Ancient & Medieval Medicine: Crash Course History of Science #9

Summary

This script explores the evolution of medical knowledge from 400 BCE to 1300 CE, emphasizing the importance of understanding life and health across different cultures. It discusses traditional Chinese medicine's balance of yin and yang, Ayurveda's five elements and holistic approach, and the humoral theory of ancient Greece and Rome. The script also highlights key medical figures like Hippocrates, Galen, and Ibn Sina, whose works formed the basis of medieval medical education and practice, shaping the way people understood health and disease.

Takeaways

• 🌐 The exchange of ideas in astronomy, math, and engineering occurred across vast regions from Beijing to Delhi and Baghdad to Constantinople.
• 🔬 The history of medicine revolves around understanding life and validating medical knowledge, questioning the advice of doctors and the effects of certain foods.
• 📚 Viewing medicine as a field that has linearly progressed over time can overshadow the effectiveness of ancient and medieval practices that worked for millions.
• 📖 Ancient medical systems provided a framework for people to comprehend health and the body, emphasizing balance and harmony.
• 🌿 In Song Dynasty China, traditional Chinese medicine (TCM) was based on the Five Elements theory and the balance of yin and yang, with treatments like acupuncture and herbal therapies.
• 📚 In Gupta Dynasty India, Ayurveda was the prevalent system, with the Charaka Samhita as a key text, focusing on eight medical specialties and the use of plants, minerals, and animals in treatments.
• 🏛️ In 14th-century Bologna, Italy, medical education was influenced by Aristotelian biology and physics, with the four humors theory being central to understanding health and disease.
• 📝 The Hippocratic corpus, despite its uncertain authorship, laid the foundation for Western medicine with its emphasis on observation, reason, and the avoidance of harm.
• 🤔 Galen's extensive writings and observations, despite some inaccuracies due to the legal restrictions on human dissection, became the standard in humoral medicine for centuries.
• 🌏 After Galen, the medical landscape was significantly influenced by scholars from the Islamic Golden Age, such as Abū Bakr al-Rāzī, who challenged existing theories and contributed to various medical disciplines.
• 📚 The Canon of Medicine by Ibn Sina, or Avicenna, became a comprehensive medical textbook that synthesized knowledge from Greek, Roman, and Persian medical traditions.

Q & A

What is the significance of the period from 400 BCE to CE 1300 in the history of medicine?

This period is significant because it marks a time when ideas in astronomy, math, and engineering, including medicine, were exchanged across various cultures from Beijing to Delhi, and from Baghdad to Constantinople.

What are the two big questions that the history of medicine addresses?

The history of medicine addresses two big questions: 'What is life?' and 'How do we know what we know?'

Why is it important to understand ancient and medieval medicine in addition to modern medicine?

Understanding ancient and medieval medicine is important because it allows us to see what worked in the past and how early medical systems helped people make sense of their bodies and health.

What is the role of the five elements in Traditional Chinese Medicine (TCM)?

In TCM, the five elements—fire, earth, metal, water, and wood—represent the composition of all things within the Entire Dang Universe, and health is maintained by balancing the forces of yin and yang.

How does Ayurveda, the Indian system of medicine, approach the treatment of diseases?

Ayurveda teaches that diseases are caused by imbalances and recommends treatments that include the use of plants, minerals, and animals, as well as practices like the five karmas for toxin removal.

What is the humoral theory of medicine as taught in medieval European universities?

The humoral theory, based on Aristotelian biology and physics, posits that the body is composed of four humors corresponding to the four elements, and illness is an imbalance in these humors.

Who is Hippocrates and what is his contribution to medicine?

Hippocrates of Cos is considered one of the founders of Western medicine. He emphasized reason, observation, and medical prediction over the direct will of the gods, and his oath 'do no harm' still underpins medical ethics.

How did Galen influence the practice of medicine?

Galen, a Roman physician, popularized the humoral system of medicine and made significant contributions to anatomy and surgery. His work became the standard in medicine until the 1800s.

What is the significance of Abū Bakr al-Rāzī in the history of medicine?

Al-Rāzī was a Persian polymath who contributed to various disciplines, including psychology and ophthalmology. He was one of the first to describe smallpox and measles as distinct diseases and challenged Galen's claims with his own observations.

What is the 'Canon of Medicine' and who wrote it?

The 'Canon of Medicine' is a comprehensive medical encyclopedia written by Ibn Sina, also known as Avicenna. It summarized and commented on Greco-Roman medical knowledge and became a foundational text for centuries.

Why is the Trotula Ensemble significant in the history of medicine?

The Trotula Ensemble, authored by Trota of Salerno, is significant because it is one of the earliest known texts on gynecology and women's health, and it was written by a woman, which was rare for the time.

Outlines

00:00

🌐 Global Exchange of Medical Knowledge

This paragraph discusses the historical exchange of medical knowledge from 400 BCE to 1300 CE, highlighting the global reach of ideas in astronomy, math, and engineering. It introduces the concept of medicine as both a science and a world-ordering theory, emphasizing the importance of understanding the past to appreciate the present. The paragraph also touches on the evolution of medical systems, such as traditional Chinese medicine (TCM) with its focus on the balance of yin and yang, and Ayurveda from Gupta Dynasty India, which includes a five-element theory and a comprehensive approach to health and disease. The narrative sets the stage for exploring the history of medical education and the textbooks that would be studied in different historical and geographical contexts.

05:04

📚 Medical Education and Textual Traditions

The second paragraph delves into the specifics of medical education and the textbooks that were used in different historical periods. It contrasts the machine-printed textbooks on traditional Chinese medicine during the Song Dynasty with the hand-copied texts used in medieval Bologna, which were based on Aristotelian biology and physics. The paragraph also discusses the influence of Hippocrates and Galen on medical theory, with Hippocrates emphasizing reason and observation, and Galen popularizing humorism. The narrative then shifts to the contributions of Persian polymath Abū Bakr al-Rāzī, who challenged Galen's claims and synthesized Greek and Indian medical knowledge. The paragraph concludes with a look at the Scholasticism approach to learning, where medical students engaged with a variety of texts and the ideas of past scholars.

10:05

📖 The Canon of Medicine and Women's Health

The final paragraph focuses on the 'Canon of Medicine' by Ibn Sina, a Persian polymath whose work became a cornerstone of medical education for six centuries. It describes the layered nature of the 'Canon,' which includes core ideas from Aristotle, Hippocrates, and Galen, surrounded by annotations from various physicians. The paragraph also introduces Trota of Salerno, a female physician whose work on women's health, 'The Trotula Ensemble,' was foundational but whose contributions were historically overlooked. The narrative concludes with a reflection on the understanding of life and health in the context of the elements and fluids, and the reliance on books as authoritative sources of medical knowledge, setting the stage for the challenges faced during the Black Plague of 1347.

Keywords

💡Astronomy

Astronomy is the scientific study of celestial objects, space, and the physical universe as a whole. In the context of the video, astronomy is part of the broader exploration of how knowledge has evolved over time, indicating the historical exchange of ideas from different cultures and regions, which is a key theme of the video.

💡Mathematics

Mathematics, often简称 as math, is the study of numbers, quantities, and shapes. It plays a crucial role in the video as one of the foundational sciences that have been traded and developed across cultures, illustrating the historical progress and exchange of mathematical ideas from ancient times to the medieval period.

💡Engineering

Engineering is the application of scientific and mathematical principles to practical problems. In the video, engineering is highlighted as a discipline that has seen significant development and exchange of ideas from various parts of the world, showcasing the practical applications of knowledge throughout history.

💡Healing

Healing refers to the process of restoring health or curing diseases. The video focuses on the history of medicine as a form of healing, exploring how different cultures and time periods have understood and approached health and illness, which is central to the video's narrative on the evolution of medical knowledge.

💡Life

In the video, 'life' is a philosophical and scientific concept that the history of medicine seeks to understand. It is presented as a complex and fragile phenomenon that has been interpreted differently across cultures and times, with medicine aiming to explain and support life through various theories and practices.

💡Medical Systems

Medical systems refer to the organized methods and theories by which health and disease are understood and treated. The video discusses various medical systems such as Traditional Chinese Medicine (TCM) and Ayurveda, emphasizing how they provide a framework for understanding health and offering treatments, which is essential to the video's exploration of medical history.

💡Textual Tradition

A textual tradition is the practice of recording knowledge in written form and passing it down through generations. The video mentions that medical knowledge was built into a textual tradition, where doctors wrote down their observations and cited earlier works, indicating the importance of written records in the development and transmission of medical knowledge.

💡Ayurveda

Ayurveda is a traditional Indian system of medicine that emphasizes the balance of body, mind, and spirit. In the video, Ayurveda is used as an example of an ancient medical system that includes detailed anatomical knowledge, theories of disease causation, and a holistic approach to health, illustrating the depth of early medical understanding.

💡Hippocrates

Hippocrates was an ancient Greek physician who is often referred to as the 'Father of Medicine.' The video discusses his contributions to medicine, including the Hippocratic Corpus, a collection of texts that influenced Western medical thought. Hippocrates' emphasis on observation, reason, and the environment's role in health is highlighted, showing his impact on the development of medical practice.

💡Galen

Galen was a prominent Roman-era physician whose works had a significant influence on medieval and Renaissance medicine. The video notes Galen's popularity and his synthesis of Hippocratic and Aristotelian ideas, as well as his own anatomical observations, which were foundational to the humoral theory of medicine that dominated for centuries.

💡Humoral Theory

The humoral theory is a concept in medicine that suggests health is a result of a balance among four bodily fluids (humors): blood, phlegm, black bile, and yellow bile. The video explains how this theory was central to medieval European medicine, with treatments aimed at restoring balance to these humors, reflecting the video's theme of understanding health through historical medical paradigms.

Highlights

Ideas in astronomy, math, and engineering were exchanged from Beijing to Constantinople between 400 BCE and 1300 CE.

The history of medicine revolves around understanding life and the credibility of medical knowledge.

Medicine is often seen as a science that has progressed over time, but this overlooks the effectiveness of ancient and medieval practices.

Early medical systems provided a framework for understanding health and the human body.

Medical knowledge was developed into a textual tradition where doctors cited earlier works.

In Song Dynasty China, medical students studied traditional Chinese medicine, focusing on the balance of yin and yang.

Gupta Dynasty India's medical education was based on the five elements and the science of life, Ayurveda.

Ayurveda includes eight specialties and emphasizes the use of plants, minerals, and animals in treatment.

Fourteenth-century Bologna's medical education was based on Aristotelian biology and the four humors theory.

Hippocrates of Cos is known for his emphasis on reason, observation, and the influence of diet and environment on health.

Galen, a Roman physician, popularized humorism and made significant contributions to anatomy and surgery.

Abū Bakr al-Rāzī challenged Galen's claims and contributed to the founding of several medical disciplines.

Ibn Sina's 'The Canon of Medicine' became a central medical textbook for six centuries, synthesizing Greco-Roman knowledge.

Trota of Salerno's 'The Trotula Ensemble' was foundational to gynecology and women's health in medieval Europe.

Medical education in medieval times often involved studying encyclopedias that compiled knowledge from various sources.

The concept of 'life' in ancient and medieval medicine was linked to the balance of fluids and elements within the body.

Medical knowledge was validated through the authority of books and the consensus of learned physicians.

Transcripts

We’ve seen how, from around 400 BCE to CE 1300, ideas in astronomy, math, and engineering

were traded all the way from Beijing to Delhi, and from Baghdad to Constantinople.

In the next episodes, we’re going to dive into how some specific kinds of knowledge

evolved over time.

First up: healing.

The history of medicine is about two of our big questions: one, what is life?

What makes it so special, so fragile, so… goopy!?

Two, how do we know what we know?

Why should I take my doctor’s advice?

Why are deep-fried Oreos bad for me?

It may be tempting to look at medicine as a science that has simply progressed over

time—that medicine used to be bad, and its history is a story of how it got better.

And don’t get me wrong: we love modern medicine!

You’ll have to take my word for it until “Crash Course: Deep-Fried Everything”

drops, but the science behind lipid transport is just fascinating.

Focusing on progress, though, obscures what worked in the past.

Ancient and medieval medicine worked for millions of people.

They understood their bodies as bounded by rules.

And regardless of what worked, early medical systems allowed people to make sense of bodies

and health.

You may think that medicine is a technē, or practically oriented knowledge.

But today, we’re going to focus on systems of medicine as world-ordering theories, or

epistēmē.

These theories were built up into a textual tradition, in which doctors wrote down what

they saw and cited earlier doctors when explaining their treatments.

So let’s turn to medical education.

What textbooks would a would-be doctor read in a given place and time?

[Intro Music Plays]

Let’s say you lived in Song Dynasty China: you’d study machine-printed textbooks on

traditional Chinese medicine, or TCM.

In this system, humans are small pieces of one vast organism called the Entire Dang Universe.

All things within this system are composed of five elements: fire, earth, metal, water,

and wood.

In TCM, health means a balance between two forces, yin and yang, representing dark and

light, femininity and masculinity, hot and cold, and so on.

Disease means imbalance.

Thus healthcare means restoring balance, in TCM, by manipulating the energy that flows

through living bodies, called qi.

You, the would-be doc, would learn all about how to move qi around using acupuncture and

acupressure, herbal therapies, exercise, and prescription diets.

If you lived in Gupta Dynasty India, you’d also get down with a five-element theory of

matter.

But you would study the science of life, Ayurveda.

You’d probably pick up the popular textbook Charaka Samhita, or one of the other samhita—or

“collections”—that could help you memorize hundreds of named body parts.

In addition to anatomy, the samhitas would also teach you etiology, or what causes different

diseases, and symptomatology, or what diseases look like.

When it came to treatment, your samhita would have information on the eight specialites:

the diseases of children, those of the elderly, mental diseases, diseases of the sense organs,

surgery, poisons and antidotes, and aphrodisiacs.

You would learn the five karmas or actions that were used for removal of toxins from

body tissues.

And, to prepare treatments, you’d learn a lot about plants, minerals, and animals.

But treating patients is only part of Ayurveda.

The science of life concerns healthful living in general, including how to prevent disease

and influence hygiene and diet.

What if you lived in, say, fourteenth-century Bologna, Italy—home to one of the oldest

universities in the world, which opened in CE 1088!

You would attend lectures, and you’d have a hand-copied textbook, not made by a press

as in Song China.

The medical theories in your textbook would be founded on Aristotelian biology and physics.

Bodies are composed of four special bodily humors.

Each of these corresponds to one of the four elements of Empedocles: blood, made of air,

phlegm, made of water, yellow bile, made of fire, and black bile, made of earth.

Illness is an imbalance in the humors.

Too much black bile, for example, causes depression.

Treatment means restoring the right humoral balance—like, with bloodletting.

When too much of one humor built up in the body, one way to restore a balance was to

let some of the excess drain off.

But the most common treatment, then as now, was simply offering good dietary advice.

Aristotle linked the four elements with the humors, but he wasn’t a doctor.

The oldest nuggets of humoral wisdom in Western Eurasian medical textbooks were attributed

to a physician named Hippocrates of Cos, which means “Gregory House” in classical Greek.

We know something of his life—he died when Aristotle was in his teens—but we don’t

have many surviving works by him.

What we do have is a collection of texts of various age and unknown authorship called

the Hippocratic corpus.

According to the corpus, Hippocrates I was a fan of the Pythagoreans.

(Remember, the secret math cult?)

But his skepticism—or doubt that certain knowledge is possible—set Hippocratic medicine

apart from a lot of Greek natural philosophy.

Hippocrates emphasized reason, observation, and medical prediction.

He emphasized that diet and the environment influence health, not the direct will of the

gods.

And his oath—“do no harm”—still underpins medical education.

Hippocrates was the Jimi Hendrix of Eurasian and North African medicine, innovating a new

style that challenged traditional ideas.

But Hippocratic physicians had to compete among many schools of healers.

It was a Roman named Galen who became medicine’s Michael Jackson—the popularizer of a standard

humorism that would last until the 1800s.

Galen’s system absorbed the smaller, uneven Hippocratic corpus.

Galen was born around CE 130 in Pergamon.

But he made his career in Rome, treating gladiators.

This gave him lots of experience peeking into the body while sewing up wounds.

Eventually he got the offer of a lifetime: court physician to Emperor Marcus Aurelius,

who was a battle-hardened general, Stoic philosopher, and all-around hardcore dude.

Galen wrote a huge number of influential texts—supposedly five hundred!

Though only eighty-three survive today.

These show that Galen built on the systems of Hippocrates and Aristotle, but also made

detailed notes on human anatomy drawn from experience.

He accurately observed how the larynx works and demonstrated the the lungs fill up with

air.

Oh ya, and he innovated cataract surgery.

But Galen definitely got some things wrong.

One reason is that human dissection was illegal in imperial Rome and the states that succeeded

it.

So a lot of anatomy was still guesswork based on observations of animals.

For example, dissecting sheep heads, Galen identified a circulatory organ called a rete

mirabile or “wonderful net” that is found in animals like sheep and dolphins… but

doesn’t actually exist in humans.

After Galen, the most notable medical theorists in the Greater Mediterranean weren’t Greeks

or Romans, but Arabs or Persians who had access to both Greek and Indian sciences.

First among was the Persian polymath Abū Bakr al-Rāzī —whose name also means “Gregory

House.”

Born in CE 854, al-Rāzī was prolific: he wrote dozens of books, including detailed

accounts of his cases.

He is considered by many historians to be one of the founders of several disciplines,

from psychology to opthamology.

And he was the first to describe smallpox and measles as distinct diseases.

Al-Rāzī also wrote for general audiences, educating them about health and disease.

Many of his works were encyclopedias based on Greek humoral medicine and natural philosophy.

His big one, al-Hawi al-Kabir or The Virtuous Life, was a large, influential medical encyclopedia.

Al-Rāzī was a unique dude who did exactly what he wanted.

Although he was one of the most scientific doctors of his time, he also wrote works of

Islamic prophetic medicine, al-tibb al-nabawi.

This discipline, an alternative to the Hippocratic–Galenic system, advocated traditional medical practices

mentioned in the Qur’an.

Al-Rāzī also influenced medicine by becoming the first fan of Greco-Roman humoral medicine

to beef with Galen!

He wrote a book called Shukuk ‘ala alinusor—Doubts About Galen—in which he said that his own

observations contradicted some of Galen’s claims.

Remember nullius in verba—“on the word of no one”—the motto of the Royal Society

of London, founded in 1660?

Al-Rāzī advocated this approach to medicine circa the year 900, over seven hundred years

earlier!

But, if you were really a medieval Italian medical student, the book you’d read probably

wouldn’t be by Hippocrates, Galen, or al-Rāzī.

Instead, you’d read a translated encyclopedia featuring all of them.

In doing so, you’d participate in the scientific wonder called Scholasticism—or learning

through close readings of approved texts that recorded the observations and theories of

earlier thinkers.

Take it away, Thought Bubble!

One of the all-time greatest hits of medical education was al-Qānūn fī al-Ṭibb, or

The Canon of Medicine.

The Canon was written by another Persian polymath, Ibn Sina, born in 980.

Ibn Sina was widely seen as the best writer to summarize and comment on the Greco-Roman

doctors.

His Canon became one of the most important medical textbooks—and introductions to Aristotle’s

physics—for six hundred years.

Your textbook is really a mashup of several different books.

Each page is like an onion: at its heart, one punctum or big idea by Aristotle, or Hippocrates

or Galen.

These are surrounded by layer upon layer of annotatio, or notes, by famous physicians

from distant cities such as Baghdad.

Your main throughline are the summaries by Ibn-Sina, whose name has been latinized as

“Avicenna”.

But there are notes by Latin translators such as Gerard de Cremona or Constantinus Africanus,

plus outer layers of notes by other medical students.

Maybe you even jot down your own.

Thus—way before WebMD—you’re in conversation with doctors from all across space!

And time!

In universities such as Bologna or Salerno, you might also have access to another textbook,

this one by… wait for it… a lady!

Trota of Salerno wrote Practical Medicine According to Trota and Treatments of Women,

one of books of the The Trotula Ensemble.

This group of three texts from around 1200 traveled widely throughout medieval Europe.

The Trotula became foundational to gynecology and all other topics related to women’s

health.

But you might not know that this foundational text on women’s health was written by a

woman, because her identity was systematically written out of history until the late twentieth

century.

Because of course it was.

Thanks Thought Bubble!

So what was “life” for many educated people in Asia and North Africa between roughly 400

BCE to CE 1300?

Life was a universal property of which humans were just interesting examples.

Life was linked to the movements of special fluids, which were the objects of medical

treatments.

Life was ultimately built out of a smaller number of elements, and good health meant

balancing fluids and elements in the right way.

How did we know what life is?

For some physicians in classical Greece or imperial Rome, careful observation and comparison

to animals were crucial methods.

Persian doctors, influenced by both Greek and Indian ideas, synthesized earlier ideas,

expanded evidence for them, and challenged and reworked them.

Why did you, medieval citizen, trust this information?

Because books told you to!

And with that, dear student, we leave you to deal with… the Black Plague of 1347.

Bummer!

Next time—we’ll deep-dive into the eternal question of “what is stuff” with a group

of thinkers who tried to “science” lead into gold—the alchemists.

Crash Course History of Science is filmed in the Dr. Cheryl C. Kinney studio in Missoula,

Montana and it’s made with the help of all this nice people and our animation team is

Thought Cafe.

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