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.

Another Roman surgeon, Heliodorus, not only describes the use of the ligature in stopping hemorrhage, but also the practice of torsion - twisting smaller vessels, which causes their lining membrane to contract in a manner that produces coagulation and stops hemorrhage. It is remarkable that so simple and practical a method as the use of the ligature in stopping hemorrhage could have gone out of use, once it had been discovered; but during the Middle Ages it was almost entirely lost sight of, and was not reintroduced until the time of Ambroise Pare, in the sixteenth century.

Even at a very early period the Romans recognized the advantage of surgical methods on the field of battle. Each soldier was supplied with bandages, and was probably instructed in applying them, something in the same manner as is done now in all modern armies. The Romans also made use of military hospitals and had established a rude but very practical field-ambulance service. "In every troop or bandon of two or four hundred men, eight or ten stout fellows were deputed to ride immediately behind the fighting-line to pick up and rescue the wounded, for which purpose their saddles had two stirrups on the left side, while they themselves were provided with water-flasks, and perhaps applied temporary bandages. They were encouraged by a reward of a piece of gold for each man they rescued. 'Noscomi' were male nurses attached to the military hospitals, but not inscribed 'on strength' of the legions, and were probably for the most part of the servile class."[6]

From the time of the early Alexandrians, Herophilus and Erasistratus, whose work we have already examined, there had been various anatomists of some importance in the Alexandrian school, though none quite equal to these earlier workers. The best-known names are those of Celsus (of whom we have already spoken), who continued the work of anatomical investigation, and Marinus, who lived during the reign of Nero, and Rufus of Ephesus. Probably all of these would have been better remembered by succeeding generations had their efforts not been eclipsed by those of Galen. This greatest of ancient anatomists was born at Pergamus of Greek parents. His father, Nicon, was an architect and a man of considerable ability. Until his fifteenth year the youthful Galen was instructed at home, chiefly by his father; but after that time he was placed under suitable teachers for instruction in the philosophical systems in vogue at that period. Shortly after this, however, the superstitious Nicon, following the interpretations of a dream, decided that his son should take up the study of medicine, and placed him under the instruction of several learned physicians.

Galen was a tireless worker, making long tours into Asia Minor and Palestine to improve himself in pharmacology, and studying anatomy for some time at Alexandria. He appears to have been full of the superstitions of the age, however, and early in his career made an extended tour into western Asia in search of the chimerical "jet-stone" - a stone possessing the peculiar qualities of "burning with a bituminous odor and supposed to possess great potency in curing such diseases as epilepsy, hysteria, and gout."

By the time he had reached his twenty-eighth year he had perfected his education in medicine and returned to his home in Pergamus. Even at that time he had acquired considerable fame as a surgeon, and his fellow-citizens showed their confidence in his ability by choosing him as surgeon to the wounded gladiators shortly after his return to his native city. In these duties his knowledge of anatomy aided him greatly, and he is said to have healed certain kinds of wounds that had previously baffled the surgeons.

In the time of Galen dissections of the human body were forbidden by law, and he was obliged to confine himself to dissections of the lower animals. He had the advantage, however, of the anatomical works of Herophilus and Erasistratus, and he must have depended upon them in perfecting his comparison between the anatomy of men and the lower animals. It is possible that he did make human dissections surreptitiously, but of this we have no proof.

He was familiar with the complicated structure of the bones of the cranium. He described the vertebrae clearly, divided them into groups, and named them after the manner of anatomists of to-day. He was less accurate in his description of the muscles, although a large number of these were described by him. Like all anatomists before the time of Harvey, he had a very erroneous conception of the circulation, although he understood that the heart was an organ for the propulsion of blood, and he showed that the arteries of the living animals did not contain air alone, as was taught by many anatomists. He knew, also, that the heart was made up of layers of fibres that ran in certain fixed directions - that is, longitudinal, transverse, and oblique; but he did not recognize the heart as a muscular organ. In proof of this he pointed out that all muscles require rest, and as the heart did not rest it could not be composed of muscular tissue.

Many of his physiological experiments were conducted upon scientific principles. Thus he proved that certain muscles were under the control of definite sets of nerves by cutting these nerves in living animals, and observing that the muscles supplied by them were rendered useless. He pointed out also that nerves have no power in themselves, but merely conduct impulses to and from the brain and spinal-cord. He turned this peculiar knowledge to account in the case of a celebrated sophist, Pausanias, who had been under the treatment of various physicians for a numbness in the fourth and fifth fingers of his left hand. These physicians had been treating this condition by applications of poultices to the hand itself. Galen, being called in consultation, pointed out that the injury was probably not in the hand itself, but in the ulner nerve, which controls sensation in the fourth and fifth fingers. Surmising that the nerve must have been injured in some way, he made careful inquiries of the patient, who recalled that he had been thrown from his chariot some time before, striking and injuring his back. Acting upon this information, Galen applied stimulating remedies to the source of the nerve itself - that is, to the bundle of nerve-trunks known as the brachial plexus, in the shoulder. To the surprise and confusion of his fellow-physicians, this method of treatment proved effective and the patient recovered completely in a short time.

Although the functions of the organs in the chest were not well understood by Galen, he was well acquainted with their anatomy. He knew that the lungs were covered by thin membrane, and that the heart was surrounded by a sac of very similar tissue. He made constant comparisons also between these organs in different animals, as his dissections were performed upon beasts ranging in size from a mouse to an elephant. The minuteness of his observations is shown by the fact that he had noted and described the ring of bone found in the hearts of certain animals, such as the horse, although not found in the human heart or in most animals.

His description of the abdominal organs was in general accurate. He had noted that the abdominal cavity was lined with a peculiar saclike membrane, the peritoneum, which also surrounded most of the organs contained in the cavity, and he made special note that this membrane also enveloped the liver in a peculiar manner. The exactness of the last observation seems the more wonderful when we reflect that even to-day the medical, student finds a correct understanding of the position of the folds of the peritoneum one of the most difficult subjects in anatomy.

As a practical physician he was held in the highest esteem by the Romans. The Emperor Marcus Aurelius called him to Rome and appointed him physician-inordinary to his son Commodus, and on special occasions Marcus Aurelius himself called in Galen as his medical adviser. On one occasion, the three army surgeons in attendance upon the emperor declared that he was about to be attacked by a fever. Galen relates how "on special command I felt his pulse, and finding it quite normal, considering his age and the time of day, I declared it was no fever but a digestive disorder, due to the food he had eaten, which must be converted into phlegm before being excreted. Then the emperor repeated three times, 'That's the very thing,' and asked what was to be done. I answered that I usually gave a glass of wine with pepper sprinkled on it, but for you kings we only use the safest remedies, and it will suffice to apply wool soaked in hot nard ointment locally. The emperor ordered the wool, wine, etc., to be brought, and I left the room. His feet were warmed by rubbing with hot hands, and after drinking the peppered wine, he said to Pitholaus (his son's tutor), 'We have only one doctor, and that an honest one,' and went on to describe me as the first of physicians and the only philosopher, for he had tried many before who were not only lovers of money, but also contentious, ambitious, envious, and malignant."[7]

It will be seen from this that Galen had a full appreciation of his own abilities as a physician, but inasmuch as succeeding generations for a thousand years concurred in the alleged statement made by Marcus Aurelius as to his ability, he is perhaps excusable for his open avowal of his belief in his powers. His faith in his accuracy in diagnosis and prognosis was shown when a colleague once said to him, "I have used the prognostics of Hippocrates as well as you. Why can I not prognosticate as well as you?" To this Galen replied, "By God's help I have never been deceived in my prognosis."[8] It is probable that this statement was made in the heat of argument, and it is hardly to be supposed that he meant it literally.

His systems of treatment were far in advance of his theories regarding the functions of organs, causes of disease, etc., and some of them are still first principles with physicians. Like Hippocrates, he laid great stress on correct diet, exercise, and reliance upon nature. "Nature is the overseer by whom health is supplied to the sick," he says. "Nature lends her aid on all sides, she decides and cures diseases. No one can be saved unless nature conquers the disease, and no one dies unless nature succumbs."

From the picture thus drawn of Galen as an anatomist and physician, one might infer that he should rank very high as a scientific exponent of medicine, even in comparison with modern physicians. There is, however, another side to the picture. His knowledge of anatomy was certainly very considerable, but many of his deductions and theories as to the functions of organs, the cause of diseases, and his methods of treating them, would be recognized as absurd by a modern school-boy of average intelligence. His greatness must be judged in comparison with ancient, not with modern, scientists. He maintained, for example, that respiration and the pulse-beat were for one and the same purpose - that of the reception of air into the arteries of the body. To him the act of breathing was for the purpose of admitting air into the lungs, whence it found its way into the heart, and from there was distributed throughout the body by means of the arteries. The skin also played an important part in supplying the body with air, the pores absorbing the air and distributing it through the arteries. But, as we know that he was aware of the fact that the arteries also contained blood, he must have believed that these vessels contained a mixture of the two.

Modern anatomists know that the heart is divided into two approximately equal parts by an impermeable septum of tough fibres. Yet, Galen, who dissected the hearts of a vast number of the lower animals according to his own account, maintained that this septum was permeable, and that the air, entering one side of the heart from the lungs, passed through it into the opposite side and was then transferred to the arteries.

He was equally at fault, although perhaps more excusably so, in his explanation of the action of the nerves. He had rightly pointed out that nerves were merely connections between the brain and spinal-cord and distant muscles and organs, and had recognized that there were two kinds of nerves, but his explanation of the action of these nerves was that "nervous spirits" were carried to the cavities of the brain by blood-vessels, and from there transmitted through the body along the nerve-trunks.

In the human skull, overlying the nasal cavity, there are two thin plates of bone perforated with numerous small apertures. These apertures allow the passage of numerous nerve-filaments which extend from a group of cells in the brain to the delicate membranes in the nasal cavity. These perforations in the bone, therefore, are simply to allow the passage of the nerves. But Galen gave a very different explanation. He believed that impure "animal spirits" were carried to the cavities of the brain by the arteries in the neck and from there were sifted out through these perforated bones, and so expelled from the body.

He had observed that the skin played an important part in cooling the body, but he seems to have believed that the heart was equally active in overheating it. The skin, therefore, absorbed air for the purpose of "cooling the heart," and this cooling process was aided by the brain, whose secretions aided also in the cooling process. The heart itself was the seat of courage; the brain the seat of the rational soul; and the liver the seat of love.

The greatness of Galen's teachings lay in his knowledge of anatomy of the organs; his weakness was in his interpretations of their functions. Unfortunately, succeeding generations of physicians for something like a thousand years rejected the former but clung to the latter, so that the advances he had made were completely overshadowed by the mistakes of his teachings.