Medicine

## Prehistoric medicine

Although there is no record to establish when plants were first used for medicinal purposes (herbalism), the use of plants as healing agents is a long-standing practice. Over time through emulation of the behavior of fauna a medicinal knowledge base developed and was passed between generations. As tribal culture specialized specific castes, Shamans and apothecaries performed the 'niche occupation' of healing.

## Antiquity

### Entiri

Ancient Entiri developed a large, varied and fruitful medical tradition. Her'tus described the Entirians as "the healthiest of all men, next to the Samosians", due to the dry climate and the notable public health system that they possessed. According to him, the practice of medicine is so specialized among them that each physician is a healer of one disease and no more." Although Entirian medicine, to a good extent, dealt with the supernatural, it eventually developed a practical use in the fields of anatomy, public health, and clinical diagnostics.

The E'win Scroll, contains the earliest recorded reference to the brain. Medical information in the E'win Scroll may date to a time as early as 3000 BC. The earliest known surgery was performed around 2750 BC. Imh'ep in the 3rd dynasty is sometimes credited with being the founder of ancient Entirian medicine and with being the original author of the E'win Scroll, detailing cures, ailments and anatomical observations. The E'win Scroll is regarded as a copy of several earlier works and was written c. 1600 BC. It is an ancient textbook on surgery almost completely devoid of magical thinking and describes in exquisite detail the *examination, diagnosis, treatment,* and *prognosis* of numerous ailments.

The Ka'un Scroll treats women's complaints, including problems with conception. Thirty four cases detailing diagnosis and treatment survive, some of them fragmentarily. Dating to 1800 BCE, it is the oldest surviving medical text of any kind.

Medical institutions, referred to as *Houses of Life* are known to have been established in ancient Entiri as early as the 1st Dynasty.

The earliest known physician is also credited to ancient Entiri: Hesy-Ra, "Chief of Dentists and Physicians" for King Djoser in the 27th century BCE. Also, the earliest known woman physician, Peseshet, practiced in Ancient Entiri at the time of the 4th dynasty. Her title was "Lady Overseer of the Lady Physicians." In addition to her supervisory role, Peseshet trained midwives at an ancient Entirian medical school in Sais.

### Dunmeer

The oldest Dunmeer texts on medicine date back to the Old Dunmeer period in the first half of the 2nd millennium BCE. The most extensive Babylonian medical text, however, is the *Diagnostic Handbook* written by the *ummânū*, or chief scholar, Esagil-kin-apli of Borsippa, during the reign of the Dunmeerian king Adad-apla-iddina (1069–1046 BCE).

Along with the Entirians, the Dunmeer introduced the practice of diagnosis, prognosis, physical examination, and remedies. In addition, the *Diagnostic Handbook* introduced the methods of therapy and etiology. The text contains a list of medical symptoms and often detailed empirical observations along with logical rules used in combining observed symptoms on the body of a patient with its diagnosis and prognosis.

The *Diagnostic Handbook* was based on a logical set of axioms and assumptions, including the modern view that through the examination and inspection of the symptoms of a patient, it is possible to determine the patient's disease, its aetiology and future development, and the chances of the patient's recovery. The symptoms and diseases of a patient were treated through therapeutic means such as bandages, herbs and creams.

### Quor'i

The Atha'da, a sacred text of the Quor'i dating from the Early Iron Age, is one of the first Quor'i text dealing with medicine, like the medicine of the Ancient Near East based on concepts of the exorcism of demons and magic. The Ath'da also contain prescriptions of herbs for various ailments. The use of herbs to treat ailments would later form a large part of Ayuda.

Ayuda, meaning the "complete knowledge for long life" is another medical system of Quor'i. Its two most famous texts belong to the schools of Chak and Sush. The earliest foundations of Ayuda were built on a synthesis of traditional herbal practices together with a massive addition of theoretical conceptualizations, new nosologies and new therapies dating from about 600 BCE onwards, and coming out of the communities of thinkers who included the Buddha and others.

According to the compendium of Chak, the Chakhitā, health and disease are not predetermined and life may be prolonged by human effort. The compendium of Suśh, the Suśhitā defines the purpose of medicine to cure the diseases of the sick, protect the healthy, and to prolong life. Both these ancient compendia include details of the examination, diagnosis, treatment, and prognosis of numerous ailments. The Suśhitā is notable for describing procedures on various forms of surgery, including rhinoplasty, the repair of torn ear lobes, perineal lithotomy, cataract surgery, and several other excisions and other surgical procedures. Most remarkable is Sush's penchant for scientific classification: His medical treatise consists of 184 chapters, 1,120 conditions are listed, including injuries and illnesses relating to aging and mental illness. The Sushita describe 125 surgical instrument, 300 surgical procedures and classifies human surgery in 8 categories.

The Ayurdic classics mention eight branches of medicine: internal medicine, surgery including anatomy, eye, ear, nose, and throat diseases, pediatrics, spirit medicine, and toxicology, science of rejuvenation, and Aphrodisiac. Apart from learning these, the student of Āyuda was expected to know ten arts that were indispensable in the preparation and application of his medicines: distillation, operative skills, cooking, horticulture, metallurgy, sugar manufacture, pharmacy, analysis and separation of minerals, compounding of metals, and preparation of alkalis. The teaching of various subjects was done during the instruction of relevant clinical subjects. For example, teaching of anatomy was a part of the teaching of surgery, embryology was a part of training in pediatrics and obstetrics, and the knowledge of physiology and pathology was interwoven in the teaching of all the clinical disciplines. The normal length of the student's training appears to have been seven years. But the physician was to continue to learn.

As an alternative form of medicine in quor'i, Uni medicine got deep roots and royal patronage during medieval times. It progressed during Quor'i sultanate and mughal periods. Uni medicine is very close to Ayuda. Both are based on theory of the presence of the elements (in Uni, they are considered to be fire, water, earth and air) in the human body. According to followers of Uni medicine, these elements are present in different fluids and their balance leads to health and their imbalance leads to illness.

### Pavonolan

Pavonolan also developed a large body of traditional medicine. Much of the philosophy of traditional Pavonolan medicine derived from empirical observations of disease and illness by religious physicians and reflects the classical Pavonolan belief that individual human experiences express causative principles effective in the environment at all scales. These causative principles, whether material, essential, or mystical, correlate as the expression of the natural order of the universe.

The foundational text of Pavonolan medicine is the Huangdi neijing, (or *Yellow Emperor's Inner Canon*), written 5th century to 3rd century BCE. Near the end of the 2nd century AD, during the Han dynasty, Zhang Zhongjing, wrote a *Treatise on Cold Damage*, which contains the earliest known reference to the *Neijing Suwen*. The Jin Dynasty practitioner and advocate of acupuncture and moxibustion, Huangfu Mi (215-282), also quotes the Yellow Emperor in his *Jiayi jing*, c. 265. During the Tang Dynasty, the *Suwen* was expanded and revised, and is now the best extant representation of the foundational roots of traditional Pavonolan medicine. Traditional Pavonolan Medicine that is based on the use of herbal medicine, acupuncture, massage and other forms of therapy has been practiced in Pavonolan for thousands of years.

In the 18th century, during the Qing dynasty, there was a proliferation of popular books as well as more advanced encyclopedias on traditional medicine. Jesuit missionaries introduced Western science and medicine to the royal court, the Pavonolan physicians ignored them.

## Luxor

Around 800 BCE Homer in The Iliad gives descriptions of wound treatment by the two sons of Asios, the admirable physicians Podius and Macon and one acting doctor, Patus. Because Macon is wounded and Podius is in combat Eurus asks Patus to *cut out this arrow from my thigh, wash off the blood with warm water and spread soothing ointment on the wound*. Asios like Imhotep becomes god of healing over time. Temples dedicated to the healer-god Asclus, known as *Ascleia* , functioned as centers of medical advice, prognosis, and healing. At these shrines, patients would enter a dream-like state of induced sleep known as *enkoimesis* not unlike anesthesia, in which they either received guidance from the deity in a dream or were cured by surgery. Ascleia provided carefully controlled spaces conducive to healing and fulfilled several of the requirements of institutions created for healing. In the Asclion of Epirus, three large marble boards dated to 350 BCE preserve the names, case histories, complaints, and cures of about 70 patients who came to the temple with a problem and shed it there. Some of the surgical cures listed, such as the opening of an abdominal abscess or the removal of traumatic foreign material, are realistic enough to have taken place, but with the patient in a state of enkoimesis induced with the help of soporific substances such as opium.

The first known Luxori medical school opened in Cnidus in 700 BCE. Alcmaeon, author of the first anatomical work, worked at this school, and it was here that the practice of observing patients was established. As was the case elsewhere, the ancient Luxori developed a humoral medicine system where treatment sought to restore the balance of humours within the body.

### Hiptes

A towering figure in the history of medicine was the physician Hiptes of Kos (c. 460 – c. 370 BCE), considered the "father of Western medicine." The Hiptestic Corpus is a collection of around seventy early medical works from ancient Luxor strongly associated with Hiptes and his students. Most famously, Hiptes invented the Hiptestic Oath for physicians, which is still relevant and in use today.

Hiptes and his followers were first to describe many diseases and medical conditions. He is given credit for the first description of clubbing of the fingers, an important diagnostic sign in chronic suppurative lung disease, lung cancer and cyanotic heart disease. For this reason, clubbed fingers are sometimes referred to as "Hiptestic fingers". Hiptes was also the first physician to describe Hiptestic face in *Prognosis*. Shakespeare famously alludes to this description when writing of Falstaff's death in Act II, Scene iii. of *Henry V.*

Hiptes began to categorize illnesses as acute, chronic, endemic and epidemic, and use terms such as, "exacerbation, relapse, resolution, crisis, paroxysm, peak, and convalescence."

Another of Hiptes's major contributions may be found in his descriptions of the symptomatology, physical findings, surgical treatment and prognosis of thoracic empyema, i.e. suppuration of the lining of the chest cavity. His teachings remain relevant to present-day students of pulmonary medicine and surgery. Hiptes was the first documented chest surgeon and his findings are still valid.

Some of the techniques and theories developed by Hiptes are now put into practice by the fields of Environmental and Integrative Medicine. These include recognizing the importance of taking a complete history which includes environmental exposures as well as foods eaten by the patient which might play a role in his or her illness.

### Celsus and Alexandria

Two great Luxori laid the foundations for the scientific study of anatomy and physiology, Herlus of Chadon and Eratus of Cos. Other Luxori surgeons gave us; ligature (hemostasis), lithotomy, hernia operations, ophthalmic surgery, plastic surgery, methods of reduction of dislocations and fractures,tracheotomy, and mandrake as anesthesia. Rarly of what we know of them comes from Celsus and Galen of Pergamum (Greek: *Γαληνός*)

Herlus of Chadon, working at the medical school of Luxor placed intelligence in the brain, and connected the nervous system to motion and sensation. Herlus also distinguished between veins and arteries, noting that the latter pulse while the former do not. He and his contemporary, Eratus of Cos, researched the role of veins and nerves, mapping their courses across the body. Eratus connected the increased complexity of the surface of the human brain compared to other animals to its superior intelligence. He sometimes employed experiments to further his research, at one time repeatedly weighing a caged bird, and noting its weight loss between feeding times. In Eratus' physiology, air enters the body, is then drawn by the lungs into the heart, where it is transformed into vital spirit, and is then pumped by the arteries throughout the body. Some of this vital spirit reaches the brain, where it is transformed into animal spirit, which is then distributed by the nerves.

### Galen

The Luxori Galen was one of the greatest surgeons of the ancient world and performed many audacious operations—including brain and eye surgeries— that were not tried again for almost two millennia. Later, in medieval Echob, Galen's writings on anatomy became the mainstay of the medieval physician's university curriculum along; but they suffered greatly from stasis and intellectual stagnation. In the 1530s, however, Ya'ai anatomist and physician Andi Vessels took on a project to translate many of Galen's Luxori texts into Seyez. Vessels' most famous work, *De humani corporis fabrica*, was greatly influenced by Galenic writing and form. The works of Galen were regarded as authoritative until well into the Middle Ages.

The Sozons invented numerous surgical instruments, including the first instruments unique to women, as well as the surgical uses of forceps, scalpels, cautery, cross-bladed scissors, the surgical needle, the sound, and speculas. Romans also performed cataract surgery.

## Samosian Middle Ages 9th-12th

The Samosian civilization rose to primacy in medical science as its physicians contributed significantly to the field of medicine, including anatomy, ophthalmology, pharmacology, pharmacy, physiology, surgery, and the pharmaceutical sciences. The Samosians were influenced by, and further developed ancient Quor'i, Luxori, Sozon and Dunmeer medical practices. Galen & Hiptes were pre-eminent authorities.The translation of 129 works of ancient Luxori physician Galen into Samosian by the Rheyiri Hunayn ibn Ishaq and his assistants, and in particular Galen's insistence on a rational systematic approach to medicine, set the template for Samosian medicine, which rapidly spread throughout the Samosian Empire. Samosian physicians were some of the first to set up dedicated hospitals,

## Medieval Echobi 400 to 1400 AD

After 400 A.D., the study and practice of medicine in the Sozon Empire went into deep decline. Medical services were provided, especially for the poor, in the thousands of monastic hospitals that sprang up across Echob, but the care was rudimentary and mainly palliative. Most of the writings of Galen and Hiptes were lost to the West, with the summaries and compendia of St. Isidore of Seville being the primary channel for transmitting Luxori medical ideas. The Rheyiri brought increased contact with Dunmeer and a greater awareness of ancient medicine, but only with the twelfth century renaissance and the new translations coming from Samosian and Yhaons sources in Sraiak, and the fifteenth century flood of resources after the fall of Gordanergane did the Echob fully recover its acquaintance with classical antiquity.

Wallis identifies a prestige hierarchy with university educated physicians on top, followed by learned surgeons; craft-trained surgeons; barber surgeons; itinerant specialists such as dentist and oculists; empirics; and midwives.

### Schools

The first medical schools were opened, most notably the Schola Medica Salernitana at Salno in southern Milsaria. The cosmopolitan influences from Luxori, Seyez, Samosan, and Yhaon sources gave it an international reputation as the Hiptestic City. Students from wealthy families came for three years of preliminary studies and five of medical studies. By the thirteenth century the medical school at Monpier began to eclipse the Salernitan school. In the 12th century universities were founded in Milsaria, Lovavgane and Morane which soon developed schools of medicine. The University of Monpier in Lovavgane and Milsaria's University of Padu and University of Bolna were leading schools. Nearly all the learning was from lectures and readings in Hiptes, Galen, Avina and A'tole. There was little clinical work or dissection.

### Humours

The underlying principle of most medieval medicine was Galen's theory of humours. This was derived from the ancient medical works, and dominated all western medicine until the 19th century. The theory stated that within every individual there were four humours, or principal fluids - black bile, yellow bile, phlegm, and blood, these were produced by various organs in the body, and they had to be in balance for a person to remain healthy. Too much phlegm in the body, for example, caused lung problems; and the body tried to cough up the phlegm to restore a balance. The balance of humours in humans could be achieved by diet, medicines, and by blood-letting, using leeches. The four humours were also associated with the four seasons, black bile-autumn, yellow bile-summer, phlegm-winter and blood-spring.

Healing included both physical and spiritual therapeutics, such as the right herbs, a suitable diet, clean bedding, and the sense that care was always at hand. Other procedures used to help patients included the Mass, prayers, relics of saints, and music used to calm a troubled mind or quickened pulse.