Formerly, when religion was strong and science weak, men mistook magic for medicine; now, when science is strong and religion weak,men mistake medicine for magic.-Thomas Szasz
Medical anthropology is an emerging science bridging the concentrations of anthropology, wilderness medicine, and history. As a discipline of anthropology it connects the anthropological theory and methods with the study of health, illness and healing. It is a focus that first emerged in the mid nineteenth century and has rapidly grown to become one of the largest areas of research and practice within anthropology (Baer, 1997). Specialties can be found within the medical anthropology spectrum.
These subjects can include: ethnomedicine, international health, comparative health systems, epidemiology in history, and clinical medical anthropology. Research in medical anthropology has included past and present cultural interpretations of illness, the influence of globalization on healthcare and the impact of the pharmaceutical industry on health (Hahn, 1999). In Foster and Anderson’s definition it is: ‘A discipline concerned with both the biological and socio-cultural aspects of human behavior and particularly with the ways in which the two interacted throughout human history to influence health and disease’ (Foster & Anderson, 1978).
These subjects can include: ethnomedicine, international health, comparative health systems, epidemiology in history, and clinical medical anthropology. Research in medical anthropology has included past and present cultural interpretations of illness, the influence of globalization on healthcare and the impact of the pharmaceutical industry on health (Hahn, 1999). In Foster and Anderson’s definition it is: ‘A discipline concerned with both the biological and socio-cultural aspects of human behavior and particularly with the ways in which the two interacted throughout human history to influence health and disease’ (Foster & Anderson, 1978).
This blog will look at the fundamentals of medical anthropology and the emergence of this field within the subject of anthropology. It will then discuss the emergence of medicine in ancient civilizations.
Fundamentals of medical anthropology
Medical anthropology is a field of science that focuses on different cultures and social groups and how they explain the causes of illness, the types of treatment they believe in, and to whom they turn when they address their health issues. It uses the methods of anthropological research to study the beliefs and practices of present and past cultures and how they relate to biological, psychological and social changes (Foster & Anderson, 1978).
To gain perspective in the field of medical anthropology, it is necessary to discuss the discipline of anthropology, from which medical subspecialty is derived. Anthropology comes from the Greek, which means ‘the study of man’. The basic premise of anthropology is the holistic study of humankind. This includes the origins of man, the development of civilizations, societies, and industrialization, the role of religion, languages, and finally the art and leisure that developed concurrently.
The study of anthropology has several main specialties. Physical anthropology is the study of the biological evolution of the human species. It discusses the causes for the current diversity within the human populations. It investigates human antiquity using the techniques of paleontology, archeology, genetics and chemical analysis (Foster & Anderson, 1978). This specialty includes the study of tools, weapons, clothes, and other tangible artifacts that can be obtained through research.
Cultural anthropology discusses the comparative research between current and past societies. This approach looks at the societal dimensions of human life. It looks at culture and society as a way that humans have manipulated his environment, and has been able to provide for economic, political and social organization (Foster & Anderson, 1978).
Archaeology is the study of humans in antiquity using the investigation of material traces such as artifacts, food remains, features, and structures. This specialty documents and explains the origins and development of human culture and studies human behavior and their impact on the environment for prehistoric societies (Tigger, 1990).
Anthropology has made important methodological contributions to public health, especially with regard to the use of ethnography for the systematic collection of field data; qualitative methods for the collection and analysis of descriptive, interpretative, and formative data; and the integration of qualitative and quantitative approaches. The ability to translate scientific knowledge into effective practice at the community level is an area where anthropological approaches have much to offer public health.
Medical anthropologists study ancient medical practices found throughout all of the emerging civilizations. These historical medical procedures, texts, and remedies can be brought into the current medical model. The resurgence of naturopathic, homeopathic and herbal medicine uses some of the lessons learned in antiquity for current maladies (Boon et. al, 2004). Medical anthropology can research the aspects of current and past medicine and find similarities within each modality. They can take the lessons learned in antiquity and integrate them into today’s medicine.
Medicine of the Ancients
The study of ancient medicine from an anthropological standpoint begins with researching the written documents passed down from the first known medical institutions. These literary whispers of medicine in antiquity are the only information that is available. Some well known physician-authors refer to the medical knowledge passed down through the centuries, but the actual documents have long since been lost to time (Nutton, 2005). Current medical anthropologists believe that the majority of medical documentation was lost during the destruction of the libraries throughout the Mediterranean. These library systems first put into place by Alexander’s empire twenty three centuries ago, were destroyed by Christians set on the suppression of knowledge seventeen centuries ago. The library in Alexandria, Egypt was believed to have been the greatest source of ancient scrolls, tablets and papyrus (Thiem, 1979). It was burned to the ground by zealots.
The physician-authors such as Aristotle, Herodotus, and in later centuries the Roman Galen preserved some of the ancient medical knowledge (Nuland, 1989). Homer’s Iliad also shed light on some of the medical practices of the Aegean civilizations centuries before the emergence of Greek medicine. The most famous rediscovery of ancient medical practices came from the Ebers Papyrus found in the mid fifteenth century between the legs of a mummy by archeologists (Ghalioungui, 1987). The one hundred and ten page scroll contains some seven hundred herbal formulas and remedies. They range from herbs for minor headaches to minor brain surgery.
The historical and medical knowledge learned from these past civilizations may not be up to par with current medical procedures, but the time tested remedies that worked thousands of years ago are still beneficial today. Additionally, with the emergence of drug resistant bacteria and viruses, current medical practices are placing more emphasis on some of these ancient remedies (Buhner, 1999). There is much to learn from ancient medicine. The current tendency for modern medical practitioners to spend less than eighteen minutes with each patient gives room for misdiagnosis, hasty therapy guidelines, and a general impersonal approach to healing (Bodenheimer, 2003). In ancient medicine, patients would journey to the healing centers where they would stay for long periods of time (Nuland, 1989). These clinics were manned by both experienced practitioners and their protégé. The patients would stay in these facilities until they either regained health or were sent home.
In current medical practices, patients are encouraged to make use of the out-patient surgery, and quick care clinics. Physicians are regulated by the insurance companies on the time they have with each patient as well as the choices for therapy. Pharmaceutical companies have much invested in today’s medical model (Gonul et. al, 2001). They heavily influence healthcare providers with the latest and greatest drug therapy options without having the time to discuss options with their patients.
Medical anthropologists have as their disposal research that shows how differently medicine was practiced in history. Past medical models can be used to influence current practices.
Medicine in antiquity has many lessons and learning available for today’s modern society. There is movement in some alternative medical practices to incorporate the knowledge from the medical past with the scientific modalities of modern medicine (Foster & Anderson, 1978). Naturopathic medicine is now a recognized form of practice that allows their practitioners to become primary care practitioners in about half of the United States (Boon et. al, 2004). Herbalists are also fast becoming a recognized healthcare system. There are few regulations governing herbal medicine, but legislature is currently being submitted to offer certification in herbal medicine (Dougherty, 2004). In Europe, alternative medicine has been a large part of their healthcare system for several centuries. Osteopathy, homeopathy, naturopathy, herbalism, hydrotherapy and massage therapy have been licensed and regulated since the beginning of the last century.
Knowledge of ancient medical history benefits modern society (Porter, 1999). It is imperative to incorporate past medical knowledge with the current medical model for the main reason that a post-oil environment can not sustain the current consumption that the medical community consumes. Medical communities of the past maintained a sustainable healthcare system that modern medicine could do well to model. Looking at the medicine of the ancients, we can glean useful information from their ability for sustainment, their use of earth-based medicines, and their patient-based medical model.
Much of the medical knowledge has been lost through the centuries leading up to the discovery of written language. Without the ability to write down the lessons learned from each generation of healer, herbalists and physicians, ancient medicine was limited to what can be taught and learned within one lifetime. During this predawn of medical learning, three distinct civilizations emerged from the darkness of the unknown medical practices. The first society to discover the written language was the kingdoms residing within Mesopotamia. This trackless land is found between the Mediterranean to the west, the steppes of Afghanistan to the north, and the borders of India to the east. This civilization created the use of cuneiform tablets to document medical knowledge. Within a few short centuries, writing was brought to the neighboring civilizations of Egypt and Greece. In these three cultures are found the first written knowledge of ancient medicine. Each of these societies had their own ideas of medical practices and procedures.
Western medicine evolved from each of these civilizations with Greece contributing the most influence to modern medicine (Edelstein & Edelstein, 1998). Each had their contributions. The Mesopotamian societies gave the world of medicine the art of written language, the Egyptians discovered the benefits of surgery, and Greek physicians created the western model of medicine.
Medicine from the Nile Valley
Magic and religion were part of everyday life in ancient Egypt. Gods and demons were thought to be responsible for illness and health. Treatments often involved some supernatural component. The priests and magicians were called on to treat disease just as often as the physicians. Incantations and magical ingredients were part of the treatments used by both physician and priest.
Physicians have had a long history in ancient Egypt. The first known reference to the healing practitioner was in the twenty-seventh century (Ghalioungui, 1987). There were many different ranks and specializations for physicians including ophthalmologists, gastroenterologist, proctologists and general surgeons. Medical institutions were established in ancient Egypt since as early as the twenty-fifth century.
Egyptian medicine had knowledge about anatomy of the human body even though there were no dissections of the human body allowed. The art of embalming shows how profound their medical knowledge was. Even current physicians and researchers have not been able to rediscover exactly how the ancient embalmers were able to retrieve the human organs without incisions (Ghalioungui, 1987). Medical knowledge in ancient Egypt was so advanced that other kings and emperors from different empires would write to the Egyptian pharaoh to send them their best surgeon to perform operations.
Egyptian physicians advised the population to shave the entire body, to wash often and watch their diet. The shaved and washed body would keep the microbes from staying on the skin and would minimize infection of any wounds received. The diet of ancient Egypt consisted of wheat, barley and vegetables. The Nile valley was a great source of sustenance. Ancient Egypt rarely suffered from famines that devastated the Mediterranean from time to time (Ghalioungui, 1987).
The Egyptian medical specialization was the first instance in antiquity that a physician could dedicate himself wholly to one small aspect of medicine. This gave way to the rise of the surgeon. Brain surgery was performed and was successful. Mummies have been recovered that have had holes drilled into their skull. The edges of the skull show growth and healing that indicate the patient lived for quite some time following the procedure (Ghalioungui, 1987).
Without the development of writing introduced by the Mesopotamian scholars, much of Egyptian medical learning would have fallen into the mists of antiquity. Even though the height of the Egyptian empire spans thousands of year before the fall of Assyria to the Greeks twenty three centuries ago, Mesopotamian knowledge and practices greatly benefited the medical lineage of Egyptian medicine (Ghalioungui, 1987). There was exchange of information and trade between the two great civilizations. Both benefited from this exchange. Although some similarities can be found between the medical practices of these two populations, Assyria has been given the honor of the first nation to document aspects of their daily life. Thus, the surviving knowledge has been passed down through the centuries to the benefit of both scholars of history as well as medical anthropologists.
Mesopotamian medicine
Most of the information available on Assyrian medicine comes in the form of cuneiform tablets. There are no useful pictorial representations that have survived in ancient Mesopotamian art, nor has a significant amount of human physical remains have been uncovered. Unfortunately, while an abundance of cuneiform tablets have survived from ancient Mesopotamia; relatively few are concerned with medical issues. Many of the tablets that do mention medical practices have survived from the library of Assurbanipal, the last great king of Assyria. The library of Assurbanipal was housed in the king's palace at Nineveh, and when the palace was burned by invaders, around twenty thousand clay tablets were baked and preserved by the great fire. By examining the surviving medical tablets it is clear that there were two distinct types of professional medical practitioners in ancient Mesopotamia. The first type of practitioner was the ashipu, in older accounts of Mesopotamian medicine often called a "sorcerer." One of the most important roles of the ashipu was to diagnose the ailment. In the case of internal diseases, this most often meant that the ashipu determined which god or demon was causing the illness. The ashipu also attempted to determine if the disease was the result of some error or sin on the part of the patient. The ashipu could also attempt to cure the patient by means of charms and spells that were designed to entice away or drive out the spirit causing the disease. The ashipu could also refer the patient to a different type of healer called an asu. He was a specialist in herbal remedies, and in older treatments of Mesopotamian medicine was frequently called "physician" because he dealt in what were often classifiable as empirical applications of medication. For example, when treating wounds the asu generally relied on three fundamental techniques: washing, bandaging, and making plasters. All three of these techniques of the asu appear in the world's oldest known medical document (Nutton, 2005).
The lessons of the asu are more relevant to today’s western trained physician, while the uses of the ashipu would be characterized with a Native America shaman or a religious figurehead. The medical knowledge that the asu had can only be extracted from the remaining medical cuneiform tablets that exist. Beyond the role of the ashipu and the asu, there were other methods of healthcare in ancient Mesopotamia. Temples played an important part in healing. Current excavations of temples have a design that could have been used for treatment of the masses. Not only could these temples have been sites for the diagnosis of illness, they could have been ancient libraries that held useful medical tablets (Avalos, 1995).
The primary care clinic in ancient Mesopotamia was in the home. The ashipu and asu mainly made house calls where the immediate family acted as care givers using whatever knowledge of medicine that they had. Outside the home, the temples and nearby rivers were used for health and religious reasons.
As the empire of Darius fell to the armies of Greece, the Assyrian way of healthcare was quickly replaced with the emerging model of Asclepius and Hippocrates.
Greek Medicine
The emergence of Greek medical traditions comes from the whispered snippets of ancient literature. Information was passed down through the centuries before the written language arrived thus bringing with it all of the additional deviations given by the oratory lineage. Greek medicine departed from the mythical and divine influences and moved toward observation and logical reasoning during the classical period of Greek civilization. This period ranged from twenty eight hundred years ago up to the fall of Alexander the Great five hundred years later.
These five centuries saw the peak of Greek society, culture, law, trade and medicine. Scholars began to make clinical observations of their medical practices. Students of medicine journeyed to the havens of medical education and knowledge. The island of Cos was integral in the evolution of modern medicine. Asclepius, the god of medicine, was thought to reside there. Ancient physicians such as Hippocrates and Praxagoras were born on the island. It was a haven of medical learning (Edelstein & Edelstein, 1998).
Greek medical communities created the use of theory, discussion and the scientific method. They were a great insight to the cause of health and disease, and theorized that there was a general cause for every phenomenon. Another aspect of Greek medicine was the generalization of causes of illness to populations based on geography, gender, and living conditions.
The ancient Greeks made important discoveries about medicine and the anatomy of the human body (Edelstein & Edelstein, 1998). The physicians practiced medicine based on a clinical approach. Their discoveries were made by studying the anatomy using post mortem dissection then applying that knowledge on living patients. Before the emergence of the scientific method, medical practitioners integrated superstition and religion into their treatment (Edelstein & Edelstein, 1998).
The Greeks are also credited with treating the cause of the disease or ailment (Phillips, 1973). Traditionally, symptoms were the only indication that the patient was not well, thus medical practice focused on the symptoms and not the disease. Hippocrates is thought to have spearheaded the new model of medicine. He saw the body as the whole and not just a mechanistic sum of its parts. Thus, his treatments were aimed at the whole system (Edelstein & Edelstein, 1998).
Greeks formulated health and fitness into their medical model. Exercise and a healthy diet were treatments for illness. The healing temples were designed not only for medical clinics for the physician visit, but a resort or spa where patients could stay, relax, and heal. Archeological digs have uncovered temples located on mountain tops with open rooms, pools, plumbing, and saunas. Current thought is that these establishments could have been a one-stop facility for healing and wellbeing (Phillips, 1973).
Ancient Greek medicine was greatly influenced by Egyptian medical knowledge (Sigerist, 1951). In the works of Dioscordes, a number of medical treatments are similar to those found in the Ebers Papyrus (Riddle, 1992). Although Diocorides was considered the authority in herbal remedies for almost two thousand years, it is interesting that his knowledge of herbs and healing have similarities with Egyptian herbal medicine, most of which has been lost to antiquity.
Greek medicine continued to influence western societies and still has major resonance with medical practices used today. With the death of Alexander the Great came the fall of the Greek empire. Greek philosophy, education and medicine still heavily influenced all aspects of western societies (Phillips, 1973). The Romans employed many Greek physicians and the spread of the Roman Empire brought proliferation to Greek thought and medicine. The Greek philosophies were adopted by the Roman cultural elite and thus secured a permanent influence of Greek thought on western civilizations. Much of the present medical model can be traced back to original Greek medical knowledge.
Mesopotamia, Egypt and Greece each have been seen to have influenced modern medicine. As medicine emerged, each of these three societies modified it for their particular needs and population issues. Each built upon the knowledge, both written and oral, that was available to them. These three cultures greatly influenced the emergence of modern medicine.
Integrating ancient medical knowledge into the current healthcare system
The influences of ancient medical societies are well established in modern medicine. But the current medical model has evolved to a point where bureaucracy is more powerful and has more influence than ever before on the outcome of treatment and available medical options. Seventy-five percent of physicians are dissatisfied with their jobs and how they are forced to practice (Hobson, 2005). Perhaps looking back to past cultures for addressing some of these current issues could be an option. Healthcare in ancient civilizations were indeed crude and often limiting and unsuccessful. One aspect of ancient medicine was that it was patient focused. Monetary gain was not a driving factor for learning the art of healing. Today, medical school applications are declining. The Journal of the American Medical Association surveyed medical school applicants which show a decline in the number of students applying to medical school (Barzansky, 2000). One thought is that the current economy offers students better money making opportunities with advanced business degrees. Other thoughts place doctor complaints about long hours and less pay as the contributing factor.
Recent research shows that the current medical model is not meeting the needs of the population (Barr, 2005). Perhaps a look at how medicine of the ancients could help with current problems. Conceivably, a patient centered medical model is needed. One only needs to read history to see that this has worked well in the past.
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