Notes on Iatrós (141 – 171)
Greek Medicine: The Sources (141)
Despite being the golden age of Athens, the time of Hippocrates produced little extent material
on the medicinal practices of the time. Hippocrates supposedly “large collection” of medical works has
vanished.
Wounds in Verse (142 - 147)
Treatment in the Iliad: the soldier is returned to the barracks, sat down, told stories, given wine
sprinkled with goat cheese and barley meal, and all of this was served by a beautiful woman.
The only action taken to stop the bleeding is “epaoidé,” meaning that someone sang a song or
recited some sort of charm over the wound.
Very little treatment of wounds. Mostly from raw plants described as bitter (possibly
counterpoisons)
Binding of wounds is rarely mentioned in Homer (two times only) – thus, many injured
warriors may have been resting or even walking around with open wounds.
Alcohol is an awesome analgesic!
Use of opium
There was even a Greek goddess of poppy (from which the opium was crudely drained)
The drug was made in Greek but utilized an Egyptian remedy
“Sucked out” - something needed to be removed from the wound (by mouth or other cleansing
method), thus comes the idea of a “bad substance” or a poison.
The word “toxin” is actually from the Greek word “tóxon” meaning bow. Thus, there is an
inseparable association between between injury by an arrow and poison.
Surgery without Surgeons (147 - 150)
Hippocrates' library was likely the library of the medical school nearby his home in Cos.
Term “epidemics” originally meant “visits to place.”
Is this where we get the universality of the word? The idea that an epidemic is a deadly
illness that visits all places?
Term iatros, in addition to meaning medicine, is also the name of the medical facilities in a
town.
Ancient doctors: skilled at bandaging; neat (spotless); had long nails; was perfumed; had good
posture; followed very specific practices when it came to the treatment of wounds; perhaps had a small
collection of medical journals.
Medicine and surgery equal, since most medical practices were surgical in nature – words
became inextricably linked.
The Greek word for surgeon is similar to the word for “hand-work.”
Outpatient Care, Hippocratic Style (150)
Atmosphere: “smoke from brazier [container of fire] where the cauteries [a device that
cauterizes] are kept red-hot, fumes of boiling drugs, the aroma of herbs, resins and spices on the
shelves, and a soupçon of roasted human flesh.” Delicious.
The iatros had two male assistants / apprentices.
Patient No. 1: Severe Hemorrhage
Carpenter with an injured foot.
The iatros elevates the injured leg; a towel with cool water is wrapped loosely around the injury
(cool water is to be applied around the spot, but not directly to the spot, a practice which was proven to
be useful in the 1970s). Warm towel wrapped about head to draw blood away from injury. Wine on a
rag!
Fig tree juices. Figured that since the juice gathered from fig-tree leaves clots milk, it must also
clot blood. Interestingly, the fig tree juice DOES clot milk, but is not so effective... at all effective on
reducing bleeding.
A gentle tie to the top of the leg will increase the blood flow to the injury, but a firm tie will
reduce the amount of bleeding. However, keep the tight tie on too long and the limb will become
gangrenous – thus, for the iaptros, it is a balance between reducing blood loss and preventing gangrene.
After the injury stops bleeding, guess what, the iaptros “slits a vein in [the injured carpenter's]
ankle.”
“Hemorrhage kills, but bleeding helps.”
Turniquets were not seen as practical and were hardly even mentioned in the literature of the
time.
“In the days of Hippocrates the tourniquet was bound to fail.”
Patient No. 2: A Round Ulcer (153 – 156)
Woman with a stubborn ankle ulcer.
“The patient who must decide whether it [temperature of a wet cloth] is comfortable.” Emphasis
on patient preference. Warmth will keep the ulcer “relaxed.” Also, heat favors bleeding (and remember,
bleeding is good!)
Occasionally puncture varicose veins.
Wound sponged with hot vinegar (the heat has already been explained, the vinegar may be used
because it functions as an antiseptic / antibiotic in other applications and is therefore seen as “good” in
the mind of the physician).
“For an obstinate ulcer, sweet wine and a lot of patience should be enough.”
Changing the shape of the ulcer is important. Anything but a circle heals well. The logic of this
is explained by the image on page 155 and further on 156. Quite simple, the edges of a round injury,
converging on one another, with inhibit the inward motion, thus slowing the healing process. Thus, the
iaptros deems it necessary to reshape wounds (in this case the ulcer) into a shape more conducive to
healing.
TURTLES!
Note: an animal experiment showed that round wounds take significantly longer to heal
than wounds of other shapes → the experiment on rabbits utilizes the triangle.
Perfumed the wounds → is the perfuming of wounds a practice that came about because of
association between bad infections (gross, smelly, oozing stuff) causing death, and non-stinky wounds
(just a cut without the accompanying bacterial putrefaction)? Odor is not something that requires a
microscope, no technology is required. The conclusion is an associative one: ie – the patient's wound
smelled awful. The patient died, an awful smell accompanied the wound that brought about fatality →
wounds that smell bad are wounds that kill.
Woman is told to only lay down.
Purgery (from both ends)
Patient No. 3: Pus in the Chest (156 – 158)
A “feverish young man” has too much pus in his chest (an imbalance of the “humors”)
Iaptros confirms diagnosis by siezing the patient and shaking him and listening to hear whether
or not there is a swishing noise. If there is a swishing noise that is good, it means that there is a balance
of fluids and free space for them to move around. However, as in the case of this young man, there is
no extra space and therefore no room for fluid-motion. Thus, “the pus must be removed.”
Clever: the physician would put potter's clay on the body and see which spot dries first to locate
the hottest area on the skin → the area of infection.
Once the pus is extracted (though surgical means) it is examined.
Pure with streaks of blood = good prognosis
Thick, greenish, and fetid = dead
The usual purging, starving and bleeding is implemented...
Inpatient vs. outpatient care
Patient No. 4: A Fallen Lung (158 – 161)
Pleuritis meant nothing more than “a thing of the side” and didn't have nearly the specificity it
does in contemporary medical usage.
Diagnosis the woman as having a “fallen lung” → the leathery noise the iaptros hears is actually
the sound of an enflamed lung rubbing against the rib cage. The only lungs an iapros would have
encountered is the lung of a dead person → a dead person's lung would have shriveled up and ascended
towards its point of anchorage, thus to the iatros there was room for the lung to descend.
Solution: insert air into the plural cavity via a syringe with a bladder to “blow the lung back into
place.”
Patient No. 5: A Cut in the Face (161 – 162)
A “youngster” comes to the iaprtos with a slave who has suffered a slash on the nose!
Injury showered in white wine.
Would have helped the wound to produce puss (since, recall, puss is not bad)
Stitches wound.
Show off their work with bandages (sexy bandages)
Probably, the best way to demonstrate one's own ability as a physician (other than the
survival of patients) is to create a good-looking remedy. Who wants to go to a doctor and get a butt
ugly bandage?
The hippocratic collection was critical of sexy bandages.
Stay away from cheese! At all costs!
Patient No. 6: Recurrent Dislocation of the Shoulder (162 – 166)
Wrestler has come in with a dislocated shoulder for the fourth time.
Technique of setting the bone still recommended.
Solution for repeated dislocation is to poke a hot rod between the bones and, effectively, harden
(cauterize) the tissue, make the connection between the bones stronger.
Iatros aware of the nearby danger (lymph nodes in the armpit, bundles of nerves) these must not
be touched by the searing hot stick.
Patient No. 7: Carpentry on the Skull (166 – 169)
11 year old boy working with a horse was kicked in the forehead (oh no!)
Examines to see if there is a fracture.
If there is one he leaves it alone.
If there is no fracture, the iatros drills a hole into the skull.
If there is an indentation he will merely scrape it away.
Closer examination: shaves head → enlarges wound → peels back the scalp around the area →
covers whole wound with plaster → next day: add black stuff → scrap stuff off → any remaining black
stuff will be inside contusions within the bone → bone contusions are bad → remove the bad bone.
“If you find no hole, make one.”
Hole necessary to allow excess humors out.
Boy comes back with another sickness → according to the iatros this is no connected to the
original injury or the fact that he drilled a hole in the boy's skull.
Patient No. 8: A Chest like Boiling Vinegar (169 – 171) → the boiling of vinigar makes crackling
noise similar to that produced in fluid-filled lungs → hence the descriptor.
An old woman comes with fluid inside her lungs
Tells patient symptoms before she has a chance to describe them herself → this is seen as
impressive, a verification of the iatros' diagnostic skill
Fluid leaks into body → fingers bulge (chronic lung disease) → fluid must be drained → drying
diet
Importance of prognosis vs. diagnosis
Class Notes (9 / 8) Iaptros
“What are people doing here or why?”
Background
Greek civilization is already a developed place when the Greeks appear.
3rd century BC: Mesopotamia (modern day Iraq) → Summarians were the ancient founders in
this area; sin and the gods were the source of disease. To get rid of that disease you need a religious
practitioner.
Egypt → Mixture of things that look like prescriptions and spells. Accompanying incantations.
The psychology of the charm (psychosomatics). Accidentally fall upon remedies.
Greek take: the Greeks go through a period of time during the Ionian Enlightenment. Homer. The
gods can cause and bring about disease, as well as ca bring healing.
Birth of philosophy during this time.
People start to wonder what the world is composed of.
Pre-socratic philosophers were more like scientists. The only way they could gain a
knowledge of something at the time was through thought → they do “science” non-empirically. “What
logically can the world be composed of.”
Thales: the world is compose of water → you can get liquid out of anyting.
Aneximides: it's all types of air.
Four elements.
Groupings of four. The body is composed of four different types of stuff (“humours”.) Blood, phlegm,
yellow bile, and black bile. An imbalance in these causes illness.
Idea of the four humors sticks until the 20th century.
The time of the sophists (Socrates) → philosophy is both about science AND about thinking. That is,
ascience is beginning to be developed that depends on empiricle data.
Hippocrates: thinking about disease, NOT doing experimentation. He is concerned with being able to
offer a prognosis (worried about what is going to happen → future looking). If the prognosis is death,
there is no need to work on them, therefore the iatros denies.
Great physicians are those who treat people well AND those who deny those who are going to die.
A lot of these doctors traveled around from place to place, thinking about the diseases that are
particular to those locations. Epidemic means to travel places.
The body of writing associated with Hippocrates are largely not his writing.
The Epidemics: gave description of an area largely because there is a certain disease in that area. IE: if
there is a large population of people with lung problems, there must be bad air in that area. Prevalent
ailments largely attributed to environmental conditions.
Malaria (the bad air) – the bad air leads to the mosquitoes.
Observation!
Atomic theory: atomos = un-cutable. Those things which cannot be divided make up those things
which you can see.
No way to stop infection, therefore there was a great amount of infection → seeing this process, they
made an association between the development of puss naturally and the need for the development of
puss in non-infected wounds.
No experimentation.
The idea of gods bringing disease upon someone is long-gone before Hippocrates, however there is still
the god of physicians.
Who had access to these physicians: anyone who could pay. Slaves would be brought to the physician
only when the master deemed it more cost-effective to save the person.
A few female physicians but later on.
Familial apprenticeship.
Galen (phrenology guy). Sewed up gladiators, so got to know the human body pretty well.
Hippocrates name becomes synonymous with physician.
Seen as the epitome of the physician and no one will ever be equal to them and that is why his
teaching went on untouched for so long → to go against him was to go against well-developed, widely
accepted, conventional knowledge.
The plague and Thucidites
Thucidites is writing this while the plague was going on, and he had it and he survived. He is in
Athens while this is happening. While this is going on, Athens and Sparta is at war.
There was a fighting season (when we're not farming, not too cold, not too hot)
The Athenians are all gathered within the walls of Athens proper in order to avoid having anyone killed
by Spartan invaders.
What the hell is the plague? (tularemia)
DNA evidence suggests typhoid... or does it!
Did the plague have such great success because no one had any strong hope for being cured once they
were diagnosed?