The Greatest Benefit to Mankind: A Medical History of Humanity. Roy Porter

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СКАЧАТЬ in the Louvre, includes medical instructions for physicians. Its rules set out fees for treatment, with a sliding scale adjusting rewards according to the patient’s rank (nobleman, commoner or slave), together with terrifying draconian fines for incompetence or failure. ‘If a physician has performed a major operation on a lord with a bronze lancet and has saved the lord’s life … he shall receive ten shekels of silver’ (more than a craftsman’s annual pay); but if he caused the death of such a notable, his hand would be chopped off. A doctor causing the death of a slave would have to replace him.

      The Mesopotamian peoples saw the hand of the gods in everything: disease was caused by spirit invasion, sorcery, malice or the breaking of taboos; sickness was both judgment and punishment. An Assyrian text of around 650 BC describes epileptic symptoms within a demonological framework:

      If at the time of his possession, while he is sitting down, his left eye moves to the side, a lip puckers, saliva flows from his mouth, and his hand, leg and trunk on the left side jerk like a slaughtered sheep, it is migtu. If at the time of possession his mind is awake, the demon can be driven out; if at the time of his possession his mind is not so aware, the demon cannot be driven out.

      Headaches, neck pain, intestinal ailments and impotence were read as omens, and remedies involved identifying the demons responsible and expelling them by spells or incantation, though when maladies were the work of a god they might be a portent of death. Sicknesses were also ascribed to cold, dust and dryness, putrefaction, malnutrition, venereal infection and other natural causes.

      Physical symptoms might be treated with empirical remedies. The Babylonians drew on an extensive materia medica – some 120 mineral drugs and twice that number of vegetable items are listed in the tablets. Alongside various fats, oils, honey, wax and milk, active ingredients included mustard, oleander and hellebore; colocynth, senna and castor oil were used as laxatives; while wound dressings were compounded with dried wine dregs, salt, oil, beer, juniper, mud or fat, blended with alkali and herbs. They had discovered distillation, and made essence of cedar and other volatile oils. Use of dog dung seems to smack of Dreckapothecary treatments, faecal ingredients designed to drive off demons.

      Such empirical remedies accompanied a prognostic bent reflecting Babylonian preoccupations with astrology, the casting of horoscopes and soothsaying through examination of animal entrails (haruspicy). Viewing disease as largely supernatural, Mesopotamian medicine might be regarded as sorcery systematized. Parallels to this are offered by Egyptian medicine, which developed at the same time and presents comparable healing practices involving prayers, magic, spells and sacrifices, together with practical drug treatments and surgery.

      EGYPT

      Egypt rose under the pharaohs in the third millennium BC; the great pyramids on the plateau at Giza, dating from around 2000 BC, show a powerful regime possessed of stupendous ambition and technological virtuosity. The earliest written evidence of their medicine appears in papyri of the second millennium BC, but such records encode far older traditions. Among the medical texts, the most important, discovered in the nineteenth century, are the Edwin Smith and the Georg Ebers papyri.

      Sometimes called a book of wounds, the Edwin Smith papyrus (c. 1600 BC, found near Luxor and named after an American Egyptologist) gives a head-to-foot inventory of forty-eight case reports, including various injuries and wounds, their prognosis and treatment. ‘If you examine a man having a dislocation of his mandible, should you find his mouth open, and his mouth cannot close, you should put your two thumbs upon the end of the two rami of the mandible inside his mouth and your fingers under his chin and you should cause them to fall back so that they rest in their places.’ The surgical conditions treated were wounds, fractures and abscesses; circumcision was also performed. Broken bones were set in ox-bone splints, supported by resin-soaked bandages. The papyrus refers to a raft of dressings, adhesive plasters, braces, plugs, cleansers and cauteries.

      The Smith papyrus shows there was an empirical component to ancient Egyptian medicine alongside its magico-religious bent. In a similar style, the London papyrus (c. 1350 BC) describes maternal care, and the Kahun papyrus (c. 1850 BC) deals with animal medicine and gynaecology, including methods for detecting pregnancy and for contraception, for which pessaries were recommended made of pulverized crocodile dung and herbs now impossible to identify, mixed with honey. Their contraceptive measures, evidently aimed at blocking the passage of semen, may have worked, since the Egyptians seem to have been able to regulate family size without recourse to infanticide.

      The Ebers papyrus (c. 1550 BC), deriving from Thebes, is, however, the principal medical document – indeed the oldest surviving medical book. Over twenty metres long, it deals with scores of diseases and proposes remedies including spells and incantations. This and other sources show the prominence of magic. Amulets were recommended, and treatments typically involved chants and supplications to the appropriate deities, the most popular being the falcon-headed sun god Ra; Thoth, the ibis-headed god of wisdom (later associated with the Greek Hermes or the Roman Mercury); and Isis and her son Horus, the god of health, whose eye formed the motif for a popular charm.

      The Ebers papyrus covers 15 diseases of the abdomen, 29 of the eyes, and 18 of the skin, and lists no fewer than 21 cough treatments. About 700 drugs and 800 formulae are referred to, mainly herbs but also mineral and animal remedies. To cure night-blindness fried ox liver was to be taken – possibly a tried-and-tested procedure, as liver is rich in vitamin A, lack of which causes the illness. Eye disorders were common, and there were numerous cures:

      To drive away inflammation of the eyes, grind the stems of the juniper of Byblos, steep them in water, apply to the eyes of the sick person and he will be quickly cured. To cure granulations of the eye prepare a remedy of cyllyrium, verdigris, onions, blue vitriol, powdered wood, mix and apply to the eyes.

      For stomach ailments a decoction of cumin, goose-fat and milk was recommended, but other remedies sound more exotic, including a drink prepared from black ass testicles, or a mixture of vulva and penis extracts and a black lizard, designed to cure baldness. Also good for hair growth was a compound of hippopotamus, lion, crocodile, goose, snake and ibex fat.

      Egyptian medicine credited many vegetables and fruits with healing properties, and used tree resins, including myrrh, frankincense and manna. As in Mesopotamia, plant extracts – notably senna, colocynth and castor oil – were employed as purgatives. Recipes include ox spleen, pig’s brain, honey-sweetened tortoise gall and various animal fats. Antimony, copper and other minerals were recommended as astringents or disinfectants. Containing ingredients from leeks to lapis lazuli – including garlic, onion, tamarisk, cereals, spices, condiments, resins, gums, dates, hellebore, opium and cannabis – compound drugs were administered in the form of pills, ointments, poultices, fumigations, inhalations, gargles and suppositories; they might even be blown into the urethra through a tube.

      Archaeological evidence and papyri afford glimpses of Egyptian medical practice, at least among the elite. Part was hierarchically organized and under state control; physicians were appointed to superintend public works, the army, burial grounds and the pharaoh’s palace. Court physicians formed the apex of the medical pyramid. Just as the gods governed different body parts, physicians (swnu) specialized in particular diseases or body organs; in the fifth century BC the Greek Herodotus observed that in Egypt ‘one physician is confined to the study and management of one disease … some attend to the disorders of the eyes, others to those of the head, some take care of the teeth, others are conversant with all diseases of the bowels.’

      As in Mesopotamia, the swnu formed one of three divisions of healers. The others were priests of Sekhmet, and sorcerers. Healers whose names have come down include Iri, Keeper of the Royal Rectum, presumably the pharaoh’s enema expert. (Enemas had a divine origin, being invented by ibis-headed Thoth; they were widely used, because Egyptian health lore feared putrefaction in the guts СКАЧАТЬ