What do medicine specialists ‘see’ in Greek Mythology – Resuscitation, Ophthalmology

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

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Abstract Myths are the keystone of mythology. They are interpretations of events that have been told as stories and legends for thousands of years, inherited from generation to generation, and have reached the present day. Although most myths are considered figments of the imagination or fictitious legends, all of them contain references to facts from the time they occurred. Mythology, which is a collection of figments of imagination concerning nature and human beings, is a product of human effort to perceive, explain, and interpret the universe and the world, much like science. The interaction between mythology and science dates back to the early days of civilization. Mythology, a reflection of human creativity, is extensively used in modern science, particularly in a terminological context. This article aims to reveal the texture of mythology in neurosurgery, by analyzing the birth of medicine in mythology; heroes such as Apollo and Asklepios, the gods of healing and medicine, as well as Hygieia, the goddess of health and hygiene; and mythological terms and phrases such as Achilles tendon, atlas vertebra, gigantism, priapism syndrome, hippocampus, lethargy, syrinx, and arachnoid. Through the use of symbols, mythology has attempted to explain several subjects, such as human nature, disease, birth, and death. In this respect, mythology and medicine dance arm in arm, and this dance has been going on for centuries. As a result, mythology has manifested itself in many fields within medicine, either anatomically or by giving names to various diseases.

(Source: “Mythology and Neurosurgery”, by Ökten Aİ)

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Abstract

Background: We reviewed Greek mythology to accumulate tales of resuscitation and we explored whether these tales could be viewed as indirect evidence that ancient Greeks considered resuscitation strategies similar to those currently used.

Methods: Three compendia of Greek mythology: The Routledge Handbook of Greek Mythology, The Greek Myths by Robert Graves, and Greek Mythology by Ioannis Kakridis were used to find potentially relevant narratives.

Results: Thirteen myths that may suggest resuscitation (including 1 case of autoresuscitation) were identified. Methods to attempt mythological resuscitation included use of hands (which may correlate with basic life support procedures), a kiss on the mouth (similar to mouth-to-mouth resuscitation), application of burning torches (which might recall contemporary use of external defibrillators), and administration of drugs (a possible analogy to advanced life support procedures). A careful assessment of relevant myths demonstrated that interpretations other than medical might be more credible.

Conclusions: Although several narratives of Greek mythology might suggest modern resuscitation techniques, they do not clearly indicate that ancient Greeks presaged scientific methods of resuscitation. Nevertheless, these elegant tales reflect humankind’s optimism that a dying human might be restored to life if the appropriate procedures were implemented. Without this optimism, scientific improvement in the field of resuscitation might not have been achieved.

(Source: “The art of providing resuscitation in Greek mythology”, by Siempos II, Ntaidou TK, Samonis G.)

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Background The myths that contain the thoughts of the Greeks on life, the law, and natural and social paradoxes embody elements of important philosophical thinking at a time well before philosophy developed into a science. Moreover, they also contain important aspects of medical knowledge.

As an example, the myth of Prometheus hides an important medical observation. Prometheus stole fire from the gods and gave it to man. To punish him for this, Zeus left him chained to a rock on Mount Caucasus, suspended over a terrifying precipice. Everyday, an eagle would come and eat away at his liver, and every night it would regenerate [Works and days 42–105, Theogonia 507–616, Prometheus Bound 488–499]. This immediately raises the question of why the eagle did not eat another organ—the lungs or kidneys, for instance—or indeed why not Prometheus’ flesh? Might the choice of the liver in this myth indicate that the ancients were aware that, unlike other organs, the liver regenerates? It is interesting to speculate under what circumstances they could have acquired this knowledge.

Greek myths contain a number of other medical references, including some related to ophthalmology. The purpose of this article was to review the main ancient Greek sources containing material relating to mythology and to examine possible ophthalmological references and discuss how these may have been related to the medical knowledge of the time.

Methods A study was made of the original Greek texts of the Homeric epics of the Iliad and the Odyssey, and the works of Hesiod, and Apollodorus, the main ancient Greek sources containing material relating to mythology.

Results In ancient Greek mythology, the physician–healer often had a divine status and was represented by Apollo himself, who was the first ophthalmologist. It was to Apollo that, much later, the Hippocratic physicians would swear their oath. Medicine, as both a form of knowledge and a skill possessed by the god–healers, was taught to a succession of heroes and great physicians. Apollo was connected genealogically to a series of deified physicians, the first being his son Asclepius, whom Homer referred to as an excellent physician [Iliad 4.194, 11.518]. Athena, sister of Apollo, had honours bestowed upon her thanks to her ability to cure eye diseases. For this reason she was given the epithets “Ophthalmitis” [Laconia, xviii.2–3], “Optilitin” (a Doric term for the eyes) [Lycurgus, xi.4], and “oxyderkis” (she who is sharp-sighted, oxy + derko = to see perceptively) [Corinth, xxiv.2]. Asclepius was taught the healing art by the centaur Chiron, a mythical being with the head and torso of a man attached to the body of a horse. His presence as a teacher of the art of medicine is connected with the knowledge and use of the medicinal herbs of the Greek earth. Asclepius then taught medicine to his sons Machaon and Podalirius, the most prominent physicians in the Homeric epics. The word ophthalmos, from which the term ophthalmology is derived, appears often in Homer’s epic poetry: “Athena aimed the arrow towards the nose, near the ophthalmos [eye] and pierced the white teeth” [Il 5.291].

In accounts of external eye diseases, the descriptions given of “knyzosis” are particularly interesting. With the term “knyzosis,” Homer refers to an eye condition that Athena inflicted on Odysseus [Od. 13.401, 433]. This gave his eyes an unpleasant appearance, although without decreasing their vision, and was accompanied by an itchy feeling (knyo = to scratch). The goddess inflicted this illness on Odysseus to change his appearance temporarily so he would not be recognized once he returned to Ithaca.

Homer characterizes the person without the sense of light as “blind” [Il. 6.139] and “maimed” [Il. 2.599]. There are many references to transient or permanent amaurosis in Homer. Achilles experienced a transient loss of vision during his battle with Aeneas, which is attributed to an intervention by Poseidon [Il. 20.321–44]. After Diomedes had been injured by a perforating wound to his right shoulder while fighting at Troy, Athena had lifted the mist from his eyes so he could fight on [Il. 5.125–7].

Among the myths that refer to the centaur Chiron is one about his treatment of the blind Phoenix, who had accompanied Achilles to Troy. “This Phoenix had been blinded by his father on the strength of a false accusation of seduction preferred against him by his father’s concubine Phthia. But Peleus brought him to Chiron, who restored his sight, and thereupon Peleus made him king of the Dolopians” [The Library iii.13, 8].

Ocular trauma is one of the most frequently mentioned eye conditions described by Homer, perhaps because such injuries involve relatively easily understood pathologies. We have descriptions of globe rupture, such as when Menelaus struck Peisandros with his sword. The blow was on the forehead, above the bridge of the nose; the bones were broken and both eyes fell down into the dust at Peisandros’ feet [Il. 13.615–619]. A similar wound was inflicted by Patroclus on Hector’s charioteer, Cebriones, whom he struck with a stone on the forehead, across both eyebrows. The frontal bone broke and both Cebriones’s eyes fell into the dust [Il. 16.740–743]. Other cases of enucleation are also described, such as Peneleus striking Ilioneus [Il. 14.493–499].

Homer makes particular mention of Odysseus’ blinding of the Cyclops Polyphemus [Od. 9.376–404]. A detailed anatomical description of the infliction of the damage is given: the burning pike first passes through the cornea, then pierces the hard sclera at the posterior pole of the eye, and then reaches as far as the orbital fat and burns the optic nerve.

When Melampus was still a child he raised two snakes, who would lick his ears with their tongues [The Library,I.ix.11]. They were essentially cleaning wax from his external ear, with the result that Melampus had such perceptive hearing that he was able to hear what the birds were saying and learn the future from them. This technique was subsequently applied to eye diseases and the snakes would lick the injuries on the front surface of the eye. This kind of treatment was obviously used for such problems as keratitis and corneal ulcers. It also appears to have been a widespread treatment at Asclepieion temples later, whilst in his play Plutus, Aristophanes describes Asclepius’ treatment of Pluto’s eye problem as the “licking” method [Plutus 727].

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Interpretation In Greek mythology, we can discern well-documented references to the transmission of medical knowledge, starting from the centaur Chiron, who is represented in mythology as a polymath. This is reflected in the necessary range of knowledge that a physician should have and in his all-around education, which required that he learn medicine as part of his general knowledge and skills. Chiron was a true teacher, teaching his students about the body and the soul. The transmission of medical knowledge, which originated in the gods and was then transmitted from father to son, influenced the Pythagorean philosophers and ultimately found expression in the Hippocratic oath.

The Homeric epics incorporated very ancient Greek myths, and they contain identifiable descriptions of illnesses and wounds, many of which relate to the eye and its functions. The knowledge of anatomy evident in Homer’s writing implies advanced observations made during injury, clinical practice, external postmortem examinations, and certainly during dissection of animals. It is only to be expected, however, that knowledge of physiology would be limited to the major and clearly obvious functions.

The myth about Odysseus’ eye condition described as “knyzosis” infers an eye disease, the symptoms of which were well known. The differential diagnosis involves conditions such as severe ocular trauma, extensive central leukomas of the cornea, strabismus, and madarosis. The absence of decreased vision and the presence of itchiness, however, exclude traumas and leukomas. In the case of strabismus, vision can be unaffected (e.g., alternating tropias) yet it is not accompanied by itchiness. Consequently, madarosis is considered to have been the most likely diagnosis for Odysseus’ eye condition.

Madarosis is present in a variety of local (infectious blepharitis, seborrheic blepharitis, eyelid malignancies), skin (psoriasis, generalized alopecia, rosacea, atopic or contact dermatitis), and systemic disorders (myxoedema, systemic lupus erythematosus, syphilis, leprosy), as well as trichotillomania. Of the many clinical entities that are related to madarosis, particular deformation of the eyelids can be caused by blepharitis due to Phthirus pubis.

Achilles’ case of transient amaurosis could be attributed, given the military context of the epics, to non organic visual loss (conversion reaction). Patients with a conversion reaction, previously called hysterical blindness, react to environmental stress. A conversion reaction of hysterical blindness on the battlefield is a reported expression of battle fatigue.

Diomedes experienced transient bilateral blurred vision, possibly due to hemorrhaging, as blood loss from his battle wound could have reduced vision by two different mechanisms: First, in primary or secondary vasospastic syndrome, patients respond with spasm to stimuli such as cold or emotional stress. Secondary vasospasm can occur in a number of clinical entities, including hemorrhage.

The eyes are frequently involved in the vasospastic syndrome, and ocular manifestations of vasospasm include alteration of conjunctival vessels, corneal edema, retinal arterial and venous occlusions, choroidal ischemia, amaurosis fugax, transient sudden visual loss, anterior ischemicoptic neuropathy, and glaucoma. Second, it is possible that there was a preexisting case of mild vertebrobasilar artery insufficiency, which, as a result of the reduced arterial pressure due to the significant hemorrhaging, was clinically manifested as transient bilateral blurred vision.

Reasonable questions can be asked of Homer’s references to ocular congenital abnormalities. Holoprosencephaly is a congenital malformation of the forebrain and midface. Holoprosencephaly can be caused by disturbances early in embryogenesis, before or during gastrulation, that result in a complex anomaly involving not only the eyes but also the anterior part of the brain and the mesodermal structures. It is surprisingly frequent during early embryogenesis (1:250), but since most affected fetuses are stillborn due to anomalous development of the brain, holoprosencephaly is rare in live births (1:15,000). The anatomical structures of the two eyes may be either completely (cyclopia) or partially (synophthalmia) fused to form an apparently single eye within a single orbit in the middle of the forehead. This appearance could well underlie the ancient legend of the Cyclopes.

In the cases of Peisandros and Cebriones, the phrase used in the Iliad, “the eye fell down in the dust beside his feet,” implies rupture of the eyeball with preservation of the sclera and extraocular muscles. The description of the blinding of Polyphemus employs the term “rizai”[Od. 9.390], namely the “roots” of the eye, which may have been used to denote the optic nerve. Other ancient Greek writings similarly liken the optic nerve to roots; for example, in Galen we find “the nerves of the eyes appear to be some kind of roots”.

In the treatment regimes described by Homer, we notice a correlation between the myth on one hand and the empirical methods and practices regularly applied on the other. The case of the “licking” treatment and the story of Melampus is characteristic, and a medical explanation can be put forward. For bacterial keratitis to become established, microorganisms must bind either to a defect in the continuity of the corneal epithelium or to exposed corneal stroma. In any case of bacterial keratitis, treatment is directed toward stopping the proliferation of bacteria, minimizing inflammation and pain, and encouraging corneal healing. As such, treatment by licking appears to have been effective because it mechanically removed bacteria from the points where they had bound to the cornea and the necrotic stroma, thus reducing the proliferation of harmful microorganisms. Moreover, it is possible that the snake saliva had an antiseptic, antibacterial, and anti-inflammatory activity and that this was beneficial in stopping bacterial keratitis. This treatment was still applied by the Greek people until the 19th century, and it was used by Professor G. Kostomiris in the 1880s.

The study of mythological references to ophthalmology suggests that these accounts in fact hide reliable medical observations of the ancient Greeks.

(Source: “Greek mythology: the eye, ophthalmology, eye disease, and blindness”, by Constantinos Trompoukis, Dimitrios Kourkoutas)

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Research-Selection for NovoScriptorium: Maximus E. Niles

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