????? (4) A Brief History of Medicine

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????? (4) A Brief History of Medicine
Yu Hai yuhai_at_zju.edu.cn
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Origin of Medicine Egypt
Babylon India
China Greece
Rome Medieval
Arabic Renaissance
Pre-modern medicine Modern medicine
TCM
Western Medicine
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Civilization and Medicine in ancient Greece
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?????Greek Civilization

• 2800-1400BC,Minoan Civilization in Island
  Crete,Mycenaean Civilization in Peloponnese
• 1100 BC Dark Age (no written record) Dorian
  invasion
• 750 BC Emerging of poleis (city states)
• 8-4 century BC,The Golden Age
• 334-323 BC Conquered by Alexander the Great
  (Hellenistic civilization)
• 146 BC Roman conquest

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Civilization of Ancient Greece
Parthenon Temple of Athens
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Civilization of Ancient Greece
Plato
Archimedes
Euclid
Socrates
Aristotle
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Civilization of Ancient Greece
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Civilization and Medicine in ancient Greece
Trojan War (11-9 BC)
Achilles and Patroclus
Achilles and Patroclus
Homer epic poet, author of Iliad and Odyssey
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Ancient Greece Medicine

• Temple of Asclepius

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?????Ancient Greece
A sick child brought to presbyter in the temple
of Asclepius John Waterhouse 1877
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????? Ancient Greece

• Hippocrates
• The Father of Medicine
• (460-377 B.C)

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Cos Island and Cos School of Medicine
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????? Medicine of Ancient Greece

• The Hippocratic Corpus is a collection of around
  seventy early medical works from ancient Greece.
  The Hippocratic Corpus contains textbooks,
  lectures, research, notes and philosophical
  essays on various subjects in medicine, the
  volumes were probably produced by his students
  and followers
• HumoralismFour humors, Four temperaments based
  on Empedocles Four ultimate elements
• Holistic medicine and prevention

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Humoralism of Hippocrates
Element Humor feature
Temperament Fire blood
hot/wet sanguine
Water Phlegm cold/wet
phlegmatic Air
yellow bile hot/dry choleric
Earth black bile cold/dry
melancholic
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????? Ancient Greece

• Four Temperaments
• (Personality types)
• Sanguine
• Phlegmatic
• Choleric
• Melancholic

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Individuals with sanguine temperaments are
extroverted and social. Choleric people have
energy, passion and charisma. Melancholics are
creative, kind and considerate. Phlegmatic
temperaments are characterized by dependability,
kindness, and affection.
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The contribution of Hippocrates to medicine

• Hippocrates is the first physician to reject
  superstitions, legends and beliefs that credited
  supernatural or divine forces with causing
  illness. He separated the discipline of medicine
  from religion, believing and arguing that disease
  was not a punishment inflicted by the gods but
  rather the product of environmental factors, diet
  and living habits.
• Hippocratic medicine was notable for its strict
  professionalism, discipline and rigorous
  practice.  The Hippocratic work On the
  Physician recommends that physicians always be
  well-kept, honest, calm, understanding, and
  serious. 

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Oath of Hippocrates
A  12th-century Byzantine manuscript of the
Oath,.
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Hippocratic Oath
I swear by Apollo, Asclepius, Hygieia,
and Panacea, and I take to witness all the gods,
all the goddesses, to keep according to my
ability and my judgment, the following Oath. To
consider dear to me, as my parents, him who
taught me this art to live in common with him
and, if necessary, to share my goods with him To
look upon his children as my own brothers, to
teach them this art. I will prescribe regimens
for the good of my patients according to my
ability and my judgment and never do harm to
anyone. I will not give a lethal drug to anyone
if I am asked, nor will I advise such a plan and
similarly I will not give a woman a pessary to
cause an abortion. But I will preserve the purity
of my life and my arts.
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I will not cut for stone, even for patients in
whom the disease is manifest I will leave this
operation to be performed by practitioners,
specialists in this art. In every house where I
come I will enter only for the good of my
patients, keeping myself far from all intentional
ill-doing and all seduction and especially from
the pleasures of love with women or with men, be
they free or slaves. All that may come to my
knowledge in the exercise of my profession or in
daily commerce with men, which ought not to be
spread abroad, I will keep secret and will never
reveal. If I keep this oath faithfully, may I
enjoy my life and practice my art, respected by
all men and in all times but if I swerve from it
or violate it, may the reverse be my lot.
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(No Transcript)
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THE HIPPOCRATIC OATH MODERN VERSION I swear
to fulfill, to the best of my ability and
judgment, this covenant I will respect the
hard-won scientific gains of those physicians in
whose steps I walk, and gladly share such
knowledge as is mine with those who are to
follow. I will apply, for the benefit of the
sick, all measures that are required, avoiding
those twin traps of overtreatment and therapeutic
nihilism. I will remember that there is art to
medicine as well as science, and that warmth,
sympathy, and understanding may outweigh the
surgeon's knife or the chemist's drug. I will
not be ashamed to say "I know not," nor will I
fail to call in my colleagues when the skills of
another are needed for a patient's recovery. I
will respect the privacy of my patients, for
their problems are not disclosed to me that the
world may know. Most especially must I tread with
care in matters of life and death. If it is given
me to save a life, all thanks. But it may also be
within my power to take a life this awesome
responsibility must be faced with great
humbleness and awareness of my own frailty. Above
all, I must not play at God.
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I will remember that I do not treat a fever
chart, a cancerous growth, but a sick human
being, whose illness may affect the person's
family and economic stability. My responsibility
includes these related problems, if I am to care
adequately for the sick. I will prevent disease
whenever I can, for prevention is preferable to
cure. I will remember that I remain a member of
society, with special obligations to all my
fellow human beings, those sound of mind and body
as well as the infirm. If I do not violate this
oath, may I enjoy life and art, respected while I
live and remembered with affection thereafter.
May I always act so as to preserve the finest
traditions of my calling and may I long
experience the joy of healing those who seek my
help. (Written in 1964 by Louis
Lasagna, Academic Dean of the School of Medicine
at Tufts University, and used in many medical
schools today).
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The Oath of Medical Students   Health ties to,
life relies on. The moment I step into this
sacred temple of medical education, I pledge
solemnly- I will devote myself to medicine, with
the loyalty to my country and love to my people
I will scrupulously abide by professional
morality, respect teachers and observe
discipline I will study assiduously and improve
my professional proficiency constantly for
all-round development of myself. I will do my
utmost to relieve peoples suffering and to
improve peoples health, to safeguard the holy
and honor of medicine I will heal the wounded
and rescue the dying, regardless the hardships I
am determined to seek truth for life long and to
dedicate all my life to medical science and to
peoples health.
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??????? Hippocrates Aphorism

• Life is short, and Art long the crisis
  fleeting experience perilous, and decision
  difficult. The physician must not only be
  prepared to do what is right himself, but also to
  make the patient, the attendants and externals
  cooperate.
• For extreme diseases, extreme methods of cure are
  most suitable.
• Those things which require to be evacuated should
  be evacuated, wherever they most tend, by the
  proper outlets.
• It is better not to apply any treatment in cases
  of occult cancer for, if treated, the patients
  die quickly but if not treated, they hold out
  for a long time.

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Hippocrates refuses gifts offered by Artaxerxes,
king of the Persians and enemy of the Greeks.
- by Girodet from 1792
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Civilization and Medicine of Rome
2000-1000BC early agriculture community 735 BC
City of Rome 510-25BC Roman Republic 25BC-476AD
Roman Empire
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Roman Mythology   Rome was founded  in 753 BC by
Romulus and Remus on Tiber river side, the twin
sons of Mars who were reared and suckled by a
wolf.
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???? Roman Empire
Caesar (100-44b.c.)
Augustus (27b.c.-14a.d.)
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???? Roman Empire
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???? Roman Empire
Colosseum Gladiator
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???? Roman Empire
Water supply and draining systemGood in drain,
not in brain

Pon tu Gard of Nimes
aqueduct bridge (flume)
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???? Roman Empire
Public health and sanitationPublic toilets and
bath
Bath of England
Private bath and public toilet in Pompey relics
(79a.d)
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Vespasianus (9-79 AD)
vespasienne(urinal) first pay
toilet Pecunia non Olet
vespasiano
(Italian) (money does not smell).
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Roman Medicine

• Galen of Pergamon
• (129-201 AD)

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Galen of Pergamon

• Therapeutics in temple of the god Asclepius
• Chief physician for gladiators
• Personal physician of Emperor Marcus Aurelius and
  others
• Great anatomist
• Pioneer of experimental physiology

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Galen of Pergamon

• dissection of human corpses was against Roma law,
  so instead he used pigs, apes and other animals

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Galen of Pergamon

• Understanding the circulation The heart and
  arteries, responsible for life-giving energy and
  the liver and veins, responsible for nutrition
  and growth, the brain to make psychic pneuma, a
  subtle material that is the vehicle of sensation
• Natural spirit ???
• Vital spirit ???
• Animal spirit ???

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Galen of Pergamon

• Pioneer of Experimental physiology
• Arteries carry blood not air
• Urine formation in the kidney not bladder
• Recurrent laryngeal nerve controls voice
• Performing transections of the spinal cord

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The influence of Galen

• Galens writings achieved wide circulation during
  his lifetime, and copies of some of his works
  survive that were written within a generation of
  his death. By AD 500 his works were being taught
  and summarized at Alexandria, and his theories
  were already crowding out those of others in the
  medical handbooks of the Byzantine world.
•  from the late 11th century ?unayns
  translations, commentaries on them by Arab
  physicians, and sometimes the original Greek
  writings themselves were translated into Latin.
  These Latin versions came to form the basis
  of medical education in the new medieval
  universities.

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Middle Ages ???

• Start from 476AD, the fall of Western Rome Empire
  by German (nomadic Goths, Frank, Vandal,
  Anglo-Saxon) lasted for roughly a millennium
• (5-15th century)
•  three "ages of European history the classical
  civilization of Antiquity, the Middle Ages, and
  the modern period

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??? Middle Ages

• As Christianity grew in influence, a
  tension developed between the church and
  folk-medicine, since much in folk medicine was
  magical, or mystical, and had its basis in
  sources that were not compatible with Christian
  faith.  The church taught that God sometimes sent
  illness as a punishment, and that in these cases,
  repentance could lead to a recovery.

The Inquisition 1232 Pope Gregory IX
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The Inquisition
Stake (execution by burning)
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Trial by Inquisition
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?????? Medieval Medicine

• Conformation

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?????? Medieval Medicine
Urine exam
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?????? Medieval Medicine
??? Bloodletting
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?????? Medieval Medicine

• In the Medieval period the term hospital encom
  passed hostels for travelers, dispensaries for
  poor relief, clinics and surgeries for the
  injured, and homes for the blind, lame, elderly,
  and mentally ill. Monastic hospitals developed
  many treatments, both therapeutic and spiritual.
  Patients were supposed to help each other through
  prayer and calm, perhaps benefiting as
• much from this as from any
• physical treatment offered.

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?????? Medieval Medicine

• From the founding of the Universities of
  Paris (1150) , Bologna   (1158) , Oxford (1167),
  Montpelier (1181) and Padua (1222), the initial
  work of Salerno was extended across Europe. To
  qualify as a Doctor of Medicine took ten years
  including original Arts training, and so the
  numbers of such fully qualified physicians
  remained comparatively small.

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The End
Thanks