Final exam Flashcards
miasma
means pollution
ie. the pollution of someone who has committed a crime
Comes to have a special medical meaning
Who are the 4 physicians we know of who came just after the time of Hippocrates?
Philistion of Locri
Diocles of Carystus
Threophrastus of Eresos
Praxagoras of Cos
Philistion of Locri
fl. early 4th century BCE
v little evidence for him and we know v little about him. None of the writings are preserved in fill. We have some fragments preserved of their writings in later authors
Believed in 3 general causes of disease:
1. internal excess or deficiency of the four qualities (hot, cold, wet, dry)
- external wounds, sores, too much or too little external heat and cold, bad nutrition
- Internal impediment of air flow throughout the body
Among the evidence we have for Philistion, there is an also a treatise by an anonymous author that introduced pneuma
Anaximenes - pneuma
concept of pneuma was originally a philosophical one. Just as our soul, which is air, dominates us, so too breath (pneuma) surround the whole world
pneuma has a slightly different meaning than air. something special
psychic pneuma
a theory was later developed for this type of pneuma - mediated between the heart and the brain
An extra special charged humor giving the brain the capacity THAT it has
Diocles of Carystus
We don’t have any of his writings, just fragments that are preserved in other authors.
Seems to have been very famous –> referred to as the ‘Second’ Hippocrates.
Supposedly wrote 20 works on various topics including anatomy, dietics, poisons, sexuality
SOme overlap with Aristotle especially on anatomy and gynaecology (so maybe a contemporary or student of Aristotle)
Supposedly wrote a specific treatise on animal anatomy. Used animals to make inferences about humans.
embraces the theory of the four elements, four qualities and the 4 humors
also paid special attention to the pneuma, the breath or refined air that spread through the vessels in the body. Linked pneuma to both mental states and physical disorders
also believed in the individualization of treatment. ie tailored treatments depending on the patient. Treat idvl, not the disease.
What did Diocles invent?
He supposedly invented a special spoon-shaped instrument called a cyathiscus.
Removed arrow heads from a wound. So we know bc of this that he is a practicing physician and not just a theorist
iron or copper
Theophrastus of Eresos
We have some of his writings!
- Not a physician
- A philosopher with wide ranging interests. He took over Lyceum (a school in Athens) after Aristotle’s death.
Sometimes called the ‘Father of Botany’ - writes on medicinal plants in a much larger botanical text called the Enquiry into plants.
-Provides both medical and non-medical uses for the plant (detailed)
- Gets his information from root cutters and drug vendors apparently
-Groups the plants according to their type. He questions whether the plants that have the same effect have a single shared property.
- also notices the reduced efficacy of a drug after continual usage - ie tolerance
- mostly removes magical/superstitious elements
Praxagoras of Cos
We do not have any of his writings, we just have fragments of what later authors said about him.
Practicing physician
Believed that the heart was the seat of soul and intellect (like Aristotle believed)
-Hippocrates, Alcmaeon, Plato, Praxagorus - thought brain/head
Performed animal dissections - recognizes that arteries began in the heart and that the veins began in the liver AND that only veins carried blood and that arteries carried pneuma
- also suggested that as arteries got smaller and branches - eventually became neura (sinews - later nerves)
Recognized the pulse has being a valuable diagnostic tool (but he thought the heart beat and pulse were different from one another)
- posited a theory of 11 humors. We know they are named but we don’t know the theory behind them.
Seems to have embraced the theory of the psychic pneuma - special pneuma mediated between the heart and the brain.
- something added to it that has given it a power.
ie. says that epilepsy occurs in the aorta – A blockage prevents the passage of the psychic pneuma to the brain and this makes the body convulse.
Teacher - taught Herophilus
a bridging figure between the comparative anatomy of Aristotle and the human anatomy of those who follow.
In what period do we see the temporary allowance in human dissection?
Hellenistic (323-31 BCE)
331 BCE - when Alexander the Great died
323 BCE - when the last of the Hellenistic kingdoms finally succommed to Roman Rule (Death of Cleopatra)
Hellenistic medicine and Alexandrian medicine – virtually synonomous
Phillip the 2nd
Son to Alexander the Great
Arrow removed by Diocles’ spoon tool
Ptolemy I Soter
Received Egypt and surrounding areas in the shake up after Alexander’s death
Wanted to make Alexandria (at the mouth of the Nile river, a center of intellectual excellence
Who was the first women ever depicted on a coin?
Ptolemy and his first wife, Berenike
Who was Ptolemy I’s son?
Ptolemy II Philadelphius
He married his sister (quite common in Egypt to keep all the belongings in the family)
Who founded the Mouseion Institution of the Muses and the Library of Alexandria
Ptolemy I or Ptolemy II Philadelphus
Intention of turning them into centres of intellectual research
Who officially sanctioned human dissection to occur during the ________ period?
One of the Ptolemy’s sanctioned this to be carried out at the Mouseion by Greek physicians or anatomists for medical research purposes.
Who were the two physicians we know of who took advantage of human dissection belong allowed?
Herophilus of Chalcedon (330-260 BCE)
Erasistratus of Ceos (fl. 260 BCE)
Greek physicians!
Prior to this, the most detailed anatomical studies were done by Aristotle, but all on animals.
Do we have any writings of Herophilus preserved?
No, just fragments preserved in later authors. Apparently he wrote a lot though
trained with Praxagoras apparently
Wrote 6 books with wide range - Anatomy, on the Pulse, Midwifery, etc
Galen mentions he has good skill in anatomy and is a competent physician (high praise for someone who doesn’t give praise too much).
Gives first accurate description of the human liver
Noted a further difference between arteries and veins than his teacher Praxagoras. He noticed a difference in their structure - the walls of arteries were much thicker than those of veins. Wasn’t clear of whether he thought the arteries carried blood or pneuma or both
Recognized that it was the heart responsible for the pulsating of the arteries - due to systole (together) and diastole (apart) of the walls
Indicates that he was potentially working on live subjects! vivisection
Portable water clock
Made by Herophilus
Klepshydra
To compare pulse rate during fever to a standard pulse rate for the age
No concept of a minute - but this could measure a specific elapsed amount of time
Likened the pulse to a fall and rise of a node, natural rhythm.
What were Herophilus ‘most’ significant discoveries?
those regarding the brain and the nervous system
He distinguished the cerebrum from the cerebellum like Aristotle but in contrast to Aristotle, he said there were four ventricles in the brain, instead of 3 like Aristotle
Who first distinguished the 3 layers surrounding the brain?
Herophilus first discovered the meninges.
He also proposed that the brain was the seat of intellect based on anatomical evidence even though his teacher, Praxagorus thought it was the heart
Did Herophilus ascribe to the Humoral theory?
We know really nothing about his theorizing but there is an excerpt that suggests he subscribed to a humoral theory - although we do not not which humoral theory …. 2,3,4, 111(like his teacher)
talked about excess and deficiency
Erasistratus of Ceos
Don’t have his writing, just fragments preserved in other authors. WE think he overlapped with Herophilus but not sure.
We have some titles of his works - General Principles, On Fevers, On Drawing blood, Diseases of the intestine
Galen doesn’t like Erasistratus really.
Made significant advances in description of the brain and NS -greater accuracy than Herophilus.
Said the reason that humans have much larger brains is because of increased intellect (like animals with larger muscles can run faster) - making observations AND correlations
Recognized and described the heart valves and coordinates their workings… Saw them opening and closing so likely doing vivisection as well.
Believed that the arteries carried pneuma. But he would have seen the blood in the arteries? Maybe it got reported wrong
Galen said that E said blood got into the artery when it got pierced (E’s principle - the following towards what is being emptied) Galen ridiculed how the pneuma could escape so quickly without notice and how the animal could still live if pneuma escaped.
Seemed to be more interested in physiology than Herophilus.
Galen’s thoughts on Erasistratus
Galen doesn’t like Erasistratus really. He praises he praises him on his research ethic but Erasistratus doesn’t seem to be a big fan of Hippocrates but G is.
He didn’t acknowledge the properties that H does like wet, dry, etc.
Galen acknowledges that the previous theories might not be entirely accurate but that Erasistratus is very arrogant for disregarding them completely.
Galen said that E said blood got into the artery when it got pierced (E’s principle - the following towards what is being emptied) Galen ridiculed how the pneuma could escape so quickly without notice and how the animal could still live if pneuma escaped.
Who distinguished nerves from arteries and their responsibility for movement?
Herophilus
He traced the origin and course of neura from the brain and spina; cord and correctly distinguished that the nerves were responsible for movement rather than arteries!
HE also made anatomical distinctions between motor and sensor nerves
Detailed more than 7 pairs of cranial nerves, including the optical.
What are some analogies that Erisistratus made with respect to physiology?
dilating heart to coppersmith’s bellows
kidneys, liver, bladder = filters
stomach = grinding and crushing food like flour mill
humoral fluids getting blocked or overflowing in vessels like a spout
this level of detail makes us wonder if the pneuma in the artery idea has been misinterpreted.
Who might be the most painted physician of all time?
Eristratus
Story involving Eristratus
Seleucus (one of Alexander’s generals- got Asia)
2nd wife of Seleucus = Stratonice
Seleucus son = Antiochus
Antiochus fell in love with Stratonice (his step mother) - love-sickness and forbidden love
E told Seleucus it was his wife Antiochus was in love with and then Seleucus asked him to give her up. E said no no and that Seleucus wouldn’t do it if he was in the same position. But then he said he would and so E told him the truth about how his son was in love with his wife but ultimately he just wanted his son to be cured. so they ended up together
E determined it was love sickness by checking his pulse every time a woman walked by Antiochus.
peripatetic
meant travelling from city to city (as a physician)
archiatroi
some cities in Greek world and the Roman world later on employed archiatroi or public physicians to serve the community
Given civic rights, immunity for taxation and military service, and a salary. Patients likely still needed to pay a bit.
foreign-some of them. So competition to attract the best elite physicians to the roles
Medical ‘schools’
centres of discourse, teaching, learning, not necessarily physical buildings (though there could have been)
A matter of GEOGRAPHY
Endless debate as to which of the Hippocratic texts were written by the Coan School and which by the Cnidian school - with the general assumption that the superior texts belong to the Coan school and the inferior ones belong to the Cnidian.
Coan school had an association with Hippocrates which ensured it maintained a big reputation
In the time after Hippocrates, a split occurred in medical thought -
hinging up on the degree to which medical theory should dictate medical practice.
It centered on the hidden causes of disease and whether understanding them aided treatment
medical sects
A matter of ideology.
dOGMATISTS
Dogmatists
Followed the doctrines and opinions (dogmata) of Hippocratic teaching
aka Logicists or Rationalists)
Believed to be founded by Hippocrates’ son in law - Polybus
They insisted that the knowledge of nature could only come about through the use of reason (logos or ratio) and the rational investigation of hidden causes
Only through this, they argued, could they truly understand the origin of a disease and treat it accordingly
Amongst the Dogmatists, there was also a group who emphasized the role of the pneuma rather than the humors (the Pneumatists) - but we do not know much about this sect
Empircists
rose in opposition to the Dogmatists
Said that nature was incomprehensible so there was no point in trying to understand it.
Believed to have been founded by Philinus of Cos, student of Herophilus
Said that it was not necessary to understand the hidden causes of diseases and that only evident causes for disease ought to be treated through accumulated experience (empeiria) and practice.EM
Methodist sect founding
Arose close to the year zero when Greek medicine had been imported into Rome.
Asclepiades of Bithynia proposed a new model of health and disease that depended on the idea of motion and flow of clumps of matter within the body
Asclepiades’ student, Themison of Laodicea - further modified the theory and founded the Methodist sect
(employed a particular method of healing)
MEthodist Sect
Methodists believed there were some general characteristics shared by all disease and that once they were recognized, the choice of treatment followed easily.
Proposed that the body is composed of continuously moving particles or atoms
Pores in the body carry bodily fluids and the pneuma
Health and disease depend on the number, size, shape and movement of the particles, and the condition of the pores.
- An unhealthy body could be in one of three states - depending on the particles and the pores
Theory of Commonalities
Made a point of emphasizing the gentle nature of their treatments, which was largely based on matters of diet, therapeutic bathing, massage and exercise (incl passive exercise like hammocks and sedan chairs) and liberal use of wines
Safely, Quickly, pleasantly
Methodist ‘Theory of Commonalities’
Status Strictus
- constriction
- treated by things that relax (decrease food intake, warm baths, humid air, bleeding, medications that promote evacuations)
Status Laxus
- relaxation (too loose)
- treated by things that constrict (increase food intake, cold baths, cold air, medications that have styptic (clotting) qualities
Status mixtus
- constriction and relaxation in different parts of the body
- treat the most severe conditions first
Methodists proved to be quite popular with the public although other professionals decried the lack of training necessary to be a Methodist physician.
Motto of methodists
Safely Quickly Pleasantly
What are Celcus’ thoughts on vivisection?
He defends dissection on the dead but says vivisection is cruel and you can find out ‘live body’ things during naturally occurring treatment. Getting a viewing when an injury has occurred for example.
What are Tertullion’s thoughts on vivisection?
He is a Christian author. 200 CE
Said that dissection in general is a case of butchery and that the body has changed once someone has died anyways so ‘why bother’
Why dissection became taboo again?
We don’t have writings from authors at the time of Herophilus and Erastratus that address the situation. Maybe practicing vivisection or suspicion of the practice of vivisection had something to do with it
There was likely an increasing blacklash against human dissection as cruel and irrelevent, along with changes in political circumstances - probs led to the demise of the practice at Alexandria
Celsus Dogmatist belief summary
- Medicine should investigate evident cxauses, hidden causes, natural actions, internal anatomy
- Comprehending nature is essential
- Importance of reasoning (dogma)
- Humoral theory
Celsus Empiricist belief summary
Medicine just investigate evident causes
Comprehending nature is impossible
Importance of experience (empeiria)
Do not need a theory
Celsus Methodist belief summary
Medicine should investiage evident causes
Comprehending nature is pointless
Importance of observation (indicates the methodos)
Theory of Commonalities
paterfamilias
Traditionally Roman medicine was performed within the family, under the authority of the paterfamilias (father of the household) thought this authority extended beyond children
The paterfamilias liked to think of himself as a man of wide learning who could master medicine, just as he could master agriculture, politics, or military matters
self sufficiency
What were early medicines based on when Greek medicine first came into Rome?
animal and vegetables. Things that would be available on the family farm
Cato the Elder (234-149 BCE)
One of the best sources for early home remedies.
Many uses of cabbage: wounds and swellings as a poultice, dislocations, ulcer, main relief, headache, eye ache, bathing in the urine of a cabbage consumer….
Cato also speaks about chants (with nonsense words) being used for healing - so magic played a role in early Roman healing
senator, soldier, historian from wealthy family.
work: On Agriculture
folk medicine
Apollo in Roman world?
Apollo did not play a role in early Roman religion - all of the Olympic gods have counter parts but not him
but he is known as well as his oracle in the Roman world (oracle at Delphi) and was contacted
Although - he seems to have entered the Roman world around 430 BCE for the purpose of averting a plague
temples raised to him and games attributed to him (Iudi Apollinares)
So a little bit of belief in Apollo being a healing god but not much and not nearly as much as in the greek world
Time of Augustus
imperial times. When the worship of Apollo increased a bit more in the Roman world
- Augustus dedicated a portion of winnings to Apollo along with a temple at Actium and another on at Rome on the Palatine towards Apollo
Augustus took Apollo as one of his championship gods
Oracle of Delphi
293 BCE - following an oracle from Delphi, the Roman senate decided to bring the Cult of Asclepius to the city
Delphi - ancient sacred site in the ancient world, site of a priestess who could communicate directly with the god of Apollo. For any important decision at the time, go to the oracle of Delphi for help (religious, political, personal reasons)
So when there was a disease outbreak, they went to her and she gave an order
Roman senate decided to bring the Cult of Asclepius to the city story
Went to oracle of Delphi and they said to bring the cult of Asclepius to the city (they went to her because there was an outbreak of a disease)
They sent delegates to Epidaurus, the most famous Asclepius shrine at the time - in order to fetch one of the sacred snakes of Asclepius and carry it back to Rome.
Upon arrival to Rome, it is said that the ssacred snake jumped off the boat into the Tiber River, and landed on the island
temple was built on this very site
Medical function of this site to this day
According to Pliny the Elder, who was the first physician in Rome?
Archagathus (Greek) who was probably invited by the state to be an archiatros.
Archagathus
First physician in Rome
Initially welcomed as a wound specialist but was later nicknamed the Executioner and his popularity decreased
Greek
Own surgery, architros
Started at a time of war - so lots of injuries to deal with
How does Cato feel about Greek physicians?
He is not a fan.
- traditional advocate for Roman ways
-thought they were worthless and conspired to murder foreigners and paid to do this
- he is anti-anything not Roman and anything new
mos maiorum
the unwritten code from which the ancient Romans derived their social norms
Asclepiades of Bithyria
Generally a negative attitude towards Greek physicians until this guy and maybe Themison came along with the methodos (Methodist Practice)
- gently treatment of Safely Quickly Pleasantly proved very popular
3 Greek Physicians that work in the Roman world
Pedanius Dioscorides, Arataeus, Soranus
Aulus Cornelius Celsus
encyclopaedist, surviving work on Medicine (de Medicina) (supposedly part of a way larger book) - this work is the best source we have for medicine at Rome
-don’t suspect he was a physician
Pliny the Elder
soldier, lawyer, equestrian
- wrote about the natural world, including Natural History - incl folk medicine
He sailed too close to Vesuvius to see the eruption and got asphyxiated by volcanic gas or else died of heart attack
Pedanius Dioscorides of Anazarbus
40-90 CE
According to Galen, he was a physician interested in pharmacology (loc- Tarsus)
‘military life’
Major work - de Materia Medica - a pharmacopeia (drug making book) arranged in 5 books (plant, animal, mineral materials)
- focused on medical plants/uses
- lists and describes 700 items, with more than 2000 recipes
- largely free of magical remedies or else doesn’t refer to them like something he believes in
He mentions that previous works were incomplete or just repeated earlier findings without personal observation and testing or they were just bad.
Teacher of Dioscorides
Areios @ Tarsus
In a letter to him, D says he is going to use a novel method of arrangement for the entries of his work - not alphabetical was instead arranged according to the natural properties of each one of them (make it easier to learn and also more functional to use as a physician)
Which sect does Dioscorides despise?
Methodist, works of the methodist sect
Properties used to arrange de Materia Medica (pharmacopeia)
Dioscorides
cooling, warming, binding, loosening, staunching (constricting), dispersing, softening/hardening, flatulence relieving/causing
He didn’t explicitly mention these but we could deduce them.
Served as the primary pharmaceutical text until the end of the 15th century
(copied in more than 7 languages)
Galen approved of his works!
Vienna Dioscorides
The most famous illustrated copy of de Materia Medica by Dioscorides. It is also the earliest version that we have today.
Ended up in Vienna after the fall of Constintonople (where the book was earlier)
> 400 illustrations of plants and animals
Aretaeus of Cappadocia
general Greek physician in the 1st century CE
v little is known about him, scarcely mentioned by other authors either
4 works lost - Fevers, Gynaecology, Surgery, Preventative Medicine
2 works survived = On Causes and Signs of Acute and Chronic Diseases, therapy on Acute and Chronic Diseases (8 books total)
Begins with diseases of the head, ended with diseases of the heel
-No distinction between somatic and mental diseases mental was just at the top because the head came first
Whose work was arranged a capite ad calcem
from head to heel
Aretaeus
side: we believe that the idea of classifying diseases into acute and chronic groupings originated with the Methodists
nosos
Greek word for disease
Interest in nosology
Aretaeus, Anonymus Parisinus, Soranus
- all had works on acute and chronic diseases
seems to be part of an increased interest in nosology (study of diseases) at this time
-categorization, naming, putting into groups
Interest in nosology
Aretaeus, Anonymus Parisinus, Soranus
- all had works on acute and chronic diseases
seems to be part of an increased interest in nosology (study of diseases) at this time
-categorization, naming, putting into groups
Aretaeus’ medical ideologies
pneumatist/eclectic
theory of disease bassed around improper quantities of/and/or improper blending of qualities, pneuma, innate heat
- health was then restored by correcting the imbalances of the qualities, the pneuma, and the innate heat by conventional methods
- treatment by opposites, surgery was last option
- His descriptions of disease are careful and systematic; site of the illness, relevant anatomical info, symptoms and causes wrt age, sex, season of patientA
Eclectic meaning
Not affiliated with a medical sect but adopting the practice and teachings that they considered best from other systems
Where was innate heat derived from according to Aretaeus?
Heart
Aretaeus is especially known for his descriptions of
coeliac disease, melancholy, diabetes, diphtheria
Gets close to identifying bipolar disorder
laments on the sufferers from tetanus.
Soranus of Ephesus
Best known practitioner of the Methodist sect
very little known about him
wrote on a variety of different topics -practical, theoretical, literary (works were lost)
Acute and Chronic diseases
Gynacology
Presence or absence of fever was an important diagnostic consideration
Descriptions are careful and systematic
- includes the views of other physicians and why they are almost always wrong
formulated an idea regarding contagion - ie getting close to an idea of germ theory - something that is being spread that we cannot see
Survived works of Soranus
-Signs of fractures (sorted in a capite ad calcem manner
- Bandages (60 brief chapters) - not sure if it was illustrated or not (later copies were)
-On Disease of Women (the Gynaecology)
-On Acute and Chronic diseases - was lost in the original Greek but we have it preserved in Latin translation
(3 acute, 5 chronic books; description of phrenitis, tetanus, cholera, pneumonia, cardiac diseases, hydrophobia (rabies))
ex. of chronic diseases- mania, melancholy, homosexuality, paralysis, obesity
What is the most extensive treatise on gynaecology to have survived from the ancient world?
On Diseases of Women
or the Gynaecology
BY SORANUS
Imperial Period
1st century CE onwards
