Thursday, April 14, 2011

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

                                           

Thursday, April 7, 2011

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”.

Sunday, April 3, 2011

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.