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Health and Disease

Beginnings

In preliterate societies, disease was often assumed to be the product of one of two opposing occurrences: object intrusion or spirit loss. The intrusion of some foreign object was invoked to explain diseases marked by pain, restlessness, and other acute symptoms. Spirit loss resulted in wasting, lethargy, and other signs of debility. These grand divisions, corresponding very roughly to "noisy" (acute) diseases and "quiet" (chronic) ones, recur throughout history. In preliterate societies, the explanations were embedded within magico-religious frameworks, and the remote causes of disease might be witchcraft, malevolent spirits, or individual transgression of some cultural taboo. Healing was often a communal affair, and the principal healer generally combined the offices of priest and doctor. While the conceptual framework was religious or magical or both, the steps toward healing, or disease prevention, rationally followed the assigned causes. Notions of health generally incorporated aspects of fecundity or potency and are reflected in famous prehistoric works of art.

Literate Near Eastern communities in Egypt, Mesopotamia, and elsewhere developed medical systems that indissolubly mixed the religious and the medical, and the priest-physician was a central figure in them all. Myths of a golden age, when disease did not exist, were common, as was the tacit assumption that individual transgression could be implicated as the root cause of disease.

Three great systems of medicine with great staying power developed in the centuries before the Common Era. These arose in Greece, India, and China. Modern Western biomedicine can be traced to the work of Hippocrates and his followers. The ayurvedic system in India developed autonomously, as did Chinese medicine. The latter two systems still have many followers and have been more impervious to change than has Hippocratic medicine. There are a few, probably incidental, commonalties in the three systems. In each of them, bodily fluids (humors) and spirits (pneuma) were more important than the solid parts in determining health and disease. Longevity was a more explicit goal of health than was fertility or potency. Notions of balance were central to each system.

There are also important differences. The Chinese associated health with plumpness (Buddha is always depicted as rotund), whereas Greek sculptures of idealized athletes show the Shaman attending to a sick child, Ladakh, India. In many early cultures, ministering to the sick was the purview of religious leaders called shamans. These healers attempted to cure the illnesses of community members through spiritual possession. © CHRIS LISLE/CORBIS taut muscular development that Western values still identify with health and vitality. The Chinese polar principles of yin and yang have no obvious parallels in Western thought. The three Indian humors (dosa) of wind, bile, and phlegm cannot be equated to the four humors of Greek medicine.

The series of treatises written between the fifth and second centuries B.C.E. by Hippocrates and his followers provide the touchstone of modern Western biomedicine. So powerful is this legacy that both the dominant scientific biomedicine and the alternative Western medical cosmologies, such as homeopathy, naturopathy, osteopathy, chiropractic, and hydropathy, all claim descent from this "father" of Western medicine. The Hippocratics naturalized disease, making it part of ordinary human existence, rather than the result of supernatural forces. They also reinforced the notion of health as a balance of the four humors, disease occurring when one or more of the humors was in excess or deficiency.

Greek humoralism was one of the most powerful explanatory systems ever devised within medicine. It was linked to Greek natural philosophy (the four humors having their counterparts in the four elements, air, earth, fire, and water) and contained a framework that made good sense of the human life cycle, individual temperament, and the role of the environment in health and disease. One Hippocratic treatise, Airs, Waters, Places, is simultaneously a subtle treatise on environmental medicine and a foundation document on the formative role of place and topography on human culture.

The Hippocratics always insisted that the physician was the servant of nature. Through their important doctrine of the healing power of nature (vis medicatrix naturae), they interpreted the phenomena of the bedside—sweating, vomiting, diarrhea, jaundice, productive coughs—as evidence that the body was trying to rid itself of its excessive humors or to restore defective or deficient ones. Disease was for them an individual affair, based on the person's stage in the life cycle, normal temperament, sex, occupation, and other individualized factors. They elaborated a system of hygiene, advice to the individual on how he or she might preserve health and achieve longevity, through diet, exercise, and mode of living. Humoral medicine made no sharp distinction between mental and bodily disorder, explicating melancholy, mania, and hysteria along identical lines as fevers, cancer, or chronic wasting diseases such as phthisis.

Hippocratic humoralism was by no means the only medical system developed during the Mediterranean antiquity, but it was the most influential one, especially after Galen (c. 129–c. 199/216) identified with it and consolidated and extended its nuances. Hippocrates and Galen enjoyed positions of un-rivalled prestige for more than a millennium. Galen's monotheism and philosophical bent especially appealed to elite physicians after Christianity became the dominant religion of the West. The otherworldly dimension of Christianity during the medieval period meant that bodily health and disease could be devalued, in pursuit of the eternal felicity of the other world, but medical orthodoxy still operated within the humoral framework. Both religion and magic also offered important alternative interpretations, and both cause and cure of disease could be sought in the realms of the supernatural. Holy shrines and pilgrimages became part of the simultaneous expiation of sin and restoration of health. Several of the seven deadly sins (gluttony and sloth, for example) were also intertwined with causative explanations of disease. Indeed, sloth (also called acedia) was actually medicalized into a diagnostic category and seemed to be especially common among monks who found it difficult to leave their warm beds for early-morning prayers.

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