Hannah Carrillo and Paul Driskill September 11, 2011

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Hannah Carrillo and Paul Driskill

September 11, 2011

Honors 490: International Epidemics

Notes on Part 2 of The Healing Hand; Thucydides

Notes and Commentary on The Healing Hand (starting at page 171):

Patient #9: Boxing, a popular Greek activity had largely degenerated into a violent activity by 400 BCE. I found that interesting because it seems to mirror what happens in our own major league sports-football, baseball etc. seem be notably more violent than they were in their earliest incarnations. I’m not sure if this reflects an increasingly violent society but seems plausible-perhaps the ancient Greeks had reached a sort of violence threshold and needed to increase aggressive behavior in sports to be entertained? Maybe this sort of over-competition becomes common when societies have reached a certain level of complexity in centralization and hierarchical organization? I’m not sure but it seems an interesting phenomenon to keep in mind. The patient being treated had barely any face visible as his injuries bled severely. Still, despite the ugly appearance of the injury, the actual wounds were fairly benign. The physician aligned the broken nose bone and holds it in place with a soft leather roll and instructs the patient to hold his bandages in position so that the fracture can heal without being disturbed. For the patient’s broken ears, the doctor does nothing because he believes that even applying a bandage would cause immense pain. I found the doctor-patient relationships interesting. The doctor (if I can apply modern terminology to ancient practices) seems at once both paternalistic and disengaged. He treats the patient without informing the patient or getting consent, but seems to have the patient’s best interests at heart. At the same time, he does not attempt to rearrange the patient’s value system-that is, he does not attempt to persuade the patient to give up this potentially fatal sport. This is a marked difference from the doctor-patient relationship many of us are familiar with in which the physician often tries to get us to change bad behaviors (smoking, drinking, eating junk food too often).

Patient # 10: The patient was a slave whose skin was crisscrossed with a multitude of sores from whipping. These sores seemed to be viciously infected. The physician applies celery root to the most badly inflamed sore, attempting to cool it. This celery root plaster must be reapplied once it warms. The physician coats the other wounds with a mixture of goat grease. Swine grease. Oil and frankincense. The physician believed these other wounds to be near healing and so applied this mixture because it was thought to help the flesh to grow back. I found the most interesting part of the account to be that the physician used medical terms so as not to alarm his patient further. Today, it seems that physicians avoid using medical jargon in front on their patients because they believe that medical terms might actually panic them. In the Greek instance, it seems that the physician attempts to calm his patient by intentionally confusing him. Since the slave cannot understand the state of his wounds and the required treatment, he feels more comfortable submitting to the doctor’s treatment. In any case, information does not flow freely between doctor and patient as is the ideal state prescribed today. Still, in this case, the Greek physician did seem briefly to inform the patient of how he was going to help the patient before treating him, albeit in esoteric medical terms.

Wounds as Disease: At the time of Hippocrates, logic was a fairly new system. It seemed so omnipotent and novel that its conclusions were often accepted by the ancient Greeks as fact. Testing hypothesis through experiment was never considered necessary when it was considered at all. The Greek physicians were obviously intelligent but were not scientific. In some ways, Greek medicine was more of an art than a science. Greek physicians studied disease by thinking about it, imagining a logical theory of how disease should work. The Greeks believed that in nature, everything was balanced. They extended this belief to the human body, formulating a theory that disease was caused by “too much” or “too little” of certain elements. They came up with an imaginary, yet very logical theory, of the 4 components of the body: blood, phlegm, yellow bile and black bile. If these 4 components were mixed in the wrong proportions, or unmixed, they caused disease. No historian knows for sure how this account came to be accepted. However, some postulate that the account was so appealing to many Greeks because it had a 4 fold symmetry with order and balance. This logical theory fit in neatly with their preconceived intellectual framework so was quickly embraced.

Any pain was explained as a disharmony of these 4 components. The logical solution was thus to reestablish the harmony of these components. Bleeding a patient got rid of bad humors; starving a patient prevented new imbalances from occurring; purging a patient also freed the body from bad humors. The Greeks also identified 3 main parts of the human body: flesh, venules (blood vessels) and blood. These three parts of the body were the main sources of disease with blood being the worst; blood could stagnate, spill out and decay. Since the Greeks knew that blood moved in the body somehow, they reasoned that if the blood stopped it would stagnate, causing disease. When flesh spasmed (shivered, cramped, convulsed), it attracted blood out of the venules. Once out of the venules, the blood decayed. Venules were said to spill blood because they became tired or were torn apart by spasms. When a wound formed, the flesh was exposed to the outer world and thus suffered. Physicians believed that wounds loved warmth because flesh naturally exists under skin, where it is warm; the same argument was applied to venules. If the wound were left exposed, the parts around the wound would spasm and become soaked in decayed blood. This decayed blood then caused infection. It never occurred to Greek physicians that the cause of infection was something on the surface of the wound.

Physicians reasoned that decayed blood generally turned into pus. Under this logic, there were 2 kinds of pus-good pus and bad pus. In today’s terminology, “good pus” corresponds to a benign infection while “bad pus” corresponds to a severe infection. For every Greek physician, the treatment of each wound began with a dilemma-to leave it alone or help it to suppurate (to form pus). They thought that helping to wound to suppurate would help the body to expel bruised flesh. Occasionally, the physicians would prevent suppuration by using a special class of drugs called eunemas. These powered drugs were a crude sort of antiseptic which were usually imported from Egypt. Wine was another popular antiseptic, although its antiseptic powers were not scientifically proven until the late 19th century. Wine disinfects with polyphenol, which is 33 times more powerful than phenol. Modern scientists claim that this sort of treatment probably did the wound little harm and probably even some good. Still, in general, ancient Greek medicine “worked for evolution”. Nevertheless, ancient Greeks seemed to hold an attitude similar to our own-they wanted to be healed and wanted the physician to actively heal fix their ailment. The medical industry thus responded with numerous drugs and salves. But, when it came to some areas, physicians acknowledged they did not have the expertise to help. Ancient physicians could not perform amputations and generally left limbs that were so severely infected alone. The general consensus seemed to be that nature generally understood how to take care of things when the physician did not. This is an interesting viewpoint which is somewhat at odds with our own modern way of thinking. I think we generally view medicine/physicians as ways to combat nature and “take control” over the body’s natural processes. Perhaps a more “laissez-faire” style medicine has become more in vogue recently. But I think it is fair to say that the medicine of late has been focused on overturning natural processes rather than letting them take their course. Perhaps this is an effect of our incredible medical technology. The ancient Greek physicians did not have access to the technologically sophisticated tools of today so were occasionally forced to submit to nature.

Near the end of the chapter, the temples of Asklepios are described in some detail. It was believed that Asklepios, patron god of physicians dwelt in these temples. Sick patients who could not be healed by a physician journeyed to the temples and waited for a god to appear to them. Generally, Asklepios would appear to the sick patient in a dream, either in person or as a sacred animal like a snake or dog. This is quite similar to how our system operates today. Many initially seek medical treatment but turn to religious centers of healing as a last resort. Despite having little “scientific value”, patients do claim that these centers heal. Similarly, I read an article for another class about a young woman who was cured of anorexia after a dream. After years of failed treatment, the woman’s family had given up. One night, the woman had a dream which convinced her of her own strength to fight the illness. I will not go into the imagery here or the different theories as to how the dream may have affected her psychologically but suffice to say the woman was rather miraculously cured. Though these types of experiences seem unbelievable, there does seem to be some forms of healing that science cannot readily explain.

Perhaps one essential quote that ties together many parts of this chapter is the physicians managed to “guess a number of rules before the game was ready to be played”. Greek physicians managed to come up with several scientifically effective treatments before they had any scientific knowledge. This incongruence led to a system of medicine which was occasionally effective but most often dangerous. This system of medicine arose from Greek philosophy, which was abstract but not experimental. Greek medicine should have begun with anatomy but instead began with thought which resulted in a brilliantly logical but a scientifically flawed system of medicine which harmed as many people as it helped.

Notes and Commentary on Thucydides

This section is part of Thucydides’ History of the Peloponnesian War. It is an account of a plague which killed 1/3 of the Athenian population in 430 BCE. The plague resulted in a greater loss of life than the Archidamian War. The extent and mortality of the plague was unparalleled in the ancient world. The plague broke out when the Spartans reached Attica. Physicians were unable to help those afflicted with the plague. A large part of the account describes the terrifying symptoms of the plague with the most terrifying symptom being the “dejection which ensued when any one felt himself sickening”. This despair took away the power of resistance in those struck by the malady, giving them no psychological strength to fight against the disease. Only those who had recovered from the plague could tend to the sick because they were immune to the disease. The contagious quality of the plague prevented the sick from being tended and many died of neglect before the illness fully took hold. The plague also forced a general change in social philosophy. Even those who did not contact the disease became “utterly careless of everything, whether sacred or profane”. Importantly, burial rites were completely upset. Citizens lived only for present enjoyment and became completely unrestrained. Seeing their fellow citizens perish led many to believe that the laws of gods and men could not affect them. Some began to connect the plague with a long forgotten oracle. Thucydides claimed that the people “made their recollection fit in with their sufferings”.

Notes on Class Discussion-Major Themes and Commentary

The Mediterranean:

The Greek civilization arose in the Mediterranean but there were other civilizations which arose near this region even before the Greeks. Most notably, a series of civilizations in Mesopotamia (modern day Iraq) began at around 7000 BCE with the formation of small farming villages on the northern plain of the region. The Sumerians were the first to create a society which fits our notion of a civilization at around 3000 BCE. Many civilizations followed Sumer in the same region. In all of these civilizations, the gods and sin were thought to be the source of disease. The sick required religious help as well as medical care. In this way, there was not a sharp distinction between a physician and religious leader. I found this interesting because ancient Mesopotamia was distinct in that its civilization made sharp distinctions between political and religious authority, unlike ancient Egypt. It is notable that while political and religious authority was separate, medical and religious authority was not. In Egypt, physicians treated illness through a hybrid mixture of prescriptions and spells. Some of their medical compounds did have scientific value such as the anti-septic qualities of honey. Still, the psychology of the charm was probably more important in Egyptian medicine. Patients were healed because they believed they would be healed.

Pre-Socratic Philosophy and Hippocrates:

The Greeks borrowed some skills and remedies from ancient Egypt but their medical framework was quite different. This medical system is fundamentally related to the Ionian enlightenment in which Greeks started to question the commonly held myths. This questioning can be thought of as the birth of philosophy. This process occurs when citizens make the transition from myth to theory. When the ancient Greeks started to questions these inherited myths, they began to transition from myth to theory. It is theory, not science, which is at the heart of ancient Greek medicine. Pre-Socratic philosophers did not complete experiments but instead thought extensively about the natural world. The thinker Thales postulated that the earth was made of water while Empedocles argued that there were four components of the universe: earth, air, fire and water. From this, early physicians applied this symmetry to the components of the body.

It is perhaps, worth asking what makes medical care possible? Or, what makes the sort of medical care practiced in ancient Greece possible? It seems that a certain amount of hierarchy and specialization is required. Greek doctors were able to devote their time to thinking about the body because others were laboring to grow their food and defend their homes. There are well documented cases of medical care in indigenous societies and nomadic peoples but it seems such intensive care requires some sort of civilization behind it. It is not possible for doctors to train if there is no specialization of labor. It may be possible that “civilization” (a highly complex society with hierarchy and centralization) is a prerequisite for an intensive medical system. Another interesting aspect of the discussion was that, logically speaking, the ancient Greek system of medicine is not incomprehensible. However, the great flaw of Greek medicine, a flaw I think we continue to struggle with, is conceptualizing everything. Since the universe was held to have 4 elements, it followed conceptually that the human body should have 4 elements. The Greeks seemed to carry a bucket of concepts around which they dumped upon anything that they did not understand instead of observing it. I think we still do that a lot and it is worth contemplating the failures of this method.

Tenants of Hippocrates:

Hippocrates was a physician who lived in the mid 5th century. He claimed that each person has a balance of 4 humors. This idea of the 4 humors remains in practice until the 20th century. Thus, Hippocrates’ theory of disease remains profoundly influential for 1500 years. Hippocrates and other ancient physicians were distinct from our modern doctors in that they could offer a prognosis for what will happen to a patient but could not determine exactly what is wrong with them. Moreover, Greek physician would often refuse to treat disease if it is sure to end in the death of the patient. The most prominent physician of the ancient world was Galen, a great admirer of Hippocrates. He is the first to learn about human anatomy by treating gladiators who had been injured in fights. Galen wrote so extensively about Hippocrates that he became the epitome of the physician-a sort of unquestionable authority. Despite Galen’s knowledge of anatomy, he incorporated many of Hippocrates’ tenants into his practice. No physician questioned these tenants for over a millennia. This indicates that the ancient Greeks did not perhaps make a full transition from myth to theory. Hippocrates’ tenants became myths because they were inherited understandings which were not questioned. I think it is important to recognize that myths do not always take a religious form-they can easily be secular understandings which remain unquestioned as well. Though we have been trained to question everything, I think it is important to recognize that secular myths can have a powerful influence on systems of thinking.

Treatment of Slaves:

Access to medical attention was not politically restricted in ancient Greece. Slaves had access to medical attention, provided their master would finance it. Since a slave was valuable property, a master would sometimes pay to have their slaves treated after applying a sort of cost-benefit analysis. In any case, anyone who had the money for a doctor could receive treatment. In this way, the ancient Greek system was similar to our own-in which medicine is treated as a business rather than a service.

The Plague:

Archaeologists uncovered a mass grave at Athens in 2006. Such mass graves were not common practice in Athens. The researchers were able to extract samples on DNA from the teeth of the buried. These samples seem to suggest that the plague might have been typhoid. Though a large percentage of Athens’ population, some refer to the plague as the “fall of Athens”. Nevertheless, Athens thrives for another 26 years until the end of Peloponnesian War. At the time of the plague, Perocles decided to let the Spartans attack and moved the Athenians inside the city walls. The city received supplies by ship and it thought that the plague came on ship as well. The plague spread quickly through the enclosed population. The Athenians become nearly insane with intense despair. Their social structure was attacked by the plague as well as their bodies. The Athenians abandon burial rites which is perhaps the most telling example of their social break down. This lack of treatment for the dead would mean that there would be no afterlife for those killed by the plague. Though Athens did not “collapse” due to the plague, it is worth considering why some take this view. The word “collapse” implies a moral judgment that the society has somehow failed. Is the failure to treat adequately treat medical issues enough to label a dark period as a collapse? Do we place such value on the medical system? Also interesting was the lack of interest in burial rites for the dead. In the ancient world, burials were often used as mechanisms for elites to further distance themselves from ordinary members of society. I am curious if elite members of Greek society suffered such mistreatment of their burial rites. If they did suffer from lack of proper burial rites, this would be an interesting phenomenon as it would expose the power of medical catastrophe to overcome class distinctions.

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