Ancient medicine: The Middle Ages AD 400 to 1400:Europe and Islamic medicine:


Ancient medicine: medicine in medieval Islamic World

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 ancient Indian, Greek, Roman and Byzantine medical practices, and developed these further. Galen and  Hippocrates were pre-eminent authorities. The translation of 129 of Galen’s works into Arabic by the Nestorian Christian Hunayn ibn Ishaq 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.

Ancient medicine: medieval medicine of Europe

After A.D. 400, 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.

Schools

The first medical schools were opened in the 9th century, most notably the Schola  Medica at Salerno in southern Italy. The cosmopolitan influences from Greek, Latin, Arabic, and Hebrew sources gave it an international reputation as the Hippocratic City. Students from wealthy families came for three years of preliminary studies and five of medical studies. By the thirteenth century the medical school at Montpellier began to eclipse the Salernitan school. In the 12th century universities were founded in Italy, France and England which soon developed schools of medicine. The University of Montpellier in France and Italy’s University of Padua and University of Bologna were leading schools. Nearly all the learning was from lectures and readings in Hippocrates, Galen, Avicenna and Aristotle. There was little clinical work or dissection.

Humours

The underlying principle of most medieval medicine was Galen’s theory of  humours. This was derived from the ancient medical works, and dominated all western medicine until the 19th century. The theory stated that within every individual there were four humours, or principal fluids – black bile, yellow bile, phlegm, and blood, these were produced by various organs in the body, and they had to be in balance for a person to remain healthy. Too much phlegm in the body, for example, caused lung problems; and the body tried to cough up the phlegm to restore a balance. The balance of humours in humans could be achieved by diet, medicines, and by blood  letting, using leeches. The four humours were also associated with the four seasons, black bile-autumn, yellow bile-summer, phlegm-winter and blood-spring.

Healing included both physical and spiritual therapeutics, such as the right herbs, a suitable diet, clean bedding, and the sense that care was always at hand. Other procedures used to help patients included the Mass, prayers, relics of saints, and music used to calm a troubled mind or quickened pulse.

 

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Ancient Medicine: Greece and Roman Empire


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. Asklepios like Imhotep becomes god of healing over time.

Temples dedicated to the healer-god Asclepius, known as  Asclepieia, 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 .  Asclepeia provided carefully controlled spaces conducive to healing and fulfilled several of the requirements of institutions created for healing.. 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. Alcmaeon of Croton wrote on medicine between 500 and 450 BCE. He argued that channels linked the sensory organs to the brain, and it is possible that he discovered one type of channel, the optic nerves, by dissection.

Hippocrates

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.  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”. 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. Hippocrates was the first documented person to practice cardiothoracic surgery, and his findings are still valid.

Some of the techniques and theories developed by Hippocrates are now put into practice by the fields of Environmental and Integrative Medicine. These include recognizing the importance of taking a complete history which includes environmental exposures as well as foods eaten by the patient which might play a role in his or her illness.

Herophilus and Erasistratus

Two great Alexandrians laid the foundations for the scientific study of anatomy and physiology, Herophilus of Chalcedon and Erasistratus of Ceos.  Other Alexandrian surgeons gave us ligature (hemostasis), lithotomy, hernia operations, ophthalmic surgery,plastic surgery,  methods of reduction of dislocations and fractures, tracheostomy.

Herophilus of Chalcedon, working at the medical school of Alexandrians 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. 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

Galen

The Greek  Galen (129–c. 216 CE) was one of the greatest physicians of the ancient world, studying and traveling widely in ancient Rome. He dissected animals to learn about the body, and performed many audacious operations—including brain and eye surgeries— that were not tried again for almost two millennia. In Ars medica (“Arts of Medicine”), he explained mental properties in terms of specific mixtures of the bodily parts.

Galen’s medical works were regarded as authoritative until well into the Middle Ages. Galen left a physiological model of the human body that became the mainstay of the medieval physician’s university anatomy curriculum, but it suffered greatly from stasis and intellectual stagnation because some of Galen’s ideas were incorrect; he did not dissect a human body nor did the medieval lecturers.

The Renaissance rediscovered Galen. In 1523 Galen’s On the Natural Faculties was published in London. In the 1530s Belgian anatomist and physician  Andreas Vesalius  launched a project to translate many of Galen’s Greek texts into Latin. Vesalius’s most famous work,  De humani  corporis fabrica was greatly influenced by Galenic writing and form.

Ancient Roman  Medicine contributions

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, and speculas.  Romans also performed cataract surgery.

The Roman army physician Dioscorides (c. 40–90 AD), was a Greek botanist and pharmacologist. He wrote the encyclopedia  De Materia Medica  describing over 600 herbal cures, forming an influential pharmacopoeia which was used extensively for the following 1,500 years.

 

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