Medicine in Ancient Greece Medical practice in the ancient

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Medicine in Ancient Greece

• Medical practice in the ancient Greek world
• Religious healing and Hippocratic medicine
• Cult of Asclepius
• Disease causation in the Hippocratic Writings
• Religion and medicine
• The Hippocratic Oath

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Pericles speech in Thucydides Acts Cori
nthians

• ANCIENT GREECE
• Archaic 750-480 BCEColonization, Hoplites,
  Tyranny, Philosophy
• Classical 480-323Persian Wars 490-479, Athenian
  Empire, Peloponnesian War 431-404, Alexander
• Hellenistic 323-146Seleucids, Macedonians,
  Ptolemies
• Roman 146 BCE-330 CECorinth and Constantinople

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Medicine in the Classical Period

• Hippocratic Writings
• 450-370 B.C.
• 60 different works
• Anonymous, by different authors
• Likely collated after 300 B.C. at Alexandria

• Cult of Asklepios
• Homer portrays Asklepios as a mortal blameless
  physician in 900-750 BC
• 5th to 4th century BC Asklepios deified in the
  mythic odes of Pindar and Hesiod

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• Pedanius Dioscorides
• 40-90 AD
• Greek physician
• Wrote De Materia Medica

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Caper Plant

• disturbes the belly, is good for the stomach and
  causes thirst
• fruit makes the spleen shrink
• moves the urine and causes bloody discharge
• helps in sciatica and paralysis, ruptures and
  convulsions
• purges away phlegm
• with barley meal used as a poultice in those
  suffering from the spleen

Materia Medica, Dioscurides, 1st Century A.D.
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Caper Plant (cont)

• Moves the menses
• chewed, helps toothache
• finely ground and mixed with vinegar, it wipes
  off leprous spots and vitiligo

Materia medica, Dioscurides, 1st century A.D.
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Illness

• Nephritis nephros kidney
• Hepatitis hepar liver
• Pleuritis pleura rib or side
• Arthritis arthron joint
• Ophthalmia ophthalmos eye

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• Varro, On Agriculture
• Famers near a city prefer to have in their
  neighborhood men whose services they can call
  upon under a yearly contractphysicians, fullers,
  and smithsrather than to have such men of their
  own on the farm.

Marcus Terentius Varro 116-27 BC. De Agri Cultura
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On the Epidemics I, section 2, 5

• The physician must be able to tell the
  antecedents, know the present, and foretell the
  future- must mediate these things, and have two
  special objects in view with regard to disease,
  namely, to do good or to do no harm. The art
  consists in three things- the disease, the
  patient, and the physician. The physician is the
  servant of the art, and the patient must combat
  the disease along with the physician.

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On Fees

• Should you begin by discussing fees, you will
  suggest to the patient either that you will go
  away and leave him if no agreement be reached, or
  that you will neglect him and not prescribe any
  immediate treatement. So one must not be anxious
  about fixing a feeit is better to reproach a
  patient you have saved than to extort money from
  those who are at deaths door.

Precepts
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On Fees

• I urge you not to be too unkind, but to consider
  carefully your patient's superabundance or means.
  Sometimes give your services for nothing, calling
  to mind a previous benefaction or present
  satisfaction. And if there be an opportunity of
  serving one who is a stranger in financial
  straits, give full assistance to all such.

Precepts
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• Purposes of medicine (The Art 3)
• Doing away with suffering of the sick
• Lessening the violence of disease
• Refusing to treat those overmastered by disease
  (recognizing that medicine is powerless in such
  cases)

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Greek Medicine in the Classical Period
Religious Healingcult of Asclepius
Hippocratic Medicine
Sick child in the temple of asclepius
Asclepius God of healing
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Asclepius

• Son of Apollo and Coronis
• Entrusted to the centaur Cheiron at birth
• A great healer

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Cult of Asclepius
Model of the Asclepian temple at Epidaurus
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Inscriptions at Epidaurus

• Aristagora of Troezen. She had a tapeworm in her
  belly, and she slept in the Temple of Asclepius
  at Troezen and saw a dream. It seemed to her
  that the sons of the god..cut off her head, but
  being unable to put it back again, they sent a
  messenger to Asclepius, asking him to come.

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Inscriptions at Epidaurus

• It seemed to her the god had come from Epidaurus
  and fastened her head on to her neck. Then he
  cut open her belly, took the tapeworm out, and
  stitched her up again. And after that she became
  well.

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Aelius Aristideswriting 150-200 AD

• And a tumour grew from no apparent cause..and my
  groin was distended, and terrible pains ensued,
  and a fever for some days..
• Finally the (god) indicated there was a certain
  drug..it contained salt. When we applied this,
  most of the growth quickly disappeared..

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Hippocratic Medicine
Frontispiece, Hippocratic writings, 1555 edition
in latin
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Hippocratic Writings

• 450-370 B.C.
• 70 different works
• Anonymous, by different authors
• Likely collated after 300 B.C. at Alexandria

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Hippocrates

• Contemporary of Socrates (469-399 B.C.)
• School of medicine on Cos (?)
• A name without a work

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On the Sacred Disease

• the patient becomes speechless and chokes froth
  flows from the mouth he gnashes his teeth and
  twists his hands the eyes roll and intelligence
  fails, and in some cases excrement is discharged.

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On the Sacred Disease

• ..It is not, in my opinion, any more divine than
  other diseases, but has a nature and a cause

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On the Sacred Disease

• I hold that those who attempt in this manner
  (purifications and incantations) to cure these
  diseases cannot consider them either sacred or
  divinethe man who can get rid of a disease by
  his magic could equally well bring it on.there
  is nothing divine about this but a human element
  is involved.

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On the Sacred Disease

• I hold that a mans body is not defiled by a god,
  the one being utterly corruptible, the other
  perfectly holy.it is the divine that purifies,
  sanctifies and cleanses us..

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On the Sacred Disease

• Divine is
• Source of purity
• Manifest in nature
• Nature is
• Divine
• Regular, susceptible to investigation

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On the Sacred Disease

• Normal function Air ? lungs ? veins ? brain
• When veins in the brain are blocked by phlegm
• ..the patient is rendered speechless and
  senseless. The hands are paralyzed and
  twistedThe eyes roll when the minor veins are
  shut off from the air and pulsate. The foaming
  at the mouth comes from the lungs for when the
  breath fails to enter them they foam and boil as
  though death were near

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Religion and Medicine

• Pre-classical age medicine subsumed under
  religion
• Homeric epics
• Classical Age Greeks Medicine achieves
  independence from religion
• Hippocratics vs Cult of Asclepius
• Medicine and religion in equilibrium
• View of medicine/religion of author of On the
  Sacred Disease, Hippocratic Oath

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Religion and Medicine

• Medicine and Religion separate but in equilibrium
• Some ancient Greeks
• Judeochristian west, Islam

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Hippocratic Oath
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Hippocratic Oath

• To hold him who has taught me this art
• as equal to my parents
• I will apply dietetic measures for the
• benefit of the sick according to my ability and
  judgment
• I will neither give a deadly drug to anybody
• if asked for it

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Hippocratic oath

• I will not give to a woman an abortive remedy.
• I will not use the knifebut will withdraw in
  favor of such men as are engaged in this
• work.
• Whatever houses I may visit, I will
• come for the benefit of the sick, remaining
• free of all intentional injustice, of all
• mischief and in particular of sexual relations..

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Hippocratic Oath

• What I may see or hear in the course of
• the treatmentI will keep to myself

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Hippocratic Oath

• Taken in a context of religion
• I swear by Apollo
• In purity and holiness I will guard my life
• and my art.
• If I fulfill this oath

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Oaths in the ancient Greek world

• Be pious in matters concerning the gods not
  only by sacrificing but also by remaining true to
  your oaths. the latter is an indication of
  goodness of character. Always honor the divine,
  but especially in association with your city.
  For thus you will seem at the same time to be
  sacrificing and to be following the laws of your
  city.

Isocrates, to Demonicus, a young Cyprian (1.12-13)
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Oaths in the ancient Greek world

• When an oath is added, a man is more careful,
  for he guards against two things, the criticism
  of his friends and committing a transgression
  against the gods.

Sophocles, frag 472 (Radt)
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Plato

• Socrates shall we not say that it was because
  Asclepius when bodies were diseased inwardly
  and throughout, he did not attempt by diet and by
  gradual evacuations and infusions to prolong a
  wretched existence for the man

Republic 407c-d
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Plato

• if a man was incapable of living in the
  established round and order of life, he did not
  think it worth while to treat him, since such a
  fellow is of no use either to himself or to the
  state.

Republic 407c-d
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• The chief consolation for Natures shortcomings
  in regard to man is that not even God can do all
  things. For he cannot, even if he should so
  wish, commit suicide, which is the greatest
  advantage he has given man among all the great
  drawbacks of life.

Pliny 23-79 AD
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Infanticide

• Exposure (abandoning in a public place)
• Killing (strangling or drowning)
• nl newborns likely uncommon but
• Not illegal
• Did happen
• Defective newborns not uncommon

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• Mad dogs we knock on the head the fierce and
  savage ox we slay sickly sheep we put to the
  knife to keep them from infecting the flock
  unnatural progeny we destroy we drown even
  children who at birth are weakly and abnornal.
  Yet it is not anger, but reason that separates
  the harmful from the sound.

Seneca (1st Century AD stoic philosopher) On
Anger
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Physicians and the Oath 300 BC to Roman Times

• Oath a minority view
• Signified transitions
• Transmittal of medicine in clans ? non-familial
  medical education
• Medicine a craft without moral overtones ?
  medicine a vocation with associated morality

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Pythagoras

• 569-475 BC
• Abstract mathematician
• Practical ethics
• Mutual friendship, honesty, unselfishness
  important
• Reincarnation
• Vegetarianism
• Sexual purity
• Suicide, abortion prohibited

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Fate of the Oath

• 1st Century AD
• Some physicians adhere to Hippocratic morality
• Galen
• 129-199 AD

• Late Roman Empire (100-476 AD)
• Hippocratic medicine integrated with patristic
  theology
• Hippocratic physiology informs the scientific
  beliefs of church fathers

• Skilled anatomist
• Medical morality emphasized philanthropy and
  charity, less so respect for life

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Fate of the Oath

• Dark Ages (500-1000 AD)
• Oath is known, likely sworn occasionally
• Other Hippocratic works preserved in the Islamic
  world
• Middle Ages (1000-1500 AD)
• Medical faculties appear 900-1100 AD
• Oath appears in medical schools early 1500s

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Contemporary Oaths

• Element of Oath
• Covenant with teachers
• Commitment to students
• Covenant with patients
• approp means
• approp ends
• Justice
• Confidentiality

• 150 schools
• 125
• 89
• 146
• 98
• 133
• 104
• 141

Orr et al., Use of the Hippocratic Oath A
Review.. Journal of Clinical Ethics 8(1997)
377-87.
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Contemporary Oaths
150 schools 16 11 20
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• Element of Oath
• Covenant with deity
• Vs. Abortion
• Vs. Euthanasia
• Chastity

Orr et al., Use of the Hippocratic Oath A
Review.. Journal of Clinical Ethics 8(1997)
377-87.
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Veatch
Robert Veatch, The New Physician 48(1984) 41-8.
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Kass

• ..the various parts (of the Oath) flow naturally
  from a profound understanding of what medicine is
  and must essentially be
• the Oathspeak(s) truly and timelessly.

Leon R. Kass, Is there a medical ethic? The
hippocratic oath and the sources of ethical
medicine, in Toward a More Natural Science
Biology and Human Affairs (NY Macmillan, 1985)