Like the chicken and the egg

Like the chicken and the egg, experimentation and conjecture revolve around each other at the heart of the scientific method. In the science of life, however, isolation of variables and repetition of trials have often proven difficult and ethically convoluted. Biological study largely evolved in conjunction with the philosophy of medicine, the natural connection being that an understanding of biological function is crucial in repairing dysfunction. Regardless of whether theory or practice arose first, “good” medicine may arguably be characterized by conservative practice. Ironically, however, most medical advances arise from happen stance, or from isolated extenuating circumstance, and after wide spread dissemination and adoption are they more thoroughly investigated; surgery for instance. Amputations, weapon removal, cataract couching, denture fixation, and even basic reconstructive surgery are documented early in the first millennia BC. Homer describes many surgical practices in his depictions of the Trojan War, but still attributed infection and disease to the uncontrollable will of the Gods. The complexity behind why of two people, with apparently similar health (or as the case may be, ailment), one turns out fine whereas the other might fall into sickness or die was beyond the philosophy and instruments of the time (and in fact wasn’t even fully understood until the 1850’s with the founding of epidemiology by John Snow). Without the proper physiochemical and biomolecular tools, and live imaging techniques of the modern century, an in depth holistic understanding of biological function was unattainable. Instead, experiments presented themselves as anatomical dissections to determine what all, and where all, everything is. Naturally, theory developed in response and vivisections subsequently arose and developed to test what all everything does, a task still hardly dented in the modern age.  

Without the instruments or methods for developing philosophy, ancient medicine progressed through widespread dissemination of practices, often between remote destinations, proven to be tried and true. Good examples are rhinoplasty, in which skin from the forehead is used to replace a nose, and cataract couching, in which the crystalline deposit blocking vision is moved out of the way, where first described in Hindu medical texts mid-millennia BC, and subsequently where included, described in generally similar terms, in the medical encyclopedia composed by Celsus (~300 AD). Shared nuances, such as specifying which hand is best for certain parts of the procedure, construction of instruments, and important help to include for expediting the process are too great for coincidence, and indicate they didn’t arise separately. Doctors tackling the issue of ‘experimenting’ with new procedures was first documented in Alexandria (~300 BC), with Herophilus and Eristatus practicing procedures on criminals sentenced to death by first inflicting than repairing ailments. Although the logic being many would benefit from the suffering of few, the practice may still seem ostensibly analogues to the atrocities of Nazi medical experimentation. The two, however, couldn’t possibly more apart, and in their separate ways each illustrate the general consensus of ‘good’ medicine being typified by a cautious and conservative approach. Permission to perform the first criminal vivisections was a city wide affair, and surprisingly controversial considering the era, and the subjects being dead men walking anyways. Though a relatively rare occurrence, the hands on experience was invaluable for training doctors, and garnished major contributions to understanding biological function. On the other hand, the reckless abandonment of human life displayed in Nazi medical experimentation, often focused on testing the bounds of human tolerance for extreme conditions, actually afforded very little relevant and no scientifically useful information despite the massive number of trials and variety of subjects implicated.        

The ethics of justified medical experimentation, however, historically only apply to human subjects and very little regard has been paid to animals. The amount of animals that die each month from experimentation is roughly equal to the number of lives lost in the Holocaust (~6-10 million), and arguably from far more gruesome means. The difference, however, is that the information is unattainable by any other means, and has proven essential for treating human diseases and developing less invasive techniques. One may argue that the ends justify the means or that animals lack the agency to comprehend their circumstance. Ironically however, the more we learn the more it seems that in fact our and animal psyches are not all that different, and that barring inherited genetic disorders, the cause of ailment is based on environmental circumstance (including contact with other organisms) and lifestyle, and that there are no ‘magic-bullet’ cures, just good old fashioned healthy living. Further, a huge body of evidence is accumulating suggesting regular use of most drugs (inherently always developed through animal testing) actually have severe health repercussions. Unlike the chicken and egg problem, which has been solved through the theory of evolution (the egg must have came first, and was a mutant laid by an almost chicken), the tragic comedy of medical experimentation may have no answer, and the harder we look the more it seems we’ve had the solution all along.      

Abortion and Sexuality

             Women in antiquity not only had limited legal status, no political voice, but were also condemned to a terrible sex life. While their husbands were away fighting wars, they were supposed to be chaste and faithful, eagerly waiting the day when their husbands would return. However, some women refused to wait and instead succumbed to sexual desires and when they did, the consequences were monumental. While I was reading Kapparis’s “Abortion in the Ancient World”, a passage really struck me and even though this was written in a 1913 novel about a couple in a small town in Greece, the evidence that is presented in both his book and from primary sources suggests that women faced similar circumstances when their “dirty” deeds were discovered.

          One evening when he returned home somewhat earlier than usual he caught sight of an old woman leaving the house by the front door. She was tall, with a black wimple tied in a knot beneath her large chin. At the sight of him in the distance, she could not suppress a tiny movement that betrayed a certain fright. Going hastily around the first corner, she disappeared. Something told him that this curious visit portended some indefinable evil for his household. Quickening his pace, he flew up the steps three at a time, the stairway creaking behind him…

       A little later that same evening, when they gathered around the dinner table with their customary bickering and began to eat, Stylianoula suddenly let out a scream with the first mouthful she took.
       ‘Oooch! Oh mama! mama!’
        A terrible pain was knifing through her stomach and abdomen, together with a nausea that made her retch the very lining of her guts…
      The blacksmith became frightened in his own right.
      ‘What’s the matter, wife? I said: What’s the mater?’
      Finally, Stylianoula  was able to blurt out in the midst of her throes:
     ‘I’m poisoned! The old hag poisoned me. Oh god, oh god.’
      She inhaled deeply. The shadow of death, passing over her eyes, made them dilate and bulge with dread.
   Suddenly Belios caught on. Seizing her hair and yanking it until he nearly lifted her off the ground, be brought her contorted and unrecognizable face close to his own at first, then dragged it next to the lamp that was hanging on the wall. In bringing it ear to the light in this way, he apparently wished to read the truth in those terror-stricken eyes, for he started into their depths with his face practically touching hers drove his gaze into her like a stiletto – until all at once, like a lightning bolt, the truth did flash through those glazed eyes that were goggling in paralyzed dismay. It was a truth that cast light for him, but at the same time burned him to the quick. ‘Slut!’ he howled. ‘So you got yourself with a child while I was away in the army, is that it? And you had that hag bring you an herb, and you took it to get rid of the bastard in your tummy? Right?
Still clutching her by the hair, he knocked her head against the wall. ‘Right, slut? And with my own mother as your bawd, eh? Viper! Whore! Lousy filthy whore!’
   ‘Forgive me, forgive …, forgive …’ whimpered his wife, who was dangling like a rag from his powerful fist, her body contracted like an injured snake’s because of the repeated pangs that were slicing through her entrails.

       Still pressing her against the wall, he began to kick her womb with the tip of his shoe and to slap her face while still banging her head against the plaster. Soon a wound opened in the back of her scalp and blood began to splatter the newly white-washed inglenook. In due course, she ceased to resist his blows any longer ot to implore his forgiveness. Instead, she commenced to groan softly and continously unsilencably. She sounded like an aggrieved child whining quietly in a corner. Eventually this muted wail died out as well, her body suddenly slumped inertly in his grasp, her arms thrashed limply this way and he pummeled her, the eyes rolled upwards until only the whites were visible, then went glazed beneath drooping lids.

           While this murder seems like an act of passion, understand that in ancient times husbands not only had the authority to murder their wives, but also their lovers. If murder was illegal in a certain city-state, then the wife was ostracized, leading her to be divorced not only from her husband, but society as well. She could not set foot in public temples, she could not wear jewelry, she certainly could not communicate with other women as she was now seen as filth. This double standard has existed much throughout history in most “civilized” nations leading the husband to have as many concubines and mistresses as he could afford because children from these affairs were simply illegitimate. However, the wife was not allowed this luxury. If she did have an affair, which would most likely be with one of the house slaves, she went to extraordinary measures to hide the evidence due to the consequences described above. I think it’s interesting that we celebrate the ancients Greeks as being a sexually open and free civilization, but women were still chained to the same constraints as they are today.



Eager Groom Shy Bride - Mary Evans



                                           

Bibliography

1) Riddle, John. (1994). Contraception and Abortion from the Ancient World to the Renaissance
               Harvard University Press, Massachusetts

Summary – This book did a phenomenal job of outlining the many different abortion practices that have occurred throughout history. It starts from antiquity and details not only the medical practices, but also the ethics behind abortion in these ancient civilizations.

2) Lonie , Iain. (1981) The Hippocratic Treatises “On Generation” “On the Nature of the 
            Child” “Diseases IV”.  New York. 

Summary – This book allowed me to study the thought processes of Hippocratic writers and how they felt about women and children. It allowed me to explore ancient sexism and a few details about abortion.

3) Kapparis, Konstantinos (2002) Abortion in the Ancient World London: Duckworth Publishers

Summary – This book was a great supplement to Professor Riddle’s book. In it Kapparis clearly describes the different abortion practices that took place in the ancient world; surgical, herbal, oral and mechanical means are all explained. What I found truly remarkable was that it also explored in great detail the thought processes of women who performed abortions knowing the immense risk involved.

4) King, Helen (1998) Hippocrates' woman: reading the female body in ancient Greece London:
              Routledge

Summary – Since Hippocractes had and continues to have an enormous impact on philsophy and politics, I wanted to see what hippocractic writers thought about the nature of women. It supplemented the Hippocratic Treatises well, but mostly it was a discussion on how women differ from men both in physiology and thought.

5) Aristotle Politics  (1885)

Summary – Along the same lines of The Hippocratic Treatises, I wanted to know how Aristotle felt about abortion and the rights of the unborn.

6) Riddle, John. (1992) Eve's Herbs: A History of Contraception and Abortion in the West (Cambridge,
                MA:Harvard University Press, 1997)   

Summary – Was a great help in allowing me to compare the differences between the herbs that were used to perform abortion in ancient Egypt and Rome.

Medicine in Ancient Egypt

           Up until now my blog has focused mostly on ancient Greek and Roman practices in regards to abortion, but I wanted to see how other ancient societies, especially Egypt, dealt with this age old practice. The earliest surviving medical writings from Egypt are different papyri, the first being the Kahun Medical Papyrus and in it scholars found that the ancient Egyptians not only had clear knowledge of many of the diseases encountered today, but also dabbled with birth control. While abortion isn’t strictly mentioned, the use of contraceptives is. John Riddle’s book Contraception and abortion from the ancient world to the Renaissance does a great job outlining some very unique contraceptives.

                          Petrie Museum of Egyptian Archaeology - Kahun Medical Papyrus


          Recipe I (Kahun. No. 21 [3, 6]):
          Not to become pregnant, that …’
          Feces of crocodile, smash up with fermented dough [or paste];
          soak …

          Recipe 2 (Kahun 22 [3, 7]);
          6/7 Pint of honey; sprinkle in her vagina.
          This is done with [hr, shm] of soda/saltpeter.
          Another Recipe.
          […mashed up] with fermented dough/paste, sprinkle in her vagina …

                Also, what I found really interesting was that ancient Egyptians revered animals as they were associated with different Egyptian gods. For example, crocodiles are associated with Seth, the god of chaos “who is also associated with thunder, desert and infertility” and according to Riddle, “Ancient Egyptian uterine amulets often have Seth on them”, thus to the ancient Egyptians, it made sense to use crocodile feces if one was planning to have an abortion or simply as a contraceptive. While this is quite different than the practices that were employed in ancient Rome and Greece, there are still some similarities especially as these recipes can be seen as herbal abortifacients which the Greeks used extensively. It’s also interesting to see that there are not many sources outside of these papyri that deal with pregnancy in ancient Egypt. One of the suggested reasons for this is that physicians and scientists were men and they were not involved during the pregnancy.
             The second ancient Papyrus (Ebers) provided me with much more information regarding ancient practices and while some scholars argue about the correct translation of the Papyrus, there are some passages which discuss how to perform an abortion using common herbs. It was also interesting to see that the Ebers papyrus is supposedly only a transcript of a much older book. “Although the Ebers scroll was written between 1550 and 1500 B.C.E, internal evidence indicates that the scribe writing it had before him a copy of a much earlier version. The prescriptions date back to the Old Kingdom” (Riddle, p.35).

                                                                    Ebers Papyrus
       One of the translated recipes reads: “To cause a woman to stop pregnancy in the first, second, or third period [trimester]:
          Unripe fruit of acacia
          Colocynth
          Dates
          Triturate with 6/7th pint of honey; moistern a pessayt of plant fiber and place in the vagina

        The reason that this recipe is so illuminating is not only because of the listed ingredients which have shown to be amazingly effective abortifacients in clinical trials, but it also shows that the ancient Egyptians knew the different stages of pregnancy really well (Riddle, p.36). This provides even more evidence for Homer’s claim in the Odyssey “In Egypt, the men are more skilled in medicine than any of human kind”.

Modern Medicine and Lessons from Antiquity

A new era of computer aided drug discovery and medicinal simulation is upon us, replacing the paradigm of test and try again. For Millennium, man relied on nature to provide beneficial compounds such as natural herbs, opiates for anesthesia, or penicillin and related compounds as natural antibiotics. Bread with blue mold was a staple of medieval folk medicine for treating infected wounds, but the common underlying thread of good medicine seems to be relying on tried and true remedies, and new discoveries face trial by fire. The last fifty years or so, however, have been marked by explosive advances in medical technology and associated methodology. Most notably the computer has been at the heart of all advances. It has enabled data analysis in days what previously could not accomplished in lifetimes, entire medical histories can be assessed and compared, it has allowed analysis of physical data revealing the structure and function of cellular machinery at approaching an atomic resolution, and it has allowed for the construction of exceedingly complex models for interpreting the data we collect. They are shifting the paradigm of drug discovery. Generally speaking, what's traditionally been done is chemists take a chemical compound known to have a specific mechanism of action, they design thousands of variants on it, test them on rodents then non-rodent mammalian models, take the top competitors, and more thoroughly investigate the pharmacokinetic properties of the drug, its toxicity, absorption and excretion. The most promising compounds then move onto clinical trials in volunteers, their effects are traced for a couple decades, and statistical analysis is applied to determine whether the drug had a marked positive influence. Successes have generally been shots in the dark, and even so they almost always have serious side effects and everyone reacts differently to them anyways. Computers aid in the individualization of medical approaches. With medicine becoming more and more of an industry, its becoming easier to overlook individual concerns, an advanced enough computer program, in a sense however could potentially act as an individual doctor.
The doctors of Antiquity laid the foundation for a theoretical approach to medicine, conjecturing possibilities and using the minimal means they had for testing them. Modern advances however yield more information than were able to analyze, and people are often too caught up on finding a "magic bullet" cure, when increasingly its becoming evident the Greek holistic view is indeed the truth. Although these tools may provide means for analyzing problems, they are still far off from designing treatments for all individuals, and then even more so there isn't the industrial infrastructure anyways to produce it all. I think the greatest medical advance will be when individuals start utilizing all the information available to them and start living preventatively instead of letting others postulate solutions.

MMA- Modern Day Gladiators

Mixed martial arts (MMA) a popular sport within the United States. The Ultimate Fighting Championship (UFC) is the most popular organization of MMA in the US. The UFC was founded in 1993 but started to gain a heavy following in 2006. I would consider MMA the modern day gladiator event. From my research I have begun to piece together what an event would be like: a violent, bloody, and not always deadly match between two individuals. That is exactly what MMA is, minus the fact that the chance of death is much lower than a gladiator fighting in the arena. Two men enter the arena after a parade through the crowd, they look to excite the crowd through expressions of excitement, and they commence beating each other senseless to the appeal of the crowd. MMA just like the ancient Roman games is an event for the crowd, the participants bring violence which excites the crowd, the participant feeds of the excitement and increase his tenacity, which in turn excites the crowd even more. It is a never ending circle of excitement and violence between the contestant and the on lookers.

Ben J Bibliography

     

1) Anita Guerrini. Experimenting with Humans and Animals; From Galen to Animal Rights Johns Hopkins University Press, Baltimore (2003)

Summary             A broad overview of experimental and medical development from the 3^rd BCE until modern day, including understanding anatomy through vivisection and disease as microscopic molecular disorders and their application to surgery and vaccination is discussed.

3) Maud Gleason. Shock and Awe: the performance dimension of Galen's anatomy demonstrations (2007) Princeton/Stanford Working papers in classics
Summary            Galen's dissection demonstrations are described with a focus on the performance aspects used by Galen to enhance his reputation. Some more notorious stories including his dissection and resuscitation of an Ape are recalled, and the tools and techniques used are described.

2) Peter James and Nick Thorpe. Ancient Inventions (1994) Random House publishing group, NY.

Summary             I focused on descriptions of the tools and techniques employed for ancient techniques including couching of cataracts, reconstructive surgery, and denture construction and fixation.

      3) JR Kirkup. The history and evolution of surgical instruments II:Origins: function: carriage: manufacture Annals of the Royal College of Surgeons of England (1982) vol. 64

Summary             An overview of instrumental development from primitive substitutions of shell or bone for teeth, and shaping of metal rods into simple surgical tools, and developments leading to more complicated fabrications. 

4)  John Stewart Milne. Surgical Instruments in Greek and Roman Times. Claredon Press: Oxford, 1907. 

Summary             Complementing resource for comparing an early 20^th CE dissertation on ancient surgical instruments to the late 20^th CE reference above.

5) John Michalczyk. In the Shadow of the Reich: Nazi Medicine (1997)

Summary             This documentary describes the rise of the Nazi regime. The steps leading up to the implementation of their "final solution" are presented, starting with mandatory sterilization for the mentally retarded modeled after preceding American legislation,  the concept of "social hygiene" and purification, the role of doctors in ghettos, and the inhumane "science" of death camps.

6) J Horner, FD Minifie. Research Ethics I: Responsible Conduct of Research (RCR)—Historical and Contemporary Issues Pertaining to Human and Animal Experimentation Journal of Speech, Language, and Hearing Research; Vol. 54, S303–S329 (2011)

Summary              The chronological  order of major legislation and developments in research ethics, largely in the last two centuries, are cataloged in this article supplement.

7) Steven Johnson. The Ghost Map. Riverhead Books: NY (2006)

Summary           The 1850's cholera outbreak in London is described and the mentality of major figures and ideas of its cause are outlined. Most notably, John Snow's medical methodology involving large scale cataloging of lifestyles surrounding affected versus unaffected individuals, tracing the outbreak back to a sewage contaminated pump, and discovery of microscopic infectious agents is presented. 

8) S Mukhopadhyay, GC Layek. Analysis of blood flow through a modelled artery with an aneurysm Applied Mathematics and Computation Volume 217, Issue 16, 15 (2011) 6792-6801  

Abstract                The intention of the present work is to carry out a systematic analysis of flow features in a tube, modelled as artery, having a local aneurysm in presence of haematocrit…. the numerical illustrations presented in this paper provide an effective measure to estimate the combined influence of haematocrit and aneurysm on flow characteristics.      

      9) John Cullis, John Hudson and Philip Jones A Different Rationale for Redistribution: Pursuit of  Happiness in the European Union Journal of Happiness Studies Volume 12, 2, (2011) 323-341

Abstract                This paper considers the role of redistribution in the light of recent research findings on self reported happiness. The analysis and empirical work reported here tries to relate this to a representative actor ‘homo realitus’ and the ‘pursuit of happiness’ rather than the traditional ‘homo economicus’. Econometrically estimating the determinants of happiness in the European Union (EU) using Eurobarometer data and the construction of an ‘Index of Happiness’ facilitates policy simulations. Such simulations find that in terms of average happiness there is little advantage to redistributing income within a country, but more from redistributing income between countries. The importance for happiness of relative income, average standard of living, marital status and age are confirmed. The theoretical rationale for redistribution is also examined.

10) Y Ohno, et al.   High-Performance Drug Discovery: Computational Screening by Combining Docking and Molecular Dynamics Simulations (2001) Public Library of Science http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2746282

 Abstract           Virtual compound screening using molecular docking is widely used in the discovery of new lead compounds for drug design. However, this method is not completely reliable and therefore unsatisfactory. In this study, we used massive molecular dynamics simulations of protein-ligand conformations obtained by molecular docking in order to improve the enrichment performance of molecular docking. Our screening approach employed the molecular mechanics/Poisson-Boltzmann and surface area method to estimate the binding free energies....This result indicates that the application of molecular dynamics simulations to virtual screening for lead discovery is both effective and practical. However, further optimization of the computational protocols is required for screening various target proteins.

11) KL Steinmetz, EG Spack. The basics of preclinical drug development for neurodegenerative disease indications (2007) http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2697630   
Abstract             Preclinical development encompasses the activities that link drug discovery in the laboratory to initiation of human clinical trials. Preclinical studies can be designed to identify a lead candidate from several hits; develop the best procedure for new drug scale-up; select the best formulation; determine the route, frequency, and duration of exposure; and ultimately support the intended clinical trial design. The details of each preclinical development package can vary, but all have some common features. Rodent and nonrodent mammalian models are used to delineate the pharmacokinetic profile and general safety, as well as to identify toxicity patterns. One or more species may be used to determine the drug's mean residence time in the body, which depends on inherent absorption, distribution, metabolism, and excretion properties...

12)  Kuntz. Structure-based strategies for drug design and discovery (1992) Science 257 pg 1078-82   

13) Rebecca White. Drugs and nutrition: how side effects can influence nutritional intake (2010) Proceedings of the Nutrition Society, 69, 558-564
  Abstract             There are many factors that can influence nutritional intake. Food availability, physical capability, appetite, presence of gastrointestinal symptoms and perception of food are examples. Drug therapy can negatively influence nutritional intake through their effect on these factors, predominantly due to side effects. This review aims to give a brief overview of each of these factors and how drug therapy can affect them.  




 Selected Excerpts from Primary Sources

Galen On The Natural Faculties 1.15

Here let us forget the absurdities of Asclepiades, and, in company with those who are persuaded that the urine does pass through the kidneys, let us consider what is the character of this function. For, most assuredly, either the urine is conveyed by its own motion to the kidneys, considering this the better course (as do we when we go off to market!¹), or, if this be impossible, then some other reason for its conveyance must be found. What, then, is this? If we are not going to grant the kidneys a faculty for attracting this particular quality,² as Hippocrates held, we shall discover no other reason. For, surely everyone sees that either the kidneys must attract the urine, or the veins must propel it.

 Celsus De Medicina Book 1, Prooemium

Homer stated, however, not that they gave any aid in the pestilence or in the various sorts of diseases, but only that they relieved wounds by the knife and by medicaments. Hence it appears that by them those parts only of the Art were attempted, and that they were the oldest.[p. 5] From the same authority, indeed, it can be learned that diseases were then ascribed to the anger of the immortal gods, and from them help used to be sought; and it is probable that with no aids against bad health, none the less health was generally good because of good habits, which neither indolence nor luxury had vitiated: since it is these two which have afflicted the bodies of men, first in Greece, and later amongst us; and hence this complex Art of Medicine, not needed in former times

At first the science of healing was held to be part of philosophy, so that treatment of disease and contemplation of the nature of things began through the same authorities; clearly because healing was needed especially by those whose bodily strength had been weakened by restless thinking and night-watching. Hence we find that many who professed philosophy became expert in medicine, the most celebrated being Pythagoras, Empedocles and Democritus. But it was, as some believe, a pupil of the last, Hippocrates of Cos, a man first and foremost worthy to be remembered, notable both for professional skill and for eloquence, who separated this branch of learning from the study of philosophy. After him[p. 7] Diocles of Carystus, next Praxagoras and Chrysippus, then Herophilus and Erasistratus, so practised this art that they made advances even towards various methods of treatment.

he Art of Medicine was divided into three parts: one being that which cures through diet, another through medicaments, and the third by hand. The Greeks termed the first Διαιτητικήν, the second Φαρμακευτικήν, the third Χειρουργίαν.

Apollonius and Glaucias, and somewhat later Heraclides of Tarentum, and other men of no small note, who in accordance with what they professed called themselves Empirici (or Experimentalists)

For they believe it impossible for one who is ignorant of the origin of diseases to learn how to treat them suitably. They say that it does not admit of doubt that there is need for differences in treatment, if, as certain of the professors of philosophy have stated, some excess, or some deficiency, among the four elements, creates adverse health; or, if all the fault is in the humours, as was the view of Herophilus; or in the breath, according to Hippocrates; or if blood is transfused into those blood-vessels which are fitted for pneuma, and excites inflammation[p. 11] which the Greeks term φλεγμόνην, and that inflammation effects such a disturbance as there is in fever, which was taught by Erasistratus; or if little bodies by being brought to a standstill in passing through invisible pores block the passage, as Asclepiades contended — his will be the right way of treatment, who has not failed to see the primary origin of the cause

Some following Erasistratus hold that in the belly the food is ground up; others, following Plistonicus, a pupil of Praxagoras, that it putrefies; others believe with Hippocrates, that food is cooked up by heat. In addition there are the followers of Asclepiades, who propound that all such notions are vain and superfluous, that there is no concoction at all, but that material is transmitted through the body, crude as swallowed

the Art of Medicine was not a discovery following upon reasoning, but after the discovery of the remedy, the reason for it was sought out

More rarely, yet now and again, a disease itself is new. That this does not happen is manifestly untrue, for in our time a lady, from whose genitals flesh had prolapsed and become gangrenous, died in the course of a few hours, whilst practitioners of the highest standing found out neither the class of malady nor a remedy. I conclude that they attempted nothing because no one was willing to risk a conjecture of his own in the case of a distinguished personage, for fear that he might seem to have killed, if he did not save her;[p. 29] yet it is probable that something might possibly have been thought of, had no such timidity prevailed, and perchance this might have been successful had one but tried it.

Themison, contend that there is no cause whatever, the knowledge of which has any bearing on treatment: they hold that it is sufficient to observe certain general characteristics of diseases; that of these there are three classes, one a constriction, another a flux, the third a mixture. For the sick at one time excrete too little, at another time too much; again, from one part too little, from another too much

But if Erasistratus had been sufficiently versed in the study of the nature of things, as those practitioners rashly claim themselves to be, he would have known also that nothing is due to one cause alone, but that which is taken to be the cause is that which seems to have had the most influence

Erasistratus himself, who says that fever is produced by blood transfused into the arteries, and that this happens in an over-replete body, failed to discover why, of two equally replete persons, one should lapse into disease, and the other remain free from anything dangerous

Hippocrates, said that in healing it was necessary to take note both of common and of particular characteristics.

Cassius, the most ingenious practitioner of our generation, recently dead, in a case suffering from fever and great thirst, when he learnt that the man had begun to feel oppressed after intoxication,[p. 39] administered cold water, by which draught, when by the admixture he had broken the force of the wine, he forthwith dispersed the fever by means of a sleep and a sweat.

Hippocrates Nutriment, introduction

A later Heraclitean, whether a professional doctor or not is uncertain, applied the theory of perpetual change to the assimilation of food by a living organism, and Nutriment is the result.

Apparently nutritive food is supposed to be dissolved in moisture, and thus to be carried to every part of the body, assimilating itself to bone, flesh, and so

Air (breath) also is regarded as food, passing through the arteries from the heart, while the blood passes through the veins from the liver. But the function of blood is not understood ; blood is, like milk, "what is left over" (πλεονας1μός2) when nourishment has taken place. Neither is the function of the heart understood, and its relation to the lungs is never mentioned.

Hippocrates De morbo sacro

The brain of man, as in all other animals, is double, and a thin membrane (meninx)divides it through the middle, and therefore the pain is not always in the same part of the head; for sometimes it is situated on either side, and sometimes the whole is affected; and veins run toward it from all parts of the body, many of which are small, but two are thick, the one from the liver, and the other from the spleen. And it is thus with regard to the one from the liver: a portion of it runs downward through the parts on the side, near the kidneys and the psoas muscles, to the inner part of the thigh, and extends to the foot. It is called vena cava. The other runs upward by the right veins and the lungs, and divides into branches for the heart and the right arm. The remaining part of it rises upward across the clavicle to the right side of the neck, and is superficial so as to be seen; near the ear it is concealed, and there it divides; its thickest, largest, and most hollow part ends in the brain; another small vein goes to the right ear, another to the right eye, and another to the nostril. Such are the distributions of the hepatic vein. And a vein from the spleen is distributed on the left side, upward and downward, like that from the liver, but more slender and feeble.

De morbis popularibus, on the epidemics Phthisis: dwindling or wasting away, tuberculosis

IN THASUS, about the autumn equinox, and under the Pleiades, the rains were abundant, constant, and soft, with southerly winds; the winter southerly, the northerly winds faint, droughts; on the whole, the winter having the character of spring. The spring was southerly, cool, rains small in quantity. Summer, for the most part, cloudy, no rain, the Etesian winds, rare and small, blew in an irregular manner. The whole constitution of the season being thus inclined to the southerly, and with droughts early in the spring, from the preceding opposite and northerly state, ardent fevers occurred in a few instances, and these very mild, being rarely attended with hemorrhage, and never proving fatal. Swellings appeared about the ears, in many on either side, and in the greatest number on both sides, being unaccompanied by fever so as not to confine the patient to bed; in all cases they disappeared without giving trouble, neither did any of them come to suppuration, as is common in swellings from other causes. They were of a lax, large, diffused character, without inflammation or pain, and they went away without any critical sign. They seized children, adults, and mostly those who were engaged in the exercises of the palestra and gymnasium, but seldom attacked women. Many had dry coughs without expectoration, and accompanied with hoarseness of voice. In some instances earlier, and in others later, inflammations with pain seized sometimes one of [p. 101]the testicles, and sometimes both; some of these cases were accompanied with fever and some not; the greater part of these were attended with much suffering. In other respects they were free of disease, so as not to require medical assistance.

Early in the beginning of spring, and through the summer, and towards winter, many of those who had been long gradually declining, took to bed with symptoms of phthisis; in many cases formerly of a doubtful character the disease then became confirmed; in these the constitution inclined to the phthisical. Many, and, in fact, the most of them, died; and of those confined to bed, I do not know if a single individual survived for any considerable time….The urine was thin, colorless, unconcocted, or thick, with a deficient sediment, not settling favorably, but casting down a crude and unseasonable sediment.

n the course of the summer and autumn many fevers of the [p. 102]continual type, but not violent; they attacked persons who had been long indisposed, but who were otherwise not in an uncomfortable state.