ANTIQUA MEDICINA from homer to versalius
Homer to Hippocrates
Although the Greeks created rational medicine, their work was not always scientific in the modern sense of the term. Like other Greek pioneers of science, doctors were prone to think that more could be discovered through reflection and argument than by practice and experiment. There was not yet a distinction between philosophy and science, including the science of medicine. Hippocrates was the first to separate medicine from philosophy and to disprove the idea that disease was a punishment for sin. Much of the traditional treatment for injuries and ailments stemmed from folk medicine, a practice which uses the knowledge of herbs and accessible drugs, collected piece by piece through the ages, to cure everything from toothaches to infertility.
Red Figure, Attic Vase, 490 BCE,Philoctetes bitten by a snake on Lemnos. While en route to Troy with the Greek army, the hero Philoctetes was bitten by a snake as he participated in a sacrifice to Chrse, a minor deity. The wound was so malodorous and caused Philoctetes to utter such inauspicious cries that his comrades marooned him on the island of Lemnos for the duration of the war. Philoctetes treated his wound with unspecified herbs until he was finally rescued from Lemnos and cured by the military doctors at Troy.
Stray references in Greek literature give us a better understanding of folk medicine and magic in Greek society. In Sophocles’s tragedy Philoctetes, the hero Philoctetes treats a snakebite on his foot using an unspecified herb as a palliative. The practice of singing incantations over wounds is mentioned in Homer’s Odyssey. Odysseus, wounded in his youth at a boar hunt, is said to have been skillfully bandaged by the sons of Autolycus, who then stopped the bleeding with incantations (Odyssey XIX, 455-458).
One of Hippocrates’s predecessors was Alcmaeon of Croton. In operating on the eye, Alcmaeon discovered ‘passages’ linking the sense organs to the brain, which he recognized as the seat of thought and feeling (an idea adopted by Plato, but not Aristotle). Alcmaeon was probably the first physician to formulate the doctrine of health as a balance among the powers of the body, these powers being constituent fluids with definite qualities and causal properties.
Fragment of a grave stele, Ionian, 5th century BCE: East Greek Tombstone of a Doctor. This tombstone can be identified as belonging to a doctor by the two small cupping vessels at the top of the stele. Because the marker is damaged, we cannot know whether the figure standing at right was a patient or an assistant.
Health, or isonome (”equality before the law“) was a balance between these fluids. When one dominated over another, illness, or monarche, developed. These terms, in another context, refer to the struggle between opposing political factions. Among the many qualities that needed to be held in balance were heat and cold, moisture and dryness, and bitterness and sweetness. This doctrine was later parlayed by Hippocrates into the Theory of the Four Humors, which provided the basis for medical theory up until the time of the American Revolution.
The philosophers/physicians Empedocles and Anaxagoras were contemporaries of Alcmaeon. Like other scientists of their day, they inquired about such quasi-medical topics as the composition of matter (is the primary element earth, fire, or water?), the seat of the human soul (some believed it to be the heart, some the liver, and still others the diaphragm), and the procreative process of humans (most held that the male sperm was exclusively responsible for conception).
A cursory survey of medical thought and practice throughout antiquity makes two underlying themes apparent. Throughout antiquity and into the Middle Ages there was a nexus between medicine and philosophy. Scientists in the ancient world often were philosophers as well as physicians, and the distinction between the two fields was often blurred. At its inception in the sixth century BCE, ancient medicine was a mere branch of natural philosophy. Even in Late Antiquity, when the philosopher/physician Galen reigned supreme, philosophy was considered a necessary part of medical training.
Unlike philosophy and medicine, which worked in harmony, the tension between medicine and religious belief often stifled or impeded physiological research. Throughout antiquity, rational medicine and faith healing existed side by side, never fully divorcing themselves from one another. Roman medicine, especially, was an eclectic blend of rational Hellenistic medicine, folk remedies, and religious cult practice. Like so many other aspects of antiquity, medicine was truly interdisciplinary, influencing and in turn being influenced by art, literature, philosophy, politics, and in no small way, religion.
We pass from myth to the opening of history. The central historical figure in Greek medicine is Hippocrates. The events of his life are shrouded in uncertainty, yet tales of his ingenuity, patriotism, and compassion made him a legend. He provided an example of the ideal physician, after which others, centuries after, patterned their existence.
Hippocrates, Greek Manuscript 2144, f 10v c. 1342 Bibliotheque Nationale, Paris
He was associated with the Asclepium of Cos, an island off the coast of Asia Minor, near Rhodes, and with a group of medical treatises known collectively as the Hippocratic Corpus. Hippocrates was the first to give the physician an independent standing, separate from the cosmological speculator, or nature philosopher. Hippocrates confined the medical man to medicine. At the same time that he assigned the physician his post, Hippocrates would not let him regard the post as sacrosanct. He set his face against any tendency toward sacerdotalism. He was also opposed to the spirit of trade-unionism in medicine. His concern was with the physician’s duties rather than his “rights.” Hence, the greatest legacy of Hippocrates: the Hippocratic Oath.
The father of medicine as envisioned by a Byzantine artist. Portraits of Hippocrates represent the physician with a noble face and impressive body to match his intellectual attributes. Various dignified ancient busts have been said to represent Hippocrates, yet no original Greek portraits have survived; hence, our evidence comes from Roman copies.
The Hippocratic Oath
The so-called Hippocratic Oath was unquestionably the exemplar for medical etiquette for centuries, and it endures in modified form to this day. Yet uncertainty still prevails concerning the date the oath was composed, the purpose for which it was intended, and the historical forces which shaped the document. The date of composition in modern debate varies from the sixth century BCE to the fourth century CE.
In antiquity, it was generally not considered a violation of medical ethics to do what the Oath forbade. An ancient doctor who took the Oath was by no means in agreement with the opinion of all his fellow physicians; on the contrary, he adhered to a dogma which was much stricter than that embraced by many, if not by most, of his colleagues.
I swear by Apollo the Physician and Asclepius and Hygeia and Panaceia and all the gods and goddesses, making them my witnesses, that I will fulfill according to my ability and judgment this oath and this covenant:
To hold him who has taught me this art as equal to my parent and to live my life in partnership with him, and if he is in need of money to give him a share of mine, and to regard his offspring as equal to my brothers in male lineage and to teach them this art—if they desire to learn it—without fee and covenant; to give share of precepts and oral instruction and all other learning to my sons and to the sons of him who has instructed me and to pupils who have signed the covenant and have taken an oath according to the medical law, but to no one else.
I will apply dietetic measure for the benefit of the sick according to my ability and judgment; I will keep them from harm and injustice. I will neither give a deadly drug to anybody if asked for it, nor will I make a suggestion to this effect. Similarly I will not give a woman an abortive remedy. In purity and in holiness I will guard my life and my art.
I will not use the knife, not even on sufferers from stone, but will withdraw in favor of such men as are engaged in this work.
Whatever houses I may visit, I will come for the benefit of the sick, remaining free of all intentional injustice, of all mischief and in particular of sexual relations with both female and male persons, be they free or slaves.
What I may see or hear in the course of the treatment or even outside of the treatment in regard to the life of men, which on no account one must spread abroad, I will keep to myself holding such things shameful to be spoken about.
If I fulfill this oath and do not violate it, may it be granted to me to enjoy life and art, being honored with fame among all men for all time to come; if I transgress it and swear falsely, may the opposite be my lot.
—Translated by Ludwig Edelstein
The organization of the Hippocratic Oath is clearly bipartite. The first half specifies the duties of the pupil toward his teacher and his obligations in transmitting medical knowledge; the second half gives a short summary of medical ethics. Because the second half of the Oath is inconsistent with Hippocrates’s own principles and practices, we must assume he was not its sole contributor, if one at all.
One immediate inconsistency is the Oath’s prohibition against abortion. The Hippocratic Corpus contains a number of allusions to the methods of abortion and the use of pessaries. The Oath’s prohibitions did not echo the general feeling of the public either. Abortion was practiced in Greek times no less than in the Roman era, and it was resorted to without scruple. In a world in which it was held justifiable to expose children immediately after birth, it would hardly seem objectionable to destroy the embryo.
A second discrepancy between the Oath and general Hippocratic principles is the ban on suicide. Suicide was not censured in antiquity. Self-murder as a relief from illness was regarded as justifiable, so much so that in some states it was an institution duly legalized by the authorities. Nor did ancient religion proscribe suicide. It did not know of any eternal punishment for those who ended their own lives. Law and religion then left the physician free to do whatever his conscience allowed.
Pythagoreanism is the only dogma that can possibly account for the attitude advocated in the Hippocratic Oath. Among all the Greek philosophical schools, the Pythagoreans alone outlawed suicide and abortion and did so without qualification. The Oath also concurs with Pythagorean prohibitions against surgical procedures of all kinds and against the shedding of blood, in which the soul was thought to reside. Again, this interdiction against the knife is especially out of keeping with the several treatises in the Hippocratic Corpus that deal at length with surgical techniques and operating room procedures.
It is little wonder that this Oath, although incorrectly attributed to Hippocrates, has remained steadfastly the symbol of the physician’s pledge. The prohibition against abortion and suicide were (and remain) in consonance with the principles of the Christian Church. The earliest reference to the Oath is in the first century CE, and it may have been appropriated soon after to fit the religious ideals of the time. The substitution of God, Christ, and the saints for the names of Asclepius and his family was easy enough. It is ironic that the Hippocratic Oath, in its present form with its religious subtext, is associated with Hippocrates, the man who first separated medicine from religion and disease from supernatural explanations.
Medicine in Mythology and Literature
The earliest account of disease in Greek literature appears in the opening episode of Homer’s Iliad, which was composed in the eighth century BCE. When Agamemnon tries to ransom his captured daughter, he insults the priest Chyrses. As punishment, the god Apollo sets a plague upon the Greek army. According to Homer, at the onset of the plague, Apollo only shot his arrows at mules and dogs in the camp and then later at the Greek soldiers themselves (Iliad I.9ff).
What Homer describes is a highly communicable disease with acute fever, sudden in onset and rapidly fatal, such as easily might attack an army. No symptoms are explicitly mentioned, nor are any recoveries. After the Greeks appeased Apollo with sacrfices and the return of Agamemnon’s daughter, they set about cleansing the camp by throwing “defilements” into the sea. This suggests that part of the disease was a severe dysentery exacerbated by battlefield conditions.
In mythology, the arrows of Apollo and his twin sister Artemis are often a symbol for the sudden onset of disease. The myth of Niobe illustrates this point. Niobe was a mortal woman who boasted that she was superior to Leto (the mother of Apollo and Artemis) because she had borne seven sons and seven daughters as opposed to Leto’s two children. As punishment for this insult to their mother, Apollo shot all seven sons with arrows and Artemis shot all seven daughters. Not only was Niobe robbed of the source of her pride, but she was forced to watch all fourteen of her children die in rapid succession, even as she tried to shield them, with her own body, from the deadly allegorical darts.
Arrows could not only cause disease, but heal it as well. In this capacity, Apollo was called Paean. He was also the father of Asclepius, the healing god whose cult was widespread in the Greek world.
In Homer’s Iliad, Apollo is addressed with his epithet Apollo Smintheus, or “Apollo the mouse god.” The Greeks associated Apollo with mice, which were believed to be vectors of disease, and so prayed to him under that name. They did not know it was the microorganisms on the fleas on the rodents, and not the rodents themselves, that were harmful. They simply recognized the correlation between rodent infestation and plague, and so prayed to the mouse god for relief.
A famous passage in Thucydides’s History describes the plague that gripped Periklean Athens during the Peloponnesian War (II.47.3-54.5). His vivid depiction of the plague and its aftermath inspired other authors in antiquity to treat similar topics, such as Sophocles’s Oedipos Tyrannos and Lucretius’s De Rerum Natura (Book V).
Greek myth is often an allegory for an historical event. One of the canonical Twelve Labors of Hercules involved ridding the swampy district of Lernea of a multi-headed serpent known as the Lernean Hydra. Every time Hercules cut off one of the serpent’s heads, two more grew in its place. Archaeologists believe this myth actually commemorates an infamous plague which devastated the population of ancient Lernea. The rapid spread of whatever sickness gripped the region corresponds to the duplicating heads of the serpent.
(TO BE CONTINUED)