Book Review: Disease and Medicine in World History

Title: Disease and Medicine in World History

Author: Sheldon Watts

Publisher: Routledge (2003)

ISBN: 0-415-27816-3 (hbk)

Disease and Medicine in World History is a concise introduction to diverse ideas about diseases and their treatment throughout the world. The author has drawn on case studies from ancient Egypt to present-day America, Asia and Europe. And this survey discusses concepts of sickness and forms of treatment in many cultures. The author also shows that many medical systems in the past were shaped as much by philosophers and metaphysicians of that culture, as by trained doctors of that system.

The author through this book is trying to dispel the euro-centric perspectives and replaces them with global history, which consisted of a very large number of cultures, each of which was distinct and separate from others. Each culture develops a cluster of formal medical systems which co-existed with various forms of empirical medicine. Thus, disease history alerts us to the diversity of human experiences around the world and this study of history would also give background information on why there is such a huge disparity in the health status of different human groupings in the world today. The study also reveals that modern scientific medicine is a recent invention of the West which is based on seminal works of a few scientists (Louis Pasteur, Robert Koch, etc.), from little more than a century and a quarter ago and the central ideas to this new system are disease specificity and specific disease causal agent (which constituted the Germ Theory of Disease), where the key insights were derived from work done in the laboratory.

Furthermore, the author is describing that before the 1860s, there were hosts of other ways, each cultural grouping in the world, at different times in history, deployed while attempting to meet the challenges posed by diseases and the road to understanding the world history lies through the need for a pluralistic approach which can only be understood in terms of their own cultures, where the particular medical system had their logic and its integrity. Here, the author makes another important point regarding the changing nature of cultures over time in history, as disease types change over time and thus, the use of the term ‘traditional culture’ which is recent in origin, with the colonial anthropologists using it for ‘simple-minded people unchanged since time immemorial', to describe people encountered by them in New world, Africa and Asia.

The author examines extinct societies like Egypt under its pharaohs (3100-525 BCE) and New World just before 1492 CE. The biological aspects of human beings and their diseases, in these long-dead societies, are carefully being examined for their DNA and RNA (though limited biological sources available) through the mummified Egyptians and Peruvians. On the other hand, the cultural aspects of humans of those eras, are being examined through the written records(papyri) surviving and important hieroglyphic symbols. The Egyptian medical doctors had treated humans, using certain metaphors for various anatomical parts and were not interested in actual human anatomy, which can be observed by their contempt towards embalmers, who may have known the exactness of various parts. The author claims that these societies had no experience with acute epidemic diseases such as cholera (though the author mentions that months when the Nile was low, due to consumption of contaminated water lethal diarrheal diseases among very young), bubonic plague, measles and smallpox or with syphilis or leprosy (though later author comments on the lesions on Ramses V resembling the pustules of smallpox). The author further divides the Egyptian era on the basis of medicine was more based on empirical experience and reason (Old Kingdom medicine,3100-2181 BCE) than the late New Kingdom and Persian periods, and terms it from ‘science to magic’, as opposed to Ronald Ross’s conviction that field of medicine had always moved from ‘magic to science’. Various excavations have provided evidence of surgery (a set of 30 scalpels found from the 2300 BCE period), dentistry and orthopaedics as different branches.

The cultural groupings in pre-conquest America were fully literate and three major groupings are named Maya’s, Aztec’s and Inca’s, but in the 1560s a Spanish Christian deliberately incinerated whole libraries of Mayan records, as considered pagan nonsense. The author describes that around 13,000 years ago, members of Clovis culture from Asia may have walked through Bering Straits to inhabit the New World and the key difference between New World cities and Old-World settlements was the almost complete absence of domesticated animals except for dogs, which can explain the New World inhabitants’ death after the 1492s conquests of Europeans. The disease causation involves a whole complex of man/land and inter-personal relations and harmony between them (macrocosm) and at an individual physical level (microcosm) where the proper flow of bodily juices is needed to remain disease free.

The Greeks literature concerning health and disease came to be known as Hippocratic Corpus but this corpus did not agree on its basic questions. Apart from differences, the experts virtually depended on oratory skills to prove their point as dissection of humans was against Greek notions of human dignity and only animal dissection was allowed. But, in Ptolemaic Alexandria, vivisection of living convicts and slaves from the non-Greek population was done to understand anatomical learnings, but such records also perished in a Library fire caused by Julius Caesar in 44 BCE. The supernatural underlay Greek rationalism in medicine as in other fields. In the Greco-Roman system, a person could keep oneself in good health by maintaining a proper balance among the four humors at work in the body and this humoralism was intensely individualistic (Galen).

The Islamic world drew on the medical achievements of the ancient Greco-Roman world and subtly transformed them to fit its purpose, to make it the Great Tradition of Greco-Romano- Arabic medicine, which by the late eleventh century was again introduced into the West. Al- Razi, around 925 revived this tradition but was seen as a learned man trespassing into the domain occupied by empirics and was himself held in contempt by jurists and theologians, as they considered themselves alone to have the competence to trace the roots of all knowledge back to Allah and the Law came to be regarded as formal and fixed, no longer subject to personal judgement. Then with Ibn Sina and Ibn Ridwan, new canons and treatises were written around health and disease, whereas Ibn Ridwan fell back on the Hippocratic idea of epidemics causation by: a change in the quality of air, a change in the quality of water, a change in the quality of food and a change in the quality of psychic events. Ibn Ridwan’s explanation of foul fumes arising from putrefying organic matter indeed had parallels in ancient pharaonic Egypt which credited unexplained disease conditions to the same cause of foul fumes (origins of Miasma theory). His writings show that trade with India brought in an increasing cornucopia of exotic new drugs, which increased from 300 in the ninth century to nearly 3000 in the late eleventh century.

With the excavations of two large stone-built cities (Harappa and Mohenjo-Daro), each with 20 or 30,000 inhabitants, dating back to the time of the Old Kingdom in Egypt (around 3000 BCE), along the Indus River and its tributaries, came a surprise ancient civilization, in present-day India and Pakistan. The presence of Harappan toilets connected to sewerage may be related to the awareness of the deadly danger posed by faecal-infected water supplies as the causal agent of diarrheal diseases, but the storage of wheaten-grain in large quantities near city centres may have caused the breeding and maintenance of rats which eventually might have led to pneumonic or bubonic plague whipping out the entire city. The tridosha theory that disease is caused by an imbalance between three bodily forces (dosas): bile, phlegm and wind or their various combinations, evolved around the time of Buddha (600 BCE). And the triangle of holy curer, the sick one and the disease was the triangle where the curer will treat the disease as an act of charity, to heal the sick. Various compendiums described the diseases under Charaka and Sushruta. Among humankind, the immutable element was the soul (male) and the other element was the body (female) which is in constant flux.

The making of Chinese medicine was a dynamic, irregular process. Starting with magical thoughts about how to keep the spirits of ancestors happy (the era of Shang and the Zhou), followed by the Han periods (260 BCE- 220 CE) when yin-yang (male-female, light-dark) balance (Taoism) and wuxing (five phases) came fully into being. The Inner Classic revolutionized the thought which said that disease is not caused by demons or ancestors but the disease is caused by happenings in the natural world which can be studied and comprehended by mankind, using human reason. Confucianism was an ethical system, not a religion and with consciously self-imposed behaviour, the gentleman would keep his internal ‘qi’ in good order.

The author quotes Chinese scholar R Bin Wong saying that in and after the mid-fifteenth century, the practice of combining trading/ mercantile activities with state-supported conquest and armed violence seems to have become a distinguishing characteristic of the Europeans. And along with trade these Europeans (post-1492 CE) brought disease to these new shores, as these whites were having acquired immunity, for example to a mild form of smallpox, but the Aztec majority population succumbed to it, which led to different inferences, namely, the natives are weak as compared to Europeans and secondly, these natives were cursed by the God, who intended they should disappear. The author sums this denuding process of the native population was achieved through three factors: European-imported diseases, European sadistic behaviours and the collapse of Native Americans’ lived worlds.

As late as WW I, the ‘manliness’ of the troops will see the armies through and those who fell sick were malingerers, but deaths from improperly treated wounds and sickness far outnumbered deaths from enemy bullets, sabre slashes or cannon. The disease like plague could only be brought under control by town magistrates in the 1450s by quarantines and cordon sanitaire in Europe and Egypt, not by doctors following humoralism. A disease like leprosy which brought ‘leprosariums’ into function could be controlled by controlling false accusations of being a leper and issuance of guides of true marks of leprosy in 1363 CE. It is only around the early nineteenth century in Germany where its rulers supported ‘Cameralism’ and in state-supported professions as medicine, theory must ultimately ally itself with practice, that scientists like Muller, Ludwig, Henle (Henle- Koch’s postulates), Virchow, in various universities across Germany, who worked on human physiology came into recognition (though Virchow held that poverty, malnutrition caused disease rather than germs). On the other side, in Britain, Chadwick (lawyer) initiated a movement which carried away from the habitation, through the sewerage system, the life-threatening miasmatic substances which were supposed to be causing fevers and with the work of Dr Simon, instrumental in achieving effective influence for the local level agencies, to control epidemics. But, the same empire building its sanitary systems from the money collected by Indians, did exactly the opposite for the Indian population, wherein, colonial doctors serving the British in India termed cholera as a type of miasma which was carried by wind and cannot be controlled by quarantines and cordon sanitaire, because their trade was getting affected at Suez Canal, if they supported quarantines. Moreover, such health policies and fruits of ‘development’ in India yielded a life expectancy which was 24.59 in 1891, to 23.63 in 1901, to 22.59 in 1911 and to only 20.1 in 1921.

After the 1950s, people in Europe, the USA and Japan saw an epidemiologic transition, wherein there was a decline in deaths from infectious diseases which increased longevity but were suffering from CVS diseases, diabetes, cancers and degenerative diseases of old age. Coupled with decreasing populations on account of reduced TFR, highly trained manpower from populations of the third world (south) were seen as a resource base for the north. The countries of Latin America and Africa were shown the development models of the West and these countries allowed themselves in these developmental projects against loans, but with the worldwide recession in the 1980s, these countries were hit most as they were only producing for West primary products rather than food for their populations. To tide over this crisis, WB and IMF gave them a loan to bail out with conditions to give priority to existing projects and cutting back on social services like education and health (SAP), wherein, debt repayment from poor countries to the rich was $178 billion a year: less than $61 billion went in other direction.

Such a well-researched survey was done by the author, but as George Rosen pointed out that all cultural groupings of the past considered cleanliness and godliness, maybe for religious reasons, which Sheldon has not acknowledged prominently. The other point in contention is the year of Soviet disintegration which is 1991, but the author for unknown reasons put 1989 on two separate occasions in the book.

Author: Sheldon Watts has served as Senior Lecturer in History at the University of Ilorin, Nigeria and visiting Associate Professor of History at the American University in Cairo. Sheldon Watts is the author of ‘Epidemics and history: Disease, Power and Imperialism (Yale, 1997)’.