The Asclepion
Prof. Nancy Demand, Indiana University
- Bloomington
Introduction to the Study of Ancient
Medicine
Ancient Medicine Viewed in Terms
of the Health Care System
The first tendency of many of us is to
view the diagnoses and treatments of ancient medicine as weird
and outlandish, clearly a product of ignorance and superstition,
although with an occasional lucky discovery that actually "worked."
Evaluation is based upon the standards of western scientific
medicine (biomedicine): what resembles the diagnoses and treatments
of biomedicine, or seems to be on the road to these, is considered
"rational," perhaps even "scientific," while
those ideas and practices that do not fit this pattern are labeled
"superstition" or "sorcery," and de-emphasized.
To some extent, this is the approach of Guido Majno, whose book,
The Healing Hand, provides the basic text of this course.
Majno presents sketches of ancient surgery and medicine, and
includes fascinating information about the healing properties
of many ancient wound drugs as tested by the methods of biomedicine.
But the selective singling out of biomedically acceptable elements
misses seeing the total healing activities of a culture (including
the aspects that we classify as "superstitious" or
"magical") as an interconnected system, a health care
system. by searching out as many aspects as possible of a particular
health care system, we can gain valuable insights into that culture
as a whole.
The health-care-system approach has been
applied to modern cultures and to the problems of intercultural
diagnosis and treatment in an especially clear and interesting
fashion in a number of books and articles by Harvard's Arthur
Kleinman, especially Patients and healers in the context of
culture. An exploration of the borderland between anthropology,
medicine, and psychiatry, Berkeley: University of California
Press, 1980. Kleinman describes the health care system as "a
local cultural system composed of three overlapping parts: the
popular, the professional, and folk sectors."(50)
1. The
popular sector is"[the lay, non-professional, non-specialist,
popular culture arena in which illness is first defined and health
care activities initiated." (50) Seventy to ninety percent
of illness episodes are managed in the popular sector. Included
in the popular sector are "perceiving and experiencing symptoms;
labeling and valuating the disease; sanctioning a particular
kind of sick role (acute, chronic, impaired, medical, or psychiatric,
etc.); deciding what to do and engaging in specific health care-seeking
behavior; applying treatment and evaluating the effect of self-treatment
and therapy obtained from other sectors of the health care system.
The sick person and his family utilize beliefs and values about
illness that are part of the cognitive structure of the popular
culture." (52)
2. The
professional sector is composed of the organized healing professions,
those sanctioned as such by the culture.
3. The
folk sector is the non-professional, non-bureaucratic, specialist
sector, encompassing both sacred and secular healers: folk healers,
shamans, folk psychotherapists (in our culture, their "treatment"
is widely disseminated by television and in popular self-help
books).
Another important concept in Kleinman's
scheme is that of Explanatory Models of illness. An Explanatory
Model (EM) is the explanation a person gives for a sickness episode;
this is especially important because people in the various sectors
tend to have different, and sometimes conflicting, EMs. For example,
I may believe that I caught flu from getting my feet wet, while
my doctor blames a virus and the multiexposures characteristic
of the classroom; one of my students may think that it is just
compensation for my giving him a low grade, and another may suggest
that a visit to a church healing ceremony would help. In today's
medical practice, understanding the difficulties of communication
and finding ways to overcome them are the most important effects
of a recognition of the concept of EMs; for the historian, the
differences in such models provide useful characterizations of
particular medical systems (the Mesopotamians blamed the gods,
the Hippocratic doctors an infalance of humors, while the ancient
Chinese were concerned about the flow of Ch'i).
Types of Evidence
Our knowledge about disease
and medicine in past cultures come primarily from the study of
textual sources, artistic representations, and human remains.
Of the three, skeletal remains and extant soft tissue, the study
of which is called paleopathology, is arguably the most revealing
about past cultures, and most certainly in preliterate societies.
Both written and artistic sources incorporate the biases of the
authors or artists. Certain aspects of disease may be selectively
represented while others are neglected. Human remains provide
relatively concrete evidence that a disease process has occurred.
This does not mean that paleopathological analysis rarely provokes
debate or disagreement, quite the contrary. It is important that
pseudopathology and the evidence of disease itself be separated
before any conclusions are made. Skeletal material removed from
an archaeological context can exhibit convincingly obvious pathologies,
but are revealed to be the result of rodents activity, insect
infestation, or roots when subjected to more intensive analysis.
The difference between the study of human remains and other sources
lies in the fact that paleopathological evidence has not been
preselected as is the case of both textual information and artistic
representations An excellent example for the use of paleopathology
is the study of trauma.
Like all rigid materials, bone will break
when sufficient force is applied to it. The exact distribution
of skeletal trauma throughout the body, as well as the overall
frequency of trauma in a given population, provides indication
of cause. Evidence of trauma to the skull as well as the middle
of the radius and ulna (forearm) is characteristic of personal
violence. On the other hand, damage to the femur (upper leg),
the tibia and fibula (lower leg), and carpals (wrist) is usually
indicative of accidental injury.
Despite the pivotal nature of paleopathology,
both literary and artistic sources provide invaluable information
as to the state of health and disease within a given society.
Textual evidence such as the Homeric writings and Egyptian medical
papyri provide useful information concerning medicine, cultural
values regarding disease and medical treatment, as well as patterns
of disease.
