ANCIENT ANCIENT METITTERANEAN METITTERANEAN MEDICINE MEDICINE

N. S. ANGELIDESN. S. ANGELIDES MD, PhD, FRCS, FACAMD, PhD, FRCS, FACA

Introduction.Introduction.

The earliest practice of medicine was The earliest practice of medicine was theocratic. The approach to the disease theocratic. The approach to the disease was magic and priests were also was magic and priests were also considered as doctors. considered as doctors.

Illness was believed to be the action of Illness was believed to be the action of evil spirits. evil spirits.

ANCIENT ANCIENT EGYPTIAN EGYPTIAN MEDICINE MEDICINE

The historian Herodotus wrote that Egypt “The historian Herodotus wrote that Egypt “is the is the gift of the Nile”,gift of the Nile”, meaning that its civilization meaning that its civilization expanded on the soil which was formed by the expanded on the soil which was formed by the recurrent floods of the Nile. recurrent floods of the Nile.

Step by step evolution. Step by step evolution.

Egypt became an organized Egypt became an organized nation about 3000 B.C.nation about 3000 B.C.

Medicine as a discipline Medicine as a discipline appeared later when Egypt had appeared later when Egypt had an ambitious Pharaoh named an ambitious Pharaoh named Zoser. His chief minister was Zoser. His chief minister was Imhotep. Imhotep.

In the Egyptian writings, In the Egyptian writings, Imhotep Imhotep was presented as a was presented as a physician and was considered physician and was considered as the god of medicine in as the god of medicine in Egypt. Egypt.

Imhotep was theImhotep was the god of medicine god of medicine in in EgyptEgypt

Medicine in Egypt was Medicine in Egypt was associated with religion and associated with religion and magic.magic.

All papyri dealt with medicine, All papyri dealt with medicine, gave the “aroma” of supernatural gave the “aroma” of supernatural formulae. formulae.

But, Medicine in ancient But, Medicine in ancient Egypt was not at all Egypt was not at all primitive.primitive. Some medical papyri were really Some medical papyri were really

explanatory. explanatory. Among them, the Among them, the “Edwin Smith “Edwin Smith

Papyrus”Papyrus” and the and the “Ebers papyrus” were “Ebers papyrus” were the most important.the most important.

In these ancient papyri In these ancient papyri many case histories were many case histories were found!found!

In addition, a great number of internal In addition, a great number of internal pathologies were reported, such as eye pathologies were reported, such as eye diseases, diabetes and rheumatism. diseases, diabetes and rheumatism.

Later on, physicians in Later on, physicians in Egypt were organized in Egypt were organized in hierarchy.hierarchy. They gradually formed a distinct They gradually formed a distinct

profession, with the court physicians at profession, with the court physicians at the top of the hierarchy. the top of the hierarchy.

ANCIENT GREEK ANCIENT GREEK MEDICINE.MEDICINE.

Acropolis is the landmark Acropolis is the landmark of of Ancient Greece Ancient Greece

The beginning of Greek The beginning of Greek Medicine.Medicine.

The history of The history of ancient Greek ancient Greek Medicine begins Medicine begins with “Iliad”, the with “Iliad”, the Homeric poem, Homeric poem, which is considered which is considered as the oldest written as the oldest written document in Greek.document in Greek.

HomerHomer

Diseases were thought to be Diseases were thought to be theocratic, sent by gods, to punish theocratic, sent by gods, to punish the mankind.the mankind.

In "Iliad" Apollo, the god of In "Iliad" Apollo, the god of light, was considered as the light, was considered as the disperser of epidemics, one disperser of epidemics, one of which was spread upon the of which was spread upon the Greek army before the Greek army before the departure to Troy. departure to Troy.

Apollo.Apollo.

Asclepius.Asclepius.

Asclepius, lived in the Asclepius, lived in the thirteenth century BC thirteenth century BC and was considered as and was considered as the Greek god of the Greek god of medicine.medicine.

His teacher was Chiron, His teacher was Chiron, the Centaur, who was the Centaur, who was taught medicine by taught medicine by Apollo and Artemis. Apollo and Artemis.

ÆsculapiusÆsculapius

The symbol of Asclepius.The symbol of Asclepius.

The symbol of The symbol of Asclepius was a Asclepius was a serpent around a serpent around a knotted staff. knotted staff.

Serpents produced Serpents produced poisons, and had a poisons, and had a reputation for reputation for wisdom as well as wisdom as well as the power of the power of renovation. renovation. A serpent entwined round A serpent entwined round

a knotted staff is the symbol a knotted staff is the symbol of Æsculapius of Æsculapius

HygiaHygia.. The Greek deity of The Greek deity of

Health was Hygia, Health was Hygia, known as Salus to the known as Salus to the Romans; she was Romans; she was considered as the considered as the daughter of Asclepius daughter of Asclepius and took care of the and took care of the sacred serpents.sacred serpents.

Goddess HygiaGoddess Hygia..

““Asclepeion”: The Temple of Asclepeion”: The Temple of AsAsclepiusclepius

Although the history of Asclepius was mixed with Although the history of Asclepius was mixed with mythology, solid facts were also present: mythology, solid facts were also present:

These facts were the splendid temples devoted to These facts were the splendid temples devoted to him, which were always built in lovely and him, which were always built in lovely and healthy places. healthy places.

These places were visited by sick people, and These places were visited by sick people, and this is why the priests of the temples also learned this is why the priests of the temples also learned the art of healing. the art of healing.

ΤΤhe “Asclepeion” at he “Asclepeion” at EpidaurusEpidaurus

The chief The chief “Asclepeion” was at “Asclepeion” was at Epidaurus.Epidaurus.

Close to “Asclepeion” Close to “Asclepeion” there was a there was a magnificent theatre, magnificent theatre, as well as a stadium as well as a stadium built to accommodate built to accommodate 20,000 spectators!20,000 spectators!The restored entrance of an The restored entrance of an

ancient “Asclepeion”ancient “Asclepeion”

ΤΤhe “Asclepeion” of Coshe “Asclepeion” of Cos

However, the most However, the most important important “Asclepeion” was “Asclepeion” was the one in the island the one in the island of Cos, the birth of Cos, the birth place of place of Hippocrates, who is Hippocrates, who is considered as the considered as the father of Medicine.father of Medicine.

The “Asclepeion” at Cos as it The “Asclepeion” at Cos as it is to-dayis to-day

Hippocrates, the father of Hippocrates, the father of Medicine.Medicine.

Hippocrates (460 BC-377 Hippocrates (460 BC-377 BC), according to Mythology, BC), according to Mythology, was a descendant of Zeus was a descendant of Zeus and Hercules from his and Hercules from his mother, and a descendant of mother, and a descendant of Asclepius from his father . Asclepius from his father .

HippocratesHippocrates

Demystification of the spiritual Demystification of the spiritual medicine: The great step!medicine: The great step!

Hippocrates rescued medicine Hippocrates rescued medicine from speculation!from speculation!

He did what no physician had He did what no physician had ever done before: He ever done before: He examined the sick carefully, he examined the sick carefully, he recorded the signs and recorded the signs and symptoms of the disease and symptoms of the disease and gave emphasis on the gave emphasis on the evidence than on spiritual evidence than on spiritual causes.causes.

He did not ask "Who is causing He did not ask "Who is causing a particular sickness?" but a particular sickness?" but "how and on what process "how and on what process does this particular sickness does this particular sickness occur?" occur?"

A Greek stamp with the A Greek stamp with the head of Hippocrates.head of Hippocrates.

Diagnosis and PrognosisDiagnosis and Prognosis

Hippocrates always based Hippocrates always based his conclusions on the his conclusions on the observations. observations.

He believed that "He believed that "the best the best physician is the one who is physician is the one who is able to establish a prognosis able to establish a prognosis at the bedside, penetrating at the bedside, penetrating the present, the past, and the the present, the past, and the future of his patient”.future of his patient”.

The lunar crater The lunar crater of “Hippocrates”.of “Hippocrates”.

Hippocrates in Hippocrates in advanced age.advanced age.

Observations made by Hippocrates.Observations made by Hippocrates.

Hippocrates classified Hippocrates classified diseases into diseases into sporadic, sporadic, epidemic, and endemicepidemic, and endemic, and , and had also separated them had also separated them into acute and chronic. into acute and chronic.

He also divided the causes He also divided the causes of diseases into two classes: of diseases into two classes: generalgeneral,, such as climate, such as climate, water and sanitation and water and sanitation and personal,personal, such as improper such as improper food and absence of food and absence of exercise.exercise.

The famous tree of The famous tree of Hippocrates in Cos as it is Hippocrates in Cos as it is demonstrated on a Greek demonstrated on a Greek stamp.stamp.

Homeric poems as a source Homeric poems as a source of information.of information.

As mentioned already, Greek As mentioned already, Greek heroes in “Iliad” were heroes in “Iliad” were wounded regularly at the wounded regularly at the battlefields and were in need battlefields and were in need of medical treatment. This was of medical treatment. This was obtained either by the help of obtained either by the help of the gods or by doctors. the gods or by doctors.

However, many times, the However, many times, the wounded heroes managed to wounded heroes managed to solve the problem by solve the problem by themselves!themselves!

Aris, god of war.Aris, god of war.

Achilles and wounded Achilles and wounded Patroklos.Patroklos.

The picture on the The picture on the left shows Achilles left shows Achilles bandaging the bandaging the wounded arm of his wounded arm of his close friend close friend Patroklos with a Patroklos with a white bandage. white bandage. (From the British (From the British Archaeological Archaeological Museum).Museum).

War injury over War injury over Patroklos in Patroklos in Troy.Troy.

Ancient Ancient AlexandriaAlexandrian Medicinen Medicine

The post Alexander The post Alexander the Grate era.the Grate era.

When the Empire of Alexander the When the Empire of Alexander the Great was subdivided, the Great was subdivided, the Egyptian share fell to Ptolemy the Egyptian share fell to Ptolemy the 1st, who founded the Alexandrian 1st, who founded the Alexandrian Library under the direction of Library under the direction of Aristotle. Aristotle.

The School of AlexandriaThe School of Alexandria

Ptolemy gathered a number of Ptolemy gathered a number of educated men in Alexandria, educated men in Alexandria, organizing a system that resembled a organizing a system that resembled a University. University.

For exampleFor example, Euclides , Euclides was the was the teacher of Mathematics, and teacher of Mathematics, and HipparchusHipparchus the father of Astronomy. the father of Astronomy.

Anatomy in Medicine was Anatomy in Medicine was inaugurated in Alexandria.inaugurated in Alexandria.

The early Alexandrian doctors The early Alexandrian doctors described the organization of the described the organization of the human body from actual dissections, human body from actual dissections, on the basis of the discoveries of on the basis of the discoveries of AristotleAristotle in natural history and in in natural history and in comparative anatomy.comparative anatomy.

Herophilus and Herophilus and Erasistratus Erasistratus

Two famous Alexandrian Two famous Alexandrian physicians and anatomists were, physicians and anatomists were,

HerophilusHerophilus (335-280 B.C.), and (335-280 B.C.), and ErasistratusErasistratus (280 B.C.). (280 B.C.). Both took part in the early medical Both took part in the early medical

teaching at the Alexandria School. teaching at the Alexandria School.

Anatomical discoveries Anatomical discoveries in in Alexandria Alexandria

HerophilusHerophilus made a lot of made a lot of anatomical discoveries; anatomical discoveries;

He also described the connections He also described the connections between the nerves and the brain, between the nerves and the brain, recognizing the essential recognizing the essential difference between motor and difference between motor and sensory nerves. sensory nerves.

Operations carried out Operations carried out in in Alexandria Alexandria

Herophilus was also Herophilus was also a good surgeon; he a good surgeon; he operated upon the operated upon the liver and spleen and liver and spleen and had a good had a good knowledge of knowledge of obstetric obstetric operations. operations.

The decline of the The decline of the medical medical School of Alexandria School of Alexandria A description of the teaching in A description of the teaching in

the School of Alexandria was the School of Alexandria was given by Celsus. given by Celsus.

However, the foundation of However, the foundation of Empiricism marked the decline of Empiricism marked the decline of the Medical School of Alexandria the Medical School of Alexandria and the destruction of an era and the destruction of an era occurred. occurred.

Ancient Cypriot Ancient Cypriot Medicine.Medicine.

The beginning of Cypriot The beginning of Cypriot Medicine.Medicine.

The history of ancient The history of ancient Cypriot Medicine started at Cypriot Medicine started at the time of Hippocrates.the time of Hippocrates.

Sources of information Sources of information were the various were the various archaeological findings, archaeological findings, the writings of ancient the writings of ancient Greek philosophers, as Greek philosophers, as well as ancient well as ancient inscriptions.inscriptions.HippocratesHippocrates

Onasilos the “healer”Onasilos the “healer”.. From the “inscription of From the “inscription of

Idalium” which is the Idalium” which is the oldest and longest ancient oldest and longest ancient written document found in written document found in Cyprus, we learned that Cyprus, we learned that StasikiprosStasikipros, the king of the , the king of the town, signed an agreement town, signed an agreement with a doctor named with a doctor named OnasilosOnasilos to treat, free of to treat, free of charge, all soldiers that charge, all soldiers that were wounded in the were wounded in the battles during the siege of battles during the siege of Idalium by the Persian Idalium by the Persian army. (5army. (5thth century BC.) century BC.)

The “inscription of The “inscription of Idalium”.Idalium”.

Onasilos, the first military Onasilos, the first military doctor in Cyprus.doctor in Cyprus.

The war ended with The war ended with an unexpected an unexpected victory of the Cypriot victory of the Cypriot army and the king army and the king honoured Onasilos honoured Onasilos and his brothers and his brothers offering them as a offering them as a price fields and price fields and political posts. political posts. Head of goddess Head of goddess

Aphrodite found in ancient Aphrodite found in ancient Salamina, Cyprus Salamina, Cyprus

Apollonius kitiefs.Apollonius kitiefs. Another famous Cypriot doctor wasAnother famous Cypriot doctor was Apollonius, Apollonius,

who who lived in the 1lived in the 1stst century B.C. His teacher was century B.C. His teacher was ZoopirosZoopiros from Alexandria. from Alexandria.

He was well known for his antidotes to various He was well known for his antidotes to various poisons. That is why poisons. That is why MithridatesMithridates, King of Pontus, , King of Pontus, had asked him to prepare for his sake a general had asked him to prepare for his sake a general antidote, in order to avoid poisoning. This antidote, in order to avoid poisoning. This preparation was taken in small doses for a preparation was taken in small doses for a prolonged period and since then this way of prolonged period and since then this way of treatment was called treatment was called “mithridadism“mithridadism”. ”.

These are the famous These are the famous “warmers” made from “warmers” made from terracotta. terracotta.

They could be applied on They could be applied on almost any surface of the almost any surface of the body filled with fluid and were body filled with fluid and were very popular as a mean of very popular as a mean of treatment of various treatment of various diseases. diseases.

Ancient Roman Ancient Roman MedicineMedicine

This is the This is the centre of centre of ancient Rome ancient Rome today today

Rome’s main source of Rome’s main source of knowledge was Greeceknowledge was Greece

Roman philosophy and Roman medicine Roman philosophy and Roman medicine were borrowed from the Greeks, who were borrowed from the Greeks, who were well known for their philosophy, were well known for their philosophy, their arts and their culture.their arts and their culture.

On the contrary, the Romans were On the contrary, the Romans were distinguished for their genius laws and distinguished for their genius laws and their governmental status. their governmental status.

AristotleAristotle

In the earlier times and before In the earlier times and before the settlement of Greek the settlement of Greek doctors in Romedoctors in Rome medical care medical care was under the jurisdiction of was under the jurisdiction of the head of the family.the head of the family. The father had great powers by the The father had great powers by the

Roman law, and he acted as physician as Roman law, and he acted as physician as well as judge over his family! well as judge over his family!

ArchagathusArchagathus

The first regular doctor in Rome was The first regular doctor in Rome was Archagathus,Archagathus, a Greek doctor who a Greek doctor who began practicing in the city by 219 began practicing in the city by 219 B.C. B.C.

He was very popular, the Roman He was very popular, the Roman authorities received him favorably and authorities received him favorably and arranged a surgery for him arranged a surgery for him

surgical instrumentssurgical instruments

The structure of the Roman The structure of the Roman society made medical practice society made medical practice in ancient Rome difficultin ancient Rome difficult

The lower classes were poor and the The lower classes were poor and the relatively small upper classes were relatively small upper classes were tyrannical, superstitious, selfish and tyrannical, superstitious, selfish and cruel. cruel.

EsculapiusEsculapius

Later on, the number of Later on, the number of doctors was increased, doctors was increased, eespecially during the reign specially during the reign of Neroof Nero.. Andromachus,Andromachus, as the 1 as the 1stst physician to physician to

the Emperor, had the title of the Emperor, had the title of archiaterarchiater In general, there were two classes of In general, there were two classes of

archiaters: archiaters: archiatri sancti palati, andarchiatri sancti palati, and archiatri popularesarchiatri populares. . The former attended the Emperor; the The former attended the Emperor; the

latter attended the people. latter attended the people.

The most eminent The most eminent doctor of Rome was doctor of Rome was Claudius Galen, Greek Claudius Galen, Greek in origin.in origin.

He went to Rome for the first time in 163 AD.He went to Rome for the first time in 163 AD. Galen had probably influenced the progress Galen had probably influenced the progress

of medical science by his writings more than of medical science by his writings more than any other medical writer. any other medical writer.

In his youth he was initiated into the In his youth he was initiated into the idealism of Plato, the realism of Aristotle, the idealism of Plato, the realism of Aristotle, the skepticism of the Epicureans, and the skepticism of the Epicureans, and the materialism of the Stoics. materialism of the Stoics.

GalenGalen

GalenGalen was also an admirer of was also an admirer of HippocratesHippocrates. .

His actions were based on Hippocrates His actions were based on Hippocrates principles, and he manage to expand principles, and he manage to expand and support his ideas and discoveries and support his ideas and discoveries by new facts and new observations. by new facts and new observations.

Roman doctors had many Roman doctors had many tools in use.tools in use.

Some of these were: Some of these were: The vaginal speculum (dioptra in Greek) The vaginal speculum (dioptra in Greek) The cautery (kauterion in Greek) and The cautery (kauterion in Greek) and the various hooks. the various hooks.

A spectacular A spectacular viginal dilatorviginal dilator

The Romans also used The Romans also used techniques that killed techniques that killed germs!germs!

Although they did not understand how Although they did not understand how germs were related to the diseases, they germs were related to the diseases, they boiled their tools before using them!  boiled their tools before using them! 

And they used And they used "acetum""acetum" an antiseptic, an antiseptic, to clean and wash all wounds. to clean and wash all wounds.

Gymnastics, Gymnastics, water supply water supply and baths as a and baths as a medical tool in medical tool in ancient Greece ancient Greece and the Roman and the Roman empireempire

Gymnastics in Gymnastics in ancient Greece and ancient Greece and RomeRome

had a very high had a very high reputation and reputation and were also used for were also used for medical purposes.medical purposes.

The exercises were applied The exercises were applied mainly by the Greeks, and the mainly by the Greeks, and the baths were applied mainly by the baths were applied mainly by the Romans. Romans.

The water supply. The water supply.

In ancient Greece, the In ancient Greece, the cities were supplied cities were supplied with water from with water from springs. springs.

The Greek aqueducts The Greek aqueducts were simple channels were simple channels cut in the rock.cut in the rock.

On the contrary in Rome, the water was carried from a long distance, with magnificent aqueducts.

Near Tarragona, Spain

The important factor about these aqueducts The important factor about these aqueducts is that no machinery was used to pump the is that no machinery was used to pump the water!water!

This is the magnificent Roman This is the magnificent Roman “Pont Du Diable” in France.“Pont Du Diable” in France.

and this is the aqueduct system in Segovia, Spain. A similar one exists in Cavalla, Greece.

Baths were always very popular in the whole Roman Empire.

These are the Baths These are the Baths of Caracallaof Caracalla   

Thermae of DiocletianThermae of Diocletian

They could They could accommodate 3,200 accommodate 3,200 bathers!bathers!

*From the medical point *From the medical point of view, baths in Rome of view, baths in Rome were used for the were used for the treatment of various treatment of various diseases, and also for diseases, and also for physical culture. physical culture. *But their legitimate use *But their legitimate use became increasingly became increasingly limited, and their abuse limited, and their abuse promoted the decay of promoted the decay of the Roman Empire.the Roman Empire.

In summaryIn summary Great civilizations were developed in Great civilizations were developed in

the Mediterranean region in ancient the Mediterranean region in ancient times, times, giving to this area the giving to this area the reputation of being the reputation of being the Cradle of Cradle of CivilizationCivilization..

Medicine had a long history in the Medicine had a long history in the Mediterranean. It goes back to the Mediterranean. It goes back to the ancient Egyptians; later on to the ancient Egyptians; later on to the ancient Greeks, to continue with the ancient Greeks, to continue with the descendants of Alexander the Great descendants of Alexander the Great and with the Romans.and with the Romans.

Thank you Thank you for your for your attention!attention!