2nd century A.D.: Medical profession starts to decline

By the 2nd century A.D. there were so many schools of medicine that a person might scratch his head in a dumbfounded effort to actually find a real doctor. Some of the schools around at this time were: (1, page 39)

1. Empiric
2. Dogmatic
3. Methodist
4. Pneumatist
5. Eclectic/ Episynthetics

There were so many schools of medicine, so many "diverse and fanciful opinions" that the medical profession, much like the rest of Rome, was falling apart, said medical historian Thomas Bradford. (1, page 39)

He said the result of this was to "lower the standard of the real medical science. The physicians nowhere aimed at useful discoveries, but simply devoted themselves to making as much money as possible. In fact, medicine like everything else in Rome at this time was fast decaying." (1, page 39)

There was also no requirement to become a doctor, so any quack, trained or otherwise, could claim to be one. This made it so those seeking help were often left confused and deterred.

So, after the death of Galen, medicine collapsed with the rest of Rome.  Of this, Bradford said:

At the death of Galen (the end of the 2nd century) there began a period during which the art of medicine not only ceased to advance, but went backward, and became enveloped in the myth and ceremonies of the priesthood. For a while the schools of philosophy and medicine still existed at Alexandria, but in the year 372 the city was subjected to pillage and fire. The scholars were stripped of their elegant quarters, the buildings were completely destroyed, and the vast collection of manuscripts were used to heat the water in the public baths. (1, page 45)

Western Civilization entered a dark ages of medicine.  Medicine would not come out from under this dark cloud until after the invention of the printing press in 1450.   In the meantime, if you needed help in times of sickness you were on your own.

References:

1. 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

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

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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