MEDICINE IN ANTIQUITY

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MEDICINE IN ANTIQUITY

• Henry A. Azar, MD PhD
• University of North Carolina at Chapel Hill
• Department of Pathology Laboratory Medicine

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Periods in History

• Antiquity (ca. 4000 BC to 476 AD)
• Early Near Eastern and Asian civilizations
• Rise of Greece and Hellenism
• Rise of Rome Augustus (r. 31 BC-14 AD) first
  emperor
• Jesus Christ (ca. 1-33)
• Augustulus deposed in 476 Eastern Empire
  continues
• Middle Ages (476-1453)
• Rise of Islam (622 AD, 1st Hegira year)
  Crusades
• Fall of Constantinople (1453)
• Modern Age (1453-1945/ 1990)
• Post-Modern Age

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Medicine in Antiquity

• Mesopotamian Medicine
• Egyptian Medicine
• Greek and Greco-Roman Medicine
• School of Alexandria
• Medicine under the Roman Empire
• Indian (Ayurvedic) Medical Traditions
• Chinese Medical Traditions

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The Fertile Crescent
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A Mediterranean World
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Mesopotamian Civilization

• Flat land between Euphrates and Tigris humid
  climate, clear skies, clay soil (bricks)
  peopled by Semites.
• Sumer, cuneiform deciphered by Grotefend in
  Perspolis,
• Epic of Gilgamish
• Akkad, language akin to Aramean/Phenician
  (Canaanite)
• Babylonia
• Assyria
• Neo-Babylon or Chaldea
• (Persia)

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Babylon

• Babylon succeeded Sumer and Akkad, a great
  metropolis later defeated by Assyria
• Code of laws promulgated by Hammurabi (ca. 1800
  BC)
• Sexagesimal and positional system
  (astronomy/astrology)
• Marduk chief god, also called Bel, successor to
  Sumerian Enlil
• Magico-religious practices incantation and
  divination zigurat at the horizon, right upper
  corner

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Assyrian and Persian Empires
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MESOPOTAMIAN MEDICINE

• Supernatural powers are
• involved in afflictions of
• mankinds
• Vast number of diseases recognized
• Collaboration between asipu (priest)
• and asu (physician)
• Code of Hammurabi
• Assurbanipal Library in Nineva
• some 800 medical texts
• Rich botanical materia medica

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CODE OF HAMMURABI

• 8 stele unearthed at Susa, Persia, in 1902--said
  to have come down from Sun God.
• Earliest codification of laws monument lists 282
  laws in 16 columns with reverse 28 columns
  several apply to physicians (asu), cow/sheep
  healers, barbers
• Fees and penalties set according to
• 3 classes (nobles, commoners and slaves)
• No penalties for priestly-medical mismanagement

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Egyptian Civilization

• A gift of the Nile
• Ancient Kingdom
• Pyramids (Imhotep) ca. 2200 BC
• Middle Kingdom
• Hyksos invasion ca. 1600 BC
• New Kingdom
• Akhneton (d. 1350) and wife Nefertiti
• Monotheism, Moses
• Assyrian Persian invasions
• Alexander (d. 322 BC)
• Cleopatra (d. 30 BC ), last of Ptolemies

Photo Museum of Fine Arts, Boston

• Pyramids of Giza
• Boston Museum. of Fine Arts

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EGYPTIAN MEDICINE

• Ebers Papyrus (Leipzig) emphasizes magical
  spells, with large section on diseases of the gut
  and intestinal worms.
• Metu, a system of vessels and canals
  originating in the heart and carrying air and
  liquids to all parts of the body, and converging
  to the anus.
• Whedu, concept of decay associated with feces.
• Large number of drugs of vegetable, botanical
  and mineral origin.

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EGYPTIAN MEDICINE (cont.)

• Kahun Gynecological Papyrus (London) almost
  entirely devoted to gynecological organs,
  including test for pregnancy (onion implanted in
  the flesh, positive outcome determined by odor in
  nose).
• Edwin Smith Surgical Papyrus (ed. J. H. Breasted,
  Univ. of Chicago Press, 1930).
• Orderly arrangement of cases from head to
  spinal vertebra. Offers brief clinical
  description, diagnosis and treatment
  surprisingly devoid of magico-religious formulae.
• Case 45 first description of a cancer (male
  breast)

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EGYPTIAN MEDICINE (cont.)

• Monuments depiction of circumcision,
  poliomyelitis?, achondroplastic dwarf.
• Mummies
• Parasitic infestations (calcified eggs of
  shistosomiasis and preserved tapeworms
• Evidence of tuberculosis, Potts disease of the
  spine
• Arthritis, atherosclerosis, gallstones
• Pneumonia, pleurisy, lung abscesses
• Splenomegaly
• Renal atrophy

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Hellenic CivilizationHomer (fl. ca. 850
BC), Iliad Herodotus, Persian Wars (492 BC- 479
BC) Thucydides, Peloponnesian War (431 BC-404 BC)
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Rise of AthensThe Age of Pericles

• 
  
• Socrates
• Plato
• Aristotle
• Photo Carolyn Buckler in A History of
  Western Civilization

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GREEK and GRECO-ROMAN MEDICINE

• Asclepius, originally a skilled physician,
  subsequently deified usually depicted with staff
  and serpent.
• Hippocrates of Cos (d. about 370 BC) ), father
  of
• medicineand Hippocratic Corpus (including
  writings of Hippocrates) gathered in Alexandria
  two centuries later.
• School of Alexandria, includes two important
  anatomists (Herophilus and Erasistratus).
• Medicine under the Roman Empire Celsus, a Roman,
• dominance of Galen and Galenism for over 1000
  years. Botany of Dioscorides.
• .

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DOMINANT TENETS OF GREEK MEDICINE

• Dissociation between medicine and religion
• Four humors phlegm, yellow bile, black bile,
  blood (corresponding to 4 elements, 4 qualities,
  4
• temperaments, etc.) a crude anatomy and
  physiology
• Health is the result of proper balance between
  the four humors disease results from an
  imbalance emphasis on proper rules of health
• Treatment rests on evacuation of undesired or
  excessive humor (purgation, emetics, phlebotomy)
• Professionalism and a code of behavior
  (Hippocratic Oath)

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Alexanders Empire
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SCHOOL OF ALEXANDRIA

• Alexandrian Library and Museum founded by
  Ptolemy (r. 382-282)
• Autopsies, vivisection?
• Herophilus arteries filled with blood,
  delineated nerves
• Erasistratus brain seat of intelligence motor
  and sensory nerves.
• Archimedes, Euclid, Ptolemy

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The Roman Empire
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GRECO-ROMAN Materia Medica

• Dioscorides (40-90 AD)
• of Anazarba, botanist and
• army surgeon under Nero,
• described and illustrated some 600 plants
• Galen incorporated much
• of Dioscoridess Materia medica in his writings
• Both had great influence on Arabic medicine

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IN CONCLUSION

• MESOPOTOMIA AND EGYPTDiseases are caused mainly
  by supernatural influences. There is a blending
  of magico-religious practices with pragmatism. An
  evolution from magician-priest-physician to
  physician and surgeon is noticeable.
• GREECE, ROME and ALEXANDRIA Natural causes
  explain disease. Greek philosophers dissociate
  science and medicine from magic and religion.
  Hippocrates establishes a strong tradition of
  pragmatism and professional behavior. Greek
  medicine flourishes in Alexandria with Herophilus
  and Erasistratus. Galen remains the dominant
  physician during the late Roman empire and up to
  modern times.

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Select General References

• L. I. Conrad, Michael Neve, Vivian Nutton, Roy
  Porter and Andrew Wear, The Western Medical
  Tradition 800 BC to AD 1800 (Cambridge, UK
  Cambridge Univesity Press, 1995), pp. 11-91 (by
  Vivian Nutton). Warren D. Dawson, The Beginnings
  Egypt Assyria (New York Paul B. Hoeber, 1930.
• Guido Majno, The Healing Hand Man and Wound in
  the Ancient World (Cambridge, MA Harvard
  Univeristy Press, 1991, paperback edition).
• Roy Potter, The Greated Benefit to Mankind A
  Medical History of Humanity (New York/London W.
  W. Norton, 1997), Ch. II.
• Plinio Prioreschi. A History of Medicine, v. I.
  Primitive and Ancient Medicine (Omaha Horatio
  Press, 1996).
• Henry E. Sigerist, A History of Medicine, v. I.
  Primitive and Archaic Medicine (New York/Oxford
  Oxford University Press, reissued 1987).

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Medicine in Antiquity Websites

• www.med.unc.edu/wrkunits/syllabus/yr4/gen/medhist
  /publish
• Microsoft PowerPoint presentations
• Eric Ball, The Code of Hammurabi
• Richard Baecher, Smith Surgical Papyrus
• Elizabeth Griffiths, Evolution of the Hippocratic
  Oath
• Denis Hadjiliades, Present Vestiges of Greek
  Medicine
• Also,
• www.indiana.edu/ancmed/concepts.htm
• Egypt Mesopotomia Greece

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Credits

• Photos of the Pyramids and of the Parthenon as
  well as all maps are from
• John. P. McKay, Bennett D. Hill and John
  Buckler, A History of Western Civilization
  (Boston Houghton Mifflin Co., 1979)
• The following illustrations are from Ralph
  Majors A History of Medicine, v. 1 (Springfield,
  Charles C. Thomas, 1954)
• Babylon of Nebuchadrezzar, Oriental Institute,
  Univ. of Chicago
• Stele of Hammurabi, Louvre Museum, Paris
• Divination Liver and Rosetta Stone, British
  Museum, London.