Early Greece

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.

**ivory diptych**

Asclepius, from an ivory diptych, 5th century CE; in the Liverpool City Museum, England.

The Bridgeman Art Library/Art Resource, New York

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.

Hippocrates

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.

In the following century the work of Aristotle, regarded as the first great biologist, was of inestimable value to medicine. A pupil of Plato at Athens and tutor to Alexander the Great, Aristotle studied the entire world of living things. He laid what can be identified as the foundations of comparative anatomy and embryology, and his views influenced scientific thinking for the next 2,000 years.

After the time of Aristotle, the centre of Greek culture shifted to Alexandria, where a famous medical school was established about 300 BCE. There the two best medical teachers were Herophilus, whose treatise on anatomy may have been the first of its kind, and Erasistratus, regarded by some as the founder of physiology. Erasistratus noted the difference between sensory and motor nerves but thought that the nerves were hollow tubes containing fluid and that air entered the lungs and heart and was carried through the body in the arteries. Alexandria continued as a centre of medical teaching even after the Roman Empire had attained supremacy over the Greek world, and medical knowledge remained predominantly Greek.

Raphael: detail from School of Athens — Raphael: detail from *School of Athens*

Plato (left) and Aristotle, detail from *School of Athens*, fresco by Raphael, 1508–11; in the Stanza della Segnatura, the Vatican. Plato is shown pointing to the heavens and the realm of forms, Aristotle to the earth and the realm of things.

Album/Oronoz/SuperStock

Asclepiades of Bithynia (born 124 BCE) differed from Hippocrates in that he denied the healing power of nature and insisted that disease should be treated safely, speedily, and agreeably. An opponent of the humoral theory, he drew upon the atomic theory of 5th-century Greek philosopher Democritus in advocating a doctrine of strictum et laxum—the attribution of disease to the contracted or relaxed condition of the solid particles that he believed make up the body. To restore harmony among the particles and thus effect cures, Asclepiades used typically Greek remedies: massage, poultices, occasional tonics, fresh air, and corrective diet. He gave particular attention to mental disease, clearly distinguishing hallucinations from delusions. He released the insane from confinement in dark cellars and prescribed a regimen of occupational therapy, soothing music, soporifics (especially wine), and exercises to improve the attention and memory.

Asclepiades did much to win acceptance for Greek medicine in Rome. Aulus Cornelius Celsus, the Roman nobleman who wrote De medicina about 30 CE, gave a classic account of Greek medicine of the time, including descriptions of elaborate surgical operations. His book, overlooked in his day, enjoyed a wide reputation during the Renaissance.

During the early centuries of the Christian era, Greek doctors thronged to Rome. The most illustrious of them was Galen, who began practicing there in 161 CE. He acknowledged his debt to Hippocrates and followed the Hippocratic method, accepting the doctrine of the humours. He laid stress on the value of anatomy, and he virtually founded experimental physiology. Galen recognized that the arteries contain blood and not merely air. He showed how the heart sets the blood in motion in an ebb and flow fashion, but he had no idea that the blood circulates. Dissection of the human body was at that time illegal, so that he was forced to base his knowledge upon the examination of animals, particularly apes. A voluminous writer who stated his views forcibly and with confidence, he remained for centuries the undisputed authority from whom no one dared to differ.

Another influential physician of the 2nd century CE was Soranus of Ephesus, who wrote authoritatively on childbirth, infant care, and women’s diseases. An opponent of abortion, he advocated numerous means of contraception. He also described how to assist a difficult delivery by turning the fetus in the uterus (podalic version), a life-saving technique that was subsequently lost sight of until it was revived in the 16th century.Although the contribution of Rome to the practice of medicine was negligible compared with that of Greece, in matters of public health the Romans set the world a great example. The city of Rome had an unrivaled water supply. Gymnasiums and public baths were provided, and there was even domestic sanitation and adequate disposal of sewage. The army had its medical officers, public physicians were appointed to attend the poor, and hospitals were built; a Roman hospital excavated near Düsseldorf, Germany, was found to be strikingly modern in design.

Christian and Muslim reservoirs of learning

After the fall of Rome, learning was no longer held in high esteem, experiment was discouraged, and originality became a dangerous asset. During the early Middle Ages medicine passed into the widely diverse hands of the Christian church and Arab scholars.

Translators and saints

It is sometimes stated that the early Christian church had an adverse effect upon medical progress. Disease was regarded as a punishment for sin, and such chastening demanded only prayer and repentance. Moreover, the human body was held sacred and dissection was forbidden. But the infinite care and nursing bestowed upon the sick under Christian auspices must outweigh any intolerance shown toward medicine in the early days.

Perhaps the greatest service rendered to medicine by the church was the preservation and transcription of the Classical Greek medical manuscripts. These were translated into Latin in many medieval monasteries, and the Nestorian Christians (an Eastern church) established a school of translators to render the Greek texts into Arabic. This famous school, and also a great hospital, were located at Jundi Shāhpūr in southwest Persia, where the chief physician was Jurjīs ibn Bukhtīshūʿ, the first of a dynasty of translators and physicians that lasted for six generations. A later translator of great renown was Ḥunayn ibn Isḥāq, or Johannitus (born 809), whose translations were said to be worth their weight in gold.

About this time there appeared a number of saints whose names were associated with miraculous cures. Among the earliest of these were twin brothers, Cosmas and Damian, who suffered martyrdom (c. 303) and became the patron saints of medicine. Other saints were invoked as powerful healers of certain diseases, such as St. Vitus for chorea (or St. Vitus’s dance) and St. Anthony for erysipelas (or St. Anthony’s fire). The cult of these saints was widespread in medieval times, and a later cult, that of St. Roch for plague, was widespread during the plague-ridden years of the 14th century.

Arabian medicine

A second reservoir of medical learning during those times was the great Muslim empire, which extended from Persia to Spain. Although it is customary to speak of Arabian medicine in describing this period, not all of the physicians were Arabs or natives of Arabia. Nor, indeed, were they all Muslims: some were Jews, some Christians, and they were drawn from all parts of the empire. One of the earliest figures was Rhazes, a Persian born in the last half of the 9th century near modern Tehrān, who wrote a voluminous treatise on medicine, Kitāb al-hāḳī (“Comprehensive Book”), but whose most famous work, De variolis et morbillis (A Treatise on the Smallpox and Measles), distinguishes between these two diseases and gives a clear description of both.

Of later date was Avicenna (980–1037), a Muslim physician, who has been called the prince of physicians and whose tomb at Hamadan has become a place of pilgrimage. He could repeat the Qurʾān before he was 10 years old and at the age of 18 became court physician. His principal medical work, Al-Qānūn fī aṭ-ṭibb (The Canon of Medicine), became a classic and was used at many medical schools—at Montpellier, France, as late as 1650—and reputedly is still used in the East.

The greatest contribution of Arabian medicine was in chemistry and in the knowledge and preparation of medicines. The chemists of that time were alchemists, and their pursuit was mainly a search for the philosopher’s stone, which supposedly would turn common metals into gold. In the course of their experiments, however, numerous substances were named and characterized, and some were found to have medicinal value. Many drugs are of Arab origin, as are such processes as sublimation.

In that period, and indeed throughout most historical times, surgery was considered inferior to medicine, and surgeons were held in low regard. Renowned Spanish surgeon Abū al-Qāsim (Albucasis), however, did much to raise the status of surgery in Córdoba, an important centre of commerce and culture with a hospital and medical school equal to those of Cairo and Baghdad. A careful and conservative practitioner, he wrote the first illustrated surgical text, which held wide influence in Europe for centuries.

Another great doctor of Córdoba, born in the 12th century, just as the sun of Arabian culture was setting, was Jewish philosopher Moses Maimonides. Banished from the city because he would not become a Muslim, he eventually went to Cairo, where the law was more lenient and where he acquired a reputation so high that he became physician to Saladin, the Saracen leader. (He was the original of El Hakim in Sir Walter Scott’s Talisman.) A few of his works, written in Hebrew, were eventually translated into Latin and printed.

Medieval and Renaissance Europe

Salerno and the medical schools

At about the same time that Arabian medicine flourished, the first organized medical school in Europe was established at Salerno, in southern Italy. Although the school of Salerno produced no brilliant genius and no startling discovery, it was the outstanding medical institution of its time and the parent of the great medieval schools soon to be founded at Montpellier and Paris, in France, and at Bologna and Padua, in Italy. Salerno drew scholars from near and far. Remarkably liberal in some of its views, Salerno admitted women as medical students. The school owed much to the enlightened Holy Roman emperor Frederick II, who decreed in 1221 that no one should practice medicine until he had been publicly approved by the masters of Salerno.

The Salernitan school also produced a literature of its own. The best-known work, of uncertain date and of composite authorship, was the Regimen Sanitatis Salernitanum (“Salernitan Guide to Health”). Written in verse, it appeared in numerous editions and was translated into many languages. Among its oft-quoted couplets is the following:

Use three physicians still, first Doctor Quiet,

Next Doctor Merryman, and Doctor Diet.

Salerno yielded its place as the premier medical school of Europe to Montpellier about 1200. John of Gaddesden, the model for the “doctour of physick” in Geoffrey Chaucer’s Canterbury Tales, was one of the English students there. That he relied upon astrology and upon the doctrine of the humours is evident from Chaucer’s description:

Well could he guess the ascending of the star

Wherein his patient’s fortunes settled were.

He knew the course of every malady,

Were it of cold or heat or moist or dry.

Medieval physicians analyzed symptoms, examined excreta, and made their diagnoses. Then they might prescribe diet, rest, sleep, exercise, or baths, or they could administer emetics and purgatives or bleed the patient. Surgeons could treat fractures and dislocations, repair hernias, and perform amputations and a few other operations. Some of them prescribed opium, mandragora, or alcohol to deaden pain. Childbirth was left to midwives, who relied on folklore and tradition.

Great hospitals were established during the Middle Ages by religious foundations, and infirmaries were attached to abbeys, monasteries, priories, and convents. Doctors and nurses in these institutions were members of religious orders and combined spiritual with physical healing.

The spread of new learning

Among the teachers of medicine in the medieval universities there were many who clung to the past, but there were not a few who determined to explore new lines of thought. The new learning of the Renaissance, born in Italy, grew and expanded slowly. Two great 13th-century scholars who influenced medicine were Roger Bacon, an active observer and tireless experimenter, and Albertus Magnus, a distinguished philosopher and scientific writer.