Ancient Egyptian childbirth scene: the mother is helped by her handmaidens and the midwife. Reconstruction of a Theban painting from the Dynasty XIX. (Photo by DeAgostini/Getty Images)
Maintaining a comfortable state of health is a goal shared by much of the world's population past and present, thus the history of health and medicine weaves a thread connecting us with our ancestors' human experiences. Yet it's easy to assume that studying it involves either celebrating the ‘eureka moments’ of well-known heroes or laughing at outdated therapies. But, as I set out to show in my new book, medicine's past features plenty of lesser-known but equally fascinating episodes…
A nearby tomb reveals the image of Merit Ptah, the first female doctor known by name. She lived in approximately 2,700 BC and hieroglyphs on the tomb describe her as ‘the Chief Physician’. That's pretty much all that's known about her career, but the inscription reveals that it was possible for women to hold high-status medical roles in Ancient Egypt.
Some 200 years later another doctor, Peseshet, was immortalised on a monument in the tomb of her son, Akhet-Hetep (aka Akhethetep), a high priest. Peseshet held the title ‘overseer of female physicians’, suggesting that women doctors weren't just occasional one-offs. Peseshet herself was either one of them or a director responsible for their organisation and training.
Although the barriers of time and interpretation make it difficult to reconstruct the day-to-day practice of Merit Ptah and Peseshet, female doctors appear to have been a respected part of ancient Egyptian society.
Sushruta advises his students that however well read they are, they are not competent to treat disease until they have practical experience. Surgical incisions were to be tried out on the skin of fruits, while carefully extracting fruit seeds enabled the student to develop the skill of removing foreign bodies from flesh. They also practised on dead animals and on leather bags filled with water, before being let loose on real patients.
Among its many surgical descriptions, the Sushruta Samhita documents cataract surgery. The patient had to look at the tip of his or her nose while the surgeon, holding the eyelids apart with thumb and index finger, used a needle-like instrument to pierce the eyeball from the side. It was then sprinkled with breast milk and the outside of the eye bathed with a herbal medication. The surgeon used the instrument to scrape out the clouded lens until the eye “assumed the glossiness of a resplendent cloudless sun”. During recovery it was important for the patient to avoiding coughing, sneezing, burping or anything else that might cause pressure in the eye. If the operation were a success, the patient would regain some useful vision, albeit unfocused.
Roman civilization, a relief portraying an ophthalmologist examining a patient. (Photo By DEA/A DAGLI ORTI/De Agostini/Getty Images)
During his first voyage to Stadacona in 1534, Cartier had kidnapped two young men, Dom Agaya and Taignoagny, taking them back to France as proof that he had discovered a new territory. Now that they were home, the men and their community had every reason not to trust Cartier – an attitude that he interpreted as “treachery” and “knavery”.
In spite of this tension, Dom Agaya showed Cartier how to make a decoction from a tree called Annedda and, although the Frenchmen wondered if it were a plot to poison them, a couple of them gave it a go and were cured within days. After that, there was such a rush for the medicine that “they were ready to kill one another”, and used up a whole large tree.
The identity of Annedda is not certain but there are several candidates including eastern white cedar and white spruce. Whatever it was, its nutritional benefits resulted in the sailors' complete cure.
Cartier repaid Dom Agaya by kidnapping him again along with nine other people. By the time of Cartier's next voyage – to Canada in 1541 – most of the prisoners were dead, but Cartier informed their relatives that they were living in style in France. The scurvy cure did not gain widespread recognition and the disease continued to claim the lives of sailors for more than 200 years.
It didn't work against Roman armies, however, and when Mithradates was defeated by the military leader Pompey in 66 BC, the recipe supposedly arrived in Rome. Emperor Nero's physician Andromachus developed it into a 64-ingredient composition, which became known as theriac. Most of the ingredients were botanical (including opium), but viper's flesh was a notable component.
In spite of early scepticism, theriac took off as a prized (and expensive) cure-all. By the 12th century Venice was the leading exporter and the substance had a high profile in European, Arabic and Chinese medicine alike. Its fortunes waned after 1745, however, when William Heberden debunked its alleged efficacy and suggested that enterprising Romans had exaggerated the Mithradates story for their own gain.
Even so, theriac remained in some European pharmacopoeias until the late 19th century.
Tin-glazed Italian pharmacy jar (or albarello) from Rome or Deruta, used by the Jesuits and intended for storing theriac, 1641. (Photo by SSPL/Getty Images)
Seishu Hanaoka (1760–1835) studied medicine in Kyoto and set up a practice in his hometown of Hirayama. He became interested in the idea of anaesthesia owing to stories that a third-century Chinese surgeon Houa T'o had developed a compound drug enabling patients to sleep through the pain. Hanaoka experimented with similar formulae and produced Tsusensan, a potent hot drink. Among other botanical ingredients it contained the plants Datura metel (aka Datura alba or ‘devil's trumpet’), monkshood and Angelica decursiva, all of which contain some potent physiologically active substances.
Tsusensan had quite a kick and if you glugged it down willy-nilly you would probably die, but in the correct dosage it rendered patients unconscious for between six and 24 hours, allowing ample time for surgery.
On 13 October 1804, Hanaoka excised Kan Aiya's tumour while she was under general anaesthesia, going on to operate on at least 150 more breast cancer patients and people with other conditions. Sadly, Kan Aiya is thought to have died of her disease the following year, but had been spared the agony that still characterised surgery in the West.
Leeches had advantages over the common practice of bloodletting using a lancet – the loss of blood was more gradual and less of a shock for those of delicate constitution. And because Broussais's followers used leeches in place of all the other medicines at the 19th-century physician's disposal, patients were spared some harsh remedies that might otherwise have made them feel worse. In 1822, a British surgeon called Rees Price coined the term sangui-suction for leech therapy.
Over the centuries, reports occasionally surfaced of caesarean sections saving the lives of both mother and baby, but even after the introduction of antiseptic methods and anaesthesia, caesareans remained a dangerous last resort. So Edinburgh surgeons were surprised to hear a lecture by Robert Felkin, a missionary doctor, about a successful operation that he had witnessed in the African kingdom of Bunyoro Kitara five years earlier.
The operation, Felkin reported, was carried out with the intention of saving both lives. The mother was partially anaesthetised with banana wine. The surgeon also used this wine to wash the surgical site and his own hands, suggesting awareness of the need for infection control measures. He then made a vertical incision, going through the abdominal wall and part of the uterine wall, before further dividing the uterine wall enough to take the baby out. The operation also involved removing the placenta and squeezing the uterus to promote contraction.
The first surgical treatment of breast cancer performed under general anaesthetic by Seishu Hanaoka (1760-1836) in 1804 (colour litho), Japanese School (19th century). (Private Collection/Archives Charmet/Bridgeman Images)
The means of dressing the incision was also highly developed: the surgeon used seven polished iron spikes to bring the edges of the wound together, tying them in place with bark-cloth string. He then applied a thick layer of herbal paste and covered this with a warm banana leaf held in place with a bandage. According to Felkin's account, the mother and her baby were still doing well when he left the village 11 days later.
Although caesarean operations had been performed in Africa by white surgeons before this date, the procedure appeared to have been developed independently by the Banyoro people – a somewhat discomfiting realisation for a British audience familiar with colonial tales of ‘savages’.
Caroline Rance blogs at www.thequackdoctor.com about the history of medical advertising and health fraud. Her latest book, The History of Medicine in 100 Facts (Amberley Publishing, 2015), explores medicine's history in bite-sized topics, from prehistoric parasites to the threat of antibiotic resistance.
1) Some of the earliest named doctors were women
Saqqara is a huge archaeological site about 20 miles south of present-day Cairo. Five millennia ago it was the necropolis for the ancient Egyptian city of Memphis, and remains home to one of the oldest surviving buildings in the world – the step pyramid of Djoser.A nearby tomb reveals the image of Merit Ptah, the first female doctor known by name. She lived in approximately 2,700 BC and hieroglyphs on the tomb describe her as ‘the Chief Physician’. That's pretty much all that's known about her career, but the inscription reveals that it was possible for women to hold high-status medical roles in Ancient Egypt.
Some 200 years later another doctor, Peseshet, was immortalised on a monument in the tomb of her son, Akhet-Hetep (aka Akhethetep), a high priest. Peseshet held the title ‘overseer of female physicians’, suggesting that women doctors weren't just occasional one-offs. Peseshet herself was either one of them or a director responsible for their organisation and training.
Although the barriers of time and interpretation make it difficult to reconstruct the day-to-day practice of Merit Ptah and Peseshet, female doctors appear to have been a respected part of ancient Egyptian society.
2) Cataract surgery was possible in the sixth century BC
One of the oldest known medical textbooks is the Sushruta Samhita, written in Sanskrit in India. Its exact date is tentative, as no original version survives and it is only known from later copies, but the current consensus is that it was written in around 600 BC. Sushruta is thought to have been a physician and teacher working in the North Indian city of Benares (now Varanasi in the state of Uttar Pradesh). His Samhita – a compilation of knowledge – provides detailed information on medicine, surgery, pharmacology and patient management.Sushruta advises his students that however well read they are, they are not competent to treat disease until they have practical experience. Surgical incisions were to be tried out on the skin of fruits, while carefully extracting fruit seeds enabled the student to develop the skill of removing foreign bodies from flesh. They also practised on dead animals and on leather bags filled with water, before being let loose on real patients.
Among its many surgical descriptions, the Sushruta Samhita documents cataract surgery. The patient had to look at the tip of his or her nose while the surgeon, holding the eyelids apart with thumb and index finger, used a needle-like instrument to pierce the eyeball from the side. It was then sprinkled with breast milk and the outside of the eye bathed with a herbal medication. The surgeon used the instrument to scrape out the clouded lens until the eye “assumed the glossiness of a resplendent cloudless sun”. During recovery it was important for the patient to avoiding coughing, sneezing, burping or anything else that might cause pressure in the eye. If the operation were a success, the patient would regain some useful vision, albeit unfocused.
Roman civilization, a relief portraying an ophthalmologist examining a patient. (Photo By DEA/A DAGLI ORTI/De Agostini/Getty Images)
3) A ‘tree of life’ tackled scurvy
Trapped in ice near Stadacona (the site of present-day Quebec City) in 1536, Jacques Cartier's ships weren't going anywhere. The crews, holed up in a makeshift fort with little access to fresh food, came down with a disease so gruesome that “their mouth became stincking, their gummes so rotten, that all the flesh did fall off, even to the rootes of the teeth, which did also almost all fall out.” They had scurvy, now known to result from a deficiency of vitamin C. Cartier had no idea what to do.During his first voyage to Stadacona in 1534, Cartier had kidnapped two young men, Dom Agaya and Taignoagny, taking them back to France as proof that he had discovered a new territory. Now that they were home, the men and their community had every reason not to trust Cartier – an attitude that he interpreted as “treachery” and “knavery”.
In spite of this tension, Dom Agaya showed Cartier how to make a decoction from a tree called Annedda and, although the Frenchmen wondered if it were a plot to poison them, a couple of them gave it a go and were cured within days. After that, there was such a rush for the medicine that “they were ready to kill one another”, and used up a whole large tree.
The identity of Annedda is not certain but there are several candidates including eastern white cedar and white spruce. Whatever it was, its nutritional benefits resulted in the sailors' complete cure.
Cartier repaid Dom Agaya by kidnapping him again along with nine other people. By the time of Cartier's next voyage – to Canada in 1541 – most of the prisoners were dead, but Cartier informed their relatives that they were living in style in France. The scurvy cure did not gain widespread recognition and the disease continued to claim the lives of sailors for more than 200 years.
4) If you want a cure for everything, try theriac
Being a king in ancient times was exhaustingly dangerous; there was always someone plotting to get rid of you. So, according to legend, Mithradates (aka Mithridates) VI of Pontus (on the shores of the Black Sea in Turkey) attempted to become resistant to poisons by taking gradually increasing doses. He was also reputed to have conducted toxicological experiments on condemned prisoners, culminating in the creation of mithridate – a medicine that combined all known antidotes in one potent formula.It didn't work against Roman armies, however, and when Mithradates was defeated by the military leader Pompey in 66 BC, the recipe supposedly arrived in Rome. Emperor Nero's physician Andromachus developed it into a 64-ingredient composition, which became known as theriac. Most of the ingredients were botanical (including opium), but viper's flesh was a notable component.
In spite of early scepticism, theriac took off as a prized (and expensive) cure-all. By the 12th century Venice was the leading exporter and the substance had a high profile in European, Arabic and Chinese medicine alike. Its fortunes waned after 1745, however, when William Heberden debunked its alleged efficacy and suggested that enterprising Romans had exaggerated the Mithradates story for their own gain.
Even so, theriac remained in some European pharmacopoeias until the late 19th century.
Tin-glazed Italian pharmacy jar (or albarello) from Rome or Deruta, used by the Jesuits and intended for storing theriac, 1641. (Photo by SSPL/Getty Images)
5) General anaesthesia helped cancer patients at the beginning of the 19th century
Kan Aiya, a 60-year-old woman, had lost many loved ones to breast cancer. She had seen her sisters die of the cruel disease, so when a tumour formed in her left breast she was well aware of the likely outcome. For her, however, there was a chance of survival – an operation. It was 1804 and she was in the best possible place for surgery – feudal Japan.Seishu Hanaoka (1760–1835) studied medicine in Kyoto and set up a practice in his hometown of Hirayama. He became interested in the idea of anaesthesia owing to stories that a third-century Chinese surgeon Houa T'o had developed a compound drug enabling patients to sleep through the pain. Hanaoka experimented with similar formulae and produced Tsusensan, a potent hot drink. Among other botanical ingredients it contained the plants Datura metel (aka Datura alba or ‘devil's trumpet’), monkshood and Angelica decursiva, all of which contain some potent physiologically active substances.
Tsusensan had quite a kick and if you glugged it down willy-nilly you would probably die, but in the correct dosage it rendered patients unconscious for between six and 24 hours, allowing ample time for surgery.
On 13 October 1804, Hanaoka excised Kan Aiya's tumour while she was under general anaesthesia, going on to operate on at least 150 more breast cancer patients and people with other conditions. Sadly, Kan Aiya is thought to have died of her disease the following year, but had been spared the agony that still characterised surgery in the West.
6) A ‘leech craze’ hit 19th-century Europe
The medicinal leech has been in use for thousands of years, and is even today considered to be a way of restoring venous circulation after reconstructive surgery. But it was in the early 19th century that the leech really soared in popularity. Led by French physician François-Joseph-Victor Broussais (1772–1838), who postulated that all disease stemmed from local inflammation treatable by bloodletting, the ‘leech craze’ saw barrels of the creatures shipped across the globe, wild leech populations decimated almost to extinction, and the establishment of prosperous leech farms.Leeches had advantages over the common practice of bloodletting using a lancet – the loss of blood was more gradual and less of a shock for those of delicate constitution. And because Broussais's followers used leeches in place of all the other medicines at the 19th-century physician's disposal, patients were spared some harsh remedies that might otherwise have made them feel worse. In 1822, a British surgeon called Rees Price coined the term sangui-suction for leech therapy.
7) Ugandan surgeons developed life-saving caesarean operations
In 1884, the caesarean section was not a new idea. It dated from the time of the Caesars, for a start, when Roman law required the procedure to be carried out in the event of a woman's death in childbirth.Over the centuries, reports occasionally surfaced of caesarean sections saving the lives of both mother and baby, but even after the introduction of antiseptic methods and anaesthesia, caesareans remained a dangerous last resort. So Edinburgh surgeons were surprised to hear a lecture by Robert Felkin, a missionary doctor, about a successful operation that he had witnessed in the African kingdom of Bunyoro Kitara five years earlier.
The operation, Felkin reported, was carried out with the intention of saving both lives. The mother was partially anaesthetised with banana wine. The surgeon also used this wine to wash the surgical site and his own hands, suggesting awareness of the need for infection control measures. He then made a vertical incision, going through the abdominal wall and part of the uterine wall, before further dividing the uterine wall enough to take the baby out. The operation also involved removing the placenta and squeezing the uterus to promote contraction.
The first surgical treatment of breast cancer performed under general anaesthetic by Seishu Hanaoka (1760-1836) in 1804 (colour litho), Japanese School (19th century). (Private Collection/Archives Charmet/Bridgeman Images)
The means of dressing the incision was also highly developed: the surgeon used seven polished iron spikes to bring the edges of the wound together, tying them in place with bark-cloth string. He then applied a thick layer of herbal paste and covered this with a warm banana leaf held in place with a bandage. According to Felkin's account, the mother and her baby were still doing well when he left the village 11 days later.
Although caesarean operations had been performed in Africa by white surgeons before this date, the procedure appeared to have been developed independently by the Banyoro people – a somewhat discomfiting realisation for a British audience familiar with colonial tales of ‘savages’.
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