Greece and Rome

Before the fifth century B.C., ancient Greece had physician-seers (Iatromantis) who combined magical procedures and drug treatments, and wound healers deft at caring for battlefield trauma.

The foremost representative of classical Greek medicine was Hippocrates, a prominent practitioner and teacher who came to personify the ideal Western physician. Within a century of his death in 370 B.C., several unknown disciples wrote nearly 60 treatises, come clinical and some theoretical, on medical sub­jects differing widely in content and style. This col­lection of writings, which comprised a comprehen­sive and rational healing system usually known as “Hippocratic” medicine, emphasized the individual patient. Its practitioners focused exclusively on physical factors related to health and disease, includ­ing the immediate environment. Indeed, among the most famous works of the Hippocratic corpus was the treatise Airs, Waters, and Places, an early primer on environmental medicine. Another was Epidemics, a day-to-day account of certain patients, and a third was Regimen, a prescription of diet and life-style conducive to health.

For the ancient Greeks, health was a state of bal­ance among four bodily humors: blood, phlegm, yel­low bile, and black bile.

Illness thus occurred when the humoral balance was upset either by a lack of proper nourishment or by the imperfect production, circulation, and elimi­nation of the humors. The physician’s goal was to restore a healthy balance through the use of diet, rest, or exercise and a limited number of drugs, all capable of aiding the natural healing powers be­lieved to exist in every human being.

This somewhat conservative approach of merely assisting nature and above all not harming the sick characterized the method of Hippocratic physicians. It was congruent with the rather tenuous social posi­tion of the early Greek healer, often an itinerant craftsman entirely dependent on his personal reputa­tion because the country lacked an educational and licensing system for medical professionals. Given the elementary state of medical knowledge as re­flected in the absence of properly identified disease entities, the demands made of Hippocratic healers were simple prognostications — will the patient live or die? - and ideally some amelioration of symptoms by complementing the healing forces. Unfettered by religious barriers, although coexisting with a reli­gious healing system based on the cult of Asclepius (the god of medicine), the techne iatriche prospered within the flexible tenets of humoralism, a cultural system that was widely shared by healers and their patients and that allowed for the gradual inclusion of new clinical observations.

After the death of Alexander the Great in 323 B.C.

Given the limitations of contemporary medical knowledge, as the Hippocratic healing profession be­gan to compete for upper-class patronage serious de­bates ensued about the value of medical theory and bedside expertise. Two “sects,” the Dogmatists and Empiricists, first became involved in this dispute. The former, led by Praxagoras of Cos, emphasized the need for theoretical knowledge in medicine, espe­cially to establish plausible explanations for the phenomena of health and disease. The Empiricists, under the guidance of Herophilus, revolted against excessive speculation and expressed skepticism about the value of medical theory, placing instead greater emphasis on bedside experience. Two centu­ries later, a third group of Greek physicians residing in Rome-the Methodists - espoused a simplistic view of bodily functioning and restricted their treat­ments to bathing, diet, massage, and a few drugs.

In Rome, healing was essentially a popular skill practiced by heads of families, slaves, and foreign­ers. A lack of regulations and low social status con­tributed to a general mistrust of physicians. An ex­ception, however, was the respect accorded to Galen of Pergamon of the second century, a well-educated follower of Hippocratic medicine who managed to overcome the schisms of sectarianism. A prolific writer who authored hundreds of treatises, Galen also carried out anatomic dissections and physiologi­cal experiments on animals. He successfully inte­grated his extensive clinical experience, which he acquired mainly as a surgeon to performing gladia­tors, into his basic theoretical knowledge, providing medicine with a comprehensive system destined to survive for nearly 1,500 years.