What we know today as medicine bears little or no resemblance to that which was practiced by tribal shamans, by witch-doctors and by healers in the early centuries of humanity. These ancient medical practices, however, have exerted a great influence upon contemporary thinking.
The understanding of prehistoric medical practice is derived from paleopathology, (The study of pictographs showing medical procedures, of skulls and skeletons, and of the surgical tools of ancient and contemporary non-technological societies). Although such study is properly the concern of anthropology, some of the methods and practices have survived, and have been incorporated into modern medicine.
Serious diseases were of primary interest to early humans although they did not effectively treat them. They divided the genesis of such disease into two categories, each involving a variety of mutually exclusive therapies. First and most numerous were diseases attributed to the influence of malevolent demons, who were believed to project an alien spirit, a stone, or a worm into the body of the unsuspecting patient. Such disabilities were to be warded off by incantation, dancing, magic effects, charms and talismans, and various other quasi-religious measures. If the demon managed to enter the body of its victim, either in the absence of such precautions or despite them, efforts were then made to make the body uninhabitable to the demon. These would include beating, torturing, and starving the patient. The alien spirit could also be expelled by potions that caused violent vomiting, or could be driven out through a hole bored in the skull. This procedure, called trepanning, was also a remedy for insanity, epilepsy, and headache.
Therapy mounted directly against a disability, however, was usually most successful. Operative procedures practiced in ancient societies included cleaning and treating wounds by cautery, poultices, and sutures, resetting dislocations and fractures, and using splints, all of which are still practiced to some extent. Additional therapy included the use of purges, diuretics, laxatives, emetics, and enemas. Perhaps the greatest success was achieved with plant extracts, the narcotic and stimulating properties of which were slowly discovered. So successful were these that 50 or more continue to be used today. Digitalis, a heart stimulant extracted from foxglove, is perhaps the best known.
Pre-scientific systems of medicine, based primarily on magic, folk remedies, and elementary surgery, existed in various diverse societies before the coming of the more advanced Greek medicine about the 6th century BC.
Although it is tempting to look back at different
cultures and judge them in terms of what we know today, I hope
to avoid this highly relative and biased form of judgment. I think
that it is possible to judge these primitive cultures on their
own terms, rather than on our highly empirico-rationalist ones.
To judge solely on what was known then when compared to what is
known now is to look only at one aspect of medicine, that of molecular
biology. I believe that, in ages to come, our efforts in the field
of molecular medicine will find its place in the much larger picture,
the picture of treating people as people rather than just chemical
systems. There is much that cannot be explained purely in a molecular
biological frame; the most outstanding being that of the placebo
effect (This can be as great as 30% in some trials). In focusing
on the highly rational and empirical, I believe that we are missing
out on large parts of the 'human experience', and experience that
would be common among many of the 'primitive' forms of medicine
that I will outline. Through-out this essay, I will compare two
distinct schools of thought regarding treatment of the sick; the
empirico-rationalist view that ultimately looks at things on a
micro- and submicroscopic scale, compared with the more holistic
school that looks and treats on a more macroscopic level.
Two distinct trends are discernible in Egyptian medicine, the magico-religious, embodying primitive elements, and the empirico-rational, based on experience and observation and lacking in mystical features.
Common diseases of the eyes and skin were usually treated rationally by the physician because of their favorable location; less accessible disorders continued to be treated by the spells and incantations of the priest-magician. In the 3rd Dynasty the physician emerged as an early form of scientist, a type distinct from the sorcerer and priest. The earliest physician whose name has survived is Imhotep (circa 2700 BC), renowned equally as vizier to the pharaoh, a pyramid builder, and an astrologer.
The physician normally spent years of arduous training at temple schools in the arts of interrogation, inspection, and palpation (examining the body by touch). Prescriptions contained some drugs that have continued in use through the centuries. Laxatives such as figs, dates, and castor oil, were used then as now. Tannic acid (which the Egyptians derived principally from the acacia nut) was used until fairly recently in the treatment of burns.
Although Egyptians practiced embalming, their anatomical knowledge remained at a low level; as a result, they attempted only minor surgical procedures. An exception was the practice of trepanning, which is still used today to relieve pressure exerted by swelling tissue (caused by a heavy blow the head) on the brain. Without this release of pressure, the medulla (The region controlling the heart) would be pushed through the Foramen Magnum. Unfortunately, the Foramen Magnum is approximately 2/3 the size of the medulla. The resulting damage to the medulla causes the heart to stop.
According to reports of the Greek historian Herodotus, the ancient Egyptians recognized dentistry as an important surgical specialty. Some evidence suggests that Egyptian studies of physiology and pathology, based on the work of the physician Imhotep, and the later vivisection of criminals by the Greek anatomist and surgeon Herophilus may have influenced the Greek philosopher Thales of Miletus, who is known to have traveled in Egypt in the 7th century BC.
In terms of our knowledge today, the Egyptians
seem to be fairly primitive. I think that this is true purely
in terms of their lack of physical expertise, but not true in
the light of their whole system. If it is possible for a society
to build wonders like the pyramids simply as graves, it seems
probable that they must have been a people of immensely strong
spirituality. I think that, while we have advanced in ways that
they have not, and could not, we have also lost sight of some
of the practices that were an inherent part of the Egyptian experience.
Due to a number of factors, such as the theocratic system prevailing in Assyria and Babylonia, medicine in these countries did not break away from the influence of demonology and magical practices. It would be easy to leave the blame for this perceived stagnation of medical advance at the feet of religion, but to do so would be to ignore the social dimension. It may well be the case that dissection was frowned upon by the prevailing religious authorities, but these prescriptions would only have come about as a result of pre-existing taboos and interdictions.
Surviving cuneiform tablets present an extensive series of well-classified case histories. Surprisingly accurate terra-cotta models of the liver (then considered the seat of the soul) indicate the importance attached to the study of that organ in determining the intentions of the gods. Dreams also were studied to learn the gods' intentions, much in the way that Freud and Jung advocated.
A large number of medical remedies were used
in Mesopotamia, including more than 500 drugs, some of which were
of mineral origin. The central position that religion held in
Mesopotamian society resulted in what we might consider an over-emphasis
on the holistic side of medicine; while there are benefits in
treating the patient as a thinking, feeling person, it cannot
completely outweigh the benefits derived from advances in molecular
Hebrew medicine derived much from contact with Mesopotamian medicine during the Assyrian and Babylonian captivities. Disease was considered evidence of the wrath of God. The priesthood acquired the responsibility for compiling hygienic regulations, and the status of the midwife as an assistant in childbirth was clearly defined.
Although the Old Testament contains a few references to diseases caused by the intrusion of spirits, the tone of biblical medicine is modern in its marked emphasis on preventing disease. The Book of Leviticus includes precise instructions on such varied subjects as feminine hygiene, segregation of the sick, and disinfection of materials capable of harboring and transmitting germs. Although circumcision is the only surgical procedure clearly described, fractures were treated with the roller bandage, and wounds were dressed with oil, wine, and balsam. The leprosy so frequently mentioned in the Bible is now believed to have embraced many skin diseases, including psoriasis. The principle of isolating the sick from areas of habitation has developed into the idea of quarantine.
The role of the priesthood in Palestinian
culture seems to be more than what we would consider a priest
to be. They functioned as the story-tellers, the healers, the
advisors, as well as religious teachers. This unification of both
person-centered and empirically derived treatment may well have
resulted in a higher standard of treatment and recovery than solely
a holistic, or solely rational one could have.
The practices of ancient Hindu, or Vedantic, medicine (1500 to 1000 BC) are described in the works of two later physicians, Charaka (2nd century AD) and Susruta (4th century AD). Susruta gave recognizable descriptions of malaria, tuberculosis, and diabetes. He also wrote about Indian hemp, Cannabis, and henbane (Hyocyamus) for inducing anesthesia, and included specific antidotes and highly skilled treatments for bites of venomous snakes. An ancient Hindu drug derived from the root of the Indian plant Rauwolfia serpentina was the source of the first modern tranquilizer. In the field of operative surgery, the Hindus are acknowledged to have attained the highest skill in all antiquity. They were probably the first to perform successful skin grafting and plastic surgery for the nose.
With the rise of Buddhism the study of anatomy
was prohibited, and with the Muslim conquest the field of advancement
in molecular-medicine declined and ultimately stagnated. Nevertheless,
much valuable knowledge concerning hygiene, diet, and eugenics
was transmitted to the West through the writings of the Arab physician
Avicenna and others.
Religious prohibitions in ancient China against dissection resulted in a poor knowledge of body structure and function. As a consequence, surgical technique remained elementary. External treatments included massage and dry cupping (a form of counter-irritation in which blood is drawn to the skin surface by application of a cup from which air is then exhausted to create a partial vacuum). Two special forms of counter-irritation used in rheumatic fever and other disorders were acupuncture to relieve pain and congestion; and cautery of the skin by the application of burning moxa (a preparation of oil-soaked leaves of Chinese wormwood). These forms of treatment, especially acupuncture, are hard to explain on the molecular level, as it would seem unlikely to you or I that lengths of metal rammed into different places on the body could have a beneficial effect. This idea, I believe, is a legacy of the over-emphasis on the empirico-rationalist in all forms of life, the idea that all things can be explained to have a logical and sensible cause.
Important Chinese drugs included rhubarb,
aconite, sulfur, arsenic, and most importantly, opium. Concoctions
of animal organs and excretions (hang-overs from ancient ritual)
were also used. What we count today as spices, things like Ginger
and ginseng, have had, and indeed still do have special significance
in the treatment of various conditions, ranging from impotency
The earliest Greek medicine depended on magic and spells. Homer considered Apollo the god of healing. Homer's Iliad, however, reveals a considerable knowledge of the treatment of wounds and other injuries by surgery, already recognized as a specialty distinct from internal medicine.
Asclepius subsequently supplanted Apollo as the god of healing, and priests practiced the healing art in his temples. Still later, a semi-priestly sect, the Asclepiades, (claiming to be descendants of the god of medicine) practiced a form of psychotherapy called incubation.
By the 6th century BC, Greek medicine had become thoroughly secular, stressing clinical observation and experience. In the Greek colony of Crotona the biologist Alcmaeon (6th century BC) identified the brain as the physiological seat of the senses. The Greek philosopher Empedocles elaborated the concept that disease is primarily an expression of a disturbance in the perfect harmony of the four elements - fire, air, water, and earth (Later to resurface as the four humors - bile, blood, phlegm and lymph) - and formulated a rudimentary theory of evolution.
Kos and Cnidus are the most famous of the Greek medical schools that flourished in the 5th century BC under the Asclepiades. Students of both schools probably contributed to the Corpus Hippocraticum (Hippocratic Collection), which is an anthology of the writings of several authors, although popularly attributed to Hippocrates of Kos, who is known as the father of medicine. In a marked departure from previous tradition, none of these works mentions supernatural cures. The highest ethical standards were imposed on the physicians, who took the celebrated oath usually attributed to Hippocrates and still in use today (The so-called "Hippocratic Oath").
Knowledge of human anatomy was based mainly on the dissection of animals. Physiology was based on the four cardinal humors, or fluids, of the body: This concept was derived from Empedocles' theory of the four elements. Pain and disease were attributed to imbalance of these humors. The true genius of Hippocrates is shown in the Aphorisms and Prognostics, containing pithy summaries of vast clinical experience that inspired countless commentaries until well into the 18th century. Of unusual excellence also is the Hippocratic work Fractures, Dislocations, and Wounds, the contents of which are still applicable today.
Although not a practicing physician, the Greek philosopher Aristotle contributed greatly to the development of medicine by his dissections of numerous animals. His work on anatomy and dissection means that he is known as the founder of comparative anatomy.
By the 3rd century BC, Alexandria in Egypt, the seat of a famous medical school and library, was firmly established as the center of Greek medical science. In Alexandria the anatomist Herophilus performed the first recorded public dissection, and the physiologist Erasistratus did important work on the anatomy of the brain, nerves, veins, and arteries. The followers of these men divided into many contending sects; the most notable were the empiricists, who based their doctrine on experience gained by trial and error. The empiricists excelled in surgery and pharmacology; a royal student of empiricism, Mithridates VI Eupator, king of Pontus, developed the concept of inducing tolerance of poisons by the administration of gradually increased dosages.
It is with the rise of Greece that empirico-rationalism
spreads, and the holistic approach to healing begins to fade.
Although it was to resurface in various minor ways of the intervening
years, empirico-rationalism has steadily gained in strength over
the intervening decades.
Alexandrian Greek medicine influenced conquering Rome despite initial resistance from the Romans. Asclepiades of Bithynia was important in establishing Greek medicine in Rome in the 1st century BC. Opposed to the theory of humors, Asclepiades taught that the body was composed of disconnected particles, or atoms, separated by pores. Disease was caused by restriction of the orderly motion of the atoms or by the blocking of the pores, which he attempted to cure by exercise, bathing, and variations in diet, rather than by drugs. This theory was revived periodically and in various forms as late as the 18th century.
The chief medical writers of the 1st and 2nd centuries AD, apart from Galen of Pergamum (Sometimes known as "Galen the Brilliant"), were the Roman Aulus Cornelius Celsus, who wrote an encyclopedia of medicine; the Greek physician Pedanius Dioscorides, the first scientific medical botanist; the Greek physician Artaeus of Cappadocia (2nd century), a disciple of Hippocrates; the Greek anatomist Rufus of Ephesus (early 2nd century), renowned for his investigations of the heart and eye; and Soranus of Ephesus, another Greek physician, who recorded information concerning obstetrics and gynecology, apparently based on human dissection. Although an adherent of the school of Asclepiades, he distinguished among diseases by their symptoms and course. Most of the work of the above mentioned authors still survives, and, although not completely correct, they came surprisingly close to what we know today.
Galen of Pergamum, also a Greek, was the
most important physician of this period and is second only to
Hippocrates in the medical history of antiquity. In view of his
undisputed authority over medicine in the Middle Ages, his principal
doctrines require some elaboration. Galen described the four classic
symptoms of inflammation and added much to the knowledge of infectious
disease and pharmacology. His anatomic knowledge of humans was
defective because it was based on dissection of apes. Some of
Galen's teachings tended to hold back medical progress. His theory,
for example, that the blood carried the pneuma, or life spirit,
which gave it its red color, coupled with the erroneous notion
that the blood passed through a porous wall between the ventricles
of the heart, delayed the understanding of circulation and did
much to discourage research in physiology. His most important
work, however, was in the field of the form and function of muscles
and the function of the areas of the spinal cord. He also excelled
in diagnosis and prognosis. The importance of Galen's work cannot
be overestimated, for through his writings knowledge of Greek
medicine was subsequently transmitted to the Western world by
the Arabs. Perhaps what Galen is best remembered for is his description
of the four humors that effect a person state of mind. It would
seem at first glance that this interpretation leaves a lot to
be desired of. However, recent work would suggest that moods and
feelings, as well as psychological conditions, come about because
of imbalances in neurotransmitters, or other neuroproteins.
Original Roman contributions were made in the fields of public health and hygiene. In the organization of street sanitation, water supply, and public hospitals, the methods of the Romans were not surpassed, until modern times.
The gradual infiltration of the Roman world
by a succession of barbarian tribes was followed by a period of
stagnation in the sciences. Western medicine in the early Middle
Ages consisted of tribal folklore, mingled with poorly understood
remnants of classical learning. Even in sophisticated Constantinople,
a series of epidemics served only to initiate a revival of magical
practices. Only a few outstanding Greek physicians such as Oribasius,
Alexander of Tralles, and Paul of Aegina maintained the older
tradition in face of the rise of moral decadence, superstition,
and intellectual stagnation.
In the 7th century a vast portion of the Eastern world was overrun by Arab conquerors. In Persia, the Arabs learned of Greek medicine at the schools of the Nestorian Christians, a sect in exile from the Byzantine Empire. These schools had preserved many texts lost in the destruction of the Alexandrian Library. Translations from Greek were instrumental in the development of a scientific revival and an Arabic system of medicine, based on Greek and Roman thought, throughout the Arab-speaking world. Followers of the system were known as Arabists.
Important among Arabist physicians were al-Razi, a famous clinician and writer, who was the first to identify smallpox, in 910 AD, and measles and to suggest blood as the cause of infectious diseases; Isaac Judaeus, the author of the first book devoted entirely to dietetics; and Avicenna, whose famous Canon remained the standard synthesis of the doctrines of Hippocrates, Aristotle, and Galen. Arabists of the 12th century include Avenzoar, who first described the parasite causing scabies and was among the earliest to question the authority of Galen; Averroës, recognized as the greatest commentator on Aristotle; Averroës' pupil Maimonides, whose works on diet, hygiene, and toxicology were widely read; and Al-Quarashi, also known as Ibn al-Nafis, who wrote commentaries on the writings of Hippocrates and treatises on diet and eye diseases, and, most important, was the first to indicate the pulmonary transit of blood, from the right to the left ventricle via the lungs.
The Arabists did much to elevate professional standards by insisting on examinations for physicians before licensure. They introduced numerous therapeutic chemical substances, excelled in the fields of ophthalmology and public hygiene, and were superior to the physicians of medieval Europe. In addition to their relatively high level of empirico-rational understanding, the role played by religion in the Islamic world broadened the spectrum of treatment, zooming out from just treating the patient as a chemical system, and more as a sentient.
We can see, then, a fairly clear progression from the most primitive of societies, with their demons, to the high level of Arabian knowledge. It is fair to say that, lacking the advantages that later stages had in terms of technology, each of the above mentioned cultures excelled in specific fields; when religion prohibited surgery, drugs and complementary treatments were developed. Knowledge also increased through the increased connections that ancient societies had, including more trade, and better, faster transport. Without some of the developments of these so-called primitive societies, modern medicine would be completely different, and not as successful. Without the discovery of opium, there could by no pain-killers; without the advances made by Romans and Arabs, there would be no public hygiene, and definitely no National Health Service.
The image that all of these small contributions gives rise to,
in my mind, is that of a tower, a tower reaching toward Heaven;
through every age and every culture, bricks and stones are added
to this tower. Some of the bricks are weak, and crack under the
strain, others however are strong enough to last through the ages.
In recent times, the speed at which this tower is added to seems
to have increased, with new technologies becoming available, but
without the foundations laid by our ancient predecessors, this
tower would not be standing, let alone being added to. There is
also a problem that follows this process; the increasing emphasis
placed on empirico-rationalism and on molecular medicine. As understanding
and knowledge increase, I believe that there will be a move to
counter this very western idea of the micro- scale. It is, I believe,
neither right, nor proper, indeed not possible to treat a person
solely as if we are a bundle of equilibria that can be fiddled
about with. Although many advances in medical science have come
about as a result of this view, I think that a more holistic concept
of medicine is required.
Microsoft Encarta (1997 edition)
The Encyclopedia Britannica CD (1997 edition)
The Greatest Benefit to Mankind - Roy Porter
The Science of Life - G. Rattray Taylor
Memories, Dreams & Reflections - C. G. Jung
The Wellcome Medical History Unit (Manchester)Web Site (www.man.ac.uk/Science_Engineering/CHSTM/Wellcome.htm)
The Wellcome Medical History Unit (Oxford) Web Site (http://users.ox.ac.uk)
The Jerusalem Bible
Copyright © Marcus Wischik 1998