A History of Science
Tome I
Tome II
Tome III Tome IV

Book 1, chapter VII
Greek science in the early attic period
Hippocrates and greek medicine
These studies of the constitution of matter have carried us to the limits of the field of scientific imagination in antiquity; let us now turn sharply and consider a department of science in which theory joins hands with practicality. Let us witness the beginnings of scientific therapeutics.

Medicine among the early Greeks, before the time of Hippocrates, was a crude mixture of religion, necromancy, and mysticism. Temples were erected to the god of medicine, aesculapius, and sick persons made their way, or were carried, to these temples, where they sought to gain the favor of the god by suitable offerings, and learn the way to regain their health through remedies or methods revealed to them in dreams by the god. When the patient had been thus cured, he placed a tablet in the temple describing his sickness, and telling by what method the god had cured him. He again made suitable offerings at the temple, which were sometimes in the form of gold or silver representations of the diseased organ - a gold or silver model of a heart, hand, foot, etc.

Nevertheless, despite this belief in the supernatural, many drugs and healing lotions were employed, and the Greek physicians possessed considerable skill in dressing wounds and bandaging. But they did not depend upon these surgical dressings alone, using with them certain appropriate prayers and incantations, recited over the injured member at the time of applying the dressings.

Even the very early Greeks had learned something of anatomy. The daily contact with wounds and broken bones must of necessity lead to a crude understanding of anatomy in general. The first Greek anatomist, however, who is recognized as such, is said to have been Alcmaeon. He is said to have made extensive dissections of the lower animals, and to have described many hitherto unknown structures, such as the optic nerve and the Eustachian canal - the small tube leading into the throat from the ear. He is credited with many unique explanations of natural phenomena, such as, for example, the explanation that "hearing is produced by the hollow bone behind the ear; for all hollow things are sonorous." He was a rationalist, and he taught that the brain is the organ of mind. The sources of our information about his work, however, are unreliable.

Democedes, who lived in the sixth century B.C., is the first physician of whom we have any trustworthy history. We learn from Herodotus that he came from Croton to aegina, where, in recognition of his skill, he was appointed medical officer of the city. From aegina he was called to Athens at an increased salary, and later was in charge of medical affairs in several other Greek cities. He was finally called to Samos by the tyrant Polycrates, who reigned there from about 536 to 522 B.C. But on the death of Polycrates, who was murdered by the Persians, Democedes became a slave. His fame as a physician, however, had reached the ears of the Persian monarch, and shortly after his capture he was permitted to show his skill upon King Darius himself. The Persian monarch was suffering from a sprained ankle, which his Egyptian surgeons had been unable to cure. Democedes not only cured the injured member but used his influence in saving the lives of his Egyptian rivals, who had been condemned to death by the king.

At another time he showed his skill by curing the queen, who was suffering from a chronic abscess of long standing. This so pleased the monarch that he offered him as a reward anything he might desire, except his liberty. But the costly gifts of Darius did not satisfy him so long as he remained a slave; and determined to secure his freedom at any cost, he volunteered to lead some Persian spies into his native country, promising to use his influence in converting some of the leading men of his nation to the Persian cause. Laden with the wealth that had been heaped upon him by Darius, he set forth upon his mission, but upon reaching his native city of Croton he threw off his mask, renounced his Persian mission, and became once more a free Greek.

While the story of Democedes throws little light upon the medical practices of the time, it shows that paid city medical officers existed in Greece as early as the fifth and sixth centuries B.C. Even then there were different "schools" of medicine, whose disciples disagreed radically in their methods of treating diseases; and there were also specialists in certain diseases, quacks, and charlatans. Some physicians depended entirely upon external lotions for healing all disorders; others were "hydrotherapeutists" or "bath- physicians"; while there were a host of physicians who administered a great variety of herbs and drugs. There were also magicians who pretended to heal by sorcery, and great numbers of bone-setters, oculists, and dentists.

Many of the wealthy physicians had hospitals, or clinics, where patients were operated upon and treated. They were not hospitals in our modern understanding of the term, but were more like dispensaries, where patients were treated temporarily, but were not allowed to remain for any length of time. Certain communities established and supported these dispensaries for the care of the poor.

But anything approaching a rational system of medicine was not established, until Hippocrates of Cos, the "father of medicine," came upon the scene. In an age that produced Phidias, Lysias, Herodotus, Sophocles, and Pericles, it seems but natural that the medical art should find an exponent who would rise above superstitious dogmas and lay the foundation for a medical science. His rejection of the supernatural alone stamps the greatness of his genius. But, besides this, he introduced more detailed observation of diseases, and demonstrated the importance that attaches to prognosis.

Hippocrates was born at Cos, about 460 B.C., but spent most of his life at Larissa, in Thessaly. He was educated as a physician by his father, and travelled extensively as an itinerant practitioner for several years. His travels in different climates and among many different people undoubtedly tended to sharpen his keen sense of observation. He was a practical physician as well as a theorist, and, withal, a clear and concise writer. "Life is short," he says, "opportunity fleeting, judgment difficult, treatment easy, but treatment after thought is proper and profitable."

His knowledge of anatomy was necessarily very imperfect, and was gained largely from his predecessors, to whom he gave full credit. Dissections of the human body were forbidden him, and he was obliged to confine his experimental researches to operations on the lower animals. His knowledge of the structure and arrangement of the bones, however, was fairly accurate, but the anatomy of the softer tissues, as he conceived it, was a queer jumbling together of blood-vessels, muscles, and tendons. He does refer to "nerves," to be sure, but apparently the structures referred to are the tendons and ligaments, rather than the nerves themselves. He was better acquainted with the principal organs in the cavities of the body, and knew, for example, that the heart is divided into four cavities, two of which he supposed to contain blood, and the other two air.

His most revolutionary step was his divorcing of the supernatural from the natural, and establishing the fact that disease is due to natural causes and should be treated accordingly. The effect of such an attitude can hardly be over-estimated. The establishment of such a theory was naturally followed by a close observation as to the course of diseases and the effects of treatment. To facilitate this, he introduced the custom of writing down his observations as he made them - the "clinical history" of the case. Such clinical records are in use all over the world to-day, and their importance is so obvious that it is almost incomprehensible that they should have fallen into disuse shortly after the time of Hippocrates, and not brought into general use again until almost two thousand years later.

But scarcely less important than his recognition of disease as a natural phenomenon was the importance he attributed to prognosis. Prognosis, in the sense of prophecy, was common before the time of Hippocrates. But prognosis, as he practised it and as we understand it to-day, is prophecy based on careful observation of the course of diseases - something more than superstitious conjecture.

Although Hippocratic medicine rested on the belief in natural causes, nevertheless, dogma and theory held an important place. The humoral theory of disease was an all-important one, and so fully was this theory accepted that it influenced the science of medicine all through succeeding centuries. According to this celebrated theory there are four humors in the body - blood, phlegm, yellow bile, and black bile. When these humors are mixed in exact proportions they constitute health; but any deviations from these proportions produce disease. In treating diseases the aim of the physician was to discover which of these humors were out of proportion and to restore them to their natural equilibrium. It was in the methods employed in this restitution, rather than a disagreement about the humors themselves, that resulted in the various "schools" of medicine.

In many ways the surgery of Hippocrates showed a better understanding of the structure of the organs than of their functions. Some of the surgical procedures as described by him are followed, with slight modifications, to-day. Many of his methods were entirely lost sight of until modern times, and one, the treatment of dislocation of the outer end of the collar-bone, was not revived until some time in the eighteenth century.

Hippocrates, it seems, like modern physicians, sometimes suffered from the ingratitude of his patients. "The physician visits a patient suffering from fever or a wound, and prescribes for him," he says; "on the next day, if the patient feels worse the blame is laid upon the physician; if, on the other hand, he feels better, nature is extolled, and the physician reaps no praise." The essence of this has been repeated in rhyme and prose by writers in every age and country, but the "father of medicine" cautions physicians against allowing it to influence their attitude towards their profession.




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© Serge Jodra, 2006. - Reproduction interdite.