Two Ways

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Although Hippocrates’s ideas were one of the first attempts to create a model of health and disease without the involvement of supernatural forces, his contemporaries did not take the step that now seems natural to us – did not hurry to get the knowledge that lay only at a distance of a knife blade, hidden under the skin. Ancient doctors did not dissect corpses; the source of their ideas about the internal structure were the few autopsies of animals and observations of deep cavity wounds.

There were several reasons for this. First, in Ancient Greece, and then in Ancient Rome, there was a ban on the opening of the human body. A dead body was considered unclean, and anyone who came into contact with it had to undergo a long rite of purification. At the same time, there was no motivation to take risks and break the taboo: a better understanding of the anatomical structure could not give the established treatment practices. Opportunities to influence the health and repertoire of medical interventions were minimal. Theories like humoral served to establish the status of a doctor – one who had special knowledge and had the right to treat – rather than to further study the body or find effective treatments. And secondly, ancient culture highly valued philosophers, but low-artisans, which were treated and doctors. The high knowledge gained by philosophical reasoning was valued more than the mundane practical experience. Not surprisingly, there were not many willing to devote themselves to such an unpleasant occupation as autopsy.

Only a hundred years after Hippocrates was a serious attempt to study the structure of the body. This was made possible by the unique situation that developed at the turn of the III and IV centuries BC in Alexandria, the capital of Egypt, which was at that time the center of the Greek Ptolemaic state and the intellectual capital of the Mediterranean. Under the patronage of this dynasty, science and art flourished here. The library of Alexandria was not only the largest collection of texts, but also an educational and scientific center. From all over the Mediterranean to Alexandria flocked the best minds – mathematicians, astronomers, geographers and doctors.

He came to Alexandria to study medicine and the young Herophilus – one of the most atypical doctors of his time. For the first time in medical history, he tried to measure and accurately describe the workings of the human body. And he was the first to use measuring instruments – for a more accurate calculation of the pulse rate, he made a portable water clock. Not far behind, and his younger colleague and competitor – Erazistrat. He made and began to use the device to measure the volume of exhaled air. Nothing like this happened in medicine either before or for a long time after.

The most important contribution of the Alexandrians is the study and description of human anatomy. Gerofi and Erazistrat were the first who systematically conducted the autopsy, detailed notes and sketched what he saw. The bodies were opened not only for research purposes, but also for the training of medical students. In addition, Gerofil conducted free public autopsies with comments for everyone-this makes him the first known popularizer of science.

This flagrant violation of the Greek taboo was made possible by the confluence of two circumstances – the tradition of autopsies in Egypt and the personal patronage of Ptolemy I, who was interested in science and was himself often present at autopsies. On his orders, doctors delivered hundreds of bodies of executed criminals. In a very short time, Herophilus and Erasistratus created the science of human structure from scratch: the brain, eyes, blood supply system were described in detail, heart valves were opened. For the first time there was a hypothesis that the life force, pneuma, enters through the trachea into the lungs, from where it enters the heart and is carried through the arteries throughout the body. Erasistratos found that the water he had drunk went down the esophagus into the stomach – before him it was thought to go into the lungs, and only food went into the stomach. Herophilus described the genitals in detail, discovered the ovaries and disproved the popular theory of the wandering uterus.

One of the darkest episodes in the history of anatomy is connected with the names of the two great anatomists. The legend says that Gerofi and Erazistrat opened not only the dead body. By order of Ptolemy they brought hundreds of condemned criminals, who were used for vivisection-anatomical autopsies alive. I want to believe that this is only a legend. However, the fact that the Alexandrians understood the difference between the sensitive and motor nerves, which is impossible to detect, dissect only the bodies and left Erasistratos entry about the benefits of studying anatomy to living bodies suggest the sad thoughts.

With the coming to power indifferent to the Sciences of Ptolemy III state support, followed by opening gradually disappeared. This was facilitated by the growing popularity of the medical school of empiricists (from the Greek empeiria – “experience”), founded by one of the students of Herophilus. Empiricists argued that the causes of the disease are unknowable, so you can not base treatment on theories that still have little to do with reality. They not only stated the artificiality of modern medical concepts, but also were against any attempts to correct the situation, including by anatomical dissections.

Empiricists chose treatment based on efficacy data, but collected them uncritically. The method could be recognized as effective on the basis of reports from absolutely fantastic sources that were not questioned and not tested in practice. Therefore, the therapeutic methods of empiricists differed little from those offered by other schools.

Empiricists opposed dogmatists (from the Greek dogma – “opinion”), who derived treatment by logical reasoning, starting from the theories of the authorities of the past, primarily Hippocrates. As we would say now, they relied on a rational method-chose treatment, guided by their ideas about the disease.

Despite the equal ineffectiveness of what both schools offered patients, the fierce discussions between them continued for centuries. Who was right? Is it possible, as did the dogmatists, to choose a rational method of treatment, based on reasoning based on our understanding of the mechanisms of the disease? Or need, followed by empiricists, to consider only evidence of the effectiveness? It took more than two thousand years to answer this question.

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