Nanomedicine, Volume I: Basic Capabilities
© 1999 Robert A. Freitas Jr. All Rights Reserved.
Robert A. Freitas Jr., Nanomedicine, Volume I: Basic Capabilities, Landes Bioscience, Georgetown, TX, 1999
18.104.22.168 Ancient Greek Medicine
By 1000 BC the communities later collectively known as the Greeks were emerging around the Aegean Sea. How much medical knowledge they took from Egypt remains controversial, but the contrasts between the two are striking. Little is known of Greek medicine before the appearance of written texts in the 5th century BC. Archaic Greece had its folk healers, including priest healers employing divination and herbs. From early times (the first Olympic games were recorded in 776 BC), the love of athletics produced instructors in exercise, bathing, massage, gymnastics and diet. The Homeric epics (ca. 600 BC) offer glimpses of early Greek medicine. Scholars count 147 cases of battle wounds in the Iliad, including 106 spear thrusts, 17 sword slashes, 12 arrow shots, and 12 sling shots. Among the arrow wound survivors was King Menelaus of Sparta, whose physician extracted the arrow, sucked out the blood and applied a salve. As with other medical interventions in Homer, this shows no Egyptian influence, supporting the idea that, even if Greek practice owed much to Egypt, it rapidly went its own way.
Various Greek gods and heroes were identified with health and disease, the chief being Asclepius, who even had the power to raise the dead. A heroic warrior and blameless physician, Asclepius was the son of Apollo, sired upon a mortal mother, who was taught herbal remedies by Chiron and then generously used them to heal humans. Incensed at being cheated of death, Hades, the ruler of the underworld, appealed to the supreme god, Zeus, who obligingly dispatched Asclepius with a thunderbolt, though he was later elevated to godhood. A different version appears in Homer, who portrays Asclepius as a tribal chief and a skilled wound healer whose sons became physicians and were called Asclepiads, and from whom all Asclepian practitioners descended. As the tutelary god of medicine, Asclepius is usually portrayed with a beard, staff and snake -- the origin of the caduceus symbol of the modern physician, with its two snakes intertwined, double-helix like, on a winged staff. The god was often shown accompanied by his daughters, Hygeia (health or hygiene) and Panacea (cure-all).
For all that, Hippocratic medicine, the foundation of Greek written medicine, explicitly grounds the art upon a quite different basis -- a healing system independent of the supernatural and built upon natural philosophy. The beginnings of true medical science in the West were established when the reliance on superstition that underpinned tribal medicine was replaced by civilized and rational curiosity about the cause of illness. The growth of civilized thought allowed for argument on medical cause and cure, with great doctrinal multiplicity. The separation of medicine from religion reveals another distinctive feature of Greek healing: its openness, a quality characteristic of Greek intellectual activity in general, owing to political diversity. There was no imperial Hammurabic Code and, unlike Egypt, no state medical bureaucracy, nor were there examinations or professional qualifications. Those calling themselves doctors (iatroi) had to compete with bone-setters, exorcists, root-cutters, incantatory priests, gymnasts, and showmen, exposed to the quips of playwrights and the criticism of philosophers. Medicine was open to all.
Empedocles (fl. 450 BC) may have been the first to advance some of the key physiological doctrines in Greek medicine, including innate heat as the source of living processes such as digestion, the cooling function of breathing, and the notion that the liver makes the blood that nourishes the tissues. His contemporary, Alcmaeon of Croton (fl. 470 BC), believed that the brain, not the heart, was the chief organ of sensation. Alcmaeon's examination of the eyeball led him to discern the optic nerve leading into the skull, a genuine observational basis. He gave similar explanations for the sensations of hearing and smelling, because the ear and nostrils suggested passages leading to the brain. Most of such knowledge depended heavily on wound observation and animal dissection, for in the classical period the dignity of the human body forbade dissection.
All we know for sure of Hippocrates (ca. 460-377 BC), who "taught all that were prepared to pay," is that he was born on the island of Cos and lived a long and virtuous life. The sixty or so works comprising the Hippocratic Corpus (ca. 440-340 BC) derive from a variety of hands, and, as with the books of the Bible, they became jumbled up, fragmented, then pasted together again in antiquity. What is now called the Corpus was gathered around 250 BC in the Library at Alexandria, with further texts added later still. Some volumes are philosophical, others are teaching texts or case notes. What unites them all is the conviction that health and disease are capable of explanation by reasoning about nature, independently of supernatural interference. Man is governed by the same physical laws as the cosmos, hence medicine must be an understanding, empirical and rational, of the workings of the body in its natural environment. Anticipating modern medicine, appeal to reason, rather than to rules or to supernatural forces, gives Hippocratic medicine its distinctiveness. It was also patient- rather than disease-centered; the Hippocratics specialized in medicine by the bedside, prizing trust-based clinical relations:
"Make frequent visits; be especially careful in your examinations, counteracting the things wherein you have been deceived at the changes. Thus you will know the case more easily, and at the same time you will also be more at your ease. For instability is characteristic of the humours, and so they may also be easily altered by nature and by chance."
"...Keep a watch also on the faults of the patients, which often make them lie about the taking of things prescribed. For through not taking disagreeable drinks, purgative or other, they sometimes die. What they have done never results in a confession, but the blame is thrown upon the physician."
The Hippocratics promulgated the idea of "vis medicatrix naturae," or the power of nature to cure itself, and thus the belief that there was a natural tendency for things to get better on their own. This tendency could be aided by providing a beneficial environment for the patient and by improving physical function with a regimen of suitable diet, lifestyle, and exercise -- the diatetica. In extreme cases, further aids to recovery could be sought. Stubbornly offending "humors" could be removed with the help of venesection (phlebotomy or bloodletting) and purgatives, sudorifics applied to induce sweating, and diuretics to increase urination. But the Hippocratic physician was extremely reluctant to administer drugs of any kind, because the physician's goal was to aid nature in healing the body.
Hippocratics scorned heroic interventions and left risky procedures to others. Their Oath (Chapter 31) explicitly forbade cutting, even for stones, and other texts reserved surgery for those used to handling war wounds. Surgery was regarded as an inferior trade, the work of the hand rather than the head, a fact reflected in its name: "surgery" derives from the Latin "chirurgia," which comes from the Greek "cheiros" (hand) and "ergon" (work); surgery was handiwork. Hippocratic surgical texts were thus conservative in outlook, encouraging a tradition in which doctors sought to treat complaints first through management, occasionally through drugs, and finally, if need be, by surgical intervention.
The art of diagnosis involved creating a profile of the patient's lifestyle, work and dietary habits, partly by asking questions and partly by the use of trained senses:
"When you examine the patient, inquire into all particulars; first how the head is...then examine if the hypochondrium [abdomen beneath lower ribs] and sides be free of pain, for...if there be pain in the side, and along with the pain either cough, tormina [painful intestinal colic] or bellyache, the bowels should be opened with clysters [enema].... The Physician should ascertain whether the patient be apt to faint when he is raised up, and whether his breathing is free..."
Hippocratics prided themselves on their clinical acuity, being quick to pick up telltale symptoms, as with the facies hippocratica, the facial look of those dying from long-continued illness or cholera: "a protrusive nose, hollow eyes, sunken temples, cold ears that are drawn in with the lobes turned outward, the forehead's skin rough and tense like parchment, and the whole face greenish or black or blue-grey or leaden." Experience was condensed into aphorisms, as for instance: "When sleep puts an end to delirium, it is a good sign."
The technique most prized among Hippocratics was the art of prognosis -- a secular version of the priestly and oracular prognostications of earlier medicine, and bearing some analogy to the 20th century weatherman, who can give a bright or gloomy forecast but is powerless to change it. Noted one Hippocratic text:2240
"It appears to me a most excellent thing for the physician to cultivate Prognosis; for by foreseeing and foretelling, in the presence of the sick, the present, the past, and the future, and explaining the omissions which patients have been guilty of, he will be the more readily believed to be acquainted with the circumstances of the sick; so that men will have confidence to entrust themselves to such a physician....Thus a man will be the more esteemed to be a good physician...from having long anticipated everything; and by seeing and announcing beforehand those who will live and those who will die."
The ultimate significance of Hippocratic medicine was twofold. First, it carved out a lofty role for the selfless physician which would serve as a lasting model for professional identity and conduct. Second, it taught that an understanding of sickness required an understanding of nature.
Last updated on 5 February 2003