Topic 2: Mesopotamia

An eye for an eye - physician

To punish the doctor in case of treatment failure according to paragraph 218 of
laws of Hammurabi dawn, creator of Babylonian empire.
Mesopotamia (land btw 2 rivers) History
First civilization developed in mesopotamia - due to fertile soil and human labor
Near Tigris and euphrates rivers
The region is made fertile by flooding of 2 rivers - aided agriculture
Tremendous amount of human labor is needed to irrigate the land and protect the
young plant
Features of mesopotamia
Cuneiform writing was used
Metal working had begun
temple built on a monumental scale (Eg: Ur Ziggurat; Ishtar gate in babylon)
Cuneiform
Established by sumerian, which required the use of stylus in order to make
wedge shped marks on wet clay tablets
Can be stored, transported when the clay is dried
Become dominant writing for 2000 yrs
People still used it even sumerian become extinct as spoken language
Provided historians with opportunity to study culture of ancient mesopotamia
Medication and cure by using cuneiform:
- There was a mail in mesopotamia and the letters were written on the clay tablet
and sealed in envelop
- Many of the tablets still preserved till present
Concept of disease and healing
- Spirit was blamed and each spirit/god was held responsible for the only one
disease
- Specific offerings were made to a particular God / ghost due to causative factor,
and this was not indicated in medical text
- Plant used in treatment to treat symptoms of the disease and not for magical
purposes
- Assyrian palace gateways were flanked by protective winged bulls to drive
away illness carrying demons
- Efforts of doctor: to relieve symptoms of disease
- Doctors was great connoisseurs of herbs, know how to cook therapeutic
compound of minerals and animals products (composition of medicine at least 20)
Mesopotamian medical practitioners

2 distinct types of professional medical practitioners: Ashipu and Asu

Ashipu
- Also accounted as sorcerer or exorcist (person able to cast out the evils)
- Diagnose the ailment - means illness was caused by god/ demons
- Determine if the disease was caused by some error of sins of patient
- Attempt to cure by means of charms and spells that were designed to drive out
the spirit causing the disease
- Also refer patient to another healer: asu
Asu
- Accounted as physician
- Specialised in herbal remedies
- Dealt with empirical application of medication (without diagnose) : usually relied
on washing, bandaging, and making plasters (mixture of medicinal ingredients applied
to a wounds and held on by bandage) when treating the wound
- Wrote prescription to cure disease and even performed surgery
Relationship btw ashipu and asu
- Not entirely clear
- They seemed to have worked tgt
- Sometimes there is overlap btw the skills of 2 types of healers
Other health providers:
- Temple of Gula (goddess of healing) - patients were not housed at the temples
dedicated to Gula while they were treated
- Majority of health care was provided at patients own house by the family, family
acts as care givers
- Mesopotamians also believed that rivers had the power to expel evil
substances, therefore some hut was set up for patients near the river
- Healing ritual taking place in reed hut; healing goddesss dog on the roof; sick
person is stretched out on bed, 2 priests carry out the rite
- Gallabu (barbers): making and unmaking of slaves and performing dental
surgery
- Barber was one of the physician, they performed surgery
- Red, white and blue on the pole - blood and bones
- Role: cut hair and slave; perform minor surgery; brand slave;
extracted teeth
- Surgical instrument, lancet - barber knife
- Most famous surgery - blood letting to balance the humour/ body
fluid (slit skin with blade / placing leeches on skin)
- Barber: blue and white pole ; surgeon: red pole
- Baru:
- Practiced hepatoscopy to predict, believing that the liver was the
seat of soul
- Used individual markings or overall shape of sheep liver

- Diagnosis and prognosis were made by consulting a coded model

of sheeps liver
- Clay model of sheeps liver; used to teach students
According to Herodotus, there is a custom in mesopotamia which make patients on the street
and squares of cities. Every passerby was obliged to stop, ask patients about his suffering and
advise some means to get rid of disease.
Sources of Mesopotamia medicine:
- Most info from cuneiform tablets
- Only few are concerned with medical issues amg those which survived
- Tablets that mentioned medical practice:
- Library of Ashurbanipal
- Last king of assyria
- Tablets were housed in kings palace
- When palace was burned by invaders, clay tablets
was baked
- Ashurbanipal describes himself as literate person in
an account written by himself on his life and education
- Ashurbanipal rule and expanded Assyria include
Babylonia, Egypt, syria and persia
- Medical text (420 tables) were found at library of Ashu
- Prescription tablets
- Treatise of medical diagnosis and prognoses
- Organized with separate subsections covering
convulsive disorders, gynecology and pediatrics
- Description of disease demonstrate a keen ability to
observe and usually clever
- Medical text are rational
- All expected disease can be found described when
the tablets are fully perserved
- Code of Hammurabi - Gallabu
collection of legal decisions made by babylonian
king Hammurabi
Doctors were to be held responsible for surgical
errors and failure use of knife
Both successful surgeon compensation and failed
of surgeons liability by status of patient
If not satisfied, patient can seek for justice from
legal system
Hygiene:
- Very strict in Mesopotamia and were regulated by priest and person of king
- Priest believed that if the kings health is at risk, according to their order the
entire palace and adjacent part of the city must be washed immediately and thoroughly
- For precautions: natural and artificial ponds were infected - not to drink the tap
water from canals and rivers

Methods of treatment:
- Spiritual

- charm (necklace to be worn during time of illness or stress)

- Coloured stones were considered beneficial properties; they
warded off eveil and protects from harm
- Spells (Ashipu)
- Rituals
- Sacrifices
Empirical
- Surgery
- Treating fracture
- Pharmaceutical
- Plants incorporated in asu prescriptions had
antibiotic effects
- Resins and spices: antiseptic value, mask the smell
of malodorous wounds
Surgery
- Law of Hammurabi infers surgery was widely performed by
Gallabu
- Clay tablets describe some surgical procedures
Delivery
- Serious threat to mother and child
Cup Gudea
- Symbols of medicine
- Inscriptions on the cup shows that he was dedicated to godhealer
- Entwined by 2 serpents in center of the cup: Symbolised: healing,
protection of life and health

Topic 3: Greek and Roman Medicine

Ancient Greek Medicine
- 1st to study cause of disease
- Looked for natural explanation not just divine ones
- Roots in ancient egypt and india
- Believed illness were divine punishments and healing was a gift from Gods
- Greek God: Asclepius: assc. With healing and medicine
- Emphasize the ideas of balance in all things : 4 elements (earth, air, fire, water);
4 seasons (summer, autumn, winter, spring) -> imbalance will cause illness
- First known greek medical school opened in Cnidus
- Alcmaeon, author of first anatomical work
- Ancient greek medicine revolved around theory of humour
Theory of humour(4 humours)
- Idea of balance in: yellow bile (summer), black bile (autumn), blood (spring)
and phlegm (winter)

Humour

Season

Element

Organ

Qualities

Temperamen
t

Temperament
characteristics

Blood

spring

air

liver

warm and
moist

sanguine

courageous,
hopeful, playful,
carefree

Yellow
bile

summer

fire

spleen

warm and dry

choleric

ambitious, leaderlike, restless,

easily angered

Black
bile

autumn

earth

gallbladder cold and dry

melancholic

despondent, quiet,
analytical, serious

Phlegm

winter

water

brain/lungs cold and moist phlegmatic

calm, thoughtful,
patient, peaceful

Bloodletting for humoral imbalance

- Treatment for imbalance humoral: restoring balance
- Relatively benign and focused on changing dietary habits,
exercise, and herbal medicines
- Other treatment could involve more aggressive like bloodletting
- Physician mistakenly believed their bodies contain excess fluid
- Last until 19th century

Leeches also used for bloodletting

Amphora vase: shows a physician bleeding with patient
Modern Bloodletting (phlebotomy):
- Used for specific medical conditions
- Research show that bloodletting improve
cholesterol, bp, blood glucose level
- Commonly use in hemochromatosis (iron
overload)
Asclepius
-

Greek God of medicine and healing

Represent the healing aspect of medical arts
Has 5 daughters:
- Hygieia (Hygiene)
- Laso (goddess of recuperation of illness)
- Aceso (goddess of healing process)
- Aglaea (goddess of beauty and magnificent glory)
- Panacea (goddess of universal remedy)
- Rod of asclepius, snake-entwined staff - symbols of medicine
- Rod of asclepius frequently confused with Caduceus, which was staff wielded by
god Hermes; ROA: one snakes with no wings ; Caduceus: 2 snakes with a pair of wingsdepicting the swiftness if hermes
- Most famous temple of asclepius - Epidaurus
- Another famous healing temple: Island of Kos, where hippocrates, may have
begun his career
- non -venomous snake was often used in healing rituals, snakes: aesculapian
snake
- Snake were introduced at founding of each new temple of asclepius
- Ritual purification would be followed by offerings or sacrifices to the God and
sick would then spend the night in holiest part of the sanctuary
Hippocrates:
- Father of modern medicine
- Documented numerous illness in Hippocrates Corpus with his students
- Hippocrates Corpus: opposes ancient belief of magic
- Hippocratics Oath: hippocratic medicine was practiced by a group of
professional physicians bound by strict ethical code
- With the Oath, practitioner swore by Apollo, Hygieia, and Panacea to respect
their teacher and not to administer poison, abuse patients in any way, or break
confidentiality
- Training based on oral instructions and hands on activity; students normally paid
a fee for training
- Establish the theory of body controlled by 4 humors: phlegm, yellow bile, black
bile and blood
- Being too hot, cold, dry or wet disturb the balance btw humours, resulting
disease and illness
- encouraged doctors to look for natural causes of disease and to use natural
treatments

- First to describe clubbing of fingers - diagnosis for chronic suppurative lung

disease, cyanotic disease
- Categories illness into acute, chronic, endemic, epidemic
- First documented chest surgeon
Aristotle:
- Contribute to greek medicine and origin of modern sciences
- Gather of comparative physiology and anatomy
- Believed man is rational animal; Golden Mean: moderation in all things
- Most important contribution: 4 Basics Qualities: Hot, cold, wet and dry foundations for all notions of balance and hemeostasis

Ancient Roman Medicine

Ancient Roman
- Learned from greek medicine
- Used ideas of greeks
- At first, they paid little attention to hippocrates whose medical concept did away
with the approach of myth and philosophy
- Relied on home-made medicines and treatments for illness
- Women knew enough about cures and medicine and most treatment done in
household, become expert to the medicine treatment
- Greek 4 theory of humours were accepted
Herbal medicine
- one of the ways they tried to cure illness (mustard seeds for stomachache and
nettle tea for rheumatism)
Asclepiades
- Not accept hippocratess ideas about 4 humours by claiming that body is made
up of tinny particles that are always moving around the body
- Known for tracheostomy procedure
Public Health
- Believed healthy mind lead to healthy body
- Spend their money on keeping fit, rather than seeing doc
- Believed illness had a natural cause and could be caused by bad water and
sewage, so they introduced public health program
- Build aqueduct : for clean water; water collected from natural springs, water
was chosen based on position of the springs, purity of its water, tastes, mineral salts
- Aqueduct: gravity moved water to the city, acted as continuous slope
- Built sewer: carry off waste
- Built public bath with filtering system
- Public bath: relaxing features in Roman
- Marks the beginning of public health and sanitation

Background History for Roman

- Roman based on conquering land with highly effective army, so many soldiers
were injured during wars
- They made advances in surgery mainly because it fixed their practice need
- Military medicine was advanced
- Doc acquired knowledge while treating the soldiers
- Surgical tools gave insights into methods and advancement of surgery in Rome
Probe
-

Use to explore the wounds before surgery

Used to drain the urine

For slicing open flesh

Cut through bone

Catheters

Scalpel

Saw

History of Pathology
- Herophilus and Erasistratus conducted early systematic examinations
- Most important early medical writer: Celsus
- One of the first prominent doctors: Galen
Celsus (early medical writer:
- Known for De Medicina
- Divided into 8 books
- Credited with recording the cardinal signs of inflammation
- calor (warmth)
- dolor (pain)
- tumor (swelling)
- rubor (redness and hyperaemia)
Claudius Galen
- Most famous doc in Roman times
- He developed Hippocratess theory of 4 Humours introducing ideas of opposites
to treat illness (if patients had cold, he gave hot pepper)
- Study anatomy of various animals (pig) by dissection and applied it to body
- Realised the importance of spinal cord
- Discovered blood circulation in body
- His theories dominated and influenced western medicine for more than 1300
years
Treatment Method during Dark Age

Prayer
Exorcism
Saintly relics
superstition

Topic 3: Ancient Egypt

Background:
Geography:
-

Located on Nile River: yearly flooding in spring

Flood cause deposition of soil on either side of river
Rich soil around Nile called: Black land; Desert: Red land
Natural barrier which helped to protect it from invasion

Egyptian Religion:
- Closely tied to daily life
- Polytheistic, worshipping many different gods
- Most important Gods: Sun (Re/ Ra/ Amon-Re)
- It was believed that Pharaoh was connected to God
Re/Ra/ Amon-Re
- Chief egyptian Gods
- God of sun
Anubis
-

Patron of embalming
Keeper for poison and medicines
Performed Opening of Mouth during funeral to restore sense of decreased
Ceremony was done by touching mouth of mummy or statue of decreased
It was believed to restore sense in preparation of afterlife

Supreme God and judge of dead

Symbols of resurrection and eternal life
Provide fertility and prosperity to living

Winged goddess - represent the wind

Restore life to Osiris by flapping her wings and filling mouth and nose with air
Great enchantress, goddess of magic
Embalmer and guardian of Osiris

Son of Osiris and Iris

He avenged the death of his father
Model of dutiful son

Osiris

Isis

Horus

Ka

Believed that each person had Ka, Soul

Mummification process begin because believe in soul exist in life

Goddess to pray during epidemic

God thought to be the God who grant physician power to cure

Sekhmet

Thoth

Ancient Egyptian Medical Papyrus

- Keep medical records of Medicine in ancient civilization
Deal with topics such as childbirth, gynaecology, reproductive and etc
- Used to keep medical records
Edwin Smith Papyrus
- Known surgery performed
- 1st textbook in Surgery
- Oldest trauma reference
- Case scenario format: Problem-based Medicine - birth of analytical thinking
- Author: Imhotep
Imhotep
-

Father of Egyptian Medicine

Building pyramid and indulging astrology
Physician lead us from magic to medicine
First figure to stand out clearly from mist of antiquity

Medicine
- Dealt with supernatural
- Evolved to anatomy, public health and clinical diagnostics
- Herodotus - Greek historian describe Egyptian is the healthiest due to dry climate
and good public health system
- Extensive use of surgery, mummification practice, and autopsy to understand
organ functions
Ebers Papyrus
- Oldest metal surgical tool in world found in Qar
- Surgery- common practice amg physician
- Physician recognized 3 categories of injuries
- Treatable
- Contestable
- Untreatable ailments
- They used knives, hooks, drills, forceps,
Treatment
-

Eye of Horus Rx
Performed amputations of toe

- Created prosthetic - patient able to balance

- Egyptian doctors had even understand blood has some kind of life saving factors
to it (quite related to modern medicine)
- They could only perform surgery on topical skin, due to lack of anaesthetics to
numb body for surgery inside body
- Medical text supposed to follow exactly (if patient died from Rx, doc was not
blamed)
- Use of herbs, minerals and drugs
- Wounds: ointments
- Chest disease: Steam inhalation
Hatshepsut
-

First woman Pharaoh

Took power for herself
Pose as man to cement her authority
Built many monuments and temples

History of Pathology
- Documentation begins with Edwin Smith Papyrus and Papyrus Ebers
- Only contain less info about pathological anatomy

Topic 4: China and Indus

Indus Civilization
Harappa:
-

Earliest known people to grow cotton

Produced cotton cloth
Use river mud to make bricks, and baked in sun
More than 1 gods, and mostly are women

Background
-

Achieved great accuracy in measuring

Measuring was precise

Indus Valley
-

Create rivals in Mesopotamia or Egypt

Skill designer and builders: making bricks
Sea-faring abilities - invent tidal clock
Hydraulic Skill - drainage system
Handicraft - seal carving
Metallurgy: bronze

Early Medicine
- Atharvaveda - first indic text of medicine, incorporate concepts of demons and
magics into medicine; also include herbs in treating illness
- Ayurveda: complete knowledge for long life; built on selected ancient herbal
practices, nothing to do with concepts of magic and demon
- Most famous text belongs to school of Charaka (court physician) and Sushruta
(compilation of herbs)
Ayurveda
-

Treats every human beings as unique entity

Believe universe made up of 5 elements: Air, Earth, Ether, Fire, Water
- Air: flow freely throughout the body, give movement to biological
functions and feeding each cell with oxygen
- Water: Life sustaining
- Fire: provide body with heat and radiant energy
- Space/Ether: provide other elements an opportunity to interact
- Earth: food from earth nourish us and to earth we return
5 elements represented in body by 3 bio-energies/ 3 dosha: Vata, Pitta, Kapha
- Vata: bio-energy control and manage bodily functions pertaining
motion
- Pitta: regulate matabolism
- Kapha: control growth of body

- Accumulation of dosha beyond desired limits result into generation of specific

disease
- LIfestyle and nutritional guidelines can help to balance 3 doshas and cure
disease
- Urge moderation food intake, sleep and sexual activity
- Avoidance of drugs and heavy materials
- 7 basic tissues: plasma, blood, muscle, fat, bone, marrow, semen
- 8 branches of Ayurveda: ***
- general medicine
- Surgery
- Peadiatrics
- demology/ psychiatry
- Toxicology
- Science of rejuvenation
- Aphrodisiacs (Rx to increase volume and viability of semen)
- ENT / opthalmology
Susruyasamhita
- describe procedure on various form of surgery
- Classifies human surgery in 8 categories
Sushruta
- First human in history who suggest surgery should learned from human body by
dissecting
- Famous of rhinoplasty (plastic surgery)
Yoga for health benefits
- Collected by Patanjali
- 9 obstacles in practice of Yoga

1.
2.
3.
4.
5.
6.
7.
8.
9.

Vyadhi (ill health)

Styana (Unpreparedness)
Samshaya (Doubt)
Pramada (Indifference)
Alasya (Laziness)
Avirati (Entanglement in Sense Objects)
Bhrantidarshana (Illusion)
Alabdha Bhumikatva (Lack of Stability)
Anavasthitathva (Slackness in Practice)

China Civilization
. Hwang Ho i. Huang Ho Valley ii. Traditional Chinese medicine

Hwang Ho Valley
- Place where civilization developed
- No records of its beginnings
- Valley cut off from other civilization
- Small round clay houses was built
Oracle script / inscription
- Contains about solar and lunar eclipses, starts and other celestial
- Ways for priest to write down history of dynasty and timeline of the king
- Mark the beginning of written chinese history
Ancient Chinese Medicine
Yellow Emperors Inner Canon
- Reject influence of spirit and the use of magics
- Composed of 2 texts: Suwen and Lingshu (known as Neijing if combined tgt)
- Explanation on relation btw human, environment
- Main fundamental theory of TCM: Qi, Yin, Yang and 5 Phases of nature
- Zhang Liang invented an instrument named Meng -> precursor for modern
stethoscope
TCM
-

Based on philosophy of Taoism

Focus on theory of holism Zheng Ti Guan Nian
2 main components in theory of holism
- First based on theory of meridian - 12 primary meridians
- External factors

Vital force that flows through all living things

Flow through channels/ meridians
Imbalance of Qi -> disease - use moxibustion or acupuncture to cure it

Qi

Yin and Yang

- Yang= male upper body
- Yin=female lower body
- >yang=fever ; >yin=accumulation of fluid
5 Phases Theory (Wu Xing) / five element theory
- Important philosophical theory
- Serve as the guiding ideology and methodology of physiology, pathology
- Connected to concept of Zang Fu
- Similar to ancient Indian and Buddhist ideas of element (earth, ether, fire, water
and air); Greek scientific idea (earth, water, air, fire,)
- Zang fu concept:
- Zang: bodys production department
- Fu: bodys processing department
- Physician use this concept to treat health problems

Methods of diagnosis in TMC

- Observation
- Auscultation
- Olfaction
- palpation
Bian que
-

Well known physician

Excellent in pulse taking

Acupuncture, moxibustion, tui na, qi gong and herbs

Topic 6: Evolution of Medicine

Da Vinci - Italy
- Influential artist of Renaissance
- Wanted to have better understanding the lying structure of the body to enhance
their artwork
- Performed many dissections to determine how muscle worked
- Sketched provided correct proportion
- A lot of anatomical sketches
Antony van Leeuwenhoek
- Father of microbiology
- Best known for discovering bacteria and creating more than 500 simple
microscopes
- Microscope made from leeuwenhoeks tiny spherical lenses - could use his lense
to resolve details as small as 1.35micrometer
Wilhelm Conrad Rontgen
- German physician
- Discover X-ray
- He detected electromagnetic radiation in wavelength range known as X-ray or
Rontgen ray
- This occurred accidentally
- He was testing whether cathode rays could pass through glass when he noticed
a glow coming from a nearby chemically coated screen
- He dubbed the rays that caused this glow x-rays because of unknown nature
- Was labelled as medical miracle
- Important in diagnostic and able to see the structure without surgery