HSS2121A

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Week 2, Sept 14th, 2017
Kerry-Anne Hogan RN PhD
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 Prehistory is a term used to describe the
period before recorded history.
The term "prehistory" can be used to refer
to all time since the beginning of the
universe, although it is more often used in
referring to the period of time since life
appeared on Earth, or even more
specifically to the time since human-like
beings appeared.
The date marking the end of prehistory,
that is the date when written historical
records become a useful academic
resource, varies from region to region. For
example, in Egypt it is generally accepted
that prehistory ended around 3200 BC.

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 Anthropology

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Artifacts Cave engraving
 Magico-religious or supernatural
ideas dominated as the cause of
disease in primitive society.
Diseases were believed to be due to:

- Supernatural power like evil spirit,

demons & god
- Rational cause like injury etc.
Diseases were due to fright, fear and
unknown terror (thunderstorm, fire,
water, rain, sun, moon, animals, etc.)

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 Physically men were affected primarily by degenerative joint
disease, fractures, respiratory diseases like sinusitis,
bronchitis, digestive disturbances, skin disease.
Various cancers are identifiable in the skeleton. Primary bone
cancer is rare, but the skeleton is a common site for the
secondary spread of cancerous growth from other tissues.
Specific traces in the skeleton system suggests certain infection
like tuberculosis (traces on the ribs and tends to destroy the
bodies of the lumbar vertebrae), congenital syphillis
(Hutchisonsincisor), leprosy (damage to the bones of the face,
fingers, and toes)
Life expectancy was 25-40 years.

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 Shamans or Sorcerers, were
considered as intermediate
between human world &
spiritual world.
He use to wore monstrous
animal mask to frighten the
evil spirits causing illness.
Shamans were considered to be
able to contact supernatural
powers and to remove the evil
spirits to cure the patients.
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 Trephining was the process
in which shamans use to make
a perforation in the skull to
expel the demon or evil
spirit.
This was practiced to cure
headache, epilepsy or
tumours.
For trephining they used
sharpened edges of stones
and flints.click here
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Treatment for Fracture
They were able to set broken or
fractured bones using clay material.
Clay used to set hard so that the bone
could heal properly.
Healing of open wound
They used pincers of certain ant
species to heal an open wound.
They allowed the ant to stand above
the wound until it bit, then its head
was removed allowing the pincers to
remain and hold close the wound.
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 They use to eat clay and earth as
well as they used to apply it
externally.
Also, early humans could have
learned about the use of various
healing clays by observing animal
behavior.
Such clay is used both internally and
externally, such as for treating
wounds, and after surgery.
The reflection of same is seen in
Naturopathic process of mud
therapy.
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 Occasionally one finds, in wall painting made by pre-historic man, the
spears or arrows plunged exactly into the vital organs of the
animals, showing that in terms of their animal victims, if not
themselves, pre-historic hunters had a precise knowledge of
anatomy.

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 The oldest historic phase of medicine known to us is that of ancient
Medicine.
All future development of medicine had some glimpses of Egyptian
medicine.
Egyptian medicine enjoyed great fame in antiquity.
Egyptians are credited with being the first to use and record
advanced medical practices.
Egyptian medicine played a dominant role in the history of
ancient medicine for about 2500 years and then it was replaced by
Greek medicine
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 Papyrus is a thick paper-like
material produced from the pith of
the papyrus plant, Cyperus papyrus.
These papyri were used to record
documents related to medicine,
religion, philosophy, mathematics,
magic etc.
Egyptians wrote there inscription on
papyri mostly in Hieroglyphic
language.
There were several papyri related to
medical texts but Edwin Smith
Papyrus and Ebers Papyrus were the
most interesting and well known.

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 Hearst Papyrus (20th century BC): Medical text relating to urinary bladder,
blood, hair and piles. It also included treatment for cancer.

Ramesseum Medical Papyrus (18th century BC): Related to

ophthalmology, Gynaecology, muscles & tendon, and Paediatrics

Edwin Smith Papyrus (16th century BC): Textbook of Surgery

Ebers Papyrus (16th century BC): Incantation and foul application meant
for disease causing demons

Chester Beatty Papyrus (12th century BC): For headache and anorectal
ailments

Brooklyn Papyrus (4th century BC): Ailments for poison

Carlsberg Papyrus (2nd century BC): Deals with eye disease and
Pregnancy

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 Hieroglyphic method of writing
contained a combination of
logographic and alphabetic
elements.
Papyrus are written mostly in
hieroglyphic writing.

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 Egyptian had some knowledge of
Anatomy can be gathered from the way
they mummified the dead body.
Mummifiers use to pierce the nasal
bone to remove the brain.
They also must have had a general idea
of the location in the body cavity of the
inner organs, which they removed
through a small incision in the left
groin.

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 They had good knowledge of physiology which they derived from
embalming the dead body.
They supposed that the disease to which men are subjected proceed
from the food they use.
Egyptian physicians were aware of the existence of the pulse and of
a connection between pulse and heart.
They could not discriminate between blood vessels, nerves and
tendon.

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 They were able to cure night blindness by feeding patients liver.
Over more than 3000 years ago, the ancients, not only knew night blindness but
also knew how to cure it. They did not know vitamins and they did not know what
we now know, that Vitamin A deficiency causes night blindness; but to be able to
cure it, they must have been aware that there was a dietary factor deficient that
caused the disease.

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 The Egyptians believed that disease and death
were caused by a god, a spirit, or some other
supernatural force.
The healers often used incantations and magic
as part of treatment.
In Egyptian time priest, doing magic &
incantations, and physicians were the one and
same.

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 They developed their theory of
"channels" that carried air, water
and blood to the body by analogies
with the River Nile.
In analogy to river Nile they said as
crops became unhealthy when it is
blocked in the same way they said
that body becomes sick when these
channels are blocked.
If a person was unwell, they would
use laxatives to unblock the
"channels".

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 They Similia principle in very crude form.
They used similia principle in the form of doctrine of signature eg
they used ostrich egg for the treatment of broken skull.
However, Hahnemann in 110 refuted the use of similia principle on the
basis of doctrine of signature.

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 Bloodroot, with its red extract, was theorized to fix problems with blood.
And the saxifrage, which breaks apart rocks as it grows, must relieve kidney stones.
Venomous bites are covered too: Alkanets viper-shaped seeds help for snake bites,
and the coiled shoots of the herb scorpius will take care of that scorpion sting lickety-
split.
Even using plants that grow in the same area where a disease like malaria is prevalent
can be used as cures.

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 They suffered from the injuries and deformities caused by hard
labor.
They suffered from insect born diseases such as malaria and
trachoma, an eye disease, small pox, measles, tuberculosis, and
cholera.
It is believed that there were occasional outbreaks of the bubonic
plague.

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 Leprosy, which had originated in Egypt, was relatively rare.

Silicosis of the lungs, caused by breathing in sand particles was a common

cause of pneumonia for the ancient Egyptians.
Eye diseases due to injuries from sandy wind from desert.

The ancient Egyptians also suffered from diet-related ailments such as

malnutrition, vitamin and mineral deficiencies, dental abrasion, and ailments
normal to all humans such as arthritis.

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 The use of surgery evolved from a knowledge of the basic
anatomy and embalming practices of the Egyptians.
They were very much skilled in healing physical injuries,
these physician were able to do amputation and for the first
time Egyptian used prosthetics.
They were skilled in performing eye surgery.

They knew how to suture wounds. They used honey as an

antiseptic and moldy bread as antibiotic.

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Prosthetic foot
 The prescription for a healthy life, meant that an individual
undertook the stringent and regular purification rituals
(which included much bathing, and often times shaving
one's head and body hair), and maintained their dietary
restrictions against raw fish and other animals
considered unclean to eat.
Among the curatives used by the Egyptians were all types
of plant (herbs and other plants), animal (all parts
nearly) and mineral compounds.
Yeast's were also taken internally for digestive disorders
and were an effective cure for ulcers.

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 In Egyptian time the art of medicine was divided so that each
physician applies himself to one disease only and not more.
Some were physicians of eyes, other for the head, others for
the teeth. Others for the intestines and others for internal
disorders.
This clearly shows that todays era of specialization and super-
specialization has come en route from Egyptian medicine.

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 Imhotep was the Egyptian demigod
of medicine.
He was earliest known physician.
(DEBATABLE)
He was founder of medicine in Egypt
and his writings were devoid of
magical thinking.
He was the original author of Edwin
Smith Papyrus.
He was also considered as the first
architect engineer. He designed the
step pyramid at Saqqara. 33
 Two thousand years after his death, Imhotep's status had
risen to that of a god of medicine and healing. He was
eventually equated with Thoth, the god of architecture,
mathematics, medicine and patron of the scribes: Imhotep's
cult had merged with that of his former tutelary god.

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 Thoth was considered one of the
more important deities of the
Egyptian pantheon.
In art, he was often depicted as a
man with the head of an ibis or a
baboon; these animals were sacred
to him.
His feminine counterpart was
Seshat.
The Egyptians credited him as the
author of all works of science,
religion, philosophy, and magic.
Mythology also credits him with the
creation of the 365 day calendar.
Seshat
Thoth 35
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 Ancient Aegean civilization began around 3000 B.C.

Greek Medicine developed with philosophy, disciplined

by strict criticism, and healing for the first time became a
science as well as an art, practiced not by priestly caste
but by laymen who replaced magic by enquiry.
From the writings of Homer (c. 850 B.C.), a great poet, we
get the earliest glimpse of Greek medicine.

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Greek God
of
Medicine &
Healing

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 He was son of Apollo and
Coronis.
A mythological story is attached
to his birth that his mother was
killed for being unfaithful to
Apollo but the unborn child was
rescued from the womb of his
dead mother.
He was called as Aesculapius
which means to cut open.
Apollo Snatching the Unborn Asclepius Apollo took the baby to Centaur
from the Flaming Womb of Coronis Chiron, son of Saturn, who
brought him up and taught him
art of medicine.
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 Aesculapius had five daughter, each reflecting a specific
feature of medical art/healing:
Hygieia : Hygiene
Panacea: Universal remedy
Laso: Medicine
Aceso: Healing
Agla: healthy glow

Hygieia

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Panacea Laso
 Aesculapius carried with him a Staff
round which twists the serpent, this
was the symbol of ancient medicine
and is still the symbol of medicine in
modern world.
This staff of Aesculapius was called as
Askelepian.
The snake symbolizes the shedding
of skin as a sign of rejuvenation or
alternatively it signifies dual nature
of physician as dealing with life and
death, health and sickness, medicine
and poison etc.

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 The temples of his cult, dedicated to healer
God Aesculapius, were known as Asclepieia.
Most celebrated Asclepieia were in Cos,
Epidaurus, Cnidus and Pergamus.
In the state of induced sleep, called as
enkoimesis, the priest presented himself
before the patient to administer medical
advice, if he happened to be awake.
If he slept, as was usually the case, the advice
came in a dream, which was interpreted
afterwards by the priests, who then
Temple of Aesculapius prescribed catharsis, emesis, blood-letting
or whatever remedy seemed appropriate.
Before these patients left the temple tablets
were hung on the wall of the temple
engraving their name, brief history and
treatment offered.
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 Aesculapius became so
proficient in the healing
art that Pluto accused
him of diminishing the
number of shades in
Hades. He was then
destroyed by a
thunderbolt of Zeus.
Zeus
Are gods immortal?

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The symbol has continued to be used in
modern times, where it is associated with
medicine and health care

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 The theory of the Four Elements is
generally attributed to Empedocles.

According to this theory, everything in the

universe, including the human body, is
composed of the Four Elements in
varying proportions:

- Fire, - Air, - Earth - Water.

Empedocles had a theory of building up,

or synthesis (anabolism) versus breaking
down, or analysis (catabolism).

The physician's job was to assess the

patient to see which aspect of metabolism
predominated, and then bring them back
into balance.

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 Thales was the first true scientist-
philosopher of the Greeks.
Thales believed that the basic element
in all animal and plant life was water,
from which came earth and air.
Although he accepted the idea of a
God, he did not use religious means
to seek or establish the natural
processes of the universe or of humans.
He has been called as the "Father of
Science".

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 Alcmaeon of Crotona gave a theory of isonomia, which
means the perfect harmony of all substances in the
metabolism.
The body is healthy as long as this metabolic harmony was
maintained; disease resulted from its disruption.
Disease was cured by restoring metabolic balance and
harmony to the organism.
Modern nutritionists and physiologists see in isonomia the
precursor of all modern metabolic theory.
But he also believed that investigation (including
dissection), not just philosophy, was needed in order to
understand the body. His combination of direct
observation and experimental testing stands out as
unique in his time.
Although many remarkable facts emerged from his
dissections (probably on animals)
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FATHER OF
MEDICINE

VIS-MEDICATRIX
NATURAE

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 Hippocrates based his principles and
practice on the theory of the existence
of a spiritual restoring essence or
principle, the vis medicatrix naturae.
In therapeutics, he believed in simply
assisting nature, his scheme of
treatment was usually confined to such
plain expedients as fresh air, good
diet, purgatives, blood-letting,
barley water, honey & water, honey
& vinegar, massage, and
hydrotherapy.
To this end, Hippocrates believed "rest
and immobilization were of capital
importance".
Here Hahnemann differed slightly from
Hippocrates. 50
 Hippocrates gave idea of four Humours:
blood,
yellow bile,
phlegm and
black bile.

He said that balance between these humours is

the state of health and any imbalance is illness.
His therapy was also directed in restoring the
balance between these humours.

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 He divided diseases into four classes
acute,
chronic,
endemic and
epidemic.

His book on Epidemic Diseases gave vivid description of these

diseases.
Hahnemann in 72 to 81 made similar survey of disease.

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 Hippocrates was constantly seeking the causes of disease.

He studied such things as climate, water, clothing, diet, habits of

eating and drinking and the effect they had in producing the
disease.
His book Airs, waters, and places stressed the relation between man
and his environment. This book contains the first enunciation of the
principles of public health.
Same concept reflects in Hahnemanns work in 4, 5, 77 of Organon
of Medicine and also at many places in Chronic Disease.

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 Hippocrates chose the simplest out of a class of diseases;
these he watched closely and described minutely.
In these simplest maladies he gave single simple
remedies out of the store of existing drugs which was then
small.

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 He devised a method of diagnostic investigation based on
observation and on reason which is even valid today.
He laid much stress on prognosis.

He & his followers evaluate an illness and induce likely progression

of disease based on the data collected and detailed case histories.
To this end Hippocrates and his follower instituted for the first time
through going examination of patients condition including facial
appearance, pulse, temperature, respiration, excreta, sputum,
localized pains and movements of the body.
They gave several clinical signs which still hold its importance in
modern medicine few important among them were
Hippocratic facies, - Clubbing of fingers,
Cheyne-stokes breathing. - Crisis etc.

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 In Greek atheletes and sports was very prevalent.

History reports that Olympoid games started in Greece in 776 B.C.

and was very prevalent in ancient time and even today.
Atheletes and sports had great impact in the development of
medicine in Greek time.
Many fractures and wounds described by Hippocrates are common
only in atheletes.
Hippocratic Bench was one of his innovative techniques for giving
traction to the fractured limb.
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 The Hippocratic Corpus (Latin: Corpus
Hippocratum) is a collection of around
seventy early medical works from
ancient Greece strongly associated with
Hippocrates and his teachings.
The Hippocratic Corpus contains
textbooks, lectures, research, notes
and even philosophical essays on
various subjects in medicine, in no
particular order.
There are a number of case-histories
in the Hippocratic Corpus, 42 to be
exact.
Two books in corpus hippocraticum
contain description about similia
principle
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 Aphorisms
Instruments of Reduction
Of the Epidemics
On Airs, Waters, and Places
On Ancient Medicine
On Fistulae
On Fractures
On Hemorrhoids
On Injuries of The Head
On Regimen in Acute Diseases
On the Articulations
On the Sacred Disease
On the Surgery
On Ulcers
The Book of Prognostics
The Law
The Oath

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 Father of Biology

Student of Plato

Teacher of Alexander
the Great

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 He was the man who gave medicine the beginning of
botany,
zoology,
comparative anatomy,
embryology,
Teratology,
physiology,
and the use of formal logic as an instrument of precision.

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 He studied development of the chick day by day, noted
the salient features of the development of the chick
embryo.
He noted the
beat of fetal heart,
the vitelline and allontoic veins,
the enveloping membrane, and
the possibility of superfetation.

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 In contrast to his predecessor philospers, but in much accordance to
the Egyptian belief, placed the rational soul in the heart rather
than brain.
He gave the doctrine of primacy of the heart, as the source of innate
heat, the seat of sensation and thought.
Contrary to the view of Alamaeon, that the brain feels and thinks,
Aristotle regarded it as a gland secreting cold humours to prevent
overheating of the body by the fiery heart (via the lungs).

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 He divided animals into
Enaima or sanguineous (vertebrates) and
Anaima or bloodless (invertebrates),

Then he also divided them as to their reproductive status

viviparous,
oviparous,
gemmulous,
spontaneous generation.

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 It was the book of Aristotle titled Organon which was
standard collection of his six works on logic.
These works are
Categories,
On Interpretation,
Prior Analytics,
Posterior Analytics,
Topics, and
Sophistical Refutations.

Later Francis Bacon (1561 -1626) gave the Novum Organum.

Hahnemann was influenced by both these works and gave a
title to his book as Organon of Medicine.

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 130 AD
Galen was fanatical in his pursuit of anatomical knowledge. He conducted
dissections and vivisections on animals, chiefly apes, to figure out by inference and
experiment how the human body was structured, and how it worked
Galen's most famous medicinal formula was Theriac, an herbal jam or electuary
with some 64 differnt ingredients that was a virtual panacea or cure-all for many
diseases, and an antidote to many poisons.
For over a thousand years after his death, Galen, with his prodigious
accomplishments, was considered to be the gospel truth, the ultimate authority on
all matters medical.

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 Andreas Vesalius was a 16th-century Flemish/Netherlandish anatomist, physician,
and author of one of the most influential books on human anatomy, De humani
corporis fabrica.
Vesalius is often referred to as the founder of modern human anatomy
Corrected over 200 of Galens mistakes

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War surgeon in 16th century
Apprenticed by a barber
Cautery and suturing

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 17th century
Found that the heart pumped blood through
the body in one way
Found flaws in Galens work

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 18th Century
Vaccination
Took fluid from a cowpox blister and scratched it into the
skin of an eight-year-old boy.
Months later, he inoculated the boy again, this time with
smallpox matter, and no disease developed.
The vaccine was a success.

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NEXT WEEK:
Top Accomplishments in Health Care

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