History of medicine

• 1. Introduction

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  Around 3230 BC, a man we now call Otzi the Iceman walked the Alps carrying what archaeologist Patrick Hunt describes as a deliberate prehistoric medical kit. Inside were birch polypore fungus, poppy seeds, sloe berries, and sphagnum moss. Hunt suggests the fungus served as a vermifuge and an antibiotic for Lyme disease. The poppy seeds dulled pain. The moss dressed wounds. This frozen traveler was treating documented ailments thousands of years before anyone wrote the word medicine.

  The history of medicine studies how human societies have understood health, illness, and injury, from prehistory to the present day. It is a multidisciplinary field. Medical historians borrow from economics, sociology, politics, and the health sciences to grasp the people and institutions that shaped healing. Where written sources fail, archaeology speaks instead.

  So how did healing travel from a frozen man's pouch of fungus to germ theory and antibiotics? Who decided that disease came from invisible organisms rather than foul air? Why did dissection move from taboo to textbook? And how did nursing and medicine themselves become professions? The answers run through Babylon and Egypt, through Greek physicians and Islamic hospitals, and through a single water pump on a London street.

• 2. Reading The Body Before Writing

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  From the first stone tools roughly 3.3 million years ago to the rise of writing about 5000 years ago, prehistoric medicine left no records of its own. Insight comes indirectly, from interpreting what early humans left behind. The archaeology of medicine reads illness in human remains, plant fossils, and excavations. There is evidence of healing practices among Neanderthals and other early human species.

  Psilocybin mushrooms appear in the Sahara around 6000 BCE, hinting that humans engaged with psychoactive plants very early. Primitive dental care surfaces even earlier, around 11,900 BCE at Riparo Fredian in present-day Italy, and again around 7000 BCE at Mehrgarh in present-day Pakistan. Anthropology helps decode the meaning behind such finds, the sociocultural relationships woven into them.

  Healing the body and healing the spirit overlapped constantly in these eras. From proto-religions to developed spiritual systems, relationships between humans and supernatural entities, from gods to shamans, ran through prehistoric medicine. A single plant might carry both a physical and a sacred purpose. This blend of nature, religion, and the human body would echo through the ancient traditions that came next, in Mesopotamia, Egypt, China, and India.

• 3. Clay Tablets And Papyrus

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  The Sumerians, the earliest known civilisation of the Fertile Crescent, developed one of the first writing systems in the 3rd millennium BCE. Their cuneiform clay tablets recorded drug prescriptions, operations, and exorcisms. These were handled by sharply defined professionals: baru, the seers; ashipu, the exorcists; and asu, the physician-priests. A prescription-like medication appears in Sumerian during the Third Dynasty of Ur, between roughly 2112 and 2004 BCE.

  Esagil-kin-apli of Borsippa, a Babylonian chief scholar, wrote the Diagnostic Handbook in the middle of the 11th century BCE, during the reign of King Adad-apla-iddina. The text catalogued symptoms and paired empirical observation with logical rules linking signs on a patient's body to diagnosis and prognosis. Mesopotamian healers recorded prophylaxis, measures against the spread of disease, accounts of stroke, and an awareness of mental illness.

  Herodotus called the Egyptians the healthiest of all men, next to the Libyans, crediting their dry climate and public health system. He noted that each physician among them healed one disease and no more. Their tradition survives on papyrus, including the Edwin Smith, Ebers, and Kahun Gynaecological papyri. The Edwin Smith Papyrus, an ancient surgical textbook nearly free of magical thinking, was copied around 1600 BCE from far older works. Imhotep of the 3rd dynasty is sometimes credited as its original author.

  The Kahun Gynaecological Papyrus, dating to 1800 BCE, treats women's complaints and is the oldest surviving medical text of any kind. Medical institutions called Houses of Life existed in Egypt as early as 2200 BCE. The earliest known physician, Hesy-Ra, served King Djoser in the 27th century BCE as Chief of Dentists and Physicians. The earliest known woman physician, Peseshet, practiced during the 4th dynasty as Lady Overseer of the Lady Physicians.

• 4. Canons Of The East

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  The Huangdi Neijing, the Yellow Emperor's Inner Canon, was written between the 5th and 3rd centuries BCE and stands as the foundational text of Chinese medicine. Much of its philosophy came from empirical observations of disease by Taoist physicians. It reflects a classical Chinese belief that individual human experience expresses causative principles at work across the whole natural order.

  Zhang Zhongjing, writing late in the 2nd century CE during the Han dynasty, produced a Treatise on Cold Damage that holds the earliest known reference to the Neijing Suwen. The Jin dynasty practitioner Huangfu Mi, who lived from 215 to 282 and championed acupuncture and moxibustion, quoted the Yellow Emperor in his Jiayi jing around 265. During the Tang dynasty, the Suwen was expanded and revised into its best surviving form. Critics today argue that traditional Chinese concepts such as qi, meridians, and acupuncture points lack a basis in modern science.

  The Atharvaveda, a Hindu sacred text from the middle Vedic age between roughly 1200 and 900 BCE, is among the first Indian texts dealing with medicine. It brims with charms, spells, and remedies drawn from medicinal herbs. Such herbal use later fed into Ayurveda, whose name means the complete knowledge for long life. Its two most famous texts belong to the schools of Charaka and Sushruta.

  The Sushruta Samhita runs to 184 chapters and lists 1,120 conditions, from injuries to ailments of aging and mental illness. It describes surgical procedures including rhinoplasty, the repair of torn ear lobes, perineal lithotomy, and cataract surgery. Sushruta detailed more than 125 surgical instruments. Ayurvedic classics name eight branches of medicine, from internal medicine and surgery to toxicology, rejuvenation, and pediatrics with obstetrics and gynaecology.

• 5. The Four Humors

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  Blood, phlegm, yellow bile, and black bile: these four humors, or bodily fluids linked to illness, dominated Western medicine until the 19th century. An excess or shortage of any one was thought to cause the imbalance that brought sickness. The idea predated 5th-century Greek medicine, but Hippocrates and his students systematized it.

  Hippocrates, who lived around 400 BCE, tied the four humors to the four seasons and the four ages of man: childhood, youth, prime age, and old age. Black bile belonged to autumn, phlegm to winter, blood to spring, and yellow bile to summer. He is also credited with the first description of clubbing of the fingers, still a diagnostic sign in chronic lung disease, so much so that clubbed fingers are sometimes called Hippocratic fingers. The Hippocratics gave physicians their famous Oath.

  Galen of Pergamon, who lived from 129 to about 216 CE, gave the theory its lasting shape and linked the humors to temperament. In De temperamentis he matched personality to a person's natural mixture of fluids. A phlegmatic person, heavy with viscous phlegm, was calm and introverted. A melancholic temperament, ruled by dark sedimentary black bile, was anxious and pessimistic. The sanguine ran on blood, the choleric on foamy red yellow bile.

  Treatment aimed to restore proportion. Too much blood called for bloodletting. Too much yellow bile called for purging. Galen further proposed three faculties: the natural in the liver governing growth, the vital in the heart governing respiration and emotion, and the psychic in the brain governing senses and thought. His authority held for nearly 1500 years, a grip so firm it bred intellectual stasis until later anatomists tested it against the body itself.

• 6. Cutting Into The Body

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  Herophilus of Chalcedon and Erasistratus of Ceos, two great Alexandrians, laid the foundations for the scientific study of anatomy and physiology. The usually banned practice of human dissection was briefly lifted in their scholarly community. Herophilus placed intelligence in the brain, distinguished arteries from veins by noting that arteries pulse, and connected the nervous system to motion and sensation.

  Erasistratus weighed a caged bird repeatedly, recording its weight loss between feedings, an early experimental touch. He linked the greater complexity of the human brain's surface to superior intelligence. In his physiology, air drawn into the heart became vital spirit, pumped through the arteries, with some reaching the brain to become animal spirit carried by the nerves.

  Galen insisted that dissection was essential to understanding medicine, working on animals anatomically similar to humans. He performed audacious operations, including brain and eye surgeries that would not be attempted again for almost two millennia. From this work he concluded that blood circulates through the body. Some of his conclusions, drawn from animals rather than people, were simply wrong.

  Medical teachers and students at Bologna began opening human bodies in the Middle Ages, and Mondino de Luzzi, who lived from about 1275 to 1326, produced the first known anatomy textbook based on human dissection. In the 1530s the Belgian anatomist Andreas Vesalius set out to translate Galen's Greek texts into Latin. In 1543 his De humani corporis fabrica portrayed the body as an interdependent system of organ groupings, and triggered such interest that European cities raced to build anatomical theatres.

• 7. Hospitals And Translators

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  Paul of Aegina, a leading Byzantine physician of the late seventh century, wrote the Medical Compendium in Seven Books, which stayed in use as a standard textbook for the next 800 years. Byzantine medicine preserved Greco-Roman knowledge and passed it onward. The first known separation of conjoined twins took place in the Byzantine Empire in the 10th century; the next recorded case came centuries later, in Germany in 1689. The neighboring Persian Academy of Gondeshapur was called the most important medical center of the ancient world during the 6th and 7th centuries.

  The Abbasid Caliphate, which ruled from 750 to 1258 CE, marked the turning point for Islamic medicine. Under Abbasid rule much of the Greek legacy was translated into Arabic. The Nestorian Christian Hunayn ibn Ishaq and his assistants rendered 129 of Galen's works into Arabic. In 805 CE the caliph Harun al-Rashid founded the first Islamic hospital in Baghdad, which trained physicians.

  The Persian polymath Avicenna, called the father of medicine, wrote The Canon of Medicine, which became a standard text in medieval European universities. His countryman Abu Bakr al-Razi was among the first to question the Greek theory of humorism, and has been described as the father of pediatrics and a pioneer of ophthalmology. The surgeon Abu Al-Qasim Al-Zahrawi wrote the Tasrif, translated into Latin and prized in European universities for its surgical techniques and its account of the spread of bacterial infection.

  Islamic hospitals developed features still used today: separate wards for male and female patients, pharmacies, medical record-keeping, and strict institutional sanitation. After 400 CE, by contrast, medicine in the Western Roman Empire fell into deep decline, with rudimentary care offered in monastic hospitals. The first medical schools opened in the 9th century, most notably the Schola Medica Salernitana at Salerno, known as the Hippocratic City. At Bologna physician training began in 1219, and the University of Padua opened its famous anatomical theatre in 1595, drawing artists and scientists to public dissections.

• 8. The Pump On Broad Street

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  In 1847 in Vienna, Ignaz Semmelweis dramatically cut the death rate of new mothers from childbed fever simply by requiring physicians to wash their hands before delivering babies. His peers marginalized and attacked him. Most people still believed infections came from foul odors called miasmas. The truth lay with invisible organisms, and a chain of researchers was about to prove it.

  Louis Pasteur confirmed in 1857 that yeast were living microorganisms, then suggested the same process might explain contagious disease. Joseph Lister took such findings seriously and introduced antisepsis to wound treatment in 1865. Robert Koch traced the life cycle of anthrax bacteria, identified their spores, and reproduced the disease in laboratory animals, a breakthrough for germ theory. In 1881 Koch reported the discovery of the tubercle bacillus, and his group discovered the cholera pathogen in 1883.

  John Snow worked the same problem from the street. In 1849 he observed that cholera's symptoms were vomiting and diarrhoea, and reasoned the contamination must come through ingestion rather than inhalation. After an outbreak had already claimed around 500 lives within a month, his insight led to the removal of the pump on Broad Street, after which deaths from cholera plummeted. Statistical maps and graphs gave public health officials a new way to see where disease spread.

  Florence Nightingale carried that statistical instinct into nursing. She analyzed data on thousands of patients in the Crimean War using graphs and tables, and her findings drove reforms across military and civilian hospitals. Her Nightingale Training School opened in 1860 and became a model. New careers opened to women as nurses from the 1870s and as physicians especially after 1970. The asylum, meanwhile, was being transformed by moral treatment, epitomized in Philippe Pinel's unchaining of the lunatics of the Bicetre Hospital in Paris.