Midterm #3 Flashcards
dreams: Galen
“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
venesection after Galen
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
Roman baths: procedure
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.
Caesarean section
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
venesection: basics
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)
Soranus
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
archaeological evidence of surgery: cauteries
for burning; heat in fire (protecting one’s own hand), then burn tissue
–> made of iron
archaeological evidence of surgery: needles
for suturing; usually with hair (horsehair), and made of copper
care of the newborn: shift in understanding
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
Roman gladiators: methods to stop bleeding
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
Roman army: background
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
gynecological treatises
only one gynecological treatise exists that is written by a woman –> yet to be translated
Asclepian temples
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
Galen: anatomical knowledge
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”
Renaissance: anatomy demonstrations
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
“crowd of gods”
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
Roman gladiators: old age
transitioned out; enslaved were sold and money was invested into someone new
Roman gladiators: doctors
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
Cato’s “On Agriculture”
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)
Galen: “Affections and Errors (Peculiar to Each Person’s Soul)”
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)
problems with understanding mental health
–> 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?
Galen’s theory of venesection
“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
growth of Rome
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
venesection: what did it treat?
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
mind and body in ancient medicine
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
chlorosis
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?
archaeological evidence of surgery: retractor
keep apart edges of surgical incisions, wounds; made of iron
Plato’s allegory of the soul
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
Celsus - procedure of arrow removal
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
care of the newborn: process
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
Galen: Nicon’s dream
–> 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
“On Treatment by Venesection”
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
medical degrees, Renaissance era
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
Aelius Aristides’ “Sacred Tales”
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
wet nurse
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
“Age of Anxiety”
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
care of the newborn: healthy?
–> is the baby crying (yes = good)?
–> do arms/legs stretch normally?
–> does baby react when touched?
temple medicine: healing process
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
Asclepius: myth of origin
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
Galen: pathway of blood
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
“5 Things the Ancient Greeks can Teach Us about Medicine Today”
- holistic: body is part of nature, part of a regime
- trust: heart of doctor-patient relationship, even today
- why do we get sick? is it truly natural, could it ever be “fated”?
- historical perspective: everything we “know” was a challenge to learn, not to be taken for granted
- humility: avoid grading mentality, since more findings are to come after us
Harvey: experiment on the dog
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
establishment of Rome
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
Cato the Elder
Marcus Porcius Cato, 234-149 BCE
–> conservative Roman politician, with pride against foreign influence
–> author of “On Agriculture”
Harvey: demonstrations
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)
anger
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
Vesalius
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
why does dissection return?
–> 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…
healing and early Christianity
–> 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
contraception
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
Artemidorus
–> 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?)
what makes Galen unique?
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)
Roman gladiators: identity
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?
purpose of dreams
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
Celsus
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”
Scribonius Largus’ “Compounds”
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
Galen: later years
–> 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
Archagathus
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
Galen: Experiment #1
“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
Roman baths: cost
cheap, or free for children
–> subsidized by government, or the wealthy as a way of showcasing affluence
archaeological evidence of surgery: scoop of Diocles
attempt to “hook” some lodged item and remove; looks like a shoehorn
–> extraction of lead balls, pebbles, small missiles
influence of Asclepiades on Celsus
rejection of drugs; deliberate attempt to appeal to other classes (make medicine for everyone, in a way)
Galen: woman with insomnia
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
early monks and health care
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)
hysteria
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
Harvey: controversy in demonstrations
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)
Galen on mind and body
division of soul (Plato), daily review and danger of strong emotions (Stoicism)
Pliny the Elder’s “Natural History”
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
Galen: to Rome
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
transition in origin of disease - Roman era
shift towards divine attribution
–> society begins rejecting medicine
anger: case studies
–> 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
Saint Basil
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
Galen: Eudemus the Philosopher
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
outcome of Archagathus
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”)…
Scribonius Largus
Greek doctor to the Roman Imperial Court (took on Roman name - possibly enslaved)
–> author of “Compounds”
dreams: Hippocratic Corpus
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
typical identity of a midwife
–> low status (poor or enslaved woman)
–> Greek (or at least non-Roman)
–> “medica”, “metilia donata”: entrance point for women into medicine
origin of Caesarean section
–> 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
dreams: Aristotle
–> 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
Stoicism
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
dissection: search for bodies
serious lack, because they had to be both criminals and of low/foreign birth (no rights and no family to be disgraced)
Galen: Experiment #2
“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
types of fever
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)
Asclepius: myth of life
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
Galen: experiments (background)
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
after Harvey
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)
William Harvey
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
shift in perspective on doctors in Rome
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
Roman baths: when?
everyday; naked bathing of Romans of all genders, all classes
–> particularly after the afternoon siesta
process of childbirth
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
Galen: Antonine Plague
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)
Roman gladiators: conditions
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
temple medicine
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
Basileias
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
Asclepius: imagery
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
Aelius Aristides
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
sympathy (ancient rituals)
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
Roman baths: genders
reputable institutions had separate facilities for men and women
–> others may have group facilities, if one chose to attend
Roman baths: bathing and diaita
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”)
venesection: background
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
archaeological evidence of surgery: forceps
artificial “fingers” for grabbing, removing objects; made of iron
requirements for an obstetrix
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)
Soranus’ fourth book: difficult births
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
innovations in dissection
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)
Pliny the Elder
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”
Aelius Aristides’ “Faith and the Tumor”
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
archaeological evidence of surgery: scalpel
cutting/incision, sometimes with decorative handles (copper) and a blade (iron or steel)
–> would use all parts of scalpel; infection treated as unavoidable
interim history (Basileias –> Harvey)
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
dreams: Greek background
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?
mental illness
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
rediscovering the gladiator cemetery: takeaways
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
Celsus’ “On Medicine”
–> 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
Galen: travels
–> 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
before the hospital
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
importing Asclepius to Rome
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
return of dissection
–> 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?
Asclepius: growth of believers
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
faith healing
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
shift from Roman Republic –> Empire
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
Galen: history
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)
archaeological evidence of surgery: speculum
mirror, or something to “open up the flesh”; looks like a Greek letter
