Monday, January 28, 2013

At the museum under our noses, by Seth Morrison

History of Medicine museum, Faculty of Health Sciences, Ben-Gurion University 

It is quite remarkable what a medical student can learn simply by walking through the corridors of the BGU-MSIH medical school campus. There, a wealth of medical historical knowledge has been built into the very walls of its interior spaces. Thus, it is really an effortless undertaking for any medical student with a curiosity to understand the origins of their profession to simply walk and read through these exhibits. A total of an hour or two spent perusing them is sufficient to attain the beginnings of a well-rounded medical historical education from ancient times to the modern era. It was with this intention that I purposefully took to these corridors one day to see what I could find, and what follows here is an account of my findings.

The ancient Egyptians practiced a form of medicine in keeping with their mythology, incorporating various rituals surrounding their deities into their treatments. There are many different unique remedies that were used on patients, including hippopotamus fat and human excrement. The Nile dwellers also acquired more knowledge of bodily organs than other contemporary civilizations due to their routine procedure of embalming the deceased.

Medicine in biblical times drew on the religious traditions in the Bible and Talmud. The Hebraic practice of medicine was fascinated with life and death, a result of the veneration of mankind imbued by its creation in the image of God. The basis of Hebraic treatment was mainly social and personal hygiene: 213 out of the 613 mitzvot (precepts of God) are related to health in some fashion. Some of the surviving rabbinic texts, like the Mishnah, reveal a stark similarity of issues to the ethics of modern medicine in the polis: the rabbi criticized physicians for over-commercialization of their services and failure to attend to the poor, and drew a hard line by saying that refusal to attend to the poor is tantamount to homicide.

The basis of Greco-Roman medicine was Galen’s Four Humors. A “humor” is not a joke or jest, but the term applied to a bodily fluid. On their account, an imbalance of these humors was the etiology behind every disease, and they determined each person’s temperament: either melancholic, sanguine, phlegmatic, or choleric. Additionally, Hippocrates was the leader of a rationalist school of medical thought in Rome, and the Hippocratic corpus descends to us from this period. This corpus, we know, provides the ethical foundations for our modern practice of medicine in the West. And have you ever wondered where the medical symbol of a serpent wrapped around a staff derives from? It comes from the myth of Asclepius, the Greek god of medicine, who apparently carried such a staff.

Medicine in the Islamic world was also heavily influenced by Galen and the Roman rationalist school. The best hospitals in the world during the Middle Ages were said to be in Cairo, Baghdad, and Damascus. Many brilliant thinkers emerged from the Islamic world. Rhazes (d. 925) wrote the first accurate clinical description of measles and smallpox. Avicenna first suggested the contagious nature of tuberculosis. Maimonides, a prominent Jewish philosopher and physician, was a physician in the court of Saladin in Cairo in the late 12th century and his fame extended into every great civilization of the time.

In medieval medicine, the term “physicus” began being applied to the academic doctors who philosophized about medicine more than they spent time treating people. Galen’s theory of humorism remained the dominant one, although there were many elements of folk medicine brought into the mix during this period. Observation of the characteristics of urine was the primary diagnostic test, and bloodletting was used as a treatment for a variety of ailments. Many odd elixirs, balms, tinctures, tonics, pills, and potions were given to patients to take, one of the most common being theriac, which had a long list of ingredients including viper flesh. Medieval doctors were not known for their effectiveness in healing. In fact, they were often derided for their impotence in jokes like this medieval poem:
Said time to the fool, be a physician,
and kill people for their riches.
You will have an advantage over the angels of death,
for they kill mankind for free.

This history may seem dry to some, but meaning always follows from reflection. It is given here merely to consider that there are many things to discover about the medicine of the past, and understanding where we came from is not a trivial pursuit. In reading these exhibits and inspecting their historical artifacts, I was reminded of the Hunterian anatomical gallery at the University of Glasgow and seeing its cadaverous collection of centuries-old anatomical specimens. It was there that I first became interested in the early roots of modern medicine.

In the end, it is unlikely that any hospital department head or patient of mine will ever be dissatisfied with me as a physician if I don’t know something about Vesalius or Boerhaave, Galen or Willis, Harvey or Hunter. Nevertheless, even though these things are inessential, I would think myself to be missing something vital if I was completely oblivious to the fact that, as Newton admitted, “if I have seen further, it is by standing on the shoulders of giants.”   - blogger of the month, Seth Morrison

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