Monday, July 9, 2012

Brief History of Medicine


In ancient times, health and illness were interpreted in a theological perspective. Medicine was dominated by magical and religious beliefs. Henry Siegerist has stated that every culture had developed a system of medicine, and medical history is but one aspect of the history of culture. Dubos says that ancient medicine was the mother of sciences and played a large role in the integration of early cultures. 
Since there is an integral relationship between medicine and human advancement, any account of medicine at a given period should be viewed against the civilization and human advancement at that time, i.e. philosophy, religion, economic conditions, form of government, education, science and aspirations of the people.

Primitive medicine 
It is said that medicine was conceived in sympathy and born out of necessity; and that the first doctor was the first man, and the first woman, the first nurse. The prehistoric man, motivated by feelings of sympathy and kindness, was always at the behest of his kindred, trying to provide relief, in times of sickness and suffering. 

Since his knowledge was limited, the primitive man attributed disease, and in fact all human suffering and other calamities, to the wrath of gods, the invasion of body by "evil spirits" and the malevolent influence of stars and planets. The concept of disease in which the ancient man believed is known as the "supernatural theory of disease". The medicine he practised consisted in appeasing gods by prayers, rituals and sacrifices, driving out "evil spirits" from the human body by witchcraft and other crude means and using charms and amulets to protect himself against the influence of evil spirits. There is also evidence that prehistoric man improvised stone and flint instruments with which he performed circumcisions, amputations and trephining of skulls. It is thus obvious that medicine in the prehistoric times (about 5000 B.C.) was intermingled with superstition, religion, magic and witchcraft. 

Primitive medicine is timeless. If we look around the world, we find that the rudiments of primitive medicine still persist in many parts of the world - in Asia, Africa, South America, Australia and the Pacific islands. The supernatural theory of disease in which the primitive man believed is as new as today. For example, in India, one may still hear the talk of curing snake bites by "mantras". Diseases such as leprosy are interpreted as being punishment for one's past sins in some cultures. Although primitive man may be extinct, his progeny -the so-called "traditional healers" are found everywhere. They live close to the people and their treatments are based on various combinations of religion, magic and empiricism.

Indian medicine 
The medical systems that are truly Indian in origin and development are the Ayurveda and the Siddha systems.Ayurveda is practised throughout India, but the Siddha system is practised in the Tamil-speaking areas of South India. These systems differ very little both in theory and practice. Ayurveda by definition implies the "knowledge of life" or the knowledge by which life may be prolonged. Its origin is traced far back to the Vedic times, about 5000 B.C. During this period, medical history was associated with mythological figures, sages and seers. Dhanvantari, the Hindu god of medicine is said to have been born as a result of the churning of the oceans during a 'tug of war' between gods and demons. According to some authorities, the medical knowledge in the Atharvaveda (one of the four Vedas) gradually developed into the science of Ayurveda. 

In ancient India, the celebrated authorities in Ayurvedic medicine were Atreya, Charaka, Susruta and Vaghbhatt. Atreya (about 800 B.C.) is acknowledged as the first great Indian physician and teacher. He lived in the ancient university of Takshshila, about 20 miles west of modern Rawalpindi. Ayurveda witnessed tremendous growth and development during the Buddhist times. King Ashoka (226 B.C.) and the other Buddhist kings patronised Ayurveda as State medicine and established schools of medicine and public hospitals. Charaka (200 A.D.), the most popular name in Ayurvedic medicine, was a court physician to the Buddhist king, Kaniska. Based on the teachings of Atreya, Charaka compiled his famous treatise on medicine, the "Charaka Samhita". Charaka mentions some 500 drugs. The Indian snakeroot (rauwolfia) was employed for centuries by the Indian physicians, before reserpine was extracted from the root and found spectacularly effective in the treatment of hypertension.

Among the many distinguished names in Hindu medicine, that of Susruta, the "father of Indian surgery" stands out in prominence. He compiled the surgical knowledge of his time in his classic "Susruta Samhita". It is believed that this classic was compiled between 800 B.C. and 400 A.D. Though this work is mainly devoted to surgery, it also includes medicine, pathology, anatomy, midwifery, ophthalmology, hygiene and bedside manners. The early Indians set fractures, performed amputations, excised tumours, repaired hernias and excelled in cataract operations and plastic surgery. It is stated that the British physicians learned the art of rhinoplasty from Indian surgeons in the days of East India Company. 

Of significance in Ayurveda is the "tridosha theory of disease". The doshas or humors are: uata (wind), pitta (gall) and kapha (mucus). Disease was explained as a disturbance in the equilibrium of the three humors; when these were in perfect balance and harmony, a person is said to be healthy.  Medical historians admit that there was free exchange of thought and experience between the Hindu, Arab, Persian, Greek and Jewish scholars. The Samhitas of Charaka and Susruta were translated into Persian and Arabic in about 800 A.D. 

Hygiene was given an important place in ancient Indian medicine. The laws of Manu were a code of personal hygiene. Archaeological excavations at Mohenjo-daro and Harappa in the Indus valley uncovered cities of over two thousand years old which revealed rather advanced knowledge of sanitation, water supply and engineering. The golden age of Indian medicine was between 800 B.C. and 600 A.D. During the Moghul period and subsequent years, Ayurveda declined due to lack of State support. 

Mention must be made of the other indigenous systems medicine namely Unani-Tibb and Homoeopathy, which are not of Indian origin. The Unani-Tibb system of medicin whose origin is traced to the ancient Greek medicine, was introduced into India by the Muslim rulers about the 10 Century A.D. By the 13th Century, the Unani system medicine was firmly entrenched in certain towns and citi notably Delhi, Aligarh. Lucknow and Hyderabad. Homoeopathy was propounded by Samu Hahnemann (1755-1843) of Germany and gained foothold India during 1810 and 1839. It is a system of pharmaco dynamics based on "treatment of disease by the use of small amounts of a drug that, in healthy persons, produce symptoms similar to those of the disease being treated". Homoeopathy is practised in several countries, but India claims to have the largest number of practitioners of the system in the world. 

The Indian systems of medicine including Unani-Tibb and Homoeopathy are very much alive in India even today and in fact, have become part of the Indian culture.

Chinese medicine 
Chinese medicine claims to be the world's first organized body of medical knowledge dating back to 2700 B.C. It based on two principles - the yang and the yin. The yang believed to be an active masculine principle and the yin negative feminine principle. The balance of these two opposite forces meant good health. Hygiene, dietetics, hydro-therapy, massage, drugs were all used by the Chinese physicians. 

The Chinese were early pioneers of immunization. They practised variolation to prevent smallpox. To a Chinese, "the great doctor is one who treats not someone who is already sick but someone not yet ill". The Chinese have great faith in the traditional medicine, which is fully integrated with modern medicine. The Chinese system of "bare-foot doctors" and accupuncture have attracted worldwide attention in recent years.

Egyptian medicine 
Egypt has one of the oldest civilizations. In Egyptian times, the art of medicine was mingled with religion. Egyptian physicians were co-equals of priest trained in schools within the temples. They often helped priests care for the sick who were brought to the temples for treatment. Egyptian medicine reached its peak in the days of Imhotep (2800 B.C.) who was famous as a statesman, architect, builder of the step pyramid at Saqqarah and physician. The Egyptians worshipped many gods. Specializatic prevailed in Egyptian times. There were eye doctors, tooth doctors etc. All these doctors were officials payed by the State. Homer speaking of the doctors of the a world considered the Egyptians to be the "the best of all".

Egyptians believe that disease was due to absorption from the intestine of harmful substances which gave rise to putrefaction of blood and formation of pus. They believed that the pulse was "the speech of the heart". Diseases were treated with cathartics, enema, blood-letting and a wide range of drugs. The best known medical manuscripts belonging to the Egyptian times are the Edwin Smith papyrus (3000-2500 B.C.), and the Ebers papyrus (1150 B.C.). Castor oil, tannic acid, opium, turpentine, gentian, senna, minerals and root drugs were all used by the Egyptian physicians. A great number of diseases are reported in the papyri such as worms, eye diseases, diabetes, rheumatism, polio and schistosomiasis.

Mesopotamian medicine 
Contemporary with ancient Egyptian civilization, there existed another civilization in the land which lies between the Euphrates and Tigris rivers called Mesopotamia (now part of Iraq), often called the "Cradle of Civilization", as long as 6000 years ago. 

Mesopotamia was the cradle of magic and necromancy. Medical students were busy in classifying "demons", the causes of diseases. Geomancy, the interpretation of dreams, and hepatoscopic divination (the liver was considered the seat of life) are characteristic of their medical lore. Sumerians, Babylonians and Assyrians were the authors of a medical astrology which flourished in the whole of Eurasia. Prescriptions were written on tablets, in cuneiform writing. One of the oldest medical prescription comes from Mesopotamia, dating back to 2100 B.C. 

Hammurabi, a great king of Babylon formulated a set of drastic laws known as the Code of Hammurabi that governed the conduct of physicians and provided for health practices. Doctors whose proposed therapy proved wrong ran the risk of being killed. Laws relating to medical practice, including fees payable to physicians and penalties for harmful therapy are mentioned in the Babylonian Code of Hammurabi.

Greek medicine 
The Greeks enjoyed the reputation as the civilizers of the ancient world. An early leader in Greek medicine was Aesculapius. He bore two daughters - Hygiea and  PanaceaPanacea and Hygiea gave rise to dynasties of healers (curative medicine) and hygienists (preventive medicine) with different philosophies. Hygiea (prevention) is at present fashionable among the intellectuals; but Panacea (cure) gets the cash. Aesculapius is still cherished in medical circles - his staff, entwined by a serpent, continues to be the symbol of medicine. 

By far the greatest physician in Greek medicine was Hippocrates (460-370 B.C.) who is often called the "Father of Medicine". He was born on the little island of Cos, in the Aegean sea, about 460 B.C. He studied and classified diseases based on observation and reasoning. He challenged the tradition of magic in medicine, and initiated a radically new approach to medicine i.e., application of clinical methods in medicine. Hippocrate's lectures and writings, as compiled later by Alexandrian scholars into the "Corpus Hippocraticum", encompassed all branches of medicine. This 72-volume work contains the first scientific clinical case histories. Some of the sayings of Hippocrates later became favourites with physicians, such as "Life is short, the art (of medicine) long, opportunity fleeting, experience treacherous and judgement difficult", and "where there is love for mankind, there is love for the art of healing". His famous oath, the "Hippocratic oath" has become the keystone of medical ethics. It sets a high moral standard for the medical profession and demands absolute integrity of doctors. Hippocrates will always be regarded as one of the masters of the medical art. Hippocrates was also an epidemiologist. Since he distinguished between diseases which were epidemic and those which were endemic, he was, in fact, the first true epidemiologist. 

In short, the Greeks gave a new direction to medical thought. The Greeks believed that matter was made up of four elements - earth, air, fire and water. These elements had the corresponding qualities of being cold, dry, hot and moist and were represented in the body by the four humors - phlegm, yellow bile, blood and black bile - similar to the "tridosha theory" in Ayurveda. The Greeks postulated that health prevailed when the four humors were in equilibrium and when the balance was disturbed, disease was the result. The human body was assumed to have powers of restoration of humoral equilibrium, and it was the physician's primary role to assist in this healing process. Outstanding amongst post-Hippocratic medical centres was Alexandria's huge museum, the first University in the world which sheltered a library containing over 70,000 books. To this house of learning came eminent men. Between 300 B.C. and 30 B.C., thousands of pupils matriculated in the school of Alexandria, which replaced Athens as the world's centre of learning. In short, the Hippocratic school inspired in turn the Alexandria school, and the Arabo-Persian medicine. The Hippocratic school changed the destiny of medicine by separating it from magic and raising it to the status of a science. 

Roman medicine 
By the first Century B.C., the centre of civilization shifted to Rome. The Romans borrowed their medicine largely from the Greeks whom they had conquered. While the politics of the world became Roman, medicine remained Greek. 

The Romans were a more practical-minded people than the Greeks. They had a keen sense of sanitation. Public health was born in Rome with the development of baths, sewers and aqueducts. The Romans made fine roads throughout their empire, brought pure water to all their cities through aqueducts, drained marshes to combat malaria, built sewerage systems and established hospitals for the sick. An outstanding figure among Roman medical teachers was Galen (130-205 A.D.) who was born in the Greek city of Pergamon in Asia Minor (now Turkey). He was physician to the Roman emperor, Marcus Aurelius. His important contributions were in the field of comparative anatomy and experimental physiology. Galen was far ahead of his time in his views about health and disease. About health he stated: "Since both in importance and in time, health precedes disease, so we ought to consider first how health may be preserved, and then how one may best cure disease". About disease, Galen observed that disease is due to three factors - predisposing, exciting and environmental factors, a truly modern idea. The doctrines of Hippocrates and Galen were often in conflict since their approaches were so different - one is synthetic, the other analytic. The author of some 500 treatises on medical subjects, Galen was literally a "medical dictator" in his time, and also for a long time thereafter. His writings influenced European medicine. They were accepted as standard textbooks in medicine for 14 centuries, till his teachings and views were challenged by the anatomist, Vesalius in 1543, and the physiologist, William Harvey in 1628, almost 1500 years after his death!

Middle ages 
The period between 500 and 1500 A.D. is generally known as "Middle Ages". With the fall of the Roman empire, the medical schools established in Roman times also disappeared. Europe was ravaged by disease and pestilence: plague, smallpox, leprosy and tuberculosis. The practice of medicine reverted back to primitive medicine dominated by superstition and dogma. Rejection of the body and glorification of the spirit became the accepted pattern of behaviour. It was regarded as immoral to see one's body; consequently, people seldom bathed. Dissection of the human body was prohibited. Consequently there was no progress of medicine. The medieval period is therefore called the "Dark Ages of Medicine". 
When Europe was passing through the Dark Ages, the Arabs stole a march over the rest of the civilization. They translated the Graeco-Roman medical literature into Arabic and helped preserve the ancient knowledge. Borrowing largely from the Greeks and Romans, they developed their own system of medicine known as the Unani system of medicine. They founded schools of medicine and hospitals in Baghdad, Damascus, Cairo and other Muslim capitals. Leaders in Arabic medicine were the Persians, Abu Beer (865-925) also called Rhazes and Ibn Sina (980-1037) known as Avicenna to the western world. Rhazes was a director of a large hospital in Baghdad and a court physician as well. Noted for keen observation and inventiveness, he was the first to observe pupillary reaction to light; to use mercurial purgatives; and to publish the first known book on Children's diseases. However, the work most highly regarded today is his book on smallpox and measles which he distinguished clinically. Avicenna was an intellectual prodigy. He compiled a 21-volume encyclopedia, the "Canon of Medicine", which was to leave its mark on medical theory and practice. He was responsible for elevating Islamic medicine to its zenith in the middle ages. The greatest contribution of Arabs, in general, was in the field of pharmacology. Seeking the "elixir of life", they developed pharmaceutical chemistry, introducing a large number of drugs, herbal and chemical. They invented the art of writing prescriptions, an art inherited by our modern pharmacists. They introduced a wide range of syrups, oils, poultices, plasters, pills, powders, alcoholates and aromatic waters. The words drug, alcohol, syrup and sugar are all Arabian. The golden age of Arabic medicine was between 800-1300 A.D.

During the turbulent middle ages, Christianity exerted a wholesome influence. The spread of Christianity led to the establishment of hospitals. Early medieval hospitals rarely specialized in treatment of the sick. Usually the sick were received for the purpose of supplying their bodily wants and catering to their spiritual needs. The first hospital on record in England was built in York in 937 A.D. With the growth of medicine, a chain of hospitals sprang up from Persia to Spain -there were more than 60 in Baghdad and 33 in Cairo. Some hospitals, like Cairo's Al Mansur had separate departments for various diseases, wards for both sexes, fountains to cool fever patients, libraries, musicians and story tellers for the sleepless. 

During the middle ages, religious institutions known as "monasteries" headed by monks, saints and abbotts also came up. These monasteries admitted men and women from all ranks including kings and queens. They not only helped preserve the ancient knowledge but also rendered active medical and nursing care to the sick.

Wednesday, July 4, 2012

Medicine and Society

From time immemorial man has been interested in trying to control disease. The medicine man, the priest, the herbalist and the magician, all undertook in various ways to cure man's disease and/or to bring relief to the sick. Medical knowledge in fact has been derived, to a very great degree, from the intuitive and observational propositions and cumulative experiences gleaned from others.

 A history of medicine thus contributes a review of accomplishments and errors, false theories and misinformation and mistaken interpretations. In the course of its evolution, which proceeded by stages, with advances and halts, medicine has drawn richly from the traditional cultures of which it is a part, and later from biological and natural sciences and more recently from social and behavioural sciences. 

Medicine is built on the best of the past. 

The "explosion" of knowledge during the 20th century has made medicine more complex, and treatment more costly, but the benefits of modern medicine have not yet penetrated the social periphery in many countries. The glaring contrasts in the state of health between the developed and developing countries, between the rural and urban areas, and between the rich and poor have attracted worldwide criticism as "social injustice". 

Currently, the commitment of all countries, under the banner of the World Health Organization, is to wipe out the inequalities in the distribution of health resources and services, and attain the Millenium Development Goals. 

The goal of modern medicine is no longer merely treatment of sickness. The other and more important goals which have emerged are prevention of disease, promotion of health and improvement of the quality of life of individuals and groups or communities. In other words, the scope of medicine has considerably broadened during recent years. It is also regarded as an essential component of socio-economic development.