What do medicine specialists ‘see’ in Greek Mythology – Pain, Anaesthesia, Analgesia

This post is a small collection of extracts from published works with reference to Medicine and ancient Greek Mythology.

1

Abstract We reviewed many of the essential Greek myths to identify the methods used at that time to relieve the pain of both illness and surgery, and we discovered many pioneering methods. Both gods and demigods implemented these methods to ease pain, to conduct surgery, and, on occasion, to kill mythological beings. The myths describe the three most common components of anesthesia: hypnosis, amnesia, and (an)algesia. Drugs and music-aided hypnosis were two of the most common methods use to treat emotional and surgical pain. This article identifies highlights in the development of concepts to treat pain in Greek mythology. The examples found in the Greek myths remind us of the historical significance of pain treatment.

(Source: “The art of alleviating pain in Greek mythology”, by Türe H, Türe U, Göğüş FY, Valavanis A, Yaşargil MG)

2

Abstract

Background: The purpose of this study is to describe the aspects of pain and his treatment as they were stated in Ancient Greece.

Material and Methods: The methodology of historical research was used. Publications and articles considering the subject was used.

Results: In ancient Greece understanding pain had the same value as treatment, and occupied many historians, tragedians and philosophers. The pain in the beginning it was treated by combination of religious rituals ( incantations ) and herbs. Asclepius and his family (wife and children) were the first recorded therapeutic group. From the Hippocratic period, and then we see the religious element begins to fade and scientific practices in pain management are in used. Herbs, plants, substances, special diets and healing techniques such as hydrotherapy are now to the forefront.

Conclusions: Basics in pain management in ancient Greece were plants and herbs and their derivatives in either beverage or pad etc. Indicative in ancient Greek literature there are reports nominative nepenthe , willow, mandrake, anise, etc that have to bring the capacity to soothe their pains. Some of the techniques and instruments we rescued to date average of folklore.

Introduction The word pain comes from the verb Paino / penomai, meaning ‘plod’ , in ancient Greek there are several words meaning pain such as algos, pathos (for describing psychological pain and suffering), odyni and pain.

Hippocrates used the word pain for the first time as a medical condition to describe a symptom of disease and it is likely the first symptom that mankind experienced.

Pain in the mythological era in ancient Greece Stories of Greek myths are all that remain of an ancient religion. Gods and goddesses represent the metaphors that ancient Greeks used to make sense of the world around them and of life in general. Greek mythology is full of myths and legends about Gods, semi gods and heroes but also about divine punishment, unearthly, enormous and hideous creatures and monsters. In an effort to explain pain and negative effects that had in their life ancient Greek people linked to several mythological creatures. Pain as viewed by ancient Greeks is known nowadays through their myths as documented by their Great epic poets Homer and Hesiod. None the less Greek philosophers such as Epicurus, Pythagoras, Aristotle, Plato were also preoccupied by pain, its nature and etiology. Great tragic writers such as Sophocles or even the comedy writer Aristophanes explored pain through their writings.

In his poems Homer has refers to pain as a state of mind, as a physical symptom symptom and emotional suffering. ‘Pain’ is used as a synonym to algos and odyni, used to point the torture of man as a result of war, injury throughout the long way journey of returning. In Homeric medicine, pain and disease was send to mankind as a divine punishment. The extensive use of herbs used by practitioners to heal pain and wounds included narcotics to relieve both physical and emotional suffering and for the soul to be alleviated.

Hesiod, in his great poem theogony, that is consisting of 1,022 verses, is referring the beginning of the world and to gods. This poem is the main source of information on Greek mythology and it is divided into five parts which are : Prooimio (introduction) , Kosmogonia – Theogony , Titans , Second phase of “Theogony ” and The birth of the heroes . According to this PONOS (pain) was the essence of hard labour and toil. A translation of this poem would be: “But abhorred Eris bare painful Ponos , and Lethe and Limos, and the Algea (Pains), full of weeping, the Hysminai and the Machai the Phonoi and the Androktasiai ,the Neikea , the Pseudo-Logoi , the Amphillogiai , and Dysnomia and Ruins, who share one another’s natures, and Horkos .” As mentioned pain was the brother of other mythical creatures called starvation, battles , Lawlessness, Ruins, Lies, murders and others. Ancient Greeks seem to attribute pain all negative results that had in their lives and compare them to those of starvation, murder and war.

Cicero (Marcus Tullius, 106–43 BCE), that was a Roman lawyer, orator, politician and philosopher. In his philosophical dialogue (De Natura Deorum) regarding the nature of gods claim that ponos (pain ) was the son of Nyx (night ) and Erevos ( a creature that representing the endless and silent night) , attributing him the same negative aspects.

The Philosophical aspects of Pain Pain used to be a fundamental question for ancient Greek philosophers, several of them had been preoccupied by it, his origins and nature. What is pain; Why man is in pain; What is the center of pain; What is the utility of pain ; These and many other questions can be found in the philosophical dialogues in ancient Greece.

In 500 B.C Antifon the Athenian, a sophist philosopher, stated that humans must act in ways that allowed him to live in great pleasure and in order to achieve it pain should be eliminated. Thus he developed a method that was healing the pain of soul and he named Alypia. He also claimed that he could give relief to tormented souls through speech and conversation therefore considered to be the precursor of morden psychotherapy.

Pythagoras of Samos 570 – 495 BC was an Ionian Greek philosopher, mathematician, and founder of the religious movement called Pythagoreanism. Pythagoras believes and teaches that pain, anger and pleasure have the potential to disrupt the harmony of soul. He argues that pleasure is something that a man pursues while pain is something involuntary. Alkmaion of Croton a Pythagorean philosopher that lived 5th century BC, was the first to dwell on the internal causes of illnesses. Alkmaion also placed the centre of pain and sensations in the brain and it was he who first suggested that health was a state of equilibrium between opposing humors and that illnesses are caused by environmental, nutritional and lifestyle related factors.

Pain in Ancient Greek tragedy and literature Pain is part of the daily life of people in ancient Greece due appearance in Ancient tragedies is frequent. Pain and emotional suffering is often attributed by the writers to their heroes. From one hand side we can see the tragic figure of Antigone in mental anguish of losing his mother and brothers and on the other hand the tragic figure of Philoctetes of Sophocles. And from the divine punishment of Orestis after murdering his mother to the burden of Ajax shame Ancient Greek tragedy is full of psychological and physical pain.

In the tragedy of Sophocles ‘ Philoctetes “the tragic hero suffers unbearable leg pain due to a wound that did not heal for nine years. In despair because of the excrutiating leg pain begs for death as his only salvation from the unbearable pain he experienced. The wound that bares those pains was caused by a snakebite and the pain was chronic with exacerbations and remissions. Also in tragedies there is reference to a magical herb, as the only relief of pain. Neoptolemus promises that he will carry him to Troy “in order to save him from pain. Indeed Philoctetes was cured by Machaonas.

Pain treatments in Greek antiquity A review of ancient Greek literature shows the complexity and variability that characterizes the meaning of pain, it may indicate a tyranny for the soul and body to a mythical daemon. Therefore, treatment practices were always associated to the chronological period and the social and scientific background of each era. The etiology of pain was defining the therapeutic methods that were used in different eras. It was thought that Gods punished men through pain and diseases but they could also relieve them. Apollo is the God that was attributed the gift of healing and manufacturing painkillers as well as the use of herbs to treat pain.

The son of Apollo, Asclepius, ” the healer “, as said by Homer (Iliad D 194) , was raised in Pelion by the centaur Chiron , who possessed the knowledge of healing with herbs and roots. Furthermore, Chiron taught Greek heroes hunting and healing art as well as Asclepius to heal any disease and any wound with prayers but mostly using painkillers and emollient herbs even surgery as necessary . Asclepius is considered an existing person who later on was worshiped like God. His wife Ipioni healed pain, his daughter Hygeia was the protector of preventive medicine , his daughter of Panacea led treatment, while Akeso and Iaso assist him in the healing process.

The oldest written information on practicing medicine and pain relief are given by Homer in his epic poems. As mentioned in those poems they used the “nepenthe” for emotional pain relief. In epic poetry ancient Greek heroes were not only trained in battle but also in medicine practices even more they used to pray to gods for healing and salvation.

Hippocrates (460 – 370.CH) lived in the golden age of Greek civilization. He was the world’s first doctor that separated diseases by religion, and searched the physical causes of them. According Hippocrates perceptions of human health , the human body had an equilibrium of four bile’s (blood , phlegm , yellow bile and black bile ) any interruption on this caused illness and pain. Thus, for the treatment of pain gave great deal to the restoration of all functions and had a holistic approach to the human body that he considered as a unity. In recommending treatments gave great importance not only to medicines (plant, animal or mineral), and baths, diet , exercise, the phlebotomist , the cautery , etc. The same perceptions had his descendants, Galen and Dioscorides. In the works of ” Hippocratic Corpus ” a collection of 236 plants is referred, including the hellebores that is causing repression, the luxuriance Belladonna , the henbane , the mandrake , the poppy , the extracts of willow bark , etc. 

(Source: “Pain: Aspects and treatment in Greek antiquity”, by Evangelos Fradelos, Georgia Fradelou, Ekaterini Kasidi)

3

Summary We endeavored to thoroughly review Greek mythology and collect tales dealing with anaesthesia and myochalasis (paralysis). Among the evaluated sources were the poems of Hesiod, the epics of Homer, the tragedies of the great Athenian poets (namely Aeschylus, Sophocles and Euripides) as well as the contributions of several Latin writers, including Ovid. We found several examples of achieving hypnosis, analgesia and amnesia through the administration of drugs (inhaled or not) and music. Adverse events of drugs used for this purpose, such as post-anaesthetic emergence delirium, hallucinations, respiratory arrest and penis erection, were described in the presented myths. We noted that providing sleep was considered a divine privilege, although several mortals (mainly women) exhibited such powers as well. The concepts of sleep and death were closely associated in ancient classical thought. This review may stimulate anaesthetists’ fantasy and may help them realise the nobility of their medical specialty.

4

The term ‘anaesthesia’ originates from the Greek word ‘aesthesis’ (αίσθησις), which means sense and the negative particle ‘a’ (an), so the whole word means “without sense”. As a medical concept denoting “loss of sensation”, the term ‘anaesthesia’ was mentioned in the Hippocratic Collection written by Hippocrates and his pupils. Later, in the first century AD, the pharmacologist Dioscorides used it to describe the hypnotic (sleep inducing) effects of the plant mandragora.

Traditionally, the beginning of modern anaesthesia is attributed to William Thomas Greene Morton, who in 1846 assisted at a surgical operation by rendering the patient unconscious with the administration of ether for the removal of a sizeable haemangioma. However, surgical procedures with the use of a kind of anaesthesia were also performed earlier than the 19th century. For example, Inca doctors chewed coca leaves and spat saliva into the wound to achieve local anaesthesia. Even earlier, ancient Egyptians used opium poppy and hyoscyamus for their analgesic and amnesic properties.

In this study, we endeavoured to retrieve the literature of Greek mythology and collate myths pertaining to the three components of anaesthesia (namely hypnosis, analgesia and amnesia) as well as myochalasis (i.e. paralysis).

Hypnosis

Achievement of hypnosis by gods Providing sleep was viewed as a divine privilege.
Gods helped, deceived or even punished mortals by making them sleep.

Hypnos According to Theogony (i.e. generation of the gods) of Hesiod, Hypnos (Sleep) was son of goddess Nyx (Night) and brother of Thanatos (Death), Oniros (Dream) and Erinnyes (Furies). The children of Hypnos were Morpheus (god of dreams), Phobetor
(who caused fear and created beasts in dreams) and Phantasus (god of fantasy and imagination, who provided the scenery of dreams). Grandchildren of goddess Nyx were Algos (Pain) and Lethe (Amnesia). One could not overlook that the above myth emphasises the strong relation between Hypnos (Sleep), Algos (Pain) and Lethe (Amnesia) which are the three components of modern anaesthesia.

Interestingly enough, Hypnos and Thanatos (personifications of sleep and death respectively) were considered brothers. The concepts of sleep and death seem to be closely associated in people’s minds; a fact probably contributing to the explanation of
fear that patients undergoing general anaesthesia experience.

Apollo, the god who embodies the ancient Greek values of harmony and reason, could heal but also induce death through plagues; he also had hypnotic powers. This was also the case for Apollo’s son, Asclepio, who was considered the god of medicine.

In his most famous temple in Delphi, Apollo temporarily alleviated Orestes from the menace of the Erinnyes (Furies) by making them sleep. Orestes killed his mother Klytaimnestra to avenge the death of his father Agamemnon and therefore was persecuted by the Erinnyes, goddesses representing the guilt one had after committing a terrible crime especially among family members.

Hermes, the divine herald, was praised as a sleep donor, protector of sleep and leader of the dreams.

There is an episode in the Trojan War where Hermes exhibited his hypnotic skills. Achilles killed Hector, son of King Priamos (Priam) of Troy, and kept the body in front of his tent. Hermes accompanied Priamos, who wanted his dead son’s body returned, when visiting Achilles and using his golden stick hypnotises the guards of Achilles.

Athena poured sleep in the eyelids of Penelope, the wife of Odysseus, to make her sleep and to relieve her sorrow for her missing husband. In another tale, the wise virgin goddess helped Hercules to kill the giant Alcyoneus by asking Hypnos to hypnotise the giant.

In a Hellenistic allegory written by Apuleius, Aphrodite grew jealous of the beauty of a princess named Psyche (personification of Soul) and sent her son Eros (Cupid) to avenge her. Eros fell in love with Psyche and went every night to her but asked her never to light a candle to see him. Eventually, Psyche disobeyed causing Eros to leave her. In her desperate quest for her lover, Psyche was captured by Aphrodite who forced her to carry out four almost impossible tasks. The fourth task was to fetch Persephone’s beauty casket from Hades (the underworld of the ancient Greeks). Psyche, victim of her curiosity, opened the casket and was immediately surrounded by a cloud provoking a death-like sleep.

Fortunately, Eros came to miss Psyche and he flew looking for her. As soon as he found her, he shut the cloud of sleep back in the casket and awakened the princess by pricking her with an arrow (or by kissing her on the mouth). By reading this myth, an anaesthetist with a lively imagination may recognise an example of volatile anaesthesia (i.e. the cloud inducing sleep), awakening an unresponsive patient with painful stimulus (i.e. pricking) and even mouth-to-mouth resuscitation.

In his eleventh labour, Hercules had to fetch fruit from a golden apple tree, a wedding gift to Hera from Mother Earth, which was guarded by the snake Ladon. According to the myth, Hesperides, nymphs of surpassing beauty, used magic herbs to put the snake to sleep, then cut the golden apple and gave them to Hercules so that the hero could accomplish his task.

Achievement of hypnosis by human beings It is interesting that the ability to make people sleep was given from the gods to several mortals as a gift. This reveals the everlasting desire of man to obtain the unique knowledge of hypnosis, which is the essence of anaesthesia. The most skilled mortal was Medea, a tragic female figure of ancient mythology. According to the myth of the Argonauts, Medea, daughter of the
king of Colchis, helped Jason to retrieve the Golden Fleece by hypnotising the dragon-guardian, using a magic potion which was sprinkled into its eyes while chanting incantations.

Achievement of hypnosis through administration of drugs In order to achieve anaesthesia these days, we use different kinds of drugs, a common practice in ancient times too. For instance, Hypnos could exhibit his sleep-inducing effects by sprinkling the dew of the river Lethe, by pouring hypnotic juices or by flapping his wings and creating hypnotic air. In the above myth, one can recognise examples of intravenous (hypnotic juices) and inhalational (hypnotic air) anaesthesia.

Several other examples of what could be inhalational anaesthetic agents were located. First, in the epic Odyssey where Homer portrayed the return trip of Odysseus; it was written that as soon as Odysseus boarded the ship of the Phaecians (Phaiakes), he lay down on the stern and was surrounded by a supernatural sleep-inducing breeze. Second, in the myth of Eros and Psyche, Psyche was surrounded by a suffocating smoke that induced a death-like sleep (as already mentioned).

On the other hand, several myths describe the use of herbs for providing sleep. In the myth of the Argonauts, for example, Medea helped Jason to reclaim the throne from his tyrannical uncle Pelias. For this purpose, Medea used magic herbs to hypnotise Pelias and his daughters, the Peliades, who experienced terrible hallucinations. Affected by these hallucinations, the Peliades killed their father by cutting him into pieces. One could parallel these magic herbs with modern agents, such as opioids, which might also be associated with hallucinations.

Modern anaesthetists know that sub-hypnotic doses of intravenous agents (i.e. serum of truth) can make patients completely co-operative and sincere.

Adverse events of drugs used for hypnosis Adverse events associated with the administration of anaesthetic agents were given very lively descriptions in numerous Greek myths. For example, in the story of the Argonauts, one could imagine a case of post-anaesthetic emergence delirium. Indeed, the dragon guarding the Golden Fleece appeared roused and upset after it regained consciousness from the herbs and spells of Medea because someone had stolen its treasure.

According to another version of the myth of Endymion, Zeus gave him youth but placed him under an eternal sleep. Selini (Moon) went every night to Endymion’s cave and made love to him. As currently recognised, penis erection is a rare, but possible adverse, side-effect in patients undergoing general anaesthesia especially with the use of propofol.

Not only adverse events but also antidotes of anaesthetic agents may be found in ancient myths. In an episode from the Odyssey, Hermes provided Odysseus with an antidote against the spells of the enchantress Kirke, who usually induced hallucinations and amnesia. Reading this myth for antidotes, one may think of naloxone (an opioid antagonist) or flumazenil (a benzodiazepine antagonist).

Achievement of hypnosis through music Apart from drugs, other measures such as music were employed in mythological times to provide sleep. For instance, Apollo’s lyre could cease the violence of Ares (the Olympian god of war and slaughter) and make gods and animals (Zeus’ eagle) sleep, according to the greatest lyric poet of classical antiquity, Pindar.

This was also the case for mortals, such as Orpheus (known for the beauty of his music), Medea and Jason. Jason used Orpheus’ lyre to put the Sirens to sleep so that the Argonauts could sail safely past. Recent contributions in the setting of the intensive care unit have revealed that music application (namely Mozart’s piano sonatas), compared with control, significantly reduced the amount of sedative drugs needed to achieve a comparable degree of sedation.

In addition, randomised controlled trials confirming the sedative effects of music over control during the perioperative period have been published.

Analgesia

Treatment of surgical pain Studying the national epic of the ancient Greeks, Homer’s Iliad, offers a plethora of narratives which can be viewed as examples of analgesia. For instance, when the god of war, Ares, was wounded he asked for the assistance of Paeon. Paeon, the wise physician of the Olympian gods, poured liquid milk from a plant on to Ares’ wound and healed him while relieving him of all pain. On another occasion, Machaon, one of Asclepius’ sons who saw action in the Trojan War, removed an arrow from Menelaus’ torso and sprinkled painkilling powder on the wound.

In addition, a case of effective analgesia was mentioned in the myth of Philoktetes, son of Poias, who was a great archer and the owner of the bow of Hercules. According to Sophocles, who wrote a socalled tragedy, Philoktetes was bitten by a snake. He suffered such unbearable pain that he could not stop screaming, causing his fellows to abandon him on the sacred island of Lemnos. The hero found some herbs to put on his wound to alleviate the pain. When the Greeks needed the assistance of Philoktetes to conquer Troy, they brought him from Lemnos to their camp. Machaon, or his brother Podalirius, operated on Philoktetes with the help of Apollo. They put him to sleep, cleaned the wound and finally applied a herb (provided by the wise centaur Cheiron) to cover the wound and ease the pain. Thus, while carrying out anaesthesia, the physicians also provided postoperative analgesia enabling Philoktetes to quickly return to the battlefield.

Treatment of emotional pain According to mythology, women exploited the properties of herbs to alleviate their emotional pain. We encountered such an example in the myth of the beautiful Helen, Zeus’ daughter and wife of Menelaus in Sparta, who was abducted by Paris with the aid of Aphrodite. This violent action instantly caused the beginning of the Trojan War. Helen, being very sad about this unhappy turn of events, put mandragora or opium in her wine to drown her sorrow. Similarly, Demeter, goddess of agriculture and patroness of Eleusinian mysteries, found relief by taking poppy leaves. Demeter suffered because her only daughter Persephone was abducted by Hades.

Amnesia

Drug-induced amnesia At least two potential examples of drug-induced amnesia were retrieved in Homer’s epic Odyssey. In the first, Odysseus reached the island of the enchantress Kirke. Odysseus divided his companions into two groups to explore the island. One of the groups found the house of Kirke, who offered them a magic drink which made them forget their task. This magic drink (that made people forget) reminds us of midazolam which is administered orally for preoperative sedation and perioperative amnesia.

In another similar adventure, Odysseus and his fellows found themselves in the land of the Lotophagoi (Lotus-eaters) who lived by consuming a sweet fruit, the lotus. Odysseus sent his fellows to investigate this unknown land. The Lotophagoi received them graciously and offered them the sweet fruit. If any foreigner tasted the fruit, the sweetness of the fruit would make them forget their home while desiring nothing else than to spend their lives on this land eating those fruits.

Music-induced amnesia Besides its hypnotic properties, music also had amnesic properties as encountered in the myth of the Sirens. The Sirens were female daimones who sang in such a charming way that sailors forgot to eat, drink and breathe; eventually they died, dazzled by the Sirens’ wonderful singing. These strange songs could be compared with benzodiazepines or opioid overdoses which can result in respiratory arrest.

Myochalasis

A lively case of myochalasis (paralysis) was mentioned in the myth of the Argonauts. Talos, a giant of bronze constructed by Hephaistos, guarded the coasts of Crete by running around the island three times a day and hurling huge rocks at unwelcome ships. Medea cast a spell so that the giant could no longer move.

Conclusion In this review, several elegant narratives pertaining different aspects of anaesthesia and myochalasis are presented. We noted that man always thought of sleep
with awe because of its similarity with death. Thus, providing sleep was considered a power ascribed mainly to gods, although several mortals also exhibited such powers; a fact that presumably highlights the old desire of humankind to acquire this knowledge.
We hope this review may stimulate the imagination of modern anaesthetists, providing them with a way out of daily routine practice while at the same time helping them realise the deep roots of their noble medical specialty.

(Source: “The art of providing anaesthesia in Greek mythology”, by Ntaidou TK, Siempos II)

5

Research-Selection for NovoScriptorium: Maximus E. Niles

 

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s

Blog at WordPress.com.

Up ↑

%d bloggers like this: