Medicine: Therapy

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Medicine: Therapy

Allopathic Remedies. Humoral theory was not just a diagnostic tool, but also provided a framework for therapy. With few exceptions, Hippocratic medicine used diet and regimen as its primary means of cure. Since disease was defined as humoral imbalance, both preventative care and restorative treatment generally took the form of allopathic remedies—that is, a cure by opposites. On the one hand, removal of excess humors was attempted by administering various purgative drugs, some of them unfortunately quite toxic. For instance hellebore, a poisonous herb of the lily family, was frequently used to induce vomiting. On the other, a careful categorization of foods and beverages in terms of what were believed to be their active qualities (hot/cold or wet/dry) offered a way of returning the patient to a balanced condition by prescribing diets to compensate for whichever humoral excess afflicted the body. Imbalances caused by an abnormal amount of black bile (cold and dry), for example, would be treated by a regimen of foods that generate heat and moisture.

Diet. It should be noted that “diet” (diaita) in ancient medicine had a far broader meaning than the modern term suggests and meant not simply food and drink but instead an entire style of living. Diet included exercise, bathing, and fixed routines of sleep and waking, as well as the patient’s emotional state. The course of therapy, whether after the fact of disease or to prevent its occurrence, was seen as a way the doctor could assist the body’s own natural tendency toward equilibrium. Illness was not a supernatural affliction but instead a rational, physiological process that ran a foreseeable course. The expert physician was the one who could accurately predict its phases and prescribe correctly at each stage.

System. The theory of the four humors clearly embodies both the strength and also the weakness of Hippocratic speculation. In this respect it is an emblem of much of ancient science as a whole, for that matter. On the one hand, it is simple, elegant, and rigorously rational. On the basis of a small number of assumptions it generated a complex, highly explanatory, and increasingly comprehensive system that put the human body at the center of a vast network of signs and events in nature. The churning humors, with their alternating cycles of hot and cold and wet and dry, were the microcosm of physical processes in the world at large, driven by the same fundamental laws that govern the production of rain, for instance, or the change from summer to fall. Time, place, climate, season, weather, temperament, age, diet, and habits were all indicators of health or disease, and also suggested the means for diagnosis and treatment. Rather than appealing to divine intervention to account for even the most bizarre and spectacular diseases—such as epilepsy, the subject of On the Sacred Disease, which attributes its cause not to God but to phlegm—the system rested on the rationalist foundation of early Greek physics.

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Speculation. At the same time, the humoral theory was obviously also sheer speculation with hardly any basis in empirical methods and real physiology. What is conspicuously lacking from a modern point of view are any signs of experimental rigor to match the rigor of theorizing. It is true that Hippocratic writers sometimes point to observable events to support their claims, as when one author refers to evidence gained from the autopsy of a goat as proof that phlegm in the brain causes epileptic seizures. For the most part, however, humoral theory developed and existed in a highly rarefied atmosphere, as a closed system that was true on its own terms and so incapable of ever being disproved. Moreover, as a framework for understanding disease and a guide for its treatment, it continued in effect for at least two millennia, well into the seventeenth century C.E., with results that often did far more harm than good to the patient. For instance, in reference to the practice of venesection to purge blood, which was still in use up until 1900, the historian Guido Majno in The Healing Hand (1975) remarked that “medicine has never produced a greater absurdity”—nor a more dangerous one, it might be added.

Limits. Not to minimize genuine Hippocratic contributions, however, the limits in which early Greek doctors worked must be kept in mind. Their fanciful understanding of physiology resulted from poor anatomical knowledge. This problem in turn was in large part due to strong religious prohibitions against opening the human body. The famous Hippocratic Oath, in fact, expressly forbids the practice of surgery. For the most part—and wisely, given the lack of sanitary conditions for treatment—invasive medical procedures were avoided.

Observation. Moreover, the Hippocratic Corpus does in fact also contain evidence of conscientious and detailed observation of facts. The importance of observation was especially emphasized because it provided material for the fine art of prognosis. Here the physician, after examining a patient, would try to describe the prior course of the disease and also predict its outcome. The prognosis also acted as a public display to showcase the physician’s expertise—and so too the legitimacy of his profession—since “he will improve his reputation as a doctor and people will feel confident about putting themselves in his hands.”

Hippocratic Faces. Therefore the authors of the books that go under the name of Epidemics provided careful, day-by-day descriptions of individual case histories and the climatic conditions in which they arose, sometimes covering as much as four months of continuous medical history. The text named Prognosis is devoted to painstaking descriptions of the patient’s face, eyes, complexion, hands, feet, movements, and overall behavior—including sleep patterns, upright and recumbent posture (“how he lies in bed”), and types of breathing. These disciplined, rigorous empirical records gave rise to the so-called “Hippocratic Faces,” a collection of diagnostic signs to guide the physician in identifying diseases and anticipating what course they would run. The following is representative:

Nose sharp, eyes sunken, temples hollow, the ears cold and drawn back with their lobes twisted, the skin of the face hard, stretched, and dry, and its color pale or dusky. If this is the appearance of the face at the onset of the disease, and it is impossible to base a diagnosis on other signs, the patient should be asked if he has insomnia, severe diarrhea, or ravenous hunger. If he affirms any of these, the case should be considered less severe . . . since its crisis will be reached in a day and a night. But if he affirms none of them....

For sheer accuracy of observation, such case histories went unrivaled for at least two thousand years. Equally valuable insights and, on the whole, more successful styles of therapy—if often painful ones—are also found in a group of texts devoted to the diagnosis and treatment of fractures, dislocations, and head wounds.

Women’s Health. Several texts in the Corpus deal with gynecological issues. These studies of female anatomy and physiology suggest communication between the exclusively male Hippocratics and the anonymous women who treated conditions specific to women and acted as mid-wives. Little is known about female patients and female caregivers at this time, however, for ancient Greek culture was vigorously misogynist, denying women both a place and a voice in society.

Hysteria. The writings on female-related health issues tend to exhibit a mixture of keen observation and pure mythology, legitimate research and blind sexism. Accordingly, a male fetus grows on the right (stronger) side of the womb, a female on the left. Male sperm contributes the essential substance of the future child; the mother merely provides a place for incubation. The uterus itself, for that matter, was believed to be an independent and highly mobile organ, which sometimes “wandered” through the body in search of the vital moisture it craved. By squeezing or knocking against other organs in the course of its travels, it drove young women to fits of nervous anxiety, giddiness, delirium, spells of choking and fainting—in short, to what was called “hysteria,” from the Greek word hustera, meaning “womb.” In such cases most doctors prescribed marriage as a cure.

Embryology. Medical theory intersected philosophical ideas in the case of embryology. The treatise On the Nature of the Child is remarkable as the first systematic observation on record of the development of an embryo, using hen’s eggs incubated over a period of twenty days. For the most part, however, such empirical work took second place to debate over the much broader issues of generation and growth. Here the main question was that of the nature of the plant or animal seed, and how a fully formed and differentiated being could grow from it. The answer proposed and generally accepted by physicians and philosophers alike was that the seed is composed of elements drawn and distilled from every part of the body, and therefore essentially contains each of its substances—tissue, bone, hair, blood, and so on.

Interdependence. The resemblance between this theory—known as pangenesis (Greek paggenesis)—and theories put forward by some of the pluralists and atomists is obvious. It emphasizes how interdependent all branches of what are now distinguished as separate disciplines—philosophy, physics, chemistry, biology, medicine—originally were. Many physicians were at the same time practicing philosophers, in fact, and quite a few physicists dabbled in medicine. It also points to the ongoing, open, and interdisciplinary nature of research in fifth- and fourth-century Greece.