ANCIENT METITTERANEAN MEDICINE

1. ANCIENT METITTERANEAN MEDICINE N. S. ANGELIDESMD, PhD, FRCS, FACA

2. Introduction. • The earliest practice of medicine was theocratic. The approach to the disease was magic and priests were also considered as doctors. • Illness was believed to be the action of evil spirits.

3. ANCIENT EGYPTIAN MEDICINE

4. The historian Herodotus wrote that Egypt “is the gift of the Nile”, meaning that its civilization expanded on the soil which was formed by the recurrent floods of the Nile.

5. Step by step evolution. Imhotep was the god of medicine in Egypt • Egypt became an organized nation about 3000 B.C. • Medicine as a discipline appeared later when Egypt had an ambitious Pharaoh named Zoser. His chief minister was Imhotep. • In the Egyptian writings, Imhotep was presented as a physician and was considered as the god of medicine in Egypt.

6. Medicine in Egypt was associated with religion and magic. • All papyri dealt with medicine, gave the “aroma” of supernatural formulae.

7. But, Medicine in ancient Egypt was not at all primitive. • Some medical papyri were really explanatory. • Among them, the “Edwin Smith Papyrus” and the “Ebers papyrus” were the most important.

8. In these ancient papyri many case histories were found! • In addition, a great number of internal pathologies were reported, such as eye diseases, diabetes and rheumatism.

9. Later on, physicians in Egypt were organized in hierarchy. • They gradually formed a distinct profession, with the court physicians at the top of the hierarchy.

10. ANCIENT GREEK MEDICINE.

11. Acropolis is the landmark of Ancient Greece

12. The history of ancient Greek Medicine begins with “Iliad”, the Homeric poem, which is considered as the oldest written document in Greek. The beginning of Greek Medicine. • Homer

13. In "Iliad" Apollo, the god of light, was considered as the disperser of epidemics, one of which was spread upon the Greek army before the departure to Troy. Diseases were thought to be theocratic, sent by gods, to punish the mankind. • Apollo.

14. Asclepius, lived in the thirteenth century BC and was considered as the Greek god of medicine. His teacher was Chiron, the Centaur, who was taught medicine by Apollo and Artemis. Asclepius. • Æsculapius

15. The symbol of Asclepius. • The symbol of Asclepius was a serpent around a knotted staff. • Serpents produced poisons, and had a reputation for wisdom as well as the power of renovation. • A serpent entwined round a knotted staff is the symbol of Æsculapius

16. The Greek deity of Health was Hygia, known as Salus to the Romans; she was considered as the daughter of Asclepius and took care of the sacred serpents. Hygia. • Goddess Hygia.

17. “Asclepeion”: The Temple of Asclepius • Although the history of Asclepius was mixed with mythology, solid facts were also present: • These facts were the splendid temples devoted to him, which were always built in lovely and healthy places. • These places were visited by sick people, and this is why the priests of the temples also learned the art of healing.

18. The chief “Asclepeion” was at Epidaurus. Close to “Asclepeion” there was a magnificent theatre, as well as a stadium built to accommodate 20,000 spectators! Τhe “Asclepeion” at Epidaurus • The restored entrance of an ancient “Asclepeion”

19. However, the most important “Asclepeion” was the one in the island of Cos, the birth place of Hippocrates, who is considered as the father of Medicine. Τhe “Asclepeion” of Cos • The “Asclepeion” at Cos as it is to-day

20. Hippocrates (460 BC-377 BC), according to Mythology, was a descendant of Zeus and Hercules from his mother, and a descendant of Asclepius from his father . Hippocrates, the father of Medicine. • Hippocrates

21. Demystification of the spiritual medicine: The great step! • Hippocrates rescued medicine from speculation! • He did what no physician had ever done before: He examined the sick carefully, he recorded the signs and symptoms of the disease and gave emphasis on the evidence than on spiritual causes. • He did not ask "Who is causing a particular sickness?" but "how and on what process does this particular sickness occur?" • A Greek stamp with the head of Hippocrates.

22. Hippocrates always based his conclusions on the observations. He believed that "the best physician is the one who is able to establish a prognosis at the bedside, penetrating the present, the past, and the future of his patient”. Hippocrates in advanced age. Diagnosis and Prognosis • The lunar crater of “Hippocrates”.

23. Hippocrates classified diseases into sporadic, epidemic, and endemic, and had also separated them into acute and chronic. He also divided the causes of diseases into two classes: general, such as climate, water and sanitation and personal, such as improper food and absence of exercise. Observations made by Hippocrates. • The famous tree of Hippocrates in Cos as it is demonstrated on a Greek stamp.

24. As mentioned already, Greek heroes in “Iliad” were wounded regularly at the battlefields and were in need of medical treatment. This was obtained either by the help of the gods or by doctors. However, many times, the wounded heroes managed to solve the problem by themselves! Homeric poems as a source of information. • Aris, god of war.

25. The picture on the left shows Achilles bandaging the wounded arm of his close friend Patroklos with a white bandage. (From the British Archaeological Museum). Achilles and wounded Patroklos. • War injury over Patroklos in Troy.

26. Ancient Alexandrian Medicine

27. The post Alexander the Grate era. • When the Empire of Alexander the Great was subdivided, the Egyptian share fell to Ptolemy the 1st, who founded the Alexandrian Library under the direction of Aristotle.

28. The School of Alexandria • Ptolemy gathered a number of educated men in Alexandria, organizing a system that resembled a University. • For example, Euclides was the teacher of Mathematics, and Hipparchus the father of Astronomy.

29. Anatomy in Medicine was inaugurated in Alexandria. • The early Alexandrian doctors described the organization of the human body from actual dissections, on the basis of the discoveries of Aristotle in natural history and in comparative anatomy.

30. Herophilus and Erasistratus • Two famous Alexandrian physicians and anatomists were, • Herophilus (335-280 B.C.), and • Erasistratus (280 B.C.). • Both took part in the early medical teaching at the Alexandria School.

31. Anatomical discoveries in Alexandria • Herophilus made a lot of anatomical discoveries; • He also described the connections between the nerves and the brain, recognizing the essential difference between motor and sensory nerves.

32. Operations carried out in Alexandria • Herophilus was also a good surgeon; he operated upon the liver and spleen and had a good knowledge of obstetric operations.

33. The decline of the medical School of Alexandria • A description of the teaching in the School of Alexandria was given by Celsus. • However, the foundation of Empiricism marked the decline of the Medical School of Alexandria and the destruction of an era occurred.

34. Ancient Cypriot Medicine.

35. The history of ancient Cypriot Medicine started at the time of Hippocrates. Sources of information were the various archaeological findings, the writings of ancient Greek philosophers, as well as ancient inscriptions. The beginning of Cypriot Medicine. • Hippocrates

36. Onasilos the “healer”. • From the “inscription of Idalium” which is the oldest and longest ancient written document found in Cyprus, we learned that Stasikipros, the king of the town, signed an agreement with a doctor named Onasilos to treat, free of charge, all soldiers that were wounded in the battles during the siege of Idalium by the Persian army. (5th century BC.) • The “inscription of Idalium”.

37. Onasilos, the first military doctor in Cyprus. • The war ended with an unexpected victory of the Cypriot army and the king honoured Onasilos and his brothers offering them as a price fields and political posts. • Head of goddess Aphrodite found in ancient Salamina, Cyprus

38. Apollonius kitiefs. • Another famous Cypriot doctor was Apollonius, who lived in the 1st century B.C. His teacher was Zoopiros from Alexandria. • He was well known for his antidotes to various poisons. That is why Mithridates, King of Pontus, had asked him to prepare for his sake a general antidote, in order to avoid poisoning. This preparation was taken in small doses for a prolonged period and since then this way of treatment was called “mithridadism”.

39. These are the famous “warmers” made from terracotta. • They could be applied on almost any surface of the body filled with fluid and were very popular as a mean of treatment of various diseases.

40. Ancient Roman Medicine

41. This is the centre of ancient Rome today

42. Rome’s main source of knowledge was Greece • Roman philosophy and Roman medicine were borrowed from the Greeks, who were well known for their philosophy, their arts and their culture. • On the contrary, the Romans were distinguished for their genius laws and their governmental status. Aristotle

43. In the earlier times and before the settlement of Greek doctors in Romemedical care was under the jurisdiction of the head of the family. • The father had great powers by the Roman law, and he acted as physician as well as judge over his family!

44. Archagathus • The first regular doctor in Rome was Archagathus, a Greek doctor who began practicing in the city by 219 B.C. • He was very popular, the Roman authorities received him favorably and arranged a surgery for him surgical instruments

45. The structure of the Roman society made medical practice in ancient Rome difficult • The lower classes were poor and the relatively small upper classes were tyrannical, superstitious, selfish and cruel. Esculapius

46. Later on, the number of doctors was increased, especially during the reign of Nero. • Andromachus, as the 1st physician to the Emperor, had the title of archiater • In general, there were two classes of archiaters: • archiatri sancti palati, and • archiatri populares. • The former attended the Emperor; the latter attended the people.

47. The most eminent doctor of Rome was Claudius Galen, Greek in origin. • He went to Rome for the first time in 163 AD. • Galen had probably influenced the progress of medical science by his writings more than any other medical writer. • In his youth he was initiated into the idealism of Plato, the realism of Aristotle, the skepticism of the Epicureans, and the materialism of the Stoics.

48. Galen • Galen was also an admirer of Hippocrates. • His actions were based on Hippocrates principles, and he manage to expand and support his ideas and discoveries by new facts and new observations.

49. Roman doctors had many tools in use. • Some of these were: • The vaginal speculum (dioptra in Greek) • The cautery (kauterion in Greek) and • the various hooks. A spectacular viginal dilator

50. The Romans also used techniques that killed germs! • Although they did not understand how germs were related to the diseases, they boiled their tools before using them!  • And they used "acetum" an antiseptic, to clean and wash all wounds.