Greek Biology & Greek Medicine

by Charles Singer

The numerous busts of him which have reached our time are no portraits. But the best of them are something much better and more helpful to us than any portrait. They are idealized representations of the kind of man a physician should be and was in the eyes of the best and wisest of the Greeks. ([See Fig. 1].)

The method of the Hippocratic writers is that known to-day as the ‘inductive’. Without the vast scientific heritage that is in our own hands, with only a comparatively small number of observations drawn from the Coan and neighbouring schools, surrounded by all manner of bizarre oriental religions in which no adequate relation of cause and effect was recognized, and above all constantly urged by the exuberant genius for speculation of that Greek people in the midst of whom they lived and whose intellectual temptations they shared, they remain nevertheless, for the most part, patient observers of fact, sceptical of the marvellous and the unverifiable, hesitating to theorize beyond the data, yet eager always to generalize from actual experience; calm, faithful, effective servants of the sick. There is almost no type of mental activity known to us that was not exhibited by the Greeks and cannot be paralleled from their writings; but careful and constant return to verification from experience, expressed in a record of actual observations—the habitual method adopted in modern scientific departments—is rare among them except in these early medical authors.

The spirit of their practice cannot be better illustrated than by the words of the so-called ‘Hippocratic oath’:

‘I swear by Apollo the healer, and Asclepius, and Hygieia, and All-heal (Panacea) and all the gods and goddesses ... that, according to my ability and judgement, I will keep this Oath and this stipulation—to reckon him who taught me this Art as dear to me as those who bore me ... to look upon his offspring as my own brothers, and to teach them this Art, if they would learn it, without fee or stipulation. By precept, lecture, and all other modes of instruction, I will impart a knowledge of the Art to my own sons, and those of my teacher, and to disciples bound by a stipulation and oath according to the Law of Medicine, but to none other. I will follow that system of regimen which, according to my ability and judgement, I consider for the benefit of my patients, and abstain from whatever is deleterious and mischievous. I will give no deadly medicine to any one if asked, nor suggest any such counsel; nor will I aid a woman to produce abortion. With purity and holiness I will pass my life and practise my Art.... Into whatever houses I enter, I will go there for the benefit of the sick, and will abstain from every act of mischief and corruption; and above all from seduction.... Whatever in my professional practice—or even not in connexion with it—I see or hear in the lives of men which ought not to be spoken of abroad, I will not divulge, deeming that on such matters we should be silent. While I keep this Oath unviolated, may it be granted me to enjoy life and the practice of the Art, always respected among men, but should I break or violate this Oath, may the reverse be my lot.’

Respected equally throughout the ages by Arab, Jew, and Christian, the oath remains the watchword of the profession of medicine.[111] The ethical value of such a declaration could not escape the attention even of a Byzantine formalist, and it is interesting to observe that in our oldest Greek manuscript of the Hippocratic text, dating from the tenth century, this magnificent passage is headed by the words ‘from the oath of Hippocrates according as it may be sworn by a Christian.’[112]

When we examine the Hippocratic corpus more closely, we discern that not only are the treatises by many hands, but there is not even a uniform opinion and doctrine running through them. This is well brought out by some of the more famous of the phrases of this remarkable collection. Thus a well-known passage from the Airs, Waters, and Places tells us that the Scythians attribute a certain physical disability to a god, ‘but it appears to me’, says the author, ‘that these affections are just as much divine as are all others and that no disease is either more divine or more human than another, but that all are equally divine, for each of them has its own nature, and none of them arise without a natural cause.’ But, on the other hand, the author of the great work on Prognostics advises us that when the physician is called in he must seek to ascertain the nature of the affections that he is treating, and especially ‘if there be anything divine in the disease, and to learn a foreknowledge of this also.’[113] We may note too that this sentence almost immediately precedes what is perhaps the most famous of all the Hippocratic sentences, the description of what has since been termed the Hippocratic facies. This wonderful description of the signs of death may be given as an illustration of the habitual attitude of the Hippocratic school towards prognosis and of the very careful way in which they noted details:

‘He [the physician] should observe thus in acute diseases: first, the countenance of the patient, if it be like to those who are in health, and especially if it be like itself, for this would be the best; but the more unlike to this, the worse it is; such would be these: sharp nose, hollow eyes, collapsed temples; ears cold, contracted, and their lobes turned out; skin about the forehead rough, distended, and parched; the colour of the whole face greenish or dusky. If the countenance be so at the beginning of the disease, and if this cannot be accounted for from the other symptoms, inquiry must be made whether he has passed a sleepless night; whether his bowels have been very loose; or whether he is suffering from hunger; and if any of these be admitted the danger may be reckoned as less; and it may be judged in the course of a day and night if the appearance of the countenance proceed from these. But if none of these be said to exist, and the symptoms do not subside in that time, be it known for certain that death is at hand.’[114]

Again, in the work On the Art [of Medicine] we read: ‘I hold it to be physicianly to abstain from treating those who are overwhelmed by disease’,[115] a prudent if inhumane procedure among a people who might regard the doctor’s powers as partaking of the nature of magic, and perhaps a wise course to follow at this day in some places not very far from Cos. Yet in the book On Diseases we are advised even in the presence of an incurable disease ‘to give relief with such treatment as is possible’.[116]

Furthermore, works by authors of the Hippocratic school stand sometimes in a position of direct controversy with each other. Thus in the treatise On the Heart an experiment is set forth which is held to prove that a part at least of imbibed fluid passes into the cavity of the lung and thence to the parts of the body, a popular error in antiquity which recurs in Plato’s Timaeus. This view, however, is specifically held to be fallacious by the author of the work On Diseases, who is supported by a polemical section in the surviving Menon fragment.

Passages like these have convinced all students that we have to deal in this collection with a variety of works written at different dates by different authors and under different conditions, a state that may be well understood when we reflect that among the Greeks medicine was a progressive study for a far longer period of time than has yet been the case in the Western world. An account of such a collection can therefore only be given in the most general fashion. The system or systems of medicine that we shall thus attempt to describe was in vogue up to the Alexandrian period, that is, to the beginning of the third century b. c.