Greece and Rome

More extensive and reliable historical sources exist for ancient Greece and Rome. The ancient Greeks (500 b.c.e.) explained health and disease cosmologically and anthropologically, that is, in close relation to nature in general and to human nature in particular. Medicine sought not only to cure disease but also to maintain health. The pre-Socratic philosophers, who were the physicians of this time, developed a universal model of health, whose outlines can be found in the medical texts of Hippocrates (c. 460-c. 377 b.c.e.) and other physicians of the Corpus Hippocraticum (400 b.c.e.—200 c.e.). These pre-Socratic physicians must be distinguished from magicoreligious healers, who still existed at that time (Kudlien).

The great physician Galen (129—c. 199 c.e.) elaborated a model of health and disease as a structure of elements, qualities, humors, organs, temperaments, times of day, and times of year (Schöner). Health was understood in this perspective to be a condition of harmony or balance (isonomia) among these basic components that make up both nature in general and the individual body. Disease, on the other hand, was regarded as discordance, or the inappropriate dominance (monarchia) of one of the basic components. Disease in the perspective of humoral (pathology determined by bodily fluids) was interpreted as the disproportion (dyscrasia) of bodily fluids or humors: phlegm, blood, and yellow and black bile. Solidistic pathology traced disease to disturbances among the solid components of the body (shape, consistency, distance, etc.). The pneumapathological (spirit) approach attributed disease to a failed relationship between body and soul. Health (eucrasia) was characterized by equilibrium in the body.

Dietetics was considered of primary importance to the therapeutic process, followed by medication and lastly by surgery, a hierarchy exactly opposite to the prevailing Western approach of today. In the ancient perspective, dietetics involved much more than a health-conscious regulation of food and drink. Rather, it entailed a broad concept of how one should live a healthy life. Dietetics was concerned with six aspects of life that, although natural, did not regulate themselves, as did such physiological functions as respiration and digestion. Because they required human manipulation, these six aspects of life were called "non-natural" (sex res non naturales). These areas included how humans deal with:

1. air and light;

2. food and drink;

4. motion and rest;

5. secretions; and

6. passions of the mind (Rather).

According to Galen, and in contrast to contemporary views, health and sickness were not the only states of existence. Rather, there was a third condition, an intermediate state of neutrality that existed between health and sickness: Medicine was therefore conceived as the science of health, sickness, and neutrality. In this notion of medicine, the overcoming of sickness was secondary to the preservation of good health or to aiding patients in living with impediments and handicaps. Galen said that because health precedes illness both in time and in esteem, one should try first to preserve health and only second to cure the illness as far as possible.

Philosophy and medicine mutually influenced one another in antiquity, although Hippocrates is said to have separated medicine from philosophy. Health and disease are not only empirical descriptions. They always have philosophical implications and practical effects. The Greek philosopher Plato (c. 428-c. 348 b.c.e.) defined medicine as the theory of health, and in the perspective of his ethical concept of health, he legitimized the active euthanasia of the physically handicapped and the mentally ill. Plato and his student Aristotle (384—322 b.c.e.) developed a typology of three physicians with corresponding types of relationships with the patient. The slave doctor commands, and the patient has to obey. The doctor for freemen explains the treatment to the patient and the patient's family. Doctors understood to be medically educated laymen signified individuals who take responsibility for their own health, sickness, and death.

While abortion and active euthanasia were forbidden as therapeutic acts for the Hippocratic physician, the Stoics justified these practices in situations in which the patient had lost or was in danger of losing moral autonomy and rational awareness. Harmony of the mind was placed above health and disease, above wealth and poverty. For the Stoic philosopher Seneca (c. 4 b.c.e.—65 c.e.), disease meant physical pain (dolor corporis), the suspension of joy (intermissio voluptatum), and the fear of death (metus mortis)—implying that disease combines physical, psychological, social, and mental dimensions. While being persecuted by the Roman emperor Nero, Seneca ended his own life through active euthanasia with the help of his friend and doctor Statius Annaeus.

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