124 B.C.: The Methodist school of medicine

Over time a third school, or sect, of medicine evolved that gained popularity in ancient Greece and Rome and had a significant affect on the remedies provided to patients. In fact, it was by following the opinions of this school that helped one famous physicians convince the Romans to accept Greek medicine, an import event allowing medicine to advance forward through time.

Like Empiricism, Methodism was a school, or sect, that evolved out of the skeptics of ancient Greece, this time through the works of Anaxagoras of Clazamenae (500-428 B.C.), Archelaos of Athens (born about 500 B.C.), Democritus (460-370 B.C.), and Zeno (490-430 B.C.).

The motto of this school went something like this:

A pathological theory we must have, but let it be simple."  (8, page xiv)

It is believed to be started with Anaxagoras of Clazomenae (50-428 B.C.), who preached that there was a distinction between mind and body. (5, page 15)

It also might have started with Parmenides of Elea (born about 540 B.C.?), who...

...argued that it is impossible for there to be change without something coming from nothing. Since the idea that something could come from nothing was generally agreed to be impossible, Parmenides argued that change is merely illusory. (10)

Archelaos of Athens (born about 500 B.C.?) was a pupil of Anaxagoras who added to his master's ideas the "fundamental principle of air."  Diogenes of Apollonia (lived around 420 B.C.?) made "air endowed with reason the origin of bodily and mental life. "  (9, page 110)

Zeno of Elea was not as purely skeptical as Pyrrho was.  Historian Norman Maccoll said, in his 1868 book, that Zeno "was in reality a dogmatist, and sceptical only to the overthrow of what opposed his own speculations." (11, page 17)

While none of Zeno's writings has survived, he is credited with writing what have become known as Zeno's paradoxes.  While none of his original paradoxes have survived, passages from other authors are thought to be direct quotations from them.  (12, page 6)

Zeno, of whom little is known, was a disciple of Parmenides (born 515 B.C.?), who "maintained that reality is one, immutable, and unchanging; all plurality, change, and motion are mere illusions of the senses," said Wesley C. Salmon, editor of the 1970 book "Zeno's Paradoxes." (12, page 6)

Salmon said "Zeno, according to Plato's testimony, propounded a series of arguments designed to show the absurdity of the views of those who made fun of Parmenides.  Zeno was not a "skeptic who denied the possibility of all knowledge." (12, page 6)

Around 450 B.C., Democritus (460-370 B.C.), who was a contemporary, although about 40 or 50 years younger, of Anaxagoras, "acknowledged the distinction, and describing both mind and body as composed of atoms or corpuscles, differing only in their nature and arrangement." (5, page 15)(9, page 109) (10)

Because he believed the body was composed of atoms he was referred to as an atomist.  The school that ultimately formed based on his ideas was called the atomist school, although later scholars referred to it as the methodist school.

Still others referred to it as the solidist school because of the belief that diseases were formed by the solid living forms of the body as compared to fluids or humors of Hippocrates.  .

The teacher of Democritus was Leucippus, and very little is known of him. It is believed that Democritus reorganized his teachers works, and then formed the anatomist theory. 10)

Sylvia Berryman, who wrote about Democritus in the 2010 Stanford Encyclopedia of Philosophy, said:

Ancient sources describe atoms  as one of a number of attempts by early Greek natural philosophers to respond to the challenge offered by Parmenides... In response, Leucippus and Democritus, along with other Presocratic pluralists such as Empedocles and Anaxagoras, developed systems that made change possible by showing that it does not require that something should come to be from nothing. These responses to Parmenides suppose that there are multiple unchanging material principles, which persist and merely rearrange themselves to form the changing world of appearances. In the atomist version, these unchanging material principles are indivisible particles, the atoms: the atomists are said to have taken the idea that there is a lower limit to divisibility to answer Zeno's paradoxes about the impossibility of traversing infinitely divisible magnitudes. (10)

Berryman explained that Democritus wrote about a world that was composed of atoms and voids.  The atoms were of varying sizes and shapes, and they were perfectly solid and, aside from changing location, were unchangeable or indestructible. Each atom also had a hook to allow it to attach to other atoms.

The atoms moved about in the void, often colliding with one another, and often becoming attached by their hooks to form clusters of varying shapes, sizes and colors that were the various objects (kosmoi)of the world, such as humans, animals, and trees. (10)

After a period of time the atoms relocate, change location through the voids, and attach to other atoms to form new kosmoi.  This process is ongoing for eternity. (10) 

Zeno of Elea collected the works of Democritus, along with the works of Anaxagoras, Parmenides, Plato, and Socrates, "which countenanced his distrust of sense knowledge." said Maccoll (11, pages 34-35)

Many of the principles of the school were established by Cleophantus of Alexandria and taught to his followers in creating a new school.  One of his students was Asclepiades. (3, page 92)

In the first century A.D. Asclepiades was an Atomist who made many "innovations" to this school, although he was originally considered a rationalist. (3, page 110)

He ultimately opposed the Hippocratic doctrines, supported the atomist hypothesis of Democritus, and added to it the the doctrine of "Strictum et Laxum" which states that disease is caused by excessive relaxation and tension of its solid particles, hence the term "solidism".  The school became known as the solidist school of medicine.  (7, page 73)

The desciple of Asclepiades was Themison of Laodicea.  Both of these physicians are often credited with forming the Methodist School of Medicine, which competed with the rational and empirical schools of medicine. (5, page 39-40)

Unlike the rationalists, they didn't try to find causes of disease. Unlike the empiricals, they didn't try to treat diseases based on their symptoms. Instead, "Themison declared that the physician should observe what symptoms various diseases have in common. He would then find that in all, or nearly all cases, there was an increase or dimunition of the secretions and extretions, and adapting this to the theory of Asclepiades, Themison argued that all diseases were due to a relaxation or a constriction of the 'pores.'" (2, page 85-6)

However, like the rationalist they believed "that the physician might reason from the seen to the unseen, e.g., from the state of the secretions to that of the pores."  From the empirics they "taught that diseases are to be judged from their symptoms, and not from their causes." They also agreed with the emperics that knowledge of anatomy irrelevent to treating diseases, "though it might be useful to know the names of the parts."  (2, page 86)

So the location of the disease was not important.  What organ caused a disease was not important.  The reason is that they considered a disease to be a general ailment of the body.  The cause wasn't important either, because they all either cause relaxation or constriction.  In other words, they believed that "constriction and relaxation are the same wherever they occur and require the same treatment." (2, page 86)

Medical historian John Brock describes it this way:

They held that molecular groups constituting the tissues were traversed by minute channels (pores); all diseases belonged to one or other of two classes; if the channels were constricted the disease was one of stasis, and if they were dilated the disease was one of flux. Flux and stasis were indicated respectively by increase and diminution of the natural secretions; treatment was the opposite by opposites -- of stasis by methods causing dilation of the channels, and conversely. (8, page xiv-xv)

Followers of this school treated diseases based on what was in the past effective in treating that disease, as opposed to treating patients based on speculation and superstition. "Their remedies were naturally divided into relaxants and astringents... They inculcated the use of gymnastic exercises, not only as remedial agents, but also as a means of counteracting the bad effects of increasing luxury and indolence." (5, page 41)

Astringent remedies used were "cold air and water, vinegar, decoctions of various herbs, especially the plantain, and the minerals, alum, lead and chalk, which were used externally.  The laxitive remdedy used most often was bleeding by venesection, cupping or leeches.  They did not use purgatives.  (2, page 86)

Their remedies tended to be gentler than dogmatic remedies, and perhaps for this is the reason Asclepiades was successful changing the Roman opinion of Greek medicine.

According to Brock "the vice of the Methodist teaching was that it looked on a disease too much as something fixed and finite, an independent entity, to be considered entirely apart from its particular setting."

Regardless of it's flaws, this school provided another option for physicians to follow and learn from, and some of the knowledge obtained later benefited the medical community in general.

References:

1. "Rationalism (philosophy), Encyclopedia Britannica.com, http://www.britannica.com/EBchecked/topic/492034/rationalism
2. Withington, Edward Theodore, "Medical History from the Earliest Times," 1894, London 
3. Watson, John, "Medical Profession in Ancient Times," 1856, New York, Baker and Godwin 
4. Magill, Frank N., editor, "Dictionary of World Biography," Volume I: The Ancient World, 1998, Salem Press Inc., California 
5. Meryon, Edward, "History of Medicine: comprising a narrative of its progress from the earliest ages to the present and of the delusions incidental to its advance from empericism to the dignity of a science," volume I, London, 1861, 
6. Adams, Charles, Kendall, editor, "Johnson's Universal Cyclopedia: A new edition," volume V, A. Johnson Company, New York, 1894 
7. Garrison, Fielding Hudson, "An introduction to the history of medicine: with medical chronology, Bibliographic data and test questions," 1913, Philadelphia and London, W.B. Saunders company 
8. Brock, John, "Galen on the natural faculties," 1916, London, New York, William Heinemann, G.P. Putnam's Sons
9. Neuburger, Max, writer, "History of Medicine," 1910, translated by Ernest Playfair, Volume I, London, Oxford University Press
10. Berryman, Sylvia, "Democritus," from the book "The Stanford Encyclopedia of Philosophy," http://plato.stanford.edu/entries/democritus/, 2010, accessed 12/22/13
11. Maccoll, Norman, "The Greek Skeptics from Pyrrho to Sextus: An Essay which obtained the Hare Prize in the Year 1868," 1868, London and Cambridge, Macmillan and Co.
12. Wesley C. Salmon, editor and author of Introduction,  "Zeno's Paradoxes," edited by Wesley C. Salmon, 1970, Bobbs-Merrill Company, Inc. 

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106-48 B.C.: Greek medicine migrates to Rome

In order for the medical ideas of Greece to stand the test of time, this "key of medicine" would have to make it's way to other cultures.  This is exactly what happened through the course of many years as Grecian medicine migrated to ancient Rome.

Although they didn't know it at the time, the Latins had picked the perfect spot to build their village.  It was one of many built around the seven hills along the Tiber River in the Italian Peninsula somewhere around 750 B.C.  (1, page 112)

It was in the lowland, as compared with other Italian villages.  While close to the sea it was built on a mountain side "where there was lava flow with a dominant position over the sea and the river Sarno."  (2)

Due to its volcanic origins, the "soil is naturally rich in water springs and minerals.  The hills were made of tufa rock, "a soft hardened rocky sponge," which the Romans were later able to use to make large buildings and monuments.  (2) The village grew into a city.

At first the Romans were peaceful farmers and herders, but around 600 B.C. the Etruscans from up north along the Tiber decided to conquer the other villages.  For the next 100 years Rome was ruled by the Etruscans.  In 509 B.C. the people of Rome rebelled and set up what became the world's first republic. (1, page 112)

The people of Rome didn't forget what had happened, and they continued to build a mighty military. Many of the people became skilled soldiers, and they decided to fight for more land.  By 270 B.C. they took over the entire Italian Peninsula, and then after 23 years of Punic wars, in 146 B.C., the Romans conquered the city of Carthage along the north coast of Africa, where the Phoenicians settled. (1, 113-114)

There were three wars with Carthage, called the Punic wars, and in the second one, Macedonia, the strongest city-state in Greece at that time, decided to help Carthage.  Romans didn't forget this either, and when Carthage was defeated, the Romans conquered Greece and took many Grecians back to Rome.

Of course many of these people were philosophers and physicians, and thus Rome was introduced to Greek adaptations to these arts. (1, page 114-15) As the Roman Empire spread, so to did Grecian culture.

Grecians taken to Rome became Roman slaves, and many were better educated than their new Roman masters.  So it "became customary for the well-to-do to select for the child's nurse a Greek slave, that a child might acquire the Greek language as naturally as its own," according to historian Harold Johnston.  (7, page 71)

Johnston explains that: (7, page 78)

The Greek language came to be generally learned and Greek ideas of education were in some degree adopted. Schools were established in which the central thing was the study of the Greek poets, and these schools we may call Grammar Schools because the teacher was called grammaticus. Homer was long the universal text-book, and students were not only taught the language, but were instructed in the matters of geography, mythology, antiquities, history, and ethics suggested by the portions of the text which they read. The range of instruction and its value depended entirely upon the teacher, as does such instruction to-day, but it was at best fragmentary and disconnected. There was no systematic study of any of these subjects, not even of history, despite its interest and practical value to a world-ranging people like the Romans.

Of course we must understand that after doing battle against many Greeks during the Punic wars, a prejudice developed among the Romans regarding Greek culture. This might explain Pliney the Elder's statement that Rome "got along for 600 years without physicians." (5, page 72)

He said that while knowing full well Rome had physicians, as he later contradicted himself by claiming the first physician came to Rome in 535 B.C. (3, page 81)

This prejudice might also explain why the Greeks were often disparagingly referred to as "graeculus esuriens of Juvenal," which means "hungry young Greek"  (5, page 72)

We must also understand that the Romans, as might be expected, had their own gods that they believed were responsible for health and sickness.  They had incantations and prayers they'd been using for hundreds of years.  They also saw Greek remedies as harsh, and the fact Greeks kept snakes in their "private houses in pursuance of the esculpian cult, did little to make medicine respectable in the eyes of the austere Romans." (5, page 97).

But the medical profession of Rome had it's problems. For one thing, the medicine was primitive in nature, and based mainly on incantations and prayers.  In describing the flaws of the Roman medical system of the time, Bradford quotes medical historian Pierre-Victor Renouard:

In the midst of this overflowing of charlatanism, the health of the citizens was given over to the first imposter who called himself a doctor; for how could the cheat and usurper of the title be distinguished from the man of knowledge and probity, who had acquired it by study? No examination, no legal proof was imposed on any one who wished to practice medicine; there was no security for the sick.''

These weaknesses may have left the door open ever so slightly to the curiosities of some of those who yearned for a remedy that Roman physicians were not providing. Regardless, as Grecian physicians and teachers migrated to Rome, they did so with little encouragement from the Romans. (4, page 96)

Yet as what usually happens, time heals all wounds.  When a person is really sick, when he realizes that incantations and prayers don't heal pain and suffering, he becomes eager to accept new ideas.  And it must have been in this way the Romans were gradually exposed to Grecian medicine, and slowly grew to respect and gain confidence in Grecian physicians.  (4, page 96)

One of the best ways to change the mindset of a people is to impress the king. Even kings are human, and even kings get sick. And kings have the ability to change the mindset of a nation. And it must have been in this way Caesar was exposed to the benefits of Grecian medicine, because in his travels he started taking physicians with him.(4, page 97)

Perhaps it was for this reason that Roman philosopher and orator Cicero (106-43 B.C.) "declared the duty of all men -- a duty particularly incumbant of himself -- to support the dignity of the healing art." (4, pages 96-97)

A Greek physician named Archagathus was among the first to escape the wars of Greece by emigrating to Rome.  When he was born no one knows, although what is known is he was born in Sparta and was later adapted by the Romans, becoming a Roman citizen in the year 219 B.C., around the time that Ptolomy Philopater in Egypt.  He was among the first physicians to emigrate to Rome.

Historian Thomas Lindsley Bradford, in his 1898 book "Quiz questions on the history of medicine," discussed the influence of Archagathus the Executioner upon Greek medicine.

He was the first of all the Greeks who attempted to introduce their kind of physic (medicine) into Italy. At first his coming was very agreeable to them, and many marked distinctions were paid him, but when he came to the cutting and burning part they changed their opinion, and conceived such an aversion to him that he was compelled to leave the city. He was called executioner on account of the too frequent use of the actual cautery and the knife. He was also called Vulnarius and Carnifex. He was honored by the Senate." (8, pages 27-28)

Bradford must have obtained much of his wisdom about Archagathus from the writings of Pliny the Elder, who wrote about 150 years later:

He obtained Roman citizenship and was extraordinarily popular on his arrival, but very soon, gained the nickname of the "executioner." (9)

Greek physicians ultimately did gain the respect and confidence of the Roman people, and the man given credit for this was Asclepiades of Bithynia.  He was born in Rome at the time of Pompey in 106 B.C., and then was educated at the school of Alexandria and practiced in Athens before moving back to Rome.  (4, page 99-101)  Despite his name, Asclepiades has no ties with the Asclepiade temples that rose in Ancient Greece and Rome. (8, page 28)

His opinions and remedies were based on the Atomist philosophy of medicine devised by Democritus, and were the opposite of the Hippocratic doctrine.  Since he believed in a different hypothesis as Hippocrates, he also had different remedies which included fresh air, light diet, hydrotherapy, massage, clysters, local application of some external medicines, and sparing use of internal medicine.  (5, page 72)(8, page 28-29)

This new medical philosophy, coupled by his "good bedside manner," made Asclepiades a very popular physician in Rome.  He was so well accepted that after his death other physicians took on his name hoping to take advantage of his fame.  (6, page 83)

Asclepiades basically believed Romans had a negative view of Greek medicine because their dogmatic remedies appeared to make a patient worse before he got better.  He believed it was perceived as a "crude and unfeeling practice."  He took advantage of this and smoothed out the edges by not using medicine that "offended the stomach" and using hygienic remedies instead.  His techniques were so well accepted he became famous and wealthy.  He wrote a book on General Remedies, and started the first school of medicine in Rome. (4, page 99)

Bradford said that:

He does not seem to have followed any course of medical study, but owing to his fashion of catering to the patient and avoiding everything that was painful and disagreeable, he soon gained a large practice.  He eschewed emetic and purgatives, though he practiced blood-letting.  He also relinquished the religious ceremonies which had held so large a place in medical practice...  His treatment was mainly dietetic and hygienic.  He advocated exercise, bathing, music, and even declamation as a means of curing disease." (8, pages 28-29)

He was revered by some as the greatest physician ever, aside from Hippocrates. Others claimed he was no more than a philosopher and charlatan. Even Galen "charged him with many absurdities, and with having but little knowledge of the great fathers of the profession, whom he affected to ridicule." (4, page 98)

Yet Caesar liked him and approve of his work, and that may have been all that was needed.  Asclepiades died in 48 B.C. "and is said to have been killed by a fall from a ladder in his extreme old age." (4, page 101)

So perhaps more so than the physicians themselves, it was a combination of both the politics, philosophy and public relations of the physicians, coupled with the approval of various emperors, who improved respect and confidence in Grecian medicine.  It is because of them Grecian medicine survived the test of time.

As John Watson said: (4, pages 97-98)

Caesar, after reaching the summit of his power, in order to attract men of science to the capital, and to improve the condition of those already there, decreed that all who practiced physic at Rome, and all the masters of the liberal arts therin residing, should enjoy the privilege of citizenship.  And Augustus, after having been relieved of a dangerous illness by his freedman, Antonius Musa, loaded this physician with wealth; raised him, by consent of the Senate, to the equestian rank; erected a bronze statue to his honor near that of Aeslepius; and, at his instigation, conferred important privileges on the whole body of the profession then residing in the city... These privileges afterwords confirmed by... later emperors." (4, pages 97-98)

Of Roman medicine, Bradford said:

Before the consolidation of the Roman empire in 31 B.C. there were no established medical laws.  The Greek system of training seems to have been in vogue.  Everyone who was liberally educated was instructed in philosophy of medicine. which explains why all the philosophers of the old days were also to some extent teachers of medicine. But the physician was expected, in common with his medical knowledge, to be familiar with the grammar of his own language, with rhetoric, arithmetic, geometry, dialectics, moral philosophy, astronomy, and even architecture. (8, page 53)

The benefactors of all this education were, of course, all those who became sick or injured. It was in this way that Greek medicine, the key to medicine, migrated from Greece to Rome, and perhaps was saved.

References:

1. Suter, Joanne, "Fearon's World History," 1994
2. "Ancient Rome Geography,"  mariamilani.com, http://www.mariamilani.com/ancient_rome/Ancient%20Rome%20Geography_.htm
3. Watson, John, "The Medical Profession in Anciet Times: an anniversary discourse delivered before the New York Accademy of Medicine November 7, 1855, New York, Baker and Godwin
4. Watson, ibid, pages 97-98, in reference to Seutonius, Octav, August, cap. lix.
5. Garrison, Fielding Hudson, "An introduction to the history of medicine: with medical chronology, Bibliographic data and test questions," 1913, Philadelphia and London, W.B. Saunders company
6. Withington, Edward, "Medical history from the earliest times: a popular history of the healing art," 1994, London
7. Johnston, Harold, "The Private Life of the Romans," 1908
8. Bradford, Thomas Lindsley, writer, Robert Ray Roth, editor, “Quiz questions on the history of medicine from the lectures of Thomas Lindley Bradford M.D.,” 1898, Philadelphia, Hohn Joseph McVey
9. Pliney the Elder, "Natural History,

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