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Case Study of Epidemics 4.11

May 19, 2013

[Hippocrates] texts entitled Epidemics are useful for the study of medical practices but also society. In this case study I examine the doctor patient relationship, treatment of the illness and the social position of the patient.

There does not appear to be a doctor patient relationship in Epidemics 4.11 as the case notes state the condition of the patient followed by the words ‘The explanation’ inferring that no communication with the patient had occurred. This is unusual considering other cases where it is apparent that conversations between doctor and patient have been undertaken (Epidemics 2.2.17 and 7.11). However, it could be inferred that the patient is unconscious because of the head wound and fever and as such only a visual diagnosis could be undertaken. There is information on what caused the injury but it is likely that the woman referred to in the case notes provided this. The details within this case are not as extensive as those in other books of Epidemics (1.2, 3.17.2 and 7.83) where there are records of several days’ worth of developments in detail. This maybe as the doctor thought the cause of the illness was apparent.

The doctor observes the area around the wound noting what it looks like. However, no other observations are undertaken. King (2001:12) comments that doctors were responsible for examining the outside to establish what was happening inside where they could not see. These observations usually comprised of a number of pieces of information such as temperature. However, it is likely that the doctor believed the cause of the illness to be the strike to the head and that no other observations were required. Nutton (2004:92) considers that ‘Once the doctor had established what is wrong with the patient, a decision has to be taken as to whether to treat or not.’ In circumstances such as these where the boy was hit in the head and it was believed a ‘chill’ took to the wound it is likely the doctor felt no further observations were needed and prescribed a treatment.

The doctor prescribed that the boy was ‘trephined without delay’. This involved making a hole in the head to allow any accumulated fluid to escape. The treatment was unsuccessful, though the doctor does not suggest a reason why. There are no references to any follow up treatment but it is unlikely that there were no other attempts to cure the patient. This can be inferred from the evidence that, as the doctor notes the development of the illness and death of the boy, he remained on the case to its conclusion. It is possible that as these treatments did not work either they were not noted.

It is likely that the doctor considered that the fever was caused by an imbalance in the humours caused through the strike to the head and attempted to rebalancing them using trephination. It was believed that, ‘when one of these is separated from the rest and stands by itself, not only the part from which it has come, but also that where it collects and is present in excess, should become diseased, and because it contains too much of the particular substance, cause pain and distress’ (Nature of Man 4). It is likely that the doctor thought it note worthy to mention that an abscess developed in the shoulder believing that this is where the fluid had been drawn from, which had subsequently become diseased, although the original area of injury did not fester. However, the development of the disease does not correlate with the statement in Nature of Man 4 as the area around the ear should have festered and become diseased as well so the doctor may have had another theory though there is no evidence of this.

In respect of the social position of the patient the boy is unnamed although it is stated that he is from Metrophantus’ house. It is likely, therefore, that he either was a slave or worked for the owner of the home. The boy is unlikely to have been a relative otherwise this would have been indicated as it is in Epidemics 4.4, ‘The chest of Philis’ son Aristodemus’. Regardless of social status it does not appear to have affected diagnosis or prescribing of treatment as they both took place. It is possible though that the owner of the house did not call out the doctor immediately preferring that one of the women look after the boy in the first instance. Nutton (2004:28) believes that slaves were likely to only see a doctor when they were up for sale which suggests that this may not have been a slave. However, Jouanna (1999:115) considers that treatment for ill slaves would have varied, some masters would have been considerate and sought help but others would not. It is likely that the decision was based on economics, is it more cost effective to pay for treatment. Although when treatment occurred doctors would treat each person in the same manner regardless of social standing. King (2001:18) holds the same view observing that ‘Hippocratic medicine…is more interested in caring for patients than making…money, giving treatment to slaves and poor people as well as to the rich.’ This is quite idealistic and although there are cases where patients were treated the same it is unlikely that all doctors behaved in this way. In this circumstance it is likely that Nutton’s observation does not stand up and that this boy was a slave whose master sought treatment for their illness.

Bibliography

Primary

[Hippocrates] Epidemics 1 and 3 Hippocrates Collected Works I Translated by Jones. W.H.S. Cambridge: Harvard University Press, 1868. Perseus Digital Library http://www.perseus.tufts.edu/hopper/text?doc=Perseus:text:1999.01.0251 [Accessed: 19 May 2013]

[Hippocrates] Epidemics 2 – The Genuine Works of Hippocrates Translated by Adams, F. London: Sydenham Society, 1849. The Internet Classics Archive http://classics.mit.edu/Hippocrates/epidemics.2.ii.html [Accessed: 19 May 2013]

[Hippocrates] Epidemics  Hippocrates Volume VII Translated by Smith, W.D. Cambridge: Harvard University Press, 1994.

[Hippocrates] On the Nature of Man – Hippocratic Writings Translated by Chadwick, J. and Mann, W. G.E.R Lloyd (Ed) London: Penguin, 1978.

Secondary

Jouanna, J. Hippocrates Baltimore: Johns Hopkins University Press; translated by M.B. DeBevoise, 1999.

King, H. Greek and Roman Medicine Bristol: Bristol Classical Press, 2006.

Nutton, V. Ancient Medicine London: Routledge, 2004.

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