Week Two

1. Week Two My Philosophy - Beginning Thoughts Spend five minutes thinking about your philosophy of practice ~ What are your beliefs now before we start to learn the history? What are these beliefs based on?

2. 1ST CENTURY AD  DIOSCORIDES

3. Studied medicine and Egypt and was a physician in Nero’s army and detailed the properties of around 1000 plants in his definitive herbal – De Materia Medica which was on the preparation, properties, and testing of drugs and describes how plants were used medicinally in various cultures. It included descriptions of appearance, medicinal qualities, methods of preparation and suggested dosages and toxicity and set the stage for similar texts for hundred of years to come. He collected all of the plants himself.

4. His work was considered absolute, and was copied, recopied and commented on and used in nearly all medical schools for 1600 years. The earliest surviving manuscript is the Codex Vindobonensis from 512 A.D. This magnificent work was illustrated with about 400 full-page hand-coloured plates and was made for the daughter of Flavius Anicius Olybrius, Emperor of the West in 472.

5. 23 – 29AD  PLINY

6. Gaius Plinius Secundus, the man we know as Pliny the Elder, was born in Como, Italy, in A.D. 23. He was a Roman scientific encyclopedist and historian By the time he died 56 years later, he had been a cavalry officer, an adviser to emperors and the author of at least 75 books, not to mention another 160 volumes of unpublished notebooks. He surveyed all the known sciences of his day, astronomy, meteorology, geography, mineralogy, zoology, and botany. Most of his works are lost, but his book “Historia naturalis” (Natural History) still exists.

7. No single work of Pliny still exists, but many of them were copied, complete or in excerpts, multiple times. To Pliny the world consisted of four elements: earth, air, fire, and water. This world view persisted for 1,500 years, and some people still believe it.

8. He is remembered today for just one of those works, his 37-volume Natural History, in which he planned to "set forth in detail all the contents of the entire world." He stated that “Nature is the servant of the people” He believed that the plants existed to meet peoples needs and that all plants are useful for either medicine, food, clothing or shelter. He postulated the earliest theory of gravity, light substances were prevented from rising by the weight of the heavy ones, and vice versa.

9. He made a model of the solar system, the Earth surrounded by seven stars, the Sun, the Moon, Mercury, Venus, Mars, Jupiter, and Saturn. Since the Moon obscured the Sun during an eclipse he thought it was larger than the Earth. But the sciences which interested him most were botany, agriculture, and horticulture. And although many of he theories later proofed to be wrong, his work is of great value.

10. He died as a scientist in AD 79 during the eruption of the volcano Vesuvius. He was in command of a fleet in the bay of Naples. • There are two versions of his death. • The heroic one tells he was going to take a closer look, and then was killed by poisonous fumes. • The other says, that he died because of a heart attack, caused by arteriosclerosis and fastened by his asthma and the stress and strenuousness of the rescue operation.

11. 131 – 200  GALEN

12. Started the Galenic Movement. • He was a doctor at a gladiator school which gave him the opportunity to develop his interest in anatomy. He revolutionised medicine by performing animal experiments on apes, pigs and goats, out of which he developed the first medicinal theories based on scientific investigations. He found the importance of the spinal cord and its essential function in our existence. • Galen believed strongly in Hippocrates idea of the Humoral system of medicine and developed it further. He promoted the idea of a cross with each branch representing hot, cold, wet and dry respectively and with perfect balance (i.e. optimum health) being in the middle.

13. He classified all diseases and all plants into these four categories and recommended the use of opposites to counterbalance. Many of his theories were proved to be wrong because they assumed animal studies would apply to human beings The different medical theories of homoeopathic and allopathic medicine would both grow out of Galen’s doctrine He was enthroned as the patron saint of the medieval medical schools. His theories provided the prominent thinking for nearly 14 centuries

14. HUMORAL MEDICINE

15. Similar to other traditional medicines, the humoral theory describes a system of forces which govern the overall functioning of the body and maintain a state of equilibrium. • Originates from Greek philosophy in that: • All existence was thought to be composed of four basic elements  earth, water, fire and air • These elements were understood to be made up of combinations of the four qualities  hot, cold, wet, dry

16. The elements were made up in these ways: • Earth  cold and dry • Water  cold and wet • Fire  hot and dry • Air  hot and wet

17. Elements, humors and qualities were believed to affect individuals, and especially their health and well being, via the humors: • Sanguine  blood  air  hot and wet • Choleric  yellow bile  fire  hot and dry • Phlegmatic  phlegm  water  cold and wet • Melancholic  Black bile  earth  cold and dry

18. In Galenic medicine the idea was to make out which humor was imbalanced and prescribe the herbs to counteract it. • There were attempts to categorise all herbs in a framework unsatisfactory in modern times but they involved: • Spices are hot • bitters and relaxing herbs are cooling • Mucilages are moistening • Astringents are drying

19. In the humoral theory: • The vital spirit is housed in the heart, circulated through the body by the arteries, where it overseas the qualities of: • Attraction • Digestion • Retention • Expulsion • The animal or soul spirit (called the animal spirit by Culpepper) resides in the brain and governs consciousness and the five senses and is conveyed via the nervous system.

20. The natural spirit, housed in the liver, controls the production of the four humors and is believed to be conveyed throughout the body by the veins. • Pneuma is the primary generative energy, usually described as being of cosmic origin, which both creates and governs the physiologicalforces.

21. The aim of the treatment is to keep the body in balance, taking into account: • The base constitution • Experiences the person has • Normal human activities • Time of life, climate, season

22. Early Greek model of humours:

23. Sanguine: • Inclined to be fat and prone to laughter • Loves mirth and music, enjoys wine, women and song • Cares not what comes after • Tends to lack maturity and discretion • If the temperament is maintained, it ‘prolongs life and keeps old age at bay’ • Respond to authority

24. Choler: • Hate being ill, are dreadful patients and cut out the memories of previous illnesses • Love action rather than peaceful activities • Tend to be arrogant, fierce, unruly, meddlers • Respond to discipline, direction and clear short term goals

25. Melancholic: • Held in the least esteem, but understand the world in a deeper way than most others • Centres on being rather than doing • Intellectual activity dominant • Tends towards quiet contemplation of the world • Stolid, sad and stubborn • Prone to getting blocked and stuck but they hang in there

26. Phlegmatic: • Prone to poor digestion, mucous accumulation and lethargy • Inclined to be rather fat and square • Stable, indifferent, slow and lazy • Gentle and quiet • Love ease

27. BLOODLETTINGhttp://www.absoluteastronomy.com/reference/bloodlettingBLOODLETTINGhttp://www.absoluteastronomy.com/reference/bloodletting

28. Bloodletting is one of the oldest medical practices, having been practiced among diverse ancient peoples, including the Greeks, the Egyptians and the Mesopotamians. • In Greece, bloodletting was in use around the time of Hippocrates, who mentions bloodletting but in general relied on dietary techniques.

29. Erastistratus, however, theorized that many diseases were caused by plethoras, or overabundances, in the blood, and advised that these plethoras be treated, initially, by exercise, sweating, reduced food intake, and vomiting. The popularity of bloodletting in Greece was reinforced by the ideas of Galen, after he discovered the veins and arteries were filled with blood, not air as was commonly believed at the time.

30. There were two key concepts in his system of bloodletting. • The first was that blood was created and then used up, it did not circulate and so it could 'stagnate' in the extremities. • The second was that humoral balance was the basis of illness or health, the four humours being blood, phlegm, black bile, and yellow bile (relating to the four Greek classical elements of earth, air, fire and water).

31. Galen believed that blood was the dominant humour and the one in most need of control. In order to balance the humours, a physician would either remove 'excess' blood (plethora) from the patient or give them an emetic (to induce vomiting) or diuretic (to induce urination).

32. A multitude of bloodletting devices were developed including the scarifier, the spring lancet and the "Lebenswecker”. • The lancet was used in venesection, or the taking of blood from a vein; fortunately, this practice disappeared in the mid 19th century. These blades and needles were typically applied to the skin by barber surgeons, while "cupping" and the application of leeches were sometimes performed by members of the household.

33. The scarificator, a series of twelve blades, was also in vogue during the 18th Century, This device was cocked and the trigger released spring-driven rotary blades which caused many shallow cuts.

34. Not surprisingly, patients were sometimes bled to extreme weakness or death. In spite of some opposition, bloodletting was an accepted practice from the time of Galen through the early 20th century.

35. Galen created a complex system of how much blood should be removed based on: • the patient's age • constitution • the season • the weather • the place • Symptoms of plethora were believed to include fever, apoplexy, and headache.

36. The blood to be let was of a specific nature determined by the disease: either arterial or venous, and distant or close to the area of the body affected. He linked different blood vessels with different organs, according to their supposed drainage. For example, • the vein in the right hand would be let for liver problems; • the vein in the left hand for problems with the spleen; • The more severe the disease, the more blood would be let; • Fevers required copious amounts of bloodletting.

37. The Talmud recommended a specific day of the week and days of the month for bloodletting, and similar rules, though less specific, can be found among Christian writings advising which saint’s days were favourable for bloodletting.

38. Islamic authors too advised bloodletting, particularly for fevers. The practice was probably passed to them by the Greeks; when Islamic theories became known in the Latin-speaking countries of Europe, bloodletting became more widespread. Together with cautery it was central to Arabic surgery. • It was also known in Ayurvedic medicine, described in the Susrata Samhita.

39. A number of different methods were employed. • The most common was phlebotomy or venesection often called "breathing a vein"), in which blood was drawn from one or more of the larger external veins, such as those in the forearm or neck. • In arteriotomy an artery was punctured, although generally only in the temples.

40. In scarification the "superficial" vessels were attacked, often using a syringe, a spring-loaded lancet, or a glass cup that contained heated air, producing a vacuum within. Blood was caught in shallow bowls. • During the 17th to 19th centuries blood was also captured in small flint glass cups. Heated air inside the cups created a vacuum causing blood to flow into the cup - a handy technique for drawing blood from a localized area. This practice was called cupping.

41. Leeches could also be used.

42. The withdrawal of so much blood as to induce syncope (fainting) was considered beneficial, and many sessions would only end when the patient began to swoon.

43. By the middle ages, both surgeons and barbers were specializing in this bloody practice. Barbers advertised with a red (for blood) and white (for tourniquet) striped pole. The pole itself represented the stick squeezed by the patient to dilate the veins.

44. Bloodletting came to the U. S. on the Mayflower. The practice reached unbelievable heights in the 18th and early 19th centuries. The first U.S. president, George Washington, died from a throat infection in 1799 after being drained of nine pints of blood within 24 hours. The draining of 16-30 ounces (one to four pints) of blood was typical. Blood was often caught in a shallow bowl. When the patient became faint, the "treatment" was stopped. Bleeding was often encouraged over large areas of the body by multiple incisions.

45. By the end of the 19th century (1875-1900), phlebotomy was declared quackery.

46. LEECHCRAFT 512 – 1115

47. It would be reasonable to assume that the word leechcraft comes from the use of leeches in medicine. But this is not the case. There have been two meanings for leech in English. The other one, long defunct, refers to a doctor or healer, from Old English læce, of Germanic origin.

48. Leech was the collective English word for medical practitioners--those who practiced all forms of healing. At one time a dog-leech was a vet. The ring finger was once called the leech-finger (also the medical finger and physic finger), a translation of Latin digitus medicus. It is believed that it got that name because the vein in it was believed to communicate directly with the heart and so gave that finger healing properties, for example in mixing ointments.

49. Engagement and wedding rings are traditionally put on that finger of the left hand for the same reason, which is why the vein became known as the vena amoris, literally “vein of love”. A herbal available in modern English is the Leechbook of Bald (925), containing may formulas and herbal remedies in a fairly sophisticated system of therapeutics, but many superstitious notions about how to apply herbal treatments as well.

50. Bald's Leechbook, was believed to have been compiled during the time of King Alfred, and very possibly at the request of Alfred himself. Though the manuscript itself was scribed at a later date, evidence suggests that the initial compilation of Bald's Leechbook was either during or shortly following the reign of King Alfred. An internal reference to King Alfred demonstrates that the Leechbook was not compiled before his reign, and other manuscript evidence shows that it could not have been compiled long after.