Aulus Cornelius Celsus

Roman medical writer

• Born: c. 25 b.c.e.
• Birthplace: Possibly near Narbo Martius, Gaul (now Narbonne, France)
• Died: c. 50 c.e.
• Place of death: Probably Rome (now in Italy)

Celsus wrote the first complete history of medicine and the first comprehensive account of medical and surgical procedures.

Early Life

Aulus Cornelius Celsus (SEHL-suhs) probably lived during the Augustan Age and the reign of Tiberius. He is thought to have been a member of the patrician family of Cornelius. Patricians were the ruling class of Rome, nobles of wealth and influence, and they considered the practice of medicine beneath their dignity. Consequently, it is highly unlikely that Celsus was a practicing physician. Still, some knowledge of medicine was customary among the educated men of Rome. The head of the household usually practiced domestic medicine on the family, slaves, and livestock. Celsus may have followed this custom.

He was an avid reader and certainly knew both Greek and Latin. Records for the years 25 and 26 c.e. clearly indicate that he lived in Rome. Quintilian, the Roman rhetorician and critic, and Gaius Pliny, or Pliny the Elder, the Roman naturalist and writer, mention Celsus with considerable praise. Celsus was never referred to as a physician, only as an author or compiler. His literary interests were apparently comprehensive in scope and resulted in an encyclopedia called De artibus (25-35 c.e.). There is no clear idea of the contents and arrangement of De artibus. It is certain, however, that there were five books on agriculture and also sections of unknown length on military science, rhetoric, history, philosophy, government, and law.

The only portion of this encyclopedia to survive is De medicina (c. 30 c.e.; The Eight Books of Medicine, 1830; better known as De medicina, 1935-1938). It was a compilation from various sources such as Hippocrates’ Corpus Hippocraticum (written during the fifth century b.c.e.) and from the lost works of Asclepiades of Bithynia, Heracleides Ponticus, Erasistratus, and others.

Life’s Work

De medicina was intended primarily for practitioners. Celsus set down a guiding principle for physicians in any age: that an accurate diagnosis must precede treatment. Celsus noted the errors of both Empiricists and Methodists. He rejected the inflexible doctrines of the Empiricists, who advocated the use of drugs, and the Methodists, who stressed diet and exercise. He was influenced by Asclepiades, who established Greek medicine in Rome, and adopted many of the physiological concepts of the Alexandrian school.

The introduction to De medicina constitutes a first attempt at a history of medicine and includes references to eighty medical authors, some of whom are known only through this book. Celsus gave an account of the Alexandrian school, the part played by Hippocrates, and the contributions of Asclepiades.

The book, actually eight books in one, is divided into three parts. Section 1 contains a general introduction on the efficacy of diet and hygiene. Two main chapters consider the subject of general and local diseases governed by diet. Section 2 considers diseases treated with drugs. Discussed at length are different remedies, divided into various groups according to their effects: purgatives, diaphoretics, diuretics, emetics, and narcotics. There is also an examination of those diseases that require immediate treatment, diseases presenting acute or chronic manifestations, accidental or traumatic manifestations, and diseases with external symptoms. Section 3 is devoted to surgical diseases. One division concentrates on the organs, the other on orthopedics, or bones.

Celsus held strictly to the teachings of Hippocrates concerning pathological concepts and etiology, or the study of the causes of disease. He took into consideration the influence of the seasons, the weather, the patient’s age and constitution, and any sudden weight changes, increases and decreases.

Diseases of the stomach are considered at length. Treatment generally consisted of diet, massage, and baths. Celsus believed that it was better to keep the bowels open by diet rather than by purgatives. Where diarrhea and fever existed, fast was the prescription. Celsus believed in the doctrine of critical days for diseases, that is, the disease’s peak within a certain number of days, after which the patient would begin to recover.

In De medicina, Celsus addressed pneumonia, arthritis, dysentery, tonsilitis, cancer, kidney and liver diseases, tuberculosis, hemorrhoids, and diabetes. Symptoms were accurately reported for a number of diseases, such as epilepsy, and mental illnesses, such as paranoia, a form of mental illness characterized by delusions. He clearly depicted the way in which malaria attacks occurred, giving a very detailed and highly accurate account of malarial fever. According to Celsus, the fever was an effort to eliminate morbid material from the body. He was the first to name the four cardinal signs of inflammation: heat, pain, swelling, and redness.

The arguments of Celsus against taking the pulse of the patient as a criterion in the identification of disease are interesting. He regarded the pulse as an uncertain indication of the health of a person, because its frequency varied considerably with the sex, age, and constitution of the patient. The pulse also varied because of the patient’s nervousness when in the presence of the doctor. For these reasons, the pulse was not to be examined on the doctor’s first visit.

In Celsus’s time, surgery was performed on all parts of the body: goiters, fistulas, tonsils, and gallstones. Cancerous growths on lips and breasts were removed. He described ulcers, tumors, amputation, and trepanation, or the removal of part of the skull, which he regarded as a treatment of last resort.

Celsus carefully reported on plastic surgery for the repair of the nose, lips, and ears and described some dental surgery, including the wiring of teeth. He also suggested lithotomy, an operation for crushing stones in the bladder; discussed ligature, or how to tie off an artery; and presented methods for stopping hemorrhages. He was very much aware of the dangers of gangrene.

Celsus was concerned with the treatment of wounds, necrosis (decaying tissues), fractures, and dislocations. His book contains an excellent account of the treatment of various fractures and dislocations. For fractures, he recommended wooden splints held in place by wax and advocated exercise after the fracture healed. Thus, he was a forerunner to modern rehabilitative therapy. In addition, Celsus described the widely used painkillers, such as opium, and anesthetics, such as the root of the mandragora plant. The root of the plant, which contained narcotics such as scopolamine, was soaked in wine, and the wine was given to the patient to induce a deep sleep.

Celsus paid particular attention to headaches, which he regarded as coming from various sources, and approved the treatment of insomnia by oil massage, which he credited directly to Asclepiades. Celsus recommended removing snake poison from a wound by sucking and correctly claimed that the venom was lethal only when absorbed into the wound, not when swallowed (although, clearly, modern physicians would regard such behavior as extremely dangerous).

Celsus clearly recognized the importance of anatomy in medicine. He attended autopsies, and his anatomical descriptions are brief but clear, including information that shows that he knew about sutures of the cranium. He distinguished between veins and arteries and favored dissection as a means to discovering more about internal organs.

In short, Celsus taught that diagnosis and prognosis must precede treatment. In so doing, he confirmed the sound doctrine of the Hippocratic school. Celsus also advocated different types of baths, massage, hygiene, and dietary rules. He relied somewhat on drugs for treatment but emphasized the benefits of sports, such as hunting, fishing, and sailing.

Significance

Galen, a Greek philosopher and writer, prepared a medical encyclopedia that remained the standard authority until the sixteenth century. When Pope Nicholas V discovered Aulus Cornelius Celsus’s work in the Vatican Library, he arranged to have it published in 1478. Thus, De medicina was the first classical book on medicine to be printed. It was also the first translation of Greek medical terms into Latin. The Latin nomenclature used in the book has dominated Western medicine for two thousand years.

The book is of interest for two reasons: its literary skill and the techniques presented. From a literary point of view, his work is outstanding. Celsus ranks as Rome’s most important master of the encyclopedic literary form. As the first comprehensive account of surgical procedures by a Roman writer, De medicina provides much useful information on medicine of the Hellenistic period and on Alexandrian surgery. It includes a careful description of more than one hundred different types of surgical instruments.

Celsus’s ideas on malaria, the treatment of fractures, and plastic surgery were ahead of his time. He was a disciple of Asclepiades, but unlike Asclepiades, Celsus was a great admirer of Hippocrates and was among the first to introduce Hippocrates’ teaching to the Romans. During the first century, it was typical for medicine and other sciences to draw on many sources. Celsus followed this custom and can thus be regarded as a true eclectic.

Bibliography

Allbutt, Sir Thomas C. Greek Medicine in Rome: The Fitzpatrick Lectures on the History of Medicine Delivered at the Royal College of Physicians of London in 1909-1910. Reprint. New York: B. Blom, 1970. This series of lectures may be too abstract for the general reader. It is a complete medical history of the period, with extensive commentary on all major figures. Includes excellent illustrations, bibliography, and chronology.

Castiglioni, Arturo. A History of Medicine. Translated by E. B. Krumbhaar. 2d ed. New York: Alfred A. Knopf, 1947. Considered a classic reference for the period, this volume contains a full translation of Castiglioni’s work. Included are numerous illustrations, chronology, and bibliography for each chapter. Designed for the general reader, it contains information relating to the content of De medicina.

Celsus, Aulus Cornelius. De medicina. Translated by W. G. Spencer. 3 vols. Cambridge, Mass.: Harvard University Press, 1960-1961. This work includes both the original Latin text and a full translation of Celsus’s work. It is a major source of information about the history of medicine, as well as medical and surgical procedures for the Hellenistic period.

Cumston, Charles Greene. An Introduction to the History of Medicine: From the Time of the Pharaohs to the End of the Nineteenth Century. 1926. Reprint. London: Dawsons, 1968. A compilation of numerous essential contributions to the general subject of a history of medicine. Written for the general reader.

Gordon, Benjamin Lee. Medicine Throughout Antiquity. Philadelphia: F. A. Davis, 1949. Gordon’s book contains only a very brief section on Celsus, along with scattered page references. Includes brief reference notes and a few illustrations but no chronology or bibliography.

Langslow, D. R. Medical Latin in the Roman Empire. New York: Oxford University Press, 2000. Systematic account of the language of Latin medical texts that includes a detailed linguistic profile of the medical terminology of Celsus and Scribonius Largus (first century c.e.) and Theodorus Priscianus and Cassius Felix (fifth century c.e.).

Lipsett, W. G. “Celsus, First Medical Historian.” Science Digest 48 (October, 1960): 83-87. Gives very complete information about the various divisions of De medicina but concentrates on the surgical chapters. A very brief article that is perhaps too simplistic in language and approach, it does have appeal to the general reader.

Major, Ralph. “Medicine in the Roman Empire.” In A History of Medicine. Springfield, Ill.: Charles C Thomas, 1954. This book requires no background knowledge about medical history. Very limited information is presented, and few illustrations are given.