2600 B.C.-1200 A.D.: The Mayan will cure your asthma

The natives of Mesoamerica had specific remedies for asthma which included healing rituals, curing steam, and herbal remedies. (3, page ?) Even if these didn't immediately give back the breath of the natives, it provided a means of keeping their minds sharp and allowing time for their lungs to naturally heal.

In their 2010 book "Empires of the Maya," Jill Rubalcaba and Angela Keller said:

(Mayan diseases were caused) when the soul fell into disharmony. Therefore, curing the illness required shamans (medicine men) to return the soul to a harmonous state. Shamans dealt with disease on both a spiritual and a physical level. They made offerings to the gods, performed spells, burned incense, and examined the sacred calendar to remedy the spiritual problem. But they also attacked the physical cause of the problem." (1, page 125)

Healing Rituals:  It's difficult to determine what these healing rituals would have been like, although we can use our imaginations, or use our references to other native American cultures. Perhaps their was dancing, gesticulations, beating of drums, shaking of gourd rattles, singing of songs, reading of rituals, grunting, and chanting.

The shaman would resort to a book called the "Ritual of the Bacabs."  This was a book or text written by Mayan scribes to preserve Mayan tradition, and contains many references to the Mayan deities called the Bacabs.  The book contains a variety of rituals and songs for specific diseases, such as asthma.  The Mayan physician probably assessed the patient, and made reference to the book based on the symptoms presented.  

Here is one such remedy for asthma:

Four days have passed without the crushing of the large substance. For four days the face of the red Moon Goddess, the white Moon Goddess, the yellow moon Goddess has spasmed. For Four days the face of the red Itzamma has spasmed. Who created you? who hid you?  It's birth, the respectable birth, was created by me. It is he, the asthma, that was born." (2, page 104)

Peter Herman Signal said both the gods Itzamna and the Moon Goddess were needed to give birth to the disease and the cure.  (2, page 104)

Part of the ritual, and part of the healing process, involved bleeding.  The shaman would bleed an area close to the diseased part, although this was probably more with external injuries as compared to internal and "mysterious" diseases such as asthma. Sacrifices, probably mostly animals and plants, were often performed in order to please the gods and goddesses.  (3, pages 336-7)

Bleeding:  Phlebotomy was commonly practiced among the natives of mesoamerica and South America, but less so in North America.  Some North American myths include the act of bleeding, although it's believed this came from the whites and was added into the myths later on.  (7, page 179-181)

Divination:  Omens, or reading of signs of the gods in order to predict future outcomes and prognosis, were common practice among the natives of both North and South America. (3, pages 336-7)

Sucking:  This was actually a common practice of medicine men in all parts of the primitive world, including Mesopotamia, Egypt, Greece, Rome, and America. It's also practiced among modern day primitives.  It involves the medicine man holding an item in his hand or mouth, a bead perhaps, and placing his mouth on the patient and pretending to suck out the poison (in this case the evil spirit).  He makes it look like he sucked the bead from the sick, which would be in the appearance of the bead.  (7, pages 183-184) (8, page 61)(9, pages 193-4)

Enemata:  This was used among most primitive tribes, and is an ideal method of entering medicines into the body.  The medicine man would use a hollow tube (perhaps a bone or reed) to insert with his mouth (or bulb syringe) the medicine into the anus.  The America Indians did this for diarrhea and hemorrhoids.  The Aztecs used wine and the narcotic parica. It was also used for other reasons, such as dysentry.  In North America syringes were made of a hollowed out bird leg, or from the stretched out bladder of a turtle, jauar, or other such animal. The Egptian goddess Isa is often depicted giving herself an enema with her beak, so we know this remedy goes a long way back.  (7, page 184-5)

Steam Baths:  Foster notes that "Masonry steam baths have been excavated at many Maya sites.  They were probably use as part of the preparation of religious rituals, and also as part of the healing ritual. If you were diagnosed with asthma this might be part of the ritual to heal you.  (3, page 336-7)

Herbal Remedies:  There are a variety of herbal remedies used by any member of the Mayan culture to prevent and heal the various ailments that plagued society.

Tobacco:  It was probably ingested in one form or another, as opposed to being smoked, as a remedy for asthma and a variety of other ailments.  (4, page 118)(3, page 337)

Sap of Ramon Tree:  Dried sap was inserted into gourds in order to make rattles for medicine men.  Perhaps in the process of doing this someone drank the sap, and realized it worked well for asthma.  (5, page 28)

Kanlol:  This was a herb that was probably ingested as a draught as a remedy for breathing ailments such as asthma.  While the Maya would not have known this, it is a diuretic that would have worked well for edema and dyspnea caused by heart failure. (3, page 337)

Strong Back:  Aztec men and women were known to carry large loads, and as a result suffered from back aches.  This herb got its name because it was used as an analgesic (pain killer).  Along the way it was also determined to be good for a variety of other ailments, such as asthma.  While the Maya would not have known this, it was an anti spasmotic medicine that relaxed muscles, including the muscles that wrap around the lungs that spasm and cause asthma.  (6, page 48)

Life Everlasting:  This was a plant that got its name from the fact that as its leaves land on the ground new plants spawn.  It was found useful as an asthma remedy.  (6, page 48)

Purslane Poultice:  This is a "pesky plant" that seems to grow everywhere: gardens, curbsides, doorsteps etc.  Many people get rid of it not knowing it's a remedy for asthma.  While the Maya would not have known this, it was an antiinflammatory good for back aches and asthma.  It's Spanish name was verdalaga. (6, page 48)

Surely there were many other remedies for asthma, although these are some of the main ones.  Chances are an asthmatic did not need to call a medicine man in order to feel better, because the American natives of both South and North America had medicine chests or bags that contained natural remedies.  There was also some degree of separation between supernatural and natural medicine, with an obvious overlap.

For example, if the disease was obvious, such as a cut on the foot, a mother might place a salve with a known herbal remedy on the cut.  If the person had asthma and the remedy was known, then perhaps a mother, or a wife, would utilize this natural remedy.  However, when the cause was not known, or if the natural remedy did not work, one did not hesitate to call for the shaman, or the medicine man.

There were obvious differences between the Maya, Aztec and Inca, although some of the culture was shared.  So there is a good chance that medicine among the Aztec and Inca, along with many of the tribes of the region, had a similar health and healing system.

References:

1. Rubalcaba, Jill, Angela Keller, "Empires of the Maya, 2010, Minnesota, Inforase Publishing
2. Sigal, Peter Herman, "From Moon Goddesses to Virgins: the colonization of Yucatocan Maya sexual desire," 2000, University of Texas Press, page 104
3. Foster, Lynn Vasco, "Handbook to life in the ancient Maya world," 2002, New York, Oxford University Press
4. Sidney, John Eric, "Maya History and Religion," 1970, U.S., University of Oklahoma Press
5. Nations, James D, "The Maya Tropical Forest: People, Parks and Ancient Cities," 2006, university of Texas Press
6. Arvigo, rosita, nadine Epstein, "Rain Forest home Remedies:  the Maya way to heal your body and replenish your soul,", 2001, 1st edition, New York, Harper Collins
7. Vogel, Virgil, "American Indian Medicine," 1970, London, Oklahoma University Press
8. Prioreschi, Plinio, "A history of medicine: Primitive and ancient medicine," volume 1, 1995, NE, Horatius Press, 
9. Sigerist, Henry, "A History of Medicine," volume 2, 1961, Oxford University Press

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2,700 B.C.: Imhotep invents rational medicine

Imhotep was deified
1500 years after his death.
(10)

Natural medicine was an art that developed over hundreds, if not thousands, of years.  Yet it culminated in the 3rd millennium B.C. during the reign of king Djoser (pronounced Zoser).  Yet this time the pharaoh was not given credit, instead it went to a non-pharaoh who became known as Imhotep.

His birth name was Thosortes or Athotis, and he was the son of Ptah.  He was born to a family of priests, and therefore he was educated in the best schools in Egypt.  He was a man of brilliant mind, one that made him a famous for his architectural, engineering, and medicinal talents.  He was also a great scribe, and it was probably this skill that made him vizier (chief advisor) to King Djoser (2650-2575 B.C.) of the Third Egyptian Dynasty.

Since all wisdom came from the gods, legend had it that he developed a close relationship with the god Thoth, who was the god of arts and sciences, and secretary to the gods. It was from Thoth that Imhotep learned how to write, and from whom he learned about architecture, engineering and medicine.

Imhotep grew to a "position of wide trust and importance," said William Osler in his 1913 history of medicine. (9, page 10)

In fact, it was during Djoser's reign with Imhotep at his side that knowledge of architecture, engineering, and medicine came to a culmination. The man given credit for it all was Thosortes, who became known as Imhotep  (2650-2600), which means physician.

Prior to Imhotep (pronounced I-em-hetep), pyramids were build of mud brick and didn't last the test of time. Imhotep was the first to suggest using stone (or at least he's given credit), and he designed Pharaoh Djoser's step pyramid in Saqqara (Sakkara).  He also is said to have invented many of the tools used to make these pyramids and an irrigation system which supplied water from the Nile to fields.  (1)

He also impressed by his ability to heal, and it was from th

King Djoser was an Egyptian Pharaoh
during the 3rd Dynasty of the Old Kingdom

is talent that he earned the name Imhotep, although there are variations of this depending on who the author is, such as Imhotpu, Emeph, Eimoph, Imothph, and Imouthes.

He had other names too, such as "scribe of numbers."  Perhaps this was in reference to the knowledge of numbers required to understand the prescriptions that were recorded, and to have an understanding of the "great many remedies that they employed for diseases of various kinds and many methods of delivering them." (2)

He was paid well for his services, most often in the form of gifts from the Pharaoh. Gifts might have been something elaborate like a necklace or bracelet, or someting as large as a plot of land or even a boat.  A boat would have been useful for traveling down the Nile to visit the sick in their homes.  (5, pages 321-322)

This is Pharaoh Djoser's step pyramid at Saqquara.
At the time it was the largest man-made structure.
Many speculate it as designed by Imhotep. (10)

He also was paid handsomely in the form of great respect throughout the dynasty, and posterity for all time.  In fact, he was so well respected that his legend lived on for centuries after his death, to the point that he became the god Imhotep, a god of health and healing similar to Thoth, Isis, Sekhmet, Heka, Serket, and Ta-Bitjet..  (5, page 321, 322)

Legend has it that he recorded all the medical wisdom he learned from Thoth for all future students of medicine to learn from.  While these documents are lost to time, they were referred to by later physicians, including Claudius Galen in the 1st century A.D.  Since the ancient Greeks referred to Thoth as Hermes Trismegistus, these documents are referred to as the Hermetic texts.

During the 19th century, two large scrolls were discovered, perhaps between the legs of a mummy. (3) They were purchased from a native dealer by Edwin Smith.
The large of the two was sold to Georg Ebers, and became known as the Ebers Papyri.

When it was translated and discovered to be a series of books about internal diseases and recipes for how to treat them, Ebers speculated it was the last six of the 42 Hermetic texts.  While this inspired some early excitement, the document was  dated about 1500 B.C., or a thousand years after Imhotep had lived.   (5, page 305)

The Ebers Papyri is now thought to be an encyclopedia of random recipes from random scrolls.  Perhaps these were recipes one physician thought were important and wanted to remember.  Chances are pretty good this physician was not Imhotep.

The smaller of the two scrolls was kept by Edwin Smith and is referred to as the Edwin Smith Papyri.  It continued to be thought to be the works of Imhotep even after the other document was proved not to be, although this, too, was later learned to be untrue.  It was learned to be fragments, or copies, of older surgical texts. (5, page 304)

Sigerist said that while some believe the Smith Papyri was the"work of a surgeon.  There is good internal evidence, however, that the book was a manual of a war surgery or rather that the experience it reflects was gained to a large extent from war injuries." (5, page 310)

While the idea that Imhotep wrote this document caused a great deal of excitement, later scholars proved this not to be the case.  Sigerist added: "It is not very probable that the vizier of a great Pharaoh would have acted as an army surgeon."

The scrolls may have been texts at one of the Egyptian schools, although they may have been owned by an Egyptian priest as a reference.  When a sick person approached the physician complaining of certain symptoms, the scrolls would have been used to find the medicinal remedy and the incantation to coincide with it.

However, Imhotep's legacy lived on even beyond the era of Egyptian supremacy. During the time when the Greeks ruled over Egypt, around 500 B.C, Imhotep was worshiped as a deity for good health and healing.  Temples in Memphis, Thebes and Pilae were built in his honor, as well as many statues.  (4)

In fact, he was so well respected by the ancient Greeks that he was often associated with the god Asclepius.  (1)  In the end, Imhotep, the great physician, became the most famous non pharaoh in all of ancient Egypt.

Further reading:

• 5000-50 B.C.: Egyptian gods educate physicians
• 5000-50 B.C.: The role of the Bible in medicine
• 5000-50 B.C.: The Ebers Papyrus: the first asthma remedy? 
• 800 B.C.- 800 A.D.: Asclepius will heal your asthma

References:

1. "Imhotep," Egyptpast.com, http://www.egyptpast.com/pyramids/imhotep.html, reviewed May, 26, 2012
2. "The First Physician," Journal of the American Medical Association, August 19, 2009, 302 (7), page 807
3. Dunn, Jimmy, "Egypt: Imhotep, Doctor, Architect, High Priest, Scribe and Vizier to King Djoser," touregypt.net, http://www.touregypt.net/featurestories/imhotep.htm, referenced May 26, 2012
4. Lambert, Tim, "A brief history of medicine," localhistories.org, http://www.localhistories.org/medicine.html, observed May 26, 2012
5. Sigerist, Henry E "A History of Medicine," vol I, "Primitive and Archaic Medicine," 1951, New York, Oxford university Press
6. Withington, Edward Theodore, "Medical History From the Earliest Times: A Popular History of the Art of Healing," 1894, London, The Scientific Press, page 14-15 (Chapter IV: Medicine in Ancient Egypt)
7. Wilder, Aleander, "History of Medicine," 1901, Maine, New England eclectic Publishing
8. Sozinskey, Thomas S., "Medical Symbolism in connection with historical studies in the arts of healing and hygiene," 1891, Philadelphia and London, F.A. Davis Publisher
9. Osler, William, "Evolution of Modern Medicine: a series of lectures at Yale University to the Silliman Foundation in April 1913, 1921", New haven, Yale University Press
10. "Stepping toward a true pyramid," nationalgeographic.com, http://www.nationalgeographic.com/pyramids/djoser.html, accessed 6/5/14

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870 B.C.: The first description of artificial resuscitation

Elijah resuscitating a child 

Similar to other ancient civilizations, the Jews believed life and death, health and sickness, was the result of the desires of their God, the Lord.  Likewise, in the rare cases when a person was believed to be dead and then brought back to life, this was due to the wishes of their God, the Lord.

No one knows what they called it, although by the 18th century it was referred to as reanimation, and by the mid 20th century it was referred to as resuscitation.

Both terms work equally well, as animate comes from the Latin term anamatus which comes from anima, meaning "to give life to" or to breathe. It may also come from the Greek word anemos for wind.  Likewise, suscitate is a Latin term for "to stir up or rouse." (1)

The first description of an animation or a suscitation was when, through Adam, God created Eve: 

Adam was all alone in the garden with no one to help him. So, God put Adam into a deep sleep and took one of his ribs and formed it into a woman to be Adam's wife. Adam named her "Eve."

The work of the Lord could also be done through a prophet.  The Lord God had many prophets over the years covered in the Bible, among the first was a prophet named Elijah.  He is believed to have lived in the Northern Kingdom of Israel sometimes around 870 or 850 years before the birth of Christ.  

He is described as performing many miracles through the assistance of the Lord. In the First Book of Kings he is described as resuscitating (or reanimating).  A Sidonian widow woman was taking care of him during a drought when her son fell ill and became apparently dead.  She approached Elijah with the body of her son: 

Some time later the son of the woman who owned the house became ill. He grew worse and worse, and finally stopped breathing. 18 She said to Elijah, “What do you have against me, man of God? Did you come to remind me of my sin and kill my son?”

“Give me your son,” Elijah replied. He took him from her arms, carried him to the upper room where he was staying, and laid him on his bed. 20 Then he cried out to the Lord, “Lord my God, have you brought tragedy even on this widow I am staying with, by causing her son to die?” Then he stretched himself out on the boy three times and cried out to the Lord, “Lord my God, let this boy’s life return to him!”

The Lord heard Elijah’s cry, and the boy’s life returned to him, and he lived. 23 Elijah picked up the child and carried him down from the room into the house. He gave him to his mother and said, “Look, your son is alive!”

Then the woman said to Elijah, “Now I know that you are a man of God and that the word of the Lord from your mouth is the truth.” (Kings 1: 17-24)

The Sidonian widow at first appears to be angry at Elijah and his God for allowing her child to become sick and to die. Perhaps she doubts Elijah because she is a Sidonian widow and not an Israelite. Once the miracle is performed, however, she no longer has any doubts that he is a prophet of the Lord.

Elijah "stretched himself out on the boy three times." Why is this such a vague description?  It was because the authors of the Bible were not concerned with what Elijah did, as all the Jewish people needed to know about medicine was that the Lord brings sickness and health.  By obeying the Lord, the Lord will heal.  By disobeying the Lord, the Lord will not heal.  That's all people needed to know.

They did not need to know that Elijah was educated in all the wisdom of the land. They did not need to know that among his education involved knowledge of physics, chemistry, philosophy, mathematics, and medicine.  They did not need to know that the procedure he performed on the boy was a method of artificial resuscitation.   What he did, the method he used, was only eluded to because it did not matter. 

References:

1. Definitions come from merriam-webster.com,  http://www.merriam-webster.com/dictionary/animate and http://www.merriam-webster.com/dictionary/suscitate, accessed 9/26/2013

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3000 B.C.: The baru will predict your future

This is the oldest known Sumerian Medical book.
The Baru  memorized remedies and incantations,
many of which are recorded in texts like this.
(drhajar.org: Arabian Gulf: Cradle of Medicine)

Divination is the interpretation of omens or signs to predict the future.  Most ancient societies, from Ancient Greece, Ancient Egypt, Ancient Mesopotamia, Ancient India, Ancient China and Ancient Rome, all believed in omens.  And there were good and bad omens.  (1,2)

You were sick.  You have sinned.  You are impure.  You are in disharmony with the world.  You are a burden on society.  You are unclean.  So you must go to see a healer, who in most cases was a priest, for healing.

Since your disease, your symptoms, was caused by magic, you needed a magical cure.  The healer would give you an incantation incantation to site to ward off the evil.  Although, if you could afford it, he'd use a divination to learn how you got sick in the first places, as this was how the best cures came about.  .

Through divination a priest might learn that the ailment could easily be cured, and this made you optimistic, or gave  you hope.

On the other hand, however, the priest might learn that your illness is futile that that you will die, and in that case fill you with gloom and pessimism.

A healer could predict success in wartime, and inspire soldiers.  Or they could predict a loss, and therefore cause resignation among soldiers.

Priests who offered divination were called baru, the diviner.  They were specially trained in the divination.  They asked you questions:  Did a bird cross your path.  If it did, was it to the left or right.  If you saw birds flying to your left when you broke your foot the birds brought back luck.  This was no coincidence.  You were cursed.  The remedy was to chant this incantation or to put this amulet on a chain around your neck, or over your doorway or window.(2)

There were other means of getting omens, depending on how much you could afford.  Probably the most expensive, yet most revealing, would be to have a baru examine the liver of a sacrificed animal. 

By studying the liver, most often by sacrificed animals such as sheep, the baru could learn much about the future.  According to Henry Osler in his series of lectures at Yale University in 1913:

Of all the organs inspected in a sacrificial animal, the liver, from its size, position and richness in blood, impressed the early observers as the most important of the body.  Probably on account of the richness in blood it came to be regarded as the seat of life --- indeed, the seat of the soul.

The liver to the Babylonians was similar to the heart to the modern world:  it was the soul of life; the center of vitality.  "Hepatoscopy," Osler said, "thus became, among the Babylonians, of extraordinary complexity, and the organ of the sheep was studies and figured as early as 3000 B.C.  In the divination rites, the lobes, the gall bladder, the appendages of the upper lobe and the markings were all inspected with unusual care."

Readings:  gallbladder... liver....

Cheaper methods would be to drop oil over water and watch what happened.  Or a flame was lit and the flickering was examined, conclusions drawn.

Knowledge that the baru had was esoteric.  Many religious texts ended in...

May he who knows instruct him who knows.  And may he who knows not read this." (2, page 433)

And...

He who does not keep the secret will not remain in health -- His days will be shortened." (2, page 433)

There were other similar sayings, although the meaning was relatively the same.

References:

1. Osler, William, "Evolution of Modern Medicine: a series of lectures at Yale University to the Silliman Foundation in April 1913, 1921", New haven, Yale University Press, pages 18-19
2. Sigerist, Henry E., A history of medicine," 1955, 2nd edition, volume 1, pages 453-5, 433

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3533-2600 B.C.: The birth of rational/civilized medicine

While many think of Imhotep (2650-2600 B.C) as the first physician,
chances are there were probably many others before him.
Yet he was so impressive for all he accomplished in his life,
that he is the one remembered by ancient accounts.

Among the first things I learned in my study of medicine in primitive and ancient societies was, given the limited medical wisdom of these people, they "rationalized" medicine to the best of their ability. They "rationalized" disease as being caused by evil spirits, demons, ghosts and gods. While we may think of this mythology and irrational, to them it was quite rational. (1, page 248)

We must keep this in mind as we continue our quest to learn the history of medicine, the history of respiratory therapy, and the history of asthma.  Our quest today, however, is to learn about the time in history when what we consider to be rational  medicine was born.  We want to know at what point in history physicians started prescribing medicine that was not mythical, and might actually make your breathing easier, or make your chest pain go away.

To prevent confusion of the term "rational," many historians use terms like magical, religious, or magico-religious to refer to mythology and religious medicine, and terms like civilized, empirico-rational, or natural to refer to real remedies.  Personally, I like the terms magico-religious and civilized, and for this reason I will try to use these terms throughout this history. Still, it's important to understand the confusion here, as the various terms continue to pop up in various historical writings. (2)(4)

By studying ancient Egypt we learn how mythology influenced medicine, and we also learn how civilized medicine was born.  Since Egyptians believed diseases were caused by gods and demons that were ubiquitous, the only means of treating and preventing disease was magic.  The person responsible for medicine was the medicine man, who offered incantations, prayers and amulets to treat disease.  He was a busy person, sought out daily by those afflicted with chronic pain, discomfort, or injuries. (2)

Generally speaking, if you suffered from basic symptoms, such as if you had a cold, you'd deal with it on your own, as you wouldn't want to be a burden to your family or clan.  If you had any symptoms of asthma -- dyspnea, chest pain, coughing, wheezing, or increased sputum -- you'd probably suffer through it until your trouble went away on their own.   If it persisted and you couldn't bare it any longer, then you might give in and seek a medicine man to treat your symptoms.

By trial and error more treatment options were learned, and these are your civilized medicine, your "physical, dietetic and pharmacological treatments."  Methods of setting broken bones, and cutting with a knife (surgery) were developed and passed on by the language that developed. (2)

The job of the medicine man became a specialized profession, and as time went by there were basically three branches of medicine that formed:  (2)

• Sorcerer: They specialized in magic, creating a link between the patient and the spirits 
• Priest: They specialized in religion, creating a link between the patient and the gods
• Physician: They specialized in civilized medicine, treating ailments with prescriptions

More than likely, all three of these paradigms existed side by side, with a patient having all three as options for healing. (1)

For instance, chances are that while physicians were preparing their prescriptions, they'd also be citing incantations and prayers, because they believed they worked by magical or religious means.  `(5, page 4)

As noted by Walter Libby in his 1922 book "The history of medicne in its salient features,": (5, page 4)

On account of the conservatism of the priest physicians, Egyptian medicine never advanced far beyond primitive medicine with its simple faith in magic spells and the virtue of a rich pharmacopoeia, and its belief that the cause of disease was the malice of a demon, the justice of an avenging god, the ill-will of an enemy, or the anger of the dead.

Technically speaking, rationalized/civilized medicine probably started early, perhaps as early as 30,000 B.C., only to be known by a few people.  As word spread of the success of these new remedies, more and more medicine men learned of them, and used them on their own patients with success.  Such wisdom was then shared by word of mouth from one generation to another, mainly through easy to remember poems and songs, until the first medical writings were available.

For the most part, however, most historians recognize rational/civilized medicine as starting early in Egypt and Mesopotamia, only to develop over a thousand years later in China. So it's easy to see that such wisdom was slow to advance and spread from man to man, and society to society.

Historians acknowledge there is evidence of physicians early on in Egypt's history, although such knowledge is sparse. Edward Withington, in his 1894 book "Medical History of the Art of Healing," describes the discovery of a tomb of Sekhet' enanch who was chief priest/ physician of the Pharaoh Sahura sometime around 3533 and 3000 B.C. . Inscriptions show he "healed the king's 'nostrils' for which his majesty wishes him 'a long life of holiness.'" (4)


The next priest/ physician we know of is Imhotep, who was the vizier (chief adviser) and architect of King Djoser around 2,600 B.C. He was believed to be the architect who designed the first great stone pyramids, and to have designed many of the tools used to build these pyramids. He was also believed, for a generation perhaps, to be the priest who communicated with the god Thoth (Hermes), thus writing the medical wisdom of the gods on stone tablets, which are known to history as the Hermatic texts.

Yet Imhotep must have been a heroic physician too, because after his life he was so heralded by the people that he became a god. Although, due to his fame, Imhotep was given credit as the inventor of medicine, something that is also sometimes debated. Yet for our purposes, the writings he is said to have written contained some of the first civilized remedies, prescriptions that involved dough pills, inhalations of smoke and steam, salves, etc. He, therefore, is often considered the father of rational/ civilized medicine.

After Imhotep, rational/civilized medicine spread throughout the whole of Egypt. Some priests studied the last six of the Hermetic texts, and they became physicians. They were often sent to the homes of the sick, and prescribed what we might refer to as rational/civilized medicine, along with the incantations that went with them.

So as the medicine man's specialties evolved, so too did the physician's specialties.  Herodotus (484-425 B.C.), the Greek historian, observed of Egypt that:

The practice of medicine is so divided among them, that each physician is a healer of one disease and no more.  All the country is full of physician, some of the eye, some of the teeth, some of what pertains to the belly, and some of the hidden diseases." (3)

Natural medicine became so common that regular folks had knowledge of it.  Common colds, asthma, headaches, and stomach aches were probably treated by the physicians in the home, as Homer noted of the Egyptians that "each one is a physician, skillful beyond all men, for verily they are of the race of Paeon (Greek physician of the gods)." (4, page 16)

What did he mean by this?  Well,  it's actually open to speculation, but some historians believe he meant that every person in Egypt was knowledgeable of medicine, at least to a certain extent.  Perhaps he meant that the average person in Egypt was like the average person in the United States today, having a medicine chest full of medicine, and the ability to treat the basic ailments and injuries of the day.

Edward Withington, in his 1894 book "Medical history from the earliest times," described two examples what may show that even non-physicians were physicians -- sort of. The first one is the discovery of the medicine chest of Pharaoh Mentu'-hotep of the 11th dynasty around 2,500 B.C. The chest belonged to his wife, and consisted of "six vases, one of alabaster and and five of serpentine, with dried remnants of drugs, two spoons, a piece of linen cloth and some roots, enclosed in a basket of straw-work, the whole standing in a wooden chest found in the queen's tomb." (4, page 16)

As the second example, Withington mentions a "curious letter from a husband to his dead wife, found attached to a small image of the latter. In it he upbraids the departed spirit for having produced disease in him, and while reproachfully calling to mind his kindness to her during life, thus describes her last illness: 'When thou wast sick, with the sickness that thou hadst, did not I go to the physician and bid him make thy medicines for thee? -- yea, he did all things whatsoever thou wouldst have him do.' This seems to imply that the lady to some extent directed her own treatment, and reminds us of the Homeric description of Egypt as the land where 'each one is a physician, skillful beyond all men, for verily they are of the race of Paeon.'" (4, page 16)

It's highly likely that if home remedies didn't work, and greater help was needed or wanted, then the sick may seek a sorcerer, priest or physician. Unexplained diseases were probably treated with magic. Bone breaks and lacerations being treated with surgery, with lotions and salves being used to soothe the pain and speed healing. Chronic disease may be treated with magic, or perhaps with one of the various salves, lotions, potions, pills of dough, and the like.

And what we're most interested in here is emperico-rational medicine --rational/ civilized. It's what is learned by observation and experimentation. The plant Belladonna laid out in the sun and was dried, and one day an asthmatic accidentally dropped some on the fire and inhaled the smoke, getting some relief. He remembered this and tried it the next time he was dyspneic with the same beneficial results. He relayed this story to his friends, and to his children, until one day it was written on papyrus, and delivered to us through time via the Georg Eber Papyrus.

Belladonna is referred to as a herbal remedy. Other available herbs included opium, coca, cinchona, ephedrine, caffeine, carcara, sagrada, chaulmoogra, digitalis, ipacacuanha, podophyllum, pyrethrum, squill, belladonna, and strammonium. These are your natural remedies. (1)

These herbs had to be prepared in such a fashion that they had some potency, some medicinal effect.  Some were best sundried, crushed and inhaled.  Some were most effective in lotions massaged on the skin.  Some were best mixed in dough and swallowed with water.  Some were best dissolved in water and made into broths.  Some worked best as salves.  Many were best mixed with other herbs, or given before or after chanting an incantation.

While these are your natural remedies, said Plinio Prioreschi in his 1991 history of medcine:

(The) pharmacological aspect of therapy must be understood, however, in the context of the supernaturalistic paradigm: the medicines worked through magic, their effect depended on the recitation of the proper words and the performance of the correct actions. In fact, the consecration of the remedies was a significant part of the sacred utterances of the healer.  The potency of herbs was usually due to their relationship with gods or goddesses who were behind their curative powers. (1)

The medicine was magical.  In this way, the physician was just another medicine man.  In a way it seems that in the absence of any truly effective remedy, the hope a priest or sorcerer provided, the hope that helped soothe your mind, may have done more for healing than any remedy of the physician. 

Just think about it:  while a prayer or incantation offered no real remedy, at least it did no harm.  The best case scenario was the placebo effect made you think something was being done.  You felt better by default.  You relaxd.  Your breath came back -- eventually.   I'll let you decide which healer you would have rather taken your chances with. 

Further reading:

• 1500 B.C.: Asthma in ancient Egyps: Ebers Papyrus
• 2600 B.C. Imhotep invents rational medicine

References:

1. Prioreschi, Plinio, "A History of Medicine," 1991, volume I, page 248
2. Sigerist, Henry E, "A History of Medicne," 1955, second editionn, vol. I, 
3. Prioreschik, op cit, page 365-6, referring to Herodotus, II, 84, Translation by A.D. Godley.  
4. Withington, Edward Theodore, "Medical history from the earliest times: A popular history of the art of healing," 1894, London, The Scientific Press, pages 14-23 (Chapter IV: Medicine in Ancient Egypt)
5. Libby, Walter, "The History of medicine in its salient features," 1922, Boston and New York, Houghton Mifflin Company

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3000-900 B.C.: Asthmatic boy in Babylon

Picture of ancient Babylon taken between 1900 and 1912

So as soon as we get back from Ancient Egypt, our time machine is ready for another journey, and we're asked to quickly board so we don't upset the time space equilibrium, whatever that is. After a few shakes and quakes the ride is rather pleasant. I'm thankful I already tucked my rescue inhaler into my pocket.

When we arrive we are amid ten people, a family I assume, each with long black hair tied with colorful ribbons, and all squatting -- all but one boy that is -- around a large bowl, eating slop with their fingers. The sun is setting in the east and the air feels cool yet comfortable, stained with the aroma of whatever was dinner and the fire (the smoke of which is making my lungs feel tight). The men and women wear whoollen cloaks, making us feel out of place in our 21st century sweatshirts and jeans. (1, page 400)

No, they don't see us, as we are merely observers. Yet as an asthmatic I can't help but to notice the teenager slumped in the corner, leaning against a flat rock. The others seem to ignore him, and he makes no effort to seek help either. I find this odd. Although our guide states this isn't odd, because the boy doesn't want sympathy. While we may surmise he has asthma, these folks have no concept of asthma. The symptom was the disease as primitive man had no concept of nosological entities, that is, of disease. The young man, if he doesn't recover, is a burden; a hindrance. He wants no sympathy.

Likewise, our guide states, we must understand that a disease is a curse and illness was a punishment of something you did wrong. The boy may simply not know what he did wrong, and maybe he didn't do anything at all. Yet that won't stop his family from assuming he was a bad boy. Because he had no idea what he did so wrong to feel so bad, he was resigned. So it was easier for the boy to hide, or pretend to be fine.

Our guide says we must be somewhere around 1500 B.C. in Babylonia. We also learn from our guide that a variety of primitive societies lived in Mesopotamia -- the land between two rivers (Tigris and Euphrates) for thousands of years, and united to manage the rivers. They dug canals that filled when the rivers rose to prevent floods from wiping out villages and cities. After the floods the canals were drained to irrigate the land. (1, page 378)

Each primitive society had it's own gods and demons, and as the people united a variety of city states formed that adapted some of these gods and demons and created some of their own. At the center of each city-state is a hill with pyramidal structure with a flat top used to worship the gods. The first ones appeared around 3,000 B.C.and this is considered the beginning of the Sumerian civilization. It's greatest city-state may have been Ur, which sat on the Tigris close to the sea. Even after Ur fell, Sumeria lasted until around 2400 B.C., and had a resurgence later that lasted until 2004 B.C.

While the Sumerians created the first civilization in Mesopotamia, they're customs and culture continued to influence people for thousands of years.  One city-state, Babylon, grew to be the largest city in the world, partly due to the influence of Hammurabi. He was a great ruler who created what we refer to as the Code of Hammurabi, which was a code of strict punishments for wrong doings.  It was an eye for an eye, a tooth for a tooth, a limb for a limb.  Its rule lasted from about 1830-1531 B.C.

Another city-state along the Tigris grew into a national state of Assyria, that lasted from about 2400-612 B.C. Nineveh would later become the new capital of the empire that flourished from 750-612 B.C.  The Book of Genesis mentions Ur as the birthplace of Abraham, and Niveveh also has a Biblical impact, mainly having to do with its demise and destruction.

Unlike the Ancient Egyptian society, which was also growing at this time, the Mesopotamians aren't concerned with the After Life.  What they are concerned about, as most primitive societies were, are all the demons that surrounded them.  They carried amulets and charms, and cited incantations and prayers to prevent and treat diseases that were caused by these demons.  Yes, these demons were everywhere, like the bacteria and viruses we have to live with today.

Yet as we don't live in fear of bacteria and viruses, they don't live in fear of demons.  They have learned through years of experience, and constant reminders by the priests, what needs to be done to keep the positive balance between the demons, the spirits, the dead, and the living.  Disease in this way can both be prevented and treated.

Plus if you lived during this time in this society, you probably worked all day, as the people we see did all day, a day that exceeded 110 degrees Fahrenheit (which I find stunning considering how cool it is).  So the Sumerians, and later the Babylonians, don't have time to worry about the transcendental, other than the rituals, incantations, and prayers.  They arduously manage their crops, the river, or fight wars, and have little time to fear the unseen.

Yet as an asthmatic myself, one who yearned for my inhaler, I know that young lad had no such inhaler to help him.  He had no rescue medicine to give him instant relief.  So what would he do if his breath didn't come back?  I know from my own personal experience with this disease he can only pretend to be fine, to hide, so long.  So what are the options for the young asthmatic in Babylon?

As we sadly watch the lad huff and puff, our guide explains that both the Sumerians and the Babylonians knew little of anatomy.  They did not dissect humans or perform autopsies, and they did not mummify the dead as the Egyptians did.  They did, however, dissect some animals in search of omens.  They examined the entrails, especially the liver, for signs of good and evil.  Yet they had no concept that diseases were caused by these organs, nor that they were essential for life.  So they rarely thought to dissect them to learn what was inside.   (1, page 455)

He explained there were three types of priests. This knowledge didn't interest me at first, because how was a priest going to help an asthmatic boy.  Yet then as I listened, I realized the priest was the best help for the boy aside from waiting it out. The three types of priests were:  Seers, Exorcists, and physicians.  Seers are experts in omens, exorcists drive out evil spirits, and physicians treat illness and wounds.  All options are viable to the boy, who finally gives up and seeks the help of his father as his father finishes licking his chops.

Another option for the boy is what Herodotus observed when he traveled to Mesopotamia to learn how they lived.  He observed the ill being set in a public square, and everyone passing by was encouraged to ask what symptoms he was suffering from.  Anyone with knowledge of the symptom and remedies was encouraged to speak up.  (2, page 34)

I watch as the family huddles around the suffering boy.  A lady, the mother perhaps, places her hand on the boy's head and says what I believe is an incantation.  He touches an amulet on the boy's chest, a small bone I think, and says another incantation.  Soon the entire family is singing a song, or perhaps it's an incantation or prayer.  I wonder if this has happened before, and the family is doing what a priest suggested to ward off whatever evil spirit is causing the dyspnea.

The father leaves the courtyard.  The mother stays with the boy, as if trying to comfort him.  The rest of the family enters the home.  Nothing changes for several hours, until the father returns with an elderly man well garnished with necklaces and earrings. He's also carrying a satchel. This, I assume, is a priest.  What kind of priest is he? I wonder.

The priest approaches the boy, who's now sitting on the ground with his mother rubbing his brow with a damp cloth.  The priest kneels so he's at the height of the boy and touches his brow. He utters some words, and then the mother rushes into the home and comes out with a pot.  He sets it between the boy and the priest, which I realize is a physician as soon as he pulls various herbs or drugs from his satchel and tosses them into the pot.  He inserts a reed tube into the pot, seals it with wheaten dough, and places it onto the fire.

Once the pot is steaming the boy places his mouth around the reed tube and inhales.  The boy appears to get little if any relief from this.  Yet he smiles as he walks with his parents inside, we assume with the hope of falling asleep.  The physician leaves.  Darkness ensues.

I attempt to follow the physician to learn more, but am shoved back into the time machine just as the door shuts.  I'm forced to return to the modern world with no knowledge of how the boy fared.
------------------------------

Back in my office I wonder about the boy.  Surely the physician had access to rational medicine to help the asthmatic?  Right?  What I  learned was quite interesting.

As my guide suggested, the gods of ancient Mesopotamia were all powerful, and they were the cause of all diseases, and they were the only means of a cure. However, the best method of treating sickness and injuries was to prevent them altogether. Each city-state had its own gods to worship, and huge temples were built for these gods to live.  The priests performed rituals where they offered prayers, incantations, and sacrifices to appease them.  Smaller temples were built where average citizens could offer sacrifices too.

To make the job more difficult these gods had the ability to make demons, and they could either be good or evil depending on the wishes of the god. These demons, or monsters, appeared in a variety of forms, such as animals, birds, or both.

Herodotus was a historian who lived in Ancient Greece from 484-425 B.C.  He traveled the world so he could write about it. He dismissed Ancient Mesopotamian medicine because he believed they had no doctors.  However, modern historians know from excavated cuneiform tablets that various types of physicians existed in Ancient Mesopotamia from an early time, just as in Ancient Egypt.

The Mesopotamian physician is among the most educated in this society; he or she is literate (a member of the literate), familiar with tradition, and well trained. (1, page 432). He will give the boy hope, and hope alone has psychological benefits that should help the boy cope until his breath comes back. 

Edward Withington, in his 1894 book "Medical history from the earliest times," explains that "If a Persian wished to practice medicine, he must first practice upon unbelievers; should three of these die under his hands he is forever incapable; should he cure three, he is qualified to act as a physician... for ever and ever..." (2, page 36)

From Henry Sigerist, in his 1955 book, "A History of Medicine," we learn that the physician probably did have knowledge of lung diseases, and he did -- as I saw on my journey, have access to an inhaler of sorts.  Yet there was no knowledge of asthma, only the symptoms of dyspnea, cough, excess sputum, chest pain, and anxiety.  Each was a disease, and the one that was most prevalent -- the dyspnea in the boy's case, was the diagnosis.

Yes, he probably did know about dyspnea.  Some examples are mentioned by Sigerist:

"A man 'coughs dry, ejecting no saliva,' or the 'lungs cough up pus and the inward parts,' or 'a man is affected in his lungs and they vomit exceedingly.'"

Surely this isn't asthma, yet it's a lung ailment.  Sigerist also writes: 

"Dyspnea is probably referred to in several passages which say:  'if a man's lungs pant with his work,' although the translation is not certain.  'When the breath of a man's mouth is difficult,' is probably also a reference to dyspnea."

Also, "'A man is affected in his lung passage' or 'suffers from the 'pipe of the lungs,'' means that the patient has a disease of the bronchi or upper respiratory organs.  You hear no specific descriptions of that make you think asthma, although bronchitis, or at least bronchitis symptoms, are known.

Sigerist mentions a passage from an Assyrian tablet:

"If the patient suffers from hissing cough, if his wind-pipe is full of murmurs, if he coughs, if he has coughing fits, if he has phlegm: bray together roses and mustard, in purified oil drop it on his tongue, fill, moreover, a tube with it and blow it into his nostrils.  Thereafter he shall drink several times beer of the first quality; thus he will recover."  (1, page 480-81)

This is the remedy we thing the priest gave to the boy.

Other than incantations and prayer, or simply toughing it out, some physicians might provide the asthmatic with what you would consider among the first inhalers, similar to the Egyptian method of heating dried herbs on stone and inhaling the smoke.  The Mesopotamian inhaler is described by Sigerist as such:

"A decoction of various drugs was placed into a pot, which was sealed with wheaten dough after a reed-tube had been inserted into it.  The pot was placed on fire and then: 'thou shalt put it (the tube) into his mouth, let him draw the steam up by the reed-tube into his mouth... it shall strike his lungs: for nine days thou shalt do this.'"

Ah, and this is so stunningly accurate to what I saw.  Amazing!

Yet there is little knowledge that the drugs placed into the pot, when inhaled, did any good to relieve the boy's dyspnea, whether it was caused by asthma, bronchitis or pneumonia.  Yet at least it proved to be a somewhat more rational (rational according to our modern definition anyway) approach to treatment of respiratory conditions, as compared with prayer, incantation, and hope alone.

We can only wonder how the boy fared.

References:

1. Sigerist, Henry E, "A History of Medicine: Primitive and Archaic Medicine," volume I, 1951, New York, Oxford University Press
2. Withington, Edward E, "Medical history from the earliest times: a popular history of the healing art," 1894, London, Aberdeen University Press

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2600 B.C.: Egyptian Priest/ Physicians Treat Asthma

So you are an Egyptian father of an Egyptian boy and you are convinced he is cursed by the god Isis. You don't know what your son did, but he is outside leaning against a tree, struggling to breathe, and he's making loud wheezing sounds with each prolonged expiration. You cannot bear to watch him suffer anymore, and so you send for help.

It's possible that in the early days of Egypt you would have your child sit in the streets, and people who walked by would offer their medical advice; their diagnosis and medical treatment. Some historians speculate this never actually occurred in Egypt, and others speculate it was an early transitional stage prior to the priest studying health at the temples, and maybe even prior to the transition of some priest into physicians who were sent to visit the sick, such as your son. (1, page 2)

Various temples were built where you could worship the various gods of Egypt, and specialized temples were built where you could worship the gods who specialized in health and healing. These temples were places where the sick could sleep in the night, and a diagnosis and remedy would occur in the night, and in the morning a priest would interpret these dreams and visions. (1, page 2) (3, page 16)(8, page 19)

Patients who were too sick to leave their homes may send for a physician. The president of the temple would determine the specialist best for the individual case, and that physician would be sent to the patient's home. In this way, physicians made house calls, and they also specialized. (2, page 4) (4, page 17)

When he treated you, he offered the following cures: (11, page 14)(12, page 13-15)

• Magic
• Draughts (potions)
• Blisters
• Poultices
• Plasters
• Powders
• Clysters
• Bleeding
• Pills made of dough
• Gargles
• Salves
• Inhalations
• Fumigations
• Supositories
• Incantations
• Amulets
• Hope
• Emetics
• Purgatives
• Diuretics
• Diaphoretics
• Cautery
• Surgery

The various drugs used were from animals (worms, snakes, insects, elephant, camel, crocodile, hyena), plants (radishes, onion), minerals (sulfur, zinc) and even humans excrements (feces, semen, saliva). These were formulated in a variety of recipes that were prepared by the priests/physicians. (12, page 15)

They would also prescribe good hygiene and a proper diet. (12, page 15) They encouraged regular baths and purgings, and perhaps this was where the old adage came from: "prevention is better than the cure." People early on in history must have learned that nary a drug cured anything, and sometimes the drugs used made people worse, or even killed them. So the emphasis was placed on good hygiene and healthy eating, with the goal of keeping them healthy, and preventing them from getting sick.

Proof of this can been found in the Bible, when God told Moses to tell the people to follow the laws set forth to prevent the spread of disease. Moses, who probably studied under the tutelage of Royal Egyptian priest/physicians, encouraged Israelites to avoid diseased people, and not to touch corpes, and to wash and have good behaviors in order to prevent sickness.

Common diseases treated were osteoarthritis, tuberculosis, rickets, and syphilis. (12, page 15) Modern evidence from mummies suggests they also treated atherosclerosis. Although their limited knowledge of anatomy prevented them from knowing about these diseases, they basically observed and treated the symptoms, which to them were caused by the gods, and, if not treated by the powerful magic of the priests/ physicians, would result in death.

References:  See "2600 B.C.: Egyptian Diagnosis and Treatment."