Conversely, the Ebers papyrus (c. 1550 BC) is full of incantations and foul applications meant to turn away disease-causing demons, and other superstition. The Ebers papyrus also provides our earliest possible documentation of ancient awareness of tumors, but ancient medical terminology being badly understood, cases Ebers 546 and 547 for instance may refer to simple swellings.
The Kahun Gynaecological Papyrus treats women's complaints, including problems with conception. Thirty four cases detailing diagnosis and treatment survive, some of them fragmentarily. Dating to 1800 BC, it is the oldest surviving medical text of any kind.
Medical institutions, referred to as Houses of Life are known to have been established in ancient Egypt as early as the 1st Dynasty. By the time of the 19th Dynasty some workers enjoyed such benefits as medical insurance, pensions and sick leave.
The earliest known physician is also credited to ancient Egypt: Hesyre, “Chief of Dentists and Physicians” for King Djoser in the 27th century BC. Also, the earliest known woman physician, Peseshet, practiced in Ancient Egypt at the time of the 4th dynasty. Her title was “Lady Overseer of the Lady Physicians.” In addition to her supervisory role, Peseshet graduated midwives at an ancient Egyptian medical school in Sais.
See also the article on ancient Egyptian medicine posted at Indiana University: Medicine in Ancient Egypt
The oldest Babylonian texts on medicine date back to the Old Babylonian period in the first half of the 2nd millennium BC. The most extensive Babylonian medical text, however, is the Diagnostic Handbook written by the physician Esagil-kin-apli of Borsippa, during the reign of the Babylonian king Adad-apla-iddina (1069-1046 BC).
Along with contemporary ancient Egyptian medicine, the Babylonians introduced the concepts of diagnosis, prognosis, physical examination, and prescriptions. In addition, the Diagnostic Handbook introduced the methods of therapy and aetiology and the use of empiricism, logic and rationality in diagnosis, prognosis and therapy. The text contains a list of medical symptoms and often detailed empirical observations along with logical rules used in combining observed symptoms on the body of a patient with its diagnosis and prognosis.
The Diagnostic Handbook was based on a logical set of axioms and assumptions, including the modern view that through the examination and inspection of the symptoms of a patient, it is possible to determine the patient's disease, its aetiology and future development, and the chances of the patient's recovery. The symptoms and diseases of a patient were treated through therapeutic means such as bandages, creams and pills.
According to the compendium of Charaka, the Charakasamhitā, health and disease are not predetermined and life may be prolonged by human effort. The compendium of Suśruta, the Suśrutasamhitā defines the purpose of medicine to cure the diseases of the sick, protect the healthy, and to prolong life. Both these ancient compendia include details of the examination, diagnosis, treatment, and prognosis of numerous ailments. The Suśrutasamhitā is notable for describing procedures on various forms of surgery, including rhinoplasty, the repair of torn ear lobes, perineal lithotomy, cataract surgery, and several other excisions and other surgical procedures.
The āyurvedic classics spoke of eight branches of medicine: kāyācikitsā (internal medicine), śalyacikitsā (surgery including anatomy), śālākyacikitsā (eye, ear, nose, and throat diseases), kaumārabhṛtya (pediatrics), bhūtavidyā (spirit medicine), and agada tantra (toxicology), rasāyana (science of rejuvenation), and vājīkaraṇa (aphrodesiacs, mainly for men). Apart from learning these, the student of Āyurveda was expected to know ten arts that were indispensable in the preparation and application of his medicines: distillation, operative skills, cooking, horticulture, metallurgy, sugar manufacture, pharmacy, analysis and separation of minerals, compounding of metals, and preparation of alkalis. The teaching of various subjects was done during the instruction of relevant clinical subjects. For example, teaching of anatomy was a part of the teaching of surgery, embryology was a part of training in pediatrics and obstetrics, and the knowledge of physiology and pathology was interwoven in the teaching of all the clinical disciplines. At the closing of the initiation, the guru gave a solemn address to the students where the guru directed the students to a life of chastity, honesty, and vegetarianism. The student was to strive with all his being for the health of the sick. He was not to betray patients for his own advantage. He was to dress modestly and avoid strong drink. He was to be collected and self-controlled, measured in speech at all times. He was to constantly improve his knowledge and technical skill. In the home of the patient he was to be courteous and modest, directing all attention to the patient's welfare. He was not to divulge any knowledge about the patient and his family. If the patient was incurable, he was to keep this to himself if it was likely to harm the patient or others.
The normal length of the student's training appears to have been seven years. Before graduation, the student was to pass a test. But the physician was to continue to learn through texts, direct observation (pratyaksha), and through inference (anumāna). In addition, the vaidyas attended meetings where knowledge was exchanged. The physicians were also enjoined to gain knowledge of unusual remedies from hillsmen, herdsmen, and forest-dwellers.
The practice and study of medicine in Persia has a long and prolific history. Persia's position at the crossroads of the East and the West frequently placed it in the midst of developments in both ancient Greek and Indian medicine. Many contributions were added to this body of knowledge in both pre- and post-Islamic Iran as well.
The first generation of Persian physicians was trained at the Academy of Jundishapur, where the teaching hospital has sometimes been claimed to have been invented. Rhazes, for example, became the first physician to systematically use alcohol in his practice as a physician.
The Comprehensive Book of Medicine (Large Comprehensive, Hawi, "al-Hawi" or "The Continence") was written by the Iranian chemist Rhazes (known also as Razi), the "Large Comprehensive" was the most sought after of all his compositions. In it, Rhazes recorded clinical cases of his own experience and provided very useful recordings of various diseases.
The Mutazilite philosopher and physician Ibn Sina (also known as Avicenna in the western world) was another influential figure. His The Canon of Medicine, sometimes considered the most famous book in the history of medicine, remained a standard text in Europe up until its Age of Enlightenment.
China also developed a large body of traditional medicine. Much of the philosophy of traditional Chinese medicine derived from empirical observations of disease and illness by Taoist physicians and reflects the classical Chinese belief that individual human experiences express causative principles effective in the environment at all scales. These causative principles, whether material, essential, or mystical, correlate as the expression of the natural order of the universe.
During the golden age of his reign from 2696 to 2598 B.C, as a result of a dialogue with his minister Ch'i Pai, the Yellow Emperor is supposed by Chinese tradition to have composed his Neijing (內經) Suwen (素問) or Basic Questions of Internal Medicine.
During the Han dynasty, Zhang Zhongjing, who was mayor of Changsha near the end of the second century A.D., wrote a Treatise on Typhoid Fever, which contains the earliest known reference to Neijing Suwen. The Jin Dynasty practitioner and advocate of acupuncture and moxibustion, Huang-fu Mi (215-282 A.D), also quotes the Yellow Emperor in his Jia Yijing, ca. 265 A.D. During the Tang Dynasty, Wang Ping claimed to have located a copy of the originals of the Neijing Suwen, which he expanded and edited substantially. This work was revisited by an imperial commission during the eleventh century A.D., and the result is our best extant representation of the foundational roots of traditional Chinese medicine.
Since the discovery in 1991 of the frozen and preserved body of Ötzi the Iceman in the Austrian-Italian Alps, it has been thought that the history of medicine moved further back in time. He was aged about 46 and had over 40 tattoos, most of them in locations where medical analysis also showed he had disease or pain such as arthritis. His death occurred in 3300 BC and his body, held in the museum in Bolzano, is the oldest preserved European mummy.
As societies developed in Europe and Asia, belief systems were replaced with a different natural system. The Greeks, from Hippocrates, developed a humoral medicine system where treatment was to restore the balance of humours within the body. Ancient Medicine is a treatise on medicine, written roughly 400 BC by Hippocrates. Similar views were espoused in China and in India. (See Medicine in ancient Greece for more details.) In Greece, through Galen until the Renaissance the main thrust of medicine was the maintenance of health by control of diet and hygiene. Anatomical knowledge was limited and there were few surgical or other cures, physicians relied on a good relation with patients and dealt with minor ailments and soothing chronic conditions and could do little when epidemic diseases, growing out of urbanization and the domestication of animals, then raged across the world.
Hippocrates, regarded as the father of modern medicine, and his followers were first to describe many diseases and medical conditions. He is given credit for the first description of clubbing of the fingers, an important diagnostic sign in chronic suppurative lung disease, lung cancer and cyanotic heart disease. For this reason, clubbed fingers are sometimes referred to as "Hippocratic fingers". Hippocrates was also the first physician to describe Hippocratic face in Prognosis. Shakespeare famously alludes to this description when writing of Falstaff's death in Act II, Scene iii. of Henry V.
Hippocrates began to categorize illnesses as acute, chronic, endemic and epidemic, and use terms such as, "exacerbation, relapse, resolution, crisis, paroxysm, peak, and convalescence." Another of Hippocrates's major contributions may be found in his descriptions of the symptomatology, physical findings, surgical treatment and prognosis of thoracic empyema, i.e. suppuration of the lining of the chest cavity. His teachings remain relevant to present-day students of pulmonary medicine and surgery. Hippocrates was the first documented chest surgeon and his findings are still valid.
Galen performed many audacious operations—including brain and eye surgeries— that were not tried again for almost two millennia. Later, in medieval Europe, Galen's writings on anatomy became the mainstay of the medieval physician's university curriculum along; but they suffered greatly from stasis and intellectual stagnation. In the 1530s, however, Belgian anatomist and physician Andreas Vesalius took on a project to translate many of Galen's Greek texts into Latin. Vesalius's most famous work, De humani corporis fabrica, was greatly influenced by Galenic writing and form. The works of Galen and Avicenna, especially The Canon of Medicine which incorporated the teachings of both, were translated into Latin, and the Canon remained the most authoritative text on anatomy in European medical education until the 16th century.
Romans invented numerous surgical instruments, including the first instruments unique to women, as well as the surgical uses of forceps, scalpel, cautery, cross-bladed scissors, surgical needle, sound, and specula. Romans were also pioneers in the cataract surgery..
Medieval medicine was an evolving mixture of the scientific and the spiritual. In the early Middle Ages, following the fall of the Roman Empire, standard medical knowledge was based chiefly upon surviving Greek and Roman texts, preserved in monasteries and elsewhere. Ideas about the origin and cure of disease were not, however, purely secular, but were also based on a spiritual world view, in which factors such as destiny, sin, and astral influences played as great a part as any physical cause.
Oribasius was the greatest Byzantine compiler of medical knowledge. Several of his works, along with many other Byzantine physicians, were translated into Latin, and eventually, during the Enlightenment and Age of Reason, into English and French. The last great Byzantine Physician was Actuarius, who lived in the early 14th Century in Constantinople.
Medicine was notably not one of the seven classical Artes liberales, and was consequently looked upon more as a handicraft than as a science. Medicine did, nevertheless, establish itself as a faculty, along with law and theology in the first European Universities from the 12th century. Rogerius Salernitanus composed his Chirurgia, laying the foundation for modern Western surgical manuals up to the modern time. The development of modern neurology began in the 16th century with Vesalius, who described the anatomy of the brain and much else; he had little notion of function, thinking that it lay mainly in the ventricles.
The Islamic civilization rose to primacy in medical science as Muslim physicians contributed significantly to the field of medicine, including anatomy, ophthalmology, pharmacology, pharmacy, physiology, surgery, and the pharmaceutical sciences. The Arabs further developed Greek and Roman medical practices. Galen and Hippocrates were pre-eminent authorities. The translation c.830-870 of 129 works of ancient Greek physician Galen into Arabic by Hunayn ibn Ishaq and his assistants, and in particular Galen's insistence on a rational systematic approach to medicine, set the template for Islamic medicine, which rapidly spread throughout the Arab Empire. Muslim physicians set up some of the earliest dedicated hospitals, which later spread to Europe during the Crusades, inspired by the hospitals in the Middle East.
Al-Kindi wrote De Gradibus, in which he demonstrated the application of mathematics to medicine, particularly in the field of pharmacology. This includes the development of a mathematical scale to quantify the strength of drugs, and a system that would allow a doctor to determine in advance the most critical days of a patient's illness. Razi (Rhazes) (865-925) recorded clinical cases of his own experience and provided very useful recordings of various diseases. His Comprehensive Book of Medicine, which introduced measles and smallpox, was very influential in Europe. In his Doubts about Galen, Razi was also the first to prove both Galen's theory of humorism and Aristotle's theory of classical elements false using an experimental method.
Abu al-Qasim (Abulcasis), regarded as the father of modern surgery, wrote the Kitab al-Tasrif (1000), a 30-volume medical encyclopedia which was taught at Muslim and European medical schools until the 17th century. He used numerous surgical instruments, including the instruments unique to women, as well as the surgical uses of catgut and forceps, the ligature, surgical needle, scalpel, curette, retractor, surgical spoon, sound, surgical hook, surgical rod, and specula, bone saw, and plaster.
Avicenna, considered the father of modern medicine and one of the greatest thinkers and medical scholars in history, wrote The Canon of Medicine (1020) and The Book of Healing (11th century), which remained standard textbooks in both Muslim and European universities until the 17th century. Avicenna's contributions include the introduction of systematic experimentation and quantification into the study of physiology, the discovery of the contagious nature of infectious diseases, the introduction of quarantine to limit the spread of contagious diseases, the introduction of experimental medicine and clinical trials, the first descriptions on bacteria and viral organisms, the distinction of mediastinitis from pleurisy, the contagious nature of phthisis and tuberculosis, the distribution of diseases by water and soil, and the first careful descriptions of skin troubles, sexually transmitted diseases, perversions, and nervous ailments, as well the use of ice to treat fevers, and the separation of medicine from pharmacology, which was important to the development of the pharmaceutical sciences.
In 1021, Ibn al-Haytham (Alhacen) made important advances in eye surgery, as he studied and correctly explained the process of sight and visual perception for the first time in his Book of Optics (1021).
In 1242, Ibn al-Nafis was the first to describe pulmonary circulation and coronary circulation, which form the basis of the circulatory system, for which he is considered the father of the theory of circulation. He also described the earliest concept of metabolism, and developed new systems of physiology and psychology to replace the Avicennian and Galenic systems, while discrediting many of their erroneous theories on the four humours, pulsation, bones, muscles, intestines, sensory organs, bilious canals, esophagus, stomach, etc.
Ibn al-Lubudi (1210-1267) rejected the theory of four humours supported by Galen and Hippocrates, discovered that the body and its preservation depend exclusively upon blood, rejected Galen's idea that women can produce sperm, and discovered that the movement of arteries are not dependent upon the movement of the heart, that the heart is the first organ to form in a fetus' body (rather than the brain as claimed by Hippocrates), and that the bones forming the skull can grow into tumors. Maimonides, although a Jew himself, made various contributions to Islamic medicine in the 13th century.
The Tashrih al-badan (Anatomy of the body) of Mansur ibn Ilyas (c. 1390) contained comprehensive diagrams of the body's structural, nervous and circulatory systems. During the Black Death bubonic plague in 14th century al-Andalus, Ibn Khatima and Ibn al-Khatib discovered that infecious diseases are caused by microorganisms which enter the human body. Other medical innovations first introduced by Muslim physicians include the discovery of the immune system, the introduction of microbiology, the use of animal testing, and the combination of medicine with other sciences (including agriculture, botany, chemistry, and pharmacology), as well as the invention of the injection syringe by Ammar ibn Ali al-Mawsili in 9th century Iraq, the first drugstores in Baghdad (754), the distinction between medicine and pharmacy by the 12th century, and the discovery of at least 2,000 medicinal and chemical substances.
see also: Medieval medicine
In western Europe the collapse of Roman imperial authority led to a halt to the development of organised medical practice. Medicine became localised, with folk-medicine augmenting what remained of the medical knowledge of antiquity. Medical knowledge was preserved and practised in many monastic institutions, which often had a hospital attached. Organised professional medicine re-emerged, with the foundation of the medical college of Salerno in Italy in the 11th century, which in co-operation with the monastery of Monte Cassino, translated many Byzantine and Arabic works. In the twelfth century universities were founded in Italy and elsewhere, which soon developed schools of medicine. Gradually the reliance on the masters of the ancient world was augmented by the results of individual observation and experience. Surgical practice improved greatly during the medieval period. With the renaissance came an increase in experimental investigation, principally in dissection and examining bodies. The work of individuals like Andreas Vesalius and William Harvey challenged accepted folklore with scientific evidence. Understanding and diagnosis improved but with little direct benefit to health. Few effective drugs existed, beyond opium and quinine, folklore cures and potentially poisonous metal-based compounds were popular treatments.
Ignaz Semmelweis (1818-1865) in 1847 dramatically reduced the death rate of new mothers from childbed fever by the simple expedient of requiring physicians to clean their hands before attending to women in childbirth. His discovery pre-dated the germ theory of disease. However, his discoveries were not appreciated by his contemporaries and came into general use only with discoveries of British surgeon Joseph Lister, who in 1865 proved the principles of antisepsis in the treatment of wounds; However, medical conservatism on new breakthroughs in pre-existing science prevented them from being generally well received during the 19th century.
After Charles Darwin's 1859 publication of The Origin of Species, Gregor Mendel (1822-1884) published in 1865 his books on pea plants, which would be later known as Mendel's laws. Re-discovered at the turn of the century, they would form the basis of classical genetics. The 1953 discovery of the structure of DNA by Watson and Crick would open the door to molecular biology and modern genetics. During the late 19th century and the first part of the 20th century, several physicians, such as Nobel prize winner Alexis Carrel, supported eugenics, a theory first formulated in 1865 by Francis Galton. Eugenics was discredited as a science after the Nazis' experiments in World War II became known; however, compulsory sterilization programs continued to be used in modern countries (including the US, Sweden and Peru) until much later.
Semmelweis's work was supported by the discoveries made by Louis Pasteur. Linking microorganisms with disease, Pasteur brought about a revolution in medicine. He also invented with Claude Bernard (1813-1878) the process of pasteurization still in use today. His experiments confirmed the germ theory. Claude Bernard aimed at establishing scientific method in medicine; he published An Introduction to the Study of Experimental Medicine in 1865. Beside this, Pasteur, along with Robert Koch (who was awarded the Nobel Prize in 1905), founded bacteriology. Koch was also famous for the discovery of the tubercle bacillus (1882) and the cholera bacillus (1883) and for his development of Koch's postulates.
The participation of women in medical care (beyond serving as midwives, sitters and cleaning women) was brought about by the likes of Florence Nightingale. These women showed a previously male dominated profession the elemental role of nursing in order to lessen the aggravation of patient mortality which resulted from lack of hygiene and nutrition. Nightingale set up the St Thomas hospital, post-Crimea, in 1852. Elizabeth Blackwell (1821-1910) became the first woman to formally study, and subsequently practice, medicine in the United States.
It was in this era that actual cures were developed for certain endemic infectious diseases. However the decline in many of the most lethal diseases was more due to improvements in public health and nutrition than to medicine. It was not until the 20th century that the application of the scientific method to medical research began to produce multiple important developments in medicine, with great advances in pharmacology and surgery.
During the First World War, Alexis Carrel and Henry Dakin developed the Carrel-Dakin method of treating wounds with an irrigation, Dakin's solution, which was a germicide which helped prevent gangrene.
The great war spurred the usage of Roentgen's X-ray, and the electrocardiograph, for the monitoring of internal bodily functions, However, this was overshadowed by the remarkable mass production of penicillum antibiotics, which resulted from government and public pressure.
Lunatic asylums began to appear in the Industrial Era. Emil Kraepelin (1856-1926) introduced new medical categories of mental illness, which eventually came into psychiatric usage despite their basis in behavior rather than pathology or etiology. In the 1920s surrealist opposition to psychiatry was expressed in a number of surrealist publications. In the 1930s several controversial medical practices were introduced including inducing seizures (by electroshock, insulin or other drugs) or cutting parts of the brain apart (leucotomy or lobotomy). Both came into widespread use by psychiatry, but there were grave concerns and much opposition on grounds of basic morality, harmful effects, or misuse. In the 1950s new psychiatric drugs, notably the antipsychotic chlorpromazine, were designed in laboratories and slowly came into preferred use. Although often accepted as an advance in some ways, there was some opposition, due to serious adverse effects such as tardive dyskinesia. Patients often opposed psychiatry and refused or stopped taking the drugs when not subject to psychiatric control. There was also increasing opposition to the use of psychiatric hospitals, and attempts to move people back into the community on a collaborative user-led group approach ("therapeutic communities") not controlled by psychiatry. Campaigns against masturbation were done in the Victorian era and elsewhere. Lobotomy was used until the 1970s to treat schizophrenia. This was denounced by the anti-psychiatric movement in the 1960s and later.
The 20th century witnessed a shift from a master-apprentice paradigm of teaching of clinical medicine to a more "democratic" system of medical schools. With the advent of the evidence-based medicine and great advances of information technology the process of change is likely to evolve further, with greater development of international projects such as the Human genome project.
The Pavia Museum of History of Medicine