370 B.C.: The dogmatic school of medicine

While Hippocrates is credited with creating the humoral hypothesis, it was his sons, Thessalus and Draco, who are credited with creating the first school, or sect, of medicine: the Dogmatic School of Medicine. (1, page)

There were various names for this school, depending on the era it was being described, and who was describing it.

Since it was based on the writings of the Hippocratic writers and Hippocrates himself, it was sometimes called the Hippocratic school, and physicians called Hippocratici. 

Since it was based on philosophers who believed it was necessary to rationalize about medicine, it was sometimes called the Rationalist school, and physicians called rationalists.

Since it was based on the belief that health was determined by a balance of the four humors (blood, phlegm, black bile and yellow bile) of Hippocrates, and diseases caused by an imbalance thereof, it was often called the Humoral school, and physicians called humoralists.

And, finally, since it was based on the dogma of Hippocrates, it was also called the Dogmatic school, and physicians called dogmatists or dogmatici. 

Regardless of the name, the general idea here is best explained by medical historian Edward Withington in 1894:  (3, page 57)

The ancient Greeks loved talking; his mind was more philosophical than scientific, and he preferred to speculate on things in general rather than to investigate particular facts... A Hippocratic writer had said, 'The physician who is also a philosopher is godlike.' This became the motto of the dogmatic school, was made the excuse for an immense amount of useless speculation, and was finally taken as the text of a special treaties by Galen himself. (3, page 57)

The dogmatic school of medicine was generally taught at the School of Cos, and was based on the opinions of Hippocrates, yet it was also based on the Stoic philosophy. This led to much "useless speculation," (3, page 57)

Part of this "useless" speculation was that diseases were caused by imbalances of the four elements and humors, and remedies were a means to re-establish the balance.  Remedies may be as simple as a lifestyle change, and as harsh as bleeding and purging.  Any particular remedy did not require any specific evidence that it worked.

You can  also learn more about Hippocratic medicine by reading about the medical wisdom of Hippocrates.

Followers of this school believed in the importance of studying anatomy, and often performed autopsies on animals such as pigs, monkeys and apes.  They performed autopsies on humans if possible, although this was frowned upon and illegal in the ancient world.  Human autopsies were performed when permission was granted, and in such cases was usually performed upon stolen corpses or, worse, live prisoners.

They had a basic understanding of human anatomy: the layout of the main organs, the vessels that line the body.  They understood the importance of correlating medicine with physiology.  The obvious problem with their school was the reliance on opinions as opposed to observation, experience and science.  Of course when the school was formed there was no knowledge of any of those things.  (3, page 60)

By about 50 A.D., when most referred to it as the Humoral or Rational School, it was under fierce competition by four other schools that also formed in Greece. Despite this competition, the basic tenants of this school would be followed by physicians all the way to the middle of the 18th century.

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, "
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. Neuburger, Max, writer, "History of Medicine," 1910, translated by Ernest Playfair, Volume I, London, Oxford University Press

3533-2600 B.C.: The birth of rational/civilized medicine

While many think of Imhotep (2650-2600 B.C) as the first physician,
chances are there were probably many others before him.
Yet he was so impressive for all he accomplished in his life,
that he is the one remembered by ancient accounts.

Among the first things I learned in my study of medicine in primitive and ancient societies was, given the limited medical wisdom of these people, they "rationalized" medicine to the best of their ability. They "rationalized" disease as being caused by evil spirits, demons, ghosts and gods. While we may think of this mythology and irrational, to them it was quite rational. (1, page 248)

We must keep this in mind as we continue our quest to learn the history of medicine, the history of respiratory therapy, and the history of asthma.  Our quest today, however, is to learn about the time in history when what we consider to be rational  medicine was born.  We want to know at what point in history physicians started prescribing medicine that was not mythical, and might actually make your breathing easier, or make your chest pain go away.

To prevent confusion of the term "rational," many historians use terms like magical, religious, or magico-religious to refer to mythology and religious medicine, and terms like civilized, empirico-rational, or natural to refer to real remedies.  Personally, I like the terms magico-religious and civilized, and for this reason I will try to use these terms throughout this history. Still, it's important to understand the confusion here, as the various terms continue to pop up in various historical writings. (2)(4)

By studying ancient Egypt we learn how mythology influenced medicine, and we also learn how civilized medicine was born.  Since Egyptians believed diseases were caused by gods and demons that were ubiquitous, the only means of treating and preventing disease was magic.  The person responsible for medicine was the medicine man, who offered incantations, prayers and amulets to treat disease.  He was a busy person, sought out daily by those afflicted with chronic pain, discomfort, or injuries. (2)

Generally speaking, if you suffered from basic symptoms, such as if you had a cold, you'd deal with it on your own, as you wouldn't want to be a burden to your family or clan.  If you had any symptoms of asthma -- dyspnea, chest pain, coughing, wheezing, or increased sputum -- you'd probably suffer through it until your trouble went away on their own.   If it persisted and you couldn't bare it any longer, then you might give in and seek a medicine man to treat your symptoms.

By trial and error more treatment options were learned, and these are your civilized medicine, your "physical, dietetic and pharmacological treatments."  Methods of setting broken bones, and cutting with a knife (surgery) were developed and passed on by the language that developed. (2)

The job of the medicine man became a specialized profession, and as time went by there were basically three branches of medicine that formed:  (2)

• Sorcerer: They specialized in magic, creating a link between the patient and the spirits 
• Priest: They specialized in religion, creating a link between the patient and the gods
• Physician: They specialized in civilized medicine, treating ailments with prescriptions

More than likely, all three of these paradigms existed side by side, with a patient having all three as options for healing. (1)

For instance, chances are that while physicians were preparing their prescriptions, they'd also be citing incantations and prayers, because they believed they worked by magical or religious means.  `(5, page 4)

As noted by Walter Libby in his 1922 book "The history of medicne in its salient features,": (5, page 4)

On account of the conservatism of the priest physicians, Egyptian medicine never advanced far beyond primitive medicine with its simple faith in magic spells and the virtue of a rich pharmacopoeia, and its belief that the cause of disease was the malice of a demon, the justice of an avenging god, the ill-will of an enemy, or the anger of the dead.

Technically speaking, rationalized/civilized medicine probably started early, perhaps as early as 30,000 B.C., only to be known by a few people.  As word spread of the success of these new remedies, more and more medicine men learned of them, and used them on their own patients with success.  Such wisdom was then shared by word of mouth from one generation to another, mainly through easy to remember poems and songs, until the first medical writings were available.

For the most part, however, most historians recognize rational/civilized medicine as starting early in Egypt and Mesopotamia, only to develop over a thousand years later in China. So it's easy to see that such wisdom was slow to advance and spread from man to man, and society to society.

Historians acknowledge there is evidence of physicians early on in Egypt's history, although such knowledge is sparse. Edward Withington, in his 1894 book "Medical History of the Art of Healing," describes the discovery of a tomb of Sekhet' enanch who was chief priest/ physician of the Pharaoh Sahura sometime around 3533 and 3000 B.C. . Inscriptions show he "healed the king's 'nostrils' for which his majesty wishes him 'a long life of holiness.'" (4)


The next priest/ physician we know of is Imhotep, who was the vizier (chief adviser) and architect of King Djoser around 2,600 B.C. He was believed to be the architect who designed the first great stone pyramids, and to have designed many of the tools used to build these pyramids. He was also believed, for a generation perhaps, to be the priest who communicated with the god Thoth (Hermes), thus writing the medical wisdom of the gods on stone tablets, which are known to history as the Hermatic texts.

Yet Imhotep must have been a heroic physician too, because after his life he was so heralded by the people that he became a god. Although, due to his fame, Imhotep was given credit as the inventor of medicine, something that is also sometimes debated. Yet for our purposes, the writings he is said to have written contained some of the first civilized remedies, prescriptions that involved dough pills, inhalations of smoke and steam, salves, etc. He, therefore, is often considered the father of rational/ civilized medicine.

After Imhotep, rational/civilized medicine spread throughout the whole of Egypt. Some priests studied the last six of the Hermetic texts, and they became physicians. They were often sent to the homes of the sick, and prescribed what we might refer to as rational/civilized medicine, along with the incantations that went with them.

So as the medicine man's specialties evolved, so too did the physician's specialties.  Herodotus (484-425 B.C.), the Greek historian, observed of Egypt that:

The practice of medicine is so divided among them, that each physician is a healer of one disease and no more.  All the country is full of physician, some of the eye, some of the teeth, some of what pertains to the belly, and some of the hidden diseases." (3)

Natural medicine became so common that regular folks had knowledge of it.  Common colds, asthma, headaches, and stomach aches were probably treated by the physicians in the home, as Homer noted of the Egyptians that "each one is a physician, skillful beyond all men, for verily they are of the race of Paeon (Greek physician of the gods)." (4, page 16)

What did he mean by this?  Well,  it's actually open to speculation, but some historians believe he meant that every person in Egypt was knowledgeable of medicine, at least to a certain extent.  Perhaps he meant that the average person in Egypt was like the average person in the United States today, having a medicine chest full of medicine, and the ability to treat the basic ailments and injuries of the day.

Edward Withington, in his 1894 book "Medical history from the earliest times," described two examples what may show that even non-physicians were physicians -- sort of. The first one is the discovery of the medicine chest of Pharaoh Mentu'-hotep of the 11th dynasty around 2,500 B.C. The chest belonged to his wife, and consisted of "six vases, one of alabaster and and five of serpentine, with dried remnants of drugs, two spoons, a piece of linen cloth and some roots, enclosed in a basket of straw-work, the whole standing in a wooden chest found in the queen's tomb." (4, page 16)

As the second example, Withington mentions a "curious letter from a husband to his dead wife, found attached to a small image of the latter. In it he upbraids the departed spirit for having produced disease in him, and while reproachfully calling to mind his kindness to her during life, thus describes her last illness: 'When thou wast sick, with the sickness that thou hadst, did not I go to the physician and bid him make thy medicines for thee? -- yea, he did all things whatsoever thou wouldst have him do.' This seems to imply that the lady to some extent directed her own treatment, and reminds us of the Homeric description of Egypt as the land where 'each one is a physician, skillful beyond all men, for verily they are of the race of Paeon.'" (4, page 16)

It's highly likely that if home remedies didn't work, and greater help was needed or wanted, then the sick may seek a sorcerer, priest or physician. Unexplained diseases were probably treated with magic. Bone breaks and lacerations being treated with surgery, with lotions and salves being used to soothe the pain and speed healing. Chronic disease may be treated with magic, or perhaps with one of the various salves, lotions, potions, pills of dough, and the like.

And what we're most interested in here is emperico-rational medicine --rational/ civilized. It's what is learned by observation and experimentation. The plant Belladonna laid out in the sun and was dried, and one day an asthmatic accidentally dropped some on the fire and inhaled the smoke, getting some relief. He remembered this and tried it the next time he was dyspneic with the same beneficial results. He relayed this story to his friends, and to his children, until one day it was written on papyrus, and delivered to us through time via the Georg Eber Papyrus.

Belladonna is referred to as a herbal remedy. Other available herbs included opium, coca, cinchona, ephedrine, caffeine, carcara, sagrada, chaulmoogra, digitalis, ipacacuanha, podophyllum, pyrethrum, squill, belladonna, and strammonium. These are your natural remedies. (1)

These herbs had to be prepared in such a fashion that they had some potency, some medicinal effect.  Some were best sundried, crushed and inhaled.  Some were most effective in lotions massaged on the skin.  Some were best mixed in dough and swallowed with water.  Some were best dissolved in water and made into broths.  Some worked best as salves.  Many were best mixed with other herbs, or given before or after chanting an incantation.

While these are your natural remedies, said Plinio Prioreschi in his 1991 history of medcine:

(The) pharmacological aspect of therapy must be understood, however, in the context of the supernaturalistic paradigm: the medicines worked through magic, their effect depended on the recitation of the proper words and the performance of the correct actions. In fact, the consecration of the remedies was a significant part of the sacred utterances of the healer.  The potency of herbs was usually due to their relationship with gods or goddesses who were behind their curative powers. (1)

The medicine was magical.  In this way, the physician was just another medicine man.  In a way it seems that in the absence of any truly effective remedy, the hope a priest or sorcerer provided, the hope that helped soothe your mind, may have done more for healing than any remedy of the physician. 

Just think about it:  while a prayer or incantation offered no real remedy, at least it did no harm.  The best case scenario was the placebo effect made you think something was being done.  You felt better by default.  You relaxd.  Your breath came back -- eventually.   I'll let you decide which healer you would have rather taken your chances with. 

Further reading:

• 1500 B.C.: Asthma in ancient Egyps: Ebers Papyrus
• 2600 B.C. Imhotep invents rational medicine

References:

1. Prioreschi, Plinio, "A History of Medicine," 1991, volume I, page 248
2. Sigerist, Henry E, "A History of Medicne," 1955, second editionn, vol. I, 
3. Prioreschik, op cit, page 365-6, referring to Herodotus, II, 84, Translation by A.D. Godley.  
4. Withington, Edward Theodore, "Medical history from the earliest times: A popular history of the art of healing," 1894, London, The Scientific Press, pages 14-23 (Chapter IV: Medicine in Ancient Egypt)
5. Libby, Walter, "The History of medicine in its salient features," 1922, Boston and New York, Houghton Mifflin Company

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