FROM EPIDAUROS TO GALENOS THE PRINCIPAL CURRENTS OF GREEK MEDICAL THOUGHT* By A. P. CAWADIAS,

O.B.E., M.D. DURH., AND PARIS, M.R.C.P., LOND.

LONDON

HE object of this paper is to that unites the irrational medicine of show the evolution of Greek the ancient Eastern people to the medical thought from the scientific medicine of the Greeks. practices of religious medi- In the scientific medicine of the cine, as symbolized by the Faith-healGreeks- four periods can be distin- Ting of Epidauros, which forms the guished. Every period is based on link with the pre-Hellenic or irra- physiological work, and it is in part tional medicine, to the death of the application of this physiological Galenos which marks the end of the work to medicine, and its develop- creative period of Greek medicine. ment through special clinical methods For the understanding of this im- of diagnosis and treatment that char- portant period of the history of acterizes the medical work of every medicine, the history of the Greeks, in period. Physiology, taken in its large general, must be taken into considera- sense, that is, including anatomy, is tion; and principally the work of the the scientific basis of medicine, and physiologists and philosophers, who thus the only way to understand the mark the various stations of Greek evolution of Greek medical thought thought, must be studied. Greek medi- will be to place distinctly at the cine bound with Greek thought, in beginning of each period, the physio- general, shows a remarkable progres- logical work on which this period is sion, from the first conceptions of based. nature, of life, of disease due to the The first period can be called the physiologists, philosophers and physi- physiological period. The physiolog- cians of the seventh and sixth cen- ical work on which the practice of turies b .c . to the complete knowledge these early physicians is founded is of physiology found in Galenos. that of the ancient Ionian philosophers Medicine is a creation of the Greek called in Greek Physiologists, such as intellect. Before the advent of the Thalles of Miletus. To this period of Greeks the people who had preceded Greek medicine belong the old schools them in the history of the world had of Magna Graecia, that is of the an attitude towards disease which did Greek colonies of the south of Italy not correspond to real medicine, which and Sicily. During this period the basic is based on science. Medicine before concepts of medicine are founded, the Greeks was mostly religious, magi- diagnosis is introduced, on the basis cal, irrational. Epidauros, and in gen- principally of physiological deduction eral the cult of Asclepios represents controlled by a rudimentary clinical the religious medicine of the Greeks, examination, and treatment begins and constitutes therefore the link on the basis of a combination of * Paper read before a meeting of the Royal Soeiety of Medicine at the Wellcome His- torical Museum, on January 30, 1930. On the occasion of the 18th Centenary of Galenos. deductions from physiology and of ritus and Diogenes of ApoIIonia, and clinical control. This period com- is represented by the late Italo-Sicilian prises the seventh and the sixth physicians and the famous schools of Cos and Cnidos. The conception of the mechanism of disease becomes more precise and the clinical method of diagnosis and treatment reaches its zenith, from the combination of the nosographical method introduced by the physicians of Cnidos, and that of the individual diagnosis developed by the physicians of Cos. This period comprises the fifth and the fourth centuries b .c . The third period receives a great impulse from the physiological work of Aristotle. It is characterized by a tendency to base diagnosis and treat- ment on rational lines, that is on deductions from physiology. This tend- ency does not succeed completely, and that is why many physicians remain faithful to the clinical methods of the previous period, while others fall into an exclusively physiological dogmatism, which brings as a reac- tion, as another dogmatism, the devel- opment of the school of the Empirics. The fourth period is represented by the work of Galenos. He is the physiologist on whom the medical work of the period is based and he is at the same time the physician who applies that medical work. The physi- ology of Galenos marks a great prog- ress over that of Aristotle and of the Alexandrians, on account of the intro- duction by Galenos of the experi- mental method. From a medical point of view this Galenic period is charac- terized by the predominant role the centuries and the early fifth century physiological method plays in diagno- B.C. sis and treatment. The second period begins with the The fifth period is the period of work of the physiologists of the fifth compilation and transmission of Greek century b .c ., Anaxagoras, Democ- medicine to the West. Epidaur os As a form of religious medicine Epi- The study of the principal currents dauros represents also the Hellenic of Greek medical thought begins with spirit regarding religion. There were Epidauros for two reasons. Epidauros, no inscrutable mysteries, no magical being the most celebrated shrine of the procedures, no manifestations of theoc- God of Medicine, of Asclcpios, sym- racy in the practice of Epidauros. bolizes Greek medicine. It is in the Those who came there were simply neighborhood of this famous temple, put into a good condition, so as to that according to some beautiful receive the effects of the religious legends, Asclcpios was born as son of suggestion. They came into a beautiful Apollo the God of Art and of the country, where they forgot all the beautiful Koronis, and it is on the worries of life, by listening to Mount Tithion, that is near the actual theatrical representations given in sanctuary, that the child Asclepios that marvelous theater of Polyclctos, was kept by a shepherd and nourished which remains today the masterpiece with the milk of a goat. of Greek theatrical architecture. They Apart from that, Epidauros is inter- visited the musical places, watched esting because it is the most important the athletic games at the Stadium, place of Greek faith-healing, and and conversed about politics or philos- represents a sort of transition between ophy with the people who had come the pre-Hellenic medicine, which was from all parts of Greece. At the cor- nearly exclusively religious, at all ners of the shady alleys, they could events magical and irrational, and read the steles on which were written the Greek medicine which was rational the miraculous cures of the God of and scientific. It may appear curious Medicine. that in the ultra-rational Greece religi- When they were thus well prepared, ous medicine, as has been demon- they were put to sleep in the Abaton, strated by the work of P. Cawadias, and the God appeared in their dream played such a great role. But this is acting as a physician, manipulating easily understood when one remem- their diseased limbs, applying an bers the marvelous sense of proportion ointment on their sore eyes, and the ancient Greeks brought into all pushing the similarity to the physi- their work. The Greek physicians cian so far as to recommend to the knew that the power of mind over patient not to forget to pay his fee to body was very great, and they knew the priests. When the patient awoke, also that nothing could have such a he was cured. power over the mind as religion, and One sees that there was a great thus they did not do anything to hin- difference between the religious medi- der the evolution of religious medicine. cine of Epidauros and the religious On the other hand the priests of medicine of the Egyptians, the Assyr- Asclepios realized that there were ians, the Babylonians and the Jews. limits in the action of mind over body, The patients who came to Epidauros and that their God could not do every- were not considered as possessed of thing, and they were probably very gods or demons, but as suffering from careful to send to the physicians disease explained by the laws of phys- who had their schools near the tem- ical nature. There was no practice of ples of Asclepios, the organic cases. magic, no manifestations of theocracy, but pure, one could say, rational century did not experiment in the psychotherapy. There was no exclu- actual sense of the word, but it is not siveness, and the collaboration of the experimentation but the critical con-

scientific physicians was often de- sideration of facts of observation and manded. The Greeks had in the experimentation that constitute the matter of religion ideas explained in science of Physiology. Thus these the story of the man who while drown- Greek physiologists were really the ing was invoking Pallas Athene, and first physiologists. They did not study to whom one of his companions man or animals or plants alone, but said, “continue to invoke Athene, all nature, because it was the only but try also to swim.” Zup ’Adr)v& method through which the place of [xai x^pcr pivec. man in Nature could be ascertained. First Per iod of Gre ek Medi cine (Sev en th , Thales of Miletos believed that water Sixth and Earl y Fift h Cent ury , was the primary element from which The Fir st Phys iologi sts (Seventh all matter was formed, and Anaxi- Centu ry ). Scientific medicine be- mander of Miletos explained the origin gins with the first physiologists who of man by various transmutations. flourished in the beginning of the It is on the work of these first physiol- seventh century. It has been remarked ogists that the first phase of Greek that the Greeks called not those who medicine is based. are designated today with this term, The Medi cal Scho ols of Crot on , but philosophers trying to unravel an d of Sici ly . Sixth Cent ury . the problems of Nature. This distinc- Three names dominate the medical tion is not justified. Of course the school of Croton, those of Pythagoras, Ionian physiologists of the seventh of Alkmeon and of Democedes. They nourished about the sixth century the perfect equilibrium of the organs b .c . The School of Agrigentum is of the body, in the perfect correlation represented by Empedocles and by of these organs and that disease

Acron who flourished in the fifth consists in the disturbance of that century b .c . equilibrium, the disturbance of that With Pythagoras the physiologist correlation. The terms have changed a becomes a physician, and the doctrines little, but the idea remains the same. of the first physiologists of Ionia, In medicine as in all other branches from which place Pythagoras origi- of human activity, the ancient Greeks nated, are transmitted to the Greek struck at once the right principles. colonies of Italy and of Sicily. With Empedocles of Agrigentum Physiology remains the basis of this conception is simplified. Instead medicine but takes a more precise of the eleven principles of Alkmeon, form. The human body for Alkmeon Empedocles admits only four, Earth, is constituted of various elements, Water, Fire and Air. such as Cold, Damp, Warm, Dry, Bitter, Sweet. Health is the perfect To the elements it came from equilibrium the taovoVta of these ele- Everything will return, Our bodies to earth ments. Disease is the rupture of that Our blood to water equilibrium resulting in the preponder- Heat to fire ance, the fj-ovapxla of one of them. Breath to air. Today we say that health consists in Matt hew Arnold : Empedocles on Etna Apart from this basic conception on physiological considerations or on of disease physiology progresses with the result of precise clinical observa- the precise work of dissections carried tions. This contrasts with the enor- on by Alkmeon and Empedocles. mous quantity of drugs used by thcv Diagnosis and treatment were based Egyptians and the other ancient East- \\ in great part on physiological consider- ern people on the basis of mystical ) ations, that is on the conception of considerations, which of course were what was going on in the body of the absolutely foreign to the Greek patient and the treatment of this physicians. disturbance, was deduced from phys- The addition of empiricism to the iological knowledge. It must be said high physiological speculations of the at once that this is not absolute and Italo-Sicilian physicians is also demon- that the Greeks, except during the strated by the preventive medical period of decadence of Greek medicine, work of Empedocles, who freed never used an exclusively deductive Selenus from a pestilence, probably physiological method of diagnosis and malaria, by draining swampy lands, of treatment. That the physicians of and who improved the hygienic condi- Croton and of Sicily were at the same tions of his native town by various time good clinicians, is demonstrated works. The clinical empirical method by what we know of the practical appears even to have been greatly clinical work of Democedes, a Cro- developed among the later repre- tonian physician of the sixth century sentatives of this school. Acron of b .c . famous for his clinical work in the Agrigentum (fifth century b .c .) taught court of Darius. distinctly that empiricism must be The therapeutical procedures of preferred to speculations, and is con- these schools were built on rational sidered as the originator of the empir- and clinical empirical lines. Many of ical school. According to Plutarch, their methods, as for example the Acron combated an epidemic by means dietetic prescriptions of Pythagoras, of funeral pyres. consisting in the limitation of meat Thus with the first physicians of eating and in the avoidance of fish the Greek towns of Italy and Sicily were based on physiological and philo- the general conception of disease is sophical conceptions. The clinical con- given, precise physiological work be- trol was however very important, and gins, diagnosis is developed on the it is to the clinical observations of lines of physiological methods tem- these physicians on the action of pered by a rudimentary clinical obser- gymnastics and diet in general that is vation, and treatment develops on based the introduction of these thera- the basis of a combination of the peutical methods. The fact that only rational or physiological method, and a sound physiology, at all events for of the empirical or clinical method. that epoch, and a precise clinical observation, guided their treatment, Seco nd Per iod of Gre ek Medic ine (Fift h is also demonstrated by the absence and Fourt h Cent uries b .c .) of drugs in the practice of the first Philos oph er Physic ians of the Greek physicians, an absence which Early Fifth Centur y . The First was instituted because the use of Humorist, Solidistic and Pneumatic drugs could not at that time be based Doctrines. The second phase of Greek medicine is based regarding its phys- Democritos of Abdera, one of the iopathological conceptions on the greatest philosophers of the ages, and work of three physiologists (or phi- also a great physician whose numerous

losopher physicians) of the early fifth medical works unfortunately have century b .c ., Anaxagoras of Klazo- disappeared, develops the teachings mene, Democritus of Abdera, Dio- of Leucippus and introduces the genes of Apollonia. This work brings Atomic theory, of which Carnot said the conception of disease on a more rightly that “none of the ideas that precise basis. Instead of considering antiquity has bequeathed to us has in man vague elements, like the Cold, had a greater or even similar success.” Dry, Damp, Bitter, Sweet of Alkmeon, The body is constituted of small and the Fire, Earth, Air, Water of solid particles, the atoms separated Empedocles, they consider elements by pores. Health is the right relation of more definite constitution, the Air, between atoms and pores. Disease the Humors, the solid parts. Thus is the disturbance of this equilibrium, physicians begin, instead of consider- therefore a disturbance, not of the ing the disturbance of the same vague humors, but of the solid parts. The elements, to consider the disturbance pathological applications of this of Air, Humors and Atoms or solid atomic theory exist in germ in Demo- particles. critus, but they will be developed Anaxagoras introduces the knowl- much later, by Erasistratus and by edge of humors by describing the bile, Asclepiades. of which he distinguishes two varieties, Thus with these three great phi- the black and the yellow. He himself losopher physicians, the general con- attributes disease to a disturbance of ception of disease takes a more definite the bile. This is the origin of the form, and from their time date the humoral theory of disease. three separate conceptions of disease Diogenes of Apollonia introduces which have divided medicine until the notion of pneuma. Pneuma is in our days, when they have been com- general air, but an air that has a bined in the Neo-Hippocratic theory. special constitution, that is even en- These doctrines are the short-lived dowed with intelligence, and pene- pneumatism, solidism and humorism. trates all bodies. This conception will On the basis of the work of these give rise later to the Pneumatic physiologists this period of Greek doctrine of disease. medicine will be characterized by a more precise conception of the as to precision in diagnosis that they mechanism of disease, but at the same are famous. time it will develop to a high degree The physicians who flourished be- clinical methods. fore the Cnidians considered the only The Late Italo -si ci li an Scho ols . reality in medicine, the diseased indi- Although eclipsed by the splendor of vidual. But the morbid phenomena their contemporary schools of Cnidos are extremely numerous and of great and of Cos, the late Italo-Sicilian variety. A method had to be found so schools continued to flourish, and as to put a certain order in this multi- amongst these late Italo-Sicilian phy- plicity of phenomena, so as to classify sicians (of the fifth and the fourth medical knowledge, and to give a safe centuries) two names must be remem- basis for diagnosis. This method was bered regarding the history of the found by the Cnidians, and consists in conception of disease. the introduction of the fictional con- Philolaos of Croton was perhaps the ceptions “of disease.” The physicians first to formulate the humoral theory of Cnidos observed that many morbid basing his work on that of Anaxagoras. phenomena, that is symptoms, shown Disease for Philolaos was determined by various individuals occurred with by certain environmental factors such a certain regularity and in a certain as too little heat, or bad food, which combination, they abstracted these brought about a disturbance of bile, combinations of symptoms from the blood and phlegm. diseased individual and constructed Philistion of Lokri, was the first to fictional species, which they called formulate the pneumatic conception “diseases.” Since that period medical of disease. He considered that health work has been ordained following this consisted in the right respiration and division into morbid categories, or exchanges of air through the pores, “diseases,” and also diagnosis and and that in disease, the disturbance treatment has been based on these of that respiration played a prepon- determinations of such “diseases.” derant role. The physicians of Cnidos knew The Scho ol of Cnid os . From a that the pure nosographical diagnosis physiological point of view the Cnidian was not sufficient, and that disease physicians follow the conceptions of was, as we say today, a fiction. They the early schools of Croton and knew how to pass from the “disease” Sicily, and the teachings of the philos- to the diseased individual, and the opher physicians of the fifth century. opposition which is often given in The most famous of the Cnidian various academical discourses between physicians, Euryphon, adds a more Cos and Cnidos did not really exist. precise conception as to the mecha- It is often said that the physicians of nism of disease, by demonstrating that Cnidos had as their sole object the disease is determined by the accumula- diagnosis of the “disease” and based tion of undigested food. He gives their treatment on that diagnosis, and therefore the first conception of that, on the contrary, the physicians alimentary toxemia. of Cos had as their sole object the The great work of the Cnidian diagnosis of the diseased individual physicians was made on clinical lines, and based on that “diagnosis of the and it is regarding the great advance person” their treatment. This idea is based on the erroneous interpretation the conception of disease. In fact his of certain texts. It must not be for- method forms also the basis of the gotten that personal rivalries played a diagnostical and therapeutical meth- great role in the life of the ancient ods followed by all great physicians of Greek physicians. The Cnidian physi- all centuries. Hippocrates bases his cians introduced disease as a means of diagnosis, in part at least, on noso- classification of medical knowledge, graphical considerations of the “Per- and as a stepping-stone, but they were son.” But from the diagnosis of the not ontologists. Like the Coans, like “disease” which is for him only a step- all other Greek physicians, they knew ping-stone he passes to the diagnosis how to pass from the “disease” to the of the patient. This part of diagnosis diseased individual. constitutes his greatness, and it is in The Scho ol of Cos . The School of the school of Cos that the real origin of Cos is dominated by the figure of personal diagnosis is found, as in Hippocrates the greatest of physicians Cnidos the origin of nosographical of all ages. Hippocrates made a great advance diagnosis. Cos and Cnidos are the two in the conception of disease. He bases pillars of medical diagnosis, and there- his work on the doctrine of equilib- fore of treatment. rium, of the Magna Graecia physi- His personal diagnosis Hippocrates cians, and on the theory of humors himself bases on the most accurate of Anaxagoras. He considers that clinical observation. He examines care- disease is explained by the disturbance fully the symptoms shown by the of the equilibrium of these humors, patient; he examines also the etio- but makes two additions of great logical conditions which have presided importance. The first is, as we say on the occurrence of disease, and today, the principle of constellation of basing his work on examination he etiological factors. This disease, this tries to find out what really happens disturbance of humors is determined in the body of the patient. For that by the action of changes of the part of his diagnosis he has of course environment, whether these changes to take also into consideration his are meteorological or alimentary, or physiological knowledge, but with due to defective hygiene in general. him physiology is the guiding star The second addition to the concep- only. He does not base himself wholly tion of disease, and by far the most on physiology, and if he comes to important, is the doctrine of the any physiopathological conception, he Physis. The body itself tries to restore controls it strictly through clinical this disturbed equilibrium Hippo- to do. It is also distinguished from the cratic Theory. physiological (or dogmatic method) Diagnosis and treatment advanced because with Hippocrates physiology with Hippocrates much more than is not the basis of diagnosis or of treatment, but serves only as a guide great impulse towards the introduc- for clinical work. tion of more precise physiological con- The pupils of Hippocrates expanded siderations which characterizes this the doctrine of the master. Two of phase of Greek medicine. them Diocles of Carystos and Praxa- The Scho ol of Alexandr ia . goras of Cos and also the sons of With the Alexandrians the physio- Hippocrates, Thessalus and Dracon, pathological conceptions make a great laid stress on physiopathological con- advance. Herophilos remains faithful ceptions more than was done by the to the humoral doctrine, Erasistratos Master; in fact they tried to find out a believes that the elements whose dis- physiological, a rational basis for turbances bring disease are not the disease and thus they form a transition humors, the liquid elements of the with the third period of Greek medi- body, but the solids, because his cine in which the physiological method anatomical dissections had taught became preponderant. him to think in terms of organs. From a vague theory the conception of Thir d Per iod of Gre ek Medic ine . (Third disease passes into a more precise Cent ury b .c . to Sec ond Cent ury a .d .) knowledge due to the accurate dis- This period extends from the foun- sections of experimentation. dation of the School of Alexandria in To the method of diagnosis of the the early third century b .c . to the Alexandrians, which was influenced birth of Galen (130 a .d .). It is charac- by important additions of physio- terized by the progressive importance pathological researches, was added up of physiological knowledge and by the to a certain point the general lines preponderance of the physiological of the Hippocratic method. They method in the approach of disease, themselves based their work on no- contrasting with the Hippocratic or sography and the more so that Cnidos clinical method. The physiological played a great role in the establishment method degenerates into dogmatic of the school of Alexandria. From considerations and as a reaction the the disease they knew how to pass school of the Empirics is founded to the diseased individual, keeping which repels all the physiological always to a strict clinical observa- considerations. Some physicians return tion, but for their general classifica- to the Hippocratic method. tion, and for the treatment of the Aristotle is the physiologist who disturbances of the diseased indi- can be considered as the originator viduals, they themselves based their of that new period of medicine. With work also in great part on their this great master biology, and espe- physiopathological conceptions. In cially physiology, are no more limited fact the great Alexandrians, regarding to vague elements or to vague Pneuma, the method of diagnosis, can be Humors, Atoms. A careful study of described as Hippocratists, but with embryology, anatomy, and of the a greater tendency towards physio- working of the mechanism of the body pathological deduction. is made. This physiological work The Dogmatic School s . This which will be continued by the two tendency to base diagnosis and treat- great Alexandrian physicians Hero- ment on physiopathological concep- philos and Erasistratus, gives the tions reaches a high degree in the so-called Dogmatic Schools. These Thessalus of Tralles, a physician of the schools differed from those of Hero- first century a .d ., neglected com- philos and Erasistratus on the one pletely the clinical method of diagno- hand, because clinical observation sis and treatment, which were based plays in their practice a much less purely on physiopathological concep- important role, and deductions from tions derived from those of Ascle- physiology a much greater, and on the piades, but compressed into a rigid other hand because their physiology dogmatic formula. For them, all dis- is compressed into simple formulas, eases depended upon abnormal condi- into rigid dogmas. The most cele- tions of the pores, abnormal conditions brated dogmatic physicians are classi- which were only of two sorts, those fied into two groups, that of the resulting in a condition of tension, and Methodists and that of the Pneu- those resulting in a condition of relaxa- matists. The school of the Methodists tion. There were therefore two com- was founded by Asclepiades of Bithy- munities of disease, and only two nia in the first century b .c . Asclepiades methods of treatment. himself was not very rigidly dogmatic; The rival dogmatic school, that of he developed the general conception of the Pneumatists, was also constituted disease by reintroducing into medicine by physicians who based their diag- the atomic theory of Democritus. For nosis and treatment on physiopatho- him disease did not consist in dis- logical theoretical conceptions derived turbances of the equilibrium of the from the doctrine of the Pneuma. humors, but in a disturbance in the The Empi ric s . One sees where relation between atoms and pores, the exclusive use of the physiopatho- that is, in a disturbance in the equilib- logical method was leading medicine. rium of the solid parts of the body. Diagnosis and treatment cannot be Contrary to the doctrine of Hippoc- based on physiological knowledge rates he denies the existence of cura- alone. Hippocrates had already tive forces, that is of the physis, in demonstrated that physiology is only the living being; thus the work of a sort of guide to clinical observation, Asclepiades marks a difference in the which remains the only method in general conceptions of disease by the medicine. consideration of the solid parts of Even a more or less scientific the body. But it marks also a retreat physiology cannot be taken as sole on account of the neglect of the physis.] basis for diagnosis and treatment, Regarding his method of diagnosis and that had been demonstrated by and treatment Asclepiades can be the great Alexandrians themselves. compared to the great Alexandrians, When instead of a broad and scientific because he used clinical observations physiology a compressed physiological to understand and to treat the patient; dogma is taken as the basis of diagno- but as the great Alexandrians, and sis and treatment, the result is often perhaps more than they did, he worse. The development of this one- based his work on physiopathological sided physiological approach to dis- conceptions. ease, and the practical non-success in The pupils of Asclepiades and prin- which it resulted, brought as a reac- cipally Themison of Laodicea a physi- tion, the origin of another very famous cian of the first century b .c . and school, that of the Empirics. This school started as an immediate conclusion by analogy directed for the offshoot of the school of Alexandria in treatment only. In fact for the Empirics the third century b .c . and its origins diagnosis was treatment, the similarity were greatly helped by the teachings of the syndromes furnished them with a of Pyrrho, the chief of the sceptical clue to the necessary remedy, and the philosophers. similarity of action of certain remedies The first great Empirics of the pointed to a correspondence in mor- third century were Philinios of Cos bid manifestations. Their favorite and Serapion of Alexandria. Other motto was “the important question great Empirics flourished later, such is not what causes disease, but what as Glaucias of Taras in the second dispels it.” century b .c . and Heraclides of Taras, Late Hippocr ati sts . Tired of the the Prince of the Empirics in the one-sided view of the Dogmatists first century b .c ., Menodotus, ofNico- and the Empirics, many Greek physi- medea in the second century a .d . It cians returned to the Hippocratic is to the Empirics that the pharma- Method. They used once more the cologists are attached, that is, the accurate bedside observation of symp- physicians who studied on man the toms and of the etiological condi- effects of drugs and of poisons, tions, which had determined the the most celebrated of them being Dio- occurrence of disease, and tried thus scorides, who lived in the first century to gain knowledge of what was occur- A.D. ring in the body of the patient, of the The Empirics did not develop the physiopathological disturbances which conception of disease or the knowledge were taking place in the body of the of its mechanism; in fact they con- patient. They used also as a guide in sidered that it was unnecessary and their interpretation of symptoms impossible to try to find out what their physiological knowledge, richer really happens in the body of the than in the days of Hippocrates, but patient. Their method of diagnosis taking great care not to let physiologi- and treatment was based purely on cal conceptions ^dominate their diagno- clinical observation. They studied sis and treatment. Three great physi- their patients, they grouped the symp- cians of the firstScentury a . d ., Rufus toms into symptom complexes, which of Ephesus, Soranus of Ephesus and they called syndromes, and they tried principally Aretaios of Cappodocia to find out what therapeutical can be described among these late methods were good in one or another Hippocratists. combination of symptoms. They developed to a very great Fourt h Per iod of Gree k Medi cine Gale nic . (130-200 a .d .) extent the method of clinical observa- tion, and based it on what is known Galenos .1 In the history of med- as the Tripod of Glaucias, that is on ical thought Galen must be considered the independent observation made by as representing an epoch of medical accident or by experiment (t ^ot ), on thought by himself. Like the Ionian the record of observation of others physiologists of the seventh century (iffropla) and on the conclusion by anal- 1 The word Galenos and (not Galen) is used ogy (H a&o tou opyiov apoXovdia), this because it corresponds to the Greek o Xtjvo s - b .c ., like the physiologists of the fifth the other Greek physicians of the century b .c ., Anaxagoras, Democritus, last three centuries b .c . and of the Diogenes of Apollonia, like the great first two centuries of our era, had fol- physiological pioneer of the fourth lowed the route traced by Aristotle. century, Aristotle, Galenos did an Basing himself on this physiological important physiological and philo- work Galenos accentuates, from a sophical work, which should have diagnostical and therapeutical point marked the beginning of a new phase of view, the physiological method of of Greek medicine. Unfortunately this diagnosis. Many physicians who came work was done in a period in which after Aristotle, as we have seen, ' the creative genius of the Greeks was tried to diagnose their patients, basing at a low ebb, and the only physician their deductions on their physiological who could base his researches on knowledge, but controlling it to a this important physiological work was great extent through clinical observa- Galenos himself. The physiology of tion. They thus simply modified the Galenos marks a great advance. The Hippocratic method by introducing a first physiologists of the seventh cen- great deal of physiological deduction. tury had given a vague notion of Galenos places the whole of his diag- elements. The physiologists of the nosis and treatment on physiological fifth century had given a greater deductions. Galenos the physician precision by introducing the notions is carried away by the discoveries of pneuma, humors, atoms. Aristotle of Galenos the physiologist. His meth- had directed physiology towards a od, from a purely medical point of view, more precise knowledge of the func- used exclusively, is wrong, because tions of life, of the functions of the diagnosis and treatment cannot be various organs and systems. Galenos based on physiological knowledge, advances that work of Aristotle by that is on a knowledge which changes introducing, and this is his immortal every day; but although his method title to fame, the experimental method, was wrong, the role he attributed to and thus reaches, regarding the func- physiological knowledge in diagnosis tions of circulation, of digestion, of has come into medicine to stay, and the nervous system, of all the other in contemporary medicine, although, systems and organs a great precision of course, the preponderant role in in knowledge. This is the place in diagnosis and treatment is held by history of Galenos the physiologist. clinical observation as in the Hippo- Galenos the physician, uses that cratic method, the process which physiological work as a basis as the makes us interpret all symptoms and physicians of Croton and of Sicily signs so as to discover what really had based their work on that of the occurs in the body of the patient first Ionian physiologists, as the late is based on physiological knowledge Italo-Sicilian schools and the schools and much greater than in the original of Cnidos and of Cos of the fifth Hippocratic method. and sixth centuries had based theirs With Galenos the creative period of on the work of Anaxagoras, Demo- Greek medicine ends and another critus, Diogenes of Apollonia. As period begins with the compilation the schools of Alexandria and all and transmission period. This, too, merits study because it is of great Greek medicine was transmitted to significance for medicine in general, the West, and to the World all over. because it is through the work of these Of the legacy bequeathed by ancient last Greek physicians, those who Greece to the world, medicine is worked between the death of Galenos without doubt the noblest, the great- and the fall of Constantinople, that est part.