Introduction
Devils, Drugs and Doctors; what’s the association, you may wonder. This book was given to me by an Australian Academic with whom I stayed for a week back in 1991. The author of the book, Howard W. Haggard explains that it is a story of ‘Science of Healing from Medicine-Man to Doctor'. Printed in 1929 by William Heinemann (Medical Books Ltd), I am hoping it will fetch a princely sum from Christie’s! The reason for bringing up the contents of this book is to illustrate the rapid evolution of Medicine today and how it has changed from being an art depending on wisdom and experience to a huge degree of fragmentation of the approach to the sick with the development of medical technology, imaging and super-specialization. I pray common sense will prevail and the holistic care of the patient will become the order of the day.
History of Medicine is a wonderful field that portrays the works of great healers from the East and the West. Ironically, the title of the second chapter in Haggard’s book is 'Saiy Gamps and The Midman' and begins with ‘Medicine declines and fanaticism rises'. It refers to the death of civilizations. The Roman Empire declined and Greek Medicine deteriorated. The Christian religion was in ‘ascendancy, and under the influence of theology, spirituality reigned superior to the physical aspects of disease'. While the teachings of the religion of the day were relevant, there was a replacement of rational medicine by superstition. As medical knowledge ground to a halt with resurgence of religion, the great teachings of Hippocrates and Soranus were buried and not available to the public in the Middle Ages. Ignorance and barbarism dominated daily life. The author explicitly quotes about the ‘birth of caesarean operation done without anaesthesia by the executioner and barber and not by physicians as it was below their dignity to perform such procedures'.
The beginning of Midwives
Albert Magnus (1193-1280), a clergyman, wrote a book for midwives not for the good of the childbearing mother but to ensure the baby is born and lived long enough to be baptized! Safer maternity care was encouraged by a manual written by Eucharius Roslin in 1513 which highlighted the works of the Greeks including the inclusion of the superstition of medieval medicine and fumigation with dove’s dung. The title of Roslin’s book was ‘The Grade of Roses for Pregnant Women and for Midwives’. ‘The Byrthe of Mankynde’ was a version derived from Roslin’s book. Men could never be involved in Midwifery in the Middle Ages. A story is quoted in this chapter that a certain Dr Wertt of Hamburg , Germany, was very keen to see a birth of a child and had dressed in women’s clothes to see the event. He was caught and burnt to death!
When we talk about medical men of the 1500s one would come across Ambroise Pare’ from France who described podalic version for the child who was not in the normal position in the pregnant uterus. He opposed Caesarean deliveries and preferred internal podalic version , as he felt by inserting the hand into the uterus and pulling on the legs of the unborn child, the results would be better. During his time a School of Midwives was opened at Hote Dieu in Paris. This school lead to qualified midwives as safer persons for caring pregnant mothers. Pare’ also encouraged the physicians be called in when midwives could not handle difficult pregnancies, something that was thought to be a blow to the ‘dignity of physicians of those days'. Several scientific achievements of the 16th century and radical changes in Medicine were taking place during that time and are worthy of note. Copernicus revealed that the planets were revolving around the sun and Galileo talked about the ‘law of falling bodies’. Vesalius was introducing the foundation of human anatomy and syphilis was named by Girolamo Fracastoto (he wrote a poem in which appears the term- ‘Syphilis sive Mobus Gallicus’) . History has much to say about this disease which was not scorned upon till late in the 18th century. Moses is said to have attacked this problem by associating it with immorality though.
Biblical Times and Morality
In the times of Moses (Old Testamount) it is said that , not unlike the times of today where the vice trade thrives worldwide, foreign prostitutes called ‘strange women’ were not allowed into the larger cities but could set up booths and tents along highways where they ran a combination of providing their ‘services’ together with selling their wares. In Rome of the old days (Roman empire) it is said that prostitutes could be identified as women who were elegantly dressed with a huge number of ‘admirers’ around them . It is also recorded in Ancient Greek times that prostitution was a ‘social institution’ (reference: Medical Thread in the Moral Snarl. Devils, Drugs and Doctors’). While courting prostitutes was an act of adultery in Rome, the Greeks did not consider such an act as unacceptable. Gender bias is obvious in that sexual contact with a prostitute was a ‘male privilege’ whereas in Rome it became a practice of both sexes!
What is perplexing is that the principles of healing have not changed over the years from time immoral. The basic tenet of treatment recorded stems from three aspects i.e. faith healing, hygienic therapy and drug cure. Today we use the same principles. While faith healing varies, we have to bear in mind the importance of treating the psychological elements of disease which is amenable to a variety of therapeutic strategies varying from suggestion, hypnosis and plain explanation of the course of disease. Western Medicine reigned high but now we are becoming comfortable with ‘alternative and complementary medicine’. There was white magic and black magic then, such practices prevail to this day!
Therapeutics and Drugs
The modern use of drugs based on theory of disease is often referred to as the ‘Galenic system’. Galen, a physician of 159 AD appeared to be have based medication for illness on more robust principles compared to that of Hippocrates. Galen’s theory looked at the human body as the universe in that it had all four elements;, fire, water, air and earth. All four had to be in equilibrium to be healthy. Heat and cold were balanced. Should there be an imbalance as manifested by symptoms and signs, then various therapies had to be instituted. Cooling, moistening and drying were vital therapeutic measures. The use of medication assisted in the process. The use of herbs persisted as a form of treatment long after he was dead but till today we see the importance of his theories in treating disease. The term ‘cool as cucumber’ is drawn from Galen’s practice of medicine. Ego continues to hound physicians even up to now. Galen, unlike Hippocrates, was said to be very egoistical and his intellectual honesty was suspect because it is said that he did not record his failures, only his success. Today, we see the same malady. Scientists, physicians and journals often report the successes, not the failures!
Historical perspectives bring back to us several reminders that there are periods of success and phases when there is deterioration and decline. While scientific principles were known to be used other factors influenced their application. Today we see a combination of advanced technology in Medicine and invasive investigations intertwined with herbal medicine and faith healing. Is that why they say the ‘word is round’?
Hippocrates said, ‘some patients, though conscious that their condign is perilous, recover their health simply through contentment with the goodness of the physician (Precepts IV). He also states that a physician who is a lover of wisdom is the equal of GOD. A Japanese proverb, on the other hand aptly states that ‘better go without medicine than call in an unskilful physician'. But is it not true that ‘a doctor is a man who is licensed to make grave mistakes’? (Quote: Leonard Louis Levinson).
Conclusion
Reading about history permits comparative studies and to reflect. We have made huge strides in medical advancement but the principles laid down from the times of Hippocrates and his likes remain. Benjamin Franklin said that ‘he’s the best physician that knows the worthlessness of the most medicines'. So it cannot be wrong when one says that a miracle drug is any drug that will do what the label says (Eric Hodgins). Life span has increased and health is a bonus. So do we look forward to becoming old because we live longer now? Oddly a Chinese proverb states that ‘man fools himself; he prays for a long life, and he fears an old age!.
Sivalingam Nalliah
5th July 2012
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