Drugs for mental illnesses in ancient greek medicine.

Drugs with psychedelic, hypnotic, narcotic, analgesic, suppressive, euphoric and stimulating effects were used in various ways during the ancient times. We can classify drug use in ancient times into two main categories. On the one hand, ancient physicians prescribed drugs based on their pharmaceutical-therapeutic actions. On the other hand, people not pertaining to medicine and not relating to its accurate implementation often abused drugs to achieve an euphoric state of mind, either for personal gratification or as an indispensable element of religion and mythology. Ancient Greek medical literature contains ample prescriptions and recipes indicating that plants were the essential components of drugs. Pedanius Dioscorides dedicated his lifetime's work to the synthesis of ancient drugs. One can find a plethora of information concerning the production methods and the plants used in drugs for the treatment of psychiatric diseases. These were herbs like black and white hellebore, mandrake, hyoscyamus (henbane), Papaver somniferum (also known as opium poppy), Strychnos, Frankincense-tree and dorycnium. The preparation of narcotics included the addition of other elements, mainly wine, to the opus of plants or to their extracts. Drugs were produced via methods of dehumidification/desiccation, grinding, squeezing or boiling of the plants' roots with a formation of a juice, oil or mush extract. In addition, drugs could also be inhaled if burnt. Many physicians of antiquity, such as Hippocrates, Galen, Ctesias and Aretaeus of Cappadocia, all refer to many of these aforementioned drugs analyzing the different symptoms which they could address, and the risks accompanying their use. Physicians of antiquity used drugs for the treatment of somatic, as well as psychiatric disorders. Most of these drugs affected the central nervous system. Taking advantage of their analgesic properties, physicians used them for the management of severe and chronic painful conditions. The hypnotic effects of some drugs were desirable in order to be used as anesthetics for surgical operations and cauterization. Drug use was also established in the initial treatment of epilepsy and seizures, regardless of their cause. Public rituals and mythology were the two main contexts in which drug use flourished, outside the realms of medicine. The psychotropic and especially the hallucinatory effects of drugs caused the person under their influence to lose control, rendering him incapable of governing his actions and thoughts. These consciousness-altering medications were frequently the central focus of mythology. In this case, one would dictate and give orders to another person, which under any other circumstances would not be carried out. This led to the formation of the concept of the magic potion. Theophrastus frequently referred to magic potions.

From thyroid cartilage to thyroid gland.

The ancient Greek physicians skipped the description of thyroid gland probablydue to their difficultly to understand the anatomy and the existence of this organ.Although the ancient physicians had described the disease bronchocele (Greek:Βρογχοκήλη), this disease did not correspond exactly to goitre. The first officialdescription of this gland was made by Andreas Vesalius (1514-1564). Thomas Wharton (1614-1673) in his work Adenographia was the one who coined the term 'Glandulae thyreoidea'.

[Psychosomatic disorders in ancient Greek medicine].

The concept of psychosomatic disorders, as defined by modern medicine, was difficult to be perceived by the ancient Greek physicians. Two main reasons contributed to this. One was that physicians in Greek antiquity had formed the idea that the mental illnesses that were recognized at that time, namely mania, melancholy, frenzy, caros, lethargy, apoplexy, but even epilepsy, was the result of a disturbance of the essential elements of the body, the balance of them contributed to the preservation of health. Thus, depending on the school of medical thought of each physician in antiquity, mental and corporal illnesses were the result of various disorders such as the dyscrasia of humors for the physicians of the Dogmatic school that followed the Hippocratic principles or the disorder of the qualitative characteristics of the humor and the pneuma (air), as the physicians of the Pneumatic School considered, but also of the stenosis or the expansion of the pores as the physicians of the Methodic school thought. Although there was the perception that the diseases were the result of various combinations of the previous theories, as concluded by the physicians who constituted the Eclectic school. The second reason was that ancient physicians could not perceive the autonomy of man's psychic world as an element of human nature in which emotional distress and irrational mental processing of stimuli from the social, cultural and natural environment of the individual would be aggravating to the challenge of mental imbalance. Nevertheless, many physicians such as physicians who wrote various work of Corpus Hippocraticum, Soranus of Ephesus (1st - 2nd c. AD) Galen (1st - 2nd c. AD), Aretaeus of Cappadocia (1st - 2nd or 4th c. AD) and Caelius Aurelianus (5th c. AD) did not forget to describe in their works psychosomatic disorders as they are defined by modern medicine. In their works there are the observations about intense sweating, tremor, eating disorders, hysteria and even death as a result of an intense and long psychological unrest. These corporal symptoms, although were onset due to a psychological unequilibrium they could not been listed by the ancient Greek physicians in any of the mental diseases as they were defined in antiquity. The psychological disturbance which could provoke the above corporal disorders arose by various phobias, shame, sorrow, anger, envy, excessive drinks and food, excessive sexual desire, passion for gambling and anxiety of everyday life.

Homosexuality according to ancient Greek physicians.

Homosexuality and pedophilia in ancient Greece greatly concerned many researchers who were mainly interested in highlighting the social aspect of this phenomenon in ancient Greek society. An important source on the subject was the paintings of a man and his lover in attic black and red figured pottery, up to the end of the 5th century BC. Another main source was the information that derived from the texts of ancient Greek literature, especially poetry. Homosexuality was not only referring to relationships between males, but it was also manifested in lesbian love. It is believed that in the Homeric world homosexuality was not favored. In Greek society of the archaic period, the restriction of women at home, the satisfaction of sexual needs with courtesans, the marriage for the purpose of maintaining and managing the property, put women aside, marginalizing them in terms of social life, impeding the cultivation of emotional relationships between sexes. At the same time, in the society of those times, the aristocratic ideal, the constant communication of men during military training and the war, the male nudity in sports and the promotion of beauty and bravery in athletic contests, as well as the gatherings and the entertainment of men at the symposia, created a suitable substrate in which male homosexuality could develop. In this context, pedophile relationships were developed mainly during the archaic period, as recorded on vase paintings, where a mature man developed a special relationship with a teenager of the same social class. The mature man had the role of mentor for the juvenile, he would look after him and cover his living expenses and education cost. In this relationship, exhibiting predominantly the social dimension of an initiation process and introduction to adult life, the erotic homosexual intercourse could find a place to flourish. The above-mentioned relationship could not last forever, given that this would later transform into an emotional connection of friendship and trust. Besides, the constant homosexual relationships and male prostitution were considered to be reprehensible behaviors. Regarding the lesbian love, the main example was Sappho and her poems that praised love between women. Nevertheless, the relationship with the girls in the poems is considered to be similar to that Socrates had with his students, an intense personal relationship which would not involve sexual love and could probably be a platonic love. Ancient Greek physicians used their methodological tools in order to interpret homosexuality as a mental disease, but ancient medical dogmas such as the theory of humors, stereopathology and their variations could not offer an explanation for homosexuality.

Dreams in ancient Greek Medicine.

Dreams preoccupied the Greek and Roman world in antiquity, therefore they had a prominent role in social, philosophical, religious, historical and political life of those times. They were considered as omens and prophetic signs of future events in private and public life, and that was particularly accentuated when elements of actions which took place in the plot of dreams were associated directly or indirectly with real events. This is why it was important to use them in divination, and helped the growth of superstition and folklore believes. Medicine as a science and an anthropocentric art, could not ignore the importance of dreams, having in mind their popularity in antiquity. In ancient Greek medicine dreams can be divided into two basic categories. In the first one -which is related to religious medicine-dreams experienced by religionists are classified, when resorted to great religious sanctuaries such as those of Asclepius (Asclepieia) and Amphiaraos (Amfiaraeia). These dreams were the essential element for healing in this form of religious medicine, because after pilgrims underwent purifications they went to sleep in a special dwelling of the sanctuaries called "enkoimeterion" (Greek: the place to sleep) so that the healing god would come to their dreams either to cure them or to suggest treatment. In ancient Greek literature there are many reports of these experiences, but if there may be phenomena of self-suggestion, or they could be characterized as propaganda messages from the priesthood of each sanctuary for advertising purposes. The other category concerns the references about dreams found in ancient Greek medical literature, where one can find the attempts of ancient Greek physicians to interpret these dreams in a rational way as sings either of a corporal disease or of psychological distress. This second category will be the object of our study. Despite the different ways followed by each ancient Greek physician in order to explain dreams, their common intention was to give a rational answer for the creation and content of dreams setting aside any supernatural beliefs. In addition they tried to explain in a scientific way the correlation that could have emerged between the story that took place in dreams and the events that happened in everyday life. Nevertheless, ancient Greek physicians focused especially on nightmares, which were associated with physical problems. For those physicians these nightmares included information about the corporal disease of the patient, which had a reflection in the dream, and they could help them to diagnose the problem in order to restore balance of the body.

Mental health and sexual activity according to ancient Greek physicians.

The ancient Greek physicians have not failed in their studies to indicate the beneficial role of sexual activity in human health. They acknowledged that sex helps to maintain mental balance. Very interesting is their observation that sex may help mental patients to recover. Nevertheless they stressed emphatically that sex is beneficial only when there is a measure in it, so they believed that sexual abstinence or excessive sexual activity affect negatively the mental and physical health of man. Ancient Greek physicians reached this conclusion by empirical observation. They tried to justify the mental imbalance, as the potential physical problems, which probably will be listed today in the psychosomatic manifestations, of people with long-term sexual abstinence or hyperactivity, based on the theory of humors which was the main methodological tool of ancient Greek medicine. Their fundamental idea was that the four humors of the body (blood, phlegm, yellow and black bile) should be in balance. Therefore they believed that the loss and the exchange of bodily fluids during sex help body's humors to maintain their equilibrium which in turn will form the basis for the physical and mental health. Although in ancient medical texts the irrationality presented by people in the aforementioned conditions was not attributed in any of the major mental illnesses recognized in antiquity, as mania, melancholy and phrenitis, our belief is that their behavior is more suited to the characteristics of melancholy, while according to modern medicine it should be classified in the depressive disorders. We have come to this conclusion, because common characteristics of people who either did not have sexual life or was overactive, was sadness, lack of interest and hope, as well as paranoid thinking that can reach up to suicide. Regarding the psychosomatic problems, which could occur in these people, they were determined by the ancient Greek physicians in the following; continuous headaches and heaviness, dilatancy, pain, dysuria and fever. But all these symptoms would disappear when the man gained a measure sexual activity, as was categorically stated by Galen. It is striking that these ideas were maintained over time, starting already from the authors of the Hippocratic Corpus, from which the distinguished work De virginum morbis, refers indeed to women who reached the point of suicide due to the absence sexual life, hanging themselves or falling into wells and eventually passing to the works of Rufus of Ephesus, Soranus of Ephesus and Galen.

Ophthalmic malignancies in antiquity as depicted in two terracotta figurines.

Ocular and orbital wall cancers were recognized by the physicians of the antiquity as incurable, lethal, and non-operable malignant entities. Paul of Aegina (7(th)c AD) was the first to refer to this type of cancer and proposed only some palliative measures, while the same approach was also preserved by Theophanes Nonnus (10(th)c AD). However, two terracotta figurines of the Hellenistic period (323-30 BC) which depicted tumorous malformations in the eye area, raise a scientific debate on the matter. Hellenic art, once more contributed in a didactic way to preserve medical knowledge of the past, and served as an auxiliary tool in order to facilitate medical study.

The medical-religious practice of votive offerings and the representation of a unique pathognomonic one inside the asclepieion of corinth.

Votive offerings to the healing gods were a common religious custom for the ill believers to achieve the expected cure. The dedication of votive offerings began in Prehistoric Crete and continued during the Classical Period, mainly connected with the god Asclepius. Most offerings presented healthy members, while in some rare cases a disease had been displayed. A unique votive offering, found in the Asclepieion of Corinth, presented an anomaly, bringing to light the religious beliefs of the era. The custom of votive offerings was absorbed by the Orthodox Christians and still remains a common practice.

Suicide in ancient Greece.

The theme of suicide appears several times in ancient Greek literature. However, each such reference acquires special significance depending on the field from which it originates. Most of the information found in mythology, but the suicide in a mythological tale, although in terms of motivation and mental situation of heroes may be in imitation of similar incidents of real life, in fact is linked with the principles of the ancient Greek religion. In ancient drama and mainly in tragedies suicide conduces to the tragic hypostasis of the heroes and to the evolution of the plot and also is a tool in order to be presented the ideas of poets for the relations of the gods, the relation among gods and men and the relation among the men. In ancient Greek philosophy there were the deniers of suicide, who were more concerned about the impact of suicide on society and also these who accepted it, recognizing the right of the individual to put an end to his life, in order to avoid personal misfortunes. Real suicides will be found mostly from historical sources, but most of them concern leading figures of the ancient world. Closer to the problem of suicide in the everyday life of antiquity are ancient Greek medicines, who studied the phenomenon more general without references to specific incidents. Doctors did not approve in principal the suicide and dealt with it as insane behavior in the development of the mental diseases, of melancholia and mania. They considered that the discrepancy of humors in the organ of logic in the human body will cause malfunction, which will lead to the absurdity and consequently to suicide, either due to excessive concentration of black bile in melancholia or due to yellow bile in mania. They believed that greater risk to commit suicide had women, young people and the elderly. As therapy they used the drugs of their time with the intention to induce calm and repression in the ill person, therefore they mainly used mandragora. In general, we would say that there were many reasons to suicide someone in antiquity. Very important factor was to avoid captivity and the consequent overcrowding of indignity, especially for politicians and military leaders. Also intention in these circumstances was to avoid torture and the disgrace of rape. Strong grief is another reason, as in case of death of family members. The erotic disappointment had place in ancient suicides, which concerned both men and women, while there were also suicide for financial reasons. Especially for the elderly, the despair of the anility in conjunction with physical illness and cachexia, were important factors for these people to decide thee suicidal. Finally, the methods of suicide fitted their epoch, but bear resemblance to those of the modern time. Poisoning was very common to both men and women but equally popular in both sexes was also the hanging. It was not unusual to fall from a high in order to reach the death, while stabbing a sword in the body for self killing was widespread in men and soldiers.

The fascinating germ theories on cancer pathogenesis.

For more than 100 years, the germ theory of cancer, proposing that microorganisms were at the origin of the disease, dominated medicine. Several eminent scientists like Etienne Burnet, Mikhail Stepanovich Voronin, Charles-Louis Malassez, and Francis-Peyton Rous argued on the pathogenesis presenting their theories that implicated cocci, fungi and parasites. The impact of these theories was culminated by the Nobel Prize in 1926 that was attributed to the Danish scientist Johannes Fibiger for his work on the nematode Spiroptera as a causative agent in cancer. Even if those theories were the result of fantasy and misinterpretation, they paved the way for the scientific research in oncology.

Aretaeus of Cappadocia and the first accurate description of uterine carcinoma.

In our article we present the work on uterine cancer of the distinguished physician Aretaeus of Cappadocia. Uterine cancer was known since antiquity and its presence is testified in ancient Egyptian and Greek medical writings. However in the 2nd century AD Aretaeus provided the first accurate description of uterine cancer, dividing it in two forms, an ulcerated and a non ulcerated, both painful and fatal.

The distinguished surgeon Bertrand Bécane (1728-1802?) and the syphilitic theory of cancer.

Bertrand Bécane, Professor of surgery in Toulouse Medical School, is considered an eminent precursor of oncology, influencing the 18th century medicine with his syphilitic theory of cancer.

The great surgeon Jean-Louis Faure (1863-1944) and his contribution in the treatment of uterine cancer.

At the beginning of the 20th century, Professor Jean-Louis Faure, one of the leading surgeons of the innovative Parisian Medical School, published an exhaustive work on uterine cancer. He was the first to perform in France the procedure of total abdominal hysterectomy by median section of the uterus contributing to the evolution of cancer surgery.

Suicide in the Byzantine Empire.

Studying the suicide in the Byzantine Empire is difficult due to the limited number of references to it. Their number is greater in the early years of the Empire, mainly because of the persecution of Christians and gradually decreases. The attitude of the Church also gradually hardens, as well as the law. The law was strictly followed to the West, but as far as the Eastern Empire is concerned there are no references of punishment, confiscation of property or vandalism of dead bodies mentioned. Avoiding public humiliation after a public crime or a military defeat, religious redemption, emotional disturbance and debts, are the main cause of suicide. There are some references of mass suicides, while women suicides are relatively fewer, if the early Christian years are excluded. Suicide is more acceptable to the pagans because of their lifestyle. The therapeutic approach comes mainly through the treatment of depression. Aretaeus and Galen cite some ways to deal with the disturbance in the internal balance of black bile. Their view echoes through the centuries and the subsequent doctors embrace it. At least after the 9th century, more importance is given to the patient's bliss. Gemistus Pletho tried to revive the Platonic view of suicide shortly before the end of the Empire. The Church forbids Christian burial and troubled soul hovers in an intangible journey.

The approach to melancholy on 30.1 Aristotelian problem.

Τhe 30.1 Aristotelian problem is the most comprehensive and organized analysis of the phenomenon of melancholy in Aristotelian Corpus. Although, there are serious doubts if this text, as it was survived today, was written by Aristotle (384-322 B.C.) or by one of his followers -perhaps Theophrastus (372-287 B.C.)- nevertheless it is widely accepted that reflects the authentic ideas of Aristotle. The two counterbalancing sentiments, this of mirthfulness and this of moroseness, which are attributed in the text to the "melancholic" persons, introduce the primary difficulty, in order to be understood the unclear notion of melancholy in this work. All the previous approaches understood these sentiments, as diversity in the symptomatology of melancholy that is the ancient mental disorder which is similar to modern depression. But according to our point of view, this text is a study of pathological physiology, underling the significant role of black bile as the causative factor of the above two emotions in humans under the specific influence of temperature. Humor's overheat had as result the mirthfulness and its overcooling the moroseness. The reference to the healthy people and the graduation of the quantity of black bile in human body, as little, middle and massive, which is associated to the mentally ill persons, indicate that these two emotions were not only recognized as pathological manifestations of patients, but also as temperamental characteristics of healthy people, which arise from the same alteration of this humor, when its quantity is limited. Examining deeper the psychopathological aspect of this content, we may assume that, due to the fact mirthfulness was presented in the form of excessive enthusiasm, passion and courage and on the other hand moroseness by the distinctive elements of irrational fear, indolence and absurdity, the first one referred to mania and the second to melancholy, since their descriptions correspond to the basic features of each disease. Therefore, under the new reading, black bile should be perceived as the common source of the above two mental disorders, expressing the Aristotelian version of their correlation, which preoccupied many of the ancient Greek physicians as Themison (1st century B.C.) and his followers, Rufus of Ephesus (1st century A.D.), Galen (130-201 A.D.) and Aretaeus of Cappadocia (2nd century A.D.). This one probably derived from the difficulty to be fixed the limits between these two diseases, because anger and fear could be present in both situations provoking the confusion. Finally, we should reject the hypothesis of bipolar disorder's presentation, because text's generality does not allow the limitation to only one pathological phenomenon, while the absence of particular data on the duration and sequence of the two different emotional states acts as a deterrent for such a conclusion.