Like the first-century BC Roman gentleman Marcus Terentius Varro (JAMA cover, September 1, 1999), his slightly younger contemporary Aulus Cornelius Celsus (fl 25 AD) wrote an encyclopedia. Entitled De artibus, it included treatises on agriculture, the military art, rhetoric, medicine, and possibly on philosophy and jurisprudence as well. Unfortunately, all of the encyclopedia has been lost except for the eight books on medicine known as De medicina. Still, they are gem enough, especially when one realizes that we have them today very likely only by chance. Thomas of Sazanne (later Pope Nicholas V) discovered the manuscript in Milan in the mid 15th century. Some 35 years later—less than 25 years after movable type had first appeared—De medicina was printed, one of the first works of medicine to be thus reproduced; the editio princeps (cover) appeared in Florence in 1478. Another "discovery" was necessary to bring the incunabulum to its current residence in the United States, however. In December 1912, the Canadian physician William Osler, then Regius Professor of Medicine at Oxford and an avid collector of rare books, sent an antiquarian catalogue to S. Weir Mitchell of The College of Physicians in Philadelphia, noting that the Celsus work was available for sale. In the catalogue margin, he wrote: "This is a superb copy. Why not bleed the fellows of the College? I will go $25: /s/ W.O." Besides Osler, who was a nonresident fellow of the College, and Weir, 12 other fellows, including then-president James C. Wilson, consented to the bloodletting, and the £84 purchase price (US $370) was raised. "Never was blood given with a better grace," wrote Wilson. With the page and capital illuminations done in real gold and lapis lazuli, the fellows got a bargain indeed. Written in Latin so elegant that Celsus is often called Cicero medicorum, De medicina is a literary as well as a medical treasure. It is also surprisingly modern in some respects, giving new meaning after 20 centuries to the oft-quoted apothegm, ars longa, vita brevis. For example, Celsus believed that study of the cadaver was necessary to truly learn medicine. So was actual experience in treating patients, for it was from experience that the art developed. If theory were enough, he reasoned, then even philosophers would be great practitioners. Again, physicians should admit their errors. Not only is this the proper behavior for persons of "great intelligence," but it would keep other physicians from committing the same errors. Celsus also recognized insanity as a disease and differentiated among several forms. When it came to the treatment of breast cancer, he recommended excision of the lump, but only when the disease was in its early stages. After that, nothing was effective. And, finally, it is to Celsus that every modern medical student owes his or her awareness of the four cardinal signs of inflammation, the classic Calor, Dolor, Rubor, and Tumor. Among early 20th-century commentators on Celsus, there has been some question as to whether or not he was a physician. Some dismiss him as a translator, others as a mere compiler, and at least one has called him a bald plagiarizer. It is as though the practice of medicine and the production of elegant prose are mutually incompatible. That such is not true has been amply proved by at least one of the book's patrons, the Oxford professor W.O. A final note is in order: The last page of De medicina bears the signature of an early (if not, indeed, its first) owner—Giorgio Antonio Vespucci, a 15th-century Dominican friar. He taught grammar and literature in Florence and was uncle and tutor to the future Italian navigator and New World namesake, Amerigo Vespucci. It would seem somehow appropriate, therefore, that this incunabulum would find its way eventually across an ocean to its current home in America, where it reminds us that medicine is a truly universal art. Aulus Cornelius CelsusNot AvailableDe medicina 1478. Florentine. 28.5 × 21.5 cm. Courtesy of The College of Physicians of Philadelphia, Philadelphia, Pa (http://www.collphyphil.org). Acknowledgment—I am grateful to Charles B. Greifenstein, MA, MS, Curator of Archives & Manuscripts, The College of Physicians of Philadelphia, for supplying information on the incunabulum not otherwise readily available and to Jane C. Lantz, MLA, ELS, Mayo Clinic Proceedings, Rochester, Minn, for help with the Latin translation.
– American Medical Association
Published: Sep 8, 1999