CHAPTER III

ROMAN ANATOMY AND SURGERY

THAT study of anatomy and practice of surgery which within the bounds of the Roman Empire reached their culmination in the first and second centuries of the Christian era can be traced in their development from the medical science of the age of Hippocrates. Diocles of Carystus, who stood next to the sage of Cos in age and distinction, was a dissector of animals, and in a work on zoötomy described the heart, the large blood-vessels, and a greater number of the smaller vessels than had been recognized in earlier works. He agreed with his contemporary Plato, as well as one of the less authentic Hippocratic writings ("On the Heart"), in looking upon the heart as the source that sent its streams to all parts of the body. Diocles knew the œsophagus, the biliary ducts, the cæcum, the ureters, and the Fallopian tubes. He was the inventor of a bandage for the head, and of the graphiscus, a spoon-like instrument later used in the Roman armies to extract arrows and spears from wounds. He made use of opium as an anodyne, and distinguished pleurisy from pneumonia. Praxagoras of Cos was the first to differentiate veins and

arteries, the former filled with blood, the latter with vital air, or pneuma. He recorded the local conditions of pleurisy, was the first among the Greeks to recognize the importance of the pulse in diagnosis, and advised laparotomy, as a last resort, in intestinal obstruction, though there is no evidence that this operation was actually put in practice in his age. Diocles and Praxagoras are classed among the Dogmatists, who were under the influence of medical speculations concerning the pneuma (which in the opinion of Diocles was renewed by respiration) and concerning the four humors. For example, both Diocles and Praxagoras attributed epilepsy to a derangement of the humors, as did also the speculative philosopher Plato and the author of "On the Sacred Disease," who was more successful in stating what is not than what is the cause of that malady.

Aristotle of Stagira, the son of the Asclepiad Nicomachus and the pupil of Plato, laid the foundations of comparative anatomy by dissecting about fifty species of animals, including the deer, elephant, horse, ox, pig, domestic fowl, chamæleon (which had been made a special study by Democritus), tortoise, frog, sepia, crab, lobster, murex, and sea-urchin. He carried into his investigations the experimental spirit, which, contrary to the teachings of many historians, was never wanting in the medical science of antiquity. He vivisected some of the lower ani

mals, discovered that the tails of saurians would grow again after being cut off, that the chamæleon would continue to breathe for a considerable time after being cut open along its entire length, and he referred to the movements of the heart of the tortoise after the organ had been excised. Aristotle must be credited with a knowledge of the rudiments of histology, as he recognized the various tissues bone, blood, fat, skin, cartilage, hair, connective tissue, and so forth. He studied the embryos of various animals, observed the early appearance of the chick's heart, its brain and eyes, the rapid growth of the allantois from the fifth day of incubation, and the allantoic and vitelline blood-vessels on the sixth. He was well acquainted in the adult with the liver, spleen, jejunum, colon, sigmoid flexure, rectum, the trachea, the brain membranes and the network of blood-vessels covering the brain, the structure of the lungs and the richness of their blood supply. Perhaps his greatest single contribution was his study of the heart with its chordæ tendineæ, and his attempt to describe the arrangement of the blood-vessels, especially the branches of the aorta, as that vessel is called in the writings of this father of science. A brief quotation from the "Historia Animalium" will serve as an example of the many passages in which Aristotle anticipated the investigations of modern scientists. "The ear,"

he says, "is constructed internally like the trumpetshell, and the innermost bone is like the ear itself, and into it at the end the sound makes its way, as into the bottom of a jar. This receptacle does not communicate by any passage with the brain, but does so with the palate, and a vein extends from the brain towards it." He failed to understand the function of the nerves that lay before him, and employed the word neuron to indicate the material of the tendons, ligaments, and of the fibrin of the blood.

Luckily the structure and functions of the nerves and brain were to a considerable extent elucidated by the investigations of Herophilus and Erasistratus at the beginning of the third century B.C. They were enabled to carry on their investigations at Alexandria through the patronage of the Greek kings of Egypt, Ptolemy Soter and Ptolemy Philadelphus, who placed at their disposal the bodies of condemned criminals for experiment and dissection. Herophilus studied the membranes of the brain, the sinuses of the dura mater, and noted the dilatation of the superior longitudinal sinus now known as the wine-press of Herophilus (torcular Herophili). He examined carefully the ventricles of the brain with their choroid plexuses, especially the fourth ventricle, or ventricle of the cerebellum, which he considered as the seat of intelligence, and gave the

furrow at the floor of the ventricle a name corresponding to the Latin calamus scriptorius. Herophilus also traced a number of the nerves to their connection with the brain and cord, and recognized their function as transmitters of will and sensation. Erasistratus, in turn, compared the convolutions of the cerebrum to the folds of the jejunum, noted their greater complexity in man than in the lower animals, and ascribed the difference in complexity to difference of mental development. He agreed with Herophilus in regarding the cerebellum as the special seat of intelligence, and remarked that the structure of this part of the brain differs from that of the cerebrum. Erasistratus further agreed with Herophilus in dividing nerves into nerves of movement and nerves of sensation. He also taught that the nerves arise from the brain substance and are filled with marrow.

Herophilus contributed to other departments of anatomy. He taught that the arteries arise from the heart, have coats six times as thick as the veins, and that they carry blood and pneuma. He called the pulmonary artery the arterious vein, named the duodenum according to its length, noted the termination of the lacteals in gland-like bodies. He described the liver with some care, comparing the liver of man with that of the lower animals. He examined the salivary glands, the pancreas, the