1 “The Practice of Medicine in Ancient Civilizations” A General ViewOsama Shukir Muhammed Amin MD, FRCP(Edin), FRCP(Glasg), FRCP(Ire), FRCP(Lond), FACP, FAHA, FCCP(USA) Associate Professor of Neurology School of Medicine, International Medical University, Malaysia

2 The Vulnerable Human Beings?Diseases and Epidemics Pregnancy and Childbirth Famines Wars Natural Disasters Image Source, click.

3 Life Expectancy of Humans?33 years: years ago (Paleolithic Era). 26 years: 5000 years ago (Bronze Era). CE (AD). CE (AD).

4 What did humans think of illnesses?Mesopotamia (Iraq), Nile Valley (Egypt and Sudan), Greece and Rome (Greeks and Roman Empire), China, Indus Valley (India), and the rest of Africa: Curse by Gods/Goddesses: Human errors and sins. Religious rituals and prayers: Cure is a divine gift. Act done by evil spirits. Gods/Goddesses and certain demigods have to interfere to ward off (prevent) or cure people.

5 Where was the “clinic” then?Temples, shrines, and sanctuaries! The divine place for super-natural powers! Or at certain non-divine places. Certain Gods and Goddesses prevented and/or cured diseases! Exactly where? Altars: offerings and sacrifices. Priests: intermediary, who should be involved to ensure that the devotee does it correctly and that message will be received by the divine powers.

6 Anything else to prevent/cure illnesses?Prehistory Era (before the invention of writing): Human being started to realize that certain plants, and even mud and soil, can help him/her get through these body curses. Where: Use at home. Recipe: Passes from one generation to another.

7 The Four Humors, Humorism!Originated from Mesopotamia or ancient Egypt, but the Greeks further analyzed and systemized them. Body fluids concept. Excess or deficiency results in diseases and derangement in temperament. Blood: Originates from the liver. Season: spring (bloodletting is usually performed in Spring). Active and social; sanguine. Yellow Bile: Spleen. Aggression and excess anger, resulting in liver disease; choleric. Back Bile: Gall bladder. Depression if excess; melancholic. Phlegm: brain and lung. Apathetic behavior; phlegmatic.

8 Revolution in the Perspectives?The Greeks in modern-day Greece…Hippocrates (started 5th century BCE). The first to observe “etiologies”. Focused on what we call today “anatomy, physiology, pathology, pharmacology, and even neurology”, e.g., Galen. Recognized that gender, age, social class, diet, and environment all interact and responsible. In addition, they concluded that patients’ beliefs and mind are critical: Basis for the illness. Role in healing process.

9 Who played the role of Physicians or Surgeons?Two groups: Temple Priests: Charms and spells, reciting certain texts (incantation). Sorcerers: This group can be subdivided into: Someone who can diagnose: Why did you get the illness? Treat empirically? Or refer without treatment to… Someone who can only treat: prescribes herbs, does certain techniques (washing wounds, plasters, and bandaging).

10 Other forms of treatments?The human being, over thousands of years, learnt that some sort of intervention may cure diseases. The best well-known example is blood-letting! Blood is moist and worm and can harbor many diseases. Ancient Mesopotamia and Egypt. Skull trepanation: The oldest known surgery, 5000 BCE. To release the evil spirit, especially in migraine and epilepsy (seizure; seized by an evil soul). Certain therapeutic body bath coupled with thigh massage to make the uterus go back to its place. Wandering Womb. Greek origin. Displaced uterus can cause many illness, e.g., hysteria (which is still more common in females!).

11 Trepanned skull, from Jericho, modern-day Palestine, 2200-2000 BCETrepanned skull, from Jericho, modern-day Palestine, BCE. The Wellcome Collection, London, UK. Photo©Osama S. M. Amin.

12 Mesopotamia (Modern-Day Iraq)Ashurbanipal II. 7th century BCE. Wall Relief from the North Palace at Nineveh, Iraq. Housed in the British Museum, London, UK.  Photo©Osama S. M. Amin, Ancient History Encyclopedia, UK.

13 There was a multitude of healthcare professionals!Goddess Gula: the main deity of healing and health. Gula was considered the “Great Physician” of Sumerians (Ancient Iraqi People, more than years ago). Gula’s son, Ninazu (meaning the “Lord Healer”) was associated with the Serpent, healing, and underworld. Because of recurrent regeneration of their skin, serpents where considered a symbol of healing and regaining health.

14 The “Diagnostic Book”, written around 1000 BCE in Babylon, Iraq by Esagil-kin-apli described various symptoms, physical signs, their treatment remedies. The world’s first recorded prescriptions were etched on a clay tablet in Mesopotamia around 2100 BCE. The first drugstores were established in the ancient city of Baghdad in the 8th century CE.

15 A medical recipe was written on this clay tablet to prevent miscarriage. It recommends that a women should wear for 3 days a particular species of dried edible mouse which has been stuffed with myrrh. From Babylon, Mesopotamia, Iraq. Circa BCE. The British Museum, London. Photo©Osama S. M. Amin, Ancient History Encyclopedia, UK.

16 Ancient Egypt (Nile Valley)Pharaoh Rameses II, 13th century BCE. The British Museum, London. Photo © Osama S. M. Amin.

17 Ancient Egypt (Nile Valley)Egyptians were the best “anatomists” because of mummification and embalmment practices. They extracted brains of dead people from their nostrils during mummification and embalming (trans-sphenoidal approach!). They knew that the pulse is connected to the heart. Many individuals learnt how to become physicians and surgeons and even dentists. Many well-known “physicians”: Merit-Ptah (c BCE), the royal court's chief physician and the first woman known by name in medicine and science.  

18 Healthcare Aspect! Egyptian medicine recognized unhealthy food, e.g., unclean meat or rotten fish. Body hair, including armpits, can bring infections: shave! Physicians used laxatives to purge the bowel of diseased persons (any body channel can cause/house disease). Many of the excavated papyri (Egyptians wrote on papyri) were found to describe treatments for trauma, surgical operations, women’s health, and children diseases. Charms and spells with incantations were an integral part.

19 The London Medical Papyrus (cThe London Medical Papyrus (c BCE) is among the oldest medical texts in the world. Image © Trustees of the British Museum.

20 Medical Papyri Excavated!The Edwin Smith Papyrus describing surgical diagnosis and treatments. The Ebers Papyrus on ophthalmology, diseases of the digestive system, the head, the skin. The Kahun Gynecological Papyrus. The Berlin Medical Papyrus. The London Medical Papyrus. The Hearst medical papyrus repeats many of the recipes found in the Ebers papyrus. The Demotic Magical Papyrus of London and Leiden contains a number of spells for treating physical ailments.

21 Examples: Common cold: milk.Heart diseases: spells, herbals, and dietary changes. Skin and eye diseases: spells and incantations. Herbal medicines were combined with beer (to gladden the heart), wine, and/or honey. Fertility test: inserting an onion into the female’s vagina. Pregnancy test: dousing emmer and barley with urine: emmer flourishers first (female), barley first (male). Contraceptives: crocodile dung into vagina, with spells.

22 Eye of Horus, the “Rx” sign!Believed to be the healing power of the eye of God Horus after being injured by his uncle God Seth. Priests put this sign on papyri with written spells and incantations and given to patients to get health. Or, may be a Latin word which means “take”.

23 This false toe was found attached to the foot of a mummy, and is an early example of the use of prosthetics in the ancient world. From Egypt. Third Intermediate Period, BCE. (The British Museum, London). Photo © Osama S. M. Amin, Ancient History Encyclopedia, UK.

24 Articles from the Ancient History Encyclopedia, www.ancient.euHealth Care in Ancient Mesopotamia, Joshua Mark. Greek Medicine, Mark Cartwright. Ancient Egyptian Medicine: Study & Practice, Joshua Mark. Egyptian Medical Treatments, Joshua Mark. Egyptian Medicine, Joshua Mark.

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27 Thank you! Tablet V of the Epic of Gilgamesh BCE. The Sulaymaniyah Museum, Iraq. Photo © Osama S. M. Amin, Ancient History Encyclopedia, UK.