Hellenistic and Later Medicine

rd.  Medicine in Lindberg; sections on Herophilus, Erasistratus and Galen in GS

human dissections begin in 3rd century; perhaps human vivisections
    d.260/250 Herophilus
    Erasistratus

Praxagoras worked on the pulse
Herophilus (first half third c. BC) studies under Praxagoras of Cos
    worked for first two Ptolemaic rulers
    investigated anatomy of brain and nervous system
    identified two brain membranes - dura mater and pia mater
    traced connection of nerves, spinal cord, brain
    distinguished sensory and motor nerves
    examined eye - identified principal humors and tunics
    traced optic nerve and argued it was filled with pneuma
    organs of abdominal cavity
    distinguished veins from arteries
    valves in heart
    arterial pulse
    described ovaries and fallopian tubes

Erasistratus b. c. 304BC studied medicine in peripatetic school at Athens and at Cos
    description of bicuspid and tricuspid valve - Galen preserves this
    heart is a bellows drawing in blood and pneuma
        expelling blood into veins, pneuma into arteries
        faced objections that blood flows from cut arteries
    Erasistratus more interested in function than Herophilus
    theory of disease - caused by flooding of veins with excess blood, owing to excessive eating
    excess blood passes through anastomoses into arteries to extremities where it causes inflammation and fever
    solved through diet or blood-letting

Philinus of Cos a student of Herophilus,
    wrote a book again certain teachings of Herophilus
    set off rounds of attacks and counter-attacks

1. Herophilans and Erasistratans become known as dogmatists or rationalists
2. Their critics were the empiricists
    rationalists committed to speculative, theoretical medicine
    empiricists - search for hidden causes a waste of time
        no use in dissection
        concentrate on visible symptoms, causes and use experience
3. in 1st century AD a third group at Rome, the methodists
    -anatomy, physiology and cause can be dispensed with
    -disease depends on tension and laxness in the body
4. pneumatists - based on Stoic principles
5. Asclepiades of Bithynia fl. 90-75 BC repudiates humor theory in favor of atomism

Galen b. Pergamum 129-210 AD
    father Nicon attended to his education
    travelled for education and patronage
    book learning was important as a criterion of a good doctor
        distinguishes him from other kinds of craftsmen
    studied medicine at Pergamum, Smyrna, Corinth, Alexandria,
    doctor to Marcus Aurelius, Commodus, Septimius Severus

a modern Hippcratic – commented on many works of the HC
    addresses question of authorship – which treatises are genuine
    good medicine impossible without philosophy
dependent on Aristotle for material theory; Timaeus for the tripartite soul
    divine creator and teleology

-stressed anatomy though human dissection could no longer be performed
    relied on Herophilus and Erasistratus
    made use of chance – dead Germans on campaign with M.Aurelius

did dissections of barbary ape, which led to the problem of the rete mirabilis
    and other mistakes of analogy (position of the kidneys)
    identification of nerves and muscles producing the voice
    muscles in the hand
    vivisected heart and lungs
-G's was the only systematic anatomy surviving to Renaissance

classified disease, their universals and causes
took four humors from On Nature of Man
    humors       qualities
    blood        hot
    phlegm        cold
    yellow bile    wet
    black bile    dry

-from these tissues are formed

pulses as important in diagnostics
    taken over from Herophilus and Aristoxenus the extravagant nomenclature
distinction between katarchtic causes, preceding causes and containing causes

adopted Plato's tripartite soul
    brain was source of nerves
    heart was source of arteries
    liver was source of veins

1. food in stomach is reduced to chyle (khylos), conveyed to liver thro' mesentery veins; in liver it becomes venous blood and is slowly transported and consumed by body
2. venous blood goes to heart thro' vena cava and some, the thinnest part is drawn into right ventricle thro' pores in the wall mixes with air from lungs and becomes arterial blood (not just pneuma, as Erasistratus claimed) imbued with vital heat and it flows to organs to keep them alive
3. brain receives some arterial blood which passes into the rete mirabile where it is refined and becomes psychic pneuma which is sent through the nerves to the rest of the body

G. was not entirely mechanistic
    all organs possess non-mechanical faculties to attract, repel, retain fluid on the basis of need
    G's system was very persuasive due partly to its comprehensiveness
    also because of his teleology
    see On the Usefulness of the Parts of the Body
    nature does nothing in vain