As the Egyptian civilization faded, the Greek one emerged around 700 BC. The Greek civilization prevailed until "the end of antiquity" around 600 AD. The Greeks were great philosophers and their physicians lent more towards rational thinking when dealing with medicine, compared to the Egyptians. Ancient Greek medicine is probably the basis of modern scientific medicine.
The first schools to develop in Greece were in Sicilly and Calabria, in what today is Italy. The most famous and influential being the Pythagorean school. Pythagoras, the great mathematician, brought his theory of numbers into the natural sciences - at that time medicine was not yet a definable subject.
Followers of Pythagoras, Pythagoreans, believed that numbers had precise meanings, especially the numbers 4 and 7. They mentioned that the Bible refers to infinity as 70x7, and that 7x4 is the duration of the lunar month as well as the menstrual cycle (28 days), 7x40 is 280 which is how long a pregnancy is when it reaches full term. They also believed that a baby would enjoy better health if he/she was born on the seventh month rather than the 8th.
The 40-day quarantine period to avoid disease contagion comes from the idea that the number forty is sacred.
According to ancient records, another early Greek medical school was set up in Cnidus in 700 BC. Alcmaen worked at this school, where the practice of observing patients began.
Alcmaeon (circa 500BC) of Croton is considered as one of the most eminent medical theorists and philosophers in ancient history. Some believe he was a student of Pythagoras. He wrote widely on medicine; however, some historians say he was probably a philosopher of science, and perhaps not a physician. As far as we know, he was the first person to wonder about the possible internal causes of illness. He put forward the idea that illness may be caused by environmental problems, nutrition and lifestyle.
Greek civilization was very different form the Egyptian one. The Egyptian empire was ruled by a monarch, while the Greek system involved several city-states which were ruled by local governments. Athens was democratic, its people voted rulers in, while Macedon was a dictatorship and Sparta was under military rule. Ancient Greece had a variety of systems.
Apart from being great traders, the Greeks were relatively wealthy; they promoted and enjoyed culture and adored poetry, public debates, politics, architecture, sculpture, comedy and drama. Their writing was phonetic, meaning it could be read out loud; a much more flexible form of written communication compared to the hieroglyphs the Egyptians used.
Their thirst for logic and logically-based discussions meant that mathematics and science could really develop. Aristotle, a mathematician, thrived in the Greek system. Socrates, a teacher, promoted the concept of asking questions into teaching methodologies.
From 600 BC onwards, the Greeks became more and more inquisitive about things around them - their discussions on why things exist, why they happen were approached rationally.
In 600 BC Anaximander put forward the idea that all matter was made up of earth, water, air and fire - which he called elements. It was not long before Greek physicians wondered whether all illnesses and
disorders might not have a natural cause, and if so, would they not better respond to natural cures, rather than incantations and attempts at repelling evil spirits, like the Egyptians did.
Around 300 BC Alexander the Great had turned Greece into a massive empire, which spread all over the Middle East. The city of Alexandria was built in Egypt, and became a vast center for education and learning.
Although they still believed in and had their gods, science gradually took over when trying to explain the reason and solution for illness and other things in general.
The ancient Greeks believed medicine revolved around the theory of humors.
The most famous, and probably the most important medical figure in Ancient Greece was Hippocrates, who is known today as "The Father of Medicine".
Hippokrates of Kos, The Father of Western Medicine
Hippocrates of Kos (or Cos) (460 BC - 370 BC) is considered as one of the giants in the history of medicine in recognition for his contributions to the medical field as founder of the Hippocratic School of Medicine. What was taught at his school revolutionized medicine - it was established as a discipline in its own right. Up until then, medicine was linked to philosophy and the practice of rituals, casting off evil spirits and incantations (Theurgy). It was Hippocrates' and his school's teachings which established medicine as a profession.
The Hippocratic Corpus, written by Hippocrates and colleagues at his school, consisted of about 60 early Ancient Greek medical works. Medical historians say it is impossible to tell what was written by him or other people.
Hippocrates is credited with creating the Hippocratic Oath, a vow taken by medical students when they become qualified doctors. The oath is also taken today by other healthcare professionals. They swear to practice medicine ethically and honestly. Some classical scholars, such as Ludwig Edelstein, believe that the oath was created by Pythagoreans. Nobody is completely sure who wrote it.
It is believed that Hippocrates advanced the systematic study of clinical medicine, i.e. the study of disease by direct examination of the living patient.
Medical historians say that Hippocrates and those practicing or having studied at his school were bound by the Hippocratic Oath and its strict ethical code. Students paid a fee to enter the school and were taken under their teacher's wing almost as if they were of the same family. Medical training would have included oral teaching and practical work as a teacher's assistant - the Oath states that a student must interact with patients.
Hippocrates and those from his school where the first people to describe and properly document several diseases and disorders. Hippocrates is thought to be the first to make a detailed description of clubbing of the fingers, a hallmark sign of chronic suppurative lung disease, cyanotic heart disease, and lung cancer. Some doctors today when making a diagnosis, will write "Hippocratic fingers" when referring to clubbed fingers.
The Hippocratic Face - this is a description of a face not long before death. It is a prognostic description, made by Hippocrates:
"(If the patient's facial) appearance may be described thus: the nose sharp, the eyes sunken, the temples fallen in, the ears cold and drawn in and their lobes distorted, the skin of the face hard, stretched and dry, and the colour of the face pale or dusky.... and if there is no improvement within [a prescribed period of time], it must be realized that this sign portends death."
Hippocrates and his school were the first to use the following medical terms for illnesses and patients' conditions:
How Aristotle and Plato influenced medical practice and research
Two famous Greek philosophers, Aristotle (384 BC - 322 BC) and Plato (424/423 BC - 348/347 BC) came to the conclusion that the human body had no use in the afterlife. This new way of thinking spread and influenced Greek doctors, who at Alexandria, Egypt, starting dissecting dead bodies and studying them. Sometimes even bodies of live criminals were cut open. It was through this kind of research that the surgeon Herophilus (335-280 BC) came to the conclusion that it was not the heart that controlled the movement of limbs, but the brain. Erasistratus (304 BC - 250 BC) found out that blood moves through the veins - however, he overlooked the fact that it circulates).
Aristotle's and Plato's philosophies, writings and speeches allowed the Greeks to start finding out about the inside of the human body in a systematic way.
Thucydides (circa 460 BC - circa 395 BC), a Greek historian, often called the "Father of Scientific History", came to the conclusion that prayers were totally ineffective against illnesses and plagues. He added that epilepsy had a scientific explanation and had nothing to do with angry gods or evil spirits.
Thycydides wrote, in his work 'History of the Peloponnesian War':
"I shall describe what the plague was like ... At the beginning the doctors were unable to treat the disease because of their ignorance of the right methods. Equally useless were prayers in the temples, consulting the oracles and suchlike."
The great minds of the time pushed science forward, so that medical professionals, scientists and researchers could seek out entirely natural theories for the cause of diseases.
The Four Humors in the Human Body
At that time, everybody thought that natural matter was made of four basic elements - earth, water, air and fire. It was not long that this theory gave them the idea that the human body consisted of the four humors, and that keeping those humors in balance was essential for good health. This theory survived for nearly 2,000 years (up to 1700 AD).
The four humors in the human body were:
- Yellow bile
- Black bile
According to Hippocrates in his work "The Constitution of Man", these four humors make up a human's body "through them he feels illness or enjoys health. When all the humors are properly balanced and mingled, he feels the most perfect health. Illness occurs when one of the humors is in excess, or is reduced in amount, or is entirely missing from the body.
Did the Greeks perform surgery?
We know the Greeks dissected dead bodies, and even live ones sometimes to find out what was going on inside. Medical historians doubt whether they performed internal surgical operations.
There were always some Greek states at war, which gave doctors vast experience in practical first aid, and they became skilled experts.
Greek doctors were good at setting broken bones and fixing dislocated ones. They could even cure a slipped disc.
As in Ancient Egypt, the Greeks had no anesthetics, and only some herbal antiseptic mixes. Without anesthetics it is virtually impossible to perform surgery deep inside the human body.
How did Greek doctors diagnose and treat patients?
The methods for reaching diagnoses by Greek doctors were not that different from what happens today. Many of their natural remedies are similar to a number of effective home remedies we currently use. Their theory of the four humors though, was mainly an obstacle to medical practice. About two thousand years later, that theory was found to be false.
Greek doctors would carry out a clinical observation; they performed a thorough physical examination of their patient. They would refer to their Hippocratic books for guidance on how to carry out the examinations and which diseases they should consider or try to rule out.
Over time, magic and appealing to gods gave way to seeking out natural causes for illnesses. This led to researching for natural cures. Greek doctors became expert herbalists and prescribers of natural remedies. They became convinced that the best healer is nature.
Hippocratic books mentioned:
- For chest diseases - barley soup, plus vinegar and honey, which would bring up phlegm.
- For pain in the side - dip a large soft sponge in water and apply gently. If the pain has reached the collar bone, then bleeding near the elbow is recommended until the blood flows bright red.
- For pneumonia - give the patient a bath, it relieves pain and helps him bring up phlegm. The patient must remain completely still in the bath.
By trying to balance the four humors when patients were ill, doctors would sometimes get things right, even if it was for the wrong reasons. When attempting to balance the natural heat of a patient, they:
- kept patients warm when they had a cold
- kept feverish and sweaty patients dry and cool
- bled patients to restore the blood balance
- purged patients to restore the bile balance. This would have been done by giving them laxatives, making them vomit, or giving them diuretics
The first two treatments mentioned above make sense in modern medicine, the third one does not, while the fourth depends on the person's illness. If the patient has swallowed something toxic, inducing vomiting might be appropriate.
Despite their apparent period of enlightenment, many doctors would still appeal to their Gods if treatments were not effective. Asklepios was the Greek god of healing, and there was a temple in Epidaurus, called Asklepion.
Some doctors would treat their patients and then take them to the abaton to spend the night asleep; the abaton was a holy place in a temple. They believed that Hygeia and Panacea, daughters of Asklepios would arrive with two holy snakes which would cure the patients. From "Hygeia" we have the word hygiene. The snake today is the symbol of pharmacists.
Did Ancient Greece have a public health system?
Authorities in Greece were not yet aware of the need for public health; the Greek city states did not strive to ensure their people had a good supply of water so they could wash themselves and keep their homes clean. There were no public sewage systems either.
However, the people were great believers in staying healthy. Well off and educated Greeks worked at remaining at a constant temperature, cleaning their teeth, washing regularly, keeping fit, and eating healthily. Their aim was to keep the four humors in balance throughout the year.
Greek doctors were strong believers in doing things in moderations.
Out of every three children born, only two would ever reach the age of two years. The life-expectancy of a healthy Greek adult was about fifty years.
According to Hippocrates, poor people would be too focused on making ends meet to be too concerned about their overall health.
Even though religion was slowly making way to logical reasoning, people still called on their gods to heal them at the Asklepion. Eventually, these temples became health spas, gymnasiums, public baths, and sports stadiums.
On the next page, we look at ancient roman medicine.