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Home , Acron, Asclepeion, Hippocrates, Polybus (physician)

Bull. Ind. Inst. Hist. Med. Vol. XXIII pp. 125 to 136

THE ROLE OF IN THE DEVELOPMENT AND PROGRESS OF MEDICAL

SAMIR YAHIA EL-GAMMAL*

ABSTRACT

Greek relations with Egypt dates back to before 2000 B.C. The early Greek known systematic began with the legendary Asclepias. the Greek God of Medicine. Round the 7th Century B.C. many migrated to Egypt. Many of them came to Egypt to study all kinds of sciences. Greek and thence the European medicine st a rt ed with the age of . Its progress centred in Hippocrates, the most famous Greek nhvscian. He founded the Coan school at Cas about 430 B.C. Hippocrutes separated Greek medicine from superstitions, and religion. He is called the father of Greek medicine. He wrote several books. the most famous of them is "The Collection" formed of 30 volumes He exacted an oath of medical also. After 300 B.C. the Hippocr a t .c colleccion began to circulate. and in it was thrown evcrvthinu that could by any device be passed off as of Hippocratic origin. Many medical schools were founded in Gr eec e. which pushed medical sciences into much progress and development

Greek relations with Eg/Pt dates Kahun papyrus (c. 2000 B.C.) back to those days when some parts speaks of women diseases as due to of were occupied by the morbid states in the uterus in a very Egyptian troops before 2000 B.C. similar manner as that found in such parts as , and Hippocrates' works such as "De probably the Greek main-land. Morbis Mulierurn", 2nd book. Edwin Civilisation followed invasion and a Smith surgical papyrus describes skull great deal of Greek medicine was injuries, svstarnaticallv arranged in a obtained from the ancient Egyptians. way recalling the Hippocrates' book

Of Pharmacist, Researcher in the & Pharmacy, P.O No 136. Maild" Cairo. Egypt. 126 Bull. Ind. Inst. Hist. Med. Vol. XXIii

"De Capites Vulneribus" (the papyrus were at Cas, , Cnidus and dates to 1550 B.C.). Also the Pergamum. They were commonly symptoms in different organs situated on wooded hills or mountain accompanying affections of the sides, near mineral springs, and thus stomach mentioned in Ebers papyrus became popular sanitaria, managed (1550 B.C.) may be compared with by trained priests .. who stir in the those stated by Alexander Trullianus patients their immaginations by (VII, Chap. 1) (6-7th centuries A.D.) counting the deeds of all The tumour section in Ebers papyrus about the success of the temple resembles one of 's books "De treatment and the remedies employed. Tumoribus Contran atururn". and The patient was purified by a bath many other examples. from the mineral spring with , inunction and the like. After the The early Greek known systematic sacrifice, he was conducted into the medicine began with the legendary special rite of incubation or temple Asclepius. the Greek God of medicine steep (many of the patients were (Aesculapius to the Romans). who is actuatlv having hysteria, barren believed to be living round the 11 th women seeking the God's help for century B.C., healed the sick and offsprings etc ). restored the dead to life. Epidaurus was the chief seat of his worship, Round the 7th century B,C., from whence it extended to Rome in many Greeks migrated to Egypt, 293 B.C. The Asclepiadae (i.e. the forming a colony in Lower Egypt descendants of Asclepius) were called Naucratis, linked Egypt and medical priests having their principal Greece with trade. Many of the seats in Cas and Cnidus Greeks of the main-land came to Egypt to study all kinds of sciences Asclepius attribute was a stalk which were taught in many temples with a snake coiled around it Of these famous (as we (because the snake, since it sloughs may call it, since it harboured many its skin, was supposed to renew its schools in each temple), were those youth). Sacred snakes were kept in at Oun (Heliopolis), Memphis. Sais, sanctuaries of Asclepius at Epidaurus Abydos, Thebes. etc. Thus all of the and else where. The customary ancient Egyptian civilisation was offering was a cock (same as was quoted by these Greek students who the customary offering to Imhotep ... transferred it back home and spread the Egyptian God of medicine .. was it every where. also the bird Ibis) Greek before Pericles The chief temples of this cult 7495-7429 B.C.) w as also partly The Hole of Hip pocretes-c-Semir Yahia EI-Garnmal 127 derived of Ionian origin, of Eresos ( ?372-? of (580-489 B.C.) studied in 287 B.C.), the Protobot anist. did for Egypt, whence he probably acquired the vegetable kingdom what Hippo- his doctrine of the mystic power of crates did for medicine. His famous numbers and tile doctrine of transmi- book "De Historia Pla ntarurn" gration of sou ls or metapsychosis contained descriptions of more than He regarded the as the central 500 different plants. organ of higher activities and founded the Italian School of philosophers in Many medical schools were Crotona. founded in Greece which pushed medical sciences into much progress Greek and thence the European and development, of these; medicine started with the age of Pericles. Its progress centred in 1-.. School of Philosophy was Hippocrates. The medical school at founded round the 7th century Cnidus was established between B C. in (on the eastern coast 700 and 600 B.C., and was mainly of the Aegea n sea), its leaders concerned with symptoms as disso- were; Thales of (?624- ciated from the patient. Later on, ?546 BC.) Anaxirnander of Miletus Hippocrates founded the Coan school (611-547 B.C.) and of at Cas (round 430 B.C) where (?535-? 475 BC ). disease was recognised as the result of natural causes, and where observa- 2 . Eleatic School: was founded tion of symptoms and their relation round the 6th century B.C., in the to the patient and environment were Greek city Elea of lower Italy; of studied and became the foundation its chief ex-ponents: Parmenicles of clinical medicine. The humoral and Zeno was postulated here 3·- Cnidian School: was an early After 300 B.C. the Hippocratic school preceding that of Hippo- Collection began to circulate, and in crates It listed symptoms without it was thrown everything that could coordination arid with haphaz ard by any device be passed off a s of therapeutics. Hippocratic origin. But dubious in its origin, the Collection had not 4- Sicilian School: its members were devoted to animal dissection and remained intact as it suffered stressed on diet regulation. Its accretion and loss The Collection leaders were of Aqrirnenturn was made of thirtv books, of these (5th century BC.) and Philiston only 12 were scr upulo us lv studied. (4th century BC.). 128 Bull. Ind. tnst . Hist. Med. Vol. XXIII

5- Peripatetic School: pertaining to Egypt under the leadership of the philosophy of (384- Philenos of Cas and Serapion of 322 B.C) who taught while (c. 280 B.C.). As walking up and down in the opposed to the Dogmatists they Lyceum at . declared that the search for the ultimate causes of phenomena 6- Dogmatic School: was founded at was vain, but they were active in Cas and the first of the post- endeavouring to discover the Hippocratic schools of medicine in immediate causes. They paid which. the open-minded spirit of particular attention to the totality Hippocrates' teachings merged of symptoms and ciinical observa- with strict formalism which cared tion and were guided in their more for the rig id doctrine th an therapeutics almost entirely by for investigation. Chief members experience. were; (400 B.C.) Paraxagoras of Cas. The 10- Methodic School: It was founded Dogmatists divided medical by Thernison (c. 50 B.C.). and was into five branches; based on the practice of the art . etiology, hygiene, of medicine on exact rules and semeiology and therapeutics. as contrasted with experience. This school followed 7- Stoic School: was founded by the that of the Empirics and Doq- disciples of the philosopher Zeno matists but concentrated its (340-260 B.C) at Athens. Later attention on the pores. Roman Stoics were Cato the younger, Seneca and Marcus 11- Pneumatic School: it was founded Aurelius. (Zeno opend his school by Atheriaeus (who practiced in a colonnade called Stoa Peikile medicine in Rorne round the at Athens). 111 idd Ie at t he first century A. D.). Its style was based upon the 8- Epicuric School: was founded by action and constitution of the the followers of (341 - 270 (or vital air) which passed B.C ) who was a Greek philosopher from the lungs into the and that taught "pleasure is the arteries, and was thence dissernin- chief good thinr, in life". ated throughout the body. SJI"I'e members of this school were s- Empiric School: it was the second Agathinus of Archiqe nes of the pOS!- Hippocratic schools of of Ap arne a, Aret aeu s of Cappa- medicine, founded in Alexandria. doci a and Antylus. -TheRole of Hip pocrates-s-Somir Yahia EI-Gammal 12S

Concerning those Greek scholars He also combined together the who played a great role in the theory of the four elements with his -deve loprnent of medical sciences ill own theory of the four humours; Greece and Rome and thence to the , , black bile (melancholy) European civilisation, the most and yellow bile (Choler). famous of them were; He is called the father of Greek Hippocrates: (460-377 B C.) most medicine, and was a man of high famous Greek , born on the character and noble ideas. At the island of Cas. He studied medicine beginning of the war as a pupil of his father Heraclides (431-404 B.C ) between Athens and who was a physician in the Sparta, Hippocrates is said to have of Cas (which was established by saved Athens from a dreadful pesti- Thales B century ago). He also studied lence. He travelled throughout Greece medicine under Democretus. He went and died at in . He to Egypt, studied medicine in the was a careful and observant physician famous Heliopolis and Memphis and a strong believer in . medical schools, then went back home, and established a famous me- Hippocrates' Coan School of dical school in Cos a round 430 B.C. medicine (established on the island after practising for some time in the of Cas was competing heavily with Asclepeion of Athens the earlier Cnidian school of medicine (established on the Cnidian peninsula, Hippocrates followers established just opposite to Cas (both in Asia a medical school after his death which Minor). The Cnidian school had its they called Hippocrates School, and chief physician Euryphon, while the was in fact an extension of Thales Co an school had Hippocrates as its School. It soon lost its vitality and chief phvsician, both were contem- concentrated on some incorrect poraries. ) physiological informations as a basis of systematic explanations in medicine. The Cnidian sc+ool (in Cnidus) considered the classification of Hippocrates separated Greek diseases as fundamental without medicine from superstitions, magic sympathy with patholoqv and prog- and religion, thus formed a new nosis. Such classification was wrong scientific basis for medicine and in many cases and hence the treat- declared that treatment depends on ment was consequently wrong. When clinical observation and scientific experimentation, that will reveal the classification was based On symptoms, causes of the disease and suggests then any variation of these symptoms the proper treatment. occurs, will bring variations of disease, J30 Bull. Ind. Inst. Hi st. Med. Vol. XXII! and so the Cnidian followers could He also approved upon the theory not distinguish between the essential of the elements same as has been and the non essential symptoms. with his predecessors in which, each person was formed of four elements Whife the Coan school (in Cas) (humours) : took more interest in , and its doctrines were valuable to scien- Blood; comprises the hot humid tists, very suggestive, inspiring and property. admiring. Yellow bile; comprises hot dry property. Hippocrates founded the Dogmatic school in Cas, of its famous pupils Black bile; comprises cold dry were; (his son- in-law), his property. son The ssalus (the private physician Phlegm; (produced in the brain), of Archel aus, king of ), Diocles and (c 350 B.C., comprises cold humid property. successor and D iocles and the teacher Although all these tour humours Herophilus). Hippocrates had another do not exist in every person in the son Desachinus whom he also taught same proportions. yet health depends medicine. on the amount of admixture of these Hippocrates medicine depended humours together, and disease occurs entirely on experience and clinical if an unusual cumulation of one of them develops, and although this observation of the patients, which shows that medical art has grown body disturbance is limited to a through the way of observing the certain part, yet the symptoms appears patient's needs and causes of the all over the body. This can be diseases. and not on some philoso- corrected with the intake of suitable phical theories on the causes of the that brings back balance to the diseases. The patient's diet was of body humours. very great importance to his practice. So, the theory of the four humours epecially in acute diseases, and any and the body side effects that occurs alteration in this diet may be made in case their proportions are unbala- according to the appearance of side nced, represented the back bone for effects due to unappropriate food, medicine for nearly 2000 years and specially in case of fevers. So to this became a part of the living heritage observation of food intake on the patients and its influence on sick of people so as to suit his physical condition, tremendous progress 10 Although this theory did not gain the art of therapy was achieved much approval in the Greek medicine, The Role of Hippocrates-Samir Yahia EI-Gammal 131 yet it was highly acceptable to Galen how keen he was and accurate in his and later to Avicena ... that Islamic observations of the symptoms inspite physician of the 11th century A.D., of the little knowledge he had in his and was not opposed until time about and physiology. proved that it is not based on any true medical basis, but still the belief He also showed that .. in the occurance of diseases as a that sacred disease which was often result of the disturbance in distr ibu thought to occur due to a blow from tion of these humours in the body an evil spirit, is merely another disease remai ned fixed in the mind of the that happens due to a natural cause scientists tor a longer time. in the same way as other diseases. He declared that the blood of the Hippocrates showed that the right side of the heart is dark and is made of one integrated that of the left side is b-iqht red. unit and if a part of it gets diseased, then the other parts will be affected In one of his compilations, eventually and becomes sick, as "Me dicatrix Naturae". Hippocrates could be understandable from the mentioned all of the philosophical theory of the four humours, in which theories that preceded him and linked he found it most explicable to those them to the new medical concepts accurate observations on how and thoughts that were spreading in diseases began. his time, and also laid down some special theories about nature as a So, a distinctive part of philoso- congregation of the vital forces in phical theories was introduced to the the internal organs of the living art of healing through Hippocrates in creatures. Greece in contradiction to that Also, Hippocrates considered the medicine in ancient Egypt and the cardiac aurecles as tools by which air Babylonians who were very practical gets inside the body, and are the in their therapeutical theories and did creation of a very skilled creator, and not care much with such useless nature could discover these ways theories without understanding or thinking and also cou.d produce the glands Yet, Hippocrates has showed in and hair, and ways of antagonizing his medical volumes that diseases death, and also creates the natural occur due to natural causes and one species and languages by which all must find ways of eleminating such creatures uses. Also, in case of causes, which represented a prelimi- dise ases. nature is able to hide their nary step to the right way to medical symptoms but is forced to reveal it in treatment. Also, it shows to the world case of much pressure 132 But], Ind. tnst . Hist . Med. Vol. XX/II

Hippocrates states also in some 5. Essays by philosophers who were of his works many valuable informa- perhaps not practicing , tions about zoology and identified a but laymen interested in medicine kind of a general primary classific a- and anxious to apply its methods tion of plants and animals. He of philosophy. discusses brilliantly many forms of plant and animal species. 6. Note-books or scrap-books.

He wrote several books, the most Group B: about 34 works which do famous of them is "The Colliection", not display to any marked degree formed of 30 volumes, of them 12 to the Hippocratic characteristics, were studied extensively namely: but are nevertheless practical on foetus, nature of man, airs ... hand-books of medicine, physio- waters and places, , prog- logy or anatomy; nostics, acute diseases regimen, surgery, the heart, places in man, gynaecology and obstetrics. epide- glands, anatomy, nature of the bones, mics, uumours. nutrients, physician's sight, dentition, diseases I, diseases establishment, fractures. This book II & III (represents the influence of became wide spread but with time, it Cnidian school). affections (shows was neglected. The Arabs translated also the influence of the Cnidian parts of an old copy of it which they school), internal affections, sores, found in Asia Minor and . fistulae, ), prorrhetic II, Hippocrates considered that anatomy the physician, crisis, critical days, is of vital importance to medical purges, use of liquids, seventh month education. but by time, it was child, eighth month child, generation, neqlected till it was revived by the nature of the child, diseases IV, Arabs. (the Collection contained 87 diseases of women, barrenness, treatises) . diseases of girls, nature of women, excision of the foetus, superfoetation, Other compilations of Hippocrates are regimen in health, regimen II & III divided into groups; with . Group A : Group C: with the philosophical 1. Text books for physicians. elements which predominates 2. Text books for laymen. over the scientific; nutriment, regimen I. 3. Pieces of research or collection Hippocrates exacted an oath of of materials for research. medical ethics, which he quoted 4. Lectures or essays for medical entirely from that oath of Thoth of students and novices. the Eqvptlans, and states : The Role of Hippocrates-Samir Yahia EI-Gammal 133

"I swear by the physician, by may cause his death. Nor will I give Aesculapius, Hygeia and . a woman a pessary to procure abor- and I take to witness all the gods, tion. But I wiil preserve the purity of all the goddesses, to keep according my life and my art. I will not cut for to my ability and my judgement the stone, even for patients in whom the following Oath' To consider dear to disease is manifest; I will leave the me as my parents him who taught operation to be performed by practi- me this art. to live in command with tioners (specialists in the art). In him, and, if necessary to share my every house where I come, I will enter goods with him, to look upon his only for the good of the patients. children as my own brothers, to teach keeping myself far from all intentional them this art if they so desire without ill-doing and all seduction, and fee or written promise, to impart to especially from the pleasures of love my sons, and the sons of my master with women or with men, be they who taught me and the disciples free or slaves. All that may come to who have enrolled themselves and my knowledge in the exercise of my have agreed to the rules of the profe- profession, or outside of my profe- ssion, but to those alone, the precepts ssion, or in daily commerce with men, and the instruction. I will prescribe which ought not to be spread abroad, regimen, for the good of my patients I will keep secret and will never according to my ability and my judge- reveal. If I keep this oath faithfully, may I enjoy my life and practice my ment and never to harm anyone. To art, respected by all men and in all please no one will I prescribe a times; but if I swerve from it or violate deadly drug, nor give advice which it, may the reverse be my lot." 134 BUll. Ind. lnst . Hist . Med. Vol. XXIII

REFERENCES

1. ANDRER-POINTIER, L.; Histoire de lil Pharmacle Paris, Doin, 1900. 2. BAISSETTE, G ; Hippocrate, Grasset, Paris 1931.

3. BOISSIER, R,; Histoire Genrale de la Medicine, t I. Paris, 1936. 4. BOURGEY, L.; Observation et experience chez les medicine de la "Collection Hippocratique", Paris 1953. 5. BOUVET, M.; La Pharmacie dans L' Antiquite, Paris 1940, 6, BURN ET, John; Early Greek Philosophy, London 1920 7. CASTIGLIONI, Arturo; A History of Medicine (translated from the Italian by E. B. Krumbhaar, 2nd edition, Routledge, London 1947, 8. DAREiv1BERG, C, V.; Histoire des Sciences Medicales, Paris, Baillere 1870. 9. DAWSON, Warren R ; Studies in Ancient , New York 1925. 10. DUMESNIL, R.; Histoire illustree de la medecine, Paris, Pion 1935 11. FESTUSIERE, A. J.; Hippocrate, L' Ancienne Medecine; Introduction, traduction et commentaire, Paris 1948, 12. GARRISON, F.H.; Introduction to the History of Medicine, Philadelphia 1921, 13. JONES, W.H.S.; and WITHINGTON; Hippocrates, 4 vol., London, Heinmann 1923-31 (Texts). 14. LAIGNEL-LAVASTINE; Histoire Generale de la Medecine, de la Pharmacie, de L' Art dentaire et de L' Art veterinaire, 2 vol.. Paris, Michel, 1936-1938. , 5. LlTTRE, Emile; Ouvres completes d'Hippocrate, 10 vol.. Paris 1839-1861. 16, METTLER, Ceilia C.: History of Medecine, Philadelphia, 1947. 17. ROUANET, G; La Medecine d'Hippccrate. Guerir 1938. 18. SIEGERIST, H.E.; History of Medecine, New York, Oxford Univ. Press, vol. 1, 1951. 19. SINGER, C ; Greek Biology and Greek Medecine, Oxford, Clarendon Press, 1922. 20. SINGER, Charles; Greek Biology anrl its relation to the rise of modern biology, Oxford 1921. 21. SING ER, Charles; Short History of Medecine, London 1962. 22. TAYLOR, Henry Osborn; Greek Biology and Medecine, New York, 1922. 23, URDANG, G.; Pharmacy in and Rome, (Am Jour. of Pharm. Education, I. t. 7 (1943), The Role of Hippocretee=Semir Yahia EI-Gammal 135

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