No Harm Done
The origins of modern medicine in the Greek healing arts.
Aug 31, 2009, Vol. 14, No. 46 • By SUSANNE KLINGENSTEIN
Mania, cholera, nausea, dyspnea, apnea, asphyxia; lipophilia, tachycardia, thrombocytopenia. If medical terminology seems all Greek to you, the delightful George L. Banay, erstwhile medical librarian at Worcester State Hospital, confirms your diagnosis: "The Hippocratics," he wrote in his still-useful 1948 introduction to the Greek and Latin derivations of medical terms, "were the first to describe diseases based on observations, and the names given by them to many conditions are still used today."
Latin speakers came late to the feast. Only a quarter of medical terms are of Latin origin (fossa, fundus, hernia). If only the great Aelius Galenus of Pergamon (129-200 A.D.) had written his 200 known essays, running to three million words, in the language of the superpower, Rome, rather than in the language of philosophical learnedness, Greek, things might have turned out differently. Yet even the magnificently expansive and innovative Galen was an epigone of sorts, because much of the structure of how to think about medicine had been put in place by his Greek precursors.
In this delightfully concise and accessible book, Bronwen L. Wickkiser, who teaches classics at Vanderbilt, unfolds the complexities of Greek medicine. The Hippocratics were not the first, and then not the only, game in town. They emerged only in the fifth century B.C., focused on observation in order to arrive at a prognosis, and were therapeutic conservatives. They recommended dietetic measures always, pharmaka rarely, and surgery hardly ever. It is easy to recognize their ruling principle at work here--"First, do no harm"--an adage that, strangely, we tend to remember in Latin rather than in Greek: Primum non nocere.
The puzzle, as Wickkiser sees it, is that parallel to the emergence and unfolding of a iatrike (medicine) that searched for causes in nature rather than among the Olympians, the cult of Asklepios experienced an unprecedented surge in popularity. Asklepios, the son of Apollo and a mortal woman, was trained by the centaur Chiron and made his first appearance in the Iliad. There the Greeks revere him and his sons Machaon and Podaleirios (whom he trained as he trained in his skills) for their ability to treat difficult wounds.
When Machaon himself is wounded, Idomeneus, rushing to save him, exclaims: "A doctor is worth many other men!" Those were the days.
Homer did not consider Asklepios divine, but in the course of human events, Asklepios ascended to the stature of a healing god. Sanctuaries were established, the most important of them at Epidauros, and visited by pilgrims afflicted predominantly with chronic ailments: blindness, deafness, baldness, paralysis, infertility, insomnia. The supplicants would sleep in the temple, hoping that Asklepios would appear to them in a dream and perform a medical procedure or prescribe a therapeutic regimen.
Why did observation-based iatrike and faith-based healing experience a simultaneous surge in fifth-century Greece? We should not be terribly surprised, since in the absence of antibiotics even the rationally inclined iatroi (doctors) could effectively do very little. Trauma surgery had already evolved into its own discipline and was practiced by manually skilled surgeons. Hence the Hippocratic Oath, a kind of buyer's guarantee that no irreversible harm will be done to patients, makes the iatros (whose major assets are astute observation and deductive acumen) declare: "I will not cut for stone, even for patients in whom the disease is manifest; I will leave this operation to be performed by practitioners, specialists in this art."
Fifth-century philosophically trained physicians knew how little they knew. They also knew that, in order to attract new customers, they had to keep their mortality figures low. Modern hospitals are familiar with that idea. Hence the Hippocratic iatroi decided that they would not treat chronic and incurable cases. As Wickkiser points out, it's important to see this not only as a shrewd business decision. As medicine established itself as a profession, it was important to delineate what it could and could not accomplish so that patients would be able to distinguish the skilled practitioner from the snake-oil vendor and charlatan. The trained physician would acknowledge the limits of his art (techne) and skill (sophia).
The more professionalized and established observational medicine became, the more patients would find themselves turned away by physicians. Those were the ones whose last resort were the temples of Asklepios. Against older theories, Wickkiser brilliantly shows how the two approaches to healing can rise to power simultaneously: When skill fails, faith prevails. Temples are the refuge of those unwilling to give up.
Had Wickkiser stopped here, this would have been a short, clear book on a fascinating facet of Greek medicine complete with the obligatory (in this case rather gentle) academic assassination. The victims here are Emma and Ludwig Edelstein, whose massive two-volume work on the cult of Asklepios appeared in 1945 and dominated the field until now. Wickkiser reproaches them for having based their interpretation of the cult on literary evidence alone while ignoring the artifacts on the ground.
The Edelsteins were German Jews who left Germany for America as soon as Emma finished her doctorate at Heidelberg in 1933. They were hardly in a position to traipse around Greece during World War II.
Wickkiser himself then adds a rather sterile reading of Athenian ruins, and shows in the process how a perfectly fine scholar gets his brain addled and his writing scrambled when he succumbs to the temptation to be hip by adopting the lingo of progressive academia.
Perfectly fine. But Wickkiser then launches into a meticulous "reading" of the Acropolis as a demonstration of Athenian dominance whose individual components "share in the reflective text of empire published across the Acropolis." It is at this point, as Wickkiser tries to combine his interpretation of the fancy new location of the cult of Asklepios on the Acropolis with an obligatory critique of empire-building, that the book falls apart.
That's a shame, because for so many pages it is a pleasure to accompany Wickkiser on his textual discoveries, and in his leisurely rambles around the ruins that were denied the valiant Edelsteins.
Susanne Klingenstein is a lecturer in the Harvard/MIT Division of Health Sciences and Technology.