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Yu Hai 医学史简论 ( 4 ) A Brief History of Medicine.

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1 Yu Hai 医学史简论 ( 4 ) A Brief History of Medicine

2 Origin of Medicine Egypt Babylon India China Greece Rome Medieval Arabic Renaissance Pre-modern medicine Modern medicine TCM Western Medicine

3 Civilization and Medicine in ancient Greece

4 古希腊文明 Greek Civilization  2800 - 1400BC , Minoan Civilization in Island Crete , Mycenaean Civilization in Peloponnese  1100 BC Dark Age (no written record): Dorian invasion  750 BC Emerging of poleis (city states)  8-4 century BC , The Golden Age  BC Conquered by Alexander the Great (Hellenistic civilization)  146 BC Roman conquest

5 Civilization of Ancient Greece Parthenon Temple of Athens

6 古希腊文明

7 Civilization of Ancient Greece Plato Socrates Archimedes Aristotle Euclid

8 Civilization of Ancient Greece

9 Civilization and Medicine in ancient Greece Homer epic poet, author of Iliad and Odyssey Trojan War (11-9 BC) Achilles and Patroclus

10 Ancient Greece Medicine  Temple of Asclepius

11 古希腊医学 Ancient Greece A sick child brought to presbyter in the temple of Asclepius John Waterhouse 1877

12 古希腊医学 Ancient Greece Hippocrates The Father of Medicine ( B.C)

13 Cos Island and Cos School of Medicine

14 古希腊医学 Medicine of Ancient Greece  The Hippocratic Corpus is a collection of around seventy early medical works from ancient Greece. The Hippocratic Corpus contains textbooks, lectures, research, notes and philosophical essays on various subjects in medicine, the volumes were probably produced by his students and followers  Humoralism : Four humors, Four temperaments based on Empedocles’ Four ultimate elements  Holistic medicine and prevention

15 Humoralism of Hippocrates Element Humor feature Temperament Fire blood hot/wet sanguine Water Phlegm cold/wet phlegmatic Air yellow bile hot/dry choleric Earth black bile cold/dry melancholic

16 古希腊医学 Ancient Greece Four Temperaments (Personality types):  Sanguine  Phlegmatic  Choleric  Melancholic 多血质 胆汁质 抑郁质 黏液质 多血质 胆汁质 黏液质 忧郁质 Individuals with sanguine temperaments are extroverted and social. Choleric people have energy, passion and charisma. Melancholics are creative, kind and considerate. Phlegmatic temperaments are characterized by dependability, kindness, and affection.

17 The contribution of Hippocrates to medicine  Hippocrates is the first physician to reject superstitions, legends and beliefs that credited supernatural or divine forces with causing illness. He separated the discipline of medicine from religion, believing and arguing that disease was not a punishment inflicted by the gods but rather the product of environmental factors, diet and living habits.  Hippocratic medicine was notable for its strict professionalism, discipline and rigorous practice. The Hippocratic work On the Physician recommends that physicians always be well-kept, honest, calm, understanding, and serious.

18 Oath of Hippocrates A 12 th -century Byzantine manuscript of the Oath,.

19 I swear by Apollo, Asclepius, Hygieia, and Panacea, and I take to witness all the gods, all the goddesses, to keep according to my ability and my judgment, the following Oath. To consider dear to me, as my parents, him who taught me this art; to live in common with him and, if necessary, to share my goods with him; To look upon his children as my own brothers, to teach them this art. I will prescribe regimens for the good of my patients according to my ability and my judgment and never do harm to anyone. I will not give a lethal drug to anyone if I am asked, nor will I advise such a plan; and similarly I will not give a woman a pessary to cause an abortion. But I will preserve the purity of my life and my arts. Hippocratic Oath

20 I will not cut for stone, even for patients in whom the disease is manifest; I will leave this operation to be performed by practitioners, specialists in this art. In every house where I come I will enter only for the good of my patients, keeping myself far from all intentional ill- doing and all seduction and especially from the pleasures of love with women or with men, be they free or slaves. All that may come to my knowledge in the exercise of my profession or in daily commerce with men, which ought not to be spread abroad, I will keep secret and will never reveal. If I keep this oath faithfully, may I enjoy my life and practice my art, respected by all men and in all times; but if I swerve from it or violate it, may the reverse be my lot.

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22 THE HIPPOCRATIC OATH: MODERN VERSION I swear to fulfill, to the best of my ability and judgment, this covenant: I will respect the hard-won scientific gains of those physicians in whose steps I walk, and gladly share such knowledge as is mine with those who are to follow. I will apply, for the benefit of the sick, all measures [that] are required, avoiding those twin traps of overtreatment and therapeutic nihilism. I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon's knife or the chemist's drug. I will not be ashamed to say "I know not," nor will I fail to call in my colleagues when the skills of another are needed for a patient's recovery. I will respect the privacy of my patients, for their problems are not disclosed to me that the world may know. Most especially must I tread with care in matters of life and death. If it is given me to save a life, all thanks. But it may also be within my power to take a life; this awesome responsibility must be faced with great humbleness and awareness of my own frailty. Above all, I must not play at God.

23 I will remember that I do not treat a fever chart, a cancerous growth, but a sick human being, whose illness may affect the person's family and economic stability. My responsibility includes these related problems, if I am to care adequately for the sick. I will prevent disease whenever I can, for prevention is preferable to cure. I will remember that I remain a member of society, with special obligations to all my fellow human beings, those sound of mind and body as well as the infirm. If I do not violate this oath, may I enjoy life and art, respected while I live and remembered with affection thereafter. May I always act so as to preserve the finest traditions of my calling and may I long experience the joy of healing those who seek my help. (Written in 1964 by Louis Lasagna, Academic Dean of the School of Medicine at Tufts University, and used in many medical schools today).

24 医学生誓言 健康所系,性命相托。当我步入神圣医 学学府的时刻,谨庄严宣誓: 我志愿献身医学,热爱祖国,忠于人民, 恪守医德,尊师守纪,刻苦钻研,孜孜不倦, 精益求精,全面发展。 我决心竭尽全力除人类之病痛,助健康 之完美,维护医术的圣洁和荣誉,救死扶伤, 不畏艰辛,执着追求,为祖国医药卫生事业 的发展和人类身心健康奋斗终生。

25 The Oath of Medical Students Health ties to, life relies on. The moment I step into this sacred temple of medical education, I pledge solemnly- I will devote myself to medicine, with the loyalty to my country and love to my people; I will scrupulously abide by professional morality, respect teachers and observe discipline; I will study assiduously and improve my professional proficiency constantly for all-round development of myself. I will do my utmost to relieve people’s suffering and to improve people’s health, to safeguard the holy and honor of medicine; I will heal the wounded and rescue the dying, regardless the hardships I am determined to seek truth for life long and to dedicate all my life to medical science and to people’s health.

26 希波克拉底格言 Hippocrates’ Aphorism  Life is short, and Art long; the crisis fleeting; experience perilous, and decision difficult. The physician must not only be prepared to do what is right himself, but also to make the patient, the attendants and externals cooperate.  For extreme diseases, extreme methods of cure are most suitable.  Those things which require to be evacuated should be evacuated, wherever they most tend, by the proper outlets.  It is better not to apply any treatment in cases of occult cancer; for, if treated, the patients die quickly; but if not treated, they hold out for a long time.

27 Hippocrates refuses gifts offered by Artaxerxes, king of the Persians and enemy of the Greeks. - by Girodet from 1792

28 Civilization and Medicine of Rome BC early agriculture community 735 BC City of Rome BC Roman Republic 25BC-476AD Roman Empire

29 Roman Mythology: Rome was founded in 753 BC by Romulus and Remus on Tiber river side, the twin sons of Mars who were reared and suckled by a wolf.

30 罗马帝国 Roman Empire Caesar ( b.c.) Augustus (27b.c.-14a.d.)

31 罗马帝国 Roman Empire

32 Colosseum Gladiator

33 罗马帝国 Roman Empire Water supply and draining system “Good in drain, not in brain” Pon tu Gard of Nimes aqueduct bridge (flume)

34 罗马帝国 Roman Empire Public health and sanitation : Public toilets and bath Private bath and public toilet in Pompey relics (79a.d) Bath of England

35 Vespasianus (9-79 AD) vespasienne ( urinal ) first pay toilet Pecunia non Olet vespasiano ( Italian ) ( money does not smell ).

36 Roman Medicine Galen of Pergamon ( AD)

37 Galen of Pergamon  Therapeutics in temple of the god Asclepius  Chief physician for gladiators  Personal physician of Emperor Marcus Aurelius and others  Great anatomist  Pioneer of experimental physiology

38 Galen of Pergamon dissection of human corpses was against Roma law, so instead he used pigs, apes and other animals

39 Galen of Pergamon Understanding the circulation : The heart and arteries, responsible for life-giving energy; and the liver and veins, responsible for nutrition and growth, the brain to make psychic pneuma, a subtle material that is the vehicle of sensation Natural spirit 自然灵 Vital spirit 生命灵 Animal spirit 动物灵

40 Galen of Pergamon Pioneer of Experimental physiology  Arteries carry blood not air  Urine formation in the kidney not bladder  Recurrent laryngeal nerve controls voice  Performing transections of the spinal cord

41 The influence of Galen  Galen’s writings achieved wide circulation during his lifetime, and copies of some of his works survive that were written within a generation of his death. By AD 500 his works were being taught and summarized at Alexandria, and his theories were already crowding out those of others in the medical handbooks of the Byzantine world.  from the late 11th century Ḥunayn’s translations, commentaries on them by Arab physicians, and sometimes the original Greek writings themselves were translated into Latin. These Latin versions came to form the basis of medical education in the new medieval universities.

42 Middle Ages 中世纪 Start from 476AD, the fall of Western Rome Empire by German (nomadic: Goths, Frank, Vandal, Anglo-Saxon) lasted for roughly a millennium (5-15th century) three "ages“ of European history: the classical civilization of Antiquity, the Middle Ages, and the modern period

43 中世纪 Middle Ages As Christianity grew in influence, a tension developed between the church and folk-medicine, since much in folk medicine was magical, or mystical, and had its basis in sources that were not compatible with Christian faith. The church taught that God sometimes sent illness as a punishment, and that in these cases, repentance could lead to a recovery. The Inquisition 1232 Pope Gregory IX

44 The Inquisition Trial by Inquisition 火 Stake (execution by burning)

45 中世纪的医学 Medieval Medicine Conformation

46 中世纪的医学 Medieval Medicine Urine exam

47 中世纪的医学 Medieval Medicine 放血术 Bloodletting

48 中世纪的医学 Medieval Medicine In the Medieval period the term hospital encompassed hostels for travelers, dispensaries for poor relief, clinics and surgeries for the injured, and homes for the blind, lame, elderly, and mentally ill. Monastic hospitals developed many treatments, both therapeutic and spiritual. Patients were supposed to help each other through prayer and calm, perhaps benefiting as much from this as from any physical treatment offered.

49 中世纪的医学 Medieval Medicine From the founding of the Universities of Paris (1150), Bologna (1158), Oxford (1167), Montpelier (1181) and Padua (1222), the initial work of Salerno was extended across Europe. To qualify as a Doctor of Medicine took ten years including original Arts training, and so the numbers of such fully qualified physicians remained comparatively small.

50 The End Thanks


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