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A History of Medicine
Third Edition
A History of
Medicine
Third Edition
Lois N. Magner
Professor Emerita, Purdue University
West Lafayette, Indiana, USA
Oliver J. Kim
Health Policy Consultant
Washington, DC, USA
CRC Press
Taylor & Francis Group
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Boca Raton, FL 33487-2742
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Contents
Preface ix
Authors xiii
1 PALEOPATHOLOGY AND PALEOMEDICINE 1

Paleopathology: Methods and problems 4
Diagnosing prehistoric diseases and injuries 7
Mummies and signs of disease 9
The Iceman 11
Paleomedicine and surgery 11
Healing rituals, traditions, and magic 13
Suggested readings 19
2 MEDICINE IN ANCIENT CIVILIZATIONS: MESOPOTAMIA AND EGYPT 21

Mesopotamia 21
Hammurabi’s code of laws 23
Egypt 25
The medical papyri 32
3 THE MEDICAL TRADITIONS OF INDIA AND CHINA 37

India 37
Ayurvedic medicine, the science of life 39
Surgery, anatomy, and dissection 42
Chinese medicine: Classical, traditional, and modern 47
The three celestial emperors: Fu Hsi, Shen Nung, and Huang Ti 48
Classical Chinese concepts of anatomy 50
Acupuncture and moxibustion 54
Drug lore and dietetics 55
Surgery 58
The Chinese cultural sphere 58
Medical practice in modern China 59
4 GRECO-ROMAN MEDICINE 63
Philosophy and medicine 64
Hippocrates and the Hippocratic tradition 65
The nature of disease and the doctrine of the four humors 68
The cult of Asclepius, god of medicine 71
Alexandrian science and medicine 73
v
vi Contents
Medicine in the Roman world 77

On Galen and Galenism 80
The Plague of Cyprian 86
5 THE MIDDLE AGES 89

Monasteries and universities 91
Surgery in the Middle Ages 94
Women and medicine 95
Epidemic diseases of the Middle Ages 97
Bubonic plague 97
From leprosy to Hansen’s disease 104
Islamic medicine 109
The great sages of Islamic medicine 112
The strange case of Ibn an-Nafis 116
The survival of Greco-Islamic medicine 117
6 THE RENAISSANCE AND THE SCIENTIFIC REVOLUTION 119

The medical humanists 120
Autopsies, art, and anatomy 121
Andreas Vesalius on the fabric of the human body 122
Medicine and surgery 125
The occult sciences: Astrology and alchemy 129
Syphilis, the scourge of the Renaissance 130
Syphilis and human experimentation 137
The discovery of the circulation of the blood 140
Blood transfusion 148
Santorio Santorio and the quantitative method 150
7 NEW WORLD CULTURES AND CIVILIZATIONS 153

New World civilizations and the “Columbian exchange” 157
Aztec civilization 158
Mayan civilization 164
Incan civilization 166
Diseases in the Americas 169
8 THE AMERICANIZATION OF OLD WORLD MEDICINE 173

The new republic 175
Heroic medicine and the death of George Washington 176
Yellow fever 178
Medical practice and regional distinctiveness 180
The Civil War 181
Medical education and the medical profession 186
The Flexner Report 188
The Flexner Report and the sectarian schools 190
Medical colleges for women and African-Americans 192
Continuing medical education 197
Medical specialization 198
Problems in the modern medical workforce 198
Contents vii
Hospitals, nurses, and nursing schools 199

9 THE MEDICAL COUNTERCULTURE 203
Alternative medicine 203
Ellen White and Seventh Day Adventism 207
From Adventist healing to breakfast cereals 208
Nutrition science for the poor 210
Patent medicines 211
Modern diets, paleo, and gluten-free 211
Christian Science 213
Faith healing 215
Religious doctrines and standards of medical care 217
Faith healing and prayer tests 218
Domestic medicine and advice books 219
Medical sects 219
Osteopathy 223
Chiropractic 224
Naturopathy 226
Alternative, complementary, and integrative medicine 227
The National Center for Complementary Medicine 229
10 MEDICAL THEORY, MEDICAL CARE, AND PREVENTIVE MEDICINE 233
Thomas Sydenham, the “English Hippocrates” 234
The eighteenth-century foundations of modern medicine 240
Nutrition, malnutrition, health, and disease 242
Smallpox: Inoculation, vaccination, and eradication 250
Edward Jenner, cowpox, and vaccination 256
The global eradication of smallpox 260
11 THE ART AND SCIENCE OF SURGERY 269
Anesthesia 269
Laughing gas, ether, and surgical anesthesia 272
Postsurgical infections 281
Childbirth, midwives, obstetricians, and childbed fever 284
Midwives and medical men 291
Antisepsis and asepsis 298
From hospitalism to nosocomial infections 302
12 MEDICAL MICROBIOLOGY 305
Louis Pasteur 306
Robert Koch 310
Microbes, miasmata, and water-borne diseases 319
Invisible microbes and virology 328
Emerging diseases 334
Biological warfare and bioterrorism 336
13 DIAGNOSTICS AND THERAPEUTICS 343
The art and science of diagnosis 344
viii Contents
Serum therapy 347

Immunology and antibiotics 350
Natural defenses: Humoral or cellular? 357
Genetics, genomics, and medicine 363
Paradoxical progress 365
Medical errors and medical malpractice 368
Testing the safety and efficacy of drugs 369
14 THE QUEST FOR WELLNESS: PUBLIC HEALTH AND ENVIRONMENTAL CONCERNS 379
Achievements in public health in the United States, 1900–1999 380
Birth control, Comstock, the pill, and abortion 382
Modern miasmas and human health 389
Hill’s criteria for causation: Occupational diseases and environmental pollution 393
Modern miasmata: Air pollution and human health 399
Poliomyelitis 400
Influenza: The last great plague? 405
Paradoxical progress 408
Epilogue 411
Index 417
Preface
My primary purpose in writing and revising this book has been to provide an updated
introduction to the history of medicine. Although the text began as a “teaching assistant” for my
own survey courses in “The History of Medicine” and “The History of Medicine in America,” I
hope that this new edition will also be of interest to a general audience, and to teachers who are
trying to add historical materials to their science courses or biomedical science to their history
courses. As in the two previous editions of this book, I have tried to call attention to major
themes in the history of medicine, the evolution of theories and techniques, and the diverse
attitudes and assumptions with which physicians and patients have understood health, disease,
and healing.
Many changes have taken place in the history of medicine since the 1940s when Henry E.
Sigerist called for a new direction in the field, a move away from the study of the great physicians
and their texts, toward a new concept of medical history as social and cultural history. From
an almost exclusive focus on the evolution of modern medical theories, historians have turned
to new questions about the social, cultural, economic, and political context in which healers
and patients are embedded. Given the broad scope of the history of medicine today, finding
a satisfactory way to present an introductory survey has become increasingly difficult. Thus,
a selective approach, based on a consideration of the needs and interests of readers who are
first approaching the field, seems appropriate. I have, therefore, selected particular examples
of theories, diseases, orthodox and alternative healers, training and education, diagnostics
and therapeutics, and attempted to allow them to illuminate themes that raise fundamental
questions about health, disease, and history.
Medical concepts and practices can provide a sensitive probe of the intimate network of
interactions in a specific society and our increasingly globalized world, as well as traces of the
introduction, diffusion, and transformation of novel ideas and techniques. Medical problems
concern the most fundamental and revealing aspects of any society—health and disease, wealth
and poverty, race and gender, disability and aging, suffering and death. All people, in every
period of history, have dealt with childbirth, disease, traumatic injuries, pain, aging, and death.
Thus, the measures developed to heal mind and body provide a valuable focus for examining
different cultures and contexts. Perhaps immersion in the history of medicine can provide a
feeling of kinship with patients and practitioners, past and present, a sense of humility with
respect to disease and nature, and a critical approach to our present medical problems.
Since the end of the nineteenth century, the biomedical sciences have flourished by following
what might be called the “gospel of specific etiology”—that is, the concept that if we understand
the causative agent of a disease, or the specific molecular events of the pathological process,
ix
x Preface
we can totally understand and control disease. This view fails to consider the complex social,
ethical, economic, and geopolitical aspects of disease in a world drawn closer together by
modern communications and transportation, while simultaneously being torn apart by vast and
growing differences between wealthy and impoverished peoples.
Public debates about medicine today rarely seem to address fundamental issues of the art
and science of medicine; instead, the questions most insistently examined concern healthcare
costs, availability, access, equity, and liability. Comparisons among the medical systems of
many different nations suggest that despite differences in form, philosophy, organization, and
goals, all have experienced tensions caused by rising costs and expectations and pressure on
limited or scarce resources. Government officials, policy analysts, and healthcare professionals
have increasingly focused their energy and attention on the management of cost-containment
measures. Rarely is an attempt made to question the entire enterprise in terms of the issues raised
by demographers, epidemiologists, and historians as to the relative value of modern medicine
and more broadly based environmental and behavioral reforms that might significantly affect
patterns of morbidity and mortality.
Skeptics have said that we seem to exchange the pestilences of one generation for the plagues
of another. At least in the wealthier, industrialized parts of the world, the prevailing disease
pattern has shifted from one in which the major killers were infectious diseases to one in which
chronic and degenerative diseases predominate, associated with a demographic shift from an era
of high infant mortality to one with increased life expectancy at birth, and an aging population.
Since the end of the nineteenth century, we have seen a remarkable transition from a period
where prevention was expensive (e.g., installation of sewer systems and municipal drinking
water systems) and therapy was basically inexpensive (e.g., bleeding and purging) to one where
therapy is expensive (e.g., coronary bypass operations and new cancer drugs) and prevention is
inexpensive (e.g., more exercise and less cigarette smoking). The demand for high-cost diagnostic
and therapeutic technologies seems insatiable, but it may well be that improvements in health
and the overall quality of life are better served by a new commitment to social services and
community health rather than more sophisticated scanners, specialized surgeons, and intensive
care facilities. After years of celebrating the obvious achievements of biomedical science
(vaccines, antibiotics, anesthesia, insulin, organ transplantation, and the global eradication of
smallpox), deep and disturbing questions are being raised about the discrepancy between the
costs of modern medicine and the role that medicine has played in terms of historical and global
patterns of morbidity and mortality. Careful analysis of the role of medicine and that of social
and environmental factors in determining human health indicates that medical technology is
not a panacea for either epidemic and acute disease, or endemic and chronic disease.
A general survey of the history of medicine reinforces the fundamental principle that
medicine alone has never been the answer to the ills of the individual or the ills of society,
but human beings have never stopped looking to the healing arts to provide a focus for cures,
consolation, pain relief, and rehabilitation. Perhaps a better understanding of previous concepts
of health, healing, and disease will make it possible to recognize the sources of contemporary
problems and the inherent limitations and liabilities of current paradigms. To keep the size of
this book within reasonable limits, only brief lists of suggested readings have been attached to
each chapter. The emphasis has been on recent books that should be readily available and useful
in obtaining further information about topics of particular interest to readers.
Once again, I would like to express my deep appreciation to John Parascandola and Ann
Carmichael for their invaluable advice, criticism, and encouragement during the preparation
Preface xi
of the first edition of this book many years ago. I would also like to thank Dr. Joanna Koster,
Julia Molloy, and Linda Leggio at Taylor & Francis for their help and encouragement during the
production of this book. For this edition of the book, I owe many thanks to Oliver J. Kim for
sharing his knowledge and insights into twenty-first century healthcare and healthcare policy.
Of course, all remaining errors of omission and commission remain my own. Many thanks also
to the students who took my courses, read my books, and let me know what was clear and what
was obscure. I have followed the advice of my very best students by attempting to use language
that is as simple, clear, and precise as possible. Although the meaning of words like science,
medicine, magic, natural, supernatural, healer, doctor, nurse, hospital, school, college, and so
forth, changes over time, I think it is best to use language that helps today’s readers relate to the
ideas and issues embedded in the history of medicine.
Lois N. Magner
Authors
Lois N. Magner is Professor Emerita, Purdue University, West Lafayette, Indiana. At Purdue
University, she taught courses in the history of medicine, the history of the life sciences, science
and society, and women’s studies. She served as Assistant Dean of the School of Humanities, Social
Science, and Education and was Director of the Women’s Resource Office. Professor Magner is
the author or co-author of numerous journal articles, book reviews, book chapters, and books,
including A History of the Life Sciences, Third Edition (Marcel Dekker), Doctors, Nurses, and Medical
Practitioners: A Bio-Bibliographical Sourcebook (Greenwood Press), and A History of Infectious
Diseases and the Microbial World (Praeger Publications). Both A History of the Life Sciences and
A History of Medicine were translated into Chinese. She also contributed to the documentary
“The War Against Microbes” (Nobelmedia and Kikim Media). Professor Magner has served as
an advisor, consultant, and contributor to several series of books devoted to the understanding of
science in its social, historical, and ethical contexts. She is a member of the American Association
for the History of Medicine. Dr. Magner received the BS degree from Brooklyn College, New York,
and the PhD degree from the University of Wisconsin, Madison.
Oliver J. Kim is the President of Mousetrap Consulting and the Executive Director of Cross-Border
Health, an organization that fosters policy exchanges between the United States and Canada. He
is also a collaborating researcher with the Center for Healthcare Research and Transformation at
the University of Michigan and was selected for the Woodrow Wilson foreign policy fellowship,
the AcademyHealth Health Policy in Action award, the Hartford Foundation Change AGEnt
program, and the American Council of Young Political Leaders’ international exchange program.
Mr. Kim earned his BA degree (1995) from Indiana University; his JD degree (2000) from the
University of Minnesota; and his LLM degree (2011) from Georgetown University, Washington,
DC. Oliver Kim has over 15 years of legislative and policy experience at the federal and state
levels. He spent over a decade working in the U.S. Senate, including eight years as a senior advisor
to Senator Debbie Stabenow (D-MI) and two as deputy director for the Special Committee on
Aging under Chairman Bill Nelson (D-FL). In the Senate, he worked on key legislation including,
but not limited to, the Medicare Modernization Act, the Children’s Health Insurance Program
Reauthorization, the Food and Drug Administration Amendments Act, the American Recovery
and Reinvestment Act, and the Affordable Care Act. He also served as a policy consultant for the
2015 White House Conference on Aging and drafted a portion of the final summary report. Mr.
Kim has been recognized for his work on aging, children’s health, reproductive health, health
financing, and health information technology. He has written on advance care planning and
spoken both domestically and internationally on aging issues and long-term care policy.
xiii
1
Paleopathology and paleomedicine
One of the most appealing and persistent myths created by our ancestors is that of a Golden
Age, or a Garden of Eden, a time before the discovery of good and evil, when death and disease
were unknown. But, scientific evidence—meager, fragmentary, and tantalizing though it often
is—proves that disease is older than humanity and was not uncommon among other species.
Indeed, studies of ancient fossil remains, skeletons in museum collections, animals in zoos, and
animals in the wild demonstrate that arthritis is widespread among a variety of medium- and
large-sized mammals. Modern diagnostic imaging techniques have revealed tumors and bone
fractures in fossilized remains. Evidence of infection has been found in the bones of prehistoric
animals and, recently, genomic studies have identified specific pathogens in mummies and other
well-preserved human remains.
Understanding the pattern of disease and injury that afflicted our earliest ancestors requires
the perspective of the paleopathologist. Sir Marc Armand Ruffer, one of the founders of
paleopathology, defined paleopathology as the science of the diseases that can be demonstrated
in human and animal remains of ancient times. Paleopathology provides information about
health, disease, diet, nutritional status, death, environment, and culture in ancient populations.
In Descent of Man and Selection in Relation to Sex (1871), Charles Darwin argued that
human beings, like every other species, evolved from previous forms of life by means of natural
selection. Human beings, Darwin concluded, descended from an ancestral species related to
that of chimpanzees and gorillas, our closest relatives among the great apes. Humans apparently
originated in Africa and migrated to Europe, Asia, and Polynesia by pathways that are being
clarified by new scientific techniques.
The fossilized remains of human ancestors provide valuable clues to the past, but such fossils
are rare and usually incomplete. In South Africa, in 1925, Raymond Dart discovered a skull
that appeared to be a transitional form between apes and humans. Dart called the new species
Australopithecus africanus (South African ape-man). After many years of controversy, Dart’s
work was confirmed by scientists who discovered remarkable fossils at other sites in Africa.
Paleoanthropology is a field in which new discoveries inevitably result in the reexamination
of previous findings and great debates rage over the identification and classification of bits of
bones and teeth. Unfortunately, the environment in which ancient remains were buried can
lead to confusion and misdiagnoses. For example, because the chemical salts in bones are quite
soluble in water, soil conditions that are conducive to leaching out calcium can cause changes
in bones that might lead to a pseudo-diagnosis of osteoporosis. Despite all the ambiguities
associated with ancient remains, some traumatic events and diseases can be revealed with a fair
degree of accuracy.
1
2 Paleopathology and paleomedicine
The temptation of Adam and Eve in the Garden of Eden. (From The New York Public Library.)
Insights from different disciplines, including archeology, historical geography, morphology,

comparative anatomy, taxonomy, molecular biology, and genomic studies have enriched our
understanding of human evolution. Changes in DNA, the archive of human genealogy, have
been used to construct tentative family trees, lineages, and possible patterns of early migrations.
The Paleolithic Era, or Old Stone Age, when the most important steps in cultural evolution
occurred, coincides with the geological epoch known as the Pleistocene, or Great Ice Age, which
ended about 10,000 years ago with the last retreat of the glaciers. Early humans are generally
thought of as hunter-gatherers, that is, opportunistic omnivores, who learned to make tools, build
shelters, carry and share food, and create uniquely human social structures. A more realistic but
less romantic version of the way early humans lived would note that they also scavenged carcasses
of animals that died a natural death or were temporarily left unattended by predators. Although
Paleolithic technology is characterized by crude tools made of bone and chipped stones and the
absence of pottery and metal objects, the people of this era produced the dramatic cave paintings
at Lascaux, France, and Altamira, Spain. Presumably, they also produced useful inventions that
were fully biodegradable and, therefore, left no traces in the fossil record. The weapons used by
hunters were more likely to survive than the implements used to gather the grains, fruits, nuts,
vegetables, insects, and small animals that probably constituted the more reliable component of
the Paleolithic diet. Women, who presumably were the gatherers, would have needed digging
sticks and sacks to carry food stuffs, especially when encumbered by infants and children.
Paleopathology and paleomedicine 3
The transition to a new pattern of food production through farming and animal husbandry is
known as the Neolithic Revolution. People of the Neolithic or New Stone Age developed crafts,
such as basket-making, pottery, spinning, and weaving. Although no art work of this period
seems as spectacular as the Paleolithic cave paintings in France and Spain, Neolithic people
produced interesting sculptures, figurines, and pottery.
While archeologists and anthropologists were once obsessed with the when and where of the
emergence of an agricultural way of life, they have become increasingly curious about the how
and why. Nineteenth-century anthropologists tended to classify human cultures into a series of
ascending, progressive stages marked by the types of tools manufactured and the means of food
production. Since the 1960s, new analytical techniques have made it possible to test hypotheses
about environmental and climatic changes and their probable effect on the availability of food
sources. Scientists are also exploring changes in the human genome that apparently occurred after
agriculture was established. Preliminary clues suggest genetic changes that ultimately affected
height, digestion, the immune system, and other traits. Indirect evidence of these alterations has
been uncovered by studying the genomes of living people from different parts of the world, but
new approaches will make it possible to see genomic changes as they occurred over thousands
of years. Like the invention of the microscope and the telescope, the introduction of genomic
techniques has had a transformative effect that makes it possible to see surprising new worlds.
Recent studies of the origins of agriculture suggest that it was widely adopted between
10,000 and 2,000 years ago. When comparing the health of foragers and settled farmers,
paleopathologists generally find that dependence on a specific crop resulted in populations that
were less well-nourished than hunter-gatherers, as indicated by height, robustness, dentition,
and so forth. Therefore, when the idea of “progressing” from hunting to agriculture is subjected
to critical analysis rather than accepted as inevitable, the causes of the Neolithic transformation
are not as clear as previously assumed. Given the fact that hunter-gatherers may enjoy a better
diet and more leisure than agriculturalists, prehistoric or modern, the advantages of a settled
way of life are obvious only to those who are already happily settled and well fed.
In early agricultural societies, the food base became narrower, with dependence on a few
or even a single crop. Thus, the food supply might have been adequate and more consistent in
terms of calories, but deficient in vitamins, minerals, and essential amino acids. Domestication
of animals, however, seemed to improve the nutritional status of ancient populations. Although
the total human population apparently grew very slowly prior to the adoption of farming, it
increased quite rapidly thereafter. Prolonged breastfeeding along with postpartum sexual
prohibitions found in many nomadic societies may have maintained long intervals between
births. A more sedentary lifestyle presumably led to earlier weaning and shorter birth intervals,
despite the grueling labor characteristic of early agriculture.
The revolutionary changes in physical and social environment associated with the transition
from the way of life experienced by small mobile bands of hunter-gatherers to that of sedentary,
relatively dense populations also allowed major shifts in patterns of disease. Permanent dwellings,
gardens, and fields provide convenient niches for parasites, insects, and rodents. Stored foods are
likely to spoil, attract pests, and become contaminated with rodent excrement, insects, bacteria,
molds, and toxins.
Lacking the mobility and diversity of resources enjoyed by hunters and gatherers, sedentary
populations are at risk of crop failures that can rapidly lead to malnutrition or even starvation.
Migrations and invasions of neighboring or distant settlements triggered by local famines could
carry parasites and pathogens to new territories and populations. Ironically, worrying about
our allegedly unnatural and artificial modern diet has become so fashionable that people in the
wealthiest nations have toyed with the quixotic idea of adopting the dietary patterns of ancient
humans or even wild primates. In reality, the food supply available to prehistoric peoples was
likely to have been inadequate, monotonous, coarse, and unclean rather than the “pure and
natural” diet that modern people with access to a globalized food supply imagine for their
ancient ancestors.
PALEOPATHOLOGY: METHODS AND PROBLEMS

Because direct evidence of disease among ancient humans is very limited, we will have to seek
out a variety of indirect approaches to reach at least a tentative understanding of the prehistoric
world. For example, studies of our closest relatives, great apes and monkeys, have shown that
living in a state of nature does not mean freedom from disease. Wild primates suffer from many
disorders, including arthritis, malaria, hernias, parasitic worms, and impacted teeth. Our human
ancestors, the first “naked apes,” presumably experienced disorders and diseases like those found
among modern primates during a lifespan that was truly “nasty, brutish, and short.” Nevertheless,
prehistoric peoples learned to adapt to harsh environments, quite unlike the mythical Garden
of Eden. Eventually, through cultural evolution, human beings changed their environment in
unprecedented ways, even as they adapted to its demands. By the domestication of animals,
the mastery of agricultural practices, and the creation of densely populated settlements, human
beings also generated new patterns of disease.
Paleopathologists must use a combination of primary and secondary evidence to draw
inferences about prehistoric patterns of disease. Primary evidence includes bodies, bones, teeth,
and charred or dried remains of bodies found at sites of accidental or intentional human burials.
Secondary sources include the art, artifacts, and burial goods of preliterate peoples, and ancient
documents that describe or suggest the existence of pathological conditions. The materials for
such studies are very fragmentary, and the overrepresentation of the hard parts of bodies—bones
and teeth—undoubtedly distorts our portrait of the past.
The probability of arriving at an unequivocal diagnosis through the study of ancient remains
is so small that some scholars insist that the names of modern diseases should never be conferred
on ancient materials. Other experts have systematically cataloged ancient ailments in terms of
congenital abnormalities, injury, infection, degenerative conditions, cancers, deficiency diseases,
and that all-too-large category, unidentified diseases.
Another approach to studying human remains in their archeological context is called
bioarcheology, a field that encompasses physical anthropology and archeology. Funerary customs,
burial procedures, and environmental conditions, such as heat, humidity, and soil composition,
can determine the state of preservation of human remains. Cremation, in particular, creates severe
warping and fragmentation. Bodies may be buried in the ground shortly after death, covered
with a mound of rocks (cairn burial), or deliberately exposed to the elements. Both nomadic
and settled people might place a body on some type of scaffold as a temporary measure if the
death occurred when the ground was frozen. Later, the skeletal remains could be interred with
appropriate ceremonies. In some burial sites the dead might be added to old graves, causing a
confusing commingling of bones. Added confusion arises from ritual mutilation of the body, the
admixture of grave goods and gifts (which may include body parts of animals or grieving relatives),
and distortions due to natural or artificial mummification. Burrowing animals and looters might
also disturb burial sites, damaging bones and changing their distribution. Catastrophes, such as
Paleopathology: Methods and problems 5
floods, earthquakes, landslides, and massacres, may provide information about a large group of
individuals during one moment in time.
Despite the increasing sophistication and power of the analytical techniques employed in
the service of paleopathology, many uncertainties remain, and all results must be interpreted
with caution. Since the last decades of the twentieth century, scientists have exploited new
methods, such as DNA amplification and sequencing, the analysis of stable isotopes of carbon
and nitrogen, and scanning electron microscopy to ask questions about the health, lifestyle, and
culture of ancient peoples. Scanning electron microscopy has been used to examine patterns
of tooth wear and enamel defects caused by stress and growth disruption and the effect of
workload on the structure of bones. Where possible, chemical investigations of trace elements
extracted from ancient bones and hair can provide insights into dietary patterns and quality of
life. Lead, arsenic, mercury, cadmium, copper, and strontium are among the elements that can
be identified in hair.
The analysis of stable isotopes of carbon and nitrogen provides insights into bone chemistry
and diet because the ratio of these isotopes found in ancient human remains suggests the relative
importance of plant and animal foods in the diet. For example, when scientists determined
the relative amounts of carbon 13 and nitrogen 15 in the bones of human beings living in
various parts of Europe more than 20,000 years ago, the results suggested that their diet was
high in fish, shellfish, and waterfowl. Analyses of the isotopes in the bones of Neanderthals,
in contrast, suggested that most of their dietary proteins came from large animals. However,
studies of Neanderthal teeth, especially dental plaque, suggest that they also ate a variety of
plants. Moreover, Neanderthals may have cooked various plants for use as foods and medicines.
The assumption that Neanderthals were strictly meat eaters was once thought to explain why
they disappeared from Europe about 25,000 years ago.
The 50,000-year-old skeletal remains of at least 13 Neanderthals in a cave in Spain provided
new evidence about how these prehistoric people lived. Calcified layers of plaque were found
on some of the teeth. By using gas chromatography and mass spectrometry to analyze organic
compounds in the plaque, investigators obtained clues about the diet of these individuals. This
approach has been called archeological chemistry. Chemical evidence from fossilized teeth and
biomarkers in coprolites (fossilized human feces) corroborates the hypothesis that Neanderthals
cooked and ate significant amounts of plants. Dental plaque contained carbohydrates and
roasted starch granules. Some chemical compounds were probably components of bitter tasting
plants like yarrow and chamomile that are still valued in herbal medicine. Analyses of coprolites
indicate that Neanderthals resembled modern humans in terms of cholesterol metabolism.
Perhaps it would be helpful to invoke such studies when reviewing twenty-first century
debates about popular diets, such as the “Paleolithic diet” which is based on the premise that
eating like our early human ancestors is the key to health, well-being, energy, and weight loss.
Advocates of the paleo diet argue that even if early hunter-gatherers did not have a long life-span,
they were healthier than modern humans. They were allegedly taller, leaner, stronger, and had
a more robust immune system than their puny modern descendants. Our ancestors supposedly
thrived on a hunter-gatherer diet for two million years. Attempts to return to the idyllic life
of Paleolithic hunters ignore the fact that our ancestors did not live happy, healthy, stress-free
lives in blissful harmony with nature. The natural environment was full of dangers, including
poisons, predators, parasites, and pathogenic microbes. Paleoanthropologist Leslie Crum Aiello
called the idea that a Paleolithic diet is a return to a better life a “paleofantasy.” Nostalgia for a
simple Paleolithic life is unrealistic and largely the product of myths about the past.
It is true that humans have spent only about 10,000 years adapting to the new food sources
provided by agriculture and animal husbandry, but insights made possible by studies of the
human genome and microbiome have found that many changes have been surprisingly rapid
and beneficial. Our evolutionary history is written into our genes, our anatomy and physiology,
and (perhaps in a more ephemeral way) in our microbiome (the communities of microorganisms
that live in and on our bodies, especially in the gut). For example, some human populations have
extra copies of amylase genes, which make it easier to digest starchy foods. Other populations
have gene mutations that support the persistence of the enzyme lactase after weaning. This
allows adults to digest lactose (milk sugar). About 5,000 years ago, mutations that provide lactose
tolerance spread throughout Northern Europe. Being able to digest milk and dairy products is
very advantageous for people with domesticated cattle. Lactose tolerance evolved independently
in certain African populations. In Japan, many people have bacteria in their gastrointestinal
tract that can digest seaweed, a popular component of the Japanese diet. Presumably, modern
humans and our distant ancestors differ more in the gut bacteria that help digest food than in
the structure of our digestive tracts or the genes that code for our own digestive enzymes.
Critics and satirists suggest that a truly authentic paleo diet would have included such large
quantities of insects that our ancestors might be called insectivores rather than omnivores.
Insects are actually a high-quality food source; they provide a variety of nutrients—protein,
iron, calcium, and essential fatty acids. Early humans are often portrayed as aggressive and
skillful hunters, who consistently brought home large quantities of meat. In the absence of
modern weapons, however, hunting is a dangerous activity with a low success rate. Ancient
hunters might have starved if not for the work of those who gathered tubers, greens, insects, and
other small animals.
Archeologists excavating a cave in Gibraltar that had been occupied by Neanderthals
about 39,000 years ago discovered stone tools, bits of animal bones, and etchings created by
Neanderthal artists. The meaning and purpose of the abstract, geometric patterns are unknown
but presumably they reflect the thoughts and symbolic world of Neanderthal people. Decorative
items such as shell beads and ochre pigments have also been found at Neanderthal sites.
The dominant theories concerning the demise of the Neanderthals have generally focused
on competition from Homo sapiens and environmental changes. It is also possible that diseases
carried out of Africa by modern humans might have been a significant factor. Late-arriving
modern humans probably brought diseases that the Neanderthals living in Europe had not
encountered before. On the other hand, genomic studies of Neanderthals and early modern
humans, in conjunction with genetic studies of common pathogens, suggest that certain
infectious diseases usually associated with modern humans may have been prevalent among
Neanderthals as well. Various epidemic infectious diseases were thought to have attacked
humans after they adopted farming and animal husbandry. However, diseases thought of as
zoonoses (diseases of animals that can be transmitted to humans) might have occurred among
Neanderthals 250,000–40,000 years ago when they were the dominant human species in Europe
and Asia.
New studies suggest that Neanderthals were not necessarily bumbling, brutish, intellectually
limited creatures, but people who made tools, jewelry, and art. The degree of interbreeding
demonstrated by DNA analyses of Neanderthals and early modern humans suggests that they
were not so very different from each other. The pioneering studies that established a draft sequence
of the Neanderthal genome were led by Svante Pääbo, Director of the Max Planck Institute for
Evolutionary Anthropology. Initially, Pääbo planned to analyze the DNA of Egyptian mummies
Diagnosing prehistoric diseases and injuries 7
housed in various museums. Typically, DNA extracted from mummies is badly degraded and
contaminated by DNA from modern humans and microbes.
Sequencing the DNA of mummies might be considered a minor challenge in comparison to
the ambitious goal of mapping the evolutionary relationships of modern humans, early hominids,
and the great apes. DNA extracted from bone fragments was used to generate the Neanderthal
genome, which was then compared to the human genome. Preliminary accounts of Neanderthal
DNA sequences were published in 1997, but it took many years of painstaking work before the
full Neanderthal genome was sequenced. In 2010, scientists published a draft sequence of the
Neanderthal genome in the journal Science.
DIAGNOSING PREHISTORIC DISEASES AND INJURIES

Today, and presumably in the distant past, most diseases and infections affect soft tissues rather
than bones, but bones and teeth may provide important clues about health, disease, age, and cause
of death. Scientists can subject skeletal remains to x-rays, diagnostic imaging, chemical analysis,
and so forth. Specific injuries identifiable in ancient remains include fractures, dislocations,
degenerative joint disease, amputations, penetrating wounds, bone spurs, calcified blood clots,
and nasal septal deformities. Projectile weapons, such as spears and arrows, have been found in
the sternum, scapula, humerus, skull, and vertebral column of ancient humans. In some cases,
long-term survival occurred after penetrating wounds, as indicated by projectile fragments that
became incorporated into injured bone and were retained as inert foreign objects.
In favorable cases, the type of injury and the length of time that elapsed between the traumatic
event and death can be estimated. Bones usually heal at relatively predictable rates. Some
skeletons exhibit healed fractures and deformities that must have caused difficulty in walking,
chronic pain, and degenerative joint disease. Survival after traumatic injury suggests some form
of treatment, support, and care during healing and convalescence. Damaged or broken bone
is usually replaced by bone, but complications may occur that lead to osteomyelitis (infection
of the bone), delayed or non-union, angular deformities, bone spurs in adjacent soft tissues,
calcified blood clots, growth retardation, aseptic necrosis, pseudo-arthrosis (the substitution of
fibrous tissue for bone), and degenerative joint disease (traumatic arthritis).
Bone is a dynamic living tissue constantly being modified in response to growth and
physiological or pathological stress. Many factors, such as age, sex, nutrition, hormones, heredity,
and illness, affect the bones. Heavy labor or vigorous exercise can result in increases in bone
mass. Degenerative processes change the size, shape, and configuration of the skeleton and its
individual bones. The skeleton can be modified by inflammation of the joints (arthritis) and by
decreases in bone density (osteoporosis). Bones respond to the demands created by body weight
and movement. The morphology of a bone, therefore, records the mechanical forces exerted on
it during life. Usually, paleopathologists are interested in bones that display obvious pathology,
but normal bones can provide evidence of body size, sexual dimorphism, activities, workloads,
and posture. Bones, therefore, may testify that an individual habitually performed heavy lifting,
pushing, pulling, carrying, standing, stooping, walking, running, or squatting. For example, a
peculiarity of the ankle joint, known as a squatting facet, is found in people who spend much of
their time in a squatting position. Thus, the absence of squatting facets distinguishes those who
sat in chairs from those who did not.
Most diseases do not leave specific signs in the skeleton, but tuberculosis, yaws, syphilis,
and some fungal infections may leave diagnostic clues. Physicians, unlike paleopathologists,
rarely see the results of historically significant severe, untreated infectious diseases. Modern
studies indicate that the skeleton is only affected in about 1%–2% of tuberculous patients, but
this might have been different in other time periods. The kinds of bone lesions caused by syphilis
are generally different from those caused by tuberculosis; congenital syphilis may produce the
so-called Hutchinson’s incisor tooth defect. Leprosy often results in damage to the bones of the
face, fingers, and toes. Because hormones regulate the growth and development of all parts of
the body, a malfunction of the endocrine glands may leave signs in the bones. Some peculiarities
in ancient skeletal remains have been attributed to abnormalities of the pituitary and thyroid
glands. Various cancers may be identifiable in skeletal remains. Although primary bone cancers
are probably rare, other cancers may spread to the bone. Some relatively uncommon conditions,
such as osteomyelitis and various benign tumors of the bone and cartilage have been of particular
interest to paleopathologists because they are easily recognized.
Various forms of malnutrition, such as rickets, scurvy, and anemia, may cause abnormalities
in the structure of the skeletal system. Rickets, a condition caused by a vitamin D deficiency,
was rare during Neolithic times, but became increasingly common as towns and cities grew.
Osteomalacia, an adult form of rickets, can cause collapse of the bones of the pelvis, making
childbirth a death sentence for mother and baby. The presence of calcified blood clots in many
skeletons might reflect the prevalence of scurvy, a disease caused by a vitamin C deficiency.
Given heavy or chronic exposure, some soil elements, such as arsenic, bismuth, lead, mercury,
and selenium, can cause toxic effects that leave their mark on the bones. Porotic hyperostosis
(a pathological condition characterized by porous, sieve-like lesions) has been found in ancient
human skulls. Generally, it is difficult to determine the specific cause of such defects. Moreover,
postmortem damage can simulate various pathological conditions and lead to pseudo-diagnoses.
Although tooth decay and cavities are often thought of as the results of a modern diet, studies of
so-called contemporary primitives and ancient skeletons have disproved this assumption. Dental
problems and diseases found in ancient human remains include dental erosion, tooth decay,
tooth loss, plaque, abscesses, fractures, and so forth. Analysis of dental micro-wear patterns by
scanning electron microscopy and micro-wear measurements began in the 1980s. Microscopic
pits, scratches on tooth surfaces, and surface attrition reveal patterns of wear caused by abrasive
particles in food. Dental disorders were often worse in women, because of the effects of pregnancy
and lactation, and the use and abuse of teeth and jaws as tools.
Bone fractures provide a record of trauma, which might be followed by infection or by healing.
The developing bones of children are particularly vulnerable to trauma, infections, and growth
disorders. Stresses severe enough to disrupt growth during childhood result in transverse lines,
usually called Harris lines or growth arrest lines that are visible in radiographs of the long
bones of the body. Because Harris lines suggest severe, but temporary disturbance of growth,
a population suffering from chronic malnutrition has fewer transverse lines than one exposed
to periodic or seasonal starvation. Starvation, severe malnutrition, and acute infections may
also leave characteristic signs in the teeth. These microdefects of dental enamel are known as
pathological striae of Retzius, enamel hypoplasias, or Wilson bands. Severe episodes of infantile
diarrheas, for example, can disrupt the development of teeth and bones. Scanning electron
microscopy makes it possible to observe disruptions in the pattern of these lines, but there is
still considerable uncertainty about the meaning of these formations.
Archeological chemistry has been used to reconstruct ancient human cultures from bits of
bone, stone tools, ceramics, textiles, paints, and so forth. By combining microscopy with chemical
analysis, scientists can recover information about the manufacture and use of ancient artifacts.
Mummies and signs of disease 9
Perhaps the most familiar aspect of archeological chemistry is the carbon-14 method for dating
ancient materials. Carbon-14 dating is especially valuable for studying remains and relics from
the last 10,000 years, the period during which the most profound changes in cultural evolution
occurred. Multidisciplinary groups of scientists have combined their expertise in archeology,
chemistry, geophysics, imaging technology, and remote sensing to establish nondestructive
investigations of sensitive archeological sites. As the techniques of molecular biology are adapted
to the questions posed by paleopathologists, new kinds of information may be teased out of the
surviving traces of proteins and nucleic acids found in some ancient materials.
MUMMIES AND SIGNS OF DISEASE

In rare instances, the soft parts of prehistoric bodies have been preserved because of favorable
burial and climatic conditions or through human ingenuity. Whether sophisticated or primitive,
mummification techniques have much in common with the preservation of food and animal
hides. Especially well-preserved bodies have been recovered from the peat bogs of northwestern
Europe. Peat has been used as a fuel for millennia, giving clumsy peat-gatherers a chance to
sacrifice themselves for the future enlightenment of paleopathologists. However, some ancient
“bog bodies” were the victims of strange forms of punishment or religious rituals. Sacrificial
victims were fed a ceremonial meal, stabbed in the heart, clobbered over the head, strangled
with ropes that were left around their necks, and pushed into the bog.
Mummified bodies have also been found in the southwestern United States, Mexico, Alaska,
and the Aleutian Islands. In the Western hemisphere, natural mummification was more
common than artificial mummification, but the prehistoric people called the Basket-Makers
deliberately dried cadavers in cists or caves, disarticulated the hips, wrapped the bodies in furs,
and stuffed them into large baskets. Peruvian mummification techniques allowed the “living
corpses” of chiefs, clan ancestors, and Incan rulers to be worshipped as gods. Such mummies
provide suggestive evidence for the existence of tuberculosis, hookworm, and other diseases in
pre-Columbian America.
The Ancient Egyptians are the most famous mummy makers, but mummy bundles dating
back to the Bronze Age—between 4,200 and 2,700 years ago—have been found in Britain.
Unfortunately, little is known about the rare but intriguing mummies discovered during
excavations at Cladh Hallan in the Outer Hebrides. The bones of several different individuals
were incorporated into mummy bundles. Mummification may have been practiced at other sites
in Bronze Age Britain. Some bodies were apparently partially preserved by immersion in a peat
bog before their processing was completed. Mummies found in Kent may have been preserved
by being smoked and dried over a fire. Bronze Age mummy makers probably kept preserved
bodies above ground for decades so that they were easily accessible for ritual purposes, such as
communicating with gods or ancestral spirits.
Where conditions favor the preservation of organic matter, coprolites may be found in or near
prehistoric campsites and dwellings. Indeed, for the dedicated paleopathologist, the contents
of cesspools, latrine pits, and refuse piles are more precious than golden ornaments from a
palace. Because certain parts of plants and animals are indigestible, information about diet,
disease, seasonal activities, and cooking techniques can be inferred from the analysis of pollen
grains, charcoal, seeds, hair, bits of bones or shells, feathers, insect parts, and the eggs or cysts
of parasitic worms found in coprolites. Moreover, the distribution of coprolites in and around
ancient dwellings may reflect prevailing standards of personal hygiene.
Fecal sterols are produced in the guts of mammals during the digestion of cholesterol.
Different species produce slightly different sterols. The use of fecal sterols as markers of
environmental change is a relatively new approach to studies of prehistoric human settlements.
(Modern environmental scientists use fecal sterols to detect sewage contamination in river
deltas and estuaries.) Archeologists have studied fecal sterols to determine whether ancient
farmers used manure on their fields and as a way to discover the location of ancient latrines.
Using fecal sterols as biomarkers, researchers investigated the occupation of Northern Norway
by humans and their grazing animals about 2,000 to 2,500 years ago. Researchers found human
fecal sterols in sediments retrieved from the bottom of Lake Liland. The establishment of human
settlements was accompanied by a sharp increase in fires and a decline in woodland. Pollen
analysis, in conjunction with charcoal analysis, provided suggestive evidence of the impact of
human activities, such as the “slash and burn” technique associated with primitive agricultural
practices, the kinds of plants chosen for cultivation, and the elimination of native plants—
otherwise known as weeds.
Patterns of injury may provide clues to occupations and environmental conditions. For
example, fractures of the leg bones were more common in Anglo-Saxon skeletons than fractures
of the forearm. These leg injuries are typically caused by tripping in rough terrain, especially if
wearing clumsy footwear. In ancient Egypt, broken arms were more common than fractures of
the leg bones. The bones may also bear witness to acts of violence, mutilation, or cannibalism.
According to studies of a site in Kenya, about 10,000 years ago one group of hunter-gatherers
apparently attacked and slaughtered another. The scattered remains of more than 25 people had
been hidden by the sediments of Lake Turkana. Some skulls had been crushed and other bones
revealed wounds caused by arrows, spear points, and clubs.
Evidence concerning cannibalism remains highly controversial, but the ritualistic consumption
of the ashes, brains, or other parts of departed relatives was practiced until recently by members
of certain tribes as a sign of respect for the dead. A disease known as kuru, a degenerative
brain disease found among the Fore people of Papua New Guinea, has been linked to ritual
cannibalism. While conducting epidemiological fieldwork in New Guinea, Daniel Carleton
Gajdusek investigated a neurological disorder found among Fore women and children.
Gajdusek concluded that the disease was transmitted by ritual cannibalism, in which women
and children ate the brains of those who had died of kuru. After the ritual was abandoned,
the disease eventually disappeared. Scientists later determined that kuru was caused by prions,
the “proteinaceous infectious particles” associated with Creutzfeldt-Jakob disease, Mad Cow
Disease, and other spongiform encephalopathies.
Eggs of various parasitic worms have been found in mummies, coprolites, and latrine pits.
These parasites cause a variety of disorders, including schistosomiasis (snail fever or bilharzia)
and the gross enlargement of the legs and genitals called elephantiasis or pachydermia. Depictions
of deformities suggesting elephantiasis are found in prehistoric artifacts. Schistosomiasis is of
special interest because stagnant water, especially in irrigated fields, serves as a home for the
snail that acts as the intermediate host for schistosomiasis. The incidence of schistosomiasis in a
population therefore, may reflect ancient agricultural and sanitary practices.
Ancient artifacts provide a uniquely human source of pseudo-diagnoses because of the vagaries
of fashion in the art world. Without knowledge of the conventions peculiar to specific art forms,
it is impossible to tell whether a strange and unnatural image represents a pathological condition
or a deliberate distortion. Masks and pottery may depict abnormalities, artistic exaggeration, or
the structural needs of the artifact, as in flat-footed and three-legged pots. Striking abnormalities
Paleomedicine and surgery 11
may be matters of convention or caricature. For example, the Paleolithic statuettes known as
“Stone Venuses” or “fat female figurines” may be fertility symbols, or examples of idiosyncratic
ideas of beauty, rather than actual portrayals of obesity.
THE ICEMAN
Perhaps the most remarkable of all naturally mummified bodies was the one discovered in 1991
emerging from a melting glacier in the Tyrolean Alps near the border between Italy and Austria.
Thought to be the oldest mummy in the world, this Neolithic hunter is now known as Ötzi, or
the Iceman. Radiocarbon dating indicated that Ötzi died about 5,300 years ago. The Iceman was
about 159 centimeters tall (5 feet, 2.5 inches), between 45 and 50 years old, tattooed, arthritic,
and infested with parasitic worms. Analysis of pollen associated with the body indicated that
Ötzi died in the spring or early summer. The tools and weapons found with the Iceman included
an axe, a dagger, a bow, a quiver made of animal skins, arrows, and material for starting a fire.
Because the axe and dagger were made of copper rather than bronze and Ötzi’s hair contained
high levels of copper and arsenic, he might have been a coppersmith. His clothing included skins
from eight different animal species, a cape made of woven grasses, shoes made of calf skin, and
a hat made of bear fur. His last meal included ibex meat, grains, and other plant foods. Ötzi’s
genome was similar to that of modern Europeans, except that he lacked the gene that allows
adults to digest lactose.
Initially, investigators thought that the Iceman died of a fall, or the cold, but closer examination
of the body revealed that a flint arrowhead had lodged in his shoulder. In addition to shattering
the scapula, the arrow must have torn nerves and major blood vessels and paralyzed the left
arm. Because of the presence of defensive wounds on his hands and traces of blood from several
individuals on the Iceman’s weapons, researchers suggest that he died in a violent fight with
several men.
In another amazing contribution to paleopathology, Ötzi’s stomach lining provided the oldest
complete genetic sequence of a human pathogen, the bacterium Helicobacter pylori. Today this
bacterium is found in about 50% of the world’s population. Although H. pylori is associated
with ulcers and other gastrointestinal problems, most of the people who test positive for the
bacterium have no symptoms or complications. The strain that infected Ötzi contained genes for
a toxin associated with the development of ulcers. Ötzi’s H. pylori was genetically distinct from
the H. pylori most common in modern Europe.
PALEOMEDICINE AND SURGERY

Evidence of the diseases and injuries that afflicted ancient humans is incomplete for epidemio
logical purposes, but more than sufficient to establish the general notion of their abundance.
Certainly, ancient humans would have found ways of alleviating the suffering caused by disease
and injury. One remarkable example is associated with a 36,000-year-old Neanderthal skull. The
owner of the skull had obviously suffered a blow with a sharp stone implement, but analysis of
the bone revealed healing around the wound. To have survived such an injury for a significant
period of time would have required care and perhaps wound treatment by other members of the
group. Such cases lead to the question: at what stage did human beings begin to administer care
that would be recognized as a form of medicine or surgery?
Clues to the existence of paleomedicine must be evaluated even more cautiously than evidence
of disease. For example, the “negative imprints” that appear to be tracings of mutilated hands
found in Paleolithic cave paintings may record deliberate amputations, loss of fingers to frostbite,
magical symbols of unknown significance, or even some kind of game or code. Early humans
may have learned to splint fractured arms or legs to alleviate the pain caused by the movement
of injured limbs, but there is little evidence that they learned to reduce fractures. Moreover, well-
healed fractures can be found among wild apes.
Ancient bones and skulls may try to tell us many things, but the enemies of preservation
often mute their testimony and generate false clues leading to pseudo-diagnoses. Except for
violent deaths in which a weapon remains in the body, ancient bones rarely disclose the cause
of death. A hole in a skull, for example, might have been caused by a weapon, the bite of a
large carnivore, postmortem damage by burrowing beetles, a ritual performed after death, or
even a surgical operation known as trepanation (drilling a hole in the skull). A discussion of a
trepanned Peruvian skull at the 1867 meeting of the Anthropological Society of Paris stimulated
the search for more examples of prehistoric surgery. Eventually, trepanned skulls were discovered
at Neolithic sites in Peru, Europe, Russia, and India. The origin of this operation is obscure, but
the procedure certainly appeared in both the Americas and the Old World before the voyages
of Columbus.
Although trepanation is sometimes mistakenly referred to as prehistoric brain surgery, a
successful trepanation involves the removal of a disk of bone from the cranium without damage
to the brain itself. When scientists first encountered trepanned skulls, they assumed that the
operation must have been performed after death as part of some primitive ritual. However,
anthropologists discovered that some contemporary tribal healers perform trepanations for
both magical and practical reasons. Prehistoric surgeons may have performed the operation in
an attempt to relieve headaches, epilepsy, and traumatic injuries of the skull. Perhaps it was also
performed as a desperate measure for intractable conditions, rather like lobotomy, or as a form
of shock therapy or punishment. Despite the lack of reliable anesthetics or antiseptic techniques,
evidence of well-healed trepanations indicates that some patients survived, and some even
underwent additional trepanations.
Trepanation by Neolithic era surgeon. (Reproduced from Wellcome L0058021.)

Three major forms of trepanation were used by prehistoric surgeons. One technique involved
creating a groove around the selected area by scraping away bone with a sharp implement. When
the groove became deep enough, a disk, called a button or roundel, could be removed from the
skull. Boring a series of small holes in a roughly circular pattern and then cutting out the button
of bone with a sharp flint or obsidian knife was the method most commonly used in Peru. The
patient could wear the disk as an amulet to ward off further misfortunes. In some regions, surgeons
performed partial or perhaps symbolic trepanations. That is, the potential disk was outlined with
a shallow crater, but left in place. Some skulls bear thin canoe-shaped cuts that form a rectangle,
but square or rectangular excisions may have been reserved for postmortem rituals.
Another prehistoric operation that left its mark on the skull is called sincipital mutilation.
In this operation, the mark is the scarring caused by cauterization (burning). Skulls with this
peculiar lesion have been found in Europe, Peru, and India. In preparation for the application
of the cauterizing agent, the surgeon made a T- or L-shaped cut in the scalp. Cauterization was
accomplished by applying boiling oil or ropes of plant fibers soaked in boiling oil to the exposed
bone. In either case, permanent damage was done to the thick fibrous membrane covering the
bone. Most of the prehistoric victims of sincipital mutilation were female, which might mean
that the procedure had a ritualistic or punitive function. During the Middle Ages, this operation
was prescribed to exorcise demons or relieve melancholy. Doubtless, the operation would dispel
the apathy of even the most melancholic patient, or would give the hypochondriac a real focus
for further complaints.
In looking at the decorative motifs for which the human body serves as substrate, objectivity
is impossible. What is generally thought of as cosmetic surgery in one society—face-lifts, nose
jobs, and liposuction—would be considered mutilations in societies that treasured double chins,
majestic noses, thunder thighs, and love handles. While most signs of prehistoric cosmetic
surgery have vanished along with the soft parts of the body, some decorative processes affected
the bones and teeth. Such customs include deforming, or molding the skulls of infants and
decorating or selectively removing teeth. Unusually shaped heads might also reflect traditional
methods of transporting infants. For example, the pressure of a cradleboard infant carrier can
alter the contours of the skull. Considerable evidence remains to suggest that tattooing and
circumcision were not uncommon in ancient times. Direct evidence can only be found in well-
preserved mummies, but studies of similar customs in contemporary traditional societies can
expand our understanding of the myriad possibilities for prehistoric cosmetic surgery.
Since the 1990s, women’s health reformers have been attempting to end the traditional practice
of female circumcision, also known as female genital mutilation, which is still practiced in parts
of Africa and the Middle East. Female circumcision is a way of ensuring chastity and was often
practiced as a coming-of-age ritual and a prerequisite to marriage. Generally, the operation was
performed with crude instruments, without anesthesia or antiseptics. Although female genital
mutilation is now prohibited in many countries, it is often performed secretly. The World Health
Organization estimates that 130 million girls and women have undergone some form of cutting
of the clitoris. In the most extreme form of female circumcision, the outer labia are sliced off and
the remaining tissues are sewn shut.
HEALING RITUALS, TRADITIONS, AND MAGIC

Paleopathologists must make their deductions about the antiquity of infectious diseases with
limited and ambiguous evidence. Their conclusions must, however, be consistent with modern
biomedical knowledge. Endemic and epidemic diseases may determine the density of populations,
the dispersion of peoples, and the diffusion of genes, as well as the success or failure of battles,
invasions, conquest, and colonization. Thus, one way to test hypotheses about disease in ancient
times is to examine the pattern of disease among contemporary peoples whose culture retains
features like those of prehistoric societies.
Even if radios, television, communication satellites, smart phones, the Internet, and social
media have turned the world into a global village, it is still possible to find people who live in
relative isolation, maintaining a way of life that seems little changed from the Old Stone Age.
Until recently, anthropologists and historians generally referred to such people as “contemporary
primitives.” Of course, in terms of biological evolution, contemporary primitives are as far
removed from Paleolithic peoples as any professor of anthropology, but the patterns of their lives
may be like those of early hunter-gatherers, nomadic followers of semi-domesticated animals,
or proto-agriculturalists. Because cultural patterns are a product of history, not biology, the term
“traditional society” is now generally substituted for the term “primitive,” which carries rather
pejorative connotations. The newer terminology is, however, somewhat confusing because of the
various shades of meaning associated with the term “traditional.” Where possible, we shall use
the term “traditional society”; where necessary for clarity we shall refer to “tribal societies” or
“so-called primitive societies.”
Many pathogens are species specific, but diseases like bubonic plague, malaria, yellow fever,
influenza, and tuberculosis are formidable exceptions to this rule. Wild or domesticated animals
can serve as reservoirs for many diseases transmitted to humans directly or via insect vectors.
The survival of pathogens that are species-specific depends on the pathogen’s virulence, the size
and population density of the host group, the immune response mounted by the host, and the
pathogen’s ability to find new victims. Certain pathogens can only be transmitted during the
acute phase of the disease because the pathogen disappears upon recovery or death. When such
an organism is introduced into a small population, virtually all individuals become infected
and subsequently recover or die. Such diseases could not establish permanent residence among
small, roving bands of Stone Age peoples. New disease patterns became part of the price paid
for living in large, densely populated, permanent towns and cities which, as Thomas Jefferson
warned, were “pestilential to the morals, the health, and the liberties of man.”
Pathogens that remain in the host during convalescence, persist in chronic lesions, or establish
permanent residence in healthy carriers are likely to find new victims even among small groups
of people. Some diseases are caused by commensal organisms—those that live harmlessly in or
on their host until some disturbance triggers the onset of illness. Commensalism indicates a long
period of mutual adaptation, which suggests that such diseases may be the most ancient. Variant
forms of proteins, such as sickle cell hemoglobin, may reflect evolutionary adaptations in the host
population to ancient scourges like malaria.
It is often assumed that modern and so-called primitive people differ in their susceptibility
and resistance to disease. Comparisons of crude mortality rates for “moderns” and “primitives”
are, however, likely to be very misleading. Mortality rates during an epidemic may reflect the
kind of care given to the sick rather than some mysterious quality called “resistance.” During
an explosive epidemic in a small, isolated population, there may be no healthy adults left to feed
infants and care for the sick. Those who might have recovered from the disease may, therefore,
die because of the lack of food, water, and simple nursing care.
In general, the trait shared by all forms of ancient medicine is a supernatural orientation,
a belief in magic. In this context, magic is not a trivial concept. Indeed, belief in magic has
influenced and shaped human behavior more deeply and extensively than scientific or rationalist
modes of thought, as we are pleased to call our own way of explaining the world. In societies
where magical and scientific beliefs coexist, one cannot predict which will be stronger or more
influential. Even today, people may vacillate between alternative systems of medicine, perhaps
relying on modern medicine for a broken arm and magical medicine for spirit possession.
In many cultures, magic provides answers to questions that cannot be answered by existing
logical or rational knowledge. Magic may be so closely related to religion that it is difficult to
define the borderline between them. The primary difference between a prayer and a spell is the
assumption that magical practices, correctly performed, must bring about the desired reaction.
A prayer, in contrast, is an appeal for aid from a supernatural being with the power to grant or
deny the request.
In so-called primitive medicine, the supernatural is involved in all aspects of disease and
healing. Because disease and misfortune are attributed to supernatural agents, magic is essential
to the prevention, diagnosis, and treatment of disease. All events must have a cause, visible or
invisible. Thus, diseases for which there are no obvious immediate causes must be caused by
ghosts, spirits, gods, sorcery, witchcraft, or the loss of one of the victim’s special souls. Illness
calls for consultation with those who have the power to control the supernatural agents of
disease: the shaman, medicine man, wise woman, diviner, priest, soul-catcher, or sorcerer. A
close examination of the roles and powers assigned to such figures may reveal subtle differences,
but for our purposes the general term “healer” will have to suffice. Most societies, however,
differentiate between the healers and herbalists who dispense ordinary remedies and the
shamans or priest-like healers who can intercede with the spirits that affect weather, harvests,
hunting, warfare, conception, childbirth, disease, and misfortune.
Although the shaman or medicine man performs magical acts, including deliberate
deceptions, he or she is neither a fake nor a neurotic. The shaman is likely to be as sincere as any
modern physician or psychiatrist in the performance of healing rituals. When sick, the shaman
will undergo therapy with another shaman, despite knowledge of all the tricks of the trade. For
the medicine man, the cause of the disorder is more significant than the symptoms because the
cause determines the manner of treatment, be it herbs or exorcisms. Diagnostic aids may include
a spirit medium, crystal gazing, and divination. One diagnostic test carried out by some healers
involved pouring the patient’s urine on the ground near an ant hill. The behavior of the ants
would provide a low-cost diagnostic test for diabetes.
After performing diagnostic tests, the healer was ready to conduct a complex ritual involving
magic spells, incantations, the extraction of visible or invisible objects, or the capture and
return of the patient’s lost soul. To drive out or confuse evil spirits, the shaman might give the
patient a special disguise or a new name, offer attractive substitute targets, or prescribe noxious
medicines to transform the patient into an undesirable host. Shamans could dispense powerful
drugs and closely observe the patient’s reaction, but it is the ritual, with its attempts to compel
the cooperation of supernatural powers, that is of prime importance to the healer, patient, and
community.
Outsiders may see healing rituals in terms of magical and practical elements, but for healer
and patient there is no separation between the magical and empirical aspects of therapy. In a
society without writing or precise means of measuring drug concentrations and time intervals,
strict attention to ritual acts may provide a means of standardizing treatment, as well as a
reassuring atmosphere. The shaman cannot isolate and demystify the pharmacologically active
component of the remedy because of the holistic nature of the healing ritual. But the problem
of evaluating remedies and procedures has always been more difficult than generally assumed.
Moreover, a modern physician is no more likely to conduct a double-blind trial of generally
accepted remedies than the traditional medicine man.
Practitioners of modern medicine find it difficult to believe that the obvious superiority
of scientific medicine has not caused the disappearance of all other systems of healing. Yet
traditional and alternative systems of medicine continue to flourish throughout the world.
On the other hand, traditional medicine has been influenced by modern theory and practice.
Today’s traditional healer may dispense both penicillin and incantations to combat germs and
evil spirits.
Ultimately, the success of any healing act depends on a combination of social, psychological,
pharmacological, and biochemical factors. Where infant mortality is high and life expectancy
low, the healer is unlikely to confront many cases of metabolic diseases among the young or the
chronic degenerative diseases of the elderly. Many perceptive practitioners of the healing arts have
acknowledged that, left to themselves, many diseases disappear without any treatment at all. Thus,
if a healing ritual and the prescribed treatment regime extend over a long enough time period,
the healer will be credited with curing a self-limited disease. Given the dubious value of many
remedies, recovery is often a tribute to the patient’s triumph over both the disease and the doctor.
Because of the uncertainties involved in evaluating the treatment of disease, historians of
medicine have often turned to the analysis of surgery as a more objective measure of therapeutic
interventions. But even here there are difficulties in comparing practices carried out under
different circumstances, by different kinds of practitioners, with different goals and objectives.
One surprising aspect of so-called primitive surgery is the fact that surgical operations for purely
medical reasons may be rare or nonexistent in a particular tribe, although the shaman may
wield the knife with great skill and enthusiasm for ceremonial, decorative, or judicial purposes.
The shaman may perform ritual scarifications that signify caste, coming of age, or as “medicine
marks” to provide protection against disease, poisons, snakebites, witchcraft, and other dangers.
Just how effective such protection might be is open to question, but there have been reports of
African healers who impregnated medicine cuts with a mixture of snake heads and ant eggs.
When twentieth-century scientists discovered how to inactivate toxins with formaldehyde,
which is chemically related to the formic acid found in some species of ants, the African ritual
suddenly seemed less bizarre.
Although amputation for ritual purposes or punishment is not uncommon in tribal and
ancient societies, interest in medically indicated amputation is rare. Some Native American
surgeons, however, amputated frozen fingers and, in Africa, traditional Maasai healers are noted
for successfully amputating fractured limbs. Some prehistoric peoples performed amputations as
a form of punishment or as part of mourning rituals. Mutilations of the genital organs are often
components of puberty rites. Circumcision and clitorectomy are the most common operations,
but some tribes practiced more extreme mutilations.
Traditional surgeons developed many ingenious methods of closing wounds. Sewing is
an ancient skill, but in the absence of antiseptic techniques, applying needle and thread to a
wound is likely to lead to serious infection. There is a better chance of success when wounds are
closed with the skewer and thread method used to keep stuffing inside a Thanksgiving turkey.
A remarkable technique devised by traditional surgeons in Africa, India, and the Americans
depended on selecting appropriate species of termites or ants. The insect was brought into
contact with the wound and stimulated to bite. When the insect’s body was broken off, the jaws
remained as natural suture clamps.
To combat bleeding, traditional healers used tourniquets or cauterization or simply packed

the wound with absorbent materials and covered it with bandages. Maasai surgeons, however,
repaired torn blood vessels with suture thread made from tendons. Wound dressings often
contained noxious materials, such as cow dung and powdered insects, as well as ingredients
that might function as astringents and antiseptics. Traditional wound dressings might contain
pharmacologically valuable ingredients, such as ergot, which is present in the mold known as rye
smut, but symbolic values are likely to predominate. Unfortunately, the odds of finding penicillin
or other valuable antibiotics in earth taken from a recent grave are actually vanishingly small.
Traditional surgeons were often quite skillful in the treatment of fractures and dislocations,
although the treatment might be considered incomplete until the appropriate incantations were
recited over the splints or a lizard’s head was tied to the wound. The shaman could also encourage
the patient by symbolic acts such as breaking the leg of a chicken and applying powerful if noxious
remedies to the unfortunate fowl.
One of the major duties of the Western surgeon, or barber-surgeon, until quite recent times
was the practice of therapeutic bleeding. Selecting the proper vein was an important aspect of
proper treatment. Unlike their Europeans counterparts, traditional healers generally thought
that extracting large amounts of blood from the body was very dangerous. Rather than opening
a vein, traditional healers usually carried out bleeding by means of scarification or cupping.
In “dry cupping” a preheated cup is placed over the skin. The cup is warmed by inserting a
flammable material, such as cotton or wool soaked in alcohol, and setting the material on fire
before quickly applying the cup to the skin. The skin is drawn into the cup as the air cools. If the
procedure is done correctly the suction is strong enough to create a hematoma (swelling caused
by blood leaking out of blood vessels at the site of injury). Ancient healers also practiced “wet
cupping,” which requires making small cuts in the skin before applying the cup. In this case,
the suction will draw out a small amount of blood. However, the process could lead to infection
if the knives or needles used to make the incisions are not sterile. During the Olympic Games
in Brazil in 2016, many observers noticed large, circular wounds that seemed to be afflicting
many Olympic athletes. They were relieved to discover that the athletes had not been repeatedly
injured during training, or bitten by giant spiders or bed bugs. The purplish bruises were actually
hematomas that signaled renewed interest in the ancient art of therapeutic cupping: applying
evacuated glass cups to the skin to draw blood to the surface. In 2004 a well-known actress was
photographed in a dress that revealed the signs of cupping, which suggests that celebrities and
athletes have revived interest in the ancient practice. Cupping is still used by some alternative
healers to treat pain in the back, shoulder, or neck. (Athletes say that the procedure helps relieve
the pain caused by overexertion without raising questions about “doping” that might be triggered
by taking conventional pain killers.) Skeptics say cupping probably acts as a counter-irritant or
semi-painful placebo.
Despite certain exceptions, traditional surgery was generally limited in scope and quality.
Part of the problem was undoubtedly lack of systematic knowledge of anatomy, asepsis,
anesthesia, and the failure of a small tribal unit to provide enough “clinical material” for the
healer to develop surgical skills through repetition. However, ideas, rather than materials, were
often limiting factors. The influence of the supernatural view of nature fosters a fear of bodily
mutilations, other than those based on religious beliefs. Moreover, the use of surgical mutilation
as punishment for the most shameful crimes produced negative associations with surgery.
Although rituals and spells may be the most dramatic aspects of primitive medicine, the
medicine man may also use pharmacologically active and effective drugs. Natural product
chemists are just beginning to exploit the ethno-botany of so-called primitive peoples. On the
other hand, healers are sometimes persecuted for using traditional remedies and “sacred plants”
that have been defined as illegal by modern authorities. Plants and animals provided the traditional
healer with analgesics, anesthetics, emetics, purgatives, diuretics, narcotics, hallucinogens,
cathartics, febrifuges, and perhaps contraceptives. From the primitive pharmacopoeia, modern
medicine has adopted salicylic acid, quinine, ipecac, cocaine, ephedrine, colchicine, digitalis,
ergot, and many other drugs.
Probably more than half of the prescriptions written by modern physicians involve drugs
extracted from plants or their synthetic equivalents. Nature provides such a formidable array of
natural products that the great problem has always been figuring out where to begin the search
for medicinal substances. Although many folk remedies may be nothing more than placebos, if
only 10%–25% of the drugs in so-called primitive pharmacopoeias are pharmacologically active,
the potential for the discovery of new drugs is prodigious. The limiting factor in evaluating such
remedies may well be the disappearance of traditional societies, with their rich, but fragile oral
traditions and their intimate knowledge of their endangered environment. In Africa, it is said
that a library vanishes every time an old person dies. It is also true that a potential drugstore
vanishes every time a unique bit of the natural environment is destroyed.
So-called primitive medicine has often been dismissed as mere superstition, but it has much in
common with the medical practices of ancient civilizations and with the folk beliefs that persist
and even flourish alongside modern medicine. Anthropologists, explorers, and tourists often
overemphasized the exotic and magical aspects of traditional medicine, leaving the impression
that an unbridgeable chasm exists between such medical systems and those of modern societies.
The customs that seem bizarre in other cultures are, however, sometimes remarkably similar to
our own quaint and charming folk practices.
When we analyze traditional and folk medicine, the apparent chaos of specific details can
generally be reduced to a few almost universal themes. Folk medicine, like primitive medicine,
generally views disease as a malevolent invader and the body as a battlefield. Our vocabulary
for illness still reflects this idea: we are “attacked” by disease, and we “fight off” infection until
the disease is “expelled” from our system. Thus, it would not be unreasonable to expect to
cure a patient by luring the invader out of the body and transferring it to a suitable recipient.
For example, a desperate parent might force a dog to eat a sandwich containing hair from a
child with whooping cough. If the dog coughed, the child would recover. A related approach,
generally known as dreckapothecary, uses remedies designed to drive out the invader by dosing
the patient with vile, nauseating, and disgusting concoctions. Presumably, saturating the patient
with remedies containing excrements, noxious insects, rancid fat, foul smelling plants, and so
forth, will make the body an unattractive abode for a fastidious invader.
The doctrine of signatures is another guiding principle of folk medicine. According to this
concept, God has furnished the world with diseases and remedies and has taught us that nothing
exists without a purpose. Therefore, we may assume that God has marked potential remedies
with some sign hinting at their medicinal virtues. For example, a plant remedy for jaundice
might sport yellow flowers and remedies for heart disease might be found in plants with heart-
shaped leaves.
Selection of the appropriate remedy may be guided by either the principle of similars or the
principle of opposites. If roasted rabbit brains fail to cure excessive timidity, courage might be
found in the blood of a ferocious beast. Lowly animals such as mice and moles were used in
remedies for warts, coughs, fevers, fits, and bedwetting, but no creature has served the healing
art as diligently as the leech. According to folk beliefs, this natural medical device can selectively
remove the “bad blood” from arthritic joints and reduce the swelling of a black eye. Insects and
insect products remain important components of folk remedies. Those who might ridicule the
use of spider webs to stop bleeding may laud the virtues of honey in the treatment of bee stings,
coughs, colds, rheumatism, and tuberculosis.
In addition to herbs, animal parts and products, and minerals, folk remedies include charms,
spells, prayers, relics, amulets, and images of gods or saints. Rings containing quicksilver
(mercury) were probably just as effective in warding off headaches as copper bracelets are in
curing arthritis. Tar-water tea, an American folk remedy prepared by soaking old ropes from
sailing ships in cold water, was popularized in Europe during the eighteenth century by Bishop
George Berkeley, who praised it as a panacea cheap enough to be used by the poorest people and
safe enough for infants. According to the good bishop, the violent opposition of physicians and
apothecaries to such inexpensive folk remedies proved that doctors feared only an outbreak of
good health.
On the other hand, we should remind ourselves that the ingredients in many traditional
remedies are so disgusting, nauseating, or toxic that the prescriptions were more likely to scare
people out of their illness than to cure them. When faced with the choice of consuming “boiled
black bugs and onions,” or pleading guilty to good health, many marginally ill and malingering
patients must have chosen the latter course. In modern societies, the spells and rituals that once
surrounded the taking of remedies have virtually disappeared. But vestiges of these actions
remain in the “old wives’ tales” told by people entirely too sophisticated to believe such stories
any more than they would worry about a broken mirror, or Friday the thirteenth, or the absence
of a “God bless you” when they sneeze.
SUGGESTED READINGS
Buikstra, J. and Roberts, C., eds. 2012. The Global History of Paleopathology. Pioneers and Prospects.
New York: Oxford University Press.
Cockburn, A., Cockburn, E., and Reyman, T. A., eds. 1998. Mummies, Disease, and Ancient Cultures.
New York: Cambridge University Press.
Cohen, M. N. and Armelagos, G. J., eds. 1983. Paleopathology and the Origins of Agriculture.
New York: Academic Press.
Conrad, L. I. and Dominik, W., eds. 2000. Contagion: Perspectives from Pre-Modern Societies.
Burlington, VT: Ashgate.
Diamond, J. 2005. Guns, Germs, and Steel: The Fates of Human Societies. New York: Norton & Co.
Fowler, B. 2002. Iceman: Uncovering the Life and Times of a Prehistoric Man Found in an Alpine
Glacier. Chicago, IL: University of Chicago Press.
Larsen, C. S. 1999. Bioarchaeology: Interpreting Behavior from the Human Skeleton. New York:
Cambridge University Press.
Pääbo, S. 2014. Neanderthal Man: In Search of Lost Genomes. New York: Basic Books.
Steinbock, R. T. 1976. Paleopathological Diagnosis and Interpretation: Bone Diseases in Ancient
Human Populations. Springfield, IL: Thomas.
Van Andel, T. H. and Davies, W., eds. 2004. Neanderthal and Modern Humans in the European
Landscape during the Last Glaciation. McDonald Institute Monographs.
2
Medicine in ancient civilizations:
Mesopotamia and Egypt
The ancient Greeks thought it easy to define civilization: it referred to the qualities of citizens—
free men living in cities. Today the concept is regarded as more complex, subtle, and problematic.
The term culture is used to encompass all the ways of life and customary behaviors invented by
human beings. Civilization is, therefore, a particular kind of culture, characterized by increasing
complexity in social, economic, and political organization, a settled life, a food supply in excess
of subsistence levels, occupational specialization, writing and reckoning, and innovations in the
arts and sciences—all maintained by a large number of people over a significant period of time.
The first civilizations developed in the period between about 3500 and 1500 bce in a few
delimited areas of the world. Historians continue to pose questions about the nature of the
factors that lead to the development of civilizations and those that nurture their growth. No
simple, definitive answer seems possible, but a variety of causes involving geographic, climatic,
and economic factors have been suggested. Presumably, it is significant that four of the earliest
civilizations developed in river valleys: the Nile River in Egypt, the Tigris-Euphrates in the
Middle East, the Indus River in India, and the Yellow River in China.
Because the evidence from the earliest periods is ambiguous and fragmentary, the question
of which civilization was the first to appear has been the subject of endless debate. Rather than
review these controversies, we will instead look at some of the major centers of civilization to see
what they can tell us about health, disease, and ancient medicine.
MESOPOTAMIA
Mesopotamia, the land between the Tigris and Euphrates Rivers, was the arena of the growth
and decay of many civilizations, including those known as Sumerian, Chaldean, Assyrian,
and Babylonian. Egyptian civilization is better known, but we will begin our survey of ancient
civilizations with Sumer to emphasize the point that other, less familiar areas also became urban
and literate at a very remote date.
Sumer flourished some 4,000 to 5,000 years ago, but by the first century its language had
vanished and its writings, in the form of wedge-shaped marks, known as cuneiform characters,
inscribed on clay tablets, were indecipherable. These marks probably evolved from simple
pictures used by “accountants” to keep tract of commodities; eventually these symbols were
used to represent sounds or words. Most Sumerian tablets dealt with mundane economic and
administrative transactions, but thousands of others recorded myths, fables, and ideas about
21
22 Medicine in ancient civilizations: Mesopotamia and Egypt
the natural world, mathematics, and medicine. Scholars have even discovered cuneiform tablets
containing recipes, which provide intriguing clues to eating, drinking, and the role of religion,
cults, feasts, and celebrations in the ancient world. Other traces of Mesopotamian civilization
have been found in photographs taken by surveillance satellites. These images show signs of
settlements and roads long buried under the sands of the Middle East.
In Sumer, the mastery of agricultural techniques led to dramatic changes in population density
and the establishment of the bureaucratic apparatus needed for planning, storing, and redistributing
crops. The great majority of people lived as peasants, but their productivity supported the small
urban elite composed of priests, warriors, and noblemen. Because law and medicine were ascribed
to divine origins, the priests also assumed the roles of judges, lawyers, and physicians.
The cuneiform texts pertaining to medicine can be divided into three categories: therapeutic
or medical texts, omen collections or symptom texts, and miscellaneous texts that incidentally
provide information about diseases and medical practice. The medical texts followed a formal
arrangement typical of Mesopotamian scribal practice. Each text contained a series of cases
following the same general format: “If a man is sick (and has the following symptoms or pains)…
in (wherever it was)….” The list of symptoms was followed by instructions for the appropriate
medicines, their preparation, and the timing and means of administration. The healer discovered
the significant symptoms by listening to the patient’s account of the illness, not by performing a
direct physical examination. Although most cases concluded with the comforting promise that
the patient would get well, certain symptoms presaged a fatal outcome.
Healers referred to as diviners or priests looked at the patient’s symptoms and circumstances
as omens that identified the disease and predicted the outcome of the illness. The priest-healer
performed a direct physical examination to discover signs and omens. Clearly the gods were at
work if a snake fell onto the sick man’s bed, because this omen indicated that the prognosis was
favorable. But wine-colored urine was a portent of progressive, debilitating illness and pain. If
the priest could not wrest sufficient information from his direct examination of the patient, he
could find signs in the viscera of sacrificial animals. Omens provided by animal livers were then
applied to the patient, whose liver was inaccessible.
Although there are many uncertainties in interpreting ancient texts, tentative diagnoses of
some common disorders include schistosomiasis, dysentery, pneumonia, and epilepsy. Various
texts lament periodic famines, but even when food supplies were adequate in quantity, the daily
diet was probably monotonous and nutritionally unbalanced. Descriptions of eye disorders,
paralysis, swollen bellies, and the “stinking disease” are consistent with various vitamin
deficiency diseases. A combination of poor quality foods and chronic infestation with various
parasites would amplify the problem of malnutrition and retard the growth of children.
Because illness was regarded as divine punishment for sins committed by the patient, healing
required the spiritual and physical catharsis obtained by combining confession and exorcism
with purgative drugs. Sumerian prescriptions include vegetable- and mineral-based drugs,
alcoholic beverages, fats and oils, parts and products of animals, honey, wax, and various kinds
of milk thought to have special medicinal virtues. Medical texts were anonymous, but some
texts included endorsements and testimonials for particular remedies. A small cuneiform tablet
composed about 4,000 years ago, containing about a dozen entries, may be the oldest written
collection of prescriptions.
The separation of magical and empirical aspects of medicine is a very recent development.
Thus, it should not be surprising that Mesopotamian patients considered it prudent to attack
disease with a combination of magic and medicine. A healer who was both priest and physician
Hammurabi’s code of laws 23
could increase the efficacy of drugs by reciting appropriate incantations. Although the healer
needed some knowledge of anatomy and drug lore, precise knowledge of magical rituals was
more important because errors in this department could alienate the gods.
Hordes of demons were associated with disease and misfortune; each evil spirit tended to
cause a particular disorder. As in the case of folk medicine and so-called primitive medicine,
Mesopotamian healers attempted to rid their patients of disease-causing demons by the
administration of noxious remedies. Enveloped in the aroma of burning feathers, and liberally
dosed with dog’s dung and pig’s gall, the patient hardly seemed an inviting abode for demons
and devils. The magician might also try to transfer a demon into a surrogate victim, such as
an animal or a suitable effigy. Sometimes healers engaged disease-causing demons in a formal
dialogue, as in the conversation that took place between a priest and the tooth worm. While
an incantation entitled “The Worm and the Toothache” hardly sounds like a major epic, this
dialogue is a rich source of cosmological concepts and creation myths. When you suffer from
toothache, an extraction, or root canal work, remember that the Tooth Worm chose to consume
gums and teeth rather than a diet of figs and apricots.
Mesopotamian pharmaceutical texts reflect familiarity with fairly elaborate chemical
operations for the extraction of drugs from plants, animals, and minerals. Plants and herbs were
so important to ancient medicine that the terms for “medicine” and “herbs” were essentially
equivalent. Drugs made from seeds, bark, and other parts of plants were dissolved in beer or
milk and administered by mouth, or mixed with wine, honey, and fats and applied externally. In
retrospect, it is logical to assume that the wine used in wound dressings provided some benefit
as an antiseptic. Whether red or white, wine is a better antiseptic than 10% alcohol, but red wine
seems to be the beverage of choice for fighting infection.
According to the Mesopotamian legend known as the Gilgamesh Epic, human beings
lost possession of the most powerful, life-giving herb in creation through the carelessness of
Gilgamesh, a great hero who was two-thirds god and one-third human. The Gilgamesh stories
were probably based on the exploits of a king who ruled Babylonia about 2700 bce. Despite his
god-like qualities, Gilgamesh learns that he, like all human beings, must inevitably succumb to
sickness and death. When his friend Enkidu was stricken with a serious illness, Gilgamesh swore
that he would never give up hope of saving him “until a worm fell out of his nose” (a striking
omen of impending death). After many trials and tribulations, and an awesome journey through
the realm of darkness, Gilgamesh learned the secret of the herb of life and swam to the bottom
of the waters where the marvelous plant grew. Before he could take the healing herb to his dying
friend, the exhausted hero stopped to rest. While Gilgamesh slept, a serpent slithered out of its
hiding place and ate the herb of life. As a result, the snake shed its old skin and was instantly
rejuvenated while Gilgamesh wept for himself and all of suffering mankind. According to the
epic, when Gilgamesh returned from his journey, he engraved an account of his adventures on
a clay tablet for the instruction of posterity. Thus, every time a snake sheds its old skin and is
reborn, human beings must remember that they will grow old and die. The epic also tells us that
even though great heroes die they can be immortalized through the historical writings that tell
the world about their great deeds.
HAMMURABI’S CODE OF LAWS

When the Greek historian Herodotus visited Babylonia in the fifth century bce, he reached the
remarkable conclusion that the Babylonians had no doctors. The sick, he said, were taken to the
marketplace to seek advice from those who had experienced similar illnesses. The enduring
lesson of this story is that we should not take the tales told by tourists too seriously. As we
have seen, Mesopotamia had a complex medical tradition. Both the empirical and the magical
approach to healing were well established, but eventually the balance of power apparently tilted
in favor of the magician. Evidence about the various kinds of healers who practiced the art in
the region can be extracted from the most complete account of Babylonian law, the Code of
Hammurabi.
Hammurabi, Babylonia’s most famous king, founded the empire that ruled southern
Mesopotamia until 538 bce, when the last of the Babylonian kings surrendered to the Persian
ruler Cyrus the Great. Toward the end of his reign, Hammurabi commissioned the creation
of a great stone monument portraying the king receiving the symbols of kingship and justice
from the gods. Below this portrait were inscribed the 282 laws now known as the Code of
Hammurabi. According to the inscription, the gods called upon Hammurabi to “bring about
the rule of righteousness in the land, to destroy the wicked and the evil-doers; so that the strong
should not harm the weak.”
The Code of Hammurabi governs criminal and civil matters such as ownership of property,
commerce, labor, personal injuries, and professional conduct. Replete with harsh punishments,
the Code reveals the relationships that governed Babylonia’s priests, landowners, merchants,
peasants, artisans, and slaves. The penalty for many infractions, such as theft or harboring a
runaway slave, was death, but many other crimes were punished by amputations. Various clauses
refer to illness, adoption, prostitution, wet nursing, pregnancy, miscarriages, and malpractice by
doctors and veterinarians. Some laws did promote Hammurabi’s promise that the laws would
protect the weak. For example, a man could take a second wife if his first wife became ill, but he
had to support his sick wife and allow her to remain in his house.
Criminal penalties were based on the principle of lex talionis, literally, the “law of the claw,”
that is, an eye for an eye, a tooth for a tooth. Retribution or punishment was designed to fit the
crime: amputation of the hand that struck the father or blinding the eye that snooped into the
secrets of others. Such punishments are generally referred to as “judicial mutilation.” Given the
number of clauses that specify amputations as punishment, one could imagine a fairly lively
business for surgeons who wanted to specialize in judicial mutilation. The penalties specified
by the laws fell with different degrees of severity on the three classes that made up Babylonian
society: aristocrats; commoners, and slaves. The Code indicates that slaves carried a 30-day
warranty against certain disorders. Therefore, if a slave was attacked by epilepsy within one
month of purchase, the seller had to reclaim that slave and return the purchase price.
The laws of special interest to the history of medicine—those pertaining to surgeons,
midwives, wet nurses, and veterinarians—follow the laws dealing with assault. Nine paragraphs
are devoted to the regulation of medical fees, especially the relationship between the status of the
patient and the appropriate fees and penalties. The severe penalties set forth for failures suggest
that practitioners would be very cautious about accepting clients and would shun those that
looked hopeless or litigious. The laws also reflect a profound distinction between medicine and
surgery. The physicians, who dealt with problems that would today be called internal medicine,
were of the priestly class and their professional conduct was not governed by the criminal laws
pertaining to assault and malpractice. Veterinarians, known as the “doctor of an ox or an ass,”
carried out various surgical operations, including castration of domesticated animals.
Because internal disorders were caused by supernatural agents, those who wrestled with such
diseases were accountable to the gods. Wounds were due to direct human error or aggression.
Egypt 25
Therefore, those who wielded the bronze knife were accountable to earthly authorities. Fees
and penalties for surgical operations were substantial. If a doctor performed a major operation
and saved the life or the eyesight of an aristocrat, his fee was 10 shekels of silver. The fee was
reduced by half for operating on a commoner, and was only 2 shekels when the patient was a
slave. However, if the surgeon performed such an operation and caused the death of a nobleman,
or destroyed his eye, the doctor’s hand should be cut off. If the physician caused the death of a
slave, he had to provide a replacement. If he destroyed the eye of a slave, he had to pay the owner
one-half his value in silver.
Just what operation was involved in opening the eye-socket or curing the eye, is a matter of
some dispute. The operation could have been the couching of a cataract (destruction of a lens
that had become opaque) or merely lancing an abscess. While an abscess could cause intense
pain, it would not affect vision; cataracts lead to blindness. Probing or lancing might help in the
case of an abscess, but if poorly done such interventions could cause blindness.
Women served as midwives, surgeons, and even palace physicians in Mesopotamia, but the
Code of Hammurabi does not specifically mention female doctors. The laws did, however, refer
to women who served as wet nurses (women who provided breast milk for the infants of other
women). If a nobleman gave his son to a wet nurse and the child died, her breasts could be cut
off if she had taken in other infants without informing the parents.
In excavating the remains of ancient Mesopotamian cities, archeologists continue to discover
cuneiform tablets. Most refer to business transactions and political matters, but as new texts are
painstakingly deciphered our picture of Mesopotamian civilizations may well undergo profound
changes. For example, descriptions of the ways in which the mind of a warrior king might change
after experiencing great mental distress are consistent with a diagnosis of post-traumatic stress
disorder (PTSD). In ancient civilizations signs of severe mental distress, including fear, depression,
memory loss, and nightmares, would generally be ascribed to torments inflicted by evil spirits.
Many warriors certainly endured traumatic experiences on the battlefield, but most wounded
soldiers were likely to die of hemorrhages or infection before they could fall victim to chronic
depression or PTSD.
EGYPT
Egyptian civilization has fascinated travelers and scholars since the fifth century bce when the
Greek historian Herodotus initiated the tradition of Nile travelogues. To Greeks and Romans,
Egypt was an ancient and exotic land, with peculiar customs, especially in terms of gender roles.
Shops and markets in Egypt were run by women and men did the weaving. Collecting Egyptian
antiquities was already fashionable in Roman times, but modern Egyptology began with the
discovery of the Rosetta Stone, a slab of black basalt inscribed in 196 bce, when Ptolemy V
was king of Egypt. The text on the Rosetta Stone is repeated in three forms of writing: ancient
Egyptian hieroglyphs, demotic script, and the Greek alphabet. Formal hieroglyphs, the words of
the gods, were not only a way of writing, but also a form of artistic expression. Egyptian scribes
developed a simplified script known as demotic, but by the fifth century other forms of writing
were adopted and the ancient texts became indecipherable. The discovery of the Rosetta Stone in
1799 by a French soldier transformed Egyptology.
The development of the first true writing system has generally been credited to ancient
Sumer, but in the 1990s archeologists discovered pictures and symbols inscribed on a cliff in
Egypt that might challenge that chronology. The carvings appear to depict the exploits of a
legendary king who played a critical role in the establishment of Egyptian civilization. Although
these inscriptions were apparently created about 5,250 years ago, they seem to resemble later
hieroglyphs. These inscriptions might represent an early stage of writing or proto-hieroglyphs.
Similar symbols—inscribed on ivory, bone, and pottery—were found by archeologists excavating
a royal tomb near Abydos, the oldest city in Egypt.
Popular ideas about ancient Egypt have been shaped by romantic images of the elaborate
tombs of the Pharaohs, such as Howard Carter’s 1922 discovery of the tomb of Tutankhamun,
popularly known as King Tut, who ruled for a brief period during the Eighteenth Dynasty.
Tutankhamun’s father, Akhenaten, had challenged Egypt’s old religion and demanded that his
people worship only Aten, the sun god. This angered the powerful priests who served Egypt’s
many gods. After Akhenaten’s death, his statues and even his name were essentially eradicated.
The old religion was restored during Tut’s reign as pharaoh. Carter and other Egyptologists
had explored many tombs in the Valley of the Kings, where pharaohs and nobles were buried
between the sixteenth and the eleventh century bce, but most had been thoroughly plundered
by grave robbers. Interest in Egyptian antiquities, as well as legends of a Pharaoh’s curse, were
revived by the remarkable artifacts found in Tutankhamun’s tomb.
King Tut’s tomb contained hundreds of precious objects, including the Pharaoh’s mummy in
a gold coffin, nested within two outer coffins. Little was known about the life of Tutankhamun,
who was only nine years old when he assumed the throne in 1333 bce and married his half-
sister, Ankhesenpaaten. Tutankhamun’s mummy confirmed the fact that he was about 18 when
he died and proved that he was significantly less handsome than his beautiful golden death mask
would suggest. Tutankhamun had abnormally wide hips, an abnormal curvature of the spine,
and fusion of the upper vertebrae. Researchers note that these findings are consistent with a
rare spinal disorder called Klippel-Feil syndrome, which generally involves congenital fusion of
cervical vertebrae. It may also involve anomalies of the musculoskeletal system, kidneys, heart,
and nervous system. If Tutankhamun had Klippel-Feil syndrome he would have had difficulty
walking. The discovery of more than 100 walking sticks among his grave goods seems to support
this theory.
Genetic analyses provided interesting revelations about Tutankhamun’s father, mother, and
grandparents. DNA sequencing confirmed the fact that Akhenaten had married his half-sister,
which was not unusual for Egyptian royal families. A virtual autopsy of Tutankhamun’s mummy,
conducted by CT scans, produced more evidence of the diseases and disabilities endured by the
young pharaoh. Tut’s body revealed evidence of malaria, clubfoot, buckteeth, wide hips, and
fractures that were probably caused by one or more falls. His clubfoot and other anomalies
would have caused a severe limp. Tutankhamun died of an infection that spread from the site of
one of his injuries. Further insights into the diseases of ancient Egyptians and the lineage of the
pharaohs, as well as the relationship between ancient Egyptians and the people of Egypt today,
may follow further DNA studies using the techniques developed by Svante Pääbo. Although
Pääbo is best known for his studies of the genomes of Neanderthals and other early humans,
he originally developed techniques for DNA cloning and sequencing in hopes of analyzing the
DNA of Egyptian mummies.
New tombs, mummies, and artifacts are still being discovered in the Valley of the Kings. In the
2010s, archeologists discovered about 50 somewhat fragmented mummies in a 3,300-year-old
tomb. Inscriptions in the tomb revealed that most of the mummies were related to Thutmose IV
and Amenhotep III, pharaohs who ruled during the fourteenth century bce. The dead included
at least eight royal daughters and four princes. The adult mummies were badly damaged by
Egypt 27
grave robbers during their search for treasures. The well-wrapped mummies of infants and
young children were mostly intact.
Ancient Greek writers from Homer to Herodotus praised the physicians of Egypt for
their wisdom and skill, but the Greeks also knew Egypt as the “mother country of diseases.”
Certainly, ancient Egyptian skeletons, portraits, writings, and mummies provide evidence of
the crushing burden of disease in the ancient world. Although mummified bodies have been
found in many parts of the world, for most people the word mummy conjures up the Egyptian
mummy, as seen in museums and late-night horror shows. The term comes from a Persian word
for bitumen (natural asphalt), reflecting the mistaken notion that ancient Egyptian bodies had
been preserved by soaking them in tar.
For the ancient Egyptians, life after death was of paramount importance, but success in the
afterlife depended on preservation of the body so that the soul would have a suitable place to
dwell. Within their tombs, wealthy Egyptians were surrounded by grave goods meant to provide
for their wellbeing in the next world. Mummies were also accompanied by elaborate paintings
on the walls of their tombs and written texts known as the Book of the Dead, which contained
spells and maps to guide them. The tombs of some Egyptian pharaohs provide evidence of
human sacrifices—probably the officials, servants, and artisans who were expected to continue
serving their king in the afterlife.
The oldest mummified bodies found in Egypt may have been the result of natural
mummification after simple burials in the desert. In predynastic Egypt (before 3100 bce),
bodies were wrapped in animal skins or linen and interred in shallow graves. If the body was not
discovered by jackals or otherwise disturbed, the hot, dry sand would draw out moisture from
the soft tissues, leaving the body looking rather like tanned leather. However, new investigations
of ancient Egyptian textiles suggest that the resins and ointments associated with Egyptian
mummification were used in burials about 2,000 years earlier than previously assumed. When
Egyptian God Anubis tending a mummy. (Reproduced from Wellcome L0027403.)

samples of funerary wrappings found in pit graves at a site called Mostagedda were subjected to
chemical analysis and carbon dating, scientists discovered that they had been used to wrap bodies
that were buried between 4200 bce and 3150 bce. The fabrics revealed traces of animal fats,
plant sterols, pine resin, aromatic plant extracts, plant-derived sugars, and natural petroleum.
Some of these substances would have had antibacterial properties. The pine resin probably came
from southeastern Anatolia (now part of Turkey). Some of the chemicals are only formed when
plant resins are heated, rather than simply mixed together. Similar compounds are found in
mummies created in the well-known era of Egyptian mummification that began around 2900
bce. The antibacterial properties of these chemicals and their preservative effect suggest that
even at this very early period Egyptians were attempting to find ways of mummifying the dead.
Simple sand burials were the norm for peasants, but during the Dynastic Period, the burial
chambers of pharaohs and nobles became increasingly elaborate. Unfortunately, putting bodies
in relatively cool, damp, underground tombs allowed the forces of putrefaction to prevail, even
if those bodies were wrapped in funerary linens treated with resins. If the pharaoh was to enjoy
both an elegant resting place and a well-preserved body, new methods of preparing the corpse
for eternity were essential. Much has been made of the mysteries of Egyptian mummification,
but the basic steps were simple: remove the viscera, dry the cadaver, and wrap the desiccated
corpse.
Desiccation could have been achieved by techniques used to preserve foods, such as salting
fish or pickling vegetables. But perhaps there was some aesthetic obstacle to preserving a pharaoh
like a pickle. A secret and mysterious procedure would surely provide a better path to eternity.
In place of hot, dry sand or a vinegary brine, embalmers used natron (a naturally occurring
mixture of salts) as a drying agent and removed the organs most susceptible to rapid decay. The
heart, which was regarded as the seat of the mind, was usually left inside the body.
Much of what is known about the mummification process comes from Greek writers like
Herodotus, paintings on tomb walls, the tools used by embalmers, and the incision patterns found
on mummies. Herodotus left the most detailed account of embalming, but his discussion contains
much doubtful material and represents a late, possibly degenerate, state of the art. According
to Herodotus, there were three methods of mummification which varied in thoroughness and
price. For the first-class procedure, the embalmers drew out the brain through the nose with
an iron hook. The intestines were removed through a cut made along the flank, the abdominal
cavity was washed with palm wine and aromatics, the belly was filled with exotic spices, and the
eviscerated body was kept in natron for 70 days. When embalming was completed, the corpse
was washed, wrapped in bandages of fine linen, smeared with gum, and enclosed in a wooden
case shaped like a person.
If the embalmers were asked to follow a more economical course, they would omit the removal
of the brain and the incision into the abdominal cavity. Instead, they injected cedar oil into the
belly through the anus and embalmed the body in natron. Seventy days later they removed the
plug from the anus and allowed the oil and dissolved bowels to escape. The cadaver, now reduced
to skin and bones, was returned to the relatives. Poorer people could only expect a simple purge
to cleanse the belly and 70 days of embalming.
Herodotus was apparently mistaken about certain details of the embalming process. Other
sources indicate that the embalmers used juniper oil rather than cedar oil and that the entire
mummification process took 70 days, of which 40 were devoted to dehydrating the body by
packing it, inside and out, with bags of natron pellets. Sometimes, the embalmers resorted to
simplified procedures, neglecting evisceration and employing onions and garlic in place of the
Egypt 29
proper aromatic preservatives. Poor workmanship and outright fraud are manifest in mummy
packs where the viscera were badly mutilated, bones broken or lost, and animal remains or
pieces of wood were used to fill out the form. Chemists attempting to recreate and analyze the
components of ancient preservatives found that cedar preparations inhibited the growth of
bacteria and were quite effective in preserving animal tissues.
One of the most peculiar uses of Egyptian mummies was the medieval practice of grinding
mummies into a powder used in the treatment of wounds. By the end of the sixteenth century,
so-called mummy powder could be found in every apothecary shop in Europe. The irony of
making medicines by destroying bodies prepared for eternal life was noted by English physician
Sir Thomas Browne, author of Religio Medici (1642).
William Konrad Roentgen’s discovery of x-rays in 1895 was almost immediately adopted
by Egyptologists. During the initial wave of excitement, some 8,000 mummies were studied
in a rather crude and hurried manner. At the School of Medicine in Cairo, Sir Grafton Elliot
Smith, anatomist; Sir Marc Armand Ruffer, bacteriologist; and Alfred Lucas, chemist; pioneered
methods of analyzing mummified tissues and experimented with mummification methods.
More recently, paleopathologists have subjected mummies to x-ray examination, computerized
tomography (CT) scanning, electron microscopy, chemical analyses, immunological evaluations,
and other analytic techniques that provide significant data with minimal damage. Well-preserved
mummies offer information about malaria, anemia, parasitic worms, traumatic injuries,
metabolic and genetic defects, and so forth. For example, biochemical studies of the mummy of
a man who died about 1500 bce provided evidence for what is probably the earliest known case
of alkaptonuria (black urine disease), a rare genetic disease caused by the absence of an enzyme
needed to break down the amino acids phenylalanine and tyrosine.
New insights into Egyptian mummification methods have come from attempts to replicate
ancient embalming techniques in the laboratory through reverse engineering and chemical
analysis of ancient recipes. In one series of experiments, researchers attempted to mummify
a man who had donated his body to science, using Egyptian natron and replicas of ancient
mortuary tools. Imaging techniques were used to examine the progress of embalming over time.
Other scientists tested mummification methods using legs taken from a cadaver to compare
two styles of mummification: natural mummification by dry heat and artificial mummification
using natron. The natural method was unsuccessful; within seven days researchers stopped
the experiment because of a high level of putrefaction. The second leg, which was immersed in
natron, was almost entirely mummified after 208 days. Although mummification took much
longer than the period referred to in ancient sources, natron was very effective in preventing
putrefaction.
One of the lessons learned from studies of mummies was the antiquity of the health hazards
associated with the Nile River. Irrigation techniques in the lands along the Nile created
conditions that encouraged the spread of schistosomiasis. The fertile soil and irrigation ditches
fed by the Nile harbored hordes of parasitic worms. At least five species of the parasitic worms
known as schistosomes infect humans. Calcified eggs found in mummies reflect the prevalence
of schistosomiasis. According to studies of 1,500-year-old Nubian mummies, about 25% suffered
from Schistosoma mansoni. (Nubia was located in what is now Sudan.) The snail in which the
parasitic worm completes an essential stage of its life cycle flourishes in stagnant irrigation
canals. When people enter infested bodies of water, schistosomes penetrate the skin, enter the
capillaries and lymphatic vessels, and migrate to the lungs, liver, intestines, and urinary tract.
Although schistosomiasis does not kill outright, chronic infestations lead to mental and physical
deterioration. Mature worms produce eggs throughout their 3- to 5-year lifespan. When eggs
are excreted in fresh water, they develop into a form that infects snails; new parasites are
produced that attack mammalian hosts and so the cycle continues. Epidemiologists estimate
that schistosomiasis still affects about 200 million people in parts of Africa, South America,
China, and South-East Asia.
Winds as well as waters were the source of debilitating conditions. Winds blowing in from
the desert carry fine particles of sand that lodge in the lungs and cause sand pneumoconiosis, a
disorder similar to black lung disease in coal minors. Sand pneumoconiosis can be detected by
electron microscopy of mummified lung tissue, but because only the elite were mummified, it is
not possible to tell how prevalent this disorder was among the common people. Another disorder
of the lungs known as anthrocosis was the result of the inhalation of carbon particles coming
from burning wood.
Sand particles found in bread and other foods caused a severe form of dental attrition.
Frequent sandstorms contaminated most foodstuffs, adding grit to everything. In addition to
wind-borne sand, foods contained particles from the stones used for milling grain. Very few
mummies had healthy teeth but cavities were rare. Obsessive about personal hygiene, the ancient
Egyptians used natron as a cleansing agent for the mouth. They also chewed on reeds to cleanse
and massage the teeth and gums.
Mummies also show signs of tuberculosis, arteriosclerosis, atherosclerosis, and arthritis.
Worn down by these ever-present hazards, even the most privileged were unlikely to attain a
life span greater than 40 years. Nevertheless, some examples of remarkable longevity did occur.
Although Rameses II suffered from arthritis, atherosclerosis, calcification of the temporal
arteries, and dental lesions with infectious complications, he was 90 years old when he died.
Researchers are now able to convert data from CT scans into three-dimensional images of
mummies without removing their outer wrappings. Carbon-14 dating can be used to estimate
the age of mummies, if uncontaminated samples of flesh or bone collagen are available. X-ray
analysis can provide valuable data about medical and dental diseases, estimates of age at death,
and morphological variations. Imaging techniques can also spare modern Egyptologists from
the embarrassing mistakes that sometimes occurred when archeologists, trying to enliven their
lectures, unwrapped the mummy of some great Egyptian prince only to find the body of a
princess or, worse yet, a baboon. In addition to diagnosing the ills of ancient pharaohs, modern
medical techniques have been used to treat mummies suffering from “museum ailments” caused
by improper storage and display, as well as the ravages of insects, fungi, and bacteria.
The abundance of diseases afflicting the ancient Egyptians provides a rationale for the
observation made by Herodotus that the whole country swarmed with specialized physicians
dedicated to care of the eyes, head, teeth, stomach, and obscure ailments. Specialists, lay
physicians, priests, and magicians apparently referred patients to each other as appropriate.
One specialist called Iri, Shepherd of the Anus (or Keeper of the Bottom), held a place of honor
among court physicians. Sometimes referred to as the first proctologist, the Keeper of the Royal
Rectum might have served primarily as the pharaoh’s enema-maker. According to Egyptian
mythology, the enema itself had a noble origin; it was invented by the god Thot.
Medical specialization in ancient Egypt was primarily the result of the religious doctrine that
no part of the body was without its own god. Priest-physicians, therefore, tended to specialize in
a particular organ or disease. Pharmacists traced the origin of their art to Isis, who had imparted
the secrets of remedies to her son Horus. All who participated in the work of the Houses of Life
attached to the temples, as well as the embalming establishments, claimed the god Anepu as
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CHAPTER III.
SWARMING OR NATURAL METHOD OF
INCREASE.
The natural method by which an increase of colonies among

bees is secured, is of great interest, and though it has been closely
observed, and assiduously studied for a long period, and has given
rise to theories as often absurd as sound, yet, even now, it is a fertile
field for investigation, and will repay any who may come with the true
spirit of inquiry, for there is much concerning it which is involved in
mystery. Why do bees swarm at unseemly times? Why is the
swarming spirit so excessive at times and so restrained at other
seasons? These and other questions we are too apt to refer to
erratic tendencies of the bees, when there is no question but that
they follow naturally upon certain conditions, perhaps intricate and
obscure, which it is the province of the investigator to discover. Who
shall be first to unfold the principles which govern these, as all other
actions of the bees?
In the spring or early summer, when the hive has become
populous, and storing very active, the queen, as if conscious that a
home could be overcrowded, and foreseeing such danger,
commences to deposit drone-eggs in drone-cells, which the worker-
bees, perhaps moved by like considerations, begin to construct, if
they are not already in existence. In fact, drone comb is almost sure
of construction at such times. No sooner is the drone brood well
under way, than the large, awkward, queen-cells are commenced,
often to the number of ten or fifteen, though there may be not more
than three or four. In these, eggs are placed, and the rich royal jelly
added, and soon, often before the cells are even capped—and very
rarely before a cell is built, if the bees are crowded, the hives
unshaded, the ventilation insufficient, or the honey-yield very
bountiful—some bright day, usually about ten o'clock, after an
unusual disquiet both inside and outside the hive, a large part of the
worker-bees—being off duty for the day, and having previously
loaded their honey-sacks—rush forth from the hive as if alarmed by
the cry of fire, the queen among the number, though she is by no
means among the first, and frequently is quite late in her exit. The
bees, thus started on their quest for a new home, after many
uproarious gyrations about the old one, dart forth to alight upon
some bush, limb, or fence, though in one case I have known the first
swarm of bees to leave at once, for parts unknown, without even
waiting to cluster. After thus meditating for the space of from one to
three hours, upon a future course, they again take wing and leave for
their new home, which they have probably already sought out.
Some suppose the bees look up a home before leaving the hive,
while others claim that scouts are in search of one while the bees
are clustered. The fact that bees take a right-line to their new home,
and fly too rapidly to look as they go, would argue that a home is
preêmpted, at least, before the cluster is dissolved. The fact that the
cluster remains sometimes for hours—even over night—and at other
times for a brief period, would lead us to infer that the bees cluster, in
waiting for a new home to be found. Yet, why do bees sometimes
alight after flying a long distance, as did a first swarm the past
season, upon our College grounds? Was their journey long, so that
they must needs stop to rest, or were they flying at random, not
knowing whither they were going?
If for any reason the queen should fail to join the bees, and
perhaps rarely, when she is among them, they will, after having
clustered, return to their old home. The youngest bees will remain in
the old hive, to which those bees, if there are any such, which are
abroad in quest of stores will return. The presence of young bees on
the ground—those with flight too feeble to join the rovers—will
always mark the previous home of the emigrants. Soon, in seven or
eight days, perhaps rarely a little later, the first queen will come forth
from her cell, and in two or three days she will or may lead a new
colony forth, but before she does this, the peculiar note, known as
the piping of the queen, may be heard. This piping sounds like peep,
peep, is shrill and clear, and can be plainly heard by placing the ear
to the hive, nor would it be mistaken. It is followed by a lower,
hoarser note, made by a queen still within the cell.
Some have supposed that the cry of the liberated queen was that
of hate, while that by the queen still imprisoned was either of enmity
or fear. Never will an after-swarm leave, unless preceded by this
peculiar note.
At successive periods of one or two days, one, two, or even three
more colonies may issue from the old home. These last swarms will
all be heralded by the piping of the queen. They will be less
particular as to the time of day when they issue, as they have been
known to leave before sun-rise, and even after sun-set. The well-
known apiarist, Mr. A. F. Moon, once knew a swarm to issue by
moon-light. They will, too, as a rule, cluster farther from the hive. The
after swarms are preceded by the queen, and in case swarming is
delayed, may be attended by a plurality of queens. Berlepsch and
Langstroth both saw eight queens issue with a swarm, while, others
report even more. These virgin queens fly very rapidly, so the swarm
will seem more active and definite in their course than will first
swarms.
The cutting short of swarming preparations before the second,
third, or even the first swarm issues, is by no means a rare
occurrence. This is effected by the bees' destroying the queen-cells,
and sometimes by a general extermination of the drones, and is
generally to be explained by a cessation of the honey yield. Cells
thus destroyed are easily recognized, as they are torn open from the
side, and not cut back from the end.
Swarming out at other times, especially in late winter and spring,
is sometimes noticed by apiarists. This is due to famine, mice, or
some other disturbing circumstance, which makes the hive
intolerable to the bees.
CHAPTER IV.
PRODUCTS OF BEES; THEIR ORIGIN AND
FUNCTION.
Among all insects, bees stand first in the variety of the useful
products which they give us; and next to the silk-moths in the
importance of these products. They seem the more remarkable and
important, in that so few insects yield articles of commercial value.
True, the cochineal insect, a species of bark-louse, gives us an
important coloring material; the lac insect, of the same family, gives
us the important element of our best glue—shellac; the blister-
beetles afford an article prized by the physician, while we are
indebted to one of the gall-flies for a valuable element of ink But the
honey-bee affords not only a delicious article of food, but also
another article of no mean commercial rank—namely, wax. We will
proceed to examine the various products which come from bees.
HONEY.
Of course the first product of bees, not only to attract attention,

but also in importance, is honey. And what is honey? We can only
say that it is a sweet substance gathered from flowers and other
sources, by the bees. We cannot, therefore, give its chemical
composition, which would be as varied as the sources from which it
comes. We cannot even call it a sugar, for it may be, and always is
composed of various sugars, and thus it is easy to understand why
honey varies so much in richness, color, flavor, and effects on
digestion. In fact, it is very doubtful if honey is a manufactured article
at all. It seems most likely that the bees only collect it as it is distilled
by myriad leaves and flowers, and store it up, that it may minister to
their and our necessities. To be sure, some writers contend that it
undergoes some change while in the bee's stomach; but the rapidity
with which they store, and the seeming entire similarity between
honey and sugar fed to them, and the same immediately extracted
from the comb, has led me to believe that the transforming power of
the stomach is very slight, if, indeed, it exists at all. To be sure, I
have fed sugar, giving bees empty combs at night-fall, and found the
flavor of honey early the next morning. In this case, honey might
have been already in the bees' stomachs, or might have been
carried from other portions of the hive. The method of collecting the
honey has already been described. The principles of lapping and
suction are both involved in the operation.
When the stomach is full, the bee repairs to the hive, and
regurgitates its precious load, either giving it to the bees or storing it
in the cells. Mr. Doolittle claims that the bees that gather, give all
their honey to the other bees, which latter store it in the cells. This
honey remains for some time uncapped that it may ripen, by which
process the water is partially evaporated, and the honey rendered
thicker. If the honey remains uncapped, or is removed from the cells,
it will generally granulate, if the temperature be reduced below 70°.
This is probably owing to the presence of the cane-sugar, and is a
good indication, as it denotes superior quality. Some honey, as that
from the South, and some from California, seems to remain liquid
indefinitely. Some kinds of our own honey crystallize much more
readily than others. But that granulation is a test that honey is pure,
is untrue; that it is a sign of superior excellence, I think quite
probable.
When there are no flowers, or when the flowers yield no sweets,
the bees, ever desirous to add to their stores, frequently essay to rob
other colonies, and often visit the refuse of cider mills, or suck up the
oozing sweets of various plant or bark lice, thus adding, may be,
unwholesome food to their usually delicious and refined stores. It is a
curious fact that the queen never lays her maximum number of eggs
except when storing is going on. In fact, in the interims of honey-
gathering, egg-laying not infrequently ceases altogether. The queen
seems discreet, gauging the size of her family by the probable
means of support.
Again, in times of extraordinary yields of honey, the storing is so
rapid that the hive becomes so filled that the queen is unable to lay
her full quota of eggs; in fact, I have seen the brood very much
reduced in this way, which, of course, greatly depleted the colony.
This might be called ruinous prosperity. The natural use of the honey
is to furnish the mature bees with food, and when mixed with pollen,
to form the diet of the young bees.
Fig. 27.
Under-side Wax-Scales in
Abdomen, situ, magnified.
magnified. w—Wax-scale.
a, a, etc.—Wax
pellets.
WAX.
The product of the bees, second in importance, is wax. This is a

solid, unctious substance, and is, as shown by its chemical
composition, a fat-like material, though not as some authors assert,
the fat of bees. As already observed, this is a secretion formed in
pellets, the shape of an irregular pentagon (Fig, 27, w, underneath
the abdomen. These pellets are light-colored, very thin and fragile,
and are secreted by and molded upon the membrane towards the
body from the wax-pockets. Neighbour speaks of the wax oozing
through pores from the stomach. This is not the case, but, as with
the synovial fluid about our own joints, is formed by the secreting
membrane, and does not pass through holes, as water through a
sieve. There are four of these wax-pockets on each side, and thus
there may be eight wax-scales on a bee at one time. This wax can
be secreted by the bees, when fed on pure sugar, as shown by
Huber, which experiment I have verified. I removed all honey and
comb from my observing-hive, left the bees for twenty-four hours to
digest all food which might be in their stomachs, then fed pure sugar,
which was better than honey, as Prof. R. F. Kedzie has shown by
analysis that not only filtered honey, but even the nectar which he
collected right from the flowers themselves, contains nitrogen. The
bees commenced at once to build comb, and continued for several
days, so long as I kept them confined. This is, as we should
suppose; sugar contains hydrogen and oxygen in proportion to form
water, while the third element, carbon, is in the same or about the
same proportion as the oxygen. Now, the fats usually contain little
oxygen, and a good deal of carbon and hydrogen. Thus, the sugar
by losing some of its oxygen would contain the requisite elements for
fat. It was found true in the days of slavery in the South, that the
negroes of Louisiana, during the gathering of the cane, would
become very fat. They ate much sugar; they gained much fat. Now,
wax is a fat-like substance, not that it is the animal fat of bees, as
often asserted—in fact it contains much less hydrogen, as will be
seen by the following formula from Hess:
Oxygen 7.50
Carbon 79.30
Hydrogen 13.20
—but it is a special secretion for a special purpose, and from its
composition, we should conclude that it might be secreted from a
purely saccharine diet, and experiment confirms the conclusion. It
has been found that bees require about twenty pounds of honey to
secrete one of wax.
That nitrogenous food is necessary, as claimed by Langstroth
and Neighbour, is not true. Yet, in the active season, when muscular
exertion is great, nitrogenous food must be imperatively necessary to
supply the waste, and give tone to the body. Some may be desirable
even in the quiet of winter. Now, as secretion of wax demands a
healthy condition of the bee, it indirectly requires some nitrogenous
food.
It is asserted, that to secrete wax, bees need to hang in compact
clusters or festoons, in absolute repose. Such quiet would certainly
seem conducive to most active secretion. The same food could not
go to form wax, and at the same time supply the waste of tissue
which ever follows upon muscular activity. The cow, put to hard toil,
could not give so much milk. But I find, upon examination, that the
bees, even the most aged, while gathering in the honey season,
yield up the wax-scales, the same as those within the hive. During
the active storing of the past season, especially when comb-building
was in rapid progress, I found that nearly every bee taken from the
flowers contained the wax-scales of varying sizes in the wax-
pockets. By the activity of the bees, these are not infrequently loosed
from their position, and fall to the bottom of the hive.
It is probable that wax secretion is not forced upon the bees, but
only takes place as required. So the bees, unless wax is demanded,
may perform other duties. Whether this secretion is a matter of the
bee's will, or whether it is excited by the surrounding conditions
without any thought, are questions yet to be settled.
These wax-scales are loosened by the claws, and carried to the
mouth by the anterior legs, where they are mixed with saliva, and
after the proper kneading by the jaws, in which process it assumes a
bright yellow hue—but loses none of its translucency—it is formed
into that wonderful and exquisite structure, the comb.
Honey-comb is wonderfully delicate, the wall of a new cell being
only about 1-180 of an inch in thickness, and so formed as to
combine the greatest strength with the least expense of material and
room. It has been a subject of admiration since the earliest time.
That the form is a matter of necessity, as some claim—the result of
pressure—and not of bee-skill, is not true. The hexagonal form is
assumed at the very start of the cells, when there can be no
pressure. The wasp builds the same form, though unaided. The
assertion that the cells, even the drone and worker-cells, are
absolutely uniform and perfect, is also untrue, as a little inspection
will convince any one. The late Prof. Wyman proved that an exact
hexagonal cell does not exist. He showed that the size varies; so
that in a distance of ten worker-cells, there may be a variation of one
diameter. And this in natural, not distorted cells. This variation of
one-fifth of an inch in ten cells is extreme, but a variation of one-
tenth of an inch is common. The sides, as also the angles, are not
constant. The rhombic faces forming the bases of the cells also vary.
The bees change from worker (Fig, 28, c) to drone-cells (Fig, 28,
a), which are one-fifth larger, and vice versa, not by any system (Fig,
28, b), but simply by enlarging or contracting. It usually takes about
four rows to complete the transformation, though the number of
deformed cells varies from two to eight.
Fig. 28.
Rhombs, Pyramidal
Bases,
and Gross-sections of
Cells
illustrated.
Honey-Comb.
a—Drone-cells, c—Worker-cells.
b—Deformed cells. d d—Queen-cells.
The structure of each cell is quite complex, yet full of interest.
The base is a triangular pyramid (Fig, 28, e) whose three faces are
rhombs, and whose apex forms the very centre of the floor of the
cell. From the six free or non-adjacent edges of the three rhombs
extend the lateral walls or faces of the cell. The apex of this basal
pyramid is a point where the contiguous faces of three cells on the
opposite side meet, and form the angles of the bases of three cells
on the opposite side of the comb. Thus, the base of each cell forms
one-third of the base of each of three opposite cells. One side thus
braces the other, and adds much to the strength of the comb. Each
cell, then, is in form of a hexagonal prism, terminating in a flattened
triangular pyramid.
The bees usually build several combs at once, and carry forward
several cells on each side of each comb, constantly adding to the
number, by additions to the edge. Huber first observed the process
of comb-building, noticing the bees abstract the wax-scales, carry
them to the mouth, add the frothy saliva, and then knead and draw
out the yellow ribbons which were fastened to the top of the hive, or
added to the comb already commenced.
The diameter of the worker-cells (Fig, 28, c) averages little more
than one-fifth of an inch—Réaumur says two and three-fifths lines or
twelfths of an inch. While the drone-cells (Fig, 28, a) are a little more
than one-fourth of an inch, or, according to Réaumur, three and one-
third lines. But this distinguished author was quite wrong when he
said: "These are the invariable dimensions of all cells that ever were
or ever will be made." The depth of the worker-cells is a little less
than half an inch; the drone-cells are slightly extended so as to be a
little more than half an inch deep. These cells are often drawn out so
as to be an inch long, when used solely as honey receptacles. The
capping of the brood-cells is dark, porous, and convex, while that of
the honey is white and concave.
The character of the cells, as to size, that is whether they are
drone or worker, seems to be determined by the relative abundance
of bees and honey. If the bees are abundant and honey needed, or if
there is no queen to lay eggs, drone-comb (Fig, 28, a) is invariably
built, while if there are few bees, and of course little honey needed,
then worker-comb (Fig, 28, c) is almost as invariably formed.
All comb when first formed is clear and transparent. The fact that
it is often dark and opaque implies that it has been long used as
brood-comb, and the opacity is due to the innumerable thin cocoons
which line the cells. These may be separated by dissolving the wax;
which may be done by putting it in boiling alcohol. Such comb need
not be discarded, for if composed of worker-cells, it is still very
valuable for breeding purposes, and should not be destroyed till the
cells are too small for longer service, which, will not occur till after
many years of use. The function, then, of the wax, is to make comb,
and caps for the honey-cells, and, combined with pollen, to form
queen-cells (Fig, 28, d) and caps for the brood-cells. (See Appendix,
page 301).
POLLEN, OR BEE-BREAD.
An ancient Greek author states that in Hymettus the bees tied

little pebbles to their legs to hold them down. This fanciful conjecture
probably arose from seeing the pollen balls on the bees' legs.
Even such scientists as Réaumur, Bonnet, Swammerdam, and
many apiarists of the last century, thought they saw in these pollen-
balls the source of wax. But Huber, John Hunter, Duchet, Wildman,
and others, noticed the presence and function of the wax-pellets
already described, and were aware that the pollen served a different
purpose.
This substance, like honey, is not secreted, nor manufactured by
the bees, only collected. The bees usually obtain it from the stamens
of flowers. But if they gain access to flour when there is no bloom,
they will take this in lieu of pollen, in which case the former term
used above becomes a misnomer, though usually the bee-bread
consists almost wholly of pollen.
As already intimated, the pollen is conveyed in the pollen-baskets
(Fig, 22, p) of the posterior legs, to which it is conveyed by the other
legs, and compressed into little oval masses. The motions in this
conveyance are exceedingly rapid. The bees not infrequently come
to the hives, not only with replete pollen-baskets, but with their whole
under surface thoroughly dusted. Dissection will also show that the
same bee may have her sucking stomach distended with honey.
Thus the bees make the most of their opportunities. It is a curious
fact, noticed even by Aristotle, that the bees, during any trip, gather
only a single kind of pollen, or only gather from one species of
bloom. Hence, while different bees may have different colors of
pollen, the pellets of bee-bread on any single bee will be uniform in
color throughout. It is possible that the material is more easily
collected and compacted when homogeneous.
The pollen is usually deposited in the small or worker cells, and is
unloaded by a scraping motion of the posterior legs, the pollen
baskets being first lowered into the cells. The bee thus freed, leaves
the wheat-like masses thus deposited to be packed by other bees.
The cells, which may or may not have the same color of pollen
throughout, are never filled quite to the top, and not infrequently the
same cell may contain both pollen and honey. Such a condition is
easily ascertained by holding the comb between the eye and the
sun. If there is no pollen it will be wholly translucent; otherwise there
will be opaque patches. A little experience will make this
determination easy, even if the comb is old. It is often stated that
queenless colonies gather no pollen, but this is not true, though very
likely they gather less than they otherwise would. It is probable that
pollen, at least when honey is added, contains all the essential
elements of animal food. It certainly contains the very important
principle, which is not found in honey—nitrogenous material.
The function of bee-bread is to help furnish the brood with proper
food. In fact, brood-rearing would be impossible without it. And
though it is certainly not essential to the nourishment of the bees
when in repose, it still may be so, and unquestionably is, in time of
active labor.
PROPOLIS.
This substance, also called bee-glue, is collected as the bees

collect pollen, and not made nor secreted. It is the product of various
resinous buds, and may be seen to glisten on the opening buds of
the hickory and horse-chestnut, where it frequently serves the
entomologist by capturing small insects. From such sources, from
the oozing gum of various trees, from varnished furniture, and from
old propolis about unused hives, that have previously seen service,
do the bees secure their glue. Probably the gathering of bees about
coffins to collect their glue from the varnish, led to the custom of
rapping on the hives to inform the bees, in case of a death in the
family, that they might join as mourners. This custom still prevails, as
I understand, in some parts of the South. This substance has great
adhesive force, and though soft and pliable when warm, becomes
very hard and unyielding when cold.
The use of this substance is to cement the combs to their
supports, to fill up all rough places inside the hive, to seal up all
crevices except the place of exit, which they often contract, and even
to cover any foreign substance that cannot be removed. Intruding
snails have thus been imprisoned inside the hive. Réaumur found a
snail thus encased; Maraldi, a slug similarly entombed; while I have
myself observed a bombus, which had been stripped by the bees of
wings, hair, etc., in their vain attempts at removal, also encased in
this unique style of a sarcophagus, fashioned by the bees.
BIBLIOGRAPHY.
For those who wish to pursue these interesting subjects more at
length, I would recommend the following authors as specially
desirable: Kirby and Spence, Introduction to Entomology; Duncan's
Transformations of Insects; Packard's Guide to the Study of Insects
(American); F. Huber's New Observations on the Natural History of
Bees; Bevan on the Honey Bee; Langstroth on the Honey Bee
(American); Neighbour on The Apiary.
I have often been asked to recommend such treatises, and I
heartily commend all of the above. The first and fourth are now out of
print, but can be had by leaving orders at second-hand book-stores.
PART SECOND.
T H E A P I A RY;
Its Care and Management.
Motto:—"Keep all Colonies Strong!"

INTRODUCTION TO PART II.
STARTING AN APIARY.
In apiculture, as in all other pursuits, it is all-important to make a

good beginning. This demands preparation on the part of the
apiarist, procuring of bees, and location of his apiary.
PREPARATION.
Before starting in the business, the prospective bee-keeper
should inform himself in the art.
READ A GOOD MANUAL.
To do this, he should procure some good manual, and thoroughly

study, especially the practical part of the business; and if
accustomed to read, think and study, should carefully read the whole
work. Otherwise, he will avoid confusion by only studying the
methods of practice, leaving the principles and science, to
strengthen, and be strengthened by, his experience. Unless a
student, he had better not take a journal till he begins the actual
work, as so much unclassified information, without any experience to
correct, arrange, and select, will but mystify. For the same reason,
he may well be content with reading a single work, till experience,
and a thorough study of this one, makes him more able to
discriminate; and the same reasoning will preclude his taking more
than one bee-periodical, until he has had at least a year's actual
experience.
VISIT SOME APIARIST.

In this work of self-preparation, he will find great aid in visiting the
nearest successful and intelligent apiarist. If successful, such an one
will have a reputation; if intelligent, he will take the journals, and will
show by his conversation that he knows of the methods and views of
his brother apiarists, and above all, he will not think he knows it all,
and that his is the only way to success. Learn all you can of such, an
one, but always let your own judgment and common sense sit as
umpire, that you make no plans or decisions that your judgment
does not fully sustain.
TAKE A COLLEGE COURSE.
It will be most wise to take a course in some College, if this is

practicable, where apiculture is thoroughly discussed. Here you will
not only get the best training as to your chosen business, as you will
study, see and handle, and thus will have the very best aids to
decide as to methods, system and apparatus, but will also receive
that general culture, which will greatly enhance life's pleasures and
usefulness, and which ever proves the best capital in any vocation.
DECIDE ON A PLAN.
After such a course as suggested above, it will be easy to decide

as to location, hives, style of honey to raise, and general system of
management. But here, as in all the arts, all our work should be
preceded by a well-digested plan of operations. As with the farmer
and gardener, only he who works to a plan can hope for the best
success. Of course, such plans will vary, as we grow in wisdom and
experience. A good maxim to govern all plans is, "go slow." A good
rule, which will insure the above, "Pay as you go." Make the apiary
pay for all improvements in advance. Demand that each year's
credits exceed its debits; and that you may surely accomplish this,
keep an accurate account of all your receipts and expenses. This will
be a great aid in arranging the plans for each successive year's
operations.
Above all, avoid hobbies, and be slow to adopt sweeping
changes. "Prove all things, and hold fast that which is good."
HOW TO PROCURE OUR FIRST COLONIES.

To procure colonies from which to form an apiary, it is always
best to get them near at hand. We thus avoid the shock of
transportation, can see the bees before we purchase, and in case
there is any seeming mistake, can easily gain a personal
explanation, and secure a speedy adjustment of any real wrong.
KIND OF BEES TO PURCHASE.

At the same price always take Italians, as undoutedly they are
best. If black bees can be secured for three, or even for two dollars
less per colony, by all means take them, as they can be Italianized at
a profit for the difference in cost, and, in the operation, the young
apiarist will gain valuable experience.
Our motto, too, will demand that we only purchase strong
colonies. If, as recommended, the purchaser sees the colonies
before the bargain is closed, it will be easy to know that the colonies
are strong. If the bees, as they come rushing out, remind you of
Vesuvius at her best, or bring to mind the gush and rush at the
nozzle of the fireman's hose, then buy. In the hives of such colonies,
all combs will be covered with bees, and in the honey season, brood
will be abundant.
IN WHAT KIND OF HIVES.

As plans are already made, of course it is settled as to the style
of hive to be used. Now, if bees can be procured in such hives, they
will be worth just as much more than though in any other hive, as it
costs to make the hive and transfer the bees. This will be certainly as
much as three dollars. No apiarist will tolerate, unless for
experiment, two styles of hives in his apiary. Therefore, unless you
find bees in such hives as you are to use, it will be best to buy them
in box hives and transfer (see Chapter VII.) to your own hives, as
such bees can always be bought at reduced rates. In case the
person from whom you purchase will take the hives back at a fair
rate, after you have transferred the bees to your own hives, then
purchase in any style of movable comb hive, as it is easier to
transfer from a movable comb hive, than from a box hive.
WHEN TO PURCHASE.
It is safe to purchase any time in the summer. In April or May—of
course you only purchase strong stocks—if in the latitude of New
York or Chicago—it will be earlier further south—you can afford to
pay more, as you will secure the increase both of honey and bees. If
you desire to purchase in autumn, that you may gain by the
experience of wintering, either demand that the one of whom you
purchase insure the safe wintering of the bees, or else that he
reduce the selling price, at least one-third, from his rates the next
April. Otherwise the novice had better wait and purchase in spring. If
you are to transfer at once, it is almost imperative that you buy in
spring, as it is vexatious, especially for the novice, to transfer when
the hives are crowded with brood and honey.
HOW MUCH TO PAY.

Of course the market, which will ever be governed by supply and
demand, must guide you. But to aid you, I will append what at
present would be a reasonable schedule of prices almost anywhere
in the United States: For box hives, crowded with black bees—
Italians would rarely be found in such hives—five dollars per colony
is a fair price. For black bees in hives such as you desire to use,
eight dollars would be reasonable. For pure Italians in such hives,
ten dollars is not too much.
If the person of whom you purchase, will take back the movable
hives after you transfer the bees, you can afford to pay five dollars

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A History of Medicine, Third Edition

History of Medicine A Scandalously Short Introduction

History of medicine a scandalously short introduction

Managing the Environment Managing Ourselves A History

A Short History of Medicine Ackerknecht Erwin H H

Shame A Brief History Peter N. Stearns

Understanding Intuition A Journey In and Out of Science

A Natural History of Ladybird Beetles 1st Edition M. E.

History of Modern Design Third Edition David Raizman

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1 PALEOPATHOLOGY AND PALEOMEDICINE 1

2 MEDICINE IN ANCIENT CIVILIZATIONS: MESOPOTAMIA AND EGYPT 21

3 THE MEDICAL TRADITIONS OF INDIA AND CHINA 37

Medicine in the Roman world 77

5 THE MIDDLE AGES 89

6 THE RENAISSANCE AND THE SCIENTIFIC REVOLUTION 119

7 NEW WORLD CULTURES AND CIVILIZATIONS 153

8 THE AMERICANIZATION OF OLD WORLD MEDICINE 173

Hospitals, nurses, and nursing schools 199

Serum therapy 347

Insights from different disciplines, including archeology, historical geography, morphology,

PALEOPATHOLOGY: METHODS AND PROBLEMS

DIAGNOSING PREHISTORIC DISEASES AND INJURIES

MUMMIES AND SIGNS OF DISEASE

PALEOMEDICINE AND SURGERY

Trepanation by Neolithic era surgeon. (Reproduced from Wellcome L0058021.)

HEALING RITUALS, TRADITIONS, AND MAGIC

To combat bleeding, traditional healers used tourniquets or cauterization or simply packed

HAMMURABI’S CODE OF LAWS

Egyptian God Anubis tending a mummy. (Reproduced from Wellcome L0027403.)

The natural method by which an increase of colonies among

Of course the first product of bees, not only to attract attention,

The product of the bees, second in importance, is wax. This is a

An ancient Greek author states that in Hymettus the bees tied

This substance, also called bee-glue, is collected as the bees

Motto:—"Keep all Colonies Strong!"

In apiculture, as in all other pursuits, it is all-important to make a

READ A GOOD MANUAL.

To do this, he should procure some good manual, and thoroughly

VISIT SOME APIARIST.

TAKE A COLLEGE COURSE.

It will be most wise to take a course in some College, if this is

After such a course as suggested above, it will be easy to decide

HOW TO PROCURE OUR FIRST COLONIES.

KIND OF BEES TO PURCHASE.

IN WHAT KIND OF HIVES.

HOW MUCH TO PAY.

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