A Brief History of Western Medicine
The history of western medicine is thick and wide, and is deeply tied to the history of humanity in the most global sense. Related to the economic, political, religious, and spiritual developments of the entire world, and with Europe in particular in terms of modern western medicine, for the purpose of this thesis I am only able to give the briefest overview. Mu goal is to build up a conception of western medicine that is adequate to understand the current western medicinal view of the heart, to determine western medicine’s view of the relationship between the heart, learning, and education.
As a lay person in medicine it is with no small amount of trepidation that I have endeavoured to offer a brief synopsis of the history and modern day tenants of western medicine. A good reason to begin with humour:
A Short History of Medicine
2000 B.C. – Here, eat this root.
1000 A.D. – That root is heathen. Here, say this prayer.
1830 A.D. – That prayer is superstition. Here, drink this potion.
1940 A.D. – That potion is snake oil. Here, swallow this pill.
1985 A.D. – That pill is ineffective. Here, take this antibiotic.
2000 A.D. – That antibiotic doesn’t work anymore. Here, eat this root…
The Ancient Roots of Western Medicine
The most ancient roots of western medicine are to be found in Mesopotamia, what many consider to be the cradle of the human race. From papyrus records of the ancient Egyptians, to the writings of ancient India, came wisdom and knowledge that influenced the ancient Greek conceptions of medicine and health. The great pantheon of the Gods was directly connected to the understanding of the human being, with Apollo regarded as the founder of modern medical sciences.
In ancient history it is the Centaur (half man, half horse) Chiron that is credited with inventing medicine. Chiron is the son of the Titan Kronos, and he tutored Achilles, Asclepios, Hercules, Jason, Aeneas, and Peleus. During a fight with the Ixion-sired Centaurs, Hercules accidentally wounded Chiron with a poisoned arrow, and Chiron then became known as the wounded healer. The relief of his suffering came through teaching and helping others.
Epidaurus was an ancient Greek city in the Peloponnese that was the most famous healing center in the ancient world. It was renowned for its sanitarium – a temple devoted to the healing god Asclepius. Asclepius was a mortal physician deified by Zeus after his death, for retrieving a patient from the underworld. Asclepius was typically depicted clutching a staff and flanked by a dog and a serpent – common symbols of wisdom. The cult of Asclepius began there in the 6th century B.C. and lasted until at least the second century B.C.
Empedocles (490 BCE – 430 BCE) was a Greek pre-Socratic philosopher and citizen of Agrigentum, a Greek colony in Sicily.
Empedocles’ philosophy is best known for being the origin of the theory that all matter is made up of four elements.
The Four Classical Elements:
Four fundamental elements: air, fire, water, and earth.
Four fundamental qualities: hot, dry, wet, and cold.
Four constituent humors of the body: blood, phlegm, yellow bile, and black bile.
The elements were regarded as being related to qualities in the human constitution and these in turn governed the respective humors. These four humors originated in the heart, brain, liver, and spleen respectively. Imbalance in the qualities and humors could be compensated by using drugs associated with the opposite qualities.
The First Medical Schools
The earliest medical schools linked to the evolution of western medicine are attributed to Cyrene in North Africa. it was in the medical school beside the shrine of Æseulapuis at Cos, that Hippocrates – the man who first placed medicine upon a scientific basis, was born and studied.
Seen as the father of modern medicine, it was through the teachings of Hippocrates that medicine left the realm of the Gods and became a science. Going against the thinking of his time, Hippocrates denied that illness was punishment meted out by the gods.
Hippocrates believed in the four humors of blood, phlegm, black bile, and yellow bile; and illness was seen as an imbalance in the humors. The treatments that he prescribed focused on bringing the humors back into balance.
The first rule of Hippocrates was to make a thorough observation of his patient to see what humors were out of balance. Then, a regimen of diet, activity, and exercise would be prescribed to balance the humors: a hot condition was treated with cool, dry with heat, etc. If this was not effective, drugs would be given in the hope of ridding the body of the imbalanced humor.
The internal structure of the human being was known primarily through comparison with animals, and from ideas based on what was outwardly visible, and from observable function.
A Summary of Hippocratic Medicine:
The patient was seen as a whole – it was the patient who was treated, not the illness or disease.
Treatment was based on the idea that nature heals, and the role of the physician was to assist that process.
Health was based on a balance of humors, and illness on a faulty mixture of humors.
Treatment through diet was supported rather then more violent means of the day such as purging, bloodletting, and vomiting.
Surgery was a last resort.
Kindness, dignity, and the virtues of cleanliness and agility were highly valued.
Hippocrates, and others of his time, developed theories and analogies that divided human nature into three spheres of function and location; reason in the brain, spirit in the heart, appetites in the liver. It was the role of philosophy via the gifts of reason, to keep the appetites in check, and the system in balance,. (p63 Porter)
The Hippocratic Writings
The Hippocratic Corpus is a collection of about sixty treatises, most written between 430 BC and 200 AD. As one can see by the dates the texts were written by several different people, grouped under the name Hippocrates. The writers may have been family members, students of Hippocrates, or students at the school at Cos.
The best know of the Hippocratic writings is the Hippocratic Oath; however, this text was most likely not written by Hippocrates himself. A famous, time-honored medical rule ascribe to Hippocrates is Primum non nocere (“first, do no harm”).
THE HIPPOCRATIC OATH
I SWEAR by Apollo the physician, and Aesculapius, and Health, and All-heal, and all the gods and goddesses, that, according to my ability and judgment, I will keep this Oath and this situation – to reckon him who taught me this Art equally dear to me as to my parents, to share my substance with him, and relieve his necessities if required; to look upon his offspring in the same footing as my own brothers, and to teach them this art, if they shall wish to learn it, without fee or stipulation; and that by precept, lecture, and every other mode of instruction, I will impart a knowledge of the Art to my own sons, and to those of my teachers, and to disciples bound by a stipulation and oath according to the law of medicine, but to none others.
I will follow that system of regimen which, according to my ability and judgment, I consider for the benefit of my patients, and abstain from whatever is deleterious and mischievous.
I will give no deadly medicine to anyone if asked, nor suggest any such counsel; and in like manner, I will not give to a woman a pessary to produce abortion.
With purity and with holiness I will pass my life and practice my Art.
I will not cut persons laboring under the stone, but will leave this to be done my men who are practitioners of this work.
Into whatever houses I enter, I will go into them for the benefit of the sick, and will abstain from every voluntary act of mischief and corruption; and further from the seduction of females or males, of freeman and slaves.
Whatever, in connection with my professional practice or not, in connection with it, I see or hear, in the life of men, which ought not to be spoken or abroad, I will not divulge, as reckoning that all such should be kept secret.
While I continue to keep this Oath unviolated, may it be granted to me to enjoy life and the practice of the art, respected by all men, and all times! But should I trespass and violated this Oath, may the reverse be my lot!
The successors to Hippocrates founded what is called the “Dogmatic School”, and they worked to take their masters’ work further. Personalities such as Diocles Carystius developed the science of anatomy, and strove to understand the relationship between symptom and disease; Praxagoras of Cos uncovered the diagnostic importance of the patient’s pulse.
The Anatomists (330-240 BC)
The early beginnings of the scientific method are found in ancient Egypt while inder the rule of Ptolemy’s. Anatomists Herophilus of Chalcedon and Erasistratus of Lulus conducted the first recorded systematic clinical trials by exact methods, and Herophilus wrote on the pulse as a tool for diagnosing illness.
The Anatomists attacked the doctrine of the four humors, and disease began to be looked from in the solid parts of the body.
The Atomist theory grew out of the anatomists, with Asclepiades of Prusa leading he way. This theory taught that health and disease were related to the motion of the atoms in the fine capillaries or pores which are found throughout the body, and it was either the contraction or relaxation of the pores that caused disease. This doctrine was simplified to included only a partial contraction or explanation, and did not have a direct relationship to anatomy or physiology.
Aristotle (834-322 BC)
Considered a great philosopher, Aristotle was a student of Plato, and a teacher of Alexander the Great.
As a philosopher, logician, biologist, and ethicist, Aristotle had great impact on the field of medicine through his creation of a scientific method of observing nature and teleology of explaining body parts according to their purpose. Aristotle was the first to use his dissection observations of animals as the foundations for his biomedical theories.
Seeing the beating heart as the first signs of life, Aristotle saw the heart as the center of the human soul and reason. Giving the heart to properties of heating the blood, it was this heat that expanded the lungs, allowing air to enter and cool the blood. It was the role of the brain, and an inherently cool organ, to also cool the heat of the blood, and to regulate the body.
The impact of Aristotle’s writings are seen until the middle ages, and emerged again during the Renaissance, when early Green texts were sought out and read in their original tongue. Aristotle’s work on human anatomy of the 3rd century was of such high caliber that it was not to be rivaled for fifteen hundred years.
Claudius Galen (129 – 199 AD)
Known simply as Galen, his is said to have considered himself the successor of Hippocrates. Galen went to Rome and revived the ideal of Hippocrates and other Greek doctors. He studied at the famous medical school in Alexandria in Egypt, and studied Philosophy and Medicine all over the Roman Empire. Galen made a deep and significant mark of the evolution of western medicine that was to last until the Renaissance.
Galen saw the basic principle of life as Pneuma (spirit) which was drawn from the general “world spirit” through the act of breathing. Pneuma entered the body via the
trachea, into the lungs and body through “arterial veins” (pulmonary veins) to the left ventricle of the heart where it mixed with the blood. Blood was made constantly in the liver from food eaten and digested, and thus was imbued with Pneuma of the natural spirit found in the earthly elements. The blood was filled with the power of growth and nutrition, and went out to the body via the venous system, and some of it seeped across tiny pores into the septum in order to get to the right side of the heart. There it mixed with the air and received its vital spirit, which then went out of the arteries to give the body activity.
In the tradition of Hippocrates, Galen put great emphasis on clinical observation, relying on a thorough examination of a patient and precisely noting their symptoms. Galen accepted the view that disease was the result of an imbalance between blood, phlegm, yellow bile, and blood bile. He also believed in the healing power of nature, and developed treatments to restore the balance of the four humors.
Galen was considered a rationalist; he believed that the physician must be a master of:
- logic (disciplined thinking)
- physics (the science of nature)
- ethics (the reflection on human behavior).
Seen as both a clinician and a medical scientist. Galen extended his knowledge of anatomy by dissecting pigs and apes and studying their bone structure and muscles. He did not do human dissections; he studied how the body worked, concentrating on the movement of blood and the working of the nervous system Galen was also a pioneer in the development of animal, vegetable, and mineral drugs and compounds. He has been credited with introducing experimentation to medicine, and was known to prescribe many different remedies to treat one illness.
Galen believed that his knowledge should be shared, and was a remarkable writer of books in his day, some 350 titles given to his credit. For many medical students his books were the primary source of medical information, and his work On the Natural Faculties remained the authority on medicine until the sixteenth century, even though many of his views about human anatomy were incorrect.
From the modern viewpoint, Galen’s theories were partially correct, partially flawed. Although he was incorrect about blood seeping across the septum, he did demonstrate that arteries carry blood not air, and made the first studies about nerve functions, the brain and the heart. In a major shift from the thinking of Aristotle, Galen argued that the mind was in the brain, not in the heart.
Michael Servetus (1511-15530
It was Servetus that proposed the pulmonary transportation of the blood, in direct opposition to Galen’s teachings of circulation. Servetus proposed a path of blood from the right to the left heart via the lungs. He figured that the size of the pulmonary artery gave ample clues to the idea that blood was being transported for more than just the lungs. It was the church’s teaching that the blood was the seat of the soul, and that the soul was breathed into man by God that lead Servetus to look for where the blood (soul/spirit) would interact with the air (God). The idea that air mixed with blood in the lungs was an unacceptable idea, which lead to the burning of both Servetus and his books.
The Ancient Romans to the Dark Ages
Through the Roman Empire expansion in to Greece, many Greek doctors came to Italy and Rome. Some were prisoners of war, and were purchased by wealthy Romans to work in their household, in time becoming valuable members of the household. Some of these men eventually bought their freedom and set up their own practices in Rome. After 200 BC, Greek doctors came to Rome on their own to practice their craft, and enjoyed success with the athletes, emperors, and the higher class Roman citizens.
Reminiscent of modern day beliefs, the Romans believed that a healthy mind equaled a healthy body. They also held the belief that if you kept fit you would be more able to combat any illness. (Medicine in Ancient Rome). The Romans believed that illnesses had a natural cause and that bad health could be caused by bad water and sewage. These thoughts lead to the creation of aqueducts, the famous roman bath houses, and public sewage systems. Roman cities, villas, and forts were built in what were considered healthy places: close to fresh water, fresh air, good sunlight, and fertile soil.
With the collapse of the Roman Empire, the medical advances in Europe almost ground to a halt. The destruction of all things Roman by the invading forces meant that many hygienic practices and advances in medicine were lost. The loss of stability in daily life brought by the upheaval of the invading forces also caused a general return to superstitious practices by the common folk.
The Middle Ages
From the Dark Ages through to the Middle Ages, magical cures abounded. There were few trained physicians, and quackery and superstition were a profitable business. Herbalists and folk remedies continued to be standard care, midwives were the experts in pregnancy and childbirth, and barbers and butchers were the dentists and surgeons.
In the middle ages it was the monastic libraries that protected and preserved medical manuscripts, which lead to monks and priests being dually trained as physicians. During this time it was the Arab and Jewish physicians such as Avicenna and Miamonides that continued the advancement of medical investigation, while the rest of Europe held fast to superstition and the ancient wisdom of Galen.
The Seed of Modern Medicine in the Renaissance in Europe
Both ancient Greek medical writings that had been translated, and medical advancements that were discovered by the Arab and Jewish scholars from Salerno in Italy, came to Europe through trade with Byzantium around 1100 AD. There were medical schools in Montpellier, Paris, Bologna, and Padua by the 13th century, and it was the texts from Padua that the scholar and physician Vesalius proved Galen had made mistakes on human anatomy by assuming similarities between animals and humans, and Paracelesus, Pare’ and Fabricius discovered the valves of the veins.
The development of medical qualifications began in the Medical Schools within Universities, with studies in surgery becoming a central focus. During this time Universities were quite medieval, and were not seen as moving toward scientific progress. Advancement is considered to have occurred in the Academies and Learned Societies, which were called the invisible schools, or free schools. Away from the eyes of the church it was here that one could challenge the ancient beliefs. An example of which is the Royal Society of London, which was charted in 1662.
In the middle ages the church in Europe regulated the healing activities; the relationship of the godly, including the soul of the body, took precedence over the earthly. The Church saw healing as its duty, and during the 13th and 14th centuries there were many religious healing shrines developed associated with religious relics. This lead to the establishment of hospitals throughout Europe that were related to religious foundations.
The long hold that the church had on medical advancement, urging people to be concerned with the afterlife more so than the problems of daily life, shifted to the renaissance desire to understand everything material. The works of Desiderius Erasmus (1466-1536) lead the way to the reintroduction of ancient Greek work on medicine. (P169 Porter) The creation of the printing press heralded a production of new books, which had formerly been held by the religious realm via monasteries.
The Birth of Modern Medicine
William Harvey (1578-1657)
In 1628, the English physician William Harvey demonstrated the circulation of blood, and described the heart as the center of the circulation system. This brought to an end the hold that Galen’s teachings had on scientific thinking. Harvey’s discovery in the western world is the point in medical history when medical science exploded with new discoveries in every area, and say the beginning of the removal of the souls an animating force in the human being, and a move towards scientific empiricism.
The wars in Europe in the 18th century provided the momentum for advancements in wound care, surgery, and further understanding of human anatomy, For the first time in western medicine, the connections between abnormal conditions of the organs, and the corresponding bodily symptoms in the living body, occurred. There was a move away from the function of the human body to the structure of the human body that clearly marks the birth of Modern Western Medicine as a separate system.
From the 1800s to 2006
The explosion of modern western medicine continued from the 1800s to today, with a depth and breadth that is astonishing To list the discoveries of the leading researchers and doctors would require a piece of work the likes of Roy Porters book The Greatest Benefit to Mankind. For the purposes of this paper what we can notice is that with the advent of the microscope and the discovery of the cell, modern western medicine became very materialistic in its approach to the human body (P233 Porter), with the conquest of disease the focal point.
Medical research since the 19th century appears to have conformed to the ‘Gospel of Specific Etiology’ i.e.
“if we can understand the causative agent of a disease, or the specific molecular events of the pathological process, then we can totally understand and control the disease.”
In 1953, at Cambridge University in England, the “secret of life” was discovered by Francis Crick and James Watson when they announced that they had unraveled the chemical structure of the fundamental molecule of heredity – deoxyribonucleic acid (DNA). This lead to science and medicine investigating the basis of molecular genetics, gene therapy, and the culmination seen in the human genome project, were scientists are racing to identify each DNA pairing of the human genetic code.
In modern western medicine, the organization of the body is understood through the following systems:
- Skeletal System: the framework that the rest of the body rests on. It includes the bones, the bone marrow which produces red and white blood cells, and the minerals stored in the bones.
- Cardiovascular System: this system pumps blood around the body, supplying oxygenated blood and the removal of waste products.
- Nervous System: the brain is the center of creativity and consciousness, and controls the rest of the body via the spinal cord and nerve branches. The nervous system works with the endocrine glands to monitor and maintain other systems.
- Endocrine System: Hormones – the chemical messengers of the endocrine glands and specialized tissues of other organs. Hormones circulate in the blood and the other body fluids maintaining a balanced inner environment. The endocrine system initiates puberty and governs the metabolism.
- Muscular System: making up almost half of the body’s bulk, muscles work with the skeleton, generating the energy to move the body in every way, including speech. There are voluntary and involuntary muscles; the cardiac muscle and all of the muscles involved in the respiratory system and digestive system.
- Immune System: it is this system that defends the body against infectious diseases and malfunctions of the internal systems of the body. This system is an intricate, interrelated system of physical, cellular, and chemical defenses.
- Respiratory System: the respiratory tract works with the breathing muscles, and carries air in and out of the lungs, where gases are exchanged. This system carries gases to and from all of the body tissues, supplying oxygen and removing the waste product carbon dioxide.
- Digestive System: this system consists of thirty feet of tubing between the mouth and anus, and completes the functions of storing food, digesting food, eliminating wastes, and using nutrients. This system is healthy when the immune and nervous system is healthy.
- Reproductive System: the body’s biological center piece, although unlike any of the other systems, it operates only for part of the human’s life span. It is also the only system that can be removed without threat to the person’s life.
- Urinary System: the kidneys produce urine for the purpose of eliminating body waste and help to maintain the body’s water and chemical balance. The production of urine by the kidneys is impacted by blood flow, blood pressure, hormones, and body rhythms and cycles such as sleeping and waking.
The Clinical Disciplines of Modern Western Medicine include:
Anesthesiology Dermatology Emergency medicine – General Practice Hospital medicine – Internal Medicine – Cardiology – Endocrinology – Gastroenterology – Hematology – Infectious Diseases – Intensive care medicine – Nephrology – Oncology – Pulmonology – Rheumatology – Neurology – Obstetrics and Gynecology – Palliative care – Pediatrics – Physical medicine and rehabilitation – Preventative medicine – Psychiatry – Radiation therapy – Radiology – Surgical specialties – Orthopedics – Urology – Ophthalmology – Neurosurgery – Plastic Surgery – Otolaryngology – Urgent care – Gender-based medical studies.
Basic Tenets of Western Medicine
The following is from a speech given by a medical doctor to his colleagues in 1999
The Hippocratic Oath is also still relevant. It is the basis and symbol of the high ethical standard of Western Medicine. Even today, its basic tenets are still very much in place. These tenets are: 1) to save lives, never to take them; 2) to avoid improper relationships with patients including sexual ones; and 3) to protect patient confidentiality.
The Modern Western Medicine View of the Heart
Seen as a dynamic pump, the heart believed to force blood around a vast network of blood vessels, in response to the body’s experience of stress and exertion. (P106 The Human Body) The heartbeat cycle is seen to be related to three sequences: diastole which is a relaxing and refilling of the heart with blood, atrial systole wherein the atria contract, squeezing remaining blood from the atria into the ventricles, and ventricular systole when the valves at the exit of both ventricles open and blood is forced onto the aorta and pulmonary artery. Then the whole cycle begins again. The regular and rhythmical beating of the heart is seen as being maintained by electrical impulses from the sinoatrial node located in the heart. The vagus nerve is seen as playing a major role via the sympathetic nervous system by setting a resting pulse rate of 60 to 70 beats per minute when the body is at rest. In western medicine illnesses of the heart are attributed to genetic factors, diet, the environment, and lifestyle. It is the brain that produces emotions, and the blood brings nutrients to all parts of the body. All notions of spirit and soul have been removed from the conception of the human body.
It is interesting to not that the heart is the one organ of the body that does not suffer from cancer.
Links between the heart and non-physical influences are generally focused on environmental and emotional stressors, with the prevailing ideas about the heart being biological, measurable, and mechanical.
“For most of us the heart has a special symbolism, being linked with emotions and virtues such as love and courage. In fact, it is simply a pump. The links between the heart and the emotions date back to ancient times, when the heart was not well understood.”
-Davies, Goode P., and Park, Edward. The Human Body, The Heart: The living Pump. Washington, D.C., U.S. News Books, U.S. News & World Report Inc. Page 101
History of Western Medicine and Surgery by E.J. Mayeaux Jr. M.D.
Porter, Roy. 1997. The Greatest Benefit to Mankind, A Medical History of Humanity. New York, N.Y., HarperCollins Publishers Lt.