Intercultural Relations
Culture and Health Care Lecture
Fall 2004
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Day 1 Objectives:
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To understand the history of medicine and
its influence on the American health care
system.
To increase awareness of one’s own
culture care values.
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Neolithic people 9,000 BC
• Trephining – A hole in
the head
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Sumeria 3,000 BC
•
Sumerian Incantation–
cuneiform tablets
• Fashion a figure of him in
dough,
Put water upon the man
and
Pour forth water of the
Incantation;
Bring forth a censer and
a torch
As the water trickleth
away from his body
So may the pestilence in
his body trickle away.
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• Magic and Religion
• Hammurabi of
Babylon (1700 BC –
surgeon’s liability
• Managed care,
regulation of
physician’s practice
• Sesame oil, antiseptic
agent, antibiotics
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Internal organs
• Babylonian sheep liver
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EGYPT 1500BC
•
Imhotep 2,700 BC first physician
•
world’s first architect –built the first
pyramid
•
author of the Edwin Smith Papyrus
5th Dynasty Egypt (circa 1500 bc)
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•
From 'Case 10', describing a deep laceration above the eyebrow:
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EXAMINATION : If thou examinest a man having a wound in the top of
his eyebrow , penetrating to the bone, shouldst palpate his wound , (and)
draw together for him the gash with stitching.
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DIAGNOSIS : Thou shouldst say concerning him : "One having a wound
in his eyebrow . An ailment which I will treat.“
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TREATMENT : Now after thou hast stitched it , thou shouldst bind fresh
meat upon it the first day . If thou findest that the stitching of this wound is
loose , thou shouldst draw (it) together for him with two strips (of plaster) ,
and thou shouldst treat it with grease and honey every day until he recovers
.
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Egypt: center of civilization
Causes of disease- hostile spirits,
caused by the anger of a god
Treatments : incantations, spells
and prayers + emetics,
purgatives, enema, diuretics,
diaphoretics and even bleeding .
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Egyptian healing prescriptions
• Cure for Diarrhea:
1/8th cup figs and
grapes, bread dough,
pit corn, fresh Earth,
onion, and elderberry.
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• Cure for Indigestion:
• Crush a hog's tooth
and put it inside of
four sugar cakes. Eat
for four days.
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Surgical instruments
• Symbol of god Horus,
protector
• Embalming
• Isis for magical cures
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Greek Medicine
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rd
3
Century BC
• Treatment of arrow
and sword wounds
described in the Iliad
and Odyssey
• Staff of Aesclepius,
symbol of medicine
• Son of god Apollo –
god of healing
• Daughters: Hygeia
and
Panacea
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Hippocrates (460 - 377 BC)
• THE HUMORAL THEORY OF
• Three Greek philosophers:
DISEASES.
Hippocrates, Plato (427-348
• Medicine equated with
BC) and Aristotle (384-322 BC)
philosophy
• Aristotle was a philosopher,
• Separated supernatural from
scientist, and the father of
biology. He emphasized the
rational explanation for health
importance of the senses in the
and disease
investigations of science.
• Treatments: herbal, cupping,
baths, fomentation, suturing of
wounds, drainage.
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Hippocrates:
• Thus a man will be the more esteemed to be
a good physician, for he will be the better
able to treat those aright who can be saved,
from having anticipated everything; and by
seeing and announcing beforehand those
who will live and those who will die, he will
thus escape censure.
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ALEXANDRIA- 300 BC
•
• "the art of healing is
with them divided up, so •
that each physician
treats one ailment and
no more. Egypt is full of •
physicians, some treating•
•
diseases of the eyes,
others the head, others •
the teeth, others the
stomach and others
•
unspecified diseases".
Herodotus
•
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Alexander the Great conquered
Egypt, ended Persian rule
Center of learning moved again to
Egypt
Human dissection
Soul separate from body
Surgery and mummification
Rational thinking and medical
observation + magic and sorcery.
Herophilus 330-260 BC Alexandria
Alexandria began its decline with the
Roman invasion in 48 B.C
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THE ROMAN EMPIRE
• Physicians were male or female
or freed slaves
• Galen of Pergamum(AD131 201) physician to the gladiators
and to Marcus Aurelius – diet,
massage, exercise, herbal
• Greek heritage and knowledge
was translated into Arabic
• Treatments: bloodletting, sea
voyages, diet, rest. myrrh, nitre,
saffron, mandrake and poppy
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Medicine in the Roman Empire
• Texts describe over 600
plants and plant extracts
• morphine, cocaine,
atropine, digitalis,
salicylate, ergot, quinine,
ephedrine, vinca.
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• Organization of
medical schools,
teachers, of public
physicians or public
and military hospitals
• Clean water supplies
• Sewer system
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Muslim Medicine & "Prophetic medicine"
(al-tibb al-nabawi).
• Al-Razi (Rhazes) 865-925 author • MOHAMMAD 570-632
of 200 medical texts.
• Encouraged cleanliness and
personal hygiene
• Ibn Sina (Avicenna) 980 -1037- • Licensing of physicians
wrote the Canon of Medicine,
quoted as a respected text for over • Pharmacology and drugs were
derived from plants, animals
five hundred years.
and minerals.
• First hospital -Baghdad 805 AD
• Ibn Nafis (d. 1288) described
human blood circulation
• Ibn Maimon (Rabbi Moses
Maimonides) 1135-1204
Ibn Sina
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“Make use of medical treatment for Allah has not made a disease
for which no treatment was made.”
• Dentistry
Page from Ibn Sina's Canon
(Encyclopedia) of Medicine, late
17th century Persian copy
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• Translation of knowledge from
• They developed new medicines
Greeks, Romans, Syrian,
camphor, saffron, myrrh, musk,
Indian, into Arabic
iodine, naphtha and senna,
• Arabic physicians became
• Distillation, sedimentation and
leaders in medicine and
crystallization of drugs
pharmacology during the Dark
Ages of Europe
• Medical schools in Damascus,
Baghdad, Cordoba and Cairo
• Retranslation of classical works
• Center for opthalmology
into Greek
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Medicine in the Bible
• Disease was God's will or
punishment; human
intervention was therefore
unlikely to work
• Ritual circumcision was
practised without
anaesthetics.
• Plague, (probably
bubonic) and leprosy were
recorded and fractures
were splinted.
• Quarantine
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• Instructions on the
disposal of excreta, and
the care taken about close
intermarriage
• the good Samaritan used
both wine (an antiseptic)
and oil (Luke 10:34). Paul
urged Timothy to use wine
to help a stomach
condition (1 Timothy
5:23).
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• "The life [sustenance] of the flesh is in the blood"
(Lev. Xvii. 11, 14;
• "Out of the heart are the issues of life." (Prov. iv.
23),
• "And the Lord God caused a deep sleep to fall
upon Adam, and he slept; and he took one of his
ribs, and closed up the flesh instead thereof" (Gen.
ii. 21).
• "Be free from anxiety; be occupied; be temperate.“
•
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Medicine in the Dark Ages – AD 400
- 1300
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People returned to a tribal existence
and the Romans knowledge of
public health was no longer used.
Books had been destroyed.
Trade of hieroglyphics
The church taught people that
illness and disease was a
punishment from God
needed to pray to be cured.
The soul was considered more
important than the body.
Medical treatments and bodily
cleanliness were of little
importance.
Minor surgery: Barbers
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•
During the dark ages, monasteries
were the only hospitals in Europe.
Patients were cared for in the
hospitals until they recovered or
died. Their fate was God’s will.
Prayer and/or pilgrimages to holy
shrines were considered the best
methods of effecting a cure.
Astrology ;influence of the planets,
stars and comets on generation,
disease and death.
Black Death
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The Black Death- Yersinia pestis
• Throughout Europe, Jews along with lepers and other minorities
became scapegoats for the devastation of the plaque. Thousands were
burned alive in retaliation.
•
one third to one half of Europe's population was destroyed
• Started sanitation laws
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Middle ages
• Role of the church- 1090-1300 - Pope Urban II calls for a
crusade to take back the Holy Land from the Muslims who
now occupy it
• Advances in medicine knights saw in their Arab and
Persian opponents and brought back to Western Europe.
• Truce times opened trade routes through contact with
Eastern merchants, opening up a whole new world to
Europe through exploration. T
• Care of the sick
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Golden Age of Islamic Medicine
Dark Ages of Europe
• Europe: disease
punishment
European scholars
• Tx: Prayer, suffering
translate large numbers • Black Magic, superstitions
of philosophical,
• No relation between
mathematical, scientific
cleanliness & health
and medical texts from
Arabic
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Salerno 9th - 13th centuries
• Derived from classic
Jewish and Arabic
medicine
• closed ultimately by
Napoleon in 1811
• organized medical school,
with a final examination;
its products called
themselves not medicus
but doctor, the learned one
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• Europe: hospitals, leper
houses, medical schools
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Italian Renaissance – 15th to 16th
Century
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Beginnings of modern scientific
medicine - dissection; hypotheses,
experimentation
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Leonardo da Vinci (1452-1519)
was a genius and polymath, a gifted
artist and theoretical engineer who
dissected the human body,
demonstrated for the first time the
maxillary sinus and the moderator
band and depicted the fetus in
utero.
•
Andreas Vesalius (1514-1564)
inaugurated the new science of
anatomy
He corrected many of the
misapprehensions of Galenic
anatomy, which was based on the
study of the pig,
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Anatomy led to physiology
• William Harvey Movement of
the blood is constant in the
circle and is brought about by
the beat of the heart.
• marked the beginning of
modern medicine.
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• Medical training was now being
organized ; medical schools
were set up all over western
Europe, e.g. in 1575
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Key Features of the Renaissance –
1500-1700
• - a rebirth of interest in the ideas of the classical period.
• Once more the ideas of Hippocrates and Galen were
studied. The four humours became the focus for medical
treatments and bloodletting was very popular.
• Science as we know it began in this period and began to
replace superstition in medicine.
• During this period it was important for well-educated
people to be knowledgeable in both science and art.
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• Printing press: 1445
• Philosophy of humanism – people are
rational, concrete over abstract
• Exploration and navigation
• Study of medicine, law, and theology
• Citizenship, social leadership
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Industrial Age
Industrial town – 1872
Factories
Urban crowding
No sewer or fresh water
Poor sanitation
Global empire
Role of religion declined
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Preventive Medicine
• Pasteur – germ theory 1822-1895
• Lister - antibacterial surgical techniques 1827-1912, carbolic acid for
wound
• Koch- 1843 to 1910 - tuberculosis and cholera
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• "The real act of discovery consists not in
finding new lands but seeing with new
eyes."
Proust
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Summary
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Prehistoric Medicine – 5000 – 3000 BC - health, herbs, spirits, trephining,
aboriginees
Ancient Egypt – 3000 – 1000 BC - gods, mummys, no dissection
Ancient Greece – 1000 – 500 BC - Asclepios, Hippocrates, Hippocratic oath,
Four Humours, Alexandria
Romans – 500BC – 400 AD - Public health, army, Galen
Arabic medicine – Mohammed, learning, Rhazes, Avicenna
Dark Ages – 400 – 1100 – no new learning, faith and superstition, monasteries
Middle Ages – 1100 – 1400 – medical schools, Galen, Four Humours, planets,
herbs, Black death, public health
Renaissance and Reformation – 1500-1700 – new ideas, science, Royal
Society, printing, Great Plague, Vesalius, Harvey
Enlightenment - 1800s – Jenner, Nightingale, Germ Theory, Pasteur, Koch,
anaesthetics - antiseptics - Lister, Industrial revolution
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