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Mesopotamia and Levant



Prehistoric medicine

 

Although there is no record to establish when plants were first used for medicinal purposes (herbalism), the use of plants as healing agents is an ancient practice. Over time through emulation of the behavior of fauna a medicinal knowledge base developed and was passed between generations. As tribal culture specialized specific castes, Shamans and apothecaries performed the 'niche occupation' of healing.

Egypt

Ancient Egypt developed a large, varied and fruitful medical tradition. Herodotus described the Egyptians as "the healthiest of all men, next to the Libyans", due to the dry climate and the notable public health system that they possessed. According to him, "he practice of medicine is so specialized among them that each physician is a healer of one disease and no more." Although Egyptian medicine, to a good extent, dealt with the supernatural, it eventually developed a practical use in the fields of anatomy, public health, and clinical diagnostics.

 

Medical information in the Edwin Smith Papyrus may date to a time as early as 3000 BC. The earliest known surgery was performed in Egypt around 2750 BC. Imhotep in the 3rd dynasty is sometimes credited with being the founder of ancient Egyptian medicine and with being the original author of the Edwin Smith Papyrus, detailing cures, ailments and anatomical observations. The Edwin Smith Papyrus is regarded as a copy of several earlier works and was written circa 1600 BC. It is an ancient textbook on surgery almost completely devoid of magical thinking and describes in exquisite detail the examination, diagnosis, treatment, and prognosis of numerous ailments.

 

Conversely, the Ebers papyrus (c. 1550 BC) is full of incantations and foul applications meant to turn away disease-causing demons, and other superstition. The Ebers papyrus also provides our earliest possible documentation of ancient awareness of tumors, but ancient medical terminology being badly understood, cases Ebers 546 and 547 for instance may refer to simple swellings.

 

The Kahun Gynaecological Papyrus treats women's complaints, including problems with conception. Thirty four cases detailing diagnosis and treatment survive, some of them fragmentarily. Dating to 1800 BC, it is the oldest surviving medical text of any kind.

 

Medical institutions, referred to as Houses of Life are known to have been established in ancient Egypt as early as the 1st Dynasty. By the time of the 19th Dynasty some workers enjoyed such benefits as medical insurance, pensions and sick leave.



 

The earliest known physician is also credited to ancient Egypt: Hesy-Ra, “Chief of Dentists and Physicians” for King Djoser in the 27th century BC. Also, the earliest known woman physician, Peseshet, practiced in Ancient Egypt at the time of the 4th dynasty. Her title was “Lady Overseer of the Lady Physicians.” In addition to her supervisory role, Peseshet trained midwives at an ancient Egyptian medical school in Sais.

Mesopotamia and Levant

The oldest Babylonian texts on medicine date back to the Old Babylonian period in the first half of the 2nd millennium BC. The most extensive Babylonian medical text, however, is the Diagnostic Handbook written by the physician Esagil-kin-apli of Borsippa, during the reign of the Babylonian king Adad-apla-iddina (1069-1046 BC).

 

Along with contemporary ancient Egyptian medicine, the Babylonians introduced the concepts of diagnosis, prognosis, physical examination, and medical prescriptions. In addition, the Diagnostic Handbook introduced the methods of therapy and etiology and the use of empiricism, logic and rationality in diagnosis, prognosis and therapy. The text contains a list of medical symptoms and often detailed empirical observations along with logical rules used in combining observed symptoms on the body of a patient with its diagnosis and prognosis.

 

The Diagnostic Handbook was based on a logical set of axioms and assumptions, including the modern view that through the examination and inspection of the symptoms of a patient, it is possible to determine the patient's disease, its aetiology and future development, and the chances of the patient's recovery. The symptoms and diseases of a patient were treated through therapeutic means such as bandages, creams and pills.

 

Most of our knowledge of ancient Hebrew medicine during the 1st millennium BC comes from the Torah, i.e. the Five Books of Moses, which contain various health related laws and rituals, such as isolating infected people (Leviticus 13:45-46), washing after handling a dead body (Numbers 19:11-19) and burying excrement away from camp (Deuteronomy 23:12-13). While the observance of these statutes would have and do lead to several health benefits, Jewish belief commands that these rituals and prohibitions be kept purely to fulfill the will of God with no ulterior motive. Max Neuberger, writing in his "History of Medicine" says

"The commands concern prophylaxis and suppression of epidemics, suppression of venereal disease and prostitution, care of the skin, baths, food, housing and clothing, regulation of labour, sexual life, discipline of the people, etc. Many of these commands, such as Sabbath rest, circumcision, laws concerning food (interdiction of blood and pork), measures concerning menstruating and lying-in women and those suffering from gonorrhea, isolation of lepers, and hygiene of the camp, are, in view of the conditions of the climate, surprisingly rational." (Neuburger: History of Medicine, Oxford University Press, 1910, Vol. I, p. 38).

India

The Atharvaveda, a sacred text of Hinduism dating from the Early Iron Age, is the first Indian text dealing with medicine, like the medicine of the Ancient Near East based on concepts of the exorcism of demons and magic. The Atharvaveda also contain prescriptions of herbs for various ailments. The use of herbs to treat ailments would later form a large part of Ayurveda.

 

In the first millennium BCE, there emerges in post-Vedic India the traditional medicine system known as Ayurveda, meaning the "complete knowledge for long life". Its two most famous texts belong to the schools of Charaka, born c. 600 BCE, and Sushruta, born 600 BCE. While these writings display some limited continuities with the earlier medical ideas known from the Vedas, historians have been able to demonstrate direct historical connections between early Ayurveda and the early literature of the Buddhists and Jains. The earliest foundations of Ayurveda were built on a synthesis of traditional herbal practices together with a massive addition of theoretical conceptualizations, new nosologies and new therapies dating from about 400 BCE onwards, and coming out of the communities of thinkers who included the Buddha and others.

 

According to the compendium of Charaka, the Charakasamhitā, health and disease are not predetermined and life may be prolonged by human effort. The compendium of Suśruta, the Suśrutasamhitā defines the purpose of medicine to cure the diseases of the sick, protect the healthy, and to prolong life. Both these ancient compendia include details of the examination, diagnosis, treatment, and prognosis of numerous ailments. The Suśrutasamhitā is notable for describing procedures on various forms of surgery, including rhinoplasty, the repair of torn ear lobes, perineal lithotomy, cataract surgery, and several other excisions and other surgical procedures. Most remarkable is Sushruta's penchant for scientific classification: His medical treatise consists of 184 chapters, 1,120 conditions are listed, including injuries and illnesses relating to ageing and mental illness. The Sushruta Samhita describe 125 surgical instrument, 300 surgical procedures and classifies human surgery in 8 categories

 

The Ayurvedic classics mention eight branches of medicine: kāyācikitsā (internal medicine), śalyacikitsā (surgery including anatomy), śālākyacikitsā (eye, ear, nose, and throat diseases), kaumārabhṛtya (pediatrics), bhūtavidyā (spirit medicine), and agada tantra (toxicology), rasāyana (science of rejuvenation), and vājīkaraṇa (aphrodisiacs, mainly for men). Apart from learning these, the student of Āyurveda was expected to know ten arts that were indispensable in the preparation and application of his medicines: distillation, operative skills, cooking, horticulture, metallurgy, sugar manufacture, pharmacy, analysis and separation of minerals, compounding of metals, and preparation of alkalis. The teaching of various subjects was done during the instruction of relevant clinical subjects. For example, teaching of anatomy was a part of the teaching of surgery, embryology was a part of training in pediatrics and obstetrics, and the knowledge of physiology and pathology was interwoven in the teaching of all the clinical disciplines. The normal length of the student's training appears to have been seven years. But the physician was to continue to learn.

 

As an alternative form of medicine in India, Unani medicine got deep roots and royal patronage during medieval times. It progressed during Indian sultanate and mughal periods. Unani medicine is very close to Ayurveda. Both are based on theory of the presence of the elements (in Unani, they are considered to be fire, water, earth and air) in the human body. According to followers of Unani medicine, these elements are present in different fluids and their balance leads to health and their imbalance leads to illness.

 

China

 

China also developed a large body of traditional medicine. Much of the philosophy of traditional Chinese medicine derived from empirical observations of disease and illness by Taoist physicians and reflects the classical Chinese belief that individual human experiences express causative principles effective in the environment at all scales. These causative principles, whether material, essential, or mystical, correlate as the expression of the natural order of the universe.

 

The foundational text of Chinese medicine is the Huangdi neijing, or Yellow Emperor's Inner Canon, which is composed of two books: the Suwen 素問 ("Basic Questions") and the Lingshu 靈樞 ("Divine Pivot"). Although the Neijing has long been attributed to the mythical Yellow Emperor (twenty-7th century BC), Chinese scholars started doubting this attribution as early as the 11th century and now usually date the Neijing to the late Warring States period (5th century-221 BC).[16] Because the medical "silk manuscripts" dating from around 200 BC that were excavated in the 1970s from the tomb of a Han-dynasty noble in Mawangdui are undoubtedly ancestors of the received Neijing, scholars like Nathan Sivin now argue that the Neijing was first compiled in the 1st century BC.

 

During the Han dynasty, Zhang Zhongjing, who was mayor of Changsha near the end of the 2nd century AD, wrote a Treatise on Cold Damage, which contains the earliest known reference to the Neijing Suwen. The Jin Dynasty practitioner and advocate of acupuncture and moxibustion, Huangfu Mi (215-282), also quotes the Yellow Emperor in his Jiayi jing, ca. 265. During the Tang Dynasty, Wang Bing claimed to have located a copy of the originals of the Suwen, which he expanded and edited substantially. This work was revisited by an imperial commission during the 11th century, and the result is our best extant representation of the foundational roots of traditional Chinese medicine.





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