Exam 1: Lecture 1-11

Aelius Aristides

(117-181 CE), a Greek orator, wrote The Sacred Tales. This is a record of the revelations made to him by Asclepius in dreams, over 30 years (142-170) He traveled to the god's temple in Pergamum, "one of the chief healing sites in the ancient world," where "incubants" slept on the temple grounds, then recorded their dreams in search of prescriptions from the god; for Aristides, these included fasting, unusual diets, bloodletting, enemas, vomiting, and refraining from bathing or bathing in frigid rivers. Temple medicine.

Galen

(129-c.216) Father of medicine: late antiquity, late Middle Ages, Renaissance A key figure in the Western medical tradition. His prodigious output: a bibliography of his genuine works lists over 350 texts. More works survive of Galen than of any other writer from Antiquity. Born in Pergamum (Asia Minor = present-day Turkey), studied medicine at Alexandria. Went to Rome in 162, eventually becoming physician to the emperor. A rationalist A master of medical autobiography: he presented his cures as exemplary, his rivals as incompetent fools (see Reading, On Prognosis)

Pliny the Elder, Natural History:

(1st c. CE) described medicine as Greek import. compilation drawn from a multitude of Greek and Latin sources, offering information for self-help medicine. Strong critique of professional physicians. Shows practical orientation of Roman medical writings

Rufus of Ephesus

(1st c. CE) sees himself as a follower of Hippocrates. He thinks that for prognosis and diagnosis the physician needs to procure information from the patients and the people around them. the physician needs to find out about the patient's "particular inclination".

Scribonius Largus, Drug Recipes

(1st c. CE): organized by disease, from head to toe.

Decline of Anatomy

(250 BCE - 1st c. CE) No formal institutionalization of the sciences to transmit ideas and practices from one generation to the next, so after Herophilus and Erasistratues there was a decline

Herophilus

(280 BCE) Alexandrian anatomist Greek Gave the first detailed description of the male and female reproductive organs, including the ovaries, which he called "female testicles". Practiced anatomy when it was taboo

Roman conquest of Greece

(2nd c. BCE) Hellenization of Roman culture Medicine as a low-status activity-75 % of doctors in Italy and the Western Latin provinces before the year 100 were slaves or ex-slaves. Only 10% of them were Roman citizens.

Erasistratus

(304-250 BCE) Alexandrian Anatomist Greek We know most of his ideas through Galen, who strongly criticized him. Said to have discovered the valves of the heart. Used experimentation and mechanical analogies to solve anatomical problems. Practiced anatomy when it was taboo

Praxagoras

(340 BCE -?) first distinguished arteries and veins: the veins originate in the liver and carry blood, the arteries originate in the heart and carry only pneuma (spirit). He noticed the movement of the arteries which he called the pulse, and which he considered as a valuable aid for diagnosis

Aristotle

(384-322 BCE) believed study of ideal forms should start from empirical observation. carried out a series of empirical studies of the natural world, on fishes, birds and animals. first evidence of dissection of animals for research purposes. An asclepiad Alexander's tutor teleological view of nature Innate heat: a theoretical, not an empirical entity. Sexist in his view of bodily functions/ purposes

Alexandria

(3rd BCE) founded by Alexander the Great when he conquered Egypt (331 BCE). City of education and learning City of anatomy

Discorides

(40 CE-90 CE) A military surgeon in the Roman army. Listed and illustrated about 700 medicinal plants, plus minerals and parts of animals believed to have medicinal value. Based on his own experience and that of others that he interviewed personally. Used the concept of autopsía (1st c. CE) wrote De Materia Medica (On medicinal substances, written in Greek). Very influential on Western pharmacopoeia up to the 16th century. Work translated into Arabic and Latin in Medieval times.

Plato

(428-347 BCE) believed the world we perceive with the senses is only a shadowy image of the true world of ideal and eternal forms, and the philosopher's task is to identify these forms.

Galenism

(6th to 16th c. CE) first established in the Eastern Roman Empire (Alexandria), subsequently developed in Islamic countries, and finally in the Latin West. prevailing medical doctrine, Physicians writing in Greek, Syriac, Arabic, Latin and Hebrew saw ancient medicine as something that could not be improved upon Overshadowed Hippocrates

Hunayn ibn Ishak (Latin=Johannitius)

(808-873) Christian translator turned physician in the Abbasid dynasty; he and colleagues translated over 100 Galenic works compiled glossaries of corresponding Greek, Syriac and Arabic words

Cato the Elder, On Agriculture

(c. 160 BCE): the earliest surviving Latin text with medical content. Contrasts Greek medicine with the Roman self-help tradition.

Thucydides

(c. 460-365 BCE), historian of the war between Athens and Sparta: political and military decisions should be reached through public, rational debate.

Ibn Sina=Avicenna

(c. 980-1037) Persian A polymath: philosopher, physician and jurist. About 250 of his works survive, mostly on philosophy and medicine. Wrote Canon of medicine

How did Christianity affect medicine?

1) A stronger belief in the link of sin and disease. Disease as a consequence of mankind's fallen nature. 2) A stronger emphasis on the healing power of the holy man (and woman). Both the Old and the New Testament presented religious charisma as the ability to work healing miracles. (Jesus as a healer) 3) Creation of charitable hospital.

Alexander the Great

356-323 BCE): his conquests extended to Egypt, Persia and even India. His military conquests lead to new botanical and zoological knowledge (his troops sent animal/plant descriptions to Athens)

Book-based medicine

3rd to 8th century medical literature often consists of commentaries and compendia (=summaries), based on earlier authors, with little novelty. Disappearance of anatomical investigation. Canonization of Hippocratic and Galenic texts (syllabus or list of set texts) = ex: Alexandrian Galenic Canon of 16 books that served as a coherent syllabus with anatomy, physiology, pathology, and therapeutics summaries of Galenic texts suppressed much of the original complexity of Galen's ideas. The theoretical side of Galen's work was emphasized over its practical and empirical side.

From Antiquity to the end of the Middle Ages (5th-14th centuries)

4th century: Roman Empire divided into Eastern and Western halves. Legalization of Christianity(becomes religion of Roman emoure) after it was a "lower religion" by Emperor Constantine in 313 Eastern capital Constantinople (= Byzantium, present-day Istanbul) founded by emperor Constantine in 330. 5th century: Collapse of Western Empire with barbarian invasions. 1453: Collapse of the Eastern Empire with Ottoman conquest of Byzantium.

al-Ghafiqi

A Muslim physician in Andalusia (Spain), used Dioscorides and Indian sources, plus first-hand knowledge of plants of Southern Spain and Morocco. He listed names of plants in Greek, Sanskrit, Syriac, Latin, Berber, Spanish, and Persian.

Gundeshapur

Ancient Iranian city a center of learning exchange involving Persian, Greek, and Indian cultures Nestorian christians exiled from Eastern Roman empire for condemning church were sent here and brought medical texts that were then translated to Syriac and Persian This is why much of ancient Greek medicine reached medieval Western Europe through the intermediation of Islamic culture, and some are only extant in Arabic

Public Physician

Appointed and paid by the town authorities. Some city-states, including Athens, attracted practitioners by paying them a retainer to reside and treat their citizens. (or by giving them fiscal advantages)

Islamic assimilation of Greek medicine

Arab conquest of Alexandria in the 640s. Decline of teaching of Greco-Roman medicine right after the conquest. Systematic revival of Greek humoral medicine in Islamic culture in the 8th and 9th centuries.

Consequences of Abbasid translations

Arabic as a new scientific language. From transliteration of Greek terms to the creation of new Arabic words. Creation of a new figure of learned physician.

Why were muscles so significant in the European anatomical vision?

Artists represented muscular bodies well before anatomists brought attention to the role of muscles. for Galen, muscles are important because "they are the organs of voluntary motion". Interest in muscles linked with the view of agency (intentional action) as the defining element of humanity. The strongly articulated body of the male Greek athlete was seen as the paradigm of humanity, in contrast with animals, barbarians and women. The well-articulated body associated with the European identity.

Comparing Asclepian and Christian healing

Asclepius heals by natural means, with collaboration of physicians. Christian saints heal by supernatural means, without collaboration of physicians. Persistence of healing in dreams: "epiphany" dreams also in Christianity.

al-Razi (Rhazes)

Born in Persia, he studied medicine (also natural philosophy, alchemy and music) in Baghdad. He was a court physician and hospital physician. A great clinician. criticized Galen his works influenced Latin West focused a lot on pharmacology

Effort to attract doctors to Rome

Caesar gave Roman citizenship to any doctor willing to come and practice in Rome (c. 49 BCE).

Cult of Relics

Collected fragment of a martyr's/saint's body as a symbol of victory over pain and death. The saint's body as a symbol of the resurrected body.

Long-term Perspective of Western Medical Tradition

Continuities: the link between learned medicine and natural philosophy Discontinuities: introduction of medical licensing in the late Middle Ages: previously, anybody could legally practice as a healer.

Arab-Islamic contribution to medicine

Development and systematization of Hippocratic-Galenic medicine. New advances in areas such as pharmacology and hygiene (including sexuality). a lot of medical compendiums Use of tables and quantitative methods to determine the degrees of the four qualities in medicinal substances.

Purpose of Anatomy

Early anatomical inquiry was linked to a religious belief in nature's purposefulness. long-lasting view of Nature as a skilled craftsman, who does nothing in vain.

Hippocratic Therapies

Favorite treatment: diet or regimen. Other therapies: bloodletting, surgery, pharmacy. Illness seen as a process, with beginning, middle and end. Notion of CRISIS and "critical days".

Aristotle's studies of animals

First evidence of dissection for research purposes (4th BCE)

Humors

Four humors, four seasons, four qualities (hot/cold, moist/dry), four elements. Blood =spring= air = moist and hot Yellow bile =summer= fire = dry and hot Black bile=autumn= earth = dry and cold Phlegm=winter= water = moist and cold

Galen as a synthesizer of Hippocrates, Plato, and Aristotle

From humors to localization of function. Three parts of the soul = three main organs: 1) Vegetative soul (liver): nutritive function (veins, venous blood) 2) Animal soul (heart): vivifying function (arteries, blood plus pneuma) 3) Rational soul (brain): intellective function (nerves, pneuma) He tried to establish a unified vision of medicine, beyond the divisions of the medical sects.

What was a book in Antiquity?

From tablets (on wood) and book-roll (on papyrus) to the codex (on parchment), similar in form to our modern book.

Christian assimilation of Galenism

Galen's belief in the Creator's wise and benevolent purpose was congenial to Christian authors.

Why did human anatomy develop in Alexandria?

Greek taboo about touching a human corpse. No such taboo in Egypt: the Egyptians practiced mummification. Bodies used for dissection were those of executed criminals.

How and why did Galen's ideas become simplified?

Growing split between theory and practice: The theory/practice distinction (absent in the Hippocratic Corpus and in Galen) became a standard feature of medical textbooks. New emphasis on theory in medical education. Information overload: The size and complexity of Galen's output made it necessary to summarize and simplify his theories for teaching purposes.

Galen's Medicine

He presented himself as the true interpreter of Hippocratism. He renovated Hippocratic theories by adding new anatomical knowledge, and a view of medicine as part of philosophy. He took the basic principles of Hippocratic humoral theory (the four humors, disease as humoral imbalance) and he combined them with notions from Plato, Aristotle and the Alexandria anatomists.

Fundamentals of Galenism: health and illness

Health = balance of the four humors (blood, yellow bile, black bile and phlegm). This balance varies according to the individual's age, sex and diet, the season of the year, and the environment. regulation of the non-naturals Six "non-naturals" = the fundamental determinants of health: 1) Diet 2) Environment (air) 3) Exercise 4) Sleep 5) Excretions (including sexual activity) 6) The soul's feelings Allopathic therapy = based on remedies that produced effects opposite to those produced by the disease.

Unani Medicine

Hippocratic medicine in Arabic version Transmitted to India in the 12th century with the establishment of Islamic rule and flourished under the Mughal Empire. Still practiced today in the Middle East and South Asia

Difference between Ibn-Sina and Galen

Ibn-Sina aimed at presenting a set of principles abstracted from any specific context of experience. He gave less emphasis to anatomical experience, clinical observation and medical debate than Galen did.

Special features of Greek Medicine

Importance of philosophical argument. Rejection of supernatural explanation of disease

Abbasid translations: What and Why?

In 8th-9th century Baghdad the Abbasid dynasty sponsored the translations of texts into Arabic Factors: Social and economic: an educated elite with the financial resources to fund scholarship. Intellectual : Like the Christians, the Muslim elite used the ancient Greek authors in defense of their own beliefs. Religious: The Galenic view of anatomy as evidence of God's design was used by both Christians and Muslims as an argument against Manichean dualism.

Christian Attitude of the body

In Christianity, the body is constitutive of personal identity, as shown by the belief in the resurrection of the body. In Christianity the body is seen as fundamentally good (not bad as in Neoplatonism or Manicheism) because created by God. In Christian asceticism, however, the body is seen as a vehicle of temptation and sin.

Galen's philosophies and beliefs

In his view, the best doctor was also a philosopher. An eclectic philosopher: he combined various views taken from his predecessors. Galen's debt to Plato: he accepted Plato's notion that mind and body are strongly linked. Galen's debt to Aristotle: he accepted the Aristotelian view of philosophy as knowledge of causes, and tried to extend it to medicine. He believed in giving a philosophical, not religious, explanation of natural phenomena (no healing miracles), but was not irreligious and had a religious motivation of anatomy

Healing as Christian Propaganda

Jesus is said to have passed on his healing power to his followers, the apostles. Strong competition with the Pagan healing gods. Healing miracles crucial in the spreading of Christianity and in the development of the cult of the Christian saints. formation of charitable hospital: it extended to all in need, Christians and non-Christians alike. As such, it played an important role in missionary outreach.

Global diffusion of Hippocratic medicine

Late antiquity: Roman Empire 8th -9th c. CE: Islamic countries 9th-17th c. : Latin West 12th-15th c. : Islamic India 16th-18th c. : Mughal Empire 16th-17th c. : Spanish and Portuguese Americas

Hygieia

Medical cult in Greco-Roman World

Rationalists

Medical group in late antiquity believed dissection is important important to be invasive believed in a balance of empirical observation and theory.

Asclepius

No healing miracles: heals by natural means. His remedies are similar to those adopted by the physicians (regimen, bloodletting, etc.). Physicians' services are described as inferior to those of the god. The physicians acknowledge the god's superiority.

Medical Marketplace

No medical licensing: no examinations, no illegal practice, no medical profession. Some healers were slaves and women. No attempt to control either the content or the personnel of medicine. No medical degrees or officially recognized qualifications. Distinction between bona fide practitioners and charlatans drawn only for taxation purposes. For tax exemption, an eye-doctor or an ear-doctor qualified as a medical practitioner, an exorcist did not.

Oribasius

Oribasius(c. 320-400) personal physician to the Emperor Julian, wrote the Compilations: A massive encyclopedia of extracts from Galen and other ancient physicians.

How the Quran affected previous views of disease

Pre-Islamic medicine: magical healing. Traditional view of disease as caused by spirits (the jinn). Muhammad on medicine: God sends down no malady without also sending down a cure. Transition from old-style tabib (=physician), who used spells and charms, to a new kind of tabib, who searched out the cures by means of inquiry into nature.

Hippocratic Theories

Primary cause of disease = imbalance of humors Four humors: blood, phlegm, yellow bile and black bile (=melancholy) Health and illness are natural phenomena, with no supernatural causes.

Physiognomics

Pseudo-Aristotelian treatise reading moral character from physique

Multiculuturalism in Western Medical Tradition

Role of Islamic culture: most ancient Greek medical texts were transmitted to the West in Arab translation. Coexistence of a learned medicine with a medicine practiced by popular healers.

Celsus

Roman medical author (1st c. CE) believed the ideal physician is a friend wrote, On Medicine: a medical manual written by a non-physician. Shows practical orientation of Roman medical writings

theoretical pluralism

Several competing views of disease even within the Hippocratic Corpus. Social reason: the medical marketplace.

Christian attitude to sickness

Some monastic rules forbade the use of medical remedies: in illness, Christians should rely on prayer alone. Sickness as a way of expiating sin. But the Christian attitude to sickness is shaped by the moral obligation of charity towards the sick, which implied a positive appreciation of medical help. (visit the sick as an act of mercy)

Nemesius of Emesa

The Christian bishop who summarized Galen in his treatise On the Nature of Man (ca. 370).

Medical Ethics in Hippocratics

The good healer should never harm the patient: better not to do anything than to do harm. The Hippocratic Oath prohibits abortion, the use of the knife, and the provision of a deadly drug upon request.

How did anatomy acquire such a central significance in Western medicine?

The history of anatomy is closely related to the history of religion and art. physiognomics

Fundamentals of Galenism: anatomy

The most important organs in the human body: The brain, source of the nerves the heart, source of the arteries the liver, source of the veins. Arteries and veins as two independent systems, with different functions: venous blood carries nutrition arterial blood carries the vital spirits.

Saints Cosmas and Damian

The patron saints of medicine presented in the hagiographic literature as having "thoroughly mastered the medicine of Hippocrates and Galen".

Early Christian Hospitals

They were shelters for the poor, the elderly, orphans, etc. not just the sick. Usually the hospitals were run not by physicians but by laymen or by religious groups. Charitable hospitals were an important factor of the success of Christianity.

Treatment

Treatment had to be calibrated for each specific person. Only inferior healers, such as root-cutters and herbalists, believed that a remedy would work for everybody.

Cult of the Saints

When Christianity was a persecuted religion, they were the martyrs. After Christianity was legalized in the 4th century, the saints were the models of Christian virtue. The saint/devotee relationship as patron/client relationship. Performed healing miracle sin life/death

Healer-Patient Relationship

Who were the patients? Evidence from Hippocratic Epidemics: cases include people of all social classes. Expectation that poor people should be treated for free (Hippocratic Precepts). Importance of the patients' trust, seen as essential in the struggle against disease (Hippocratic Prognostic).

Ibn Butlan

a Christian physician in Baghdad. created a self-help guide(Taqwim al‑sihha (Maintenance of Health), 11th c.) for patients on how to regulate the six "non-naturals": food and drink air exercise sleep 5) evacuation of humors 6) emotions. Organized by tables.

hagiography

a literature devoted to recording the lives of the saints and their miracles.

Hippocratic Corpus

about 60 texts, all attributed to Hippocrates in Antiquity, but actually written between 420 and 370 BCE by several unidentified authors; assembled at Alexandria in Egypt around 280 BCE. included aphorisms for teaching, some argued a specific thesis, some elegantly written, some case-notes

Hippocrates

an Asclepiad from Cos

historía

ancient Greek word; inquiry into the natural world and the nature of man, including health and disease.

autopsía

autopsy=ocular first-hand experience

Sack of Rome

by Visigoths in 410, signified the collapse of the Western Roman Empire Decline of culture (including medical culture).

Sir William Osler

disagreed with norm by believing that historical background should be part of clinical instruction in 19th century America a Canadian physician and one of the four founding professors of Johns Hopkins Medical School and Hospital. Osler created the first residency program for specialty training of physicians. A polymath, in addition to being a physician, he was also a historian, author, and bibliophile also founded the History of Medicine Society as a section of the British Royal Society of Medicine.

Karl Sudhoff

founded the first history of medicine institute founded in Leipzig, Germany in 1905

What to observe in/ ask a patient

from the common nature of all and the particular nature of the individual from the custom, mode of life, practices and ages of each patient All the symptoms that have previously occurred. The whole course of treatment the patient has been undergoing and the apparent effect on him/her of each item of it. What food pleases the patient best. Use of dreams for diagnosis. Question people around patient

Caracalla's pilgrimage

in 213-15, the Emperor Caracalla first sent his servants and then went in person to seek help from several gods: Apollo in Germany, Asclepius at Pergamum, Sarapis (an Egyptian god) at Alexandria... example of religious healing

Hippocratic physician

itinerant healer

sophists

itinerant intellectuals that taught practice of arguing both sides of an issue

Asclepiads

medical clan, supposedly descendants of the healing god Asclepius, at Con and Cnidus (Ionia= West Turkey)

Empiricists

meidical group in late antiquity prominent after Herophilus and Erasistus Medicine based on experience Human dissection scientifically unnecessary

Myth of Hagnodike

mulan for medicine; law amended and all women were allowed to study medicine; maiai/obstetrices (midwives).

Iatrocentric

physician-centered history of medicine; physicians had a classical education and interest in history

Hippocratic Practice

prevent excess/deficiency of any single humor in the body. Favorite treatment: diet or regimen individualized medicine Importance of observation Prognosis more important than diagnosis.

incubation

prime feature of many Greek healing cults, including that of Asclepius.

pneuma

spirit; carried in the arteries

sphygmology

theory of the pulse

Gerard of Cremona

translated the Canon into Latin (second half on the 12th century). Toledo, Spain

episteme

true knowledge; is only reached when one understands the "why" of a phenomenon, not just the "how". The "why" means to identify the final cause of something, that is, nature's purpose in creating that thing = teleological view of nature

Galen's Anatomy

used anatomy to show that medicine can explain the use, that is the purpose, or final cause, of bodily parts, and therefore it can be considered a science. He stressed the need for dissection to be repeated over and over again, in order to verify results. Dissected animals

Canon of medicine

written by Avicenna medical encyclopedia; organized Galen's medical writings into a system based on Aristotelian philosophy and epistemology (tried to combine both, Aristotle's teachings are true, but Galen is best for practical purposes) (first single, complete, and continuous book that taught the art of medicine most clearly and coherently) medicine is presented as a science in the Aristotelian sense = knowledge derived from true premises by demonstration. Implicit rejection of medicine as an art or craft. Focus on therapy more than anatomy covered universals of medical theory, ailments specific to organs, treatments, disease, and preparation of medicine fundamental text in Arabic medicine until 19th century, still very important in Unani Medicine, important in European medical teaching from 14th-17th bc of Galen-Aristotle combo Printed several times and had different commentaries