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Friday, June 5, 2015

50 A.D.: Pneumatic School of Medicine

About 50 A.D. Athenaeus of Attaleia established the Pneumatic School of Medicine, which is an advancement of sorts of the Hippocratic/ Dogmatic School of Medicine. Members of this school were known as "pneumatists." (3, page 490, (2 page 110) (8, page 73)

According to Claudius Galen, Athenaeus (which today would be in South West Turkey) was the pupil of the stoic Posidonius. (3, age 490)(4, pages 156-158)(5, page 207-208).

Medical historian Vivian Nutton said, in her 2013 book, "Ancient Medicine," that the medical theories of Athenaeus were a mixture of stoicism and Dogmatism (Hippocratic, Rational), and he rejected Atomism.

Medical historian Plinio Prioresch said, in 2002, that no one knows for certain when Athenaeus lived, although by the fact that Celcus and Pliney wrote nothing about him, and Galen did, and that Galen said he was the Pupil of Posidonius, many historians say he lived in the first century, but not after 50 A.D. He sad he might have been born during the reign of Tiberius (14-37 A.D.) and "flourished" during the reign Claudius (41-54 A.D.). (4, pages 156-158)

Prioreschi said:
Probably Athenaeus felt that Methodism by reducing all pathogeneses to status strictus, laxus and mixtus, was unsatisfactory it its simplism; that Empiricism with its rejection of all medical theories lacked intellectual stature; that Dogmatism simply rejected the old view of Hippocrates. Possibly, he felt that something new was needed. He therefore developed an intriguing old philosophical concept that was part (even if a secondary one) of the Hippocratic paradigm:  the pneuma. (4, pages 156-158)
This idea of a "vital substance" was recorded in the Hippocratic writings, and believed to have been influenced by the Sicilian medical school that was founded by Empedocles.  

Medical historian Max Neuburger said in 1910 that Empedocles believed that respiration occurred through the mouth and the skin, and "that the blood is the seat of inherent warmth."  (10, page 117-118)

Sicilian physicians studied and wrote about the heart, its valves, pericardium and pericardial fluids, and these were mentioned as the Hippocratic writers were describing the heart.  (10, page 117-118)

Neuburger said: (10, page 117-118)
Anatomical observation of the emptiness of the arteries after death, as well as general scientific consideration upon the significance of the air and of wind-movements, may have brought it about that Sicilian physicians looked upon the pneuma as the most important regulator of organic life. The pneuma was supposed to be distributed through the veins, to circulate with the blood, to temper the heat of the body, to assist all sense impressions and movements and, by stimulation, of putrefactive process, in conjunction with warmth to aid digestion. The heart was regarded as the center organ of the pneuma. (10, page 119) 
Prioreschi said:
According to Athenaeus, the pneuma is the world soul or energy, from which the souls of men, animals, and plants emanate; it is also the maker of all that exists. He considered the four qualities (heat, cold, dryness, and wetness) of the elements (fire, earth, air and water), the primary constituents of man, and added to them pneuma.  Pneuma, absorbed from the air, passes from the lungs to the heart and through the arteries to the whole body, and its alterations determine health and disease. (4, pages 156-158)
Prioreschi quotes Galen:
According to Athenaeus, the four primary elements of man are not fire, air, water and heart but their qualities, that is to say, heat, cold, dryness and wetness.  Of these, two are active, mainly heat and cold, and two are passive, namely dryness and wetness.  From stoic doctrine he also introduced a fifth one: pneuma, which penetrates everything, by which everything is held together and governed.  Athenaeus and Archegenes believed that... all diseases result from an alteration of the pneuma. Hence, those who believe that all depend on the pneuma are called Pneumatists. (6, page 158) 
Pneumatists, therefore, believed health was maintained by the balance of the humors and pneuma, which means "vital air" or "spirit."  Pneuma was inhaled through the lungs, stored in the heart, circulated by the vessels, and measured by the pulse.   (2, page 110)

Pneumatists believed disturbances in the four humors (blood, phlegm, yellow bile and black bile), or an excess or deficiency in any one, would disturb the pneuma of that person, and cause medical problems. (2, page 111)

They also believed that: (2, page 112)(5, page 208)
  • Blood is formed in the liver from food (2, page 112)
  • Phlegm is secreted from the brain to other organs (2, page 112)
  • Yellow bile comes from the liver (2, page 112)
  • Black bile comes from the spleen (2, page 112)
  • The most important organ is the heart, since it's the site of heat and pneuma (2, page 112)
  • The heart draws pneuma from the lungs, which cools it, and is stimulated by it  (2, page 112)(5, page 208)
  • The spinal cord was an expansion of the brain, so all neurons began in the brain (2, page 112)
  • Respirations are a result of expansion and contraction of the lungs, involving the thorax and diaphragm (2, page 112)
  • The nose was the most important organ in the body, mainly because it was used to inhale air, and pneuma.  (7, page 58)
Because the temperature of the pneuma could be affected by the environment around a person, Athenaeus paid special attention to the seasons, and other things that might affect the atmosphere around a person, including such things as design of the house. To keep the pneuma healthy, a steady diet was necessary, along with clean drinking water and exercise. (4, page 208)(5, page 208) 

Athenaeus and the pneumatists who followed him believed contrariis contrarius, or opposite by opposite.  By this he believed that the remedy was the opposite of the cause, or diseases caused by heat were treated with coolness. For example, a fever was cured by placing a cool rag on the patient's forehead or ice under their armpits.  (4, page 208)

Nutton said that if the Posidonius mentioned by Galen was Posidonius of Apamea, and if Posidonius actually attended his lectures, it's actually possible that the pneumatist school was formed as early as 50 B.C. or 60 B.C. (5, page 207)

However, considering neither Celsus nor Pliney mention it, Nutton said that most historians agree that he probably lived around 50 B.C., which is the date that most historians attribute as the beginning of the Pneumatist School of Medicine.

The basic tenants of the Pneumatic school were carried on by Claudius Agathinus of Sparta (50-100 A.D), who was a pupil of Athenaeus and lived during the reign of Nero.  Although, he most likely referred to the school he created as episynthetic, which was basically an eclectic school, because he also accepted ideas from the Methodist and Empiric schools. (4, page 159) (8, page 73)(11, page 98)(12)

The two most famous pupils of Agathinus were Herodotus and Archigenes of Apamea, and they carried on the basic tenants of pneumatism.  (4, page 160)

Nutton said the pneumatists became the "most influential rivals of the Methodists of the first and second centuries.  (5, page 207)

Many of the medical ideas of the Pneumatists were later picked up by Galen of the 2nd century, particularly the idea of the pneuma and contrariis contrarius. 

Further reading:
  1. 1st Century:  The four schools of medicine 
  2. 100 A.D.:  Aretaeus defines asthma
  1. Moffat, John, translator, "Aretaeus: consisting of eight books, on the causes, symptoms, and cure of acute and chronic diseases; translated from the original Greek." 1785, London, Logographic Press
  2. Magill, Frank N., editor, "Dictionary of World Biography," Volume I: The Ancient World, 1998, Salem Press Inc., California
  3. Algra, Keimpe, Jonathon Barnes, Jaap Mansfeld, Maldolm Scholfield, editors, "The Cambridge History of Hellenistic Philosophy," 2002, Cambridge University Press
  4. Prioreschi, Plinio, "A History of Medicine," volume III "Roman Medicine," 2001, NE, Horatius Press
  5. Nutton, Vivian, "Ancient Medicine," 2nd edition, 2013, Routledge, NY, GreenGate Publishing Services
  6. Prioreschi, op cit, page 158, reference given by Prioreschi is: Pseudo-Galen, Introduction sive medicus, ix, K, XIX, pp. 698, 699
  7. Hastings, James, John Alexander Selbie, Louis Herbert Gray, "Encyclopedia of Religion and Ethics," volume XII, 1922, New York, Charles Scribner's Sons
  8. Garrison, Fielding Hudson, "An introduction to the history of medicine: with medical chronology, Bibliographic data and test questions," 1913, Philadelphia and London, W.B. Saunders company
  9. Meryon, Edward, "History of Medicine: comprising a narrative of its progress from the earliest ages to the present and of the delusions incidental to its advance from empericism to the dignity of a science," volume I, London, 1861,
  10. Neuburger, Max, writer, "History of Medicine," 1910, translated by Ernest Playfair, Volume I, London, Oxford University Press
  11. Garrison, Fielding Hudson, "An introduction to the history of medicine," 1922, Philadelphia, W.B. Saunders Company
  12. "Agathinus, Claudius,",, accessed 6/24/14
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