From the historical record, it would appear that the medical profession in ancient times was a death cult with a body fluid fetish, whose members passed the bulk of their workdays draining patients’ blood and/or slathering them with animal droppings. Of course, to fault them for getting it wrong would suggest that we’ve gotten it right, when in reality we’re still very much in the dark. Plus, it wasn’t all pigshit and sterilised bloodletting – plenty of the ancients’ advancements still have some value today, or served as crude but useful prototypes for current medical practices. For this week’s Giz Asks, we reached out to a number of experts for a runthrough of some of these.
Lecturer, Ancient Studies, University of Maryland Baltimore County
An example that tends to surprise my students is using bronze to make medical instruments. Most instruments we get from the ancient Mediterranean are made of bronze, which is a copper alloy. Even in alloy form, copper has a range of antimicrobial effects. (We now take advantage of this by using copper in the touch-plates on hospital doors.) So while I wouldn’t say bronze medical instruments are self-sterilising, they are safer than using, say, steel, which was available in the ancient world, and used for things that had to stay sharp, like scalpel blades. But often, when they were operating with steel, they would heat the scalpel blades over hot coals in a brazier, in order to make them hot enough to cauterise as they cut, but this also had the secondary effect of making your medical instruments clean. And even when applying drugs, they wouldn’t use their hands, but would rather use a little spatula probe, which limited the amount of skin-to-skin contact between doctor and patient. Again, sterile would be a bit of an overstatement, but it’s cleaner than you might think.
“Most instruments we get from the ancient Mediterranean are made of bronze, which is a copper alloy. Even in alloy form, copper has a range of antimicrobial effects.”
Associate Professor, Classics, University of Iowa
Therapies in ancient medicine included advice about diet and exercise, drugs, and surgeries. While contemporary medicine judges many historical therapies and practices unsuccessful, others proved to be in the right direction.
In general, poor peoples of the ancient Mediterranean ate less meat and walked more than contemporary populations. The common Mediterranean diet was then, as today, rich in a variety of seafood, cereals such as wheat and barley, the fats of olive oil, with seasonal fruits and vegetables, all consumed with wines. It’s a healthy diet in combination and moderation.
Many of our own drugs are isolates of the natural properties of certain plants and minerals that humans have used for medicinal purposes for thousands of years. Copper and honey have antibacterial properties, wine contains polyphenols that are antiseptic for dressing wounds, willow bark contains an anti-inflammatory chemical related to aspirin, opium is a natural soporific and analgesic, mandrake is a natural narcotic. The 2015 Nobel prize in medicine was awarded for an antimalarial drug developed from the plant wormwood, a plant long used in classical Chinese medicine to treat fevers associated with malarial infection. But we rarely know whether ancient people’s use of these plants and minerals in their version of compounded drugs actually worked: among other issues, the plant could have been prepared poorly or the dosage could have been too low or high.
Ancient peoples had successful (if sometimes crude) surgeries for a variety of problems. Drilling into the skull to relieve swelling has been practised since Neolithic times. With the caution that historical success rates are difficult to know, competent ancient doctors could perform these surgeries: removing bladder stones, resetting broken bones, draining the accumulation of fluid around the lungs in pneumonia, curing abscesses and fistulae, removing broken teeth and installing false ones, restoring limited vision to patients by couching for cataracts, and some selective plastic surgeries, such as cures for cleft palate, rhinoplasty, and decircumcision. The continual development of medical instruments and surgical equipment led to more efficient surgeries over the centuries. Yet the great surgical advances of anaesthetics, asepsis, and blood transfusions had to wait for the 19th and 20th centuries.
“Many of our own drugs are isolates of the natural properties of certain plants and minerals that humans have used for medicinal purposes for thousands of years. Copper and honey have antibacterial properties, wine contains polyphenols that are antiseptic for dressing wounds, willow bark contains an anti-inflammatory chemical related to aspirin, opium is a natural soporific and analgesic, mandrake is a natural narcotic.”
Emeritus Professor, Classical Studies, Open University
You’ll read many claims that ancient medicine really works. An example from the ancient Greeks would be willow bark, which contains salicin – sometimes described as ‘nature’s aspirin’. One much-copied claim online is that ‘Hippocrates’ advised women to chew willow leaves, or used an infusion of willow bark for headaches and labour pains.
In addition to the point that not all species of willow contain the same concentrations of salicin, there are two problems with these claims. First, it’s hard to know how to translate some of the many plant names mentioned in ancient texts. The word promalos is sometimes translated as willow, but not all experts would agree with this. This may be an entirely different plant. Second, and even more importantly, when you look at the Hippocratic texts on gynaecology which use promalos, they are not about the bark, but the leaves; they are not about pain relief; and they don’t mention chewing anything. For example, if the womb changes position, ground barley, promalos and deer’s horn are soaked in wine and applied as a fumigation to the vulva—basically, heated and the smoke allowed to rise up. If there is too much blood in the body, promalos leaves will be smoked and the patient will sit while the smoke enters her womb. So, even if promalos means ‘willow’, this isn’t going to kill any pain.
Another plant used in ancient Greek medicine was pennyroyal, in Greek glechona. Oil extracted from the leaves has been used in many herbal medicine systems, as an insect repellent and antispasmodic, as well as to cause abortion. The active agent is pulegone, which is toxic to the liver. In ancient Greek medicine, however, both seeds and leaves were used, and not necessarily in the ways people would use them now. For example, rather than being seen as an abortive, the seeds were drunk in wine to cure heavy periods; it was included in a drink to prevent a threatened miscarriage; and, to improve fertility, some was dried and applied to the body while some was drunk at bedtime.
An even larger question concerns what we mean by ‘effective’: in our terms, or in theirs? If you believe that symptoms are caused by a suppressed menstrual period, then anything which causes bleeding would be seen as a successful treatment; and in ancient Greece that included beetles inserted into the vagina.
“An even larger question concerns what we mean by ‘effective’: in our terms, or in theirs?”
Assistant Professor, Assyriology, University of Chicago, who studies ancient Mesopotamian and Greco-Roman science and medicine
Many features and themes in modern practice appeared already in earlier times. While ignorant of bacteria and viruses, ancient Mesopotamian healers protected themselves with magic spells before approaching their patients, for fear of coming into contact with malevolent divinities, demons, or ghosts responsible for the illness. The lavatory demon Šulak, in folk etymology, was linked to “hands” (ŠU) that are “not” (lā) “clean” (KU3), attributing the dangers of human excrement to failures in personal hygiene. Advances in sanitation and public health came with the development of sewage systems among the Mesopotamians, Greeks, and especially the Romans. Taboos against touching corpses or the sick – and, in some cultures, prohibitions against eating “unclean” animals or certain kinds of food preparation – reveal ancient perceptions that threats lurked invisibly in one’s surroundings and could harm or spread upon contact.
The importance of diagnosing sickness in an unbiased way is apparent in a Mesopotamian Diagnostic Handbook titled ‘Sa-gig,’ which suggested how, without jumping to assumptions about a patient’s illness, medical signs could be methodically evaluated in head-to-foot order. Acknowledging the limits of medical intervention and resources, the ancient Egyptian ‘Edwin Smith Papyrus’ classified traumatic injuries into “that which I will treat,” “that against which I will fight,” and “that for which nothing is done” – a practice reminiscent of the assigning of yellow, red, and black tags in emergency triage today. The recording of patient case histories, for instance in the Hippocratic treatises on Epidemics, continues to the present day, and recognises that a disease’s manifestations can vary with the age, sex, occupation, preexisting health, allergies, and even psychological state of the individual. In fact, aligned with ancient Greco-Roman emphases on the body’s internal balance of humours (e.g., blood, phlegm, bile) or qualities (e.g., warm–cold, wet–dry), medicine could be defined as not merely the curing of sickness, but also the maintenance of health – with attention given to proper nutrition and exercise, as elements of a healthy lifestyle that we take for granted today. As precursors of the modern sanatorium or hospital, the healing temples of the god Asclepius sheltered sick visitors, who participated in prayers, music, baths, and dream incubation in an environment devoted exclusively to healing.
It is worth also reflecting on aspects of ancient practice downplayed in medical historiography, because they tend not to be recorded in the historian’s written sources. Manual procedures such as setting fractures, correcting dislocations, bandaging sprains, closing wounds, and lancing boils, etc., were mostly learned by imitation and practice, rather than taught using detailed written instructions. Anthropological parallels suggest that effective home remedies could have circulated orally in familial and close-knit social circles. In ancient cultures where literacy was much the province of scribal elites, practitioners of lower status like the midwife and the wet nurse depended on a wealth of unwritten tradition and experience, in facilitating pregnancy and child-birth, and treating ailments specific to women and infants.
“Acknowledging the limits of medical intervention and resources, the ancient Egyptian ‘Edwin Smith Papyrus’ classified traumatic injuries into ‘that which I will treat,’ ‘that against which I will fight,’ and ‘that for which nothing is done’ – a practice reminiscent of the assigning of yellow, red, and black tags in emergency triage today.”
Featured image: Illustration: Benjamin Currie (Gizmodo)