Ancient Greek Medicine (an Outline)

Medicine was first established in Greece on a rational basis (Passages 1 and ii), even though Asclepios, the god of  healing worked side by side with the doctor. The Hippocratic Corpus (5th- 4th c. BC) marks the beginning of medical science. Galen summarises Greek medicine at the end of its productive period (2nd c. AD).

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 (1 talent p.a.), Athens (1 1/2 talent p.a.), Samos. He healed Darius (sprained ankle), and Atossa (breast tumour). The best known serious physician before Hippocrates.

Hippocrates, (born c.a. 460 BC) the great, the admirable, the divine, as Galen repeatedly calls him, looms on the sky-line of the distant past, like a mountain, half hidden by mists and clouds. (F.B. Lund).

76 studies survive under the name of Hippocrates, some certainly not his, (The Nature of Man , according to Aristotle, was  written by Polybos). Some present common sense and purpose, others very different. According to Plato, Hippocrates suggested that one should treat disease by taking into account specific and general conditions, environmental factors etc. (Passage iv).

The contribution of Hippocrates: Disease is a natural process. The doctor could only try to assist (Passages 2, 3, v). Clinical observation could allow anticipation of the course of the disease. The doctrine of the four humours formed the basis of ancient pathology (Blood, Phlegm, Black bile, Yellow bile). When in balance = health. If balance is upset = disease: E.G. Colds, catarrh and pneumonia = predominance of Phlegm. Cold  air through the lungs was cooling down the heart = the very essence of life (psyche ).

Some titles of his works:
On Airs, Waters, and Places
On Ancient Medicine
Aphorisms
On the Articulations
On Fractures
On Injuries of the Head
The Oath
Epidemics
On Regimen in Acute Diseases
On the Sacred Disease
On the Surgery

The heirs of Hippocrates:

Dogmatists = theory, Empirics = observation, Pneumatists = the role of air, Methodists = atomic theory, mainly mechanical explanations of disease and cure.

4th century:

Diocles from Carystos (4th c.) was quite practical  in his methods. He realised that fever is not a disease in itself, but the result of disease.

Aristotle is based too much upon deduction and often reaches absurd conclusions, but his influence was enormous. Teleological treatment of anatomy and physiology. His main contribution is his advocacy of the general critical observation of natural phenomena, scientific logical construction and historical investigation.

Hellenistic and Imperial Era

This era was not highly original. A blend of cultures and knowledge results to more medicines and drugs. Under Egyptian influence dissections of human bodies (Herophilos; Erasistratos; Asclepiades: fierce opponent of humoral theory; Aretaios: Sagacious, cautious, traditional, highly moral, used few treatments to cure; Ruphos of Ephesos: paid much attention to anatomy).

Soranos of Ephesos (2nd c. AD) The most famous gynaecologist. Methodist but only as far as convenient. He had deep perceptions, an unbiased mind, independent judgement, and no time for superstition. His advice on the care of mother and baby are almost as good as any. He knew a lot about gynaecological conditions and treated them rationally. He was an eminent surgeon and justly won the reputation ' Medicorum Princeps '

Galen: (2nd c. AD.) an acrimonious controversialist, brilliant and temperamental, but with an independent judgement. He made an invaluable contribution to anatomy, physiology, circulation and the nervous system. Like Aristotle, he believed that nature or God does nothing without a purpose. He went over the entire body of medicine, and had interests in rhetoric and philosophy. He was very industrious and had a cosmopolitan mind. He had a tinge of superstition, but in general his main objective was the conversion of medicine into an exact science, and placed it on a broader basis. He paid attention to gymnastics, dietetics, hygiene, baths. Because he was given such a status of authority, subsequent centuries did not follow his path of experiment and independent research, but relied on him, until the Renaissance.

Oreibasios (born c. 32. Made a compilation of previous medicine with a spirit of practical science and common sense.

Greek Medical Ethics

Greek medicine was practised on a free-lance basis to a large extent. As no professional qualifications were required, a doctor's reputation was an essential property for his success. Several studies give advice to doctors regarding their conduct, having in mind both the interests of the patient (to receive help without exploitation) and the interests of the doctor (to safeguard his reputation and inspire confidence and trust).

Finance: A doctor should not be guided by financial considerations. He should not refuse treatment to the poor. He should not undertake desperate cases and unnecessarily try to prolong a painful existence for profit. He should not prescribe useless drugs for profit. He should not negotiate about payment before treatment (Passage 4).

Manner: A doctor must inspire confidence and seem to know what he is doing. He must look healthy, well nourished, well dressed. He should look, prudent and disciplined, thoughtful, but not stern, pleasant but not vulgar, he must have self-control and watch his words. His behaviour must be gentle, noble, dignified, and humane His treatment must be rather correct than an exhibition of skills. On the whole he should be a man of wisdom (passages 5-8 and iii).

Confidentiality: A doctor should not reveal things said to him in confidence, he must be quiet and not reveal everything to the patient (Passage 7). He should not be concerned with the morals of his patient, unless one's lifestyle affects his/her well being.

Philanthropy: The doctor must be motivated by his love for humanity.

The Oath: Some of the stipulations in the Oath are not consonant either with ethical precepts prevalent elsewhere in the Hippocratic corpus and in other classical literature or with the realities of medical practice as revealed in the sources.  (D. Amundsen).

L. Edelstein has suggested that the Oath is a text of Pythagorean origin, but this view has been rejected in recent years.

- The prohibition of administering poison, if understood as a prohibition of Euthanasia, might be in dissent from mainstream Greek thought, which did not condemn suicide, if this appeared to be a better alternative than a miserable or dishonoured life. However, the Pythagoreans objected suicide altogether (See: Plato Phaedo  61e-62). Yet this rather essential issue of not causing harm to the patient or issuing poisons would rather be a universally respected principle.

- The Pythagoreans believed that one acquires human identity from the moment of conception and, naturally would be totally opposed to abortion. Otherwise Greek doctors were divided. Some refused to perform abortions altogether, others would do only therapeutic abortions, but a fair number of doctors would not hesitate to induce abortions on demand.

- The rest of the clauses of the oath (prohibiting sexual harassment of their patients or their relatives, keeping one's art and lifestyle clean) would be in accordance with mainstream medical ethics.

On the whole the Pythagoreans saw the well being of the body as part of the well-being and moral lifestyle of the person as a whole, and emphasised this unity.

In general Greek Medicine perceived that it was its duty to deal with a person's well-being as a whole. In Galen's words, the doctor should not think that it was only the philosopher's duty to deal with the well-being of the soul. The doctor had to deal primarily, but not exclusively with the body.  

Primary Sources

1. Nature speaking:

Oh, you ungrateful generation of mortals, the patient does not die ; he is killed in vain, and I am accused of fragility. There are terrible diseases, but I have given you cures. Poisons are hidden in the trees, but many drugs for your salvation are also produced.

                                                               Priscianus Euporiston  1,2

2. A doctor should help, or at least not cause harm.

                                                               Hippocrates Epidemics  I,11

3. The physicians were no avail. At first they treated without any knowledge; but they themselves were most likely to die inasmuch as they were the ones who chiefly visited the sick. Altogether, no human skill was of any use, and prayers to the temples and requests to the oracles, and any other such means, all proved useless.

                                                               Thucydides History  2,47,4

4. If you start negotiating about payment you might give the impression that you are going to leave the patient in pain or that you will neglect him, if he does not agree to your demands,... It is better to chase a patient who has been cured than try to squeeze money out of somebody who is on the verge of death.

                                                               Hippocrates Praecepts  4

5. You better know what you should do before you enter, for in many cases help is needed, not thought.

                                                               Hippocrates Decorum  11

6. The doctor must have a pleasant and easy manner, because severity is unwelcome by healthy and sick people alike.

                                                               Hippocrates Decorum  7

7. One must do everything quietly, with modesty,  and carefully keep most things secret from the patient.

                                                               Hippocrates Decorum  16

8. One must transplant medicine into wisdom and wisdom into medicine, for a philosopher doctor is equal to a god. This is because there is little difference between these two, as things pertinent to wisdom can be found in medicine too: freedom from avarice, shyness, a reserved manner, good repute, good judgement, quiet disposition, clear answers, clarity, the ability to give an opinion,, knowledge of all things useful and necessary for one's life, riddance of the unclean, luck of superstition, divine excellence. What they have, they have in opposition to intemperance, vulgarity, greed, improper desires, extortion, shamelessness.

                                                               Hippocrates Decorum  5

Pythagoreans

And they took care  of their bodies ... so that they were neither skinny nor overweight, because they perceived these conditions to be an indication of an irregular lifestyle.

                                                            Iamblichos De vita Pythagorica  196 ff.

Some of the desires are acquired and created, while others are natural.

                                                            Stobaios Florilegium  3,10,66

To desire food when the body is empty is a natural thing, and again, the desire to evacuate when the body is full is again natural. However, to have a desire for unusual food or an unusual and luxurious dress or place to lie down, or an unusual, luxurious and ornate residence is an acquired taste...and of all human defects this is the one which cannot be halted, but always tends to the infinite.

                                                            Iamblichos De Vita Pythagorica  205-6

HIPPOCRATIC OATH

    I swear by Apollo Physician, by Asclepius, by Health, by Heal-all, and by all the gods and goddesses, making them witnesses, that I will carry out, according to my ability and judgment, this oath and this indenture: To regard my teacher in this art as equal to my parents; to make him partner in my livelihood, and when he is in need of money to share mine with him; to consider his offspring equal to my brothers; to teach them this art, if they require to learn it, without fee or indenture; and to impart precept, oral instruction, and all the other learning, to my sons, to the sons of my teacher, and to pupils who have signed the indenture and sworn obedience to the physicians' Law, but to none other.

    I will use treatment to help the sick according to my ability and judgment, but I will never use it to injure or wrong them. I will not give poison to anyone though asked to do so, nor will I suggest such a plan. Similarly I will not give a pessary to a woman to cause abortion. But in purity and in holiness I will guard my life and my art.

    I will not use the knife either on sufferers from stone, but I will give place to such as are craftsmen therein. Into whatsoever houses I enter, I will do so to help the sick, keeping myself free from all intentional wrong-doing and harm, especially from fornication with woman or man, bond or free. Whatsoever in the course of practice I see or hear (or even outside my practice in social intercourse) that ought never be published abroad, I will not divulge, but consider such things to be holy secrets.

    Now if I keep this oath and break it not, may I enjoy honour, in my life and art, among all men for all time; but if I transgress and forswear myself, may the opposite befall me.

 Source: W.H.S. Jones, The Doctor's Oath. ( Cambridge: Cambridge UP, 1924), 11, 12.

Links to imprortant sites on the History of Medicine:

http://www.bium.univ-paris5.fr/amn/
(Ancient Medicine Newsletter, in French)

http://medhist.ac.uk/
(The pages of the Wellcome Institute)

http://hsc.virginia.edu/hs-library/historical/antiqua/anthome.html
(A good electonic summary of Ancient Medicine)