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The Healing Hand: From Tree Wounds to Human Wounds

12 Jan

The Healing Hand: From Tree Wounds to Human Wounds

 

The Perfumes of Arabia

There is a lost fragrance about ancient drugs.  A disconcerting fragrance of incense, roses and cinnamon, which keeps luring the mind out of medicine into the church, the kitchen, and the beauty parlor.  But these contrasts are entirely a matter of custom.  Our ancestors, who liked to smear themselves with cinnamon oil, might have marveled at cinnamon bread as we would at incense pie*  besides, perfume for them was a far broader concern, with broader implications than it has today.  What was good to breathe, or eat, or drink was also good for the gods, for disease, and for wounds.  So the Greeks had one lovely word arómata, to cover much of what we would now break down into incense, perfumes, spices, and drugs.** Aromata were the zest of life.  That is what the Romans meant when they said “my myrrh, my cinnamon” as we would say “my darling.”

* The cosmetic use of cinnamon is well documented in the Bible and in Pliny. See also FH p.519; Burkhill 1935 p. 543; Moldenke 1952 p. 75; Rosengarten 1969 p. 188.

** Dictionaries translate arómata as “herbs” or “spices,” but the word has a broader meaning. E.g. Theophrastus, Concerning Odours, lists myrrh under aromata (#34/LB II 357).

*** The use of spices for endearment was no more bizarre than today’s use of honey for the same purpose (see Lewis and Short under cinnamomum)

 

 

From Tree Wounds to Human Wounds

 

 

Someone spread the rumor that burning incense, the prototype of all aromata, gives off carbolic acid, the magic odorous drug with which Lister opened the era of antisepsis.* Startled by thisoverlap of bodily and spiritual health, Ihad the statement verified.  it turned out to be chemically true, but medically irrevelant.  In the words of the chemsit,’The amount of phenols set free in the atmosphere of a church should be far from having a purifying effect, at least on a material level.”**  It is nevertheless perfectly true that the chemical formula of many scents given off by balsams and spices are variations on a theme: the skeleton of carbolic acid.

* Thorwald 1963 p. 65

** Professor P. Favager, Head of the Dept. of Biochemistry, University of Geneva, was kind enough to test the smoke of frankinscence (gum olibanum) and myrrh, both obtained from Fritche, Dodge & Olcott, Inc., new York  The smoke was bubbled through an alkaline solution, so as to trap the phenol, and then tested by several reactions (ferric chloride, diazotation, uranyl nitrate)  Phenol was detectable but in very small amounts, a rough estimate from ferric chloride reaction showed that 10.5mg of frankincense yielded about 15mg of total phenols.

 

Guido Majno: The Healing Hand Man and Wound in the Ancient World (Harvard press University Press Cambridge, Massachusetts, © 1975) pp. 207, 219-220, 501, 503

The Healing Hand: The Laws of Hammurabi

11 Jan

 

Engraved around this great black stone, nearly eight foot tall, are the laws of Hammurabi, c. 1700 B.C. At the top is the king himself, receiving the word from Shamash, the Sun-god.

 

 

2.16 Hammurabi’s law 215 which refers to the surgeon’s knife. The pencil, shown for scale, points to the leter A of asu, ‘physician.” 2.17 Locating the wound and the lancet in the text of Fig. 2.16, tipped to the left so that the lines read horizontally.

 

 

Guido Majno: The Healing Hand Man and Wound in the Ancient World (Harvard press University Press Cambridge, Massachusetts, © 1975) pp. 44-45.

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Documentary History of Psychiatry • The Etiology of Insanity (Excerpt)

2 Jan

The Route of Hippocratic Medicine as it returned to Europe through the Nestorians, via the University of Jundi Shapir and then the Muslims

30 Dec

The Route of Hippocratic Medicine as it returned to Europe through the Nestorians, via the University of Jundi Shapir and then the Muslims

 

 

To end, I must pay tribute to the earliest and most important revival of Greek medicine: its reappearance in oriental dress, during the Middle Ages, in one of the most interesting and least known detours of history—the Nestorian epic.*  In the year 431 A.D., a church crisis ended dramatically at the Council of Ephesos when Nestorios, the tough patriarch of Constantinople, was excommunicated for heresy.  He maintained that the divine and human persons were not entirely merged in the person of Christ, and especially that Mary should not be called Theotôkos, “Mother of God,” as was then customary.  Nestorios was exiled, and died—probably in Egypt—in 451.  His followers, the first Nestorians, were forced to flee.  Their first refuge was among the erudite monks of Edessa, in upper Mesopotamia.  But the long hand of the church reached them even there and caused them to scatter as far as India and China.  One group found permanent asylum in Persia, thanks to its tolerant king.  They settled in his capital, Jundi Shapur, an ancient and beautiful city not far from Susa, with a university and a hospital that functioned also as a medical school.  Happily transplanted, the Nestorians flourished.  Partly through their influence, partly through its fortunate circumstances, the University of Jundi Shapir became one of the leading intellectual centers of the time.  Its geographical setting allowed it to become a unique meeting point of cultures—Persian, Greek, Alexandrian, Jewish, Hindu, and Chinese—and its tolerant atmosphere allowed scholars of different creeds to work together in peace, as nowhere else in the world.  When the city fell to the Arabs in 636, the university was not disturbed; in fact, the conquerors adopted it and made of its medical school their principal training center. **  Two of the Prophet’s physicians were graduates of Jundi Shapur.  All the while, the Nestorians were performing a huge bibliographic task: translating Greek books into Syriac, the language of the university.  Hippocrates and Galen were among their first translations.  Then Muslims worked at Arabic translations of the Syriac.  Eventually a large body of Greek literature became available in Syriac and Arabic.

 

Toward the end of the tenth century Bagdhad, having become the capital of the caliphate, began to drain away the talents of Jundi Shapir.  The end came fast.  Today, nothing is left of that glorious city except for a few vague trenches in the ground.

 

The adventure of the Nestorians explains why some Greek works have come down to us ultimately as Latin versions from an Arabic text translated from the Syriac.  A new book of Galen, in Arabic, was discovered in Constantinople as late as 1931. **** The Nestorian experience also explains why the great Arabic physicians—Rhazes, Avicenna, Albucasis—not only revered the Greek masters, but spoke their same words, and tempered them with Hindu medicine.

 

* Literature on this major episode is amazingly scant.  See Whiple 1936; Elgood 1938; Major 1954 p. 227. on which I based my account.  For the sad lot of today’s Nestorians see atiya 1968.

 

** The tolerance of the early Muslims should be emphasized.  They found little difference between their creed and that of the Nestorians; and to the Nestorians, the Islamic message did not sound very different from their own (Jargy 1969)

 

*** On Medical Experience, a ninth-century copy of the original Arabic translation by Hubaish of the Syriac version by the Nestorian scholar Hunain. The book had been written by Galen at the age of nineteen!

 

 

Guido Majno: The Healing Hand Man and Wound in the Ancient World (Harvard press University Press Cambridge, Massachusetts, © 1975) pp. 420-421.

 

The Healing Hand Man and Wound in the Ancient World: Wine and Vinegar As Antiseptics (Excerpt)

22 Dec

Wine and Vinegar As Antiseptics

 

Vinegar owes its sting to acetic acid, which is a powerful antiseptic.1  A 5 percent solution—about the same strength as in vinegar—was tested recently in Makere, Uganda, on a series of patients suffering from burns and superficial wounds.  Some bacteria proved resistant, but infections with Pseudomonas did very well.  As expected, the dressings were painful, but the pain did not last.2 Vinegar is definitely a rational wound wash.

As for wine, it has been the commonest item in wound treatment since the Greeks.  This record alone suggests that there should be something effective in it.  The first question to arise is whether this something could be alcohol.

The 9-11 percent concentrations of ethyl alcohol in ordinary wines have very little effect on bacteria.  The optimal strength of alcohol-water mixtures against E. coli and staphylococci is 70 percent by weight.3  Yet most experiments with wine as an antiseptic have proven successful.

 

 

The first were published in 1892 by Alois Pick, an Austrian military doctor.  They came in the wake of an epidemic of cholera in Paris, during which a Dr. Rabuteau had noticed that wine drinkers were relatively spared by the disease, and he therefore advised everybody to mix wine into the water.4  To test this theory, Dr Pick took cultures of cholera and typhoid bacilli, and added 1 cc of each to each of five flasks containing either water, wine (red or white), or 50-50 water-wine mixtures.  In the two flasks with water, the bacteria flourished; whereas the wine, straight or diluted, killed all cholera vibrios within ten or fifteen minutes.  Although some of the typhoid bacilli were still alive at the same time, they too had disappeared after twenty-four hours.  Dr Pick concluded that during cholera or typhoid epidemics it was advisable to drink water that had been mixed some time earlier with wine.

Thus forceful one-page article was followed by many others.  Despite the variety of wines and authors, a review of the results in 1951 showed consistent data: wine kills cholera vibrios in 0.5-10 minutes,  E. typhi in 5-240 minutes.5  Rhine wines, both red and white, kill staphylococci in one hour, or in two if they are diluted with equal amounts of water.  In Bordeaux, Prof. Ribéreau-Gayon found his strain of staphylococci so sensitive that he had to dilute the wine in order to obtain any bacterial growth after fifteen minutes.6

This long list should be convincing enough; but I resorted once again to my bacteriological friends for first-hand confirmation, using Greek wine.  Two samples of white wine—on resonated, one not—were obtained from a farmer in Crete; they were tested against bacterial cultures on agar plates, by the “center well” method that had also been used to test copper compounds.  Both wines behaved as if they contained an antibacterial substance, yet this could not be the 10 percent alcohol, because tests with the latter proved to have no effect.  Thereafter, four bottles of red wine were sacrificed to science: a  Chianti, a Beaujolais, a Dôle du Valais, and a Rioja from Spain.  Samples were infected with Staphylococcus aureus, Streptococcus pyogenes, E. coli, Proteus mirabilis, and Pseudomonas aeruginosa.  After six hours no live bacteria could be recovered, except a few staphylococci, but they too failed to grow after twelve hours.7

The antiseptic power of wine is no myth.  Since it cannot depend on alcohol alone—in fact, it persists when the alcohol is removed8—it was thought for some time that it depended on a mutual reinforcement between alcohol and the organic acids of which wine is rich.9  Recent studies from Bordeaux have taken an entirely new departure.  They pin down the mechanism to the anthocyanes, a subgroup in the large group of polyphenols present in wine.10  The most important member of this group of compounds, as regards antibacterial effects, is also a principal pigment of red wines, malvoside or oenoside; there is a colorless equivalent for white wines.

This pigment is already present in the grapes, but combined with a carbohydrate and thus not antiseptic; during alcohol fermentation it splits free and becomes activated.  This hydrolytic cleavage cannot take place unless the solution is acid; but all the steps in the sequence work out as if prearranged, because wine is very acid.  The average pH for red wines is 3.6, which is also the degree of acidity that corresponds to optimal solubility of the red pigment.11  One would therefore expect the bactericidal power of wine to increase with age; and so it does, in unison with the behavior of the pigment, as shown in the following tabulation.  The bactericidal index was obtained by finding the maximum dilution of wine in water that would kill a given strain of E. coli in no more than ten minutes but no less than five minutes.  For example, an index of 17 means that the maximum active dilution was 1/17.12

The effect of wine is thus truly bactericidal, not bacteriostatic.  Red and white wines are about equal in this respect.  Most effective are the strong southern wines like port. Among which the palm goes to a Greek wine from Samos, which kills E. coli within three minutes.13  Other polyphenols in wine may help, but their concentration is small.14  It is pleasing to know that the bacteria are killed by substances really present in native wine, not by the sulfurous anhydride that is now almost universally added to prevent acetic fermentation.

So the Greeks were quite right to pour wine into wounds and over dressings.  Wine has to be used generously, however, because its power is short-lived: the active principles are rapidly bound and inactivated by proteins,15  which explains why wine is not currently sold in first aid kits.

By cleansing wounds with wine the Greeks were actually disinfecting them with a polyphenol, a more complex version of Lister’s phenol—the pioneer drug of antiseptic surgery.  And the polyphenol of wine, malvoside—weight for weight and tested on E. coli—is 33 times more powerful than phenol.16

 

  1. Kass and Sossen 1959
  2. Phillips and others 1968
  3. Price 1939 p. 537
  4. Ribéreau-Gayon and Peynaud 1961 p. 135.
  5. Draczynski 1951 p. 26
  6. Stucky 1949
  7. Ribéreau-Gayon and Peynaud 1961 p. 1961 p. 145
  8. The experiments were carried out by Dr. D. Kekessy of the Institut d’Hygiène, University of geneva. For the samples of Greek wine, I am much indebted to Isabelle Joris and Lise Piguet, who brought them from Crete, and to Dimitros Nevrakis, who supplied them
  9. Ribéreau-Gayon and Peynaud 1961 p. 136
  10. Draczynski 1951 p. 26
  11. Ribéreau-Gayon and Peynaud 1961 p. 124 ff.
  12. Masquelier and Jensen 1953 p. 107
  13. Draczynski 1951 p. 137.
  14. Ribéreau-Gayon and Peynaud 1961 p. pp, 139, 143
  15. Draczynski 1951 p. 32; Ribéreau-Gayon and Peynaud 1961 p. 145
  16. Masqueuelier and Jensen 1953 pp. 106-107. In the experiment just quoted, the bacteria were still sensitive to phenol at 3.33 g/l. to oenidol at 0.1 g/l.

 

Guido Majno:  The Healing Hand Man and Wound in the Ancient World (Harvard press University Press Cambridge, Massachusetts, © 1975) pp. 186-188.

 

 

Ways of Health: Illnesses In Primitive Societies (Excerpt)

30 Oct

Primitive societies regard illness as a misfortune involving the entire person, directly affecting his relationship with the spirit world and with other members of his group.  Although they recognize different kinds of illness, their classifications often bear no relation to those of Western medicine.  In particular, they may not distinguish sharply between mental and bodily illness, or between that due to natural and that due to supernatural causes.

Illnesses tend to be viewed as symbolic expressions of internal conflicts of of disturbed relationships to others or both.   Thus they may be attributed to soul loss, possession by and evil spirit, the magical insertion of a harmful body by a sorcerer, or the machinations of offended or malicious ancestral ghosts.  It is usually assumed that the patient laid himself open to these calamity through some witting or unwitting transgression against the supernatural world, or through incurring the enmity of a sorcerer or someone who has employed a sorcerer to wreak revenge.  The transgression need not have been committed by the patient himself.  He may fall ill through the sin of a kinsman.

Although many societies recognize that certain illnesses have natural causes, this does not exclude the simultaneous role of supernatural ones.  A broken leg may be recognized as caused by a fall from a tree, but the cause of the fall may have been an evil thought or a witch’s curse.

Because of the high mortality rates among primitive peoples many diseases represent a great threat to the patient, and the longer the illness lasts, the greater the threat becomes. In societies subsisting on a marginal level, illness is a threat to the group as well as to the invalid.  It prevents the invalid from making his full contribution to the group’s support and diverts the energies of those who must care for him from group purposes.  Therefore, it seems likely that every illness has overtones of anxiety, despair and similar emotions, mounting as cure is delayed.  That is, persons for whom healing rituals are performed probably are experiencing emotions that aggravate their distress and disability, whatever the underlying pathological condition.  The invalid is in conflict within himself and out of harmony with his group.  The group is faced with the choice of abandoning him to his fate by completing the process of extrusion, or of making strenuous efforts to heal him, thereby restoring him to useful membership in his community.

These considerations may be exemplified by a personal disaster than can befall members of certain groups and that may have a counterpart in civilized societies.  This is the so-called taboo death, which apparently results from noxious emotional states related to certain individual and group assumptive systems about supernatural forces and which also involve the victim’s relationships with his group.

Ed., Sobel, D.S., Ways of Health-Holistic Approaches to Ancient and Contemporary Medicine (Harcourt, Brace, Jovanovich., New York and London ©1979) Unorthodox Medicine- Nonmedical Healing: Religious and Secular (Part 3) by Jerome D. Frank pp. 235-236.

Ways of Health •Holistic Approaches to Ancient and Contemporary Medicine

7 Oct

On the Limitations of Modern Medicine

THE FUTURE OF MEDICINE

 

It has been suggested that the character of medical culture is largely determined by that of the wider culture of which it is a part and that the medical beliefs and behaviors of individuals are largely socially determined.  It would be wrong however to ignore the scope for voluntary activity.  For one thing, current developments do not always fulfill past expectations.  Thus strains are created, both in the sphere of practice and the sphere of theory.  The old ways of seeing the world are fractured and through the cracks the real world becomes more visible.  The scope of human freedom expands.  Within the wider sphere of productive life, as indeed within medicine, the most serious emerging strains derive from industrial man’s relation to the natural world.

It is clear that the increase in human numbers and the increase in material consumption per capita must reach limits in a finite world.  Currently each is increasing at around 2 percent per year with global levels of material production thus rising around 4 percent and doubling in less than 20 years.  Because of the momentum inherent in demographic growth and of the effect of rising global expectations in sustaining economic growth, some studies have suggested that the global “population-capital system” seems bound for “overshoot and collapse” before re-stabilising within the limits nature imposes on man*.  This is not a problem that will go away if it is ignored and an increasing awareness of it is likely to lead to a fundamental reassessment of the wider constraints on human action.  As ecology is central to health, it would be surprising if such a reassessment did not also involve re-examination of the assumptions underlying modern medicine.  In any case medicine contains its own particular expression of the wider crisis—diminishing returns and a self-defeating dependence on economic growth to solve the health problems associated with such growth.

 

* Meadows, D.H., D.L., Randers, J. and Behrens, W.W., The Limits to Growth (New York: NAL, 1972).  Also see Mesarovic, M., and Pestel, E. Mankind at the Turning Point (New York: E. P. Dutton & Co., 1974).

 

Sobel, D. S., Ways of Health Holistic Approaches to Ancient and Contemporary Medicine (New York Harcourt Brace Jovanovich ©1979) P. 77.