User:LBird BASc/sandbox/ATK/Seminar5/History

This week's topic is History!

History of Medicine
- ancient paradigm: belief and patient mindset/'disposition of soul' played a role just as (or even more so) important in health than one's physical condition Medicine, as an autonomous practice (which does not mean that it is radically separated from the dominant religion), develops in what is commonly called “open societies”, that is, societies whose structures are subject to change and in which collective life is paced by debate and conflict. These are, in general, communities where contact with the outside world, particularly in the form of trade, tends to become widespread. In this way, a favourable climate is created for research through the confrontation of ideas. The fate of the free individual appears, at least in part, as a guarantee of the common future, human health and a significant increase in life expectancy. To become a science, he had to be able to rely on other sciences and techniques which are all his younger ones and whose applications were indispensable for the identification and treatment of pathological conditions. Thus, if the knowledge of the cell involved the discovery and preliminary development of the microscope by the physicists.

Medicine in Ancient Egypt (Greta)
1.General information about ancient Egyptian medicine

Ancient Egypt was a civilization that lasted from 3300 to 525 B.C.E. Some of the earliest records of medical care come from ancient Egypt. Egyptian medicine served as a source for Greek and Roman civilizations, as even Hippocrates (the "father of medicine") acknowledged its contribution to the advancement of Greek medicine.

2. Pharmacology/Nutrition

The ancient Egyptians amply discovered the medicinal properties of plant life around them. They used ingredients such as honey or pomegranate juice for different medical purposes and even experimented with animal faeces and metals as treatments. The most important pharmacological legacy of the Egyptians is the Ebers Papyrus, in which there are over 800 remedies; ranging from ointments, wrappings and oral medications (such as pills and mouth rinses) to inhalation. They were also at least partially aware of the importance of diet, both in balance and moderation. Owing to Egypt's great endowment of fertile land, food production was never a major issue, although, no matter how bountiful the land, paupers and starvation still existed. 3.Practices

Egyptians were aware of basic human anatomy. For example, in the classic mummification process, mummifiers knew how to insert a long hook through a nostril, breaking the thin bone of the braincase and removing the brain. The oldest metal surgical tools were also discovered in Egypt. Magic was also a really important element of the healing process. Evil gods and demons were thought to be responsible for many ailments, so often the treatments involved a supernatural element, such as beginning treatments with an appeal to the gods. Doctors believed that spirits blocked channels in the body and that this affected the way the body worked. They looked for ways to unblock these channels. They used a combination of prayer and natural — or non-spiritual — remedies. Amulets, in general, were very popular.

(Sources: main "ancient Egyptian medicine" Wikipedia page and MedicalNewsToday)

Medicine in Ancient Greece (Stasi)
- general 'Ancient Greek Medicine' wikipedia page used as primary source

- threshold concept - the 4 humours: sanguine (blood), choleric (yellow bile), phlegmatic (phlegm), melancholic (black bile); any disease is related to a lack/excess of their respective substances; for astrological and other links, see 'Four Temperament Ensemble' in TVTropes (unchecked sources); for wiki page, see 'Humorism'

- recognition of the role circumstances play - location, sex, social class, diet, previous trauma, etc.

- early on - diseases viewed as divine punishment and good health - as a blessing;

- implemented Egyptian substances

- aesclepia - temples that functioned as healing centres (Aesclepius); patients drugged into sleep, may receive instructions for healing or answers from the gods about healing; may be operated on while asleep; dreams were interpreted;

- Hippocratic corpus - first heavily biological approach

- Aristotle argues for empirically derived rules

NB! Galen, one of the greatest 'doctors' of antiquity, was Greek, but he made contributions in Rome, so I'm leaving him for Patrick to cover if he wants to.

Medicine in Ancient Rome (Patrick)
Medicine in Ancient Rome can be seen as a direct progression from Greece - particularily in the practical application of Greek theories.

Public Health
This is especially true in the case of advancements in effective public health, such as:
 * The construction of Aquaducts to bring fresh water from outside of the cities and so avoid the re-use of polluted water. (Though the discovery of Germ Theory would only follow Louis Pasteur's Swan Neck Flask experiment in the 1860's)
 * The construction of large sewer systems to then remove the water that was dirty.
 * More sophisticated hospitals allowing new surgical procedures for soldiers. (Whilst Rome advanced public health, these changes were mostly kept to those with wealth or who served in the Roman Army.)

Influence of Galen
Aelius Galenus [Galen] was a greek physician who spent the majority of his career in the Roman Empire.
 * Galen discovered that the arteries were the vessels that carry blood around the body. However, he did not discover the circulation of the blood by the heart. (This was Ibn al-Nafis in 1242. Discovered the pulmonary circulation of blood, disproving Galen's own original theory.)
 * Galen also investigated the role of nerves in breathing. During a demonstration, he sliced a pig's laryngeal nerve, accidentally, finding that the pig's screaching immediately stopped.

Whilst Galen is widely celebrated as a key Roman physician, his work is limited heavily by his inability to dissect human cadavers (around since 150BC). He instead had to rely on the dissections of dogs and monkeys. Galen's discoveries were prevolent for centuries after his death following the Fall of Rome in 376 to invasion. This left much of the surrounding area with little governance and so saw a rapid decline in the public health commonplace within Roman cities. However, the Islamic world saw many medical advancements following the fall of Rome. Andreas Versalius was one of the first western physicians to discredit Galen's work and saw much criticism for doing so (now able to dissect human cadavers).

Medicine in the Middle Ages (Viky)

 * Average life expectancy in the 1350s was 30-35 years.
 * Medical practices and general medical knowledge regressed after the fall of Rome.
 * Treatments mostly consisted of herbal remedies, bleeding (bloodletting or leeches) and purging, or practices based on supernatural ideas. While herbal cures may have been successful, they were often paired with more drastic measures, such as the ones previously mentioned. Additionally, doctors would use strong smells to cover up the foul air, drain pus, heat or cool patients through, for example, hot or cold baths, apply trepannation (the practice of drilling a hole in the patient's skull to relieve pressure). On the supernatural side, praying or self-punishments were also popular forms of treatments.
 * Due to dissection of corpses being banned, there was very little medical advance and doctors could not be sure of the causes of diseases; Galen's theory of the four humours was still prevalent. Oftentimes, supernatural entities, like demons or the wrath of God, as well as minorities, such as Jewish populations or women, were blamed for outbreaks of diseases.
 * There is proof, however, that there were efforts to introduce more hygiene through food inspections, the development of clean water supplies and sewage disposals (gong farmers). Cities would also be quarantined, especially with the beginning of leprosy outbreaks and some hospitals were established. First aid was also somewhat advanced, as wine was found to be a mild antiseptic, and painkillers like opium were developed.

Sources: BBC and Encyclopedia Britannica

Early Cultures

 * celestial objects associated with gods and spirits
 * first astronomers were priests, who believed in connection between the divine and sky→astrology
 * Stonehenge: astrological alignments with religious and social purposes
 * Calendars were set after moon and sum cycle, importance to agriculture
 * common modern calendar is based on roman calendar which originally was a lunar calendar, Julius Caesar then updated the calendar in 46 BCE, proposed by Greek astronomer Callipus

(Sun and moon cycle as schema???)

Prehistoric Europe

 * due to fair amount of astronomical artefacts found throughout Europe it’s assumed that Neolithic and Bronze Age Europeans had sophisticated knowledge of astronomy; e.g.: Warren Field Calendar found in Scotland in 2004, as oldest known calendar (8000 BC)

India

 * Astronomy used for creating Calendars by Indus Valley Civilisation (3000 BC)
 * Vedanga Jyotisha: oldest Indian astronomical text, about motions of sun and mood for rituals (astrology)
 * in his main work, published 499, Aryabhata suggested a planetary system, where the earth was spinning on its axis and calculated many astronomical constants correctly
 * During the Shunga empire (187- 78 BC) astronomy was further developed in India
 * Buddhist university of Nalanda offered courses in Astronomy

Egypt

 * already 3000 BCE Egyptians used the 365-day calendar
 * observation of stars was crucial for calculating annual flooding of the Nile
 * in Roman Egypt Claudius Ptomely (90-186 CE) wrote the Almagest, one of the most influential books at the time about the motions of stars and planetary paths
 * once again: astronomy as way of fixing religious dates

Medieval Middle East (9-11th century)
With Greek, Indian and Persian astronomy being translated into Arabic, the Persian and Arabic world began to make major contributions to the discipline, particularly in the area of observational astronomy, concerned with recording data about the observable universe. The first astronomical observations in the Muslim world where recorded in the Zij star catalogues, which list stars according to position, brightness, colour and properties such as their spectral type. These schemata noted in the Zij star catalogues were essential in the categorisation of observations based on common elements and characteristics and were used by astronomers in western Europe to interpret and predict the world.

During the 10th century additions to the Zij Star Catalogues where made by Abd al-Rahman al-Sufi (Azophi), whose work included the first descriptions and illustrations of the Andromeda Galaxy, informally known as "A Little Cloud", which is a dwarf galaxy near the Milky Way. Other contributions include the observation of the brightest supernova (SN 1006) in recorded history, by Ali ibn Ridwan In 1006. Furthermore, Abu-Mahmud al-Khujandi used an observatory built near Tehran in Iran to observe the time where the sun reaches its highest position in the sky, also known as Sun–meridian transit time, which is a threshold concept that allowed him to calculate the tilt of the Earth's axis relative to the Sun. His observation that recorded measurements by earlier (Indian, then Greek) astronomers had found higher values for this angle, providing a possible source of evidence that the axial tilt is decreasing as opposed to being constant.

Also, the complication of many tables allowed Omar Khayyám to amend colanders used, which became closer to the Gregorian calendar presently used, demonstrating the evolution of the discipline. One major contribution was the correction of previous data, which is fundamental in resolving the Ptolemaic model, also referred to as the geocentric model, which details the Earth as the centre of the universe, with the moon, sun and other planers orbiting in cycles. This was important in creating the foundation of the heliocentric model of the universe, a threshold concept, whereby the earth rotated around the sun. There was also a clear separation made by many Arab Astronomers between natural philosophy (particularly Aristotelian physics) and astronomy leading to the development of an astronomical physics. This is a clear example of a paradigm shift in the discipline, where it was previously used in a religious context, with information derived from religious texts, and instead, using empirical data and evidence, it gained practical applications of predicting the earth's movements and tracking time accurately.

Medieval Western Europe (5-15th century)
The western world experienced difficulties with disease and famine, affecting the intellectual production of the continent, which meant the development of the astronomical discipline was thwarted. Nevertheless, Western astronomers used the works produced in the Middle East to master the knowledge of Greek astronomy.

Astronomy was used by English Monks to calculate the date of Easter, and thus remained an important element of education of the clergy, demonstrating the disciplines ongoing applications in religion was still prominent in Western Europe, a key difference from the paradigm shift in the Arab world. Another distinct difference, was that the Western religious bodies rejected the Ptolemaic model proposed in the Arab astronomical texts, as they fundamentally contradicted the teachings of the Bible. However, during this time, Nicole Oresme, a 14th century bishop, argued that a rotating earth is a simpler explanation than that of Ptolemy, using the principle of Relative Motion to defend the Corpernican model. However, he still chose to accept the geocentric model, stating "everyone maintains, and I think myself, that the heavens do move and not the earth: For God hath established the world which shall not be moved".

Nevertheless, astronomy began to undergo the paradigm shift in Western Europe during the renaissance period also known as the Copernican revolution, pioneered by Nicolaus Copernicus, who suggested the model of a heliocentric system (a threshold concept), whereby the sun was the body with which the Earth and planets revolved around. His work: De Revolutionibus Orbium Coelestium was published in 1543, the theory became the foundation of work by Galileo Galilei and Isaac Newton who both are famous for championing this theory, allowing it to become the accepted contemporary model of the solar system.

This was controversial as Copernican astronomy seemed to contradict God’s word, as certain passages in the Bible insinuated that the Sun moves and the Earth stands still. Thus the Bible seemed to support the Ptolemaic picture of the Universe, and explains why there was rejection by most astronomers with a religious background, and why there was mass controversy surrounding the introduction of the heliocentric model into the mainstream.

Overall, it is clear that both the Middle Eastern and Western European astronomers began to used scientific methods that produced empirical evidence used to reveal 'truth' in the discipline. This paradigm shift, caused by the introduction of threshold concepts such as Heliocentrism and sub-meridian time allowed the discipline to evolve into modern astronomical physics as opposed to natural philosophy, with increasing applications of the discipline from dating of religious events, to medicine (many programming languages used for astronomical investigation) have made image processing in diagnosing easier), and even the energy sector, affecting all aspects of modern life.

Modern astronomy
·      In 1814, Joseph Von Fraunhofer discovery of spectrum lines in the sun begun the process of inventing the modern spectroscope.

·      The lines were also significant in the development of the study of quantum physics now.

·      Further investigation in the sun followed, with experiments that showed that both hydrogen

·      and helium were found in the sun.

·      The discipline not only advanced in its research but it started to give roles to women

·      some played parts in important discoveries, although they received little or no recognition.

20th century

Other discipline outside astronomy aided further discovery, for example:

Photography allowed more detail to be seen:

''Such as the fact the sun was part of a galaxy of 10 billion stars and Edwin Hubble’s discovery of other galaxies, like  Andromeda nebula,  settled a long running debate in the discipline. Hubble also tracked the movement of the galaxies, which showed that the galaxies were expanding. Advances in Spectroscopy, saw the discovery of the milky way.''

Physics study of invisble light, like radio waves and microwaves helped develop branches of the discipline, using these forms of light to aid further exploration, such as radio astronomy.

Astronomy itself also aided discoveries in other disciplines: helping with the modelling of the big bang.

21st century

Astronomy, in the 21st century has had much more of a focus on the possibility of extra-terrestrial life, particularly focusing on Mars.

references:Hoskin, Michael. The History of Astronomy: A Very Short Introduction. Oxford University Press. ISBN 0-19-280306-9

Literature
The representation of trauma for characters or personas in various forms of literature is often expressed through literary devices or through the structure that pieces have. These often mimic the feelings of the characters in order to give an accurate portrayal of their turmoil.


 * 1) The Bluest Eye, Toni Morrison

In this novel set in the early 1940s, Pecola, a young black girl, is trying to adhere to the white society which rejects her while simultaneously rejecting her black community. The latter inevitably ends up doing the same. What is vividly expressed is the indoctrination of white values through the "Dick and Jane" primer. This preface to the novel is an extract of a children's book describing the ideal nuclear family, however, it is repeated 3 times. The first time normally, the second without punctuation, the third without spaces between words. There is a mimicking of the drilling of the same values which is shown as making less and less sense to the black community. Moreover, small extracts from this primer are used at the start of various chapter in order to illustrate the divide between communities, the duality of the society of the time. In this sense, structure and literary devices illustrate the trauma of various characters or communities as a whole.


 * 1) Acquainted With The Night, Robert Frost

In one of his many poems dealing with mental health issues, Frost portrays the speaker of this poem as a man who is progressively detaching himself from society. Through the repetition of "I have been one acquainted with the night" the reader can understand a distance from human contact and a closeness to darkness or what could be considered depression, as the night is interpreted as an extended metaphor of the condition.As such, the poem ends and opens with that quote, demonstrating a cyclical aspect or what could be interpreted as a downwards spiral. With every stanza the speaker is seen distancing himself from different aspects of human life. For example, "he passed by the watchman on his beat" demonstrate his incapacity to make contact with the only other human he sees. Moreover, "on luminary clock against the sky proclaimed the time was neither wrong nor right" demonstrates not only a the divide between the speaker and human concepts such as time, but a profound indifference to them. Once more, through another form of literature, literary devices and structure attempt to give accurate portrayals of trauma and suffering in order to help the reader understand the feelings of various characters and the effects of various conditions.

''' Looking at Post Traumatic Stress Disorder (PTSD) from a neuroscientific point of view. ' Neuroimaging has revealed that the brain of a PTSD patient differs to that of a healthy patient.''

Effects on the Hippocampus

Patients suffering from PTSD reveal significant shrinking of the hippocampus in the brain. However, the hippocampus plays a particular role in the brain. It replays memories according to external stimuli, it also allows the patient to differentiate past and present. This implies that alteration of the hippocampus affects the patient's memories, hence flashbacks that many patients that have undergone trauma witness, and their inability to understand that they are in fact, safe.

Therefore, victims of PTSD have traumatic flashbacks when in an environment that has remotely similar elements to that of their trauma. These flashbacks lead to a bodily flight or fight response, even though one is not necessary.

Effects on the Ventromedial Prefrontal cortex

This region of the brain receives emotional signals from the amygdala, and, in a healthy patient, triggers the appropriate response. However, in a PTSD patient, this part of the brain is altered and the individual will have extreme reactions of fear, anger or stress to certain situations.

Effects on the amygdala

This part of the brain is responsible for our emotional responses and for the feeling of fear. Therefore, if the two regions of the brain, the hippocampus and prefrontal cortex, that are responsible for regulating the excitation levels of the amygdala that triggers a fear response are deregulated, this is translated through symptoms of PTSD.

Pharmacological Treatment of PTSD

Post Traumatic Stress Disorder is an anxiety disorder that might cause symptoms such as depression, anxiety, insomnia due to recurring nightmares as well as many other symptoms. In addition to psychological treatments, medications are also commonly used to aid in managing a patient's symptoms.

Selective Serotonin Reuptake Inhibitors (SSRIs) such as sertraline and paroxetine work by increasing serotinin, a neurotransmitter, in the brain. For example, in a clinical trial using paroxetine on war veterans, the “PTSD rate in our sample was reduced from 100% to 64% after treatment.” This can be explained by analysing the mechanism of the drug. Paroxetine works by forcing serotonin to remain in the synaptic gap, allowing serotonin to send more electrical information to the surrounding neurons and stimulate nerve cells in the brain which supposedly act as a mood booster. Due to the effectiveness of SSRIs, they are often given as a first-line treatment to patients who suffer from mild to severe depression.

However, drugs are not always needed to cure depression. In a double-blind trial, PTSD patients showed a placebo response rate of up to 62% despite placebos not containing any active substances. This neuroscientific approach known as the placebo effect provides an insight into the complexity of the mechanisms in brain, showing the psychological effects of drugs. Although placebos are currently only being used in clinical trials, there is a need to attain knowledge of its mechanisms of action as well as other non-specific factors in different disease models that could potentially contribute to medical research in the future.

Philosophy
In Ancient Greece, there were no psychiatrists but philosophers claimed to be psyche iatros which means 'doctors of the soul'. They were expected to help other citizens reach a certain mental stability through their teachings, and therefore philosophy started to be seen as a form of therapy.

Both the stoïcs and epicureans wanted to and taught how to reach ataraxia, a state of tranquillity of the mind. However, this philosophical therapy was only really a way to relieve fears and worries, it didn't provide any actual treatment for mental disorders and trauma.

Plato distinguished madness to illnesses from madness due to character, giving a certain legitimacy to mental disorders. On the other hand, Aristotle recognizes the existence of 'mad' people in the city but he claims that they should be ignored and that they don't fit in his idea of humanity.

Therefore, ancient philosophy helped the citizens reach a state of peace within themselves but it couldn't be considered helpful in treating what we consider mental disorders.

Nowadays, philosophy is closely linked to psychiatry as most of the research in the latter admit certain philosophical concepts such as rationality, perception of reality, the link between the body and the mind, to be true and serves as a way to answer ethical questions regarding mental health.