The Greatest Benefit to Mankind. Roy Porter

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СКАЧАТЬ waters. Popular therapeutic magic and religious healing could be interchangeable. Rejecting Catholic ‘superstition’, Protestants fought such ‘contamination’ of religion with magic; but the Reformation’s iconoclasm towards magic within the Church encouraged it to flourish in a kind of ‘black market’ outside. Modernizing forces – literacy, the availability of commercial medicines, the rise of the medical profession – gradually peripheralized such beliefs. But the finger of God might continue to be seen in visitations of illness and injury. ‘Last Wednesday night while carrying a bucket of water from the well,’ noted the Revd Francis Kilvert (1840–79) in his journal on 26 December 1874, ‘Hannah Williams slipped upon the icy path and fell heavily upon her back. We fear her spine was injured for though she suffers acute pain in her legs she cannot move them. The poor wild beautiful girl is stopped in her wildness at last, and perhaps by the finger of God.’

      What must be stressed is the ceaseless dialectic of popular and educated medicine, and everything between. Superficially at least, the distinctive medical systems seem to have nothing in common but animosity. The medical missionary and explorer, David Livingstone (1813 – 73), recorded an exchange between representatives of quite different medical systems:

       MEDICAL DOCTOR: Hail, friend! How very many medicines you have about you this morning! Why, you have every medicine in the country here.

       RAIN DOCTOR: Very true, my friend; and I ought; for the whole country needs the rain which I am making.

       M.D: So you really believe that you can command the clouds? I think that can be done by God alone.

       R.D: We both believe the very same thing. It is God that makes the rain, but I pray to him by means of these medicines, and, the rain coming, of course it is then mine.

      As the Rain Doctor recognized, they had more in common than met the eye. And the similarities yet differences between diverse medical systems and practices have always been evident to the sick themselves. In modern Taiwan, for instance, the sick use modern western doctors for certain ailments, traditional Chinese medicine for others, Japanese medicine and local herbal medicine and healers.

      This sense of difference in commonness should help focus our attention to what is special to modern western scientific medicine: it is one healing system among many, yet it has, formally at least, in large measure broken with the traditional wisdom of the body. Herein lie its strengths and weaknesses. A distinguished historian of medicine, Jean Starobinski, writes,

      The historian who hopes to make sense out of the development of medicine cannot simply list the discoveries in the field, adding them up as if one grew spontaneously out of the other. These conquests have been made possible only by a never-ending struggle against entrenched error, and by an unflagging recognition that the accepted methods and philosophical principles underlying basic research must be constantly revised.… Disease is as old as life, but the science of medicine is still young.

      Contained within those remarks are the ideology of western medicine and some genuine historical insights. The following pages explore these ambiguities.

* Smallpox, the largest of all viruses, is the product of a long evolutionary adaptation of cowpox to humans – something clearly perceived two hundred years ago by Edward Jenner. His An Inquiry into the Causes and Effects … of the Cow Pox (1798) noted that:

      The deviation of man from the state in which he was originally placed by nature seems to have proved to him a prolific source of diseases. From the love of splendour, from the indulgence of luxury, and from his fondness for amusement he has familiarized himself with a great number of animals, which may not originally have been intended for his associates.

      Jenner thus perceived the dangers animals posed to human health. Now, in the late 1990s, the transmission chain between the cattle disease, bovine spongiform encephalopathy (BSE), and the human Creutzfeldt-Jakob Disease (CJD), is a hot epidemiological and political issue in Europe.

CHAPTER III ANTIQUITY

      AT THE END OF THE LAST ICE AGE about ten thousand years ago, a revolution began which decisively changed the symbiosis of society and disease. As we saw in the previous chapter, communities learned to master animals, to herd them for food, yoke them for traction, and spur them to war. Familiarity with soils, seeds and seasons made it possible to harvest crops regularly. Settlements grew, and with them arts and crafts. Story-telling and public memory were cultivated and the gods propitiated through priestly rituals. With the Bronze Age (from about 4000 BC), metal-working was improved, the wheel exploited, the reckoning of time and space rationalized and the calendar invented. Learning was encouraged, cities administered, tributes extracted, treasure hoarded, laws promulgated, empires enlarged. All such developments – the ABC of civilization – brought new approaches to healing and, for the first time, the writing down of medical practice. Medicine entered history.

      MESOPOTAMIA

      By around 3000 BC the warm and fertile region in the Middle East watered by the Tigris and the Euphrates was cradling some of the world’s first great civilizations: Ur on the Euphrates, founded by the Sumerians, a hundred miles upriver from the Persian Gulf; Babylon, farther up the Euphrates; Assyria, centred on Assur, and later Nineveh on the Tigris, near Mosul in modern Iraq. Assyria destroyed Babylon; Nineveh reached its height under its kings Sennacherib (r. 705–681 BC) and Assurbanipal (r. 668–627 BC); its fall to the Persians in 608 BC is celebrated in the Bible.

      All these Mesopotamian (‘land between the rivers’) kingdoms have left magnificent remains, archaeological and written, which permit reconstruction of their dynasties and deities, and the agrarian and bureaucratic infrastructures that sustained them. Their healing practices remain cloudy, but among the 30,000 or so surviving clay tablets covered with cuneiform writing there are about a thousand from the library of Assurbanipal on medicine, containing diagnoses and prognostications, remedies and their ingredients. These date from the seventh century BC, though the Sumerian/Assyrian healing traditions they record go back much further.

      The chief text, called ‘The Treatise of Medical Diagnosis and Prognosis’, comprises some three thousand entries on forty tablets. It is basically a fist of ailments, and some are identifiable today: ‘the patient coughs continually. What he coughs up is thick and frequently bloody. His breathing sounds like a flute. His hand is cold, his feet are warm. He sweats easily, and his heart activity is disturbed’ – this sounds like tuberculosis. Eye disorders are prominent, and mention of ‘stinking disease’ and distended bellies suggests the vitamin-deficiency diseases symptomatic of the new grain-growing economies.

      The framework for disease interpretation was largely omen-based, using divination based on inspection of the livers of sacrificed animals (hepatoscopy), because the liver was regarded as the seat of life. Prognostication may also have involved techniques like observing a flickering flame. Medical practice mixed religious rites and empirical treatments. Mention is made of three types of healers, presumably cooperating with one another: a seer (bârû), specializing in divination; a priest (âshipu), who performed incantations and exorcisms; and a physician (âsû), who employed drugs and did bandaging and surgery. An official head physician presided, and court doctors were expected to take an oath of office and allegiance.

      The sixth king of the first dynasty of Babylon, Hammurabi (17 28–1686 BC) was a mighty ruler who made Babylon feared. Alongside the mathematical treatises, dictionaries, astrological, magical writings and other forms of learning that gave lustre to his reign, his greatest work was a legal code, whose 282 laws deal with the regulation of society, family life and occupations. The Code of Hammurabi, СКАЧАТЬ