© 2009 Jan Herca (license Creative Commons Attribution-ShareAlike 4.0)
¶ Mesopotamian medicine
The “land between two rivers” was home to some of the earliest and most important human civilizations (Sumerian, Akkadian, Assyrian, and Babylonian) since the Neolithic period. Around four thousand years before our era, the first Sumerian cities were established in this territory, and for more than three thousand years, these four cultures flourished, characterized by the use of a written language (cuneiform) that has survived to this day in numerous tablets and engravings. It is precisely this capacity to transmit scientific, social, and administrative information through an enduring system that determined the cultural development of the first Sumerian settlements and allowed later historians to reconstruct their legacy.
The principal testimony to the way of life of Mesopotamian civilizations is found in the Code of Hammurabi, a collection of laws and administrative regulations compiled by the Babylonian king Hammurabi. It was carved on a block of diorite approximately 2.5 m high by 1.9 m wide and placed in the Temple of Sippar. Thirteen articles, it sets forth the responsibilities of physicians in the practice of their profession, as well as the punishments imposed in the event of malpractice.
Thanks to this text and a set of some thirty thousand tablets compiled by Ashurbanipal (669-626 BC), from the library discovered in Nineveh by Henry Layarde in 1841, it has been possible to gain insight into the conception of health and illness during this period, as well as the medical techniques used by its professional healers. Of these tablets, some 800 are specifically dedicated to medicine, and among them is the description of the first known prescription. Most striking is the intricate social organization around taboos and religious and moral obligations, which determined the individual’s destiny. A supernatural conception of illness prevailed: it was a divine punishment imposed by different demons after breaking some taboo. Thus, the first thing the doctor had to do was identify which of the approximately six thousand possible demons was causing the problem. To do this, they used divinatory techniques based on the study of bird flight, the position of the stars, or the livers of certain animals. The disease was called shêrtu. But this Assyrian word also meant sin, moral impurity, divine wrath, and punishment.
Any god could cause illness through direct intervention, abandoning the person to their fate, or through enchantments cast by sorcerers. During healing, all these gods could be invoked and summoned through prayers and sacrifices to withdraw their harmful influence and allow the sick person to heal. Among the entire pantheon of gods, Ninazu was known as “the lord of medicine” for his special connection to health.
The diagnosis then included a series of ritual questions to determine the source of the illness: “Have you set father against son? Or son against father? Have you lied? Have you deceived the balance?” And the treatments did not escape this cultural pattern: exorcisms, prayers, and offerings are common healing rituals that seek to ingratiate the patient with divinity or free them from the demon that stalks them. However, it is also worth noting an important herbal arsenal compiled in several tablets: some 250 healing plants are listed in them, as well as the use of some minerals and various substances of animal origin.
The generic name for the physician was asû, but some variants can be found, such as the bârû, or diviner in charge of ritual interrogation; the âshipu, specialized in exorcisms; or the gallubu, a low-caste barber-surgeon who anticipated the figure of the medieval European barber and who finds a counterpart in other cultures (such as the Aztec Tepatl). This healer was in charge of simple surgical procedures (tooth extraction, drainage of abscesses, phlebotomies, etc.).
In the Louvre Museum, you can see a Babylonian alabaster seal more than four thousand years old, bearing a legend mentioning the first known name of a physician: “O Edinmungi, servant of the god Girra, protector of women in labor, Ur-Lugal-edin-na, the physician, is your servant!” This seal, used to sign documents and prescriptions, depicts two knives surrounded by medicinal plants.
The Persian invasion of 539 BC marked the end of the Babylonian Empire, but we must go back another three thousand years to mention the other great civilization of the ancient Near East that possessed a written language and a remarkably advanced medical culture: the Egyptian.
¶ Egyptian medicine
During the more than three thousand years of ancient Egyptian history, a long, varied, and fruitful medical tradition developed. Herodotus once called the Egyptians the people of the most healthy, due to their remarkable public health system and the existence of “a physician for every disease” (the first reference to specialization in medical fields). In Homer’s Odyssey, Egypt is described as a country “whose fertile soil produces a multitude of medicines” and where “every man is a physician.” Egyptian medicine largely maintained a magical conception of disease, but it began to develop a practical interest in fields such as anatomy, public health, and clinical diagnosis, which represented a significant advance in our understanding of how we become ill (UB 81:2.9).
The climate of Egypt has favored the conservation of numerous papyri with medical references written in hieroglyphic writing (hierós, sacred, and glypho, to engrave, that is, “the sacred words”) or hieratic:
- The Ramesseum papyri (1900 BC), which describe recipes and magic formulas.
- The Kahun papyrus (1850 BC), which deals with subjects as diverse as obstetrics, veterinary medicine and arithmetic.
- The Ebers Papyrus (1550 BC), one of the most important and longest written documents found from ancient Egypt: measuring more than twenty meters in length and about thirty centimeters in height, it contains 877 sections describing numerous diseases in various fields of medicine, such as ophthalmology, gynecology, gastroenterology, and their corresponding prescriptions. This papyrus includes the first written reference to tumors.
- The Edwin Smith Papyrus (1650 BC), primarily focused on surgery. The medical information contained in the Edwin Smith Papyrus includes the examination, diagnosis, treatment, and prognosis of numerous pathologies, with special attention to various surgical techniques and anatomical descriptions obtained during the embalming and mummification of corpses. This papyrus establishes, for the first time, three prognostic degrees, similar to those of modern medicine: favorable, doubtful, and unfavorable.
- The Hearst Papyrus (1550 BC), which contains medical and surgical descriptions and some master formulas.
- The London Papyrus (1350 BC), where recipes and magical rituals are intermingled.
- The Berlin Papyri (the “Book of the Heart”) (1300 BC) which detail some cardiac pathologies quite accurately.
- The Chester Beatty Medical Papyrus (1300 BC), a varied recipe book.
- The Carlsberg Papyrus (1200 BC) on obstetric and ophthalmological themes.
Among the numerous anatomical descriptions offered by Egyptian texts, those relating to the heart and the circulatory system stand out, as recorded in the treatise “The Physician’s Secret: Knowledge of the Heart”, included in the Edwin Smith Papyrus: “The heart is a mass of flesh, the origin of life and the centre of the vascular system (…) Through the pulse, the heart speaks through the vessels to all the members of the body.”
The earliest references to him date back to the early monarchical period (2700 BC). According to the Egyptian priest and historian Manetho, Atotis or Aha, a pharaoh of the First Dynasty, practiced the art of medicine, writing treatises on the technique of opening bodies. Also from this period are the writings of Imhotep, vizier of Pharaoh Necherjet Dyeser, a priest, astronomer, physician, and the first known architect (LU 80:6.4). Such was his fame as a healer that he was eventually deified, considered the Egyptian god of medicine. Other notable physicians of the Old Kingdom (2500-2100 BC) were Sachmet (physician to Pharaoh Sahure) and Nesmenau, director of one of the Houses of Life, temples dedicated to the spiritual protection of the Pharaoh but also proto-hospitals where medical students were taught while the sick were cared for.
Several gods watch over the practice of medicine: Thoth, god of wisdom; Sekhmet, goddess of mercy and health; Duau and Horus, protectors of eye specialists; Thueris, Heget, and Neith, protectors of pregnant women during childbirth; and Imhotep himself after being deified.
There is evidence of medical institutions in ancient Egypt from at least the First Dynasty. In these institutions, as early as the Nineteenth Dynasty, employees enjoyed certain benefits (health insurance, pensions, and sick leave), and their working hours were eight hours.
The first known female physician, Peseshet, was also Egyptian and practiced during the Fourth Dynasty. In addition to her supervisory role, Peseshet evaluated midwives at a medical school in Sais.
Medicine in ancient Egypt was taught in the Houses of Life attached to temples. Special care was provided to the sick, and physicians were specifically trained through practices supervised by priests, practices which the priests then practiced with their clients.
Illness was the physical demonstration of possession of the patient’s body by supernatural agents: enemies with access to magical power, an angry god, a disgruntled deceased, etc. This is why doctors and enchanters worked in parallel: first came the enchanter, then the doctor.
The body shell is a necessary element for achieving eternal life, and its destruction would prevent this. The worst possible situation for an ancient Egyptian was to die by drowning or being burned, resulting in the loss of their body.
The 21st-century worldview leads us to think of Egyptian medicine in comparison with today’s services, but the first thing to keep in mind is the fact that, as far as we know, the system depended on the temple, viewed as an institution.
The ancient Egyptian medical care system was a public service with the following characteristics: free, therefore accessible to all; general, to all social classes; national, available throughout the country; available at any time. It was part of a broader community service, which also took care of irrigation canals, education, justice, grain reserves, everything necessary for the Egyptian population, and was under the authority of the temple. In the House of Life, the temple managed, among other things, the scribal school, open to all, which trains future scribes but retains only the best. It also ensures the training of doctors and priests. This institution also manages the medical care facilities within the temple, and especially a care space, later called a “sanatorium,” which was not a spa as has been believed, but rather priestly spaces with tubs filled with sacred water, where the sick were immersed in the hope of divine healing.
Sanitary laws were strict, hygiene was scrupulously observed, and there were medical ordinances to supervise the waters, not only for the cleanliness of the living but also for the hygiene of the mortuary. All of this indicates a high degree of medical development.
Apparently, the standards of learning and practice were promulgated by the pharaoh’s physician, who stood at the top of the medical hierarchy. Below him were the palace physicians, one of whom was the Chief Doctor of the North and South, a kind of Minister of Health. Under his command were the inspectors, supervisors, and the master physicians. A lower rank included the vast majority of practicing physicians.
The standards of learning and practice were dictated by the pharaoh’s physician, and they were not allowed to deviate from orthodoxy or employ therapeutic methods other than those indicated in the manuals. By following this guideline, even if the results were not as desired, the physician was free from reproach. This rigidity constituted a very significant obstacle to innovation and learning from one’s own observations. We do not know if any of them engaged in research, although if they did, they must have been in higher echelons for their discoveries to be accepted.
There was a high degree of knowledge of the human body, partly due to the mummification process of corpses. They only treated diseases they could cure. They classified ailments as follows: “This is a disease I know and I will cure,” “This is a disease I know and I will not treat,” “This is a disease I don’t know and I will not treat.”
Apparently, the standards of medical learning and practice were promulgated by the pharaoh’s physician, who stood at the top of the medical hierarchy. Below him were the palace physicians, of whom one served as supervisor. The others were medical inspectors and constituted a less important group. A lower rank included the vast majority of practicing physicians.
Medical training took place at the House of Life. Young students were recruited after a period of observation, and Greek physicians who arrived to complete their training in Egypt, which was reputed to have the best physicians, were also taught. This additional training could last ten years. The educational system is not known, but it appears to have been based on a master-apprentice partnership.
The Ebers Papyrus describes three types of physicians in Egyptian society:
- Physicians, called by the Egyptians sun-nu, which means “man of those who suffer or are sick,” practiced outside the temple. They did so in a “secular” manner, but according to the temple’s precepts. Their tutelary god was Djehuty, whom the Greeks called Thoth. They began their practice as itinerant physicians, visiting patients and treating a single type of illness; they were specialists. Only a doctor with recognized extensive experience became a generalist. After an itinerant period, the sun-nu could try to enter a nursing home or practice in his or her residence.
- The uabu-sekhmet physicians practiced only in the temple. For them, the practice of medicine was completely imbued with religion; they practically practiced magic. They were dependent on the goddess Sekhmet, the goddess of healing, and knowledgeable in a wide range of drugs. These were the physicians of the pharaoh, the god on earth.
- The exorcist doctors, who cured by means of charms and amulets.
- A class of assistants, called ut, who were not considered healers, assisted the medical caste in large numbers, advancing the nursing corps.
The methods were varied. There were doctors for all parts of the body, for the spirit, for women, men, children, and even for the season. The case of the eye doctor who operated on cataracts and that of a women’s doctor who performed pregnancy tests, including predicting the sex of the child, have survived to history (Berlin Papyri).
Medicine was regulated since the time of Imhotep, as evidenced by an inscription on a wall at Saqqara, with clearly defined ethical rules governing the profession: the location of the treatment centers, their supervision, supervision of the activity of the sun-nu, evaluation of their performance, and disciplinary actions. He was not allowed to employ therapeutic methods that deviated from orthodoxy; he could only use those defined by the authority of classical treatises, and in such cases, even if the results obtained were not satisfactory, he was free from all reproach.
The diagnostic system is described in the Ebers Papyrus. The sequence is as follows:
- Ask the patient questions in an orderly and patient manner,
- Investigate among those close to him,
- Find the direct and indirect origin of suffering,
- Look for the existence of family history,
- In case of relapse, check if the treatment is adequate,
- Prepare a short- and medium-term care plan.
- At this point, the diagnosis becomes confused with the prescription: it becomes a detailed report that includes medical care and medications. The first goal is to prevent suffering, then to halt the progression of the disease, and finally to eliminate it.
The therapeutic methods used by the Egyptians were simple, diverse, and varied, surprising to today’s public. They fall into different categories:
- Medicines: there were all kinds: mineral, vegetable and animal.
- Minerals: northern salt (natron), copper chips, powdered Memphis stone (local anesthetic?), yellow ochre for burns,
- Plants: There is a rich pharmacopoeia, which was kept a professional secret, making it difficult to distinguish the plants used among the current flora (the warming climate that has occurred since 3000 BC has modified the region’s fauna and flora, and the translation of names is in doubt). Certain substances have not been identified, and others are a source of debate (was nicotine present in ancient Egypt, when tobacco arrived from America?). For example, coriander, carob, garlic, onion, acacia resin, roasted barley, etc. have been identified.
- Animal products: meat (to heal wounds), honey (as a local antiseptic), wax, cobweb (disinfectant, as it has a weak antibiotic action), cow fat, donkey milk, pig viscera, etc.
Medications were prepared by prescription, following rigorous protocols. They were used in various forms: local preparations (ointments, plasters, salves); preparations for absorption (macerated in beer); and fumigations (involving burning various elements and inhaling the resulting smoke).
Pharmacy was highly developed. The Grapow and Deines papyri record up to seven hundred formulas for the preparation of remedies and perfumes. The Ebers papyrus contains up to a thousand recipes, and among the most commonly used remedies are onion, garlic, honey, beer, figs, flax seeds, fennel, myrrh, aloe, saffron, opium, and lettuce. They used coffee as a stimulant, along with certain preparations of lead, copper, and antimony. The use of purgatives was very common.
- Magical remedies: These were mixed remedies, using excrement and magic, to provide repugnant nourishment to the spirit invading the body, thereby repelling it. These excrements were generally from donkeys, crocodiles, hippopotamuses, pelicans, cattle, flies, and even humans. There were also alchemists, whose goal was to find magical substances that would cure diseases, rejuvenate people, grant immortality, increase sexual potency, etc.
- Surgery: some interventions are attested, as well as the probable use of analgesics and anesthetics.
- Removal of thorns and treatment of bites (dog, crocodile, lion, hippopotamus, etc.).
- Suturing wounds, reducing shoulder dislocations and bone fractures by immobilizing limbs.
- Healing of war wounds.
- Cataract surgery, which is attested to in the Ptolemaic period. The instruments used are depicted on a back wall of the Kom Ombo temple.
- Trepanation is visible in some skulls, but the purpose of this intervention is not known.
- Circumcision is depicted in some bas-reliefs and paintings, but it is not explained, so its technique is unknown.
- Post-traumatic and punitive amputations (nose, tongue, ears, hand, etc., by court order). These techniques are described in the Edwin Smith Papyrus.
- Music: The Kahun Papyrus is also the first written record of the influence of music on the human body. Other earlier medical papyri contain references to the influence of music on women, linking it to fertility. They also cured illnesses through breathing, using chants in which specific breathing patterns were observed throughout the passages. Herophilus, a physician from Alexandria, regulated heart rate according to the musical scale.
- Drugs: The discovery of tobacco and cocaine components dates back to the arrival on French soil in 1976 of the royal mummy of Ramses II, thanks to a study carried out by historian and Egyptologist Christiane Desroches Noblecourt. The presence of a plant belonging to the Nicotiana L. genus, evenly distributed in the most inaccessible parts of the mummy, rules out the hypothesis of hoax. It seems that the Egyptians were familiar with these species earlier than previously thought. The exact use of these exotic plants among Egyptian priests remains to be determined: Did they have a narcotic effect, allowing priests to connect with the divinity in hallucinatory sessions? What basic principle prompted the priests to use such rare and distant plants in embalming? Finally, how did they obtain them?
Medicine and magic were closely linked in ancient Egypt, where illness was often the result of the intervention of evil spirits, ill-intentioned humans, or other divinities. They were the messengers of Sekhmet, the lion-headed goddess, who spread illness and death. Since she also had the power to heal, she was the goddess of physicians, who often served as her priests.
Magic has a special resonance, owing to the myth of Osiris. Isis, “The Great Magician,” after reconstructing the corpse of her divine husband, brought him back to life through her powerful magic, and was “miraculously” impregnated, giving birth to Horus.
Spells were often associated with other remedies; they were spells that a god had cast under similar conditions, and were recited to ensure the remedy’s effectiveness. Each illness had a specific formula to be recited.
As for prophylactic methods, to avoid disease they had amulets, prophylactic steles (steles depicting Horus riding a crocodile were considered protective against bites and stings from poisonous animals), and images of healing gods.
Many patients visited the sanctuaries of healing gods, such as Imhotep and Amenhotep, both of whom were deified, in the hope of being cured. Others sought healing at the sanatorium at the Temple of Hathor in Dendera and at the Temple of Hatshepsut.
The gods associated with medicine were: Isis, goddess of health and inventor of remedies; Horus, often invoked in cases of animal bites; Hathor, goddess of love and protector of women; Thoth, god of scribes and patron of ophthalmologists; Sekhmet, goddess of healing; Bes, protector of sleep and good spirit of pregnant women; Selkis, protector of bites.
And the deified men: Imhotep, chaty and architect of Pharaoh Dyeser (Dynasty III), founder of Egyptian medicine, and author of the Edwin Smith Papyrus on cures, ailments and anatomical observations; and Amenhotep (son of Hapu), architect of Pharaoh Amenophis III (Dynasty XVIII), was considered a benevolent magician who interceded with Amun and the other divinities and who also possessed healing and protective powers.
¶ Egyptian Obstetrics
Min is the god of fertility, and the goddess Tueris protects mother and child during childbirth by frightening away evil spirits that might harm the child. She is often accompanied by the god Bes.
The goddess Hathor, goddess of motherhood and fertility, was used to come to the aid of the child and the mother, by means of spells: “Place barley and wheat in two canvas bags with sand and dates; urinate on them every day; if the barley and wheat sprout, she will give birth; if the barley sprouts first, it will be a boy; if the wheat, it will be a girl; if they do not sprout, she will not give birth.”
But doctors countered the idea that pregnancy is due to the intervention of supernatural powers, gods, or demons. Egyptian papyri contain an attempt at rationalization, amidst spells, mythical concepts, and superstitions.
The Kahun Papyrus, dating from the 12th Dynasty, is a detailed treatise on gynecology and mentions a tissue-devouring disease (cancer). Egyptian physicians had noted the beneficial effects of honey in gynecology.
They knew contraceptive or abortive methods, described simply as “abandoning the state of pregnancy,” described in the Kahun, Ebers, Berlin, Carlsberg, and Ramesseum papyri. They consisted of various types of washings, such as those performed with very hot oil.
The first medical text on contraceptive methods was found in the Kahun papyri, which included advice and prescriptions such as the use of crocodile dung mixed with a paste that served as a vehicle and irrigation with substances such as sodium carbonate. In the 14th century BC, condoms were being made from animal bladders as a means of birth control. Some papyri include several recipes for intravaginal contraceptives, with ingredients such as acacia resin, sour milk, and acacia spikes. Compounds derived from the acacia tree have been shown to be spermicidal in modern in vitro research, with a sperm-immobilizing effect. Their use may have been a consequence of the observation by shepherds that animals that ate certain plants did not reproduce.
Among the methods used to diagnose pregnancy was counting the number of times a woman vomited when placed in a mixture of beer and dates. This aversion to strong odors is studied today as evidence of pregnancy.
During childbirth, which took place at home, women crouched on four ritual bricks, representing Meskhet, while midwives assisted. The placenta was preserved for medicinal purposes. Afterward, women would separate themselves for fourteen days to purify themselves, as they were considered impure after childbirth.
There are some suggestions in certain writings that perineal tears were sutured after childbirth, such as one papyrus that referred to “re-stitching the vagina.”
¶ Erectile dysfunction in Egypt
They had remedies made from carob, pine, or watermelon. Current studies indicate that carob has a high content of histidine, a major component of histamine. Laboratory studies have shown that histamine-deficient mice have a low reproductive rate due to a decrease in male libido.
¶ Egyptian Childcare
The Brugsh Papyrus is the oldest known document on pediatrics. This specialty was limited to infants; all other children were treated by adult physicians.
A newborn’s cry and muscle tone were used as indicators of health. The papyrus establishes that if the newborn said “nai,” it would live, and if it said “mibi,” it would die. It was also believed that if the child moaned or lowered its head, it would die. Crying and muscle tone are two of the five parameters used in the 20th century to determine the condition of newborns, according to the Apgar score.
Infanticide was severely punished. The Book of the Dead includes among its prohibitions the procurement of abortion. And although procuring it was legally punishable, it was justified in some cases.
In cases of birth with physical malformations or chronic illness, infanticide was not used, and the children were accepted, considered to have been touched by divine grace and were included in society with great respect.
¶ Egyptian Ophthalmology
Knowledge of ophthalmology in ancient Egypt was limited to the pupil, the sclera, and external aspects: eyelids, eyelashes, and eyebrows; the Egyptians were largely unaware of the internal structure of the eye. However, ophthalmology developed because eye diseases were very common, especially “desert ophthalmia,” known today as trachoma, which is still endemic in Egypt. One of the defenses against this disease was the use of kohol, which acted on two fronts: to reduce intense light, as it was black, and as an effective disinfectant, as it was made from antimony sulfate.
The eyelids were called the “back of the eye”; the white of the eye was already called the sclera; the iris was studied; some texts indicate that its examination allowed the sex of the fetus to be determined; and the pupil was called “the girl in the eye” due to the image of people reflected in the cornea against the black background of the pupil. (pupil: poupée: doll).
Despite the skill of Old Kingdom artisans, who crafted perfect replicas of eyes in glass and enamel for statues, there is no reason to believe that these objects were used as prosthetics.
From the First Dynasty, texts mention eye care, with practices mixed with magic: Thoth, the god of science and medicine, is the ancestor of ophthalmologists; according to mythology, he replaced the eye that Horus lost in his fight against Seth, and declared, “I am Thoth, the physician of the eye of Horus.”
Later, in the time of Pepy I of the Sixth Dynasty, a funerary stele depicts a man, sometimes seated and sometimes walking, with this dedicatory inscription: “Pepy Anj Iri, director of the royal physicians, physician of the eyes of the palace, custodian of the intestinal orifice, he who prepares documents, he who trains scorpions.”
The Ebers and London papyri contain several magical spells invoking Thoth, which had to be repeated several times while applying the eye drops: “He who saved the eye of Horus in his fight against Seth will be able to restore light to those with eye problems.”
¶ Egyptian Dentistry
Possible dental care is not documented. Poor dental condition is known and explained by the presence of tiny grains of sand in the flour (sand originating from the sandstone used for grinding), which is responsible for significant dental wear. There is one example of a dental prosthesis (two molars joined with a gold wire) that appears more like a solution to a problem than a cosmetic fix, but there is no other evidence, as should have been established by studying the mummies.
A fragment of a wooden panel from the tomb of Hesy-Ra at Saqqara (3rd Dynasty), now in the Egyptian Museum in Cairo, bears his title as chief dentist and physician. He is described as “the greatest of the physicians who treat teeth.” This is the oldest record of a physician dedicated to dentistry and dates back to 3000 BC. He was an important dignitary in Memphis during the time of Djezer and held several other titles. His high position reflects the reputation and respect enjoyed by physicians who dealt with dental diseases.
Evidence that dental treatment was separated from general medicine is found in the lower part of a stele commissioned by Pharaoh Sahure as a gift for his favorite physician. It features a small figure, identified by a hieroglyphic inscription as Men-Kaura-Ankh, “the man of the tooth.”
Houi was a healer of the ancient empire who treated diseases of the teeth and anus, this makes sense if one considers that both the anus (protodeum) and the mouth (stomodeum) derive embryologically from the same tissue systems.
There has been much controversy recently over whether dentists had their own separate training. It seems that there were two types of individuals dedicated to the dental arts: those referred to as “sinu” (doctor), and others without this designation.
¶ Hebrew Medicine
Most of our knowledge of Hebrew medicine during the first millennium BC comes from the Bible’s Old Testament. It cites several health-related laws and rituals, such as the isolation of infected persons (Leviticus 13:45-46), washing after handling dead bodies (Numbers 19:11-19), and the burial of excrement away from homes (Deuteronomy 23:12-13). These mandates include the prevention and suppression of epidemics, the suppression of venereal diseases and prostitution, skin care, bathing, nutrition, housing and clothing, work regulation, sexuality, discipline, and more. Many of these commandments have a rational basis, such as the Sabbath rest, circumcision, laws relating to food (prohibition of blood and pork), measures relating to menstruation, women in labor and those suffering from gonorrhea, isolation of lepers, and household hygiene.
¶ Indian Medicine
Between 2800 and 1600 BC, in the Indus Valley (present-day Pakistan), there existed an urban society with some similarities to the Sumerian city-state civilization.
Before the 4th century BC (the date of the oldest known manuscript), the Ayur Veda (‘The Truth about Longevity’) was written, which viewed health as the harmony between body, mind, and spirit. The two most famous texts of this system belong to the Charaka and Sushruta schools. According to Charaka, neither health nor illness is predetermined, and life can be extended with some effort. Sushruta, on the other hand, understands medicine as the set of useful techniques to cure diseases, protect health, and extend life.
Ayur Veda comprises eight different disciplines: kayachikitsa (internal medicine), shalyachikitsa (surgery and anatomy), shalakyachikitsa (ENT), kaumarabhritya (pediatrics), bhutavidya (psychiatry), agada tantra (toxicology), rasayana (science of rejuvenation), and vajikarana (science of fertility).
In addition to the learning of these eight disciplines, the Áir Vedá required knowledge of ten arts indispensable for the preparation and application of medicines, namely: distillation, operative skills, cooking, horticulture, metallurgy, sugar manufacture, pharmacy, analysis and separation of minerals, composition of metals, and preparation of alkalis. Certain teachings were carried out during the instruction of the most important clinical subjects. For example, anatomy was part of surgery, embryology was part of training in pediatrics and obstetrics, and knowledge of physiology and pathology was derived from the teaching of clinical subjects.
¶ Medicine in China
Traditional Chinese medicine emerged as a fundamentally Taoist way of understanding medicine and the human body. The Tao is the origin of the Universe, which is sustained in an unstable balance resulting from two primordial forces: Yin (earth, cold, feminine) and Yang (sky, heat, masculine), capable of modifying the five elements of which the universe is composed: water, earth, fire, wood, and metal. This cosmological conception determines a model of disease based on the disruption of equilibrium, and its treatment is based on a restoration of that fundamental balance. One of the earliest vestiges of this medicine is the Nei Jing, a compendium of medical writings dating from around 2600 BC and which would represent one of the pillars of traditional Chinese medicine for the next four millennia. One of the earliest and most important revisions is attributed to the Yellow Emperor, Huang Di. This compendium contains some interesting medical concepts for the time, especially surgical ones, although the reluctance to study human cadavers seems to have diminished its methods’ effectiveness. Chinese medicine developed a discipline halfway between medicine and surgery called acupuncture. According to this discipline, the application of needles to one of the 365 insertion points (or up to 600 depending on the school) would restore the lost balance between yin and yang.
Several medical historians have questioned why Chinese medicine remained anchored in this cosmological vision, failing to achieve the status of “technical science,” despite its long tradition and extensive body of knowledge, as opposed to the classical Greco-Roman model. The reason, according to these authors, lies in the development of the concept of logos by Greek culture, as a natural explanation unrelated to any cosmological model (mythos).
With the arrival of the Han Dynasty (206 BC–220 AD), and the rise of Taoism (2nd century BC–7th century AD), emphasis began to be placed on herbal and mineral remedies, poisons, dietetics, as well as breathing techniques and physical exercise. From this dynasty, and up to the Sui Dynasty (6th century), the following sages stood out:
- Chun Yuyi: From their observations it is clear that they already knew how to diagnose and treat diseases such as cirrhosis, hernias and hemoptysis.
- Zhang Zhongjing: He was probably the first to differentiate symptomatology from therapeutics.
- Hua Tuo: A great multidisciplinary surgeon credited with the techniques of narcosis (Ma Jue Fa) and abdominal openings (Kai Fu Shu), as well as suturing. He also focused on obstetrics, hydrotherapy, and gymnastic exercises (Wu Qin Xi).
- Huang Fumi: Author of Zhen Jiu Yi Jing, a classic on acupuncture.
- Wang Shu He: Author of Mai Jing, a classic on pulse taking.
- Ge Hong: alchemist, Taoist and herbalist who developed longevity methods based on breathing, dietary and pharmacological exercises.
- Tao Hongjing: expert in pharmacological remedies.
¶ Greek Medicine
The classical term coined by the Greeks to define medicine, tekhne iatriké (the technique or art of healing), or the terms used to name the “doctor of diseases” (ietèr kakôn) and the surgeon (worker of the hands or kheirourgein) summarize this concept of medicine as a science. Man begins to dominate nature and allows himself (even through his own myths) to challenge the gods (Anchises, Peleus, Lycaon, or Ulysses himself).
The oldest written Greek works that include medical knowledge are the Homeric poems: The Iliad and The Odyssey. The former describes, for example, how Phereclus was speared by Meriones in the buttock, “near the bladder and below the pubic bone,” or the treatment King Menelaus received after being hit by an arrow in the wrist during the siege of Troy. The surgeon turns out to be Asclepius, the Greek god of medicine, trained in the science of medicine by the centaur Chiron. From his name comes Aesculapius, an ancient synonym for physician, and the name of Hygea, his daughter, served as inspiration for the current branch of preventive medicine known as Hygiene. Asclepius is also credited with originating the Rod of Asclepius, a universal medical symbol today.
In the 6th century BC, Alcmaeon of Croton, a Pythagorean philosopher devoted to medicine, developed a theory of health that began to move away from the pre-technical healing rituals that had underpinned Greek medicine until then: prayer (eukhé) to the gods of health (Asclepius, Artemis, Apollo, Pallas Athena, Hygeia, etc.); healing dances or rites (Dionysus); and empirical knowledge of basic remedies. Alcmaeon was the author of the first known work on anatomy, founded the first known school of medicine in Ancient Greece, in Cnidus, and also established the practice of patient observation. Medical schools following Alcmaeon’s concept, based on natural science, or physiology, began to flourish in Croton, Cos, and Cnidus.
But the quintessential medical figure of classical Greek culture is Hippocrates. We know of this physician, thanks to the biography written by Soranus of Ephesus some 500 years after his death, that he was born in Cos around 460 BC, and that his life coincided with the golden age of Hellenistic civilization and its innovative worldview of reason versus myth. Galen and later the Alexandrian school considered him “the perfect physician,” which is why he has been classically acclaimed as the father of modern medicine. In reality, the work attributed to Hippocrates is a compilation of some fifty treatises (Corpus Hippocraticum) produced over several centuries (mostly between the 5th and 4th centuries BC), so it is more appropriate to speak of a “Hippocratic school,” founded on the principles of the so-called Hippocratic Oath. The medical fields covered by Hippocrates in his treatises include anatomy, internal medicine, hygiene, medical ethics, and dietetics.
Hippocrates was the first to assert that diseases were caused by natural elements. The existence of the Hippocratic Oath implies that this “Hippocratic medicine” was practiced by a group of medical professionals bound, at least among themselves, by a strict ethical code. Aspiring medical students, who typically paid a fee for their training, entered into a virtual familial relationship with their teacher. This training included some oral instruction and, likely, experience as an assistant to the professor, since the oath assumes that the student had some interaction with patients. The Oath also places limits on what the physician could or could not do and suggests the existence of another class of specialist professionals, perhaps similar to surgeons.
One of the characteristics of Hippocratic medicine is the theory of the four humors, which is related to the theory of the four elements (proposed by Empedocles). Hippocrates and some contemporaries also agreed that diseases were found in the blood, so the practice of extracting a little blood from patients’ arms began. In most cases, however, different herbs were prescribed. Some examples are:
The balance between the four humors equals health, according to Hippocrates.
- Euphrasia: it was used for optical diseases.
- Hyssop: Hippocrates prescribed it for coughs, bronchitis and other infections.
- Candelaria: used to combat coughs (still used today).
- Motherwort: thought to relieve heart disease and pain from childbirth.
- Smooth sow thistle: supposedly relieved stomach ailments and scorpion stings.
Many of the substances used by the ancient Egyptians in their pharmacopoeia were exported to Greece, and their influence increased after the establishment of a Greek medical school in Alexandria.
The first operations also emerged in Greece. These operations were rare and performed without anesthesia (and with simple instruments). They were very painful, and almost all patients died from infection or shock.
Despite all the advances in medicine and the practice of sports in gyms, the average life expectancy was very low; men generally lived to 44 years of age and women to 35.
The following two centuries (4th and 3rd BC) marked the rise of Greek philosophical movements. Aristotle learned medicine from his father, but there is no record of his regular practice of this discipline. However, his Peripatetic school was the birthplace of several important physicians of the period: Diocles of Carystus, Praxagoras of Cos, and Theophrastus of Eresus, among others.
Around 300 BC, Alexander the Great founded Alexandria, the city that would soon become a cultural centerpiece for the Mediterranean and the Near East. The Alexandrian school compiled and developed all the medical knowledge (and many other disciplines) known at the time, helping to train some outstanding physicians. Some sources suggest that the Ptolemies made prisoners condemned to death available to perform vivisections.
One of the most notable physicians of the Alexandrian school was Erasistratus of Ceos, who discovered the common bile duct (the tube that empties bile into the small intestine) and the portal circulation system (a venous system that carries blood from the digestive tract through the liver). Herophilus of Chalcedon was another of the great physicians of this school: he accurately described the structures known as the meninges, the choroid plexuses, and the fourth ventricle of the brain.
At the same time, the empiricist school developed, whose main medical exponent was Glaucus of Tarentius (1st century BC). Glaucus could be considered the precursor of evidence-based medicine, since for him there was only one reliable basis: results based on one’s own experience, that of other physicians, or on logical analogy, when there was no prior data for comparison.
From the incorporation of Egypt as a Roman province (30 BC) the Alexandrian period ends and the age of splendor of Roman medicine begins.
¶ Medicine in Rome
Medicine in Ancient Rome was an extension of Greek medical knowledge. Before importing Greek knowledge, the Etruscan civilization had barely developed a significant body of medical knowledge, with the exception of remarkable skill in the field of dentistry.
But the growing importance of the metropolis during the early periods of expansion attracted important Greek and Alexandrian medical figures who eventually formed Rome into the main center of medical, clinical, and educational knowledge in the Mediterranean area.
The most important medical figures of Ancient Rome were Asclepiades of Bithynia (124 or 129 BC – 40 BC), Aulus Cornelius Celsus (25 BC — 50 AD), Pedanius Dioscorides of Anazarbaeus (40 AD – 90 AD), and Galen of Pergamon (129 or 130 AD — 200 or 216 AD). The former, openly opposed to the Hippocratic theory of the humors, developed a new school of medical thought, the Methodic School, based on the work of Democritus and which explains disease through the influence of atoms passing through the pores of the body, in anticipation of the germ theory. Some physicians who belonged to this school were Themison of Laodicea, Thesalus of Tralles, and Soranus of Ephesus, the author of the first known biography of Hippocrates.
Between 25 BC and 50 AD, another important medical figure lived: Aulus Cornelius Celsus. There is no evidence that he actually practiced medicine, but a medical treatise (De Re Medica Libri Octo) has been preserved, included in a larger, encyclopedic work called D_e artibus_ (On the Arts). This medical treatise includes the clinical definition of inflammation that has survived to this day: “Heat, pain, swelling, and redness.”
With the beginning of the Christian era, another medical school developed in Rome: the Pneumatic School. While the Hippocratics referred to liquid humors as the cause of disease, and the Atomists emphasized the influence of solid particles called atoms, the Pneumatics saw the pneuma (gas) that enters the body through the lungs as the cause of the pathological disorders suffered by humans. This school of thought was followed by Athenaeus of Attalia and Aretaeus of Cappadocia.
In Rome, the medical caste was already organized (in a way reminiscent of the current division by specialty) into general physicians (medici), surgeons (medici vulnerum, chirurgi), oculists (medici ab oculis), dentists, and ear specialists. There was no official regulation for being considered a doctor, but following the privileges granted to physicians by Julius Caesar, a maximum quota was established per city. Furthermore, the Roman legions had a field surgeon and a team capable of setting up a hospital (valetudinaria) on the battlefield to care for the wounded during combat. One of these legionary doctors, enlisted in Nero’s armies, was Pedanius Dioscorides of Anazarba (Cilicia), the author of the most widely used and best-known pharmacological manual until the 15th century. His travels with the Roman army allowed him to compile a large collection of herbs (around six hundred) and medicinal substances to write his magnum opus: De Materia Medica (Hylikà, popularly known as “the Dioscorides”). The text describes some 600 medicinal plants, including mandrake, some 90 minerals, and around 30 substances of animal origin.
But the quintessential Roman medical figure was Claudius Galen, whose influence (and anatomical and physiological errors) lasted until the 16th century (Vesalius was the first to correct them). Galen of Pergamum was born in 130 AD, under Greek influence and under the protection of one of the largest temples dedicated to Aesculapius (Asclepius). He studied medicine with two followers of Hippocrates, Straconius and Satyrus, and later visited the medical schools of Smyrna, Corinth, and Alexandria. Finally, he traveled to Rome, where his fame as a gladiator doctor led him to be chosen as physician to the emperor (Marcus Aurelius). However, autopsies were prohibited in Rome, so his knowledge of anatomy was based on animal dissections, which led him to make some errors. But he also made notable contributions: he corrected the error of Erasistratus, who believed that arteries carried air, and is considered one of the first experimentalists in medicine: “Short and skillful is the path of speculation, but it leads nowhere; long and painful is the path of experiment, but it leads us to know the truth.”
He was the main exponent of the Hippocratic school, but his work is a synthesis of all the medical knowledge of the time. His treatises were copied, translated, and studied for the next thirteen centuries, leading him to be considered one of the most important and influential physicians in Western medicine. His main work, Methodo medendi (On the Art of Healing), exerted enormous importance in medicine for fifteen centuries.
Aretaeus of Cappadocia did not achieve the fame and public recognition of Galen, but the scant written material that has survived from him demonstrates a great deal of knowledge and even greater common sense. Not much is known about this modest Roman physician, except that he came from the present-day Turkish province of Cappadocia and that he lived during the first century AD. He must have trained in Alexandria (where autopsies were permitted), as his knowledge of visceral anatomy is very comprehensive. He was the first physician to describe the clinical picture of tetanus, and he is the author of the modern names for epilepsy and diabetes.
A major contribution of Roman public medicine is worth highlighting. Among the leading Roman architects (Columella, Marcus Vitruvius, and Marcus Vipsanius Agrippa) there was a conviction that malaria was spread by insects or marshy waters. Based on this principle, they undertook public works such as aqueducts, sewers, and public baths aimed at ensuring a supply of quality drinking water and an adequate sewage disposal system. Modern medicine would prove them right almost twenty centuries later, when it was demonstrated that the supply of drinking water and the sewage disposal system are two of the main indicators of a population’s health.
¶ References
- Wikipedia — History of medicine
- Wikipedia — Medicine in Ancient Egypt
- Wikipedia — Medicine in Ancient Greece