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A DESCRIPTIVE OUTLINE of the HISTORY of MEDICINE from ITS EARLIEST DAYS to 600 B.C.* by JAMES F

A DESCRIPTIVE OUTLINE OF THE OF FROM ITS EARLIEST DAYS TO 600 B.C.* By JAMES F. BALLARD

BOSTON, MASS. N 1891 Dr. James Finlayson of Glasgow medicine. These two exhibits were not of gave the first of his so-called biblio- the same type as Finlayson’s demonstrations, graphical demonstrations. He believed which were primarily historical lectures illus- that a better understanding of the tiated by texts and supplemented by sources could be had if the of information for further study. Istudent could be brought into direct contact Two exhibits6 arranged by Dr. E. C. with the original texts and sources of informa- Streeter, one on Vesalius shown at the tion. He selected for his first demonstration American Medical Association meeting at a number of anatomical works containing Atlantic City in 1914 and the other on many curious illustrations. Then in succes- infections shown at the American Medical sion he gave an evening each to a discussion Association meeting at Boston in 1921, of physiognomic diagnosis, Hippocrates, deserved and received the highest commen- Galen, Celsus, ancient Egyptian medicine, dation. The last was a model of its kind. and the Alexandrian School.1 Dr. Finlay- Pagel6 divides the history of medicine son’s method was to show the actual texts, into three main groups: Ancient, to 130 read extracts from them, commenting on a .d .; middle period, 130 to 1500 a .d .; mod- the importance of the period or individual ern period, 1500 a .d . to date. Ancient he under discussion, and finally to show the subdivides into: Prehistoric, the medicine sources of information. of primitive peoples from the beginning Dr. F. H. Garrison2 calls attention to of the world to 4500 b.c .; medicine of the the exhibits of Dr. J. S. Billings3 and of older , 4500 b.c . to 600 b.c .; Dr. George Dock.4 Dr. Billings exhibited classical period, Greek and Roman, 900 b.c . forty-four rare medical dating from to 130 A.D. 1470 to 1848, arranged in chronological I shall confine myself in this paper to order but without particular reference to the first two subdivisions, first taking up their historical importance. Dr. Dock primitive medicine. exhibited thirty-seven works selected from his own library, mostly of the modern PREHISTORIC PERIOD7 period, and relating chiefly to clinical According to Neuburger: *Read before the Boston Medical History Club, Jan. 15, 1923, in connection with an exhibition of If . . . purposeful, instinctive actions texts, source books, pictures and other material which serve to mitigate pain or irritation may illustrating the subject. be considered as medical in the widest sense of the term, being as they are outward manifesta- a keen appetite, had immediately taken food tions of the healing power of nature, then may in the first days of their illness, while others, medicine be considered not only to extend back feeling a nausea, had abstained from it; and the to the childhood of the human race, but to exist disorder of those who had abstained was more as animal medicine. alleviated; also some, in the paroxysm of a fever, had taken food; some a little before it Heated animals refresh themselves in came on, and others after its remission; and it cold water, warm their stiffened limbs in succeeded best with those who had done it the sun, and destroy irritating parasites. after the disappearance of the fever. In the same Cats and dogs lick their wounds, dogs eat manner, some used a full diet in the beginning of grass to promote vomiting. Monkeys seek a disease; others were abstemious, and those to the flow of by application grew worse who had eaten plentifully. These of the paw, and are adept in the extraction and like instances daily occurring, diligent men of foreign bodies, such as thorns. The observed attentively what method generally answered best, and afterwards began to pre- medicine of animals, moreover, is not con- scribe the same to the sick. This was the rise fined to self-help, but extends at times to of the art of medicine, which by the frequent help of others, particularly when dealing recovery of some and the death of others, dis- with the young. Similar primitive actions tinguishes what is pernicious from what is salu- may be considered to have formed also the tary; and when the remedies were found, men foundation of human medicine. began to discourse about the reasons of them. The first lessons came to primitive man by Medicine was not invented in consequence of injuries, accidents, bites of beasts and their reasoning, but theory was sought for after serpents. The experiments of nature made the discovery of medicine. clear to him the relation of cause and effect. Certain simple operations of very early In the study of primitive medicine one is greatly helped by observation of the medi- date show traces of purposeful intelligence: cine of those races which even now lead an drawing foreign bodies (thorns) from the existence analogous to that of primitive skin with the fingers, laying cooling leaves man (aborigines). upon injured places, and smearing the skin Modern anthropologists claim that both with clay as a protection against cold, religion and medicine had their origin in insects and surface wounds. magic. To primitive man magic was the dates from the time when instru- setting in motion of a spiritual power to ments of daily use were used as means of help or hurt the individual. Primitive man healing. In earliest times flints, thorns, recognized many of these superhuman splinters of wood, shells, fishbones, pointed agencies relating to disease, such as the bones, teeth and horns could be used for spirits of the dead, either human or animal, the extraction of foreign bodies, the opening independent disease demons or individuals of abscesses, and with them bloodletting who might act by controlling the spirits and scarification could be performed. Tre- or agencies of disease. The evidences of phining of the skull was performed as far magical therapeusis which have descended back as the early . Recent re- to our time consist of from the early searches have added much to our knowledge stone age and from the early age, of the diseases and injuries of ancient man. the former consisting of pieces of bone Celsus (53 B.C.-7 a .d .) in his “De medicina trephined from the skull after death and libri octo,” describes the growth of rational carried on a string, the latter of animals’ medicine as follows: teeth, weasel-bones, cats’ claws, birds’ Medicine, even in its infancy, was not deduced windpipes, snakes’ vertebrae, etc. The amu- from these inquiries, but from experiments; for let is the oldest form of prophylaxis against of the sick who had no physicians, some, from disease and originated in the belief that the possession of portions of another body code is engraved on a monument which was endowed the possessor with their functions. found in December, 1901, and January, 1902, From the original devouring of organs was on the Acropolis of . It is a block of derived the simpler custom of wearing on black , nearly eight feet high, broken the body portions of animals, particularly into three pieces which fortunately were animals immune against poisons (such as easily rejoined. On the obverse is a bas- spiders) and polished or odoriferous objects. relief of King Hammurabi receiving the laws from the Sun God; under this relief THE PERIOD OF THE OLDER arc engraved sixteen columns of text, four CIVILIZATIONS and a half of which form the prologue. BABYLONIAN-ASSYRIAN8 There were originally live more columns In considering this period we must on the obverse, but these were cut off by remember that the Babylonian-Assyrian- the Elamitic conqucior. There are twenty- Sumcrian, Egyptian, Hindu and Chinese eight columns on the reverse, the last live of civilizations were practically contemporane- which form the epilogue. ous. Authorities differ as to the date of the Hammurabi was the sixth king of the first beginning of , but all agree that dynasty of and reigned for fifty- it was between 4500 and 4000 b .c . five years, about 2250 b .c . He was a great The Sumerians founded Babylon about soldier and a pious, god-fearing king. He 4500 b .c . They possessed originally a codified the existing laws, that the strong , running from left to might not oppress the weak, that they right. About 3800 b .c . they were conquered should give justice to the orphan and by the Babylonians and Assyrians, but their widow, and in general, that wrong be made writing, speech and culture endured for right. This code shows the importance centuries after their fall. The science of attached to the fees of physicians as early Babylon and reached a much higher as 2250 b .c . and that medicine even then stage than that of . was looked upon as a responsible profession. Medicine was secondary to religion. In 1849 there was discovered on the site Disease was due to evil spirits or demons. of Nineveh a great library of some thirty There were different incantations for differ- thousand clay tablets gathered by King ent diseases and medicinal remedies accom- Asurbanipal of Assyria (668-626 b .c .). From panied the incantations. The first recorded some eight hundred medical tablets most observations on are in connection of our knowledge of Assyro-Babylonian with the art of divination. The liver was medicine is derived, much of it translated used for this purpose, that of the sheep by Morris Jastrow. having been studied as early as 3000 b .c . and hepatoscopy became of extraordinary EGYPTIAN9 importance among the Babylonians. Jas- Theearliest known physician was , trow describes the earliest known anatomi- a medical demigod, the Aesculapius of the cal model, a sheep’s liver made of clay, , who flourished about 4500 b .c . dating about 2000 b .c . The pharmacopeia of the Egyptians was The second contribution of Babylon and exceedingly rich, one mentioned Assyria to medicine relates to the supposed over seven hundred different drugs; hygiene influence of the heavenly bodies upon man’s reached a high stage of development. Medi- welfare. This was the beginning of medical cine was associated with magic and was a . priestly occupation. The earliest recorded The third feature in Babylonian medicine use of secretions and parts of the animal is the evidence afforded by the famous body as medicine is to be found in the Hammurabi code of about 2250 b .c . This medical papyri. While there are isolated fragments, such as the pyramid inscriptions, destroyed, but there are remaining forty- most of our knowledge of Egyptian medicine eight cases, arranged as follows: skull 1-10; is obtained from the medical papyri. The nose 11-17; mandible, ears and lips 18-27; principal ones are the Papyrus Ebers,10 throat and neck (cervical vertebrae) 28- Westcar (Lesser Berlin),11 Brugsch (Greater 33; collar bone and shoulders (clavicle and Berlin),12 Kahun,13 ,14 Hearst,15 scapula) 34-38; thorax and mammae 39- and the recently described Edwin Smith16 47; and spine 48, incomplete. papyrus. With the exception of the Smith Each of the cases is methodically ar- papyrus, these are essentially magic rolls, ranged. There is the title, always begin- containing a hodgepodge of recipes, and ning: “Instructions for ...” (name of were the working of superstitious ailment); an examination, always begin- practitioners of demoniacal medicine. ning: “ If you examine a man having . . .” There are three kinds of Egyptian writ- (symptoms follow); a diagnosis, always be- ing: the hieroglyphic, which is the oldest ginning: “You should say concerning him: and is used on monuments; the hieratic, a sufferer with ...” (name of trouble the cursive used in sacred and follows); a verdict, always one of three: medical papyri; and the , which is “An ailment I will treat” (favorable), “an the writing of the people. ailment I will contend with” (doubtful), “an The most important of the older papyri ailment I will not treat” (unfavorable); is the Ebers, obtained at Thebes in 1872, the treatment; and explanatory glosses. and dating back to about 1550 b .c . It con- The description of the cases is most sists of 110 pages of hieratic script, the text interesting. In speaking of a trouble in the in black letter, the rubrics in red. It is now “inaccessible region of the nose” it is regarded as a simple compilation, made up recommended that the secretions be cleared from several earlier treatises; a photographic away by using two swabs of linen and reproduction was issued in 1875 by Ebers. thereupon two rolls of linen dipped in The Edwin Smith papyrus is the most ointment arc placed in the nostrils. The remarkable medical papyrus in existence, gloss defines the affected region as “the because it contains the most important middle of the nose as far as the back, pene- medical knowledge which has survived to us trating to the region between the two eye- from or from any Oriental brows,” probably an attempt to define the country. It is a roll 15 feet, 4^ inches in frontal sinus region. length, with 377 lines on the front and 92 The most interesting part of the work is lines on the back, written about 1600 b .c ., the glosses, seventy in number, which arc and was bought by Mr. Smith in 1862. It appended to the cases. They arc definitions consists of three parts, drawn from different of words and terms and idioms which must sources: first, the seventeen columns of the have been obsolete at the time the papyrus front; second, the incantation of expelling was copied. It is evident that the original the wind of the year of Pest; third, the in- discussion was from an inherited text, cantation of transforming an old man into which was sufficiently respected so that a youth of twenty. The last two are brief it was not to be altered by insertion of magical treatises. It is the first part which explanations, but these were appended to makes the Smith papyrus unique. It con- t the cases. The glosses are in the tains part of an extraordinary ancient of the middle kingdom, several centuries of surgery and external medicine, which was earlier than the Smith papyrus, and prob- based on actual cases and classified anatomi- ably the copyist found already appended cally, beginning with the skull and proceed- to the text these explanations of the quaint ing in orderly progression down the body or no longer intelligible words and phrases to the spine. Part of the papyrus has been of his ancestors. Undoubtedly this papyrus forms part of 1500 to 800 b .c ., the Brahmanistic, 800 b .c . a great, lost medical book on surgery to 1000 a .d ., and the Arabic from 1000 a .d . already so old in about 1600 b .c . that com- The Vedic epoch is so-called because its mentaries on the many terms and phrases state of civilisation is represented by four had long before become necessary. This , the holy of the East. The commentary may already have been several and the Atharvavcda have the centuries old when copied into the Smith greatest interest from a medical standpoint. papyrus. It is known that as early as 2800 The medicine in the Vedas is entirely b .c . there were enough medical rolls to theurgic and treatment consists ol the fill a case, and it may be that the Smith usual spells and incantations. The , papyrus is a copy of one of them. In method on the science of life, was composed by and character the Smith papyrus is far and is based on the Rigveda in superior to all other medical papyri; it con- so far as medicine is concerned, while tains a systematic arrangement and dis- surgery seems to be derived from the cussion of cases; each and every case is Atharvavcda. The Ayurveda is the oldest treated in a routine manner, history, exami- medical book of the and is divided nation, diagnosis, verdict or prognosis, and into eight parts: surgery, diseases above treatment, and they are arranged in ana- the clavicles (such as eyes, nose, mouth, tomical order. We have here the first attempt cars), general diseases, demoniacal diseases, at medical classification and the first case diseases of children, toxicology, therapeu- history book. The Smith papyrus has not tics, and disorders of generative organs. yet been published, but it has been de- According to Wise, the manuscript no scribed by J. H. Breasted. longer exists and only fragments are to be found in the or commentaries on HEBREW17 the Vedas. In the Brahmanical period The principal sources of our knowledge medicine was entirely in the hands ol the of Jewish medicine are the Bible and the priests and scholars. Talmud. In the Bible there is not a The three leading texts of Brahmanical single reference to the priests acting as medicine arc the , the Susruta and physicians; they serve rather as hygienic the Vagbhata. Jee states that both the police in relation to contagious diseases. Charaka and Susruta arc compilations The physicians were a class by themselves. based on the Ayurveda. Of these, the most There were also professional pharmacists important is the Susruta (200 b .c . to 300 and professional midwives. The ancient a .d .) which is the great storehouse of Hebrews were the founders of prophylaxis. surgery. The ancient Hindus were famed lor Neuburger states that the chief glory of their highly specialized knowledge of opera- biblical medicine lies in the institution of tive surgery which remained unimproved social hygiene as a science. The by the and Romans who came after mandates contained in the five books of them. The Susruta describes about 121 the Pentateuch (Torah) form the beginning, different surgical instruments. These had not only of social science, but of medical proper handles and were kept sharp and jurisprudence. The Talmud consists of the clean. The Hindus apparently knew every laws transmitted by verbal tradition, a body important operative procedure except the of knowledge which began to accumulate use of the . They performed lith- after the Babylonian captivity, about 536 b .c . otomy without a staff, Cesarean section, excision of tumors, removal of omental INDIAN18 hernia through the scrotum, amputated The history of Indian medicine can be limbs, checking hemorrhage by boiling on divided into three epochs: the Vedic, 1800 to cauterization or pressure. They were cspcr cially expert in skin-grafting and plastic which medicine is based are the works of surgery and their operation for cataract Huang-ti, 2697 b .c . They were done in has survived to the . They lacquer upon strips of bamboo or palm were clever in teaching surgery, the student leaves. These tadpole , the ana- practicing on plants and dead animals. logue of the Egyptian picture-writings, were What the Susruta is to surgery the later modified and done with and paper. Charaka is to medicine. It dates from about This book of Huang-ti gives valuable 200 b .c . Indian medicine was weak in measurements of the bones and alimentary anatomy, but diagnosis was carefully made tract. Physical anthropometry is clearly and semeiology and prognosis combined of Chinese origin. Angiology and osteology acute observation with the usual folk super- were studied as topographic aids to acu- stitions. In the Susruta there is a recogniz- puncture (2697 b .c .), cauterization and to able description of malaria, which is attrib- the practice of what might now be called uted to mosquitoes. Inoculation against osteopathy. There is good evidence that smallpox has been found in a text dissection was performed, usually upon the antedating Hippocrates. bodies of executed criminals. The Chinese In the treatment of disease, hygiene and were wonderfully clever at and diet were considered of at least equal impor- were acquainted early with identification by tance with drugs. The pharmacopeia was finger-prints. The doctrine of the pulse rich. The majority of the therapeutic sub- reached such extraordinary development stances were of vegetable origin; Charaka that the whole practice of medicine centered knew five hundred, Susruta seven hundred round its different characters. Organo- healing plants. Animal and mineral sub- therapy was as extensively practiced in stances were also used. as in Egypt; reached a Vagbhata is supposed to have flourished remarkable development and inoculation sometime between 200 b .c . and 700 a .d ., for smallpox was practiced as early as the according to different authorities. His style eleventh century. was very clear and concise, but he added Japanese medicine to 96 b .c . was passing nothing to what is contained in the Susruta through the mythical phases common to or Charaka. all forms of early medicine. The earliest PERSIAN19 Japanese medical book21 was not published The medicine of ancient Persia, like that until 982 a .d . This late beginning of medical of , owes its origin to primitive Aryan by them has fortunately not medicine. Our knowledge is obtained from interfered with their wonderful progress the religious writings, the Zend-Avesta. in recent years. * The book of the Law devotes almost the whole of the last three chapters to medicine. BIBLIOGRAPHY The treatment of the sick was in the hands 4 1. Finl ays on , J. Glasgow M. J., xxxv ii , 253, 321, of the priests, and consisted in the casting and xxxix, 321; and Brit. M. J., Lond., 1892, out of the demons of disease by purification 1, 573, 720, 781, and 1893, 1, 748, 1014, 1061. supplemented by the use of water and herbs. 2. Garri son , F. H. Introduction to the history of medicine, ed. 3, p. 863, Phila., 1922. Physicians’ fees were arranged according \j 3. Johns Hopkins Hosp. Bull., Balt., 1890, 1, 29. to a definite scale depending on the patients’ X/4. Physician and Surg., Detroit, 1906, xxvm, 180. means and were frequently paid in kind. X/ 5 Str ee te r , E. C. Exhibit commemorating the quarter-centenary of the birth of Vesalius, CHINESE AND JAPANESE20 Atlantic City, 1914; and exhibit of early The medicine of the Chinese presents the * Note : It is the author’s intention to continue his same picture today as thousands of years ago. account of the story of medicine from where he leaves The earliest of the Chinese classics upon it in this paper bringing it up to modern times. medical texts illustrating practice in fevers, 13. Grif fi th , T. L. The Petrie papyri, Lond., plague, etc., Boston, 1921. 1898. 6. Page l , J. L. Zeittafeln zur Geschichte der 14. Wreszi ns ki , W. Op. cit. Medizin, Berk, 1908. 15. Univ. Calif. Pub., Egyptian , 1, 7. Bart el s , M. Die Medicin der Naturvolkcr, Berkeley, 1905. Leipz., 1893. 16. N. Y. Hist. Soc., Quart. Bull, vi, i, Apr., 1922. Greiv e , J. A. A. C. Celsus, of medicine in 17. Garr ison , F. II. Op. cit. eight books, ed. 3, revised by G. Futvoyc, Preu ss , J. Biblisch-talmudische Medizin, Loud., 1838. Berk, 1911. Hovor ka , O. and Kronf eld , A. Vcrgleich- 18. Bloc h , I. 1 Iandbuch derGeschichteder Medizin, ende Volksmedizin, 2v., Stuttg., 190809. Jena, 1902, 1, 118-152. Luc as -Cham pion nier e , J. Les origines de la Hes sl er , F. Susrutas . 3 v., trepanation decompressive, trepanations Erlangen, 1844-50, and Commentarii et ncolithique, Paris, 1912. annotationcs, Erlangen, 1852-55. Milla r , R. Disquisitions in the history of Jee , B. S. A short history of Aryan medical medicine, Edin., 1811. science, Lond., 1896. Moodie , R. L. Antiquity of disease, Chic., Jol ly , J. Indische Medizin, Strasb., 1901. 1923. Kayiratna , A. V. Charaka-, Cal- Neub erg er , M. Geschichte der Medizin, 1, cutta, 1888-1908. transl. by E. Playfair, Lond., 19-10. Kunte , A. M. The Astrangahridwya of Ruff er , M. A. Studies in the palaeopathology Vagbhata, ed. 2, Bombay, 1891. of Egypt, Chic., 1921. Muir , J. The original Sanskrit texts on the Vena ble s , R. First four books of Celsus origin and history of the people of India, “De medicina,” ed. 2., Lond., 1837, p. 11. hi , iv, 1868-73. 8. Har pe r , R. F. The , king Neubur ger , M. Op. cit. of Babylon about 2250 b .c ., ed. 2, Chic., 1904. Whitney , W. D. samhita, 2 v., j Jas tro w , M. The liver in antiquity and the Camb., 1905. beginnings of anatomy, Tr. Coll. Phys., Wilso n , II. W. Rigveda-samhita, 3 v., Phila., 1907, xxix, 117-138, and Proc. Poy. Lonck, 1850-57. Soc. Med., Lond., 1914, vn, 109-176. Wise , T. A. Commentary on the Hindu Neub urge r , M. Op. cit. system of medicine, Calcutta, 1845, PP- 2~6- Oefe le , F. Keilschriftmedicin, Breslau, 1902. 19. Fonah n , A. Zur Quellenkunde dcr persischen Osl er , W. Evolution of modern medicine, Medizin, Leipz., 1910. New Haven, 1921. Neubu rger , M. Op. cit. 9. Alp ines , P. De medicina aegyptorium, Venice, Spie gel , F. Avesta: die heiligen Schriften I59I- der Parsen, trans, by A. H. Blecck, 3 v., Finla ys on , J. Op. cit. Hertford, 1864. Milla r , R. Op. cit. 20. Cleye r , A. Specimen medicinae sinecae, Osler , W. Op. cit. Francof, 1682. Wres zin sk i, W. Die Medizin der alten Dabr y , P. La medecine chez les Chinois, Agypter, 3V., Leipz., 1909-13. Paris, 1863. 10. Eber s , G. Papyros Ebers, 2v., Leipz., 1875. Fujikaw a , Y. Geschichte der Medizin in Joa chi m , L. Papyros Ebers, Berk, 1890. , Tokyo, 1911. 11. Ahhandl. d. Berl. Akad. d. Wissenscb., 1901. Garr ison , F. II. Op. cit. 12. Breg sch , H. Notice raisonnqe d’un traite medi- Neub urg er , M. Op. cit. cale datant de xivme siecle avant notre ere, Regna ult , J. Medecine et pharmacie chez Leipz., 1863, and Facsimile in Rec. de monum. les Chinois, etc., Paris, 1902. Egypt, Leipz., 1863, Ixxv-cvii. 21. Tambu , Y. Ishinho.

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