Anesthesia and the Classics

Essays on avatars of professional values

Robert S. Holzman

• Publisher: CRC Press
• Year: 2022
• ISBN:
  9781000510683
• Edition: 1
• Topic: Medicine
• Subtopic: Anesthesiology & Pain Management

A collection of 25 thought provoking Essays which create a bridge between the Classical personification of values and link them to current training and education in Western Medicine. This readable and erudite text provides a framework for modern clinical values - with a particular emphasis on anesthesiology - set in the context of ageless dilemmas facing each generation of physicians.

Medicine as a profession carries some specific obligations.The qualities of empathy, knowledge, generosity, respect, and scholarship provide a "family" of values that was personified by the Ancients in the family of Asklepios, and which form the basis of professional values today. Moreover, a substantial amount of professional growth should come from reflection based on the experience ofcaring for real patients – an appreciation of the human condition. Each essay within this beautifullycrafted book illustrates the importance of expertise, skill, focus, mindfulness, and collaboration, all of which are integral to professionalism in medicine, and in particular to those working in the field of anesthesiology.

Anesthesiologists, Certified Registered Nurse Anesthetists and Anesthesia Assistants will find much to enhance their professionalunderstanding within this text. The principles, values and traits of professionalism are relevant to all medical specialties and these essays provide a lyrical understanding of the traits required for professional development.

Part IThe Human Condition

Everything was perfection … until it was perfection no longer. This morality parable has existed since Original Sin in the Bible, and certainly in oral history before that. Everything was Paradise until the apple. In Hellenic mythology, everything was all right until Pandora’s curiosity caused her to open the lid of the jar, letting disease and suffering out and only leaving Hope within. This set the stage for medicine, professionalism and the challenge of understanding diseases as well as the suffering, pain – and hope – that is the human condition.

The Fall and Expulsion from the Garden of Eden. 1509–1510 Michaelangelo (1475–1564). (Michelangelo, public domain, via Wikimedia Commons.)

This fresco in the Sistine Chapel shows Adam and Eve to the left, the pair expelled from Paradise to the right, and the anthropomorphized Tree of Knowledge with the female temptress in the center. To the left, the Garden of Eden is lush, to the right, barren. The story flows from left to right – Eve grasps the apple confidently, Adam intensely and selfishly. He senses his impending abandonment by God (Sistine Chapel, Vatican).

1Disease: The Nosoi

DOI: 10.1201/9781003201328-3

Pandora. 1896. Oil on canvas by John William Waterhouse (1849–1917). (John William Waterhouse, public domain, via Wikimedia Commons.)

For ere this (the opening of Pandora’s jar) the tribes of men lived on earth remote and free from ills (kakoi) and hard toil (ponoi) and heavy sickness (nosoi) which bring the Keres (Fates) upon men; for in misery men grow old quickly.

But the woman took off the great lid of the jar (pithos) with her hands and scattered all these and her thought caused sorrow and mischief to men.¹

The use of fire, stone tools and speech paved the way for the development of family, extended family, tribe and, eventually, civilization. Although our forebears were consistently exposed to trauma, injuries, arthritis, and short lifespans, they probably were not exposed to widespread infectious diseases because they lacked the high population density required, a situation with which we are now all too familiar. In addition, because of the need to search for food, small groups did not remain in the same place for long enough to pollute water sources or accumulate the filth that attracts disease-producing insects. Moreover, hunter-foragers did not tend cattle and other tamed animals. Nomadic lifestyles continued until the end of the last Ice Age, around 12,000–10,000 years ago, when agriculture, the cultivation of plants and eventually animals in a fixed location gave rise to sedentary human civilization. Farming, planting, irrigation, and the rise of villages and towns followed – and with them, disease.

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Zeus assigned Prometheus, the Titan of forethought, the task of creating the race of man, but Prometheus was despondent at man’s lot, such as it was at the whim of the Gods. He therefore stole fire from the Gods to help man. Zeus, furious at this betrayal, commanded Hephaistos (L. Vulcan), the Greek god of artisans and craftsmen, to create the first woman.

As Hesiod relates:

Prometheus outwitted him (Zeus) and stole the far-seen gleam of unwearying fire in a hollow fennel stalk. And Zeus who thunders on high was stung in spirit … and he made an evil thing for men as the price of fire; for the very famous (Hephaistos) formed of earth the likeness of a shy maiden as the son of Kronos willed. And the goddess bright-eyed Athene girded and clothed her with silvery raiment, and down from her head she spread with her hands an embroidered veil.²

The creation of Pandora (“All gifts”) was a collaborative effort, as Hesiod further describes in Works and Days:

(and other gods were instructed to bestow their gifts upon her.) And all obeyed Lord Zeus, the son of Kronos. The renowned strong smith modelled her figure of earth, in the likeness of a decorous young girl, as the son of Kronos had wished … and (Hermes) put a voice inside her, and gave her the name of woman, Pandora, because all the gods who have their homes on Olympos had given her each a gift, to be a sorrow to men who eat bread.³

While Hephaistos mixed earth and water in order to fashion a “sweet, lovely maiden-shape” Athena taught her needlework and weaving, Aphrodite gave her grace, and Hermes gave her a “shameless mind and a deceitful nature.”⁴ Thus, it was inevitable that she, ironically known as “All-Gifts,” would ultimately bestow misery and disease on man. Endowed with beauty and cunning, Pandora was herself gifted to Prometheus’ younger brother Epimetheus as a bride. For his part, Zeus gave Pandora a storage jar (pithos) as a wedding gift, knowing that her nature would result in its opening, releasing the evil spirits contained within, which would plague mankind forever. Prometheus had warned his brother not to accept any gifts from Zeus but Epimetheus did not listen; he accepted Pandora, who promptly scattered the contents of her jar.

Catastrophic consequences to the opening of the jar followed:

Pandora brings with her (a jar or box) containing burdensome toil and sickness that brings death to men, diseases and a myriad other pains.⁴

Hesiod further elaborates in Works and Days:

Only Hope was left within her unbreakable house, she (Hope) remained under the lip of the jar, and did not fly away. Before (she could), Pandora replaced the lid of the jar. This was the will of aegis-bearing Zeus the Cloudgatherer.¹

What were the evils that flew out of Pandora’s jar and how did they plague the health of mankind? Only a general reference to Nosoi – “diseases” – is provided in Greek mythology, despite the etymology of “nosology,” that branch of medicine that deals with the classification of diseases. The specifics of these evils were better described in Roman mythology by their Latin names Morbus, Lues, Pestis, Tabes and Macies.

Morbus Gallicus (the “French Disease”) is also known as syphilis, and was well recognized throughout ancient Europe. The use of the Latin “Lues” denoted disease, especially contagious disease. Syphilis was also known as Lues venerea, or simply, Lues. Clinically identifiable in primary, secondary and tertiary presentations, its initial presentation consisted of skin lesions and ultimately, if untreated, often progressed to neurological dysfunction including insanity. The moral notion of punishment by disease was reflected in the naming of syphilis itself by the Italian physician-poet Girolamo Fracastoro (1478?–1553), who wrote “Syphilis, sive Morbus Gallicus” (“Syphilis, or the French Disease”).⁵ It was an epic poem about a boy named Syphilus who insulted Apollo, and was in turn punished with the disease. He also added, at the end of the poem, two mythological tales written in the style of the Roman poet Ovid, giving supernatural accounts of the disease’s origin and supposed cures, including mercury and guaiacum (a tree extract, the efficacy of which was disputed by his contemporary, Paracelsus 1493/4–1541). In so doing, Fracastoro offered Europeans a physical distraction and scapegoat by describing its introduction to Europe by the French. He also allowed the Church to distance itself from the disease (Rome had thousands of prostitutes at the time) concomitant with the Papal edict for sexual abstinence as treatment.⁶ It is clear historically that syphilis itself was recognized long before. In 1025 the Persian physician Avicenna (980–1037) suggested the use of mercury for treating syphilis.

Similarly, Romans called epilepsy morbus caducus (the falling sickness) as well as morbus comitialis (disease of the assembly hall), morbus sacer (the sacred sickness) or morbus demoniacus (the demonic sickness). It was a Roman custom to shut down the public assembly (comitia) for ritual purification whenever any legislator experienced a seizure.^7,8

Pestis is La...