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Medicine

The history of great inventions

Medicine in Mythology and Literature

The earliest account of disease in Greek literature appears in the opening episode of Homer's Iliad which was composed sometime in the 8th century BCE. The god Apollo sent a plague among the Greek army before Troy in punishment for Agamemnon's insulting the priest Chryses when he came to ransom his captured daughter. According to Homer, at the onset of the plague, Apollo only shot his arrows at mules and dogs in the camp and then later at the Greek soldiers themselves (Iliad I.9ff). What Homer describes is a highly communicable disease with acute fever, sudden in onset and rapidly fatal, such as easily might attack an army; although no symptoms are mentioned explicitly, nor are any recoveries. After the Greeks appeased Apollo with sacrfices and by the return of the girl, they set about cleansing the camp by throwing "defilements" into the sea. This suggests that part of the disease was a severe dysentery exacerbated by battlefield conditions.

In mythology, the arrows of Apollo and his twin sister Artemis are often a symbol for the sudden onset of disease. The myth of Niobe illustrates this point. Niobe was a mortal woman who boasted that she was superior to Leto, the mother of Apollo and Artemis, because she had borne seven sons and seven daughters as opposed to Leto's two children. As punishment for this insult to their mother, Apollo shot all seven sons with arrows and Artemis shot all seven daughters. Not only was Niobe robbed of the source of her pride, but she was forced to watch all fourteen die in rapid succession as she tried to shield them from the deadly allegorical darts with her own body. Arrows not only cause disease, but heal it as well. In this capacity, Apollo was called by the name Paean, once a distinct god, whom he absorbed into himself. Apollo was also father of the healing god Asclepius, whose cult was widespread in the Greek world.

In Homer's Iliad, Apollo is addressed with his epithet Apollo Smintheus, or "Apollo the Mouse God". The Greeks associated Apollo with mice and so prayed to him under that name because they recognized that rodents were vectors of disease, although they did not realize that it was actually the microorganisms on the fleas on the rodents and not the rodents themselves that were harmful. They recognized the correlation between plague and rodent infestation and so prayed to Apollo Smintheus to abate plagues.

A famous passage in Thucydides' History describes the plague that gripped Periklean Athens during the Peloponnesian War (II.47.3-54.5). The vivid picture of the plague and the toll it took on its victims and Athens in general inspired other authors in antiquity who treated similar topics, such as Sophocles' Oedipos Tyrannos and Lucretius' De Rerum Natura (Book V).
Greek myth is often merely an allegory for an historical event. One of the canonical Twelve Labors of Hercules involved ridding the swampy district of Lernea of a multi-headed serpent known as the Lernean Hydra. Every time Hercules cut off one of the serpent's heads, two more grew in its place. Archaeologists believe this myth actually commemorates an historical plague which devastated the population of ancient Lernea. The rapid spread of whatever sickness gripped the region corresponds to the duplicating heads of the serpent.

Surgery and Surgical Instruments

Finds of instruments throughout the Roman Empire indicate that the art of surgery had progressed and proliferated. If any one of the branches of medicine had achieved true competence in the Empire, surgery is the most serviceable example. Surgery was important in the training of the conscientious physician, and both Galen and Celsus emphasize it although they came from divergent medical traditions (Celsus, prooemium VII; Galen, II, 272).

Technical competence in surgery became better as new shapes were devised for medical tools, and as new metals and alloys were found to provide sharper edges and cheaper equipment. Most instruments were made of bronze, or occasionally of silver. Iron was rarely used because, as in most ancient cultures, it was considered taboo by both the Greeks and Romans, and so was never used for surgical instruments on religious grounds. The design of many medical instruments remained unchanged and the quality of manufacture was seldom bettered until recent times. The full repertoire for Roman surgical equipment is far from completely known, and newly identified tools include a special forceps for applying caustics.

Occasionally instruments not originally manufactured for surgical purposes were implemented. Galen and Celsus both mention that the strigil, a curved piece of metal with a handle used for scraping oil and sweat off the body after exercise, was often used to get into small openings. Galen says, "After having heated the fat of a squirrel in a strigil, insert it into the auditory canal" (Galen, XII, 623).

Surgery was refined as long as the patient had courage and the doctor had good tools and experience. The patient's chances increased if the head and abdomen were not involved. A cursory reading of Celsus' summary of surgical techniques as they existed in the first century shows a sure knowledge of human anatomy.

Archaeological remains of what appear to be surgeon's shops are common enough to indicate physicians specialized in surgery. Particularly famous is the so-called House of the Surgeon at Pompeii, where most of the surgical tools now housed in Naples were found. Philological evidence seems to support the idea that there was at least some distinction, even if not a rigid one, between general practitioner and surgeon. Medieval texts distinguish the two positions with different terms: medicus for a doctor, and magister for a surgeon.

The Romans enlarged upon the variety of instruments available for surgery, and Galen wrote detailed instructions on their use. The makers of medical instruments are at best shadowy figures. The well-known relief pictured below is one of the few archaeological finds which helps clarify the situation. It suggests that some medical instruments were manufactured by specialist blade makers rather than by craftsmen who specialized in medical instruments. It seems improbable that there would have been sufficient demand for craftsmen dealing exclusively in medical instruments and there is as yet no known inscription naming such a specialist. In the larger cities of the Roman empire, physicians would probably have found craftsmen who could provide the broad range of medical equipment.

Ancient Gynecology

In ancient Greek society, male dominance extended even to childbirth. Greek medicine cast man as the bringer of sanity and health to biologically defective, subservient woman through intercourse, which was believed to relieve the buildup of menstrual blood around the heart. Men also received full credit for conception, since the womb was seen mainly as a receptacle for sperm. Abortion, if not condoned in the Hippocratic Oath, was permitted under Greek law, and infanticide, particularly of female newborns, was widely practiced.

BIRTH CONTROL

Women in the ancient world practiced birth-control with little interference from religious or political authorities. A precise knowledge of plants which could either block conception or cause abortion was resident in the oral female culture of herbalists and midwives who were eventually marginalised by the professionalisation of medicine in the 19th century CE. One of the most common contraceptive agents used in the ancient Mediterranean world was silphium which grew exclusively in the country of Cyrene in North Africa. Since Cyrene was the sole exporter of the plant, it became the city's official symbol on its coinage and it remained the city's primary source of income until the first century BCE.

Other plants used in classical times as contraceptives or abortafacients included pennyroyal, artemisia, myrrh and rue. In Aristophanes' comedy Peace, first performed in 421 BCE, Hermes provides Trigaius with a female companion. Trigaius wonders if the woman might become pregnant. "Not if you add a dose of pennyroyal," advises Hermes. Pennyroyal grows wild and would have been readily available to ancient women. Recent studies show that pennyroyal contains a substance called pulegone that terminates pregnancy in humans and animals.

CAESAREAN SECTION

The Caesarean section operation did not derive its name from the fact that Julius Caesar was born in this manner. It was called Caesarean because the Roman or Caesarean law demanded that when a pregnant woman died, her body could not be buried until the child had been removed. The law also stipulated that a Caesarean section could not be performed on a living pregnant woman until the tenth month of gestation. Ancient physicians were unable to save the life of the mother in such cases, thus the procedure was rarely performed. We know from ancient sources that Julius Caesar could not have been born by Caesarean section, because his mother, Aurelia, lived to be an adviser to her grown son.

HYSTERIA AND THE WANDERING WOMB

The word "hysteria" is derived from the Greek word hystera, "womb". Greco-Roman medical writers believed that hysteria was an illness caused by violent movements of the womb and that it was therefore peculiar to women. As early as the sixth century BCE, medical writers believed that the womb was not a stationary object, but one that traveled throughout the body, often to the detriment of the woman's health. Aretaeus of Cappodocia, a contemporary of Galen, included in his medical treatises a section describing the wandering womb.

"In women, in the hollow of the body below the ribcage, lies the womb. It is very much like an independent animal within the body for it moves around of its own accord and is quite erratic. Furthermore, it likes fragrant smells and moves toward them, but it dislikes foul odors and moves away from them...When it suddenly moves upward [i.e., toward a fragrant smell] and remains there for a long time and presses on the intestines, the woman chokes, in the manner of an epileptic, but without any spasms. For the liver, the diaphragm, lungs and heart are suddenly confined in a narrow space. And therefore the woman seems unable to speak or to breathe. In addition, the carotid arteries, acting in sympathy with the heart, compress, and therefore heaviness of the head, loss of sense perception, and deep sleep occur...Disorders caused by the uterus are remedied by foul smells, and also by pleasant fragrances applied to the vagina...". (Medical Writings 2.11.1-3)

Crusades

During the Crusades of the 11th Century, the Knights of St John received instruction in first-aid treatment from Arab and Greek doctors. The Knights of St John then acted as the first emergency workers, treating soldiers on both sides of the war of the battlefield and bringing in the wounded to nearby tents for further treatment. The concept of ambulance service started in Europe with the Knights of St John, at the same time it had also become common practice for small rewards to be paid to soldiers who carried the wounded bodies of other soldiers in for medical treatment.

The Surgeon-in-Chief of the French Grand Army, "Baron Dominiquie Larrey" created the first official army medical corp. in 1792. Trained attendants with equipment moved out from the field hospitals to give first-aid to the wounded on the battlefield and/or carried them back by stretcher, hand-carts and wagons to the field hospitals.

Medicine in ancient Egypt

Medicine in ancient Egypt was but one aspect of an advanced civilization. It was not practiced by witch doctors as in primitive tribes, with mixture of magic, herbal remedy, and superstitious beliefs. This was acknowledged by Homer in the Odyssey:

"In Egypt, the men are more skilled in Medicine than any of human kind".

Sovereigns from foreign lands have frequently appealed to pharaohs to send them their physicians. A wall painting in a Thebean grave of the 18th dynasty (1400 BC) depicts "Nebamun", scribe and physician of the king, receiving a Syrian prince paying him for his services in gifts. According to Herodotus, King Cyrus of Persia has requested Amasis (Ahmose II of the 26th dynasty, 560 BC) to send him the most skilful of all the Egyptian eye-doctors.

MEDICAL PAPYRI

Some kind of medicine was already practiced in Egypt in the earliest prehistoric days, (the use of malachite as an eye paint in the Badarian age - around 4000 BC, and the same use of galena in predynastic times). The oldest yet discovered papyrus is the "Kahun Gynecology Papyrus", dating back to 1825 BC, during the reign of Amnemhat III. It describes methods of diagnosing pregnancy and the sex of the fetus, toothache during pregnancy, diseases of women, as well as feminine drugs, pastes and vaginal applications.

The most famous and elaborate papyri are the "Edwin Smith Papyrus" (1600 BC) and the "Ebers papyrus", which refers to King Den (1st dynasty, 3000 BC), suggesting a much earlier origin. The Edwin Smith Papyrus is 5 meters long, and is chiefly concerned with surgery. It described 48 surgical cases of wounds of the head, neck, shoulders, breast and chest. Unfortunately, the scribe who copied it did not proceed further from the thorax, and it ended abruptly in the middle of a sentence. The papyrus listed the manifestations, followed by prescriptions to every individual case. It included a vast experience in fractures that can only be acquired at a site where accidents were extremely numerous, as during the building of the pyramids. The Ebers Papyrus is a huge roll of more than 20 meters long and 30 cm wide. It is chiefly an internal medicine reference, as well as diseases of the eye, skin, extremities, gynecology and some surgical diseases. Anatomical and physiological terminology are also included. For treatment of those diseases, 877 recipes and 400 drugs were described.

THE CAUSES OF DISEASES, ANATOMY AND PHYSIOLOGY

The human body was believed to be born in a healthy state, and could not fall ill or die except through the influence of a foreign agent. In case of wounds or intestinal worms, that agent was visible and the treatment prescribed was hence rational. As they were not aware of microbiology, internal diseases were thought to be due to an occult force attributed to evil gods, a divine punishment or magical procedures. The physician was obliged to neutralize this evil before turning into actual treatment.

Despite such limitation in their knowledge of the causes of diseases, their study of anatomy and physiology was so advanced. No doubt, this was due to their embalming of the dead, when other nations at that time used to burn them. For instance, the process of emptying the skull through the nostrils by means of a long hook could have never been devised without a good knowledge of the anatomy of the head and brain. In our modern medicine, many brain surgeries are nowadays performed through this route. They obtained a good knowledge of the meninges, the cerebrospinal fluid, and the twitches and pulsations, and were aware that the brain was the seat of the body control.

"If thou examines a man having a gaping wound in his head penetrating to the bone, smashing his skull, and rending open the brain of his skull, thou shouldst palpate his wound. Shouldst thou find that smash which in his skull like those corrugations which form in molten copper, and something therein throbbing and fluttering under thy fingers, like the weak place of an infant's crown before it becomes whole- when it has happened there is no throbbing and fluttering under thy fingers until the brain of his skull is rent open and he discharges blood from both his nostrils, and he suffers with stiffness in his neck."

The Ebers Papyrus describes the position of the heart precisely, and illustrates some of its disorders, as dropped beats. Egyptian physicians recognized the heart as the source of blood vessels. They were aware that the blood vessels were hollow, having a mouth which opens to absorb medications, eliminate waste elements, distribute air and body secretions and excretions, in a confusion between blood vessels and other passages, as ureters.

Learn how and why Ancient Rome, Greece and Egypt were invented during Renaissance.

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