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
Summary of main points

   Medical practices              No theory of germs in
    traceable to neolithic          the past.
    (besides shamanism).           Surgeries were
   Hard to know how                frequently successful.
    effective remedies             Specialized class of
    actually were.                  physicians enjoyed
   Potential that many             high status.
    provided some relief.          Many ancient remedies
   Clear efforts to discover       survive to this day in
    and pass on knowledge           modified form.
   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.

   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

   Egypt
   Indus
   Mesopotamia
   China

Each developed specialized medical practices.
 Some are in use today or formed the basis of
 modern practices.
Evidence

   Texts
   Skeletal remains
   Tomb carvings and
    paintings
   Folk legend
   Living practices
Tomb carvings of physician
depicting medical tools.
Brain surgery.




Trepanation. Known from sites as early as 2000 BC.
Ancient
Greek
surgical
gear. You
don’t want
to know…
Surgical instruments.
   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.
Medicines

   Oldest Egyptian papyrus was written in 1850
    BC. Several medical papyrus survive.
   Many medicines contain natural ingredients
    which contained suitable compounds for
    treatment.
   No evidence of a “theory of ‘germs” in the
    ancient world. Magic still had a major role.
   No evidence physicians understood why a
    particular treatment worked.
Written in stone

   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.
   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).
Scientific validation

   Clinical studies using myrrh, honey, red wine,
    and other plant substances reveal a genuine
    knowledge of toxicology among ancient
    physicians.
   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.
Research in ancient medicine

   Text based        Guido Majno, MD, PhD

   Clinical trials
   Ethnographic
   Anthropological
Myrrh

   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.
Egyptian temple relief painting showing the harvesting of myrrh.
   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.
   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 medical, remedies from the past.
The Assyrians

   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”).
   Other recipes include turpentine, copper*,
    spices, lead residue, and arsenic.

   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.
Greek Developments

   Experiments in medical practices were
    combined with traditional methods.
    Considerable effort to properly diagnose
    illnesses.

   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.
Ever popular
blood-letting.
        Spoon of Diokles (for
        removing projectile points
        and spears)




Greek

                        Surgical tools. Don’t
                        ask.)
Salves, ointments, concoctions

   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

   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.
                   4200 year old dental
                   office, Egypt. Tomb
                   commemorates three
                   dentists.




Earliest bridge.
Egypt
Dental drill
Indus cavity drilling technique.
Roman innovations

   Romans perfected the production of false
    teeth using metals, bridges, carved ivory,
    modified animal teeth, and caps.
   Invented the modern hospital.
   Traded with India for eye slaves and
    medicines. Good archaeological evidence.
   Experimented with natural pain killers, like
    henbane (a powerful and toxic herb).
   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

   Herbal medicines and early trials at
    acupuncture which may have developed from
    the practice of medical tattooing.

   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

   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

   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…

   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.
   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.
   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.”


   A Greek treatise reads: “…to treat the body
    without also treating the mind…will be unsuccessful.”