Everything Is Just Dandy!

The Evolution of Modern Medicine: Chapter II – GREEK MEDICINE

William Osler

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OGRAIAE gentis decus! let us sing with Lucretius, one of the great interpreters of Greek thought. How grand and how true is his paean!
Browning’s famous poem, "Childe Roland to the Dark Tower Came," is an allegory of the pilgrimage of man through the dark places of the earth, on a dismal path beset with demons, and strewn with the wreckage of generations of failures. In his ear tolled the knell of all the lost adventurers, his peers, all lost, lost within sight of the dark Tower itself—
lost in despair at an all-encircling mystery. Not so the Greek Childe Roland who set the slug-horn to his lips and blew a challenge. Neither Shakespeare nor Browning tells us what happened, and the old legend, Childe Roland, is the incarnation of the Greek spirit, the young, light-hearted master of the modern world, at whose trumpet blast the dark towers of ignorance, superstition and deceit have vanished into thin air, as the baseless fabric of a dream. Not that the jeering phantoms have flown! They still beset, in varied form, the path of each generation; but the Achaian Childe Roland gave to man self-confidence, and taught him the lesson that nature’s mysteries, to be solved, must be challenged. On a portal of one of the temples of Isis in Egypt was carved: "I am whatever hath been, is, or ever will be, and my veil no man has yet lifted."
The veil of nature the Greek lifted and herein lies his value to us. What of this Genius? How did it arise among the peoples of the AEgean Sea? Those who wish to know the rock whence science was hewn may read the story told in vivid language by Professor Gomperz in his "Greek Thinkers," the fourth volume of which has recently been published (Murray, 1912; Scribner, 1912). In 1912, there was published a book by one of the younger Oxford teachers, "The Greek Genius and Its Meaning to Us,"(1) from which those who shrink from the serious study of Gomperz’ four volumes may learn something of the spirit of Greece. Let me quote a few lines from his introduction:
"Europe has nearly four million square miles; Lancashire has 1,700; Attica has 700. Yet this tiny country has given us an art which we, with it and all that the world has done since it for our models, have equalled perhaps, but not surpassed. It has given us the staple of our vocabulary in every domain of thought and knowledge. Politics, tyranny, democracy, anarchism, philosophy, physiology, geology, history—these are all Greek words. It has seized and up to the present day kept hold of our higher education. It has exercised an unfailing fascination, even on minds alien or hostile. Rome took her culture thence. Young Romans completed their education in the Greek schools…. And so it was with natures less akin to Greece than the Roman. St. Paul, a Hebrew of the Hebrews, who called the wisdom of the Greeks foolishness, was drawn to their Areopagus, and found himself accommodating his gospel to the style, and quoting verses from the poets of this alien race. After him, the Church, which was born to protest against Hellenism, translated its dogmas into the language of Greek thought and finally crystallized them in the philosophy of Aristotle."
Whether a plaything of the gods or a cog in the wheels of the universe this was the problem which life offered to the thinking Greek; and in undertaking its solution, he set in motion the forces that have made our modern civilization. That the problem remains unsolved is nothing in comparison with the supreme fact that in wrestling with it, and in studying the laws of the machine, man is learning to control the small section of it with which he is specially concerned. The veil of thaumaturgy which shrouded the Orient, while not removed, was rent in twain, and for the first time in history, man had a clear vision of the world about him—"had gazed on Nature’s naked loveliness" ("Adonais") unabashed and unaffrighted by the supernatural powers about him. Not that the Greek got rid of his gods—far from it!—but he made them so like himself, and lived on terms of such familiarity with them that they inspired no terror.(2)
Livingstone discusses the Greek Genius as displayed to us in certain "notes"—the Note of Beauty—the Desire for Freedom—the Note of Directness—the Note of Humanism—the Note of Sanity and of Many-sidedness. Upon some of these characteristics we shall have occasion to dwell in the brief sketch of the rise of scientific medicine among this wonderful people.
We have seen that the primitive man and in the great civilizations of Egypt and Babylonia, the physician evolved from the priest—in Greece he had a dual origin, philosophy and religion. Let us first trace the origins in the philosophers, particularly in the group known as the Ionian Physiologists, whether at home or as colonists in the south of Italy, in whose work the beginnings of scientific medicine may be found. Let me quote a statement from Gomperz:
"We can trace the springs of Greek success achieved and maintained by the great men of Hellas on the field of scientific inquiry to a remarkable conjunction of natural gifts and conditions. There was the teeming wealth of constructive imagination united with the sleepless critical spirit which shrank from no test of audacity; there was the most powerful impulse to generalization coupled with the sharpest faculty for descrying and distinguishing the finest shades of phenomenal peculiarity; there was the religion of Hellas, which afforded complete satisfaction to the requirements of sentiment, and yet left the intelligence free to perform its destructive work; there were the political conditions of a number of rival centres of intellect, of a friction of forces, excluding the possibility of stagnation, and, finally, of an order of state and society strict enough to curb the excesses of ‘children crying for the moon,’ and elastic enough not to hamper the soaring flight of superior minds…. We have already made acquaintance with two of the sources from which the spirit of criticism derived its nourishment—the metaphysical and dialectical discussions practiced by the Eleatic philosophers, and the semi-historical method which was applied to the myths by Hecataeus and Herodotus. A third source is to be traced to the schools of the physicians. These aimed at eliminating the arbitrary element from the view and knowledge of nature, the beginnings of which were bound up with it in a greater or less degree, though practically without exception and by the force of an inner necessity. A knowledge of medicine was destined to correct that defect, and we shall mark the growth of its most precious fruits in the increased power of observation and the counterpoise it offered to hasty generalizations, as well as in the confidence which learnt to reject untenable fictions, whether produced by luxuriant imagination or by a priori speculations, on the similar ground of self-reliant sense-perception."(3)
The nature philosophers of the Ionian days did not contribute much to medicine proper, but their spirit and their outlook upon nature influenced its students profoundly. Their bold generalizations on the nature of matter and of the elements are still the wonder of chemists. We may trace to one of them, Anaximenes, who regarded air as the primary principle, the doctrine of the "pneuma," or the breath of life—the psychic force which animates the body and leaves it at death—"Our soul being air, holds us together." Of another, the famous Heraclitus, possibly a physician, the existing fragments do not relate specially to medicine; but to the philosopher of fire may be traced the doctrine of heat and moisture, and their antitheses, which influenced practice for many centuries. There is evidence in the Hippocratic treatise peri sarkwn of an attempt to apply this doctrine to the human body. The famous expression, panta rhei,—"all things are flowing,"—expresses the incessant flux in which he believed and in which we know all matter exists. No one has said a ruder thing of the profession, for an extant fragment reads: ". . . physicians, who cut, burn, stab, and rack the sick, then complain that they do not get any adequate recompense for it."(4)
The South Italian nature philosophers contributed much more to the science of medicine, and in certain of the colonial towns there were medical schools as early as the fifth century B.C. The most famous of these physician philosophers was Pythagoras, whose life and work had an extraordinary influence upon medicine, particularly in connection with his theory of numbers, and the importance of critical days. His discovery of the dependence of the pitch of sound on the length of the vibrating chord is one of the most fundamental in acoustics. Among the members of the school which he founded at Crotona were many physicians. who carried his views far and wide throughout Magna Graecia. Nothing in his teaching dominated medicine so much as the doctrine of numbers, the sacredness of which seems to have had an enduring fascination for the medical mind. Many of the common diseases, such as malaria, or typhus, terminating abruptly on special days, favored this belief. How dominant it became and how persistent you may judge from the literature upon critical days, which is rich to the middle of the eighteenth century.
One member of the Crotonian school, Alcmaeon, achieved great distinction in both anatomy and physiology. He first recognized the brain as the organ of the mind, and made careful dissections of the nerves, which he traced to the brain. He described the optic nerves and the Eustachian tubes, made correct observations upon vision, and refuted the common view that the sperma came from the spinal cord. He suggested the definition of health as the maintenance of equilibrium, or an "isonomy" in the material qualities of the body. Of all the South Italian physicians of this period, the personality of none stands out in stronger outlines than that of Empedocles of Agrigentum—physician, physiologist, religious teacher, politician and poet. A wonder-worker, also, and magician, he was acclaimed in the cities as an immortal god by countless thousands desiring oracles or begging the word of healing. That he was a keen student of nature is witnessed by many recorded observations in anatomy and physiology; he reasoned that sensations travel by definite paths to the brain. But our attention must be confined to his introduction of the theory of the four elements—fire, air, earth and water—of which, in varying quantities, all bodies were made up. Health depended upon the due equilibrium of these primitive substances; disease was their disturbance. Corresponding to those were the four essential qualities of heat and cold, moisture and dryness, and upon this four-fold division was engrafted by the later physicians the doctrine of the humors which, from the days of Hippocrates almost to our own, dominated medicine. All sorts of magical powers were attributed to Empedocles. The story of Pantheia whom he called back to life after a thirty days’ trance has long clung in the imagination. You remember how Matthew Arnold describes him in the well-known poem, "Empedocles on Etna"—
a quotation which will give you an idea of some of the powers attributed to this wonder-working physician.
But of no one of the men of this remarkable circle have we such definite information as of the Crotonian physician Democedes, whose story is given at length by Herodotus; and his story has also the great importance of showing that, even at this early period, a well-devised scheme of public medical service existed in the Greek cities. It dates from the second half of the sixth century B.C.—fully two generations before Hippocrates. A Crotonian, Democedes by name, was found among the slaves of Oroetes. Of his fame as a physician someone had heard and he was called in to treat the dislocated ankle of King Darius. The wily Greek, longing for his home, feared that if he confessed to a knowledge of medicine there would be no chance of escape, but under threat of torture he undertook a treatment which proved successful. Then Herodotus tells his story—how, ill treated at home in Crotona, Democedes went to AEgina, where he set up as a physician and in the second year the State of AEgina hired his services at the price of a talent. In the third year, the Athenians engaged him at 100 minae; and in the fourth, Polycrates of Samos at two talents. Democedes shared the misfortunes of Polycrates and was taken prisoner by Oroetes. Then Herodotus tells how he cured Atossa, the daughter of Cyrus and wife of Darius, of a severe abscess of the breast, but on condition that she help him to escape, and she induced her husband to send an expedition of exploration to Greece under the guidance of Democedes, but with the instructions at all costs to bring back the much prized physician. From Tarentum, Democedes escaped to his native city, but the Persians followed him, and it was with the greatest difficulty that he escaped from their hands. Deprived of their guide, the Persians gave up the expedition and sailed for Asia. In palliation of his flight, Democedes sent a message to Darius that he was engaged to the daughter of Milo, the wrestler, who was in high repute with the King.(6)
Plato has several references to these state physicians, who were evidently elected by a public assembly: "When the assembly meets to elect a physician," and the office was yearly, for in "The Statesman" we find the following:(7) "When the year of office has expired, the pilot, or physician has to come before a court of review" to answer any charges. The physician must have been in practice for some time and attained eminence, before he was deemed worthy of the post of state physician.
"If you and I were physicians, and were advising one another that we were competent to practice as state-physicians, should I not ask about you, and would you not ask about me, Well, but how about Socrates himself, has he good health? and was anyone else ever known to be cured by him whether slave or freeman?"(7a)
All that is known of these state physicians has been collected by Pohl,(8) who has traced their evolution into Roman times. That they were secular, independent of the AEsculapian temples, that they were well paid, that there was keen competition to get the most distinguished men, that they were paid by a special tax and that they were much esteemed—are facts to be gleaned from Herodotus and from the inscriptions. The lapidary records, extending over 1000 years, collected by Professor Oehler(8a) of Reina, throw an important light on the state of medicine in Greece and Rome. Greek vases give representations of these state doctors at work. Dr. E. Pottier has published one showing the treatment of a patient in the clinic.(8b)
That dissections were practiced by this group of nature philosophers is shown not only by the studies of Alcmaeon, but we have evidence that one of the latest of them, Diogenes of Apollonia, must have made elaborate dissections. In the "Historia Animalium"(9) of Aristotle occurs his account of the blood vessels, which is by far the most elaborate met with in the literature until the writings of Galen. It has, too, the great merit of accuracy (if we bear in mind the fact that it was not until after Aristotle that arteries and veins were differentiated), and indications are given as to the vessels from which blood may be drawn.
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Osler, William. 2006. The Evolution of Modern Medicine. Urbana, Illinois: Project Gutenberg. Retrieved April 2022 from https://www.gutenberg.org/files/1566/1566-h/1566-h.htm#link2HCH0002
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