Tuesday, April 16, 2013

124 B.C.: The Methodist school of medicine

Over time a third school, or sect, of medicine evolved that gained popularity in ancient Greece and Rome and had a significant affect on the remedies provided to patients. In fact, it was by following the opinions of this school that helped one famous physicians convince the Romans to accept Greek medicine.

The motto of this school went something like this: 
A pathological theory we must have, but let it be simple."  (8, page xiv)
It is believed to be started with Anaxagoras of Clazomenae (50-428 B.C.), who preached that there was a distinction between mind and body. (5, page 15)

It also might have started with Parmenides of Elea (born about 540 B.C.?), who:
argued that it is impossible for there to be change without something coming from nothing. Since the idea that something could come from nothing was generally agreed to be impossible, Parmenides argued that change is merely illusory. (10)
Archelaos of Athens (born about 500 B.C.?) was a pupil of Anaxagoras who added to his master's ideas the "fundamental principle of air."  Diogenes of Apollonia (lived around 420 B.C.?) made "air endowed with reason the origin of bodily and mental life. "  (9, page 110)

Around 450 B.C., Democritus (460-370 B.C.), who was a contemporary, although about 40 or 50 years younger, of Anaxagoras, "acknowledged the distinction, and describing both mind and body as composed of atoms or corpuscles, differing only in their nature and arrangement." (5, page 15)(9, page 109) (10)

Because he believed the body was composed of atoms he was referred to as an atomist.  The school hat ultimately formed based on his ideas was called the atomist school, although later scholars referred to it as the methodist school.

Still others referred to it as the solidist school because of the belief that diseases were formed by the solid living forms of the body as compared to fluids or humors of Hippocrates.  .

The teacher of Democritus was Leucippus, and very little is known of him. It is believed that Democritus reorganized his teachers works, and then formed the anatomist theory. 10)

Sylvia Berryman, who wrote about Democritus in the 2010 Stanford Encyclopedia of Philosophy, said:
Ancient sources describe atomism as one of a number of attempts by early Greek natural philosophers to respond to the challenge offered by Parmenides... In response, Leucippus and Democritus, along with other Presocratic pluralists such as Empedocles and Anaxagoras, developed systems that made change possible by showing that it does not require that something should come to be from nothing. These responses to Parmenides suppose that there are multiple unchanging material principles, which persist and merely rearrange themselves to form the changing world of appearances. In the atomist version, these unchanging material principles are indivisible particles, the atoms: the atomists are said to have taken the idea that there is a lower limit to divisibility to answer Zeno's paradoxes about the impossibility of traversing infinitely divisible magnitudes. (10)
Berryman explained that Democritus wrote about a world that was composed of atoms and voids.  The atoms were of varying sizes and shapes, and they were perfectly solid and, aside from changing location, were unchangeable or indestructible. Each atom also had a hook to allow it to attach to other atoms.

The atoms moved about in the void, often colliding with one another, and often becoming attached by their hooks to form clusters of varying shapes, sizes and colors that were the various objects (kosmoi)of the world, such as humans, animals, and trees. (10)

After a period of time the atoms relocate, change location through the voids, and attach to other atoms to form new kosmoi.  This process is ongoing for eternity. (10) 

Many of the principles of the school were established by Cleophantus of Alexandria and taught to his followers in creating a new school.  One of his students was Asclepiades. (3, page 92)

In the first century A.D. Asclepiades was an Atomist who made many "innovations" to this school, although he was originally considered a rationalist. (3, page 110)

He ultimately opposed the Hippocratic doctrines, supported the atomist hypothesis of Democritus, and added to it the the doctrine of "Strictum et Laxum" which states that disease is caused by excessive relaxation and tension of its solid particles, hence the term "solidism".  The school became known as the solidist school of medicine.  (7, page 73)

The desciple of Asclepiades was Themison of Laodicea.  Both of these physicians are often credited with forming the Methodist School of Medicine, which competed with the rational and empirical schools of medicine. (5, page 39-40)

Unlike the rationalists, they didn't try to find causes of disease. Unlike the empiricals, they didn't try to treat diseases based on their symptoms. Instead, "Themison declared that the physician should observe what symptoms various diseases have in common. He would then find that in all, or nearly all cases, there was an increase or dimunition of the secretions and extretions, and adapting this to the theory of Asclepiades, Themison argued that all diseases were due to a relaxation or a constriction of the 'pores.'" (2, page 85-6)

However, like the rationalist they believed "that the physician might reason from the seen to the unseen, e.g., from the state of the secretions to that of the pores."  From the empirics they "taught that diseases are to be judged from their symptoms, and not from their causes." They also agreed with the emperics that knowledge of anatomy irrelevent to treating diseases, "though it might be useful to know the names of the parts."  (2, page 86)

So the location of the disease was not important.  What organ caused a disease was not important.  The reason is that they considered a disease to be a general ailment of the body.  The cause wasn't important either, because they all either cause relaxation or constriction.  In other words, they believed that "constriction and relaxation are the same wherever they occur and require the same treatment." (2, page 86)

Medical historian John Brock describes it this way:
They held that molecular groups constituting the tissues were traversed by minute channels (pores); all diseases belonged to one or other of two classes; if the channels were constricted the disease was one of stasis, and if they were dilated the disease was one of flux. Flux and stasis were indicated respectively by increase and diminution of the natural secretions; treatment was the opposite by opposites -- of stasis by methods causing dilation of the channels, and conversely. (8, page xiv-xv)
Followers of this school treated diseases based on what was in the past effective in treating that disease, as opposed to treating patients based on speculation and superstition. "Their remedies were naturally divided into relaxants and astringents... They inculcated the use of gymnastic exercises, not only as remedial agents, but also as a means of counteracting the bad effects of increasing luxury and indolence." (5, page 41)

Astringent remedies used were "cold air and water, vinegar, decoctions of various herbs, especially the plantain, and the minerals, alum, lead and chalk, which were used externally.  The laxitive remdedy used most often was bleeding by venesection, cupping or leeches.  They did not use purgatives.  (2, page 86)

Their remedies tended to be gentler than dogmatic remedies, and perhaps for this is the reason Asclepiades was successful changing the Roman opinion of Greek medicine.

According to Brock "the vice of the Methodist teaching was that it looked on a disease too much as something fixed and finite, an independent entity, to be considered entirely apart from its particular setting."

Regardless of it's flaws, this school provided another option for physicians to follow and learn from, and some of the knowledge obtained later benefited the medical community in general.

  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," 1856, New York, Baker and Godwin 
  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. Brock, John, "Galen on the natural faculties," 1916, London, New York, William Heinemann, G.P. Putnam's Sons
  9. Neuburger, Max, writer, "History of Medicine," 1910, translated by Ernest Playfair, Volume I, London, Oxford University Press
  10. Berryman, Sylvia, "Democritus," from the book "The Stanford Encyclopedia of Philosophy," http://plato.stanford.edu/entries/democritus/, 2010, accessed 12/22/13

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