History of Medicine

Sugana T Padjadjaran University

Introduction

Medicine has been scientific for a long time During and after the nineteenth century became obvious to a large extent scientific Natural science adapted to medicine promote the development of medicine in science and economics

Medical education is complete only if it implant certain moral and ethical values in the future doctor There are often pressure and temptation to lower the professional standard for the sake of money and popularity are numerous

Medical history can play a valuable role those acquainted with the teaching of Hippocrates with the lives of such men with high ethic and moral as Pare, Lister, Pasteur, Osier and many other will find them ever-flowing sources of moral strength

A man can be a competent doctor without a knowledge of medical history But an acquaintance with medical history can make him or her a better doctor Anyone who has seen how the truth of today becomes the error of tomorrow will adopt a more independent and critical attitude and will be better equipped to assimilate new truths

In the middle ages medicine had cantered round libraries. During the following three centuries it had focused upon the individual sickbed In the 19th century it centered around hospital. This particular period might well be characterized as the period of hospital medicine, as distinguished from its predecessors, library and bedside medicine Later it can be called laboratory medicine

Industrial revolution fostered rapid urbanization. Number of hospital increased Very many peasant, male and female streamed into the growing cities as seekers of jobs in industries. Having neither homes nor families for care. Often they fell victims to typhoid fever or tuberculosis hospitals became crowded Patient became materials for clinical observations and of course for autopsies new discoveries new theories

History of medicine does not lack of dark pages. It is a long road which man has made steps in his fight against diseases As a whole it is considerably more encouraging than the history of many human activities. It is full of interesting events and valuable lessons and will evoke fascination and enthusiasm

In the 17th and 18th centuries nowhere in the world was a special system of medical services. Diagnose skills of doctors and therapy was not practiced by persons who were special trained for it Treatment of diseases was based on trial and errors and sometimes was done harshly or unpleasantly rough, without thinking of the suffering of pain pf the patient

Ultimate of the 18th and beginning of the 19th century the western medicine started to be introduced to the inhabitant of Indonesia First the Dutch only care for their own community Epidemics and many victims of trouble and war against them, the Dutch recruited Indonesian human resources

Primitive Medicine

When man was in the primitive stage of civilization the character of the early medicine is very dim Evidence that are encountered now from the past must be used with full awareness Primitive tribes lived and remained fundamentally on a stone age level, did not develop to more advanced level of appropriate technology, social organization and ideology With the primitive mind they did not remain static Though they do not have a written history, they have been subject to historical change

It is assumed that they have maintain many characteristics of their pre historic predecessors in the field of medicine and others. Studying the primitive medicine has an important reason because it has the fascinating feature of primitiveness much more different from our own, but function static fotorily for them at that time The best way to become familiar with primitive medicine is to observe as typical medical treatment as it is actually carried through in a given contemporary primitive society

As an example and for an illustration that sometimes to still see an act of primitive medicine in our contemporary modern world
A man felt ill. He and his family behave much as would a modern man does. At first there is not much speculation as to the character and origin of this indisposition of feeling. The patient rests, and household remedies are applied. Only when no improvement can be obtain in this way, the sick man really thing of disease.

From this point on two types of medicine separate

The family assumes that the disease has been caused by a supernatural agency :

An animal spirit A ghost A Sorcerer (santet)

A medicine man or a magician was called not a man who has been trained for treating disease :

Ceremony was organized Prayers, magic formulas Sometimes drumming or noises Sacreed object

If the sick has been the victim of a sorcerer, the medicine man sucks out disease producing arrow

Smallbones Pebbles From the body of the patient (In Indonesia often the dukun take out neeedles or other hard material) Prescribing drugs from herb Amuleeet Taboo for a certain period of the time

Other simpler treatment

Such an idea concerning the causes of disease will be found in all primitive societies Magico-religious or super naturalistic ideas Some diseases are sent by :

Ghost Spirits or dewa

Due to taboo violation

Inflicted by sorcerer Supernatural forces Existence of a soul in the body (Kesambet)

Primitive prophylaxis :

Amulets Ritual mutilations (circumcisition) Ritual painting of the body Clipped nail or cut hair must be hidden
It can be used against the original owner

Main ground for the basic differences between medical approach and the modern scientific methods is a supernatural orientation

Humanity has believed in super natural forces, rather than in natural law A strong believe in natural forces STILL exist EVEN IN MODERN COMMUNITY Primitive pharmacopeias :

It was a moisture of innumerable in effective drugs with a few of marked effect which are valued element of our own pharmacopeias The different point of view is magic power and magic relation

No distinction between

Organic functional and mental disease. There is only disease and treatment

Treatment always contained psychotherapeutic as well as objective elements

Epidemic diseases
Typhoid Measles Diphtheria Smallpox Yellow fever Cholera Were unknown to primates before

Life expectancy was low

MEDICINE IN ANCIENT CIVILIZATION

Nature favored some places for human settlement Usually valleys of great rivers

Due to :
Easy transport Soil is fertile, no need to be fertilize because every year flood bring fertilized mud Plenty of water Enough protein from fishery

Tribal group grew into organized community

Later became empires and developed urban civilization with someone as leader Advanced civilized empire developed writing, which was needed for communication and information Thanks to these old writing, we know their history

Information concerning the ancient happening Are derived from written records as well as from rich archeological findings-proper history begins Changes in social structures, technology and ideology brought in the development of empires also brought about important changes in medicine

Outstanding civilization were found in Egypt, Babylonia, Mexico, Peru, Persian, Jew, Phoenicia, Cretan and Etruscan At the same time : the valley of Indus and Yang Tse Kiang (maybe older) Social change influenced pathology and medicine. Densely settled empires and their large cities made it possible for acute infection to last and for the great epidemics to spread until the twentieth century

EGYPT Year 1000 BC Egypt enjoyed great fame antiquity Homer (Greece) : many good doctors Herodotus (5th century BC) : people in Egypt as being particularly healthy in contrast to what was observed in the middle age (500-1500 AD) and modern times 2700 BC in Egypt there were already physicians and dentist especially at court for the need of the emperor

Egyptian physician were demand in the near east and after the advent of Greek physician are liked in the Mediterranean Beside good physicians, super naturalism in Egypt reminded dominant for disease and treatment

Firaun was consider as a God and he named himself also as God, whose pyramid and mummies bore witness to its tremendous preoccupation with life after death and whose priests played an important political role

Training of physician happened in temple schools and probably as priest like in the west Spirits and demons continued from the ancient time to cause disease and spells continued to be used against them

Later spells were replaced by prayers demons are overshadowed by Gods There were special Gods for protection against special disease

God would both send a disease and also can cure it Amulet were used extensively Healing Gods were : Re, Thoth and Isis

About 2900 BC Imhoptep was a new healing God

He is a historical figure was fizier of Firaun

from a medical herd later he became God of medicine. Later Asclapius became also God of medicine Beside the super naturalistic orientation Egypt had also highly organized medicine to contain unknown to primitive societies

This is the beginning of a rational theory of disease and life in general

Historically Egyptian medicine is known based on certain papyri, written documents on material made from stems of papyrus plant. Papyri are easily destroyed by nature Papyrus reflects the medical ideas of about thousands years ago

There are still a variety of papyri preserved and well kept in Museas
1. 2. 3. 4. 5.

6.

Kanun papyrus : deals with gynecology (2000 BC) Edwin papyrus : deals with surgery (1600 BC) Eber papyrus is a kind of medical text book (1500 BC) Berlin papyrus and prescription and Hearst papyrus magical spells (1350BC) London papyrus (1350 BC) contains more magical spells

As it happened in the west Egyptian medicine experienced also a decline. It started out with a comparatively rational approach and became more and more magical and went parallel with the decline of Egyptian civilization Edwin Smith papyrus and the Ebers papyrus is more informative and reveal considerable talent in presenting case histories and in establishing a general disease notion

Surgeon of the past limited himself to wound treatment and bone setting Operative procedure remained rare up to the second half of the nineteenth century Also was encountered the refusal of the medical practitioner to treat hopeless cases, an attitude which remained legitimate and ethical while many as late as the eighteenth century

Greece

Ancient Greek medicine is incomparably closer to modern medicine than any other historical form of medicine Modern terminology is to a large extent Based on Greek. Greek medicine covered a period of about one thousand years. Diseases was no longer regarded as a super natural phenomenon but approached from a rational, naturalistic and scientific point of view. Priest bureaucracy was prevented by political division.

The radical change happened of a sudden in the history, and without explanation what ever. Greece is located in the most eastern part of the Mediterranean. This part is a busy trade area between Egyptian, Mesopotamian, Phoenician and Cretan who are already highly civilized people were free people with a variety of culture. Greeks were intellectually and physically a kind of Hybrid vigor. Greek physicians separated their practice from their religious beliefs.

Religious medicine was also known - especially for the poor - for the incurable There were many gods Apollo was regarded the god of disease and healing After the fifth century replaced by asclepius (Aesculapius, askulap) with the staff and the holy snake of medical profession. Treating patient was by incubation by sleeping a night in temples hoping a dream would give guideline of therapy and prognosis.

In the year 460-377 BC Emerged Hippocrates. Treatises of Hippocrates collection known as corpus Hippocraticum. Probably have bee written between 400-380 BC Before Asclepius and Hippocrates about the year 1000 cc appeared a book written by homer. In this writing of Homer apeare respected craftsmen, consists almost entirely of military surgery. His epics deal mostly with warfare. VIIth century A.D in Cnides (Asia Minor) There was a Greek settlement with a school, concerned primarily with diagnosis of diseases, developing a some what elaborate system of classification.

Arab and their Medicine

Scientific Development of the Arab is part of Medieval Medicine In 1130 council of Clermont forbade practice of medicine in monastery Arab science came into force to change the direction of medicine this had an impact also on the field.
Numeral Chemistry Physic Astronomy

School emerged University founded

HIPPOCRATIC MEDICINE

Greek medicine was greatly influenced by philosophers development of medicine was practical effort in the field of clinical observation Hippocrates is a symbol of creative period of Greek medicine (480 377 BC) His name has come to represent the beauty value and dignity of medicine off all time His golden period was between the victory of Salami (480 BC) and the beginning of Peloponnesian war (431 BC). Here begin the distinction of Greek

CORPUS HIPPOCRATICUM Is a collection of 50-60 books in the 3rd century BC in Alexandria +/- 480 380 BC. It is not a work of one man or group Dealing with :

Diet (regulation of the whole existence not just of food intake) Epidemic diseases (island thasos) Prognosis Air Water Places Surgical dealing with fractures dislocation wound, ulcers etc. Sacred diseases Nature of man Book of oath Law and physician

Professional attitude and the ethical obligation of the physician

The last one dealing in the corpus Hippocraticum is : The aphorism discusses all aspect of medical practice particularly on the subject of the critical days in the development of diseases. All the Hippocratic books have some fundamental trait in common

They stress the naturalistic approach declaration of independence Value of observation of the disease process on the practical non on the theoretical

THE HIPOCRATIC OATH I swear by Apollo the physician and all Gods and Goddesses, that according to my ability and judgment, I will keep this oath and this stipulation to recon him who thought me this art equally dear to me as my parents, to share my substance with him and relieve his necessities if required : to look upon his off spring in the same footings my own brothers, and to teach them this art if they shall wish learn it, without fee or stipulation etc. This oath is sworn by physician when they finished the apprenticeship to behave facing patient

For the benefit of patient the part of oath was

I will follow that system of regimen which according to my ability and judgment, I consider for the benefit of my patients, and abstain from whatever is deleterious and mischievous. I will give no deadly medicine to any one if asked, nor suggest any such council, and in like manner I will not give a women apessary to produce abortion. With purity and with holiness I will pass my life and practice my art I will not cut persons laboring under the stones, but will leave this to be done by men who are practitioners of the work. Into whatever houses I enter, I will go into them for the benefit of the sick, and will abstain from every voluntary act of mischief and corruption, and further the seduction of females or male, of freemen and sleeves.etc

FOR THE PATIENT SECRET ..I see or hear, in live of men, which ought not to be spoken of abroad, I will not divulge as reckoning that all such should be kept secret, etc

But should I trespass and violate this oath, may the reverse be my lot

MEDIEVAL MEDICINE

Greek medicine roughly speaking covered the millennium 500 BC to 500 AD The next millennium is AD 500 AD 1500 called the middle ages, in this century the medieval medicine faced the problem of the invading Barbarian

Franken Viking Germanium Defunct empire Christian religions Crusades Latin language became medical text for the next 1300 years

Middle ages

Dark ages = monastic medicine end 1000 AD Late middle ages scholastic medicine Arabic period

John S. Wellington (Univ. of California)

Western medicine entered Indonesia in the year 1700 (18th century) Toward the Second World War it speeded up because the Dutch army needed more manpower including medical Indonesian physician got more authority

In the 17th and 18th century everywhere in the world medical service system was not orderly arrange yet. Skill of diagnosis and treatment did not a school yet as a whole but more in the form of trial and error Sometimes surgical was done in a harshly manner.

Why did the VOC (Dutch East India Company) need more doctors, and accept native people

Sea travel from the Netherlands took almost one year. All kind of disease could attack the travelers No fresh food during the sea voyage At the landing in East India many were sick, Hospital were lack of doctors. Every ship had to have a doctor

In the 19th century the colonial grip of the Dutch enforced and expand. Security must in the hand of the military. So also services.

1825-1830 Diponegoro War Medical officers killed

1947 Aceh war begin First 5 year 28 med. officers killed. The Dutch need more medical assistance
In the 1870 total Dutchmen in Indonesia were 36.000 with 300 doctors. Hospitals were military hospitals. Medical services were only for the Dutch. Native people did not get medical attention from the Dutch

1879 there were 191 med officers

2/3 got western military training 1/3 were Dutch civilian physician 37 men were non Dutch (German and Denmark)

1804 The first vaccination against smallpox with forced by military men native aids called = mantri cacar. Since then all nurses is called mantri 1851 Army need additional medical manpower medical skill training place founded 1931 Native medical training teacher started

Japanese occupation period

March 8, 1942 Dutch surrender to the Japanese. Many Dutch doctors imprisoned. Medical school in Jakarta (Batavia) and Surabaya closed The last year medical student recanted by the Japanese Medical school reopened by the Japanese (29 April 1943) also the pharmacy faculty Lectures in the faculties for the first time in the Indonesian language

The initiative for using our own language in medical faculty were

Dr. Bahder Djohan Dr. A.Ramali Dr. Soetomo Tjokronegoro

Dean of Med. faculty (ika dai gaku) in Jakarta was Prof. Itagaki other faculties were

Dr. Dr. Dr. Dr. Dr. Dr. Dr.

Asikin Wijayakusuma Aulia Bahder Djohan A.Ramali Sarwono Soemedi Sartono Kertopati