Module 5: Health and Disease

Objectives:

  1. Students will articulate the difference between transmission and miasma.
  2. Students will demonstrate an understanding of the impact of plagues on society and medicine.
  3. Students will understand the importance of dietetics as a less invasive treatment in ancient medicine.

Miasma Theory / Environment

Hippocrates, Airs, Waters, Places (This is 15 pages long.  It can be dry at times, but it is difficult to underestimate its importance in this course.  This is clearly intended for the itinerant physician as a basis from which to make assessments about typical diseases in each town, though it is stressed that he must consider individual cases.  In the beginning Hippocrates also stresses looking at the lifestyle of the patient, which looks forward to our section on dietetics.  He then goes on to address which winds are healthful and which are not, followed by which types of water are dangerous or safe.  Paragraphs 12-24 are devoted to a comparison of the people of Europe and Asia.  Hippocrates explains the characteristics of each race in relation to their climate.  It may be interesting to compare descriptions of these races to Herodotus’ descriptions of them.  What prejudices are revealed?  How would this influence the diagnosis?  Does this still happen today?  Also, what is the relationship between nomos and phusis in the development of character?  You can compare this with current theories of environmental medicine.  Here is an interview with Dr. Lisa Nagy, who studies environmental medicine.  You can break the reading up by assigning airs to one group, waters to another, and places (the comparison of Europe and Asia) to another, though I highly recommend that they all read the entire work.)

Assignment: Have the students assess the climate and terrain of their hometown and predict, according to Hippocrates, what diseases they are most likely to suffer from.

Rosenberg, Charles, “Epilogue: Airs, Waters, Places. A Status Report” (This article is 10 pages and very readable.  He shows how the ideas in AWP were carried into the 18th and 19th century.  He also brings up issues of public health and the role of the doctor in society.  This article is less about the Hippocratic text and more about the impact it had on future medicine and how our present concepts of the body and disease interact with it.  It is a quick read and may help students understand why these texts are important to understanding our own society and ways of understanding the world.)

Epidemics 1.Section II. 8-9 (This is a very short reading, about one page.  It is a good selection of how a change in climate can affect one’s constitution and health.)

Nutton, Vivian, “Patterns of Disease” in Ancient Medicine. (This chapter is 17 pages long.  This is not the best copy. I will see if I can remedy that soon. He spends the first three pages discussing demographics, which would be extremely helpful to students at this point.  He also acknowledges the difficulties with identifying ancient diseases, but goes on to “sketch an outline of the disease profile in Classical Antiquity” (23). Nutton, then, goes on to discuss the absence of a concept of public health in antiquity.  He gives a nice overview of what diseases were the most prevalent in antiquity, reminding the reader that the treatments and the healers could be just as dangerous as the disease.  Overall, this chapter is extremely helpful in gaining a big picture of disease and how the concept of disease develops over time.)

Longrigg chapter on “Epidemic Disease” (This chapter is 12 pages, however, much of the material will be useful for the Plagues section of this module.  The section on Rational Causation focuses on the air as the cause.  This could be a good opportunity to discuss whether or not they understood infectious transmission, which is mentioned in Rosenberg’s chapter above.  The section on the Athenian Plague contains mostly Thucydides and Diodorus.  If you wanted to leave off Diodorus, I think you could address how he uses Thucydides as a model in class.  In his final note in this section, Longrigg discusses the adaptation of miasma theory by the Hippocratics.  Because these texts cover the topics of environment, miasma theory, and plague, they provide an excellent bridge to the next section.)

Plagues

R. J. Littman, “The Plague of Athens: Epidemiology and Paleopathology” (This article is 12 pages long and very easy to read.  This article will certainly be interesting to students with a public health and medical background.  There is an abstract at the beginning so students can know where the argument is going.  He begins with a brief overview of plagues throughout history.  About two of which (Antonine and Justinian) we will read.  The difference between his epidemiological approach and previous clinical approaches to the Athenian plague are clearly outlined.  Littman carefully mines the text and walks the reader through the epidemiological evidence in Thucydides.  He also mentions the DNA evidence from a mass grave in Athens uncovered in 2001.  Students might find this new discovery exciting.  It will hopefully leave them with the sense that there is still work to be done.

Robin Mitchell-Boyask. Plague and the Athenian Imagination : Drama, History and the Cult of Asclepius (Chapter 7.) This chapter is 17 pages long. I would recommend this as background reading for instructors. Most of the article is dedicated to making connections between Dionysus and Asclepius. If you wanted to include material culture you could use this article to discuss the uniqueness of the Asclepeion in Athens as a reaction to the plague.

On My Own Books (There is a brief mention of the Antonine Plague on page 8)

Danielle Gourevitch, “The Galenic Plague”(This article is 13 pages long.  It has a lot of very technical vocabulary and Greek and Latin words that are not translated, so it should not be assigned to undergraduates in its entirety.  However, it does translate all the relevant passages of Galen regarding the Antonine Plague.  Pages 62-64 contain a description of the plague from Galen’s Methodus Medendi. Gourevitch goes on to discuss which disease this might have been, but the article is valuable for its citations alone.)

Procopius Book 2.22-33 (This text is only 3,000 words, and so should take no more than 30 minutes to read.  This is a description of the Plague of Justinian.  Procopius outlines the course of the disease and its symptoms noting its impact on society.  His description is similar to Thucydides in many ways, however there are traces of Hippocratic writings as well.)

Assignment: Compare the descriptions of the Athenian, Antonine, and Justinian plagues.  How does genre dictate what is included and excluded?  How do the earlier authors influence later authors?  Can you find traces of influence from authors studied in the course so far?

Dietetics (Lifestyle Differences, Elitist Perspective)

Hippocratic On Ancient Medicine (This is 20 pages in its entirety.  In Chapter 3, the author roots the study of regimen, and therefore medicine, in early man.  Chapters 5-6 address whether or not the sick should eat solids.  In Chapters 8-11, the author discusses hunger and depletion.  Chapter 12 defends medicine’s methods of discovery.  Chapters 13-15 deal with the properties of food: hot, cold, wet, dry, insipid, and astringent.  Chapters 16-17 discuss the body’s attempt to balance coldness with heat and vice versa and 18-19, the importance of balancing the humors.  The author defends the study of dietetics as crucial to the understanding of humans in Chapters 20-21.  Chapters 22-23 address the relationship between humors and “structures” of the body.  This treatise can drag on at times and the author’s terminology may be confusing to some undergraduates.  However, this could also look forward to the module, “Medical Ethics/The Doctor in Society,” because the author discusses what can happen if a patient receives a bad remedy.  However, if you want to focus on dietetics only, you can cut the reading down to Chapters 3-15.)

Hippocratic On Regimen in Health (This reading is only 6 pages long.  It begins on page 45, after “On the Nature of the Human Being.”  Make sure that your students know which one they are reading.  This is a list of diets for different constitutions and different body types.  The author takes into account whether they are wet or dry, old or young, athlete or layperson, and overweight or thin.  Overall, this is a quick read that students might enjoy more than On Ancient Medicine.)

Galen – On Hygiene (Text forthcoming.  We will be looking at Book 2.1.)

Assignment: Have students write up the basic tenants of a Hippocratic or Galenic diet in modern terms and compare with a modern dietetic regimen.  See if the other students can figure out which one is the ancient diet.