Medicine: The Theory of Healing
Medicine: The Theory of Healing
Asclepius. Throughout the ancient world, belief in the healing powers of the great god Asclepius, son of Apollo, probably drew the most devout support among the general public. Hundreds of shrines to Asclepius have been identified across the Mediterranean, and the cult flourished from its official establishment in the fourth century b.c.e. well into Roman and early Christian times. Central to Asclepiadic therapy was the so-called dream cure. After ritual offerings and purifications, the pious patient would sleep in a special dormitory attached to the shrine, and there would be visited in dreams by the god himself. Asclepius would either prescribe a remedy for the patient to purchase later from priests who took care of the temple, or else he might even directly effect the cure.
Man of Torone. The results, advertised on dozens of stone tablets displayed in the precinct of Asclepius’s main temple at Epidaurus, were often quite spectacular:
A man of Torone with leeches. In sleep he saw a dream. It seemed to him that the god cut open his chest with a knife and removed the leeches, which he put into his hands, and then he stitched up his chest again. At daybreak he departed, cured, with the leeches in his hands.
Credibility. Against such a background of tradition, magic, and religion, it was imperative for doctors both as individuals and as a group to distinguish themselves and establish their credibility. Despite ongoing theoretical disputes within the profession, they all consistently rejected supernatural cures as superstitious and firmly endorsed the same rationalist framework that had motivated research since the time of the Milesians in the preceding century. Disease had natural causes, not supernatural ones, and treatment must be rational in order to be scientific and effective.
Health. Earlier thinkers had in fact also concerned themselves with the human body and biological processes. Both Empedocles and Anaxagoras had speculated on the ultimate constituents of flesh and bone, and Alcmaeon of Croton in southern Italy was credited with dissection of an eyeball and discovery of the optic nerve. Even more important was his definition of health as the “equal balance” (isonomia) within the body of such basic qualities as moist and dry, cold and hot, bitter and sweet. The dominance of any one of them, on the other hand, caused illness.
Four Humors. Alcmaeon’s definition was highly influential and productive. While opinions differed widely over which theory of disease to endorse—and even over whether theory was useful at all in a science that was supposed to cure sick individuals, not sickness itself—the Corpus still shows a general agreement on basic issues. One of the most common ideas is that of illness as a kind of disequilibrium that needs to be corrected. Specifically, most Hippocratic writers seem to have viewed health as a balance in the relative quantities of certain natural fluids that were present in the human body. This approach is the basis of the well-known theory of the four “humors” (khumoi) or “juices”: yellow bile, black bile, phlegm, and blood.
Blood. The existence of these fluids seemed to be a matter of simple observation. Blood—all too visible in the case of wounds, hemorrhages, and menstruation—was obviously crucial for life and also played a central role in religious and magical medicine. It was believed that the quantity of blood in the body regularly reached its height during the spring, when venesection or bloodletting would be used to drain off any harmful excess. A vein would be cut, usually in the wrist or ankle but in other parts of the body too, depending on where the physician felt the most blood had accumulated.
In a medical diagnosis of hysteria, from the Hippocratic text Young Girls there is a certain degree to which gender biases lurk behind and also implicitly get support from apparently “objective” scientific study:
Many people choke to death as a result of visions, [especially] virgins who do not take a husband at the appropriate time for marriage, [and who thus] experience these visions... at the time of their first monthly period.... For after their first period the blood collects in the womb in preparation to flow out; but when the mouth of the womb is not opened up, and more blood flows into the womb … then [it] rushes up to the heart and to the lungs. When these are filled with blood, the heart becomes sluggish and then, because of the sluggishness, numb and then, because of the numbness, insanity takes hold of the woman: [then] the girl goes crazy because of the violent inflammation, and becomes murderous, because the blood starts to decay…. In some cases . . . the visions order her to jump up and throw herself into wells and drown, as if this were good for her and served some useful purpose. . . . When this person returns to her right mind, women give various offerings to [the goddess] Artemis, especially very expensive women’s robes. They are deceived, however the fact is that the disorder is cured when nothing impedes the downward flow of blood. My prescription is that when virgins experience this trouble, they should cohabit with a man as quickly as possible. If they become pregnant, they will be cured.
Source: Mary R. Leflkowiz and Maureen B. Fant, eds.. Women’s life in Greece and Rome A Source Book in Translation (Baltimore: Johns Hopkins University Press, 1982).
Biles and Phlegm. Forms of dysentery (an intestinal disorder), on the other hand, which were common in the dry, hot summer months, were often accompanied by high fever and vomiting of bile. This reaction was interpreted as the body’s spontaneous attempt to purge an abnormal abundance of that fluid. Cold, damp winters, by contrast, seemed to favor overproduction of the white, sticky phlegm that caused colds and respiratory ailments. The fourth humor, black bile (melaina khole), was the most mysterious of the group. It was thought to be observable in excrement and sometimes in the dark fluid of vomit, as well as in blackish, dried blood. Its seasonal peak occurred in the autumn months, dry and cold, when black bile brought on prolonged, chronic ailments that were especially difficult to cure, owing to the humor’s thick and malignant character.
Below are opening passages from the Hippocratic text Sacred Disease in which the anonymous author uses the new scalpel of logic to refute religious and magical claims about the causes of epilepsy and the ways to treat it:
I do not believe that the so-called “Sacred disease” is any more divine or sacred than any other disease but, on the Contrary, has specific characteristics and a definite cause. Nevertheless, because it is completely different from other diseases, it has been regarded as a divine visitation by those who … view it with ignorance and astonishment. The claim of divine origin is kept alive by the difficulty of understanding the malady, but destroyed by the simplistic method of healing they adopt, consisting as it does of purifications and incantations…. In my opinion, those who first called this disease “sacred” were the sort of people we now call witch-doctors, faith-healers, charlatans, and quacks. These are exactly the people who pretend to be very pious and to have superior knowledge. Shielding themselves by citing the divine as an excuse for their own perplexity in not knowing what treatment to apply, they held this condition to be sacred so that their ignorance might not be so obvious...
The author gives a list of traditional treatments for epilepsy, both dietary and behavioral, including ritual purifications and a prohibition against touching goats. He is quick to seize on the logical inconsistency of these prescriptions, and to draw them out to their absurd conclusion.
I suppose that none of the inhabitants of inner Libya can possibly be healthy, seeing that they sleep on goat skins and eat goat meat. In fret, they own neither blanket, clothing, nor shoe that is not made of goat skin, because goats are the only animals they have. If contact with or eating of this animal causes and exacerbates the disease while abstinence cures it, then diet alone determines the onset of the disease and its cure. Therefore no god can be blamed and the purifications are useless, and the idea of divine intervention makes no sense…
I believe that this disease is not in the least more divine than any other, but has the same nature as other diseases and a similar cause. Moreover, it can be cured no less than other diseases. . . . Like other diseases it is hereditary. If a phlegmatic child is born from a phlegmatic parent, a bilious child from a bilious parent... why should the children of a father or mother who is afflicted with this disease not suffer similarly? The seed comes from all parts of the body; it is healthy when it comes from healthy parts, diseased when it comes from diseased parts. Another important proof that this disease is no more divine than any other is the fact that the phlegmatic are constitutionally prone to it while the bilious escape. If its origin were divine, all types would be affected to the same degree.
The true cause of epilepsy, the author states with confidence, is an excess of cold, sticky phlegm in the brain. In the following passage, note first the rather vague anatomy of respiration; and second, the dual purpose ascribed to air:
Should the routes for the passage of phlegm from the brain be blocked, the discharge . . . causes loss of voice, choking, foaming at the mouth, clenching of the teeth and convulsive movements of the hands; the eyes are fixed, the patient becomes unconscious…. I will explain the reason for each of these signs. Loss of voice occurs when the phlegm suddenly descends and blocks the vessels so that air can pass neither to the brain nor to the body cavities. For when a man draws in breath through the mouth and nose, the air passes first to the brain, and then the greater part of it goes to the stomach, but some flows into the lungs and blood-vessels. From there it is dispensed throughout the rest of the body by means of the vessels. The air that flows into the stomach cools it, but the air that goes to the lungs and blood-vessels thence enters the body cavities and the brain and has a further purpose. It induces intelligence and is necessary for the movement of the limbs. Therefore, when the vessels are shut off from this supply of air by the accumulation of phlegm . . . the patient loses his voice and his wits. The hands become powerless and move convulsively because the blood can no longer maintain its customary flow. Divergence of the eyes takes place when the smaller blood-vessels supplying them are shut off and no longer provide an air supply; the vessels then pulsate. The froth which appears at the lips comes from the lungs, for when air no longer enters them, they produce froth…
Source: Hippocratic Writings, edited by G. E. R. Lloyd (Hamondsworfv U.K. & New Yorlc Penguin, 1978).
Regional Differences. This apparent link between humors and seasons was further generalized into an elaborate web of regional, climatic, and meteorological links. The Hippocratic text called On the Nature of Man presented the theory in its most systematic form; many other texts assumed it as a basis for their own theorizing. Here the four humors are associated not only with the seasons but also with the four parts of the known world—Europe, Africa, Asia, and Greece—and thus incidentally provided a justification for racial and ethnic stereotyping. The inhabitants of the far north, for instance, dwellers in perpetual winter, tend on the whole to be white, fat, lazy, and mentally slow, because of the abundance of phlegm in their bodies. By contrast, and due to the yellow bile in which their tissues are soaked, Egyptians and Libyans are usually dry and dark, thin and easily agitated southerners. As for the Greeks themselves, they live in by far the best climate and locale in
the whole world, thanks to which their temperament is the most moderate, balanced, and healthiest!
Linkage. These associations provided a structure for still other links. The author of On the Nature of Man assigned to each humor a set of qualities—blood (hot and wet), yellow bile (hot and dry), black bile (cold and dry), phlegm (cold and wet)—and in doing so placed them into line with the quartet of elements (fire, air, earth, and water) proposed by Empedocles as the roots of reality. Over the following centuries, this highly influential theory was further expanded to include four stages of life (childhood, adolescence, adulthood, old age), four times of day, four types of fever, four colors, four flavors, four food groups, and even four emotional temperaments or personality types—sanguine, bilious, melancholy, and phlegmatic. In Christian times, the apostles Matthew, Mark, Luke, and John were also included in the linkages.
G. E. R. Lloyd, ed., Hippocratic Writings (Harmondsworth, U.K. & New York: Penguin, 1978).
Guido Majno, The Healing Hand: Man and Wound in the Ancient World (Cambridge, Mass.: Harvard University Press, 1975).