After AD 400, the study and practice of medicine in the Western Roman Empire went into deep decline. Medical services were provided, especially for the poor, in the thousands of monastic hospitals that sprang up across Europe, but the care was rudimentary and mainly palliative. Most of the writings of Galen and Hippocrates were lost to the West, with the summaries and compendia of St. Isidore of Seville being the primary channel for transmitting Greek medical ideas. The Carolingian renaissance brought increased contact with Byzantium and a greater awareness of ancient medicine, but only with the twelfth-century renaissance and the new translations coming from Muslim and Jewish sources in Spain, and the fifteenth-century flood of resources after the fall of Constantinople did the West fully recover its acquaintance with classical antiquity.
When the medicine of ancient Egypt is examined, the picture becomes clearer. The first physician to emerge is Imhotep, chief minister to King Djoser in the 3rd millennium bce, who designed one of the earliest pyramids, the Step Pyramid at Ṣaqqārah, and who was later regarded as the Egyptian god of medicine and identified with the Greek god Asclepius. Surer knowledge comes from the study of Egyptian papyri, especially the Ebers papyrus and Edwin Smith papyrus discovered in the 19th century. The former is a list of remedies, with appropriate spells or incantations, while the latter is a surgical treatise on the treatment of wounds and other injuries.
Prize Citation: In “Digital Natives: How medical and Indigenous histories matter for Big Data,” Joanna Radin argues for critical engagement with “the metabolism of Big Data”. Radin presents the remarkable history of a dataset known as the Pima Indian Diabetes Dataset (PIDD), derived from research conducted with the Akimel O’odham Indigenous community in Arizona. Since the loss of their ability to farm the land, this community has an extremely high rate of diabetes. Reconstructing the circumstances of the dataset’s production and its presence in a Machine Learning repository where it is used in projects far removed from diabetes, Radin draws attention to the way that data is naturalised, and bodies and economic struggle are elided. Significant questions are raised about the ethics and politics of research in an age of Big Data, including the reproduction of patterns of settler colonialism in the research enterprise, and the community’s work to redefine the research encounter. The prize committee were impressed by Radin’s depth of research, quality of analysis, and the contribution to multiple literatures, and commend her for an inspired and inspiring article.
In the 19th and early 20th centuries anthropologists studied primitive societies. Among them treatment for injury and sickness was a mixture of common sense and magic. People knew, of course, that falls cause broken bones and fire causes burns. Animal bites or human weapons cause wounds. Primitive people had simple treatments for these things e.g. Australian Aborigines covered broken arms in clay, which hardened in the hot sun. Cuts were covered with fat or clay and bound up with animal skins or bark. However primitive people had no idea what caused illness. They assumed it was caused by evil spirits or magic performed by an enemy. The 'cure' was magic to drive out the evil spirit or break the enemies spell.
In 1478 a book by the Roman doctor Celsus was printed. (The printing press made all books including medical ones much cheaper). The book by Celsus quickly became a standard textbook. However in the early 16th century a man named Theophrastus von Hohenheim (1493-1541) called himself Paracelsus (meaning beyond or surpassing Celsus). He denounced all medical teaching not based on experiment and experience. However traditional ideas on medicine held sway for long afterwards.
According to the compendium of Charaka, the Charakasamhitā, health and disease are not predetermined and life may be prolonged by human effort. The compendium of Suśruta, the Suśrutasamhitā defines the purpose of medicine to cure the diseases of the sick, protect the healthy, and to prolong life. Both these ancient compendia include details of the examination, diagnosis, treatment, and prognosis of numerous ailments. The Suśrutasamhitā is notable for describing procedures on various forms of surgery, including rhinoplasty, the repair of torn ear lobes, perineal lithotomy, cataract surgery, and several other excisions and other surgical procedures. Most remarkable is Sushruta's penchant for scientific classification: His medical treatise consists of 184 chapters, 1,120 conditions are listed, including injuries and illnesses relating to aging and mental illness.
In 1953 Jonas Salk announced he had a vaccine for poliomyelitis. A vaccine for measles was discovered in 1963. Meanwhile surgery made great advances. The most difficult surgery was on the brain and the heart. Both of these developed rapidly in the 20th century. A Swede named Rune Elmqvist invented the first implantable pacemaker in 1958. The first heart transplant was performed in 1967 by Christiaan Barnard. The first artificial heart was installed in 1982. The first heart and lung transplant was performed in 1987.
James Maskell: Yeah, absolutely. And it’s cool as well. So in this summit, we have a doctor track as well as a patient track. And in the doctor track, we’re actually talking about some of the ways that this is actually being delivered. And there are ways to deliver functional medicine on insurance. We’re featuring the group visit model in one of the doctor-specific tracks. That’s been very successful at bringing people together, developing a community around groups of people with the same disease. They want accountability. They want support. They want to hear from other people that have the same issues as them. So that’s working and that’s going to be included in the functional center at Cleveland Clinic. And then also health coaches. They’re looking at using different providers together, so you can have higher-cost and lower-cost providers working together. So it’s really exciting. I feel like once we get more and more organizations doing it that are credible, people will work out how to get this done on insurance and how to do this at a bigger scale. The first thing is just the clinical acceptance that’s been a long time coming.
The Romans were also skilled engineers and they created a system of public health. The Romans noticed that people who lived near swamps often died of malaria. They did not know that mosquitoes in the swamps carried disease but they drained the swamps anyway. The Romans also knew that dirt encourages disease and they appreciated the importance of cleanliness. They built aqueducts to bring clean water into towns. They also knew that sewage encourages disease. The Romans built public lavatories in their towns. Streams running underneath them carried away sewage.
When I sold the practice to my partner he converted the practice to a membership model and has continued to be successful, but with less patients and staff. I am now taking over and expanding a new practice and have asked both the owners to read this as we are transitioning the practice from a limited scope practice to a Functional Medicine practice. I have also recommended this book to friends who are looking to enjoy medicine again and are considering getting into Functional Medicine. I would strongly recommend this book to anyone wanting to get a better understanding of what Functional Medicine is and how to transition into a practice that will enable them to help many people that are today stuck in the cycle of disease = medication. This is not alternative medicine, it is a continuum of the science-based approach that those of us trained in western medicine have grown up in. The difference is it gives you the tools to "go upstream" and help patients to achieve true wellness. Once you start helping people at this level the biggest problem is having too many patients wanting to see you.