Medical Advance, Public Health and Social Evolution

275 Pages·1965·4.498 MB·English

by  Charles Wilcocks, D. F. Bratchell and E. F. Candin (Auth.)

MEDICAL ADVANCE, PUBLIC
HEALTH AND SOCIAL
EVOLUTION
by
CHARLES WILCOCKS
C.M.G., M.D., F.R.C.P., D.T.M. AND H.
Formerly President, Royal Society of Tropical Medicine and Hygiene;
Tuberculosis Research Officer, Tanganyika; and
Director, Bureau of Hygiene and Tropical Diseases
PERGAMON PRESS
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Copyright © 1965 Pergamon Press Ltd.
First edition 1965
Library of Congress Catalog Card No. 65-25332
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Acknowledgements
I AM indebted to Mr. G. L. Watt for reading the typescript of
this book, and for a number of suggestions relating to its contents,
most of which I have incorporated. I am also indebted to Dr.
E. Ashworth Underwood, Formerly Director of the Wellcome
Historical Medical Museum, for all the illustrations, which he
has kindly looked out for me, and to Mr. L. M. Payne, Librarian
of the Royal College of Physicians, who has been of great help in
directing me to original sources. I must also acknowledge the
help of Mrs. Doris Hamilton, who has typed the book with her
customary skill and accuracy.
vi
CHAPTER 1
Introduction
THIS book is not a history of medicine; it is an attempt to relate
medical progress to the intellectual climate of the various broad
periods of history, and to the social changes which took place in
those periods and which influenced—and were influenced by—
medical progress. Many details of surgical and medical tech-
niques, therefore, which would have been appropriate for men-
tion in a history of medicine, have not been included here; they
would have been outside the main theme.
But although the book is not intended to be a history of medi-
cine, the intellectual developments and historical events which
have impinged upon medical progress have occurred in the
setting of history, and it has therefore been convenient to divide
the book into chapters with a historical basis.
The written history of man does not go very far back, and
although the inscriptions on old monuments of the Near East,
and the legends and poems of ancient India, Egypt, Israel and
Greece, are remarkably vivid accounts of what must have been
highly organized and civilized communities, they do not go as
far back as some of the remains of the artistic life of those remote
times, which suggest to us that man had reached a high degree
of corporate life and government long before he was able to
write its history.
These remains—the buildings, sculptures, and literature—·
show not only this organized social structure, but also a very
high quality of artistic merit which some people think has not
since been excelled. They also show a profound understanding
of human nature, of character and motive, and they demonstrate
I
2 MEDICAL ADVANCE, PUBLIC HEALTH AND SOCIAL EVOLUTION
the faculty of philosophical speculation on the origin and nature
of the universe, which has been the basis of all religions and which
continues to the present time. And in this speculation the peoples
of antiquity used rational argument based upon such observa-
tions of nature as they were able to make.
In some respects the observations of the ancients were remark-
ably exact. Without knowledge of the stresses which great
buildings would have to bear, and without precise measure-
ments of angles and distances, the ancient temples and pyramids
could not have been built. Such knowledge involves not only the
study of materials but also the comprehension of mathematical
and geometrical relationships, of a high order. It is one thing to
build a log cabin, but quite another to build a pyramid, a
Parthenon, or a Colosseum.
The fact of the high degree of organized society which existed
alongside these colossal achievements in building and sculpture
indicates that the agricultural structure on which all civilizations
rest must have been competent. Much of the literature of ancient
Israel, Greece and Rome shows that in such matters as the
exploitation of land for food, and of water for fish, the people of
antiquity had learned much from experience at first hand. They
had made their observations on the techniques of cultivation and
animal husbandry, and applied them with skill. The peasant
communities must have been efficient within their knowledge
and experience; they lived in a less crowded world than our own,
and did not therefore need to study so closely how to conserve
it, as we must do. But they did, in fact, use the general scientific
method of observation and experiment, trial and error, in their
work, and on the basis of this experience they built their customs
and theories. The fact that they supported great cities, with their
armies and industries, is proof of the high degree of competence
of these people, governors and governed alike.
The peasants must also have been competent in the handling
of domestic animals, to produce meat, milk and hides, and they
must have possessed much practical knowledge of the biological
processes of these animals. This was day-to-day knowledge
INTRODUCTION 3
obtained for the practical object of creating food, or breeding
for transport, and as such it had its value.
It seems, therefore, that in antiquity there was wide know-
ledge of natural phenomena and of the mathematics and geometry
necessary to the practical purposes of the construction of great
buildings, and there was much speculation on the universe and
the forces which govern it which led to the construction of vast
philosophical and religious systems. The point I wish to make
here is that biological observations important to medicine were
not so advanced. Explanations of life and disease based on religion
or traditional beliefs were enough to satisfy the curiosity of the
ancients on such matters. Disease might be a natural pheno-
menon—a part of life itself; but it was also bound up with the
wishes of the gods or the powers of evil-doers, with witchcraft
and the evil eye. Even accidents could be caused by super-
natural influences—the god, or the witch, would cause a man to
fall, or drown, or damage himself with a weapon, and, conversely,
when the suitors of Penelope cast their spears together at Odys-
seus, Athene turned them aside. The subject is developed further
in the chapter on Greek Life and Medicine. Trivial injuries may
or may not have been attributed to such causes—we do not
know; they must have been plentiful in farm life.
In particular, certain diseases of the nervous system such as
epilepsy or chorea (St. Vitus's dance), or of the mind such as the
many forms of what was formerly known as lunacy, were held
to be of satanic or divine origin. The epileptic was considered to be
possessed by devils (as in the Bible), and some forms of lunacy
were thought of as sacred diseases, the patient having been
singled out by a god, and therefore being regarded as, in some
way, privileged.
This attitude to disease is still held by many millions of people
in large areas of the world. It was, in fact, the attitude of most of
the illiterate people of Europe until quite recent times, the more
rational explanation of disease which is now current in educated
communities having grown very slowly from the ideas of a
few observers down the centuries. These ideas, until recent
4 MEDICAL ADVANCE, PUBLIC HEALTH AND SOCIAL EVOLUTION
centuries, were known only to the few, and even to them the
ideas were only gradually revealed as research went on, sporadi-
cally. It is only since the modern great spread of general education
that these natural explanations of biological phenomena have
become common knowledge. We should not, therefore, in the
West, feel too strongly any sense of intellectual superiority;
we are perhaps wiser than our ancestors because we know more
facts, but we know those facts because of the intellectual courage
and inventiveness of our forefathers, not because we are their
superiors in intelligence.
The corollary of this primitive magical explanation of disease
and injury was—and is—that both prevention and cure may be
attained by related procedures. If disease is due to the displeasure
of a god or the machinations of a witch, the obvious treatment is
to placate the god or circumvent the witch, and the obvious
prevention is to do the will of the god or confront the witch with
magic stronger than her own—or kill her. And these are the
beliefs and practices still current in large parts of the world. It is
necessary to remember that in our own advanced civilization
we have religious sects who believe that disease is nothing more
than error in a religious sense, and all Christians pray for the
protection and cure of the sick. Even in Britain there are still
people who believe in, and practise, the rites of magic.
The physicians of primitive societies therefore combined the
functions of physician, priest and magician, and in the Middle
Ages the care of the sick still largely rested in the hands of monks
and nuns, partly, no doubt, because of this ancient tradition of
the religious origin of disease, and partly because of the teaching
of the Christian Church concerning the healing of the sick.
We now have a truer conception of health and disease, and we
have found as a matter of experience that this conception has
proved most fruitful in enabling us to overcome the mass of
disease which killed so many of our forefathers. We should not
forget how immensely indebted we are to those great and often
isolated figures in the history of medicine who gradually worked
out the natural history of disease and enabled us to build up our
INTRODUCTION 5
rational techniques of cure and prevention on the basis of their
fundamental discoveries, which usually went so much against the
general opinions current in their times. Outstanding among these
pioneers of the methods of observation and deduction were the
Greeks, and in medicine and biology Hippocrates and Aristotle
overtopped the rest.
CHAPTER 2
Greek and Roman Life and Medicine :
Hippocrates, Aristotle, Galen, Celsus
GREEK LIFE
THE Greek poets, Homer (who lived and wrote probably about
the ninth or tenth century B.C.) and Hesiod (about 750-700
B.C.), describe a community with a high degree of civilization.
Organized city states existed, whose buildings remain to the
present time, and whose ships undertook extensive voyages.
The arts flourished, and articles of domestic metal work and
pottery show that there was a very high degree of technical skill
and craftsmanship. The fact that the great poems have come down
in such sophisticated and polished language is itself evidence of
the very advanced state of learning and social intercourse which
must have existed at that time.
But, as always, these arts were for the wealthy, and there
existed the mass of peasants on whom all such civilizations rest.
Hesiod describes the lives of these peasants, their ploughs and
hand implements, their houses, their food and drink, and their
dress of cloth and cured skins. The agricultural methods of the
Greeks, like those of all primitive people, were no doubt gradually
evolved as a result of hard experience, the best times for ploughing,
sowing and reaping, and the best methods of animal husbandry
being worked out by trial and error, and the knowledge thus
gained being handed down from generation to generation. In
most communities at that stage of development only this word-of-
mouth lore exists; it is a sign of the sophistication of the Greeks
that it came to be written down.
6
GREEK AND ROMAN LIFE AND MEDICINE 7
But with the Greeks, as with other peasant communities, this
faculty of learning by experience was modified by religious
beliefs, and no doubt there were prescribed rituals and sacrifices
appropriate for all the activities of the peasants, as there were for
the military commanders (for instance Xenophon, (pp.98, 231)
during his famous march) and for all who revered the
gods (for instance Socrates on the last day of his life, when he
asked Cri to to sacrifice a cock to Asclepius) (Plato, The Trial
and Death of Socrates, p. 212).
But the impression left by the Greeks is that there was a great
intellectual and artistic flowering of an intelligent and curious
aristocracy, based upon a peasantry perhaps in its own sphere
equally intelligent, yet bearing some of the characteristics of
peasants all over the world.
The Greek world was at least partly a slave world, domestic
servants were slave women, and slave men were the artisans and
factory workers (Glover, 1944). In the Peloponnesian war
20,000 slaves escaped from Athens, and it was common practice
to sell the surviving population of a captured city into slavery.
But slavery in Athens, though bad for master and slave, Cidoes
not show the horrors of Roman slavery, or of American. No
Negro slave in New York or New Orleans is known to have
inherited his master's widow along with a bank" (Glover, 1944,
pp. 126-7).
GREEK SOCIAL STRUCTURE
The social structure of Greece was that of the polis or city state.
The unit was comparatively small. In Sparta the city state was
governed by an aristocratic upper class of soldiers, who brought
up their children to be tough, hardy, uncomplaining and dis-
ciplined. Below them were the peasants, free men with certain
rights, who could serve in the army. At the bottom were the
helots, the slaves, owned by the state. Sparta remained a closed
society, its members did not tend to travel abroad, and it did not
welcome strangers.