Our sources of knowledge of Greek medicine and physicians are (1) works of ancient physicians; (2) notices of early writers concerning Greek medicine and physicians, as Plato, Aristotle, Plutarch, Pausanias, and Galen; (3) various medical instruments in the great museums of Athens, Berlin, Paris, and London, such as knives, probes, needles, balsam cups; (4) inscriptions and papyri; (5) altars, temples, and caves; (6) images of gods and votive offerings.
Our earliest account of Greek medicine and physicians is in the Homeric pcems. There were two sources of disease-supernatural, referred to the wrath of gods, as plague and melancholia; and natural, as from drugs or wounds. Already physicians were called demiurges and were recognized as public servants. The most famous were Asklepios and his two sons. According to Homer and Hesiod, Asklepios was a Thessalian prince who had learned from Cheiron about drugs. Later, Apollo was assigned as his father, and a snake became the symbol of his healing power. His two sons-‘the cunning leeches’-were Machaon, to whom he taught surgery, and Podaleirios, to whom he taught medicine, which he himself preferred. Homer said, ‘a physician outweighs many other men’ (Il. xi. 514). Drugs were used for poison, charms, soothing pain, and healing wounds. Battles were occasion for many bodily injuries and became an incentive for medical and surgical tact. Anatomical knowledge was slight, and was gained from sacrificial victims and from those wounded in battle. There was no connexion between priests and medical men; only as priest was Calchas summoned during the plague. Women, as Helen and Agamede, had medical knowledge.
The cult of Asklepios flourished widely in Greece and Asia Minor. In the traditions concerning him, that which associated him with Epidauros finally prevailed. Shrines were dedicated to him; one might even call these asklepia hospitals, Heilstätte. Of these there were more than 300 at Athens, Cnidos, Cos (the ruins of which have been uncovered within the last few years), Delphi, Pergamos, Rhodes, and Trcezen. They were usually situated in salubrious places, on mountain-sides, by pure fountains or streams, by mineral or hot springs. They were cared for with fastidious cleanliness. None could get the benefit of them without preliminary rites-shampooing, baths, friction, fasting, abstinence from food and wine; nor were religious rites of an impressive character, including music, overlooked. Those who were to be treated were shown votive offerings and inscriptions of those who had been healed. To the divinity there was the sacrifice of a goat or ram, a cock or hen, accompanied by fervent prayer for succour. In an attitude of intense expectancy the sufferer slept in the abatons near the statue of Asklepios on a bed, or in the neighbourhood of the temple on a skin of the sacrificial victim, where, as he fell into a deep slumber, the divinity awaited him. Whatever of surgery was applied, as of binding or anointing, was probably performed by temple attendants, whom the patient’s dream identified with supernatural power. Theurgy was thus joined to natural means of cure. The death of a patient was attributed to his lack of confidence. In the asklepia were case-books left by the patients which recorded symptoms, treatment, and result.
Gymnasia existed in Greece before the Asklepiadae began to practise medicine. These provided three orders of service: the director-gymnasiarch; the subordinate who had charge of pharmacy with reference to the sick; those who gave massage, put up prescriptions, bled, dressed wounds and ulcers, and reduced dislocations. Gymnasts by reason of their experience were often called in to treat injuries, dislocations, or fractures before the arrival of the physician. Naturally the influence of these men increased. They were of special use where baths, dietaries, and physical manipulations were indicated.
In addition to the priests and the gymnasts, there were earlier Asklepiadae-hereditary physicians whose medical art was handed down from father to son. Later, promising youths from outside were trained for this practice. Physicians were put in charge during epidemics, gave expert testimony in courts, accompanied armies and fleets, and practised at places provided at public expense. Anatomy was learned from oral and written tradition, from sacrifices and domestication of animals, injuries in the gymnasia, from bodies long exposed to the elements or to wild animals, and from dissection of wild animals. Many gatherers and distillers of roots and herbs set themselves up in business. Druggists also with various remedies claimed the curative worth of their prescriptions. There were survivals of folk-medicine. Women practised as midwives, when they were past the age of childbearing. They treated diseases which it was not proper for men to know or for women to divulge to men. Some of these announced themselves as ‘beauty’ doctors.
The chief centres of medicine were Cyrene, Crotona, Cnidos, and Cos-the last the home of the dogmatists. Pythagoras (born c._ 575 b.c.), founder of a gild at Crotona, appears to have studied the structure of the body and reproduction, but knew very little of surgery, advocated poultices and salves, inculcated dietetic and gymnastic practices, and advised a limited amount of meat but no fish or beans. The Pythagoreans were the first to visit their patients at home; they also went from city to city, and thus gained the name of ambulant physicians. Following Pythagoras, whose order was dissolved by law about 500 b.c., were Alkmaion of Crotona, who from his dissection of animals was reported to be the first Greek anatomist, and Demokles (c._ 520 b.c.), the first physician of whom we have a reliable account. He migrated from Crotona to aegina, where he was made medical officer with a salary of one talent (about £240) a year. Later, at Athens, he received £406; later still, at Samos under Polykrates, £480. Afterwards, taken captive and brought to the court of Dareios, he cured the king of a sprained ankle and treated his gum for mammary abscess.
Particular occasion for the rapid advance in Greek medicine is contact with Egypt and the East, knowledge of drugs, rivalry of centres of culture, and separation of the priestly class from medicine.
An account of the history of physicians in general would be incomplete without at least a cursory reference to the great philosophers of the 5th and 4th centuries b.c. They furnished the philosophy on which physicians often based their theories of disease. Aristotle (384-322 b.c.), descended from a long line of physicians, investigated anatomy, embryology, and physiology, and for the first time held that animal life is spontaneous movement. Anaxagoras of Clazomenae (c._ 555 b.c.) practised dissection of animals and even dissected the brain. Empedokles (490-430 b.c.) followed Pythagoras, and also professed magical powers of healing. He resolved all conditions into warm, cold, moist, and dry; held the doctrine of the four substances, fire, air, water, and earth, to which he assigned a soul-hylozoism. Love and hate rule development and dissolution. At Selinos and Agrigentum he put an end to two pestilences by seeking for and remedying the natural causes. He discovered the labyrinth of the ear.
The name, however, which stands out above all others in the history of Greek medicine is that of Hippokrates. Born at Cos about 460 or 459 b.c., son of Herakleides, his descent was traced on his father’s side from Asklepios, on his mother’s from Herakles. He was the second of seven of this name. He was a contemporary of Pheidias, Perikles, Sophokles and Euripides, Thukydides, Praxiteles and Zeuxis. Plato assigned him a place alongside of Pheidias and Polykleitos. Aristotle called him ‘the Great,’ Galen, ‘the Divine’; and from that day to this he has been acclaimed ‘the Father of Medicine.’ Of the writings attributed to him in the Corpus Hippocraticum, it seems impossible to decide which portions are genuine, and which belong to an earlier or later period. They form, however, a tolerably compact body of writings, and for 2,000 years have turned attention away from speculation to observation, and thus have profoundly influenced the medical ideal. So far as his character can be made out from these treatises and from tradition, he was a man of great genius and noble character, with an unsullied regard for his art, his patients, and his pupils. The peculiarities of his system may be summarized. (1) He followed Empedokles in holding to the four elements and the four conditions, but added the four humours-black bile, yellow bile, blood, and phlegm. He recognized no supernatural cause of disease: ‘none is more divine or human than another,’ and ‘none arises without a natural cause.’ (2) He held a theory of crises or critical days. Diseases pass through three stages to a climax; the crude humours are ‘cooked,’ and finally resolved, either being excreted or causing death. Sometimes nature eliminates the disease by sweating or vomiting, sometimes the physician aided by bleeding, or administering purgatives and diuretics. (3) To physis and dynamis, which is really the vis medicatrix naturCE, in distinction from the power of the gods, all recovery is referred. ‘Natural powers are the healers of disease.’ The task of the physician is to observe the progress of the disease, to interfere, direct, divert. ‘Nature suffices for everything under all conditions.’ (4) Prognosis is recommended for securing and retaining the esteem of others, for freeing the physician from blame which might arise, and as an aid towards effecting a cure through its appeal to expectancy. By prognosis is meant a complete knowledge of the patient together with the tendency of the disease. ‘The best physician is the one who is able to establish a prognosis, penetrating and exposing, first of all at the bedside, the present, past, and future of his patients, and adding what they omit.’ An essential aspect of his practice was appeal to suggestion in the patient. One-eighth of the entire Corpus Hippocraticum is occupied with the subject of prognosis. (5) Hippokrates emancipates medicine from all but practical aims. In his hands it was freed from theurgy and speculation, and placed on a secure empirical basis, not that of casual observation, but of taking account of all facts which have bearing on the case. He left forty-two histories of clinical cases, twenty-five of which cases issued fatally-a practice almost wholly neglected for 2,000 years until the 17th century. His treatises on ‘Fractures’ and ‘Dislocations’ have been claimed as the ablest works ever written by a physician. A Hippokratic maxim runs, ‘Life is short, art is long, opportunity fleeting, experiment fallacious, and judgment difficult.’ He laboured under serious limitations. Naturally he had no knowledge of either elementary and physiological chemistry or of bacteriology; he took no account of pulse, temperature, respiration, or analysis of urine. Owing to customary reverence for bodies of the dead, autopsies were unknown, unless indeed a criminal or a traitormay have furnished material, and anatomical knowledge, apart from that concerning bones, had to be derived from dissecting animals, from sacrificial animals, and surgical cases. Two significant designations have survived: ‘Hippokratic succession,’ and Facies Hippocratica.
The Hippokratic Oath is herewith given:
‘I swear by Apollo, the physician, by Asklepios, by Hygeia, by Panakeia, and by all gods and goddesses, that I will fulfil religiously, according to the best of my power and judgment, the solemn vow which I now make. I will honour as my father the master who taught me the art of medicine; his children I will consider as my brothers, and teach them my profession without fee or reward. I will admit to my lectures and discourses my own sons, my master’s sons, and those pupils who have taken the medical oath; but no one else. I will prescribe such medicines as may be best suited to the cases of my patients, according to the best of my judgment; and no temptation shall ever induce me to administer poison. I will not give to a woman an instrument to procure abortion. I will religiously maintain the purity of my character and the honour of my art. I will not perform the operation of lithotomy, but leave it to those to whose calling it belongs. Into whatever house I enter, I will enter it with the sole view of relieving the sick, and conduct myself with propriety towards the women of the household. If during my attendance I happen to hear of anything that should not be revealed, I will keep it a profound secret. If I observe this oath, may I have success in this life, and may I obtain general esteem after it; if I break it, may the contrary be my lot.’
The other school of medicine in Greece, the Cnidian-empiric-were adepts in clinical examinations, auscultations of the chest, and gynaecology. They were, however, handicapped by lack of anatomical and physiological knowledge. They employed analogy of men with cosmic, vegetable, and animal existence. The two chief physicians were Euryphon and Ktesias. Euryphon described pleurisy as affection of the lungs, explained the cause of disease as insufficient elimination of waste products, and haemorrhage as from the arteries as well as from the veins, contrary to the general opinion. He was probably influential in compiling the Cnidian Sentences. Ktesias (after 398 b.c.), for seventeen years a prisoner at the Persian court of Artaxerxes Mnemon, showed a general interest in poisons, and wrote a book on hellebore.
In the Alexandrian era under the Ptolemys medicine was transplanted from Cos and Cnidos to Alexandria. As a literary and commercial centre it offered great attractions. Here was one of the largest libraries of the world, with 600,000 MSS_, and here philosophers of all sects had established themselves. Commerce brought from all quarters a vast supply of new medicaments. Interest in botany, zoology, and mineralogy flourished. Physical discoveries were made which could be pressed into the service of medicine. At the beginning of the 3rd cent. b.c. the collection of books attributed to Hippokrates had been brought together and edited by scholars commissioned by the Ptolemys; other medical MSS_ also invited study. Patients from many quarters were attracted by the treatment offered by Greek, Jewish, and Egyptian practitioners. Fresh inquiry had opened up a deeper interest in diagnosis, pharmacology, and toxicology. Anatomy received an impulse hitherto unknown. Not only animals but cadavers were dissected; vivisection was reported as performed on criminals. The Ptolemys encouraged and even themselves engaged in dissections. Objects exhumed in Pergamos disclose the accuracy of anatomical knowledge. In Alexandria medicine was divided into surgery, dietetics, and rhizotomy or pharmacy.
Two names stand out in this period (c._ 300 b.c.). Herophilos of Chalcedon in Bithynia, one of the most distinguished physicians of antiquity, followed closely the methods of Hippokrates. With him anatomical science may be said to have had its beginning; he investigated the brain, the nerves, the eye, the vascular system, the liver; he named the duodenum. He first regarded the nerves as the organs of sensation, and first operated for cataract by extracting the crystalline lens. He made use of the amazing number of new drugs available by commerce. He practised venesection freely. He taught obstetrics and wrote a book for midwives. ‘The most perfect physician is he who distinguishes between the possible and the impossible.’ Erasistratos of Julis, of the island of Ceos, son of a physician, left the court of Seleucus Nicator and went to Alexandria, where he wrote on fevers, paralysis, hygiene, and therapeutics. He was an anatomist, and described the brain as seat of the soul and centre of the nerves, distinguished the cerebrum from the cerebellum, and gave the trachea its name; disease was ‘plethora’-an overfilling of the vessels of the body with alimentary matter, giving rise to fever. He opposed venesection.
By reason of the special conditions of the time, toxicology exerted a powerful fascination over very many experimenters in Asia Minor. Krateros at the court of Mithridates VI., Eupator, a rhizotomist, Mithridates himself, Nikandros of Colophon, dealing with animal and vegetable poisons, cultivated and experimented with various toxic agents.
Greek physicians and midwives made their appearance in Rome in the 3rd. cent. b.c. Pliny, writing in the 1st. cent., said that for 600 years Rome had been without physicians. The Romans were a sturdy race and had had little occasion for the physicians who flourished elsewhere; in this respect they were behind all other civilized peoples. Sickness was referred to supernatural agencies. The cult of Asklepios was transferred to Rome in 291 b.c., and the worship was with ‘superstitious rites and ceremonies.’ Every function of life was presided over by a divinity; therapeutic agencies were magical, through sin-offering, invocations, omens, and the like. There was no scientific medicine. In his Natural History Pliny devotes many pages to a description of the ancient popular medicine, a crude empiricism mingled with fantastic and superstitious formulae; but even he makes no distinction between scientific and purely traditional domestic methods. Medicine was partly in the hands of priests, and partly consisted of popular practice and rough surgery. Votive offerings of bronze and alabaster disclose the limitations in Etruscan anatomical knowledge. Gymnastic assistants in Greece came to Rome and set up in the practice of their profession. Other Greek arts had come to Rome, but owing to Roman prejudice medicine lagged behind. Archagathos was among the first, although not the first Greek physician, as Pliny states (HN_ xxix. 6), to come from the Peloponnesos; he arrived in 219 b.c. Extraordinarily successful, and at length emboldened by his fame, he undertook so many serious cases of cutting and burning that he was dubbed ‘carnifex’ and driven from the city. Later, Asklepiades of Prusa (Bithynia), born about 124 b.c., reconciled the Romans to Greek medicine. An adherent of atomism, he won the favour of the influential Epicureans at Rome. He rejected the Hippokratic axiom that nature is the healer of disease; often nature does not help but even hinders recovery. His principal significance lay in therapeutics; he relied mainly on diet, hygiene, and physical and medical treatment.
In 49 b.c. all Greeks, and therefore Greek physicians, were made freedmen by Julius Caesar. This action led to two results: it increased the number of Greek physicians in Rome, and it gave them a prestige which they had not before enjoyed. In his Natural History (xxix. 8) Pliny wrote that those who adopt the Greek language in their prescriptions, no matter what their pretensions, nor how serious the peril, are fully believed. For a century and a half after 25 b.c. a galaxy of Greek physicians practised in Rome, all of whom were natives of Asia Minor. Themison of Laodicea (born c._ 50 b.c.), founder of the methodic sect, sought for the symptoms of disease with a common sign, in distinction from Asklepiades, who inquired after the cause. He recognized only three forms of disease-rigidity or congestion, relaxation, and a combination of these two with one or other condition preponderating. The treatment was to relax for congestion, to constrict for relaxation. Prophylactic measures were also practised. He was the first to make use of leeches. The strict methodists conceded neither specific disease nor specific remedies, and disallowed such medicines as purgatives, emetics, diuretics, and emmenagogues. The school increased rapidly, since it was so easy to complete the preparation. Thessalos of Tralles in Lydia announced himself as able to train physicians in six months. Among his pupils were smiths, dyers, and cobblers. He dedicated to Nero his writings, in which he treated of diet, chronic disease, and surgery. He taught his pupils at the bedside of his patients. Scribonius Largus (c._ a.d. 47) dedicated to Claudius, whom he had accompanied on an expedition to Great Britain, a collection of 271 formulae for treatment of every portion of the body, from head to foot. These were in part from Greek sources, and in part from secret remedies got by bribery from physicians and quacks at health resorts; some were popular, others magical and fantastic. He was the first to describe the method of abstracting opium and of applying electricity for severe headache. Dioskurides of Anazarba near Tarsus in Cilicia, perhaps a contemporary of Pliny, simplified pharmacology, relieving it of all superstitious remedies, and wrote the first book on this subject, Περὶ ὕλης ἰατρικῆς, in a.d. 77 or 78. This consisted of five books, and included the three kingdoms. He also wrote on poisons and antidotes, and on poisonous beasts. He was familiar with all the plants of Arabia and Asia Minor, and in a single book he describes these with such exactitude that they have been identified by modern botanists. To him we owe descriptions of ginger, pepper, gentian, alces, and wormwood, and also metallic agents such as quicksilver, acetate of lead, and copper oxides. A. Cornelius Celsus, not indeed of Greek birth, drew all his inspiration from Greek sources. Probably not a practising physician, not perhaps even medically trained, he wrote in the first half of the century eight books on medicine, including diet and hygiene, general and special pathology, and surgery. Particularly famous are his descriptions of lithotomy, operation for cataract, and obstetrics.
In the middle of the 1st cent. there arose a new school, the Pneumatics, who would explain all diseases by reference to ‘vital air’; pneuma takes the place of humours in disease and health. The school was founded by Athenaios of Attaleia in Pamphylia. He paid much attention to air, water, food-stuffs, influence of different climates on health, exercise, baths, mineral waters, dietetics rather than drugs. For the sake of its value in sexual development he advocated physical as well as mental training for youth. Women were to find in their domestic and social activity a means of health. Archigenes of Apamea in Syria completed the study of the pulse, wrote on drugs, especially hellebore. He was skilful as a surgeon and pharmacologist. In therapentics he made use of amulets for their value in suggestion. He was not above preparing hair-dye for ladies of high rank. He operated for cancer and used the vaginal speculum. Aretaios (at the close of the 1st cent.) was equalled only by Hippokrates in the description of diseases and in the principles of therapy. For the most part he advocated mild remedies, and held that even if the patient were hopelessly and protractedly ill, the duty of the physician toward him was not relaxed. Rufus of Ephesus, who also practised medicine in the reign of Trajan, was educated at Alexandria. He derived his anatomical knowledge from the dissection of monkeys. Soranos of Ephesus, who received his medical and anatomical training in Alexandria, was the most famous obstetrician of antiquity. One learns from him what were the most approved methods of practice in this department of medicine. In him the methodic school culminated.
If Luke was a physician (Colossians 4:14), as Harnack has adduced strong reasons for maintaining (Lukas der Arzt, Leipzig, 1906, p. 122 ff., Eng. tr._, Luke the Physician, London and New York, 1907, Appendix, p. 175 ff.; cf. W. K. Hobart, The Medical Language of St. Paul, Dublin, 1882; T. Zahn, Einleitung in das NT, Erlangen, 1897-1900, ii. 435 ff., Eng. tr._, Introduction to the NT, Edinburgh, 1909, iii. 160 ff.), and, further, if Luke was a Greek either of Antioch or of Antiochian descent, he may have had such training as was characteristic of Asia Minor at that time.
Literature.-Hippokrates, Genuine Works, Eng. tr._, London, 1849; Edward Meryon, The History of Medicine, do., 1861; H. E. Handerson, Outlines of the History of Medicine and the Medical Profession, New York, 1889; T. Puschmann, History of Medical Education, Eng. tr._, London, 1891; A. Harnack, Medicinisches aus der ältesten Kirchengeschichte, Leipzig, 1892; Edward Berdce, The Origin and Growth of the Healing Art, do., 1893; J. Pagel, Einführung in die Geschichte der Medicin, Berlin, 1898; Max Neuburger and J. Pagel, Handbuch der Geschichte der Medizin, Jena, 1901-05; Roswell Park, An Epitome of the History of Medicine, Philadelphia, 1906; Max Neuburger, Geschichte der Medizin, Stuttgart, 1906; J. S. Milne, Surgical Instruments in Greek and Roman Times, Oxford, 1907; W. M. Ramsay, Luke the Physician, London, 1908; David Allyn Gorton, The History of Medicine, New York, 1910; J. E. Sandys, A Companion to Latin Studies, Cambridge, 1910, p. 715 ff.
C. A. Beckwith.