Glimpses under the history of medicine

ANCIENT SYSTEM OF MEDICINE IN INDIA The concepts and techniques of "Healing the Ailing" is as old as life itself from antiquity. India is known as the cradle of this art and Ayurveda the mother of healing that consists of a complete and holistic system integrating the body, mind, and spirit. According to Indian mythology, this is a divine art and science revealed by the creator of this universe, Lord Brahma[1] who passed on this knowledge to some of the learned sages (Rishis) as documented in holy Hindu scriptures viz., Vedas. Out of the four Vedas, Rigveda and Atharvaveda contains detailed descriptions about a spectrum of diseases and their remedies. The first prescription of medicine, "Amruth" is contained in Mrithunjaya Mantra which is a part of Rig Veda - Apart from curative treatment with various herbal medicines, prevention of diseases through life style modulation, yoga,[2] and hygienic living distinguished Ayurveda from other ancient systems of medicine. Ayurveda had also influenced other ancient system of medicine to a considerable extent especially the Tibetian,[3] Chinese, and Greek systems of medicine and this is the reason why Ayurveda was known as the Mother of Healing. The practical text of Ayurveda was divided into 8 branches (Ashtangas) Together, the practice of all these branches was named as Ashtangas of Ayurveda. It is worth mentioning the most important Ayurvedic text which is considered the most valid learning resources in Ayurveda. Even though the exact origin of Ayurveda is a matter of speculations, everybody accepts that the period from 6th century B.C to 7th century A.D was the golden age of the Indian system of medicine, and most of the literary creation in Ayurveda took place during that period. The first literary creation in Ayurveda seems to be Agnivesh Samhitha that consists of all the Ayurveda formulations invented by Arthreya and Agnivesha. Charaka updated and modified Agnivesh Samhitha and brought out a revised edition with his own contribution in the form of Charaka Samhitha against a wide spectrum of disease entities. In fact, there were two schools of medicine during the period of Samhithas, i.e., between 6th century B.C. and 7th century A.D[4] - the Arthreya School of Ayurveda and the Dhanavanthri School of Ayurveda. While Charaka belonged to the Arthreya School of Ayurveda, Shushrutha, the Father of Surgery, belonged to the Dhananvanthri School. Arthreya was the head of the department of Medicine at Nalanda University while Shushrutha independently did his research and surgical work. He used to collect dead bodies from river Ganges and dissect them to learn human anatomy. He also created a treatise called "Shushrutha Samhitha"[56] that contained 84 chapters describing 1120 different disease entities, 700 medicinal plants, and 64 formulations from mineral sources and 57 from animal sources. He also described 300 surgical procedures under 8 categories and 125 surgical instruments. Ashtanga Hridya is another valuable creation in Ayurveda written by VagBhada and is a compilation of relevant portions in Charaka Samhitha and Shushrutha Samhitha with his own original contributions. Ayurvedic knowledge emphasizes the importance of maintaining a harmonious balance between the five components with which the human body is made up of, like any other physical entity, viz, Panchabhuthas that represent the Earth, Air, Sky, Fire, and Water. The diseases are due to the failure to keep healthy balance between these five factors. Any treatment should be aimed at regulating these factors at four levels viz., Body or Sharira, Senses or Indriya, Mind or Manasa, and Soul or Atma. The diagnosis in Ayurveda is based on proper history taking and physical examination. Like the humoral theory of diseases in Greek medicine, Ayurveda believes that the Thridoshas[7] viz, Vada, pitah, and kapha are the three etological factors that predispose to the various disease entities, and the Ayurvedic formulations were prescribed to counteract the imbalance between the Tridoshas. Unani is another system of medicine that had deep roots and royal patronage in India during the Indian Sultanate and Moghul periods. The system was very similar to Ayurveda based on the balance between elements. While Ayurveda followed the Panchabhutha theory of Charvachakas, Unani proposed only four elements viz, Fire, Air, Water, and Earth excluding Sky. ANCIENT SYSTEM OF MEDICINE IN EGYPT[8] Herodotus,[9] a celebrated Alexandrian surgeon, described Egyptians as "healthiest of all men next to Libyans" due to the noble public health system that they possessed. According to him, each physician of the ancient Egypt was a unique specialist in healing only one particular disease and not more. The sources of information is from the famous Edwin Smith Papyrus,[10] which contains the medical formulations of ancient Egypt from 300 B.C. onwards. Father figure of Egyptian medicine, Imhotep is considered to be one of the original authors of Edwin Smith papyrus and claims to have performed the first surgery as early as 2750 B.C. Several authors contributed and finally Edwin Smith Papyrus was compiled into one of the ancient texts of medicine and surgery like Shushrutha Samhitha of India, which is considered to be a more systematic and authentic treatise on surgery. KAUN Gyneugological Papyrus[11] is another ancient Egyptian Papyrus on Obstetrics and Gynaecology dating back to 1800 B.C., which narrates 34 distinct cases of obstetrics and gynaecology including cases with diagnosis and problems of conception and their treatment. Hesey RA, the chief Physician and Dentist of King Djoser, is considered to be one of the earliest physicianin history of Babylonian medicine. Like the Egyptians, the Babylonians also had a rich heritage in healthcare. They also followed a systematic practice of medicine that consisted of detailed history taking, physical examination, diagnosis and treatment, and follow up of prognosis. Their earliest text book was "Diagnostic hand book" written by Esagil-Kin-Apla of Borcippa during the time of KingAdad-Apla-Iddina between 1069-1046 B.C. CHINESE SYSTEM OF MEDICINE[12] China too had a rich tradition in the healing art and the fundamental text of Chinese medicine "HaemidiNeijing" was written between 5th and 3rd century B.C. The Chinese had another text book viz, "Tritisa on cold damage" which gives references from "Haemidi Neijing"[4], "Yellow Emperor's Inner Cannon". They had a third creation of medical literature"Jijyijing" written by HaungfuMitha, the founder of Acu Puncture. During the time of Tang dynasty 'HaemidiNeijing' was revised incorporating all the later inventions and is considered as the authoritative text on Chinese traditional medicine based on herbal therapy, Acu Puncture and massage. GREEK AND ROMAN MEDICINE In 1800 B.C., Homer in his famous poem "Iliad" describes the treatment of the wound on the thigh of one of the two sons of Askla Poas, the healer God of Greece. The patient himself was a renowned physician of that time, and he gives directions to another Dr. Patroclus to remove the foreign body in the wound on his thigh, wash it with hot water, and treat it with herbal medicines. One of the ever living testimony to the in depth knowledge of the Greek in healthcare is the Asklepeon of Epidaurus, which is the installation of three large marbles erected in 350 B.C. with the inscription of the names, history, complaints, and cures of about 70 patients who were treated in their temples. These cases include opening of abdominal abscess, removal of foreign body, etc. under Eukoinesis induced by opium products. The first known medical school in Greece was opened in 700 B.C. in Snidus and Alcaumen,[13] the author of first work on anatomy worked in this school. The Greeks proposed the theory of humors as the basis of health and disease, and the aim of the treatment was to restore the balance of these four humors viz., black bile, yellow bile, phlegm, and blood. The Hippocrates (460-370 B.C.), the father of western medicine,[14] was Greek and compiled a collection of 70 early medical works contributed mainly by the author and his students. The treatise came to be popularly known as the Hippocratic Corpos. He also formulated the famous Hippocrat oath that is still being taken by the medical graduates entering into the medical profession throughout the world. Hippocrates and his students described many diseases and their clinical manifestations. However, the most notable ones are the clubbing of fingers observed in chronic separative lung disease, congenital cynotic heart diseases, infective endocarditis, chronic liver diseases, etc., and the Hippocratic Facies. He only classified the diseases according to the duration into acute and chronic and according to the geographical distribution of diseases into endemic and epidemic. He was the first thoracic surgeon who described the clinical manifestation of emphyemaor, the collection of puss in the pleural cavity. SURGEONS OF ALEXANDRIA Two great anatomists and surgeons of Alexandria viz, Erasistratus of Ceos and Hirophilus of Chalceon controlled bleeding during surgery using ligatures, bringing down the mortality of the patient by a considerable extent. For the first time in history, they used the lithotomy position for various diagnostic and therapeutic procedures. They had performed many standard surgical procedures like herniography, ophthalmic surgery, etc. Herophilus, while working in the medical school of Alexandria, proposed brain as the seat of intelligence and connected central nervous system to the motor and sensory functions of the body. Herophilus for the first time in the history spelt out the distinction between arteries and veins. Cornelius Celsus (30 B.C.-38 A.D.)[15] Cornelius Celsus was a nonmedical scholar who wrote "De Re Medicina" in eight volumes. He was the first to describe the four signs of inflammation viz. rubor, calor, tumor, and dolor. Cadaveric dissection was made illegal in Rome, similar to what the Buddhist did in India; this created a period of stagnation in the progress of medicine during the medieval period. Galen (129-201 A.D.) Galen[16] was born in Pergaunus in Asia minor. He spent considerable time in the rich Alexandrian library and mastered all the existing literature in medicine. He became a follower of Hippocrates and propagated the Greek concepts including the humoral theory through his extensive writings. He described the crab-like growth of cancer and also described the fifth sign of inflammation "loss of function". He had written 500-600 books and treatises including "seat of diseases", "abnormal tumours," and an exhaustive text on anatomy and surgery, which was followed all over the world until the onset of renaissance. Romans invented surgical instruments viz. forceps, scalpel, cetray, surgical scissors, specula, surgical needles and sounds, etc., and the surgeons had performed a spectrum of surgeries. ISLAMIC CONTRIBUTION TO THE MIDDLE AGES AND MEDICINE The period between Galen and renaissance was controlled by the Arab physicians. Aetius of Amida (502-575 A.D.) was the physician of emperor Justirian. Aetius described many disease entities including carcinoma of the uterus, hemorrhoids, condyloma, and fissures and ulcers of the rectum. Avicenna (890-1037 A.D.)[17] The great physician of the Islamic golden age wrote the famous book "Cannons of Medicine," which was followed throughout the world along with the books of Galen in medical education. Galen's Charisma and the humoral theory flourished up to the dawn of renaissance when Andreas Vesaluis,[18] a Belgian anatomist and surgeon came out with his famous work "De - Humanis Corpora Fabrica," which brought out nearly 200 mistakes that Galen had committed in his text book of anatomy. Galen's Anatomy was based on dissection conducted in Apes while Andreas Vesaluis dissected the human cadavers and published the correct anatomy of the human body. Obviously, Andreas Vesaluis came to be known as the Father of Human Anatomy. Andreas translated Galen's work from Greek to Latin before publishing his own book. The renaissance brought in a new enlightenment in Western Europe and introduced the idea of the medical classics of antiquity. The new awakening resulted in the establishment of medical schools in Europe. Two of these medical schools made considerable contributions towards the growth of medicine. "Schola Medica Salar Nitanan" at Salarno of South Italy was one of the first medical schools in Europe. The school had a cosmopolitan influence from Latin, Greek, Arab and Hebrew sources of medical knowledge and acquired an international reputation. The school could attract students from wealthy families of different countries to study medicine. The campus later came to be known as the Hippocratic City. The graduates were awarded the degree of "magister" which means Doctor. In fact, the term "doctor" was first used at the school of Salarno of Italy. Other European countries like France and England also came forward to establish schools of medicine. University of Mount Pellier of France, University of Paduva[19] and Bologana of Italy were the leading schools of medicine, where students were taught the ancient literature created by Hippocrates, Galun, Avicenna, and Aristotle. Medical practice at the dawn of renaissance[20] depended on the theory of four humors. The balance between these humors, viz., black bile, yellow bile, phlegm, and blood were considered essential to maintain a person healthy; their imbalance leads to diseases. The balance of humors was achieved through balanced diet, herbal medicines, hygienic living, and blood-letting using leeches. To calm down the patients, massive prayers, relics by saints, and music therapy were used. Beyond opium and quinine, there were no effective drugs. Ibn al-Nafis discovered the existence of pulmonary circulation and tried to disprove the humoral theory in 1546. Michael Servetus rediscovered pulmonary circulation and published in the manuscript of Paris and theological work in 1553, for which he had to pay with his life. Pathology came up as a separate entity in the first half of the 16th century through Jean Fernal (1497-1558) through his work "Medicina". He diagnosed acute appendicitis on autopsy and suggested syphilitic etiology for aneurysm. One of the important breakthrough that happened during the first half of the 17th century was the discovery of circulation of blood and function of the heart disproving the existing humoral theory. William Harvey[21] (1578-1657) published his famous book "De Motu Cordis Het Sangunious" in 1628 describing the heart as the centre of the circulatory system and the organization and structure of the vascular system. He also described ventricular rupture and left ventricular hypertrophy in patient with aortic regurgitation. Morgagni published his book "Desedebais Het Causis Morborul" in 1761, which proposed that diseases are organ-based. John Hunter (1728-1793) worked together with his brother William Hunter and contributed significantly to the growth of pathology and medicine. They described inflammation as a defensive response and initiation of reparative process. John Hunter died of heart attack during a heated discussion on admission of students to his St. George Hospital. The use of microscope in medicine was introduced by Thomas Hodgkin (1798-1866) and published the paper jointly with Lister, the father of Joseph Lister, pioneer of aseptic surgery. Rudolph Virshow (1821-1902) made a revolution by making histopathology an effective diagnostic tool in medicine and is rightly known as the father of histopathology. Van Recklin Ganson, whose name later became famous with a condition of multiple neurofibromatosis, was the student of Rudolph Virshow. In 1847 in Vienna, Ignaz Semmelveis insisted the physician wash their hands before attending childbirth and reduced maternal mortality due to childbirth fever by 50%. Louis Pasteur in France declared that yeasts are microorganisms and Davaine called these micro organisms as bactirida. Louis Pasteur proposed the theory of fermentation. He also proposed that anthrax was caused by one such bactirida. The British surgeon Joseph Lister introduced the concept of aspsis and antiseptic surgery in 1865. The German physician Albert Koch understanding the report of Ferdinand Cohns regarding the spore stage of certain bacteria traced the life cycle of the Davaine's bacterida, identified the spores, inoculated into laboratory animals, and produced anthrax proving the germ theory of diseases and completely disproving the humoral theory. Koch published his landmark treatise on bacteriological infections on wounds in 1878. In 1881, Koch reported the discovery of Tuberculosis bacillus. Soon there was an epidemic of cholera in Alexandria in Egypt. Two medical teams were sent to investigate and attend the sufferers, one by Louis Pasteur and the other under Robert Koch. Koch returned successful in 1878 discovering Vibrio cholerae. In 1883, Louis Pasteur invented the epoch-making Rabies vaccination. He established the famous Pasteur Institute,[22] the first biomedical institute in 1888. Now, Koch put forth the famous Koch's postulate[23] to confirm the bacteria-specific pathogenicity. In 1905, Koch was awarded the Noble Prize in Medicine and became famous as the founder of Microbiology along with Louis Pasteur and Ferdinand Cohns. The major breakthrough in epidemiology came with the introduction of statistical maps and graphs introduced by Florence Nightingale. 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