Tuesday, February 26, 2013

370 B.C.: The dogmatic school of medicine

While Hippocrates is credited with creating the humoral hypothesis, it was his sons, Thessalus and Draco, who are credited with creating the dogmatic school of medicine. (1, page) It was the first medical sect, and consisted of physicians who followed the opinions of Hippocrates.  They were called Hippocratici.

There were various names for this school, depending on the era it was being described, and who was describing it.  Some referred to it as the Hippocratic School, some as the Dogmatic School, some as the Rational School.  Regardless, these are all referring to the same thing, with the followers being those who believe in the ideas of Hippocrates.

The opinions of this school were formed by the philosophers who influenced the Hippocratic writers, and of course Hippocrates himself.  Of course we've decided that Hippocrates himself probably was given credit for the works of many, as historians believe some of the writings attributed to him were written before his time, during his time, and after his time.

Medicine was taught by philosophers who believed it was necessary to rationalize about medicine, hence the name rational.  They speculated as to the cause of disease and why a certain remedy might benefit it.


The general idea here is best explained by Edward Withington:  (3, page 57)
The ancient Greeks loved talking; his mind was more philosophical than scientific, and he preferred to speculate on things in general rather than to investigate particular facts... A Hippocratic writer had said, 'The physician who is also a philosopher is godlike.' This became the motto of the dogmatic school, was made the excuse for an immense amount of useless speculation, and was finally taken as the text of a special treaties by Galen himself.
The dogmatic school of medicine was generally taught at the school of cos, and was based on the opinions of Hippocrates, yet it was also based on the Stoic philosophy. A famous motto of the school was:  "The physician who is also a philosopher is godlike."  (3, page 57)

This led to much "useless speculation," (3, page 57) such that diseases are caused by imbalances of the four elements and humors, and remedies are a means to re-establish the balance.  Remedies may be as simple as a lifestyle change, and as harsh as bleeding and purging.  They didn't require any real evidence the remedies worked.

Followers of this school believed in the importance of studying anatomy, and often performed autopsies on animals such as pigs, monkeys and apes.  They performed autopsies on humans if possible, although this was frowned upon and illegal in the ancient world.  Human autopsies were performed when permission was granted, on stolen corpses, and live prisoners.

They had a basic understanding of human anatomy: the layout of the main organs, the vessels that line the body.  They understood the importance of correlating medicine with physiology.  The obvious problem with their school was the reliance on opinions as opposed to observation, experience and science.  Of course when the school was formed there was no knowledge of any of those things.  (3, page 60)

The dogmatic school would be followed by Greeks and later Romans, and remained a relatively common belief all the way to the end of the 18th century. By the first century A.D. the school would be referred to as rationalism and would be in competition with two other schools or sects called empiricism and Methodism, both of which I will expound upon in a later post.

Over time there became two basic theories that came out of this school:

1.  Humoralism:  These are the rationalists who believe in and follow the opinions of Hippocrates. They rationalized disease was caused by an imbalance of the four elements of empedocles and the four humors of Hippocrates, and were resolved when the balance was re-established. Physicians of this school were called HumoralistsThis hypothesis was most popular in ancient Greece and Rome, and continued to have sway in medicine until the end of the 18th century.  (6, page 41)  To learn how the humoral school was formed you can click here

2.  Pneumatistm:  It's an advancement of sorts of the Humoral School created by the stoics, or people who don't believe in the afterlife (7, page 73).  Followers believed health was maintained by the pneuma, or "vital air" that was inhaled through the lungs, stored in the heart, circulated by the vessels, and measured by the pulse.   (5, page 110)  

This idea of a "vital substance" was recorded in the Hippocratic writings, and believed to have been influenced by the Sicilian medical school that was founded by Empedocles.  

Medical historian Max Neuburger said Empedocles believed that respiration occurred through the mouth and the skin, and that "that the blood is the seat of inherent warmth."  (8, page 117-118)

Sicilian physicians studied and wrote about the heart, its valves, pericardium and pericardial fluids, and these were mentioned as the Hippocratic writers were describing the heart.  (8, page 117-118)

Neuburger said: (8, page 117-118)
Anatomical observation of the emptiness of the arteries after death, as well as general scientific consideration upon the significance of the air and of wind-movements, may have brought it about that Sicilian physicians looked upon the pneuma as the most important regulator of organic life. The pneuma was supposed to be distributed through the veins, to circulate with the blood, to temper the heat of the body, to assist all sense impressions and movements and, by stimulation, of putrefactive process, in conjunction with warmth to aid digestion. The heart was regarded as the center organ of the pneuma. (8, page 119)
The pneumatists believed excess or deficiency in any of the elements or four humors would disturb the pneuma of that person, and cause medical problems. 

They also believed that (5, page 112)
  • Blood is formed in the liver from food
  • Phlegm is secreted from the liver
  • Black bile comes from the spleen
  • The most important organ is the heart, since it's the size of heat and pneuma
  • The spinal cord was an expansion of the brain, so all neurons began in the brain
  • Respirations are the result of expansion and contraction of the lungs, involving the thorax and diaphragm
The school was established about 50 A.D by Athenaeus of Attaleia. It's an advancement of sorts of the Hippocratic school, with members being known as pneumatists. (4, page 490, 5 page 110) This school is essential to our asthma history because it focused attention on medicine, and generated many of the remedies used for all diseases, including asthma.

Yet by the 1st century A.D. the school had fierce competition.  

References:
  1. "Rationalism (philosophy), Encyclopedia Britannica.com, http://www.britannica.com/EBchecked/topic/492034/rationalism
  2. Withington, Edward Theodore, "Medical History from the Earliest Times," 1894, London
  3. Watson, John, "Medical Profession in Ancient Times, "
  4. Magill, Frank N., editor, "Dictionary of World Biography," Volume I: The Ancient World, 1998, Salem Press Inc., California
  5. Meryon, Edward, "History of Medicine: comprising a narrative of its progress from the earliest ages to the present and of the delusions incidental to its advance from empericism to the dignity of a science," volume I, London, 1861,
  6. Adams, Charles, Kendall, editor, "Johnson's Universal Cyclopedia: A new edition," volume V, A. Johnson Company, New York, 1894
  7. Garrison, Fielding Hudson, "An introduction to the history of medicine: with medical chronology, Bibliographic data and test questions," 1913, Philadelphia and London, W.B. Saunders company
  8. Neuburger, Max, writer, "History of Medicine," 1910, translated by Ernest Playfair, Volume I, London, Oxford University Press

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