ANCIENT GREEK MEDICINE|
Ancient Greek medicine was a compilation of theories and practices that were constantly expanding through new ideologies and trials. Many components were considered in ancient Greek medicine, intertwining the spiritual with the physical. Specifically, the theories and ideologies from which ancient Greek medicine derived included the humors, gender, geographic location, social class, diet, trauma, beliefs, and mindset. Early on, ancient Greeks believed that illnesses were "divine punishments" and that healing was a "gift from the Gods." As trials continued wherein theories were tested against symptoms and results, ancient Greek medicine also grew such that the pure spiritual beliefs as to "punishments" and "gifts" were converted to a foundation based in the physical, i.e., cause and effect."
The ancient Greeks initially regarded illness as a divine punishment and healing as, quite literally, a gift from the gods. However, by the 5th century BCE, there were attempts to identify the material causes for illnesses rather than spiritual ones and this led to a move away from superstition towards scientific enquiry, although, in reality, the two would never be wholly separated. Greek medical practitioners, then, began to take a greater interest in the body itself and to explore the connection between cause and effect, the relation of symptoms to the illness itself and the success or failure of various treatments.
Humorism (or the four humors) refers to blood, yellow bile, black bile and phlegm. It was also theorized that gender played a role in medicine because some diseases and treatments were different for women than for men. Moreover, geographic location and social class affected the living conditions of the people and might subject them to different environmental issues such as mosquitoes, rats, and availability of clean drinking water. Diet was thought to be an issue as well and might be affected by a lack of access to adequate nourishment. Trauma, such as that suffered by gladiators, from dog bites or other injuries, played a role in theories relating to understanding anatomy and infections. Additionally, there was significant focus on the beliefs and mind set of the patient in the diagnosis and treatment theories. It was recognized that the mind played a role in healing, or that it might also be the sole basis for the illness. Humoral theory states that good health comes from perfect balance of the four humors blood, phlegm, yellow bile, and black bile. Consequently, poor health resulted from improper balance of the four humors. Hippocrates, known as the "Father of Modern Medicine", established a medical school at Cos and is the most important figure in ancient Greek medicine. Hippocrates and his students documented numerous illnesses in the Hippocratic Corpus, and developed the Hippocratic Oath for physicians, which is still in use today. The contributions to ancient Greek medicine of Hippocrates, Socrates and others had a lasting influence on Islamic medicine and medieval European medicine until many of their findings eventually became obsolete in the 14th century.
The earliest known Greek medical school opened in Cnidus in 700 BC. Alcmaeon, author of the first anatomical compilation, worked at this school, and it was here that the practice of observing patients was established. Despite their known respect for Egyptian medicine, attempts to discern any particular influence on Greek practice at this early time have not been dramatically successful because of the lack of sources and the challenge of understanding ancient medical terminology. It is clear, however, that the Greeks imported Egyptian substances into their pharmacopoeia, and the influence became more pronounced after the establishment of a school of Greek medicine in Alexandria. Greek medicine was not a uniform body of knowledge and practice but rather a diverse collection of methods and beliefs which depended on such general factors as geography and time period and more specific factors such as local traditions and a patientís gender and social class. Nevertheless, common threads running through Greek medical thought included a preoccupation with the positive and negative effects of diet and a belief that the patient could actually do something about their complaint, in contrast to a more fatalistic and spiritual mindset of earlier times.
However, the distinction between the spiritual and physical worlds are often blurred in Greek medicine, for example, the god Asclepius was considered a dispenser of healing but also a highly skilled practical doctor. The god was called upon by patients at his various sanctuaries (notably Epidaurus) to give the patient advice through dreams which the site practitioners could then act upon. Grateful patients at the site often left monuments which reveal some of the problems that needed to be treated, they include blindness, worms, lameness, snakebites and aphasia. As Epidaurus illustrates, there could, then, be both a divine and a physical cause or remedy for illnesses. Lifestyle and such factors as heat, cold and trauma were discovered to be important factors in peopleís health and they could alleviate or worsen the symptoms of an illness or the illness itself. It was also recognised that a personís physical constitution could also affect the severity of, or susceptibility to, an illness. There was also a growing belief that a better understanding of the causes of an illnessí symptoms could help in the fight against the illness itself. With a greater knowledge of the body there also came a belief that the balance of the various fluids (humours) within it could be a factor in causing illness. So too, the observation of symptoms and their variations became a preoccupation of the Greek doctor.
Asclepius was espoused as the first physician, and myth placed him as the son of Apollo. Temples dedicated to the healer-god Asclepius, known as Asclepieia, functioned as centers of medical advice, prognosis, and healing. At these shrines, patients would enter a dream-like state of induced sleep known as "enkoimesis" not unlike anesthesia, in which they either received guidance from the deity in a dream or were cured by surgery. Asclepeia provided carefully controlled spaces conducive to healing and fulfilled several of the requirements of institutions created for healing. The Temple of Asclepius in Pergamum had a spring that flowed down into an underground room in the Temple. People would come to drink the waters and to bathe in them because they were believed to have medicinal properties. Mud baths and hot teas such as chamomile were used to calm them or peppermint tea to sooth their headaches. The patients were encouraged to sleep in the facilities too. Their dreams were interpreted by the doctors and their symptoms were then reviewed. Dogs would occasionally be brought in to lick open wounds for assistance in their healing. In the Asclepieion of Epidaurus, three large marble boards dated to 350 BC preserve the names, case histories, complaints, and cures of about 70 patients who came to the temple with a problem and shed it there. Some of the surgical cures listed, such as the opening of an abdominal abscess or the removal of traumatic foreign material, are realistic enough to have taken place, but with the patient in a state of enkoimesis induced with the help of soporific substances such as opium. The Rod of Asclepius is a universal symbol for medicine to this very day. However, it is frequently confused with Caduceus, which was a staff wielded by the god Hermes. The Rod of Asclepius embodies one snake with no wings whereas Caduceus is represented by two snakes and a pair of wings depicting the swiftness of Hermes.
The Hippocratic Corpus opposes ancient beliefs, offering biologically based approaches to disease instead of magical intervention. The Hippocratic Corpus is a collection of about seventy early medical works from ancient Greece that are associated with Hippocrates and his students. Although once thought to have been written by Hippocrates himself, many scholars today believe that these texts were written by a series of authors over several decades. The Corpus contains the treatise, the Sacred Disease, which argues that if all diseases were derived from supernatural sources, biological medicines would not work. The establishment of the humoral theory of medicine focused on the balance between blood, yellow and black bile, and phlegm in the human body. Being too hot, cold, dry or wet disturbed the balance between the humors, resulting in disease and illness. Gods and demons were not believed to punish the patient, but attributed to bad air (miasma theory). Physicians who practiced humoral medicine focused on reestablishing balance between the humors. The shift from supernatural disease to biological disease did not completely abolish Greek religion, but offered a new method of how physicians interacted with patients.
Ancient Greek physicians who followed humorism emphasized the importance of environment. Physicians believed patients would be subjected to various diseases based on the environment they resided. The local water supply and the direction the wind blew influenced the health of the local populace. Patients played an important role in their treatment. Stated in the treatise "Aphorisms", it is not enough for the physician to do what is necessary, but the patient and the attendant must do their part as well". Patient compliance was rooted in their respect for the physician. According to the treatise "Prognostic", a physician was able to increase their reputation and respect through "prognosis", knowing the outcome of the disease. Physicians had an active role in the lives of patients, taking into consideration their residence. Distinguishing between fatal diseases and recoverable disease was important for patient trust and respect, positively influencing patient compliance.
With the growth of patient compliance in Greek medicine, consent became an important factor between the doctor and patient relationship. Presented with all the information concerning the patient's health, the patient makes the decision to accept treatment. Physician and patient responsibility is mentioned in the treatise "Epidemics", where it states, "there are three factors in the practice of medicine: the disease, the patient and the physician. The physician is the servant of science, and the patient must do what he can to fight the disease with the assistance of the physician".
Through long contact with Greek culture, and their eventual conquest of Greece, the Romans absorbed many of the Greek ideas on medicine. Early Roman reactions to Greek medicine ranged from enthusiasm to hostility, but eventually the Romans adopted a favorable view of Hippocratic medicine. This acceptance led to the spread of Greek medical theories throughout the Roman Empire, and thus a large portion of the West. The most influential Roman scholar to continue and expand on the Hippocratic tradition was Galen (d. c. 207). Study of Hippocratic and Galenic texts, however, all but disappeared in the Latin West in the Early Middle Ages, following the collapse of the Western Empire, although the Hippocratic-Galenic tradition of Greek medicine continued to be studied and practiced in the Eastern Roman Empire (Byzantium). After AD 750, Arab, Persian and Andalusi scholars translated Galen's and Dioscorides' works in particular. Thereafter the Hippocratic-Galenic medical tradition was assimilated and eventually expanded, with the most influential Muslim doctor-scholar being (Ibn Sina). Beginning in the late eleventh century, the Hippocratic-Galenic tradition returned to the Latin West with a series of translations of the Classical texts, mainly from Arabic translations but occasionally from the original Greek. In the Renaissance, more translations of Galen and Hippocrates directly from the Greek were made from newly available Byzantine manuscripts.
Galen's influence was so great that even after Western Europeans started making dissections in the thirteenth century, scholars often assimilated findings into the Galenic model that otherwise might have thrown Galen's accuracy into doubt. Over time, however, Classical medical theory came to be superseded by increasing emphasis on scientific experimental methods in the 16th and 17th centuries. Nevertheless, the Hippocratic-Galenic practice of bloodletting was practiced into the 19th century, despite its empirical ineffectiveness and riskiness.
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