LECTURE 2

1. LECTURE 2 Ancient Greek medicine

2. Greek Medicine • Roman medicine • Medicine in the Pre-Columbian Americas

3. Ancient Greek Medicine • When Greek medicine is mentioned, the name of Hippocrates comes to our minds. However, centuries before Hippocrates there were many developments in medical practice, both on the mainland and the islands of the Aegean Sea. • Almost every god in the Greek mythology, as well as many demigods and heroes, seem to have had some association with illness. • The "Iliad" of Homer speaks of Asclepios as a warrior-king in the Trojan war. About two centuries after Homer, Asclepios was considered the principal god of healing • Asclepios had a large family and his daughter, Hygeia was the deity of health who represented the prevention of disease. Panacea, another daughter, represented treatment.

4. Ancient Greek Medicine • The healing temples of Asclepios developed about the sixth century B.C. The Asclepian temples were extremely popular among both rich and poor. The dominant structure was usually the main temple, in which a statue of Asclepios was given a prominent place. A round building, the tholos, contained water for purification. The most important structure was the incubation site, the abaton, where the patient went to sleep until he was visited by the god. • The ceremony begun after sundown and consisted of rituals that,together with the impressiveness of the buildings and the influence ofmany successful case histories, put the visitor into a mental statereceptive to the healing ministrations of the priests. • We do not know precisely the nature of medicine in the centuries between the Homeric period of the sixth or eighth century B.C. and the advent of the philosopher-scientist in the sixth century. A few information from Hesiod's "Works and Days" of the eighth century suggest the existence of a kind of folk medicine that combined basic hygienic rules with use of plants, but it also included religious and magical associations.

5. Ancient Greek Medicine • Thales (640?-546 B.C.) was the first true scientist-philosopher of the Greeks. He believed that the basic element in all animal and plant life was water, from which came earth and air. Thales has been called the "Father of Science" because his explanations of phenomena were not based on supernatural forces. • Two influential thinkers followed Thales: Anaximander and Anaximenes. The former thought that all living creatures had their beginnings in water and that the universe was constituted of opposite forces in balance. His pupil Anaximenes considered air rather than water the primary element and therefore the essential requirement for life. • By the sixth century B.C., four basic elements were generally accepted as the components of all substances: water, earth, fire and air, each having its corresponding characteristic: wet, dry, hot and cold.

6. Ancient Greek medicine • At the western borders of the Greek world, in the sixth century, an Italic school of philosophers was created in Sicily. The main name was Pythagoras. He focused principally on the soul and the spiritual universe. Therefore surgical operations were forbidden because they might interfere with the soul. • Alcmaeon had a theory centered on man not on cosmos. He said ,,health is harmony, disease is disturbance of the harmony”. He established the connection between the sense organs and the brain. • Empedocles’s doctrine concerned with the purity of mind, body and behaviour. The four elements (earth, air, water and fire) are joined during life and separate after death. • Anaxagoras considered that each element was composed of many small invisible particles which were released from food by digestion and then reconstituted into components of the body, such as bone and muscles.

7. Ancient Greek Medicine • By the time of Hippocrates the Greeks had developed a hypothetical system which explained the mechanism of illness with four basic humours of the body. • The key principle was that all body fluids were composed of varying proportions of blood (warm and moist), phlegm (cold and moist), yellow bile (warm and dry) and black bile (cold and dry). When these humours were in balance the body was in health. Excess or deficiency of one or more caused illness. • In attitudes toward mental disease, the Greeks showed a gradual development from belief in supernatural causes to more rational explanations. By the fifth century B.C. the mind and its derangements were clearly located in the brain. • The methods of treatment were general and local. Regimens consisted of diet, daily exercise and temperate behaviour in eating, sleeping and sexual activity. • Although medicines were used most often for external application, some drugs were taken internally to produce purging or vomiting, to eliminate the excess humours.

8. Ancient Greek Medicine • Injuries to the bones and joints made up a substantial part of medical practice. The manipulations to reduce dislocations and fractures achieved a high degree of sophistication, sometimes with the employment of mechanical devices. • The cautery was effectively used to treat infections, wounds and tumours. • The most famous name that has come down to us is Hippocrates. • Hippocrates, also called "the father of medicine", was probably born in 460 B.C. on the island of Cos and died about 370 in Thessaly. He was a practising physician and surgeon, a teacher on Cos and the author of a number of writings. • The whole collection of about seventy-two books and fifty-nine treatises, known as "Corpus Hippocraticum" represents the teaching of one school and not of Greek medicine in general. What makes these writings unique is the spirit in which they are written. They establish for all time how medicine ought to be practiced and what doctors should try to be.

9. Ancient Greek Medicine • Anatomical details are relatively sparse and unsystematized. The pericardium, the muscular ventricles, the heart valves and the great vessels are mentioned. Nerves are confused with ligaments. Differences between arteries and veins are not understood. • The four humours are the physiological bases of body function. Harmony of all parts is necessary to health. The heat of the body necessary for life comes from the "pneuma" of the air and is taken in by lungs. • Hippocrates is much concerned with prognosis - predicting the course of an illness • In forming his prognosis the physician has to make a diagnosis -to identify the patient's ailment. Hippocrates studied each patient and related what he found to what he had learned of other patients. • Diet and general hygiene take first place • Drugs are used sparingly, mostly for the relief of pain, flatulence and constipation. Narcotics, however, are also advised

10. Ancient Greek Medicine • Surgery is reserved for the cases where drugs will not help. Cauterization is mentioned a number of times • Operative techniques are reported in detail, including preparation of the patient, table, light, instruments and assistants. Tumours, fistulas, ulcers and haemorrhoids are among the disease treated by surgery. • The code of behaviour is the best known of the Hippocratic writings, its origin may be Egyptian, and the early Indian physicians had a similar oath. The Oath as we know it was presumably taken on admission to the medical school of Cos. Graduating medical students for centuries have stood to swear to its provisions, either unaltered or with modifications. • The rational attitudes expressed in the Hippocratic writings, free of religious or supernatural explanations, represent a great advance in medical thinking, but they were only arrived at after centuries of gradual development.

11. Roman Medicine • Roman medicine had a long history of its own, inherited from the Etruscans. The religious healing had the more lasting influence and virtually each disease or symptom there was a special divinity. • According to legend, the Greek medical deity Asclepios, Aesculap in Latin, was introduced to Rome in 295 B.C. in the form of a snake sent from the temple of Epidauros. • The first well-known Greek physician to come to Rome was Archagathos of Sparta, about 219 B.C. His career illustrates the swings in the Roman attitude toward physicians. Initially he was cheered, receiving the honor of citizenship and his brilliant surgical procedures earned him the appellation of "wound healer". Because of overenthusiasm for operating or because of failures, he was repudiated and called "the butcher".

12. Roman Medicine • An important role to acceptance of Greek practitioners in the first century B.C. had Asclepiades of Bithynia. He abandoned the doctrine of the four humours. Instead he created a system which regarded the body as composed of atoms of different sizes always in motion, between which flowed the body liquids. • Health depended on the activity of the atoms. Sickness occurred when the motions were disordered. Themison, a pupil of Asclepiades, developed these ideas in founding the system of Methodism. • One of his most successful procedures was tracheotomy (making an opening in the windpipe) for obstruction to breathing. • Most Roman practitioners were mainly freed slaves and slaves. They were usually of Greek origin, but immigrant Egyptians and Jews also practiced • Each military unit had a specific number of physicians according to the size of the force. They were probably simple soldiers with special experience in medical care. • The training of physicians was made by salaried teachers in a school that included courses other than medicine

13. Roman Medicine • The greatest achievements of Roman Hygiene were the water supply and the sanitation system. By the end of the first century A.D. nine aqueducts were channeling water to Rome. • There was also a system of draining used water and sewage out of the city. The famous "Cloaca Maxima" was only one part of a great complex of sewers and conduits running beneath buildings and streets. In some houses, people still emptied refuse pots directly into streets, but for most part streets, roads and alleys were kept clean. • Much of the information on Roman medicine is based on the writings of two encyclopaedists: Cornelius Celsus and Caius Pliny the Elder, both of the first century A.D. • Celsus tried to summarize most of the knowledge available at the time, including agriculture, law, philosophy and medicine. He was the author of the earliest Latin medical treatise - "De Medicina". The eight surviving volumes covered a wide range of topics: the history of medicine, the preservation of health and derangements of almost every system of the body.

14. Roman Medicine • Pliny the Elder (23-79) was the author of a massive compendium of scientific knowledge and superstition, which included several books on medical matters. He had no personal knowledge of medicine, but because he wrote so much about it he was considered an authority for many centuries. • Many of his descriptions of plants and drugs were correct, but others were superstitious and inaccurate. He had a horror of menstruation, reporting that dogs went mad if they licked the fluid. • Another contributor to medicine in Rome in the second century A.D. was Soranus. His principal field of work was obstetrics and the diseases of woman. Soranus is regarded as the best gynaecologist of antiquity. He observed the complications in delivery due to pelvic abnormalities and the improper presentation of the baby and recommended methods of correcting abnormal positions

15. Roman Medicine • Of all the practitioners, contributors and medical writers of Roman times, Galen's personality was the most impressive. Greek in origin, physician and biologist, also called "the Prince of Physicians" he was the most influential man and one of the most prolific writers in medical history. For fifteen centuries after his death, Galen's doctrines carried almost the authority of scripture. • As a physician Galen was the most successful of his day. He spent most of his professional life in Rome, where he looked after the emperor Marcus Aurelius and his son Commodus. • The greatness of Galen lies in his observations. One characteristic of Galen's work is the concentration on anatomical details. Galen carried out some important experiments. He showed conclusively that the arteries contain blood and not, as has been supposed, air. Galen described the veins and arteries as two separate trees.

16. Roman Medicine • He differentiated sensory and motor nerves, elucidated the effects of transecting of the spinal cord examined the physiological actions of the chest cavity and proved that the heart could continue to beat without nerves. • Galen used the humoural theory inherited from early Greek times. The four fundamental humours: phlegm, blood, yellow bile and black bile were responsible for health and illness. Galen used this conception in classifying all personalities into four types: phlegmatic, sanguine, choleric and melancholic, terms still used to characterize dispositions. • A particular characteristic of Galen was the large-scale use of medications. He gathered medicinal plants and prepared his own prescriptions. The many ingredients which he put together in a single preparation have sometimes been referred to as "Galenicals". The term means unrefined, vegetable drugs, or crude extracts of plants used medicinally. Now that the active principles of most vegetable drugs can be isolated and purified, "galenicals" are seldom used, because doses are difficult to standardize. In many countries "galenical" means much the same as "pharmaceutical" - concerning the preparation of drugs.

17. Roman Medicine • One extraordinary pharmaceutical combination made by Galen was theriac. This ancient multi-ingredient preparation originated as an antidote against snakebite and eventually was used to combat all poisons and plagues. • Galen also made important observations on surgical practice. He gave suggestions on the use of instruments, advised on placing incisions and closing them, on the management of the open abdominal cavity and on the draining of abscesses. • The tragedy of Galen was that he needed a successor and there was none. If someone more self-critical had been there to continue Galen's experiments, scientific medicine might have begun in the second instead of the 16th century.

18. Pre-Columbian Medicine • When the conquistador Heman Cortes and his followers arrived in the Gulf of Mexico for the first time in the year 1519, they expected to find primitive peoples like those encountered in the Caribbean Islands. Instead, they found a flourishing civilization with advanced forms of government, large cities, engineering and architectural skiffs, a system of writing and recording history through pictograms, a developed agriculture. Mathematics and other sciences, including medicine were also in front places.

19. Pre-Columbian Medicine • About 3500 years ago, the Olmecs began a civilization that was to define much of the cultural values of all peoples of Mesaamerica. At about the height of their splendour, the Olmecs suddenly disappeared for reasons unclear even today. • One thousand five hundred years ago, the Maya civilization achieved impressive advances in art and science. They were settled in the Yucatan Peninsula, Guatemala and Honduras. Their calendar was more accurate than many others formerly used in Europe. • About the year 1 000 A.D., the Toltecs established their empire in central and southern Mexico, which was probably the first politico-military state in the New World. Several hundred years later, the semibarbarian Aztecs migrated into the area and within a century had established complete dominance. • The Aztecs and other tribes believed that before the appearance of man, a race of giants or gods had sacrificed themselves for the maintenance of the sun. • The pre-Columbian cultures maintained an intricate blending of religion, magic and science to combat sickness, similar to the medicine of primitive societies. Disease represented a loss of balance between favourable and unfavourable influences.

20. Pre-Columbian Medicine • Nothing was natural, not even death. A supernatural power toyed with humankind, as in other ancient civilizations. • As in the primitive medicine of less advanced civilizations, magical practices were mixed with procedures shown by experience to be effective. • The roles of doctor, witch doctor and priest were commonly united in the same person. Another kind of healer-priest was the shaman, characterized by his use of trances. • Among the Maya, the art of healing was entrusted to priests who were organized into a medical society. Their knowledge was thought to be inherited from the gods. • The high quality of medical care provided by Aztec physicians made the conquistadors to prefer them instead of their own physicians trained in Europe. King Philip II sent one of his doctors, Francesco Hernandez to Mexico to study the native medicine and put together a catalogue of medicinal plants.

21. Pre-Columbian Medicine • In Mexico, the climate favoured the growth of many species of plants that were of great importance to Aztec medicine. Montezuma maintained a royal nursery of medicinal plants which supplied medications to the rest of the kingdom. Above all, the Aztecs preferred drugs which induced purging, vomiting or sweating to expel bad spirits. • Surgical procedures were also developed among some of the pre-Columbian populations. Wounds were cleaned and closed with astringent vegetable decoctions or egg substances and covered with feathers or bandages. The surgeon was often a separate practitioner who looked after wounds, performed bloodletting or trepanned the skull. • In each street there were public latrines, the refuse was collected and buried outside the city limits and the streets were cleaned. Thus, at the beginning of the sixteenth century, the Aztec capital was not only a prosperous city, but also a healthy one without epidemics before the arrival of the Spaniards