Ancient Med FINAL (week 7 onwards)

The role of the midwife

Female healers place vs new hippocratic gynecological writers One theory- hippocratic physicians trying to corner the market on different types of medicine, including childbirth- some have argued that certain recipes are male physicians trying to coopts women's healthcare. Midwife

Epidauros Iamata

healing accounts incised on stone and displayed in the sanctuary "a man's toe was healed by a snake, he was in terrible condition from a malignant ulceration on his toe. During the day he was carried out of the Abaton by the servants and was sitting on a seat.

Galen's perception and corpus

self-identified with hippocrates- in going through hippocratic writings created notion of Hippocrates in his own works- insertion of himself, his commentaries etc. are a big part of the lasting legacy Commentaries on hippocratic treatises (17) in this, he was trying to make clear to readers/audiences what Hippocrates had actually meant. Mine the vocabulary in contemporary Ancient Greek authors, different genres to interpret different passages in the treatises- applied in an attempt to establish varying degrees of authenticity. Further intervening in canonical corpus. Creating authoritative image of Hippocrates which in turn bolstered Galen. Galen claimed hippocratic precedent in his practices big part of his intellectual formation By 157 CE, Galen known for his knowledge of surgery, retained by high priest to look after gladiators attended to diet, overall health, wounds, went to Rome in 162 CE and once he got there in the population dense city had public anatomical debates and disputes with great success 168 CE_intended but didnt attend roman emperor as a imperial doctor for Aurelius (northern italy) work based on imperial court- Rome, through his writing and dissection displays, open argumentation with other physicians- established a correct way of doing medicine- enforced by his own successful interventions Anatomical work- tripartite (liver, heart, brain parallel systems, building off Plato's ideas) bodily system fleshed out (Nutton), how one should perform a dissection, vivisection Heart, veins, arteries- built up anatomical understanding of the human body Looking at Human body at any opportunity- studied corpse when tomb was flooded - looked at executed criminals whose bodies were hanging in the gallows, bodies of war dead in battlefield, description of different bones precise, issues w his descriptions heart anatomy more an issue of working w animals vs humans Galen- animal dissections, hands-on experience ,criticizes rival doctors for laziness, rare practice of art/skill of dissection wrote frequently, tells of travels to Turkey, Italy, etc. Taste through Galen of great mobility and globalized mediterranean world- spread of disease/pathogens during this period

Section 6, The Seed

" Another point about women: if they have intercourse with men their health is better than if they do not. For in the first place, the womb is moistened by intercourse, whereas when the womb is drier than it should be it becomes extremely contracted, and this extreme contraction causes pain to the body.resultant sex is determined by whichever sperm prevails in quantity. For suppose that the weak sperm is much greater in quantity than the stronger sperm: then the stronger sperm is overwhelmed and, being mixed with the weak, results in a female. If on the contrary the strong sperm is greater in quantity than the weak, and the weak is overwhelmed, it results in a male." -**introduction to concept of gender in greek antiquity, even before birth social understanding that female in utero the result of weaker seed - structural level gender disparities embedded in all levels of greek society Now this consideration shows that both the man and the woman have male and female sperm. -strong sperm from strong parts of the body- child will most resemble the parent that contributed a greater amount of sperm to the resemblance (early notions of genetics/heredity) "The child will resemble in the majority of its characteris tics that parent who has contributed a greater quantity of sperm to the resemblance, and from a greater number o f bodily parts. And so it sometimes happens that although the child is a girl she will bear a closer resemblance in the majority of her characteristics to her father than to her mother, while some times a boy will more closely resemble his mother. All these facts too may be regarded as evidence for my contention above, that both man and woman have male and female sperm."

Iamata descriptions

"A man from Torone, leeches.When he was sleeping he saw a dream. It seemed to him that the god ripped open his chest with a knife, took out the leeches and gave them to him in his hands, and sewed his breast together. When day came, he left having the animals in his hands, and had become well "

Superfetation- social class

"Dip the spatulas into a solution of one of the softening agents that seems to likely to have a beneficial effect. Pounded celery seed, the seed of Ethiopian cumin and the best grade of frankincense: have her drink, in the fasting state, as much of this seems fitting, and for many days as seem necessary. Also have her eat the meat of puppy and polypus boiled in sweet wine, drink the sauce from this, take some boiled cabbage, and after that drink white wine. " likely referring to Ancient Greek heads of households who could afford frankincense and could pay for expensive drug, herbal remedies described.

Excision of the fetus (400 bCE)

"Concerning pregnancies that do not proceed in the normal way but which are cut to pieces inside, the matter is as follows. First place a cloth over the woman, girding it above each breast, and you must also cover her head with a cloth so that she will not see what you are doing and become frightened. Now if the fetus falls sideways and one arm comes out, take hold of the arm, and drawing it as far out as possible, excoriate the upper arm and strip its bone bare - text addressing high risk, difficult pregnancies with a stillborn child- try to save the life of the mother -technae/craft of Ancient Greek physician description of pain in mother whose water breaks too soon, instructions given for shaking of the patient to secure the birth presentation- "A parturient should be shaken in the following way. Spread a cloth beneath a woman, lean her back, and place another cloth over her so that her genitals are hidden; put the cover around each leg and each limb. Have two women each take hold of one leg and two others each take hold of one arm" -interesting in reference to women involved in the childbearing process despite the fact this task was described for male physicians. Women's exact function not articulated, but possible midwives Section 5- uterine prolapse can be treated by cutting the membrane of the womb, treatment would have been extremely harrowing and painful and introduced incredible amounts of bacteria to the woman's uterus Rationale is cuts into the uterus would cause inflammation that would enable the uterus to stay back in the woman's body "5. If the uterus moves outside, either from a labour or a birth and you take the women on when this has just happened, such cases are worth attempting, otherwise, decline them. You must do as follows- make incisions in the membrane of the uterus, both straight and crosswise, rub with a piece of linen..." -didactic, meant for physician who has taken on this very risky, high stakes patient

Section 3/4- The Sacred Disease

"If the disease can be cured by purification and similar treatment then what is to prevent its being brought on by like devices ? The man who can get rid of a disease by his magic could equally well bring it on; again there is nothing divine about this but a human element is involved. By such claims and trickery, these practitioners pretend a deeper knowledge than is given to others; with their prescriptions of ' sanctifications ' and ' purifications ', their patter about divine visitation and possession by devils, they seek to deceive. " "And yet I believe that all these professions of piety are really more like impiety and a denial of the existence of the gods, and all their religion and talk of divine visitation is an impious fraud which I shall proceed to expose" -references to impiety, use of magic. -Agenda of physician- take group of healers who claim to interact with the gods and claim they are frauds. Using opponents own basis in healing to defraud them.

Fractures, Hippocratic corpus

"In dislocations and fractures, the practitioner should make extensions in as straight a line as possible, for this is most conformable with nature ;* but if it inclines at all to either side, it should turn towards pronation [palm down] rather than supination [palm up], for the error is less. Indeed, those who have no preconceived idea make no mistake as a rule, for the patient himself holds out the arm for bandaging in the position impressed on it by conformity with nature" setting should occur with the natural position of the limb, description of fractured forearm- mistake of operating on the outstretched arm :But, to begin with, if the arm were kept extended in supi nation it would be very painful; anyone who held his arm extended in this position would find how painful it is. In fact, a weaker person grasping a stronger one firmly so as to get his elbow extended in supination might lead him whither he chose, for if he had a sword in this hand he would be unable to use it, so constrained is this attitude. Further, if one put up a patient's arm in this position and left him so, the pain, though greater when he walked about, would also be great when he was recumbent. Again, if he shall bend the arm, it is absolutely necessary for both the muscles and bones to have another position. Besides the harm done, the practitioner was ignorant of the following facts as to the position. T

Section 17-20

"It ought to be generally known that the source of our pleasure, merriment, laughter and amusement, as of our grief, pain, anxiety and tears, is none other than the brain. It is specially the organ which enables us to think, see and hear, and to distinguish the ugly and the beautiful, the bad and the good, pleasant and unpleasant. Sometimes we judge according to convention; at other times according to the perceptions of expediency. It is the brain too which is the seat of madness and delirium, of the fears and frights which assail us, often by night, but sometimes even by day" "The brain may be attacked both by phlegm and by bile and the two types of disorder which result may be distinguished thus: those whose madness results from phlegm are quiet and neither shout nor make a disturbance; those whose madness results from bile shout, play tricks and will not keep still but are always up to some mischief. Such are the causes of con tinued madness, but fears and frights may be caused by changes in the brain" "The brain is also the organ of comprehension, for when a man draws in a breath it reaches the brain first, and thence is dispersed into the rest of the body, having left behind in the brain its vigour and whatever per tains to consciousness and intelligence. If the air went first to the body and subsequently to the brain, the power of under standing would be left to the flesh and to the blood-vessels; it would only reach the brain hot and when it was no longer pure owing to admixture with fluid from the flesh and from the blood and this would blunt its keenness." "As then the brain is the first organ in the body to per ceive the consciousness derived from the air, if the seasons cause any violent change in the air, the brain undergoes its greatest variations. This is my reason for asserting that the diseases which attack the brain are the most acute, most serious and most fatal, and the hardest problem in diagnosis for the unskilled practitioner. "21. This so-called ' sacred disease' is due to the same causes as all other diseases, to the things we see come and go, the cold and the sun too, the changing and inconstant winds. These things are divine so that there is no need to regard this disease as more divine than any other; all are alike divine and all human. Each has its own nature and character and there is nothing in any disease which is unintelligible or which is insusceptible to treatment. The majority of maladies may be cured by the same things as caused them." A malady flourishes and grows in its accustomed circumstances but is blunted and declines when attacked by a hostile substance. A man with the knowledge of how to produce by means of a regimen dryness and moisture, cold and heat in the human body, could cure this disease too provided that he could distinguish the right moment for the application of the remedies. He would not need to resort to purifications and magic spells. - see the group with whom the author is vying for clout and legitimacy in contemporary society

Section 6-12, The Sacred Disease

"So far from this being the case, the brain is the seat of this disease, as it is of other very violent diseases. I shall explain clearly the manner in which it comes about and the reason for it." Transition into a discussion of anatomy of the brain, vascular system "the human brain, as in the case of all other animals, is double; a thin membrane runs down the middle and divides it. This is the reason why headache is not always located in the same site but may be on either side or, sometimes, affects the whole head. There are a large number of tenuous veins which extend to this structure from all parts of the body; there are also two large vessels, one coming from the liver and one from the spleen. That which comes from the liver is disposed as follows: one half runs down on the right side in relation with the kidney and the lumbar muscles, to reach the inside of the thigh and thence continues to the foot" Function of vessels in respiration also explained Description of cold phlegm causing the blood to congeal and blocking the passage of vital air. "For when cold phlegm reaches the lungs and heart, the blood is chilled and the blood-vessels, as a result o f being violently cooled in the region of the lungs and heart, jump and the heart palpitates. Such circumstances force the onset of asthma and diseases charac terized by orthopnoea because, until the phlegm which has flowed down has been warmed and dissipated by the blood vessels, it is impossible to inspire as much air as is needed. When the phlegm has been removed, palpitation and asthma stop. The length of an attack depends upon the quantity of phlegm which has flowed in. The more frequent these dis charges of phlegm, the more frequent the attacks." "All these symptoms are produced when cold phlegm is discharged into the blood which is warm, so chilling the blood and obstructing its flow.If the cold material is copious and thick, the result is immediately fatal as though its coldness had overcome and congealed the blood. If the quantity is less, however, although at first it may have the upper hand and obstruct respiration, in the end it is dispersed throughout the blood which is plentiful and warm, and if it be overcome in this way, the blood-vessels again take in air and consciousness returns" -explaining end of epileptic attack, explaining theories of phlegm, internal vascular system. Works through effects of these attacks in people of different ages (infants, adults)

Illnesses of maidens

"The beginning of medicine in my opinion is the constitution of the ever- existing. For it is not possible to know the nature of diseases, which indeed it is [the aim] of the art to discover, if you do not know the beginning in the undivided, from which it is divided out." - medicine, nature of disease depends on nature, staking out a claim for new type of hippocratic medicine "First about the so-called sacred disease, and about those who are stricken, and about terrors, all that men fear exceedingly so as to be out of their minds and to seem to have seen certain daimons hostile to them, either in the night or in the day or at both times. For from such a vision many already are strangled, more women than men; for the female nature is more fainthearted and lesser." -reference to sacred disease, seizures and terrors, depression common in women who are weaker and more prone to depression. **theme of women Girls can have episodes similar to epilepsy if they remain unmarried after they get periods. -"But I myself bid maidens, whenever they suffer such things, to cohabit with men as quickly as possible, for if they conceive, they become healthy. But if not, either immediately in the prime of youth, or a little later, she will be seized by the illness, if not by some other illness. And of married women, those who are sterile suffer this more often." -direct connection between women, health and a constant cycle of reproduction (women's place in society exemplified by giving birth constantly, and for those who did not, symptoms akin to that of epilepsy) blood flows in because of nourishment and the growth of the body, at this time the blood, not having an outlet, bursts forth by reason of its magnitude into the kardia (heart) and phrenes (diaphragm). Whenever these are filled, the kardia becomes sluggish; then from sluggishness comes torpor; then from torpor, madness. It is just as when someone sits for a long time, the blood from the hips and thighs, pressed out to the lower legs and feet, causes torpor, and from the torpor the feet become powerless for walking until the blood runs back to its own place; and it runs back quickest whenever, standing in cold water, you moisten the part up to the ankles. -explanation of blood gathering in the womb, traveling to other places like the heart, analogous to problems of pins and needles , symptoms of shivering, madness, suicidal urges Women, misled by seers make dedications to Artemis, but seers do not see that it is a result of what he outlined in terms of blood- if they conceive, they will be cured. Treatment of a social, not biological subject, place of women in society, argument for keeping women reproducing, married, to prevent these health issues. girls should marry as soon as possible, having regular intercourse (young, unmarried women or widows prone to these problems) TONE: strong, argumentative, injunction to marry as soon as possible, couched in confident language, dismissive of seers (Like sacred disease) well versed in debates on intermittent disease, sacred disease Notion of the wandering womb present throughout these treatises.

Sophocles' Oedipus the King

"new genre- greek tragedy, performed around 420 BCE- close to the time of a historical plague that struck Athens opening introduction- in which Thebes is being destroyed by plague was a response to a historical epidemic that was historicized by Thucidydes. Picture of the city- plague/pestillance has been sent down, polluted - correlation between plague and wrongful events of humans, indication of moral failings of the humans. My children, latest generation born from Cadmus, why are you sitting here with wreathed sticks in supplication to me, while the city fills with incense, chants, and cries of pain? - connected to the sins of the king himself - Townspeople gathered around in supplication- seer/priest communicated with the gods on behalf of the mortal realm. Many would have had recent (6 years prior) familiarity with a devastating epidemic. "Oedipus, ruler of my native land,you see how people here of every age are crouching down around your altars,some fledglings barely strong enough to flyand others bent by age, with priests as well— 20for I'm priest of Zeus—and these ones here,the pick of all our youth. The other groupssit in the market place with suppliant branchesor else in front of Pallas' two shrines, [20]or where Ismenus prophesies with fire. "For our city, as you yourself can see ,is badly shaken—she cannot raise her head above the depths of so much surging death.Disease infects fruit blossoms in our land, disease infects our herds of grazing makes women in labour lose their children, and deadly pestilence, that fiery god, swoops down to blast the city, emptying the House of Cadmus, and fills black Hades [30]with groans and howls." -correlation of a great plague upon a population collapsing the world of humans and plants and animals (similar to the Iliad) Townspeople of Thebes come to oedipus begging him to end the disease- find the cause for the plague which led to the blight of disease Oedipus looks for what sort of cleansing is needed -purification

Cult of Asklepios (late fifth century BCE)

- An important Asklepios cult came to be located in Epidauros as well as Athens, Pergamon and Kos (4th century BCE and later) -Cult from Epidauros spread to Athens and rest of Greco-Roman world - Abaton- places in which patients would have slept overnight, sacred place for patients. -Tholos- acoustic healing? site of sacred serpents of asclepius? Nutton, Ancient Medicine- "cult"- worship, sanctuary, sacred activities that surrounded Asklepios Throughout ancient mediterranean

Athenian Plague of 430 B.C

- Athenian plague connections with Thucydides and hippocratic treatises -lens of epidemic that battered athens, ethiopia, other greek city states - breakdown of social, cultural fronts - Thucydides was an athenian general, historian and eyewitness to the Athenian plague of 430 BCE which ravaged for four years

Agora well- why were the bones discarded of in this way?

- Instances in which the neonate has died and bodied was discarded, no burial, coffin, sort of ceremony -Ancient Greek babies, like Ancient Rome weren't considered full people until a ceremony called the Amphidromia or naming ceremony was conducted on the 10th day, which marked the end of the period of greatest danger for the infant and head of household decided whether or not to rear the child -marked entrance of baby into the world of living- if babies died before this ceremony, ended up in this well -not yet recognition of person until they had survived the risky 7-10 days after birth (bacterial meningitis, cleft palette) -improper barrier bc personhood not assigned yet. -survived and brought into the community after these 10 days

Disability in the Ancient Greek World- Sneed on the Architecture of Access

- Opens with Americans with Disability Act, ways in which legislation was meant to remove architectural barriers to access Segway into thinking about similar questions in anquity- evidence to show disabled people were brought into the fold? In the fourth century BC, for example, the city of Athens provided a daily allowance for those dis- abled individuals who were unable to support themselves financially (Lysias, For the disabled man 24; Athenian Constitution 49.4; Rackham 1935; Todd 2000). Although it is not pos- sible, on the available evidence, to determine which disabilities or impairments qualified an individual for this welfare, at least one adult male citizen with a mobility impairment that required him to walk with the aid of two crutches figures among the recipients (Lysias, For the disabled man 24; Todd 2000). While such social programmes were rare in the ancient world, allowances for disability existed in a variety of forms, including in the architecture of sanctuaries. fixed stone ramps in Ancient Greek sanctuaries The concentration of ramps at sites frequented by individuals with mobility (and other) impairments appears to suggest that the ancient Greeks consciously provided for the needs of the users of these spaces. In much the same way that sites associated with athletics were provisioned with stadia and gymnasia, healing sanctuaries were provided with the buildings and features necessary for the successful inclusion of its intended visitors in ritual activities. If there was any evidence of antiquity for interventions to enable participation of disabled individuals -one thoughtful idea was ramps for persons who did have mobility based impairments Different architectural choices, large spaces that might invite this sort of access- individuals who went to healing sanctuaries (individuals went for chronic, recurring ailments, related to infected battle injuries in times of war, fertility, open to those with mobility based impairments. Carefully planned and permanent ramps put in place in different healing sanctuaries- accessible to individuals who may have struggled with using stairs (elderly, pregnant women, small children) Impairment vs disability (biological vs sociocultural in nature) Ancient persons, resident immigrants, foreigners, slaves experiencing disability - concentration of ramps in different healing sanctuaries, perhaps way in which ancient greeks providing for needs of all citizens within healing spaces.

Galen, the Best physician is also a philosopher

- Speak to the importance of integrating the humanities with sciences, trained in thinking through logic. Bemoans overly myopic practitioners Galen's personality- arrogant, bombastic and convinced of his role as the best doctor like Hippocrates. Humanities in medicine- Wrote in the period of high Roman Empire, serious education had a grounding in hellenistic, greek curricula-hydaea- history, rhetoric, poetry and philosophy sense in treatise that during the time there was an increasing scientific specialization- emphasis among doctors on business like skills at the expense of training in the arts/humanities. moved to write with great discontent with the medical culture of his day- doctors didn't follow Hippocrates properly, lacked broader training, bad upbringing (people valued wealth over virtue) It is impossible for someone who puts wealth before virtue and studies the art for the sake of personal gain rather than public benefit to have the art itself as his goal. It is impossible to pursue financial gain at the same time as training oneself in so great an art; someone who is really enthusiastic about one of these aims will inevitably despise the other. science and medicine best practiced in a human context, should be grounded in humanistic context Doctors who understand the physical, philosophical world will know how to make the best doctor, understand ethics and will be virtuous. Treatise on Exhortation to study the arts (borders between intellectual disciplines were more permeable, urges doctors to study all of the arts) The arts, techne** sets of practices to advance humankind, scientists experts, humanists, morally responsible all related- he himself did this as well.

Types of treatment mentioned in the hippocratic corpus

- Surgery (treatment of fractures/dislocations, use of the knife, trephining and cautery) -bloodletting, purging, emetics, baths -fomentations, ointments, plasters, suppositories -Control of regimen (diet and exercise) *surgery (trepanation, cautery we have seen in ancient medicine already)

Grubbs, Infant exposures

- What happened if infant survived the harrowing birth process-- Infanticide in the greek and roman world Even if the child survived birth, may not be raised afterwards Ancient practice of ancient exposure- abandonment of a newborn within the first few weeks of life. Exposure allowed the possibility of the infant's survival and rescue by a third party. Left parents, midwifes less culpable in the infants death. Was not uncommon, and with advent of christianity later christian apologists. Was quite common in premodern world Exposure was widespread in the ancient world, where reliable means of preventing conception were not widely used and abortion was a dangerous undertaking for the mother. Hippocratic corpus- Abortion by pessary (Oath) or by jumping (Nature of the child) Always father's right to decide the fate of the baby. - often fatherless babies were exposed, illegitimate children, etc. where the mother was without means Often midwife was the one to expose infants- no father in the picture, baby was least likely to be raised. Earliest reference to exposure is clause in Gortyn's Great Law Code in Crete (450 BCE) which required a woman who gave birth after divorce to bring it to her husband and if he rejected it, she had the right to raise or expose it. If she exposed the baby without presenting it to the husband, could be fined.

Inscriptions from the Healing Sanctuaries

- descriptions would have conditioned the patient pilgrim before he even incubated -Psychologically sculpted the patient's belief of a good outcome "Antikrates of Knidos was hit by a spear through both his eyes in a battle; he had become blind and was carrying the spearhead around with him lodged inside his face. While sleeping in the Abaton, he saw a vision; the god seemed to him to draw the weapon out and fit the so-called girls back into his eyelids- the next day he left healed. "Similarly Gorgias of Herakleia was wounded in the lung by an arrow in battle and for a year and six months it was festering so badly that he filled sixty-seven bowls with pus. When he was sleeping in the shrine, he saw a vision- it seemed to him that the god drew out the barb from his lung. When the day came he left well, carrying the barb in his hands. " -person, where he came from, malady/injury, how long problem had been there, then the patient lays down to sleep in the Baton and saw a vision- Asklepius drew out the barb healing act happened during nighttime ritual- who was doing this? (priests, medical attendants?) Sanctuaries wildly popular- efficacious spaces for healing

Hays- Disease and Power

- configuration of disease as the product/bane of the powerless. - States recognized connections between population, military might, and economy- concern in the 18th century for the health of soldiers and sailors (initial state interest in health so that they could work) Vaccination -State control of smallpox inoculation in the 1800s - delivery of vaccine could cause pain, expense, inconvenience - local leaders/clergy played a role and vaccine suspicion was common -powerful arguments against mandating vaccination included the moral view of disease (disease was a punishment sent by the gods to humans- 1980s/90's response to Aids as punishment for homosexuality)(placing blame for devastating diseases)** -State rights vs family rights regarding children -Attempts to incentivize vaccinations (1835 Prussia state benefits to those who were amenable towards vaccination, parents threatened with arrest if they had a child with smallpox) -Sweden- first to eradicate smallpox in 1895, and in subsequent decades France made vaccination compulsion... while this was playing out in the west, smallpox remained a deadly killed in Asia - 1977 only eradicated in Somalia. ** constructs of power, disease, wealth- required development of a freeze-dried vaccine, inroads into remote areas. ties into global inequities vaccine distribution today. - Eugenics movements in early 1900s -US state of Washington prohibited marriage for the feebleminded, insane, epileptics, venereal disease (idea of controlling the reproductive population) (medicine disease and power **) -Vasectomies as a eugenic solution for the incarcerated in 1902. -Context for eugenics in nazi germany- 1933 German sterilization law singled out epilepsy, feeble-mindedness, deafness, blindness as genetic problems meriting sterilization (subjective categories strengthen constructs of power) 17 year old euthanized noting her feeble-mindedness and sexual promiscuity Relationship between power and disease, how medicine has been utilized by different groups to exert power, bound up in social context of disease. *** WOMEN -medicalization of pregnancy, menopause, etc. doctors could extend professional power over women -hysteria, anorexia treatment by biomedicine AIDS (placing blame ) -male homosexuals dominant in early proponents -early name- Gay related immune deficiency -Haitians, hemophilias, heroin addicts stigmatized by the disease, playing along the lines of power. -Tulsa disinfected swimming pool after gay group used it -Urging of prohibiting laws against gay people social component of disease, placing blame on the powerless. ]here is a fine line between education and con- trol."48 Some attempt at the reformation of habits, whether of the poor, the homo- sexual, or the drug user, meant the imposition of morality from "outside,"

Liston and Rotroff- Babies in the Well cont.

- not all the babies died of natural causes -one baby head fracture as a result of a abused child, jaw fracture as time of death. Liston "grim, hard to create professional distance" Question of the other remains in the well- dogs? -Synder- dogs were killed as purificatory sacrifices, relieving pollution. -Childbirth and death of neonate polluting- dogs killed to help cleanse themselves, ritually purify the area. ** shed light on infant mortality, exposure, and infanticide which were rather common in antiquity, cross culturally for premodern cultures **

Thucydides Plague

- progression, symptoms effects in context of Hippocratic corpus - interesting in terms of ancient historical aftermath of the epidemic religious measures taken to appease Apollo (god of healing in Illiad, Oedipus) 425 BCE- island of Delos, Apollo's sanctuary- purified, action in response to second major outbreak of plague in 427/6 BCE, removed graves, overhauled and enlarged festival in Apollo's honor. Altar dedicated to Apollo and Athena- documents concern health during plague years Expansion of healthcare options- healing shrines like those to asklepios, Artemis, male coming of age rituals receive emphasis during these years, dire societal concerns about depopulation, need to regrow the state and household in times of plague. CHOes in 430-410 BCE show children, need to replenish athenian population. Richer understanding of disease and healthcare- broader issues of to whom we turn to when healthcare system collapses, what happens next, are we going to see sociocultural changes after COVID, demographic changes. "symptoms by which anyone who studies it cannot fail to possibly recognize it with this foreknowledge, if it ever strikes again"/

Healing sanctuary of Aclepius

- role of social body in belief and favorable outcomes -God himself with you, incubate overnight in a space lined with testaments of the god's efficacy, previously cured individuals dedications on walls. -Spa with access to medical treatment, aspect of the divine -place to sleep and be visited by the god overnight - Sites had places for exercise called a palaestra, gymnasium, stadium, theater

Celsus- instruments for surgery

- small saw (serrula) -treatment of battle wounds -drill and chisel to remove missile wedged in joint *drawn from hippocratic treatises, Galen, celsus- similar methods, instruments.

Jackson, 'Holding on to Health- Bone surgery and instrumentation in the Roman Empire (1st century CE)

- small saw as an operative instrument, serrula- range of bow saws used by roman carpenters "Scoop of diocles" drawn from Greek, hippocratic treatises was designed to remove a broad weapon by military surgeons (basic surgical interventions important in the Roman Empire, when Rome was expanding and conquering, army- great need for specialized surgical medicine) Majority of references to bone surgery in Ancient Rome were of trepanations, which were a therapeutic measure in the treatment of epilepsy, paralysis, mental disease. 1st century CE Modiolus found all over the greek and roman world, Some reason for optimism in bone surgery of the Roman Imperial era.- Large numbers of people engaged in constant battle, roman army medical techniques carefully honed. Generally excellent operative techniques described in medical texts had their counterpart in finely designed surgical tools. By the time of the hippocratic surgical treatises measure to determine whether something was a fracture or a natural suture. -celsian version of hippocratic technique for disclosing a hairline fracture of the skull and distinguishing it from a natural suture. retract scalp and membrane and apply an inky paste, scrape off and those which are stained black are distinguished from natural sutures (innovative surgical intervention outlined in hippocratic treatises that was passed down) examples of various greek and roman tools.

Religion and Healing

-Divine, religious healing in greek, roman and Egyptian antiquity -healing sanctuary to address disease/illness to regain health vs hippocratic physicians

Section 2, the Seed

-Eunuchs used as a test case to think about impotence, seeds, reproduction - culture has taboos about human dissection, workaround "The reason that eunuchs do not have intercourse is that their spermal passage is destroyed. The passage lies through the testicles themselves. Moreover, the testicles are connected to the penis by a mass of slender ligaments, which raise and lower the penis. These are cut off in the operation, and that is why eunuchs are impotent." work through of anatomy of infertility

Epidemics in the Ancient world

-Illiad Book 1 revisited -Book of Samuel, Septuagint 2nd century BCE -Oedipus the King, Sophocles 420 BCE *Notions of guilt and causality for the plague, actions of a ruler who is symbolic of the state/city more broadly, state/people share in the sins/god-sent punishments of the ruler. *Need to purify, appease the gods, sanctify the city to eradicate this disease which is indicative of religious or ritual pollution. contrast to actual accounts of Thucidydes plague (more grounded in medical knowledge from Hippocratic corpus)

Claude Levi Strauss- the Sorcerer and his magic (1908-2009)

-structural anthropology- notion that the savage mind(colonial notions) had the same structures underpinning as the civilized mind -1949 idea - deep seated cross-cultural structures, all are equitable. -searching for underlying patterns of thought in different communities ancient medicine within communities- role of belief and community 1. Shaman from Brazilian tribe, 1938, Nambicuara Indians 2. Zuni in New Mexico, narrative of sorcery, judges didn't want to see the body reject the theory, community required the boy to validate the system. Quesalid- Kwakiutl Indian from Canada * introduce the social death of a person who is the target of sorcery, importance of group belief in efficacy of healing. "An individual who is aware that he is the object of sorcery is thoroughly convinced that he is doomed according to the most solemn traditions of his group. His friends and relatives share this certainty. From then on, the community withdraws. Standing aloof from the accursed, it treats him not only as though he were already dead but as though he were a source of danger to the entire group. On every occasion and every action, the social body suggests death to the unfortunate victim, who no longer hopes to escape what he considers to be his ineluctable fate" - certainty- as sure of as biomedicine -community isolation sudden total withdrawal of support systems.. proclamation of death- object of fear, ritual and taboo dissolution of the social personality." -importance of social group in belief, physical effects of this anxiety. -Efficacy of magical practices ( with regards to the shaman's illness in the form of a bloody worm. ------ Healer's belief in effectiveness of techniques Patient's belief in the sorcerer/healer Faith and expectations of the group (modulate healer-patient relationship) -----

Hellenistic World and Rise of Anatomy 1 (300-250 BCE)

300-250 BCE Medicine and healing in the hippocratic corpus, healing sanctuaries to short window which saw the quick rise and development of human anatomy (interventions in dissection) localized to a specific time and place - Alexandria, Egypt Sources attribute revelation of dissection to two individual physicians- Herophilus and Erasistratus (Part of the energized environment of scientific inquiry) Rise of Anatomy -interest in comparative anatomy in the Hippocratic corpus (the Sacred Disease goat brain, superfetation drew from evidence from animals in which this phenomenon was common bc it was quite rare in humans) -Decision to cut into human body extension of already established inquiry, move from looking into internal structures of an animal to human- Von Staden (fraught with taboos on human dissection, mutilation of human corpse) -Greeks had some knowledge prior to 300 BCE of the internal workings of battlefield wounds.

Healing Rituals of Asklepieia

A patient in pursuit of a cure came to Asklepieion with offerings of honey cakes at the altar. The patient would then drink and bath in the sacred waters, patient was induced to sleep in silence because it was believed that Asklepios cured the sick in dreams. During the dream, Asklepios or his snakes would give clues in regards to healing their ailments. -Small fee in order to enter the sanctuary -Then, patient would wander around the sanctuary, take in cure narratives, view the various dedications/statues, think about success of the miraculous healings. -Concept of theater of healing, social group that would have had an understanding of the sanctuary as a place in which healing took place- informed patient pilgrim before he entered the site, expectation of cure. -other healers as well in healing sanctuaries- Athens Sanctuaries of Asklepios often associated with the healing powers of sacred springs- spring and shrine behind the sanctuary of Asklepios on the acropolis, Athens. Temple, altar, gated off area- area for patients to sleep overnight. Patient is brought to holy tree to tempt snake to lick the wounds, votives from Asklepion represented a patient's ailment and their thanks for the cure. Depicted varicose veins, hand injuries. Some painted white to indicate female skin. Anatomical votives represented the ill part of the body.- Asklepius sanctuary in Corinth Testaments to rich array of cures and healings being performed. Red (male, white female). Striking comparison to modern Roman Catholic tradition.

Section 4-5, The Seed

Account of intercourse/conception, reference to part of the woman (who releases something from her body- mixing of fluids -Gendered conceptions of how intercourse was understood by male physicians :Another point about women: if they have intercourse with men their health is better than if they do not. For in the first place, the womb is moistened by intercourse, whereas when the womb is drier than it should be it becomes extremely contracted, and this extreme contraction causes pain to the body. -recurring concept of role of women in society, best for women to be exposed to constant intercourse, keep them reproductively active, reinforced gender boundaries

Dealing with Disability - Dillon

Aristotle "- in the ideal state there ought to be a specific law that no deformed child is to be raised. - Points out the provisions to disabilities in different greek city states, Sparta new born babies who were deformed and had physical disabilities would be exposed in a pit-like place near Mount Taygetos and this had the force of law. Plutarch describes the exposure of deformed children at Sparta --encountered exposure and infanticide- social scrutinies in different greek city states and in Sparta more formally organized Amphidronia festival in Ancient Athens- naming only after 10 days.

Thucydides Plague

Athenian plague of 430 BCE -succinct description embedded in larger history of Athenian- Peloponnesian war which ranged from 431-401 BCE and was a world war with protracted fighting that extended to areas like Turkey. -Pericles devised a wartime strategy for combatting the spartan infantry. In 431 BCE, Pericles tried to bring in the rural population to the city to save them from the spartan invasion, safe inside the long walls which connected Athens to the navy and harbor. Sustain population without engaging army in countryside. "and wherever each one could find a place, for the city did not have room for them. But afterwards they distributed into lots and occupied the space between the long walls and the greater part of Peiraeus." -Everyone outside of the city-condensed into tight quarters. -Epidemiology and public health- how emphatic this move was Context in which the ancient epidemic hit Athens- taking shelter in close quarters during a time of invasion, pressure on sewage system. Abundance of bodies crammed into tiny space transmitted the disease. Of all the other regions "nowhere was so serious a disease of such destruction of human life recorded as taking place" Longrigg - Death and epidemic disease in classical athens -widespread notion of disease coming from Ethiopia, same disease struck island of Lemnos earlier. Hegemonal naval league facilitated interconnected movement of people- spread of pathogens with merchants and trade goods. Athens one of the most globalized cities at the time by sea. -Reports of the plague's devastation elsewhere before it came to Athens. Ancient outbreak took time to register, sudden severity of first outbreaks led some to claim the spartans had poisoned the wells. Great confusion, panic furthered by misinformation -Physicians died in sizable numbers, hippocratic corpus guided treatments. ** What were medical approaches around 400? -treatment would have included diet and exercise prescription -administration of drugs, suppositories enemas -perhaps surgery -goal to restore health by recreating balance of humors within an individual body. Disease arose when one element gained the upper hand. Thucydides provides personal insight- "I will say what it was like in its course and describe here, as one who had the plague myself and saw others suffering from it myself, the symptoms by which anyone who studies it cannot possibly fail to recognize it with this foreknowledge, if it ever strikes again. " "When it fixed in the stomach, it upset it and discharges a bile of every kind named by the physician ensued, accompanied by a very great distress." -describes later humoral theory of contemporary hippocratic Nature of man. Clue that notion was widely present in society. -no constitution showed sufficiency against it, cared for by every regime

Von Staden, Herophilus (300-250 BCE)

By exploring, in particular, some traditional Greek ideas about, and valorizations of, the corpse, the skin, and cutting, one might begin to approach an understanding (a)of the cultural heritage that prevented human dissection during almost all of antiquity, and, consequently, (b) of the radical audacity of the human hand that first cut open cadavers for heuristic, scientific purposes. -so dramatic, ancient greeks placed a great deal of value on the inviolability of the human body, huge shift. Herophilus named the anatomical structures he discovered as Celsus stated, noted that arteries contained blood and breath, discovered brain ventricles, nerves, sensory vs motor nerves, exploration of the nervous system impressive in an age where this had been very limited. Dissected the eye, especially interested in vision and structure of eye, optic nerve duct and tract naming. Dissected male and female reproductive parts- demystified human uterus, dispensed with wandering womb idea ** discovered broad ligaments and tubes anchoring the womb in place, yet in spite this wandering womb notion continued to be popular in patriarchal societies. Anatomical discoveries so new and important- received large attention, but he also supported bloodletting, treatment by opposites, complex pharmacology, midwifery, pulsation studies constructed a portable water clock- timed pulses, delineated different pulse types, vocabulary parallels with music theory. Erasistratus- work on the heart, dissection and vivisection, showed irreversibility of flow of blood, mechanical pump/bellow (smiths) function of the heart. Valves of the heart. Disease result of mechanical failures. Later criticisms - Galen criticized him for not using venesection to remove excess blood Favored diet alterations, use of bandages which could move blood away from swollen areas, cut away liver membranes to apply medication directly, studied animals with great scrutiny. Erasistratus associated with vivisection of criminals handed to him by kinds *What is must have meant for a greek to cut through human skin, penetrate into human body for purposes of scientific inquiry. high stakes- corpse in Ancient Greek were sources of pollution, body was whole, inviolable, skin guarantor of spatial and temporal unity. Long standing cultural deterrent which fought against human dissection in the Ancient Greek world. The development of Herophilus violated longstanding taboos- striking development . Anatomical dissection disappears after their deaths and discontinued. Did not flourish/become commonplace after this- unclear why-power and insistence of traditional values in the face of what may have been seen as a new affront. Tenacity of traditional values in response to this audacious practice -Disappearance of dissection- new rival school of medical school of empiricism which claimed that human dissection was uneccessary, suggested that clinical results could be obtained empirically, attacked human dissection. Philinos of Kos (250 bce) Herophilus first to cross the last frontier into anatomy- but this crossing was very short lived. -Possible debt of Herophilus and Erasistratus to Egyptian mummification some see a non-greek, Egyptian origin for human anatomy as egypt has a sophisticated terminology, organ removal procedures- connection between embalmment and why dissection occurred here. Precedent of ritual embalming could show that cadavers could be opened with ritual/moral impunity.

Surgery, Witt

Celsus 1CE writes that surgery's effect is the most obvious of all three branches of medicine, elaborated by Hippocratic Corpus which is the oldest written source on western surgery, and second oldest in general (first is Edwin smith papyrus from 1600 BCE), and hippocratic surgical lore dates back to other treatises- Iliad describes military surgery and wound care (700 BCE) Generally speaking, the surgical treatises of the Hippocratic Corpus are very technical in that they focus on describing the different steps on diagnosis and therapy. In contrast, we gain very little information about the social circumstances of the persons involved. Fridolf Kudlien suggested dating Hippocratic treatises dealing with non-trauma surgery to the period of the third century BC or later, as it was only 'around 300 BC that the reluctance to cut was overcome Hippocratic archive of emergency surgery from which the treatises Surgery, Joints, Fractures, Wounds in the Head, Sores, and probably also the lost Wounds and Missiles are fragments. Whereas the Hippocratics practised all types of emergency surgery, including therapies of injured organs and abdominal wall sutures, elective non-trauma surgery seems to have been performed only if it was not particularly risky or detrimental to the Hippocratic doctors' reputation. Lithotomy is a risky intervention that could be detrimental to a physician's reputation, either because of the compli- cations involved or because people associated this operation with charlatanry. The Oath left it to those 'who are craftsmen in this kind Oath allegedly referred to stonecutters, semi-professional healers, as they are known from the Middle Ages and early modern times; or to surgeons This might be interpreted in a similar way as the refusal to treat hopeless cases: refusing this kind of treatment was intended to save the Hippocratics' reputation, which was judged as being more important than providing help under all circumstances.

Thucydides on the Plague

Descriptions of skin, skin temperature. "internally it burned so that the patient could not bear to have on him clothing or linen. What they would have liked best would have been to throw themselves into cold water; as indeed was done by some of the neglected sick who plunged into cisterns in their agonies of unquenchable thirst; though it made no difference. "internal burning on the ninth or seventh day" (another example of drawing on hippocratic treatises epidemics, which charted the progression of illness on a day by day basis, empirically recorded crisis) -in treating the disease contemporary physicians were met with little success Dread with which people reacted to the initial symptoms. "by far the more terrible feature of the malady was the dejection which ensued when ...." "Dead and dying lay on top of one another, and half dead men tumbled into the streets" -erosion of social values, fatalism and chaos triumphed, shameless modes of burials, multiple on the funeral pyres. -Fear of gods and law of man did not restrain people -sanctuaries of shelter filled with corpses, and people developed indifference towards sacred and profane alike. -altered the natural environment (birds left) - described the long term effects, loss of memory, extremities, eyes. Thucidydes notes that the epidemic was not a one-off -resurged and persisted for 6 years total, second wave in 426 BCE. Disease never fully left the city. Untold number of athenians died, up to a third of the population which doesn't count for immigrants, women, or slaves. Population of athens in 430 BCE- loss of over 100,00 with plague and war. -Lurid and medically attentive detail- description could have been exaggeration because the account contrasts with Pericles' funeral oration which praises Athens handling of the plague, external material evidence enhances our understanding- archaeological understanding links the plague with -Kerameikos cemetery mass burials -First mass grave, hastily dumped bodies, shallow, Five successive layers of bodies, males and females interspersed, heaped atop one another. (dated on the basis of pottery found in the grave, vases found in pieces, showing the haste) - interrment supports date of plague 420s BCE. Disregarded bodies dissimilar to proper athenian ritual burials.

Lysias 24

Defending his right to the allowance, which he has received for many years but which had been disallowed in the latest dokimasla, the speaker of Lysias 24 stresses that he has no property: My father bequeathed me nothing, and I only stopped looking after my mother when she died two years ago, and at this stage I have no children to care for me, I carry out a trade (techne) which gives me but little help, and it's a difficult one for me to Work at, and I'm not able yet to find someone who could take over the work of it for me. I have nothing to live on bar this payment: if you take it away from me, I would be in grave danger of being in the most dreadful circumstances -Careful to cue that he has no inheritance, no children who could care for him- During the man's scrutiny, has to show no money, notes that he has a trade(shoemaking or metal sales), without state disability benefit the man would not be able to sustain himself. Clever line of argumentation - IF the speaker is NOT disabled, he should be able to exercise his citizen right to the fullest extent possible. "At Kos and other places, laws discriminated against the disabled, not by naming disabilities which made people ineligible for religious roles, but by ruling that priests and priestesses had to be 'whole of body'. Appealing to the religious sensitivities of the bouleutai, the adunatos facing disqualification in Lysias 24 advances a very persuasive argument when he puts this proposition to the bouleutai: if the prosecutor convinces them that he is not disabled, he can exercise his citizen rights to their fullest possible extent: Ifhc should convince you that I am sound of body, boule, what is to stop me from drawing the lot to hold office as one of the nine archons, and you from divesting me of the one obol, as being of sound health (hygiainontos), and all of you voting to award the obol to this man as being a cripple ianapiirosft For actually, if you took away this allowance from me because I am sound of limb (dynamenos)" Payments to the adunatoi were a realization of the fact that adunatoi, unlike other citizens, could not draw pa (misthas) for political office, and in particularly could not draw the most common paymc~ which 6,000 citizens did, chosen each year to be dikastai jurors. -Archon- highest offices in the state, oversaw aspects of democracy, religious obligations, sacrifices, officiating festivals Because of his disability, speaker is not eligible for these higher offices- proof to the council that he should be eligible for this disability benefit. If he is not disabled, he should be able to run for this. - Speaker gestures towards his walking sticks, in dialogue with council about impaired mobility- socially degrading bc opponent said he was riding horses (speaker describes how he needs to borrow horses because he cannot Walk, cannot afford any other means of transportation) Natural for all persons who have had a misfortunate of this kind to seek a way to cope with their distress with as little stress as possible (making a case for a very human condition- thinking about data in the Sneed article, where today 15% of the world's population live with a disability of some time, hard to try to estimate what that would have looked like in antiquity, present and quite common- thinking about what life would have been like for those individuals.

*living as a woman in Ancient Greece

Diseases of women- argued that childbearing benefits women's health and differences in bodily constitution of men and women are explained Illnesses of maidens "But I myself bid maidens, whenever they suffer such things to cohabit with men as quickly as possible, for if they conceive they become healthy. But if not, either immediately in the prime of youth or a little later, she will be seized by this illness, if not by some other illness. And of married women, those who are sterile suffer this more often."

Surgery in ancient medicine

Egypt -1600 BCE Edwin Smith Papyrus -Case four, practice for a gaping wound- manage him with oil, supports of bricks, no bandage Excerebration in the Egyptian tradition- removal of brain for the embalming process In ancient americas/china- southern russia/georgia- Trepanation- preceded the interventions of the hippocratic treatise- trepanation aimed at treating subdural and epidural hematomas- an accumulation of blood in the brain due to a severe head injury -subdural space in which concentration of blood built up- trepanation alleviated.

Greek Medicine at Rome, King

From third century BCE onwards, strong Greek influences on Roman medicine, roman medicine was presented as something more simple, cheap and effective than Greek medicine. Roman medicine was performed within the family and seen as traditional, stable and trustworthy. Greek medicine done by others for a fee. As Rome came to eclipse the eastern mediterranean,greek and alexandrian medicine flows in . Galen pored over hippocratic treatises, close readings of texts and wrote interpretations of treatises, commentaries, interpreted them and gave them authority, claimed expertise. Many texts came to last so many decades subsequently. passed down into medieval Europe, Arabic east, piece in historical puzzle.

Religious Healing: healing sanctuaries

Healing sanctuaries housed different deities- most famous was asclepius in Ancient Greece, Gula in Ancient Mesopotamia. Tradition of religious healing, incubating and receiving a cure from a deity translated cross-culturally Disease as not confined to the private realm, concern of the community, prerequisite for a thriving community- communal concern Different cities opted to house these healing sanctuary within their borders. array of medical options- consult a hippocratic physician, get a purification/amulet from a ritual practitioner, religious healing/temple medicine.

Section 12, the Nature of the Child

If the seed which comes from both parents remains in the womb of the woman, it is first of all thoroughly mixed together - for the woman of course does not remain still - and gathers into one mass which condenses as the result of heat. Next, it acquires breath, since it is in a warm environment. When it is filled with breath, the breath makes a passage for itself in the middle of the seed and escapes.Once this passage of escape for the warm breath has been formed, the seed in spires from the mother a second quantity of breath, which is cool. It continues to do this throughout the whole period: the warmth of its environment heats it, and it acquires cold breath from the mother's breathing (process of developing the seed, crucial role of breath in the process (pre-socratic thinkers thinking about air as the most important element)) Integrated into embryological theory of breath animating mass forming in utero.

Women and wandering womb

Notion of the wandering womb- throughout the greek and roman period, medical texts and itinerant ritual practitioners primarily seemed to be comprised of womb healers and authors were exclusively male - concept of the wandering womb even after dissection and anatomical inquiry discovered presence of ligaments enforced patriarchal ideas of early marriage and constant intercourse.

Incubation

Nutton -When individuals were sick, option of visiting the sanctuary of asclepius- complex pilgrimage site with place to speak, spa-like sanctuaries, stay for several days -Purifying baths, fasts, foods that were excluded -sleep in a special, reserved building (Abaton)- curative sleep -comes from latin word to lay down/recline -Key ritual that led to a cure of the illness/disease in these sanctuaries. Part of the processes- idea that Asclepius would come and visit the patient by way of a dream/epiphany and either perform a cure for the patient or prescribe a regime for cure that the patient would then be able to act upon. -in the dreams the god either cured the patient or gave instructions for treatment regimen. God made himself apparent to incubating patient and priest decoded them. -After patient regained health, set up thank you to Asklepios in a dedication. -Inscriptions found by 19th century greek archaeologists in the Abaton.

Septuagint, Book of Samuel

Plague, ruler- theme throughout primary source texts Reference to a prophet, David's seer. Choice of three years of famine, three days of plague, three months of fleeing form enemies- with this choice a plaque was sent to Israel by the lord god. - One response to the plague- altar built to the lord so that the plague wound end **notion of plague divinely sent for a human action. So David bought the threshing floor and the oxen and paid fifty shekels[e] of silver for them. 25 David built an altar to the Lord there and sacrificed burnt offerings and fellowship offerings. Then the Lord answered his prayer in behalf of the land, and the plague on Israel was stopped. mustbeworthtotheofferings Same tropes of plague sent in response to human missteps. Similar to book 1 of homer's Iliad conceptions of plague, reasons for how it was sent, offerings appeased the gods which alleviated the plague.

Leven reading - Retrospective diagnosis

Problem of retrospective diagnosis, applying present medical knowledge to ancient sources Texts about health and disease do not transmit data which can be analyzed by modern medicine, but transmit concepts shaped by medical knowledge and worldviews of the time (Thucydides description of bile, crises- Hippocratic corpus) Worldview incomparable with our present medicine. Pathomorphosis- relations between microbes and man evolving Virgin soil encounter- the first time the infection falls upon the population would spread explosively and show unique symptoms. aLlows for premise of vanishing in that form. not comparable with return of the disease, retrospective diagnosis futile. So it is hardly possible to identify the Athenian plague, which spread explosively, with a disease which in early mod- ern Europe became an endemic childhood disease. The theory of a 'virgin soil encounter' at Athens finally allows for the possibility that Thucydides' plague hit once and then vanished forever. Some sim- ilarities between the plague of Athens and modern infectious dis- eases, like smallpox, measles or typhus, in this case would be by mere chance.

Publius Aelius Aristides (117-ca. 180 CE), The Sacred Tales

Recount his various visits to the sanctuary of Asklepius- leaves us with specific accounts of what happened to him and outcomes. submitting to a series of invasive examinations, he failed to get a diagnosis, let alone a cure, and he returned an invalid to his hometown of Pergamum, on the west coast of Asia Minor. It was around this time that he started receiving dreams from Asclepius, the most popular healing god in classical antiquity (and one of the most stubborn holdouts against that arriviste healer Jesus Christ). Not even the dreams provided all the answers. But they did offer clues, triggering a practice of daily decoding and therapeutic response to what settled into a chronic condition, as well as a lifelong cult of devotion whose most tangible evidence is the hefty bulk of the Sacred Tales (itself culled from a larger lost archive).

Archaeological evidence of athenian plague

Research projects -Greek archaeologists facially reconstructed an 11 year old female resident of 430 BCE athens named Myrtis - evokes grief and loss of the city (whose identity may have been untold in writings like Thucydides) -Molecular DNA testing of three teeth - incriminates typhoid fever as a probable cause of the plague of athens using PCR and compared to presequenced DNA of known diseases. 93% similarity to typhoid fever. Mutation of strain over time to better infect. but pretty soon after claimed not to be true-hundreds of scientific literature on what the disease may have been? -Tyhoid, smallpox, measles? ? Physicians sorted through thucidydes accounts and tried to sort through what the disease could be.

Cornelius Celsus

Roman encyclopedist known for his work De Medicina- a primary source on diet, pharmacy and related fields, one of the best sources concerning medical knowledge in the Roman world (25 BC-50 CE) *lasting impact of hippocratic surgical treatises

Lysias, 400 BCE

Speech writer around 400 BCE Paid to write compelling speeches for delivery in the law courts Speech written for scrutiny by the Athenian Council of 500

BBC articles- bridging the wandering womb with present day

Taboos surrounding women's activities and rights in Ghana, India In antiquity women couldn't access shrines, temples during menstruation. Menstruation taboos in modern communities surrounded in power structures that prevent girl from receiving an equal education. This too serves to regulate and police female behavior.

Gender in the Temple- Scott

Take of Ithmonika who incubated for pregnancy - differs from earlier accounts of battle wounds, long term arrows in the lungs filling up cups of pus. -Hoping to give birth to a child, didactic cure with asking the god for everything you need (not just pregnancy but pregnancy and delivery)

Section 17-18, The Nature of Man

The bones grow hard as a result of the coagulating action of heat; moreover they send out branches like a tree. Both the internal and external parts of the body now become more distinctly articulated. The head begins to project from the shoulders, and the upper and lower arms from the sides. -understanding of fetal growth, rooted in natural phenomenon "By now the foetus is formed. This stage is reached, for the female foetus, in forty-two days at maximum, and for the male, in thirty days at maximum" another important distinction, inbuilt biases Women as formed from the weaker seed, and take longer to form, absence of proper growth as compared to their male counterpart. theories about baldness, return to eunuchs, discrepancies between boys and girls First fetal movement 3 months boys, 4 months girls Breast milk "Now when a seed is planted in the earth, it is filled with moisture from it (the earth contains many different varieties of moisture, which is why it can nur ture plants). Once the seed is filled with moisture, it becomes inflated and swells." Comparison to plants, significance of temperature and seasons, winds come from water, process of growth in plants and humans seen as the same When it is time for the mother to give birth, what happens is that the child by the spasmodic movements of its hands and feet breaks one of the internal membranes. Once one is broken, then the others of course are weaker, and these break too in order of their proximity to the first, right up to the last one.When the membranes are broken, the embryo is released from its bonds and emerges from the womb all -agency given to fetus over mother twins produced from a single act of intercourse

Iamata

The healing- refers to healing sanctuary of asclepius and miracle cures. (5th century BCE)

Living as a woman in Ancient Greece

The seed and nature of the child embryological treatises explored the growth of the embryo and problems of generation, heredity and sex differentiation The seed is when what is provided by the man and what is provided by the woman is mixed together. -if both partners produce a stronger sperm then a male is the result, if they produce a weak form, then the female is the result. Section 13- administering of an induced miscarriage in The Nature of man Males formed in 30 days vs females in 42 -formation of the extremities, hair and nails described, theories on baldness with regard to eunuchs -growth of the child in utero is likened to growth of plants, trees, cucumber in a jar, etc. (paradigm shift from plague arrows from Apollo in Illiad)

Section 3, the Seed

The sperm is, as I say, secreted from the whole body - from the hard parts as well as from the soft, and from the total bodily fluid. This fluid has four forms: blood, bile, water *subbed for two forms of bile* and phlegm. -Humoral theory, but different than those encountered in On the Nature of man , another inconsistency in hippocratic corpus

332-1 BCE, Alexander in Egypt

Window of Anatomical Dissection- Alexander the Great of macedon conquered egypt and brought the Egyptians under greek rule, after his conquest, city of Alexandria named after him, founded on one of the mouths of the Nile river. Extremely important port city connecting the Nile to the mediterranean. Alexandria founded as a greek city, under general successor of Egypt Ptolemy Came to host a supportive environment for intellectual innovation (Library of Alexandria-poets, geographers) Largest collection of books/knowledge, ships sailing in and out had to stop, give over books) frontier society free from longstanding greek taboos about the human body Medical knowledge -Under Ptolemys ripe ground for human dissection. King centrally controlled political action and religious life. similarly the kings who handed over condemned criminals and corpses to Herophilus and Erasistratus for experimentation, including dissection and vivisection. Celsus (later author of roman period but primary source for works of Herophilus and Erasistratus) Ptolemy- set up a system of patronage Premium placed on innovation- unshackled freedom to pursue artistic and scientific inquiry and experimentation. Ptolemys presented themselves as the royal heirs, perpetuators of older Egyptian customs, demonstrated willingness to break with traditional greek customs/taboos. Long standing native traditions went over greek traditions. (egypt anatomical dissection frequently practiced through mummification, embalmment) 300-250 BCE - human cadavers systematically dissected, and only resumed in the 14th century CE after this due to taboos.

Diseases of women

Women's flesh described as softer and more spongelike, with a tendency to absorb moisture in greater quantities than men's flesh- significant for humoral theory, inherent difference for women. warmer blood (all the previous theories like Regiment, Airs waters places water on health inherently different for women vs men due to structural dif between women and men) Argued that childbearing benefits women's health and differences in the bodily constitution of men and women are explained. _major point- childbearing benefits women's health which justifies why women should continuously be reproducing. sections 2-6- discussion of menstruation section 7- fascinating discussion of uterine suffocation, womb displacement., wandering womb Explanations for failure to conceive, connections to excessive moisture in the womb (inherent difference in flesh of men and women) discussion of phlegm, humoral theory, fumigation treatment, insertion of smoke, incense with a reed, lead probes, etc. Inherent is the notion that women knows if or when she has conceived, when women should refrain from walking uphill etc. regimen. Excerpts of the difficult birth presentations, prescriptions/recipes for pain relief during labor. *Treatise amalgamation of therapeutic measures, importance of childbirth and continuing fertility is portrayed throughout. Cantharid- beetle-type bug, women treated with recurrently (bacteria introduced to a woman after childbirth, unpleasant, dangerous interventions"

Trephination

a surgical intervention where a hole is drilled, incised or scraped into the skull using simple surgical tools. The dura mater is exposed, used to treat intracranial diseases, seizures, primitive form of emergency surgery to remove shattered pieces of bone from fractured skulls after receiving a head wound. Evidence for trephination occurs from prehistoric times in the forms of cave paintings and human remains from the Neolithic period onwards- France around 6500 BCE (thousands year older than Otzi), skulls show signs of healing and indicate the patient lived for years afterward. Hippocratic treatises- mention trepanning, Galen mentioned as well

Surgery, Celsus' De Medicina

appreciated the need to eradicate all of the diseased flesh and bone, which involved cutting into the sound tissue slightly, understood the need to allow an exit for fluid after surgery and closure of the wound (used until WW1) -drew heavily on greek sources, including On wounds in thread, on surgery, fracture ,joints, and alexandrian and roman surgeons Book.8 gives a detailed account of the techniques and tools of skull surgery (carpentry on the cranium, verbs of cutting, sawing, drilling, gouging) Surgery was often viewed as a last resort sourced from archaeological/funerary contexts paired with Celsus' writings. C

-Treatments for wandering womb

attempted to fumigate, let the uterus flee downward, or sweet smelling perfumes were used to attract the errant womb to its rightful place

Timaeus

by Plato- describes how male penis and female uterus are animated creatures in their own right. account of the wandering womb

The Nature of the Child, Hippocratic corpus

likely understood with the Seed - Articulation of growth in the womb

Votive relief of Archinos (370 BC)

dedicated by a patient to a healing god, Amphiaraus -gets at the question of the incubation process- patient pilgrim comes to healing sanctuary, reclines, and while he is dreaming sees a epiphany of the healing god, dreams that the healing god touches his right arm and heals it- in the relief the snake is viewed as licking the arm. Final part of the healing process is the patient setting up a dedication commemorating the healing god.

Section two, The Sacred Disease

disease does not differ inherently from other diseases in character or origins- affects those of phlegmatic constitutions -Already see author tapping into the worldview of humoral, elemental theory. insight into how faith healers were performing their practice. Careful reference to foods that ritual healers forbade, striking attention to detail in the argument Intervention into diet and regimen (similar to other hippocratic practitioners) "By invoking a divine element they were able to screen their own failure to give suitable treatment and so called this a 'sacred' malady to conceal their ignorance of its nature. By picking their phrases carefully, prescribing purifications and incantations along with abstinence from baths and from many foods unsuitable for the sick, they ensured that their thera peutic measures were safe for themselves. The following fish were forbidden as being the most harmful: mullet, black-tail, hammer and eel. Goat, venison, pork and dog were considered most likely among meats to upset the stomach."

Jouanna, J- Hippocrates and the Sacred

doctors of the hippocratic corpus clarified the disease 'called' sacred to distance it from a traditional meaning that did not correspond to their understanding These people," he declares, "using the divine as a veil and defence to hide their own inability to give any useful prescription, suggested that this disease was sacred in order to avoid that their total ignorance be obvious."18 The criticism is very outspoken, no less than that of Oedipus against Tiresias. Just like, according to Oedipus, the seer is blind to the art of divination, so, according to Hippocratic medicine, healers that sacralised the disease are totally ignorant of the art of medicine. Just as Oedipus wishes to uncover the deception of the seer that acts with hidden cunning to deceive him, the Hippocratic author denounces the imposture of healers that use the divine to deceive patients. Competitive medical marketplace, competition between enlightened doctors and charlatans, rivalry between seers and doctors, period where medical profession was not guaranteed by titles. Rejection of impotence in the Scythians as caused by divinity in Airs, Waters,Places, but less harsh than The Sacred disease bc the author is not dealing with any potential competitors *Significantly, both in Airs, Waters, Places and in The Sacred Disease a divine conception of disease is criticised, but the notion of the divine, far from being rejected, is preserved in the Hippocratic author, and given a new explanation instead. **Thus, the traditional belief in the gods, far from being criticised, serves to denounce the falseness of the belief in the divine origin of a particular disease. In The Sacred Disease, the position of the doctor regarding traditional religion is even clearer. He defends traditional religion, accusing his adversaries of impiety and atheism: "It seems to me that their discourse is not pious, as they suppose, but rather impious and atheist; what for them is pious and divine, in reality is impious and unholy."31 In particular, he highlights the impure and impious character of their treatment through purifications and incantations. The first is that, despite a common element of rationalism that unites the treatises, it would be futile to suggest that all the Hippocratic doctors held a unified position on the sacred. The second is that their rationalism, even in those cases where they oppose superstition and magic, is not atheistic **lthough openly attacking the seers and charlatans, alongside whom they practiced an unregulated art, these doctors never oppose the traditional religion of the great sanctuaries. Their rationalism was not atheistic, and they could reconcile concepts of the divine, such that one founded medical science and the other a purified religion. The development of rational medicine in the fifth century was in part probably the work of members of an aristocratic family that claimed to descend from the god Asclepius.

Dokimasia

examination of adunatoi to determine rations Lysais (crutch walking sticks, inability to move frequently references) Difficult even for those eligible. The dokimasia of a disabled citizen involved him physically displaying the disability which rendered him unfit for work and would need to take place within a venue and by a political body which could clearly see his infirmity or in the case of infirmities such as blindness, could be carried out at close quarters. Assessment of other forms of income were conducted and individuals could come under fire for another craft. The speaker of Lysias 24 enjoins the Boule to believe the evidence of its "own eyes Aristotle describes "A dokimasia of the adunatoi is carried out by the boule: for there is a law (nomos) which prescribes that those who own less than 3 mani worth of property and are disabled, with the consequence that they are unable to carry out any work, are to be scrutinized by the boule, which is to give them 2 obols a day for sustenance from public money. There is a treasurer for the adunatoi, being elected by lot. "

Female Patients, Lesley Dean Jones

exercise and advice in the corpus on regimen not fully applicable to women who need to nourish the embryo Frequent intercourse recommended as a preventative measure, threat of dry womb Wandering womb- belief began because the male body was taken as paradigmatic of the human body and because it had no place for the womb, there could not be one in the emale body either. Trapped menses caused a wide variety of non-gynecological diseases Menstruation an important prognosticator in women's illnesses, women as an afterthought Women characterized as distinct, with spongy flesh and if becomes pregnant- blood serves as a function of nourishment for the fetus and if not can be trapped in the woman's body and cause a variety of ailments

Galen

greek physician from Pergamon, prominent physician, surgeon and philosopher in the Roman Empire. Came to influence physiology, pathology, pharmacology, and logic. Though born in Pergamon, traveled extensively, familiarized with a wide variety of theories (200 AD) Galen's medicine lay in his conviction of the supreme importance of anatomy- Traveled extensively, wide variety of medical practice, intervene with herbalists who had new bloodletting practice or plant * influenced by four humors from on the nature of man Theories dominated his own understanding o medicine, western medical science with Galen as an intermediary Long thread of continuity in western medical practice. Produced a lot of anatomical reports based on his own dissection of animals, apes and pigs- dissections remained largely uncontested until the mid 1500;'s CE when Vesalius started work on human dissections. Galen was building upon his greek predecessors and doing dissections himself- great deal of work pertaining to human anatomy . Medical students still studying writings of Galen into 19th century CE Galen's writings translated to arabic, greek, latin - many also destroyed in intervening centuries. Galen's writings on anatomy in medieval Europe became the mainstay of the medieval physician's universal curriculum. Even though some of his ideas were incorrect bc he did not dissect, work still remain important through the renaissance. Emphatic on importance of observation, correlated pulses with diseases, understood surgical intervention as a last resort with the important exception of bloodletting- type of therapeutic regimen, should be done thoughtfully so. Intervened in diet, exercise, sleep and the environment. Relate properties of food to the four humors (warming food etc. ) IN line with hippocratic predescessors many books on pharmacology-drugs acting through qualities like hot and cold, wet and dry, intervene pharmacologically to restore the body;'s natural balance- Galen became a figure of legend, poster child of medicine in subsequent literature including greek, latin, arabic and Syriac translations. Alexandria- premier center for medical education- sense that until the Renaissance (around the 14th century, we see input of human dissection again- when aspects of Galen's anatomical work was corrected) Galen was seen as the culmination of medicine. Firm final words on medicine. Lots of ancient papyri from Roman Egypt- fragments of his writings (medical and philosophical) By 3rd century CE, soon after lifetime, people copying out his works. Centuries later, after Alexandria captured and conquered, Galen still read and understood as the cornerstone of medicine- Survived in Arabic tradition. Vast corpus- commentaries on hippocratic treatises passed down to us (Nutton, Ancient Medicine and Disease, Galenic medicine)

excision of the fetus themes

in general, treatise is concerned with difficult problems of obstetrics in antiquity cutting the fetus to pieces in the uterus to save the women's life risks of pregnancy and childbirth in antiquity practical, surgical stance Not ascribing to the oath bc of cutting diversity of voices in hippocratic treatises ** Uterine prolapse and radical therapy-- instruction to treat according to what has been said - wider context with other gynecological treatises In section 5 of the greek text, nuance that the practitioner, physician wielding the scalpel is male (masculine participle used in greek) In section 4- greek text- four persons performing the shaking or shaking were women, unique insight into practice (late 5th century BCE)

NatGeo- Healing power of faith

likewise described the importance of a group in healing -the impact of a social group could help explain why religion may be the opium o ht masses- tap into the ability to access our own store of beliefs and expectations - role of group belief in treatment efficacy -Placebo effect- theater of medicine symbols that hospitals can manipulate for the patient's benefit including the White coat, tests, diplomas on the wall. Doctor, patient and social group create the items as symbols and tools in the healing process. -importance of the mind in the process of healing CASES @ Mike Pauletich- Parkinson's, progressively degenerative 2011 took part in Ceregene study experimental therapy where they cut two holes in each hemisphere of the brain and inject the drug (simulation of actual operation) (trial had failed, and Mike had gotten a Placebo but he showed impressive results, shaking disappeared, mobility improved, speech clearer. Aspects of disease even reversed, extremely rare. Placebo effect and theater of healing- placebos can tap into neurochemical mind-body mechanisms (fake surgeries powerful placebos, * a supportive patient- practitioner relationship was key in creating belief in a successful outcome (patient, healer and broader social community levels of belief) @Healing is instinctive, how does theater of medicine work? -Classical conditioning- Scientists train immune system of rats by pairing sweet liquids with cyclosporine A, a drug that blocks the function of immune cells to keep patients from rejecting transplanted organs. Every time the rat gets the sweet drink, it also gets the drug- but after enough trials the sweet drink alone is enough to shut down the rat's immune response Conditioned response of placebo to pain is to release endorphins, painkillers, expectation of pain relief

Homer's Iliad

plague sent by Apollo, god of plague, healing Plague arrows raining upon the greek army and animals. "So he prayed, and Phoebus Apollo heard him. Down he came, in fury, from the heights of Olympus, with his bow and inlaid quiver at his back. The arrows rattled at his shoulder as the god descended like the night, in anger. He set down by the ships, and fired a shaft, with a fearful twang of his silver bow. First he attacked the mules, and the swift hounds, then loosed his vicious darts at the men; so the dense pyres for the dead burned endlessly.For nine days the god's arrows fell on the army, and on the tenth Achilles, his heart stirred by the goddess, white-armed Hera, called them to the Place of Assembly, she pitying the Danaans, whose deaths she witnessed. And when they had assembled, and the gathering was complete, swift-footed Achilles rose and spoke: 'Son of Atreus, if war and plague alike are fated to defeat us Greeks, I think we shall be driven to head for home: if, that is, we can indeed escape death. But why not consult some priest, some prophet, some interpreter of dreams," -consultation of seer/prophet- role of intermediary figures, notion of purification- men had to purify themselves and wash themselves in salt water, offer a sacrifice to Apollo Remission only after Chryses the priest who had prayed to Apollo received back his daughter.

Faraone, Wandering Womb

starts in period of plato and hippocratic authors, continues down in time to think about doctors and exorcists of Roman and byzantine periods Womb as a wild animal controlled by fumigations, other treatments Situated in terms of ritual practitioners and healers, including exorcists and purifiers. Overlap between these different groups that accounts for the robustness of this theory by 400 BCE. What could prevent a wandering womb? -Best was marrying as close to menarche and possible engaging in repeated intercourse, doing this would keep the womb always moist or always weighted down, incapable of movement. -Ability of the womb provided an ideal justification in enabling the social idea of a woman's existence within a patriarchal society, perpetuated idea of repeated pregnancy, intercourse -Complications due to wandering womb result of social hierarchy breached. Treatments included fumigations, substances like wool, asphalt, castor oil, sulfur to shift the womb. uterus a sentient creature - passage from plato which describes the womb as a living creature similar mechanism in on illnesses of maidens - in some girls the first menstrual blood is trapped and can't find an exit and can flood into the heart which would create suffocation just as the wandering womb did- Illnesses of maidens likewise compares this condition to epilepsy as described in On Sacred disease sees as a blocked passage. Evidence for ways in which writers found medical justifications for women's place in society. advent of human dissections in Alexandria in the early 3rd century found tendons and ligaments anchoring the uterus in place (brief window in which vivisection was tolerated) but this did NOT displace the notion of the wandering womb0- still so firmly in place that we find references in later Roman handbooks Through these various iterations, fumigation treatments, lay within the realm of male practitioners and ritual experts and new hippocratic physicians.

Nutton, Medical meeting place

vast medical marketplace, variety of healing practitioners, - ancient medicine enshrined in a wider social context- Healers working, teaching praying and competing together

superfetation - on conceiving a m vs f child

when he wishes to beget a male child, let him have intercourse when his wife's menses are ceasing or have stopped, and he should push very hard until he ejaculates. When he wishes to beget a female child, he should have intercourse when his wife's menses are still present and flowing in their greatest amount, and also he should bind up his right testicle as tightly as he can stand. When he wishes to beget a male child, bind up the left testicle.

Section 13, the Nature of the Child

"As a matter of fact I myself have seen an embryo which was aborted after remaining in the womb for six days. It is upon its nature, as I observed it then, that I base the rest o f my inferences. It was in the following way that I came to see a six-day-old embryo. A kinswoman of mine owned a very valuable danseuse, whom she employed as a prostitute. It was important that this girl should not become pregnant and thereby lose her value. Now this girl had heard the sort of thing women say to each other - that when a women is going to conceive, the seed remains inside her and does not fall out. She digested this information, and kept a watch. One day she noticed that the seed had not come out again. She told her mistress, and the story came to me. When I heard it, I told her to jump up and down, touching her buttocks with her heels at each leap. After she had done this no more than seven times, there was a noise, the seed fell out on the ground, and the girl looked at it in great surprise. It looked like this: it was as though someone had removed the shell from a raw egg, so that the fluid inside showed through the inner mem brane - a reasonably good description of its appearance. It was round, and red;" -Personal anecdote, author giving proof for his claims -levels of removal prostitute has over her own body, owned by another person, physician author male (gender and social hierarchies) -careful description of his understanding of embryo (Drawing from personal experience as a physician, insight into methodology)

section 10-12, The Sacred Disease

"Should these routes for the passage of phlegm from the brain be blocked, the discharge enters the blood-vessels which I have described. This causes loss of voice, choking, foaming at the mouth, clenching of the teeth and convulsive move ments of the hands; the eyes are fixed, the patient becomes un conscious and, in some cases, passes a stool. I will explain the reason for each of these signs." accounts for the different symptoms of an epileptic attack "Infants who suffer from this disease usually die if the phlegm is copious and if the weather is southerly. "(brings to mind Airs, Waters, Places- circulating corpus of medical knowledge) "Adults neither die from an attack of this disease, nor does it leave them with palsy. The blood-vessels in patients of this age are capacious and full of hot blood; as a result, the phlegm cannot gain the upper hand and chill and freeze the blood. Instead the phlegm is quickly overcome as it is diluted by the blood, and the vessels take in air again so that conscious ness returns and the symptoms mentioned above are less pronounced owing to the strength of the patient." "Cases who have been free from the disease in childhood having their first attack after the age of twenty are very rare if not unheard of. At this time of life the vessels are filled with a great quantity of blood while the brain is stiffand solid. There is thus no discharge into the blood vessels or, if there is, it does not overcome the blood because this is so ample and warm." "When the disease has been present from childhood, a habit develops of attacks occurring at any change of wind and specially when it is southerly. " strong parallel to airs waters places. "This is hard to cure because the brain has become more moist than normal and is flooded with phlegm. This renders discharges more frequent." "This observation results specially from a study of animals, particularly of goats which are liable to this disease. Indeed, they are peculiarly susceptible to it. If you cut open the head you will find that the brain is wet, full of fluid and foul smelling, convincing proof that disease and not the deity is harming the body. It is just the same with man, for when the malady becomes chronic, it becomes incurable" -In Ancient Greece, no access to internal human dissection/anatomy, dissection taboo BY 400 BCE_ people were conducting inquiries on animals- goats which also suffered epileptic attacks. Proof of what happens int he human body, proof of natural causes, not gods Climatic conditions frequently flagged, changes in wind direction thought to precipitate changes- southerly winds are often implicated- fleshed out in Airs, Waters and Places ** (some scholars think written by the same author)

Section 9,10 the Seed

*Explanations of birth weaknesses and deformities in the child are blamed on the mother's womb harkens back to the Nelkin and Gilman article on placing blame for diseases -- cause understood to be constriction of female womb during pregnancy (analogy from natural world of cucumber growing in a small vessel) "It is similar to what happens if you place in a narrow vessel a cucumber which has finished flowering but is still young and still growing from the bed." Looking to nature to explain birth deformity, understanding workings of human body. -likening of female womb to agricultural space Placing blame -deformities blamed on contusion to the mother's womb - when contusion is extensive, membrane enveloping embryo is broken and it is aborted. Another analogy to trees which grow when obstructed in the roots by a stone.

Why did the construct of the wandering womb persist?

- Theories that account for origin around 400 BCE **may have originated due to uterine prolapse- protrusion of uterus outside the woman's body, women's uterus would have left the internal vaginal cavity. (dean Jones) Treatment of uterine prolapse as defined by Diseases of women included attaching the woman's feet to a ladder with the head down and pushing the womb inside with one's hand (ladder treatment typically used for curved spine but used in ***three cases in gynecological treatises to treat prolapsed uterus) Assumption that because the male body has no uterus and was understood as the default body- in women the uterus must have been a wandering, moveable entity. Treatments of the wandering womb seemed to suggest as Faraone argues, that this was developed by male practitioners that served to justify women's subordinate place in society and encourage them to reproduce as much as possible. Built into this notion was that the female body had internal tubes through which the womb could wander, from the vagina up throughout he diaphragm to nostrils. Notion is assumed in many treatises, especially in tests and recipes for conception. Women would sit over something strong smelling and would test if they could smell, which would indicate the internal passageway was open. Aristotle differed slightly from plato noting that the womb of animals and humans was held in place by tendons. Still, he thought the empty female womb could push upward as a result of lack of sexual intercourse- test by inserting different pessaries to test openness of women's passageways in the body.

Dillon- Legal Disability

Athens was the only Greek state, as far as the evidence indicates, which had specifically legislated for a financial payment to be made to those male citizens whom the state considered to be physically disabled: a disabled citizen, speaking in defence of his right to collcet an allowance due to his disability, notes: 'the city voted us this allowance' (Lys. 24.22: by a psephisma, dceree). This law, it might seem to go without saying, applied only to Athenian male citizens. - Dillon, Legal Disability - State support not available for women, immigrants, enslaved people Degree of scrutiny one had to undergo in order to be considered for the small financial payment 400 BCE- in Athens allowance to the physically disabled who were male citizens, considered poor (no property, livelihood) One obol per day by 400 BCE< 320 BCE when Aristotle was writing 2 obols per day. Spartan infants who were born disabled were left to die in a pit, either by written or unwritten law; Plato would legislate that physically disabled babies be killed at birth. Athens cared for physically disabled citizens by a law granting them a specific daily allowance, paid monthly. But it was scrupulous about the award of this single obol, or later two, and the physically disabled had to prove their disability and their lack of property. That the cripple with two sticks in Lysias 24 can earn some money ought to have disqualified him, for the law specifically stated that the allowance was for those who were 'unable to carry out any work' ([Arist.J Ath. Pol. 49.4).

Votive reliefs from Greece- 400-350. BCE

Dedications to Asklepios, accompanied by a figure like Igea, Hugea (personification of hygiene, healing, Panacea), surrounded by personifications of health and healing. Dedications from Roman Catholic faith have the same visual iconography Photographs from Epidaurus- Abaton, Tholos with circular channels for sacred snakes. Portico at Epidauros- patient receives a dream message from asklepios

Roman medicine and Galen

Galen flourished under the Roman Empire Medicine as a techne found its way into rome- were not specialized apprenticeships and schools of medicine- but great flow/exchange of ideas, aspects of greek medicine flowing into Rome. Galen

The Sacred Disease

Exposes medical marketplace around 400 BCE Sacred disease refers to epilepsy but not solely so, Various types of seizures fell into this category Epilepsy, meningitis, encephalitis, reactions to infections could create these convulsions or seizures. Subject is clearly introduced in opening words- "1 do not believe that the ' Sacred Disease* is any more divine or sacred than any other disease but, on the contrary, has specific characteristics and a definite cause."- Primary argument Main thread that unites is despite peculiarities of this "sacred disease" no divine origin. With whom is the author arguing/competing with? Arguing with an established group of practitioners who viewed disease as sent from the gods (Apollo and plague arrows in Illiad book 1) Arguing against seers, purifiers, traditional ritual healers, people who believed in incantations/magic to heal who were popular in diseases like epilepsy which were thought to be divinely sent. Author clearly a doctor coming up against the validity of traditional incantations/magic. Trying to take clients away from his opponents, sheds light on complicated healing environment/marketplace in the time, learn about different approaches to epilepsy in ancient world. *Text is unique and celebrated for a supposedly rational stance evinced in the author's denial that the sacred disease has any peculiarly sacred character to it- Structure tightly argued and clearly said Personal, reveals great degree of proof (the goat), polemical in its arguments -Epilepsy grounded in natural causes, not divine -Phlegmatic constituent patients -Argues against other healers who practice ritual purifications, labels as frauds, charlatans. Writer is certainly a doctor(complex arguments about the vascular system, trying to win clients, sophistication of anatomical and physiological understandings, clinical account of symptoms, categorized by young/old. Description of blood vessels is one of the most detailed, description of respiration- familiarity with comparative anatomy (dead goat), using medical nomenclature throughout. Tone of the writing is combative, polemical, verbs of speech rather than writing. Oral treatise, didactic in tone (people ought to...) common authorship to Airs, waters, places (reference to seasonality, parallel content, similar greek)- Seed originates from all parts of the body, description of reproductive system cues us to a common strand of thought. questions of food that is suitable similar to regimen (400 BCE)

Temple medicine

Field of healing sanctuaries had been ignored/undervalued due to issues with dichotomies of science and religion, rational and irrational. Temple medicine operated under the same premises as hippocratic, but with inclusion of the supernatural Hippocratic medicine concurrent with rise and spread of healing sanctuaries, symbiotic relationship. Temple medicine, or religious medicine is an integral part of medicine- medical history cannot be only written from the point of view of the physician, but should include the perspective of the patient, for whom an intellectual hippocratic physician was not the obvious choice Asklepios Comes to Rome by the 2nd cenutry BCE, Greek world fell to Roman conquest, ASklepios becomes increasingly popular Etching of 2nd century Roman statue of Asklepios in the uffizi, Florence. Anatomical votives throughout Roman provinces, including France. Sign of lump in hand pathology from anatomical votives in Corinth.

Fractures, broad themes

Galen valued and esteemed this treatise Wrote in his first hippocratic commentary (with the most authentic/useful works) (100 CE) Highly technical, practical, attracting medical attention by the roman period Throughout treatise, fractures and dislocations discussed- Overall order- takes account of relative severity of injury (start with simple to more complex cases (section 24 onwards), generally material ordered in accordance with the limb affected (forearm first, etc.) Coherent, rigid Accounts of prognosis, then treatment- degree of cross referencing (verbs of speech and writing) Section 9- reference to previous speech on hand anatomy parallel to that of the foot (some material lost at beginning of this treatise) Thorough knowledge of anatomy, bones, joints, references to muscle and internal vessels TONE: confident- opposing other practitioners who make methodological mistakes/blunders, deficient in surgical practice, pragmatic, physical treatise, references to the skilled use of hands, invoke help of strong men. Familiar with different types of spasms and fevers with serious cases of broken bones *importance of timing in treatment (crisis, epidemics), daily monitoring of the patient, number of days desirable between changing of bandages, times bones require for setting, aphoristic statements (avoidance of excess, treatment individualized, different temperaments including an excess in bile"

The Seed, Hippocratic Corpus

Gender and sexuality within ancient medicine -gender difference, disease, illness and medicine Theme of Female gender controlled by sociocultural differences, Hippocratic authors regard pregnancy or childbirth as a form of health/therapy, notions that female health inextricably tied to their motherhood. Truncated period between menstruations and marriage, soon after marriage women were expected to begin giving birth- enforce women's reproductive roles. Embryological treatise/Gynecological Treatises within the Hippocratic Corpus (female body) on growth of embryo, generation, heredity and sex differences Thread of how constructs present in western medicine, gendered concepts of disease continues today. Sperm = seed Begins with an account of the origin of sperm in the body. "The sperm of the human male comes from all the fluid in the body: it consists of the most potent part of this fluid, which is secreted from the rest. The evidence that it is the most potent part which is secreted is the fact that even though the actual amount we emit in inter course is very small, we are weakened by its loss." -clear indication of gender, male physician, "we emit, we are weakened" *The Seed: thinking through heredity, sex differentiation

Demand, Risks of Childbirth

Hippocratic (400-600 BCE) era doctors lacked basic tools of biomedicine including antibiotics, and thus women faced a variety of conditions including hemorrhage, pelvic deformity, analysis of skeletal remains and epitaphs which offered evidence of death in childbirth in the form of fetuses lodged in pelvic bones (issues with greek soil, age and sex determination of skeletal remains) Childbirth cases in epidemics can be assessed, malaria and pregnancy in classical greece- Practices of hippocratic medicine, including use of cathartics, succussion, and manual interference in delivery were themselves the cause of complications that sometimes proved fatal- ample evidence that women suffered from rB , malaria Thus there was every reason for greek women facing pregnancy and childbirth to seize on cultural or religious promise in addition to medical care.

Gynecology, Caldwell

Hippocratic humoral theory- deficiency or excess caused illness- but women faced a particular challenge because their bodies by nature tended towards imbalance They were inclined to be overly moist -Menstruation as the primary way in which the healthy female body self-regulated fluid Gender-based social norms and expectations- pregnancy and female health,birth thought to open the network of vessels throughout he body, solve the problem of the wandering womb Lack of dissections- reliance on observation of external signs, fluids excreted, analogies Soranus- dissent from hippocratic viewpoint that female reproductive health was assisted by marriage and pregnancy Prescriptions for women's health revealed an explicit awareness of the social expectations, Iamata- religious healing, charms, incantations spells, provided therapy for intimate problems without the discomfort of physically invasive therapy

Primary sources- healing sanctuaries.

Pausanias, Description of Greece II.27.1-28.2 On the sanctuary of Asklepios at Epidauros: "The sacred grove of Asclepius is surrounded on all sides by boundary marks. No death or birth takes place within the enclosure the same custom prevails also in the island of Delos. All the offerings, whether the offerer be one of the Epidaurians themselves or a stranger, are entirely consumed within the bounds. At Titane too, I know, there is the same rule. [2] The image of Asclepius is, in size, half as big as the Olympian Zeus at Athens, and is made of ivory and gold. An inscription tells us that the artist was Thrasymedes, a Parian, son of Arignotus. The god is sitting on a seat grasping a staff; the other hand he is holding above the head of the serpent; there is also a figure of a dog lying by his side. On the seat are wrought in relief the exploits of Argive heroes, that of Bellerophontes against the Chimaera, and Perseus, who has cut off the head of Medusa. Over against the temple is the place where the suppliants of the god sleep. -Pausanias- greek travel writer, described sanctuary of Asklepius which was already ancient by the Roman period. Image of askleipus within the temple, Tholos building, descriptions of facets of the sanctuary, sacred servants.

Quesalid, Levi-Strauss

Quesalid- Kwakiutl Indian from Canada narrated by Boas. Quesalid was a shaman or healer- enters as a doubter and grapples with his own power and ability to believe. Training include stimulating fainting and nervous fits, learning sacred songs, learning the technique known as the art magna- of inducing vomiting **Crux of his healing art- bloody worm technique- craft of hiding a little tuft of down in the corner of his mouth that he then spits back up after healing someone, exorcising, etc. - covered at blood after biting his tongue and present it to his patient and audience as a physical embodiment of the pathological foreign body that he had extracted from the people -was important and persuasive, bloody worm as proof of definitive treatment. -Through meetings with other shamans, quesalid comes to believe in his own power while doubting other practitioners. (just saliva vs bloody worm) Power of community of belief, colleagues, other shamans plunged into doubt about their own methods "old shaman, ashamed and despairing because of the ill repute into which he has fallen and by the collapse of his therapeutic technique.... social death" -Quesalid doesn't see this as deceit, belief in his own powers (1/3 of equation of faith healing)He knows the bloody worm is not the actual illness, but symbol of the healing he is able to get for his patient, knows that this is his job - create an environment through which he can manipulate symbols so that the patient and social group can believe in this healing. Success, healing and health is determined socially by the group, triangulation of patient, healer, Symbols physician/healer can manipulate for patient's benefit.

Infant exposures cont.

Question of whether to raise or expose a child was gendered- ** women childbearing and passing on of property, pressure for male children. Pressure not to rear a handicapped, disabled, female child that could not inherit property Number of children taken into consideration (if already had several healthy children) Resources and access to resources (temporary or chronic poverty) -slave women compelled to expose their children if owner needed the woman to wet nurse. Enslaved women had no control over their own pregnancy. Cases of multiple births could also result in exposure. Ad-hoc decision if mother died in childbirth, noticeable birth defects, if crops were not favorable that years. Babies who survived abandonment were usually reared as slaves who were forced to wet nurse, couldn't get pregnant, control their own families, etc. Owners of enslaved persons were willing to abandoned babies of lactating slaves to make them available for free women of the household Infants were abandoned (grecoroman egypt, papyri records- individuals who bear copronyms or dung names- children were taken off the dung heap were raised as slaves. Threptoi- brought up as slaves after infant exposure. Those left on dung heaps would decompose, wails of hungry babies, stench of decomposing bodies, and sight of infant bones and practices.

Section 1, The Sacred Disease

This theory of divine origin, though supported by the difficulty of under standing the malady, is weakened by the simplicity o f the cure, consisting merely of ritual purification and incantation. If remarkable features in a malady were evidence o f divine visita tion, then there would be many ' sacred diseases', as I shall show. Quotidian, tertian and quartan fevers are among other diseases no less remarkable and portentous and yet no one re gards them as having a divine origin. I do not believe that these diseases have any less claim to be caused by a god than the so- called ' sacred' disease but they are not the objects o f popular wonder. around 400 BCE- physical symptoms, bodily illness became contested sites of interpretation Contemporary evidence of references to the sacred disease -Herodotus noted that a Persian king was afflicted from a disease which some called sacred, skepticism of whether this was truly the case Broader societal notion of epilepsy as a divinely sent disease vs grounded in natural causes which The Sacred Disease takes up. Insight into lively public debate on interpretation of disease/illness.

Superfetation

Simultaneous development of more than one developing offspring within the womb of a single animal- formation embryo from a different cycle and an embryo already in the uterus Very common in certain animal species, sheep and goats but extremely rare in humans Superfetation- looking to animals and erroneously grafting those conclusions onto the female reproductive system. Describes that when in pregnancy a second conception occurs, the outcome depends on the position of the first fetus int he womb description of difficulties in birthing process, when an arm, or foot comes out first Managing of expulsion of placenta Deals with childbirth in antiquity- not such ancient history, infant and maternal mortality prior to development of antibiotics Risks still current less than a 100 years ago. Childbirth easier if intercourse avoided during pregnancy 16 and 17- signs of pregnancy int he woman's eyes, hollowness, swelling in face similar to epidemics- careful recording of symptoms would give the future physician knowledge and ability to prognoses certain outcomes. Birthmarks as a sign of maternal cravings (placing blame) Signs of positioning of the fetus treatment with different types of pessaries, ingredients, hodgepodge Seasonality (airs, waters, places)- spring the best time to conceive pessary- mass, soluble amalgam inserted into different parts of the body in order to treat infection, act as a contraceptive, enhance fertility First menstruation fails to appear in a young woman- suffers bile, fever, pain, thirst hunger treatment for uterine prolapse, absence of menstruation.

Agora Well, Liston Rotroff

analysis of bones and artifacts from the abandoned well in the Agora to examine the disposal of infants skeletons of infants disposed along with dogs and pottery in the second century BCE athens- central Greece in the agora which is the main commercial square Well found with 450 dead infants, 150 dogs and one adult with a physical deformity, pottery shards dated back to 165-150 BCE (end of hellenistic period, when romans had invaded Greece, territory in transition) - thought that well was results of mass infanticide -others thought a plague was to blame Reconstructed skull of infant found that they had died naturally, less than a week old at the time of death- as many as 1/3 had died of bacterial meningitis which is caused by cutting the umbilical cord with an unsterilized object. Statistic gives an abundance of insight into how common these deaths must have been in antiquity (no sterilization, high stakes of infant mortality) Another datum that was found- out of 164 preserved jaw bones, 9 with incompletely formed palette (full term infants, instances of cleft palettes- inhibited infant nursing, died soon after birth in antiquity Second of two post-natal infants who died at about four to six months of age- one of the individuals partial skull and skeleton recovered, suffered from hydrocephalus Neonates with no visible cause of death thought to have dehydrated. Vast majority had died a week or so after birth Well surrounded by several metalworking shops, bronze and copper alloy leeched into the bones and fortified them for all these centuries

Fractures later sections

forearm fractures of radius/ulna, appropriate treatment with setting, bandaging, compressing, use of a. sling If you are convinced that the bones are sufficiently ad justed in the former dressings, and there is no painful irritation nor any suspicion o f a sore, you should leave the part put up in splints till over the twentieth day. It takes about thirty days altogether as a rule for the bone of the forearm to unite sections on humerus, foot, bones which connect the leg "Those who, in leaping from a height, come down violently on the heel, get the bones separated, while there is extravasation from the blood-vessels since the flesh is contused about the bone. Swelling supervenes and severe pain, for this bone is not small, it extends beyond the line of the leg, and is connected with important vessels and cords. The back ten- donf is inserted into this bone. You should treat these patients with cerate, pads and bandages, using an abundance of hot water, and they require plenty of bandages, the best and softest you can get. If the skin about the heel is naturally smooth, leave it alone, but if thick and hard as it is in some persons, you should pare it evenly and thin it down without going through to the flesh. It is not every man's job to bandage such cases properly, for if one applies the bandage, as is done in other lesions at the ankle, taking one turn round the foot and the next round the back tendon, the bandage compresses the part and excludes the heel where the contusion is, so that there is risk of necrosis of the heel-bone; and if there is necrosis the malady may last the patient's whole life. fibula, tibula Sections 19-23- related to femur fractures section 24- contusions, exposed bone, more complicated problems Section 25-27 - critical of faulty treatments, "Then there are others who treat such cases at once with bandages, applying them on either side, while they leave a vacancy at the wound itself and let it be exposed. Afterwards, they put one of the cleansing applications on the wound, and treat it with pads steeped in wine, or with crude wool. This treatment is bad, and those who use it probably show the greatest folly in their treatment of other fractures as well as these. For the most important thing is to know the proper way of applying the head of the bandage" section 28-29 use of compresses, Section 30-32- iron rods/levers, leather pads, instructions to make equipment for wounds not amenable to bandaging. loss of injured bone -33 34- compresses and medications 35-36 drug hellebore, and diet (regimen) dislocations of knee, elbow (more problematic), radius, rare dislocation of humerus, ulna, concludes with general observations about dislocations and bandaging principles that become established in western medicine for decades

Fractures terms

fractures = broken bones To set them, the pieces of bone must be brought back into alignment and then held together until they unite Closed/simple fractures = bone ends do not penetrate the skin, relatively easy to treat. Open/compound fractures- more difficult to treat and usually fatal prior to discovery of antiseptics Dislocations- injuries to joints such that the ends of the bones are forced out of connection with one another Displacement of bones, contusion of the surrounding tissues, tearing of ligaments that bind the bones together Dislocations are classified as simple or compound- bone in the latter case forced through the skin Congenital (present at birth) vs acquired (through injury) Levers (leverage) and application of a pulling force by weights and pulleys (traction) - to secure correct alignment of damaged bones Necrosis- tissue death

Wandering womb

notion that a woman's womb or uterus was not anchored in place in her body and could wander around and attach to different organs like the heart, liver, bladder, etc if not held in place by pregnancy or kept moist by constant intercourse- when it becomes dry it is attracted to other moist organs. Underpinning this notion is the argument that women should be having regular intercourse and some women (unmarried, widowed) are particularly prone to these problems. Linking of social and biological . (300-400 BCE) but continued long into Greek medicine despite the fact ligaments were found to anchor the uterus in place- still notion that the uterus could wander around up into the Roman period. (Faraone) Acute fo young widows -earliest evidence for the construct (dialogue of plato's timaeus- late 4th/5th century BCE, common knowledge of it) soranus and galen write and reinterpret this construct in different ways. Amulets meant to stop the womb from moving, incantations Arena of medicine (different players)