Teaching New Doctors Old Tricks: Greek Medicine’s Impact on Modern Healthcare

If I have seen further than others, it is by standing upon the shoulders of giants.

—Sir Isaac Newton

We are all aware of the role Hippocrates, the father of modern medicine, played in the early development of medicine. However, before we discuss Hippocrates, it is necessary to provide some background on Asclepius, who was considered the first physician. In Greek mythology, Asclepius, the son of Apollo, was considered to be the god of practically everything—including but not limited to healing.

To this day the rod of Asclepius is a universal symbol for the medical profession.

Temples dedicated to the healer-god Asclepius functioned as centers of medical advice and healing. At these shrines, patients would enter a dream-like state of induced sleep known as enkoimesis where they received guidance from the deity in a dream. At the Temple of Asclepius in Pergamum, a spring flowed down into an underground room in the temple. People would come to drink the waters and to bathe in them because they were believed to have medicinal properties. Mud baths and hot teas, such as chamomile (to calm patients) or peppermint (to soothe headaches) were offered, remedies still used by many.

One day Asclepius was examining a man whom Zeus had recently struck dead with a thunderbolt. During the examination, a snake entered the room and surprised Asclepius, who responded by killing the snake with his staff. When a second serpent entered the room, Asclepius placed medicinal herbs into the mouth of the dead serpent and brought the snake back to life. Asclepius acknowledged the healing power of the herbs and, as a sign of respect, made this emblem of a single snake coiled around his staff the insignia of the healthcare profession. To this day, the rod of Asclepius, which consists of one snake on a staff, is a universal symbol for the medical profession. This symbol of a rough-hewn branch with a single snake coiled around it is as recognizable as the white lab coat, black bag (a symbol that dates back to the days when doctors routinely made house calls), and stethoscope.

It is worth noting that sanctuaries of Asclepius were established in many ancient Greek communities, with almost every big town seeking to provide what was essentially a healthcare facility for its residents and neighbors. These healthcare sanctuaries, which were called Asclepieia, served as sacred hospitals and were the precursors of modern hospitals where the very sick go for healing.

Let’s now look at the origin of the caduceus, which is represented by two snakes and is the symbol of the modern medical profession. Most healthcare professionals are not aware that two distinct symbols—the caduceus and the staff of Asclepius—were previously used and have very different origins.

Hermes, one of the 12 Olympian gods, was the god of commerce and trade and also was considered the god of thieves. He was given a staff by Apollo to separate two fighting snakes, and this symbol, the caduceus, became the permanent symbol of medicine, which is used instead of the staff of Asclepius.

Several centuries later, the symbol of the caduceus was used as a printer’s mark in general publishing in England, particularly in medical publishing. Thus the caduceus was inadvertently connected to the medical profession in the minds of physicians, especially in the United States. It was the United States Army that first used the caduceus instead of the staff of Asclepius, as the symbol of the Army Medical Corps, in 1903, and to this day the symbol with the two snakes is the one used as the insignia of the medical profession.

Hippocrates

Ancient Greek medicine was a compilation of theories and practices that were constantly evolving through new ideologies and trials. The ancient Greeks believed health was affected by the four humors: blood, phlegm, and bile, both yellow and black; geographic location; social class; diet; trauma; beliefs; and mindset. They believed that illnesses were divine punishments and that healing was a gift from the gods. Responsibility for the illness was placed squarely on the patient, and the role of the physician was to commune with the gods or exorcise the demon with prayers, spells, and sacrifices. The early Greek healers replaced these spiritual beliefs with an understanding of illness as based on physical causes and effects.

Hippocrates (born 460 BCE—died ~375 BCE) is considered the father of modern medicine. He separated medicine from other disciplines such as philosophy, mathematics, and mythology. Until his time, medicine had been considered a part of philosophy and had involved the practice of rituals, incantations, and the casting off of evil spirits.

Hippocrates and the ancient Greek physicians emphasized the importance of the doctor–patient relationship, and they stressed that it is up to the patient to make the decision to accept treatment.

Before Hippocrates, illness was blamed on the afflicted person having angered the gods. Hippocrates did away with holding gods and demons responsible for causing disease by punishing the patient, but theorized that illness is attributed to natural causes such as bad air, or the miasma theory. Hippocrates argued that if all diseases were derived from supernatural sources, then pharmacologic medicines would not work. The humoral theory of medicine focused on the balance between the humors: blood, yellow and black bile, and phlegm. According to Hippocrates’ theories of disease, if patients were too hot, too cold, or had dry or wet conditions or lesions, this disturbed the balance between the humors, resulting in disease and illness. Hippocrates and his students documented numerous illnesses and developed the Hippocratic Oath that nearly all physicians throughout the world take today following graduation from medical school.

Hippocrates and the ancient Greek physicians emphasized the importance of the doctor–patient relationship, and they stressed that it is up to the patient to make the decision to accept treatment. Physician and patient responsibility are mentioned in the treatise Epidemics, which states: “there are three factors in the practice of medicine: the disease, the patient, and the physician. The physician is the servant of science, and the patient must do what he can to fight the disease with the assistance of the physician.”(1)

It is of interest that gender played a role in medicine because some diseases and treatments were different for females than for males. Moreover, geographic location and social class affected living conditions and might subject people to different environmental issues, such as mosquitoes, rats, and the availability of clean drinking water. Diet was thought to be an issue as well and might be affected by a lack of access to adequate nourishment. Trauma, such as that suffered by gladiators or from dog bites or other injuries, played a role in theories relating to understanding anatomy and infections. We believe that it was recognized early on that the mind played a role in healing, or that it might even serve as the basis for the illness itself.

Galen

Galen, a prominent Greek physician, surgeon, and philosopher, is considered the most accomplished of all medical researchers after Hippocrates. Galen influenced the development of various scientific disciplines, including anatomy, physiology, pathology, and pharmacology, as well as philosophy and logic. Galen was born in Pergamon (present-day Bergama, Turkey). He settled in Rome, where he served as personal physician to several emperors. Galen’s understanding of anatomy and medicine was influenced by ancient Greek physicians, especially Hippocrates. His theories dominated and influenced Western medical science for more than 1300 years. For example, Galen’s theory of the physiology of the circulatory system endured until 1628, when William Harvey published his treatise in which he established that blood circulates through the body, with the heart acting as a pump. Galen saw himself as both a physician and a philosopher, as he wrote in his treatise That the Best Physician is also a Philosopher.(2)

The Impact of Greek Medicine on Contemporary Healthcare

The ancient Greeks are given credit for having founded Western medicine more than 2000 years ago. What can we learn from how ancient Greek physicians approached patient care even before anyone knew about bacteria, circulation of blood, or pharmacology? We believe that the ancient Greeks can help us think through a number of topics that are still relevant today.

Contemporary doctors probably can learn quite a bit by looking at ancient writings from the early Greek physicians. It may be possible, although it hasn’t happened yet, that a forgotten plant used in the ancient world will one day prove to be the basis for a new drug.

Ancient Greek doctors made an effort to understand what their patients were thinking, understand what they were feeling, and help them to trust the physician.

However, drugs were not the starting point of ancient medicine. First came diet, and the importance of leading a healthy lifestyle—with attention paid to food, fluids, exercise, bowel and bladder symptoms, and sleep. Health was believed to be affected by the balance of different fluids in the body.

A patient’s condition was thought to result not just from the balance inside his or her body but also from the patient’s relation to the environment. Today, with diseases related to obesity and mental health taking an increasing amount of modern doctors’ time, it is not surprising that contemporary medicine is turning more and more to a Greek-style holistic approach.

Ancient Greek doctors made an effort to understand what their patients were thinking, understand what they were feeling, and help them to trust the physician—because if they trusted the doctor, then they’d take the remedies. To gain a patient’s trust, a doctor had to make sure his image was right. In ancient Greece it was all about wearing plain, simple clothing; avoiding strong perfumes; and (perhaps) being on time. Today, we stand on the shoulders of those ancient Greek doctors where the mere initials “MD” after our name generates trust and confidence in our patients. Because of this trust, patients will share the most intimate details of their medical history with a doctor after only a few minutes when he or she is in the exam room. When a patient trusts their doctor, that doctor can prescribe acrid medications, treatments, and even a surgical procedure if the doctor feels that would be the best approach to the patient’s medical condition.

The ancient Greek doctors were preoccupied with finding an explanation of why their patients became ill. Ancient religion blamed the gods, or the patient’s failure to honor the gods in the right way. Before the ancient Greek physicians, illness was explained in terms of what the patient did wrong. However, with the advent of Greek medicine, doctors began to place an emphasis on patients’ actions, such as eating the wrong foods or taking too little exercise, as the cause of disease. These ancient doctors were curious about why patients became sick so they could plan what to do to make the patient better. Ancient medicine suggests that putting the blame only on the patient does not help, something modern medicine is just beginning to comprehend. For example, shaming an obese patient won’t result in weight loss. Patients are more likely to have a positive attitude and perhaps be more compliant if they can look to a “why” that’s outside themselves.

The ancient Greek doctors thought they had the answers to everything. Sometimes contemporary doctors suffer from the same over-inflated opinions of ourselves. Let’s not forget that for centuries doctors had all the knowledge and patients depended on them for providing the information that was necessary for the diagnosis and the treatment. The Internet has leveled the playing field, so that today a patient can know the results of the latest research, the latest medications, and the most recent advances in surgery, immunotherapy, and precision medicine even before the information reaches the doctor. Ancient Greek medicine still teaches modern doctors that we should never accept anything without asking why and without being prepared to change our decision making if new evidence comes along. An example in relatively recent times is the causation of gastric ulcers, which were, until just a few decades ago, attributed to hyperacidity. However, Marshall, an Australian doctor, discovered that the bacteria Helicobacter pylori was the culprit, and the treatment needed was antibiotics, not antacids.

The ancient Greeks also teach us that medicine needs to make sense to our patients as well as to our colleagues. There is no one pill or “one size fits all” for every illness or condition. The message the ancient Greeks doctors sent us is that the sensitive and astute doctor customizes the treatment for each individual patient.

Bottom Line: We have learned a great deal from the ancient Greek doctors. It is on their shoulders that we stand today.

References

1. Bartoˇs H. The Cambridge Companion to Hippocrates ed. by Peter E. Pormann (review). Bulletin of the History of Medicine. 2020;94(1), 133-135.

2. Brian P. Galen on the ideal of the physician. South Africa Medical Journal. 1977;52: 936-938.