The History of Medicine: Straight Path or Winding Road?

Introduction: The Illusion of Linear Progress

Looking back at the history and trajectory of various sciences and other areas of human achievement from a modern vantage point, it can be easy to see the past as a straight line of accomplishments that build on each other, leading directly and inevitably to the current state of human knowledge. One discovery leads to another, which leads to another, and as knowledge is refined in one area new applications are found in other areas, driving all sciences and knowledge forward at the same pace — or so it often seems. In reality, few individual discoveries, let alone whole bodies of science and knowledge, actually progress in such a linear fashion. Rather, there are fits and starts, false leads, parallel courses of inquiry, and a variety of backtracks, twists, and turns that make the progress of science and knowledge more accurately described as a winding mountain path than a straight line. Though neither metaphor is perfect, the mountain path is far more accurate.

This is no less true in the history and trajectory of medicine than it is in the realm of other sciences. Though it might seem as though medicine has undergone a straight and simple path from the time of the ancient Greeks to today — with ever-increasing rationality and empiricism leading to ever-greater discoveries — this is far from the truth. The study and science of medicine has undergone several different iterations at different times throughout the history of civilization. At times there are what can be said to be steps "backwards," and at other times concurrent investigations and advances occur completely independent of each other. In short, there are many complexities to the trajectory of medicine's history and progress.

Early Medicine: Myth, Ritual, and Rational Beginnings

The non-linear nature of medicine's development can be seen from its very earliest advances as a science rather than an extension of mythological and superstitious beliefs. As society progressed from mythopoeic hunter-gatherers to agricultural communities able to sustain food surpluses — and thus turn their attention to other pursuits in a more concentrated way — illness and health began to acquire natural and rational rather than supernatural and divine causes in several civilizations at around the same time. Even with this increase in rational empiricism in Egypt, Mesopotamia, and slightly later in Greece, however, medicine was not suddenly subjected to the careful, direct, and skeptical inquiry that we expect of it today.

Instead, even the briefest examination of an ancient Egyptian medical papyrus reveals a high level of religious influence in the diagnosis and treatment of disease, and many of the "rational" conclusions reached were entirely spurious. The same is true of the Greek priests of medicine, who — like the Egyptians — admitted patients to their temples only after pre-diagnosing them and selecting individuals who were likely to survive, thus inflating the perceived efficacy of the temple and the priesthood.

The Greek Leap and Roman Regression

Then, suddenly, the appearance of Hippocrates and Galen seemed to propel medicine almost entirely out of the realm of superstition. These later Greek thinkers brought true scientific inquiry to medicine almost from nowhere — a very rare occurrence in science at all, let alone as the birth of a new discipline. This was not part of a real gradual trajectory, but rather a sudden leap forward in the perspective toward and the capabilities of medical science.

As if to instantly affirm the principle that progress cannot continue on a simple and direct path, the Romans came after the Greeks and took medicine in a far less rigorous direction. Seeing the Greeks and their dependence on physicians as effeminate, Romans insisted that exercise, diet, and a few traditional herbal remedies — used only out of past practice and not empirical evidence — were all that was needed to maintain health. Despite other advances in hygiene and the remarkable civil engineering projects the Romans undertook, historians have generally agreed that Roman knowledge and practice of medicine was inferior to that of the Greeks, possibly vastly so. Though health was indeed promoted by many Roman activities and endeavors, medicine was one of the areas in which the least progress was made, and which had the least positive and direct benefit on the health of the large population of the Roman Empire.

Conclusion: Medicine as a Collective, Non-Linear Endeavor

Medicine, like all human knowledge, is a collective endeavor. This, coupled with major changes in the overall trajectory of human civilization, has meant that medicine's progress has moved in several directions, sometimes backwards, at different times. Though there has certainly been progress in medicine overall, it has not been in a straight line — nor would many current advancements have occurred if it had been.