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For two and a quarter millennia doctors insisted that medicine was a
science that saved lives. But there were critics from the very beginning.
An ancient work called The Science of edicine! which dates to c."#$ bc!
is the %rst defence of &i''ocratic medicine against its critics. The
'hiloso'her &eraclitus! for e(am'le! said that doctors tormented the sick!
and were )ust as bad as the diseases they claimed to cure. *t was
&eraclitus! not the author of The Science of edicine! who had the better
argument! for &i''ocratic medicine was inca'able of ful%lling its
'romises.
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+alen ,ad 1"1-.01/ said 'rognosis 'ro'erly included the subdisci'lines of
diagnosis ,identifying the 'atient0s 'resent condition/ and a form of
mnemonics ,identifying the 'atient0s 'ast conditions/1 but both were
subsidiary to 'rognosis. Skill at 'rognosis! in traditional &i''ocratic2
+alenic medicine! in fact served as a substitute for skill in thera'y.
.
Because in later centuries all doctors came to agree with each other!
because a uni%ed medical 'rofession eventually came to e(ercise an
e3ective mono'oly over treatment! it is easy to assume that from the
beginning doctors thought alike. But in fact! within these shared
assum'tions! there was considerable disagreement amongst the %rst
&i''ocratics! and disagreement remained common'lace throughout the
classical 'eriod. *t is not until 1.00 that a single body of medical doctrine
established an unchallenged 'redominance both in *slam and in
4hristendom.
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*t might be thought that there was an inevitable tension between a four5
humour system and! where the 6uids were concerned! a three5 fold
thera'eutic 'ractice ,bloodletting! emetics! and 'urgatives/! and 'erha's
'ractice was more in line with an earlier system which had thought in
terms of three humours--blood! bile and 'hlegm. Black bile was
a''arently a new discovery! later de%ned by +alen as the dregs or
sediment of the blood! that which lay at the bottom if blood was allowed to
stand and se'arate. Black bile! we may sus'ect! was invented to bring
medicine into harmony with the cosmology of
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8m'edocles. But it was also
believed that all four humours were to be found! in varying 'ro'ortions! in
the blood! and that they se'arated out when blood was left to stand. *t
was thus easy for bloodletting to come to be regarded as the sovereign
remedy! far more im'ortant than emetics and 'urgatives.
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*n +alen0s view 9:hatever sickens the body from internal evil has a
twofold e('lanation! either 'lethora or dys'e'sia.0 ;ys'e'sia resulted
from eating the wrong foods1 'lethora from consuming more food than one
burnt u' or e(creted.
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Thus +alen held that the +ermans and 4elts! because they lived in a cold!
wet climate! had soft! white skin! while the 8thio'ians and Arabs had hard!
dry! and black skin. But the +ermans and 4elts bottled u' their internal
heat within themselvesB 9:hatever internal heat they have has retreated!
along with the blood! into the internal organs1 and there the blood churns
about! con%ned in a small s'ace! and boils1 and thus they become s'irited!
bold! and quick5tem'ered.0 To achieve a healthy body and dis'osition you
thus needed to counteract the e3ects of the climate and the season--in
summer! and in +ermany! you would want to cool your blood1 in winter!
and in Africa! to heat it.
#
>nder normal circumstances our control over our bodies de'ended u'on
mani'ulation of what +alen called the non5naturals! contrasting them to
the naturals ,over which we have no control-- climate! season! age! se(!
etc./ and the unnaturals ,those conditions that
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were directly associated
with disease/. The non5naturals were food and drink! the environment ,e.g.
e('osure to the air/! slee' and waking! e(ercise and rest! evacuations
,including se(ual/! the 'assions and emotions. A ma)or di3erence between
medicine in the time of +alen and medicine si( centuries earlier! in the
time of &i''ocrates! was that +alen was convinced that we could
fundamentally control the conditions needed for health1 this involved
shar'ly down'laying the role of climate and season com'ared to the views
e('ressed by the &i''ocratic writers! for whom a change in the direction
of the wind had been suDcient to e('lain an outbreak of illness EFG.
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+alen! and all doctors after +alen! thus advocated 'ro'er diet. +alen
recommended a diet designed to thin the humours! consisting of %sh! fowl!
barley! beans! onions! and garlic for all chronic diseases. They
recommended sensible e(ercise. +alen abhorred gymnastics as too violent
EFG but recommended instead 9e(ercise with the small ball0! a game of
catch.
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+alen saysB
*n my youth . . . * once saw a man in a hurry to o'en a door. :hen
he could not get it to o'en! he began to bite the key! to kick the
door! to curse the gods1 his eyes went wild like those of a madman!
and he was all but frothing at the mouth like a wild boar. The sight
caused me to hate anger so much that * would never a''ear thus
dis%gured by it.
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&e had 'articular contem't for those who struck out at their slaves. &is
father
frequently berated friends who had bruised their hands in the act of
hitting servants in the teeth. &e would say they deserved to su3er
convulsions and to die from the in6ammations they had sustained.
=nce * even saw a man lose his tem'er and strike his servant in the
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eye with a 'encil! causing him to lose the sight of one eye. And it is
related of the em'eror &adrian that he once struck one of his
household sta3 in the eye with a 'encil! causing him to lose the
sight of one eye. :hen &adrian realiIed what had ha''ened! he
summoned the servant and agreed to grant him a gift of his own
request in e(change for the loss he had su3ered. But the in)ured
'arty was silent. &adrian re'eated his o3erB that he should request
anything he wished. At which the servant grew bold and said that
he wanted nothing but his eye back.
1.
This 'reoccu'ation with the 'assions might seem a 'urely
autobiogra'hical obsession of +alen0s EFG.But the idea of self5control was
also central to his understanding of human biology.
1"
*n many res'ects +alen was a ?latonistB he admired the Timaeus and
thought it evident that the human body had been designed by a divine
architect. &e agreed with ?lato! who thought there were three 'rinci'les of
life in the human body! reason ,located in the brain/! spirit ,located in the
heart/! and appetite ,located in the liver/! re)ecting Aristotle0s argument
that all life was centred in the heart EFG. But he was com'letely
un'ersuaded by ?lato0s arguments for the immortality of the soul!
'referring to regard it as 9a mi(ture or faculty of the body0! and so mortal.
For later generations of uslim and 4hristian medical commentators!
+alen0s account of the relationshi' between mind and body was
'rofoundly unsettling. EFG in the seventeenth century Thomas Browne0s
Religio Medici EFG is intended as a 'arado( or 'uIIle. For +alen! unlike
?lato! your body is who you are. >nderstanding how the body worked was
thus the key! not only to 'hysical health! but also to 'sychological well5
being.
17
The %rst &i''ocratics had never taken the 'ulse of their 'atients! but now
the 'ulse became a key source of information about the involuntary
system! as o''osed to the voluntary one. :e now begin to get some sense
of why the idea of self5control was so im'ortant to +alen. To be human
was to be in control of those bodily activities that were voluntary1 to lose
control! to strike and bite! was to allow the 'assions to seiIe control! and
so to become an animal rather than a human being. There was! however!
a fundamental ambiguity in this
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way of thinking. =ne could treat the
voluntary and involuntary systems as two as'ects of the human body! as
+alen did! or one could see them as re6ecting a fundamental distinction
between the 'hysical and the mental! between body and soul! between
the 'assions and reason. *f one went down this alternative route!
dissection! which had started as a study of function! could now be said to
have con%rmed a fundamental claim of Socratic 'hiloso'hyB that the mind
was se'arate from the body! that mental functions and bodily functions
were di3erent in nature. Thus the distinction between the veins and
arteries on the one hand! and the nerves on the other! along with the
reconce'tualiIation of 96esh0 as 9muscles0! was the 'hysiological 'roof of
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the new 'hiloso'hy. ?reviously not only had veins and arteries been
lum'ed together as blood vessels but nerves and tiny arteries had not
been distinguished. @ow anatomy had shown that one could trace the
contrasted ideas of voluntary and involuntary action through the %nest
details of the dissected body. &ow could one control those functions of the
body over which one had no conscious controlJ *t was medicine0s
res'onsibility to answer this question.
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odern scholars believe that +alen himself never had an intact human
body to dissect! and that his knowledge--which was! as we shall see later!
e(tensive-- derived from both dissection and vivisection of a'es.
1#
*t is easy! when reading a work such as +alen0s On Anatomical Procedures!
to be struck by the e(tent to which his knowledge of anatomy coincides
with our own. But it is im'ortant always to remember that his
understanding of biological 'rocesses is fundamentally di3erent from ours.
4onsistently! +reek doctors read the outside a''earance of the body! and
the substances e(creted from it! as a sign of what is going on inside.
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*n De Medicina ,c.ad 70/ 4elsus says that 9the Art of edicine is divided
into three 'artsB one being that which cures through diet! another through
medicaments! and the third by the hand0. The idea that surgery is
handwork is straightforward as the Katin word chirurgia derives from the
+reek words for hand and work. But 4elsus0 descri'tion of cure through
diet includes not only regimen or the non5naturals! but also bloodletting
and rocking ,regarded as a form of gentle e(ercise1 even the act of
thinking was for &i''ocratic doctors a form of e(ercise which warmed the
soul/! and the taking of 'urgatives and emeticsB in other words all of what
we would think of as internal medicine comes under the heading of dietary
healing. Lenesection and 'urging were considered! at the time! as being
means of re5 establishing the necessary balance that had been destroyed
by unhealthy diet! and thus as e(tensions of dietary thera'y. :hen we
turn to 4elsus on medicaments we discover that this section of his work is
not concerned at all with things like 'urgatives and emetics ,which we
might well think of as drugs/ but only with substances
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a''lied to'ically
to the bodyB oils! 'oultices! embrocations! liniments! and so forth.
.0
A hundred and thirty years later! +alen also assumes that a 9drug0 is
normally something a''lied to the e(terior of the body. *t works by
entering through the 'ores1 the %ner the material the further it 'enetrates
into the body. There! according to its nature! it warms or cools! dries or
dam'ens the body. For +alen drugs that are ingested work in e(actly the
same way as those that are not ingested. But if they are ingested they
function both as drugs and as food. Take let5 tuce! which cools and is a
so'ori%c. A''lied to the body its function is straightforward. *ngested! it
initially functions as a drug1 but when digested it functions as a food! and
all foods have a heating quality and encourage wakefulness. +alen thus
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com'ares lettuce as a food to 'utting green wood on a %re--initially it
dam'ens the %re down! but in the end it burns brightly.
.1
EFG medicaments were understood sim'ly to heat and cool! dry and
dam'en! and were therefore almost in%nitely substitutable one for
another.
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&i''ocratic doctors did not treat diseases1 in their view diseases
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were
themselves sym'toms of an underlying imbalance of the humours1 it was
therefore the 'atient! not the disease! that had to be treated.
.7
To work through the list of &i''ocratic medicaments! as modern scholars
do! looking for ones that we would take to be e3ect5 ive--not lettuce! for
sure--is to miss the 'oint that drugs were rarely 9s'eci%cs0! directed at
s'eci%c diseases ,the case for such drugs was %rst argued by ?aracelsus in
the si(teenth century! using the e(am'le of mercury as a treatment for
sy'hilis/! and that our belief! for e(am'le! that bathing a wound in a liquid
containing alcohol might have an anti5bacterial e3ect would have been
incom'rehensible in a world where there was no conce't of infection.
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?rior to &arvey! materia medica was %rst and foremost about ointments!
not drugs! even when they were ingested into the body. And what these
ointments could be understood to do was constrained by the humoral
theory that governed their use. Between ?olybus and +alen that theory
had been develo'ed and re%ned. For the ne(t fourteen or %fteen hundred
years doctors were more concerned to 'reserve and transmit this
intellectual inheritance than to question or im'rove it.
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:hen 4elsus wrote about medicine in ad 70 he identi%ed three main
schools of medical 'ractitioner. The 9dogmatists0! the followers of
&ero'hilus! believed we must look for hidden causes in order to e('lain
biological 'rocesses! and therefore believed in vivisection and dissection!
even if they had no o''ortunity to 'ractise either. The 9methodists0 had a
sim'le mechanical account of disease as the result of 'articles travelling
either too quickly or too slowly through the body! and believed a doctor
could be trained in si( months. And the 9em'irics0 re)ected all theories of
disease! insisting that we must learn from 'ast e('erience which sorts of
intervention are e3ective. A century later! +alen ,who was a dogmatist/
EFG.
.#
E+alenG was 'erha's because he was dee'ly interested in logic! and so his
te(ts %tted well into a 'rogramme of education grounded in the
Aristotelian syllogism. oreover! +alen0s understanding of the body was!
unlike that of the methodists and em'irics! entirely com5 'atible with an
Aristotelian 'reoccu'ation with function.
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EFG the &i''ocratic te(ts survive in large 'art because +alen declared
himself to be a follower of &i''ocrates and wrote commentaries on key
&i''ocratic te(ts.
.H
An abbreviated edition of +alen0s =n the >se of ?arts of the Body! which
includes frequent references to dissection!
"0
+alen himself had o''osed the use of astrology ,which had been im'orted
into +raeco5 Moman medicine from Babylonia/. &e had! on the other hand!
edited with a''roval the &i''ocratic te(t Megimen! which advocates diag5
nosis from a 'atient0s dreams. To dream of a rough sea! for e(am'le!
9indicates disease of the bowels. Kight and gentle la(atives should be used
to e3ect a thorough 'urgation0. But! e(ce't for the interest in astrology! he
would easily have recogniIed medicine in 1<$0 as a direct continuation of
medicine in .00.
"1
:hat would seem to us one of the sim'lest of all substances! water! was
almost in%nitely com'le( for &i''ocratic doctors! who recogniIed!
'erfectly sensibly! that it varied immensely from 'lace to 'laceB the title of
Airs, Waters, Places identi%es it as one of the three crucial environmental
variables.
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EFG but water did not begin to be treated to make it safe to drink until
after ?asteur0s germ theory of disease. Before then water was sometimes
%ltered! or even chemically treated! to 'revent it from smelling foul! but
not to kill germs. So we can easily agree with the &i''ocratics that water
was a ma)or cause of disease! but not with their e('lanation that it might
not only be too salt! too sweet! or too astringent! too hard or too soft! but
also too hot or cold! too light or heavy. Five hundred years after Airs,
Water, Places! 4elsus sums u' this analysis of water with what a''ears to
be admirable sim'licity by classifying water in terms of degrees of
heaviness! e(ce't for the fact that he de%nes heavy waters as those which
have the most nourishment and are hardest to digest.
""
Since health lay in a balance of humours! and such a balance could be
obtained through a correct regimen ,a correct management of the non5
naturals/ everyone ought to be able to achieve health. Nust as we might
think that someone with a hangover has brought it u'on themself! so
ancient medicine ,at least after the Ale(andrian revolution in anatomy/
im'lied that someone who was ill was in some degree res'onsible for their
own condition. Although we believe that 'eo'le who choose to live high5
'ressure lives may bring on heart attacks! we rarely blame 'eo'le for
getting cancer or arthritis1 ancient medicine! by contrast! im'lied that all
diseases re6ected de%ciencies in lifestyle.
"7
As a result the burden of res'onsibility often lay heavy u'on the 'atient.
9?hysicians come to a case in full health of body and mind0 says the author
of the &i''ocratic Science of edicine! taking it for granted that no one
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would hire a doctor who was not able to ensure his own health. ?atients!
by contrast!
are full of disease and starved of nourishment1 they 'refer an
immediate alleviation of 'ain to a remedy that will return them to
health. Although they have no wish to die! they have not the
courage to be 'atient. E@ote the automatic and unthinking
reference to the three to'ics with which medicine concerns itselfB
the alleviation of 'ain! the restoration of health! the deferral of
death.G Such is their condition when they receive the 'hysician0s
order. :hich then is more likelyJ That they will carry out the
doctor0s orders or do something elseJ *s it not more likely that they
will disobey their doctors rather than that the doctors . . . will
'rescribe the wrong remedies. There can be no doubt that the
'atients are likely to be unable to obey and! by their disobedience!
bring about their own deaths.
edicine de%ned itself as a science by transferring res'onsibility for
failure! %rmly and remorselessly! from doctor to 'atient.
"$
+alen went further. &e wrote at enormous length on the 'ulseB a thousand
'rinted 'ages survive. *n The ?ulse for
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Beginners he e('lains that
arteries have three dimensions--length! de'th! breadth. *n other words! in
order to understand the 'ulse he immediately thinks of the anatomy of the
body as e('osed by dissection.
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+alen himself says that his knowledge of 'ulses is not something that can
adequately be e('ressed in words. *t involved a distinctive and elaborate
e('ertise of the touch. But was this e('ertise realJ +alen s'ent years
trying to decide whether he could 9feel0 the contraction of the artery as
well as its e('ansion. For later generations the question of )ust what one
could and could not feel was to be a matter of unending dis'ute! a dis'ute
which 'arallel5 led the unending dis'ute over how much one should bleed
and where from. *n +alen0s own day the em'iricists insisted that there was
an enormous ga' between the faint 6uttering sensation at the end of
one0s %ngerti's and a general theoretical claim about the heart and the
arteries.
"C
&i''ocratic doctors thought the body0s e(cretions were the best indication
of what was ha''ening within! and bodily e(cretions often assault the
senses. @ot sur'risingly! &i''ocratic doctors had little choice but to use all
their senses.
"H
E1G Ancient +reek doctors listened to the lungs by 'ressing an ear to the
'atient0s chestB modern doctors still hear through their stethosco'es the
sound 9like leather0 that characteriIes certain lung diseases and was %rst
described by the early &i''ocratics.
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E.G They tasted ear wa(B if it was sweet death was imminent! if bitter
recovery could be e('ected. +alen re)ected the claim that the heart was a
muscle! not only on the grounds that one could not control its beat! but
also on the grounds that if one cooked and ate a heart it tasted nothing
like 6esh.
E"G :hen 4elsus ins'ected urine he noted its colour! whether it was thick
or thin!
E7G its smell! and its te(ture ,was it slimyJ/B black! thick! malodorous urine
was a harbinger of death. Sight was 'articularly im'ortant. :e have seen
4elsus stress that
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the doctor must have a good view of his 'atient. 8very doctor was trained
to look out for the change in facial a''earance that marked the
imminence of deathB the nose becoming 'ointed! the tem'les sunken! the
eyes hollowed! the ears cold and 6accid with the ti's droo'ing slightly! the
skin of the forehead hard and tight. Aou could see death a''roaching. E$G
But touch was also fundamental. The %rst &i''ocratics always 'al'ated
the hy'ochondrium! literally the 'arts under the cartilage! that is! the
sides of the abdomen under the ribs. EFG The &i''ocratic te(t Prognosis
discusses at length what you could e('ect to learn by feeling a 'atient
here! and concludesB 9*n brief! then! 'ainful hard large swellings Eof the
hy'ochondriumG mean danger of a s'eedy death1 soft! 'ainless swellings
which 'it on 'ressure mean 'rotracted illness.0 A hy'ochondriac was
originally someone with something wrong with their hy'ochondrium1 it
was only in the nineteenth century! when the hy'ochondrium ceased to be
of medical interest! that the term was freed to refer to someone who was
mistaken in their belief that they had something wrong with them ,there
had long been a term in French for such 'eo'leB they were malades
imaginaires/.
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Since the humours were classi%ed in terms of hot and cold! dry and wet!
then these were all directly e('erienced by touch. +alen thought long and
hard about whether our e('erience of hot and cold! dry and wet was
ob)ective or sub)ective. &is conclusion was that it was ob)ective because
human beings had been designed to be! when in health! at the ob)ective
mid'oint between the four e(tremesB healthy humans were neither hot nor
cold! neither dry nor wet when com'ared to other humans1 but they were
also so when com'ared to the universe as a whole. oreover in the body it
was crucially the skin! and of the skin it was above all the skin of the 'alm
of the hand which had reliable sensationB the hands 9were designed to be
the instrument of assessment of all 'erce'tible ob)ects0! created as 9the
7.
organ of touch suited to the most intelligent of all animals. *t there5 fore
had to be equidistant from all e(tremes.0 Skin 'rovides 9the standard or
yardstick against which to e(amine all other 'arts of the animal0. To
function as the yardstick! however! the doctor himself had to be in 'erfect
health! his own body a 'ro'er balance of the humours! his skin neither
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cold nor clammy! neither feverish nor dry. For +alen medicine was above
all a tactile science.
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From the early thirteenth century surgery was normally se'arated from
medicine ,as it had brie6y been at the very beginning--in the original
&i''ocratic Oath doctors 'romise not to use a knife/B this was not entirely
true in *taly! where the occasional university degree in surgery was
bestowed1 but throughout @orthern 8uro'e medicine and surgery soon
became di3erent 'rofessions! and surgery was normally taught outside
the universities! though it too was taught on the basis of +reek and Arabic
te(ts. >nderlying this was a conviction that the educated should not
engage in manual activity
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:hen doctors did visit their 'atients! taking their 'ulse re'resented a form
of 'olite touchingB even +alen had recommended taking the 'ulse at the
wrist as that did not require the 'atient to undress. :hen called to advise
the em'eror he hesitated even to touch his wrist until he was urged to do
so.
7$
=ne of the factors at work in this retreat by doctors from 'hysical contact
with the bodies of their 'atients was certainly a fear of contact between
the se(es. *n the earliest &i''ocratic te(ts! doctors conduct vaginal
e(aminations themselves1 soon though they e('ect women to conduct
them on their behalf. The Athenian Agnodice was! according to legend!
one of &ero'hilus0 'u'ils. ;istressed by the anguish of women who would
rather die than be e(amined by a man! she crossdressed in order to study
medicine so that she would be able to treat women.
7<
Through the iddle Ages! it seems! male doctors were 're'ared! on
occasion! to 'al'ate the hy'ochondria of their female 'atients! but in the
early modern 'eriod such contact was increasingly regarded as
ina''ro'riate.
7#
Arthur &ertIler! a Oansas doc5 tor! wrote in 1H"C! 9* can scarcely think of a
single disease that the doctors actually cured during those early years . . .
The 'ossible e(ce'tions were malaria and the itch. ;octors knew how to
relieve su3ering! set bones! sew u' cuts and o'en boils on small boys.0
But the fact that there was no 'rogress--far too little to have any
systematic im'act on life e('ectancy--and the fact that medical
intervention did more harm than good! does not mean that doctors did not
cure 'atients. odern studies of the 'lacebo e3ect show that it is a
mistake to think that there are some thera'ies that are e3ective and
others which though ine3ective work on those who res'ond to the 'lacebo
e3ect.
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:hen 'atients believe that a thera'y will work! their belief is ca'able of
rendering it sur'risingly eDcacious1 when doctors believe a thera'y will
work their con%dence is consistently transferred to the 'atient.
7H
*t is im'ortant though to stress that if &i''ocratic medicine bene%ted its
'atients by mobiliIing the 'lacebo e3ect! &i''ocratic thera'ies were not
in themselves 'lacebos. ?lacebos are inert sub5 stances! and new drugs
are regularly tested against 'lacebos in blind clinical trials--a drug has to
out'erform a 'lacebo before it is regarded as having any thera'eutic
e3ect. But &i''ocratic remedies were far from inert. Bloodletting! 'urging!
and emetics acted 'ower5 fully and! in so far as they acted on the body!
they were bad for 'atients. *n so far as they acted on the mind they may
have been good for 'atients! but we can be con%dent that if one tested
&i''ocratic remedies against 'lacebos the 'lacebos would out'erform the
&i''ocratic remediesB doing worse than a 'lacebo is! if you like! a
technical de%nition of what * am calling 9bad medicine0 or 9doing harm0. By
this de%nition! which * think is the a''ro'riate one! you are doing harm
even if your 'atient is more likely to recover as a result of receiving your
treatment than if he had received no treat5 ment at all! 'roviding your
treatment is less bene%cial than a 'lacebo. The doctor Foucault tells us
about! who abandoned &i''ocratic remedies and gave all his 'atients
quinine! was giving them a better
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thera'y! not because quinine is
e3ective! but because he was coming closer to giving a true 'lacebo.
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:ithout three technical develo'ments Lesalius could never have
accom'lished what he didB the 'rinting 'ress using movable ty'e1 the
woodcut1 and 'ers'ectival re'resentation. *n order to claim that he knew
more than +alen had done! Lesalius had to direct his audience to reliable
editions of +alen. &e himself edited! for the great +iunta edition of +alen0s
Opera Omnia that a''eared in 1$71-. and included many new
translations from the best +reek manuscri'ts! the key anatomical te(t of
+alen! the one that had ins'ired his own bone5stealing in 1$"<. An
anatomist like ondino! in the fourteenth century! could not read the full
range of +alen0s writings! or be sure that the co'ies he had were reliable
,even Lesalius com'lained that he could not get sight of crucial +reek
manuscri'ts that he needed to check the accuracy of the Katin
translations/. By 1$7. any educated 'erson with
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Lesalius and access to a
decent library could trace the full range of +alen0s views on any to'ic! and
could be con%dent that the te(ts at his dis'osal were generally accurate.
&e could now claim to be sure of what +alen thought and consequently to
be in a 'osition to )udge whether he was wrong or right. The 'rinting 'ress
and the new scholarly editions that it made 'ossible were fundamental to
Lesalius0s enter'rise of sur'assing +alen.
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For Aristotle and +alen scienti%c knowledge always included the
understanding of what they called 9%nal0 causes1 that is to say! the
'ur'ose served by any natural 'rocess.
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Livisection was not new with &arvey. +alen had 'ractised vivisectionB one
of his favourite 'ublic demonstrations was to show that the voice was
controlled by the brain not ,as Aristotelians believed/ by the heart1 by
sli''ing loo's of thread around the inter5 costal nerves he could de'rive a
squealing 'ig of its ca'acity to make a sound! and then restore its voice to
it.
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Aristotle had shar'ly distinguished the roles of the se(esB in se(ual
congress! the man su''lied the form! the woman the matter. en were
agents and women were 'assive. But +alen had taken the su'5 'osed
similarity in the biological structure of men and women entirely seriously.
Both men and women! he believed! had orgasms!
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and both 'roduced
semen--a theory that im'lied that women could not become 'regnant
without orgasm. *t was the mi(ing of these semens that made conce'tion
'ossible. The di3erence between men and women was thus a matter of
degree! not kind. This general theory survived the discovery of the clitoris
by the other 4olumbus! Mealdo 4olombo ,1$1<-$H/!
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The &i''ocratic authors had for the most 'art assumed that when whole
communities were hit by 'lague this was because they all breathed the
same air and drank the same water. +alenic medicine!
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however! 'laced
much less em'hasis on e(ternal environment as a cause of disease!
leaving it much harder to understand why very di3erent 'eo'le--the
young! the old! the %t! the frail--should su3er simultaneously from the
same disease.
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Sy'hilis was clearly usually 'assed by close contact between two
individuals! but 'lague seemed to have the ca'acity to lay dormant and
then break out. *talian communes! ignoring +alenic and &i''ocratic
orthodo(y! had long 'ractised quarantine to 'revent the transmission of
'lague! and burnt the 'ersonal e3ects of those who died of 'lague. These
meas5 ures seemed to work. But whyJ Fracastoro! 'robably drawing on
'assing remarks in +alen and a key 'assage in Kucretius! ;e Merum
@atura ,c.$< bc/! e('lored the ways in which a disease might enter a
healthy body from the outside. *t might be com'arable to a 'oison! or it
might be com'arable to a seed! which could lie dormant! be carried by the
wind! and then s'rout when it found favourable conditions.
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Kocke! in his 8ssay 4oncerning &uman >nder5 standing ,1<CH/! the most
in6uential work of 'hiloso'hy for eighteenth5century scientists! insisted
that if we had microsco'es for eyes! the knowledge we gained would be
useless! )ust as someone who could see the inside of a clock but not its
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face would be unable to tell the time. +od! in fact! has ada'ted our senses
to our needs. 4onsequently! microsco'ical science is 9lost labour0. This was
to
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restate +alen0s view that the 'hysician0s hand is ,thanks to +od0s
careful design/ the 'erfect instrument with which to measure hot and cold!
dry and wet1 now the 'hysician0s eyes too were 'erfectly ada'ted to their
task.
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