Unit 8 · Ancient Medicine

In 1862 an American collector named Edwin Smith bought an old roll of papyrus in Luxor, Egypt. Papyrus is a paper-like material made from a river reed. The roll was about 1600 BCE, but experts think it was copied from an even older text. It is now one of the oldest known writings about surgery and injuries.

The papyrus describes 48 cases. A case is one patient’s problem, written up with its signs and care. The cases start at the head and move down toward the chest and spine. For each one, the writer explains how to examine the patient: look, feel with the fingers, and ask questions.

The scholar James Henry Breasted of the University of Chicago published an English translation in 1930. Readers were struck by how practical the text is. Most cases use splints, bandages, stitches and rest, with only a little use of spells. It shows ancient Egyptian healers building knowledge by watching patients closely.

Another famous roll is named for Georg Ebers, a German scholar who bought it in 1873. The Ebers Papyrus dates to about 1550 BCE. It is much longer than the Edwin Smith roll. It holds around 700 remedies and many short passages about illness.

A remedy is something used to treat an illness. The Ebers remedies use honey, plants, minerals and animal products. Some use honey on wounds. Honey can slow the growth of some germs, so this idea has some support today. Many other remedies have no scientific support.

The Ebers Papyrus also includes spells and prayers. To Egyptian healers, medicine and religion worked together. The roll also describes the heart as a center with vessels running through the body. That idea was not fully correct, but it shows healers trying to explain how the body is connected.

Egypt was famous in the ancient world for its doctors. The Greek writer Herodotus, about 440 BCE, said that Egyptian healers each focused on one part of the body. Historians are not sure how exact his report was. Still, it shows that others admired Egyptian medicine.

One lasting habit was careful observation. Observation means watching and noting what you see, hear and feel. The Edwin Smith cases ask the healer to examine first and decide second. Modern doctors do the same when they check a patient before choosing a treatment.

Another habit was the prognosis. A prognosis is a prediction about how an illness or injury will turn out. The Egyptian healer sorted injuries into those to treat, those to try, and those beyond help. Doctors today still think about the likely outcome before they plan care.

In ancient Greece, sick people often traveled to a temple of Asclepius. The Greeks honored Asclepius as the god of healing. One of his most famous temples was at Epidaurus, in southern Greece. Visitors bathed, made offerings and prayed there.

Then came incubation. In this practice, a patient slept in a special hall of the temple. Greeks believed the god might appear in a dream and show a cure. Priests helped explain the dreams. Stone tablets at Epidaurus record thanks from people who said they were healed.

Historians see these temples as part of Greek religious life. Rest, clean water, calm and hope may have helped some visitors feel better. The staff with a snake wrapped around it, called the rod of Asclepius, is still a symbol of medicine today.

Hippocrates lived on the Greek island of Kos, about 460 to 370 BCE. We know little about his life. Many writings carry his name, but historians think many authors wrote them over many years. Together they are called the Hippocratic Corpus. A corpus is a body of writings.

The big idea in these writings is that illness has natural causes. That means causes in the body or the world, like food, weather or water, not the anger of gods. One text, On the Sacred Disease, is about seizures. It argues that seizures come from the brain, not from the gods.

Hippocratic doctors watched patients over days and wrote notes. They paid attention to diet, sleep and exercise. The Hippocratic Oath asked doctors to help the sick and do no harm on purpose. Doctors today still take oaths inspired by it, though the words have changed.

Hippocratic writers had a theory about the body. A theory is an idea that tries to explain many things at once. They said the body holds four fluids, called the four humors. The humors were blood, phlegm, yellow bile and black bile.

In this theory, health meant the humors were in balance. Illness meant one humor was too strong or too weak. A cold with a runny nose seemed to show too much phlegm. Fever and a red face seemed to show too much blood. Healers linked each humor to a season as well.

To bring back balance, healers changed a patient’s diet, rest and exercise. They also used bloodletting, which means removing some blood on purpose. The humors theory made sense to people because it was based on things they could see, like mucus and fever. It shaped medicine for about 2,000 years.

The humors theory lasted a very long time. Doctors in Europe and the Middle East used it into the 1800s. Bloodletting was still common in the early 1800s. Many patients were weakened by it, because losing blood makes it harder to fight illness.

Science slowly tested the theory. In 1858 the German doctor Rudolf Virchow argued that disease starts in the body’s cells, the tiny living units that make up the body. In the 1860s to 1880s, Louis Pasteur and Robert Koch showed that many diseases are caused by germs, tiny living things such as bacteria.

Doctors could now see causes under the microscope and test treatments. The four humors did not match this evidence, so the theory was set aside. This is how science works. A popular idea can last for centuries, but it changes when careful tests show something better.

Galen was born about 129 CE in Pergamon, a Greek city in what is now Turkey. As a young doctor, he treated gladiators in Pergamon. Their wounds let him see muscles and organs up close. Later he moved to Rome and became a doctor to emperors.

Galen studied anatomy, the structure of the body. Human dissection was not allowed in Rome. So he did dissection on animals such as pigs and monkeys. Dissection means carefully cutting open a body to study its parts. In one famous test, he showed that arteries carry blood, not air, as some earlier doctors thought.

Galen wrote a huge number of books. He accepted the four humors and built on them. He also did experiments, like tying off nerves in animals to see what stopped working. That was a real step toward testing ideas instead of only arguing about them.

After Galen died, about 216 CE, his books spread widely. Scholars in the Islamic world translated them into Arabic and added their own ideas. Later they were translated into Latin for European universities. For centuries, doctors learned anatomy mainly from Galen’s writings, which gave him great authority.

But Galen had studied animals, not people. Some parts of animal bodies are different from human bodies. For example, he described a jawbone in two pieces and a liver with many lobes, as in some animals. Because of his authority, few people questioned these errors.

In 1543 the anatomist Andreas Vesalius published On the Fabric of the Human Body. He had dissected human bodies himself in Padua, Italy. His careful drawings corrected many of Galen’s mistakes. Vesalius still respected Galen, but he trusted evidence he could see over old books.

Ancient Rome was a crowded city, with perhaps a million people at its peak. Crowded cities need clean water. In 312 BCE the Romans built the Aqua Appia, their first aqueduct. An aqueduct is a channel that carries water from far away, often using a gentle downhill slope.

Over the next centuries Rome built about eleven major aqueducts. The water flowed to public fountains, homes of the rich and large public baths. Many Romans visited the baths almost daily to wash, exercise and meet friends. A great drain called the Cloaca Maxima carried waste water toward the Tiber River.

These projects are early examples of public health, which means protecting the health of a whole community. The Romans did not know about germs. Still, clean water and drains help stop the spread of many diseases. Around 97 CE, the official Frontinus wrote a book about managing Rome’s water.

The Huangdi Neijing means the Yellow Emperor’s Inner Classic. It is written as talks between a legendary ruler, the Yellow Emperor, and his wise advisers. Historians think many authors wrote it, and it was put together around 2,000 years ago or a bit earlier. It is a founding text of Traditional Chinese Medicine, or TCM.

TCM teaches that the body is filled with qi, often translated as vital energy or breath. In this tradition, health means qi flows smoothly. Illness means qi is blocked, weak or out of balance. Qi is an idea of the tradition. Scientists have not found a way to measure it.

The Neijing also uses yin and yang. These are two opposite but connected forces. Yin is linked with cool, dark and rest. Yang is linked with warm, bright and activity. TCM teaches that health needs a balance of both, like day and night following each other.

TCM also uses the five phases: wood, fire, earth, metal and water. Each phase is linked to seasons, colors, tastes and organs. For example, wood is linked with spring and the liver. The phases are said to support or hold back one another in a cycle.

TCM teaches that qi flows through channels called meridians. There are twelve main meridians, each tied to an organ. Along them lie specific points. These points are the places where acupuncture needles are placed.

Anatomists have looked for meridians as physical tubes or structures. They have not found them. Scientists see meridians as a map inside the tradition, not as a part of the body you can dissect. TCM practitioners use the map to decide where to treat.

Imagine a TCM doctor gently placing three fingers on a patient’s wrist. She presses lightly, then more firmly. This is pulse diagnosis. Diagnosis means figuring out what is causing a health problem. The doctor feels the pulse at three spots on each wrist.

TCM names many types of pulse, such as slippery, wiry or thin. Each type is said to show the state of qi and organs. The doctor also looks at the tongue: its color, shape and coating. Then she asks about sleep, food and mood.

Modern doctors also check the pulse, but for different things. They count the heart rate and feel whether the beat is steady. Studies have found that TCM doctors do not always agree with each other when they read the same pulse. That makes it hard to test pulse types as a way to diagnose disease.

Acupuncture is placing very thin needles into points on the skin. TCM teaches that this helps qi flow along the meridians. In many studies, acupuncture has helped some people with certain kinds of pain, such as low back pain or headaches. But fake needling often helps almost as much, so scientists still debate why it works.

TCM also uses herbal formulas. These are mixes of several plants, and sometimes minerals, chosen together. One famous story connects to Tu Youyou, a Chinese scientist. She read an old Chinese text about sweet wormwood and fever. Her team found artemisinin in that plant, and it became a major malaria medicine.

Tu Youyou won a Nobel Prize in 2015. Her work shows that old texts can point to a useful plant. But the medicine had to be purified and tested first. Some herbal products can be contaminated or can interact with other medicines. Always tell your doctor or pharmacist about any herbs you take.

Ayurveda is the traditional medicine of India. The name comes from Sanskrit and means knowledge of life. Its oldest great books were written down about 2,000 years ago, from even older teachings. Ayurveda is still practiced by many people in India today.

The Charaka Samhita is one of those great books. A samhita is a collection. Charaka’s collection focuses on internal medicine, which means illnesses inside the body treated without surgery. It was shaped and edited by several scholars over time.

The Charaka Samhita puts a strong focus on prevention, which means stopping illness before it starts. It gives advice on daily routines, sleep, food that suits the season, and a calm mind. It also tells healers to examine patients carefully and treat them with kindness.

The Sushruta Samhita is linked to Sushruta, a healer and teacher of ancient India. Like other old texts, it grew over centuries. It is famous as one of the world’s earliest detailed books about surgery. Surgery means treating the body by cutting, repairing or removing parts.

The book describes many surgical tools, often counted at over 100. Many are shaped like the beaks of birds or the jaws of animals. It also describes more than 300 procedures, from treating wounds to removing stones.

The Sushruta Samhita gives careful advice on training. Students practiced cuts on melons and gourds and practiced stitching on cloth and leather. The book also stresses cleanliness around the patient. It shows that ancient Indian surgeons valued skill, practice and preparation.

In ancient India, a person could lose part of the nose through injury or as a harsh punishment. The Sushruta Samhita describes a way to rebuild it. The surgeon cut a flap of skin from the cheek, kept it attached at one end, and turned it to shape a new nose. This is an early form of reconstructive surgery.

Much later, in 1794, a London magazine reported a similar nose operation performed in India, using skin from the forehead. European surgeons learned from these reports. Today, plastic surgeons still use skin flaps that stay attached to their blood supply.

The text also describes treating a cataract, a cloudy lens in the eye that blurs vision. In a method called couching, a needle pushed the cloudy lens out of the way so light could enter. It could help people see some light and shapes. Modern cataract surgery is very different and much safer: the cloudy lens is removed and replaced.

Ayurveda teaches that the body is guided by three doshas. A dosha is a basic force or quality in the body, in this tradition. The three are vata, pitta and kapha. They are built from five elements: space, air, fire, water and earth.

Vata is linked with air and movement. Pitta is linked with fire and digestion. Kapha is linked with water and earth, and with steadiness and strength. Ayurveda holds that each person is born with their own mix of doshas, called their nature.

In Ayurveda, illness comes when the doshas fall out of balance. Healers suggest foods, routines, oils and herbs to restore balance. The doshas are ideas of the tradition, like qi in TCM. Scientists have not found a way to measure them, and studies of dosha types have given mixed results.

Walk into a large hospital in China today and you may find two kinds of departments. One offers modern medicine with scans and lab tests. Another offers TCM with herbs and acupuncture. Many patients use both. This mix is called integrative medicine.

In the United States, acupuncture is offered at some clinics and hospitals, often for pain. The National Institutes of Health funds studies of these practices. Some studies show benefits for certain uses. Others show no clear benefit beyond a placebo, a fake treatment that can still make people feel better.

TCM herbs can be powerful. Some have caused liver or kidney harm, and some products have been found to contain hidden drugs or metals. That is why it matters to buy from trusted sources and to tell your doctor or pharmacist about every herb or supplement you take.

Ayurveda is still part of daily life for many families in India. The Indian government has a ministry, called AYUSH, that supports Ayurveda, yoga and other traditional systems. There are Ayurvedic colleges and hospitals. Around the world, many people use Ayurvedic ideas about diet and routine.

Scientists study Ayurvedic plants, such as turmeric. Turmeric contains curcumin, which is being studied for its effects on the body. So far, results are mixed, and turmeric has not been shown to cure any serious disease. This is an example of clinical trials, careful tests of a treatment in people.

Some Ayurvedic products have raised safety concerns. A 2008 study led by Robert Saper tested products sold online and found that about one in five contained lead, mercury or arsenic. These are heavy metals that can harm the body. Some traditional recipes add metals on purpose. Always ask a doctor or pharmacist before using such products.