Nutton: ANCIENT MEDICINE

Peter Jones in The Sunday Telegraph, June 13 2004

Lacking modern technology, ancient doctors drew their conclusions from what the naked eye told them. So if their theories about disease (say) seem to us completely potty, that is not surprising. All they could do was to take a view on the matter, determined by whatever philosophy of medicine they clung to, and crack on. After all, germs, bacteria and viruses were discovered not much more than a hundred years ago.

One very influential ancient theory of health was that of the 'four humours'. Observing what came out of the body when it was ill - blood, phlegm, bile and black bile (the four 'humours', or liquids) - doctors recommended what to put back into it to prevent excess of any humour, thus keeping the body 'in balance' and ensuring good health. Diagnosis and prognosis were 'improved' when these humours became associated with bodily temperature, and then with the seasons; so cold food and drink could be confidently recommended for the sick in the hot summer. As a theory of disease it is all nonsense, but it has been superseded only relatively recently - though there is still, apparently, a practitioner in Torquay.

That said, no medical breakthrough has ever been more critical than the Greeks' assertion that disease was not supernatural: it had physical causes and could therefore be dealt with physically. So doctors did what they could within their limitations. Symptoms were observed and the progress of illnesses tracked (Greeks were good at prognosis); healthy and unhealthy locations and climates were identified (they may not have known about malaria but they certainly observed its effects); dietetics ('life-style' studies) covered everything from food to exercise; and there were bodies to be examined, alive or dead. A good gaping wound from the battlefield could reveal a lot, and ancients were not squeamish about working on animals. For a short while in third century BC Alexandria, even human bodies were dissected - normally taboo in the Greek world (the practice was not repeated till the 2ndC AD).

In this brilliant book (part of Routledge's excellent 'Sciences of Antiquity' series), Vivian Nutton, Professor of the History of Medicine at University College, London, surveys clearly and in gripping detail the story of ancient medicine from early Greece (8thC BC) to Late Antiquity (7thC AD). There are two figures that dominate: Hippocrates from the island of Cos (5thC BC), who was so important that treatises written hundreds of years after his death were ascribed to him (including the 'four-humour' theory), and Galen, a Greek from Pergamum and follower of Hippocrates, who made his name in Rome (2ndC AD) and left us his own frequently dogmatic and pugnacious but deeply influential thoughts on medicine and many other topics, running to nearly three million words.

That said, a major theme of Nutton's book is that ancient doctors were their own men. Then, as now, there was no simple acquiescence in a theory merely because it had an authority's imprimatur.

Amid all the nonsense, much extremely impressive work was done. There was accurate observation of significant symptoms (breath, pulse, fever, discoloration); fractures could be set, dislocations reduced; nerves were divided into motor and sensory. Galen himself was a pioneer in understanding the significance of mind-body interaction (stress was a particular speciality). He was also passionate about dissection, arguing that merely reading about it was about as useful as a steersman navigating from a book (Nutton points out that many doctors today advocate interactive videos in place of the real thing). He carried out public dissections on animals, impressing audiences when the pig's loud squeals ended the moment the free passage of nerves along the spinal cord was cut. The number and variety of recovered instruments suggest a high level of surgical competence and sophistication.

Relationships between doctor and patient were also widely discussed. The famous Hippocratic oath, whose heavily religious tone suggests that it was not by Hippocrates, came to encapsulate proper ethical practice (though it was not universally imposed till very late on). Ancient doctors also knew that the quality of care depended on the quality of the patient as well as that of the doctor ('they won't take medicine they don't like, and so die; but the doctor gets the blame').

As Nutton says, 'the legacy of Antiquity is still with us'. Fortunately, however, much of its practice isn't.