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

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СКАЧАТЬ physician or overseer, proof of the existence, as in Mesopotamia, of female healers; and the celebrated Imhotep (‘he who cometh in peace’) chief vizier to Pharaoh Zozer (fl. 27 cent, BC), high priest at Heliopolis, renowned as an astrologer, priest, sage and pyramid designer (the Step Pyramid of Sakkarah), but above all as a physician.

      Imhotep became a figure akin to the Greek god Asclepius (Aesculapius in Latin). His ‘sayings’ were later recorded and preserved among the classics of Egyptian wisdom, and within a few generations he was being deified. There is, however, little evidence of his cult for another millennium, and only around 300 BC did it blossom. As with Asclepius, Imhotep became associated with healing shrines and temple sleep (incubation cures). Patients would sleep overnight in the inner precincts where they would be visited in their dreams by a god, or an emissary like a snake, and their illness or infertility remedied.

      The Egyptians believed well-being was endangered by earthly and supernatural forces alike, in particular evil spirits stealing into the body through the orifices and consuming the victim’s vital substance. Health was associated with correct living, being at peace with the gods, spirits and the dead; illness was a matter of imbalance which could be restored to equilibrium by supplication, spells and rituals. Thus, someone struck blind might invoke a god: ‘Ptah, the lord of Truth, has turned his justice against me; he has rightly chastised me. Have pity on me, deign to regard me with merciful countenance.’ Handling burns, a magician would swab the wound with the milk of a mother of a baby boy, while appealing to Isis by repeating the words the goddess had supposedly used to rescue her son Horus from being burned: ‘There is water in my mouth and a Nile between my legs; I come to quench the fire.’

      Surgery was limited to repairing injuries and bone fractures; sutures and cautery were used, and wound dressings to promote healing, which combined honey with grease or resin; but no surgical instruments survive. Anatomical knowledge remained limited to bones and major organs. As mummification suggests, the Egyptians did not share the taboos that have so widely forbidden tampering with corpses, but embalmers formed a separate guild and were of low caste; moreover, since mummification aimed to preserve the body intact, embalmers did not open cadavers up; they eviscerated and extracted the organs through small incisions. The brain was removed through the nose by hooks, though the heart was left in place, being the seat of the soul.

      According to Egyptian medical theory, humans were born healthy, but were susceptible to disorders caused not only by demons but by intestinal putrefaction. Life lay in breath, and a speculative heart-centred physiology pictured a mesh of vessels carrying blood, urine, air, semen, tears and solid wastes to all bodily parts. This vascular network was likened to the Nile and its canals and, as with that water-system, the point was to keep it free of obstruction. Rotting food and faeces clogging the system were considered perilous, hence the need to prevent pus formation and to cleanse the innards with laxatives. Herodotus noted that three days each month were set aside for evacuating the body with emetics and enemas.

      As with Mesopotamia, Egypt’s imposing political regime made for an organized medical practice. It is, however, with Greek civilization that evidence of recognizable medical discourse first appears.

      GREECE

      By 1000 BC the communities later collectively known as the Greeks were emerging around the Aegean sea, in Ionia (the western seaboard of Asia Minor or Turkey), the Greek mainland (the Peloponnese), and the intervening islands. How much medical knowledge they took from Egypt remains controversial. On Crete, midway between Africa and the Greek mainland, the remarkable Minoan civilization had developed after 2000 BC, with its dazzling pottery and frescos found at Knossos and other palaces; and the Greeks of the Mycenean period (c. 1200 BC) were in close touch with Egypt, certainly getting drugs from there. But the contrasts between old Egyptian and new Greek medicine are striking.

      Little is known of Greek medicine before the appearance of written texts in the fifth century BC Archaic Greece undeniably possessed folk healers, including priest healers employing divination and drugs. From early times (Olympic games are recorded from as early as 776 BC), the love of athletics gave rise to instructors in exercise, bathing, massage, gymnastics and diet. Throughout Greek civilization, as with the Roman later, ideals of manliness required keeping one’s physique in peak condition; admiration for the lithe, fit, attractive warrior shines through classical art and myths. Dancing, martial arts and working out in the gymnasium with the help of trainers – men-only practices, women being excluded from public life – were regarded as essential for the well-being of the body. The archaic warrior developed into the beauty-loving citizen of the polis (city state), with his ideal of a cultivated mind in a disciplined body. Athenian sculpture and painting revered the human form, proudly displaying its naked magnificence and finding in its geometrical forms echoes of the fundamental harmonies of nature. A tradition was thus begun that would climax in the Renaissance image of ‘Vitruvian Man’, the representation of the naked male figure inscribed at the centre of the cosmos.

      Glimpses of early Greek medicine are offered by the Homeric epics, dating from before 600 BC but incorporating older narratives. Painstaking scholars have counted some 147 cases of battle wounds in the Iliad (that is, 106 spear thrusts, 17 sword slashes, 12 arrow shots and 12 sling shots). Among survivors of arrow wounds was King Menelaus of Sparta, whose physician extracted the arrow, sucked out the blood and applied a salve. As with other medical interventions in Homer, this shows no Egyptian influence, supporting the idea that, even if Greek practice owed much to Egypt, it rapidly went its own way. Certainly Greek medicine as known from written sources is highly distinctive, for from the beginning Greek medical texts were essentially secular.

      Admittedly, Greek society at large drew heavily upon sacred healing. In Homer, Apollo appears as the ‘god of healing’ – now the spreader of plague, now the avenger. In the Iliad deities visited plagues upon humans, and Greek myths abound in injuries inflicted by the gods, for instance Prometheus having his liver torn out by an eagle. Various gods and heroes were identified with health and disease, the chief being Asclepius, who even had the power to raise the dead. A heroic warrior and blameless physician, Asclepius was the son of Apollo, sired upon a mortal mother. Taught herbal remedies by Chiron the centaur, he generously used them to heal humans. Incensed at being cheated of death, Hades (Roman: Pluto), the ruler of the underworld, appealed to the supreme god, Zeus, who obligingly dispatched Asclepius with a thunderbolt (though he was later elevated to the ranks of the gods).

      A different version appears in Homer, who portrayed Asclepius as a tribal chief and a skilled wound healer, whose sons became physicians and were called Asclepiads, from whom all Asclepian practitioners descended. As the tutelary god of medicine, Asclepius is usually portrayed with a beard, staff and snake (the origin of the caduceus sign of the modern physician, with its two snakes intertwined, double-helix like, on a winged staff; the shedding of the snakes’ skin symbolized the renewal of life). The god was often shown accompanied by his daughters, Hygeia (health or hygiene) and Panacea (cure-all).

      Asclepius eventually became a cult figure and the physicians’ patron. Pindar wrote:

      They came to him with ulcers the flesh had grown, or their

      Limbs mangled with the grey bronze, or bruised With the stone flung from afar, Or the body stormed with summer fever, or chill, and he Released each man and led him From his individual grief.

      During the third century the cult of Asclepius spread, and by 200 BC every large town in Greece had a temple to the god. The best known of these Asclepieions were on the island of Cos, Hippocrates’ birthplace, and at Epidaurus, thirty miles from Athens, but at least 200 other sites have been uncovered; they played a role similar to medieval healing shrines or to Lourdes today. The major shrines sported splendid temples and their cures were celebrated in memorial inscriptions. Pilgrims stayed the night in special incubation chambers where, before an image of Asclepius, they hoped through ‘temple sleep’ to receive a vision in СКАЧАТЬ