This article deals with medicine as practiced by trained professionals from ancient times to the present. The ancient Egyptians had a system of medicine that was very advanced for its time and influenced later medical traditions. The Egyptians and Babylonians both introduced the concepts of diagnosis, prognosis, and medical examination. The Greeks went even further, and advanced as well medical ethics. The Hippocratic Oath, still taken by doctors up to today, was written in Greece in the 5th century BCE. In the medieval era, surgical practices inherited from the ancient masters were improved and then systematized in Rogerius's The Practice of Surgery. Universities began systematic training of physicians around the years 1220 in Italy. During the Renaissance, understanding of anatomy improved, and the microscope was invented. The germ theory of disease in the 19th century led to cures for many infectious diseases. Military doctors advanced the methods of trauma treatment and surgery. Public health measures were developed especially in the 19th century as the rapid growth of cities required systematic sanitary measures. Advanced research centers opened in the early 20th century, often connected with major hospitals. The mid-20th century was characterized by new biological treatments, such as antibiotics. These advancements, along with developments in chemistry, genetics, and lab technology (such as the x-ray) led to modern medicine. Medicine was heavily professionalized in the 20th century, and new careers opened to women as nurses (from the 1870s) and as physicians (especially after 1970). The 21st century is characterized by very advanced research involving numerous fields of science.
All human societies have medical beliefs that provide explanations for birth, death, and disease. Throughout history, illness has been attributed to witchcraft, demons, adverse astral influence, or the will of the gods. These ideas still retain some power, with faith healing and shrines still used in some places, although the rise of scientific medicine over the past millennium has altered or replaced many of the old beliefs.
Although there is no record to establish when plants were first used for medicinal purposes (herbalism), the use of plants as healing agents is a long-standing practice. Over time through emulation of the behavior of fauna a medicinal knowledge base developed and was passed between generations. As tribal culture specialized specific castes, Shamans and apothecaries performed the 'niche occupation' of healing.
The Edwin Smith Surgical Papyrus, written in the 17th century BC, contains the earliest recorded reference to the brain.
Ancient Egypt developed a large, varied and fruitful medical tradition. Herodotus described the Egyptians as "the healthiest of all men, next to the Libyans", due to the dry climate and the notable public health system that they possessed. According to him, the practice of medicine is so specialized among them that each physician is a healer of one disease and no more." Although Egyptian medicine, to a good extent, dealt with the supernatural, it eventually developed a practical use in the fields of anatomy, public health, and clinical diagnostics.
Medical information in the Edwin Smith Papyrus may date to a time as early as 3000 BC. The earliest known surgery was performed around 2750 BC. Imhotep in the 3rd dynasty is sometimes credited with being the founder of ancient Egyptian medicine and with being the original author of the Edwin Smith Papyrus, detailing cures, ailments and anatomical observations. The Edwin Smith Papyrus is regarded as a copy of several earlier works and was written c. 1600 BC. It is an ancient textbook on surgery almost completely devoid of magical thinking and describes in exquisite detail the examination, diagnosis, treatment, and prognosis of numerous ailments.
The KahunGynaecological Papyrus5 treats women's complaints, including problems with conception. Thirty four cases detailing diagnosis and treatment survive, some of them fragmentarily. Dating to 1800 BCE, it is the oldest surviving medical text of any kind.
Medical institutions, referred to as Houses of Life are known to have been established in ancient Egypt as early as the 1st Dynasty.citation needed
The earliest known physician is also credited to ancient Egypt: Hesy-Ra, "Chief of Dentists and Physicians" for King Djoser in the 27th century BCE. Also, the earliest known woman physician, Peseshet, practiced in Ancient Egypt at the time of the 4th dynasty. Her title was "Lady Overseer of the Lady Physicians." In addition to her supervisory role, Peseshet trained midwives at an ancient Egyptian medical school in Sais.
The oldest Babylonian texts on medicine date back to the Old Babylonian period in the first half of the 2nd millennium BCE. The most extensive Babylonian medical text, however, is the Diagnostic Handbook written by the ummânū, or chief scholar, Esagil-kin-apli of Borsippa, during the reign of the Babylonian king Adad-apla-iddina (1069–1046 BCE).
Along with the Egyptians the Babylonians introduced the practice of diagnosis, prognosis, physical examination, and remedies. In addition, the Diagnostic Handbook introduced the methods of therapy and etiology. The text contains a list of medical symptoms and often detailed empirical observations along with logical rules used in combining observed symptoms on the body of a patient with its diagnosis and prognosis.
The Diagnostic Handbook was based on a logical set of axioms and assumptions, including the modern view that through the examination and inspection of the symptoms of a patient, it is possible to determine the patient's disease, its aetiology and future development, and the chances of the patient's recovery. The symptoms and diseases of a patient were treated through therapeutic means such as bandages, herbs and creams.
There was little development after the medieval era. Major European treatises on medicine took 200 years to reach the Middle East, where local rulers might consult Western doctors to get the latest treatments. Medical works in Arabic, Turkish, and Persian as late as 1800 were based on medieval Islamic medicine.
The Atharvaveda, a sacred text of Hinduism dating from the Early Iron Age, is the first Indian text dealing with medicine, like the medicine of the Ancient Near East based on concepts of the exorcism of demons and magic. The Atharvaveda also contain prescriptions of herbs for various ailments. The use of herbs to treat ailments would later form a large part of Ayurveda.
In the first millennium BCE, there emerges in post-Vedic India the traditional medicine system known as Ayurveda, meaning the "complete knowledge for long life". Its two most famous texts belong to the schools of Charaka, born c. 600 BCE, and Sushruta, born 600 BCE. While these writings display some limited continuities with the earlier medical ideas known from the Vedas, historianswho? have been able to demonstrate direct historical connections between early Ayurveda and the early literature of the Buddhists and Jains. The earliest foundations of Ayurveda were built on a synthesis of traditional herbal practices together with a massive addition of theoretical conceptualizations, new nosologies and new therapies dating from about 400 BCE onwards, and coming out of the communities of thinkers who included the Buddha and others.
According to the compendium of Charaka, the Charakasamhitā, health and disease are not predetermined and life may be prolonged by human effort. The compendium of Suśruta, the Suśrutasamhitā defines the purpose of medicine to cure the diseases of the sick, protect the healthy, and to prolong life. Both these ancient compendia include details of the examination, diagnosis, treatment, and prognosis of numerous ailments. The Suśrutasamhitā is notable for describing procedures on various forms of surgery, including rhinoplasty, the repair of torn ear lobes, perineal lithotomy, cataract surgery, and several other excisions and other surgical procedures. Most remarkable is Sushruta's penchant for scientific classification: His medical treatise consists of 184 chapters, 1,120 conditions are listed, including injuries and illnesses relating to ageing and mental illness. The SushrutaSamhitadescribe 125 surgical instrument, 300 surgical procedures and classifies human surgery in 8 categories
The Ayurvedic classics mention eight branches of medicine: kāyācikitsā (internal medicine), śalyacikitsā (surgery including anatomy), śālākyacikitsā (eye, ear, nose, and throat diseases), kaumārabhṛtya (pediatrics), bhūtavidyā (spirit medicine), and agadatantra (toxicology), rasāyana (science of rejuvenation), and vājīkaraṇa (aphrodisiacs, mainly for men). Apart from learning these, the student of Āyurveda was expected to know ten arts that were indispensable in the preparation and application of his medicines: distillation, operative skills, cooking, horticulture, metallurgy, sugar manufacture, pharmacy, analysis and separation of minerals, compounding of metals, and preparation of alkalis. The teaching of various subjects was done during the instruction of relevant clinical subjects. For example, teaching of anatomy was a part of the teaching of surgery, embryology was a part of training in pediatrics and obstetrics, and the knowledge of physiology and pathology was interwoven in the teaching of all the clinical disciplines. The normal length of the student's training appears to have been seven years. But the physician was to continue to learn.
As an alternative form of medicine in India, Unani medicine got deep roots and royal patronage during medieval times. It progressed during Indian sultanate and mughal periods. Unani medicine is very close to Ayurveda. Both are based on theory of the presence of the elements (in Unani, they are considered to be fire, water, earth and air) in the human body. According to followers of Unanimedicine, these elements are present in different fluids and their balance leads to health and their imbalance leads to illness.
By the 18th century A.D., Sanskrit medical wisdom still dominated. Muslim rulers built large hospitals in 1595 in Hyderabad, and in Delhi in 1719, and numerous commentaries on ancient texts were written. Some European plants and medicinals were gradually incorporated into the Indian pharmacopeia, but otherwise there was little intellectual exchange with the West.
China also developed a large body of traditional medicine. Much of the philosophy of traditional Chinese medicine derived from empirical observations of disease and illness by Taoist physicians and reflects the classical Chinese belief that individual human experiences express causative principles effective in the environment at all scales. These causative principles, whether material, essential, or mystical, correlate as the expression of the natural order of the universe.
The foundational text of Chinese medicine is the Huangdineijing, or Yellow Emperor's Inner Canon, written 5th century to 3rd century BCE).near the end of the 2nd century AD, during the Han dynasty, Zhang Zhongjing, wrote a Treatise on Cold Damage, which contains the earliest known reference to the NeijingSuwen. The Jin Dynasty practitioner and advocate of acupuncture and moxibustion, HuangfuMi (215-282), also quotes the Yellow Emperor in his Jiayijing, c. 265. During the Tang Dynasty, the Suwen was expanded and revised, and is now the best extant representation of the foundational roots of traditional Chinese medicine. Traditional Chinese Medicine that is based on the use of herbal medicine, acupuncture, massage and other forms of therapy has been practiced in China for thousands of years.
In the 18th century, during the Qing dynasty, there was a proliferation of popular books as well as more advanced encyclopedias on traditional medicine. Jesuit missionaries introduced Western science and medicine to the royal court, the Chinese physicians ignored them.
Finally in the 19th century, Western medicine was introduced at the local level by Christian medical missionaries from the London Missionary Society (Britain), the Methodist Church (Britain) and the Presbyterian Church (USA). Benjamin Hobson (1816–1873) in 1839, set up a highly successful Wai Ai Clinic in Guangzhou, China.20 The Hong Kong College of Medicine for Chinese was founded in 1887 by the London Missionary Society, with its first graduate (in 1892) being Sun Yat-sen, who later led the Chinese Revolution (1911). The Hong Kong College of Medicine for Chinese was the forerunner of the School of Medicine of the University of Hong Kong, which started in 1911.
Due to the social custom that men and women should not be near to one another, the women of China were reluctant to be treated by male doctors. The missionaries sent women doctors such as Dr. Mary H. Fulton (1854–1927). Supported by the Foreign Missions Board of the Presbyterian Church (USA) she in 1902 founded the first medical college for women in China, the Hackett Medical College for Women, in Guangzhou.
Greek and Roman medicine
Around 800 BCE Homer in The Iliad gives descriptions of wound treatment by "the two sons of Asklepios, the admirable physicians Podaleirius and Machaon and one acting doctor, Patroclus. Because Machaon is wounded and Podaleirius is in combat Eurypylus asks Patroclus "to cut out this arrow from my thigh, wash off the blood with warm water and spread soothing ointment on the wound." Askelpios like Imhotep becomes god of healing over time. Temples dedicated to the healer-god Asclepius, known as Asclepieia (Ancient Greek: Ἀσκληπιεῖα, sing. Ἀσκληπιεῖον, 'Asclepieion), functioned as centers of medical advice, prognosis, and healing. At these shrines, patients would enter a dream-like state of induced sleep known as enkoimesis (ἐγκοίμησις) not unlike anesthesia, in which they either received guidance from the deity in a dream or were cured by surgery. Asclepeia provided carefully controlled spaces conducive to healing and fulfilled several of the requirements of institutions created for healing. In the Asclepieion of Epidaurus, three large marble boards dated to 350 BCE preserve the names, case histories, complaints, and cures of about 70 patients who came to the temple with a problem and shed it there. Some of the surgical cures listed, such as the opening of an abdominal abscess or the removal of traumatic foreign material, are realistic enough to have taken place, but with the patient in a state of enkoimesis induced with the help of soporific substances such as opium.
The first known Greek medical school opened in Cnidus in 700 BCE. Alcmaeon, author of the first anatomical work, worked at this school, and it was here that the practice of observing patients was established. As was the case elsewhere, the ancient Greeks developed a humoral medicine system where treatment sought to restore the balance of humours within the body.
A towering figure in the history of medicine was the physician Hippocrates of Kos (c. 460 – c. 370 BCE), considered the "father of Western medicine."2425 The Hippocratic Corpus is a collection of around seventy early medical works from ancient Greece strongly associated with Hippocrates and his students. Most famously, Hippocrates invented the Hippocratic Oath for physicians, which is still relevant and in use today.
Hippocrates and his followers were first to describe many diseases and medical conditions. He is given credit for the first description of clubbing of the fingers, an important diagnostic sign in chronic suppurative lung disease, lung cancer and cyanotic heart disease. For this reason, clubbed fingers are sometimes referred to as "Hippocratic fingers".citation needed Hippocrates was also the first physician to describe Hippocratic face in Prognosis. Hippocrates began to categorize illnesses as acute, chronic, endemic and epidemic, and use terms such as, "exacerbation, relapse, resolution, crisis, paroxysm, peak, and convalescence."
Another of Hippocrates's major contributions may be found in his descriptions of the symptomatology, physical findings, surgical treatment and prognosis of thoracic empyema, i.e. suppuration of the lining of the chest cavity. His teachings remain relevant to present-day students of pulmonary medicine and surgery. Hippocrates was the first documented chest surgeon and his findings are still valid.
The PlinthiosBrokhos as described by Greek physician Heraklas, a sling for binding a fractured jaw. These writings were preserved in one of Oribasius' collections.
Celsus and Alexandria
Two great Alexandrians laid the foundations for the scientific study of anatomy and physiology, Herophilus of Chalcedon and Erasistratus of Ceos.30 Other Alexandrian surgeons gave us; ligature (hemostasis), lithotomy, hernia operations, ophthalmic surgery, plastic surgery, methods of reduction of dislocations and fractures,tracheotomy, and mandrake as anesthesia. Most of what we know of them comes from Celsus and Galen of Pergamum (Greek: Γαληνός)
Herophilus of Chalcedon, working at the medical school of Alexandria placed intelligence in the brain, and connected the nervous system to motion and sensation. Herophilus also distinguished between veins and arteries, noting that the latter pulse while the former do not. He and his contemporary, Erasistratus of Chios, researched the role of veins and nerves, mapping their courses across the body. Erasistratus connected the increased complexity of the surface of the human brain compared to other animals to its superior intelligence. He sometimes employed experiments to further his research, at one time repeatedly weighing a caged bird, and noting its weight loss between feeding times. In Erasistratus' physiology, air enters the body, is then drawn by the lungs into the heart, where it is transformed into vital spirit, and is then pumped by the arteries throughout the body. Some of this vital spirit reaches the brain, where it is transformed into animal spirit, which is then distributed by the nerves.
The Greek Galen was one of the greatest surgeons of the ancient world and performed many audacious operations—including brain and eye surgeries— that were not tried again for almost two millennia. Later, in medieval Europe, Galen's writings on anatomy became the mainstay of the medieval physician's university curriculum along; but they suffered greatly from stasis and intellectual stagnation. In the 1530s, however, Belgian anatomist and physician Andreas Vesalius took on a project to translate many of Galen's Greek texts into Latin. Vesalius's most famous work, De humanicorporisfabrica, was greatly influenced by Galenic writing and form. The works of Galen were regarded as authoritative until well into the Middle Ages.
The Romans invented numerous surgical instruments, including the first instruments unique to women, as well as the surgical uses of forceps, scalpels, cautery, cross-bladed scissors, the surgical needle, the sound, and speculas. Romans also performed cataract surgery.
Islamic Middle Ages 9th-12th
The Islamic civilization rose to primacy in medical science as its physicians contributed significantly to the field of medicine, including anatomy, ophthalmology, pharmacology, pharmacy, physiology, surgery, and the pharmaceutical sciences. The Arabs were influenced by, and further developed Greek, Roman and Byzantine medical practices. Galen & Hippocrates were pre-eminent authorities.The translation of 129 works of ancient Greek physician Galen into Arabic by the Nestorian Christian HunaynibnIshaq and his assistants, and in particular Galen's insistence on a rational systematic approach to medicine, set the template for Islamic medicine, which rapidly spread throughout the Arab Empire.
Medieval Europe 400 to 1400 AD
After 400 A.D., the study and practice of medicine in the Western Roman Empire went into deep decline. Medical services were provided, especially for the poor, in the thousands of monastic hospitals that sprang up across Europe, but the care was rudimentary and mainly palliative. Most of the writings of Galen and Hippocrates were lost to the West, with the summaries and compendia of St. Isidore of Seville being the primary channel for transmitting Greek medical ideas. The Carolingian renaissance brought increased contact with Byzantium and a greater awareness of ancient medicine, but only with the twelfth century renaissance and the new translations coming from Muslim and Jewish sources in Spain, and the fifteenth century flood of resources after the fall of Constantinople did the West fully recover its acquaintance with classical antiquity.
Wallis identifies a prestige hierarchy with university educated physicians on top, followed by learned surgeons; craft-trained surgeons; barber surgeons; itinerant specialists such as dentist and oculists; empirics; and midwives.