Arateus
of the Capadócia
Prehistoric Period:
• Had you been mentally ill at a time during the
prehistoric period, a time believed to be
dominated by mystical viewpoints, your
symptoms may have been interpreted as signs
of possession by a demon or other malevolent
spirit. Displays of abnormal behavior may easily
be seen as proof of the control the supernatural
entity had over you. Frightened by you, society
may have sent you to a shaman who would
carry out an exorcism or perform other spells to
remove the demon’s control over you.
10000 B.C. – 3,000 B.C. --Prehistoric Times
•
As far as historians can ascertain, Paleolithic
people saw no distinction between medicine, magic,
and religion.Archeologists have uncovered skulls
with holes drilled in them dating back as far as
8,000 B.C.Researchers have determined that, for
some, bone healed near these holes indicating that
the procedure may have been surgical and that the
person survived.
Many theories have been developed as a means
to explain the purpose behind this surgery, called
trephining.Some anthropologists theorize that the
holes may have been drilled into the skull as a
means of releasing “evil spirits” that were trapped
inside the head causing abnormal behavior.Other
anthropologists believe that trephining was used to
treat medical problems (e.g., removal of a
tumor).However, the true purpose for trephining
during the Stone Age remains unknown.Trephining
continues to be practiced today among certain
African tribes for the relief of head wounds.
•
For an idea of how you might have been treated if
you had a mental illness in the Stone Age
1800-1700 B.C. Mesopotamina
• It seems likely that if you had a mental illness in Mesopotamina
during the 1700’s B.C. you would have been sent to see a physician
called an Ashipu (“sorceror”) or an Asu (“physician”).If you were
seen by the Ashipu he would first attempt to diagnosis which spirit or
sin you had committed to cause the illness.He would then perform
and use a variety of spells to drive the spirit out of your body.The
Asu may have more been more likely to use herbal remedies to treat
you.In addition, it is possible that the Asu may haveused a knife to
“scrape the skull of the patient,” based on two cuneiform tablets
titled “Prescriptions for Diseases of the Head.”Payment for the
services would most likely depend on your social status in the
society, where the physician himself may be punished for failure to
cure you if you were of high social status.
1800 B.C. – 1700 B.C. -- CODE
OF HAMMURABI
•
In Mesopotamia, between 1795-1750
B.C., Hammurabi, King of Babylon, issued a
structured code of laws, known as the Code of
Hammurabi. The Code of Hammurabi was
preserved on Cuneiform, a system of writing
developed by the Sumerians, which consisted of
writing onto wet clay with a wedge and then drying
those clay tablets.This code is the first-known
example an orderly body of laws created by a ruler.
The code of laws includes legal procedures for
physicians in the treatment of a variety of physical
ailments such as payment for successful services
rendered as well as punishment for a failed service
to his patient (e.g., loss of the physician’s
hands).Mesopotamian diseases were viewed from a
primarily mystical perspective and were blamed on
spirits: gods, ghosts, etc.Each spirit was believed to
cause a disease in any one part of the body.Some
diseases were referred to as “Hand of …” signifying
a divine cause whereas others were simply
identified by names (e.g., bennu).
For an idea of how you might have been treated in
Mesopotamia during the 1700's B.C
800 B.C. -Greek and Roman
Civilization
• If you had a mental illness
during the 800’s B.C., you may
have been sent to relax and
sleep in a serene and peaceful
locations such as anatural,
warm spring.You may have
been given drugs to help you
sleep.During your sleep,
Asclepius would come into
your dreams and cure you.In
addition to this “sleep therapy,”
you may be placed onto a diet
and encouraged to exercise.
400 B.C. -Greek and Roman
Civilization
•
If you had a psychological disorder in Greek or
Roman civilization during Hippocrates life, you
would most likely undergo a variety of different
treatments depending on the particular mental
illness that you were suffering from.If you were
found to be “melancholic” you may be given a
laxative or emetic (nausea-producing substance)
and also placed onto a diet rich in fruits and
vegetables.Someone who was choleric may be
encouraged to drink lots of fluids and may be given
a diuretic as well as a proper diet.A person that was
phlegmatic may be treated through purging and
possibly bleeding.Finally, those individuals who
were seen as having “sanguine” would likely receive
bleeding as the preferred treatment.If you were
particularly difficult to treat, you may have been
incarcerated.There were humanitarian treatments
as well as more spiritual treatments in Greek and
Roman civilization, but the views of Hippocrates
were dominant.
The Middle (DARK) Ages
•
If you suffered from a psychological disorder (particularly
the more severe forms, such as schizophrenia) during the
early periods of the Middle Ages and were treated by a
physician or priest you would likely be treated according to
the variety of mystical beliefs or to theories related to an
excess of certain bodily fluids. Most likely, if you sought
treatment or were forced into treatment, you would see a
priest and be given an exorcism.Exorcism during the
Middle Ages may not correspond to the current
perceptions of exorcism we have today. Exorcism would
be viewed more like torture today and basically consisted
of beatings, starvings, forced eating of substances (foultasting, blood, sheep dung) agitating the spirit and causing
it to flee the body. Otherwise, you may have seen a
physician and be subject to the variety of treatments
recommended by Hippocrates such as bloodletting. You
may have also been subject to a trephining procedure to
“remove the stones. ”If you were seen as threatening or
burdensome to the community, you may have been
executed or ostracized from the community. You may have
been left to wander the countryside seeking help from
wherever you could find it, receiving much ridicule and
derision.
Treatment at the Bedlam
•
If you were to have a serious mental illness during
the later half of the Middle Ages during the 13001600’s you may have been sent to an asylum, much
like the Hospital of St. Mary of Bethlehem in
London.In the asylum, especially after the 1400’s
you would find yourself in the absolute worst
conditions.You may have been referred to as an
inmate and be placed into a cell, devoid of fresh air,
light, and given very little nutrition.It is possible that
you would have been chained to the wall or to your
bed and had to lie in your own excrement and that
of the other “inmates.”You may have shared a
mattress on the floor with 5 or more “inmates,”
some of whom were criminally ill, and others who
were suffering from a variety of other mental
disorders.Later in the asylums years, you may have
become a tourist attraction where local citizens
could come through and view you and all the other
“lunatics.”If you became unruly you would be
subject to beatings as a means of controlling your
behavior.In many cases you would be all but
forgotten by society and left in the asylum to
die.However, there were those, such as the artist
William Hogarth who spent time in the asylum and
were able to leave.
14th and 15th Century
•
During the 14th and 15 centuries in
Europe, if you were suffering from a
mental illness (especially more severe
forms of mental illness) you may have
been labeled a witch by the
church.Once labeled as a witch, there
was virtually no escape.There were a
variety of “tests” to determine who was
and was not a witch.However, often
you proved you were not a witch by
your death (e.g., drowning) during the
test. Had you been a witch, it was
believed your powers/demons would
have protected you.If they determined
that you were a witch, you may have
been given an exorcism or burned at
the stake.If you were lucky, you may
have fallen under the care of more
humanitarian beliefs which began to
become more predominant in the 16th
and 17th centuries.
17th, 18th, and 19th Centuries
•
Mesmer conducted most of his work cloaked
in mystery. In a group setting, many people
would encircle a tub filled with chemicals
that had iron rods protruding from the
mysterious liquid. Mesmer would use one of
the soaked rods and rub it on the patients
afflicted area. In some cases, Mesmer could
even have his subjects swallow iron tablets
to increase the magnetism between himself
and the afflicted.Rush used some crude
devices to treat the mentally ill; none of
which were very effective. The circulating
swing (top left) was used to spin depressed
patients at high speeds. The tranquilizer
chair (top right) was used to calm people
suffering from mania. The crib (bottom) was
widely used to restrain violent patients. Rush
also felt that frightening the patient was
beneficial. Some subjects were told
repeatedly of their impending death, and
then placed in a casket with holes that was
submerged in water for several minutes.
Rush’s favorite treatment was bleeding. He
felt that many mental disorders were caused
by a buildup of blood in the brain.
• 6000 yıl önce Sümerle cennette şunu
bildirdiler:
– The sick eyed says not I am sick eyed. The sick
headed (says) not I am sick headed (Gözleri hasta
olan, gözlerim hasta değil demektedir. Kafası
hasta olan ise kafam hasta değil..)
• MÖ 3500:Eber papiruslarında
”Courtesan of Pharoah” mahkemesi ile
ilgili bir vak’ada kişi “ başının yarısında
hastalıklı” olarak tanımlanmıştır
Prehistorik Period
Dünyada uygulanan en eski beyin ameliyatının (trepanasyon),
20-25 yaşlarında bir kadın hasta üzerinde Aşıklı Höyük’te
olduğunu işaret etmektedir.
Hittite Dönemi (MÖ 1750-1200)
Kafkasya yolu ile Avrupa’dan gelen insanlar, MÖ 1200 yılları civarında
Kapadokya çevresine yerleşmişler ve bu bölgedeki yerleşik halk ile
birleşerek bir İmparatorluk kurmuşlardır. Dilleri ise Indo-Avrupa kökenlidir
PYTHOGORUS (samos)
ASCLEPION (ASCLEPİDİAS)
GALEN (pergamum)
SORONUS
RUFUS (ephesus)
AVICENNA
(buhara)
LEUCIPPUS (miletus)
DIOGENES (bodrum)
HIPPOCRATES (cos)
ARATEUS (cappodocia)
DIABETES MELLITUS
• MÖ 1552: 3. Hükümdarlık periyodunda
Dr. Hesy-Ra ilk defa diyabeti tanımlamış
ve semptom olarak poliüreden
bahsetmiştir.
• MS 1. yüzyılda Arateus diyabeti “yağ ve
bacakların eriyerek idrara karışması”
olarak tarif etmiştir.
Diabetes mellitus
• Aşagıdakiler Kapadokyalı Areteus tarafından, MS 2.
veya 3. yüzyılda yazılmıştır.
• Diabet, erkekler arasında pek sık görülmeyen ve et
ile uzuvların eriyip idrara akmasına neden olan bir
durumdur. Sebebi soğuk ve nemli doğadır.
• Seyri ise genellikle bellidir; böbrekler ve mesane hiç
bir zaman idrar yapmayı bırakmaz, ancak akış, sanki
orifisler açık kalmış gibi süreklidir.
• Bundan sonra hastalık kronik bir seyir izler ve
oluşması uzun süre alır. Hastalık tam olarak kendini
ortaya koyduğunda ise hastanın ömrü kısadır, erime
çok hızlı gelişir ve ölüm çabuktur
• Hasta idrar yapmaktan kurtulamaz.
Diabetes mellitus
• Susamayı tedavi edecek ilaçlar gereklidir,
cünkü kesinlikle önüne geçilemeyen bir
susuzluk söz konusudur, dolayısı ile bu
susuzluğu geçirecek kadar su içmek
mümkün değildir. Bu nedenle mutlaka mideyi
güçlendirmemiz gerekmektedir, çünkü burası
susuzluğun merkezidir..
• İçelecek su, sonbahar meyvaları ile
kaynatılmalıdır. Yiyecek olarak süt ile beraber
nişasta, buğday ve yulaf yenmelidir. Buruk
şaraplar mideye tonus kazandırır. Çok tuzlu
yenmemelidir, çünkü bu suzusluğu artırır.
Hippocrates
• 440-390 BC:Hippocrates
distinguished different
types of headaches in his
Aphorism, and was the
first state that this was a
true disorder and not a
visitation from the gods.
• He was the first to describe
several well-known features of
migraine, vizuel aura, the onset
of headache after the aura, the
headache becoming
generalized and its relief by
vomiting
• The Greek word, hemicrania,
was changed by the Romans
to the Latin, hemicranium, and
then corruted into low Latin as
hemicraia, them emigranea,
migranea and migrana.
• In English, it appeard as
mygraine (1398), myegrym
(1460), migrien (1579), and
megrim (1713). Migraine
appeard in English (from the
French) in 1777. Megrim has
neen spelled in 33 different
ways
MS 30-90 : Kapadokyalı Arateus
• Arateus of Cappococia: Migrenli birçok
doktor gibi Kapadokyalı Arateus ta kendi
migrenine önem verdi ve klinik tanımını
yaptı. Vizüel auranın detaylı tanımını yaptı:
“..ağrıdan önde mor-siyah ışık çakmaları
görülür..”
• İlk defa fotofobi ve fonofobiyi tanımladı
Kendi başağrısı
• ....ağrı. Başın yarısında
kalır. Buna heterokania
denir. Hafif başlasa bile
kesinlikle hafif bir hastalık
değildir...
• Akut olarak başlar, bazen
hoş olmayan, korkunç
semptomlar
görülür..bezdirici bulantı,
safra kusma, başta ağırlık,
anksiyete görülür...karanlık
hastalığı örter..
• Celsus (25 BC to 50 AD)
ilk defa migrenin hayat
boyu süren, öldürücü
olmayan fakat tetikleyici
faktörleri olan bir hastalık
olarak tanımladı
• Efesli Soranus (90-138
AD) skotomayı tanımladı
• Galen (131-201 AD)
HEMICRANIA terimini
kullandı
30-90 AD: Arateus of Cappococia:
• 3 Değişik tip baş ağrısı
tanımlamıştır
– Cephalalgia: hafif, seyrek olarak gelen, bir kaç gün
süren, gerilim başagrısı olması muhtemel ağrı
– Cephalea: daha uzun süren, daha şiddetli, tedavisi
zor, muhtemelen yapısal bir probleme bağlı
– Heterocrania: Heterokrania: gözlerin önünde
kararmalar olan, tek taraflı başağrısı, bulantı, kusma,
fotofobi ve osmofobi (MİGREN)
– Eğer gün doğuşunda başlarlarsa, ertesi gün, öglen
vaktinde sona ererler; ve eğer gün ortasında başlarlarsa,
gün batarken sonlanırlar. “Bir atağın daha uzun süremesi
nadirdir”. Ataklar 6 ile 24 saat arasında sürerler. Başağrısı
başın iki yanından birinde veya frontal, vertikal olabileceği
gibi aynı gün içinde de değişlikler gösterebilir. Ağrı
lokalize olduğunda heterokrania adı verilir.
ARATEUS
• …those affected with melancholy are not every
one of them affected according to one particular
form but they are suspicious of poisoning or flee
to the desert from misanthropy (insanlardan
kaçan, nefret eden) or turn superstitious or
contract a hatred (düşmanlık, kin) of life.
• The patients are dull or stern (katı), dejected
(kederli) or unreasonably torpid (uyuşuk,
durgun)……they also become peevish (huysuz),
dispirited (neşesiz, keyfsiz) and start up from a
disturbed sleep
DEVELOPMENT OF PSYCHIATRY
• Eski çağlarda: Zihinsel hastalıklar alternatif gerçek olarak kabul
edilmiştir. Tedavi topluluğun saygı gören bir üyesi tarafından
uygulanmaktaydı. Holistic yaklaşım sıktır.
• Mısır, MS 2850: Uyku terapisi. Nil gezintileri, müzik, dans, resim.
• Mezopotamya, MÖ 2000: Mental ve fiziksel hastalıkların tedavisi
için farklı gruplar, holistic yaklaşım, psikoterapinin başlangıcı
• Prehistorik: Mental ilness regarded as alternate reality;
treatment administered by respected member of community.
Holistic approach is common.
• Egypt, 2850 B.C.: Sleep therapy. Nile excursions, music,
dancing, painting.
• Mesopotamia, 2000 B.C.: Division of labor betwen treatment of
physical and mental ailments, holistic approach, beginning of
psychotherapy.
DEVELOPMENT OF PSYCHIATRY
• MÖ 5. Yüzyıl:
– Hippocrat birçok mental
hastalığı dökümante etti.
Beyni, düşünce ve duyguların
merkezi olarak belirledi.
– Plato, Freud’un ego,
süperego ve id teorisinin öncü
teorisini ortaya koyar
• MÖ 4. Yüzyıl:
• Aristo hareketleri, duyguları ve
düşünceleri bir bütün olarak
kabul eder ve mental
hastalıklarda genetik yatkınlık
bulunduğunu tarifler. Arzular ve
mantık ile ilgili çalışır. Aristofanes,
Freud teoreminin erken şekillerini
içeren oyunlar yazar.
•
•
•
•
Eski insanlar, psikiyatrik hastalıkları, doğa üstü güçler tarafından ele
geçirilmek olarak açıklamaktaydılar.
Üzerlerinde geniş delikler açılmış olan eski kafastasları bulunmuştur.
Buna trepanasyon adı verilmektedir. Amaç kötü ruhları serbest
bırakmaktır.
Koslu Doktor Hipokrat (MÖ 450) üzüntü, apati ve kendine güvenin
kaybı ile seyreden tabloya, siyah safradan kaynaklandığını düşünerek,
melankoli adını vermiştir (melanos: siyah cholle: safra)
Bu terim daha sonra Arateus (MS 120-180) ve Galeno (MS 129-199) gibi
doktorlar tarafından da kullanılmıştır.
Arateus
• ...melankoli tarafından etkilenenler her zaman
aynı şekilde davranmamaktadır: zehirlenmekten
süphe duymaktadırlar, veya insanlardan kaçıp
çöle yerleşirler, veya fazlası ile batıl inançlı hale
gelirler, ya da hayattan nefret ederler.
• Hastalar sıkıcı veya acımasız, kederli veya
anlaşılmaz şekilde hareketli olabilirler...aynı
zamanda huysuz, ruhsuz hale gelirler, uyku
problemleri vardır.
DEVELOPMENT OF PSYCHIATRY
• 50-130 A.C.: Arateus writes an accurate
description of bipolar illness; views
normal and abnormal behavior as a
continuum
• 9th-10th Century A.C: Rhazes operates
hospital in Baghdad with a separate
psychiatric ward, where patients are
humanely treated.
Trigeminal Neuralgia:
• Arateus, MS 1. yüzyılda ilk defa “trigeminal
nevralji” veya diğer adı ile Tic douloreux’u
(Fransızca’da Acılı Tik) tarif etmiştir.
• 1677’de, John Locke, bu durumu tarif eden ilk
doktordur.
• Nicolaus Andre 1756 da ayri b’r kl’n’k ant’te
olarak TN tanimladi.
• TN en sık gözlenen fasial nevraljidir ve
hastaların yaşayabileceği en ağrılı durumlardan
biri olarak kabul edilmektedir.
EPILEPSY
•
•
•
•
2. yüzyılda, Greko-romen Pneumatic Tıp Okulunda, Kapadokyalı Arateus auralı epilepsiyi
tanımlamıştır.
Galenos zamanında (130-200 AC) epilepsi ataklarının ayın (lunar) hareketleri ile ilişkili
olduğu düşünüldüğü için bu kişilere lunatik adı verilmiştir.
Orta çağ Avrupasında epilepsinin sihirli veya dinsel güçlerle ilişkili olduğu düşünülmüştür.
XVI. Yüzyılda (1493-1541), Paracelsus epilepsiyi histeri ile ilişkilendirdi ve bulaşıcı bir
hastalık olduğunu iddia etti.
•
In century II, Arateus of the Capadócia described the aura of the epileptic crisis in the
Pneumatic School of Greco-roman Medicine.
•
At the time of Galenos (130-200 AC) the popular belief started to associate the epiletic
attack with lunar alterations and the patients were called lunatics, persisting this idea until
century XVII.
•
In the medieval Europe, the cause of the epilepsy was attributed to the magical or religious
factors
•
It started to appear the practical one of exorcisms (witches had blunted). In that occasion it
had a mixture and confusion between: religion, misticism, witchcraft and histeria.
•
In century XVI (1493-1541), the Paracelsus associated the epilepsy with histeria and
described the epilepsy as contagious disease.
• Arateus, bütün mental hastalıkların orijininin
saptanamyacağını öne süren ilk bilgindir. Mental
hastalıkların kafadan veya abdomenden
kaynaklanabileceğini ve diğer organın ikincil olarak
etkilenebileceğini belirtmiştir.
• Aynı zamanda premorbid kişilikler hakkında çalışmış
ve manik olan kişilerin daha öncesinde de labil
yapılı, kolaylıkla alınan, kızan veya mutlu olan
insanlar olduğunu ileri sürmüştür. Melankolik olan
kişiler ise daha sonraki hayatkarında depresyona
daha yatkındırlar.
• Emosyonel bozukluklar, mevcut karakteristik
özelliklerin uzantısı veya ekzajerasyonu olarak kabul
görmüştür. Ayrıca, mani ve depresyonun aynı kişide
görülebildiğini öne sürmüş ve bu Kraeplin’in
çalışmalarının temelini oluşturmuştur.
Arateus and Galen (30-90 AC)
Souls
Location
Function
Rational
Brain
Controls internal and
external functions
Internal: imagination,
judgement, memory,
apperception, movement
External: 5 senses
Irrational
Heart and Liver
Controls all emotions
• Kapadokyalı Arateus, MS 2.
yüzyılda, “Mısırlı Hastalığı” veya
“Suriyeli Ülseri” olarak bilinen
tonsillerin ülserasyonu, burundan
yemek gelmesi ve nefes alamamak
ile seyreden hastalığı tarif etmiştir.
SPECULUM
•
•
•
•
The first evidence that a speculum was used
in antiquity is found in the Talmud about
1300B.C.,
This speculum was a cylinder made initially of
bamboo or the stem of a gourd and later of
metal.
The present name of speculum was adopted
in the Roman era, and it was Galen (AD 130200) who made the first record of a speculum.
In 1818 in the excavation of Pompeii two
specula were found which were estimated to
have been buried in AD 79. These were
bronze dilators; one with three and the other
with four blades which diverged when a
centrally located screw is turned and they
were used in the time of Galen and Celsus
(27 BC to A.D.50) and very likely in the Middle
Ages.
At about the second century, speculum was
described in several medical books of the
time. Soranus of Ephesus, Arateus,
Archingenes, Aspasia and Leonido, are few of
the physicians who recognised the
association of speculum with anorectal and
gynaecological examination.
Ancient Greek Solar System. CELLARIUS, A. [Amsterdam, 1660]
Saturn was the outermost planet in ancient cosmology, as it is the furthest planet visible with the naked eye. The
planets are represented by fine medallions of the ancient gods and goddesses after whom they are named.
Groups of astronomers in the lower corners are seen conversing around globes. Knowledge of the ancient Greek
solar system derived from an epic poem by Arateus, referred to in the chart's title, which was written in the third
century B.C.