Lesson 1

The Medicine of Ancient Greece

In its early phases, western medicine (we are not concerned here with Oriental medicine) was a theurgic medicine, in which the disease was considered to be divine castigation, a concept which is found in a great many Greek texts such as the Iliad, and is still connaturalised by man today.

The symbol of medicine The symbol adopted for medicine was the serpent, thought of as a sacred creature because it was erroneously believed to be immune from illness and disease. However, according to another version the symbol is not the representation of the serpent, but the extirpation of the worm Dracunculus medinensis known as the serpent of Medine. Moreover, the serpent had an important practical function in ancient medicine: every temple had a type of underground passage with serpents. In fact, the temple was not only a place of devotion, but also the site where the ill and sick were brought. The purpose of the serpent pit was to frighten the patient, who probably received potions to help him, or her, in order to induce a state of shock and make the God appear in front of them who would thus heal them.

With the passage of time, medicine moved further and further away from religion until the rational medicine of Hippocrates arrived, signalling the boundary between rationality and magic.

The first schools to develop were in Greece and in Magna Grecia, that is to say, in Sicily and Calabria in Italy. Among these, the most important was the Pythagorean school.

The great mathematician Pythagoras originally operated from the island of Samos, but moved to Crotone when the tyrant Policrates took power in this city. He brought his theory of numbers to natural science, as yet not definable as medicine: according to Pythagoreans, some numbers had precise meanings and, among these, the most important were 4 and 7. Seven always had a significant meaning. For example, in the Bible the number of infinity is indicated by 70 times 7. Among other things, 7 multiplied by 4 is 28, that is to say, the duration of lunar month ad of menstrual period; seven multiplied by 40 is 280, that is to say, the duration of gravidity in days. Furthermore, the magic seven meant that it was better for a baby to be born in the seventh month rather than the eighth. The period of quarantine, too, the forty days that served to avoid contagion from diseases, is derived from the concept of the number 40 being sacred.

Taletes elaborated an important system according to which the universe was composed of the fundamental elements: air, water, earth, to which Heraclytus added fire. In this period great relevance was also given to the qualities of dryness and humidity, hot and cold, sweet and bitter, etc.

In the VI-VII centuries B.C., Alcmaeon of Crotone, was first to have the idea that man might be a microcosm constituted of Talete's four individual elements. According to him, a person's state of health derives from the equilibrium of these elements, which he called isonomy or democracy, whereas disease derived from monarchy, or rather from the prevalence of one element over and above the others. Alcmaeon also was the first to identify the brain as the most important organ in the body. Until then, very little importance had been given to the brain: in Greek times the body was sacred and so dissection was not practised, but even during animals sacrifices, brain was seen only as a cold and gelatinous mass of little interest. Alcmaeon, instead, asserted that it was the very organ that controlled the whole organism. He also may have deduced, a fact that was then denied by others, that the nerves might serve to conduct nervous impulses, but this idea made no headway in science at that time.

Portrait of Hyppocrates The real and true rational medicine is attributed to Hippocrates (ca. 460-377 B.C.) , so he is known as the father of medicine. Hippocrates was born on the island of Kos, in the Dodecanese, where he developed the rational school with which a great many of the ideas attributed to Hippocrates are associated. He lived in the 50 years of Periclean peace, a period in which philosophy flourished, and travelled extensively in the Mediterranean area. We know that his journeys took him, inter alia, to mainland Greece, Sicily, Alexandria, Cyrine, and Cyprus. Fundamentally, the basis of rational medicine is a negation of divine intervention in the disease. Even the famous sacred illness, epilepsy, was attributed to a dysfunction of the organism. Hippocrates also made humours correspond with the seasons: the first season, that of blood and air corresponded to spring; the summer was fire, bile and liver; autumn was earth, black bile and spleen, while winter was the season of water, of phlegm (mucus) and of the brain. In addition, a parallel was drawn between the four seasons of life, infancy and early youth, then mature youth, followed by virile advanced years, and, ultimately, senility.

Referring back to what Alcmaeon of Crotone had said, Hippocrates maintained that disease was caused by a disequilibrium, no longer speaking of democracy or monarchy so as not to offend the tyrants, and that where there was equilibrium between the humours there was health. Cures lay in removing the humour that was in excess. The theory of humoursHis theory also explained the various temperaments: a coleric subject had too much bile, a phlegmatic one too much mucus, and so on. The most important element at the centre of Hippocrates' conception was not the disease, which he explained in a holistic manner, but man. Compared to the rival Cnidus's school, which focussed on a reductionist conception of disease much as occurs today, Hippocrates' conception made his school's fortune; his school prevailed as it concentrated on the man, while that of Cnidus concentrated on the disease and, because it did not have the necessary evidence to carry out its ideas, it ceased to exist, whereas that of Hippocrates remained active.

Underlying Hippocrates' conceptions was a profound and practical philosophy based notably on common sense. The fundamental principles were simply to leave things to nature, that is to say, to the healing powers of nature, and to observe the illness very carefully, intervening as little as possible, and paying attention to nutrition and to the wholesomeness and healthiness of the air. In order to eliminate the disequilibrium, the excess material (the so-called materia peccans) had to be removed. Means available to dispose of materia peccans were 'headpurges' (= purges of the head) which consisted of inducing sneezing with drugs such as pepper, and enema (clyster), or otherwise by blood-letting. The latter was not much used by Hippocrates' followers, but in the Roman Epoch, and especially in the Middle Ages, it became a very common procedure with grave consequences for patients who, in some cases were bled to death. It must be noted, however, that, Hippocrates recommended that physicians employ all medical treatments with the maximum of frugality.

Hippocrates texts, or those believed to be such, were taught in the universities until 1700. These texts were composed of a series of aphorisms, amongst which is the famous "Life is brief, art is long, opportunity is fleeting, experience is fallacious, judgment is difficult"; these form the basis of his philosophy and lead to careful, repetitious thought before a medical intervention.

Hippocrates thus created a holistic medicine based on the man or microcosm, preaching the use of the available therapies with the maximum of conservation. Remedies were few because at that time pharmacology did not exist and the first hint of herbal medicine did not arrive until about a century later, from one of Aristotle's students called Theophrastus. Hippocrates is also remembered because he expressed the first concepts of medical ethics, which still apply today, and in fact are contained in the Hippocratic oath, effectively encoding the person of the doctor.

The Hippocratic Oath
Original Version

The Hippocratic Oath
Modern Version

I SWEAR by Apollo the physician, Aesculapius, and Health, and All-heal, and all the gods and goddesses, that, according to my ability and judgement, I will keep this Oath and this stipulation.
TO RECHON him who taught me this Art equally dear to me as my parents, to share my substance with him, and relieve his necessities if required; to look up his offspring in the same footing as my own brothers, and to teach them this art, if they shall wish to learn it, without fee or stipulation; and that by precept, lecture, and every other mode of instruction, I will impart a knowledge of the Art to my own sons, and those of my teachers, and to disciples bound by a stipulation and oath according the law of medicine, but to none others.
I WILL FOLLOW that system of regimen which, according to my ability and judgment, I consider for the benefit of my patients, and abstain from whatever is deleterious and mischievous. I will give no deadly medicine to any one if asked, nor suggest any such counsel; and in like manner I will not give a woman a pessary to produce abortion.
WITH PURITY AND WITH HOLINESS I will pass my life and practice my Art. I will not cut persons laboring under the stone, but will leave this to be done by men who are practitioners of this work *. Into whatever houses I enter, I will go into them for the benefit of the sick, and will abstain from every voluntary act of mischief and corruption; and, further from the seduction of females or males, of freemen and slaves.
WHATEVER, IN CONNECTION with my professional practice or not, in connection with it, I see or hear, in the life of men, which ought not to be spoken of abroad, I will not divulge, as reckoning that all such should be kept secret. WHILE I CONTINUE to keep this Oath unviolated, may it be granted to me to enjoy life and the practice of the art, respected by all men, in all times! But should I trespass and violate this Oath, may the reverse be my lot.

I SWEAR in the presence of the Almighty and before my family, my teachers and my peers that according to my ability and judgment I will keep this Oath and Stipulation.
TO RECKON all who have taught me this art equally dear to me as my parents and in the same spirit and dedication to impart a knowledge of the art of medicine to others. I will continue with diligence to keep abreast of advances in medicine. I will treat without exception all who seek my ministrations, so long as the treatment of others is not compromised thereby, and I will seek the counsel of particularly skilled physicians where indicated for the benefit of my patient.
I WILL FOLLOW that method of treatment which according to my ability and judgment, I consider for the benefit of my patient and abstain from whatever is harmful or mischievous. I will neither prescribe nor administer a lethal dose of medicine to any patient even if asked nor counsel any such thing nor perform the utmost respect for every human life from fertilization to natural death and reject abortion that deliberately takes a unique human life.
WITH PURITY, HOLINESS AND BENEFICENCE I will pass my life and practice my art. Except for the prudent correction of an imminent danger, I will neither treat any patient nor carry out any research on any human being without the valid informed consent of the subject or the appropriate legal protector thereof, understanding that research must have as its purpose the furtherance of the health of that individual. Into whatever patient setting I enter, I will go for the benefit of the sick and will abstain from every voluntary act of mischief or corruption and further from the seduction of any patient.
WHATEVER IN CONNECTION with my professional practice or not in connection with it I may see or hear in the lives of my patients which ought not be spoken abroad, I will not divulge, reckoning that all such should be kept secret. WHILE I CONTINUE to keep this Oath unviolated may it be granted to me to enjoy life and the practice of the art and science of medicine with the blessing of the Almighty and respected by my peers and society, but should I trespass and violate this Oath, may the reverse by my lot.

* This is a jeremiad against surgery because surgery had disastrous results at that time. In fact, there was no incentive at all to study anatomy because it was believed that disease was caused by the disequilibrium of the humours and so organs had no importance at all. Therefore, surgery was empirical, an incision was made without knowing what was being cut, and there were no concepts of asepsis or of anaesthesia. Owing to this prohibition, for about two millennia surgery was considered to be a secondary skill of no practical use: in fact it was not thought of as a science until the end of the 18th century. Surgeons and physicians wore different clothing: the physicians, were graduates and wore magistri gowns, whereas surgeons could not wear a gown, for they were not formally educated and did not know Latin, which was the language of teaching in the medieval and more modern eras (in the surgery of the 16th, 17th and 18th centuries doctors in the long toga down to their feet were distinguished from surgeons with uncovered legs). While this corollary was at first justified, it brought about as the practice of surgery by people deprived of any theoretical knowledge at all.

Even if the body was taboo in Greece, the enormous development of figurative arts, above all of sculpture, presupposed some anatomical knowledge, which in turn indicates that dissection was practised in Greece. Certainly, it is known that dissection of human body was little practised after the Hippocratics and actually found most favour in the Alexandrian school.

The greatest scientist and biologist of the ancient world was Aristotle (384/3 B.C.-322/1 B.C.), who not only contributed enormously to medicine per se, but also to the natural sciences, for he was the first to classify animals (and his pupil Theophrastus was the first to classify plants). Unfortunately, certain steps taken by Aristotle, perhaps because they were interpreted badly, brought about an error which had grave consequences on the evolution of science. It seems that he sustained the notion that certain "inferior" animals such as insects (whose name derived from the evident segmentation of the body into its components) came into the world spontaneously from decomposing material regenerating and so their growth could not be limited or restrained. This concept began to be attacked only at the end of the 17th century. Aristotle elaborated a physiological system centred on the heart, in which according to him, there burned a life-giving vital flame maintained by a spirit named pneuma or spiritus vitalis (vital spirit) that produced heat. He felt that the lungs and the brain had a primary function of cooling. The heart was the most important organ because when the heart stopped, the body died. Furthermore, in his studies of embryology, Aristotle noted that the heart began to beat in the initial phases of the organism's development: primum oriens, ultimum moriens (The first to be born, the last to die).

In his theory, heat was the most important thing and gave life. He sustained that man, having a great deal of heat, managed to use all his body's resources and to produce sperm. On the other hand, women did not have enough heat so a part of the body's blood was eliminated during menstruation. With its heat, sperm acted on menstruation, producing the embryo. According to Aristotle, his theory was validated by the heat derived from the sperm in the puerperium period causing women to produce milk: in most cases, menstruation itself was not fully present because this blood, being in abundance, was transformed into milk thanks to the heat.

Aristotle also taught Alexander the Great, who brought Hellenic culture to its maximum fruition, expanding throughout the Mediterranean. But the great expansion later led to collapse.

  Home: Notes of the lessons on the History of Medicine

From the notes of Francesca Spina