Hippocrates Oath and Principles

• The School of Medicine valued intellect, experience and ethics
• It focused on the healing capacity of the organism
• It recognized the healing force of nature, or "physis vitale"
• The relationship of trust with the patient is essential and requires a balance between technique and humanity
• Overcoming diseases is possible through accumulating knowledge
• Progressive improvement follows a linear rather than a circular route
• An intrinsic order in nature could be investigated and understood

Hippocrates Oath

• The oath involved swearing to carry out duties according to one's strength and judgment

• Doctors should esteem their master as a father and teach the art to their sons

• The standard of living should be regulated for the good of the sick

• Doctors should refrain from causing harm

• Doctors would not administer deadly drugs or suggest advice, or give abortion medicine

• Doctor's should guard their life with innocence and purity

• Doctors would not operate on those who suffer from the "evil of the stone" and will retreat in favor of men who dedicate themselves to this practice

• Doctors will enter any house for the relief of the sick

• Doctors will never divulge anything heard during their profession, holding such things as holy secrets``

• The very nature of medicine requires idealistic foundations like altruism and love, otherwise it may degenerate into a business

• Hippocratic doctors recognized this early on and preached idealism

• Socrates (470-399 BC, Athens) believed knowledge about human beings requires different tools and arguments than physical sciences.

• Plato (428-347 BC, Athens) referred to knowledge of things as doxa, and knowledge of ideas as nòesis, emphasizing absolute models.

• Aristotle (384-322 BC, Stagira, Macedonia) believed knowledge is organized into disciplines and knowledge comes from experience.

• Aristotle also questioned nature through scientific experiment

• Aristotle believed in things that are generated and exist in nature, there is a final cause

• He believed teleology and theology are two sides of the same coin

Greek Medicine and Dreams

• Incubation practice involved sleeping inside a temple's sacred areas
• Dreams were considered paths that the divinity would use to suggest the healing path
• Asclepius and Serapis were the most famous deities
• In "Sacred Speeches" by Elio Aristide, the placebo effect is explored, questioning how the power of a god could bring health, while others failed

Hellenism

• Knowledge was accessible to few and passed down without elaboration
• Some institutions included the museum and library of Alexandria
• Intellectuals and physicians were separated from the real world

Medicine in Rome

• There was synthesis between Greek and oriental medicine, specifically from Egypt

• Terentius Varro and Aulus Cornelius Celsus made catalogs and summaries of available knowledge inspired by Alexandria's library.

• There were military doctors who were paid by the state

• Pedanius Dioscorides (1st century AD) Wrote a treatise on Medical Therapy, focused on medicinal plants called “Herbolario”

• This list included hundreds of different erbal species, a copy of which is in Vienna: Codex Aniciae Julianae or Codex Vindobonensis

• There was a strong Hippocratic imprint but with magical and divinatory practices

• Claudius Galen (130-201 AD, Pergamum, Asia Minor) worked mainly in Rome as the physician of Marcus Aurelius.

• He was a proponent of Hippocratic medicine and its methodological and ethical rigor

• Galen believed that an excellent doctor must also be a philosopher

• The theory of humors survived until the 18th century and included includes blood, mucus (phlegm), yellow bile and black bile, associated with air, water, fire, and earth

• Health results from the balance of humors, known as eucrasia, versus dyscrasia

Four Temperaments

• Blood (Sanguine) Element: Air, Qualities: Hot, moist, Trait: Courageous, hopeful, amorous

• Yellow bile (Choleric) Element: Fire, Qualities: Hot, dry, Trait: Short tempered, ambitious

• Black bile (Melancholy) Element: Earth, Qualities: Cold, dry, Trait: Introspective, sentimental

• Phlegm (Phlegmatic) Element: Water, Qualities: Cold, moist, Trait: Calm, unemotional

• Treatment involved rebalancing moods and using the doctor's skill to find the right balance

• The organism was viewed as a unit.

• The theory of opposites guided: hot/cold/dry/humid through emetics, purgatives, laxatives, anesthetics such as castor oil, poppy latex, enemas, and bloodletting

• Each organ has a specific function to achieve perfect harmony

• Organisms are complex entities created in the optimal way

• No evolutionary or dynamic perspective or adaptation was considered

• Claudius Galen opposed commodification of medical are and asserted it is not possible to get rich and cultivate medical art

Medicine in the Early Middle Ages

• Isidore of Seville (570-636 AD) created the «Etymologiae», a 20-book encyclopedia, with the fourth dedicated to medicine.
• This work summarized medieval knowledge in Latin and focused on researching the etymology of words, considering the original meaning as more authentic.

Medicine in Byzantium

• Hospitals for civilian patients were established
• The first hospitals were in Egypt during the 4th century AD
• Initially they were secular, funded by the State and private donations
• A hospital in Byzantium had 5 sections
• Doctors were paid by the state, which was considered a privilege
• Carrying out private business was prohibited
• This indicated social management of public health, or "Byzantine socialism".
• xenodochia were religious "hospitals" adjacent to monasteries or bishoprics that hosted pilgrims, travelers, the poor, and the sick.
• The Code of Justinian (6th century AD) provided for orphanotrophia, ptochotrophia, and gerontocomia
• This meant there was hospitality in competition with private facilities
• "«it is therefore necessary to compare the damage expected from the administration of wine to the patient with the advantage expected to be obtained from it. If the favorable elements are preponderant
• It is allowed to let the patient drink some wine without worrying too much
• In fact, it is always possible that a drug that brings some benefit can also do some damage at the same time."
• The doctor needed to compare and evaluate these situations
• If each remedy is administered according to the right proportions and in the correct quantity, in due time and with decisive promptness, all the interventions of the medical art will have a successful outcome and will reach the goal: better outcome
• It is always possible that a drug that brings some benefit can also do some damage at the same time.
• Alexander of Trailes (525-605)

Arab Medicine

• Knowledge was believed to be a way of approaching God
• This was similar to Christianity
• There was syncretism or openness to other cultures, which originated from the tension towards God
• Nature was considered a testimony to God's work
• Scrutinizing the secrets of divine will was impossible
• Limits were place on man's action
• There were three levels of knowledge: empirical/experimental, rational/speculative, gnostic/fideistic
• practical orientation was favored, for example: surgical cleaning of purulent wounds
• Avicenna, Abû Alî al-Husain Ibn Sînâ, (Buckara, Uzekistan, 980-1037) favored religion and faith as interpretive tools of God's plan
• Averroes, Ibn Rushd, Cordoba (1126-1198) favored philosophy/science as the only interpretive key of God's plan
• ordinary mortal has access only to limited beliefs and implemented a "Double truth" theory

The Plague (Black Death)

• Evoked a lot of fear
• Thomas Malthus (1766-1834) proposed epidemics, famines, and wars served to regulate population
• The plague is caused by Pasteurella pestis or Yersin Bacillus
• Alexander Yersin isolated the bacillus in 1894, in China
• Transmitted by rat-flea-human species
• It came in bubonic, pneumonic and septicemic forms
• There have been numerous epidemics were described in scripture, such as in the Bible and the work of Thucydides
• The Bubonic and pneumonic plague of 1347-1353 caused 25-30 million deaths in Europe, which equated to 30% of the population
• It spread Caffa to Scandinavia
• It Had very high mortality rate among those infected with rates between 60-90%
• Official medicine was completely inadequate and impotent
• It Delegitimized tradition and the search for new answers
• Subverted human relationships
• Opposite reactions: penance or libertinism
• Some interpreted the outbreak as illness as divine punishment: the flagellants
• Hedonistic attitude
• Hatred for those who are different: the search for the scapegoat
• Etiology unknown and prompted many hypotheses
• Girolamo Fracastoro (1478-1533) theorized "microbial" contagion
• Pasteur and Kock were second half of the 19th century that contributed to this area
• Epidemics continued until the 17th century
• 1461, 1630 (Manzoni, The Betrothed) 1656-57 (Genoa), 1665 (London)
• Last: Marseille Plague (1720)
• The Health Magistrate was establish and first promoted in Italy
• Restriction of movement, health passports, quarantines
• Limes between East and West (health militia)
• Social organization
• The WHO reported : 2010-2015 around 3500 cases of plague on different continents
• There is no God so intolerant as to desire to take revenge on man by condemning him to death and suffering for the sins committed. Fighting with awareness against the evil generated by epidemics may mean having to free ourselves from our own prejudices, recognizing the common fragility of human beings before any temptation to discriminate against anyone
• A difficult path where the plague had the merit of illuminating, forcing man to exercise the most difficult of his values and his possibilities of choice, forgiveness and acceptance of others. F. Perrozziello, medical historian, 2020.

Infectious Diseases

• There was a Theory of the spontaneous generation of <«inferior» living beings
• Gerolamo Fracastoro theorized about contagion with his book De contagione et de contagiosis morbis (1546)
• "Seminaria" were theorized as spreaders of the disease (typhus)
• Orpiment was arsenic and sulphur that was used to combat this
• Antoni Van Leeuwenhoek (1632-1723) posited microorganisms were visible only under a microscope
• Francesco Redi (1626-1697) and Lazzaro Spallanzani (1729-1799) provided evidence against the theory of spontaneous generation
• Louis Pasteur (1822-1895) gave the definitive proof against this

Ignác Fülöp Semmelweis

• Obstetric Clinic directed by Prof. Johann Klein (1788-1856) was in Vienna in 1846
• Puerperal fever had caused high death rates among women giving birth
• It especially affected ordinary women who gave birth in the hospital
• The Second Obstetrics department directed by Prof. Bartch: had almost no instances of puerperal fever
• There was University department vs. hospital department based on attendance of interns
• Reversal of frequency was seen with Puerperal fever also in the second ward
• Poor women who gave birth on the street were protected from puerperal fever
• Hand washing with a disinfectant solution helped
• Prof. Klein did not agree with Semmelweis and he was fired
• There was the death of a colleague and friend that was injured during autopsy and then got speticemia
• Semmelweis Resumed to work in the second department
• He imposed disinfection and hand washing again resulting in a mortality from puerperal fever of 0.27%
• He was but he was fired again
• He returned to Budapest in 1849
• He created Obstetrics department San Rocco hospital
• He developed a Treatise: Etiology of puerperal fever
• He made contact with Rudolph Virchow and in 1856 he became Chief at the San Rocco department
• Imposition of hygiene measures had poor results
• He was Unheard, derided as a doctor and as a teacher
• He advised women not to give birth in hospital
• Began to show signs of mental instability
• He was admitted to a mental hospital in June 1865 then died in August of the same year

Louis Pasteur (1822-1895)

• Joseph Meister (1876-1940)
• July 6th, 1885 represented an important discovery
• Pasteur determined The yeast responsible for the fermentation of beets and found it to be a living organism
• Preservation of milk after pasteurization was later discovered
• Left-handed and right-handed isomer molecules were found
• 1864 : an experiment on "spontaneous generation"was carried out
• In 1985 he Developed a rabies vaccine
• 1892: Dmitry Ivanovsky demonstrates the existence of infectious particles smaller than bacteria
• In 1898 the term virus was introduced

Quotes of Louis Pasteur

• Theory is the mother of practice; without theory, practice is nothing but a habit formed by habit; only theory develops the spirit of invention
• "there are narrow minds who disdain everything in science that does not have immediate application in the field of observation, luck only strikes minds prepared to receive it"
• Work published in 1879 with the title «Conservation, revolution et positivisme» is full of the errors that the positivist doctrine made him commit both in politics and in sociology. Why be surprised? Politics and sociology are sciences in which proof is too difficult to give. The number of factors that contribute to the solution of the problems they raise is too high When human passions intervene, the field of the unexpected is immense. 27 April 1882

Medicine and Nazism

• There was a Social Darwinism push
• Society must take responsibility for improving its composition through social evolution
• David Emile Durkeim (1858-1917, French) and Herbert Spencer (1820-1903, English) sought to identify «social diseases» and prepare «cures»
• People must be allowed to freely live in a competitive society
• Alfred Hoche (1865-1943) and Karl Binding (1841-12920), Germans wrote «Permission to destroy lives unworthy of life»
• State was thought to have the right and duty to get rid of "unfit" human beings
• Francis Galton (1822-1911) English, cousin of Charles Darwin coined Eugenics to improve the human species using strategies introduced by man
• Adolf Jost, 1895 wrote «The right to one's own death» while promoting the idea that The state has the right to organize the birth and death of individuals

Impacts of Nazism on Medicine

• Mein Kampf (My Battle) was published in 1924
• It put forward the idea of a Natural inequality among individuals and that Submission of inferiors to superiors – the human races
• Alfred Rosenberg (1893-1946) and Joseph Goebbels (1897-1945) were inspired by Joseph Arthur de Gobineau (1816-1882, French)
• His work, Essay on the inequality of human races touched on Nordic-Mediterranean-Slavic races
• United States as an example: Native Americans
• Lothrop Stoddart (1883-1950) USA used the Bolshevik danger as an example of downward pathway
• He spoke of Risk of degeneration of the species and prevalence of individuals of "lower rank"
• The United States and Scandinavia carried out tens of thousands of forced sterilizations in over 20 states
• The prestige that medicine had gained fueled the eugenic push
• Germany Passed the Law on the prevention of the birth of people affected by hereditary diseases on July 25, 1933
• This was used to sterilize About 400 thousand people
• It created Hereditary health courts made of two doctors and a judge
• About 350,000 people sterilized
• There was No major protests from doctors, civil society or the Church
• 1935: the program Lebensborn was enacted
• 1939: Program T4 was put forward at Tiergartenstrasse 4, Ministry of Health, Berlin
• Eugenics taken to the extreme - Extermination camps
• Many Jews adhered to Marxism
• There was a Madagascar Project and Operation Barbarossa
• Extreme planning and bureaucratization was carried out
• Doctors had a central role: high respect for formal aspect
• Trucks with red cross insignia and doctors in immaculate white coats!

Modern Era Medical Advancements

• Joseph Lister (1827-1912) wrote ON THE ANTISEPTIC PRINCIPLE IN THE PRACTICE OF SURGERY in 1867
• Ernst von Bergmann (1836-1907) promoted Asepsis
• William Halstead (1853-1922) promoted the Use of gloves during surgery