The roots of Western medicine
The transition from magic to science was a gradual process that lasted for centuries, and there is little doubt that ancient Greece inherited much from Babylonia and Egypt and even from India and China. Modern readers of the Homeric tales the Iliad and the Odyssey may well be bewildered by the narrow distinction between gods and humans among the characters and between historical fact and poetic fancy in the story. Two characters, military surgeons Podaleirius and Machaon, are said to have been sons of Asclepius, the god of medicine. The divine Asclepius may have originated in a human Asclepius who lived about 1200 BCE and is said to have performed many miracles of healing.
Asclepius was worshipped in hundreds of temples throughout Greece, the remains of which may still be seen at Epidaurus, Cos, Athens, and elsewhere. To these resorts, or hospitals, sick persons went for the healing ritual known as incubation, or temple sleep. They lay down to sleep in the dormitory, or abaton, and were visited in their dreams by Asclepius or by one of his priests, who gave advice. In the morning the patient often is said to have departed cured. There are at Epidaurus many inscriptions recording cures, though there is no mention of failures or deaths.
Diet, baths, and exercises played their part in the treatment, and it would appear that these temples were the prototype of modern health resorts. Situated in a peaceful spot, with gardens and fountains, each had its theatre for amusements and its stadium for athletic contests. The cult of incubation continued far into the Christian era. In Greece, some of the Aegean islands, Sardinia, and Sicily, sick persons are still taken to spend a night in certain churches in the hope of a cure.
It was, however, the work of the early philosophers, rather than that of the priests of Asclepius, that impelled Greeks to refuse to be guided solely by supernatural influence and moved them to seek out for themselves the causes and reasons for the strange ways of nature. The 6th-century philosopher Pythagoras, whose chief discovery was the importance of numbers, also investigated the physics of sound, and his views influenced the medical thought of his time. In the 5th century BCE Empedocles set forth the view that the universe is composed of four elements—fire, air, earth, and water—and this conception led to the doctrine of the four bodily humours: blood; phlegm; choler, or yellow bile; and melancholy, or black bile. The maintenance of health was held to depend upon the harmony of the four humours.
Medical thought had reached this stage and had partially discarded the conceptions based upon magic and religion by 460 BCE, the year that Hippocrates is said to have been born. Although he has been called the father of medicine, little is known of his life, and there may in fact have been several men of this name, or Hippocrates may have been the author of only some, or none, of the books that make up the Hippocratic Collection (Corpus Hippocraticum). Ancient writers held that Hippocrates taught and practiced medicine in Cos, the island of his birth, and in other parts of Greece, including Athens, and that he died at an advanced age.
Whether Hippocrates was one man or several, the works attributed to him mark the stage in Western medicine where disease was coming to be regarded as a natural rather than a supernatural phenomenon and doctors were encouraged to look for physical causes of illness. Some of the works, notably the Aphorismi (Aphorisms), were used as textbooks until the 19th century. The first and best-known aphorism is “Life is Short, Art long, Occasion sudden and dangerous, Experience deceitful, and Judgment difficult” (often shortened to the Latin tag “Ars longa, vita brevis”). This is followed by brief comments on diseases and symptoms, many of which remain valid.
The thermometer and the stethoscope were not then known, nor indeed did Hippocrates employ any aid to diagnosis beyond his own powers of observation and logical reasoning. He had an extraordinary ability to foretell the course of a malady, and he laid more stress upon the expected outcome, or prognosis, of a disease than upon its identification, or diagnosis. He had no patience with the idea that disease was a punishment sent by the gods. Writing of epilepsy, then called “the sacred disease,” he said, “It is not any more sacred than other diseases, but has a natural cause, and its supposed divine origin is due to human inexperience. Every disease,” he continued, “has its own nature, and arises from external causes.”
Hippocrates noted the effect of food, of occupation, and especially of climate in causing disease, and one of his most interesting books, entitled De aëre, aquis et locis (Air, Waters and Places), would today be classed as a treatise on human ecology. Pursuing this line of thought, Hippocrates stated that “our natures are the physicians of our diseases” and advocated that this tendency to natural cure should be fostered. He laid much stress on diet and the use of few drugs. He knew well how to describe illness clearly and concisely and recorded failures as well as successes; he viewed disease with the eye of the naturalist and studied the entire patient in his environment.
Perhaps the greatest legacy of Hippocrates is the charter of medical conduct embodied in the so-called Hippocratic oath, which has been adopted as a pattern by physicians throughout the ages:
I swear by Apollo the physician, and Asclepius, and Health, and All-heal, and all the gods and goddesses…to reckon 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 upon 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 to 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 to a woman a pessary to produce abortion…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.
Not strictly an oath, it was, rather, an ethical code or ideal, an appeal for right conduct. In one or other of its many versions, it has guided the practice of medicine throughout the world for more than 2,000 years.