A history of medicine
Author : Lois N Magner, Oliver J. Kim
Publishers : London: CRC Press (Taylor and Francis Group); 2018
Edition : 3rd
There are numerous books introducing the history of medicine to young readers and scholars. Dr. Douglas Guthrie's A History of Medicine was published in 1945. Mr. George Bernard Shaw's favorable review made it a must-read volume on both sides of the “pond” (as some facetiously term the Atlantic Ocean) in a short space of time. Dr. Guthrie packed much information in 400 pages.
In sharp contrast was the earlier book by Lt. Col. Dr. Fielding H. Garrison, Surgeon-General to the U.S. Army. Modestly titled An Introduction to the History of Medicine, it was spread over 942 pages!
These are two path-breaking books in the English language; and, many others notwithstanding, there is cause for rejoicing at the publication of the third edition of the book by Drs. Lois Magner and Oliver Kim. Dr. Magner is Professor Emerita at Purdue University. (I balked at the term “Emerita” but was happy to add it to my modest stock of knowledge when the dictionary pointed out that while a mere male is honored by being appointed Professor Emeritus, a lady is titled Professor Emerita.) Page xiii provides brief biographical notes on both authors and deserves study.
I must confess that I have not seen either of the earlier editions of this book.
We learn that the book had its beginnings as a “teaching assistant” during Dr. Magner's courses on the history of medicine and is, indeed, predominantly the product of her labors. Dr. Kim's expertise appears to be in the fields of health care policy and in 21st-century medicine.
Dr. Magner refers to the call for a new direction in the study and teaching of history of medicine by the Swiss historian Dr. Henry E. Sigerist, who later served as the director of the Institute of History of Medicine at Johns Hopkins University. He advocated replacement of the earlier concentration on the study of great physicians and their works with emphasis on individuals by analytical, social, and cultural history. As time progressed, Dr. Sigerist was criticized for going overboard on this theme and espousing the social systems followed in the Soviet Union.
As is evident in the works by Sigerist and, indeed, in this volume as well, while the analytical narrative provides much food for thought, it deprives the reader of learning of the human aspects of those who contributed to our science. We learn little of their feelings—exasperations when encountering opposition and failure and jubilation when they struck scientific gold.
Dr. Magner has “selected particular examples of theories, diseases, orthodox and alternative healers, training and education, diagnostics and therapeutics and attempted to allow them to illuminate themes that raise fundamental questions about health, disease and history.” As we shall see, the book is far from dreary and sustains the interest of the average reader even as it provides considerable mental nourishment to the professional historian. Witty statements are often encountered.
I was especially struck by Dr. Magner's excellent summation of the reasons why all of us in the field of medicine must study our antecedents: “Immersion in the history of medicine can provide a feeling of kinship with patients and practitioners, past and present, a sense of humility with respect to disease and nature and a critical approach to our present medical problems.” Humbly, I add that such study also provides inspiration as we study the lives and works of those who, over the ages, have been our role models.
I also warmed to her criticism of the fact that “public debates about medicine today rarely seem to address fundamental issues of the art and science of medicine.” She has ensured that this volume does not err in this respect.
The book consists of 14 chapters ranging from paleopathology and medicine in prehistoric times to traditions in ancient cultures (Mesopotamia, Egypt, India, China, Greece, Rome, etc.); descriptions of the upheavals in the Middle Ages and during the Renaissance; medicine in ancient and modern America; the development of what we term alternative health care systems; and the evolution of diagnostics, therapeutics, modern medicine, and surgery. The epilogue looks into the future and ponders the dominance of technology and concerns on the increasing numbers of the aged in the world's population. Each chapter has a brief list of “suggested readings” where the emphasis is on recent books that are readily available.
It is impossible to deal comprehensively in this review with the vast spread of information and thought spread over 415 pages. I shall focus on some segments so as to give you a glimpse of what is in store when you actually study the entire text.
“Until very recent times, the only analytic laboratory available to the physician was made up of the five senses.” This is illustrated again and again in descriptions of practices in different parts of the ancient world.
The section on medicine in India is to be found between pages 37 and 46, though details are scattered throughout the rest of the book as well. In addition to comprehensive descriptions of the “Triad of Ancients”—Caraka, Susruta, and Vagbhata, the evolution of Ayurveda, dissection as described by Susruta and the development of surgery—the reader is provided interesting insights.
The myth of the restoration of failing powers in the God, Indra, by transplantation of the testes of a ram, is referred to. The legends of visha kanyas (dating as long ago as 340-293 B.C.E.) are recounted as is the antidote—feeding the king small doses of poison so as to render him immune to the toxins from their bodily fluids.
From the hymn in the Rigveda labeled the Purusha Sukta, the authors provide a summary of the origins of the caste system in India whereby from the sacrifice of the cosmic body, the brahmans arose from the head, the kshatriyas from the arms, the vaishyas from the thighs, and the sudras from the feet.
The modern prohibition against killing the cow is traced to the evolution of Hindu, Buddhist, and Jain doctrines on nonviolence.
In addition to taking a detailed history and conducting a thorough physical examination, the ancient Indian physicians assessed the odors and tastes of secretions and discharges. Urine, in particular, was fed to ants and other insects and their reactions were noted. They were aware of the honey urine disease, known to us as diabetes mellitus. Yoga is also discussed in some detail in this section.
The section on medicine in China (pages 47-60) is of similar interest: the section on Fu Hsi (2000 B.C.E.), author of the I Ching and the person who conceived the yin-yang opposites being quite descriptive. It is of interest that physiology and not anatomy formed the basis of classical Chinese medicine. It is small wonder that surgery remained rudimentary as the elite physicians in China stayed away from it.
We learn that Chinese scholars knew of the relationship between the heart and the circulation of blood much before William Harvey announced it in the West. As blood was a vital bodily fluid, the Chinese rejected the practice of bloodletting.
The great importance paid to preventive medicine is evident from the fact that superior physicians guided the healthy person while inferior physicians treated the sick. An entire section deals with the origins of acupuncture and moxibustion and another on drug lore and dietetics.
Islamic medicine is discussed in a separate section on pages 109 to 118. I was unaware that “in a literal sense, the Koran could actually be taken as medicine by writing a passage from the sacred book on a cloth, washing out the ink and drinking the wash water.” Healers were enjoined to confess that all remedies worked only by God's will. The centers of Islamic medicine—Jundishapur in Persia, Baghdad, and Cairo—are described briefly. “In 1258, the Mongols conquered Baghdad and its great libraries were destroyed. Chroniclers said that the Tigris ran black, green and red with ink because so many manuscripts were thrown into the river.” The work of Rhazes, Avicenna, Albucasis, and Al-Kindi is highlighted. Ibn an-Nafis's pioneering description of the pulmonary circulation is referred to in some detail. When al-Nafis was very ill, his colleagues advised him to take wine as a medicine. He refused because he did not wish to meet his Creator with alcohol in his blood.
The section on Greco-Roman medicine is longer than that on medicine in the Orient. The authors state, “Where Greek medicine appears to be unique is the development of a body of medical theory associated with natural philosophy.” And yet, a study of the Caraka and Susruta Samhitas shows a similar association.
You may be forgiven for being startled when you read, “... there is little evidence to prove that.... Hippocrates.... was a real person.” Truly, we have no historical proof of the existence of Hippocrates or, for that matter, Aesculapius, Caraka, and Susruta. Certainly, we have no surviving engravings on rocks, manuscripts (on palm leaves or any other medium), or authentic likenesses of these individuals. The authors compromise with tradition by accepting Hippocrates as the author of the corpus of works named after him. Given these observations, we are surprised when we read that Hippocrates was accused of plagiarizing the prescriptions of Aesculapius before destroying this god's temple. Details on the collection of essays and texts attributed to Hippocrates follow. It is impossible to disagree with the Hippocratic maxim, “Prayer, indeed, is good but while calling on the Gods, one must oneself lend a hand.”
It is of interest that the most vivid portrait of the plague that struck Athens in 430 B.C. was provided not by a physician but by the Greek historian, Thucydides (c. 460-400 B.C.). You will recall Thucydides's History of the Peloponnesian War, admired and studied by General George Patton with profit during World War 2. Thucydides has been acclaimed for his “scientific history and political realism.” He also provided us this gem from Pericles's funeral oration: “The whole earth is the sepulchre of famous men; they are honoured not only by columns and inscriptions in their own land, but in foreign nations on memorials graven not on stone but in the hearts and minds of men.”
The section on Alexandrian medicine contains the woeful statement attributed to Alexander, the Great, as he lay dying at the age of 33 years: “I am dying with the help of too many physicians.” This bewildered observation while dying has been made by many other eminent personalities over the centuries.
Most historical accounts describe anatomical studies on live convicts by Herophilus (335-280 B.C.) and Erasistratus (304-250 B.C.) making shivers run up and down our spines. Magner and Kim provide a cautionary note. Celsus and others who accused them of such vivisection of humans were not eyewitnesses, and the truth of their allegations is uncertain. The writings by Herophilus and Erasistratus were destroyed when the library of Alexandria was sacked along with other “pagan institutions” by Julius Caesar and his later Christian leaders. (See pages 74-76 for details on these two anatomists).
The section “On Galen and Galenism” (pages 80-86) deserves careful study as it discusses the life and work of the man whose works were to dominate Western medicine for 1300 years. Here, I reproduce just one of his principles. “Galen taught that the best physician was also a philosopher. Therefore, the true physician must master the three branches of philosophy: logic, the science of how to think; physics, the science of nature and ethics, the science of what to do... Ideally, the physician would practice medicine for the love of mankind, not for profit, because the pursuit of science and money were mutually exclusive” (page 81). Such was Galen's hold on the medical world that in the 1530s, Andreas Vesalius's teacher, Jacobus Sylvius (whose name we invoke whenever we describe the fissure containing the middle cerebral blood vessels), denounced his former pupil as Vesanus (madman), purveyor of filth and sewage, pimp, liar, and so on for daring to challenge the statements of Galen. (See below for more on Vesalius).
The period 500-1500 A.D. is labeled as the Dark Ages in the West as progress in science almost came to a standstill, religion dominated in all spheres of life, and the patient's spiritual welfare took precedence over his physical well-being.
The section on bubonic plague—termed the Black Death—provides interesting details and almost brings us up to date on this disease. There is, however, no mention of Paul-Louis Simond, who, for the first time, described, in 1898, the role of fleas in transmitting the plague bacillus to man, or of Waldemar Haffkine and his pioneering work on the plague vaccine in India between 1893 and 1896. There is a reference, however, to how Pope Clement VI granted absolution to all plague victims who left their worldly goods to the Church! While physicians did advocate a direct attack on the plague bubo, awareness of the likely consequences of such intervention prompted them to send a surgeon for the purpose.
The section on leprosy follows that on plague. You will find the paragraphs on suggested cures (page 108) of special interest as they included flesh of a black snake, half a bushel of toads, eating human gall bladders, and bathing in blood.
The beginnings of modern medicine date to the Renaissance (1300-1650) when printing, gunpowder, and the compass came into use; Thomas Linacre and John Caius injected humanism into medical practice, and artists such as Leonardo da Vinci and Michelangelo deemed dissection of the human body vital to art. Leonardo is reputed to have dissected 30 bodies and has left behind an unfinished book with text illustrated by his magnificent drawings on the wonderful structure of man. Anatomy was never the same after Andreas Vesalius (1514-1564) published his classic book on the fabric of the human body, overturning earlier misconceptions and many of the statements of Claudius Galen. Of special interest to us are the experiments described on page 124 of this book. When King Henry II of France was injured while jousting, Vesalius and, the great French surgeon, Ambroise Paré were consulted. They used the heads of four recently decapitated criminals and created the injuries sustained by the king in them. On the basis of their findings, they correctly predicted a fatal outcome.
Vesalius lay the foundations of modern anatomy. In doing so, he also provided the impetus for the development of surgery.
The section on Vesalius is followed by that describing the work of Ambroise Paré. It was he who stopped the dreadful practice of pouring boiling oil to stop bleeding into wounds sustained at battle. Instead, he used a dressing made up of eggs, oil of roses, and turpentine. To the surprise of all other medical attendants on the battle field, the wounds of patients treated thus healed much better. Taking away some of Paré's sheen is the account of the manner in which he prepared puppy oil. (Cautionary note: all those devoted to canines would do well to stay away from this description on page 127).
The section on syphilis occupies pages 130 to 140 and is followed by that on the discoveries on the circulation of blood. Here, we encounter one of the martyrs in medicine—Michael Servetus—who, by his description of the pulmonary circulation in 1531, so upset Calvin that he moved the inquisitor-general of Lyon (France) to punish Servetus. Servetus fled to Geneva where he was burnt alive “without mercy” in 1553. (If mercy had been shown to him, he would have been strangulated before being burnt.) The details on Servetus deserve study.
Descriptions of the work on the circulation of the blood by Fabricius and his student William Harvey follow. The authors point to the one failing in the work of Harvey: his inability to deduce the presence of a capillary network. Instead, he suggested the presence of hypothetical anastomoses or pores in the flesh.
Mention is made of the uses of Hirudo medicinalis—the leech—in medicine.
Bloodletting (along with the use of enemas, blisters, and emetics) continued as an important form of therapy up to the end of the 19th century especially for cerebral apoplexy. It is salutary to learn that Sir Robert Grant, Governor of Bombay and founder of the medical college named after him, was unsuccessfully treated thus in the hope of arresting the bleeding in his brain.
Thomas Sydenham (the English Hippocrates) and Herman Boerhaave of the Netherlands are rightly acclaimed for their emphasis on the care of the patient at the bedside, detailed observation on the natural history of disease, and using the most humane forms of treatment. It is ironic that Sydenham suffered greatly from the gout but failed to appreciate the value of the crude extract of the autumn crocus that yields colchicum. (Colchicine was isolated 200 years later by the two Josephs—Pelletier and Bienaimé).
Chapter 7, describing medicine in the New World—the Americas—is followed by “the Americanisation of Old World Medicine” (Chapter 8) as American influence spread throughout the West.
The chapter titled “The Medical Counterculture” discusses alternative medicine, Christian Science, faith healing, osteopathy, naturopathy, and other debatable forms of therapy (pages 203-230).
Surgery, anesthesia, asepsis, and antisepsis are dealt with in Chapter 11. Oliver Wendell Holmes Sr. had reflected the knowledge of his time when he said that nature offered only three anesthetics: sleep, fainting, and death! Of course, opium, magic mushrooms, fermented drinks, and other psychoactive substances have been used from time immemorial to relieve pain and alter consciousness. Later, hypnotism and Mesmerism More Details came into vogue. Laughing gas, ether, and chloroform followed, leading to the development of modern anesthesia. The ferocity of attacks against the use of anesthetic drugs is well described. “Did the Bible not say that Eve was condemned to bring forth children in sorrow?” How, then, could anesthesia be used to render child birth painless? It was only after Queen Victoria sanctioned the use of chloroform by Dr. John Snow to ease the delivery of her eighth child that anesthesia became generally acceptable.
The development of our knowledge of the world of microbes, the contributions by Louis Pasteur and Robert Koch, and our knowledge of the causes and treatment of such diseases as typhoid and cholera are outlined in Chapter 12 (pages 305-342). The final chapters deal with the emergence of newer techniques for diagnoses and therapy, immunology, antibiotics, genetics, and measures to improve public health.
A cautionary note regarding the index: merely going by the entries in it will deprive you of many other references to the subject you wish to study. Here is one example. “Women physicians” have just one entry—page 191. In fact, there are interesting details to be found on pages 75, 95-97, 188-190, 192-197, 221, 222, 224, and so on.
Should you read this book?
Let me ask you some questions:
Who was the person who died 5300 years ago, whose stomach lining provided the oldest complete genetic sequence of Helicobacter pylori? (P. 11).
Was there any scientific rationale behind the insertion of the eggs of certain ants into wounds by primitive physicians and the use of decapitated heads of a species of ants to hold together the edges of wounds? (P. 16).
In which country were physicians honored as specialist “Shepherds of the Anus” and “Keeper of the Royal Rectum”? (P. 30).
When were bedbugs used as ingredients of medical remedies? (P. 79). and burnt frog in oil? (P. 33).. and crocodile or elephant dung as a vaginal suppository for contraception? (P. 34).
Who used “oracle bones” and how did they function? (P. 47-48).
What is the modern term for “heavenly blossom disease”? (P. 57).
Who was known as the Medical Pope of the Middle Ages by some and as a mulehead by others? (P. 80).
Who is reputed to have carried a child in her womb for three years because of a faulty prayer to the Gods? (P. 73).
What were leechbooks? (P. 93).
What was the substance isolated by Dr. Albert Szent-Gyorgi that was initially termed by him ignose (I don't know) and later “godnose” (as he was uncertain of its chemical structure)? (Pp. 246-247).
In 1913, U.S. Surgeon-General Joseph Goldberger organized filth parties in which food to be consumed was mixed with nasal mucous, scales from the skin, and excrements. Why was this done and what was the disease being studied? (P. 247).
What ailment was treated with powdered beetles, rattlesnake venom in vinegar, kissing a donkey, biting off the head of a mouse, application of powdered crow dung, and inserting a live louse into the diseased area? (P. 274).
If you had difficulties answering these, you need to study this book. (Answers to the above questions are provided on the pages in brackets).