Rheumatology International (2019) 39:947–955 Rheumatology https://doi.org/10.1007/s00296-019-04261-4 INTERNATIONAL REVIEW The Greek (Hellenic) rheumatology over the years: from ancient to modern times Lazaros I. Sakkas1 · Panagiotis Tronzas2 Received: 07 January 2019 / Accepted: 20 February 2019 / Published online: 25 February 2019 © Springer-Verlag GmbH Germany, part of Springer Nature 2019 Abstract Rheumatology has its roots in ancient Greece. Hippocrates and other prominent Greek (Hellenes) physicians in ancient times, Hellenistic, Roman, and Byzantine period were acute observers of disease course and of patients and were able to define many disorders. They wrote books on various aspects of medicine and these writings were the basis of medical practice and education in Europe and the Arabic world well into the seventeenth century. In 1821, Greece emerged from a long occupa- tion by the Turks. In 1930, Adamantiades, a Greek Ophthalmologist, before Behcet of Turkey, described what is known as (Adamantiades)–Behcet disease. The first scientific Hellenic Society for Rheumatology (ERE) was established in 1960 and today ERE having been merged with the Professional Union of Greek rheumatologists (EPERE) is known as ERE-EPERE. Rheumatology is a strong specialty with 348 rheumatologists for a population of around 11 million. Greek rheumatologists have contributed to rheumatology science and practice, and are active physicians participating in the American College of Rheumatology and the EULAR annual congresses and in many educational postgraduate courses. ERE-EPERE formed thera- peutic protocols for inflammatory and autoimmune rheumatic diseases which were incorporated in the electronic National prescription system. Rheumatologists are authorized to use this platform to prescribe biologicals free of charge for patients. ERE-EPERE publishes a peer-reviewed English language journal, the Mediterranean Journal of Rheumatology (MJR), an open access journal with no publication fees. MJR is a quarterly journal with international Editorial Board. Keywords Arthritis · Behcet’s disease · Byzantine · Galen · Gout · Hippocrates · Hellenistic · Mediterranean Introduction Arabic world for hundreds of years, and many are still valid today. Honoring these authors, many medical terms today Medicine as we know it today has its roots in ancient Greece have Greek names. Rheumatology itself comes from the (Hellas). At that time, prominent Greek physicians were Greek (Hellenic) word ρεύµα (rheuma) which means flow- acute observers of disease course and patients, and they were ing current, because ancient Hellenes believed that diseases able to accurately define disorders and treat them. Greek are caused by flowing fluid (humor). What we will describe physicians at that time had broad education and were also in the next few pages about rheumatic diseases is the tip of anatomists, philosophers, mathematicians, teachers and writ- the iceberg of what ancient Greek authors have written on ers. What these Greek physicians left behind in writings various aspects of Medicine. were astonishing and formed the basis or even were the sole source of medical practice and teaching in Europe and the Ancient Greece (Hellas) * Lazaros I. Sakkas At first, physician-priests in Greece practiced mostly spir- [email protected] itual healing. Asklepios, the son of God Apollo and mor- Panagiotis Tronzas tal Coronis from Thessaly in central area of Greece, was a [email protected] demi-God hero and Asklepions, devoted to Asklepios, were sanctuary of healing based on dreams and appeared first in 1 Faculty of Medicine, University of Thessaly Biopolis, 41 110 Larissa, Greece Thessaly and then throughout Greece [1, 2]. 2 SOTIRIA general Hospital, 11527 Athens, Greece Vol.:(0123456789)1 3 948 Rheumatology International (2019) 39:947–955 widely used by eminent physicians during the Hellenistic and Roman periods, was translated into Arabic and later into Latin and was the main book of medicine through the seventeenth century. Hippocrates systemically studied dis- eases and patients to make a diagnosis “learning from the common features of the diseases and the specific features of each one, learning from the patient, from the diet, from the profession, from the age of each one” (Hippocrates work: Epidimion A, Sect. 23) [3]. Hippocrates’s work “On Joints” advised physicians to avoid nerve damage when reducing joint dislocations. Hippocrates describes gout as an affection of the rich and he says in his aphorisms: A woman does not get gout unless her manses are stopped A young man does not take gout until he indulges in Fig. 1 A statue of Hippocrates in Larissa, in central Greek area of coition Thessaly Eunuchs do not get gout nor become bald Hippocrates (circa 460–370 BC) was born in the island of Kos and practiced medicine in Kos, Athens, and finally in the city of Larissa in Thessaly, where he died (Fig. 1). Hip- pocrates is widely considered as the father of Medicine, as he moved physicians away from spiritual healing and founded Medicine as a rational discipline (Figs. 2, 3). His total works, known as “Corpus Hippocraticum” were taken by the king of Egypt Ptolemy I, one of Alexander the Great successors, to Alexandria. Alexandria became the cultural and scientific center of the ancient world. The Corpus Hippocraticum was Fig. 3 Anathem of Lysimachides, son of Lysimachus of Athens to Fig. 2 Amphiaraus treats a shoulder disorder in a Temple (400– the Temple of hero-physician Amynos. The anathem shows a leg 350 BC). National Archaelogical Museum of Athens (with permis- with varicose vein, indicating patient’s affection (fourth century BC). sion) National Archaeological Museum of Athens (with permission) 1 3 Rheumatology International (2019) 39:947–955 949 In gouty affections inflammation subsides within Aristoteles (Aristotle) (384–322 BC), born in Stageira, 40 days [4] Chalkidiki in the northern Greek area of Macedonia, studied in Plato’s Academy in Athens. He was the teacher of Alexan- Others relevant to rheumatology aphorisms include der the Great in Macedonia and established his own School, What remains in diseases after the crisis is apt to pro- the Lyceum, in Athens. Aristotle became a great scientist, duce relapses teacher, and the greatest philosopher of all times. He laid Swellings and pains in the joints of the gouty nature the foundations of comparative anatomy, and he is regarded and sprains are generally improved by copious affusion as the first biologist. Above all, he is the founder of formal of cold water which reduces the swelling and removes logic which changed the way of human thinking [13]. the pain. “All disease begins in the gut”. Today we know that the microbiota of the gastrointestinal tract plays a crucial role Hellenistic/Roman period in shaping the immune response and this is convincingly shown to be involved in the pathogenesis of rheumatoid During the Hellenistic period, Ptolemy I, one of Alexan- arthritis [5]. der the Great successors and king of Egypt, made Alexan- “When bubbles settle on the surface of the urine, they dria in Egypt the cultural and scientific centre of ancient indicate disease of the kidneys and that the complaint will world. Herophilos of Alexandria, a Greek physician born be protracted”. Later Galen explained: “Bubbles are cre- in Chalkedon and lived in Alexandria, taught in the famous ated when the liquid contains something sticky”. We now Medical School of Alexandria, excelled in anatomy and is know that protein increases surface tension and explains this widely considered the father of anatomy [14]. Erasistratus phenomenon [6]. (310–250 BC) was a collaborator of Herophilus in anatomi- Hippocrates also described a condition that resembles cal dissections [15]. was it is known as (Adamantiades)–Behcet’s disease. In During the Roman empire, it was the Greek physicians his ‘Epidimion’ Book 3, Case 3, he described an endemic who established the medical practice in Rome. In Rome, disease: “There were other fevers which will be described. there were no native physicians and Archagathos of Sparta Many had oral ulcers and aphthae. Genitals with ulcers. was the first Greek physician to introduce Greek medicine Nodules external and internal in the groin. Watery inflam- to Romans around 218 before current era (BCE). Many mation of eyes painful, chronic, growths on the eyelids, Greek medical Schools flourished in Rome, including the external and internal, reducing the sight in many cases… Methodiki school (founded by Asclepiades of Bithynia and Herpetic lesions many and large” “Ησαν δε και άλλοι his student Themison of Laodicea), the Pneumatiki School πυρετοί περ ιών γεγράφεται. Στόµατα πολλοίσιν αφθώδεα (founded by Athenaeus), the Empiriki school (founded by ελκώδεα, ρευµατα περι αιδοία πολλά ελκώµατα φύµατα Serapion of Alexandria and Philinus of Kos), and Eklektik έξωθεν, έσωθεν τα περί βουβώνας. Οφθαλµίαι υγραί school (founded by Agathinus of Sparta). µακροχρόνιοι µετα πόνων, επιφύσιες βλεφάρων, έξωθεν, Asclepiades of Bithynia (130–40 BCE) established Greek έσωθεν, πολλών φθείροντα τας οψίας. ..Εκθύµατα µεγάλα, medicine in Rome. Asclepiades studied in Athens and Alex- έρπητες πολλοίσι µεγάλα [3, 7, 8]. Many medical terms andria before moving to Rome. Based on Democritus and today are the same as used by Hippocrates [9]. Even more Epicurus theories, he proposed that the human body com- importantly, Hippocrates stressed the ethics of medical prac- posed of atoms and pores whereas the disease is associated tice “do good not harm” and today