- All around the Mediterranean the Greeks developed a supernatural approach to medicine.
- Greek culture spread across southern Europe.
- The notion of countries bounded by geographical borders - lines on a map - is rather recent. When we talk of the ancient Greeks we are referring not to people who lived in Greece, but to people who lived the way the Greeks did - they were culturally Greek.
- Greek civilisation was made up of independant city states around the shores of the Mediterranean and the Black Sea.
- Greek culture flourished between around 700 BC and 300 BC and its medicine was influenced by the Egyptians.
- They believed the world was controlled by many gods, and they told and wrote down heroic tales (myths) about people, gods and monsters. They also loved to debate.
- Greek culture involved lots of debate. Loads of views were expressed, but being in the more fierce debates could be dangerous. The philosopher Socrates' enemies charged him with impiety and corrupting the young - and sentenced him to death. two systems of medicine flourished side by side: one based on religion and one on logical philosophy.
- Greek was a culture rather than a country and the Greeks believed in many gods - hence their belief in supernatural causes and cures.
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Asclepios (Greek god of healing)
- A spiritual/ supernatural approach to medicine was followed b the cult of Asclepios, god of healing. His temples were called Asclepions and people went to stay at them when they were ill - much like we might visit a healh farm or like Catholics might go on a pilgrimage to Lourdes. The cult was most popular in the 5th and 4th centuries BC.
- Visitors were expected to undergo ceremonial washing in the sea, make a sacrafice to the god and sleep in a building called an abaton. An abaton was a narrow building with a roof but no solid walls so that it was open to the air. Whilst sleeping there the god was supposed to come to them in a dream and cure them.
- Priests also did 'ward rounds', administering ointments and performing rituals, some of which involved placing snakes on the patients. The snake is the sacred animal of Asclepios and can still be seen in the logos of many medical organisations.
- Success stories were recorded in inscriptions on the wall of the Asclepions.
- Asclepio's daughters, Hygeia and Panacea, were also involved in healing. Their names developed into words used in modern medicine (hygiene - cleanliness, and panacea - a remedy for all ills). Women were allowed to be doctors in Ancient Greece.
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- Greek philosophers sought to devise rational explanations and logical codes of conduct. They attracted bands of followers such as the brotherhood of Pythagoras. These followers became devotees and argued with other philosophers. Religion was interwoven with their logic.
- Thales of Miletus, founder of Greek philosophy, thought that water was the basis of life (580BC). Anaximander (560 BC) said all thngs were made of four elements; earth, air, water and fire. Pythagoras (580-500 BC) thought life was about the balance of opposites.
- Hippocrates (460-377 BC) is acknowledged as the founding father of modern medicine. He was born on the island of Kos, travelled a bit and then taught medicine in Kos before dying in Larissa. Very little else is known about him but he is associated with the Hippocratic Oath and the Hippocratic Corpus.
- The Hippocratic Oath is a promise made by doctors to obey rules of behaviour im their professional lives. Medical ethics are based on the Hippocratic Oath.
- The Hippocratic Corpus is a collection of medical books, some of which might have been written by Hippocrates or his followers. It is probably what survived of the library of the Kos school of medicine at which Hippocrates taught.
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Clinical Method of Observation
- Hippocrates saw the healthy body as being in balance - he thought that illness was an imbalance of the elements.
- 'Airs, Waters and Places' a book from the Hippocratic Corpus looks for environmental causes for disease - not Gods or spirits.
- The books 'Prognostic, 'Coan Prognostic' and 'Aphorisms' improved on the Egyptian ideas of diagnosis. They suggest that, by studying enough cases, a doctor could learn to predict the course of an illness.
- They also encourage the use of the four-step method for treating illness that we would now call the 'clinical method of observation'
- Diagnosis - Study the symptoms, Prognosis - Consider and predict, Observation - Observe, note, compare, Treatment - Treat with confidence.
- They suggest that no action should be taken before a reliable diagnosis is made. Illnesses should also, where possible, be left to run their course. Today we call this 'Minimum Intervention'.
For hundreds of years Hippocrates' natural approach existed side by side with the supernatural ideas of Asclepios.
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- The Ancient Greeks were big believers in healthy living.
- 'A Regimen for Health' and 'Regimen in Acute Diseases', both from the Hippocratic Corpus, recommended lifestyles for healthy living or recovery from illness.
- The Ancient Greeks believed that to be healthy they needed to exercise. Men and boys spent a lot of time in the gymnasium - a public area in part devoted to sport and physical training.
- Hygiene was important, with emphasis placed on washing - keeping skin, hair and teeth clean.
- While most Greek cities would have had little public sanitation, ancient Athens had a system which brought in clean water using clay pipes.
- Diet was also thought to be important. 'A Regimen for Health' suggested a diet which changed with the seasons - eating as much as possible in winter, but drinking little - while in the summer drinking more and eating less.
- This text also prescribes the amount of sleep and exercise required by people, depending on whether they have digestive problems.
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- Aristotle (384-322 BC) developed the Hippocratic balance of elements to suggest that the body was made up of four fluids or humours - blood, phlegm, yellow bile and black bile. These were linked to the four seasons and the four elements. They needed to be in balance for good health.
- In winter we get colds and produce more phlegm. Also, it rains more. This is why Aristostle linked water, winter and phlegm. Unfortunately, Aristotle failed to see that a bunged up nose, fevers and suchlike are symptoms or effects of disease. He thought they were the causes.
- Treatments developed from the theory of the humours aimed at bringing the four back into balance. Some focused on getting rid of an excess of one or another of the humours (e.g. by getting rid of excess blood with bloodletting, or by giving emetic - a substance that triggers vomitting) to rid the body of too much bile.
- Other treatments aimed at counterbalancing the problem. Different foods, drinks, herbs and spices were considered as having a humour. Someone with a cold (too much cold, wet phlegm) could be given chicken, pepper or wine - all considered hot and dry - to correct the imbalance in the humours.
- The four humours were a big theory in medicine for a long time and they continue to pop up right through the Middle Ages and beyond.
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- With a lot of books and a little dissection, Alexandria put itself at the forefront of medicine.
- Alexander the Great (who was tutored by Aristotle) founded Alexandria in Egypt in 331 BC as his new capital city. The library of Alexandria attempted to amass all the knowledge of the world. It made copies of books for other libraries, which was lucky as several fires eventually destroyed the collection.
- Unlike in the rest of 'Greece', human dissection was allowed in Alexandria. For a short time they even allowed vivisection (dissection when still alive) of condemned criminals. People began to see the human body as having served its purpose once the soul had left it.
- Alexandria became famous for training medics and surgeons. Accurate observation was the key to much of the advancement made there. Herophilus (335-280 BC) compared human and animal anatomy and worked on the nervous system. He correctly identified the connections to the brain but thought the nerves were vessels carrying pneuma or life-force.
- Erasistratus (250 BC) identified the differences between arteries, veins and nerves and saw that nerves were not hollow and so couldn't be vessels for fluid.
- Doctors from Alexandria went to practise all over the world but also divided into competing intellectual camps which, whilst encouraging debate, also led doctors to refuse to consider anything except the teachings of their own group.
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- The mechanics of surgery advanced (which bits to cut, how to make the cut), but effective anaesthetics, antiseptics and the understanding of germs and infection were far in the future.
- As a result surgery was a risky procedure with the patient often dying from trauma or infections such as sepsis.
- Ancient Greeks only used surgery as a last resort - most treatments were performed outside the body. Exceptions to this rule included the draining of lungs infected with pneumonia.
- Surgeons developed good techniques for setting broken bones and in extreme cases would amputate.
- A range of surgical instruments such as scalpels, forceps, shears, probes and hooks were developed, made from iron, steel and brass.
- Some Ancient Greek texts describe eye operations being carried out, possibly to remove cataracts and other foreign bodies.
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