HISTORY OF MEDICINE
Primitive medicine
In the long process of discovering which plants are edible, humans in the Stone Age also identify many which seem to cure ailments or soothe a fever.
Herbal medicine is the earliest scientific tradition in medical practice, and it remains an important part of medicine to this day – in a line descending directly from those distant beginnings. The early physicians stumbled upon herbal substances of real power, without understanding the manner of their working.
The snakeroot plant has traditionally been a tonic in the east to calm patients; it is now used in orthodox medical practice to reduce blood pressure. Doctors in ancient India gave an extract of foxglove to patients with legs swollen by dropsy, an excess of fluid resulting from a weak heart; digitalis, a constituent of foxglove, is now a standard stimulant for the heart. Curare, smeared on the tip of arrows in the Amazonian jungle to paralyze the prey, is an important muscle relaxant in modern surgery.
The long centuries of primitive experiment mean that Susruta, a physician working in India in about the 6th century BC, is able to list hundreds of herbal remedies.
Even so, herbal substances form only a small part of the repertoire of the tribal physician, for it is generally agreed that serious illnesses have spiritual rather than physical causes. The doctor’s main duty is to appease or expel the evil spirit troubling the sick person.
Incantation, spells and self-induced trances (often assisted by herbal drugs) form the standard practice of the medicine man or shaman. Even the world’s earliest surgical operation, practised at least 4000 years ago, is more probably intended to strengthen the doctor’s own powers than to cure a patient.
A hole in the head: perhaps from 2000 BC
The earliest surgical operation in human history is carried out in prehistoric times in several parts of the world – in Europe, in Asia and particularly in Peru, where well-preserved mummies survive. Many of these mummies have the hole in the skull which is the result of trepanning (also known as trephining or trephination).
Healing in the bone around the wound in these mummies, and in skulls found elsewhere, suggests that as many as 50 percent of the ‘patients’ survive the operation.
The reason for the alarming decision to cut a hole in a living skull is likely to have been religious rather than medical in any modern sense. To let out evil spirits perhaps; or to give spiritual authority to a shaman who submits himself to the knife.
Merely by surviving the operation the shaman proves that he is favoured by the spirits. And his hole in the head, healed over with a flap of skin, will continue to suggest that he has an open channel of communication with unseen influences.
It is not known how such operations were done. One method may be cutting and scraping away at the bone of the skull with a sharp flint, until a hole is virtually rubbed away. Another may be making a circle of small holes with a flint drill and then cutting between them.
Whatever the method, it is to be hoped that there is a herbal mixture of some kind to serve as at least a mild form of anaesthetic.
Medicine in India: from the 6th century BC
Susruta, the founding father of Indian medicine, establishes a tradition later enshrined in a classic text, the Susrutasamhita. He identifies 1120 diseases, lists 760 medicinal drugs, and says that the surgeon’s equipment amounts to 20 sharp instruments (including knives, scissors, saws and needles) and 101 blunt ones (such as forceps, tubes, levers, hooks and probes).
His explanation of how to rebuild a patient’s nose has given him the status of the first plastic surgeon. This is an important operation in ancient India. Amputation of the nose is a punishment for adultery.
Indian medicine enshrines the theory that the human body consists of three substances, and that health requires a balance between them. They are usually translated as spirit, phlegm and bile.
Greek medicine will later advance a similar theory, but one based on four humours rather than three.
The Hippocratic Oath and the four humours: 4th c. BC
Hippocrates practises and teaches medicine in about 400 BC on the Greek island of Kos. He will later be regarded as the father of medicine – partly because he is unlike his more theoretical contemporaries in paying close attention to the symptoms of disease, but also because a century or more after his death a group of medical works is gathered together under his name.
This Hippocratic Collection, and in particular the Hippocratic oath which is part of it, has remained the broad basis of medical principle up to our own day.
A slightly later Greek text, called On the Nature of Man and attributed to an author by the name of Polybus, introduces a medical theory which will be orthodox in Europe for some 2000 years. It states that human beings are composed of four substances or ‘humours’, just as inanimate matter is made up of four elements. India has a similar theory based on three.
The humours are blood, phlegm, black bile (melancholia) and yellow bile (chole). Too much of any one will give a person certain recognizable characteristics. He or she will be sanguine, phlegmatic, melancholy or choleric.
Human vivisection: c.300 BC
Early in the 3rd century BC two surgeons in Alexandria, Herophilus and Erasistratus, make the first scientific studies designed to discover the workings of human anatomy.
The cost of their contribution to science would be considered too high in modern times (they acquire much of their information from vivisection of convicted criminals). But Celsus, a Roman writer on medical history, energetically justifies the suffering of the criminals as providing ‘remedies for innocent people of all future ages’.
Acupuncture: 3rd century BC
A Chinese text, the Nei Ching or ‘Book of Medicine’, describes the practice of acupuncture. The document is written in about the 1st century BC, by which time acupuncture is already a long-established tradition.
The underlying theory is that a healthy body depends on a flow of energy. This can be interrupted by blockages, which may be either the symptom or the cause of illness. Inserting a needle into the correct spot on the energy path (as many as 365 possible places are specified) will improve the energy flow by clearing a blockage or releasing pressure. The use of acupuncture as a form of anaesthetic, familiar in China today, is a modern development of the traditional science.
The influential errors of Galen: 2nd century AD
The newly appointed chief physician to the gladiators in Pergamum, in AD 158, is a native of the city. He is a Greek doctor by the name of Galen. The appointment gives him the opportunity to study wounds of all kinds. His knowledge of muscles enables him to warn his patients of the likely outcome of certain operations – a wise precaution recommended in Galen’s Advice to doctors.
But it is Galen’s dissection of apes and pigs which give him the detailed information for his medical tracts on the organs of the body. Nearly 100 of these tracts survive. They become the basis of Galen’s great reputation in medieval medicine, unchallenged until the anatomical work of Vesalius.
Through his experiments Galen is able to overturn many long-held beliefs, such as the theory (first proposed by the Hippocratic school in about 400 BC, and maintained even by the physicians of Alexandria) that the arteries contain air – carrying it to all parts of the body from the heart and the lungs. This belief is based originally on the arteries of dead animals, which appear to be empty.
Galen is able to demonstrate that living arteries contain blood. His error, which will become the established medical orthodoxy for centuries, is to assume that the blood goes back and forth from the heart in an ebb-and-flow motion. This theory holds sway in medical circles until the time of Harvey.
