Section G—Chairman's Address
The Impact of Science on an Ancient Art
Dept. Postgraduate Obstetrics and Gynaecology Univ. N.Z.
Medicine is an ancient art. Its practice can be traced back into the mists of antiquity and written reports of this art are as old as those recording the activities of man.
Abraham was once looked upon as a primitive figure silhouetted against the dawn of human history, but recent archeological research has revealed an advanced civilisation in his home town, Ur of the Chaldees, some 500 to 1,000 years before his birth.
Hammurabi, who is the author of the oldest known Code of Laws, is considered to be a contemporary of Abraham. The Code of Hammurabi includes legislation governing medical practice. For example, it states that “if the doctor shall treat a gentleman and shall open an abscess with a bronze knife and shall preserve the eye of the patient, he shall receive ten shekels of silver. If the patient is a slave, his master shall pay two shekels of silver.” Professor Blaiklock has estimated that ten shekels of silver represented the yearly return from 250 acres of rich farm land. Although medical practice in the days of Abraham was a well-paid profession. its ethical responsibilities were equally high. Nor could the physician in those days afford to take any risks in treating his patients, for Hammurabi's Code laid down that “if the doctor shall open an abscess with a bronze knife and shall kill the patient, or shall destroy the sight of the eye, his hands shall be cut off.” In the case of a slave, the penalty was less drastic—“he shall replace the slave with another slave.”
In subsequent centuries, medical practice in Babylonia appears to have degenerated, for Heroditus, writing about 430 B.C., describes the Babylonian custom of laying the sick in the street so that any passerby who may have suffered from a similar complaint, could proffer the patient advice. As no one was allowed to pass the sick man in silence, one wonders what the reaction of the patient must have been to the advice of such an innumerable number of amateur physicians, but this practice may not be so remotely removed from the consultations that occur every day in our modern age, over the back fence and around the social cup of tea.
Imhotep is looked upon as the father of Egyptian medicine and in later centuries the Egyptians held him in such high regard that he was deified as the God of Medicine, and later, the Greeks identified him with their own Aesculapius. Imhotep held a position in the Court of Pharaoh similar to that occupied by Joseph about a thousand years later.
While no record has been left of the medical activities of Imhotep, he is credited with being the architect and designer of the Step Pyramid of Sakkarah, a familiar sight to every tourist who ascends the Nile or visits Memphis.
Sekhetenanach might even compete with Imhotep for the distinction of being the oldest known physician, as he served one of the Pharaohs who lived
about 3,000 B.C. In his tomb he is depicted dressed in a leopard skin, and carrying two sceptres, while behind him stands his wife, her hand resting on his shoulder. Of Sekhetenanach it is briefly recorded that he “healed the King's nostrils”. The grateful king requested him to name his fee, and the Egyptian physician, with an eye possibly to ethical advertising, requested that a statue of the Pharaoh be fashioned in stone together with a record of the case, and that this monument be set up in a prominent position in the palace.
It is significant that as early as 1500 B.C. castor oil was used for medical purposes in Egypt. The Ebers Papyrus was discovered in a tomb of Thebes. It contains 110 pages of recipes and prescriptions with marginal notes indicating the transcribers' opinions of the various remedies. It had been copied from other work many centuries older and in the margin are notes such as “good, I have often used it” and “excellent remedy”.
Another medical work consists of the Edwin Smith Papyrus, discovered at the same time and place as the Ebers Papyrus, and is probably of slightly earlier date than the latter. It is a text book on the treatment of wounds and bruises and describes the treatment of fractures with splints. Its description of how to reduce a dislocated jaw would not be out of place in a modern text book of orthopaedics.
The Kahun Papyrus. written about 1850 B.C., is in a fragmentary condition, but appears to deal with the treatment of vaginal and uterine disease and is. in effect. the oldest known text book of gynaecology.
Without pausing to describe more modern figures such as Hippocrates, who was born in 460 B.C., and who is so well known that he requires no further description, it has been established that medicine is indeed an ancient art.
What, then, of the impact of science upon this ancient art? While it is true that the ancient Greek physicians observed and described systematically symptoms and signs, and so had legitimate claim to being medical scientists, they still described medicine as an art; an art that was starting to feel the impact of scientific methods as represented by the sound observation and logical reasoning of Hippocrates.
However, it was not until the fifteenth century that science really made an appreciable impact upon the art of medicine. The stimulus came from such great artists as Leonardo da Vinci, who desired more factual information concerning the human body. In order to gain first hand knowledge of the structure of the human frame he undertook dissection and compiled artistic but scientifically accurate illustrations and descriptions of his work. Other great artists who engaged in dissection were Michael Angelo, Raphael and Albrecht Dürer. A few years later Andreas Vesalius, the foremost anatomist of the Renaissance. was born in Brussels. This phase of the impact of science on the art was a descriptive one, which resulted in the discard of imperfect or inaccurate concepts of structure and laid the foundation for the later development of physiology as exemplified by the discovery of the circulation by Harvey. The notes of Harvey's first lecture, delivered in 1660, a week before the death of Shakespeare, contained the statement. “The movement of the blood is constantly in a circle and is brought about by the beat of the heart.”
It was another sixteen years before Antony van Leeuwenhock was born. He was a merchant of Delft who was able to devote his long life of ninety years to microscopic study, and was successful in obtaining a magnification
of 160 times, even with his primitive instruments. The influence of physics, later magnified many times, provided the means for the demonstration of bacteria and the discovery of the aetiological factors in infectious disease.
Medical science, having passed through first a descriptive and then an aetiological phase, took on the form of a physiological approach to the problems remaining in the art of medicine.
Although it was known that tuberculosis was due to a specific acid-fast bacillus, this knowledge did not explain why some succumbed to the ravages of this disease while others were apparently unaffected by it. It was not sufficient to know the aetiological factor; what was equally important was to have a physiological knowledge of the reaction of the host and his defence mechanisms. Physiology, however, is based upon chemistry and physics, as well as anatomy, and it was only after progress had been made in these associated sciences that techniques were developed for the elucidation of some of the functions of the human body.
More recent developments have been due to the design of better recording apparatus and this has been made possible by advances in electronic technology. Progress in biochemistry, which is a specialised form of physiology, has been made possible by exploiting the use of radio-active isotopes.
The art of medicine cannot be transformed into a true science until such time as the physiological approach has made a deeper and more extensive impact on clinical medicine, surgery, obstetrics and gynaecology, for it is only as the underlying mechanisms of the bodily functions are understood that a rational and scientific approach can be made to their correction when they become disarranged.