Medical Practices of the Ancient World

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Medical Practices of the Ancient World

• If a physician performed a major operation on a
  seignior with a bronze lancet and has saved his
  lifehe 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 seigniorthey shall cut off his
  hand
• From Akkadian texts concerning medical practices
  using a knife. Hammurabi, 1700 BC

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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.
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Summary of main points

• 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

• 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.
• 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
  failurebut recourse was to call on higher forces
  for aid.

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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.

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Ancient Greek surgical gear. You dont want to
know
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Evidence

• Texts
• Skeletal remains
• Tomb carvings and paintings
• Folk legend
• Living practices

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Tomb carvings of physician depicting medical
tools.
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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.

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• Cuneiform tablet dated to 2158 BC includes oldest
  known descriptions for wound dressings.
• A mix of red wine, honey, myrrh, and camphor.

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Research in ancient medicine
Guido Majno, MD, PhD Biomedicalanthropologist

• Text based
• Clinical trials
• Ethnographic
• Anthropological

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Scientific validation

• 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.

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Medicines

• 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.

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Egyptian temple relief painting showing the
harvesting of myrrh.
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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
  making19 types).

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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.

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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.

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Organ knives. Egyptian
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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.

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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).

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• 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 and saved lives.

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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.

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Homer describes a physician examining the spear
that caused a wound in order to diagnose and
predict infection.
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Aside from obvious injuries requiring attention,
most medical diagnoses was based on the
physicians assessment of a patients temperament.
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Binding the wound of Achilles. But alas
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Ever popular blood-letting. The use of leeches
is again in popular practices, as is the use of
flesh eating larvae.
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Spoon of Diokles (for removing projectile points
and spears)
Greek
Surgical tools. Dont ask.)
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Salves, ointments, concoctions

• Most have a base such as honey or fat.
• Herbs and spices were also added to salves.
  Modern salves are little differenta medicinal
  antiseptic added to a binding agentNeosporin.
• Around 400BC Hippocrates describes a powder made
  from tree bark and willow branch resins.
  (Contains saliciaingredient in acetylsalicylic
  acid, aka aspirin)

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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.
• Several examples of cosmetic surgery known from
  the Indus civilization.

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4200 year old dental office, Egypt. Tomb
commemorates three dentists.
Earliest bridge. Egypt
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Dental drill. Same type for drilling holes in
stone beads.
The next time you visit a dentist be thankful for
high powered drills.
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Indus cavity drilling technique.
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Roman innovations

• 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 anatomyknowledge 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)

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Roman surgical kit, 1st century AD From the
coliseum.
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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.

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Acupuncture has been shown to be a complex form
of neurosurgery.
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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.
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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.

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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.
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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.

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Carry over into modern times

• This concept of balance plays out in medical
  diagnosis and treatment. Oppositions and
  complimentary character of treatment were the
  physicians 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 livedo not
  accept the case.
• A Greek treatise reads to treat the body
  without also treating the mindwill 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 didnt kill
  you the treatment might).

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Diagnosis depended on attitude and other factors.