Balkan Military Medical Review
Apr - Jun 2013; 16(2): 92-98
Review Article
The Concept of Health in Ancient Greek Medicine
Emmanouil MAGIORKINIS1, Nikolaos PETROGIANNIS2, Christos BISSIAS3, Aristidis
DIAMANTIS4*
Affiliation of authors:
1. BSc, MD, PhD
2. Commander, MD, HN
3. Commander, MD, MSc, HN
4. Captain, MD, PhD, HN
Office for the Study of History of Hellenic Naval Medicine, Naval Hospital of Athens, Greece
Corresponding Author:
Captain Aristidis Diamantis, MD, PhD, HN
2 Karaiskaki, 15562, Cholargos,
Athens, Greece
Tel: +30-210-6526711
E-mail: [email protected]
Magiorkinis E. et al: The Concept of Health in Ancient Greek Medicine
Abstract
The purpose of this article is to
summarize the views on Health in
Ancient Greek Medicine. We studied
mainly the Hippocratic and Galenic
Corpus as well as the views of
contemporary scholars on the subject.
Important aspects on human health
include the “four humors theory”, the strict connection of human physiology
with the laws of Nature and the
interconnection between the functions
of human body and the way of life and
habits of the patient. The humoral
theories provided the basis for
treatment strategies in Hippocratic
medicine
which
was
strictly
individualized and case restricted.
Hippocrates, on the basis of those
theories, also suggested a set of rules for
everyday life in his “Regimen” suggesting a direct association between
health and life style. In all aspects of
human life, the golden mean is
considered to be the optimum way,
according to the writer of the
Hippocratic texts, in order to restore the
balance between opposing powers that
tend to disturb the homeostasis of
human health.
Keywords: Hippocrates, Galene, health,
disease, humoral theory
Introduction
Sickness and health represent two
opposing forces which co-exist and form the
balance of human existence. According to
WHO “Health is a state of complete physical, mental and social well-being and
not merely the absence of disease and
infirmity” [1]. During the history of medicine,
two theoretical approaches as far as health
is concerned have been formulated: the
ontological and the functionalist (or
93
holistic). The ontological theory gained
favor during the middle of the 19th century
and the beginning of the 20th century due
to the advances in public health, in
bacteriology and the discoveries of
antibiotics. The functionalistic theory was
dominant during the previous period and
physicians applied treatments that would
restore the proper function of the organism
as a whole.
Hygeia as a deity in Ancient Greece
Health in Ancient Greece before
the advent of the Hippocratic era was
connected with cults and deities. Apollo,
son of Zeus and Leto, the God of Light
was also considered as a god who could
bring ill-health and deadly plague. Centaur
Chiron was known for his exceptional
knowledge on medicine and therapeutics;
among his famous students was Asclepius
which was later worshipped as the god of
Medicine and healing. The worship of
Asclepius was connected with the erection
of temples, the Asclepieions. The
daughters of Asclepius were Hygeia (the
personification of health, cleanliness and
sanitation), Iaso (the goddess of
recuperation from illness), Aceso (the
goddess of healing process), Aglaea (the
goddess of beauty) and Panacea (the
goddess of universal remedy) (Figure 1).
Hygeia was considered as a minor
deity who was worshiped in conduction
with Asclepius. In various works of art she
was depicted as a virgin dressed in a long
robe with an expression of mildness and
kindness, either alone or grouped with her
father and sisters, sitting or standing or
leaning on her father. She was
accompanied by a serpent, which she is
feeding from a cup. Although she was
identified with physical health, she is
sometimes connected with mental health.
According to Pausanias, Hygeia was
depicted on the Acropolis of Athens along
with Athena [2], whereas at the temple of
94
Amphiaraus in Oropos, the fourth portion
of the altar was to Aphrodite and Panacea,
and further to Iaso, Hygeia and Athena
Paionia [3]. According to Pausanias,
Hygeia was also worshiped in most of the
Asclepieions and in most places of Greece
(Figure 2).
Figure 1. Hygeia and Asclepius
Figure 2. Greek God Hermes, Asclepius and his
three daughters
Balkan Military Medical Review
Vol. 16, No 2, Apr-Jun 2013
Views of health in Hippocratic-Galenic
Medicine
The scientification of Medicine by
Hippocrates changed the views on health
and disease radically (Figure 3). Humors
are in the center of Hippocratic medicine,
since the human body was held to be a
seething mass of fluids rather than an
assemblage of discrete organs or cells.
According to Hippocrates, the human
body was exclusively composed of a
mixture of four humors, whereas the four
ancient elements – water, fire, earth, and
air – constituted the humors. Humors
themselves had qualities: phlegm was cold
and wet, black bile was cold and dry,
blood was hot and wet and yellow bile was
hot and dry. Each individual possessed a
complexion or temperament that reflected
a unique blend of qualities which also
differed according to age and sex. The
young tended to be hotter and moister than
the aged, who were dryer and colder. Men,
as a rule, were hot and dry, while women
were inclined to be colder and moister [4].
Disease was the result of humor
imbalance, in the same way that it could
be caused by the “corruption” or “putrefaction” of one or another of the body’s humors. Standard therapies and preventives depended on readjusting
perceived imbalances either by siphoning
off a humor that had grown too strong or
become corrupt, or by bleeding, purging,
vomiting and other means.
In humoral medicine, prevention
was as important as treatment. The best
means of maintaining health was to
practice moderation in all things,
especially in the use of the six non-natural
elements: 1) air; 2) sleep and waking; 3)
food and drink; 4) rest and exercise; 5)
excretion and retention; and 6) the
passions or emotions. A healthy regimen
was predicated on observing those rules of
nature
and
avoiding
exhaustion,
overheating, excessive consumption of
Magiorkinis E. et al: The Concept of Health in Ancient Greek Medicine
spirits and immoderate desires. Such ideas
were prevalent and formed not only
medical theories but, also, more popular
versions of health and illness as well.
Figure 3. Hippocrates
Humors exhibited their own
distinguishing
characteristics
and
preponderance over one or another which
believed to determine a person’s physical and mental make-up. Phlegm was a white,
clear humor and individuals with an
overbalance of phlegm tended to have
dull, phlegmatic temperaments. Yellow
(sometimes red) bile was produced in the
liver and stored in the gall bladder; an
excess resulted in a bilious and
quarrelsome nature. Black bile was
associated with the spleen and determined
the gloomy, melancholic personality.
Blood ranked as the most critical and
elevated of the humors. It was considered
to be the vital juice of life, since it plays
fundamental role in the utilization of
nourishment and in reproduction, whereas
it governed the sanguine temperament [5].
95
Moderation in all things, according
to the Hippocratic writings, should
characterize early modern advice on
regimen, whereas a good lifestyle served
as the most practical way to maintain and
restore health. The ‘golden mean’ is
referred as the key for health and
prosperous life. By modifying lifestyle,
especially in the realm of diet, a person
could hope to preserve health or regain it.
People should avoid drafts, exhaustion,
strong drinks, and a sedentary lifestyle, as
well as rich and fatty foods.
Common beliefs on health
associated regimen with the idea of the
bodily constitution. Each person possessed
an individualized constitution that was
more or less the sum of bodily parts,
humors, spirits and habits. In HippocraticGalenic medicine the importance of
knowing an individual’s constitutional idiosyncrasies is emphasized if health was
to be preserved or restored. Accordingly,
cures must be highly individualized and
snugly fitted to the person in question.
Constitutional differences could also,
however, explain why some individuals
contracted a disease while others living in
close proximity, or even in intimate
contact,
remained
unaffected.
Constitutions
were
commonly
characterized as “strong”, “weak”, “robust” or “delicate”. Constitutions endogenously weak were never right and
could be blamed for deaths even in late
adulthood. Yet, even rugged constitutions
could be ruined by bad habits, horrible
accidents or even frightening experiences
that shattered the mind and wrecked the
body [6].
What went on inside the body was
hard to discern and the ways people
referred to bodily processes tended to be
metaphoric. There was one way that
people could know what went on inside
the shell of humanity: the doctor had to
read the signs inscribed on the bodily
96
exterior and especially on the skin, on the
limbs, and mainly in the face.
Some Treatments
To recover health within the
humoral system, it was necessary to regain
a lost humoral balance. The reasoning
behind taking a “spring cure” - a seasonal
purging, sweating, or bloodletting - rested
just on this premise. Oppositions between
hot and cold or wet and dry could both
explain the occurrence of disease and
pointed to a cure. The logic of sympathy,
and sympathetic healing, worked in a
similar manner; people sought to expel
their diseases by transferring them to other
objects. The principle of transference
suggested, for example, that if one rubbed
a wart with the cut side of an onion and
then buried the onion, the wart would
shrivel as the onion rotted. Sympathy
worked by both likes and opposites,
especially in regard to herbal remedies.
For example, yellow herbs were good for
curing jaundice as well as evoking strong
diuretic reactions.
The road to health flowed through
the bowels, bladder, skin and veins. The
stoppage or unnaturally meager or heavy
flow of sweat, urine, stools or blood
(menstruation, hemorrhoidal flows and
nosebleeds) was sure to cause illness and,
in severe cases, even death. Catarrh was,
therefore, not merely the cough and cold
that we might think it to be, but a far more
general condition where the watery and
phlegmy humors thickened beyond their
normal state and then clogged up the areas
where they were usually found: the
bowels,
lungs
and
nose.
Such
accumulations produced not only sniffles,
but “wet coughs”, “slimy diarrheas”, and the “whites” (a nonvenereal vaginal discharge). A very different affliction,
stroke, resulted from abuses of the nonnaturals: too cold, too warm, or too humid
air; too sedentary a lifestyle; violent
Balkan Military Medical Review
Vol. 16, No 2, Apr-Jun 2013
passions; gluttony; or the omission of a
customary purging or bloodletting. Even
using a strong sulfur salve to treat a skin
eruption, like scabies, could “drive it back” into the body where it might work maleficently on the brain. Rheumatism
came from an “obstructed perspiration”. Even melancholy was caused by
something going on not in the brain, but in
the abdomen, the stomach, and the spleen.
Such perceptions also conditioned
therapies [7].
Scholars generally accept that
magic and astrology exerted a potent
influence on the early modern mind. Under
magical healing, a form of sympathetic
magic is understood that tried to obtain
cures for a variety of diseases. It is not
necessary that the disease itself be
magically caused, although magical
healing was often employed to combat
magical harming. In astrological medicine,
“man is said to be a Microcosm and in him the Almighty has imprinted his own
Image”. Sympathy worked because it
accorded with the prevalent belief of that
intimate microcosm/macrocosm associa
tion. The astrological healing involved
restoring the harmony between the
macrocosm and the microcosm. While
diagnosis depended on casting a
horoscope, therapies often looked very
much like those other practitioners
employed: attempts were made to adjust a
humoral derangement by purging, sweating
and bleeding [8].
The Hippocratic physicians always
worked on the same pattern. First, they
described the symptoms and the results of
examination
in
detail.
Inspection,
auscultation and palpation were used, and
the smell and taste of secreted body fluids
were studied.
The diagnosis was followed by
prognosis. Various questions should be
answered first such as: “What course could the illness be expected to take?” or “How long might the patient live?” If Magiorkinis E. et al: The Concept of Health in Ancient Greek Medicine
treatment was thought worthwhile, general
rules were first given about rest, diet,
proper climate and so forth. Then came
specific measures against the actual
illness, including operations. Fresh air,
light in the home and ward, cleanliness
and a sound diet were among the favourite
themes of Hippocrates. He often
recommended bathing, massage and
moderate exercise, although he opposed
arduous bodily movement. A wide range
of healing plants was known to him, many
being considered sensible even today. But
on the whole he was rather cautious with
medicaments, even if he did admit that
extreme conditions called for extreme
methods.
Conclusions
Overall, health in Ancient Greek
Medicine is considered as a balance
between various natural forces and
ingredients co-existing within the human
body. Disease is the result of disturbance
of this balance, and the role of the
physician is to restore it. If one should
summarize the Hippocratic method, it
could be done in mainly four points:
observe the patient as a whole, study the
patient more than the disease, make an
honest evaluation and assist the nature.
Hippocrates stressed that it was important
to take an intensive and detailed medical
history. The physician for that reason
should employ all his senses without
prejudice: sight, hearing, smell, taste and
touch. The emphasis was on how the
patient reacted to their illness, not just on
the type of disease. According to
Hippocratic writings, the patient’s makeup, surroundings and way of life were all
equally important in the evaluation of the
state of illness and the likelihood of
recovery. The Hippocratist opposed the
practice of classifying diseases according
to the organs affected. Hippocrates also
stressed the importance of prognosis; in
97
many cases described in the Hippocratic
texts, the author did not hesitate to admit
the lack of response to treatment. The
writer of the Hippocratic texts stress the
importance of the connection between man
and nature. The physician’s chief function, therefore, is to make condition propitious
for the forces of nature within the body to
reach harmony and therefore health. The
physician must do what he can do- that is,
what has been proved by his past
experiences.
However, one should note that
weaknesses may be found in many of the
Hippocratic methods. The writer of the
Hippocratic texts has a scant and
unsystematic knowledge of human
anatomy. A second limitation lays in the
lack of specific diagnosis and a type of
nihilism in therapy. The great emphasis on
nature taking its course often resulted in a
wait-and-see approach. Yet, in addition to
dietary and other regimens Hippocrates did
use direct methods, as witnessed by the
numerous surgical and mechanical
techniques in the Collection. However, he
recognized his limitations and did only
what appeared to be useful. Another
weakness was the strong espousal of the
‘four humors’ theory. This doctrine,
together with many ramifications which
had origins long before Hippocrates, was
to be a principal basis for medical
speculation in subsequent centuries, but
Hippocrates used the system chiefly to
explain illness in current terms. However,
his treatment was not based on that theory
alone since extreme remedies were not
employed.
Furthermore,
Hippocrates
judged results not on how they fit the
theory but only on the outcome. Yet, like
Galen much later, Hippocrates had need of
a base, a system, a theory, to underline the
knowledge of physiology and illness [9].
Another common idea in the
Hippocratic Corpus was that of health and
illness as some form of balance and
imbalance. This type of explanation was
98
given by many of the Pre-Socratics in their
attempts to understand the stability and the
changeability of the universe. Balance and
imbalance were regarded by the
Hippocratic writers in two separate ways.
The author of On regimen thought that the
whole body was in a perpetual state of
flux, and health consisted in keeping this
flux within certain limits. By contrast, the
author of On the nature of man argued that
the body remained in a stable balance until
something, external or internal, occurred to
overturn it. On both views, once the
individual balance was understood, this
knowledge could be applied by the healer
to its preservation or restoration.
Hippocrates relied on his own
observations, while using the past
experiences of others, for he recognized
that knowledge did not begin with him. If
the Hippocratic method is used today, the
physician can observe objectively, avoid
rigid postures, foreswear arrogance and
shun abject adherence to doctrines;
furthermore, we are just beginning to learn
once again the Hippocratic doctrine of
attending to the whole person in his own
environment.
References
1. Preamble to the Constitution of the
World Health Organization as adopted
by
the
International
Health
Balkan Military Medical Review
Vol. 16, No 2, Apr-Jun 2013
2.
3.
4.
5.
6.
7.
8.
9.
Conference, New York, 19-22 June
1946; singed on 22 July 1946 by the
representative of 61 States (Official
records of the WHO, no. 2 p. 100) and
entered into force on 7 April, 1948.
Pausanias. Description of Greece
1.23.5. Translated by W.S.H. Jones.
Loeb Classical Library, 1918.
Pausanias. Description of Greece,
1.34.3. Translated by W.S.H. Jones.
Loeb Classical Library, 1918.
Paul Potter. A Short Handbook of
Hippocratic Medicine. Quebec : Les
Editions du Sphinx, 22-25, 1988.
Roy Porter, Dorothy Porter.
In
Sickness and in Health: The British
Experience
1650-1850.
Oxford:
Blackwell publishing, 46, 1988.
John Evelyn. The diary of John Evelyn.
London: William Bray, 16, 1973.
James C. Riley.
The EighteenthCentury Campaign to Avoid Disease.
New York: Abradale Press. Harry
Abrams, 10, 1987.
Michael
MacDonald,
Mystical
Bedlam: Madness, Anxiety, and
Healing in 17th-Century England.
London: Cambridge University Press,
229-231, 1981.
Mary Fissell. Patients, Power, and the
Poor in 18th Century Bristol. London:
Cambridge History of Medicine, 22,
1991.