Lectures on history of medicine

Study sources of history of medicine

History of medicine is obliged by its existence to sources. Sources are divided into natural (physical, chemical, biological, etc.) and social (historic, philosophical, etc.). Historic sources are subdivided into primary sources and secondary sources. Primary source is an object, created by person on the base of subjective image of objective world. Secondary source is based on various primary sources, on the one hand, summing up, on the other hand, analyzing and comparing it. Primary source often reflects concrete, particular fact, events or phenomenon, but secondary source reflects total sum of facts, events and phenomenon.

According to classification, proposed in 40^th years of XX c. by professor Tikhomirov M.N., and a more precise definition was given by professor Pronshtein A.P., all historic sources are divided into 7 main groups: written, material, ethnographical, verbal (folkloric), linguistic, cinema-photo-documentary, phone-documentary.

Written source are monuments of past, which were passed with help of graphic signs, i.e. manuscript or printed document on paper, papyrus.

Epigraphic sources are similar to written sources. They are inscriptions on strong materials- stones, trees, clays, etc. Epigraphic material is transitional group between written and material sources. Written sources can be original or copy.

Material sources are different by shape. Main parts of them are archeological monuments, which are important for study of before written period. Material sources also include paleoanthropological material (fossil relics of man).

Ethnographical sources are phenomenon of cultural and social life, inherited from previous epochs, preserved by memory and continue to exist in new form in present time. They are superstitions, beliefs, customs, and rites.

Verbal (folkloric) source is a source, created by people and characterized by verbal form of transmission, shape of reality. This source does not contain precise information about persons, facts, events. Folk-lore is important part of people culture and history of culture, is creation of mass with class features, with own people estimation of historic events.

Linguistic sources are reflection of real historic reality in speech form. Typical peculiarities of language can serve sources for solving of scantily explored problems: relationship and interrelation between whole groups of people, border of settling on early period of development of human society.

Cinema-photo-documentary is source which originated due to development of photography and cinematography. Photography is static document of history. Cinema-photo-documentary fixes events more precisely and can reproduce past.

Phone-documentary reflects sound side of historic fact and present phonogram which made at the instant of event.

Transitional groups of sources between material and written are works of small forms of imitative arts which are coins, medals, stamps, post-cards and etc. They are object of study for auxiliary historic science like numismatics, philately, phylocratics, etc.

Philately is a science about signs of post payment and their collection. Medical themes can be presented by sections: “Prominent workers”, “Struggle against tuberculosis”, “Medicinal plants”, “Work of Red Cross”, etc.

Philomenia is a collection of match-boxes. It aroused in 30-th years of XIXc. Medical themes can reproduce by labels.

Phylocratics is a collection of post-cards. Many post-cards devoted to prominent medical workers.

Ex-libris from Latin means “from books”. There were medical symbology and attributes in ex-libris.

Numismatics is a science about coins, which study their picture, legends, weigh, size and quality, area and time of their circulation, technique of making. Numismatics is not only science about coins, but medals also.

Bonistics is auxiliary historic discipline, which study paper monetary signs. Paper money is objective and impartial documents of history. Legends on paper money are fixed when and who issued them, their degree of securing, area of circulation, etc.

Phaleristics is collection of badges. Nowadays every international meeting, congress, jubilee of institutions is accompanied by issue of badge.

Main stages of medicine development in connection with development and changes of social-economic structures
The one compulsory requirement in study of medicine history is appointment of stages. Right division into periods is main precondition of scientific historic research.

Character and level of medicine development is defined by social structure, by productive forces, productive relations, and by level of knowledge.

History of medicine is divided into epochs, social-economic structures: primitive communal system, slave-owning system, feudal, capitalist system and socialism.

Medicine has original features in every system. Medical science and practice changed in connection with changes in economics, science and technique of each epoch.

History of medicine visual shows progresses and changes in medicine, as changes in society life.
Development of medicine during the epoch

of the primitive-communal system.

Becoming of the primitive society and origin of doctoring

(more 2 million years ago - about 40 thousand years ago)
The history of mankind begins with the advent of the human, since that time they appeared labour activity. The primitive history covers more than 99 % of all history of mankind. Through a primitive-communal system have passed all peoples of a planet, therefore great value has studying the initial stage of mankind for correct understanding of all subsequent course of its historical development.

Transition from the nearest ancestors of the human /Australopithecus/ to hominid subfamily was on a boundary tertiary and quaternary periods. The hypothesis about an origin of the human from fossil humanoid monkeys has been put forward by Ch .Darwin He had developed the concept about evolution of animate nature on the basis of a principle of natural selection which has stated in work "The origin of species by natural selection, or preservation of the elected breeds in struggle for a life" (“The Origin of Species by means of nature selection”, 1859).

There are two approaches in an establishment of border between fauna and the human: anthropological and philosophical. The biological originality of the human, his morphological differences from the nearest ancestors are the basis of the anthropological approach This difference is defined by the hominid triad: 1) erected man, or biped; 2) free hand with opposable big finger, hand able to do thin labour operations; 3) rather large mature brain.

Signs of hominid triads were generated at different stages of evolution so erect pacing was developed at the end of the tertiary period at Australopithecus, free hand - on a boundary of the lower and average Paleolithic periods, an advanced brain at a stage Paleonthrop.

In a basis of the philosophical approach to definition of border between fauna and the human was the social essence of the human - his thinking, language, social relations, labour activity.

One of the major problems of anthropogenesis is the question about home of mankind. By the opinion of Ch. Darwin, an ancestral home of mankind is the African continent where live most close to the human anthropoids - chimpanzee and gorilla. Last finds of remains of the most ancient hominids are the evidence of the African ancestral home of mankind. But there are also other points of view. The final decision of this question can probably only on the basis of the further scientific researches.

The primitive human herd was the early form of the organization of the ancient people. The most ancient people (arhanthrops) were erected, carried on nomadic or semi-nomadic way of life. Their labour activity promoted formation of primitive articulate speech, sources of languages, development of thinking and consciousness. Paleopsychology defines 3 spheres of the primitive human consciousness: 1) empirical experience, 2) generalizations of results of empirical experience and 3) abstract consciousness. The first and second spheres are chronologically inseparable and have arisen together with primitive thinking, articulate speech and sources of languages. The third sphere of consciousness - abstract thinking of arhanthrops has been still insufficiently developed, therefore on early stages of anthropogenesis there were no burials and cults of died, religious representations and magic actions, was not rocky figures and other rudiments of primitive art.

Ancient people (paleonthrops) - ancestors of the human of modern kind - have created the stone industry, were engaged in collecting, fishery, hunting, supported fire, skins of animals were used for manufacturing clothes, warming of dwelling. The first burial places (in caves of Le-Musteua, La Ferassi in territory of France; in Keek-Coba in Crimea), testify to perfection at of abstract consciousness.

Thousand-year acquaintance of the most ancient and ancient people with properties of plants has allowed them to singled out by empirical way suitable plants for a feed, poisonous and medicinal substances.
Doctoring during the prosperity of primitive society

(about 40 thousand years ago - X-V millenniums B.C.)
The anthropogenesis process and becoming of the modern kind human- Homo sapiens have come to the end to the beginning of the upper Paleolithic period. Hominid triad was finally generated. Oicumena has considerably extended. The adaptation to various environmental conditions and formation of modern races (Negroid, Europiad, Mongoloid and Austroloid) were in parallel ways.

Developments of collectivism, gun techniques, invention of a bow and arrows (XIV-VII c.c. B.C.) have led to rise of productive forces. Early tribal community of hunters, collectors and fishers, and later - the developed tribal community of farmers and cattlemen were aroused.

The early tribal community of hunters, collectors and fishers was quite generated human society. The woman was the most stable part of a society in early human collectives. She cared of children, kept house. The cult of mothers – the original mothers, hearth’s keeper was in that time. Man and woman were equal, the head of a clan could be both either the woman, or the man.

Rational and irrational notions were closely bound in spiritual culture of early tribal community. Result of rational outlook was knowledge and methods of doctoring. Natives of Australia lived in the Stone Age. They cured diseases of a stomach, stopped bleedings by ashes, webs; they made washings by urine and put clay at skin diseases; they could splint, phlebotomy, used medical products of vegetative, animal and mineral origin. They could do ritual circumcision and Cesarean section. The first surgical tools were stone and bone knifes, the fish scales, thorns and prickles.

By the empirical way natives of America used narcotics as anesthetics. Cactuses’ juices and extracts were used as anesthetics within several days.

But knowledge of the primitive human was not so large. The primitive human thought, that he was related to animals and plants which had human properties. Thus, early kinds of beliefs have arisen: totemism, fetishism, animism and magic.

Totermism is a religious belief that is frequently associated with shamanistic religions. The totem is usually an animal or other naturalistic figure that spiritually represents a group of related people such as a clan.

Fetishism is attributing some kind of inherent value or powers to an object. For example, the person who sees magical or divine significance in a material object is mistakenly ascribing inherent value to some object which does not possess that value. A fetish (from French) is an object believed to have supernatural powers, or in particular a man-made object that has power over others.

Animism (from Latin anima, "soul") is the belief that souls inhabit all or most objects. Animism attributes personalized souls to animals, vegetables, and minerals wherein the material object is—to some degree—governed by the qualities which compose its particular soul. Animistic religions generally do not accept a sharp distinction between spirit and matter, and they generally assume that this unification of matter and spirit plays a role in daily life. Animism (soul, spirit) - belief in souls, spirits and general spiritual of nature.

The magic (sorcery) is belief in ability to human influence on other people, subjects, events or natural phenomena by supernatural way.

There was also a medical magic - magical doctoring of wounds and the illnesses, based on cult practice. Primitive cult practice was finally arranged during the period of advanced tribal community.

Anthropologists studied primitive societies in the 19th and early 20th centuries. Among them treatment for injury and sickness was a mixture of common sense and magic. People knew, of course, that falls cause broken bones and fire causes burns. Animal bites or human weapons cause wounds. Primitive people had simple treatments for these things e.g. Australian Aborigines covered broken arms in clay, which hardened in the hot sun. Cuts were covered with fat or clay and bound up with animal skins or bark. However primitive people had no idea what caused illness. They assumed it was caused by evil spirits or magic performed by an enemy. The 'cure' was magic to drive out the evil spirit or break the enemies spell.

The later tribal community of farmers and cattlemen is characterized, first of all, by transition from an appropriating economy to making productive agriculture (from IX-III millennium B.C.) and to rearing of pets (from VI-III millennium B.C.)

During this period of a mankind history a dog, a sheep, a goat, the bull and a horse have been domesticated; spinning, weaving, ceramics, wheel transport and a sailing boat construction of buildings from a brick have been invented.

Complication of production activity of the primitive human has expanded a circle of his knowledge: accounting devices were appeared, religious notions were complicated. Notion about disease was as installation in a body of ill spirit of died ancestor. It influenced on methods of doctoring which purpose became banishment of spirit of an ancestor from the patient’s body. The ritual ceremony was operation of craniotomy. The first of the fossil man has been found in Latin America - in area of Cusco (Peru) in 1865. The analysis of trephined skulls shown, that in most cases (about 70 %) trepanation was successfully operated: formation of a callus testified to it.

The skull with a high brain box which belonged to the Europiad man (V-IV B.C.) was found in the place Karabie (Karaganda region). On the left temporal the skull had trepanation as 5 holes drilled one after another. Scientists established, that trepanation was made by a metal drill. On trepanation of the fifth hole the vessel, probably, has been touched, and hemorrhage became the reason of death.

Modern neurosurgeons were surprised by great skill of their colleague of VI c. The skull was found out in the south of Kazakhstan.

The primitive human thought, that through the hole in a skull the disease’s spirit could leave the body of the patient. On island Uvei in the Pacific ocean till the middle of XIX c. absolute trepanation of skulls in newborns was exist as preventive measure.

Many things of the primitive human usage were widely adopted in present time: efedrum as a herb was known in China 5 thousand years ago. Medical properties of cinchona had opened by Hincks. Adonis vernalis was used as drugs for dropsy and breathlessness. Special knowledge was used in national medicine. Knowledge of curative properties of some plants, herbs, leeches, mineral waters, pitches of plants and many other things is inherited to us from national medicine.

Economic and social development of mankind during the advanced tribal community has prepared preconditions for origin of the private property and decomposition of the primitive-communal system which has begun before all in fertile valleys of the largest rivers of our planet.

Doctoring during the period of the primitive society’s decomposition

(since X-V millenniums B.C.)
Decomposition of the primitive society passed in two forms: patriarchy and late matriarchy which developed in parallel ways.

Patriarchy was more extended. The leading economic and social role of the man was formed the social inequality.

Matriarchy was the rare form of decomposition of the primitive-communal system and it was developed, when the public inequality was formed at leading economic role of women. There were the tribes (hyraces, minanckbas, etc.) living on traditions of matriarchy on our planet.

Process of decomposition of the primitive society in more favorable economic regions had come to the end to III-II millennium B.C. (Mesopotamia, Egypt, basin of Hind). In the least favorable areas of Oceania, Australia, Africa it is going on.

At the end of this period the major event was the invention of hieroglyphic writing in IV c.B.C.: first at Sumerians and Egyptians, and later at Chinese.

Development of doctoring skills, usage of medical products, medical tools from metal, and amputation of limb began to be applied. Obstetric aid was improved.

Strengthening of the tribal organization promoted to development of religious notions and professional servants of a cult have appeared. Their basic activity was doctoring. Now in some countries of Asia, Africa, on islands of Oceania national doctors-sorcerers are exists. Sorcerers are people with a high professional standard. So, in Africa pupils of sorcerers forced to breathe up to a faint a smoke in a special hut, and then they stood the test with big ants. In India since the childhood pupils -vedyi should study medicinal substances, ways of their preparation and usage, and also various spells and magic methods. If illness was mighty evil, the healer should be more the big exorcist of demons. Frequently sorcerers in the primitive society combined usage of special methods and medical products: at treatment of gastrointestinal disturbance the patient drunk grasses’ extracts, at some other diseases he was whipped nettle. For treatment “magic influence” was used: amulets which were frequently applied in a combination with medicines. So, in beads of amulets was the medicinal substance. Amulets from garlic were applied at such diseases, as a scarlet fever and diphtheria.

Thus, the medicine during an epoch of the primitive-communal system has arisen and developed as a result of activity of primitive people at all stages of their existence. Doctoring and usage of medical products were changed and improved together with evolution of the society.

Experience taught primitive people to use natural medical remedies, to collect plants and to prepare medicines, to apply antidotes, to use medical properties of animals’ bodies. Numerous medical methods and medical products were the basis of national medicine and national doctoring.

As a whole the primitive human had rather poor arsenal of medical products and methods. Being weaker than his enemies, he created around himself other nature and became the mightiest powerful creature on the Earth changed the world.

According to world history stages, the end of the primitive society coincides with the beginning of the history of class societies when have appeared first slaveholding states 4000 years ago. But the rests of the primitive-communal system were kept in all class societies during all their history.

BIBLIOGRAPHY

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2. MEDICINE IN THE SLAVE-OWNING STATES OF ANCIENT EAST: BABYLON, ASSYRIA, EGYPT, INDIA AND CHINA
Epoch’s characteristics
In the conditions of decomposing primitive system the slave-owning system was natural phenomenon. It showed wide opportunities of productive forces’ increase. Population was divided into free and slave in the slave-owning system. Free persons were divided into class of big landowners (they were also big slave-owners) and class of small producers (artisans, peasants). Priests played big role in the epoch of slavery and they were big landowners and slave-owners.

Ancient East was cradle of human culture. Transition from primitive system to slave-owning system happened there earlier than in other places. Slave-owning system prevailed in Mesopotamia and Egypt (IV-III millennium B.C.), India (in the middle of III millennium B.C.), China (II millennium B.C.), Transcaucasus (state Urrartu, I millennium B.C.).

Predominant political system was despotic monarchy with survivals of tribal system. Influential caste was priests.

Before some millenniums B.C. first sources of materialistic ideology and knowledge about nature had occurred to East people. Materialistic thought of Ancient East considered world as it is, wanted to understand it as dynamic and developed single whole.

Common features of medicine development in slave-owning states

of Ancient East

Invention of a written language (since IV millennium B.C.) and creation of first medical texts (since III millennium B.C. in Sumerians).

Forming of two direction of doctoring: 1) Folk (empirical) doctoring based on practical experience of people and 2) Cultic (temple) doctoring based on religious beliefs;

Notion about diseases origin (moral-ethic, connected with nature, with religion);

Teaching of doctors -healers (family tradition and study in temple schools);

Creation of ancient sanitary-hygienic constructions. Development of hygienic skills;

Class approach of doctoring in class society. Forming of medical ethics’ basics;

Mutual influence and succession in doctoring development in ancient civilizations.

Medicine of Babylon and Assyria
The name Mesopotamia (meaning "the land between the rivers") refers to the geographic region which lies near the Tigris and Euphrates rivers and not to any particular civilization.

Babylon state appeared in the end of III-beginning of II millennium B.C.

Later in I millennium B.C., state Assyria arose in the south-eastern part of Mesopotamia. The main place in economic and cultural development, especially in medicine belonged to Babylon.

Numerous monuments testified to medicine existence in ancient slave-owning states, which were between rivers Tigris and Euphrates - Babylon kingdom (XX-IV B.C.) and Assyria (XV-VII B.C.).

Babylon kingdom reached high growth in the old-Babylonian period, great ruler Hammurabi (1792-1750 B.C.) created powerful state during his reign for 42 years. After his death Babylon was many attacked by conquerors.

Great monument of Babylonian legislation – laws of King Hammurabi (XVIII B.C.). These laws summarized all old laws. Articles, which engraved on basaltic pillar, were devoted to activity of doctor and his responsibility.

Hammurabi, a great king of Babylon who lived around 2000 BC formulated a set of drastic laws known as the Code of Hammurabi that governed the conduct of physicians and provided for health practices. Doctors whose proposed therapy proved wrong ran the risk of being killed. Laws relating to medical practice, including fees payable to physicians for satisfactory services and penalties for harmful therapy are contained in the Babylonian Code of Hammurabi, the very first codification of medical practice. While the code of Hammurabi reflected a high degree of social organization, the medicine of his time was devoid of any scientific foundation.

Babylon’s neighbor was Assyria, which reached high growth by statesman Assurbanipal (668-about 626 B.C.). During his reign, large royal library was created in Nineveh. It had collection of clay tables. As a rule, tables began from words “If a man ill …” The detailed description of disease’s symptom and advices about preparing and use of medicine. Table ends with words “…he will recover”.

There were two different types of medical practitioners in Mesopotamia: asutu (translation “art of doctors”) and ashiputu (“art of charmers”). Both traditions remained till the second half of I millennium B.C., then they became one, closer to ashiputu.

Notions about diseases divided into three categories:

1. Supernatural reasons – “God’s hand”, “whiff of vicious ghost”, “embraces of Lamashtu” (Old woman Lamashtu walked in night and spread children’ fever).

2. Retribution for violation of ritual, lawful, moral and other directions in community.

3. Natural reasons, connected with nature phenomenon and way of life (usage of unhealthy food, bathing in dirty river).

Doctor-asu thought that origin of diseases depends from natural reasons. His prognoses were optimistically: “he will recover”, “he must treat”.

Doctoring of asu based on practice of doctor-empiric: his intuition plus acquired knowledge. His aims of treatment were real: “to stop fever”, “lead oedeata (hypostasis) ”, etc. Doctors - asu were great experts on medical flora. They gathered, kept and made drugs by themselves. They cooked on honey, vinegar, water or fat and used it as ointment, powder, pills, suppositories and plugs.

Ashipu’s set of medicinal remedies was less than asu’s set. But there were instructions for using medicines. For example, “pound a sage and mix with oil, say the conjuration three times and put on teeth”. This conjuration “Exorcism against toothache” is great work of art of Ancient Mesopotamia.

Main method of doctoring ashipu was reading of invocations. Diagnosed a disease and its cause, ashipu made prognoses before treatment. There were inauspicious prognoses in his texts: “he will die”, “he will not recover”. Favorable prognoses were rarely: “he will live”, “his disease will go”. If prognosis was hopeless, ashipu didn’t treat.

Body structure was unknown in Mesopotamia, dissection didn’t make, but dissections of sacrificial animals gave only common notion about internal organs: liver, kidney, heart, stomach.

Only women were engaged in delivery (birth).

Big role played astrology in culture and in medicine of Assyrians and Babylonians. They had astrologic calendar, there they defined star-location, good or bad date for operation, for delivery, etc.

At the excavations of ancient towns (Babylon, Nineveh), remainders of roadways, sewerage, and water pipes were found. Laws about sending away of sick persons who had infectious disease.

Like in other countries of Ancient East, treatment was available for rich men in Babylon. Greek historian Herodotus (V B.C.) described distinctive custom for treatment of poor men: they went into streets and people, who were there, gave poor men advices, based on their experience.