Читать книгу The Greatest Benefit to Mankind - Roy Porter - Страница 21

By 1000 BC the communities later collectively known as the Greeks were emerging around the Aegean sea, in Ionia (the western seaboard of Asia Minor or Turkey), the Greek mainland (the Peloponnese), and the intervening islands. How much medical knowledge they took from Egypt remains controversial. On Crete, midway between Africa and the Greek mainland, the remarkable Minoan civilization had developed after 2000 BC, with its dazzling pottery and frescos found at Knossos and other palaces; and the Greeks of the Mycenean period (c. 1200 BC) were in close touch with Egypt, certainly getting drugs from there. But the contrasts between old Egyptian and new Greek medicine are striking.

Little is known of Greek medicine before the appearance of written texts in the fifth century BC Archaic Greece undeniably possessed folk healers, including priest healers employing divination and drugs. From early times (Olympic games are recorded from as early as 776 BC), the love of athletics gave rise to instructors in exercise, bathing, massage, gymnastics and diet. Throughout Greek civilization, as with the Roman later, ideals of manliness required keeping one’s physique in peak condition; admiration for the lithe, fit, attractive warrior shines through classical art and myths. Dancing, martial arts and working out in the gymnasium with the help of trainers – men-only practices, women being excluded from public life – were regarded as essential for the well-being of the body. The archaic warrior developed into the beauty-loving citizen of the polis (city state), with his ideal of a cultivated mind in a disciplined body. Athenian sculpture and painting revered the human form, proudly displaying its naked magnificence and finding in its geometrical forms echoes of the fundamental harmonies of nature. A tradition was thus begun that would climax in the Renaissance image of ‘Vitruvian Man’, the representation of the naked male figure inscribed at the centre of the cosmos.

Glimpses of early Greek medicine are offered by the Homeric epics, dating from before 600 BC but incorporating older narratives. Painstaking scholars have counted some 147 cases of battle wounds in the Iliad (that is, 106 spear thrusts, 17 sword slashes, 12 arrow shots and 12 sling shots). Among survivors of arrow wounds was King Menelaus of Sparta, whose physician extracted the arrow, sucked out the blood and applied a salve. As with other medical interventions in Homer, this shows no Egyptian influence, supporting the idea that, even if Greek practice owed much to Egypt, it rapidly went its own way. Certainly Greek medicine as known from written sources is highly distinctive, for from the beginning Greek medical texts were essentially secular.

Admittedly, Greek society at large drew heavily upon sacred healing. In Homer, Apollo appears as the ‘god of healing’ – now the spreader of plague, now the avenger. In the Iliad deities visited plagues upon humans, and Greek myths abound in injuries inflicted by the gods, for instance Prometheus having his liver torn out by an eagle. Various gods and heroes were identified with health and disease, the chief being Asclepius, who even had the power to raise the dead. A heroic warrior and blameless physician, Asclepius was the son of Apollo, sired upon a mortal mother. Taught herbal remedies by Chiron the centaur, he generously used them to heal humans. Incensed at being cheated of death, Hades (Roman: Pluto), the ruler of the underworld, appealed to the supreme god, Zeus, who obligingly dispatched Asclepius with a thunderbolt (though he was later elevated to the ranks of the gods).

A different version appears in Homer, who portrayed Asclepius as a tribal chief and a skilled wound healer, whose sons became physicians and were called Asclepiads, from whom all Asclepian practitioners descended. As the tutelary god of medicine, Asclepius is usually portrayed with a beard, staff and snake (the origin of the caduceus sign of the modern physician, with its two snakes intertwined, double-helix like, on a winged staff; the shedding of the snakes’ skin symbolized the renewal of life). The god was often shown accompanied by his daughters, Hygeia (health or hygiene) and Panacea (cure-all).

Asclepius eventually became a cult figure and the physicians’ patron. Pindar wrote:

They came to him with ulcers the flesh had grown, or their

Limbs mangled with the grey bronze, or bruised

With the stone flung from afar,

Or the body stormed with summer fever, or chill, and he

Released each man and led him

From his individual grief.

During the third century the cult of Asclepius spread, and by 200 BC every large town in Greece had a temple to the god. The best known of these Asclepieions were on the island of Cos, Hippocrates’ birthplace, and at Epidaurus, thirty miles from Athens, but at least 200 other sites have been uncovered; they played a role similar to medieval healing shrines or to Lourdes today. The major shrines sported splendid temples and their cures were celebrated in memorial inscriptions. Pilgrims stayed the night in special incubation chambers where, before an image of Asclepius, they hoped through ‘temple sleep’ to receive a vision in a dream. The god would either perform the cure himself, or would give the patient a dream to be deciphered by the priest. The restored patient usually raised in the precinct a memorial of this marvel: ‘Hermodikes of Lampsakos was paralysed in body. In his sleep he was healed by the god.’ Physicians rarely acted as dream interpreters, but around the temples religious and secular healing rubbed shoulders.

The Greeks also went in for other religious healing, involving exorcists, diviners, shamans and priests. Certain diseases, notably epilepsy, were ascribed to celestial wrath: the Iliad opens with a plague sent by Apollo, and relief from the appalling great plague of Athens (430 – 427 BC) was sought through invoking the gods.

For all that, Hippocratic medicine, the foundation of Greek written medicine, explicitly grounds the art upon a quite different basis: a healing system independent of the supernatural and built upon natural philosophy. The author of the Hippocratic text, On the Sacred Disease (c. 410 BC), utterly rejected the received idea of a divine origin for epilepsy. He sarcastically paraded the different gods supposed to produce epileptic seizures: if the convulsive patient behaved in a goatlike way, or ground his teeth, the cause allegedly lay in Hera, the mother of the gods; Hecate, the goddess of sorcery, was to blame if the sufferer experienced nightmares and delirium; and so forth. But what evidence was there for any of these fantasies? ‘Men regard its nature and cause as divine from ignorance and wonder’, insisted the author, ‘and this notion is kept up by their inability to comprehend it.’ How foolish! For if a condition ‘is reckoned divine because it is wonderful, instead of one there would be many diseases which would be sacred’. Nowhere in the Hippocratic writings is there any hint of disease being caused or cured by the gods.

This scoffing at the ‘sacred disease’ chimed with an elitist ideal of professional identity. Staking their claims in the medical market-place of the polis, Hippocratic doctors scolded traditional healers. Those pretenders ‘who first referred this disease to the gods’, the author complained, were like conjurors and charlatans. Elevating themselves above such dabblers in divination, the Hippocratics posited a natural theory of disease aetiology. On the Sacred Disease plucked disease from the heavens and brought it down to earth. The true doctor would no longer be an intermediary with the gods but the bedside friend of the sick.

This separation of medicine from religion points to another distinctive feature of Greek healing: its openness, a quality characteristic of Greek intellectual activity at large, which it owed to political diversity and cultural pluralism. In the constellation of city states dotting the mainland and the Aegean islands, healing was practised in the public sphere, and interacted with other mental pursuits. There was no imperial Hammurabic Code and, unlike Egypt, no state medical bureaucracy; nor were there examinations or professional qualifications. Those calling themselves doctors (iatroi) had to compete with bone-setters, exorcists, root-cutters, incantatory priests, gymnasts and showmen, exposed to the quips of playwrights and the criticism of philosophers. Medicine was open to all (as later in Rome, slaves sometimes practised medicine).

Doctrinally, too, there was great multiplicity, in complete contrast to what is known of Babylonian or Egyptian medicine, which have left no trace of controversy, being essentially lists of instructions. Greek medical writers loved speculation and argument, doubtless angling for public attention. Trading facts and chopping logic, physicians jousted to unsaddle their rivals.

The ultimate challenge was to fathom the order of the universe, and because this included the human body viewed as a microcosm of the grand order of nature (macrocosm), such metaphysical speculations had direct medical implications. The earliest Ionian philosophers hoped to identify a single elemental substance, but Parmenides of Elea in southern Italy criticized such monocausal theories. A shaman-like figure, Parmenides (c. 515–450 BC) maintained that the key question concerned not material essence but the processes governing change and stability within a regular universe.

Various solutions to the riddle of the cosmos followed. For the geometer Pythagoras (c. 530 BC), living at Croton in Sicily, the key lay in number and harmony – and the dynamic balance of contraries, based on the opposition of odd and even. For Heraclitus (c. 540–475 BC) the true constant was change itself, in a macrocosm composed of fire and water; for Democritus (c. 460 BC), the essence was a flux of atoms in a void.

Others, like the Sicilian Empedocles (fl. mid-5th century BC), regarded nature as composed of a small number of basic elements (earth, air, fire, and water) combining into temporarily stable mixtures. Building on Parmenides, Empedocles seems to have been the first to advance some of the key physiological doctrines in Greek medicine. These involve the concept of innate heat as the source of living processes, including digestion; the cooling function of breathing; and the notion that the liver makes the blood that nourishes the tissues.

His contemporary, Alcmaeon of Croton (fl. 470 BC), believed that the brain, not the heart, was the chief organ of sensation. This had a real observational basis: examination of the eyeball led him to discern the optic nerve leading into the skull. He gave similar explanations for the sensations of hearing and smelling, because the ear and nostrils suggested passages leading to the brain.

Discounting the role of demons in disease, Alcmaeon treated health in a rather Pythagorean way as the dance of primary pairs of bodily powers – hot and cold, sweet and sour, wet and dry. Seated in the blood, marrow or brain, illness could arise from an external cause or an internal imbalance, caused by too much or too little nutriment. Similar views can be found in several texts in the Hippocratic Corpus (440–340 BC), though no direct influence can be proved. Indeed, all these early writers are obscure, for their opinions survive only through later commentators and critics, such as Plato, who used them for their own polemical purposes.

What is clear is that in classical Greece philosophical speculations about nature became enmeshed in dialogue with medical beliefs about sickness and health; dialogue and debate were integral to Greek intellectual life. Unlike healing in the Near East, elite Greek medicine was not a closed priestly system: it was open to varied influences and accessible to outsiders, guaranteeing its flexibility and vitality.

This openness followed from the fact that Greek civilization developed in multiple centres from Asia Minor to Sicily, and no single sect of doctors possessed a state or professional monopoly. Athens was the first city to support a fair number of full-time healers making a livelihood out of fees, and, according to his younger contemporary Plato (427–347 BC), the great Hippocrates taught all who were prepared to pay.