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This chapter examines the historical path that has led to personalized medicine as we know it today, in the hope of gaining a better perspective on where it will take us in the not-too-distant future. The foundations of anatomy, toxicology, histology, and cellular pathology were established in the centuries after Hippocrates, but it was not until the middle of the 20th century, when we began to get a deeper molecular understanding of disease, and then at the turn of the 21st century, with the sequencing of the human genome, that we could develop the tools to truly personalize diagnosis and treatment. This set in motion the transformation of personalized medicine from an intention to a practice.

The first chapter of Part I begins by taking stock of European theories of fever, and of the importance of the work of the Hippocratic revival, particularly as reflected in the work of Sydenham, Boerhaave, and Hoffman. The discussion then turns to medical work in the tropical colonies during the sixteenth and seventeenth centuries, placing British medicine in the context of earlier work by the Portuguese and Dutch. The chapter examines both the East and the West Indies. It shows the growing importance of climate and morbid anatomy in theories of disease and how ideas about disease had a bearing on concepts of race. The strongly natural‐historical orientation of colonial practice is emphasized, along with its connections to the politics of medical reform in Britain.

In order to understand the Hippocratic revolution in medicine and how it led to the perception of the brain as the ruling member of the body, we must think of ancient Greece at three different but unequal points in time. These epochs can be designated Early Greece, the Golden Age of Greece, and the Hellenistic Era. Hippocrates lived from approximately 460 to 377 B.C., during the middle period or Golden Age of Greece. The three time periods are very different culturally. In each one, not only are there differences in government, religion, and the arts, but they also provide us with distinctly different views of the mind and the brain. This chapter also discusses the myths and legends surrounding the healing powers of Asklepios, son of Apollo and the nymph Coronis; medicine in Homer's epic poems Odyssey and Iliad; the Hippocratic Collection known as Corpus Hippocraticum, which had references to the brain and brain damage; and dissection, the nervous system, and the association between humor and disease.

Galen's vivisection experiments concerned with the nervous system may rank among the most sophisticated known from ancient sources. Galen appears to inaugurate a new era in medicine, and anatomy in particular, by systematically working his way along the spinal chord and nerves, making incisions and carefully recording the resultant phenomena of paralysis. This chapter examines the nature and historical significance of Galen's experiments as reported in the first three books of On the Doctrines of Hippocrates and Plato. The main focus is on theoretical aspects, i.e. with the epistemological, or argumentative, status of the experiments as well as with their method. It is a fair assumption that Galen refined the method and technique of the experiments of his predecessors, particularly Herophilus and Erasistratus. His advocacy of the Platonic conception of the soul was destined to become immensely influential. Nevertheless, it would be wrong to suppose that he carried the day.

Curiosity about the causes and occurrence of disease is not unique to epidemiologists. After all, who wouldn’t be interested in knowing about how to live a healthy life?—or to predict and ward off sickness, injury and death? As the historical record makes clear, people long have tried to account for disease occurrence: both individual cases and population patterns—and have done so steeped in the ideas of their times. Hence, as prelude to analyzing more familiar post-Renaissance epidemiologic theories, Chapter 2 considers four examples spanning from the ancient classical texts of Greek Hippocratic humoral theory and Chinese medicine to the current oral traditions of the Kallawaya in the Andes and the Ogori in Nigeria. Together, these examples reveal how diverse peoples in ancient and contemporary traditional societies have sought to explain their society's patterns of health and disease, as influenced by both their societal and ecologic context.

This chapter shows that a clear initial conception of the variables to be involved is critical to construct an effective epidemiological study. In the most general sense, this has been an essential foundation of the major medical and public health advances contributed by epidemiology: each advance attained new clarity in the specification of variables constituting causal models, clarity that in turn depended on new concepts. These advances have followed as investigators specified, either formally or only by implication, the nature of the variables they first attempted to relate to each other and then to elucidate their causal links and time sequences. The chapter presents historical examples from early times to illustrate the process.

The idea that matter is composed of four fundamental elements—Earth, Air, Fire, and Water—dates back to the Greek philosopher Empedocles. This idea was enormously influential. It was adapted to medicine by Hippocrates, who developed the theory of the four humours and the four temperaments. It also influenced the proto-science of alchemy. The eighth-century Islamic scholar known in Europe as Geber or Jabir believed that all metals are composed of mixtures of sulphur and mercury. Geber speculated that idealized philosophic sulphur and philosophic mercury were thought to be the chemical forms of two of the elements: Fire and Water.

Sixteenth century historians and jurists in France elaborated a position of legal relativism as a means of asserting independence from canons of Roman law and the domination of the Roman Catholic Church. Drawing on the premise that different peoples required different laws and political institutions, Jean Bodin elaborated a comparative scheme, based on Hippocrates, and Aristotle’s theories of the effect of climate upon the body’s humors. Those who lived in hot, cold, and temperate climates had different dispositions, with denizens of temperate climates best suited to rule. Large parts of Europe were outside the temperate zone, which also included Turkey, Persia, and China. Cold climates were associated with the development of the body as opposed to the mind, as opposed to hot climates, including Morocco and Abyssinia, praised for their religiosity. Bodin also wrote a long dialogue between partisans of different religions, promoting an ideal of religious harmony rather than the exclusive domination of any single religion.

If the quest for the rational defines Greek biology and medicine as ventures in the ‘scientification’ of knowledge, what we read remains most often ‘unscientific’. We see in operation less a reflection delving deeply into observations in vivo, with a gradual adaptation of thought to reality, than just one more product of the imagination; in this instance, the masculine working from an a priori conception of the feminine. Reading Hippocrates or Aristotle, we realise the extraordinary distance that separates them from the customary picture of Greece, homeland of reason and the devastating effects of their ideological interpretation of the body. In the classical era, commonsense, well represented by Xenophon in his Oeconomicus, contrasts men and women in their social functions, in absolute terms. This chapter discusses the female body and sexuality in ancient Greece, focusing on female physiology, reproduction, the embryo, the relative speeds of development of male and female, polysexuality, misogyny, feminisation and feminine ways of making love.

One night in early October 1997, Felipe G., a nine-year-old child of Dominican immigrants to New York City living in East Harlem, woke up struggling for breath. Felipe had had asthma attacks before, and his parents knew, or thought they knew, what to do: they called for an ambulance, which rushed him to the emergency room of Harlem Hospital nearby. But this time he stopped breathing on the way to the hospital, and could not be revived there. His younger sister Ana also has asthma, but so far has never had to go to the emergency room. The tenement building in which Felipe’s family lives is three blocks from the Harlem River Drive, a highway on which thousands of cars travel each workday, emitting, in spite of their catalytic converters, large quantities of oxides of nitrogen, carbon monoxide, and incompletely combusted gasoline. Several blocks north is a parking garage for the diesel trucks of the New York City Department of Sanitation. The drivers of the trucks that use the lot often keep their motors idling, so that great quantities of diesel exhaust particles are emitted to the surrounding area. The Harlem district of New York City, inhabited mainly by African-Americans and Hispanics, is shielded to a large extent from the prevailing west winds by higher areas on the west side of Manhattan. Hence, air pollution produced within Harlem—for example, by cars, diesel trucks, and buses, and by an electric power generating plant located there—tends to remain longer than in other areas of the city. The New York City Department of Environmental Protection operated a network of air monitoring stations from the 1940s to the 1970s, during which time Harlem was consistently found to be the most polluted area in the city. It had then, and still has, one of the highest rates of hospitalization for asthma in the city. In most countries, asthma is more common among children of higher social class. In the United States this pattern is reversed: people living in the inner cities of the United States, mostly low-income minorities, have higher rates of asthma than other Americans.

This chapter draws upon the conceptions of gendered bodily suffering found in the ancient medical corpus (Hippocrates, Galen and inscriptions), martyrdom literature, and the Roman judicial rhetoric of punitive suffering to read apocalyptic depictions of bodily suffering as “effeminizing” punishments, which in turn utilized masculinity and bodily normativity to police behavior, and equated early Christian ethical norms with masculinity and bodily “health.” By highlighting the different types of bodies found in these texts, as well as the ways in which Christian norms interacted with Greek and Roman notions of the body, the chapter shows how masculinity and ancient notions of bodily normativity worked in concert to mark sin in early Christian hell, in turn creating an ancient Christian culture of bodily normativity. These early Christian texts expanded the existing frameworks of bodily suffering as a disciplinary performance and focused on the non-normative body as a punitive spectacle and pedagogical object.

The debate over climate change, both from natural causes and human activity, is not new. Although the Baron C.-L. de Montesquieu is undoubtedly the best known Enlightenment thinker on the topic of climatic determinism, others, notably the Abbé Du Bos, David Hume, and Thomas Jefferson, observed that climatic changes exerted a direct influence on individuals and society and that human agency was directly involved in changing the climate. Climate—from the Greek term klima, meaning slope or inclination—was originally thought to depend only on the height of the Sun above the horizon, a function of the latitude. A second tradition, traceable to Aristotle, linked the quality of the air (and thus the climate) to the vapors and exhalations of a country. The Hippocratic tradition further linked climate to health and national character. As late as 1779, the Encyclopdédie of Denis Diderot and Jean le Rond D’Alembert defined “climat” geographically, as a “portion or zone of the surface of the Earth, enclosed within two circles parallel to the equator,” in which the longest day of the year differs in length on its northern and southern boundaries by some quantity of time, for example one-half hour. The article goes on to mention Montesquieu’s position on “l’influence du climat sur les mœurs, le charactère, et les loix des peuples.” The second definition of climate provided by the Encyclopdédie was medical, identified primarily as the temperature of a region and explicated through its effects on the health and well-being of the inhabitants. The idea that climate influenced culture was derived in part from the writings of ancient and medieval philosophers, geographers, and historians, including the works of Hippocrates, Albertus Magnus, and Jean Bodin. With no established science of climatology, Enlightenment thinkers apprehended climate and its changes primarily in a literary way. They compared the ancient writings to recent weather conditions, linked the rise and fall of creative historical eras to changes in climate, and promoted a brand of climatic determinism based on geographic location and the quality of the air.

Inflammation and immunity, like all other normal reactions of the body, are meant to preserve or restore health. They can nonetheless cause a range of uncomfortable symptoms. Inflammation is such a complicated process that one would have a hard time reaching a consensus on its definition. Historically, inflammation was one of the earliest recognized and defined diseases. Two thousand years ago, Roman physician and encyclopedist Aulus Cornelius Celsus (25 B.C.–50 A.D., not to be confused with Celsius, the unit for temperature) described the four cardinal signs of inflammation: calor (warmth), dolor (pain), tumor (swelling), and rubor (redness). The fifth element of inflammation, functio laesi (loss of function or movement), was noted later. Classic inflammatory diseases include rheumatoid arthritis and Crohn’s disease, an inflammatory bowel disease. However, evidence is mounting that inflammation is implicated in many diseases that are not normally considered inflammatory. For instance, when arterial plaques become inflamed they can burst open, prompting a myriad of heart diseases. Inflammatory bowel conditions greatly increase the risk of colon tumors. Even diabetes has been associated with a number of inflammatory compounds. It was hard to define what inflammation was, but finding a remedy was even more challenging. Aspirin, available in 1880, represented possibly the first really effective treatment for inflammation, whereas cortisone and other corticosteroids were not available for the treatment of rheumatoid arthritis until the early 1950s. Louis Pasteur stated, “Dans les champs de l’observation, le hazard ne favorise que les esprit préparés” [In the field of experimentation, chance favors the prepared mind]. Like numerous cases in drug discovery, Philip S. Hench’s discovery of cortisone for the treatment of rheumatoid arthritis illustrates Pasteur’s point. Rheumatoid arthritis (RA) is a chronic inflammatory disease characterized by pain, swelling, and subsequent destruction of joints. Until the late 1940s, there was no viable treatment, and, understandably, pessimism prevailed in medical society about its prognosis. Even William Osler, one of the greatest physicians, said “When an arthritic patient walks in the front door, I want to run out the back door!” The situation did not change much until Hench discovered a “miracle drug” in 1949.

Feelings of low mood are not trivial. In 2010 the National Center for Health Statistics of the Department of Health and Human Services asked a random sample of the U.S. population about their mood. In reply to Do you feel hopeless?, 6.8%, or 1 in 15, said yes. In reply to Do you feel worthless?, 5.3% said yes. In reply to Do you feel that “everything is an effort”?, a whopping 16%, or one in seven, said yes. Low feeling is very common. Yet it is not melancholia. Historically, plenty of people have suffered from low moods. Today, few of us can stay in our beds because we have to earn a living. Yet it was once common for middle-class women, in households that had servants, to take to their beds when feeling down. In 1917, London literary figure Virginia Woolf, age 36, noted in her diary for October 25: “Owing to the usual circumstances, I had to spend the day recumbent.” She meant that she was having her period, and always had to lie down. Still, menstruation was not the only reason she went recumbent. Late in 1918 she had a tooth out and spent two weeks in bed, “and being tired enough to get a headache—a long dreary affair, that receded and advanced much like a mist on a January day.” “Here is a whole nervous breakdown in miniature,” she recorded in July 1926. “Sank into a chair, could scarcely rise; everything insipid; tasteless, colourless. Enormous desire to rest.” In November 1931 she was assailed by “a perpetual headache,” and “so took a month lying down.” On October 5, 1932, she said, “I spent yesterday in bed; headache; infinite weariness up my back: clouds forming in my neck; half asleep.” So this is the kind of nervous behavior that was congruent with people of her social class at that place and time. But there are deeper, more alarming notes.

Much of western philosophy, especially ancient Greek philosophy, addresses the problems posed by embodiment. This chapter argues that to grasp the early history of embodiment is to see the category of the body itself as historically emergent. Bruno Snell argued that Homer lacked a concept of the body (sōma), but it is the emergence of body in the fifth century BCE rather than the appearance of mind or soul that is most consequential for the shape of ancient dualisms. The body takes shape in Hippocratic medical writing as largely hidden and unconscious interior space governed by impersonal forces. But Plato’s corpus demonstrates that while Plato’s reputation as a somatophobe is well grounded and may arise in part from the way the body takes shape in medical and other physiological writing, the Dialogues represent a more complex position on the relationship between body and soul than Plato’s reputation suggests.

This chapter argues that thinking about notes clarified some of the challenges and opportunities of the ‘new philosophy,’ or empirical science, in early modern Europe. Francis Bacon called for the making of natural histories?that is, huge collections of empirical information on topics ranging from celestial phenomena to technology, thus yielding histories of the air, of heat and cold, of sounds, blood, of life and death. This programme, embraced by Fellows of the Royal Society, required methodical and collaborative note-taking. Robert Boyle presented the modern virtuoso as one who eschewed premature systems and sought detailed information from a wide range of sources. As Secretary, Henry Oldenburg facilitated this programme and communicated about protocols for note-taking and information-sharing. In defending the long-term character of empirical inquiry, the virtuosi found sustenance in Hippocrates's first aphorism about life being short and art (or science) long.