Case Histories in Ancient Medicine: Cross-Cultural Comparisons & Philosophical Reflections
A talk by Sir Geoffrey Lloyd
Published: Monday, November 13, 2006
by Andrew H. Miller
Given Sir Geoffrey Lloyd's breadth of comparative research, it was no coincidence that his October 24 presentation--"Case Histories in Ancient Medicine: Cross-Cultural Comparisons and Philosophical Reflections"--attracted a diverse audience. Classicists, medical professionals, and historians of science joined students and scholars of East Asia in attending Lloyd's lecture, which was sponsored by the UCLA Center for Chinese Studies as part of its series of Tuesday afternoon talks.
Medical Case Histories and the Problem of Induction
Professor Lloyd, the Senior Scholar in Residence at the Needham Research Institute, University of Cambridge, used his survey of ancient medical case histories to explore the problem of induction within the tradition of the philosophy of science. Deductive reasoning dominates the field of modern science, and this bias toward deduction has its roots in Aristotle's preference for the use of universal laws and clear causal connections to draw sure conclusions about a particular phenomenon. However, the case histories surveyed by Lloyd portray medical practitioners in the ancient world as primarily relying on induction and analogical reasoning in their care of patients. From the point of view of philosophers of science, an inductive approach is problematic because it raises the question of how the practitioners used many particular cases to draw a general theory of medicine that could be reliably employed in the treatment of patients. The case histories, especially those recorded in the Hippocratic Epidemics, document a bewildering variety of symptoms, and physicians had to learn to use these symptoms to diagnose patients and seek proper treatments. Ultimately, though, inferences from particular cases or symptoms do not invariably lead to a universal explanation of the cause of illness. For example, a pale face can indicate illness, but not always.
Case Histories and Analogical Reasoning
The lack of "absolute certainty" in the case histories has relegated the methods of ancient medical practitioners to a low standing within the history of science, but Lloyd reappraised their analogical reasoning on the basis of the fact that the "absence of conclusive evidence does not mean the absence of evidence." Although the case histories are without the universal laws that philosophers of science have come to expect of science, they indicate that ancient medical practitioners were being trained in a style of scientific thought. In their daily medical practice, doctors may face different diseases that present similar symptoms, or they may confront different symptoms for the same disease. Whatever the case, a thorough grounding in analogical reasoning was requisite for a successful practice of medicine in the ancient world. Such reasoning skills would have helped physicians to compare the similarities and differences of a particular illness with other cases and to reach conclusions about the importance of such similarities for a case at hand. (The medical professionals in the audience concurred with Lloyd on this point.) The kinds of evidence of disease recorded in the case histories may not comply with the standards for evidence used to verify universal laws of modern science, but the variety of the particular cases documented could have further expanded an experienced practitioner's power of inductive reasoning, which was essential for the correct diagnoses and prognoses of patients. Moreover, the case histories for Lloyd highlight the existence of and training in different modes of reasoning in the ancient world, a world not solely dominated by the deductive model of modern science.
Sir Geoffrey built his conclusions on a thorough analysis of the purposes behind the compilation of case histories. He relied on a sample set of case histories from China and Greece that included those recorded in the biography of Chunyu Yi in Shiji 105, the cases recorded in the Asclepius temple inscriptions, those in the Hippocratic Epidemics, and those recorded by the second-century physician Galen. Lloyd identified six primary functions for the recording of case histories:
- case histories serve as an "aide-memoire" of the patients in a physician's clinical practice
- case histories serve as a database to aid in research and in the verification and improvement of diagnoses
- case histories can be an attempt "to establish a pathological or therapeutic theory"
- case histories can be used to test medical theories
- case histories are "apologia" used to construct and defend the reputation of a practitioner
- case histories can provide a practitioner with a "claim to authority" as they testify to a physician's ability to determine the right style of treatment.
These six aims of case histories are not mutually exclusive, and during his discussion of the primary sources, Lloyd would often point out how these six items were applicable to various sections within the sources. Lloyd, however, especially emphasized the fifth and sixth functions, as these demonstrate what the "image of the practitioner" was in the ancient world.
Chinese & Greek Case Histories Compaired
In the Chinese case histories, even though seven of twenty-five patients died, Chunyu Yi's reputation was bolstered by the fact that he correctly predicted this would be the outcome for those seven patients. Throughout his biography, Chunyu Yi strives to explain how he reached his diagnoses. Chunyu Yi often used the pulse as the key method for attaining a correct diagnosis, but he did not derive this technique from some universal law of the pulse. Instead, his authoritative diagnoses stemmed from his ability to identify a myriad of pulse types, an ability developed from years of experience and well-honed skills of analogical reasoning.
The Greek case histories all develop authority claims as well but in very different ways. The temple inscriptions, which primarily focus on cures and their outcomes, boast a one hundred percent success rate, and the divine assistance behind many of the cures only adds to the authority of the medicine. The cases recorded in the Hippocratic Epidemics are unique in that they do not strive to establish the credentials of any individual practitioner. In fact, Lloyd admitted their primary function seems to be more of an attempt to prove or establish a medical theory.
They are full of observations detailing the course of a disease from its onset until its conclusion, and all this data gives the reader the impression that the cases are striving toward some medical theory even though one is never actually postulated. Accounts of therapies and responses to them are minimal, and despite the negative outcome of most diseases, the histories accurately record the mortality rate. Lloyd feels this confession of failure in the Hippocratic cases is an important means of establishing the authority of practitioners. By adopting a "stance of scrupulous honesty," the cases demonstrate how an experienced doctor should be able to weigh a vast quantity of data as well as be able to recognize the limits of medicine. Although Galen was an ardent follower of the Hippocratic Epidemics, Galen's case histories most resemble those of Chunyu Yi in that he used them to set himself and his techniques apart from other practitioners.
While case histories in these two cultures share the six functions listed above, Lloyd pointed out that the Chinese and Greek cases he examined all differ considerably in terms of style and content. The Shiji cases are very stylized while those of Galen follow no set form. How the cases choose to highlight the success rate and how they justify particular therapeutic techniques are other obvious differences. Lloyd stressed the need to consider how aspects of the historical context--such as the legal proscriptions against medicine in the two cultures--might have shaped the different approaches taken in fulfilling the cases' apologetic function. Lloyd himself did not have time to begin exploring the complex influence of context on the case-histories; nevertheless, he did leave the audience with a question about how the historical context might relate to his primary thesis about the need for analogical reasoning among ancient medical practitioners. Lloyd wondered what impact the correlative cosmology of early China might have had on the development and evolution of analogical reasoning in the training of Chinese medical practitioners. He speculated too on how the Chinese development of medical reasoning differed from the Greek situation, in which Aristotelian philosophy was most prominent. Such comparative issues fueled the lively discussion that followed Professor Lloyd's lecture.
Following is an autobiographic sketch by Professor Sir Geoffrey Lloyd
Throughout my University career I have been based chiefly at Cambridge, holding various University and College posts, first at King's and then at Darwin. From 1983 onwards I held a personal Chair in Ancient Philosophy and Science and from 1989 to my retirement in 2000 I was Master of Darwin College. I was Chairman of the East Asian History of Science trust, which is the governing body directing the work of the Needham Research Institute from 1992 to 2002, and I am currently Senior Scholar in Residence at that Institute.
I have held visiting professorships and lectured across the world, in Europe (France, Italy, Spain, Germany, Portugal, Holland, Belgium, Greece) in the Far East (Fellow of the Japan society for the Promotion of Science in Tokyo in 1981, visiting professor at Beijing daxue in 1987, visiting professor at Sendai in 1991, and the first Zhu Kezhen Visiting Professor in the History of Science at the Institute for the History of Natural Science, Beijing, in 2001) and in North America (Bonsall professor, Stanford in 1981, Sather professor Berkeley in 1984, AD White professor at large, Cornell from 1990 to 1996: I have also lectured at Harvard, Princeton, the Princeton Institute for Advanced Studies, Yale, Brown, University of Pennsylvania, Pittsburgh, UCLA, Austin, Chicago among other places).
I serve on the editorial committee of 8 journals, including Studies in the History and Philosophy of Science, Journal of the History of Astronomy, Physis, History of the Human Sciences, Arabic Sciences, and Philosophy and Endoxa.
I have published 16 books and edited a further 4, and various of these books have been translated into French, Italian, Spanish, German, Greek, Romanian, Polish, Japanese, Korean and Chinese. In addition I have published some 140 articles and about the same number of reviews.
I was elected a Fellow of the British Academy in 1983, I received the Sarton medal in 1987, I was elected to a Honorary Fellowship at Kings in 1991, to Honorary Foreign Membership of the American Academy of Arts and Sciences in 1995, to the International Academy for the History of Science in 1997, to an Honorary Fellowship at Darwin in 2000, and to an Honorary D.Litt by the University of Athens in 2003. I was knighted for “services to the history of thought” in 1997.
Following up my most recent book (The Delusions of Invulnerability) I am planning a study of various aspects of the problem of the psychic unity of humankind. There has been extensive debate in recent years between universalists and relativists on topics such as the cognition of space, colour, causation, the emotions, personhood. My own contribution aims (ambitiously) to take into account the most recent work in the domains (a) of the neuro-sciences and evolutionary biology, (b) in social and linguistic anthropology, and (c) philosophy, as well as adding a historical dimension from studies of ancient Greece and China, in order to clarify the key issues. I do not side either with the universalists or their opponents. My aim is rather to show more clearly than has been done in most other studies the limits there must be to claims for the psychic unity of humans, and how differences are to be explained where they exist.
In addition Variorum will be publishing a collection of my articles in 2006 and I have papers commissioned and due to be published in the next 18 months on Chinese Warring States Rhetoric, Fourth Century Greek Astronomy, Sign-inference in Greek medicine, The 'mathematisation of physics' in Greece and China, Galen, and Matteo Ricci.
Andrew H. Miller is a graduate student in the Department of Asian Languages & Cultures, specializing in traditional Chinese drama, Chinese folklore, and popular religion.