Vestiges of Greek Medicine in Modern Medicine Denis Hadjiliadis, M.D.

Introduction Greek Medicine: 6 th century BC to 4 th century AD Classical, Hellenistic and early Byzantine era

Significance Terminology Diseases are thought not as acts of wrath of gods Diseases are thought as imbalance of humors in the body (  Systematic observation, history and physical exam become the focus of physicians Many medical and surgical treatments are introduced

Terminology Nosocomial infections are caused by Staphylococcus, Pseudomonas, Enterococcus, Enterobacter and other pathogens. Pneumonia and sepsis are paradigms of nosocomial infections and they are commonly iatrogenic. Sepsis when caused by gram negative bacteria has an ominous prognosis. Endotoxin, which is released by gram negative bacteria, is a microscopic protein that initiates a series of symptoms and signs: tachypnea, tachycardia, dilatation of arteries, cardiomyopathy and pulmonary edema. Despite advancements in microbiology and new methods of therapy, mortality remains high.

Terminology cont’d Word count: 53 different words Greek words: 27 English: 20 Latin: 6

Disease etiology Classical Greece context: Philosophy: effort to explain natural events without attributing them to supernatural forces. History: documentation of events in a logical manner, with causation and results of human actions analyzed.

Disease etiology cont’d Classical Greece context: Politics: democracy first appeared. Equality of citizens against the law and the city-state acknowledged (unfortunately only free men). Medicine: contact with Phoenicians, Egyptians brings new ideas.

Disease etiology cont’d

Health: harmony of humors in balance; “natural way” (eucrasia) Disease: harmony disturbed, imbalance; dyscrasia. Nature (physis) has healing powers. Physician supports patient till nature heals him/her. Treatment was generally conservative

Disease etiology cont’d Allopathic medicine is created Example in modern times: patient has a fever, s/he is treated with acetaminophen to take the fever away.

Disease etiology cont’d Other theories were opposing humoralists Disease is caused by factors that need treatment (methodists, empiricists and pneumatists are in this group).

Disease descriptions Hippocrates: father of Medicine. Born in Cos 460 BC; died 70 to 90 years later. Little known about his life, but traveled a lot; spent large amount of time in Athens. Multiple medical works of Classical Greece attributed to him: “Corpus Hippocraticum”.

Disease descriptions cont’d

Epidemics Book I (Case IX) “Crito, in Thasos, while walking about, was seized with a violent pain in the great toe. He took to bed the same day with shivering and nausea; regained a little warmth; at night was delirious. Second day. Swelling of the whole foot, which was rather red about the ankle, and distended; black blisters; acute fever; mad delirium. Alvine discharges unmixed, bilious and rather frequent. He died on the second day from the commencement.”

Disease descriptions cont’d Epidemics III (constitution) “Many were attacked by the erysipelas all over the body when the exciting cause was a trivial accident or a very small wound…Many even while undergoing treatment suffered from severe inflammations, and the erysipelas would quickly spread in all directions. Flesh, sinews and bones fell away in large quantities. The flux which formed was not like pus but a different sort of putrefaction with a copious and varied flux…The bones were bared and fell away, and there were copious fluxes. Fever was sometimes present and sometimes absent…

Disease descriptions cont’d Epidemics III (constitution cont.) “There were many deaths. The course of the disease was the same to whatever part of the body it spread. Many lost the arm and the entire forearm. If the malady settled in the sides there was rotting either before or behind. In some cases the entire thigh was bared or the shin and the entire foot. But the most dangerous cases of all such cases were when when the pubes and genital organs were attacked.”

Disease descriptions cont’d Diseases described: Vibrio vulnificus Strep. Pyogenes Other diseases: tuberculosis, puerperal fever, Cheyne-Stokes breathing, frostbites

Treatment of diseases On Joints (Spinal diseases and treatment) Hippocratic ladder Hippocratic board Both were early brace devices used to correct kyphosis or scoliosis

Treatment of diseases cont’d

Treatment of diseases cont.

Treatment of diseases cont’d Dislocations of the shoulder: Hippocratic method is still taught in medical school. Treatment offered for chronic dislocation.

Other physicians Galen: born in Pergamon in 130 AD. Died in 201 AD. Great contributions in anatomy by dissection of animals. Multiple commentaries on earlier medical literature. Prescriptions for medications. Bridged humoral theory with non-humoral; believed in medications.

Other physicians Cosmas and Damian: 3 rd century AD in Asia Minor. First transplant of a limb from one person to another Christian patron saints of medicine