Ancient Roman Medicine

Plato, Aristotle,

and Galen of Pergamum

 Recap of Key Issues from Ancient Greek Medicine

n    Belief in rational explanations for health and illness

n    Concept of four humors and balance/imbalance of humors as source of health/illness

n    Treatment tailored to individuals: prognosis and diagnosis; diet and regimen, only drugs as last resort

End of Greek Golden Age

n     404 BCE Defeat of Athens by Sparta during Peloponnesian War

n     Rise of Hellenistic (“Greekish”) Culture in Egypt, Italy, India, Mespotamia, parts of France through empire of Alexander the Great  (reign 336-323 BCE) of Macedonia

n     Ptolemy (323-282 BCE) – made Alexandria, Egypt, center of learning (library and museum)

Influential Philosophers of Medicine: Plato and Aristotle 

n    Plato (428-347 BCE)

n    see “Timaeus” in Rothman

n    Aristotle (384-322 BCE)

n    “On the Generation of Animals” in Rothman

Plato: Theories of the Body

n    Tripartite human soul

n    Reasoning Soul    (brain)

n    Spirited Soul        (heart)

n    Appetitive Soul     (liver)

n    Parts of body created out of 4 elements (earth, air, fire, water) by Demiurge (creator of Universe)

Plato, continued

n      Disease = excess or deficiency of these 4 elements—or decomposition of bodily part into its original elements

n      The soul is directly affected by bodily changes:

n     Moisture in bone marrow produces sexual intemperance

n     Phlegm and bile produce bad temper, cowardice, stupidity

n      Because the body and the mind are inextricably linked, the physical healer and the philosopher must work together to produce health

Aristotle   

n     Doctor’s son whose systems of logic became the basis of scientific and medical thought through Middle Ages

n     Empirical studies of the natural world, including dissections of animals: scientific method

n     Writings on psychology (“On the Soul”), drama, highly influential and a continuing basis for literary theory

Aristotle’s anatomy studies

n    Teleology  (logic of ends: purpose determines structure)

n    Nature does nothing in vain

n    Specific anatomical arguments:

n   Three-chambered heart (formerly believed 2)

n   Heart is sole seat of soul and emotions (not the brain, as Hippocrates argued—see “The Sacred Disease” 143)

Other key developments: 

n    Hellenistic Alexandria: anatomy and physiology

n    Human dissections

n    Egyptians did not have taboos against mutilating body of dead (Greeks did)

n    Greek invaders of Egypt may have dissected slaves and criminals

Anatomical Discoveries    

n    Structure of eye, liver, reproductive organs, brain

Rome: Overview of Medical Culture

n    Doctors were outsiders, non-citizens, sometimes slaves

n    Roman hospitals restricted to slaves and soldiers

n    Poor people were likely to go to healing shrines (divine recourse as they had no access to doctors)

Methods of Treating Illness

n    Same as in Greece: diet, exercise, drug therapies only as a last resort and surgery (though they knew how to perform a wide range of surgical procedures) as a VERY last resort

Galen of Pergamum (129-216
CE)

n    Central figure in the development of Western medical tradition (physician, not philosopher per se)

n    Highly influential on later generations

n    Transmitter (and screener) of most of our information on early medicine

n    Prolific writer himself

Galen - 2

n     Born in what is now Turkey to wealthy architect and farmer who dreamed of Asclepius and decided his son must be a doctor

n     Learned of Hippocratic tradition of medicine; studied in Alexandria (10 years! Longest medical education on record?)

n     Moved to Rome in 162 and became renowned physician

Galen - 3

n    Philosophy of Medicine:

n    Like Aristotle, teleology (see “The Hand”)

n    Believed in tripartite soul (and used anatomical discoveries to support this)

n    Believed cooperation of patient was essential in treatment of illness

n    Good doctor = philosopher as well

n    Unity of reason and experience makes good medicine

Galen - 4

n    Galen’s dissections of animals formed basis of his conclusions about human anatomy

n    Sometimes wrong!

n    Galen also believed in observation:

n    Palpation

n    Pulse-taking (wrote whole treatise on it)

n    Urine

Galen – 5

n    Heart and Blood: 

n    Two types of blood:

n   “nutritive” blood

n    Made by liver and carried through veins to organs, where it was consumed

n   “vital” blood

n    Made by the heart and carried by arteries to convey “vital spirits”

n    Heart did not pump but suck (concept persisted until Harvey in 17^th century)

Galen’s other key contribution

n     Transmission of ideas about Hippocrates and Hippocratic Corpus

n     Galen can be said to have “created” Hippocrates as a unified source

n     While we know that the Hippocratic Corpus was multiple-authored, and that the Hippocratic Oath was probably not written by any of them, the tradition of Hippocrates as core of Western medical tradition continues, with Galen largely responsible.

Thinking Back:

n    Increasing knowledge about the anatomy of animals, generalizable to humans, made it possible to think systematically about health and illness, and the emphasis on philosophy of medicine in the Hellenistic world encouraged this.

What about the gods?

n    As we see in Philoctetes, and will see in Boccaccio, the rise of new philosophies of medicine coexisted with other kinds of beliefs about the causes (including supernatural ones) for illness and misfortune, AS THEY DO IN OUR OWN TIME.

How are the Ancients different from us? 

n     At the same time, the philosophy of medicine could dominate because doctors and scientists’ knowledge of human anatomy and bodily functioning remained partial

n    i.e. Aristotle’s theory of the female as inverted male.

n    Galen’s theories held sway until experimentation AND transformation of cultural climate made change possible

Effects of combining philosophy and physiology

n    There are many! But I want you to think about three:

n    Desire to create theories that work at all levels from the universe to the society to the individual.

n    Support for an integration of body and mind/spirit.

n    Support as well for metaphorical thinking about illness.

Key issues and names:

n      Plato, Aristotle, and Galen

n      Medicine and Philosophy

n      Teleology

n      Tripartite Soul (and other philosophies of anatomy)

n      Dissection and Observation

n      Reason and Experience

n      Universe-society-individual

n      Mind-body and metaphor