Occupational Medicine

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Thanks to the emergence of writing about medicine ancient Mesopotamia we know much more, than about priests prehistoric civilizations. Cuneiform clay tablets brought to us information about both the healers and the medicines they used, including methods of manufacture and prescriptions for use. It is in Mesopotamia that the first division of the ancient profession known to us is planned into two: the priests who exorcised evil spirits were engaged in health, and the doctors – manufacturers of drugs. But the line between the two types of medicine was blurred: treatment was always accompanied by prayers that were supposed to give the drugs strength.

Medicines were prepared from plants and minerals, and despite many different formulations, almost all of them were useless. The exceptions were two herbal painkillers: opium and cannabis – the first and for a long time the only real medicines of mankind. In addition, the inhabitants of Babylon actively used animal excrement: their stench forced evil spirits to leave the body of the patient. It was the banishment of evil from the patient that was given the main role, drugs were considered only a way to temporarily relieve suffering. Therefore, the diagnosis was reduced to finding out which of the many evil spirits settled in the patient and which of the angry gods caused the disease.

Even more, thanks to the numerous papyri, we know about the medicine of Ancient Egypt. In this civilization, medicine for the first time stood out in a separate area that is not part of the religious system. Treatment was not performed by priests, but by doctors – Sunu [13]. They used an extensive Pharmacopoeia [14] – more than 700 drugs, the vast majority of which had no effect. Nevertheless, we are aware of attempts to treat inflamed wounds with moldy bread. Thus, the Egyptians may have been the first to unknowingly use a mold-produced antibiotic. Like the Babylonians, the Egyptians used cannabis and other herbal painkillers. They were aware of the deadly danger of overdosing on opium and certain other substances, so their prescriptions contained precise dosages for the first time in history.

Although medication could be accompanied by spells, and diseases could be explained by possession by evil spirits, it was the Egyptians who made the first attempt to treat diseases without the involvement of supernatural forces, based on their understanding of the human structure. Making mummies, they often opened the body and well studied the anatomy of humans and animals. However, such an autopsy gave information only about the appearance and location of the organs, so the idea of their functions was erroneous. Thus, the brain is considered secondary authority, whose role was limited to secretion of mucus to moisten the nose (in other words, the production of snot), and the role of store consciousness took heart. Therefore, during mummification, the heart was extracted and carefully stored in a separate vessel, and the brain was bailed out through the nose and thrown away.

The ancient Egyptians believed that through the body passes a system of interconnected channels metu, carrying air, water and nutrients, and to the metu referred and blood vessels, and tendons, and nerves. Traditional wishes of good health was “let your meta will be fine.” Cause of disease was considered to be the formation of putrefactive substances weed that appeared in the feces for undigested food. If, accumulating, uidu reached critical concentration, it could rise through the system of channels in the heart. Therefore, the treatment was aimed at removing uidu from the body, which used drugs that can, according to doctors, move through the channels. They were made from plants, different parts of animals, their excrement, urine, milk or eggs.

In the selection of drugs, the doctor often relied on the principles already familiar to us. For example, to increase libido women appointed by the saliva of the horse. And to make the leg more mobile, it was wrapped in the skin of a deer or other fast animal. To slow the growth of hair, shaved head rubbed smooth crushed worms.

To remove putrefactive weed toxin from the body used laxatives and diuretics. And paradoxical way for us and treated laxatives constipation, and diarrhea. This was absolutely logical from the point of view of the ancient Egyptian doctors: both conditions were caused by an excess of uidu, which had to be eliminated. Much attention was paid to prevention: healthy people were prescribed three days of each month to take emetic and laxative. Enemas were very popular. Quoted by Pliny the legend says that the Egyptians taught The God himself: going down in the image of an IBIS on the ground, he filled his curved beak with water and cleaned myself the intestine. Another consequence of the ancient Egyptian models of diseases – the disproportionate attention that the doctors get paid the anus. Eighty-two of the recipes that have come down to us describe ways to treat various ailments by cooling, softening, fumigating, and preventing the sticking and twisting of this important part of the body.

Ancient Greece is often called the cradle of Western civilization. Its culture has largely shaped the world we live in. Many believe that modern science originated there. Indeed, it was in Ancient Greece in the VII-IV century BC that modern mathematics was born – a language of numbers that allows to describe the world in a uniquely understandable way, eliminating the ambiguity of ordinary language and minimizing errors. It was ancient Greek mathematicians who began to use mathematical proofs to assess the truth of statements. Some of them we studied in school, when proved theorems on lessons geometry. Thanks to the development of mathematics became possible and practical achievements of the ancient Greeks, for example, quite accurate measurements of the size of celestial bodies [15].

In the V century BC on the island of KOs, Hippocrates worked the man they call the father of medicine and whose name is frequently associated with the emergence of the medical profession. Although the profession originated earlier, it was thanks to the Hippocratic Corpus – a collection of six dozen texts associated with his name and which had a huge impact on the future of medicine – that doctors began to feel like a separate caste, part of a large ancient tradition passed down from teacher to student. The “Corpus” includes texts on the causes of the disease, their treatment, prognosis, diet and principles, including ethical, medical craft. The most famous of the texts is the Hippocratic oath. Medical-educated students still pronounce modern versions of this oath, completing their studies.

Interestingly, we know almost nothing about Hippocrates for sure. He was probably one of the first people in Ancient Greece to teach medicine for money to anyone, not just members of his family. Before that, healing was exclusively a family profession, inherited. Perhaps that is why he became the founder of a large school of grateful students who immortalized his name. The books included in the Hippocratic Corpus are by different authors; Hippocrates himself has written at best some of them. As for the famous oath, it must have been written after his death. Therefore, speaking of Hippocrates, we will mean that the author of the ideas set forth in the “Corpus” is not only himself, but also his many unknown followers.

One of the most significant ideas of the Hippocratic Corpus is the humoral theory formulated in it, which determined the approaches to treatment for two thousand years ahead. Humoral theory was one of the first attempts to describe health and disease without the help of supernatural forces. According to it, the human body is filled with four fluids – humors) – blood, phlegm, yellow and black bile [17]. The correct balance of the four fluids corresponded to complete health, and the prevalence of one of them caused illness. The reasons for the imbalance were considered, for example, too varied food. According to Hippocrates, this food is worse digested and it remains undigested cause pathogenic changes. Familiar idea, isn’t it?

Certain properties were attributed to each of the liquids. For example, blood-wet and hot, so its excess leads to fevers, which are accompanied by heat and sweating. The body tries to restore the disturbed balance and gets rid of excess fluid through perspiration, abscess suppuration, runny nose, vomiting or diarrhea. If the body does not cope, the doctor can come to the rescue by cutting a vein and releasing excess blood.

Although humoral theory did not need invisible spirits and tried to explain the disease as a material phenomenon, it also operated on non-existent substances. Only two of the four fluids actually exist: blood and yellow bile. The idea of a transparent or white fluid present in the body – phlegm [18] – could be caused by the observation of different mucous and purulent secretions. And on some dark substance, black bile, black zapekalsya of blood, appearance of moles or dark hair in children [19]. The ancient Greek physician observed the man from the outside and could therefore only speculate about his internal structure on the basis of external signs and casual observations of the wounded.

Many ancient concepts of the world and man are similar to each other. As a result, similar ideas about diseases and approaches to treatment. The number of liquids echoes with the four elements-earth, water, air and fire, of which, according to popular in Ancient Greece, all things are composed. Both of these ideas are reminiscent of the idea of the three primary elements of the human body, which is based on Ayurveda ancient Indian medicine. They are echoed by the ancient Chinese humoral concept and the theory of the five elements, as well as the European alchemical theory of the three elements, which arose in the XV century, on which Paracelsus relied.

Of course, this does not mean that Hippocrates visited Ancient China or Paracelsus studied Ayurveda: international scientific exchange in those distant times was extremely limited. The similarity of the concepts is due to the fact that the tools of their authors were the same – they could rely only on what was directly accessible to the senses. The mention of body fluids, elements and energies should not be misleading. These terms were not used in the sense that we now put them. They only symbolized perceptible properties, such as dry and wet, hot and cold, static and mobile.

Without the dissection of human bodies, before the advent of biochemical laboratories and microscopes, there was no way to correctly describe the causes of fever and the changes occurring in the body. The doctor could only state that the patient’s skin was hot and moist. But the ancient physician, and modern, it was not easy to say, “I don’t know what with the patient, except that he has a fever”. After all, he is paid as a professional, trained, which gave him intimate knowledge about the work of the body in health and disease.

Hence the idea of health as a balance and the disease as its violation: if the touch of the patient’s skin normal temperature (not too hot and not too cold), then, then, hot and cold fluids (elements, energy) are in equilibrium. If too hot, then hot prevail. Hence the characteristic of such systems division of people into constitutional types: if a person is too emotional or prone to redness of the skin, it is dominated by a hot start, and this should be taken into account in the treatment. This feature is preserved in modern alternative systems, called holistic [20], for example in homeopathy or in modern Ayurvedic medicine.

The therapeutic Arsenal of Hippocratic medicine is small. The doctor could remove excess humors by giving a laxative or releasing blood, could relieve symptoms by warming or cooling the patient, but most of the recommendations came down to a change in diet. However, some methods, for example treatment hysteria, were quite exotic. Hysteria Greeks called the disorder of women’s behavior, accompanied by a sense of difficulty breathing. It was explained by the fact that the uterus moves inside the body and rises so high that it prevents breathing. To coax the uterus back into place was fumigating the crotch of the patient fragrant fumes and inserting into the vagina irritating pessary.

Despite the fact that many things in the eyes of the modern reader looks strange, the texts of the “Corpus” captivate with their sincerity. Hippocrates does not try to imagine himself omnipotent, aware of the limitations of their capabilities and attaches great importance to natural recovery. The doctor’s job is to “let nature do her thing,” helping her only when possible. Its main advantage is the ability to recognize situations when it is better to refrain from medical intervention.

Much attention is paid to prognosis-the ability to predict the outcome of the disease. Prognosis was a separate duty of the doctor and to no less extent than treatment, determined his reputation, and therefore demand. As already mentioned, it is not easy for a doctor in any era to admit to a patient or to himself that he does not understand what is happening. Therefore, the reader of the “Corpus “from time to time stumbles upon some such prognostic advice:”in diarrhea, the change in the color of excrement – to recovery, except in cases where the deterioration.”

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