Ancient Greece

Asclepius and the abaton

Healing before Hippocrates

Greek healing began in the sanctuary. The sick traveled to the temples of Asclepius at Epidaurus, Kos, and Pergamon, bathed, made their offering, and slept in a hall called the abaton.

In the night the god was expected to appear in a dream, either performing the cure directly or prescribing one for the priests to carry out in the morning. Inscribed tablets at Epidaurus record the cures claimants reported.

The regimen surrounding the dream is the part that survived: rest, bathing, diet, exercise, and quiet in a fixed sequence, applied to people who had usually traveled a long way to be there.

Alcmaeon of Croton

Health defined as the equal rule of powers

Around 500 BCE Alcmaeon of Croton defined health as isonomia, the equal rule of the body's opposing powers: hot and cold, wet and dry, bitter and sweet. Disease he called monarchia, the dominance of any one of them.

The words are borrowed from politics. Isonomia is the equal distribution of power among citizens, and monarchia is rule by one. Alcmaeon read the body as a well-ordered city that falls ill when one faction takes control.

He also placed intelligence in the brain, and argued that physicians should draw conclusions from what they observe. Plato and Philolaus both accepted his view that the brain is the seat of intelligence, and the balance model went on to shape the Hippocratic writers and every humoral theory after them.

Illness leaves the temple

Disease given natural causes

The Hippocratic writers moved the cause of illness out of the sanctuary. On the Sacred Disease attacks the idea that epilepsy is sent by a god and insists it has a natural cause in the body like any other complaint.

The four humours, blood, phlegm, yellow bile, and black bile, gave the balance model a substance to work with. Health was their proper proportion and mixture, called krasis. Illness was dyskrasia, a bad mixture.

The humours were wrong as chemistry and right as structure. They encode a system with four quantities that must hold a proportion, where illness is a proportion lost rather than a thing acquired.

Sixty books and a method

What the Hippocratic Corpus actually is

The Hippocratic Corpus is not one book by one man. It gathers roughly sixty works written by many hands across the fifth and fourth centuries BCE, disagreeing with one another on substance and agreeing on method.

The method is the inheritance. Take the history. Examine the patient. Record the course day by day. State what you expect to happen, and write down whether it happened.

The doctrine of critical days came out of that record keeping. Fevers were held to turn at particular intervals, so the physician watched the clock as closely as the patient. Illness was treated as a process with a shape in time rather than a state to be named once.

Physis

The body's own power to right itself

The Hippocratic writers named physis, the nature of a thing and its tendency to return to its proper state. In medicine it meant the body's own capacity to heal, and the physician's first duty was to assist it rather than to override it.

That is why so much Hippocratic treatment is regimen: food, drink, exercise, sleep, air, and rest, adjusted in small amounts and watched. The physician sets conditions and the body does the work.

The claim underneath is that the body is already trying to return to a value it defends. Treatment supplies what the return needs. Physis is the governing principle of Hippocratic medicine.

On the Articulations

The oldest surviving book on the spine

The Hippocratic treatise On the Articulations is the earliest surviving manual of the spine. It describes the structure of the vertebral column, what happens when it is displaced, and what a healer can do by hand.

It gives technique in detail. Pressure is applied along the back, traction on a bench, and succussion drops a patient bound to a ladder a controlled distance to reduce a displacement. The treatise is specific about how much force, applied where, and by whom.

The Greeks assigned the spine its own book. The reasoning is mechanical rather than metaphysical, and the variables it names are site, direction, and amount, which is the vocabulary of a graded physical input.

Alexandria, c. 280 BCE

The tradition that found the nerves

Herophilus of Chalcedon and Erasistratus of Chios dissected the human body systematically in Alexandria in the first half of the third century BCE, and they found the nervous system. No one else in the ancient world managed it.

Herophilus discovered the nerves, described at least seven pairs of cranial nerves, and separated the nerves that produce movement from those that carry sensation. He traced the nerves of the spinal cord directly to the brain. Between them the two men described the meninges, the dural sinuses, and the ventricles, and attributed neurological disease to failure of the nervous system itself.

The window lasted no more than thirty or forty years. Human dissection was then forbidden and was not resumed for roughly eighteen hundred years.

Greek medicine therefore reached the anatomy of regulation and could not keep it. What passed down through Galen into medieval Europe was the balance model. The wiring diagram had to be found again in the Renaissance.

Regimen

Prevention written as a prescription

Hippocratic medicine put most of its effort into regimen: the daily management of food, drink, exercise, bathing, sleep, and air, adjusted to the season, the place, the work, and the person.

Airs, Waters, Places instructs a physician arriving in an unfamiliar city to study its winds, its water, and its soil before treating anyone in it, because the illnesses of a place follow from its conditions.

The unit of treatment is a person in an environment over time. Health is maintained by keeping the inputs in proportion, and the physician has the most influence before anything has gone wrong.

Tonos

The word itself, and where it went

Greek medicine used tonos for tension, tautness, and the state of being strung. It is the direct ancestor of the English word tone, and it passed through Galen into the whole later vocabulary of muscle tone and tonic states.

The Greek term and the modern one are not the same concept, and the descent of a word proves nothing about the descent of an idea. The Greek usage described a tension a physician could feel in a body.

Galen, working in the second century CE, gathered the tradition into a system that governed European and Islamic medicine for more than a thousand years. He also kept pneuma, the breath and vital air, as the medium through which the nerves were held to act.

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