Histoire de la médecine Partie 1 (Antiquité) - UPH #9

Medicine is the struggle against death and pain, taking into account others and their physical or mental suffering. It also encompasses assistance with birth and support throughout life.

For a very long time, medicine has been linked to religion, spirituality, or shamanism in different parts of the globe.

Medicine is the fruit of the work of men and women who fought, searched, discovered, and transmitted their knowledge across centuries to help others.

The history of medicine presented here is somewhat ethnocentric, focused on certain regions and civilizations.

Traces of medicine before the invention of writing are very rare since writing appeared late in human history.

• Predecessors who, by observing nature and the effects of plants, deduced it was possible to ease pain or cure illness. • Trepanation practiced in the Neolithic period, confirmed by skulls found showing signs of scarring.

Certain people accumulated medical knowledge and knowledge of plants, then transmitted their experience orally to others within tribal communities.

These people can be called healers or shamans, using plants and spiritual recourse to attempt healing someone.

Physical proof of medical practice dates back to Mesopotamia, the region where writing was discovered, allowing medical practices to be documented.

• Code of Hammurabi discovered in Babylon around 1750 BCE on a stele. • First true written legal text, containing approximately 300 articles, a dozen of which address medicine and surgery. • Medicine existed then since its practice was recognized and legally regulated.

Physicians questioned patients before examining them, recognized certain diseases through experience, and could identify respiratory, intestinal, and urinary disorders. They performed basic urine analysis, examined breath odor, took pulse and temperature.

Medicine was extremely expensive: saving a man wounded by a spear cost 10 shekels, equivalent to a slave's annual salary, making care inaccessible to the poor.

• Ointments, syrups, plant mixtures, alcohol, potions, resins burned for inhalation. • Remedies resembling home remedies used in modern society.

• Respiratory difficulties treated with deep enemas. • Excrement used in mixtures to treat sore throats.

For fractures, wounds, and other injuries, wars provided many wounded patients. Physicians used splints for immobilization and surgery began to develop in Mesopotamia.

Writings suggest cosmetic surgery was already practiced in Babylon, notably on the nose where bone implants may have been attempted.

In the 7th century BCE, a great library was created in Assyria: Ashurbanipal's Library, containing official documents, literary texts, and works on scientific advances.

A significant portion of the library was devoted to medicine, allowing physicians to visit and train through writings left by other physicians.

This was the first place where transmission of medical knowledge through writing was organized on a large scale, marking the formal beginning of medical education.

Documents allowing transmission of medical knowledge already existed before this library was built, particularly in Egypt.

The Edwin Smith Papyrus, dating to 1500 BCE, primarily addresses surgery and served as a medical reference for military purposes.

• Cases of fractures, wounds, crushing injuries and ways to treat them. • Sutures, immobilizations, balms, and other therapeutic techniques.

The papyrus distinguishes between the rational and scientific on one side, and the religious and magical on the other, focusing on practical trauma management.

The Edwin Smith Papyrus is considered a copy of other lost works whose original author may have been the physician and architect Imhotep during the 3rd Dynasty, around 3000 BCE.

• Imhotep, physician and architect of the 3rd Dynasty. • Peseshet, female physician around 2500 BCE, overseer of midwives and founder of a training school.

Childbirth was almost exclusively reserved for women until the early 16th century in France. This practice made sense since childbirth was highly ritualized in ancient Egypt with exclusively female personnel assisting.

From the Late Period onward, medicine became more spiritual and less rational, developing a large proportion of priests among healers, coexisting with physicians called sounous.

• General practitioners and specialists for eyes, teeth, and belly. • Prosthetists for amputees and physicians for the anus, called shepherd of the anus. • Hierarchy with basic physicians, chief physicians, inspectors, up to chief physician of all physicians and physician to the king.

A complex and complete medical system was already established in Egypt with hierarchical organization and defined specializations.

This medical system was considered a free public service for everyone, an important point to emphasize regarding history.

Many medical treatises were written during this period, most considered copies of originals, proving written transmission of medical knowledge long before Mesopotamian legal structures.

This Egyptian medicine lasted practically until the end of the first millennium, around 30 CE, showing remarkable continuity.

In the 7th century BCE, the first true settled physicians appeared in Greece who remained in the city to treat the sick.

• In some cities, physicians were considered state employees paid without charging patients. • In others, their situation was extremely precarious.

The physician traveled through the city to heal ailments but also received patients at home. The physician's own house became the ancestor of the medical office, equipped with beds for patients and surgical instruments.

Physicians' homes contained equipment for treating various conditions, marking the beginning of structured medical infrastructure.

In the 6th century, followers of Pythagoras, particularly Alcmaeon, a physician, argued that the brain controls everything, challenging the belief that it was the heart or liver.

This assertion was revolutionary in medical circles and most of Alcmaeon's colleagues categorically refused to acknowledge the truth of his claims.

• Empedocles, Sicilian physician of the 5th century, concluded that the embryo results from two seeds, from man and woman, and grows in the uterus with the placenta. • He identified optimal reproduction periods, developing the idea of ovulation.

Empedocles' theory of roots, based on balance between several elements for health, greatly inspired other physicians despite some theories being incorrect.

Dissection methods appeared, mostly practiced on animals since they were forbidden on humans, enabling major anatomical advances.

Drawings and sketches were made during dissections to better understand human body function.

Aristotle enabled many medical advances through his treatise on animals in 330 BCE, helping better understand human body function.

Diogenes, a famous physician, performed numerous dissections, contributing significantly to anatomical advances of the era.

Hippocrates assumed that if illness exists, it is not due to the divine but to other factors such as diet, climate, and environment.

This rational approach changed much since against a rationalized illness, one could be more pragmatic in treatment.

• Rest, often prescribed in large quantities. • Medications and plants. • Immobilization for fractures, sometimes combined with machines for repositioning. • These techniques yielded rather positive results compared to other medical schools.

Hippocrates compiled medical information of the era, free of mysticism, in a massive text corpus containing approximately 70 works: manuals, conference records, research, and notes.

Hippocrates placed great importance on operation conditions: the physician's and patient's position, instruments, and assisting personnel. This defined procedure and represented a much more professional aspect of medicine.

• Oath based on ethics, still recited by medical graduates in our time. • Patients must conduct their practice in respect for the patient and for the patient. • The modern version is modified and Hippocrates' authorship of this oath is sometimes questioned.

• Hippocrates improved vocabulary and disease classification. • Introduced terms like relapse and peak still used today. • Classified diseases into types: acute, chronic, endemic, and epidemic.

Hippocratic medicine was founded on patient prognosis, that is, how illness would evolve based on current condition. He also laid foundations for diagnosis with his students, seeking the origin of the patient's disease.

Hippocratic medicine was based primarily on the theory of humors influenced by the 4 elements: fire, water, earth, and air, having their equivalents in the body: blood, lymph, yellow bile, and black bile.

According to this theory, if all elements were balanced in the body, one had perfect health. If the balance tipped one way or another, one became ill.

Although the notion of balance is still mentioned today, the theory of humors is no longer applied to explain and understand patient illness.

• Hippocrates' influence was so great that his death caused medical stagnation. • People rested on laurels without questioning this remarkable work. • There were sometimes even setbacks because Hippocrates also had weaknesses.

Roman medicine's rise was largely due to Greek physicians who settled in Rome even before Greece was controlled by the Roman Empire.

Before Greek physicians arrived, medicine was poorly regarded in Rome. Most families who owned slaves saw no benefit in having a slave physician.

• Private medicine with physicians charging very high fees for services. • Public service, primarily organized from the 2nd century CE onward, consisting of Popular Archiaters, guild formation limited by city size, mission to care for the poor.

Many physicians gathered in groups to practice and gain recognition, since there were no diplomas and reputation created legitimacy.

• For the first time in Rome, midwives gathered in guilds to create a true entity. • General practitioners and specialists to better support patients. • True entities emerged, each with specialties: general medicine, childbirth, surgery for gladiators.

These professional groups created structures enabling better recognition and transmission of medical knowledge.

At this time, there was no diploma and physician reputation created legitimacy and authority.

Professional entities brought together varied specialists enabling better coverage of population medical needs.

Rome understood the value of maintaining a fit army with physicians capable of treating fighters, developing sophisticated military medicine.

• War physicians trained with titles, sometimes as non-combatant officers. • Important role during and after battle for overall army effectiveness.

Some physicians were positioned behind front lines to evacuate the wounded, at the center of action for emergency effectiveness.

When a wounded person could not be treated on site, ambulances with horses transported the patient to the military hospital usually located in the Roman camp.

Field hospitals were built with certain rigor around a garden where medicinal plants could be found, composed of several rooms with specific functions.

• Waiting area separate from examination. • Morgue, pharmacy, and other distinct areas to prevent contamination.

One specialty of Roman medicine was the emphasis placed on hygiene: lifestyle hygiene and purity of water used for drinking, washing, and wound cleaning.

For Roman surgery, highly developed for the era, surgical instruments were boiled before use, even without knowledge of bacteria, achieving sterilization and reducing contamination.

Dioscorides wrote a 5-volume work laying the foundations of modern pharmacology, one of the most important books of the era.

Soranus of Ephesus wrote the most complete treatise of Antiquity on diseases of women and gynecology, marking significant progress in this field.

• Greek physician who spent much of his life in Rome. • Laid foundations of Western medicine for over 1000 years. • Capital observations on anatomy consistent with Renaissance physicians' approach.

Galen's work was immense, covering practically all domains of medicine, mathematics, philosophy, and more. Much of it unfortunately was lost during the fall of the Roman Empire.

Galen stated: "I affirm that the physician must know how each of the bones is in itself, and how it assembles with other bones, if he wishes to treat their fractures and dislocations correctly."

Galen's work, compared to Hippocrates', is characterized by its immensity and coverage of practically all domains of medicine.

Much of Galen's work was lost during the fall of the Roman Empire, marking a major break in continuity of medical knowledge.

The first episode's end raises questions for the next episode: How did Europe manage the crisis after the Roman Empire's fall and what impact on medicine?