Book review: “The History of Medicine in 50 Objects” by Gill Paul
Gill Paul outlines the history of medicine from the Stone Age to the present day. Such a large framework is best exemplified, and so the author works out 50 objects on which the developments in the art of healing can be traced. The history of medicine shows at the same time the history of human cultures and the changes in thinking caused by changed production conditions, scientific knowledge and values and norms that have arisen from new conditions.
An overview of the chapters
So the work begins with the archaic period, when our ancestors lived in a magical world and diseases demonstrated the work of evil spirits. Then it goes to ancient Egyptians, the Islamic scholars, the advanced medicine in Persia, China and India. In 50 chapters, Paul presents a medical achievement, in chronological order from the trepanations of the Stone Age to the Persian doctor Avicenna in the 11th century, Harvey's illustration of the blood circulation, Florence Nightingales lamp, the mouthguard for flu, the first heart transplant and protective clothing for Ebola .
Progress and stagnation
This cultural history was by no means just progress. False ideas became dogmas and hindered further development for centuries, even though experience knowledge opposed them: The Galensian four-juice theory is an example of how a misguided presumption prevented medical progress.
In addition, most therapies were ineffective at best until modern times; this often meant senseless agony for the patients and sometimes even led to a "painful death". Nevertheless, the history of the 50 objects shows that in all cultures and at all times doctors did everything possible to make life worth living.
Almost every fifth skull from the Neolithic Age has boreholes. These trephined skulls were found in the South Pacific as well as in North Africa, in Europe, Asia and New Zealand. It is the oldest known surgical procedure. The purpose of these operations is unclear.
In some cases, previous skull injuries were clearly evident, so that the holes were probably used to remove bone fragments. Scientists suspect that the cranial openings were also used to cure headaches, epilepsy and mental disorders.
According to archaic thinking, they came from evil spirits that had settled in the body and were able to get out through the holes. The pieces of bone removed probably served as talismans.
Sometimes the holes were closed with shell shells, later metal plates made of gold or silver. Already 4000 BC BC the doctors used bow drills to drill the holes.
The risks were immense: bleeding, blood clots and shock as well as brain swelling, but above all infections. The knowledge of the early doctors is astonishing. After all, two thirds of the skulls show healed wounds, which at least means that these patients survived. Surgeons were most likely careful not to injure the brain.
These skull openings lasted until modern times and developed independently of each other. The Maya and Aztecs, who very often performed trepanations, had no contact with the Chinese, who also carried out these operations, and they, in turn, had no connection to medieval European doctors.
In the Middle Ages, harmful vapors in the body were believed to cause illness, and the skull opening released these vapors into the outside world. Trepanations were also considered a remedy for insanity, and in the early modern period they were considered a remedy for epilepsy.
As strange as it sounds to let evil spirits or harmful vapors escape by opening the skull, trepanation makes sense in certain cases, and doctors still use them today.
Trepanation can relieve increased skull pressure that arises from bleeding in the brain, as well as headaches that occur after a head injury.
Edwin Smith's papyrus
The papyrus of Edwin Smith is one of the most important discoveries in medical history. Smith was a British archaeologist who accidentally came across an ancient scroll from a dealer in Luxor in 1862.
This papyrus was more than four meters long, and when the hieroglyphs could be deciphered, it was shown that it was a medical manual for almost 50 diseases. Some of the methods date back to around 3000 BC; it is the oldest known medical text.
The record showed that the Egyptians 5000 years ago had a knowledge of diseases that far exceeded that of the European Middle Ages: The script contains detailed descriptions of the human brain and they knew that the blood moved - with the heart as the center in the Center.
Urea against wrinkles
An anti-wrinkle ointment contained urea, which is still used today in anti-wrinkle agents; the author was aware that damage to certain parts of the body triggered incontinence, paralysis and convulsions. The papyrus is strictly scientific and contains little evidence of magic. The method corresponds to today's science: the author concluded from observations and drew logical conclusions from them.
It is therefore no coincidence that the ancient Egyptian healing arts had such a high reputation that it was regarded as a special distinction in Greece and later Rome when a doctor had had his education in Egypt.
The Nineveh Library
In addition to Egypt, Mesopotamia was a center of medicine in the ancient world, under the changing sovereignty of Babylon, Assyria and later the Persian Empire. 600 cuneiform documents from the time of Assurbanipal of Assyria showed a rational understanding of medicine, which served as a guide for centuries.
The Mesopotamians separated between ashipu, healers who also used spells and incantations and whose rituals reminded one of today's alternative practitioners and the doctors, asu, who used herbal remedies and worked as surgeons.
The people of the country between the Euphrates and Tigris believed that gods controlled the world and spirits were omnipresent, but they knew a medicine that was based on rational knowledge.
Some of the herbal remedies they use are still used today because they have an antiseptic effect - so they used soaps made from resin and animal fats that kept bacterial infections at bay. The clay tablets owned by Assurbanipal are arranged in sections on, for example, gynecology and paediatrics.
The Atharvaveda from the Vedic scriptures characterizes Indian medicine. Ayurvedic belief saw a balance between air, fire, water and soil as crucial for human health, and they were unique in each person from birth.
In Ayurvedic literature, healthy nutrition and medicine were inseparable. Treatments for diseases were based on which type of element a condition corresponded to. Therapies included Panchakarma (cleansing), Shamana (relaxation) and Bhrimana (nutrition).
Cataracts and bladder stones
In addition, the doctors of ancient India were well versed in surgery and used over 100 instruments, for example to remove cataracts, remove bladder stones and cauterize wounds. However, their knowledge of anatomy was limited for the same reason as that of doctors of the Christian Middle Ages: they were not allowed to dissect corpses.
The teachings of the Huangdi
The mythical yellow emperor of the third millennium BCE in ancient China provided a fictitious question-and-answer textbook between Huangdi and his ministers that appeared in the first millennium BCE. The first part deals with diagnoses, the second part with acupuncture.
This Huangdi Neijing argued that both internal and external influences can cause illness. The external causes were therefore wind, cold, heat, moisture and summer heat, the inner joy, anger, brooding, grief, fear and sudden horror. These factors all led to specific symptoms, such as heat, dizziness and nausea.
Yin and yang
The aim of treatment was to create a balance in the body between the opposing forces Yin and Yang as well as between the elements earth, water, fire, wood and metal, which in turn were related to the human organs, as well as to the colors, the types of climate , the senses and flavors.
The Huangdi Neijing described six different pulses, and an elementary part of the medical diagnosis was to feel them.
Huangdi Neijing defines the 12 main meridians, lines of force through which the substance Chi flows in the body. These lines are related to organs and body functions, and here are the 365 acupuncture points. The doctor stimulates the flow of chi by pricking fine needles at points on the meridians.
Although these meridians do not exist anatomically, acupuncture is suitable for the relief of certain diseases and to support treatment with traditional Chinese medicine.
There are nerve conduits for transmission pain, that is, pain that occurs in other parts of the body than the injury itself. Dissection was also prohibited in China, and the ancient Chinese doctors came to fundamentally correct results based on external observations.
Galen lived from 150-210 CE, studied medicine in Pergamon and Alexandria, among others. In order to document its importance for medicine, Paul introduces his so-called phlebotome, a lancet to open the patient's veins during bloodletting.
Galen showed that the brain controls the muscles via the nerves and not the heart, as Hippocrates had thought. He did this in a gruesome manner, cutting the nerves of a living pig, causing the pig to scream in pain and only stop when he cut the nerve to the larynx.
Galen also noted that there was light blood in the arteries and dark blood in the veins. He believed that venous blood was a product of the liver, arterial blood was a product of the heart.
He stuck to the four-juice theory and supplemented it with a temperament theory, in which each juice was linked to a typical personality: black bile led to melancholy, yellow bile corresponded to choleric people and phlegm to marked phlegmatists.
Galen found that the kidneys produced urine, not the bladder.
His most important method was bloodletting, which he preferred to all other therapies and prescribed for numerous illnesses. These ranged from epilepsy to pneumonia. For him, bloodletting was not the same as bloodletting: One should open his right hand for liver diseases, one left hand for spleen complaints, and one on the right elbow if there was bleeding from the right nostril.
Galen's teaching was preserved well into modern times. In addition to real discoveries such as the connection of nerves to the brain, his temperament was unfortunately wrong, as was the inflationary use of bloodletting.
The raven mask
Today we know the raven mask mainly from the Venice Carnival. It dates from the plague epidemic and marked the plague doctors. In 1346, more than 50% of Europe's population died of the plague in seven years. Many doctors refused to treat the plague, presumably because they suspected that the disease was contagious. The doctors who helped the sufferers tried to protect themselves by putting on a raven mask.
The Byzantine Plague
During an early plague epidemic of 541-543 CE, the plague broke out in Constantinople after it reached China from China via the silk roads and the sea route. The Byzantine Empire primarily obtained grain from Egypt, and the vats in which it was kept were a paradise for rats.
In today's Istanbul, 5,000 people died every day, and the epidemic spread to Arabia and Europe. Some historians see this epidemic as a trigger for the decline of the Roman Empire. However, this continued to shrink in the east until 1453, and in the west it was destroyed in the fifth century by migration.
The bird of death
The raven was symbolically the bird of death, but the mask served a practical purpose: the doctors filled the beak with herbs that they hoped in vain to protect against the plague.
Bubble and lung plague
The sufferers suffered from swollen lymph nodes, swelling in the armpits and groin. Pus and blood oozed from these “bumps”. Then the victims fevered and vomited blood, followed by black and red spots on the skin. 80% of the sick died.
Some sufferers have difficulty breathing and coughed up blood. Their lungs were infected. The infection spread through sneezing. The doctor mask could help at least against the lung plague. Up to 95% of the patients died of lung plague, and almost 100% of plague episodes.
It was not until the end of the 19th century that it became clear that Yersinia pestis caused the plague and was transmitted by infested fleas sucking on their hosts. These are mostly rodents, and they carry the disease on. In Europe, it was mostly hiking rats. The fleas hopped from rats to humans, and humans became infected with flea bites. A transmission from person to person was also possible.
In the Middle Ages the cause was unknown, the helpless attempts to master the plague led to people losing respect for doctors and looking for scapegoats. They accused the Jews of poisoning the wells and burned the innocent alive. There was talk of devilish conspiracies, Roma and lepers had to fear for their lives just as much as strangers who were in a city. In Strasbourg alone, the mob slaughtered 1,349 2,000 Jews.
Although the transmission route was unknown, the doctors rightly tried to avoid any skin contact with the sick. In 1619, Charles de Lorme developed a pestle suit with a waxed overcoat, gloves and a bird mask with a beak that contained spices and herbs to filter the contaminated air: amber, lemon balm, camphor, mint and cloves. The doctors examined the patients with a stick instead of touching them.
Doctors also fell ill, but even if the flea infection was unknown, avoiding skin contact certainly helped. But it was enough that the fleas jumped on the pest suit. Then when the doctor took it off and it got on his skin, he became infected too.
The actors of the Commedia dell'Arte took over the pest suit, and so he entered the Venetian carnival.
The Red Cross
The chapter on the Red Cross introduces war medicine. In 1859, the Swiss Henry Dunant decided to act. He passed a battlefield near Solferino, Italy, where 40,000 men were wounded among the dead, and many of them died.
Dunant designed a neutral aid organization for war wounded, which should be recognizable by an armband with a red cross. In 1914 there were already 45 national Red Cross organizations. After the First World War, the International Red Cross expanded its activities to natural and man-made disasters such as famines.
Well-trained medical personnel for war injuries are known from the ancient Romans; these followed the army and treated injuries on their own side. Treating enemies was taboo.
Brutal and senseless
War medicine was cruel even for the own people until the modern times and above all a matter for the surgeons, who were colloquially called bone saws. The overwhelmed doctors knew one method above all to treat the wounded: they amputated the injured limbs to prevent infections. They burned the wounds with glowing iron or poured boiling oil over them. More than half of the amputees died of blood loss or gangrene.
Mobile field hospitals
In the 19th century, Dominique Jean Larrey developed mobile field hospitals that followed the armies and a new profession emerged: the stretcher carriers and the ambulance drivers had to act quickly, and the doctors had to decide which wounded needed first treatment - just like today's emergency physicians It was also up to them to make the hard decision as to which injuries had little chance of survival.
Larrey served Napoleon, but his people treated injuries on both sides. This went hand in hand with the bourgeois code of the Napoleonic armies, which prohibited unnecessary cruelty to the enemy.
Anecdotes and surprises
Gill Paul has achieved something great: she builds lighthouses in an ocean of history that stretches from the Stone Age to the present day, from the fall of the Roman Empire to psychoanalysis, from childbirth aids to knowledge about the bloodstream, from magic to science.
We learn that malaria means bad air because the Romans believed that the air in the swamps triggered the disease, how the X-ray machine came about or how cholera was rampant. The reader does not have to read the book from start to finish, but can pick what interests him. Each chapter is coherent and should be read very fluently.
Sometimes errors have crept in. The origin of the Red Cross is dated 1959, a hundred years too late. This does not affect the author, but the editing does, because such mistakes cause confusion for the reader.
These little flaws are annoying, but they fade away from the work. It is by no means a boring chronicle, like many contributions to the history of medicine. A wealth of images and a mountain of anecdotes make history come alive.
The author often provides surprises. The ancient Egyptians and Mesopotamians did research in gynecology, but obstetrics were not an issue for scholars in the European Middle Ages. The midwives and their traditional knowledge reserved for the care of pregnant women, women giving birth and women who had recently given birth. This is another reason why an extremely large number of women died during childbirth and various children in the first years of life.
Also, hardly anyone knows that malaria is not a tropical disease, but raged in England as "swamp fever", that the plants white willow and meadowsweet were the precursors of aspirin and Hippocrates already knew them as a pain reliever.
To learn from mistakes
The author masterfully manages not to stifle medical milestones in technical jargon, but enables laypersons to understand the historical circumstances and the meaning of the objects presented. It is unlikely that anyone is aware today that every second person in Europe died of the plague in the 14th century and that it had an impact on local societies like a nuclear war.
"The history of medicine in 50 objects" teaches that we should neither look down on the medicine of our ancestors nor glorify it as "old knowledge". The Greek knew Dioskorides in the first century AD. Z more than 1000 herbal remedies. Among them was a brew of willow bark for gouty arthritis, which contained the main component of aspirin.
At the same time, however, many methods that are now considered “better medicine” in “alternative medicine” were based on misconceptions, which were often pointless and sometimes worked for other reasons than the doctors at the time thought that acupuncture or even caused serious damage to the patient until death .
Gill Paul studied medicine, but also literature and history, and she manages to combine these three disciplines in a playful way. She has both the medical and historical expertise that is required for this popular science work as well as the literary sensitivity to convey this knowledge in a pleasant way. (Dr. Utz Anhalt)
Source: Gill Paul; The history of medicine in 50 objects. Haupt-Verlag Bern (www.haupt.ch). 2017