Aristotle, godfather of evidence-based medicine (a)


Introduction
Aristotle, one the greatest minds that ever existed, is indeed the godfather of evidence-based medicine.
His teachings of logic and philosophy have been a driving force continuously guiding medicine away from superstition and towards the scientific method.
Today, the revival of evidence-based medicine is only a reaffirmation of his early teachings dating from the fourth century BC.

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Fig. 1. — Statuette of Imhotep in the Louvre

Medicine in ancient Egypt

In ancient Egypt, Imhotep was the god of medicine (Fig. 1). He lived during the third dynasty of ancient Egyptian history between 2650 and 2600 BC, and   was the vizier (prime-minister) to the King and priest of the sun god Ra at Heliopolis. Imhotep was the
architect who built the oldest still standing stone monument on earth: the stepped pyramid of King Djoser at Saqqara. But he was also a physician and was so clever in treating patients that the Egyptians made him their god of medicine (Shehata, 2004;Mikić, 2008).
Since the early work of Imhotep, ancient Egyptian medicine evolved along the years.

Various treatments and therapeutic procedures were developed and recorded in the ancient Egyptian textbooks, written in the form of papyri and many of these medical
papyri have survived. The famous ones are the Edwin Smith papyrus, the Ebers papyrus, the Kahun gynaecological papyrus and the London and Leiden papyrus.
But medicine in ancient Egypt was tainted with religion (Risse, 1986). For example, the Ebers papyrus, the largest (110 pages and 20 meters long) and one the oldest preserved medical document dating from 1552 BC, describes many diseases concerning the heart and vessels (Fig. 2). It also contains chapters on contraception, diagnosis of pregnancy and other gynecological matters, intestinal disease and parasites, eye and skin problems, dentistry and the surgical treatment of abscesses and tumors, bonesetting and burns. Mental disorders such as depression and dementia are also covered. However, for
most of these diseases, in addition to prescriptions,the papyrus describes some 700 magical formulas and remedies and contains many incantations meant to turn away disease-causing demons (Joachim,1890; Ebbell, 1937; Cunha, 1949).

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Fig. 2.— Ebers Papyrus: treatment of cancer

Medicine in ancient Greece

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Fig. 3. — Asclepius, god of medicine in ancient Greece

In Greek mythology, Asclepius (Asklepios) was the god of medicine (Fig. 3). He was the son of Apollo and Coronis, and the father of Hygea, goddess of health and Panacea, goddess of cure from all ailments. Asclepius had followers for hundreds of years all across Greece and Asia Minor and numerous temples were built in his honor to which the sick would travel for purification rituals and sacrifice.

These temples were called Asclepia (single:Asclepion) and the most important were those built in Athens, Larissa, Cnide and in the island of Cos.
In the Asclepion, the sick’s dreams were interpreted by the priest on site who would also prescribe some treatment. The priests were therefore performing the dual function of priest and healer.
The most famous Asclepion was the one built in Cos, where a famous physician named Hippocrates was in charge. Hippocrates (ca. 460 BC-ca. 370 BC) grew to become the greatest physician of the classical world and is considered “the father of Western
medicine” (Fig. 4). He taught and practiced medicine throughout his life and is credited for
founding the Hippocratic School of medicine. He or his followers compiled a great work known as the Hippocratic Corpus (Latin: Corpus Hippocraticum),a collection of around seventy early medical works  from ancient Greece (Chadwick and Mann, 1950;Yapijakis, 2009).
Although Hippocrates work was based on observation of clinical signs and rational conclusions,many of his theories were not based on logic,particularly his theory on “humorism”, which was an extension of the Pythagorean theory on nature.
Hippocrates believed that illness was the result of an imbalance in the body of the four humours: blood,black bile, yellow bile and phlegm (dyscrasia, meaning “bad mixture”). The person would then become sick and remain that way until the balance was somehow
restored. Hippocratic therapy was directed towards restoring this balance. For instance, using citrus was thought to be beneficial when phlegm was over abundant (Garrison, 1966; Doufas and Saidman, 2010).

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Fig. 4. — Hippocrates, father of Western medicine

Aristotle

Aristotle (384 BC-322 BC) was a Greek philosopher and a student of Plato (Fig. 5). He was born in Stageira, Chalcidice, in 384 BC, near modern-day Thessaloniki in the northern Greek area of Macedonia. His father Nicomachus was the personal  physician to King Amyntas of Macedonia (McLeisch, 1999).

At about the age of eighteen, Aristotle traveled to Athens where he continued his education at Plato’s Academy. He remained at the academy for nearly twenty years until the death of Plato in 347 BC. He then traveled to the court of his friend King Hermias of Atarneus in Asia Minor. When Hermias died in 343 BC, Aristotle was invited by Philip II of Macedon to return to Macedonia and become the tutor to his son Alexander the Great and some of his
colleagues including Ptolemy I, the future king of Egypt (Dunn, 2006).
In 335 BC, Aristotle returned to Athens, where he established his own school known as the Lyceum and taught there for the next twelve years. It is during this period in Athens from 335 to 323 BC, that Aristotle is believed to have composed many of his works (Russell, 1972). Much of Aristotle’s writings were lost and the works that have survived are in
treatise form and are generally thought to be lecture aids for his students. His most important treatises include Physics, Metaphysics, Nicomachean Ethics,
Politics, De Anima (On the Soul) and Poetics.
Aristotle studied almost every subject possible at the time and made significant contributions to most of them. He studied anatomy, astronomy, embryology,
geography, geology, meteorology, physics and zoology. He also wrote on aesthetics, ethics, government,metaphysics, politics, economics, psychology,rhetoric and theology and studied education, foreign customs, literature and poetry. His combined works constitute a virtual encyclopedia of Greek knowledge, but his main contribution to the human mind
is, no doubt, the introduction of the concept of “logic”, where all natural phenomena and laws were to be based on common sense (if A = B and if B =C, then A = C). The adoption of this principle in all areas of knowledge gave a strong boost to the human mind and continues to do so. Twenty-three hundred years after his death, Aristotle remains one of the most influential people who ever lived and leaves every scientist and philosopher in debt to his essential contribution to the scientific method (Durant,1926; Dunn, 2006).

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Fig. 5. — Aristotle

(TO BE CONTINUED)

Hassan N. SALLAM
Professor in Obstetrics and Gynaecology, University of Alexandria, and Director of the Suzanne Mubarak Regional Center
for Women’s Health and Development, Alexandria, Egypt.

SOURCE F, V & V IN OBGYN, 2010, 2 (1): 11-19 ,HISTORY OF MEDICINE

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