Brief History of Medicine 2018

Brief History of Medicine
Prof. Dr. Harlina Halizah Siraj
Dept of Medical Education
Faculty of Medicine UKM

Learning outcomes
At the end of this module, learners would be able to:
• Explain the importance of history generally and
medicine specifically.
• Illustrate the timelines that composed the history of
medicine.
• Elaborate briefly the significant medical contributions
of each civilization to mankind.
• Appreciate the in-depth values of human
achievements throughout history

Contents
 Importance of history
 Timeline for history in medicine
 Brief review on :
 Prehistoric medicine
 Ancient Chinese medicine
 Ancient Indian medicine
 Ancient Egyptian medicine
 Ancient Babylonian medicine
 Greeks and Romans
 Middle Ages
 Islamic medicine
 The Renaissance
 18th and 19th century
 20th century
 21st century

Why do we need to learn history?
If you would understand anything, observe its beginning and
its development.
Aristotle
The value of history. ..is that it teaches us what man has done
and thus what man is.
R. G. Collingwood
In history, a great volume is unrolled for our instruction,
drawing the materials of future wisdom from the past errors
and infirmities of mankind.
Edmund Burke
Not just His-story, but also Her-story………….

Health & Sickness :
Fundamental Questions
• Why do some man become sick, while others remain
healthy?
• What causes sickness?
• Where does sickness come from?
• How do we stop/cure/treat sickness and then
prevent death?

Flow of a `Fragile' Life
HEALTHY
SICKNESS
Gets Better Worsens
DEATH

Timeline of Medical History
Prehistoric
8000 BC
Ancient
Egyptian
2000 BC
Greeks & Romans
400 BC – 300 AD
Ancient
Chinese
3000 BC
Ancient
Indians
3000 BC Modern Medicine
18th – 21st century
Middle Ages
(Dark Ages)
500 – 1400 AD
Islamic Medicine
700 – 1500 AD)
AD
Latin : anno domini
`In the year of our Lord‘
(Birth of Christ)
The
Renaissance
1400 – 1700 AD
Ancient
Babylonian
2000 BC

Prehistoric
8000 BC
AD
Latin : anno domini
In the year of our Lord
(Birth of Christ)

Prehistoric Medicine
• Believed in spirits and supernatural forces – good and
bad.
• Sickness – as a result of failure to comply to wishes and
likings of spirits and forces.
• Witch doctors ( Shamans) – mediators between man and
the spirits.
• Dispensed first medications – herbs, animal stuffs, blood,
human sacrifices.
• Archeological findings – primitive brain surgery –
trepanning.

Perak Man : the respected shaman
• 1991. USM archeological team
made a discovery of a burial
cave, Gua Gunung Runtuh,
Lenggong Perak Tengah.
• It contained the 11,000-year-
old Perak Man, the region’s
best-preserved Stone Age
skeleton – and the only one
found with a genetic skeletal
disorder, Brachymesophalangia
type A2.

Perak Man : the respected shaman
• The skeleton’s foetal
position, surrounded
by a cornucopia of
objects, suggested to
archaeologists that his
deformity had elevated
him to a well-
respected shaman.

Perak Man : The Respected Shaman

Trepanning:
to allow spirits to leave the body of the sick

Ancient
Chinese
3000 BC AD
Latin : anno domini
(Birth of Christ)

Ancient Chinese Medicine
• Dated 5,000 years ago, supporting documentation abut
2,000 years.
• Believed that man became sick if balance between
natural elements were not maintained ( Yin & Yang
concept) and the `chi’ or life energy was not flowing well.
• To cure / treat : to retain balance between all five
elements (wood, fire, earth, metal and water) and chi to
flow.
• Chinese physicians were also philosophers.
• Treatment : herbal, acupuncture

 The first written documentation on traditional
Chinese medicine is the Hung-Di Nei-Jing (Yellow
Emperor's Cannon of Internal Medicine).
 The oldest medical textbook in the world, 800 BC.
 Contents :
 Foundation for theories of Chinese medicine - previous
experience and theories of medicine,eg. the meridian
theory, physiology, pathology, prevention, diagnosis,
treatment, acupuncture.

QUOTES
A good healer cannot depend on skill alone.
A quote from the Yellow Emperor’s Classics of Medicine
The superior doctor should first adjust the patient’s
diet and life style. Only if that does not eliminate
disease should the doctor go on to administer
acupuncture and herbs.
Sun Si Maio,the greatest doctor of the Tang Dynasty
(618-907)

Ancient
Indians
3000 BC
AD
Latin : anno domini
(Birth of Christ)

Ancient Indian Medicine
• Basis : Physical health is part of spiritual health.
• Ayurveda ( the science of living): a form of ancient
Indian science of medicine, with eight disciplines :
▫ Internal medicine
▫ Surgery & anatomy
▫ ENT
▫ Paediatrics
▫ Toxicology
▫ Spirit medicine
▫ Science of rejuvenation
▫ Aphrodisiacs

Ancient Indian Medicine
• Famous ayurvedic practitioner : Chakara
• Concept : health and disease are not predetermined
and life may be prolonged by human effort and
attention to lifestyle.
• A physician who fails to enter the body of a patient with the lamp of
knowledge and understanding can never treat diseases. He should first
study all the factors, including environment, which influence a patient's
disease, and then prescribe treatment. It is more important to prevent the
occurrence of disease than to seek a cure.
Chakara ( born 300BC)

Ancient
Egyptian
2000 BC
AD
Latin : anno domini
(Birth of Christ)

Ancient Egyptian Medicine
• Concept : Illness was due to evil spirits or poisons and
removing these from the body with prayers to the
gods would cure the disease.
• Documentation & prescription of medicine
• Medical procedures & process of mummification

Eber Papyrus – 1550 BC
• A 110-page scroll, which is about 20 meters long.
• The scroll contains some 700 magical formulas and remedies.

Ancient
Babylonian
2000 BC AD
Latin : anno domini
(Birth of Christ)

Ancient Babylonian (Mesopotamian) Medicine
• Revolved heavily around magic, with little scientific
process aside from diagnoses and prognoses –
though even these processes were saturated with
supernaturalism.
• Overall, Babylonian healthcare relied on magic and
incantations.
• This information is revealed primarily through
Assyrian copies of Babylonian texts thought to
originate in the first half of the 2nd millennium BC.
https://healthandfitnesshistory.com/ancient-medicine/babylonian-medicine/

Ancient Babylonian (Mesopotamian) Medicine
• Babylonian healthcare
system seems to have
been fairly well
standardized, subject to
some level of legal code.
• The Hammurabi Code (c.
2000 BC), inscribed on an
8-foot tall block of black
diorite, covers doctor
payment and
malpractice.
https://healthandfitnesshistory.com/ancient-
medicine/babylonian-medicine/

Hammurabi Code (2000BC) - Lines 218 to 221
• If the doctor has treated a man for a severe wound with lances of
bronze and has caused the man to die, or has opened an abscess of
the eye for a man and has caused the loss of the man’s eye, one shall
cut off his hands.
• If a doctor has treated the severe wound of a slave of a poor man
with a bronze lances and has caused his death, he shall render slave
for slave.
• If he has opened his abscess with a bronze lances and has made him
lose his eye, he shall pay money, half his price.
• If a doctor has cured the shattered limb of a gentleman, or has cured
the diseased bowel, the patient shall give five shekels of silver to the
doctor.
https://healthandfitnesshistory.com/ancient-medicine/babylonian-medicine/

Greeks & Romans
400 BC – 300 AD
AD
Latin : anno domini
(Birth of Christ)

The Greeks
• Believed diseases were sent as a punishment
from the gods.
• Treatments were aimed at pleasing the gods.
• Important figures :
▫ Hippocrates ( Father of Medicine – Hippocrates
Oath ) Four humors – choleric, melancholic,
sanguine & phlegmatic.
▫ Galen - One of the first physicians to use
dissections to understand how the body works

Hippocrates Oath
• I swear by Apollo the physician, and Asclepius, and Hygieia and Panacea and all the gods and goddesses as
my witnesses, that, according to my ability and judgement, I will keep this Oath and this contract: To hold
him who taught me this art equally dear to me as my parents, to be a partner in life with him, and to fulfill
his needs when required; to look upon his offspring as equals to my own siblings, and to teach them this
art, if they shall wish to learn it, without fee or contract; and that by the set rules, lectures, and every other
mode of instruction, I will impart a knowledge of the art to my own sons, and those of my teachers, and to
students bound by this contract and having sworn this Oath to the law of medicine, but to no others.
• I will use those dietary regimens which will benefit my patients according to my greatest ability and
judgement, and I will do no harm or injustice to them.
• I will not give a lethal drug to anyone if I am asked, nor will I advise such a plan; and similarly I will not give
a woman a pessary to cause an abortion.
• In purity and according to divine law will I carry out my life and my art.
• I will not use the knife, even upon those suffering from stones, but I will leave this to those who are trained
in this craft.
• Into whatever homes I go, I will enter them for the benefit of the sick, avoiding any voluntary act of
impropriety or corruption, including the seduction of women or men, whether they are free men or slaves.
• Whatever I see or hear in the lives of my patients, whether in connection with my professional practice or
not, which ought not to be spoken of outside, I will keep secret, as considering all such things to be private.
• So long as I maintain this Oath faithfully and without corruption, may it be granted to me to partake of life
fully and the practice of my art, gaining the respect of all men for all time. However, should I transgress this
Oath and violate it, may the opposite be my fate.
Translated by Michael North, U.S. National Library of Medicine, 2002

The Romans – Public health hygiene
• The Romans realized that there was a link between
dirt and disease.
• To improve public health, they built aqueducts to
supply clean drinking water and sewers to remove
wastes safely.
• Improved personal hygiene helped to reduce disease
and Roman baths were places to socialise as well as
stay clean

Middle Ages
(Dark Ages)
500 – 1400 ADAD
Latin : anno domini
(Birth of Christ)

Middle (Dark) Ages
• The fall of the Roman Empire – lack of public hygiene
practices.
• People in Europe – lack of access to clean drinking
water, regular bathing or a sewage system.
• Starvation and disease were common.
• Medicine in the middle ages was dominated by
religion.
• Sickness - a punishment from God for sins
• Only way to cure someone was to pray for their
forgiveness.

Middle (Dark) Ages
• Doctors were usually priests or other religious scholars.
• Hospitals were set up in monasteries and other religious
establishments.
• The patients were given food and comforted by religious
nursing staff but little else was done to cure their illness.

Middle (Dark) Ages
• Traditional cures, using herbal remedies and potions
were seen as witchcraft and outlawed by the church.
• Laws stated that only trained and registered people
could practice medicine.

Middle (Dark) Ages
• Biggest challenge : Black death, or Bubonic
Plague. In 1347, an outbreak of bubonic
plague broke out in Istanbul.
• Traders soon carried the disease throughout
Europe and records show that in some areas it
killed up to 90% of the population. (49 million
people killed)
• Poor public hygiene, congested living
condition

Islamic
Medicine
700 – 1500 AD)
AD
Latin : anno domini
(Birth of Christ)

Islamic Medicine
 After the fall of the Roman Empire, the Arabic world was
the centre of scientific and medical knowledge.
 Texts from Greece and Rome were translated into Arabic
and studied by Islamic scholars.
 They developed and refined Hippocrate's theories and
Islamic physicians began to use the regulation of diet,
exercise and the prescription of medicinal herbs in the
treatment of their patients.

Islamic Medicine
 Arabic pharmacists became
skilled in the formulation of
medicines from plants and
minerals.
 Even though they did not know
about microbes, they used
alcohol to clean wounds which
healed better and did not
become infected.

Islamic Medicine
• Muslim practiced universal
healthcare :
▫ Hospitals were not just for the
wealthy and treated rich and poor
alike.
▫ Large hospitals were involved in
the training and licensing of
doctors and pharmacists.
▫ Officials tested medicines to certify
that they were safe and visited
pharmacists to make sure that
prescriptions were being made
correctly.

Islamic Medicine
• Records show that Muslim doctors performed many
different surgical operations including the removal of
varicose veins, kidney stones and the replacement of
dislocated limbs.
• They used sponges soaked in narcotic drugs which
were placed over the patient's nose as early
anaesthetics.

Islamic Medicine
• Most important medical books of
its time was written by the
physician Ali al-Husayn Abd Allah
Ibn Sina (also known as Avicenna).
• His massive manuscript, called the
Laws of Medicine, was completed
around 1030 AD and translated
into Latin in the 12th Century.
• This encyclopaedia of medicine
contained five books detailing the
formulation of medicines,
diagnosis of disorders, general
medicine and detailed therapies.

Az Zahrawi : Father of Modern Medicine

The
Renaissance
1400 – 1700 ADAD
Latin : anno domini
(Birth of Christ)

The Renaissance
• The Renaissance was a period in European history during
which there was a revival in the ideas of ancient Rome
and Greece.
• Culture, art, science and medicine were studied by
aristocrats and scholars who prized themselves on their
education.
• Ideas flourished and the newly invented printing press
allowed books to be produced quickly.
(The printing press was a revolution in information technology and
resulted in ideas spreading around)

The Renaissance
Medical research was intensified during this
period.
 Medicine remained dominated by the teachings of the
church but physicians began to learn more about the
human body.
 They read books translated from Arabic medical texts
and began to study anatomy in a scientific and
systematic way.

The Renaissance
 Andreas Vesalius and Leonardo Da Vinci dissected
human bodies and made the first anatomical
drawings.
 The church did not permit the dissection of 'God
fearing bodies' so it was often the bodies of criminals
or 'sinners' that were used. Doctors learned about
anatomy from watching these dissections.

Renaissance : Da Vinci’s medical paintings

Modern
Medicine
18th – 21st century
AD
Latin : anno domini
(Birth of Christ)

Modern Medicine :
18th - 19th century
• Two of the big medical advances of this time were:
▫ Vaccinations
▫ X-rays
• The study of microbes, or microbiology, was born and
the increased knowledge of pathogenic microbes led to
the development of new medicines to tackle infectious
diseases.
• The pharmaceutical industry was born
• Surgery – discovery of anaesthesia & antiseptic

The Visit of The Doctor : 1867

Marie Curie
(1867 – 1934)
• Nothing in life is to be
feared, it only to be
understood. Now is the
time to understand more
that we may fear less

Manchester Medical School :
1904

Modern Medicine : 20th century
• Major advances in healthcare which include
development of:
▫ Antibiotics : Penicillin - the discovery and development
of antibiotics by Fleming, Florey and Chain.
▫ Insulin: Banting and Best's work to show that insulin can
be used to treat diabetes.
▫ Other medicines: pharmaceutical laboratories around
the world are constantly producing new treatments for
diseases.
▫ Imaging techniques
▫ DNA & human diseases

Father of Modern Medical Education

Modern Medicine : 21st century
• Human genome project
▫ It started in 1990 and completed in 2003.
• Genetic & medicine
▫ Genetic engineering
▫ Genetic manipulation & enhancement
• Ethic & medicine
▫ Dealing with the controversial issues

Harlinasiraj2010©
Dr. Francis S. Collins
Head of Human Genome Project
I started this journey of intellectual exploration to
confirm my atheism. That now lay in ruins as the
argument from the Moral Law ( and many other
issues) forces me to admit the plausibility of the
God hypothesis.
Faith in God now seemed more rational than
disbelief.

TO BECOME COMFORTABLE
WITH UNCERTAINTY IS ONE OF
THE PRIMARY GOALS IN THE
TRAINING OF A PHYSCIAN”
Sherwin B. Nuland
(1930 – 2014)
PBL 1

What’s next?
• Personalized
medicine is an
emerging practice
of medicine that
uses an individual's
genetic profile to
guide decisions
made in regard to
the prevention,
diagnosis, and
treatment of
disease.

CONGENITAL ZIKA VIRUS INFECTION
Severe microcephaly

https://paul4innovating.com/2018/01/27/shifting-our-thinking-within-the-fourth-industrial-revolution/

http://prcouncil.net/wp-content/uploads/2016/01/WEF-ketchum-infographic-2016.jpg

Conclusion
 Medicine continues to progress……..
 Main duty of medical healthcare providers are
to preserve the nobility of the profession.
 What I fear most for the future is a world which is
too technologically advanced, but too morally
backward’
Prof Dr. Mahmoud Fathalla (FIGO President – 1994 – 1997)

Brief History of Medicine 2018

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