ancient medicine exam 2

Galen: the organ acts __________ to accomplish its goal

naturally

two different conceptions of disease

ontological conception: disease is a physical substance physiological conception: disease is mis-performing functions of the body

Roman Vein Clamp

original (upper) reconstruction (lower)

Celsus ranking the suitability of patients for the operation and listing the operations in order of painfulness, as if he is making a sort of ________________________

pain management

What does Galens work: Compound Drugs by Place & Compound Drugs by Class (1700 pages) discuss

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

ancient __________ medicine remained the medicine of the elite

philosophical

What does Galens work: Natural Faculties (300 pages) discuss

physiology

Greek E Roman W: Christian Authors on Medicine intellectually minded Christians were positive/negative toward Greek medicine

positive Nemesius fl. 370 CE, a bishop, wrote On the Nature of Man, combining Galenic anatomy and Galen's physiological account of the three bodily systems with a theological interpretation Since Nemesius intended his work to be persuasive to pagans, his use of Galen is evidence of Galen's enormous medical authority at the time

Organization of Body Parts Art of Medicine: -principles (4) -subservient to them (4) -parts which manage themselves (5)

principles: brain, heart, liver, testicles subservient: -brain: nerves and spinal cord -heart: arteries -liver: veins -testicles: spermatic ducts manage themselves: gristle, bone, ligament, membrane, glands

What can be deemed responsible for the Hellenistic physicians to go out of circulation

probably the adoption of Galen's views by Late Antiquity which led to Galen's writings circulating while forcing those of the Hellenistic physicians to go out of circulation and hence are now lost to us

Galen Bodily Systems purpose: liver and veins

production of nutrition

What does Galens work: Anatomical Procedures (1200 pages) discuss

professional dissection manual

individualism: The doctor cannot state exactly the ____________ of any of these three factors: patient, medication, nature of wound

quantities -there is a limit of our ability to acquire and articulate knowledge of therapy

Asclepius and religious medicine: sanctuaries and worshippers

sanctuaries throughout Greece sick worshippers would go sleep in the temple, the god would come to them in a dream and tell them what they needed to do to get better (called incubation) after they healed worshippers would dedicate casts of the healed body part to the god within the sanctuary (legs, arms, chests, eyes, heads, hands, breasts, penises, feet)

"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 Galen's work The Medical Art is the introduction to his entire medical system. It presents medicine as a ________

semiotic--a system of signs that the doctor must interpret to balance the forces at play.

surgeries newer from Civilian developmebt

soft tissue operations in lower abdomen surgery for fistulae bladder stone operations --Celsus gives a very long description in On Medicine 7.26 of an operation for a bladder stone --Nutton p. 186-7 gives a medieval picture for this operation & an illustration of instruments used in this operation

Greek E Roman W: Christianty and Medicine: in late antiquity Christianity, it is believed Christ, healer of the ___________ more than of ___________

soul; body

Galen's Advice to an Epileptic Child: Galen recommends the use of a medication made from vinegar-honey (exactly what it sounds like) and the juice of ________ plant. This is a type of bulbous flowering plant. The liquid extract is still used today as an expectorant (promotes the bringing up of mucus from lungs and airways) in cough medicines.

squill

What does Galens work: On the Doctrines of Hippocrates and Plato (500 pages) discuss

synthesis of Hippocratic medicine and Platonist philosophy

What does Galens work: On the Usefulness of the Parts (800 pages) discuss

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

The performance of the laryngeal nerve relies on the importance of physiological function, the goal-directedness of the parts (___________)

teleology

contrast Galen's _________________ with _______________' atomism (the purposeless and randomness of parts and activities)

teleology; Asclepiades'

"black bile" and the insistance of cooking plants prior to eating gives us what hint about the origins of Roman medicine?

that it didn't fully originate without influence from Greek medical thought

Greek E Roman W: folk medicine and christianity: -what was the ability to heal connected to -St. Artenius

the ability to heal was a sign of connection to the divine some healing shrines were specialized: St. Artemius in Constantinople specialized in cures of the genitalia

Asclepiades' Theories: pores

the body had channels or pores through which material passes disease was the blockage of the pores by ongkoi, a word which means lumps or corpuscules --hence therapy meant the gentle unblocking of the pores

Galens Views of Health: substance

the body is composed of four elements hot, cold, wet, dry A healthy body is balanced between these elements in a mixture mixture is a technical term 'crasis' in Greek

We can see the balance of theory and practice in Galen's life -search for books in libraries -search for drugs on sci voyages -methodology

the importance of the written word, of other physicians' medical thought, of theory in a book the importance of personal inspection, of collecting material from all over the Roman empire Galen counts as a Rationalist physician, but he combines the best of Empiricist and Rationalist practice. he did not like the Methodists

factors of individualism (3)

the patient's nature nature of the medication the nature of the superficial wound

plague in Rome, 166

the plague traveled with the army back from Mesopotamia was possibly the first outbreak of smallpox, probably not bubonic plague Galen may have wished to leave the crowded city of Rome and return to the countryside where he would be safer

Galens remarks treating Marcus Aurelius: pulse -what does it indicate? -inference from pulse? -what treatment does he suggest?

the pulse provides an indication of bodily health Galen compares the pulse to a standard: "It seemed to me that his pulse, compared with the general norm for each age and constitution, was far from showing the onset of an attack of illness" inference from the pulse: MA's stomach has turned his food to phlegm, a humour with cold and wet qualities suggests a treatment by opposites: wine with pepper (that is, the qualities of hot and dry)

Galens remarks treating Marcus Aurelius: treatment -medication rejection -why does patient demand safer treatment? -why is the new treatment safer?

the social status of the patient demands a safer treatment wool with warm nard (also hot and dry) applied to the mouth of the stomach how is it safer: the wine and pepper are applied internally, the wool with nard is applied externally. the amount of peppered wine cannot be controlled once ingested, and the amount must be calculated based on MA's own nature

Lithotomy

the surgical excision ("-tomy") of calcified deposits in the bladder, called stones or calculi in English ("litho-"). The modern operation is called lithotripsy ("stone-crushing") because the calculi are crushed with sonic waves rather than surgically removed.

Native Roman vs Greek medicine from Cato in On Agriculture (7)

there is no fee treatment is done at home, not at a shop there are no treatments for severer wounds healing is encapsulated in common foods, not professional training or exotic ingredients there are no medical professionals Cato's medicine values self-sustaining ritual independence and self-reliance in Cato

Dietetics: Galen similarities and diff from Hippocratic Corpus

theres not much diff in thought from the Hippocratic Corpus The largest difference concerns the ROLE of other medical health professionals vs. the doctor -Exercise takes place in the large public baths of the cities of the Roman empire: courtyards, steam rooms, and massage tables -Galen's work On Exercise with a Small Ball -Galen is concerned to demonstrate that athletic trainers and masseurs don't understand health (Thrasybulus- Galen)

The purpose of Galens voyages to the East: (2)

to know a region and its specialties better to acquire mineral and vegetable products for pharmacological useand possibly to add information to his pharmacological books

Further surgical developments/ Civilian developments: trade brought what

trade with India (and further east) brought silk to Rome which replaced rope, leather, and hemp surgical thread

Roman Empire and Medicine Pharmacology: trade and authors

trade with neighboring countries brought new materials ancient tradition and Roman authors --Scribonius Largus --Dioscorides

Galen's Therapeutic Practices: preferred patients

urbane and philosophical, his preferred patients are wealthy urban men, and most treatments take place in large cities

Asclepiades of Bithynia therapies and focus

used wine in therapy (later called 'wine-giver') advised dietetics, moderation in personal habits, mild exercise (swinging, rocking in a chair, being carried around in a litter), massage, bathing, and minimal and careful use of drugs

What did writings from ancient pharmacological writers prior to the Roman Empire consist of

various Hippocratic works mentions pharmacy many writers wrote on venomous animals famous sect physicians wrote on drugs (a Herophilean invented compounded drugs) some writers experimented with poisons (worked under Hellenistic kings who poisoned criminals to test the efficacy of toxicological substances and their antidotes)

contrast Galen's ____________ with the mechanical analogies of _____________

vitalism; Erasistratus

Archagathus: specialties

was a specialist in wounds performed surgical techniques of excision, cautery

Nutton's Euro-centric View: why does she think we care

we care because we are the inheritors of European medicine

Where have we seen this pattern of movement before? What do his personal scientific voyages resemble?

we have seen this pattern with other Greek physicians, such as Asclepiades His scientific voyages in search of personally investigating pharmacological compounds is similar to the soldier's life of Dioscorides

Galen: In Method of Healing 3.1-3 he is concerned with a simple breakdown of bodily structures, whether in bone or flesh. He never mentions ____________ it.

what causes it cause is important, Galen is a Rationalist-type physician. But for therapy he is concerned to repair what is lost.

problems for physiological disease

why should the endless variation of forms and graduations of function somehow admit a clear dividing line between 'health' and 'disease' by therapy a patient should be restored to her former state: is this health or simply the state before the doctor's treatment?

Cato the Elder, a Roman politician, 230s-149 BCE

wrote a book On Agriculture c. 160 BCE which survives, one of the earliest extant pieces of Latin literature --how to plant crops, run a farm with slaves, take care of the health of the household

were herbals illustrated in ancient pharmacological writings

yes Nutton p. 3 gives an ancient illustration on papyrus

"The Rationalists agreed with the Empiricists that medicine was a genuine art even if it could not achieve complete precision and reliability in treatment; their problem was to explain how medicine could be based on a body of universal knowledge and nevertheless be unable to guarantee perfect success." this supports Galen following Empiricist/Rationalist values

—Schiefsky 2005: 374 Rationalist

Asclepiades of Bithynia therapeutic slogan

'swiftly, safely, pleasantly' **Remember how Methodists sought quick cures

"And Erasistratus says that a lead dental forceps is prominently displayed in the temple of Apollo of Delphi for the purpose of showing that those teeth should be pulled which are ready to come out or are loose and shaky, in short, those requiring for extraction no more than the pull of a lead instrument." who is this quote from?

- Caelius Aurelianus CM 2.4.84

"For thus the thread cuts through the skin overlying the fistula slowly, and whilst the skin is released from the thread undergoes healing, that which is still gripped is being cut through. This method of treatment is lengthy but causes no pain."

- Celsus 7.4 Celsus advises that the doctor make a twisted thread, insert it into the fistula, and knot it together. It must be moved twice a day and changed every three days. As it is tightened, the thread cuts into the fistula and gradually separates it.

"In front of these is a drop of humor like white of an egg, from which comes the faculty of seeing; it is named by the Greeks crystalloids." what does this tell of ancient vision? who wrote this?

- Celsus 7.7.13C Ancient physicians believed that the faculty of vision was the lens.

"Now a surgeon should be youthful or at any rate nearer youth than age; with a strong and steady hand which never trembles, and ready to use the left hand as well as the right; with vision sharp and clear, and spirit undaunted; filled with pity, so that he wishes to cure his patient, yet is not moved by his cries, to go too fast, or cut less than is necessary; but he does everything just as if the cries of pain cause him no emotion." Who is this from and what is the purpose or main argument

- Celsus 7.pr. 4 Celsus ideal surgeon Qualities: ambidextrous, keen eyes, bold, piteous, quick as necessary

"If you wish to examine surgeons correctly, you should be similarly acquainted with all other diseases, such as: stones in the bladder, aneurysmal veins and those which open at the orifice, fistulae, tonsillitis, scrofulous glands, thickness of the uvula, cataract, pterygium, trichiasis, tumours, and similar diseases." What does this passage say about Galens thoughts on surgeons handle on disease?

- Galen On Examining the Best Physicians 14.3 Galen at least thought that a competent surgeon should be able to handle diseases that included many of these surgeries:

"I say that to one who through practice has acquired dexterity in exposing the vagus nerve it will become so easy that he will be able to complete the task with a single stroke of the knife. And this is not something which I alone can accomplish, for it is performed by many of my colleagues also. To do the same in his turn is easy indeed for anyone who is present when one performs it, and who see it with its own eyes. But to describe this in words is very difficult. However, as I have though it right to try to serve the advantage of those who have never been present or seen me when I was performing a dissection, I must describe this operation in the clearest possible way." which text is this from and which text describes the same operation, but from different ends

-- Galen Anatomical Procedures 11.11 similar to operation On Prognosis

"When a man who has been wounded can be saved, there are in the first place two things to be kept in mind: that he should not die from hemorrhage or inflammation. If we are afraid of hemorrhage which can be judged both from the position and size of the wound and from the force of the flowing blood, the wound is to be filled with dry lint and over that a sponge applied, squeezed out of cold water, and pressed down by the hand. If the bleeding is not checked this way, the lint must be changed several times, and if it is not effective when dry, it is to be soaked in vinegar. ... But if even these [medicaments] are powerless against profuse bleeding, the blood-vessels which are pouring out blood are to be seized and round the wounded spot they are to be tied in two places and cut across between so that the two ends coalesce each on itself and yet have their orifices closed. When circumstances do not even admit this, the blood-vessels can be burnt with a red-hot iron." Who wrote this and what about?

--Celsus On Medicine 5.26.21C trans. Loeb Celsus on hemorrhaging

anatomical performance: "And so I say that it is best that you extend the animal on its back on a board that is perforated by holes which run the cords with which its limbs are tethered, so that they come through and out on the undersurface of the board, and are so knotted together that they completely prevent the animal from moving about. Previously I have also said that it is best if the animal be a pig." what technique is shown throguh this text? what text is this from?

--Galen Anatomical Procedures 11.11 Galen straps the animal to a board

anatomy on animals: "For in all animals which have a larynx, the activity of the nerves and muscles is one and the same, but the loathsomeness of the expression in vivisection is not the same for all animals. Because of that for my own part, as you know already, I illustrate such vivisections on the bodies of swine or goats, without employing apes. But it is necessary that you should extend your studies and examine the larynx. This is constructed in the same way in the bodies of apes and men, a construction which is shared by the other animals which have a voice." some animals are better to use to ________________ than others.

--Galen Anatomical Procedures 11.4 demonstrate function

"I too am very much persuaded that there is a certain method for the discovery of the things sought, the beginning of which is the indicator that comes from each of the diseases. For the dissolution of continuity requires union. In a bone [this dissolution] is called a fracture, while in a fleshy part it is called a wound (helkos), just as in fact is also called a wound (trauma), rupture or tear. It is a wound when the wounding occurs in a fleshy part, whereas rupture or tearing occurs apart from wounding, the former when there is dissolution of continuity in the rending of a fleshy part, and the latter when it arises in rupture of a sinewy part. What [goal] is indicated for all these things is union." -where is this from -this shows dissolution of ____________

--Galen Method of Healing 3.1, 10.160K dissolution of continuity

"It is clear that [we should] begin from the most simple [diseases]. What is simpler than a superficial wound in a fleshy part? If this wound is simple, the object of the cure is union. If it has a cavity, the objective is twofold in that the condition is also twofold -- the wound is a dissolution of continuity, while the cavity is a destruction of some substance proper to the organism. In this situation, it is often found that one of the objectives is impossible; for example, if not only the flesh is destroyed but also the underlying bone. A cavity of this kind cannot be filled up perfectly but it can be scarred over, which is a cure of the wound, although the cavity will be left behind incurable. This itself is something which, in general, we must know either through experience or through reason." where is this from

--Galen Method of Healing 3.2, 10.162K

"I promised a demonstration of the minutest nerves, and to show how there is a hairlike pair implanted in the muscles of the larynx." "I showed that an intake of breath is produced by the dilation of the thorax, an exhalation by its contraction, and displayed the muscles by which it is dilated and contracted, and also the nerves branching to them which have their origin in the spinal cord. I also demonstrated how an unforced release of breath produces a soundless exhalation and the alternative, forced release is accompanied by a sound and we call it efflatus. I also revealed how this efflatus itself, when, in its passage along the larynx, it strikes against the cartilages there, produces voice: these cartilages are activated by muscles and damage to the nerves that activiate the letter results in loss of voice." -who wrote this? -what body part is being shown? -what functions are shown?

--Galen On Prognosis 5.18-19 The animal screams until the recurrent laryngeal nerve is ligated and continues to move although without sound Galen showed how the respiration and voice is produced: he demonstrated the function of the muscles by cutting or ligating nerves or muscles which moved parts necessary for the activity

"True medicine aims conjecturally at the nature of the patient. Many doctors, I believe, call this idiosyncrasies and all agree that it cannot be grasped. Hence they concede true medicine itself to Apollo and Asclepius." -what problem for therapeutics is being described? -

--Galen, Method of Healing 10.209K, trans. Berrey patients are unique, composed of their individual mixtures and habits. there is no universal patient

"It is clear that what the flesh of the bodies underlying those wounds will be the "demiurge" of the flesh that will be regenerated. But the nature of each of the bodies was shown to consist of a certain krasis of heat, cold, dryness, and moisture. It is clear that the eukrasia of these qualities in the underlying part will have the ground of the "demiurge" by which we will cause the growth of the flesh that is lacking. First then, we must consider in every hollow wound and ulcer these two things: whether what is underlying is eukratic--that is to say, if it is in accord with nature, for it was shown that health in homoiomerous bodies lies in a eukrasia of the four qualities--and in addition, if the flow of blood is of the right quality and quantity." This is an example of _______ passing on the ____________ method

--Galen, Method of Healing 3.3, 10.174K Galen; Hippocratic *That is, therapy must be targeted at the individual, who has his own balance of humors

"For as I too have often said, none of the matters and medications pertaining to the craft of medicine is inexpressible in terms of kind, but the quantity cannot in each be stated, or written, or, in a word, taught. Further, in the case of wounds and ulcers, the moistness and filth are not inexpressible whereas the quantity in each is inexpressible." -where is this from -how does this tie into problems with individualism

--Galen, Method of Healing 3.3, 10.183K The doctor cannot state exactly the quantities of any of these three factors: patient, medication, nature of wound there is a limit of our ability to acquire and articulate knowledge of therapy

individualism: "For as I too have often said, none of the matters and medications pertaining to the craft of medicine is inexpressible in terms of kind, but the quantity cannot in each be stated, or written, or, in a word, taught. Further, in the case of wounds and ulcers, the moistness and filth are not inexpressible whereas the quantity in each is inexpressible." This passage shows the problem as a __________ one, not a ____________ one

--Galen, Method of Healing 3.3, 10.183K pedagogical; theoretical

Greek E Roman W: Galen's Criticism of Creation Stories"Could our creator have ordered [new eyebrow hairs] equal to these hairs but keeping their size? Do the hairs, either fearing the command of their master or reverencing their ordering god or forced to be better, keep doing this, as they have been commanded? Did Moses reason better about nature in this way and do it better than Epicurus? It is in no way better, since to attribute the origin of the creator's command as the beginning in all creation is like Moses. For this reason our creator made it necessary for the hairs to maintain their size, because it is better. Since he knew that it was necessary to accomplish this, therefore he supplied a hard body like cartilage to some hairs and a hard skin growing out of the cartilage through the eyebrows, for it was not possible for them to be self-sufficient. For, if he should have wished suddenly to make a rock into man, this would not have been possible. This is the reason our opinion and the opinion of Plato and the opinion of the rest of the Greeks who have rightly taken up an accounting of nature differs from the opinion of Moses. He thinks that god wanted to create the cosmos and created it at once. For he thinks that all things are possible for god, even if he should wish to make a monster into a horse or a cow but we do not recognize this but claim that some things are impossible by nature and god cannot at all attempt these but he choses the best possible from what can come to be." -who is giving ctiticism in this passge? -what are they criticising?

--Galen, On the Usefulness of the Parts 11.4, 3.905-6K trans. Berrey Galen's criticism of Creation Stories

"For it is appropriate to examine the remarks of the ancients in these practices. Cassius Hemina, among the most ancient writers, is the authority to record that there had come to Rome from the Peloponnesus the first of the doctors, Archagathus son of Lysanias, when L. Aemilius and M. Liviuswere consuls in the year of the city 535 [=219 BCE]. He was given citizenship and a shop was purchased for him in the crossroads of the Acilii at public expense. He had been a famous surgeon and his coming was wonderfully received at the beginning, but then from the savagery of his cutting and burning he got the name hangman, and brought the art and all doctors to disrepute..." what does this passage support about the introduction to Greek medicine?

--Pliny the Elder NH We have a record of the first Greek doctor to practice in Rome; the Romans saw a difference between Greek and Roman medicine

"One [i.e. a doctor] aims at some criterion as to what constitutes a correct diet, but you will find neither number nor weight to determine what this is exactly, and no other criterion than bodily feeling. Thus exactness is difficult to achieve and small errors are bound to occur. I warmly commend the physician who makes small mistakes; infallibility is rarely to be seen." The ___________________ too recognizes the nature of this problem about general knowledge claims and the individuality of the patient

--[Hippocrates] Tradition in Medicine Hippocratic Corpus

(1) "Wild cabbage has the greatest strength; it should be dried and macerated very fine. When it is used as a purge, let the patient refrain from food the previous night and in the morning, still fasting, take macerated cabbage with four cyathi of water. Nothing will purge so well, neither hellebore, nor scammony; it is harmless and highly beneficial; it will heal persons whom you despair of healing."

-Cato On Agriculture 157.12 trans. Loeb.

"Headache and eye-ache [cabbage] heals alike. It should be eaten in the morning, on an empty stomach. Also if there is black bile, if the spleen is swollen, if the heart is painful, or the liver, or the lungs, or the diaphragm-in a word, it will cure all the internal organs which are suffering."

-Cato On Agriculture 157.7 trans. Loeb (modified)

"The instrument consists of two iron or even copper blades, one blade has at each angle of its end a hook, turned downwards; the other blade has its sides turned up so that it forms a groove, also its end is turned up somewhat and perforated by a hole. The latter blade is first passed up to the weapon, and then underneath it, until the point is reached, the blade is then rotated somewhat until the point becomes engaged in the perforation. After the point has entered the perforation, the hooks of the first mentioned blade are fitted by the aid of the fingers over the upturned end of the blade already passed, after which simultaneously the spoon and the weapon are withdrawn." Who wrote and what instrument is discussed

-Celsus On Medicine Spoon of Diocles

"A strong and well-trained man, seated on a high stool, seizes the boy from behind and draws him backward until his buttocks rest on the man's knees. When the boy's legs have been drawn up, the man orders him to put his hands behind his knees, and to pull upon them as much as he can, and at the same time the man keep them in this position." "the skin over the neck of the bladder next to the anus should be incised by a semilunar cut, the horns of which point towards the hips ... a second cut is to be made under the skin, at a right angle to the first, to open up the neck of the bladder until the urinary passage is opened so that the wound is a little larger than the stone" who wrote this? what procedure is being described? what instruments are used?

-Celsus26.2C. Kidney stone removal The patient is laid on his back The operator searches for the position of the calculi with both hands from above and below two fingers inserted into the anus, the other hand pressing upon the region between the stomach and pubes If the stone is small, the operator pushes it out with his hands. The only instruments are the knife and a hook

"Another spell for barring air of the bitterness of the night-demons, those of smallness, Sekmet's messengers. Retreat, night-demons! Winds shall not reach me until those who pass by for tempest pass by me. I am Horus, who passed by Sekmet's infection." -where is this from? -does it support the ontological or physiological concept of disease?

-Edwin Smith Papyrus, Spell 2 Ontological

"And I myself, once when I was traveling into the countryside far from the city, together with two adolescents the same age as myself, I overtook some peasants who had already eaten and the women were about to make bread (for they were out of bread). One of them threw wheat all at once into a pot and boiled it, then she seasoned it with a moderate amount of salt and asked us to eat it. We were ready and willing to do this, as was likely, since had been traveling and we were hungry .. Through the whole next day we suffered from indigestion and lack of appetite, so that we could eat nothing, and we were full of flatulent gas and headaches and our vision was clouded. And nothing passed below [through the bowels], which was the only remedy for indigestion. Therefore I asked the peasants if they also were ever affected this way when they ate boiled wheat. They said that they had often eaten it under the same necessity which we had suffered, and that wheat prepared in this way was a heavy food and difficult to digest." does this passage support or negate the notion that Galen treated all ranks of society

-Galen, Aliment.Fac. 1.7, 6.498-9K, trans. Mattern 2008: 54. SUPPORTS

"There are two instruments for every discovery—experience and reason. Someone who knows what has been discovered but is not able to state the reason for it has clearly made his discovery from experience." what is this a reference to in discussing the acquisition of knowledge?

-Galen, Method of Healing 3.2, 10.164K This is clearly a reference to the debate between Hellenistic medical sects, the Rationalists and the Empiricists.

"You tell me to be at your service all day, Gallus, and traverse your Aventine hill three times or four. Cascelliusextracts or restores an ailing tooth; you, Hyginus, burn off hairs that trouble the eyes; Fannius doesn't cut but removes a dripping uvula; Eros effaces the repulsive brand of slaves; Hermes is said to be the Podalirius of hernias; tell me, Gallus, who is that helps heal the broken?" Who wrote this and what does it argue regarding specialization in surgery

-Martial (a Roman poet, fl. 80-100 CE) Epigrams 10.56 specialist doctors

historical period called Late Antiquity -where? -when? -what was major religious movement?

-Mediterranean basin in relation to northern Europe (what is now Germany, Hungary) and the Middle East (Iraq, Arabian peninsula) 250-600 CE Christianity becomes a major movement, the Roman Empire suffers from internal and external turmoil

Greek E cities they were from -Oribasius -Aetius -Paul

-Oribasius: Antioch -Aetius: Constantinople -Paul: Alexandria

Later in Art of Medicine 23 Galen lists 6 causes that a patient must deal with which change the body:

-air and environment -motion and rest -sleep and wakefulness -food and drink -evacuation and repletion -passions of the mind

Galen's Surgical Techniques compared to Hippocrates: -bandaging -venesection -surgical excision

-some improvement since Hippocrates; more elaborate shapes -more systematic account of when, where, why than Hippocrates -great advance on Hippocratic abilities

Nutton's predictions on Galen's time period of writing

-sometimes he wrote out his material himself -sometimes he dictated to amanuenses -he would often start a book, write half, stop, then pick it up again 10-20 years later and finish it amazingly his medical thought seems to be consistent across time

What acts did Dioscorides of Anazarbus do in the preface that align with Empiricist methodology

-talked to locals -used strong observation of patients -read historical texts from other physicians

Galen's Surgical Techniques: what faced little change since Hippocrates (3)

1 Cauterization 2 Bone-setting (More variety of machines available; mechanics has improved dramatically since Hippocrates) 3 Direct auscultation

Medicine and Christianity: Ancient Greek and Roman medicine was transmitted in two different directions (immediately following Late Antiquity)

1 Medieval Islamic World 2 Medieval European World "Islamic medicine is largely a continuation and further development of the Greek medical tradition." -P & S-S p.24

The Creation of a Canon: In the medical schools at Alexandria in late antiquity 16 works of Galen were taught -7 teachings -what books covered what

1) Principles On Sects, Art of Medicine 2) introductory therapeutics Synopsis of Pulse, Method of Healing for Glaucon 3) anatomy for beginners On Bones, On Muscles, On Nerves, On Veins and Arteries 4) physics and physiology On Elements, On Mixtures, On the Natural Faculties 5) Symptomology On Affected Places 6) pulse treatises 16 books on the pulse fever, critical days theory, therapeutics, dietetics On the Difference Between Fevers, On Crises, On Critical Days, Method of Healing, On the Preservation of Health

European Middle Ages: Ancient Greek and Roman medicine was transmitted to the Latin-speaking European Middle Ages in two waves: -how -who

1) through whatever Latin translations were available in Late Antiquity --Caelius Aurelianus, Medicina Plinii 2) through the translations done by the medical school at Salerno (s. Italy) in the 11th century (not officially a university for 2 more centuries) --Several famous translators: Constantine the African (fl. 1000), Niccolo of Rheggium (fl. 1350)

Who ruled while Scribonius Largus was around

25 BCE-55 CE Caligula (ruled 37-41 CE) Claudius (ruled 41-55 CE)

Celsus' Expected Surgeries -description: war wounds, plastic surgery, Hernias

=> Surgeries WERE NOT

Rudolf Virchow -who is he -defined disease

A famous 19th century pathologist and anthropologist of public health, Rudolf Virchow, defined disease as 'life under changed circumstances' "Treat the patient, not the disease"

Roman army hospitals valetudinarium who for? where? staff?

A new medical institution -only for professional soldiers, not civilians -Part of permanent base of Roman soldiers along frontiers of empire, not close to fighting -staffed with pharmacological supplies and surgical equipment -probably had professional camp doctors (could support 2-20% of troops in a unit)

Was there Surgical Specialization in Antiquity

A very difficult question. Celsus recommends that the same individual be able to perform dietetics, pharmacy, and surgery. An ideal of unity But we hear from other sources of doctors who specialized in different surgeries:

Diagnosing by Semiotics: What are two 1/3's of the Art of Medicine

About a third of the Art of Medicine is taken up with a discussion of the proper mixtures (crasis) of the various principles, organs, and bodily systems The other third of the Art of Medicine is taken up with a discussion of the morbid states of various principles, organs, and bodily systems and what they signify

examples of physiological concept of disease through Galen -in substance -in arrangement -in physiology

According to Galen, morbid states of the body are understood as failing to attain health in some way substance: a body has a bad mixture (dyscrasia), whereby one or two elements predominate at the expense of others arrangement: morbid state in size, complexion, shape, number, position, hardness and softness, heat and cold these affect parts and organs physiology impairment of function e.g. difficult breathing, derangement of mental faculties, impairment of voluntary motion, excretions

which empiricist and rationalist physicians did Galen work with at 16

Aischrion, an Empiricist Stratonicus, a Hippocratic and student of Satyrus Satyrus (student of Quintus, the most famous physician of his generation) Aiphicianus

Hellenized Jews -how did this happen? -who are they? -how does this affect circumcision?

Ancient Jews were ruled by the Greeks and Romans at various points. --Some assimilated to a Hellenic lifestyle; others did not. --The assimilated were called Hellenized Jews. For Hellenized Jews, they wanted to be able to be naked at Greek gymnasia without evidence of their religious orientation --surgical need to reconstruct the penis as if there had been no circumcision

Who overthrew Galen's anatomy in 1543 with De humani corporis fabrica

Andreas Vesalius

Who was the first Greek doctor to Rome

Archagathus Was introduced into Rome in 219 BCE Rome is in the middle of a long war with their chief enemy, Carthage

Roman reactions to Greek medicine: Archagathus disliked why?

Archagathus proved to be unpopular because of his violent cures although brought to Rome at public expense, he soon left

An additional argument: individualism (2 arguments)

Argument (1) Galen draws attention to the differences of substances, individually and together Argument (2) Galen claims that what cure will work for one person will not necessarily work for another --this is a claim about the individualism of patients, set in Rationalist terms as their humoural constitution or natural health

________________, an ancient philosopher influential on Galen, thought that for something to count as science it had to make general claims about knowledge

Aristotle aligns with general claims from Galen

Who was the most famous practitioner of Rome

Asclepiades of Bithynia probably flourished in Rome 120-91 BCE

Asclepius and religious medicine: who was he?

Asclepius was a mortal man famous for his healing, father of Podilarius and Machaon, the doctors of the Iliad He became worshipped as a god represented both as a man with a stick & as a living snake

dissolution of continuity: ________ is known for the nature of the disease itself

CURE disease is understood not to be an invasive substance, but harmed function The harmed function is loss of continuity: union restores continuity

"I shall speak about the Greeks in their own place, Marcus my son, what I have acquired at Athens and how it is good to examine their literature, but not to learn it. I shall prove that they are the most base and unteachable race, and so take this as the word of a seer: whenever that race gives their literature to us it will corrupt everything - the more so if they send their doctors. They have sworn an oath among themselves to kill all barbarians by their medicine, but they do it for profit in order to provide trust and ruin us easily. Us too they call barbarians and befoul us more basely than others by the name Opicoe. I have forbidden you their doctors." Whose opinion is this on Greek doctors? Where is this exerpt from?

Cato on Greek doctors -Pliny NH 29.6 = J. ad filium f. 1 trans. Berrey From Cato's letter to his son, Marcus, written circa 180 BCE

who was the main informant on surgical pain, fistulae, cataracts, and dentistry

Celsus

"[The scoop] is thin at the end, beaten out into a semicircular shape, smooth on the outer side, where it comes into contact with the body, rough on the inner where it touches the stone. The scoop must be rather long, for a short one has not the strength to extract." what surgery is described

Celsus 26.2K lithotomy of stone that is large, operator uses a lithotomy scoop

"[Once the skin in front of the pubes is cut through in a circle], the prepuce slides forward towards the tie, and a sort of small ring is laid bare in front of the pubis, to which lint is applied in order that the flesh may grow and fill it up." "[To raise the prepuce] is not so very painful, for once the margin has been freed, it can be stripped up by hand as far back as the pubis, nor in so doing is there any bleeding." who is this by and what procedure is being described?

Celsus 7.25.1B the two operations of cicumcision

"A hook is inserted to the calculus so that it easily prevents it from returning backward; then an iron instrument of moderate thickness is applied, with its tip thin but blunted"

Celsus De Medicina 7.26.3C: Celsus' operation of bladder calculus

Best sources on ancient surgeries in Roman Empire

Celsus books 7-8 Oribasius Paul of Aegina book 6 **We're going to take Celsus as our main informant for surgery under the Roman Empire.

"But when the hand has reached the dead foetus its position is immediately felt. For it lies head on or feet foremost, or crosswise; generally, however, so that there is either a hand or foot within reach. It is the object now of the surgeon to direct it with his hand either into a head or even into a foot presentation, if it happens to be present otherwise: and if there is no other course, when a hand or foot is grasped, the trunk is straightened." who wrote this? what is it regarding?

Celsus positions of the Fetus

"This operation is not suitable for every season or at any age or for every lesion, but it must be used in the spring alone, in a boy who is not less than nine years of age and not more than fourteen, and if the disease is so bad that it cannot be relieved by medicaments, or endured by the patient without shortly bringing his life to a close." who wrote this? what procedure is being refrenced? what is its purpose? who was the opperation mainly performed on?

Celsus' 7.262A discrimination for patients Lithotomy A confusing statement, since the operation was chiefly performed on adults (mostly men)

excision of dead fetus: celsus views

Celsus' description concerns only how to remove a fetus already dead. He gives no account of how to expel a still-living fetus (abortion). He gives no reason for why the fetus is dead.

"And, if the glans is bare and the man wishes for the look of the thing to have it covered, that can be done; but more easily in a boy than in a man; in one in whom the defect is natural than in one who after the custom of certain races has been circumcised; and in one who has the glans small and the adjacent skin rather ample, while the penis itself is shorter, rather than in one in whom the conditions are contrary." who is this? what surgery is this for?

Celsus' pain management for decircumcision

couching

Celsus' term for cataract surgery, only known surgery before 1750 only successful in 40% The operator sits or stands opposite the patient positioned lower than the operator.• Patient is held down by an assistant. The operator inserts a needle into the patient's eye and forcefully pushes over the lens of the eye.• The lens lays down on its side (French coucher -- hence the English name of the operation) If the lens will not fall over, the operator uses the needle to break up the lens into small fragments.

"Take about a span of very fine thread of raw linen, fold it in five, twist it together, and wrap it around a horsehair. Then make a tin probe with an eye at one end, thread the end of the twisted linen into the probe, and, passing the probe into the fistula, at the same time introduce the index finger of your left hand into the anus. When the probe touches your finger, use the finger to draw it out through the anus by bending aside its end and the thread in it; remove the probe, and tie together the ends of the thread with a double or treble knot; turn back the rest of the thread and tie it against the knot with a bandage. Then let the patient go about his business. Any slackness in the thread that arises as the fistula suppurates should be tightened up daily; again turn back the ends. If you find that the thread dissolves before the fistula is eaten through, attach another thread to the horsehair, pull it through, and fasten it in the same way." - Hippocrates What does this say about Celsus treatment on fistulae

Celsus' treatment is Hippocratic

Greek E Roman W: folk medicine and christianity: As the Christians destroyed or closed the ancient healing temples, ____________ sprang up in their place -prayer -

Christian shrines to saints people prayed to saints for divine intercession to heal, sometime slept in the shrine overnight for a visitation from the saint in a dream --very similar to the experience of patients in a shrine to Asclepius

The Vienna Dioscorides: 2 herbs illustrated example

Climbing Birthwort and Mullein

Pharmacology: Galen's two systematic treatises on drugs and their properties

Compound Drugs by Place & Compound Drugs by Class

Greek E Roman W: Christrianity: Christianity became a social and political force in the Roman world c. 310 CE when ______________, the Roman emperor, adopted Christianity -leadership changes -religion + philosophy

Constantine only one more Roman emperor, Julian the Apostate ( 361-363 CE), was pagan Christianity became official religion of Roman empire over 4th cent Pagan temples, shrines, cults closed 4th and 5th cents Greek philosophy, associated w some pagan religion, suspected in some circles

Galen's Therapeutic Practices: Modes of Treatment: Galen continues therapeutic tripod

Dietetics Pharmacology Surgery Compare development of therapeutics since Hippocratic Corpus Galen's therapeutics are in the same categories as we have seen since the Hippocratic Corpus, but he is the beneficiary of 550 years of progress in knowledge

"There are many kinds of cassia that are grown in spice-bearing Arabia. It has thick-barked twigs, leaves similar to those of pepper. Select that which is pale yellow, fresh, and healthy looking, resembling coral, slender, long, and hard, like shepherd's pipe [a type of plant], bitter in taste, and astringent with much fiery quality, aromatic, like wine in smell. Such is called by the inhabitants of the country by the name of achy, but it is named daphnitis by the merchants in Alexandria. Better than this one is the dark, purple, thick kind called gizir, having a smell like rose, most suitable for medicinal usages and the kind mentioned not often coming before the first-mentioned kind. The third kind is called mosulitis gatos. The other kinds are of inferior quality, such as that which is called asuphe, black with thin bark, and burst bark, also those kinds called kitto and darka." Who wrote this and what is it?

Dioscorides on cassia: description --Dioscorides On Materia Medica Riddle

"It has a diuretic, warming, drying, gently astringent quality. It is suitable for improving sight and as an emollient; with honey it removes moles; it brings out the menses and drunk it helps those with spider bites and also being drunk it is good for internal inflammations and inflammations of the kidneys and for women either as a sitz bath or as a fumigant it dilates the orifice of the uterus. If cinnamon should be lacking then double the amount [of cassia]; it will do the same [as cinnamon]. It is very useful for so many things."

Dioscorides on cassia: uses --Dioscorides On Materia Medica 1.13 trans. Riddle

Limited analgesics in ancient world (2)

Dioscorides on opium --nearly a soporific (induces sleep) Electric rays; a few other drugs

Galen's Experiment: Galen constructed an experiment/ demonstration, to show (2) Galen also performed falsification experiments especially to oppose _________________ views

Erasistratus'

Anatomical Procedures: T or F, Galen says (p.105-6, p.5-6 of the pdf) that ligating one of the recurrent laryngeal nerves (= sixth vagus nerve) produces the same effect of voicelessness as ligating the two nerves.

FALSE

Galen's Advice to an Epileptic Child: T or F, For epilepsy, Galen believes in an ontological instead of a physiological account of the disease

FALSE

T or F, In Art of Medicine 7 Galen claims that red hair is a sign of the brain being too hot.

FALSE

T or F, the different poppy seeds grew in differing locations

FALSE

T or F, surgery for cataracts is mentioned in the Hippocratic Corpus

FALSE Surgery for cataracts is unknown to the Hippocratic Corpus. --Our first Greco-Roman evidence appears c.250 BCE. But surgery for cataracts is attested in the writings of the doctors of ancient India. --Since the Greeks on the campaigns of Alexander the Great (c.330 BCE) met and fought Indians, it is possible that Greek doctors borrowed the operation from Indian doctors. This is a modern scholarly view. Ancient doctors give no evidence where this operation derived.

T or F, the romans didn't have medicine before Greek medicine

FALSE The Romans had a medicine before Greek =medicine arrived. Cato the Elder, a Roman politician, 230s-149 BCE

T or F, Dioscorides of Anazarbus believed poppy seeds couldn't be adulterated

FALSE they were

T or F, Cato the Elder liked Greek doctors

FALSE thought they were trying to kill all Romans --a misunderstanding of the Hippocratic oath?

T or F, Roman medicine continued on as before, in large cities, connected to philosophy, taught more systematically

FALSE the Latin-speaking Western Roman empire was changing as Germanic peoples moved into Romanized areas -collapse of urban centers -collapse of Roman military power -Roman army hospitals collapse of Roman rule

T or F, Asclepiades himself was a Methodist

FALSE, Asclepiades himself is usually called a 'Rationalist' type physician his 'Rationalist' pupils were called Asclepiadians

quiz 16 T or F, Galen compares doctors to musicians

False

Galen away from home -why unknown -what was happening in Rome at the time?

From 166-68 CE Galen left Rome and returned to the East In his autobiography Galen claims that his reputation grew to such an extant he was afraid that the emperor would call upon him to be imperial physician and make him remain in Rome But in 166 a plague hit Rome

Dioscorides of Anazarbus where from? when? who is he?

From Anazarbus (small village near Tarsus in Turkey) flourished 40-80 CE Was either a civilian doctor or soldier in the Roman army

Greek E Roman W: Therefore let us pay attention and let us see [him as] the healer. For if, in the case of doctors, whenever they cut or cauterize or incise or cut through a patient maimed in some way and weakened, many people stand around the patient and the doctor doing these things. So much more must we do these things here, when the doctor is better, the disease is more difficult, and the patient made right not by human skill by divine grace. There we see the skin being cut, the humor flowing, the tumor moving; we remain while a great disgust arises from the sight, as well as great pain and distress, not only from the sight of the wounds but also the suffering of those who are cauterized and cut. No one is so hard that, when he stands next to those suffering these things and hearing their wailings, he does not weep, pity them, and take great disturbance in his soul. But nonetheless we remain because of our desire to see all these things. In our case nothing of such thing is it possible to see, not the fire being applied, not the cautery iron being dipped in water, not the blood flowing, not the patient in pain or howling. The reason: the wisdom of the doctor needs nothing of those external matters but is self-sufficient. It is enough for him to order; terrible things cease. What is amazing is not only he makes his cure not only with ease but also with painlessness, adding no toil to his patients. Since therefore the wonder is greater, the cure more, the pleasure to the spectators pure from every disturbance, come let us observe with precision Christ the healer this quote is the Metaphor of Medicine, Good/Bad to Think -from who?

GOOD to Think John Chrysostom (c.350-407 CE), Archbishop of Constantinople, Holimy Preached on the Paralytic Let Down Through the Roof

Who can these 6 works be attributed to 1) On the Usefulness of the Parts (800 pages) 2) Method of Healing (1000 pages) 3) On the Doctrines of Hippocrates and Plato (500 pages) 4) Anatomical Procedures (1200 pages) 5) Compound Drugs by Place & Compound Drugs by Class (1700 pages) 6) Natural Faculties (300 pages)

Galen

most of what we know about ancient medicine (apart from Hippocrates) comes from _________

Galen Galen's writings encompass some 22000 pages of material

Oribasius, Aetius, and Paul's works quote, organize, and summarize _________'s and each other's summaries

Galen Oribasius quotes Galen and Hellenistic authors Aetius quotes and summarizes Galen and Oribasius Paul summarizes Oribasius and Aetius

Who used the writing method of Whiggism (dangerous type of history-writing)

Galen history's winners are the prophets of current scientific thought

anatomical performance: "And now, when you ligature each one of the two nerves by itself, then you will see what it is that the animal experiences as a result. What happens is that when the thread has been tightened round one of these two nerves, the animal retains only one-half of its normal voice. And when both of these nerves are tightly constricted with the thread, the result is that the animal remains without any voice whatsoever, except that it then has a kind of respiration which resembles hoarseness of the voice." -what text is this from? -Galen performs the ligatation, so that the function of the ________ is shown, not the _________ themselves.

Galen Anatomical Procedures 11.11 nerves

"What proceeds from the very nature of the best-constituted bodies is the balance of the homogenous parts in respect of heat, cold, dryness, and moisture; and the balance of the organic parts in respect of quantity and magnitude of their component elements, and also in construction and position of each of its parts and of the organ of the whole. What proceeds from the attributes which are necessary consequences of these homogenous parts is as follows: with respect to the sense of touch, a balance between hardness and softness; with respect to sense of sight, a good color and balance between smoothness and roughness; in the context of activities, the perfect performance of them, which is also called 'excellence'. What proceeds from the necessary consequences of these organic parts consists in the proportion and beauty of the organs of the body as a whole, and also in the excellence of their activities. Such are the diagnostic signs of the best constitution of the body." -who wrote this -what belief does it tell us more about

Galen Art of Medicine describes Galens Views of Health

"I promised a demonstration of the minutest nerves, and to show how there is a hairlike pair implanted in the muscles of the larynx, on both right and left, which if ligated or cut render the animal speechless without damaging its life or its functional activity." In the spring of 163 CE in Rome, ___________ gave several public demonstrations of his __________ knowledge and skill

Galen On Prognosis 5.14 Galen; anatomical public anatomical dissections!!

"A high priest followed this method of choosing physicians when I returned to our city from places which I had set out to visit. Although, at that time, I had not yet completed thirty years of my age he entrusted me with the treatment of all the wounded men among those who had fought duels in combats ... I performed many anatomical demonstrations before the spectators: I made an incision in the abdomen of an ape and exposed its intestines: then I called upon the physicians who were present to replace them back into position and to make the necessary abdominal sutures -- but none of them dared do this. We ourselves then treated the ape displaying our skill, manual training, and dexterity. Furthermore, we deliberately severed many large veins, thus allowing the blood to run freely, and called upon the Elders of the physicians to provide treatment, but they had nothing to offer. We then offered treatment, making it clear to the intellectuals who were present that physicians who possessed skills like mine should be in charge of the wounded. That man was delighted when he put me in charge of the wounded -- and he was the first me to entrust me with their care." who and what is this on

Galen On Recognizing the Best Physician 9.4-7. Galen and the Gladiators in Pergamum

Scientific Voyages in the East: Galen -how many voyages -where did he go

Galen made two voyages in search of scientific specimens and pharmacological compounds Galen sailed to various Greek islands in the Aegean to procure certain special earths Galen traveled to Syria and Palestine in search of other mineral compounds

"Once a cow cheese had been brought to me, which I guessed from the odor to be rancid, I threw it away; and then thought it had been disposed of by the servants, but they are accustomed to save such things; they brought it from the storeroom a long time afterwards, and asked what I wanted done with it." Who wrote this? What does this support about who Galen worked with?

Galen once he says he was chatting with his slaves about rotten cheese. They were probably a mixture of household slaves and slaves who assisted in his medical work. We never directly hear of a single student, although Galen often dedicates his works to people who, he claims, seem him engaged in some medical work.

Case of Philiscus: ontological or physiological "The fault, dear Brutus, lies not our stars but in ourselves"

Galen understands disease to be physiological. His method of healing is therefore aimed at restoring to what degree the body has fallen away from its proper activity.

Galens first job (27/28)

Galen was physician to a school of gladiators in Pergamum from 157-161 CE. --Officials sponsored gladiatorial shows as part of the business of holding public office and gathering political support --Doctors were engaged to keep the gladiators (slaves) alive after the competitions Galen lost only 2 gladiators to injury, compared to his predecessor's 16 dead

"Although I was then in to sleep at the Palace, it was just when the lamps had been lit that an emissary from the emperor came to summon me. Three doctors had already examined him at dawn and at the eighth hour; they had taken his pulse; and they agreed that this was apparently the opening of an attack of an illness. When I stood by in silence, the emperor looked at me and asked why, when the others had taken his pulse, I alone had not done so. I replied that since they had already done so twice and the peculiarities of the pulse were probably known to them through their experiences on their travels abroad with him, I expected that they could obtain a better diagnosis of his present condition than I. On hearing this, he commanded me to take his pulse. It seemed to me that his pulse, compared with the general norm for each age and constitution, was far from showing the onset of an attack of illness, and so I said that there was no attack of fever, but his stomach was overloaded with the food he had taken, which had turned to phlegm before excretion, and that this was now quite clear. After praising my diagnosis three times in these word: 'That's it, what you have said is just it: I feel that some rather cold food is upsetting me,' he asked what was to be done. I told him that what I knew and said that, had it been anybody else in that condition, I should have prescribed my usual dose of wine with pepper on top: but in the case of kings like him, when doctors should employ the safest remedies, it was enough to place over the mouth of the stomach a pad of wool impregnated with warm nard ointment. He replied that in any case, when he had a stomach complaint, he used to apply warm nard ointment smeared on scarlet wool, and he ordered Peitholaus to do that and then dismiss me. After the ointment had been applied and his feet warmed by the warm hands of the masseurs, he called for Sabine wine, sprinkled pepper on it, and drank it." of whom is Galen treating? What is this from?

Galen's Treatment of Marcus Aurelius --Galen, On Prognosis 11.2-8, 14.658-660K, trans. Nutton

_______ came to be known as the 6 non-naturals (the 'neither' category in the Art of Medicine) and were an extremely influential division of prescriptive medicine in the European and Islamic Middle Ages

Galen's list of 6 causes that a patient must deal with which change the body we have thousands of prescriptions by medieval physicians to their patients dividing their dietetic advice into these areas

Galen's Therapeutic Practices: Places and People what is mentioned in this section

Galen's surgery, house calls, and his patients

Overall, what of Galen's medical thought led to Galenic medicine becoming medicine for 1600 years

Galen's systematic nature of medical thought

"When there was discussion about those who had made a display of medicine and philosophy not only in words but also in deeds, not a few of the emperors' circle named me as being such a person." -who said this -what does this suggest -what text his this from

Galen-- On Prognosis 9.5 trans. Berrey It suggests that Galen's philosophical interests were as important as his medical interests and that the public anatomical displays he had performed during his first stay in Rome brought him intellectual respectability

_________ pathology and therapeutics endured until the 19th century in European medicine

Galenic

medical history goes dark for 150 years 216-360 CE when written medicine reappears in 4th century that is _______ medicine 3 large causes of shifts

Galenic This is the way that Galen's writings were understood as a medical philosophical system, called Galenism 1) the institutionalization of Galenic doctrine 2) the changing Roman Empire 3) the role of Christianity

"Learned doctors and other intellectuals were now agreed that the human body, organised anatomically and physiologically into three almost separate systems based on the brain, heart, and liver, depended for its health ultimately on a balance between its four constituent humours, blood, bile, black bile and phlegm. This balance varied according to the individual's age and diet (in the broadest sense of the term), the season of the year and environment, and determined not only physical but also mental well-being. It was a system standing firmly on the twin pillars of observation and logic, and gained added authority from the longevity of the theories on which it was based and from the ease with which it could be co-ordinated with other systems of thought such as Aristotelianism, Platonism and monotheism. It was not entirely immune to change, although its rhetoric of certainty did not allow for radical developments or more than a circumscribed area of disagreement. Such a theory, backed up by centuries of observations and apparently effective therapies, had deservedly triumphed." this represents what type of medical thinking -Hellenistic _Hippocratic _Galenism

Galensim in 650 CE

European Middle Ages: Medical schools began to flourish in conjunction with hospitals (1200-1349) -standardization of medicine -instruction by who? -importance of structure

Greek and Latin medicine became standardized, with formal instruction of Galen and his Byzantine and Arabic commentators --would-be physicians were instructed on the Articella, a compendium of primarily introductory Galenic medical texts the importance of institutional social structures to credential physicians and provide continuity of medical doctrine --we see the formal association of two emerging institutional structures (hospitals and universities) for mutual social authority

What does Nutton articulate to be on of the most tremendous social changes in Greek medicine and why?

Greek medicine becoming common in Rome Greek was translated into Latin (lang of W till 19th century) Greek medicine is the standard intellectual medicine of the Mediterranean basin, of Romanized areas (France, Germany, Britain, Spain)

Asclepiades' Theories: cause of disease

He believed that disease was not caused by humors, but by certain mechanical problems

Celsian Surgery: practical accounts focus? what did he leave out? old/new?

He is focused on therapeutic intervention. He almost never gives an account in his description of how a patient came to suffer some disease. Celsus' surgeries are sometimes new, sometimes old. Sometimes he mentions new instruments devised for old surgeries.

Galen, the Bookish Doctor -libraries -what thought was he interested in? -what did he write?

He searched out rare books and copied them down; he spent time in the libraries at Rome and other cities He was interested in earlier Greek medical thought and earlier Greek philosophy He wrote a dictionary, he also wrote works on ancient literature such as comedy

Galen's Exceptionalism (4)

He spent 13-15 in schooling in both philosophy and medicine (an exceptionally long period of time) he trained with every major medical sect (Hippocratics, Rationalists, Empiricists, Methodists) he studied with every major philosophical sect except the Cynics (Platonists, Aristotelians, Stoics, Epicureans) he was the imperial physician to numerous Roman emperors (Marcus Aurelius, Commodus, Septimius Severus, Caracalla)

Asclepiades of Bithynia start

He started life as a public speaker, then switched to medicine His practice was very successful he had many prominent patients among Roman aristocrats

What was Galens main job till he died?

He was in charge of following the imperial party from palace to palace, keeping the pharmacological stores of the palace, and generally making sure the imperial family was healthy He lived the life of an aristocrat and scholar he visited the many libraries in Rome and wrote voluminously during this time he dissected the emperor's elephant after it died

Galen personal info: -autobiography -time of life -citizenship -family

He wrote an autobiography, called On Prognosis, which tells of his career up to 177/9 CE. 129 in Pergamum - c.216 CE in Rome Was a Greek who lived life under the height of the Roman empire; almost certainly possessed Roman citizenship --there's a mixture of Greek culture and Roman power in his writings His father was Nicon, an architect --His father taught Galen geometry, arithmetic, architecture, logistics, astronomy, and grammar.

Alexander the Great's conquests and Greek medicine's spread in the _________________ kingdoms have already ensured that Greek medicine is the medicine of Syria, Babylonia, Persia, and is introduced to India

Hellenistic kingdoms

describe pharmacology of -Hellenistic physicians -Dioscorides' -Galen

Hellenistic physicians invented compounded pharmaceuticals, beyond simple substances Dioscorides' work enlarged and systematized the material of Hellenistic pharmacology Galen himself made several scientific voyages in search of rare and unique ingredients

_______________ is the most important model for how medicine works for Galen

Hippocrates -Galen finds in the Hippocratic Corpus theories which align with Galen's own views -He attributes those treatises to the authentic Hippocrates -But this method is circular interpretation

Mod 7 6 physicians in the Western tradition who worked prior to the 18th century that everyone should know

Hippocrates (fl. 5-4th centuries BCE) Galen (fl. 2nd century CE) Rhazes, also called al-Razi (fl. 9-10th century CE) Andreas Vesalius (fl. 16th century CE) Ambroise Paré (fl. 16th century CE) William Harvey (fl. 17th century CE)

Pharmacology: The ___________________________ had little systematic exposition of plants and minerals, with no discussion of their properties _____________, by contrast, wrote two enormous systematic treatises on drugs and their properties

Hippocratic Corpus; Galen Galen's pharmaceutical knowledge is a great advance on the Hippocratic Corpus

Typical aspects of Galens life -movement

His movements from the Greek east in his youth to Rome as an adult and medical practitioner are typical of the movement of Greek intellectuals (including doctors) to the center of Roman power

Galens historical influence: -what image do his writings construct? -Who did he look to as example? -Nature of Man influence

His writings construct an image of past medicine and position himself as the culmination of past tradition Hippocrates as the exemplar of medicine, rather than Herophilus Erasistratus We read certain books in the Hippocratic Corpus largely because Galen thought they were important the canonical image of Hippocrates' invention of the four humors is due to Galen's reading of Nature of Man

problems for ontological disease

Is disease a perennial, lasting thing (because it is a substance): how does one individual agent (the attacking substance) provide such a wide variety of responses in different individuals, such that their symptoms can be quite different? Shouldn't there be as many different substances capable of causing disease as symptoms? Shouldn't there be as many diseases as substances which contribute to the body (as in genetics, for example)?

Where there illustrations in Dioscrides?

It is possible that the original manuscript was illustrated --Pliny the Elder tells us that earlier herbals were illustrated There are several illustrated manuscripts --Most famous is the manuscript in Vienna --they do not all show the same level of skill --It is still unknown which illustrations might represent the original copies

Rome the magnet city: in 49 BCE _________________ granted Roman citizenship (legal rights in the areas under Roman control) to any doctor working in Rome

Julius Caesar

The physician's tactile skill in ancient Rome handling his instruments and making incisions is certainly greater than / less than the Hippocratic surgeon's.

LESS THAN An eminent historian of medicine has suggested that therapeutic efficiency and success of ancient Roman surgery was not surpassed until the 18th century. The technical details are impressive. He is concerned to minimize pain or to restrict the operation to suitable patients.

LIKE Herophilus and Erasistratus, he (2) UNLIKE Herophilus and Erasistratus, he (1)

LIKE: uses comparative animal anatomy AND breaks open the body UNLIKE: relies on vivisection to show physiological function

What two languages helped spread ancient Greek medicine>

Latin and Greek

Mechanical theories and philosophical affiliation: Erasistratus and Atonomism

Like Erasistratus, Asclepiades believed in a mechanical universe There was a philosophical school, the Epicureans, who believe in an atomistic vision of the universe (small particles moving through space) & who deny the purposiveness of the universe

In 168 the two Roman emperors serving at the time (____________ and _______________) summoned Galen to attend them at an army camp in northern Italy -what happened?

Lucius Verus; Marcus Aurelius -Lucius died, everyone returned to Rome -Marcus Aurelius went off to fight along the Danube -Galen was left in Rome in charge of the imperial heir, Commodus

Marian operation vs Supra-pubic operation vs Lateral perineal operation

Marian: used in regular practice from c. 1710 also called high operation Supra-pubic: used in regular practice from c. 1710, also called high operation Lateral perineal: first practiced by Jacques Beaulieu, Frère Jacques (1651-1720) improved by William Cheselden (1688-1752), a leading lithotomist

Importance of Casualty: Galen -medicine being a semiotic art -signs and significance

Medicine is primarily a semiotic art, signs are important types of signs: diagnostic, prognostic, mnemonic preservative, therapeutic, and prophylactic what they signify: current, future, and past disease

Which is Galen's major therapeutic treatise? -what did it consist of? -two main issues?

Method of Healing Combination of general treatise on medicine with treatise on surgery Two main issues: 1) Disease 2) Acquisition of knowledge --what method --how is it possible

Galen goes on in _____________________ to say that any doctor could claim to have understood the need for a sarcotic or enfleshing medication -- that is, a medication which would make the flesh grow to repair the superficial wound. A ____________ or ___________ doctor would claim that it is known on the basis of experience.

Method of Healing Methodist; Empiricist

Some of Asclepiades of Bithynia students will eventually become the empiricists/rationalists/methodist medical sect

Methodist medical sect

Galen Disease and Cure: We must have an explanation for why this is so; that is, a doctor needs a theoretical account of why cures work and a theoretical account of the discovery of medications. both of these arguments are directed against ________________ and ______________

Methodists and Empiricists We need to account for why it works and why it does not work so that, if does not work, we can pass on to an effective therapy the haphazard and random cures of the Methodists and Empiricists cannot change their therapies effectively if they fail

Greek E Roman W: Health + Sickness: deafness, muteness, blindness, leprosy, fever, dysentery, uterine hemorrhage, lameness, paralysis, dropsy, a withered hand, a severed ear, open wound, a condition of being eaten by worms, pestilence (Anderson and Ferngren 1995: 2949) these medical conditions are in the what

NT: written in Koine Greek, the common language of the eastern Roman empire, and health and sickness are described in the normal Greek language of the eastern Mediterranean world

Hunayn Ibn Ishaq -beliefs? -role in medicine -most important role in Greek medicine

Nestorian Christian working for Islamic caliphs started to learn medicine in Baghdad, traveled to Alexandria to study Greek, return to Iraq Most important translator of Greek medical texts into Arabic translated in stages, from Greek to Syriac, then Syriac to Arabic --used multiple manuscripts, translated for sense of passages the materials he translated were primarily those available in Alexandria in late Antiquity

"Thus Galen the scholar-physician creates a picture of an unerring Hippocrates that, in turn, justifies and inspires Galen. The self-identification of hero-worshipper with hero is almost complete." Whom wrote this

Nutton

ontological or physiological concept of disease? -attributed usually to an external agent, which has broken into the body -attack of demons; attack of plague

ONTOLOGICAL

What written work was done by Dioscorides of Anazarbus

On Materia Medica 700 plants used in 2000 recipes was tremendously influential organized by drug affinities rather than alphabetically

Which writing of Galen offers most extensive work on dietetics?

On Preservation of Health also Advice to an Epileptic Boy but is more concise

Roman Army forceps

Open (upper) Closed (lower)

Late Antique Medical Authors (3)

Oribasius of Pergamum fl. 360 Aetius of Amida fl. 530 Paul of Aegina fl. 7th century

ontological or physiological concept of disease? -disease is a process, an activity of living proceeding over time -disease is a misperforming of the best state of the body, whether it is because of substance, arrangement, or physiology (Galen)

PHYSIOLOGICAL

ontological or physiological concept of disease? A(n) ________________ notion of disease is based on a case history of the patient, her regular biological rhythms, and natural ways of being

PHYSIOLOGICAL the temporal aspect of the process of disease is emphasized

Who did Galen work with in Smyrna

Pelops, a Hippocratic and a student of Numisianus (possibly a student of Quintus) Albinus, a Platonist philosopher

Greek E Roman W: Salvation and Physical Health: "Rulers and elders of the people! If we are being called to account today for an act of kindness shown to a cripple and are asked how he was healed, then know this ... It is by the name of Jesus ... that this man stands before you completely healed. [Jesus] is 'the stone you builders rejected, which has become the capstone.' Salvation is found in no one else, for there is no other name under heaven given to men by which we must be saved." -Acts 4.8-12 -who are the two in which this conversation is based -whom are they explaining to -what are they explaining

Peter and John explain to the Sanhedrin how they healed a crippled beggar

change in Roman W: the collapse -Medicina Plinii -Pliny the Elder -Caelius Aurelianus -passing on -translation

Philosophical medicine - urbanized, associated with the upper classes - collapsed too Medicina Plinii - tradition: the circulation of extracted medical bits, especially pharmaceuticals, from the Latin encyclopediast Pliny the Elder • some poetry, some Christian authors, some botanical writers • one of the main traditions of ancient med passed on to the Latin-speaking medieval European medicine (600-1000 CE) - 400 CE Caelius Aurelianus, translator of Greek doctor Soranus, wrote books on diseases + fevers in N. Africa, stable Latin-speaking province - Some Greek medicine translated into Latin in the 5th / 6th cent, but knowledge of Greek lost in the W for cent's after

postsurgical care of Lithotomy

Postsurgical care includes warmth to the region, applying astringents (vinegar), sewing up the wound and laying pharmaceuticals over it. The patient is observed until he urinates without problems.

We have seen that Galen along with _______________ doctors understand medicine to be a series of claims about knowledge

Rationalist knowledge of anatomy and physiology is achieved through dissection on specific, individual bodies but the knowledge claim is universal of all human bodies

It seems clear that anatomy, physiology, and causality (important _____________ knowledge claims) count as _____________ claims about all human bodies, all human physiologies, all types of causal signs and accounts

Rationalist; universal

Drawing lines between his theoretical claims and his practical ones Galen follows _________________ practice

Rationalists

Methodism was a Roman/Hellenistic phenomenon Rationalism and Empiricism are Roman/Hellenistic phenomena

Roman Hellenistic

Archagathus: shop at public expense

Roman senate, just like with Asclepius, acts on behalf of the state Rome is acting like a Greek Hellenistic city that hires a public physician --these particular leaders of the Roman government, the consuls, were well-known patrons of Greek culture --the cross-roads where the shop was set-up was prominent for Greek cultural attractions

Rome the magnet city: As _____________ power grows and the Hellenistic kingdoms of the east weaken (the political story of the Mediterranean world from 200-31 BCE), _____________ increasingly attracts ___________ doctors

Roman; Rome; Greek It became fashionable for Roman aristocrats to employ a Greek doctor in their household Roman aristocrats spoke Greek and there was a large Greek-speaking community in Rome, including philosophers and other intellectuals

Galen ended up staying where for the rest of his life

Rome, died between 81 and 87

Galen's Writings (amounts)

Roughly 2 million words; roughly 150 different books 10% of all surviving Greek literature before the year 300 CE is Galen's writing This probably represents 1/3 of what he entirely wrote 2/3 of Galen's writings has been lost but occasionally a previously-lost text is discovered: the most recent discovery was in 2005 we have knowledge of 441 different titles

Greek E Roman W: "Sickness and healing are never approached in the Bible from the medical or scientific point of view, but always from the religious point of view, that is to say, from the viewpoint of the particular relationship which they create or make apparent between the sick person and God. It is not the nature of the sickness, its development or its treatment, which receives attention, but the fact itself envisaged as an event significant of man's destiny or condition within the general perspective of the history of salvation." -where is this from -this argues NT disease is __________

Roux, quoted in Anderson and Ferngren 1995: 2945 theological

book: Compounded Drugs -author? -content?

Scribonius Largus long introduction about the duties of the doctor (the ideal of the Hippocratic Oath) 271 recipes arranged by their application to body-part --head to heel arrangement --no theoretical constructs; more of a practical manual

ancient tradition and Roman authors (2 main)

Scribonius Largus Dioscorides

"For Treatment of Angina: And the following has proven beneficial for many patients, and is certainly quite powerful and quite effective: 2 drachmas each of costus, celery seeds, anise seeds, oil of camel grass, and cinnamon-cassia, one-half drachma of cardamom, 2 drachmas of the wild rue (two-thirds of which is the seed), one-half ounce of fissile alum, 5 medium-sized ground-up oak galls, 2 drachmas of saffron, one-half drachma of the refined residue of the oil of saffron, one-half drachma of myrrh, 4 drachmas of Cretan birthwort, 3 drachmas of cinnamon, one ounce of the ashes of a young wild swallow, and one-half drachma of spikenard. All these ingredients are to be conjoined and either pounded or otherwise produced separately each having been skimmed in Attic honey. And whenever the compound is to be used, a sufficient amount of the same honey should be added to it. The Augusta always has this compound at hand." Who wrote this and where is it from?

Scribonius Largus' medication for tonsillitis Scribonius Largus, Compounded Drugs 70 trans. Scarborough

"These type of knots come about from a material which does not rot easily. Such stuff in Rome comes from those things called Gajetanic, which is carried from the lands of the Celts, and is sold especially along the sacred road which leads to the marketplace from the temple of Roma. It is easiest to acquire these things in Rome. They sell them most cheaply. But if you practice medicine in a different city, let be prepared for you one of the threads called serica [=silk]. Rich women in most places of the Roman empire have these threads and especially in the large cities, in which there are many of these women. If this is not available, select an imperishable material from those in the region where you happen to be, such as material made of thin cords." Who wrote this and what new item from trade with India is discussed

Silk surgical thread -Galen, Method of Healing

Galen death of his father -how old was Galen -what did Galen do following his death for 8-9 years? where did he go (3) ?

Smyrna, Corinth, and Alexandria

Greek E Roman W: Christianty and Medicine: describe the different attitudes toward Greek med in Christianity

Some emphasized divine power above human knowledge and were hostile to philosophical medicine Others tried to reconcile theological and Greek medical knowledge and were positive toward philosophical medicine

Was pain management a principle of ancient surgeries? -Hippocratic corpus -Deontological treatises

Sometimes the Hippocratic Corpus talks as if pain management is a principle, other times not Deontological treatises advise 'gentleness' in treatment

treatment for cataracts

Surgery was the removal of the blockage, the gray matter in front of the faculty of vision

Anatomical Procedures: T or F, Galen establishes (p.86-7, p.4 of the pdf) that, contrary to his expectations, even animals with long necks that have a larynx have a recurrent nerve from the brain down to the thorax then back to the larynx that controls the voice.

TRUE

Galen's Advice to an Epileptic Child: T or F, Advice to an Epileptic Child is an example of how Galen's therapeutics privileged of the values of the urban Greek-style male.

TRUE

On Prognosis: T or F, Galen showed that damage to certain nerves results in loss of voice.

TRUE

Quiz 20 Galen's Advice to an Epileptic Child: T or F, Galen says that, while massage is good, the head is the seat of the disease.

TRUE

T or F, At 16 Galen began to study medicine (Asclepius commanded his father in a dream) with both Empiricist and Rationalist physicians

TRUE

T or F, In Art of Medicine 10 Galen says that people with cold hearts have smaller pulses, lack courage, and have smooth chests.

TRUE

T or F, It seems that therapeutics can never be as general a knowledge claim as anatomy and physiology and, consequently, medicine cannot achieve exact precision

TRUE

quiz 17 T or F, According to the Art of Medicine healthy, morbid, and neither come in three categories: body, cause, and sign. Group of answer choices

TRUE

T or F, Ancient physicians were reluctant to pull teeth.

TRUE A tooth broken in extraction could easily become infected and kill the patient.

T or F, ancient doctors worked with patients who expected to experience pain in surgery.

TRUE Discovery of general anesthesia (1846) is recent: patients' expectations for surgical pain diminished; they did not fear surgery because of its pain.

T or F, Galen treated people in their homes and study. Most likely had a class aspect to it.

TRUE Patients who were wealthy enough had Galen come to them, whereas patients without much resources or slaves may have stayed with Galen for several days of treatment.

Individualism from Method of Healing: T or F, Galen recognizes the intellectual problem, but draws a line between his theoretical concepts and their practical implementation

TRUE The problem of individual therapeutics is a pedagogical one, not a theoretical one

T or F, Asclepiades denied the Hippocratic doctrine of critical days

TRUE denied because there was no day more or less favorable to the patient due to the blockage of pore

T or F, There are instruments found in archaeological excavations which indicate surgeons all over the Roman world tried to prevent hemorrhaging in surgeries.

TRUE vein clamps Forceps

T or F, Greek-speaking medicine continued on as before, in large cities, connected to philosophy, taught more systematically at Alexandria

TRUE The social and political stability of the eastern empire protected the structure of philosophical medicine continuity of intellectual heritage exists in the Greek east and those sections of the Roman empire which belong to the Byzantine Empire.

T or F, it is NOT possible to do retrospective diagnoses for medical conditions of the NT

TRUE it is not even possible to understand NT disease from the perspective of Greek medicine

Greek E Roman W: T or F, Christian authorities did not interfere with Greek physicians

TRUE unless they were violating religious tenets paganism was suspect and medicine was not seen as attached to paganism

T or F, His pharmacology and surgery is of the same rank as Dioscorides' and Celsus'

TRUE!

cataracts: term history

The English term 'cataract' derives from the ancient Latin and Greek words. kataraktes in GK (= cataract) is one of the water-falls of the Nile river, where the water passes so violently over a series of rocks so that further navigation is impossible Ancient doctors believed that there was a 'fall of water' in front of the faculty of vision that blocked the patient's vision --Celsus calls this 'suffusio' = Lat. "waterfall"

Who did and did not circumcise themselves in ancient times

The Greeks and Romans did not circumcise themselves but certain other ancient peoples (principally Jews) did.

"Nicon made his discourse, / For the good to the technitae / experienced always, for the sake of memory. / Generally divine, of sweet nature together / always is the cone, the sphere, the cylinder. / If the cylinder should enclose both / in its touch in sweet tangency the diameter of the sphere in its opening / will be equal / to all circular diameters, but / separately in heights. / The proportion, a conflict in the solid / is a progression '1, 2, 3': / some divine equivalency, / but also sympathy / of the solid, always the proportion '1, 2 ,3' / beautiful and amazing would be solid / three forms: / eternal [equalization] makes an equal ratio / both to solids and whole planes / the cube, and if the cylinder overlap, / but separate also the divine sphere, / guide to all [shapes]: the cube 42 / the cylinder 33, the sphere 22 / uniquely, such would be their proportion / divine, both in the solid and in / the entire plane. / I wonder at no sweeter kind / of thing in life / as with a progression of the universe / indescribable, always moving / and eternally will mount the sweet / contrary movement of the sun / and together good light of all / solid in nourishment for all animals / and plants. / Geometry will rule the muses." What is this

The Poem of galen's Father (Nicon)

Nutton's Analysis: intro of god, public or private?

The introduction of the god is a public act, not a private one Induced by the priests from sacred books

Nutton's Analysis: island site of the Asclepius temple

The island site of the Asclepius temple indicates a Greek-Roman mixture neither inside nor outside the city site shared between Asclepius (Greek healing god) and Juppiter (chief Roman divinity)

risks of Excision of Dead Fetus

The operation is risky. Sepsis will set in quickly; the dead fetus must be removed for the woman's health.

teleology

The philosophical belief that body parts have a purpose there is a goal-directedness to parts and their activities

vitalism

The philosophical belief that organs and body parts act dynamically on their own (as if the organs were independent organisms)

Nutton's Analysis: story between which countries?

The story is between Rome and Greece there were native Italian healing gods already but we don't hear about them the story only concerns the city of Rome and its plague

Analysis of Cato's cabbage: folk or philosophical medicine?

The use of medicinal plants (such as cabbage) for a variety of internal problems seems like folk medicine. There is no mention of any surgical techniques (bone-setting, venesection, cautery, etc.) Internal organs mentioned (heart, liver, lungs, diaphragm, spleen) are known from slaughter of animals. Compare the liver of Piacenza.

What does Galens work: Method of Healing discuss

Therapeutics

"The disease descended further into the bowels, inducing a violent ulceration there accompanied by severe diarrhea, this brought on a weakness which was generally fatal. For the disorder first settled in the head, ran its course from thence through the whole of the body, and even where it did not prove mortal, it still left its marks on the extremities; for it settled in the privy parts, the fingers and the toes, and many escaped with the loss of these." -where is this from? -does it support the ontological or physiological concept of disease?

Thucydides 2.49.6-8 Ontological

two questions of precision:

To what degree can medicine achieve precision? Is medicine a science or an art? Ancient doctors and philosophers had extensive debates about these questions: -these words and their definitions changed over time, so the linguistic discussion is better transferred to a language class -we can still come to understand the main issues by approaching Galen's thought through the debate of epistemological issues of the Hellenistic medical sects

T or F, The failure of contemporary physicians to attain Galen's goal results from intellectual laziness rather than lack of ability. Correct!

True

Asclepius to Rome

Upon instruction from the oracular books, the Roman senate (the elected body of aristocrats) invited the god Asclepius to Rome to end a plague in 293 BCE; Roman aristocrats convey the god's sacred snake from Epidaurus in Greece (the most famous sanctuary of Asclepius) to Rome The snake takes up refuge on an island in the middle of the Tiber river in Rome; the temple and sanctuary of Asclepius is built there

A Dioscorides manuscript in Naples: herbs illustrated

Varieties of Hellebore

Who made the infamous chart on the arteries, "Tabulae Anatomicae Sex 1538 and 1638) of arteries and veins

Vesalius

Celsus expected surgery WILL or WILL NOT cover the following: war wounds plastic surgery Hernias

WILL NOT going to cover War-wounds --advances in removal of arrow and missiles Plastic Surgery --correction of congenital defects (e.g. cleft palate) Hernias --difficult, risky surgery but untreated certain death » important to control blood loss

Celsus DID or DID NOT think surgery would cover: Fistulae Cataracts Dentistry Decircumcision bladder stones (lithotomy) excision of fetus

WILL cover

Who overthrew Galen's physiology in 1628 with De motu cordis

William Harvey

Thomas Eakins "The Gross Clinic" (1875)

XXX

UI surgical Amphitheater with Class

XXX

Did Archagathus have Roman citizenship?

Yes

"Let the assistants hold the patient down by his head and arms so he doesn't move whenever he is cauterized [for hemorrhoids] -- but let him shout during cautery since it makes the anus stick out more"

[Hippocrates] Hemorrhoids 2 pain management

'idiosyncrasy'

[more literally] 'individual mixture'

Galens training in philosophy and medicine: at 14, Galen studied philosophy of the four major Greek philosophical schools with ... (4)

a Stoic student of Philopator a Platonic student of Gaius an Aristotelian student of Aspasius an unnamed Epicurean

Freudian psychological therapy

a based on physiological conception of disease Genetic conceptions of disease (misperforming body) might belong here too

Galen on diseased bodies: in substance

a body has a bad mixture (dyscrasia), whereby one or two elements predominate at the expense of others

Fistulae -what is it -common where -social impact

a pathological tube that opens between bodily cavities or between an internal cavity and the outside most common are anal fistulae, that allow excrement to pass outside the body uncontrolled without going by way of anal sphincter can be serious but not always; certainly socially embarrassing

Which Late Antique Medical Author a) Aetius of Amida fl 530 b) Paul of Aegina fl 7th cent c) Oribasius of Pergamum fl 360 --probably a court physician to the Byzantine emperor Justinian, possibly personal physician to empress Theodora --16 chapters on the whole of medicine

a) Aetius of Amida fl 530

Anatomical Procedures: Galen says (p.86, p.4 of the pdf) "I illustrate such vivisections on the bodies of swine or of goats, without employing apes. But it is necessary that you should extend your studies and examine the larynx. This is constructed in the same way in the bodies of apes and men, a construction which is shared by the other animals which have a voice. You must, then, dissect a dead man and an ape and other animals furnished with a voice which have, besides the voice, the vocal apparatus, the larynx." In this quote Galen expresses the methodological principle of which sect? a) Rationalists b) Methodists c) Empiricists d) Eclectics

a) Rationalists

Quiz 19 Anatomical Procedures: Galen says (p.85 on the sheet, p.3 of the pdf): "If now you have learned to recognise, in the body of a dead animal, the position of each one of the nerves which are joined and connected to the larynx, then it will not be difficult for you to recognise and find each one of them as they are exposed in the body of a living animal." In this quote Galen expresses the methodological principle of which sect? a) Rationalists b) Methodists c) Empiricists d) Eclectics

a) Rationalists

Galen's Advice to an Epileptic Child: which food does Galen say "the worst of all", to be avoided by the patient? a) mushrooms b) lettuce c) squill d) pork

a) mushrooms

Galens impact areas and languages

adopted by later Greco-Roman practitioners in Late Antiquity translated into Syriac, Armenian, and Arabic and was the basis of Arabic medicine into the 19th century translated into Latin (by way of Arabic or Greek) and was the basis for medieval European medicine

Roman Empire and Medicine: advances

advances in hemostatic techniques led to more complex surgery development of surgical implements trade with neighboring countries brought new materials

Roman Empire: surgery developments -advances

advances in hemostatic techniques led to more complex surgery development of surgical implements trade with neighboring countries brought new materials

Roman Empire and Medicine: hospitals

affiliated with the Roman army at the frontier

Roman Empire: hospitals

affiliated with the Roman army at the frontier

Decircumcision

an operation to restore a foreskin covering to the glans penis (the end of the penis) that has already been removed.

Anatomical Procedures is his professional dissection handbook Use of Parts describes the purpose of each anatomical part of the body Both of these pieces support Galen's work on ___________

anatomy

two types of comparison in comparative anatomy

anatomy by book vs. anatomy by performance

On Prognosis: ______ sent shorthand writers to Galen to take down the notes of his lectures. a) Epigenes b) Boethus c) Alexander d) Severus

b) Boethus

Which Late Antique Medical Author a) Aetius of Amida fl 530 b) Paul of Aegina fl 7th cent c) Oribasius of Pergamum fl 360 --taught in Alexandria at the beginning of Islam --7 chapter work on all of medicine

b) Paul of Aegina fl 7th cent

Galens Views of Health: arrangement (formation of body parts)

balanced according physician's senses --touch, sight balanced according to proportionality of body parts --size, shape, number, position

Marian operation: lithotomy in 18th century

began c.1500, described first by Marianus Sanctus (1489-post 1550) in 1522also called greater operation or apparatus major

Ancient doctors belief about couching surgery

believed that they were destroying the waterfall, not the lens. So ancient Greek and Roman physicians performed a corrective therapy (they destroyed the lens) for the wrong reasons (they thought the waterfall was blocking the source of vision, the lens).

which procedure is described below: "But various contingencies call for some further observations. There are some stones which are not merely rough but also spinous, which if they have come down to the neck of the bladder of their own accord may be extracted without any danger. But it is not safe to search for these within the bladder and draw them out, for when they have wounded the bladder they cause a speedy death from spasm, and much more so if a spinous stone sticks to the bladder, and when being drawn down has folded it over. Now it may be inferred that the stone is at the neck of the bladder, when the patient has difficulty in passing water: or that the stone is spinous, when he passes bloody urine in drops."

bladder stones

Celsus describes the practice of closing off ______________ to prevent a loss of blood.

blood vessels

Galens Views of Health: physiology ( function of body parts (activities))

body parts perform their activities flawlessly

match the principles to their subservient parts: a) brain b) liver c) testicles d) heart 1)bone and flesh 2) arteries 3) veins 4) spermatic ducts 5) nerves and spinal cord

brain: nerves and spine liver: veins testicles: spermatic ducts heart: arteries

Which Late Antique Medical Author a) Aetius of Amida fl 530 b) Paul of Aegina fl 7th cent c) Oribasius of Pergamum fl 360 --doctor to the last pagan Roman emperor, Julian the Apostate --70 chapter work on the whole of medicine, 30 are extant

c) Oribasius of Pergamum fl 360

Galen's Advice to an Epileptic Child: Galen advises the patient to avoid the intake of foods that promote which humor? a) yellow bile b) blood c) phlegm d) black bile

c) phlegm

which procedure is described below: "The needle should not be, however, entered timidly, for it passes into the empty space; and when this is reached even a man of moderate experience cannot be mistaken, for there is then no resistance to pressure. When the spot is reached, the needle is to be sloped against the suffusion itself and should gently rotate there and little by little guide it below the region of the pupil; when the cataract has passed below the pupil it is pressed upon most firmly in order that it may settle below."

cataracts

Late Antiquity: Roman Empire: turmoil -changes and continuity

changes: West, Latin-speaking, gradually falls apart as Germanic tribes invade » capitol shifts from Rome to Milan and other places continuity: East, Greek-speaking, begins the Byzantine Empire, centered around Constantinople (now Istanbul) which lasts until 1453

What was history of teeth connected to in written records

closely connected with diet of excess sugars Dentistry as a surgical specialty took off in the 18th/ 19th century, when refined sugars from Caribbean plantations became available in widespread quantities. Sugar was much rarer in the premodern era; honey was the sweetener most commonly available

oldest illustrated herbal

comfrey Symphitum officinale Johnson Papyrus, c.400 CE Wellcome ms 5753

Galen Bodily Systems purpose: heart and arteries

control of internal heat, supplied pneuma (air) in different forms to different parts of body

Galen Bodily Systems purpose: brain and nervous system (2)

control of sensation and perception voluntary and involuntary movement (muscles)

what were some things that Dioscorides of Anazarbus claimed of poppy seeds being used for

could be made to salves for those with insomnia external and internal salves (sometimes an enima)

How do Galen's treatises on causes and cause types relate to his importance of casualty

cover invisible as well as visible causes Rationalist causality (as understood through the debate of the Hellenistic medical schools)

The issue of Greek medicine is embedded in a larger question about Roman interest in Greek __________ , like language, literature, art, science

culture there is some evidence that the Romans who invited Archagathus were Cato's political opponents, and Cato's opinions may not be representative of all Romans therefore the Romans' response to Greek medicine is partly a political question about the Roman response to Greek culture

Quiz 18 On Prognosis: Why does Galen refuse to dissect publicly, after Alexander doubts that we should believe the evidence of the senses? a) The findings of anatomy derive from logical demonstration. b) Alexander is a Methodist. c) Boethus was not yet present. d) The findings of anatomy derive only from sensory experience.

d) The findings of anatomy derive only from sensory experience.

spacial frame --Rome

dealing with medicine in the areas under Roman control the Romans expanded from Rome and its immediate surroundings to all of Italy and then beyond

which procedure is described below: "And, if the glans is bare and the man wishes for the look of the thing to have it covered, that can be done; but more easily in a boy than in a man; in one in whom the defect is natural, than in one who after the custom of certain races has been circumcised; and in one who has the glans small and the adjacent skin rather ample, while the penis itself is shorter, rather than in one in whom the conditions are contrary."

decircumcision

"Sometimes the calculus slips into the urethra and sticks not far from the exit; if it happen it is fitting to dig it out, if not, the skin most nearby ought to be stretched as much as possible, and with the calculus discovered, and tied with string: then a shaft ought to be cut from the side by a straight cut, and the stone taken out: then the skin relaxed, then made so that a whole part of the skin cover the cut shaft and urine will flow naturally: useful for this task is the knife drawn." what tool is being described? where is this from?

della Croce, Giovanni Andrea. 1596. Officina Chirurgica. Venice. 35, 36. "the hook of Celsus"

ther importance of mathematics for Galen's medical thought

demonstration of secure knowledge from a few agreed-upon principles His father taught Galen geometry, arithmetic, architecture, logistics, astronomy, and grammar.

which procedure is described below: "And this procedure is not altogether free from danger, especially in the case of the short teeth, which generally have shorter roots, for often when the forceps cannot grip the tooth, or does not do so properly, it grips and breaks the bone under the gum. But as soon as there is a large flow of blood it is clear that something has been broken off the bone. It is necessary therefore to search with a probe for the scale of bone which has been separated, and to extract it with a small forceps. If this does not succeed the gum must be cut into until the loose scale is found."

dentistry

Galen's Surgical Techniques: advances on Hippogratic abilities

development of hemostatic techniques in Hellenistic/early Roman empire surgery for certain cancers; direct surgery for bladder stones trade associated with the growth of the Roman empire brought new materials, such as silk, for surgical purposes Galen also talks abt smiths cast medical instruments designed by himself for his own use

Removal of calculi is mentioned as easy/difficult for physicians in the Hippocratic Corpus

difficult The Hippocratic Oath advises against 'cutting for the stone'

who was Scribonius Largus

doctor at the court of the Roman emperors fluent in both Greek and Latin

time frame --ancient med in Rome

during the initial expansion of its rule, Rome was a republic (with a government elected from its aristocrats) Republican era c.500-51 BCE We are concerned with the time contemporaneous with the Greek Hellenistic world, roughly 230 - 51 BCE

What did Galen's First Stay at Rome consist of? -what did he accomplish? -who was his sponsor? -what did he do?

established his medical reputation through connections to Greek philosophers and intellectuals living in Rome Galen's sponsor was a leading government official named Flavius Boethus Galen performed public dissections and anatomical demonstrations

which procedure is described below: "The surgeon making use of this opportunity should first insert the index finger of his greased hand, and keep it there until the mouth is opened again, and then he should insert a second finger, and the other fingers on the like opportunity, until the whole hand can be put in. To allow of this, much depends both on the size of the vagina, and the resistance of its sinewy tissues, and the patient's constitution, and also her strength of mind, especially since on occasion even both hands have to be passed in. It is also important that the hypogastrium and extremities should be kept very warm, that inflammation should not have begun, but that the treatment should be adopted without delay."

excision of the fetus

What acts did Dioscorides of Anazarbus do in the preface that align with Rationalist methodology

experimented on patients

which procedure is described below: "The linen thread should be made up of two or three strands of raw flax, twisted up so as to make one. Meanwhile the patient can do his business, walk, bathe, and take food as if in the best of health. Only this thread is to be moved twice a day, but without undoing the knot, the part of the thread outside being drawn within the fistula, and the thread must not be left until it becomes foul, but every third day the knot is to be undone, and to one end that of another fresh thread is tied, and the old thread being withdrawn the new one is to be left in the fistula after being similarly knotted."

fistulae

Galen Bodily Systems purpose: testicles and reproductive tubes

generation of new individuals and continuation of species

Cataracts

gradual dimming of vision: either vision grows darker or less distinct with increasingly blacked-out areas It can ultimately lead to blindness caused by the clouding of the lens of the eye

Select which Galen does NOT think are necessary for physicians to obtain. a) knowledge of the typology and symptomology of diseases b) distinctions between genus and species c) prognosis d) knowledge of the types of local environment which give rise to certain diseases e) logical training f) knowledge of the elements and their mixtures in body parts g) knowledge of substance and the composition of the body h) physical ability

h) physical ability

Do the surgical books persuade us to belief Celsus WAS or WASNT a medical practicioner?

he WAS

Who did Galen work with in Alexandria

he studied with Heracleianus, doctor and son of Numisianus Julianus, doctor and Methodist

Who did Galen work with in Corinth

he studied with an unnamed doctor who Galen respected for his anatomical ideas

The major advance of surgery in the early Roman Empire is to prevent _________________________.

hemorrhaging from bleeding vessels

Military developments: instruments + inventions

hemostatic instruments were obviously at use on the frontier for soldiers fighting invention of other techniques of removing missiles, arrows, and spear wounds (spoon of Diocles)

Organization of Body Parts Art of Medicine 5, 1.319K organizes the body parts into _______________

hierarchies

Galen on diseased bodies: in physiology

impairment of function e.g. difficult breathing, derangement of mental faculties, impairment of voluntary motion, excretions

must of an opperator during excision of dead fetus

insert hand into vagina determine position of fetus; reorient to vertical extract by means of hook

What was the culture of Roman Empire like from 31BCE - 250 CE (geography and politics)

largely a time of internal peace: wars at the limits of Roman control with neighboring peoples Mediterranean, England and Wales, continental Europe south of the Rhine and Danube, northern Black sea, all of Turkey, Armenia, some of Iraq, Syria, Egypt and all the north African coast ruled by a series of emperors, sometimes from the same family; sometimes one emperor would adopt the next; occasionally internal military revolt would chose the next emperor

Celsus emphasizes that the tooth must be ________ before it is pulled with a forceps. If a tooth cannot be pulled, what is recommended? What type of evidence do we have to support this?

loose If it cannot be pulled is it best to bind up the tooth with goldwire (orthodontics) We have limited evidence of orthodontics from antiquity Some gold wire on skeletons Old female prostitutes are often said to have false wooden teeth Ancient illustration from Pompeii of a doctor extracting an arrow using a forceps

Celsus, with other ancient physicians, believed that the lens was centered in the ___________ of the eye cavity.

middle

anatomy on animals: Galen refuses to use live ____________ because the expression on their faces in vivisection evoke pity from the spectators

monkeys *empathy is not a productive emotion in surgical operations

Galen on diseased bodies: in arrangement

morbid state in size, complexion, shape, number, position, hardness and softness, heat and cold these affect parts and organs