On the occasion of an interesting article published in Science in July 2012:
‘Google Effects on Memory: Cognitive Consequences of
Having Information at Our Fingertips’
(Betsy Sparrow, Jenny Liu and Daniel M. Wegner; 15 July 2011: Vol. 333 no. 6040 p. 277).
Two thousand five hundred years ago, Plato wrote that reading had created
a generation of pedants who believe they know everything but master nothing:
“For this <the art of writing> will cause forgetfulness in the minds of those who have learned,
because they will neglect their memory.
Having put their trust in writing, they will recall to memory things from outside,
by means of external marks; not from inside themselves, by themselves.
You have invented a pharmakon not for memory, but for reminding” (Totelin, 2009).
In Ancient times, doctors did not have the luxury of easy access to information, as we do today.
Before the 5th century BC no book on medicine really existed.
This meant that oral tradition was very important.
People had to pay attention and remember what they heard.
A good memory was necessary and, when combined with experience in the practice of medicine,
it distinguished a good from a bad doctor.
As Plato said, if you experience something, know it from within yourself,
then you have a memory of it.
The art of medicine can be acquired through practicing it,
not through reading about it.
This is even more relevant today with the available technology and information overload.
A doctor’s aim, Hippocrates argues, should be to push medicine forward, taking what has already been discovered and improving it further, to advance the Art of Medicine:
In my opinion, however, to discover what was unknown before is the ambition and task of intelligence, and so is to bring to completion what was already accomplished in part (The Art 2.1; Jones 1923).
Hippocrates called for physicians to engage with research in health and disease, as today. Every new discovery opens up another level of inquiry that goes deeper into understanding how the human body functions.
An aspect of Hippocratic Medicine that was innovative at the time relates to the practice of collecting detailed records of the patients Hippocrates cared for. This practice marked a significant shift from the then traditional oral transmission of knowledge. Plato commented on this new movement of the written word, in his work Phaedrus:
For this [the art of writing] will cause forgetfulness in the minds of those who have learned, because they will neglect their memory. Having put their trust in writing, they will recall to memory things from outside, by means of external marks; not from inside themselves, by themselves. You have invented a pharmakon not for memory, but for reminding (Plato, Phdr. 275a; Totelin, 2009).
Perhaps these records were used for teaching purposes. We do not really know what their purpose was. Hippocrates challenged the then oral tradition, by recording his observations. When a person came to see him about their illness, he examined details about their habits, lifestyle, food intake and their symptoms and signs of disease. With his companions and disciples, he recorded his findings, analysed them and later developed his theories. Through this system, which was based on clinical observation, he drew original conclusions and pushed medicine forward to a new era, influencing physicians more than anyone else before him.
The case histories written in some of the books, such as the Epidemics, are only epigrammatic recollection of certain patients. It is possible that the information presented was only a summary of the actual cases and its purpose was primarily for teaching. Yet, what these writings show is a discrimination of cases and a search for understanding of what determines disease progression and prognosis:
The most acute diseases, the most severe, difficult and fatal belong to the continuous fevers. The least fatal and least difficult of all, but the longest of all, is the quartan… It is necessary also to consider the person’s mode of life and to take it into account when prescribing. Many other important symptoms there are which are akin to these… These must be duly weighed when considering and deciding who is suffering from one of these diseases in an acute, fatal form, or fatal illness, or one from which he may recover… (Epidemics I 1.XXIV-V; Jones 1923).
The woman suffering from angina who lay sick in the house of Aristion began her complaint with indistinctness of speech. Tongue red, and grew parched. First day: Shivered, and grew hot. Third day: Rigor; acute fever; a reddish, hard swelling in the neck, extending to the breast on either side; extremities cold and livid, breathing elevated; drink returned through the nostrils –she could not swallow- stools and urine ceased. Fourth day: general exacerbation. Fifth day: Death (Epidemics III, 1.Case VII; Jones, 1923).
Chalmers I (2007) The lethal consequences of failing to make full use of all relevant evidence about the effects of medical treatments: the importance of systematic reviews. In: Rothwell P, ed. Treating individuals: from randomised trials to personalised medicine. London:Elsiever, pp 37-58.
Jones WHS (1923). Hippocrates. Volume I. With an English Translation by WHSJ. Cambridge, Mass & London: Loeb Classical Library.
Plato, Phaedrus 275a. In: Totelin LMV (2009) Hippocratic Recipes: Oral and Written Transmission of Pharmacological Knowledge in Fifth- and Fourth-Century Greece, Leiden: Brill, p 1.