COMM 101: History of Medicine

• This document is about the history of medicine
• The lecture is for COMM 101
• The lectures were created by Khadeejah Liman Hamza of the Department of Community Medicine, College of Medical Sciences, ABU Zaria
• The creation date of the lectures is February 09, 2024

Course Objectives

• The goal is to describe the development and evolution of medicine through the ages, considering techniques, organization, and ideas
• History of medicine should be situated within the context of general world history, recognizing the link between medicine and culture
• To identify the contributions of historical practices to the current body of scientific medicine
• There is a need to demonstrate continuing research and development
• Medical truths of today may become ridiculous 'errors' of tomorrow
• The intent is to introduce aspiring doctors to the ethical and moral principles of the profession
• Course duration is estimated at 11-13 hours, with a CA examination after 6 hours of lecture
• The examination is scheduled for mid-March, anytime between the 4th and 9th, and will use CBT format, likely on a Wednesday or Saturday

Lecture Titles

• Why History of Medicine?
• Prehistoric Medicine and Medicine of Ancient Civilizations
• Greek Medicine (500BC-500AD)
• Medieval & Renaissance Medicine (500-150AD)
• Medicine in the 17th Century
• Medicine in the 18th Century
• Medicine in the 19th Century
• Medicine in the 20th and 21st Centuries
• Medicine in Nigeria

Medicine in Ancient Civilizations

• Ancient medicine history covers 3000 BCE to 500 CE
• It began with the development of writing systems and ends at the beginning of the post-classical period
• Socio-cultural and technological developments varied locally and globally
• Healing theories connected nature, religion, and humans through ideas of circulating fluids and energy
• Medicinal insights from prominent scholars and texts have been lost or destroyed over time
• The loss can be attributed to poor communication, localized reinterpretations, and inconsistent applications

Documentation of History of Medicine

• Writing developed independently in five locations:
• Mesopotamia
• Egypt
• India
• China
• Mesoamerica

Evolution of Writing

• Proto-literate cuneiform spread in the Middle East by 3400 BC
• Egypt created hieroglyphs by approximately 3200 BC
• The Indus Valley civilization developed the Indus script by 2800 BC, which is still undeciphered
• Writing in China was developed during the Shang Dynasty (1600 to 1100 BC)
• The beginning of writing in Mesoamerica can be traced to the Zapotec civilization in 600 BC

Mesopotamia

• This corresponds to present-day Iraq, Kuwait, Syria, Iran, and Turkey
• Civilizations included the Sumer, Akkadians (Assyrians and Babylonians)
• Mesopotamia means "between rivers," referring to the Tigris and Euphrates
• These rivers merge into the Persian Gulf
• Mesopotamia is known as the Cradle of Civilization
• Approximately 5,000 years ago, the first writing was developed and the first cities were built

Mesopotamia...2

• The Sumerians developed one of the earliest known writing systems
• They created numerous cuneiform clay tablets containing drug prescriptions, operations, and exorcisms
• Their ideas about medicine overlapped with science, magic, and religion
• Early Mesopotamian healing practices were a hybrid of naturalistic and supernatural belief systems
• Highly defined professionals administered and carried out these practices; including exorcists called âs[h]ipu, and physician-priests called asû

Mesopotamia...3

• The Sumerian civilization was conquered by the Akkadian Empire which then collapsed
• Babylonian civilization dominated the region, thus their medicine was dominantly known
• Babylonian medicine includes the extensive Babylonian medical text, the Diagnostic Handbook, by ummânū, or chief scholar, Esagil-kin-apli of Borsippa
• Details to the practice of diagnosis, prognosis, physical examination, and remedies were provisioned by this medical text
• Rationales to understand the causes of disease and injury were contained in the text
• The text contained supporting theories of that time that considered natural, supernatural magic and religious explanations
• Evidence supports practices of prophylaxis as measures to prevent the spread of disease, including isolation
• Recovered artifacts from the ancient Mesopotamian civilizations relate to Assyrians or Babylonians, the last empires ruled by native Mesopotamians
• Medical clay tablets are among the artifacts discovered

Mesopotamia...4

• The most famous ruler of the Old Babylonian dynasty was Hammurabi (reigned 1728-1686 B.C.)
• Hammurabi's code of laws is significant
• Thousands of inscribed clay tablets from this era exist, making it one of the best-known cultures of Near Eastern antiquity

Mesopotamia...5

• Civilizations of Mesopotamia exerted powerful influences on their neighbors, as well as subsequent centuries
• Hebrew, Greek, Christian, and Islamic cultures owe many debts to ancient Mesopotamia
• Some of the most famous early Bible stories have precursors in venerable Sumerian legend
• Mesopotamia's most important contribution to the world was the introduction of a writing system (attributed to the Sumerians around 3000 B.C.)
• Cuneiform writing was adapted by subsequent civilizations and used to preserve records and literature
• Clay tablets were found by the thousands among the ruins of Babylon, Mari, and Nineveh
• Many tablets list representative plants, animals, and implements and provide a rudimentary zoological and botanical survey of the area
• These tablets list the dynasties of rulers and major events; which have enabled historians to work out a satisfactory chronology for the era

Mesopotamia...6

• Innovations from Mesopotamia include:
• metallurgy
• the wheel
• the arch
• clock dials
• uniform weights and measures
• the sexagesimal system
• The Chaldeans, under Nebuchadnezzar, developed extensive astronomical information and astrology which was used in Greco-Roman, Arabic, and medieval medicine
• The Code of Hammurabi (c. 1700 B.C.) contained the earliest known regulations for medical practices

Ideas About Disease

• Mesopotamian cultures generally agreed on cosmology, despite differences
• Illness was a curse or punishment from the gods, potentially visited on the family or descendants
• A moral code was knowingly or inadvertently violated
• A realization of nonspiritual causes for illness may have existed, as physicians were admonished to avoid treatment for hopeless cases
• There were numerous deities, local patrons responsible for illness or cure

Ideas About Disease...2

• The three principal Sumerian deities were Anu, Enlil, and Enki
• Enlil's son, Ninib, was a healing god
• An important Babylonian god was Ea, Lord of Water and the first cosmic ancestor of physicians
• Ea's son Marduk was an influential god in Babylonian worship
• Marduk's son Nabu ruled over medicine; a temple was erected for him where a medical school developed
• Ningishzida, a healing god, is pictured with a double-headed snake as his emblem
• In the early Sumerian epic of Gilgamesh, a snake stole and ate the plant of everlasting life
• The snake immediately shed its skin and appeared rejuvenated, symbolizing regeneration and the cure of illness

Ideas About Disease...3

• Evil demons filled the spirit world and brought different diseases
• Nergal gave fever
• Ashakku gave debilitating consumption
• Tiu gave headache
• Namtaru gave throat ailments
• The Evil Seven who wandered about afflicting the unwary were especially feared
• Physicians did not treat patients on days of an illness divisible by seven because of these demons

Methodology of Healing

• Mesopotamian doctors depended on divination to uncover the sin committed by a sick person
• They learned the expiation demanded by the gods after the sin, and also observed patient symptoms assess seriousness
• A method of divination, hepatoscopy, involved detailed examination of the liver and organs of sacrificed animals
• Mesopotamians considered the liver to be the seat of life, as it appeared to be the collecting point for blood
• Clay models of livers with markings may have been used for teaching divination or to guide the priest
• Recitations, ceremonies, prayers, and sacrifices to beseech the gods for a cure were performed
• A pharmacopoeia of drugs was used in treatment
• Clay tablets reported illnesses with their symptoms, diagnosis, prognosis, treatment, and drug uses

Methodology of Healing...2

• Plants, minerals, and animal substances were the therapeutic agents
• These agents were administered by mouth, skin application, body orifices, vapor inhalation, or suppositories and enemas
• Oil was a balm for open wounds
• Medications were administered with rituals, the time of day, and the positions of constellations

Methodology of Healing...3

• No cuneiform tablets devoted exclusively to surgery have survived
• Surgical practices were common due to medical rules in the Code of Hammurabi related to surgical outcomes
• Wounds, abscesses, broken bones, sprained tendons, and brand marks of slaves fell in the province of surgery
• References to bronze lancets indicated the use of surgical instruments
• Few isolated archaeological recoveries of knives
• A possible trephine has been unearthed, but no examples of trepanned skulls found in Mesopotamia
• Trepanned skulls have been uncovered in nearby Judea, which got its medical knowledge from Mesopotamia

Practitioners

• Medical practice appeared to be in the hands of three types of priests:
• The Baru dealt with diagnosis and prognosis
• The Ashipu drove out evil demons
• The Asu acted as a physician, employing charms, divination, drugs, and operations

The Practitioners...2

• Healing priests were educated in schools associated with temples
• Their learning came from practical instruction and a large number of texts available on clay tablets
• The library of Ashurbanipal contained over 20,000 tablets by the seventh century B.C., discovered at Nineveh 150 years ago
• Extensive knowledge about Mesopotamian society, including medicine, comes from such tablets; recently unearthed tablets date back to Sumerian times

Practitioners...3

• The priest-physician primarily ministered to the court, nobility, and upper classes
• Barbers (surgeons) performed some surgical procedures and branded slaves
• Barbers also treated tooth disorders and performed extractions
• Veterinary practice was handled by either the low-class barber or the upper-class asu
• Exclusive healers for animals are not known
• Medical practice was regulated by laws
• The Code of Hammurabi devoted 10 statements (out of 282 provisions) to practitioner fees and punishments

Public Health and Hygiene

• Numerous instructions on clay tablets show that physicians treated a large number of ailments
• Ailments were listed and classified according to the location of the symptoms, rather than by disease entity
• Aches were in the head
• Eye and ear pains and swellings existed
• Tooth abscesses were present
• Chest problems included cough, pain, and spitting of blood
• Cramps, vomiting, and diarrhea were illnesses of the abdomen

Public Health and Hygiene...2

• Epidemics must have occurred often due to wars and invasions
• Plagues were reported in cuneiform tablets of the eighth century B.C.
• Fevers were mentioned frequently in medical texts
• Alexander the Great's shaking chills while campaigning in Mesopotamia in the fourth century B.C. may have resulted from malaria

Public Health and Hygiene...3

• A sick person was excused from work and service to the king
• The afflicted person was shunned to avoid transference of offending demons
• This relative isolation was hygienically beneficial although its purpose was based on religio-magical reasoning
• The taboo against touching the sick was carried over into Hebrew culture and became a key factor in public hygiene
• This is one further example of Mesopotamia's long-lasting influence on contemporary and later cultures (e.g. COVID-19)

Ancient Egyptian Medicine

• Ancient Egypt developed a mystic and priestly medical tradition that was large, varied and fruitful
• The Egyptians were considered "the healthiest of all men, next to the Libyans" because of the dry climate and established public health system
• Specialization characterized the practice of medicine
• A physician was a healer of one disease and no more
• Egyptian medicine used the supernatural but developed practical applications in anatomy, public health, and clinical diagnosis
• Medical institutions ("Houses of Life") are known to have been established in ancient Egypt as early as 2200 BCE
• Imhotep was considered a god of health

ANCIENT EGYPTIAN MEDICINE

• Imhotep was considered a god of health, and his name was placed in temples, sanctuaries, and sanatoria
• Life was associated with blood-controlled respiration
• Remedies included honey, onions, garlic, castor oil, yeast and animal fats
• Cleanliness and hygiene were believed to be required in the sight of God

Additional Notes on Ancient Egypt

• Medical information from the Edwin Smith Papyrus may date back to 3000 BCE
• Imhotep is credited with being the founder of ancient Egyptian medicine and the author of the Edwin Smith Papyrus
• This papyrus details cures, ailments, and anatomical observations and is regarded as a copy of earlier works written in 1600 BCE
• The papyrus is a nearly magical-thinking-free surgical textbook, describing the examination, diagnosis, treatment, and prognosis of ailments, including head injuries
• The Kahun Gynaecological Papyrus deals with women's complaints, including conception problems
• Thirty-four fragmented cases with diagnosis and treatment survive
• This papyrus dates to 1800 BCE, making it the oldest surviving medical text
• The Ebers Papyrus is the oldest written text mentioning enemas

Ancient Indian Medicine

• The oldest Indian texts that discuss medicine originate from Ayurveda, Unani, and Siddha medicine

• A summary follows: -The Atharvaveda, a sacred Hindu text from the Early Iron Age, discusses medicine and includes herbal prescriptions

  • Herbal use in treating ailments would form a large part of the later Ayurveda
  • Ayurveda means "complete knowledge for long life"
  • Its two most famous texts belong to Charaka and Susruta
  • Early foundations were built from traditional herbal practices and theoretical conceptualizations and therapies from communities of thinkers, including the Buddha
  • TheCharakasamhitā compendium states health and disease are not predetermined and life may be prolonged by human effort -The Suśrutasamhitā compendium defines the purpose of medicine to cure the sick, protect the healthy, and prolong life
  • Both compendia include details of examination, diagnosis, treatment, and prognosis of numerous ailments

• Suśruta samhitā contains various forms of surgery, including torn ear/nose repair and cataract surgery

• Susruta, known is considered the father of modern plastic surgery due to his rhinoplasty descriptions

• He also detailed more than 125 surgical instruments

• Susruta's medical treatise consists of 184 chapters, listing 1,120 conditions (including injuries and illnesses relating to aging and mental illness)

• Ayurvedic classics list eight branches of medicine: kāyācikitsā (internal medicine), śalyacikitsā (surgery including anatomy), śālākyacikitsā (eye/ear/nose/throat diseases), kaumārabhṛtya (pediatrics, obstetrics, gynecology), bhūtavidyā (spirit & psychiatric medicine), agada tantra (toxicology, stings, bites), rasāyana (rejuvenation science), vājīkaraṇa (aphrodisiac & fertility)

• Āyurveda students were expected to know 10 indispensable arts: distillation, operative skills, cooking, horticulture, metallurgy, sugar manufacture, pharmacy, analysis/separation of minerals, compounding of metals, preparation of alkalis

• Anatomy was part of surgery teaching; embryology was part of training in pediatrics and obstetrics

• Physiology and pathology were interwoven in clinical discipline teaching

• The teaching lasts approximately seven years with lifelong continuation to learn.

• Unani medicine gained royal patronage during medieval times in India and progressed during the Indian sultanate and mughal periods

• It is similar to Ayurveda, based on the presence of elements (fire, water, earth, air) in the human body

• Unani medicine states that elements in different fluids lead to health and imbalance leads to illness

• Muslim rulers built large hospitals in Hyderabad (1595) and Delhi (1719), and commentaries on ancient texts were written

• The Siddha System evolved in South India, especially in Tamil Nadu

• According to Siddha literature, Hindu God Shiva taught it to Parvati, who passed the knowledge to Nandi

• The Siddhar Agasthyar is considered the founding father, The original texts and treatise are written in Tamil

• Siddha views disease as the normal equilibrium of three humors mukkuttram (collectively called vaadham.airy).pittham , fiery) and kapam, watery) being disturbed; factors include environment, climate, diet, physical activities, stress

• , Diet and lifestyle play a major role in health and curing diseases in. Siddha medicine

• This is known as pathiyam and apathiyam is a rule-based system with do’s and don’ts. Herbal agents are prominent

• Siddha medicine has not been recognized by the Indian national government since 1953. Tamil Nadu state trains

History of Medicine

• It is a study of medicine throughout history
• It is a multidisciplinary field to explore medical practices throughout human societies
• The field incorporates anthropology, archaeology, economics, health sciences, sociology, and politics to understand the institutions, practices, people, professions, and social systems that have influenced and shaped medicine
• As a documentation of medicine over time, the history of medicine shows how societies have changed in their approach to illness and disease from ancient times to the present
• Early medical traditions were in Babylon, China, Egypt, and India
• The Hippocratic Oath was written in ancient Greece in the 5th century BCE and is a direct inspiration for oaths of office that physicians swear upon entry into the profession today
• Surgical practices were improved and systematized in Rogerius's The Practice of Surgery in the Middle Ages
• Universities began systematic training of physicians around 1220 CE in Italy

Why Medical History

• It helps to understand where we are coming from to chart our future course and allows for the provision of explanation for what exists today

The Hippocratic Oath

• It is an oath of office introduced by Hippocrates
• The second (Hippocrates II) of the name believed that diseases were caused naturally, not supernaturally
• He rejected superstition and upheld rational thought in healing
• He allied philosophy and medicine and separated medicine from religion
• He believed disease results from environmental factors, diet, and living habits

The Hippocratic Oath 2

• Hippocrates of Kos (c. 460 – c. 370 BC), or Hippocrates II, was a Greek physician and the "Father of Medicine"
• He is most well-known for clinical observation, and a systematic categorization of diseases
• He created the humoral theory
• The Hippocratic school of medicine revolutionized medicine during the period and it as a discipline separate from other fields with which it traditionally was associated , such as philosophy

The Hippocratic Oath 3

• The Hippocratic Oath, a seminal document on medical ethics/morality, is part of the Hippocratic Corpus
• The Hippocratic Corpus was attributed to Hippocrates but may have been written after his death
• The Hippocratic Oath is probably the most famous document of the Hippocratic Corpus
• It serves as a foundation for similar Oaths and laws that define medical practice and morals
• Modern medical graduates regularly take such derivatives of the Oath before entering medical practice

The Hippocratic Oath 4

• The oath introduces a doctor into the process of service to humanity
• It provides a doctor with the legality of practicing medicine
• It causes the doctor to realize the enormity of the responsibility they carry
• It requires the moral obligations of being a doctor
• "Doctor heal thyself" has now been included in the oath

The Hippocratic Oath 5

• There are ethical issues to consider, which include:
• Loyalty to the profession
• Service irrespective of economic or social status, race, or creed
• Holding oneself far from wrongdoing and corruption
• Avoiddoing harm (non-maleficence), promoting beneficence, respecting patient autonomy, and upholding consent, privacy, confidentiality, and justice
• Striving for moral satisfaction by doing a good job and doing one's best to help those in need
• Maintaining trustworthiness by keeping patient's secrets
• Refraining from conducting abortions
• Sharing knowledge
• Emphasizing disease prevention

Medical Symbolism

• The medical symbol of serpents wrapped around a staff is used in the field
• Another symbol is the caduceus (winged), in which the stick is actually a staff carried by Hermes
• In Greek mythology, Hermes was a messenger between the gods and humans and a guide to the underworld
• Hermes was the patron of travelers
• Physicians traveled great distances by foot to visit patients

"…on a stick"

• The actual depiction of the medical symbol is the staff of Asclepius
• Asclepius is the Greek demigod of medicine, son of Apollo and the human princess Coronis
• According to mythology restores health to the sick and brought the dead back to life
• The Greeks regarded snakes as sacred and used them in healing rituals for Asclepius
• snake venom thought to be remedial
• skin-shedding was rebirth and renewal

Assignment

• Required to use Times New Roman font, size 12, with single spacing
• The paper should be 4 pages( 2 sheets of paper please, no binding) and is due 2 weeks from January 27th 2024
• Groups of 10 are allowed, and each must sign and identify their individual contributions via name, and numbers
• The subjects are Sir Ahmadu Bello, Prof Umaru Shehu, and Prof Ishaya Audu, and the Hippocratic OathEvolution of the Ahmadu Bello University Zaria Medical School
• References and page numbering is also required

Prehistoric Era

• No written evidence that can be used for investigation into the prehistoric period of history by definition
• Other sources must be used, such as human remains and anthropological studies of societies living under similar conditions
• Human remains from this period are rare; many destroyed by burial rituals or made useless by damage over time
• The most informative archaeological evidence is mummies, remains which have been preserved by freezing conditions
• These bodies can provide information on subjects' (at the time of death): weight, illnesses, height, diet, age, and bone conditions
• Prehistoric people left paintings using mineral-based paints and brushes on the walls of caves

Stone Age

• The Stone Age was during which stone was widely used to make stone tools
• The Stone Age lasted for roughly 3.4 million years and ended with the advent of metalworking It therefore represents nearly 99.3% of human history
• The Stone Age is the first period in the three-age system frequently used in archaeology to divide the timeline of human technological prehistory into functional periods, with the next two being the Bronze Age and the Iron Age, respectively
• The Stone Age is divided into three distinct periods of the Paleolithic era, Mesolithic era and the Neolithic era

Bronze age

• The melting and smelting of copper marked the end of the Stone Age
• This occurred between 4000 to 2000 BC when bronze became widespread
• The term Bronze Age is used todescribe cultures that had developed techniques and technologies for working copper alloys

Prehistoric Medicine

• History of medicine examines the order of discovery of the significant developments in the history of medicine
• History of medicine investigates changing human beliefs concerning the causes of diseases
• Human beliefs about the causes of disease followed a logical progression from supernatural causes, such as the wrath of the Gods, to natural causes, involving imbalances within the human body
• During the pre-historical period, understanding was based on spirits and gods and no real medical care was given

Medicine

• Discoveries all occurred in a necessary and inevitable order
• the easiest discoveries being made first and the harder discoveries being made later
• The order of discovery determined the course of the history of medicine
• Is and is an example of how social and cultural history has to follow a particular course determined by the structure of the world around us

discoveries through the ages 2

• Prehistoric medicine is any use of medicine prior to invention of writing
• Writing documented history of medicine
• prehistoriMedicine encompasses periods and dates
• The study of prehistoric medicine relies on artifacts and human remains, anthropology
• Previously uncontacted peoples and certain ingenious peoples who live in ways traditional who have be the subject of anthropological studies in order to gain insight into both contemporary and ancient practices

discoveries through the ages 3

• Some diseases and ailments were more common in prehistory than they are today
• There is evidence that many people suffered from osteoarthritis
• (painful joints), probably caused by the lifting of heavy objects which would have been a daily and necessary task in their societies There is also evidence of rickets, bone deformity and bone wastage (osteomalacia) which is caused by a lack of vitamin D
• The life expectancy in prehistoric times was low, 25–40 years , with men living longer than women – archaeological evidence of women and babies found together suggests that many women would have died in childbirth accounting that results in lower life expectancy in women than men Another Possible explanation for shorter life span- also- men as hunters and women has more resisytance to certain desases that makes them live a better way

Treatment of Diseases

• Treatment of Diseases consisted of several things:
• Plant materials were used
• Earth and clay were used to support broken bones
• Surgery included: epanning/trephining, amputation
• Fracture support cast in clay, pincers