Here in the United States, medicine is omnipresent. Each day, thousands of Americans take prescription drugs, visit the hospital, and undergo surgery. In 2015, there were 136.9 million emergency room visits. In 2016, 3.7 billion drugs were ordered or provided to patients and 76.2% of physician office visits involved drug therapy. The healthcare industry is massive and still growing with new innovations and technologies being developed all the time. In fact, much of the medical technology and innovations we take for granted were created within the last hundred years. Despite this, the medical arts have been around since the first ancient humans attempted to cure their illnesses by doing something other than just lying down and accepting their deaths.
Prehistoric medicine was a far cry from what would follow but was the foundation for the more advanced practices of early civilizations. The earliest medicine was largely indistinguishable from religion or mysticism, as our ancestors generally believed sicknesses to be the work of the divine. For this reason, most ancient medicine was largely ritualistic in nature. Many of these rituals involved incantations and mixtures administered by medicine men or witch doctors. However, along with these rituals, medicinal herbs and clays were used as well. Clays were used in casts to stabilize broken bones and crude surgery was also practiced. Trepanning, or the drilling of a hole in the skull, was used to cure epilepsy, headaches, and mental illnesses. Based on cave paintings, it is believed the ancients thought that trepanning would release evil spirits that were causing issues. It is also believed that it was used to treat head injuries as a means of cleaning out broken bone pieces and to prevent blood pooling. Despite the barbaric nature of early medicine, they formed the basis for later medical advancements in the civilizations that would follow.
One of the oldest among these ancient civilizations was Mesopotamia, a region that now makes up parts of modern day Iraq, Kuwait, Saudi Arabia, Syria, Turkey and Iran. In addition to their noteworthy accomplishments in developing a writing system and agriculture, the Mesopotamians also had a robust knowledge of medicine. Like the preceding hunter-gatherers, many of their doctors were witch doctors called “ašipu” as well as practitioners called “asu” who were more in line with modern physicians. They used folk remedies to resolve issues, as well as simple surgeries. However, the greatest claim to fame for the Mesopotamians in terms of medicine is the Diagnostic Handbook, “Sakikkŭ” written by Esagil-kin-apli, the chief scholar of the Babylonian king Adad-apla-iddina. Written near the end of the second millennium BC, the Diagnostic Handbook depended on logical assumptions and rational observation as opposed to the mysticism that plagued medicine at the time. It introduced the concepts of diagnosis and prognosis, as well as examination and recording of symptoms. It also included a list of symptoms and observations associated with various maladies and possible therapies for them. These therapies included bandages, herbs, and creams. Unfortunately, the Mesopotamians were not as skilled at treating mental illness. They believed that mental illnesses were caused by specific deities and failed to sufficiently treat them.
Similarly, the Egyptians attributed many afflictions to the wrath of the gods and healers and priests were often indistinguishable. Like the Mesopotamians though, the Egyptians also had a medical manuscript that focused on actual medicine, called the Edwin-Smith Papyrus. Written circa 1600 BC but likely a copy of works that may date to 3000 BC, the Edwin-Smith Papyrus was largely devoid of magic or supernatural leanings, detailing a wealth of medical knowledge including cures, ailments, surgeries, and anatomical observations. Egyptians possessed a decent knowledge of human anatomy, no doubt thanks to their practice of mummification. In addition to the general knowledge contained within the manuscript, specialized texts were written as well; one of the oldest surviving medical texts is the Kahun gynecological papyrus. The text dealt with female health issues including problems with conception.
Specialization was a key feature of the Egyptian medicine, and where Egyptian medicine differed from the Mesopotamian variety; gastroenterology, ophthalmology, and dentistry are some of the known specialties. In fact, the earliest known physician was Egyptian, a man named Hesy-Ra, who held the title “Chief of Dentists and Physicians” during the Third Dynasty around 2600 BC. Another key difference is the presence of a public health system in Egypt. Medical institutions known as houses of healing were established as early as 2200 BC and Egyptian physicians practiced general prophylaxis by advising patients to eat a balanced diet and practice hygiene. However, like the Mesopotamians, Egyptians were still prone to using magic and incantations, as well as prescribing useless or harmful therapies.
This trend of mysticism and ineffectual therapies continued for some time in Western medicine and was not largely erased until the time of the Greeks and Romans. Initially, the Greeks practiced a fusion of religion and medicine, like many other cultures. Asclepieia, temples dedicated to the healing god Asclepius, provided places for Greek physicians to practice their craft. Patients would sleep in the temple and receive guidance from the gods in their dreams. According to marble boards dated to 350 BC found in the asclepieionin Epidaurus, treatments included surgeries, sacrifices to gods, and herbal remedies. It was not until the time of Hippocrates and his school in Kos that medicine started to become something similar to what we would recognize today. Credited as the father of Western medicine, Hippocrates and his students revolutionized the field. Rather than relying on guidance from the gods, the Hippocratic school focused on biological causes for diseases and their biological cures. With this focus in mind, the Hippocratic school made innumerable contributions to medicine, including the documentation of many diseases along with potent cures and therapies. Eventually this also lead to the development of the humoral theory, that illness was caused by an imbalance between blood, yellow and black bile, and phlegm. This theory would dominate Western medicine well into the Renaissance. Hippocrates placed strong emphasis on professionalism and patient care as well as recording data for future use. Indeed, this emphasis is still relevant today, as doctors swear by the Hippocratic Oath when they assume the mantle of physician. However, it was not only Hippocrates who contributed to medicine. During the time of the Ptolemies in Alexandria, two Greek physicians named Herophilus and Erasistratus conducted research into human anatomy, further advancing medicine with more accurate knowledge of the human body.
Much of this anatomical knowledge, as well as other medical texts such as the Hippocratic Corpus, were stored in the famed Library of Alexandria. When the Romans captured it in the first century BC, they also captured a wealth of medical information that would greatly enhance their already extensive medical knowledge. As in many other respects, the Romans were strongly influenced in medicine by the Greeks, so much so that having a Greek physician was common.
Prior to Greek influence, medicine was traditionally handled by the male heads of the household who relied on traditional remedies passed down orally. This changed primarily for two reasons: the introduction of Greek physicians and the establishment of hospitals. Greek physicians traveled to Rome to practice their arts and brought with them the Greek style of healing. Perhaps the most prolific of these Greek physicians was Galen of Pergamon, whose theories dominated Western medicine for over a millennium. Galen moved to Rome in 162 AD, where he quickly gained renown as a physician. He is credited with the continuation of Hippocratic ideals and theories, such as the four humors. In addition, he advanced medicine greatly though his advancements in anatomical understanding. The dissections he performed on pigs and apes gave him greater insight into human anatomy, allowing him to perform advanced surgeries on patients such as cataract removal. During the era of the Roman Empire, these surgical techniques appear to have been widespread due the large amount of various surgical instruments that have been unearthed. It is likely these techniques were practiced in the valetudinaria, or military hospitals. These hospitals were not open to the public, but instead reserved for soldiers, slaves and gladiators. They were commonly found in military forts. Only later, after the acceptance of Christianity, did public hospitals become commonplace, established by Christians seeking to aid the afflicted.
Unfortunately, these hospitals, along with much of the medical knowledge of the time, were lost with the fall of Rome in the West. The subsequent Dark Ages would see a sharp decline in the quality of medical treatment, a consequence of the sacking, looting, and raiding perpetrated by the Germanic tribes. The fall of Rome marks the end of ancient history in the West, and with it the end of ancient medicine. Luckily, this medical knowledge was preserved by the Byzantines, who built upon the knowledge of their western countrymen. This knowledge would later become instrumental in the Renaissance, paving the way for medicine as we know it today.