Historical overview of spinal deformities in ancient Greece

Abstract

Little is known about the history of spinal deformities in ancient Greece. The present study summarizes what we know today for diagnosis and management of spinal deformities in ancient Greece, mainly from the medical treatises of Hippocrates and Galen. Hippocrates, through accurate observation and logical reasoning was led to accurate conclusions firstly for the structure of the spine and secondly for its diseases. He introduced the terms kyphosis and scoliosis and wrote in depth about diagnosis and treatment of kyphosis and less about scoliosis. The innovation of the board, the application of axial traction and even the principle of trans-abdominal correction for correction of spinal deformities have their origin in Hippocrates. Galen, who lived nearly five centuries later impressively described scoliosis, lordosis and kyphosis, provided aetiologic implications and used the same principles with Hippocrates for their management, while his studies influenced medical practice on spinal deformities for more than 1500 years.

Figure 1

Wall paintings of female figures wearing tight bodices that expose their breasts. Knosos, Crete, 3^rd millennium BC.

Figure 2

The Boxing Boys" fresco from Room Beta 1, Akrotiri, Thera (1600 BC).

Figure 3

A marble statue of Alexander the Great, showing a characteristic body asymmetry in the axis of the head, shoulders and neck, Istanbul, Turkey.

Figure 4

Marble portrait of Plato, an eminent Classical Greek philosopher.

Figure 5

A portrait of Empedocles, a Greek pre-Socratic philosopher.

Figure 6

Portrait of Aristotle, a Greek philosopher, student of Plato and teacher of Alexander the Great.

Figure 7

Asclepios, the God of health, while examining a patient.

Figure 8

Hippocrates the Koan.

Figure 9

A graphic illustrating the Asklepion of Kos.

Figure 10

An illustration showing one of the numerous editions of "Corpus Hippocraticum".

Figure 11

Galen of Pergamon.

Figure 12

Hippocrates examining a child, a painting by Robert Thom, 1950's.

Figure 13

The Hippocratic ladder for correction of spinal deformities with the head pointing upwards. From the illustrated comments of Apollonius of Kitium on the Hippocratic treatise On Articulations. Bibliotheca Medica Laurenziana, Florence.

Figure 14

The Hippocratic ladder for correction of spinal deformities with the head pointing downwards. From the illustrated comments of Apollonius of Kitium on the Hippocratic treatise On Articulations. Bibliotheca Medica Laurenziana, Florence.

Figure 15

An illustration of Hippocratic board by Apollonius of Kitium showing the correction of a spinal deformity. To reduce the hump, the physician or a trained assistant uses his hands, his foot, or even his whole body to press it, while traction is applied. Bibliotheca Medica Laurenziana, Florence.

Figure 16

A drawing attributed to Vidus Viceus (16^th century AD) showing correction of spinal deformity on the Hippocratic board. Paris National Library.

Figure 17

An illustration of Hippocratic board by Apollonius of Kitium showing correction of a spinal deformity by applying stronger force to restore the anatomy of the spine, by using a plank. One end of this plank is adjusted to an incision made in the wall or in the post embedded in the ground. With the hump lying below the plank, one or two assistants press down its opposite end. Bibliotheca Medica Laurenziana, Florence.

Figure 18

A schematic representation of the application of corrective forces for spinal deformities by the use of straps and bands, properly adjusted on the Hippocratic board.

Figure 19

The Hippocratic board with the addition of the third bar by Orebasius.

Figure 20

A drawing showing Galen's method of correction of spinal deformity on a device similar to the Hippocratic board by applying pressure on the patient's back.

Figure 21

A drawing showing Galen's method of correction of spinal deformity on a device similar to the Hippocratic scamnum by applying pressure with the use of a board attached in the wall.

Figure 22

The Hippocratic scamnum.

Figure 23

Hippocrates and Galen. Fresco of Taddeo Gaddi, Santa Maria Novella, Florence, Italy.