Greek Medicine From Hippocrates To Galen: Selec...
Medieval medical tradition in the Golden Age of Islam adopted the theory of humorism from Greco-Roman medicine, notably via the Persian polymath Avicenna's The Canon of Medicine (1025). Avicenna summarized the four humors and temperaments as follows:
Greek Medicine from Hippocrates to Galen: Selec...
16th-century Swiss physician Paracelsus further developed the idea that beneficial medical substances could be found in herbs, minerals and various alchemical combinations thereof. These beliefs were the foundation of mainstream Western medicine well into the 17th century. Specific minerals or herbs were used to treat ailments simple to complex, from an uncomplicated upper respiratory infection to the plague. For example, chamomile was used to decrease heat, and lower excessive bile humor. Arsenic was used in a poultice bag to 'draw out' the excess humor(s) that led to symptoms of the plague. Apophlegmatisms, in pre-modern medicine, were medications chewed in order to draw away phlegm and humors.
Throughout the first half of the 20th century, infectious medicine was ruled by the dominance of the germ theory and the spectacular control of germs that antibiotics increasingly afforded. It is humbling, in a way, to note medicine's re-attention to lifestyle and environment in the late 20th and early 21st century. Germs and, now, genes are indeed "master molecules," to be reckoned with in the diagnosis and treatment of illness. Yet, we are coming to realize more and more that the same germ or gene affects different people differently. As the Hippocratics turned their focus away from the supernatural and toward the individual patient, the contemporary physician, too, knows that neither germs nor genes are sacred; successful treatment begins with understanding the individual patient.
Hippocrates, and those from his school of medicine, were the first people to describe and properly document several diseases and disorders, including a detailed description of clubbing of the fingers.
Soranus said that Hippocrates learned medicine from his father and grandfather (Hippocrates I), and studied other subjects with Democritus and Gorgias. Hippocrates was probably trained at the asklepieion of Kos, and took lessons from the Thracian physician Herodicus of Selymbria. Plato mentions Hippocrates in two of his dialogues: in Protagoras, Plato describes Hippocrates as "Hippocrates of Kos, the Asclepiad"; while in Phaedrus, Plato suggests that "Hippocrates the Asclepiad" thought that a complete knowledge of the nature of the body was necessary for medicine. Hippocrates taught and practiced medicine throughout his life, traveling at least as far as Thessaly, Thrace, and the Sea of Marmara. Several different accounts of his death exist. He died, probably in Larissa, at the age of 83, 85 or 90, though some say he lived to be well over 100.
Hippocrates is credited with being the first person to believe that diseases were caused naturally, not because of superstition and gods. Hippocrates was credited by the disciples of Pythagoras of allying philosophy and medicine. He separated the discipline of medicine from religion, believing and arguing that disease was not a punishment inflicted by the gods but rather the product of environmental factors, diet, and living habits. Indeed there is not a single mention of a mystical illness in the entirety of the Hippocratic Corpus. However, Hippocrates did work with many convictions that were based on what is now known to be incorrect anatomy and physiology, such as Humorism.
Hippocratic medicine and its philosophy are far removed from that of modern medicine. Now, the physician focuses on specific diagnosis and specialized treatment, both of which were espoused by the Knidian school. This shift in medical thought since Hippocrates' day has caused serious criticism over their denunciations; for example, the French doctor M. S. Houdart called the Hippocratic treatment a "meditation upon death".
Another important concept in Hippocratic medicine was that of a crisis, a point in the progression of disease at which either the illness would begin to triumph and the patient would succumb to death, or the opposite would occur and natural processes would make the patient recover. After a crisis, a relapse might follow, and then another deciding crisis. According to this doctrine, crises tend to occur on critical days, which were supposed to be a fixed time after the contraction of a disease. If a crisis occurred on a day far from a critical day, a relapse might be expected. Galen believed that this idea originated with Hippocrates, though it is possible that it predated him.
The Hippocratic Corpus contains textbooks, lectures, research, notes and philosophical essays on various subjects in medicine, in no particular order. These works were written for different audiences, both specialists and laymen, and were sometimes written from opposing viewpoints; significant contradictions can be found between works in the Corpus. Notable among the treatises of the Corpus are The Hippocratic Oath; The Book of Prognostics; On Regimen in Acute Diseases; Aphorisms; On Airs, Waters and Places; Instruments of Reduction; On The Sacred Disease; etc.
After Hippocrates, the next significant physician was Galen, a Ancient Greece who lived from AD 129 to AD 200. Galen perpetuated the tradition of Hippocratic medicine, making some advancements, but also some regressions. In the Middle Ages, the Islamic world adopted Hippocratic methods and developed new medical technologies. After the European Renaissance, Hippocratic methods were revived in western Europe and even further expanded in the 19th century. Notable among those who employed Hippocrates' rigorous clinical techniques were Thomas Sydenham, William Heberden, Jean-Martin Charcot and William Osler. Henri Huchard, a French physician, said that these revivals make up "the whole history of internal medicine."
Had most profound influence on Western and some aspects of Easternmedicine of anyone in history. His esteem increased with time, as his legend (based ontruth or rumor) grew. A collection of his works, "Corpus Hippocraticum" (72books), probably including contributions from others, was assembled in 4th cent. BC inlibrary, established by Ptolmey, at Alexandria, Egypt. First to mention 4 humors. Balance of 4 humors determines the state ofthe microcosm (body) as the state of the world (macrocosm) was determined by the 4elements (which were formalized by Aristotle). Ideas in hisbooks: Anatomy: scant information. Heart description quite complete, including pericardium ventricles, valves, auricles and ventricles. Didn't understand the differences between veins and arteries.
Physiology: heat of the body necessary for life comes from the pneuma of the air, and is taken in by lungs. Air and blood fills arteries. Sight depends on lens and gel in eyeball. 4 humors corresponding to 4 elements are physiological bases of body function. Harmony necessary for health.
Pathology: cause of illness due to internal or external influences like climate, diet, activity, surroundings. 3 stages of disease: degeneration of humors; cooking, and crisis with departure of bad humors. 40 case histories.
Therapy: avoid interfering with course of illness except at right time. Assist nature in cure. Used few drugs. Laxatives and emetic herbs main agents. Diet, baths important.
Diagnosis: list few diseases and syndromes. Condition of patient most important, so get info. on past and present behavior and problems. Observe patient and excretions. Orifices probed with speculums. Listen to breathing but not much info. on heart sounds. Little uses of pulses.
Prognosis: Use all info. to consider prognosis. Patient confidence and reputation of physician depend mostly on accurate prognosis.
Surgery: Most extensive listing. Fractures, dislocations, wounds of skull given much treatment. Bandaging and cauterization stressed; "What drugs fail to cure, that the knife cures; what the knife cures not, that the fire cures; but what fire fails to cure, this must be called incurable. " Treat tumors, ulcers, hemorrhoids with surgery.
Gynecology/Obstetrics: fetus thought to initiate own delivery. Diseases of uterus known but it was thought to wander around (as in the case of hysteria).
Mental Illness: Brain was seat of thought and understanding (later to be changed by Aristotle). Accurate description of epilepsy, deliriums, depression, anxiety
Ethics: Exceptional treatment of ethics. Deal with who should enter profession, how the physician should act, what they should say and do to comfort patient. Physician should lead a moderate life.
Western Europe emerged from dark ages about 1000 AD, but stillanother 500 years before middle ages ended. French culture with combination of faith,feudalism, and chivalry model for Europe. Each person had role/function. Mediterraneanculture in disarray. Role of Church - Aquinas: 1225-1274: Such a supporter of Aristotelian thought that his influence lasted through middle ages. Didn't believe Nature did anything unnecessarily; hence everything in Nature had simple explanation. Thought change occurred when the essence of things become expressed (such as an acorn becoming an Oak tree). No being can become something without the inherent potential to do so. Hence all other changes come from God, the power source of all change. Lead to his doctrine of effective causation, which was foundation of Scholasticism, where supernatural had supremacy over Nature. Suppressed independent thought for the rest of the middle ages. Even though Church controlled universities, monastic medicine decline, and hospitals control shifted form the Church to cities. Aquinas: – rediscovered Aristotle, Christianized his philosophy – basis for later Middle Ages. Summa Theologica. Aim to show harmony btw Aristotle and Christianity. Ethics 2 dimensions: natural and theological. Natural ethics (as from Aristotle) – development of reason and practice in living morally and leads to earthly happiness.. Theological ethics – achieve virtues of faith, hope, and charity through grace which lead to eternal life. Believe in natural lab: divine law as written in hearts of people. – which discovered by reason and cultivated by conscience. Since allow to turn to secular knowledge without guilt, pave way for more scientific view of world Natural Law - dominant theory in Christian thought world is rational order with values and purposes built into its nature (from Greek thought) - teleological. Aristotle 4 ?: What is it; What's it made of? How did it come to exist: What is is for? (Plants for animals, etc - Nature make all ultimately for man. - anthropocentric. Christians liked but add God - God made things for purpose, including values
(corollary) Laws of nature describe how things are and ought to be. Drought natural evil; Some ways behaving natural (derived from nature), other unnatural and morally wrong; supports beneficence but others more contentious as well - sex zb.
Moral judgments dictates from laws of reason which grasp since God, author, made us rational. Religious believer no special access to moral truth. all must reason. Aquinas most influential natural law theorist: moral life lived "according to reason" (Summa Theologocia) Conscience as voice of God (but not apparent to disbeliever) 041b061a72