Ancient Greek medicine
Ancient Greek medicine was a compilation of theories that were constantly expanding through new ideologies and trials. Many components were considered in Ancient Greek Medicine, intertwining the spiritual with the physical. Specifically, the theories and ideologies from which Ancient Greek Medicine derived included the humors, gender, geographic location, social class, diet, trauma, beliefs, and mind set. Early on, Ancient Greeks believed that illnesses were “divine punishments” and that healing was a “gift from the Gods.” (Cartwright, Mark in “Greek Medicine.”) As trials continued wherein theories were tested against symptoms and results, Ancient Greek medicine also grew such that the pure spiritual beliefs as to “punishments” and “gifts” were converted to a foundation based in the physical, i.e., cause and effect.
Humorism refers to blood, yellow bile, black bile and phlegm. It was also theorized that gender played a role in medicine because some diseases and treatments were different for women than for men. Moreover, geographic location and social class affected the living conditions of the people and might subject them to different environmental issues such as mosquitoes, rats, and availability of clean drinking water. Diet was thought to be an issue as well and might be affected by a lack of access to adequate nourishment. Trauma, such as suffered by gladiators, or from dog bites or other injury played a role in theories relating to understanding anatomy, and infections. Additionally there was significant focus on the beliefs and mind set of the patient in the diagnosis and treatment theories. It was recognized that the mind played a role in healing, or that it might also be the sole basis for the illness.
Ancient Greek medicine began to revolve around the theory of humors. Humoral theory states that good health comes from perfect balance of the four humors blood, phlegm, yellow bile, and black bile. Consequently, poor health resulted from improper balance of the four humors. Hippocrates, known as the "Father of Modern Medicine", established a medical school at Kos and is the most important figure in ancient Greek medicine. Hippocrates and his students documented numerous illnesses in the Hippocratic Corpus, and developed the Hippocratic Oath for physicians, which is still in use today. The contributions to ancient Greek medicine of Hippocrates, Socrates and others had a lasting influence on Islamic medicine and Medieval European medicine until many of their findings eventually became obsolete in the 14th century.
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.
Hippocrates and Hippocratic medicine
A towering figure in the history of medicine was the physician Hippocrates of Kos (ca. 460 BC – ca. 370 BC), considered the "Father of Modern Medicine." The Hippocratic Corpus is a collection of about seventy early medical works from ancient Greece that are associated with Hippocrates and his students. Hippocrates notoriously wrote the Hippocratic Oath which is relevant and in use by physicians to this day.
The existence of the Hippocratic Oath implies that this "Hippocratic" medicine was practiced by a group of professional physicians bound (at least among themselves) by a strict ethical code. Aspiring students normally paid a fee for training (a provision is made for exceptions) and entered into a virtual family relationship with his teacher. This training included some oral instruction and probably hands-on experience as the teacher's assistant, since the Oath assumes that the student will be interacting with patients. The Oath also places limits on what the physician may or may not do ("To please no one will I prescribe a deadly drug") and intriguingly hints at the existence of another class of professional specialists, perhaps akin to surgeons ("I will leave this operation to be performed by practitioners, specialists in this art").
Hippocrates and his followers were first to describe many diseases and medical conditions. He is given credit for the first purple description of clubbing of the fingers, an important diagnostic sign in chronic suppurative lung disease, lung cancer and cyanotic heart disease. For this reason, clubbed fingers are sometimes referred to as "Hippocratic fingers". Hippocrates was also the first physician to describe Hippocratic face in Prognosis. Shakespeare famously alludes to this description when writing of Falstaff's death in Act II, Scene iii. of Henry V.
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.
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.
Asclepius was espoused as the first physician, and myth placed him as the son of Apollo. Temples dedicated to the healer-god Asclepius, known as Asclepieia (Greek: Ἀσκληπιεῖα; sing. Ἀσκληπιεῖον Asclepieion), functioned as centers of medical advice, prognosis, and healing. At these shrines, patients would enter a dream-like state of induced sleep known as "enkoimesis" (Greek: ἐγκοίμησις) not unlike anesthesia, in which they either received guidance from the deity in a dream or were cured by surgery. Asclepeia provided carefully controlled spaces conducive to healing and fulfilled several of the requirements of institutions created for healing. The Temple of Asclepius in Pergamum had a spring that flowed down into an underground room in the Temple. People would come to drink the waters and to bath in them because they were believed to have medicinal properties. Mud baths and hot teas such as chamomile to calm them or peppermint tea to sooth their headaches. The patients were encouraged to sleep in the facilities too. Their dreams were interpreted by the doctors and their symptoms were then reviewed. Dogs would occasionally be brought in to lick open wounds for assistance in their healing. In the Asclepieion of Epidaurus, three large marble boards dated to 350 BC preserve the names, case histories, complaints, and cures of about 70 patients who came to the temple with a problem and shed it there. Some of the surgical cures listed, such as the opening of an abdominal abscess or the removal of traumatic foreign material, are realistic enough to have taken place, but with the patient in a state of enkoimesis induced with the help of soporific substances such as opium.
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.
Ancient Greek philosopher Aristotle was the most influential scholar of the living world from antiquity. Though his early natural philosophy work was speculative, Aristotle's later biological writings demonstrate great concern for empiricism, biological causation, and the diversity of life. Aristotle did not experiment, however, holding that items display their real natures in their own environments, rather than controlled artificial ones. While in modern-day physics and chemistry this assumption has been found unhelpful, in zoology and ethology it remains the dominant practice, and Aristotle's work "retains real interest". He made countless observations of nature, especially the habits and attributes of plants and animals in the world around him, which he devoted considerable attention to categorizing. In all, Aristotle classified 540 animal species, and dissected at least 50.
Aristotle believed that formal causes guided all natural processes. Such a teleological view gave Aristotle cause to justify his observed data as an expression of formal design; for example suggesting that Nature, giving no animal both horns and tusks, was staving off vanity, and generally giving creatures faculties only to such a degree as they are necessary. In a similar fashion, Aristotle believed that creatures were arranged in a graded scale of perfection rising from plants on up to man—the scala naturae or Great Chain of Being.
He held that the level of a creature's perfection was reflected in its form, but not foreordained by that form. Yet another aspect of his biology divided souls into three groups: a vegetative soul, responsible for reproduction and growth; a sensitive soul, responsible for mobility and sensation; and a rational soul, capable of thought and reflection. He attributed only the first to plants, the first two to animals, and all three to humans. Aristotle, in contrast to earlier philosophers, and like the Egyptians, placed the rational soul in the heart, rather than the brain. Notable is Aristotle's division of sensation and thought, which generally went against previous philosophers, with the exception of Alcmaeon. Aristotle's successor at the Lyceum, Theophrastus, wrote a series of books on botany—the History of Plants—which survived as the most important contribution of antiquity to botany, even into the Middle Ages. Many of Theophrastus' names survive into modern times, such as carpos for fruit, and pericarpion for seed vessel. Rather than focus on formal causes, as Aristotle did, Theophrastus suggested a mechanistic scheme, drawing analogies between natural and artificial processes, and relying on Aristotle's concept of the efficient cause. Theophrastus also recognized the role of sex in the reproduction of some higher plants, though this last discovery was lost in later ages. The biological/teleological ideas of Aristotle and Theophrastus, as well as their emphasis on a series of axioms rather than on empirical observation, cannot be easily separated from their consequent impact on Western medicine.
Following Theophrastus ( d.286 BC ), the Lyceum failed to produce any original work. Though interest in Aristotle's ideas survived, they were generally taken unquestioningly. 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.
Erasistratus connected the increased complexity of the surface of the human brain compared to other animals to its superior intelligence. He sometimes employed experiments to further his research, at one time repeatedly weighing a caged bird and noting its weight loss between feeding times. Following his teacher's researches into pneumatics, he claimed that the human system of blood vessels was controlled by vacuums, drawing blood across the body. In Erasistratus' physiology, air enters the body, is then drawn by the lungs into the heart, where it is transformed into vital spirit, and is then pumped by the arteries throughout the body. Some of this vital spirit reaches the brain, where it is transformed into animal spirit, which is then distributed by the nerves. Herophilus and Erasistratus performed their experiments upon criminals given to them by their Ptolemaic kings. They dissected these criminals alive, and "while they were still breathing they observed parts which nature had formerly concealed, and examined their position, colour, shape, size, arrangement, hardness, softness, smoothness, connection."
Though a few ancient atomists such as Lucretius challenged the teleological viewpoint of Aristotelian ideas about life, teleology (and after the rise of Christianity, natural theology) would remain central to biological thought essentially until the 18th and 19th centuries. In the words of Ernst Mayr, "Nothing of any real consequence in biology after Lucretius and Galen until the Renaissance." Aristotle's ideas of natural history and medicine survived, but they were generally taken unquestioningly.
Galen was a noteworthy doctor and scientist who contributed greatly to Ancient Greek Medicine. During this period, Greeks had a single name, whereas Romans bore a string of names. Galen was of Greek lineage. He was born in the former Greek City of Pergamum on September 22, 129 A.D. (or possibly 130 A.D.). In exchange for a promise to protect the independence of Pergamum, a former ruler had given the city to the Romans well before Galen was born. However, the citizens of Pergamum still considered it a Greek city and were of Greek lineage.
Galen’s primary focus was on anatomy. He believed that how the parts of the body were arranged and worked together was the foundation of understanding how to treat and cure it. Galen experimented with various minerals and herbs, combining them in different extracts and tried them on his patients to determine which ones had the best results. He wrote down the combinations of these prescriptions and, in his lifetime, composed more than thirty pharmaceutical books. Galen prescribed medicinal treatment for both physical and mental ailments.
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.
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.
Galen began his study of medicine at the Temple of Aesculapius, after having learned language, philosophy, and Greek as well as Roman math. He was clearly characterized to love problem solving and enjoyed geometry. At the age of nineteen, just after he graduated from the Aesculapius, Galen's father, a wealthy man named Nicon, died. Upon his death, Galen left his home to travel the world. Unlike many physicians or scientists of the time, his inherited wealth allowed him to gain more access to medical texts, pharmaceutical texts, and works on anatomy. Overall he could afford an advanced education and travel to better schools. His circumstances ultimately allowed him a greater understanding of the human body and mind. His travels took him to localities where he learned from other physicians. Galen’s first destination was Smyrna. There, he studied with Pelops, a famous doctor who had lectured at Aesculapius when Galen was attending school there. Pelops had his own school. This led Galen to spend more time studying botany, philosophy and medicine while in Smyrna. Galen enjoyed botany and the potential it provided for cures in the form of prescriptions. He began collecting plants on his travels for this purpose.
When Galen became bored in Smyrna, he traveled on to Corinth, then Alexandria in Egypt to attend another school called Museum. The trip from Corinth to Alexandria took Galen across the Mediterranean. En route, the ship stopped at Crete to obtain supplies. During the stop, Galen walked the hills and collected herbs for his medicinal chest.
At Museum, Galen was finally able to view a human skeleton. There were two skeletons at the Museum, though dissections of humans were not allowed. Both were stripped clean by natural causes, one by animals and the other had been in a river for an extended period of time. Both had been retrieved from where they were found and brought to Museum. Up until that time, Galen had only seen the structures of animals (which could be dissected). Galen began to form opinions and theories after studying the skeletons and applying the knowledge he had gained from dissecting animals. Based on his own studies as well as those of Aristotle, Galen determined that the body had three systems. He called them the natural spirit (veins and liver which provided nutrition), the vital spirit (heart) and the animal spirit. Galen's knowledge of animal anatomy came from his practice of vivisection. He also performed these procedures in public. Postulating that animals and humans have similar anatomy was an accepted theory. In reality, many animals have different or extra organs. Regardless, these organs were not only thought to be present in the human body but vital to human bodily functions, possibly even holding an important part of the soul. Galen again grew bored and determined that it was time to return home to begin his career as a doctor. Upon his return to Pergamum, he went to work as a doctor for a ludi, a school for gladiators. He set bones, sewed wounds closed, reset dislocations, completed cauterizations, and discovered that an injury to one side of the brain affected the opposite side of the body. He was able to observe muscles, tissues and other parts of the human body through open wounds. Ultimately it gave Galen a foremost position as a physician, an exceptional reputation, and a superb practice of medicine. Galen stayed in this position for three years.
Galen again grew bored and went to Rome. Galen’s opportunity to shine came in the form of his father’s friend, Eudemus, who was very ill. He called for Galen’s help when he heard he was in the city. Eudemus had been under the care of one of the best physicians in the city, but had been growing sicker in spite of this. Galen concocted medications for Eudemus from his store of herbs. Eudemus was healed, and suddenly Galen’s services were in high demand. Galen then was called to heal the wife of the consul, Flavius Boethius. Upon her cure, Boethius paid Galen a handsome sum and then provided Galen with a lecture hall. Galen provided lectures to the educated on the human systems. As a part of the presentations, he completed dissections of animals, exhibited how the blood contains oxygen, and showed how thoughts come from the brain rather than from the heart as previously believed. He also taught the importance of the spinal cord and that injuries to it would cause loss of the use of the parts of the body below the severed part of the cord,(brain which provided intelligence and senses). Galen used this basis to begin to put together how the various parts of the body functioned together.
His most famous patients included Marcus Aurelius, Lucius Verus, and Commodus Aurelius. He was the doctor for most of the aristocrats of Rome. Galen was the greatest diagnostician of his time. He could feel a fever, recognized the changes pulse, knew the sounds of the heart, and was attune to skin color. He recognized the importance of the various symptoms with which a patient presented. Galen was the first pharmacist to measure out and write down the ingredients of his prescriptions. He was very particular about the ingredients he included in his remedies and would either travel to get them himself, asking local people how they used the various herbs and plants, or often would order them directly from people whom he knew and trusted. After four years in Rome, Galen once again returned to Pergamum. It was at a time when the plague was striking Rome. However in 168 A.D., Marcus Aurelius summoned Galen back to Rome to care for wounded soldiers and to serve as the doctor for Commodus. Galen spent the next twenty years in Rome. In the year 192, many of Galen’s writings were destroyed in a fire at the Temple of Peace where they were stored, yet many were saved. It is believed that Galen may have lived to be 87 years of age.
The first century AD Greek physician, pharmacologist, botanist, and Roman army surgeon Pedanius Dioscorides authored an encyclopedia of medicinal substances commonly known as De Materia Medica. This work did not delve into medical theory or explanation of pathogenesis, but described the uses and actions of some 600 substances, based on empirical observation. Unlike other works of Classical antiquity, Dioscorides' manuscript was never out of publication and his materia medica formed the basis for the Western pharmacopeia through the 19th century, a true testament to the efficacy of the medicines described ; moreover, the influence of work on European herbal medicine eclipsed that of the Hippocratic Corpus.
Through long contact with Greek culture, and their eventual conquest of Greece, the Romans absorbed many of the Greek ideas on medicine. Early Roman reactions to Greek medicine ranged from enthusiasm to hostility, but eventually the Romans adopted a favorable view of Hippocratic medicine.
This acceptance led to the spread of Greek medical theories throughout the Roman Empire, and thus a large portion of the West. The most influential Roman scholar to continue and expand on the Hippocratic tradition was Galen (d. c. 207). Study of Hippocratic and Galenic texts, however, all but disappeared in the Latin West in the Early Middle Ages, following the collapse of the Western Empire, although the Hippocratic-Galenic tradition of Greek medicine continued to be studied and practiced in the Eastern Roman Empire (Byzantium). After AD 750, Arab, Persian and Andalusi scholars translated Galen's and Dioscorides' works in particular translated. Thereafter the Hippocratic-Galenic medical tradition was assimilated and eventually expanded, with the most influential Muslim doctor-scholar being (Ibn Sina). Beginning in the late eleventh century, the Hippocratic-Galenic tradition returned to the Latin West with a series of translations of the Classical texts, mainly from Arabic translations but occasionally from the original Greek. In the Renaissance, more translations of Galen and Hippocrates directly from the Greek were made from newly available Byzantine manuscripts.
Galen's influence was so great that even after Western Europeans started making dissections in the thirteenth century, scholars often assimilated findings into the Galenic model that otherwise might have thrown Galen's accuracy into doubt. Over time, however, Classical medical theory came to be superseded by increasing emphasis on scientific experimental methods in the 16th and 17th centuries. Nevertheless, the Hippocratic-Galenic practice of bloodletting was practiced into the 19th century, despite its empirical ineffectiveness and riskiness.
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