WHEN QUARTAN FEVER RELIEVED DEPRESSION: THE INCEPTION OF PYRETOTHERAPY IN THE GRECO-ROMAN ANTIQUITY.

OBJECTIVE: The aim: This paper explores the documentation of the effect of quartan fever on, the ancient Greek equivalent of conditions falling nowadays under the spectrum of depression, in Greco-Roman medical sources. PATIENTS AND METHODS: Materials and methods: The authors searched original medical texts written in Greek by physicians who lived and practiced Medicine in the broader Mediterranean region from the 5th century BC to the 7th century AD for records related to quartan fever and neuropsychiatric diseases. CONCLUSION: Conclusions: Quartan fever was used as a treatment for neuropsychiatric conditions until the middle of the 20th century. Although malaria can have severe neuropsychiatric sequelae, the neuroimmunological underpinnings of the effect of fever and heat on depression warrant further investigation.

Hippocratic concepts of acute and urgent respiratory diseases still relevant to contemporary medical thinking and practice: a scoping review.

BACKGROUND: The collected works of Hippocrates were searched for concepts on the diagnosis, prognosis, and treatment of acute and urgent respiratory diseases, with the objective to trace their origins in the Hippocratic Collection. METHODS: A scoping review was performed to map out key concepts of acute and severe respiratory diseases in the entire Hippocratic Collection. The digital library Thesaurus Lingua Graeca (TLG) was researched for references in the entire Hippocratic Collection regarding the epidemiology, pathophysiology, prognosis, diagnosis and treatment of acute respiratory diseases; then, the relevant texts were studied in their English translation by the Loeb Classical Library. RESULTS: Hippocratic physicians followed principles of treatment for pneumonia and pleurisy, still relevant, such as hydration, expectoration, analgesia and prompt mobilisation. Other approaches, including the inhalation of "vapours through tubes" in angina, can be considered as forerunners of modern medical practice. Thoracic empyema was diagnosed by shaking the patient and direct chest auscultation after "applying your ear to his sides". In case of an emergency from upper airway obstruction, urgent insertion of primitive airway equipment, such as a small pharyngeal tube, was applied. CONCLUSIONS: The main Hippocratic concepts on four still common acute and urgent respiratory diseases -pneumonia, pleurisy, thoracic empyema and upper airway obstruction- were identified and most of them were found to be in agreement with contemporary medical thinking and practice.

Early contribution of Alexandria medical school to the anatomy, physiology and pathology of the nervous system.

Alexandria's famous medical school was established about 300 BC. It was the seat of learning for many Greco-Roman physicians. The physiologist Erasistratus, the anatomist Herophilus - named the Father of Anatomy were outstanding pioneers. Their work and discoveries of the nervous system, its structure and function, are described. In the 2nd century AD they were succeeded by Rufus of Ephesus - the medical link between Hippocrates and Galen, - and Aretaeus a leading anatomist and physician in this period.

Examining the osteological paradox: Skeletal stress in mass graves versus civilians at the Greek colony of Himera (Sicily).

OBJECTIVES: Bioarchaeologists interpret skeletal stress as evidence of resilience or frailty, where absence of lesions might result from lack of exposure to pathogens (i.e., good health) or extreme vulnerability (i.e., selection). We examine physiological stress in two skeletal series from Greek Himera: (1) nine mass graves from the battles of Himera (480 and 409 BCE) and (2) Himeran civilians (648-409 BCE). Civilians are assumed to have died from multiple causes, including ill health leading to their deaths. Individuals from the battles presumably died while in relatively good health, in battle. More skeletal stress among civilians than battle casualties would support the idea that skeletal stress is a sign of frailty at Himera. We compare variation in skeletal stress between and among civilians and battle casualties. MATERIALS AND METHODS: Cribra orbitalia, porotic hyperostosis, linear enamel hypoplasia (LEH), and sub-periosteal new bone formation, were examined in 474 individuals (mass graves n = 64; civilians n = 410). RESULTS: Chi-square tests showed significantly higher prevalence of LEH (p = 0.04) and sub-periosteal new bone formation (p = 0.05) among young and mid-aged adult male civilians than mass grave casualties. Skeletal stress was also lower in the earlier battle, and varied among civilians with burial style. DISCUSSION: Our findings generally support the hypothesis that skeletal stress is evidence of frailty (i.e., leading to greater risk of mortality). However, the relationship between stress and frailty is complicated by social factors, when considering historical context. In particular, a possible "soldier-class" may have experienced less stress than the overall civilian population.

Katharsis of the skin: peeling applications and agents of chemical peelings in Greek medical textbooks of Graeco-Roman antiquity.

BACKGROUND: Recipes for peelings date back to medical texts of old Egypt. The oldest medical papyri contain recipes for 'improving beauty of the skin' and 'removing wrinkles' by use of agents such as salt and soda. The Egyptian Queen Cleopatra (69-30 BC) is said to have taken bathes in donkey's milk to improve the beauty of her skin. However, little is known about other agents and peeling applications in later Greek medical textbooks. OBJECTIVE: We will discover new agents and describe ancient peeling applications. First, we will have to identify ancient Greek medical terms for the modern terms 'peeling' and 'chemical peeling'. Second, on the basis of the identified terms, we will perform a systematic full-text search for agents in original sources. Third, we will categorize the results into three peeling applications: (i) cleansing, (ii) aesthetical improvement of the skin and (iii) therapy of dermatological diseases. METHODS: We performed a full systematic keyword search with the identified Greek terms in databases of ancient Greek texts. Our keywords for peeling and chemical peeling are 'smexis' and 'tripsis'. Our keywords for agents of peeling and chemical peeling are 'smégmata', 'rhýmmata', 'kathartiká' and 'trímmata'. RESULTS: Diocles (4th century BC) was the first one who mentioned 'smexis' and 'tripsis' as parts of daily cleansing routine. Criton (2nd century AD) wrote about peeling applications, but any reference to the agents is lost. Antyllus (2nd century AD) composed three lists of peeling applications including their agents. CONCLUSION: Greek medical textbooks of Graeco-Roman antiquity report several peeling applications such as cleansing, brightening, darkening, softening and aesthetical improvement of the skin by use of peeling and chemical peeling, as well as therapy of dermatological diseases. There are 27 ancient agents for what is contemporarily called peeling and chemical peeling. We discovered more specific agents than hitherto known to research.

The Hippocratic Method of Surgical Cauterization for the Tumescence Spleen in the Rare "Spetses Syndrome".

Spleen in antiquity was considered by the Hippocratic medicine as a viscerous organ of spongy character, which could clear human body of the black bile. According to the Hippocratic doctrine of the 4 humors, black bile could cause a series of diseases. Both the anatomical position and shape of the spleen were also recognized. In the case of a splenic hardening, with simultaneous augmentation of its dimensions and dermal ulceration and/or splenic abscess, some interventions were proposed. Thus, herbal medicine, phlebotomy, and minimal surgery with local cauterization were applied for treatment, to confront a disease that was considered serious but not fatal. The Hippocratic physicians encountered various spleen diseases and among them they most probably confronted a rare splenic pathological entity, named centuries later as "Spetses syndrome," a rare type of thalassemia of the Spetses island of Saronikos Gulf. Although the approach seems in modern terms rather primitive, the ancient Greek medico-philosophers most likely understood the significance of the spleen.

Trauma management in Homer's Iliad.

Homer's Iliad is one of the highest intellectual products of the early ancient Greek civilisation. A plethora of medical information lies within Iliad's 24 rhapsodies, and a total of 147 injuries are described. The present study records and evaluates all cases of trauma management included in this epic poem. Not only Iliad's original text but also all myths related to Iliad from the five-volume Greek Mythology by Ioannis Kakridis were meticulously studied to locate the injured person, the type of trauma, the care provider and the type of given care as well as the outcome of each case. A total of 21 cases were found and evaluated with a 5% mortality rate. The majority of these injuries were caused by an arrow (43%) and were located to the upper extremity (43%). Injuries of the head, neck and trunk were not treated as all of them were lethal. Many of the recorded trauma management techniques can be correlated to modern medicine. Furthermore, the role and skills of military doctors and paramedics, mentioned by Homer, is discussed.

Nursing Philosophy 2016, response to Peter Allmark's article, "Aristotle for Nursing".

Preparing to lecture on Aristotle's contribution to Nursing at the International Philosophy of Nursing Conference August 22, 2016, in Quebec City, Quebec, Canada, I came upon the recently published article by my IPONS colleague, Allmark (2016), "Aristotle for Nursing." Allmark (2016) provides a comprehensive and understandable overview of Aristotle's philosophical system including the substantial nature of being and the four causes of change. Nurses using Aristotle to support practice and theoretical research will benefit from a careful reading of Allmark to enrich their use of the realist understanding of knowledge of nature (epistemology) and the matter-form causal relationships within natural being (ontology and teleology). Allmark carefully displays the distinction between good health and flourishing; a distinction sometimes hard to grasp. Nurses are concerned with the end of health, but cannot achieve for others, the fullness of living which is flourishing. We will limit ourselves to expanding three areas that seem important, first, that nursing is much more than a productive science or craft, second, that Aristotle does provide an important note on the persistence of the soul, and, third, while Aristotle does not address the possibility of a personal creative highest being as Allmark says, his references to the divine are worth considering.

Aristotle for nursing.

This article aims: (1) to introduce the wider philosophy of Aristotle to nurses and healthcare practitioners; (2) to show that Aristotle's philosophical system is an interdependent whole; and (3) to defend its plausibility and usefulness despite its ancient and alien origins. Aristotle's system can be set out as a hierarchy, with metaphysics at the top and methodology running throughout. Beneath metaphysics are the sciences, with theoretical, practical and productive (or craft) sciences in hierarchical order. This hierarchy does not imply that, say, metaphysics is superior to biology or nursing, but rather that metaphysics can be understood without reference to the other two but, as we shall see, not vice versa. Two themes run through Aristotelian philosophy. The first is Aristotle's method of inquiry, central to which is that our starting point is not pure empirical data, but rather current puzzles; complementing this method is a realist philosophy. The second theme is teleology, the understanding of action in the world in terms of ends, as when we say a plant grows roots to reach water and nutrients. IMPLICATIONS FOR NURSING: Good health is the good functioning of the material aspect of humans; flourishing is good functioning of humans per se. The goals of nursing, which are based on health, are subsumed by the overall human goal of flourishing, and this helps us to understand and set boundaries to health care. Two examples illustrate this. The first is that mental illness is strongly within the purview of nursing and health care whereas bad decisions, such as smoking, are only marginally so. The second is ethics, where it is argued that the attempt to describe ethical decision-making as in addition to and separate from the decisions made within nursing and health care itself cannot be sustained.

Pathfinders in oncology from ancient times to the end of the Middle Ages.

This commentary highlights the onset and progression of the diagnosis and treatment of cancer from ancient times to the 15th century. During the preparation of this synoptic review of the lives and contributions to oncology of 7 ancient physicians, it became clear that despite separation by centuries, ethnicity, and religion, they had many things in common. For example, with the exception of Chauliac, all were born into wealthy families, had an excellent education in the liberal arts and sciences, and were mentored by outstanding teachers. After they became physicians, they traveled extensively, were polyglots, were sponsored by influential individuals, had inquisitive minds, searched for the true nature of diseases, and were proud to share the results of their observations with others. Except for Galen, all of them were kind and well-mannered individuals. They cared with sincere dedication for the poor and those who had untreatable disease, including cancer. Although their understanding of cancer was limited, they were deeply concerned about the neglect and hopelessness of cancer patients. They were aware of their shortcomings in offering effective treatment beyond the surgical excision of early cancers. For advanced cancers, they had nothing to give beyond palliative care with herbals and minerals. All physicians who care for cancer patients owe these pioneer physicians, whatever their shortcomings, an inexpressible debt for their attempts to cure cancer. Cancer 2016;122:1638-46. © 2016 American Cancer Society.

[Greek science in the centre of the Dialogue between Orient and Occident ].

Most pre-Socratic Greek philosophers originated from Ionia, in Minor Asia, where Achaeans had been installed since the 11th century B. C. During the Age of Pericles, Empedocles of Agrigento, in Sicily, Leucippus and Democritus from Abdera, Anaxagoras of Clazomenae, active in Athens, and Socrates in Athens also took over philosophy and science in Continental Greece. Plato, Socrates' disciple and founder of Academia, and his own disciple Aristotle, founder of the Lyceum, and his pupils, such as Theophrastus of Eresos, followed them. In the area of medicine and pharmacy, Hippocrates of Cos and his disciples and followers redacted between 450 and 300 B. C., what is known as Hippocratic corpus. Then came Galen from Pergamum who completed the theory of Humours, during the second century. Nestorian Christians, considered as heretical in the Byzantine Empire, were accepted in Sassanid Persia and carried Greek culture with them. After Arabic conquest and Baghdad City creation, in 762, they translated Hippocratic corpus in Arabic language so that Hippocratico-Galenic theory could pass in Arabic-Muslim world. It was then developed by Al-Kindi in Baghdad, Ibn Al-Jazzar in Kairouan, Razes or Avicenna, both Persians. The 11th and the 12th centuries were characterised by Latin translations, by Constantine the African in Monte-Cassino, Gerard of Cremona or Mark of Toledo. The School of Salerno created then the conditions for the fusion of Greek, Arabic and Jewish medicines. The creation of modern science from Greek philosophy was a consequence of a permanent dialogue between Orient and Occident.

Panic and Culture: Hysterike Pnix in the Ancient Greek World.

Starting perhaps in the second century BCE, and with Hippocratic precedent, ancient medical writers described a condition they called hysterike pnix or "uterine suffocation." This paper argues that uterine suffocation was, in modern terms, a functional somatic syndrome characterized by chronic anxiety and panic attacks. Transcultural psychiatrists have identified and described a number of similar panic-type syndromes in modern populations, and a plausible theory of how they work has been advanced. These insights, applied to the ancient disease of hysterike pnix, demystify the condition and illuminate the experience of the women who suffered from it.

Whistleblowing in medicine and in Homer's Iliad.

'Thinking with Homer', or drawing creatively on themes and scenes from Homer's Iliad and Odyssey, can help us to better understand medical culture and practice. One current, pressing, issue is the role of the whistleblower, who recognises and exposes perceived poor practice or ethical transgressions that compromise patient care and safety. Once, whistleblowers were ostracised where medical culture closed ranks. However, in a new era of public accountability, medicine looks to formally embrace whistleblowing to the point that not reporting transgressions can now constitute a transgression of professionalism. Where medical students identify with the history and traditions of medical culture, they inevitably find themselves in situations of conflicting loyalties if they encounter senior clinicians behaving unprofessionally. What are the implications of facing these dilemmas for students in terms of role modelling and shaping of character as a doctor, and how might a study of Homer help with such dilemmas? We suggest that a close reading of an opening scene in Homer's the Iliad can help us to better appreciate such ethical dilemmas. We link this with the early Greek tradition of parrhesia or 'truth telling', where frankly speaking out against perceived injustice is encouraged as resistance to power and inappropriate use of authority. We encourage medical educators to openly discuss perceived ethical dilemmas with medical students, and medicine as a culture to examine its conscience in a transition from an authoritarian to an 'open' society, where whistleblowing becomes as acceptable and necessary as good hygiene on the wards.

[The research on medicine in Greco-Roman Egypt in the Centre de Documentation de Papyrologie Littéraire (CEDOPAL) of the University of Liège]. / Les recherches sur la médecine dans l'Égypte gréco-romaine au Centre de Documentation de Papyrologie Littéraire (Cedopal) de l'Université de Liège.

The paper presents the research on medicine in Greco-Roman Egypt conducted in the last forty years at the Centre de Documentation de Papyrologie Littéraire (CEDOPAL) at the University of Liège. It describes the main results obtained by deciphering, editing, translating and commenting Greek and Latin medical papyri, be they literary, documentary or magical.

[Anonymous Londinensis and the Greek documentary papyrus of medicine at the CEDOPAL]. / L'Anonyme de Londres et les papyrus documentaires grecs de médecine au Cedopal.

The present paper proposes an account of my research on human and veterinary medicine in Graeco-Roman and Byzantine Egypt, undertaken since 2008 at the CEDOPAL at the University of Liège. This research focuses on literary papyri, particularly on the Anonymus Londiniensis (Hermopolis?, 2d half of the 1st).

The art of providing resuscitation in Greek mythology.

BACKGROUND: We reviewed Greek mythology to accumulate tales of resuscitation and we explored whether these tales could be viewed as indirect evidence that ancient Greeks considered resuscitation strategies similar to those currently used. METHODS: Three compendia of Greek mythology: The Routledge Handbook of Greek Mythology, The Greek Myths by Robert Graves, and Greek Mythology by Ioannis Kakridis were used to find potentially relevant narratives. RESULTS: Thirteen myths that may suggest resuscitation (including 1 case of autoresuscitation) were identified. Methods to attempt mythological resuscitation included use of hands (which may correlate with basic life support procedures), a kiss on the mouth (similar to mouth-to-mouth resuscitation), application of burning torches (which might recall contemporary use of external defibrillators), and administration of drugs (a possible analogy to advanced life support procedures). A careful assessment of relevant myths demonstrated that interpretations other than medical might be more credible. CONCLUSIONS: Although several narratives of Greek mythology might suggest modern resuscitation techniques, they do not clearly indicate that ancient Greeks presaged scientific methods of resuscitation. Nevertheless, these elegant tales reflect humankind's optimism that a dying human might be restored to life if the appropriate procedures were implemented. Without this optimism, scientific improvement in the field of resuscitation might not have been achieved.

On the origin of Ammon's horn.

INTRODUCTION: Greek and Roman worship of their gods and myths go back to Ancient Egyptian times. Images engraved in Greco-Roman coinage range from references to the assassination of Caesar and legendary stories like the arrival of a snake shaped demi-god Aesculapius to save the Romans from the plague, to invocations of major deities including Apollo the physician or Ammon the protector. DEVELOPMENT: Depicted with the horns of a ram, Ammon was adopted by the Greeks as an epithet of Zeus and later incorporated by the Romans as Jupiter. References to the cult of Ammon appear on tetradrachms minted for Alexander The Great and on provincial Roman coins struck under Claudius. It is thrilling to hold a coin depicting Marcus Aurelius with Salus on the reverse and think that it could have been handed to Galen in payment for his services. However, it is rare to find figures other than rulers on coins and the physician of Pergamum is no exception. Inspired by the Renaissance school of Padua, French anatomists in the Enlightenment (Garengeot in 1742 and Flurant in 1752) continued reviving ancient myths and named the curve-shaped-inner portion of the temporal lobe Ammon's horn. Outstanding scholars who studied this primitive structure of the brain included Lorente de Nó and his mentor Cajal, whose portrait appeared on fifty-pesetas notes issued in 1935. CONCLUSIONS: As primary sources of great archaeological and artistic value, Greco-Roman coins provide information about the origins of the myths and gods of classical antiquity and continue to inspire the arts and sciences to this day.