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Hippocrates Timeline

Hippocrates Timeline


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Hippocrates Timeline - History

450 B.C. – Golden Age of Greece

Hippocrates (Greek physician, father of modern medicine)

  • Denied that deities/demons caused mental illness.
  • Viewed abnormal behavior and illness in general as having internal causes, and thus having biological natures or etiologies.
  • Has a key belief that if you took care of your body, your mind would also stay well (Hippocrates, 2010).
  • Treatment was to modify the environment (tranquil life, sobriety, exercise, and abstinence from excess).
  • Believed patients needed to choose health over mental illness.
  • Was the basis for the Hippocratic Oath
    • Physicians or healers will not deliberately harm an individual who seeks their help they will treat anyone who comes seeking their aid they will not give a deadly drug if the patient requests it and they keep all information about doctor-patient professional relationships confidential (Hippocratic oath, 2010).
    • Such harms still later included:
      • Terrible conditions (patients shackled to walls or dark cells).
      • Treatment (electric shock, bleeding, spinning, restraints) used to intimidate patients into choosing health over illness.

      1800s – Reforms in Mental Health Treatment

      • Published the first American textbook on psychiatry, Mental Inquiries and Observations upon the Diseases of the Mind.
      • Believed the cause of mental illness was exposure to severe psychological and social stressors.
      • Treatment was “moral management”, which focused on the patient’s social, individual, and occupational needs (manual labor, spiritual discussion, humane treatment).
      • Frenchman and early reformer in the proper treatment of mentally ill individuals.
      • Like Rush, also believed mental illness were caused by excessive psychological and social stresses.
      • Advocated that the mentally ill be treated with sympathy, compassion, and empathy.
      • One of the founders of psychiatry.
      • Helped establish 32 mental hospitals throughout the United States.
      • 1845 – first public mental hospital in Pennsylvania Harrisburg State Hospital.
      • 1847 – first state mental institution in Illinois established.
      • 1856 – first state mental institution in North Carlina opened and named in her honor.
      • Authored bills that were intended to protect, and reform treatment for, mentally ill patients.

      1900s – Modern Era

      • Major breakthrough: Discovery of biological cause of general paresis (syphilis of the brain) (Jasmin, 2008).
      • Symptoms of syphilis are paralysis, insanity, and death.
      • Treatment was to infect sufferer with malaria (high fever would kill the syphilis organism).
      • Led to increased focus on diseased bodily organs as underlying cause of mental illness.
      • Accompanied by tremendous advances in anatomy, physiology, neurology, chemistry.
      • Developed a classification system of mental disorders (precursor to The DSM).
      • Classified psychosis into two forms, manic depression and dementia praecox.
      • Recognized that different types of disorders had different outcomes.
      • Emphasized importance of underlying brain pathology.
      • Performed extensive work and research in human sexual behavior
      • Wrote Psychopathia Sexualis, the first major study of sexual perversity. This coined many terms associated with sexuality today (i.e, sadism, masochism, etc.)
      • Served as authoritative influential study of human sexual behavior until Freud.

      Advances in psychological understanding of mental disorders:

      • Developed psychoanalytic theory – the theory of psychological development in terms of stages throughout life.
      • Believed unconscious processes, motives, and urges are at the core of many of our behaviors and difficulties.
      • Developed the doctor-patient paradigm.
      • The doctor was viewed as being in a power position, and the patient was a sick individual who would take the doctor’s words as an unquestionable fact.
      • Father of radical behaviorism.
      • Believed that any behavior that was reinforced or rewarded would be more likely to increase or recur any behavior that was either not reinforced or was punished would be more likely to decrease or be extinguished.
      • Created experiments which demonstrated operant conditioning. Most well known for creating the Skinner Box, a devise demonstrating conditioning of rats pressing a lever to receive food. http://www.youtube.com/watch?v=PQtDTdDr8vs.
      • Teaches at Stanford University.
      • Developed Social Learning Theory(Modeling).
      • Suggested that we could learn based upon what we observed in a model. .
      • Believes that we get depressed and develop other mental illnesses because of faulty thinking. (REBT).
      • REBT works well with Anxiety Disorder and Mood Disorders.
        who believed in the innate goodness of all people and in the ability of all people to grow and lead constructive lives.
    • Developed the client- or person-centered therapy.
      • The psychologist is seen as someone who is a skilled listener, not judgmental, and certainly not powerful nor omniscient.
      • Theorized that dysfunction begins in infancy.

      • Introduced Thorazin.
      • Used for the treatment of Schizophrenic Disorders by calming patients without putting them to sleep.
      • Led to widespread use of the treatment for Schizophrenic Disorder and the field of psychopharmacology.


      Hippocrates

      Hippocrates made such an impression on medical history that his name is still very much associated with medicine today. All newly qualified doctors take what is called the ‘Hippocratic Oath’ and some see Hippocrates as the father of modern medicine even though he did most of his work some 430 years before the birth of Christ.

      Greek doctors had started to look at the issue of poor health and disease by using a process of reasoning and observation. The most famous of these was Hippocrates. He is thought to have been born in Cos in 460 BC. In fact, we know very little about Hippocrates as a person but his fame was such that Plato and Aristotle wrote about him. While Hippocrates has found fame in medical history, there were other Ancient Greek doctors who were not so lucky.

      Ancient Greek medical knowledge is demonstrated in what is known as the Hippocratic Collection. This is a collection of sixty medical books of which Hippocrates wrote just some. We do not know who wrote most of them but they cover a time span of 150 years so they could not have all been written by Hippocrates.

      Hippocrates and other Greek doctors believed that the work done by a doctor should be kept separate from the work done by a priest. They believed that observation of a patient was a vital aspect of medical care. Ancient Greek doctors did examine their patients but Hippocrates wanted a more systematic period of observation and the recording of what was observed. Today, we would call this ‘clinical observation’. Such ideas have lead to Hippocrates being called the ‘Father of Medicine’.

      The Hippocratic Collection gave Greek doctors detailed advice on what to do with their patients:

      “First of all the doctor should look at the patient’s face. If he looks his usual self this is a good sign. If not, however, the following are bad signs – sharp nose, hollow eyes, cold ears, dry skin on the forehead, strange face colour such as green, black, red or lead coloured. If the face is like this at the beginning of the illness, the doctor must ask the patient if he has lost sleep, or had diarrhoea, or not eaten.” From “On forecasting diseases”.

      In the book “On Epidemics”, doctors were told to note specific symptoms and what was observed on a day to day basis. By doing this they could make a natural history of an illness. Hippocrates and other doctors believed that by doing this they could forecast the development of the illness in future:

      “I believe that it is an excellent thing for a physician to practice forecasting. He will carry out the treatment best if he knows beforehand from the present symptoms what will take place later.” From ‘On forecasting diseases’

      The ideas of Hippocrates and others spread in the eastern Mediterranean and others took to writing down what they saw with regards to illnesses. These writings have survived and have given historians a vast resource to study.

      Hippocrates and other doctors worked on the assumption that all diseases had a natural cause rather than a supernatural one. Priests believed that an illness such as epilepsy was caused by the gods. Hippocrates believed that with all other illnesses it had a natural cause.


      Hippocrates’ Contributions to Science

      Hippocrates is famous because:

      • he systematized medicine
      • he founded antiquity’s greatest school of physicians
      • he invented the famous

      “I will use treatment to help the sick according to my ability and judgment, but never with a view to injury and wrong-doing. Neither will I administer a poison to anybody when asked to do so, nor will I suggest such a course. Similarly I will not give to a woman a pessary to cause abortion. But I will keep pure and holy both my life and my art. I will not use the knife, not even, verily, on sufferers from stone, but I will give place to such as are craftsmen therein. Into whatsoever houses I enter, I will enter to help the sick, and I will abstain from all intentional wrong-doing and harm, especially from abusing the bodies of man or woman, bond or free. And whatsoever I shall see or hear in the course of my profession, as well as outside my profession in my intercourse with men, if it be what should not be published abroad, I will never divulge, holding such things to be holy secrets.”

      Some of the successes of the Hippocratic School were:

      • attributing diseases to natural rather than supernatural causes
      • treating diseases through rational reasoning rather than magic or sacrifices to gods
      • identifying that environment, diet, and lifestyle can contribute to ill-health
      • emphasizing kindness, gentleness, and cleanliness in treatments
      • ensuring practitioners operated in a professional way, including keeping medical records for each patient
      • prognosis – detailed record-keeping for many patients enabled physicians to know the likely path an illness would take

      Some of its failures were:

      • a lack of understanding of human anatomy – dissections of human bodies were illegal
      • the pseudoscientific practice of relating diseases and ill-health to imbalances in ‘humors’ of black bile, blood, phlegm, and yellow bile
      • an over-reliance on nature’s own healing power to cure illnesses: even in ancient times, this was criticized: Asclepiades of Bithynia in the second century BC described it as a “meditation upon death.” In the Hippocratic texts Epidemics I and III, of the 42 case histories reported, over half ended with the patient’s death.

      The Medical Science Vanguard

      Hippocrates was in the vanguard of scientific medicine and therefore made mistakes which are entirely understandable. For example, we know that the Ancient Greeks were aware of desalination.

      Not long after Hippocrates’ lifetime, Aristotle, wrote:

      “Saltwater, when it turns into vapor, becomes sweet and the vapor does not form salt water again when it condenses.”

      No doubt Hippocrates was aware of the apparent goodness of evaporated water when he described an experiment on ice and meltwater.

      “The following experiment will prove it. In winter, measure water into a vessel and leave it in the open, where it will freeze best. On the next day bring it under cover, where the ice will melt best. After it has thawed, you will find there is less than you began with.”

      Hippocrates incorrectly believed that ‘the lightest, sweetest part’ of the water was lost in the process of freezing and thawing, leaving inferior water behind. He drew the false conclusion that drinking melt water was a poor choice for people seeking good health.

      We can only admire his belief in the power of experiments to reveal the truth, although on this occasion it led him to a false conclusion.

      The service Hippocrates did to science and health by disentangling disease from superstition cannot be understated. Trying to understand a disease using reasoned, logical explanations rather than blaming possession by an evil spirit, for example, was a critical step in human development.

      However, it would take almost another 2,500 years, before:

        established that the true cause of disease is malfunctioning cells. established the germ-theory of disease, showing cell-malfunction is in many cases caused by invading micro-organisms.

      Not all of the medical books attributed to Hippocrates were actually written by him – indeed there is no direct proof that he personally wrote any of them. Some or all of the body of 60 Hippocratic works were definitely written by followers of his doctrines, such as his son-in-law Polybus. Many of the works have been lost.

      Hippocratic medicine dominated the field for 500 years until it was it was absorbed and surpassed by Galen’s works.

      “Read the past, diagnose the present, foretell the future practice these acts. As to diseases, make a habit of two things — to help, or at least to do no harm.”

      Some Personal Details and the End

      Hippocrates died and was buried in Larissa, Thessaly. He is said to have died in about the same year as Democritus, which would mean that – depending on source – he died at the age of 90, or possibly 104, or even 109.

      His sons, both trained as physicians by him, continued the family tradition by training their own sons to be physicians both also named a son Hippocrates. In historical works, the subject of this article, Hippocrates of Kos, is often referred to as Hippocrates II, his grandsons as Hippocrates III and Hippocrates IV, and his grandfather as Hippocrates I.

      After Hippocrates’ death, a cult was established on his home island of Kos. Hippocrates was given divine status, with sacrifices made on his birthday. Whether Hippocrates, a rational scientist, would have approved of this we cannot be sure.

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      Further Reading
      Hippocrates, translated John Moffat
      The Prognostics And Prorrhetics Of Hippocrates
      T. Bensley, 1788

      Hippocrates, translated by W. H. S. Jones
      Hippocrates Volume 1
      Harvard University Press, 1923

      Jacques Jouanna, translated by M. B. DeBevoise
      Hippocrates
      The Johns Hopkins University Press, 1999

      Creative Commons
      Image of Greek Vase by Marie-Lan Nguyen under the Creative Commons Attribution 3.0 Unported license.


      Hippocrates of Chios

      The suggestion is that this 'long stay' in Athens was between about 450 BC and 430 BC.

      In his attempts to square the circle, Hippocrates was able to find the areas of lunes, certain crescent-shaped figures, using his theorem that the ratio of the areas of two circles is the same as the ratio of the squares of their radii. We describe this impressive achievement more fully below.

      Hippocrates also showed that a cube can be doubled if two mean proportionals can be determined between a number and its double. This had a major influence on attempts to duplicate the cube, all efforts after this being directed towards the mean proportionals problem.

      He was the first to write an Elements of Geometry and although his work is now lost it must have contained much of what Euclid later included in Books 1 and 2 of the Elements. Proclus, the last major Greek philosopher, who lived around 450 AD wrote:-

      Hippocrates' book also included geometrical solutions to quadratic equations and included early methods of integration.

      Eudemus of Rhodes, who was a pupil of Aristotle, wrote History of Geometry in which he described the contribution of Hippocrates on lunes. This work has not survived but Simplicius of Cilicia, writing in around 530 , had access to Eudemus's work and he quoted the passage about the lunes of Hippocrates 'word for word except for a few additions' taken from Euclid's Elements to make the description clearer.

      We will first quote part of the passage of Eudemus about the lunes of Hippocrates, following the historians of mathematics who have disentangled the additions from Euclid's Elements which Simplicius added. See [ 6 ] both for the translation which we give and for a discussion of which parts are due to Eudemus:-

      To follow Hippocrates' argument here, look at the diagram.

      Now since segment 2 is twice segment 1 , the segment 2 is equal to the sum of the two segments marked 1 .

      However, Hippocrates went further than this in studying lunes. The proof we have examined in detail is one where the outer circumference of the lune is the arc of a semicircle. He also studied the cases where the outer arc was less than that of a semicircle and also the case where the outer arc was greater than a semicircle, showing in each case that the lune could be squared. This was a remarkable achievement and a major step in attempts to square the circle. As Heath writes in [ 6 ] :-


      The Sugar Timeline

      S ugar is an umbrella term for sweetness in its many forms—cane sugar, beet sugar, honey, molasses, fruit juice concentrate, maple syrup, high-fructose corn syrup, agave nectar, among the many naturally-occurring and synthetically-derived sweeteners known to humans. In early recorded history it was mostly a sweetener experience dominated by sugar cane and honey, and that is where our story begins.

      8,000 BC —It is conjectured that sugar cane was first domesticated in New Guinea and its cultivation then spread to Southeast Asia, China, and then beyond.

      2,400 BC —Earliest evidence of beekeeping in hives to collect honey for honey cakes found at a religious temple near present day Cairo, Egypt.

      350 AD —Sugarcane growers in India discover and master how to crystallize sugar using a boiling process of refining cane juice.

      11th Century —British and French Christian crusaders encounter sugar from sugar cane grown by Arabs and bring back this ‘new spice’ to their own lands where it becomes an expensive delicacy for the rich and nobility.

      1319 —A kilo of sugar (known as ‘white gold’) goes for two shillings a pound in London, the equivalent of about $50 a pound in current dollars, keeping it a luxury item that few people below the richest class will experience in a lifetime.

      1493 —On his second voyage to the ‘new’ world of the Americas, Christopher Columbus brings along sugar cane plant seedlings for planting in the Caribbean islands of Hispaniola, where the warm climate is conducive for growth of the plant, giving rise to the sugar cane industry.

      16th Century —Native Americans are enslaved by Europeans throughout the Caribbean islands, particularly Barbados and Jamaica, and in Central and South America, as labor to harvest sugar cane. When their numbers become depleted by disease and harsh working conditions, African slaves are shipped in to take their place in the fields and processing operations. Millions will die in the sugar cane fields from the brutal labor, lack of medical care, or in attempting to escape imprisonment.

      1700 —An average person in Britain consumes four pounds of sugar a year that amount will gradually increase as the price of sugar falls due to overproduction in the Americas, making it affordable for the middle class and poor.

      1747 —Sugar beets are identified as a new source of commercial sugar. This new source further drives down world prices and makes sugar more affordable to generations of lower and middle class people never exposed to it before. Sugar is being added to jams, candy, tea, coffee, and many other food items.

      1800 —A French medical student identifies the first series of patients with Rheumatoid Arthritis, a condition characterized by the body’s own immune system attacking joint linings and cartilage. Two centuries later medical research will link sugar consumption as a cause of Rheumatoid Arthritis.

      1807 —By the time Britain bans slave trading in this year, at least six million African slaves have been incarcerated on sugar cane plantations.

      1870 —The average resident of Britain consumes 47 pounds of sugar a year.

      1880 —Cheaper sugar beets now replace sugar cane as the principal sugar source for Europeans.

      1890 —Indentured servants now eclipse slaves as the primary work force worldwide growing and processing sugar. An estimated 450,000 indentured servants, most serving ten years or more in servitude, are moved around the world, most to Fiji, Hawaii, and Australia. Once indentured servitude ends in the early 20th Century, sugar production remains an industry characterized by meager wages and workers living in harsh working conditions and extreme poverty.

      1900 —The average Briton now eats about 100 pounds of sugar annually the average American consumes 40 pounds.

      1906 —A German physician, Dr. Alzheimer, first identifies a form of dementia characterized by dramatic shrinkage Sugar’s Sordid Timeline History 21 in brain nerve cells. By the end of the 20th century, an estimated 5 million Americans a year will be diagnosed with Alzheimer’s disease.

      1910 —A medical explanation emerges in the U.S. for the rising rates of diabetes: the pancreas of a diabetes patient was unable to produce what termed “insulin,” a chemical the body uses to break down sugar. Thus, excess sugar ended up in the urine.

      1962 —An estimated 13% of American adults meet the criteria for obesity.

      1967 —A Japanese scientist invents a cost-effective industrial process for using enzymes to convert glucose in cornstarch to fructose. High Fructose Corn Syrup derived from corn becomes a cheap alternative sweetener to sugar.

      1975 —In the U.S. 400 new cases of cancer occur for every 100,000 people.

      1984 —Soft drink manufacturers such as Pepsi and Coca-Cola switch from sugar to the cheaper high-fructose corn syrup in U.S. production facilities.

      1992 —Cancer rates have climbed to 510 new cases for every 100,000 people in the U.S.

      1997 —An estimated 19.4% of U.S. adults meet criteria for obesity.

      2004 —Obesity now affects 24.5% of U.S. adults.

      2005 —Each U.S. citizen eats about 100 pounds of added sugars each year, up from about 40 pounds in 1900.

      2008 —An ordinary American now consumes 37.8 pounds of high-fructose corn syrup every year, mostly unknowingly because it is laced in thousands of processed food and drink products. It is considered one of the ‘hidden’ sweeteners because, like many sugars and artificial sweeteners, it uses numerous chemical aliases making it difficult to identify on food label ingredient lists.

      2008 —The obesity rate for adult Americans reaches 32.2% of men and 35.5% of women. Obesity is considered a contributing factor to the deaths of nearly 400,000 Americans annually.

      2009 —The American Heart Association issues health recommendations that women consume no more than six teaspoons per day of sugars and men consume no more than nine teaspoons a day. Generally both men and women consume three times that amount daily.

      2015 —The Dietary Guidelines Advisory Committee, which meets every five years to issue dietary recommendations to the U.S. Department of Health and Human Services and the U.S. Department of Agriculture, advises for the first time that American consumers dramatically cut back on the amount of added sugars to 12 teaspoons a day, half of what Americans currently consume. Much of these added sugars are derived from consumption of juices, sodas and a wide range of sugary drinks.

      “A Brief History of Honey.” The Honey Association. http://www.honeyassociation. com/index.asp?pid=9

      A Splendid Exchange: How Trade Shaped the World. William Bernstein. 2009. London: Atlantic Books.

      “Adult Obesity Facts.” Centers for Disease Control and Prevention. http://www.cdc.gov/obesity/data/adult.html

      Alzheimer’s Foundation of America. Statistics. http://www.alzfdn.org/AboutAlzheimers/statistics.html

      “Cancer Statistics.” NIH Fact Sheets. National Institutes of Health. http://report.nih.gov/nihfactsheets/viewfactsheet.aspx?csid=75

      “Cancer Trends During the 20th Century.” Journal of Australian College of Nutritional & Environmental Medicine. Vol. 21, No. 1. April 2002.

      “Diabetes Public Health Resource.” Centers for Disease Control and Prevention. http://www.cdc.gov/diabetes/statistics/prev/national/figbyage.htm

      Dietary sugars intake and cardiovascular health: A scientific statement from the American Heart Association . Circulation, 120:1011–1020.

      “History of Type 2 Diabetes.” Healthline. April, 2013. http://www.healthline.com/health-slideshow/history-type-2-diabetes#3

      “How Sugar is Made—the History.” http://www.sucrose.com/Ihist.html

      “Is sugar the missing link in RA? Weissmann G. Internal Medicine News. 200639(16):11.

      “Major Milestones in Alzheimer’s Research.” Alzheimer’s Association. http://www.alz.org/research/science/major_milestones_in_alzheimers.asp

      “Periodontitis Health Guide.” The New York Times. http://www.nytimes.com/health/guides/disease/periodontitis/risk-factors.html

      “Processed Food: A 2-Million-Year History.” Scientific American .Vol. 309, Issue 3. http://www.scientificamerican.com/article/processed-food-a-two-million-year-history/

      “Sugar Consumption in the US Diet between 1822 and 2005.” Guyenet,Stephan & Landen, Jeremy. Online Statistics, Rice University andTufts University. http://onlinestatbook.com/2/case_studies/sugar.html

      “Sugar Love.” Rich Cohen. National Geographic. August, 2013.

      “Sugar and Sweeteners.” Anderson J. & Young L. Colorado StateUniversity, Fact Sheet No. 9.301. Food and Nutrition Series. Revised May 2010.

      “The Real Bad Egg Is Sugar.” The New York Times . Feb. 19, 2015.196 References

      The Sugar Barons: Family, Corruption, Empire and War. Matthew Parker. 2011. London: Hutchinson.

      “Why Did Thematoid Arthritis Begin in 1800?” Richard S. Panush, M.D. The Rheumatologist . Sept. 2012. http://www.the-rheumatologist.org/details/article/2543901/Why_Did_Rheumatoid_Arthritis_Begin_in_1800.html

      Educate and nurture people to take responsibility for their health.


      A Beautiful Mind: The History of the Treatment of Mental Illness

      Asylums. Electro-Shock Therapy. Skull Drills. Pills. Exorcisms. Isolation. Lobotomies. Many of the drastic procedures that have been put in place to relieve a person with mental illness such as schizophrenia are only successful in creating ‘vegetables’ out of patients, not curing their illness but making them ghosts of their previous selves.

      Throughout history, there have been radical changes in how the mentally ill are treated and cared for most of these occurred because of changing societal views and knowledge of mental illness. These changes have brought psychiatrics out of a negative light and have given psychiatric studies a brighter, more positive outlook.

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      The history of treating mental illnesses dates as far back as 5000 B.C.E. with the evidence of “trephined skulls.”

      In the ancient world cultures, a well-known belief was that mental illness was “the result of supernatural phenomena” this included phenomena from “demonic possession” to “sorcery” and “the evil eye”. The most commonly believed cause, demonic possession, was treated by chipping a hole, or “trephine”, into the skull of the patient by which “the evil spirits would be released,” therefore healing the patient.

      Although ancient Persians also believed that the illnesses were caused by demons, they practiced precautionary measures such as personal hygiene and “purity of the mind and body” in order to “prevent and protect one from diseases”.

      Similarly, the Egyptians recommended that those stricken with mental illness should participate in “recreational activities” in order to relieve symptoms which displayed that, as a civilization, the Egyptians were very advanced in their treatment of mental handicaps. (Foerschner)

      During the 5 th and 3 rd centuries B.C.E., the Greeks changed the way that psychological disorders were viewed. The philosopher and physician, Hippocrates, discovered that illnesses come from “natural occurrences in the body” (Foerschner).

      As Hippocrates was studying mental illness, he stepped away from the superstitious beliefs and towards the medical aspect of it. He studied the pathology of the brain and suggested that mental illness stemmed from imbalances in the body.

      These imbalances were in the “four essential fluids” blood, phlegm, bile, and black bile which produce “unique personalities of individuals.” In order to restore the body’s balance, the Greeks used techniques such as phlebotomies, bloodletting, purging, and imposing diets on the afflicted (Foerschner).One treatment that Hippocrates advocated was changing the occupation and/or environment of the patient.

      Although these treatments had gained popularity amongst most cultures, there were still vast majorities of people who believed in the supernatural causes of mental illness and used treatments such as amulets, talismans, and sedatives to “ease the torment” of the afflicted (Foerschner).

      Historically, those with mental illnesses had a “social stigma” attached to them. It was believed that “a mentally ill member implies a hereditary, disabling condition in the bloodline” threatening the family’s “identity as an honorable unit”.

      In countries, or cultures, that had strong ties to family honor, such as China and Japan and even some parts of the United States, the ill were hidden by their families so that the community or society that they were a part of wouldn’t believe the illness was “a result of immoral behavior by the individual and/or their relatives”.

      As a result of this social stigma, many of the mentally ill were forced to either “live a life of confinement” or were abandoned and forced to live on the streets. Any of those that were abandoned to live on the streets and were rumored “dangerous and unmanageable” were either put in jail or dungeons, out of the public eye (Foerschner, 1).

      According to Dr. Eve Leeman of the New York- Presbyterian Hospital, the social views on the sexes also affected the treatment of patients, particularly women. In the early 20 th century, women were “preferentially sterilized and lobotomized” and were sometimes even subjected to unnecessary procedures such as the five women in the Stockton State Hospital who were given a clitoridectomy. The justification for these procedures was that having a mental illness was “unladylike” and required “surgical intervention” (Leeman).

      These negative perspectives of the mentally ill were maintained throughout history and into modern societies as shown by Nurse Ratched’s treatment of the patients in One Who Flew Over the Cuckoo’s Nest (Kesey). Throughout the novel, Nurse Ratched abuses her position and uses her power to submit her patients to cruel treatment as punishment for misbehavior.

      This is due to the fact that she doesn’t see her patients as human beings but as animals who need to be trained.

      In the early 15 th century many of those afflicted with psychological disorders were placed in workhouses, madhouses, or asylums because it was too burdensome for the families to care for them. The state of these institutions was abhorable.

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      Those that were admitted to madhouses were abused and often abandoned by their caregivers who were not trained in the treatment of mental disorders. Private madhouses, however, were often run by clergy men on direct orders from the Vatican and were significantly more humane.

      The treatments instituted by the clergymen included regular church attendance, pilgrimages, as well as priests solacing individuals to confess their sins and repent. Asylums, on the other hand, were incredibly inhumane in the treatment of their patients.

      Many of those admitted were abused, abandoned, treated like animals, restrained with shackles and iron collars, cared for by untrained staff, and even put on display. An infamous example of the horrors of early asylums would be La Bicetre.

      In this French asylum, patients were shackled to walls with very little room to move, were not adequately fed, only visited when brought food, their rooms were not cleaned, and they were therefore forced to sit in their own wastes. Another example would be Saint Mary of Bethlehem, an asylum nicknamed “Bedlam” due to its horrific treatment of the mentally ill.

      Their “violent” patients were on display like “sideshow freaks” and their “gentler” patients were forced to beg on the streets. Patients who were allowed to be visited by family often begged their families to be released, however, since the current stigma of mental handicaps was so negative, their pleas would be ignored.

      Treatments in these asylums, as well as others, included purging, bloodletting, blistering, dousing patients in either boiling or ice-cold water to “shock” them, sedatives, and using physical restraints such as straitjackets (Foerschner).

      Due to the obviously horrific treatment of patients in asylums, many reforms began to take place starting in the mid-to-late 1800s.

      Two reformists greatly influenced the spread of what is known as the “Humanitarian Movement,” the first being Phillipe Pinel, in Paris. Pinel believed that “mentally ill patients would improve if they were treated with kindness and consideration” instead of filthy, noisy, and abusive environments he implemented his hypothesis when he took over La Bicetre.

      Another major reformist, William Tuke, founded the York Retreat where patients were treated with “respect and compassion” (Foerschner). After Tuke and Pinel, came Dorothea Dix who advocated the hospital movement and in 40 years, got the U.S. government to fund the building of 32 state psychiatric hospitals as well as organizing reforms in asylums across the world (Module 2).

      The Hospital movement started in the 18 th century and was justified by reasons such as: “to protect society and the insane from harm, to cure those amenable to treatment, to improve the lives of the incurable, and to fulfill the humanitarian duty of caring for the insane” (Dain).

      Along with the creation of state psychiatric hospitals, various organizations and acts, such as Mental Health America (MHA) and the U.S. Community Mental Health Centers Act of 1963, were created to “improve the lives of the mentally ill in the United States” (Module 2). With the reforms came the increase in psychoanalysis.

      Sigmund Freud, who is referred to as the father of psychology, was, basically, the creator of psychoanalysis. Freud wrote the Psychoanalytic Theory in which he explains “the id, the ego, and the superego” as well as therapeutic techniques such as hypnosis, “free thinking”, and dream analysis (Foerschner). Freud believed that allowing a patient to focus on repressed thoughts and feelings, he could cure the patient of his/her disorder.

      One form of psychoanalysis had goals to help and individual “identify and achieve their own goals” and would keep patients occupied and “thus cure them from delusions and irrationalities” (Dain). Lastly, Somatic treatment was introduced in asylums which included psycho-pharmacology, psychosurgery, electroconvulsive therapy, and electric shock therapy, among others.

      The first non-sedative drug used in the treatment of patients was chlorpromazine which “cured” many mental ailments and patients “became free of symptoms entirely and returned to functional lives” (Drake).

      The introduction of pharmacology led to the deinstitutionalization reform which changed the view from institutionalized care to “community-oriented care” to improve the “quality of life” (Module 2). According to Foerschner, this backfired and led to 1/3 of the homeless population being the mentally ill.

      Many of the treatments enacted on mentally ill patients throughout history have been “pathological sciences” or “sensational scientific discoveries that later turned out to be nothing more than wishful thinking or subjective effects” and haven’t actually benefited those being treated.

      But, with these failures have come new lessons which will inform the development of new treatments for new psychological disorders. iPhone addictions and the new difficulties brought on by Social Media and the Internet are growing challenges within younger generations and solutions will need to be found.


      GIVING BIRTH TO NATURALISTIC AND HUMANISTIC MEDICINE

      Little is known of Greek medicine before the appearance of written texts in the fifth century B.C. Greece as many other prehistoric countries possessed folk healers, including priest healers and chief tribunes employing divination and drugs. Greek society at large drew heavily upon sacred healing. In Homer, Apollo appears as the ‘god of healing’. Various gods and heroes were identified with health and disease, the more predominant being Asclepius, who is portrayed just as a tribal chief and a skilled wound healer since physicians did not seem to be much appreciated by that time. In Homeric times, physicians were of inferior standing and were considered craftsman, not noblemen. In the Odyssey, physicians are placed in a class with other itinerant laborers, and in the Homeric epic, Asklepius is not even recognized as the son of the god Apollo ( Homer, 1925). It is only after 700 B.C. with the Asklepieion myth told by Heriod and many others that Asclepius becomes the son of the god Apollo and therefore a semi-god. This upgrading of Asclepius’ position signified an upgrading of medicine and at the same time a re-orientation of medical care.

      The Edelsteins attribute the rapid ascendancy of Asklepius to his popularity among the poor and lower classes, who saw in Asklepius a god particularly interested in their welfare ( Edelstein and Edelstein, 1945). Alone among Greco-Roman gods, Asklepius is described as ‘looking after man’ and as a lover of all people regardless of station ( Aristides, 1973).

      Once Asklepius was recognized as the god of medicine, physicians who considered themselves followers of Asklepius had a clear obligation to treat the rich and the poor alike. The donations of the rich were used to subsidize care for the poor in the Asklepieions care units in a way that the contemporary welfare state redistributes income through taxation and social insurance. Cost shifting is evidenced by the many temple inscriptions recording cures of those able to afford traveling from out of town ( Edelstein and Edelstein, 1945). The Hippocratic Precepts explicitly encouraged similar cost shifting ( Hippocrates, 1923). An inscription at the Athenian temple to Asklepios on the Acropolis reads ‘These are the duties of a physician… he would be like God savior equally of slaves, of paupers, of rich man, of princes and to all a brother, such help he would give’ ( Oliver and Maas, 1939).

      Few centuries later the appearance of Asklepius, Hippocratic medicine makes a much more decisive step in refounding medicine upon a quite different basis: a healing system independent of the supernatural and built upon natural philosophy. This separation of medicine from religion points to another distinctive feature of Greek healing: its openness, a quality of Greek intellectual activity, which it owed to political diversity and cultural pluralism ( Porter, 1997). But Hippocratic medicine is not only an appeal to reason, and by that virtue a pre-scientific endeavor, but it was also a patient-centered rather than disease-oriented, concerned more with observation and experience then with abstractions.

      Therefore, it is not accidental that the well-known Asklepieions, a temple to the god, where Hippocratic medicine was practiced, like in Epidaurus, Kos and Pergamon were located in the countryside, in a valley or on a hill where the climate was healthy and the water was pure, among beautiful and clean surroundings ( Pentogalos, 1983). Nor was it accidental that these temples had in close proximity theatres, gymnasiums, pools and other facilities where the holistic approach to health was implemented in practice providing the prerequisites for physical, psychological, social and spiritual well-being. All these innovations comprised a radical re-orientation of health services, which shares a lot of similarities with Ottawa’s principles for health promotion.

      Asklepeia contributed in the maintenance of social capital and in the growth of the wealth of the country ( Corey et al., 1977). During the fourth and the third century the cult of Asclepius and the practice of Hippocratic medicine spread, and by 200 B.C. every large town in Greece had an Asklepieion.

      On the other hand, philosophy of ethics of Socrates would almost be inconceivable without the model set by medicine ( Raya, 1995). Ethics is the philosophical study of morality, the systematic examination and critical reflection on living morally, designed to illuminate behaviors that should be taken in consideration of ordinary actions, judgments and justifications. Beauchamp and Childress (1979) in their seminal work Principles of Biomedical Ethics documented four key ethical principles—autonomy beneficence, nonmaleficence and justice considered to be prima facia or to have equal weight or priority in a particular situation. Autonomy and justice, as already mentioned, were key principles in ancient Greek regiments. In health care, autonomous involves respect for clients’ rights to make decisions about and for themselves and their care. Beneficence and nonmaleficence are age old requirements of the Hippocratic Oath for health professionals to ‘do good’ and ‘do not harm’ ( Racher, 2007).

      Hippocratic doctors should take under consideration the social status of their patients, since their advices and guidance affected the way of life of the patients. They had to indicate those who could afford a wealthy life from the poor and they were also in charge of the health of the slaves ( Temkin, 1949).

      The fact that the institution of ‘public doctor’ was functioning in ancient Greece was not accidental. In Athens, these ‘public doctors’ were elected by the church of the people. The city was paying their salary in the same way it was paying for the drugs.

      In order to caver their salary and their expenses, a special kind of public taxation—called ‘ιατρικóν’—was taken place, thus providing for the care of the poor and wounded warriors. History though provides some testimonies about doctors, such as Menecratis from Syracuse, who was forcing the serious ill to become his slaves if he was able to cure them ( Flaceliére, 1971). However, this practice seems to be rather the exception than the rule of a dominant moral approach in ancient Greek medicine.

      The earliest writer to mention Hippocrates and his theories, Plato in his book Timaeus taught that morality was not simply a matter of education because the mind was influenced by the body, according to Plato, the doctor had a part to play in teaching virtue. Timaeus became a highly influential text, linking medicine and philosophy, health and politics, in such a way that reminds the contemporary conception of the sociopolitical determinants of health.


      Adult talents

      Hippocrates is credited with healing many, including the king of Macedonia whom he examined and helped to recover from tuberculosis (disease of the lungs). His commitment to healing was put to the test when he battled the plague (a bacteria-caused disease that spreads quickly and can cause death) for three years in Athens (430� B.C.E. ). It is also clear that the height of his career was during the Peloponnesian War (431� B.C.E. ).

      His teaching was as well-remembered as his healing. A symbol of the many students he encouraged is the "Tree of Hippocrates," which shows students sitting under a tree listening to him. In time he apprenticed his own sons, Thessalus and Draco, in the practice of medicine. The teacher and doctor role combined well in 400 B.C.E. , when he founded a school of medicine in Cos.


      Civilization's Painkiller: A Brief History of Opioids

      This article originally appeared on Medical Daily.

      Opioid abuse has become rampant in the U.S., whether the drugs are natural opiates like morphine and codeine (made directly from poppy plants) semi-synthetic opioids like oxycodone and heroin, developed in labs from natural opiates or fully synthetic/manmade opioids, like fentanyl, methadone and dextropropoxyphrene. All opioids, however, originated thousands of years ago in the form of a simple flower known as the Papaver somniferum, or the poppy plant. Here's how this little flower went from treating pain in ancient times to fueling a current epidemic of addiction.

      ANCIENT

      3400 B.C. The opium poppy is first cultivated in lower Mesopotamia. Named Hul Gil or the "Joy Plant" by the Sumerians, the plant was known to produce euphoric effects through the collection of poppy juice (opium latex, the "white milk" from the plant, which contains the naturally-occurring analgesic alkaloid morphine) in making opium.

      1300 B.C. The Sumerians pass the cultivation of the opium poppy to ancient Egypt, where the capital city of Thebes develops poppy fields known as opium thebaicum. During this time, ancient Assyrians, Babylonians and Egyptians used opium in both medicine and executions. The Ebers Papyrus, an ancient Egyptian medical document, describes using poppy grains to stop a crying child it was also administered to patients via sponge during long surgeries.

      During the next several hundred years, various civilizations gave opium religious and spiritual significance, often delegating its use only to priests, physicians, and magicians. Opium was widely cultivated, traded, smoked and used medically.

      460 B.C. Hippocrates, an ancient Greek physician known as the father of medicine, notes that opium is an incredibly useful drug in treating pain, internal diseases and epidemics. Specifically, he mentions drinking white poppy juice mixed with the seed of nettle, noting its features as a narcotic, hypnotic and cathartic drug, according to a report by the United Nations Office on Drugs and Crime (UNODC) website. Some 100 later, Alexander the Great of Greece introduced opium to Persia and India.

      MEDIEVAL

      400 A.D. Opium is introduced to China by Arab traders.

      1300. Not much is documented about opium during the Middle Ages in Europe, likely due to the fact that the Holy Inquisition had branded the Eastern drug as evil.

      1483. In China, one of the first clearest depictions of opium use is written by Xu Boling, who notes that it is "mainly used to aid masculinity, strengthen sperm and regain vigor," and also that "its price equals that of gold."

      1500. Portuguese traders come across opium again when trading along the East China Sea. They begin smoking the drug, noting it could affect a person instantly.

      1527. It isn't until several decades later, however, that opium is reintroduced to European medical texts and common usage. In the mid 16th century, a Swiss German philosopher and physician named Paracelsus returns to Europe after traveling throughout the Middle East, bringing back "Stones of Immortality" that contain opium thebacium and citrus juice, and are used as painkillers. Paracelsus is credited with developing laudanum, the medieval European term for opium as medicine.

      MODERN

      1600s. Shortly after opium is reintroduced into Europe toward the end of the Middle Ages, Portuguese trade routes begin directing opium into China.

      1700s. Dutch and British shipments of opium to China spark an opium epidemic, with addiction levels continuously rising. The Dutch introduce the notion of smoking opium in a tobacco pipe to the Chinese, and opium dens&mdashshops where opium is sold and smoked&mdashbecome more common in European and Chinese cities.

      1729. In an attempt to quell the opium epidemic in China, Emperor Yung Cheng prohibits opium smoking and selling it domestically, unless it was to be used as medicine. Despite these laws, the British East India Company was growing stronger and continued to import opium to China. In 1750, the company took control of Bengal and Bihar, huge opium markets that led to the British dominating the opium trade's entire route from India to China.

      1799. Chinese Emperor Kia King bans opium entirely.

      1800. In 1729, some 200 chests of opium per year arrived from Europe to China by 1800, that number rises to 4,500 chests, according to the Cambridge Illustrated History of China. By now, the British East India Company had established a monopoly on the opium trade, with Indian poppy growers prohibited from selling opium to other companies. Despite the Chinese ban the year before, Western traders attempt to smuggle opium into the country.

      1803. In Germany, a certain Friedrich Sertürner studies opium by dissolving it in acid and neutralizing it with ammonia, discovering its active ingredient. This experiment results in alkaloids, known as Principium somniferum, or morphine. For the first time in history, the poppy plant and opium has been "tamed" into what's considered "God's own medicine," a safe and effective way to treat pain. This is the beginning of the end of opium's reign, an era that ushered in new synthetic opioids.

      1839. During this time, the smuggling of opium continues into China. In 1839, Lin Tse-Hsu, imperial Chinese commissioner heading the opium suppression campaign, orders foreign traders to give up their opium. This sparks the First Opium War, as British warships are sent to the Chinese coast to protect Western mercenaries. The British ultimately defeat the Chinese in 1841, with one of the resulting concessions being that Hong Kong is given to the British.

      1843. Dr. Alexander Wood, a Scottish physician, discovers that injecting morphine into patients is far more effective and three times as potent.

      1874. Heroin &mdash known originally as diacetylmorphine &mdash is first synthesized by C.R. Wright, an English researcher working at St. Mary's Hospital Medical School in London. By boiling morphine and acetic anhydride over a stove for several hours, he was able to produce a more potent form of morphine. The new drug is described as inducing "great prostration, fear and sleepiness" after being injected into dogs and rabbits. It caused "the eyes being sensitive, and pupils constrict&hellipRespiration was at first quickened, but subsequently reduced, and the heart's action was diminished, and rendered irregular. Marked want of coordinating power over the muscular movements, and loss of power in the pelvis and hard limbs." Despite being heroin's predecessor, diacetylmorphine is not used widely in medicine until decades later.

      1898. Chemist Felix Hoffman, working at Bayer pharmaceutical company in Germany, develops an acetylated form of morphine that is more potent. It's dubbed "heroin," after the German word heroisch, which means "heroic" or "strong." For the next decade or so, heroin is produced commercially by Bayer, sold as a cough suppressant.

      1910. After nearly two centuries, the British dismantle the opium trade from India to China, with physicians and experts encouraging them to do so based on the knowledge that opium is addictive.

      1914. With the Harrison Narcotics Tax Act, non-clinical use of opioids, as well as cocaine, is criminalized in the U.S.

      1924. The U.S. bans heroin entirely. However, in light of diacetylmorphine leaving a need for painkillers, scientists begin developing designer drugs similar to hydromorphone and dihydromorphone.

      1930s-50s. More synthetic opioids are developed, including methadone, pethidine and fentanyl. In 1950, Oxycodone is available in the U.S. in the form of Percodan tablets.

      1960s-70s. The Vietnam War triggers increases in heroin smuggling into the U.S., and the number of heroin addicts in the U.S. continues to rise up to 750,000 people.

      1980s. Interestingly, this decade is defined by "opiophobia," in which most doctors were afraid of prescribing opioids to patients because of their addictive features.

      1990s. Pain management changes in the 1990s, when physicians begin prescribing more opioids after noticing that pain is generally undertreated. To make up for opiophobia before, however, doctors begin prescribing a little too much morphine, fentanyl, oxycodone and hydromorphone well into the 2000s, triggering the new opioid and heroin epidemic.

      2011. The Obama administration announces it must deal with what it calls an "epidemic of prescription drug abuse."


      Watch the video: Ο Όρκος του Ιπποκράτη - Η άγνωστη φιλοσοφία της Ιατρικής - Γιώργος Α. Χαραλαμπίδης (February 2023).

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