MEDICINE IN CLASSICAL ANTIQUITY

Since the beginning of time, nature tends to evolution, using a mechanism of continuous and permanent perfectioning based on the improvement of the qualities of each living being, and of course, the maintenance of the state of health to enhance these qualities and to be able to assure its transmission to its descendants. In the case of the human being, in order to achieve it, it is crucial to develop one of its most important characteristics, knowledge through intelligence and logic. The passage in classical antiquity of an empirical medicine – from one based on magic and on the attribution of the causality of facts to deities invented by man to a medicine more based on scientific knowledge – is proof of this.

We divide Classical Antiquity into eight stages according to Laín, which date back to around 500 BC, when Alcmaeon of Croton wrote the text with which the universal history of scientific pathology was formally initiated until the two centuries following the death of Galen:

1) Pre-Socratic stage

2) Hippocratic stage

3) Among the Hippocratics and the Alexandrians

4) Alexandrians and Empiricists

5) Penetration of Greek medicine in Rome

6) Development and diversification of Hellenistic medicine within the Roman Empire

7) Galen’s work

8) Post-galenic medicine

In the pre-Socratic era there was a technification and rationalization of Greek medicine (the lógosover the mýthos, the rational explanation of the fearful and fantastic folk tradition) thanks to the concept of physis, that a series of thinkers such as Pythagoras, Heraclitus of Ephesus, and others forged between the first half of the sixth century and the first decades of the fourth century BC.

In the Hippocratic period, from 500 BC, the physiology or natural science of the pre-Socratics was taken as the basis for building the foundations of a more sensible medicine. Hippocrates, considered the father of Western medicine, lived in the fifth century BC and was almost contemporary with Plato and Aristotle, who praised his work based on a “Humoral Theory” within which is the Corpus Hippocraticum, a series of 53 writings that give body to the technical and “physiological” conception of the art of healing. I would like to present one of his writings: About the sacred disease, in which we can read:

About the disease they call sacred, the following happens. In nothing seems to me to be something more divine or more sacred than the others, but it has its own nature, like other diseases, and from there it originates. But its foundation and natural cause was considered by men as a divine thing because of its inexperience and its astonishment, since in nothing it resembles the others. But if by their inability to understand it they retain that divine character, by the banality of the method of healing with which they treat it they come to deny it. Because they treat it by means of purifications and spells (…) It seems to me that the first ones to consecrate this ailment were people like wizards, purifiers, charlatans and tricksters,who give themselves the air of being very pious and of knowing more. These, in fact, took the divine as shelter and shield of their inability to have no remedy to be served, and so that it was not evident that they knew nothing considered sacred this affection. And they added explanations at their convenience, and settled the curative treatment on the safe ground for themselves, adducing purifications and spells, prescribed to depart from the baths and a good number of foods that would be inconvenient food for the sick.

[Trad. taken from Hippocratic Treaties I. Madrid, Editorial Gredos, 1990, pp. 399-400.].

Among the Hippocratics and the Alexandrians (IV – III BC), writings of the Corpus hippocraticum continued to be written. The great Greek philosophical doctrines (Plato and the Academy, Aristotle and the Lyceum, Zeno of Citium and the Stoics) were born and spread then, influencing medicine.

Aristotle, for example, considered that human reason was made to obtain a “true” knowledge of the world, from the correct processing of the data we receive from external environment, for which it establishes norms to think correctly in his work The Logic. He began the general anatomy through a study on the composition of living beings, and laid the foundations of embryology with his work About the generation of animals, and comparative anatomy, proposing concepts such as the “analogy” applicable to anatomical parts of the same function and relative position and “homology” (structural and origin similarity).

In Alexandrian and Empiricists times Alexander the Great started the Hellenistic period of Greek culture by founding the Greek-Egyptian city of Alexandria, considered the most important intellectual center of the time by his Museum, a kind of great teaching and research institution where a hundred scientists of all the subjects (medicine, mathematics, mechanics, astronomy, geography, etc.) developed their work, and its Library where thousands of volumes could be consulted, with a serious competitor, the Library of Pergamon.

Herófilo de Chalcedonia (335 BC – 280 BC) and Erasistratus de Ceos (304 BC – 250 BC) stood out for being two doctors of the time who founded their schools, the herophilia and the erasistráteos, which lasted until the third century AD developing a new medicine based on a renewed experience of the skeptical human body with respect to the Hippocratic and the Aristotelian.

The fact that in this period the first dissections of corpses took place was of particular importance. Herófilo was one of the first to perform them, providing anatomical knowledge that continues today, as well as a work methodology based on observation of the symptoms and the next causes of the diseases, distrusting the finalist interpretation of the physis. He measured the pulse using a water clock.

On the other hand, Erasistratus, in addition to making important anatomical contributions, also made “anatomopathological” findings such as the hardening of the liver in the ascites.

If here, according to F. Kuldien, the Greek language became a cosmopolitan language, Greek medicine became the medicine of the known world.

The work of Herófilo and Erasístratus was the base of schools that lasted several centuries, but did not have continuity due to their inability to innovate. As a counterpoint, the empiricists rejected the dissection of human and animal corpses, basing their objectives on their own observation, on the observation of others and on the use of analogy or similarity.

Pharmacotherapy (e.g.: Cratevas), toxicology (Nicandro de Colofón), surgery and the philological commentary of the Hippocratic texts were developed during the second and first centuries BC under the influence of the empiricists and on occasion of the followers of Herófilo and Erasistratus. The empiricists divinized the figure of Hippocrates.

The penetration of Greek medicine in Rome, due to a series of circumstances, meant the arrival of doctors from the eastern Mediterranean. Until then it was a domestic or popular medicine that was at a pre-technical level.

The development and diversification of Hellenistic medicine in the heart of the Roman Empire led to the Romans little by little taking over the medicine that Greek doctors, still considered outsiders despite their fame, took them. Asclepiades of Bithynia, he was the first important Greek physician. He opposed the approaches of the empiricists and also the humoralists proposing that the body was composed of disconnected particles, or atoms, separated by pores and based the treatment on exercise, baths and a proper diet, opposing bloodletting and the use of drugs.

We can distinguish between:

– The methodicals – Themison of Laodicea (second half of the first century BC) founded a medical school based on the ideas of Asclepiades. For them the diseases were produced by the tension of the walls of the pores, by relaxation or by a mixture of both, limiting themselves to using dilator or constrictor drugs.

– Pneumatic school – They considered the pneuma as a balance between the four qualities of the human being, whose disorder produces a disease, based on the pulse as a manifestation of the state of such balance. The observation of the symptoms was based on the Hippocratic treatises.

– The eclectics – During the first century the tires derived in eclecticism, Areteo de Capadocia returned to the Hippocratic tradition, giving importance to the clinic of the most common pathologies of the time: epilepsy, migraine, leprosy, diphtheritic angina, tetanus, etc.

The eclecticism had some influence on the methodical school (e.g.,Sorano of Ephesus, who excelled in gynecology and obstetrics).

Dioscorides de Anazarba, a doctor in the Roman army of Nero, made a compilation of the pharmacological remedies that had been collected during classical antiquity, and which is still published today.

The importance of the work of Galen is due to the development and culmination of medical knowledge of classical antiquity, which remained in force almost completely over fifteen centuries.

Galen was a doctor who lived between the year 131 and 200-203 AD and is considered one of the great celebrities of Classical Antiquity who was influenced by the work of Hippocrates(whoclaimed to be his heir), to which he endowed the scientific rigor of the logic of Aristotle, from whom he took anatomical models that united others like the Alexandrians, considering the soul (pneuma) to be the principle on which all movement or change in living beings depends.

In post-Galenic medicine Alexandria and the methodical school (third century AD) stood out, with Sorano as representative. The influence of Galen, whose works were compiled as was done before with those of Hippocrates, was dominated later by the work of Zeno of Cyprus and his disciple Oribasiusof Pergamum. His compilation of works, which he titled as Medical Collections, and which he summarized with the title of Synopsis, was considered the starting point of the so-called “medieval galenism,” first in the Byzantine world, then in Arabic and finally in Western Europe.

CONCLUSION

Thus, man was able to function thanks to reason and the use of his intellectual capacity in a world of ignorance about diseases, such as Classical Antiquity, where doctors formed freely in “medical schools” such as those of Cyrene, Crotone, Rhodes, Cnidus and Cos (from the sixth century BC) or the Museum of Alexandria in Hellenic times, offering their services according to social classes, sometimes with contractual agreements and sometimes freely, without hospitals considered as such that were not the “valetudinaria” of the Roman military camps of the borders of the Empire for wounded or sick soldiers, and competing with herbalists, gymnasts, healers, medicine vendors and magical-religious healers.

However, having mentioned the oldest times and circumstances that are known, I would like to put on the table the fact that even today, there are herbalists, gymnasts, healers, medicine vendors and magical-religious healers (I repeat myself to influence the continuity of this fact throughout the evolution of medicine) that overreach their functions by harming the population rather than providing knowledge and efficiency.

Finally, one last consideration … people can decide whether or not to have faith in the existence of a God, but they continue to blame or give thanks when good or bad things happen … it is very possible that, if this God exists, He/She will not make a decision about what happens in each person’s life, and simply will be there to stay withus when things happen.