Midterm #3

Question 1

dreams: Galen

Answer 1

“On Diagnosis in Dreams”: object is to attack Methodists for arguing that dreams are not diagnostic tools
–> importance of dreams: linked to humoral theory
–> still wants to believe that gods send dreams (consider his life story - dreams from Asclepius)
–> dream of: fire = yellow bile, black smoke/darkness = black bile, rain = blood, snow = phlegm

Question 2

venesection after Galen

Answer 2

continues through to 19th century, exemplified through art and artifacts
–> fancy estates may have had “leecheries”, places to bleed out
–> practiced even after discovery of circulation; not disproved until clinical studies in late 1800s

Question 3

Roman baths: procedure

Answer 3

man enters via main entrance, woman through the back
–> put clothes in change room; in lighter clothes, be covered in olive oil and exercise (ball games, boxing, wrestling - not naked)
–> have oil, dirt scraped off by bath attendants
–> bathe: hot bath near furnaces, tepid in middle, cold bath only for men on the far end (women already naturally cold)
–> bath complexes would also have apartments, shops, etc.

Question 4

Caesarean section

Answer 4

in ancient world: only performed if woman is already dead
–> death during childbirth: child can only be saved if cut out as soon as possible
–> religious discourse: “special blessing” from the gods, as birth necessitated involvement of a man

Question 5

venesection: basics

Answer 5

with needles; for generalized problems (e.g. insomnia), make incision in the arm; for localized (e.g. blindness, foot ache), make it as close as possible
–> take patient to stage of loss-of-consciousness
–> recognized as unsafe by Galen (would not perform on pregnant, elderly, those under 14); only done if considered strong enough to withstand procedure
–> use of medicinal leech for patients who could not tolerate excess blood loss (first record: Nicander)

Question 6

Soranus

Answer 6

Greek gynecological author, in Rome during the Trajan era (98 - 117 CE)
–> Methodist, although advice often seems medical; frequently dissuades diagnosis based purely on cause or experience
–> evidence of continuity: even 500 years later, first priority for doctors is to declare sect association

Question 7

archaeological evidence of surgery: cauteries

Answer 7

for burning; heat in fire (protecting one’s own hand), then burn tissue
–> made of iron

Question 8

archaeological evidence of surgery: needles

Answer 8

for suturing; usually with hair (horsehair), and made of copper

Question 9

care of the newborn: shift in understanding

Answer 9

previously believed that, after birth, oldest living free male would decide if child was raised or exposed
–> not true; rather, nurse would inspect for health, and expose if not

Question 10

Roman gladiators: methods to stop bleeding

Answer 10

both Galen and Scribonius Largus do not recommend tourniquets; would supposedly squeeze out more blood, rather than stop the flow
–> instead: put finger in the wound; twist the blood vessel; try to tie off the vessel with hair, fine silk; or apply a styptic (something sticky to block movement of blood)
–> small wounds may benefit from cauterization

Question 11

Roman army: background

Answer 11

Rome always had an army; by 1st century, it was standing
–> people would volunteer; if already a citizen, would serve 20 years before receiving benefits
–> non-citizens: serve 25 years to receive benefits, citizenship

Question 12

gynecological treatises

Answer 12

only one gynecological treatise exists that is written by a woman –> yet to be translated

Question 13

Asclepian temples

Answer 13

Epidaurus: oldest in mainland Greece, with museum (now), racecourse, theater
Pergamom: largest megacomplex, in Galen’s hometown and where Aelius Aristides went to be healed

Question 14

Galen: anatomical knowledge

Answer 14

most mistakes are because of differences between animals and humans
–> not many of his own discoveries, but good at systematizing existing ones
–> first instance of blood having a “path”

Question 15

Renaissance: anatomy demonstrations

Answer 15

England, Italy; pubic celebratory events (with music, food)
–> ritual: professor (lector) would read Galen; demonstrator (ostensor) would point to corresponding parts of body; cutter (sector) would make incisions

Question 16

“crowd of gods”

Answer 16

new searches for guidance in Age of Anxiety meant Asclepius, Jesus, Isis, the sun…etc. became new gods
–> rise of new religions: state never attempted to control any growth, so theories abounded

Question 17

Roman gladiators: old age

Answer 17

transitioned out; enslaved were sold and money was invested into someone new

Question 18

Roman gladiators: doctors

Answer 18

very similar to military doctors; meant to keep gladiators alive, if necessary
–> arenas had attached doctors for specific medical care
–> note: Galen returns to hometown at 28 to become a gladiator doctor, which kickstarts his career
–> innovations: understandings of human anatomy (injury severity), suturing, wound cleaning (using unmixed wine), methods to stop bleeding

Question 19

Cato’s “On Agriculture”

Answer 19

earliest work of Latin prose; helps create the sense of Roman identity
–> full of references to medicine (vehement distrust for doctors)
–> veterinary medicine, with no doctors required (do it oneself)
–> ingredients as local as possible
–> mix between rationality and magical ritual (more of latter)

Question 20

Galen: “Affections and Errors (Peculiar to Each Person’s Soul)”

Answer 20

error: mistake of judgement by rational part of soul
affection: emotion, drive existing in non-rational part of soul
–> psychological advice: eliminate affections from soul by recognizing presence
–> have a “supervisor” who will tell you when affection is taking over; hard because of self-love, where we don’t believe our own faults
–> good supervisor: older, moral, calm/wise (outside affection)

Question 21

problems with understanding mental health

Answer 21

–> how to find a good, trustworthy supervisor?
–> should all affections be treated the same?
–> would a person free of affections really be perfect, or complete?

Question 22

Galen’s theory of venesection

Answer 22

“On Treatment by Venesection”: adoption of model of humors from “Nature of Man” (blood, phlegm, black bile, yellow bile)
–> “eukrasia” = good mixture, balance, healthy; “dyskrasia” = bad balance
–> residues: when we eat, food is ideally converted into blood by hematopoiesis; if process is not perfect, digestive waste will cause imbalance
–> purpose: evacuation (get rid of excess of humor, purge, by bloodletting); revulsion (attract excess humor to opposite point in body, which required knowledge of where that point was)
–> evacuation considered better than purging because doctor could be in control

Question 23

growth of Rome

Answer 23

culture, literature, art, and religion lag; only start becoming “grand” when conquering of other territories begins
–> Romulus and Remus myth used to make sense of “late development”
–> “young culture”, used to “coming last”; almost all aspects of culture are drawn from others surrounding them

Question 24

venesection: what did it treat?

Answer 24

anything related to an imbalance of humors (aches, illness, infertility)
–> did NOT work, and was so dangerous for the body; but survived because of psychological appeal

Question 25

mind and body in ancient medicine

Answer 25

Greek, “psyche” (soul) –> no real distinction between soul and mind, so mental illness was an illness of the soul
–> Galen influenced by Plato, Stoicism: rational vs. unrational thought, self-critique

Question 26

chlorosis

Answer 26

mentioned in Hippocratic “On Girls”, but completely fake
–> strangest treatise in Corpus: 3 paragraphs, discussing techne; wandering blood (?); and the idea of marrying virgins as quickly as possible
–> is it Cnidan, because of disconnect with Coan? Is it a Sophic paradoy of the Hippocratics, assumed to be real?
–> popular in Renaissance as “On the Diseases of Virgins”: “chreia”, or “duties” mistranslated as “chroia”, or “skin color”; said that women changed skin color if not married or pregnant early enough, becoming literally green
–> modern ideas: love-sick lover turning “green” with envy?

Question 27

archaeological evidence of surgery: retractor

Answer 27

keep apart edges of surgical incisions, wounds; made of iron

Question 28

Plato’s allegory of the soul

Answer 28

if soul is moving upwards, the rational part is the chariot-driver; the “spirited” (white horse) anger, passion; and the “desiring” (black horse) lust, envy, pleasure
–> rational part must govern the drives of the horses

Question 29

Celsus - procedure of arrow removal

Answer 29

take out through entry wound (enlarge the cut, so as not leave behind arrowhead) OR counter-opening (push arrow, rather than pull?)
–> no way to avoid consequences, like internal bleeding; simply attempt to keep patient alive

Question 30

care of the newborn: process

Answer 30

after birth, first food should be boiled honey and wine
–> colostrum: first breast milk after birth, helpful for giving antibodies (different from normal); Soranus said avoid colostrum, which may have affected infant mortality rate of 30-40% within first year

Question 31

Galen: Nicon’s dream

Answer 31

–> growing up in 2nd century CE, in a Greek-speaking part of Roman empire; wealthy, and so should not have pursued medicine
–> Nicon had dream that Galen should become a doctor (possibly a visit from Asclepius?)
–> later: at 16, Galen had his own dream - a visit from Asclepius, pointing to the area of skin between pointer finger and thumb; bleeding himself there led to curing his persistent stomach illness

Question 32

“On Treatment by Venesection”

Answer 32

Galen; treatise written very late in life, summarizing much of earlier works
–> target: Erasistrateans, who could not find accurate physiological reason for venesection
–> apparently, a “sudden reversal in opinion” in favor of venesection after reading Galen
–> for evacuation: cut kat’ixin (on same side)
–> revulsion vs. evacuation: try revulsion first, esp. if pain is localized (less intense); then evacuation
–> no time limit; can be performed on any day and consecutively, although one must be careful

Question 33

medical degrees, Renaissance era

Answer 33

at Oxford, Cambridge; only in Latin
–> just about reading Galen; took 6 years, requiring attendance at just 2 dissections
–> final oral exam was fully in Latin, and response were about only what Galen would say on a topic

Question 34

Aelius Aristides’ “Sacred Tales”

Answer 34

memoirs of his journey through illness, esp. as follower of Asclepius
–> experience of temple medicine
–> non-chronological order
–> competition between traditional and new religious medicines

Question 35

wet nurse

Answer 35

woman hired to breastfeed a child –> free women would not breastfeed themselves
–> requirements: older, having given birth before; healthy; “self-controlled, sympathetic and not ill-tempered” (transmitting personality through milk); Greek

Question 36

“Age of Anxiety”

Answer 36

2nd century CE; Galen not representative, but MOST people seemed insecure
–> decrease in human connections (expansion of empire) and loss of hold habitudes
–> rise in superstition, with people trying to personally connect with divine in lieu of each other
–> move from social feelings of certainty to chance: dice altar, where quadrant of dice landing meant immediate answer to a question

Question 37

care of the newborn: healthy?

Answer 37

–> is the baby crying (yes = good)?
–> do arms/legs stretch normally?
–> does baby react when touched?

Question 38

temple medicine: healing process

Answer 38

sacrifice/prayers/vows –> incubation in abaton –> dream from Asclepius –> follow offered regime at sanctuary, where priests would help with tasks –> thank for healing via votive object (e.g. shape of body part)
–> iamata: instructions of gods; prescriptions, tests…both science and faith
–> skepticism: likely could have all been a fraud

Question 39

Asclepius: myth of origin

Answer 39

Greek: Asklepios, or Latin: Aesculapius
–> mother was mortal Coronus, lover of Apollo; Coronus wanted a mortal lover with whom to age; took one, and a white bird (raven/crow) told Apollo; outraged, he turned the bird black and shot an arrow to kill Coronus, leaving Asclepius to be born via Caesarean

Question 40

Galen: pathway of blood

Answer 40

the liver: stomach digests food, moves raw blood (chyle) into liver; chyle turned into red blood via hematopoesis
–> blood from liver to heart; enters through non-existent porous septum, then is infused with pneuma (which explains why blood is different colors)
–> blood to brain, passing through “net of nerves” (rete mirable) in back, becoming infused with the “animal spirit”
–> does not realize circulation, but rather a movement straight from right of heart to left

Question 41

“5 Things the Ancient Greeks can Teach Us about Medicine Today”

Answer 41

1. holistic: body is part of nature, part of a regime
2. trust: heart of doctor-patient relationship, even today
3. why do we get sick? is it truly natural, could it ever be “fated”?
4. historical perspective: everything we “know” was a challenge to learn, not to be taken for granted
5. humility: avoid grading mentality, since more findings are to come after us

Question 42

Harvey: experiment on the dog

Answer 42

showed quantity, force of blood in demonstrations by tying a dog to a table and cutting its pulmonary artery; blood would spurt out, and his showmanship (and brutality) would shock audience

Question 43

establishment of Rome

Answer 43

move to the West (Greece/Egypt/Asia Minor –> Italy) except for Carthage, in North Africa (near Sicily)
–> Roman and Carthaginian Empires battle in the Punic Wars; Rome wins, establishes itself as prominent in the West Mediterranean
–> future: Rome will cover area of approximately 50 modern countries
–> mythological: Romulus and Remus raised by a she-wolf; after killing Remus, Romulus founds Rome in 753 BCE

Question 44

Cato the Elder

Answer 44

Marcus Porcius Cato, 234-149 BCE
–> conservative Roman politician, with pride against foreign influence
–> author of “On Agriculture”

Question 45

Harvey: demonstrations

Answer 45

returns to England, starts massively practicing dissection (probably on grave-dug bodies)
–> experiments are similar to Vesalius, and he is not afraid to go against Galen - but also makes his works a spectacle, and also has an ego (just like Galen)
–> European tour to show heart is a pump, like Erasistratus said, but blood not absorbed at end of veins; rather so powerful because blood is constantly cycling through body
–> popular events (Harvey = celebrity)

Question 46

anger

Answer 46

Plato/Aristotle: anger is spirited, dangerous in excess but not inherently bad
–> Stoicism: anger is weakness (loss of control)
–> Galen: anger is powerful on soul (mind) and body

Question 47

Vesalius

Answer 47

Italian child prodigy; had performed all dissections completely by himself, no assistants
–> started making real discoveries because of lack of spectacle
–> vs. Galen: took courage, but he disproved existence of rete mirable and porous septum

Question 48

why does dissection return?

Answer 48

–> no more religious taboos (no notion of pollution)
–> return of Galen in Latin translation
–> social acceptance of open bodies (e.g. crucified Christ, public executions)
–> perhaps: embalming growing as a fashion, at least for the wealthy…

Question 49

healing and early Christianity

Answer 49

–> background: life story of Christ very similar to Asclepius (followers were antagonists of each other); early Christian explanation was that demons had planted Asclepius to draw followers away from Christ
–> Jesus as healer: Greek doctor = “iatros” (iatroi), but starts to mean only human doctors; Jesus called a healer, but never iatros, because his medicine was divine
–> faith INSTEAD of medicine

Question 50

contraception

Answer 50

exists, but is not very effective; three categories, in which woman is always to blame
1. actions taken by women during sex (movements; getting up and expelling sperm via jumping, sneezing)
2. applications of styptic to vagina (oil, honey) to stop flow
3. oral contraceptives (literal poisons: lead, silphium, opium)
* also: uterine magic

Question 51

Artemidorus

Answer 51

–> in ancient world: possible always to visit a professional dream interpreter
–> “Oneirocritica”: not a medical text, but instead divination; logic is just catalog of dreams and causes
–> partially critical of Roman government/society
–> oneiroi (predict dreams) vs. enhypnia (non-predictive): enhypnia are wish fulfillment (deep desires, non-rational part of soul), while oneiroi are sent by gods to predict some encoded future
–> dreamer: must be considered individually (what meaning underscored by identity?)

Question 52

what makes Galen unique?

Answer 52

quantity of surviving works: over 122,000 pages, spanning about 10% of all existing ancient Greek writings
–> extent of personality found in writings (Galen is his own “superhero”)
–> obsessions: medicine, ambition to become the most famous doctor ever
–> frustrating to read (aggressive to rivals, highly egotistical)

Question 53

Roman gladiators: identity

Answer 53

all enslaved, bottom tier of society; people who wanted to become gladiators would have to sign contracts to enslave themselves
–> why choose to be a gladiator? for celebrity in the ring, even if not outside?

Question 54

purpose of dreams

Answer 54

sent by gods (divine origin), to tell us something we don’t or should know
–> ex. Assyrian Dreambook (c. 8th century BCE): “if __, then __” structure, similar to Diagnostic Handbook
–> pre-Hippocratic: predictive power, but could be false

Question 55

Celsus

Answer 55

Aulus Cornelius Celsus (c. writings 20 - 47 CE)
–> not a doctor; author of “On Medicine”
–> upper-class Roman, attempting to explain medical knowledge to wary population
–> “harmonizing Hippocratic ideals with elite Roman lifestyles”

Question 56

Scribonius Largus’ “Compounds”

Answer 56

only one book, c. 44 - 48 CE; drug recipes “arranged from head to toe”, or “a capite ad calcem”
–> preface: written to attack Asclepiades and Methodists; drugs have fallen into disrepute, but are still valid in medicine
–> reference to Hippocratic Oath?
–> first description of medicine as a profession
–> recipe for toothpaste: has strange ingredients, such as glass, making one consider whether oral care was ever a priority

Question 57

Galen: later years

Answer 57

–> 169: called by Marcus Aurelius to be imperial doctor to son Commodus (180 - 192 CE); Commodus is crazy, dangerous to be near, and to be imperial doctor is Galen’s greatest fear
–> final disaster (192 CE): great fire destroyed libraries, storerooms, and all Galen’s works in imperial library; he copes by his extensive “mental training”
–> rest of life: attempts to recreate works, with a mysterious (unplaceable) death

Question 58

Archagathus

Answer 58

Rome’s first doctor (tradition of healing, but no formal doctor until 219 BCE)
–> arrives from Greece with ability to “cure wounds”, thus becoming “wound-man”
–> honored by people, government until noticed that he uses surgery; suddenly, public is so terrified that he becomes “executioner” and is ran out of town

Question 59

Galen: Experiment #1

Answer 59

“The Squealing Pig”
–> aim: show that a particular nerve controls ability to make sound (“recurrent laryngeal nerve”, from Latin “recura”, to run back)
–> method: strap down a pig; ligate nerve and sound stops; untie and sound restarts

Question 60

Roman baths: cost

Answer 60

cheap, or free for children
–> subsidized by government, or the wealthy as a way of showcasing affluence

Question 61

archaeological evidence of surgery: scoop of Diocles

Answer 61

attempt to “hook” some lodged item and remove; looks like a shoehorn
–> extraction of lead balls, pebbles, small missiles

Question 62

influence of Asclepiades on Celsus

Answer 62

rejection of drugs; deliberate attempt to appeal to other classes (make medicine for everyone, in a way)

Question 63

Galen: woman with insomnia

Answer 63

wealthy older wife, depressed, with no fever; Galen realizes while measuring pulse and overhearing a conversation that her heart races upon mention of Pylades, a pantomime (erotic) dancer
–> “test” done by having same woman say another name; no reaction
–> same story as Erasistrates, so Galen is trying to make himself a “contemporary” likeness of the great

Question 64

early monks and health care

Answer 64

two Christian values: philanthropia (love of humans, doing good for others) and asceticism (denial of pleasures, usually by distant or isolatory retreat)
–> monasteries (3rd-5th century CE): = attempts to balance asceticism with philanthropia, likely places were sick travelers were cared for (birth of concept of hospital)

Question 65

hysteria

Answer 65

never existed; used by male doctors to justify violent treatments against women
–> “name without a disease”, through Renaissance and Early Modern eras; “hysteria” = “womb”
–> Corpus: “hysterika” = uterine conditions, but not mania nor disease; not even used to refer to pnix
–> long-term culture of mistreating, imprisoning women on nonexistent grounds

Question 66

Harvey: controversy in demonstrations

Answer 66

other European doctors not understanding his propositions
–> how else would body get nutrients?
–> is blood lacking something (oxygen) by God, which would be an impious belief>
–> how is blood transferred between veins and arteries? (later research after Harvey’s death would find capillaries)

Question 67

Galen on mind and body

Answer 67

division of soul (Plato), daily review and danger of strong emotions (Stoicism)

Question 68

Pliny the Elder’s “Natural History”

Answer 68

collection of “weird facts” from many different places
–> shot through with xenophobia (looking down upon ideals from other cultures)
–> many writings seem like “reports”, but really question remedies of other cultures

Question 69

Galen: to Rome

Answer 69

leaves Pergamum, of 120,000 people, to Rome of 2 million
–> battle of the sects raging: Methodists, Empiricists still hugely influential, as well as “Erasistrateans”; Galen most in common with Dogmatists, but thinks himself above them all
–> builds reputation during 30s: heals his own dislocated shoulder from wrestling

Question 70

transition in origin of disease - Roman era

Answer 70

shift towards divine attribution
–> society begins rejecting medicine

Question 71

anger: case studies

Answer 71

–> Hadrian: emperor of Rome 117-138. Stuck a stylus into secretary’s eye and was afterwards remorseful, but secretary wanted nothing more than his eye back
–> traveling friend: killed a slave (illegal), then went into hiding; remorseful, asked Galen to beat him for actions - but Galen would only lecture instead

Question 72

Saint Basil

Answer 72

orator, administrator, political, theologian (330 - 379 CE); one of the Cappadocian Fathers
–> in twenties: went to tour existing monasteries in Egypt, and was impressed with philanthropia
–> dream: instructed to give back, but with his medical education; decided to create Basileias, “Basil-complex” or “kingdom”, an institution like a monastery but devoted only to care for the sick

Question 73

Galen: Eudemus the Philosopher

Answer 73

famous case; Eudemus, a philosopher, was already in his 60s (shouldn’t have been treated, because soon to die)
–> suffering from fever, which Galen thinks is quartan
–> other doctors say to bathe in hot water; he does, Galen confirms quartan fever
–> told to take theriac (“wonder-drug”), which Galen believes will make it worse; after theriac, paroxysms start to come sooner
–> Galen recognizes two simultaneous quartan fevers, takes a urine sample to prove it; then 3, all at the same time
–> orders evacuations (bloodletting), while monitoring pulse until all 3 gone

Question 74

outcome of Archagathus

Answer 74

late stage in Roman culture; initial welcome, then anger and hostility
–> beginning of long-term fear, suspicion of doctors in Rome, mostly because of Greek ethnicity
–> myth or reality? Archagathus means “good origin”, and the story commemorates the origin of mistrust (“bad origin”)…

Question 75

Scribonius Largus

Answer 75

Greek doctor to the Roman Imperial Court (took on Roman name - possibly enslaved)
–> author of “Compounds”

Question 76

dreams: Hippocratic Corpus

Answer 76

divine –> rational shift; dreams generated by the human body
–> indicate state of bodily health, giving them diagnostic properties
–> treatment for bad dreams: diaita, just like anything else (or venesection if severe)
–> dreaming of daily habits = regular, healthy; strange or harmful events indicates imbalance, and weirder = worse
–> why dream? free activity of the soul (psyche), when not occupied with maintaining body

Question 77

typical identity of a midwife

Answer 77

–> low status (poor or enslaved woman)
–> Greek (or at least non-Roman)
–> “medica”, “metilia donata”: entrance point for women into medicine

Question 78

origin of Caesarean section

Answer 78

–> theory for name: Caesar, from “caedere”, “to cut”; first Caesar born through Caesarean section
–> in later generations, rise of Julius Caesar meant people though Julius was born by Caesarean, making him unique & the process named after him
–> later tradition (Renaissance era): Caesarean section = “male birth”, imparts more power

Question 79

dreams: Aristotle

Answer 79

–> sleep/dreams linked to digestion; in “On Sleep” when body rests, soul has free rein
–> sleep occurs when exhalation (vapor waste from digestion) wafts up to head
–> sleep when one has not eaten = result of medicine, or disease acting like digestion
–> dreaming = uninterrupted sleep; excess in exhalations based on diet, digestion

Question 80

Stoicism

Answer 80

virtue is apatheia (being free from all passions), where wise men feel no anger or clouding of mind
–> to achieve apatheia, one must practice training and daily self-critical review

Question 81

dissection: search for bodies

Answer 81

serious lack, because they had to be both criminals and of low/foreign birth (no rights and no family to be disgraced)

Question 82

Galen: Experiment #2

Answer 82

“The Elephant’s Heart-bone”
–> Galen comes across “gang” of doctors debating if elephant has a bone, separating chambers of the heart; most say no, but he wants to prove yes
–> takes elephant from imperial kitchen and dissects; reveals heart-bone, then keeps it on his desk as a reminder
–> truth: elephants have no heart-bone (os cordias); theory is that Galen was either lying, had confirmation bias, or “magnifies” an experiment done on an ox/cow to have a bigger effect

Question 83

types of fever

Answer 83

depends on the paroxysm
–> continual (temp spikes every day)
–> tertian (temp spikes every 2 days, because ancients counted inclusively)
–> quartan (temp spikes every 3 days)

Question 84

Asclepius: myth of life

Answer 84

raised by Chiron (centaur, horse + human = nature + culture)
–> learnt medicine; became “culture hero” (taught god-associated knowledge to humans, like Prometheus)
–> too much success; began to be able to resurrect the dead
–> Zeus killed him to strengthen boundary between under and over world; then brought back to life; why? = mythic gap

Question 85

Galen: experiments (background)

Answer 85

in Rome, after the plague
–> human dissection? likely not, as never mentioned, and most errors are because animal bodies are assumed to reflect human
–> all dissections on animals, which could have been bred on his estate or taken from arena, discarded kitchens
–> best animal for dissection: ape (Barbary ape), but people were too sympathetic because they looked human during spectacles

Question 86

after Harvey

Answer 86

next theory to die is the humors –> realized that they depend on perfect balance, which is impossible with constantly circulating blood
–> Galen taught, but critically, and with other writings to dispel his ideas
–> “dogmatic drag”: some ideas linger long after being disproven (e.g. Harvey still believes in dissection)

Question 87

William Harvey

Answer 87

1578 - 1657; Renaissance / Early Modern Era
–> benefits from humanists initiating return of Greek, as well as teaching of “medical degrees”
–> dissatisfied with medical education; goes to Italy to follow his hero Vesalius, who had rebelled by performing his own dissections

Question 88

shift in perspective on doctors in Rome

Answer 88

doctors are still Greek, but more respected because of place in military
–> associated with prestige of the army (Roman crux was military)
–> different patient-doctor dynamics (doctor had to operate before convincing patient of techne)
–> emergency military surgeries led to medical advances (decisions made “on one’s feet”)
–> Celsus: entire 7th book is about military surgery

Question 89

Roman baths: when?

Answer 89

everyday; naked bathing of Romans of all genders, all classes
–> particularly after the afternoon siesta

Question 90

process of childbirth

Answer 90

seated, with aid from midwife/enslaved
–> preparation: olive oil, warm water/fomentations (e.g. hot water bottle), soft sea sponges, pieces of wool, bandages, pillow, things to smell (to regain consciousness), midwife’s chair
–> position: sitting up, in Greece and in Rome; only extreme difficulty or obesity may cause lying down
–> chair: high back for reclining, hole in seat
–> ease pain: massage with oil, fomentations
–> swaddling after birth: limbs of infant not strong enough to be free, need to be tightly wrapped

Question 91

Galen: Antonine Plague

Answer 91

rumor building about a “mystery disease” soon to prophetically attack Rome –> Antonine Plague, 168 - 169 CE
–> killed approx. 60 million people on Earth; whole towns in Egypt dropped off map
–> cause: smallpox (first documented occurrence)
–> Galen retreats to Pergamum, somehow surviving (though lied and said he was going to Italy)

Question 92

Roman gladiators: conditions

Answer 92

lived at the “fighting academy” (ludus), which was also the jail
–> chances of survival: at the arena, morning devoted to beast hunt and parade; afternoon to siesta and duel-execution fights; and later to gladiator fights, which were organized to not be deadly
–> didn’t want gladiators dying in every fight - to expensive to train, and needed more

Question 93

temple medicine

Answer 93

temples of Asclepius were places of healing; altars, clean purifying water, and abaton (incubation chamber, “he who is not pure cannot cross”)
–> often also had theaters - catharsis, cleansing of the soul?
–> many Aesculapian snakes (non-venomous and bred in the temple); let into abaton while one was asleep, crawled over body to help draw up a prophetic dream

Question 94

Basileias

Answer 94

massive; emperor likely gave Saint Basil some public land to create
–> “a new city”, “as big as the pyramids” (exaggeration)
–> no archaeological remains
–> dedicated to care, hospitality (sick would stay until healed, even if infectious disease)
–> unified solitary and communal life

Question 95

Asclepius: imagery

Answer 95

always presented as young, maybe just post-pubescent male
–> healer, associated with snakes
–> traveled to Tiber Island as a snake; snakes licked his ears to teach him medicine; snakes shed skin, which is regenerative

Question 96

Aelius Aristides

Answer 96

exact contemporary of Galen (2nd century CE; “Age of Anxiety”), probably knew each other
–> birth: Mysia, in modern-day Turkey; had lust for adventure as young man, tried to sail and find the mouth of the Nile
–> desire: be the most famous public speaker; plagued by disease from Nile for lifetime, then after later health issues became exclusive follower of Asclepius

Question 97

sympathy (ancient rituals)

Answer 97

take actions that reflect what you want to happen in the body
–> “state of feeling together”; so, literally doing to the body what one hopes to happen inside

Question 98

Roman baths: genders

Answer 98

reputable institutions had separate facilities for men and women
–> others may have group facilities, if one chose to attend

Question 99

Roman baths: bathing and diaita

Answer 99

connected to Hippocratic Corpus
–> baths mentioned as one part of diaita, but Celsus adapts to be a heavy focus
–> greater emphasis in Rome because of engineering advances: aqueducts, etc. allowed Romans to have and thus prioritize elaborate baths
–> healthy? revolutionary to have piping systems, but the water was still and left all day to use; wounds submerged would likely become infected, crust over like a cancer (“crab”)

Question 100

venesection: background

Answer 100

terminology: venesection from Latin “vene” (vein) + “section” (to cut); phlebotomy from Greek “phlebe” (vein) + “otomy” (to cut)
–> phlebotomy is the term used today, although modern practice is very different; venesection used to refer to ancient practice
–> origin: in all ancient Mediterranean cultures (Babylon, Egypt, Greece, Rome); appealed to instictive human urge to “let out” the illness, like an exorcism
–> approx. 70 mentions in Hippocratic Corpus, but not often used because of placement in hierarchy

Question 101

archaeological evidence of surgery: forceps

Answer 101

artificial “fingers” for grabbing, removing objects; made of iron

Question 102

requirements for an obstetrix

Answer 102

midwife, “she who stands opposite you”
–> literate (to be able to read his works? also, unrealistic since only ~10% of Roman population was literate)
–> physical capabilities: strength, slim fingers
–> free from superstition
–> free from greed (evidence of payment)

Question 103

Soranus’ fourth book: difficult births

Answer 103

if breech birth, try to gently turn infant with lubricated hands, so that head comes out first
–> do not forcibly dilate uterus
–> Soranus, though accompanying some instances of childbirth, believed that most often midwives would be alone

Question 104

innovations in dissection

Answer 104

Mondinus, “restorer of anatomy”; Italian scientist and first to again perform public dissection
–> early 14th cent; no spike in anatomical knowledge because Mondino only wanted to prove Galen right (confirmation bias - e.g. saw rete mirable, porous septum even though nonexistent)

Question 105

Pliny the Elder

Answer 105

age of Nero, 23 - 79 CE
–> author of “Natural History:, the first encyclopedia (37 books)
–> died at Pompeii; chose to run towards volcano “in search of knowledge”

Question 106

Aelius Aristides’ “Faith and the Tumor”

Answer 106

tumor growing on his groin; doctors say to have removed, Asclepius says to foster and help it grow (act of faith)
–> tests of faith: participate in running race, barefoot in winter; go horseback riding (with the tumor); sail across harbor in a storm, then vomit
–> reward for completion: epiphany dream, Asclepius showing miracle drug

Question 107

archaeological evidence of surgery: scalpel

Answer 107

cutting/incision, sometimes with decorative handles (copper) and a blade (iron or steel)
–> would use all parts of scalpel; infection treated as unavoidable

Question 108

interim history (Basileias –> Harvey)

Answer 108

loss of knowledge of Greek in West because of fall of Rome; Islamic translation project (in Baghdad, Iran and Eastern Roman Empire) helps preserve most necessary works
–> movement of scholars brings ideas back to West, now in Latin; Renaissance catalyzed

Question 109

dreams: Greek background

Answer 109

Greek, “oneiros”, split into two categories
–> epiphany: messenger (divine or mortal) appears
–> episode: you, as a character, experiencing some scenario
–> historical shift: almost all attested records of dreams are epiphany, but today seem mostly episode; has the nature of dreams changed? poor evidence, or indicative of something different?

Question 110

mental illness

Answer 110

physical, with physical solutions, or psychological with philosophical solutions
–> phrenitis/mania: excess of yellow bile; loud, raving; case of man at window, who was throwing his possessions to a crowd until he almost threw his slave
–> melancholy: excess of black bile; depressive, sadness, social withdrawal
–> treatments: social intervention, rebalancing of humors (venesection), training

Question 111

rediscovering the gladiator cemetery: takeaways

Answer 111

Ephesus, Turkey
–> many young and one old, likely the trainer
–> many antemortem (before-death, non-fatal) wounds had healed; gladiators received good medical care if ever injured
–> traumata blows in similar places on bodies; fights were precise, moves had numbers, and discipline was necessary to ensure death did not accidentally occur
–> perimortem trauma (during death) not from battle, but because injured fighter was killed offstage by hammer to the head

Question 112

Celsus’ “On Medicine”

Answer 112

–> balance (diaita?)
–> audience = elite Romans
–> independence (have control over one’s own health)
–> preservation of masculinity (Hippocratic at basis)
–> emphasis on types of physical exercise, bathing

Question 113

Galen: travels

Answer 113

–> first to Alexandria, to learn medicine at the Museum; 500 years after Herophilus and finds himself disappointed by no more library, dissection, etc.
–> “cries in happiness” when he sees a corpse in the wilderness, so happy to have something to observe
–> return to Pergamum at 29: doctor to official gladiatorial school, gaining practical experience in suturing, etc. - but wants new horizons

Question 114

before the hospital

Answer 114

Hippocratic period: traveling doctors, so no need for institution
–> surgical workshops only (e.g. that of Archagathus); valetudinarium = sick bay, temple medicine, but nowhere to stay
–> hospital: from Latin “hospes”, meaning host, guest, stranger; basically everyone hospitable to everyone else

Question 115

importing Asclepius to Rome

Answer 115

293 BCE (plague year): Rome has no doctors –> shrine to Asclepius exists in Epidaurus, so a Roman embassy travels there to pray
–> “come to Rome, we need you and will honor you”; worries Asclepian priests, but Asclepius appears in a dream to a Roman as a snake, nodding its head
–> Asclepius travels, as a snake, on a boat and over to the Tiber Island (on Tiber River, near Rome); Tiber Island becomes sacred shrine to the god, although outside of the city because he is foreign

Question 116

return of dissection

Answer 116

–> late 13th/early 14th century, due to monumental revisitation of old texts
–> first steps: autopsies, with many occurring during Black Death (on animals and humans); maybe dissection in secret?

Question 117

Asclepius: growth of believers

Answer 117

Age of Anxiety: people began to treat him as some sort of cult (not just when sick)
–> salvation for all
–> Asclepius as one god, to help in all areas (subject of hymns)
–> resurrection; could he help souls after death?
–> mixed evidence of cooperation vs. competition; depended on instance, individual (e.g. Galen accepted some Asclepius, while Aelius Aristides would only follow him)
–> doctors would worship to help patients, patients to help their doctors

Question 118

faith healing

Answer 118

opposed to medical science, rather in favor of the gods
–> usually a spectacle
–> acts often paradoxical with the cure
–> endurance of pain, competition with medicine
–> conversion of doctors after Asclepian miracles

Question 119

shift from Roman Republic –> Empire

Answer 119

nationalism and suspicion: taking from other cultures, but still holding ethnic prejudices against them & wanting to usurp
–> shift occurs likely in 31 BCE; medicine comes especially from the Greeks, which Romans view as culturally superior but militarily inferior

Question 120

Galen: history

Answer 120

born in Pergamum, or Pergamom (western Turkey); home of massive shrine to Asclepius
–> worshipped his father during childhood (learned, moral); disliked his mother (disgraceful, short temper)

Question 121

archaeological evidence of surgery: speculum

Answer 121

mirror, or something to “open up the flesh”; looks like a Greek letter