Medical Practices of the Ancient World

“If a physician performed a major operation on a seignior with a bronze lancet and has saved his life…he shall receive ten shekels of silver…”

If a physician performed a major operation on a seignior with a bronze lancet and caused the death of the seignior…they shall cut off his hand…”

From Akkadian texts concerning medical practices using a knife. Hammurabi, 1700 BC

Trepanation. Known from sites as early as 2000 BC.

Brain surgery.

Trepanation involves removing a section of skull to have access to tumors or to relieve pressure. Also lets out malignant spirits.

Summary of main points

Medical practices traceable to neolithic (besides shamanism).

Hard to know how effective most remedies actually were.

Potential that many provided some relief.

Clear efforts to discover and pass on knowledge

No theory of germs in the past.

Surgeries were frequently successful.

Specialized class of physicians enjoyed high status.

Many ancient remedies survive to this day in modified form.

Although our best knowledge of ancient medical practices date from classical Greek and later Roman periods, we have evidence of different treatments and diagnoses as early as 4000 BC.

Considerable evidence that if someone had a disease or illness it was perceived to be their own fault, they had committed sin, or some outside agent or spirit was to blame; therefore a physician could not be held accountable for failure—but recourse was to call on higher forces for aid.

Four main river-valley civilizations Egypt Indus Mesopotamia China

Each developed specialized medical practices. Some are in use today or formed the basis of modern practices.

Ancient Greek surgical gear. You don’t want to know…

Evidence

Texts Skeletal remains Tomb carvings and

paintings Folk legend Living practices

Tomb carvings of physician depicting medical tools.

Surgical instruments.

Cuneiform texts include words for wounds, drugs, illness, cure, tumor, ulcer, sores

Much is written about diagnosis. Texts describe treatment options that vary

from primitive first-aid to sorcery.

No evidence of a concept of bacterial, viral, or germ theory.

Cuneiform tablet dated to 2158 BC includes oldest known descriptions for wound dressings.

A mix of red wine, honey, myrrh, and camphor.

Research in ancient medicine

Text based Clinical trials Ethnographic Anthropological

Guido Majno, MD, PhD

Biomedicalanthropologist

Scientific validation

Honey is rich in antibacterial agents, as is myrrh. Tannins in red wine also have practical medical value. Myrrh and red wine mixed together constitute a strong sedative.

Myhrr has strong antiseptic properties released in the presence of alcohol.

Medicines

Oldest Egyptian papyrus was written in 1850 BC. Several medical papyrus survive.

Many medicines contain natural ingredients which contained suitable compounds for treatment.

Magic still had a major role in diagnosis. No evidence physicians understood why a

particular treatment worked.

Egyptian temple relief painting showing the harvesting of myrrh.

Written in stone

Hammurabi codified law, and among them were laws governing medical practices. From around 1700 BC we have the first account of a medical malpractice suit.

However, of 150,000 administrative texts

recovered so far, only two are medical tablets (by contrast, they wrote an entire book on beer making—19 types).

Myrrh

Egyptians used Myrrh from at least 2500 BC and a text describes using it to treat battle victims in 1350 BC.

Herodotus states it was favorite among the Persians 5th century BC.

Greek Hippocrates prescribes it 54 times in his medical books and the Roman Celsus in the 1st century AD uses it mixed with wine for burns.

Antiseptic qualities of wine and beer were noted. One Sumerian treatment for a wound included washing the wound with juniper mixed in beer and hot water.

Organ knives. Egyptian

Greek medical pots for preparing ointments and brews.

Concoctions include mud from the river. Muds are known to contain microbes and

anti-bacterial agents. Many modern medicines are derived from muds.

(Paleobotanicalpharmocology) new science of seeking natural medical remedies from the past.

The Assyrians

Developed an extensive pharmacology using plant roots, distillates and resins.

Items include: pine, spruce, honey, wine, myrrh, essence of cedar, fat from male sheep kidneys, glasswort.

Many drugs were processed from a class of plants that gave ashes rich in alkali. (Arabic word al-quali “the [plant] ash”).

Other recipes include turpentine, copper*, spices, lead residue, and arsenic.

Inclusion of copper powders, derived from malachite ores, were antiseptic. Since infection was among the leading causes of death after a wound, using a balm that included copper may have prevented infection and saved lives.

Greek Developments

Experiments in medical practices were combined with traditional methods. Considerable effort to properly diagnose illnesses.

Physicians code of “first do no harm.” recognition that in many cases patients did better when left alone.

Homer describes a physician examining the spear that caused a wound in order to diagnose and predict infection.

Aside from obvious injuries requiring attention, most medical diagnoses was based on the physicians assessment of a patient’s temperament.

Binding the wound of Achilles. But alas…

Ever popular

blood-letting. The use of leeches is again in popular practices, as is the use of flesh eating larvae.

Greek

Spoon of Diokles (for removing projectile points and spears)

Surgical tools. Don’t ask.)

Salves, ointments, concoctions Most have a base such as honey or fat. Herbs and spices were also added to salves.

Modern salves are little different…a medicinal antiseptic added to a binding agent…Neosporin.

Around 400BC Hippocrates describes a powder made from tree bark and willow branch resins. (Contains salicia—ingredient in acetylsalicylic acid, aka: aspirin)

Indus

Clear evidence of early dental surgery. Indus people may have invented the bow-drill

for bead work and applied it to dentistry. Earliest evidence is from 4000 BC in the form

of skeletons with indications of dental work. Several examples of cosmetic surgery known

from the Indus civilization.

4200 year old dental office, Egypt. Tomb commemorates three dentists.

Earliest bridge. Egypt

Dental drill. Same type for drilling holes in stone beads.

The next time you visit a dentist be thankful for high powered drills.

Indus cavity drilling technique.

Roman innovations

Romans perfected the production of false teeth using metals, bridges, carved ivory, modified animal teeth, and caps.

Invented the modern hospital, wards, central receiving, surgical areas and recovery rooms.

Traded with India for eye salves and medicines. Good archaeological evidence.

Experimented with natural pain killers, like henbane (a powerful and toxic herb).

Because of battlefield injury and gladiator contests, Roman physicians had considerable knowledge about human anatomy—knowledge lost after the collapse of the empire and not regained until the late 18th century AD

(The Church forbid dissection and so European doctors could not study human bodies, and so adopted and relied on the faulty understanding of the ancient Greeks)

Roman surgical kit, 1st century AD

From the coliseum.

China

Herbal medicines and early trials at acupuncture which may have developed from the practice of medical tattooing.

From about 1000 BC Chinese medical knowledge was being written down and included a massive herbal pharmacology.

Acupuncture has been shown to be a complex form of neurosurgery.

Centuries of practice have refined the practice and located specific “trigger points.” Still, a certain degree of spiritual/cosmological elements remain part of the “science.”

Chinese medicine more than needles Tremendous pharmacology developed Surgical practices were not as advanced as

Mesopotamia, but patient treatment was superior by any standard and included a sophisticated understanding of diet and health.

Modern Chinese medicines based in ancient traditional practices.

Continuity of practices to the present have encountered new resistance in various markets owing to what is viewed as exploitation of endangered species.

Parallels

Ancient Chinese and later Greek medicine were based on the concept of “balance” within the body.

For Chinese there was a relationship between the five elements metal, water, wood, fire, earth.

For the Greeks the elements were fire, water, air (wind), earth. Would evolve into the “humors” of European medicine.

Carry over into modern times… This concept of balance plays out in medical

diagnosis and treatment. Oppositions and complimentary character of treatment were the physician’s responsibility.

The philosophy carried into near modern times as ailments were diagnosed as “cold or hot”, “wet or dry” etc., and treated by methods thought to balance the ailment.

Both Greek and Chinese medicine recognized the mental state of the patient as critical to recovery. One Chinese text reads: “…if the patient does not exhibit the will to live…do not accept the case.”

A Greek treatise reads: “…to treat the body without also treating the mind…will be unsuccessful.”

The elements manifested in man as “temperaments” to be treated accordingly.

Purges were administered to regain balance between the humors. May involve induced vomiting, enemas, blood letting using leeches and vein opening, or sweating. (If the illness didn’t kill you the treatment might).

Diagnosis depended on attitude and other factors.