Lectures on history of medicine

Medicine development in Ancient Egypt
The ancient hearth of Egypt civilization was lower reaches of the river Nile, there appeared first settlements in VI millennium B.C., and then they became cities-states. United state aroused about 3200 B.C.

Sources about medicine in Egypt are numerous hieroglyphic inscriptions on sarcophagus, pyramids and papyruses (rolls, which were made from plant-papyrus in the valley of the Nile.) More famous medical papyruses are: papyrus from Kahun (about women’ diseases, 2000 B.C.), Smith’s papyrus (devoted to surgery, 1500 B.C.), big medical papyrus of Ebers (middle of II B.C.), Brugsh’s papyrus (about 1450-1350 B.C.) devoted to treatment of children’s diseases. Papyruses were studied especially by Russian Egyptologists.

The first doctor known to history was Sekhet-eanach who 'healed the pharaoh's nostrils'. The second doctor we know of was Imhotep (2600 B.C.) who was vizier or prime minister to the pharaoh. He was also a doctor and he was so famous that after his death he was worshipped as a god.

Ancient Egyptians knew mathematical, astronomical, geographical and medical knowledge. Knowledge acquisition in anatomy was lightening by methods of embalming and mummification of dead body. Used in Egypt anatomical terms testified about knowledge of internal organs: brain, liver, heart. Egyptians emphasized heart with 22 divergent vessels.

Egyptians book described diseases of enteric, respiratory tract, skin, bleeding, elephantiasis, eye diseases (widespread), and fever. Greek historian Herodotus, traveled in Egypt in V B.C. said that “Egyptians had the doctors on every body region”. It was evidence of doctor’s specialization in Ancient Egypt. Big development achieved medical cosmetics; Egypt considered the land of cosmetics. Only nobility could presume that medical branch. Rich people used of massage, water-treatment, expensive drugs.

Military doctors what accompanied Egyptian host saved up knowledge about treatment of wounds, fractures and traumas. Egyptian doctors used a huge range of drugs obtained from herbs and minerals. They were drunk with wine or beer or sometimes mixed with dough to form a 'pill'. Egyptian doctors also used ointments for wounds and they treated chest complaints by getting the patient to inhale steam. There were pictures of operations on tombs in Ancient Egypt.

However the Egyptians still believed that spells would help the sick and they carried amulets to ward off disease. Nevertheless they were beginning to seek a physical cause for illness.

Ancient Egypt was hearth of worm’s diseases. Moreover the Egyptians were clean people. They washed daily and changed their clothes regularly, which must have helped their health.

There were temple shelters chiefly for lunatics as in Mesopotamia as in Egypt. They were more isolator, then treatment institution. These shelters were prototype future hospitals attached to monasteries.

The profession of dentist was existed from of old in Egypt. Disease of tooth and gums were described in papyruses. Toothache was explained by Egyptians as worm is growing in tooth. Researches of mummies of Ancient Egypt revealed about widespread inflammatory diseases of periosteum, which result was jaw’s changes and falling of tooth. Even pharaohs had not stomatologic intervention: packing of carious cavities, tooth filling by gold and other metals. Only witnesses of tooth gold usage in Ancient Egypt were discovery of two lower molar (tooth) which were connected by thin gold wire.

There were found diseased tooth on cemetery. It testified to stomatology was conservative. Treatment was in medical pastes and solutions applying on disease teeth. Papyruses of Ebers described about 11 prescriptions for sanitation and treatment of tooth and gums. It helped to localize pain, but not to stop further development of diseases.

They employed ointments, water solutions, bathing, enema (invention of Egyptians), compresses, lotions, and plasters for treatment. Widely were used plants, stones, salt. Products of organic origin (fats, animal blood, honey, livers, etc.) were used.

Means for treatment of skin diseases were used, that’s why some historians suppose Egypt is motherland of dermatovenerology.

Heritage of Egypt medicine had influence on medical knowledge development in countries of Ancient East, Ancient Greece, and Rome.

Medicine in Ancient India

To the end of IV millennium B.C. – beginning of III millennium B.C. India had slave-owning system.

Study sources about social system, economics, culture and medicine are Code of laws of Manu (1000-500 B.C.), “Veda” – collections of religious and social instructions, works of folk eposes – poems “Mahabharata”, “Ramayana” and archeological data. Ayurveda (the science of living), the Vedic system of medicine originating over 3000 years ago, views health as harmony between body, mind and spirit. Its two most famous texts belong to the schools of Charaka and Sushruta. According to Charaka, health and disease are not predetermined and life may be prolonged by human effort. Sushruta defines the purpose of medicine to cure the diseases of the sick, protect the healthy, and to prolong life.

Information about body structure was very complete in Ancient India.

Dissection of corpse was not prosecuted. Corpse was under process of maceration during 7 days in flowing water. Anatomic terms were indicative of presence of anatomic knowledge, even about brains and spinal cord, but not exact.

Doctor used by methods of interrogatory and examination. Tachycardia and respiration were studied either at rest, as in work and running.

Surgical tools, discovered in excavations, testify about development of surgery. Sushruta, one of the authors of “Ayurveda” considered surgery is the first and the best medical science.

Indian doctors made some operations: amputation, ophthalmologic and plastic operations – substitutions of defects of nose, ears, and lips; obstetric – Caesarean operation.

Sources of specialization, notion about unity of medical activity were exist.

By opinion of Sushruta: “doctor, who can operate but neglect medical knowledge, is a bird with one pinion”. Doctor was liable to fine for unsuccessful operation. Size of fine was depending on caste of sick person.

Strong side of Indian medicine was hygiene. Hygienic directions were included in Code of laws of Manu. It was condemned surfeit; it was recommended fresh food and vegetable diet. Rules about body care, cleanness of vessels. But it all was available to rich people. During the excavations in Machendgo-Daro were found sewerage, water pipes, and ponds, concerned to the IV-beginning of III c. B.C.

It was described a hospital, based in the second half of VI c. B.C., hospitals in ports and in big roadways.

Religion in India had strong influence on medicine, at first it was Brahmanism, then Buddhism.

Secrecies of old Indian medicine consolidated in rules of deontology: respect to teachers, blameless outward appearance, free treatment of poor and friends, constant perfection of knowledge.

Medicine of Ancient India influenced on development of medicine in many countries.

Medicine development in Ancient China

In the IV-III millennium B.C. one of the old civilizations was conceived in the valley of the Hwang Ho River, then in the middle of II c. B.C. it was found state system. Old China gave to world silk and powder, compass and paper, faience (pottery) and porcelain, book-printing and many other discoveries in the field of natural science and medicine.

Chinese medicine claims to be the world's first organized body of medical knowledge dating back to 2700 BC. It is based on two principles - the yang and the yin. The yang is believed to be an active masculine principle and the yin a negative feminine principle. The balance of these two opposing forces meant good health. Hygiene, dietetics, hydro-therapy, massage, drugs were all used by the Chinese physicians.

The Chinese were early pioneers of immunization. They practised variolation to prevent smallpox. To a Chinese, "the great doctor is one who treats not someone who is already ill but someone not yet ill". The Chinese have great faith in their traditional medicine, which is fully integrated with modern medicine. The Chinese system of «bare-foot doctors» and acupuncture has attracted worldwide attention in recent years.

Old hierologic books said about medicine development. The old is encyclopedic work of Neijing (18 books). First nines (Su van) were devoted to structure and functions of organism, diagnostics and treatment of diseases. The others nine books (Lin Shu) described old method – chzen tzu therapy (chzen- acupuncture or needle therapy; tzu-moxca or cauterization). Chinese doctors knew about existence of “vital points”, irritation which had made medicinal effect. First detailed description was given in III B.C. To the XIV c. were counted 700 “vital points”, which united in 14 “vital lines”.

Needles for irritation were made from flint and jasper, then from bones and bamboo, later from metal – bronze, silver, gold, platinum. For training they had special atlas and tailor’s dummies (mannequins).

Old doctors achieved big proficiency in pulse diagnostics. Their founder was doctor Byan- tczyao; he recommended examining pulse in nine different places.

Chinese doctors marked out from 24 to 200 kinds of pulse, the main were 10.

In the III c. A.D. Chinese science about pulse were united in the 10 volumes treatise (Mo-jing, 280).

Medicinal therapy achieved big proficiency in China. Monumental work of Lee Shi Tjen in 52 volumes described 1892 medicinal means.

The system of payment to doctors widely used – not for treatment but for prevention of diseases by advices.

They paid attention to treatment like diet, massage, water procedures, and gymnastics.

China had state medical institution, main aim was service of emperor’s court, but in fact their duties were wider (struggle with epidemics, etc.). Drug store also existed as a special institution that time.

Thus, folk, secular and temple medicine existed in the conditions of slave-owning system in the countries of Ancient East. Medicine much influenced on temple medicine in Mesopotamia (Assyria), medical writing and first laws (Babylon), sources of stationary attached to temples, especially for lunatics (Egypt) and civil hospitals (India). There were drugs’ depot and places for its preparing in Egypt, drug-store as special medical institution in China. Big towns of Ancient East had elements of improvement and sanitation.

People of Ancient East had great experience for diagnostics and prophylaxis of illnesses and means for their treatment.
BIBLIOGRAPHY
1. Арцишевский А. Этюды о врачевателях и фармацевтах / А. Арцишевский // Казахстанский фармацевтический вестник - 2002.- N1-2. -С.8-9.

2. Богоявленский Н.А. О раковых заболеваниях в рабовладельческом обществе / Н.А. Богоявленский.- // Из истории медицины: Сб. ст.- Рига, 1967.- С. 129-135.

3. Георгадзе В.И.Эмблемы медицины / В.И. Георгадзе, Э.Д. Грибанов.- Тбилиси, 1979. - 112с.

4. История медицины / П.Е. Заблудовский, Г.Р. Крючок, М.К. Кузьмин,

М.М. Левит. - М.: Медицина, 1987. - 352 с.

5. Камов Б. Секреты тибетских лекарей /Б. Камов.- // Фармацевтический бюл. -2001.- N9.- С.35-36.

6. Лисицын Ю.П. История медицины /Ю.П. Лисицын. - М.: ГЭОТАР-МЕД, 2004. -393 с.

7. Мультановский М.П. История медицины /М.П. Мультановский. - М.: Медицина, 1967. - 272 с.

8. Сорокина Т.С. Атлас истории медицины. Древний мир / Т.С. Сорокина. - М.: УДН, 1981.-160с.

9. Сорокина Т.С. История медицины. Краткий курс лекций / Т.С. Сорокина. - М.: УДН., 1988.- 72 с.

10. Сорокина Т.С. История медицины: Учебник для студ. высш. мед. учеб. заведений / Т.С. Сорокина. – 4-е изд., стер.- М.: «Академия», 2005.-560с.

3. 
   MEDICINE DEVELOPMENT IN ANCIENT GREECE
   

AND ANCIENT ROME
Medicine in Ancient Greece

Countries of Mediterranean basin, in the first place Ancient Greece (Ellada) and Ancient Rome had big influence on historic development of humanity. Ancient Greece in the VI – IV B.C. consisted of small slave-owning states.

Originality of geographic and economic conditions of Ancient Greece promoted that its people played big role in culture development. Greece was commercial mediator between more ancient countries of Southern and Western Europe, widely developed trade and handicrafts.

The highest internal growth of Ancient Greece, rise of art, science, philosophy and culture was in V B.C. This growth was stipulated by social contradictions and struggle in the country. Greece had big social upheaval, transition from primitive system to class slave-owning system. Struggle for freedom and independence from Persian conquerors, defeat of slave-owning aristocracy and successes of slave-owning democracy provoked growth of art, science and philosophy.

Knowledge of Ancient Greeks was united in one notion - “philosophy”. Ancient Greece’s natural history was characterized by limited accumulation of exact knowledge and abundance of hypothesis and theories. Philosophy of Ancient Greece was characterized by natural dialectics.

Philosophical tendencies – matherialism and idealism – reflected sharp class struggle. Struggle of materialistic “line of Democritus” with idealistic “line of Platoon” was struggle of progressive slave-owning democracy with reactionary land slave-owning aristocracy.

Greeks’ participants in international commercial intercourse, communication with different people, contact with different religions and cultures - all of them promoted development of Greek world view, which came into history under the name the Greek natural philosophy.

Democritus was a Greek materialist philosopher (born at Abdera in Thrace ca. 460 B.C.-370 B.C.). Democritus was a student of Leucippus and co-originator of the belief that all matter is made up of various imperishable, indivisible elements which he called atoma (atom) or "indivisible units".

Though intelligence is allowed to explain the organization of the world, according to Democritus, he does give place for the existence of a soul, which he contends is composed of exceedingly fine and spherical atoma (now called atoms, as mentioned above). He holds that, "spherical atoma move because it is their nature never to be still, and that as they move they draw the whole body along with them, and set it in motion." In this way, he viewed soul-atoma as being similar to fire-atoma: small, spherical, capable of penetrating solid bodies and good examples of spontaneous motion.

Democritus explained senses along these lines, as well. He hypothesized that different tastes were a result of differently shaped atoms in contact with the tongue. Smells and sounds could be explained similarly. Vision works by the eye receiving "images" or "effluences" of bodies that are emanated. He stated that, "Sweet exists by convention, bitter by convention, color by convention; but in reality atoms and the void alone exist." Atomism was opposite to god’s influence on fate of world and people.

There are two forms of knowledge: one legitimate, one bastard. To the sort belong all the following: sight, hearing, smell, taste, touch. The legitimate is quite distinct from this. When the bastard form cannot see more minutely, nor hear nor smell nor taste nor perceive through the touch, then another finer form must be employed. Democritus extracted the essence of every known herb and then devoted the rest of his life to researches into the properties of minerals and plants.

Successor of Democritus was Epicurus.

Greek natural philosophy had influenced on development of material notions and diseases.
Study sources about medicine of Ancient Greece
Ancient Greece’s literature is very old literature of Europe. First Greek literal monuments are “Iliad” and “Odyssey” of Homer and they are only sources about medicine of ХII – VI B.C.

Great monument of medical literature – “Hippocrates collection” testified about medicine of classical period in Greece history. Some medical articles were written by Herodotus (V B.C.) in his work “History in the 9 books”.

Archeological investigations in Miken (i. Crit) don’t yield to the values of discovery of Tutankhamen’s tomb. Evans discovered ruins of great Cnoss palace on i. Crit in 1900. There were catch pits, bath-houses, airings in III B.C. Treasure from Kul – Ob funeral- is famous gold vase aimed for devotions, it kept in Hermitage. By diggings it was discovered old temples, among it sanctuary of God for doctoring Asclepios – asclepions. There was found one of the famous sanctuary of Asclepios in town Epidavr in 1881-1887.
Мythology and medicine

“Childhood of human society was developed only splendid” in Ancient Greece. It was more reflected in mythology and religion. Greek gods were invested with all human qualities as good as bad.

Important place had gods-healers in Greek mythology. First of all was god Apollo, he was father of god –doctor Asclepios. He embodied sun, which could heal by its heat. He was healing god and god -prophet. Apollo was not only doctor of gods and god of doctors but he was god of wisdom, poetry, music and beauty.

The most important medical deity was god of doctoring Asclepios. He was pupil of Herron. Asclepios surpassed his teacher: he could not only treat, also he could return died people to life. Asclepios healed people and may have even made them immortal.

Antique art depicted Asclepios with stick embraced by snake, Hygeia was as young beautiful girl in tunic with diadem and snack. Later snack became medicine symbol. The famous children of Asclepios were Hygeia – goodness of health, Panaceia – patroness of medicinal doctoring, Machaon became famous military surgeon and Podalirius treated internal diseases. They all learnt medicine by their father.

Folk and temple medicine

Roots of Greek medicine connected with medicine of Ancient East. Doctors were respectable.

Homer in his poems described 141 damages on body and extremities, he knew about medicinal properties of sulphur.

Herodotus described treatment of illnesses, climate influence on health, high status of doctor in society, respect to this profession.

Sophocles had mentions about shivering (fever), medicinal mineral sources.

Development and strengthening of slave-owning system to the VI B.C. stipulated intensification of religion positions. Those times were origin of temples and temple medicine. So, Greek medicine was secular, folk, which temple medicine couldn’t destroy.

On the one hand most Greeks believed in a god of healing called Asclepios. Sick people made sacrifices or offerings to the god. They then slept overnight in his temple. They believed that the god would visit them in their sleep (i.e. in their dreams) and when they woke up they would be healed.

At the same time Greek doctors developed a rational theory of disease and sought cures. However one did not replace the other.

There were more then 300 asclepieions in Ancient Greece. The majestic temple was temple of Asclepios (IV B.C.). There were temples of Hygeia, Aphrodite, Femida, and Apollo on the territory of sanctuary.

There were bath-house, library, gymnasium, stadium and theater on the territory of sanctuary in Epidavrium.

Abaton – one from three component parts of asclepieions (temple, source and abaton). Interpretation of dreams was base of temple medicine. Priests asked and then treated by physical methods of doctoring: massage, gymnastics, water procedures, etc.

The cult of Asclepios and Greek medicine existed side by side.

Medical schools of Ancient Greece
Doctoring was family profession and handed down from father to son – it was secret of family in Ancient Greece. Such system became family medical schools. Later those schools were wider, because it had pupils for payment. Medical schools were formed in Greece and in Greek colonies around the Mediterranean.

Greek medicine reflected two directions of philosophy: materialistic and idealistic.

Idealistic tendency was in schools of Pythagoras, Plato.

Materialistic tendency displayed in schools on islands (i. Rodos, i. Cos, Asia Minor), in towns (Cyrene, Crotona, Cnidus).

Glory of ancient medicine was in Crotona, Cnidus and Cos schools.

Crotona medical schools had growth in VIc.B.C. Their thesis: 1) organism – is unity of opposites; 2) healthy organism – is a result of balance of opposite forces: dry and wet, hot and cold, etc., prevalence of one is an illness cause; 3) opposite is recovered by opposite. Prominent representative of this school was philosopher and doctor Alcmaeon of Crotona (IV – V c. B.C.) in Italy said that a body was healthy if it had the right balance of hot and cold, wet and dry. If the balance was upset the body grew ill.

Cnidus medical schools 1) based humoral teaching, then health is favorable mix (dyscrasia) of fourth liquids (blood, mucus, light bile and dark bile), but their unfavorable mix (dyscrasia) is illnesses cause; 2) developed teaching about symptoms of diseases and diagnostics (method by auscultation). Prominent representative of this school was Euryphon of Cnidus (V c. B.C.).

Cos medical school was the main one in Ancient Greece. First information was to 584 B.C. Growth of school was connected with name of Hippocrates II The Great (about 460-about 377 B.C.), he is known as Hippocrates. Cos medical school 1) considered organism in close connection with nature; 2) elaborated principle of observation and treatment near patient’s bed; 3) elaborated basis of doctor ethics.

Hippocrates. “Collection of Hippocrates”
Hippocrates, or Ippocrates (“horse-tamer” in Greek) lived in the period of the highest internal bloom of Greece, there were many prominent representatives in every field of human activities: in politics - Periclus, history had – Herodotus and Phucididus, philosophy – Leucippus, Democritus, Empedocles, Socrat, Plato, poetry had Sophocles, Euripides, Aristophanes, and in medicine it was epoch of Hippocrates.

Hippocrates II The Great, was born on island Cos. His genealogy was from clan asclepiads, from son of Asclepios – Padalirius. Asclepios clan had seven Hippocrates. Hippocrates II The Great was doctor – periodevtist, he visited many towns of Greece, Asia Minor, Skiff lands, Livia, east seaboard of the Black Sea, Egypt. His fame about doctoring was spread in many countries.

The last days of his life, Hippocrates spent in Larissa (Fessaliya), when he died in one day with Democritus.

Hippocrates had real notions about medicine, its possibilities, difficulties and purposes. He was doctor- philosopher. He challenged the tradition of magic in medicine, and initiated a radically new approach to medicine i.e., application of clinical methods in medicine.

Heritage of Hippocrates and other doctors of Ancient Greece generalized in “Collection of Hippocrates”, which was composed in III c. B.C. and was in famous Alexandrian library. Library was based by successors of Alexander Macedonian - Ptolemaists. By their order manuscripts of world scientists were brought in library. 72 medical works were written in Greek.

Works of Hippocrates are: “Aphorisms”, “Epidemics”, “About air, water, places”, “About ancient medicine”, etc.

Hippocrates and other Greek doctors believed that the work done by a doctor should be kept separate from the work done by a priest. They believed that observation of a patient was a vital aspect of medical care. Ancient Greek doctors did examine their patients but Hippocrates wanted a more systematic period of observation and the recording of what was observed. Today, we would call this ‘clinical observation’. Such ideas have lead to Hippocrates being called the ‘Father of Medicine’.

The Hippocratic Collection gave Greek doctors detailed advice on what to do with their patients.

In the book "On Epidemics", doctors were told to note specific symptoms and what was observed on a day to day basis. By doing this they could make a natural history of an illness. Hippocrates and other doctors believed that by doing this they could forecast the development of the illness in future.

The ideas of Hippocrates and others spread in the eastern Mediterranean and others took to writing down what they saw with regards to illnesses. These writings have survived and have given historians a vast resource to study.

Hippocrates and other doctors worked on the assumption that all diseases had a natural cause rather than a supernatural one.

The definition of word “epidemics” was not clear, the Greeks called diseases widely spread in people, such as fever, consumption, eye diseases, skin diseases, etc.

Illness was considered by Hippocrates as change of 3 conditions: dampness, welding and rarity. Hence, teaching about period, rhythms of diseases and main methods of treatment:

1) First of all not to harm

2) Opposite is recovered by opposite.

3) Follow to law of proportionality.

4) Treat in conformity with nature laws, i.e. take into account “nature” of sick man, conditions of his life, influence of environment.

Big significance had mode of life in ancient Greece. Teaching music, reading and writing, hygiene, physical training and hardening were stand in one row.

Study of mode of life allowed Hippocrates to define 4 basic types of frame and temperament of people. They based on notions of ancient Greeks about predominance of one from 4 basic liquids in organism.

Works on surgery – “About fractures”, “About head wounds”, etc. gave notions about high development teaching about bandages, treatment of fractures, wounds, etc.

Doctors of Ancient Greece did not dissect and had not special knowledge on anatomy. Their notions were empiric.

259 medicinal means of vegetable and 50 of organic origin were described in “Collection of Hippocrates”. Hippocrates used 60-70 medicinal means.

There were 5 works in the “Collection of Hippocrates”, which were devoted to deontology and behavior rules of doctor in Ancient Greece. They are: “Law”, “Oath”, “About doctor”, “About decent behavior”, “Admonitions”.

Stable rules of behavior were devotion to teachers and respect to colleagues, which consolidated in “Oath”, written down in III B.C. in Alexandrian library and named after Hippocrates.

The Greeks gave a new direction to medical thought. They rejected the supernatural theory of disease and looked upon disease as a natural process, not a visitation from a god of immolation. The Greeks believed that matter was made up of four elements - earth, air, fire and water. These elements had the corresponding qualities of being cold, dry, hot and moist and were represented in the body by the four humors - phlegm, yellow bile, blood and black bile.

Greeks postulated that health prevailed when the four humors were in equilibrium and when the balance was disturbed, disease was the result. The human body was assumed to have powers of restoration of humoral equilibrium, and it was the physician's primary role to assist in this healing process. While the humoral theory of Hippocrates was based on incorrect foundations, the concept of the innate capacity of the body of responding to disturbances in the equilibrium that constitutes health is highly relevant to modern medicine.

Outstanding amongst post-Hippocratic medical centre was Alexandria's huge museum, the first University in the world which sheltered a library containing over 70,000 books. To this house of learning came eminent men. Between 300 BC and 30 BC, thousands of pupils matriculated in the school of Alexandria, which replaced Athens as the world's centre of learning. In short, the Hippocratic school inspired in turn the Alexandria school and the Arabo-Persian medicine. The Hippocratic school changed the destiny of medicine by separating it from magic and raising it to the status of a science. They had scientific method, although not scientific knowledge. The glorious Greek civilization fell into decay and was succeeded by the Roman civilization.