50-200 A.D. The four schools of medicine

By 50 A.D., or about the time of the Roman invasion of Britain in 55-60 A.D., the Dogmatic School had competition from other schools originating in ancient Greece:

1. Rationalism/ Humoralism/ Dogmatism:  They basically followed the ideas of Hippocrates.  They attempted to rationalize diseases and made up theories to explain them.  Their main theory was that health was maintained by a balance of the four elements of Empedocles (fire, earth, air and water) and the four humors of Hippocrates (blood, phlegm, yellow bile, black bile). They basically believed diseases were caused by disturbances in the liquids of the body. 
2. Empiricism: They came to conclusions about disease based on their own experiences.  
3. Methodism/ Solidism/ Atomism: They believed diseases were caused by the arrest of molecules through invisible pores. They believed diseases were caused by disturbances in the solids of the body. 
4. Pneumatism: This was sort of an offshoot of Dogmatism where they believed a pneuma or spirit in the inspired air was responsible for maintaining a balance of the four elements and humors. They believed diseases were caused by disturbances in the gases of the body.

During the course of the first and second centuries, Roman physicians had problems with the basic tenets of Greek medicine, mainly that its remedies (bleeding, cupping, friction, and purging) for internal ailments were too harsh for their patients.  Or, worded another way, their patients preferred the prayers and magic offered by religion and mythology, as compared with the poisons and knives of Greek physicians.  

So Roman physicians were known to take the best ideas of the four Greek schools, becoming known as "free lances."  They became known as eclectics.  (1, page 98)

Now, was this a fifth school of medicine called the School of Eclectics?  Some experts would debate that it was.  Others, however, believe it was simply a term used to describe "any physician who deviated from the strict interpretation of the doctrine of the School to which he was supposed to belong and accepted some tenets from another." (4, page  170)

Agathinus of Sparta (50-100 A.D.) was a pupil of Athenaeus of Attaleia, who established the Pneumatic School of Medicine.  While a pneumatist at heart, he liked some of the ideas of Methodism and Empiricism. For this reason, he often referred to himself as an episynthetic, which was basically another term for eclectic.  (3, page 159)

Or, was this a fifth school of medicine called the Episynthetic School of Medicine?  Some experts would debate that it was a formal school.  Others would go as far as to suggest that Episynthetic and Eclectic were two separate schools that formed in the first two centuries.  (4, page 170)

Prioreschi said the basic tenets of the Pneumatic and Eclectic Schools were close, and wondered if the later might have been an "off-shoot" of the former, especially considering Agathinus considered himself an episynthetic, and that some referred to his pupil, Archegenes, as an eclectic.  Some say eclectic was basically a term used to describe a Pneumatist who accepted ideas of Methodism and Empiricism.

Regardless, an eclectic physician came to be one who adapted the best ideas of all four schools of medical thought.  He probably considered himself a member of one of the four Greek schools.  Although he was, as were most Roman physicians, an eclectic at heart.  Examples here include Celcus, Antyllus, Aretaeus of Cappadocia and, of course, Claudius Galen. These are all physicians whose practices, as you will soon see, would have an impact on our asthma history. (1, page 98)(2, page 111):

Now, you might be saying, who cares about the schools of medicine?  However, it is important, because our goal by writing this history is to learn how asthma would be treated in ancient Rome.  And, how your illness was treated totally depended on which one of these schools your physician belonged, and which tenets of the others he purported to believe.

The four Greek schools held the keys to all medical wisdom, and Roman physicians knew this.  Yet to appease their patients, they adapted the best tenets of Greek medicine and became eclectics.

References:

1. 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
2. Algra, Keimpe, Jonathon Barnes, Jaap Mansfeld, Maldolm Scholfield, editors, "The Cambridge History of Hellenistic Philosophy," 2002, Cambridge University Press
3. Prioreschi, Plinio, "A History of Medicine," volume III "Roman Medicine," 2001, NE, Horatius Press
4. "Agathinus, Claudius," encyclopedia.com, http://www.encyclopedia.com/doc/1G2-2830900054.html, accessed 6/24/14

225 - 200 B.C. Dogmatism is challenged

Even while the dogmatic school of medicine (rational medicine) was being formed at the school of Cos by Hippocratic writers, so too was forming the emperical school of medicine at the school of Cnidos, about 20 miles away. (1, page 29)

In other words: "By the side of dogmatic philosophies Skepticism slowly arose," said Norman Maccoll in 1868.  (6, page 10, 18-19).

What is skepticism?  It is a branch of ancient Greek philosophy thought to have been created by Pyrrho.  Who was he?

Pyrrho lived lived 360-270 B.C., and was among the first of the skeptics, or philosophers who doubted that all wisdom could be learned.  (Skeptic comes from the ancient Greek term "skepsis," which, according to Meriam-Webster, means examination or doubt).

He is often considered as the father of skepticism. His followers were called Pyrrhoneans.  His philosophy was called Pyrrhonism, his school called the Pyrrhonean School. (6, page 13)

However, as was normal for the ancient world, many believe ideas contributed to him arose prior to his lifetime and were merely attributed to him later on.  (6, page 13)

Of his disciples or pupils, Maccoll said the one most important to historians of philosophy was Timon, who lived from 320-230 B.C.  While Pyrrho is known to have written only one poem addressed to Alexander, Timon wrote voluminously. Therefore, it "was through him that Pyrrho's doctrine became first generally known." (6, page 27, 28, 30)

Maccoll wrote that it was Timon who said that a philosopher should ask the following questions:

1. How are things constituted?  Our conclusions should not come from our opinions or senses because answers derived from them are neither true nor false.  Answers must be derived from empirical evidence. (6, page 21, 22)
2. In what relation should we stand to them?  We cannot form opinions on things that are beyond our knowledge.  In other words, "We cannot distinguish the false from the true, for both to the senses and the reason all things are alike: they possess no criterion of truth: we must not hazard those decided judgments, in which the dogmatist indulges: we must incline neither to the right hand nor to the left: we must remain unmoved." (6, page 21, 22)
3. What will result to us from our relation to them? "What effect on our happiness will our attitude to Things have ? This attitude has already been determined to be suspension of judgment. If therefore we are to make a rule of abstaining from all judgments, our happiness must be dependent on this abstinence, and consist in regarding everything external with undisturbed tranquillity of mind; for there is no certainty with regard to what is external, and, where there is no certainty, there can be no happiness. The soul must retire upon itself, looking upon all outside itself as indifferent, and striving to become neither the slave nor the mistress of circumstances, but separate from, and independent of, them." (6, page 21, 23)

Of this third question, Maccoll said: 

The answer to the third question shows the aim of Pyrrho's doubt: like all his contemporaries he searched for a summum bonum: he was not a sceptic in the modern sense of the word : he doubted because doubt appeared to give him the most secure promise of happiness. (6, page 24)

Of the three questions, Maccoll said:

They relate of course to the old points: " Is knowledge absolutely relative ? Is there any objective truth ? Can we have any knowledge of Things as they are in themselves ?" (6, page 31)

The quest of Pyrrhonism was to find the summum bonum, or the highest good. In this regard, Pyrrhoneans were considered eudaemonistic (eudaemonism), which, according to Merriam-Webster, was a theory that the highest goal is happiness and personal well being. (6, pages 8-9,24)

Skepticism died out after the death of Timon, only to be re-established by later philosophers.  (6, page 69)

However, it was from the skeptics, or Pyrrhoneans, that arose the empirical school.  It was the empirics who would ultimately counter dogmatism.  

Empiricism arose through the wisdom of the following triad:  (1, page 29) (3, page 68)(4, page 91)

• Herophilus:  He lived 325-280 B.C., and came up with many of the theories followed by the the empirical school of medicine
• Philinus: He was a pupil of Herophilus around 250 B.C., and started the empiric school of medicine
• Serapion: He was successor of Philinus around 225 B.C., and supported empiricism

This Empirical School of Medicine was basically established to counter the "extravagances" of the Dogmatic School of Medicine at the School of Cos.  (3, page 69)

A common saying of the empiracist was:

"It is not the cause but the cure of disease that concerns us; not how we digest, but what is digestible." (5, page xiii)

The major differences between these schools were as follows:  (1, page 29)(3, page 69) (4, page 68-9)

Dogmatists/ Rationalists/ Hippocratic Dogmatic School of Medicine	Empiricists/ Emperics Empirical School of Medicine
Supported ideas of the physician Hippocrates	Supported ideas of the philosopher Pyrrho
Were in search for causes of disease	Were not concerned with causes.  A person was ill is all they needed to know
Speculated on possible causes and remedies	Did not speculate
Created theories to explain causes and why a remedy will work.  Generally, diseases were caused by the body as a whole.	Did not create theories to explain anything.  If something was unknown, it was left at that
Cures were based on the theory postulated.	Cures were based on experience.  If something worked in the past, it will work today.  Medicine not based on experience could injure
They had few remedies, many of which were harsh, such as bleeding, purging, and vomiting	They had many remedies, and they were generally friendlier than dogmatist remedies and probably worked better
They believed anatomy was important to understand the physiology of disease	They despised anatomy and physiology.

Serapion was the most outspoken of the empirics, and "he wrote with great vengeance  (1, page 29), as he said:

"What is the use of  knowing the shape and position of the brain and liver, or whether there are such things as brains or livers at all."  (4, page 68)

Another common saying of the empirics was:

"It is not the cause, but the cure of diseases that concerns us; not how we digest, but what is digestible." (4, page 68)

Galen wrote about Serpion the empirist in his Outline of Empericism: (2, page 161)

Of the ancients, however, Hippocrates, Erasistratus, and Herophilus have stated nothing about the treatment suffering from the disease (i.e. lethargy).  But Serapion the Empericist, in Book 1 of his treaties Against the Haireseis, gave some instructions (about this) which are, however, too obscure to be reported here.

Serapion thus became an experimentalists.  He experimented to see what drugs worked best for said disease.  He recorded and made conclusions based on his own observations and experiments, as opposed to coming to speculative conclusions.  (1, page 30)

As described by Edward Withington:

"In short, they (empiricists) reduced the whole art and science of medicine to a system of therapeutics.  A person is ill, that is, he has certain unpleasant feelings or symptoms; surely the first thing to do is to find something which will remove them, and the whole duty of the physician is to discover what particular treatment, and especially what drugs, will get rid of particular sets of symptoms."  (3, page 68-9)

The way to do this is based on the "tripartite foundation" (1, page 30) of the following three methods:  (3, page 69)

1. Experience:  His own experience and observations
2. History:  Learning from the experience and observation of his contemporaries and  predisessors
3. Analogy:  Drawing conclusions based on similar situations to find remedies for new and strange cases

 And thus was formed the Empirical school of medicine.

The empirics were essential to this time because they created an important alternative to the dogmatists, some of whom (see Erasistratus) performed autopsies on live convicted criminals to see what organs did during life.  Hopefully, as some reports suggest, many such victims were given a large dose of morphine before the procedure.  Yet still it was considered inhumane and irrational by the empiricist, and reasonably so.

While the dogmatists based their remedies on speculation, the empiricists used only remedies that were shown by experience to work. This was a viable alternative to the extreme remedies of bleeding and purging used by many dogmatists.  The empiricist also added quite an array of new remedies, including opium and sulpher.

The dogmatists became known as rationalists due to their desire to rationalize diseases and their remedies.  They believed "everything must have a sufficient reason for its existence," Empirics believed what can be observed by experience is known, and what is not known is not to be speculated upon.

References

1. 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,
2. Eijk, Philip J., editor, "Ancient Histories of Medicine: essays in medical doxography and histeriography in classical antiquity," 1999, Boston,
3. Withington, "Medical History from it's Earliest Times: a popular history of the healing art," 1894, London, The Scientific Press
4. Watson, John, "Medical Profession in Ancient Times: an anniversary discourse delivered before the New York Accademy of Medicine November 7, 1855," 1856, New York, Baker and Godwin
5. Brock, John, "Galen on the natural faculties," 1916, London, New York, William Heinemann, G.P. Putnam's Sons
6. 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.
7. "Ancient Greek Skepticism," Internet Encyclopedia of Philosophy, http://www.iep.utm.edu/skepanci/, accessed 6/20/14

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