Medicine in Ancient Greece

1. Medicine in Ancient Greece Medical practice in the ancient Greek world Religious healing and Hippocratic medicine Cult of Asclepius Disease causation in the Hippocratic Writings Religion and medicine The Hippocratic Oath

5. ANCIENT GREECE Archaic 750-480 BCEColonization, Hoplites, Tyranny, Philosophy Classical 480-323Persian Wars 490-479, Athenian Empire, Peloponnesian War 431-404, Alexander Hellenistic 323-146Seleucids, Macedonians, Ptolemies Roman 146 BCE-330 CECorinth and Constantinople Hippocratic writings and cult of asclepius both arise in the classical period�hippocratic oath likely later than most of the writings, may have been composed around 300 BC..Hippocratic writings and cult of asclepius both arise in the classical period�hippocratic oath likely later than most of the writings, may have been composed around 300 BC..

6. Medicine in the Classical Period Hippocratic Writings 450-370 B.C. ~60 different works Anonymous, by different authors Likely collated after 300 B.C. at Alexandria Cult of Asklepios Homer portrays Asklepios as a mortal �blameless physician� in 900-750 BC 5th to 4th century BC: Asklepios deified in the mythic odes of Pindar and Hesiod

7. Doc palpating abdomen Detail from a physician�s tombstone, attica, 2nd century adDoc palpating abdomen Detail from a physician�s tombstone, attica, 2nd century ad

8. Pedanius Dioscorides 40-90 AD Greek physician Wrote �De Materia Medica�

9. Caper Plant disturbes the belly, is good for the stomach and causes thirst� fruit makes the spleen shrink moves the urine and causes bloody discharge helps in sciatica and paralysis, ruptures and convulsions purges away phlegm with barley meal used as a poultice in those suffering from the spleen

10. Caper Plant (cont) Moves the menses chewed, helps toothache finely ground and mixed with vinegar, it wipes off leprous spots and vitiligo Dioscurides gives us a catalogue of remedies to use for these various sorts of illness. Dioscurides gives us a catalogue of remedies to use for these various sorts of illness.

11. Illness Nephritis nephros: kidney Hepatitis hepar: liver Pleuritis pleura: rib or side Arthritis arthron: joint Ophthalmia ophthalmos: eye

12. Varro, On Agriculture Famers near a city �prefer to have in their neighborhood men whose services they can call upon under a yearly contract�physicians, fullers, and smiths�rather than to have such men of their own on the farm�. Marcus Terentius Varro 116 BC to 27 BC; upper class roman scholar who wrote about running his large estate� Physicians lumped in with fullers and smiths Fullers are involved in clothmaking; smiths work with metals; physicians work with sick bodies�.medicine here is one more craft, a manual skill; no more or less than what�s done by various kinds of craftsmen. Clearly in this passage they are men; work for women in the ancient world of greece or rome was limited to the household; physicians might be men in the neighborhood; or the farmers men on the farm; in the neighborhood: someone the farmer could hire, like your local plumber; one of the farmer�s men on the farm�in other words, slaves. So the overall picture here is of medicine as on a level with other kinds of craft work; and those who do it are like craftsmen. Certainly they don�t have any privileged position in society�and the kind of cookbook identify-an-illness-and-here�s-the-remedy type of practice ive deduced from diocorides�s pharmacopoiea might well fit with that. Marcus Terentius Varro 116 BC to 27 BC; upper class roman scholar who wrote about running his large estate� Physicians lumped in with fullers and smiths Fullers are involved in clothmaking; smiths work with metals; physicians work with sick bodies�.medicine here is one more craft, a manual skill; no more or less than what�s done by various kinds of craftsmen. Clearly in this passage they are men; work for women in the ancient world of greece or rome was limited to the household; physicians might be men in the neighborhood; or the farmers men on the farm; in the neighborhood: someone the farmer could hire, like your local plumber; one of the farmer�s men on the farm�in other words, slaves. So the overall picture here is of medicine as on a level with other kinds of craft work; and those who do it are like craftsmen. Certainly they don�t have any privileged position in society�and the kind of cookbook identify-an-illness-and-here�s-the-remedy type of practice ive deduced from diocorides�s pharmacopoiea might well fit with that.

13. On the Epidemics I, section 2, #5 The physician must be able to tell the antecedents, know the present, and foretell the future- must mediate these things, and have two special objects in view with regard to disease, namely, to do good or to do no harm. The art consists in three things- the disease, the patient, and the physician. The physician is the servant of the art, and the patient must combat the disease along with the physician. Doc must be good at prognosis� Must seek to do good and to do no harm Finally, the art�.Doc must be good at prognosis� Must seek to do good and to do no harm Finally, the art�.

14. On Fees �Should you begin by discussing fees, you will suggest to the patient either that you will go away and leave him if no agreement be reached, or that you will neglect him and not prescribe any immediate treatement. So one must not be anxious about fixing a fee�it is better to reproach a patient you have saved than to extort money from those who are at death�s door. �

15. On Fees �I urge you not to be too unkind, but to consider carefully your patient's superabundance or means. Sometimes give your services for nothing, calling to mind a previous benefaction or present satisfaction. And if there be an opportunity of serving one who is a stranger in financial straits, give full assistance to all such.�

16. Purposes of medicine (The Art 3) Doing away with suffering of the sick Lessening the violence of disease Refusing to treat those overmastered by disease (recognizing that medicine is powerless in such cases)

17. Greek Medicine in the Classical Period

18. Telesphorus, child god of convalescence Coronis ("crow" or "raven"), daughter of Phlegyas, King of the Lapiths, was one of Apollo's lovers. Pregnant with Asclepius, Coronis fell in love with Ischys, son of Elatus. A crow informed Apollo of the affair and he sent his sister, Artemis, to kill Coronis. Her body was burned on a funeral pyre, staining the white feathers of the crows permanently black. Apollo rescued the baby though and gave it to the centaur Chiron to raise. Phlegyas was irate and torched the Apollonian temple at Delphi and Apollo killed him. On the staff�from wilcox on cadeuceus in annals Several myths describe how Asklepios chose his symbol (4). In perhaps the most popular tale, Asklepios is examining a man, Glaukos, whom Zeus had recently struck dead with a thunderbolt. During the examination, a snake gliding into the room surprised Asklepios, and he responded by killing it with a blow from his staff. Asklepios was subsequently intrigued by the arrival of a second serpent, which placed certain herbs in the mouth of the dead serpent and thereby restored it to life. Asklepios quickly perceived the lesson, revived Glaukos by recourse to the same herbs, and, as a mark of respect, adopted the serpent coiling about his staff as his emblem (4). Telesphorus, child god of convalescence Coronis ("crow" or "raven"), daughter of Phlegyas, King of the Lapiths, was one of Apollo's lovers. Pregnant with Asclepius, Coronis fell in love with Ischys, son of Elatus. A crow informed Apollo of the affair and he sent his sister, Artemis, to kill Coronis. Her body was burned on a funeral pyre, staining the white feathers of the crows permanently black. Apollo rescued the baby though and gave it to the centaur Chiron to raise. Phlegyas was irate and torched the Apollonian temple at Delphi and Apollo killed him. On the staff�from wilcox on cadeuceus in annals Several myths describe how Asklepios chose his symbol (4). In perhaps the most popular tale, Asklepios is examining a man, Glaukos, whom Zeus had recently struck dead with a thunderbolt. During the examination, a snake gliding into the room surprised Asklepios, and he responded by killing it with a blow from his staff. Asklepios was subsequently intrigued by the arrival of a second serpent, which placed certain herbs in the mouth of the dead serpent and thereby restored it to life. Asklepios quickly perceived the lesson, revived Glaukos by recourse to the same herbs, and, as a mark of respect, adopted the serpent coiling about his staff as his emblem (4).

19. Cult of Asclepius

21. Inscriptions at Epidaurus Aristagora of Troezen. She had a tapeworm in her belly, and she slept in the Temple of Asclepius at Troezen and saw a dream. It seemed to her that the sons of the god..cut off her head, but being unable to put it back again, they sent a messenger to Asclepius, asking him to come.

22. Inscriptions at Epidaurus It seemed to her the god had come from Epidaurus and fastened her head on to her neck. Then he cut open her belly, took the tapeworm out, and stitched her up again. And after that she became well.

23. Aelius Aristideswriting 150-200 AD And a tumour grew from no apparent cause..and my groin was distended, and terrible pains ensued, and a fever for some days.. Finally the (god) indicated: there was a certain drug..it contained salt. When we applied this, most of the growth quickly disappeared.. The account was written sometime in the latter half of the second Christian century at one of Aristides's estates in the northern end of the Roman province of Asia (western Turkey). Book I is primarily a record of dreams that Asclepius gave to Aristides. The dreams reveal Aristides's personal piety as well as religious practices and institutions associated with Asclepius. The account was written sometime in the latter half of the second Christian century at one of Aristides's estates in the northern end of the Roman province of Asia (western Turkey). Book I is primarily a record of dreams that Asclepius gave to Aristides. The dreams reveal Aristides's personal piety as well as religious practices and institutions associated with Asclepius.

25. Hippocratic Writings 450-370 B.C. ~70 different works Anonymous, by different authors Likely collated after 300 B.C. at Alexandria

26. Hippocrates Contemporary of Socrates (469-399 B.C.) School of medicine on Cos (?) �A name without a work� Definitely taught medicine for a fee (plato); he or his students may have written some of the hippocratic writings;�but the hippocratic authors disagreed with one another and probably included teachers who were rivals to hippocrates..Definitely taught medicine for a fee (plato); he or his students may have written some of the hippocratic writings;�but the hippocratic authors disagreed with one another and probably included teachers who were rivals to hippocrates..

27. On the Sacred Disease �the patient becomes speechless and chokes; froth flows from the mouth; he gnashes his teeth and twists his hands; the eyes roll and intelligence fails, and in some cases excrement is discharged�.

28. On the Sacred Disease ..It is not, in my opinion, any more divine than other diseases, but has a nature and a cause�

29. On the Sacred Disease I hold that those who attempt in this manner (purifications and incantations) to cure these diseases cannot consider them either sacred or divine�the man who can get rid of a disease by his magic could equally well bring it on;�.there is nothing divine about this but a human element is involved. Trying to Trying to

30. On the Sacred Disease I hold that a man�s body is not defiled by a god, the one being utterly corruptible, the other perfectly holy�.it is the divine that purifies, sanctifies and cleanses us..

31. On the Sacred Disease Divine is: Source of purity Manifest in nature Nature is: Divine Regular, susceptible to investigation

32. On the Sacred Disease Normal function: Air ? lungs ? veins ? brain When veins in the brain are blocked by phlegm: ..the patient is rendered speechless and senseless. The hands are paralyzed and twisted�The eyes roll when the minor veins are shut off from the air and pulsate. The foaming at the mouth comes from the lungs; for when the breath fails to enter them they foam and boil as though death were near�

33. Religion and Medicine Pre-classical age: medicine subsumed under religion Homeric epics Classical Age Greeks: Medicine achieves independence from religion Hippocratics vs Cult of Asclepius Medicine and religion in equilibrium View of medicine/religion of author of �On the Sacred Disease�, Hippocratic Oath

34. Religion and Medicine Medicine and Religion separate but in equilibrium Some ancient Greeks Judeochristian west, Islam

37. Hippocratic Oath To hold him who has taught me this art as equal to my parents I will apply dietetic measures for the benefit of the sick according to my ability and judgment; I will neither give a deadly drug to anybody if asked for it

38. Hippocratic oath I will not give to a woman an abortive remedy. I will not use the knife�but will withdraw in favor of such men as are engaged in this work. Whatever houses I may visit, I will come for the benefit of the sick, remaining free of all intentional injustice, of all mischief and in particular of sexual relations..

39. Hippocratic Oath What I may see or hear in the course of the treatment�I will keep to myself�

40. Hippocratic Oath Taken in a context of religion �I swear by Apollo�� �In purity and holiness I will guard my life and my art.� �If I fulfill this oath��

41. �Be pious in matters concerning the gods not only by sacrificing but also by remaining true to your oaths. �the latter is an indication of goodness of character. Always honor the divine, but especially in association with your city. For thus you will seem at the same time to be sacrificing and to be following the laws of your city.� Oaths in the ancient Greek world

42. Oaths in the ancient Greek world �When an oath is added, a man is more careful, for he guards against two things, the criticism of his friends and committing a transgression against the gods.�

43. Plato Socrates: shall we not say that it was because Asclepius � when bodies were diseased inwardly and throughout, he did not attempt by diet and by gradual evacuations and infusions to prolong a wretched existence for the man�

44. Plato �if a man was incapable of living in the established round and order of life, he did not think it worth while to treat him, since such a fellow is of no use either to himself or to the state.

45. �The chief consolation for Nature�s shortcomings in regard to man is that not even God can do all things. For he cannot, even if he should so wish, commit suicide, which is the greatest advantage he has given man among all the great drawbacks of life.� Urbane roman military officer, magistrate, scientist, man of letters, friend of VespasianUrbane roman military officer, magistrate, scientist, man of letters, friend of Vespasian

46. Infanticide Exposure (abandoning in a public place) Killing (strangling or drowning) nl newborns: likely uncommon but: Not illegal Did happen Defective newborns: not uncommon

47. �Mad dogs we knock on the head; the fierce and savage ox we slay; sickly sheep we put to the knife to keep them from infecting the flock; unnatural progeny we destroy; we drown even children who at birth are weakly and abnornal. Yet it is not anger, but reason that separates the harmful from the sound.�

48. Physicians and the Oath ~300 BC to Roman Times Oath a minority view Signified transitions Transmittal of medicine in clans ? non-familial medical education Medicine a craft without moral overtones ? medicine a vocation with associated morality

49. Pythagoras 569-475 BC Abstract mathematician Practical ethics Mutual friendship, honesty, unselfishness important Reincarnation Vegetarianism Sexual purity Suicide, abortion prohibited

50. Fate of the Oath 1st Century AD: Some physicians adhere to Hippocratic morality Galen 129-199 AD Skilled anatomist Medical morality: emphasized philanthropy and charity, less so respect for life The integration of hippocratic medicine into patristic theology did not translate into a regard for prolonging life during the patristic age (see Temkiin, the adoption of hippocratic medicine, in �hippocrates in a world of pagans and christians�).The integration of hippocratic medicine into patristic theology did not translate into a regard for prolonging life during the patristic age (see Temkiin, the adoption of hippocratic medicine, in �hippocrates in a world of pagans and christians�).

51. Fate of the Oath Dark Ages (500-1000 AD) Oath is known, likely sworn occasionally Other Hippocratic works preserved in the Islamic world Middle Ages (1000-1500 AD) Medical faculties appear 900-1100 AD Oath appears in medical schools early 1500s this is from Nutton, beyond the hippocratic oaththis is from Nutton, beyond the hippocratic oath

52. Contemporary Oaths Element of Oath Covenant with teachers Commitment to students Covenant with patients approp means approp ends Justice Confidentiality 150 schools 125 89 146 98 133 104 141

53. Contemporary Oaths Element of Oath Covenant with deity Vs. Abortion Vs. Euthanasia Chastity

54. Veatch

55. Kass �..the various parts (of the Oath) flow naturally from a profound understanding of what medicine is and must essentially be�� �the Oath�speak(s) truly and timelessly.�