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MEDICINE IN ANTIQUITY

MEDICINE IN ANTIQUITY. Henry A. Azar, MD PhD University of North Carolina at Chapel Hill Department of Pathology & Laboratory Medicine. Periods in History. Antiquity (ca. 4000 BC to 476 AD) Early Near Eastern and Asian civilizations Rise of Greece and Hellenism

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MEDICINE IN ANTIQUITY

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  1. MEDICINE IN ANTIQUITY Henry A. Azar, MD PhD University of North Carolina at Chapel Hill Department of Pathology & Laboratory Medicine

  2. Periods in History • Antiquity (ca. 4000 BC to 476 AD) Early Near Eastern and Asian civilizations Rise of Greece and Hellenism Rise of Rome; Augustus (r. 31 BC-14 AD) first emperor Jesus Christ (ca. 1-33) Augustulus deposed in 476; Eastern Empire continues • Middle Ages (476-1453) Rise of Islam (622 AD, 1stHegira year); Crusades Fall of Constantinople (1453) • Modern Age (1453-1945/ 1990) • Post-Modern Age

  3. Medicine in Antiquity • Mesopotamian Medicine • Egyptian Medicine • Greek and Greco-Roman Medicine School of Alexandria Medicine under the Roman Empire • Indian (Ayurvedic) Medical Traditions • Chinese Medical Traditions

  4. The Fertile Crescent

  5. A Mediterranean World

  6. Mesopotamian Civilization Flat land between Euphrates and Tigris; humid climate, clear skies, clay soil (bricks);peopled by Semites. Sumer, cuneiform deciphered by Grotefend in Perspolis, Epic of Gilgamish Akkad, language akin to Aramean/Phenician (Canaanite) Babylonia Assyria Neo-Babylon or Chaldea (Persia)

  7. Babylon Babylon succeeded Sumer and Akkad, a great metropolis; later defeated by Assyria Code of laws promulgated by Hammurabi (ca. 1800 BC) Sexagesimal and positional system (astronomy/astrology) Marduk chief god, also called Bel, successor to Sumerian Enlil Magico-religious practices: incantation and divination; zigurat at the horizon, right upper corner

  8. Assyrian and Persian Empires

  9. MESOPOTAMIAN MEDICINE Supernatural powers are involved in afflictions of mankinds Vast number of diseases recognized Collaboration between asipu (priest) and asu (physician) Code of Hammurabi Assurbanipal Library in Nineva some 800 medical texts Rich botanical materia medica

  10. CODE OF HAMMURABI 8’ stele unearthed at Susa, Persia, in 1902--said to have come down from Sun God. Earliest codification of laws: monument lists 282 laws in 16 columns with reverse 28 columns; several apply to physicians (asu), cow/sheep healers, barbers Fees and penalties set according to 3 classes (nobles, commoners and slaves) No penalties for priestly-medical mismanagement

  11. Egyptian Civilization • A gift of the Nile • Ancient Kingdom Pyramids (Imhotep) ca. 2200BC • Middle Kingdom Hyksos invasion ca. 1600 BC • New Kingdom Akhneton (d. 1350) and wife Nefertiti Monotheism,Moses • Assyrian & Persian invasions • Alexander (d. 322 BC) • Cleopatra (d. 30 BC ), last of Ptolemies Photo Museum of Fine Arts, Boston • Pyramids of Giza • Boston Museum. of Fine Arts

  12. EGYPTIAN MEDICINE • Ebers Papyrus (Leipzig): emphasizes magical spells, with large section on diseases of the gut and intestinal worms. Metu, a system of vessels and canals originating in the heart and carrying air and liquids to all parts of the body, and converging to the anus. Whedu, concept of decay associated with feces. Large number of drugs of vegetable, botanical and mineral origin.

  13. EGYPTIAN MEDICINE (cont.) • Kahun Gynecological Papyrus (London): almost entirely devoted to gynecological organs, including test for pregnancy (onion implanted in the flesh, positive outcome determined by odor in nose). • Edwin Smith Surgical Papyrus (ed. J. H. Breasted, Univ. of Chicago Press, 1930). Orderly arrangement of cases from head to spinal vertebra. Offers brief clinical description, diagnosis and treatment; surprisingly devoid of magico-religious formulae. Case 45: first description of a cancer (male breast)

  14. EGYPTIAN MEDICINE (cont.) • Monuments: depiction of circumcision, poliomyelitis?, achondroplastic dwarf. • Mummies: Parasitic infestations (calcified eggs of shistosomiasis and preserved tapeworms Evidence of tuberculosis, Pott’s disease of the spine Arthritis, atherosclerosis, gallstones Pneumonia, pleurisy, lung abscesses Splenomegaly Renal atrophy

  15. Hellenic CivilizationHomer (fl. ca. 850 BC), IliadHerodotus, Persian Wars(492 BC- 479 BC) Thucydides, Peloponnesian War (431 BC-404 BC)

  16. Rise of AthensThe Age of Pericles Socrates Plato Aristotle Photo Carolyn Buckler in A History of Western Civilization

  17. GREEK and GRECO-ROMAN MEDICINE • Asclepius, originally a skilled physician, subsequently deified; usuallydepicted with staff and serpent. • Hippocrates of Cos (d. about 370 BC) ), “father of medicine;”and Hippocratic Corpus (including writings of Hippocrates) gathered in Alexandria two centuries later. • School of Alexandria, includes two important anatomists (Herophilus and Erasistratus). • Medicine under the Roman Empire:Celsus, a Roman, dominance of Galen and Galenism for over 1000 years. Botany of Dioscorides. .

  18. DOMINANT TENETS OF GREEK MEDICINE Dissociation between medicine and religion • Four humors: phlegm, yellow bile, black bile, blood (corresponding to 4 elements, 4 qualities, 4 temperaments, etc.); a crude anatomy and physiology • Health is the result of proper balance between the four humors; disease results from an imbalance; emphasis on proper rules of health • Treatment rests on evacuation of undesired or excessive humor (purgation, emetics, phlebotomy) • Professionalism and a code of behavior (Hippocratic Oath)

  19. Alexander’s Empire

  20. SCHOOL OF ALEXANDRIA Alexandrian Library and Museum founded by Ptolemy (r. 382-282); • Autopsies, vivisection? • Herophilus: arteries filled with blood, delineated nerves • Erasistratus: brain seat of intelligence; motor and sensory nerves. • Archimedes, Euclid, Ptolemy

  21. The Roman Empire

  22. GRECO-ROMAN Materia Medica • Dioscorides (40-90 AD) of Anazarba, botanist and army surgeon under Nero, described and illustrated some 600 plants • Galen incorporated much of Dioscorides’s Materia medica in his writings • Both had great influence on Arabic medicine

  23. IN CONCLUSION… • MESOPOTOMIA AND EGYPT:Diseases are caused mainly by supernatural influences. There is a blending of magico-religious practices with pragmatism. An evolution from magician-priest-physician to physician and surgeon is noticeable. • GREECE, ROME and ALEXANDRIA: Natural causes explain disease. Greek philosophers dissociate science and medicine from magic and religion. Hippocrates establishes a strong tradition of pragmatism and professional behavior. Greek medicine flourishes in Alexandria with Herophilus and Erasistratus. Galen remains the dominant physician during the late Roman empire and up to modern times.

  24. Select General References • L. I. Conrad, Michael Neve, Vivian Nutton, Roy Porter and Andrew Wear, The Western Medical Tradition 800 BC to AD 1800 (Cambridge, UK: Cambridge Univesity Press, 1995), pp. 11-91 (by Vivian Nutton). Warren D. Dawson, The Beginnings: Egypt & Assyria (New York: Paul B. Hoeber, 1930. • Guido Majno, The Healing Hand: Man and Wound in the Ancient World (Cambridge, MA: Harvard Univeristy Press, 1991, paperback edition). • Roy Potter, The Greated Benefit to Mankind: A Medical History of Humanity (New York/London: W. W. Norton, 1997), Ch. II. • Plinio Prioreschi. A History of Medicine, v. I. Primitive and Ancient Medicine (Omaha: Horatio Press, 1996). • Henry E. Sigerist, A History of Medicine, v. I. Primitive and Archaic Medicine (New York/Oxford: Oxford University Press, reissued 1987).

  25. Medicine in Antiquity Websites www.med.unc.edu/wrkunits/syllabus/yr4/gen/medhist/publish Microsoft PowerPoint presentations: • Eric Ball, The Code of Hammurabi • Richard Baecher, Smith Surgical Papyrus • Elizabeth Griffiths, Evolution of the Hippocratic Oath • Denis Hadjiliades, Present Vestiges of Greek Medicine Also, www.indiana.edu/~ancmed/concepts.htm • [Egypt] [Mesopotomia] [Greece]

  26. Credits Photos of the Pyramids and of the Parthenon as well as all maps are from: John. P. McKay, Bennett D. Hill and John Buckler, A History of Western Civilization (Boston: Houghton Mifflin Co., 1979) The following illustrations are from Ralph Major’s A History of Medicine, v. 1 (Springfield, Charles C. Thomas, 1954): Babylon of Nebuchadrezzar, Oriental Institute, Univ. of Chicago; Stele of Hammurabi, Louvre Museum, Paris; Divination Liver and Rosetta Stone, British Museum, London.

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