Transcript Medical Practices of the Ancient World

Medical Practices of the Ancient
World
“If a physician performed a major
operation on a seignior with a
bronze lancet and has saved his
life…he shall receive ten shekels
of silver…”
If a physician performed a major
operation on a seignior with a
bronze lancet and caused the
death of the seignior…they shall
cut off his hand…”
From
Akkadian texts concerning
medical practices using a knife.
Hammurabi, 1700 BC
Brain surgery.
Trepanation
involves
removing a
section of skull to
have access to
tumors or to
relieve pressure.
Also lets out
malignant spirits.
Trepanation. Known from sites as early as 2000 BC.
Summary of main points
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Medical practices
traceable to neolithic
(besides shamanism).
Hard to know how
effective most remedies
actually were.
Potential that many
provided some relief.
Clear efforts to discover
and pass on knowledge
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No theory of germs in
the past.
Surgeries were
frequently successful.
Specialized class of
physicians enjoyed
high status.
Many ancient remedies
survive to this day in
modified form.
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Although our best knowledge of ancient
medical practices date from classical Greek
and later Roman periods, we have evidence
of different treatments and diagnoses as
early as 4000 BC.
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Considerable evidence that if someone had a disease or illness it was
perceived to be their own fault, they had committed sin, or some outside
agent or spirit was to blame; therefore a physician could not be held
accountable for failure—but recourse was to call on higher forces for aid.
Four main river-valley civilizations
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Egypt
Indus
Mesopotamia
China
Each developed specialized medical practices.
Some are in use today or formed the basis of
modern practices.
Ancient
Greek
surgical
gear. You
don’t want
to know…
Evidence
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Texts
Skeletal remains
Tomb carvings and
paintings
Folk legend
Living practices
Tomb carvings of physician
depicting medical tools.
Surgical instruments.
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Cuneiform texts include words for wounds,
drugs, illness, cure, tumor, ulcer, sores
Much is written about diagnosis.
Texts describe treatment options that vary
from primitive first-aid to sorcery.
No evidence of a concept of bacterial, viral,
or germ theory.
Cuneiform
tablet
dated to 2158 BC
includes oldest known
descriptions for
wound dressings.
A
mix of red wine,
honey, myrrh, and
camphor.
Research in ancient medicine
Guido Majno, MD, PhD
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Text based
Clinical trials
Ethnographic
Anthropological
Biomedicalanthropologist
Scientific validation
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Honey is rich in antibacterial agents, as is
myrrh. Tannins in red wine also have
practical medical value. Myrrh and red wine
mixed together constitute a strong sedative.
Myhrr has strong antiseptic properties
released in the presence of alcohol.
Medicines
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Oldest Egyptian papyrus was written in 1850
BC. Several medical papyrus survive.
Many medicines contain natural ingredients
which contained suitable compounds for
treatment.
Magic still had a major role in diagnosis.
No evidence physicians understood why a
particular treatment worked.
Egyptian temple relief painting showing the harvesting of myrrh.
Written in stone
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Hammurabi codified law, and among them
were laws governing medical practices. From
around 1700 BC we have the first account of
a medical malpractice suit.
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However, of 150,000 administrative texts
recovered so far, only two are medical tablets
(by contrast, they wrote an entire book on
beer making—19 types).
Myrrh
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Egyptians used Myrrh from at least 2500 BC
and a text describes using it to treat battle
victims in 1350 BC.
Herodotus states it was favorite among the
Persians 5th century BC.
Greek Hippocrates prescribes it 54 times in
his medical books and the Roman Celsus in
the 1st century AD uses it mixed with wine for
burns.
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Antiseptic qualities of wine and beer were
noted. One Sumerian treatment for a wound
included washing the wound with juniper
mixed in beer and hot water.
Organ knives. Egyptian
Greek medical pots for preparing
ointments and brews.
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Concoctions include mud from the river.
Muds are known to contain microbes and
anti-bacterial agents. Many modern
medicines are derived from muds.
(Paleobotanicalpharmocology) new science
of seeking natural medical remedies from the
past.
The Assyrians
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Developed an extensive pharmacology using
plant roots, distillates and resins.
Items include: pine, spruce, honey, wine,
myrrh, essence of cedar, fat from male sheep
kidneys, glasswort.
Many drugs were processed from a class of
plants that gave ashes rich in alkali. (Arabic
word al-quali “the [plant] ash”).
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Other recipes include turpentine, copper*,
spices, lead residue, and arsenic.
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Inclusion of copper powders, derived from
malachite ores, were antiseptic. Since
infection was among the leading causes of
death after a wound, using a balm that
included copper may have prevented
infection and saved lives.
Greek Developments
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Experiments in medical practices were
combined with traditional methods.
Considerable effort to properly diagnose
illnesses.
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Physicians code of “first do no harm.”
recognition that in many cases patients did
better when left alone.
Homer describes a physician examining the spear that
caused a wound in order to diagnose and predict infection.
Aside from obvious
injuries requiring
attention, most medical
diagnoses was based
on the physicians
assessment of a
patient’s temperament.
Binding the wound of
Achilles. But alas…
Ever popular
blood-letting. The
use of leeches is
again in popular
practices, as is
the use of flesh
eating larvae.
Spoon of Diokles (for
removing projectile points
and spears)
Greek
Surgical tools. Don’t
ask.)
Salves, ointments, concoctions
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Most have a base such as honey or fat.
Herbs and spices were also added to salves.
Modern salves are little different…a medicinal
antiseptic added to a binding
agent…Neosporin.
Around 400BC Hippocrates describes a
powder made from tree bark and willow
branch resins. (Contains salicia—ingredient in
acetylsalicylic acid, aka: aspirin)
Indus
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Clear evidence of early dental surgery.
Indus people may have invented the bow-drill
for bead work and applied it to dentistry.
Earliest evidence is from 4000 BC in the form
of skeletons with indications of dental work.
Several examples of cosmetic surgery known
from the Indus civilization.
4200 year old dental
office, Egypt. Tomb
commemorates three
dentists.
Earliest bridge.
Egypt
Dental drill. Same type for drilling holes in
stone beads.
The next time you visit a dentist be
thankful for high powered drills.
Indus cavity drilling technique.
Roman innovations
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Romans perfected the production of false
teeth using metals, bridges, carved ivory,
modified animal teeth, and caps.
Invented the modern hospital, wards, central
receiving, surgical areas and recovery rooms.
Traded with India for eye salves and
medicines. Good archaeological evidence.
Experimented with natural pain killers, like
henbane (a powerful and toxic herb).
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Because of battlefield injury and gladiator
contests, Roman physicians had
considerable knowledge about human
anatomy—knowledge lost after the collapse
of the empire and not regained until the late
18th century AD
(The Church forbid dissection and so
European doctors could not study human
bodies, and so adopted and relied on the
faulty understanding of the ancient Greeks)
Roman surgical kit, 1st century AD
From the coliseum.
China
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Herbal medicines and early trials at
acupuncture which may have developed from
the practice of medical tattooing.
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From about 1000 BC Chinese medical
knowledge was being written down and
included a massive herbal pharmacology.
Acupuncture has been shown to be a complex form of neurosurgery.
Centuries of practice have
refined the practice and
located specific “trigger
points.” Still, a certain
degree of
spiritual/cosmological
elements remain part of
the “science.”
Chinese medicine more than needles
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Tremendous pharmacology developed
Surgical practices were not as advanced as
Mesopotamia, but patient treatment was
superior by any standard and included a
sophisticated understanding of diet and
health.
Modern Chinese
medicines based
in ancient
traditional
practices.
Continuity of
practices to the
present have
encountered new
resistance in
various markets
owing to what is
viewed as
exploitation of
endangered
species.
Parallels
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Ancient Chinese and later Greek medicine
were based on the concept of “balance”
within the body.
For Chinese there was a relationship
between the five elements metal, water,
wood, fire, earth.
For the Greeks the elements were fire, water,
air (wind), earth. Would evolve into the
“humors” of European medicine.
Carry over into modern times…
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This concept of balance plays out in medical
diagnosis and treatment. Oppositions and
complimentary character of treatment were
the physician’s responsibility.
The philosophy carried into near modern
times as ailments were diagnosed as “cold or
hot”, “wet or dry” etc., and treated by
methods thought to balance the ailment.
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Both Greek and Chinese medicine
recognized the mental state of the patient as
critical to recovery. One Chinese text reads:
“…if the patient does not exhibit the will to live…do not
accept the case.”
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A Greek treatise reads: “…to treat the body
without also treating the mind…will be unsuccessful.”
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The elements manifested in man as
“temperaments” to be treated accordingly.
Purges were administered to regain balance
between the humors. May involve induced
vomiting, enemas, blood letting using leeches
and vein opening, or sweating. (If the illness
didn’t kill you the treatment might).
Diagnosis
depended on
attitude and other
factors.