Case Study Epidemics 2.3.11

This is my second case study of Epidemics examining the doctor patient relationship, treatment of the illness and the social position of the patient.

The doctor-patient relationship in this case is as expected. There is an in-depth physical examination identified in the case notes, ‘continuous fever…florid tongue…Fairly rapid breathing’ ([Hippocrates Epidemics 2.3.11). There are also observations in respect of sleep, material expelled and details of excretions. It can be inferred from knowledge of Scopas’ diet that the doctor has spoken with him otherwise he would not have been able to make assessments based on this information. Conversations with patients were part of the Hippocratic practice, as diagnosis of an illness required the patient to answer questions (King, 2001:12).  Doctors listened to everything a patient had to say and needed to be confidant in the information provided to avoid an incorrect diagnosis.

The doctor’s observations are particularly thorough. Demand (1997) observes that the cases in book 2 seem to ‘give the impression of being rough notes taken at the bedside.’ The details of this case reflect Demand’s analysis, particularly the fragmentary statements and the question at the end. King (2001:11) suggests that, the texts in note form are like a diary, in which a doctor wrote down anything significant so that he could go back later and think about it. The case of Scopas supports King’s assertion as nothing seems to be omitted. Doctors could not discount anything as irrelevant as they did not know what was causing the problem and so every minor detail was important (Grmek 1989:301). It maybe inferred that it is unlikely there have been any omissions in the write up of this case.

Wartweed was the treatment administered to the patient but this did not prove sufficiently successful, ‘nothing was brought through’ ([Hippocrates Epidemics 2.3.11). The following day the doctor used suppositories but these also had no affect. There is reference to Scopas drinking ‘honey and vinegar water’ which may have been another form of prescribed treatment as there are no further prescriptions referred to after the suppositories ([Hippocrates Epidemics 2.3.11). It is unlikely that a doctor would prescribe no further treatment as they would want to cure the patient. Reputation was important to a doctor as demonstrated by the career of Democedes who:

Within the first year after settling there, he excelled the rest of the physicians, although he had no equipment nor any medical implements. In his second year the Aeginetans paid him a talent to be their public physician; in the third year the Athenians hired him for a hundred minae, and Polycrates in the fourth year for two talents.

Herodotus The Histories 3.131

Doctors could obtain such positions but it required the reputation for being able to cure individuals.

The doctor assumes that the restriction in Scopas’ bowel was a result of ‘a poor diet’. King (2001:18) observes that, ‘the delicate juggling act of maintaining health was essentially an individual matter based on self-awareness…altering diet and exercise to make fine adjustments to the balance.’ It is likely that the doctor would have assessed Scopas’ overall illness a result of his diet; demonstrated through the actions taken to try and evacuate the body. Several of the observations made relate to the lower abdomen area such as, ‘stretching of the lower abdomen…Pain in the hypochondrium…Afterwards his belly was softer’ ([Hippocrates Epidemics 2.3.11). It maybe inferred that the doctor considered that the nature of the illness was related to diet causing a humoral imbalance.

There is no indication of the patient’s social position. The case notes refer to Scopas by name, with no trade and no statement that he belonged to anyone and so it is likely he was a free man. Given that Scopas is not linked to a trade it may be inferred that he could have been a wealthy land owner. The treatment of the individual through observation is similar to Epidemics 4.11. There are more details of the condition but this is likely due to the doctor attending from the start and that the cause was not clear (there is no wound). One thing has become apparent from studying both cases is that ‘the Hippocratic physician, whether he was called to a slave’s bedside or to that of a free man, made no distinction between the two’ (Jouanna 1999:115). This is further supported by examining closely other cases within the Hippocratic corpus (Epidemics 1.1, 4.2 and 4.38).

Bibliography

Primary Sources

[Hippocrates] Epidemics 1 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: 26 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: 26 May 2013]

[Hippocrates] Epidemics 4 Hippocrates Volume VII Translated by Smith, W.D. Cambridge: HarvardUniversity Press, 1994.

Herodotus, The Histories Translated by Godley, A. Cambridge: Harvard University Press, 1920. Perseus Digital Library http://www.perseus.tufts.edu/hopper/text?doc=Hdt.+3.131&fromdoc=Perseus%3Atext%3A1999.01.0126 [Accessed 17th March 2013]

Secondary Sources 

Demand, N. ‘Overview of Hippocratic Epidemics’ 1997. http://www.indiana.edu/~ancmed/epidemics.htm [accessed 10th March 2013]

Grmek, M. Diseases of the Ancient Greek WorldBaltimore: JohnHopkinsUniversity Press, 1989.

Jouanna, J. Hippocrates Baltimore: JohnHopkinsUniversity Press, 1999.

King, H. Greek and Roman MedicineBristol Classical Press, 2001.