THE ANCIENT ERA

The earliest known civilizations lived in harmonious relationships with their surroundings. They held a holistic and vitalistic view of life and their explanations for life were based primarily on folk wisdom and subjective observation. Their pursuit of understanding the world and the human spirit were the same thing (Magner 1992). Linear causality and logical concepts were introduced in this era and the first dissections were performed.

The Eastern medical systems of Ayurvedic, Chinese and Greek–Unani medicine had existed for centuries and were based on holistic and vitalistic concepts. (These systems of medicine are expanded upon in Chapter 2.) Hippocrates (460–377 bce) is considered the father of Western medicine. He based his views of health on the humoral theories of Greek–Unani medicine.

Pythagoras of Samos (ca. 530 bce), furthered this theory as he believed that the universe was composed of opposite qualities and the harmony, or balancing of pairs of qualities, such as hot and cold, moist and dry, was important in matters of health and disease. Alcmaeon, a pupil of Pythagoras, taught that health was a harmonious blending of each of the qualities with its appropriate opposite and that disease occurred due to excess or deficiency; for example an excess of heat causes fever, an excess of cold causes chills (Magner 1992).

Socrates (469–399 bc) used the term logos or ‘will to live’ to describe the vital principle present in man, yet the origins of vitalism are often associated with Aristotle (384–322 bce). Aristotle developed a biological and materialistic approach to psychology where he believed that the ‘soul’ animated and directed the body. (González-Crussi 2007)

Much of the early understanding of how the inner body functioned was derived from dissections that were performed on animals, especially monkeys. Aristotle conducted dissections, yet most were not documented, and it is Galen (129–199 ce) who is credited with much of the initial understanding of anatomy as he performed and documented thousands of dissections.

Galen also introduced the concept that certain personality types were associated with particular diseases, and he reinforced the idea that the four elements of matter had ‘qualities,’ namely dryness, humidity, coldness, and heat. In his view, just as disease was thought to result from imbalances in the Hippocratic humors, it could also be caused by a number of factors that can disturb the respective qualities of these humors (Duffin 2007). After Galen, scientific knowledge was kept alive for years primarily by Arabic scholars who advanced the surgical art and study of internal medicine. They traveled extensively and established links with the traditions of the Far East, including India and China, and contributed greatly to the sharing of medical knowledge between these different cultures.

THE MIDDLE AGES

The European Middle Ages (500 to 1500 ce) was a period in which ideas about the nature of the universe, the nature of human beings, and their proper place in the universe – including their relationship to their Creator – underwent profound changes (Magner 1992). The Middle Ages saw the separation of medicine and surgery, the innovation of the hospital, and the challenge of devastating diseases. It was a period of transition from the Hippocratic traditions to medieval Christianity.

Ancient Greeks regarded good health as the highest good, yet seeking health was not congruent with Christian doctrine. According to Christianity, illness was regarded as a divine punishment for sins committed by the patient and healing required the spiritual and physical catharsis obtained by combining confession and exorcism with purgative drugs (Magner 1992). By the eleventh century, some monasteries were training their own physicians as it was felt that these physicians would uphold the Christianized idea of the healer who offered mercy and charity towards all patients, whatever their status and prognosis. Not everyone embraced these Christian concepts and hence the followers of Hippocratic medicine found ways to accommodate Christian beliefs and theologists found ways to justify the Hippocratic methods of healing.

The plague and leprosy contributed to the death of many and challenged the beliefs and ability of the current medical systems. The plague had been around previously but the outbreak in the fourteenth century was the most famous epidemic in Western history (Duffin 2007). The origins and transmission of disease, the concepts of resistance and immunity, and the necessity for proper hygiene were yet to be understood. This was a time of great learning as it contributed to the understanding of disease and the need for public health standards. For some, epidemics and disease were viewed as divine punishment, others felt they were brought by foreign travelers, and for most it was a time of great panic and suffering. Because of the inability of the church and their medics to handle diseases such as the plague, they lost a lot of credibility (Duffin 2007).

The Middle Ages was a difficult time for surgery and surgeons. Surgery was split into three classes. The highest class was the physicians who were university educated. Their role was to prescribe and to give advice. Next were hands-on practitioners who could dress wounds, set fractures, and apply poultices and plasters but who did not perform incisions or invasive procedures. Last were the ‘barber-surgeons,’ who were the ‘untouchable caste,’ so to speak, of the profession. They could bleed patients, lance boils, and perform other invasive procedures. They had no university education, and were regarded by their more exalted colleagues as menials (González-Crussi 2007). This distinction between the classes of medical men changed in 1540 when King Henry VIII signed a charter that incorporated barbers and surgeons in a common guild. Shortly after that medicine was established as a profession based on a formal education, standardized curriculum, licensing, and legal regulations.

Women have always been associated with the healing arts, yet from the twelfth century to the fourteenth century, although some Universities allowed women to study and teach medicine, women were discouraged or forbidden to practice formalized medicine. Hildegard of Bingen (1098–1179) was one of the twelfth century’s most notable women (Magner 1992). She re-introduced the concept of treatments based on the principle of opposites and wrote about the medical uses and toxic properties of herbs, trees, mammals, reptiles, fishes, birds, minerals, gems, and metals. Other women served as nurses, herbalists, and healers.