Ophthalmology in Greek mythology

In this post we present selected parts of the the very informative paper titled “Greek mythology: the eye, ophthalmology, eye disease, and blindness“, by Constantinos Trompoukis & Dimitrios Kourkoutas (2007).

Among many interesting things we read:

“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.”

“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].”

Asclepius

“Asclepius was taught the healing art by the centaur Chiron … 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”

“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 of Panoptes with eyes over all his body suggests the possibility that the ancient Greeks understood the concept of the visual field of the human eye. The visual field is the space that one eye can see while remaining fixed. Panoptes was able to comprehend the space that surrounded him to its full extent. The literal placement of eyes all over Panoptes’ body, rather than the use of a metaphorical expression such as “eyes in the back of his head”, reflects an understanding of the limited visual field of two eyes alone. In the case of Panoptes, the idea of visual field may also have been connected with visual acuity. Visual acuity refers to the eye’s ability to see an in-focus image and resolve fine details at a standardized distance. Panoptes acuity in discerning fine detail made him an excellent guard.

The myth about Odysseus’ eye condition described as “knyzosis” infers an eye disease, the symptoms of which were well known … madarosis is considered to have been the most likely diagnosis for Odysseus’ eye condition.”

“Achilles’ case of transient amaurosis could be attributed, given the military context of the epics, to nonorganic 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 … 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.”

“From the descriptions of injuries, especially those mentioned earlier, we can deduce cases of evisceration. 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 antiinflammatory activity and that this was beneficial in stopping bacterial keratitis.”

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

Research-Selection for NovoScriptorium: Maximus E. Niles

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