MEDICINE, PRE-SCIENTIFIC

the aim of primi- tive medicine, like that of primitive religion of which it at first formed an inseparable part, was to safeguard life, using the same means to attain their common end. main causes of disease.—modern investigations reveal that savage races still attribute disease to three main causes:— (a) the projection of some foreign substance into the body; (6) the abstraction of something from the body; (c) a sympathetic process operating on some part of the body or on some object that has been in contact with the victim. as the supposed results are ascribed to the agency of men or spirits, their machinations have to be circumvented or their wrath diverted. many practices illustrate these points. thus suction is a common ceremony, performed upon the sick by many peoples, to extract the offending object. to discover the source of the evil, divination is employed. in many cases the native conception of the nature of the lesion associated with disease is very concrete. thus certain aus- tralian tribes look upon it as due to the abstraction of adrenal fat. in melanesia it is held that removal of part of the soul, due to spirits, is the cause of many symptoms. the treatment of disease by savage fe can only be understood in reference to their pathological theory. trephining —among the most remarkable of the forms of treat- ment is trephining, which was performed from a very early date with stone implements before the introduction of metals. a de- compressive trephining for epilepsy or other disorders of the brain, real or supposed, is still practised among the aymaras of bolivia and the guichuas of peru. the belicfs at the back of the process are still not clear, primitive surgery.—the surgical measures of uncivilised man are not always as inaclequate as might be supposed. some savage folk have developed more than a rudimentary idea of bone-setting. moss, fresh leaves, ashes or natural balsams are used to dress wounds, which, when poisoned, are treated by sucking or cautcrisation. among surgical instruments we note horns for cupping, a sharp thorn for opening an abscess, saws of stone and bone for amputations and spectal instruments for letting blood. the latter operation is very widely practised. medicine, pre-scientific the medicine man.—the position of the medicine man is doubtless very similar among savages of to-day to what it was with early races. he exhibits a gradual differentiation from the priest. in indonesia the medicine man is now quite distinct from the priest, but in polynesia and north america the relation- ship is often so close that the two may be indistinguishable. survivals.—the remains of the savage’s mode of treating disease survive with peculiar persistence even in centres of western civilisation. belief in magic and in the efficacy of charms still plays a considerable part in the attempted prevention and cure of many ailments in europe and america, ‘thus, for instance, the mountaineers of southwestern virginia and eastern tennessee believe that an iron ring, worn on the third finger of the left hand, will drive away rheumatism. this practice shows a persistence of the very anctent belief in magical proper- ties of the third finger and of iron. a modern english herb-doctor will peel the bark of an elm downwards if a cold has to be drawn down from the head, and peel it «pwerds if it has to be drawn up from the chest. warts are rubbed at regular intervals with a gold ring. the persistence of colour as a significant factor in folk- medicine is shown by the use of red flannel as a bandage for sore throats and whooping cough, a case of sympathetic connection between the redness of inflammation and the redness of material. finsen’s red-light treatment to prevent pitting in smallpox has been said to trace back to the same folk-custom, employed in the case of the son of edward ii. in ireland homeopathic doc- tors give for jaundice yellow medicines, such as saffron, turmeric, sulphur, even yellow soap. egyptian medicine.—of the pre-scientific systems of medicine of the ancient civilisations, the best known is that of egypt. ancient egyptian medical treatment, chiefly magical, included a large number of traditional practices which had survived from very early times. for long the art of healing was in the hands of the temple priests. these men formed an organised body with a sort of physician-in-chief at its head. they concentrated on hygiene and diet, advising abstention from many vegetable foods, especially beans and onions, the latter a supposed aphrodisiac which also provokes thirst and tears, from mutton and pork, from certain milks and from salt which produces drunkenness and gluttony. on three days out of every 30, emetics or clysters were to be taken. among hygienic measures, dwelling houses were to be kept clean and fumigated with resin and myrrh, the body was to be frequently bathed and suitably clothed and gymnastic exercises were recommended. oimtments, potions and poultices were in use. among drugs were honey, incense, salt, cedar oil, sycamore bark, nitre, sulphate of copper, alum, the brains, liver, heart and blood of various animals, stag’s horn and oil of camomile for frictions. fever patients were wrapped in woollen stuffs to promote perspiration. ebers papyrus—the ebers papyrus mentions a number of symptoms and diseases (some difficult to identify) such as intes- tinal worms, inflammation in the region of the anus, haemor- rhoids, disorders at the pit of the stomach, fluttering of the heart, pains in the head, urinary affections, dyspepsia, angina and about 30 different affections of the eyes. among the reme- dies are blood-letting, sudorifics, diuretics, drugs to produce sneezing, copper salts and oxymel of squills to produce vomiting, castor oil given in beer as an apericnt and pomegranate seeds for the expulsion of worms. edwin smith papyrus.——the edwin smith papyrus, not yet fully described, seems to suggest skill in surgery in advance of that of any of the contemporaries of ancient egypt. it suggests, too, rather more anatomical knowledge than kad hitherto been considered likely among the egyptians. statues of healing.—on the purely magical level were the statues of healing. these were placed in rectangular basins upon which texts and images were carved. the water that flowed through the basins acquired magical properties through contact with the statues and thus became curative for all reptile bites. the water, either taken internally or used as a lotion, was all-sufficient; it was even unnecessary to repeat the magic formulae carved on the garments of the statue or on the basins. medicine, pre-scientific these remedies were therefore more especially used by the illiterate. statues of horus on the crocodiles were the most widely-spread and most efficacious instruments of protection against and cure for the bites of scorpions, serpents and croc- odiles, their use probably going back beyond the xix dvynasty. coptic medicine.—during the last few years our knowledge of the meclicine of the copts has been considerably extended by the publication of a long and important text and bv several minor finds. the coptic material exhibits a rapid recession of the ancient egyptian element. coptic materia medica reveals unmistakable greek and arabic influences and magic is of secondary importance. the mouse, goat, wolf, hyaena, and other animals are all mentioned in prescriptions, but the greater num- ber of medicaments are of vegetable or mineral origin and include, as in all early writings, emetics and purgatives. eye- troubles were always rife in egypt. it is thus not remarkable that about half of the 237 prescriptions contained in the cairo papy- rus (c. oth century a.d.) deal with these conditions. for the majority of the ophthalmic remedies there is no indication of the condition for which they were applied. there are, however, 13 for cataract, 18 for dimness of vision, three each for abscesses and inflammation, 13 for trachoma and two for amauroses. among the skin and scalp affections prescribed for are melanoderma, herpes, itch and lichen. we read of remedies for abscesses, boils, sores, cuts and bites, ulcers, gangrene sores and swellings. cummin ground with moistened rue is taken for three days for fever. opium, calf’s fat and milk melted together and applied warm cures earache with such rapidity that the physician is advised to collect his feeinadvance! a mixture of red and yellow vitriol and alum is recommended for toothache. two formulae for the extraction of teeth are of interest, for though dental caries and alveolar abscesses have been found in mummies of the pharaonic period there is no evidence of the extraction of teeth at that early time. considerable knowledge of and skill in sur- gery may be gathered from a coptic surgical instrument case in the cairo museum, the space allotted for knives and scalpels showing that operations were no simple affair. mesopotamian medicine.—the civilisation of the valley of the euphrates and the tigris had reached an advanced degree of de- velopment about 4,000 b.c. babylonian medicine was purely empirical. it occupied, however, a less important rdele in the art of healing than magic. the liver was regarded as the central organ for the blood, the true life principle, which was divided into two kinds, blood of the day and blood of the night. disease was a demon that entered the body and must be expelled. the pharmacopoeia made use of mineral, vegetable and animal sub- stances. among remedial agents were honey and syrup of dates, herbs, blood-letting, use of cups for drawing blood to the surface of the body, cold shower and warm baths, clysters, various salves, friction with oil. an ointment composed of plants cooked in grease, or a decoction of copper-ore in beer, was used in cases of ophthalmia, a very common complaint in mesopotamia also. assyrian medicine—the more northern assyrian medicine had the same foundations and followed the same methods as the southern babylonian. therapy was exorcism and incantation was prophylaxis, although the accounts of surgical procedure in the code of hammurabi imply an elementary knowledge of anatomy. we gather hints, however, from the medical texts that the physicians of nineveh may have been less ignorant than has been supposed. some 250 vegetable drugs and 120 min- eral drugs were known, as well as 180 derived from other uniden- tified sources, making a total of 550. the names of these drugs occur many thousands of times in the medical texts. to the above must be added remedies consisting of various alcohols, fats, oils, honey, wax and various kinds of milk. among the names most frequently met with in the texts are: pine and fir turpentines, rose, cedar, darnel, marigold, heliotrope, asafoetida, tamarisk, liquidambar, storax, mustard, galbanum, henbane, lupin, myrrh, arnoglosson, castor oil plant, mint, tragacanth, fennel, cypress, nightshade, millet, poppy, fig, laurel, pome- granate, wheat flour and mandrake. the mandrake secms to have entered medical magic from babylonian sources. 863 persian medicine.—iranian medicine became laicised in zoroaster’s time when the ‘‘ mages’”’ were superseded by the physicians whose business was to restore health. it bears points of resemblance to ancient hebrew medicine which may be de- pendent on it. treatment of the sick consisted of incantations, vegetable drugs and the use of the knife. hygiene was one of zoroaster’s main preoccupations: ‘‘ a healthy man is a moral man,” indian medicine.—hindu conceptions concerning the causes of disease were very confused. the confusion may be the result of the mixed origin of indian pathology. the earlier indian physicians utilised the senses of taste and smell as well as inspec- tion, palpation and auscultation for purposes of diagnosis. hy- giene and «diet played an important part in the life of the people. the pharmacopoeia of india is very rich, the great majority of drugs belonging to the vegetable kingdom. charaka (pre-bud- dhistic period) knew of 500 plants that possessed remedial virtues, susruta mentions 760, of which cinnamon, pepper, cardamons, spices and sugar were native. he also gives lists of drugs classed according to their action into lists of cerebral sedatives, emetics, purgatives, anodynes, etc. diabetes mellitus was first described by indian physicians who noticed that flies and other insects were attracted to the urine of patients suffering from this malady. in surgery the ancient hindus were probably superior to any of their oriental neighbours. susruta mentions eight kinds of surgical operations. fourteen different kinds of surgical dress- ings were in use; cotton, woollen, linen and silk for bandages. special splints of withes of bamboo were employed in cases of fracture and dislocation. these were later adopted in the british army as the “ patent rattan cane splint.” it is regret- table that it continues impossible to assign dates to ancient indian medical documents with any degree of confidence. deteriorated remains of scientific medicine —it has become increasingly evident that the culture of many savage and semi- savage tribes is in fact little but decayed civilisation. this is particularly true in the department of medicine. researches, for instance, on anglo-saxon medicine have shown it to be little but the system of the classical peoples corrupted, deteriorated and misunderstood. in view of this ‘ derivative ’ character of much so-called ‘‘ primitive ’’ medicine, a reinvestigation of the medical customs of savage peoples 1s demanded. bibliography.—for general bibliography see k. sudhoff, kurzes tlandbuch der geschichte der medizin, 4th ed. (berlin 1922)... . for medicine of savage and semi-savage folk see w. h. r. rivers, medicine magic and religion (1924) and social organisation (1924); m. h6fler, dze volksmedizinische organotherapie (berlin 1922); and walter addison jayne, the healing gods of ancient civtlisations (1925); mare bloch, les rots thaumaturges (strasbourg 1925); s. seligmann, die zauberkraft des auges und das berufen (hamburg 1922); ‘“‘ ethnografische medeelignen over de dajaks,”’ bijdragen tot de taal, land en volkenkunder van nederiandsch-indie, and j. leite de vasconcellos, a. figa (oporto 1925)... . for egyp- tian medicine see edwin smith papyrus, in the proceedings of the society of medical history of chicago, vol. 3, p. 58 (jan. 1923). see also p. lacau, ‘‘ les statues guerisseuses dans l’ancienne e-gypte,”’ monuments et memotres publies par l’academie des inscriptions et belles-lettres, vol. 25, p. 189 (paris 1921). walter wreszinski has published der londoner medizinische papyrus und der papyrus hearst (leipzig 1912) and der papyrus eebers (leipzig 1913), all with tran- scription and translation. see w. m. flinders petrie, a mulets (1914), c. g. seligmann and m. a. murray in afan, vol. 11, p. 115 (1911), marc armand ruffer in his siudies an the paleopathology of egypt (1921), andg, eniot smith and w. r. dawson, mummies (1925). ... for coptic medicine sce e. chassinat’s un popes medical cople (paris 1921); also w. r. dawson, ‘‘ egyptian medicine under the copts,” proc. royal society of afedicine (l1istorical section), vol. 17 (1924) .... on assyrian medicine new investigations are an- nounced in r. campbell thompson, the assyrian herbal (1924) and assyrian medical texts (1923), translations in the proc. royal society of medicine (utistorical section), vol. 17, p. 1 (1924) and vol. 19, p. 29 (1926); also ludwig dennefeld in babylonisch-assyrische geburis- omina (leipzig 1914). ... the biblical system of medicine has been treated authoritatively by julius preuss, brblisch-talmudische medisin (berlin 1911). .see also james a. montgomery, aramuic incantation texts from nippur (1913). . . the history of indian medicine: valuable but quite uncritical collections are: kaviraj kunja-lal bhishag-ratna, dn fuglish translation of the sushruta sumhita, 3 vol. (calcutta 1907-16); girindra-natha mukhopad- 864 hyaya, the surgical instruments of the hindus (calcutta 1913); and c. chrakraverti, 4n interpretation of anctent indian medicine (calcutta 1923). . . . for greek pre-scientific medicine see charles singer, greek biology and greek medicine (1922); and m. n. tod, ‘recently discovered records of ancient cures,’’ proc. royal society of medicine (ilistorical section), vol. 15, p. 24 (1922). . . . an inter- esting oriental survival of greek rational medicine, so deteriorated as to resemble pre-scientific medicine, is contained in m. w. hilton- simpson, arab medicine and surgery, a study of the healing art in sligeria (1922). fe, a. wallis budge, syrian anatomy, pathology and therapeutics (1913), is in the main a syriac translation from the greek of galen’s de locis affectis. the last section, however, is a valuable collection of mesopotamian folk-medicine, much of which ts deteriorated greek medicine and some of which is greco-babylonian magic. see also the syriac book of protection, edited and translated by hermann gollancz, and the hebrew sepher amlaphteah sheiomo (book of the key of solomon) by the same author (1914)... . for sino-japanese medicine see k. y. fujikawa, geschichte der medizin in japan (yoky6 1911); eugene vincent, la afedecine en chine au n xe siecle (paris 1915); the series of valuable publications in ger- man issued by the royal japanese institute for infectious diseases from 1911 onward; e. v. cowdry, ‘‘taoist ideas of hfuman anat- omy,” annals of medical history, vol. 3, p. 301 (1921). for chinese medicine see h. a. giles, “‘ the hsi yuan lu or instructions for the coroner,” proc. royal society of medicine (itistorical section), vol. 17, p. 59. a work having implications with modern medicine is k. dohi, betirdge zur geschichte der syphilis . . . in ostasien (yoky6 1923). . . . for primitive medicine in western europe see anthropological publications, especially the journal folk/ore. so far as primitive medicine in great britain is concerned, the main publications are p. diverres, le plus ancien texte des meddygon myddvex (paris 1913), timothy lewis, a welsh leech book or lixfr o feddyginiaeth (1914), e. stanton roberts, liysieulyfr meddyginiaethol a briodolir + william salesbury (a herbal attributed to william salesbury) (1916), charles singer, early english magic and medicine (1920), and “ the lorica of gildas the briton (?547),”’ proc. royal soctety of medicine ({11s- torical section), vol. 12, p. 124 (1920), and herbert scheffler, be?- trieige zur mittelenglischen mediziniiteratur (halle 1919). f. ohrt, danmarks trylleformler (copenhagen 1917), texts in friedrich wil- helm’s denkmdler deutscher prosa des 11. und 12, jahrhunderts ‘munich torg4 and following years) and articles scattered through the pages of johannes hoops, reallexikon der germanischen alter- tumskunde (strassburg 1911-9) and the international dutch journal janus, the surviving gaelic mss. contain a surprising peeper ion of medical texts. by the publication of the catalogues of these mss. in the advocates library at edinburgh (1912), in the libraries of trinity college, dublin (1926), and in the british museum (1926), a new source of folk medicine has been tapped. (c38) medina (sce 18.64).— before the world war, medina was less known to europeans than mecca, although it was described by the earlier travellers, burckhardt and burton, and by wavell, who visited it in 1908. before the world war the normal resident population was estimated at 40,000, of whom a large proportion were aliens who had settled after pilgrimage. the turks de- ported about three-quarters of the inhabitants during the blockade, and, allowing for further decrease by disease, the population in 1920 was well under 10,000. much new information regarding existing conclitions in the city was obtained as a result of the war operations. the dimensions of the city were over- estimated by earlier writers, the walls actually measuring not more than 13 m. in circumference, with the longest diameter a little over $ m. east and west. the hejiz railway has its terminal station outside the city walls at the bab el ‘ambari, the gate on the southwest through which runs the road to yenbo’. there are normally three trains weekly from damascus, and the journey takes 53 days. during the war a branch was carried from the main line, through a breach in the walls on the northwest side, to the outskirts of the haram or great mosque, which was used as a munition store and was intended to serve as an inner citadel in case of siege. at the outbreak of the revolt in june 1916 the arabs, unable to take the city by assault, withdrew and began a blockade, which —as they were unwilling to bombard the city for fear of damage to the holy places and refused to cut the water supply conduit— lasted until the turks surrendered the city in jan. 1919. in 1917 fakhri pasha, commander of the garrison, devised a scheme for the rebuilding and modernisation of medina, but all that happened was the destruction of a great number of houses for the sake of the beams and woodwork to feed the railway loco- motives. extensive palm plantations outside the walls, east and northeast, were also ravaged for the same purpose. large palm medina—mediterranean sea gardens which formerly occupied much space within the walls were in great part built over, and the barrel manakha, or central open space, was encroached upon. sherif ali, son of king hu- sein, became emir of medina in 1925. in the later part of that year the city was invested by wahhabi troops.