[ALOCHONA] Interesting read: history of medicine

Interesting read on the History of Medicine


-----Forwarded Message-----
>From: Sekhar Ramakrishnan
>Sent: Aug 2, 2011 9:02 AM
>To: foil-l@insaf.net
>Subject: [foil] EPW on daya's history of medicine
>
>A very nice review, with a good summary of the book. The book is sold
>online at
http://www2.xlibris.com/bookstore/bookdisplay.aspx?bookid=90516
>
>Sekhar
>
http://beta.epw.in/newsItem/comment/190216/
>
> Economic & Political Weekly Vol XLVI No.31 July 30, 2011
> Capitalism, Democracy and Medicine
> By: Mridula Ramanna
>
>The Art and Science of Healing since Antiquity by Daya Ram Varma (USA:
>Xlibris Corporation), 2011; pp 413 (price not stated).
>
>[Mridula Ramanna (mridularamanna@hotmail.com) is with the Department of
>History, SIES College, Mumbai.]
>
>Writings on the history of medicine have included valuable contributions
>from social scientists and medical professionals, and attract a wide
>readership of both academics and general readers. The author of The Art
>and Science of Healing since Antiquity, Daya Ram Varma, studied medicine
>at Lucknow from 1950-55 and is professor emeritus, Department of
>Pharmacology and Therapeutics, at McGill University, Montreal, Canada.
>Written for a broad a­udience, the stated aim of the book is to address
>the questions of why there are so many schools (systems) of medicine and
>why they are likely to continue for long. The evolution of these schools
>is explored from the point of view of the prevalent s­ociopolitical
>context. Based on an impressive range of secondary sources, the book has
>17 chapters and three appen­dices, including a review of the
>historio­graphy of works in this field, a list of natural drugs currently
>used by modern medicine as therapy and the 1978 Alma Ata Declaration on
>Primary Health Care.
>
> 'Do No Harm´
>
>The chapter on "The Science and Art of Medicine" endorses the view that
>medicine includes a scientific aspect and an applied aspect in the form of
>therapeutics, which could be treated as the art of medicine. While great
>advances were made in medical science from Susruta and Hippo­crates to the
>first quarter of the 20th century, Varma notes that there was minimal
>progress in therapy. The essence of medical science involved discovering
>the causes of diseases and how to treat them. But since science is not
>neutral, there could be both the "good and bad" use of medical science,
>for example, the use of ultrasound technology for sex detection. Even
>though the Hippo­cratic principle is "Do No Harm", physicians can do harm
>since they too are subject to societal prejudices. Social, p­olitical and
>economic factors influenced advances in medical sciences, more so than in
>physical sciences, because medical needs are an integral part of society.
>The author contends that the replacement of the feudal mode of production
>by the capitalist mode of production was a major impetus in development of
>medicine. Commendably, Varma highlights the gender bias in medicine. The
>commercialisation of medicine led to the creation of a market for the use
>of hormones by women, when no real need for them exists, and women´s
>bodies were subjected to medical interventions, as is evidenced by the
>numerous and increasing births by caesarean sections. The relative silence
>on the role of women is illustrated with various examples, like the
>contribution of Rosalind Franklin to the discovery of the double helical
>structure of DNA which was ignored. Varma credits the feminist movement
>with the posthumous recognition of her role. The other example of bias in
>medicine was the attribution of cholera in the early 19th century, to the
>poor of London or to the colonies, before the demonstration by John Snow
>that cholera was water borne.
>
>Chapters four to 14 discuss different medical schools. The author suggests
>that witchcraft and magic were the forerunners of medicine and natural
>sciences, and that the earliest healers were probably women. The stages of
>medicine from the birth of humans to the beginning of "­materialistic"
>medicine around 700 BC comprised phases, which are termed as "intuitive"
>medicine, "observational" medicine and "spiritual" medicine. It was after
>these stages that "materialistic" medicine began with the ayurveda and
>Chinese medicine systems and Hippocrates. Egyptian medicine, which was
>"empirical" medicine originated a thousand years before these schools.
>Despite the many gods and demon figures in Egyptian beliefs, the medical
>papyri bear evidence of physicians of different specialisations,
>veterinarians, dentists, surgeons, and various medicaments of animal and
>chemical o­rigin. There are also gynaecological and surgical papyri. The
>weakness of Egyptian medicine was its silence on the theory of health and
>disease. Its advances were checked with the decline in central political
>authority and the many invasions that Egypt encountered.
>
> Egyptian Medicine
>
>The ayurveda and Chinese medicine systems are regarded as marking the
>transition to materialistic medicine. While not much is known of the
>medical system of the Indus Valley civilisation, ayurveda is associated
>with the Vedic age, reaching its peak during the Buddhist period. That is
>when, in Varma´s opinion, it made a dramatic shift towards materialistic
>medicine. Its significance was not in the correctness of its formulations
>or its pharmacopoeia but in the materialistic theoretical approach of the
>tridoshas. He further contends that the stagnation of ayurveda coincided
>with the decline of Buddhism and did not occur during the Moghul or
>British rule. Varma contests the view that ayurveda is the oldest medical
>science and points out that the Egyptian papyri are older than ayurvedic
>texts. The current popularity of ayurveda is attributed to the spiritual
>appeal, the natural therapeutic regimen with herbs, yoga and diet, its
>efficacy and its association with nationalism. The three main features of
>Chinese medicine are the following: (1) disease is internal to the yang-
>yin relationship and not due to external factors, (2) herbs are healing
>tools, and (3) acupuncture can produce healing and analgesic effects. The
>yang-yin is a universal philosophical approach and not limited to
>medicine, yang-yin can be distinguished but not separated, and can control
>and transform each other. The classification of diseases was based on an
>excess of yang or yin. Different diseases could have the same treatment
>and conversely the same disease could have different treatments, because
>it could affect different people differently. An important feature of
>medicine in China was the role of the State, which took over the
>healthcare system by opening hospitals and centres to train physicians.
>Both the ayurveda and Chinese medicine systems have maintained their
>continuity.
>
>Elevating Hippocrates to the position of the father of medicine, according
>to Varma, reflects a western bias in medical historiography. A comparison
>of ayurveda with Greek medicine shows the latter as more materialistic and
>divorced from religious overtones, which was a major development.
>Hippocrates´ theory of the four humours was a significant contribution,
>health being considered as a state of ­balance between them, with disease
>reflec­ting imbalance. Corpus Hippocraticum was based on close scrutiny of
>disease and on clinical observations. While most of what it contains was
>in the Charaka Samhita, 500 years earlier, the latter is not free from
>religiosity. Galenic medicine did much to advance the rich legacy of
>Hippocrates and emphasised philosophy and ethics. The period from Galen to
>the Renaissance is the phase when medical science regressed with the
>increasing control of the church and the emergence of feudalism. It was
>asserted that everything known was written in the holy books and men were
>to imbibe the truth as revealed by messengers of god. The Islamic medicine
>system, the Unani Tibb, is based on Galenic medicine. It not only
>popularised science by translating Greek texts into A­rabic but also made
>original contributions in astronomy, mathematics, chemistry and medicine.
>The rapid increase in the number of followers of Islam and its spread in
>Persia, Mesopotamia and Egypt, which themselves had advanced civilisations
>and science, contributed to the expansion of Islamic medicine. It is
>popular today in many parts of the world.
>
> Schools of Medicine
>
>"The Age of the Witch Hunt" looks at the phenomenon of discovering witches
>and burning them alive and ascribes it to the culture generated by the
>emerging capitalism, slavery, the assertion of the power of the church and
>to gender biases. Other reasons postulated are the inexplicable illnesses
>of different types, locations in in­accessible geographical regions, the
>greed to confiscate property belonging to the ­s­o-called witches,
>conflict between different Christian denominations, and unexpected natural
>disasters. It was also used as a means to suppress rebellion. The author
>sees this tendency extended today to p­olitical dissent.
>
>Surpassing all schools of medicine and second to modern medicine is
>homeo­pathy, which originated as a reaction to the sinister use of toxic
>doses of suspect drugs and bloodletting by followers of the Hippocratic
>medicine system. Homeo­pathy believes that disease and sickness are caused
>by disturbances in a hypothetical vital force and these disturbances
>manifest themselves in unique symptoms. This vital force reacts and adapts
>to internal and external causes, referred to as the law of susceptibility.
>Varma holds that the basic premise of homeopathy is wrong, but opines that
>it will survive until modern medicine convincingly demonstrates its
>superiority.
>
>The comprehensive chapter on therapeutics is based on the premise that the
>history of medicine revolves around h­uman efforts to eradicate a disease
>or at least to alleviate suffering and that drugs occupy a central
>position in this endea­vour. The period preceding Hippocrates was the
>golden age of Therapeutics, when the Peruvian bark (source of quinine),
>poppy plant (source of morphine) and ­willow bark (source of salicin, the
>precursor of ­aspirin) were discovered. But from the Hippocratic era to
>the 20th century, Varma contends, all kinds of drugs were used, which did
>more harm than good, with the notable exceptions of the anti-smallpox
>vaccine and carbolic acid. With the advances in natural sciences and in
>chemistry and a better understanding of human physiology and pathology, a
>scientific approach to drug discovery began in the 20th century. The
>discovery of sulpha drugs and penicillin opened the way to treating
>infectious diseases, insulin enabled the treatment of constitutional
>diseases, some progress was made in the treatment of cancer and the
>contentious areas of gene therapy and stem cell research promised hope.
>
>Unlike other schools of medicine modern medicine realised that the
>mysteries of health and disease are knowable, and that the gaps in its
>understanding of h­uman physiology and pathology of diseases could be
>filled. It is neither allo­pathy, in that it is not based on administering
>massive doses of medicines, nor is it Hippocratic, in that it is not based
>on the four humours theory of diseases. Advances in all branches of
>science made it possible to solve problems, reject the older theories of
>diseases and identify specific causes of diseases, whether environmental,
>genetic or due to deficiencies of essential nutrients. The recognition of
>neuroplasticity, nerve regeneration, brain neurotransmitter and receptors,
>mechanism of different kinds of pain including phantom pain,
>electrophysiology of the heart, advances in immunology and public health
>measures has opened new approaches to therapeutics and prophylaxis.
>Surgery and dentistry can do marvels and prognosis is more accurate. While
>the achievements are monumental, challenges remain in the form of diseases
>like diabetes, hyper­tension, heart failure and Alzheimer´s disease. The
>author is optimistic that all diseases can be conquered. Much of the
>criticism of modern medicine is based on the role of medical
>professionals, not on the science, per se. Doctors are in no way different
>from other professionals. They have been both heroes and assassins, have
>placed o­bstacles to health reforms on the one hand, and on the other
>functioned as s­ocial workers. They face dilemmas in deciding whether to
>save or not to save the life of a terminally ill patient in agony. Varma
>opines that medical ethics is determined by the prevailing norms and civil
>laws of a given society and can differ widely.
>
> Ushering in Capitalism
>
>Joseph Needham posed the question why science grew in the west and not in
>China, India or the Islamic world. While supporting his supposition that
>it is due to differences in social structure and culture, the author
>suggests that the rivers Yangtse, Ganges and Nile did not allow for
>des­pondency in China, India and Egypt, r­espectively. ­Europe needed to
>dismantle feudalism and acquire colonies, and capitalism was ushered in.
>This together with democracy and the freedom to pursue research gave great
>impetus to science. In the concluding chapter, Varma answers the question
>as to why alternative systems of medicine continue to exist. This is
>neither due to the strength of these systems nor the weakness of modern
>medicine but due to the poor healthcare in most countries of the world.
>When universal healthcare becomes the norm, says Varma, the popularity of
>other schools of medicine would decline.
>
>The premises in the book are clearly spelt out, the arguments cogently put
>across, the style is lucid, and examples from many situations familiar to
>the lay reader makes it a good buy. Careful editing could have avoided
>repetitions.
>
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