Medicine is as old as civilization itself; humankind has always made attempts to heal, cure, and prolong life. Even in the nascent phases of our development, our hominid ancestors recognized disease and sickness, and they made attempts to combat this with what was available at that time, mostly herbs and rituals. In our current phase of evolution, technology and applied intelligence have improved our understanding of what disease, sickness, and even death actually are. Now with the completion of the Human Genome Project and the possibility of genetically tailored treatments, an unprecedented chapter in medicine is about to begin. This entry provides a brief account of medicine’s evolution and speculates on its future direction.
Primitive, Ancient, and Modern Medicine
The word medicine is derived from the Latin word medicus, meaning “physician,” and the feminine declension medicinus, which means “of a doctor.” However, the actual definition of what medicine is has changed as our civilization itself has developed through time.
Medicine in its primitive form could be defined as a ritual practice, sometimes involving a sacred object that a society believes capable of controlling natural or supernatural powers that act as a form of prevention or remedy for physical ailments. This could involve the use of herbs, potions, prayers, or incantations and was usually performed by a specialized member of a society—a shaman or medicine man. These individuals held special status in their societies for their apparent ability to heal. It should also be noted that even though herbs and potions may have been believed to have supernatural effects by those giving and taking them, some of these herbs and potions did have potent pharmacological effects that were not understood as such until the modern era.
Evidence of prehistoric surgical procedures has been found, most notably for trepanation, a process in which a hole is drilled into the skull, evidently for therapeutic purposes. Trepanation is believed to be one of the oldest invasive surgical procedures, and without any doubt it is one of the first neurosurgical procedures. Evidence on prehistoric human skulls and in cave paintings of the Neolithic era (8500 BCE) establishes that this procedure was in fact practiced widely, most likely with the intent to cure aliments such as headaches, seizures, and possibly psychiatric disorders.
Some of the first evidence of ancient medical information and texts can be found in ancient Egypt in the so-called Edwin Smith papyrus, which has been dated to around 3000 BCE. This scroll is also believed to be one of the first ancient textbooks that illustrates in detail the examination, diagnosis, treatment, and prognosis of a large number of physical ailments. There is evidence of what are believed to be the first surgeries performed in manuscripts from 2750 BCE (250 years after the Edwin Smith papyrus is dated).
In ancient Greece and in early Europe, a natural system of medicine was devised that was called humoral medicine. Hippocrates is often credited with innovating this system, but it was actually derived from Pythagoras’s idea of humoral medicine, which was based on the treatment of a patient by balancing what were called the four humors: blood, phlegm, black bile, and yellow bile. An imbalance in any of these four humors is what was believed to cause physical ailments. (Pythagoras’s four humors were influenced in turn by Empedocles’s “four elements.”)
A modern definition of medicine is that it is an objective science of diagnosing, treating, and in some cases preventing disease and other insults to the body or mind. This type of science implements treatments with pharmacological drugs, diet, exercise, and other surgical and nonsurgical interventions. These therapeutic interventions are performed by a specialized member of society who has extensive education and training. In addition, modern medicine is now based increasingly on scientific evidence and clinical trials, or what is presently called “evidence-based medicine.” More specifically, according to the definition provided by the Centre for Evidence-Based Medicine in 1996,evidence-based medicine is the conscientious, explicit, and judicious use of current evidence in making decisions about the care of individual patients.
Comparing and Contrasting
Primitive and Modern Healers
There are several similarities between primitive medicine and modern medicine. First, the healers themselves share many similarities. They are in all accounts possessors of some form of specialized knowledge, be it of the spirit world or of anatomy and physiology. In order to perform healing, they all have to undergo some form of training or rite of passage that entitles them to special recognition within their society as a person who can heal. In the past, it was an apprenticeship or a ritual. Today there are formal study, graduations, clinical training, and certifications. In addition, healers hold a high status in their respective societies and command special recognition for what they do.
Second, healers, primitive and modern, have a similarity in their methods of healing, and that is the administration of medicines. Even though the actual types of medication given by the healers differ drastically, the intention is the same, which is to put something external into the body to elicit an improvement of physical symptoms. The universal expectation among patients, primitive or modern, is that the healer “make the pain go away.”
Third, healers of any era must inspire the patients’ belief. Modern physicians understand that patients’ belief that the doctor can help them get well is a large part of successful treatment. The patient needs to have confidence in the physician’s knowledge of medicine and experience of practicing it successfully. For ancient medicine as well, the patient had to believe that the shaman’s connection with the spirit world was real and that the rituals and herbs would cure aliments.
Healers and Their Methods: Then and Now
Although ancient medicine and modern medicine are separated by thousands of years and have become very different in how they are practiced, another notable similarity is that, as previously mentioned, the function of healing and curing is and was performed by a specialized member of society; not just anyone could do it.
Evidence of shamanism has been dated back to the Neolithic period (8500 BCE), which would predate all organized religions. Presently, some forms and remnants of shamanism are still seen in some societies in Africa and South America. It is also seen in regions of Asia such as Korea, the Ryukyu Islands, and sparsely populated rural areas in Japan.
Many disciplines define a shaman and his function, in a basic sense, as an intermediate between the physical (or what is call the natural) world and the nonphysical realm (or what is sometimes referred to as the spirit world). It was believed that the shaman had the ability to travel between these two worlds and was able to commune with spirits and ancestors to assist them in the healing (or in some cases the harming) of another person. Essentially, the core of shamanism is based on the belief that the physical world is somehow interconnected with the nonphysical world and that the nonphysical world can have a profound effect on the physical world.
Contemporary physicians have long since been divested of their powers of enchantment and connection with the spirit world. They are equipped instead with scientific knowledge of disease and disorders of the human body, and they have access to a vast body of medical knowledge and research. They also have the benefits of modern technology, such as diagnostic imaging and laboratory tests, and thousands of pharmacological agents to choose from. Along with primary and family care physicians who treat a wide variety of general conditions, there are more specialized physicians who treat one specific bodily system or one type of disease or disorder—for example, cardiologists, dermatologists, and psychiatrists.
In medieval Europe, a typical physician was neither well versed in the rituals of the spirit world nor educated in topics such as pharmacology or physiology. Rather, he studied humoral medicine, alchemy, astronomy, and dogmatic textbooks that were sometimes centuries old. These were his tools for diagnosing and treating patients, mostly on the basis of conjecture. Historically the medieval physician did very little to cure rampant outbreaks of diseases or plagues. In fact, most were unwilling to actually touch their patients for an examination. The transitional period between the medieval era and the Renaissance was the time of Paracelsus (1493-1541), who has been credited with pioneering the use of chemicals and minerals to treat sickness. He believed that the human body (and nature) should be studied and understood and that alchemy, whatever its purported ability to make gold and silver from base metals, was unsuited as a tool for medicine.
Sickness: Then and Now
How did our earliest ancestors view sickness and disease? Primitive humans would most likely have perceived sickness and disease as something unnatural or even as a supernatural event. Lacking knowledge of infectious diseases or microorganisms, sick persons could be perceived as being adversely affected by the spirit world or a curse, because they were being affected by something that was invisible or poorly understood. Therefore, only an individual capable of communicating with, and able to influence, the spirit world could abate these supernatural events and thus heal.
In mainstream Western culture today, when someone becomes sick, it now automatically comes to mind that “she has a virus” or “he needs an antibiotic for his infection.” No longer do most people blame evil spirits or retribution from the spirit world for illness. Spells, curses, and the “evil eye” have been discounted as causes of illness; the average person today has a better understanding of what “being sick” is and what can be done to cure various aliments.
Pharmacology: From Plants to
A change has taken place in what is used to cure illness and disease. Early humans had to be very resourceful and use what was abundant and available to them at the time, mostly plants. Today, medical botany or herbalism, the use of plants and plant extracts to cure and heal aliments, has largely been supplanted by modern pharmacology, and most drugs are now manufactured in high- tech laboratories. They are distributed in exact doses, taken for prescribed periods of time, and have extensively studied effects.
In 1960, a Neanderthal skeleton (determined to be over 60,000 years old) was uncovered from a burial site in what is known today as the Shanidar Cave (in Iraq). This specimen was buried with eight species of plants that are believed by medical anthropologists to be used medicinally all over the world. However, the earliest record of the use of plants for medicinal purposes is found in paintings in the Lascaux Cave in France, which have been dated to between 13,000 and 25,000 BCE.
It is believed that early tribal societies eventually created a small semireliable repertoire of medical knowledge based on generations of trial and error experience. The observed effects of specific plants and herbal preparations were transmitted from generation to generation and used therapeutically by a specialized member of society. Ancient societies and early European physicians would use potions and tinctures to treat patients, although they lacked the knowledge of what these potions were doing in a pharmacological or physiological sense.
Penicillin, a byproduct of a fungus, was one of the first antibiotics discovered and used therapeutically. Originally noted by a French medical student, Ernest Duchesne, in 1896, it was rediscovered by Alexander Fleming in 1928. However, the internal use of penicillin as an antibiotic did not begin until the 1940s. Since that time, thousands of medications and hundreds of classes of medications, from blood pressure medication to antidepressants, have been manufactured and administered to patients.
Eventually, with the continued growth and application of knowledge gained from the Human Genome Project, medications may be developed that are genetically tailored for optimum effectiveness with a given patient’s genetic makeup. With further research, some genetic diseases will be treated directly by genetic therapies, that is, by actual alteration or manipulations of the genome. It is believed that this will improve the efficacy of treatments and reduce side effects and adverse reactions. The treatment of a patient with therapeutics engineered to correct underlying genetic causes is call “gene therapy” or “genetic medicine.” The concept of genetic medicine will challenge the manner in which modern medicine treats life-threatening illness such as cancer, which currently utilizes the surgical extraction of tumors, radiation treatments, and chemotherapy. Our current approach to treating cancer with chemotherapy and radiation inevitably involves some toxic effects for the patient as physicians attempt to localize these effects to the actual cancer.
Modern medicine, despite some shortcomings, has provided our present-day population with several tremendous benefits. With the advent of new medications, treatments, and vaccines, people are now living longer and more productive lives. In fact, global life expectancy has increased from about 37 years in the year 1800 to 67 years in the year 2000, for a global average increase of 40 years.
Medicine in the Future
As medicine has developed from rituals, through alchemy and astrology, to modern technology and to the possibility of genetically tailored treatments, one fact has remained and will remain consistent: The human body becomes ill, breaks down, and dying and death continue to occur. Given humankind’s desire to prolong life, the human body will always need healing, repair, and medical treatment by specialists.
The future prospect of space travel suggests the possibility of encountering new forms of diseases and ailments as a result of exposure to the outer space environment. This new environment could also put us into contact with alien microorganisms that could cause different types of illnesses. In addition, space travelers may need to be placed in hibernation for long journeys, and muscle strength would need to be maintained in zero gravity conditions. All of these possibilities would open up a new area of space-travel medicine, a new specialty that would deal with these unprecedented medical problems.
John K. Grandy
See also DNA; Dying and Death; Egypt, Ancient;
Paracelsus; Time Travel
Ball, P. (2006). The devil’s doctor: Paracelsus and the world of renaissance magic and science. New York: Farrar, Straus, & Giroux.
Harner, M. (1982). Way of the shaman (1st ed.). New York: Bantam.
Porter, R. (2004). Blood and guts: A short history of medicine. New York: Norton.
Porter, R. (2006). The Cambridge history of medicine. Cambridge, UK: Cambridge University Press.
Sackett D. L., Rosenberg W. M., Gray, J. A., Haynes, R. B., & Richardson W. S. (1996). Evidence-based medicine: What it is and what it isn’t. British Medical Journal, 312(7023), 71-72.