PAST GLORIES THE GREAT LIBRARY OF ALEXANDRIA

Transcription

1 HISTORY OF MEDICINE PAST GLORIES THE GREAT LIBRARY OF ALEXANDRIA Rachel Hajar, MD, FACC* The world of books is the most remarkable creation of man. Nothing else that he builds ever lasts. Monuments fall; nations perish; civilizations grow old and die out; and, after an era of darkness, new races build others. But in the world of books are volumes that have seen this happen again and again, and yet live on, still young, still as fresh as the day they were written, still telling men s hearts of the hearts of men centuries dead. Clarence Day, F abled in antiquity for its treasures of wisdom, the Library of Alexandria was the envy of the civilized world. Alexandria was by no means the first great book repository, but because it contained antiquity s most extensive collection of recorded thought, it undoubtedly was the greatest. The library became a wonder of the scholarly world, eventually containing, it was said, 700,000 manuscripts, and its facilities included an observatory, zoological gardens, lecture halls, and rooms for research. For nine brilliant centuries, from around 300 BC to the 7 th century AD, Alexandria was a place of inspiration. Alexandria stood as a beacon of learning and discovery and played a central role in the development of medical thought and practice. The medical books in the library were dominated by Greek theories. To appreciate fully Alexandria s impressive position in the evolution of medical theory and practice, it is necessary to touch briefly on the great thinkers, Plato and Aristotle, for their ideas and doctrines were the cornerstones of Western thought, which profoundly influenced science and medicine in the West. Together with Hippocrates before them, and Galen afterwards, their doctrines were the roots of pagan, Christian, and Muslim medical thought. The Great Philosophers One might begin with philosophy but would end with medicine; or start with medicine and find oneself in philosophy. At first glance, Aristotle s *Director, Non-Invasive Cardiac Laboratory, Cardiology and Cardiovascular Surgery Dept., Hamad Medical Corporation, P.O. Box 3050, Doha, Qatar. rachel@hmc.org.qa saying may not seem relevant in today s technologically advanced medicine. But the questions that pervade all of philosophy: Who am I? What is the good life? are as relevant today as they were to the ancients because philosophy is a living tradition that has a bearing on how each of us lives our lives. Indeed, the word, medicine (from Latin medicinus or medicina), refers to a person, agency, or influence that affects wellbeing. The ideas of the philosophers Plato and Aristotle were among the important influences that shaped medical thinking. Plato (c BC), a contemporary of Hippocrates, a student of Socrates, and the teacher of Aristotle, became one of the most influential thinkers in the history of the Western world. Plato s interests lay mainly in the nature of the soul and matter, and his medical speculations, unsupported with direct experimentation, led to a number of faulty conclusions about the human body, which persisted for several centuries. His method of reasoning at a distance rather than actual anatomy or the bedside signs was resurrected and perpetuated in the Middle Ages. However, some of his teachings have a bearing on medical practice today, for he expected the ideal state to provide for the health of its citizens and to prevent poverty and overpopulation. Aristotle (c BC), son of a physician and pupil of Plato, also had a profound influence on later medicine, especially among the Arabic authors. Aristotle s methods were based on careful investigations of both animals and humans, and his studies were milestones in science. He described the early development of the heart and great vessels and was the first to observe the beating of the embryo s heart. He described some differences between arteries and veins and identified and named the great arterial vessel the 278

2 aorta. He also taught that the fetus did not breathe while in the uterus. But he believed in the doctrine of humors and placed the seat of intelligence in the heart. He confused nerves with ligaments and tendons and linked veins from the liver to the right arm and from the spleen to the left arm. Hence, he advocated bloodletting on the side corresponding to the location of the diseased organ. The doctrines of Plato and Aristotle had a deep influence on science and medicine in the Middle Ages and the Renaissance. After the time of Hippocrates, groups of teachers and practitioners split into separate medical systems or cults. Greek medicine after Hippocrates reached its zenith in Alexandria with the founding of its celebrated library. Founding the Library Alexander the Great founded and named the city after himself in 331 BC. He died in 323 BC in Iraq. His defeat of the Persian Emperor Darius III brought Egypt within the Hellenistic sphere of influence. The Hellenistic world stretched from the Arabian Gulf to Sicily and consequently, there was a remarkable increase of knowledge about animals, plants, minerals, and drugs. After Alexander s death, science gained a prominent place at the court of King Ptolemy, who ruled Egypt from 323 to 282 BC. King Ptolemy s main cultural creations were the Alexandrian Library and the Museum (sanctuary of the Muses). The library gave poets, historians, musicians, mathematicians, astronomers, and scientists an opportunity to live and work under royal patronage. The results were grandly impressive. Euclid worked out the elements of geometry whereas Ptolemy mapped the heavens. The poet and scholar Eratosthenes determined the circumference of the earth. Ctesibius designed a water-clock and built the first keyboard instrument. Archimedes refined his theory that explained the weight and displacement of liquids and gases, Callimachus, the famous poet and librarian, catalogued the huge collection of scrolls and Zenodotus produced authentic versions of Homer s epics by collating every known text that he could find. Collecting treasures of wisdom Manuscripts and books are essential to sustain and nourish learning, scholarship, and experimentation. To this end, the Ptolemy dynasty founded the library to gather under one roof all the world s knowledge, an ambitious undertaking. Remarkably, that task was assiduously pursued with glorious and enriching results. King Ptolemy I Soter empowered the orator Demetrios Phalereus, to collect, if he could, all the books in the inhabited world. The king also sent letters to all the sovereigns and governors on earth requesting that they furnish works by poets and prose-writers, rhetoricians and sophists, doctors and soothsayers, historians, and all the others too. Agents were sent out to scout the cities of Asia, North Africa, and Europe, and were authorized to spend whatever was necessary. Every possible source was explored, to the point that foreign vessels calling in at Alexandria were searched routinely for scrolls and manuscripts. Anything of interest found on board was confiscated and copied. Transcripts were returned in due course, but the originals always stayed in the library. A key work of Hippocrates carried by a travelling physician is said to have entered the collection in this manner. According to Galen, these acquisitions were so commonplace that they were catalogued under a special heading, books of the ships. Galen further asserted that Ptolemy s representatives borrowed the original dramatic works of Aeschylus, Sophocles, and Euripides from the state archives in Athens by posting fifteen silver talents as a pledge against their safe return. What went back to Athens, however, were copies, the security deposit notwithstanding. The Ptolemies wanted their Library to be universal. Not only should it contain the bulk of Greek knowledge, but also writings from all nations to be ultimately translated into Greek. Foremost among non-greek works were no doubt, the Egyptian sacred records from which Hecataeus of Abdera derived data for his Aegyptica. Manethon, the Egyptian priest who was familiar with the Greek language and Greek culture, undertook to write a comprehensive history of Egypt in Greek so that the library should have a full corpus of Egyptian records. Berossos, a Chaldean priest, wrote a history of Babylonia in Greek and his book became well known in Egypt. The new medicine The great center of Greek learning at Alexandria soon became world-renowned and was the leading medical school in antiquity, attracting 279

3 medical talent. Medical research in the Alexandrian Museum became famous. Indeed, its reputation lasted long after the Ptolemaic dynasty ended with the death of Cleopatra VII in 30 BC. Ptolemaic patronage encouraged a more purely academic interest, which may have been a distinct advantage over other centers of study and training in medicine. In the Greek world before Alexandria, all members of the medical profession belonged to one tradition, the Hippocratic tradition. They generally were called Asclepidae, in the sense that they were the spiritual descendants of Asclepius, the divine founder of the art of healing. At Alexandria, dissection of corpses was a regular practice, probably for the first time in history. The two outstanding medical investigators in Alexandria were Herophilus (c BC) and his contemporary Erasistratus (c BC). They were the two leading professors of the new medicine, which sprouted. Their writings have been lost and most of our knowledge of these two is derived from later commentators, especially Celsus and Galen in the Roman period. Celsus reported that they dissected, or at least experimented upon, living humans (Porter R, The Greatest Benefit To Mankind, Harper Collins Publishers, London, 1997). Herophilus had been a pupil of Praxagoras of Cos who was among the first to separate the functions of arteries and veins. The great efforts of Herophilus and his school were directed towards a scientific medicine. In contrast with the classified mass of physical observations and disease descriptions of the Hippocratic School, the Herophileans were concerned with direct knowledge and precise terminology. In order to achieve this, Herophilus embarked upon a new study of the human body, based on anatomy and human dissection. Tertullian, a representative of the Methodists in Rome, bitterly criticized Herophilus pioneer work: Herophilus the physician or that butcher who cut up hundreds of human beings so that he could study nature. But Galen was genuinely appreciative. In connection with the ovarian arteries and veins observed by Herophilus in his anatomy of the womb, Galen admits: I have not seen this myself in other animals except occasionally in monkeys. But I do not disbelieve that Herophilus observed them in women; for he was efficient in other aspects of his art and his knowledge of facts acquired through anatomy was exceedingly precise, and most of his observations were made not, as is the case with most of us, on brute beasts but on human beings themselves. As a result of his anatomical studies on the nervous system, Herophilus proved that the brain and not the heart was the seat of intelligence, a revolutionary breakthrough for that period since it contradicted a prevailing Arsitotelian concept. Correspondingly, medical terminology benefited from Herophilus original research work. For the first time many human organs were accurately defined and their parts and sections given special medical terms. Some of them in their Latin form are still in use. He named the duodenum from the Greek for 12 fingers, this being the length of what he found. In a number of cases he derived names from the local Alexandrian scene; for example pharoid, having the shape of the lighthouse, for the styloid process; calamus scriptorius, for the cavity in the floor of the fourth ventricle of the cerebrum, because it resembled the Alexandrian writing pen. Like the ancient Egyptians, he pointed out that the heart transmitted pulsation to the arteries and described extensive variations of the pulse in disease. He observed that the arteries were six times thicker than veins and had different structure. But for all his brilliant, accurate, and objective observations, Herophilus still believed in the ancient doctrine of the four humors in his treatment. He used bleeding to evacuate the plethora of the humors. Some of Herophilus pupils founded their own independent schools. One school, called Empirical School, founded by Philinus of Cos, and later succeeded by Sarapion, a citizen of Alexandria, broke away from the Herophileans. The contrast with the Herophileans was marked, for while the latter directed their major energy to the study of anatomy and physiology, the Empiricist s interest lay in therapeutics and disregarded anatomy and physiology, claiming that basically a disease must be treated experimentally. They developed their own medical doctrine based on experiment (peira) or direct knowledge of the circumstances of a particular case as well as precedent cures for individual cases (historia). The gap, however, between these two schools was bridged in the last century BC by Heracleides of Tarentum, the most important Empiricist in the entire history of the Alexandrian school. He combined the best of the two schools; he practiced human anatomy and also developed surgical techniques, while maintaining the experimental method of cure of his school. Among his known books are a work on drugs, a symposium on 280

4 dietetics and a history of the Empirical school. Regrettably, these works have survived only in fragments, but Galen wrote a book on the Empirical School. Only fragments of this book have survived in Greek, but the bulk of it has safely come down to us in Arabic translation. Erasistratos, Herophilus contemporary, emphasized physiological experimentation as well as anatomical investigation. His main discoveries concerned the brain, which like Herophilus regarded as the seat of intelligence. He differentiated between sensory and motor nerves but confused ligaments with nerves as others had before him. He associated ascites with a hard liver, probably cirrhosis. He also described the epiglottis and described its function of blocking off the air passages during swallowing. He did not believe in humoral pathology and believed that atoms were the basis of the body s structure. These atoms required pneuma from the inspired air to be activated and that they circulated in arteries which contained no blood. The followers of Herophilus and Erasistratus were involved in spiteful controversies for centuries. Despite this, the Alexandrian doctors discovered one life-saving technique: the ligature of blood vessels. This enabled them to perform operations that were not possible before such as removal of goiters and bladder stones, hernia repairs, and amputations. In the 2 nd century AD, Alexandria s reputation in the study of medicine attracted Galen, the last of the great physicians of the ancient world. The impact of Alexandrian medical learning on Galen was so great that in his numerous writings, he immortalized much of what we know of Alexandrian medicine. And as late as the 4 th century AD the eminent historian Ammianus Marcellinus remarks: Medicine continues to grow from day to day, so that a doctor who wishes to establish his standing in the profession can dispense with the need for any proof of it by saying that he was trained at Alexandria. The fate of the library In 48 BC during the Roman civil war, Caesar in hot pursuit of Pompey arrived in Alexandria where he learned of Pompey s death and a civil war in Egypt between Cleopatra (fig. 1) and her younger brother Ptolemy XIII. Seeing himself outnumbered at sea, Caesar set fire to the ships. The fire spread beyond the ships, to other quarters of the city. Plutarch wrote: When the enemy tried to cut off Fig.1. Cleopatra VII (left) and her son by Julius Caesar, Caesarion (right), making offerings. (Temple of Hathor, Dendera) his fleet, Caesar was forced to repel the danger by using fire, which spread from the dockyards and destroyed the Great Library. The 4 th century historian Ammianus Marcellinus wrote of the burning down by fire of a priceless library of 700,000 books during the Alexandrian war when the city was destroyed in the time of Caesar. Great, indeed, was the loss of the Royal Library; yet, Alexandria was rich in its libraries. The Museum, in a separate building from the Royal Library, survived the disaster, and after the annexation of Egypt by Rome in 30 BC, it continued to enjoy the protection of the emperors. The Museum hall had a fair collection of books, and the Daughter Library (a branch of the Royal Library), in the Sarapeum (Temple of Sarapis) located in the Egyptian quarter, became the principal library in Roman Alexandria. Another building, the Caesarion, also had a considerable number of books. In addition, it is said that Mark Antony presented to Cleopatra a gift of 200,000 books from Pergamun, rival center of learning and culture in antiquity. Alexandria thrived during the first two centuries of Roman rule and the existing libraries enabled scholars to carry on the Alexandrian tradition of scholarship. However, repeated wars and persecutions took its toll; still intellectual life continued to burn. But in AD 391, the Sarapeum and remaining libraries were totally destroyed by a Christian mob. The Christian Emperor Theodosius issued a decree sanctioning the demolition of the temples of Alexandria. Thus began the war waged against pagan books by Christian extremists, not only in Alexandria but also throughout the empire. Ammianus Marcellinus, the historian, speaks of certain people in Rome who hate learning like [hating] poison and that libraries were closed forever like the tomb. 281

5 PTOLEMAIC EGYPT (ALEXANDRIA, BC) When Alexander died in 323 BC, his body was brought to Egypt and buried, first at Memphis, and then in a splendid tomb in the new city of Alexandria. His vast empire was divided among his generals and Egypt became the share of General Ptolemy whose descendants ruled the country for the next 250 years. Alexandria became the capital of the Ptolemy dynasty and was renowned as a center of Greek learning. Although the Egyptians were allowed to go on building temples to their gods, Alexandria was essentially a Greek rather than an Egyptian city. It was known as Alexandrea ad Aegyptum: Alexandria beside Egypt rather than within it, as if it were a separate country in its own right. As a family the Ptolemies were cruel and quarrelsome and the women were as ruthless as the men. The most famous of the Ptolemies, Queen Cleopatra VII, had already killed an elder sister The Greek ruler Ptolemy V ( BC) makes offerings to the sacred bull, believed to be the living incarnation of a god and revered since the beginning of Egyptian history. Bull-worship continued under the Ptolemies who introduced the cult of Serapis, a syncretic deity combining the traits of Greek and Egyptian gods. Temples dedicated to Serapis known as Serapeum, sprang up in Alexandria and throughout Egypt. The Temple of Serapis in Alexandria housed part of the Alexandrian Library collection and became the principal library after Caesar s fire destroyed the Royal Library. and was fighting a war against her younger brother when Julius Caesar arrived in Egypt in 48 BC. To save his throne during a revolt, Cleopatra s father had put Egypt under Roman protection and Rome was only waiting for an excuse to make the country part of her growing empire. Cleopatra kept Egypt independent by winning Caesar s favor and, after Caesar s murder, that of Mark Antony s. Cleopatra and Antony both killed themselves after their defeat by Octavian. Their love story is immortalized by Shakespeare in his play The Tragedy of Antony and Cleopatra. In 30 BC, Egypt became a mere province of the Roman Empire but Alexandria enjoyed special status and continued to flourish as the center of scientific and intellectual learning until the 4 th century AD, when the city temples and the Library were completely destroyed. A church was built where the Temple of Sarapis once stood, and in time, Alexandria again became the center of a new intellectual movement based on Christianity. Arab conquest in AD 642 put an end to Greco- Roman dominion and the center of learning was transferred to Baghdad in the East and Cordova in the West. Scientific and intellectual life flourished under the Arab Empire but no doubt inspired by Greco-Roman scientific heritage. The major source of Greek medical books that reached the Arabs was through Alexandria. Ibn Abi Sobiah ( ), a Syrian physician who authored a 3-volume book on The Layers of Physicians, wrote: Most of these [Alexandrian] books exist and Al-Razi has referred to them in his book Al Hawi. Al Hawi is the 25-volume Encyclopedia of Medicine written by Al-Razi (d. 920). In the beginning of Arab rule in Egypt, 16 books of Galen were considered the bibles of medicine and formed the core of medical teaching in Alexandria. These were translated into Arabic later. The Small Pulse, The Big Pulse, Anatomy, Diseases and Symptoms, Fevers, Humors, The Value of Organs, and Drugs were a few of the books written by Galen. Not a single stone remains of the Great Library, but its glorious life live on in books that it once sought to shelter. Books are the legacies that genius leaves to mankind, to be delivered down from generation to generation, as presents to those yet unborn. Joseph Addison, AD Hamad Medical Corporation. References: Mostafa El-Abbadi, Life and Fate of the Ancient Library of Alexandria, UNESCO, Paris, Albert S. Lyons and R. Joseph Petrucelli II, Medicine An Illustrated History, Harry N. Abrams Inc., New York, Roy Porter, The Greatest Benefit To Mankind, Harper CollinsPublishers, London, Jenny Sutcliffe and Nancy Duin, A History of Medicine, Barnes & Noble Inc., New York,

6 HISTORY OF MEDICINE PAST GLORIES THE GREAT LIBRARY OF ALEXANDRIA Rachel Hajar, MD, FACC* The world of books is the most remarkable creation of man. Nothing else that he builds ever lasts. Monuments fall; nations perish; civilizations grow old and die out; and, after an era of darkness, new races build others. But in the world of books are volumes that have seen this happen again and again, and yet live on, still young, still as fresh as the day they were written, still telling men s hearts of the hearts of men centuries dead. Clarence Day, F abled in antiquity for its treasures of wisdom, the Library of Alexandria was the envy of the civilized world. Alexandria was by no means the first great book repository, but because it contained antiquity s most extensive collection of recorded thought, it undoubtedly was the greatest. The library became a wonder of the scholarly world, eventually containing, it was said, 700,000 manuscripts, and its facilities included an observatory, zoological gardens, lecture halls, and rooms for research. For nine brilliant centuries, from around 300 BC to the 7 th century AD, Alexandria was a place of inspiration. Alexandria stood as a beacon of learning and discovery and played a central role in the development of medical thought and practice. The medical books in the library were dominated by Greek theories. To appreciate fully Alexandria s impressive position in the evolution of medical theory and practice, it is necessary to touch briefly on the great thinkers, Plato and Aristotle, for their ideas and doctrines were the cornerstones of Western thought, which profoundly influenced science and medicine in the West. Together with Hippocrates before them, and Galen afterwards, their doctrines were the roots of pagan, Christian, and Muslim medical thought. The Great Philosophers One might begin with philosophy but would end with medicine; or start with medicine and find oneself in philosophy. At first glance, Aristotle s *Director, Non-Invasive Cardiac Laboratory, Cardiology and Cardiovascular Surgery Dept., Hamad Medical Corporation, P.O. Box 3050, Doha, Qatar. rachel@hmc.org.qa saying may not seem relevant in today s technologically advanced medicine. But the questions that pervade all of philosophy: Who am I? What is the good life? are as relevant today as they were to the ancients because philosophy is a living tradition that has a bearing on how each of us lives our lives. Indeed, the word, medicine (from Latin medicinus or medicina), refers to a person, agency, or influence that affects wellbeing. The ideas of the philosophers Plato and Aristotle were among the important influences that shaped medical thinking. Plato (c BC), a contemporary of Hippocrates, a student of Socrates, and the teacher of Aristotle, became one of the most influential thinkers in the history of the Western world. Plato s interests lay mainly in the nature of the soul and matter, and his medical speculations, unsupported with direct experimentation, led to a number of faulty conclusions about the human body, which persisted for several centuries. His method of reasoning at a distance rather than actual anatomy or the bedside signs was resurrected and perpetuated in the Middle Ages. However, some of his teachings have a bearing on medical practice today, for he expected the ideal state to provide for the health of its citizens and to prevent poverty and overpopulation. Aristotle (c BC), son of a physician and pupil of Plato, also had a profound influence on later medicine, especially among the Arabic authors. Aristotle s methods were based on careful investigations of both animals and humans, and his studies were milestones in science. He described the early development of the heart and great vessels and was the first to observe the beating of the embryo s heart. He described some differences between arteries and veins and identified and named the great arterial vessel the 278

7 aorta. He also taught that the fetus did not breathe while in the uterus. But he believed in the doctrine of humors and placed the seat of intelligence in the heart. He confused nerves with ligaments and tendons and linked veins from the liver to the right arm and from the spleen to the left arm. Hence, he advocated bloodletting on the side corresponding to the location of the diseased organ. The doctrines of Plato and Aristotle had a deep influence on science and medicine in the Middle Ages and the Renaissance. After the time of Hippocrates, groups of teachers and practitioners split into separate medical systems or cults. Greek medicine after Hippocrates reached its zenith in Alexandria with the founding of its celebrated library. Founding the Library Alexander the Great founded and named the city after himself in 331 BC. He died in 323 BC in Iraq. His defeat of the Persian Emperor Darius III brought Egypt within the Hellenistic sphere of influence. The Hellenistic world stretched from the Arabian Gulf to Sicily and consequently, there was a remarkable increase of knowledge about animals, plants, minerals, and drugs. After Alexander s death, science gained a prominent place at the court of King Ptolemy, who ruled Egypt from 323 to 282 BC. King Ptolemy s main cultural creations were the Alexandrian Library and the Museum (sanctuary of the Muses). The library gave poets, historians, musicians, mathematicians, astronomers, and scientists an opportunity to live and work under royal patronage. The results were grandly impressive. Euclid worked out the elements of geometry whereas Ptolemy mapped the heavens. The poet and scholar Eratosthenes determined the circumference of the earth. Ctesibius designed a water-clock and built the first keyboard instrument. Archimedes refined his theory that explained the weight and displacement of liquids and gases, Callimachus, the famous poet and librarian, catalogued the huge collection of scrolls and Zenodotus produced authentic versions of Homer s epics by collating every known text that he could find. Collecting treasures of wisdom Manuscripts and books are essential to sustain and nourish learning, scholarship, and experimentation. To this end, the Ptolemy dynasty founded the library to gather under one roof all the world s knowledge, an ambitious undertaking. Remarkably, that task was assiduously pursued with glorious and enriching results. King Ptolemy I Soter empowered the orator Demetrios Phalereus, to collect, if he could, all the books in the inhabited world. The king also sent letters to all the sovereigns and governors on earth requesting that they furnish works by poets and prose-writers, rhetoricians and sophists, doctors and soothsayers, historians, and all the others too. Agents were sent out to scout the cities of Asia, North Africa, and Europe, and were authorized to spend whatever was necessary. Every possible source was explored, to the point that foreign vessels calling in at Alexandria were searched routinely for scrolls and manuscripts. Anything of interest found on board was confiscated and copied. Transcripts were returned in due course, but the originals always stayed in the library. A key work of Hippocrates carried by a travelling physician is said to have entered the collection in this manner. According to Galen, these acquisitions were so commonplace that they were catalogued under a special heading, books of the ships. Galen further asserted that Ptolemy s representatives borrowed the original dramatic works of Aeschylus, Sophocles, and Euripides from the state archives in Athens by posting fifteen silver talents as a pledge against their safe return. What went back to Athens, however, were copies, the security deposit notwithstanding. The Ptolemies wanted their Library to be universal. Not only should it contain the bulk of Greek knowledge, but also writings from all nations to be ultimately translated into Greek. Foremost among non-greek works were no doubt, the Egyptian sacred records from which Hecataeus of Abdera derived data for his Aegyptica. Manethon, the Egyptian priest who was familiar with the Greek language and Greek culture, undertook to write a comprehensive history of Egypt in Greek so that the library should have a full corpus of Egyptian records. Berossos, a Chaldean priest, wrote a history of Babylonia in Greek and his book became well known in Egypt. The new medicine The great center of Greek learning at Alexandria soon became world-renowned and was the leading medical school in antiquity, attracting 279

8 medical talent. Medical research in the Alexandrian Museum became famous. Indeed, its reputation lasted long after the Ptolemaic dynasty ended with the death of Cleopatra VII in 30 BC. Ptolemaic patronage encouraged a more purely academic interest, which may have been a distinct advantage over other centers of study and training in medicine. In the Greek world before Alexandria, all members of the medical profession belonged to one tradition, the Hippocratic tradition. They generally were called Asclepidae, in the sense that they were the spiritual descendants of Asclepius, the divine founder of the art of healing. At Alexandria, dissection of corpses was a regular practice, probably for the first time in history. The two outstanding medical investigators in Alexandria were Herophilus (c BC) and his contemporary Erasistratus (c BC). They were the two leading professors of the new medicine, which sprouted. Their writings have been lost and most of our knowledge of these two is derived from later commentators, especially Celsus and Galen in the Roman period. Celsus reported that they dissected, or at least experimented upon, living humans (Porter R, The Greatest Benefit To Mankind, Harper Collins Publishers, London, 1997). Herophilus had been a pupil of Praxagoras of Cos who was among the first to separate the functions of arteries and veins. The great efforts of Herophilus and his school were directed towards a scientific medicine. In contrast with the classified mass of physical observations and disease descriptions of the Hippocratic School, the Herophileans were concerned with direct knowledge and precise terminology. In order to achieve this, Herophilus embarked upon a new study of the human body, based on anatomy and human dissection. Tertullian, a representative of the Methodists in Rome, bitterly criticized Herophilus pioneer work: Herophilus the physician or that butcher who cut up hundreds of human beings so that he could study nature. But Galen was genuinely appreciative. In connection with the ovarian arteries and veins observed by Herophilus in his anatomy of the womb, Galen admits: I have not seen this myself in other animals except occasionally in monkeys. But I do not disbelieve that Herophilus observed them in women; for he was efficient in other aspects of his art and his knowledge of facts acquired through anatomy was exceedingly precise, and most of his observations were made not, as is the case with most of us, on brute beasts but on human beings themselves. As a result of his anatomical studies on the nervous system, Herophilus proved that the brain and not the heart was the seat of intelligence, a revolutionary breakthrough for that period since it contradicted a prevailing Arsitotelian concept. Correspondingly, medical terminology benefited from Herophilus original research work. For the first time many human organs were accurately defined and their parts and sections given special medical terms. Some of them in their Latin form are still in use. He named the duodenum from the Greek for 12 fingers, this being the length of what he found. In a number of cases he derived names from the local Alexandrian scene; for example pharoid, having the shape of the lighthouse, for the styloid process; calamus scriptorius, for the cavity in the floor of the fourth ventricle of the cerebrum, because it resembled the Alexandrian writing pen. Like the ancient Egyptians, he pointed out that the heart transmitted pulsation to the arteries and described extensive variations of the pulse in disease. He observed that the arteries were six times thicker than veins and had different structure. But for all his brilliant, accurate, and objective observations, Herophilus still believed in the ancient doctrine of the four humors in his treatment. He used bleeding to evacuate the plethora of the humors. Some of Herophilus pupils founded their own independent schools. One school, called Empirical School, founded by Philinus of Cos, and later succeeded by Sarapion, a citizen of Alexandria, broke away from the Herophileans. The contrast with the Herophileans was marked, for while the latter directed their major energy to the study of anatomy and physiology, the Empiricist s interest lay in therapeutics and disregarded anatomy and physiology, claiming that basically a disease must be treated experimentally. They developed their own medical doctrine based on experiment (peira) or direct knowledge of the circumstances of a particular case as well as precedent cures for individual cases (historia). The gap, however, between these two schools was bridged in the last century BC by Heracleides of Tarentum, the most important Empiricist in the entire history of the Alexandrian school. He combined the best of the two schools; he practiced human anatomy and also developed surgical techniques, while maintaining the experimental method of cure of his school. Among his known books are a work on drugs, a symposium on 280

9 dietetics and a history of the Empirical school. Regrettably, these works have survived only in fragments, but Galen wrote a book on the Empirical School. Only fragments of this book have survived in Greek, but the bulk of it has safely come down to us in Arabic translation. Erasistratos, Herophilus contemporary, emphasized physiological experimentation as well as anatomical investigation. His main discoveries concerned the brain, which like Herophilus regarded as the seat of intelligence. He differentiated between sensory and motor nerves but confused ligaments with nerves as others had before him. He associated ascites with a hard liver, probably cirrhosis. He also described the epiglottis and described its function of blocking off the air passages during swallowing. He did not believe in humoral pathology and believed that atoms were the basis of the body s structure. These atoms required pneuma from the inspired air to be activated and that they circulated in arteries which contained no blood. The followers of Herophilus and Erasistratus were involved in spiteful controversies for centuries. Despite this, the Alexandrian doctors discovered one life-saving technique: the ligature of blood vessels. This enabled them to perform operations that were not possible before such as removal of goiters and bladder stones, hernia repairs, and amputations. In the 2 nd century AD, Alexandria s reputation in the study of medicine attracted Galen, the last of the great physicians of the ancient world. The impact of Alexandrian medical learning on Galen was so great that in his numerous writings, he immortalized much of what we know of Alexandrian medicine. And as late as the 4 th century AD the eminent historian Ammianus Marcellinus remarks: Medicine continues to grow from day to day, so that a doctor who wishes to establish his standing in the profession can dispense with the need for any proof of it by saying that he was trained at Alexandria. The fate of the library In 48 BC during the Roman civil war, Caesar in hot pursuit of Pompey arrived in Alexandria where he learned of Pompey s death and a civil war in Egypt between Cleopatra (fig. 1) and her younger brother Ptolemy XIII. Seeing himself outnumbered at sea, Caesar set fire to the ships. The fire spread beyond the ships, to other quarters of the city. Plutarch wrote: When the enemy tried to cut off Fig.1. Cleopatra VII (left) and her son by Julius Caesar, Caesarion (right), making offerings. (Temple of Hathor, Dendera) his fleet, Caesar was forced to repel the danger by using fire, which spread from the dockyards and destroyed the Great Library. The 4 th century historian Ammianus Marcellinus wrote of the burning down by fire of a priceless library of 700,000 books during the Alexandrian war when the city was destroyed in the time of Caesar. Great, indeed, was the loss of the Royal Library; yet, Alexandria was rich in its libraries. The Museum, in a separate building from the Royal Library, survived the disaster, and after the annexation of Egypt by Rome in 30 BC, it continued to enjoy the protection of the emperors. The Museum hall had a fair collection of books, and the Daughter Library (a branch of the Royal Library), in the Sarapeum (Temple of Sarapis) located in the Egyptian quarter, became the principal library in Roman Alexandria. Another building, the Caesarion, also had a considerable number of books. In addition, it is said that Mark Antony presented to Cleopatra a gift of 200,000 books from Pergamun, rival center of learning and culture in antiquity. Alexandria thrived during the first two centuries of Roman rule and the existing libraries enabled scholars to carry on the Alexandrian tradition of scholarship. However, repeated wars and persecutions took its toll; still intellectual life continued to burn. But in AD 391, the Sarapeum and remaining libraries were totally destroyed by a Christian mob. The Christian Emperor Theodosius issued a decree sanctioning the demolition of the temples of Alexandria. Thus began the war waged against pagan books by Christian extremists, not only in Alexandria but also throughout the empire. Ammianus Marcellinus, the historian, speaks of certain people in Rome who hate learning like [hating] poison and that libraries were closed forever like the tomb. 281

10 PTOLEMAIC EGYPT (ALEXANDRIA, BC) When Alexander died in 323 BC, his body was brought to Egypt and buried, first at Memphis, and then in a splendid tomb in the new city of Alexandria. His vast empire was divided among his generals and Egypt became the share of General Ptolemy whose descendants ruled the country for the next 250 years. Alexandria became the capital of the Ptolemy dynasty and was renowned as a center of Greek learning. Although the Egyptians were allowed to go on building temples to their gods, Alexandria was essentially a Greek rather than an Egyptian city. It was known as Alexandrea ad Aegyptum: Alexandria beside Egypt rather than within it, as if it were a separate country in its own right. As a family the Ptolemies were cruel and quarrelsome and the women were as ruthless as the men. The most famous of the Ptolemies, Queen Cleopatra VII, had already killed an elder sister The Greek ruler Ptolemy V ( BC) makes offerings to the sacred bull, believed to be the living incarnation of a god and revered since the beginning of Egyptian history. Bull-worship continued under the Ptolemies who introduced the cult of Serapis, a syncretic deity combining the traits of Greek and Egyptian gods. Temples dedicated to Serapis known as Serapeum, sprang up in Alexandria and throughout Egypt. The Temple of Serapis in Alexandria housed part of the Alexandrian Library collection and became the principal library after Caesar s fire destroyed the Royal Library. and was fighting a war against her younger brother when Julius Caesar arrived in Egypt in 48 BC. To save his throne during a revolt, Cleopatra s father had put Egypt under Roman protection and Rome was only waiting for an excuse to make the country part of her growing empire. Cleopatra kept Egypt independent by winning Caesar s favor and, after Caesar s murder, that of Mark Antony s. Cleopatra and Antony both killed themselves after their defeat by Octavian. Their love story is immortalized by Shakespeare in his play The Tragedy of Antony and Cleopatra. In 30 BC, Egypt became a mere province of the Roman Empire but Alexandria enjoyed special status and continued to flourish as the center of scientific and intellectual learning until the 4 th century AD, when the city temples and the Library were completely destroyed. A church was built where the Temple of Sarapis once stood, and in time, Alexandria again became the center of a new intellectual movement based on Christianity. Arab conquest in AD 642 put an end to Greco- Roman dominion and the center of learning was transferred to Baghdad in the East and Cordova in the West. Scientific and intellectual life flourished under the Arab Empire but no doubt inspired by Greco-Roman scientific heritage. The major source of Greek medical books that reached the Arabs was through Alexandria. Ibn Abi Sobiah ( ), a Syrian physician who authored a 3-volume book on The Layers of Physicians, wrote: Most of these [Alexandrian] books exist and Al-Razi has referred to them in his book Al Hawi. Al Hawi is the 25-volume Encyclopedia of Medicine written by Al-Razi (d. 920). In the beginning of Arab rule in Egypt, 16 books of Galen were considered the bibles of medicine and formed the core of medical teaching in Alexandria. These were translated into Arabic later. The Small Pulse, The Big Pulse, Anatomy, Diseases and Symptoms, Fevers, Humors, The Value of Organs, and Drugs were a few of the books written by Galen. Not a single stone remains of the Great Library, but its glorious life live on in books that it once sought to shelter. Books are the legacies that genius leaves to mankind, to be delivered down from generation to generation, as presents to those yet unborn. Joseph Addison, AD Hamad Medical Corporation. References: Mostafa El-Abbadi, Life and Fate of the Ancient Library of Alexandria, UNESCO, Paris, Albert S. Lyons and R. Joseph Petrucelli II, Medicine An Illustrated History, Harry N. Abrams Inc., New York, Roy Porter, The Greatest Benefit To Mankind, Harper CollinsPublishers, London, Jenny Sutcliffe and Nancy Duin, A History of Medicine, Barnes & Noble Inc., New York,