Modern concept of health and disease

HISTORY OF MEDICINE
EARLY PERIOD
ANTIQUE TIMES
INTRODUCTION TO MEDICINE
Lecture 7
October 15, 2013
Lecturer: ADÉL TÓTH, MA, PhD

MAIN POINTS
1. Medicine in pre-historic times
2. Ancient Egyptian medicine
3. Medicine in Mesopotamia and Babylon
4. Medicine in ancient China
5. Medicine in ancient India
6. Medical knowledge of ancient Jewish people
7. Medicine of ancient Greece – cradle of
European medicine, school of Hippocrates
8. Physicians of the Antique Roman Empire –
Varro, Celsus, Galen

MEDICINE IN PRE-HISTORIC TIMES
Palaeolithic, neolithic people: No
disease types unknown today,
devastating diseases mild diseases
today
Life expectancies: Nomadic tribes:
around 30-35 years for females and
males
Main factors of premature death:
Violent causes, bad weather, other
hardships
Settling down: Appearance of infant
diseases, various stress factors
Shamans and medicine men chased
away the evil spirits causing diseases
Most cultures applied trepanation (75%
survival rate)

MEDICINE IN ANCIENT EGYPT - 1
Period between 3300 BC and 525 BC (Persian
invasion)
FAITH AND TRUST
- Faith: Curative power of magic, charismatic persons
extracted from cosmic harmony, Ecstatic states of
the healer
- Trust: In the efficiency of methods
MEDICINE: Highly advanced; included non-invasive
purging, setting of bones, set of pharmacopoeia,
magical spells, specific steps of examination, diagnosis,
prognosis, treatment - often rational and appropriate
ADVICE TO PRESERVE HEALTH: Wash and shave
the body, including under the arms - preventing
infections; Look after diet, avoid foods considered to be
unclean (raw fish)
SUPERNATURAL ELEMENTS OF TREATMENT:
Gods and demons to be responsible for many ailments
(health related amulets, trust in efficacy: placebo effect)
EARLIEST RECORDED PHYSICIAN: Hesyre, “Chief
of Dentists and Physicians” for Pharaoh Djoser in the
27th century BC

MEDICINE IN ANCIENT EGYPT - 2
MUMMIFICATION
• No study of functional
anatomy: Egyptians never
dissected the body
• Importance of heart, but
no idea about circulation,
no distinction between
blood vessels, tendons,
and nerves.
• Paleopathology: To
survey the medical state of
ancient Egyptians and
their common illnesses

MEDICINE IN ANCIENT EGYPT - 3
EBERS PAPYRUS SCROLL 1550 BC
• Purchased in 1872 by German Egyptologist and
novelist Georg Ebers, now found in University
Library of Leipzig, Germany
• First systematic list of medical experience
- Three fields of medical activity:
Physicians; chirurgeons; magi, exorcist
- Three categories of diseases: Symptoms that can
be treated; that can be battled; that cannot be cured
• HEART: Centre of blood supply, meeting point of
numbers of vessels that carried all the fluids of the
body — blood, tears, urine and sperm.
• DISEASES, MEDICAL ACTIVITIES: Depression,
dementia, contraception, diagnosis of pregnancy,
other gynaecological matters, intestinal diseases and
parasites, eye and skin problems, dentistry, surgical
treatment of tumours, bone-setting, burns.
- Asthma: A mixture of herbs heated on a brick – a
sufferer could inhale their fumes.
- Death: Half an onion and the froth of beer - "a
delightful remedy against death."

MEDICINE IN MESOPOTAMIA AND
BABYLON
MEZOPOTAMIA - Clay tablets of
Assurbanipal (7th c. BC)
• 660 tablets store medical information
• Texts refer to 1000 years earlier period
• Tablets about symptoms, prognosis, and
the possible treatment
BABYLON – Hammurabbi’s column
(17th c. BC)
• Medical practice: Regulated by laws
• Fees for various procedures precisely
specified
• „If a physician performs major surgery
on a noble… and thereby causes his
death … his hand shall be chopped off.”

MEDICINE IN ANCIENT CHINA
Traditional Chinese medicine: Based on Taoist philosophical thinking
Health: A condition of balance of yin and yang
• Yang: Immaterial - Qi
• Yin: Material - Blood (very roughly equivalent to physiological blood)
• Free flow of Qi, "vital energy”
Acupuncture treatment regulates the flow of Qi and Blood
• An axiom of acupuncture is "no pain, no blockage; no blockage, no pain."
• An acupuncturist decides which points to treat by making a diagnosis by methods
of: inspection, auscultation and olfaction, inquiring, and palpation
Inspection focuses on the face and the tongue (tongue size, shape, tension, colour
and coating, and the absence or presence of teeth marks around the edge)
Auscultation and olfaction refer to listening for particular sounds (e.g. wheezing)
and attending to body odour
Inquiring focuses on the "seven inquiries": chills and fever; perspiration; appetite,
thirst and taste; defecation and urination; pain; sleep; and menses and leucorrhoea.
Palpation includes feeling the body for tender "ashi" points, and palpation of the left
and right radial pulses at two levels of pressure (superficial and deep) and three
positions Cun, Guan, Chi

MEDICINE IN ANCIENT INDIA
Ajurvedic medicine: Intertwined with mythology and religion
Ajurvedic literature created in Vedic period (1700 – 150 BC)
Sushruta Samhita (6 th c. BC) and Charaka Samhita (1 st c. BC) –
Influential works on traditional medicine
Five great elements: Earth, water, fire, air and space –
forming the universe, including the human body
Balance of three substances (DOSHAS): Vata (wind/spirit/air), pitta (bile)
and kapha (phlegm), each representing divine forces
Balance in lifestyle: To stay within the limits of reasonable balance and
measure : Moderation in food intake, sleep, sexual intercourse, and intake of
medicine
Charaka Samhita recommends a tenfold examination; Qualities to be
examined: Constitution, abnormality, essence, stability, body measurements,
diet suitability, psychic strength, digestive capacity, physical fitness and age
Sushruta Samhita emphasises the proper function of body channels
transporting fluids; Lack of healthy channels may lead to disease and
insanity (to rheumatism, epilepsy, paralysis, and convulsions); Sweating,
steam bathing, and other steam related cures are favoured to open up the
channels and dilute the Doshas causing blockages and harming the patient.

MEDICAL KNOWLEDGE OF ANCIENT
JEWISH PEOPLE
Old Testament: Health regulations of
the 8th and 3th centuries BC
Foundation of public health
Regulations of sanitation, cleanliness
and waste-storage - sound even today
To stop epidemics: Forty-day
separation measure (the European
quarantine)

ANCIENT GREECE -
CRADLE OF EUROPEAN MEDICINE - 1
ASCLEPIUS – God of medicine
His daughters:
HYGIEIA – goddess of health
PANACEIA – goddess of medication
His staff – snakes
Greek philosophy: Basis for the developing
science of medicine
Belief in the omnipotent power of nature
Emphasis on harmony
The balance of the four cardinal humours:
Blood
Phlegm
Yellow bile
Black bile

ANCIENT GREECE -
CRADLE OF EUROPEAN MEDICINE - 2
Emphasis on cleanliness
Usage of auscultation, and probes to
examine wounds
Emphasis on proper lifestyle
Practice of blood-letting, and the role
of pus
Temple medicine successful in the
treatment of psychosomatic diseases
TEMPLES:
• Night sanatoriums
• Patients could sleep in beautiful
surroundings
• Could await in their dreams the visit
of Asclepius

GREEK PHYSICIANS - HIPPOCRATES
School of medicine (5-4th centuries BC,
on the island of Kos, age of Pericles
Corpus Hippocraticum – Hippocratic Collection, Hippocratic Oath
Father of scientific medicine: Establishing medicine
as a discipline distinct from religion and philosophy
Summarising the medical knowledge of previous schools
Disease: Not a punishment inflicted by the gods but rather the product of
environmental factors, diet and living habits
Cause of illness: Imbalance of the four humours in the body
Giving prognosis; Therapeutic approach: Based on the healing power of nature; Body has
the power to re-balance the four humours and to heal itself; Therapy: Simply easing this
natural process by prescribing rest and immobilization; Gentle treatment, keeping the
patient clean (clean water or wine being used on wounds)
Importance of observation and documentation: Physicians recorded their findings and
medicinal methods in order to be employed by other physicians
Clinical symptoms and devices named after Hippocrates:
• Hippocratic face: Change produced in the countenance by death;
• Hippocratic fingers: Clubbing, a deformity of the fingers and fingernails
• Hippocratic succussion: Internal splashing noise of hydropneumothorax or pyopneumothorax
• Hippocratic bench: A device which uses tension to aid in setting bones
• Hippocratic bandage: Cap-shaped
bandage

ANTIQUE ROMAN PHYSICIANS
The Greek school in Rome: Based on
the Corpus Hippocraticum
Private practitioners
Family physicians
Health officers
TERENTIUS VARRO: Ideas about
small invisible creatures causing
diseases
CORNELIUS CELSUS:
De Medicina – His description of acute
inflammation: Rubor, tumor, cum calore
et dolore (Red, painful, warm swelling)
CLAUDIUS GALENUS
(129-199 AD)

ROMAN PHYSICIANS - GALENUS
GALENUS OR GALEN (129-199 AD)
Born in Pergamon (Asia Minor, Turkey)
Traditional career was planned for him in philosophy
or politics. His father had a dream: The god Asclepius
commanded to send his son to study medicine.
Studied medicine in Pergamon, Smyrna (Izmir),
Cyprus, Alexandria
Aged 28, returned to Pergamon as a physician of
gladiators (There, he learnt the importance of diet,
fitness, hygiene and preventive measures, anatomy,
treatment of fractures and severe trauma,
Wounds = windows into the body)
Aged 33, launched his medical career in Rome;
Became a personal physician of emperors (Marcus
Aurelius and his son Commodus, and Septimius
Severus)
Followed Hippocratic school: Provided prognosis,
promoted venesection (blood-letting), explanation of
pathology relied on the four humours theory,
benevolent effect of pus

ROMAN PHYSICIANS - GALENUS
Galen's fame rested on his anatomical demonstrations,
performed vivisections of numerous animals to study
the function of the kidneys and the spinal cord
Mistaken ideas: A group of blood vessels near the back
of the brain (rete mirabile) was thought common in
humans, although absent in humans
Recognition of the role of blood in feeding tissues:
Identified venous (dark red) blood, originated in the
liver and arterial (brighter and thinner) blood,
originated in the heart
Mechanism of nerve function
Performed operations - brain and eye surgeries - that
were not tried again for almost two millennia
Author of about 600 treaties (He employed 20 scribes
to write down his words)
Legendary reputation: "Primum sane medicorum esse,
philosophorum autem solum" (First among doctors and
unique among philosophers. Marcus Aurelius)

ROMAN PHYSICIANS - GALENUS
Islamic culture respected the teachings of
Aristotle and Galen, systematised and
commented their works
11th century: Latin translations of Islamic
medical texts - appeared in Salerno medical
school, later incorporated into teaching at the
universities of Naples and Montpellier
Galen: the "Medical Pope of the Middle Ages"
Determined medicine for 15 centuries –
dogmatic period
Galenic teaching about blood-letting as a
remedy against almost any ailment remained
influential until the 1800s

THANK YOU
FOR YOUR
ATTENTION