The Romano Greek physician Galen

Image – statue of the Romano-Greek physician Gallen in Turkey (his place of birth)

Chris’s unofficial history of medicine

Too often, one man copies what another man wrote fifty years ago, without bothering to corroborate it, and publishes his findings as new information. This has been too true of both history and medicine. Often there is no sincere effort to delve into real facts……..”

Dr. Cyrus C. Sturgis

The most important part of any inquiry or exploration is its beginning. As has often been pointed out, if a false or superficial beginning has been made, one may employ the most rigorous methods during the later stages of investigation but they will never retrieve the situation.”

Dr. E.F. Schumacher

It is a curious and depressing truth, demonstrated time and again in medical history that the desire of the average physician to administer powerful and active drugs is only equalled by the desire of the average patient to have powerful and active drugs administered to him.”

…it (use of antimony)illustrates another curious and persistent fact about medical treatment: once a powerful and potentially dangerous drug is accepted into practice on the grounds that extremely serious illness justifies its use, it tends to be increasingly prescribed for trivial ailments. (Modern antibiotics are an excellent example of this tendency.)”

Barbara Griggs: “The Green Pharmacy” (It’s a history of the use of medicines and herbs – a very enjoyable read and highly recommended.)

Numbers help to make belief respectable and no matter how fallacious an opinion is, if it is backed up by a numerous following, its advocates feel a sense of security that comes from knowing that many believe as they do.

This is true in all walks of life; even doctors like to be on the popular side. The majority wields such a social influence that it gathers the richest professional rewards. The few who dare to differ materially from their fellows succeed in making themselves odious and become targets for malice and misrepresentation; after they are dead, their work will often be appreciated, often appropriated without credit, by those who furnished the jibes and jeers for the forgotten.”

John H. Tilden M.D. 1912

How come, throughout history, we have allowed ourselves to be impressed and bamboozled by physicians’ claims to understand pathology and its cure because of their supposed “scientific” knowledge of anatomy and physiology? How did we get to the situation we find ourselves in today where so called “scientific medicine” considers anything other than synthetic drugs, surgery or high tech machinery to be unscientific, “quack” medicine? How did we come to be so in awe of medical technology? How did we reach the absurd situation where diet is considered to have nothing to do with disease pathology? How come, that the more our “scientific” and “medical” knowledge has supposedly increased, the less we understand about the real causes of pathology? Surely we can find some lessons in history?

In the modern disdain of many people for big Pharma’s medical model, there is often a suspicion that there must once have been a “golden age of medicine” where diseases were cured effectively, mainly with diet. Hippocrates is usually the poster boy for this idea. So by delving into the history of medicine, I wanted to see for myself just how effective or ineffective the medicine of the past really was. I have tried to avoid the tone of many potted histories of medicine which often regard past medical practices as anachronisms which furnish subject matter for amusing anecdotes.

I have tried instead to look at these practices without prejudice and through the optic of an amateur naturopath with the idea that every procedure or practice should be carefully evaluated for its effectiveness or lack thereof in the light of modern knowledge, whether that knowledge be from an orthodox or an alternative source. (To see the history of medicine through the eyes of a professional herbalist, see “The Green Pharmacy” by Barbara Griggs, which is organised by theme.) I started with the belief that there might be a great deal of wisdom and some effective therapies contained in some ancient or past practices and have found that there were, albeit mixed in with the plainly barbaric usages, like bleeding, or increasingly huge doses of mercury given as an internal medicine, or the medieval dead end of belief in astrology and magic as indispensable therapeutic arts.

My time-line is a “mash up” of the scientific breakthroughs together with the social forces which have shaped medicine. I have also inserted things that are usually left out of histories of medicine, like the discovery that the body has its own in-built mechanism for overcoming disease in the form of fasting, or the discoveries in nutrition and dentistry by Weston-Price in the 1920s etc.

You may wish to skim most of this chapter but I recommend that you come back to at least read carefully the parts on the 19th and 20th century in America which detail how the Rockefeller family and heirs to the fortunes made by other 19th century robber barons, the so-called blue bloods, came to own organized medicine, the drug industry and the processed food industry lock stock and barrel. Note: For parts pertaining to antiquity I have relied on modern books and journals and I have done much condensing, so there may well be some inaccuracies and distortions. I have tried to use as many different sources as possible in order to avoid errors. Proper scholarship in this subject would require a thorough knowledge of Greek and Latin, which I do not have, in order to examine many ancient texts in the original versions. Even if I could, many ancient Greek texts perished in the fire(s) of the library in Alexandria and what we know of them comes from later commentators or from Arabic translations.

Several things become apparent in pre 20th century medicine.

  1. Some of the key figures, for example, Galen or Paracelcus, were charismatic and larger than life and their often erroneous theories were accepted because a) they had many therapeutic successes as physicians b) at the time their hypotheses seemed plausible and c) because of their own powerful self-belief; rather than the scientifically demonstrable correctness of the theories.

  2. Many of the European physicians who made key discoveries often travelled to medical centres of excellence in other countries where they thought they would get the best education (like Harvey or Vesalius who both went to Padua, a great centre for the study of anatomy). Bologna then Padua in Italy were at one time the leading centres and later on Montpelier in the South of France. In medieval times and later, this medical cosmopolitanism was made easier by the fact that Latin was a kind of Esperanto for scholars, understood and written and spoken by the educated. Medical education started with a proper humanist education, especially in Latin and increasingly, also in Greek.

  3. Progress in medical knowledge was hampered for many centuries by the fact that human dissection was taboo and dissection had to be carried out instead on animals. This often lead to errors of understanding.

  4. Expertise in dissection and understanding of the human anatomy has always been, in the lay public’s imagination, synonymous with skill as a physician, even though a knowledge of physiology has little to do with therapeutic skill (and this continues today). Galen, for example, quickly made a name for himself when he first moved to Rome by dazzling virtuoso public displays of dissection and vivisection on animals.

  5. The history of western medicine is about theoretical “systems” such as the four humors of Hippocrates and the elements of Aristotle (combined by Galen). The “four humors” idea persisted for much of recorded history, getting ever more refined and complicated – right up until the last part of the nineteenth century, co-existing with breakthroughs in anatomical understanding and persisting for centuries even after these breakthroughs demonstrated how false Galen’s system was. So medical treatment according to dogma, protected and disseminated by vested interests, instead of according to the evidence, is nothing new.

  6. Botanicals”, i.e. herbs, would have been the most effective therapeutic agents throughout pre-recorded and recorded history. Galen, Al Razi and Avicenna all had extensive pharmacopias in addition to (and largely based on) those of Theophrastus, Dioscorides and Pliny. I suspect that the history of these guides to pharmacy is a much more interesting story than the ingenious and completely mistaken “humour” and “temperament” theories and consequent blood-letting, blistering and purging that were current right up to and including the 19th century.

  7. Many factual errors about medical history have been repeated down through the ages and continue to be repeated, particularly in potted histories (and no doubt I shall be as guilty of this as anyone). For example Paracelsus is credited with discovering opium (on a supposed trip to Constantinople) and inventing laudanum, tincture of opium. Knowledge of how to make tinctures dates from the 12th century or earlier, however and there is a chapter on opium in Dioscorides’ De Materia Medica dating from the 1st century AD. Opium was also a key ingredient in Theriac which also dates from the first century AD.

  8. Arab Medicine’s slavish reverence for the Romano Greek Galen and the Persian/Arab Avicenna’s works meant that the “humor” and “element” theories went unchallenged . This slavish reverence was re-transmitted to the European medicine of the middle ages. Medicine in Europe from the middle ages up to the advent of “scientific medicine” was as tightly regulated at it is now, with only graduates from medical schools being licensed and allowed to practise and this was true throughout Europe. With Latin being the universal language of medicine in the middle ages and renaissance, a standardised “orthodox” medicine based on “humors”, “temperaments” and astrology, as rigid, dogmatic and exclusive as today’s scientific medicine was practised across Europe and like orthodox medicine today it was embedded in the state and enforced by law. (Note: the reliance on astrology has been airbrushed out of most popular histories of medicine). This system perpetuated and disseminated all the errors of the doctors of antiquity and stifled a proper understanding of the “specifici”, or “simples” in the sophisticated Classical Greek, Romano Greek and Roman materie medice, which were nevertheless available in medieval times. The methodic school founded by Asclepiades and his pupils in the first century BC with its emphasis on diet , exercise, enemas and sunbathing was forgotten until the Celsus manuscript was re-discovered in medieval times, because few texts from this school survived and it was therefore not considered or transmitted by the Arabs.

  9. From the time of Hippocrates there have been many sects which claimed to understand the pathology of disease. From the 1st century onwards, the Galenic sect dominated and became the orthodoxy. This orthodoxy was challenged in the sixteenth century by Paracelsus and medicine then split into two camps, the Galenists and those who called themselves Paracelsians (I call them neo-Paracelsians). Paracelsus took the secret of most of his remedies to the grave. The new “chemical” medicine promoted in Paracelsus’ name was a licence to use increasingly large doses of terrrifyingly dangerous medicines (mercury, antimony, arsenic etc), for increasingly trivial complaints, and the Galenic humoral and elemental theories that Paracelsus had despised were largely maintained, with the new medicines being incorporated into the old theoretical framework.

  10. In the nineteenth century in America, qualified doctors were few and far between in the early part of the century and they were usually British immigrants. The traditional Materia Medica of Europe was irrelevant in a continent with its own, indigenous plant species.

Furthermore, for the first time in centuries, there was no licensing of doctors. For a brief period in history, “orthodox” medicine was not embedded in and protected by the state. Many different sects flourished in this void: the Thompsonians in the early part of the century with their homespun, plant based remedies, inspired by native Indian knowledge, the Homeopaths (who in the middle and later part of the nineteenth century were chalenging orthodox medicine for supremacy), the Eclectics, a professionalisation of Thompsonian medicine with their own, highly sophisticated and organized, native Materia Medica; the Osteopaths; the Chiropracters, and in the last part of the century the Hygienists, who believed that illness was caused by wrong living habits and poor dietary choices and that disease could be cured by fasting, for short or long periods.

In the US, the “orthodox” doctors, trained in traditional European Galenist or neo-Paracelsian traditions nearly became marginalised (althout “regulars” always remained in the majority) and their attempts to dominate the other sects by organising medical associations and state licensing were largely ineffectual until the arrival of the discoveries of Koch and Pasteur in the late 19th century and the realisation that many diseases were obstensibly, wholy caused by bacteria. (This has become established dogma but some doctors challenged the dogma at the time and many continue to challenge it.) The “bacterial origin of disease” seemed to herald a new dawn of so called “scientific medicine” and orthodox medicine was then seized on and organized from the ground upwards by John D. Rockefeller’s philanthropy, using endowments of medical schools as a tax haven where he could park some of the incredible wealth that his monopoly of oil production, refining and distribution had produced; swapping ownership for control. Orthodox medicine in the US was completely reorganized, starting in around 1910 and Rockefeller endowed many prestigious medical schools as well as the Ivy League universities. The faculty of these medical schools became highly specialized researchers rather than practising physicians, as had been usual up until then. From 1920 onwards, increasingly stringent state licensing and persecution by Federal authorities made it increasingly difficult for other sects to survive and they have been marginalized throughout the twentieth century. To practise as a herbalist in the US, for example, is illegal. American “scientific” medicine, based solely on synthetic, patented drug therapy, surgical interventions and high tech, and funded by Rockefeller endowments and foundations has become the world model, the dominant, global sect and American English has become what Latin was earlier, the scientific lingua franca.

China, India and Tibet all had their own pre-scientific or pseudo-scientific systems analogous to the four humors of Aristotle which went together with a highly developed system of herbal medicine.

Egyptian and Greek medicine

Greek medicine was based on Egyptian medicine. According to Homer in the Odyssey c. 800 BC : “In Egypt, the men are more skilled in medicine than any of human kind” and “the Egyptians were skilled in medicine more than any other art”. Hippocrates studied medicine in Egypt. The Greek historian Herodotus visited Egypt around 440 BC and described their medical practices. The Egyptians had an extensive pharmacopoeia. Regular fasting was part of the Egyptian hygiene for health. Much of Egyptian medicine centred on magic and incantations.

1550 BC Egypt. Codex Ebers Papyrus

The Codex Ebers is written: Egyptian medical papyrus containing over 800 therapeutic formulae. Many of them (22) mention garlic as a remedy for various disorders including headache, heart problems, tumours, bites and worms. In the 19th century, Egyptologists began finding papyri on medical matters. The first of these is the so called Georg Ebers papyrus, which he published in 1875. It is a scroll of over 20 meters in length, containing 108 columns of text. It is dated in the reign of Amenophis I (1536 BC.) It is thought that it may be a copy of various other papyri, possibly dating as far back as 3,000 BC. The papyrus lists over 500 medicinal plants and 876 herbal formulas made from them. Included is a recommendation to bandage mouldy bread over wounds to prevent infection. The first antibiotics?

Egypt 1500 BC Edwin Smith Papyrus – Treatise on surgery and trauma

Edwin Smith Papyrus named after the dealer who bought it in 1862. It is a treatise written about 1500 BC on the surgical treatment of trauma and was probably a manual of military surgery. It is around 5 metres in length. Most of it is concerned with trauma and surgery, with some sections on gynaecology and cosmetics. 48 different cases of injury are described, descending from the head down to the feet. For each kind of injury; diagnosis, prognosis and treatment are described. Some magic spells and incantations are given.

Egypt 1628 BC “London Medical Papyrus”

In the British Museum. 61 recipes with 25 being medical and the rest concerned with magic. Subjects treated are skin complaints, eye complaints, bleeding and burns. Papyrus first published in 1912 in Leipzig.

460 BC Greece – Hippocrates c. 490 – 370 BC

Hippocrates was born on the island of Cos. He is the first physician to dispense with the supernatural and believed that all illness had a rational explanation. Little is known about his life but around 70 treatises survive. Until modern times the treatises were all thought to be the work of Hippocrates. Nowadays it is thought that some, many, or all of them were written by his students . He believed that disease was the product of diet and living habits. Many of the Greek originals of these texts were lost. Most were known up to the middle ages only through Arabic translations that were later translated into Latin (see school of Toledo). In the later middle ages, with increasing Greek scholarship, the hunt was on, in monasteries, the Vatican and Byzantium (Constantinople) for the Greek originals and many were re-discovered and translated into Latin, leading to a re-appraisal and increasing respect for the Hippocratic writings, known previously mainly through the writing of Galen and others.

Hippocrates thought that physicians should observe and takes notes and record their findings and methods so that treatments could be based on past experiences of similar conditions and that these records could be passed down to future physicians. His therapeutic approach was based on the healing power of nature. The body contains within itself the power to re-balance the four humors and heal itself. Rest and immobilization were very important – with the patient being kept clean and sterile. He made use of fasting and consumption of apple cider vinegar (still to this day a folk cure-all – I take some every day). Many of Hippocrates methods are still in use today such as his treatment for haemorrhoids. Famous quotes are “Let food be your medicine” and “Walking is man’s best medicine”.

The humour theory According to Hippocrates the body contains four humors that can flow from its orifices as part of its natural function. The humors were blood, phlegm, black bile and yellow bile. Illness was caused by the excess accumulation of one of the fluids in a part of the body. They could spill out during illness. (Vomiting of bile or a runny nose for example). Physicians were still using leeches and lancets to bleed patients because of a supposed excess of blood, right into the nineteenth century.