He came of a distinguished family, in which the following of medicine as a profession might be looked upon as hereditary. His father was a physician, and it is probable that there were physicians in preceding generations, and one of his brothers, Dioscoros, was also a successful physician. Altogether four of his brothers reached such distinction in their life work that their names have come down to us through nearly fifteen hundred years. The eldest of them was Anthemios, the builder of the great church of Santa Sophia in Constantinople. As this is one of the world's great churches, and still stands for the admiration of men a millennium and a half after its completion, it is easy to understand that Anthemios' reputation is well founded. A second brother was Metrodoros, a distinguished grammarian and teacher, especially of the youthful nobility of Byzantium, as it was then called, or Constantinople, as we have come to call it. A third brother was a prominent jurist, also in Constantinople. The fourth brother, Dioscoros, like Alexander, a physician, remained in his birthplace, Tralles, and acquired there a great practice.
It was with his father at Tralles that Alexander received his early medical training. The father of a friend and colleague, Cosmas, who later dedicated a book to Alexander, was also his teacher, while he was in his native city. As a young man, Alexander undertook extensive travels, which led him into Italy, Gaul, Spain, and Africa, everywhere gathering medical knowledge and medical experience. Then he settled down at Rome, probably in an official position, and practised medicine successfully until a very old age. He was probably eighty years of age when, some time during the first decade of the seventh century, he died.
Puschmann, who has made a special study of Alexander's life and work, suggests that since some of his books have the form of academic lectures he was probably a teacher of medicine at Rome. As might be expected from what we know of the relations of the rest of the family to the nobility of the time, it is easy to understand, especially in connection with hints in Alexander's favorite modes of therapeutics, that costliness of remedies made no difference to his patients, that he must have had the treatment of some of the wealthiest families in Rome.
His principal work is a Treatise on the Pathology and Therapeutics of Internal Diseases, in twelve books. The first eleven books were evidently material gathered for lectures or teaching of some kind. The twelfth book, in which considerable use of Aëtius' writings is made, was written, according to Puschmann, toward the end of Alexander's life, and was meant to contain supplementary matter, comprising especially his views gathered from observation as to the pathology of internal diseases. A shorter treatise of Alexander is with regard to intestinal parasites. There are many printed editions of these books, and many manuscript copies are in existence. Alexander was often quoted during the Middle Ages, and in recent years, with the growth of our knowledge of medical history, he has come to be a favorite subject of study.
Alexander's first book of pathology and therapeutics treats of head and brain diseases. For baldness, the first symptom of which is falling out of the hair, he counsels cutting the hair short, washing the scalp vigorously, and the rubbing in of sulphur ointments. For grey hair he suggests certain hair dyes, as nutgalls, red wine, and so forth. For dandruff, which he described as the excessive formation of small flake-like scales, he recommends rubbing with wine, with certain salves, and washing with salt water.
He gives a good deal of attention to diseases of the nervous system. He has a rather interesting chapter on headache. The affection occurs in connection with fevers, after excess in drinking, and as a consequence of injury to the skull. Besides, it develops as a result of disturbances of the natural processes in the head, the stomach, the liver, and the spleen. Headache, as the first symptom of inflammation of the brain, is often the forerunner of convulsions, delirium, and sudden death. Chronic or recurrent headache occurs in connection with plethora, diseases of the brain, biliousness, digestive disturbances, insomnia, and continued worry. Hemicrania has its origin in the brain, because of the presence of toxic materials, and specially their transformation into gaseous substances. It also occurs in connection with abdominal affections. This latter remark particularly is directed to the cases which occur in women.
For apoplexy and the consequent paralysis, Alexander considered venesection the best remedy. Massage, rubbings, baths, and warm applications are recommended for the paralytic conditions. He had evidently had considerable experience with epilepsy. It develops either from injuries of the head or from disturbances of the stomach, or occasionally other parts of the body. When it occurs in nursing infants, nourishment is the best remedy, and he gives detailed directions for the selection of a wet nurse, and very careful directions as to her mode of life. He emphasizes very much the necessity for careful attention to the gastro-intestinal tract in many cases of epilepsy. Planned diet and regular bowels are very helpful. He rejects treatment of the condition by surgery of the head, either by trephining or by incisions, or cauterization. Regular exercise, baths, sexual abstinence are the foundation of any successful treatment. It is probable that we have returned to Alexander's treatment of epilepsy much more nearly than is generally thought. There are those who still think that remedies of various kinds do good, but in the large epileptic colonies regular exercise, bland diet, regulation of the bowels, and avoidance of excesses of all kinds, with occupation of mind, constitute the mainstay of their treatment.
Alexander has much to say with regard to phrenitis, a febrile condition complicated by delirium, which, following Galen, he considers an affection of the brain. It is evidently the brain fever of the generations preceding the last, an important element of which was made up of the infectious meningitises. Alexander suggests its treatment by opiates after preliminary venesection, rubbings, lukewarm baths, and stimulating drinks. Every disturbance of the patient must be avoided, and visitors must be forbidden. The patient's room should rather be light than dark. His teaching crops up constantly in the centuries after his time, until the end of the nineteenth century, and while we now understand the causes of the condition better, we can do little more for it than he did.
Alexander divided mental diseases into two, the maniacal and melancholic. Mania was, however, really a further development of melancholia, and represented a high grade of insanity. Under melancholy he groups not only what we denominate by that term, but also all depressed conditions, and the paranoias, as also many cases of imbecility. The cause of mental diseases was to be found in the blood. He counselled the use of venesection, of laxatives and purgatives, of baths and stimulant remedies. He insisted very much, however, on mental influence in the disease, on change of place and air, visits to the theatre, and every possible form of mental diversion, as among the best remedial measures.
After his book on diseases of the head, his most important section is on diseases of the respiratory system. In this he treats first of angina, and recommends as gargles at the beginning light astringents; later stronger astringents, as alum and soda dissolved in warm water, should be employed. Warm compresses, venesection from the sublingual veins, and from the jugular, and purgatives in severe cases, are the further remedies. He treats of cough as a symptom due to hot or cold, dry or wet dyscrasias. Opium preparations carefully used are the best remedies. The breathing in of steam impregnated with various ethereal resins, was also recommended.
He gives a rather interestingly modern treatment of consumption. He recommends an abundance of milk with a strong nutritious diet, as digestible as possible. A good auxiliary to this treatment was change of air, a sea voyage, and a stay at a watering-place. Asses' and mares' milk are much better for these patients than cows' and goats' milk. There is not enough difference in the composition of these various milks to make their special consumption of import, but it is probable that the suggestive influence of the taking of an unusual milk had a very favorable effect upon patients, and this effect was renewed frequently, so that much good was ultimately accomplished. For hemoptysis, especially when it was acute and due as Alexander thought to the rupture of a blood vessel in the lungs, he recommended the opening of a vein at the elbow or the ankle—in order to divert the blood from the place of rupture to the healthy parts of the circulation. He insisted that the patients must rest, that they should take acid and astringent drinks, that cold compresses should be placed upon the chest (our ice bags), and that they should take only a liquid diet at most lukewarm, or, better, if agreeable to them, cold. When the bleeding stopped, a milk cure was very useful for the restoration of these