Hippocratic messages for modern medicine (the vindication of Hippocrates).

Medicine feels the need to combine more than ever the traditional concepts of Hippocrates in perfect balance with the enormous power of modern biotechnology. In our times, the old message 'go back to Hippocrates' sounds like a utopian vision. On the other hand, technological progress tends to remove modern medicine from its anthropocentric mission. The realistic message for tomorrow's physicians must be 'to go forward' together with his perennial humanistic values and clinical messages, combining the recent advances of biotechnology with the Hippocratic rationalism, which is based on logical reasoning, on careful clinical examination, and on a whole humane approach to the patient and his environment. Today's physician can still learn from the Hippocratic heritage and will need to be an expert Hippocratic physician, ever more humane and competent to use all new methods and facilities of basic dermatological research.

Obesity in byzantine and in modern era from a public health perspective.

Obesity is one of today's most serious and amplified public health problems. Surprisingly, obesity constituted a health problem through the Byzantine Empire (3rd to 15th century AD) as well; the extent of the problem was then very much alike to that one seen in modem industrialized and developing countries of today. In this report we perform an historical throwback in Byzantine years in order to explore the link regarding the aspects of obesity in these years and in modem era.

Galen: a pioneer of spine research.

Galen of Pergamum AD (2nd century), the most eminent Greek physician after Hippocrates, marked the history of medicine for more than 14 centuries. His doctrines, expressed in his voluminous work, combined the medical heritage of the Hippocratic, the Alexandrian, and some of the most important medical schools of antiquity. The strong influence of the Hippocratic tradition can characteristically be traced in orthopaedics and particularly in Galen's presentation of the spine. Based on his observations, derived from dissection and vivisection of animals, Galen established a pioneer model for the study of human spine. His research ended in an accurate description of the vertebral column and the spinal cord. He also described the course and the distribution of the nerves emerging from the spine. In addition, he dealt with the diseases affecting these structures focusing on spinal tuberculosis and the injuries of the spine and the spinal marrow. Galen was the first physician to demonstrate the neurological implications following transection of the spinal cord at several levels. The predominant feature in Galen's reference to spine is its teleological perspective; the great physician tended to attribute the prodigious structure of the spine to nature's providence. Despite the inevitable anatomical errors, Galen's inspired experiments remained the only thorough approach of spinal anatomy and pathology until the recent centuries, when the evolution of sophisticated technical aids opened new pathways to spine research.

Abandonment of terminally ill patients in the Byzantine era. An ancient tradition?

Our research on the texts of the Byzantine historians and chroniclers revealed an apparently curious phenomenon, namely, the abandonment of terminally ill emperors by their physicians when the latter realised that they could not offer any further treatment. This attitude tallies with the mentality of the ancient Greek physicians, who even in Hippocratic times thought the treatment and care of the terminally ill to be a challenge to nature and hubris to the gods. Nevertheless, it is a very curious attitude in the light of the concepts of the Christian Byzantine physicians who, according to the doctrines of the Christian religion, should have been imbued with the spirit of philanthropy and love for their fellowmen. The meticulous analysis of three examples of abandonment of Byzantine emperors, and especially that of Alexius I Comnenus, by their physicians reveals that this custom, following ancient pagan ethics, in those times took on a ritualised form without any significant or real content.

Hippocrates. The father of spine surgery.

Hippocrates (5th-4th century B. C.), the founder of scientific medicine, left a valuable heritage of knowledge and methodology, which extends to almost all branches of modern medicine. Among the many fields of medicine he explored, he devoted much of his scientific interest to the study of orthopedics. In fact, some of the principles found in the Hippocratic treatises On Fractures and On Joints are still valid today. This great physician also was the first to deal with the anatomy and the pathology of human spine. In his books, he provides a precise description of the segments and the normal curves of the spine, the structure of the vertebrae, the tendons attached to them, the blood supply to the spine, and even its anatomic relations to adjacent vessels. The Hippocratic list of spinal diseases includes tuberculous spondylitis, post-traumatic kyphosis, scoliosis, concussion, dislocations of the vertebrae, and fractures of the spinous processes. Hippocrates devised two apparatuses, known as the Hippocratic ladder and the Hippocratic board, to reduce displaced vertebrae. Those pioneer methods are deemed to be the precursors to the sophisticated techniques used in spine surgery today. Because of his thorough study of spinal diseases and their management, which was the first such study in orthopedics in the history of medicine, Hippocrates should be regarded as the father of spine surgery.

The modern hippocratic tradition. Some messages for contemporary medicine.

Hippocrates (5th century B.C.), the most prominent physician of antiquity, was born in the small Greek island of Kos, which is near the coast of Asia Minor. Before his era, medicine was practiced as an empirical art and had a religious nature. Hippocratic medicine represents the landmark for the evolution of Western medicine. This "father" of rational medicine assimilated the accumulated knowledge of the past and formed a diagnostic system based on clinical observation and logical reasoning. The great physician attributed diseases to natural causes, believed in the healing power of nature, and gave special emphasis to the prevention and prognosis of illnesses. He treated patients as psychosomatic entities (a holistic medical approach) in relation to their natural environment. In his treatises, Hippocrates defined the ethical principles guiding medical practice. His entire work was inspired by humanistic ideals and an undeviating dedication to the patient. Modern medicine can derive valuable lessons from the Hippocratic tradition. For the coming 21st century, medicine more than ever senses the need to combine the concepts of humanistic values and the Hippocratic messages with the technologic "imperative" (power). This bond is necessary to the improvement of medicine in the future because, currently, the enormous biomedical technology so far has contributed little to the traditionally human fields of psychosomatic and functional disturbances, posing new dilemmas and threatening scientific problems.

Saint Marina: the protectress of nephrology.

Saint virgin and martyr Marina (Margarita) of Antioch in Pisidia (255-270) is recognized as the patron saint of kidney sufferers and the protectress of nephrology. Beginning in the 13th century she heals in particular patients suffering from nephropathies, pregnant women having a difficult childbirth, barren women and sickly children. She protects the patients from every side effect and complication. Saint Marina is represented in hagiography as a victor, defeating the dragon satan, holding a hammer or a cross and wearing a belt around her back in the area of kidneys. According to writers, artists and sculptors the belt is the perceivable means of Saint Marina for the miraculous recovery from and healing of kidney diseases. Therefore, kidney sufferers and pregnant women put belts upon her relics for blessing and then wore them. From the Middle Ages and Renaissance and up to the contemporary period Saint Marina (Margarita) was considered the patron saint of kidney sufferers. Justifiably she is recognized by the modern medical world as the protectress of nephrology.

Kidney disease in Byzantine medical texts.

The most significant contribution of the great Byzantine physicians to the evolution of medicine is their effort to summarize all the medical knowledge of the Greco-Roman world, which included earlier sources in antiquity, lost forever in our days. The transition from ancient to medieval medicine included the adoption of Christian spiritual values, which took place in the early Byzantine period (4th to 7th century). In the field of nephrology, under the influence of Hippocratic and Galenic doctrines, the most prominent medical personalities, Oribasius of Pergamum, Aetius of Amida, Alexander of Tralles and Paul of Aegina, performed the role of the researcher and healer, as well as that of the encyclopedist. Their works on kidney disease are presented in this paper.

Experimental nephritis: one of the earliest publications on the subject by a pioneer of Neohippocratism.

From the beginning of the 20th century, cumulative experimental work has provided considerable evidence for the possible immune mechanisms by which certain diffuse glomerular diseases develop. The first classic well-documented studies are attributed to Masugi and his research team (1933), whose experimental model involved the induction of glomerulonephritis by the administration of antikidney sera. However, 23 years earlier, in 1910, Alexander Cawadias had published a monograph on the same subject, for which he was honored with the Medal of the Paris University School of Medicine. In his study, Cawadias concluded that the mechanism of experimental nephritis was multifactorial and that the progression and the aggravation of uremic disease was caused by the production of nephrotoxins and/or antibodies against renal tissue. Cawadias referred to 'a new colloid substance', a kind of autoantibody in the context of anaphylaxis; he can be credited with foreseeing the modern era of the autosensitivity and immunology of renal diseases. Although Cawadias is well-known as a pioneer of Neohippocratism, his contribution to experimental nephritis has not been amply appreciated; he merits better recognition as one of the pathfinders in the field of renal immunopathogenesis.

Intestinal obstruction: a paradigm of earlier influences on the medicine of late Byzantium.

The study and analysis of aetiology, symptomatology and treatment of intestinal obstruction, based on the texts of Byzantine physicians from the early until the late epoch, prove that the way in which this illness is conceived is substantially unchanged throughout this period. The texts of Byzantine historians and chroniclers present three fatal instances of this disease (ileus or chordapsus, according to the terminology of Byzantine medicine). These are the cases of the Emperor Tiberius I Constantine (578-582), Patriarch Anastasius (730-754) and Empress Theodora (1042 and 1055-1056); the causes of their death remained unknown in the broader medical and historical bibliography. Intestinal obstruction is one of the diseases which probably supported earlier researchers in their opinion of a substantially 'static condition' of Byzantine medicine.

The Conners-28 teacher questionnaire in clinical and nonclinical samples of Greek children 6-12 years old.

It is accepted practice in child psychiatry to use more than one source of information in assessing behavioural problems in children and adolescents. Employing standardized tools for these assessments allows cross-cultural comparisons and better interchange of the findings. Achenbach's Child Behavior Checklist (CBCL) and Teacher's Report Form (TRF) are two widely accepted instruments that were standardized in Greece within the framework of the European Network for the Study of Hyperkinetic Disorder. We studied the Conners-28 teacher questionnaire in a Greek community sample of primary schoolchildren aged 6-12 years. The factor structure showed to be similar to that originally reported from the USA. Discrimination between the referred and nonreferred sample was high, especially for the Inattentive-passive scale. Conners-28 scores were highly correlated with the TRF (scored by the same informant), much less so with the CBCL (scored by a different informant). Our study demonstrates the usefulness and applicability of the Conners-28 item questionnaire.

The carbon monoxide poisoning of two Byzantine emperors.

CASE REPORT: In this paper, two possible cases of acute carbon monoxide poisoning previously not identified in the medical and historical literature are discussed. The first concerns the famous Byzantine Emperor Julian the Apostate, who may have suffered mild carbon monoxide poisoning from which he quickly and completely recovered. The second case involves his successor, Jovian, who may have succumbed to severe carbon monoxide poisoning. Both cases were in all likelihood due to the burning of coal in braziers, a usual method of indoor heating during that epoch.

Studying and teaching the history of medicine in Greece: the National University of Athens experience (1837-1997).

In medical education, little interest is shown in medical history. However, the history of medicine is one vital pathway to the proper study of the evolution of medicine, from ancient to modern times, and it should be a requisite of the medical curriculum. The value of medical history in the understanding of the present and in creating the medicine of the future, is enormous. Our experience has indicated that medical students and younger physicians who ignore the mistakes of their forefathers are destined to repeat them. Furthermore, the history of medicine is needed not only to broaden the students' horizon, it is also necessary in order to prevent the physicians of the 21st century from becoming dehumanized by their bio-technological training. The history of medicine, therefore, is the best antidote to overconcentration on, and overspecification in medical technology and it is the most useful stimulus to more humane professional behaviour and optimal medical education. The new history of medicine does not consist only of the accumulation of dates, events and names; it is a discipline needed for life and action. Tomorrow's historians will view the last years of the second millennium as an eventful and critical period for the medical education of the future.

The survival of the ritualistic over the 'scientific' element of hydrotherapy in Greece.

In this paper we present some elements of the history of 'scientific' psychiatric hydrotherapy and, moreover, of a particular form of the water-purifying ritual--that is, foot washing--among the populations living in Greece and in Orthodox communities in the Balkans. We speculate on the reasons that caused the virtual disappearance of the former, while the latter still flourishes.

The fatal disease of the Byzantine Emperor Andronicus III Palaeologus (1328-1341 AD).

The Byzantine Emperor Andronicus III Palaeologus (1328-1341 AD) died at age 45 from a disease the nature of which is unknown. However, light is thrown on this by the texts of the Byzantine historians John Cantacuzenus (who became Emperor under the name of John VI) and Nicephorus Gregoras, both of whom belonged to the immediate entourage of the Emperor. From their descriptions of the symptoms it appears that Andronicus suffered from malaria for 20 years (1321-1341). The coma that preceded the Emperor's death was probably a cerebral manifestation of chronic malaria.

The parallels between Asclepian and Hippocratic medicine on the island of Kos.

At the end of the 20th century, Hippocratic medicine--which developed at the cross-roads between the occidental and oriental civilisations--acts as a link, a bridge and a symbol for the need to combine both the experience of traditional (Eastern) and the trends of modern (Western) medicine. Hippocratic medicine is one vital pathway to the proper study of the evolution of the medical art. Not only is it the beginning of the art and science of medicine, but modern medicine can still learn from the Hellenic medicine of ancient Greece. Hippocratic medicine is both an antidote to an overconcentration and overemphasis on medical technology and a stimulus to more humane technical achievements. Hippocratic bedside examination has not died, but is merely pushed aside temporarily by modern technology. The fact that ancient Hellenic medicine was based on the coexistence of both Asclepian (traditional) and Hippocratic (rational) medicine on the island of Kos reveals and symbolises the necessary coexistence and cooperation of both systems, a synthesis of their concepts being essential to solve the problems threatening the future of humankind. Hellenic medicine serves to highlight that the parallels between Asclepian and Hippocratic medicine are closer than medical historians usually realise, and that alternative medicine may function in a complementary way to conventional primary medical care.