religious character his own faith and missionary zeal the Arab army, the Saracens, as they came to be called, filled with fanatic fervour, and utterly indifferent to death, or, rather, eager for it as the introduction to the Paradise which their prophet had seen and told them of, formed such an irresistible force as on a small scale has only been reproduced by Cromwell in our nation.

But the rapidity of the conquests of Mohammedanism was perhaps less remarkable than the extraordinary assimilation of ancient learning and the development of new science among these hitherto unlettered Arabs. Mohammed was born in the year 569 of our era. The Koran was the first substantial piece of Arabic literature. Alexandria was taken and Egypt conquered by the Moslems under Amrou in A.D. 640, Persia and Syria having been previously subdued. Amrou was himself disposed to yield to the solicitations of some Greek grammarians, who implored him to spare the great Library of the city, the depository of the learning of the ancient world. But he considered it necessary to refer the request to the Caliph Omar. The reply of the Commander of the Faithful is one of the most familiar of the stories in Gibbon’s fascinating history. “If the writings support the Koran they are superfluous; if they oppose it they are pernicious; burn them.” It is declared that the papers and manuscripts served as fuel for the baths of the city for six months.

The destruction of the Alexandrian Library is often alluded to as a signal triumph of barbarism over civilisation. Gibbon cynically remarks that “if the ponderous mass of Arian and Monophysite controversy were indeed consumed in the public baths a philosopher may allow with a smile that it was ultimately devoted to the benefit of mankind.” But at least the spirit which animated Omar in 640 may be noted for comparison with the encouragement of learning which was soon to characterise the Arab rulers.

Only a lifetime later, in A.D. 711, the sons of the Alexandrian conquerors invaded Spain, and within the same century made their western capital, Cordova, the greatest centre of learning, civilisation, and luxury in Europe. The following quotation from Dr. Draper’s “History of the Intellectual Development of Europe” will give an idea of this achievement:

Scarcely had the Arabs become firmly settled in Spain than they commenced a brilliant career. Adopting what had become the established policy of the Commanders of the Faithful in Asia, the Emirs of Cordova distinguished themselves as patrons of learning, and set an example of refinement strongly contrasting with the condition of the native European Princes. Cordova under their administration, at the highest point of their prosperity, boasted of more than two hundred thousand houses, and more than a million inhabitants. After sunset a man might walk through it in a straight line for ten miles by the light of the public lamps. Seven hundred years after this time there was not so much as one public lamp in London. Its streets were solidly paved. In Paris, centuries subsequently, whoever stepped over his threshold on a rainy day stepped up to his ankles in mud. Other cities, as Granada, Seville, Toledo, considered themselves rivals of Cordova. The palaces of the Khalifs were magnificently decorated. Those sovereigns might well look down with supercilious contempt on the dwellings of the rulers of Germany, France, and England, which were scarcely better than stables--chimneyless, windowless, with a hole in the roof for the smoke to escape, like the wigwams of certain Indians.

About the same time the passion for learning was growing in the East. Bagdad was founded A.D. 762, and about the year 800 Haroun Al-Raschid founded the famous university of that city. Libraries and schools were established throughout the two sections of the Saracenic dominions. Greek and Latin works of philosophy and science were translated, but the licentious and blasphemous mythology of the classical poets was abhorred by this serious nation, and no Arabic versions of Olympian fables were ever made. Astronomy, mathematics, metaphysics, and the arts of agriculture, of horticulture, of architecture, of war, and of commerce, were advanced to an extent which this century does not realise, while amid all this progress the study of chemistry, medicine, and pharmacy was pursued with particular eagerness.

Curiously the Arabs owed their instruction in these branches of knowledge to those whom we are accustomed to regard as their traditional foes. The dispersion of the Nestorians after the condemnation of their doctrines by the Council of Ephesus in A.D. 431 resulted in the foundation of a Chaldean Church and the establishment of famous colleges in Syria and Persia. In these the science of the Greeks, the philosophy of Aristotle, and the medical teaching of Hippocrates were kept alive when they had been banished by the Church from Constantinople. The Jews had also acquired special fame for medical skill throughout the East, and they and the Nestorians appear to have associated in some of the schools. It was to these teachers the Arabs turned when, having assured their military success, they demanded intellectual advancement. The Caliphs not only tolerated, they welcomed the assistance of the “unbelievers,” and, in fact, depended on them for the equipment of their own schools, and for the private tuition of their children. To John Mesuë, a Nestorian, and a famous writer on medicine and pharmacy, Haroun Al-Raschid entrusted the superintendence of the public schools of Bagdad.

The first Nestorian college is believed to have been established in the city of Dschondisabour in Chuzistan (Nishapoor), before the revelation of Mohammed. Theology and Medicine were particularly studied at this seat of learning, and a hospital was established to which the medical students were admitted, but they had first to be examined in the Psalms, the New Testament, and in certain books of prayers.