Учебное пособие (Методичка) по Истории Медицины. И.Ю.Худоногов

Theme 3. Healing in the countries of the Ancient East (Mesopotamia, Ancient

Egypt, Ancient India, Ancient China)

The first major centers of agriculture and the first slave states arose in areas with a hot climate, in the valleys of large rivers. The first, well-studied by archaeologists, slave states appeared 5-3 thousand years BC in the East. A relatively more progressive slave-owning mode of production has opened up great opportunities for the development of all aspects of social life, as well as medicine. The invention of writing, first pictography, and then simpler writing (cuneiform writing, hieroglyphics) was one of the outstanding achievements of the culture of that time. Thanks to this, the peoples of the Ancient East left a significant number of literary works, which together with archaeological materials give an idea of the standard of living, methods of healing the peoples of this era. The development of medicine in the countries of the Ancient World is characterized by the following general features:

1. Two types of medicine are formed folk (empirical) and temple (priestly, theurgic).

2.Medicine stands out as an independent profession.

3.Professional medicine required the appearance of the first medical schools. Medical schools were of the following types: a) family medical schools (family dynasties) in which knowledge was transferred only to members of their family. The longest such type of schools persisted in Ancient Greece; b) temple medical schools. The priests were engaged in healing, as the most educated people, and not everyone could enter such a school at the temple (for example, in Egypt); c) secular (private) medical schools in which anyone could study for a fee (such schools were in China, India, Greece and the Roman state); d) state (military) medical schools (in the Roman Empire);

4.Formed new ideas about the causes of disease. They are conditionally divided into two groups: a) related to the violation of moral, ethical, legal, religious norms, rites and traditions; b) the influence of natural factors, among which the leading

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place was occupied by food, climate, lack of personal hygiene and unhygienic

maintenance of dwellings, as well as lack or excess of physical activity;

5.Formation of the fundamentals of medical ethics and deontology;

6.New treatments related to new living conditions. In addition to common features, there were features inherent in individual countries and civilizations.

Healing in the Babylonian State and Assyria

The ancient Sumerian state existed on the territory of Mesopotamia (between the Tigris and Euphrates rivers). In the 4th millennium BC Sumerian priests invented writing - cuneiform writing. Subsequently, large slave states arose on this territory, for example, the Babylonian state (flowering – the 18th century BC) and Assyria (flowering – the 7th century BC). The main sources of information about healing in Mesopotamia include archaeological excavations, cuneiform medical texts written on clay tablets, stone, metal, the Hammurabi's code of laws, and evidence from historians of Ancient Greece and Egypt. The analysis of texts of medical content (2nd-1st millennium BC) showed that in the Old Babylonian period (17-12 centuries BC), two main areas of healing were formed:

a) the art of healers (asutu) usin empirical means of treatment;

b) the art of spellcasters (ashiputu), the basis of treatment was magic rites, rituals, etc.

There is no information about the autopsies in cuneiform texts, therefore highly likely the healers of Mesopotamia did not study the structure of the human body (anatomy), and the dissection of sacrificial animals gave only a general idea of the internal organs. Obstetrics was carried out by women only. Cesarean section was allowed after the death of the mother to save the child only. Other surgical interventions related to internal organs are not mentioned in written sources. The Hammurabi's code of laws (18th century BC) are a typical and very valuable source of medical information. The text of the laws was carved on a basalt pillar found near the city of Susa (Iran) in the early 20th century. Among almost 300 points of laws, ten regulate the legal aspects of the activity of physicians from high remuneration in case of successful treatment to severe punishment in case of an

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unfavorable outcome (up to cutting off the arm). In addition, strict hygiene requirements existed in Mesopotamia, especially for priests, the king and his entourage. These requirements included personal hygiene, wearing clean clothes, etc. Sewage systems in the cities of Mesopotamia have not been built at first. The first channels for supplying water and removing sewage in Assyria were built in the 7th century BC. The transfer of medical knowledge was carried out among a narrow circle of initiates. Cuneiform texts indicate the presence of some medical specialization. Throughout the centuries-old history, the Babylonian-Assyrian culture has had an invaluable influence on the development of knowledge, including medical knowledge, among the peoples of Western Asia and others.

Questions for self-control:

1.What causes of the origin of diseases were considered the main ones in the slave-owning states, are there any coincidences with the ideas of the healers of a classless society, and is there something new?

2.What factors occupy the greatest place among the natural causes of diseases,

3.What are the common features of the development of medicine in the countries of the ancient world, and why are there so many of them?

4.What kind of medical information does the earliest Sumerian texts and later Babylonian cuneiform texts contain?

5.What materials, technologies and skills were required for ancient healers to create written sources of information about medicine in the Babylonian state?

6.What substances were considered medicinal by the healers of Mesopotamia; list their modern names and give a brief description of the therapeutic effects?

7.How and why were healers called in the Sumerian state?

8.How and why were healers portrayed in the Sumerian state?

9.How do the laws of Hammurabi relate to medical practice?

10.How did the Laws of Hammurabi to established the legal status of physicians?

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11.How did the Laws of Hammurabi to become an instrument of social and economic stability of society and maintaining a high level of responsibility and welfare of healers?

12.What is the regulation of medical activities and sanitary supervision? Give examples of the first successful attempts to move in the indicated direction in the cities of ancient Mesopotamia.

13.Who were Divine patrons of healing in the countries of Mesopotamia?

14.What achievements (priorities) in all branches of science belong to the ancient Babylonians and Sumerians?

15.How and why mythology and healing are related in Ancient Mesopotamia; try to describe the demons of diseases and to explain why amulets for them were made?

16.What types of medical schools existed in countries of the ancient world, and what is the reason for their diversity and large number?

17.Who and why collected the Ashurbanipal Library – the oldest collection of texts, what behavioral features are observed in such library collectors?

18.How did the inhabitants healers of Ancient Mesopotamia imagine the

causes of diseases?

19.Two directions of healing in Ancient Mesopotamia: asutu (the art of empiric priests-healers) and asiputu (the art of priests-healers-spellcasters) as successive stages of professional socialization; what treatment methods were characteristic of the healers of each direction and why?

20.Why did the medical ethics of Ancient Mesopotamia appear and in what way?

Healing in Ancient Egypt

The first settlements in the Nile Valley appeared in the 6th millennium BC. e. Egypt reached its power peak in 3–1 millennium BC. e. Sources of information about healing in Egypt are:

1.Substances (materials of archaeological excavations)

2.Written texts:

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a)Images and inscriptions on the tombs associated with the funeral cult and Ancient Egyptian cult of afterlife (“texts of the pyramids”)

b)Medical papyruses (Ebers, Smith, Kahunsky, Brugsha, etc.)

c)Descriptions of historians (Herodotus, Manethon, etc.).

There was very little information about Ancient Egypt Until the 19th century. The first ideas about the once powerful civilization began to take shape only with the beginning of systematic excavations in the Nile Valley, with the decoding of ancient papyri (French scientist J. F. Champollion found the key to reading hieroglyphs).

The cult of afterlife is one of the most important features of Egypt, which was not in other countries of the Ancient world. The Egyptians believed that after the death of the physical body the immortal soul leaves him and after more or less prolonged wanderings returns. Therefore, the custom arose preserve the bodies of deceased people by embalming. Internal organs were removed through natural or small artificial holes: the brain was removed with long hooks through the nostrils; internal organs were pulled through the groin region incision. It had having made possible to obtain information about the structure of the extracted organs (anatomy) – color, size, etc. Removing the organs, the priests could also notice the results of tissue damage by the disease (elements of pathology). After organ removal, the body cavity was washed with infusions of plants, dehydrated by immersion in potassium lakes or in a solution of caustic soda of a certain concentration (based of chemistry knowledge). Priests poured aromatic resins into the skull (most often used rosin), then filled the body cavity with various medicinal plants (knowledge of pharmacy), sewn the incision into the groin (elements of surgery), and put on a face mask from a thin sheet of gold or applied makeup (knowledge of cosmetology).

The secrets of embalming are unknown. There are descriptions of this procedure made by Herodotus supplemented by studies conducted in the twentieth century only. Most diseases were considered in Egypt have to be associated with pathology of the heart and blood vessels. The heart was considered the main organ, so it was

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returned to the body during embalming. The remaining organs were stored in special vessels next to the sarcophagus or the mummy. The Egyptians had ideas about the circular movement of blood; they formed the beginnings of a humoral doctrine, which will be further developed in the writings of doctors in Ancient Greece. Currently, 12 papyruses are known, which are fully or partially devoted to healing. Ebers Papyrus (16th century BC), dedicated to therapy and pharmacy, is an encyclopedia of Egyptian medical knowledge. Ebers papyrus is the largest in terms of information; it consists of 108 sheets with a total length of 20.5 meters. The papyrus contains 900 recipes for the treatment of gastrointestinal diseases, liver, respiratory organs, eyes, ears, throat, skin, parasitic diseases, etc. Description of the preparation and use of ointments, plasters, potions, etc. are given in the text of the papyrus. Some recipes contain more than 30 ingredients. There is a section in cosmetology in the Ebers papyrus that contains recipes for removing moles, staining eyebrows, eyelashes, smoothing wrinkles, etc. The ancient Egyptians associated the causes of diseases with th natural factors (eating disorders, work and rest regime, hygiene, climate change) and the wrath of the gods for various sins. The Edwin Smith Papyrus (18th century BC) is dedicated to anatomy and surgery. Unfortunately, part of the papyrus was preserved, in which 48 cases of traumatic injuries of the bones of the skull, chest, and spine are described. E. Smith Papyrus contains the first information about the brain that has reached us, i.e. the relationship between brain damage and impaired function (paresis, paralysis) has already been noticed. Brugsch Papyrus is dedicated to maternal and child health. Kahun Papyrus describes obstetric care and gynecology. Papyri dedicate to dentistry, veterinary medicine, parasitic diseases, etc., have also exist. The division of diseases by specialty indicates a large volume and high level of medical knowledge of the ancient Egyptians. An important role in their life was given to hygiene. The rules recommended swimming four times a day, wearing clean, light-colored clothes, 3-4 times a month to artificially empty the gastrointestinal tract, etc. Scientists believe that E. Smith's papyrus is not an original script, but a copy. The original was written back in the 28th century BC by

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supreme priest, healer, architect Imhotep. Imhotep was deified, became the god of medicine in Egypt and was depicted with a symbol (hieroglyph) in his hand. This character has become one of the oldest emblems of medicine. This is a cruciform loop, Imhotep Ankh (tau cross = eternal life, or life after death). Knowledge of medicine was obtained in temples' schools. Half a century BC (during the period of the Great Greek colonization) the knowledge of the Egyptians, including medical, began to spread to other regions.

Questions for self-control:

1.What features of the ancient Egyptian culture distinguish it from other ancient civilizations, and what types of medical schools were characteristic of Ancient Egypt?

2.How and why did the “Book of the Dead” (“Chapters on Coming Out to the

afterlife?

3.How and why did the traces of mythology of Ancient Egypt penetrate into the cultural basis of subsequent civilizations?

4.Why was the technologyembalming the dead invented in Ancient Egypt, how is this related to the funeral cult?

5.What knowledge about the structure and functioning of the human body did the ancient Egyptians acquire and accumulate while embalming?

6.What information do modern scientists obtain by examining bone remains and mummies?

7.What characteristic features distinguish ancient Egyptian medicine from a number of other national medicine systems?

8.How to assess the level of professional development of ancient Egyptian medicine?

9.How did the ancient Egyptian papyri reflect internal medicine aspects?

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10.How did the ancient Egyptian papyri describe operative medicine and the means used for pain relief during operations in Egypt and neighboring countries of the Ancient East?

11.What hygienic traditions appeared in Ancient Egypt, and why?

12.What is schistosomiasis, and why was it widespread in ancient Egypt?

13.What elements of medical ethics appeared in Ancient Egypt?

14.How was training in healing organized in Ancient Egypt ("House of Life")?

15.With the help of what sources was it possible to obtain such detailed information about medicine in Ancient Egypt?

16.Which papyrus is the encyclopedia of medical knowledge of the Egyptians and why?

17.What is the name of the priest-healer, who was deified and was considered the God of medicine in Ancient Egypt, what are services to the inhabitants of

Ancient Egypt and a brief biography?

18.What symbol (hieroglyph) of healing (eternal life and health) appeared in Ancient Egypt, and what is its further fate and later application?

19.What cult existed in Egypt, which did not exist in other states of the ancient world, what is its medical human meaning, in which subsequent religions did

it find its reflection?

20.What organ and why did the Egyptians consider the main one and associated with it most diseases?

Healing in Ancient China

Chinese civilization arose in the 3-2 millennium BC. Sources of information on the development of Chinese medicine are materials of archaeological excavations and texts written on bamboo tablets, fabrics, wax tablets, then on paper (invented in the 1st century BC). The most important literary and medical monument (the ancient Chinese book) is called "Huang Ti Nei Ching Su Wen: The Yellow Emperor's Classic of Internal Medicine" (The book about the internal by Huang Ti). It was

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written in the 1st half of the III thousand BC and was edited until the 3rd century BC and consisted of 18 volumes. According to Nei Ching, the philosophical basis of Chinese medicine was the doctrine of the 5 cosmic primary elements (fire, earth, water, metal, wood) and the doctrine of 2 principles - "yang" (masculine) and "yin" (feminine). Five primary elements in the process of interaction and transformations form the material Universe (macrocosm). Human was considered part of the universe (microcosm) in China. Therefore, the human body based on the same primary elements forming tissues, but in micro quantities. Each of the primary elements has two opposite properties - stimulation and inhibition. By “yang” and “yin” in the Universe we understood the Sun and the Moon. In the body, “yin” is venous blood (slow, passive and thick). When air enriched with oxygen enters the body, the blood becomes bright, scarlet, arterial, carries the active principle of “yang”. According to the doctrine, the beginnings of “yang” and “yin” must be in equilibrium. For various reasons, a person violates this balance, and then diseases

arise. The goal of the treatment was restore the balance between “yang” and “yin”. Three therapeutic techniques have appeared in China to restore balance about the body:

1.Acupuncture (acupuncture)

2.Cauterization (moxa)

3.Massage (usually acupressure).

The principle of treatment consisted in influencing biologically active points in different ways. More often, the goal of exposure is to stimulate the passive onset of yin changing the rheological properties of blood.

Acupuncture. Ancient Chinese healers made needles first from stone, bamboo, bone, then from bronze and precious metals (gold, silver and platinum). A typical set consisted of 40 needles representing 9 varieties of length (from 1 cm to 28 cm). Highly qualified doctors knew up to 1,500 acupuncture points, novice specialists had to know 295 points. Thanks to acupuncture with hollow needles, Chinese healers were able to develop technologies for treating lung abscess, exudative pleurisy and ascites.

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Cauterization (moxa – moxibustion). Wormwood (the Chinese name for wormwood is moxa) was used for cauterization (warming). First, healers performed cauterization with bunches of smoldering herbs, then they began to make special cigarettes filled with wormwood or a mixture of medicinal herbs. Cauterization can be direct (touching the body with a smoldering cigarette for a split second) and indirect (exposure to heat from a distance). The combination of acupuncture and cauterization is called Zhen-jiu therapy. About a thousand years ago, Zhen-jiu therapy began to spread in Asian countries (Japan, Korea, Vietnam). In the 13-17 centuries. The method entered Europe, then America. Currently, many countries are conducting scientific research of this method. Since 1945, there is an International Acupuncture Association.

Massage (acupressure) – treatment and prevention of diseases through pressure

on certain points of the body. From the point view of official medicine, it is a

type of reflexotherapy.

After the introduction of Confucianism, autopsy and surgical treatment was limited due to religious prohibitions in China. Therefore, therapeutic treatment and diagnostic methods began to develop intensively. Chinese diagnostics include:

a) a general examination the patient (skin, eyes, ears, mucous membranes of

the natural openings and tongue);

b)determination of the general condition and mood;

c)listening to sounds;

d)interviewing a patient;

e)palpation (determination of pulse, feeling);

f)the study of discharge (urine by smell, color and taste, sputum, etc.).

The pinnacle of Chinese diagnosis is represented by a pulse study. Bian Que was the founder of pulse diagnostics (5-4th century BC), and Wang Shuhe wrote a 10volume treatise on the pulse. Chinese healers identified 28 characteristics of the pulse, listened to it at 9 points. The Chinese attached great importance to the prevention of disease always. The system of important therapeutic and preventive measures included massage, breathing exercises. There is information about the

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