A History of Medicine - part 3

26 October 2008

October 25 2008 By Fjordman

This is the third part of an extensive essay on the origins of modern medicine. The first two parts can be read at Brussels Journal and Atlas Shrugs.

The Romans have been credited with the invention of several surgical instruments and were advanced in surgery for their time, a necessity for a large empire with a constant need for treating war injuries. They used some forms of herbal antiseptics and painkillers such as opium, but in the Roman Empire as elsewhere in the world before late nineteenth century West, surgery was a painful and dangerous undertaking.

Caesarean section was almost always fatal for the mother of the baby prior to modern antiseptics. The Romans relied heavily on the Greeks for medical theory, as they did in many other sciences, but they were prolific builders of public bath houses and aqueducts. Many larger cities had advanced sewage systems.

Rome was among the earliest cities in the region to be equipped with running water, with the possible exception of Knossos in Crete (before 1450 BC), a center of Minoan civilization, the first literate European culture. Great aqueducts carried large amounts of water to Rome every day. The Cloaca Maxima is the great sewer opening into the Tiber River.

According to Michael Kennedy in his fascinating book A Brief History of Disease, Science and Medicine, "The great contribution of the Romans to medicine was in the area of public health and civil engineering. Roman public health and sanitation were more advanced in 300 CE than any country's would be again until the nineteenth century. The only hospitals constructed by the Roman government were for the military."

Hospitals in the European tradition are a product of the Christian era. Moreover, "Roman construction and Roman roads confirmed their expertise as the greatest civil engineers of antiquity, notwithstanding the pyramids of the Egyptians or the temples of the Greeks. Pompeii and Herculaneum, covered in volcanic ash (preserving the towns as time capsules) in an eruption of Vesuvius in 79 CE, each have an elaborate system of waterworks with flushing water closets. In 70 CE a public building with marble urinals was erected by Vespasian."

The Roman sanitary systems reduced the incidence of endemic diseases, but the roads, and the armies that marched across the Roman Empire, brought great epidemics to the cities. In contrast, Greek cities of the Hellenic Age were smaller and travel was less common. Consequently, epidemics were rare. One exception was the great epidemic in Athens of 430 BC, described by Thucydides in his history of the Peloponnesian War.

The Plague of Justinian which haunted the Byzantine (Eastern Roman) capital of Constantinople in the years 541–542 AD apparently did not cross the Bosphorus Strait. Urban growth during the High Middle Ages (AD 1000-1300), the rise of towns and the appearance of the rat brought to Europe a disease known in China for millennia. Most of Europe had by then been free of major epidemics for 800 years following the disintegration of urban civilization in much of the continent after the collapse of the Western Roman Empire.

Now, increased contacts with Asia brought about by the Mongol conquests brought Asian diseases as well. The Black Death undermined Church authority and triggered a number of attacks on Jews, who were accused of causing the plague by poisoning the wells. The black rat, which unlike the brown rat tends to live in houses and ships, had inhabited the fields of North Africa since the beginning of history but was largely unknown in Europe. Mice are described in manuscripts from the Early Middle Ages, but not rats. Urban growth changed this and facilitated the spread of plague. As Kennedy puts it:

The disease is caused by the organism Yersinia pestis, formerly known as Pasteurella pestis (Alexander Yersin was an associate of Pasteur who discovered the organism in 1894), a gram negative bacterium that is transmitted by fleas' saliva. The flea lives on rats, its preferred host, but will parasitize and bite humans if rats are not available.

Bubonic plague epidemics are often precipitated by massive die-offs of infected rats sending their fleas on a search for new hosts. Increased trade with the East was probably the immediate source of the pestilence. It began in Tashkent in central Asia and arrived at the Black Sea, where it broke out among Muslim Tatars fighting Italian merchants in Crimea.

The Christians took refuge in the citadel at Kaffia where they were besieged. The plague forced the Tatars to raise the siege, much as the Carthaginians had done in Sicily 1,600 years earlier, but before leaving, they invented biological warfare by catapulting the bodies of plague victims into the citadel. The escaping Christians brought the plague (and presumably the infected rats and fleas) back to Messina and Genoa where it spread across Europe,The theory that the plague was deliberately spread to Europe by Islamized Mongols in the 1340s is not universally accepted, but it has been and still is debated. Alexandre Yersin (1863–1943), a Swiss-born bacteriologist who worked with Pasteur in France, and the Japanese bacteriologist Kitasato Shibasaburo (,1853-1931) who had studied under Robert Koch in Germany, independently discovered the causative organism in of plague in 1894.

The French bacteriologist Paul-Louis Simond (1858-1947), who was affiliated with the Pasteur Institute in Paris, discovered the plague organism in dead rats while studying an epidemic in Mumbai (Bombay) in India in 1898. In the 1660s, Isaac Newton had to flee the University of Cambridge in England due to the threat of plague. The disease disappeared from Europe after the eighteenth century, but it remained endemic in Africa and Asia after this. Kennedy again:

Why did plague stop in Europe after being such a pestilence for centuries? One theory, widely considered to be the best explanation, is that the black rat, comfortable in ships and houses, was killed off or driven out by the ferocious brown Norwegian rat, which first appeared in 1720 in Europe. The brown rat, more at home in sewers, is infested with a different flea that is less likely to transfer to humans. Evidence against this theory is the fact that the two varieties, having different habitats, do not compete for living space.

A second point against this theory is that the black rat, absent from Europe for two centuries, has returned since 1910. Another consideration is the introduction of arsenic as a rat poison, which may have reduced the level of contact between humans and rats and their fleas. Whatever the explanation, the plague vanished from Europe after three centuries and medical practice can claim no credit.The word "quarantine" comes from the Latin quaranti giorni, "forty days." Some of the Italian city-states from the late 1340s during the Black Death isolated ships for a limited time period in an attempt to contain the spread of disease. Originally the period was one month, but this was later extended to forty days. This system was eventually adopted by other Europeans.

As scholar M. N. Pearson writes in his book The World Of The Indian Ocean, 1500-1800:

As early as the fourteenth century Italian cities had introduced quarantine to keep out ship-borne bubonic plague from the Middle East. Once the disease appeared, affected areas were cordoned off; in the sixteenth century national policies evolved to achieve this. In 1663 the Jesuit overland traveller, Manuel Godinho, arrived in Malta but was not allowed ashore 'despite our carrying health certificates, for having come from the East, because it is always presumed there is plague there.' He was more lucky in Marseilles: 'The lazaretto, or quarantine, at this port is not as strict as at Lyons and Venice and the health officers discharged me from it in seven days.'
Like Europeans, Indians knew that plague was somehow infectious, although the exact nature of its transmission was not understood in the pre-microscopic era, and that rodents had something to do with its spread.

Mughal Emperor Jahangir was informed in the early seventeenth century on an outbreak of plague in Kashmir and northern India. As Pearson states,

Some learned men said it came because there had been two years' drought, others because the air had been corrupted by drought and scarcity. Jahangir commented on this debate that 'Wisdom is of Allah, and we must submit to Allah's decrees.' Perhaps for this reason, I have found no mention of attempts in Mughal India to quarantine sufferers from infectious diseases. This is a strong contrast with the situation we noted prevailing in Europe at the same time.
While Europeans instituted quarantine to contain plague outbreaks, this Muslim ruler in India did nothing because it was up to Allah to determine who should live and die.

According to M. N. Pearson, "When we look at disease, its transmission and cure, in our period we must take seriously the concept of Eurasia. Plague in the fourteenth century, and cholera in the nineteenth, both spread from Asia to Europe, while syphilis came from America via Europe to Asia. Eurasia was one disease zone.

Thus the recently influential notion of 'ecological imperialism,' where 'virgin soil epidemics' spread rapidly in areas newly opened to Europeans and their exotic diseases, such as the Americas, Australia and the Pacific, has little currency in Eurasia. The most that can be said is that improved communications in the nineteenth century facilitated a more rapid spread of disease, the great exemplar of this being cholera."

Cholera was a feared disease which had been endemic in India for at least 2000 years. It became pandemic and spread from Bengal all over the Indian Ocean area and to Europe and the Americas in the nineteenth century. About half of those affected died in these great pandemics. It spread through polluted water, and as public health and sanitation improved in Europe and North America during this age (a process which started even before the major breakthroughs in bacteriology, as we shall see later), the mortality rates declined.

Pearson believes that when Europeans first started arriving in significant numbers in the Indian Ocean from the sixteenth century onwards, they had no decisive advantage over the Hindus in medical matters such as diagnosis and healing. One possible exception is institutional, in the use of hospitals, evidence of which is fragmentary from many regions of India at this point. Another exception is anatomy.

As far as I have been able to establish, it is likely that Renaissance Europe was he first civilization in history to develop a sustained tradition of human dissection with the stated purpose of gaining a more scientific understanding of the human body. Westerners enjoyed an edge in matters related to surgery and anatomy, but not necessarily in actual treatment until well into the nineteenth century.

French physician and traveller François Bernier (1625–1688) was employed as the personal physician of the Mughal Emperor Aurangzeb in the 1660s. The brutal and Islamically intolerant Aurangzeb ruled much of India for 48 years, until his death in 1707, and did serious damage to its non-Islamic population and heritage in the process. He replaced his father Shah Jahan in 1658. Emperor Shah Jahan was responsible for building the famous Taj Mahal mausoleum, completed in Agra around 1648, in memory of his favorite wife Mumtaz Mahal. However, his extensive military campaigns drained the treasury.

The fact that a European physician was chosen for a prestigious position at the imperial court is interesting. Bernier was well read on the latest techniques in Europe and often talked to his patron at the Mughal court of the recent discoveries of Englishman William Harvey (1578–1657) and Frenchman Jean Pecquet (1622-1674) in anatomy.

Bernier saw little difference in levels of knowledge in general medical matters between Asians and Europeans. His attitude to Indian medicine was neutral for the most part. However, he considered copious bleeding to be old-fashioned, done as a result of the influence of Galen but not now considered to be very advisable. As we noted, there was already then a noticeable gap in knowledge of anatomy.

According to M. N. Pearson, "Bernier was not the only one to show that in the area of surgery a perception of a pronounced gap had appeared between India and Europe. [Portuguese physician] Garcia d'Orta in Goa in the mid-sixteenth century was the first, but by no means the last, European doctor to be critical of Indians' anatomical knowledge: 'As for anatomy, they do not know where the liver is, nor the spleen, nor anything else.' Dr John Fryer, whom we have quoted several times as being roughly on a par with his Indian peers in medical knowledge, did in a modern way think too much bleeding was detrimental, and he noted how they knew nothing of veins."

Europeans in the seventeenth century commented on the lack of innovation among Persian physicians, who were seen to be wed to older books and did little research of their own. As a consequence, European medical doctors were often in demand for surgery. Pearson again:

In India the Abbé Carré in the 1670s several times commented on a local preference for European surgeons. When he himself was to be bled, one of his Indian servants was eager to do it, for 'He himself (he said) had lived with a French surgeon, both at Surat and Rajapur, had witnesses many fine operations by him, and remembered what he had seen done.' This servant even apparently thought he would be qualified to do an amputation, again because he had seen a French surgeon do one.

Later a Muslim officer approached him in Madras and 'begged me first of all to send them a good French surgeon to look after one of their camp-marshals, who had been badly wounded by two musket-balls…', and soon after he noted how two 'badly wounded Moor officers had withdrawn to the suburbs of Madras, hoping to find English surgeons.'

In the early eighteenth century we even hear of an Indo-Portuguese woman who was considered to be a skilled surgeon. This prestige seems to mark a pronounced difference as compared with the situation in the previous century.European medicine had at this point become increasingly professionalized. In contrast, the English physician John Fryer (c. 1650–1733) noted how in Surat in 1675 medicine was still a craft, not a profession, and was still governed by caste rules. The Brahmins were meant to do theology, but also did other things related to learning as well.

India was reasonably advanced in medicine from an early date. According to by Michael Kennedy, the early Indian medical text the Atharvaveda

gives descriptions of rheumatism, gout, epilepsy, dropsy (called 'water in the belly'), jaundice, elephantiasis, and mentions a connection between dropsy and cardiac complaints. Treatments were of a magical or religious nature, along the lines of exorcism, although a few drugs are prominently mentioned. One was called 'soma' and was derived from a plant of the same name. The plant and the nature of the drug are unknown, but the name survives as a soothing, pain relief remedy.
Ayurveda, the ancient system of health care or "knowledge of life," evolved gradually over time. Among the earliest Indian physicians we have knowledge of was Sushruta, a surgeon and teacher and the alleged author of the Sanskrit medical treatise Sushruta Samhita. He lived during the sixth century BC and practiced his art on the banks of the Ganga in the present-day city of Varanasi (also called Benares) in North India.

Varanasi was a holy city for Hindus and Jains as well as for Buddhists (Gautama Buddha is supposed to have held his first sermon here), and has later been pillaged by Muslims. The Sushruta Samhita was translated into Arabic in Baghdad in the early Islamic period, along with Indian mathematical texts. The most important works translated were generally Greek ones, but Indian, Persian and a number of other scientific works were also translated at this time. According to Kennedy, two great Indian textbooks of medicine survive from this early age:

The Charaka Samhita is the older and is attributed to the sage Charaka in a city of northwest India and the ancient university of Taksasila (or Taxila). The city and university did not survive, but the text is dated to 100 CE or earlier. It contains much philosophic discussion of the causes of disease, a materia medica, and praises the Brahmin healer. Prominent in its proposed remedies are dung and urine. An oath, similar to the Hippocratic Oath although it includes a promise of vegetarian life, is provided. It proposes a three humour (wind, bile, and phlegm) system of physiology and disease. The English translation of this text runs 1,000 pages.

The Susrutha Samhita includes medical remedies similar to Atharvaveda and the Charaka Samhita, some with similarities to Hippocrates works. Susruta (or Susrutha) was a physician who lived in Benares, a holy city of the Brahmins that has survived, and the remarkable book he wrote contains, unlike Charaka's book, a discussion of anatomy, including instructions for dissection of a human cadaver. The explanation for disease and of normal physiology were no more accurate than those of Hippocrates.The first great center of Ayurvedic medicine was established at Taxila in the Gandhara region in present-day Pakistan. The great emperor Ashoka turned it into one of the most prestigious seats of Buddhist learning in the third century BC, which it remained for centuries. However, I am skeptical of using the Western term "university" of this institution, since universities in the modern sense are primarily a product of the European Middle Ages.

An Indian institution which more resembled a European university was the Great Monastery of Nalanda south of Pataliputra, established under the Guptas in the fifth century AD. Besides Buddhist scriptures, it taught Sanskrit grammar, logic and metaphysics, medicine, mechanics and the calendar and also some secular literature and attracted pupils and scholars from Korea, Japan, China, Tibet, Persia and Southeast Asia. The influence of Buddhism had peaked within India even before Islam, but it was still a force to be reckoned with until the Islamic conquests. Nalanda was sacked by Muslims during a Jihad in 1193 AD.

According to M. N. Pearson, "India's earliest texts, the Vedas (c. 1500 BC), show a very primitive medical knowledge, but by 600 BC at least the ayurvedic system was established. This Hindu system thus pre-dated the classical Greek system associated with Hippocrates, who was born around 460 BC, and Galen, who lived from AD 129 to 199.

In India, by the early centuries of the Christian era we find a fully evolved system….This system was far from fixed and static. For example, at first Indian doctors used only drugs, mostly vegetable products, but from around the seventh century metals were used, too, especially mercury but also compounds of iron and other minerals. By the thirteenth century the pulse was being examined."

The examination of the pulse was probably imported from other cultures, for instance the Chinese. Medicine was a conservative discipline, but there was undoubtedly some exchange of ideas between the various civilizations. Kennedy speculates whether some of the concepts attributed to Greeks like Hippocrates may have had their origin in India. It is difficult to establish how much intellectual exchange there was in the fifth or sixth centuries BC, but there certainly was some later. It is likely that Indian medicine influenced Chinese medicine and herbology.

According to Pearson, "In the case of India, some Hindu medical texts were influenced by Galen and Hippocrates. In the period of the Abbasid khalifat in Baghdad (AD 750 onwards) Muslim scholars travelled to India to study medicine, and also recruited Hindu doctors to come back with them to Baghdad, where some of them became very influential physicians at court, and translated Sanskrit works on medicine, pharmacology and toxicology into Arabic. In effect some parts of the knowledge of the Greek masters were preserved in India, and copiously added to. Then the new synthesis was taken to the Muslim world and so returned to Europe."

The Muslim invasions brought more of Yunani medicine to India, meaning "Ionian" from mainland Anatolia where the first centers of Greek philosophy had been before the golden age of Athens. Yunani medicine is derived from Galenic medicine and continues to be used today, especially by Muslims in the Indian subcontinent while Ayurvedic physicians treat Hindu patients.

From British rule onwards Indians were increasingly influenced by Western medicine, but their medical traditions still exist in the early twenty-first century alongside modern drugs and antibiotics, just as traditional Chinese medicine still exists in China.

Kennedy speculates whether the slow progression of leprosy may explain why it was transported to the Mediterranean region prior to the construction of Roman roads. It was apparently unknown in this region before Alexander the Great's incursions into India:

The first description of leprosy, called kustha, is in the Susrutha Samhita and dates to about 600 BCE, rather late in the development of infectious diseases. The account of loss of sensation, the loss of fingers, deformity, and ulceration of limbs and the sinking in of the nose provide a clear description of the disease. An account in China about 300 BCE is also thought to describe leprosy.

There is no evidence of the typical skeletal changes of leprosy in Mesopotamia, Persia, or Egypt prior to the expedition of Alexander in 336 BCE and it is possible that this disease, which was to become a scourge in biblical times up to the present, was brought back to the Greek world by returning soldiers or their camp followers.In the New Testament in the Christian Bible there is the story of how Jesus heals the Leper (Mark 1:40-45). Of course, whether you believe this or not is a matter of religious faith, but what it does show is that leprosy was an established fact in the eastern Mediterranean by the first century AD, yet we have no indications that it was a common disease in this region a few centuries earlier.

The Gospel of Mark, generally ascribed to Saint Mark the Evangelist, is believed by scholars to be the earliest of the canonical gospels, dating from around the year 70 AD. The story of St Mark is fascinating in itself. He was supposedly the founder of the church of Alexandria, Egypt, and thus of Christianity in Africa.

In the ninth century, Venetian merchants stole his alleged relics from Alexandria and brought them to Venice, Italy, hidden under layers of pork to deter the Muslim corsairs who raided the seas. They now lie in the Byzantine-style Saint Mark's Basilica in the beautiful St Mark's Square in the heart of Venice.

The Norwegian physician Gerhard Henrik Armauer Hansen (1841–1912) identified the bacterium Mycobacterium leprae in 1873 as the causative agent of leprosy, the first identification of a bacteria as the agent causing human disease. Born in the city of Bergen on the west coast of Norway, Hansen earned a medical degree in the 1860s at the University of Christiania (Oslo).

In 1868 he began to study leprosy, which was still a serious problem at the time. A minor city such as Bergen alone had several lepra hospitals. A grant allowed him to travel to Germany and Austria to study advances in microscopy, and in Bergen in 1873 he discovered Mycobacterium leprae and published his results.

Most people ridiculed this idea at first, but within a few years Louis Pasteur (1822–1895) and others would firmly establish the germ theory of disease. Robert Koch (1843–1910) would demonstrate the bacterial cause of anthrax, and in 1882, Koch announced before the Physiological Society of Berlin that he had isolated and grown the tubercle bacillus Mycobacterium tuberculosis, which causes most cases of tuberculosis. He later received the newly established Nobel Prize in medicine for this discovery.

India had a promising beginning in surgery, although this did stagnate later. As Kennedy states:

"The most remarkable section of the Susrutha Samhita is the discussion of surgery. Many surgical instruments are described and special tables for 'major operations' are mentioned. An accurate description of a cataract treatment called 'couching,' (the lens was displaced out of the visual axis by a knife through the edge of the cornea) is included and, while the translation has been controversial, there is no question about the procedure….

A procedure with no precedent outside of India is the restoration of a mutilated nose. Amputation of the nose was a common punishment of the early Vedic Age and the number of such cases no doubt stimulated interest in the procedure. In the early Hindu myths Prince Rama, a virtuous model prince, and the Demon King, Ravana, are rivals.

The Demon King sends his sister, the Lady Supanakha, to tempt Prince Rama. Rama's brother, Lakshan, recognizes her intent and, to reveal her evil nature, cuts off her nose. The procedure, called nacta in the Hindu language, is still practiced at times and cases of unfaithful wives, who have had their noses cut off by their husbands, are still seen in modern British emergency rooms, as well as in India.Reconstruction of the nose was successfully performed in spite of the lack of asepsis or anesthesia, although opium might have been used against pain. The earliest method described by Susrutha used a cheek flap to reconstruct the nose, later a flap of skin from the forehead or even the arm. This was described by an Italian around 1550, but the technique was lost again in Europe until a British newspaper published an article from India on nose reconstruction in 1794. The Indus Valley Civilization also practiced an early form of dentistry, among others things, in very ancient times. Michael Kennedy writes:

There were several alternatives to the Brahmin dominated Hindu religion, which emphasized passive suffering and karma in hopes of a better life in another incarnation. One alternative emphasized breathing exercises and mind control that resonates with the emphasis on 'wind' in early physiological theories of Indian physicians. It is called yoga and tablets illustrating typical yoga positions have been found in Mohenjo-daro, the city of the Indus River civilization from the third millennium BCE.

The other candidate for the source of medical progress and experimentation was Buddhism and it is clear that, by 300 BCE, Buddhist monks and nuns were constructing and staffing hospitals. The Tamils of southern India and Ceylon had their own medical traditions and King Duttha Gamani, on his deathbed in 151 BCE, listed among his achievements the building of eighteen hospitals for the poor in Ceylon. The Tamils' practices differed from the Atharvaveda, particularly in the use of metals, such as mercury, in therapy. The legendary founders of Siddha (Tamil) medicine were Bogar, who was said to have visited China, and Ramadevar, who was supposed to have visited Mecca and taught the Arabs alchemy.Treatment of bladder stone is another surgical procedure that probably originated in India. It is described in Europe in medieval times, but the account in the Susrutha Samhita is identical, indicating the origin of the procedure. However, despite promising beginnings, the caste system and other obstacles limited further development of surgery in India. Some of the knowledge of the early advances survived, mainly among lower caste practitioners. M. N. Pearson in The World Of The Indian Ocean, 1500-1800:

As in medieval Europe, the basic notion was of humours. Five elements were recognized in ayurvedic medicine: earth, water, fire, air and ether. Health was maintained through keeping an even balance between the three vital bodily fluids, wind, gall and mucus, to which some added a fourth, blood. Bodily functions were maintained by five winds. Food digested by one of these, the stomach, became chyle, which proceeded to the heart, thence to the liver, and so to blood, which in turn was converted to flesh.

There was no clear idea of the brain because, like Homer, these Hindu doctors believed that the centre of consciousness, thought and feeling was the heart. Nevertheless, the importance of the spinal cord was recognized, and cleanliness was acknowledged to be medically valuable. There was copious use of drugs. A major problem was the Hindu taboo against contact with dead bodies. There was thus very little dissection, and obviously anatomy suffered as a result.The Chinese medical tradition developed along somewhat different lines, with less emphasis on surgery than in India. At least from Shang Dynasty in the second millennium BC, the earliest documented phase of what would eventually become Chinese civilization, the concept of humors, or elements, appears.

There were five elements, wood, fire, earth, metal and water, but the number five also applied to other objects, planets, colors, flavors, seasons, directions etc. Chinese pharmacology was wedded to the idea of five categories. Red medicine was like fire and was used to treat the heart, which is fiery.

The five-element theory applied to cosmology and philosophy as well as to medicine. In Confucian philosophy, Confucius talks about five relationships: Sovereign to subject, parent to child, husband to wife, elder to younger sibling and friend to friend. In the first four categories, the latter owes loyalty and obedience to the former, whereas the relationship between friends should be on equal terms.

Kennedy writes in A Brief History of Disease, Science and Medicine:

Since the world was composed of five elements, there were five chief organs, the yin organs: the heart, liver, lung, kidney and spleen. Then there were five auxiliary organs, the yang organs: the large intestine, small intestine, gall bladder, stomach, and bladder. The relationship of these organs between each other was influenced by the relationship of the elements. The kidney, as the organ of water, must be antagonistic to the heart since that was the organ of fire.

Each organ had a specific planet and season. The heart had a relationship with summer. The interplay between yin and yang, concepts going back to the Shang Dynasty, were important as was the role of Tao, the world spirit. The world spirit entered the body with air, through the lungs, and earth, through food taken into the intestines. It moved through a system of arteries and nerves that do not correspond to human anatomy.

Note the absence of the brain in the list of important organs. When the sympathetic and parasympathetic nervous systems were discovered in the nineteenth century some speculated that the forces of yin and yang had correlated with these pathways. The Chinese were far from unique in not understanding the importance of the human brain, a mistake which was common in cultures from ancient Egypt via Polynesia to medieval Islam. In fact, the seeds of a scientific understanding of the brain can be traced to Europe during the Scientific Revolution.

The Englishman Thomas Willis (1621–1675), a doctor and co-founder of the Royal Society of London, with his studies at Oxford in the 1660s is often considered the founder of neurology. In his groundbreaking anatomical works in the sixteenth century based on human dissections, Vesalius did not describe the brain in any great detail. Willis, on the other hand, removed the brain from the cranium and was able to describe it more clearly.

According to scholar Roy Porter in The Greatest Benefit to Mankind: A Medical History of Humanity,

From Hippocrates in the fifth century BC through to Galen in the second century AD, 'humoral medicine' stressed the analogies between the four elements of external nature (fire, water, air and earth) and the four humours or bodily fluids (blood, phlegm, choler or yellow bile and black bile), whose balance determined health. The humours found expression in the temperaments and complexions that marked an individual.

The task of hygiene was to maintain a balanced constitution, and the role of medicine was to restore the balance when disturbed. Parallels to these views appear in the classical Chinese and Indian medical traditions.Traditional medicine, in Europe as well as in Asia and the Middle East, paid great attention to general health maintenance through regulation of diet, exercise, hygiene and lifestyle, in part because the true causes of diseases were not understood. According to Michael D. Coe, a scholar and expert on pre-Columbian Mesoamerican cultures, the medical knowledge Europeans brought to the Americas "was largely ineffectual." As he states:

It will be recalled that in Galen's theory and practice, the body contained four humors, and that good health depended on a balance between them. Each of these humors had specific properties – 'hot' or 'cold,' and 'dry' or 'moist.' Each humor was seated in an organ of the body, and that organ's function was to produce its humor. For example, before Harvey's discovery of the circulation of the blood, it was thought that blood was generated in the liver, and taken by the arteries to all parts of the body.

We might well laugh at this Galenic notion, but we still talk of love being seated in the heart. In the European Baroque Age, the humoral theory was extended to include all sorts of phenomena and conditions, such as the divisions of the day, the four seasons, and even the cardinal points.Well yes, but as we have seen above, much the same could be said about the Indians, the Chinese, Middle Easterners and others at the same time. Coe continues:

We can afford (at times) to chuckle over the naiveté of this theory and practice, but consider the medical horrors that were faced by our Baroque Age Europeans. No one had any real idea of disease etiology – what caused infections, epidemics, and plagues, why women often died of childbed fever, and so forth.

Knowledge of anatomy and physiology was just beginning, but had little effect so far on medical practice. Surgery was carried out without anesthesia or antiseptics, necessarily at great speed, and if patients failed to succumb to loss of blood or from shock, at least half of them later fell victim to septecemia and gangrene.

As we have said, European knowledge of plants which might have been efficacious in some diseases was pathetic compared to that of the New World natives whom they had fairly well destroyed by this time. In these circumstances, it was only natural that sick persons and those treating them would grasp at straws, in this case the much-flawed system of Hippocrates and Galen – and pray to the saints.True, but then no nation on Earth understood what caused diseases at this time. In fact, the European medical tradition was the first and only medical tradition in history to develop a modern, scientific understanding of diseases as well as of the human body. So why does Mr. Coe single out the European medical tradition alone for ridicule? The criticism continues:

[W]hile the Aztec ticitl or doctor used a good deal of magic in his or her cures, and while Aztec disease etiology also had an overall theoretical scheme made up of contrary principles (such as 'hot' vs. 'cold'), native medical practices were light years ahead of the Spaniards'. This was due in large part to their incredible knowledge of the plant world included within the empire's frontiers.

They had, as the anthropologist (and chemist) Bernard Ortiz de Montellano has shown, an excellent empirical understanding of the actions of hundreds of plants in effecting real cures; the emperor even had a botanic garden at Huaxtepec in Morelos, where many of these plants were grown and tested.

Word of this pharmacopeia reached the ears of Philip II, and that is why he sent his Royal Physician Francisco Hernández across the Atlantic in 1570….Hernández classified the plants of Mexico as either 'hot' or 'cold,' and 'wet' or 'dry' (please bear in mind that this has nothing to do with their actual temperature or humidity). Thanks to his slavish application of Galenic theory, it is almost impossible to find out how the Aztecs actually classified these same plants.Francisco Hernández de Toledo (1514–1587) travelled on the first scientific mission in the Americas. He spent years collecting specimens, interviewing natives and conducting studies of plants in Mexico and the Philippines, assisted by painters who made illustrations. Shouldn't he be commended for showing such curiosity and willingness to learn from others?

I have no doubt that some of the plants Mesoamericans and other pre-Columbian cultures used did indeed have useful properties. The same could be said about cultures in sub-Saharan Africa, pre-colonial Australia and the Pacific region. I have seen TV-programs where representatives of modern pharmaceutical companies have followed indigenous peoples and taken notes from their comments about local plants and their properties, which in many cases can potentially have medical uses even today. The Mayans had healers who received extensive education. A number of drugs, among them tobacco, were used as painkillers with some success among Native Americans.

Nevertheless, the empirical knowledge of plants and their properties, while undoubtedly very useful, does not alone establish true medical science, and the shamanist healer tradition with incantations against evil spirits is rather different from the practices of a modern medical doctor. Coe claims that "Aztec disease etiology bore little resemblance to the Galenic nonsense of the Europeans."

Perhaps, but I would be tempted to say that the Aztec religion, which required them to murder thousands of victims of human sacrifice every year by ripping out their hearts in order to prevent the Sun from disappearing, hardly indicates that they were beacons of enlightenment and scientific reasoning.

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