SCHOOLS OR SECTS OF GRECO-ROMAN MEDICAL THOUGHT
No great traditional healing system has arisen in a vacuum; without exception, all of the world's great traditional healing systems arose from a rich and robust background of philosophical thought, which included medicine and healing as part of its natural philosophy. The intellectual ferment that arose from competing schools of philosophical thought and inquiry then acted as a catalyst to further the advancement of medicine and the healing arts. The medical marketplace in ancient Rome was quite competitive as ambitious physicians, eager to promote themselves, as well as their personal philosophy and practice of healing by demonstrating the superiority of their approach over their competitors. And many, if not most, of the prominent physicians in ancient Rome were of Greek origin.
Even in modern times, the medical historian can see trends and counter-trends in medical philosophy and practice, but back in Greco-Roman times, the divergence between these schools of thought, and their exclusive or cliquish nature, was much more pronounced than it is today. Perhaps the major reason for this diversity was that medicine, as well as the general science and natural philosophy of the day, was still working out basic scientific problems as they related to medicine. Take the basic nature, structure and properties of matter, for instance - there was a diversity of competing theories and explanations as to exactly what matter was, and how it functioned. And of course, such a subject has immense importance and relevance to medicine: Not only does it explain the nature and constitution of the human body, and all its constituent parts, as well as the biochemical reactions and metabolic processes occurring within it, both in health (physiology) and disease (pathology), but it also is of great relevance to the field of pharmacology, providing the theoretical infrastructure to explain exactly how and why medicinal substances work the way they do. Today, all, or at least most, of the basic sciences have been worked out, and we take this for granted, but in Greco-Roman times, this was not the case.
The art of medicine can be broadly divided into theory and practice. With medicine being an eminently practical art, the ultimate test of the value of any theoretical model is the results its application achieves in actual medical practice. If the results are not forthcoming, then the overall standing and reputation of a medical system will decline, and patient patronage of it will plummet. With the advantage of hindsight, modern scientists and physicians tend to look back on medicine in those comparatively primitive times with a certain degree of condescension and chauvinism. For example, how terribly misguided they were to think that there were only four elements when today we know of over a hundred! But, aside from their grasp, or lack thereof, of literal scientific or physical truth, the main question that medical historians need to ask was what was the practical usefulness of their particular theoretical models of human physiology and pathology in obtaining reliable results in treatment? A classical or traditional medical model does not have to concur in every detail with the findings of modern science to be reliable and useful in clinical practice. In the final analysis, the reliability of the clinical results obtained by a medical system or model is the ultimate arbiter of how successful it is in the medical marketplace.
In the years and centuries after the time of Hippocrates, and up until the time of Galen, several competing schools or sects of medical theory and practice emerged within the Greco-Roman world. You might say that the classical period of classical Greco-Roman medicine was the time of Hippocrates, when the Father of Medicine first codified the theory and natural philosophy of medicine into a single, unified, coherent system. In the years and centuries following Hippocrates, medical thinking and practice digressed and diverged from the Hippocratic system until there were several competing schools of medical thought when Galen arrived on the scene. I would like to briefly introduce these schools and sects, and their salient features, below. Although modern medicine and medical science may consider itself to have evolved far beyond these classical schools of medical thought, which may seem quite primitive and fanciful in comparison to modern biomedicine, perhaps it is possible to discern within them certain definite perspectives and tendencies that exist within modern medicine as well. For these schools of medical thought were grappling with problems that have a perennial relevance to the theory and practice of medicine in any age, whatever the particulars of their theories might have been.
The Dogmatics were those who adhered to the mainstream of classical medical theory and practice laid out by Hippocrates. This system centered around the theory of the Four Humors, the Four Temperaments, the Four Basic Qualities, Pneuma, Pepsis and the like, which is the core of the system of Greek Medicine presented in this website. Galen considered himself to be basically a Dogmatist, or a follower of Hippocrates, and lamented how far physicians had wandered and gone astray from the sound, demonstrable system of Hippocrates in the five centuries or so that had passed from his day until his own. Galen saw himself as following in the footsteps and tradition of Hippocrates, but developing his theories even further.
The Rationalists believed in the use of reason in formulating and adopting a theory concerning the structure and/or function of the body, and the nature of health and disease. They believed that every medical phenomenon, every disease, has a cause, or causes, and that, while many of these causes are evident, many others may be hidden from direct observation. They also believed that these rationally derived theories of bodily structure and function, and the nature of health and disease, based on observation and logical deduction, should then be applied to the treatment of disease, and finding appropriate and effective remedies for them. The Roman physician Celsus was a chief proponent of this school.
The Empiricists believed in the supremacy of actual clinical observation and experience over any underlying theory, whether rationally derived or otherwise. Above all, they opposed overly speculative theories concerning that which could not be seen or otherwise proven, such as the atomic theory of matter, especially as it existed in classical times. Their chief tools for acquiring medical knowledge and competence were experience, observation, case histories and medical inquiry, and inference through forming analogies. Practical experience and observable facts took precedence over theories, said Aristotle, who could be called an empiricist in his basic approach, because if a newly discovered or observed fact contradicted a previously held theory, the old theory had to be discarded or modified to accommodate the new facts. The Alexandrian physicians Herophilus and Erasistratus were proponents of the Empiricist school.
The Methodics based their theories of physiology and pathology on the basic notion that the body was primarily composed of fragile corpuscles that moved through small pores or channels, and that pathology and disease arose when these channels or pores were either too constricted, too lax, or some combination of the two, although the causes of these pathological changes were not clearly elucidated. Although their basic theory could be said to be rational in a sense, it was not directly observable or amenable to experience, especially in classical times, before the advent of the microscope, which has enabled us to see cells, which would be analogous to their corpuscles, and the various microscopic vessels and channels of the body. The main founder of the Methodic school was Asclepiades, and later proponents were Themison and Thessalus, whom Galen deplored. In fact, Galen called the Methodics "methodless" in his Method of Medicine. The Methodics were also notorious for maintaining that a brief six month training period was all that was necessary in order to begin the practice of medicine.
The Pneumatists were physicians and medical philosophers who emphasized the importance of pneuma, or the Vital Force, which is derived from the Air through the breath, in both their concepts of physiology as well as pathology. Hippocrates, who had a basic concept of pneuma, could be counted among their number, and so could Galen, who took Hippocrates' basic concept of pneuma and developed it even further, differentiating it into three types according to its functions and distribution within the human organism. Obviously, the Pneumatic school was not exclusive to the other schools, especially the first three, and did not exist independently of them.
The above schools or sects of medical thought diverged, developed and flourished during the centuries intervening between Hippocrates and Galen, but seemed to wither away or die out shortly after Galen's death. This could very well be due to the transformative influence of Galen on classical medical thought, since, in him, classical Greco-Roman medicine reached its acme or apex. Although Galen considered himself to be primarily a Dogmatist and follower of Hippocrates, he was not beholden to any one school of medical thought, but took from each as appropriate and necessary to his needs and objectives, creating a remarkable synthesis of both theory and practice. One might say that Galen took what he needed from every school - with the probable exception of the Methodics, who he was not in agreement with. Galen's works are full of heated philosophical polemics against schools and practitioners he had issues or disagreements with, and Galen called things as he saw them, and was quite vocal and outspoken in his rhetoric.
The Perennial Relevance of a Philosophy of Healing
In the modern world, we tend to think of medicine simply as a black and white, clear cut matter of "just the facts", but the truth is that medicine is much more than a cold, hard science; it is also an art, in which priorities and value judgments need to be set, which are not clear cut. This demands of each physician that he or she formulate a personal philosophy of medicine and healing. Many schools of holistic healing that have emerged in more recent and modern times, such as Homeopathy, for instance, have criticized their opponents in conventional modern medicine for lacking a coherent guiding philosophy. The spiritual and philosophical background behind the system is one of the things that has attracted many to Oriental systems of healing, like Chinese Medicine and Ayurveda.
That being said, some of the main philosophical issues confronting physicians today are the following:
1) The lack of a clear, coherent unifying philosophy of Nature, and man's proper and optimal place within the natural world, and the natural order. The ideal of fitting into the natural order is a highly satisfying and edifying one, both for the doctor as well as for the patient.
2) An over-reliance on lab tests and quantitative data in lieu of the value judgments and personal decisions that really need to be made about the relative merit of various treatment options. Such over-reliance on quantitative data also makes physicians too dependent on numbers and lab tests, and on medical technology, and lessens their clinical sensitivity to, and perception of, qualitative diagnostic and clinical data that is obtainable from the patient, which used to be highly honed and developed in the traditional healer.
3) The proper role of theory versus experience and observation in the optimum practice of medicine. Where exactly is the optimum balance struck between these two dimensions of medicine, and where do we start to sacrifice one for the other? Experience and observation without a sufficient theoretical foundation to guide it tends to be random and aimless, and nothing more than trial and error. Conversely, a theory that is too overriding and dominant can artificially skew or put undue "spin" on the physician's clinical observations as everything is twisted or tailored to fit the theory. We also need to be wary of dominant or overriding theories that are artificially propped up by hidden agendas that don't have the patient's best interests at heart.
4) In spite of all the spectacular advances in modern medical science and technology, including diagnostic technology, the physician still needs to be aware exactly of where the known leaves off, and the unknown begins. It is at this point that the physician needs to have faith that he or she has done the best that they can, and leave the rest to Medicatrix Naturae, or the healing power of Nature and Nature's God.
5) What is the place of therapeutics in the medical system being practiced, and how does it interface with diagnostics? In traditional medical models, one is tailored to fit hand in hand right into the other. And slavish adherence to numbers, lab tests and other hard, quantifiable data may not always provide the modern physician with all the guidance that he or she needs in formulating the best treatment plan for the patient. Medicine is not just a hard science, it is also an art, and the physician must also act therapeutically in such a way that he ensures the compliance of the attendants, and above all the patient, who must follow through with the treatment regimen - and for this, human relations skills are crucial, as well as spending quality time with the patient.
These are just a few of the basic problems and issues that confront the physician, which are as relevant today as they have always been. You might even be able to think of others.
Source: Galen's Method of Medicine, Books 1 - 4, pp. xlii - xlviii. Edited and Translated by Ian Johnston and G. H. R. Horsley. Published by Harvard University Press, Cambridge Massachusetts, London, England, 2011.