Ancient Greek and Roman Medicine Exam 2

Herophilus (from, dates, student of, moved to)

From Chalcedon

330/320-260/250 BCE

student of Praxagoras of Cos, (4th century)

moved to Alexandria as a colonist

Where was Erasistratus from?

Iulis

What were the approximate dates of Erasistratus's life?

320/310-250/240 BCE

Who was a student of Erasistratus?

Chrysippus of Cnidus

Where did Erasistratus move as a colonist?

Alexandria

To which location did Erasistratus possibly move after Alexandria?

Antioch (modern Turkish/Syrian border)

Vivisection

no Greek linguistic equivalent

analysis of biological structure and function

living organism

Herophilus and Erasistratus did this in the best way by far when they cut open men who were alive, criminals out of prison, received from kings

earliest evidence of systematic dissection

non-human organisms: Aristotle

for human beings: Herophilus and Erasistratus

did herophilus or erasistratus come first

herophilus

where did herophilus and erasistratus work

Alexandria, preserved in Celsus, De Medicina 1st century CE

three hypotheses for why dissection occurred w/ herophilus and erasistratus

Egyptian hypothesis: came from mummification (but mummification sacred and ritualistic)

Comparative anatomy hypothesis: animal dissection common from 400-323 BCE, aristotle dissected animals (but taboo to cut up human bodies)

frontier town hypothesis: attempt to build new greek culture in alexandria-- no roots, royal patronage important, dissectin of humans and animals ceased after herophilus and erasistratus-- cultureal project complete?

Erasistratus discoveries

neurology

motor and sensory nerves

cardiac anatomy

identified the four chambers of the heart

described structure and function of

tricuspid, mitral, aortic, and pulmonary valves

recorded that they prevented reversal of blood flow

heart's action was like a bellows

Herophilus discoveries

in brain

ventricles

calamus scriptorius (part of brainstem)

torcular Herophili (confluence of the sinuses)

in eye

four membranes of eye

viscera

duodenum, liver, hepatic/pancreatic duct?

reproductive organs

epididymis and vas deferens in men

Fallopian tubes and ovaries in women

angiology

difference between arteries and veins

Erasistratus on Experiment

Medicine must make active intervention to understand underlying causes

Observation is necessary but not sufficient

ex. bird experiment-- bird weighs less then the excreta that has passed

Eristratus on Digestion

Mechanical processes

Solids

stomach grinds and crushes food like a mill-stone

not ripening or cooking

Liquids

nutrition filtered

kidneys, liver, bladder

Mechanical metaphors

Herophilus on the pulse

Distinction b/w arteries and veins, Praxagoras--> arteries: pneuma, veins: blood in 4th century BCE

Herophilus explains distinction

arteries have a coat 6x thicker/ veins (fr. 116 vS)

Isolates pulsation to arteries, as norm

pulsation of arteries natural not pathological

Characteristics of Herophilus' pulse

1) amount

2) size

3) speed

4) vehemence

5) rhythm

What is the pulse good for?

Diagnostic tool

baseline, normal pulse

contrasted with pulse taken

evaluated by 4/5 criteria given for pulse characteristics

Herophilus' timing of the pulse by water-clock

2 types of machines

machines internal to body: eristratus heart as bellows

machines applied to body: herophilus pulse by water clock

Erasistratus' heart as a bellows

Similarities concern action of heart in a static state

Focus attention on heart as center of vascular system

Fluids move through heart in separate systems (air and blood)

Heart function: expands and contracts

--> Pump does not

--->Bellows does

Erasistratus and mechanics

Many natural bodily actions 'machine-like'

digestion, grinding like mill-stone

liver, kidneys, bladder, filters

heart's contraction and expansion, bellows

Image of the body and nature: made for purpose (teleological), dynamic, always in action

Timing the Pulse by Water-Clock

Herophilus

water-clock holds expressed measurement for natural pulses of each age-group

consultation

sets water-clock

measures difference

deviation from norm = degree of fever

mixed sciences

aristotelian term, usually mathematical principle underlie

more broad: when sciences interact with one another in a theoretical way

Herophilus on Music

Music integrated with motion of the arteries

rhythm as criterion

"One pulse seems to differ and be recognized generally as different from another, as was said, in rhythm, size, speed, vehemence."

objective criterion

opposed to subjective criteria: size, speed, vehemence

Candidate Characteristics of Experiment

Designed to test a proposed hypothesis

Deliberate, often artificial, conditions

Theoretical analysis of conditions is necessary

Involves directed observation

Repeatable

Quantification? - more as hellenistic period moves forward

Medical Sects

Dogmatists

Empiricists

Methodists

Origin of three sects

Dogmatists - not unified - takes shape from theories of herophilus

Empiricists - response to dogmatists - founded by philinus - also serapion of alexandria

Methodists - founded by Themison - very popular in imperial rome. Also associated with Soranus

theoretical views - sects

Dogmatists - Must know underlying causes

Empiricists - cannot compare living and dead body, can't see something = irrelevant. Nature is unknowable

Methodists - knowledge of causes therapeutically useless, knowledge of general disease useful

Dogmatists defined as

not empiricists (negatively defined)

Dogmatists believed in medicine from

philosophy (underlying causes)

Dogmatist four defining features

1. hidden causes (drink coffee and feel good)

2. evident causes (Coffee smells good - IDK abt chemical reaction)

3. natural actions (relevant natural actions)

4. anatomy

Rationalists agree on ___order issues but not on ___ order issues

second; first

methodology is the same but particular beliefs may be different

rationalists 1st order differences

corpuscular theory, humoral theory, pneumatic theory

Dogmatists are followers of _____

Herophilus, Eristratus, Aclepiades, etc.

Empiricists founder

Philinus of Cos (250 bce)

student of herophilus

also Serapion of Alexandria

Empiricist methodology (Tripod)

1) see things for yourself (first hand experience) - not enought to encounter a disease once, must see many times (autopsia)

2) history (archival)

3) transition to the similar - analogical reasoning

take aspirin and helps pain in head

so when knee hurts, we can try aspirin as well

Empiricist had ___concerns regarding dogmatist views because of _______ accounts of facts and the fact that nature is _____

epistemological

competing

unknowable

Empiricists: Anatomy

Superfluous, Cruel

Disanalogy b/w living and dead or dying

Adventitious anatomy = Accidental learning

___is the goal for empiricists

Therapy

___is the goal for dogmatists

research/knowledge

Empiricists demanded mastery of ____

evident signs

Scientific progress was gained via _____ and ____ for empiricists and dogmatists

therapy (emp); research/knowledge (dog)

_____ maintained the dominant medical theory in the Roman Empire

Methodists

Methodists trained for _______ __

6 months (truncated)

Methodism founded by

Themison of Laodicea (1st

century BCE)

came from greek-speaking docs in Rome and italy

Methodists arose due to dissatisfaction with ____ AND _____

empiricists; dogmatists

We have a ______ of texts for methodists

lack

methodist three classes of disease

constriction, flux, mixture

Methodist treatment

Gentle - adjust after observation, nothing superstitious unless soothes patients

Is patient history important to methodists?

No

Is individual care important to methodists?

Yes but not individual circumstances

Are causes of the disease important to methodists?

No

Treatment matters, causes don't

Methodists: symptoms =

disease

Methodist - types of disease is ____across _____poeple

common; all

Empiricist most important factor

experience (not dissection). Can't know nature

dogmatist methodology

make inferences to the unknown based on what can be seen and observed, Do whatever is necessary to gain anatomical knowledge

dogmatist - is disease individual?

Yep

celsus account of empiricists and dogmatists

traditional/simplistic, omits more innovative accounts

three sects debt to hippocrates

Dog - he is ours - we are the direct descendants (unseen causes and ind variation in prognosis, deviation from normal state - epidemics)

Emp - he is ours - we are the direct descendants - he traveled and observed a lot - epidemics

He confuses things - distracts from thinking about disease as common across ind cases - season and humors don't matter - individualizes cases and methodists do not

greek ideas relevance in roman empire

greek medical ideas become the medical ideas of the Roman empire

cato the elder

Roman politician, wrote On Agriculture: one of the earliest extant pieces of Latin Lit; how to plant crops, take care of health of household

folk medicine: use of medicinal plants (like cabbage), no mention of surgical techniques

asclepius to Rome

293 BCE: roman senate invite god asclepius to rome to end a plague

archagathus

first greek doctor to rome

219 BCE

shop set up at public expense at intersection of 2 streets; specialist in wounds and performed surgical techniques of excision

unpopular bc of his violent cures

differences in native roman medicine vs greek

in medicine described by Cato:

- no fee

- treatment done at home

- no treatment for severe wounds

- healing encapsulated in common foods, not pro training or exotic ingredients

- no medical pros

- self-sustaining ritual

- independence and self-reliance

Archagathus' greek medicine differs in all these ways

greek practitioners to Rome

followers of herophilus and erasistratus lived and worked in Greek east, only in 1st century BCE do a few Greek doctors start to work in Italy

as roman power grew and hellenistic kingdoms weaken, it became fashionable for Roman aristocrats to employ a greek doc in their household

most famous practitioner in rome (notes about students)

Asclepiades of Bithynia

some students eventually become the Methodist medical sect

Methodism was a ____ phenomenon

rationalism and empiricism are _____ phenomenon

Roman

Alexandrian

Asclepiades of Bithynia

- started life as public speaker, then switched to medicine

- successful practice

- prominent patients among Roman aristocrats

wine therapy

- advised dietetic (contrasted w violent surgical excesses of Archagathus)

whos therapeutic slogan was swiftly safely pleasantly

Asclepiades

Asclepiades believed that disease was cause by _____ problems

mechanical

disease was a blockage of pores

General advances in surgery under roman empire

new hemostatic techniques

new surgical implements

new materials via trade with neighboring countries

Hospitals (valetudinaria)

Roman army at the frontier

advances in civilian surgery

silk replaces rope, leather, and hemp for sutures

trade with India (and further east) increased range of supplies

bladder stone operations (lithotomy = λιθοτομία)

surgery for fistulae (lead pipe to connect rupture in organs

Scribonius Largus

1st century CE, wrote in Greek and Latin, recipes of compounded drugs from head to heel arrangement (not theoretical)

Dioscordes

-from Anazarbus

-civilian doc or soldier in Roman army

de materia medica

written by Dioscordes, 700 plants in 2000 recipes, very influential, organized by pharmacological property

Most major surgical advance under roman empire

Major surgical advance: hemostatis

Literary Evidence

closing off blood vessels to stem blood loss

Celsus De Medicina 5.26.21

Archaeological evidence

- surgical instruments

spoon of diocles

Hellenistic if genuine

Archaeological evidence

surgical instruments

vein clamps

forceps

Roman army hospitals

called valetudinaria

New Medical Institution

Part of permanent forts along frontiers

not close to fighting

only for professional soldiers

staffed with pharmacological supplies and surgical equipment

probably had professional camp doctors

could support 2-20% of troops in a unit

Galen from

Pergamum

Galen training

14: trained in 4 major greek philosophical schools (stoic, platonic, aristotelian, epicurean)

16: medical training: empiricist, satyrus, student of satyrus

Flavius Boethus

Galen's sponsor and government official

Galen's voyages

2 voyages for specimens and pharmacological compounds

how much did galen write

22,000 pages

150 books

2/3 lost

Galen 6 major works

1.Anatomical procedures

2.on the usefulness of the parts

3.natural faculties

4. method of healing

5.compound drugs by place and compound drugs by class

6. on the doctrines of hippocrates and plato

Galen 6 non-naturals

6 non-innate causes of health (Art of Medicine 23):

-air and environment

-motion and rest

-sleep and wakefulness

-food and drink

-evacuation and repletion

-passions of the mind

6 non-naturals

'neither' category in Art of Medicine)

extremely influential division of prescriptive medicine in European and Islamic Middle Ages

thousands of medieval prescriptions dividing dietetic advice into these areas

Organization of Body Parts

principle

-brain, heart, liver, (testicles/ovaries)

subordinate

-brain: nerves and spinal cord

-heart: arteries

-liver: veins

-testicles: spermatic ducts

homogeneous (homoeomerous)

-gristle, bone, ligament, membrane, glands

Importance of Causality for galen

Inference from signs

types

diagnostic, prognostic, mnemonic

preservative, therapeutic, and prophylactic

signification

current, future, and past disease

(Ars medica)

Galen's Body, top down

Physiology: function

-organs

Arrangement: formation

-balanced according to physician's senses

--touch, sight

-balanced according to proportionality of body parts

--size, shape, number, position

tissues: elemental composition

-hot, cold, wet, dry

-A healthy body is balanced between these elements in a mixture

--mixture is a technical term 'krasis' in Greek

Morbid states of the body are understood as failing to attain health in some way. What ways?

in substance

-bad mixture (dyskrasia)

in arrangement

-morbid state in size, complexion, shape, number, position, hardness and softness, heat and cold

--parts and organs

in physiology

-impairment of function

semiotic

the study of signs

The Medical Art = Ars Medica

"Medicine is knowledge of what is healthy, what is morbid, and what is neither ... What is healthy, what is morbid, and what is neither -- each of these comes in three different categories: those of body, cause, and sign." --Galen Art of Medicine 1, 1.307K

ontological vs. physiological conceptions of disease

Ontological conceptions

- disease is potentially independent substance

- attack of demons; attack of plague

- external and invasive agent

- bacteriological and viral conceptions

• interaction between host and invader

• genetic conceptions of disease (internal substance) might

belong here too

• Physiological/Functional conceptions

- disease is impairment of bodily function

- normative

- disease is a process, activity of living over time - Galen

• genetic conceptions of disease (malfunctioning body ) might belong here too

Galen definition of disease

any physical condition that is contrary to nature and that impairs natural function perceptibly

Physiological or Functional according to Galen

• Galen: disease is the impairment of natural function

- naturalism

- in physiology

• impairment of function

- e.g. difficult breathing, derangement of mental faculties,

impairment of voluntary motion, excretions - in arrangement

• parts and organs: size, complexion, shape, number, position, hardness, temperature

- in substance

• bad mixture (dyskrasia) = one or two elements in excess

problems with ontological

- diphtheria today = diphtheria in 300 BCE?

- - Have to assume that agents are similar or identical to talk about the same disease. This is not true, symptoms and reactions to disease change over time

- how does an individual agent result in such a

variety of responses?

Problems for physiological/functional

problems of normativity = normal vs. pathological

- is health simply the state before the doctor's treatment?

- must establish normality -

difficult but can do with some specificity.

Did galen believe in ontological or physiological?

• Physiological/Functional

- therapy aimed at restoring lost function

• Method of Healing 3.1-3

- the wound, cavity

- here, lack of emphasis on external agent

• but cause is important

Treat the _____ not the _____ according to galen

Treating the patient, not the disease

different patients, different results - humoral balance, constitution, krasis - Galen's view of the Hippocratic method

3 factors of individualism

the patient's nature

the nature of medication

the nature of superficial wound

doc cannot state exact quantity of three factors

Galen's Major Works

On the Usefulness of the Parts (800 pages)

-teleological account of muscles, nerves, organs, and how each body part is positioned in the best way possible

Method of Healing (1000 pages)

-therapeutics

On the Doctrines of Hippocrates and Plato (500 pages)

-synthesis of Hippocratic medicine and Platonist philosophy

Anatomical Procedures (1200 pages)

-professional dissection manual

Compound Drugs by Place & Compound Drugs by Class (1700 pages)

-pharmacology, organized by application to body and by kinds of drugs

Natural Faculties (300 pages)

-physiology

Xenodokeia

The civic hospital was created in Christian late antiquity; contrast the Roman army valetudinarium

xenodokeion (pl. xenodokeia)

"place for receiving guests", "hotel"

some as large as 200 beds

part of the Christian mission of public charity

sometimes form of charitable housing

In large cities, like Constantinople, they could be specialists in different sorts of surgeries or treatments of women

both secular and sacred

sometimes including professionalized medical care