Hydatid cysts in Classical and late Antiquity / Quistes hidatídicos en la Antigüedad clásica y tardía

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Liver abscess in ancient Greek and Greco-Roman texts.

OBJECTIVE: This paper presents liver abscesses, as studied in the ancient Greek and Greco-Roman bibliography. METHODS: Numerous references concerning this entity can be found in the writings of the Hippocratic doctors (5th cent. B.C.), Archigenes of Apamea (1st cent. A.D.), Galen (2nd cent. A.D.), Aretaeus of Cappadocia (2nd cent. A.D), Oribasius (4th cent. A.D.), Theophilus Protospatharius (7th cent. A.D.), and Paulus Nicaeensis (7th-10th cent. A.D.). RESULTS: In most cases the clinical manifestations, the prognosis and the method of treatment are presented. In all ancient writings we studied, the rupture of a liver abscess is also part of the main theme. In specific, the path that the fluid would follow after a rupture was considered to be a main prognostic factor, i.e. if the fluid "coursed into the stomach", the patient would definitely die. CONCLUSIONS: In this work, an attempt is also made to correlate the ancient descriptions to modern medical entities, such as amebic or pyogenic liver abscess.

The manifestation of "gangrene" in the Hippocratic corpus.

We trace the early historical references concerning "gangrene," specifically in the treatises of the Hippocratic corpus. The term "gangrene" today refers to the necrosis, or death, of tissues resulting from prolonged ischemia, bacterial invasion, and subsequent putrefaction. Apart from the name "gangrene," another term, "sphacelus," exists in the corpus, referring to similar decay. An effort is made to correlate cases of "gangrene" and "sphacelus" described in the Hippocratic texts and related bibliography. In this study we retained only references to "sphacelus" that have the same end points as "gangrene." References to necrosis of the skull, the brain, the teeth, the jaw, the extremities, the ribs, and some resulting from "ulcers" were isolated. Their clinical manifestations, prognosis, and treatment are presented, together with general comments on the disease's etiology.

The ancient technique of "gastrorrhaphy".

OBJECTIVE: The paper describes "gastrorrhaphy," deriving from the Greek words "gastir" meaning "abdomen" and "rhaphy" meaning "suturing," which was a technique used for the treatment of abdominal wounds. METHODS: The technique is described in detail in the texts of Celsus (first century A.D.) and in those of Galen (second century A.D.). Furthermore, references were found in Oribasius' texts (fourth century A.D.) and in the writings of two veterinarian doctors of the same period. We provide our drawings in order to elucidate the different techniques of suturing. RESULTS: Celsus described one method of "gastrorrhaphy" while Galen presented two different methods for this procedure. All three methods agree on the processes required: replacement of the prolapsed viscera, cleaning of the wound, and suturing. The difference in methods is in the way of suturing the wound; Celsus suggests stitches in layers. While Galen's first method refers to stitching of the peritoneum with the abdominal wall, his second method refers to stitching of similar structures, meaning peritoneum to peritoneum and abdominal wall to abdominal wall. CONCLUSIONS: Celsus' method strongly resembles stitching in layers with cross-sutures, while both of the Galenic techniques of gastrorrhaphy are versions of the full-thickness sutures used nowadays. It should be stressed out that Galen's methods of "gastrorrhaphy" were used by Andreas Vesalius and Ambroise Paré many centuries later.

Management of obesity in the writings of Soranus of Ephesus and Caelius Aurelianus.

Caelius Aurelianus (5th century AD) is famous for translating the writings of Soranus of Ephesus (2nd century AD) into Latin. In his book On acute and chronic diseases, Caelius gives an almost complete edition of the works of Soranus, while adding some of his own and other writers' material. Obesity was even at that time considered to be a disease and the authors treat the subject extensively. The nature, etiology, the clinical manifestations of obesity are described, although treatment covers the greatest part of the material. Infliction of perspiration, very low caloric intake diet, exercise, and diuresis are proposed, and one cannot overlook the strong similarities of some of the treatments with those used nowadays as secondary aids for weight loss.

"Empyemas" of the thoracic cavity in the Hippocratic Corpus.

Thoracic "empyemas" appear often in the Hippocratic Corpus and with detailed descriptions of their etiology and clinical manifestation. To find the precise thoracic location suffering from "empyema," the physician asks the patient to turn on one side and inspects there for pain. The Hippocratic physicians give a very detailed description of "empyemas" caused by "peripneumonia," which is an illness resembling today's pneumonia. The proposed therapeutic method in this case, thoracostomy and drainage of the empyema, constitutes a cornerstone of our surgical heritage, appearing for the first time in the Hippocratic texts.

Jaundice in the Hippocratic Corpus.

The Hippocratic physicians were among the first who described jaundice (icterus). The Hippocratic Corpus has numerous appearances of the condition, where its etiology, description, prognosis, and treatment are provided. The connection made between the liver and jaundice was remarkable, bearing in mind that the Hippocratic physicians had not performed dissections and that their medical views were based on observation. The Hippocratic doctors described five kinds of jaundice. The etiology was, as in most cases of diseases mentioned in the Hippocratic Corpus, "humoral" imbalance. The diagnosis and prognosis were based on the color of the skin, the urine, the feces, and several other factors, such as the season of the year during which the disease first appeared or the coexisting diseases. The treatment, finally, consisted of herbal medications, baths, diet, and blood-letting, depending on the type of jaundice in question. Finally, an attempt is made to correlate modern diseases with the Hippocratic types of jaundice.

Greco-Roman and Byzantine views on obesity.

This paper focuses on the Greco-Roman views on obesity with certain extensions to the Byzantine era. The writers reported hereby are Aulus Cornelius Celsus (circa 25 BC), Dioscorides Pedanius (40-90 AD), Soranus of Ephesus (98-138 AD) whose writings on the subject survived through Caelius Aurelianus (5th c. AD), Claudius Aelianus (3rd C. AD), Oribasius (324-400 AD), Aetius of Amida (circa 450 AD), Alexander Trallianus (6th c. AD), Paulus Aegineta (7th c. AD), and Theophilus Protospatharius (9th C. AD). All of the authors treat the subject of etiology, clinical manifestations and treatment, while the Hippocratic and Galenic views seem to be taken into consideration. The most important observation made on the basis of the studied texts is the emersion of the notion of the "Mediterranean diet" that was advised as an extremely successful conservative way to treat obesity. The Greco-Roman and Byzantine writers continue the long tradition of treating obesity and set the foundations for modern methods of treatment.

Goitrous beauty in Artemisia Gentileschi's Judith and her Maidservant.

This paper discusses the representation of goiter in Artemisia Gentileschi's painting Judith and her Maidservant. Judith is depicted with a goiter, which despite being the manifestation of a possible hypothyroidism, in no way detracts from her beauty. The case is presented in the wider context of the representation of goiter in art.

Obesity in the Neolithic era: a Greek female figurine.

In this paper, we present a female figurine made of clay, found in Farsala, Thessaly, Greece, and which is housed in the Athanassakeion Archaeological Museum of Volos, Greece. This Neolithic figurine has visible characteristics of female obesity and belongs to a class of figurines ironically named "Venuses". The figurine is described, and speculation underlying the reason for its construction and uses are presented. In addition, the historical and social background of the Prehistoric period is taken into consideration, in an attempt to evaluate the characteristics of ancient feminine obesity and compare it to its modern definitions.

Galen on obesity: etiology, effects, and treatment.

Only a few studies have been conducted to determine the historical background of obesity, and even fewer have focused on specific writers who have made great contributions on the subject. Galen was among the first to establish scientific methods to describe and treat morbid obesity, and a presentation of his ideas is important because of the influence he has exerted even up to modern times. The methodology of the current research was based on detailed study of Galen's treatises, which concern the nature of obesity, the etiology, the consequences, and the treatment, often in comparison to the writings of other writers from the Hippocratic period up to recent years. Galen stated that obesity results from the surplus of "bad humors" in the body and specifically from a surplus of blood. He specifically described patients' conditions, both physiologic and practical; he presented side effects; and he introduced methods of treatment that are used even today. Galen also described an illness he called polisarkia, which today we call morbid obesity. According to Galen's views, we can identify morbid obesity under the description of polisarkia. Galenic physiology and pathology have been proved wrong and have been set aside. Nevertheless, he proposed some treatments for obesity such as diet, exercise, and medications that are still valuable and are nearly the same as what is advocated today.

Methods used by the hippocratic physicians for weight reduction.

In classical antiquity, particularly in the Hippocratic Corpus, obesity was considered the cause of disease and, in the extreme, death. This attitude mirrors the general ideology of the times where any deviation from the norm and from logic was unacceptable. The image of balance and of the ideal body weight was clearly depicted in ancient Greek art. The same attitude is reflected in the Hippocratic texts where obesity is again condemned as a deviation from the norm. The cause of obesity refers to the surplus of one of the liquids circulating in the body. Thus treatment points mainly to restoring the balance of liquids. This is accomplished by diet, drugs, and most importantly exercise. Walking, running, wrestling, and other practices are advised together with baths, massage, rest, and the "appropriate" life style.