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Book Review: "The History of Medicine in 50 Objects" by Gill Paul

Gill Paul sketches 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 in which the developments of the art of healing can be understood. At the same time, the history of medicine shows the history of human cultures and the changes in thinking caused by changed production conditions, scientific knowledge and values ​​and norms resulting from new conditions.

contents

  • Book Review: "The History of Medicine in 50 Objects" by Gill Paul
  • The chapters at a glance
  • Progress and stagnation
  • Trepanierte skull
  • superstition?
  • The papyrus of Edwin Smith
  • Urea for wrinkles
  • The library of Nineveh
  • Ayurveda
  • Cataract and bladder stones
  • The teachings of Huangdi
  • Yin and yang
  • referred pain
  • Galens phlebotome
  • Inflationary bloodletting
  • The raven mask
  • The Byzantine plague
  • The death bird
  • Bump and lung plague
  • Hunt for scapegoats
  • Pestärzte
  • The Red Cross
  • Brutal and meaningless
  • Mobile field hospitals
  • Anecdotes and surprises
  • To learn from mistakes

The chapters at a glance

Thus, the work begins with the archaic era, when our ancestors lived in a magical world and diseases demonstrated the action of evil spirits. Then it goes to ancient Egyptians, the Islamic scholars, the advanced medicine in Persia, China and India. In each of the 50 chapters, Paul presents a medical achievement in chronological order, from the Stone Age trepanations to the 11th-century Persian physician Avicenna, Harvey's presentation of the circulatory system, the Florence Nightingale lamp, the flu mask, the first heart transplant, and protective clothing at Ebola.

The English author Gill Paul sketches the history of medicine on the basis of 50 chronologically ordered objects. (Image: Chinnapong / fotolia.com)

Progress and stagnation

This cultural history was by no means just progress. Misconceptions became dogmas and hampered development over the centuries, although empirical knowledge precluded them: Galen's four-subject theory exemplifies how a misguided assumption prevented medical advances.

In addition, most therapies up to the modern era were at best irresponsible; For the patients, this often meant senseless agony and sometimes even led to a "painful death". Nevertheless, the history of the 50 objects exemplifies that in all cultures and all time doctors did everything possible to make life more liveable.

Trepanierte skull

Almost one in five Neolithic skull finds has holes. These trepanierten skulls found themselves in the South Sea as in North Africa, in Europe, Asia and New Zealand. It is the oldest known surgical procedure. It is unclear what purpose these operations served.

In some cases, clearly previous skull injuries were seen, so that the holes probably served to remove bone splinters. Scientists suspect that cranial openings were also used to cure headaches, epilepsy and mental disorders.

According to archaic thinking, they were caused by evil spirits who had lodged in the body and could escape through the holes. The dislodged pieces of bone probably served as talismans.

Sometimes the holes were closed with shells, later metal plates of gold or silver. Already 4000 v. Chr. The doctors used bows to drill the holes.

Drilling a hole in the skull (trepantation) is the oldest surgical procedure in the history of medicine. (Image: Marina / fotolia.com)

The risks were immense: bleeding, blood clots and shock as well as brain swelling, but especially infections. The knowledge of the early doctors, however, amazes. After all, two-thirds of the skulls show healed wounds, which means at least that these patients survived. Most likely, the surgeons were careful not to hurt the brain.

These skull openings lasted until modern times and also developed independently. Thus, the Maya and Aztecs, who frequently performed trepanations, had no contact with the Chinese, who also performed these operations, and these, in turn, had no connection with the European medics of the Middle Ages.

In the Middle Ages, it was believed that harmful vapors in the body caused disease, and the opening of the skull released these exhalations into the outside world. Thus, trepanations were also considered a means against insanity, and in the early modern period they were considered as a remedy for epilepsy.

superstition?

Strange as it may be to release evil spirits or harmful vapors by opening the skull, trephining is useful in certain cases, and doctors still use it today.

Trepanations can relieve increased cranial pressure resulting from cerebral haemorrhage as well as headaches that occur after a head injury.

The papyrus of Edwin Smith

One of the most important medical history discoveries is the papyrus of Edwin Smith. Smith was a British archaeologist who accidentally came across an ancient scroll in 1862 at a merchant in Luxor.

The British archaeologist Edwin Smith discovered in 1862 by chance an ancient scroll, which turned out to be the oldest known medical text. (Image: Andrea Izzotti / fotolia.com)

This papyrus was more than four meters long, and when the hieroglyphs could be decoded, it turned out to be a medical manual for nearly 50 diseases. The methods partly went back to the time around 3000 BC. It is therefore the oldest known medical text.

The transcript showed that 5000 years ago the Egyptians had a knowledge of diseases that far exceeded that of the European Middle Ages: the scriptures contain detailed descriptions of the human brain and they knew that the blood was moving - with the heart as the center center.

Urea for wrinkles

An ointment against wrinkles contained urea, which is still used today in anti-wrinkle remedies; the author was aware that damage to certain parts of the body causes 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 from these logical conclusions.

It is no coincidence that Egyptian medicine enjoyed such a high reputation in antiquity that in Greece and later Rome it was a special distinction when a doctor had received his education in Egypt.

The library of Nineveh

In addition to Egypt, Mesopotamia was a center of medicine of the ancient world, under the changing supremacy of Babylon, Assyria and later the Persian Empire. Six hundred cuneiform inscriptions from Assurbanipal of Assyria showed a rational understanding of medicine that served as a guide for centuries.

The Mesopotamians parted between ashipu, healers who also used spells and incantations and whose rituals reminded today's naturopaths and the physicians, asu, who used herbal remedies and worked as surgeons.

Although the people of the land between the Euphrates and Tigris believed that gods were directing world affairs and spirits were omnipresent, they knew of a medicine based on rational knowledge.

The herbal remedies they use are also used today because they have an antiseptic effect - they used soaps made of resin and animal fats, which kept bacterial infections at bay. The clay tablets owned by Assurbanipal are organized into sections for example on gynecology and paediatrics.

Nutrition is one of the core elements of Ayurveda. (Image: barmalini / fotolia.com)

Ayurveda

The Atharvaveda from the Vedic scriptures characterizes Indian medicine. The Ayurvedic faith saw balance between air, fire, water, and soil as vital to human health, with each human being in unique relationship from birth.

In Ayurvedic literature, healthy nutrition and medicine were indivisible. The treatment of disease was based on which type of element a disease corresponded to. Therapies included panchakarma (cleansing), shamana (relaxation) and bhrimana (nutrition).

Cataract and bladder stones

In addition, the doctors of ancient India were also versed in surgery and used over 100 instruments, for example, to remove the cataract, remove bladder stones and cauterize wounds. Their knowledge of anatomy, however, was restricted for the same reason as that of the doctors of the Christian Middle Ages: they were not allowed to dissect corpses.

The teachings of Huangdi

The mythical Yellow Emperor of the third millennium BC provided a template in ancient China for a fictional Q & A textbook between Huangdi and his ministers, which appeared in the 1st millennium BC. The first part is about diagnoses, the second part about acupuncture.

This Huangdi Neijing argued that both internal and external influences can cause disease. The external causes were thus wind, cold, heat, humidity and summer heat, the inner joy, anger, brooding, sorrow, fear and sudden terror. These factors all led to specific symptoms, such as dizziness and nausea.

Yin and yang

The aim of treatment was to balance the opposing forces of yin and yang in the body as well as 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 climatology , the senses and tastes.

The Huangdi Neijing described six different pulses, and an elementary part of the medical diagnosis was to feel them.

In Huangdi Neijing, the 12 major meridians are defined, 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 pinching fine needles at points on the meridians.

One of the central assumptions of Traditional Chinese Medicine (TCM) is that there are a total of 365 acupuncture points on the body's 12 energy pathways. (Image: Björn Wylezich / fotolia.com)

referred pain

Although these meridians do not exist anatomically, acupuncture is still suitable for alleviating certain diseases and supporting treatment with traditional Chinese medicine.

There are pathways of the nerves for transmission pain, so for pain that occur in other parts of the body as the injury itself. Also in China, dissection was banned, and the ancient Chinese doctors came to basically correct results due to external observations.

Galens phlebotome

Galen lived from 150-210 n.u.Z, studied medicine among others in Pergamon and Alexandria. To document its importance to medicine, Paul introduces his so-called phlebotome, a lancet to open patients' veins during bloodletting.

Galen showed that the brain controls the muscles through the nerves and not the heart, as Hippocrates had thought. He did this in a gruesome way, cutting the nerves of a live pig, whereupon the pig screamed in pain and only stopped when he cut the nerve to the larynx.

Galen also found that there was light blood in the arteries and dark blood in the veins. He considered the venous blood to be a product of the liver, the arterial a product of the heart.

He stuck to the four-man apprenticeship and supplemented it with a theory of temperament in which each juice was linked to a typical personality: black bile thus led to melancholy, yellow gall bladder corresponded to choleric and mucus marked phlegmatic.

Galen found that the kidneys produced urine, not the bladder.

Inflationary bloodletting

His main method was phlebotomy, which he preferred over all other therapies and prescribed him for countless illnesses. These ranged from epilepsy to pneumonia. For him, bloodletting was not the same as phlebotomy: in liver disease one of the right hand should be opened, in spleen complaints one of the left hand, and on the right elbow bleeding from the right nostril.

Galen's teachings were preserved far into modern times. In addition to right discoveries such as the connection of the nerves to the brain, his temperament was unfortunately wrong, as was the inflationary use of bloodletting.

The raven mask

Today we know the Rabenmaske especially from the Carnival in Venice. It dates from the times of the plague epidemics and marked the plague doctors. In 1346, over 50% of Europe's population died of plague in seven years. Many doctors refused to treat plague sufferers, presumably because they suspected the disease was infectious. The physicians who helped the sufferer tried to protect themselves by putting on a raven mask.

Due to the high risk of infection, many plague doctors protected themselves with masks with long bills and sealed eye openings. (Image: Dennis van de Hoef / fotolia.com)

The Byzantine plague

In an early plague epidemic in 541-543 AD, the plague broke out in Constantinople, after it had passed from China via the Silk Roads and the sea route to North Africa. The Byzantine Empire received grain mainly from Egypt, and the vats in which it was kept were a rat-paradise.

5000 people died in Istanbul today, and the disease spread to Arabia and Europe. Some historians see this epidemic wave as the trigger for the decline of the Roman Empire. However, in the East this shrank dramatically until 1453, and in the west it was already destroyed in the fifth century by the migration of the peoples.

The death bird

The raven was symbolically the bird of death, but the mask had a practical meaning: the doctors filled the beak with herbs that they hoped in vain to protect against the disease.

Bump and lung plague

The patients suffered from swollen lymph nodes, swelling in the armpits and groin. From these "bumps" pus and blood welled up. Then the victims feverishly and vomited blood, followed by black and red spots on the skin. 80% of the patients died.

Some sufferers got difficulty breathing and coughed blood. The lungs were infected with them. The infection was over sneezing. At least against the lung plague, the doctor's mask could help. Up to 95% of the patients died of pneumonic plague, almost 100% of a plague episode.

It was not until the late 19th century that it became clear that Yersinia pestis caused the plague and transmitted by infecting affected fleas with their hosts. These are mostly rodents, and they carry the disease on. In Europe, it was mainly brown rats. The fleas hopped from rats to humans, and humans became infected by flea bites. Also a transmission from person to person was possible.

Hunt for scapegoats

In the Middle Ages, the cause was unknown, the helpless attempts to control the epidemic made people lose respect for doctors and sought out 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 as well as strangers who were in a city. In Strasbourg alone, the mob slaughtered 2,000 Jews in 1349.

Pestärzte

Although the transmission route was unknown, the doctors quite rightly tried to avoid any skin contact with the patient. In 1619, Charles de Lorme developed a pest 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.

Even doctors fell ill, but even if the infection with the fleas was unknown, the avoidance of skin contact certainly helped. But it was enough that the fleas jumped on the pest suit. If the doctor then removed this and they got to his skin, he also became infected.

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 into war medicine. In 1859, the Swiss Henry Dunant decided to act. He passed a battlefield near Solferino in Italy, where 40,000 men were wounded between dead and many of them died themselves.

Dunant designed a neutral aid organization for war wounded, which should be recognizable by a armband with a red cross. In 1914 there were already 45 national Red Cross organizations. After the First World War, the International Red Cross extended its activities to natural and manmade disasters such as famine.

Already by the ancient Romans are well-educated physicians for war wounded known; These followed the army and treated wounded ones own side. Treating enemies was taboo.

Amputations were carried out to modern times with knives, saws, pliers and chisels. (Image: jsr548 / fotolia.com)

Brutal and meaningless

Also for the own people war medicine until the modern time was cruel and above all a matter of the surgeons, which were colloquially bones bearers. Above all, the overwhelmed physicians knew one way to treat wounded people: they amputated their injured limbs to prevent infection. The wounds burned them with hot 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 created a new profession: the stretcher wearers and the ambulance drivers had to act swiftly and the doctors needed to decide which wounded needed first treatment - as did today's emergency physicians It was also their hard decision, which injured had little chance of survival.

Although Larrey served Napoleon, but his people treated injured both sides. This went hand in hand with the bourgeois code of the Napoleonic armies, which forbade useless cruelties against the enemy.

Anecdotes and surprises

Gill Paul has achieved something great: building lighthouses in an ocean of history that stretches from the Stone Age to the present, from the downfall of the Roman Empire to psychoanalysis, from birthing aids to knowledge of the bloodstream, from magic to science.

We learn that malaria means bad air because the Romans believed that the air in the marshes caused the disease, how the x-ray developed, or how cholera was rampant. The book does not have to read the reader from start to finish, but can pick out what interests him. Each chapter is coherent and read fluently.

Sometimes mistakes in content have crept in. Thus, the formation of the Red Cross is dated 1959, one hundred years too late. This is not the author, but the editing, because such errors cause confusion in the reader.

These little flaws are annoying, but fade before the work. It is by no means a boring chronicle, how many contributions to the history of medicine. A wealth of images and a mountain of anecdotes bring the story to life.

Often the author provides surprises. Although the ancient Egyptians and Mesopotamians were already doing research in gynecology, in the European Middle Ages birth medicine was not a topic for scholars. Concern for pregnant women, women giving birth, and women who had recently given birth remained reserved for midwives and their traditional knowledge. This is another reason why extremely many women died at birth and several children in their first years of life.

Probably hardly anyone knows that malaria is not a tropical disease, but raged in England as "malaria", that the plants silver willow and meadowsweet were precursors of aspirin and already Hippocrates knew them as a remedy for pain.

The medicinal plant meadowsweet was already known at the time of Hippocrates as a painkiller. (Image: Starover Sibiriak / fotolia.com)

To learn from mistakes

The author masterfully manages to stifle medical milestones not in jargon, but allows medical layman to understand the historical circumstances and the importance of the presented objects. Today, hardly anyone is aware that in the 14th century, every second person in Europe died of the plague, and that it had an effect on the 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 them as "ancient knowledge". Thus already the Greek Dioskorides knew in the first century n.u. 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 today in "alternative medicine" are considered to be "better medical science" were based on misconceptions that were often meaningless, sometimes for other reasons than the physicians of the time thought, such as acupuncture or inflicted even severe harm to death on the patient.

Gill Paul studied medicine, but also literature and history, and she playfully manages to unite these three disciplines. She has both the medical and historical expertise necessary for this popular science work, as well as the literary sensitivity to convey that knowledge in a pleasant way. (Dr. Utz Anhalt)
Specialist supervision: Barbara Schindewolf-Lensch (doctor)

Source: Gill Paul; The history of medicine in 50 objects. Main publishing house Berne (www.haupt.ch). 2017