Medical Milestones

by Food and Drug Administration (FDA)

The history of medicine has never been a particularly attractive subject in medical education and one reason for this is that it is so unbelievably deplorable ... bleeding, purging, cupping and the administration of infusions of every known plant, solutions of every known metal, every conceivable diet including total fasting, most of them based on the weirdest imaginings about the cause of disease, concocted out of nothing but thin air — this was the heritage of medicine until a little over a century ago.

— Lewis Thomas, American physician, 1913-1993

A young boy chants rhythmically over a medallion hanging from his neck to ward off sickness. A man gets a haircut and a cyst removed — both by his barber. Roses and mustard pounded together and mixed with purified oil — a small portion placed on the tongue, the remainder blown through the nostrils — soothes a chronic cough and controls wheezing.

It matters not that the boy may be an Indian, the man a medieval prince, or that there was no scientific approach to this 11th century cure for bronchitis. Every culture has its folklore about health and medicine, whether material or magical, depending on the particular stage of human evolution.

Historians say it seems probable that as soon as humans were able to reason, they discovered by trial and error which plants might be used as foods, which of them were poisonous, and which had some medicinal value. People found herbal remedies to deal with common discomforts, such as colds or constipation. In fact, almost all the laxatives that appear on our pharmacists' shelves today, according to John M. Riddle, alumni distinguished professor of history at North Carolina State University, were used by ancient societies. And it was discovered thousands of years ago that willow bark, which contains salicin, a substance related to the salicylates used to make aspirin, relieves pain.

Primitive physicians showed their wisdom by treating the whole person — soul as well as body. At times, treatments and medicines that produced no physical effects, nevertheless, could make a patient feel better. Ironically, this so-called "placebo effect" remains applicable even in clinical medicine today.

Other cultures made medicines from parts of animals and minerals, which were especially favored as antiseptics. Selecting the appropriate remedy was often guided by either the principle of "opposites" or "similars." For example, if the roasted brains of a fearful rabbit failed to cure excessive timidity, courage might be found in the blood of a ferocious animal. But while ancient Egyptian medical treatments were said to include ox spleen, pig's brain, and tortoise gall, historians believe that "ass's heads" and "pig's teeth" may have been no more what they seemed than are "buttercups" cups of butter or "foxgloves" gloves worn by foxes.

Accounts of miraculous healing indicate that saints and their relics stood alongside home remedies and local medical practitioners to treat the ill. Sometimes prayer and anointing with oil in the name of the Lord was the extent of treatment. Diet, baths and exercises all have played their part in treating illness, as well as drinkable gold and "temple sleep." Attempts by the Chinese to understand a complex world by simple principles led to the notions of yin and yang — two complementary life forces considered to be balanced in health but disturbed in sickness.

Because early civilizations had a high rate of infant death and an even higher rate of illness, life expectancy was appallingly short. Many of today's common cancers rarely occurred simply because most people didn't live long enough for the diseases to emerge. And the gnarled hands and painful joints associated with old age were not thought of as a disease but as the natural condition of those who were blessed to have survived the major epidemics of their times.

Magic and Faith (A.D. 1000 to 1492)

The medical system of the early part of the millennium lacked experts trained in healing, as well as specialized medical institutions, because the institutions that trained or employed practitioners — the monasteries or courts — were not exclusively or even primarily medically knowledgeable themselves. Virtually anyone could be a healer. There was no licensing, and some patients drew on the services of practitioners holding radically different and contradictory beliefs. Self-help was widespread, and often illness was treated at home.

Medicine was still dominated by the ideas of Galen, an ancient Greek physician whose theoretical principles were based on notions that human functioning was composed of mixed and blended elements (fire, water, air, and earth) and humors (blood, phlegm, yellow bile, and black bile), each with particular qualities, and all vital for life.

When someone fell ill without obvious cause, especially with such symptoms as fits, vomiting, confused speech, or delirium, there were three possible explanations: disease, fraud, or demonic possession. Along with animal remedies — including blood, bile, bone and even excrement — magic symbols, faith healing, and sacred amulets became widely used to combat disease.

Drugs used were very simple, and most were extractions from plants such as thyme, dandelion, St. John's wort, lavender, and poppy. The entire plant or just roots, leaves, or seeds, were used in the preparation. No precise details have survived as to quantities or weights of such preparations, but instructions such as "a handful, a bundle, a cup" were recorded, and wafers were the preferred dosage form.

In the midst of a belief in magical powers to afflict and to heal, events of medical enormity began raging in the form of epidemics. Lice and ticks carried typhus and other diseases associated with poor hygiene. Bacteria, mold and other contaminants in spoiled foods could cause convulsions or gangrene. Poor diet resulted in scurvy and other deficiency diseases.

While it was unthinkable that invisible parasites, transported by fleas to rats and then to humans, could be responsible for ravaging whole populations, some did recognize the link between hygiene and health.

"Thou must not put either thy fingers into thine ears, or thy hands to thy head," wrote Fra Bonvicino da Riva in 1290, a time when hands, not forks, were the utensils of choice. "The man who is eating must not be cleaning by scraping with his fingers at any foul part." Although Brother Bonvicino failed to define "foul part" in his courtesy books, later less-inhibited writers instructed their readers not to blow their noses with their fingers and not to scratch at that segment of the male anatomy generally known as the "codware."

But a 14th century German writer later recommended, "If it happens that you cannot help scratching, then courteously take a portion of your dress and scratch with that. That is more befitting than that your skin should become soiled." The scratcher's dinner partner, as it happened, was not as concerned with smudges on the scratcher's face as he was with the possibility of having a louse transferred back to the bowl from which he ate.

About the Author

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FDA is A United States government body that oversees medical devices, including contact lenses, intraocular lenses, excimer lasers and eyedrops. In the US, these products must be approved by the FDA before they can be marketed.