How did Medicine develop in the Ancient World?


Edwin Smith Papyrus

Early medicine developed in a number of societies, both in the New and Old Worlds, as populations around the world were able to quickly learn that plants that grew around them often have natural healing qualities and health benefits. Several regions around the world, which had early complex societies, have left us evidence or documents that describe some of the relatively sophisticated medical techniques or practices that developed at early dates.

Egypt and Mesopotamia

Egypt and Mesopotamia arguably developed the first true urban and complex societies anywhere. As these societies were literate at an early date, we also obtain relatively early information about important medical knowledge already known in the ancient world.[1]

In both Mesopotamia and Egypt, healers or what are equivalent to physicians had exists probably by the 3rd millennium BC. However, these early physicians were often priests who integrated their healing practices with medical techniques as well as religious practices, including prayers or even forms of exorcisms.[2]

The Edwin Smith papyrus (ca. 1600 BC; Figure 1) is a famous example that is the first known text to deal with traumatic injuries, perhaps even battlefield wounds.[3] It also deals with dislocations, tumors, and bone fractures. The text provides diagnoses of different injuries and ailments, where the physician, unlike most other Egyptian texts, proceeds with a more scientific approach. The physician seems to understand the concept of a pulse and diagnosis of specific ailments; different treatments are prescribed such as bandaging, suturing the wounds, and stopping the bleeding.

The Ebers papyrus (c. 1550 BC) is a more magical text but has hundred of remedies, including with how to deal with psychological problems such as depression and dementia.[4] There is clear knowledge of the circulatory system and the heart’s central role in circulation of blood; such knowledge may not be surprising given Egyptian practices of mummification and extracting organs. Different eye, skin, and parasitic ailments are understood and medicines would be applied, such as the use of ochre. There were method for birth control, such as using a paste of dates, while the treatment for guinea worm disease includes using a stick for extraction by wrapping the worm, a process still used today (making it one of the longest-lived treatments known to us). One of the oldest relatively complete medical texts anywhere is the Kahun Gynecological papyrus (c. 1800 BC).[5]

Babylonian tablet dealing with medical prescriptions

The text mostly deals with women’s’ ailments such as gynecological diseases, fertility, pregnancy, contraception, and other areas. None of the treatments are surgical and all deal with applying medicines to different body parts to address the ailment. From other texts it is clear there was an understanding of things such as excessive bleeding, burns, skin problems, eye infections, and other sicknesses. These involved both combinations of magical rituals but also practical treatments including medicines, applying bandages. Surgery was carried out as well; bronze surgical equipment have been found in a tomb and it is known different tools have been used. Surgery was seen as more risky and was probably not considered the first option.[6]

In Mesopotamia, by 1800-1600 BC many texts had existed that dealt with medical issues; medicine here was clearly very This includes texts that we can describe as medical textbooks, where groups of tablets together formed a volume that was likely used as a reference for physicians. In fact, these texts would have sections on diagnosis as well as sections on prognosis and treatments.[7] What is surprising is the amount of emphasis put on observation before diagnosis in Mesopotamia, with prescribed treatments given in cases where the ailment is known. While omens and magical practices formed a large part of medical practices, it is clear there was an empirical side to medicine, with one physician focused on the magical aspects of healing and the other on the more practical methods of healing including providing medicines and other treatments.

Innovations such as medical ethics can be seen in the Law of Hammurabi (c. 1750 BC), for instance, where punishments against medical practitioners would be done in cases of failed surgeries or improper treatment.[8]Infections that could spread were understood and people stricken would be quarantined.[9] Medicines were well developed and long lists of different types of medicines are known, in essence a form of pharmaceutical lists, some of the earliest known anywhere (Link below). We can deduce that the Babylonians, perhaps roughly contemporary with the Egyptians, had created the concepts of diagnosis, prognosis, physical examination, and prescriptions by the 2nd millennium BC. Similar to Egypt, surgery was practiced, including c-sections performed on women, while removal of boils or skin ailments were done as well.[10]

India

In India, at about 1000 BC, we begin to see that medical knowledge was established in the form of the Atharva veda, a type of medical text similar to those in Egypt as it had a combination of magic and belief in demons along with practical medical knowledge. For instance, there seems to have been a developed knowledge of treating leprosy using lichens, which could provide some practical results, while at the same time attributing the ailment to demons. We also know by 500 BC, surgery was well developed, including the practice of extracting teeth, fixing broken bones, and even clearing the intestine.[11]

China

China had also developed similarly in combining magical aspects of healing, where spells would be recited, along with practical knowledge of using herbs, cauterizing, and using surgical techniques. Interestingly, by 100 BC, there seems to have been a shift away from the earlier ideas of demons making you sick to making medicine a more empirical-based study, although philosophical concepts still dominated. At this time, the concept of yin and yang was developing and imbalances in lifestyles were seen as possible reasons why people became sick. Such imbalances could be overeating, not exercising, which were considered lifestyles that can cause ailments. We now see exercise, in addition to herbal medicines, and acupuncture being utilized as part of the medical practice.[12]

Greece

Most of our knowledge of ancient Greek medicine derives from Hippocrates and his work developed between 470-370 BC. While some of his work, such as the famous "Corpus," were likely influenced by earlier Mesopotamian and Egyptian medicine, one clear contribution, whether it was Hippocrates or one of his associates, is the establishment of medicine as a distinct area that began to be more separate from religion.[13] Although we had seen hints of this in Mesopotamia and Egypt, we know by this time it began to be truly studied for its own benefit rather than as part of religious beliefs, although philosophy and unsubstantiated ideas continued to be very influential, such as Humorism (i.e., belief that four fluids in the body control health).

Summary

What we can see is that medicine developed most likely in many societies. In Egypt and Mesopotamia, it became a profession, although generally associated with priests and their sets of religious practices. Advanced knowledge in surgery, medicines, treatments, diagnosis, and empirical observations, nevertheless, were made by these societies. This knowledge is also evident in India and China. However, by the time of Hippocrates, whether it was him or someone else, we begin to see that medicine becomes a separate field independent of religious practices.


References

  1. For more information about Egyptian medicine and knowledge, see: Nunn, J. F. 2002. Ancient Egyptian Medicine. Norman: University of Oklahoma Press. For information about Mesopotamian medicine, see: Geller, Markham J. 2010. Ancient Babylonian Medicine: Theory and Practice. Ancient Cultures. Chichester, West Sussex, U.K. ; Malden, MA: Wiley-Blackwell.
  2. For information about priests and their involvement in medical practices, see Sigerist, Henry E. 1987. A History of Medicine. Publication / Historical Library, Yale Medical Library, no. 27. New York: Oxford University Press.
  3. For information on this text, see: Sanchez, Gonzalo M., Edmund S. Meltzer, Edwin Smith, and W. Benson Harer, eds. 2012. The Edwin Smith Papyrus: Updated Translation of the Trauma Treatise and Modern Medical Commentaries. Atlanta, Ga: Lockwood Press.
  4. For information on this text, see: Ancient Egyptian Medicine: The Papyrus Ebers. 1974. Chicago: Ares Publishers.
  5. For information on this text, see: Halioua, Bruno, and Bernard Ziskind. 2005. Medicine in the Days of the Pharaohs. Cambridge, MA: Belknap Press of Harvard University Press, pg. 177.
  6. For general information on surgery, treatments dealing with bleeding, infections, and other ailments and treatments, see Nunn 2002.
  7. For information on medical texts and how they were utilized, see: Scurlock, Jo Ann, and Burton R. Andersen. 2005. Diagnoses in Assyrian and Babylonian Medicine: Ancient Sources, Translations, and Modern Medical Analyses. Urbana: University of Illinois Press.
  8. For information on patient isolation, see: Scurlock and Andersen. 2005, pg. 218.
  9. For information about Hammurabi’s code and its approach to medical ethics, see: Carrick, Paul. 2001. Medical Ethics in the Ancient World. Washington, D.C.: Georgetown University Press, Pg. 72.
  10. For aspects of Babylonian medicine that is evident, see: Geller 2010.
  11. For details on key Indian texts and medical knowledge, see: Zysk, Kenneth G. 2010. Asceticism and Healing in Ancient India: Medicine in the Buddhist Monastery. Corr. ed., reissued. Indian Medical Tradition 2. Delhi: Motilal Banarsidass.
  12. For a recent evaluation of ancient Chinese medicine, see: Liu, Guohui. 2015. Foundations of Theory for Ancient Chinese Medicine: Shang Han Lun and Contemporary Medical Texts. London ; Philadelphia: Singing Dragon.
  13. For information on the contributions of Hippocrates, see: Kosak, Jennifer Clarke. 2004. Heroic Measures: Hippocratic Medicine in the Making of Euripidean Tragedy. Studies in Ancient Medicine, v. 30. Leiden ; Boston: Brill.

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