the evolution of modern medicine-第3章
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tional medicine。 〃Some of the sick on account of their eagerness took food on the first day； some on account of loathing abstained； and the disease in those who refrained was more relieved。 Some ate during a fever； some a little before it； others after it had subsided； and those who had waited to the end did best。 For the same reason some at the beginning of an illness used a full diet； others a spare； and the former were made worse。 Occurring daily； such things impressed careful men； who noted what had best helped the sick； then began to prescribe them。 In this way medicine had its rise from the experience of the recovery of some； of the death of others； distinguishing the hurtful from the salutary things〃 （Book I）。 The association of ideas was suggestivethe plant eyebright was used for centuries in diseases of the eye because a black speck in the flower suggested the pupil of the eye。 The old herbals are full of similar illustrations upon which； indeed； the so…called doctrine of signatures depends。 Observation came； and with it an ever widening experience。 No society so primitive without some evidence of the existence of a healing art； which grew with its growth； and became part of the fabric of its organization。
With primitive medicine； as such； I cannot deal； but I must refer to the oldest existing evidence of a very extraordinary practice； that of trephining。 Neolithic skulls with disks of bone removed have been found in nearly all parts of the world。 Many careful studies have been made of this procedure； particularly by the great anatomist and surgeon； Paul Broca； and M。 Lucas…Championniere has covered the subject in a monograph。＇2＇ Broca suggests that the trephining was done by scratching or scraping； but； as Lucas…Championniere holds； it was also done by a series of perforations made in a circle with flint instruments； and a round piece of skull in this way removed； traces of these drill…holes have been found。 The operation was done for epilepsy； infantile convulsions； headache； and various cerebral diseases believed to be caused by confined demons； to whom the hole gave a ready method of escape。
＇2＇ Lucas…Championniere： Trepanation neolithique； Paris； 1912。
The practice is still extant。 Lucas…Championniere saw a Kabyle thoubib who told him that it was quite common among his tribe； he was the son of a family of trephiners； and had undergone the operation four times； his father twelve times； he had three brothers also experts； he did not consider it a dangerous operation。 He did it most frequently for pain in the head； and occasionally for fracture。
The operation was sometimes performed upon animals。 Shepherds trephined sheep for the staggers。 We may say that the modern decompression operation； so much in vogue； is the oldest known surgical procedure。
EGYPTIAN MEDICINE
OUT of the ocean of oblivion； man emerges in history in a highly civilized state on the banks of the Nile； some sixty centuries ago。 After millenniums of a gradual upward progress； which can be traced in the records of the stone age； civilization springs forth Minerva…like； complete； and highly developed； in the Nile Valley。 In this sheltered； fertile spot； neolithic man first raised himself above his kindred races of the Mediterranean basin； and it is suggested that by the accidental discovery of copper Egypt 〃forged the instruments that raised civilization out of the slough of the Stone Age〃 （Elliot Smith）。 Of special interest to us is the fact that one of the best…known names of this earliest period is that of a physicianguide； philosopher and friend of the kinga man in a position of wide trust and importance。 On leaving Cairo； to go up the Nile； one sees on the right in the desert behind Memphis a terraced pyramid 190 feet in height； 〃the first large structure of stone known in history。〃 It is the royal tomb of Zoser； the first of a long series with which the Egyptian monarchy sought 〃to adorn the coming bulk of death。〃 The design of this is attributed to Imhotep； the first figure of a physician to stand out clearly from the mists of antiquity。 〃In priestly wisdom； in magic； in the formulation of wise proverbs； in medicine and architecture； this remarkable figure of Zoser's reign left so notable a reputation that his name was never forgotten； and 2500 years after his death he had become a God of Medicine； in whom the Greeks； who called him Imouthes； recognized their own AEsculapius。〃＇3＇ He became a popular god； not only healing men when alive； but taking good care of them in the journeys after death。 The facts about this medicinae primus inventor； as he has been called； may be gathered from Kurt Sethe's study。＇4＇ He seems to have corresponded very much to the Greek Asklepios。 As a god he is met with comparatively late； between 700 and 332 B。C。 Numerous bronze figures of him remain。 The oldest memorial mentioning him is a statue of one of his priests； Amasis （No。 14765 in the British Museum）。 Ptolemy V dedicated to him a temple on the island of Philae。 His cult increased much in later days； and a special temple was dedicated to him near Memphis Sethe suggests that the cult of Imhotep gave the inspiration to the Hermetic literature。 The association of Imhotep with the famous temple at Edfu is of special interest。
＇3＇ Breasted： A History of the Ancient Egyptians； Scribner； New York； 1908； p。 104。
＇4＇ K。 Sethe： Imhotep； der Asklepios der Aegypter； Leipzig； 1909 （Untersuchungen； etc。； ed。 Sethe； Vol。 II； No。 4）。
Egypt became a centre from which civilization spread to the other peoples of the Mediterranean。 For long centuries； to be learned in all the wisdom of the Egyptians meant the possession of all knowledge。 We must come to the land of the Nile for the origin of many of man's most distinctive and highly cherished beliefs。 Not only is there a magnificent material civilization； but in records so marvellously preserved in stone we may see； as in a glass； here clearly； there darkly； the picture of man's search after righteousness； the earliest impressions of his moral awakening； the beginnings of the strife in which he has always been engaged for social justice and for the recognition of the rights of the individual。 But above all； earlier and more strongly than in any other people； was developed the faith that looked through death； to which； to this day； the noblest of their monuments bear an enduring testimony。 With all this； it is not surprising to find a growth in the knowledge of practical medicine； but Egyptian civilization illustrates how crude and primitive may remain a knowledge of disease when conditioned by erroneous views of its nature。 At first； the priest and physician were identified； and medicine never became fully dissociated from religion。 Only in the later periods did a special group of physicians arise who were not members of priestly colleges。＇6＇ Maspero states that the Egyptians believed that disease and death were not natural and inevitable； but caused by some malign influence which could use any agency； natural or invisible； and very often belonged to the invisible world。 〃Often； though； it belongs to the invisible world； and only reveals itself by the malignity of its attacks： it is a god； a spirit； the soul of a dead man； that has cunningly entered a living person； or that throws itself upon him with irresistible violence。 Once in possession of the body； the evil influence breaks the bones； sucks out the marrow； drinks the blood； gnaws the intestines and the heart and devours the flesh。 The invalid perishes according to the progress of this destructive work； and death speedily ensues； unless the evil genius can be driven out of it before it has committed irreparable damage。 Whoever treats a sick person has therefore two equally important duties to perform。 He must first discover the nature of the spirit in possession； and； if necessary； its name； and then attack it； drive it out； or even destroy it。 He can only succeed by powerful magic； so he must be an expert in reciting incantations； and skilful in making amulets。 He must then use medicine ＇drugs and diet＇ to contend with the disorders which the presence of the strange being has produced in the body。〃＇6＇
＇5＇ Maspero： Life in Ancient Egypt and Assyria； London； 1891； p。 119。
＇6＇ Maspero： Life in Ancient Egypt and Assyria； London； 1891； p。 118。
＇7＇ W。 Wreszinski： Die Medizin der alten Aegypter； Leipzig； J。 C。 Hinrichs； 1909…1912。
In this way it came about that diseases were believed to be due to hostile spirits； or caused by the anger of a god； so that medicines； no matter how powerful； could only be expected to assuage the pain； but magic alone； incantations； spells and prayers； could remove the disease。 Experience brought much of the wisdom we call empirical； and the records； extending for thousands of years； show that the Egyptians employed emetics； purgatives； enemata； diuretics； diaphoretics and even bleeding。 They had a rich pharmacopoeia derived from the animal； vegetable and mineral kingdoms。 In the later periods； specialism reached a remarkable development； and Herodotus remarks that the country was full of physicians；〃One treats only the diseases of the eye； another those of the head； the teeth； the abdomen； or the internal organs。〃
Our knowledge of Egyptian medicine is derived largely from the remarkable papyri dealing specially with this subject。 Of these； six or seven are of the first importance。 The most famous is that discovered by Ebers； dating from about 1500 B。C。 A superb document； one of the great treasures of the Leipzig Library； it is 20。23 metres long and 30 centimetres high and in a state of wonderful preservation。 Others are the Kahun； Berlin； Hearst and British Museum papyri。 All these have now been publishedthe last three quite recently； edited by Wreszinski。＇7＇ I show here a reproduction from which an idea may be had of these remarkable documents。 They are motley collections； filled with incantations； charms； magical formulae； symbols； prayers and prescriptions for all sorts of ailments。 One is impressed by the richness of the pharmacopoeia； and the high development which the art of pharmacy must have attained。 There were gargles； salves； snuffs； inhalations； suppositories； fumigations； enemata； poultices and plasters； and they knew the use of opium； hemlock； the copper salts； squills and castor oil。 Surgery was not very highly developed； but the knife and actual cautery were freely used。 Ophthalmic surgery was practiced by specialists； and there are many prescriptions in the papyri for ophthalmia。
One department of Egyptian medicine reached a high stage of development； vis。； hygiene。 Cleanliness of the dwellings； of the cities and of the person was regulated by law； and the priests set a splendid example in their frequent ablutions； shaving of the entire body； and the spotless cleanliness of their clothing。 As Diodorus remarks； so evenly ordered was their whole manner of life that it was as if arranged by a learned physician rather than by a lawgiver。
Two world…wide modes of practice found their earliest illustration in ancient Egypt。 Magic； the first of these； represented the attitude of primitive man to nature； and really was his religion。 He had no idea of immutable laws； but regarded the worl
