In this video we’ll be discussing the concepts of illness and wellness in the premodern world.
Disease and illness, by illness we mean the experience of being sick – disease and illness
are part of being human, and so what we might call the healing arts have been a part of
human societies for at least – for tens of thousands of years.
We have evidence in ancient cave paintings – some as much as 17,000 years old – that
show men in animal masks performing ritual dances that some archeologists suggest are
evidence of the first medicine men.
We have written evidence of the healing arts in Mesopotamia, Egypt, India, Siberia, the
Americas – so really the concept of healing is a universal phenomenon.
It’s nothing new.
It’s been part of human societies for millennia, at the very least.
So what we’ll be doing today is taking a look at these healing arts and the variety
of ways in which the healing arts have been approached in world history.
So let’s begin with a couple of classifications.
We can divide the practice of medicine into two basic categories.
There are Eastern or holistic approaches to healing and there are Western or more rational
and scientific approaches to medicine.
Let’s start with Eastern medicine.
In the ancient world, there were two basic types, or two basic approaches to Eastern
medicine.
There was Indian medicine, called Ayurveda – Ayurveda is Sanskrit for life knowledge
– that was the foundation of a medical system that’s existed for more than 2,000 years.
Ayurveda is specifically tied to religion and it was a belief that medical knowledge
or knowledge of the healing arts was handed down from the gods to the sages, and then
to human physicians.
Early Sanskrit texts taught about three bodily humors called doshas that are the key to wellness.
Whenever one of those doshas is out of balance, then a person experiences illness or a person
feels out of sorts.
So wellbeing, in other words, meant keeping the doshas in balance through the manipulation
of bodily tissues.
These beliefs, again, were handed down, or were written down in these Sanskrit texts.
But they were handed down primarily through oral tradition.
So the practice of Ayurveda was left to learned men, who more or less just memorized these
Sanskrit texts and then used the process of diagnosis – asking questions, studying the
patient – to decide which of the doshas to apply, which of the doshas would help restore
their balance of these bodily humors.
Further East, another kind of traditional Asian medicine emerged and that was traditional
Chinese medicine.
Chinese medicine is very often described as being somewhat constant, unchanging – but
that isn’t necessarily true.
In fact, what we can identify as traditional Chinese medicine developed out of the interplay
of a variety of different influences.
It incorporated elements from India, Tibet, and Central Asia; coalesced in China, and
then in turn spread throughout East Asia – into places like Japan and Taiwan, Korea.
Traditional Chinese medicine was largely based on theoretical knowledge, taking a holistic
approach to wellness.
The basic belief was that health depended on harmony within the body and between the
body and the material world.
The principle material of the natural world was Qi and Qi had the ability to define both
wellness – so if one had good Qi, then one was well – and illness, which was caused
by pathogenic Qi.
The goal of medicine then was to balance the Qi and to balance the body within the natural
and social worlds.
Everything was connected in this holistic approach to wellness.
Traditional Chinese medicine largely lacked what we can identify as a biomedical concept
of disease, even though certain diseases were eventually understood to be caused by pathogenic
Qi that was communicated by contact – in other words, it was contagious.
The Chinese medicine, Eastern medicine, tended to take a much broader view of health and
balance.
Traditional Chinese healers relied primarily on compound drugs that they called feng, and
they used things like acupuncture, moxibustion, and cupping to stimulate key points on the
Qi to bring back balance.
This model of traditional medicine would kind of define East Asia until the arrival of Europeans,
who brought Western-style medicine with them in the 19th century, and the two continued
to coexist – at times uneasily – not just in China and East Asia more broadly, but in
many Western countries as well.
So let’s now turn our attention to the Western-style medicine or what we could identify as Western-style
medicine – beginning with its foundations in the ancient Mediterranean, or the Greco-Roman
world.
The roots of Western medicine can be traced to ancient Greece, and it’s oftentimes traced
to a man named Hippocrates.
Hippocrates is generally considered the father of modern medicine, but as he laid out the
foundation of organized medicine to this day – not in the sense that Hippocrates truly
understood, correctly, the human body or the germ theory of disease or what caused illness
and wellness – but rather it’s based on his approach to medicine and healing as a
rational, not religious or superstitious, phenomenon or a rational discipline.
Hippocrates believed that the human body was the product of natural forces, and he identified
– or he labeled these natural forces as humors.
Hippocrates believed that there were four basic humors at work in the human body.
Those humors were elemental properties that roughly corresponded to the elements of nature
– fire; air; earth; and water.
So the four humors were hot; cold; dry; and wet – and the health of a human depended
on having these four humors in balance.
So you’ll see some similarities between the Indian-style approach to doshas, for example,
and this Western concept of humors.
It was imbalance of the humors that caused illness.
Hippocrates’ foundation for organized medicine was picked up by philosophers like Aristotle,
spread throughout the Hellenistic world, and then engaged with by Roman philosopher/physicians
like Galen.
Galen was an Ionian-Greek doctor and philosopher living in the Roman Empire, who built on the
work of Hippocrates.
Galen argued that the four humors, identified by Hippocrates, corresponded with bodily fluids.
The four bodily fluids that helped to establish balance in the human body were blood; black
bile; yellow bile; and phlegm.
Different people had different dominant fluids and that fluid – or his understanding of
the humors – determined not only a person’s health, but his or her temperament and personality
as well.
So physical and mental health was tied up in this concept of humors; whenever a person’s
fluids were out of balance they got sick.
So for example, if someone was understood to be sick – excuse me – because they
had too much blood, they could be relieved of some of that blood in a process called
bloodletting.
Galen’s medical texts would be the foundation of Western medicine until the scientific revolution.
They would continue to be spread throughout the Roman Empire until the fall of Rome in
the 5th century – and then medical knowledge shifted East and South as Rome fell.
Western Europe entered into a period known as the early Middle Ages, from roughly the
6th century through the 11th century, which many people for a long time called the Dark
Ages.
It was called the Dark Ages or it was colloquially known as the Dark Ages, because it was a period
when very few written records were published, and so the sense was that Europe had entered
into a period where there was a lack of learning, and more broadly – the world had moved into
a period where there was a lack of learning being produced.
But that’s not actually accurate – either in Europe or the in the world in general,
because while much of Northern Europe did fall into a period where learning was limited,
where cultural flourishing was limited – places like the Iberian Peninsula, where modern-day
Spain and Portugal are located, which was under control of the caliphate of Cordova
– had a period of cultural flourishing.
You see arts; sciences; literature; other forms of culture and learning that are reaching
their peak in the Iberian Peninsula.
There was also a great deal of learning and knowledge in the Byzantine Empire, which maintained
the traditions of the Greco-Roman world.
So there were pockets of continued learning and cultural output that continued well past
the fall of Rome that just weren’t in Northern and Western Europe – rather they were centered
on the Byzantine and Islamic worlds.
So I want to talk a little bit about Islamic medicine and the tradition of Islamic doctors
keeping this organized medicine alive.
So formal Arab-Islamic medicine developed in the early 9th century; it began with something
that’s known as the translation movement, in which the medical texts of antiquity – of
Greece and Rome –were translated into Arabic.
This then established the foundation for Islamic scholars who studied and commented on these
texts, the most famous of whom was a man who became known in the Western world as Avicenna.
Avicenna was a Persian scholar in the 10th and 11th centuries.
Like Aristotle before him, Avicenna was a polymath – meaning he knew a great deal
about a wide variety of topics, and he wrote hundreds of texts on these different topics
– including 40 on the topic of medicine.
His most famous text on medicine was the Kitch al-Qunam or the Medical Code, often just referred
to as the Canon, which consolidated and commented on the basic principles of math – no, sorry
– of medicine; pharmacology; and anatomy that emerged from the classical Greek, Roman,
Arab, and Persian worlds.
There was tremendous value in the work of Avicenna and other Islamic medical scholars
from the 8th through the 12th centuries, primarily because of the thoroughness and clarity with
which they preserved, organized, and commented on existing knowledge – because organized
medicine wouldn’t re-emerge in Europe until the 12th century as we move into a period
known as the Middle Ages and the High Middle Ages, in which you see the re-establishment
and the growth of European learning and cultural outpouring.
So I want to talk a little bit about this medieval and early modern approach to medicine
as it existed in Europe – because more or less what exists in this period is a divide
between high and low medicine.
High medicine was defined by the university.
They relied on medical knowledge, building from Galen and kept alive by the Islamic world,
and it was transmitted to these new doctors or these new physicians in medieval Europe
through a series of texts.
So the primary form of learning in – of learning medical knowledge in medieval Europe
relied on a specific canon of texts supplemented by lectures.
This was largely a theoretical knowledge, not really focused on practical knowledge
at all, no real concept of training at the bedside.
After about 7 years of study and exams graduates began to practice as what were called learned
physicians.
The Middle Ages also saw the emergence of hospitals, although the earliest hospitals
were more comparable to care centers or perhaps hospice, in that they didn’t necessarily
have a doctor on staff but were really just designed to care for ill patients.
By the 13th century they evolved to having physicians in residence and they became places
where medicine was practiced at the bedside.
These hospitals would spread throughout Europe in the late medieval and early modern periods
and became an important institution of Western medicine.
In the Middle Ages there were three different categories of healers that worked in learned
or high medicine.
There were physicians, trained at universities who primarily treated illness with things
like diet, drugs, and lifestyle changes, focused on balancing the humors.
There were surgeons and barber surgeons, who did things like the bloodletting, cupping,
suturing, applying ointments, sort of the practical elements of medicine.
Then there apothecaries, sort of like modern-day pharmacists, who formulated and distributed
medicines to both doctors and patients.
The late medieval and early modern periods were often characterized by tensions between
these categories of healers.
So for example, in much of Northern Europe surgery was treated like a trade or a craft,
rather than a learned discipline.
They were excluded from university education.
They were taught and trained through apprenticeships, governed by guilds, and they were often seen
as lower status than the philosopher/physicians of the university system.
So there were often tensions between learned doctors or learned healers, but there was
also tension between high medicine and what we could define as low medicine, which was
the medicine of folk healers.
Much of the actual practice of medicine, particularly in the countryside, was done by people who
had no university training or no guild/apprenticeship training.
These were people like folk healers, often called white witches, who continued the influence
of magic and superstition in the healing arts.
Childbirth was managed by midwives, who often came from a village.
These were oftentimes older women in villages, who were responsible for facilitating this
female-centric realm of childbirth.
It’s important to understand, as we talk about the emergence of organized medicine
– globally speaking, that for most of human history medicine was not particularly successful.
The life expectancy was still very low in the Middle Ages and early modern period.
Mortality rates were high.
They had no real way of dealing with epidemic diseases, no concepts of infection or the
germ theory of disease.
So as we talk about the emergence of this medicine, of this organized professional medicine
– it’s important to remember that many people avoided medicine because they didn’t
feel that it would do any good and oftentimes the medical outcomes were not particularly
successful – at least until the modern period.
Thank you.