Hello my dear friends ! Before going further in this
giant saga I prepared just for you, I think it’s appropriate to give a definition of medicine. Indeed, medicine is a little bit about a battle against death, pain,
taking the other people into account, his sorrows, whether they are physical or psychological. But it’s also about helping with birth delivery, life, accompanying life, and it’s why medicine has been linked for a long time to
religion, spirituality, or even shamanism in some parts of the world.
We can also say that medicine is about men and women, who struggled,
led research and found and who delivered their knowledge
throughout the centuries in order to help people. So let’s go back together on a fairly ethnocentered history of medicine… Starting from when can we really talk about medicine ?
Indeed, it’s extremely difficult to answer this question since Writing appears
quite late in human history, and therefore, the tracks of medical practices before the invention of writing are fairly rare. However, we cannot deny that there have been precursors at a given time that, mostly due to chance by observing the nature and the effects of various plants on one’s peers, deduced that it was possible to ease a pain,
heal a cough or even to save a wounded man’s life. If the evidence are extremely sparse,
archeology revealed that the practice of trepanning, the act of piercing a hole in someone’s skull to acess his brain, is already successfully used around the Neolithic,
as some skulls that were found display marks of healing. Of course, the method was quite rudimentary, and we used a flint to do the trick, which may not have been the most
convenient nor pleasant for the patient. Anyway, we can think that some people who gathered medical knowledge, plants knowledge, etc, passed their experience orally to other people, and so on until some form of medicine foundation was laid in contemporary tribal communities.
Nowadays, we can qualify those people of healers, shamans, etc, who can use plants as a spiritual solution in order to attempt saving people. But once again, all of this is nothing but logical deduction, and we must wait until the start of Antiquity to make sure that these practices were really applied. The physical evidence that prove some form of
medical practice existed dates back to the Mesopotamian era, because it’s in this region that was first discovered writing. To be more specific, in Babylon, a text of law was found on an 1750 before our era (BC) stele. Quite a famous stele as it is the Hammurabi code that I mentioned during the
episode on death penalty, and that we can qualify as the very first text of law written black on white. In the code of Hammurabi, there are a little bit less than 300 legislation articles quoted, including the notorious Talion law that you can all quote “an eye for an eye,
a tooth for a tooth, …” and within these 300 articles, a dozen are about medical practice, and more specifically about surgery practices. But also and on the top of it, as it is a legal text,
the condemnations that doctors risked if they made a mistake, or even their honoraries.
It’s really from this point on that we can say that medicine as such exists, as its practice is recognized, and legally framed. So let’s be careful once again, the medicine we’re talking about is still fairly rudimentary, and even if we can correctly diagnose, remedies are not always adapted to the patient’s suffering. We can still point out that there is some sort of protocol
that is starting to be set up, because when a doctor receives a patient, he starts by asking him a whole bunch of questions before he starts to examine him,
just like doctors do nowadays. The main issue is that medicine and religion are both tightly bound
together at that time, and some questions are relevant but others aren’t. For instance “Did you lie recently ?” The goal here was to know if the patient had anything to blame himself for regarding the gods, and if it was the case, well then we could have the start of an explanation for his disease. Fortunately, doctors didn’t stop there and already at that time, doctors were able to recognize some diseases with practice, and they were
able to identify respiratory difficulties, intestinal issues, urinary issues, etc… And by the way, they also had rudimentary urine analysis techniques, of the smell of their patients’ breath, they were also able to take a patient’s pulse, his
temperature, which helped a lot when in medicine you wanted to start understanding the how and the why. However, it’s not rare that a prayer is prescribed in order to heal an illness, but it did not prevent the doctors from prescribing real remedies too. Therefore, we have a lot of indications concerning the plants and the prodedures used to heal the patients: ointments, syrups, plants mixing, alcohol, potions, burnt resins the patient had to inhale, well basically any kind of things that makes you think of grandma’s remedies that we use from time to time nowadays. Still, let’s quote bizarre methods used to treat some pathologies, like for instance, breathing difficulties that could be treated with deep enemas… Yup… There are also faeces, that were used as a mixture to heal a sore throat. I already mentioned it in my very first episode on old medicine stuff. Concerning the fractures, wounds and such, we can
also denote some medical skills because wars made many men wounded, and that all efforts had to be made to keep them is the best shape. Thus, we could already find splints, and it seems like some early surgery skills already existed in Mesopotamia. Speaking of surgery, there are also some writings that let us believe that cosmetic surgery was already used in Babylon, especially nose surgery as bone implants may have been attempted. Of course, medicine had a cost, and this is how we can realize that inequalities already existed at that time.
For instance, if a man was wounded by a spear, and that a doctor managed to save him, this man had to pay him 10 shekles. A shekle might not ring any bell to you, but at that time you could buy 50kg (~100lbs) of dates with 1 shekle, 2 shekles and you could buy a lamb, which is no small matter. And the annual salary of a slave -because yup, they were paid- was 3 shekles a year. 10 shekles therefore represented quite a substantial amount of money for someone who doesn’t have any. Therefore, the antique Mesopotamian society was not that much different from ours, as in some countries we can still observe the same issues in the Health services. Around the 7th century BC is created a huge library in Assyria, a region that is North of Mesopotamia: The library of Ashurbanipal. In this library were found official documents, literature, but also papers about scientific breakthroughs, with a major part talking about medicine. It’s the first place where doctors can come and learn about medicine with the help of writings written by other doctors. We can say that medical training had just been created. Although it is mostly a large-scale initiative, such documents already existed before this library was built, in order to pass on the medical knowledge. In Egypt we could also find such writings, like the papyrus Edwin Smith which dates from 1500 years BC and which is mostly about surgery.
At that time, it seems that the draft was used as a medical basis that could have military uses. We can find in it reports of fractures, wounds, crushing, etc…
and the way we could treat them like stitches, immobilisation, balms, etc.
What’s also interesting is that this papyrus differentiates what’s rational and scientific
on one side, and what’s religious and magic on the other one.
This is therefore the very first document that put the magical aspect aside to only focus on the practical aspect of trauma care. Of course, it was written around 1500 BC, but that doesn’t mean that those practices date from that time,
and as I mentioned earlier, we can almost be certain that they date from a previous time. We consider that the papyrus of Edwin Smith is actually a copy of other writings that may have disappeared, and whose original author might be the doctor and architect Imhotep during the 3rd dynasty, so around 3000 BC. Talking about that, there are many medical drafts at that time, and the majority of them are considered as being duplicates from other originals, which proves that we can trace everything quite far back, long before the first legal structure we mentioned in Mesopotamia. Those writings left the prints of doctors like Imhotep that we mentioned earlier, but also of female doctors like Peseshet, who would have worked around 2500 years BC, and who was the one responsible for midwives training. She may even have delivered midwives diplomas in a school created just to train this staff.
Child delivery was almost exclusively reserved for women until the beginning of the 16th century in France, I found it important to highlight it. All of this had of course a lot of meaning, since birth delivery was extremely ritualized in ancient Egypt society, and the contemporary practices required a lot of trained staff around the mother-to-be to help her deliver, almost exclusively female staff. If you want to know more about child delivery at that time, I invite you to dive back into my child delivery special episode, that I wrote and realized with Leo from Dirty Biology ! my child delivery special episode, that I wrote and realized with Leo from DirtyBiology ! Even if throughout the whole egyptian era that we just mentioned we can feel quite a space created with a more mystical aspect of medicine, well this space won’t get bigger with time, as we could have predicted it. Starting from the lower Times of 750 to 332 BC, the medicine becomes a bit more spiritual, a little bit less rational, which will develop almost until the end of the first millennium, around the year 30 BC. There is a massive proportion of priests in the healers, but that doesn’t exclude the doctors we called “sounous” in Egypt. The sounous were kind of the general practictioners, and many specializations also started to appear, with doctors for the eyes, the teeth, the belly, prothesists for amputees, and even doctors for the anus, kind of the ancestors of proctologists, who had quite an unusual title as they were referred to as “anus shepherds”. Among these numerous doctors, we can also observe some form of hierarchy emerging, with basic doctors, chief doctors, inspectors, and even the big chief doctor, the king’s doctor, etc… It is therefore quite a complex and complete medical system that existed in Egypt, considered by the way as a free public service for everyone, which is quite important to mention. Around the VIIth century BC in Greece, appeared the very first settled doctors who remained in the City to heal the sick. Depending on the Cities, their status differed as politics were extremely different from one city to another : In some Cities, doctors were considered as civil servants, paid by the state and who don’t charge the patients, while others in the same situation lived an extremely precarious life. The doctor moved from town to town to heal the sick, but also received people at home. The ancestor of the doctor’s office is therefore the doctor’s own house. It’s often equipped with beds to lay down sick people, but also with several tools to practice surgery, and tools to fix a little bit of everything. Around the VIth century BC, some evolutions shook up the traditional practices of medicine. Until that time, the other populations considered that the leading organ in the body, and that allowed one to live was either the heart or the liver. With the arrival of philosophers, especially Pythagora’s pupils, who wasn’t a mathematician only, we started to question this conclusion, and Alcmaeon, a doctor, concluded that it was the brain that was the real Master and Commander. His announcement was such a revolution in this field that most of his peers categorically refused to recognize the truthfulness of his words. Empedocles, a doctor born in Sicilia around the Vth century BC, addressed the issue of reproduction and foetuses. He deduced that the embryo is the result of 2 seeds, respectively the man and the woman’s, and that it grows in the uterus where the placenta is. He also studied the optimal periods of reproduction, bringing out the idea of what will be better known later under the name of ovulation. Finally, he created the Roots theory, which consists in believing that a man’s health rests on a subtle balance between several elements; but I won’t go further in the details. The most important thing to point out is that at that time, several theories will be developped and although they might not have always been exact, some of them, including the Roots theory will inspire immensely other future doctors. At that time, we could also see some methods of dissection appear, mostly on animals since they were forbidden on humans. The famous doctor Diogenes realized several dissections, which led to huge advances in anatomy, especially with drawings and sketches that led to a better understanding of the human body. Aristotle also contributed to make significant progress in medicine, especially with his draft on animals written in 330 BC, which helped us to better understand the functioning of our own body. One interesting thing to point out here is that, even if in a first time medicine tended to run away from religion, so did it from philosophy in a second time, which played a central role in the understanding of medicine, at the beginning of the Greek era. And we owe this to one of the most famous doctors in our history : Hippocrates. Hippocrates hypothesized that if someone’s ill,
it’s not because of the divine, but rather because of other factors such as food, climate, the environment, etc… This approach, even if it might seem quite rudimentary to us, changes many things because by definition if we become more rational against a disease,
we can also become more pragmatic in the treatment. Treating in hippocratic medicine most often consisted in rest, a lot of rest, and also some drugs, plants, …
In the case of fractures, it was often recommended to immobilize, and to combine it with machines that will help put everything back in order. These techniques often give positive results, in comparison with other schools of medicine. By the way, he didn’t reject the other schools at all, far from that, he’ll even -well at least the legends give him all the credit although they absolutely shouldn’t- compile all the contemporary medical data, out of any mysticism, just the way he wanted, in a huge corpus of texts that’s called the Hippocratic Corpus. We can find in it around 70 documents, including guides, oral presentation reports, researches, notes or even reminders.
We can easily see the importance of such a compilation as it could help future doctors to better understand and heal diseases and wounds. I precised that the credit thing was all a legend because we suspect his pupils and later doctors to have gathered all these writings during approximately one century. However, we can say that he is the one who initiated this project, but he’s not the author of it, or at least not the only one obviously. What Hippocrates also brought to medicine is a form or rigour in the way doctors analyzed and healed the patient.
For instance, he really attached a lot of importance on the conditions of a surgery : The positioning of the doctor, of the patient, the tools used, the assistants, etc…
What characterized Hippocrates was the procedure he implanted,
and after him, one could say that medicine way more professional. He also attached a primordial importance to ethics in his works, and this will later on give birth to the renowned “Hippocratic Oath”, that we all know and that every freshly graduated M.D. must recite nowadays, in order to swear to always show respect to the patient and to always practice medicine for the patient. There is however one slight change that was brought on this text, since the version that we have nowadays is most often a modified version, and the paternity of Hippocrates regarding this oath is sometimes questioned. Still, he participated in enhancing the vocabulary and the classification of diseases and pains. He used terms like “relapse”, or “peak” that are still in use today, and categorized diseases in different types : Acute, chronic, endemic and epidemic. By the way, if Hippocratic medicine is mostly based on the patient’s prognosis
-on the way the disease will evolve based on his current state-
he will also lay the foundations, with his pupils, of diagnosis, research, and investigating on the origins of the evil that eats the patient away. And this is also quite a progress since this is the basis for modern medicine. eats the patient away. And this is also quite a progress since this is the basis for modern medicine. Let’s get over with Hippocrates, since he doesn’t own the exclusivity of modern medicine, we can also point out that he might have been mistaken. For instance, his notion of medicine rested mostly on what he called Humorism, a theory influenced by the 4 elements theory.
Basically, the 4 elements, fire, water, earth and air had their equals in our body : Blood, Lymph, Yellow bile and Black bile. If all these elements are equally balanced in our body, we’re in good health; If the balance inclines on one side or the other, we’re sick. If the notion of balance can perfectly be used nowadays,
this theory is absolutely not applied anymore to explain and understand the patient’s disease. The issue with Hippocrates is that the influence of his work and of his medicine was so important, that medicine went through a sort of stagnation for a long time after his death. I’m not saying that there were no progress, but mostly the advances in medicine were far less abundant because everyone rested on his laurels. Sometimes, there were even declines, because we had difficulties questioning the amazing work of Hippocrates, which had still its own weaknesses. A few times later, in the continuity of Ancient Greece, the Roman Empire allowed new evolutions. And that’s pretty normal since the development of roman medicine is mostly due to the greek doctors who came and settled in, even before Greece was controlled by the Roman Empire. Fortunately for them, as before all of this, medicine was not particularly renowned in Rome; most of the families who already owned slaves didn’t see the point in owning one more slave who’s a doctor. Anyway, a private medicine system progressively set up with on one side doctors who could heavily charge their bills for their services, and on the other side some sort of public service, mostly ran around the IIIrd century. This public health service was made of doctors called the popular Archiaters, who were reunited into a guild, limited in the amount of available places depending on the size of the city,
their mission consisted in healing the poors. This formation was public, but many doctors also reunited in groups to practice medicine and try to make themselves known, since at that time there were no medical diploma, and only the doctor’s fame made his legitimacy. These groups were not opened to doctors only, since in Rome, midwives united for the first time in a corporation, to create an authentic entity, composed of general midwives and specialized midwives, who could offer a better care. Therefore, real entities start to appear each one with their own speciality, whether it is general medicine, birth deliveries, gladiator surgery, etc… But the other thing that made medicine develop in Rome were the military institutions. Indeed, Rome quickly understood the convenience to have doctors in his army to keep it in shape, to heal the fighters. Therefore, war doctors started to be trained, who had titles, sometimes were named non-fighting officers, and owned an important place during and after the battles. During the battles, some doctors were placed behind the front lines to evacuate the wounded, they were also in the middle of the action, in order to heal the soldiers in situations of emergency. And when a wounded soldier couldn’t be fixed on the battleground, there were ambulances, dragged by horses, that transported the patient to the nearest military hospital, usually located in the roman camp. that transported the patient to the nearest military hospital, usually located in the roman camp. These campaigns hospitals were also built according to rigorous plans, around a garden where several medicinal herbs could be found. They were made of several rooms, and each room had a distinct function in order to avoid infections. On one side is the waiting room, on the other side is the auscultation room, and eventually the morgue, the pharmacy, etc… Everything isn’t done in the same place. And this is one distinct feature of Roman medicine, meaning the importance granted to hygiene. Whether it is living hygiene, or the cleanliness of the water used to drink, wash, clean the wound, etc… By the way, it’s interesting to see that in Roman surgery, which was extremely developed at that time since we’ll have to wait more than 1000 years to have more sophisticated tools and procedures, we boiled the surgery tools before we used them, while we ignored the very existence of bacteria. Therefore, we sterilized the tools and reduced the risks of contaminations and infections. As we said earlier, one of the most famous doctor in history is most certainly the Greek Hippocrates, but the Romans also had their big names in medicine,
3 doctors in particular : Dioscorides, who wrote a 5 volumes work and laid the foundation of modern Pharmacopoeia, one of the most important books at the time.
Soranus of Ephesus who wrote one of the most complete books in Antiquity about women’s disease and gynecology and finally Claudius Gallienus, who was Greek but spent a majority of his life in Rome, and who simply laid the foundation of western medicine for more than 1000 years. That alone. He also made an observation of the utmost importance on anatomy, in perfect accordance with the methods of the Renaissance doctors : “I claim that the doctor must know how in itself is each and every bone, and how it is assembled with the others, if he wants to heal correctly their fractures and dislocations.” We could say as much about Gallienus as we said about Hippocrates, but we’ll settle for the fact that his work is huge on every domain of medicine, but also on mathematics, philosophy, and many other domains. Unfortunately, a major part of his work got lost during the fall of the Roman Empire. My dear friends, this first part is finished, but what will happen at the fall of the Roman Empire ? How did Europe as it is nowadays handle this crisis ? Did that have an impact on medicine, and if so, how ? Well, we’ll see that in the second part of this episode on medicine. In the meantime, thank you all for watching this video, I invite you to join me on the social networks, and on Tipeee if you ever want to support me in this adventure. Thank you all, see you next time !