Medicine in Europe and the United States

The ancient Greeks had many ways of healing the sick. Plant gatherers and drug sellers, especially of herbal medicines, were the key people in the establishment of the vast Greek pharmacopoeia. Women healers had their own special categorization. And there were two groups making up a motley crew specializing in diagnosis and treatment calling on the gods and their evil relatives. One constant in Greek medicine was the existence of religious medicine, practiced in the sanctuaries of Asclepius, the Greco-Roman god of medicine. The heritage of Asclepius continues to survive in his professional symbol, the caduceus (one snake only). The medicine of the gods used declamation, singing, and music to speed up the healing process. Ancient Greeks, heavily invested in the "irrational," had more in common with Catholics who go to Lourdes for cures than with rationalist skeptics.

Hippocratic medicine.

The most famous document in medical history, the Hippocratic Oath (c. 400 B.C.E.), which established a model of ethical and professional behavior for healers, invoked all the gods, beginning with Apollo. When did the epistemological rupture between mythical thinking and the sort of thinking flattered as scientific, implying a rupture between sacred and scientific healing, take place? The traditional answer is that the change occurred or at least is evident in the Hippocratic corpus, a diverse collection of sixty-odd works by different authors beginning in the sixth century B.C.E., cobbled together about 250 B.C.E. in the library at Alexandria. (A scholarly industry keeps changing the dates of composition of the works and squabbling about textual authenticity.) In the ongoing creation of the Western medical myth it is Hippocrates (the mythic father, also a real person living c. 460–370 B.C.E.) and his followers, who are given credit for establishing the rationalistic basis of scientific medicine. The text On the Sacred Disease (c. 410 B.C.E.) denies that epilepsy is a sacred disease, assigning it a natural etiology within the humoral paradigm based on the four body fluids: phlegm, yellow bile, black bile, and blood. (Epilepsy was caused by phlegm convulsing the body as it struggled to free itself from being blocked in the air passages.)

This Hippocratic corpus is notorious for having developed the theory of humors (chymoi), which provided a grid for many medical systems over the centuries. On the Nature of Man, an anatomical and physiological treatise, went farthest among the Hippocratic writings in the acceptance of the theory of the four humors. According to humoralism, a person's physical and mental qualities are determined by the four chief fluids of the body, thus making it possible to explain health and disease in humoral terms, with health being an overall balance of the four humors. An upset in this balance, with too much or too little of a humor or two, produces disease. The grid of the system was composed of the humors associated with four organs and the qualities or nature of their products. The heart is associated with blood, warm and moist; the brain with phlegm, cold and moist; the liver with yellow bile, warm and dry; and the spleen with black bile, cold and dry. A sick person could correct an imbalance by taking substances characterized by the opposite qualities. In this scheme both people and medicinal substances had complexions and temperaments, that is, a defining humoral composition. The qualities of the humors were thought to correspond to the qualities of the basic elements of the universe: air, water, fire, and earth. This unified theory of humanity in the universe proved so satisfactory to the Western mind that the medical part of the theory was accepted, though much mangled, up through the eighteenth century. The theory "provided the 'reasons' for techniques of evacuation … such as venesection [blood-letting], cupping, cathartics, emetics, sneezing, sweating, [and] urination and so on" (Ackerknecht, p. 53). In the flexible Hippocratic humoral grammar the number of humors varied from one text to another. These humors also existed in a healthy person, though invisible to the medical gaze in this case.

The Hippocratic treatise On Regimen gave a great deal of attention to diet in the context of an active, well-regulated life. People absorb food and air, which become part of them and are also the main cause of internal diseases. Wine, which Louis Pasteur later classified as a food, was also an ideal item of medication, for it could be prescribed in many forms and was the best of excipients for the many herbs at the doctor's disposal. Taken pure or mixed with other ingredients, wine could be tailored to individual constitutions. The text Affections praised wine and honey for both sick and healthy people. Wine could be mixed with honey or even milk. Greek civilization generally required that wine be cut with two or three parts water to one part wine, but the medical canon permitted the doctor to prescribe it pure or in a variety of mixtures, according to the seasons. In winter the heat and dryness of a small amount of pure wine could counter the baleful effects of humidity and cold. Sometimes doses were quantified, sometimes not.

Galen.

By the third century B.C.E., Greek civilization had spread through the Mediterranean basin, blossoming brilliantly in Alexandria, where Ptolemy I ruled from 323 to 285 B.C.E. Hellenistic or Alexandrian medicine placed much emphasis on anatomy and physiology, with Herophilus of Chalcedon (c. 330–c. 260 B.C.E.) and Erasistratus of Chios (fl. 330–250 B.C.E.) providing a mechanistic description of the organs of the human body; humoral theory played only a minor role. Dissection became an important tool in the advancement of medical knowledge, leading to the discovery of new organs such as the prostate and establishing the importance of the brain within the newly represented nervous system. Both theories and sects pullulated in Greek medicine, including groups now classified as empiricists, rationalists, and methodists. Healers became more clearly professional, though they were still trained privately rather than institutionally. By the time Rome conquered the Greek world in the second century B.C.E., Greek medicine was already leavening the simpler medical thought of the conqueror. Greek was a technical language designating diseases, remedies, and instruments for which words had not yet been invented in Latin, but sometimes with the arrival of new works in medicine and in botany Greek terms drove out Latin words in professional discourse. Many of the Roman healers were not citizens, and some were even slaves without civil rights, thus ensuring low social status for most physicians.

The most famous doctor in the history of medicine between Hippocrates and Sigmund Freud was a Greek practicing in the Roman Empire. Other names (Aretaeus of Cappadocia and Soranus and Rufus of Ephesus, for example) earn a paragraph or so in medical history books but only in the shadow of Galen (129–216 C.E.). After arriving in Rome in 161 he gained a reputation in treating upper-class patients, became physician to the imperial family, and pioneered in sports medicine as official physician to the gladiatorial school. He was one of the greatest scribblers in the history of medicine; the classical philologist Ulrich von Wilamowitz-Moellendorff (1848–1931) called him a windbag. He produced works running the gamut from On Bones for Beginners to his more philosophical work, On the Therapeutic Method. Much was just lifted wholesale from other authors. Galen believed that the physician is a philosopher as well as a healer. A good case can be made for Galen's being "the central figure in the development of the Western tradition of medicine," as Vivian Nutton points out, especially in his transmission of a Galenized Hippocratic gospel to posterity (p. 58). The great clinician, perpetuator of the tradition of bedside medicine, at least for his wealthy clients, stands out also for his discoveries through experiments on animals and for diagnosis and surgery. Dissection of human corpses and, possibly, vivisection of living criminals had gone out of style, with animals replacing the cadavers and victims. Galen left significant errors for other great minds to correct—in clinical medicine as well as in physiology and anatomy. His legacy was eclipsed by the breakup of the empire accompanied by economic and urban decline.