HISTORY OF MEDICINE
Rachel Hajar, MD, FACC*
“Formerly, when religion was strong and science weak, men mistook magic for medicine; now, when science is strong and religion weak, men mistake medicine for magic.”
Thomas
Szasz
At the dawn of the 21st century, we stand at
the threshold of a new age.
Technology
has opened up a brave new world that is rapidly changing our way of life.
The influence of technology is greatest in the field of medicine:
robotic surgery, gene therapy, tissue engineering and stem cells to grow new organs to replace malfunctioning or failing organs.
The most recent arrival on the scene is nanomedicine, which promises to revolutionize the practice of medicine by developing supercomputers the size of a human cell.
Their miniature size would enable them to patrol the body in search of disease and effect repairs at the cellular level.
It may sound like science fiction but the incredible progress in technology over the last decade has blurred the distinction between science fiction and reality.
It will change how people interact with their physicians.
These are intensely exciting times for medicine. We hope and dream of curing disease, reversing the aging process, and prolonging longevity.
Technology promises to make those dreams reality.
However, despite the brilliant advances in diagnosis and treatment of disease over the last fifty years and the exhilarating promise of technology, we shall never be able to prevent death – the inevitable end of any living organism. Hence, medicine will continue to be palliative and caring.
The word medicine comes from Latin medicinus or medicina and refers to a person, agency or influence that affects well-being.
Webster’s Third New International Dictionary defines well-being as a condition characterized by happiness, health, or prosperity; in other words, the good life.
Thus, medicine does not deal only with disease but touches every field of human activity and thought.
Although methods of science are used to combat disease, medicine is a social science (1).
By promoting health and preventing illness, medicine keeps individuals adjusted to their environment as useful and contented members of society.
Or by restoring health and rehabilitating the former patient, it helps to readjust individuals to their environment.
Underlining the social character of medicine is the fact that in all medical actions, there are always two parties involved: physician and patient.
They meet not only as individuals but also as members of society with obligations toward it.
Since Life and Death are central themes, the quest for meaning in life inevitably arises.
As Aristotle stated 1600 years ago, "One might begin with philosophy but would end with medicine or start with medicine and find oneself in philosophy".
The ideas of the great philosophers, Plato and Aristotle were among the important influences that shaped modern Western medical theories.
"There are only two classes of mankind in the
world – doctors and patients", so wrote Rudyard
Kipling in A Doctor’s Work.
But it was not always so.
Disease must be as old as life itself.
The origins of medicine are lost in the mists
of time but some tendencies in medicine seem to
be instinctive, for animals as well as people
(1).
Animals follow their instincts when ill – they
lie down or eat certain plants.
The dog taken by a fever seeks rest in a quiet
corner, but is found eating herbs when his stomach
is upset.
Gorillas and chimpanzees purposefully eat several
types of plant that are effective against intestinal
worms, joint pains, and other conditions (2).
Nobody taught them what plants or herbs to eat.
More than once, I observed our family cat eating
the rose petals from a flower bouquet in my library.
It was a source of constant perplexity for
me until I found out that for centuries, in the
Islamic world, rosewater has been used for medicinal
purposes and was widely used as a remedy for eye
infections and colds. Although not generally known,
rose hip contains vitamin C more than any other
fruit or vegetable, and hence very effective in
combating infection (2). Cats bury their feces
carefully and lick themselves constantly to keep
clean and free from parasites. The water buffalo
and other cattle immerse themselves in water not
only to keep themselves cool but also to keep
insects and parasites off. Other animals roll
themselves in mud to cover themselves with a protective
layer. Stone Age people, living in caves, must
have struggled against parasites too, and must
have instinctively tried to keep clean by bathing
in rivers and lakes. The fight against parasites
is rooted in hygiene. Cleanliness is the first
defense against many acquired diseases.
Like other animals, man also behaves instinctively
to preserve the integrity of the organism. So,
in health as in illness, man sought the animal
parts, plants and minerals that his body required
for sustenance and to overcome illness (1). There
is no sharp distinction between food and drug.
For example: Figs are food, but eaten in large
quantities they act as purgative.
Citrus fruits are food to the healthy individual
and a specific remedy to one suffering from scurvy.
Experience and observation are apparent in the
way we deal with illness, even today in our sophisticated
society. For example:
The migraine sufferer will avoid certain foods,
bright lights, noise, heat, and lack of sleep
because he would have noted that they bring on
the headaches.
Likewise, a person with peptic ulcer would avoid
certain foods such as hot, spicy foods, coffee,
etc. since he would have experienced that such
foods trigger the stomachache; or he may have
noticed that drinking milk relieves the pain.
For centuries, people in the Arabian Gulf applied
neel, a plant based blue-colored poultice to treat
heat rash.
In addition, Arabian Gulf women covered themselves
during the summer months with neel to protect
their skin from the sun. The older generation
claims that it was soothing and kept their skin
soft and light.
Today, dermatologists advise people to apply sunscreen
lotion over their bodies as protection from the
harmful effects of the ultraviolet rays of the
sun. Through a combination of instinct, experience,
and observation, man discovered healing herbs.
As an example, the African herbalist teaches his
students or trainees to listen to various sounds
while in the forest and to observe the behavior
of animals such as rodents, lizards, chameleons,
snakes, birds and insects. To stress his point,
the trainer narrated his observation of a fight
between two chameleons.
At the climax of the fight one of the chameleons
passed out.
The other quickly dashed into a thicket and came
back with a piece of leaf in its mouth.
It forcibly pushed the leaf into the mouth of
the unconscious lizard.
In a matter of two to three minutes the defeated
chameleon shook its body and took off (3).
Not surprisingly, the herbalist claims that that
specific plant "can spring a dying person to life"
and will not disclose the plant's name except
to "those who become one of us", after proper
initiation and training. Almost all primitive
people possess considerable drug lore.
The healing properties of many plants are discovered
by chance.
An English man suffering from arthritis made the
first written account of the analgesic properties
of the willow tree in the mid-18th century.
Frustrated, he accidentally chewed on a twig of
the willow tree.
He was amazed that despite its "extraordinary
bitterness", it relieved his arthritic pain (4).
But the willow is listed in the herbal remedies
in the Ebers papyrus of ancient Egypt (5) and
the ancient Greeks had been using the powder from
willow bark to ease aches and pains and reduce
fever (6).
Not too long ago, (only 225 years ago – less than
the blink of an eye in the history of mankind),
William Withering learned the healing effect of
foxglove in congestive heart failure from an old
woman.
One of his patients was dying; he thought the
case was hopeless. But the patient, unwilling
to give up, took a gypsy brew, and got better.
So, Withering hunted down the gypsy and asked
what was in that magic potion. He found that the
vital ingredient was foxglove (7).
Thus, from such chance encounters, people from
different cultures in time and space learnt of
the therapeutic properties of plants and certain
actions.
As Louis Pasteur famously remarked "Where observation
is concerned, chance favors only the prepared
mind." Archaeological evidence reveals that not
only did Stone Age people have considerable knowledge
of healing herbs, intoxicants, and other plants;
they could also set fractured and broken bones
(8).
Other healing methods that are found universally
in different cultures are trepanation and phlebotomy.
Bleeding as a method of treatment was so widespread
and early observations probably contributed to
its rapid development as a standard form of treatment
for various illnesses.
With time, man learned to differentiate between treatments, became aware of them, remembered them and passed them on from one generation to another.
Thus, a body of empirical medical lore accumulated. As man abandoned the hunting way of life and settled into agricultural societies, writing was invented, a giant leap in the history of mankind.
As civilization developed and flourished, people wrote down their old traditions and mythology explaining the phenomena of nature, including disease.
The explanations of natural phenomena and disease were similar in all the ancient civilizations: magical and religious.
Healing remedies have taken a huge variety of forms:
from preparations using plants, animals and minerals, to removal of infected and diseased parts, to prayers or incantations for spirits or gods to restore health.
In ancient Egypt and Mesopotamia, complex medicine was practiced, intertwined with religion and magic.
The collective historical evidence of image and text testifies to the evolution of medicine from magic and myth to scientific thought.
"There were shamans before there were gods" (9).
Indeed, drawings and paintings showing dancing
masks, sorcerers or shamans are found in Old Stone
Age caves that date back to 30,000 years BC.
In the Les Trois Freres cave in the French Pyrenees,
there is a figure made up of composite anatomical
parts from different animals: wolf’s ears, deer's
antlers, horse's tail, and bear's paws. (Fig.1).
The drawing, seen sideways on, depicts a male
creature that gazes straight out at the viewer
with round eyes. The overall effect is startlingly
human and has been nicknamed the "dancing sorcerer"(10).
The figure is thought to be a shaman. The British
Museum's Paleolithic collection contains a fragment
of reindeer rib (c. 30,000 – 27,000 BC) with engraving
of a Paleolithic shaman in animal mask performing
a ceremonial dance.
In addition, functionaries recognizable as shamans
are found worldwide in primitive cultures in the
Americas, Eurasia, Africa, and South Asia and
attests to their antiquity. The word shaman has
been used interchangeably with "medicine-man/woman",
"sorcerer", "magician" and "witch-doctor.
" It is derived from the Siberian word saman,
which means "he who knows."
Shamans can be found wherever hunting-gathering
peoples still exist and wherever ancient
Fig. 1. The Dancing Sorcerer.
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sacred traditions have been preserved despite the encroachment of modern
civilization.
In the rainforest of Indonesia, among the Mentawai
people, medicine-men are called kereis, those
chosen by the spirits to act as their messengers
and who have been given "the eyes to see the spirits"(11).
The people believe that a long, long time ago,
primeval people split into two groups, both sharing
the same hidden world of the Beyond.
One group became the first ancestors, who with
their descendants, live in their own invisible
umas [houses]; the second group, are the forest
spirits, some of whom resemble pixies or elves.
The problem was that we humans could not see these
spirits and this is where the kereis came in:
they were given the gift of being able to see
the spirits, so that they could interpret their
needs.
Those needs were complicated by the fact that
the spirits lived in the forest that the people
depended on for food and herbs.
Every time an animal was hunted or trees harvested,
there was danger of upsetting the ancestors. Animals,
plants,
even the rocks had souls; a person's well-being
depended on his respect for things around him.
The Mentawai wear flowers in their hair and decorate
themselves with tattoos not to be attractive for
those around them, but to make their bodies attractive
places for their souls to live in and be content
in. They fear that their souls might be tempted
to leave because the world of the spirits was
so much more attractive than our world. Likewise,
when someone died, people adorned themselves to
encourage their souls not to leave with that of
the deceased.
When someone has a fever or falls ill, the Mentawai
call the kerei who arrives on the scene to assess
the situation. He asks questions about how the
patient became ill and may "examine" the patient.
He inspects the house for "spirits of sickness."
If he sees any, then perhaps, the family has eaten
something forbidden or done something bad or broken
a taboo. A "diagnosis" is made and off he goes
to the rainforest to pick healing plants and herbs.
He consults with other kereis on the right thing
to do to drive away the evil spirits and purify
the house and give offerings.
The Mentawai believe that illness comes because
the souls of the sick have left their bodies,
and needed to be encouraged back with sweet songs,
flowers, and food. The herbs that were gathered
by the kerei are displayed and also talked to,
and also asked to help in making the patient well.
The patient is given the plant medicine to swallow
and gently massaged with the herbs, which are
said to have cooling properties that would make
their bodies attractive for their souls to return
to. Flowers and generous helpings of food on plates
are placed on the floor as inducement to the missing
souls. In a soft, sweet voice, the kerei sings
to coax the soul back to the patient's body: "Spring
quickly, soul, see your body, and return to your
friend and believe in your body again. Please
come." The ritual of calling the soul back combined
with herbal remedies and herbal massage to cleanse
the sick man from evil spirits is repeated until
the patient is well again. Many different kinds
of plants are used for specific conditions. Sometimes
the spirit that captured the soul is nasty or
stubborn and so, the kerei has to perform a ritual
dance to drive away or battle against such evil
spirit in order to initiate the healing process.
Kerei healing practices were banned in Indonesia
in 1956 and "people died." Rainforest people of
course have no access to modern medicine. So,
to heal, the Mentawai had to break the law by
calling on the services of kereis. But this changed
when a policeman’s wife became sick. She was very
ill, so the kereis went to the village head to
let them heal the woman because "If you don’t
let us heal her she will die." The kereis claimed
that they could hear her sickness in the plants
they gathered. They could see the feet, teeth,
hair and ears of a dog. They made an offering
and rang the bell to call the spirits. "We could
hear the bells in the river and started to see
a dog’s bone, dog’s teeth, his fur, his feet,
his intestines and his heart. . ." The kereis
performed their ritual for the woman discovering
that the dog spirit was angry because her husband
had eaten a dog. When his wife got better, the
policeman wrote a report that the kereis were
like doctors in the Western sense: "They help
sick people. They give medicines. . ." (11).
The kereis say that they learn the medicinal
properties of plants in dreams – "the time when
your soul travels away from the body and meets
the ancestors, the souls of other living kerei
and laymen." An ancestor or spirit reveals this
special knowledge to them personally, hence, it
is kept secret (11). According to kerei tradition,
the forest supplies all their needs – food and
medicines, and therefore, its ecosystem must be
respected and kept in equilibrium. The Mentawai
do accept that there are some illnesses that can
be cured only with Western medicine, but still
the root cause of a malady can be explained in
spirit terms. The concept that illness is caused
by the soul being lost and wandering in the spirit
world is universal among primitive peoples. The
soul may have wandered off of its own accord,
or have been lured away, or captured or imprisoned.
The capturing spirit must be fought and outwitted.
But often there is some degree of connivance,
and it is the captured soul itself, which must
be deceived into allowing itself to be rescued.
A South American Indian woman recounted how, on
one occasion when she was ill, a shaman's spirit
helpers on a canoe trip spotted her soul. The
soul was attracted by the sound of their drumbeat
but then gave them the slip because of its "wild"
nature. The patient was a renowned dancer and
the spirit helpers encouraged her soul to dance
to show off its skill. Gradually the soul was
won over by their flattery and finally it became
"tame" and allowed itself to be caught and returned
to its owner (10).
Among the Sora of India, the spirit of the dead
may enter a shaman. For example, a boy has died
and his mother is grieving. The spirit of the
dead boy enters the shaman's body and speaks to
his mother and his other relatives through the
shaman (10). The conversation that ensues between
the spirit of the dead boy through the medium
of the shaman and his mother and his other relatives
results in a resolution of the mother's mourning
process. In addition, inheritance of the boy’s
belongings depends on the outcome of the conversations
that pass between them. Thus, the shaman serves
not only as a therapist but also as a lawyer,
both roles being accomplished in a kind of psychodrama.
The resolution of psychological and neurotic conflicts
through talking is widely employed in psychoanalysis
and clinical psychiatry.
Among the Even of Siberia, the shaman was sent
for only after all ordinary forms and methods
of folk medicine have been tried. Various healers
and members of the family performed the functions
of a physician. The antlers of young reindeer
were used as a general tonic. Other popular medicines
were ginseng and the poplar buds, which were used
as a painkiller. For liver and stomach diseases,
jaundice, dysentery, rheumatism, painful joints,
abscesses and ulcers, the healers used bear's
gall and musk, a secretion from the stomach glands
of the musk deer.(10)
Before the eradication of smallpox, whole clans in Siberia sometimes perished from smallpox. The Even believed that the evil spirit of smallpox appeared on the migration routes of reindeer herders in the form of a woman with light hair. She arrived sitting unnoticed on a sledge at the back of a caravan of visitors. But the shaman saw her and knew that she had come to their place "to pay a social call." The shaman then prepared himself for combat. Most shamans were unable to fight alone against the spirit of smallpox, which charged them in the form of a huge red bull. If a shaman was strong enough to win this battle, he saved his kinsfolk. If he lost, all of them including the shaman himself would die, with the exception of two relatives who always remained alive to bury the dead (10).
Clearly, the above examples demonstrate that primitive peoples around the world in different epochs share a common ritual and belief-system that is essentially shamanistic suggesting the same historical and psychological origins.
Shamanic cultures have particular assumptions about what exists and
how things happen. In essence, shamanistic societies
believe that the soul can leave the body. This
happens to everyone at death and this conviction
is also shared by many religions. Soul flight,
such as that undertaken by the shaman, is a recurring
theme in the mythology of the Mesopotamians, ancient
Egyptians, and Greeks. Many peoples believe that
humans have more than one soul. Spirits may kidnap
souls from bodies, which remain, for the time
being, alive. The soul that wanders represents
the person's consciousness or personality, while
the soul that stays behind, keeps the body's metabolism
functioning. If the wandering soul does not return,
the soul left behind will not survive long. Primitive
societies believe that illness is due to offending
a spirit or a person's soul being lost. The role
of the shaman is to pacify the spirits through
performance of certain rituals and to rescue a
lost soul by traveling to the realm of the spirits
to fight for it, bring it back, and thus restore
the patient's health. The breaking of taboos,
which are considered basic to morality and good
living, can cause illness. Such acts weaken the
patient through a withdrawal of vital forces.
This kind of misfortune often afflicts whole communities,
leading to disasters such as crop failure or pestilence.
The cure usually involves confession of one's
misdeeds. The belief that illness was punishment
from the gods was widespread in Mesopotamia, Egypt,
and ancient Greece. Illness as punishment is so
ingrained in the human psyche that traces of this
belief still persist, even in modern societies.
Shamans employ certain tools and rituals to see
the causes of disease and predict the future.
Equipment of the trade includes a repertoire
of costumes, usually animal (Fig.2), masks, drums,
rattles, and other musical instruments. He uses
healing herbs and psychoactive plants (10). Costumed
and masked, the shaman enacts his ritual of cleansing,
curing, or vision quest through dance and mime,
accompanied with the beating of drums, music,
chants, and words. The shaman primarily uses narrative
to express his intentions, or a particular psychic
state, or experiences into an epic series of initiations,
journeys and battles. The drama that unfolds reflects
the shaman's or the patient's current situation,
but it is also part of a story. Obstacles are
described and surmounted. The shaman gives a full-scale
dramatization to the many trivial or major events,
which occur in everyday life. As the narrative
unfolds over time, it moves from problem to resolution.
Conventional Western medicine also follows the
Fig.2. A North American Indian medicine-man performing a healing ritual.
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same pattern.
There is a great deal of ritual, awe, and status
involved in most people's consultations with a
doctor.
The placebo effect shows that people, given a
dummy pill, often respond to it as well as if
it contained an active medicine.
In most situations where traditional healers are
available, patients combine shamanic treatment
with hospital medicine in subtle and complex ways.
Conventional medicine in turn is increasingly
influenced by shamanic attitudes, especially where
the focus is on fostering a good relationship
between doctor and patient.
The parallels are closest in psychotherapy and
also where healing involves a social context,
as in group therapy. These approaches emphasize
the need to understand the world and one's own
position in it.
The shaman's ritual may work because it expresses
needs and feelings, and so may change the patient's
health by altering perception. By shifting the
patient's perception of reality or his situation,
the shaman's ritual may produce physiological
changes.
However, physiological effects are not the only
proofs of efficacy, just as the symptoms alone
are not the illness itself. Equipped with an impressive
corpus of empirical knowledge, plant cures, and
a profound understanding of human behavior, the
shaman fulfills the vital role of healer of diseases.
In addition, he attempts to restore social and
natural imbalance through experience and insight
acquired in drug-induced visions.
He strives for harmony and equilibrium in nature
and in so doing, plays a cathartic role to cultural
change. Shamanic techniques and practices for
entering into altered states of consciousness
are receiving increasing attention and have opened
up research into the nature and history of consciousness
in ways not previously possible.
In addition, the enormous knowledge of medicinal
plants possessed by primitive societies are the
subject of intense research by ethnobotanists
who hope to tap into their vast reservoir of botanical
remedies for diseases that still baffle modern
science. Technological evolution has continually
redefined our views of our world and how we relate
to our environment.
But, however sophisticated the technology, human
nature is constant and unchanging and this is
most apparent in the setting of illness.
Virchow defined disease as nothing else but life
– life under changed circumstances (1).
Illness is a story of suffering.
The diagnostic tools and treatment of disease
have become highly sophisticated as we understand
the nature of disease processes at the molecular
level but the scientific physician still make
use of “narratives” to interact with the patient
on a personal level, just as the Stone Age shaman
did or still do in cultures where ancient traditions
are still alive today.
Regardless how sophisticated and scientific medicine
is today, the "spirits and souls" concept continue
to haunt us.
Discussions and studies about out-of-body and
near death experiences appear in modern medical
literature.
The December 15, 2001 issue of the Lancet published
a very interesting article about near-death experience
in survivors of cardiac arrest (12).
Eighteen percent of the 344 consecutive cardiac
arrest patients who were successfully resuscitated
reported near-death experience.
In the article, a nurse describes the extraordinary
story of a 44-year-old Dutchman who was brought
by ambulance in the ER. He had been found an hour
before in a meadow by passers-by.
He was cyanotic and comatose. CPR was performed
for one-and-half hours.
When he regained consciousness a week later, he
identified the nurse who removed his denture during
the CPR while he was in coma.
The patient described to the nurse in detail how
she had removed the dentures and
"put them onto that car [crash cart], it had all these little bottles on it and there was this sliding drawer underneath and there you put my teeth.
" The nurse said: "The man had seen himself lying in bed, that he had perceived from above how nurses and doctors had been busy with CPR.
At the time that he observed the situation he had been very much afraid that we would stop CPR and that he would die."
Shamans appeal to the spirits to bring back souls; 21st century physicians invoke high technology.
Moliere, the 17th century French comic dramatist, neatly summed the practice of medicine in the following conversation between two characters in his satirical play, Le Medicin malgre lui [The Doctor Inspite of Himself].
Geronte: "It seems to me that you've got things in the wrong place; that the heart is on the left and liver on the right."
Sganarelle: "Yes, that's how they were once, but we've changed all that. We now practice a totally new sort of medicine."
1. Sigerist SE. A history of medicine. New York: Oxford Univsrsity Press, 1987.
2. Lipp SJ. Herbalism. London: MacMillan, 1996.
3. Ayensu ES. A worldwide role for the healing power o plants. In: Carmichael AG,
Ratzan RM, eds. Medicine a treasury of art and literature.
New York: Hugh Luter Levin Associates, Inc., 1991:194 – 196.
4. Sutcliffe J, Dunn N. A history of medicine. New York: Barnes & Noble, 1992:49
5. Nunn JF. Ancient Egyptian medicine. London: British Museum Press, 1996:158.
6. Chevallier A. The encyclopedia of medicinal plants. London:
Dorling Kindersley, 1996:96, 128.
7. Withering W. An account of the foxglove and some of its medical uses.
Birmingham, Alabama: The Classics of Medicine Library, 1979.
8. Roberts C, Manchester K. The archaeology of disease.
New York: Cornell University Press, 1995.
9. La Barre, W. The ghost dance. The origins of religion.
London: George Allen & Unwin, 1972.
10. Vitebsky P. The shaman. London: MacMillan, 1995.
11. Allen B. Last of the medicine men. London: BBC Worldwidw Ltd, 2000.
12. Lommel PV, et al. Near-death experience in survivors of cardiac arrest:
a prospective study in the Netherlands. Lancet. 2001;258(9298)
The soul (heart) of Ani is weighed against the feather.
(Papyri of Ani, 1600 BC).
The ancient Egyptians believed that when a person dies, the heart is weighed against a feather, which was the symbol of order, truth, and justice. The heart was regarded as the center of feelings, emotions, and conscience.
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*Director, Non-Invasive Cardiac Laboratory, Department of
Cardiology & Cardiovascular
Surgery, Hamad Medical Corporation,
Doha, Qatar Correspondence to
Dr. Rachel Hajar, Hamad Medical
Corporation, P.O. Box 3050,
Doha, Qatar. E-mail:rachel@hmc.org.qa
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