Diagnostical Skepticism

Hot on the heels of the Odysseus in America post comes this item from Anesthesiology News:

Sing, O Muse, of the rage of Achilles, of Peleus’ son, murderous, man-killer, fated to die of massive hemorrhage secondary to an acute laceration of the calcaneal tendon, indicating the likely presence of an inherited coagulopathy such as hemophilia or von Willebrand disease. (Note: The patient’s parentage—half mortal, half immortal—could have predisposed him to yet-undescribed clotting disorders.)

Classicists who devote their lives to the analysis of ancient texts such as Homer’s Iliad tend to be skeptical of physician historians who examine these literary works for insight into ancient medical practices—and who, in the process, come up with post hoc diagnoses such as the mockery above. And they’re evidently right to be wary.

An anesthesiologist and a pair of classicists have identified numerous errors in the methods and conclusions drawn by several medical researchers about medicine during the time of The Iliad. The researchers, from Wake Forest University, in Winston-Salem, N.C., and Temple University, in Philadelphia, presented their findings at the 2012 annual meeting of the American Society of Anesthesiologists (abstract 1320).

Lead author and anesthesiologist Raymond C. Roy, MD, PhD, said that five of the six articles published from 2000 to 2010 discussing medical care in The Iliad fell into common traps. Mistakes included incorrect assumptions that Homer was an eyewitness reporter of actual events and real injuries, that accurate comparisons could be made to modern-day medical care based on limited descriptions, that there was a one-to-one relationship between ancient Greek and modern English medical terms, that medical care was organized then as it is now, and that physicians provided care to wounded heroes during the Trojan War.

Dr. Roy said his interest in the subject was stimulated by his daughter and her husband, both classicists at Temple University in Philadelphia. “We have engaged in some very interesting discussions over the coffee and drinks regarding ancient Greek medicine and current perceptions of it,” he said. “It has been fun to have this project with my children and to be ‘forced’ to read The Iliad … and a monograph by Salazar. Our thesis was that physicians who ‘dabble’ in history, like myself, frequently fall into traps that lead classicists to be critical of our conclusions.”

The epic poem about gods, heroes and heroic wounding and death near the end of the war stems from an oral tradition. Estimates of when it was composed (1184-675 B.C.) and first recorded (800-675 B.C.) range widely, and there are multiple versions of the work.

All accounts of Homer’s life place him centuries after the Trojan War. However, physician researchers have written: “We are amazed by Homer’s meticulous account of the wounds inflicted to combatants” and “it may therefore be inferred that Homer was a witness of the war and that he even participated in it: he may have been one of the people appointed to nurse wounds of the injured warriors.”

Other comments revealed a lack of knowledge about the practice of medicine in the period. Those included a reference to the likelihood that anesthetic procedure was already present in ancient Greece as well as the statement: “Numerous findings indicate that Greek physicians were present on the battlefield.”

Dr. Roy and his team point out that there were no field hospitals, and surgical instruments were rarely found at archeological digs of Bronze Age battles. With regard to anesthetics, salves were applied after, not during, an arrowhead extraction. Disease was left untreated because it was believed to be inflicted by the gods, and healing temples appeared after Homer. Healers took orders from heroes and could only treat non-heroes—only heroes had the status to treat other heroes. In fact, the primary function of the healers was to fight.

Medical terms that appear in modern translations present added red herrings, Dr. Roy said, “Classics like The Iliad are constantly evolving as each translator chooses more modern words, terms and concepts based on knowledge acquired since the previous translations, and this evolution has the effect of attributing more understanding by the ancients than they actually had.” For example, sinews, tendons, nerves, arteries and veins have all been used in place of the ancient term neuron, he said.

The authors conclude that for reasons ranging from national pride to the projecting of modern beliefs and knowledge onto the past, physicians who otherwise are rigorous in their scientific and medical endeavors tend to be naively positive in their analysis of the quality and efficacy of ancient treatments as encountered in classics. Although medical training can aid in the analysis of ancient healing practices, Dr. Roy warned, “Physicians writing historical articles about medicine in ancient times need to collaborate with classicists, archeologists and full-time historians to avoid drawing conclusions that are at odds with facts.”

That final paragraph should become some sort of mantra … you can substitute the non-classics profession of your choice for “Physician” as you desire …

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