Midterm #2 Flashcards
“The Seed”: twins
- pouches –> womb was split in two halves, allowing for two children to be carried at once
- ‘mouth’ of womb closes during gestation –> if mouth does not close properly, repeat sex could induce another pregnancy
“The Epidemics”
set of 7 books describing ~ 400 medical cases, as described by traveling physicians
–> completely practical, with very little theory
–> no mentions of medical history
Hippocratic surgery: cupping
wet cupping: light candle under cup –> make incision –> cup suctions to skin from heat, draws up humors and releases
dry cupping: no incision
Themison
theorist, 1st century BCE; immigrant to Rome and student of Asclepiades
–> three commonalities: flux (good), constriction (bad), and mixed (both)
–> “three-day period”: doctors should monitor patients in pockets of three days, in order to allow for change to occur
–> no anatomy, diseases, or patient individuality; limited use of drugs, surgery
Ptolemy
general of Alexander the Great; established Ptolemies, the ruling family in Egypt, by marriage
–> wanted Alexandria to be the center of culture and learning in the empire (e.g. Library of Alexandria)
–> era ends with the rise of Rome (last Ptolemy, Cleopatra, sides with Mark Anthony and then loses)
Nicander
figure in Alexandrian Museum; cross-disciplinary pharmacological poet (wrote two epics)
–> Hellenistic literature was attracted to science, obscurity; Nicander drew from tradition of recipes written in verse (for memory, spectacle, and preservation of correct ingredient list)
–> themes: celebration of medicine (discoveries in Museum); man vs. “monstrous nature”; learning as heroism
–> first written description of medicinal use of leeches
“The Seed”: life of the fetus
fetus is different from the child after birth; “plant soul” (being nurtured) –> “animal soul”
–> later thinkers would consider the fetus as a potential living thing
“one-body model”
the normal body was the male body; the female appeared only in the Corpus when it differed
–> female existence is just a modification of male
–> extremes: some women transition back into men when menstruation stops, as it is the only distinct female trait
“In the Surgery”
Hippocratic treatise describing how to prepare a room for a surgery
remedies for pnix
–> changes in diaita introducing more moisture (more sex, childbirth, bathing)
–> drugs (fumigation): burning substances under womb might “lure” it back into place, by straddling over a burning pot
–> magical: “uterine magic”, or using spells/charms; supernatural attempts to control the opening/closing through spells, curses, or amulets
plaga
Latin, “blow”/”strike”; plague
–> implies punishment, more so than disease
–> something brought from elsewhere (non-native), as not all diseases are plagues
–> something inflicted, not endured
“The Seed”: development
–> legitimate children must resemble their parents (though to what degree depends on strength of each’s sperm)
–> cucumber comparison (sections 9-10): a child can only grow to the size and shape allowed by the womb
–> ideoplasty: a child can be shaped by a woman’s mind, as well as her body
“The Heart”: the atria
“ears”; function as bellows, allowing for respiration (as air is “captured” by the ears)
modern parallel to sects
disputes still exist, but not as sharply; doctors use combinations of expertise and experience to make diagnoses
Erasistratus
follower of Herophilus and researcher in Museum; made theory of digestion (role of stomach in decomposition), theory of heart as a pump (influenced by nearby engineers) even though no understanding of blood circulation
–> story: Antiochus, the prince, fell ill. Father, king, sent for Erasistratus - who sees that prince is sick because his pulse races near his father’s new wife, Stratonice. Tells king that prince is in love with Erasistratus’ wife -> king tells him to give her up, so he reveals the truth. King gives son the bride.
the womb
purpose: store moisture, nurture fetus –> childbirth seen as necessary for the health of woman, making later menstruation easier
–> imagery: house/care, oven (digestion/gestation), jar (amphorae = wine-jars)
–> “wandering womb”: no fixed place within the woman’s body
Hippocratic prejudice against drugs
association with women, even going back to Homer
–> women to drugs, drugs to poison
–> Greek word “pharmacon” means drug OR poison
–> witchcraft
–> foreigners (outside influence)
–> hard to understand path of a drug, and mystery of unknown was frightening
Alexandrian pharmacology
transition from margins –> center of medicine
–> Herophilus: “drugs are the hands of the gods”
–> more disparate ingredients available (Egyptian, imported)
–> detailed measurements (more “scientific”), which was very rare for the time
–> recognition of “powers” of drugs (Diocles: substances have strength regardless from their size, shape, arrangement)
Sophists vs. “The Science of Medicine”: arguments against medicine as a techne
- medicine is just luck –> based on past successes, people who follow principles are more likely to be healed
- patients can heal without doctor’s help –> principles of diaita can be fixed without a doctor
- patients can die with doctor’s help –> “not our fault”; maybe they didn’t follow instructions
- doctors are unwilling to help everyone –> proves rationality; to heal everyone would be evidence of magic
“The Science of Medicine”: goal
to answer the question, “does medicine exist?”
–> prove against Sophists that medicine is a techne
–> argue that medicine can be the “complete removal” of distress of the sick; alleviation of violent disease; or even refusal to treat certain cases
modern heart
left chest, under sternum; about 1 pound and the size of a first
–> sits in a sac with some fluid (pericardium), which allows it to pump without getting stuck
–> collect in right atrium > pump > collect in right ventricle > pump > out to lungs, oxygenation > pump > collect in left aorta > pump > collect in left ventricle > pump > out to body
–> valves prevent backflow, preserve regular flow
–> vessels bringing blood to: vena cava, pulmonary veins
–> vessels bringing blood away: aorta, pulmonary artery
–> thickness of myocardium varies according to function of the chamber, except in the fetus; the atria are thin-walled, while ventricles are thicker (and left is thickest to support full circulation)
“The Heart”: experiment one
“Drinking Pig”: dye water blue and give it to a pig; it will drink quickly, and by slitting its throat, one can see blue dye in the trachea, showing how epiglottis let some go through
–> problem: this is intermediate step (doesn’t prove that liquid goes all the way to heart); also, pig drinks so fast that water in trachea is inevitable
“The Heart”: experiment three
animal’s heart; animal’s left ventricle is always empty at death, which is why the left ventricle is seen as perpetually being empty
epidemic
Greek, “to the people”
–> “epi” (towards) + demos (people)
patients in Hippocratic Corpus
–> men and women
–> free and enslaved (confusion with pais)
–> those who could pay fee, and charity in some cases for those who could not
“Tradition in Medicine”
in section 3, “the anthropology”, a reversal of pessimistic narrative of human civilization
–> weak, ignorant in primitive state; didn’t understand our relationship to food
–> discovery of cooking, powers of food (within diaita) allowed civilization to be born
–> arguably either optimistic (we are getting better) or pessimistic (we are so weak that we needed to discover our diaita)
gender of the child: Hippocratic Corpus
- contest of the sperm (same as “The Seed”)
- left/right (more sperm from left testicle = girl, right = boy)
- menstrual cycle (conception after period, when body is dry, is boy; close to period, with moisture, is girl)
Asclepiades’ 5 Step Regime
- regulate food/wine
- give massage
- go for a walk
- take a bath
- go on a swing
“The Heart”: orifices
text is dubious; valves? atria?
Great Plague of Athens: symptoms
–> fever
–> chest cough
–> separations (bile, vomit)
–> pustules/ulcers
–> 7th/8th day krisis
–> loss of body parts (fingers, toes, eyes)
hairesis
Greek, “sect”; any intellectual group with systematized knowledge
–> medical sects: central arguments were on basis of epistemology, or origin of knowledge; how do we know what we know? Where does new knowledge come from?
–> both Dogmatists and Empiricists considered themselves Hippocratics, but in different ways (Dogmatists = “Airs, Waters, Places”; Empiricists = “Aphorisms”)
“spongy” female bodies
male flesh should be hard, but female soft to the touch and better at absorption
–> female body sometimes compared to wool; as if needing more protection, or being delegated to the home (weaving as only chore?)
trends in pharmacology
as empires expand, importance of pharmacology increases
–> access to new drugs, recipes
–> growing demand for recipes (increase in population)
–> also true in Colonial period (e.g. in Britain, expanding into India)
–> movement from pharmacology to pharmaceuticals occurs in Chemical Revolution in 19th century (chemistry allows for extraction of active ingredients from substances, like nicotine from tobacco or cocaine from cocoa)
Herophilus
scientist in Alexandra (worked at the Museum); not a healer, but only a researcher
–> only fragments of any of his writings survive; probably the first person in Greek, though maybe all of Western, history to deliberately research via dissection
Hippocratic Bench, Board, and Ladder
idea of spectacle: Hippocratic doctors were opposed, but they impressed crowds
–> Bench: relocate joints by spinning patient on a rotating panel
–> Board: correct spinal deformities by strapping to board, jumping on back
–> Ladder: correct spinal deformities by strapping upside down, raising and then dropping ladder
techne (τέχνη)
Greek, “rational body of knowledge”
–> plural: technai
–> process of organizing knowledge into systems
Hippocratic pharmacology
certainly drugs existed, but almost only ever mentioned in Corpus in treatises about women
–> 82% of mentions are in gynecological texts
–> drugs as “gendered female”? assumption by men that drugs should only be prescribed after changing diaita, and even then only for women
–> typically local, simple ingredients (about 60% of all recipes contain only local Greek ingredients)
–> layering: adding something expensive/luxurious to otherwise cheap recipe to enhance its value, create a trademark, assist dealers in markets
Great Plague of Athens: Thucydides
not a doctor (though maybe knowledgable in the Corpus, given interest in diaita); rather a military general, historian
–> wrote doctors were “useless” during plague because they were the first to die
–> qualified because he had the plague, then survived
shift in narratives of humanity
early: pessimism (humans have become worse as time has passed)
in Classical period: achievement has brought us out of our primitive state, into our knowledge today
–> achievement makes this less divine
“The Heart”: heart & pericardium
pyramid-shaped, crimson; sits in “sac”
pais
Greek, “boy” and “slave”
–> confuses patient stories b/c unclear which applies
hodos
Greek, “method”
–> observation - something repeatable (could happen again)
–> NOT experiment, which arises in the Hellenistic period
“The Epidemics”: treatments
not mentioned, so as to make it seem like doctors were recording the “natural course” of the disease
–> still a “world of surfaces” (only symptoms are those palpable on the body)
discoveries of Herophilus
–> structure of brain (cerebellum, cerebrum, ventricles)
–> distinguishing between veins and arteries, based on shape (though says arteries carry pneuma)
–> nervous system (small arteries called neurons carry sensation)
–> four layers of the eye (cornea, later Roman word, for “horny area”)
–> male/female reproductive systems (fallopian tubes)
–> pulse (error: says it contracts to carry pneuma)
“The Heart”: the two ventricles
“cavities”, “stomachs”; myocardium
–> ventricle: Latin, “little stomach”; different in shape, with a thicker and rougher wall on the left side
–> left side thicker because it is hotter; “seat of fire”, or essentially location of the soul
“The Seed”: umbilical cord
hardened, excess moisture from the lack of menstruation during pregnancy
Dogmatists vs. Empiricists
Dogmatists reject Empiricism: hard to gain the right experiences, and experience is often incomplete; takes too long to transmit experience
Empiricists reject Dogmatism: experience is certain, while reason is only abstract; too much disagreement, not enough orientation towards legitimate ethical care
–> Common ground: would probably give the same diagnoses, just in different ways
“The Decorum”
second half: how to perform home visits to a patient
–> describes ideal doctor’s personality: elegance, grace, sense of humor (uplifting), able to perform kindnesses, wary of patient lies, polite but firm
“The Epidemics”: key features of cases
–> time
–> temperature/fever
–> bodily signs (‘separations’), i.e. urine, stool, sweating, breath, bile, pus
–> change (physical and mental)
menstruation
vital for health
–> stops when pregnant because excess moisture goes to fetus instead
opium
first mentioned in Homer; poppy flower cultivated long before ancient Greece in many surrounding cultures
–> only mentioned in Corpus in gynecological treatises, as an anesthetic
–> poppy head + different things (honey, etc.) could treat different illnesses
–> danger of overdose: opium used as a poison when in excess, so avoid giving too much
–> caused “sleepiness”, which was associated in some cases with death
Great Plague of Athens: Myrtis
reconstructed skull of a young girl –> used as model by CDC to discuss epidemics
silphium
herb from ancient Libya; never grown in Greece, despite many attempts
–> popular for cooking
–> abortifacient (“puts wind in the womb”)
–> no modern idea of taste, color, as it went extinct during Roman era (traceable end)
votive object
small figure used to dedicate to the gods
–> prayers for healing
–> showed how ancient societies viewed certain internal body parts
–> some simple, some detailed; would be created and then burned
Empiricist hierarchy
- personal experience
1a. involuntary
1a1. natural
1a2. chance
1b. voluntary
1c. initiative - transmitted experience
- transference of similar
–> most reliable when something was experienced oneself, with as little influence as possible
–> “chance” means something, though maybe involuntary, intervened in process of healing
–> voluntary: random choice made for healing, but it works; initiative: you know your choice beforehand
“The Epidemics”: missing information
specific anatomical language
medical histories
details of treatments
dissection
some forms existed in Classical period, but only on animals; Hellenistic period saw beginning of human experimentation
–> resulted in massive spike in anatomical knowledge
–> taboos: religious pollution from touching dead bodies; disturbance of cutting through skin, which was a powerful protective symbol
objections to Methodism
–> confusion over commonalities - what’s the point if we don’t know the difference?
–> ignorance, disrespect for medical histories
–> lack of medical knowledge
–> no individualized patient care
–> anyone can be a doctor (no longer a techne)
“The Seed”: term of pregnancy
nine months (sometimes written as 10 with inclusive counting)
–> premature birth = dangerous, but some superstitions held that birth in the seventh month was healthier than in the eighth
Dogmatism
“rationalism”; using reason to form conclusions
–> founders: Herophilus, Erasistratus
–> label of “dogmatist” was only ever used against them; doctors would probably refer to themselves, if anything, as “Herophilist”
–> in order to cure a disease, you must understand its cause; heavy interest in anatomy, experimentation, pulse
krisis
Greek, “to decide”; the moment where it could be identified whether a patient would live or die
–> “critical days”: Hippocratic doctors thought crisis was mostly likely to occur on certain days (odd day if disease began on an odd; numerology)
“The Science of Medicine”: what makes a science scientific?
–> author is against hypothesis (postulate)
–> medicine is any observable phenomenon, not speculation (which is philosophy)
–> “scientific”: knowledge from observable phenomena as a basis, with a method of discovery
Empiricism
perceived as more intellectual sect in Hellenistic period
–> founder: Philinus of Cos; had a stronger sense of group identity, would actually use “Empiricist” as a name
–> Philinus created sect after being disgusted with Herophilus’ research; was explicitly based on healing patients first, seeing anatomy and experimentation as indulgent
–> against “hidden causes” (unreliable)
“The Heart”: nourishment
right ventricle: holds blood, air from the atria
left ventricle: free of blood, instead the seat of emotion and soul (can’t be polluted)
–> left ventricle gets nutrients through “rays”, which are sent to blood so some essence of nutrition can come back to the body
–> rationale: blood is usually not found in LV after death (because of pumping of heart), so likely dissections would have always shown emptiness
Great Plague of Athens: modern diagnosis
smallpox: highly contagious, rash = ulcers, acquired immunity; BUT no loss of extremities & Athens had cross-species
bubonic plague: cross-species BUT lack of bubos (swelling) in gland areas
measles: pustules? BUT impossible to imagine such a high mortality rate
typhoid fever: seemed to be linked by DNA evidence in 2006, but debunked after microorganisms were closer to salmonella
–> impossible to identify? Did Thucydides forget some symptoms, or is this evidence of a disease that no longer exists?
“Prognosis”
treatise with base principle that the more deviation a patient has from the norm, the more unhealthy that patient is
Hellenistic Period
3rd - 2nd century BCE; “hellen” (“Greece”) + suffix meaning “ish” –> “Greekish”
–> period during which Greek culture spreads beyond borders
–> difference from Hellenic because of suffix
“The Heart”: pericardial fluid
heart sits in small amount of “urine-like” fluid
–> protects pulsation (cushion)
–> cools down heat from heart (heart is “inner fire”, especially left ventricle)
–> heart absorbs some fluid for moisture
–> actual truth: pericardial fluid replaced by the pericardium; in text, author says there in an epiglottis (lid) protecting fluid from going down the trachea and into lungs, except for a small amount that somehow becomes pericardial fluid
Hellenistic period: “sect”
infatuation with organizing knowledge –> sects were intellectual groups
origin of sperm in Hippocratic Corpus
pangenesis: comes from everywhere, so child can inherit everything about a parent
encephalomyelitic: begins in the brain, travels down spine, distributed to genital areas
–> “The Seed” attempts to combine the two theories
–> friction to foam: sperm comes out as foam after ejaculation because of “shaking” during intercourse
kindnesses
actions taken by Hippocratic doctors to make a patient more comfortable
–> good smells, hiding bad news, general deceptions
–> possible form of placebo
Methodism
not Hippocratic; because Rome was more culturally complex and dynamic than Greece, and because there was a greater variety of class hierarchies, a new system was needed
–> essentially, anything that does not seem like outright medicine; appealed to a wider group, assuaging fears without introducing new techniques
–> little training necessary (needed only 6 months, sometimes less), so accessible for poor and illiterate
–> efficient, and adaptable to massive population increases
“The Heart”: hidden membranes
inner lining, valves
–> heart kept in place in the sac by “ropes”
–> valves keep things flowing properly, blocking anything from entering left ventricle
dissection: why now?
–> culture of scientific inquiry, intellectual openness
–> relaxation of certain taboos because of new location
–> no more Athenian democracy (people more willing to take chances, because less risk of being “voted out” for insubordinance)
–> pre-existing Egyptian culture of working with bodies (e.g. mummification)
–> racial? were Greeks not opposed to operating on Egyptians?
the Hippocratic Triangle
patient, doctor, and disease must all cooperate in order for a treatment to work
–> patient must assist if necessary (during surgery, must allow for it to occur)
differences between male and female bodies
women are naturally colder, wetter than men
–> women “dry out” over time (menopause?)
–> women lose moisture during menstruation, so must be constantly absorbing wetness to replace it
–> the womb is warm, wet because it takes excess fluids not used in menstruation
Great Plague of Athens: moral impact
- Depression and Fear (thought of catching plague scarier than plague itself)
- Isolation or Risk (neglect, or risky socialization)
- Immunity and Arrogance (people who survive likening themselves to gods)
- Neglect of the Dead (no typical ceremonies - funerals, rites, pyres)
- Lawlessness (dying soon anyway!; religious skepticism)
womb as a living creature
Plato, and later Roman periods: the womb was a living creature inside the woman
–> stored and required moisture, for which it would go looking if required
–> would “turn around”/”go back”, where the mouth would flip upside down and then travel through body
–> could block passageways and cause illness until intercourse, as it wanted a fetus
–> why? older women with different-shaped uteruses; one-body model (men have no womb, so there is no place in the body for womb to go)
prognosis (action)
important to Hippocratics for:
–> knowledge of sequence
–> independence from patients (able to ignore extraneous symptoms)
–> win respect for techne
–> avoid failure (not take on lost causes)
the Museum of Alexandria
Greek; “temple to the muses” (first one in history built in Alexandria)
–> center for government-funded learning, research, translation, literature, etc.
–> sponsorship of the most learned people to simply be together, find new beginnings from each other
–> place of systematization of knowledge (e.g. Hippocratic Corpus) in medicine, science, agriculture…
–> place of experimentation; location of Herophilus, Erasistratus
–> shift towards viewing body as a mechanism
Great Plague of Athens
summer of 430 BCE –> then 429 BCE; Athens already suffering from Peloponnesian War with Sparta, then hit with disease
–> approx. 1/3 of total population dies, as told by source Thucydides
–> use of mass graves, simply to get rid of the bodies
Hippocratic facies
signs of death (appearance of the face preceding imminent death)
medicine and philosophy
doctors were not philosophers; although they may have been inspired by certain philosophical ideas (e.g. Empedocles), they tried to focus on what was observable
Hellenistic Period: onset
mid-4th century BCE: King Philip I of Macedonia attempting to spread Greek culture in aftermath of Peloponnesian War
–> Greece weakened, taken by Philip’s son Alexander the Great
–> no infrastructure to support expansion; empire only lasted if certain generals established footholds in that area
“The Heart”: valves
membranes that allow for blood to pass from the right ventricle to the lungs; and for air to enter the right ventricle, etc.
Asclepiades
inspiration, 1st century BCE; teacher of rhetoric, immigrant to Rome –> saw gap in market for Romans who were afraid of traditional Greek medicine
–> received hostility from “real doctors”
–> quick celebrity, popular with social elite; rejected former sects
–> theory: invisible particles moved through pores in body; if blocking/imbalance occurred, so would sickness
–> promised he would never perform surgery or give drugs; motto “swiftly, safely, pleasantly”
“The Heart”
treatise in Hippocratic Corpus, but actually dates to Hellenistic period (product of human dissection)
–> why included? just because it was in the Library?
–> author unknown; probably a follower of Herophilus
–> mystery: text discovers many things, but not circulation; ancient authors thought blood was made from food, so it would need to be absorbed at some point (couldn’t go back around, or bodies would starve)
Hippocratic surgery: “The Oath” vs. other texts
doctors definitely DID perform surgery, and it was often very complex (e.g. cataract)
–> however, remember the Hippocratic hierarchy (surgery was almost absolute last)
“The Epidemics”: language
highly specific, detailed by nature; clearly not meant to be read by non-doctors
–> secrecy to help hide mistakes in treatment from the public
vivisection
did it occur? hard to tell –> only information that survives is in writings bashing dissection as a whole
the Sophists
group of philosophers, attempting to argue they understood “virtue”
–> “man is the measure of all truths” (we create truths - nothing is objective)
–> link between nature and convention in language is arbitrary (why names?)
–> power of rhetoric
–> often attacking medicine in writing (sophism as a techne used to criticize other technes)
“The Seed”: gender of the child
contest of the sperm (section 6): men and women both have male and female sperm –> which is majority?
“The Heart”: takeaways
–> innovations in cardiac anatomy (similar to Herophilus, Erasistratus)
–> three experiments show culture of inquiry
–> limitations: blood as food, interpretation of left ventricle, reversal from “The Sacred Disease” of heart as seat of emotion
hirudiniasis
medical danger of drinking infested water, in the dark, and ingesting leeches into mouth/nose
–> could cut off blood flow/air circulation
“The Heart”: experiment two
valves close as tightly as seals; proven because, when closed artificially, nothing can pass through
castoreum
ancient version of modern castor oil; used in soaps, oils, etc.
–> “oil from the castor”, Latin for beaver; oil believed to be produced in beaver testicles, though actually in anal glands
–> theory: when chased, a beaver would cut off its testicles, knowing that humans wanted them for the oil
–> promoted fertility, sexual performance
pnix
Greek, “suffocation”/”strangulation”; uterine suffocation as a consequence of the wandering womb
–> upturned mouth of womb might press against an organ, blocking respiration (or respiration of woman entirely)
end of dissection
influence of Philinus was more charismatic than Herophilus, Erasistratus –> shift in policy of Ptolemies
–> as sects migrated, taboos returned and practices changed
growth of techne
fashionable in ancient Athens to systematize bodies of knowledge for certain ideas (e.g. architecture, medicine, wrestling)
–> answer philosophical questions: what is the techne for being a good leader? a good person? for virtue?
Hippocratic surgery: instruments
cupping vessels (“gourds”)
scalpels
cauteries (flat piece of metal to protect hand)
retractors (hooks to pull back skin)
forceps (artificial tweezers)
needles (suturing)
–> all present in some form today
–> question: would doctors have training for these skills? how/would they teach apprentices?
Thessalus
“true founder”, 1st century CE
–> court doctor to Nero (ruled 54-68 CE), immigrant to Rome
–> claimed he founded Methodism, came up with the “method” for curing (that we don’t know)
