Tuesday, March 12, 2013

225 - 200 B.C. Dogmatism is challenged

Even while the dogmatic school of medicine (rational medicine) was being formed at the school of Cos by Hippocratic writers, so to was forming the emperical school of medicine at the school of Cnidos (1, page 29) by the following triad:  (1, page 29) (3, page 68)(4, page 91)
  • Herophilus:  (325-280 B.C.)  He came up with many of the theories followed by the school
  • Philinus (pupil of Herophilus, around 250 B.C.):  Started empiric school of medicine
  • Serapion (successor of Philinus, around 225 B.C.)  He supported empiricism
This school was basically established to counter the "extravagances" of the Dogmatic School of Medicine at the School of Cos.  (3, page 69)  A common saying of the empiracist was "It is not the cause but the cure of disease that concerns us; not how we digest, but what is digestible." (5, page xiii)

The major differences between these schools were as follows:  (1, page 29)(3, page 69) (4, page 68-9)

Dogmatists/ Rationalists/ Hippocratic
Dogmatic School of Medicine
Empiricists/ Emperics
Empirical School of Medicine
Supported ideas of the physician Hippocrates
Supported ideas of the philosopher Pyrrho
Were in search for causes of disease
Were not concerned with causes.  A person was ill is all they needed to know
Speculated on possible causes and remedies
Did not speculate
Created theories to explain causes and why a remedy will work.  Generally, diseases were caused by the body as a whole.
Did not create theories to explain anything.  If something was unknown, it was left at that
Cures were based on the theory postulated. 
Cures were based on experience.  If something worked in the past, it will work today.  Medicine not based on experience could injure
They had few remedies, many of which were harsh, such as bleeding, purging, and vomiting
They had many remedies, and they were generally friendlier than dogmatist remedies and probably worked better
They believed anatomy was important to understand the physiology of disease
They despised anatomy and physiology. 

Serapion was the most outspoken of the empirics, and "he wrote with great vengeance  (1, page 29), as he said:
"What is the use of  knowing the shape and position of the brain and liver, or whether there are such things as brains or livers at all."  (4, page 68)
Another common saying of the empirics was:
"It is not the cause, but the cure of diseases that concerns us; not how we digest, but what is digestible." (4, page 68)
Galen wrote about Serpion the empirist in his Outline of Empericism: (2, page 161)
Of the ancients, however, Hippocrates, Erasistratus, and Herophilus have stated nothing about the treatment suffering from the disease (i.e. lethargy).  But Serapion the Empericist, in Book 1 of his treaties Against the Haireseis, gave some instructions (about this) which are, however, too obscure to be reported here.
Serapion thus became an experimentalists.  He experimented to see what drugs worked best for said disease.  He recorded and made conclusions based on his own observations and experiments, as opposed to coming to speculative conclusions.  (1, page 30)

As described by Edward Withington:
"In short, they (empiricists) reduced the whole art and science of medicine to a system of therapeutics.  A person is ill, that is, he has certain unpleasant feelings or symptoms; surely the first thing to do is to find something which will remove them, and the whole duty of the physician is to discover what particular treatment, and especially what drugs, will get rid of particular sets of symptoms."  (3, page 68-9)
The way to do this is based on the "tripartite foundation" (1, page 30) of the following three methods:  (3, page 69)
  1. Experience:  His own experience and observations
  2. History:  Learning from the experience and observation of his contemporaries and  predisessors
  3. Analogy:  Drawing conclusions based on similar situations to find remedies for new and strange cases
 And thus was formed the Empirical school of medicine.

The empirics were essential to this time because they created an important alternative to the dogmatists, some of whom (see Erasistratus) performed autopsies on live convicted criminals to see what organs did during life.  Hopefully, as some reports suggest, many such victims were given a large dose of morphine before the procedure.  Yet still it was considered inhumane and irrational by the empiricist, and reasonably so.

While the dogmatists based their remedies on speculation, the empiricists used only remedies that were shown by experience to work. This was a viable alternative to the extreme remedies of bleeding and purging used by many dogmatists.  The empiricist also added quite an array of new remedies, including opium and sulpher.

The dogmatists became known as rationalists due to their desire to rationalize diseases and their remedies.  They believed "everything must have a sufficient reason for its existence," Empirics believed what can be observed by experience is known, and what is not known is not to be speculated upon.

References
  1. 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,
  2. Eijk, Philip J., editor, "Ancient Histories of Medicine: essays in medical doxography and histeriography in classical antiquity," 1999, Boston,
  3. Withington, "Medical History from it's Earliest Times: a popular history of the healing art," 1894, London, The Scientific Press
  4. Watson, John, "Medical Profession in Ancient Times: an anniversary discourse delivered before the New York Accademy of Medicine November 7, 1855," 1856, New York, Baker and Godwin
  5. Brock, John, "Galen on the natural faculties," 1916, London, New York, William Heinemann, G.P. Putnam's Sons

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