Tuesday, November 06, 2012

2,600 B.C.: The birth of Rational Medicine

Editors Note:  The following post was rewritten here

Without knowledge of the human anatomy ancient men and women rationalized illness by the only means they understood, and that was by assuming it was caused by evil spirits, demons, the dead or the gods.  To them this was rational medicine. (1)  What they would call rational we refer to as magico-religious.  As we travel back in time in our quest to learn about asthma this is essential for us to understand.

To the modern asthmatic rational medicine is anything that truly makes breathing easier; it's medicine that has a real effect; it's civilized medicine.  According to Henry E. Sigerist in his book, "A History of Asthma," rational means "physical, dietic, and pharmacological treatments that are not mystical in themselves; it's also surgery; cutting with the knife.  They are generally treatments used by physicians, although they can work their way into the magico-religious."

According to historians rational medicine as we define it developed early on in Egyptian and Mesopotamian medicine, but developed over 1,000 years later in Ancient China.  The west often credits Imhotep, although most speculate physicians with their rational medicine existed long before the vizier and architect of King Djoser around 2,600 B.C.

Edward Withington, in his 1894 book "Medical History of the Art of Healing," describes the discovery of a tomb of Sekhet' enanch who was chief physician of the Pharaoh Sahura.  Inscriptions show he "healed the king's 'nostrils' for which his majesty wishes him 'a long life of holiness.'"

The tomb of Sekhet' enanch is dated to sometime around 3533 and 3000 B.C., as the physician is believe the pharaoh and physician were members of the 5th dynasty of Egypt.  He is the first known physician, although there is evidence of physicians before him.

Withington explains that the first physicians were probably medicine men.  In Egypt the "profession" was later divided up as specialties developed: Sorcerers specialized in magic, priests in religion, and physicians in civilized medicine.

Common ailments such as colds, asthma, headaches, and stomach aches may have been treated with herbal remedies, but the unexplained diseases were probably treated with magic. Wounds from war, bone breaks, lacerations were treated with surgery.  The type of medical treatment you receive is generally up to you, who you know, and/or your location. (4)

Empirico is defined as what we learn from experience and observation.  A good example is the asthmatic who is having trouble breathing.  One of his friends tosses Belladona leaves into the fire and this asthmatic just happens to inhale some of the smoke.  His breathing gets better.  He assumes it was the Belladonna that helped him.  He remembers this for next time.  He experiments.  He observes.  He tells his kids.

Belladonna is referred to as a herbal remedy.  It's natural, although even while so the "pharmacological aspect of therapy must be understood, however, in the context of the supernaturalistic paradigm: the medicines worked through magic, their effect depended on the recitation of the proper words and the performance of the correct actions. In fact, the consecration of the remedies was a significant part of the sacred utterances of the healer.  The potency of herbs was usually due to their relationship with gods or goddesses who were behind their curative powers." (1)

Many historians like to refer to magic and religious medicine as magico-religious and natural medicine as emperico-rational.  Magico-religious medicine will be explained further in another post.  Emperico-Rational medicine consists of natural remedies for natural diseases. Natural diseases are those that are normally occurring, such as your common colds, aches and pains, pneumonia, pleurisy, etc.  (2)

Natural diseases were generally treated with herbs, massage, broths, salves, etc. Herbs available included opium, coca, cinchona, ephedrine, caffeine, carcara, sagrada, chaulmoogra, digitalis, ipacacuanha, podophyllum, pyrethrum, squill, belladonna, and strammonium. While their effect may have been known, they knew not the why or how.  Generaly, the why and how was believed to be magical. 

In our modern world we see herbal remedies such as Belladona as rational: it may actually make you feel better.  Yet as we take into mind the scope of knowledge of primitive men and women, we must understand that even what we view as magico-religious medicine may actually have a rational or real effect. So in the scope of the primitive mind, magico-religious was rational medicine, according to Plinio Prioreschi. in his 1991 book "A history of Medicine."

It would be similar to you or me going to your priest for help with your hardluck asthma because your doctor has done all he can for you.  As far as medicine, you are on all the best medicine and it's not helping you.  So you seek a priest for guidance.  He may help you pray. He may help you find comfort.  In this way he may help soothe your mind.  In a sense, this is good medicine.  Studies even show those who "believe" get better quicker than those who don't believe. 

In fact, in 30,000 B.C. magico-religious medicine may even be better than emperico-rational. If you had asthma you may even prefer to seek out a priest or sorcerer over a physician.  Just think about it.  Your physician may prescribe you take Ipacec to vomit. He may prescribe an emetic to make you relieve your bowels.  These things can make you worse. 

On the other hand, while magico-religious medicine may offer no real remedy, at least it does no harm.  The best case scenerio is the placebo effect makes you think something is being done.  You feel better.  You relax.  Your breath comes back -- eventually. 

In this way, sometimes doing nothing is better than doing something stupid, which primitive physicians might do.  Now the physician may prescribe for you to inhale the fumes of dried and crushed belladona placed on heated bricks.  If he does you are in luck.  Yet if he prescribes something quacky you may have been better off calling for a priest or scorcerer. 

As both Henry E. Sigerist and Plinio Prioreschi wrote in their respective books on the history of medicine, primitive man developed magico-religous medicine first prior to developing emperico-rational medicine.  Ultimately the two paradigms existed side by side, and this actually continues to be true to this day as we have rational medicine working side by side with religion, as an example.  In China and India you see this to a greater degree.

Emperico-Rational medicine first started, as noted above, by trial and error by primitive men.  A societies further developed along the Tigris, Euphrates and Nile rivers medicine further developed into a specialty of physicians.  This is believed to have happened early on in Egypt and Mesopotamia, and over 1000 years later in China.

While the true birth of emperico-rational medicine probably happened early on, perhaps even early than 30,000 B.C., it was available by random people at random locations.  Knowledge was obtained mainly through word of mouth, mainly from parents, and perhaps through poems that were easily memorized.  Yet it's Imhotep, around 2,600 B.C. who is given credit as the inventor of rational medicine.  For this reason the year 2,600 is usually noted by historians as the birth of rational medicine.

Many ancient writings have made their way to us from around 2,000 B.C., although the information contained on these texts is much older, going as far back as 5,000 B.C.  The texts that we now possess are believed to be copies of copies of copies.  Even the originals were copies of what was at first handed down by word of mouth. So the knowledge goes way back, farther than what we might suspect.

Herodotus traveled the world to learn and write about the culture of other civilizations other than Greek.  He observed there were many different types of physicians in Ancient Egypt:
The practice of medicine is so divided among them, that each physician is a healer of one disease and no more.  All the country is full of physician, some of the eye, some of the teeth, some of what pertains to the belly, and some of the hidden diseases." (3)
Herodotus observed the Ancient Mesopotamians had a dislike of physicians, although this may actually represent the Greek view of Mesopotamia rather than fact.  Many records from history show Mesopotamia had many physicians and they were respected.  So rational medicine was widely available in ancient civilizations.

Homer wrote of the Egyptians that "each one is a physician, skilful beyond all men, for verily they are of the race of Paeon." (4, page 16) By this he may mean that every person, to some degree, had knowledge of medicine sort of like most people today have some knowledge of how to treat common colds, cuts, scrapes and the like.  Likewise, we all have some knowledge of medicine, with some salves, pills and lotions in our medicine cabinets.

In fact, Withington (page 16) describes the discovery of the medicine chest of Pharaoh Mentu'-hotep of the 11th dynasty around 2,500 B.C.  The chest belonged to his wife, and consisted of "six vases, one of alabaster and and five of serpentine, with dried remnants of drugs, two spoons, a piece of linen cloth and some roots, enclosed in a basket of straw-work, the whole standing in a wooden chest found in the queen's tomb."

Whithington explains this may be one example of the medical skills of the general population of Egypt that Homer was referring to.

So if you had asthma-like symptoms in Egypt, Mesopotamia, or China after the discovery of natural/ rational medicine, you now had the option of seeking out a priest or scorceror for your magico-religious treatment, or one of many different types of physicians for your emperico-rational treatment.  Although if you were among the primitive folks your priest or scorcerer would be just as rational, if not more so, than your physician.  Your choice.

References:
  1. Prioreschi, Plinio, "A History of Medicine," 1991, volume I, page 248
  2. Sigerist, Henry E, "A History of Medicne," 1955, second editionn, vol. I, 
  3. Prioreschik, op cit, page 365-6, referring to Herodotus, II, 84, Translation by A.D. Godley.  
  4. Withington, Edward Theodore, "Medical history from the earliest tiimes: A popular history of the art of healing," 1894, London, The Scientific Press, pages 14-23 (Chapter IV: Medicine in Ancient Egypt)

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