The monasteries are thus seen to have been in touch with Greek medicine from the earliest medieval time. The other important historical documents relating to Medieval Medicine which we possess concern the work of the men born and brought up in Asia Minor, for whom the Greeks were so close as to be living influences. Aetius, Alexander of Tralles, and Paul of JEgma have each written a series of important chapters on medical subjects, full of interest because the writers knew their Greek classic medicine, and were themselves making important observations. Aetius, for instance, had a good idea of diphtheria. He speaks of it in connection with other throat manifestations under the heading of 44 crusty and pestilent ulcers of the tonsils." He divides the anginas generally into four kinds. The first consists of inflammation of the fauces with the classic symptoms; the second presents no inflammation of the mouth nor of the fauces, but is complicated by a sense of suffocation —apparently our neurotic croup. The third consists of external and internal inflammation of the mouth and throat, extending towards the chin. The fourth is an affection rather of the neck, due to an inflammation of the vertebras—retropharyngeal abscess—which may be followed by luxation, and is complicated by great difficulty of respiration. All of these have as a common symptom difficulty of swallowing. This is greater in one variety than in another at different times. In certain affections he remarks that even 44 drinks when taken are returned through the nose".
Aetius declares quite positively that all the tumours of the neck region, with the exception of scirrhus, are easily cured, yielding either to surgery or to remedies. The exception is noteworthy. He evidently saw a good many of the functional disturbances and the enlargements of the thyroid gland, which are often so variable in character as apparently to be quite amenable to treatment, and which have actually been " cured " in the history of medicine by all sorts of things from the touch of the hangman's rope to the wrapping of the shed skin of the snake around the neck. A few cervical tumours were beyond resource. Aetius suggests the connection between hypertrophy of the clitoris and certain exaggerated manifestations of the sexual instinct, as well as the development of vicious sexual habits.
It requires only a little study of this early medieval author to understand why Cornelius, at the time of the Renaissance, was ready to declare : " Believe me, that whoever is deeply desirous of studying things medical, if he would have the whole of Galen abbreviated and the whole of Orbiasius extended, and the whole of Paulus (of ^Egina) amplified; if he would have all the special remedies of the old physicians, as well in pharmacy as in surgery, boiled down to a summa for all affections, he will find it in Aetius".
Alexander of Tralles was, as we have said, the brother of the architect of Santa Sophia of Constantinople, and his writings on medical and surgical subjects are worthy of such a relationship. His principal work is a treatise on the " Pathology and Therapeutics of Internal Diseases " in twelve books, the first eleven books of which were evidently material gathered for lectures or teaching purposes. He treats of cough as a symptom due to hot or cold, dry or wet, dyscrasias. Opium preparations judiciously used he thought the best remedies, though he recommended also the breathing in of steam impregnated with various ethereal resins.
He outlines a very interesting because thoroughly modern treatment of consumption. He recommends an abundance of milk with a hearty nutritious diet, as digestible as possible. A good auxiliary to this treatment in his opinion was change of air, a sea voyage, and a stay at a watering-place. Ass's and mare's milk are much better for these patients than cow's and goat's milk. We realize now that there is not enough difference in the composition of these various milks to make their special prescription of physical importance, but it is probable that the suggestive influence of the taking of an unusual milk had a very favourable effect upon patients, and this effect was renewed with every drink taken, so that much good was ultimately accomplished. For haemoptysis, especially when it was acute and due, as Alexander felt, to the rupture of a bloodvessel in the lungs, he recommended the opening of a vein at the elbow or the ankle—in order to divert the blood from the place of rupture to the healthy parts of the circulation. He insisted, however, that the patients must in addition rest, as well as take acid and astringent drinks, while cold compresses should be placed upon the chest [our ice-bags], and that they should take only a liquid diet, at most lukewarm, or, better, if agreeable to them, cold. When the bleeding stopped, he declared a milk cure [blood-maker] very useful for the restoration of these patients to their former strength.
He paid particular attention to diseases of the nervous system, and discussed headache at some length. Chronic or recurrent headache he attributed to diseases of the brain, plethora, biliousness, digestive disturbances, insomnia, and prolonged worry. Hemicrania he thought due to the presence of toxic materials, though it was also connected with abdominal disorders, especially in women. Alexander has much to say of the paralytic and epileptic conditions, and recommended massage, rubbings, baths, and warm applications for the former, and emphasized the need for careful directions as to the mode of life, and special attention to the gastro-intestinal tract, in the latter. A plain, simple diet, with regular bowels, he considers the most important basis for any successful treatment of epilepsy. Besides, he recommended baths, sexual abstinence, and regular exercise. He rejected treatment of the condition by surgery of the head, either by trephining or by incisions or by cauterization. His teaching is that of those who have had most experience with the disease in our own time. For sore throat he prescribes gargles or light astringents at the beginning, and stronger astringents, alum and soda dissolved in water, later in the case.