Unit 3 - Medical Practice in Antiquity
University of Thessaloniki (EL)
An effort is made to present medicine in Homer’s times, the medical elements found in Greek mythology, and medicine practiced in the Asclepieia, demonstrating that medicine was empiric and theocratic, while examples are provided demonstrating the physician-healer. After the appearance of the first scintillae of philosophy, numerous philosophical questions stirred up the well-established belief in hypernatural powers that intervene in people’s lives. A direct result was Empedocles’ theory of the four elements, according to which, everything is comprised of four cosmogonic elements. Hippocratic medicine arrived in this crucial moment and marks history being the first attempt to rationalize medicine and to build a “pathophysiological theory” based on the body, the environment and other physiological factors. The Hippocratic “protocol” when meeting a patient is presented, which is many instances remain the same as today. Common or personal diagnostic/prognostic factors that play a key role appear with Hippcoratic medicine and issues like season, area of residence, age or sex seem to influence diagnosis and/or prognosis. The tools of the doctor were simple but experience made them powerful: the five senses were exploited to the maximum so as to reach a diagnosis. Palpation, auscultation, uroscopy are mere examples of the use of the five senses in medicine. Hippocratic therapeutics were simple: first do no harm! Under this scope the physician should try to heal the patient always avoiding to harm him. Later, Hellenistic period is marked by the legitimate performance of post-mortem examinations for research purposes. As a result, Herophilus and Erasistratus made history with their discoveries in the fields of anatomy and physiology. Alexandrine physicians used diet, medicaments and surgery, with all its subtypes such as venesection, cautery, trephination etc. Renowened are the Alexandrine surgeons that performed more complicated procedures such as lithotome and added knowledge to already known diseases such as cancer. Nevertheless, this temporally tiny ray of progress was followed by the establishment of the Roman Empire whose fear for everything new – all the more for medical progress – led to regression and to the reintroduction of theocratic and empirical beliefs and practices. The local Etruscan population practiced primitive medicine with auguty and liver divination, despite their exemplary establishment of public health structures. This is the existing background when Galen came to the fore. He conducted experiments to animals and discovered and described numerous entities, reinstating and enriching the Hippocratic tradition. For him, the good doctor has specific characteristics: Excellent knowledge of the medical art, undestanding of the body structure and logic. The theory of pneuma as the carrier of life and regulator of powers was mastered, while diseases were thought to be caused by a derangement of either the four humors, or the tissues or the organs. Galen also mastered the art of sphygmology on which he allegedly wrote 8 treatises. Venesection (with special mention of arteriotomy), cupping, leeching, cautery and various surgical operations are presented with examples.