HISTORY of MEDICINE![]() |
Gods dominated the lives of the Greeks. Natural occurrences were explained away by using gods. This, however, did not occur in medicine where Ancient Greek physicians tried to find a natural explanation as to why someone got ill and died. Medicine during the time of the ancient Greeks was limited in its ability to cure diseases. The field of medicine combined science and religious beliefs. The ancient Greeks believed that sickness was brought on by an imbalance in four substances known as “humors.” The four humors were blood, yellow bile, black bile, and phlegm. Those who practiced medicine drew blood and induced vomiting or sweating to bring the four humors back into balance. The Ancient Greeks, some 1000 years before the birth of Christ, recognized the importance of physicians, as related in the works of Homer, injured warriors were treated by physicians. They continued to develop the art of medicine and made many advances, although they were not as skilled as the Ancient Egyptians, whom even Homer recognized as the greatest healers in the world. Whilst they imported much of their medical knowledge from the Egyptians, they did develop some skills of their own and certainly influenced the course of the Western history of medicine. The ancient Greeks initially regarded illness as a divine punishment and healing as, quite literally, a gift from the gods. However, by the 5th century BCE, there were attempts to identify the material causes for illnesses rather than spiritual ones and this led to a move away from superstition towards scientific enquiry, although, in reality, the two would never be wholly separated. Greek medical practitioners, then, began to take a greater interest in the body itself and to explore the connection between cause and effect, the relation of symptoms to the illness itself and the success or failure of various treatments. From the earliest times, treatments involved incantations, invoking the gods, and the use of magical herbs, amulets, and charms. Drug sellers, root cutters, midwives, gymnastic trainers, and surgeons all offered medical treatment and advice. In the absence of formal qualifications, any individual could offer medical services, and literary evidence for early medical practice shows doctors working hard to distinguish their own ideas and treatments from those of their competitors. The roots of Greek medicine were many and included ideas assimilated from Egypt and the Near East, particularly Babylonia. Doctors and Medicine in Ancient Greece Medicine during the time of the ancient Greeks was limited in its ability to cure diseases. The field of medicine combined science and religious beliefs. The ancient Greeks believed that sickness was brought on by an imbalance in four substances known as “humors.” The four humors were blood, yellow bile, black bile, and phlegm. Those who practiced medicine drew blood and induced vomiting or sweating to bring the four humors back into balance. Although their methods were primitive, the ancient Greeks did make advancements in the field of medicine, going beyond religious superstitions to a more scientific endeavor. Hippocrates, known as the “father of modern medicine,” brought a more scientific method to the treatment of illnesses. He observed a variety of symptoms to determine the natural causes of diseases. (Doctors today still take a Hippocratic Oath to “do no harm to their patients.”) They were able to set broken bones, amputate limbs, and many other difficult procedures. Surgery was always a last resort, since most people died from shock, blood loss, or infection afterwards. From the limited evidence we have, it has been estimated that only two out of three children survived to see their second birthday. The average age of death for healthy Greek adults during this period was fifty. Good health, according to those in the Hippocratic school, results when the humors are in balance with one another and in tune with one's constitutional nature and temperament--a condition Hippocrates and his followers called “being in temperament.” Conversely, the further one strays from this harmonious, balanced state of being in temperament, the more out of balance and unhealthy one becomes. This state of being out of balance with one's innate constitutional nature was called a distemperament. However, the distinction between the spiritual and physical worlds are often blurred in Greek medicine, for example, the god Asclepius was considered a dispenser of healing but also a highly skilled practical doctor. The god was called upon by patients at his various sanctuaries (notably Epidaurus) to give the patient advice through dreams which the site practitioners could then act upon. Grateful patients at the site often left monuments which reveal some of the problems that needed to be treated, they include blindness, worms, lameness, snakebites and aphasia. As Epidaurus illustrates, there could, then, be both a divine and a physical cause or remedy for illnesses. Asclepios, (8th C BC) a man who was among the first known physicians in Greece, eventually came to be worshipped a Greek god of health and disease. As a god he was considered to have powers even to raise the dead. Asclepios’ human son, Machaon, was also worshipped as the god—the god of surgery, and another son, Podalirios, was worshipped as the god of medicine. Like their father and brothers, Asclepios’s daughters, Hygeia, Panacea, and Iaso were also associated with health. Hygeia was the goddess of public health, Panacea was the goddess of therapy and Iaso was the goddess of cures, remedies and modes of healing. The Rod of Asclepius is a universal symbol for medicine to this very day. However, it is frequently confused with Caduceus, which was a staff wielded by the god Hermes. The Rod of Asclepius embodies one snake with no wings whereas Caduceus is represented by two snakes and a pair of wings depicting the swiftness of Hermes. In the late 6th century B.C., two Greek city-states were famous for their doctors, those of Croton (in Southern Italy) and Cyrene (in Northern Africa). But in the fifth century the most famous centers were Cos, the birthplace of Hippocrates, and Cnidus, just opposite Cos on the mainland of Asia Minor. They developed flourishing medical schools. These schools became the main centers for the teaching of medicine, and the doctors associated with either place shared certain medical practices. The instruction in these schools was very informal, compared to now. No set term was made to the period of training that a medical student should undergo, nor at the end of it did he obtain a certificate of his right to practice. So far as is known no legal or general method existed to prevent an amateur, an inadequately trained apprentice, or a quack from practicing. His establishing himself as a doctor depended not on how he had been trained, but on his own conscience, the reputation he acquired in practice, and keeping the confidence of his clients. The earliest known Greek medical school opened in Cnidus in 700 BC. Alcmaeon, author of the first anatomical compilation, worked at this school, and it was here that the practice of observing patients was established. Despite their known respect for Egyptian medicine, attempts to discern any particular influence on Greek practice at this early time have not been dramatically successful because of the lack of sources and the challenge of understanding ancient medical terminology. It is clear, however, that the Greeks imported Egyptian substances into their pharmacopoeia, and the influence became more pronounced after the establishment of a school of Greek medicine in Alexandria. The first medical writers (before Hippocrates): Alcmaeon (discovered the optic nerve) and Philolaos, both Pythagoreans, founded a medical school. Demokedes of Croton, was Public Doctor in Aegina, Athens and Samos. He healed Darius (sprained ankle), and Atossa (breast tumour). The best known serious physician before Hippocrates. Hippocrates of Cos (460--360 B.C.) was a Greek physician who founded his practice on the theory of humors. He was very important in his time not only for his writings and theories, but for his school of medicine. The writings Hippocrates and his followers have been preserved to form what is today called the Hippocratic Corpus. In the corpus are depictions of histories and clinical observations. The primary treatments by those in the Hippocratic School included herbal medicines and blood letting. They focused on prevention and health prescribing healthy diets, baths, and applying hot and cold compresses. Hippocratic surgery involved suturing wounds, cutting to drain infections, and trephining (drilling a hole in the skull).Hippocrates used the theory of humors to understand bodily functioning and disease. He, saw the world as being made up of four elements: earth, air, fire, and water. These elements, he theorized, are also expressed within each person as four “cardinal humors”, black bile, blood, yellow bile (choler), and phlegm. Each of the four basic elements were seen by Hippocrates as having two qualities (e.g., fire: hot and dry), and these qualities applied to the humors as well. For example, blood makes the body hot and wet. Choler or yellow bile was gastric juice. It serves digestion and makes the body hot and dry. Phlegm, a fluid that made up the colorless secretions of the body results in a cold and wet body and serves as a lubricant and coolant. Black bile is a dark liquid almost never found in pure form. It was seen as being responsible for darkening other fluids such as when the blood, skin, or stools blackened. It produced a cold and dry body. Greek doctors, influenced by Hippocratic thought, would study the case history of patients, asking questions and attempting to find out as much as possible from the patient before arriving at a diagnosis. This two-way interaction between patient and doctor became a foundation of the history of medicine, still used by modern practitioners. The idea that diseases have natural, and not divine causes is a critical point in Hippocratic medicine. Additionally, the emergence of regimens containing diet and exercise, humors, and purging can all be attributed to Hippocratic medicine. Purging included bloodletting, emetics, laxatives, diuretics, and enemas. Physicians would first examine the face, eyes, hands, posture, breathing, sleep, stool, urine, vomit, and sputum of their patients. They would also check for coughing, hiccupping, flatulence, fever, convulsions, pustules, tumors and lesions. Hippocrates noted that to treat burns Greek and Roman doctors would use pig fat, resin and bitumen. Hippocrates began to categorize illnesses as acute, chronic, endemic and epidemic, and use terms such as, "exacerbation, relapse, resolution, crisis, paroxysm, peak, and convalescence." Another of Hippocrates's major contributions may be found in his descriptions of the symptomatology, physical findings, surgical treatment and prognosis of thoracic empyema, i.e. suppuration of the lining of the chest cavity and hair loss and baldness. His teachings remain relevant to present-day students of pulmonary medicine and surgery. Hippocrates was the first documented chest surgeon and his findings are still valid. The Hippocratic Corpus contains the core medical texts of this school. Although once thought to have been written by Hippocrates himself, today, many scholars believe that these texts were written by a series of authors over several decades. Since it is impossible to determine which may have been written by Hippocrates himself, it is difficult to know which Hippocratic doctrines originated with him. Hippocrates forwarded the idea that brain was the seat of sensation, thought, and emotions. His cephalocentric focus was a departure from previous theories, such as those forwarded by the Egyptians, that placed the heart in a key role of bodily governance. The Hippocratic texts deal with all manner of medical topics but can be grouped into the main categories of diagnosis, biology, treatment and general advice for doctors. Another source is the fragmentary texts from the Greek natural philosophy corpus dating from the 6th to 5th century BC. Philosophers in general, seeing the benefits of good health on the mind and soul, were frequently concerned either directly or indirectly with the human body and medicine. These thinkers include Plato (especially in Timaeus), Empedocles of Acragas, Philistion of Locri and Anaxagoras. Famous medical practitioners included the 4th century BC figures of Diocles of Carystus (who had a head bandage and spoon instrument for removing arrow heads named after him), Praxagoras of Cos (noted for his ‘discovery’ of the pulse and being the first to distinguish veins from arteries), and the Athenians Mnesitheus and Dieuches. These experts in their field could examine a patient’s face and make a diagnosis helped by information such as the patient’s diet, bowel movements, appetite and sleeping habits. Treatments often utilised natural plants such as herbs and roots but could also include the use of amulets and charms. Surgery was generally avoided as it was considered too risky but minor operations may have been carried out, especially on soldiers wounded in battle. In general, Greek doctors practiced privately, with occasional employment by a city-state for a year at a time. And to be sure that the doctors didn’t make too much money, they were ordered to, when necessary, treat their patients without payment. The usual rule was that doctors charged their patient for their services. While some doctors were permanently resident in a particular city, a large number traveled from place to place in search of a living and in response to the demand for doctors. The insecure position of the doctor is reflected in many features of Greek medical practices. Therefore, one of the goals of the diagnosis is to impress the patient and win his confidence. The Greek doctors would try to tell their patients not only what was going to happen to them but also their present and past symptoms. The practice of prognosis was evidently an important psychological weapon in the battle to win the patients’ confidence. By realizing and announcing beforehand which patients were going to die, he would avoid any blame. However, not all Ancient Greeks turned to physicians when ill. Many still turned to the gods. The god Apollo was consulted at a temple in Delphi and by the sixth century B.C., many turned to the god Asclepios for help. Places called asclepeia were built for those in poor health. These were like temples and here people came to bathe, sleep and meditate. The poor were also allowed to beg for money in these buildings. Those who went to asclepeias were expected to leave offerings to Asclepios. The asclepeias were run by priests. Patients to asclepeias were encouraged to sleep as it was believed that during sleep they would be visited by Asclepios and his two daughters, Panacea and Hygeia. A visit by these three was expected to cure all ailments. Those who were not cured could stay at the asclepeia where they were. Over time doctors came to acquire a basic knowledge of human anatomy, assisted, no doubt, by the observation of grievously wounded soldiers and, from the 4th century BC, animal dissection. However, some claimed this was useless as they believed the inner body changed on contact with air and light and still others, as today, protested that using animals for such purposes was cruel. Human dissection would have to wait until Hellenistic times when such discoveries as the full nervous system were discovered. Nevertheless, there was an increasing urge to discover what made a healthy body function well rather than what had made an unhealthy one break down. The lack of practical knowledge, though, did result in some fundamental errors such as Aristotle’s belief that the heart and not the brain controlled the body and the idea proposed in the treatise On Ancient Medicine (5th century BC) that physical pain arises from the body’s inability to assimilate certain foods. The Asclepiades, an ancient guild of doctors from the 6th to the 2nd century Greece, was made up of devotees of Asclepios. By 200 BC every large town in Greece had a temple where people could go to cure their ailments and appeal for help from the god Asclepios and his devotees. Temples and centers associated with Asclepios, such as the one at Epidaurus on Greece's mainland, contained spas, overnight sleeping arrangements, and sites of entertainment, such as theatres. Pilgrims would stay over night at the temples. They would request a health cure from Asclepios and then sleep before an image of the god. The god would visit them in a dream, or his snake would come to them, and when the person awoke from their temple sleep they would either be cured or have their dream interpreted by Asclepean priest-doctors to identify a cure. The ancient Greek playwright Aristophanes in his play Plutos, describes how Asclepios cured a pilgrim/god of his blindness. It is not until the age of Alexandria under the Ptolemies that advances in biology can be again found. The first medical teacher at Alexandria was Herophilus of Chalcedon, who differed from Aristotle, placing intelligence in the brain, and connected the nervous system to motion and sensation. Herophilus also distinguished between veins and arteries, noting that the latter pulse while the former do not. He did this using an experiment involving cutting certain veins and arteries in a pig's neck until the squealing stopped. In the same vein (no pun intended), he developed a diagnostic technique which relied upon distinguishing different types of pulse. He, and his contemporary, Erasistratus of Chios, researched the role of veins and nerves, mapping their courses across the body.
When mentioning the Roman influence on the history of medicine, the physician Galen is the most illustrious name. This Greek, granted an expensive education by his merchant father, studied in the medical school at Pergamum and frequented the Aesclepions. In 161 AD, Galen moved to Rome, where he acted as physician to the gladiators, which allowed him to study physiology and the human body. Galen summarises Greek medicine at the end of its productive period (2nd c. AD). Galen wrote about his constantly evolving theories. He was espoused as the most important doctor of his time, having written over three hundred books and papers on medical topics. He essentially comprised an encyclopedia of medicine for the ancient world. His writings would fill 78 modern day books. Galen based many of his original theories on the work of Hippocrates. Hippocrates believed that where a person worked, ate, and lived were important to understanding their health issues. These beliefs were valid, as they acknowledged that mosquitoes carry certain illnesses or that a local contaminated water source could indeed be the origin of particular illnesses. Hippocrates also believed that there were both physical and mental illnesses. Though ethnically Greek, Galen was a Roman citizen. He was greatly influenced by his study of Hippocrates and Hippocrates' case studies of medicine and medical practice. It was Galen's premise to investigate the facts and opinions on each case study rather than simply agreeing with what the previous author had written. Therefore, he would add notes or extra realizations to existing case studies in order to improve knowledge of medical practice itself. For example Galen "added the theory of pulses to Hippocrates' tehne." Although this seems like a simple elaboration, it led to a deeper understanding of human bodily functions. Furthermore, Galen accepted the concept of The Four Humors adopted by many ancient Greek and Roman physicians. The Four Humors are similar to Aristotle's theory of five elements (excluding aether): air, water, fire, and earth. Though Galen was well read on ancient philosophers, he profoundly rejected the ideals and theories inspired by Stoicism. The Roman contribution to the history of medicine is often overlooked, with only Galen, of Greek origin, believed to be notable of mention. However, this does the Romans a great disservice and they put their excellent engineering skills to use in preventative medicine. The Romans understood the role of dirt and poor hygiene in spreading disease and created aqueducts to ensure that the inhabitants of a city received clean water. The Roman engineers also installed elaborate sewage systems to carry away waste. This is something that Europeans did not fully understand until the 19th Century; before this period, sewage was still discharged close to drinking water.
|