Neurological concepts in ancient Greek medicine

225 Pages·2016·1.64 MB·English

by  Thomas M Walshe III

Neurological Concepts
in Ancient Greek Medicine

Neurological Concepts
in Ancient Greek Medicine
THOMAS M. WALSHE III, MD
ASSISTANT PROFESSOR OF NEUROLOGY
HARVARD MEDICAL SCHOOL
CHIEF, GENERAL NEUROLOGY DIVISION
BRIGHAM AND WOMEN’S HOSPITAL
BOSTON, MA
1
1
Oxford University Press is a department of the University of Oxford. It furthers
the University’s objective of excellence in research, scholarship, and education
by publishing worldwide.Oxford is a registered trade mark of Oxford University
Press in the UK and certain other countries.
Published in the United States of America by Oxford University Press
198 Madison Avenue, New York, NY 10016, United States of America.
© Oxford University Press 2016
All rights reserved. No part of this publication may be reproduced, stored in
a retrieval system, or transmitted, in any form or by any means, without the
prior permission in writing of Oxford University Press, or as expressly permitted
by law, by license, or under terms agreed with the appropriate reproduction
rights organization. Inquiries concerning reproduction outside the scope of the
above should be sent to the Rights Department, Oxford University Press, at the
address above.
You must not circulate this work in any other form
and you must impose this same condition on any acquirer.
Library of Congress Cataloging-in-Publication Data
Names: Walshe, Thomas M., author.
Title: Neurological concepts in ancient Greek medicine / by Thomas Walshe.
Description: Oxford ; New York : Oxford University Press, [2016] | Includes
bibliographical references and index.
Identifiers: LCCN 2015026009 | ISBN 9780190218560 (alk. paper)
Subjects: | MESH: Neurology—history—Greece. | Greek World—history—Greece.
| History, Ancient—Greece.
Classification: LCC RC339.A1 | NLM WL 11 GG6 | DDC 616.800938--dc23 LC record available at
http://lccn.loc.gov/2015026009
9 8 7 6 5 4 3 2 1
Printed by Sheridan, USA
This material is not intended to be, and should not be considered, a substitute for medical or other
professional advice. Treatment for the conditions described in this material is highly dependent on
the individual circumstances. And, while this material is designed to offer accurate information
with respect to the subject matter covered and to be current as of the time it was written, research
and knowledge about medical and health issues is constantly evolving and dose schedules for
medications are being revised continually, with new side effects recognized and accounted for
regularly. Readers must therefore always check the product information and clinical procedures
with the most up-to-date published product information and data sheets provided by the
manufacturers and the most recent codes of conduct and safety regulation. The publisher and the
authors make no representations or warranties to readers, express or implied, as to the accuracy or
completeness of this material. Without limiting the foregoing, the publisher and the authors make
no representations or warranties as to the accuracy or efficacy of the drug dosages mentioned in the
material. The authors and the publisher do not accept, and expressly disclaim, any responsibility for
any liability, loss or risk that may be claimed or incurred as a consequence of the use and/or
application of any of the contents of this material.
CONTENTS
FOREWORD VII
PREFACE IX
NOTE ON THE REFERENCES XV
1. Neurologic Concepts in the Homeric Epics 1
2. Hippocrates and the Corpus Hippocraticum 16
3. A Neurology Text Before There Was Neurology 27
4. On the Sacred Disease: Hippocrates 43
5. Head Injury 61
6. On Wounds of the Head: Hippocrates 65
7. Hippocratic Medicine and Neurologic Conditions 83
8. Ancient Greek Ideas of Cognition 107
9. The Separation of the Nerves from Other Fibers 136
10. The Hellenistic Pursuit of Neuroanatomy 153
11. The Hippocratic Oath and a Modern Digression 176
INDEX 195

FOREWORD
Medical lectures invariably contain the phrase “we now know that… .”
We are told that, thanks to our powerful tools of genetics and imaging,
we are in a completely unique era and on the cusp of unlocking all of the
secrets of biology and disease. We are constantly amused by what they
thought “back in the day.” But, is this true? In fact, is it even remotely
possible that our era is any more unique and enlightened than any prior
one?
In his compelling work, Neurological Concepts in Ancient Greek
Medicine, Thomas M. Walshe, an expert neurologist and Greek scholar,
weaves 11 essays into a fascinating story of what the ancient Greeks
thought about what we now call neurology. His analysis begins with ref-
erences to the nervous system found in the Homeric epics, which reflect
ideas from the 13th century BCE. Although there are no actual medical
descriptions in the Odyssey and Iliad, Walshe scoured the texts for ref-
erences to the nervous system, which reveal some sophistication about
the contents of the skull and nervous system disease, often traumatically
induced. The story then leaps forward eight centuries to the Hippocratic
literature of the fifth and fourth centuries BCE. A detailed analysis of The
Sacred Disease and a new Walshe translation of the text follow. Wounds of
the Head is analyzed next with another new translation of this work from
the ancient Greek by Walshe.
Walshe then analyzes the major features of Hippocratic medicine,
followed by a consideration of what the ancient Greeks thought about
viii FOREWORD
cognition and aspects of the peripheral nervous system (i.e., nerves and
other fibers). The most modern aspect of the book is the Hellenistic pur-
suit of neuroanatomy, covering the period 323–31 BCE. Walshe’s essays
end well before Galen’s profound effect in the common era on concepts
about medicine and neurology. In his final chapter, Walshe translates the
Hippocratic Oath and muses about the distortions and ironies that mark
our current medical experience.
Every physician will be edified by reading this book. Those interested
in the nervous system may have a particular penchant for it, but anyone
interested in the perspective of history on modern thought will find this
a compelling work. In Walshe’s self-deprecating preface, he worries out
loud about how the classical scholars will rate his work. I believe they
will be pleased that a modern neurologist would take this subject so seri-
ously as to study Greek and work on the preparation of this manuscript
for over 30 years. In reading this wonderful compendium of essays, one
cannot help but wonder if our current concepts of biology, medicine, and
neurology are really superior in any sense to those of the ancient Greeks.
Perhaps that is Walshe’s major message. Perhaps this is not a question that
has any real meaning.
Martin A. Samuels
Chairman, Department of Neurology
Brigham and Women’s Hospital
Boston, MA
PREFACE
The story of neurology as a discipline begins in the 17th century with
Thomas Willis, who opened the door to neurology with his observations
of the anatomy, pathology, and clinical aspects of the nervous system.1
The field was not fully realized until much later in London in 1859 with
the founding of the National Neurological Hospital at Queen’s Square.2 In
1892, France saw the birth of clinical neurology as a separate discipline at
the Salpêtrière Hospital with Jean Martin Charcot, who was a specialist
of diseases of the nervous system. Neurology was defined in the United
States by the development at Boston City Hospital (BCH) of a neurologi-
cal unit, endowed by the Rockefeller Foundation in 1925 to advance aca-
demic clinical neurology. Derek Denny-Brown, a New Zealander trained
in England in neurology, was recruited by Harvard Medical School in
the 1940s to lead the BCH Neurological Unit, which planted the roots of
neurology in the United States.3
The observations that became the discipline of neurology, however, are
foreshadowed in the ancient papyri from Egypt and are certainly found
in the ancient Greek world beginning with descriptions in the Homeric
epics. The Hippocratic doctors provided a starting point for modern
medicine, and although they did not have a firm basis in medical fact,
their works reveal the power of their observational skills. Medical prac-
tice progressed with the discoveries by Herophilus and Erasistratus in the
second century BCE that started the study of neuroanatomy. Galen and
other Greco-Roman physicians who wrote a few hundred years later at