He particularly emphasized that trust should not be placed in any single method of treatment. Every available means of bringing relief to the patient should be tried. " The duty of the physician is to cool what is hot, to warm what is cold, to dry what is moist, and to moisten what is dry. He should look upon the patient as a besieged city, and try to rescue him with every means that art and science placed at his command. The physician should be an inventor, and think out new ways and means by which the cure of the patient's affection and the relief of his symptoms may be brought about." The most important factor in Alexander's therapeutics is his diet. Watering-places and various forms of mineral waters, as well as warm baths and sea baths, are constantly recommended by him. He took strong ground against the use of many drugs, and the rage for operating. The prophylaxis of disease is in Alexander's opinion the important part of the physician's duty. His treatment of fever shows the application of his principle : cold baths, cold compresses, and a cooling diet, were his favourite remedies. He encouraged diaphoresis nearly always, and gave wine and stimulating drugs when the patient was very weak.
Some of the general principles of medical practice which Alexander lays down are very significant even from our modern standpoint. He deprecated drastic remedies of all kinds. He did not believe in severe purgation nor in profuse or sudden bloodletting. His diagnosis was thorough and careful. He insisted particularly on inspection and palpation of the whole body; on careful examination of the urine, of the faeces, and the sputum; on study of the pulse and the breathing. He dwelt on the fact that much might be learned from the patient's history taken carefully. The general constitution was the most important element, in his estimation. His therapeutics is, above all, individual. Remedies must be administered with careful reference to the constitution, the age, the sex, and the condition of the patient's strength. Special attention must always be paid to seconding nature's efforts to cure. Alexander had no sympathy at all with the idea that nature was to be disturbed, much less that remedies must work in opposition to natural tendencies to recovery.
Paul of JEgma, educated at the University at Alexandria, probably flourished during the reign of the Emperor Heraclius, who died 641 ; his works contain more of surgical than of medical interest.
The Arab writer, Abul Farag, to whose references we owe the definite placing of the time when Paul lived, said that " he had special experience in women's diseases, and had devoted himself to them with great industry and success. The midwives of the time were accustomed to go to him and ask his counsel with regard to accidents that happen during and after parturition. He willingly imparted his information, and told them what they should do. For this reason he came to be known as the Obstetrician." Perhaps the term should be translated the man-midwife, for it was rather unusual for men to have much knowledge of this subject. His knowledge of the phenomena of menstruation was wide and definite. He knew a great deal of how to treat its disturbances. He seems to have been the first one to suggest that in metrorrhagia, with severe haemorrhage from the uterus, the bleeding might be stopped by putting ligatures around the limbs. This same method has been suggested for severe haemorrhage from the lungs as well as from the uterus in our own time. In hysteria he also suggested ligature of the limbs, and it is easy to understand that this might be a very strongly suggestive treatment for the severer forms of hysteria. It is possible, too, that the modification of the circulation to the nervous system induced by the shutting off of the circulation in large areas of the body might very well have a favourable physical effect in this affection. Paul's description of the use of the speculum is as complete as that in any modern textbook of gynaecology.
In the chapter on the medieval care of the insane, there are some clinical observations and suggestions as to treatment from Paul which make it very clear what a careful observer he was, and how rational in his application of such knowledge as he had to the treatment of patients. Probably his contributions to the difficult subject psychiatry, well above a thousand years ago, will serve to make his genius as a physician clearer than almost anything else that could be said of him.
Among the great Arabian physicians who represent the transition period, from the earlier Middle Ages directly under Greek influence, still surviving to the later Middle Ages, when the earlier Renaissance brought back the Greek masters once more, were Rhazes, Ali Abbas, Avicenna—whose name had been transformed from the Arabic Ibn Sina—Abulcasis, Avenzoar, and Averroes, the last named a philosophic theorist but not a physician. The first three named were born in the East, the last three in Spain. Besides these Maimonides, the great Jewish physician, who was born and educated at Cordova in Spain, deserves a place. In this earlier period Rhazes must be mentioned, while the others who merit special attention will be considered in the chapter on Later Medieval Medicine.
Rhazes (died 932) is one of the great epoch-makers in the history of medicine. He was the first to give us a clear description of smallpox. Some of his medical aphorisms are well worth noting, and make it very clear that he was a careful observer.
" When you can heal by diet, prescribe no other ^ remedy; and where simple remedies suffice, do not take complicated ones".
Rhazes knew well the value of the influence of mind over body even in serious organic disease, and even though death seemed impending. One of his aphorisms is : " Physicians ought to console their patients even if the signs of impending death seem to be present." He considered the most valuable thing for the physician to do was to increase the patient's natural vitality. Hence his advice: "In treating a patient, let your first thought be to strengthen his natural vitality. If you strengthen that, you remove ever so many ills without more ado. If you weaken it, however, by the remedies that you use, you always work harm." The simpler the means by which the patient's cure can be brought about, the better in his opinion. He insists again and again on diet rather than artificial remedies. " It is good for the physician that he should be able to cure disease by means of diet, if possible, rather than by means of medicine." Another of his aphorisms seems worth while quoting : " The patient who consults a great many physicians is likely to have a very confused state of ^ mind".
/ During the ninth and tenth centuries the Arabs continued to be the most important contributors to medicine, until the rise of the school at Salerno gave a new impetus to clinical observation, and furnished a new focus of medical attention in the West. Constantine brought whatever of Arab influence there was in Salerno, as we have pointed out in the chapter on the Beginnings of Medical Education; but after his time there is an originality about Salernitan medicine which makes it of great value as the foster-mother of the sciences related to medicine during the later Middle Ages.