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The Humoral Theory Mesopotamia (G= Between the rivers) Concepts and Treatments of Disease were Religious. • Code of Hammurabi - Indicate Government-controlled Fees and Malpractice Legislation • Divination - Dream Interpretations - Astrology - Sheep Livers • Assyrian Herbal - 250 Vegetable Substances and 120 Minerals are listed as Prescriptions in Cuneiform (L= wedge-shaped) Ancient Egypt The Smith Papyrus (~ 2600 and 2200 BC) Most Egyptian Papyri are named after the Person who discovered them.

• Probably a War Surgery Manual All the Patients are Male, and all the Wounds seem to be caused by Weapons

• First Mention of the Process of Inflammation The Ebers Papyrus (Contemporary with the Smith Papyrus) • Complete Medical Text - The first recorded Homeostatic Method (G= stop blood): Burning • Two Categories of Disease - Treatable; Referred to Physicians - Not Treatable; Referred to Priests • Triage (L= to sort) - Developed for use under Battlefield Conditions • Treatable; Require immediate Attention • Treatable; Do not require immediate Attention • Not Treatable

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Ancient India Atharva Veda (~1000 BC) • Contains Charms and Spells to ward-off Disease Ayur Veda (~600 BC) • An Upveda (“Ancillary Veda”) of the Atharva Veda • A Compendium of Hindu Medicine - The Body was thought to be composed of Seven Elements These are Chyle, Blood, Flesh, Fat, Bone, Marrow and Semen. Every 5 Days each was transformed into the Following (i.e. Fat became Bone).

- Devotes considerable Detail to Hygiene These Details include Tooth-Brushing twice a Day, Regular Washing, Regular Physical Exercise, Proper Diet and Rest.

Susruta (~400 BC?) • Hindu Surgeon • Wrote Susruta-Samhita (“The Collection of Susruta) -Primarily devoted to Surgery But also deals in Medicine, Pathology, Ophthalmology, Anatomy, Midwifery, Hygiene and no small Amount of Psychology and Bedside Manner.

- Explained Disease as an Imbalance of Three Humors • Gall (Pita) • Mucus (Kapha) • Wind (Vata) There were 5 Types of Wind: Wind seated in the Throat; Responsible for Speech (Udana) Wind seated in the Heart; Responsible for Breathing (Prana) Wind seated in the Stomach; “Cooks” (Digests) Food (Samana) Wind seated in the Bowels; Expels Urine and Feces (Apana) Wind dispersed throughout the Body; Maintains Blood and Sweat (Vyana)

- Symptoms of Disease were due to the Loss, Absence or Imbalance of these Humors • Treatment involved Prayers, Incantations and Drug Therapy - Susruta mentions 760 Plant Drugs

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Ancient Greece Temples of Asclepius (Asclepia [singlular Asclepium]) • Asclepius was probably an early tribal Medicine Man Eventually Asclepius came to be considered the Son of Apollo. From ~500 BC to ~500 AD Asclepius was the most important Greco-Roman God of Healing

• Asclepia were like highly-respected Health Resorts - Asclepia Priests seem to have taken on Patients that Greek Physicians could not treat There was no Rivalry between Temple Priests and Physicians

- Incubation • Patients would sleep in the Asclepium • Asclepius would appear to the Patient in a Dream Asclepius was easily identifiable by his Caduceus, a wooden Staff with a single entwined Serpent. The Modern Representation of a Caduceus is a Staff with two intertwined Serpents. Technically speaking, this is Mercury’s Caduceus (or Hermes’, to stick with the Greek Pantheon).

Hippocratic Corpus (L= body [of works] of Hippocrates) • Collection of Diagnostic Techniques and recommended Treatments - These probably weren’t all written by Hippocrates (460-377 BC [?]) There’s no End of Confusion as to whether the Hippocratic Corpus was written by Hippocrates or edited by Hippocrates. For that matter, there’s some Confusion as to whether Hippocrates was an Individual Physician or a Collection of Physicians. Regardless, Hippocrates is considered the Father of Western Medicine.

- Naturalistic Approach • Emphasis on Observation and Diagnosis • Diet was considered the first Treatment - Followed by Drugs • Followed by (very limited) Surgery • The Hippocratic Corpus contains some interesting Sayings about Medicine: - Physicians are many in title, but very few in reality - You must not only do the proper thing, but do it at the right time

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Galen (129-210 AD) • Born 129 AD in Pergamum (Bergama, Turkey) Pergamum was an important Ancient City with the largest and most architecturally impressive Asclepium in the Greco-Roman World. At the Age of 19 Galen became a Therapeutes (Attendant) at this Temple. Galen claims that Asclepius appeared to him in a Dream and told him to become a Physician. At least, that’s what he told his very wealthy and influential Father, who had wanted him to become a Politician.

• Attended Medical School in Alexandria Quite simply, there was no better Medical School in the Ancient World.

• Returned to Pergamon as Physician for local Gladiators (157-161 AD) - Galen was considered an excellent Surgeon Being Physician to the Gladiators was considered an extremely boffo Position. It represented an absolutely unique Opportunity to study Human Anatomy. Human Dissections were Illegal and were considered Sacrilegious.

• Moved to and set up Practice in Rome in 169 - Cured the Emperor Marcus Aurelius and became Imperial Physician He did this by stopping the Treatment; Marcus Aurelius had Indigestion.

• Galen performed lots of Animal Dissections - He used Monkeys for External Anatomy - And Pigs for Internal Anatomy Galen never dissected a Human Cadaver, and stated this openly.

• Became a prolific Writer - The Galen Canon (L= Standard) • Sixteen Volumes on Medicine - On the Usefulness of the Parts of the Body was The Anatomy Text until the Renaissance He explained Breathing, Digestion, and gave the first Explanation of the Function of numerous Vessels. Galen viewed the Human Body as a Microcosm of Roman Technology. The Liver was like a Brewery, the Heart was like a Smelter, and Vessels were like the Heating and Plumbing Systems in a Roman Bath

Galen was a strong Advocate of the contemporary Humoral Theory of Disease • Galen bestowed upon the Humoral Theory an Aura of Authority that lasted for nearly 1000 Years

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The Humoral Theory (G= fluid) Melancholy

Choleric

Black Bile

Yellow Bile

Earth

Fire Dry Cold

Hot Wet

Water

Air

Phlegm

Blood

Phlegmatic

Sanguine

• The Four Humors: Blood, Phlegm, Black Bile, Yellow Bile These 4 Fluids related with the 4 Qualities (Cold, Hot, Dry, Wet), the 4 Elements (Earth, Air, Fire, Water) and the 4 Temperaments (Sanguine, Phlegmatic, Melancholy, Choleric). The Greeks loved Symmetry and they loved the Number 4.

• Probably based on Experience with Containers of Blood that had been allowed to settle into Layers (From Top to Bottom): HUMORL THEORY

MODERN TERM

Yellow Bile Phlegm Blood Black Bile

Plasma Buffy Coat of WBC Oxygenated RBCs Deoxygenated RBCs

The Greeks excelled at Observation and the Humoral Theory was based on the Observation that an ill Patient really does produce an “Imbalance of Humors” when bled. We now know that Fever produces the still poorly understood Acute Phase Proteins, which make RBCs “sticky” and sediment faster. This would result in a quantifiable Increase in Black Bile when the Patient was bled.

• Illness was thought to be caused by an Imbalance of Humors. For example, too much Black Bile (the “Sickly Humor”) would make you Melancholy (G= black bile).

• The Humoral Theory represents a major Advance for Medicine - It contains nothing Supernatural Disease is presented as a Natural Phenomenon within the Context of the Known Elements, implying that Disease is likewise a Natural Phenomenon and so is probably Treatable by Manipulation of these Known Elements

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The Classical Islamic World The Middle Ages really were the “Dark Ages” for Medicine in Europe. The Rational Treatments of the Greeks and Romans were forgotten and replaced with Magic, Astrology and Palmistry. Islam arose in the 7th Century in what is now Saudi Arabia and within 300 Years had spread from as far West as the South of France to as far East as Malaysia. Arabic rapidly become the Language of Learning within this aggressively Intellectual Islamic World. Medical Knowledge was maintained -- and grew considerably -- under Islam. A Translation Bureau was established in Baghdad in the Ninth Century. Hippocrates and Galen were Translated by the End of the Century. Arab Physicians accepted The Humoral Theory. With their Goal of preserving Good Health, Classical Islamic Physicians were somewhat analogous to Today’s Public Health Officials. The two Great Physicians produced by the Classical Islamic World were Rhazes (Abu Bakr Muhammad ibn Zakuriyya) [841-926] and Avicenna (Abu ‘Ali al-Husayn ibn ‘Abd Allah ibn Sina) [980-1037] Both were Prolific Writers. Rhazes wrote Al-Kitab al-Hawi (The Comprehensive Work), a 25 Volume Encyclopedia that emphasizes the Importance of Patient History, Physician-Patient Trust, and a Positive Attitude in the Patient’s Presence. Rhazes instituted Consultations among Physicians. Avecinna wrote Al-Qanun fi al-Tibb (The Canon of Medicine). The Canon was a Codification of Contemporary Medical Knowledge -- which included a rich Mix of Greek, Roman, Arabic, and Vedic Medicine -- that was used until well into the 19th Century. It served as a Medical Bible for a longer Time than any other Medical Work Avicenna also proposed that Disease might be spread by “Traces” in the Air, Water, and Soil. Dante places Avicenna next to Hippocrates and Galen in The Inferno,

The European Renaissance (L= rebirth) Arab Medical Texts were translated into Latin at the End of the 12th Century in Solerno and Toledo (both in Spain). Both Cities were Islam-Christian-Jewish Intellectual CuisineArts. The Renaissance may have been born in Italy, but its Conception was in Spain. Solerno became Europe’s First Great Medical Facility. Medical Schools were soon established on the Italian Peninsula. The Medical School at Bologna was briefly Italy’s Top Facility. Students established Salaries, Schedules, and Curricula. Galen was rediscovered and -- just as important -- Galen was questioned. The Church took over the Medical School at Bologna at the Start of the 16th Century and brought this Early Experiment in Intellectual Democracy to a screeching Halt. The Medical School at Padua rapidly became Europe’s preeminent Medical School Renaissance Italy was flush with what we would now term Disposable Income. The Medical School at Padua was fortuitously aligned with the powerful, independent (and stinking rich) Venetian Republic. William Harvey attended Padua. Galileo taught there.

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Microscopy Antony Van Leeuwenhoek (1632-1723) was a prosperous Draper [Figure 1.13] • Leeuwenhoek did not invent the Microscope - But he made the first High Resolution Microscopes 1 - He ground his own Lenses The Dutch Astronomer Christian Huygens worked with Leewenhoek on Lens Grinding. Huygens made the first Telescope that was capable of resolving the Rings of Saturn.

2 - He made simple, single Lens Microscopes It’s fairly easy to grind one really good Lens.

3 - He masked the outer Portion of his Lenses This Process is called “stopping down” a Lens.

4 - He used Darkfield Illumination This is similar to the Jeweler’s Trick of illuminating the Gem from the Side while keeping the Background Dark (usually Dark Velvet).

Leeuwenhoek’s Observations weren’t terribly original at first, but he rapidly branched out and seems to have had a great deal of, well, Fun • Pond Water - He

was the first to see Protozoa.

• Cheek Epithelial Cells • Teeth Scrapings - He was the first to see Bacteria • Blood (his own) - He was the first to see Red Blood Cells • Semen (his Dog’s; then his own) - He was the first to see Sperm • Leeuwenhoek sent his Observations to The Royal Society in London where they were translated into English and received a wide Readership Leeuwenhoek, while not himself a Biologist, stimulated Work in Biology. Unfortunately, Leeuwenhoek’s Observations had no immediate Impact on Medicine. The World wasn’t quite ready to accept Microbial Life Forms.

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