Medical Profession in Patristic Times, The
From a merely cursory glance at the publishers' lists one gathers that contemporary interest in medicine is widespread. Never has an age been so prolific in books on the subject. It is, however, only in the extent of its interest that our age is unique, for in every era, as students of literature are aware, the medical profession has received not a little attention. Particularly is this true of the early Christian centuries, a fact to which the writings of the Fathers of the Church testify. Their works abound in allusions to medicine.
Various reasons may be adduced to account for this interest on the part of the Fathers. In the first place, there has ever been a close bond between the healers of physical and of spiritual ills. Then, it was to the medical art that patristic writers turned for illustrations in defending and clarifying Christian teachings. Some of the Fathers had themselves studied medicine, and all of them numbered physicians among their friends and acquaintances.
Despite this fact, standard histories of medicine give but brief consideration to patristic writings. The history of medicine, it is true, has only in recent years attained its academic majority, and contemporary investigation in the field has not as yet made many notable advances beyond the realm of scientific medical writings properly so called. The chief reason, nevertheless, that the works of the Fathers have been ignored, or when consulted, treated with disdain, is the persistence of certain misconceptions of the nineteenth century relative to the Fathers of the Church and science. Foremost among these misconceptions is the notion that not only were the Fathers themselves woefully ignorant of things scientific, but that they sought to prevent by all means in their power both the acquisition and dissemination of any such knowledge. It was particularly in the field of medicine that they were considered hopelessly obscurantist. Belief in miracles and in the curative power of prayer was held accountable for this obscurantism. Miracles, it was objected, could not and did not exist, and belief in them was incompatible with interest in or devotion to scientific and practical medicine.
How erroneous these views are, those who read the Fathers may see. What has been persistently ignored is the evidence that the miraculous cure was unusual, that such methods were employed, in most instances, only after natural means had proved of no avail. St. Gregory Nazianzen's admonition is typical. Those who are ill should seek the ministration of a physician. Proper care should be taken of the body because of its Creator. For the same reason, the bodies of others should be cared for not less diligently, since all are one in Christ.
In a sketch such as this, limitations of space preclude anything like a detailed treatment of the subject. Only references to the physician, to therapeutics, and to surgery have been assembled here. These have been selected from the writings of St. Basil (329-379), St. Gregory Nazianzen (325-389), St. Gregory of Nyssa (331-394), and St. Augustine (354-430), because of their varied and more interesting character.
It was doubtless because of his own infirmities that St. Basil manifested on all occasions his appreciation of physicians. His references to them indicate that they were men of learning and skill. He esteemed theirs as the highest of professions, since all who practiced it practiced philanthropy as well. He considered his own physician not only highly expert in medical knowledge, but helpful in the cure of spiritual ills also.
The fact that St. Basil and his friend, St. Gregory Nazianzen had studied medicine at Athens, lends a particular interest to the allusions found in their works. According to St. Gregory, St. Basil mastered both the theoretical and the practical branches, but his greatest achievement in the medical field was the foundation of his hospital beyond the walls of Caesarea. This institution soon took on the proportions of a city "New Town," St. Gregory calls it. It was the first public hospital devoted especially to the care of the sick, but it also included a home for the poor and a hospice for travelers and strangers. It is to be regretted that neither Gregory nor Basil gives detailed information about it. In one of his letters, St. Basil states that all the buildings were a credit to the locality and a source of pride to the governor. Basil's devoted care of the lepers elicited eloquent praise from Gregory, who enthusiastically declares that the hospital deserved to be numbered among the wonders of the world, so numerous were the sick and the poor who came there, and so admirable were the devotion and efficiency with which they were served.
St. Gregory's interest in medicine lay chiefly in its theoretical aspects, although he zealously attended the sick with Basil while they were students at Athens. His brother St. Caesarius, however, was the most distinguished physician of his day, and Gregory recounts with fraternal pride the story of his brilliant career. Endowed with high intellectual gifts, distinguished in bearing with pleasing voice and kindly manner, the handsome young man appears to have been the ideal physician. After establishing a brilliant record as a student at Alexandria, where the best medical education was to be obtained, he went to Byzantium, the capital of the Empire and at that time the most important city in all Europe. Here, in virtue of his extraordinary ability, he soon attained pre-eminence in his profession. Public honors, a marriage into an illustrious family, and the senatorial dignity were offered to him. Caesarius refused them all, and in company with Gregory retired to Nazianzus to spend some time with his parents.
In the meantime, a special commission was sent to the Emperor to request that the city be honored by having Caesarius as its metropolitan archiater, or chief physician. Constantine, acceding to their wishes, appointed him to the office and raised him to the rank of count, whereupon, much to Gregory's dismay, Caesarius went to live at Court. Honors and revenues were showered upon him. In a short while his reputation surpassed that of even the senior physicians. Gregory attributes his brother's rise to fame to the fact that he ever made it a point of honor to place his services at the disposal of the authorities, refusing all remuneration. His indifference to riches and his devotion to the poor won for him the confidence of wealthier patients.
At Court he was the friend of the Emperor and of the high officials, all of whom were anticipating still greater achievements for him. Even Julian upon his accession loaded him with honors and flattery, hoping thereby, so Gregory believed, to win the devout young physician over to the revival of paganism. But Caesarius clung steadfastly to his Christian principles, and it was not long before a singular opportunity for proving his faith was afforded him. The apostate Emperor challenged him to a public debate, but strove in vain to outwit his intrepid opponent. After the debate Caesarius felt obliged to leave the city, although Julian had not formally commanded him to do so. Once again, to the great joy of his family, Caesarius retired to Nazianzus.
Upon the death of the Apostate, Jovian, his successor, summoned Caesarius to Court again. Later, Valens appointed him imperial treasurer in Bithynia, a position, Gregory states, which the Emperor intended to be the prelude to the highest offices of the state. After a disastrous earthquake in the province, Caesarius retired from public life in order to devote himself to things spiritual, and only a short while after died of a sudden illness.
St. Gregory of Nyssa shared his brother's (St. Basil's) admiration for medical men and referred to his friends among them frequently, but unfortunately for us, he fails to give any details about them. His chief concern was physiology.
St. Augustine's communicativeness on the subject of his physician friends is more to our liking. The glimpses, which he gives of these men in his writings, reveal their upright characters and high professional ideals. Several enjoyed prominent positions in the community. Thus, Hilarinus was the leader of the municipal senate in Hippo as well as the chief physician. A later incumbent of the office of chief physician was Dioscorus. The extraordinary cure of his daughter, to whom he was greatly devoted, was instrumental in bringing about his conversion. Prior to his conversion, Augustine states, the physician's contemptuous attitude toward Christians had been a blemish on an otherwise kindly nature. Maximus, a recent convert from Arianism, was a man of high social standing. St. Augustine hopes that his example will influence others.
It is in the Confessions that the Saint first mentions Vindicianus, a "skilled and renowned physician," the outstanding figure in the medical profession of his day. He had attained the rank of governor and it was in that capacity that he had awarded Augustine the crown of victory in a rhetorical contest. Vindicianus by his kind fatherly advice succeeded in reclaiming him, at that time a youthful teacher of rhetoric, from his dabblings in magic. Gennadius, another physician friend, had enjoyed a wide reputation as a practitioner in Rome before coming to Carthage. The Saint commends his deeply religious character and his generous and compassionate care of the poor.
There is one interesting reference to a slave practitioner. St. Augustine mentions his ignorance and states that the physicians called in to take charge of Innocentius, his master, refused to have him in the room with them when they held their consultations. Ironically enough, it was the slave's diagnosis, proffered without request and to the exasperation of his master, which proved to be the correct one.
In the City of God an incident is related of a famous Alexandrian surgeon his name is not given whose fine regard for the ethics of his profession had impressed St. Augustine. When asked to take over a particularly difficult case, the Alexandrian, after examining the procedure of the physicians in charge, persuaded the patient to allow these same men to continue with the case. He commended their skill and explained that the little to be done would not entitle him to take the credit for the cure.
The general references to the medical profession in the writings of the four Fathers considered in this sketch are striking in their similarity. There is frequent mention of the physician's patience, his untiring care, his calm acceptance of abuse when painful remedies have to be applied, his skill, his knowledge, his kindness. But there were charlatans and quacks, although references to them are few. Adopting the procedure of respectable practitioners, they played upon the credulity of the unsuspecting with clever impudence. Aetius, the heresiarch, was of their number. His colorful career, described at length by St. Gregory of Nyssa, makes entertaining, if not particularly edifying reading. His escape from serfdom marked the beginning of a devious advance. He became a tinker, but this phase of his career was brought to a close when he was punished for cheating a woman out of her gold ornaments. He next became an assistant to a wandering quack. This employment seems not to have been sufficiently lucrative for the ambitious assistant. A wealthy foreigner proved easy prey and the scheming Aetius was taken on as personal physician. Attendance at medical conventions marked his next advance. In these gatherings, St. Gregory explains, his faculty of always being on the winning side in an argument causes him to be in frequent demand among the controversialists. His passion for controversy grew, and convinced finally that theology offered greater attractions in this line than medicine, he set about equipping himself for his new career. A knowledge of the chief tenets of the Arian heresy and some fine phrases from Aristotle proved sufficient. Thus was Aetius lost to the medical profession.
It was from his sister Macrina, who during her illness had noted carefully the physician's professional procedure, that St. Gregory of Nyssa obtained his detailed information on the subject. The posture of the patient, he explains, the loss of weight, the pale and somewhat bilious complexion, the expression of pain in the eyes, all revealed the internal condition to the glance of the experienced physician. The shortness of breath and the accompanying groans aided him in ascertaining the nature of the disease. Even the sense of smell helped, enabling him, as it did, to detect the kind of disorder, since "the particular quality of the breath indicates the secret sufferings of the vital organs." He also paid great attention to the pulse, for by it he believed he could determine in what organ the disease originated, whether or not it was inflammatory, and the degree of fever.
Physicians were all skilled in the preparation of drugs. They were fortunate, so St. Gregory of Nyssa believed, in not having to learn at their own peril the healing and the harmful drugs. Thanks to the experiments of earlier physicians, these had already been differentiated. Physicians had to know also the properties of drugs, the effects they produced, how long they retained their strength, to whom they would prove harmful, to whom helpful. If a drug were mixed with some other medicine, he had to be able to tell when the compound was capable of producing insensibility or torpor, and when it would cause death.
According to St. Gregory Nazianzen, the greater number of drugs were made from the roots and juices of plants, though some drugs were compounded from reptiles. St. Gregory of Nyssa mentions the medicinal properties of pine oil, mastic, saffron, balsam, laurel, the poppy, and wormwood as manifestations of God's skill and goodness in healing the ills of men. Although St. Augustine says that experience in many diseases necessarily brings about the invention of numerous remedies, there is nothing in his writings, or in those of "the three Cappadocians," to suggest that drugs were, as is sometimes charged, of overwhelming importance in the medicine of that day. Gregory of Nyssa's comments on the ill effects consequent on plying the incurably ill with drugs and his reminder to physicians that such a procedure can in no way add to their reputations, suggests, however, that there were some abuses in this respect.
Augustine and the two Gregorys testify that baths were still a part of the health regimen of their day. At least three passages in the writings of Gregory Nazianzen refer to the therapeutic use of natural springs. Cold and hot springs were both considered healing in their effect. Gregory himself was obliged by his physician to frequent those at Xanxaris, the usual resort of the people in Cappadocia. In a letter to Olympus, the governor of the region, he expresses the hope of meeting him there.
Diet also came within the physician's province, for "as the food we eat," St. Augustine remarks, "such is our resulting health." As with medicine, so with food, St. Gregory Nazianzen explains: the same kinds are not to be served in every case. A difference is to be observed according to the state of the patient's health. The locality, climate, season, and age of the person must be noted. Convalescents must be watched carefully lest by indulging their appetites in the manner of healthy persons they relapse into their former illnesses. Need and not pleasure should determine the measure of one's indulgence, though pleasure may mingle with the satisfaction of the need, for hunger sweetens everything.
All the Fathers inveigh against over-indulgence in food and drink, pointing out the fact that this evil destroys not only virtue but health as well. The excessive use of wine is particularly harmful since it confuses the mind and at the same time seriously injures the body. Most of the painful diseases, St. Gregory of Nyssa avers, can be traced to intemperance in eating and drinking, and St. Augustine maintains that it is difficult to cure persons whose illness is due to intemperate living.
Surgery, according to St. Gregory of Nyssa, was a severe form of treatment to be used only when less painful methods could not be considered. He mentions only the removal of unnatural excrescences such as tumors, warts, and wens. St. Augustine mentions operations for cancer, fistula, and blindness, all of which imply a considerable degree of skill on the part of the physician. Anesthesia, of course, was not to be used for several hundred years, so the frequent references to the painfulness of operations and the patient's dread of them can be readily understood.
There were usually spectators present during the operation whose endurance was often severely taxed. Augustine himself once witnessed the preparations for an operation, the details of which he describes vividly. There is the patient, pale with dread and fear. His friends strive to cheer and encourage him, while other spectators stand about in wonder and suspense. The surgeons arrive, the instruments they are horrible to look at are laid out, and the limbs of the patient are arranged and tied on the couch as required. The body is then laid bare and the surgeon stands, knife in hand, ready to begin his work.
The medical allusions found in the patristic writings do not, it is true, constitute anything like a systematic treatment of medicine. They do, however, afford some notion of the contemporary practitioner's professional knowledge and ideals, and they reflect rather clearly many of the popular medical theories of the times. They are interesting because of the light they throw on the careers of the outstanding physicians, and more important still, they add to our all too meager knowledge concerning St. Basil's great hygienic contribution in the establishment of his hospital at Caesarea. It is, furthermore, significant that the Fathers could write of the medical profession as they did. They reveal, albeit indirectly, that its weaknesses were the weaknesses of their times, but they likewise reveal, and quite clearly, its strength. That strength was the strength of a vigorous Christianity which was not only salvaging for future ages what was best in the ancient medical tradition, but was at the same time elevating and ennobling that tradition by the application of the teachings of its Divine Founder.
© 1943 Missionary Society of St. Paul the Apostle (The Paulist Fathers), New York.
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