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Medicine through Ages

Part I: Prehistoric, Ancient Egyptian and Ancient Greek

By

Dr. Alok MishraPost graduate Trainee, National Institute of Homoeopathy

Under Guidance of

Prof. LM Khan

HOD, Organon of Medicine, National Institute of Medicne

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If no use were to be made of labors of the

past ages, the world must remain in the

infancy of Knowledge.

- CICIRO

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Prehistoric Medicine

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Prehistory: Timeline• Prehistory is a term used to describe the

period before recorded history.

• The term "prehistory" can be used to refer to all time since the beginning of the universe, although it is more often used in referring to the period of time since life appeared on Earth, or even more specifically to the time since human-like beings appeared.

• The date marking the end of prehistory, that is the date when written historical records become a useful academic resource, varies from region to region. For example, in Egypt it is generally accepted that prehistory ended around 3200 BC.

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Knowledge about Prehistoric era

Artifacts

Anthropology

Cave engraving

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Causes of disease

• Magico-religious or supernatural ideas dominated as the cause of disease in primitive society.

• Diseases were believed to be due to:

- Supernatural power like evil spirit, demons & god

- Rational cause like injury etc.

• Diseases were due to fright, fear and unknown terror (thunderstorm, fire, water, rain, sun, moon, animals, etc.)

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Diseases of prehistoric era• Physically men were affected primarily by degenerative joint

disease, fractures, respiratory diseases like sinusitis, bronchitis, digestive disturbances, skin disease.

• Various cancers are identifiable in the skeleton. Primary bone cancer is rare, but the skeleton is a common site for the secondary spread of cancerous growth from other tissues.

• Specific traces in the skeleton system suggests certain infection like tuberculosis (traces on the ribs and tends to destroy the bodies of the lumbar vertebrae), congenital syphillis (Hutchison’sincisor), leprosy (damage to the bones of the face, fingers, and toes)

• Life expectancy was 25-40 years.

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Shamans: the healers• Shamans or Sorcerers, were

considered as intermediate between human world & spiritual world.

• He use to wore monstrous animal mask to frighten the evil spirits causing illness.

• Shamans were considered to be able to contact supernatural powers and to remove the evil spirits to cure the patients.

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Trephining• Trephining was the process

in which shamans use to make a perforation in the skull to expel the demon or evil spirit.

• This was practiced to cure headache, epilepsy or tumours.

• For triphining they used sharpened edges of stones and flints.

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Healing art in Prehistoric eraTreatment for Fracture

• They were able to set broken or fractured bones using clay material.

• Clay used to set hard so that the bone could heal properly.

Healing of open wound

• They used pincers of certain ant species to heal an open wound.

• They allowed the ant to stand above the wound until it bit, then its head was removed allowing the pincers to remain and hold close the wound.

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Prehistoric era and Naturopathy• They use to eat clay and earth as

well as they used to apply it externally.

• Also, early humans could have learned about the use of various healing clays by observing animal behavior.

• Such clay is used both internally and externally, such as for treating wounds, and after surgery.

• The reflection of same is seen in Naturopathic process of mud therapy.

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Knowledge of anatomy

• Occasionally one finds, in wall painting made by pre-historic man, the spears or arrows plunged exactly into the vital organs of the animals, showing that in terms of their animal victims, if not themselves, pre-historic hunters had a precise knowledge of anatomy.

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Ancient Egyptian Medicine

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Importance of Egyptian Medicine

• The oldest historic phase of medicine known to us is that of ancient Medicine.

• All future development of medicine had some glimpses of Egyptian medicine.

• Egyptian medicine enjoyed great fame in antiquity.

• Egyptians are credited with being the first to use and record advanced medical practices.

• Egyptian medicine played a dominant role in the history of ancient medicine for about 2500 years and then it was replaced by Greek medicine

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Papyrus

• Papyrus is a thick paper-like material produced from the pith of the papyrus plant, Cyperus papyrus.

• These papyri were used to record documents related to medicine, religion, philosophy, mathematics, magic etc.

• Egyptians wrote there inscription on papyri mostly in Hieroglyphic language.

• There were several papyri related to medical texts but Edwin Smith Papyrus and Ebers Papyrus were the most interesting and well known.

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List of Medical Papyrus

• Hearst Papyrus (20th century BC): Medical text relating to urinary bladder, blood, hair and piles. It also included treatment for cancer.

• Ramesseum Medical Papyrus (18th century BC): Related to ophthalmology, Gynaecology, muscles & tendon, and Paediatrics

• Edwin Smith Papyrus (16th century BC): Textbook of Surgery

• Ebers Papyrus (16th century BC): Incantation and foul application meant for disease causing demons

• Chester Beatty Papyrus (12th century BC): For headache and anorectal ailments

• Brooklyn Papyrus (4th century BC): Ailments for poison

• Carlsberg Papyrus (2nd century BC): Deals with eye disease and Pregnancy

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Hieroglyphic writing

• Hieroglyphic method of writing contained a combination of logographic and alphabetic elements.

• Papyrus are written mostly in hieroglyphic writing.

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Knowledge of Anatomy

• Egyptian had some knowledge of Anatomy can be gathered from the way they mummified the dead body.

• Mummifiers use to pierce the nasal bone to remove the brain.

• They also must have had a general idea of the location in the body cavity of the inner organs, which they removed through a small incision in the left groin.

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Knowledge of Physiology

• They had good knowledge of physiology which they derived from embalming the dead body.

• They were able to cure night blindness by feeding with liver.

• They supposed that the disease to which men are subjected proceed from the food they use.

• Egyptian physicians were aware of the existence of the pulse and of a connection between pulse and heart.

• They could not discriminate between blood vessels, nerves and tendon.

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Concept of disease

• The Egyptians believed that disease and death were caused by a god, a spirit, or some other supernatural force.

• The healers often used incantations and magic as part of treatment.

• In Egyptian time priest, doing magic & incantations, and physicians were the one and same.

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Theory of Channels• They developed their theory of

"channels" that carried air, water and blood to the body by analogies with the River Nile.

• In analogy to river Nile they said as crops became unhealthy when it is blocked in the same way they said that body becomes sick when these channels are blocked.

• If a person was unwell, they would use laxatives to unblock the "channels".

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Similia in Egyptian time

• They Similia principle in very crude form.

• They used similia principle in the form of

doctrine of signature eg they used ostrich

egg for the treatment of broken skull.

• However, Hahnemann in § 110 refuted the

use of similia principle on the basis of

doctrine of signature.

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Common diseases of their time• They suffered from the injuries and deformities caused by hard

labor.

• They suffered from insect born diseases such as malaria and trachoma, an eye disease, small pox, measles, tuberculosis, and cholera.

• It is believed that there were occasional outbreaks of the bubonic plague.

• Leprosy, which had originated in Egypt, was relatively rare.

• Silicosis of the lungs, caused by breathing in sand particles was a common cause of pneumonia for the ancient Egyptians.

• Eye diseases due to injuries from sandy wind from desert.

• The ancient Egyptians also suffered from diet-related ailments such as malnutrition, vitamin and mineral deficiencies, dental abrasion, and ailments normal to all humans such as arthritis.

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Knowledge of Surgery• The use of surgery evolved from a knowledge of the basic

anatomy and embalming practices of the Egyptians.

• They were very much skilled in healing physical injuries, these physician were able to do amputation and for the first time Egyptian used prosthetics.

• They were skilled in performing eye surgery.

• They knew how to suture wound. They used honey as an antiseptic and moldy bread as antibiotic.

Prosthetic foot

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Therapeutic knowledge

• The prescription for a healthy life, meant that an individual undertook the stringent and regular purification rituals (which included much bathing, and often times shaving one's head and body hair), and maintained their dietary restrictions against raw fish and other animals considered unclean to eat.

• Among the curatives used by the Egyptians were all types of plant (herbs and other plants), animal (all parts nearly) and mineral compounds.

• Yeast's were also taken internally for digestive disorders and were an effective cure for ulcers.

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Specialization

• In Egyptian time the art of medicine was divided so that each physician applies himself to one disease only and not more.

• Some were physicians of eyes, other for the head, others for the teeth. Others for the intestines and others for internal disorders.

• This clearly shows that today’s era of specialization and super-specialization has come en route from Egyptian medicine.

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Imhotep: Egyptian Demigod (2655 -2600 B.C.):

• Imhotep was the Egyptian demigod of medicine.

• He was earliest known physician.

• He was founder of medicine in Egypt and his writings were devoid of magical thinking.

• He was the original author of Edwin Smith Papyrus.

• He was also considered as the first architect engineer. He designed the step pyramid at Saqqara.

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Thoth

• Thoth was considered one of the more important deities of the Egyptian pantheon.

• In art, he was often depicted as a man with the head of an ibis or a baboon; these animals were sacred to him.

• His feminine counterpart was Seshat.

• The Egyptians credited him as the author of all works of science, religion, philosophy, and magic.

• Mythology also credits him with the creation of the 365 day calendar. Seshat

Thoth

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Ancient Greek Medicine

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Aegean Civilization

• Ancient Aegean civilization began around 3000 B.C.

• Greek Medicine developed with philosophy, disciplined by strict criticism, and healing for the first time became a science as well as an art, practiced not by priestly caste but by laymen who replaced magic by enquiry.

• From the writings of Homer (c. 850 B.C.), a great poet, we get the earliest glimpse of Greek medicine.

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Aesculapius

Greek God

of

Medicine & Healing

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Aesculapius: Birth Mythology

• He was son of Apollo and Coronis.

• A mythological story is attached to his birth that his mother was killed for being unfaithful to Apollo but the unborn child was rescued from the womb of his dead mother.

• He was called as Aesculapius which means “to cut open”.

• Apollo took the baby to Centaur Chiron, son of Saturn, who brought him up and taught him art of medicine.

Apollo Snatching the Unborn Asclepius from the Flaming Womb of Coronis

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Daughters of Aesculapius• Aesculapius had five daughter, each reflecting a specific

feature of medical art:

Hygieia : Hygiene

Panacea: Universal remedy

Laso: Medicine

Aceso: Healing

Aglæa: healthy glow

Hygieia

Panacea Laso

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Staff of Aesculapius: Askelepian

• Aesculapius carried with him a Staff round which twists the serpent, this was the symbol of ancient medicine and is still the symbol of medicine in modern world.

• This staff of Aesculapius was called as Askelepian.

• The snake symbolizes the shedding of skin as a sign of rejuvenation or alternatively it signifies dual nature of physician as dealing with life and death, health and sickness, medicine and poison etc.

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Temple of Aesculapius: Asclepieia• The temples of his cult, dedicated to healer

God Aesculapius, were known as Asclepieia. Most celebrated Asclepieia were in Cos, Epidaurus, Cnidus and Pergamus.

• In the state of induced sleep, called as enkoimesis, the priest presented himself before the patient to administer medical advice, if he happened to be awake.

• If he slept, as was usually the case, the advice came in a dream, which was interpreted afterwards by the priests, who then prescribed catharsis, emesis, blood-letting or whatever remedy seemed appropriate.

• Before these patients left the temple a tablets were hung on the wall of the temple engraving there name, brief history and treatment offered.

Temple of Aesculapius

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Death of Aesculapius

• Aesculapius became so proficient in the healing art that Pluto accused him of diminishing the number of shades in Hades. He was then destroyed by a thunderbolt of Zeus, and so became and objects of worship.

Zeus

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EMPEDOCLES (c. 493-c. 433 B.C.) • The theory of the Four Elements is

generally attributed to Empedocles. 

• According to this theory, everything in the universe, including the human body, is composed of the Four Elements in varying proportions viz.:

- Fire, - Air, - Earth - Water.

• Empedocles had a theory of building up, or synthesis (anabolism) versus breaking down, or analysis (catabolism). 

• The physician's job was to assess the patient to see which aspect of metabolism predominated, and then bring them back into balance. 

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THALES (640-546 B.C.)

• Thales was the first true scientist-philosopher of the Greeks.

• Thales believed that the basic element in all animal and plant life was water, from which came earth and air.

• Although he accepted the idea of a God, he did not use religious means to seek or establish the natural processes of the universe or of humans.

• He has been called as the "Father of Science".

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ALCMAEON OF CROTONA (c. 500 B.C.)

• Alcmaeon of Crotona gave a theory of isonomia, which means the perfect harmony of all substances in the metabolism. 

• The body is healthy as long as this metabolic harmony was maintained; disease resulted from its disruption. 

• Disease was cured by restoring metabolic balance and harmony to the organism.

• Modern nutritionists and physiologists see in isonomia the precursor of all modern metabolic theory. 

• But he also believed that investigation (including dissection), not just philosophy, was needed in order to understand the body. His combination of direct observation and experimental testing stands out as unique in his time.

• Although many remarkable facts emerged from his dissections (probably on animals)

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Hippocrates(c 460-377 B.C.)

VIS-MEDICATRIX NATURAE

FATHER OF MEDICINE

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• Hippocrates based his principles and practice on the theory of the existence of a spiritual restoring essence or principle, the vis medicatrix naturae.

• In therapeutics, he believed in simply assisting nature, his scheme of treatment was usually confined to such plain expedients as fresh air, good diet, purgatives, blood-letting, barley water, honey & water, honey & vinegar, massage, and hydrotherapy.

• To this end, Hippocrates believed "rest and immobilization were of capital importance".

• Here Hahnemann differed slightly from Hippocrates.

Vis medica trix naturae

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Humoral Pathology

• Hippocrates gave idea of four Humours:

• blood,

• yellow bile,

• phlegm and

• black bile.

• He said that balance between these humours is the state of health and any imbalance is illness.

• His therapy was also directed in restoring the balance between these humours.

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Survey of Diseases

• He divided diseases into four classes

• acute,

• chronic,

• endemic and

• epidemic.

• His book on Epidemic Diseases gave vivid description of these diseases.

• Hahnemann in §72 to §81 made similar survey of disease.

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Man and environment

• Hippocrates was constantly seeking the causes of disease.

• He studied such things as climate, water, clothing, diet, habits of eating and drinking and the effect they had in producing the disease.

• His book Airs, waters, and places stressed the relation between man and his environment. This book contains the first enunciation of the principles of public health.

• Same concept reflects in Hahnemann’s work in § 4, § 5, §77 of Organon of Medicine and also at many places in Chronic Disease.

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Law of simple

• Hippocrates chose the simplest out of a

class of diseases; these he watched

closely and described minutely.

• In these simplest maladies he gave single

simple remedies out of the store of existing

drugs which was then small.

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Similia vs Contraria

• Hippocrates gave two ways of applying

medicines:

• On the basis of similia

• On the basis of contraria

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Clinical Knowledge• He devised a method of diagnostic investigation based on

observation and on reason which is even valid today.

• He laid much stress on prognosis.

• He & his followers evaluate an illness and induce likely progression of disease based on the data collected and detailed case histories.

• To this end Hippocrates and his follower instituted for the first time through going examination of patient’s condition including facial appearance, pulse, temperature, respiration, excreta, sputum, localized pains and movements of the body.

• They gave several clinical signs which still hold its importance in modern medicine few important among them were

– Hippocratic facies, - Clubbing of fingers,

– Cheyne-stokes breathing. - Crisis etc.

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Surgery

• In Greek atheletes and sports was very prevalent.

• History reports that Olympoid games started in Greece in 776 B.C. and was very prevalent in ancient time and even today.

• Atheletes and sports had great impact in the development of medicine in Greek time.

• Many fractures and wounds described by Hippocrates are common only in atheletes.

• Hippocratic Bench was one of his innovative techniques for giving traction to the fractured limb.

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HIPPOCRATIC CORPUS• The Hippocratic Corpus (Latin: Corpus

Hippocratum) is a collection of around seventy early medical works from ancient Greece strongly associated with Hippocrates and his teachings.

• The Hippocratic Corpus contains textbooks, lectures, research, notes and even philosophical essays on various subjects in medicine, in no particular order.

• There are a number of case-histories in the Hippocratic Corpus, 42 to be exact.

• Two books in corpus hippocraticum contain description about similia principle

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BOOKS AUTHORED BY HIPPOCRATES• Aphorisms

• Instruments of Reduction

• Of the Epidemics

• On Airs, Waters, and Places

• On Ancient Medicine

• On Fistulae

• On Fractures

• On Hemorrhoids

• On Injuries of The Head

• On Regimen in Acute Diseases

• On the Articulations

• On the Sacred Disease

• On the Surgery

• On Ulcers

• The Book of Prognostics

• The Law

• The Oath

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Aristotle (384 – 322 B.C.)

Father of Biology

Student of Plato

Teacher of Alexander the Great

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Father of Biology

• He was the man who gave medicine the beginning of

• botany,

• zoology,

• comparative anatomy,

• embryology,

• Teratology,

• physiology,

• and the use of formal logic as an instrument of precision.

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Embryology

• He studied development of the chick day by day,

noted the salient features of the development of

the chick embryo.

• He noted the

• beat of foetal heart,

• the vitelline and allontoic veins,

• the enveloping membrane, and

• the possibility of superfetation.

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Cardiocentric

• In contrast to his predecessor philospers, but in much accordance to the Egyptian belief, placed the rational soul in the heart rather than brain.

• He gave the doctrine of primacy of the heart, as the source of ‘innate heat,’ the seat of sensation and thought.

• Contrary to the view of Alamaeon, that the brain feels and thinks, Aristotle regarded it as a gland secreting cold humours to prevent overheating of the body by the fiery heart (via the lungs).

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Classification of animals

• He divided animals into

• Enaima or sanguineous (vertebrates) and

• Anaima or bloodless (invertebrates),

• Then he also divided them as to their reproductive status

• viviparous,

• oviparous,

• gemmulous,

• spontaneous generation.

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Aristotle: Organon• It was the book of Aristotle titled “Organon” which was standard

collection of his six works on logic.

• These works are

– Categories,

– On Interpretation,

– Prior Analytics,

– Posterior Analytics,

– Topics, and

– Sophistical Refutations.

• Later Francis Bacon (1561 -1626) gave the Novum Organum.

• Hahnemann was influenced by both these works and gave a title to his book as Organon of Medicine.

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