A unique moment, when the old pagan and Jewish city and the new Christian one might have come together to set a new path, a new interpretation of the work the museum had striven for so many centuries to achieve, had been wasted. Instead, the seeds of a bitter and ultimately deadly struggle that would tear up the very roads and colonnades of the city itself were sown in their place. Imperial Rome and Christianity were on a collision course. If the infant religion was to survive, it would have to learn to fight even before it had learned to walk. Words were all well and good, but they had not safeguarded Clement in his city. His pupil Origen and the young catechumens had seen just how little the masters of the world cared for philosophy. If Rome wanted a fight, they could have it.
CHAPTER FIFTEEN
INTO THE SOFT MACHINE
Our body is a machine for living. It is organised for that, it is its nature.
Leo Tolstoy, War and Peace
While the talk in the markets and shops of Alexandria was now more often than not centered on the subject of religion, that was not yet the overriding consideration for either the provincial government or the museum. Rome had more serious worries than the growth of Christianity that were even now pressing on her borders.
The second half of the second century saw the emergence of a new threat to the Roman world order, not from within but from without. The barbarian German tribes, along with their Sarmatian allies, were massing along the northeastern frontiers of the empire, along the east banks of the Danube and Rhine, and threatening to flood into the empire itself.
It is an irony of history that the first emperor who tried to contain the threat was also one of its most sophisticated intellectuals, a man better suited to the museum and library in Alexandria than to the wilds of his empire’s frontiers. Marcus Aurelius (ruled 161-80) was also known as Marcus Aurelius Antoninus the Philosopher, and the collection of imperial biographies known as the Historia Augusta says that “Plato’s judgement was always on his lips, that states flourished if philosophers ruled or rulers were philosophers” (Anonymous, Historia Augusta, 27.7).
Sadly for this frail and thoughtful emperor, his rule would seem to prove otherwise. On his accession Marcus Aurelius had immediately taken his adoptive brother Lucius Verus into the emperorship with him, for the first time splitting the primary role in the empire between two people. It was a move born out of pity more than practicality, granting the man who had always been in his shadow an equal position that, unfortunately, he was unequal to. The timing also could not have been worse. At the very moment the two men were taking the imperial throne, hostilities were already breaking out on the British frontier along Hadrian’s Wall and along the Danube, while in the east the Parthians had seized the province of Armenia, destroying two whole Roman legions in the process. For the first time the empire appeared vulnerable, and Alexandrians, despite their chafing against Roman rule, must have prayed that their occupiers would prove up to the task of keeping the barbarians outside their protected and, as they saw it, civilized world.
Marcus Aurelius, for all his love of philosophy, could still prove a man of action. While choosing to tackle the Danube problem himself, he sent the dithering and indulgent Verus to deal with Parthia, along with his best general, Avidius Cassius. Avidius was also from an academic family, his father having been a rhetorician in Syria, but under Verus’s nominal command he fortunately showed himself also to be a great soldier, restoring peace in the East. For this he was rewarded with supreme command over the entire region, including Egypt, the same post Mark Antony had held before him. And it was perhaps this unfortunate precedent that then began to work on his mind.
Verus, for his part, returned west with a less welcome trophy—soldiers infected by a plague which then swept the ancient world. At the same moment the barbarians beyond the Danube finally broke out and swarmed into the empire, reaching Italy itself. In a mad scramble Marcus Aurelius recruited two new legions and saved the situation, eventually agreeing to peace terms and managing to take back Italy. On his triumphant return to Rome, his co-emperor Verus died of apoplexy in 169, removing at least one threat to Marcus Aurelius’s rule.
But the impenetrable facade of imperial might had been breached, and Egypt itself was encouraged to revolt. When Avidius Cassius quickly suppressed the rebellion, Marcus Aurelius must have believed he had finally found an ally he could trust. He was very wrong.
Avidius Cassius’s experience of imperial rule in the form of an ineffectual co-emperor had given him unusual ambition. Now as virtual ruler of the East, the inheritor of Mark Antony’s mantle and perhaps seduced by his dream, he struck. Hearing that Marcus Aurelius had been killed on the northern frontier (or at least claiming that to be the case), he proclaimed himself emperor, possibly encouraged in this by Marcus Aurelius’s own wife, Faustina. Faustina had long despaired of her husband’s frequent bouts of ill health, something which in these turbulent times she knew could have direct effects on her and her children. If her husband suddenly died there was no one to guarantee her safety, and any new imperial candidate would almost certainly begin his campaign to gain legitimacy by killing the true heirs—her children. Perhaps in Avidius she found a guarantor for her children, or at least saw the opportunity to force the hand of history. Whether Avidius knew he was bluffing when he announced the emperor’s death is uncertain, although the Historia Augusta is suspicious.
Nevertheless, Avidius evidently persuaded several senior officials to back his claim to the laurels, and among these was the governor of Alexandria, Lucius Maecianus, who had once been Marcus Aurelius’s tutor and who may have had ambitions of joint sovereignty with Avidius. Egypt and Alexandria stood once again on the brink of king making, but once again it would prove a false dawn.
Marcus Aurelius was not dead; indeed, he was marching back toward Rome, and from there he would perhaps sail across the Mediterranean to Egypt. Certainly the specter of this was enough to unnerve Avidius’s soldiers, and his three-month-old “empire” dissolved as quickly as it had appeared. Fearing the emperor’s retribution, one of Avidius’s own centurions turned on him and stabbed him to death. The assassination of the governor of Alexandria was not far behind.
It was with some trepidation then that the people of Alexandria turned out to greet their emperor when he arrived in their city in the winter of 176. No place had been more closely connected with the usurper, and the emperor could hardly be expected to leave the city unscathed. Julius Caesar had burnt the city and very possibly the precious library when he had arrived to remove the upstart Mark Antony, and many must have feared a reprise.
But Marcus Aurelius did nothing. Certainly he shed some crocodile tears for the dead Avidius, just as Caesar had “wept” for the murdered Pompey, protesting that he would have spared his life if only he had reached Egypt in time. The Historia Augusta says that on receiving Avidius’s head the emperor
did not rejoice or exult, but rather was grieved that he had lost an opportunity for showing mercy; for he said that he had wished to take him alive, so that he might reproach him with the kindness he had shown him in the past, and then spare his life.
Anonymous, Historia Augusta, chapter 8
It was, of course, a story Alexandrians had heard before, but provided he chose to play the victorious Octavian rather than the vengeful Caesar, they were happy to go along. And Marcus Aurelius had no desire to harm such a spiritual homeland. So instead of a bloodbath, the citizens of Alexandria enjoyed the company of their philosopher-emperor, and he in turn took delight in the open and vibrant civic life of the city as well as the intellectual life of the museum and library.
If the emperor needed a reason to preserve Alexandria he had only to walk through the gardens and lecture halls in the museum to find it, for this institution was still the training ground for some of the greatest minds in antiquity. One of those who had benefited from an education here was his personal physician and the greatest doctor in the Roman world, Galen.
Galen was born in Ale
xandria’s great rival city of Pergamum around 129, about a century and a half after Mark Antony had bequeathed the city’s two-hundred-thousand-volume library to his lover Cleopatra. Despite this loss, the city had thrived and become particularly famous for its temple and sanctuary of Asclepius, the Greek god of healing, where people from across the empire came to seek cures both through prayer and through the ministrations of the doctors who gathered there. Galen’s father, Nicon, had been a successful and affluent architect, and he had given his son a broad classical education in mathematics, logic, grammar, and philosophy, embracing all four major schools—those of Plato and Aristotle as well as Stoicism and Epicureanism.
But it was to medicine that young Galen turned when he was just sixteen—according to legend, after his father had a dream revealing the youth’s destiny in the subject. In years to come, as Galen went on to become the greatest doctor in the Roman world, many of his patients must have thought that the dream had been sent by Asclepius himself. Galen began his studies at the Asclepian shrine in Pergamum before traveling on to study under other masters in Smyrna (now Izmir in Turkey), then in Corinth, before finally reaching the great medical school at Alexandria in 152. Alexandria was still the obvious place to finish an education in medicine in the second century, not simply because of its great heritage of physicians and anatomists but because in Alexandria, thanks to its Egyptian heritage, it was still possible to do there what could not be done elsewhere: dissect the human body. Such procedures were still taboo across most of the empire, and without a chance to look inside the body, most doctors were forced to rely on outward symptoms both to identify and to cure an ill. But here, Galen tells us, you could “look at the human skeleton with your own eyes. This is very easy in Alexandria, so that the physicians of that area instruct their pupils with the aid of autopsy” (Galen, quoted in translation by Kühn, vol. 2, p. 220).
These experiences gave Galen a passion for dissection, which would both make and, many centuries later, break his reputation. By opening human bodies, both living and dead, he was able to view the body as a machine, like one of Hero’s automatons, and brilliantly deduce its functions. In his later career he would repeat his investigations on animals in front of astounded crowds, while he challenged the other doctors of the empire to disagree with his findings. A particularly famous experiment involved a rather gruesome operation on a live pig. Cutting an incision down its back, he would slowly sever groups of spinal nerves to show their function. Of course all the while the pig would squeal, until he tied off the laryngeal nerve and the pig suddenly stopped. And so he proceeded, removing or tying off various vital pathways and identifying their purpose from the effect. He tied off animals’ ureters to demonstrate kidney and bladder function, and closed off veins and arteries to prove that, contrary to the popular theory of the day, they carried blood and not air.
On the basis of remarks made in Plato’s Laws, it seems that prior to Galen the medical system in the Hellenistic world was two tiered. Physicians for the wealthy treated their patients in accordance with theoretical principles (they were known as Dogmatists). Physicians for slaves relied upon trial and error, and were known as Empiricists. Detractors claimed that the Dogmatists honored theory above observation and experience. Between these two extremes were the Methodists, whose sole concern was the disease itself, ignoring the patient, his or her medical history, and so on. Galen claimed to belong to none of these schools, though we know that he was certainly educated in the Dogmatic school and practiced both Empirically and Methodically. He recognized that it was necessary both to develop theories from practical observation and experience, and to test existing theory against observations, modifying or abandoning it if it seemed not to work.
Much of Galen’s theory was based on the teachings of Hippocrates, the Greek “Father of Medicine.” Hippocrates held that the human body was controlled by four humors: phlegm, blood, black bile, and yellow bile. Each humor was also related to parts of the body: head (phlegm), heart (blood), liver (black bile), and gallbladder (yellow bile). Imbalance in these four basic humors caused illness, and it was the job of the physician to right this balance. From Plato, Galen also employed the four-element theory (earth, air, water, fire) and the theory of contraries (hot/cold, wet/dry). Like the four elements, humors were characterized by two qualities. The earth was considered the heaviest of elements, and black bile, with its coldness and dryness, was seen as the heaviest of the humors, an excess of which caused melancholy. Blood (like air) had the qualities of heat and moisture, phlegm (like water) had coldness and moisture, and yellow bile (like fire) had heat and dryness. He then formulated an almost quantitative scale of admixture of such things, which he wrote up in a book called On Mixtures. So if a person was suffering from a cold, wet condition, such as a chest infection, he should be treated with a hot and dry drug, such as certain molds and fungi (penicillin, perhaps?). While Western medicine may have moved away from such elemental concepts (we should note that much Indian and Chinese medicine has not), what Galen was doing was making the task of diagnosis and treatment multidimensional, looking at both the illness and the cure from multiple perspectives. He himself acknowledged his eclectic, pluralist approach, and this is perhaps Galen’s most enduring contribution to the history of medicine.
Inspired by this theoretical grounding and the anatomical mysteries he witnessed in Alexandria, Galen returned to his native Pergamum to begin his medical practice. Pergamum would prove a difficult place for him to work, however, as it did not allow its doctors to dissect human bodies. Fortunately, an official appointment came up that suited him perfectly—as physician to the gladiators.
Gladiatorial combat was a standard entertainment in the Roman world and was not always the deadly spectacle it is imagined to be. Gladiators were the football superstars of their day, the subject of adulatory graffiti in public baths and the pinups of young girls everywhere. A good gladiator, although a slave, was worth a fortune to his owner and hoped to win one day the “wooden sword” that would mark his retirement and freedom. So he would be attended on by the best physicians his master could afford—the sports physiotherapists of their day, whose job it was to keep the gladiator healthy and fighting.
Although Galen could not dissect criminals or corpses, he could use the skills he had learned in the Alexandrian anatomy theaters to cure the gladiators’ often horrific wounds. Provided it was a gladiator who made the incision in the arena and not a doctor on the operating table, no one complained if he then used these wounds—or “windows onto anatomy” as he called them—to explore the inner workings of the body. At the same time he also pioneered the treatment of the more usual sports injuries—sprains, breaks, dislocations, and concussions. From these he developed 130 of the 150 basic surgical techniques that are still in use today—everything from brain surgery to repairing compressed fractures to the use of traction beds to straighten broken limbs. Even at the end of a gladiator’s career there was one last procedure that Galen developed that would assist his patient in his new life as a free man: the removal of the tattoo that marked him as a slave.
It was not long before it became clear that Pergamum was too small a world for such a great doctor, and five years after his return there from Alexandria, he moved to Rome. Here he found medicine in a similarly primitive state, held back by its taboos against Alexandrian anatomy. The Roman poet Martial noted ironically: “Until recently, Diaulus was a doctor; now he is an undertaker. He is still doing as an undertaker, what he used to do as a doctor” (Martial, Epigrams, book 1.47).
Not surprisingly then this new doctor from the East dazzled the court, and as a superb self-publicist, Galen took every opportunity to put his rivals in the shade. One such occasion was provided by the arrival of a Persian merchant complaining of a loss of feeling in the ring and little fingers and half the middle finger of one hand. For some time Roman doctors had been applying unguents and creams to the fingers in the hope of stimulating them, but to no effect. Galen asked him
an unusual question: Had he hurt his arm recently?
The question must have been quite surprising. The man’s problem was clearly in his fingers. What did that have to do with his arm? But Galen was right. The man said he had taken a bad fall and hurt his back. Galen diagnosed a spinal lesion and recommended bed rest and soothing compresses for the injury site. It worked, and the man’s fingers recovered. It may sound like a small thing, numb fingers, but in curing them Galen was laying the foundations of modern neurology.
Such demonstrations made Galen famous, while his arrogance, his outspoken attacks on his detractors, and his withering humiliation of less successful doctors made him many enemies. Galen was not a modest man, and in later life he would happily compare himself to a Roman emperor: “I have done as much for medicine as the Emperor Trajan did for the Roman Empire when he built bridges and roads through Italy. It is I, and I alone who have revealed the true path of medicine” (Galen, quoted in F. Marti-Ibanez, The Epic of Medicine, p. 93).
In 166, sensing a plot by his powerful enemies, Galen slipped secretly out of the city in the nick of time. Though he claimed the plot as the reason for his abrupt exit, an impending outbreak of the plague, which he had successfully identified, may have been the more compelling motive.
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