III
To the Greeks, the preservation of health through
temperance in eating, drinking, and other activities was
a model for healthy thinking (Snell, 1953), sōphrosynē,
soundness of mind. With it were connected well-being
and deliverance from ills, as the etymological roots of
the allied Greek words
sōs, sōtēria, “suggest.” For
Aeschylus (
Eumenides, 535-37) “much desired happi-
ness, beloved by all, [comes] from a healthy mind.”
To the Stoic philosopher, happiness lay in virtue; a
person was healthy if his contentment relied on the
things in his power (Seneca,
Epistulae morales, lxxii,
7). The wisdom of the sage thus coincided with his
attainment of true health.
Here was a transition from the classical ideal of
health as symmetry and beauty (Plato, Timaeus
87E-88A) to the ideal of spiritual beauty and spiritual
health, acquired, if necessary, at the expense of the
body, “the flesh,” as the Gospel has it.
Suffering in general and disease in particular had
long been seen as consequences of sin. With the spread
of Christianity, they could appear as chastisement of
those whom the Lord loved. Disease could be a portal
through which man acquired eternal salvation. Jesus
told the sufferer from a palsy that his sins were for-
given. To show “that the Son of man hath power on
earth to forgive sins,” he bade the sick man: “Arise,
take up thy bed, and go unto thine house” (Matthew
9:2-7). Again, Jesus justified his eating “with publicans
and sinners” by saying that “They that be whole need
not a physician, but they that are sick” (ibid., 10-13).
Thus sickness was not only a consequence of sin, sin
itself was a disease which needed healing. This has
found expression in endless allegories from Origen to
authors of modern times. When Matthew (17:14ff.)
speaks of a lunatic boy whom Mark (9:14ff.) describes
as deaf and dumb, Bede interprets this as a reference
to persons waxing and waning in sundry vices as the
moon changes, deaf to the sermon of faith and dumb
because not expressing faith.
The ascetic life regarded disease not only with in-
difference but even with pride, as mortification of the
flesh. To care for the lepers and thereby to expose
oneself to infection was a sign of sanctity. It has to
be admitted that the positive evaluation of disease had
also another, secular, root. In the pseudo-Aristotelian
Problems (xxx,i) the question was raised why all men
outstanding in philosophy, politics, poetry, or the arts
appeared to be of a melancholic temperament, even
to the extent of being afflicted with the sicknesses
arising from the black bile. This was to lead to the
notion of melancholy as a disease of superior intellects,
a notion that achieved its best-known artistic expres-
sion in Dürer's engraving Melencolia I (Klibansky et
al., 1964) and its most learned treatment in Burton's
Anatomy of Melancholy (1621).
The concept of disease at a given period is not
altogether independent of the nature of the prevailing
ailments. The Middle Ages and the Renaissance
suffered much from infections that appeared in massive
epidemic waves or were endemic, i.e., native to the
population. Arabic and Latin authors of the time
elaborated the ancient concept of infections and con-
tagious disease. As a dye or a poison (virus) could stain
a large amount of water or kill a large animal; as
putrescent material, marked by an evil smell, corrupted
what had been sound, so an infection polluted the body
and could spread among a population. Virus, stain, evil
smell, putrescence, and miasma were the notions asso-
ciated with infection and contagion.
The concept of infection was broad and unclear:
infection could develop in the body with the disease,
it could be due to the influence of the stars (hence
“influenza”), and it could take on different forms (the
word “pestilence” designated any severe epidemic). If
the disease spread by personal contact, it was conta-
gious. Of all epidemics, the plague, which manifested
itself in bubonic and pulmonary forms, was the most
severe. It appeared during the reign of the emperor
Justinian (A.D. 527-65), then in the fourteenth century
(“the black death”), and in many subsequent outbreaks,
of which those of London (1665) and Marseilles (1720)
were among the last in Western Europe. The plague,
dreaded as contagious, provoked public health meas-
ures, quarantine and isolation, to counteract the dan-
ger. In Romeo and Juliet (Act V, Scene ii) the searchers
of the town, suspecting that Friar Laurence and his
brother monk “... both were in a house/ where the
infectious pestilence did reign/ seal'd up the doors...”
and did not let them leave.
The most serious endemic contagion was leprosy;
then from about 1495, syphilis assumed first place.
Whether syphilis was imported from the new world
by the crew of Columbus or had existed in Europe
before is a moot question. The disease became widely
known as the French disease (the French, in turn,
calling it mal de Naples). The name syphilis was given
to the disease in a Latin poem Syphilis sive morbus
gallicus (1530), by Girolamo Fracastoro, who also
elaborated a theory of contagious disease which in its
fundamentals survived till the mid-nineteenth century.
Imperceptibly small particles, seminaria, capable of
propagating themselves, transferred contagious diseases
by direct contact, through an object (fomes), or at a
short distance. It is not likely that he thought of the
seminaria as microorganisms; rather he anticipated
something of the notion of a leaven (Greek: zumē). A
contagious disease was specific: it retained its character
in the transmission from man to man. The ontological
view of diseases, i.e., thinking of them as real, distinct
entities, was nothing new. Even the comparison of a
disease with an animal was old—Plato (Timaeus 89B)
had used it, and Varro (116-27 B.C.) had actually
spoken of animals, too small to be seen by the eye,
“which by mouth and nose through the air enter the
body and cause severe diseases” (
rerum rusticarum 1,
2). But in the sixteenth to seventeenth centuries the
ontological concept of disease was considerably
strengthened. The Paracelsists, including their master
Paracelsus (1493-1541) and their rebellious member
van Helmont (1577-1644), contributed by endowing
disease with a body, thinking of it as a parasite, at-
tributing its causes to external factors independent of
man. Van Helmont, in particular, opposed the old
theory of diseases as catarrhs, as fluxes from the brain
to which vapors had ascended. He spoke of the
spina,
the thorn, i.e. irritations, the form in which diseases
acted in the body. Outside the circle of Paracelsists,
William Harvey (1578-1657) in his embryological
work (Exercise 27) thought of tumors as leading a life
of their own, and of diseases from poison or contagion
as having their own vitality (Pagel, 1968).
The most impressive presentation of the ontological
point of view came from Thomas Sydenham (1624-89).
He took up the Hippocratic notion of the “consti-
tution” of a year, associated with the diseases prevalent
during the period. According to Sydenham, epidemics
had different constitutions depending upon “an occult
and inexplicable alteration in the very bowels of the
earth, whence the air becomes contaminated by the
kind of effluvia which deliver and determine the human
bodies to this or that disease” (Opera, 1844). Diseases
should be observed and their species studied as plants
were studied by the botanists, and though he could
not explain the formation of the species, Sydenham,
nevertheless, hinted at their origin. When the humors
of the body could not be concocted, or when they
contracted “a morbific blemish from this or that at-
mospheric constitution” (ibid.), or when they turned
poisonous because of a contagion, then they were
“exalted into a substantial form of species” (Works,
1848). The disease itself was Nature's struggle to re-
store health by elimination of the morbific matter.
With great praise, Sydenham quoted the Hippocratic
saying, “Nature is the healer of disease.” Nature needed
simple help from the physician; sometimes not even
that.
Sydenham was one of the founders of nosology, the
science of classifying diseases, which came into its own
at the time of the great systematist Linné (1707-78).
Boissier de Sauvages (1706-67), Cullen (1710-90), Pinel
(1745-1826), and Schoenlein (1793-1864) created
nosological systems which, on the basis of clinical
symptoms, classified diseases into orders, families,
genera, and species. This was the practitioner's science:
if, by its symptoms, he could diagnose the disease and
find its place in the scheme, he could then also pre-
scribe the remedies recommended for it. If he wished,
he could go further and instruct himself about the
scientific explanation of the disease, but he need not
do so if he distrusted the various theories offered.
