HUMOURS AND THE YIN AND THE YANG
DOCTORS OF YESTER ERAS
The Author
JANUARY, 2020
INTRODUCTION
In the preceding narrative we have seen that humans first met with disease when they began to live close to their domesticated animals some 10 to 12,000 years ago; the latter gifting them with germs hitherto unbeknownst to them.
Since that first day, until quite recently on the historical time scale, people have tried to solve the mysteries of infections, contagion and epidemics, attempting to figure out their causes , how to avoid them and how to recover from . They met with modest results if that. In this narrative we look at such efforts from the earliest civilizations of Mesopotamia and Egypt, to Antiquity with Greece and Rome, to the lands of Islam and medieval Europe up to its Renaissance. We similarly look at what the explanations and cures contemplated by the rich early civilizations of India and China.
Around the Mediterranean, a theory of disease prevailed for a long time, in fact until the 1800’s. It may have originated with the Egyptians or even earlier, but was developed by the Greeks and passed on to the Romans and the Europeans thereafter. It was privileged, too, with Muslim physicians. This being the case , I felt it appropriate to describe it at the outset.
It is called the theory of ‘bodily humours’. There were four of them: blood, yellow bile, black bile, and mucus corresponding to the four elements of the universe: fire, air, earth and water. For good health, it was imperative to keep all four humours in balance; otherwise an excesse quantity of one or the other resulted in an abnormality the type and severity of which depended on the problematic humour. For example an excess of blood (paired with air) “thought to be produced in the liver” made a person sanguine : optimistic and confident. To the contrary an overproduction of yellow bile (paired with fire) “produced in the gall bladder” made one bad tempered and choleric. And depression was caused by too much black bile (paired with earth) “allegedly coming from the spleen”. All this is conveniently summarized in the table below taken from Medical News Today.
And how does one go about balancing the humours. Or more to the point , cutting down the excess quantity. Simply with “a vomitive, laxative or diuretic”. But perhaps worst of all was the withdrawal of blood or bloodletting which was practiced up until the 19th century in ignorance of the fact that it could lead to shock and death; as confirmed by ScienceNordic:
...over the years [bloodletting] has killed significantly more patients than the few who benefited from this treatment.
Bloodletting was either performed ‘mechanically’ as shown in the image on the right respectively in medieval times and in the mid-19th century, or through the intermediary of a blood sucking medicinal leech shown on the left (see 1 in Appendix)
As usual, I have gleaned information from the Web. The sources I have finally selected are entries, publications and others in Ancient History Encyclopedia (AHE), Encyclopedia Britannica (BRIT),Encyclopedia.com,
Historyworld.net (HWN), History Extra (HE), Los Angeles Times, Medical News Today (MNT), National Geographic (NG), New World Encyclopedia (NWE), Resaearchgate (RG), ScienceNordic (SN), WebMD and Wikipedia (WIKI).
THE BEGINNING
As soon as Homo sapiens became cognizant, that is: able to think, reason, remember past events and imagine future ones etc. they identified in the flora they gathered not only herbs fit to eat but also non-edible even poisonous varieties, useful nonetheless as pain relievers and others. Interestingly, the extracts of some of these plants are used in modern medicine. Snakeroot for example, long favoured in India against “snakebites, epilepsy and mental disorders is nowadays part of the combat against hypertension. Similarly, foxglove also of Indian origin , was traditionally the cure for the swelling of legs affected by oedema(). It is currently a component of drugs for heart treatment. Finally, curare long placed by Amazonians on the tips of arrows and darts to immobilize prey, is today an “important muscle relaxant in modern surgery”.
But for any discomfort more serious than a common cold was taken to be caused by supernatural forces. Enters the shaman(). His duty , in the words of BRIT:
...was to extract the evil intruder, be it dart or demon, by counterspells, incantations, potions, suction, or other means.
There is agreement that the earliest surgical procedure was a hole in the skull or trepanning (image). Curiously it emerged independently among cultures in a few locations around the world. The first punctured skull was discovered in 1865 in Peru and dated to about 3,500 years ago. The perforation was done by either scraping bone or drilling down to the “dura mater” membrane covering the brain (image). The removed bone was covered with skin. Indications are that it was carried out on live subjects, who, improbably enough, did recover.
Less consensus exists as to purpose of skull trepanning. One version suggests that some shamans volunteered to undergo the procedure to show mere mortals, by recovering, their closeness to the spirits and their power of intercession with them. Another version proposes that the hole created a passage for the spirits inhabiting the body of a sick person to depart it. A third, proposed by HE appearing in BBC History Magazine in April 2016, gives credit to the scientific thinking of those early people by proposing that:
With head wounds a familiar consequence of conflict or accident, practitioners might have observed the course of infection and realised that dead bone would eventually disintegrate.... Removing these fragments manually would have been worth a try.
HEALERS AND THE HAMMURABI CODE
As every 6th grader already knows: Mesopotamia, mostly today’s Iraq, is the place where human organized societies began. The first civilized polity was Sumer some 6,500 years ago. Illness, in those days was always attributed to angry gods seeking to punish sinners.In the words of history scholar Jean Bottero (1914-2007) quoted by AHE:
Every breach of whatever norm ...became an offence against the rule of the gods, a `misdeed’ against them, a `sin’. And as sovereigns punish anything that defies their authority, it was now up to the gods to suppress such unruliness with suitable punishments. These punishments were the ills and misfortunes of life.
Even righteous, sin-free people could be made to suffer by malevolent spirits merely out of spite. They entered the body and wreaked havoc. Worse, even the dead could harm the living as explained by historian Robert Biggs (DOB: 1934), quoted by AHE:
The dead – especially dead relatives – might also trouble the living, particularly if family obligations to supply offerings to the dead were neglected. Especially likely to return to trouble the living were ghosts of persons who died unnatural deaths or who were not properly buried - for example, death by drowning or death on a battlefield.
Clearly, then, faced with such overwhelming foes, Mesopotamian society badly needed intermediaries to intercede with the gods and combat the evil spirits, so as to keep their harm at bay. Enter the healers about 5,000 years ago. Much respected, they came from educated classes and were incorporated in the priestly class. They attended special schools attached to temples and graduated in one of three disciplines:
As divination specialists to read omens and diagnose a disease and foresee its course.
As exorcists who could dislodge an evil spirit from a person’s body and appease angry gods.
As physicians who treated patients by a combination of the supernatural and empirical medicine (i.e. based on experience and observation).
Among healers, too , were those who attended to toothaches. A painfultooth was believed to be the work of a ‘tooth worm’ which according to historian Biggs, begged the gods to:
Let me live between the teeth and jaw! I will suck the blood from the teeth! I will chew upon the food in the jaw!
Notwithstanding , healers-dentists proceeded with incantations before either pulling the bad tooth or prescribing herbal concoctions.
Mesopotamian healers were cognizant of the importance of cleanliness to keep patients free from infections. They also knew of scores of “vegetal, animal and mineral” ingredients from which to prepare remedies. Taking, for example, an injury to the cheek, in Babylon, a healer would begin by washing both his hands and the wound with a solution of beer and hot water (see 2 in Appendix). He would then proceed according to author Emily K . Teall reported by AHE, to:
...pound together fir-turpentine, pine-turpentine, tamarisk, daisy, flour of Inninnu; mix in milk and beer in a small copper pan; spread on skin, bind on him.
As for antiseptics he would have resorted to a mixture of “alcohol, honey, and myrrh”. Every stage of the procedure was accompanied by incantations to stave off any evil spirits.
By and large the practice of healing was highly regulated. The famous ‘Code of Hammurabi’ king of Babylon, dating some 3,800 years ago aimed at organizing the lives, occupations etc. of his subjects contained clauses relating to the practices of healing and surgery. According to an RG publication, the Code among other things:
...laid down acceptable medical fees for the first time in history. Retribution for injuries sustained because of medical treatment was outlined; compensation was influenced by social status – least for plebeians and slaves. Some regulations were quite Draconian, e.g. a healer causing death or blindness to a high born person, had his hands cut off. Healers did not work on certain days of the month, considered unlucky, and it was unethical to attend to hopeless cases. Also included were instructions for veterinarians, barbers, dental surgeons and wet-nurses.
Healers were remunerated for their interventions. The fees, however varied with the status of the sick man\woman’s family. Upper class people paid in gold while more modest clients compensated healers with “a bowl of soup or a clay cup”.
And yet, inevitably, Mesopotamian healing remained heavily dependent on magic and superstition. As told by author, K.R Nemet-Nejat, should an exorcist come across a black pig while on his way to a patient , he will deduce that his client would die. On the other hand should he chances to see a white pig he will understand that he would live. Dreams and visions, as well, had their meanings. In this context the author writes:
If, when he was suffering from a long illness, he saw a dog, his illness will return to him; he will die. If...he saw a gazelle, that patient will recover. If ...he saw a wild pig, when you have recited an incantation for him, he will recover.
In the final analysis healers, of necessity, could not be and were not held responsible if patients failed to recover and indeed, died. If in spite of their best efforts and intents, if in spite of assiduously reciting the right incantations , going through the required devotional acts and prescribing the correct medicines, the patient succumbed then it simply meant that at least some of the all- powerful, capricious and thin-skinned gods were still not assuaged. Or, the healers simply underestimated the gravity of the sin(s) at the origin of the illness.
We close with the legacy of Mesopotamian medicine. Teall concludes that ancient Egyptian medicine was inspired by it. In turn Egyptians influenced the Greeks. Or:
More than a thousand years prior to the lifetime and teaching of Hippocrates [see hereinafter]…medicine in pre-1000 BCE Mesopotamia was a well-established profession that included diagnosis, pharmaceutical applications, and the proper treatment of wounds.
LEARNING FROM THE MUMMIES
One of the oldest world civilizations, Ancient Egypt endured uninterruptedly and essentially unchanged for 3,000 years (from 3100 to 34 BCE). Among its achievements are its unsurpassed medical practices enduring well into the Christian era.
We are cognizant of Egyptian medicine thanks to the detailed papyri (plural of papyrus, the writing medium of that time) (image), discovered in the 19th century. From them historians are acquainted with the practitioners, their methods and the remedies they recommended. According to AHE:
Medical practice in ancient Egypt was so advanced that many of their observations, policies, and commonplace procedures would not be surpassed in the west for centuries after the fall of Rome and their practices would inform both Greek and Roman medicine... Later famous physicians of Rome and Greece.....studied the Egyptian texts and symbols and so passed down the traditions to the present day.
First, however, to lead an illness free life, Egyptians were directed to being moderate in their consumption of food and drink. The Los Angeles Times, of 22 January 1990 quotes an ancient text advising :
He who eats too much bread will suffer illness. He who drinks too much wine lies down in a stupor. All kinds of ailments are in the limbs because of overeating. He who is moderate in his manner of life, his flesh is not disturbed. Illness does not burn him who is moderate in food.
A healthy life,equally , meant cleanliness and hygiene. Egyptians regularly washed and shaved the entire body. And, obviously what went for commoners did too for those who practiced the medical professions. Thus, physicians bathed as often as possible. From this it can only be implied that Egyptians, though they had no knowledge of germs, nevertheless suspected that some disease-causing nastiness lurked where uncleanliness existed. In short, they knew about infection even if they ignored its origins.
The foregoing notwithstanding, Egyptians did suffer from dozens of ailments and diseases. Naveen Helmy Abou El-Soud of the National Research Center, Egypt, reported by RG, adds that the crowding along the narrow fertile ribbon along the Nile eased the spread of contagious diseases among communities. Not only epidemics of bubonic plague, smallpox, cholera etc. ran their deadly courses among the population but additionally Egyptians contracted bilharzia and a form of leprosy resembling elephantiasis (see 3 and 4 in Appendix). and many more. And, to top it all, ancient Egyptians chronically suffered from bad teeth, if only because they could not rid their food of the ever present desert sand.
And yet, all these afflictions did not prevent renown Greek historian Herodotus (484- 425 BCE) to marvel:
[that Egyptians are] the healthiest of all men...[and that]... the practice of medicine is so specialized among them that each physician is a healer of one disease and no more.
Medicine in ancient Egypt was practiced by literate men and women. Among them were physicians, surgeons, dentists, midwives. There were also wet nurses who cared for newborns in cases of death of the mothers, during childbirth, a common enough occurrence in those days. Apparently, the first Egyptian physician was Imhotep the chief minister of king Djoser who reigned from 2630 to 2611 BCE. He incidentally, was the architect of the Saqqara stepped pyramid, the first such monument.
It helped medical knowledge that mummification was widely practiced. Let us recall my description of the procedure in an earlier narrative: embalmers extracted the brain bit by bit through the nostrils with specially made instruments with hooks; next, an incision was made in the side of the abdomen with a flint knife for the removal of all organs etc. Nevertheless, sources agree that though Egyptian doctors knew about the innards, they never cared to study their functions.
There are indications that dentistry was an active occupation, given the atrocious condition of Egyptian dentition as already mentioned. Rotten teeth were extracted after anaesthetizing with opium. Evidence also exists of fillings cavities.
Surgical interventions were common and:
...were frequently successful as evidenced by mummies and other remains found who survived amputations and even brain surgery for years. Prosthetic limbs, made usually of wood, have also been found [image].
according to AHE which ,further lists some of the instruments and tools sugeons used (image).They included:
...flint and a metal scalpel, dental pliers, a bone saw, probes, the catheter, clamps for stopping blood flow, specula, forceps, lancets for opening veins, sponges, scissors, phials, bandages of linen.
Ancient Egyptian doctors and chemists invented and concocted a great many medicines made from plants/herbs, minerals and animal origins. They included cumin, pomegranates, castor and linseed oil, opium, cannabis, frankincense, thyme, coriander, henna and many more from the vegetal world. According to Abu El-Soud:
Egyptians thought garlic and onions aided endurance, and consumed large quantities of them.
Those plants not available locally were brought from abroad.
From the animal variety they made use of honey, eggs, liver, hairs, milk, horns, fat, wax and even feces. As for minerals, medicines included salts, copper, magnesium, calcium carbonate and more. In fact overall there were as many as 800 remedies.
With all considered, Egyptologist Margaret Bunson, in AHE, writes that Egyptians had at their disposal laxatives, diuretics, sedatives, antispasmodics and astringents (for closing surface wounds). For example, constipation was treated with “berries from the castor oil tree”; tape worms in an individual’s intestines were dislodged with “pomegranate root in water”. And for those with bad breath, they were given, to chew a gum ball of honey, cinnamon, myrrh, frankincense, and pignon”.
Egyptian also dealt with household pests thus:
...a dried fish or a piece of nitron [?] placed at the entrance of a serpent’s hole, will keep it inside. A piece of cat fat spread around the house will keep rats away.
All cures, remedies were prepared and dispensed in accordance with detailed prescriptions written by physicians. Each one:
...began with a description of the medicine, e.g., " Medicine to discharge blood out of wounds", followed by ingredients and measures used in addition to method of preparation and usage whether in tablet form , ointment or by inhaling.
Despite all that knowledge Egyptian medicine men and women, as well as royalty and commoners at large were strong believers in the roles of gods and demons in the meting out and outcome of illnesses and diseases. That is why, all medical interventions were accompanied by incantations and pleas for recovery. For example, similarly to Mesopotamian, toothache was attributed to a tooth worm to be dislodged by magic ‘spells and incantations’.
More than one source agree that this strong belief in the supernatural may have had a strong placebo effect on patients. As expressed by Abou El- Soud:
...the strong belief of the patient in the divine origins of the cure may well have been a large part in its effectiveness.
PHILOSOPHERS AND HIPPOCRATES
Let’s begin with this statement from BRIT:
...there is little doubt that ancient Greece inherited much from Babylonia and Egypt and even from India and China.
The Greek civilization era we are concerned with is the one stretching from 1200 BCE to the death of Alexander the Great in 323 BCE. At its onset, similarly to other ancient civilizations, illnesses and cures were in the hands of the gods. But by its end, the causes and remedies and had come down to Earth.
Initially, Apollo was the god of healing. He passed his responsibilities to his son, the god Asclepius who in turn delegated his powers to his sons and daughters. Incidentally, one of the latter was Hygieia, in charge of cleanliness; quite clearly the origin of the term hygiene.
The temples in honour of Asclepius, of which there were many throughout Greece, were the destinations of the diseased seeking healing. They were located in pleasant surroundings and had their playhouses and stadia for athletic activities. Sufferers there were treated with spells and ‘medical art’. BRIT notes that the patients:
...lay down to sleep in the dormitory... were visited in their dreams by Asclepius or by one of his priests, who gave advice. In the morning the patient often is said to have departed cured.... Diet, baths, and exercises played their part in the treatment.
The relegation of the supernatural influence on health to the back seat, was driven by the philosophers for whom Greek civilization is reputed. By the 5th century BCE the ‘bodily humours’ concept already described in the Introduction, became the established medical wisdom.
Enters Hippocrates (about 460-375 BCE), the promoter-in-chief of the theory of humours. His writings discredit the involvement of the gods and demons and emphasize the bodily and environmental causes of disease. According the BRIT:
Some of [Hippocrates] works.... were used as textbooks until the 19th century.... [He] noted the effect of food, of occupation, and especially of climate in causing disease... He laid much stress on diet and the use of few drugs...He had an extraordinary ability to foretell the course of a malady.... He had no patience with the idea that disease was a punishment sent by the gods.
And, of course, there is the Hippocrates oath, universally taken by all doctors entering the profession. It is:
... rather, an ethical code or ideal, an appeal for right conduct. In one or other of its many versions, it has guided the practice of medicine throughout the world for more than 2,000 years [BRIT’s version appears under 5 in Appendix].
With warfare a frequent occurrence in ancient Greece, physicians had plenty of opportunity to train and practice on injured soldiers. They became adept at fixing broken limbs and in dealing with wounds. In the case of the former we learn from SN that:
Patients with fractures were stretched to relieve the fracture site and promote setting, and to prevent a shortening of the fractured bone, which caused the patient to limp.... Dislocated shoulders were fixed by pushing the heel into the armpit of the lying patient while pulling and turning his arm – a procedure that has not changed over the past 2,300 years.
Furthermore, surgeons surmised that:
Wounds should only be cleaned with wine since the water was contaminated; clean cuts should be kept dry so that they can heal; all blood should be emptied from the wound, and wounds with broken tissue should be cleansed of pus and ample drainage provided to avoid infection....Bleeding was stopped by cold wrapping, compression, or burning.
Physicians-surgeons also extracted foreign objects such as arrowheads from wounds. There were instances of the use of opium as anesthetic but the injured were much more likely worked on while being forcibly held down. And wound were closed with stitches with “flax or linen thread”.
Apart from the foregoing surface interventions, very little internal surgery was attempted except “ hernia, removal of bladder stones, and cauterization (burning of body tissue) of hemorrhoids”.
Let us close with these words attributed to Hippocrates:
What is not healed with medicine, is healed with the knife; what the knife does not heal, is healed with the cautery, and what the cautery does not heal must be considered incurable.
GALEN AND THE GLADIATORS
The story of the Romans begins with the founding of the city of Rome itself in 753 BCE and ends with the fall in 410 CE of the western empire. In the last two centuries BCE, they became acquainted with all aspects of Greek civilization. So much so, that speaking Greek and being familiar with Greek philosophy and culture became status symbols among Roman high society.
Roman medicine, similarly, was influenced by that of this earlier civilization. As Greece was overtaken by Rome, its doctors flooded into Roman domains in search of new opportunities and lucre. They were generally, well received by the local populations and highly valued. But not by all. According to AHE, they were, for instance, criticized by Roman philosopher and author Pliny the Elder (23-79 CE) for :
... their high fees, immoral conduct with patients and general malpractice.
At that time, traditional Roman cures included, among others, egg yolk to combat dysentery, garlic considered good for the heart and boiled liver for aching eyes. Cabbage, too had a role to play in their curative philosophy. It was prescribed as an antidote to hangovers and to heal wounds. But more curiously, they believed that eating a large quantity caused the kidneys to excrete urine of therapeutic quality. So much so that according to AHE:
... bathing a patient or a baby in the urine of someone who had eaten a lot of cabbage was extremely beneficial to the constitution.
The best known of the Greek immigrants was Galen of Pergamon (129 - 216 CE), a believer in Hippocrates’s doctrine of the four bodily humours already introduced. In 158 CE, he was appointed medical officer in charge of gladiators whose sole purpose was to take part in deadly combat for the entertainment of Roman populace and elites. In this position he learned a great deal about wounds made by swords, lances and what have you and the means to remedy them by , for example, sterilizing them with bandages soaked in wine. Further, he was in favour of bloodletting with leeches (see 1 in Appendix).
But Galen learned much more from his dissections of animals, apes in preference. And despite Roman cultural taboos against cutting up human corpses, he did manage to dissect a few, nonetheless. From these probes according to BRIT:
Galen recognized that the arteries contain blood and not merely air. He showed how the heart sets the blood in motion in an ebb and flow fashion, but he had no idea that the blood circulates.
Galen displayed an excellent knowledge of bone structure. After cutting the spinal cord of a pig and observing it, he also realized that the brain sends signals to control the muscles.
The works and findings of Galen formed the basis of medical sciences in Medieval Europe until challenged by the work of Belgian/Flemish Andreas Vasalius (see hereinafter).
Apart from Galen, others of Greek origin included gynecologist and childbirth specialist Soranus of Ephesus (2nd century CE). An opponent of abortion he recommended various methods of contraception. More, as told by BRIT:
He also described how to assist a difficult delivery by turning the fetus in the uterus (podalic version), a life-saving technique that was subsequently lost sight of until it was revived in the 16th century.
Another was the botanist and physician Pedanius Dioscorides (40-90 CE) who published volumes describing the benefits of some 600 herbal medicines, which remained unchallenged for about 1,500 years.
Roman surgery did not venture beyond skin depth. But in addition to handling wounds, surgeons removed cataracts and trepanned skulls as seen earlier. They had available a gamut of surgical instruments which they sterilized in boiling water. They included arrow extractors, catheters, scalpels, and forceps. Opium acted as anesthetic. According to AHE:
Wounds were stitched following surgery using flax, linen thread or metal pins. Dressings were of linen bandages or sponges and either dry or wet, that is, soaked in wine, oil, vinegar or water and kept moist with a cover of fresh leaves.
What the Romans lacked in medical knowledge , they made up for with cleanliness and hygiene. They knew that cleanliness is conducive to good health and mitigated the incidence of disease. Thus the famous Roman aqueducts bringing clean water from rivers and lakes to cities and towns for drinking and to public baths and more. In the words of MNT:
There were nine public baths in Rome alone. Each one had pools at varying temperatures. Some also had gyms and massage rooms. Government inspectors were vigorous in their enforcement of proper hygiene standards.
Clearly, all the efforts in this respect would have come to nothing had the Roman not built a sewer system to dispose safely and adequately with waste effluents:
The sewage system in Rome was so advanced that nothing matching it was built again until the late 17th century...
ALRAZI, IBN SINA AND, AL- ZAHRAWI.
As Islam moved out of the Arabian Peninsula from the seventh century CE onwards, it gradually acquired domains extending from Persia to Spain east and west respectively. There it came in contact with Greek, Roman and other earlier sciences, such as a center of Greek medicine in Gondeshapur, Persia. In short, as stated by MNT:
While Europe was in the so-called Dark Ages, Islamic scholars and doctors were building on the work of the Greeks and Romans and making discoveries that continue to influence medical practice.
..Islamic thinkers elaborated the theories of the ancient Greeks and made extensive medical discoveries..... and Islamic doctors and scholars wrote extensively, developing complex literature on medication, clinical practice, diseases, cures, treatments, and diagnoses.
To such an extent that:
...Western doctors first learned of Greek medicine, including the works of Hippocrates and Galen, by reading Arabic translations.
One of the early great names in the field of Islamic medicine is that of the Persian polymath: Abū Bakr Muhammad al-Rāzī (854-925 CE). He wrote voluminously on the subject. Most notably he explained the differences between measles and smallpox. Another of his treatises, according to MNT is on the “Diseases of Children” for which he is known as the “father of pediatrics”. He also discoursed on ophthalmology, allergy and medical ethics. Reportedly, he penned:
The doctor's aim is to do good, even to our enemies, so much more to our friends, and my profession forbids us to do harm to our kindred, as it is instituted for the benefit and welfare of the human race, and God imposed on physicians the oath not to compose mortiferous remedies.
The ‘prince of physicians’, according to BRIT, was another Persian by the name of Abū Alī al-Husayn ibn Sīnā, (980-1037 CE), the most famous name in Islamic science. He was a polymath with about 450 books to his name , 40 of which dealt with medical matters, most notably ‘The Canon of Medicine’ in Arabic ‘Al-Qānūn fī at-Tibb’. It consisted of five volumes subsequently translated to several languages. It and another, ‘The Book of Healing’ became standard fare in European universities such as Leuvin in Belgium and Montpelier in France, till the 1650’s. MNT adds that today both the American universities of California, Los Angeles and Yale “teach some principles of ‘The Canon of Medicine’ in their history of medicine courses”.
Ibn Sina also gave recommendations about the preparation, testing and efficacy of drugs and medicines, such as:
The drug must be pure and not contain anything that would reduce its quality...[It] must match the severity of the disease...[It must undergo] several trials showing the same results....[Tests must be carried out on] humans, not animals, as it may not work in the same way for both.
These drugs were issued from a variety of herbs and vegetable, the like of cannabis and opium to cabbage, cinnamon and garlic with many more in between. They were prescribed in various combinations, boiled or otherwise as anesthetics and cures against cancer, urinary troubles etc. Indeed, as far as BRIT is concerned, the most important influence of Islamic medical science:
...was in chemistry and in the knowledge and preparation of medicines.... Many drugs are of Arab origin, as are such processes as distillation and sublimation.
Other practices included cauterization of wounds, meaning the application of a hot iron to stem the flow of blood and prevent infections. Another was the removal of excess blood or, bloodletting, to rebalance the four humours identified in Hippocratic times as we have already seen.
Islamic doctors used the knife more often than their Greek and Roman predecessors. The best known surgeon was Arab Abū al-Qāsim al-Zahrāwī (936-1013) aka the ‘father of surgery’ according to Wikipedia and who, in the words of BRIT, was a:
...careful and conservative practitioner, he wrote the first illustrated surgical text, which held wide influence in Europe for centuries.
And according to MNT, that text amounted to a 30-volume reference manual describing:
...surgical instruments [image], operating techniques, pharmacological methods to prepare tablets and drugs to protect the heart, surgical procedures used in midwifery, cauterizing and healing wounds, and the treatment of headaches.
Al Zahrawi is credited with the use of “catgut() to sew up wounds”
There were others such as Ala-al-Din abu al-Hasan al-Dimashqi (1213-1288) from Damascus, updated and corrected the work of Galen of Rome in matters of the heart and blood circulation (see hereinbefore).
The human eye was not ignored in the Islamic scientific quest. Arab physicist Hasan Ibn al-Haytham (965-1040) penned the ‘Book of Optics’ in which he explained the organ’s anatomy and described it, correctly as an optical system. It remained a reference manual till the 17th century. Another, ,Ali ibn Isa al-Kahhal (940-1010), nicknamed according to Wikipedia ‘Jesu[s] Occulist’() in Europe:
...was the best known and most celebrated Arab ophthalmologist of medieval islam.
Under the heading ‘How Early Islamic Science Advanced Medicine’ NG tells us that this Iraqi scientist:
...wrote perhaps what was the most complete book of eye diseases, the ‘Notebook of the Oculist’, detailing 130 conditions. The book was translated into Latin in 1497 followed by several more languages, allowing it to serve as an authoritative work for centuries.
A second ophthalmologist, finally, Abu al-Qasim ibn Ali al-Mawsili (996-1020) operated on cataracts with a syringe of his conception.
NG’s article elaborates on the great medical institutions of medieval Islam. In particular, it mentions the hospitals built in places such as Harran (Turkey), Cairo and Baghdad, in which, as is the current practice, medical students followed their Muslim, Christian and Jewish masters as they dealt with patients of all classes of society. In this respect, these institutions:
...allowed the poorest to benefit from the knowledge of outstanding doctors: Beggars in Baghdad might be operated on by Rhazes [al-Razi].
NG proceded with a description of Cairo’s ‘Al- Mansouri Hospital’ built in 1285 and of the 12th century ‘Al-Nouri’ teaching hospital in Damascus. The Cairene institution:
...[had] four wards, each one specializing in different pathologies, were reputed to house thousands of patients. The buildings surrounded a courtyard cooled by fountains.
As for the Damascene, it was:
...the leading medical schools of its time, complete with an impressive library... scholars learned from mentoring by experienced doctors...[it had spaces] where talks and readings of classic manuscripts would be held.
DAVINCI, VASILIUS AND GUTENBERG
Historians distinguish four eras in the story of Europe. The earliest two, only, are of interest to us here. First is the medieval era or the Middle Ages, spanning the period between the demise of the western Roman Empire in the 400’s CE and the capture of Constantinople by the Ottomans in 1453. Next is the era of the Renaissance and the Age of Discovery, extending up to the 1600’ s.
In the early Middle Ages, the Church in Europe preached that sickness was a punishment sent by God to punish sinners. It also taught that the human body was sacred and could not be cut up even in the cause of science. In consequence while medical knowledge was being actively sought after in the Islamic lands, notably in nearby Andalusia, Europeans, to the contrary, were seeking relief in prayers and invocations to saints, pilgrimages and other devotional acts along with some herbal medicines.
This notwithstanding, Christian monks, practically the only persons who could read or write, undertook, nonetheless, the translation of the medical texts of Greece and of the Islamic World. Furthermore, Crusaders and other pilgrims to the Holy Land returned home with knowledge of medical procedures there. Besides, religious institutions established the first hospitals in which, in the words of BRIT, all:
...doctors and nurses...were members of religious orders and combined spiritual with physical healing.
They housed people who were sick, poor, and blind, as well as pilgrims, travelers, orphans, people with mental illness, and individuals who had nowhere else to go....Christian teaching held that people should provide hospitality for those in desperate need, including food, shelter, and medical care if necessary.
Examples of these are the ‘Hotel-Dieu’ hospitals in Lyon and Paris established in 542 and 652 respectively.
Later medical schools were established. The first and very prestigious one was in Salerno, Italy in the 9th century. It drew on Greek, Roman and Islamic heritage and taught the theory of the bodily humours explained in the Introduction. For this, Salerno was known as the ‘Hippocratic City’. Its reputation was such that it was attended by an international body of students. Salerno school was copied by the others established in “Montpellier and Paris, in France, and at Bologna and Padua, in Italy”.
Crucially the ban on the dissection of the human body was progressively lifted, beginning in the 14th century.
Surgery in medieval times was carried out by barber-surgeons. They were adept enough for dealing with combat wounds and broken and dislocated bones. They could also remove bladder stones, mend hernias and remove cataracts. In cases of neurological problems , they trepanned skulls “to let the demons out”. But nothing much beyond that.
Surgeons made use of anesthetics whose main component was opium. A document dating from 1265 described by HW tells of one concoction consisting, in addition to opium, of three or four other plants. The whole was boiled in the presence of a sponge which thoroughly soaked up the mixture. It was thereafter “applied to the nostrils of the patient”. With the intervention completed , another sponge dipped in vinegar was similarly applied to bring the patient back to consciousness.
Wine, in addition to being a pleasant drink was employed as an antiseptic against infections of wounds etc. Cauterization was another mean of achieving the same. Even so, in those days, medieval practitioners had no idea what caused them. Worse they did not associate them with a lack of hygiene (see 2 in Appendix).
Medieval physicians studied the symptoms of the sick and examined their feces. Following this they could, according to BRIT, prescribe:
... diet, rest, sleep, exercise, or baths, or they could administer emetics and purgatives or bleed the patient.
They may also prescribe medication consisting of herbs and plants. For this purpose, monasteries/hospitals extensively cultivated what they believed was necessary to restore the balance of the four humours.
The Renaissance era as described by BRIT:
...was much more than just a reviving of interest in Greek and Roman culture; it was rather a change of outlook, an eagerness for discovery, a desire to escape from the limitations of tradition and to explore new fields of thought and action.
In the field of medicine, it was an era in the course of which:
...it was perhaps natural that anatomy and physiology, the knowledge of the human body and its workings, should be the first aspects of medical learning to receive attention from those who realized the need for reform.
The Renaissance began in Italy and spread thereafter to the rest of Western Europe. One cannot talk, read or write about it without remembering its icons: the painter and sculptor Michelangelo (1475-1564) and the polymath Leonardo da Vinci (1452-1519). Among his many interests and talents da Vinci was eager to learn about the human body. He was able to study dissected corpses and in due course, collaborated in a 200 page illustrated book about his findings. He paid particular attention to the mechanics of bones and muscles .
There was also Andreas Vasalius (1514-1564), a Flemish (Belgian) Professor of medicine who published “one of the most influential books on human anatomy”. Its dissemination, across Europe, was greatly helped by Gutenberg’s printing press, first used in the early 1500’s.
Another was the Englishman William Harvey (1578-1657) who correctly interpreted the cardiovascular system whereby the heart pumps blood round the body; thus putting to rest the ebbing and flowing theory of the Galen (see hereinbefore)
French surgeon. Ambroise Pare’ (1510-1590) is known for doing away with painful cauterization of wounds in preference for “ligatures and dressing”. He is also known for his work on “forensic pathology”, the study of the cause of death by carrying out autopsies.
Finally, Girolamo Fracastoro (1478-1553), another Italian polymath was interested in infections and contagions. Eventually he published his findings. According to BRIT:
In his great work, De contagione et contagiosis morbis (1546), he theorized that the seeds of certain diseases are imperceptible particles transmitted by air or by contact.
Dishearteningly, healers of the Renaissance, despite all the progress described, were no nearer to successfully deal with contagious diseases and epidemics that their predecessors on the Middle Ages. So much so that MNT relates that a form of tuberculosis was called “The King’s Devil”. In consequence:
At one time, doctors asked [the king] to help by touching sick people in an attempt to cure them of scrofula, a type of tuberculosis (TB).
SUSHRUTA AND CORPSE IN A BASKET
Hindus had their own version of the theory of humors. Theirs numbered three, instead of four: spirit, bile and phlegm (the viscous substance secreted by nasal membranes). As with other cultures good health depended on their proper balance .
To begin with, cleanliness was next to holiness in Hindu culture. According to BRIT:
Bathing and care of the skin were carefully prescribed, as were cleansing of the teeth with twigs from named trees, anointing of the body with oil, and the use of eyewashes.
Dietary discipline was taught as well. No more than two meals daily were required with constituents and ingredients clearly specified including the quantity of water to be had before and after meals, and more.
“The golden age of Indian medicine”, stretches from 800 BCE to 1000 CE or some 1200 years long. It was a time of abundant writing of medical compendia (compilations) which variously:
...brought together not only treatises on anatomy, including embryology, diagnosis, surgery, epidemics, pharmacology, and so forth, but many reflective philosophical passages discussing, for example, the origin of the human being, the rules of medical debate, methods for the interpretation of technical terminology and scientific expression, and so forth.
to borrow the words of Encyclopedia.com.
The best known compendium is the one composed by surgeon/physician Sushruta who lived between 600 and 500 BCE. His writings are wide ranging. He lists 1120 diseases, among them smallpox, and 760 remedies. He wrote, as well, on plastic surgery and on removing cloudiness of the eye lens in a cataract operation. His was the earliest written recommendation on the adaptation of leeches in medicinal bloodletting (see 1 in Appendix). Further, he identified 20 sharp and 101 blunt instruments (image).
And, oddly enough, in order to by-pass the Hindu ban on mutilation of the human body, he recommended placing a corpse in a basket, immersing it in a stream for a duration of seven days in the wake of which the body can be disassembled without the need for a knife.
Thanks to Sushruta and his peers, Indian surgeons were particularly adept at removing bladder stones and the restitution of amputated noses, a much sought after plastic intervention in a culture which condemned adulterers to the loss of their noses . BRIT explains how it was done:
...repair was carried out by cutting from the patient’s cheek or forehead a piece of tissue of the required size and shape and applying it to the stump of the nose. The results appear to have been tolerably satisfactory, and the modern operation is certainly derived indirectly from this ancient source.
Indian surgeons were also capable of clearing cataracts, thereby restoring a far from perfect vision but an amelioration nevertheless. HE relates the dictate of Sushrata in this instance:
The patient had to look at the tip of his or her nose while the surgeon, holding the eyelids apart with thumb and index finger, used a needle-like instrument to pierce the eyeball from the side. It was then sprinkled with breast milk and the outside of the eye bathed with a herbal medication. The surgeon used the instrument to scrape out the clouded lens until the eye “assumed the glossiness of a resplendent cloudless sun”. During recovery it was important for the patient to avoiding coughing, sneezing, burping or anything else that might cause pressure in the eye.
We have already seen that Sushruta had identified in his treatises 760 remedies. A colleague of his knew of 500 more. They were, quite naturally of the herbal version. But others were concocted from animal products “such as the milk of various animals, bones, gallstones” and of mineral variety such as “sulfur, arsenic, lead, copper sulfate, gold”. Further, “Alcohol seems to have been used as a narcotic during operations, and bleeding was stopped by hot oils and tar”.
Physicians, however, greatly favoured what was known as the “five procedures: the administration of emetics, purgatives, water enemas, oil enemas, and sneezing powders”. Further “Inhalations were frequently administered, as were leeching, cupping, and bleeding.
QI AND, YIN AND YANG
Traditional Chinese medicine (TCM) is an ancient set of practices, free from any outside influence, based on notions which evolved through centuries of observations, analyses and studies of cosmic, natural and biological phenomena. So much so that by at least 3,000 years ago the established wisdom of TCM revolved around:
‘Qi’, meaning the flow of life energy through invisible channels .
in the human body,
‘Yin’, is the dark, negative influence, female gendered, represented by Earth.
‘Yang’, is the opposite influence, positive ,male, represented by the heavens.
From all this, China’s wise men reasoned that good health, happiness and indeed success in whatever one undertakes depended on the proper balance of the black yin and the white yang (image) in the qi or life energy.
Moreover, TCM thinkers decided that humans are made of the same five elements as the natural world: wood, fire, earth metal and water and that their bodies housed:
...five organs (heart, lungs, liver, spleen, and kidneys), which store up but do not eliminate, and five viscera (such as the stomach, intestines, gallbladder, and bladder), which eliminate but do not store up.
In addition, there are 365 bones and an equal number of joints.
A traditional healer called to the bedside of a sick person enquired:
...about the history of the illness and about such things as the patient’s taste, smell, and dreams. Conclusions are drawn from the quality of the voice, and note is made of the colour of the face and of the tongue. The most important part of the investigation, however, is the examination of the pulse.
according to BRIT. Thereafter the physician sets out his healing programme which may include:
...such components as acupuncture, herbs, lifestyle changes, and foods for healing”.
Traditional Chinese pharmacology identifies hundreds of remedies made from plant, herbal, mineral, animal and even human elements (image). We know from BRIT that:
In 1578 Li Shizhen published his famous Bencao gangmu (Compendium of Materia Medica), which lists 1,892 drugs and some 11,000 formal prescriptions for specific ailments.
A visit to a traditional Chinese pharmacy is like a visit to a small natural history museum. The hundreds of cabinet drawers, glass cases, and jars in a typical pharmacy hold an enormous variety of desiccated [dried] plant and animal material.
And revealingly:
Nearly 200 modern medicines have been developed either directly or indirectly from the 7,300 species of plants used as medicines in China.
Then there are the external curative practices , the best known of which is acupuncture, or the insertion of needles through the skin to a certain depth at selected spots chosen depending on the ailment to be cured. According to BRIT, the needles are metallic, range from as little 3 cm and as much as 24 cm long. Further:
...they are often inserted with considerable force and after insertion may be agitated or screwed to the left or right.
The whole theory behind acupuncture is the unblocking of a congested invisible energy flow (qi) channel to restore the balance of the yin and the yang. There are 365 spots on the body to choose from depending on the organ afflicted. Moreover, we know from HN that acupuncture is also a form of anesthetics.
Unlike with other civilizations, the adoption of modern medicine did not result in the rejection ‘en masse’ of TCM. To the contrary. One reason for this, advanced by NWE, is its “palliative() efficacy” not matched by present day pain killers. It further advances that TCM is:
...used by some to treat the side effects of chemotherapy, treating the cravings and withdrawal symptoms of drug addicts and treating a variety of chronic conditions, such as pains, that conventional medicine has not been able to treat.
In China itself TCM is “an important part of the public health care system”. Even more. According to NWE:
Graduates from TCM university courses are able to diagnose in Western medical terms, prescribe Western pharmaceuticals, and undertake minor surgical procedures. In effect, they practice TCM as a specialty within the broader organization of Chinese health care
APPENDIX
It was almost universally believed that the sucking action of a medicinal leech placed on the skin would either “initiate blood flow” or empty it in that location of the body. It was a favoured procedure until well into the 19th century in America, Asia and Europe.
In the early part of that century a “leech mania” took hold in Europe and America. We have the word of BRIT that:
Enormous quantities of leeches were used for bleeding—as many as 5 to 6 million being used annually to draw more than 300,000 litres of blood in Parisian hospitals alone. In some cases patients lost as much as 80 percent of their blood in a single leeching.
It was not till well into the 19th century, less than 200 years ago, that a Hungarian physician, Ignaz Semmelweis (1818-1865) recognized the importance of surgeons washing their hands before operations particularly if they had just carried out autopsies. He correctly estimated that should doctors wash their hands before intervening mortality among patients going under the knife would dramatically drop. He published a book on the matter in 1861.
His colleagues did not agree. They believed that mortality occurred because “infections were spread through the air by something called miasmas”. Semmelweis died at age 47 in an asylum for insane persons. His work was posthumously acclaimed in light of the work of the like of French microbiologist Louis Pasteur (1822-1895).
Biharzia is a decease found mostly in South America, Southeast Asia and Africa including Egypt. It affects farmers and peasants in places like the Nile Valley where their livelihood requires contact with river water. This includes wading or swimming in the current or drinking from it.
Infection is caused by a parasitic worm (image) which enters the exposed skin, gets into the bloodstream and thereafter infect various organs. Ironically the presence of these parasites are promoted by human urine and feces discharged in the water by already contaminated persons.
Early stages symptoms may include, depending on the internal organ(s) affected: breathing difficulties, muscle pain, headache and fever. As the disease advances, again depending or where the invasion occurred, the sufferer may see blood in the urine or in the feces; he/she may develop diarrhea or constipation, liver fibrosis and run a high risk of bladder cancer. Perhaps worst of all are infected children whose growth may be stunted and learning ability reduced.
According to the ‘Center for Disease Control and Prevention’, there are currently about 200,000,000 Bilharzia victims worldwide. No cure or vaccine exists, but treatment can reduce the impact of the affliction.
Medically it is called ‘lymphatic filariasis’. It causes harm to the lymph system “impairing the immune system”. People affected:
tend to get more bacterial infections of the skin, causing it to become dry, thick, and ulcerated with repeated infections.
Some patients, not all, exhibit ugly swelling of the arms, legs, breasts and genitals. The image shows clearly why the disease is also known as ‘elephantiasis’.
Similarly to bilharzia it is caused by parasitic worm. In this instance, however, it enters the body of its victim through the bite of a mosquito, again ironically, taken on by the insect through an earlier bite of an infected human host.
The ‘World Health Organization’ has estimated the number of presently infected worldwide at 120,000,000 distributed between Africa, India South America, Southeast Asia.
Medication does exist but fails to effectively rid a patient of the parasite.
5)Hippocrates Oath
The version below is that of Encyclopedia Britannica:
I swear by Apollo the physician, and Asclepius, and Health, and All-heal, and all the gods and goddesses…to reckon him who taught me this Art equally dear to me as my parents, to share my substance with him, and relieve his necessities if required; to look upon his offspring in the same footing as my own brothers, and to teach them this art, if they shall wish to learn it, without fee or stipulation; and that by precept, lecture, and every other mode of instruction, I will impart a knowledge of the Art to my own sons, and those of my teachers, and to disciples bound by a stipulation and oath according to the law of medicine, but to none others. I will follow that system of regimen which, according to my ability and judgment, I consider for the benefit of my patients, and abstain from whatever is deleterious and mischievous. I will give no deadly medicine to any one if asked, nor suggest any such counsel; and in like manner I will not give to a woman a pessary to produce abortion…Into whatever houses I enter, I will go into them for the benefit of the sick, and will abstain from every voluntary act of mischief and corruption; and, further from the seduction of females or males, of freemen and slaves. Whatever, in connection with my professional practice or not, in connection with it, I see or hear, in the life of men, which ought not to be spoken of abroad, I will not divulge, as reckoning that all such should be kept secret.
