Transcript Document

LECTURE 2
Ancient Greek
medicine
Greek
Medicine
Roman medicine
Medicine in the Pre-Columbian
Americas
Ancient Greek Medicine
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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.
Ancient Greek Medicine
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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
of
many successful case histories, put the visitor into a mental state
receptive 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.
Ancient Greek Medicine
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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.
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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.
Ancient Greek medicine
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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.
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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.
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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.
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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.
Ancient Greek Medicine
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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.
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.
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Ancient Greek Medicine
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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
Ancient Greek Medicine
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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.
Roman Medicine
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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".
Roman Medicine
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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
Roman Medicine
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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.
Roman Medicine
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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
Roman Medicine
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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.
Roman Medicine
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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.
Roman Medicine
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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.
Pre-Columbian
Medicine
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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.
Pre-Columbian Medicine
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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 politicomilitary 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.
Pre-Columbian Medicine
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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.
Pre-Columbian Medicine
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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 preColumbian 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